bluuebunny/crossref_metadata_2025 huggingface dataset:
Beehive fence deters crop‐raiding elephants
Authors: King Lucy E. , Lawrence Anna , Douglas‐Hamilton Iain , Vollrath Fritz
Published: June 2009

Previous work has shown that African elephantsLoxodonta africanawill avoid African honeybeesApis mellifera scutellata. Here we present results from a pilot study conducted to evaluate the concept of using beehives to mitigate elephant crop depredation. In Laikipia, Kenya, we deployed a 90‐m fence‐line of nine inter‐connected hives, all empty, on two exposed sides of a square two‐acre farm that was experiencing high levels of elephant crop depredation. Compared with a nearby control farm of similar status and size, our experimental farm experienced fewer raids and consequently had higher productivity. Socioeconomic indicators suggest that not only was the concept of a beehive fence popular and desired by the community but also that it can pay for its construction costs through the sale of honey and bee products. We are calling for experiments testing this concept of a ‘guardian beehive‐fence’ to be conducted rigorously and scientifically in as wide a range of agricultural settings as possible to evaluate jointly its effectiveness and efficiency.
Cutaneous metastases of hepatocellular carcinoma
Authors: Serrano M. L.
Published: June 2009

Cutaneous metastases are an unusual finding that may present as the first sign of an internal neoplasia. A case of cutaneous metastases of hepatocellular carcinoma, which may often involve other organs but very rarely metastases to the skin, is reported.
Non‐native fish in the fresh waters of Portugal, Azores and Madeira Islands: a growing threat to aquatic biodiversity
Authors: RIBEIRO F. , COLLARES‐PEREIRA M. J. , MOYLE P. B.
Published: June 2009

Abstract  Portugal, the Azores, and Madeira had a combined total of twenty six non‐native fish species introductions, with the mainland having the highest number (twenty three), followed by the Azores with ten and Madeira with two records. Fifteen of these species established in Portugal, six in the Azores and one in Madeira. The oldest known introduction (1792) was goldfish, Carassius auratus (L.), while the newest (2005) was tinfoil barb, Barbonymus schwanenfeldii (Bleeker). Ten species had been introduced in Portugal by the beginning of 20th century, but the rate of introduction continues to increase, with four species introduced since 2000. In mainland Portugal, the Douro, the Tejo and the Guadiana drainages had the highest number of introduction records, while the Lima and the Mira drainages had the fewest. Management measures are offered to reduce current rate of fish introductions in Portuguese watersheds.
Age‐related movement patterns and population structuring in southern garfish, Hyporhamphus melanochir, inferred from otolith chemistry
Authors: STEER M. A. , FOWLER A. J. , GILLANDERS B. M.
Published: June 2009

Abstract  The southern garfish, Hyporhamphus melanochir (Val.), is an important inshore fishery species in South Australia. Over the past few years there have been concerns with this fishery, which is now considered to be over‐exploited. Currently, the fishery is assumed to consist of two separate stocks, but there is no understanding of movement patterns both within and between these two stocks to justify this assumption. Otolith chemistry was used to infer age‐related patterns of movement, delineate potential sub‐populations and determine the extent of mixing within South Australian coastal waters. Results indicated that the population structuring of garfish is more complex than previously assumed and it seems that stocks can be discriminated at a much finer spatial scale. Garfish collected from sites separated by <60 km displayed significantly different chemical signatures (relative concentrations of 7Li, 24Mg, 55Mn, 88Sr and 138Ba) in their otoliths, especially during their second year of growth, indicating that they had inhabited different water bodies. From a broader perspective, South Australian garfish can be partitioned into six regional components with various levels of inter‐mixing. From these results, it was suggested that assessment and management of the fishery may have to be restructured to align with the smaller spatial units.
A socio‐economic perspective on gear‐based management in an artisanal fishery in south‐west Madagascar
Authors: DAVIES T. E. , BEANJARA N. , TREGENZA T.
Published: June 2009

Abstract  Artisanal fisheries are important socially, nutritionally and economically. Poverty is common in communities dependent on such fisheries, making sustainable management difficult. Poverty based on material style of life (MSL) was assessed, livelihoods surveyed and the relationship between these factors and fishery data collected using a fish landing study were examined. Species richness, diversity, size and mean trophic level of catches were determined for six fishing gears in an artisanal fishery in south‐west Madagascar. There was little livelihood diversification and respondents were highly dependent on the fishery. No relationship was found between poverty and gear use. This suggests that poverty does not have a major impact on the nature of the fishery; however, this study was dominated by poor households, so it remains possible that communities with more variation in wealth might show differences in fishing methods according to this parameter. The fishery was heavily exploited with a predominance of small fish in the catches. Beach seines caught some of the smallest fish, overlapped in selectivity with gill nets and also had the highest catch per fishers. Thus, a reduction in the number of beach seines could help reduce the catch of small fish and the overlap in selectivity among gears.
Movements by adult cutthroat trout in a lotic system: implications for watershed‐scale management
Authors: SANDERSON T. B. , HUBERT W. A.
Published: June 2009

Abstract  Movements by adult cutthroat trout, Oncorhynchus clarkii (Richardson), were assessed from autumn to summer in the Salt River watershed, Wyoming‐Idaho, USA by radio telemetry. Adult cutthroat trout were captured during September and October 2005 in the main stem of the Salt River, surgically implanted with radio transmitters, and tracked through to August 2006. Adult cutthroat trout were relatively sedentary and resided primarily in pools from October to March, but their movement rates increased during April. Higher movement rates were observed among tagged fish during May and early June. Among 43 fish residing in the Salt River during April 2006, 44% remained in the river, 37% moved into mountain tributaries and 19% moved into spring streams during the spawning season. Fish did not use segments of mountain tributaries or the upstream Salt River where fish passage was blocked by anthropogenic barriers or the channel was dewatered during summer. Almost all the fish that moved into spring streams used spring streams where pools and gravel–cobble riffles had been constructed by landowners. The results suggest that adult Snake River cutthroat move widely during May and early June to use spawning habitat in mountain tributaries and improved spring streams. Maintaining the ability of adult fish to move into mountain streams with spawning habitat, preserving spawning habitat in accessible mountain tributaries and removing barriers to upstream movements, and re‐establishing summer stream flows in mountain tributaries affected by dams appear to be habitat management alternatives to preserve the Snake River cutthroat trout fishery in the Salt River.
Mortality of Diplodus annularis and Lithognathus mormyrus released by recreational anglers: implications for recreational fisheries management
Authors: ALÓS J. , PALMER M. , GRAU A. M.
Published: June 2009

Abstract  The factors affecting mortality in Diplodus annularis (L.) and Lithognathus mormyrus (L.) caught and released in a recreational fishery in the Balearic Islands (NW Mediterranean) were examined. A total of 194 and 214 specimens of each species, respectively, were caught and individually monitored in containment tanks for 10 days. The circumstances of the catch, such as capture depth, water temperature, fish size, hook type, hook location, bleeding, unhooking time and cutting the hook line were tested with a logistic regression model. Diplodus annularis experienced moderate rates of mortality (15%), and only deep‐hooking was a significant predictor of death. The incidence of undersized fish for this species was 48%. By contrast, L. mormyrus exhibited higher mortality rates (33%) with over 90% of the catch under the minimum legal size. Deep‐hooking was the strongest predictor of mortality. When circle hooks were used, or if the line was cut when the fish were deep‐hooked, mortality was considerably reduced. Strategies, such as promoting the use of more selective gears that reduce the capture of undersized fish and implementing gentler release techniques, should be considered in managing these species.
Factor VIII prophylaxis for adult patients with severe haemophilia A: results of a US survey of attitudes and practices
Authors: WALSH C. E. , VALENTINO L. A.
Published: June 2009

Summary.  The emergence of a population of relatively healthy adults with severe haemophilia A presents a unique challenge for haemophilia care in the 21st century. Understanding how best to continue, restart, initiate or modify prophylaxis in younger and older adult patients is essential to optimizing their care. To elucidate practice and outcome data, a survey was sent to 23 US hemophilia treatment centers (HTCs); 10 centers responded, providing data concerning up to 145 adults (mean age of 34 years). Forty‐eight patients (33%) were on regular prophylaxis when first seen at the HTC; the prophylactic regimen was modified for 22/48 (46%), often because of breakthrough bleeding. Five of 21 patients (24%) for whom data were available discontinued prophylaxis. Three of those five patients (60%) experienced increased bleeding episodes and the other two (40%) subsequently resumed regular prophylactic infusions because of the increased bleeding. Of the 77 patients not initially receiving prophylaxis for whom data were available, prophylaxis was started or resumed in all. The prophylactic regimen was modified in 57/77 patients (74%) at some point during treatment, often because of breakthrough bleeding. Of the 55 patients whose prophylactic regimens were modified for whom data were available, 22 (40%) discontinued prophylaxis. Thirteen of 20 patients (65%) for whom data were available experienced an increase in bleeding episodes and 7/18 patients (39%) who had discontinued prophylaxis and for whom data were available subsequently resumed regular prophylactic infusions because of bleeding. These findings suggest that prophylaxis prevents bleeding in adults with severe haemophilia A and that discontinuation of the prophylactic regimen is associated with increased bleeding events.
Thromboelastography reflects global hemostatic variation among severe haemophilia A dogs at rest and following acute exercise
Authors: OTHMAN M. , POWELL S. , CHIRINIAN Y. , HEGADORN C. , HOPMAN W. , LILLICRAP D.
Published: June 2009

Summary.  The heterogeneity among severe haemophilia A patients reflects on variable tendencies for bleeding and also variable responses to FVIII therapy. This variability cannot be detected or predicted by routine coagulation tests. Thromboelastography (TEG) has recently been evaluated for assessing hemostatic patterns in haemophiliacs and proved valuable in monitoring therapy and/or prophylaxis, however, usually only in limited small case series. Exercise is an important component of overall haemophilia care, however, in severe haemophiliacs there is an increased risk of bleeding. The availability of a validated hemostatic test to evaluate the influence of exercise would be advantageous. This study has used TEG analysis to evaluate the global hemostatic status of a group of severe haemophilia A dogs at rest and after a standardized period of exercise. The study demonstrated significant inter and intra‐individual variations based on TEG patterns at rest and following acute exercise as well as significant improvement of global hemostasis after exercise in the majority of tested dogs. The study supports the utilization of TEG in assessment of the hemostatic pattern in severe haemophilia A and provides a potential for utilizing TEG evaluation in managing exercise regimens for haemophilia care.
Age‐dependent increase of FVIII:C in mild haemophilia A
Authors: MIESBACH W. , ALESCI S. , KREKELER S. , SEIFRIED E.
Published: June 2009

Summary.  Variability of FVIII:C levels in healthy individuals and age‐dependent increase are a known phenomenon. In haemophilia, increasing FVIII:C levels with age have not been described yet. In our study, we evaluated this issue retrospectively in a cohort older than 45 years of 29 patients with mild haemophilia and 14 patients with moderate or severe haemophilia at last visit at the haemophilia centre Frankfurt. The median duration of observation evaluated in this study was 17 years (range 5–28). Results show a significant correlation of increasing FVIII:C levels with age in mild haemophilia (P = 0.000041) and a non‐significant tendency to a higher increase in higher age (P = 0.085652). The median difference of FVIII:C level between the first and last measurement was 8% of normal plasma concentration (range −3% to +35%). Median FVIII:C level increase of patients younger than 62 years was 7.5% (range −3 to 22), median increase in older patients was 12% (range 0–35). This tendency could not be correlated to decreased number of bleedings, but FVIII substitution dosage should be adapted to changing plasma levels at higher age to prevent overdosing or thrombotic risks. Possible causes and contributing factors for increasing FVIII:C levels are discussed. Statistical significance remains to be confirmed in larger prospective studies also including younger patients.
Divergent differentiation in urothelial carcinoma and other bladder cancer subtypes with selected mimics
Authors: Shanks J H , Iczkowski K A
Published: June 2009

Conventional urothelial carcinoma accounts for most carcinomas of the urinary tract lining. However, neoplastic urothelium has the capacity to demonstrate enormous plasticity. A variety of unusual architectural patterns of urothelial carcinoma, such as the nested, microcystic and inverted variants, can be mistaken for reactive processes or benign tumours. Others such as the micropapillary, plasmacytoid and discohesive variants, can mimic metastatic tumour from other sites. The micropapillary variant in particular is more aggressive. In addition, urothelial carcinoma has a propensity to demonstrate divergent differentiation with glandular, squamous, small cell neuroendocrine, lymphoepithelioma‐like, sarcomatoid or other elements. Pure squamous carcinoma or adenocarcinoma (the latter in particular) can be difficult to distinguish from contiguous or metastatic spread. Some variants have prognostic and potential therapeutic implications. Molecular genetic evidence has emerged recently supporting a close relationship between urothelial carcinoma and various divergent elements. Sarcomatoid carcinoma and its differential diagnosis with other spindle cell lesions of urinary tract will be covered in a separate review.
L‐type amino acid transporter 1 expression is a prognostic marker in patients with surgically resected stage I non‐small cell lung cancer
Authors: Imai Hisao , Kaira Kyoichi , Oriuchi Noboru , Yanagitani Noriko , Sunaga Noriaki , Ishizuka Tamotsu , Kanai Yoshikatsu , Endou Hitoshi , Nakajima Takashi , Mori Masatomo
Published: June 2009

Aim:  To evaluate the prognostic value of L‐type amino acid transporter 1 (LAT1) in patients with stage I non‐small cell lung cancer (NSCLC).

Methods and results:  A total of 282 consecutive patients with completely resected pathological stage I NSCLC were retrospectively reviewed. Expression of LAT1 and proliferative activity, as determined by the Ki67 labelling index, were also evaluated immunohistochemically and correlated with the prognosis of patients after complete resection of the tumour. LAT1 expression was positive in 114 patients (40%) [19% of adenocarcinoma (36 of 186 patients), 83% of squamous cell carcinoma (73 of 88 patients) and 63% of large cell carcinoma (five of eight patients)]. There was a significant correlation between LAT1 expression and Ki67 labelling index (γ = 0.6935, P < 0.001). LAT1 expression was significantly associated with gender, disease stage and pathological features. The 5‐year survival rate of LAT1+ patients (69.1%) was significantly worse than that of LAT1− patients (89.4%; P < 0.001). Multivariate analysis confirmed that positive expression of LAT1 was an independent factor for predicting a poor prognosis.

Conclusion:  LAT1 expression is a promising pathological factor for predicting the prognosis in patients with resectable stage I NSCLC.
The matrix metalloproteinase/tissue inhibitor of matrix metalloproteinase profile in colorectal polyp cancers
Authors: Jeffery Natalie , McLean Mairi H , El‐Omar Emad M , Murray Graeme I
Published: June 2009

Aims:  The matrix metalloproteinase (MMP)/tissue inhibitor of metalloproteinase (TIMP) system has a major role in tumour invasion and metastasis. Roles in pathways involved in early tumour development are also being identified for this system, and the aim of this study was to define the expression profile of the major MMPs and TIMPs in colorectal polyp cancers.

Methods and results:  The expression and cellular localization of individual MMPs and TIMPs was determined in colorectal polyp cancers by immunohistochemistry. All the MMPs and TIMPs showed immunoreactivity in carcinomatous epithelium. MMP1 (P < 0.001), MMP2 (P = 0.003), MMP3 (P = 0.004), TIMP1 (P = 0.01) and TIMP2 (P < 0.001) showed significant increases in immunoreactivity in carcinomatous epithelium compared with adenomatous epithelium. MMP7 showed immunoreactivity in carcinomatous epithelium, but showed no immunoreactivity in either normal epithelium or adenomatous epithelium. MMP and TIMP expression was limited in normal epithelium to MMP1, MMP2 and TIMP3.

Conclusions:  This study defines the expression profile of MMPs and TIMPs in colorectal polyp cancers and shows that the increased expression of MMPs and TIMPs occurs at an early stage of colorectal neoplasia. It provides evidence to support the hypothesis that these molecules have a key involvement in the early stages of tumour development.
Spectrum of fungal rhinosinusitis; histopathologist’s perspective
Authors: Das Ashim , Bal Amanjit , Chakrabarti Arunaloke , Panda Naresh , Joshi Kusum
Published: June 2009

Aims:  Clinical presentation can provide a clue to the subcategories of fungal rhinosinusitis (FRS); however, tissue examination provides accurate classification. The aim was to analyse the incidence and histopathological spectrum of FRS.

Methods and results:  A retrospective analysis of all the cases of rhinosinusitis reported in the last 5 years was carried out. Haematoxylin and eosin‐stained sections along with special stains such as periodic acid–Schiff and Grocott’s were examined. These cases were subclassified based on the presence of allergic mucin, mycelial elements and tissue reaction. Out of a total of 665 cases of rhinosinusitis, 284 (42.7%) were of FRS. On histopathological examination they were broadly categorized as: (i) non‐invasive FRS (n = 171, 60.2%), which included 160 cases (56.3%) of allergic fungal rhinosinusitis (AFRS) and eleven (3.9%) of fungal ball; (ii) invasive FRS (n = 101, 35.6%), which included 48 cases (16.9%) of chronic invasive granulomatous FRS, four (1.4%) of chronic invasive FRS and 49 (17.3%) of acute fulminant FRS; and (iii) mixed pattern FRS, comprising 12 cases (4.25%).

Conclusions:  AFRS is the most common type of FRS. Cases with mixed reaction pattern suggest that different types of FRS represent a progressive spectrum of disease. An exact histopathological categorization of FRS is important as regards treatment.
Dermatofibrosarcoma protuberans: clinical, pathological, and genetic (COL1A1‐PDGFB ) study with therapeutic implications
Authors: Llombart Beatriz , Sanmartín Onofre , López‐Guerrero Jose Antonio , Monteagudo Carlos , Serra Carlos , Requena Celia , Poveda Andrés , Vistós Juan Luis , Almenar Sergio , Llombart‐Bosch Antonio , Guillén Carlos
Published: June 2009

Aims:  To analyse the presence of collagen type I alpha 1–platelet‐derived growth factor beta (COL1A1–PDGFB) transcripts in 20 cases of dermatofibrosarcoma protuberans (DFSP) and to assess the relationship between COL1A1 breakpoints and clinical and histopathological variables.

Methods and results:  Multiplex reverse transcriptase‐polymerase chain reaction was carried out using frozen tissue. Our series contained 14 men and six women. Histologically, most cases were of conventional type (n = 9), followed by fibrosarcoma (n = 4), Bednar tumour (n = 2), sclerosing (n = 2), myoid (n = 1) and atrophic (n = 1) DFSP, and giant cell fibroblastoma (n = 1). Immunohistochemistry revealed CD34 expression in 90% of cases. COL1A1–PDGFB fusion transcripts were present in 89% of cases (exons 18, 19, 20, 25, 26, 31, 33/34, 39, 40, 46, 47 and 48 of COL1A1 with exon 2 of PDGFB). There was no recurrence of DFSP in any of the 19 patients treated by Mohs surgery. A partial response was obtained in the two patients treated with imatinib.

Conclusions:  The COL1A1–PDGFB fusion was present in all histological subtypes of DFSP, but not all cases expressed the fusion transcript. No association was observed between different COL1A1 breakpoints and clinicopathological parameters. Imatinib mesylate can be useful in locally advanced tumours and metastases.
Expression of the interferon‐inducible proteins MxA and IFI16 in liver allografts
Authors: Borgogna Cinzia , Toniutto Pierluigi , Smirne Carlo , Azzimonti Barbara , Rittà Massimo , Avellini Claudio , Fabris Carlo , Landolfo Santo , Gariglio Marisa , Pirisi Mario
Published: June 2009

Aims:  To test the hypothesis that the activation of the interferon (IFN) system pathways might link hepatitis C virus (HCV) recurrence in the liver allograft with acute cellular rejection.

Methods and results:  In this retrospective study, allograft biopsy specimens from 28 adult patients (14 HCV+ and 14 HCV−) who had undergone their first liver transplantation were analysed. Eleven biopsy specimens showed acute cellular rejection (Banff rejection activity index score ≥3). Specimens were immunostained for two IFN‐inducible proteins, MxA and IFI16, and for CD45. The predominant MxA reactivity pattern was hepatocytic, whereas IFI16 was expressed in both the hepatocellular and inflammatory compartments. Moderate to strong MxA expression in hepatocytes was associated positively with rejection score (P < 0.01), donor’s age ≤45 years (P < 0.05) and aspartate aminotransferase levels >40 U/l on the day of biopsy (P < 0.05), and inversely with infiltration of portal triads by IFI16+/CD45+ cells (P < 0.005) and time to progression beyond Ishak stage 2 of recurrent hepatitis C (P < 0.01). On multivariate analysis, MxA expression in hepatocytes was independently associated with allograft rejection and donor’s age.

Conclusions:  Acute allograft rejection and recurrence of HCV infection in the liver allograft appear to intersect in the IFN system pathways.
Metastatic melanoma volume in sentinel nodes: objective stereology‐based measurement predicts disease recurrence and survival
Authors: Riber‐Hansen Rikke , Nyengaard Jens R , Hamilton‐Dutoit Stephen J , Sjoegren Pia , Steiniche Torben
Published: June 2009

Aims:  Sentinel lymph node (SLN) status is the most important prognostic factor in intermediate thickness melanoma. The amount of metastatic disease in positive SLNs varies greatly between patients, and this tumour burden appears to influence the prognosis of node‐positive patients. The aim was to use objective stereological techniques to correlate accurately total SLN tumour burden with recurrence and patient survival.

Methods and results:  SLNs from 327 patients were examined by complete step sectioning and immunohistochemistry. The total metastasis volume (TMV) of 156 positive SLNs from 99 patients (30.3%) was measured using stereological methods based on the 2D‐nucleator and Cavalieri’s principle. The maximum metastasis diameter was also measured. These two measurements were correlated with disease recurrence and patient survival. The mean TMV for SLN+ patients was 10.5 mm3 (median 0.05 mm3; range 0.0001–623.7 mm3). Median follow‐up was 26.3 months. On multivariate analysis, TMV was an independent predictor of recurrence when corrected for primary tumour thickness (P = 0.001) and was a stronger prognosticator compared with the maximum metastasis diameter (P < 0.0001 versus P = 0.01).

Conclusions:  Combining total step sectioning of SLNs with stereological assessment of metastases, we found metastasis volume to be a highly significant predictor of disease recurrence and survival.
Twenty‐three neutrophil granulocytes in 10 high‐power fields is the best histopathological threshold to differentiate between aseptic and septic endoprosthesis loosening
Authors: Morawietz Lars , Tiddens Obbe , Mueller Michael , Tohtz Stephan , Gansukh Tserenchunt , Schroeder Joerg H , Perka Carsten , Krenn Veit
Published: June 2009

Aims:  The histopathological diagnosis of infection in periprosthetic tissue from loose total joint endoprosthesis has been the subject of controversy. The aim was to define a histological criterion that would best differentiate between aseptic and septic endoprosthesis loosening.

Methods and results:  Neutrophilic granulocytes (NG) were enumerated histopathologically in 147 periprosthetic membranes obtained from aseptic and septic revision surgery, using periodic acid–Schiff (PAS) stains and CD15 immunohistochemistry. Cell numbers were correlated with the results of microbiological culture and the clinical diagnoses. Using receiver–operating characteristics, an optimized threshold was found at 23 NG in 10 high‐power fields (HPF). Using this threshold, histopathological examination had a sensitivity of 73% and specificity of 95% when compared with microbiological diagnosis (area under the curve 0.881), and a sensitivity of 77% and specificity of 97% when compared with clinical diagnosis (area under the curve 0.891).

Conclusions:  We therefore recommend a counting algorithm with a threshold of ≥23 NG in 10 HPF (visual field diameter 0.625 mm) for the histopathological diagnosis of septic endoprosthesis loosening. If the enumeration of NG is difficult in conventional haematoxylin and eosin‐stained slides, CD15 immunohistochemistry should be performed, whereas the PAS stain has not proven to be helpful .
Autoimmune pancreatitis‐related cholecystitis: a morphologically and immunologically distinctive form of lymphoplasmacytic sclerosing cholecystitis
Authors: Wang Wei‐Lia , Farris Alton B , Lauwers Gregory Y , Deshpande Vikram
Published: June 2009

Aims:  Gallbladder involvement in autoimmune pancreatitis (AIP) is reported to be histologically similar to that seen in primary sclerosing cholangitis (PSC) and biliary obstruction secondary to pancreatic ductal adenocarcinoma (PDAC). The aim was to identify unique morphological and immunological features that could help distinguish gallbladders of AIP from those associated with PSC and PDACs.

Methods and results:  Archival gallbladders from well‐characterized individuals with AIP (n = 22), PSC (n = 13) and PDAC (n = 23) were examined. Quantitative immunohistochemical analysis for IgG and IgG4 plasma cells was performed and an IgG4/IgG ratio was derived. Dense extramural infiltrates were almost exclusively seen in AIP cases (41%), but seen in only 4% of PDAC‐associated cases and 0% of PSC cases (P = 0.001). Phlebitis was more frequently noted in AIP cases (41%) (P = 0.03). Inflammatory nodules were almost exclusively seen in AIP (27%) (P = 0.04). AIP gallbladders showed higher IgG4/IgG ratios (P = 0.0001) than PDAC‐associated and PSC gallbladders.

Conclusions:  The findings support our hypothesis that gallbladder involvement in AIP is a primary manifestation of this disease and not a secondary phenomenon related to biliary obstruction. In conjunction with imaging and serology, examination of the gallbladder could provide collaborative evidence of AIP. Evaluation of the gallbladder could also distinguish PSC from AIP‐related cholangitis.
Routinely diagnosed low‐grade dysplasia in Barrett’s oesophagus: a population‐based study of natural history
Authors: Gatenby Piers , Ramus James , Caygill Christine , Shepherd Neil , Winslet Marc , Watson Anthony
Published: June 2009

Aims:  To examine the natural history of columnar‐lined oesophagus with routinely diagnosed low‐grade dysplasia and ascertain the risk of oesophageal adenocarcinoma development.

Methods and results:  A multicentre retrospective cohort study of 283 patients with low‐grade dysplasia. Follow‐up data were obtained from examination of hospital records. One hundred and forty‐four patients had biopsies prior to low‐grade dysplasia diagnosis and 217 had follow‐up biopsies after index low‐grade dysplasia diagnosis. In these patients the incidence of high‐grade dysplasia and adenocarcinoma combined was 4.6% per annum and of adenocarcinoma alone was 2.7% per annum. At most recent follow‐up, 43 (19.8%) had persistent low‐grade dysplasia, 37 (17.1%) had changes indefinite for dysplasia and 108 (49.8%) had non‐dysplastic columnar‐lined oesophagus. When prevalent cases were excluded (those occurring within 1 year of index low‐grade dysplasia diagnosis), the annual incidence of high‐grade dysplasia and adenocarcinoma combined was 2.2% and of adenocarcinoma alone was 1.4%. The relative risk for adenocarcinoma development in low‐grade dysplasia compared with non‐dysplastic columnar‐lined oesophagus was 2.871 (P = 0.002).

Conclusions:  Low‐grade dysplasia has a threefold increased risk of progression to cancer compared with non‐dysplastic epithelium, but in the majority of patients dysplasia is not subsequently detected.
The experience of uncertainty among patients having peritoneal dialysis
Authors: Madar Hadassa , Bar‐Tal Yoram
Published: June 2009

Title.  The experience of uncertainty among patients having peritoneal dialysis.

Aim.  This paper is a report of a study conducted to examine factors (severity and duration of the disease, credible authority, social support, education) that may influence the level of uncertainty and stress in patients having peritoneal dialysis.

Background.  Although home peritoneal dialysis improves the patient’s quality of life, it has both physiological and psychosocial disadvantages. These disadvantages, along with the experience of chronic disease (end‐stage renal disease), create strong feelings of stress and uncertainty. Few studies have examined the correlation between the peritoneal dialysis experience and this level of uncertainty.

Method.  The sample comprised 71 patients having peritoneal dialysis. Their average age was 57 years (SD = 12·8), average number of years of education was 11·9 (SD = 3·25), and average time on peritoneal dialysis was 30·6 months (SD = 12·8). Data were collected from February to June 2004; the subjects answered a questionnaire comprising medical data, perception of the nurse and/or physician as epistemic authority, satisfaction with social support, level of uncertainty regarding the disease, its treatment and outcomes, and level of stress.

Findings.  Only patients’ self‐rated health and level of education, and doctors’ epistemic authority contributed statistically significantly to explaining patients’ uncertainty. Level of education was found to affect both uncertainty and stress. The factors that most influenced patients’ uncertainty were related to their ability to process information. Familiarity with their disease was less influential.

Conclusion.  Peritoneal dialysis nurses should be aware of the fact that they can reduce their patients’ uncertainty and stress by helping them to maintain hope and to view their health status positively.
A cost‐effectiveness study of a patient‐centred integrated care pathway
Authors: Olsson Lars‐Eric , Hansson Elisabeth , Ekman Inger , Karlsson Jón
Published: June 2009

Title.  A cost‐effectiveness study of a patient‐centred integrated care pathway.

Aim.  The aim of the study was to compare costs and consequences for an integrated care pathway intervention group with those of a usual care group for patients admitted with hip fracture.

Background.  Rehabilitation for patients with hip fracture consists of training in hospital and/or in a rehabilitation unit, and on their own at home with assistance from community care staff. It is important for hospitals to provide methods of care that can safeguard these older patients’ physical function and potential for independent living.

Methods.  A consecutive sample of 112 independently living participants, aged 65 years or older and admitted to hospital with a hip fracture, were included in the study. Data were collected over an 18‐month period in 2003–2005. A cost‐effectiveness analysis was performed to compare an integrated care pathway intervention (treatment A) with usual care (treatment B).

Results.  There was a 40% reduction for each participant in the average total cost of treatment A of €9685 vs. €15,984 for treatment B. Moreover, clinical effectiveness was much improved. The cost‐effectiveness ratio for treatment A was €14,840 vs. €31,908 for treatment B. In addition, 75% of the participants in treatment A were successfully rehabilitated vs. 55% in treatment B.

Conclusions.  The recovery trajectory for hip fracture surgery may be shortened if nurses pay more attention to the individual patient’s resources and motivation for rehabilitation. The application of an integrated care pathway with individualized care appears to enhance both rehabilitation outcomes and cost‐effectiveness.
Caring for abused women: impact on nurses’ professional and personal life experiences
Authors: Goldblatt Hadass
Published: June 2009

Title. Caring for abused women: impact on nurses’ professional and personal lifeexperiences.

Aim. This article is a report of a study of the impact of caring for abused women on nurses’ professional and personal life experiences.

Background. Encountering abused women can have emotional, cognitive and behavioural influences on nurses, known as vicarious traumatization. They may feel incompetent to deal with such an overwhelming problem and may avoid screening survivors of abuse. Thus, nurses treating these survivors need to be aware of their attitudes, emotions and differential responses during these interactions.

Method. A phenomenological study was carried out in 2005 in Israel. The data were collected using in‐depth, interviews with 22 female Israeli nurses in hospitals and community healthcare clinics.

Findings. Data analysis revealed one main theme, ‘Struggling on work and home fronts’, based on two subthemes: ‘Encounter with domestic violence: a challenge to nurses’ professional role perception’ and ‘Between work and home’. Nurses experience perplexity regarding abused women and their professional care. Encounters with these women challenge nurses’ personal and professional attitudes, as well as influencing their personal lives (intimate relationships, parenthood and gender attitudes). These encounters induce empathy and compassion, but also anger and criticism towards abused women, creating emotional labour for the nurses.

Conclusion. The dissonance between personal values, attitudes and emotions and the desirable professional intervention procedures might impede nurses’ performance in caring for abused women. Implementing training programmes for screening and intervening with abused women might reduce the emotional labour required, enhance nurses’ responses to domestic violence, and enable personal growth.
Characterizing violence in health care in British Columbia
Authors: Kling Rakel N. , Yassi Annalee , Smailes Elizabeth , Lovato Chris Y. , Koehoorn Mieke
Published: June 2009

Title.  Characterizing violence in health care in British Columbia.

Background.  The high rate of violence in the healthcare sector supports the need for greater surveillance efforts.

Aim.  The purpose of this study was to use a province‐wide workplace incident reporting system to calculate rates and identify risk factors for violence in the British Columbia healthcare industry by occupational groups, including nursing.

Methods.  Data were extracted for a 1‐year period (2004–2005) from the Workplace Health Indicator Tracking and Evaluation database for all employee reports of violence incidents for four of the six British Columbia health authorities. Risk factors for violence were identified through comparisons of incident rates (number of incidents/100,000 worked hours) by work characteristics, including nursing occupations and work units, and by regression models adjusted for demographic factors.

Results.  Across health authorities, three groups at particularly high risk for violence were identified: very small healthcare facilities [rate ratios (RR) = 6·58, 95% CI =3·49, 12·41], the care aide occupation (RR = 10·05, 95% CI = 6·72, 15·05), and paediatric departments in acute care hospitals (RR = 2·22, 95% CI = 1·05, 4·67).

Conclusions.  The three high‐risk groups warrant targeted prevention or intervention efforts be implemented. The identification of high‐risk groups supports the importance of a province‐wide surveillance system for public health planning.
Elective caesarean section as a transformative technological process: players, power and context
Authors: Hewer Nancy , Boschma Geertje , Hall Wendy A.
Published: June 2009

Title.  Elective caesarean section as a transformative technological process: players,power and context.

Aim.  In this paper we present a critical analysis of the debate surrounding elective caesarean section using the Social Construction of Technology perspective as a framework of analysis.

Background.  The rate of caesarean section births is increasing worldwide in industrialized countries. Reasons given for the increase include women’s characteristics, care providers’ attitudes, prevention of pelvic floor disorders and adverse outcomes.

Data Sources.  CINAHL, PubMed, Ovid, Academic Search Premier and Cochrane Data bases were searched for the years 2000 to 2007 using search terms elective caesarean section, caesarean section on demand and maternal choice caesarean section.

Discussion.  The social constructivist approach explains how caesarean section as a mode of delivery has been transformed from an emergency to an elective procedure. Analysing elective caesarean section as a socially constructed technological process exposes positions taken by obstetricians, midwives, perinatal nurses and women, including the power dynamics and contextual influences.

Conclusion.  The Social Construction of Technology perspective creates space for perinatal nurses to examine the implications of the use and meaning of elective caesarean section in a broader social context. Examining elective caesarean section from the Social Construction of Technology perspective exposes an emphasis on safety and risk for the foetus, while avoiding the equally important goal of promoting optimal postnatal health for mothers and infants. The Social Construction of Technology perspective highlights how those who define the problem control the solution.
The nature of advocacy vs. paternalism in nursing: clarifying the ‘thin line’
Authors: Zomorodi Meg , Foley Barbara Jo
Published: June 2009

Title.  The nature of advocacy vs. paternalism in nursing: clarifying the ‘thin line’.

Aim.  This paper is an exploration of the concepts of advocacy and paternalism in nursing and discusses the thin line between the two.

Background.  Nurses are involved in care more than any other healthcare professionals and they play a central role in advocating for patients and families. It is difficult to obtain a clear definition of advocacy, yet the concepts of advocacy and paternalism must be compared, contrasted, and discussed extensively. In many situations, only a thin line distinguishes advocacy from paternalism.

Data sources.  A literature search was conducted using PubMed and CINAHL databases (2000–2008) as well as a library catalogue for texts.

Discussion.  Four case stories were described in order to discuss the ‘thin line’ between advocacy and paternalism and develop communication strategies to eliminate ambiguity. Weighing the ethical principles of beneficence and autonomy helps to clarify advocacy and paternalism and provides an avenue for discussion among nurses practicing in a variety of settings.

Implications for nursing.  Advocacy and paternalism should be discussed at interdisciplinary rounds, and taken into consideration when making patient care decisions. It is difficult to clarify advocacy vs. paternalism, but strategies such as knowing the patient, clarifying information, and educating all involved are initial steps in distinguishing advocacy from paternalism.

Conclusion.  Truly ‘knowing’ patients, their life experiences, values, beliefs and wishes can help clarify the ‘thin line’ and gain a grasp of these difficult to distinguish theoretical concepts.
Coitus interruptus as a contraceptive method: Turkish women’s perceptions and experiences
Authors: Çiftçioğlu Sibel , Erci Behice
Published: June 2009

Title.  Coitus interruptus as a contraceptive method: Turkish women’s perceptions and experiences

Aim.  This paper is a report of a study conducted to determine the perceptions and experiences of coitus interruptus as a contraceptive method used by married women in Turkey.

Background.  Various factors affect women’s choice of contraceptive methods. One of these factors is socioeconomic status, which may have an effect on the practice of coitus interruptus by women. Socioeconomic status refers to the relative position of a family or individual in a hierarchical social structure based on their access to or control over wealth, prestige and power.

Methods.  The study population consisted of married Turkish women from two different socioeconomic status groups in Turkey who were currently using coitus interruptus. Structured interviews on their demographic characteristics and perceptions and experiences of coitus interruptus were carried out between August 2004 and August 2005 with a convenience sample of 422 women (response rate 97·2%).

Findings.  Most participants were satisfied with the practice of coitus interruptus. Conception was the most common reason for discontinuing practice of the method. Age and educational level of participants did not affect failure in coitus interruptus practice in women of either socioeconomic status. The majority of the women of both socioeconomic statuses began practising coitus interruptus again after having stopped.

Conclusions.  Women generally favoured coitus interruptus, believing in its efficacy and safety, and stated that both women and their husbands preferred to use it. Nurses and midwives should promote knowledge of all effective methods for fertility regulation while women are in the fertile ages.
Assigning poetry reading as a way of introducing students to qualitative data analysis
Authors: Raingruber Bonnie
Published: June 2009

Title.  Assigning poetry reading as a way of introducing students to qualitative dataanalysis.

Aim.  The aim of the paper is to explain how poetry reading can be used to teach interpretive analysis of qualitative data.

Background.  A number of studies were located in the nursing literature that focused on using poetry to help students develop empathy for patients, to teach students to reflect on their own practice, and to assist them in developing self‐understanding. No studies were found that described the use of poetry reading as a way of teaching the skill of interpretive analysis. There are, however, a number of parallels between the principles of poetry reading and qualitative analysis that suggest that this method of teaching would be successful.

Data sources.  International papers published on PubMed, Medline, and CINAHL were reviewed to identify challenges facing educators and ways of teaching the process of qualitative data analysis using poetry reading.

Findings.  Using poetry reading to teach skills of qualitative data analysis helps motivate students, cultivates a reflective mindset, and develops the skill of working as a member of an interpretive group. Framing interpretive work as being like reading poetry helps students pick up more quickly on the art that is a major component of the work. This approach also helps students learn the importance of cultural and contextual particulars as they begin analyzing qualitative data.

Conclusion.  Using poetry reading to introduce students to the complex skill of qualitative data analysis is an effective pedagogical strategy.
Effect of dietary behaviour modification on anthropometric indices and eating behaviour in obese adolescent girls
Authors: Sarvestani Raheleh Sabet , Jamalfard Mohammad Hoseein , Kargar Marziye , Kaveh Mohammad Hoseein , Tabatabaee Hamid Reza
Published: June 2009

Title.  Effect of dietary behaviour modification on anthropometric indices and eating behaviour in obese adolescent girls.

Aim.  This paper is a report of a study conducted to evaluate the effects of behaviour modification on anthropometric indices and to explore if behaviour modification could improve eating behaviour in adolescents.

Background.  Obesity is currently the most important nutritional disease of children and adolescents. To date, several attempts to achieve weight loss in children have been made, but little is known about their effects on improving eating behaviours.

Method.  Sixty obese adolescent girls participated in a behaviour modification program which was held for 16 weeks in 2007. The participants were randomly selected from two different schools and were assigned to an experimental and control group (30 participants each). Anthropometric indices and eating behaviours were assessed before and after the program. Eating behaviour was assessed using the Dutch Eating Behaviour Questionnaire.

Result.  There were statistically significant differences in changes in body weight (−2·75 kg vs. 0·62 kg), body mass index (−1·07 kg/m2 vs. 0·24 kg/m2) and arm circumference (−2·31 cm vs. 0·5 cm) in the experimental group in contrast to controls (P < 0·001). There were also statistically significant differences in scores for eating behaviour, emotional eating (0·63, 0·17), external eating (0·99, 0·05) and restrained eating (0·72, 0·03) in the experimental vs. the control group respectively (P < 0·001).

Conclusion.  Nurses, more than other healthcare professionals, can address obesity in adolescents and they should not concentrate solely on weight reduction, but also encourage children to acquire a healthy lifestyle.