bluuebunny/crossref_metadata_2025 huggingface dataset:
Pressure ulcer prevalence in intensive care patients: a cross‐sectional study
Authors: Shahin Eman S. M. , Dassen Theo , Halfens Ruud J. G.
Published: May 2008

Background  Pressure ulcers are a potential complication for intensive care patients and their prevention is a major issue in nursing care. Therefore, this study aims to assess pressure ulcer prevalence in intensive care patients, patients' characteristics and preventive measures related to pressure ulcer prevalence in intensive care patients and to determine the most common body sites of pressure ulcers.

Method  The research design was a cross‐sectional study. The sample consisted of 1760 patients (298 in 2002, 408 in 2003, 453 in 2004, 368 in 2005 and 233 participants in 2006) from surgical, medical and interdisciplinary intensive care.

Results  The results revealed a mean prevalence rate of ±30% from 2002 to 2005 while it considerably decreased down to 16.2% in 2006. Half of the pressure ulcers were of grade 1. Furthermore, a significant relation was found between the presence of pressure ulcers and age (P ≤ 0.022), Braden score (P ≤ 0.01) and bowel incontinence (P ≤ 0.01).

Conclusion  It is crucial to select appropriate and applicable preventive material/devices and nursing care measures. Moreover, factors related to the presence of pressure ulcers should be taken into consideration in order to prevent development of further pressure ulcers.
Outpatient versus inpatient laparoscopic cholecystectomy: a prospective randomized study of symptom occurrence, symptom distress and general state of health during the first post‐operative week
Authors: Barthelsson Cajsa , Anderberg Bo , Ramel Stig , Björvell Catrin , Giesecke Kajsa , Nordström Gun
Published: May 2008

Background  Few randomized clinical trials focus on patients' symptoms of the first post‐operative week following outpatient (OPS) versus inpatient (IPS) laparoscopic cholecystectomy (LC). The objective was to compare these treatment modalities with regard to patients' perceptions of pain and other post‐operative symptoms, amount of distress, level of anxiety and general state of health during the first post‐operative week.

Methods  One hundred patients were randomized. Seventy‐three LC patients were valid for efficacy (OPS n = 34, IPS n = 39). Data were collected by means of questionnaires.

Results  The main result was that no differences were seen between the groups regarding the occurrence of post‐operative symptoms or symptom distress. Approximately 90% of the patients in both groups perceived pain, reduced mobility and tiredness on day 1. Nausea and loss of appetite were reported by half of the patients. Post‐operative day 1, both groups reported much or very much distress related to pain and reduced mobility (approximately 40%) and nausea (approximately 20%). Although both groups reported less symptoms on day 7, one‐third still experienced pain, but only one patient reported this to be distressing.

Conclusion  Laparoscopic cholecystectomy patients in both groups recover equally well, indicating that a greater proportion of LC patients should be offered the outpatient modality.
Agreement between parental reports and patient records in food allergies among infants and young children in Finland
Authors: Tuokkola Jetta , Kaila Minna , Pietinen Pirjo , Simell Olli , Knip Mikael , Virtanen Suvi M.
Published: May 2008

Rationale, aims and objectives  A third of parents suspect food allergy in their children. Questionnaire‐based studies usually overestimate the occurrence of food allergies. The aim of the present study was to validate a study questionnaire by comparing children's use of special diets as reported by parents with patient records at the hospital.

Methods  A population‐based cohort with genetic susceptibility to type 1 diabetes (15% of those screened) was recruited in the Tampere area between 1997 and 2001, and followed for development of food allergy for 3 years. Food allergies and other special diets were queried at the age of 3 years with a structured questionnaire. The hospital records of the children, whose parents had reported an elimination diet of the child, were studied to validate the parental reports of food allergies. The hospital database was also checked for the respective diagnosis codes to estimate underreporting.

Results  Altogether, 1122 parents returned the questionnaire at the study center visit when the child was 3 years old. Food allergy was reported by 15.0% of the parents. In 10.6% of the children food allergy had been diagnosed or confirmed at the hospital. Hospital‐confirmed food allergy was unreported in 0.9% of the cases. The measure of agreement between reported and hospital‐confirmed food allergies, using crosstabulation with Cohen's Kappa, was within 0.71–0.88 for cow's milk allergy, 0.74–0.82 for cereal allergy and 0.66–0.86 for any reported food allergy.

Conclusion  We found that the validity of the questionnaire obtaining information on food allergies of infants and young children was good to excellent based on a comparison between parental reports and information obtained from patient records.
Ancient divisions, recent expansions: phylogeography and population genetics of the round goby Apollonia melanostoma
Authors: BROWN JOSHUA E. , STEPIEN CAROL A.
Published: May 2008

During the past two decades, the round goby Apollonia melanostoma (=Neogobius melanostomus) has expanded its range via shipping transport and canals, extending north and west from the Ponto‐Caspian region of Eurasia and to the North American Great Lakes. Exotic populations of the round goby have been very successful in the Baltic Sea and the Great Lakes regions, exerting significant ecological changes. Our study evaluates the population genetic and biogeographical structure of the round goby across its native and nonindigenous ranges, in light of geological history and its expansion pathways. We analyzed seven new nuclear microsatellite loci and mitochondrial DNA cytochrome b gene sequences from 432 individuals in 22 locations. Population structure was tested using FST‐analogs, phylogenetic trees, clustering diagrams, Bayesian assignment tests and nested clade analyses. Results show that native populations in the Black vs. the Caspian Sea basins diverge by 1.4% and c. 350 000 years, corresponding to closure of their prior connections and supporting the taxonomic separation of the Black Sea A. m. melanostoma from the Caspian Sea A. m. affinis. Their within‐basin populations diverge by ~0.4% and 100 000 years. Nonindigenous populations in the Baltic Sea and Danube and Dnieper Rivers trace to separate northern Black Sea origins, whereas the upper Volga River system houses mixed populations of A. m. melanostoma and A. m. affinis. Native populations average twice the genetic diversity of most exotic sites; however, sites in the Volga River system have high diversity due to mixing of the two taxa. Our results highlight how vicariance and anthropogenic disturbances have shaped a rapidly expanding species’ genetic heritage.
Multicenter trial of everolimus in pediatric renal transplant recipients: Results at three year
Authors: Ettenger Robert , Hoyer Peter‐Friedrich , Grimm Paul , Webb Nicholas , Loirat Chantal , Mahan John D. , Mentser Mark , Niaudet Patrick , Offner Gisela , Vandamme‐Lombaerts R. , Hexham J. Mark ,   the Everolimus Pediatric Study Group
Published: May 2008

Abstract:  There are few prospective clinical trials of mTOR inhibitors (or proliferation signal inhibitors) combined with CNI inhibitors in de novo pediatric renal transplantation. Results reported here are from a multicenter, open‐label study in de novo pediatric renal transplant patients (≤16 yr), in which patients received everolimus with cyclosporine and corticosteroids for one yr, then entered an extension study for a further two yr. Nineteen patients completed the one‐yr study, of whom three discontinued study medication. Fifteen of the remaining 16 patients entered the extension study, eight of whom were aged <10 yr (Group 1) and seven were aged 10–16 yr (Group 2). Mean daily dose of everolimus during the first 36 months was 1.53 mg/m2 BSA. Biopsy‐proven acute rejection occurred in three patients in Group 2 and in one patient in Group 1. Biopsy‐proven chronic allograft rejection was reported in four patients (two in each age group). Graft survival at one yr was 100%; one patient in Group 2 lost their graft subsequently during the extension. For patients entering the extension, patient survival at three yr was 100%. There were three cases of viral infection, including one case of cytomegalovirus infection. At three yr, mean total cholesterol was 5.5 ± 0.8 mm/L (213 ± 31 mg/dL) and four patients received statin therapy. Mean serum creatinine at 36 months was 96 ± 36 μm/L (1.1 ± 0.4 mg/dL). This is the first long‐term prospective study to demonstrate that a regimen of everolimus, cyclosporine, and corticosteroids provides good efficacy, tolerability, and safety in de novo pediatric renal transplant patients.
Screening for PTLD in lung and heart–lung transplant recipients by measuring EBV DNA load in bronchoalveolar lavage fluid using real time PCR
Authors: Michelson Peter , Watkins Bradley , Webber Steven A. , Wadowsky Robert , Michaels Marian G.
Published: May 2008

Abstract:  Pediatric L‐HLTx recipients are at risk for developing PTLD with the lung being a primary site of disease. We hypothesized that BALF is a better sample than peripheral blood for measuring EBV DNA load in this high‐risk population. Archived BALF specimens from pediatric L‐HLTx recipients with and without PTLD were assayed for EBV DNA load using a quantitative real time TaqMan PCR assay. These values were compared with values determined in peripheral blood by a competitive PCR assay. Fifty‐five BALF specimens from 16 L‐HLTx patients were evaluated. Three patients with PTLD had mean BALF EBV DNA load values almost 50‐fold higher than subjects without PTLD (4.6 × 105 copies/mL vs. 1.0 × 104 copies/mL). Patients who were EBV seronegative pretransplantation (i.e., high risk for PTLD) had elevated EBV DNA load values vs. patients who were EBV seropositive pretransplantation, regardless of the diagnosis of PTLD (mean values of 3.2 × 105 copies/mL vs. 1.1 × 104 copies/mL). Lastly, BALF analysis identified all subjects with PTLD, whereas peripheral blood analysis identified only one of these cases. Therefore, it can be concluded that monitoring EBV DNA load in BALF following L‐HLTx facilitates detection of PTLD in high‐risk patients and may be superior to peripheral blood assays.
An unconditioned bone marrow transplantation in a child with purine nucleoside phosphorylase deficiency and its unique complication
Authors: Aytekin Caner , Yuksek Mutlu , Dogu Figen , Yagmurlu Aydin , Yildiran Alisan , Fitoz Suat , Kologlu Meltem , Babacan Emel , Hershfield Michael S. , Ikinciogullari Aydan
Published: May 2008

Abstract:  Purine nucleoside phosphorylase deficiency is a rare immunodeficiency syndrome characterized by recurrent infections, neurological dysfunction, and autoimmunity. Early diagnosis and hematopoietic stem cell transplantation may reverse the dismal prognosis in PNP deficiency. This report presents a new PNP deficiency case successfully transplanted without a conditioning regimen from an HLA‐identical family donor, who developed a complication of disseminated BCG infection.
The role of lutein in the acclimation of higher plant chloroplast membranes to suboptimal conditions
Authors: Pérez‐Bueno María L. , Horton Peter
Published: May 2008

Two mutants of Arabidopsis thaliana deficient in lutein have been investigated with respect to their responses to growth under a range of suboptimal conditions. The first mutant, lut1, was enriched in violaxanthin, antheraxanthin, zeaxanthin and zeinoxanthin compared with the wild‐type (WT). In the second mutant, lut2, the lack of lutein was compensated for only by an increase in xanthophyll cycle (XC) carotenoids. Upon transfer of plants grown under optimal conditions to high light (HL), drought or HL + drought, both mutants acclimated during several days to the new conditions to the same extent as the WT. In contrast, transfer to chilling conditions (6°C) for 6 days induced responses that were different between WT and mutants and between the mutants themselves. In contrast to the WT, the lut2 mutant in particular exhibited a large increase in the Chl a/b ratio and the XC pool size, extensive de‐epoxidation and an enhanced extent of non‐photochemical quenching. It is suggested that although the role of lutein in the structure and organisation of the light‐harvesting complexes can be fulfilled by other xanthophylls under excess light conditions at optimal temperatures, this is not the case at low temperature.
Effects of Pre‐natal Glucocorticoids on Testicular Development in Sheep
Authors: Pedrana G. , Sloboda D. M. , Pérez W. , Newnham J. P. , Bielli A. , Martin G. B.
Published: May 2008

We tested the hypothesis that acute pre‐natal exposure to high levels of synthetic glucocorticoid (betamethasone) would alter fetal testicular development through actions on gonadal glucocorticoid receptors (GRs). Pregnant Merino ewes bearing singleton male fetuses (n = 24) were allocated randomly among four equal groups to be injected intramuscularly with saline or betamethasone (0.5 mg/kg) either on day 109 of gestation or on both day 109 and day 116 of gestation. Fetal testes were collected at post‐mortem, 5 days after each treatment. The volume of interstitial tissue and the volume, length and diameter of the sex cords were measured, and Sertoli cells and gonocytes were counted. For cord volume and interstitial tissue volume, control testes demonstrated maturational changes as fetal age advanced from 109 to 116 days of gestation. For that period, the single injection of betamethasone significantly reduced Leydig cell proliferation (P < 0.05), but had no effect on Sertoli cell numbers. Immunohistochemistry was used to localize GR and proliferating cell nuclear antigen in testicular cells. GR immunoexpression in Leydig cells was higher in fetuses exposed to betamethasone at 109 days of gestation than in control fetuses. Sertoli cells showed low levels of GR. It was concluded that, during mid‐gestation, a brief period of glucocorticoid treatment could affect testicular development in male sheep fetuses. The mechanism probably involves direct effects on Leydig cells, as these cells express extra‐GR in response to the treatment. Sertoli cells seem to produce less GR than Leydig cells, perhaps explaining their lack of response to betamethasone. These outcomes may have important implications for future fertility in male offspring.
Morphological Analysis of the Foramen Magnum of Dogs from the Iron Age
Authors: Janeczek M. , Chrószcz A. , Onar V. , Pazvant G. , Pospieszny N.
Published: May 2008

The investigations were carried out on 37 skulls from the Van‐Yoncatepe early Iron Age necropolis (in eastern Anatolia) (first group) and 11 skulls from the scythians castle from Bileskoje Iron Age (second group). The major distance between both occipital condyles and both bases of the jugular processes, the major width of the foramen magnum, height of the foramen magnum, height of the skull, height of the occipital triangle and the length of the dorsal notch were measured. A dorsal notch was present in seven dogs (six male and one female) from Van‐Yoncatepe. The average length of the dorsal notch was 2.5 mm. The investigation states that the dorsal notch occurred in dogs from the Iron Age. This anatomical formation had no association with their death.
Assessment of Cold and Heat Tolerance of Winter‐grown Canola (Brassica napus L.) Cultivars by Pollen‐based Parameters
Authors: Singh S. K. , Kakani V. G. , Brand D. , Baldwin B. , Reddy K. R.
Published: May 2008

Winter‐grown canola (Brassica napus L.) production is limited mostly by frost and winter kill in the southern canola‐growing regions of the United States. Tolerance to cold and heat were assessed by studying percentage of pollen viability (PV), in vitro pollen germination (PG) and pollen tube length (PTL) for 12 field‐grown cultivars. Freshly collected pollen from all cultivars were incubated on artificial solid growth media at a constant temperature ranging from 10 to 35 °C at 5 °C interval for 30 h to determine PG and PTL. A modified bilinear model best described the temperature response functions of PG and PTL. Canola cultivars showed significant variability (P < 0.001) for PV (61.3 % to 89.7 %), PG (29.0 % to 48.2 %) and PTL (463 to 931 μm). The average cardinal temperatures, Tmin, Topt and Tmax, for PG and PTL were 6.4, 24.3 and 33.7 °C, respectively. Principal component analysis revealed that maximum PG, PTL, Tmin and Topt of both PG and PTL were the most important factors in determining cold tolerance, whereas Tmax of PG and PTL, and maximum PG and PTL were more responsible in separating the cultivars for heat tolerance. The canola cultivar, KS3077, was the most cold tolerant with the lowest Tmin and the widest temperature adaptability range, and the cultivar Kadore was the most heat tolerant with the highest Tmax for the PG. The identified cold‐ and heat‐tolerant cultivars may be useful in canola‐breeding programmes to develop cultivars suitable for a niche environment.
Heterologous In Vitro Fertility Evaluation of Cryopreserved Iberian Red Deer Epididymal Spermatozoa with Zona‐intact Sheep Oocytes and its Relationship with the Characteristics of Thawed Spermatozoa
Authors: Soler AJ , Poulin N , Fernández‐Santos MR , Cognie Y , Esteso MC , Garde JJ , Mermillod P
Published: May 2008

Contents

A heterologous in vitro system, using zona‐intact sheep oocytes, was used to evaluate the relationship between sperm factors of Iberian red deer thawed epididymal sperm and the percentage of cleaved oocytes. Epididymal spermatozoa were recovered from six males, diluted with freezing extender and cryopreserved. After thawing sperm motility (SM) and acrosome and membrane integrities were evaluated. Again, these parameters were assessed after incubation in freezing extender at 37°C for 2 h. After cryopreservation the values for SM and acrosome and membrane integrities were high (∼80, 80 and 70% respectively). However, these values significantly decreased after incubation (∼59, 62 and 47% respectively). Red deer thawed epididymal sperm fertilized zona‐intact sheep oocytes, although the percentage of cleaved oocytes was low (∼22%). No relationship was found between sperm parameters assessed after thawing and the percentage of cleaved oocytes. Likewise, any sperm parameter evaluated after incubation was assessed in relation to the percentage of cleaved oocytes. However, acrosome and membrane integrities were near to significance (p = 0.06 and p = 0.09 respectively). Then, we conducted a reduced model with these two variables and both were related to the percentage of cleaved oocytes (p = 0.02 and p = 0.04 respectively). Thus, acrosome and membrane integrities were related to the percentage of cleaved oocytes negatively and positively respectively. It was concluded that the classical parameters assessed in deer thawed sperm samples can be good predictors of the ability to fertilize zona‐intact sheep oocytes.
Calves Born after Direct Transfer of Vitrified Bovine In Vitro‐produced Blastocysts Derived from Vitrified Immature Oocytes
Authors: Vieira AD , Forell F , Feltrin C , Rodrigues JL
Published: May 2008

Contents

Vitrification has been the method of choice for the cryopreservation of bovine oocytes, as rapid cooling decreases chilling sensitivity. The aim of this study was to determine the in vitro and in vivo survival and the viability of immature oocytes vitrified using super‐cooled liquid nitrogen. Immature oocytes were randomly allocated to three groups: (i) non‐vitrified control group, (ii) vitrified in normal (−196°C) liquid nitrogen (LN2) and (iii) vitrified in super‐cooled LN2 (≤−200°C). Open‐pulled glass micropipettes were used as vitrification containers. Immature oocytes were in vitro‐matured, fertilized and cultured to the blastocyst stage. In vitro viability was assessed by cleavage and blastocyst rates on days 2 and 7 of culture respectively. Vitrified blastocysts derived from the immature vitrified oocytes were directly transferred to synchronous recipients. The in vitro embryo development of vitrified immature oocytes was not influenced by the LN2 state. After direct transfer (one embryo per recipient) of 16 embryos obtained from immature vitrified oocytes (eight from each vitrified group), two healthy calves were born in each group. These results indicated that vitrification of immature bovine oocytes using glass micropipettes under normal or super‐cooled LN2, resulted in viable blastocysts and live calves following in vitro embryo production.
Ovarian Cyclicity and Reproductive Performance of Holstein Cows Carrying the Mutation of Complex Vertebral Malformation in Japan
Authors: Ghanem ME , Isobe N , Kubota H , Suzuki T , Kasuga A , Nishibori M
Published: May 2008

Contents

This study was carried out on 71 lactating Holstein Friesian cows to investigate the resumption of ovarian cyclicity postpartum and the reproductive performance in cows carrying the mutation of complex vertebral malformation (CVM) compared with control ones. The cows were distributed in two dairy farms in Hiroshima Prefecture, Western Japan. Blood samples were collected from the cows to detect carrier cows with CVM mutation. Furthermore, plasma samples were collected weekly after calving from control cows (n = 10) and CVM carrier cows (n = 10), until 10 weeks postpartum to investigate the day of first ovulation and the resumption of ovarian cyclicity postpartum. The reproductive parameters were investigated and compared with control and CVM carrier cows. Thirty‐six cows were diagnosed to be CVM carriers by DNA examination and confirmed later by DNA sequencing. The pedigree analysis of the carrier cows revealed that they were daughters of six types of CVM carrier semen that still was used in dairy farms in Western Japan. In terms of reproductive indices, there were no significant differences between the control and the CVM carrier cows on the day of the first ovulation postpartum and the interval from calving to first insemination. However, CVM carrier cows significantly required more inseminations per conception and showed a significantly longer period to conception and subsequent calving than control ones. In conclusion, the reproductive performance of the CVM carrier cows was lowered through conception failure that might indicate the occurrence of intra‐uterine mortality in those cows.
Quantification and Viability Assessment of Isolated Bovine Primordial and Primary Ovarian Follicles Retrieved Through a Standardized Biopsy Pick‐Up Procedure
Authors: Aerts JMJ , Martinez‐Madrid B , Flothmann K , De Clercq JBP , Van Aelst S , Bols PEJ
Published: May 2008

Contents

The feasibility of repeated collection and enzymatic isolation of large numbers of viable primordial and primary follicles from living donor cows were tested. Ovarian cortical biopsies were collected transvaginally by the Biopsy Pick‐Up (BPU) device, a modification of an Ovum Pick‐Up instrument. Follicles were enzymatically isolated from the retrieved cortical tissue samples, and follicle viability was determined by a live/dead fluorescent assay. Six cows were subjected to BPU once per week during 4 consecutive weeks, and in each BPU session 4 cortical tissue samples were collected per ovary. Over the 4‐week trial period, a total of 1443 primordial and primary follicles were collected, 1358 (94%) of which were primordial and 85 (6%) were primary follicles. In each BPU session, an average 60.1 ± 10.7 (mean ± SEM) primordial and primary follicles were isolated per cow. The number of follicles varied considerably throughout the trial period and between cows. Statistical analysis of the data, however, did not support the presence of any distinct trends in the follicle yields over time or between cows. A total of 111 enzymatically isolated follicles were analyzed for viability with fluorescent probes. The vast majority of isolated follicles (92.8%) were totally viable. We conclude that the standardized BPU procedure generates sufficiently large numbers of vital primordial and primary follicles, thus validating BPU as a new tool for research into early bovine follicular development.
Roles of mechanosensitive ion channels in bladder sensory transduction and overactive bladder
Authors: Araki Isao , Du Shuqi , Kobayashi Hideki , Sawada Norifumi , Mochizuki Tsutomu , Zakoji Hidenori , Takeda Masayuki
Published: May 2008

Abstract: In the storage phase, mechanical stretch stimulates bladder afferents. These signals generate sensations and trigger voiding responses, however the precise mechanisms by which mechanical stimuli excite bladder afferents are yet to be explored. For mechanosensory transduction, the presence of mechanosensors is essential in the peripheral sensory systems including sensory nerve endings, urothelium and others. There is increasing evidence that mechanosensitive ion channels, such as degenerin/epithelial Na+channel (ENaC) and transient receptor potential (TRP) channel families, play key roles in the mechanosensory transduction of the urinary bladder. Pharmacological interventions targeting mechanosensitive ion channels may provide a new strategy for the treatment of bladder dysfunction.
The prognostic impact of pelvic lymph node metastasis and lymphovascular invasion on bladder cancer
Authors: Herrmann Edwin , Stöter Eva , van Ophoven Arndt , Bierer Stefan , Bolenz Christian , Hertle Lothar , Wülfing Christian
Published: May 2008

Objectives:  To present long‐term results of a single‐center series of patients undergoing bilateral pelvic lymphadenectomy and radical cystectomy for bladder cancer and to analyze the impact of pelvic lymph node metastasis and lymphovascular invasion on clinical outcome.

Methods:  Between 1986 and 2005 833 patients were treated with bilateral pelvic lymphadenectomy and radical cystectomy at our institution. 614 of them with valid clinical follow‐up information and no neoadjuvant therapy could be evaluated.

Results:  Disease‐free and overall survival in the entire cohort was 56.7% and 49.5% at 5 years and 52.4% and 38.2% at 10 years, respectively. 28.1% of all patients had pelvic lymph node metastasis. We found organ‐confined tumor stages (≤pT2) in 43.8%. Patients with non‐organ‐confined tumor stages (≥pT3) and positive pelvic lymph nodes had a significantly shorter overall survival than those without lymph node metastasis (P < 0.0001). In the subgroup of ≤pT2, the presence of pelvic lymph node metastasis did not show a statistically significant effect on overall survival (P = 0.618). The presence of lymphovascular invasion was associated with an impaired survival (P < 0.0001). In multivariate analysis, pathological tumor stage (P < 0.0001), lymph node stage (≥pT3) (P = 0.004) and lymphovascular invasion (P = 0.001) were independent prognostic parameters.

Conclusions:  According to the present series, survival for patients with ≤pT2 does not depend on the lymph node stage. Lymphovascular invasion is an independent parameter of impaired survival and should be determined routinely in cystectomy specimens to identify patients, who may benefit from adjuvant systemic therapy.
‘I know it is only exercise, but to me it is something that keeps me going’: A qualitative approach to understanding mental health service users' experiences of sports therapy
Authors: Crone Diane , Guy Helen
Published: May 2008

ABSTRACT:  The relationship between exercise and mental health is well documented and has led to the inclusion of exercise into the treatment of people with mental health problems. A qualitative (grounded theory) methodology, using focus groups, investigated the experiences of people with mental health problems, who had successfully participated in exercise as part of their treatment. The aim of this study was to investigate the experiences of service users who had successfully participated in sports therapy as part of their treatment. One of the researchers is also a service user who has participated in sports therapy and these experiences provided an insight into the research, especially in the design of the interview schedule, data collection (empathy with participants), and in the interpretation of the data. The dual role of service user and researcher is commended in contemporary mental health research and as such makes this study unique. A conceptual model is presented that explains the participants' subjective experiences, opinions, and perceptions of the role exercise has in their treatment, and their perceived outcomes from participation. The findings support sports therapy as an acceptable and beneficial adjunct to usual treatment for some people with mental health problems within the community, but that problems exist regarding knowledge and understanding of the theory underpinning its use.
Exploratory study of mental health consultation‐liaison nursing in Australia: Part 1 demographics and role characteristics
Authors: Sharrock Julie , Bryant Jenni , McNamara Paul , Forster John , Happell Brenda
Published: May 2008

ABSTRACT: Mental health nursing roles in Consultation‐Liaison (CL) psychiatry and emergency departments are rapidly developing within Australia since the mainstreaming of mental health services within the general health‐care system. Anecdotal evidence suggests that many of these positions have been initiated and developed in relative isolation and with little formalized support. Consequently, a comprehensive understanding of these roles and the nurses who occupy them is limited. A survey was developed and distributed to gather information on CL nurses in Australia. The survey was aimed at CL nurses working in a range of settings and included questions relating to demographics, qualifications, experience, clinical practice, organizational structure, education, clinical supervision, education and training and work satisfaction. This, the first of a two‐part paper, will present the key findings relating to demographics and characteristics of the role. Overall, the findings demonstrated that the CL nurses who responded to the survey (n = 56) were experienced psychiatric/mental health nurses working primarily in general hospital wards and/or emergency departments; receive requests for consultation from a range of health professionals but predominantly nurses; provide education to a range of staff groups; and use a range of titles to identify their role.
Parasites in food webs: the ultimate missing links
Authors: Lafferty Kevin D. , Allesina Stefano , Arim Matias , Briggs Cherie J. , De Leo Giulio , Dobson Andrew P. , Dunne Jennifer A. , Johnson Pieter T. J. , Kuris Armand M. , Marcogliese David J. , Martinez Neo D. , Memmott Jane , Marquet Pablo A. , McLaughlin John P. , Mordecai Erin A. , Pascual Mercedes , Poulin Robert , Thieltges David W.
Published: May 2008

Parasitism is the most common consumer strategy among organisms, yet only recently has there been a call for the inclusion of infectious disease agents in food webs. The value of this effort hinges on whether parasites affect food‐web properties. Increasing evidence suggests that parasites have the potential to uniquely alter food‐web topology in terms of chain length, connectance and robustness. In addition, parasites might affect food‐web stability, interaction strength and energy flow. Food‐web structure also affects infectious disease dynamics because parasites depend on the ecological networks in which they live. Empirically, incorporating parasites into food webs is straightforward. We may start with existing food webs and add parasites as nodes, or we may try to build food webs around systems for which we already have a good understanding of infectious processes. In the future, perhaps researchers will add parasites while they construct food webs. Less clear is how food‐web theory can accommodate parasites. This is a deep and central problem in theoretical biology and applied mathematics. For instance, is representing parasites with complex life cycles as a single node equivalent to representing other species with ontogenetic niche shifts as a single node? Can parasitism fit into fundamental frameworks such as the niche model? Can we integrate infectious disease models into the emerging field of dynamic food‐web modelling? Future progress will benefit from interdisciplinary collaborations between ecologists and infectious disease biologists.
Characteristics of human intestinal Escherichia coli with changing environments
Authors: Skurnik David , Bonnet Daniel , Bernède‐Bauduin Claire , Michel Rémy , Guette Christian , Becker Jean‐Marie , Balaire Corinne , Chau Françoise , Mohler Jacqueline , Jarlier Vincent , Boutin Jean‐Paul , Moreau Brigitte , Guillemot Didier , Denamur Erick , Andremont Antoine , Ruimy Raymond
Published: May 2008

To investigate if the characteristics of human intestinal Escherichia coli are changing with the environment of the host, we studied intestinal E. coli from subjects having recently migrated from a temperate to a tropical area. We determined the phylogenetic group, the prevalence of the antibiotic resistance, the presence of integrons and the strain diversity in faecal isolates from 25 subjects originally from metropolitan France and expatriated to French Guyana. These characteristics were compared with those of 25 previously studied Wayampi Amerindian natives of French Guyana and from 25 metropolitan French residents. The three groups of subjects were matched for age and sex, had not taken antibiotics for at least 1 month, nor had been hospitalized within the past year. In all, the characteristics of intestinal E. coli from Expatriates were intermediate between those found in residents from metropolitan France and those found in natives of French Guyana. Prevalence of carriage of resistant Gram‐negative bacteria in Expatriates was intermediate between French residents and Wayampi as were the prevalence of integrons in E. coli (12.3% versus 16.3% and 7.8% respectively), and the intra‐host diversity of E. coli (2.3 strains/subject versus 1.9 and 3.1, respectively); lastly, in Expatriates, the prevalence of carriage of phylogenetic group B2 strains was lower than in French residents (16% versus 56%, P = 0.005), while carriage of phylogenetic group A strains was lower than in Wayampi (56% versus 88%, P = 0.03). Our results suggest that the composition of the commensal intestinal flora of humans is not static but changes dynamically in response to new environmental conditions.
Botulinum toxin reduces anal spasm but has no effect on pain after haemorrhoidectomy
Authors: Singh B. , Box B. , Lindsey I. , George B. , Mortensen N. , Cunningham C.
Published: May 2008

Objective  Pain following haemorrhoidectomy is due to a combination of factors including spasm of the internal sphincter, an open wound and local infection. In this study, we investigated the effect of botulinum toxin on postoperative pain following Milligan–Morgan haemorrhoidectomy.

Method  A prospective randomized controlled trial was conducted in 32 patients undergoing haemorrhoidectomy. Routine postoperative care included metronidazole and bupivacaine. Patients were also given an inter‐sphincteric injection of either placebo or botulinum toxin (150 units). Maximal resting pressure (MRP) and maximal squeeze pressure (MSP) were measured postoperatively. A linear analogue score was used to assess postoperative pain. The sample size calculation was calculated to show one standard deviation difference between groups. The primary endpoint was reduction in postoperative pain.

Results  The MRP was significantly lower in the botulinum toxin group (mean 50.5 mmHg; 95% CI 39.77–61.23) compared with the placebo group (mean 64.94 mmHg; 95% CI 55.65–74.22) (P = 0.04) at week 6. At week 12 there was no significant difference in MRP between the two groups. In contrast MSP was significantly lower in the botulinum toxin group at weeks 6 and 12 (mean 87.1 mmHg; 95% CI 66.9–107.1) compared with the placebo group (mean 185.8 mmHg; 95% CI 134.2–237.4) at week 12 (P = 0.0014). There was no significant effect on overall or maximal pain scores. Median time for return to normal activities was not significantly different between groups.

Conclusion  Botulinum toxin reduces anal spasm but has no significant effect on postoperative pain.
Case report of uncontrollable pelvic bleeding – managed by a previously unreported method (QuikClot®)
Authors: Shanmugam V. , Robinson M. H.
Published: May 2008

Pelvic haemorrhage can be difficult to control. Several measures including packing, drawing pins, stenting and embolization are available. We present a case where these measures failed to control catastrophic pelvic bleeding while operating in the pelvis to excise a dumbbell tumour involving the right S1 nerve root. Attempted surgical control by a vascular surgeon and radiological control through stenting and embolization failed to control the bleeding. QuikClot® is an inert substance and acts as a selective sponge. This product is licensed for external use by the British military. We felt that ‘internal’ use of Quikclot in this situation might be lifesaving and was applied to the bleeding area, stopping the bleeding immediately.
Extramural vascular invasion is an adverse prognostic indicator of survival in patients with colorectal cancer
Authors: Courtney E. D. , West N. J. , Kaur C. , Ho J. , Kalber B. , Hagger R. , Finlayson C. , Leicester R. J.
Published: May 2008

Background/aims  Extramural vascular invasion (EVI) in colorectal cancer is reported to be a stage‐independent adverse prognostic factor, and is a core item in the Royal College of Pathologists minimum data set for colorectal cancer histopathology reporting. The detection of EVI is also highly variable amongst pathologists. Our aims were to analyse both the frequency of EVI in colorectal cancer resections, and the effect of EVI on survival, in patients operated on over a 5‐year period.

Method  A retrospective analysis of patients having potentially curative surgery for colorectal cancer between January 1999 and December 2004.

Results  Over 5 years, 378 patients underwent a potentially curative resection. One‐hundred seven (28.3%) cancers exhibited EVI, of which 104 (97%) were T3 and T4 tumours. Survival curves with and without EVI, unadjusted for nodal status and T stage, were significantly different (P = 0.0001) with 5‐year survivals of 52% and 73% respectively. Survival curves for T3 and T4 tumours stratified with and without EVI also showed significantly different survival distributions (P = 0.007). A significant difference in frequency of EVI year on year was seen (P < 0.001), ranging from 8.5% to 46.7%, whereas the number of T3 and T4 tumours in each year was not significantly different (P = 0.677).

Conclusions  EVI is an adverse prognostic indicator for survival in patients undergoing potentially curative resection of colorectal cancer, and the routine requirement of EVI in colorectal cancer histopathology reporting is justified. Optimal specimen preparation, meticulous histopathological analysis and regular auditing of EVI detection rates are essential for the accurate staging of colorectal cancer.
Prognostic factors in survival of colorectal cancer patients after surgery
Authors: Mehrkhani F. , Nasiri S. , Donboli K. , Meysamie A. , Hedayat A.
Published: May 2008

Objective To determine the factors affecting survival, following resection of large bowel for colorectal carcinoma.

Method From the cancer database of a single referral institution, a total of 1090 patients who had undergone colorectal resection between 1999 and 2002 were identified. Cases with recurrent colorectal cancer or previous history of neoadjuvant chemotherapy were excluded. Survival curves were plotted using the Kaplan–Meier method. Univariate analysis of factors thought to influence survival was then made using Logrank test. Criteria studied consisted of age, sex, TNM stage, T‐status, nodal status, distant metastasis, histological grade, lymphatic and vascular invasion, tumour location, preoperative carcinoembryonic antigen (CEA) level and liver function tests. Multivariate analysis was conducted using Cox regression analysis.

Results The mean survival time for all patients was 42.8 (SEM = 2.8) months. The overall 1‐, 3‐ and 5‐year survival rates were 72%, 54% and 47%, respectively. In univariate analysis, patients’ age (P < 0.0001), TNM stage (P < 0.0001), T‐status (P = 0.015), nodal status (P = 0.016), distant metastasis (P < 0.0001), grade (P = 0.005), lymphatic and vascular invasion (P < 0.0001) and presurgery CEA level > 5 ng/ml (P = 0.021) were found to be predictors that could affect survival. In Cox regression analysis, age (P < 0.0001), TNM stage (P = 0.001) and grade (P = 0.008) were determined as independent prognostic factors of survival.

Conclusion Age, TNM stage, T‐status, nodal status, distant metastasis, grade, lymphatic and vascular invasion and presurgery CEA level can predict the postsurgical survival rate in patients with colorectal cancer.
The prevalence of parastomal hernia after formation of an end colostomy. A new clinico‐radiological classification
Authors: Moreno‐Matias J. , Serra‐Aracil X. , Darnell‐Martin A. , Bombardo‐Junca J. , Mora‐Lopez L. , Alcantara‐Moral M. , Rebasa P. , Ayguavives‐Garnica I. , Navarro‐Soto S.
Published: May 2008

Introduction  Parastomal hernia (PH) is a common complication of end colostomy, found in over 50% of patients. Abdominal computerized tomography (CT) may help diagnosis. The prevalence of PH may be higher than previously reported. We present a new CT classification for use in clinical practice.

Method  A cross‐sectional, descriptive observational study was carried out, assessing the clinical and radiological prevalence of PH in 75 patients with an end colostomy operated on since 1997. Clinical examinations were performed by a single surgeon. Abdominal CTs were assessed by a single radiologist.

Results  PH was observed clinically in 33 (44%) of 75 patients and 27 (82%) were symptomatic. Using the classification 0 (Normal), I (Hernial sac containing stoma loop), II (Sac containing omentum), III (Sac containing a loop other than stoma), radiological PH was observed in 35 (47%) patients. Clinical/radiological concordance (Kappa index = 0.4) increased proportionally with sac size. All type‐III PHs (n = 9) were symptomatic. The combined prevalence of PH detected by one or other method was 60.8%.

Conclusion  Clinical and radiological prevalence of PH is high. As there is no gold standard for PH detection, we recommend a combination of the two methods. A new classification for use in clinical practice is proposed.
Validity of segmental transit studies used in routine clinical practice, to characterize defaecatory disorder in patients with functional constipation
Authors: Cowlam S. , Khan U. , Mackie A. , Varma J. S. , Yiannankou Y.
Published: May 2008

Objective  Segmental colonic transit can be determined by performing regional counts of radio‐opaque markers on an abdominal radiograph. It has been claimed that the pattern of markers can be used to characterize the type of constipation, with a concentration of markers seen in the rectosigmoid region in patients with defaecatory disorders. The aim of our study was to examine this hypothesis in a cohort of patients with functional constipation.

Method  Consecutive patients presenting to a specialist constipation clinic and satisfying inclusion criteria were studied. All patients had the following assessments: radio‐opaque marker study performed according to a standard protocol; proforma‐based symptom assessment using Likert scoring; and radioisotope defaecating proctogram. Transit study data included total transit time, rectosigmoid transit time and geometric mean of markers. Symptom scores were recorded for straining, incomplete evacuation and digitation, together with a cumulative symptom score. Evidence of outlet obstruction from the proctogram included four previously described parameters.

Results  A total of 108 patients with functional constipation according to the Rome criteria with a median age of 41 years were studied. Neither rectosigmoid transit time nor the geometric centre of markers could differentiate patients with a functional defaecatory disorder (FDD). There was no correlation between the pattern of marker distribution and any of the parameters denoting outlet obstruction.

Conclusion  Our data do not support the hypothesis that assessment of segmental transit, using standard methods applicable to routine clinical practice can determine the type of constipation. In particular, patients exhibiting evidence of FDD are no more likely to have recto‐sigmoid retention of markers than those without.
To Fair Value or Not to Fair Value: A Broader Perspective
Authors: Ronen Joshua
Published: May 2008

Fair value is considered here with respect to the two primary objectives of financial statements proposed in the joint conceptual framework that is under development by the FASB and the IASB, namely (a) informativeness—to assist providers of capital in predicting, evaluating, and comparing the amounts, timing and uncertainty of future cash flows, and (b) stewardship—to assist in evaluating how efficient and effective managers have been in enhancing shareholders’ value. More specifically, a comprehensive set of accounting measures and a set of corporate governance reforms intended to align corporate insiders’ and auditors’ behaviour and decisions with the interests of investors is outlined. Suggested reforms show how to present a mix of effectively historical quantifications, exit values, and the discounted values of future cash flows expected from the particularized use of combinations of assets within the firm. Additionally, the article describes how markets can be reformed in order to align the interests of the officers who prepare such accounts, and the auditors who certify them, with those of investors. These market‐based reforms would require auditors to insure misrepresentations, and managers to take equity to induce truthful reporting. Also included is a radical extension to earlier proposals by the author, requiring an officer of the company to make the market in shares in a way that would place limits upon the value of the insider's private information.
Managerial Ownership and Earnings Management: Theory and Empirical Evidence from Japan
Authors: Teshima Nobuyuki , Shuto Akinobu
Published: May 2008

This paper examines the relationship between managerial ownership and opportunistic managerial behavior relating to earnings management. Economics theory identifies two apparently conflicting effects of managerial ownership on managers' incentives: the incentive alignment effect and the management entrenchment effect. We construct a theoretical model demonstrating the two effects. This model suggests that as managerial ownership increases, earnings management decreases for both high and low levels of managerial ownership, while it increases for intermediate levels of managerial ownership if the sensitivity of the probability of managerial dismissal to the corporate performance is high enough and/or the manager's private benefit derived from managerial position is high enough. In a sample of Japanese firms, we find a significant nonmonotonic relationship between managerial ownership and discretionary accruals, consistent with our model.