bluuebunny/crossref_metadata_2025 huggingface dataset:
Analysis of the blennioid assemblages associated with different rocky shore habitats in the Ligurian Sea
Authors: La Mesa G. , Vacchi M.
Published: May 2005

The differences among blennioid assemblages (families Blenniidae and Tripterygiidae) on different habitats were assessed at two localities of the Ligurian Sea, namely Arenzano and Riva Trigoso. The assemblage composition and species relative density were evaluated visually on four different habitats of diverse wave exposure and substratum orientation (macro‐habitat characteristics): two vertical intertidal and subtidal habitats (exposed and sheltered rockwalls) and two horizontal subtidal habitats (semi‐exposed flat rock and boulders and pebbles). Each habitat was also characterized in relation to micro‐habitat features, such as substratum complexity, heterogeneity and amount of algae cover. Patterns of differences among habitats in assemblage variables and fish density, and the influences of macro‐ and micro‐habitat features on these patterns were studied at small (within localities) and large (across localities) spatial scales. Higher values of species richness (S), diversity and evenness (J) were generally associated with vertical habitats, as a result of a positive correlation with substratum orientation. The presence of an intertidal zone in the rockwall habitats may partially explain the observed differences in assemblage variables between vertical and horizontal habitats. The strength of relationships between S, and J and the other investigated habitat variables (exposure, complexity, heterogeneity and algae cover) varied greatly depending on spatial scale. All these relationships were positive, except for complexity. Significant variation in the assemblage total density among habitats was recorded only at Arenzano, where a larger number of fishes were counted on rockwalls rather than on the horizontal habitats. The positive effect of orientation on fish total density was strictly dependent on spatial scale. Fish total density showed a negative correlation with complexity and a positive correlation with heterogeneity, both relationships being unaffected by spatial scale. The unexpected relationship with complexity was probably due to the fact that, in the most complex habitat (i.e. boulder and pebbles), the potential positive effect of high complexity on fish density might be overcome by the negative influence of other environmental features, such as horizontal orientation and low wave exposure. Complexity and heterogeneity thus seemed good predictors of fish total density, but their role needs to be carefully interpreted. The most marked differences in species composition and relative density were found between rockwalls and the other habitats, mostly due to an unbalanced distribution of some stenoecious species. Variations in species relative density were related to different combinations of both macro‐ and micro‐habitat features, and these relationships usually changed depending on spatial scale.
Intestinal epithelium in Anarhichas lupus L., with emphasis on cell renewal
Authors: Hellberg H. , Bjerkås I.
Published: May 2005

Histomorphological studies on the dynamics of intestinal epithelium in larvae, juveniles and adult stages of common wolffish Anarhichas lupus showed that the major structural development took place during the first 8 weeks after hatching (c. 320 day degrees). This development preceeded a period of increase in relative growth. The mucosa of the proximal and distal intestine gradually developed from simple primary mucosal folds into a complex structure of primary and secondary folds with regularly distributed crypts. Cell proliferation, based on the observations of the presence of immature cells, mitotic figures and proliferating cell nuclear antigen reacting cells, was limited to the crypts after 8 weeks of age. The observation of bands of epithelial cells showing apoptotic and necrotic changes, suggested the existence of extrusion zones, where effete cells were eliminated by both shedding and phagocytosis. In the proximal intestine of adult common wolffish, increasing amounts of lipids were observed from the upper part of the crypts to the surface epithelium, probably reflecting an increased maturation of epithelial cells.
Changes in reproductive physiology and behaviour over the nesting cycle in male three‐spined sticklebacks
Authors: Páll M. K. , Hellqvist A. , Schmitz M. , Olsson P.‐E. , Mayer I. , Borg B.
Published: May 2005

Plasma 11‐Ketotestosterone (11 KT) and testosterone (T) levels and spiggin‐mRNA levels, as well as the kidney‐somatic index (IK) were measured in sexual males and in paternal males at the middle (5 days paternal) and at the end (8 days paternal with hatched eggs) of the nesting cycle in three‐spined sticklebacksGasterosteus aculeatusfrom two populations. Glueing (using threads of 11 KT induced kidney‐protein spiggin) and fanning behaviour was measured daily. Fanning increased in paternal fish and remained low in sexual males. Plasma 11 KT and T levels, on the other hand, declined significantly in parental compared to sexual males as did spiggin expression,IKand glueing behaviour. Thus, the drastic decrease in circulating 11 KT levels during the later parental phase may have resulted in an energy‐saving decrease in spiggin‐production and glueing, when this was no longer needed for nest maintenance. In addition, the mRNA levels of the β‐subunits of both gonadotropins, luteinising hormone (LH) and follicle stimulating hormone (FSH) were measured. The expression of both gonadotropins declined in the parental phase (not significant for β‐FSH in one of the populations) which was consistent with a decline in androgen levels possibly controlledviadecreased gonadotropin secretion.
Skin structure in six dragonet species (Gobiesociformes; Callionymidae): interspecific differences in glandular cell types and mucus secretion
Authors: Sadovy Y. , Randall J. E. , Rasotto M. B.
Published: May 2005

A comparative histological and histochemical study on the skin structure of six dragonet species, Synchiropus splendidus, Synchiropus picturatus, Synchiropus ocellatus, Repomucenus richardsonii, Callionymus decoratus and Callionymus risso showed that the epidermis of all species was rich in mucous cells (globlet cells), varying in distribution and elaboration among species. A second, distinctive, cell type, the sacciform cell, was also found in S. splendidus and S. picturatus. The secretions of these two cell types probably serve several functions, including those related to predation and the close contact that these species have with the substratum. The differences in type, elaboration and distribution of the cells suggested a pattern among the six callionymid species, in relation to habitat and body colouration differences.
Relationship between flow regime and fish abundances in a gravel‐bed river, New Zealand
Authors: Jowett I. G. , Richardson J. , Bonnett M. L.
Published: May 2005

The key elements of the flow regime of the Waipara River on the east coast of New Zealand, that affected fish abundances were the timing of floods and the magnitude and duration of low flows. Generally, fish abundances were highest in early summer, and lowest at the beginning of winter. Spring floods opened the river mouth, allowing recruitment of diadromous fish species, and non‐diadromous fish species spawned after the floods in spring or early summer. Reductions in fish abundances over summer and autumn were consistent with the magnitude and duration of low flows, with significant reductions in the year of lowest flow and little change in abundance in the year when low flows were highest. Variations in fish abundances during periods of low flow were consistent with the amount of instream habitat available, such that abundances of species with high velocity preferences decreased during periods of low flow, whereas abundances of species with low velocity preferences increased.
Long‐term patterns in growth of Oneida Lake walleye: a multivariate and stage‐explicit approach for applying the von Bertalanffy growth function
Authors: He J. X. , Rudstam L. G. , Forney J. L. , VanDeValk A. J. , Stewart D. J.
Published: May 2005

Total length (LT) and its inter annual variation of walleye Sander vitreus from Oneida Lake, New York, based on 51 years (1950–2000) of data for ages 1 to 7 years were analysed. Growth increased over time at young ages, did not change at intermediate ages and decreased at old ages. Total length at age increased over time to age 4 or 5 years, but was stable at older ages. Principle component analysis was used to study the pattern of variations in annual LT increments among years. More than 92 and 91% of inter annual variability in growth was described by the first three principal components for males and females, respectively. The first principal component was a general indicator of annual growth at all ages, but was dominated by annual growth at intermediate ages. The second and third principal components represented contrasts among yearling LT, yearling growth and growth at older ages. Therefore, changes in the three stage‐specific parameters, yearling LT, yearling growth and asymptotic LT, explained most of the variance in observed growth. Using these three stage‐specific parameters for the von Bertalanffy growth function facilitated interpretations of growth comparisons.
Determination of body shape variation in Irish hatchery‐reared and wild Atlantic salmon
Authors: Von Cramon‐Taubadel N. , Ling E. N. , Cotter D. , Wilkins N. P.
Published: May 2005

Discriminant function analysis was used to distinguish morphologically between samples of parr, smolts and adult Atlantic salmon Salmo salar from several hatchery and river systems in Ireland. The effect of habitat shift was investigated in Atlantic salmon parr. Parr grown from the eyed‐egg stage with a non‐sibling group in a hatchery environment, came to resemble the mean body shape of their host hatchery Atlantic salmon stock more closely than that of a full sibling group grown at their natal hatchery. Wild Atlantic salmon smolts differed in shape from hatchery‐reared smolts. This difference was less pronounced, but still statistically significant when wild adults were compared with hatchery‐reared adults captured in the coastal drift‐net fishery after a year spent at sea. Rearing conditions had a significant impact on the production and growth of fish body shape. This in turn may have affected adaptability and survivorship of ranched Atlantic salmon in the marine environment.
Synovitis in a murine model of human factor VIII deficiency
Authors: Hakobyan N. , Kazarian T. , Valentino L. A.
Published: May 2005

Summary.  Recurrent joint bleeding is the most common musculoskeletal manifestation of haemophilia and leads to a target joint and synovitis. The pathobiology of haemophilic synovitis (HS) is not well understood. Here the histopathological changes that occur following haemarthrosis were examined in an animal model for human HS. After two haemarthrosis, there was soft tissue and joint swelling and histological changes of acute synovitis included infiltration of the sub‐synovial layer by mononuclear cells and neutrophils, thickening of the synovial membrane with villus formation, and hyperplasia of blood vessels. Subacute changes were evident after three haemarthrosis; muscle atrophy was present and an intense mononuclear cell infiltrate filled the sub‐synovial space. There was destruction of articular surfaces and loss of cartilage. Seventeen months after three haemarthrosis, chronic joint changes included gross deformity and loss of congruence due to dense fibrotic tissue filling the joint space. The mononuclear inflammatory cell infiltrate and thickened synovial membrane persisted. Pits and erosions of articular surfaces and sub‐chondral cysts were present. There was fibro‐cartilage and new bone formation. This model of human HS should be useful to fully evaluate the biochemical and molecular changes that occur following joint bleeding and to test novel therapeutics to prevent HS.
Knee and hip arthroplasty infection rates in persons with haemophilia: a 27 year single center experience during the HIV epidemic
Authors: Powell D. L. , Whitener C. J. , Dye C. E. , Ballard J. O. , Shaffer M. L. , Eyster M. E.
Published: May 2005

Summary.  Total joint replacement (TJR) is an option for the management of chronic haemophilic arthropathy. Because surgery is technically challenging, there is a high rate of deep prosthetic infections, particularly in human immunodeficiency virus (HIV)‐infected individuals. We determined the incidence of deep infection rates following total knee and hip arthroplasties in HIV‐seropositive and HIV‐seronegative persons with haemophilia. Fifty‐one primary joint replacements were performed on 32 patients seen at a regional comprehensive haemophilia care center from 1975 to 2002. Thirty prostheses were placed in patients who were HIV‐seropositive prior to surgery (n = 14) or seroconverted later (n = 16). Median age at the time of surgery was 33 years (range: 20–61) among 19 HIV‐seropositive patients and 35 years (range: 26–74) among 13 HIV‐negative patients. Median duration of follow‐up was 83 months (range: 2–323). Rate of primary joint infection per artificial joint‐year by HIV status was compared by Poisson regression. Main outcome measures were the incidence of primary replacement joint infections by HIV status. Deep infections developed in five (9.8%) of 51 replacement joints. There were two infections during 204.15 joint‐years without HIV infection and three infections during 205.28 joint‐years with HIV infection. The incidence rate of joint infection (0.98 vs. 1.46 per 100 joint‐years) was not increased with HIV (relative risk, RR: 1.49, 95% CI: 0.25–8.93, P = 0.66). We conclude that HIV infection is not a contraindication to knee or hip replacement arthroplasty in the appropriate clinical setting.
Hepatitis C infection among Dutch haemophilia patients: a nationwide cross‐sectional study of prevalence and antiviral treatment
Authors: Posthouwer D. , Plug I. , Van Der Bom J. G. , Fischer K. , Rosendaal F. R. , Mauser‐Bunschoten E. P.
Published: May 2005

Summary. Hepatitis C is a major co‐morbidity among patients with haemophilia who received inadequately or non‐virus‐inactivated clotting factor concentrates before 1992. The objectives of this study were to investigate the prevalence of hepatitis C and the use of antiviral therapies during the last decade among patients with haemophilia in the Netherlands. We performed a cross‐sectional study and a questionnaire was sent to all 1519 patients known with haemophilia in the Netherlands between 2001 and 2002. The study population for the present study consisted of 771 patients who had received clotting factor products before 1992 of whom 638 reported their hepatitis C status. In total, 441 of the 638 (68%) patients ever had a positive test for hepatitis C virus (HCV); 344 patients (54%) had a current infection, and 97 (15%) had cleared the virus. Among 344 patients currently HCV infected, 111 (32%) had received treatment for hepatitis C, while 34% (33/97) of patients with an infection in the past had been treated for hepatitis C. In 2002 the prevalence of hepatitis C among patients with haemophilia who received clotting factor products before 1992 was 54%. The majority of patients with a current HCV infection had not been treated with antiviral therapy.
Pulmonary embolism in a patient with severe congenital deficiency for factor V during treatment with fresh frozen plasma
Authors: García‐Noblejas A. , Osorio S. , Durán A. I. , Córdoba R. , Nistal S. , Aguado B. , Loscertales J. , Gómez N.
Published: May 2005

Summary.  Thrombosis is a rare complication in patients with congenital clotting factor deficiencies. In most cases, it is related to inherited procoagulant factors, use of central venous catheters or administration of coagulation factor concentrates. There are only a few case reports about thrombotic events during treatment with fresh frozen plasma (FFP). We report the case of a patient with homozygous inherited factor V deficiency, who developed a pulmonary embolism at a time of treatment with methylene blue treated FFP (MBFFP). The patient had only two other factors predisposing to thrombosis and both were acquired: obesity and bed rest. He started anticoagulant treatment with low molecular weight heparin (LMWH) while the deficient factors were replaced with MBFFP. After 8 days of treatment the patient developed a severe respiratory insufficiency. Pulmonary haemorrhage was considered among the differential diagnosis and LMWH was stopped. An inferior vena cava filter was placed without any further thrombotic complications. To our knowledge, there are no reports about patients with clotting factor deficiencies who developed a thrombotic event during treatment with MBFFP.
Reliability of progressive and additive MRI scoring systems for evaluation of haemophilic arthropathy in children: Expert MRI Working Group of the International Prophylaxis Study Group
Authors: Doria A. S. , Lundin B. , Kilcoyne R. F. , Babyn P. S. , Miller S. , Nuss R. , Rivard G. , Stephens D. , Pettersson H.
Published: May 2005

Summary.  Effective treatment of haemophilic arthropathy requires a detailed evaluation of joint integrity. Methodological assessment of magnetic resonance imaging (MRI) scores are needed to assure reproducibility of measurements when comparing results of clinical trials conducted in different centres. We compared the reliability of two MRI scoring systems for assessment of haemophilic arthropathy: one progressive system that displays the most severe change and one additive system that depicts osteochondral and soft tissue‐related changes. A total of 47 1.5 T MRI examinations of knees (n = 21) and ankles (n = 26) of 42 haemophilic boys, age range, 22 months to 18 years, performed at different centres (Toronto, n = 20, Europe, n = 12 and Denver, n = 15) were independently reviewed by four radiologists at two occasions. Twenty‐two examinations were from children <9 years and 25 from children ≥9. Sagittal and coronal gradient‐echo (MPGR, 3D FLASH with fat saturation, GRASS) images were obtained. The MRI examinations of the ankle and knee studies presented with osteochondral abnormalities in 38.5% and 23.8% of the cases respectively. The two scoring systems demonstrated an excellent inter‐reader [progressive, 0.88; additive (A, e, s and h components), 0.86] and intra‐reader [progressive, 0.92; additive (A, e, s and h components), 0.93] reliability using intraclass correlation coefficients (ICCs). Although ICCs were slightly higher for knees when compared with ankles, and for older children when compared with younger children, all values fell within excellent inter‐ and intra‐reader reliability categories. The two MRI scoring systems demonstrated a comparable reliability. This result constitutes the basis for further development of a combined MRI scoring system for assessment of haemophilic arthropathy, which incorporates progressive and additive components.
A cost minimization model for the treatment of minor bleeding episodes in patients with haemophilia A and high‐titre inhibitors
Authors: Putnam K. G. , Bohn R. L. , Ewenstein B. M. , Winkelmayer W. C. , Avorn J.
Published: May 2005

Summary. Treatment of acute bleeding episodes in patients with haemophilia A and inhibitory antibodies to factor VIII (FVIII) most often involves the use of bypassing haemostatic agents, such as activated prothrombin complex concentrates (aPCC) or recombinant factor VIIa (rFVIIa). We constructed a cost minimization model to compare the costs of initial treatment with aPCC vs. rFVIIa in the home treatment of minor bleeding episodes. We developed a clinical scenario describing such a case and presented it to a panel of US haemophilia specialists. For each product class, we asked panellists to provide dosing regimens required to achieve complete resolution of a minor haemarthrosis in a child with high‐titre inhibitors, and for the probabilities of success at two time points (8–12 and 24 h). Consensus among the panellists was refined by a second round of the process, and the median values resulting were used as inputs to a decision analysis model. Sensitivity analyses were conducted to determine threshold values for key variables. The base case model found that initial treatment with aPCC would result in a mean cost per episode of $21 000, compared with $33 400 for initial treatment with rFVIIa. Sensitivity analyses over a range of clinically plausible values for cost, dosing, and efficacy did not change the selection of aPCC as the dominant strategy.
Pressures generated in vitro during Stabident intraosseous injections
Authors: Whitworth J. M. , Ramlee R. A. M. , Meechan J. G.
Published: May 2005

Aim  To test the hypothesis that the Stabident intraosseous injection is a potentially high‐pressure technique, which carries serious risks of anaesthetic cartridge failure.

Methodology  A standard Astra dental syringe was modified to measure the internal pressure of local anaesthetic cartridges during injection. Intra‐cartridge pressures were measured at 1 s intervals during slow (approximately 15 s) and rapid (<10 s) injections of 2% Xylocaine with 1 : 80 000 adrenaline (0.25 cartridge volumes) into air (no tissue resistance), or into freshly prepared Stabident perforation sites in the anterior mandible of freshly culled young and old sheep (against tissue resistance). Each injection was repeated 10 times over 3 days. Absolute maximum pressures generated by each category of injection, mean pressures at 1 s intervals in each series of injections, and standard deviations were calculated. Curves of mean maximum intra‐cartridge pressure development with time were plotted for slow and rapid injections, and one‐way anova (P < 0.05) conducted to determine significant differences between categories of injection.

Results  Pressures created when injecting into air were less than those needed to inject into tissue (P < 0.001). Fast injection produced greater intra‐cartridge pressures than slow delivery (P < 0.05). Injection pressures rose more quickly and to higher levels in small, young sheep mandibles than in larger, old sheep mandibles. The absolute maximum intra‐cartridge pressure developed during the study was 3.31 MPa which is less than that needed to fracture glass cartridges.

Conclusions  Stabident intraosseous injection conducted in accordance with the manufacturer's instructions does not present a serious risk of dangerous pressure build‐up in local anaesthetic cartridges.
Collagenase‐3 (MMP‐13) is expressed in periapical lesions: an immunohistochemical study
Authors: Leonardi R. , Caltabiano R. , Loreto C.
Published: May 2005

Aim  To determine whether or not matrix metalloproteinase 13 (MMP‐13) is present in periapical granulomas with and without epithelium.

Methodology  Seventeen open periapical granulomas of pulpal origin (seven lesions without epithelium and 10 with proliferating epithelium) were fixed in formalin and then embedded in paraffin prior to being processed for immunohistochemical analysis. A monoclonal antibody against human MMP‐13 was used to evaluate MMP‐13 expression. Immunocomplexes were subsequently treated with the secondary antibody and then detected by means of streptavidin peroxidase. Immunoreactivity was visualized by development with 3,3′‐diaminobenzidine.

Results  An immunopositive cytoplasmatic reaction for MMP‐13 was observed in all the specimens, although the immunostaining by anti‐MMP‐13 antibody was heterogeneous and its levels varied according to histopathological findings. In periapical lesions without epithelium MMP‐13 immunolabelling was detected in a few fibroblast‐like cells, and in some plasma cells within the granulomatous tissue. A clear upregulation of MMP‐13 expression was detected in periapical lesions with epithelium, especially in small island and thin strands of epithelium.

Conclusions  The expression pattern of MMP‐13 demonstrates that it is involved in the conversion of a periapical granuloma with epithelium into a radicular cyst. This property is related to the ability of MMP‐13 to influence not only the migration of epithelial cell but also the invasion of granulomatous tissue.
The sealing ability of an epoxy resin root canal sealer after Nd:YAG laser irradiation of the root canal
Authors: Depraet F. J. H. W. , De Bruyne M. A. A. , De Moor R. J. G.
Published: May 2005

Aim  To evaluate ex vivo the effect of Nd:YAG laser irradiation with and without black ink on instrumented root canal walls, and the degree of both coronal and apical microleakage of filled root canals.

Methodology  Seventy‐two single‐rooted teeth were instrumented up to a size 40 K‐file, and then divided into six groups of 10 teeth: groups 1 and 4 remained unlased and acted as control groups, groups 2 and 5 were treated with a Nd:YAG laser (Fidelis Plus, Herzele, Belgium), groups 3 and 6 were treated with a laser and black ink; the remaining 12 teeth served as positive and negative controls. The laser was operated at 1.5 W, 15 Hz, four times for 5 s with a 20‐s interval. Groups 4–6 were filled using cold lateral condensation of gutta‐percha and AH26. After storage in water for 48 h at 37 °C, through‐and‐through leakage (L in μL day−1) was measured for 48 h under a pressure of 1.2 atm using a fluid transport model and recorded as L = 0 (L1), 0 < L ≤ 10 (L2), L > 10 (L3). After the assessment of leakage with the fluid transport model, the teeth were immersed in rhodamine B solution for 48 h at 37 °C. Apical and coronal dye leakage was scored after longitudinal splitting of these teeth. All teeth of groups 1–3 were split longitudinally and observed under SEM for evaluation of remaining smear layer.

Results  Through‐and‐through leakage was only observed in the group lased with black ink (two samples – L2). Apical and coronal dye leakage was observed in all groups; there were no statistically significant differences amongst the three experimental groups. The through‐and‐through leakage, measured with the fluid transport model in two teeth of group 6, was confirmed in the dye leakage test (rhodamine B dye was observed along the total length of the root filling). There was evidence of melted and ablated root canal dentine in the laser‐treated groups. These findings were more obvious in root canals lased in association with black ink. All apical foramina in the lased group remained patent.

Conclusions  Nd:YAG laser irradiation with black ink increased the amount of melted and ablated dentine areas compared with that without black ink. Nd:YAG lasing in association with black ink did not result in a reduction of either coronal or apical microleakage in root filled teeth.
SEM analysis of the integrity of resected root apices of cadaver and extracted teeth after ultrasonic root‐end preparation at different intensities
Authors: De Bruyne M. A. A. , De Moor R. J. G.
Published: May 2005

Aim  To compare the integrity of root apices of cadaver and extracted teeth after resection, ultrasonic root‐end cavity preparation at medium and low ultrasonic power settings and retrieval.

Methodology  Root canal treatment, perpendicular root‐end resection and root‐end preparation were performed on single‐rooted anterior and premolar teeth (49 teeth in situ in maxillary and mandibular jaws from cadavers and 45 extracted teeth). Apical root‐end cavities were prepared with the S12/90°D tip and the Suni‐Max ultrasonic unit (Satelec, Merignac, France) at the intensity prescribed by the manufacturer (power 7 at power mode S) (34 cadaver teeth, 30 extracted teeth) and at a lower intensity (power 4 at power mode S) (15 cadaver teeth, 15 extracted teeth). After ultrasonic preparation the cadaver teeth were retrieved from the jaws. Exaflex impressions (GC Corporation, Tokyo, Japan) were made of the root apices after resection, root‐end preparation and retrieval. These impressions were processed for SEM analysis, and the recordings evaluated for cracks and marginal chipping.

Results  In general, extracted teeth showed significantly more cracks and chipping than cadaver teeth. Lowering the ultrasonic power from medium to low intensity resulted in equal scores for cracks on extracted teeth and for chipping on cadaver teeth, in higher scores for cracks on cadavers and in lower scores for chipping on extracted teeth. Complete cracks and cracks originating from the root surface occurred only in extracted teeth.

Conclusions  The number of cracks and degree of chipping caused by ultrasonic root‐end preparation was higher on extracted teeth than on cadaver teeth. Lowering the ultrasonic power from medium to low intensity cannot be recommended as it resulted in more cracks and equal chipping on cadaver teeth. Investigation of techniques and materials should be conducted in situ and not on extracted teeth.
Whole systems working and acute inpatient psychiatry: an exploratory study
Authors: BOWLES N. , JONES A.
Published: May 2005

The concept of ‘whole system’ working is fundamental to contemporary policy and consequently to practice and service development within UK mental health services. This paper reports on an exploratory study of the meaning of the ‘whole system’ to staff working within adult mental health services in North Wales, conducted within a broader practice development project. A focus group was used to collect data from a multiprofessional group drawn from two acute inpatient wards, Community Mental Health Teams (CMHTs) and an assertive outreach team. Thematic analysis generated three themes central to effective whole system working in adult mental health services. Discussion on the efficacy of the whole system gave rise to an understanding that this whole system varies in its effectiveness in responding to people with differing clinical presentations. Furthermore, it appears that under certain circumstances, the whole system may work to shift responsibility in order to manage worker's anxiety more adroitly than, for example, working creatively to respond to people's needs. The paper concludes that whilst by no means exhaustive or complete, these three themes enable critical reflection, discussion and identification of practice development challenges that may facilitate more effective whole system working and better services in North Wales and possibly in other settings.
Adverse factors and the mental health of older people: implications for social policy and professional practice
Authors: CLARKE J.
Published: May 2005

Defining ‘older people’ as a homogenous group is problematic; it can lead to stereotypical and stigmatizing perceptions of what old age is, attracting consequent negative attitudes to later life. Nevertheless, evidence suggests that some in the older age bracket are subject to particular stressors and physical changes that can adversely affect their mental health. This paper will consider challenges to mental health in older age groups and particularly the phenomenon of dementia. The role and influence of diagnosis, social policy and professional practice will also be addressed and suggestions will be made as to how people could improve their responses to either the predisposition to or the actual occurrence of mental distress in later life. In addition, it is argued that person‐centredness is important as the caring/cultural medium through which provisions and policies are mediated: that obtaining appropriate balances between corporate and individual contributions and interventions must constitute the context wherein future developments lie.
The powers and duties of psychiatric nurses under the Mental Health Act 1983: a review of the statutory provisions in England and Wales
Authors: HOULIHAN G. D.
Published: May 2005

This paper examines the powers and duties that psychiatric nurses have under the Mental Health Act 1983 with respect to the care and treatment of mentally disordered people. This statute saw for the first time specific reference to the powers and duties of psychiatric nurses. These powers and duties are primarily concerned with the nurse's role in relation to consent to treatment, the administration of medication, the right to be consulted and to ensuring that detained patients are informed of their rights under the 1983 Act. The 1983 Act also provides and extends the powers of psychiatric nurses to detain certain inpatients with mental disorder against their will. In order to avoid the potential charges of ‘treatment without consent’ and ‘unlawful detention’, it is vital that psychiatric nurses, when caring for this client group, have a sound working knowledge of their powers and duties under current legislation. The legal definitions of mental disorder are explored as well as the issue of ‘treatabilty’ for mental disorder in clinical practice.
The Impact Message Inventory (IMI‐C): generalizability of patients’ command and relationship messages across psychiatric nurses
Authors: HAFKENSCHEID A.
Published: May 2005

This paper tests the hypothesis that patients’ stereotypical dysfunctional interpersonal communication styles would be validly measurable by the command or relationship messages experienced by psychiatric nurses while interacting with the patient in the relatively unstructured every day context of the psychiatric ward. The generalizability of interpersonal pressures exerted by patients was tested by having different psychiatric nurses independently appraise patients’ command or relationship messages with the Impact Message Inventory, circumplex version (IMI‐C). Generalizablity of interpersonal pressures strongly depended on the specific combination of psychiatric nurses. Out of eight classes of command or relationships three turned out to be generalizable across nurses: Dominance, Hostile‐Submissive and Friendly Dominance.
Work stress and physical assault of nursing aides in rural nursing homes with and without dementia special care units
Authors: MORGAN D. G. , STEWART N. J. , D’ARCY C. , FORBES D. , LAWSON J.
Published: May 2005

Purpose:  This study compared nursing aides (NAs) employed in rural nursing homes with and without dementia special care units (SCUs) on (1) exposure to and distress from disruptive behaviours exhibited by residents, (2) job strain and (3) physical assault.

Design and methods:  The data were drawn from a larger study conducted in Saskatchewan, Canada, in which all rural nursing homes of ≤ 100 beds that had an SCU were matched to same‐sized rural facilities with no SCU. Nursing aides (n = 355) completed a mailed survey questionnaire.

Results:  Nursing aides employed in nursing homes with an SCU reported significantly less frequent exposure to disruptive behaviours (including aggressive and aversive behaviours) than NAs in non‐SCU facilities, less distress when these behaviours were directed toward them, less exposure to aggressive behaviour during caregiving, lower job demands and lower job strain. There was a trend toward increased risk of being assaulted in the last year associated with being in a non‐SCU facility. Having a permanent position, increased job strain, and feeling inadequately prepared for dementia care were significantly associated with higher risk of being assaulted. In the SCU facilities, NAs who worked more time on the SCU reported more assaults but less distress from disruptive behaviour, lower psychological job demands, lower job strain and greater work autonomy.

Implications:  Providing more dementia care training and reducing job demands and job strain may help to reduce work‐related stress and physical assault of nursing aides employed in nursing homes.
An exploration of the decision‐making processes at the point of referral to an Admiral Nurse team
Authors: BURTON J. , HOPE K. W.
Published: May 2005

The Admiral Nursing Service supports individuals caring for people with dementia. As a response to the high demand for one team's service, a temporary closure to referrals was agreed. This provided the impetus to explore the influence of nurses’ decision making at the point of referral on demand for the service. The research questions addressed were: How do Admiral Nurses make decisions regarding referrals and What factors influence this decision‐making process? Sixteen case studies were retrospectively reviewed through the auspices of a semi‐structured interview aimed at identifying which factors influenced the nurses’ acceptance or rejection of these referrals. Results indicated that the Admiral Nurses had a clearly identified focus in supporting the carers of people with dementia, but that the complexity of the carers situation which included the person with dementia was significant. However, the desire to fulfil a case‐management role while attempting to provide a service that is of a specialist nature and of limited capacity generated tensions. The decision to offer a service to carers was consequently influenced not only by perceived need but also upon the nurses feeling professionally responsible for perceived gaps in service provision.
Increased Expression of Mycobacterium tuberculosis 19 kDa Lipoprotein Obliterates the Protective Efficacy of BCG by Polarizing Host Immune Responses to the Th2 Subtype
Authors: Rao V. , Dhar N. , Shakila H. , Singh R. , Khera A. , Jain R. , Naseema M. , Paramasivan C. N. , Narayanan P. R. , Ramanathan V. D. , Tyagi A. K.
Published: May 2005

Mycobacterium tuberculosis can not only neutralize immune effector functions, but also has the ability to modulate host‐signalling cascades involved in the development of these responses. The 19 kDa antigen (Rv3763), a lipoprotein of M. tuberculosis, elicits high levels of interleukin (IL)‐12 from macrophages in addition to its powerful immunomodulatory properties, leading to suppression of antigen‐presentation signalling cascades. The present study was aimed at analysing the effect of overexpression of this antigen on the immunostimulatory properties of M. bovis Bacille Calmette–Guérin (BCG). We have constructed a recombinant BCG strain (rBCG19N) producing higher levels of the 19 kDa antigen in both the cytoplasmic (approximately eightfold) and extracellular (approximately fivefold) fractions as compared to the wildtype BCG. Immunization of mice with rBCG19N elicited high levels of interferon‐gamma (IFN‐γ) and relatively low levels of IL‐10 against the purified 19 kDa antigen. However, in response to total BCG sonicate, mice immunized with rBCG19N produced significantly high levels of IL‐10 with relatively very low levels of IFN‐γ. This polarization of the host immune responses towards T‐helper 2 subtype resulted in complete abrogation of the protective efficacy of BCG, when rBCG19N was used as a live vaccine against M. tuberculosis challenge in guinea pigs.
Quantification of Tissue Inhibitor of Metalloproteinases 2 in Plasma from Healthy Donors and Cancer Patients
Authors: Larsen M. B. , Stephens R. W. , Brünner N. , Nielsen H. J. , Engelholm L. H. , Christensen I. J. , Stetler‐Stevenson W. G. , Høyer‐Hansen G.
Published: May 2005

Tissue inhibitor of metalloproteinases (TIMP)‐2 is a highly conserved molecule, which binds both active and latent matrix metalloproteinase (MMP)‐2. TIMP‐2 is also involved in the activation of MMP‐2 on the cell surface. A quantitative enzyme‐linked immunosorbent assay (ELISA) was established and optimized for measurement of TIMP‐2 in plasma. The capturing antibody in the ELISA was a monoclonal, while the detecting antibody was a chicken polyclonal antibody recognizing the native form of human TIMP‐2. The levels of TIMP‐2 were measured in ethylenediaminetetraacetic acid (EDTA) and citrate plasma from healthy donors. The median values were determined as 163 ng/ml (n = 186) with a range of 109–253 ng/ml for EDTA plasma and 139 ng/ml (n = 77) with a range of 95–223 ng/ml for citrate plasma. The TIMP‐2 concentration in citrate plasma from 15 patients with advanced, stage IV breast cancer had a median value of 160 ng/ml, only slightly higher but statistically distinguishable from the level found in citrate plasma from the healthy donors. In addition, the TIMP‐2 concentration in EDTA plasma from colorectal cancer patients revealed a significantly higher level in plasma from patients with Dukes stage A (P = 0.01) compared with patients with more advanced Dukes stages.
Inhibitory Effects of Anti‐Oxidants on Apoptosis of a Human Polyclonal T‐Cell Line, MT‐2, Induced by an Asbestos, Chrysotile‐A
Authors: Hyodoh F. , Takata‐Tomokuni A. , Miura Y. , Sakaguchi H. , Hatayama T. , Hatada S. , Katsuyama H. , Matsuo Y. , Otsuki T.
Published: May 2005

To clarify the effects of silica and silicates on cellular features of lymphocytes, a human T‐lymphotropic virus type‐1‐immortalized polyclonal T‐cell line, MT‐2, was exposed to various concentrations of chrysotile‐A, an asbestos classified as silicate. MT‐2 cells underwent apoptosis in a dose‐ and time‐dependent manner. The mitochondrial apoptotic pathway was activated during chrysotile‐A‐induced apoptosis of MT‐2 cells, because of the phosphorylation of JNK and p38, increase of BAX and release of cytochrome‐c from mitochondria to cytoplasma. In addition, anti‐oxidants such as hydroxyl‐radical excluders and capturers of superoxide and inhibitors of superoxide production effectively reduced the size of the apoptotic fraction in MT‐2 cells cultured with chrysotile‐A. These results indicate that the activation of reactive oxygen species may play a central role in asbestos‐induced T‐cell apoptosis, and anti‐oxidants may help to prevent complications of pneumoconiosis.
Identification and Molecular Characterization of Streptococcus equi subsp. zooepidemicus Isolated from Camels (Camelus dromedarius) and Camel Milk in Kenya and Somalia
Authors: Younan M. , Estoepangestie A. T. S. , Cengiz M. , Alber J. , El‐Sayed A. , Lämmler C.
Published: May 2005

Seventeen Streptococcus equi subsp. zooepidemicus strains isolated from camels and camel milk in Kenya and Somalia were identified by their cultural characteristics, by biochemical and serological reactions with the help of commercial identification systems and by molecular studies using a multiplex PCR. The isolates were further characterized by a PCR‐mediated detection of size polymorphisms in the 16S–23S rDNA intergenic spacer region and the virulence gene szp and by amplification of the virulence gene cne. These molecular analysis are potentially useful in identifying and characterizing S. equi subsp. zooepidemicus strains of this origin and could possibly be valuable in epidemiological investigations.
Molecular Typing of Mycobacterium bovis Isolates from South‐east Brazil by Spoligotyping and RFLP
Authors: Zanini M. S. , Moreira E. C. , Salas C. E. , Lopes M. T. P. , Barouni A. S. , Roxo E. , Telles M. A. , Zumarraga M. J.
Published: May 2005

The identification of 163 strains of Mycobacterium bovis by polymerase chain reaction (PCR) and microbiological tests was carried out on 252 tuberculous‐like lesions (TLLs) collected from slaughtered cattle in south‐east Brazil. This study compared the usefulness of three genotyping techniques, IS6110‐restriction fragment length polymorphism (RFLP), polymorphic guanine‐cytosine‐rich sequence (PGRS)‐RFLP and direct repeat (DR)‐spoligotyping, as applied to M. bovis isolates. Based on IS6110‐RFLP genotyping we selected a group of 23 isolates containing more than one IS6110 copy, along with 16 samples containing one IS6110 copy from different geographical areas, evenly distributed among dairy (eight) and beef cattle (eight). These selected isolates were analysed by PGRS‐RFLP and DR‐spoligotyping genotyping. Dairy cattle (17%) display a higher frequency of multiple IS6110 copies than beef cattle (10%). A comparison between the genotype data obtained fails to show a correlation between the main clusters found by the three techniques. However, the clustering of each genotyping procedure revealed that the majority of strains are closely related. The RFLP‐PGRS patterns showed a sizable group (20.5%) containing a 5.5 kb fragment and the predominant spoligotype is similar to that from the BCG vaccine strain. Unexpectedly, four strains (2.4%) showed drug resistance to 0.2 μg/ml isoniazid and 20 μg/ml ethionamide, but none of them was resistant to rifampicin or other antibiotics tested.
Treatment for lupus nephritis: A revisit
Authors: LAI KAR NENG , TANG SYDNEY C W , MOK CHI CHIU
Published: May 2005

SUMMARY:  The optimal treatment of severe lupus nephritis remains unclear. Regimens consisting of steroid and cyclophosphamide (CYC) appear to be most effective. Infection and gonadal toxicity is a major concern of CYC use in patients of reproductive age. In addition, failure to respond or refractory to CYC treatment may lead to the development of end‐stage renal disease. Mycophenolate mofetil (MMF) is a new immunosuppressive agent that selectively inhibits activated lymphocytes and renal mesangial cells. Data from experimental lupus nephritis and controlled studies, albeit small and lacking statistical power, have revealed that MMF is as effective in lupus patients as CYC in the induction of renal remission or as maintenance therapy to reduce renal flare in the short term. The significantly less ovarian toxicity and infection when compared to CYC are particularly attractive for the consideration of MMF in lupus nephritis. The potential of other new therapeutic agents is discussed together with the need for patient recruitment in future trials of lupus nephritis to address the importance of ethnicity as well as histological grading.
Higher rate and earlier peritonitis in Aboriginal patients compared to non‐Aboriginal patients with end‐stage renal failure maintained on peritoneal dialysis in Australia: Analysis of ANZDATA
Authors: LIM WAI H , JOHNSON DAVID W , MCDONALD STEPHEN P
Published: May 2005

Background:  Aboriginal patients maintained on peritoneal dialysis (PD) have a higher rate of technique failure than any other racial group in Australia. Peritonitis accounts for the bulk of these technique  failures,  but  it  is  uncertain  whether  the  increased  risk  of  peritonitis  in  Aboriginal  patients was independent of associated comorbid conditions, such as diabetes mellitus.

Methods:  Using data collected by the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), peritonitis rates and time to first peritonitis were compared between Aboriginal (n = 238) and non‐Aboriginal patients (n = 2924) commencing PD in Australia between 1 April 1999 and 31 March 2003.

Results:  Aboriginal PD patients were younger, and had a higher incidence of diabetes than their non‐Aboriginal counterparts. Mean peritonitis rates were significantly higher among Aboriginal (1.15 episodes/year; 95% confidence interval (CI): 1.03–1.28) than non‐Aboriginal patients (0.60 episodes/year; 95% CI: 0.57–0.62, P < 0.05). Using multivariate negative binomial regression, independent predictors of higher peritonitis rates include Aboriginal racial origin (adjusted odds ratio 1.78; 95% CI: 1.45–2.19), obesity, age and absence of a recorded dialysate : plasma creatinine ratio (D/P creatinine) measurement. Aboriginal racial origin was also associated with a shorter median time to first peritonitis (9.9 vs 19.3 months, P < 0.05), which remained statistically significant in a multivariate Cox proportional hazards model (adjusted hazard ratio 1.76; 95% CI: 1.47–2.11, P < 0.05).

Conclusion:  Aboriginal and obese PD patients have a higher rate of peritonitis and a shorter time to first peritonitis, independent of demographic and comorbid factors. Further investigation of the causes of increased peritonitis risk in Aboriginal patients is needed.