bluuebunny/crossref_metadata_2025 huggingface dataset:
A Novel Interdisciplinary Analgesic Program Reduces Pain and Improves Function in Older Adults After Orthopedic Surgery
Authors: Morrison R. Sean , Flanagan Steven , Fischberg Daniel , Cintron Alexie , Siu Albert L.
Published: November 2008

OBJECTIVES: To examine the effect of a multicomponent intervention on pain and function after orthopedic surgery.

DESIGN: Controlled prospective propensity score–matched clinical trial.

SETTING: New York City acute rehabilitation hospital.

PARTICIPANTS: Two hundred forty‐nine patients admitted to rehabilitation after hip fracture repair (n=51) or hip (n=64) or knee (n=134) arthroplasty.

INTERVENTION: Pain assessment at rest and with physical therapy (PT) by staff using numeric rating scales (1 to 5). Physician protocols for standing analgesia and preemptive analgesia before PT were implemented on the intervention unit. Control unit patients received usual care.

MEASUREMENTS: Pain, analgesic prescribing, gait speed, transfer time, and percentage of PT sessions completed during admission. Pain and difficulty walking at 6, 12, 18, and 24 weeks after discharge.

RESULTS: In multivariable analyses intervention patients were significantly more likely than controls to report no or mild pain at rest (66% vs 49%, P=.004) and with PT (52% vs 38%, P=.02) on average for the first 7 days of rehabilitation, had faster 8‐foot‐walk times on Days 4 (9.3 seconds vs 13.2 seconds, P=.02) and 7 (6.9 vs 9.2 seconds, P=.02), received more analgesia (23.6 vs 15.6 mg of morphine sulfate equivalents per day, P<.001), were more likely to receive standing orders for analgesia (98% vs 48%, P<.001), and had significantly shorter lengths of stay (10.1 vs 11.3 days, P=.005). At 6 months, intervention patients were less likely than controls to report moderate to severe pain with walking (4% vs 15%, P=.02) and that pain did not interfere with walking (7% vs 18%, P=.004) and were less likely to be taking analgesics (35% vs 51%, P=.03).

CONCLUSION: The intervention improved postoperative pain, reduced chronic pain, and improved function.
Perceptions of Physician Recommendations for Joint Replacement Surgery in Older Patients with Severe Hip or Knee Osteoarthritis
Authors: Schonberg Mara A. , Marcantonio Edward R. , Hamel Mary Beth
Published: November 2008

OBJECTIVES: To exfamine patient perceptions of physician discussions and recommendations about total joint arthroplasty (TJA).

DESIGN: Prospective cohort study.

SETTING: One large academic medical center and four community affiliates in Boston.

PARTICIPANTS: One hundred seventy‐four patients aged 65 and older with severe osteoarthritis of the hip or knee for at least 6 months not controlled with medications.

MEASUREMENTS: Patient perceptions of primary care physicians' (PCPs) and orthopedists' communication about TJA were assessed at baseline for all patients and at 12 months for those who did not undergo surgery.

RESULTS: Of the 174 patients, 49 were aged 80 and older, 82% were non‐Hispanic white, and 69% had knee osteoarthritis. Eighty‐seven percent of individuals with baseline interviews and a PCP (142/163) reported that they had discussed their hip or knee arthritis with their PCP at baseline, and 26% (42/163) reported that their PCP discussed TJA as a treatment option. Of the 128 patients who saw an orthopedist, 65% reported that their orthopedist recommended TJA. Only 29% (51/174) of patients underwent TJA. Those who reported discussing TJA with their PCP at baseline were more likely to undergo TJA (P<.01). Thirty‐six percent (44/123) of the patients who did not undergo TJA reported that their PCP discussed surgery as a treatment option at baseline or at 12month follow‐up.

CONCLUSION: Patients with severe osteoarthritis of their hip or knee who report discussing TJA as a treatment option with their PCP are more likely to undergo TJA within the next year, but few older adults report having these discussions. Improvement is needed in communication between PCPs and patients about TJA.
Starting granulocyte–colony‐stimulating factor (filgrastim) early after autologous peripheral blood progenitor cell transplantation leads to faster engraftment without increased resource utilization
Authors: Thompson James M. , Carlton Pam , Akard Luke P. , Dugan Michael J. , Jansen Jan
Published: November 2008

BACKGROUND: Hematopoietic growth factor support is routinely used after autologous stem cell transplantation. The optimal starting date of this growth factor support has not been established yet, but many engraftment studies now recommend the fifth day after stem cell infusion (Day 5).

STUDY DESIGN AND METHODS: After switching the start date of granulocyte–colony‐stimulating factor (G‐CSF) support from the day of transplant (Day 0 group), to Day 5 after stem cell infusion (Day 5 group), the impression arose that there was an associated delay in engraftment of both white blood cells and platelets (PLTs). A retrospective analysis of two cohorts was performed with attention to engraftment variables and resource utilization.

RESULTS: Patients in the Day 0 group recovered an absolute granulocyte count of more than 0.500 × 109 per L significantly earlier than patients in the Day 5 group (p < 0.001 in log‐rank test; median difference, 1 day). Time to PLT recovery of more than 20 × 109 per L, without transfusion support, was not significantly different between the Day 0 and Day 5 groups (p = 0.16; medians of 10 and 12 days, respectively). Resource utilization, defined as number of red blood cell and PLT transfusions, days with fever or on intravenous antibiotics, days with mucositis, and length of hospital stay, were not significantly different between the two groups (p ≥ 0.15 in each case). Total charges for the transplant episode were also not different between the two groups (p = 0.48).

CONCLUSION: Starting G‐CSF support on the day of stem cell infusion, instead of on Day +5, leads to faster hematologic recovery without a significant impact on resource utilization.
Free cholesterol testing as a motivation device in blood donations: evidence from field experiments
Authors: Goette Lorenz , Stutzer Alois , Yavuzcan Gürcan , Frey Beat M.
Published: November 2008

BACKGROUND: Health tests are often seen as promising donor incentives to improve the supply of blood. However, systematic behavioral evidence on donor recruitment is scarce.

STUDY DESIGN AND METHODS: To study the effectiveness of a free cholesterol test in attracting new donors and motivating previous donors, two field experiments were conducted. In Study 1, 2825 nondonors were randomly assigned to one of three treatments: a solicitation letter, a solicitation letter plus an appeal, or a solicitation letter plus an appeal and the offer of a free cholesterol test. In Study 2, 8269 previous donors were randomly assigned to one of three treatments: a standard invitation, an invitation plus an appeal, or an invitation plus an appeal and a cholesterol test. Marginal effects from probit estimations were calculated to study the effects of the treatments on donors' response.

RESULTS: In Study 1, only 0.6 percent reacted to the solicitation letter. There were no significant differences in the response rates between the three treatments. In Study 2, 45.3 percent of the invited previous donors came to donate. The appeal (marginal effect, −0.5%; standard error [SE], 1.9%) and offering a cholesterol test (marginal effect, 1.6%; SE, 1.8%) did not significantly increase the probability of a donation relative to the standard invitation. The treatment effects for the cholesterol test did not systematically differ between frequent and infrequent donors and female and male donors. There is some evidence that young donors responded relatively most positive to the cholesterol test (marginal effect, 4.4%; SE, 2.2%).

CONCLUSIONS: Contrary to conclusions from survey studies, free cholesterol testing did not significantly increase donations from nondonors and previous donors during a 3‐month campaign. The two studies show that field experiments are an important method to evaluate donation incentives, because measuring donors' intentions alone can lead to significantly different conclusions.
The Sickle Cell Sabbath: a community program increases first‐time blood donors in the African American faith community
Authors: Price Cynthia L. , Johnson Michael T. , Lindsay Terianne , Dalton Douglas , DeBaun Michael R.
Published: November 2008

BACKGROUND: Blood transfusion therapy is an established treatment for primary and secondary prevention of strokes in children with sickle cell disease (SCD), a disease that predominantly affects African Americans. African American blood donors are more likely to have compatible minor red blood cell antigens for children with SCD who routinely receive transfusions. This study tested the hypothesis that when informed at church about the importance of blood donation, African Americans will have a higher than expected rate of first‐time blood donation compared to the general population.

STUDY DESIGN AND METHODS: The Sickle Cell Sabbath Program was developed to increase awareness about SCD and the importance of blood donations within the African American faith community. Church involvement in the program included a 5‐minute scripted educational session about SCD that included the importance of blood donations followed by a blood donor drive that was hosted by the church.

RESULTS: Thirteen African American churches sponsored 34 blood drives from 2003 through 2006. Each church sponsored at least two blood drives. Approximately 1200 donors participated in the sickle cell blood drives. The majority of the donors were first‐time donors and represented a greater than expected first‐time donor rate when compared to first‐time donors in the metropolitan St Louis area, 60 percent (422 of 699) and 12.2 percent (21,516 of 175,818), respectively (p = 0.001).

CONCLUSION: An educational program that engages the African American faith community more than quadruples the rate of expected first‐time blood donors when compared to the general community over this 4‐year period.
Studying Children's Perspectives on Self‐Determination and Nurturance Rights: Issues and Challenges
Authors: Peterson‐Badali Michele , Ruck Martin D.
Published: November 2008

Over the past three decades there has been a growing interest in children's and adolescents' rights and the tendency to grant young people many of the rights traditionally reserved for adult members of society. Increased awareness of children's rights is clearly reflected in the UN Convention on the Rights of the Child (CRC; United Nations, 1989), which recognizes children as worthy of citizenship and attempts to increase the commitment of nations worldwide to children's rights. If children's rights are to serve their intended function—to protect children from harm and promote their development and well‐being—it is essential to examine how children understand and think about their rights. In this article we review the literature on children's and adults' thinking about children's rights and discuss conceptual and methodological considerations related to this body of research, including the importance of how we conceptualize the construct of children's rights, the types of questions researchers pose about young people's attitudes, knowledge and reasoning regarding children's rights, and the methods used to answer these questions. We address the implications of developmental research on young people's perspectives on children's rights.
Children's Nurturance and Self‐Determination Rights: A Cross‐Cultural Perspective
Authors: Cherney Isabelle D. , Shing Yee L.
Published: November 2008

Increasing awareness of children's developmental needs and rights has led to a global move toward giving children and adolescents a greater degree of autonomy in the decisions affecting their own lives. This article presents two studies examining the role of culture and religion in 12‐year‐old children's perceptions of their rights across three cultures. The first study showed that U.S. and Swiss children advocated for more self‐determination rights than Chinese‐Malaysian children; U.S. and Chinese‐Malaysian children advocated for more nurturance rights than Swiss children. Within the Chinese‐Malaysian sample, Buddhist children were more likely to advocate for self‐determination rights as compared to Christian children. Using a revised Children's Rights Interview (rCRI), the second study showed that on average U.S. and Chinese‐Malaysian children were more likely to advocate for self‐determination rights than nurturance rights. However, there were no significant differences between the two cultural groups in terms of the overall responses. The results of the studies are discussed in terms of the cultural orientation and constructivist frameworks.
Adolescents' Approach toward Children's Rights: Comparison among Christian, Jewish, and Muslim Children in Jerusalem
Authors: Khoury‐Kassabri Mona , Ben‐Arieh Asher
Published: November 2008

With the universal ratification of the United Nations Convention on the Rights of the Child (CRC), societies have recognized children as human beings entitled to their own rights. This recognition calls for a thorough investigation of children's understanding of rights at large and their own personal rights in particular. It further calls for an examination of the role of context in forming the concept of children's rights. This study examined adolescents' (ages 12–14) approach to children's rights among three ethnic–religious groups: Arab‐Christian, Arab‐Muslim, and Jewish adolescents living in Jerusalem. The results indicated that Jewish adolescents had higher agreement and support for children's rights than Arab adolescents, except in the case of children's rights in governmental procedures, where Arab adolescents were in greater support. When comparing Muslim and Christian‐Arab adolescents, the results show almost no significant differences. Similarly, adolescents' degree of religiosity was only partially correlated with their approach to children's rights. The findings suggest that nationality is an important factor in the formulation of adolescents' approach to children's rights.
To Be an American: Immigration, Hyphenation, and Incorporation
Authors: Deaux Kay
Published: November 2008

Central to many immigration debates in the United States, past and present, are questions about what it means to be an American. In this article, I address three forms of this question: (a) What is an immigrant? (b) What is an American? and (c) What is a hyphenated American. Answers to these questions can vary, depending upon whether one is taking the perspective of the observer/host or of the immigrant himself or herself. Data suggest that neither unidimensionality nor simple dichotomy are appropriate frames for analyzing national identity.
Subnational Taxes in Developing Countries: The Way Forward
Authors: BAHL ROY , BIRD RICHARD
Published: November 2008

Both theory and experience in a variety of circumstances around the world suggest strongly that if fiscal decentralization is to produce sustainable net benefits in developing countries, subnational governments require much more real taxing power than they now have. Students of public finance have studied the subject, and practitioners in developing countries have installed many different versions of subnational government tax. In most developing countries there are potentially sound and productive taxes that subnational governments could use: personal income tax surcharges, property taxes, taxes on the use of motor vehicles, payroll taxes, and even subnational value‐added taxes and local “business value” taxes may all be viable options in particular countries. Still, there is no general consensus about what works and what does not. In this review paper, we try and pull together enough evidence to suggest the way forward. We also develop the argument that given political realities one cannot usually decentralize significant revenues to subnational governments without having in place an intergovernmental transfer system to offset at least some of the disequalizing effects that would otherwise occur. Nor does it make sense to think of decentralizing exactly the same package of tax choices to all subnational governments regardless of their scale and scope of operations.
Does Earmarked Revenue Provide Property Tax Relief? Long‐Term Budgetary Effects of Georgia's Local Option Sales Tax*
Authors: ZHAO ZHIRONG JERRY , JUNG CHANGHOON
Published: November 2008

This study examines the long‐term effects of the 1% General‐purpose Local Option Sales Tax (LOST) on the level of property tax in Georgia counties with a pooled interrupted time‐series analysis. The LOST has been earmarked for property tax relief in Georgia counties since 1976, but debates remain on whether the proceeds have been used as additional revenues. We find that the adoption of LOST brought short‐term property tax relief but not long‐term property tax reduction. The result suggests that long‐term property tax relief would not be realized by earmarked revenue without careful policy design to safeguard fungibility.
Reforming Credit Reform
Authors: LUCAS DEBORAH , PHAUP MARVIN
Published: November 2008

The Federal Credit Reform Act (FCRA) improved the treatment of credit in the federal budget, but failed to make the budget cost of credit and noncredit programs fully comparable. Inconsistencies and downwardly biased credit costs arise from the restriction under FCRA that cash flows be discounted at Treasury rates, and from the omission of certain administrative costs. We describe the shortcomings of FCRA and policy distortions that may occur, and propose modifications to the Act that would more closely align budget costs of credit and noncredit programs.
Using Vehicles to Challenge Antisleeping Ordinances
Authors: Wakin Michele
Published: November 2008

Homeless people who sleep on city streets are subject to regulation practices that target their appearance, status, and behavior. Vehicle living affords a private sleeping area, yet occupants are still frequently cited for sleeping in public. The right to sleep has recently become controversial, as cities that do not provide adequate shelter cannot legally outlaw public sleeping. This article uses interviews, surveys, and municipal court trial data to present an ethnographic case study of the vehicle community in Santa Barbara, CA. Like many California coastal cities, the visible presence of homeless people is troubling to citizens, city officials, and tourists who seek unfettered access to beaches and shopping areas. Homeless people who sleep in these areas see their vehicles as essential for personal survival, as a way of escaping negative public attention, and as a way of arguing for social legitimacy.
Boredom, Drugs, and Schools: Protecting Children in Gentrifying Communities
Authors: Martin Leslie
Published: November 2008

Gentrification beings a host of economic and social changes. Changes in community culture do not directly impact residents’ livelihoods or homes, but these differences in lifestyles shape peoples’ experiences of their homes. I examine rhetoric in three gentrifying neighborhoods in Atlanta, GA to see how it expresses both the uncertainty that new and long–time residents feel about their communities, and how it is indicative of boundary–work residents engage in to distinguish their group from the “others.” Residents express concern about the safety and happiness of children in demographically changing communities. I find that residents focus on threats to children as a socially acceptable way to object to the different class, and sometimes race, background of their neighbors. This boundary maintenance activity serves to calcify divisions between groups of residents, and obscures the underlying schisms between the privileged and less–privileged residents in gentrifying neighborhoods.
Symposium on the Ghetto.s
Authors: Haynes Bruce , Hutchison Ray
Published: November 2008

Nearly a decade into the new millennium, many traditionally black ghettos like Harlem, the Fillmore, and Chicago's South Side have experienced declining population and gentrification. Now seems like a fitting time to evaluate the conceptual merits of the term and the trajectory of research on the “ ghetto.” Much of the research on poverty neighborhoods focuses on Chicago—but is Chicago's South Side representative of poverty neighborhoods (and ghettos) in other cities? Recently, this issue has been widely discussed on the Community and Urban Sociology listserve; as a follow–up, we invited an international group of scholars to offer their views on the subject in this Symposium on the ghetto.
Inferior Vena Cava Diameter (IVCD) Measured with Transesophageal Echocardiography (TEE) Can Be Used to Derive the Central Venous Pressure (CVP) in Anesthetized Mechanically Ventilated Patients
Authors: Arthur Mary E. , Landolfo Carolyn , Wade Marlene , Castresana Manuel R.
Published: November 2008

Background: Estimation of right atrial pressure (RAP) from variations in the diameter of the inferior vena cava (IVC) during the respiratory cycle using transthoracic echocardiography (TTE) is used routinely to calculate pulmonary artery systolic pressure, adding to right ventricular systolic pressure (RVSP) from the jet velocity of tricuspid regurgitation. Using transesophageal echocardiography (TEE) we sought to determine if the inferior vena cava diameter (IVCD) could be used to derive the central venous pressure (CVP) in anesthetized, mechanically ventilated patients. Methods: The IVCD was measured in its long axis (bicaval view) at the cavo‐atrial junction using TEE and ECG synchronization (to coincide with the end of the T‐wave) in 95 anesthetized, mechanically ventilated patients undergoing elective cardiac surgery. Each patient received a pulmonary artery catheter (PAC) that allowed for continuous monitoring of the CVP. Three independent readers were assigned to document the IVCD and the CVP. Statistical analysis was performed using bivariate correlation, variance (ANOVA), linear regression, Bland–Altman and Passing‐Bablock analysis of agreement. Results: The IVCD measured in millimeters at the cavo‐atrial junction showed a positive correlation with the CVP (n = 95, r = 0.860, P < 0.0001, r2= 0.737, P < 0.0001). The linear regression equation [CVPc = (IVCD−4.004/0.751] was prospectively tested in a cohort of 12 anesthetized, mechanically ventilated patients under various hemodynamic conditions with a good correlation between the mean CVP (CVPm) and the calculated CVP (CVPc) (r = 0.923, P < 0.0001, r2= 0.851, P < 0.0001). Conclusion: The TEE measured IVCD at the cavo‐atrial junction showed a statistically significant correlation with the mean CVP. Using an equation derived from linear regression analysis, a reliable CVP can be estimated from the IVCD.
Congenital Mitral Stenosis by Multimodality Cardiac Imaging
Authors: Hamilton‐Craig Christian , Anscombe Russell , Platts David , Burstow Darryl , Slaughter Richard
Published: November 2008

This vignette illustrates a classic case of congenital mitral stenosis (Ruckman‐VanPraagh type 1) presenting in adulthood and demonstrates the benefits of multimodality cardiac imaging prior to successful surgical intervention.
Idiopathic Pulmonary Artery Aneurysm
Authors: Kotwica Tomasz , Szumarska Joanna , Staniszewska‐Marszalek Edyta , Mazurek Walentyna , Kosmala Wojciech
Published: November 2008

Pulmonary artery aneurysm (PAA) is an uncommon lesion, which may be associated with different etiologies including congenital cardiovascular diseases, systemic vasculitis, connective tissue diseases, infections, and trauma. Idiopathic PAA is sporadically diagnosed by exclusion of concomitant major pathology. We report a case of a 56‐year‐old female with an idiopathic pulmonary artery dilatation identified fortuitously by echocardiography and confirmed by contrast‐enhanced computed tomography. Neither significant pulmonary valve dysfunction nor pulmonary hypertension and other cardiac abnormalities which might contribute to the PAA development were found. Here, we describe echocardiographic and computed tomography findings and review the literature on PAA management.
Noninvasive Estimation of Pulmonary Vascular Resistance in Pulmonary Hypertension
Authors: Rajagopalan Navin , Simon Marc A. , Suffoletto Matthew S. , Shah Hemal , Edelman Kathy , Mathier Michael A. , López‐Candales Angel
Published: November 2008

Background: Determination of pulmonary vascular resistance (PVR) in patients with suspected or known pulmonary hypertension (PH) requires right heart catheterization. Our purpose was to use Doppler echocardiography to estimate PVR in patients with PH. Methods: Patient population consisted of 52 patients (53 ± 12 years; 35 females) who underwent Doppler echocardiography and right heart catheterization within 24 hours of each other. The ratio of peak tricuspid regurgitation velocity (TRV) and right ventricular outflow time‐velocity integral (VTIRVOT) was measured via transthoracic echocardiography and correlated to invasively determined PVR. A linear regression equation was generated to determine PVR by echocardiography based upon the TRV/VTIRVOT ratio. PVR by echocardiography was compared to invasive PVR using Bland‐Altman analysis. Results: Significant correlation was demonstrated between TRV/VTIRVOT and PVR by catheterization (r = 0.73; P < 0.001). However, Bland‐Altman analysis showed that agreement between PVR determined by echocardiography and invasive PVR was poor (bias = 0; standard deviation = 4.3 Wood units). In a subset of patients with invasive PVR < 8 Wood units (26 patients), correlation between TRV/VTIRVOT and invasive PVR was strong (r = 0.94; P < 0.001). In these patients, agreement between PVR by echocardiography and invasive PVR was satisfactory (bias = 0; standard deviation = 0.5 Wood units). There was no correlation between TRV/VTIRVOT and invasive PVR in patients with PVR > 8 Wood units (n = 26; r = 0.17). Conclusion: While TRV/VTIRVOT correlates significantly with PVR, using it to estimate PVR in a PH patient population cannot be recommended.
Advances in Antiplatelet Therapy for ACS and PCI
Authors: MOLITERNO DAVID J.
Published: November 2008

Platelet activation and thrombin formation play significant roles in the pathophysiology of acute coronary syndrome. To overcome this pathophysiology, antiplatelet agents are utilized to decrease platelet aggregation and anticoagulants to decrease thrombin formation. Current antiplatelet agents are designed to inhibit various mediators of platelet activation, such as thromboxane A2 and adenosine diphosphate, and platelet‐surface receptors (e.g., glycoprotein IIb/IIIa receptors). The rationale for upstream versus deferred administration of antiplatelet therapy in patients scheduled for percutaneous intervention and the current ACC/AHA guidelines for the management of patients with unstable angina/non‐ST‐segment myocardial infarction are discussed. The next‐generation antiplatelet drugs are in various stages of clinical development, with unique differentiating mechanistic and pharmacokinetic properties. The newer P2Y12 thienopyridine receptor antagonists and protease receptor inhibitor are also examined, in addition to the rationale of various outcome studies evaluating the efficacy and safety of the different agents.
Maternal Perceptions of Insufficient Milk Supply in Breastfeeding
Authors: Gatti Lisa
Published: November 2008

Purpose: Improving the duration of exclusive breastfeeding is a national and international priority. Insufficient milk supply is one of the most commonly cited reasons for early cessation or decreased exclusivity in women who have initiated breastfeeding. This paper is an integrative review of current research pertaining to perceived insufficient milk (PIM).

Design and Methods: CINAHL, MEDLINE, and PubMed were searched combining “human milk” and “milk supply” and “perceived milk supply.” Articles were limited to original research studies related to healthy, full‐term breastfeeding dyads conducted over the past 10 years. Critical review indicated robust findings, limitations, and gaps in this body of literature.

Findings: A lot of women discontinue breastfeeding during the first few weeks of the post‐partum period because of PIM and approximately 35% of all women who wean early report PIM as the primary reason. Many women utilize infant satisfaction cues as their main indication of milk supply and many researchers, clinicians, and breast‐feeding women do not evaluate actual milk supply. The relationships between PIM and socioeconomic or demographic variables as well as early breastfeeding behaviors have not been adequately addressed in the literature.

Conclusions: Recommendations include improvement of maternal education about behaviors to ensure adequate supply, assessment of milk supply, and infant cues as well as further research into the root causes of PIM.

Clinical Relevance: Practitioners involved with maternal child health can improve their care of women and infants by understanding the subjective nature and questionable accuracy of PIM and changing assessment of milk supply.
Breast‐Cancer‐Related Lymphedema: Information, Symptoms, and Risk‐Reduction Behaviors
Authors: Fu Mei R. , Axelrod Deborah , Haber Judith
Published: November 2008

Purpose: To explore the effect of providing lymphedema information on breast cancer survivors' symptoms and practice of risk‐reduction behaviors.

Design: A cross‐sectional design was used to obtain data from 136 breast‐cancer survivors in New York City from August 2006 to May 2007. Descriptive statistics, t tests, chi‐square tests, and correlations were calculated.

Methods: Data were collected using a demographic and medical information interview tool, two questions regarding status of receiving lymphedema information, the Lymphedema and Breast Cancer Questionnaire, and Lymphedema Risk‐Reduction Behavior Checklist.

Findings: Fifty‐seven percent of the participants reported that they received lymphedema information. On average, participants had three lymphedema‐related symptoms. Only 18% of participants were free of symptoms. Participants who received information reported significantly fewer symptoms (t=3.03; p<0.00) and practicing more risk‐reduction behaviors (t=2.42; p=0.01).

Conclusions: Providing lymphedema information has an effect on symptom reduction and more risk‐reduction behaviors being practiced among breast cancer survivors.

Clinical Relevance: In clinical practice, nurses and other healthcare professionals could consider taking the initiative to provide adequate and accurate information and engage breast‐cancer survivors in supportive dialogues concerning lymphedema risk‐reduction.
Nurses' Body Size and Public Confidence in Ability to Provide Health Education
Authors: Hicks Mary , McDermott Laura L. , Rouhana Nicole , Schmidt Melissa , Seymour Megan Wood , Sullivan Tina
Published: November 2008

Purpose: To replicate research about confidence level in receiving health teaching from either an overweight or a weight‐appropriate RN.

Methods: A quasi‐experimental post‐test only design was used. Participants were randomly assigned to be shown images of a nurse, either overweight or weight‐appropriate, then asked to rate their confidence in health teaching received from that nurse. Descriptive statistics, t test for independent samples, and covariate analyses were performed.

Results: A significant difference in confidence p=0.000 was noted between participants who viewed the image of a weight‐appropriate nurse and participants who viewed the image of an overweight nurse.

Conclusions: Weight‐appropriate nurses may inspire more confidence in their teaching. Further study is indicated to explore the implications of these findings for practice.

Clinical Relevance: Nurses need to be conscious of clients' perceptions of weight when planning teaching interventions.
Diagnostic value of CD163 in cutaneous spindle cell lesions
Authors: Pouryazdanparast Pedram , Yu Limin , Cutlan Jonathan E. , Olsen Stephen H. , Fullen Douglas R. , Ma Linglei
Published: November 2008

Background:  The histologic diagnosis of atypical fibroxanthoma (AFX) can sometimes be challenging. No specific marker exists to confirm the diagnosis other than excluding other entities. CD163 has been shown to have great specificity for tumors of monocyte/histiocyte lineage. In this study, we evaluated the diagnostic utility of CD163 in diagnosing AFX and in identifying skin lesions with histiocytic/dendritic derivation.

Methods:  A total of 157 cases, including 14 AFXs, 5 spindle cell squamous cell carcinomas (SCCs), and 7 spindle cell/desmoplastic melanomas, along with other cutaneous spindle cell and histiocytic/fibrohistiocytic lesions, were stained with CD163.

Results:  CD163 was expressed in 11 of 14 (79%) AFXs, with moderate to strong intensity. No staining was observed in cases of spindle cell SCC (0/5) and dermatofibrosarcoma protuberans (0/10). Rare spindle cell/desmoplastic melanomas (2/7) and cutaneous leiomyosarcomas (1/5) demonstrated positive staining. CD163 reactivity was seen in 24 of 29 of benign fibrous histiocytomas (BFHs), including 8 of 8 celular fibrous histiocytomas and 6 of 9 epithelioid cell histiocytomas. The majority of cutaneous histiocytic lesions, including juvenile xanthogranuloma, Langerhans cell histiocytosis and Rosai–Dorfman disease, were positive for CD163.

Conclusion:  CD163 is a useful adjunct in distinguishing AFX from other malignant cutaneous spindle cell tumors and offers improved specificity in identifying cutaneous histiocytic/dendritic lesions.
Prehistoric species richness of birds on oceanic islands
Authors: Franklin Janet , Steadman David W.
Published: November 2008

Using data on prehistoric and modern birds from seven islands in the Kingdom of Tonga, we demonstrate that there is no positive relationship between species richness (S) and island area (A) over the observed range of A (1.8–259 km2). The uniform S‐values occur across more than three orders of magnitude of A when prehistoric data are included, and the strongest predictor of S on any island is the level of fossil sampling (number of identified bones). Below a minimum value for A (in Tonga < 1.8 km2), S declines to zero as A does the same. Within the ranges of island elevation (E) and inter‐island isolation (I) among the seven islands, neither E (11–312 m) nor I (0.6–38 km) has much if any effect on S. Under natural (pre‐human) conditions, a positive species‐area relationship may not be a valid generalization for birds on oceanic islands.
The evolution of an ‘intelligent’ dispersal strategy: biased, correlated random walks in patchy landscapes
Authors: Barton Kamil A. , Phillips Ben L. , Morales Juan M. , Travis Justin M. J.
Published: November 2008

Theoretical work exploring dispersal evolution focuses on the emigration rate of individuals and typically assumes that movement occurs either at random to any other patch or to one of the nearest‐neighbour patches. There is a lack of work exploring the process by which individuals move between patches, and how this process evolves. This is of concern because any organism that can exert control over dispersal direction can potentially evolve efficiencies in locating patches, and the process by which individuals find new patches will potentially have major effects on metapopulation dynamics and gene flow. Here, we take an initial step towards filling this knowledge gap. To do this we constructed a continuous space population model, in which individuals each carry heritable trait values that specify the characteristics of the biased correlated random walk they use to disperse from their natal patch. We explore how the evolution of the random walk depends upon the cost of dispersal, the density of patches in the landscape, and the emigration rate. The clearest result is that highly correlated walks always evolved (individuals tended to disperse in relatively straight lines from their natal patch), reflecting the efficiency of straight‐line movement. In our models, more costly dispersal resulted in walks with higher correlation between successive steps. However, the exact walk that evolved also depended upon the density of suitable habitat patches, with low density habitat evolving more biased walks (individuals which orient towards suitable habitat at quite large distances from that habitat). Thus, low density habitat will tend to develop individuals which disperse efficiently between adjacent habitat patches but which only rarely disperse to more distant patches; a result that has clear implications for metapopulation theory. Hence, an understanding of the movement behaviour of dispersing individuals is critical for robust long‐term predictions of population dynamics in fragmented landscapes.
Functional diversity predicts overyielding effect of species combination on primary productivity
Authors: Griffin John N. , Méndez Verónica , Johnson Andrew F. , Jenkins Stuart R. , Foggo Andy
Published: November 2008

The effect of biodiversity on ecosystem functioning has proven variable both within and among manipulative studies. Species richness is the most commonly used measure of biodiversity in such studies, but the range of species’ functional traits (functional diversity), not the number of species per se, likely underpins a key mechanistic link between species richness and ecosystem functioning. However, the majority of experiments that have examined the effect of functional diversity have manipulated functional group richness, an approach recognised to suffer numerous limitations. Continuous measures of functional diversity avoid many of these limitations, but the relationship between continuous functional diversity and the magnitude of ecosystem processes has been largely untested. Using one vs two‐species mixtures of rock pool macroalgae as a model, we conducted a field experiment to determine the effect of a continuous measure of functional diversity (functional attribute diversity, FAD, the degree of functional differentiation based on four functional traits) on the magnitude of net primary productivity and overyielding, based upon two alternative null‐models. The total magnitude of productivity was largely determined by the identity of species present, not FAD. However, FAD proved to be a good predictor of overyielding (variation in productivity after the dominant effects of species identity had been accounted for). Furthermore, despite differences in the mean magnitude of the effect of combining species, the positive relationship between FAD and overyielding was consistent according to both additive and substitutive null‐models. Our findings imply that whilst knowledge of species’ independent contributions remains indispensable in the prediction of biotic effects on ecosystem functioning within a trophic level, continuous measures of functional diversity should be used as a supplementary tool to predict the magnitude of overyielding, thereby refining predictions.
Density‐dependent age at first reproduction in the eastern kingbird
Authors: Cooper Nathan W. , Murphy Michael T. , Redmond Lucas J. , Dolan Amy C.
Published: November 2008

Theory predicts that maximal fitness is obtained by individuals who begin to breed immediately upon reaching sexual maturity. However, delayed breeding occurs regularly in some taxa, and in birds and mammals is most often associated with long lifespan and/or limited access to suitable habitats. Delayed breeding is not expected among relatively short‐lived species such as migratory passerine birds, but this assumption remains untested in many species. Here we quantify age at first reproduction in an eastern kingbird Tyrannus tyrannus population breeding in an ecological island, and through both observational and experimental approaches, investigate the potential causes for the high frequency of delayed breeding that occurs in this population. Nearly half of the fledged nestlings that returned to the breeding grounds did not breed in their first potential breeding season. Some non‐breeders occupied territories, for at least some period, but most remained as non‐territorial ‘floaters’. Parentage analysis failed to show any reproductive success for female floaters, and only limited success for male floaters, indicating that floating was not a successful reproductive tactic. On the other hand, a strong negative relationship existed between population size and the proportion of young birds that bred in their first year, and non‐territorial birds of both sexes quickly filled territory vacancies created by experimental adult removals. Limited breeding habitat and territorial behavior of older birds thus appear to be the main causes of delayed breeding in kingbirds. The frequency of delayed breeding in most species is unknown but of potential significance because failure to incorporate accurate estimates of age at first reproduction in population models may lead to flawed population projections.
The adaptive value of energy storage and capital breeding in seasonal environments
Authors: Varpe Øystein , Jørgensen Christian , Tarling Geraint A. , Fiksen Øyvind
Published: November 2008

Timing of reproduction in a seasonal cycle is a life history trait with important fitness consequences. Capital breeders produce offspring from stored resources and, by decoupling feeding and reproduction, may bend the constraints caused by seasonality in food or predation. Income breeders, on the other hand, produce offspring from concurrent food intake, with the disadvantage of less flexibility, but with high efficiency and no inventory costs of carrying stores. Here, we assess relative profitability of capital and income breeding in herbivorous zooplankton inhabiting seasonal, high‐latitude environments. We apply a state‐dependent life history model where reproductive values are used to optimise energy allocation and diapause strategies over the year. Three environmental scenarios were modelled: an early, an intermediate, and a late feeding season. We found that capital breeding was most important in the early season. Capital breeding ranged from 7–9% of the eggs produced but, because of the high reproductive value of early eggs, capital breeding ranged from 9–30% when measured in terms of reproductive value. The main benefit of capital breeding was reproduction prior to the feeding season – when the reproductive value of an egg peaked. In addition, capital breeding was also used to increase egg production rates at times of income breeding. For individuals born late in the season the model predicted a two‐year cycle instead of the typical annual life cycle. These individuals could then reap the benefits of early reproduction and capital breeding in their second year instead of income breeding late in the first year. We emphasize the importance of evaluating reproductive strategies such as capital and income breeding from a complete life cycle perspective. In particular, knowing the seasonality in offspring fitness is essential to appreciate evolutionary and population‐level consequences of capital breeding.
Orchid mycorrhiza: implications of a mycophagous life style
Authors: Rasmussen Hanne N. , Rasmussen Finn N.
Published: November 2008

Orchid mycorrhiza probably affects about 25 000 plant species and thus roughly one tenth of all higher plants. Histologically, this symbiosis resembles other kinds of endomycorrhiza, the fungal hyphae growing within living plant cells. Considerable evidence, however, suggests that it is not a two‐way exchange relationship and thus not potentially mutualistic, such as the wide‐spread endomycorrhiza between plants and Glomalean fungi, known as arbuscular mycorrhiza. During the achlorophyllous seedling stage orchids are obligately dependent on the fungi; some species remain so through life, while others establish photosynthesis but to varying degrees remain facultatively dependent of /responsive to fungal infection as adults. None of the fungi involved are so far known to depend on the symbiosis with orchids. Transfer of organic carbon compounds from hyphae to the orchid has been demonstrated repeatedly, but it is not clear to what extent this takes place during a biotrophic phase while the intracellular hyphae remain intact, or during the subsequent extensive degradation of the hyphal coils. The advantage of viewing orchid mycorrhiza basically as a unilateral mycophagous relationship, in spite of hypothetical beneficial spin‐offs to the mycobiont, is that it provides a conceptual framework similar to that of other parasitic or fungivore relationships; mechanisms known in such relationships could be searched for in future studies of the orchid–fungus symbiosis. These could include mechanisms for recognition, attraction and selection of fungi, physiological regulation of internal hyphal growth, breakdown, and material transfer, nutritional consequences of the plant's preference(s) and trophic changes, fungal avoidance mechanisms, and consequences at population and ecosystem levels. A whole range of possible life strategies becomes apparent that could support divergent evolution and lead to the proliferation of species that has indeed occurred in the orchid family. We outline some of the possible physiological mechanisms and ecological implications of this approach.
Can small‐scale experiments predict ecosystem responses? An example from peatlands
Authors: Wiedermann Magdalena M. , Gunnarsson Urban , Nilsson Mats B. , Nordin Annika , Ericson Lars
Published: November 2008

Oligotrophic, Sphagnum‐dominated peatlands have been regarded as long‐term stable ecosystems that function as carbon sinks. As a result of environmental perturbations, particularly anthropogenic N deposition, this view is now increasingly questioned. We examined whether small‐scale field experiments can predict the direction and magnitude of ecosystem responses to increased N supply. We, therefore, compared data from a 10‐year field experiment (involving deposition of 2, 15 and 30 kg N ha−1 year−1) with data from a gradient associated with increased N deposition (2, 8 and 12 kg N ha−1 year−1). We chose to compare: (1) the physiological response of Sphagnumbalticum, measured in the form of N accumulation as free amino acids (NAA); and (2) changes in the total Sphagnum cover, the cover of S. balticum, and vascular plant cover. In all cases we found a highly significant correlation between the two data sets. We attribute the high correspondence between the two data sets to the key function of the dominant group of organisms, the Sphagna, that monopolize N availability and control the water balance, creating an environment hostile to vascular plants. Thus the key role of Sphagna as ecosystem engineers seems to supersede the role of other, scale‐dependent processes. We also conclude that NAA is a sensitive indicator that can be used to signal the slow and gradual shift from Sphagnum to vascular plant dominance.