bluuebunny/crossref_metadata_2025 huggingface dataset:
Occupational health and school health: a natural alliance?
Authors: Croghan Emma , Johnson Carol
Published: December 2004

Background.  The United Kingdom National Health Service aims to provide a holistic ‘cradle to grave’ service. In order to achieve this, systems are in place for effective communication between providers of services for babies and children. However, when children leave school, communication between the school health services and workplace health services to protect and promote the health of the new workforce is rare. Working together is a commonly‐stated rhetoric of contemporary nursing theory, but often this is not applied in practice. School health and occupational health have similar aims and objectives and, by working together, may be able to improve the health of large populations for a lifetime.

Aim.  This paper aims to examine the similarities in principles and practices between school health and occupational health nurses, and to identify areas of overlap in which collaboration could improve care for clients of both services.

Discussion.  The paper examines the nature of nursing in occupational and school settings, and similarities and differences in policy, law and principles. It also examines these two areas of practice within a public health framework, looking for areas of overlap. A basis is suggested for collaborative working between the two areas, and barriers, facilitators and benefits of this practice are examined.

Conclusion.  We conclude that there does exist a natural alliance between occupational and school health nursing, and that the two should work together to provide continuity of care for clients on leaving school, and to prepare children and young people for the workplace and any special health issues in their chosen careers.
Barriers to evidence‐based practice in primary care
Authors: McKenna Hugh P. , Ashton Sue , Keeney Sinead
Published: December 2004

Background.  Evidence‐based practice is one of the most important underlying principles in modern health care. In the United Kingdom, successive governments have highlighted the fact that a quality health service is built upon the use of best evidence. Health professionals are becoming more accountable within clinical governance structures for the care they provide. The need to use robust research findings effectively is a critical component of their role. However, studies show that a number of barriers prevent the effective use of best available evidence.

Aim.  This study aimed to identify barriers to evidence‐based practice in primary care.

Method.  A specially designed questionnaire was used to gather respondents’ perceptions of the barriers to evidence‐based practice. Data were collected in 2000/2001.

Findings.  Findings show that general practitioners (GPs) ranked barriers differently to community nurses. GPs believed that the most significant barriers to using evidence in practice were: the limited relevance of research to practice, keeping up with all the current changes in primary care, and the ability to search for evidence‐based information. In contrast, the most significant barriers to the identified by community nurses were poor computer facilities, poor patient compliance and difficulties in influencing changes within primary care. This suggests that these two groups may require different strategies for barrier removal.

Conclusions.  Identifying barriers is just the first step to addressing issues surrounding the use of evidence‐based practice. Extra resources will be needed if these barriers are to be tackled. However, if the resultant change improves the health and wellbeing of people and communities, then the extra costs would be offset by more efficient use of services.
Assessment of malnutrition in mental health clients: nurses’ judgement vs. a nutrition risk tool
Authors: Abayomi Julie , Hackett Allan
Published: December 2004

Background.  The existence of malnutrition in general hospitals is well documented. Psychiatric patients are known to have increased risk of malnutrition, yet physical examinations and nutritional assessments rarely take place in psychiatric hospitals.

Aim.  The purpose of this study was to adapt an established nutrition risk score for use with psychiatric patients, using criteria previously agreed by the care team, and to assess whether the clinical judgement of ward staff alone identified a similar group of patients to be at risk.

Method.  The risk score assessment was compared with a subjective risk assessment made by nursing staff as patients were admitted to the unit. Data were collected for 112 patients.

Results.  The comparison revealed that nurses did not identify malnutrition in the same patients as the risk score, overlooking 27 (29%) at risk patients. Nurses associated malnutrition with psychotic illness, suggesting that depressed patients are more likely to be overlooked.

Study limitations.  Although the risk score was based on a validated tool and its content and face validity were established, it has not itself been validated against criteria of nutritional status (malnutrition).

Conclusions.  Implementing routine nutritional screening on such units would assist in identifying at risk patients, enabling referral for dietetic intervention to be made. Providing nutrition education for staff might help to improve knowledge and awareness of malnutrition for this patient group.
Benefits and challenges of nurse prescribing
Authors: While Alison E. , Biggs Kathryn S.M.
Published: December 2004

Background.  Since 1999, all health visitors and district nurses in the United Kingdom (UK) have received additional education to permit their registration as independent prescribers from a limited list of medicinal products. Little research has investigated how more than 20 000 health visitor and district nurse prescribers have implemented their new role since the evaluation of the pilot sites.

Aims.  The aims of the study were to describe prescribing practices of healthvisitors and district nurses, the factors (contextual and professional) which enable and facilitate nurse prescribing, and views about the Nurse Prescribers’ Formulary.

Method.  A mail survey was conducted of all health visitors and district nurses working in three trusts in southern England. A 74% response rate was achieved (n = 91).

Findings.  Most respondents prescribed less than three times a week, with district nurses prescribing significantly more than health visitors (P ≤ 0·001). Over two‐thirds of the sample found nurse prescribing at least moderately helpful to their professional role and over four‐fifths reported that they were more than moderately confident nurse prescribers. A range of information sources was identified as helpful, regarding both new products and for continuing educational needs. Over two‐thirds reported that the current Nurse Prescribers’ Formulary did not cover their prescribing needs, and a number of factors were identified as hindering prescribing. Most respondents said that their general practitioner/primary care team was at least moderately supportive of their prescribing role.

Limitations.  The survey was conducted in three primary care trusts in southern England, which may be unrepresentative of trusts elsewhere in UK.

Conclusions.  The level of reported prescribing by health visitors and district nurses in this study indicates that they are not acting as substitute prescribers for general practitioners of the products in the limited formulary. Implementation of a major role change such as nurse prescribing requires a number of conditions, including adequate education/preparation, a formulary that meets practitioners’ needs, and acceptance by the practitioners themselves.
Involvement of the L‐arginine/nitric oxide neural pathway in non‐adrenergic, non‐cholinergic relaxation of the bovine oesophageal groove
Authors: Barahona M. V. , Sánchez‐Fortún S. , San Andrés M. D. , Ballesteros E. , Contreras J. , San Andrés M.
Published: December 2004

The distribution and localization of nitric oxide synthase (NOS) immunoreactivity and nicotinamide adenine dinucleotide phosphate diaphorase (NADPH‐d) activity in the bovine oesophageal groove were investigated by immnunohistochemical and histochemical staining techniques. Functional in vitro studies were performed to correlate the presence of NOS‐ immunoreactivity (IR) and NADPH‐d staining with smooth muscle relaxations involving the L‐arginine/nitric oxide neural pathway in the bovine oesophageal groove activity.

NOS‐IR and NADPH‐d were expressed in nerve cell bodies of the myenteric, submucosal and intramuscular ganglia, and in nerve fibres distributed around blood vessels and throughout the different muscular layers of the bovine oesophageal groove.

In oesophageal groove strips treated with guanethidine (10−5 M) and atropine (10−7 M) to block noradrenergic neurotransmission and muscarinic receptors, respectively, electrical field stimulation (EFS, 0.5–32 Hz, 1 ms duration, 20‐s trains) induced relaxations which were practically abolished by tetrodotoxin (TTX, 10−6 M).

Incubation with an inhibitor of nitric oxide synthesis, NG‐nitro‐L‐arginine (L‐NOARG, 3 × 10−5 M), significantly inhibited relaxations induced by EFS. This inhibition was partially reversed by L‐arginine (L‐arg, 5 × 10−3 M). D‐NOARG (3 × 10−5 M) had no effect on EFS‐induced relaxations.

NO added as an acidified solution of NaNO2 (10−6–10−3 M) and S‐nitroso‐L‐cysteine (10−7–10−4 M) caused concentration‐dependent relaxations of the bovine oesophageal groove. These relaxations were unaffected by L‐NOARG (3 × 10−5 M).

The presence of NO‐synthesizing enzyme in nerves and ganglia, and the pharmacological evidence for NO‐mediated smooth muscle relaxation suggested that the L‐arg/NO neuronal pathway is involved in the inhibitory neurotransmission of the bovine oesophageal groove.
The role of MAO‐A and MAO‐B in the metabolic degradation of noradrenaline in human arteries
Authors: Figueiredo I. V. , Caramona M. , Paiva M. Q. , Guimarães S.
Published: December 2004

Segements of human cystic, gastric and ileocolic arteries were obtained from patients undergoing surgery.

Segments of arterial tissues, the noradrenaline content of which ranged between 0.27 and 0.52 μg g−1, were incubated with 0.1 μmol l−1 [3H]‐noradrenaline for 30 min and the accumulation of the amine as well as the formation of metabolites was measured.

In all the arteries, oxidative deamination predominated over O‐methylation; the mean values of the deaminated and O‐methlated metabolites formed for the three arteries were 247.6 and 82.4 pmol g−1 tissue, respectively. Dihydroxymandelic acid (DOMA) was the most abundant metabolite.

Both clorgyline (a selective MAO‐A inhibitor) and selegiline (a selective MAO‐B inhibitor) reduced the formation of dihydroxyphenylglycol (DOPEG), DOMA and O‐methylated‐deaminated metabolites (OMDA), and increased that of normetanephrine (NMN). However, clorgyline depressed the formation of DOPEG more than that of DOMA, while selegiline depressed the formation of DOMA more than that of DOPEG.

In conclusion, three major differences distinguish the metabolism of noradrenaline by human arteries from that observed in other species: (1) the large predominance of deamination over O‐methylation; (2) the extremely high formation of DOMA; and (3) the relative lack of selectivity of clorgyline and selegiline for MAO‐A and B, respectively. Since the arterial vessels used were collected from patients older than 60 years, the morphological changes depending on age may explain the increase in DOMA formation.
Electromechanical coupling in human vas deferens: effects of agents that modulate intracellular release of calcium
Authors: Amobi N. I. B. , Smith I. C. H.
Published: December 2004

The effects of ryanodine, cyclopiazonic acid (CPA) and caffeine on electromechanical coupling in human vas deferens were investigated.

High [K+]o (120 mM) evoked nifedipine‐sensitive contractions of longitudinal and circular muscle which consisted of initial and secondary components.

Exposures to ryanodine (≤10 μM) or CPA (≤ 3 μM) induced a change of basal tension, and higher doses (30 μM) induced intermittent rhythmic contractions of both muscle types in the quiescent tissue. In the presence of the drugs, contraction to high [K+]o was preceded by marked rhythmic activity.

In circular muscle, ryanodine (1–30 μM) or CPA (1–30 μM) reduced both components of contractions to high [K+]o. In longitudinal muscle, the drugs enhanced the initial component and prolonged the secondary component. High doses (≥ 10 μM) produced variable effects on the initial component.

Caffeine (20 mM) reliably contracted longitudinal, but not circular muscle. Pre‐exposures to caffeine enhanced both components in the post‐caffeine contractions of circular muscle to high [K+]o. In longitudinal muscle, only the initial component (post‐caffeine) was enhanced.

Contractions evoked in longitudinal muscle by caffeine were not blocked by ryanodine (30 μM) or CPA (30 μM). However, the enhancement of post‐caffeine contractions to high [K+]o was inhibited.

These results show that ryanodine and CPA produced comparable effects on the excitability of longitudinal and circular muscle in the quiescent tissue, but electromechanical coupling was affected differently. The findings suggest that the muscle types utilize different mechanisms to regulate elevations in cytosolic Ca2+ during stimulation.

Electromechanical coupling in both muscle types involves Ca2+ influx via nifedipine‐sensitive voltage‐operated calcium channels and activation of ryanodine‐sensitive calcium‐induced calcium release from the sacroplasmic reticulum (SR). In longitudinal muscle, the SR also buffers increases in cytosolic Ca2+ via a pharmacologically distinct Ca2+ compartment (caffeine releasable but ryanodine/CPA‐insensitive). In circular muscle, the SR (ryanodine/CPA‐sensitive) serves mainly in the regulation of excitability of the quiescent tissue.
Enhanced bradycardia induced by β‐adrenoceptor antagonists in rats pretreated with isoniazid
Authors: Vidrio H. , Sánchez‐Salvatori M. A. , Medina M.
Published: December 2004

High doses of isoniazid increase hypotension induced by vasodilators and change the accompanying reflex tachycardia to bradycardia, an interaction attributed to decreased synthesis of brain γ‐aminobutyric acid (GABA). In the present study, the possible enhancement by isoniazid of bradycardia induced by β‐adrenoceptor antagonists was determined in rats anaesthetised with chloralose‐urethane.

Isoniazid significantly increased bradycardia after propranolol, pindolol, labetalol and atenolol, as well as after clonidine, but not after hexamethonium or carbachol.

Enhancement was not observed in rats pretreated with methylatropine or previously vagotomised.

These results are compatible with interference by isoniazid with GABAergic inhibition of cardiac parasympathetic tone. Such interference could be exerted centrally, possibly at the nucleus ambiguus, or peripherally at the sinus node.
Cardiac rehabilitation: the importance of patient expectations – a practitioner survey
Authors: Lau‐Walker Margaret
Published: December 2004

Background.  Numerous cardiac rehabilitation national guidelines consistently endorse the need for psychological support to create effective individualized care. Recent surveys suggest that the psychological factors remain poorly assessed and the measurement of psychological parameters remains patchy.

Aim.  To examine cardiac rehabilitation practitioners’ perception and understanding of the importance of patient expectations and their capacity to assess and utilize these expectations to develop individualized care.

Methods.  A survey of cardiac rehabilitation professionals from 10 hospitals in the south‐east of England. The questionnaire used in the survey was developed from content analyses of the current cardiac rehabilitation literature and expectancy theory articulated in Bandura's writings.

Results.  The results of the study show that cardiac rehabilitation practitioners are very aware of the general importance of patient expectations but have little structured support in the development of techniques to either assess these expectations or to utilize them in a therapeutic context. This leaves them unsure about the extent to which patients do receive individualized care and how best to develop their own practice in this regard.

Relevance to clinical practice.  This study suggests that there is a need for the development of a structured assessment tool, which has a sound theoretical basis to assess patients’ expectation if good practice is to be established in providing individualized car in cardiac rehabilitation.
Day surgery: patients’ perceptions of a nurse‐led preadmission clinic
Authors: Gilmartin Jo
Published: December 2004

Background.  Previous research studies have demonstrated that nursing intervention is often lacking in the provision of adequate information and psychological support, and fails to meet the holistic needs of patients in the preassessment for day surgery.

Aim.  The aim of this study was to elicit patients’ perceptions of the preassessment preparation they received prior to day surgery.

Method.  A hermeneutic phenomenological research approach was utilized to elucidate the participants’ experiences of the preassessment process and to collect data. Qualitative data were collected using face‐to‐face interviews and analysed thematically following procedures expounded by Colaizzi and van Manen.

Sample.  The sample included 30 patients undergoing day surgery in a large teaching hospital in the north of England. The day unit built for this purpose consisted of a preassessment unit, a seated preoperative area, three theatres, a six space first stage recovery area, a 24 space second stage recovery area and a separate seated recovery area. The patient groups focused on individuals scheduled for general surgery, gynaecology and urology procedures.

Results.  Findings suggest that the nurse‐led clinic appeared to function effectively; most patients felt they were adequately assessed and prepared for day surgery. The majority reported receiving comprehensive information about procedures, appreciated health education interventions and had opportunity to ask questions. A few patients pointed to deficits in information giving, indicating that their individual needs were not met, leaving them feeling anxious. Others alluded to problems associated with unexpected cancellation of procedures, which threw them into states of disequilibrium.

Relevance for clinical practice.  The findings indicate that information giving, psychological support and person‐centred care could be strengthened in the preassessment preparation of patients undergoing day surgery.
Substance abuse: prevalence in a sample of nursing students
Authors: Ahmadi Jamshid , Maharlooy Najmeh , Alishahi Mohammadjavad
Published: December 2004

Aims.  The aim of this research was to evalvate the prevalence of substance abuse in a sample of Iranian nursing students.

Design and measurements.  Four hundred nursing students (85.25% were females and 14.25% were male) were assessed by a confidential questionnaire based on DSM‐IV, which was distributed, completed by the students and collected in the same session.

Findings.  Mean age of the females was 20.3 and of males was 22.8. Of the subjects, 27.3% (21.4% of females and 61% of males) reported usage of substance(s) once or more sometime during their lives: cigarette (25.3%), alcohol (5.8%), opium (8.5%), cocaine (1.5%), hashish (1.5%), marijuana (0.8%) and morphine (0.5%). Only 3.8% of the participants (1.8% of females and 15.3% of males) reported still using substances: cigarettes (3.3%), alcohol (1.7%), opium (0.8%), cocaine (0.5%) and marijuana (0.3%). About 11.8% of the subjects (10% of females and 22% of males) reported using of substances occasionally (at least once a month): cigarette (10.8%), alcohol (3.5%), opium (4.3%), cocaine (0.5%) and hashish (0.3%). Some used or were using more than one substance.

Conclusions.  Substance use was significantly related to sex: higher among males than females. Tobacco and opium were found to be the most prevalent form of substance use among students. Pleasurable purposes, habit, need (to avoid withdrawal symptoms) and tension were the major reasons for substance use. There was no report of psychedelics use. These results are, however, different from those studies carried out in the west, although there is some overlap. Cultural attitudes toward substance use quite likely affect the types and patterns of use. These findings can be considered when planning preventive and therapeutic programmes.

Relevance to clinical practice.  Substance use can reduce scientific progress and academic achievement of nursing students; therefore, authorities of the university must be able to assess the extent of the problem, understand the contributing factors, recognize signs and symptoms, and use educational interventions in identifying and preventing substance dependency.
Coronary heart disease: causes and drug treatment – spouses’ conceptions
Authors: Kärner Anita , Dahlgren Madeleine Abrandt , Bergdahl Björn
Published: December 2004

Background.  Spouses are important in the rehabilitation process of their partner after coronary heart disease event. Their knowledge and attitudes have an impact on their support to the partner concerning lifestyle changes and drug treatment after an event.

Aims and objectives.  To explore spouses’ conceptions concerning causes of coronary heart disease and drug treatment 1 year after the partner's cardiac event.

Design.  Qualitative with an empirical and inductive approach.

Methods.  Semi‐structured interviews with strategically selected spouses (17 women and eight men) were taped. The transcripts were analysed within the phenomenographic framework.

Results.  Spouses’ conceptions about causes of coronary heart disease and its treatment consisted of correct facts, as judged on a lay level, less elaborated conceptions and misconceptions. Among causes of coronary heart disease, the spouses were most knowledgeable about fat intake. They knew less about contributions from inactivity, stress and smoking. Ambivalent feelings were expressed about benefits vs. side effects of drugs. The treatment was conceived as necessary for the heart, but harmful for other organs. Men and women were evenly distributed in most of the derived categories. More women than men considered stress as a cause of coronary heart disease and also misconceived physical exercise to cause the disease.

Conclusion.  A variation of spouses’ conceptions was revealed about causes of coronary heart disease and drug treatment. There was a lack of understanding concerning important parts of cardiac rehabilitation activities. These misconceptions may have implications by influencing their partner's co‐operative behaviour.

Relevance to clinical practice.  Spouses’ pre‐existing conceptions of coronary heart disease and its treatment should be considered in the rehabilitation process of their partner. Couples with misconceptions should be given the opportunity to increase qualitatively their knowledge starting from their point of view rather than from that of the professional perspective.
Rheumatology: the expectations and preferences of patients for their follow‐up monitoring care: a qualitative study to determine the dimensions of patient satisfaction
Authors: Arthur Valerie , Clifford Collette
Published: December 2004

Background.  Patient satisfaction has rarely been defined. It is a multi‐dimensional concept and relates to expectations and preferences for care. This paper reports the findings of a study to determine the expectations and preferences of rheumatology patients for their follow‐up monitoring care.

Aims and objectives.  To identify the dimensions of satisfaction important to rheumatology patients in the provision of their care in two locations; primary and secondary. The objectives were to determine the expectations and preferences of this group and to gather data to inform a larger study of patient satisfaction.

Design. ensp; This small qualitative study used semi‐structured interviews with a convenient sample of 10 patients; five from each location.

Methods.  Interviews were recorded and transcribed. Qualitative data analysis revealed a framework and conceptual categories.

Results.  Empathy, specialism, information provision, technical aspects, time, and continuity of care were identified as being important in the provision of care for this group of patients.

Conclusions.  These categories had already been found in a validated questionnaire and justified the use of this tool in the larger comparative study.

Relevance to clinical practice.  Patient satisfaction cannot be accurately assessed unless important categories of care are identified and used in the measurement tool.
Temporal and spatial distribution of paramoebae in the water column – a pilot study
Authors: Douglas‐Helders G M , O'Brien D P , McCorkell B E , Zilberg D , Gross A , Carson J , Nowak B F
Published: December 2004

Amoebic gill disease is the main disease affecting the salmonid industry in Tasmania, but no information on the distribution of the causative pathogen, Neoparamoeba pemaquidensis, in the aquatic environment is available. This pilot study aimed to determine temporal and spatial distributions of paramoebae species in the water column, using an immuno‐dot blot technique. Water samples were collected from inside fish cages at various depths (0.5, 5.5 and 11.0 m) in both summer and winter, as well as various distances (0, 0.5, 240, 280, 750 and 1100 m) away from the sea cage and farming site. Paramoebae densities were estimated using the most probable number technique (MPN). Temperature, salinity, dissolved oxygen, turbidity, nitrite and nitrates, and bacterial counts were measured for each water sample. Data were analysed using a residual maximum likelihood test and significant associations between paramoebae densities and environmental factors were analysed. Results showed that densities were significantly higher in summer (P = 0.017), at 5.5 m depth (P = 0.029), and reduced to the lowest density at 1100 m away from the cage sites (P = 0.008). Bacterial counts, turbidity and temperature were found to be significantly associated with paramoebae densities.
Zoon's balanitis: presentation of 15 patients, five treated with a carbon dioxide laser
Authors: Retamar Roberto Adrián , Kien M. C. , Chouela E. N.
Published: December 2004

Background Zoon's balanitis is a chronic erosive process of the penis. The lesions are refractory to conservative topical and some surgical therapy, and frequently require circumcision as a curative measure.

Methods Fifteen patients with a clinical and histopathologic diagnosis of Zoon's balanitis were studied between October 1991 and October 2001. Five were treated with a carbon dioxide laser.

Results The ages of the patients ranged from 36 to 69 years (average, 50.8 years). All the men were uncircumcised and presented with a discharge and erythematous lesions on the glans penis; the balanopreputial fold was affected in 10 patients and eight had a lesion on the internal surface of the prepuce. One patient was human immunodeficiency virus positive. Five were treated with a carbon dioxide laser. Two relapsed 1 and 3 years later, respectively, and the remaining three have been followed up for 2, 5, and 6 years, respectively, without relapse. One patient developed lichen sclerosus et atrophicus of the prepuce.

Conclusions We have presented our case study of 15 patients with Zoon's balanitis, and emphasize the possible use of a carbon dioxide laser as an alternative therapy.
A seroepidemiologic survey of the prevalence of varicella‐zoster virus in the pediatric population in two university hospitals in Brazil
Authors: Semenovitch Ivan , Lupi Omar
Published: December 2004

Background  Varicella‐zoster virus (VZV) is an alpha‐herpesvirus causing varicella (chickenpox) and herpes zoster (shingles). Varicella results from primary VZV infection, and is a common childhood illness associated with fever and a generalized, pruritic, vesicular eruption. Herpes zoster is caused by VZV reactivation later in life (most cases after the fifth decade), and is characterized by a localized, painful, and vesicular eruption involving one or adjacent dermatomes. The incidence of herpes zoster increases with age and immunosuppression.

Objective  To estimate the seroprevalence of VZV in the Brazilian pediatric population by evaluating the prevalence of specific antibodies to VZV in children from two university hospitals in the state of Rio de Janeiro.

Methods  A population composed of 160 children derived from two university hospitals in the state of Rio de Janeiro was included in the study. All patients completed a questionnaire regarding their socio‐epidemiologic characteristics, and a complete physical examination was performed. All blood samples were screened using a commercial enzyme‐linked fluorescent assay (ELFA) kit, specific for the detection of immunoglobulin G (IgG) antibodies to VZV.

Results  The seroprevalence of VZV was 58.1% in the overall population, with a statistically significant correlation between seroprevalence and increasing age (P < 0.0001). A previous history of measles infection (P < 0.04), previous history of varicella infection (P < 0.0001), and the presence of skin lesions (P < 0.05) were significantly associated with seropositivity to VZV.

Conclusions  Further studies should be performed in order to evaluate the endemicity of VZV infections and to establish criteria for the use of the specific vaccine in Brazil.
Erosive perianal lichen planus responsive to tacrolimus
Authors: Watsky Kalman L.
Published: December 2004

A 46‐year‐old man presented with bleeding and painful sores around the anus of 2–3 years’ duration. The lesions had improved with a course of oral antimicrobials prescribed by a surgeon, who had performed a biopsy reported as showing nonspecific changes. Topical corticosteroids had also led to improvement, accompanied by the development of painful “pimples.” The patient had a history of recurrent oral herpes simplex, but denied other medical problems, persistent oral lesions, or human immunodeficiency virus risk factors.

 A total body skin examination revealed two shallow ulcerations of the perianal mucosa with minimal background erythema. No other cutaneous or mucosal lesions were noted. The remainder of the examination was unremarkable. A viral culture was negative, and there was no response to a 5‐day course of oral antiviral therapy (500 mg of valacyclovir twice daily). After avoiding topical therapies for 10 days, a lacy white discoloration was noted (Fig. 1). Review of the original biopsy specimen showed a band‐like lymphocytic infiltrate in the papillary dermis with involvement of the basal layer, consistent with lichen planus.

Lacy white discoloration and erosions of the perianal mucosa

image

The patient began a course of topical halobetasol ointment therapy, complicated by folliculitis, which was treated with topical clindamycin lotion. After 10 weeks, the area had completely healed (Fig. 2) and the patient discontinued topical therapy. One year later, the patient had a recurrence of erosions in the same location. Wishing to avoid the complications of high potency topical corticosteroid therapy, the patient chose therapy with the commercially available formulation of tacrolimus 0.1% ointment. One month later he called to report complete clearing and was tapered off therapy.

Normal mucosa after treatment with halobetasol ointment

image
Leukocytoclastic vasculitis associated with bullous erysipelas
Authors: Margolin L. , Feinmesser M. , Hodak E.
Published: December 2004

We report the case of a 65‐year‐old women with history of noninsulin‐dependent diabetes mellitus and hyperparaproteinemia kappa (IgM) who was admitted to the Dermatology Department of Rabin Medical Center because of painful erythema of the left leg associated with high fever (39 °C), which developed approximately 2 weeks before admission, and purpuric lesions over the lower extremities, which developed approximately 3 days before admission.

Biopsy obtained from one of the purpuric lesions revealed changes characteristic of leukocytoclastic vasculitis, and DIF from the purpura revealed perivascular precipitates of C3; antistreptolysin antibody titer was 1 : 400. HBV, HCV serology, C3, C4, ANA and cryoglobulins were within normal limits. To the best of our knowledge, this is the first case report indicating an association between erysipelas and leukocytoclastic vasculitis.
Pityriasis amiantacea: a clinical and etiopathologic study of 85 patients
Authors: Abdel‐Hamid Ibrahim A. , Agha Salah A. , Moustafa Yosry M. , El‐Labban Ayman M.
Published: December 2004

Background Studies on pityriasis amiantacea (PA) in the literature are limited and mostly retrospective. We prospectively analyzed the clinical and etiopathologic factors in a large series of PA diagnosed at our department within a defined period (2000–01).

Methods All PA patients who attended our department were evaluated clinically and underwent bacteriologic, mycologic, and histopathologic examinations. Forty healthy control persons were similarly subjected to bacteriologic and mycologic investigations of their scalp hairs.

Results A total of 85 PA patients were collected and studied. Pathological diagnosis of scalp psoriasis was confirmed in 35.3% of cases. Eczematous features suggesting a diagnosis of seborrheic and atopic dermatitis were detected in 34.2%. Diagnosis of tinea capitis, diagnosed by potassium hydroxide preparation, fungal culture, and periodic‐acid Schiff staining, was detected in 12.9% of the PA patients. Staphylococcus isolates were detected in 96.5% of the PA patients compared with 15% in healthy persons as the control (P > 0.00001).

Conclusions Pityriasis amiantacea represents a particular reaction pattern of the scalp to various inflammatory scalp diseases. The most frequent skin diseases associated with PA are psoriasis and seborrheic dermatitis. It is important to keep the diagnosis of tinea capitis in mind when evaluating PA patients. Staphylococci on the scalp could participate in the pathogenesis of PA.
Long‐term control of mycosis fungoides of the hands with topical bexarotene
Authors: Lain Ted , Talpur Rakhshandra , Duvic Madeleine
Published: December 2004

Background Limited Stage IA mycosis fungoides (MF) is often treated with topical steroids, which can cause atrophy, or with nitrogen mustard, which imposes several limitations on the patient's lifestyle. Topical bexarotene is a novel synthetic rexinoid with few side‐effects that has shown efficacy for treatment of mycosis fungoides skin lesions in recent Phase II–III clinical trials. The Phase I–II trial involving 67 stage IA–IIA MF patients demonstrated complete response (CR) in 21% and partial response (PR) in 42% of the patients. The median time to response was approximately 20 weeks. In the phase III trial of refractory stage IA, IB and IIA MF, the patients demonstrated a 44% response rate (8% CR). Patients with no prior therapy for mycosis fungoides responded at a higher rate (75%) than those with prior topical therapies.

Methods Case report of a patient with MF limited to the hands treated with topical bexarotene 0.1% gel in a open label phase II clinical trial.

Results Partial response occurred after 2 weeks of topical bexarotene therapy and the lesions were well controlled for 5 years using bexarotene monotherapy, with only occasional mild local irritation.

Conclusions Topical bexarotene is effective as long‐term treatment monotherapy for limited MF lesions. To our knowledge this is the longest use of the drug by any individual.
Development of fluctuating asymmetry in tail feathers of the barn swallow Hirundo rustica
Authors: Møller A. P.
Published: December 2004

Fluctuating asymmetry represents usually small, random deviations from symmetry in bilateral morphological characters. The ontogeny of asymmetry in morphological characters may reveal information about developmental processes in a general sense. I studied the development of fluctuating asymmetry in feather characters of the barn swallow Hirundo rustica, that are developed repeatedly during the single annual moult, with the following results. First, the side developing a larger feather was found to be partially biased, as demonstrated by one side consistently developing a larger feather under natural and experimentally induced growth episode events. Second, asymmetric feathers were found to consist of asymmetric daily growth increments, and the size of the increments developing under different environmental conditions were positively correlated. Third, fluctuating asymmetries of feathers developing under different environmental conditions were positively correlated, although the level of asymmetry was larger under adverse environmental conditions. Fourth, individual asymmetries in tail length and growth bar length were unrelated to the duration of the developmental period, although late growth increments were smaller and more symmetric than early increments. These observations suggest that fluctuating asymmetry partially arises as a consequence of a random bias in the feather follicles and differences in environmental conditions during ontogeny of feathers.
Dimorphisms and fluctuating asymmetry in the forceps of male earwigs
Authors: Tomkins J. L. , Simmons L. W.
Published: December 2004

Male dimorphisms are particularly conspicuous examples of the alternative reproductive strategies employed within some species. Such dimorphisms are thought to exist as genetic polymorphisms under ESS conditions, or to be conditional strategies where exogenous conditions determine the adult body plan. Fluctuating asymmetry (FA) is currently considered to be a fitness correlate of significant use in interpreting the functional significance of secondary sexual characteristics. In particular, negative slopes of FA on trait size are thought to arise in traits whose expression is dependent on condition. We measured forceps lengths and asymmetries in 2 island populations of the European earwig Forficula auricularia and Museum specimens of 5 other earwig (Dermaptera, Forficulidae) species from different genera, that appeared to be dimorphic. In a detailed study of Forficula auricularia we found a significant fit to a statistical model for the identification of dimorphisms and, for all species examined, morphs differed in the slope and/or elevation of the allometric relationship between body size and forcep length. Possible determinates of male dimorphisms are suggested from the data. Contrary to expectation, FA was not found to be greater in the minor morphs. Negative relationships between FA and forceps length were absent in both morphs of species examined from museum collections. Of the two island populations of Forficula auricularia, the smaller and more isolated population had higher FA and a negative relationship between FA and forceps length in the major morph. We discuss these patterns in the light of recent theories of FA and honest signalling.
Molecular phylogeny and the historical biogeography of the warblers of the genus Sylvia (Aves)
Authors: Blondel J. , Catzeflis F. , Perret P.
Published: December 2004

A molecular phylogeny based on DNA/DNA hybridization revealed that the Sylvia‐Parisoma complex is monophyletic and includes three main groups of species, the “mid‐European” warblers, the genus Parisoma, and the “eu‐Mediterranean” Sylvia species sensu stricto. The latter can be assigned to three main clusters, a “West‐Mediterranean” group, a “Central‐Mediterranean group”, and an “East‐Mediterranean” group. The radiation of the whole complex is much more ancient than formerly believed. It started ca 12–13 Ma ago and the ancestors of the main extant groups differentiated during the Pliocene. Only speciation events within the “eu‐Mediterranean” lineages occurred during the Pleistocene. The paleoclimatical and paleoecological history of the Mediterranean region is too complicated to provide any evidence for direct relationships between past events and evolutionary steps of these taxa which did not leave any reliable fossil record. However, some major speciation events may be related to well documented climatical crises as well as paleobotanical data. The largely man‐induced extension of matorrals over several millenia presumably extended the range of several species that were formerly much more restricted, which complicates reconstruction of the spatio‐temporal course of speciation.
Energy Use and Output Assessment of Food‐Forage Production Systems
Authors: Lal B. , Rajput D. S. , Tamhankar M. B. , Agarwal I. , Sharma M. S.
Published: December 2004

An assessment of the energy requirements of different intensive forage production systems was carried out at the Indian Grassland Fodder, and Agroforestry Research Institute, Jhansi. This included assessment of energy use and output for five intensive crop production systems: (1) sorghum (single‐cut)–berseem, (2) cowpea–sorghum (single‐cut)–berseem + mustard–maize + cowpea, (3) sorghum (multi‐cut)–berseem + oats, (4) guar–oats–maize and (5) sorghum (single‐cut)–wheat–fallow. In all the systems, the Napier bajra hybrid (IGFRI‐3) was transplanted in regular plots of 50 m × 13 m. Results revealed that the total annual energy use was highest for sorghum (multi‐cut)–berseem + oats (36 606 MJ ha−1), followed by sorghum (single‐cut)–berseem + mustard, sorghum (single‐cut)–berseem–cowpea, guar–oats–maize and sorghum (single‐cut)–wheat–fallow (for which values were 31 086, 30 449, 29 867 and 25 956 MJ energy ha−1, respectively). The high value found for sorghum (multi‐cut)–berseem + oats might be attributable to the multi‐cuts in this system. Energy use by fertilizers represented the major part of the total energy use, amounting to 28–38 % in all treatments, followed by energy used in electricity, machinery, seeds, human labour and farmyard manure (FYM), in case of all with slight increase in input. In sorghum–wheat, energy use by seeds occupied the second position, followed by energy used in electricity, human labour, FYM and machinery/diesel. Pesticides contributed the least energy utilization in all the treatments. Herbicides were used for the control of weeds. Among the five forage production systems, sorghum (single‐cut)–berseem + mustard–maize + cowpea was found to be the most energy efficient, followed by sorghum (multi‐cut)–berseem + oats–sorghum (multi‐cut), sorghum (single‐cut)–berseem–cowpea, guar–oats–maize and sorghum (single‐cut)–wheat–fallow. Sorghum (single‐cut)–berseem + mustard–maize + cowpea increased the fertility of the soil, resulting in a higher percentage of organic carbon, higher availability of nitrogen and optimal balancing of the C:N ratio in the upper layers of the soil. These intensive crop production systems also maintain the optimum microbial population in the crop root zone. The benefit–cost ratio (B:C ratio) for the most energy‐efficient forage production system was 1.37 : 1. However, the highest B:C ratio was found in the sorghum–wheat rotation (1: 1.57).
Effects of Osmotic Stress on the Growth of Etiolated Mung Bean Seedlings
Authors: Passos L. P.
Published: December 2004

The alterations in growth and water status of dark‐grown mung bean tissues following sudden osmotic stress were investigated. Photographic measurements of hypocotyl elongation revealed that stress (−0.2 to −0.8 MPa) induced growth cessation within one minute, with resumption occurring at lower rates after a latent period; periods which tended to increase in accordance with whether the seedlings were 4, 5 or 6 days old. Tissue water status was related to growth as water and osmotic potentials were highest in the expanded root region and the lowest in the growing hypocotyl region. These rankings were not verified under osmotic stress, and values were reduced in the course of 24 h. Turgor levels were similar in all tissues and were not altered by stress. The responses were not caused by substantial water loss, which was detected only after 24 h of stress, and could have resulted from the accumulation of osmotic solutes. The results indicate that plants exposed to sudden osmotic stress, besides exhibiting rapid growth cessation, show growth resumption at lower rates and no subsequent short‐term changes in any water status measure of the growing region. Because growth resumes without further detectable turgor increments, water status alterations are unlikely to be the cause of the observed immediate growth stoppage.
Response of Photosynthesis and Water Relations of Rice (Oryza sativa) to Elevated Atmospheric Carbon Dioxide in the Subhumid Zone of Sri Lanka
Authors: De Costa W. A. J. M. , Weerakoon W. M. W. , Abeywardena R. M. I. , Herath H. M. L. K.
Published: December 2004

The objective of the present paper is to determine the response of the physiological parameters related to biomass production and plant water relations in a standard Sri Lankan rice (Oryza sativa) variety (BG‐300) to elevated CO2 (i.e. 570 µmol/mol). During two seasons, rice crops were grown under three different experimental treatments; namely, at 570 µmol/mol (i.e. ‘elevated’) and 370 µmol/mol (‘ambient’) CO2 within open top chambers, and at ambient CO2 under open field conditions. Leaf net photosynthetic rate in the elevated treatment increased by 22–75 % in comparison to the ambient. However, the ratio between intercellular and ambient CO2 concentrations remained constant across different CO2 treatments and seasons. CO2 enrichment decreased individual leaf stomatal conductance and transpiration rate per unit leaf area, and increased both leaf and canopy temperatures. However, the overall canopy stomatal conductance and daily total canopy transpiration rate of the elevated treatment were approximately the same as those achieved under ambient conditions. This was because of the significantly greater leaf area index and greater leaf–air vapour pressure deficit under CO2 enrichment. The leaf chlorophyll content increased significantly under elevated CO2; however, the efficiency (i.e. photochemical yield) of light energy capture by Photosystem II (i.e. Fv/Fm) in chlorophyll a did not show a significant and consistent variation with CO2 enrichment.
Dry‐Matter Production, Allocation and Nutritive Value of Forage Chicory Cultivars as a Function of Nitrogen
Authors: Belesky D. P. , Ruckle J. M. , Clapham W. M.
Published: December 2004

Forage chicory cultivars vary in origin and morphology and may respond differently to nutrient inputs because of photosynthate allocation and resource acquisition. Understanding nitrogen (N) influences on chicory seedling development and allocation of photosynthates among plant parts is important in terms of stand establishment, plant persistence, herbage production and nutritive value. We conducted experiments in the glasshouse to determine if amount (0, 50 and 100 mg N kg−1 soil) and source (ammonium nitrate or urea) of exogenous N influenced leaf dry‐matter (DM) production, N nitrate (NO3) and total non‐structural carbohydrate (TNC) allocation among roots and shoots in the chicory cultivars Forage Feast, Lacerta or Grasslands Puna. Herbage DM productivity and the ratio of energy (TNC) : protein varied among cultivars because of differential photosynthate allocation between shoots and roots, and occurred later in the growth interval when N was applied. Forage Feast, compared with the other cultivars, produced the largest roots and greatest herbage DM without added N. Leaf appearance rate in Lacerta and Grasslands Puna increased with increasing N. Instantaneous growth rates of Grasslands Puna and Lacerta at 100 N were three times that of 0 N plants. Nitrate concentrations were very high in young seedlings of all three cultivars before applying N. The findings help define application practices for these cultivars and N management practices for optimal leaf production in establishing forage chicory plants.