bluuebunny/crossref_metadata_2025 huggingface dataset:
Safe and effective sedation and analgesia for bone marrow aspiration procedures in children with alfentanil, remifentanil and combinations with midazolam
Authors: Antmen Bülent , Şaşmaz Ilgen , Birbiçer Handan , Özbek Hayri , Burgut Refik , IşIk Geylan , Kilinç Yurdanur
Published: February 2005

Background : Invasive procedures such as bone marrow aspiration in children may be painful and cause anxiety. We investigated the efficacy and safety of remifentanil (R) alfentanil (A), remifentanil‐midazolam (RM), and alfentanil‐midazolam (AM) combinations in providing analgesia and sedation for bone marrow aspiration.

Methods : Eighty children undergoing a diagnostic bone marrow aspiration whose ages ranged from 5–16 years (mean 9.20 ± 3.00  years) were enrolled in this study. The patients were randomly assigned to one of 4 treatment groups. Vital signs, sedation and pain scores, somatic responses (sweating and tears) were recorded before, during bone marrow aspiration and after 5 and 15 min of the procedure.

Results : There were no statistical differences between sedation and the CHEOPS scores of the four groups during and after the procedures. The VAS scores were significantly higher for group A compared with groups R and RM during the procedure (P < 0.008). There were no differences between the VAS scores in group AM compared with groups R and RM (P > 0.008). There were also no statistical differences among the VAS scores of four groups after the procedure (P > 0.008). All patients had adequate sedation and analgesia. None of the patients in the study had deep sedation, hypotension, bradycardia, hypoxemia, or respiratory depression.

Conclusions : Remifentanil, alfentanil, remifentanil‐midazolam, and alfentanil‐midazolam combinations are effective in children and can be used safely in bone marrow aspiration which is a brief but painful procedure performed in the pediatric patient group.
Perioperative care of the patient with Williams syndrome
Authors: MEDLEY JOHN , RUSSO PIERANTONIO , TOBIAS JOSEPH D.
Published: February 2005

Williams syndrome, initially described by Williams, Barratt–Boyes, and Lowe in 1961, consists of characteristic dysmorphic features, congenital heart disease, and distinctive behavioral and emotional traits. In addition to acquired and congenital heart disease, manifestations in the renal, endocrine, musculoskeletal, and central nervous system may have implications during the perioperative period. Congenital and acquired heart disease can be a significant issue as sudden death, related to abnormalities of the coronary arteries, has been reported perioperatively in these patients. The authors present a 7‐month‐old infant, previously diagnosed with Williams syndrome, who required anesthetic care for repair of subaortic and supravalvular aortic stenosis. The potential perioperative implications of Williams syndrome are discussed.
Dexmedetomidine as the primary sedative agent for brain radiation therapy in a 21‐month old child
Authors: SHUKRY MOHANAD , RAMADHYANI USHA
Published: February 2005

Dexmedetomidine (PrecedexTM) is an α2 adrenoceptor agonist which is gaining popularity as a sedative and anesthetic adjuvant. In this case report, dexmedetomidine was used safely and easily to provide sedation for 12 radiation‐therapy sessions in a pediatric patient. It provided smooth induction and fast recovery with minimal respiratory depression.
The ProSealTM laryngeal mask airway in children
Authors: LOPEZ‐GIL M. , BRIMACOMBE J.
Published: February 2005

Background : The ProSealTM (PLMA) is a new laryngeal mask device with a modified cuff to improve the seal and a drain tube to provide access to the gastrointestinal tract. We assessed the performance of the size 2 (which has no dorsal cuff) and size 3 (which has a dorsal cuff) in terms of insertion success, efficacy of seal, tidal volume, gas exchange, fiberoptic position, gastric tube placement and frequency of problems.

Methods : Eighty children undergoing minor surgery were studied (n = 40, size 2 PLMA, weight 10–25 kg; n = 40, size 3 PLMA, weight >25–50 kg). Induction was with remifentanil and propofol. Insertion was with the introducer tool and by experienced users. Maintenance was with propofol or sevoflurane and pressure controlled ventilation.

Results : The first‐time and overall insertion success rate was 84 and 100%, respectively. Oropharyngeal leak pressure was 31 ± 5 cmH2O. There were no gastric or drain tube air leaks. Tidal volume and gas exchange was adequate in all patients, other than two brief episodes of hypoxia because of airway reflex activation. The vocal cords and epiglottis were visible in 99 and 80%, respectively, via the airway tube. The first‐time and overall insertion success rate for gastric tube insertion was 87 and 100%, respectively. During maintenance, the PLMA was removed in one patient with airway reflex activation and another required epinephrine for bronchospasm. There were no differences in performance between the sizes 2 and 3 PLMA.

Conclusion : The PLMA is an effective airway device in children and isolates the glottis from the esophagus when correctly positioned. Despite the lack of a dorsal cuff, the performance of the size 2 was similar to the size 3 PLMA in the age groups tested.
Pediatric sedation in North American children's hospitals: a survey of anesthesia providers
Authors: LALWANI KIRK , MICHEL MARLON
Published: February 2005

Background : Information about the existence and organization of pediatric sedation services in North America is not available. We conducted a survey to collect this information from anesthesiologists at pediatric institutions and to identify factors perceived as limiting the development of sedation services.

Method : We electronically mailed a confidential survey about pediatric sedation practice to an attending anesthesiologist involved in pediatric sedation at 116 children's hospitals in the United States and Canada. We identified the institutions using Internet resources. Electronic mailing addresses were obtained from departmental websites, society membership directories and departmental administrators. Our follow‐up for nonresponders was by a second e‐mail and a telephone call.

Results : A total of 54 completed questionnaires were received, a response rate of 47%. Forty‐nine (91%) were received from US hospitals, and the remainder from Canadian. Fifty percent of hospitals had a formal pediatric sedation service. Fifty‐four percent utilized a ‘mobile’ provider model. Hospital credentialing for nonanesthesiologist providers varied between 66 and 76% for ‘deep’ and ‘conscious’ sedation, respectively. A nurse–physician provider combination was the most common, utilized in 59% of hospitals. Anesthesiologists were the sole sedation providers in 26% of institutions. Propofol was used regularly by nonanesthesiologists for sedation of nonintubated (42%) and intubated (63%) patients. Eighty‐seven percent of institutions reported barriers to development of pediatric sedation services. The most common barrier was a shortage of providers, particularly anesthesiologists.

Conclusions : Propofol use by nonanesthesiologists is common. Addressing the shortage of providers, and allocating resources for credentialing providers will encourage further development of pediatric sedation practice.
Children's drawings as a measure of anxiety level: a clinical pilot study
Authors: PUURA ARTO , PUURA KAIJA , RORARIUS MICHAEL , ANNILA PÄIVI , VIITANEN HANNA , BAER GERHARD
Published: February 2005

Background : No simple method exists to distinguish children in need for premedication. The present study was planned to detect preoperative anxiety levels of children by rating their drawings.

Methods : Sixty ASA I children aged 4–7 years undergoing adenoidectomy were divided into AGIT and CALM groups according to agitation level observed during venous cannulation. All children drew a picture at three different times: (i) just after arrival in the day‐case unit, (ii) 10 min before operation and, (iii) prior to leaving for home. The children were also randomized to three premedication groups: group D, rectal diazepam 0.5 mg·kg−1; group P, 0.9% NaCl 0.1 ml·kg−1 rectally; group NT, no premedication. Five features (size of the drawing, form of the drawing line, colors used, mark of the pen and clarity of the picture) from the children's drawings were rated with a 3‐point scale. The ratings of each feature were made to form a sum score of anxiety ranging from 0 to 10. In the analysis of variance for repeated measures both the premedication group and agitation score were taken into the model as factors.

Results : The anxiety score of the drawings of the agitated children (during venous cannulation) was significantly higher already after arrival in the hospital [AGIT 4.76 (95% CI: 3.56–5.96) Vs CALM 3.67 (95% CI: 2.97–4.37) P = 0.029], but there were no statistical differences between the different premedication groups.

Conclusions : When routine sedative premedication is not used the drawings of the children might detect the children needing sedative premedication.
Recurrent life‐threatening bradycardia in a child with retained tracheal stent
Authors: JUAN CHUNG‐HAU , CHU CHI‐CHUN , CHANG WEN‐KEI , TSAI SHEN‐KOU
Published: February 2005

We report a child with a retained welded tracheal stent scheduled for removal developing refractory bradycardia and cardiac arrest during attempt to remove the stent. Cardiac massage and pacing were necessary to reestablish circulation. The same type of arrhythmia occurred three times in the postanesthetic care unit after tracheal suction or coughing.
Investigation of bacteremia following nasotracheal intubation
Authors: ÖNÇAĞ ÖZANT , ÇÖKMEZ BERNA , AYDEMİR ŞÖHRET , BALCIOĞLU TANER
Published: February 2005

Background : The aim of this study was to detect the risk of bacteremia from nasotracheal intubation in children undergoing dental treatment under general anesthesia.

Methods : Two 10 ml blood samples were taken, the first as a baseline and the second within 30 s following the nasotracheal intubation. The samples were inoculated into 5 ml aerobic and 5 ml anaerobic blood culture bottles. Following incubation in an automated blood culture system, bacteria were identified by using conventional biochemical methods and commercial identification systems. Mc Nemar's test was used to assess the findings statistically.

Results : Of 74 patients only nine (12.3%) had positive blood cultures after the intubation and seven of these had been intubated without trauma. The incidence of bacteremia was significantly higher after atraumatic intubation (7/9) compared with traumatic intubation (2/9) (P < 0.05). The most common bacteria in positive cultures were Streptococcus viridans, four of 74 (5.4%).

Conclusions : Since the occurrence of bacteremia after nasotracheal intubation is hazardous for patients at risk for developing infective endocarditis, to prevent further complications prophylactic antibiotic treatment is recommended.
Species names and metaphyly: a case study in Discodorididae (Mollusca, Gastropoda, Euthyneura, Nudibranchia, Doridina)
Authors: Dayrat Benoît , Gosliner Terrence M.
Published: February 2005

Dayrat, B. & Gosliner, T. M. (2005). Species names and metaphyly: a case study in Discodorididae (Mollusca, Gastropoda, Euthyneura, Nudibranchia, Doridina) —Zoologica Scripta, **, ***–***.

Absence of resolution in phylogenetic trees, or metaphyly, is a common phenomenon. It mainly results from the fact that each data set has its own limit and can hardly be expected to reconstruct alone an entire hierarchy. Because metaphyly helps point out which regions of a tree merit further investigation, one should not avoid metaphyly but rather should try to detect it by addressing carefully node reliability. In this paper we explore the implication of metaphyly for species names. We present a phylogenetic analysis of Discodorididae (Mollusca, Gastropoda, Nudibranchia, Doridina), with an emphasis on relationships among species of Discodoris and its traditionally close ‘allies’ such as Peltodoris and Anisodoris. We demonstrate that some species must be transferred to different discodoridid subclades with which they share synapomorphies, but that many species form a metaphyletic group at the base of Discodorididae, and therefore cannot be placed in any taxon of genus level. We demonstrate that the current International Code of Zoological Nomenclature does not allow taxonomists to handle this situation because it requires selecting a taxon name of genus rank for every species binomial. Then we evaluate the results provided by new forms of species names, both in a rank‐based system, such as the current nomenclature, and a rank‐free system. All solutions considered would cause radical changes to the ‘spirit’ of the current ICZN (and, by extension, to the other current codes). In a rank‐free system of nomenclature, such as the PhyloCode, the best result is obtained with an epithet‐based form that does not mention supra‐specific relationships. Under this method, official species names would take the form ‘boholiensis Bergh, 1877’, although page numbers and letters can be added for uniqueness purposes. Taxonomists would then be free to add supra‐specific taxon names in ‘common’ species names, such as Discodorididae boholiensis Bergh, 1877 or simply Discodorididae boholiensis. Here we wish to stimulate discussion of a problem that we believe merits wide debate: absence of resolution in phylogenetic reconstruction and its impact on species nomenclature.
A phylogeny of the fossil and extant zeiform‐like fishes, Upper Cretaceous to Recent, with comments on the putative zeomorph clade (Acanthomorpha)
Authors: Tyler James C. , Santini Francesco
Published: February 2005

Tyler, J. C. & Santini, F. (2005). A phylogeny of the fossil and extant zeiform‐like fishes, Upper Cretaceous to Recent, with comments on the putative zeomorph clade (Acanthomorpha). —Zoological Scripta,**, ***–***.

A phylogenetic hypothesis based on 107 morphological characters is proposed for a data set of 43 taxa. Thirty‐three are extant and belong to the orders Zeiformes (20 taxa), Caproiformes (2), Tetraodontiformes (2), Beryciformes (3), Stephanoberyciformes (3) and Perciformes (3). Ten are fossil taxa previously assigned to the Zeiformes (3), Caproiformes (1), Tetraodontiformes (2), Perciformes (1), and to two extinct Eocene families, the Sorbinipercidae (2) and the Zorzinichthyidae (1). This analysis indicates the existence of a previously undocumented clade formed by the families Sorbinipercidae + Zorzinichthyidae that may be related to the tetraodontiforms. It also shows that two uppermost Palaeocene species,Archaeozeus skamolensisandProtozeus kuehnei, sequentially represent the two most basal lineages of zeiforms, whereas the most ancient known zeiform, the Upper CretaceousCretazeus rinaldii, belongs within the clade of extant species in a polytomy with many other zeiform lineages. A reduced data set of 25 mostly zeiform taxa, after the removal of most outgroups, shows at least weak support forCretazeusbeing nested deeply within the extant zeiforms; such a placement would indicate that at least six lineages of zeiforms were present during the Upper Cretaceous, and survived the Cretaceous/Tertiary (K/T) extinction to radiate in Cenozoic seas.
Molecular evidence for a fourth species within the Isotoma viridis group (Insecta, Collembola)
Authors: Burkhardt Ulrich , Filser Juliane
Published: February 2005

For identification of single species within the Isotoma viridis group, we present polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP) as a fast and efficient DNA‐based molecular method. We used five PCR primers amplifying the cytochrome oxidase II (COII) region (760 bp) of the mitochondrial DNA. The sequences clearly separated four species (I. viridis, I. riparia, I. anglicana and I. caerulea) out of samples from Norway, Sweden, Germany and Switzerland. Examination of genetic variation and phylogenetic relationship did not support the separation of two colour pattern forms of I. viridis into distinct species. For RFLP, several restriction enzymes were tested for their ability to produce not only species‐specific restriction fragment patterns but to discriminate more than one species per enzyme used with as few cleavage sites as possible. Such a design should render a clear fragment pattern when performing a double digest. These demands appear to be fulfilled best by the combination of the restriction enzymes Mfe I, Nci I and one of Aci I, Bst EII, Nde I, or Sfc I. From the enzymes tested in a previous study, Ase I proved to be reliable, whereas Mbo I can no longer be recommended.
Phylogenetics of the common raven complex (Corvus: Corvidae) and the utility of ND4, COI and intron 7 of the β‐fibrinogen gene in avian molecular systematics
Authors: Feldman Chris R. , Omland Kevin E.
Published: February 2005

The common raven (Corvus corax) is one of the most widely distributed and recognizable avian species in the world. Recent molecular work, however, described two mitochondrial lineages of the common raven, termed the Holarctic clade and the California clade, and questioned the monophyly of this taxon by placing the Chihuahuan raven (C. cryptoleucus) sister to the California clade. We evaluated this phylogenetic hypothesis with additional sequence data and increased taxon sampling. We used ∼3.7 kb of DNA sequence data from sections of the mitochondrial coding genes COI, cyt b and ND4, a fragment of the non‐coding mitochondrial DNA control region, and the entire intron 7 of the nuclear β‐fibrinogen gene (β‐fibint 7). We combined these DNA sequence data to erect hypotheses of relationships for lineages of the common raven and related taxa. Maximum parsimony, maximum likelihood, and Bayesian methods yield a paraphyletic common raven. These analyses nest the Chihuahuan raven within the common raven, with strong support for a sister relationship between the Chihuahuan raven and the California clade. In addition, the pied crow (C. albus) is also nested within the common raven, and is sister to the Holarctic clade. Our analyses reveal the challenge of determining phylogenetic relationships and species boundaries in this morphologically conservative genus, and suggest that future molecular work with increased taxon sampling will uncover cryptic species and novel evolutionary relationships. Lastly, this survey is one of a growing number of avian phylogenetic studies to employ either β‐fibint 7 or COI, and the first to use ND4. We developed a simple procedure for comparing rates of evolution in molecular markers, and show that in Corvus the nuclear intron β‐fibint 7 is evolving at a considerably slower pace than the mitochondrial markers, while COI is evolving at a slower rate than cyt b, and ND4 approximately the same rate as cyt b. Hence, β‐fibint 7 and other individual nuclear introns may have limited utility in resolving relationships among recently evolved taxa, whereas both COI and ND4 should be useful in a wide range of avian molecular genetic investigations.
Phylogenetic relationships of the globally distributed freshwater prawn genusMacrobrachium(Crustacea: Decapoda: Palaemonidae): biogeography, taxonomy and the convergent evolution of abbreviated larval development
Authors: Murphy Nicholas P. , Austin Christopher M.
Published: February 2005

There has hitherto been little research into evolutionary and taxonomic relationships amongst species of the freshwater prawn genusMacrobrachiumBate across its global distribution. Previous work by the authors demonstrated that the endemic Australian species did not evolve from a single ancestral lineage. To examine whether other regionalMacrobrachiumfaunas also reflect this pattern of multiple origins, the phylogeny of 30Macrobrachiumspecies from Asia, Central/South America and Australia was inferred from mitochondrial 16S rRNA sequences. Phylogenetic relationships demonstrate that, despite some evidence for regional diversification, Australia, Asia and South America clearly containMacrobrachiumspecies that do not share a common ancestry, suggesting that large‐scale dispersal has been a major feature of the evolutionary history of the genus. The evolution of abbreviated larval development (ALD), associated with the transition from an estuarine into a purely freshwater lifecycle, was also mapped onto the phylogeny and was shown to be a relatively homoplasious trait and not taxonomically informative. Other taxonomic issues, as well as the evolutionary origins ofMacrobrachium, are also discussed.
Jordanian baccalaureate nursing students’ perception of their learning styles
Authors: Abu‐Moghli F. A. , Khalaf I. A. , Halabi J. O. , Wardam L. A.
Published: February 2005

Aim:  The purpose of this descriptive study was to determine Jordanian nursing students’ perception of their learning styles.

Method:  All nursing students enrolled in four universities offering a baccalaureate degree in nursing at the time of the research project (n = 420) were approached. A structured self‐administered questionnaire (Autonomous Learner Index) developed by the researchers was used for data collection. The questionnaire was pilot tested on a sample of nursing students who were not included in the study. The tool was reliable with an alpha coefficient of 0.89.

Findings:  The majority of Jordanian nursing students perceived themselves as independent learners. The vast majority of students indicated that they have a desire to learn new things, are curious to learn, and can identify their goal independently. However, a low percentage of students indicated having good study skills, ability to concentrate while studying and using their study time efficiently. The two‐tailed t‐test indicated no significant differences at alpha 0.05 levels between students’ learning preferences and the selected demographic variables.

Conclusion:  Based on the study findings, it is suggested that nurse educators should provide positive reinforcement of students’ active involvement in the learning process, which will stimulate continued self‐direction. Moreover, courses on study skills, writing skills, and literature searching skills should be introduced early in nursing curricula.
Separation of conjoined twins: experiences of perioperative nurses and their recommendations
Authors: Martin‐McDonald K. , McIntyre P. , Hegney D.
Published: February 2005

Background:  Within an 8‐month period, an unprecedented and historical first in Queensland, Australia, the perioperative nurses were members of teams involved in the surgical separation of two sets of conjoined twins. Little is known about the (dis)stress that some of these perioperative nurses experienced nor how best to support them during such experiences.

Aim:  The aim of this paper is to report on the qualitiative study that explored the experiences of those perioperative nurses involved in the surgical separation of cojoined twins and from their stories propose recommendations to support perioperative nurses who are confronted with such workplace experiences.

Methods:  Using a narrative methodology, nine perioperative nurses shared their stories of being involved in the surgical separation of conjoined twins in Australia. Narrative and thematic analyses were conducted and recommendations to support perioperative nurses through workplace (dis)stress were identified. Participants validated the findings and recommendations.

Findings:  The analyses revealed the themes of professionalism, teamwork, ‘them vs. us’ and emotional loads.

Discussion:  The sensationalism around the rarity of conjoined twins brought an intensive intrusiveness from the world media. As a result, secrecy within the hospital about the conjoined twin cases created divisions between those perioperative nurses on the teams and those not. The processes and outcomes of the two surgical cases were in contrast to each other. For some perioperative nurses this caused distress. It is essential that professional support is offered in a way in which the perioperative nurse can take it up without fear of negative judgement.
An international programme in nursing and midwifery: building capacity for the new millennium
Authors: Wright S. , Cloonan P. , Leonhardy K. , Wright G.
Published: February 2005

Aim:  The global economy is changing rapidly and frequently affects the ability of the health sector to respond to a variety of needs. Nurses and midwives are reaching across national boundaries to strengthen their ability to improve the health of populations. This article describes an innovative programme of collaboration among different nations to strengthen the capacity of nurses and midwives.

Background:  Over the course of 4 years, nurses and midwives from several countries in East Central Europe, Central America, and the Caribbean came together in the United States and in Europe to learn about opportunities for growth and collaboration to improve professional development, leadership capacity, educational and curricular development, and knowledge about international health.

Conclusion:  Programme participants reported increased capacity to perform their professional roles as a result of their having participated in this programme. More capacity building activities are needed to further enable nursing professionals to meet the demands for health care around the world.
Community health development: what is it?
Authors: Huang C.‐L. , Wang H.‐H.
Published: February 2005

The Department of Health in Taiwan initiated community health development (CHD), a new approach to national community health care. Community‐based research and evaluation approaches have recently been shifting from ‘traditional’ research to ‘participatory’ research. However, there is vagueness about the theoretical foundation of CHD and the appropriateness of using participatory action research (PAR) to evaluate CHD. This article explores theoretical concepts of CHD and discusses the compatibility of PAR and CHD in the theoretical and philosophical foundations. Community health development is a developing and changing process that involves both the social and the health contexts. It operates on the basis of three approaches to care: primary care, health promotion and community development. Partnership and empowerment between community health nurses and the community are concurrently involved in the entire process of CHD practice. The fundamental tenet of PAR focuses on the development of knowledge through partnership and empowerment between the researcher and the community, and the creation of critical consciousness leading to necessary action and effective change. Unlike empirical community‐based research, PAR is flexible enough to capture an understanding of the complex social and health phenomena in the CHD framework. Furthermore, utilizing the PAR approach is appropriate not only for the methodological framework of the CHD evaluation, but also for the enhancement of the CHD actualization.
A holistic approach to the promotion of older hospital patients’ health
Authors: Berg G. V. , Hedelin B. , Sarvimäki A.
Published: February 2005

Purpose:  To describe how nurses interpreted health promotion related to older patients in a medical hospital ward and the presuppositions for this work.

Methods:  The study had a descriptive and explorative design. Data were created through participant observation of five nurses and informal dialogues with four nurses working in an infection unit in a small hospital in Norway. The nurses where followed during a period of 6 months. The observations and dialogues were interpreted and transformed into text. This text was analysed with qualitative content analysis and interpreted hermeneutically on three levels: (1) reading the text to get an overview of the themes; (2) systematically separating central patterns; and (3) highlighting the patterns with examples.

Findings:  The nurses’ interpretation of health promotion was closely connected to their interpretation of health and holistic nursing. Two main aspects were uncovered in the informal dialogues: a biomedically oriented nursing view and a holistically oriented nursing view. The observations showed that presuppositions, such as waiting for something or somebody, constantly changing situations, complexity and diversity in patient cases, influenced the nurses’ work in general and also their focus on health promotion. The nurses balanced between the biomedical and the holistic approach. It seemed to be important for the nurses to be the masters of walking on a tightrope and to have professional clinical competence.

Conclusion:  It was difficult to find a clear focus on health promotion. The most visible focus was on diagnosis and treatment, while the more complex and comprehensive situations related to health promotion of older patients seemed to be underprioritized. The phenomenon of ‘waiting’ may be an important issue for further research.
Patients with moderate chemotherapy‐induced mucositis: pain therapy using low intensity lasers
Authors: Nes A. G. , Posso M. B. S.
Published: February 2005

Background:  Intensive cancer therapy normally affects malignant and normal cells with high replication rates. Cells in the gastrointestinal tract are therefore commonly affected by cytotoxins. This often results in the development of chemotherapy‐induced oral mucositis (COM). COM is the inflammatory response of the oral mucous membrane to the chemotherapy drugs. Low level laser therapy (LLLT) has proved to be effective in treating and repairing biologically damaged tissue and to reduce pain. LLLT has also proven to be an efficient method for the prevention of oral mucositis.

Objective:  To investigate the effect of LLLT on pain relief among patients who have developed COM.

Method:  The study was performed as a clinical test with a sample consisting of 13 adult patients receiving oncology treatment. The patients were treated during a 5‐day period, and the pain was measured before and after each laser application. The laser used was an AsGaAl, with a wavelength of 830 nm and a potency of 250 mW. The energy given was 35 J cm−2.

Analysis:  The results were analysed using the Wilcoxon test.

Results:  There was a significant (P = 0.007) 67% decrease in the daily average experience of pain felt before and after each treatment, confirming that LLLT can relieve pain among patients who have developed COM.

Study limitations:  The low number of COM patients at the hospital did not allow a control group to be included in the study, and therefore the results contain a potential placebo effect.

Implications for nursing care:  The most important benefit the authors consider to be the value for the patients of better and quicker treatment with a drastic reduction in painful mucositis.
Value Chain Envy: Explaining New Entry and Vertical Integration in Popular Music*
Authors: Mol Joeri M. , Wijnberg Nachoem M. , Carroll Charles
Published: February 2005

abstract The concepts of value creation, value capture, and value protection are employed to explain new entry and vertical integration. It is posited that if, at one stage of the value system, the share of value captured is disproportionally higher than the share of value created, value chain envy will ensue. This value chain envy will result in new entry and vertical integration towards that desirable stage provided that the means of value protection available to the incumbents can be overcome. Within the popular music industries, the value created at the stage of music publishing has diminished steadily over the course of the 20th century, but the value captured has remained high. This has triggered value chain envy both inside and outside of the value system. The data presented in this paper show high levels of vertical integration into that stage originating primarily from the stages upstream in the value system, while the level of new entry has been comparatively low. At the same time, the data indicate that the recent introduction of new information communication technologies (ICT) have not significantly affected the levels of new entry and vertical integration into music publishing.
Unpacking Commitment: Multiple Loyalties and Employee Behaviour*
Authors: Redman Tom , Snape Ed
Published: February 2005

abstract  We present findings from three UK studies on the nature and consequences of employees’ multiple commitments in the workplace, with samples drawn from private manufacturing, private services and the public sector. Co‐workers, the union, the union representative, customers, and the immediate boss emerge as separate foci of commitment, distinct from ‘global’ commitment to the organization as a whole. Consistent with social exchange theory, attitudinal and behavioural outcomes are predicted by commitment to those foci that might be expected to benefit from the outcome in question. There is evidence that global organizational commitment mediates the relationship between foci‐specific commitments and organization‐related outcomes, but there is no mediation in the case of those foci and outcomes that are more cognitively distant from the organization. A comparison of the studies suggests that the pattern and outcomes of commitment are influenced by the nature of the job and of the work context.
The Impact of Organizational Culture and Reshaping Capabilities on Change Implementation Success: The Mediating Role of Readiness for Change
Authors: Jones Renae A. , Jimmieson Nerina L. , Griffiths Andrew
Published: February 2005

abstract  It was hypothesized that employees’ perceptions of an organizational culture strong in human relations values and open systems values would be associated with heightened levels of readiness for change which, in turn, would be predictive of change implementation success. Similarly, it was predicted that reshaping capabilities would lead to change implementation success, via its effects on employees’ perceptions of readiness for change. Using a temporal research design, these propositions were tested for 67 employees working in a state government department who were about to undergo the implementation of a new end‐user computing system in their workplace. Change implementation success was operationalized as user satisfaction and system usage. There was evidence to suggest that employees who perceived strong human relations values in their division at Time 1 reported higher levels of readiness for change at pre‐implementation which, in turn, predicted system usage at Time 2. In addition, readiness for change mediated the relationship between reshaping capabilities and system usage. Analyses also revealed that pre‐implementation levels of readiness for change exerted a positive main effect on employees’ satisfaction with the system's accuracy, user friendliness, and formatting functions at post‐implementation. These findings are discussed in terms of their theoretical contribution to the readiness for change literature, and in relation to the practical importance of developing positive change attitudes among employees if change initiatives are to be successful.
Anti‐Discrimination Rights Without Equality
Authors: Holmes Elisa
Published: February 2005

Anti‐discrimination rights are nearly always thought to be justified or explained by equality, although the precise nature of this relationship is rarely considered. In this article I consider the two most plausible relationships, both of which are commonly at least implicitly asserted: that anti‐discrimination rights are deontic equal treatment norms, and that anti‐discrimination rights are instrumentally aimed at achieving telic equality. I try to show that, as a conceptual matter, anti‐discrimination rights are not equal treatment norms: they do not require that all people (perhaps in a certain category) are treated the same. They allow for different treatment, but they prohibit different treatment only on some grounds. Although the suggestion that anti‐discrimination rights are instrumentally aimed at telic equality (in some dimension) is conceptually plausible (like all instrumental relationships), it is most unlikely that anti‐discrimination rights can be justified on this ground.
Against Lumley v Gye
Authors: Howarth David
Published: February 2005

The Lumley v Gye tort of inducing a breach of contract is the foundation of strike law, although it also has a wider commercial role. We should reject the view that Lumley liability follows automatically from general contractual liability. Contract law is optional. Imposing its obligations on unwilling parties requires special justification. We should also be sceptical about the claim that Lumley liability increases confidence that contracts will be enforced. Such scepticism should be enhanced by parallels between Lumley liability and restitutionary damages for breach of contract. Some Lumley cases illustrate the point that ‘efficient breach of contract’ has a moral core, not just an economic core. For example, it can sometimes be unreasonable and unjust for parties to insist on precise contractual performance when they know that circumstances have changed in ways that the contract did not anticipate. For all these reasons the justification defence to Lumley should be widened.
The Law Commission Consultative Report on Company Security Interests: An Irreverent Riposte
Authors: McCormack Gerard
Published: February 2005

I was once at a sermon by a well‐known Northern Ireland politician and minister of religion in which, talking about the fall from grace of a British minister following a sex scandal, he commented that while the will of God worked slowly it also worked surely. Be that as it may, one might comment that the process of law reform, whatever about working surely, can certainly work slowly. Back in July 2002 the Law Commission produced with some haste a consultation paper on Registration of Security Interests.1 There was a bit of a fanfare, a short consultation period and talk of imminent legislative change. Things went quiet for a while. More than 2 years later the Law Commission came back in September 2004 with a further consultation paper only this time called a “consultative report”2 with the promise of a Final Report in July 2005. In this article I will look at the consultative report and ask whether it is going to be the harbinger of legislative transformation.
On the Regenerative Capacity of Human Skeletal Muscle
Authors: Wernig Anton , Schäfer Ralf , Knauf Ulrich , Mundegar Rustam R. , Zweyer M , Högemeier Oliver , Martens Uwe M. , Zimmermann Stefan
Published: February 2005

Abstract:  The proliferative capacity of organotypic muscle stem cells, the satellite cells, from nine healthy human donors aged between 2 and 78 years was investigated. There was a loss in proliferative capacity with age, but the oldest donors (76, 78 years) would still be able to replace their musculature several times. Depending on frequency of desmin‐positive (i.e., myogenic) cells during prolonged expansion, myoblast cultures could be designated as stable or unstable. There was a weak correlation between mean telomere lengths (estimated by flow‐FISH) and remaining mean population doublings until senescence. A bimodal distribution  of  mean  telomere  lengths  was  apparent  in both stable and unstable myoblast cultures and could be assigned to populations of differently sized cells. Furthermore, due to the presence of nonmyogenic cells with  longer  telomeres,  unstable  cultures  tended  to  show an  increasing  rather  than  decreasing  mean  telomeric length on expansion. Bimodal distributions in myoblast cultures could be due to hitherto undefined myoblast populations.
Functional Electrical Stimulation of Denervated Muscles: Basic Issues
Authors: Salmons Stanley , Ashley Zoe , Sutherland Hazel , Russold Michael F. , Li Feng , Jarvis Jonathan C.
Published: February 2005

Abstract:  Denervating injuries result in flaccid paralysis and severe atrophy of the affected muscles. This work reviews the potential for functional restoration of such muscles by electrical stimulation, focusing on the basic scientific  issues.
Electrical Stimulation of Denervated Muscles: First Results of a Clinical Study
Authors: Mödlin Michaela , Forstner Claudia , Hofer Christian , Mayr Winfried , Richter Wolfgang , Carraro Ugo , Protasi Feliciano , Kern Helmut
Published: February 2005

Abstract:  To evaluate the effects of electrical stimulation on denervated muscles in spinal cord injured humans, the EU Project RISE was started in 2001. The aims of this project are: to design and build sufficient stimulators; to develop stimulation protocols by means of mathematical models, animal experiments, and practice in humans with denervated lower limbs; to develop examination methods and devices for evaluation of electrical stimulation training effects; and to acquire basic scientific knowledge on denervated and stimulated denervated muscle. In the clinical study 27 spinal cord injured individuals were included, furthermore 13 pilot patients participated. After a series of initial examinations they underwent an electrical stimulation program for their denervated lower limb muscles. Some of the patients have already follow up examinations. A marked increase of muscle mass and quality was observed, the trophic situation of the denervated lower limbs  had  improved  obviously.
Determination of the Chronaxie and Rheobase of Denervated Limb Muscles in Conscious Rabbits
Authors: Ashley Zoe , Sutherland Hazel , Lanmuller Hermann , Unger Ewald , Li Feng , Mayr Winfried , Kern Helmut , Jarvis Jonathan C. , Salmons Stanley
Published: February 2005

Abstract:  Measurements of the rheobase and chronaxie can be used to define the excitability of nerves and muscles. The aim of this study was to obtain a record over many weeks of changes in the rheobase and chronaxie of denervated rabbit tibialis anterior muscle (TA). A custom‐built electronic stimulator was implanted into the peritoneal cavity of New Zealand White rabbits. Large stainless steel electrodes were placed on the denervated TA muscle. Rheobase and chronaxie were measured noninvasively at weekly intervals by means of a laptop PC, which communicated with the stimulator via a radio‐frequency link. At each setting the denervated TA was palpated manually to detect the response of the muscle. During the first few days after denervation the rheobase increased transiently to 0.8 ± 0.13 mA, approximately twice the value for normal innervated muscle, then decreased to normal for the remainder of the experimental period. Chronaxie underwent a significant 3‐fold increase from 4.5 ± 1.1 ms to 14.1 ± 1.1 ms during the first two weeks of denervation and remained elevated throughout. The custom‐built implantable electronic stimulator allowed changes in muscle excitability to be studied over a long period of denervation within individual animals, providing an accurate assessment  of the time course of denervation‐induced changes in  muscle  excitability.
Motor Control in the Human Spinal Cord
Authors: Dimitrijevic Milan R , Persy Ilse , Forstner Claudia , Kern Helmut , Dimitrijevic Meta M
Published: February 2005

Abstract:  Features of the human spinal cord motor control are described using two spinal cord injury models: (i) the spinal cord completely separated from brain motor structures by accidental injury; (ii) the spinal cord receiving reduced and altered supraspinal input due to an incomplete lesion. Systematic studies using surface electrode polyelectromyography were carried out to assess skeletal muscle reflex responses to single and repetitve stimulation in a large number of subjects. In complete spinal cord injured subjects the functional integrity of three different neuronal circuits below the lesion level is demonstrated: first, simple mono‐ and oligosynaptic reflex arcs and polysynaptic pathways; second, propriospinal interneuron system with their cell in the gray matter and the axons in the white matter of the spinal cord conducting activity between different spinal cord segments; and third, internuncial gray matter neurons with short axons and dense neuron contact within the spinal gray matter. All of these three systems participate continuously in the generation of spinal cord reflex output activating muscles. The integration of these systems and their relative degree of excitation and set‐up produces characteristic functions of motor control. In incomplete spinal cord injured patients, the implementation of brain motor control depends on the profile of residual brain descending input and its integration with the functional neuronal circuits below the lesion. Locomotor patterns result from the establishment of a new structural relationship between brain and spinal cord. The functions of this new structural relationship are expressed as an alternative, but characteristic and consistent neurocontrol. The more we know about how the brain governs spinal cord networks, the better we can describe human motor control. On the other hand such knowledge is essential for the restoration of residual functions and for the construction of new cord circuitry to expand the functions of the injured spinal cord.
Overcoming Abnormal Joint Torque Patterns in Paretic Upper Extremities Using Triceps Stimulation
Authors: Keller Thierry , Ellis Michael D. , Dewald Julius P.A.
Published: February 2005

Abstract:  The goal of this research project was to quantitatively assess whether transcutaneous triceps stimulation can overcome the expression of abnormal torque patterns in the paretic upper limb of subjects with hemiparetic stroke. Abnormal torque patterns consist of strong coupling between shoulder abduction (SAB) and elbow flexion (EF) or between elbow extension (EE) and shoulder adduction (SAD) torques. Both patterns reduce the active range of motion during arm movements. Eight chronic stroke subjects with moderate to severe (Fugl‐Meyer assessment scores of 21/66–36/66) upper limb motor impairment participated in this study. Shoulder and elbow joint torques were measured with a 6‐degrees‐of‐freedom load cell under isometric conditions, while the triceps muscle was stimulated to generate EE torques. At the same time the subjects were asked to lift up their arm to generate different SAB torque levels. The obtained isometric results showed that electrical stimulation can overcome abnormal torque patterns in chronic stroke subjects while generating SAB. This is likely to have potential benefits to increase the  reaching  workspace  of  the  paretic  arm.