bluuebunny/crossref_metadata_2025 huggingface dataset:
The experience of working on a locked acute psychiatric ward
Authors: JOHANSSON I. M. , SKÄRSÄTER I. , DANIELSON E.
Published: July 2012

Accessible summary

Acute psychiatric wards, many of which are locked, are challenging work environments. This study explores the experience of health‐care staff working on such a ward.

The study shows that the health‐care staff have to manage a changing and demanding work environment. A need for security and control is indicated.

Some positive experiences from work are described, such as meaningfulness and personal development, which counterbalance the burden of working in this environment.

The forces that drive health‐care staff and their motivation for working on acute psychiatric wards need to be studied further.

This study's aim was to elucidate health‐care staff experience of working on a locked acute psychiatric ward. In many countries changes in health care has contributed to fewer beds available in inpatient care, and a concentration of patients with severe psychiatric conditions. This implies a changing work environment in acute psychiatric care. Qualitative interviews with health‐care staff (n= 10) were carried out on a ward for patients with affective disorder and eating disorder in a Swedish hospital. Qualitative content analysis was used. Four themes were identified from the data: ‘undergoing changes in care delivery’, ‘feeling a need for security and control’, ‘managing the demands at work’ and ‘feeling a sense of responsibility’. This study adds to earlier research into how a sense of responsibility can place a significant burden on health‐care staff working on a locked psychiatric ward and also contribute to increased control of patients. This study also shows that relationships and power structures among health‐care staff need to be addressed when organizational changes are made in care delivery. Further research is needed to reach a comprehensive understanding of care on locked acute psychiatric wards, including a development of nursing and medicine as knowledge domains in one common context.
Quantitative electroencephalography during rapid eye movement (REM) and non‐REM sleep in combat‐exposed veterans with and without post‐traumatic stress disorder
Authors: COHEN DANIEL J. , BEGLEY AMY , ALMAN JENNIE J. , CASHMERE DAVID J. , PIETRONE REGINA N. , SERES ROBERT J. , GERMAIN ANNE
Published: July 2012

Sleep disturbances are a hallmark feature of post‐traumatic stress disorder (PTSD), and associated with poor clinical outcomes. Few studies have examined sleep quantitative electroencephalography (qEEG), a technique able to detect subtle differences that polysomnography does not capture. We hypothesized that greater high‐frequency qEEG would reflect ‘hyperarousal’ in combat veterans with PTSD (n = 16) compared to veterans without PTSD (n = 13). EEG power in traditional EEG frequency bands was computed for artifact‐free sleep epochs across an entire night. Correlations were performed between qEEG and ratings of PTSD symptoms and combat exposure. The groups did not differ significantly in whole‐night qEEG measures for either rapid eye movement (REM) or non‐REM (NREM) sleep. Non‐significant medium effect sizes suggest less REM beta (opposite to our hypothesis), less REM and NREM sigma and more NREM gamma in combat veterans with PTSD. Positive correlations were found between combat exposure and NREM beta (PTSD group only), and REM and NREM sigma (non‐PTSD group only). Results did not support global hyperarousal in PTSD as indexed by increased beta qEEG activity. The correlation of sigma activity with combat exposure in those without PTSD and the non‐significant trend towards less sigma activity during both REM and NREM sleep in combat veterans with PTSD suggests that differential information processing during sleep may characterize combat‐exposed military veterans with and without PTSD.
In situ hybridization for the detection of hepatitis C virus RNA in human liver tissue
Authors: Li G. , Li K. , Lea A. S. , Li N. L. , Abdulla N. E. , Eltorky M. A. , Ferguson M. R.
Published: July 2012

In situ hybridization (ISH) enables visualization of specific nucleic acid in morphologically preserved cells and tissue sections. Detection of the HCV genomes in clinical specimens is useful for differential diagnosis, particularly between recurrent HCV infection and acute cellular rejection in transplant specimens. We optimized an ISH protocol that demonstrated sensitivity and specificity for detecting genomic and replicative form of HCV RNA in tissue biopsies. Digoxigenin (Dig)‐labelled sense and anti‐sense riboprobes were synthesized using a plasmid containing a fragment of the highly conserved HCV noncoding region as a template. The efficiency of the Dig‐labelled riboprobes in detecting genomic and replicative‐intermediate HCV RNA was analysed in 30 liver biopsies from patients infected or uninfected with HCV in a blinded study. A Huh7 cell line that stably replicates genome‐length HCV RNA was developed to be used as a positive control. Negative control riboprobes were used in parallel to evaluate and control for background staining. The anti‐sense probe detected HCV RNA in 20/21 specimens from HCV‐infected liver tissues obtained from patients and in 0/9 samples from patients with non‐HCV‐related liver diseases, resulting in a sensitivity and specificity of 95% and 100%, respectively. HCV genomic RNA was variably distributed in tissue sections and was located primarily in the perinuclear regions in hepatocytes. Detection of HCV RNA by our optimized ISH protocol appears to be a sensitive and specific method when processing clinical specimens. It may also be revealing when exploring the pathophysiology of HCV infection by verifying the presence of viral genetic material within heptocytes and other cellular elements of diseased liver tissue. This methodology might also evaluate the response to antiviral therapies by demonstrating the absence or alteration of genetic material in clinical specimens from successfully treated patients.
Effect of immunosuppressive therapy on patients with inflammatory bowel diseases and hepatitis B or C virus infection
Authors: Morisco F. , Castiglione F. , Rispo A. , Stroffolini T. , Sansone S. , Vitale R. , Guarino M. , Biancone L. , Caruso A. , D'Inca R. , Marmo R. , Orlando A. , Riegler G. , Donnarumma L. , Camera S. , Zorzi F. , Renna S. , Bove V. , Tontini G. , Vecchi M. , Caporaso N.
Published: July 2012

Viral hepatitis reactivation has been widely reported in patients undergoing immunosuppressive therapy; however, few data are available about the risk of HBV and HCV reactivation in patients with inflammatory bowel disease, receiving immunosuppressive drugs. The aim of our study was to assess the prevalence of HBV and HCV infection in a consecutive series of patients with inflammatory bowel disease and to value the effects of immunosuppressive therapy during the course of the infection. Retrospective observational multicenter study included all consecutive patients with inflammatory bowel disease who have attended seven Italian tertiary referral hospitals in the last decade. A total of 5096 patients were consecutively included: 2485 Crohn's disease and 2611 Ulcerative Colitis. 30.5% and 29.7% of the patients were investigated for HBV and HCV infection. A total of 30 HBsAg positive, 17 isolated anti‐HBc and 60 anti‐HCV‐positive patients were identified. In all, 20 patients with HBV or HCV infection received immunosuppressive therapy (six HBsAg+; four isolated anti‐HBc+ and 10 anti‐HCV+). One of six patients showed HBsAg+ and one of four isolated anti‐HBc+ experienced reactivation of hepatitis. Two of six HBsAg patients received prophylactic therapy with lamivudine. Only one of 10 anti‐HCV+ patients showed mild increase in viral load and ALT elevation. Screening procedures for HBV and HCV infection at diagnosis have been underused in patients with inflammatory bowel disease. We confirm the role of immunosuppressive therapy in HBV reactivation, but the impact on clinical course seems to be less relevant than previous reported.
Determining the age of adult flesh flies, Boettcherisca peregrina, using pteridine fluorescence
Authors: ZHU G. H. , YE G. Y. , LI K. , HU C. , XU X. H.
Published: July 2012

To assess the potential application of pteridine fluorescence in determining the age of adult Boettcherisca peregrina (Diptera: Sarcophagidae) Robineau‐Desvoidy and further for the postmortem interval, the age‐dependent changes of pteridine fluorescence were investigated for the adults maintained at five constant temperatures. From the results, significant linear relationships were found between pteridine fluorescence and the age of the adults maintained at 16, 20, 24, 28 or 32 °C (P < 0.001, r2 > 0.85). In addition, the relationships between the rate of pteridine accumulation and temperature were well described using linear equations for adult females and males. Then for each cohort of the flies at the ambient temperature, a calendar was constructed and used to determine the ages of females and males, respectively, in which was recorded in reverse time order the amount of pteridine accumulated per hour by the flies and their expected pteridine level when they emerged at the specified time. A significant linear relationship between estimated ages and chronological ages was observed for female or male adults, with the mean errors of the estimated ages of ±1.82 days for females and ±1.58 days for males. It is suggested that pteridine fluorescence analysis has a potential value in determining the age of adult B. peregrina.
Antiretroviral therapy uptake and coverage in four HIV community cohort studies in sub‐Saharan Africa
Authors: Wringe Alison , Floyd Sian , Kazooba Patrick , Mushati Phyllis , Baisley Kathy , Urassa Mark , Molesworth Anna , Schumacher Christina , Todd Jim , Zaba Basia
Published: July 2012

Objective  To compare socio‐demographic patterns in access to antiretroviral therapy (ART) across four community HIV cohort studies in Africa.

Methods  Data on voluntary counselling and testing and ART use among HIV‐infected persons were analysed from Karonga (Malawi), Kisesa (Tanzania), Masaka (Uganda) and Manicaland (Zimbabwe), where free ART provision started between 2004 and 2007. ART coverage was compared across sites by calculating the proportion on ART among those estimated to need treatment, by age, sex and educational attainment. Logistic regression was used to identify socio‐demographic characteristics associated with undergoing eligibility screening at an ART clinic within 2 years of being diagnosed with HIV, for three sites with information on diagnosis and screening dates.

Results  Among adults known to be HIV‐infected from serological surveys, the proportion who knew their HIV status was 93% in Karonga, 37% in Kisesa, 46% in Masaka and 25% in Manicaland. Estimated ART coverage was highest in Masaka (68%) and lowest in Kisesa (2%). The proportion of HIV‐diagnosed persons who were screened for ART eligibility within 2 years of diagnosis ranged from 14% in Kisesa to 84% in Masaka, with the probability of screening uptake increasing with age at diagnosis in all sites.

Conclusions  Higher HIV testing rates among HIV‐infected persons in the community do not necessarily correspond with higher uptake of ART, nor more equitable treatment coverage among those in need of treatment. In all sites, young adults tend to be disadvantaged in terms of accessing and initiating ART, even after accounting for their less urgent need.
Patterns of uptake of HIV testing in sub‐Saharan Africa in the pre‐treatment era
Authors: Cremin Ide , Cauchemez Simon , Garnett Geoffrey P. , Gregson Simon
Published: July 2012

Objectives  To compare nationally representative trends in self‐reported uptake of HIV testing and receipt of results in selected countries prior to treatment scale‐up.

Methods  Demographic and Health Survey (DHS) data from 13 countries in sub‐Saharan Africa were used to describe the pattern of uptake of testing for HIV among sexually active participants. Univariate and multivariate logistic regression were used to analyse the associations between socio‐demographic and behavioural characteristics and the uptake of testing.

Results  Knowledge of serostatus ranged from 2.2% among women in Guinea (2005) to 27.4% among women in Rwanda (2005). Despite varied levels of testing, univariate analysis showed the profile of testers to be remarkably similar across countries, with respect to socio‐demographic characteristics such as area of residence and socio‐economic status. HIV‐positive participants were more likely to have tested and received their results than HIV‐negative participants, with the exception of women in Senegal and men in Guinea. Adjusted analyses indicate that a secondary or higher level of education was a key determinant of testing, and awareness that treatment exists was independently positively associated with testing, once other characteristics were taken into account.

Conclusion  This work provides a baseline for monitoring trends in testing and exploring changes in the profile of those who get tested after the introduction and scale‐up of treatment.
The impact of antiretroviral treatment on mortality trends of HIV‐positive adults in rural Uganda: a longitudinal population‐based study, 1999–2009
Authors: Kasamba Ivan , Baisley Kathy , Mayanja Billy N. , Maher Dermot , Grosskurth Heiner
Published: July 2012

Objective  To investigate trends in all‐cause adult mortality after the roll‐out of an antiretroviral therapy (ART) programme in rural Uganda.

Methods  Longitudinal population‐based cohort study of approximately 20 000 residents in rural Uganda. Mortality in adults aged 15–59 years was determined for the 5‐year period (1999–2003) before introduction of ART in January 2004 and for the 5‐year period afterwards. Poisson regression was used to estimate mortality rate ratios (RRs) for the period before ART, 1 year after ART introduction (from January 2004 to January 2005) and more than 1 year after ART introduction. Trends in mortality were analysed by HIV status, age and sex.

Results  Before ART became available, the mortality rate (deaths per 1000 person‐years) was 4.0 (95% CI = 3.3–4.8) among HIV‐negative individuals and 116.4 (95% CI = 101.9–133.0) among HIV‐positive individuals. During the period January 2004–end November 2009, 279 individuals accessed ART. In the year after ART was introduced, the mortality rate (deaths per 1000 person‐years) among HIV‐negative individuals did not change significantly (adjusted RR = 0.95, 95% CI = 0.61–1.47), but among HIV‐positive individuals dropped by 25% to 87.4 (adjusted RR = 0.75, 95% CI = 0.53–1.06). In the period 2005–2009, the mortality rate (deaths per 1000 person‐years) among HIV‐positive individuals fell further to 39.9 (adjusted RR = 0.33, 95% CI = 0.26–0.43). The effect was greatest among individuals aged 30–44 years, and trends were similar in men and women.

Conclusion  The substantially reduced mortality rate among HIV‐positive individuals after ART roll‐out lends further support to the intensification of efforts to ensure universal access to ART.
HIV status and participation in HIV surveillance in the era of antiretroviral treatment: a study of linked population‐based and clinical data in rural South Africa
Authors: Bärnighausen T. , Tanser F. , Malaza A. , Herbst K. , Newell M. ‐L.
Published: July 2012

Objective  To examine whether HIV status affects participation in a population‐based longitudinal HIV surveillance in the context of an expanding HIV treatment and care programme in rural South Africa.

Method  We regressed consent to participate in the HIV surveillance during the most recent fieldworker visit on HIV status (based on previous surveillance participation or enrolment in pre‐antiretroviral treatment (pre‐ART) care or ART in the local HIV treatment and care programme), controlling for sex, age and year of the visit (N = 25 940). We then repeated the regression using the same sample but, in one model, stratifying HIV‐infected persons into three groups (neither enrolled in pre‐ART care nor receiving ART; enrolled in pre‐ART care but not receiving ART; receiving ART) and, in another model, additionally stratifying the group enrolled in pre‐ART and the group receiving ART into those with CD4 count ≤200/μl (i.e. the ART eligibility threshold at the time) vs. those with CD4 count >200/μl.

Results  HIV‐infected individuals were significantly less likely to consent to participate in the surveillance than HIV‐uninfected individuals [adjusted odds ratio (aOR), 0.74; 95% confidence interval, 0.70–0.79, P < 0.001], controlling for other factors. Persons who were receiving ART were less likely to consent to participate (aOR, 0.75, 0.68–0.84, P < 0.001) than those who had never sought HIV treatment or care (aOR, 0.82, 0.75–0.89, P < 0.001), but more likely to consent than persons enrolled in pre‐ART care (aOR 0.62, 0.56–0.69, P < 0.001). Those with CD4 count ≤200/μl were significantly less likely to consent to participate than those with CD4 count >200/μl in both the group enrolled in pre‐ART and the group receiving ART.

Conclusion  As HIV test results are not made available to participants in the HIV surveillance, our findings agree with the hypothesis that HIV‐infected persons are less likely than HIV‐uninfected persons to participate in HIV surveillance because they fear the negative consequences of others learning about their HIV infection. Our results further suggest that the increased knowledge of HIV status that accompanies improved ART access can reduce surveillance participation of HIV‐infected persons, but that this effect decreases after ART initiation, in particular in successfully treated patients.
Adult mortality and probable cause of death in rural northern Malawi in the era of HIV treatment
Authors: Chihana Menard , Floyd Sian , Molesworth Anna , Crampin Amelia C. , Kayuni Ndoliwe , Price Alison , Zaba Basia , Jahn Andreas , Mvula Hazzie , Dube Albert , Ngwira Bagrey , Glynn Judith R. , French Neil
Published: July 2012

Objectives  Developing countries are undergoing demographic transition with a shift from high mortality caused by communicable diseases (CD) to lower mortality rates caused by non‐communicable diseases (NCD). HIV/AIDS has disrupted this trend in sub‐Saharan Africa. However, in recent years, HIV‐associated mortality has been reduced with the introduction of widely available antiretroviral therapy (ART). Side effects of ART may lead to increased risk of cardiovascular diseases, raising the prospects of an accelerated transition towards NCD as the primary cause of death. We report population‐based data to investigate changes in cause of death owing to NCD during the first 4 years after introduction of HIV treatment.

Methods  We analysed data from a demographic surveillance system in Karonga district, Malawi, from September 2004 to August 2009. ART was introduced in mid‐2005. Clinician review of verbal autopsies conducted 2–6 weeks after a death was used to establish a single principal cause of death.

Results  Over the entire period, there were 905 deaths, AIDS death rate fell from 505 to 160/100 000 person‐years, and there was no evidence of an increase in NCD rates. The proportion of total deaths attributable to AIDS fell from 42% to 17% and from NCD increased from 37% to 49%.

Discussion  Our findings show that 4 years after the introduction of ART into HIV care in Karonga district, all‐cause mortality has fallen dramatically, with no evidence of an increase in deaths owing to NCD.
Access to, and uptake of, antiretroviral therapy in a developing country with high HIV prevalence: a population‐based cohort study in rural Uganda, 2004–2008
Authors: Kazooba Patrick , Kasamba Ivan , Baisley Kathy , Mayanja Billy N. , Maher Dermot
Published: July 2012

Objectives  To investigate antiretroviral therapy (ART) uptake after its introduction in 2004 in a longitudinal population‐based cohort and its nested clinical cohort in rural Uganda.

Methods  A HIV serosurvey of all adults aged ≥15 years is conducted annually. Two intervals were selected for analysis. Interval 1 (November 2004–October 2006) provided 2 years of follow‐up to prospectively evaluate access to HIV services. Interval 2 (November 2007–October 2008) was used to evaluate current coverage of services. Logistic regression was used to identify sociodemographic factors associated with ART screening within 2 years of diagnosis. ART coverage was assessed using Weibull survival models to estimate the numbers needing ART.

Results  In Interval 1, 636 HIV‐positive adults were resident and 295 (46.4%) knew their status. Of those, 248 (84.1%) were screened for ART within 2 years of diagnosis. After adjusting for age, those who were widowed, separated or never married were more likely to be screened than those who were married. In Interval 2, 575 HIV‐positive adults were residents, 322 (56.0%) knew their status, 255 (44.3%) had been screened for ART and 189 (32.9%) had started ART. Estimated ART coverage was 66%.

Conclusions  In this cohort, ART access and uptake is very high once people are diagnosed. Owing to intensive screening in the study clinic, nearly all participants who were eligible initiated ART. However, this is unlikely to reflect coverage in the general population, intensified efforts are needed to promote HIV testing, and ART screening and uptake are needed among those found to be HIV‐positive.
The effect of antiretroviral therapy provision on all‐cause, AIDS and non‐AIDS mortality at the population level – a comparative analysis of data from four settings in Southern and East Africa
Authors: Floyd Sian , Marston Milly , Baisley Kathy , Wringe Alison , Herbst Kobus , Chihana Menard , Kasamba Ivan , Bärnighausen Till , Urassa Mark , French Neil , Todd Jim , Zaba Basia
Published: July 2012

Objective  To provide a broad and up‐to‐date picture of the effect of antiretroviral therapy (ART) provision on population‐level mortality in Southern and East Africa.

Methods  Data on all‐cause, AIDS and non‐AIDS mortality among 15–59 year olds were analysed from demographic surveillance sites (DSS) in Karonga (Malawi), Kisesa (Tanzania), Masaka (Uganda) and the Africa Centre (South Africa), using Poisson regression. Trends over time from up to 5 years prior to ART roll‐out, to 4–6 years afterwards, are presented, overall and by age and sex. For Masaka and Kisesa, trends are analysed separately for HIV‐negative and HIV‐positive individuals. For Karonga and the Africa Centre, trends in AIDS and non‐AIDS mortality are analysed using verbal autopsy data.

Results  For all‐cause mortality, overall rate ratios (RRs) comparing the period 2–6 years following ART roll‐out with the pre‐ART period were 0.58 (5.9 vs. 10.2 deaths per 1000 person‐years) in Karonga, 0.79 (7.2 vs. 9.1 deaths per 1000 person‐years) in Kisesa, 0.61 (6.7 compared with 11.0 deaths per 1000 person‐years) in Masaka and 0.79 (14.8 compared with 18.6 deaths per 1000 person‐years) in the Africa Centre DSS. The mortality decline was seen only in HIV‐positive individuals/AIDS mortality, with no decline in HIV‐negative individuals/non‐AIDS mortality. Less difference was seen in Kisesa where ART uptake was lower.

Conclusions  Falls in all‐cause mortality are consistent with ART uptake. The largest falls occurred where ART provision has been decentralised or available locally, suggesting that this is important.
Cohort monitoring of persons with hypertension: an illustrated example from a primary healthcare clinic for Palestine refugees in Jordan
Authors: Khader Ali , Farajallah Loai , Shahin Yousef , Hababeh Majed , Abu‐Zayed Ishtaiwi , Kochi Arata , Harries Anthony D. , Zachariah Rony , Kapur Anil , Venter Wendy , Seita Akihiro
Published: July 2012

Objective  Recording and reporting systems borrowed from the DOTS framework for tuberculosis control can be used to record, monitor and report on chronic disease. In a primary healthcare clinic run by UNRWA in Amman, Jordan, serving Palestine refugees with hypertension, we set out to illustrate the method of cohort reporting for persons with hypertension by presenting on quarterly and cumulative case finding, cumulative and 12‐month analysis of cohort outcomes and to assess how these data may inform and improve the quality of hypertension care services.

Method  This was a descriptive study using routine programme data collected through E‐Health.

Results  There were 97 newly registered patients with hypertension in quarter 1, 2012, and a total of 4130 patients with hypertension ever registered since E‐Health started in October 2009. By 31 March 2012, 3119 (76%) of 4130 patients were retained in care, 878 (21%) had failed to present to a healthcare worker in the last 3 months and the remainder had died, transferred out or were lost to follow‐up. Cumulative and 12‐month cohort outcome analysis indicated deficiencies in several components of clinical performance related to blood pressure measurements and fasting blood glucose tests to screen simultaneously for diabetes. Between 8% and 15% of patients with HT had serious complications such as cardiovascular disease and stroke.

Conclusion  Cohort analysis is a valuable tool for the monitoring and management of non‐communicable chronic diseases such as HT.
Leprosy trends in Zambia 1991–2009
Authors: Kapata Nathan , Chanda‐Kapata Pascalina , Grobusch Martin Peter , O’Grady Justin , Bates Matthew , Mwaba Peter , Zumla Alimuddin
Published: July 2012

Objective  To document leprosy trends in Zambia over the past two decades to ascertain the importance of leprosy as a health problem in Zambia.

Methods  Retrospective study covering the period 1991–2009 of routine national leprosy surveillance data, published national programme review reports and desk reviews of in‐country TB reports.

Results  Data reports were available for all the years under study apart from years 2001, 2002 and 2006. The Leprosy case notification rates (CNR) declined from 2.73/10 000 population in 1991 to 0.43/10 000 population in 2009. The general leprosy burden showed a downward trend for both adults and children. Leprosy case burden dropped from approximately 18 000 cases in 1980 to only about 1000 cases in 1996, and by the year 2000, the prevalence rates had fallen to 0.67/10 000 population. There were more multibacillary cases of leprosy than pauci‐bacillary cases. Several major gaps in data recording, entry and surveillance were identified. Data on disaggregation by gender, HIV status or geographical origin were not available.

Conclusion  Whilst Zambia has achieved WHO targets for leprosy control, leprosy prevalence data from Zambia may not reflect real situation because of poor data recording and surveillance. Greater investment into infrastructure and training are required for more accurate surveillance of leprosy in Zambia.
Apoptosis of mouse mast cells is reciprocally regulated by the IgG receptors FcγRIIB and FcγRIIIA
Authors: Fang Y. , Larsson L. , Bruhns P. , Xiang Z.
Published: July 2012

Background

Mast cells are important effector cells in allergy. They usually have a long life span and resist cell death induction. Fcγ receptor– and IgG immune complex–mediated apoptosis has been demonstrated in B‐lineage cells, but not in mast cells. The aim of the current study was to investigate whether mast cells could respond to apoptosis induction by IgG immune complex aggregation of Fcγ receptors. It is known that mouse mast cells express the low‐affinity Fcγ receptors FcγRIIB and FcγRIIIA, which bind IgG especially in the form of antigen–IgG immune complexes.

Methods

Mouse bone marrow–derived cultured mast cells were examined for surface expression of FcγRIIB and FcγRIIIA. Apoptosis of such cells from wild‐type, FcγRIIB−/− or FcγRIIIA−/− mice was measured following receptor aggregation by IgG immune complexes.

Results

Our data demonstrate that aggregation of either FcγRIIB or FcγRIIIA by IgG immune complexes induced apoptosis of mouse bone marrow–derived cultured mast cells. However, mast cells expressing both FcγRIIB and FcγRIIIA were able to resist cell death induction by IgG immune complexes.

Conclusion

Our findings reveal a fine‐tuning system for regulating mast cell apoptosis through aggregating Fcγ receptors by IgG immune complexes. Such apoptosis regulation may have a substantial impact on mast cell homeostasis during allergic inflammation.
Human Mendelian pain disorders: a key to discovery and validation of novel analgesics
Authors: Goldberg YP , Pimstone SN , Namdari R , Price N , Cohen C , Sherrington RP , Hayden MR
Published: July 2012

We have utilized a novel application of human genetics, illuminating the important role that rare genetic disorders can play in the development of novel drugs that may be of relevance for the treatment of both rare and common diseases. By studying a very rare Mendelian disorder of absent pain perception, congenital indifference to pain, we have defined Nav1.7 (endocded by SCN9A) as a critical and novel target for analgesic development. Strong human validation has emerged with SCN9A gain‐of‐function mutations causing inherited erythromelalgia (IEM) and paroxysmal extreme pain disorder, both Mendelian disorder of spontaneous or easily evoked pain. Furthermore, variations in the Nav1.7 channel also modulate pain perception in healthy subjects as well as in painful conditions such as osteoarthritis and Parkinson disease. On the basis of this, we have developed a novel compound (XEN402) that exhibits potent, voltage‐dependent block of Nav1.7. In a small pilot study, we showed that XEN402 blocks Nav1.7 mediated pain associated with IEM thereby demonstrating the use of rare genetic disorders with mutant target channels as a novel approach to rapid proof‐of‐concept. Our approach underscores the critical role that human genetics can play by illuminating novel and critical pathways pertinent for drug discovery.
The impact of local anesthetic distribution on block onset in ultrasound‐guided interscalene block
Authors: LANG R. S. , KENTOR M. L. , VALLEJO M. , BIGELEISEN P. , WISNIEWSKI S. R. , OREBAUGH S. L.
Published: July 2012

Background

Recent investigations of local anesthetic distribution in the lower extremity have revealed that completely surrounding the sciatic nerve with local anesthetic provides the advantage of more rapid and complete anesthesia in the territory served by the nerve. We hypothesized that a pattern of distribution that entirely envelops the targeted nerve roots during interscalene block would provide similar benefits of more rapid anesthesia onset.

Methods

During interscalene block guided by ultrasound with nerve stimulator confirmation, the pattern of local anesthetic distribution was recorded and later classified as complete or incomplete envelopment of the visible nerve elements in 50 patients undergoing ambulatory shoulder arthroscopic surgery. The pattern was then compared with the extent of block setup at pre‐determined intervals, as well as to post‐operative pain levels and block duration.

Results

 Twenty‐two patients (44%) had complete envelopment of the nerves in the plane of injection during ultrasound imaging of the interscalene block. There was no difference in the fraction of blocks that were fully set‐up at 10 min with regards to complete or incomplete envelopment of the nerves by local anesthetic. All of the patients had complete setup of the block by 20 min. In addition, the post‐operative pain levels and duration of block did not vary among the two groups with complete vs. incomplete local anesthetic distribution around the nerves.

Conclusion

The presence or absence of complete envelopment of the nerve elements in the interscalene groove by local anesthetic did not determine the likelihood of complete block effect at pre‐determined time intervals after the procedure.
With a little help from my kin: barn swallow nestlings modulate solicitation of parental care according to nestmates' need
Authors: Romano A. , Caprioli M. , Boncoraglio G. , Saino N. , Rubolini D.
Published: July 2012

In altricial species, offspring competing for access to limiting parental resources (e.g. food) are selected to achieve an optimal balance between the costs of scrambling for food, the benefits of being fed and the indirect costs of subtracting food to relatives. As the marginal benefits of acquiring additional food decrease with decreasing levels of need, satiated offspring should be prone to favour access to food by their needy kin, thus enhancing their own indirect fitness, while concomitantly reducing costs of harsh competition with hungry broodmates. We tested this prediction in feeding trials of barn swallow (Hirundo rustica) nestlings by comparing begging behaviour and food intake of two similar‐sized nestmates, one of which was food‐deprived (FD). Non‐food‐deprived (NFD) offspring modulated begging intensity depending on their nestmate's need: when competing withFDnestmates,NFDnestlings reduced both the intensity and frequency of begging displays compared to themselves in the control trial before food deprivation. Hence,NFDnestlings reduced their competitiveness to the advantage ofFDnestmates, which obtained more feedings and showed a threefold larger increase in body mass. Moderation of individual selfishness can therefore be adaptive in the presence of a needier kin, because the indirect fitness benefits of promoting its condition can outweigh the costs of forgoing being fed, and because it limits the cost of begging escalation against a vigorous competitor.
Updating knowledge on growth, population dynamics, and ecology of the blue and red shrimp, Aristeus antennatus (Risso, 1816), on the basis of the study of its instars
Authors: Orsi Relini Lidia , Mannini Alessandro , Relini Giulio
Published: July 2012

Both national (GRUND) and international (MEDITS) trawl surveys carried out in the Italian seas since 1994 have produced consistent and rather homogeneous samples of red shrimps (per season, gear, and methods to ascertain abundance). Study and discussion of data regarding Aristeus antennatus (Risso, 1816) from Ligurian fishing grounds during the REDs project (FISH/2004/03‐32) made it possible to verify how key instars of the life of the female shrimp can be recognized from length frequency distributions derived from trawl surveys, allowing the age distributions to be split up. The segment of life that can be studied spans ages 1 and 10 and includes 20 instars, but larger sizes have been found which may extend the life span another 3 years. After age 5, only one growth instar per year occurs. Based on our study of the instars, we developed a size/age key for A. antennatus and used it to derive a von Bertalanffy growth function, total mortality rates and exploitation rates. Our results are related to basic biological and ecological characteristics of this species. Large individuals (females ≥50 mm CL at age 5 onward) present in a considerable percentage in the Ligurian Sea, are very important because (i) their fecundity is very high and therefore greatly influences the reproductive potential and (ii) they represent commercially the most valuable part of the catch. In addition, substantial relationships between the life history of A. antennatus and local oceanographic processes exist because the long life span of the species enlarges the area to which eggs and larvae are transported in surface currents, as well as the active return movements in deep waters where adult life mainly takes place. In the study area, the Northern Current provides the possibility of great horizontal displacement of A. antennatus eggs, larvae and early juveniles and, in general, attention to surface circulation may help to identify affinities in distant Mediterranean populations. This study presents A. antennatus in terms of a resource on the move at a Western Mediterranean scale.
Molecular and Cellular Characterization of Buffalo Bone Marrow‐Derived Mesenchymal Stem Cells
Authors: Gade NE , Pratheesh MD , Nath A , Dubey PK , Amarpal  , Sharma B , Saikumar G , Taru Sharma G
Published: July 2012

Contents

Immune privileged mesenchymal stem cells (MSCs) can differentiate into multiple cell types and possess great potential for human and veterinary regenerative therapies. This study was designed with an objective to isolate, expand and characterize buffalo bone marrow‐derived MSCs (BM‐MSCs) at molecular and cellular level. Buffalo BM‐MSCs were isolated by Ficoll density gradient method and cultured in Dulbecco’s modified Eagle’s medium supplemented with fetal bovine serum (FBS). These cells were characterized through alkaline phosphatase (AP) staining, colony‐forming unit (CFU) assay, mRNA expression analysis (CD 73, CD 90, CD 105, Oct4 and Nanog), immunolocalization along with flow cytometry (Stro 1, CD 73, CD 105, Oct4, Sox2 and Nanog) and in situ hybridization (Oct4 and Sox2). Multilineage differentiation (osteogenic, adipogenic and chondrogenic) was induced in vitro, which was further assessed by specific staining. Buffalo BM‐MSCs have the capacity to form plastic adherent clusters of fibroblast‐like cells and were successfully maintained up to 16th passage. These cells were AP positive, and further CFU assay confirmed their clonogenic property. RT‐PCR analysis and protein localization study showed that buffalo BM‐MSCs are positive for various cell surface markers and pluripotency markers. Cytoplasmic distribution of mRNA for pluripotency markers in buffalo BM‐MSCs and multilineage differentiation were induced in vitro, which was further assessed by specific staining. To the best of our knowledge, this is the first report of buffalo BM‐MSCs, which suggests that MSCs can be derived and expanded from buffalo bone marrow and can be used after characterization as a novel agent for regenerative therapy.
Kenya and distance education: A model to advance graduate nursing
Authors: Mutea Naomi , Cullen Deborah
Published: July 2012

Africa is faced with a myriad of challenges, such as HIV/AIDS, malaria, tuberculosis, and a variety of political and historical complications that have affected the educational system for advanced nursing practice. In Kenya, the current situation in the higher education sector does not give nurses an opportunity to pursue graduate education after they have acquired the basic diploma in nursing due to limited government support and the type of education system existing in the country today. Although distance education has been available in Kenya for professionals such as teachers, in public universities, this kind of opportunity is unreachable for nurses who are working and need to further their education. Nurses desire to have access to advanced practice education to equip them with the relevant knowledge to cope and address the complex health issues arising in the management and care of patients. A collaborative model is presented as a potential solution for this need. Four major constituents are identified including hospitals and agencies, communities of interest, Kenyan universities and international education partners. Each has a part to play including contributions to information, communication of opinion and expertise, money and support, infrastructure and in‐kind resources. Distance education is cost‐effective and will help in building capacity at various levels of nursing including leadership in clinical practice, teaching, administration and research.
Nursing documentation: Experience of the use of the nursing process model in selected hospitals inIbadan,OyoState,Nigeria
Authors: Ofi Bola , Sowunmi Olanrewaju
Published: July 2012

The descriptive study was conducted to determine the extent of utilization of the nursing process for documentation of nursing care in three selected hospitals,Ibadan,Nigeria. One hundred fifty nurses and 115 discharged clients’ records were selected from the hospitals. Questionnaires and checklists were used to collect data. Utilization of nursing process for care was 100%, 73.6% and 34.8% in the three hospitals. Nurses encountered difficulties in history taking, formulation of nursing diagnoses, objectives, nursing orders and evaluation. Most nurses disagreed or were undecided with the use of authorized abbreviations and symbols (34.3%, 40.3% and 69.5%), recording errors that occurred during care (37.1%, 56.1% and 52.2%) and inclusion of change in clients‘ condition (54.3%, 56.1% and 73.8%). Most nurses appreciated the significance of documentation. Lack of time, knowledge and need for extensive writing are the major barriers against documentation. Seventy‐seven point four per cent of the 115 clients’ records from one hospital showed evidence of documentation, no evidence from the other two. Study findings have implications for continuing professional education, practice and supervision.
Community palliative care nurse experiences and perceptions of follow‐up bereavement support visits to carers
Authors: Chang Esther , Bidewell John , Hancock Karen , Johnson Amanda , Easterbrook Sally
Published: July 2012

Community (district) nurses (CNs) are well positioned to provide follow‐up home visits to bereaved families and carers of their recently deceased palliative clients. An Australian survey of CN's (n = 58, response rate 29%) described their experiences of bereavement support visits, perceptions of their role in bereavement care and their professional support needs. Although positive experiences were commonly reported, with 95% of participants considering bereavement follow‐up visits as consistent with their role, 53% found the visits difficult for reasons such as the nurse or client not understanding the purpose, the CN‘s excessive personal identification with the client's situation, the emotional intensity of visits, and lack of confidence or skills despite prior training. The nature and quality of the CN‘s prior relationship with the bereaved family was an important determinant of the visits’ success. Results highlight the value of bereavement support visits, while identifying professional development needs. Managing emotionally intense episodes should receive priority in preparing CN's for this challenging role.
Translating and testing the Liver Disease Symptom Index 2.0 for administration to people with liver cirrhosis in Egypt
Authors: Youssef Naglaa FA , Shepherd Ashley , Evans Josie MM , Wyke Sally
Published: July 2012

The Liver Disease Symptom Index (LDSI) 2.0 is a simple, short and specific liver disease questionnaire in English, but an Arabic version does not exist, therefore we translated the LDSI‐2.0 into Arabic and tested its psychometric properties in a pilot cross‐sectional study. A convenience sample of 38 patients with liver cirrhosis from one hospital in Cairo, Egypt, were interviewed for approximately 45 min. Patients completed a background data sheet, the translated LDSI‐2.0 and the Short Form (SF)‐36v2. Construct convergent validity was examined by correlating LDSI‐2.0 items with the SF‐36v2 eight domains. Reliability was estimated using measures of internal consistency, test–retest reliability and internal consistency reliability. Median completion time was 10 min. The correlation between the translated LDSI‐2.0 items and the SF‐36 domains confirmed that there was moderate to high overlapping between the two measures, suggesting convergent validity of the LDSI‐2.0. The LDSI‐2.0 showed good to very good retest reliability (kappa value 0.62–0.94). Chronbach's alpha coefficient for the multi‐item scales ranged from 0.73 to 0.96. The Arabic LDSI‐2.0 therefore has satisfactory validity, retest reliability and internal consistency.
Effects of the contact isolation application on anxiety and depression levels of the patients
Authors: Findik Ummu Yildiz , Ozbaş Ayfer , Cavdar Ikbal , Erkan Tulay , Topcu Sacide Yildizeli
Published: July 2012

This study was aimed to assess the effects of contact isolation application on anxiety and depression levels of the patients, the effects of certain sociodemographics and patient characteristics on anxiety and depression levels, and the thoughts of the isolated patients about contact isolation. This non‐randomized quasi‐experimental study was carried out with 60 isolated and 57 non‐isolated patients with hospital infection. The data were acquired from Hospital Anxiety and Depression Scale (HADS‐A (anxiety) and HADS‐D (depression)) and patient information form. There was no statistically significant difference between the anxiety and depression levels of the isolated and non‐isolated patients. In the isolated patients, the depression points were higher in patients who were, women, received primary education and had lower income levels. Of the patients, 86.4% of them told that they were happy to be in the isolation room. Contact isolation application did not affect anxiety and depression levels of the patients. However, personal attributes increased the development of depression. In contact isolated patients, personal attributes should be taken into consideration in nursing care planning to prevent development of depression.
Development and pilot test of pictograph‐enhanced breast health‐care instructions for community‐residing immigrant women
Authors: Choi Jeungok
Published: July 2012

Current written text‐based health‐care instructions are not suitable for presenting lengthy, complex breast health‐care instructions and are difficult for immigrant women with limited literacy skills. The aims of this study were to develop breast health‐care instructions enhanced by pictographs (simple line drawings representing health‐care actions) and pilot test the instructions in a sample of six immigrant women with limited literacy skills. Based on the Mayer's Cognitive Theory of Multimedia Learning, pictographs were developed in addition to low‐literacy text. The text and the pictographs were then pilot tested with six immigrant women in community health centres for clarity, comprehension and acceptability through face‐to‐face interviews. Participants perceived that the drawings were engaging and enhanced clarity of the intended health‐care messages. The black and white simple line drawings were well received by participants of varying race and ethnicity. The pictograph‐based approach might be an effective tool in developing health‐care instructions for immigrant women with limited literacy skills. Future research is needed to compare the effect of pictograph‐enhanced instructions with written text‐based instructions on adherence to instructions and health outcomes.
Easy guide to searching for evidence for the busy clinician
Authors: Caldwell Patrina HY , Bennett Trish , Mellis Craig
Published: July 2012

The busy clinician is constantly faced with clinical questions regarding patient care. It is easy to feel overwhelmed by the large amount of health information available electronically. This article offers one easy approach for searching the electronic database. It is intended for the busy clinician who is unsure how to conduct an electronic search. It provides guidance on where to search and how to search using the PICO search method. It also provides a list of useful resources to help clinicians critically appraise the articles found to determine its relevance.
Seed germination time course and seedling development of Clintonia udensis Trautv. et Mey. (Uvulariaceae): a typical cool temperate woodland perennial in Japan
Authors: SUZUKI KOJIRO , IWASAKI NAHO , KAWANO HITOMI , KAWANO SHOICHI
Published: July 2012

Seed germination time course and seedling development mechanisms of Clintonia udensis Trautv. et Mey. (Uvulariaceae) were investigated under experimental condition. Seed germination tests were carried out under four thermal regimes, i. e. 10, 15, 20, and 25°C, after seeds were harvested, and stored at 5°C in wet conditions for 6 months under light‐exposed or shaded conditions. Approximately 63% of all seeds produced had the potential to germinate beyond 4 years and 6 months. The developmental process after germination continued for over 2 years. Phase I: the radicle first breaks through the seed coat 2 years after fructification. Phase II: the radicle becomes much larger with a hypocotyle. Phase III: part of the cotyledon elongates over 20 mm. Phase IV: the plumule further develops in two steps, i. e. the plumule is first formed, while cotyledon is disappearing, and then the plumule appears with second and third radicles, growing with cotyledon.