bluuebunny/crossref_metadata_2025 huggingface dataset:
Stability of the Synechococcus elongatus PCC 7942 circadian clock under directed anti-phase expression of the kai genes
Authors: Ditty Jayna L. , Canales Shannon R. , Anderson Breanne E. , Williams Stanly B. , Golden Susan S.
Published: August 2005

The kaiA, kaiB and kaiC genes encode the core components of the cyanobacterial circadian clock in Synechococcus elongatus PCC 7942. Rhythmic expression patterns of kaiA and of the kaiBC operon normally peak in synchrony. In some mutants the relative timing of peaks (phase relationship) between these transcription units is altered, but circadian rhythms persist robustly. In this study, the importance of the transcriptional timing of kai genes was examined. Expressing either kaiA or kaiBC from a heterologous promoter whose peak expression occurs 12 h out of phase from the norm, and thus 12 h out of phase from the other kai locus, did not affect the time required for one cycle (period) or phase of the circadian rhythm, as measured by bioluminescence reporters. Furthermore, the data confirm that specific cis elements within the promoters of the kai genes are not necessary to sustain clock function.
Specific gene targeting in Spiroplasma citri: improved vectors and production of unmarked mutations using site-specific recombination
Authors: Duret Sybille , André Aurélie , Renaudin Joël
Published: August 2005

In Spiroplasma citri, where homologous recombination is inefficient, specific gene targeting could only be achieved by using replicative, oriC plasmids. To improve the probability of selecting rare recombination events without fastidious, extensive passaging of the transformants, a new targeting vector was constructed, which was used to inactivate the crr gene encoding the IIA component of the glucose phosphotransferase system (PTS) permease. Selection of recombinants was based on a two-step strategy using two distinct selection markers, one of which could only be expressed once recombination had occurred through one single crossover at the target gene. According to this strategy, spiroplasmal transformants were screened and multiplied in the presence of gentamicin before the crr recombinants were selected for their resistance to tetracycline. In contrast to the wild-type strain GII-3, the crr-disrupted mutant GII3-gt1 used neither glucose nor trehalose, indicating that in S. citri the glucose and trehalose PTS permeases function with a single IIA component. In addition, the feasibility of using the transposon γδ TnpR/res recombination system to produce unmarked mutations in S. citri was demonstrated. In an arginine deiminase (arcA-disrupted) mutant, the tetM gene flanked by the res sequences was efficiently excised from the chromosome through expression of the TnpR resolvase from a replicative oriC plasmid. Due to oriC incompatibility, plasmid loss occurred spontaneously when selection pressure was removed. This approach will be helpful for constructing unmarked mutations and generating multiple mutants with the same selection marker in S. citri. It should also be relevant to other species of mollicutes.
Bond characteristics of structural polypropylene fibres in concrete with regard to post‐crack strength and durable design
Authors: Richardson A.E.
Published: August 2005

Purpose

Seeks to examine the bond strength of a large range of structural polypropylene fibres, as used in concrete, to determine the most effective fibre capable of transmitting load (N/mm2) between fibre and cement within the concrete matrix.

Design/methodology/approach

Following fibre selection characterised by the highest bond strength, determined from a series of pull out tests, BS flexural tests were carried out using high bond strength fibres (40 mm × 0.9 mm diameter used at 6 kg/m3) to determine whether or not structural polypropylene fibres had any effect on the ultimate flexural strength of fibre‐reinforced concrete, when compared with the plain control sample. Fibre orientation, type of rupture failure mode and post‐crack performance were examined.

Findings

Even structural fibre dispersion was found to be best achieved with the use of monofilament polypropylene fibres (19 mm × 22 micron used at 0.9 × kg/m3) in addition to the 6 kg/m3 structural fibre dose. Structural polypropylene fibres were found not to provide additional flexural strength however, they did provide post‐crack control, limiting the crack width with subsequent enhanced durability that in turn will provide lower life cycle costs.

Practical implications

In addition to increased durability the use of fibre reinforcement negates the need to place steel reinforcement bars.

Originality/value

Investigates the ambiguity in literature between claims made by different investigators regarding the effects of polypropylene fibres on compressive and flexural strengths.
The business value of e‐government for small firms
Authors: Viana Thompson Debora , Rust Roland T. , Rhoda Jeffrey
Published: August 2005

Purpose

To propose and test a model about the business value of government electronic services (e‐government) to small firms. Two dimensions of e‐government use (search‐oriented and transaction‐oriented) are measured and the effects of three types of e‐government benefits on small firms' profitability are tested.

Design/methodology/approach

Survey of 100 small firms in three states of the USA (Maryland, New York, and Washington).

Findings

Small firms' information technology capabilities are positively associated with the use of e‐government services. Search‐oriented use of e‐government is positively related to enhanced intelligence generation, new business development, and time savings. The relationship between use of e‐government and profitability is mediated by firms' intelligence generation.

Research limitations/implications

The study uses self‐reported data and was based on a sample of firms from three states of the USA. Thus results are limited by the specificity of this geographic context.

Practical implications

Small firms should use e‐government as an information source to enhance their market intelligence and build revenues. IT suppliers should emphasize e‐government services that link small firms to customers and collaborators, and facilitate access to key information resources. Government agencies should enhance their e‐government information services to improve small business performance and increase tax receipts.

Originality/value

The paper provides empirical evidence about the positive effect of use of e‐government services on the financial performance of small firms.
Natural convection in a porous cavity with spatial sidewall temperature variation
Authors: Saeid Nawaf H. , Mohamad A.A.
Published: August 2005

Purpose

To study the natural convention in a square porous cavity induced by heating one of the sidewalls and the other sidewall is cooled, while the horizontal walls are adiabatic. The heated wall is assumed to have spatial sinusoidal temperature variations about a constant mean value.

Design/methodology/approach

The Darcy model is used in the mathematical modeling of the natural convection in porous cavity. A finite volume method based on QUICK scheme is used to solve numerically the non‐dimensional governing equations.

Findings

It is found that the average Nusselt number varies based on the hot wall temperature. It increases with an increase in the amplitude, while the maximum average Nusselt number occurs at the wave number of k=0.75 for Rayleigh number based on the permeability of the medium of 500 and 1000 and at k=0.70 for a Rayleigh number of 10‐200.

Research limitations/implications

The effects of the amplitude (0‐1.0) and the wave number (0‐5) of the heated sidewall temperature variation on the natural convection in the cavity are investigated for Raleigh number 10‐1000.

Practical implications

The spatial sinusoidal temperature variation occurs in the applications when a cylindrical heater or a periodic array of heaters placed on a flat wall.

Originality/value

This paper is providing the details of the heat transfer inside the cavity which can be used in thermal design.
Social networking on the semantic web
Authors: Finin Tim , Ding Li , Zhou Lina , Joshi Anupam
Published: August 2005

Purpose

Aims to investigate the way that the semantic web is being used to represent and process social network information.

Design/methodology/approach

The Swoogle semantic web search engine was used to construct several large data sets of Resource Description Framework (RDF) documents with social network information that were encoded using the “Friend of a Friend” (FOAF) ontology. The datasets were analyzed to discover how FOAF is being used and investigate the kinds of social networks found on the web.

Findings

The FOAF ontology is the most widely used domain ontology on the semantic web. People are using it in an open and extensible manner by defining new classes and properties to use with FOAF.

Research limitations/implications

RDF data was only obtained from public RDF documents published on the web. Some RDF FOAF data may be unavailable because it is behind firewalls, on intranets or stored in private databases. The ways in which the semantic web languages RDF and OWL are being used (and abused) are dynamic and still evolving. A similar study done two years from now may show very different results.

Originality/value

This paper describes how social networks are being encoded and used on the world wide web in the form of RDF documents and the FOAF ontology. It provides data on large social networks as well as insights on how the semantic web is being used in 2005.
Fostering safe work behaviour in workers at construction sites
Authors: Ai Lin Teo Evelyn , Yean Yng Ling Florence , Sern Yau Ong Derrick
Published: August 2005

Purpose

The purpose of this paper is to propose and test a framework to foster safe work behaviour among workers on construction sites.

Design/methodology/approach

The proposed framework identifies two main reasons for unsafe behaviours: “don't know how”, and “don't care”. Technical and safety training is proposed to overcome the former problem, while for the latter it is proposed that organisations systematically apply operant conditioning techniques to promote safety, using organisational behaviour modification. A postal survey of contractors in Singapore was conducted to test the framework. The four tools of operant conditioning theory (positive reinforcements, negative reinforcements, extinction, and punishments) were evaluated.

Findings

Close and strict supervision, sending workers for safety and health training, and imposing fines are found to be most effective methods. Positive reinforcements (both monetary and non‐monetary) have also been found to be effective, while extinction did not receive much support. Other methods that may foster safe work behaviours are also discussed.

Originality/value

Safety on site could be enhanced via training and application of operant conditioning theory.
Managing foreign exchange risk among Ghanaian firms
Authors: Abor Joshua
Published: August 2005

Purpose

This paper reports on the foreign exchange risk‐management practices among Ghanaian firms involved in international trade. The study focuses on how Ghanaian firms manage their foreign exchange risk and the problems involved in managing exchange rate exposure. It also seeks to ascertain the extent to which these firms use foreign exchange risk management techniques.

Design/methodology/approach

Descriptive statistics were used in the presentation and analysis of empirical results.

Findings

The results indicate that close to one‐half of the firms do not have any well‐functioning risk‐management system. Foreign exchange risk is mainly managed by adjusting prices to reflect changes in import prices resulting from currency fluctuation, and also by buying and saving foreign currency in advance. The main problems the firms face are the frequent appreciation of foreign currencies against the local currency and the difficulty in retaining local customers because of the high prices of imported inputs, which tend to affect the prices of their final products sold locally. The results also show that Ghanaian firms involved in international trade exhibit a low level use of hedging techniques.

Originality/value

The main value of this paper is the analysis of foreign exchange exposure management from the Ghanaian perspective. Relevant recommendations aimed at enhancing the foreign exchange risk‐management practices among Ghanaian firms are made. The paper is useful not only to firms involved in international trade, but also to financial institutions interested in providing hedging products to these firms.
Conceptual design of performance measurement and management systems using a structured engineering approach
Authors: Sousa George W.L. , Cesar Ribeiro Carpinetti Luiz , Groesbeck Richard L. , Van Aken Eileen
Published: August 2005

Purpose

To provide and illustrate a structured engineering approach for conceptual design of enterprise performance measurement and management systems.

Design/methodology/approach

The paper proposes and utilizes a design approach based on combining an enterprise engineering process with a system dynamics (SD) modeling methodology. A research case application in a call center using real data serves as an illustration of these ideas.

Findings

This proposed approach provided clear guidance through all the steps of the research case developed. When compared to traditional alternatives, it especially enhanced considerations pertaining to causality relationships among performance metrics, both in a qualitative as well as in a quantitative way.

Originality/value

The explicit combination of enterprise engineering and SD methods creates new research and application opportunities. From a research perspective it establishes a framework for dealing with performance from a systems life‐cycle perspective as well as points to the need for developing integrated modeling techniques. From a practical perspective, the results achieved to this point provide a conceptual design guideline of immediate applicability.
An empirical study of performance measurement in manufacturing firms
Authors: Gosselin Maurice
Published: August 2005

Purpose

The recent performance measurement literature suggests that organizations should put more emphasis on non‐financial measures in their performance measurement systems, that organizations must use new performance measurement approaches such as the balanced scorecard and that measures should be aligned with contextual factors such as strategy and organizational structure. The purpose of this paper is to assess the extent to which organizations are following these prescriptions.

Design/methodology/approach

A survey of a sample of Canadian manufacturing firms was conducted. In the questionnaire, organizations had to indicate the extent to which they use 73 performance measures. They also had to respond to questions about determinants such as strategy, organizational structure and environmental uncertainty. More than 100 organizations responded to the survey. The response rate was 50.5 percent.

Findings

The results show that manufacturing firms continue to use financial performance measures. Despite the recommendations from experts and academics, the proportion of firms that implement a balanced scorecard or integrated performance measurement systems is low. Furthermore, organizations that use these approaches are not employing more extensively non‐financial measures than those which are applying traditional performance measurement approaches. This research project also shows that there are some significant relationships between the types of measures and contextual factors like strategy, decentralization and environmental uncertainty. This research finally demonstrates clearly that there is a need to develop a theory that explains how firms can use their performance measurement system to enhance their performance.

Originality/value

This paper provides information on performance measures used by organizations and their association with organizational determinants.
Blood profiles, body fat and mood state in healthy subjects on different diets supplemented with Omega‐3 polyunsaturated fatty acids
Authors: Fontani G. , Corradeschi F. , Felici A. , Alfatti F. , Bugarini R. , Fiaschi A. I. , Cerretani D. , Montorfano G. , Rizzo A. M. , Berra B.
Published: August 2005

Background  Diets and Omega‐3 polyunsaturated fatty acids have been considered as important factors to reduce the risk of cardiovascular and inflammatory diseases, but there are few details on the effects on healthy subjects. The aim of the present study was to examine the variation of several physiological parameters in healthy subjects on different diets supplemented with Omega‐3 fatty acids.

Materials and methods  The experiment was carried out on 33 subjects divided into four groups according to a double‐blind cross‐over design with a 1 : 1 ratio for Omega‐3 (vs. placebo) and open‐label parallel‐groups with a 1 : 1 ratio for the Zone diet (vs. the diet suggested by the Italian National Research Institute for Nutrition and Foods). Blood samples were collected at the beginning of the experiment and after 35 (cross‐over) and 70 days. The Profile of Mood States test (POMS) was also performed.

Results  The arachidonic acid/eicosapentaenoic acid ratio (AA/EPA) was strongly reduced by Omega‐3 with a supplementary effect of the diet and in particular the Zone diet. The AA/EPA reduction was correlated with a concomitant decrease of insulin and homocysteine levels. The Zone diet reduced skinfold thickness and body fat percentage and also showed antioxidant effects. The mood state changed after Omega‐3 supplementation, with an increased POMS index. This was related to a concomitant reduction of AA/EPA and was particularly evident in the Zone diet.

Conclusion  AA/EPA and mood state are differently influenced by diet and Omega‐3, body fat is particularly reduced by Zone diet, while blood parameters such as triglycerides/HDL ratio, insulin and homocysteine are related to AA/EPA variations. These findings are discussed in terms of differences in the composition of the diets and the influences of Omega‐3 on physiological functions.
Electrogastrography in neonates
Authors: Lange A. , Huang L. , Funch‐jensen P.
Published: August 2005

Abstract Background and aims: Procedures for diagnosis of gastrointestinal (GI) symptoms in newborn and preterm infants should preferably be non‐invasive. This study evaluates the usability of electrogastrography (EGG), a non‐invasive, cutaneous recording of the gastric myoelectrical activity in newborn infants.

Method: Sixty‐two randomly selected infants [27 girls and 35 boys with median gestational age of 36 weeks (range 29–42)] divided into six groups (by postconceptional age) were studied on median day 5 (range 1–24) after birth. None had GI symptoms. EGG recordings were made by Digitrapper EGG recording system.

Results: Findings were highly dispersed and without statistical difference both between pre‐ and postprandial periods and among the six study groups. Dominant frequency of 2.5 cycles per minute was found for 57 of 62 infants, with distribution of normal, bradygastric and tachygastric slow wave frequency uniformly dispersed around 50, 35 and 15% respectively.

Conclusion: We find EGG unsuitable for clinical use because of significant variation in gastric slow wave frequency in normal term and preterm infants without GI symptoms.
Towards a better understanding of abdominal bloating and distension in functional gastrointestinal disorders
Authors: Houghton L. A. , Whorwell P. J.
Published: August 2005

Abstract  Abdominal bloating is an extremely common symptom affecting up to 96% of patients with functional gastrointestinal disorders and even 30% of the general population. To date bloating has often been viewed as being synonymous with an actual increase in abdominal girth, but recent evidence suggests that this is not necessarily the case. This review examines the relationship between the symptom of bloating and the physical sign of abdominal distension, as well as examining the epidemiology, pathophysiology and treatment options available for this debilitating aspect of the functional gastrointestinal disorders. Pathophysiological mechanisms explored include psychological factors, intestinal gas accumulation, fluid retention, food intolerance and malabsorption of sugars, weakness of abdominal musculature, and altered sensorimotor function. Treatment options are currently rather limited but include dietary changes, pharmacological approaches, probiotics and hypnotherapy.
Aerophagia in children: characterization of a functional gastrointestinal disorder
Authors: Chitkara D. K. , Bredenoord A. J. , Wang M. , Rucker M. J. , Talley N. J.
Published: August 2005

Abstract    The purpose of this study was to describe presenting symptoms, diagnostic testing, treatments and outcomes in a group of children with a diagnosis of aerophagia. A computerized diagnostic index was used to identify all children between the age of 1 and 17 years diagnosed with aerophagia at a tertiary care medical centre between 1975 and 2003. Individual medical charts were abstracted for information on the demographics, clinical features, co‐morbid diagnoses, diagnostic work up and treatment of children with aerophagia. Information on presenting symptoms was also collected for a group of children who were retrospectively classified as having functional dyspepsia for comparison (n = 40). Forty‐five children had a diagnosis of aerophagia. The mean duration of symptoms in children with aerophagia was 16 ± 5 months. The most common gastrointestinal symptoms were abdominal pain, distention and frequent belching. Children with functional dyspepsia had a higher prevalence of nausea, vomiting, abdominal pain and unintentional weight loss compared to children with aerophagia (all P < 0.05). In conclusion, aerophagia is a disorder that is diagnosed in neurologically normal males and females, who can experience prolonged symptoms. Although many children with aerophagia present with upper gastrointestinal symptoms, the disorder appears to be distinct from functional dyspepsia.
Aspirin‐triggered 15‐HETE generation in peripheral blood leukocytes is a specific and sensitive Aspirin‐Sensitive Patients Identification Test (ASPITest)*
Authors: Kowalski M. L. , Ptasinska A. , Jedrzejczak M. , Bienkiewicz B. , Cieslak M. , Grzegorczyk J. , Pawliczak R. , DuBuske L.
Published: August 2005

Background:  We have previously demonstrated that aspirin triggers specific generation of 15‐hydroxyeicosateraenoic acid (15‐HETE) from nasal polyp epithelial cells and peripheral blood leukocytes (PBL) from aspirin‐sensitive (AS) but not aspirin‐tolerant (AT) patients with asthma/rhinosinusitis. The goal of this study was to assess the diagnostic value of ASA‐induced 15‐HETE generation measurement to identify AS patients.

Methods:  PBL were obtained from 43 AS patients with asthma and rhinosinusitis, 35 AT asthmatics and 17 healthy control (HC) subjects. PBL were incubated with 2–200 μM aspirin (ASA) and 15‐HETE release was measured in cell supernatants with competitive ELISA.

Results:  Unstimulated PBL from all three groups of patients generated similar amount of 15‐HETE. Incubation with 200 μM ASA resulted in an increase in an 15‐HETE generation (mean increase +421%) in AS‐asthmatics but small and nonsignificant response in AT‐asthmatics or control subjects. Receiver operating curve (ROC) analysis revealed that the sensitivity of the test for confirmation of ASA‐sensitivity was 83% and the specificity 82%. Positive predictive value was 0.79 and negative predictive value was 0.86. Naproxen induced a significant increase in 15‐HETE only in some AS‐asthmatics, but not in AT‐asthmatics.

Conclusion:  Our data demonstrate that ASA‐induced 15‐HETE generation by PBL is a specific and sensitive aspirin‐sensitive patients identification test (ASPITest).
Differential dependence of eosinophil chemotactic responses on phosphoinositide 3‐kinase (PI3K)
Authors: Mishra R. K. , Scaife J. E. , Harb Z. , Gray B. C. , Djukanovic R. , Dent G.
Published: August 2005

Background:  Control of eosinophil migration to sites of inflammatory responses is a potentially therapeutic intervention in diseases such as bronchial asthma. Chemoattractants, their receptors and the associated signalling pathways may, therefore, be important targets for novel therapeutics. While several potentially important chemoattractants have been identified, the signalling pathways mediating their actions are incompletely understood.

Aims of the study:  The role of phosphoinositide 3‐kinase (PI3K) in responses of human eosinophils to two important eosinophil chemoattractants – platelet‐activating factor (PAF) and eotaxin (CCL11) – was studied to determine whether this enzyme activity might be crucial for eosinophil migration.

Methods:  Eosinophils were isolated from atopic donor blood by immunomagnetic selection. Chemotaxis was assayed in a 96‐well blind‐chamber cell fluorescence assay. Respiratory burst and leukotriene C4 secretion were also assayed.

Results:  Two PI3K inhibitors, wortmannin and LY294002, caused concentration‐dependent inhibition of PAF‐induced eosinophil chemotaxis (IC50 = 0.54 nM and 0.15 μM, respectively) but exhibited at least 100‐fold lower potency against eotaxin‐induced responses (IC50 = 48 nM and >100 μM, respectively), indicating that these responses were not dependent upon PI3K. Wortmannin and LY294002 also inhibited PAF induced respiratory burst but not PAF‐induced LTC4 secretion.

Conclusions:  We conclude that PI3K‐dependence varies with stimulus and response, and that eotaxin‐induced eosinophil migration is not controlled by PI3K. This may indicate a limit to the potential of PI3K inhibitors to suppress tissue eosinophilia in diseases such as asthma.
Nurses’ perceptions of discharge planning
Authors: Watts Rosemary , Gardner Heather
Published: August 2005

Abstract  The present paper investigates what the term discharge planning actually means to nurses working in the acute care environment. A qualitative approach was used for this study. Twelve volunteer registered nurses (RNs) working in a large metropolitan Victorian public hospital were interviewed. All participants stated emphatically that they were involved in the discharge planning process although differing levels of involvement existed. ‘Organizing’ and ‘planning’ were key words used by participants to define the term discharge planning. All but one participant considered the nurse to be the coordinator of the discharge planning process. How participants communicated with other nursing staff regarding the discharge planning needs of individual patients depended on the policy of each individual ward. Communication was perceived to be a major factor that either enhanced or impeded the discharge planning process.
Issues and challenges in international doctoral education in nursing
Authors: Ketefian Shaké , Davidson Patricia , Daly John , Chang Esther , Srisuphan Wichit
Published: August 2005

Abstract  Education is a driving force in improving the health and welfare of communities globally. Doctoral education of nurses has been identified as a critical factor for provision of leadership in practice, scholarship, research, policy and education. Since the genesis of doctoral education in nursing in the USA in the 1930s, this movement has burgeoned to over 273 doctoral programs in over 30 countries globally. The present article seeks to identify the issues and challenges in nursing doctoral education globally, and those encountered by doctoral program graduates in meeting the challenges of contemporary health care systems. Information was derived from a comprehensive literature review. Electronic databases and the Internet, using the Google search engine, were searched using the key words ‘doctoral education’; ‘nursing’; ‘International Network for Doctoral Education in Nursing’; ‘global health’; ‘international research collaboration’. Doctoral education has been a critical force in developing nurse leaders in education, management, policy and research domains. An absence of consensus in terminology and of accurate minimum data sets precludes comparison and debate across programs. The complexity and dynamism of contemporary globalized communities render significant challenges in the conduct of doctoral programs. Addressing funding issues and faculty shortages are key issues for doctoral programs, especially those in developing countries, to achieve an identity uniquely their own. These challenges can also afford considerable opportunities for discussion, debate and the formulation of innovative and collaborative solutions to advance nursing knowledge and scholarship. In spite of discrete differences between countries and regions, the similarities in the issues facing the development of doctoral programs internationally are more striking than the differences. The harnessing of a global collective to address these issues will likely serve to not only forge the future viability of doctoral education of nurses but to improve the health and well‐being of communities. This paper proposes international collaborative strategies to address a number of the challenges identified.
Review of the Australian Incident Monitoring System
Authors: Spigelman Allan D. , Swan Judith
Published: August 2005

Background:  A survey was conducted to assess the benefits and limitations of the Australian Incident Monitoring System (AIMS) as a programme to improve patient safety.

Methods:  A 12‐point questionnaire was sent to 12 current users of AIMS in November 2002.

Results:  The AIMS provides a consistent system of coding, trending and monitoring of incident data. It promotes a patient safety culture and an awareness of system error. Other benefits include the building of teamwork and the implementation of strategies to reduce the prevalence and severity of incidents. The majority of respondents (83%) reported that AIMS investigations resulted in significant changes to equipment usage, medication prescribing or administration, clinical protocols, training programmes and falls risk assessment tools. Although 75% of users reported improvements in patient outcomes, these were difficult to measure. A major limitation of AIMS was the low rate of incident reporting by medical staff. Voluntary reporting systems did not capture all incident data and the information was often too generic for root cause analysis. There were difficulties benchmarking data and concerns were raised regarding the ownership of information. The programme requires ongoing resources to implement change strategies and to maintain incident reporting levels. On a scale of 1 (poor rating) to 10 (excellent rating) the mean benefit rating was 7.6.

Conclusion:  The Australian Incident Monitoring System is beneficial as a component of a clinical risk management strategy. Usefulness could be improved by increased participation by medical staff. The level of resources required should not be underestimated if the programme is to demonstrate improvements to patient outcomes. More recent versions of AIMS promise improved capabilities and will require similar evaluation.
Predictors of mortality, length of stay and discharge destination in blunt trauma
Authors: Gabbe Belinda J. , Cameron Peter A. , Wolfe Rory , Simpson Pam , Smith Karen L. , McNeil John J.
Published: August 2005

Background:  The present study explored a range of variables to identify predictors of mortality and morbidity and to develop prediction models based on these variables.

Methods:  Tools for predicting mortality, hospital length of stay and a patient's destination post‐hospital discharge were developed using logistic regression in one dataset (design) and evaluated for prediction performance in a separate dataset (validation). The performance of the mortality model was compared to the trauma and injury severity score (TRISS) and a severity characterization of trauma (ASCOT).

Results:  The profile of variables contributing to the final prediction models developed from the design dataset varied across the different outcomes of interest although age, injury severity score, development of complications and triage category were common predictors of all three outcomes. The performance of the new mortality prediction model was superior to both TRISS and ASCOT in the validation dataset. Overall, the new models did not meet the prespecified performance criteria.

Conclusions:  The present study identified key predictors of mortality and morbidity (length of hospital stay and discharge destination). The newly developed mortality model out‐performed published trauma scoring methods. However, further development and trial of the new prediction models is required before implementation as definitive audit and benchmarking tools could be recommended.
Musculoskeletal tissue banking in Western Australia: review of the first ten years
Authors: Winter Joyleen M. , Cowie Anne I. , Wood David J. , Zheng Ming H.
Published: August 2005

Background:  Musculoskeletal tissue allotransplantation has been used as a standard approach for reconstructive surgery. The present study has reviewed the banking of musculoskeletal tissue at the Perth Bone and Tissue Bank (PBTB) and provided evidence of quality assurance on musculoskeletal tissue allotransplantation.

Methods:  All donor tissues were processed in accordance with the Therapeutic Goods Administration's relevant codes of good manufacturing practices. Microbiological monitoring at each step of manufacture and postoperative surveying of the musculoskeletal allotransplantations were both conducted. The possible contribution of contaminants in allografts to postoperative infections was also assessed.

Results:  Of the 5276 donors obtained over the last 10 years, 1672 were rejected, giving an overall donor rejection rate of 32%. Milled femoral heads were the most frequently implanted allografts, followed by whole femoral heads. In the postoperative survey an infection rate of 4.9% was found (113/2321 recipients). The infectious agents were identified in 65 cases but for 60 of these there were no correlations with the positive culture test results for the allografts. The organism most commonly identified in postoperative infections was Staphylococcus species.

Conclusions:  The present study shows evidence that musculoskeletal tissue allotransplantation is a safe procedure when accompanied by high standards of quality assurance.
Dysmorphology and the spectacle of the clinic
Authors: Featherstone Katie , Latimer Joanna , Atkinson Paul , Pilz Daniella T. , Clarke Angus
Published: August 2005

Dysmorphology is the medical study of abnormal forms in the human and is concerned with the identification and classification of a variety of congenital malformations. Such diagnostic work rests on the inspection of images of affected individuals. Based on physical appearance individuals are classified in terms of a wide range of conditions, often with ‘exotic’ nomenclatures. This paper will describe the features of clinical dysmorphology and the process of classification. It derives from an ethnographic study of clinical consultations and meetings among medical geneticists in UK hospitals. We suggest that contemporary dysmorphology can be understood in terms of long‐standing forms of medical knowledge, medical representations and medical discourse. Notwithstanding the new forms of technology provided by genetic science, ‘the clinic’ still asserts its symbolic and functional power: the ‘gaze’ of the clinician and the clinician's warrant of personal knowledge exert their influence. The adjudication of dysmorphology is a contemporary exemplar of the spectacular.
Stress in Parents of Adults with Intellectual Disabilities Attending Special Olympics Competitions
Authors: Weiss Jonathan A. , Diamond Terry
Published: August 2005

Background  It is important to determine how programmes serving the individual with intellectual disability may also help to reduce stress in parents of adult children with intellectual disabilities. The aim of this study was to test whether parents who frequently watch their children at Special Olympics (SO) competitions report less stress than those who watch with less frequency.

Methods  A total of 57 mothers and 39 fathers completed the Parenting Stress Index in reference to their children with intellectual disability, whose ages ranged from 17 to 42.3 years. Frequency of parental attendance at competition and volunteering for SO was also assessed.

Results  Parents who frequently attended their children's competitions reported less stress than those who attended with less frequency. Mothers who volunteer, reported more child‐related stress than those who did not. A number of other gender‐specific relations were found.

Conclusions  These results support the hypothesis that parents who frequently see their children compete in SO have a more positive parent–child experience than those who do not attend with the same frequency. Experimental research, with controlled pre–post designs, is needed to directly assess any causal effect.
Investigating Sexual Abuse: Findings of a 15‐Year Longitudinal Study
Authors: McCormack Bob , Kavanagh Denise , Caffrey Shay , Power Anne
Published: August 2005

Background  There is a lack of longitudinal large‐scale studies of sexual abuse in intellectual disability services. Such studies offer opportunities to examine patterns in disclosure, investigation and outcomes, and to report on incidence and trends.

Methods  All allegations of sexual abuse (n = 250) involving service users as victims or perpetrators of sexual abuse over a 15‐year period in a large Irish community‐based service were analysed based on the data extracted from extensive contemporaneous case notes.

Results  Victims or families were the most common concern raisers of abuse. Following multidisciplinary investigation, almost half (47%) of all allegations of sexual abuse were confirmed (n = 118). In confirmed episodes, more than half the perpetrators were adolescents and adults with intellectual disabilities, while almost a quarter were relatives. The most common type of abuse was sexual touch, although 31% of episodes involved penetration or attempted penetration. The most common location was the family home, followed by the day service and public places. A notable feature was the variation in the incidence of abuse over the study period, largely caused by episodes of multiple abuse.

Conclusions  The incidence of confirmed episodes of sexual abuse of adults with intellectual disabilities may be higher than previously estimated. There is an urgent need for statutory guidelines, which require reporting of adult abuse, and provide protection for bona fide whistle blowers, similar to existing child protection legislation.
Hydroquinone and its analogues in dermatology – a potential health risk
Authors: Westerhof W , Kooyers T J
Published: August 2005

Hydroquinone has been used for decades as a skin lightening agent. Since January 1, 2001, its use in cosmetics has been banned. This ban is as a result of mid‐term effects such as leukoderma‐en‐confetti/occupational vitiligo and exogenous ochronosis. However, a recent literature search on hydroquinone as a skin lightening agent suggests that possible long‐term effects such as carcinogenesis may be expected as well.

Metabolites of hydroquinone formed in the liver, e.g., p‐benzoquinone and glutathione conjugates of hydroquinone, are mainly responsible for this. In the bone marrow, hydroquinone is oxidized into p‐benzoquinone because of the high myeloperoxidase activity. Topically applied hydroquinone‐containing creams may give rise to accumulation of these compounds, which can cause DNA damage and mutations. They also have the capability to disrupt protective mechanisms, whereby they facilitate further development of cancer. In the bone marrow, long‐term effects such as aplastic anemia and acute myeloid leukemias may occur. Most of the evidence stems from research on benzene toxicity, which appears to arise via its metabolite hydroquinone.

There is no report yet demonstrating carcinogenesis resulting from the application of hydroquinone‐containing creams. However doctors should be aware of these potential health risks which were up until now disregarded.
Neurofibromatosis Type One and West Syndrome: A Relatively Benign Association
Authors: Motte J. , Billard C. , Fejerman N. , Sfaello Z. , Arroyo H. , Dulac O.
Published: August 2005

Summary: Fifteen patients with neurofibromatosis type one (NF1) and West syndrome (WS) were studied. The evolution of WS was clearly different from that seen in the other neurocutaneous syndromes, especially tuberous sclerosis. Steroids were efficacious and spasms disappeared. There was no relapse after discontinuation of steroids and antiepileptic drugs were succesfully stopped several years later. Mental outcome was also very good. The association of both conditions does not seem to be a coincidence. WS with NF1 seems remarkably benign and resembles idiopathic WS more than symptomatic WS.
Neuropathologic Study of Resected Cerebral Tissue from Patients with Infantile Spasms
Authors: Vinters Harry V. , De Rosa Michael J. , Farrell Michael A.
Published: August 2005

Summary: Studies to date on the neuropathologic substrates of infantile spasms have largely utilized autopsy material of children who die after a long and complicated seizure history. This makes the interpretation of primary versus secondary changes in the cerebral tissue difficult if not impossible. We have recently had the opportunity to review the neuropathologic changes in cortical tissue resected from infants and children with a history of infantile spasms. The major identifiable abnormalities were destructive lesions, sometimes classifiable as cystic‐gliotic encephalomalacia, and dysplastic changes of varying degree. The cortical dysplasias had some similarity to cerebral changes described in tuberous sclerosis, including the presence of bizarre gemistocytic “balloon” cells, and secondary cytoskeletal changes within neuronal cell bodies. Such material provides an opportunity to apply immunohistochemical and molecular techniques to epileptic tissue in an attempt to understand the morphologic substrates of infantile spasms and other types of generalized epilepsy.
Seizures Associated with Propofol Anesthesia
Authors: Mäkelä J. P. , Iivanainen M. , Pieninkeroinen I. P. , Waltimo O. , Lahdensuu M.
Published: August 2005

Propofol is a new, fast‐acting intravenous (i.v.) anesthetic. Involuntary movements or epileptic sei zures have occurred during or after propofol‐induced an esthesia in ∼50 reported cases; a third of the patients have had epilepsy. We report 5 patients with seizures in association with propofol anesthesia. A female epileptic patient developed severe status epilepticus; the other patients with short‐lasting seizures had no previous epi lepsy. Although propofol has been used in treatment of patients of status epilepticus, the risk of precipitation of epileptic seizures warrants consideration especially when planning anesthesia for epileptic patients.
Carbamazepine‐Valnoctamide Interaction in Epileptic Patients: In Vitro/In Vivo Correlation
Authors: Pisani F. , Haj‐Yehia A. , Fazio A. , Artesi C. , Oteri G. , Perucca E. , Kroetz D. L. , Levy R. H. , Dialer M.
Published: August 2005

Six patients stabilized with carbamazepine (CBZ) therapy received an 8‐day “add‐on” supplement of valnoctamide (VCD), a tranquilizer available over the counter (OTC) in several European countries that exhibits promising anticonvulsant activity in animal models. During VCD intake, serum levels of the active CBZ metabolite, carbamazepine‐10,ll‐epoxide (CBZ‐E), increased fivefold from 1.5 ± 0.7 μg/ml at baseline to 7.4 ± 4.4 μg/ml after 4 days of VCD therapy and 7.7 ± 3.1 ^g/ml after 7 days of VCD therapy (means ± SD, p < 0.01). In 4 patients, the increase in serum CBZ‐E levels was associated with clinical signs of CBZ intoxication. CBZ‐E levels returned to baseline after VCD therapy was discontinued. Serum CBZ levels remained stable throughout the study. The interaction observed in this study is similar to that described in patients treated with CBZ and valpromide (VPD, an isomer of VCD). In a mechanistic study, therapeutic concentrations of VCD inhibited hydrolysis of styrene oxide in human liver mi‐crosome preparations. Thus, VCD is a potent inhibitor of microsomal epoxide hydrolase (IC50 15 μM). There was a striking similarity between in vitro and in vivo inhibition potencies. In this study, VCD clearance was higher in epileptic patients (treated with CBZ) than in healthy subjects.
Periodontal Condition of Epileptic Adults Treated Long‐Term with Phenytoin or Carbamazepine
Authors: Dahllof Goran , Preber Hans , Eliasson Soren , Ryden Hans , Karsten Johan , Modéer Thomas
Published: August 2005

The periodontal condition of 40 adult epileptic subjects (mean age 51 years) receiving long‐term therapy (mean 18 years) with phenytoin (PHT) or carbamazepine (CBZ) was studied. The subjects completed a questionnaire and underwent clinical and radiologic examination. Patients receiving PHT exhibited the same level of alveolar bone loss as those receiving CBZ. Patients receiving PHT exhibited more units with gingival overgrowth, reflected by the significantly higher number of gingival units with increased probing depth (p < 0.05). The results indicate that long‐term PHT does not result in increased risk for alveolar bone loss as compared with CBZ.
Thyroid Status of Patients Receiving Long‐Term Anticonvulsant Therapy Assessed by Peripheral Parameters: A Placebo‐Controlled Thyroxine Therapy Trial
Authors: Tiihonen Mikko , Liewendahl Kristian , Waltimo Olli , Ojala Mikael , Välimäki Matti
Published: August 2005

Summary: Thyroid hormone concentrations and measures reflecting thyroid function were studied in sera from 35 patients receiving long‐term phenytoin (PHT) or carbamazepine (CBZ) therapy. The mean concentrations of T4 FT4 FT3 and rT3 but not T3 of these patients were significantly lower than those of 19 controls of similar age and sex distribution. The mean serum thyrotropin (TSH) concentration was slightly but significantly higher in patients than in controls, but the serum TSH response to TRH was not significantly increased. In patients, the higher mean clinical diagnostic index of hypothyroidism (CDI‐HT: ‐20.3 ±‐19.1 vs.‐33.7 ± 8.5, p < 0.05) and higher ratio of preejection period to left ventricular ejection time (PEP/LVET: 0.343 5 0.065 vs. 0.334 2 0.030, p < 0.05) than in controls were compatible with tissue hypothyroidism. However, comparison of the mean levels of alanine aminotransferase (ALAT), creatine kinase (CK), creatinine, triglycerides, cholesterol, high‐density lipoprotein (HDL) cholesterol, osteocalcin, procollagen type III aminoterminal propeptide, and somatomedin‐C showed no significant differences between patients and controls. The increased mean angiotensin convertase and sex hormone‐binding globulin (SHBG) levels, typical of hyperthyroidism, were probably caused by drug effects. Fourteen patients with a subnormal FT4 concentration in serum participated in a doubleblind thyroxine treatment cross‐over study. Neither the mean CDI‐HT score, nor the systolic time intervals were significantly different between the thyroxine and placebo periods. Five patients benefited subjectively from the treatment. On the basis of all data from the cross‐sectional and thyroxine treatment studies, we conclude that patients receiving anticonvulsant drugs chronically are eumetabolic and do not need thyroxine supplementation.