bluuebunny/crossref_metadata_2025 huggingface dataset:
A20 takes on tumors: tumor suppression by an ubiquitin-editing enzyme
Authors: Malynn Barbara A. , Ma Averil
Published: May 2009

Many B cell cancers are characterized in part by the dysregulation of the NF-κB signaling pathway. A new study identifies somatic mutations in TNFAIP3, the gene encoding the NF-κB inhibitor A20, in Hodgkin lymphomas and primary mediastinal lymphomas. These data reveal the role of A20 as a tumor suppressor protein.
Shane Crotty: Exploring immune memory
Authors: Heller Kira
Published: May 2009

Virologist and published author Shane Crotty sees immune memory as the key to making a better vaccine.
Genetic and non‐genetic influences on the development of co‐occurring alcohol problem use and internalizing symptomatology in adolescence: a review
Authors: Saraceno Luca , Munafó Marcus , Heron Jon , Craddock Nick , Van Den Bree Marianne B. M.
Published: May 2009

Aims  Alcohol problem use during adolescence has been linked to a variety of adverse consequences, including cigarette and illicit drug use, delinquency, adverse effects on pubertal brain development and increased risk of morbidity and mortality. In addition, heavy alcohol‐drinking adolescents are at increased risk of comorbid psychopathology, including internalizing symptomatology (especially depression and anxiety). A range of genetic and non‐genetic factors have been implicated in both alcohol problem use as well as internalizing symptomatology. However, to what extent shared risk factors contribute to their comorbidity in adolescence is poorly understood.

Design  We conducted a systematic review on Medline, PsycINFO, Embase and Web of Science to identify epidemiological and molecular genetic studies published between November 1997 and November 2007 that examined risk factors that may be shared in common between alcohol problem use and internalizing symptomatology in adolescence.

Findings  Externalizing disorders, family alcohol problems and stress, as well as the serotonin transporter (5‐HTT) S‐allele, the monoamine oxidase A (MAOA) low‐activity alleles and the dopamine D2 receptor (DDR2) Taq A1 allele have been associated most frequently with both traits. An increasing number of papers are focusing upon the role of gene–gene (epistasis) and gene–environment interactions in the development of comorbid alcohol problem use and internalizing symptomatology.

Conclusions  Further research in adolescents is warranted; the increasing availability of large longitudinal genetically informative studies will provide the evidence base from which effective prevention and intervention strategies for comorbid alcohol problems and internalizing symptomatology can be developed.
Differences in the measured alcohol content of drinks between black, white and Hispanic men and women in a US national sample
Authors: Kerr William C. , Patterson Deidre , Greenfield Thomas K.
Published: May 2009

Aims  To measure and describe drink alcohol content differences between Hispanic, non‐Hispanic white and non‐Hispanic black men and women in the United States.

Design  A telephone survey re‐interview of 397 respondents who participated originally in the 2005 National Alcohol Survey, of whom 306 provided complete information on home drinks.

Setting  United States.

Participants  Adults aged 18 years and older from across the United States.

Measurements  Direct measurement by respondents of simulated drink pours in respondents' own glassware using a provided beaker and reported beverage brands were used to calculate drink alcohol content.

Findings  Black men were found to have the largest overall mean drink alcohol content at 0.79 oz (23 ml) of alcohol. This was significantly larger than the mean for white men or for black women and added 30% to black men's monthly alcohol intake when applied to their reported number of drinks. Spirits drinks were found to be particularly large for men. Multivariate models indicated that drink alcohol content differences are attributable more to income and family structure differences than to unmeasured cultural factors tied to race or ethnicity per se. Models predicting alcohol‐related consequences and dependence indicate that adjusting drink alcohol content improves model fit and reduces differences between race/ethnicity defined groups.

Conclusions  Differences in drink alcohol content by gender, race/ethnicity and beverage type choice should be considered in comparisons of drinking patterns and alcohol‐related outcomes. Observed differences can be explained partially by measured characteristics regarding family structure and income.
Inbreeding in horsenettle influences herbivore resistance
Authors: DELPHIA CASEY M. , DE MORAES CONSUELO M. , STEPHENSON ANDREW G. , MESCHER MARK C.
Published: May 2009

Abstract 1. Plant traits (e.g. nutrition, allelochemistry) are an important determinant of the feeding preferences and performance of insect herbivores. Recent evidence suggests that plant inbreeding can affect plant–insect interactions by impacting host‐plant quality and resistance to herbivory.

2. The effect of inbreeding on host‐plant quality for, and resistance against, the tobacco hornworm, Manduca sexta L., was assessed in the wild solanaceous weed horsenettle, Solanum carolinense L. Caterpillar preference, relative growth rate (RGR), total leaf consumption (TC), and per cent total nitrogen in leaves were examined using selfed and outcrossed progeny of eight maternal plants.

3. Inbreeding significantly influenced insect preference, with caterpillars preferring leaf discs from selfed versus outcrossed plants. There was also a breeding effect for RGR and TC, with both higher on selfed plants. No breeding effect for per cent total nitrogen was observed.

4. The results of this study indicate that inbreeding decreased resistance against the tobacco hornworm, but did not affect plant quality. Decreased plant resistance will likely alter interactions with the herbivore community and could also have important consequences for plant–herbivore–natural enemy interactions.
Immunohistochemical detection of EGFR, fibrillin‐2, P‐cadherin and AP2β as biomarkers for rhabdomyosarcoma diagnostics
Authors: Grass Beate , Wachtel Marco , Behnke Silvia , Leuschner Ivo , Niggli Felix K , Schäfer Beat W
Published: May 2009

Aims:  Subclassification of rhabdomyosarcoma (RMS) has clinical relevance, as the two major subclasses embryonal (ERMS) and alveolar (ARMS) rhabdomyosarcoma differ greatly in terms of aggressiveness and prognosis. However, histological analysis is not always sufficient for an unequivocal subclassification of RMS. Furthermore, clinical presentation of ARMS has been reported to mimic other tumour types, specifically lymphoma. The aim was to determine the role of four biomarkers in the diagnosis of rhabdomyosarcoma.

Methods and results:  Recently, we identified four potential biomarkers to subclassify RMS with high sensitivity and specificity. These included epidermal growth factor receptor (EGFR) and fibrillin‐2 as markers for ERMS, and AP2β and P‐cadherin as markers for translocation‐positive ARMS. Here, we further validate the potential of these four markers in a second, independent patient cohort by immunohistochemistry on 80 sections of RMS biopsy specimens as well as a tissue microarray representing 18 different additional tumour types, including seven lymphomas. The combination of EGFR and fibrillin‐2 was able to detect ERMS with a specificity of 76% and sensitivity of 90%. The combination of AP2β and P‐cadherin detected ARMS with a specificity of 97% and sensitivity of 90%, data very similar to our previous study. Furthermore, all lymphomas were clearly negative for AP2β and P‐cadherin.

Conclusions:  These four biomarkers are suitable for clinical implementation in the future diagnosis of RMS.
Host immunization shapes interspecific associations in trematode parasites
Authors: Karvonen Anssi , Seppälä Otto , Tellervo Valtonen E.
Published: May 2009

1. Individuals of free‐living organisms are commonly infected by multiple parasite species. Under such circumstances, positive or negative associations between the species are possible because of direct or indirect interactions, details in parasite transmission ecology and host‐mediated factors. One possible mechanism underlying these processes is host immunity, but its role in shaping these associations has rarely been tackled experimentally.

2. In this study, we tested the effect of host immunization on associations between trematode parasites infecting eyes of fish. We first analysed the associations between three species (Diplostomum spathaceum, Diplostomum gasterostei and Tylodelphys clavata) in wild hosts, roach (Rutilus rutilus) and perch (Perca fluviatilis). Second, using rainbow trout (Oncorhynchus mykiss) as a model fish species, we experimentally investigated how sequential immunization of the host (i.e. one parasite species infects and immunizes the host first) could affect the associations between two of the species.

3. The results indicated that most of the associations were positive in wild hosts, which supports between‐individual variation in host susceptibility, rather than competitive exclusion between the parasite species. However, positive associations were more common in roach than in perch, possibly reflecting differences in ecological conditions of exposure between the host species. The experimental data showed that positive associations between two of the species were eroded by host immunization against one of the parasite species.

4. We conclude that sequential immunization of hosts has a marked effect on interspecific parasite associations and basically can determine if positive associations are detected or not. This implies that correlative results suggesting non‐interactive community structure in general may be obscured by the sequence of previous parasite exposure and corresponding dynamics of host immunization.
Improved quality and comprehensiveness in nursing documentation of pressure ulcers after implementing an electronic health record in hospital care
Authors: Gunningberg Lena , Fogelberg‐Dahm Marie , Ehrenberg Anna
Published: May 2009

Aims.  One aim was to compare the quality and comprehensiveness in nursing documentation of pressure ulcers before and after implementation of an electronic health record in a hospital setting. Another aim was to investigate the use of preformulated templates for pressure ulcer recording in the electronic health record.

Background.  With the possibilities of the electronic health record to provide information and give accurate and reliable feedback to the healthcare organisation, it is of high priority to develop standardised documentation practices for various areas of care (e.g. such as pressure ulcer care).

Design.  A cross‐sectional retrospective review of health records.

Methods.  Three departments in a Swedish university hospital participated. In 2002, there were 413 patients, including 59 paper‐based records identified with notes on pressure ulcers and in 2006, 343 patients, including 71 electronic health records with pressure ulcer recording. Recorded data on pressure ulcers were retrospectively reviewed.

Results.  Significantly more patient records showed notes of pressure ulcer grade (p < 0·001), size (p = 0·004), risk assessment (p = 0·002), nursing history (p = 0·040), nursing diagnoses (p < 0·001), nursing goals (p < 0·001) and nursing outcomes (p = 0·016) in 2006 than in 2002. One third of the recordings used preformulated templates.

Conclusions.  Although there were significant improvements in pressure ulcer recording after the change to the electronic health record, several deficiencies remained. Due to the short time of our follow‐up after implementation of the electronic health record, we suspect that the quality of recording will improve when nurses become more familiar with the new system.

Relevance to clinical practice.  Education related to the use of the electronic health record and evidence‐based pressure ulcer prevention should be provided to the nurses. To facilitate documentation, the templates need to be refined to be more user‐friendly.
Reliability and validity of the Korean version of the Way‐finding Effectiveness Scale for Persons with Dementia
Authors: Hong Gwi‐Ryung Son , Lim YoungMi
Published: May 2009

Aims and objectives.  To evaluate the psychometric properties of the Korean version of the Way‐finding Effectiveness Scale (WES) for Korean persons with dementia (PWDs).

Design.  A descriptive, cross‐sectional survey method was used.

Methods.  Data were collected with a non‐probability sampling strategy using structured format face‐to‐face interviews. A convenience sample of 83 community‐dwelling PWDs and their family caregivers were recruited. The participants were PWDs who were over 60 years of age, had been medically diagnosed with dementia or showed signs and symptoms of dementia, had a Mini Mental State Examination (MMSE) score of less than 24 of 30 and were independent in walking.

Results.  Internal consistency for the 29‐item KWES was 0·93 and exceeded 0·70 for the four subscales (complex way‐finding goals, CWG; analytic strategy, AS; global strategy, GS; and simple way‐finding goals, SWG). The intercorrelations for total KWES and subscales demonstrated a high to moderate relationship ranging from 0·84 (total and CWG) to 0·24 (AS and SWG). Pearson correlations between each subscale scores of the KWES and K‐MMSE demonstrated significant, moderate relationships ranging from 0·41 (CWG and K‐MSE) to 0·28 (AS and K‐MMSE). Differences in current and prior behaviour of KWES were significant for the total (t = −21·00, p < 0·001) and subscales (t = −28·33–−9·33, p < 0·001).

Conclusion.  Acceptable reliabilities and validities support the conclusion that the KWES is a valid and reliable instrument for examining way‐finding effectiveness for Korean PWDs.

Relevance to clinical practice.  The KWES will contribute to the development of understanding of way‐finding ability for community‐dwelling PWDs in both research and clinical practices.
Strategies for success: a toolbox of coping strategies used by breastfeeding women
Authors: O’Brien Maxine L , Buikstra Elizabeth , Fallon Tony , Hegney Desley
Published: May 2009

Aims.  The purpose of this paper is to present the findings of two qualitative studies which identified strategies used by breastfeeding women to assist them to continue breastfeeding.

Background.  While breastfeeding initiation rates are high in Australia, the majority of women wean before the recommended time. The identification of interventions which may increase breastfeeding duration is therefore a research priority.

Design.  The Against All Odds study used a case‐controlled design to investigate the characteristics of women who continued to breastfeed in the face of extraordinary difficulties. Phase One of the I Think I Can study employed the Nominal Group Technique to investigate the views of subject matter experts regarding which psychological factors may influence the duration of breastfeeding.

Method.  Against All Odds study participants (n = 40) undertook a one‐ to two‐hour interview and the transcribed data were analysed using thematic analysis. Stratified purposeful sampling was employed in the I Think I Can study (n = 21), with participants assigned group membership according to their most recent breastfeeding experience. A fourth group was composed of experienced breastfeeding clinicians. The nominal group technique was used to generate group data and segments of the discussion were audiotaped and transcribed for thematic analysis.

Results.  Participants in both the studies raised strategies used to assist them in their efforts to cope with the challenges of breastfeeding and early motherhood. These strategies included increasing breastfeeding knowledge, staying relaxed and ‘looking after yourself’, the use of positive self‐talk, challenging unhelpful beliefs, problem solving, goal setting and the practice of mindfulness.

Conclusions.  Employment of these simple behavioural and cognitive strategies may assist women to cope with the pressures inherent in the experience of early mothering, thereby increasing the duration of breastfeeding.

Relevance to clinical practice.  These results may represent a ‘tool box’ of coping strategies which can be provided to women for use in the postnatal period.
Helping adolescents who self‐mutilate: parental descriptions
Authors: Rissanen Marja‐Liisa , Kylmä Jari , Laukkanen Eila
Published: May 2009

Aim.  The purpose of this qualitative descriptive study was to explore parental views on how to help adolescents who self‐mutilate.

Background.  Self‐harm, including self‐mutilation, is common among adolescents. However, parental conceptions of helping adolescents who self‐mutilate have rarely been investigated in nursing science.

Design.  Qualitative descriptive design.

Method.  Four parents of self‐mutilating adolescents were interviewed in depth. Qualitative content analysis was applied.

Results.  Three main categories emerged: a description of an adolescent who self‐mutilates and descriptions of ways to help self‐mutilating adolescents and ways to help their parents and family. An adolescent who self‐mutilates appears externally to feel very well, but inside feels lonely and inferior to others. Help may include an adolescent helping herself by performing some activities alone or in relation to other people and an adolescent receiving help from a safe and trusting human relationship. Such a relationship can be with anyone who knows about the self‐mutilation and is of utmost importance, but a caring attitude is particularly expected from adults. Factors that facilitate helping were identified as well as those considered help‐hindering or helpful. Help that had been provided to parents and the family included factors considered helpful and unhelpful.

Conclusion.  Adolescents who self‐mutilate try to help themselves, but are in need of external, probably professional help. Parents are in need of information about self‐mutilation as a phenomenon to be able to help their children. Help for self‐mutilating adolescents as perceived by their parents also includes help for the whole family.

Relevance to clinical practice.  The findings of this study could assist health care professionals in approaching and helping both self‐mutilating adolescents and their parents.
To evaluate the effectiveness of a discharge‐planning programme for hip fracture patients
Authors: Lin Pi‐Chu , Wang Ching‐Hui , Chen Chyang‐Shiong , Liao Li‐Ping , Kao Shu‐Fen , Wu Heng‐Fei
Published: May 2009

Aims and objectives.  This study aimed to evaluate the effectiveness of a comprehensive discharge‐planning service for hip fracture patients, including length of stay, functional status, self‐care knowledge and quality of life (QOL).

Background.  Hip fractures are the most devastating result of osteoporosis. Care of these patients from the moment they enter the hospital until discharge and postdischarge is a challenging task, requiring a coordinated approach by an interdisciplinary team.

Design.  An experimental design was used.

Methods.  Fifty hip fracture patients were recruited from a medical centre in Taipei, Taiwan and randomly divided into two groups. The control group received routine discharge nursing care and the experimental group received comprehensive discharge planning. After patient admission, researchers assessed discharge‐planning needs, provided discharge nursing instruction, coordinated services and determined discharge placement based on assessment results.

Results.  (i) Mean age of 50 hip fracture patients was 78·75 (SD 6·99) years. Mean length of stay was 6·04 (SD 2·41) days for the experimental group and 6·29 (SD 2·17) for the control group. Difference between groups was not significant (t = −0·394, p = 0·696). (ii) The self‐care knowledge of the experimental group was higher than that of the control group (F = 11·569, p = 0·001). (iii) Significant improvements were observed in functional status of both groups at three months postdischarge, with no significant differences observed between groups. However, the functional status of experimental group patients showed a slightly better trend than that of the control group. (iv) At three months postdischarge, QOL of experimental group patients was better than control group patients.

Conclusions.  A comprehensive discharge‐planning service can improve hip fracture patients’ self‐care knowledge and QOL.

Relevance to clinical practice.  Results of this study can be used clinically as a basis for practical implementation of discharge‐planning services in fracture patients.
Negotiating the transition: caring for women through the experience of early miscarriage
Authors: Murphy Fiona , Merrell Joy
Published: May 2009

Aim.  To explore women’s experiences of having an early miscarriage in a hospital gynaecological unit.

Background.  Miscarriage is a global health issue affecting significant numbers of women and is usually considered a distressing experience. This distress is often interpreted as being characteristic of grief. Nurses and other health professionals in hospital and community settings are therefore expected to provide appropriate care to meet the physical and emotional needs of the woman.

Design.  A qualitative, ethnographic study of a hospital gynaecological unit in the UK.

Methods.  The primary method was 20 months of part‐time participant observation. Data were also collected through documentary analysis of key documents in the setting and formal interviews. These were with eight women who had an early miscarriage and 16 health professionals (nurses, doctors, ultrasonographers) working in the unit.

Results.  Three clear phases emerged in the women’s experience of miscarriage and hospital admission; first signs and confirmation, losing the baby and the aftermath. These were interpreted as being components of a process of transition. The hospital admission emerged as vital in these early phases in which the importance of nurses and other health professionals providing sensitive, engaged care to meet the emotional and physical needs of the woman was identified.

Conclusions.  The hospital setting emerged as highly influential in shaping the care that was given to women and influencing their experiences. Transition models were felt to be more appropriate than grief and bereavement models in guiding the psychological care given to women.

Relevance to clinical practice.  The experience of hospital admission and the actions of nurses and other health professionals is influential in how women negotiate the transition through miscarriage.
A critical view of how nursing has defined spirituality
Authors: Clarke Janice
Published: May 2009

Aims.  To offer a detailed discussion of the issue of ‘lack of critique’ in the literature on spirituality in nursing. The discussion will include the limited use of sources from theology and religious studies and the demand to separate spirituality and religion and will go on to examine the consequences of the resulting approach. The drive for unique knowledge to further professionalisation and the demands of inclusiveness are suggested as possible reasons for the development of the current model. The dangers and pitfalls of definition are explored. The paper suggests that theology could provide insights into explaining spirituality.

Background.  The last four decades have seen a proliferation of definitions of spirituality in the nursing literature. Recently, in response to their own concerns and prompts from outside the ‘spirituality’ community authors have suggested that we revisit this literature with a more critical stance. This paper is in response to that suggestion. During the course of a PhD supervised from a department of practical theology I have critically analysed the literature from several perspectives and this paper is one result of that review.

Design.  Literature review.

Methods.  Critical reflection on how spirituality has been defined.

Conclusion.  The lack of critique has produced a bias in the literature towards broad, generic, existential definitions which, together with the intentional divorce from religion and theology have led to definitions which have the tendency to result in a type of spiritual care which is indistinguishable from psychosocial care, hard to explain to patients and difficult to put into practice.

Relevance to clinical practice.  The acceptance of a diverse range of understandings of spirituality and a greater focus on practical ways of using it in nursing care are the direction the profession should be moving into.
The experiences of people with an intersex condition: a journey from silence to voice
Authors: MacKenzie Drew , Huntington Annette , Gilmour Jean A
Published: May 2009

Aim and objectives. The aim of this research was to explore the experiences of people with intersex conditions. The main objective was to contribute to knowledge of the condition by giving voice to a group of people who are invisible in society.

Background. Medical management of intersex conditions has historically focused on erasing visual bodily difference through gender assignation and medical/surgical intervention to ensure congruent body appearance. People with intersex conditions require support to live free from shame in a normalising society and need particularly sensitive care when engaged with the health system.

Design. A small‐scale qualitative study was undertaken. Recruitment of participants was difficult because of barriers created by invisibility and marginalisation. After extensive and careful negotiation with one contact, three people in New Zealand agreed to participate in the research.

Methods. In‐depth interviews were undertaken and thematic analysis used to develop themes that were common across participants’ experiences.

Results. Three themes emerged from the data: managing silence, coping with difference and development of acceptance. These themes highlight: the negative impact of societal ignorance, lack of acceptance of body difference and the journey from silence to disclosure and acceptance of individuality and choice in gender identification.

Conclusion. These findings highlight the need for nurses to be knowledgeable and skilled communicators to ensure age‐appropriate information and support is provided to enable individual choice in gender identification and normalisation for people with intersex conditions.

Relevance to clinical practice. Many nurses will be unaware of the condition of being intersex and have little knowledge of the challenges faced by this group yet are likely to be involved in their care. People with intersex conditions require particularly sensitive care and nurses can provide appropriate, supportive and ‘safe’ care if they are aware of the condition and its challenges.
A review of smoking cessation: potentially risky effects on prescribed medications
Authors: Schaffer Susan D , Yoon Saunjoo , Zadezensky Immo
Published: May 2009

Aims and objectives.  To identify prescription drugs that require dosage adjustment or monitoring in patients who quit smoking and to provide recommendations for dosage adjustment based on available evidence.

Background.  Health care providers are urged to facilitate smoking cessation for patients who smoke, but the effects of smoking cessation on the metabolism of some drugs is not routinely considered.

Design.  A comprehensive literature review.

Methods.  The review was conducted in 2008 using a computerised drug interaction program and multiple PubMed and CINAHL searches to identify prescription drugs with clinically significant pharmacokinetic or pharmacodynamic changes caused by smoking cessation.

Results.  Although much of the evidence is case report, dosage adjustments are clearly indicated for warfarin, olanzapine, clozapine and theophylline since they are metabolised by cytochrome P450 CYP1A2 and also have narrow therapeutic ratios. Careful monitoring is recommended for other CYP1A2 metabolised drugs, including those for hypertension and Alzheimer’s disease. For many affected drugs, smoking cessation reverses smoking‐induced CYP1A2 hepatic enzyme levels to normal, increasing plasma concentrations in patients whose dose was established while smoking. Because the effect on hepatic microsomal enzymes is not related to the nicotine component of tobacco, nicotine replacement will not alter the effect.

Conclusions.  The effects of smoking cessation on drugs metabolised by CYP1A2 have been under‐appreciated by health care providers. Smoking cessation may increase plasma levels of some drugs to potentially toxic levels. Further research is warranted to clarify this effect.

Relevance to clinical practice.  When patients stop smoking, providers should carefully review prescribed drug regimens and adjust or monitor drugs whose metabolism is affected by smoking cessation. This is particularly important for patients who abruptly stop smoking due to hospitalisation and for older patients who are likely to be taking multiple medications.
Triaging dysphagia: nurse screening for dysphagia in an acute hospital
Authors: Cichero Julie AY , Heaton Sarah , Bassett Lynell
Published: May 2009

Aims and objectives.  To (1) develop a dysphagia screening tool to triage all patients at risk of aspiration/dysphagia on admission to acute hospital wards, (2) evaluate tool reliability, (3) evaluate nursing compliance and (4) develop a robust dysphagia training programme.

Background.  Failure to diagnose dysphagia has significant medical and economic costs. Dysphagia screening reduces pneumonia threefold. Most nurse‐screening tools have focused on stroke. However, many other conditions are associated with dysphagia. A multidisciplinary team developed a nurse‐administered, evidence‐based swallow screening tool for generic acute hospital use.

Design.  Prospective, quasi‐experimental.

Methods.  Nurses were assessed for knowledge pre‐ and post‐training. All patients were nurse‐screened for dysphagia on admission. All patients were reviewed by speech pathologists to determine screening accuracy. Results were not blinded. The one page tool encompassed (1) diagnostic categories, (2) patient/carer interview, (3) dysphagia indicators and (4) if applicable, water swallow test.

Results.  Thirty‐eight nurses participated in a seven‐week study; 442 patients were screened on two general medical wards. Three speech pathologists counter‐assessed each patient by clinical examination or chart review. Sensitivity was 95%; specificity was 97%. Positive predictive value was 92%; negative predictive value was 98%. 3·4% of clinical screening decisions were incorrect. Compliance rate was 85%.

Conclusions.  Caution is advised in interpretation of the results due to lack of blinding. Initial results suggest that the dysphagia screening tool is a quick and robust tool for triaging individuals with dysphagia. Training is critical to successful screening.

Relevance to clinical practice.  Twenty‐five to 30% of acute hospitalised individuals have dysphagia. All adult acute patients are screened for dysphagia using the Royal Brisbane and Women’s Hospital dysphagia screening tool. Patients are triaged into categories of ‘those requiring additional specialist intervention’ and ‘those who can proceed directly to regular diets and liquids’. Improved quality of care and cost savings is likely.
Using the cardiac depression scale in men recovering from coronary artery bypass surgery
Authors: King Kathryn M , Colella Tracey JF , Faris Peter , Thompson David R
Published: May 2009

Aims.  To examine the utility and validate the use of the Cardiac Depression Scale in patients who had first‐time coronary artery bypass graft surgery.

Background.  The Beck Depression Inventory, though frequently used, may not be sufficiently sensitive for use in cardiac patients. The Cardiac Depression Scale has been shown to identify the range of depression in medical cardiac patients.

Design.  Survey.

Methods.  The Beck Depression Inventory and Cardiac Depression Scale were administered to 120 men at hospital discharge, as well as six, 12 and 36 weeks postoperatively. Cronbach’s α scores were calculated for the measures at each point. Changes in scores over time were analysed using repeated measures analysis of variance. Associations between the measures scores were calculated using Pearson product–moment correlations. Agreement between the measures’ dichotomised scores (depression/no depression) was examined using Cohen’s Kappa statistic.

Results.  Internal consistency was similar for the Beck Depression Inventory (0·793–0·904) and Cardiac Depression Scale (0·859–0·910). Depression scores decreased over time with the Beck Depression Inventory [F(2·50, 175·29) = 22·27, p < 0·001] and Cardiac Depression Scale [F(2·68, 190·37) = 13·18, p < 0·001]. The measures had similar power [Cohen’s f = 0·65 (Beck Depression Inventory) and 0·43 (Cardiac Depression Scale)] to reveal changes over time. The continuous scores were highly correlated at each point [0·737 (p < 0·001)–0·819 (p < 0·001)]. However, when dichotomised scores were compared, the chance corrected level of agreement was less impressive [0·198 (p = 0·014)–0·381 (p < 0·001)].

Conclusions.  The Cardiac Depression Scale may have utility for use with surgical cardiac patients. However, continued examination of this measure of depression is warranted.

Relevance to clinical practice.  Given the prevalence of depression and its negative impact on coronary artery disease, it is important to identify even mild depression in cardiac patients. Using a measure of depression specifically for cardiac patients, rather than a generic measure, may best accomplish this goal.
The growing role of football as a vehicle for interventions in mental health care
Authors: PRINGLE A.
Published: May 2009

In recent years there has been a growing interest in the use of football as a vehicle for mental health interventions. This paper outlines some of the ways that mental health service providers have begun to develop strategies with football clubs, the Football Association and government departments that involve playing or watching football and placing mental health services in football clubs. The paper also looks at how some attempts are being made at regional and national levels to develop and bring together services that use football as a vehicle for mental health service delivery.
Insights from inside: the duties and activities of nurses at the psychiatric clinic Münsterlingen (CH). A qualitative study
Authors: SCHOPPMANN S. , LÜTHI R.
Published: May 2009

In the German‐speaking countries: Austria, Germany and Switzerland, which have a joint annual conference in psychiatric nursing, the process of academization of nursing has led to a discussion about which adaptations to make in psychiatric nursing in order to develop a profile, which is practicable in the future. Therefore, it was necessary to describe the current duties and activities of psychiatric nurses. With this, the knowledge and abilities of the nurses were to be made more explicit and their identity was to be strengthened. Data were generated by using participant observation and group discussions with the involved nurses to validate the observations and the emerging categories of activities. Participant observation took place in a psychiatric clinic in Switzerland over a period of 11 months on 14 psychiatric wards with different specializations. Data analysis followed a qualitative content analysis. Findings show that by means of descriptions of nursing situations the duties and activities of the nurses can be summarized into 12 categories. Many of the described activities can be found in psychiatric nursing textbooks. This concurrence suggests that there is something like a basic framework of psychiatric nursing. In addition, the findings illustrate how wide the variety of tasks are and how challenging psychiatric nursing is.
Linkage of T3 and Cpa pilins in the Streptococcus pyogenes M3 pilus
Authors: Quigley Bernard R. , Zähner Dorothea , Hatkoff Matthew , Thanassi David G. , Scott June R.
Published: May 2009

The important human pathogen Streptococcus pyogenes (group A streptococcus, GAS) initiates infection by pilus‐mediated attachment to host tissue. Thus, the pilus is an excellent target for design of anti‐infective strategies. The T3 pilus of GAS is composed of multiple covalently linked subunits of the T3 protein to which the two minor pilins, Cpa and OrfB, are covalently attached. Because the proteins of GAS pili do not contain either of the motifs required for pilus polymerization in other Gram‐positive bacteria, we investigated the residues involved in their linkage. We show that linkage of Cpa to T3 by the sortase family transpeptidase SrtC2 requires the VPPTG motif in the cell wall‐sorting signal of Cpa. We also demonstrate that K173 of T3 is required both for T3 polymerization and for attachment of Cpa to T3. Therefore, attachment of Cpa to K173 of a T3 subunit would block further addition of T3 subunits to this end of the growing pilus. This implies that Cpa is located exclusively at the pilus tip, a location supported by immunogold electron microscopy, and suggests that, as for well‐studied pili on Gram‐negative bacteria, the role of the pilus is to present the adhesin external to the bacterial capsule.
Biogenesis of bacterial membrane vesicles
Authors: Deatherage Brooke L. , Lara J. Cano , Bergsbaken Tessa , Barrett Sara L. Rassoulian , Lara Stephanie , Cookson Brad T.
Published: May 2009

Membrane vesicle (MV) release remains undefined, despite its conservation among replicating Gram‐negative bacteria both in vitro and in vivo. Proteins identified in Salmonella MVs, derived from the envelope, control MV production via specific defined domains that promote outer membrane protein–peptidoglycan (OM–PG) and OM protein–inner membrane protein (OM–PG–IM) interactions within the envelope structure. Modulation of OM–PG and OM–PG–IM interactions along the cell body and at division septa, respectively, maintains membrane integrity while co‐ordinating localized release of MVs with distinct size distribution and protein content. These data support a model of MV biogenesis, wherein bacterial growth and division invoke temporary, localized reductions in the density of OM–PG and OM–PG–IM associations within the envelope structure, thus releasing OM as MVs.
Histological Studies of Growing and Mature Antlers of Red Deer Stags (Cervus elaphus)
Authors: Cegielski M. , Izykowska I. , Podhorska‐Okolow M. , Gworys B. , Zabel M. , Dziegiel P.
Published: May 2009

This study aims at presenting histology of growing and mature antlers in red deer stag (Cervus elaphus). Growing antlers constitute a model organ for examining regeneration processes of tissues because they are the only mammalian appendages capable of regeneration. Histological study revealed that the tip of a growing antler consists of hairy skin, perichondrium, mesenchyme and chondroprogenitors area. By performing immunochistochemistry, we found that cell expressing Ki‐67 and PCNA antigens were localized in basal layer of epidermis, skin glands and beneath their secretory sections, mesenchyme as well as within and in the vicinity of central blood vessels. Ultrastructurally, cells from chondroprogenitors zone have chondroblast‐like morphology and take part in producing of collagen fibres followed by the process of cartilage mineralization. However, mature antlers also consist of lamellar osseous tissue.
Oviposition Preferences in Newts: Does Temperature Matter?
Authors: Dvořák Jan , Gvoždík Lumír
Published: May 2009

A female’s decision where and when to place her eggs has important fitness consequences for her offspring. Although temperature is considered among the most relevant abiotic factors affecting female oviposition site choice in ectotherms, little is known about the relative importance of temperature cues in complex oviposition decisions. In this study, we examined female’s oviposition choice under conflicting demands for temperature and embryo protection by studying oviposition behaviour in female alpine newts, Triturus alpestris, exposed to various thermal conditions and the availability of egg‐wrapping vegetation. Females oviposited between 12.5 and 22.5°C in the aquatic thermal gradient (5–32.5°C) with the unrestricted availability of oviposition vegetation. The removal of the vegetation from predominantly chosen oviposition temperatures (15–20°C) induced egg‐retention in most females. This suggests that both temperature and the presence of egg‐wrapping vegetation play important roles in oviposition site choice of alpine newts.
Management of the rare entity of primary pancreatic cystic neoplasms
Authors: Stamatakos Michael , Sargedi Constantina , Angelousi Anna , Kontzoglou Konstantinos , Safioleas Panagiotis , Petropoulou Constantina , Safioleas Michael
Published: May 2009

Primary cystic neoplasms of the pancreas constitute a rare entity and are composed of a variety of neoplasms with a wide range of malignant potential. Approximately 90% of these lesions are serous cystic neoplasms or mucin‐producing neoplasms. In contrast to serous cystadenomas which are nearly always benign, the mucinous cystic neoplasms represent a more diverse, heterogenous spectrum of related neoplasms. Intraductal papillary mucinous neoplasms manifest a much greater latent or overt malignant potential than other cystic neoplasms of the pancreas. The various subgroups of cystic neoplasms of the pancreas are evaluated and compared through a review of current literature. No symptoms or signs are pathognomonic for the cystic pancreatic neoplasms. While identification of a cystic tumor is relatively easy, the identification of the specific tumor type may be difficult. Most investigators agree that accurate differentiation of benign from malignant neoplasms can be made only at histopathologic examination of the entire resected segment of the pancreas. Because of the low mortality and low postoperative morbidity, surgical resection is indicated in all patients with cystic tumors.
Comparison of one‐week and two‐week empirical trial with a high‐dose rabeprazole in non‐cardiac chest pain patients
Authors: Kim Jeong Hwan , Sinn Dong Hyun , Son Hee Jung , Kim Jae J. , Rhee Jong Chul , Rhee Poong‐Lyul
Published: May 2009

Background:  In patients with non‐cardiac chest pain (NCCP), the optimal duration of an empirical trial with a high‐dose proton pump inhibitor (PPI) is unclear. We aimed to compare the efficacy of one‐week and two‐week PPI trial in patients with weekly or more than weekly NCCP and to determine its optimal duration for diagnosing gastroesophageal reflux disease (GERD)‐related NCCP.

Methods:  Forty‐two patients with at least weekly NCCP were enrolled. The baseline symptoms were assessed using a daily symptom diary for seven days. Also, esophago‐gastro‐duodenoscopy and 24 h esophageal pH monitoring were performed for the diagnosis of GERD. Then, patients were treated with rabeprazole 20 mg twice daily for 14 days. To assess NCCP improvement during the PPI trial, the first week and the second week symptom diary were kept for 1–7 and 8–14 days. The PPI test was considered positive if a symptom score improved (50% compared to the baseline.

Results:  There was no significant difference for a positive PPI test between GERD‐related NCCP group (n = 8, 50%) and non GERD‐related NCCP group (n = 6, 23%) during the first week of the PPI test. However, during the second week, GERD‐related NCCP had a higher positive PPI test (n = 13, 81%) than non GERD‐related NCCP (n = 7, 27%) (P = 0.001) with a sensitivity and specificity of 81% and 62%, respectively.

Conclusions:  The rabeprazole empirical trial was diagnostic for patients with GERD‐related NCCP, and its optimal duration was determined to be at least two weeks.
Review article: Bone density in patients with chronic kidney disease stages 4‐5
Authors: OTT SUSAN M
Published: May 2009

Skeletal fractures are common in dialysis patients. Bone density measurements predict fractures in the general population, but in patients with chronic kidney disease (CKD) there is limited ability to predict fractures with these techniques. A review of the literature in patients with CKD stage 5 shows that bone density in the cortical bone of the radius or hip is generally lower compared with normal reference ranges by about one to two standard deviations, whereas in the spine bone density tends to be closer to the average expected values. The bone density is not able to predict the underlying histology in patients with renal osteodystrophy. The serum PTH levels are inversely related to bone density in some studies, and not related in other studies, but none found a positive association of serum parathyroid hormone (PTH) and bone density. There are very few data about longitudinal changes of bone density in these patients, and also inadequate studies of whether osteoporosis medications are effective in this population. Therefore, at this time the clinical utility of bone density measurements in patients with CKD‐5 is uncertain.
The National Socialist Sisterhood: an instrument of National Socialist health policy
Authors: Schweikardt Christoph
Published: May 2009

When Adolf Hitler (1889–1945) came to power in 1933, the new Nazi government focused the German health system on their priorities such as the creation of a racially homogeneous society and the preparation of war. One of the measures to bring nursing under their control was the foundation of a new sisterhood. In 1934, Erich Hilgenfeldt (1897–1945), the ambitious head of the National Socialist People’s Welfare Association (Nationalsozialistische Volkswohlfahrt), founded the National Socialist (NS) Sisterhood (Nationalsozialistische Schwesternschaft) to create an elite group that would work for the goals of the National Socialist German Workers’ Party (Nationalsozialistische Deutsche Arbeiterpartei, NSDAP). Hilgenfeldt proclaimed community nursing as a priority for NS Sisterhood nurses. Catholic and Protestant sisters, who were traditionally dedicated to community nursing, were to be gradually replaced. However, other competing priorities, such as hospital service for the training of junior nurses and work in conquered regions, as well as the lack of NS nursing personnel, hampered the expansion of community nursing. The paper also addresses areas for future research: everyday activities of NS nurses, the service of NS Sisterhood nurses for NSDAP organisations such as the elite racist paramilitary force SS (Schutzstaffel, Protective Squadron), and involvement in their crimes have hardly been investigated as yet.