bluuebunny/crossref_metadata_2025 huggingface dataset:
Childhood asthma and early life exposure to indoor allergens, endotoxin and β(1,3)‐glucans
Authors: Bertelsen R. J. , Lødrup Carlsen K. C. , Carlsen K.‐H. , Granum B. , Doekes G. , Håland G. , Mowinckel P. , Løvik M.
Published: January 2010

Background
Divergent results have been reported regarding early life exposure to indoor environmental agents and the risk of asthma and allergic sensitization later in life.

Objective
To assess whether early exposure to indoor allergens, β(1,3)‐glucans and endotoxin modifies the risk of allergic diseases at 10 years of age.

Methods
The concentrations of mite, cat and dog allergens, endotoxin and β(1,3)‐glucans were determined in dust from the homes of 260 two‐year‐old children with lung function measured at birth (tidal flow volume loops) in the Environment and Childhood Asthma study in Oslo. At 10 years, the health status was assessed in a follow‐up study including a structured interview of the parents and an extended clinical examination.

Results
Cat and dog keeping at 2 years of age was reported in 6.5% and 5.5% of the families, respectively. Mite allergens were detected in only 4/260 dust samples. The adjusted odds ratio for asthma at age 10 was 1.20 (95% confidence interval: 1.01–1.43) and 1.22 (1.02–1.46) for bronchial hyperresponsiveness (BHR) per 10 μg/g dust increase in cat allergen exposure at 2 years of age. No association was seen with allergic sensitization. Moreover, endotoxin and β(1,3)‐glucan exposure did not modify the risk of asthma or allergic sensitization. None of the measured environmental factors were associated with lung function at 10 years of age or a relative change in lung function from birth.

Conclusion
In a community with a low prevalence of pet keeping and low mite allergen levels, exposure to cat allergens early in life increased the risk of late childhood asthma and BHR, but not the risk of allergic sensitization. No risk modification was seen for dog allergens, endotoxin and β(1,3)‐glucans.

Cite this as: R. J. Bertelsen, K. C. Lødrup CarlsenK.‐H. Carlsen, B. Granum, G. Doekes, G. Håland, P. Mowinckel and M. Løvik, Clinical & Experimental Allergy, 2010 (40) 307– 316.
Processing‐dependent and ‐independent pathways for recognition of iodinated contrast media by specific human T cells
Authors: Keller M. , Lerch M. , Britschgi M. , Tâche V. , Gerber B. O. , Lüthi M. , Lochmatter P. , Kanny G. , Bircher A. J. , Christiansen C. , Pichler W. J.
Published: January 2010

Background
One to three percent of patients exposed to intravenously injected iodinated contrast media (CM) develop delayed hypersensitivity reactions. Positive patch test reactions, immunohistological findings, and CM‐specific proliferation of T cells in vitro suggest a pathogenetic role for T cells. We have previously demonstrated that CM‐specific T cell clones (TCCs) show a broad range of cross‐reactivity to different CM. However, the mechanism of specific CM recognition by T cell receptors (TCRs) has not been analysed so far.

Objective
To determine how T cells specifically recognize CM.

Methods
CM‐specific TCCs were generated from human blood of three CM‐allergic patients and a specific TCR was transfected into a mouse T cell hybridoma. Functional analysis such as proliferation assays, IL‐2 secretion assays, and calcium influx experiments were performed using irradiated, glutaraldehyde‐fixed, CM‐pre‐incubated, human leucocyte antigen (HLA)‐DR‐matched or ‐mismatched antigen‐presenting cells (APCs), and HLA‐blocking antibodies.

Results
We identified two mechanisms of T cell stimulation: some TCCs and the transfectant reacted to CM independent of uptake by APCs because proliferation/IL‐2 secretion occurred in the presence of glutaraldehyde‐fixed APCs, and intracellular calcium increased within seconds after drug addition. Other TCCs required functional APCs, compatible with uptake and presentation of CM on MHC‐class II molecules, as implied by three findings: (1) glutaraldehyde fixation of APCs abrogated presentation; (2) CM could not be washed away from CM‐pre‐incubated APCs; and (3) the optimal pulsing time was 10–20 h. Because allogeneic, MHC‐matched, CM‐pulsed APCs could induce proliferative responses as well, the ability of CM uptake and presentation is not unique to APCs from patients with CM‐induced delayed hypersensitivity.

Conclusion
Our data suggest that CM may be stimulatory for T cells either by direct binding to the MHC–TCR complex or by binding after uptake and processing by APCs. This questions the assumed inert nature of CM.

Cite this as: M. Keller, M. Lerch, M. Britschgi, V. Tâche, B. O. Gerber, M. Lüthiuthi, P. Lochmatter, G. Kanny, A. J. Bircher, C. Christiansen and W. J. Pichler, Clinical & Experimental Allergy, 2010 (40) 257–268.
Experimental hookworm infection: a randomized placebo‐controlled trial in asthma
Authors: Feary J. R. , Venn A. J. , Mortimer K. , Brown A. P , Hooi D. , Falcone F. H. , Pritchard D. I. , Britton J. R.
Published: January 2010

Background
Epidemiological studies suggest that hookworm infection protects against asthma, and therefore that hookworm infection may have a direct or an indirect therapeutic potential in this disease. We now report the first clinical trial of experimental hookworm infection in people with allergic asthma.

Objectives
To determine the effects of experimental hookworm infection in asthma.

Methods
Thirty‐two individuals with asthma and measurable airway responsiveness to adenosine monophosphate (AMP) were randomized and double blinded to cutaneous administration of either ten Necator americanus larvae, or histamine solution (placebo), and followed for 16 weeks. The primary outcome was the change in provocation dose of inhaled AMP required to reduce forced expiratory volume in 1 s by 20% (PD20AMP) from baseline to week 16. Secondary outcomes included change in several measures of asthma control and allergen skin sensitivity and the occurrence of adverse effects.

Results
Mean PD20AMP improved in both groups, more in the hookworm [1.49 doubling doses (DD)] than the placebo group (0.98 DD), but the difference between groups was not significant (0.51 DD; 95% confidence interval: −1.79 to 2.80; P=0.65). There were no significant differences between the two groups for other measures of asthma control or allergen skin sensitization. Infection was generally well tolerated.

Conclusions
Experimental infection with ten hookworm larvae in asthma did not result in significant improvement in bronchial responsiveness or other measures of asthma control in this study. However, infection was well tolerated and resulted in a non‐significant improvement in airway responsiveness, indicating that further studies that mimic more closely natural infection are feasible and should be undertaken.

Cite this as: J. R. Feary, A. J. Venn, K. Mortimer, A. P Brown, D. Hooi, F. H. Falcone, D. I. Pritchard and J. R. Britton, Clinical & Experimental Allergy, 2010 (40) 299– 306.
Differences in allergy trends between East and West Germany and possible explanations
Authors: Krämer U. , Oppermann H. , Ranft U. , Schäfer T. , Ring J. , Behrendt H.
Published: January 2010

Background
At the time of the German reunification in 1990, manifestations of most allergic diseases were less prevalent in East than in West Germany. It was hypothesized that these East–West differences would diminish with lifestyle and pollution changes in East Germany.

Objective
To investigate whether changes in the prevalence of asthma, hayfever, eczema or allergic sensitization in East Germany approached the levels seen in West Germany and to identify possible lifestyle or environmental factors that may influence this.

Methods
Between 1991 and 2000, 6‐year‐old children from four areas in East Germany participated in an annual survey. Every 3rd year, a parallel survey was performed in four areas of West Germany. In total, 31 903 children were included. Parents completed a questionnaire regarding lifestyle factors and diagnoses and symptoms of asthma, hayfever and eczema. In sub‐areas, eczema was clinically assessed by a dermatologist. Specific IgE sensitization was determined for 6121 children. Logistic regression was used to analyse differences in time trends and the influence of lifestyle and pollution changes.

Results
Lifestyle and pollution changed significantly differently between East and West Germany. The trends in hayfever and in strong (specific IgE >3.5) sensitization against pollen, and particularly birch pollen, were steeper in East than in West Germany. The trend towards marked pollen sensitization was four times stronger (95% confidence interval 1.2–13.9) in East than in West Germany. Increasing numbers of only children, less single‐room heating with fossil fuels and increasing importance of traffic‐related pollution in East Germany partly explained these differences in time trends.

Conclusions
Hayfever and sensitization against pollen were the most sensitive allergic manifestations to changes experienced specifically in East Germany. Influences of lifestyle (single‐room heating, living as a single child) were important in explaining different trend developments.

Cite this as: U. Krämer, H. Oppermann, U. Ranft, T. Schäfer, J. Ring and H. Behrendt, Clinical & Experimental Allergy, 2010 (40) 289– 298.
Non‐uniqueness with refraction inversion – the Mt Bulga shear zone
Authors: Palmer Derecke
Published: January 2010

The tau‐p inversion algorithm is widely employed to generate starting models with many computer programs that implement refraction tomography. However, this algorithm can frequently fail to detect even major lateral variations in seismic velocities, such as a 50 m wide shear zone, which is the subject of this study.

By contrast, the shear zone is successfully defined with the inversion algorithms of the generalized reciprocal method. The shear zone is confirmed with a 2D analysis of the head wave amplitudes, a spectral analysis of the refraction convolution section and with numerous closely spaced orthogonal seismic profiles recorded for a later 3D refraction investigation.

Further improvements in resolution, which facilitate the recognition of additional zones with moderate reductions in seismic velocity, are achieved with a novel application of the Hilbert transform to the refractor velocity analysis algorithm. However, the improved resolution also requires the use of a lower average vertical seismic velocity, which accommodates a velocity reversal in the weathering. The lower seismic velocity is derived with the generalized reciprocal method, whereas most refraction tomography programs assume vertical velocity gradients as the default.

Although all of the tomograms are consistent with the traveltime data, the resolution of each tomogram is comparable only with that of the starting model. Therefore, it is essential to employ inversion algorithms that can generate detailed starting models, where detailed lateral resolution is the objective.

Non‐uniqueness can often be readily resolved with head wave amplitudes, attribute processing of the refraction convolution section and additional seismic traverses, prior to the acquisition of any borehole data. It is concluded that, unless specific measures are taken to address non‐uniqueness, the production of a single refraction tomogram that fits the traveltime data to sufficient accuracy does not necessarily demonstrate that the result is either correct, or even the most probable.
Bernard Soulier syndrome in pregnancy: a systematic review
Authors: PEITSIDIS P. , DATTA T. , PAFILIS I. , OTOMEWO O. , TUDDENHAM E. G. D. , KADIR R. A.
Published: January 2010

Summary.  Bernard Soulier syndrome (BSS) is a rare disorder of platelets, inherited mainly as an autosomal recessive trait. It is characterised by qualitative and quantitative defects of the platelet membrane glycoprotein (GP) Ib‐IX‐V complex. The main clinical characteristics are thrombocytopenia, prolonged bleeding time and the presence of giant platelets. Data on the clinical course and outcome of pregnancy in women with Bernard Soulier syndrome is scattered in individual case reports. In this paper, we performed a systematic review of literature and identified 16 relevant articles; all case reports that included 30 pregnancies among 18 women. Primary postpartum haemorrhage was reported in 10 (33%) and secondary in 12 (40%) of pregnancies, requiring blood transfusion in 15 pregnancies. Two women had an emergency obstetric hysterectomy. Alloimmune thrombocytopenia was reported in 6 neonates, with one intrauterine death and one neonatal death. Bernard Soulier syndrome in pregnancy is associated with a high risk of serious bleeding for the mother and the neonate. A multidisciplinary team approach and individualised management plan for such women are required to minimise these risks. An international registry is recommended to obtain further knowledge in managing women with this rare disorder.
Cytotoxicity and genotoxicity of sodium percarbonate: a comparison with bleaching agents commonly used in discoloured pulpless teeth
Authors: Fernández M. R. , Carvalho R. V. , Ogliari F. A. , Beira F. A. , Etges A. , Bueno M.
Published: January 2010

Fernández MR, Carvalho RV, Ogliari FA, Beira FA, Etges A, Bueno M. Cytotoxicity and genotoxicity of sodium percarbonate: a comparison with bleaching agents commonly used in discoloured pulpless teeth. International Endodontic Journal, 43, 102–108, 2010.

Aim  To evaluate the cytotoxicity and genotoxicity of sodium percarbonate (SPC) in comparison with bleaching agents used on discoloured pulpless teeth.

Methodology  The cytotoxicity and genotoxicity of bleaching agents were evaluated both in their pure form as well as at concentrations commonly used in clinical practice. Hydrogen peroxide (HP), carbamide peroxide (CP), sodium perborate (SP) and SPC were diluted in Dulbecco’s modified Eagle’s medium (DMEM) in series. To evaluate the cytotoxicity, the survival of 3T3/NIH mouse fibroblasts was measured photometrically using an 3‐(4,5‐dimethylthiazol‐2‐yl)‐2,5‐diphenyltetrazolium bromide assay after a 24 h‐exposure period. Genotoxicity was indicated by micronuclei (MN) formation, and modification of the normal cell was analysed by light microscopy (400×). Statistical analysis was performed by one‐way anova, followed by a multiple‐comparison Tukey post hoc test (P < 0.05).

Results  All groups exhibited a dose‐dependent cytotoxicity. However, CP showed a similar cytotoxic effect when compared with DMEM‐untreated control (UC) group. HP and SPC were significantly more cytotoxic than SP. The genotoxicity test showed that SPC and SP had an intermediate rate of MN frequency when compared with the UC group. The mean rate of MN frequency for HP was higher and statistically more significant than for the other groups tested. No difference was observed when CP and UC groups were compared.

Conclusions  Sodium percarbonate showed cytotoxicity and genotoxicity similar to those of the other products tested. However, before SPC is used clinically, studies should be conducted to confirm its safety in vivo.
Activated platelets increase proliferation and protein synthesis of human dental pulp–derived cells
Authors: Agis H. , Stampfl B. , Watzek G. , Gruber R.
Published: January 2010

Agis H, Stampfl B, Watzek G, Gruber R. Activated platelets increase proliferation and protein synthesis of human dental pulp–derived cells. International Endodontic Journal, 43, 115–124, 2010.

Aim  To evaluate the impact of activated platelets on the mitogenic expansion of human dental pulp–derived cells (DPC) in vitro.

Methodology  The effect of supernatants released from activated platelets (PRS) and the corresponding platelet membranes (MEM) on proliferation and protein synthesis of DPC was evaluated. The contributions of the phosphoinositide 3‐kinase (PI3K)/AKT and mitogen‐activated protein kinase (MAPK) pathways to the response of DPC were assessed using kinase inhibitors. Also examined was whether the presence of calcium hydroxide or the inflammatory mediators tumour necrosis factor alpha, interleukin‐1, interleukin‐6 and lipopolysaccharide of Escherichia coli modulated the expansion of DPC.

Results  Physiologic concentrations of PRS and MEM stimulated proliferation and protein synthesis by 18.4‐fold (P < 0.01) and 2.9‐fold (P < 0.01), respectively. This mitogenic expansion was paralleled by activation of AKT and the MAP kinases extracellular signal‐regulated kinase (ERK), c‐Jun N‐terminal kinase (JNK) and p38. Inhibitor studies revealed that the mitogenic response of DPC involved PI3K/AKT, JNK and p38 signalling (P < 0.05). Calcium hydroxide and inflammatory factors did not significantly modulate the mitogenic response of DPC to PRS and MEM.

Conclusion  Supernatants released from activated platelets and the corresponding platelet membranes stimulated DPC proliferation and protein synthesis involving PI3K/AKT and MAPK signalling. These findings may serve as a basis for preclinical studies that address the role of activated platelets in dental pulp repair.
Acute right‐sided facial pain: a case report
Authors: Sanner F.
Published: January 2010

Sanner F. Acute right‐sided facial pain: a case report. International Endodontic Journal, 43, 154–162, 2010.

Aim  To report a case of mixed neuralgic and dental pain and to discuss the possible pathophysiological background.

Summary  A case of coexistent dental and neuralgic pain in the distribution of the trigeminal nerve is presented, and the endodontic and neurological treatments are described. The possible diagnostic and pathophysiological correlations are discussed.

Key learning points 

Pre‐trigeminal and atypical neuralgias are amongst the possible differential diagnoses of acute dental pain.

In a patient with nonodontogenic pain, simultaneous dental pain in the same area could be overlooked.

Dentists should consider a nonodontogenic origin as a possible explanation for burning, lancinating or atypical pain. In such cases, an appropriate medical specialist should be consulted.
Examining the characteristics of workplace violence in one non‐tertiary hospital
Authors: Chapman Rose , Styles Irene , Perry Laura , Combs Shane
Published: January 2010

Aim.  This study sought to determine the prevalence and characteristics of workplace violence directed at a volunteer sample of nurses at one non‐tertiary hospital. Respondents’ reasons for not reporting these incidents were also investigated.

Background.  Incidents of workplace violence are increasing worldwide. However, no studies have investigated this phenomenon from the perspective of nurses in Western Australian non‐tertiary hospitals.

Design.  Survey.

Method.  A survey was distributed to all 332 nurses working in several areas of one non‐tertiary hospital in Western Australia to determine their experiences of workplace violence over a 12 month period.

Findings.  Of the 113 nurses who agreed to participate in this study, 75% reported experiencing workplace violence in the previous twelve months. When asked about their most recent incident, 50% of the nurses said they had reported it verbally, mostly to more senior staff. Only 16% of the nurses completed an official incident report. Reasons for not reporting included the view that WPV is just part of the job and the perception that management would not be responsive.

Conclusion.  This study showed that for this sample of nurses violent events are occurring at a rate that is similar to those reported in other studies. This finding should be of great concern to the organisation and the community in general.

Relevance to clinical practice.  Organisations are obliged to improve the safety of the workplace environment for both staff and patients. The findings of our study may be of help to healthcare institutions in developing education programmes for nurses, patients and their friends and relatives to reduce the impact and frequency of workplace violence.
Illness representations in patients with traumatic injury: a longitudinal study
Authors: Lee Bih‐O , Chaboyer Wendy , Wallis Marianne
Published: January 2010

Aims.  This study aimed to elucidate the illness representations of patients with traumatic injury and to examine what extent their illness representations change over time.

Background.  Traumatic injury has attracted global concern because it is the major reason for death and disability in people under 45 years old. One model, the Common Sense Model of Illness Representation (CSMIR), has the potential to help individuals adjust to changes in health status such as traumatic injury.

Design.  Longitudinal study design.

Methods.  This study was conducted using a and collected data prior to hospital discharge and at three and six months after hospital discharge. One individual question form and the Chinese Illness Perception Questionnaire Revised (IPQ‐R) (Trauma) were used to collect demographic data, clinical data and illness representations.

Results.  A total of 114 participants completed the survey three times. The overall response rate was 79·7%. Six subscales of the Chinese (Trauma): identity, emotional representations, consequences, controllability, illness coherence and causes of the Chinese IPQ‐R (Trauma) changed significantly over time. Two subscales, Timeline (acute/chronic) and Timeline Cyclical, did not change significantly.

Conclusions.  Based on these findings, there may be a window of opportunity to provide appropriate interventions to individuals with traumatic injury at each time point. The results of this study have implications for nursing practice and further nursing research.

Relevance to clinical practice.  Understanding illness representation in patients with traumatic injury may help nurses to provide anticipatory guidance and to design nursing interventions before and after hospital discharge, ultimately to improve health outcomes of those patients.
The focus of family members’ functioning in the acute phase of traumatic coma
Authors: Verhaeghe Sofie TL , Van Zuuren Florence J , Grypdonck Mieke HF , Duijnstee Mia SH , Defloor Tom
Published: January 2010

Aims.  The identification and description of the basic psychological process linked with the focus of family members’ functioning during the acute phase of traumatic coma.

Background.  Earlier research learned that hope is a core category in coping with traumatic coma. Hope seems to be the drive to keep family members going and to enable them to fulfil their main task namely protecting. In two articles on the focus of family members functioning, this task is defined and the process linked with it is described.

Design.  A qualitative approach according to the grounded theory method with constant comparison.

Method.  Twenty four in‐depth interviews with 22 family members of 16 patients with traumatic coma.

Results.  Family members describe the period after the confrontation with traumatic coma as a battle. During this battle, they feel the urge to protect their relative in coma, other family members and themselves. They go through three phases: protecting life, protecting from suffering, protecting what remains to rebuild live. In this article (Part One) we describe the initial battle and the phase of protecting life.

Conclusions.  All relatives go through the three phases. Family members who have already overcome previous set‐backs get through the process slightly more quickly and experience less extreme emotions.

Relevance to clinical practice.  Understanding the process of protecting in different phases may help health care professionals to do anything in their power to avoid unnecessary suffering, to ease the pain and to support family members in their task of protecting.
Perceived barriers to physical activity among older adults residing in long‐term care institutions
Authors: Chen Yuh‐Min
Published: January 2010

Aims.  This study explored barriers that older residents of long‐term care (LTC) institutions experience in regular physical activity participation.

Background.  Despite the benefits of physical activity, a large proportion of older adults still lead a sedentary lifestyle. Especially, for older residents of LTC institutions, ability and resources for practising physical activity are more restricted than community‐dwelling older adults. They are very likely to encounter barriers to physical activity. However, little is known about what factors impede them from being physically active. To implement successful interventions, more information is needed to address barriers to regular physical activity.

Design.  A qualitative exploratory design.

Methods.  Purposive sampling was performed to recruit 90 older residents from six nursing homes in Taiwan. The interview transcripts were analysed by qualitative content analysis.

Results.  The results revealed that barriers to physical activity can be personal or environmental, including physical health problems and physical frailty, fear of resultant injury or falling, past sedentary lifestyle, insufficient understanding about physical activity and environmental restriction.

Conclusions.  The findings advance knowledge of barriers that impede the institutionalised older adults to perform physical activity. Participation in physical activity was negatively influenced by these barriers. However, these barriers are modifiable. Assessment and problem solving to overcome barriers could result in positive outcomes.

Relevance to clinical practice.  Health care providers are in a unique position to influence older residents to adopt regular physical activity. Health care providers should consider these barriers to the development and maintenance of physical activity and to plan effective individual interventions to reduce these barriers. In planning physical activities, it is also important to provide a supportive environment.
Maintaining a therapeutic connection: nursing in an inpatient eating disorder unit
Authors: Snell Lynlee , Crowe Marie , Jordan Jenny
Published: January 2010

Aim.  The aim of this study was to investigate and theorise the experiences of nurses in developing a therapeutic relationship with patients admitted to a specialised eating disorder inpatient service for weight recovery.

Background.  Nursing in in‐patient eating disorders units can be both challenging and intensive work. It is an area of practice associated with high rates of stress, burnout and frustration. The establishment of therapeutic relationships is difficult because of the nature of patients’ symptoms.

Design.  This is a qualitative study exploring nurses’ descriptions of practice in an inpatient eating disorder unit.

Method.  This study used a grounded theory methodology to interview seven registered nurses about their experiences of establishing therapeutic relationships. The process of analysis involved open and axial coding and the integration of theory.

Results.  The central variable that emerged from the analysis was ‘connecting’. This variable was fundamental to the three major categories: (1) developing the therapeutic connection, (2) negotiating the therapeutic connection and (3) coordinating the connection. The central category that emerged was maintaining the therapeutic connection. The contextual variables that had the strongest influence on shaping the categories were the specific nature of eating disorders and the unit’s approach to treatment.

Conclusion.  Nurses play a crucial role in enabling the smooth functioning of the eating disorders unit and the successful treatment of the patients’ eating disorders. This role was at times invisible and it was through these nurses’ descriptions that it became apparent.

Relevance to clinical practice.  The round the clock care provided by nurses in in‐patient settings for eating disorders provides unique challenges and opportunities in the key task of developing a strong therapeutic relationship to engage patients with the treatment and recovery process.
Enough of the problem: a review of time for health care transition solutions for young adults with a chronic illness
Authors: Rapley P , Davidson PM
Published: January 2010

Aims and objectives.  In this article, we critically assess the state of the science of transition care in chronic conditions using diabetes care as an exemplar and provide a case for the adoption of the principles of the Chronic Care Model in driving health care reform.

Background.  Globally, there is an increasing burden of chronic conditions including among adolescents and young adults. As a consequence adolescents are transitioning, at an increasing rate, from paediatric services into mainstream adult services, which are often ill equipped to meet their needs.

Design.  Integrative literature review.

Methods.  An integrative literature review method was used to summarise key issues facing adolescents with chronic illness and generate strategies for improving health care services.

Conclusion.  Strengthening the capacity for transitioning from a service that is family focused to one with an individual orientation requires a paradigmatic shift and clear identification of roles and responsibilities in the health care system. The absence of empirically developed models of care, in a context of growing need, signals the importance of ongoing discussion, debate and research.

Implications for clinical practice.  There is a need for a change in philosophical orientation to promote service provision on the basis of need, rather than a model based on diagnosis and chronology. Nurses and other health professionals need to increase their awareness of issues facing adolescents with chronic conditions making the transition to adult health services.
Risk factors related to the development of pressure ulcers in the critical care setting
Authors: Kaitani Toshiko , Tokunaga Keiko , Matsui Noriko , Sanada Hiromi
Published: January 2010

Aim.  This study identified risk factors for pressure ulcer development early in the admission stage to determine what appropriate interventions might be conducted early in the admission stage to decrease the risk of pressure ulcer development.

Background.  Among patients who develop pressure ulcers, 8–40% of them occur in a critical care setting. Therefore, the development of pressure ulcers is a common problem.

Design.  Prospective cohort study.

Methods.  The study facility was a 606‐bed tertiary care hospital. Ninety eight patients admitted to the intensive care unit (ICU) or the high care unit (HCU) from 16 April 2003–15 July 2003 were evaluated in the final analysis.

Results.  The mean patient age was 62·3 (SD 16·1) years, and the incidence of pressure ulcers in this study was 11·2% during the observation period. Multivariate analysis showed that ‘emergency ICU/HCU patients’ and ‘infrequent turning’ were related to pressure ulcer development. Patients with pressure ulcers experienced significantly fewer turns and repositionings (OR = 0·452, 95% CI: 0·212–0·966], p < 0·05. Fewer pressure ulcers developed in scheduled ICU/HCU patients than in emergency ICU/HCU patients (OR = 0·041 [95% CI: 0·004–0·470], p < 0·01).

Conclusion.  There was no relationship between pressure ulcer development and APACHE II score, or any medication that affected skin integrity. The frequency of turning and repositioning and patients with an emergency admission to the ICU/HCU can be the prognostic indicators for developing scoring system in critical care settings.

Relevance to clinical practice.  These patients admitted directly to ICU or HCU were in a high risk group, further preventive strategies will be required.
A randomised controlled trial on the effect of clamping the indwelling urinary catheter in patients with hip fracture
Authors: Nyman Maria Hälleberg , Johansson Jan‐Erik , Gustafsson Margareta
Published: January 2010

Aim.  To investigate the effect of clamping the urinary catheter before its removal in patients with hip fracture.

Background.  Difficulties to return to normal bladder function after removal of the urinary catheter are frequent in patients with hip fracture. Clamping the urinary catheter before removal is proposed to shorten the amount of time required to return to normal bladder function.

Design.  A randomised controlled trial was conducted at the orthopaedic clinic at a Swedish university hospital.

Methods.  Patients with hip fracture aged ≥50 without a urinary catheter, without cognitive impairment or additional severe physical problems at the time of admission (n = 113) were included. They were randomly assigned either to have their urinary catheter clamped before removal or to have their catheter removed with free drainage. Blinding was not possible because of the nature of the study. The primary outcome was the amount of time required to return to normal bladder function. Secondary outcomes were need for re‐catheterisation and length of hospital stay. All patients were analysed in accordance with the intention‐to‐treat principle.

Results.  The median time required to return to normal bladder function was six (Q1 4–Q3 8) hours in the clamped catheter group and four (Q1 3–Q3 7·25) hours in the free drainage group. There were no significant differences between the groups regarding the time required to regain normal bladder function (p = 0·156), the number of patients requiring re‐catheterisation (p = 0·904) and the mean time in hospital (p = 0·777).

Conclusion.  This randomised trial did not show any advantage or disadvantage with clamping the urinary catheter before removal.

Relevance to clinical practice.  Clamping is an additional task for the nursing staff in the removal of the indwelling urinary catheter. Therefore, when considering the present results, it seems that clamping the indwelling urinary catheters in patients with hip fracture is not indicated.
Fitness for practice in nursing and midwifery education in Scotland, United Kingdom
Authors: Holland Karen , Roxburgh Michelle , Johnson Martin , Topping Keith , Watson Roger , Lauder William , Porter Mary
Published: January 2010

Aim.  The aim of this paper is to report findings from a major study that evaluated the Fitness for Practice nursing and midwifery curriculum in Scotland, UK.

Background.  The competence of student nurses and midwives at the point of registration has been the focus of debate and research. However, no major study, on such a large scale, had specifically evaluated pre‐registration programmes to determine whether they enabled students to achieve ‘fitness to practice’.

Design.  The study had a broad evaluation design conducted in three phases using a mixed methodology.

Method.  Phase 1 involved questionnaires, Objective Structured Clinical Examination's (OSCE) and curriculum evaluation. Phase 2 involved semi‐structured interviews (some telephone) and focus groups across main stakeholders: students (n = 78), mentors (n = 78), practice‐education facilitators (n = 24), academics (n = 59), senior clinical (n = 46) and education managers (n = 16), service users and carers (n = 10).

Results.  The findings suggest that the Fitness for Practice curriculum model in Scotland has on the whole been successful. The key finding is the predominant opinion of stakeholders that newly qualified nurses and midwives are perceived as being fit for practice at the point of registration. A perceived lack of confidence is, as with all transitions to new roles, an understandable outcome.

Conclusions.  Previous concern that student nurses and midwives are not ‘fit for practice’ has focused on the perceived lack of clinical skills at the point of registration, not on competence to practice in general. This study demonstrates that this is an important distinction and recognises that registration is only the beginning of a life long learning experience.

Relevance to clinical practice.  Students need to be supported to develop their confidence following registration as well as additional skills in their chosen field of practice. Appropriate mentorship and a period of preceptorship should be in place to accommodate this.
How East Asian classrooms may change over the next 20 years
Authors: Chan Tak‐Wai
Published: January 2010

Our schools have been experiencing three overlapping waves of technology adoption since the mid‐1980s: the personal computer lab wave, the online learning wave and the digital classroom wave. In this position paper, I tried to explain why we are now at the onset of the digital classroom wave, why it will cause great changes in education and why those changes could not occur prior to the digital classroom wave. By proposing a series of conjectures, I described with some confidence how classrooms in Taiwan may change. I also believed that some schools in other East Asian countries may experience similar changes. Basically, the classroom will undergo a transition from a pursuit of individualization and productivity in the first stage to the pursuit of personalization and global citizenship in the second stage. The linkage between the first stage and the second stage is also the linkage between the Internet world and the classroom world, which are now virtually separate. Technology adoption is determined by the availability of that technology, and we researchers in the field have little influence over it; however, we can build compelling, sustainable and ‘disseminable’ experimental digital classroom sites to set out classroom reform. To shed light on the development and dissemination of experimental sites, I drew parallels between Deng's economic reform of China and classroom reform. In the process of building digital classroom experimental sites, we are revealing fundamental problems, setting out fundamental changes and hailing the advent of a new era of formal education.
Conspecific plant–soil feedbacks reduce survivorship and growth of tropical tree seedlings
Authors: McCarthy‐Neumann Sarah , Kobe Richard K.
Published: January 2010

1. The Janzen–Connell (J–C) Model proposes that host‐specific enemies maintain high tree species diversity by reducing seedling performance near conspecific adults and promoting replacement by heterospecific seedlings. Support for this model often comes from decreased performance for a species at near versus far distances from conspecific adults. However, the relative success of conspecific versus heterospecific seedlings recruiting under a given tree species is a critical, but untested, component of the J–C Model.

2. In a shade‐house experiment, we tested plant–soil feedbacks as a J–C mechanism in six tropical tree species. We assessed effects of conspecific versus heterospecific cultured soil extracts on seedling performance for each species, and we compared performance of conspecific versus heterospecific seedlings grown with soil extract cultured by a particular tree species. Additionally, we tested whether soil microbes were creating these plant–soil feedbacks and whether low light increased species vulnerability to pathogens.

3. Among 30 potential comparisons of survival and mass for seedlings grown in conspecific versus heterospecific soil extracts, survival decreased in seven and increased in two, whereas mass decreased in 13 and increased in 1. To integrate survival and growth, we also examined seedling performance [(mean total mass × mean survival time)/(days of experiment)], which was lower in 16 and higher in 2 of 30 comparisons between seedlings grown with soil extract cultured by conspecific versus heterospecific individuals. Based on performance within a soil extract, conspecific seedlings were disadvantaged in 15 and favoured in 7 of 30 cases relative to heterospecific seedlings.

4. Species pairwise interactions of soil modification and seedling performance occurred regardless of sterilization, suggesting chemical mediation. Microbes lacked host‐specificity and reduced performance regardless of extract source and irradiance.

5. Synthesis. These results, along with parallel research in temperate forests, suggest that plant–soil feedbacks are an important component of seedling dynamics in both ecosystems. However, negative conspecific feedbacks were more prevalent in tropical than temperate species. Thus, negative plant–soil feedbacks appear to facilitate species coexistence via negative distance‐dependent processes in tropical but not temperate forests, but the feedbacks were mediated through chemical effects rather than through natural enemies as expected under the J–C Model.
The ZnuABC operon is important for Yersinia ruckeri infections of rainbow trout, Oncorhynchus mykiss (Walbaum)
Authors: Dahiya I , Stevenson R M W
Published: January 2010

Signature‐tagged mutagenesis was used to identify genes essential for survival of Yersinia ruckeri in its natural host, rainbow trout, Oncorhynchus mykiss. A mini‐Tn5‐Km2 signature‐tagged mutant, C6‐1, was missing from rainbow trout kidney at 7 days after an immersion challenge. The transposon insertion in C6‐1 was in a homologue of the znuA gene of Escherichia coli that encodes ZnuA, a zinc‐binding periplasmic protein of the high‐affinity zinc transporter ZnuABC. Further sequencing of the C6‐1 locus in Y. ruckeri identified homologues of two other genes: znuB, encoding a putative inner membrane permease, and znuC, encoding a putative ATPase. When present on a low‐copy plasmid, the znuABC locus of Y. ruckeri fully restored growth of a zinc transport–deficient ΔznuABC mutant of E. coli. Unlike ΔznuABC mutants of E. coli and Salmonella typhimurium, the ΔznuABC mutant of Y. ruckeri did not demonstrate significantly slower growth in zinc‐deficient M9 minimal medium or in Luria–Bertani (LB) medium supplemented with the metal chelators EDTA and tetrakis‐(2‐pyridylmethyl)‐ethylenediamine (TPEN). In LB medium, the znuA::lacZ and znuCB::lacZ transcriptional fusions of Y. ruckeri were derepressed by addition of EDTA and TPEN and were repressed by addition of zinc and manganese. In a competitive challenge by immersion, the ΔznuABC mutant was unable to compete with the parental strain and survived poorly in rainbow trout kidney, indicating that the ZnuABC transporter has a role in establishing and maintaining a rainbow trout infection by Y. ruckeri.
Bowhead whales Balaena mysticetus in the Okhotsk Sea
Authors: IVASHCHENKO Yulia , CLAPHAM Phillip
Published: January 2010

Little is known about the endangered population of bowhead whales Balaena mysticetus in the Okhotsk Sea (OS). Here, we review existing information about this stock, including much material published in Russian.

Whaling for OS bowheads began around 1846, was pursued intensively for two decades and continued sporadically until about 1913. Beginning in 1967, whalers from the USSR killed bowheads illegally, although the number of whales taken remains unknown. Estimates of the pre‐exploitation population size have ranged from 3000 to 20000 whales, but all such estimates are based upon untested assumptions and incomplete data.

Information on historical and current distribution of bowheads comes from whaling records (notably Townsend 1935) and from modern (notably Russian/Soviet) marine mammal surveys. Little is known about winter distribution. During spring and summer, known bowhead concentrations occur in Shelikhov Bay and at Shantar. Although historical whaling data show bowheads in Shelikhov Bay during summer and early autumn, there have been no recent sightings later than June. However, extensive 19th century catches were made over much of the northern OS, and the present range and habitat use of the population is probably broader than existing data suggest. There is evidence for age or maturational class segregation between Shantar and Shelikhov Bay; the former hosts immature whales and lactating females, and the latter hosts adults.

Genetic data indicate that the OS bowhead stock is separate from the Bering‐Chukchi‐Beaufort population, but that the two populations share a common ancestry. There is no evidence that bowheads ever leave the OS.

Russian observers have put the current size of the OS stock in the low hundreds, but this is not based on quantitative analysis. Overall, the OS bowhead population is very likely to be relatively small; it did not recover from the intensive whaling in the 19th century, and the illegal Soviet catches of the 1960s have further set back its recovery. Dedicated surveys and other research are required to assess the status and conservation needs of the population.
Cryptic Kin Selection: Kin Structure in Vertebrate Populations and Opportunities for Kin‐Directed Cooperation
Authors: Hatchwell Ben J.
Published: January 2010

Animal societies of varying complexity have been the favoured testing ground for inclusive fitness theory, and there is now abundant evidence that kin selection has played a critical role in the evolution of cooperative behaviour. One of the key theoretical and empirical findings underlying this conclusion is that cooperative systems have a degree of kin structure, often the product of delayed dispersal, that facilitates interactions with relatives. However, recent population genetic studies have revealed that many non‐cooperative animals also have kin‐structured populations, providing more cryptic opportunities for kin selection to operate. In this article, I first review the evidence that kin structure is widespread among non‐cooperative vertebrates, and then consider the various contexts in which kin selection may occur in such taxa, including: leks, brood parasitism, crèches, breeding associations, territoriality and population dynamics, foraging and predator deterrence. I describe the evidence that kin‐selected benefits arise from interacting with kin in each of these contexts, notwithstanding the potential costs of kin competition and inbreeding. I conclude that as the tools required to determine population genetic structure are readily available, measurement of kin structure and the potential for kin selection on a routine basis is likely to reveal that this process has been an important driver of evolutionary adaptation in many non‐cooperative as well as cooperative species.
Efficacy of postoperative epidural analgesia in adolescent scoliosis surgery: a meta‐analysis
Authors: TAENZER ANDREAS H. , CLARK CANTWELL
Published: January 2010

Background:  Scoliosis surgery is one of the most painful operations performed. Postoperative pain management has been historically based on the use of intravenous opioids. Many of the adolescents who undergo these procedures are at increased risk for opioid‐related side effects because of underlying medical problems. Epidural analgesia has been demonstrated to provide superior pain control with fewer side effects for chest and abdominal surgery in children as well as adults. We aim to analyze the available literature for sufficient evidence to allow recommendations regarding the use of epidural analgesia with parenteral opioids vs. intravenous opioids only.

Search strategy:  Public Medline and the Cochrane database were searched (1966‐10/2008) using scoliosis‐related and epidural analgesia‐related terms. In Medline, the intersection of these results was combined with Phases 1 and 2 of a highly sensitive search strategy recommended for identifying randomized trials. No limits were used in any search. Additionally, professional journals and proceedings of meetings were screened, and nationally recognized experts in the field of pediatric pain management were asked for further sources of data.

Selection criteria:  Randomized, controlled trials comparing the use of a continuous infusion of epidural local anesthetics plus intravenous opioids vs. intravenous opioids only for postoperative pain management in adolescent scoliosis repair were eligible for inclusion in the meta‐analysis.

All studies had to include at least the primary outcome of interest, postoperative pain scores.

Data collection and analysis:  After the development of a data collection and extraction form, two independent reviewers extracted all. No data conflicts were encountered. Data were analyzed with Review Manager when possible, significance for difference between relative rates between groups was analyzed by chi‐square tests.

Main results:  Average pain scores were lower in the epidural group than no epidural group at 24, 48 and 72 h after surgery. Pain scores (0–100) were lower on all first three postoperative days (POD) in the epidural group: −15.2 on POD1, −10.1 on POD2 and −11.5 on POD3. Differences were significant in the summary analysis for all 3 days (P < 0.05).

Authors’ Conclusion:  Epidural analgesia is beneficial to patients in terms of improving pain control and reducing side effects. The influence on respiratory depression, length of stay in the intensive care unit, or mortality is not available in the literature at this time.