bluuebunny/crossref_metadata_2025 huggingface dataset:
Sterile syringe access conditions and variations in HIV risk among drug injectors in three cities
Authors: Bluthenthal Ricky N. , Malik Mohammed Rehan , Grau Lauretta E. , Singer Merrill , Marshall Patricia , Heimer Robert ,   the Diffusion of Benefit through Syringe Exchange Study Team
Published: August 2004

Aim  Better sterile syringe access should be associated with a lower likelihood of syringe re‐use and receptive syringe sharing, although few empirical studies have examined gradients in syringe access using both individual and ecological data. In this study, we compare syringe re‐use and receptive syringe sharing among injection drug users (IDUs) with syringe exchange program (SEP) and legal over‐the‐counter pharmacy access with limits on syringes that can be purchased, exchanged or possessed to IDUs with no pharmacy sales but unlimited syringe access through SEPs. We address three questions: (1) Does residing in an area with no legal syringe possession increase the likelihood of police contact related to possessing drug paraphernalia? (2) Among direct SEP users, is use of more permissive SEPs associated with less likelihood of syringe re‐use and receptive syringe sharing? (3) Among non‐SEP users, is residing in an area with pharmacy access associated with lower likelihood of syringe re‐use and receptive syringe sharing?

Design  Quantitative survey of IDUs recruited from SEPs, subject nomination and outreach methods. Multivariate analyses compared police contact, syringe re‐use and receptive syringe sharing among IDUs recruited in three cities.

Findings  In multivariate analyses, we found that police contact was associated independently with residing in the area with no legal possession of syringes; among SEP users, those with access to SEPs without limits had lower syringe re‐use but not lower syringe sharing; and that among non‐SEP users, no significant differences in injection risk were observed among IDUs with and without pharmacy access to syringes.

Conclusion  We found that greater legal access to syringes, if accompanied by limits on the number of syringes that can be exchanged, purchased and possessed, may not have the intended impacts on injection‐related infectious disease risk among IDUs.
Anabolic steroid users’ attitudes towards physicians
Authors: Pope Harrison G. , Kanayama Gen , Ionescu‐Pioggia Martin , Hudson James I.
Published: August 2004

Aims  To assess anabolic‐androgenic steroid (AAS) users’ trust in the knowledge and advice of physicians.

Design  Interviews of AAS users and non‐users.

Setting  Research offices.

Participants  Eighty weight‐lifters (43 AAS users, 37 non‐users) recruited by advertisement in Massachusetts and Florida, USA.

Measurements  Personal interviews and questionnaire responses, including subjects’ ratings of physicians’ knowledge regarding various health‐ and drug‐related topics. AAS users also rated their level of trust in various sources of information about AAS.

Findings  Both groups of subjects gave physicians high ratings on knowledge about general health, cigarette smoking, alcohol, and conventional illicit drugs, but gave physicians markedly and significantly lower ratings on knowledge about AAS. When rating sources of information on AAS, users scored physicians as no more reliable than their friends, Internet sites, or the person(s) who sold them the steroids. Forty percent of users trusted information on AAS from their drug dealers at least as much as information from any physician that they had seen, and 56% had never revealed their AAS use to any physician.

Conclusion  AAS users show little trust in physicians’ knowledge about AAS, and often do not disclose their AAS use to physicians. These attitudes compromise physicians’ ability to educate or treat AAS users. Physicians can respond to these problems by learning more about AAS and by maintaining a high index of suspicion when evaluating athletic male patients.
Who pays for the drinking? Characteristics of the extent and distribution of social harms from others’ drinking
Authors: Rossow Ingeborg , Hauge Ragnar
Published: August 2004

Aims To explore the extent and distribution of experienced negative consequences from other people's drinking and to explore what characterizes the victims of these harms.

Design, participants and measurements Cross‐sectional survey in a national sample of adults. Net sample comprised 2170 respondents. Negative consequences from others’ drinking during the past 12 months were assessed by seven items.

Results The more severe types of consequences (being physically hurt or property damage) were reported less often (by 3.1% and 4.8%, respectively) than the least severe type of consequence (being kept awake at night by drunk people, reported by 21.2%), thus leaving the four other types of consequences (being harassed in public places, being harassed in private parties, being scolded at and being afraid of drunk people in public areas) somewhere in between. The extent to which the respondents had been subject to social harm from others’ drinking displayed a very skewed distribution. The majority reported not to have experienced any such harms, whereas a small proportion had been harmed repeatedly and in various ways. Multivariate analyses showed that social harms from others’ drinking were most often reported by younger persons, women, those with high education level, those who reported a higher annual alcohol intake, more frequent episodes of intoxication and more frequent visits to public drinking places. The impact of intoxication frequency on victimization from alcohol‐related social harms was stronger for women than for men. Similar individual characteristics were also associated with victimization from physical harm and victimization in the public sphere.

Conclusions Relatively minor harms from others’ drinking are experienced quite frequently. The social victims of others’ drinking tend to drink heavily themselves, yet in contrast to what characterizes social consequences of own drinking, we find that the burden of social harms from others’ drinking is to a larger extent carried by women than by men.
High mortality among young crack cocaine users in Brazil: a 5‐year follow‐up study
Authors: Ribeiro Marcelo , Dunn John , Laranjeira Ronaldo , Sesso Ricardo
Published: August 2004

Aims  Follow‐up studies show that smokers, alcoholics and heroin addicts have high mortality rates, but there is little information on crack users. We have investigated the mortality rate among this population, including its risk factors and causes of death.

Design  A 5‐year follow‐up study.

Participants and setting  A cohort of 131 crack‐dependent patients, admitted to a public detoxification unit in São Paulo between 1992 and 1994.

Measurements  Data collected from a structured personal interview and from a review of patients’ hospital records, confirming the deaths from records held at the Municipal Offices.

Findings  Of the 124 (94.6%) patients located, 23 (18.5%) had died (a mortality ratio of 7.6). Homicide was the most common cause of death (n = 13). Observed mortality rate, adjusted for age and sex, was 24.92 per 1000, while the expected all‐cause mortality rate in São Paulo, also adjusted for age and sex, was 3.28 per 1000, giving an excess mortality rate of 21.64 per 1000. Survival analysis showed that the probability of being alive 5 years post‐treatment was 0.80 (95% CI = 0.77–0.84). Cox's proportional hazards regression showed three factors predicted mortality: history of intravenous drug use (hazard ratio 3.28, 95% CI 1.42–7.59), unemployment at index admission (hazard ratio 3.48, 95% CI 1.03–11.80) and premature discharge from index admission (hazard ratio 2.21, CI 0.94–5.18).

Conclusions  Community‐based and tailored interventions should be considered to improve those patients’ social support and permanence in treatment.
Changing profiles of injecting drug users with AIDS in a Hispanic population
Authors: Amill Alejandro , Gómez María De Los A. , Fernández Diana M. , Bangdiwala Shrikant I. , Ríos Eddy , Hunter Robert F.
Published: August 2004

Aims  To describe and assess the changing trends in socio‐demographic, risk, clinical and immunological parameters in male intravenous drug users (IDU) with AIDS.

Design, setting and participants  Baseline description by year of entry of 610 male IDU with AIDS who entered into a cohort study in Bayamón, Puerto Rico, from 1992 to 2000. Study participants were evaluated at in‐patient health‐care facilities in the University Hospital Ramón Ruiz Arnau or in the ambulatory immunology clinic facilities.

Findings  The median age at which subjects entered the study and the proportion of patients with an educational level lower than a high school degree increased from 1992 to 2000. Upward trends were also observed in the practice of injecting non‐prescription drugs during the last 12‐month period, the practice of needle sharing and the use of a combination of heroin and cocaine (‘speedballs’). Higher proportions of subjects were also diagnosed with wasting syndrome and bacterial pneumonia. The median CD4 count recorded at entry decreased over the course of the study.

Conclusions  Puerto Rican male IDU diagnosed with AIDS are arriving at health‐care facilities in the latest stages of the disease. Better and early interventions with different health care approaches need to be developed.
Efficacy of bupropion and predictors of successful outcome in a sample of French smokers: a randomized placebo‐controlled trial
Authors: Aubin H. J. , Lebargy F. , Berlin I. , Bidaut‐Mazel C. , Chemali‐Hudry J. , Lagrue G.
Published: August 2004

Background  Previous published studies assessed the efficacy of bupropion in smoking cessation only in North American populations of smokers. Results of therapeutic drug trials are not always directly applicable in other populations.

Aims  To confirm the efficacy of bupropion in smoking cessation in European smokers.

Design  A multi‐centre, randomized, double‐blind placebo‐controlled trial.

Setting  Seventy‐four smoking cessation out‐patient clinics in France.

Participants  The study included 509 smokers motivated to quit smoking.

Intervention  Subjects were randomized to either slow‐release bupropion 150 mg b.i.d. (B) or to placebo (Pl) in a 2 : 1 ratio, treated for 7 weeks, and followed‐up for 26 weeks.

Measurements  Main outcome measure: 6 months’ point prevalence abstinence, determined by self‐report and expired air carbon monoxide measurement. Secondary outcome measures: weeks 4–7 and weeks 4–26 continuous abstinence rates, craving, withdrawal symptoms, weight and cigarette consumption in smokers unable to quit. Adverse events were recorded systematically.

Findings  Six months’ point prevalence abstinence rates were 31% and 16%[odds ratio = 2.3, confidence interval (CI) 95%: 1.4–3.7] in the B and Pl groups, respectively. Continuous abstinence rates were 41% (B) and 21% (P) with OR = 2.5 (CI 95%: 1.6–3.9) for weeks 4–7, and 25% (B) and 13% (P) with OR = 2.2 (CI 95%: 1.3–3.6) for weeks 4–26, respectively. Craving decreased significantly more with B than with Pl during treatment period, but there was no difference for total withdrawal symptoms score. Abstinent subjects gained significantly less weight at week 7 with B than with Pl. Low level of nicotine dependence, high motivation, absence of smoking‐related disease, long duration of previous quit attempts, male gender, low level of current alcohol problems and living as a couple were predictive of successful cessation. With the exception of marital status, no interaction was observed between any of these predictive factors and the efficacy of bupropion. More of those who continued smoking in the B group than the P group reduced their consumption by at least 50%.

Conclusions  Sustained‐release bupropion is efficacious as an aid to smoking cessation in European smokers. No outcome predictors were identified that might indicate that certain subgroups of smokers would benefit more than others from treatment with bupropion.
Age, period and cohort influences on beer, wine and spirits consumption trends in the US National Alcohol Surveys
Authors: Kerr William C. , Greenfield Thomas K. , Bond Jason , Ye Yu , Rehm Jürgen
Published: August 2004

Aims  To estimate the separate influences of age, period and cohort on the consumption of beer wine and spirits in the United States.

Design  Linear age–period–cohort models controlling for demographic change with extensive specification testing.

Setting  US general population 1979–2000.

Measurements  Monthly average of past‐year consumption of beer, wine and spirits in five National Alcohol Surveys.

Findings  The strongest cohort effects are found for spirits; cohorts born before 1940 are found to have significantly higher consumption than those born after 1946, with especially high spirits consumption for men in the pre‐1930s cohorts. Significant cohort effects are also found for beer with elevated consumption in the 1946–65 cohorts for men but in the pre‐1940 cohorts for women. Significant negative effects of age are found for beer and spirits consumption, although not for wine. Significant period effects are found for men's beer and wine consumption and for women's spirits consumption. Increased educational attainment in the population over time is associated with reduced beer consumption and increased wine consumption.

Conclusions  Changing cohort demographics are found to have significant effects on beverage‐specific consumption, indicating the importance of controlling for these effects in the evaluation of alcohol policy effectiveness and the potential for substantial improvement in the forecasting of future beverage‐specific consumption trends, alcohol dependence treatment demand and morbidity and mortality outcomes.
Treatment of chronic hepatitis C in patients with drug dependence: time to change the rules?
Authors: Schaefer Martin , Heinz Andreas , Backmund Markus
Published: August 2004

Aims Approximately 170 million people world‐wide are chronically infected with the hepatitis C virus (HCV). While the seroprevalence in the general population ranges between 0.2 and 2%, 50–90% of injection drug users are chronically HCV‐infected. However, most patients who are drug abusers are still excluded from treatment of chronic HCV infection with interferon (IFN)‐α. Due to the recent treatment advances resulting in sustained response rates between 50 and 80%, it becomes increasingly important to reflect the still existing contraindications and restrictions for IFN‐α treatment, especially for patients with intravenous drug use (IDU) with or without psychiatric comorbidity.

Methods We reviewed clinical trials that focus on the treatment of chronic hepatitis C in patients with drug addiction published between 1987 and 2003.

Findings Only seven clinical trials investigating HCV treatment among drug users were found: four open prospective uncontrolled trials and three controlled trials. Thus far, no trials using pegylated IFN‐α have been conducted. Data about sustained response and adherence in HCV‐infected methadone substituted patients were either comparable to control groups or to representative clinically controlled trials using the same treatment regimen (IFN‐α monotherapy or combined with ribavirin). Patients with former or present drug abuse seem more likely to discontinue treatment early. HCV‐infected IDUs tended to be older with higher inflammatory activity and stage of fibrosis when interferon treatment was started. Psychiatric comorbidity did not negatively influence adherence or treatment outcome.

Conclusions There is no clinical evidence suggesting that HCV treatment with IFN‐α should be limited to IDUs or methadone substituted patients. However, more prospective controlled trials on HCV treatment for patients with IDU are needed to establish and apply new rules and guidelines.
Randomized controlled trial of brief cognitive–behavioural interventions for insomnia in recovering alcoholics
Authors: Currie Shawn R. , Clark Stewart , Hodgins David C. , El‐Guebaly Nady
Published: August 2004

Aims  To test the efficacy of a cognitive–behavioural approach to treating disturbed sleep in abstinent alcoholics.

Design  Sixty recovering alcoholics with insomnia were assigned randomly to individual therapy, self‐help with telephone support or waiting‐list control.

Setting  Participants were volunteers recruited from out‐patient treatment programs and through the media.

Measurements  Outcomes were assessed at post‐treatment, 3‐month and 6‐month follow‐ups using sleep diaries, the Pittsburgh Sleep Quality Index, wrist actigraphs and time‐line follow‐back interviews.

Intervention  Five sessions of out‐patient cognitive–behavioural therapy for insomnia or a self‐help manual with five telephone support calls. Treatment duration was 7 weeks.

Findings  Treated participants were significantly more improved than control participants on diary measures of sleep quality, sleep efficiency, awakenings and time to fall asleep. No significant differences between the individual therapy and self‐help treatment conditions on measures of insomnia severity were evident at post‐treatment. Self‐reported improvement in sleep was corroborated by clinician and spousal ratings of insomnia severity, but not by actigraph recordings of nocturnal activity. At 3‐ and 6‐month follow‐up assessments treatment gains were reasonably maintained in both treatment groups, although individual therapy was associated with a higher rate of clinically significant improvement. At the 6‐month follow‐up, 60% participants who were regular users of sedative medication at baseline discontinued the use of their medication. Treatment appeared to have little impact in preventing relapses to alcohol.

Conclusions  Recovering alcoholics with insomnia can achieve better sleep by applying cognitive–behavioural strategies.
Is competition important to arctic zooplankton community structure?
Authors: Dzialowski Andrew R. , John O'Brien W.
Published: August 2004

1. Daphnia pulex and Daphnia middendorffiana are commonly found in the Toolik Lake region of arctic Alaska. These two species are very similar morphologically, although their natural distributions differ markedly: D. pulex is restricted to shallow ponds, while D. middendorffiana is widely distributed and found in a variety of ponds and lakes. We compared the reproductive capabilities of D. pulex and D. middendorffiana grown under similar resource conditions and in the absence of the invertebrate predator Heterocope septentrionalis. In situ life table and mesocosm experiments were conducted in Toolik Lake and Dam Pond, habitats that have historically contained natural populations of D. middendorffiana, but never D. pulex.

2. Daphnia pulex exhibited a significantly higher net growth rate than D. middendorffiana in both life table and mesocosm experiments although D. pulex has never been found in either Toolik Lake or Dam Pond. Daphnia middendorffiana exhibited a negative net growth rate in Dam Pond, which had lower resource levels then Toolik Lake. Therefore, the smaller D. pulex appears to have a lower food threshold concentration than the larger D. middendorffiana.

3. Our results indicate that D. pulex is a superior resource competitor in the Toolik Lake region. These results combined with distributional patterns suggest that the restricted distribution of D. pulex in these arctic lakes and ponds cannot be explained by resource competition alone. We suggest that in the presence of H. septentrionalis, predation is an important factor structuring arctic zooplankton communities in the Toolik Lake region.
Quantitative analysis of the importance of wind‐induced circulation for the spatial structuring of planktonic populations
Authors: Thackeray Stephen J. , Glen George D. , Jones Roger I. , Winfield Ian J.
Published: August 2004

1. Several studies have shown that wind‐induced water movements have an important effect on the spatial distribution of crustacean zooplankton. However, few attempts have been made to quantify the effect of physical processes on these broad‐scale patterns. Much of our understanding of this spatial structure has been based on the results of isolated surveys, which do not capture the dynamic nature of the pelagic environment.

2. In this study, we have used a combination of high‐speed sampling (at a spatial resolution of 240 m) and spatial data analysis to quantify the factors influencing the horizontal spatial structure of the Daphnia galeata population in Windermere.

3. The results show that lake‐wide circulation patterns, as indicated by water temperature, account for 29–47% of the basin‐scale spatial variance in D. galeata abundance. However, these patterns are highly dynamic and change in response to the prevailing weather. This lack of temporal persistence means that the results of single‐survey sampling campaigns must be interpreted with caution.
Response of American dippers (Cinclus mexicanus) to variation in stream water quality
Authors: Feck Jules , Hall Robert O.
Published: August 2004

1. Semi‐aquatic birds may be sensitive to altered water quality. While avian species are not used in the bioassessment of streams, they may complement the more common use of benthic macroinvertebrates and fish. We estimated the extent to which water quality can predict attributes of the populations of one common semi‐aquatic bird, the American dipper (Cinclus mexicanus).

2. First, we estimated dipper presence/absence in relation to water quality as measured by a multimetric assessment index and individual bioassessment metrics. Second, we estimated dipper territory area and reproductive success in response to variation in water quality. We studied the diet, territory area and fecundity of dippers and sampled benthic macroinvertebrates, water chemistry and physical variables at 32 sites with and 17 sites without nesting dippers.

3. Dipper presence was only weakly related to chemical, physical and commonly recorded bioassessment metrics such as per cent Ephemeroptera, Plecoptera and Trichoptera (%EPT). Dippers were strongly related to the abundance of their common prey, Drunella and Heptageniidae, which are only a small component of the commonly recorded bioassessment metrics. The variances in territory area and reproductive success were weakly predicted by water quality variables.

4. Dipper presence reflected disturbance as measured by their common prey, showing that lower abundance of these stream invertebrates affected this semi‐aquatic bird. We suggest dipper presence/absence might be used in multimetric indices of biotic integrity for the bioassessment of streams.
Effects of food quality on life history of the rotifer Brachionus calyciflorus Pallas
Authors: Jensen Thomas C. , Verschoor Antonie M.
Published: August 2004

1. Herbivorous zooplankton face considerable temporal and spatial variation in food quality, to which they respond by adapting their life histories. Zooplankton may even take up mineral nutrients directly, and use these to counter the effects of algal nutrient limitation (mineral compensation). This study examined the life history of the rotifer Brachionus calyciflorus fed phosphorus‐, and nitrogen‐limited Scenedesmus obliquus (Chlorophyta), and investigated whether B. calyciflorus was capable of mineral compensation.

2. Both phosphorus‐ and nitrogen‐limited algae gave similar life history responses: somatic growth and reproduction were reduced, whereas lifespan remained unaffected.

3. No evidence was found for mineral compensation in B. calyciflorus in relation to detrimental life history effects, so mineral compensation does not seem to be relevant for this species under field conditions.

4. The similarity in life history responses of B. calyciflorus and the low levels of ω‐3 PUFAs in both phosphorus‐ and nitrogen‐depleted algae suggest that ω‐3 PUFAs were limiting to B. calyciflorus, although other (bio)chemicals or mineral nutrients may also have been important.

5. No trade‐off was observed between life span and reproduction during algal nutrient limitation. Reduced population growth rates of B. calyciflorus were caused by shorter reproductive periods.
Effects of habitat complexity on benthic assemblages in a variable environment
Authors: Taniguchi Hiromi , Tokeshi M.
Published: August 2004

1. Habitat complexity is thought to exert a significant influence on ecological communities, but its operation under variable natural conditions is not well understood, particularly in freshwater. To elucidate the role of habitat complexity, in particular the fractal structure of surface irregularity, in a stream system, field colonisation experiments were conducted at three times of year (summer, winter and spring) using natural substrates with different levels of fractal dimension in a small coastal mountain stream of southern Japan.

2. In the winter experiment, comparison was also made between the standard (control) treatment and the resource‐preconditioning treatment whereby experimental plates were conditioned in the natural stream environment to allow the accumulation of potential food resources (algae and detritus) for 1 month prior to the experiment.

3. Species abundance patterns observed at different times of year showed little systematic variation with levels of habitat complexity but largely followed the patterns expected from, or lying in between, the Random Assortment model and the random fraction model.

4. Taxon richness and density increased with habitat complexity in all seasons except for density in spring. Different taxa showed different patterns of change with habitat complexity, which also varied with seasons. Biomass of invertebrates showed no systematic trend with an increase in habitat complexity.

5. Chlorophyll‐a concentrations tended to be lower in more complex habitats, particularly in summer. In contrast, fine particulate organic matter (FPOM) tended to increase with habitat complexity. However, the relationship between these potential food resources and invertebrate assemblages remain unclear.

6. While there were no significant differences in taxon richness and biomass of invertebrates between the resource‐preconditioning and the control treatment, density was higher in the former than in the latter. The abundance of relatively large, surface‐dwelling animals showed more marked temporal variation over the entire period of colonisation in the resource‐preconditioning treatment than in the control treatment.

7. Body size of invertebrates tended to decline with fractal complexity, indicating that crevice sizes could affect habitat use by benthic animals of different sizes. In addition, body size was larger in the resource‐preconditioning treatment than in the control treatment, suggesting that body size in invertebrate assemblages was controlled by a mixture of factors. Thus, the present study demonstrates that habitat structure affects benthic invertebrate assemblages in a complex manner.
Distribution of Daphnia in a trade‐off between food and temperature: individual habitat choice and time allocation
Authors: Kessler Kirsten
Published: August 2004

1. In a thermally stratified water column with a deep‐water algal maximum, Daphnia face a trade‐off between food (high fecundity) and temperature (fast development). Recent studies showed that Daphnia populations move up and down the entire water column to take advantage of both, but the proportion of time allocated by individuals to the epilimnion, metalimnion and hypolimnion with their specific food and temperature conditions is not yet known.

2. In a system of 1 m deep, vertical perspex tubes, I established three temperature gradients with 2, 5 and 10 °C differences between the surface (epilimnion) and the bottom layer (hypolimnion). Algae were added to the hypolimnion to simulate a deep‐water algal maximum.

3. The migration behaviour of individual neonate and egg‐bearing Daphnia hyalina × galeata was monitored in order to measure the proportions of time the individuals allocated to the different vertical habitats and to assess the frequency of their shifts between epilimnion and hypolimnion.

4. Neonates stayed continuously at the surface, taking advantage of the higher temperature, possibly because feeding was less important for them because of egg yolk reserves. In contrast, egg‐bearing females spent more time feeding in the hypolimnion when the temperature gradient was weak, but also migrated into the epilimnion to take advantage of the higher temperature. In the steepest temperature gradient, the egg‐bearing females either shifted between epilimnion and hypolimnion, or dwelled constantly in the metalimnion with intermediate conditions.
Spatial scale and ecological relationships between the macroinvertebrate communities of stony habitats of streams and lakes
Authors: Johnson Richard K. , Goedkoop Willem , Sandin Leonard
Published: August 2004

1. Comparative studies of distinct, but not ecologically isolated, systems such as lakes and streams may improve our understanding of the importance of ecological linkages in aquatic ecosystems.

2. In this study we compared the macroinvertebrate benthos of stony habitats in Swedish lakes and streams. Community composition was used to evaluate zoogeographic patterns and functional feeding guilds were used to identify mechanisms potentially affecting such patterns.

3. Stream communities were generally more diverse and species‐rich and had a higher proportion of grazers, shredders and passive‐filter feeders than lakes. Lake communities had a higher proportion of predators and collector‐gatherers. Of the 10 most common taxa, only Leptophlebia mayflies, clams (Sphaeriidae) and the isopod Asellus aquaticus were recorded in both lakes and streams.

4. Among‐site variance in macroinvertebrate communities accounted for by regional‐scale variables was low (6.4% for lakes and 10.1% for streams), compared with that by local‐scale variables (21% for lakes and 37.6% for streams). For lakes, the among‐site variance in macroinvertebrate communities was best explained by habitat‐scale characteristics followed by ecosystem, riparian, catchment, geographic position and ecoregion. For streams, the variance in macroinvertebrate communities was best explained by ecosystem characteristics followed by habitat, catchment, riparian, ecoregion and geographic position.

5. Conspicuous differences in spatial pattern were revealed between lakes and streams. For lakes, the most unequivocal differences in community composition and function occurred at the transition zone between the mixed forests in the south and the boreal coniferous forests in the north. Surprisingly, streams did not respond as strongly to profound landscape‐level differences in climate and vegetation cover.

6. The spatial differences noted between macroinvertebrate communities of lakes and streams may be because of differences in retention of detrital matter. Our findings imply that detrital inputs are qualitatively similar, but that the retention and processing of coarse particulate organic matter was presumably higher in lake littoral regions than in stream riffle habitats.

7. Although our findings support the conjecture that species distribution is determined fundamentally by conditions prevailing at the local‐scale, regional factors such as land use/type and the role of history were important and seemingly act as strong determinants of large‐scale patterns in biodiversity.
Associating particulate essential fatty acids of the ω3 family with phytoplankton species composition in a Siberian reservoir
Authors: Sushchik Nadezhda N. , Gladyshev Michail I. , Makhutova Olesia N. , Kalachova Galina S. , Kravchuk Elena S. , Ivanova Elena A.
Published: August 2004

1. We studied variation in the composition of fatty acids in the seston of a small freshwater reservoir with changes in phytoplankton composition during four growth seasons. We focused on the dynamics of the ω3 fatty acids because of their potential importance for zooplankton nutrition.

2. Total diatoms were related to the 20:5ω3 fatty acid (eicosapentaenoic, EPA) content in seston. Among two dominant diatom genera, Cyclotella was not associated with EPA content. In contrast, there was a significant correlation between Stephanodiscus and the percentage contribution and content of EPA throughout the study. Hence, freshwater diatoms can differ strongly in content of the essential EPA.

3. We considered abundant cyanobacteria as a potential source of 18:3ω3 fatty acid (linolenic, ALA) to aquatic food webs. Among four dominant cyanobacteria species, two (Anabaena flos‐aquae and Planktothrix agardhii) showed significant correlation with the ALA content of the seston, while the other two (Aphanizomenon flos‐aquae and Microcystis aeruginosa) did not.

4. Dinophyta had a relatively high level of 22:6ω3 (docosahexaenoic, DHA) for freshwater species and can be also a source of EPA to aquatic food webs.

5. Our results show that various species of diatoms as well as cyanobacteria can be of contrasting nutritional value for zooplankton because of their different content of the essential PUFAs. Diatoms, which are low in EPA, could not be considered as a valuable food, while some field populations of cyanobacteria might be valuable sources of essential ALA.
Physiological flexibility: the key to success and survival for Antarctic fairy shrimps in highly fluctuating extreme environments
Authors: Peck Lloyd S.
Published: August 2004

1. The anostracan fairy shrimpBranchinecta gainiinhabits one of the most hostile environments on earth, living in pools and lakes in Antarctica. Between January 2002 and January 2003 temperatures in two pools whereB. gainiare extremely abundant on Adelaide Island ranged from −18.6 to −15.7 °C in winter, to 19.4 to 17.1 °C in summer, whilst air temperatures ranged from −34 to 6.3 °C.

2.Branchinecta gainisurvives winter as cysts, but endures large summer temperature fluctuations as adults. Cysts froze between −24.4 and −25.7 °C. In experiments adults survived 0–10 °C with no mortality for 1 week, 25 °C for nearly 48 h with 50% mortality, and at 32 °C complete mortality occurred in <1 h.

3. Oxygen consumption (ṀO2) inB. gainiapproximately doubled for every 10 °C temperature rise (Q10 = 2.04) up to 20 °C where it reached a peak. Females had, on average 19% higher ṀO2than males. Females also had greater metabolic scopes, (maximum–minimum ṀO2across temperatures was ×3.6 for females, ×3.1 for males).

4. Ventilation frequency increased linearly with temperature, and did not decline at 25 °C, indicating animals were ‘trying’ progressively harder to supply oxygen to tissues, and oxygen deficiency was the probable cause of death. Females had a higher ventilation frequency than males (8.6–17.1% higher) and they also exhibited greater scope to raise ventilation frequency (×2.4 for females versus ×1.5 for males).

5. Great metabolic flexibility allowsB. gainito exploit extreme, highly fluctuating environments, and larger ventilatory and respiratory scopes allow females to survive higher temperatures than males. Because of this flexibility their prospects for coping with physical environmental change are high.
COPD‐intuition or template: nurses’ stories of acute exacerbations of chronic obstructive pulmonary disease
Authors: Bailey Patricia Hill , Colella Tracey , Mossey Sharolyn
Published: August 2004

Study rational. A number of nurse‐researchers have examined the experience of dyspnoea reduction during non‐acute phases of the chronic obstructive pulmonary disease (COPD). However, nurses working on in‐patient hospital units are frequently required to care for individuals suffering from acute exacerbations of their disease (AECOPD). These critically ill individuals present at health care institutions incapacitated by severe shortness of breath/dyspnoea that is frequently refractory to treatment. To date, little is known about the nurses’ understanding of the care they provide for individuals hospitalized because of these acute episodes of their chronic illness.

Study objectives. The research project was undertaken, in part, to develop an understanding of nurses’ experience of caregiving for individuals hospitalized for in‐patient care during an AECOPD.

Methodological design. This focused ethnographic narrative examined the caregiving stories of 10 nurse caregivers. The 10 nurse caregivers were interviewed while caring for a patient and their family during an experience of an AECOPD characterized by incapacitating breathlessness.

Results. The nurse caregivers told a number of caregiving stories that illustrated a common care template that appears to be based on intuition or pattern recognition focusing on anxiety sometimes to the exclusion of dyspnoea.

Conclusions. Analysis of these stories emphasized the need to facilitate nurses individualization of standard templates. More importantly, this analysis illustrated the critical need to develop strategies to facilitate the reshaping of inaccurate templates in the presence of new knowledge.
To feel betrayed and to feel that you are betraying the older residents: caregivers’ experiences at a newly opened nursing home
Authors: Häggström Elisabeth , Skovdahl Kirsti , Fläckman Birgitta , Kihlgren Annika Larsson , Kihlgren Mona
Published: August 2004

Background. In Sweden and internationally, little research has focused on the working situation of Enrolled Nurses and Nurses’ Aides who form the majority of workers in geriatric care today. With this in mind, it is important to focus on how these occupational groups experience their working situation with older residents in municipal care.

Aims and objectives. The aim of the study was to investigate the deeper meaning of work satisfaction and work dissatisfaction at a newly opened nursing home for older residents. The study focused on the narratives supplied by the caregivers at the nursing home. The participants included: one Registered Nurse, sixteen Enrolled Nurses, and three Nurses’ Aides. All were directly involved in patient care.

Design. The present study is part of a larger longitudinal study within the municipal geriatric care system in Sweden, with a quasi‐experimental design.

Method. The interviews were analysed with a phenomenological‐hermeneutic method inspired by the philosophy of Ricoeur.

Result. The caregivers experiences of work satisfaction and work dissatisfaction was expressed in four themes: (i) ‘Experience of betrayal’ describes how the staff felt let down in several ways; (ii) ‘Experience of failing others’ describes how the staff felt that they did not pay enough attention to older people, in several different ways; (iii) ‘Experience of insufficiency’ describes how the staff encountered overwhelming demands from several directions; (iv) ‘Experience of work satisfaction’ describes how the staff felt that they were given support in various ways. Each theme emerged from several subthemes that originated from the caregivers’ narratives.

Conclusions. The study shows that the caregivers’ experience of work dissatisfaction overshadows their experience of work satisfaction. It also suggests that their feelings of failing the older residents are connected to their own experiences of feeling betrayed.

Relevance to clinical practice. The findings can be used when other nursing homes in municipal care are opened, as a means of preventing work dissatisfaction and increasing work satisfaction among future employees.
Nosocomial infections in neurosurgery intensive care units
Authors: Çelik Sevim Akgül
Published: August 2004

Background.  Nosocomial infections can lead to complications in the patients admitted to neurosurgery intensive care units. The most common causes are ventriculitis, shunt infections, meningitis, surgical wound infections, urinary tract infections, pneumonia, intravascular catheter related to infections and gastrointestinal infections.

Aim and objective.  This article is written to determine strategies that nurses can apply to minimize nosocomial infections seen in neurosurgery intensive care units.

Design.  The article is systematic review.

Method.  A MEDLINE and CINAHL search was carried out using descriptor terms. This overview is targeted at neurosurgery intensive care nurses to demonstrate to them that principles of infection control in the neurosurgery intensive care units are based on simple concepts and that basic measures are easy to implement at the bedside. The 20 articles were identified that met the requirements for methodological quality and inclusion criteria.

Result.  In order to reduce infection rates it is useful to inform intensive care nurses about the infection sources and it is useful to change their behaviours.

Conclusion.  Infection control measures are to be viewed as priority and have to be integrated fully into the continuous process of improvement of quality of care.

Relevance to clinical practice.  Little research about the treatment/care and rates of nosocomial infections in the neurosurgery care unit was found. It was found that this subject has not been widely covered in nursing journals. This article can provide knowledge regarding the effective strategies of infection control in the neurosurgery intensive care units. Practicing nurses can use that knowledge to enhance the quality of nursing care.
Clinical governance in primary care: a literature review
Authors: Tait Allison R
Published: August 2004

Background.  A systematic review of the research literature published between 1999–2003 was carried out to review how primary care trust groups and primary care organisations were monitoring the implementation of clinical governance and the effects this may have on nursing.

Method.  Studies were limited to research papers with explicit methodology applicable to primary care trusts. The selection criteria, search procedures and methods of data extraction and analysis were formed at the outset.

Data collection.  A data extraction tool developed by Cormack was adapted as a guide to include nine areas of methodological appraisal in summary forms.

Results.  Initially 87 articles were identified from the search. When papers were omitted on the exclusion criteria seven studies remained.

Conclusion.  Clinical governance is a notable example of co‐ordinated policy development and the entire concept can be difficult to translate into the integrated and systematic approach to improving quality of care. Clinical governance requires changes at three levels: the individual health care professional, primary care teams need to become multidisciplinary with clear understanding, primary care organisations need to put in place systems and local arrangements to support such teams.

Relevance to clinical practice.  Clinical governance is about changing the way people work; demonstrating that leadership, teamwork and communication is as important to high quality care as risk management and clinical effectiveness. Whilst the sharing of information between practices is seen to be increasing with multi‐professional study days occurring in some areas this in turn needs commitment for time and funding. The organisational and cultural environment within the trust as well as resource issues needs continuous attention if high quality governance is to become the norm.
Pressure ulcer prevention in nursing homes: views and beliefs of enrolled nurses and other health care workers
Authors: Buss Inge C , Halfens Ruud JG , Abu‐Saad Huda Huyer , Kok Gerjo
Published: August 2004

Background.  In the Netherlands much attention has been paid to pressure ulcer prevention. National guidelines on pressure ulcer prevention were developed in 1985 and adapted in 1992 at the request of a national organization for quality assurance in health care. Several studies indicate that nurses seem to be insufficiently informed about pressure ulcer preventive activities. There is, however, no information available about the reasons why nurses seem to be insufficiently informed.

Aims and objectives.  This study was planned to elucidate the views and beliefs of health care workers (especially enrolled nurses) in Dutch nursing homes about pressure ulcer prevention and about issues related with pressure ulcer prevention.

Design.  A qualitative study with semi‐structured, tape‐recorded interviews.

Method.  Interviews were conducted with enrolled nurses, team leaders, head nurses, staff nurses and physicians. The interviews were coded and analysed.

Results.  Analysis of the interviews revealed that today's pressure ulcer preventive activities are very much based on old traditions in nursing. It also showed that enrolled nurses have no intention to change the care they deliver with regard to pressure ulcer prevention.

Conclusions.  It is concluded that a systematic approach is necessary to change nursing thinking and acting with regard to pressure ulcer prevention.

Relevance to clinical practice.  This study gives an overview of the views and beliefs of health care workers (especially enrolled nurses) in Dutch nursing homes about pressure ulcer prevention. These views and beliefs can be used as a starting point for effective implementation of guidelines regarding the prevention of pressure ulcers.
Rapid assessment of a helpdesk service supporting severe acute respiratory syndrome patients and their relatives
Authors: Chung Joanne WY , Wong Thomas KS , Chang Katherine KP , Chow CB , Chung Betty PM , Chung Grace , Ho Simone , Ho Jacqueline SC , Lai Claudia KY , Lai Adela , Lam Veronica SF , Lau Josephine , Liu Justina , Mok Esther , Wong Daniel
Published: August 2004

Background.  To contain severe acute respiratory syndrome, the Hong Kong Hospital Authority set a policy that stipulated there should be no visitors to hospital wards. A helpdesk service was established with the goal of providing immediate emotional and communication support to relatives while severe acute respiratory syndrome patients were isolated during the acute phase of the illness.

Aim.  This study describes the results of a rapid assessment of the effectiveness of a helpdesk service designed to meet the immediate needs of relatives of severe acute respiratory syndrome patients in Hong Kong.

Design.  Survey.

Method.  Eighty‐three respondents, representing about 46.3% of relatives (179), attending the helpdesk on the day of the study were recruited. Service evaluation data was collected using a self‐administered questionnaire completed by respondents.

Results.  Nearly 100% of respondents who used the service found the delivery service with on‐site counselling useful for alleviating their anxiety. However, about half of these relatives complained of insufficient information regarding the patient's condition and progress. The majority of respondents were satisfied with the service. In describing the most important traits of the service providers, caring and enthusiasm were mentioned most frequently by respondents who stated that they were very satisfied with the service.

Conclusion.  The results support the value of the service, and demonstrate that the service is effective in meeting relatives’ immediate needs. These needs include information, aid in fulfilling their role as caretaker for the patient (delivering prepared soup) and psychological support. The results suggest that facilitation of visitation of patients by relatives via video conferencing and education of the public on the nature and course of severe acute respiratory syndrome to reduce the social stigma of having a potentially life‐threatening disease should be introduced in Hong Kong.

Relevance to clinical practice.  The results highlight important attributes that helpers (nurses) should have in order to alleviate the suffering of severe acute respiratory syndrome patients and their relatives.
Nurse–patient interaction: a review of the literature
Authors: Shattell Mona
Published: August 2004

Aims. The aims of this paper are to review a theoretical model useful for developing nursing knowledge related to nurse–patient interaction, review the literature on nurse–patient interaction, and discuss areas for further research.

Theoretical model. Goffman's theory of face work.

Results. Nurse–patient interaction is a central element of clinical nursing practice. This paper shows how Goffman's model can be used as a theoretical framework for understanding nurse–patient communication.

Relevance to clinical practice. Issues such as power, the social and cultural context, and interpersonal competence are shown to be important in the quality of nurse–patient interactions and nurses need to take cognizance of these factors in their interactions with patients.