bluuebunny/crossref_metadata_2025 huggingface dataset:
Inbreeding and Outbreeding Depression in Natural Populations ofChamaecrista fasciculata(Fabaceae)
Authors: Fenster Charles B. , Galloway Laura F.
Published: March 2003

Abstract:The deleterious consequences of inbreeding have been well documented. There are, however, few empirical studies that have examined the consequences of restoring heterozygosity and hence the fitness of inbred populations by conducting interpopulation crosses and measuring the performance of later‐generation hybrids under field conditions. We conducted interpopulation crosses of 100 m to 2000 km, which spans the range ofChamaecrista fasciculata( Fabaceae) in eastern North America. We then contrasted the performance of the F1 and later‐segregating F3 hybrids with the parental generation. We found almost universal F1 superiority over the parents. The F3 hybrids suffered a loss of fitness compared to the F1 hybrids. The drop off in fitness of the F3 reflects both the loss of heterozygosity and the disruption of coadapted gene complexes. The F3 performance, however, was still often equal to that of the parents, suggesting that heterosis can outweigh the loss of coadaptation except for the longest‐distance crosses. In a subset of environments, the F3 performance of long‐distance (≥1000 km) interpopulation crosses was less than that of both parents and indicated true outbreeding depression. ForC. fasciculata, it appears that crossing populations of up to intermediate distances of hundreds of kilometers has a short‐term beneficial effect on progeny performance through F1, and that longer‐term effects are not necessarily disruptive of fitness, at least relative to parental performance. The degree of F1 heterosis and F3 outbreeding depression varied between site and year, however, indicating an important role for the environment in the expression of these effects.
A Case for Using Plethodontid Salamanders for Monitoring Biodiversity and Ecosystem Integrity of North American Forests
Authors: Welsh Hartwell H. , Droege Sam
Published: March 2003

Abstract: Terrestrial salamanders of the family Plethodontidae have unique attributes that make them excellent indicators of biodiversity and ecosystem integrity in forested habitats. Their longevity, small territory size, site fidelity, sensitivity to natural and anthropogenic perturbations, tendency to occur in high densities, and low sampling costs mean that counts of plethodontid salamanders provide numerous advantages over counts of other North American forest organisms for indicating environmental change. Furthermore, they are tightly linked physiologically to microclimatic and successional processes that influence the distribution and abundance of numerous other hydrophilic but difficult‐to‐study forest‐dwelling plants and animals. Ecosystem processes such as moisture cycling, food‐web dynamics, and succession, with their related structural and microclimatic variability, all affect forest biodiversity and have been shown to affect salamander populations as well. We determined the variability associated with sampling for plethodontid salamanders by estimating the coefficient of variation (CV ) from available time‐series data. The median coefficient of variation indicated that variation in counts of individuals among studies was much lower in plethodontids (27%) than in lepidoptera (93%), passerine birds (57%), small mammals (69%), or other amphibians (37–46%), which means plethodontid salamanders provide an important statistical advantage over other species for monitoring long‐term forest health.
Possible Environmental Factors Underlying Amphibian Decline in Eastern Puerto Rico: Analysis of U.S. Government Data Archives
Authors: Stallard Robert F.
Published: March 2003

Abstract: The past three decades have seen major declines in populations of several species of amphibians at high elevations in eastern Puerto Rico, a region unique in the humid tropics because of the degree of environmental monitoring that has taken place through the efforts of U.S. government agencies. I examined changes in environmental conditions by examining time‐series data sets that extend back at least into the 1980s, a period when frog populations were declining. The data include forest cover; annual mean, minimum, and maximum daily temperature; annual rainfall; rain and stream chemistry; and atmospheric‐dust transport. I examined satellite imagery and air‐chemistry samples from a single National Aeronautics and Space Administration aircraft flight across the Caribbean showing patches of pollutants, described as thin sheets or lenses, in the lower troposphere. The main source of these pollutants appeared to be fires from land clearing and deforestation, primarily in Africa. Some pollutant concentrations were high and, in the case of ozone, approached health limits set for urban air. Urban pollution impinging on Puerto Rico, dust generation from Africa ( potential soil pathogens), and tropical forest burning ( gaseous pollutants) have all increased during the last three decades, overlapping the timing of amphibian declines in eastern Puerto Rico. None of the data sets pointed directly to changes so extreme that they might be considered a direct lethal cause of amphibian declines in Puerto Rico. More experimental research is required to link any of these environmental factors to this problem.
The Bias of Complementarity Hotspots toward Marginal Populations
Authors: Araújo Miguel B. , Williams Paul H.
Published: March 2003

Abstract:It has been suggested that using complementarity to identify networks of important areas for conserving biodiversity may preferentially select areas within the margins of species ranges. We tested this idea by examining the location of complementarity hotspots in relation to two measures of range core‐periphery. The first measures patterns of aggregation among records within each species' range to identify areas within the core (i.e., areas with aggregated distributions) and periphery (i.e., areas with scattered distributions) of the range. The second measures spatial turnover among species to identify areas with a high density of range edges. For three selected groups of terrestrial vertebrates in Europe—mammals, birds, and herptiles—areas chosen based on complementarity were located within the margins of species' ranges more often than expected by chance. This pattern was consistent for the two measures of core‐periphery we used. The bias of complementarity hotspots toward marginal populations is especially important for species with restricted range sizes. If extinctions are determined mainly by demographic factors, then selecting areas at the peripheries of species' ranges might be a poor option. But if extinctions are determined mainly by extrinsic factors, then peripheral populations might be important to ensure the long‐term persistence of species.
Effects of Artisanal Fishing on Marine Communities in the Galápagos Islands
Authors: Ruttenberg Benjamin I.
Published: March 2003

Abstract: The Galápagos Islands harbor some of the least impacted marine ecosystems in the tropics, but there are indications that local artisanal fishing is affecting exploited marine communities. To quantify these effects, I sampled communities of fishes and sea urchins at a number of heavily fished and lightly fished sites throughout the central islands of the archipelago. Sites were selected based on information collected as part of a local fisheries monitoring study and standardized across a number of abiotic factors. Abundance and biomass of the primary target species were significantly lower in the heavily fished sites than in the lightly fished sites. Community structure also differed between heavily and lightly fished sites. Cluster analyses of the full community of fishes and a subset of nontarget fishes revealed that sites within a treatment were more similar to one another than sites between treatments. Herbivorous fishes tended to be lower in abundance and sea urchins tended to be higher in abundance in heavily fished sites, but these differences were not significant. My results are encouraging in that the direct effects of artisanal fishing are limited to the primary target species, which probably results from a high specificity of fishing gear. The differences in community structure, however, suggest that artisanal fishing also has cascading effects on noncommercial species throughout the community. An improved understanding of important ecological interactions, increased ecological and fishery monitoring, and effective precautionary management are needed to ensure that human effects in these waters remain minimal.
Variation among Individuals and Reduced Demographic Stochasticity
Authors: Kendall Bruce E. , Fox Gordon A.
Published: March 2003

Abstract:Population viability analysis ( PVA) is a technique that employs stochastic demographic models to predict extinction risk. All else being equal, higher variance in a demographic rate leads to a greater extinction risk.Demographic stochasticityrepresents variance due to differences among individuals. Current implementations of PVAs, however, assume that the expected fates of all individuals are identical. For example, demographic stochasticity in survival is modeled as a random draw from a binomial distribution. We developed a simple conceptual model showing that if there is variation among individuals in expected survival, then existing PVA models overestimate the variance due to demographic stochasticity in survival. This is a consequence of Jensen's inequality and the fact that the binomial demographic variance is a concave function of mean survival. The effect of variation among individuals on demographic stochasticity in fecundity depends on the mean‐variance relationship for individual reproductive success, which is not presently known. If fecundity patterns mirror those of survival, then variation among individuals will reduce the extinction risk of small populations.
Establishing a New Wild Population of Tuatara (Sphenodon guntheri)
Authors: Nelson Nicola J. , Keall Susan N. , Brown Derek , Daugherty Charles H.
Published: March 2003

Abstract: Translocations of reptiles and amphibians have been questioned as a conservation tool because they generally have not been successful. However, translocation is the only method by which many species can be restored to parts of their former range, which increases their conservation security. Tuatara (  Sphenodon spp.), sole surviving members of the reptilian Order Sphenodontia, are restricted to offshore islands of New Zealand. Dispersal into former habitat on the mainland or other islands, following removal of the causes of extinction, is unlikely. Captive rearing of reptile hatchlings from eggs collected in the wild to produce founders for new populations is also a conservation technique that has had mixed success. However, captive incubation and rearing are techniques that allow large numbers of tuatara to be produced to start new populations without detrimental effects on small source populations. We document the first contemporary translocation of S. guntheri, providing details on selection of release sites and founders. Release sites were chosen on a rodent‐free island that provided a variety of habitats for tuatara as well as abundant food and shelter. The release propagule comprised 18 wild‐caught adults and 50 captive‐reared juveniles. Four separate release sites were established to separate adults from juveniles during the establishment phase. Five years of monitoring indicate that at least 57% of tuatara survived translocation and that reproduction has occurred on the new island. All tuatara increased in weight and length, demonstrating that tuatara have an indeterminate growth pattern. The 56% of recaptured juveniles represented a cross section of the sizes released. We evaluated the use of head‐started juveniles as founders, based on survival and growth data. Because tuatara are long‐lived, late‐maturing reptiles with slow reproduction, establishment of a self‐sustaining population will take decades of monitoring to confirm.
Proposal for Adaptive Management to Conserve Biotic Integrity in a Regulated Segment of the Tallapoosa River, Alabama, U.S.A.
Authors: Irwin Elise R. , Freeman Mary C.
Published: March 2003

Abstract: Conserving river biota will require innovative approaches that foster and utilize scientific understanding of ecosystem responses to alternative river‐management scenarios. We describe ecological and societal issues involved in flow management of a section of the Tallapoosa River (Alabama, U.S.A.) in which a species‐rich native fauna is adversely affected by flow alteration by an upstream hydropower dam. We hypothesize that depleted low flows, flow instability, and thermal alteration resulting from pulsed flow releases at the hydropower dam are most responsible for changes in the Tallapoosa River biota. However, existing data are insufficient to prescribe with certainty minimum flow levels or the frequency and duration of stable flow periods that would be necessary or sufficient to protect riverine biotic integrity. Rather than negotiate a specific change in the flow regime, we propose that stakeholders—including management agencies, the power utility, and river advocates—engage in a process of adaptive‐flow management. This process would require that stakeholders (1) develop and agree to management objectives; (2) model hypothesized relations between dam operations and management objectives; (3) implement a change in dam operations; and (4) evaluate biological responses and other stakeholder benefits through an externally reviewed monitoring program. Models would be updated with monitoring data and stakeholders would agree to further modify flow regimes as necessary to achieve management objectives. A primary obstacle to adaptive management will be a perceived uncertainty of future costs for the power utility and other stakeholders. However, an adaptive, iterative approach offers the best opportunity for improving flow regimes for native biota while gaining information critical to guiding management decisions in other flow‐regulated rivers.
Spatial Tests of the Pesticide Drift, Habitat Destruction, UV‐B, and Climate‐Change Hypotheses for California Amphibian Declines
Authors: Davidson Carlos , Shaffer H. Bradley , Jennings Mark R.
Published: March 2003

Abstract: Wind‐borne pesticides have long been suggested as a cause of amphibian declines in areas without obvious habitat destruction. In California, the transport and deposition of pesticides from the agriculturally intensive Central Valley to the adjacent Sierra Nevada is well documented, and pesticides have been found in the bodies of Sierra frogs. Pesticides are therefore a plausible cause of declines, but to date no direct links have been found between pesticides and actual amphibian population declines. Using a geographic information system, we constructed maps of the spatial pattern of declines for eight declining California amphibian taxa, and compared the observed patterns of decline to those predicted by hypotheses of wind‐borne pesticides, habitat destruction, ultraviolet radiation, and climate change. In four species, we found a strong positive association between declines and the amount of upwind agricultural land use, suggesting that wind‐borne pesticides may be an important factor in declines. For two other species, declines were strongly associated with local urban and agricultural land use, consistent with the habitat‐destruction hypothesis. The patterns of decline were not consistent with either the ultraviolet radiation or climate‐change hypotheses for any of the species we examined.
Reducing Cesarean Section Rates Safely: Lessons from a “Breakthrough Series” Collaborative
Authors: Flamm Bruce L. , Berwick Donald M. , Kabcenell Andrea
Published: March 2003

Background:

Almost one million cesarean operations are performed each year in the United States. The objective of this project was to test the hypothesis that a structured collaborative effort can help participating health care organizations to reduce their cesarean delivery rates safely.

Methods:

Experts associated with the collaborative helped participant organizations to explore several categories of change concepts and to develop action plans for safely reducing their cesarean delivery rates. Over the course of one year participants attended three two‐day learning sessions. In the interval between these sessions, collaborative participants communicated by weekly conference calls and a dedicated Internet site.

Results:

Of 28 participating organizations, 15 percent achieved cesarean delivery rate reductions of 30 percent or more during the 12‐month period of active collaborative work. An additional 50 percent achieved reductions between 10 and 30 percent.

Conclusions:

The Healthy People 2000 goal of a cesarean delivery rate below 15 percent by the year 2000 is attainable. Clinical leadership from doctors and nurses toward the achievement of that goal is timely, ethical, and in the best interests of childbearing women in the United States. (BIRTH 25:2 June 1998)
Effect of Labor Analgesia on Breastfeeding Success
Authors: Halpern Stephen H , Levine Tracey , Wilson Donna B , MacDonell Jo , Katsiris Sandra E , Leighton Barbara L
Published: March 2003

Background: The effect of labor analgesia on breastfeeding success is not well defined. Some authors have hypothesized that labor analgesia may affect lactation success. The purpose of this observational study was to determine if intrapartum analgesia influenced breastfeeding success at 6 weeks postpartum in a setting that strongly supported breastfeeding. Methods: Healthy women with uncomplicated term pregnancies who planned to breastfeed consented to a telephone interview. We recorded demographic data, labor induction status, delivery mode, and analgesic medications. At between 6 and 8 weeks postpartum, patients were asked to describe breastfeeding use, problems encountered, solutions derived, sources of support and information, and satisfaction. We created a logistic regression model using intrapartum analgesia information and controlling for demographic factors previously correlated with lactation success. Results: We enrolled 189 women, contacted 177 women postpartum, and obtained complete data on 171 women. Of these, 59 percent received epidural analgesia, 72 percent breastfed fully, and 20 percent breastfed partially (> 50% of infant nutrition) at 6 weeks postpartum. After controlling for demographics and labor outcome, we could not demonstrate a correlation between breastfeeding success at 6 to 8 weeks and labor analgesia. Conclusions: In a hospital that strongly promotes breastfeeding, epidural labor analgesia with local anesthetics and opioids does not impede breastfeeding success. We recommend that hospitals that find decreased lactation success in parturients receiving epidural analgesia reexamine their postdelivery care policies.
Managing Labor Using Partograms with Different Action Lines: A Prospective Study of Women's Views
Authors: Lavender Tina , Wallymahmed Akhtar H , Walkinshaw Stephen A
Published: March 2003

Background: The precise timing of medical intervention for women in prolonged labor is the subject of considerable debate. The partogram action line is a tool to assist practitioners in the correct diagnosis of prolonged labor. Despite its widespread use, the precise timing of the action line has not been rigorously studied, and women's views have rarely been sought. The aim of this study was to assess the effect on maternal satisfaction of managing labor using partograms with action lines drawn at 2, 3, or 4 hours to the right of the alert line. Methods: As part of a large pilot randomized controlled trial, women's views were explored using a specifically designed questionnaire that was completed by 615 primiparas 2 days after giving birth. The quantifiable data were analyzed by comparing means using ANOVA followed by the Scheffe test. Results: Women in the 2‐hour arm were significantly more satisfied than those in the other two arms (
p < 0.001), despite having the most obstetric intervention. Conclusions: For women in prolonged labor, obstetric intervention can be an acceptable or even favorable option. Midwives and obstetricians need to provide labor management that takes into account the preferences of the women to whom they give care.
Breastfeeding Experience and Milk Weight in Lactating Mothers Pumping for Preterm Infants
Authors: Hill Pamela D. , Aldag Jean C. , Chatterton Robert T.
Published: March 2003

Background:
Research about parity or breastfeeding experience and its relationship with milk production in humans is limited. The purpose of this study was to determine if any difference in milk volume occurred among mothers with and without breastfeeding experience who used either a single or double breast pumping regimen the first 5 weeks postpartum.
Methods:
A convenience sample of 39 mothers of nonnursing preterm infants participated from two tertiary care centers in the midwestern United States. The sequential single pumping group consisted of 20 mothers, 7 of whom had previous breastfeeding experience; the simultaneous double pumping group consisted of 19 mothers, 2 of whom had previous breastfeeding experience. Income and pumping group regimen were used as blocking variables, and average frequency of kangaroo care per week and average frequency of breast pumping per week were covariants in the repeated measures analysis of variance.
Results:
Mothers with previous breastfeeding experience had greater milk weights over time, but weights were not significantly different when compared with those mothers with no previous breastfeeding experience. Additional analysis with the covariants of pumping frequency and kangaroo care, and with the independent variables of group, breastfeeding experience, and income resulted in statistically significantly greater milk yield in the women with previous breastfeeding experience.
Conclusions:
The findings of the two repeated analyses indicated the complexity of the milk production response, and the importance of considerations of environmental as well as physiologic factors.
Adherence to the Ten Steps of the Baby‐Friendly Hospital Initiative in Minnesota Hospitals
Authors: Dodgson Joan E. , Allard‐Hale Cheryl J. , Bramscher Adrienne , Brown Faye , Duckett Laura
Published: March 2003

Background:
A worldwide campaign has been initiated to improve the in‐hospital care of mothers and babies through increased breastfeeding. The four objectives of the current investigation were to determine the in‐hospital breastfeeding rate for Minnesota hospitals, to analyze the relationship between the in‐hospital breastfeeding rates and selected hospital demographic characteristics, to determine the rate of adherence to each of the Baby‐Friendly Hospital Initiative (BFHI) Ten Steps, and to analyze the relationship between the adherence rates for each of the Ten Steps and selected demographic characteristics.
Methods:
A descriptive survey was conducted and analyzed for the year of 1994 from 79 (83%) Minnesota hospitals. Respondents were directors of nursing, nursing managers, or other staff familiar with their hospital's breastfeeding policies and practices.
Results:
The average breastfeeding initiation rate was 59 percent. Four of the Ten Steps were implemented with a low adherence rate (0–49%), five were implemented with a moderate rate (50–89%), and none was implemented with a high rate (90–100%). Breastfeeding initiation rates and adherence to the Ten Steps varied with the size of the city and the number of births per year.
Conclusions:
Improvements in breastfeeding policies, practices, and staff education are needed if Minnesota hospitals are to provide care consistent with the Ten Steps of the BFHI. The results provide baseline information to guide institutional change that could promote successful breastfeeding experiences for postpartum families. This survey instrument could be used easily by researchers in other sites to assess nine of the Ten Steps.
Intrapartum Nursing Care: A Case Study of Supportive Interventions and Ethical Conflicts
Authors: Sleutel Martha R.
Published: March 2003

Background:
Studies have shown that one‐to‐one labor support is associated with a reduced rate of operative births, and with long‐term improvements of parenting and breastfeeding rates. Labor support by nurses may reduce the cesarean birth rate, but this has not been adequately studied. No one knows which labor support strategies nurses use, if they are effective, and how they work.
Methods:
This pilot study used the qualitative techniques of observation and an audiotaped interview with an expert intrapartum nurse to describe labor support techniques and strategies to enhance labor progress and prevent cesarean births.
Results:
The narrative revealed three major themes. The first theme, “the nurse's approaches to labor,” included three subcategories: “following the mother's body,”“hastening and controlling labor,” and “labor support techniques.” The second and third major themes, “ethical dilemmas: an unwilling partnership” and “nurse‐physician conflict,” were unanticipated. Labor support practices were limited by some physician practices. Inappropriate physician practice created ethical dilemmas for the nurse and impeded labor support interventions.
Conclusions:
Intrapartum nursing care reflected both a medical model of controlling and hastening birth, as well as a supportive, nurturing, and empowering model of practice that used independent clinical judgments and advocacy. Questionable medical care entangled the nurse in these practices and created moral dilemmas and nurse‐physician conflicts. The nurse used various strategies to promote the wishes and welfare of the laboring mother.
WHO Principles of Perinatal Care: The Essential Antenatal, Perinatal, and Postpartum Care Course
Authors: Chalmers Beverley , Mangiaterra Viviana , Porter Richard
Published: March 2003

World Health Organization (WHO) recommendations and meta‐analyses of controlled trials have concluded that inappropriate perinatal care and technology continue to be practiced widely throughout the world, despite the acceptance of evidence‐based principles and care. The WHO Regional Office for Europe, in consultation with policy makers and reproductive health experts recently proposed ten “Principles of Perinatal Care,” which have been endorsed by the reproductive health units of most member states. A comprehensive training program, based on the principles, is now being offered throughout the European region. This paper describes the development of the WHO principles and the WHO training course “Essential Antenatal, Perinatal and Postpartum Care.” Together they provide an innovative model of evidence‐based and psychosocially sensitive care for the future guidance of perinatal policy makers and caregivers worldwide.
Epidural Analgesia Use as a Marker for Physician Approach to Birth: Implications for Maternal and Newborn Outcomes
Authors: Klein Michael C. , Grzybowski Stefan , Harris Sue , Liston Robert , Spence Andrea , Le Grace , Brummendorf Dorothea , Kim Sharon , Kaczorowski Janusz
Published: March 2003

Background:
Understanding the association between caregiver belief systems and practice patterns is an emerging area of research. We hypothesized an association between a maternity caregiver's belief system and his or her behavior. The study objective was to determine if a family physician's overall approach to maternity care, as measured by average use of epidural analgesia, was associated with maternal and fetal outcomes.
Methods:
Retrospective analysis was conducted of the births of three cohorts of 1992 nulliparous, low‐risk
women attended by 96 family physicians within an 18‐month period in the department of family practice at the largest maternity hospital in Canada. Cohorts were based on the physicians' mean use of epidural analgesia for the women. Family physicians attending fewer than 5 births were excluded. The main outcome measures, by physician epidural utilization cohort, were maternal/newborn morbidity, procedure rates, consultation rates, and length of stay.
Results:
Family physicians were separated into cohorts based on their mean use of epidural analgesia at rates of: low, 0–30 percent (15 physicians, 263 births); medium, 31–50 percent (55 physicians,
1323 births); and high, 51–100 percent (26 physicians, 406 births). After adjustment for maternal age and race, patients of low versus high epidural users were admitted at a later state of cervical dilation (mean 4.0 vs 3.1 cm), received less electronic fetal monitoring (76.4 vs 87.2%) and oxytocin augmentation (12.2 vs 29.8%), sustained fewer malpositions (occiput posterior or transverse)(23.2 vs 34.2%), had fewer cesarean sections (14.0 vs 24.4%), less obstetric consultation (47.9 vs 63.8%), and fewer newborn special care admissions (7.2 vs 12.8%).
Conclusions:
In our setting, high use of epidural analgesia is a marker for a style of practice characterized by malpositions leading to dysfunctional labors and higher intervention rates leading, in turn, to excess maternal/newborn morbidity.
A Modified McMullen's Staining for Helicobacter pylori: A High‐Contrast, Visibly Prominent Method
Authors: Iwaki Hiroyuki , Sugiyama Toshiro , Asaka Masahiro
Published: March 2003

Background.

Many stains can be used for the histological assessment of Helicobacter pylori, but all have defects from the standpoint of sensitivity, convenience, stability, visible prominence and cost. This paper describes a stain which produces satisfactory results on all the above accounts.

Materials and Methods.

Paraffin‐embedded sections were dewaxed and treated with 0.2% w/v carbol fuchsin for two min; then 1.0% w/v malachite green was applied for two minutes.

Results.

This technique stained the bacterial form a deep magenta against a light green background. The characteristic morphology of H. pylori was identified very easily as a stumpy curved rod, and the coccoid forms were also identified. Staining was not specific with mixed samples of bacteria, but it was sufficient to identify H. pylori in the gastric mucosa.

Conclusion.

We have established an easy, stable, convenient, low‐cost, and easily recognizable staining method for H. pylori in paraffin‐embedded tissue.
High Concentrations of Ammonia, But Not Volatile Amines, in Gastric Juice of Subjects with Helicobacter pylori Infection
Authors: Verdú Elena F. , Armstrong David , Sabovcikova Lionella , Idström Jan‐Peter , Cederberg Christer , Blum André L. , Bercík Premysl
Published: March 2003

Background.~

Helicobacter pylori (H. pylori) produces large amounts of ammonia. Based on higher readings obtained with an ammonia‐sensitive electrode when compared to a specific enzymatic assay, it has been claimed that H. pylori also produces potentially toxic volatile amines.

Method.

We measured ammonia concentrations (NH3) in gastric aspirates from 11 H. pylori positive subjects (22–40 y, 6~
m), using an ammonia electrode sensitive to ammonia and amines, and an enzymatic assay specific for ammonia. Continuous aspiration was performed overnight and 220 aspirates were analyzed before and 6~weeks after cure of H. pylori. Gastric samples were diluted 1:3 (before cure) and 1:1 (after cure) according to dilution curves constructed prior to the assays.

Results.

Median (95% CI) NH3 detected by the elec‐trode/enzymatic assay were 4.34~m
m[4.12–4.61]/4.50~m
m [4.28–4.68] (p~>~.05) before cure and 0.54~m
m[0.42–0.60]/0.73~m
m[0.71–0.81] after cure (p~>~.05). Intra‐class correlation coefficient between the two methods was 0.91 before cure and 0.90 after cure (p~<~.001). Without dilution, the enzymatic assay was linear for NH3 from 0.01 to 1~m
m and saturated at 2.5~m
m; the electrode was linear for NH3 from 0.01 to 20~m
m. When appropriate dilutions were performed, the enzymatic assay was accurate for NH3 greater than 2.5~m
m.

Conclusion.

In subjects with H. pylori infection there is a high NH3 in gastric juice; production of volatile amines appears to be negligible in vivo. An ammonia‐sensitive electrode and a specific enzymatic assay are both suitable methods for determining NH3 in the gastric juice of subjects with H. pylori infection.
Helicobacter pylori Culture from a Positive, Liquid‐Based Urease Test for Routine Clinical Use: A Cost‐Effective Approach
Authors: Jaup Bernhard H. , Stenquist Bo , Brandberg Åke
Published: March 2003

Background. The aim of our study was to test the feasibility of culturing Helicobacter pylori directly from biopsies aimed for rapid urease test in routine clinical practice.

Materials and Methods. In 260 consecutive patients referred for gastroscopy because of dyspepsia one antral biopsy was routinely used for our “in house” rapid urease test (RUT). Positive biopsies were placed in a transport medium and sent to the laboratory. The biopsies were cultured and incubated at 37°C for 5–7 days. H. pylori was identified and routinely tested for antimicrobial resistance by using the E‐test.

Results. In 118 out of 260 patients (45%) the urease test turned positive and the growth of H. pylori was sufficient to allow testing of antimicrobial resistance.

Conclusion. H. pylori could be cultured from almost all positive RUT specimens. A liquid RUT is thus more suitable for culture, saving additional biopsies.
Long‐Term Helicobacter pylori Infection in Japanese Monkeys Induces Atrophic Gastritis and Accumulation of Mutations in the p53 Tumor Suppressor Gene
Authors: Oda Touta , Murakami Kazunari , Nishizono Akira , Kodama Masaaki , Nasu Masaru , Fujioka Toshio
Published: March 2003

Background. Helicobacter pylori is accepted as a definite human gastric carcinogen from an epidemiological point of view despite insufficient experimental data. Although we previously showed that the number of p53 immunopositive cells in the atrophic gastric mucosa of H. pylori‐infected Japanese monkeys gradually increased over time, data on p53 gene mutations were not obtained in that study. To obtain direct evidence of carcinogenesis associated with H. pylori infection, we investigated whether p53 gene mutations are present in the gastric mucosa of a nonhuman primate model susceptible to H. pylori.

Materials and Methods. Using the DNA from gastric tissues obtained from six H. pylori‐uninfected monkeys of different ages, nucleotide sequence of the wild‐type p53 gene was determined by amplification of exons (Ex) 5, 6, 7 and 8 and sequencing. Gastric specimens obtained from eight Japanese monkeys that had been infected with H. pylori for different lengths of time (1.5–7.5 years), were analyzed for mutations in exons 5–8 of p53.

Results. In the six H. pylori‐uninfected monkeys, nucleotide sequences of p53 Ex 5–8 were completely common and no mutations were noted. However, among the monkeys that were infected with H. pylori over various periods of time, there was an accumulation of p53 nucleotide (amino acid) substitutions as the gastric atrophy score increased.

Conclusions. We conclude that the appearance of p53 gene mutation may be closely associated with the degree of gastric mucosal atrophy, which depends on the duration of H. pylori infection. Searching for p53 gene mutations may be useful for studying the progression of gastric carcinogenesis associated with H. pylori.
Helicobacter pylori infection in geriatrics
Authors: Pilotto Alberto , Salles Nathalie
Published: March 2003

The prevalence of Helicobacter pylori infection increases with age worldwide. However, the percentage of H. pylori‐positive elderly patients who are tested and treated for their infection remains very low. We now have data that demonstrate the benefit of curing H. pylori infection in elderly patients with H. pylori‐associated peptic ulcer disease and severe chronic gastritis. Furthermore, the cure of H. pylori may prevent progression of intestinal metaplasia and gastric atrophy. Studies are needed to clarify the role of eradication for elderly patients who have nonulcer dyspepsia, gastroesophageal reflux disease and who use nonsteroidal anti‐inflammatory drugs. H. pylori infection may be easily diagnosed by histological evaluation, rapid urease test or culture performed on gastric biopsies taken during endoscopy. However, the biopsy site must be carefully selected in elderly patients. For noninvasive monitoring of H. pylori infection after treatment, the 13C‐urea breath test has significantly higher accuracy than serology in the elderly. The role of the H. pylori stool antigen test in old age still needs to be clarified. One‐week PPI‐based triple therapy regimens including clarithromycin, amoxycillin and/or nitroimidazoles are highly effective and well tolerated in elderly patients. Low doses of both PPIs and clarithromycin (in combination with standard doses of amoxycillin or nitroimidazoles) are sufficient. Antibiotic resistance and low compliance are the main factors related to treatment failure at any age.
Recent Advances in Pharmacotherapy for Cancer Pain Management
Authors: Lucas Lise K. , Lipman Arthur G.
Published: March 2003

purpose: This review provides an outline of several recent advances in drug treatment options and strategies for managing cancer pain.

overview: The development of cyclooxygenase‐2‐selective nonsteroidal anti‐inflammatory drugs (NSAIDs) and transmucosal fentanyl citrate provide new pharmacologic options for the treatment of cancer pain. Combinations of opioid agonists and antagonists have provided data on new strategies to balance effective analgesia with analgesic‐related adverse effects. In addition, the spectrum of adjuvant agents for the treatment of neuropathic pain has been extended to various antidepressants and topical analgesics. There is continued research on the role of the N‐methyl‐d‐aspartate (NMDA) receptor and, specifically, on NMDA receptor antagonists that may augment analgesia and combat opioid resistance. Finally, a more potent generation of bisphosphonates may lead to improved pain relief for patients with bone metastases.

clinical implications: With a combination of emerging new clinical research and professional practice experience of the cancer care team, new strategies will continue to be developed and implemented, resulting in the continued improved care of patients with cancer.
Pain Management Issues for Cancer Survivors
Authors: Lyne Marjorie E. , Coyne Patrick J. , Watson Ashby C.
Published: March 2003

purpose: The authors review issues that cancer survivors face daily related to pain management, the etiologies of pain in survivors, and ways to achieve successful pain management for cancer survivors.

overview: The review includes a discussion of pain issues in the 6‐month period after diagnosis and pain issues that may arise throughout survivorship. The authors describe a successful pain management program as including thorough and ongoing assessment, communication among the healthcare team members, interdisciplinary interventions, and reassessment of the whole management process. Various barriers to effective pain management are described.

clinical implications: It is hoped that this review may give members of the multidisciplinary cancer care team new insights into the issues encountered by survivors regarding pain and potential therapeutic techniques.
Spirituality and Quality of Life in Gynecologic Oncology Patients
Authors: Gioiella Marie Elena , Berkman Barbara , Robinson Mark
Published: March 2003

PURPOSE
: The inclusion of spiritual well‐being in healthcare assessments can provide insight into patients' needs and coping resources. This study explored the relationship between spiritual well‐being and quality of life (QOL) in gynecologic oncology patients in an attempt to clarify the significance of spiritual well‐being in the assessment process.

DESCRIPTION OF STUDY
: Eighteen women with gynecologic cancer completed a self‐administered questionnaire that obtained sociodemographic, medical, spiritual, and functional information. The Spiritual Well‐being Scale was used to assess spiritual well‐being, and the Functional Living Index: Cancer (FLIC) measured QOL. Data were analyzed using descriptive statistics, comparison of means, and analysis of variance.

RESULTS
: Patients with gynecologic cancers other than ovarian reported a better QOL and a higher degree of spiritual, existential, and religious well‐being. Older patients consistently reported higher degrees of spiritual well‐being and QOL than did younger patients. Married patients consistently reported higher degrees of spiritual well‐being than patients who were not married (never married or separated). Catholic patients scored higher in degrees of religious and spiritual well‐being as well as in FLIC scores than other patients.

CLINICAL IMPLICATIONS
: Health professionals do not generally assess spiritual well‐being in their evaluations of patients' needs. The findings from this study support the inclusion of spirituality as part of routine patient assessment and intervention. Clinical intervention that would increase a patient's level of spiritual awareness and his or her level of comfort associated with a personal perspective on death could help decrease the patient's level of psychosocial distress. Despite the medical establishment's bias to the contrary, religion and spirituality are positively associated with both physical and mental health and may be particularly significant to terminally ill patients. The curricula of medical, nursing, and other health schools should be redesigned appropriately.
Fatigue, Pain, and Depression in Pre‐Autotransplant Breast Cancer Patients
Authors: Gaston‐Johansson Fannie , Fall‐Dickson Jane M. , Bakos Alexis B. , Kennedy M. john
Published: March 2003

objectives: The purpose of this study was to determine the influence of fatigue, pain, and depression on health status in breast cancer patients who had completed adjuvant chemotherapy and were scheduled for autologous bone marrow/peripheral blood stem cell transplant (AT).

materials and methods: A predictive, correlational design was used. A convenience sample of 127 women with stages II, III, and IV breast cancer was recruited. The setting was an urban National Cancer Institute‐designated comprehensive cancer center located in the Eastern United States. Standardized questionnaires and the Gaston‐Johansson Painometer (POM) were used to measure the variables. The subjects completed questionnaires in the outpatient clinic. Relationships between the multiple dimensions of fatigue and pain, depression, and health status were examined. Hierarchical regression techniques were used to determine the variance in health status accounted for by fatigue, pain, and depression.

results: The subjects were age 22 to 60 years (Mean = 45; SD = 7.6), and primarily were married, white, Protestant, college educated, employed in a professional position, and had an average yearly household income of equal to or greater than $50,000. All subjects had previously received surgery and chemotherapy. Ninety‐one percent of the participants reported fatigue as measured by the Fatigue Visual Analogue Scale. Forty‐seven percent of the participants reported pain as measured by the Gaston‐Johansson POM visual analogue scale. Fifty‐four percent of the participants reported depression, ranging from mild to severe/high. Subjects reported a mean total perceived health status rating of 50.73 (SD 10.79). Fatigue, pain, and depression were all significantly correlated to each other and to total health status. Depression (P < .001) and pain (P < .01) significantly accounted for 64% (adjusted R2 = .60) of the variance in total health status. Fatigue (P < .05) and depression (P < .001) accounted for 42% (adjusted R2 = .36) of the variance in the perception of health status.

conclusions: Women with breast cancer previously treated with chemotherapy and awaiting AT may experience fatigue, pain, depression, and alterations in health status. Pain and depression had a significant impact on a woman's total health status, whereas depression and fatigue had an influence on perceived health status. Of the different dimensions of health status, one's perceptions of health status had the strongest correlation to total health status (r = .84, P < .001). Healthcare professionals need to be aware of the effects of multiple symptoms on health status and to provide appropriate care to alleviate them.
Parents' Perceptions of Randomization in Pediatric Clinical Trials
Authors: Wiley Frances M. , Ruccione Kathy , Moore Ida M. , McGuire‐Cullen Patsy , Fergusson Jean , Waskerwitz Mary J. , Perin Gail , Ge Jeff , Sather Harland N. ,   For the Children's Cancer Group
Published: March 2003

objectives: The purpose of this study was to investigate parents' knowledge and perceptions about randomization in clinical trials for children with cancer, and to determine whether parents' decisions were influenced by demographic factors, randomization circumstances, the clinical characteristics of the child with cancer, or a combination.

materials and methods: This study collected information from 192 parents of patients with various forms of childhood cancer who either accepted or refused randomization. A comparative case‐control design was used. The Clinical Investigation Randomization Scale was administered to all participants. This scale included 32 questionnaire items (QIs) pertaining to randomization as well as a mixture of open‐ended questions to obtain information about demographic and other factors.

results: A predictor model was developed that accurately predicted acceptance or refusal of randomization 87% of the time. Demographic information was found to have less influence than expected on parents' decisions regarding randomization. Knowledge deficits were found among both groups of parents, those who accepted and those who refused randomization.

conclusions: What most distinguished parents who refused from those who accepted randomization was not their knowledge and information about randomized clinical trials. By far, the majority of QIs that accurately predicted acceptors and refusers involved parents' beliefs, values, and perceptions. Further research is needed to determine interventions that may enable the healthcare team to provide information and decisional support most effectively to improve the informed consent process.
Impact of Development on Children's Mourning
Authors: Christ Grace H.
Published: March 2003

Purpose:

A qualitative approach was used to analyze the impact of development on the grief responses of 157 children from 88 families to the death of a parent from cancer.

Description of study :

Children from age 3 to 17 years were divided by developmental characteristics, derived from interview data, into five development‐derived age categories.

Results:

The responses of children in different categories clarified the impact of development on their distinct expressions of grief, attributes of the parent they mourned, and the parent's tasks in enhancing the reconstitution of the child and the family.

Clinical implications:

This first attempt to find a way to segregate children into developmentally more homogenous subgroups led to the clarification of patterns of mourning behaviors that are clinically useful. The increased precision of findings, such as the way development affects the child's mourning and the related parental support they need, may help clinicians develop more specific interventions to help children cope with the death of a parent and guide parents in understanding their children's differing responses. The pivotal role of the surviving parent and the tasks required of that parent are important for healthcare professionals to understand and support.