bluuebunny/crossref_metadata_2025 huggingface dataset:
Acid ceramidase is a novel factor required for early embryo survival
Authors: Eliyahu Efrat , Park Jae-Ho , Shtraizent Nataly , He Xingxuan , Schuchman Edward H.
Published: February 2007

Recent studies suggest that the lipid, ceramide, induces the default apoptosis process in eggs. Yet, it is obscure how newly formed embryos overcome this fate. Acid ceramidase (AC) is a key regulatory enzyme involved in ceramide metabolism, and mutations in the AC gene (Asah1) result in Farber Lipogranulomatosis, a fatal human genetic disorder. Our previous studies revealed that AC knockout (Asah1—/—) mice had a lethal phenotype, and herein we reveal the mechanism underlying this observation. A single‐cell, polymerase chain reaction (PCR) genotyping method was developed to analyze individual embryos from Asah1 ± intercrosses. Combined with Annexin V staining, this genotype analysis demonstrated that Asah1— /— embryos could not survive beyond the 2‐cell stage, and underwent apoptotic death. Notably, sphingosine‐1‐phosphate (S1P) treatment of early 2‐cell embryos from the Asah1 ± intercrosses rescued Asah1— /— embryos, and enabled their progression from the 2‐cell to 4‐8‐cell stage. Quantitative PCR also revealed that expression of the Asah1 gene in healthy embryos was initiated at the 2‐cell stage, coincident with embryonic genome activation (EGA). AC activity and Western blot analyses further demonstrated high expression and activity of the enzyme in normal, unfertilized eggs, which likely provide the protein to newly formed embryos prior to EGA. Based on these observations, we suggest that AC is an essential factor required for embryo survival that functions by removing ceramide from the newly formed embryos, thus inhibiting the default apoptosis pathway.—Eliyahu, E., Park, J.‐H., Shtraizent, N., He, X., Schuchman, E. H. Acid ceramidase is a novel factor required for early embryo survival. FASEB J. 21, 1403–1409 (2007)
The Effect of Server Posture on the Tips of Whites and Blacks
Authors: Leodoro Gina , Lynn Michael
Published: February 2007

This study examined the effects on tips left by Black and White restaurant patrons of having a White waitress sit down or lean over at the table during the service encounter. A significant server posture by patron race interaction was obtained. Sitting at the table significantly increased the tips left by White patrons and marginally significantly decreased the tips left by Black patrons. Potential explanations for this interaction are discussed along with its practical implications.
Association Between Hypnotizability, Perceived Self‐Efficacy, and Provider Contact in a Healthy College Student Sample: An Analogue Adherence Study1
Authors: DiClementi Jeannie D. , Berrenberg Joy L. , Giese Lisa
Published: February 2007

This study examines the relationship between hypnotizability, perceived self‐efficacy, provider contact, and participants' ability to complete an analogue task modeled after HIV medication schedules. Participants (n=74) completed the Hypnotic Induction Profile, received instructions designed to manipulate their perceptions of self‐efficacy, and assigned to provider contact conditions (high vs. low). Participants were given jellybeans, a schedule for consuming them, and report logs. A main effect for susceptibility was found, such that participants rated high in susceptibility were more successful in following the schedule than those low in susceptibility. This is consistent with previous research that found initial positive responses to therapeutic interventions among highly hypnotizable psychiatric patients. Suggestions for modifying adherence interventions depending on level of hypnotizability.
Capacity for Direct Attention in Patients Undergoing Percutaneous Coronary Intervention: The Effects of Psychological Distress
Authors: Carroll Diane L.
Published: February 2007

Emphasis is placed on educating coronary heart disease patients about lifestyle choices to reduce the risk of further cardiovascular events, but little attention has been paid to the impact of attentional capacity on patients' learning. The purpose of this study is to identify and compare the capacity for direct attention and the effect of psychological distress during hospitalization and 6 weeks after percutaneous coronary intervention. Forty subjects, mean age of 63 years, 27 men and 13 women, completed components of the Wechsler Memory Test to measure direct attention, and the Profile of Mood States. There were significant differences in the Digit Span Test‐backward, a measure of working memory (t=–2.79; p<0.009), and the Profile of Mood States total score, a measure of psychological distress (t=3.183; p<0.003), from hospitalization to 6 weeks post‐percutaneous coronary intervention. Data demonstrate psychological distress and reduced capacity for direct attention during hospitalization indicating that hospital environments are suboptimal for learning.
Evaluation of F cells in sickle cell disorders by flow cytometry – comparison with the Kleihauer–Betke's slide method
Authors: ITALIA K. Y. , COLAH R. , MOHANTY D.
Published: February 2007

Adult F cell numbers are raised in inherited haemoglobin disorders, such as β‐thalassaemia and sickle cell anaemia, hereditary persistence of foetal haemoglobin, and some acquired conditions, such as juvenile myelomonocytic leukaemia, during acute erythropoietic stress and pregnancy. True foetal erythrocytes containing foetal amounts of HbF can also occur in the adult circulation during the leakage of HbF‐containing cells from the foetus to the maternal circulation. In normal adults, HbF is restricted to a small proportion (3–7%) of red blood cells (RBC), termed ‘F cells’. Techniques estimating the amount of HbF use lysates prepared from RBC, whereas those that estimate the adult F cell count use intact RBC. An accurate assessment of adult F cells in sickle cell disorders is important because increased adult F cells are associated with decreased morbidity in these disorders. In the present study, HbF levels were measured and adult F cell numbers were estimated in 100 blood samples (25 normal individuals, 25 sickle heterozygotes, 25 sickle homozygotes and 25 sickle β‐thalassaemia cases), using high pressure liquid chromatography for HbF levels, and flow cytometry and the Kleihauer–Betke (KB) acid elution microscope slide method for cell counts. Flow cytometry gave a more accurate assessment of adult F cells, eliminating any manual error, as compared to KB, which was less sensitive and precise as it is based on subjective visual interpretation.
Host plant finding in the specialised leaf beetle Cassida canaliculata: an analysis of small‐scale movement behaviour
Authors: HEISSWOLF ANNETTE , ULMANN SANDRA , OBERMAIER ELISABETH , MITESSER OLIVER , POETHKE HANS JOACHIM
Published: February 2007

Abstract 1. Host plant finding in walking herbivorous beetles is still poorly understood. Analysis of small‐scale movement patterns under semi‐natural conditions can be a useful tool to detect behavioural responses towards host plant cues.

2. In this study, the small‐scale movement behaviour of the monophagous leaf beetle Cassida canaliculata Laich. (Coleoptera: Chrysomelidae) was studied in a semi‐natural arena (r = 1 m). In three different settings, a host (Salvia pratensis L., Lamiales: Lamiaceae), a non‐host (Rumex conglomeratus Murr., Caryophyllales: Polygonaceae), or no plant was presented in the centre of the arena.

3. The beetles showed no differences in the absolute movement variables, straightness and mean walking speed, between the three settings. However, the relative movement variables, mean distance to the centre and mean angular deviation from walking straight to the centre, were significantly smaller when a host plant was offered. Likewise, the angular deviation from walking straight to the centre tended to decline with decreasing distance from the centre. Finally, significantly more beetles were found on the host than on the non‐host at the end of all the trials.

4. It is concluded that C. canaliculata is able to recognise its host plant from a distance. Whether olfactory or visual cues (or a combination of both) are used to find the host plant remains to be elucidated by further studies.
Long‐term effects of ungulates on phytophagous insects
Authors: GÓMEZ JOSÉ M. , GONZÁLEZ‐MEGÍAS ADELA
Published: February 2007

Abstract 1. Most plants interact with a diverse suite of herbivores, allowing the opportunity for the existence of positive and negative interactions between highly dissimilar organisms. However, most studies on herbivorous interactions have been performed under the assumption that they occur mainly between similar species. Consequently, ecologists are still far from a full understanding of the ecological factors that determine insect population dynamics.

2. In this study, a 7‐year field experiment was conducted that manipulated the presence of ungulates to evaluate their effects on the abundance, attack rate, and survival of four guilds of co‐occurring herbivorous insects living on the same host plant: seed predators, stem borers, gall makers and sap suckers. These four guilds differed in habits and behaviour, the first three being sessile and endophytic and the last being free‐living.

3. This study shows that the abundance of all four guilds was negatively affected by ungulates. However, the effect on attack rate differed among guilds, as mammals do not affect the seed predator attack rate. Ungulates also differentially affected insect survival, ingesting only seed predators and gall makers.

4. In summary, this study suggests that diverse mechanisms may affect different insect guilds in different ways. Therefore, competition between disparate herbivores appears to be complex and can be provoked by multiple mechanisms.
Acute hantavirus infection or renal transplant rejection
Authors: Meier M. , Helmchen U. , Fricke L. , Ulrich R. , Schütt M.
Published: February 2007

Abstract: Hantaviruses belong to the so‐called emerging pathogens that are transmitted to humans by infected rodents and their excreta. In Central Europe, hantavirus infections usually occur in a mild to moderate form of hemorrhagic fever with renal syndrome. In contrast to the mostly benign or even asymptomatic course of hantavirus infections in previously healthy individuals, the acute hantavirus infection in kidney transplant recipients represents an exceptional situation regarding diagnosis and therapy. We describe the case of a 44‐year‐old kidney transplant recipient with acute renal transplant failure associated with acute hantavirus infection.
Kluyvera co‐infection in two solid organ transplant recipients: an emerging pathogen or a colonizer bystander?
Authors: Cheruvattath R. , Balan V. , Stewart R. , Heilman R.L. , Mulligan D.C. , Kusne S.
Published: February 2007

Abstract: Kluyvera species are opportunistic, gram‐negative bacilli in the family Enterobacteriaceae. Ordinarily occurring as a commensal, Kluyvera have been reported to cause serious infections in immunosuppressed and immunocompetent hosts, causing diarrhea, urinary infections, peritonitis, and cholecystitis. We report Kluyvera infections in 2 solid organ transplant recipients. An 18‐year‐old female with alpha‐1 antitrypsin deficiency underwent living donor liver transplantation and presented 6 months later with a liver abscess. The abscess aspirate grew mixed organisms including Kluyvera cryocrescens. A 22‐year‐old female with renal failure secondary to focal segmental glomerulosclerosis underwent a deceased donor kidney transplant and presented 3 months later with pyelonephritis; the urine culture grew Kluyvera ascorbata. Both patients improved only when their antibiotic coverage was broadened to include Kluyvera. The isolation of Kluyvera as a pathogen in transplant patients emphasizes that this commensal organism may be virulent in this patient population.
Ex vivo monitoring of human cytomegalovirus‐specific CD8+ T‐cell responses using QuantiFERON®‐CMV
Authors: Walker S. , Fazou C. , Crough T. , Holdsworth R. , Kiely P. , Veale M. , Bell S. , Gailbraith A. , McNeil K. , Jones S. , Khanna R.
Published: February 2007

Abstract: We have developed a novel diagnostic technology to monitor the human cytomegalovirus (HCMV)‐specific CD8+ T‐cell responses that is based on the detection of secreted interferon‐gamma (IFN‐γ) in the whole blood (referred to as QuantiFERON®‐CMV). Evaluation of QuantiFERON®‐CMV in healthy individuals revealed that this technology was at least as sensitive and with some HCMV epitopes more sensitive than the ELISPOT for detecting ex vivo IFN‐γ. Results from QuantiFERON®‐CMV assays showed 97% (36/37 individuals) agreement with the anti‐HCMV serology test in healthy individuals. Furthermore, we also show that this technology can be used to assess HCMV‐specific T‐cell responses in transplant patients. This study shows that QuantiFERON®‐CMV is a simple, reproducible, and reliable test for the detection of IFN‐γ in response to HCMV CD8+ T‐cell epitopes, and may be a valuable diagnostic test for the detection of HCMV infection and a useful clinical tool for monitoring the immune response in immunosuppressed patients during therapy.
The need to develop nursing practice through innovation and practice change
Authors: SG Wright
Published: February 2007

This paper examines some of the strategies that can be used to produce change in nursing. These strategies range from the power‐coercive through rational‐empirical to the normative‐re‐educative. Strategies that promote a‘bottom up’approach are advocated for clinical nursing and some of the principal factors towards success, such as team building, the presence of a clinical leader and planning are indicated. The paper will also expand on what needs to be changed in nursing, and what the purpose of such changes are. It is argued that externally focused efforts of change, such as the organization of care or new practices are only part of the picture. The journey of change also requires an inner exploration of who we are and what we are seeking to achieve in nursing.
The mirror as a therapeutic tool for patients with dementia
Authors: Tabak Nili , Bergman Rebecca , Alpert Rachel
Published: February 2007

The aim of the study was to examine changes in patient behavior that occurred as a consequence of looking in a mirror. How do dementia patients relate to their image in the mirror? Is the use of the mirror effective in raising levels of self‐awareness, calmness and satisfaction? The survey was carried out on 100 patients suffering from dementia: 67 women and 33 men aged between 67 and 85. The findings showed that most responses to looking in the mirror were positive and raised the patients’awareness regarding self‐care. In a small number of patients, looking into the mirror aroused feelings of anger or despair, followed by relief and calmness. Findings indicated that the use of mirrors enabled nurses and caregivers to communicate better with patients. Most patients appeared to benefit in various ways from looking into the mirrors. The staff felt that use of mirrors was an inexpensive and efficient therapeutic tool for improving care of demented aged patients.
Surgical patients’information needs on discharge: Are they being met?
Authors: Henderson Amanda , RN Sandy Phillips
Published: February 2007

Increasingly patients are being encouraged to participate more in their health care. Patients are being discharged earlier; therefore their need for information may potentially increase if they are to be involved in their care. This study explored the information that patients received prior to their discharge and, through follow‐up interviews after their return home, investigated the usefulness of the information provided. Only 11 of a total 20 patients (55%) routinely received discharge information. This information was not solicited and its content was ad hoc. Nine patients (45%) did not routinely receive discharge information. If these patients needed information they had to ask for it. Despite the lack of comprehensive discharge information for the 20 surgical patients, the majority of patients (75%) did not access services after discharge. Only one of the five patients who did seek advice was in need of further medical intervention. The remaining four required further information so that they could be reassured. These findings emphasize the need for further research on the type and extent of information required by patients on their return home so that they can effectively participate in their recovery.
Innovations in community health nursing: Examples from practice
Authors: Cusack Lynette , Smith Morgan , Byrnes Tess
Published: February 2007

Cusack L, Smith M, Byrnes T. International Journal of Nursing Practice 1997; 3: 133–136

Innovations in community health nursing: Examples from practice

The Ottawa Charter for Health Promotion is cited internationally as an appropriate conceptual framework for healthcare service delivery yet the literature reveals minimal evidence of nursing services interpreting and applying the Ottawa Charter strategies into nursing practice. Nurses with the community services of Noarlunga Health Services and the Drug and Alcohol Services Council of South Australia, however, do use the strategies to plan and implement their services. The Ottawa Charter strategies of developing personal skills; creating supportive environments; strengthening community action; building healthy public policy; and re‐orienting services in the interest of health can be used as a tool to assist nurses to identify the purpose of their interventions and select a comprehensive range of nursing actions which address the needs of individuals while acknowledging the broader determinants of health. This article presents a nursing analysis of the Charter and provides examples of how the strategies are used to influence nursing practice in both organizations. The examples provided from the two different nursing services also demonstrate the adaptability and relevance of the strategies to diverse community nursing practice settings.
Surgical treatment of age‐related macular degeneration: will there be a role in the future?
Authors: Wong David , Durnian Jon M
Published: February 2007

Abstract

Surgical treatment has been shown to be able to improve vision that is lost as a result of age‐related macular degeneration. Surgery is complex, such that improvement has always to be weighed against risk of complications. The availability of Ranibizumab and Bevacizumab is set to dramatically alter our management options. Surgical treatment will have a limited role to play in the next few years.
EVOLUTION TO NEPHRON‐SPARING SURGERY FOR RENAL CELL CARCINOMA
Authors: O’Malley Patrick J. , Bruyere Franc , Costello Anthony J.
Published: February 2007

Earlier diagnosis of renal cell carcinoma has lent itself to significant developments in its management. Traditional treatment has been with radical open nephrectomy; however, minimal invasive procedures and nephron‐sparing surgery have now established themselves as contemporary treatment methods for this condition.
LIVER REGENERATION: MECHANISMS, MYSTERIES AND MORE
Authors: Khan Aamir Z. , Mudan Satvinder S.
Published: February 2007

Background:  Liver regeneration remains a fascinating topic, still partly clouded to many as to the exact cellular and molecular mechanisms that bring about this phenomenon. It is an area, therefore, of active research today. This review looks at the recent published reports that have led to a greater understanding of this process.

Methods:  A database search was carried out on Medline search using the terms liver regeneration with no linguistic limitations from 1966 to 2006.

Results:  There are two randomized controlled trials on the topic and most data and information have come from experimental studies in animals.

Conclusion:  Liver regeneration is a complex, tightly controlled process involving many inflammatory cells growth factors and hormones. More information about it is awaited in studies on humans.
Intra‐operative placement of intercostal catheter for post‐thoracotomy pain relief in a child
Authors: COOPER M.G. , SEATON H.L.
Published: February 2007

Intra‐operative placement of a catheter in the posterior intercostal space at thoracotomy is technically easier than other forms of regional analgesia such as thoracic epidural. Intermittent bolus dosing of bupivacaine with adrenaline allows subpleural spread to other intercostal interspaces. This spread is volume dependent and may be even greater due to smaller distances between these spaces in children. This technique has advantages over interpleural analgesia which may not be completely effective for post‐thoracotomy pain. Analgesia can occur for up to 10 h with each dose, and markedly decrease opioid requirements. This technique is described in a 7‐year‐old child undergoing anterior thoracic spine fusion.
An evaluation of the laryngeal mask airway during routine paediatric anaesthesia
Authors: McGINN G. , HAYNES S.R. , MORTON N.S.
Published: February 2007

During a six week period, all anaesthetists at the Royal Hospital for Sick Children, Glasgow were asked to complete a questionnaire whenever a laryngeal mask airway (LMA) was used. Seniority of anaesthetist, age of patient, anaesthetic technique, technique of LMA insertion, ease of LMA insertion, and any problems encountered either during LMA insertion, or during induction, maintenance, and recovery from anaesthesia were documented. Complete data were obtained from 211 patients aged 5 weeks to 15 years. Ninety‐six children were anaesthetized by consultant paediatric anaesthetists, and 115 by trainees. LMA insertion was successful at the first attempt in 86% of all cases, achieved with some difficulty in 11% of cases, and failed or its use was abandoned in 6 cases (3%). Difficulties other than with LMA placement per se occurred in 11% of cases during induction of anaesthesia. Seniority of anaesthetist and choice of anaesthetic agent influenced neither the success rate of insertion nor the frequency of other difficulties encountered during induction of anaesthesia. Significantly fewer problems were encountered at LMA removal if this was done during deep anaesthesia compared with removal when protective reflexes were present (P < 0.05).
Arthrogryposis multiplex congenita (AMC). A review of 32 years’ experience
Authors: ZAMUDIO I.A. , BROWN T.C.K.
Published: February 2007

Arthrogryposis multiplex congenita (AMC) is an uncommon condition with multiple congenital joint contractures of variable severity that is present in 1:3000 to 1:10 000 newborns. This abnormality results from a neuropathic or occasionally a myopathic lesion present in utero. Surgery is required for the correction of skeletal deformities and associated visceral anomalies. A retrospective study of the Royal Children's Hospital experience with AMC patients over the last 32 years is presented. The anaesthetic drugs and techniques used, complications, surgical procedures and mortality in 143 patients are reviewed. Thirteen patients were severely affected and died during their first week of life. One hundred and twenty‐eight patients underwent 928 procedures, the majority of them orthopaedic. Seventy complications were reported. Ten patients had a moderate increase in temperature (less than 2°C) out of 43 in whom it was recorded. There were 27 difficult intubations in 9 patients who had a total of 81 anaesthetics. Patients with AMC require careful preoperative assessment of their airway. Skill in gaining intravenous access and at intubation is essential. Monitoring of temperature, neuromuscular function and careful assessment of ventilation at the end of the anaesthetic is necessary.
An audit of sedation, analgesia and muscle relaxation in paediatric intensive care in the United Kingdom
Authors: MATTHEWS A.J.
Published: February 2007

A questionnaire detailing four clinical cases (epiglottitis; head injury; aspiration pneumonitis and a neonate requiring postoperative pulmonary ventilation) was used to elicit the opinions of consultant paediatric anaesthetists in the UK regarding airway management, sedation level and drugs used in paediatric intensive care. Sixteen out of 18 replied. The preferred level of sedation varied and was deepest in head injury and lightest in epiglottitis. Airway management in epiglottitis most commonly involved a breathing system utilizing continuous positive airway pressure (CPAP). In the management of a head injury, a mixture of sedative, analgesic and muscle relaxant was preferred (15/16). Different combinations of drugs were preferred in managing the other three clinical cases. A majority of the participants (15/16) favoured intravenous infusions as the method of choice for drug delivery. Of the more recently introduced drugs, propofol was used occasionally or often in 11 units, compared with isoflurane and alfentanil in 1 and 4 units respectively. Complications from the long term use of many sedative drugs have been reported and constant vigilance is required to detect these effects.
Development of a monitoring protocol for safe use of opioids in children
Authors: MORTON N.S.
Published: February 2007

A monitoring protocol incorporating pulse oximetry was developed for children receiving patient‐controlled analgesia (PCA) and was applied to 75 children undergoing major abdominal, urological or orthopaedic procedures. Patients used PCA for a mean of of 48.9 h (range 11–147 h). Eighty‐three percent of hourly pain scores were 0 or 1, indicating no pain or mild pain, with only 1.7% of 3669 recorded pain scores indicating severe pain. The mean minimum oxyhaemoglobin saturation (Spo2) value while breathing ambient air was 92% (range 84–99%). Eighty‐four percent of Spo2 recordings were in the range 95–100%. Only 1% of Spo2 recordings were <90% and none of these was associated with a slow respiratory rate or oversedation. The mean minimum respiratory rate was 17 (range 10–26). The protocol proved to be easy to use in the general ward. It can be readily adapted for use in all children receiving opioids by whatever route and for children undergoing sedation for investigative procedures.
Patient‐controlled analgesia in children. A comparison of two infusion techniques
Authors: SKUES MARK A. , WATSON DUNCAN M. , O'MEARA MOIRA , GODDARD JOHN M.
Published: February 2007

The effectiveness of patient‐controlled intravenous morphine with and without a supplementary fixed rate infusion was studied in 40 children after orthopaedic surgery and 40 children after abdominal surgery. The use of a background infusion after orthopaedic surgery, where the majority of children received intra‐operative regional blockade, resulted in a higher total dose of morphine (P < 0.05) without evidence of improved analgesia, compared to PCA alone. Children receiving a background infusion after abdominal surgery showed evidence of improved sleeping patterns post‐operatively compared with those receiving PCA alone, despite similar overall morphine consumption. There were no episodes of excessive sedation, or respiratory depression with the use of either regimen, and over 90% of the children studied were assessed as experiencing either no pain or mild pain. The suitability and efficacy of patient controlled analgesia for management of post‐operative pain for children aged between 5 and 17 years appears to be confirmed. The use of a supplementary background infusion may be of value in children.
A pain service for children
Authors: LLOYD‐THOMAS A.R. , HOWARD R.F.
Published: February 2007

The development of an acute pain service has enabled hospital staff to improve postoperative analgesia. Patient protocols have been coordinated to ensure consistent and safe management throughout the hospital. Patient satisfaction has been very high with consistently over 90% of patients having good pain relief. High quality analgesia highlights side effects especially urinary retention with extradural opioids. Further research is needed to diminish the incidence of these complications.
Therapeutic bronchoalveolar lavage for pulmonary alveolar proteinosis in an infant
Authors: TROJE CHRISTIAN , MOUNSAVENG SALEM , DUBOIS MARIECLAUDE , DELORME MONIQUE , GRIMFELD ALAIN , MURAT ISABELLE
Published: February 2007

A 2‐year‐old male infant suffering from pulmonary alveolar proteinosis was treated by four unilateral bronchoalveolar lavages (BAL) in a 12‐month period. The lavages were performed under general anaesthesia and controlled ventilation by introducing a fibrescope (3.6 mm external diameter) though either a tracheal tube (4.5 mm internal diameter) or a rigid bronchoscope. Each lobe of the lung was successively catheterized and the segments were washed separately with prewarmed saline solution injected through the side channel of the fibrescope. The described technique allows to perform BAL in safe conditions (i.e., controlled airways) in infants weighing more than 9 kg.
Four different fluid regimes during and after minor paediatric surgery—a study of blood glucose concentrations
Authors: SANDSTRÖM K. , LARSSON L.E. , NILSSON K.
Published: February 2007

In order to evaluate the efficiency of glucose homeostatic mechanisms in otherwise healthy infants and children during and after anaesthesia and surgery four different fluid regimes were studied in 40 patients, 6–24 months old. The four regimes all resulted in a total fluid volume of 10 ml·kg−1·h−1 intraoperatively and 3 ml·kg−1 h−1 postoperatively. One group received a combination of glucose 300 mg·kg−1h−1 and Ringer acetate intraoperatively and glucose postoperatively, a second group was given the same intraoperative fluid followed by glucose free Ringer acetate postoperatively. A third group received Ringer acetate both intra‐ and postoperatively and a fourth group was given Ringer acetate intraoperatively and glucose postoperatively. Blood glucose concentrations were measured after induction (Preop.), immediately after surgery (Postop.) and after 30, 60 and 120 min. Increased blood glucose concentrations were found in all children immediately after surgery. The concentrations were highest among children given glucose. Postoperatively blood glucose remained elevated in children receiving glucose after surgery. In patients without postoperative glucose supply blood glucose concentrations declined. Hypoglycaemia was not seen on any occasion. The differences in blood glucose concentrations with different regimes were significant but small. We conclude that the studied group of healthy children appeared to be capable of regulating blood glucose levels within normal limits with or without intraoperative glucose and also if the intraoperative glucose supply was interrupted postoperatively.
Blood glucose and insulin levels during epidural anaesthesia in children receiving dextrose‐free solutions
Authors: GOUYET LOUISE , DUBOIS MARIE‐CLAUDE , MURAT ISABELLE
Published: February 2007

Summary

This study was designed to evaluate the hyperglycaemic response to surgery in two groups of children undergoing minor surgical procedures and receiving dextrose‐free solutions during the perioperative period. Twenty‐four unpremedicated children of less than eight years of age were randomly assigned to receive either general anaesthesia using halothane, vecuronium and narcotics (GA group, n= 12) or general anaesthesia (halothane, vecuronium) combined with caudal anaesthesia (RA group, n= 12). In both groups blood glucose and insulin concentrations were measured during inhalational induction (T0), at the end of surgery (T1) and 30, 60, 120 min after surgery (T2, T3, T4). A significant hyperglycaemic response to surgery was observed in the GA group, while no changes in blood glucose were observed in the RA group. The maximal blood glucose value was observed 30 min after completion of surgery. Insulin changes followed closely changes in blood glucose values. This study demonstrates that epidural anaesthesia was effective in reducing the hyperglycaemic response to surgery in children scheduled for minor surgical procedures. The lack of increase in blood glucose values under epidural anaesthesia suggests that blood glucose levels should be monitored during the perioperative period, especially after a prolonged fasting time and when oral intake might be delayed.
Preoperative anxiety and gastric fluid secretion in healthy children scheduled for outpatient surgery
Authors: PATEL RAMESH I. , HANNALLAH RAAFAT S. , VERGHESE SUSAN T.
Published: February 2007

Summary

A prospective study of otherwise healthy unpremedicated children scheduled for outpatient surgery was undertaken to determine the relationship between preoperative anxiety and gastric fluid volume and acidity in children. The anxiety level of the child, using a six point anxiety scale, was determined in the preoperative holding area 15–30 min before surgery. After induction of anaesthesia and tracheal intubation, a multi‐port large bore catheter was inserted orally to aspirate gastric contents. Gastric fluid volume was measured and its pH was determined by an Accumet® 915 pH meter. One hundred and fifty patients, between 2 and 10 years of age (mean 5.3 ± 3.0 yrs), weighing 11.2–69.0 kg (mean 22.3 ± 15.4) were studied. Gastric contents could only be aspirated in 101 out of 150 patients. Gastric fluid volume averaged 0.41 ± 0.31 ml·kg−1 in these 101 patients. The average pH was 1.54 ± 0.40. Thirty two patients (21%) had gastric fluid volume > 0.4 ml·kg−1 and pH <2.5. Neither the gastric volume nor the pH correlated with the preoperative anxiety scores. We conclude that in otherwise healthy children undergoing outpatient surgery, preinduction anxiety does not affect gastric volume and/or acidity.
Paediatric post orchidopexy analgesia—effect of diclofenac combined with ilioinguinal/iliohypogastric nerve block
Authors: MANNION D. , ARMSTRONG C. , O'LEARY G. , CASEY W.
Published: February 2007

Summary

When ilioinguinal/iliohypogastric nerve blockade is used to provide postoperative analgesia after paediatric orchidopexy, supplemental analgesia may be required postoperatively. Diclofenac is a nonsteroidal analgesic which produces effective analgesia after tonsillectomy. We examined the effect of combining diclofenac with inguinal field block for post orchidopexy analgesia. Following induction of anaesthesia, group 1 (n= 25) received ilioinguinal block and rectal diclofenac (2 mg·kg−1) and group 2 (n= 25) received ilioinguinal block alone. Objective pain scores were assessed for the first three h postoperatively and the incidence of postoperative rescue analgesia, noted. Pain scores were significantly less in group 1 at 45, 60, 90 and 120 min postop (P < 0.05). The postoperative analgesic requirement was significantly lower in the diclofenac group compared to control (P < 0.05). A single administration of rectal diclofenac is a simple and effective method of significantly improving analgesia associated with inguinal field block, after paediatric orchidopexy.
Postoperative nausea and vomiting in paediatric surgical inpatients
Authors: BYERS G.F. , DOYLE E. , BEST C.J. , MORTON N.S.
Published: February 2007

A prospective study of postoperative nausea and vomiting (PONV) was conducted in 415 children presenting for inpatient surgery. The overall incidence of PONV was 18.1%. The highest incidence was in children undergoing ENT procedures and increased with age. Avoidance of intraoperative opioids and the use of local anaesthesia and/or non‐steroidal anti‐inflammatory drugs reduced the incidence of nausea and vomiting postoperatively.
Anaesthesia in children with viral respiratory tract infections
Authors: VAN DER WALT JOHAN
Published: February 2007

The effects and consequences of anaesthesia in a child with a respiratory tract infection (RTI) are controversial. There is a high incidence of viral RTI in children presenting for surgery and anaesthesia. The social and economic impact of postponing the procedure is significant; for the child, family and institution. The clinical effects of the common cold are well known, affecting the respiratory tract from the nose down to the small airways and lung parenchyma. The systemic effects of the toxic viraemic phase are also well recognized but not so the potential risk of a viral myocarditis. There is an increased incidence of intra‐ and postoperative respiratory related complications up to six weeks after a RTI. These include airway obstruction, laryngeal spasm, vagally mediated reflex bronchoconstriction, increased bronchial secretions, desaturation, atelectasis and postoperative respiratory complications. Children with symptoms of a moderate to severe RTI presenting for elective surgery should be postponed for six weeks. Emergency surgery should proceed with a mask anaesthetic for minor surgery or by adopting a modified rapid sequence induction (atropine but no cricoid pressure) to gain rapid control of the airway to avoid laryngeal spasm and vagally mediated reflex bronchoconstriction; IPPV, awake extubation, postoperative monitoring of respiratory function and appropriate analgesia.
An audit of adverse events in children sedated with chloral hydrate or propofol during imaging studies
Authors: MEROLA CRAIG , ALBARRACIN CYNTHIA , LEBOWITZ PHILIP , BIENKOWSKI ROBERT S. , BARST SAMUEL M.
Published: February 2007

We examined records of sedations provided by the paediatric anaesthesiology staff for 455 children (ages 1 mo‐17 yr) undergoing MRI or CT scans at our institution over a twelve‐month period with regard to the monitoring of adverse events: excessive sedation, agitation, vomiting, hypoxaemia, and major airway compromise. One hundred‐and‐thirty‐one patients (29%) received chloral hydrate; 324 patients (71%) received propofol. All patients were monitored with continuous noninvasive pulse oximetry and received supplemental oxygen via nasal cannulae. Of the patients who received chloral hydrate, 64 (49%) were over one year of age; of the patients who received propofol, 318 (98%) were one year of age or older. In the chloral hydrate group, 23 patients (19%) were deemed excessively sedated and four patients (3%) were agitated; no patients in the propofol group experienced any of the adverse outcomes reviewed. Furthermore, no patients in either group had significant airway compromise and none was admitted to the hospital as a result of the sedation.
Morphine consumption and respiratory depression in children receiving postoperative analgesia from continuous morphine infusion or patient controlled analgesia
Authors: BRAY R.J. , WOODHAMS A.M. , VALLIS C.J. , KELLY P.J.
Published: February 2007

Thirty children, aged between five and 15 years, were randomly allocated to receive postoperative analgesia from continuous morphine infusion (CMI) or patient controlled analgesia (PCA), also using morphine. The children's morphine consumption, respiratory rates, oxygen saturations and observation points during which they were sleeping were recorded during two periods, one on the day of operation and one the following day. The median dose of morphine consumed by the children using PCA was significantly larger than that consumed by the children having continuous infusions. Children aged between nine and 15 years using PCA had significantly lower minimum respiratory rates and minimum oxygen saturations than similarly aged children receiving continuous infusions. There was no significant difference between the PCA and CMI groups in the number of observation times that the children were asleep or in the minimum respiratory rates and minimum oxygen saturations in the awake and sleeping children.
Anaesthesia for patients with Trisomy 13 (Patau's syndrome)
Authors: POLLARD R.C. , BEASLEY J.M.
Published: February 2007

Patau's syndrome (Trisomy 13) is usually fatal within the first six months of life. For the few survivors, corrective surgery is only undertaken if the child has a reasonable chance of living for some time. Hence the reports of anaesthesia and surgery in the literature are rare. We describe the anaesthesia for a repair of cleft lip and palate on two children who presented to our department.
Anaesthesia for Rett syndrome
Authors: DEARLOVE O.R. , WALKER R.W.M.
Published: February 2007

Rett syndrome is a devastingly disabling neurological disease that is only observed in girls. Scoliosis occurs in roughly half the girls and surgery may be required. Anaesthesia is described in three patients. Sudden death may be a feature of the disease which occurred four weeks postoperatively in one case. Although a long QTcinterval may be seen, it did not occur in any of our cases.
Neuromuscular effects of rocuronium in children during halothane anaesthesia
Authors: VUKSANAJ DILA , SKJONSBY BARBARA , DUNBAR BURDETT S.
Published: February 2007

Rocuronium bromide, a nondepolarizing muscle relaxant has been shown to have a short onset and intermediate duration of action in adults and young children. We evaluated onset time, intubating conditions, as well as duration of action of rocuronium in children ages four to 12 years during nitrous oxide‐halothane anaesthesia. Following a stable recording of train‐of‐four (TOF) impulses at the ulnar nerve, patients were given rocuronium 600 μg˙kg−1 intravenously. We found that the time to 90% and 100% neuromuscular (N‐M) block of the (TOF) was 51 ± 18 s and 66 ± 32 s respectively. Intubation was achieved at 94 ± 31 s and rated as good or excellent in all cases. Time to recovery of N‐M transmission to 25%, 75% and 90% of control was 29 ± 8 min, 42 ± 14 min and 46 ± 16 min respectively. Heart rate increased ∼12 BPM after drug injection, while the blood pressure remained unchanged. From our data we conclude that, as in other age groups, rocuronium has a rapid onset, intermediate duration of action in children 4–12 years of age, and appears devoid of significant side effects.
Effective pain relief with continuous intrapleural bupivacaine after thoracotomy in infants and children
Authors: SEMSROTH MARGOT , PLATTNER OLGA , HORCHER ERNST
Published: February 2007

The effect of continuous intrapleural bupivacaine on pain relief after lateral thoracotomy was studied in nine infants (≤ 15 kg body weight) and 11 children (> 15 kg body weight). An intrapleural catheter was inserted under direct vision during surgery. After extubation, the patients were transferred to the ICU where vital signs and pain scores were monitored. An intrapleural infusion of bupivacaine 0.25% with adrenaline was given at a loading dose of 0.625 mg˙kg−1 body weight followed by a continuous infusion with a starting rate of 1.25 mg˙kg−1˙h−1. Haemodynamic and respiratory parameters did not differ significantly from control values throughout the study period in either group. The mean infusion rate could be reduced stepwise in both groups to 0.75 ± 0.32 mg˙kg−1˙h−1 and 0.73 ± 0.38 mg˙kg−1˙h−1 respectively. The pain score indicated a rapid onset of analgesia in both groups and remained low during the study period. The degree of analgesia amongst other factors was position dependent. The lack of any recognizable side effects or complications related to this method has been most encouraging. Only one child required a supplementary dose of an opioid. We conclude that continuous intrapleural access has proved to be a safe and suitable route for pain relief in infants and children following thoracotomy.
The use of ondansetron to treat pruritus associated with intrathecal morphine in two paediatric patients
Authors: ARAI LYNDA , STAYER STEPHEN , SCHWARTZ ROY , DORSEY ALFRED
Published: February 2007

Intrathecal morphine is an effective technique for providing postoperative analgesia after major surgical procedures in children. Pruritus is a common side effect associated with intrathecal morphine. We report two patients who experienced significant pruritus associated with intrathecal morphine administration and were successfully treated with ondansetron. Ondansetron appears to be a beneficial and safe method of relieving pruritus associated with intrathecal morphine.
Colorectal MDTs: the team's perspective
Authors: Sharma A. , Sharp D. M. , Walker L. G. , Monson J. R. T.
Published: February 2007

Objective  Multidisciplinary teams (MDTs) are an integral part of the National Cancer Plan. However, there is surprisingly little empirical research on how these are perceived by colorectal surgeons (CRSs) and colorectal clinical nurse specialists (CNSs). The purpose of this study therefore was to obtain the views of a national cohort of CRSs and CNSs regarding various important aspects of MDT functioning and role of CNS in current setting.

Method  Two hundred and fifty‐three CRSs and 177 CNSs, identified from the Association of Coloproctologists of Great Britain and Ireland, responded to an ad hoc postal questionnaire.

Results  96.5% of respondents considered that MDTs improved the overall quality of care of colorectal cancer patients, and 78.6% thought MDTs were good for their morale. Eighty per cent considered that they improved training. Seventy‐three per cent of surgeons and nurses thought that MDTs were cost effective, and 89% did not consider them to be a passing fad. However, more than half (50.4%) of the CRSs and 35.2% of the CNSs stated that their job plan did not contain adequate time to attend MDT meetings. Compared with CRSs, CNSs were significantly more likely to have positive views regarding the MDT (P < 0.005).

Conclusion  CNSs and CRSs consider that colorectal MDTs have very beneficial effects on patient care, training and morale. However, many surgeons and nurse specialists consider that attendance at MDTs is not taken into account adequately in terms of their job plans, and this issue needs to be addressed.
Theoretical Perspectives on Welfare
Authors: Pinker Robert
Published: February 2007

SOCIETY AND SOCIAL POLICY: THEORETICAL PERSPECTIVES ON WELFARE by Ramesh Mishra
New Middle Principles for The Welfare State
Authors: Fogarty Michael
Published: February 2007

Health, Wealth and Housing By R.A.B. LEAPER (ed.)
Central Questions and Some Answers: the State of the Sociology of Education
Authors: David Miriam E.
Published: February 2007

Schooling, Ideology and the Curriculum By Len Bartonet al. (eds.)

Education and The State By Roger Daleet al. (eds.)

The Missing Half: Girls and Science Education By Alison Kelly (ed.)
Prisons and Panopticons
Authors: Forsythe Bill
Published: February 2007

This article concerns a number of aspects of the history of social policy during the nineteenth century. In particular it argues that the five stage model of development proposed by Dr Oliver MacDonagh in 1958 has been somewhat too peremptorily dismissed by historians, and it uses the prison system between 1777 and 1877 as a test of each stage of the model as far as this part of the social administrative system is concerned.

In addition MacDonagh's views on the part of Jeremy Bentham in the changes which occurred in social policy in the nineteenth century were also said to be invalid and thus an attempt is made to illuminate further Bentham's role in prison reform.

The article therefore sets out to test MacDonagh's thesis in one particular area of development and suggests that as far as prisons are concerned it throws a good deal of light upon the processes of change which occurred.
District Health Organization
Authors: Kinston Warren
Published: February 2007

Government policy in the UK has been to provide comprehensive personalized health care to the whole population free at the point of delivery. However, the first major attempt to unify and regionalize the service in 1974 left a number of problems, and a further restructuring of the NHS was required. This article reports on the results of research into the 1982 restructuring. The main feature of this second reorganization was the formation of territorial entities called “Districts”, and their organizational subdivision into “Units”. The kind and level of work and authority assigned to Districts and Units is discussed. An important fading, seemingly counter to official policy, is the existence of small Districts which operate at the same level as Units of the larger Districts.