bluuebunny/crossref_metadata_2025 huggingface dataset:
High plasma levels of the soluble receptor for advanced glycation endproducts in patients with symptomatic carotid atherosclerosis
Authors: Basta G. , Castagnini M. , Del Turco S. , Epistolato M. C. , Righini P. , Sangiorgi G. M. , De Caterina R. , Tanganelli P.
Published: October 2009

Background  Advanced glycation endproducts (AGEs), particularly carboxymethyl(lysine)‐adducts (CML), exert part of their cellular effects by binding to a receptor, named receptor for AGEs (RAGE). The soluble form of this receptor (sRAGE) has been shown to have an athero‐protective role. We hypothesized the existence of a relationship between the AGE–RAGE axis and the occurrence of symptoms related to carotid atherosclerosis in nondiabetic conditions.

Materials and methods  We evaluated plasma levels of CML and sRAGE (by ELISA), and tissue levels (tAGEs and tRAGE, semiquantitatively, by immunohistochemistry) in endarterectomy carotid plaque tissue in 29 nondiabetic patients. At the time of surgery, 10 patients were asymptomatic and 19 were symptomatic.

Results  Plasma levels of sRAGE were higher in symptomatic patients than in asymptomatic patients [median (interquartile range): 676 (394–858) pg mL−1 vs. 347 (284–479) pg mL−1, P = 0·009]. In symptomatic patients, plasma levels of sRAGE correlated positively with CML (r = 0·60, P < 0·01), C‐reactive protein (CRP) (r = 0·618, P < 0·01) and fibrinogen (r = 0·522, P<0·005), while in asymptomatic patients, no correlation was observed. Although tissue and plasma levels of AGEs and RAGE did not correlate between each other, tAGEs and tRAGE were also positively correlated only in symptomatic patients (χ2 = 8·93, P = 0·003).

Conclusions  Plasma levels of sRAGE are higher in symptomatic than asymptomatic carotid atherosclerosis. Higher levels of sRAGE in symptomatic patients may be markers of a higher degree of vascular inflammation in such patients.
Discriminant analysis of biogeochemical indicators of nutrient enrichment in a Florida wetland
Authors: Corstanje R. , Portier K. M. , Reddy K. R.
Published: October 2009

Eutrophication of wetlands can lead to extensive changes in the ecosystem structures. The water‐borne nutrient inputs change the soil biogeochemistry prior to structural changes in the ecosystem. The objective of this study was to determine the biogeochemical variables that are strongly associated with eutrophication. We postulated that in wetlands the soil chemical properties function as driving factors (primary indicators) to which the indicators of the soil biological processes respond (secondary indicators). The alternative hypothesis is that the soil biology shows a more rapid response to an increase in nutrient availability from the water column, with the soil chemical properties responding more slowly. This study employed an extensive database from three sites covering a nutrient enrichment gradient in the Everglades, Florida (enriched, intermediate and unenriched). This database contained 28 biogeochemical variables, which we divided into two sets: a set of chemical descriptors and a set of microbiological descriptors. We applied a combination of stepwise discrimination and canonical discrimination (“stepwise canonical discrimination”) to determine differences between the sites. For the group of chemical descriptors, the variables selected were total nitrogen (N), total carbon (C), organic C, labile organic phosphorus (P), fulvic‐, humic‐, labile inorganic‐ and residual P, ammonia and aluminium. We then applied the discriminant analysis using the microbiological descriptors. The variables selected were mineralizable P and N, microbial P and phosphatase activity. Discrimination using chemical variables was more successful than that based on the microbiological variables. Subsequent bootstrap cross‐validation indicated that the microbiological variables seemed to have a more integrative function with associated stability and robustness. We suggest that for this system the canonical variates themselves may be viewed as indicator variables of enrichment, and that the constituent variables may be important as indicators in other P‐limited marsh systems at risk of eutrophication.
Silage quality whenMoringa oleiferais ensiled in mixtures with Elephant grass, sugar cane and molasses
Authors: Mendieta‐Araica B. , Spörndly E. , Reyes‐Sánchez N. , Norell L. , Spörndly R.
Published: October 2009

Fourteen different silages were prepared using mixtures of Moringa (Moringa oleifera), Elephant grass (Pennisetum purpureumcv Taiwan) or sugar cane (Saccharum officinarum). Molasses from sugar cane was used in the amounts of either 10 or 50 g kg−1fresh matter (FM) in treatments without sugar cane. A completely randomized design with three replicates of each treatment was used. The silages were prepared in 1800 mL micro silos and opened after 120 d. The presence of Moringa and Elephant grass in the silage changed the pH by −0·8 and +0·7, respectively (P < 0·001), indicating a favourable effect of Moringa on silage pH. Overall differences were found among treatments for dry matter content, crude protein and acetic acid concentrations, weight loss, CO2production and silage pH after spoilage (P < 0·001). Weight loss was proportionately 0·034 and 0·014 in silages with and without sugar cane respectively (P < 0·001). Overall, differences (P < 0·05) were also found for neutral‐detergent fibre and lactic acid concentrations, lactic acid bacteria counts, clostridial counts and time to spoilage of the silages. Treatments containing Moringa had higher lactic acid concentrations (+16 g kg−1DM;P < 0·01) compared to treatments without but the presence of Moringa decreased time to spoilage by 67 h (P < 0·05). No differences were found in propionic acid concentration or fungal growth of the silages. It is concluded that Moringa can be used as a component of high quality silages which also contain high concentrations of crude protein.
In Lynch syndrome adenomas, loss of mismatch repair proteins is related to an enhanced lymphocytic response
Authors: Meijer Tineke W H , Hoogerbrugge Nicoline , Nagengast Fokko M , Ligtenberg Marjolein J L , Van Krieken J Han J M
Published: October 2009

Aims:  Lynch syndrome‐associated tumours are characterized by the presence of an increased number of tumour‐infiltrating lymphocytes. This enhanced lymphocytic response may be elicited by genetically altered proteins that may arise as a result of a defective DNA mismatch repair system. The aim was to investigate this hypothesis by correlating loss of mismatch repair proteins and infiltration of lymphocytes in Lynch syndrome‐associated adenomas and hyperplastic polyps.

Methods and results:  Mismatch repair protein expression and the number of tumour‐infiltrating lymphocytes were assessed in Lynch syndrome (41 adenomas and nine hyperplastic polyps) and in familial colorectal cancer (nine adenomas and one hyperplastic polyp). Nineteen sporadic adenomas were included as a control group. Twenty of 32 (63%) adenomas with loss of mismatch repair protein expression showed an increase in tumour‐infiltrating lymphocytes. Eight adenomas (8/32; 25%) displayed many tumour‐infiltrating lymphocytes, whereas most adenomas (12/32; 38%) showed a minor increase. In adenomas with mismatch repair protein expression, both sporadic and Lynch syndrome associated, not one showed an increased number of tumour‐infiltrating lymphocytes. Hyperplastic polyps in Lynch syndrome patients showed neither loss of mismatch repair expression nor an increase in tumour‐infiltrating lymphocytes.

Conclusions:  There is a correlation between the loss of mismatch repair proteins and the infiltration of lymphocytes in Lynch syndrome‐associated adenomas.
Differential expression of the semaphorin 3A pathway in prostatic cancer
Authors: Yacoub Mokrane , Coulon Alix , Celhay Olivier , Irani Jacques , Cussenot Olivier , Fromont Gaelle
Published: October 2009

Aims:  To analyse the expression pattern of the semaphorin 3A (Sema3A) pathway, including the receptor neuropilin 1 (NRP1) and its ligands the ‘antitumoral’ Sema3A and the ‘protumoral’ vascular endothelial growth factor (VEGF)in prostatic cancer.

Methods and results:  tissues were obtained from 120 patients treated by prostatectomy for clinically localized prostatic cancer, and 31 hormone‐refractory prostatic cancer (HRPC) samples. Immunohistochemistry was performed on tissue microarrays using antibodies directed against Sema3A, NRP1 and VEGF. Moreover, real‐time reverse transcriptase‐polymerase chain reaction was performed on frozen prostatic tissue, including normal prostate, clinically localized tumours and HPRC. Sema3A immunoreactivity of the membrane of cancer cells was closely associated with NRP1 expression in clinically localized prostatic cancer, but not in HRPC. In clinically localized cancer, Sema3A expression correlated with lower preoperative prostate‐specific antigen (PSA) and pathological stage; NRP1 reactivity was associated with lower PSA and Gleason score, and VEGF reactivity with higher PSA and Gleason score. HRPC displayed higher expression of NRP1 compared with clinically localized cancer, and lower Sema3A immunoreactivity.

Conclusions:  These results support the hypothesis that dysregulation of the Sema3A pathway plays a key role in prostatic cancer progression, and suggest a loss of the inhibitory Sema3A autocrine loop in HRPC.
Translation and validation of a Chinese language version of the Early Childhood Oral Health Impact Scale (ECOHIS)
Authors: LEE GILLIAN H. M. , MCGRATH COLMAN , YIU CYNTHIA K. Y. , KING NIGEL M.
Published: October 2009

Objective.  This study aimed to adapt the Early Childhood Oral Health Impact Scale (ECOHIS) for pre‐school children in a Chinese speaking community and to investigate its psychometric properties (validity and reliability).

Methods.  A Chinese language version of the ECOHIS was derived through a forward–backward translation and tested for face and content validity among a focus group. A convenient sample of pre‐school children (n = 111) was recruited (including a sub‐sample with early childhood caries and caries‐free children). Parents of the children self‐completed the derived Chinese‐ECOHIS measure. Validity of the measure was assessed by investigating the relationship between dental caries status and Chinese‐ECOHIS scores (construct and criterion validity). A sub‐sample of the parents repeated the ratings of the measure to enable reliability assessments. Both internal and test–retest reliability were determined.

Results.  A Chinese version of ECOHIS was derived with minor modification to the original version. Chinese‐ECOHIS scores were associated with children’s caries experience (dmft) (r = 0.66, P < 0.05) supporting convergent validity. In addition, variations in ECOHIS scores were apparent with respect to caries and caries‐free groups (P < 0.001), supporting the ability to distinguish between patient groups. Cronbach’s alpha values (internal reliability) for total ECOHIS score were 0.91 and intraclass correlation coefficient value (test–retest reliability) was 0.64.

Conclusions.  A Chinese version of the ECOHIS was developed and demonstrated acceptable validity and reliability. These findings can enable assessments of pre‐school child oral health‐related quality of life in Chinese speaking communities.
Review: the legal duty of care for nurses and other health professionals
Authors: Young Andy
Published: October 2009

Aims and objectives.  To explore the nature and extent of the legal duty of care in relation to contemporary healthcare practice.

Background.  The paper seeks to re‐frame and update the legal duty of care for clinical nursing practice in the 21st century, taking into account collaborative and partnership working in healthcare practice.

Design.  Doctrinal legal ‘approach’.

Method.  ‘Black letter’ legal research methodology used for data collection and analysis. Literature search using Westlaw and LexisNexis database(s) to identify recent common law decisions.

Results.  There has been a perceptible doctrinal shift away from paternalism and toward patient empowerment and autonomy in the last decade. This has implications for nurses and other healthcare professionals in terms of consenting patients and acting reasonably to ensure quality patient care.

Conclusions.  A number of experienced nurses are currently assuming extended roles and some are completing medical tasks, traditionally allocated to doctors. These specialist practitioners must remember that additional responsibility invariably means increased professional risk and accountability. Therefore, it is essential that those engaging in advanced nursing practice, fully understand the nature and reach of their professional duty of care and the significance of statutory and common law developments.

Relevance to clinical practice.  Nurses and other healthcare professionals must update their clinical skills and practice within a legal framework and to certain standards. The cases cited and discussed are relevant to all branches of nursing and indeed to all health professions.
Effectiveness of two rehabilitation strategies provided by nurses for stroke patients in Mexico
Authors: Torres‐Arreola Laura del Pilar , Doubova (Dubova) Svetlana Vladislavovna , Hernandez Sergio F , Torres‐Valdez Laura E , Constantino‐Casas Norma P , Garcia‐Contreras Fernando , Torres‐Castro Sara
Published: October 2009

Objective.  Rehabilitation strategies have been developed to improve functional state in stroke patients. The main objective of this study was to evaluate the effectiveness of the early rehabilitation at hospital and its continuity at home provided by nurses, on the functional recovery of basic and social activities in stroke patients compared with conventional care.

Design.  A randomised clinical trial was carried out in three general hospitals of the Mexican Institute of Social Security (IMSS) in Mexico City between April 2003–May 2004.

Participants.  Stroke patients.

Methods.  Two rehabilitation strategies provided by nurses for stroke patients were compared: physiotherapy plus caregiver education in rehabilitation (strategy 1, S1) vs. education alone (strategy 2, S2). The main outcome variables were the basic (Barthel index) and social (Frenchay activities index) activities of daily living, of each patient. Age, sex, morbidity, stroke symptoms, complications, neurological damage (Canadian Scale), cognitive state (mini‐mental state examination questionnaire) and duration of hospitalisation were defined as the control variables. Patients were evaluated at baseline and months one, three and six thereafter.

Results.  One hundred and ten patients with ischaemic stroke were enrolled and randomised; 59 were assigned to S1 and 51 to S2. Comparison of the outcome variables showed that patients improved significantly over time, but no differences were observed between groups. We observed no significant difference in strategy performance with regard to the basic and instrumental activities of daily living.

Relevance to clinical practice.  Participants who received physiotherapy with additional caregiver education benefit no more than those whose caregivers received education alone. Those countries that do not have integral rehabilitation programmes for stroke patients should understand their importance and budget resources for them. Meanwhile, both caregiver education and nurses trained in specific care and physiotherapy are alternatives that benefit these patients.
The relationship between intravenous infusate colonisation and fluid container hang time
Authors: Rickard Claire M , Vannapraseuth Boun , McGrail Matthew R , Keene Lorraine J , Rambaldo Sam , Smith Chloe A , Ray‐Barruel Gillian
Published: October 2009

Aims.  To examine the level of microbial colonisation in intravenous fluids after 24 hours of use in an acute care setting to determine the necessity of changing infusate bags on a time‐related basis.

Background.  Catheter‐related bloodstream infections are a serious and life‐threatening complication of intravascular devices. Colonised intravenous fluids are one potential source of infection; however, there is little published literature on incidence rates and few recent studies. Routine intravenous fluid replacement has been advocated as an infection control method, but the effectiveness of this is unknown and the optimal duration for infusate use remains uncertain.

Design.  Cross‐sectional study over 18 months in a 257‐bed teaching hospital.

Methods.  Infusate specimens (n = 264) were obtained from crystalloid fluids that had been used for 24 hours or more. Microbiological culture and sensitivity testing was performed and infusate‐related bloodstream infection (IRBSI) rates were recorded. Sample testing of previously unopened intravenous solutions acted as a control.

Results.  The infusate colonisation rate was 0·4%, or 0·09 per 1000 infusion hours. The only isolated organism was coagulase‐negative Staphylococcus. Infusions had been in use for 24–185 hours (1–8 days). There was no difference in median duration of use for colonised (35·0 hours) and sterile (34·0 hours) specimens (Mann–Whitney test, p = 0·99). There were no cases of IRBSI.

Conclusion.  The incidence of intravenous fluid colonisation and the risk of related bloodstream infection are low even after several days of infusate use. Current practice appears to successfully maintain the sterility of intravenous fluids.

Relevance to clinical practice.  Routine replacement of intravenous fluids continues in many settings, often 24 hourly, in the belief that this prevents infection. We found no relationship between duration of use and colonisation and routine replacement may be unnecessary. Further research is needed to investigate the effectiveness of routinely replacing intravenous fluids at set time points to prevent colonisation and infection.
Seeking connection: family care experiences following long‐term dementia care placement
Authors: Bramble Marguerite , Moyle Wendy , McAllister Margaret
Published: October 2009

Aim.  To outline the experiences of family caregivers in Brisbane, Australia who have placed a relative with dementia into long‐term care.

Background.  Whilst the aged care literature in Australia highlights the rising numbers of people with dementia admitted to long‐term care, empirical research exploring family and staff relationships and their influence on quality of care remains limited. International research demonstrates that the transition to long‐term care is stressful for families and the person with dementia, often resulting in ongoing family and staff conflict.

Design.  The study utilised a descriptive qualitative design.

Methods.  A purposive sample of 10 participants from a large study that tested an education intervention took part in the qualitative phase of this mixed method, sequential design study. Semi‐structured interviews and confirmatory thematic analysis were used to identify family caregiver experiences following placement of their relative in long‐term care.

Results.  The findings emphasise the increasing isolation and burden of care felt by families prior to admission, which often is perpetuated during long‐term care placement and may present as dissatisfaction with care.

Conclusions.  Improving staff–family relationships has the potential to reduce conflict and to improve the long‐term care environment, relieve the pressure of work overload, decrease staff frustration and reduce negative reactions to family caregivers.

Relevance to clinical practice.  The findings highlight the crucial need for long‐term care facilities to support families, as well as the person with dementia, through the transition to the care environment. The resulting improved family relationships with staff, based on negotiation and increasing knowledge of dementia care, can then provide potential to develop more specialised evidence‐based dementia care and service delivery.
Implementation and evaluation of a nursing process support system for long‐term care: a Taiwanese study
Authors: Yeh Shu‐Hui , Jeng Bingchiang , Lin Li‐Wei , Ho Tien‐Hui , Hsiao Chiu‐Yueh , Lee Li‐Na , Chen Shu‐Li
Published: October 2009

Aims.  To (1) develop and implement a Nursing Process Support System in Chinese (NPSSC) enabling computerised documentation for nursing home residents, (2) evaluate the efficiency of NPSSC, (3) assess obstacles to the use of the NPSSC and (4) assess nurse users’ satisfaction with the NPSSC.

Background.  Long‐term care facilities in Taiwan have been slow to computerise resident’s medical records. The development and implementation of a computerised documentation system provides a way to enhance nursing documentation in long‐term care settings and can prevent hazards that result from documentation errors.

Design.  Quasi‐experimental.

Methods.  This study used one group pre/post‐test. Five nursing homes in Taiwan were included in the study. Twenty‐seven nurses used the NPSSC to computerise 396 residents’ medical records. Using the NPSSC allowed nurses to enter health assessment data into the computer system, which automatically triggered appropriate nursing diagnoses. The NPSSC included geriatric nursing interventions and the use of alternative Chinese therapies.

Results.  Obstacles that hindered nurses' use of the NPSSC were identified and possible solutions to overcome these hindering factors were discussed. The use of the NPSSC significantly improved nursing documentation in that resident’s records were organised and consistent and nurses were able to complete a comprehensive care plan within 48 hours. Nurses reported a higher satisfaction in nursing documentation after the implementation of the NPSSC than previously.

Conclusions.  This study suggested a pathway to develop and implement a computer‐based, user‐friendly nursing documentation system for nursing homes. This study may be used as a template for implementing computerised documentation worldwide.

Relevance to clinical practice.  Nursing home providers may consider implementing the NPSSC to replace the traditional hand‐written documentation system. An effective use of in‐service programs within the workplace helped ease the transition from hand‐written documentation to the computer‐based NPSSC.
Rhodopsin population genetics and local adaptation: variable dim‐light vision in sand gobies is illuminated
Authors: EBERT DANIEL , ANDREW ROSE L.
Published: October 2009

The visual pigments of fish are thought to be adapted to the variable spectral qualities of aquatic light environments. Most research on the role of natural selection on the evolution of rhodopsins and dim‐light vision in fish has focused on variation among species and higher taxa. In this issue, Larmuseau et al. reveal substantial intraspecific sequence variation in RH1 (the rhodopsin gene) in sand gobies (Pomatoschistus minutus). Using population genetics and molecular evolution approaches, they detect positive selection on RH1 and find evidence for adaptation to local light conditions.
No evidence of over‐reporting of SARS in mainland China
Authors: Liu Wei , Han Xiao‐Na , Tang Fang , Borsboom Gerard J. J. M. , Yang Hong , Cao Wu‐Chun , De Vlas Sake J.
Published: October 2009

Objective  To find out whether there was over‐reporting of SARS patients in mainland China in view of the relatively low case fatality ratio in mainland China, in comparison with other affected countries and areas.

Methods  We searched PubMed for all SARS antibody detection papers (in English or Chinese language) using the keywords ‘SARS’ and ‘antibody’. Then the resulting articles were further read through to select the SARS detection results using ELISA methods of serum samples collected at least 1 month after disease onset. A multi‐level logistic regression was applied to test for possible differences in the proportions positive between locations of the study.

Results  A total of 48 studies were identified, including 39 from mainland China and nine from elsewhere (Hong Kong, Taiwan, Canada and Vietnam). For mainland China, there was no difference between Guangdong, Beijing and other provinces in the proportions testing positive (83.0%, 85.8% and 85.4% respectively). The grand average of 84.2% seropositive was lower than the 95.1% for the countries and areas outside of mainland China combined. However, this difference was far from significant after correcting for dependency of individual tests within the same study.

Conclusions  Our study showed no evidence of over‐reporting of SARS in mainland China, nor in Guangdong, where the SARS epidemic started. Even if the lower seroprevalence in mainland China, relative to other affected areas, does represent actual over‐reporting, then this factor can only explain a modest 10% of the lower case fatality in mainland China.
The SARS outbreak in a general hospital in Tianjin, China: clinical aspects and risk factors for disease outcome
Authors: Wei Mao‐Ti , De Vlas Sake J. , Yang Zhen , Borsboom Gerard J. J. M. , Wang Lihong , Li Haiying , Li Yuming , Zhang Zhilun , Richardus Jan Hendrik , Wang Shi‐Xin
Published: October 2009

Objectives  To describe clinical characteristics of severe acute respiratory syndrome (SARS) patients in a hospital in Tianjin, China, thereby comparing probable and suspected cases; to study risk factors associated with the death of cases; to describe the implementation of preventive interventions during the hospital outbreak.

Methods  Physical and haematological information was obtained from clinical records. White blood cell counts, and percentages of neutrophilic granulocytes and neutrophilic lymphocytes were measured. The service department of the hospital provided information about daily use of protective materials. Differences in clinical symptoms between probable and suspected SARS cases were tested by Fisher’s exact test. Non‐linear mixed modelling was used to test for differences between the haematological patterns for probable and suspected cases. Risk factors for dying among probable SARS cases were tested by logistic regression.

Results  The SARS outbreak started with a patient from Beijing on 15 April 2003, and spread quickly among the healthcare workers and in‐patients in the hospital. In total 90 probable and 21 suspected cases were reported, with 17 deaths among them (case fatality rate 15%). Haematological patterns were significantly different between probable and suspected cases, whereas the percentages with certain clinical symptoms showed no apparent difference. Death of probable SARS cases was only significantly associated with high age and use of a respiratory machine (mainly for the most severe cases), whereas e.g. co‐morbidity and steroid treatment showed no impact in multivariate analysis. Stringent control measures, including distribution of huge numbers of protective materials, started on 20 April, which soon lead to a strong decrease in the incidence of new cases. After the last SARS case left the hospital on 6 June, protective materials were dispensed at substantially lower rates, but not to zero, as was the case during the first days of the outbreak.

Conclusion  The working definition of probable SARS used during the epidemic appeared to have been fairly accurate. Many valuable lessons were learned regarding prevention of hospital spread of infection, especially the need to have sufficient protective supplies available and to implement these rigidly and at an early stage of an (threatening) epidemic.
The impact of public health control measures during the SARS epidemic in mainland China
Authors: De Vlas Sake J. , Feng Dan , Cooper Ben S. , Fang Li‐Qun , Cao Wu‐Chun , Richardus Jan Hendrik
Published: October 2009

We tracked the effective reproductive number (Rt) over time to assess the impact of important public health control measures in the five most SARS‐affected geographic areas in mainland China. As soon as the Chinese authorities gained full control of all activities to combat SARS, Rt decreased dramatically and consistently below one. Many control measures that seriously affected public life were implemented afterwards, i.e., when the epidemic was already dying down.
Institutionalized children: The underprivileged
Authors: Eapen Doncy J
Published: October 2009

The focus of this article is on negative effects of institutionalization in children, which is based on findings of a descriptive study conducted in India. The author reviews related literature in order to discuss the effect of institutionalization in children and the importance of addressing those children's unmet social and emotional needs. The discussion includes significant findings of the author's study. The author explores strategies for improving these children's outcomes, including placing the children in adoption or foster care so that they will have a family environment.
Nurse‐led telephone triage in an Australian rural mental health service
Authors: Barnett Tony , Henderson Susan , Henry Darrin , Gumpold Anne , Foote Peter , Gallop Steve
Published: October 2009

This paper reports on changes in referral patterns of a rural mental health telephone triage service based in Gippsland, Victoria, Australia. A retrospective audit of service data over the period 1999–2005 was undertaken as part of a quality improvement exercise. Data collected included service utilization statistics and critical reflection on the role of the mental health triage clinician within the service.

There was an average of 2771 referrals each year and a trend for increased use by general practitioners and hospital emergency departments. Triage nurses reported concerns about: professional isolation, lack of formal education, difficulties in making decisions based on limited data as well as poor understanding of the role by users (patients and referrers). Further research is needed to evaluate the impact of this form of patient assessment on psychiatric nursing practice and clinical outcomes.
Change in knowledge and self‐efficacy of patients with rheumatoid arthritis: A six‐month follow‐up study
Authors: Mäkeläinen Paula , Vehviläinen‐Julkunen Katri , Pietilä Anna‐Maija
Published: October 2009

The purpose of this study was to examine rheumatoid arthritis (RA) patients' knowledge of the disease and its treatments and their self‐efficacy changed in a 6‐month period. The data were collected from 223 RA patients during August 2004–March 2005 using self‐administered questionnaires. The main finding was that the patients' knowledge of exercise, joint protection and energy conservation increased and their self‐efficacy strengthened over the 6‐month period. However, the RA patients' general knowledge of the disease (e.g. of its aetiology) decreased significantly. Weak relationships exist between the patients' self‐efficacy and their knowledge of exercise, joint protection and energy conservation. The patients who had follow‐up visits during the 6‐month period had slightly better knowledge levels, but their pain and other symptoms self‐efficacy was weaker. It is important that nurses encourage patients to seek clarification of any unclear issues concerning their disease, and concentrate on supporting those patients whose self‐efficacy is weak.
Analysing oral history: A new approach when linking method to methodology
Authors: Miller‐Rosser Kolleen , Robinson‐Malt Suzanne , Chapman Ysanne , Francis Karen
Published: October 2009

This paper discusses a pragmatic and innovative approach to the data analysis of oral testimonies when used within a methodological framework of Historiography. Oral testimony is increasingly perceived as an exciting research method within the nursing discipline. However, the availability of a clear method to guide the researcher in their analysis of oral testimonies as the primary data for a Historiography is limited. A practical approach to the interpretation of oral testimony is needed to ensure the continued and successful use of Historiography as a valued research methodology in nursing science. The primary discussion revolves around the explication of a four‐stage method proposed as a pragmatic tool for the analysis of oral testimonies. Theoretical literature from the Historian, Paul Thompson and Pragmatist Philosopher, Richard Rorty is drawn upon to bring validity and reliability to the proposed method of analysis. This new technique can be easily used by nurses and many other disciplines in their efforts to efficiently analyse the qualitative data obtained from oral testimonies.
The communication challenges faced in adopting a palliative care approach in advanced dementia
Authors: Johnson Amanda , Chang Esther , Daly John , Harrison Kathleen , Noel Michael , Hancock Karen , Easterbrook Sally
Published: October 2009

This paper discusses one aspect from the findings of an Australian study aimed at understanding the needs of people with advanced dementia. Specifically, this paper focuses on the communication issues that might potentially inhibit the implementation of a palliative care approach for a person with advanced dementia in a residential aged care facility (RACF). Six focus groups consisting of 34 participants and 24 semistructured interviews were conducted. Participants were drawn from palliative care specialty staff, palliative care volunteers, designated aged or dementia specialist staff from an area health service, general practitioners, RACF staff and family carers. The findings show communication issues identified by the participants were a significant factor impacting on their capacity to adopt a palliative care approach in caring for people with advanced dementia. The findings support the need for education, skill development and networking to occur among the key providers of care in RACFs to ensure the provision of ‘best practice’ palliative care to residents with advanced dementia and their families.
Tectonics of an Early Carboniferous forearc inferred from a high‐P/T schist‐bearing conglomerate in the Nedamo Terrane, Northeast Japan
Authors: Uchino Takayuki , Kawamura Makoto
Published: October 2009

The Nedamo Terrane, an Early Carboniferous accretionary complex, is the oldest biostratigraphically dated accretionary complex in Japan. The purpose of this study is to describe and interpret a conglomerate from the Nedamo Terrane that contains clasts of high‐pressure/low‐temperature (high‐P/T) schist (mainly garnet‐bearing phengite schist) and ultramafic rock, and to infer the tectonics of an Early Carboniferous arc–trench system at the eastern margin of the paleo‐Asian continent. Clasts of high‐P/T schist and ultramafic rock within the conglomerate make up 8.4 and 6.7% of the total clasts, respectively, based on modal counts. These clasts are subangular to subrounded, whereas volcanic clasts are well rounded. The source of the schist clasts, which yield a radiometric age of 347–317 Ma, is considered to be the Renge Metamorphic Rocks of Southwest Japan or equivalent rocks. Based on the chemical composition of chromian spinel, the source of ultramafic clasts is inferred to be the island‐arc‐type Ordovician Miyamori and Hayachine ultramafic complexes in the Kitakami Massif. The conglomerate records multiple provenance regions, including an island arc (South Kitakami Terrane) and a forearc ridge; the high P/T schist and ultramafic rocks were exhumed in the forearc region. The duration of the interval from the early stages of exhumation of the schist to its deposition in the trench as clasts is estimated to have been less than 30 my.
Use of the ‘CURB 65’ score in hospital practice
Authors: Karmakar G. , Wilsher M.
Published: October 2009

Background:  The ‘CURB 65’ score is a simple well‐validated tool for the assessment of severity in community acquired pneumonia (CAP). Whether it is used routinely is unknown. The aim of this study was to determine the frequency of use of the score in routine hospital practice and correlate this with clinical decision making and patient outcome.

Methods:  Retrospective cohort study of all patients with CAP (n= 174) presenting in three winter months. Demographic and clinical outcome data were recorded and comparisons were made between those patients who had score applied on admission with those that did not. A CURB 65 score was assigned to all patients using data from the patient record, and admission decisions were compared.

Results:  Only 9 (5.2%) CAP patients had the ‘CURB 65’ score applied at admission. The overall mortality rate was 3.4%. On applying a score to all cases retrospectively, appropriate admission decisions were made for patients with moderate or severe pneumonia and outcome was in accordance with published results. However, 23 (13%) patients age <65 with mild CAP and no comorbidities were admitted in spite of guideline recommendation for community care.

Conclusions:  These data demonstrate that clinical decision making in respect of moderate or severe CAP is the same whether or not a pneumonia severity score is applied. However, routine use of the score will identify patients with mild CAP thus potentially reducing unnecessary admission.
Referral patterns to a palliative care service in rural Australia servicing indigenous Australians
Authors: To T. , Boughey M.
Published: October 2009

Background: Territory palliative care (TPC) of the Northern Territory covers a population of 150 000 over 400 000 km2 in urban, rural and remote settings. Thirty‐two per cent of the population are indigenous Australians. There is little documentation of palliative services to the indigenous Australians.

Methods: We retrospectively reviewed the referral characteristics of patients who died in or were discharged from the TPC over 6 months in order to define unique characteristics of palliative care of such a population.

Results: The records of 151 consecutive patients were analysed, with a mean age 63 ± 17 years, 62% male, 59% non‐indigenous, 70% urban dwellers and 71% referred for malignancies. Median time to separation was 69 days, with 33% discharged within 30 days, while 28% survived beyond 6 months. Eighty‐two per cent of patients died, and of these 52% in the hospice. indigenous patients were more likely to be younger (54 vs 70 years), female (52% vs 29%), living rurally (52% vs 12%) and to die at home (47% vs 11%).

Conclusion: These data showed major differences from the largest Australian study published so far, based on a population of predominantly non‐indigenous Australians. This study identifies for the first time how TPC needs to have an encompassing service plan and delivery model to cater for indigenous patients and people in remote locations.
Emergency department management of exacerbation of chronic obstructive pulmonary disease: audit of compliance with evidence‐based guidelines
Authors: Considine J. , Botti M. , Thomas S.
Published: October 2009

Background: Emergency departments (ED) play a key role in management of exacerbation of chronic obstructive airways disease (COPD). Current guidelines for management of exacerbation of COPD showed highest levels of evidence (Level A and B) were related to use of medications and non‐invasive positive pressure ventilation (NIPPV).

Aims: The aim of this study was to examine compliance with high level evidence for management of exacerbation of COPD during the first 4 h of ED care.

Methods: A retrospective medical record audit was conducted at four public and one private ED in Melbourne, Australia. Participants were adult patients with COPD presenting to the ED with a primary complaint of shortness of breath from July 2006 to July 2007. Outcome measures were compliance with evidence‐based recommendations regarding use of bronchodilators, methylxanthines, steroids and NIPPV.

Results: Of 273 patients in this study, 72.4% received short‐acting beta‐agonist bronchodilators, 37.8% received an inhaled short‐acting anticholinergic medication and 56.6% received systemic steroid therapy. NIPPV was used in 21 patients, 15 of whom had documentation of acidosis and/or hypercapnia).

Conclusions: There was variation in the use of high level evidence for the ED management of exacerbation of COPD. The highest rate of compliance was non‐use of methylxanthines and the greatest deficit was poor compliance with evidence related to NIPPV. There was also scope for improvement in the use of bronchodilators and systemic steroids.
Exploratory study of the ‘weekend effect’ for acute medical admissions to public hospitals in Queensland, Australia
Authors: Clarke M. S. , Wills R.‐A. , Bowman R. V. , Zimmerman P. V. , Fong K. M. , Coory M. D. , Yang I. A.
Published: October 2009

Aims:  To determine whether in‐hospital deaths of patients admitted through emergency departments with acute exacerbations of chronic obstructive pulmonary disease (COPD), acute myocardial infarction, intracerebral haemorrhage and acute hip fracture are increased by weekend versus weekday admission (the ‘weekend effect’).

Methods:  We performed a retrospective analysis of statewide administrative data from public hospitals in Queensland, Australia, during the 2002/2003–2006/2007 financial years. The primary outcome was 30‐day in‐hospital mortality. The secondary outcome of 2‐day in‐hospital mortality helped determine whether increased mortality of weekend admissions was closely linked to weekend medical care.

Results:  During the study period, there were 30 522 COPD, 17 910 acute myocardial infarction, 4183 acute hip fracture and 1781 intracerebral haemorrhage admissions. There was no significant weekend effect on 30‐day in‐hospital mortality for COPD (adjusted risk ratio = 0.92, 95% CI: 0.81–1.04, P= 0.222), intracerebral haemorrhage (adjusted risk ratio = 1.01, 95% CI: 0.86–1.16, P= 0.935) or acute hip fracture (adjusted risk ratio = 0.78, 95% CI: 0.54–1.03, P= 0.13). There was a significant weekend effect for acute myocardial infarction (adjusted risk ratio = 1.15, 95% CI: 1.03–1.26, P= 0.007). Two‐day in‐hospital mortality showed similar results.

Conclusion:  This is the first Australian study on the ‘weekend effect’ (in a cohort other than neonates), and the first study worldwide to assess specifically the weekend effect among COPD patients. Observed patterns were consistent with overseas research. There was a significant weekend effect for myocardial infarction. Further research is needed to determine whether location (e.g. rural), clinical (e.g. disease severity) and service provision factors (e.g. access to invasive procedures) influence the weekend effect for acute medical conditions in Australia.
Tissue‐type plasminogen activator‐plasmin‐BDNF modulate glutamate‐induced phase‐shifts of the mouse suprachiasmatic circadian clock in vitro
Authors: Mou Xiang , Peterson Cynthia B. , Prosser Rebecca A.
Published: October 2009

The mammalian circadian clock in the suprachiasmatic nucleus (SCN) maintains environmental synchrony through light signals transmitted by glutamate released from retinal ganglion terminals. Brain‐derived neurotrophic factor (BDNF) is required for light/glutamate to reset the clock. In the hippocampus, BDNF is activated by the extracellular protease, plasmin, which is produced from plasminogen by tissue‐type plasminogen activator (tPA). We provide data showing expression of proteins from the plasminogen activation cascade in the SCN and their involvement in circadian clock phase‐resetting. Early night glutamate application to SCN‐containing brain slices resets the circadian clock. Plasminogen activator inhibitor‐1 (PAI‐1) blocked these shifts in slices from wild‐type mice but not mice lacking its stabilizing protein, vitronectin (VN). Plasmin, but not plasminogen, prevented inhibition by PAI‐1. Both plasmin and active BDNF reversed α2‐antiplasmin inhibition of glutamate‐induced shifts. α2‐Antiplasmin decreased the conversion of inactive to active BDNF in the SCN. Finally, both tPA and BDNF allowed daytime glutamate‐induced phase‐resetting. Together, these data are the first to demonstrate expression of these proteases in the SCN, their involvement in modulating photic phase‐shifts, and their activation of BDNF in the SCN, a potential ‘gating’ mechanism for photic phase‐resetting. These data also demonstrate a functional interaction between PAI‐1 and VN in adult brain. Given the usual association of these proteins with the extracellular matrix, these data suggest new lines of investigation into the locations and processes modulating mammalian circadian clock phase‐resetting.
IL1RAPL1 controls inhibitory networks during cerebellar development in mice
Authors: Gambino Frédéric , Kneib Marie , Pavlowsky Alice , Skala Henriette , Heitz Stéphane , Vitale Nicolas , Poulain Bernard , Khelfaoui Malik , Chelly Jamel , Billuart Pierre , Humeau Yann
Published: October 2009

Abnormalities in the formation and function of cerebellar circuitry potentially contribute to cognitive deficits in humans. In the adult, the activity of the sole output neurons of the cerebellar cortex – the Purkinje cells (PCs) – is shaped by the balance of activity between local excitatory and inhibitory circuits. However, how this balance is established during development remains poorly understood. Here, we investigate the role of interleukin‐1 receptor accessory protein‐like 1 (IL1RAPL1), a protein linked to cognitive function which interacts with neuronal calcium sensor 1 (NCS‐1) in the development of mouse cerebellum. Using Il1rapl1‐deficient mice, we found that absence of IL1RAPL1 causes a transient disinhibition of deep cerebellar nuclei neurons between postnatal days 10 and 14 (P10/P14). Upstream, in the cerebellar cortex, we found developmental perturbations in the activity level of molecular layer interneurons (MLIs), resulting in the premature appearance of giant GABAA‐mediated inhibitory post‐synaptic currents capable of silencing PCs. Examination of feed‐forward recruitment of MLIs by parallel fibres shows that during this P10/P14 time window, MLIs were more responsive to incoming excitatory drive. Thus, we conclude that IL1RAPL1 exerts a key function during cerebellar development in establishing local excitation/inhibition balance.
Transgenic and other experimental models of pancreas and islet damage
Authors: Herrera P. L.
Published: October 2009

To unravel the cellular and molecular mechanisms involved in β‐cell renewal and expansion throughout life, several different experimental models were devised in the past. A number of experimental approaches and transgenic models have been engineered to trigger specifically pancreatic injury and thus explore regeneration. Globally, three main strategies are followed to induce pancreas damage: surgical, chemical and genetic. Some of the most relevant studies regarding these three approaches are briefly summarized in this short overview. Although significant progress has been achieved in recent years, there is much room for improving our understanding of many fundamental processes regulating β‐cell mass maintenance.