bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical management of equine recurrent uveitis with single port pars plana vitrectomy
Authors: Frühauf B. , Ohnesorge B. , Deegen E. , Boevé M.
Published: March 2003

Current information suggests that equine recurrent uveitis (ERU) is an immune‐mediated reaction to infectious agents or to autologous ophthalmic tissue. Recurrences are associated with progression of irreversible ocular damage. This report describes the intraoperative technique, complications, and long‐term results of 38 eyes in 35 horses with ERU that underwent pars plana vitrectomy. The majority of the horses were warm‐blooded. Recurrence of ERU was prevented in 35 of the 38 eyes. Some horses, especially in patients with incipient cataracts, developed vision loss in postoperative, quiescent eyes which was usually associated with cataract formation. Vision was stable in 85% of all eyes that underwent vitrectomy. Pars plana vitrectomy in horses appears successful in interrupting the cycle of repeated episodes of ERU, and the subsequent globe destruction in the majority of eyes. Removal of uveitis‐induced ‘immunologic memory’ in the vitreous by vitrectomy may reduce adverse interaction between the vitreous and the uveal tract, and therefore reduce the recurrence of ERU.
Feline ocular toxoplasmosis
Authors: Davidson M.G. , English R.V.
Published: March 2003

Ocular infection withToxoplasma gondiiis a well‐recognized and important clinical entity in many animal species. In the cat, ocular toxoplasmosis is commonly associated with systemic infection, yet its role in causing anterior uveitis in an otherwise healthy cat is unclear. The purpose of this article is to review the salient epidemiological, clinical, and histopathologic features of systemic and ocular toxoplasmosis in the cat. Additionally, pathogenesis and possible immunopathogenic mechanisms of ocular toxoplasmosis, which may account for the higher prevalence of anterior uveitis in cats seropositive forT. gondii, are discussed. Finally, diagnosis, treatment and prevention of feline toxoplasmosis are reviewed.
Iridociliary epithelial tumors in 100 dogs and 17 cats: a morphological study
Authors: Dubielzig  , Steinberg  , Garvin  , Deehr  , Fischer
Published: March 2003

The morphological features of iridociliary epithelial tumors in 100 dogs and 17 cats were reviewed. Twenty‐seven cases were in either Golden Retrievers or Labrador Retrievers. Affected globes were stained for light microscopy with alcian blue, periodic acid Schiff (PAS) and hematoxylin and eosin stains. Selected tissues were examined by immunohistochemistry for vimentin, desmin, cytokeratin, S‐100, neuron‐specific enolase (NSE), and glial fibrillary acid protein (GFAP). The presence or absence of hyaluronic acid was recorded by staining with alcian blue before and after digestion of the tissue with hyaluronidase. Canine tumors were divided into papillary and solid tumors based on the pattern of growth. Twenty‐eight of 57 papillary tumors exhibited invasive behavior including eight of the 57 which showed infiltration of the sclera. Twenty‐nine of 43 solid tumors were invasive including 13 of 43 with scleral invasion. Tumors with scleral invasion were designated adenocarcinoma. Tumors of both types could be pigmented or nonpigmented and often contained smooth basement membranes reminiscent of the inner membrane of the nonpigmented ciliary body epithelial cell. All of the feline tumors were nonpigmented and 14 of 16 feline tumors were solid and two of the tumors were papillary. Eighteen of 20 canine tumors and three of four feline tumors stained positive for vimentin. Cytokeratin stain was positive only in a few of the highly aggressive tumors. The finding of pigmented epithelial cells, thick, smooth basement membrane structures, positive staining for vimentin, S‐100, and NSE as well as hyaluronic acid deposition were considered to be features which define iridociliary epithelial tumors in dogs. The positive staining for vimentin and NSE are highly specific markers which help to characterize iridociliary epithelium and distinguish this tumor from metastatic epithelial tumors. The finding of solid nonpigmented tumors with small epithelial cells packeted by thin PAS‐positive membranes staining positive for vimentin were considered significant features defining iridociliary epithelial tumors in cats. Follow‐up information on survival and cause of death was obtained on 43 canine cases and only two feline cases. The average follow‐up interval in dogs was 25 months and only two dogs died with lesions that could have been due to metastasis although neither was confirmed. We concluded that neither iridociliary adenomas nor adenocarcinomas is likely to metastasize.
Congenital ocular abnormalities of Rocky Mountain Horses
Authors: Ramsey  , Ewart  , Render  , Cook  , Latimer
Published: March 2003

Objective:To determine the incidence and describe ocular abnormalities in a cross‐section of the population of Rocky Mountain Horses.

Design:Prospective study.

Animals:Five‐hundred and fourteen Rocky Mountain Horses.

Procedure:Ophthalmic examinations were performed using a slit‐lamp biomicroscope and an indirect ophthalmoscope. Intraocular pressures were measured by applanation tonometry. Eyes from six horses were obtained for histologic examination.

Results:Cysts of the posterior iris, ciliary body, and peripheral retina were detected most frequently (249 horses), and were always located temporally. Curvilinear streaks of retinal pigmented epithelium extending from the peripheral temporal retina marked the boundary of previous retinal detachment in 189 horses. Retinal dysplasia was detected in 125 horses. Multiple ocular anomalies were evident in 71 horses and were always bilateral and symmetrical. Affected eyes had a large, clear cornea that protruded excessively and had an apparent short radius of curvature, a deep anterior chamber, miotic and dyscoric pupil, and iris hypoplasia. Pupillary light responses were decreased or absent and pupils failed to dilate after repeated instillation of mydriatic drugs in horses with multiple ocular anomalies. Less frequently encountered abnormalities included peripheral iridocorneal adhesions and goniosynechiae. Congenital cataract was always present in eyes with multiple abnormalities. Intraocular pressures did not differ among horses with normal eyes and horses with multiple ocular abnormalities. Histologic examination of eyes corroborated the clinical appearance.
Comparative Doppler imaging of the ophthalmic vasculature in normal Beagles and Beagles with inherited primary open‐angle glaucoma
Authors: Gelatt‐Nicholson  , Gelatt  , MacKay  , Brooks  , Newell
Published: March 2003

The objective of this study was to compare orbital and ocular vasculature velocity, measured by Doppler imaging, in normal Beagles and Beagles with inherited primary open‐angle glaucoma. Eight normal Beagles and 13 Beagles with different stages of primary open‐angle glaucoma were evaluated twice with a 2–4‐week period between measurements. Doppler imaging was performed with the dogs anesthetized, and the Doppler transducer applied directly on the corneal surface. The majority of the orbital vasculature (external ethmoidal artery; internal ophthalmic artery and vein; and external ophthalmic artery and vein) and ocular blood vessels (anterior ciliary artery and veins; long posterior ciliary arteries; short posterior ciliary arteries; primary retinal arteries; and the vortex veins) were identified and Doppler blood velocity parameters were determined. The glaucomatous dogs demonstrated significant differences in the Doppler velocity parameters of several orbital vessels (external ethmoidal, external ophthalmic, and internal ophthalmic arteries), and several ocular vessels (anterior ciliary, short posterior ciliary, and long posterior ciliary arteries). These differences included decreased blood velocities, and increased pulsatility and resistive indexes. The Doppler blood flow velocities of the primary retinal arteries were unchanged between the normal and glaucomatous dogs. In the glaucomatous dogs, the Doppler imaging suggests increased vascular resistance downstream in both the orbital and ocular vasculature. These blood velocity parameter changes may be primary or secondary, and may offer therapeutic opportunities to increase perfusion, prolong the retina and optic nerve head function, and maintain vision in the canine glaucomas.
Angioinvasive pulmonary carcinoma with posterior segment metastasis in four cats
Authors: Cassotis  , Dubielzig  , Gilger  , Davidson
Published: March 2003

The objective of the research was to characterize the clinical, fluorescein angiographic, pathologic and microscopic features of feline pulmonary carcinoma with ocular metastasis that resulted in ischemic chorioretinopathy. Four cats with confirmed or presumed primary pulmonary neoplasia with posterior segment metastasis were studied. The medical records from four cats with a diagnosis of bronchogenic carcinoma and intraocular metastasis were reviewed. Physical and ophthalmic examinations and thoracic radiographs were performed in all cases, and fluorescein angiography was performed in two cases. Classification of the neoplasms was determined by fine‐needle aspiration and biopsies of peripheral metastatic lesions, and/or complete necropsies. All four cases had unilateral or bilateral blindness and ophthalmoscopic lesions characterized by a wedge‐shaped, tan discoloration in the tapetal fundus, variable but mild serous exudation under the retina, and profoundly attenuated retinal vasculature. Painful swelling and necrosis of the distal extremities and/or mass lesions in the appendicular musculature were also present. Clinical findings, along with microscopic findings from biopsy specimens or complete postmortem examination, documented widespread metastasis of variably differentiated, neoplastic, columnar epithelial cells presumed to be of bronchial origin. Tumor cells were predominately located within the systemic vasculature, consistent with classification of angioinvasive pulmonary carcinoma. Fluorescein angiographic and histopathologic findings in the affected globes suggested that the posterior segment lesions resulted from invasion and growth of neoplastic cells within the chorioretinal vasculature, resulting in secondary ischemic necrosis of the retina and choroid. Ischemic chorioretinopathy and necrosis of the distal extremities, associated with primary bronchogenic carcinoma, appear to be a unique neoplastic syndrome in the domestic cat.
Persistent fetal intraocular vasculature in the European ferret (Mustela putorius): clinical and histological aspects
Authors: Lipsitz Lee , Ramsey David T. , Render James A. , Bursian Steven J. , Auelrich Richard J.
Published: March 2003

ObjectiveTo describe the clinical and histological appearance of persistent fetal intraocular vasculature in a colony of ferrets.

DesignProspective study.

Animals studiedEighty‐six European ferrets (Mustela putorius).

ProcedureBoth eyes of 76 genetically related progeny and 10 breeding, adult, colony‐raised ferrets were studied using a slit lamp biomicroscope and an indirect ophthalmoscope. Ferret progeny were examined after eyelid opening at 5–6 weeks of age, and at 12 months of age. After euthanasia, globes were enucleated and examined histologically.

ResultsPersistent fetal intraocular vasculature was evident in 21 progeny ferrets at 5–6 weeks of age and in three mature progenitor ferrets. Clinical appearance of diminutive vasculature was characterized by focal remnants of the posterior tunica vasculosa lentis, muscae volitantes, and an occluded hyaloid artery extending from the optic papilla and terminating in the anterior vitreous body. Extensive persistent vasculature was characterized by a perfused hyaloid artery, vasa hyaloidea propria and posterior tunica vasculosa lentis, posterior cortical and capsular cataract, and proliferation of fibrovascular tissue along the posterior lens capsule. Fetal vasculature persisted in 7 of 21 progeny ferrets at one year of age and in three progenitor ferrets. Results of histologic examination showed persistence of the hyaloid vasculature, proliferation of retrolental fibrovascular tissue with osseous metaplasia, posterior capsular and cortical cataract, and occasional retinal detachment.

ConclusionsPersistent fetal intraocular vasculature in ferrets appears similar clinically and histologically to persistent fetal intraocular vasculature reported in humans and dogs. The ferret may be a suitable animal model for vasculogenic mechanisms of persistent fetal intraocular vasculature and for evaluating vasoinhibitory growth factors and angiostatic test compounds.
Persistent hyperplastic tunica vasculosa lentis and persistent hyperplastic primary vitreous (PHTVL/PHPV) in two cats
Authors: Allgoewer Ingrid , Pfefferkorn Beatrice
Published: March 2003

Two domestic shorthair cats (6 and 9 months old) were presented for examination of ocular opacities. One cat had bilateral persistent pupillary membranes, unilaterally accompanied by persistent hyperplastic tunica vasculosa lentis, persistent hyperplastic primary vitreous (PHTVL/PHPV), and cataract. The second cat had bilateral PHTVL/PHPV with dense white plaques in the posterior lens capsule and subcapsular cortex.
Effects of topical 0.5% tropicamide on intraocular pressure in normal cats
Authors: Stadtbäumer Katrin , Köstlin Roberto G. , Zahn Klaus J.
Published: March 2003

The objective of the study was to determine the effect of topical 0.5% tropicamide on intraocular pressure (IOP) in normotensive feline eyes. IOP was measured bilaterally in 70 clinically healthy cats and gonioscopy (and goniophotography) was performed. Thereafter, 50 cats were treated unilaterally with one drop of 0.5% tropicamide. The contralateral, left eye served as a control. In the placebo group consisting of 20 cats, one drop of physiologic saline solution was administered to the right eye. In all cats, IOP of both eyes was measured 30, 60 and 90 min after topical administration. After unilateral tropicamide application, IOP increased significantly both in the right and in the left eye. Maximum average IOP increase was observed at the control measurement performed 90 min after treatment, with an elevation of 3.8 ± 4.2 mmHg in the right eye and 3.5 ± 3.6 mmHg in the left eye. Maximum IOP increase after treatment was 18.0 mmHg in the treated eye and 17.0 mmHg in the left eye. Measurements made at 60 min after treatment revealed a significantly higher increase in IOP in the right eye as compared to the left eye (P60 < 0.05), whereas the differences between right and left eye in IOP increase were not significant at 30 and 90 min after mydriatic application (P30 = 0.123;P90 = 0.305). Although tropicamide‐induced mydriasis was observed in the treated eye, the contralateral eye did not show any changes in pupillary function at any time. With increasing age of the cats, IOP increase was found to be more moderate, whereas the gender of the cats did not have any significant influence on IOP changes. In the 20 cats in the placebo group, no significant changes in IOP were observed. We conclude that topical 0.5% tropicamide causes a significant elevation of IOP in the treated and untreated eye in normal cats.
Phacoemulsification in an adult Savannah monitor lizard
Authors: Colitz Carmen M. H. , Lewbart Greg , Davidson Michael G.
Published: March 2003

An adult male Savannah monitor lizard (Varanus exanthematicus) was presented for bilateral lens opacities that had progressed rapidly over the previous 2 months. A diagnosis of bilateral mature cataracts was made and phacoemulsification cataract extraction was performed. Surgery restored vision and normal activity to the patient.
Five new Liphistius species (Araneae, Mesothelae) from Thailand
Authors: Schwendinger Peter J.
Published: March 2003

In Schwendiger’s (1998) paper on new liphistiid trapdoor spiders from Thailand the illustrations were produced in unusually poor quality. Due to unaccountable technical problems during printing, morphological details given in the illustrations were lost and the overall appearance of the paper became grossly unsatisfactory. To correct this, all figures in that article are reprinted on the following pages.
First incidence of inquilinism in gall‐forming psyllids, with a description of the new inquiline species (Insecta, Hemiptera, Psylloidea, Psyllidae, Spondyliaspidinae)
Authors: Yang Man‐Miao , Mitter Charles , Miller Douglass R.
Published: March 2003

The two largest lineages of holometabolous gall‐forming insects, cynipid wasps and cecidomyiid flies, have given rise to numerous obligate inquilines, species which are unable to form galls themselves and survive by inhabiting galls formed by other species. In contrast, only a single obligate inquiline, an aphid, is known in the sternorrhynchous Hemiptera, the hemimetabolan lineage in which gall‐forming is best developed. We describe the first known gall inquiline in psyllids (Sternorrhyncha, Psylloidea),Pachypsylla cohabitansYang & Riemann sp. n. All other members of this genus produce closed galls on hackberries,Celtisspp. (Ulmaceae). Newly hatched nymphs ofP. cohabitansfeed next to nymphs of several species of leaf gall‐makers, becoming incorporated into the gall as the stationary nymphs are gradually enveloped by leaf tissue. In the mature gall, the inquilines occupy separate, lateral cells surrounding a central cell containing a single gall‐maker.Pachypsylla cohabitansis similar in morphology to leaf‐gallers, but differs in nymphal and adult colour, allozyme frequency, especially in the malic enzyme, and in adult phenology. Laboratory‐reared progeny of side‐cell females, when caged alone, never form galls, while progeny of centre‐cell individuals alone only form galls comprising single individuals. Multiple‐cell galls are formed only when adults of side‐cell and centre‐cell individuals are caged together. Experimental removal of centre‐cell nymphs in early stages of gall initiation leads to smaller galls or death of side‐cell individuals. We conclude that the side‐cell individual is an obligate inquiline that is incapable of forming a gall on its own but is derived from a leaf‐galling ancestor. We speculate on selective forces that might favour this evolutionary transition.
Phylogeny and biogeography of the extant species of triplespine fishes (Triacanthidae, Tetraodontiformes)
Authors: Santini Francesco , Tyler James C.
Published: March 2003

A new phylogenetic hypothesis for the living species of triplespine fishes of the Indo‐Western Pacific family Triacanthidae (Tetraodontiformes, Teleostei) is proposed. A data set of 55 morphological characters (34 osteological and 21 morphometric) was constructed. A cladistic analysis of the osteological data set yielded a single most‐parsimonious tree. This cladogram does not support the monophyly of one of the four genera, Tripodichthys, but Bremer values for this analysis are low. The osteological data set was then combined with a data set of 21 morphometric characters that had previously been used to diagnose the four genera. The analysis of the combined data set produced the same phylogenetic hypothesis, but with greater nodal support. The biogeographical distribution of the living species is then interpreted with the use of this new phylogenetic information.
Paediatric antiretroviral therapy audit in South London
Authors: Doerholt K , Sharland M , Ball C , DuMont G
Published: March 2003

Objectives To audit clinical and surrogate marker outcome data following the introduction of combination antiretroviral therapy to HIV‐infected children in South London.

Methods We performed a retrospective cohort study of 110 HIV‐infected children under the care of the Paediatric HIV in South London Network (PHILS‐NET) from January 1996 to September 1999. The following were identified: type of antiretroviral therapy used; duration of therapy; toxicity; impact on viral load and CD4 count; reasons for changing therapy; and clinical progression.

Results Ninety‐one (83%) of the 110 children (55 females; median age 6.3 years) received 166 antiretroviral therapy regimens. Sixty per cent of the regimens were triple therapy: either two nucleoside reverse transcriptase inhibitors (NRTIs) and one protease inhibitor (58; 34.9%) or two NRTIs and one non‐nucleoside reverse transcriptase inhibitor (39; 23.5%). The mean duration of completed therapy was 46 weeks for first line therapy with a standard deviation (SD) of 38 weeks and 40 weeks in third line therapy with an SD of 22 weeks. Changes in antiretroviral regimens were owing to virological failure in 60% and toxicity in 10%. Overall, 46% of children on first line and 37% on second line antiretroviral therapy achieved an undetectable viral load of < 400 HIV‐1 RNA copies/mL. Clinical progression for the whole cohort fell from 3.7% per year for children on dual therapy to 0.7% per year for children on highly active antiretroviral therapy.

Conclusions This audit shows the clinical benefit of antiretroviral therapy use in a cohort of children with moderately advanced HIV disease. The surrogate outcome data seen for the viral load and CD4 count are similar to those of reports from clinical trials. Antiretroviral therapy regimens were sequenced rapidly, mainly owing to virological failure.
Shared Governance within the market‐oriented health care system of New Zealand
Authors: Bamford A. , Porter‐O’Grady T.
Published: March 2003

Abstract

The New Zealand health reforms, announced in 1991 and implemented over the 3‐year period 1992–1994, were market‐oriented, following a competitive model that had been applied across New Zealand’s public sector. Consideration is given to the effects of the health reforms on nursing and midwifery at Capital Coast Health Limited (CCHL), with the introduction of a market/economic model of health care and its accompanying managerialism. The market model, or the economic era of health care, as some describe it, created an environment where nurses felt powerless. All the directors of nursing and on‐going hospital educational programs were disestablished in the public sector; nurses were disheartened, confused and lacked representation at senior management.

Integral to, and accompanying, corporatization is managerialism. With corporatization, came managers from the non‐health care sector who had no understanding of the complexities of health care. Accompanying managerialism is the notion that any able manager was capable of managing any agency, whether public or private.

Naturally, there was an underlying conflict between the caring relationships and their related work in the clinical environment, and the desire for efficiency and economy. It seemed that we were dealing with contrasting themes of ‘the market’ and ‘humanity’. This led to further confusion and disempowerment, as the dollar gained prominence, for nursing has always been grounded in the ‘humanities’.

It was into this environment, after 5 years of the health reforms, that a Nurse Executive was appointed and the concept of Shared Governance was introduced.

This article describes why Shared Governance was considered an appropriate model to introduce at CCHL, and identifies some of the tangible benefits being realized 18 months post implementation. Discovering that membership in cross‐organizational teams provides a mechanism for networking and creating a broader understanding of the organization has been but one of the major benefits.
From vision to reality: how to actualize the vision of discharging patients from a hospital, with an increased focus on prevention
Authors: Olsen L. , Wagner L.
Published: March 2003

Experiences in creating dialogue possibilities to stimulate interdisciplinary and intersectoral collaboration in hospital discharge and prevention are presented. Time is often a major constraint that persuades decision‐makers to avoid using qualitative methodologies in research and development. Quick results are demanded of today's health‐care system, not allowing ideas to be implemented or visions owned by professionals. Action‐orientated research is used and recommended, despite its time‐demanding methodology. A multidisciplinary management team and the authors, over a 2‐year period, worked with the development and implementation of ‘Preventive Discharge’ in a Danish hospital clinic. The empirical starting point, developmental processes, piloting and implementation of the project are described. Earlier research from a literature review on discharge is referenced. The results show that while there are many barriers to dialogue between professions and between organizational levels, it is possible to frame such opportunities and improve interdisciplinary and intersectoral collaboration for health. External supervision may be an effective tool for stimulating dialogue. The testing phase afforded a valuable lesson when pilot‐site collaborators, initially not involved in the development of the process tools, reformulated the project to suit their cultural climate while maintaining the project's original aims. Finally, a discussion is presented on actualizing the vision for ‘Preventive Discharge’.
Hasten slowly: a needs analysis for nurse and village health worker education in East Timor
Authors: McAuliffe A. V. , Grootjans J. , Fisher J. E. M.
Published: March 2003

Abstract

This article reports on a needs analysis undertaken to determine the educational needs of nurses and health workers in East Timor. The needs analysis, which used a theoretical framework described by Wass (1994), was conducted in both Australia and East Timor. It addressed the current health status of the East Timorese people and the educational requirements of East Timorese nurses and village health workers. Utilizing interviews, field observations and data from the World Health Organization and the United Nations, the following four categories of needs were assessed: felt; expressed; comparative; and normative. The findings document the almost complete destruction of the health infrastructure in East Timor and demonstrate the urgent need for assistance in the re‐establishment and enhancement of nursing and primary health care education programmes. A series of recommendations outlining nurse and village health care worker education programmes are proposed.
Assessing patients’ needs: does the same information guide expert and novice nurses?
Authors: Taylor C.
Published: March 2003

The difficulties experienced by nurses in assessing patients before providing care have been the subject of enquiry for many years. Much has been written about the nursing process and, in particular, the data‐collection component, where the nurse gathers information before deciding on a diagnosis and nursing intervention. There is, however, very little published on the differences between expert and novice nurses, in either the way they gather information or the emphasis placed on the different data sources accessed when preparing to carry out a nursing procedure. Communication between nurses is essential in the provision of safe, competent care, and yet we have minimal understanding of how experts use data sources to plan procedural care giving. This article reports on the findings of one component (the differences between expert and novice nurses in accessing data before implementing a nursing procedure) of a larger study into the identification of problem‐solving strategies adopted by nurses during procedural care giving. The study was conducted in clinical settings and used a qualitative research methodology of observation followed by an in‐depth semistructured interview. The study results indicate that expert and novice nurses accessed four similar information sources before meeting a patient. However, there were differences noted between the two groups in the amount of information accessed, as well as in the interpretation and use of that information. This is an important issue for nurse educators.
Inventing International Nursing: The first decade (1899–1910)
Authors: Lynaugh Joan E.
Published: March 2003

Below, a window is opend on some of the thoughts of ICN founders as they planned and worked at the turn of the 20th century and how they viewed themselves and nursing, based on a detailed written record of their first substantial discussions about broad nursing issues.
Usingphronesisinstead of ‘research‐based practice’ as the guiding light for nursing practice
Authors: Flaming Don
Published: March 2003

AbstractPhronesis, a popular Aristotelian concept that emphasizes deliberation and moral action, should replace the phrase ‘research‐based practice’ as the guiding light for nursing practice. Knowledge from research is still essential, of course, but is insufficient by itself for practice. In this paper, the author describes assumptions behind the apparent superiority of research‐based knowledge, and offers a critique of this position. One critique is that by automatically accepting the superiority of research‐based knowledge other types of knowledge (e.g. intuitive, ethical, personal) are devalued. A second critique is that undeliberated, indiscriminate use of research findings may lead to inappropriate nursing practice.Phronesisis then described, and its application to nursing. For example,phronesisrequires that the context of the situation be considered very carefully before acting. Aristotle stated that the goal of personalphronesisis to reacheudaimonia, or genuine happiness or ‘human flourishing’. Infusing nursing practice withphronesismeans that an anthropomorphized discipline'seudaimoniawould be theeudaimoniaof patients. That is, nursing practice would be guided by a desire for patients' genuine happiness or human flourishing. The final section of the paper offers rebuttals to potential criticisms.
Discourse analysis and the epidemiology of meaning
Authors: Allen David , Hardin Pamela K.
Published: March 2003

AbstractThis paper delineates a postmodern discourse analysis that is positioned within a semiotic theory of language. This theory of language foregrounds the performative aspects of language usage and provides the theoretical space from which to theorize the interrelationship between social organizations or structure and social agents or individuals. Our version of discourse analysis contends that social structure is enacted (production and reproduction) through the employment of various vocabularies: social structure is not something outside of, behind, or underneath these performances, and we argue that social organization is not produced by external structures operating upon or causing people to adopt certain behaviours. Rather, social structure is aneffectof taking up practices and reproducing and modifying them. From this perspective, individuals are constituted by being recruited into and reproducing discursive practices. Hence, by looking at the actualemploymentof language – its tactical, practice dimensions – one can avoid the usual binary of seeing the person aseitherthe autonomous origin of his or her experience or the ideological pawn of social determination. This methodology calls into question how the narratives or stories that individuals recount are imbricated within relational plays of power, and concomitantly, how subjects reauthorize their own positions. We assert that the methodological challenges of research addressing social injustice cannot be reduced to either: (i) interpersonal relationships between researcher and participants, or (ii) relegated to ‘social structures’ acting upon or outside of individuals.
A critical evaluation of the theory and practice of therapeutic touch
Authors: O'Mathúna Dónal P. , Pryjmachuk Steven , Spencer Wayne , Stanwick Michael , Matthiesen Stephen
Published: March 2003

AbstractIn this paper, the theory and practice of therapeutic touch (TT) is scrutinized from a number of perspectives. Firstly, the alleged close relationship between TT and Martha Rogers’ Science of Unitary Human Beings is evaluated. Secondly, the employment of the language of modern physics in Rogers’ theory and TT is critically examined. The authors then review the research literature on TT's efficacy, completing their critique by discussing the ethical issues involved in the practice of TT. As each of the perspectives considered reveals some concerns, the paper concludes that TT is a questionable intervention, underpinned by a very weak theoretical, clinical and research base.
Morphological investigation of chemical peel on photodamaged facial skin
Authors: El Samahy M.H. , Ghoz M.M. , Ramzy N.
Published: March 2003

Chemical peeling involves the topical application of a wounding agent with the goal of effecting an organized regeneration of the skin. The histological and ultrastructural features of actinic‐ and age‐related damage include structural abnormalities that disrupt normal epidermal and dermal architecture. In the present study, five patients with actinically damaged skin underwent an enhanced medium depth peel using 70% glycolic acid and 35% trichloroacetic acid. Biopsy specimens were taken before the peel, and 3 months after the peel for histological and electron microscopic examination. Clinical resolution of actinic damage corresponded with restoration of epidermal polarity. Characteristic histological and ultrastructural features of the skin after peeling include markedly decreased epidermal intracytoplasmic vacuoles, decreased elastic fibres, increased activated fibroblasts and organized parallel arrays of collagen fibrils. We conclude that electron microscopic studies after a medium depth peel of photodamaged skin reveal more profound changes than those seen histologically.
A study on the conditioning effects of natural shampoos using the scanning electron microscope*
Authors: Bellare J. , Iyer R. , Mainkar A.R. , Jolly C.I.
Published: March 2003

Synopsis

The scanning electron microscope (SEM) was successfully used to study the effects of toiletry treatment with shampoo on the microstructure of hair. This paper describes the use of SEM for comparing the conditioning effects of herbal shampoos.

Commercially available herbal shampoos are not completely natural, but contain herbal extracts in a synthetic detergent base, along with other chemical additives. Completely natural shampoos were formulated in the laboratory and their conditioning effects were evaluated by comparing with a commercially available herbal shampoo. The micrographs were studied quantitatively using ‘Image Analyser Software’ and the extent to which the hair scales were uplifted was measured. The results obtained from the quantitative comparison were in agreement with those obtained from other tests, such as protein loss determination.

The damage caused to the hair due to sodium lauryl sulphate was visible in the micrographs. The laboratory formulations were found to be better than the commercially available product. Thus, quantitative measurements from SEM micrographs are a valuable tool to compare the conditioning effects of hair care products.

Résumé

Le microscope electronique balayant (SEM) est appliqué avec succès a étudier les effets de traitments hygiéniques par shampooing sur le microstucture de cheveux. L’éxposé présent signale l’emploi de SEM a comparer l’effet conditionant des shampoing naturelle (herbacé).

Les shampooing herbal de commerce ne sont pas totalement naturelle mais contient extrait de herbe medicinale melangés avec une base de détergent synthetique et d’autres produits chimiques; donc shampooing totalement naturelle a eté formulés dans laboratoire et leurs effets conditionant evalués en comparant avec shampooing herbal (naturelle) de commerce. Les micrographs étaient étudiés quantitativement utilisant ‘Image Analyser Software’ en mesurant le degré de relèvement de écailes des cheveux. Les résultats obtenues par comparison quantitative sont en accord avec ceux obtenues par d’autres éprevues comme perte de protéine.

Le dommage causé aux cheveux par SLS est visible dans les micrographs. Les formulations de laboratoire étaient trouvés meilleurs en comparant avec les produits de commerce. Donc le measure quantitative des micrographs SEM est un outil valable a comparer les effets conditionant de produits hygienique pour cheveux.
Gestational weight gain and ‘maternal obesity’
Authors: Ellison George T. H. , Harris Helen E.
Published: March 2003

Summary There is an enduring belief, amongst mothers and obstetricians alike, that weight gain during pregnancy (i.e. ‘gestational weight gain’) increases the risk of permanent maternal weight gain (i.e. ‘maternal obesity’). In practice, such risks are only relevant to those mothers whose energy intake and/or energy expenditure place them in positive energy balance during pregnancy. For this reason, few studies from low‐income countries (except those amongst well‐nourished and predominantly sedentary populations) find evidence of ‘maternal obesity’. In contrast, a variety of cross‐sectional and longitudinal studies in high‐income countries suggest that pregnancy is accompanied by long‐term weight gain and an increased risk of ‘maternal’ obesity. Unfortunately, the results of all but four of these studies are compromised by the use of imprecise weight measurements, inadequate controls for potential confounding, and/or failure to account for increases in body weight with age. The four longitudinal analyses that did address these methodological concerns found that populations of women from Western European (Netherlands) and North American (United States) countries experience, on average, a net increase in body weight between conception and 1 year postpartum of 0.5 to 3.3kg (1.1 to 7.31b). These findings suggest that most well‐nourished women can expect to gain some weight in association with pregnancy, although it remains unclear whether this is wholly the result of weight gained during pregnancy (i.e. ‘gestational weight gain’) or partly reflects a pre‐pregnant and/or postpartum tendency to gain weight irrespective of pregnancy itself. In this regard, parental obesity and pre‐pregnant body weight are both associated with an increased risk of ‘maternal obesity’, as are inadequate social support, increased food intake and reduced activity during the postpartum period. Longitudinal analyses that record changes in body weight before, during and after pregnancy are therefore required to establish the role that gestational weight gain plays in ‘maternal obesity’.
Very low energy diets in the treatment of obesity
Authors: Mustajoki P. , Pekkarinen T.
Published: March 2003

Very low energy diets (VLEDs) are defined as diets which contain energy levels of less than 3.4 MJ (800 kcal) per day and contain daily allowances of all essential nutritional requirements. These diets have been in clinical use for more than 20 years. They are used as the only source of nutrition for 8–16 weeks, which usually achieves a weight loss of 1.5–2.5 kg per week. Before using this type of diet a medical investigation is necessary to evaluate contraindications and to check medication use during the diet. To facilitate maintenance, cognitive behavioural counselling should always be included in a weight reduction programme using a very low energy diet. VLEDs have no serious harmful effects and can safely be used in patients with various chronic diseases. Programmes using VLEDs produce better short‐term weight loss than programmes without the diet. However, in randomized controlled trials VLED‐based programmes have not achieved significantly better long‐term maintenance than conventional programmes. VLEDs are used when rapid weight loss is necessary because of an obesity‐related disease. In other patients with obesity it is an alternative to other conservative approaches for treatment of obesity. In type 2 diabetes it may improve long‐term glucose metabolism better than conventional weight reducing diets. Some studies suggest that after a VLED‐based programme long‐term maintenance is better among men than women. This possible gender difference is an important topic for further research.
The influence of obesity on hyperandrogenism and infertility in the female
Authors: Diamanti‐Kandarakis E. , Bergiele A.
Published: March 2003

Although a critical mass of adipose tissue is essential for the normal development of female reproductive function, obesity has been shown to produce menstrual disturbances and subfertility. The severity of obesity and the distribution of fat tissue are important factors that influence the female reproductive system. The pathogenetic mechanistic links between them aren’t clearly elucidated. Obese women, especially those with upper body obesity, have insulin resistance and hyperinsulinaemia, hyperandrogenaemia, increased peripheral aromatization of androgens to oestrogens, altered gonadotrophin secretion, decreased sex hormone binding globulin, decreased growth hormone (GH) and insulin like growth factor binding proteins (IGFBPs), increased leptin levels and altered neuroregulation of the hypothalamic‐pituitary‐gonadal axis. These have been considered as some of the links in the sequence of events of the disrupted ovulatory process. The mechanisms of these actions and their influence on female reproductive function are discussed below.
Mitochondrial uncoupling as a target for drug development for the treatment of obesity
Authors: Harper J. A. , Dickinson K. , Brand M. D.
Published: March 2003

Mitochondrial proton cycling is responsible for a significant proportion of basal or standard metabolic rate, so further uncoupling of mitochondria may be a good way to increase energy expenditure and represents a good pharmacological target for the treatment of obesity. Uncoupling by 2,4‐dinitrophenol has been used in this way in the past with notable success, and some of the effects of thyroid hormone treatment to induce weight loss may also be due to uncoupling. Diet can alter the pattern of phospholipid fatty acyl groups in the mitochondrial membrane, and this may be a route to uncoupling in vivo. Energy expenditure can be increased by stimulating the activity of uncoupling protein 1 (UCP1) in brown adipocytes either directly or through β3‐adrenoceptor agonists. UCP2 in a number of tissues, UCP3 in skeletal muscle and the adenine nucleotide translocase have also been proposed as possible drug targets. Specific uncoupling of muscle or brown adipocyte mitochondria remains an attractive target for the development of antiobesity drugs.
From instinct to intellect: the challenge of maintaining healthy weight in the modern world
Authors: Peters J. C. , Wyatt H. R. , Donahoo W. T. , Hill J. O.
Published: March 2003

The global obesity epidemic is being driven in large part by a mismatch between our environment and our metabolism. Human physiology developed to function within an environment where high levels of physical activity were needed in daily life and food was inconsistently available. For most of mankind’s history, physical activity has ‘pulled’ appetite so that the primary challenge to the physiological system for body weight control was to obtain sufficient energy intake to prevent negative energy balance and body energy loss. The current environment is characterized by a situation whereby minimal physical activity is required for daily life and food is abundant, inexpensive, high in energy density and widely available. Within this environment, food intake ‘pushes’ the system, and the challenge to the control system becomes to increase physical activity sufficiently to prevent positive energy balance. There does not appear to be a strong drive to increase physical activity in response to excess energy intake and there appears to be only a weak adaptive increase in resting energy expenditure in response to excess energy intake. In the modern world, the prevailing environment constitutes a constant background pressure that promotes weight gain. We propose that the modern environment has taken body weight control from an instinctual (unconscious) process to one that requires substantial cognitive effort. In the current environment, people who are not devoting substantial conscious effort to managing body weight are probably gaining weight. It is unlikely that we would be able to build the political will to undo our modern lifestyle, to change the environment back to one in which body weight control again becomes instinctual. In order to combat the growing epidemic we should focus our efforts on providing the knowledge, cognitive skills and incentives for controlling body weight and at the same time begin creating a supportive environment to allow better management of body weight.
Dietary fat plays a major role in obesity: no
Authors: Willett W. C.
Published: March 2003

The percentage of dietary energy from fat has been suggested to be an important determinant of body fat, and this presumed effect has been invoked to justify the general promotion of low‐fat diets. Dietary fat and the prevalence of obesity are lower in poor countries than in affluent countries. However, these contrasts are seriously confounded by differences in physical activity and food availability; within areas of similar economic development, per capita intake of fat and the prevalence of obesity have not been positively correlated. Randomized trials are the preferable method for evaluating the effect of dietary fat on adiposity because they avoid problems of confounding that are difficult to control in other studies. In short‐term trials, a small reduction in body weight is typically seen in individuals randomized to diets with a lower percentage of calories from fat. In a meta‐analysis of these trials, it was estimated that a decrease in 10% of energy from fat would reduce weight by 16 g d–1, which would correspond to a 9‐kg weight loss by 18 months. However, compensatory mechanisms appear to operate because in trials lasting one year or longer, fat consumption within the range of 18–40% of energy has consistently had little, if any, effect on body fatness. Moreover, within the United States (US), a substantial decline in the percentage of energy from fat during the last two decades has corresponded with a massive increase in obesity, and similar trends are occurring in other affluent countries. Diets high in fat do not account for the high prevalence of excess body fat in Western countries; reductions in the percentage of energy from fat will have no important benefits and could further exacerbate this problem. The emphasis on total fat reduction has been a serious distraction in efforts to control obesity and improve health in general.
Epidemiological study on obesity and its comorbidities in urban Chinese older than 20 years of age in Shanghai, China
Authors: Jia WP. , Xiang KS. , Chen L. , Lu Jx. , Wu YM.
Published: March 2003

The aim of this work was to establish the prevalence of overweight and obesity and its associated comorbidities in a Chinese population older than 20 years of age. A group of 2776 randomly selected adults (20–94 years of age) living in the Huayang Community in Shanghai, China, were investigated between 1998 and 2000. Body weight, height, waist and hip circumferences and blood pressure were measured, as were fasting blood glucose, fasting insulin and lipid profile, as well as blood glucose 2 h after a glucose load, and a 75‐g glucose tolerance test was performed. The prevalence of overweight was 29.5% and obesity was 4.3%, with a greater number of women being obese than men. More than one‐third of the population had abnormal lipid levels. Impaired glucose regulation (IGR) occurred in 10.8%; and 9.8% of the population were classified as having type 2 diabetes mellitus. Hypertension was present in 58.4% of this population. About 21% and 29.3% of the population suffered from high total cholesterol and high triglyceride, respectively. The prevalence of metabolic syndrome was 10.2%. The prevalence of diabetes, IGR and metabolic syndrome increased progressively in association with a body mass index (BMI) of >23 kg m−2. Hence, although the prevalence of obesity is low in this Chinese population, higher BMI and waist circumference values are clearly associated with an increasing prevalence of comorbidities. The absolute risk of having diabetes, IGR and metabolic syndrome is high in adults with a BMI of ≥23 kg m−2.