bluuebunny/crossref_metadata_2025 huggingface dataset:
Application of new homologous in vitro bioassays for human lactogens to assess the actual bioactivity of human prolactin isoforms in hyperprolactinaemic patients
Authors: Leaños‐Miranda Alfredo , Cárdenas‐Mondragón Guadalupe , Rivera‐Leaños Roxana , Ulloa‐Aguirre Alfredo , Goffin Vincent
Published: July 2006

Background   Prolactin (PRL) plays a central role in mammary gland development and lactation. Due to its molecular heterogeneity, measurement of PRL immunoreactivity does not necessarily reflect its intrinsic bioactivity. For many years the Nb2 rat lymphoma cell bioassay has been the only reference bioassay for human lactogens. This bioassay, however, does not always correlate with the clinical features found in some patients exhibiting normal or elevated immunoreactive serum PRL concentrations.

Objectives   (1) To determine the concentrations of bioactive PRL in serum samples from individuals with normoprolactinaemia or with different forms of hyperprolactinaemia using two recently described homologous in vitro bioassays (i.e. a transcriptional bioassay in HEK‐293 cells and a proliferation assay in Ba/F3 cells); and (2) to compare these results with those generated by the classical Nb2 cell bioassay.

Design   Cross‐sectional study.

Setting   An institutional biomedical research laboratory.

Participants   Ten patients with symptomatic hyperprolactinaemia due to prolactinoma, 11 patients with asymptomatic hyperprolactinaemia and macroprolactinaemia, and nine normal women.

Main outcome measures   Measurement of immunoreactive and bioactive concentrations of serum PRL.

Results   Samples from normal women and patients with tumoral hyperprolactinaemia due to prolactinoma exhibited similar within‐group concentration values of bioactive and immunoreactive serum PRL when tested by the three bioassays and the immunoradiometric assay employed. By contrast, measurement of bioactive PRL in samples from patients with macroprolactinaemia revealed that macroprolactin was poorly active in the homologous receptor bioassays, while it was more active in the Nb2 bioassay.

Conclusions   The reduced bioactivity of PRL in patients with macroprolactinaemia may further explain the absence of clinical features of hyperprolactinaemia in these individuals. In addition, our findings indicate that species‐specificity and sensitivity of the bioassays are determinant factors in the measurement of the intrinsic biological activity of circulating PRL.
The role of chromogranin A in the management of patients with phaeochromocytoma
Authors: Grossrubatscher Erika , Dalino Paolo , Vignati Federico , Gambacorta Marcello , Pugliese Raffaele , Boniardi Marco , Rossetti Ornella , Marocchi Alessandro , Bertuzzi Michaela , Loli Paola
Published: July 2006

Objective  Chromogranin A (CgA) is the most accurate general marker of neuroendocrine tumours. Supranormal CgA concentrations have been recorded in patients with tumours of neuroectodermal origin such as phaeochromocytoma and paraganglioma.

Design  The present study was performed to assess the role of CgA determination in the management of patients with phaeochromocytoma, in comparison with urinary catecholamines and their metabolites.

Patients  The patients studied included 22 cases with phaeochromocytoma at initial presentation or at relapse some years after surgical cure or during follow‐up of a malignant phaeochromocytoma. Seventeen patients were evaluated before and after surgical removal of phaeochromocytoma. To assess the specificity of the hormonal parameters, 20 subjects were enrolled as controls; they were from a group of patients referred to our observation for possible phaeochromocytoma and who were subsequently proven not to have the disease.

Results  Urinary epinephrine and norepinephrine were supranormal in 82% and 77% of patients, respectively. Urinary metanephrines and normetanephrines were supranormal in 84% and 89% of patients, respectively. The combination of urinary metanephrine and normetanephrine had a sensitivity of 100% in identifying a phaeochromocytoma. CgA was supranormal in 91% of patients. Combining the results of CgA and urinary catecholamines (epinephrine and norepinephrine), the sensitivity for diagnosis of phaeochromocytoma was 100%. Urinary catecholamines, metabolites (metanephrine and normetanephrine) and CgA levels in patients with malignant phaeochromocytoma did not differ significantly from those of patients with benign lesions. In most cases, CgA normalized after surgery.

Conclusions  Our results indicate that CgA is a good marker of phaeochromocytoma; measurement of CgA could have a role in the follow‐up of patients operated on for phaeochromocytoma.
Insulin resistance, endocrine function and adipokines in type 2 diabetes patients at different glycaemic levels: potential impact for glucotoxicity in vivo
Authors: Lindmark S. , Burén J. , Eriksson J. W.
Published: July 2006

Objective  To evaluate the interplay between hyperglycaemia, insulin resistance, hormones and adipokines in patients with type 2 diabetes mellitus (T2DM).

Design and methods  Ten patients with T2DM with good glycaemic control (G), 10 with poor control (P) and 10 nondiabetic control subjects (C) were matched for sex (M/F 6/4), age and body mass index. A hyperinsulinaemic, euglycaemic clamp was performed and cytokines and endocrine functions, including cortisol axis activity were assessed.

Results  Patients with diabetes were more insulin resistant than group C, and group P exhibited the highest degree of insulin resistance (P = 0·01, P vs C). Tumour necrosis factor (TNF)‐alpha levels were elevated in patients with diabetes (P = 0·05) and group P had the highest levels of fasting serum cortisol (P = 0·05), nonesterified fatty acids (NEFA; P = 0·06) and C‐reactive protein (CRP; P = 0·01). Adiponectin levels were lower in the P group. In partial correlation analyses, significant associations were found: glycaemic level (HbA1c) with insulin resistance, TNF‐alpha, CRP and basal and ACTH‐stimulated cortisol levels, insulin resistance with plasma NEFA, TNF‐alpha and stimulated cortisol levels.

Conclusion  Poor glycaemic control in patients with T2DM was associated with insulin resistance and with elevated TNF‐alpha, CRP and basal as well as stimulated cortisol levels. Inflammatory mediators, e.g. TNF‐alpha, may contribute to insulin resistance in hyperglycaemic patients with T2DM and this might be a partial explanation for glucotoxicity.
Early activation of the inhibin B/FSH axis in obese Tanner stage G1PH1 boys
Authors: Fu Jun‐fen , Dong Guan‐ping , Liang Li , Jiang You‐Jun , Chen Li‐qing , Dayan Colin
Published: July 2006

Objective  To determine whether early activation of the inhibin B/FSH axis is detectable in prepubertal obese boys.

Methods  Thirty‐five simple obese Tanner stage G1PH1 boys with body mass index over 25 aged 8–11 years old and 25 age‐matched nonobese healthy prepubertal boys (G1PH1) were clinically examined and testicular size measured by ultrasound. Serum inhibin B, testosterone, LH, FSH, dehydroepiandrosterone (DHEA), DHEA sulfate (DHEAS) and bone age were measured. GnRH‐stimulating tests were performed in the obese children and the relationships between inhibin B and bone age, testicular volume, DHEA, DHEAS, and stimulated peak LH, FSH and testosterone were analysed.

Results  The majority of basal LH and testosterone levels were undetectable in both groups of G1PH1 children and no difference was apparent between the groups. However, testicular volume (left 1·21 ml vs 0·83 ml, right 1·15 ml vs 0·81 ml), bone age, DHEA and DHEAS levels were significantly higher in obese children. Inhibin B was detectable in all children. Basal levels were significantly higher in obese children (103·3 ng/l vs 60·95 ng/l, P < 0·001) and correlated with testicular volume (left: rs = 0·655, right: rs = 0·638, P < 0·001) and bone age (rs = 0·554, P < 0·05). Basal FSH levels did not correlate with inhibin B. However, after GnRH stimulation, a clear negative correlation between peak FSH and basal inhibin B was apparent (rs = −0·583, P < 0·001) consistent with early activation of the inhibin B/FSH axis.

Conclusions  Activation of the inhibin B/FSH axis is apparent in obese Tanner stage G1PH1 boys and appears to represent an early hormonal change of puberty in these individuals.
Growth hormone secretion is impaired in amyotrophic lateral sclerosis
Authors: Morselli L. L. , Bongioanni P. , Genovesi M. , Licitra R. , Rossi B. , Murri L. , Rossi G. , Martino E. , Gasperi M.
Published: July 2006

Objective   ALS is the most common motor neurone disorder in human adults. Scanty data on endocrine abnormalities have been reported. The aim of the present study was to investigate the GH‐IGF‐I axis in ALS patients.

Patients   Twenty‐two ALS patients (12 men, 10 women), mean age 61 years, and 25 normal age‐ and sex‐matched subjects. No patient was under riluzole therapy.

Measurements  Patients and controls underwent a GHRH plus arginine test. IGF‐I was determined at baseline. A complete evaluation of pituitary function was also performed.

Results   Mean (± SD) basal GH levels were significantly reduced compared with normal controls (0·2 ± 0·3 vs 1·6 ± 1·8 ng/ml, P < 0·01), as well as peak GH concentrations after GHRH + arginine administration (12·6 ± 8·9 vs 39·9 ± 18·7 ng/ml, P < 0·001). Six (27%) patients showed a normal GH response to stimulus; 7 (32%) patients displayed a moderate GH deficiency; in 9 (40%) patients GH response was markedly deficient. IGF‐I levels were normal in the majority of patients (mean ± SD: 143·6 ± 63·8 ng/ml). No significant correlation was observed between peak GH concentrations and age, BMI, disease duration, severity or clinical form. A higher incidence of GH deficiency was observed in male compared to female patients (83%vs 60%), with a peak GH response in males significantly lower than in females (8·9 ± 6·6 vs 17 ± 9·6 ng/ml, P = 0·03). Eighteen patients repeated the test after 5 months and similar results were obtained.

Conclusions   The present data indicate a reduction of GH secretion in ALS patients.
Use of an individual‐based model to forecast the effect of climate change on the dynamics, abundance and geographical range of the pest slugDeroceras reticulatumin the UK
Authors: WILLIS JENNA C. , BOHAN DAVID A. , CHOI YOON H. , CONRAD KELVIN F. , SEMENOV MIKHAIL A.
Published: July 2006

Slugs are serious agricultural pests and their activity is strongly driven by ambient temperature and soil moisture. The strength of this relationship has been shown through the development of a deterministic model, based upon temperature and soil moisture conditions alone, which accurately describes the population dynamics and abundance ofDeroceras reticulatum. Because of this strong climatic dependence, slug abundance and dynamics are likely to be affected by climate change. We used a validated individual‐based model (IbM) ofD. reticulatum, to assess the effects of climate change on the abundance of this species in the UK. Climatic scenarios were based on the UKCIP02 predictions and constructed using the LARS‐WG stochastic weather generator. The IbM of slugs predicted population dynamics at three time slices (2020s, 2050s and 2080s), and two scenarios of greenhouse gas emissions. The maximum generation number, the number of population peaks, the number of slug‐days in each season, the percentage of years when the population passes over a threshold for damage and the percentage of years in which populations go extinct were investigated. Currently, the south‐west of the UK has the best conditions forD. reticulatumto thrive, with the north‐east of Scotland having the most adverse. By 2080 under both low‐ and high‐emissions scenarios, the north and west of Scotland will have the most favourable conditions for the survival of this species and the east of the UK and Scotland will have the harshest. By 2080 the climate in the north‐west of Scotland will become more like the current climate in south‐east England, which explains the shift in the pattern of abundance. The north‐west of Scotland will have increased slug damage and south‐west England and west‐Wales will have decreased slug damage with some changes becoming evident by 2020.
Sorption of dissolved organic matter by mineral soils of the Siberian forest tundra
Authors: KAWAHIGASHI MASAYUKI , KAISER KLAUS , RODIONOV ANDREJ , GUGGENBERGER GEORG
Published: July 2006

Because of low net production in arctic and subarctic surface water, dissolved organic matter (DOM) discharged from terrestrial settings plays an important role for carbon and nitrogen dynamics in arctic aquatic systems. Sorption, typically controlling the export of DOM from soil, may be influenced by the permafrost regime. To confirm the potential sorptive control on the release of DOM from permafrost soils in central northern Siberia, we examined the sorption of DOM by mineral soils of Gelisols and Inceptisols with varying depth of the active layer. Water‐soluble organic matter in the O horizons of the Gelisols was less (338 and 407 mg C kg−1) and comprised more dissolved organic carbon (DOC) in the hydrophobic fraction (HoDOC) (63% and 70%) than in the O horizons of the Inceptisols (686 and 706 mg C kg−1, 45% and 48% HoDOC). All A and B horizons from Gelisols sorbed DOC strongly, with a preference for HoDOC. Almost all horizons of the Inceptisols showed a weaker sorption of DOC than those of the Gelisols. The C horizons of the Inceptisols, having a weak overall DOC sorption, sorbed C in the hydrophilic fraction (HiDOC) stronger than HoDOC. The reason for the poor overall sorption and also the preferential sorption of HiDOC is likely the high pH (pH>7.0) of the C horizons and the smaller concentrations of iron oxides. For all soils, the sorption of HoDOC related positively to oxalate‐ and dithionite–citrate‐extractable iron. The A horizons released large amounts of DOC with 46–80% of HiDOC. The released DOC was significantly (r=0.78, P<0.05) correlated with the contents of soil organic carbon. From these results, we assume that large concentrations of DOM comprising large shares of HiDOC can pass mineral soils where the active layer is thin (i.e. in Gelisols), and enter streams. Soils with deep active layer (i.e. Inceptisols), may release little DOM because of more frequent infiltration of DOM into their thick mineral horizons despite their smaller contents of reactive, poorly crystalline minerals. The results obtained for the Inceptisols are in agreement with the situation observed for streams connecting to Yenisei at lower latitudes than 65°50′ with continuous to discontinuous permafrost. The smaller sorption of DOM by the Gelisols is in agreement with the larger DOM concentrations in more northern catchments. However, the Gelisols preferentially retained the HoDOC which dominates the DOC in streams towards north. This discrepancy can be explained by additional seepage water from the organic horizons that is discharged into streams without intensive contact with the mineral soil.
The optimization of the extrusion process when using maize flour with a modified amino acid profile for making tortillas
Authors: Milán‐Carrillo Jorge , Gutiérrez‐Dorado Roberto , Perales‐Sánchez Janitzio Xiomara Karina , Cuevas‐Rodríguez Edith Oliva , Ramírez‐Wong Benjamin , Reyes‐Moreno Cuauhtémocc
Published: July 2006

Maize with a modified amino acid profile, i.e. greater amounts of lysine and tryptophan than normal, is known as ‘quality protein maize’ (QPM). The objective of this work was to find the best combination of extrusion process variables to produce QPM flour for making tortillas. QPM grits were mixed with lime and water and had a moisture content of 28%. The single screw extruder operation conditions were selected from factorial combination of three process variables: extrusion temperature (ET, 70–100 °C), lime concentration (LC, 0.1–0.3% of the maize weight) and screw velocity (SV, 80–250 rpm). Response surface methodology was used as an optimization technique. In vitro protein digestibility (PD); total colour difference (ΔE) of the flours, and tortilla puffing (TP) were chosen as response variables. A graphical method was used to obtain maximum PD, TP and minimum ΔE. The optimum combination of process variables was: ET = 85 °C/LC = 0.21%(w/w)/SV = 240 rpm. Tortillas from QPM flour had similar chemical composition, physicochemical and sensory properties to tortillas from commercial nixtamalized maize flour; however, the former had the highest (P ≤ 0.05) available lysine content and were therefore better nutritionally.
Productions and monomer compositions of exopolysaccharides by Lactobacillus delbrueckii subsp. bulgaricus and Streptococcus thermophilus strains isolated from traditional home‐made yoghurts and raw milk
Authors: Aslim Belma , Beyatli Yavuz , Yuksekdag Zehra Nur
Published: July 2006

In this study, a total of forty‐five strains of lactobacilli and streptococci were determined exopolysaccharide (EPS) production in skim milk and Man Rogosa and Sharpe (MRS)/M17 medium, viscosity and proteolytic activity. The exopolysaccharide production by lactobacilli strains during growth in MRS medium was twenty‐one to 211 mg L−1, while in skim milk was to thirty‐six to 315 mg L−1. The EPS production by streptococci strains during growth in M17 medium was sixteen to 114 mg L−1, while in skim milk was to twenty‐four to 140 mg L−1. The EPS production of strains was lower in MRS/M17 medium than skim milk. Results showed that it was not clear correlation between the viscosity and EPS production of some strains. All strains were shown proteolytic activity. Positive correlations between exopolysaccharide production and proteolytic activity in skim milk were found some strains of Lactobacillus delbrueckii subsp. bulgaricus and Streptococcus thermophilus. These results indicated that the high exocellular protease‐producing strains can produce high EPS in skim milk. The monomer compositions of the EPSs formed by selected five strains were analysed. Mannose dominated (99–100%) on the EPS produced by L. delbrueckii subsp. bulgaricus and S. thermophilusstrains (except L. delbrueckii subsp. bulgaricus 22) in skim milk and MRS/M17 medium. Besides, the EPSs of strains in skim milk contained small amount of lactose.
Effect of addition of sucrose and aspartame on the compression resistance of hydrocolloids gels
Authors: Bayarri Sara , Izquierdo Luis , Durán Luis , Costell Elvira
Published: July 2006

The effect of adding sucrose (5–25% w/w) and aspartame (0.04–0.16% w/w) on the compression resistance of three hydrocolloid gelled systems: κ‐carrageenan, gellan gum and κ‐carrageenan/locust bean gum at three different concentrations (0.3, 0.75 and 1.2% w/w) was studied. Sucrose addition increased true rupture stress in the three‐gelled systems, this effect being stronger in gellan gels. The deformability modulus increased with sucrose concentration in gellan gels, but not in the other systems. Rupture stress and deformability modulus increased with the addition of sucrose only in the harder gels (0.75 and 1.2% w/w). The effect of sucrose addition on the true rupture strain was significant but, in general, not important, mainly for lower gum concentrations. Aspartame addition did not affect the compression parameters.
Evolution of practice nursing in Australia
Authors: Halcomb Elizabeth J. , Patterson Elizabeth , Davidson Patricia M.
Published: July 2006

Aim. This paper describes the evolution of Australian practice nursing and documents seminal events in crystallizing the importance of the nursing role in general practice.

Background. Internationally, the potential for nurses to improve health in primary care settings is acknowledged. The general practice setting is a focal point for primary care in many health systems. Despite the important role played in the delivery of primary health care by nurses working in general practice in the United Kingdom and New Zealand, the role of nurses in Australian general practice is much less clearly defined, as reflected by the paucity of research and scholarship in this area. Fuelled by the increasing challenges of workforce shortages and the increasing need for multidisciplinary care, interest in the developing role of the Australian practice nurse among clinicians, researchers and policy makers is increasing.

Discussion. Australian practice nursing has reached a critical point in its evolution. It is imperative for the promotion of nursing in general practice that knowledge from descriptive, exploratory research be used to inform strategic decision‐making in terms of professional development issues, policy, research and scholarship. These data also need to inform systematic outcome studies. To date, the embryonic nature of practice nursing as a discrete professional entity in Australia has inhibited its representation in nursing curricula and professional bodies.

Conclusion. In order to advance the Australian practice nurse movement and demonstrate its important contribution to primary health care, nurses need to take the lead in strategic planning of this emerging specialty. As well as leadership from an academic, research and policy perspective, clinical leaders need to be fostered among the ranks of practice nurse clinicians to drive clinical practice development and the delivery of evidence‐based primary care.
Ethical codes in nursing practice: the viewpoint of Finnish, Greek and Italian nurses
Authors: Heikkinen Anne , Lemonidou Chryssoula , Petsios Konstantinos , Sala Roberta , Barazzetti Gaia , Radaelli Stefania , Leino‐Kilpi Helena
Published: July 2006

Aim. This paper is a report of a study exploring the use of ethical codes and obstacles to their use in nursing practice as perceived by Finnish, Greek and Italian nurses.

Background. In all European countries nurses are responsible for the well‐being of patients, for their own technical and ethical competence and, for their own part, for the high standard of health care in society. These points illustrate the central content areas of nursing codes of ethics. Recent advances in medical technology have added to the complexity of nursing. Nurses today are increasingly confronted with ethical dilemmas, underlining the role and meaning of ethical codes in their decision‐making. However, there is only very limited research literature on codes of ethics, their use in nursing practice and obstacles to their use.

Methods. Twenty‐three focus group interviews were conducted in 2003 with a total of 138 Registered Nurses: 35 in Finland, 54 in Greece and 49 in Italy. The data were content analysed.

Findings. Two main categories emerged from our analysis of the use of ethical codes: (1) conscious and (2) unconscious use. Seven main categories described the obstacles to the use of ethical codes: (1) the codes themselves, (2) nurses themselves, (3) multiprofessional teamwork, (4) patients’ family members, (5) the organization, (6) the nursing profession and (7) society/healthcare policy. Participants in all three countries were firmly committed to the values expressed in ethical nursing codes. Nonetheless, continued efforts are needed in all these countries to remove the remaining obstacles so that nursing care can be provided in keeping with the requirements of ethical codes.

Conclusion. The use of codes is connected with the changes in nursing profession and in society at large. The core of nursing, however, has remained stable. Future studies should be conducted in order to generalize the findings to a broader population.
Trainee teachers' views on what helps them to use information and communication technology effectively in their subject teaching
Authors: Barton R. , Haydn T.
Published: July 2006

Abstract
This study explored the views of initial teacher trainees on various components of their training in the use of new technology to teach their subject. The research focused on trainees' reflections on their experiences of trying to ‘get better’ at information and communication technology (ICT) in the course of their training. Data collection involved baseline and follow‐up questionnaire surveys of trainees' attitudes to the use of ICT in subject teaching and the factors that they felt had hindered or promoted their development in the use of ICT, and focus group interviews with small groups of trainees. In spite of the importance attached to this facet of initial training, and significant investment in terms of time and training materials and resources, there is evidence to suggest that much of this investment is not found to be helpful by trainees. In particular, there appears to be a danger that they have simply been overwhelmed with information about the use of ICT to such an extent that they do not feel that they can realistically be expected to engage with many of the materials that have been produced. In addition to ascertaining trainees' views on strategies and interventions that they did not find helpful, the data identify some key factors and moments that trainees felt had a major impact on their progress in the use of ICT. The outcomes of the enquiry reveal clear preferences among trainees for modes of working with ICT, and in terms of the experiences that they felt had impacted on their ability to use ICT in their subject teaching. The concluding section of the paper considers the ways in which trainees' induction into the use of new technology might be made more effective.
Using handhelds in a Jigsaw cooperative learning environment
Authors: Lai C.‐Y. , Wu C.‐C.
Published: July 2006

Abstract
This paper reports our implementation of a handheld wireless environment to support Jigsaw cooperative learning activities in a college setting. A quasi‐experimental research design was conducted to investigate the effects of using handhelds, as well as issues associated with the use of handheld technology. Two intact classes of fourth‐year students from a five‐year junior nursing college participated in the experiment. Our findings showed that handheld tools enhanced both students' attitudes and performance in learning, and promoted better interactions among students and instructors. We also found that the handheld technology was not sophisticated enough to support cooperative learning goals without full support from a technology specialist.
Computer‐assisted teaching and mathematical learning in Down Syndrome children
Authors: Ortega‐Tudela J. M. , Gómez‐Ariza C. J.
Published: July 2006

Abstract
The present study aims to explore the extent to which computer‐assisted teaching facilitates the learning of basic mathematical concepts and skills in children with Down Syndrome (DS). Thus, the effectiveness of a multimedia teaching method is compared with a traditional one in the teaching of counting and cardinality abilities and concepts. In our study, two groups of DS children were trained. One of them was taught by using mathematical multimedia software whereas the other learned by means of pencil–paper‐based tasks on the same material as the multimedia group. The children of both groups were evaluated before and after training sessions. The multimedia group showed a higher performance than the paper and pencil assisted teaching group on a variety of tasks and measures, suggesting a clear relation between teaching method and mathematical learning in DS children. These findings are discussed in terms of their theoretical as well as applied relevance.
Adolescent Drug Abuse Diagnosis (ADAD) vs. Health of Nation Outcome Scale for Children and Adolescents (HoNOSCA) in clinical outcome measurement
Authors: Holzer Laurent , Tchemadjeu Irène Kölbl , Plancherel Bernard , Bolognini Monique , Rossier Valérie , Chinet Léonie , Halfon Olivier
Published: July 2006

Background  The Adolescent Drug Abuse Diagnosis (ADAD) and Health of Nation Outcome Scales for Children and Adolescents (HoNOSCA) are both measures of outcome for adolescent mental health services.

Aims  To compare the ADAD with HoNOSCA; to examine their clinical usefulness.

Methods  Comparison of the ADAD and HoNOSCA outcome measures of 20 adolescents attending a psychiatric day care unit.

Results  ADAD change was positively correlated with HoNOSCA change. HoNOSCA assesses the clinic’s day‐care programme more positively than the ADAD. The ADAD detects a group for which the mean score remains unchanged whereas HoNOSCA does not.

Conclusions  A good convergent validity emerges between the two assessment tools. The ADAD allows an evidence‐based assessment and generally enables a better subject discrimination than HoNOSCA. HoNOSCA gives a less refined evaluation but is more economic in time and possibly more sensitive to change. Both assessment tools give useful information and enabled the Day‐care Unit for Adolescents to rethink the process of care and of outcome, which benefited both the institution and the patients.
The Western Canada Waiting List Project: development of a priority referral score for hip and knee arthroplasty
Authors: De Coster Carolyn , McMillan Stewart , Brant Rollin , McGurran John , Noseworthy Tom ,   Primary Care Panel of the Western Canada Waiting List Project
Published: July 2006

Background  Recognizing the concerns about long waiting times to see some specialists in Canada, and the burden this places on both primary care and specialist clinicians, the Western Canada Waiting List (WCWL) undertook the Primary Care Project. The goal was to develop a valid, reliable, standardized prioritization tool for use by primary care providers in making referrals to specialists. WCWL is a 20‐partner collaboration committed to addressing long waiting times to access scheduled health care services.

Methods  A previously developed prioritization tool for hip and knee replacement was adapted for use by family doctors, based on expert feedback from a clinical panel of primary care providers and from orthopaedic surgeons. Rater assessments of standardized paper cases were used to generate weights for criteria items in the Priority Referral Score (PRS). Intraclass correlations (ICCs) were calculated to assess reproducibility, and weights were estimated using a mixed‐effects model. The weights and criteria items were modified following feedback of these results to the panel. The resulting PRS was reliability‐tested with a different set of standardized case descriptions.

Results  One item was removed from the Hip and Knee Surgery tool and two items more pertinent to family medicine (mobility and medications) were added. The resulting eight‐item PRS had a test–retest ICC of 0.84. The mean intrarater ICC was 0.79.

Conclusions  An eight‐item priority‐setting tool has been developed to assist in queuing patients in order of urgency when they are referred to an orthopaedic surgeon for possible hip or knee arthroplasty. The tool had excellent inter‐ and intrarater reliability and was seen to have face validity by a panel of primary care providers who advised on the project.
Parent implemented early intervention for young children with autism spectrum disorder: a systematic review
Authors: McConachie Helen , Diggle Tim
Published: July 2006

Background  Recent estimates concerning the prevalence of autism spectrum disorder (ASD) suggest that at least one in 200 children is affected. This group of children and families have important service needs. The involvement of parents in implementing intervention strategies designed to help their autistic children has long been accepted as helpful. The potential benefits are increased skills and reduced stress for parents as well as children.

Methods  This research review focused on interventions for children aged 1–6 years, and was carried out using systematic methodology: a comprehensive search of psychological, educational and biomedical databases, as well as bibliographies and reference lists of key articles, contact with experts in the field, and hand search of key journals. Only studies which involved a concurrent element of control were included.

Results  The review found very few studies that had adequate research design from which to draw conclusions about the effectiveness of parent‐implemented early intervention. Both randomized and controlled studies tended to suggest that parent training leads to improved child communicative behaviour, increased maternal knowledge of autism, enhanced maternal communication style and parent child interaction, and reduced maternal depression.

Conclusion  It seems that parent training can successfully contribute to intervention for young children with ASD. However, the review highlights the need for improved research in this area.
Distribution of mycobacteria in clinically healthy ornamental fish and their aquarium environment
Authors: Beran V , Matlova L , Dvorska L , Svastova P , Pavlik I
Published: July 2006

Some mycobacterial species (particularly Mycobacterium marinum) found in aquarium environments may cause chronic diseases in fish and cutaneous infections in humans, the so‐called ‘fish tank granuloma’. The presence and distribution of mycobacterial species in clinically healthy aquarium fish and their environment has not been adequately explored. The present study analysed the occurrence of mycobacteria in a decorative aquarium (Brno, South Moravia) and in five aquaria of a professional fish breeder (Bohumin, North Moravia). After Ziehl–Neelsen staining, acid‐fast rods (AFR) were observed in six (14.3%) and mycobacteria were detected by culture in 18 (42.9%) of 42 tissue samples from 19 fish. Sixty‐five samples of the aqueous environment from all six aquaria were examined; AFR were found in 16 (24.6%) and mycobacteria were detected by culture in 49 (75.4%) samples. Forty‐one (70.7%) of 58 selected mycobacterial isolates were identified biochemically as follows: M. fortuitum, M. flavescens, M. chelonae, M. gordonae, M. terrae, M. triviale, M. diernhoferi, M. celatum, M. kansasii and M. intracellulare. The clinically important species for humans and fish, M. marinum, was not detected. Mycobacterium kansasii was isolated from one sample of the aquarium environment from North Moravia, which is a region of the Czech Republic with endemic incidence of M. kansasii in water. The incidence of other conditionally pathogenic mycobacterial species in healthy fish and in all investigated constituents of the aquarium environment including snails and crustaceans used for fish feeding, was quite high. Accordingly, mycobacterial species from aquarium environments may serve as a possible source of infection for both aquarium fish and immunodeficient fish handlers.
Detection of betanodavirus in juvenile barramundi, Lates calcarifer (Bloch), by antigen capture ELISA
Authors: Fenner B J , Du Q , Goh W , Thiagarajan R , Chua H K , Kwang J
Published: July 2006

Betanodavirus infection of fish has been responsible for mass mortalities in aquaculture hatcheries worldwide. Betanodaviruses possess a bipartite single‐stranded RNA genome consisting of the 3.1 kb RNA1 encoding an RNA‐dependent RNA polymerase and the B2 protein, while the 1.4 kb RNA2 encodes the viral nucleocapsid protein, alpha. A panel of six monoclonal antibodies against the alpha protein of greasy grouper nervous necrosis virus (GGNNV) was developed for use in diagnostics. All antibodies reacted with native and recombinant alpha in immunoblot and indirect immunofluorescence assays. Each of the monoclonal antibodies reacted against discrete regions of the alpha protein, though none reacted with the extreme C‐terminal region of the protein. One of the monoclonal antibodies, specific for the K151–T246 region of alpha, was used for the development of an antigen capture ELISA. In this assay we could detect 103–104 TCID50 units of virus derived from infected tissue culture supernatants. Head tissue extracts prepared from experimentally infected barramundi, Lates calcarifer, juveniles were assayed for GGNNV using the antigen capture assay and a clear increase in alpha antigen was detected from 5 to 15 days post‐challenge. The assay thus represents a useful method for field‐based detection of betanodavirus in fish hatcheries.
An exploration of substance misuse in people with intellectual disabilities
Authors: Taggart L. , McLaughlin D. , Quinn B. , Milligan V.
Published: July 2006

Background  Little is known about the characteristics of people with intellectual disabilities (IDs) who misuse substances and how such problems impinge upon their well‐being. The aim of this paper is to describe how alcohol and drugs affect the health of people with IDs.

Methods  A questionnaire was forwarded to all the community ID teams and mainstream addiction teams across Northern Ireland: 67 substance users with IDs and substantial substance‐related problems were identified.

Results  Alcohol was found to be the main substance to be misused, with one‐fifth of the substance users also found to be using a combination of illicit drugs and/or prescribed medication. Nearly three‐quarters of the sample were found to be hazardously using alcohol for more than 5 years. Being male and young, having a borderline/mild ID, living independently and having a mental health problem were found to be risk factors for developing a ‘substance related problem’. Various problematic behaviours were identified, including aggression, erratic mood changes, sexual exploitation, difficulties in maintaining relationships and loss of daily routine.

Conclusions  The findings of this study suggest that greater emphasis needs to be placed upon the early identification of this hidden population by primary and secondary healthcare personnel, and also ID personnel. Such early identification may also diminish the long‐established patterns of use and associated related‐behaviours that have been reported within this paper.
Working across boundaries: clinical outcomes for an integrated mental health service for people with intellectual disabilities
Authors: Hall I. , Parkes C. , Samuels S. , Hassiotis A.
Published: July 2006

Background  The Mental Health Service for People with Learning Disabilities (MHSPLD) is a service development in keeping with UK government policy that promotes cross agency working and access to mainstream mental health services for people with intellectual disabilities. We aimed to show whether the service model brought about improvements in people’s mental state and level of functioning.

Method  Community and inpatient groups were compared across three time points using a range of clinical outcome measures that assessed psychiatric symptoms, risk, needs and level of functioning.

Results  Inpatients and community groups had similar mental health problems, but inpatients had higher unmet needs and lower functioning, and were at greater risk. There were significant improvements across the range of outcome measures in both groups.

Conclusions  Working with mainstream mental health services and across health and social service boundaries delivers effective mental health care for people with intellectual disabilities.
Psychopathology in tuberous sclerosis: an overview and findings in a population‐based sample of adults with tuberous sclerosis
Authors: Raznahan A. , Joinson C. , O’Callaghan F. , Osborne J. P. , Bolton P. F.
Published: July 2006

Background Tuberous sclerosis (TS) is a multi‐ system disorder with complex genetics. The neurodevelopmental manifestations of TS are responsible for considerable morbidity. The prevalence of epilepsy and intellectual disabilities among individuals with TS have been well described. Ours is the first study that explores the prevalence and pattern of psychopathology in a population‐based sample of adults with TS.

Methods Sixty subjects were identified through a capture–recapture analysis of TS. Information was gathered as to seizure history, cognitive functioning (WISC‐III) and psychopathology (SADS‐L, SAPPA). Lifetime psychopathology was categorized according to Research Diagnostic Criteria. The overall pattern of mental illness (MI) was examined as well as how this varied with IQ and seizure history.

Results Twenty‐four (40.0%) subjects had a history of MI. The most common diagnosis was that of an affective disorder [18 (30.0%)], the majority of which were major depressive episodes. Alcoholism [4 (6.7%)] and anxiety disorders [3 (5.0%)] were the next most common diagnoses. Two (3.3%) subjects had had a tic disorder. Only one individual had a diagnosis of schizophrenia. MI was found in 75.0% of those with a history of epilepsy and 37.5% of those without epilepsy. MI was significantly more prevalent in those with a full‐scale IQ above 70.

Conclusions A significant proportion of adult with TS experience MI. MI was significantly less prevalent in subjects with a full‐scale IQ above 70. Reasons for such a finding are explored, and related methodological considerations for future research outlined.
Psychiatric co‐morbidity and gender differences in intellectual disability
Authors: Tsakanikos E. , Bouras N. , Sturmey P. , Holt G.
Published: July 2006

Background  Although gender differences in psychopathology among the general psychiatric population appear to be well documented, such differences have been either ignored or inconsistently investigated among people with intellectual disability (ID).

Methods  The study examined psychiatric co‐ morbidity in 295 men and 295 women with ID and significant social impairments living in community settings. The sample was drawn from consecutive clinical referrals to a specialist mental heath service of South‐East London. Psychiatric diagnoses were based on ICD‐10 criteria.

Results  Personality disorder was more common among men, although dementia and adjustment reaction were more common among women. There were also gender differences in marital status, with a larger percentage of women being either married or in a stable relationship. Gender differences in the source of referral were also observed, with more women being referred through primary care and more men being referred through generic mental health services.

Conclusions  Female patients seem to have at some extent different mental health needs from male patients. Such differences should be taken into account in the design and delivery of clinical service for people with ID.
Mental health and intellectual disability: culture and diversity
Authors: Littlewood R.
Published: July 2006

Background  Compared with that in mental illness, cultural variation in popular conceptualisations of intellectual disability has been rarely addressed.

Methods  A survey of the relevant literature was conducted.

Results and Conclusion  Preliminous conclusions are that local conceptualisation does not lead to invariant social response, but that intellectual disability is generally distinguished from mental illness.
So what exactly is a nurse?
Authors: CLARKE L.
Published: July 2006

The problematic nature of defining nursing is examined. Contrasts are set out in respect of the work of different grades of practitioner and how these do or do not constitute nursing care. A concept of caring and caring profession is utilized as a backdrop by which it is argued that caring can be defended as an ethical position independently of its objects of care. The paper asserts the existence of different perspectives within mental health nursing and demonstrates how these are influenced by extraneous forces. It concludes by (1) defending universal moral rules that operate independently of situations or the objects to which they apply and (2) that the usefulness of invoking a nursing identity may be less rather than more illuminative in exposing what mental health (psychiatric) ‘nursing’ is.
Can mainstream health services provide meaningful care for people who self‐harm? A critical reflection
Authors: SIMPSON A.
Published: July 2006

People who self‐harm currently access health care based in a wide variety of settings. These include primary care, accident and emergency departments, and specialist mental health providers. This paper considers whether meaningful care for people who self‐harm can be provided within these mainstream health services. The paper begins by clarifying the meaning of self‐harm and distinguishes self‐harm from suicide. Four treatment models applied in clinical practice are identified: (i) psychodynamic, (ii) behavioural, (iii) biosocial and (iv) feminist. Each of these is critically considered in terms of practical utility, professional attitudes and wider organizational/policy context.
Molecular neuropathology of MELAS: level of heteroplasmy in individual neurones and evidence of extensive vascular involvement
Authors: Betts J. , Jaros E. , Perry R. H. , Schaefer A. M. , Taylor R. W. , Abdel‐All Z. , Lightowlers R. N. , Turnbull D. M.
Published: July 2006

Mitochondrial DNA (mtDNA) disease is an important genetic cause of neurological disability. A variety of different clinical features are observed and one of the most common phenotypes is MELAS (Mitochondrial Myopathy, Encephalopathy, Lactic Acidosis and Stroke‐like episodes). The majority of patients with MELAS have the 3243A>G mtDNA mutation. The neuropathology is dominated by multifocal infarct‐like lesions in the posterior cortex, thought to underlie the stroke‐like episodes seen in patients. To investigate the relationship between mtDNA mutation load, mitochondrial dysfunction and neuropathological features in MELAS, we studied individual neurones from several brain regions of two individuals with the 3243A>G mutation using dual cytochrome c oxidase (COX) and succinate dehydrogenase (SDH) histochemistry, and Polymerase Chain Reaction Restriction Fragment Lenght Polymorphism (PCR‐RFLP) analysis. We found a low number of COX‐deficient neurones in all brain regions. There appeared to be no correlation between the threshold level for the 3243A>G mutation to cause COX deficiency within single neurones and the degree of pathology in affected brain regions. The most severe COX deficiency associated with the highest proportion of mutated mtDNA was present in the walls of the leptomeningeal and cortical blood vessels in all brain regions. We conclude that vascular mitochondrial dysfunction is important in the pathogenesis of the stroke‐like episodes in MELAS patients. As migraine is a commonly encountered feature in MELAS, we propose that coupling of the vascular mitochondrial dysfunction with cortical spreading depression (CSD) might underlie the selective distribution of ischaemic lesions in the posterior cortex in these patients.