bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient narratives in the investigation and development of nursing practice expertise: a potential for transformation
Authors: Hardy Sally , Titchen Angie , Manley Kim
Published: February 2007

This paper is a review of the experiences gained whilst working with the ‘expertise in practice project’. The project was concerned with understanding the complex phenomenon of practitioners investigating and evaluating their own practice. The research intention was focused on making a difference to how those nurses practised, through introducing systematic practice‐based inquiry processes that could enable nurses to think more critically about their work and how their practice affects others. Particular attention is paid to the process of engaging people who use healthcare services, as research participants in the evaluation of nursing practice expertise. We outline how the project incorporated practitioners’ concerns about asking people who use health care services opinions on nursing practice expertise and how a process of discovery emerged that enabled transformation of practice and consideration of the patient‐participants’ role as a sophisticated evaluator of health‐care. As a result, we present a case for transformational qualitative research. Such research is values‐driven and uses inclusive, collaborative and facilitative processes. It contributes to human flourishing, not only through its ‘ends’ (i.e. research products) but also, intentionally, through its ‘means’ (e.g. research processes and stakeholder involvement). Thus, transformational research is complex and requires that researchers engage in reflexivity (deep self‐reflection) to examine and critique their personal values.
The persistence of memory: using narrative picturing to co‐operatively explore life stories in qualitative inquiry
Authors: Simpson Angela , Barker Phil
Published: February 2007

Narrative picturing is a creative interviewing technique that can be applied within qualitative research interviews with the aim of enhancing the ‘richness’ of narrative data. This paper describes briefly narrative picturing and its theoretical underpinnings. Whilst using this technique within a dedicated study of people with experience of self‐cutting, two key factors emerged in relation to advancing the use of narrative picturing. These were overcoming the inhibitions of the person interviewed and the exploration of personal meaning(s) disclosed during narrative picturing, which were commonly found to be particularly abstract or unprocessed. This paper suggests interviewing techniques aimed at overcoming these potential limitations. Once overcome, narrative picturing appeared to support the exploration and narration of more ‘in‐depth’ accounts of lived experience, enhancing understandings of both the person interviewed and the researcher.
Evaluating in political turmoil: nursing challenges in prevention programs
Authors: Laperrière Hélène
Published: February 2007

The concrete insertion of nurses into the context of an inquiry contributes to empirical evaluation research of health promotion programs. As interveners and concrete actors in social movements, nurses are in a privileged position to give realism to a local understanding of the political and cultural context of evaluative research. Drawing on the practice of empirical evaluation research, this paper seeks to generate new methodological approaches in a way that broadens nursing inquiries in community health nursing. It explores new ways of thinking about epistemology and knowledge production in nursing practice. For 5 months an evaluative research project adopting a participatory‐action research approach was conducted with local community actors in an AIDS prevention project in Amazonas (Brazil) in a prostitution setting. An auto‐ethnographic journal was used as a reflective approach for the critical analysis of nursing research activities. This paper calls for a closer relationship between scientific research settings and the sociopolitical and the sociocultural aspects of nursing practice. It increases an incorporation of popular, social and professional experiential learning and skill acquisition in embedded knowledge production.
Towards a framework for establishing rigour in a discourse analysis of midwifery professionalisation
Authors: Nixon Anne , Power Charmaine
Published: February 2007

This paper develops a framework for establishing rigour for a discourse analysis of professional transition in midwifery, theorised as a ‘female professional project’. Discourse analysis has gained recognition as a useful approach in nursing and midwifery research. It provides an alternative to those qualitative approaches that propose to reveal a ‘reality’ from the perspective of the individual experience, and that this lived experience can be directly represented in language. There are multiple discourse analytic approaches, and often researchers are not explicit about what type they are employing. Furthermore, to date there are few clear guidelines for what constitutes rigour in a discourse analytic study.

 Rigour in qualitative research broadly falls into two categories: the replication perspective that argues for the maintenance of criteria of validity and reliability, usually with an underpinning assumption (often unquestioned) that a ‘truth’ can be revealed. The second is the parallel perspective that questions the ontological and epistemological assumptions of the replication perspective and argues for the development of criteria that reflect the assumed questionable nature of truth and reality. Transferring these criteria to a discourse analytic study revealed some problems. A common challenge identified in achieving rigour in discourse analysis is the maintenance of congruity between the epistemological and ontological basis of a piece of research and the actual analysis conducted or reported. A framework is proposed to address these incongruities and includes six elements. As nurses and midwives increasingly employ discourse analysis in their research, attempts to clarify how rigour will be determined are important if the outcomes of such research are to be seriously considered for their implications for theory, policy and practice.
Inheritance pattern of chloroplast DNA is correlated with gamete types based on sex‐specific arrangement of the cell fusion site in Caulerpa (Ulvophyceae, Chlorophyta)
Authors: Miyamura Shinichi , Nagumo Tamotsu
Published: February 2007

Using field emission scanning electron microscopy (FE‐SEM) and fluorescence microscopy, the respective relationships between the arrangement of the gamete cell‐fusion site and the inheritance pattern of chloroplast DNA (cp‐DNA) were studied for Caulerpa brachypus Harvey, C. okamurae Weber‐van Bosse, C. racemosa (Forsskål) J. Agardh var. laete‐virens (Montagne) Weber‐van Bosse, and C. serrulata (Forsskål) J. Agardh var. serrulata f. lata (Weber‐van Bosse) Tseng. The eyespot of the biflagellate gamete was visualized using FE‐SEM. The female gamete, but not the male, has one eyespot on the cell body posterior. In most mating pairs, the female gamete is fused at the anterior left side of the eyespot and the male gamete at a cell surface that is perpendicular to the plane of the flagellar beat when both gametes are mixed. Then, the inheritance pattern of cp‐DNA was observed using fluorescence microscopy after staining with 4′6‐diamidino‐2‐phenylindole. Male and female gametes have one cell nucleus and one chloroplast each. Chloroplasts of the female gamete usually contain 1–11 spherical or rod‐shaped nucleoids. In contrast, nucleoids are not usually detected in the male gamete’s chloroplast. After mixing male and female gametes, the male gamete without nucleoids and female gametes with nucleoids are always associated at the lateral side and become planozygotes. Such a correlation between the arrangement of the cell fusion site and the inheritance pattern of cp‐DNA was found in another member of Caulerpales, Bryopsis maxima Okamura. These results suggest the possibility that the arrangement of the cell fusion site in the gamete is not determined randomly regardless of sex, but is rather correlated with specific mating types. The relation of these results to those for Chlamydomonas is discussed.
The use of vacuum‐assisted closure of abdominal wounds: a word of caution
Authors: Rao M. , Burke D. , Finan P. J. , Sagar P. M.
Published: February 2007

Objective  Vacuum‐assisted closure (VAC) has been used in our centre to aid the closure of abdominal wounds. The aim of this study was to examine the clinical outcome of patients in whom VAC therapy had been used in conjunction with laparostomy.

Method  All patients in whom VAC was used in the management of open abdominal wounds from November 2003 to March 2005 were included in this study.

Results  There were 29 patients in the study. Nineteen (65.5%) needed ICU care. Six (20%) patients developed leakage of small bowel contents into the abdominal wound cavity because of intestinal fistulation during the VAC therapy. Four of the six (66%) died, all from multi‐organ failure.

Conclusion  Our study has demonstrated a high incidence of intestinal leakage following VAC therapy. The reasons for this are multifactorial. We would recommend caution in using it on patients with bowel anastomoses or enterotomy repairs.
Expanding the Tension‐Reduction Model of Work Stress and Alcohol Use: Comparison of Managerial and Non‐Managerial Men and Women*
Authors: Moore Sarah , Sikora Patricia , Grunberg Leon , Greenberg Edward
Published: February 2007

abstract  The tension‐reduction model that links workplace stress to alcohol use and problems has received mixed support in previous investigations. Following recommendations that this model include moderated mediated relationships (Frone, 1999) using more specific forms of workplace stress, we examine the impact of gender ratio, generalized workplace abuse, and stereotype threat in an effort to predict alcohol use and problems particularly for managerial women. A total of 1410 (57 per cent response rate) employees completed a survey containing items on job stress, escapist reasons for drinking, and alcohol consumption and problems, and SEM analyses were conducted separately for managerial and non‐managerial men and women. Results revealed that: (a) these three workplace stressors were differentially related to general workplace stress for the four groups; and (b) the contributions of the three stressors and of general work stress to the alcohol‐related variables varied by group.
Elite Social Relations and Corporate Political Donations in Britain
Authors: Bond Matthew
Published: February 2007

Elite theory critiques of corporate political action rest on the claim that it advances the political interests of elite status groups. This article examines that claim by investigating the relationship between a British corporation's propensity to make donations to the Conservative party and its directors' educational backgrounds and social club affiliations. Using a structural equivalence blockmodel, it is shown that among the largest 250 British corporations in 1995 there was a set with directors who came from elite educational backgrounds and were members of elite social clubs. These corporations made a disproportionate number of donations. I argue that these results support the elite theory critique.
Rationalist and Constructivist Perspectives on Reputation
Authors: Sharman J. C.
Published: February 2007

This article argues for a new and broader understanding of reputation as a generally shared belief concerning a referent's character or nature, based on a range of information, associations and social cues. This is in place of the conventional rationalist definition of this concept as the degree to which an actor reliably upholds its commitments, based on a record of past behaviour. A brief literature review shows that this concept is crucial in underpinning a wide range of work in political science and economics premised on strategic interaction. The difference between a rationalist and constructivist understanding of reputation hinges on three points. Firstly, reputation is argued to be a relational concept rather than a property concept. Secondly, reputation is a social fact with an emergent, intersubjective quality, not just a collection of individual beliefs. Thirdly, rather than being an inductively derived objective record of past behaviour, reputation is based on associations, feelings and social cues. The last section of the article applies this broader conceptual understanding to two empirical examples: the importance of international organisations' reputation for their influence over policy-makers, and the way in which small states are classified as tax havens by a reputation test.
Together Forever? Explaining Exclusivity in Party—Firm Relations
Authors: McMenamin Iain , Schoenman Roger
Published: February 2007

Parties and firms are the key actors of representative democracy and capitalism, respectively, and the dynamic of attachment between them is a central feature of any political economy. This is the first article to analyse systematically the exclusivity of party–firm relations. We consider exclusivity at a point in time and exclusivity over time. Does a firm have a relationship with only one party at a given point in time, or is it close to more than one party? Does a firm maintain a relationship with only one party over time, or does it switch between parties? Most important, how do patterns of exclusivity impact on a firm's ability to lobby successfully? We propose a general theory, which explains patterns of party–firm relations by reference to the division of institutions and the type of party competition in a political system. A preliminary test of our theory with Polish survey data confirms our predictions, establishing a promising hypothesis for future research.
Degeneracy in the Maximum Likelihood Estimation of Univariate Gaussian Mixtures for Grouped Data and Behaviour of the EM Algorithm
Authors: BIERNACKI CHRISTOPHE
Published: February 2007

Abstract. In the context of the univariate Gaussian mixture with grouped data, it is shown that the global maximum of the likelihood may correspond to a situation where a Dirac lies in any non‐empty interval. Existence of a domain of attraction near such a maximizer is discussed and we establish that the expectation‐maximization (EM) iterates move extremely slowly inside this domain. These theoretical results are illustrated both by some Monte‐Carlo experiments and by a real data set. To help practitioners identify and discard these potentially dangerous degenerate maximizers, a specific stopping rule for EM is proposed.
Younger brother and fishing hook on Timor: reassessing Mauss on hierarchy and divinity
Authors: Hicks David
Published: February 2007

Marcel Mauss, in two of his most influential papers, proposed conflicting perspectives on the status relationship between gods and human beings. In an earlier study (1888), written in collaboration with Henri Hubert, he contended that the gifts given in ritual sacrifice by human beings to divinity are important, even necessary, for the existence of their gods. Hence the status relationship between the divine and human contains some degree of parity. In his later paper, ‘Essai sur le don’, however, Mauss emphasized the superiority of divinity, so much so that human beings were now decisively relegated to a condition of subordination. This article argues in support of Mauss's (and Hubert's) original thesis by adducing as evidence a set of five oral narratives from Timor that suggest human beings may in certain circumstances gain a measure of superiority over the divine, and demonstrates that in each narrative the agents by which this superiority is accomplished are the younger brother and a fishing hook or equivalent artefact which intrude from the quotidian world into the realm of spirit. Its findings suggest that recent propositions arguing for the interactive influence of material artefacts on human values are tenable and that the role of narrative as a medium of communication be reaffirmed as a prime forum for religious reflexivity.
Ethnography, art, and death
Authors: Irving Andrew
Published: February 2007

A problem facing anthropologists, given the centrality of memory and imagination to all social life, is how to access memory and the imaginary when there is no independent access to consciousness. Moreover, the discipline has ‘largely failed to distinguish itself’ in response to understanding HIV/AIDS (Annual Review of Anthropology30, 2001: 163). In response to these observations I would argue that orthodox approaches are limited and we need to create new forms of collaborative research and representation with regard to understanding experiences of illness. Accordingly this article attempts to bring to life the interior dialogue of persons living with HIV/AIDS through performance by ‘mapping’ the city of Kampala through its emotions and memories rather than buildings and streets.
Why India Lags Behind China and How It Can Bridge the Gap
Authors: Panagariya Arvind
Published: February 2007

Though India has been growing at six per cent annually since the late 1980s, it trails behind China, which has been growing at ten per cent per annum since 1981. The single most important factor explaining this difference is the relatively poor performance of Indian industry. Whereas the share of industry in China's GDP rose from 42 per cent in 1991 to 51 per cent in 2001, it remained virtually stagnant in India. By contrast, services grew rapidly in India, expanding from 42 per cent in 1991 to 48 per cent in 2001. With the information technology sector less than two per cent of the GDP, services growth was largely in the informal sector. Approximately 77 per cent of India's workers live in rural areas. To bring a large chunk of this workforce into the modern sector, India must achieve a much higher growth in the traditional, unskilled‐labour‐intensive industry. Growth in the information technology sector gives India an extra lever but cannot be the main engine of transformation. Therefore, the right approach is to walk on two legs: traditional labour‐intensive industry and the modern IT industry. Both legs need strengthening through further reforms. The paper suggests four specific reforms, three for industry and one for IT, necessary to achieve the transformation to a modern economy.
China's Environment: Problems and Policies
Authors: MacBean Alasdair
Published: February 2007

Historically, rapid growth has produced environmental destruction. China is no exception. Because of its huge and growing population, 20 years of over nine per cent per annum growth, a history of neglect and adverse geography, China faces crises. Floods devastate in the south while droughts afflict the north. One in three of China's rural people lacks safe drinking water. China suffers air pollution, deforestation, loss of grasslands, and species, erosion, encroaching desert, acid rain, dust storms that engulf cities such as Beijing and can carry far abroad. It has 16 of the 20 most polluted cities in the world. Environmental degradation grows and China's development is threatened by it. Water shortages have hit industries and factories have been shut by energy crises. The costs of cleaning up the environment will grow still greater if prompt and effective action is not taken. China's government recognises these problems and developed laws and institutions to protect the environment, but at grassroots level they fail to be implemented because local governments value short‐term gains in growth and jobs over a better environment. The international community can help, but only China can deal with the problems.
Foreign Direct Investment, Economic Performance and Trade Liberalisation
Authors: Greenaway David , Sapsford David , Pfaffenzeller Stephan
Published: February 2007

In a number of influential papers published by V. N. Balasubramanyam and collaborators during the decade of the 1990s, compelling arguments and supporting evidence was presented to indicate that export‐promoting trade and investment strategies attract more and more productive inflows of foreign capital than do import‐substituting strategies. This paper revisits these hypotheses in the context of more recent cross‐section data and reports evidence to suggest that the earlier findings are robust.
Student and Tutor Perceptions of the Role of the Tutor in a Sixth Form College
Authors: SCHOFIELD TONIA
Published: February 2007

This article aims to explore and understand tutor and student perceptions of the role of the tutor in a large Sixth Form College. It examines whether these perceptions are the same and looks at whether the needs of the student are being met within the college. The tutorial structure within the college is described and the unique role of tutors in a further education setting is identified. The findings reveal how students perceive the tutors to have a wide range of roles, which are primarily focused on supporting and promoting learning. It also describes how, despite the acknowledgement of students for the need of emotional support and the recognition and willingness of tutors to fulfil this role, there is a gap in meeting the students' needs. The reasons for this are explored and shown to be a consequence of time constraints and the underlying relationship between students and their tutor.
A Qualitative Evaluation of a Project to Enhance Pupils' Emotional Literacy Through a Student Assistance Programme
Authors: CARNWELL ROS , BAKER SALLY‐ANN
Published: February 2007

Recent policy highlights schools' responsibility for safeguarding children and promoting their health and welfare and addressing their emotional and behavioural needs. In doing so, it is anticipated that their emotional literacy and social competence might be enhanced. Recognizing that an increasing number of children exhibit emotional and behavioural difficulties affecting their learning, Wrexham Local Education Authority implemented a Student Assistance Programme (SAP). SAP offers primary prevention and early intervention to pupils who exhibit high‐risk behaviours and supports those whose circumstances affect their ability to engage with others at home and school, through participation in support groups. A study was conducted to evaluate the effectiveness of SAP. The study aimed to illuminate changes in student behaviour as described by themselves and facilitators, and to identify any wider implications of the SAP in terms of its effects on peers, teachers and family members. Using an interactive, responsive evaluation design, 11 focus group interviews were conducted involving 21 facilitators, seven head‐teachers and 64 children. Data were analysed using qualitative content analysis. The findings revealed benefits, challenges and issues of sustainability. This paper discusses the findings of the study and the implications for future sustainability.
Prospective Analysis of Factors Related to Migraine Attacks: The PAMINA Study
Authors: Wöber C , Brannath W , Schmidt K , Kapitan M , Rudel E , Wessely P , Wöber-Bingöl Ç
Published: February 2007

Migraine is related to numerous factors such as hormones, stress or nutrition, but information about their actual importance is limited. Therefore, we analysed prospectively a wide spectrum of factors related to headache in migraineurs. We examined 327 migraineurs recruited via newspapers who kept a comprehensive diary for 3 months. Statistical analysis comprising 28 325 patient days and 116 dichotomous variables was based on the interval between two successive headache attacks. We calculated univariate Cox regression analyses and included covariables with a P-value of <0.05 in two stepwise multivariate Cox regression analyses, the first accounting for a correlation of the event times within a subject, the second stratified by the number of headache-free intervals. We performed similar analyses for the occurrence of migraine attacks and for the persistence of headache and migraine. Menstruation had the most prominent effect, increasing the hazard of occurrence or persistence of headache and migraine by up to 96%. All other factors changed the hazard by <35%. The two days before menstruation and muscle tension in the neck, psychic tension, tiredness, noise and odours on days before headache onset increased the hazard of headache or migraine, whereas days off, a divorced marriage, relaxation after stress, and consumption of beer decreased the hazard. In addition, three meteorological factors increased and two others decreased the hazard. In conclusion, menstruation is most important in increasing the risk of occurrence and persistence of headache and migraine. Other factors increase the risk less markedly or decrease the risk.
Interoceptive sensitivity and physical effort: Implications for the self‐control of physical load in everyday life
Authors: Herbert Beate M. , Ulbrich Pamela , Schandry Rainer
Published: February 2007

This study examined the relationship between interoceptive sensitivity and the behavioral self‐regulation of physical load. According to their performance in a heartbeat detection task, 34 participants were classified as good or poor heartbeat perceivers. Participants pedaled on a bicycle ergometer for 15 min and were free to choose the tempo of their cycling. Good heartbeat perceivers covered a significantly shorter distance and showed a significantly smaller increase in mean heart rate, stroke volume, and cardiac output. There were significant negative correlations between heartbeat perception score and covered distance, changes in heart rate, changes in stroke volume, and changes in cardiac output. These results were not explained by differences in physical fitness level (PWC150). The findings suggest that good heartbeat perceivers show a more finely tuned behavioral self‐regulation of physical load than poor heartbeat perceivers.
Creating consumer satisfaction in maternity care: the neglected needs of migrants, asylum seekers and refugees
Authors: Jentsch Birgit , Durham Roberta , Hundley Vanora , Hussein Julia
Published: February 2007

An estimated 190 million people are now living outside their countries of birth or citizenship, and the rate of this migration is expected to remain high. The resulting growing cultural and ethnic diversity in societies adds specific challenges to the requirement of delivering public services such as health care to consumers. Globally, about half of the migrant population are women. Migrants’ outcomes of pregnancy are known to be poor, showing significant disparities when compared with those of native populations. Although these disparities have been noted, knowledge is limited regarding the availability and accessibility of healthcare services, as well as the acceptability of maternity care for women with experiences of free and forced migration. Healthcare research in general, and maternity care research specifically, have often neglected this population. This paper examines the existing international guidelines intended to address inequities in health outcomes, policies which have been introduced at national levels, and the widely used concepts of ‘patient‐centred’ and ‘woman‐centred’ health services. The ideals implicit in those guidelines and concepts are contrasted with the available evidence of many overseas nationals’ experiences with healthcare provisions in general, and maternity care in particular. This is followed by reflections on deficiencies in current studies and on those methodological problems which make research on maternity care for migrant women particularly challenging. The conclusion considers the appropriateness and relevance of guidelines currently promoting equity in maternity care and suggests a future agenda for priority research.
Flu: Past and Present
Authors: Dehner George
Published: February 2007

The interaction of humans and epidemic diseases is as old as the human story and the human population remains firmly linked with the natural world. In the twentieth century, influenza pandemics illustrate the impact of infectious diseases despite continuing efforts to safeguard the human population, and serve to illustrate the unintended effects of an interconnected world. The influenza virus – highly infectious and transmissible – is a disease that readily exploits global connections, and despite intense study on the virus and methods to protect the population, the virus remains a pandemic threat. Changing patterns of living arrangements, food production, commerce, and travel have created new opportunities for old and new pathogens alike. Human populations will continue to face challenges from infectious organisms for the foreseeable future.
Afghanistan Historiography and Pashtun Islam: Modernization Theory's Afterimage
Authors: Caron James M.
Published: February 2007

In contrast to major developments in general South Asian historiography, the historiography of modern Afghanistan has largely persisted as something of a scholarly throwback to the ‘modernization theory’ trend of the 1950s and 60s. The way Pashtun experiences of Islam have been treated in history writing draws heavily upon this larger modernization‐oriented thematic, which in turn has existed in a dialectic with journalistic and policy‐oriented writing. This article analyzes a number of scholarly works in which questions of Islam and social change in Pashtun polities form a major focus. The article focuses on works focusing on the pre‐1979 situation, which has been examined only perfunctorily in works of authors employing more current analytical techniques. The article identifies a number of appropriate thematic questions in existing work which could improve our understanding of the cultural history of pre‐1979 Islam in Pashtun areas of Afghanistan, and raises a few new questions worth investigating.
Reshaping British History: The Historiography of West Indians in Britain in the Twentieth Century
Authors: Rush Anne
Published: February 2007

Just after the Second World War, a group of migrants from the Caribbean arrived in Britain on a former troopship, theEmpire Windrush, heralding a significant post‐war migration of Commonwealth colonials to Britain. The arrival of West Indians in Britain after 1945 launched a complex and diverse historiography that not only took notice of the centuries‐long presence of people of colour in Britain, but has been vital to reshaping the way that historians understand the field of British history. This article traces the myriad paths of the historiography devoted to West Indians who lived in Britain in the twentieth century, looking at the work of scholars as they have explored West Indians in the context of the black diaspora, immigration, British national identity and culture, the British Empire and domestic decolonisation.
Hepatitis viruses: live and let die
Authors: Herzer K. , Sprinzl M. F. , Galle Peter R.
Published: February 2007

Viral hepatitis is a diffuse inflammatory reaction of the liver caused by hepatotropic viruses. Among the hepatitis viruses, only hepatitis B virus and hepatitis C virus are able to persist in the host and cause chronic hepatitis. In the course of persistent infection, inflammation forms the pathogenetic basis of chronic hepatitis that can lead to nodular fibrosis, which can progress to cirrhosis and, eventually, hepatocellular carcinoma (HCC). Of the different antiviral defense systems employed by the host, apoptosis significantly contributes to the prevention of viral replication, dissemination, and persistence. Pathomorphologic studies have shown acidophilic bodies and hepatocyte dropout, features that are compatible with apoptosis. The number of hepatocytes showing features of apoptosis in patients with chronic hepatitis B and C was found to be higher than in healthy subjects, indicating that apoptosis is involved in the pathogenesis of these diseases. There are various data suggesting that hepatitis B and C viral proteins may modulate apoptosis. Vice versa, mechanisms of apoptosis inhibition might represent central survival strategies employed by the virus which, in the end, may contribute to HCC development. While the expression and retention of viral proteins in hepatocytes may influence the severity and progression of liver disease, the mechanisms of liver injury in viral hepatitis are defined to be due not only to the direct cytopathic effects of viruses, but also to the host immune response to viral proteins expressed by infected hepatocytes. However, the exact role of these observations in relation to pathogenesis remains to be established. The mechanism and systems are complex. This report aims to provide an overview and intends to cite only a small number of pertinent references.
Endoscopic intraluminal brachytherapy and metal stent in malignant hilar biliary obstruction: a pilot study
Authors: Singh Virendra , Kapoor Rakesh , Solanki Kuldip Kumar , Singh Gurpreet , Verma Ganga Ram , Sharma Suresh C.
Published: February 2007

Background/Aims: Malignant hilar biliary obstruction carries a poor prognosis, as the disease is often unresectable at the time of diagnosis. Various palliative measures as surgical/radiological/ endoscopic drainage with or without radiotherapy/chemotherapy have been tried with dismal outcome. We prospectively studied the effect of unilateral metal stent with intraluminal high dose rate (HDR) brachytherapy in patients with type II malignant hilar biliary obstruction.

Methods: Eight patients with type II malignant hilar biliary obstruction were treated with contrast‐free unilateral metal stenting followed by endoscopic intraluminal brachytherapy (ILBT). A retrospectively analyzed group of 10 patients treated only with contrast‐free unilateral metal stenting served as historical controls.

Results: A successful drainage was achieved in all, cholangitis occurred in none and no patient died within 30 days in both groups. The mean (±SD) patency of metal stent was 305 (±183.96) days and 143.9(±115.11) days in patients with and without intraluminal brachytherapy, respectively (P=0.03). Mean (±SD) survival of these patients was 310 (±192.68) days and 154.9 (±122.51) days in patients with and without intraluminal brachytherapy, respectively (P=0.05). Kaplan–Meier analysis showed estimated median survival of 225 (95% CI; 169.5, 280.4) days in brachytherapy and 100 (95%CI; 94.1, 105.8) days in control group (P=0.025). No major complications related to metal stent or ILBT were observed.

Conclusions: Contrast‐free unilateral metal stenting with HDR ILBT in type II malignant hilar biliary obstruction is a safe and effective method of palliation and appears to prolong patient survival as well as patency of stent in these patients, however, a larger, randomized trial is required to validate the same.
Use of Capecitabine to Prevent Acute Renal Allograft Rejection in Dog Erythrocyte Antigen‐Mismatched Mongrel Dogs
Authors: MILOVANCEV MILAN , SCHMIEDT CHAD W. , BENTLEY ELLISON , SCHWAB MICHELLE , DUBIELZIG RICHARD R. , GENDRON‐FITZPATRICK ANNETTE P. , McANULTY JONATHAN F.
Published: February 2007

Objective— To assess efficacy and toxicity of a capecitabine (CAP)‐based regimen for preventing rejection of renal allografts in dog erythrocyte antigen (DEA)‐mismatched mongrel dogs.

Study Design— Prospective, pilot study.

Animals— Eight healthy, unrelated, DEA mismatched, adult mongrel dogs.

Methods— All dogs received CAP, starting at 50 mg/m2 PO b.i.d. 4 days preoperatively, increasing to 200 mg/m2 PO b.i.d. by the day of surgery. All dogs received cyclosporine‐A (CsA) and prednisolone starting 2 days preoperatively. Standard heterotopic renal transplantation with native nephrectomy was performed. After 90 days, surviving dogs were euthanatized and histopathologic examination was performed.

Results— Two of 8 dogs developed acute neurotoxicity leading to death or euthanasia within 5 days of surgery. For the 6 remaining dogs, there were no statistically significant changes in complete blood count or serum biochemical values. No opportunistic infections developed during the study period. Five of 6 dogs had no to minimal evidence of graft rejection. Two of 6 dogs developed superficial and pigmentary keratitis. Significant histopathologic findings in all dogs included mild lymphoplasmacytic gastroenteritis, steroid hepatopathy, and corneal epithelial thinning. One dog had moderate interstitial nephritis and pyelitis.

Conclusions— In this experimental model, a CAP–CsA–prednisolone immunosuppressive regimen was effective in preventing rejection of allografts in DEA‐mismatched dogs. Severe, unpredictable neurotoxicity and variable ocular toxicity significantly limit clinical applications at this time.

Clinical Relevance— A CAP–CsA–prednisolone protocol is an effective, oral immunosuppressive regimen for prevention of allograft rejection in DEA‐mismatched mongrel dogs. For clinical application, identification of patients susceptible to toxic side effects would be necessary.
Diagnostic stability and evolution of bipolar disorder in clinical practice: a prospective cohort study
Authors: Baca‐Garcia E. , Perez‐Rodriguez M. M. , Basurte‐Villamor I. , López‐Castromán J. , Fernandez del Moral A. L. , Jimenez‐Arriero M. A. , Gronzalez de Rivera J. L. , Saiz‐Ruiz J. , Leiva‐Murillo J. M. , De Prado‐Cumplido M. , Santiago‐Mozos R. , Artés‐Rodríguez A. , Oquendo M. A. , De Leon J.
Published: February 2007

Objective:  To evaluate the long‐term stability of International Classification of Diseases‐10th revision bipolar affective disorder (BD) in multiple settings.

Method:  A total of 34 368 patients received psychiatric care in the catchment area of a Spanish hospital (1992–2004). The analyzed sample included patients aged ≥18 years who were assessed on ≥10 occasions and received a diagnosis of BD at least once (n = 1153; 71 543 assessments). Prospective and retrospective consistencies and the proportion of subjects who received a BD diagnosis in ≥75% of assessments were calculated. Factors related to diagnostic shift were analyzed with traditional statistical methods and Markov's models.

Results:  Thirty per cent of patients received a BD diagnosis in the first assessment and 38% in the last assessment. Prospective and retrospective consistencies were 49% and 38%. Twenty‐three per cent of patients received a BD diagnosis during ≥75% of the assessments.

Conclusion:  There was a high prevalence of misdiagnosis and diagnostic shift from other psychiatric disorders to BD. Temporal consistency was lower than in other studies.
Effect of smoking on serum RANKL and OPG in sex, age and clinically matched supportive‐therapy periodontitis patients
Authors: Lappin David F. , Sherrabeh Sakhr , Jenkins William M. M. , Macpherson Lorna M. D.
Published: February 2007

Methods: The serum concentrations of receptor activator of nuclear factor κB ligand (RANKL) and osteoprotegerin (OPG) in age‐ and sex‐matched groups of smokers and non‐smokers with almost identical levels of periodontal disease were determined by an enzyme‐linked immunosorbent assay (ELISA).

We ensured that the 35 smokers were gender, age and clinically matched with a group of 35 non‐smokers (confirmed by cotinine immunoassay) from the same population of maintained patients with susceptibility to periodontitis.

Results: Cigarette smoker patients tended to have lower serum concentrations of RANKL and OPG than non‐smoker patients. While no statistically significant difference was observed for RANKL, there were significant differences in the median serum concentration of OPG (smokers 23.76 pM, non‐smokers 59.28 pM) and the ratio of serum concentrations of RANKL and OPG. Concentrations of OPG in the smoker patients also had a statistically significant negative correlation with tobacco consumption.

Conclusion: Bone loss in smoker‐related periodontitis patients may be partially explained by suppression of OPG production.
Invasive aspergillosis localised to the colon presenting as toxic megacolon
Authors: Mohite U. , Kell J. , Haj M. A. , O'Brien C. , Kundu S. , Rees J. , Burnett A. K.
Published: February 2007

Primary gut involvement by Aspergillus is an exceedingly rare and often a fatal complication of intensive chemotherapy in patients with acute leukaemia. We report a 46‐yr‐old patient with granulocytic sarcoma of the testis. He received acute myeloid leukaemia type treatment with ADE chemotherapy (Cytosine Arabinoside, Daunorubicin and Etoposide). While neutropenic he presented with pyrexia, abdominal pain and massive abdominal distention. He was treated with intravenous antibiotics and antifungals according to our usual institutional protocol without any response. He was found to have toxic megacolon on plain X‐ray and subsequently underwent total colectomy and ileostomy. The colon histology showed Aspergillus fungal hyphae infiltrating the bowel wall. There was no any evidence of pulmonary, hepatic, splenic or renal lesions on the computerised tomography scan. Following colectomy, he was treated with 2 wk of antifungal treatment. He recovered well and was discharged home. The increased awareness, high degree of clinical suspicion of unusual presentation and early surgical intervention with aggressive antifungal treatment, has a key role in the management of these rare and often fatal cases.
Prolonged survival of patients with angioimmunoblastic T‐cell lymphoma after high‐dose chemotherapy and autologous stem cell transplantation. The GELTAMO experience
Authors: Rodríguez José , Conde Eulogio , Gutiérrez Antonio , Arranz Reyes , Gandarillas Marcos , Leon Angel , Ojanguren Jesus , Sureda Anna , Carrera Dolores , Bendandi Mauricio , Moraleda Jose , Ribera Jose Maria , Albo Carmen , Morales Alfonso , García Juan Carlos , Fernández Pascual , Cañigral Guillermo , Bergua Juan , Caballero María Dolores ,   On behalf of the Grupo Español de Linfomas/Trasplante Autólogo de Médula Ósea (GEL‐TAMO – Spanish lymphoma/autologous bone marrow transplant study group)
Published: February 2007

Objectives:  Angioimmunoblastic T‐cell lymphoma (AIL) is a rare lymphoma with a poor prognosis and no standard treatment. Here, we report our experiences with 19 patients treated with high‐dose chemotherapy and autologous stem cell transplantation (HDC/ASCT) within the GELTAMO co‐operative group between 1992 and 2004.

Methods:  The median age at transplantation was 46 yr. Fifteen patients underwent the procedure as front‐line therapy and four patients as salvage therapy. Most patients received peripheral stem cells (90%) coupled with BEAM or BEAC as conditioning regimen (79%).

Results:  A 79% of patients achieved complete response, 5% partial response and 16% failed the procedure. After a median follow‐up of 25 months, eight patients died (seven of progressive disease and secondary neoplasia), while actuarial overall survival and progression‐free survival at 3 yr was 60% and 55%. Prognostic factors associated with a poor outcome included bone marrow involvement, transplantation in refractory disease state, attributing more than one factor of the age‐adjusted‐International Prognostic Index, Pretransplant peripheral T‐cell lymphoma (PTCL) Score or Prognostic Index for PTCL.

Conclusions:  More than half of the patients with AIL that display unfavourable prognostic factors at diagnosis or relapse would be expected to be alive and disease‐free after 3 yr when treated with HDC/ASCT. Patients who are transplanted in a refractory disease state do not benefit from this procedure.
‘Out of hours’ non‐contrast head CT scan interpretation by senior emergency department medical staff
Authors: Khoo Nee Chen , Duffy Martin
Published: February 2007

Objective:  To assess the accuracy of ‘out of hours’ (17.00–08.00 hours) non‐contrast head computed tomography (NCHCT) scan interpretation by senior ED medical staff.

Methods:  The study was undertaken in an inner‐city tertiary hospital in Sydney. A sample of 315 consecutive ‘out of hours’ NCHCT scans was compiled from a log book in the Medical Imaging Department and randomized into 21 sets of 15 scans. The scans were reviewed by emergency physicians and registrars recruited for the study and their interpretations were compared with the formal radiologist report.

Results:  Seven emergency physicians and 14 registrars took part in the study. Two hundred and eighty‐seven ED interpretations were used in the 2 × 2 table analysis. The overall observed agreement was 0.67 (95% confidence interval [CI] 0.61–0.72), sensitivity 0.57 (95% CI 0.45–0.69), specificity 0.70 (95% CI 0.64–0.76) and kappa 0.24 (95% CI 0.13–0.36). There were 32 false negative interpretations including three small contre coup contusions and three subdural haemorrhages.

Conclusion:  ‘Out of hours’ NCHCT scan interpretation by senior ED medical staff is only correct two‐thirds of the time. Further education for all senior ED staff is indicated to improve our accuracy. The safety of NCHCT scan interpretation by senior ED medical staff needs further study.
Emergency department staff can effectively resuscitate in level C personal protective equipment
Authors: Udayasiri Ruwangi , Knott Jonathan , McD Taylor David , Papson Jonathan , Leow Fiona , Hassan Fariza A
Published: February 2007

Objective:  ED staff are expected to perform resuscitation of trauma victims of chemical, biological and radiation incidents while wearing level C personal protective equipment (PPE). The present project assessed the subjective discomfort, physiological impact and performance of staff wearing PPE.

Methods:  A paired intervention study of ED staff in a resuscitation scenario comparing task performance wearing gown and gloves with PPE. Data were collected using a structured self‐administered questionnaire and by objective and subjective measurements.

Results:  Seven ED doctors and 11 ED nurses were enrolled. Nine had previous PPE training although only one had used PPE clinically. Overall, ED staff felt that PPE did not affect their ability to perform trauma resuscitation. For individual tasks, staff felt that PPE impaired assessment of pulse, i.v. cannulation, i.v. line attachment, use of a mini‐jet, bag and mask ventilation, and communication. However, the only objective difference in task performance was time to control haemorrhage (increase from 38 to 47 s, P = 0.02). PPE was well tolerated, with minimal physiological or psychological impact. Staff wore PPE for a median of 37 min (interquartile range: 33–38) and estimated that PPE could be worn for a further 30 min if required.

Conclusions:  ED staff are able to perform resuscitation procedures in PPE without adverse physiological effects or impact on performance. Subjective concerns regarding task performance were not reflected in objective measurements. This might indicate that appropriate training and feedback could reduce the negative impression associated with activities undertaken while wearing PPE.
Emergency department deaths despite active management: Experience from a tertiary care centre in a low‐income country
Authors: Khan Nadeem U , Razzak Junaid A , Alam Syed MH , Ahmad Humaid
Published: February 2007

Objective:  To determine the frequency and causes of ED deaths despite active management, in a tertiary care centre of a low‐income country.

Methods:  We conducted a retrospective chart review over a 2 year period (January 2001–December 2002) for all patients who died despite active management in an ED in Karachi, Pakistan.

Results:  Of the 78 418 patient visits, 601 patients (0.7%) were pronounced dead. Of these, 577 patients had complete records. Seventy per cent of these were dead‐on‐arrival, 1% had do‐not‐resuscitate orders and 29% (n = 166; 95% confidence interval [CI] 25–32%) died despite active management. Initial vital signs were found to be abnormal in almost all cases (98%). The leading causes of death were sepsis (23%; 95% CI 19–26%), myocardial infarction (19.7%; 95% CI 16–22%), cerebrovascular accident (10.7%; 95% CI 8–13%) and pneumonia (8.2%; 95% CI 6–10%) among adults and sepsis (36.4%; 95% CI 32–40%), myocarditis (15.9%; 95% CI 13–18%) and pneumonia (9.1%; 95% CI 6–11%) among children.

Conclusion:  Sepsis is the leading cause of death in patients of all age groups in the ED of this hospital.