bluuebunny/crossref_metadata_2025 huggingface dataset:
Consensus generation and variant detection by Celera Assembler
Authors: Denisov Gennady , Walenz Brian , Halpern Aaron L. , Miller Jason , Axelrod Nelson , Levy Samuel , Sutton Granger
Published: March 2008

Motivation: We present an algorithm to identify allelic variation given a Whole Genome Shotgun (WGS) assembly of haploid sequences, and to produce a set of haploid consensus sequences rather than a single consensus sequence. Existing WGS assemblers take a column-by-column approach to consensus generation, and produce a single consensus sequence which can be inconsistent with the underlying haploid alleles, and inconsistent with any of the aligned sequence reads. Our new algorithm uses a dynamic windowing approach. It detects alleles by simultaneously processing the portions of aligned reads spanning a region of sequence variation, assigns reads to their respective alleles, phases adjacent variant alleles and generates a consensus sequence corresponding to each confirmed allele. This algorithm was used to produce the first diploid genome sequence of an individual human. It can also be applied to assemblies of multiple diploid individuals and hybrid assemblies of multiple haploid organisms.

Results: Being applied to the individual human genome assembly, the new algorithm detects exactly two confirmed alleles and reports two consensus sequences in 98.98% of the total number 2 033 311 detected regions of sequence variation. In 33 269 out of 460 373 detected regions of size >1 bp, it fixes the constructed errors of a mosaic haploid representation of a diploid locus as produced by the original Celera Assembler consensus algorithm. Using an optimized procedure calibrated against 1 506 344 known SNPs, it detects 438 814 new heterozygous SNPs with false positive rate 12%.

Availability: The open source code is available at: http://wgs-assembler.cvs.sourceforge.net/wgs-assembler/

Contact:  gdenisov@jcvi.org
BicOverlapper: A tool for bicluster visualization
Authors: Santamaría Rodrigo , Therón Roberto , Quintales Luis
Published: March 2008

Summary: BicOverlapper is a tool to visualize biclusters from gene-expression matrices in a way that helps to compare biclustering methods, to unravel trends and to highlight relevant genes and conditions. A visual approach can complement biological and statistical analysis and reduce the time spent by specialists interpreting the results of biclustering algorithms. The technique is based on a force-directed graph where biclusters are represented as flexible overlapped groups of genes and conditions.

Availability: The BicOverlapper software and supplementary material are available at http://vis.usal.es/bicoverlapper

Contact:  rodri@usal.es
PedMine—a simulated annealing algorithm to identify maximally unrelated individuals in population isolates
Authors: Douglas Julie A. , Sandefur Conner I.
Published: March 2008

Summary: In family-based genetic studies, it is often useful to identify a subset of unrelated individuals. When such studies are conducted in population isolates, however, most if not all individuals are often detectably related to each other. To identify a set of maximally unrelated (or equivalently, minimally related) individuals, we have implemented simulated annealing, a general-purpose algorithm for solving difficult combinatorial optimization problems. We illustrate our method on data from a genetic study in the Old Order Amish of Lancaster County, Pennsylvania, a population isolate derived from a modest number of founders. Given one or more pedigrees, our program automatically and rapidly extracts a fixed number of maximally unrelated individuals.

Availability:  http://www.hg.med.umich.edu/labs/douglaslab/software.html (version 1.0.0)

Contact:  jddoug@umich.edu
The trophic roles of microzooplankton in marine systems
Authors: Calbet Albert
Published: March 2008

Calbet, A. 2008. The trophic roles of microzooplankton in marine systems. – ICES Journal of Marine Science, 65: 325–331. Microzooplankton (here defined as <200 µm grazers) are key components of marine foodwebs. Their grazing significantly affects primary producers and usually exceeds that of mesozooplankton. However, our knowledge of the detailed roles that microzooplankton taxa play in marine ecosystems is surprisingly limited. Here, I identify the main protists responsible for most of the grazing impact on phytoplankton in two contrasting marine ecosystems: oligotrophic waters and productive waters, such as upwelling systems, spring blooms, and other blooms in nearshore and estuarine systems. Evidence indicates that pico- and nano-sized flagellates, which are routinely included with the microzooplankton size class of protists, appear to be the main grazers of phytoplankton in oligotrophic habitats, whereas heterotrophic and mixotrophic dinoflagellates are candidates for the dominant grazing impact in upwelling and other productive ecosystems. Microzooplankton are also important contributors to mesozooplankton diet, especially in oligotrophic areas, although the strength of the mesozooplankton–microzooplankton link is traditionally overlooked in plankton studies. As a final remark, this review emphasizes the need to develop suitable methods for studying the role of microbial grazers in the dynamics of marine ecosystems.
Jacob Christian Schäffer FRS, a versatile eighteenth-century naturalist, and his remarkable pioneering researches on microscopic crustaceans
Authors: Fryer Geoffrey
Published: March 2008

Jacob Christian Schäffer was the first to appreciate the morphological complexity of the microscopic crustaceanDaphnia. His investigations, published in 1755, provide an excellent example of the difficulties facing those who, for the first time, attempted to elucidate the structure of extremely complicated animals of small size, of which there were no familiar counterparts. Nevertheless he not only revealed many hitherto unsuspected anatomical features but attempted, with some success, to explain their function. Most notably he showed thatDaphniaproduces a current of water that draws suspended particles into its complex food-handling machinery. An earlier suggestion of how it feeds was completely erroneous and misleading. A pioneer of the comparative method, Schäffer provided an excellent example of how it helped him to understand, if not entirely to resolve, a complicated mechanism. That reproduction can be either parthenogenetic or sexual presented problems that were not resolved for more than another century. Unaware that males exist, and on the basis of seemingly sound, but misleading, observations, he concluded thatDaphniais a hermaphrodite.
A theory for the finite displacement of a thin-walled Bernoulli–Euler beam and lateral post-buckling analysis
Authors: Usuki Tsuneo
Published: March 2008

The state vector equation for lateral buckling in finite displacement theory is formulated using only the hypothesis of the Bernoulli–Euler beam. By using an appropriate orthogonalization of the warping functions, the normally complicated calculation has been processed systematically using only matrix notation. As a numerical analysis, the lateral buckling load on the cantilever receiving a concentrated end load on the upper flange was calculated using the coefficient matrix of the first-order increment; the post-buckling behaviour was investigated with increasing load. Since the state vector equation is a higher order nonlinear equation, the original coefficient matrix was fixed with an arbitrary initial value and the solution was provided by the Runge–Kutta transfer matrix method. Subsequent calculations were pursued in the same way with the solution obtained via Runge–Kutta methods as a new initial value and then shifted to the next load condition. This theory and analysis method does not employ an assumed displacement function, such as the Ritz's method; it is therefore useful for the finite displacement analysis of a beam with arbitrary boundary conditions and intermediate support conditions.
Ehlers‐Danlos syndrome – a historical review
Authors: Parapia Liakat A. , Jackson Carolyn
Published: March 2008

Ehlers‐Danlos syndrome is an inherited heterogeneous group of connective tissue disorders, characterized by abnormal collagen synthesis, affecting skin, ligaments, joints, blood vessels and other organs. It is one of the oldest known causes of bruising and bleeding and was first described by Hipprocrates in 400 BC. Edvard Ehlers, in 1901, recognized the condition as a distinct entity. In 1908, Henri‐Alexandre Danlos suggested that skin extensibility and fragility were the cardinal features of the syndrome. In 1998, Beighton published the classification of Ehlers‐Danlos syndrome according to the Villefranche nosology. From the 1960s the genetic make up was identified. Management of bleeding problems associated with Ehlers‐Danlos has been slow to progress.
β2‐Adrenergic receptor and adenylate cyclase gene polymorphisms affect sickle red cell adhesion
Authors: Eyler Christine E. , Jackson Terry , Elliott Laine E. , De Castro Laura M. , Jonassaint Jude , Ashley‐Koch Allison , Telen Marilyn J.
Published: March 2008

Sickle red cell (SS RBC) adhesion is thought to contribute to sickle cell disease (SCD) pathophysiology. SS RBC adhesion to laminin increases in response to adrenaline stimulation of β2‐adrenergic receptors (β2ARs) and adenylate cyclase (ADCY6), and previous evidence suggests such activation occurs in vivo. We explored whether polymorphisms of the β2AR and ADCY6 genes (ADRB2 and ADCY6, respectively) affect RBC adhesion to laminin. We found that the β2AR arg16→gly substitution and two non‐coding ADCY6 polymorphisms were associated with elevated adhesion. We postulate that ADRB2 and ADCY6 polymorphisms may influence SCD severity through the mechanism of RBC adhesion.
Effects of extensive splenomegaly in patients with myelofibrosis undergoing a reduced intensity allogeneic stem cell transplantation
Authors: Ciurea Stefan O. , Sadegi Barry , Wilbur Andrew , Alagiozian‐Angelova Victoria , Gaitonde Sujata , Dobogai Lisa C. , Akard Luke P. , Hoffman Ronald , Rondelli Damiano
Published: March 2008

Changes in spleen size postallogeneic haematopoietic stem cell transplantation (HSCT) in patients with primary myelofibrosis have been poorly characterized. We analysed 10 patients with myelofibrosis and splenomegaly following a reduced‐intensity allogeneic HSCT. All patients fully engrafted donor cells including five patients with extensive splenomegaly. Extensive splenomegaly was associated with a prolonged time to neutrophil and platelet recovery. In all 10 patients, a progressive reduction of splenomegaly was documented within 12 months post‐transplant and paralleled the reduction of marrow fibrosis. These findings suggest that myelofibrosis patients with extensive splenomegaly may proceed with allogeneic HSCT without prior splenectomy.
The non‐haematopoietic biological effects of erythropoietin
Authors: Arcasoy Murat O.
Published: March 2008

In the haematopoietic system, the principal function of erythropoietin (Epo) is the regulation of red blood cell production, mediated by its specific cell surface receptor (EpoR). Following the cloning of the Epo gene (EPO) and characterization of the selective haematopoietic action of Epo in erythroid lineage cells, recombinant Epo forms (epoetin‐alfa, epoetin‐beta and the long‐acting analogue darbepoetin‐alfa) have been widely used for treatment of anaemia in chronic kidney disease and chemotherapy‐induced anaemia in cancer patients. Ubiquitous EpoR expression in non‐erythroid cells has been associated with the discovery of diverse biological functions for Epo in non‐haematopoietic tissues. During development, Epo–EpoR signalling is required not only for fetal liver erythropoiesis, but also for embryonic angiogenesis and brain development. A series of recent studies suggest that endogenous Epo–EpoR signalling contributes to wound healing responses, physiological and pathological angiogenesis, and the body’s innate response to injury in the brain and heart. Epo and its novel derivatives have emerged as major tissue‐protective cytokines that are being investigated in the first human studies involving neurological and cardiovascular diseases. This review focuses on the scientific evidence documenting the biological effects of Epo in non‐haematopoietic tissues and discusses potential future applications of Epo and its derivatives in the clinic.
Therapy‐associated genetic aberrations in patients treated for non‐Hodgkin lymphoma
Authors: Basecke Jorg , Podleschny Martina , Becker Annegret , Seiffert Edda , Schwiers Ivonne , Schwiers Roman , Haase Detlef , Glass Bertram , Schmitz Norbert , Trumper Lorenz , Griesinger Frank
Published: March 2008

Therapy‐associated myelodysplastic syndromes and acute myeloid leukaemia (t‐AML/MDS) following high dose chemotherapy are significant problems, with a cumulative incidence of 20% or more in myeloablative treatment regimen. Retrospective findings indicated that t‐AML/MDS associated genetic aberrations can be observed directly after exposure to chemotherapy and can precede t‐AML by several months. To determine the incidence of post‐therapeutic aberrations and their predictive value, we prospectively investigated 316 samples of 95 patients with non‐Hodgkin lymphoma (NHL) who were treated with intermediate and high dose chemotherapy (Arm A and B of the megaCHOEP (cyclophosphamide, doxorubicin, etoposide, vincristine, prednisolone) trial of the German High Grade NHL study group). Molecular aberrations (RUNX1/RUNX1T1, PML‐RARA, CBFB‐MYH11, MLL‐MLLT1, BCR‐ABL1) were observed in 33·3% (Arm A) and 55·4% (Arm B) of patients and in 14·9% and 28·7% of respective samples. Cytogenetic analysis of 53 NHL patients after high dose therapy showed frequent chromosomal breakage. Clonal aberrations were found in three patients. None of these patients developed a t‐AML/MDS during a 3‐year clinical follow up period. We concluded that the high incidence of genetic aberrations reflected a dose‐dependent, transient therapy‐induced genetic damage which is not predictive of a t‐AML/MDS.
Long‐term reactions of Ni, Zn and Cd with iron oxyhydroxides depend on crystallinity and structure and on metal concentrations
Authors: Buekers J. , Amery F. , Maes A. , Smolders E.
Published: March 2008

Iron oxyhydroxides are long‐term sinks for toxic trace metals and are suggested as factors to explain long‐term metal immobilization in soil. It is unknown how crystallinity and crystal structure of iron (Fe) oxyhydroxides affect the long‐term kinetics of trace metal adsorption. Adsorption kinetics of nickel (Ni), zinc (Zn) and cadmium (Cd) on to four synthetic Fe oxyhydroxides (hydrous ferric oxide (HFO), ferrihydrite (FH), goethite (GT), haematite (HT)) were characterized in suspensions during 70 days at different initial metal concentrations and various pH values (3.8–7.0) maintained within 0.2 units. The slow reactions, defined as those occurring beyond day 1 were most pronounced in GT and least in HT. The extent of the slow reaction was surprisingly unrelated to crystallinity or microporosity as determined by N2 adsorption. Freundlich adsorption isotherms fitted to the data show that ageing between 1 and 70 days decreases metal concentrations in solution by factors of 2–30 (Ni), 1–20 (Zn) and 1–4 (Cd) depending on the type of oxyhydroxide. These factors become significantly larger at smaller concentrations for Ni and Zn in some oxyhydroxides and this concentration dependency suggests that slow reactions are not only related to diffusion. The short‐term adsorption strength of carrier‐free metal radio‐isotopes was similar at 1 or 70 days after reaction with these iron oxyhydroxides and excludes the possibility that long‐term reactions are related to solid‐phase transformations or changes in solution properties. The extent of slow reactions in GT decreased with decreasing pH and was less than a factor 2 within 70 days at pH 3.7. The results confirm that slow reactions in Fe oxyhydroxides can explain lessened metal availability by ageing in pH neutral soils. The uncertainty of their actual structure and crystallinity in soils does not allow quantitative predictions based on the behaviour of synthetic oxyhydroxides.
Sucking habits in childhood and the effects on the primary dentition: findings of the Avon Longitudinal Study of Pregnancy and Childhood
Authors: DUNCAN KAREN , MCNAMARA CLARE , IRELAND ANTHONY J. , SANDY JONATHAN R.
Published: March 2008

Introduction.  Most previous research on non‐nutritive sucking habits has been cross‐sectional in nature. This study determined the prevalence of non‐nutritive sucking habits and the effects on the developing dentition within a longitudinal observational cohort.

Methods.  The Children in Focus group of the Avon Longitudinal Study of Pregnancy and Childhood study was studied. Questionnaire data on non‐nutritive sucking habits were collected on the children at 15 months, 24 months, and 36 months of age. Dental examinations were performed on the same children at 31 months, 43 months, and 61 months of age.

Results.  At 15 months, 63.2% of children had a sucking habit, 37.6% used just a dummy, and 22.8% used a digit. By 36 months, sucking had reduced to 40%, with similar prevalence of dummy and digit sucking. Both habits had effects on the developing dentition, most notably in upper labial segment alignment and the development of anterior open bites and posterior crossbites.

Conclusions.  The majority of children had non‐nutritive sucking habits up until 24 months of age. Both digit and dummy sucking were associated with observed anomalies in the developing dentition, but dummy‐sucking habits had the most profound influence on the anterior and posterior occlusions of the children.
Bacterial invasion of dentinal tubules beneath apparently intact but hypomineralized enamel in molar teeth with molar incisor hypomineralization
Authors: FAGRELL TOBIAS G. , LINGSTRÖM PETER , OLSSON STINA , STEINIGER FRANK , NORÉN JÖRGEN G.
Published: March 2008

Background.  The most common problems for a patient with molar incisor hypomineralization (MIH) are the collapse of enamel and cavitations, loss of fillings, and secondary caries, but most of all, severe hypersensitivity.

Objective.  The aim of this paper was therefore to histologically study possible bacterial invasion of dentinal tubules beneath apparently intact, but hypomineralized enamel in permanent molars with MIH.

Material and methods.  Five extracted permanent first molars diagnosed with MIH were fixated, demineralized, and sagittally serially sectioned in a bucco‐lingual direction in a microtome with a thickness of 4–5 µm. Sections were stained with a modified Brown and Benn staining for bacteria, unstained sections were analysed in field emission SEM.

Results.  Stained sections from the cuspal areas, below the hypomineralized enamel, the staining indicated the presence of bacteria in the dentinal tubules. The HTX staining showed that the pulp in sections without any findings was normal and free from bacteria or infiltrates from inflammatory cells. In sections where bacteria were found in the cuspal areas or deeper in the dentin, a zone of reparative dentin was found, and in sections from one tooth, the coronal pulp showed an inflammatory reaction with inflammatory cells. In sections adjacent to those without any bacterial staining, the SEM analyses revealed empty dentinal tubules without any odontoblast processes or signs of bacteria. When odontoblast processes were found, the dentinal tubules were filled with bacteria located on the surface of the odontoblast processes. In some areas, a large number of tubules were found with bacteria. No bacteria were found close to the pulp. The odontoblast processes appeared larger in areas where bacteria were found.

Conclusions.  The presence of bacteria in the dentinal tubules and inflammatory reactions in the pulp indicate that oral bacteria may penetrate through the hypomineralized enamel into the dentin, thus possibly contribute to hypersensitivity of teeth with MIH.
Nursing work in Jordan: an example of nursing work in the Middle East
Authors: Shuriquie Mona , While Alison , Fitzpatrick Joanne
Published: March 2008

Aim.  The study aimed to investigate Jordanian nurses’ perceptions of their role in clinical practice.

Background.  The lack of regulation of nursing practice by the profession across the Middle East until now has led to each institution setting its own policies regarding the role of the nurse and the practice of nursing. No study to date has examined the role of the nurse working in the acute hospital environment nor explored the practice of nursing in this region.

Design and methods.  A cross‐sectional questionnaire survey was conducted using a quota sample. A total of 348 medical‐surgical staff nurses and practical nurses from the three healthcare sectors in Jordan participated in the study with a response rate of 77%. The results were analysed by constructing multiple response tables, chi‐square test, anova and log‐linear analysis.

Results.  Staff nurses in Jordan were expected to carry out the majority of nursing care activities. The role of the practical nurse was limited to the physical and professional domains of nursing care. Activities requiring higher levels of emotional or intellectual labour and interdisciplinary communication were attributed only to the staff nurse. The majority of the respondents reported nursing had not been their first choice of career. Male nurses had a higher intention to leave the nursing profession. The predominant method of care delivery used by nurses was task‐oriented.

Conclusion.  There was a general consensus regarding what constituted the nurse's work in the clinical area across the three healthcare sectors in Jordan. Role delineation between the two levels of nurses was also clear. There is a need to move from task‐oriented to patient‐centred care to promote quality patient care.

Relevance to clinical practice.  This study explores the role of the nurse working in the acute hospital environment in Jordan.
Learning from the severe acute respiratory syndrome (SARS) epidemic
Authors: Chan Engle Angela , Chung Joanne WY , Wong Thomas KS
Published: March 2008

Aims and objectives.  This study uses two models of nursing practice, conventional and modular design, to compare nursing activities, hand hygiene, time efficiency and nurse–patient satisfaction in medical and surgical wards.

Background.  Learning from the SARS epidemic pointed to the importance of quality nursing practice considerations that minimize cross‐transmission of infection while maximizing patient‐focused care. Hence, a modular nursing model was adopted.

Design and method.  This study comprised pre‐ and postintervention phases. Data collection tools to evaluate modular nursing practice included a work sampling observation checklist, focused group interviews with nurses, questionnaires addressing nurses’ perceived competence and caring attributes, a patient satisfaction questionnaire, and a hand hygiene audit. A series of education sessions were conducted between the two phases. Quantitative and qualitative analyses were used for data triangulation.

Results.  Modular nursing practice, focusing on continuity of care, led to changes in the nature of direct care activities and improvement in patient/family education frequency. Also, a general increase in nurses’ hand washing frequency was noted. However, when nurses perceived time pressure, a lapse in hand hygiene compliance was found. Because of human resource and inefficiency issues, some nurses in the studied wards did not embrace geographical separation for infection control. Positive correlations were found for nurses’ perceived infection control practice competence and their perceived caring attributes.

Relevance to clinical practice.  In examining nursing practice models within complex clinical situations, the significance lies not only in the model's effects but also in other operational outcomes.
Investigating the knowledge, attitudes and practice patterns of operating room staff towards standard and transmission‐based precautions: results of a cluster analysis
Authors: Chan Moon Fai , Ho Aly , Day Mary Christine
Published: March 2008

Aims.  To examine the relationship on knowledge, attitudes and practice levels of operating room staff towards the standard precautions and transmission‐based precautions, and to identify profiles of them based on their demographic variables and their knowledge, attitudes and practices towards the standard precautions and the transmission‐based precautions.

Research method.  During January 2006, 113 staff working in the operating room of a public hospital completed a self‐reported questionnaire.

Outcome measures.  Demographic information, knowledge, attitudes and practices scores were collected.

Results.  Two‐step cluster analysis yielded two clusters. Clusters 1 and 2 consisted of 50·4% (n = 57) and 49·6% (n = 56), respectively. Cluster 1 subjects were younger, had a higher educational attainment level and worked at a more senior level than Cluster 2 subjects. They reported good knowledge, positive attitudes and practices. Cluster 2 subjects were characterized by relatively poor knowledge, negative attitudes and practices. Significant differences towards standard and transmission‐based precautions were found between clusters, except attitudes towards choosing protective personal equipment (p = 0·095) and practices on wearing gowns and eye shields/goggles (p = 0·759). Attitudes of Cluster 2 staffs were highly significant, but weakly correlated with practices (rs = 0·39, p < 0·05).

Conclusion.  This study clearly profiles knowledge, attitudes and practice patterns of operating room staff, which may benefit healthcare educators in planning and developing appropriate educational programmes, may help organizations to provide a safe workplace climate and may aid healthcare workers to learn the importance of personal responsibility in preventing infectious disease transmission to patients, co‐workers and even themselves.

Relevance to clinical practice.  To date, the only protection against infection is to minimize risk by modifying behaviour and practice patterns. Education and communication play a major role of the precautions. Tailoring interventions to fit different specific groups of operating room staff is needed to improve compliance with the standard and transmission‐based precautions.
A review of the psychosocial issues for nurses in male genitalia‐related care
Authors: Zang Yu‐Li , Chung Loretta YF , Wong Thomas KS
Published: March 2008

Aim.  This literature review aimed to highlight psychosocial issues for nurses in the practice of male genitalia‐related care so as to guide the improvement of the teaching and practice of male genitalia‐related care.

Background.  Male genitalia‐related care is common in hospitals and in the community. In several conditions, e.g. incontinence, postradiotherapy or following operation for cancer of genitalia, bladder, colon or rectum, patients will require male genitalia‐related care. Patients who require male genitalia‐related care may encounter psychosocial and/or sexual dysfunction. In the holistic approach to men's health, nurses are expected to meet patients’ psychosocial and sexual needs, while the literature suggests that nurses’ perceptions and attitudes in providing certain male genitalia‐related care, e.g. genital hygiene, sexual counselling, are negative.

Method.  Systematic literature review.

Conclusion.  Issues surrounding male genitalia‐related care for nurses are complicated and may be related to privacy, intimacy, sexuality, dirty work and emotional discomfort. Age, gender, race and social class could compound these issues.

Relevance to clinical practice.  Nurses’ negative perceptions, responses and attitudes towards male genitalia‐related care may exacerbate patients’ conditions under which male genitalia‐related care is required. Appropriate strategies should be developed to overcome these problems.
From critical care to comfort care: the sustaining value of humour
Authors: Dean Ruth Anne Kinsman , Major Joanne E
Published: March 2008

Aims and objectives.  To identify commonalities in the findings of two research studies on humour in diverse settings to illustrate the value of humour in team work and patient care, despite differing contexts.

Background.  Humour research in health care commonly identifies the value of humour for enabling communication, fostering relationships, easing tension and managing emotions. Other studies identify situations involving serious discussion, life‐threatening circumstances and high anxiety as places where humour may not be appropriate. Our research demonstrates that humour is significant even where such circumstances are common place.

Method.  Clinical ethnography was the method for both studies. Each researcher conducted observational fieldwork in the cultural context of a healthcare setting, writing extensive fieldnotes after each period of observation. Additional data sources were informal conversations with patients and families and semi‐structured interviews with members of the healthcare team. Data analysis involved line‐by‐line analysis of transcripts and fieldnotes with identification of codes and eventual collapse into categories and overarching themes.

Results.  Common themes from both studies included the value of humour for team work, emotion management and maintaining human connections. Humour served to enable co‐operation, relieve tensions, develop emotional flexibility and to ‘humanise’ the healthcare experience for both caregivers and recipients of care.

Conclusions.  Humour is often considered trivial or unprofessional; this research verifies that it is neither. The value of humour resides, not in its capacity to alter physical reality, but in its capacity for affective or psychological change which enhances the humanity of an experience, for both care providers and recipients of care.

Relevance to clinical practice.  In the present era which emphasises technology, efficiency and outcomes, humour is crucial for promoting team relationships and for maintaining the human dimension of health care. Nurses should not be reluctant to use humour as a part of compassionate and personalised care, even in critical situations.
Workforce profile, organisation structure and role responsibility for ventilation and weaning practices in Australia and New Zealand intensive care units
Authors: Rose Louise , Nelson Sioban , Johnston Linda , Presneill Jeffrey J
Published: March 2008

Aims and objectives.  To provide an analysis of the scope of nursing practice and inter‐professional role responsibility for ventilatory decision‐making in Australian and New Zealand (ANZ) intensive care units (ICU).

Background.  Currently, little empirical data describe nurses’ role in decision‐making for ventilation and its weaning. Delineation of roles and responsibilities for ventilatory practices vary according to unit structure, staffing and skill‐mix, patient case‐mix and unit leadership models.

Methods.  Self‐administered questionnaire sent to nurse managers of eligible ICUs within ANZ.

Results.  Survey responses were available from 54/180 ICUs. The majority (71%) of responding ICUs were located within metropolitan areas and categorised as a tertiary level ICU (50%). The mean number of nurses employed per ICU bed was 4·7 in Australia and 4·2 in NZ, with 69% (IQR: 47–80%) of nurses holding a postgraduate specialty qualification. All units reported a 1:1 nurse‐to‐patient ratio for ventilated patients with 71% reporting a 1:2 nurse‐to‐patient ratio for non‐ ventilated patients. Key ventilator decisions, including assessment of weaning and extubation readiness, were reported as predominantly made by nurses and doctors in collaboration. Overall, nurses described high levels of autonomy and influence in ventilator decision‐making. Decisions to change ventilator settings, including FiO2 (91%, 95% CI: 80–97), ventilator rate (65%, 95% CI: 51–77) and pressure support adjustment (57%, 95% CI: 43–71), were made independently by nurses.

Conclusions.  The results of this survey suggest, within the ANZ context, nurses participate actively in ventilation and weaning decisions. In addition, the results support an association between the education profile and skill‐mix of nurses and the level of collaborative practice in ICU.

Relevance to clinical practice.  Mechanical ventilation may result in significant complications if not applied appropriately. Collaborative practice that encourages nursing input into decision‐making may improve patient outcomes and reduce complications.
Impact of quality circles for improvement of asthma care: results of a randomized controlled trial
Authors: Schneider Antonius , Wensing Michel , Biessecker Kathrin , Quinzler Renate , Kaufmann‐Kolle Petra , Szecsenyi Joachim
Published: March 2008

Rationale and aims  Quality circles (QCs) are well established as a means of aiding doctors. New quality improvement strategies include benchmarking activities. The aim of this paper was to evaluate the efficacy of QCs for asthma care working either with general feedback or with an open benchmark.

Methods  Twelve QCs, involving 96 general practitioners, were organized in a randomized controlled trial. Six worked with traditional anonymous feedback and six with an open benchmark; both had guided discussion from a trained moderator. Forty‐three primary care practices agreed to give out questionnaires to patients to evaluate the efficacy of QCs.

Results  A total of 256 patients participated in the survey, of whom 185 (72.3%) responded to the follow‐up 1 year later. Use of inhaled steroids at baseline was high (69%) and self‐management low (asthma education 27%, individual emergency plan 8%, and peak flow meter at home 21%). Guideline adherence in drug treatment increased (P = 0.19), and asthma steps improved (P = 0.02). Delivery of individual emergency plans increased (P = 0.008), and unscheduled emergency visits decreased (P = 0.064). There was no change in asthma education and peak flow meter usage. High medication guideline adherence was associated with reduced emergency visits (OR 0.24; 95% CI 0.07–0.89). Use of theophylline was associated with hospitalization (OR 7.1; 95% CI 1.5–34.3) and emergency visits (OR 4.9; 95% CI 1.6–14.7). There was no difference between traditional and benchmarking QCs.

Conclusions  Quality circles working with individualized feedback are effective at improving asthma care. The trial may have been underpowered to detect specific benchmarking effects. Further research is necessary to evaluate strategies for improving the self‐management of asthma patients.
The validity and reliability of the Turkish version of the MacNew Heart Disease Questionnaire in patients with angina
Authors: Daskapan Arzu , Höfer Stefan , Oldridge Neil , Alkan Neslihan , Muderrisoglu Haldun , Tuzun Emine Handan
Published: March 2008

Aims and objectives  Health‐related quality of life (HRQL) is an important patient‐reported outcome when identifying the effects of the angina and evaluating the efficacy of treatment. The aim of this study was to determine the reliability and validity of the Turkish version of the MacNew Heart Disease HRQL Questionnaire (MacNew) in patients with angina.

Method  The Short Form SF‐36, the MacNew, and the Hospital Anxiety and Depression Scale were completed by the 125 patients in first 2–3 days after admission to the coronary care unit. Internal consistency reliability (Cronbach’s α) and reproducibility (intraclass correlation coefficients, ICC) of the MacNew were assessed, and test–retest reproducibility was evaluated over a 2‐month period in 25 clinically stable patients.

Results  The original three‐factor structure for the Turkish MacNew was confirmed, with construct validity only partially confirmed; reliability statistics show that Cronbach’s α exceeded 0.80 and the ICC exceeded 0.60 for all MacNew scales. Discriminative validity of the MacNew was confirmed.

Conclusion  The MacNew appears to be reliable and valid in Turkish patients with angina.
Impact of an educational intervention on internal medicine residents’ physical activity counselling: the Pressure System Model
Authors: Katz David L. , Shuval Kerem , Comerford Beth P. , Faridi Zubaida , Njike Valentine Y.
Published: March 2008

Rationale, aims and objectives  Systematic reviews point to inconclusive evidence that counselling patients in a primary care setting is effective in increasing adults’ physical activity (PA) levels. This study evaluates the impact of an innovative physician counselling programme on physicians’ PA counselling behaviour and their patients’ PA levels.

Methods  A controlled educational study conducted at six Yale School of Medicine hospitals. Sixty‐five internal medicine residents and 316 primary care patients were randomized to intervention or control groups. Intervention physicians participated in five interactive sessions outlining details of the Pressure System Model, while control physicians received usual residency training. Intervention and control patients’ PA levels and residents counselling behaviour were assessed using a validated questionnaire and compared pre‐ and post intervention. Data analysis was performed using paired t‐tests and repeated measures anova.

Results  At 6‐month follow‐up intervention, patients’ PA levels increased significantly from baseline (1.77 ± 0.84; P = 0.0376). A similar pattern was observed after 12 months (1.94 ± 0.98; P = 0.0486). Control patients’ PA did not change significantly from baseline at 6 or 12 months (0.35 ± 1.00; P = 0.7224 and 0.99 ± 1.52; P = 0.5160, respectively). At 12 months, intervention residents provided PA counselling 1.5 times more than they did at baseline (P < 0.05) compared with no significant changes in the control group.

Conclusions  The present study has shown that providing residents with a practical tool, enabling them to deal with patients’ barriers and previous failure in behavioural change, is efficacious in increasing PA levels of adult patients.
Projection of the supply of and demand for board‐certified nephrologists for ESRD in Taiwan
Authors: Chang Huan‐Cheng , Liou Yi‐Min , Yen Amy Ming‐Fang , Chen Tony Hsiu‐Hsi
Published: March 2008

Objective  Taiwan is the country where end‐stage renal disease (ESRD) is most prevalent. The purpose of this study was to investigate whether the rising demand for dialysis or transplantation as a result of ESRD can be balanced by the supply of board‐certified (B‐C) nephrologists.

Methods  Two Markov processes were applied for the projection of the supply of B‐C nephrologists in ESRD and for the projection of the demand from ESRD in 2020, assuming linear, exponential growth and no increase.

Results  The supply of B‐C nephrologists was projected at 1346 in 2020. To make allowance for the share of total time of professional activities in full‐time equivalent (FTE) for B‐C nephrologists, the demand was 1556, 962 and 2652 with assumptions of steady, linear and exponential growth, respectively. By the year 2020, 210 and 1306 additional FTE nephrologists will be required to meet, respectively, a linear and an exponential increase in demand from ESRD.

Conclusions  The projection of the supply of and the demand for B‐C nephrologists was made in this study using two Markov processes. The methods and results can be adopted as a reference for health manpower planning on B‐C nephrologists.
Therapeutic approaches to fibromyalgia in the Netherlands: a comparison between 1998 and 2005
Authors: Kroese Mariëlle E. A. L. , Schulpen Guy J. C. , Sonneveld Henk M. , Vrijhoef Hubertus J. M.
Published: March 2008

Rationale  In this study, information was gathered from five disciplines on their usual management methods for fibromyalgia (FM) in order to asses whether treatment regimens have changed in the Netherlands during a period of 6 years. In addition, insight was gained into the therapeutic motives of the professionals.

Method  A questionnaire was sent to a sample of 150 persons per discipline: general practitioners (GPs), rheumatologists (RMTs), rehabilitation specialists (RS), physical therapists and psychologists.

Results  The overall response rate was 40.4%. The referral behaviour changed (significantly), especially between GPs and RMTs. An increased choice for aerobic exercise (RS: P = 0.023) and multidisciplinary therapy (RMT: P = 0.046) was found. RMTs and RS showed decreased medication prescribing (RMT: P = 0.024). Preferences of treatment for FM differ per discipline. The choice is principally made on the basis of subjective, professional group‐bound factors. Particularly for GPs, dynamic patient factors are an important motive in the management of FM.

Conclusions  Despite the fact that most changes found are in conformity with the literature, the absolute application percentages of recommended therapies are still very low. The differences in practice between the several disciplines seem explicable on the basis of the factors that have a prominent role in the choice of a therapy for FM. This study underlines the need for further research into methods and processes of the management of FM, and their clinical effectiveness. An effective way of dissemination, especially of guidelines, is essential.
Safety is part of quality: a proposal for a continuum in performance measurement
Authors: Kazandjian Vahé A. , Wicker Karol G. , Matthes Nikolas , Ogunbo Sam
Published: March 2008

Objectives  Safer care is a strategic priority for health care organizations worldwide. Yet, the measurement and evaluation of key processes and outcomes associated with safer care remains challenging, even with existing performance measurement indicators. The multi‐national Quality Indicator Project (QI Project®) data are analysed to [1] document the patterns of safety indicators used between 1999 and 2006 among hospitals in Asia, Europe and the USA; and [2] to identify trends in using both organization‐level and patient‐level data in hospital performance improvement.

Design and setting  Retrospective data are used to ascertain how the use of safety indicators has changed in comparison to other QI Project® indicators. ‘Continent’ rather than ‘hospital’ is used as the unit of analysis and P‐values of the differences in use percentages across Asia, Europe and the USA are calculated.

Results  There was a significant increase in the use of QI Project® indicators in Asia between 1999 and 2006. Measured as the mean percentage of usage, the safety versus ‘all other’ indicators' increase in Asia was 43.7% versus 27% (P < 0.05) and 37.2% versus 24.4% (P < 0.05), respectively, during the study's time period. The European participants used both safety and all other indicators less frequently, 14.7% versus 18% (P < 0.05) and 9.5% versus 19.8% (P < 0.05), respectively. Finally, USA hospitals demonstrated a larger difference in the decrease of QI Project® indicator use than European hospitals between the ‘safety’ and ‘all other’ indicators, 12.7% decrease for safety indicators and 7.1% for all others (P < 0.05). These findings are consistent with trends reported in a previous study.

Conclusion  Traditional performance measures continue to assist hospitals in identifying crucial aspects of safety in the delivery of care. Building on the findings of a previous study, there are emerging trends in the type of measures used in hospitals in Asia, Europe and the USA pursuing the improvement of overall performance. The increasing use of patient‐level data specifically, in tandem with organizational level indicators, may signal the continuum of measurement strategies, now still predominately in the USA but anticipated to be adopted both in Europe and Asia.
Gender differences and temporal variation in the incidence of type 1 diabetes: results of 8012 cases in the nationwide Diabetes Incidence Study in Sweden 1983–2002
Authors: Östman J. , Lönnberg G. , Arnqvist H. J. , Blohmé G. , Bolinder J. , Schnell A. Ekbom , Eriksson J. W. , Gudbjörnsdottir S. , Sundkvist G. , Nyström L.
Published: March 2008

Objectives.  To establish the gender difference amongst newly diagnosed type 1 diabetic patients aged 15–34 years, considering age at diagnosis, temporal trend and seasonal variation at time of diagnosis.

Study design.  A population‐based prospective study with a mean annual population at risk of 2.3 million.

Setting.  All departments of medicine, endocrinology and paediatrics and primary health care units in Sweden.

Subjects.  Incident cases of diabetes aged 15–34 years at diagnosis 1983–2002.

Measure instrument.  Basic characteristics of patients at diagnosis were reported by the diagnosing doctor on a standardized form. Level of ascertainment was estimated at 80–90%.

Results.  Amongst all incident cases (n = 8012), 74% was diagnosed with type 1 diabetes. The mean annual incidence rate of type 1 diabetes was 12.7/100 000, in men 16.4/100 000 and in women 8.9/100 000. The incidence of type 1 diabetes decreased slowly by increasing age but was in all age groups higher in men, yielding an overall male/female ratio of 1.8. In both genders the incidence of type 1 diabetes decreased in average of 1.0% per year. A seasonal pattern with significantly higher incidence during January–March and lower during May–July was seen in both genders.

Conclusions.  A clear male predominance of type 1 diabetes was seen in all ages. The temporal trend and the seasonal pattern was similar in men and women. Hence, internal factors related to the gender rather than differences in the exposure to environmental factors seem to explain the consistent male–female bias in the postpubertal risk of developing type 1 diabetes.
Autologous transplantation of bone marrow mononuclear cells for limb ischemia in a caucasian population with atherosclerosis obliterans
Authors: Vriese A. S. De , Billiet J. , Droogenbroeck J. Van , Ghekiere J. , Letter J. A. De
Published: March 2008

Background.  Autologous transplantation of bone marrow mononuclear cells (ATBMMNC) has been used successfully in critical limb ischemia. All reported patients were of Asian descent, however, and several studies included only young patients with thromboangiitis obliterans. Whether the beneficial results can be extrapolated to older Caucasian patients with atherosclerosis obliterans and a heavy burden of cardiovascular risk factors remains unclear.

Methods.  We enrolled 16 patients (age 78 ± 2 year) with critical limb ischemia and a high prevalence of hypertension, smoking, diabetes, hypercholesterolemia and uremia. Mononuclear cells were isolated from the bone marrow and injected in the gastrocnemius muscle of the affected limb.

Results.  Four patients died because of progressive gangrene (two) or unrelated causes (two). Three patients required an amputation and one patient a femorocrural bypass within 12 weeks. The remaining eight patients had a modest improvement of resting pain and/or trophic lesions. Transcutaneous oxygen pressure (ratio lesion/reference) improved from 0.51 ± 0.11 before to 0.86 ± 0.03 (P < 0.001) after 12 weeks, whereas ankle‐brachial index did not change significantly (0.42 ± 0.15 vs. 0.59 ± 0.1; P = 0.23). The number of visible collateral vessels on digital subtraction angiography changed with 0.89 ± 0.86 on a scale of 1–4 (P = 0.33). Capillary surface area in a biopsy of gastrocnemius, evaluated by immunostaining for endothelial nitric oxide synthase, increased from 0.61 ± 0.07% to 2.38 ± 0.73% (P < 0.05).

Conclusions.  Although ATBMMNC was associated with objective signs of neovascularization, symptomatic improvement was only modest and restricted to the least affected patients. The discrepancy with previous findings may be related to the high prevalence of cardiovascular risk factors which causes endothelial progenitor cell dysfunction.