bluuebunny/crossref_metadata_2025 huggingface dataset:
Artificial hydration and nutrition in advanced Alzheimer's disease: facilitating family decision‐making
Authors: Eggenberger Sandra K , Nelms Tommie P
Published: August 2004

Background.  As Alzheimer's disease progresses to its final stages of dementia and dysphagia, whereby patients can no longer swallow food and fluids, families suffer with difficult decisions regarding initiation of artificial hydration and nutrition.

Aims and objectives.  Through the use of a hypothetical family scenario, this theoretical article presents the ethical principals of beneficence and autonomy as a framework for use by nurses to hear and inform family decision‐makers of the physiology of death in the advanced stages of Alzheimer's and examines the current literature related to benefits and burdens of artificial hydration and nutrition.

Conclusions.  While a beneficial consideration, ethical principles are critiqued for their inability to provide an absolute answer and relieve family suffering in this clinical situation.

Relevance to clinical practice.  A nurse‐lead consensus building process is proposed to guide family decision‐making regarding artificial hydration and nutrition with advanced Alzheimer's disease.
The role of histones in chromatin remodelling during mammalian spermiogenesis
Authors: Govin Jérôme , Caron Cécile , Lestrat Cécile , Rousseaux Sophie , Khochbin Saadi
Published: August 2004

One of the most dramatic chromatin remodelling processes takes place during mammalian spermatogenesis. Indeed, during the postmeiotic maturation of male haploid germ cells, or spermiogenesis, histones are replaced by small basic proteins, which in mammals are transition proteins and protamines. However, nothing is known of the mechanisms controlling the process of histone replacement. Two hints from the literature could help to shed light on the underlying molecular events: one is the massive synthesis of histone variants, including testis‐specific members, and the second is a stage specific post‐translational modification of histones. A new testis‐specific ‘histone code’ can therefore be generated combining both histone variants and histone post‐translational modifications. This review will detail these two phenomena and discuss possible functional significance of the global chromatin alterations occurring prior to histone replacement during spermiogenesis.
Thioredoxin Ch1 of Chlamydomonas reinhardtii displays an unusual resistance toward one‐electron oxidation
Authors: Sicard‐Roselli Cécile , Lemaire Stéphane , Jacquot Jean‐Pierre , Favaudon Vincent , Marchand Christophe , Houée‐Levin Chantal
Published: August 2004

To test thioredoxin resistance to oxidizing free radicals, we have studied the one‐electron oxidation of wild‐type thioredoxin and of two forms with the point mutations D30A and W35A, using azide radicals generated by γ‐ray or pulse radiolysis. The oxidation patterns of wild‐type thioredoxin and D30A are similar. In these forms, Trp35 is the primary target and is ‘repaired’ by one‐electron reduction; first by intramolecular electron transfer from tyrosine, and then from other residues. Conversely, during oxidation of W35A, Trp13 is poorly reactive. For all proteins, activity is conserved showing an unusual resistance toward oxidation.
An α‐proteobacterial type malate dehydrogenase may complement LDH function in Plasmodium falciparum
Authors: Tripathi Abhai K. , Desai Prashant V. , Pradhan Anupam , Khan Shabana I. , Avery Mitchell A. , Walker Larry A. , Tekwani Babu L.
Published: August 2004

Malate dehydrogenase (MDH) may be important in carbohydrate and energy metabolism in malarial parasites. The cDNA corresponding to the MDH gene, identified on chromosome 6 of the Plasmodium falciparum genome, was amplified by RT‐PCR, cloned and overexpressed in Escherichia coli. The recombinant Pf MDH was purified to homogeneity and biochemically characterized as an NAD+(H)‐specific MDH, which catalysed reversible interconversion of malate to oxaloacetate. Pf MDH could not use NADP/NADPH as a cofactor, but used acetylpyridine adenine dinucleoide, an analogue of NAD. The enzyme exhibited strict substrate and cofactor specificity. The highest levels of Pf MDH transcripts were detected in trophozoites while the Pf MDH protein level remained high in trophozoites as well as schizonts. A highly refined model of Pf MDH revealed distinct structural characteristics of substrate and cofactor binding sites and important amino acid residues lining these pockets. The active site amino acid residues involved in substrate binding were conserved in Pf MDH but the N‐terminal glycine motif, which is involved in nucleotide binding, was similar to the GXGXXG signature sequence found in Pf LDH and also in α‐proteobacterial MDHs. Oxamic acid did not inhibit Pf MDH, while gossypol, which interacts at the nucleotide binding site of oxidoreductases and shows antimalarial activity, inhibited Pf MDH also. Treatment of a synchronized culture of P. falciparum trophozoites with gossypol caused induction in expression of Pf MDH, while expression of Pf LDH was reduced and expression of malate:quinone oxidoreductase remained unchanged. Pf MDH may complement Pf LDH function of NAD/NADH coupling in malaria parasites. Thus, dual inhibitors of Pf MDH and Pf LDH may be required to target this pathway and to develop potential new antimalarial drugs.
Molecular characterization of recombinant mouse adenosine kinase and evaluation as a target for protein phosphorylation
Authors: Sahin Bogachan , Kansy Janice W. , Nairn Angus C. , Spychala Jozef , Ealick Steven E. , Fienberg Allen A. , Greene Robert W. , Bibb James A.
Published: August 2004

The regulation of adenosine kinase (AK) activity has the potential to control intracellular and interstitial adenosine (Ado) concentrations. In an effort to study the role of AK in Ado homeostasis in the central nervous system, two isoforms of the enzyme were cloned from a mouse brain cDNA library. Following overexpression in bacterial cells, the corresponding proteins were purified to homogeneity. Both isoforms were enzymatically active and found to possess Km and Vmax values in agreement with kinetic parameters described for other forms of AK. The distribution of AK in discrete brain regions and various peripheral tissues was defined. To investigate the possibility that AK activity is regulated by protein phosphorylation, a panel of protein kinases was screened for ability to phosphorylate recombinant mouse AK. Data from these in vitro phosphorylation studies suggest that AK is most likely not an efficient substrate for PKA, PKG, CaMKII, CK1, CK2, MAPK, Cdk1, or Cdk5. PKC was found to phosphorylate recombinant AK efficiently in vitro. Further analysis revealed, however, that this PKC‐dependent phosphorylation occurred at one or more serine residues associated with the N‐terminal affinity tag used for protein purification.
Multiple effects of DiS‐C3(5) on mitochondrial structure and function
Authors: Yamamoto Takenori , Tachikawa Aiko , Terauchi Satsuki , Yamashita Kikuji , Kataoka Masatoshi , Terada Hiroshi , Shinohara Yasuo
Published: August 2004

3,3′‐Dipropyl‐2,2′‐thiadicarbocyanine iodide [DiS‐C3(5)], often used as a tracer dye to assess the mitochondrial membrane potential, was investigated in detail regarding its effects on the structure and function of isolated mitochondria. As reported previously, DiS‐C3(5) had an inhibitory effect on NADH‐driven mitochondrial electron transfer. On the contrary, in the presence of inorganic phosphate, DiS‐C3(5) showed dose‐dependent biphasic effects on mitochondria energized by succinate. At higher concentrations, such as 50 µm, DiS‐C3(5) accelerated mitochondrial oxygen consumption. Measurements of the permeability of DiS‐C3(5)‐treated mitochondrial membranes to poly(ethylene glycol) and analysis of mitochondrial configuration by transmission electron microscopy revealed that the accelerating effect of DiS‐C3(5) on mitochondrial oxygen consumption reflects the induction of the mitochondrial permeability transition (PT). When the mitochondrial PT was induced by DiS‐C3(5), release of mitochondrial cytochrome c was observed, as in the case of the PT induced by Ca2+. On the contrary, at a low concentration such as 5 µm, DiS‐C3(5) showed an inhibitory effect on the latent oxygen consumption by mitochondria. This effect was shown to reflect inhibition of the PT induced by a low concentration of Ca2+. Furthermore, in the absence of inorganic phosphate, DiS‐C3(5) caused mitochondrial swelling. Under this condition, DiS‐C3(5) caused changes in the membrane status of the mitochondria, but did not induce a release of mitochondrial cytochrome c.
Diabetes mellitus in itself is not a risk factor for antibiotic resistance in Escherichia coli isolated from patients with bacteriuria
Authors: Meiland R. , Geerlings S. E. , De Neeling A. J. , Hoepelman A. I. M.
Published: August 2004

Aim  To investigate whether diabetes mellitus is a risk factor for resistance in Escherichia coli isolated from patients with bacteriuria.

Methods  Data were obtained from a multicentre study. A clean‐voided midstream urine culture was collected from 636 women with diabetes, who were between 18 and 75‐years‐old, attended an out‐patient department and had no symptoms of a urinary tract infection. The resistance of E. coli was determined for different antimicrobials. The results were compared with resistance data from routine isolates of E. coli, obtained from women in the same age category, time period and location.

Results  A total of 135 E. coli were isolated from women with diabetes mellitus (mean age 57 ± 14 years) and compared with 5907 routine isolates of E. coli obtained from female patients visiting an out‐patient department (mean age 52 ± 17 years). The resistance rates of E. coli isolated from diabetic patients and the routine isolates of E. coli to trimethoprim‐sulfamethoxazole were 19% and 23%, respectively, to amoxicillin 16% and 32%, to nitrofurantoin 1% and 3%, to ciprofloxacin 0% and 4%, to ofloxacin 0% and 5%, and to norfloxacin 1% and 4%.

Conclusion  The resistance of uropathogenic E. coli in non‐hospitalized women with diabetes mellitus is not higher than that seen in routine isolates of E. coli. This suggests that diabetes in itself is not a risk factor for resistance.
Chronic painful peripheral neuropathy in an urban community: a controlled comparison of people with and without diabetes
Authors: Daousi C. , MacFarlane I. A. , Woodward A. , Nurmikko T. J. , Bundred P. E. , Benbow S. J.
Published: August 2004

Aims  A cross‐sectional study has been performed in order to estimate the prevalence, severity, and current treatment of chronic painful peripheral neuropathy (CPPN) in people with diabetes in the community.

Methods  Using a structured questionnaire and examination we have assessed these factors in a community sample of people with diabetes (n = 350) and compared them with 344 age‐ and sex‐matched people without diabetes from the same locality.

Results  The prevalence of CPPN was estimated to be 16.2%[95% confidence interval (CI): 6.8–16%] in people with diabetes compared with 4.9% (95% CI: 2.6–7.2%) in the control sample (P < 0.0001). Diabetic subjects with and without CPPN did not differ in age, sex, type and duration of diabetes, body mass index, smoking status and glycaemic control. However, CPPN diabetic subjects had significantly higher Visual Analogue Scale (VAS) scores for pain over the preceding 24 h [median (interquartile range) 3.5 (1.5–6.7) cm vs. 0.7 (0–3.9) cm, P < 0.0001]. Also, the total McGill Pain Questionnaire Score (a measure of pain quality and severity) was 18 (13–31.5) vs. 10 (4–16) (P < 0.0001). Of patients with diabetes and CPPN, 12.5% (7/56) had never reported their symptoms to their treating physician and 39.3% (22/56) had never received any treatment for their painful symptoms.

Conclusions  CPPN is common, often severe but frequently unreported and inadequately treated.
Validation of a system of foot ulcer classification in diabetes mellitus
Authors: Treece K. A. , Macfarlane R. M. , Pound N. , Game F. L. , Jeffcoate W. J.
Published: August 2004

Objective  The lack of a simple, robust classification of diabetic foot ulcers has critically hampered research into optimum patterns of care. We have therefore attempted validation of the previously published S(AD) SAD system, which is based on grading of ulcer features using simple clinical methods.

Research design and methods  This was a prospective study in which 300 people with ulcers newly referred to a hospital‐based multidisciplinary clinic between 1 January 2000 and 1 July 2002 were classified at the time of their first assessment. If a patient had more than one episode, the last to occur was selected as the index ulcer. If two or more ulcers were registered simultaneously, the one which was regarded as the more significant was chosen. Ulcers were categorized according to area, depth, sepsis, ischaemia and neuropathy. All patients were followed for at least 6 months, or until death if earlier. Outcome criteria used were healed and unhealed (unhealed persisting, unhealed at amputation or death) and were cross‐tabulated with different baseline variables.

Results  Ulcers healed in 209 of the 300 patients (69.7%), while 30.0 (10%) had been resolved by amputation (eight major; 22 minor) and 32 (10.7%) by death. Twenty‐nine (9.7%) persisted unhealed. There were significant differences in outcome according to area (χ2 = 25.9, P < 0.001), depth (χ2 = 33.8, P < 0.001), sepsis (χ2 = 13.5, P = 0.004) and arteriopathy (χ2 = 33.7, P < 0.001), but not to denervation (χ2 = 5.1, P = 0.16). The strength of these associations was confirmed using Somers d: area (rs = −0.24, P < 0.001), depth (rs = −0.32, P < 0.001), sepsis (rs = −0.15, P < 0.01), arteriopathy (rs = −0.30, P < 0.001), denervation (rs = −0.10, P = 0.08). Logistic regression analysis using area, depth, sepsis and arteriopathy as independent variables, and those which contributed significantly to the model were area (P = 0.01), depth (P < 0.001) and arteriopathy (P < 0.001).

Conclusions  These data demonstrate that simple clinical methods can be used to categorize features of individual ulcers, and that area, depth and arteriopathy contribute independently to a model to predict outcome. A system of classification such as this is an essential requirement for the categorization of populations with similar features and similar prognosis, which may then be used as the basis for prospective research into optimal wound management.
No substantial psychological impact of the diagnosis of Type 2 diabetes following targeted population screening: The Hoorn Screening Study
Authors: Adriaanse M. C. , Snoek F. J. , Dekker J. M. , Spijkerman A. M. W. , Nijpels G. , Twisk J. W. R. , Van Der Ploeg H. M. , Heine R. J.
Published: August 2004

Aims  To examine the impact of the diagnosis of Type 2 diabetes on psychological well‐being and perceived health status in subjects who participated in a targeted population‐screening programme.

Methods  This study was conducted within the framework of a screening project in the general (aged 50–75 years) Dutch population. The final study population consisted of 259 subjects with a high‐risk score on the Symptom Risk Questionnaire; 116 of whom were subsequently detected with Type 2 diabetes and 143 who were non‐diabetic. The impact was assessed approximately 2 weeks (shortly) and 6 and 12 months after the diagnosis, using the 12‐item Well‐Being Questionnaire (W‐BQ12) and the Medical Outcomes Study Short Form 36 (SF‐36), respectively. Analyses of co‐variance (ancova) were used.

Results  Approximately 2 weeks after the diagnosis, no significant mean differences were found on either the W‐BQ12 or the SF‐36, between the screening‐detected Type 2 diabetes subjects and the non‐diabetic subjects. Six months after the diagnosis, we found lower scores in the screening‐detected Type 2 diabetes subjects compared with the non‐diabetic subjects on the SF‐36 dimensions Role Physical (mean difference (95% CI); −8.2 (−16.2; −0.1); P = 0.046) and Role Emotional (mean difference (95% CI); −7.9 (−15.3; −0.5); P = 0.038). One year after the test results, no significant mean differences were found between both groups on either instrument (W‐BQ12; SF‐36).

Conclusions  The diagnosis of Type 2 diabetes has no substantial adverse or positive effect on psychological well‐being and perceived health status, shortly, and 6 and 12 months after the diagnosis.
‘Urine testing is a waste of time’: newly diagnosed Type 2 diabetes patients’ perceptions of self‐monitoring
Authors: Lawton J. , Peel E. , Douglas M. , Parry O.
Published: August 2004

Aims  To date, there is no convincing evidence that non‐insulin treated patients who undertake self‐blood glucose monitoring (SBGM) have better glycaemic control than those who test their urine. This has led to a recommendation that non‐insulin dependent patients undertake urine testing, which is the cheaper option. This recommendation does not take account of patients’ experiences and views. This study explores the respective merits of urine testing and SBGM from the perspectives of newly diagnosed patients with Type 2 diabetes.

Methods  Qualitative study using repeat in‐depth interviews with 40 patients. Patients were interviewed three times at 6‐monthly intervals over 1 year. Patients were recruited from hospital clinics and general practices in Lothian, Scotland. The study was informed by grounded theory, which involves concurrent data collection and analysis.

Results  Patients reported strongly negative views of urine testing, particularly when they compared it with SBGM. Patients perceived urine testing as less convenient, less hygienic and less accurate than SBGM. Most patients assumed that blood glucose meters were given to those with a more advanced or serious form of diabetes. This could have implications for how they thought about their own disease. Patients often interpreted negative urine results as indicating that they could not have diabetes.

Conclusions  Professionals should be aware of the meanings and understandings patients attach to the receipt and use of different types of self‐monitoring equipment. Guidelines that promote the use of consistent criteria for equipment allocation are required. The manner in which negative urine results are conveyed needs to be reconsidered.
Hypoglycaemia and driving in people with insulin‐treated diabetes: adherence to recommendations for avoidance
Authors: Graveling A. J. , Warren R. E. , Frier B. M.
Published: August 2004

Background  Hypoglycaemia impairs driving performance, so drivers with insulin‐treated diabetes should try to avoid hypoglycaemia when driving, and treat it effectively if it occurs. It is not known how many insulin‐treated drivers are familiar with, or adhere to, recommended safe practice.

Methods  We surveyed a representative sample of 202 current drivers with insulin‐treated diabetes (115 with Type 1 diabetes), using a structured questionnaire. Data were obtained on driving history, estimated frequency of hypoglycaemia, and measures taken to avoid and treat hypoglycaemia when driving.

Results  The licensing authority (DVLA) and motor insurance company had been informed by almost all participants. Sixty‐four participants (31.7%) had experienced hypoglycaemia while driving, and 27 (13.4%) reported that this had occurred within the preceding year. A minimum blood glucose level of 4.0 mmol/l or higher was considered necessary for driving by 151 drivers (74.8%), and 176 (87.1%) reported always keeping carbohydrate in their vehicle. However, 77 (38.1%) reported never carrying a glucose meter when driving, and 121 (59.9%) that they never test blood glucose before driving, or test only if symptomatic of hypoglycaemia. Most participants (89%) would stop driving to treat hypoglycaemia and would not resume driving immediately, although only 28 (13.9%) would wait longer than 30 min. Almost half of participants were failing to observe at least one essential aspect of safe driving.

Conclusions  Compliance with statutory requirements to inform the licensing authority and motor insurer is good, and drivers’ perceptions of the minimum safe blood glucose level for driving are encouraging. However, most drivers rely on symptoms to detect hypoglycaemia while driving, and seldom test blood glucose before driving. Patient education should emphasize the role of blood glucose monitoring in relation to driving, and highlight the potential deterioration in driving performance when blood glucose falls below 4.0 mmol/l.
A case of secondary diabetes mellitus with acromegaly improved by pioglitazone
Authors: Watanabe A. , Komine F. , Nirei K. , Tamura K. , Nabe K. , Aiba N. , Kamoshida S. , Otsuka M. , Okubo H. , Kanou M. , Sawada S. , Uchiyama T. , Nakamura S. , Arakawa Y.
Published: August 2004

Aim  The acromegaly patient was diagnosed with Type 2 diabetes mellitus. His HbA1c was 10.6% and fasting blood glucase (FBG) 15.3 mmol/l. We prescribed glibenclamide (10 mg/day), but his HbA1c and FBG remained high. At this stage, treatmer with short‐acting insulin was instigated at a dose of 20 U/day. However, the patient's blood glucose level remained unsatisfactory. We tried using pioglitazone.

Method  Pioglitazone was prescribed at 30 mg/day in combination with the insulin.

Results  The FBG and HbA1c value decreased to 7.2 mmol/l and 7.3%, respectively, within 2 months and insulin was discontinued. Pioglitazone alone was able to control the FBG level.

Conclusions  Pioglitazone treatment might be considered as a choice for similar cases of diabetes secondary to acromegaly.
HOW GIVING SANCTIFIES: THE BIRTHDAY OF THAMANYA HSAYADAW IN BURMA
Authors: Rozenberg Guillaume
Published: August 2004

This article addresses the role and meaning of different practices of giving in the production process of sainthood in Theravāda Buddhism. Its focus is an account of the birthday ceremony of Thamanya Hsayadaw, the most venerated monk in contemporary Burma. Two ways of giving are defined, reciprocity and redistribution, which appear in the course of the ceremony and which correspond to the two most standard kinds of giving involving a Theravādin monk in a social relationship. The birthday ceremony itself is then described and discussed on two complementary levels. First, the meaning and implications of the gifts made during the ceremony are scrutinized. Second, at a more comprehensive level, the analysis shows that each of these gifts falls within a specific configuration and participates in a sanctification mechanism. This process entails not just the simple addition of various gifts but also their general articulation. It is this sanctifying dynamic of giving that is examined in detail.
REMEMBERING WITHOUT COMMEMORATION: THE MNEMONICS AND POLITICS OF HOLOCAUST MEMORIES AMONG EUROPEAN ROMA
Authors: Stewart Michael
Published: August 2004

Much has been written in recent years about the ways Gypsies (Roma) relate to their past. One important study of Holocaust memory has used the Roma as a paradigmatic case of a people who forget rather than remember their history. Rather than examining processes of ‘obliterating’ or downplaying the past, the approach taken here is to consider ways in which, despite Gypsy ‘presentist’ rhetoric, the past is ‘remembered’ among Gypsy populations. Following Maurice Bloch's call for greater integration of psychological and anthropological work, this article considers what can be gained from seeing memory as a socially distributed function in which the role of ‘implicit’ memories, embedded in dealings with others, is significant. This approach enables us better to grasp how Romany communities, which were persecuted by the Nazis and their allies during the Second World War, ‘remember’ the past even though they may not commemorate it.
EMOTIONAL CLIMATES: RITUAL, SEASONALITY AND AFFECTIVE DISORDERS
Authors: Harrison Simon
Published: August 2004

This article discusses resemblances between the religious symbolism of the annual cycle in certain societies, and seasonally linked mood disorders (notably seasonal affective disorder, or SAD) in contemporary Europe and North America. Two conclusions are drawn: first, that the ritual and symbolism connected with seasonality in some societies may be partly motivated by neurophysiology; second, that SAD is a culture‐bound syndrome limited to societies that generate disjunctions between ‘social’ and ‘natural’ time.
PLASTINATION FOR DISPLAY: A NEW WAY TO DISPOSE OF THE DEAD
Authors: Walter Tony
Published: August 2004

Plastination provides a new method, governed by medical technique rather than religious ritual, by which human remains may be transformed from unstable/wet to stable/dry. In the Körperwelten/Body Worlds exhibition, the public pay to view plastinated bodies, and are invited to donate their bodies for plastination after death. This article addresses the question of whether Body Worlds visitors accept plastination for display as a legitimate form of disposal. Three sources of data are drawn on: the ethnographer's account of his first visit to the exhibition in Brussels; the written comments of visitors to the London exhibition; and the stated motives of some donors. Plastination as final disposal is accepted by the vast majority of visitors; they perceive the dry, odourless body interiors within the clinical, scientific framework encouraged by the exhibition, and are often fascinated by what they see. This is complicated, however, by certain surface features and modes of display which enable the problematic reinsertion of personhood. So, plastination itself is accepted, but not all forms of display.
PERPETUAL LAMENT: KAVA‐DRINKING, CHRISTIANITY AND SENSATIONS OF HISTORICAL DECLINE IN FIJI
Authors: Tomlinson Matt
Published: August 2004

Themes of historical decline are common cross‐culturally, but in certain contexts they may transcend nostalgia and become the motivation for political action. This article examines the ways in which themes of historical decline are made intelligible and palpable for indigenous Fijians in the Tavuki Bay area of Kadavu Island. After addressing the roles of colonial subjugation and Christianization in generating people's senses of powerful pasts and weakened presents, I describe one particular ritual site in rural Fiji, that of evening kava‐drinking sessions, arguing that such sessions are key sites in which people come to understand and feel that Fijian society has lost power. By drinking kava in communal sessions and describing excessive kava‐drinking as a sign of decline, people come to know the theme of decline intellectually and to feel it in their bodies. This theme, having come to seem a natural fact, can then help to inspire political action.
Achieving a new equilibrium? The stability of cooperative employer–union relationships
Authors: Oxenbridge Sarah , Brown William
Published: August 2004

The current popularity of ‘partnership’ in workplace industrial relations raises the question of the durability of such arrangements. This article investigates the stability of cooperative employer–union relationships by means of case studies. It analyses perceptions of the experience of negotiation and consultation. Continuing net benefits are reported both by managers and by union representatives in workplaces where cooperative relationships are robust. The benefits come primarily from the informal consultative processes and levels of trust that are engendered. Nonetheless, parties to the relationship, however robust they were, faced substantial challenges to their efforts to diffuse and sustain cooperative working. It is concluded that cooperative relationships are likely to be stable where employers wish to maintain an independent employee voice, especially where workplace union density remains relatively high.
Partnership at work and worker participation: an NHS case study
Authors: Tailby Stephanie , Richardson Mike , Stewart Paul , Danford Andy , Upchurch Martin
Published: August 2004

This article considers issues of workplace union strategy in a study of a National Health Service hospital trust in which the focus of the investigation is the ‘employee voice’ gains, or losses, arising from partnership and worker participation. The impact of government policy on local management and, in turn, employees’ opportunities to participate in organisational decision making is therefore the main theme explored in this analysis.
Opening doors as well as banging on tables: an assessment of UNISON/employer partnerships on learning in the UK public sector
Authors: Munro Anne , Rainbird Helen
Published: August 2004

The academic debate on partnerships has so far mainly focused on whether there are mutual gains for both unions and employers and whether they support or undermine branch organisation. This debate is here assessed in relation to learning partnerships, which are considered to be a distinctive form of partnership and represent a process of institution‐building.
Parsing the late positive complex: Mental chronometry and the ERP components that inhabit the neighborhood of the P300
Authors: Dien Joseph , Spencer Kevin M. , Donchin Emanuel
Published: August 2004

Falkenstein, Hohnsbein, and Hoorman (1994) suggested that common measures of P300 latency confound a “P‐SR” component whose latency corresponds to stimulus evaluation time and a “P‐CR” component whose latency varies with response‐selection time, thus casting doubt on work in mental chronometry that relies on P300 latency. We report here a replication and extension of Falkenstein et al. (1994) using a high‐density 129‐electrode montage with 11 subjects. Spatiotemporal PCA was used to extract the components of the ERP. A centroid measure is also introduced for detecting waveform‐timing changes beyond just peak latency. In terms of componentry, we argue that the P‐SR and the P‐CR, correspond to the P3a/Novelty P3 and the P300, respectively. Conceptually, we dispute the proposed distinction between stimulus evaluation and response selection. We suggest a four‐stage ERP model of information processing and place the P3a and the P300 in this framework.
Classic and false memory designs: An electrophysiological comparison
Authors: Nessler Doreen , Friedman David , Bersick Michael
Published: August 2004

In false memory tasks new items either overlap with the semantic concepts of studied items (LURE) or do not (NEW). ERP differences between OLD and NEW items in false memory tasks have been interpreted as similar to episodic memory effects observed in classic recognition studies. However, NEW items in a false memory task can be rejected on the basis of semantic information alone, a strategy useless in classic tasks. Here a medial frontal (400 to 500 ms) episodic memory effect was revealed in both classic and false memory tasks, whereas a parietal (500 to 700 ms) episodic memory effect was found only in the classic task. In the false memory task a large, parietally focused positivity was evident for NEW items, assumed to reflect a targetlike response to new semantic information. The brain activity underlying false memory effects, therefore, cannot be interpreted as a straightforward example of that arising during a standard recognition task.
What's special about personally familiar faces? A multimodal approach
Authors: Herzmann Grit , Schweinberger Stefan R. , Sommer Werner , Jentzsch Ines
Published: August 2004

Dual‐route models of face recognition suggest separate cognitive and affective routes. The predictions of these models were assessed in recognition tasks with unfamiliar, famous, and personally familiar faces. Whereas larger autonomic responses were only triggered for personally familiar faces, priming effects in reaction times to these faces, presumably reflecting cognitive recognition processes, were equal to those of famous faces. Activation of stored structural representations of familiar faces (face recognition units) was assessed by recording the N250r component in event‐related brain potentials. Face recognition unit activation increased from unfamiliar over famous to personally familiar faces, suggesting that there are stronger representations for personally familiar than for famous faces. Because the topographies of the N250r for personally and famous faces were indistinguishable, a similar network of face recognition units can be assumed for both types of faces.
Revealing effects of noninformative spatial cues: An EEG study of inhibition of return
Authors: Wascher Edmund , Tipper Steven P.
Published: August 2004

Simple responses to noninformatively cued spatial stimuli can be delayed whenever a cue has been briefly presented at the location of the subsequent target. This phenomenon (inhibition of return) might be due to a mechanism that inhibits irrelevant information. However, with sustained cues no inhibition is observed. It has been hypothesised that in the latter, task inhibition is masked by an excitation process. ERP measures support the inhibition–excitation account: (a) P1 suppression, assumed to reflect inhibition, was observed for all targets presented at a cued location. (b) A later negative component (Nd250) was increased with sustained cues, and hence might reflect the excitation process. (c) A negative component at right parietal electrode sites (Nd310) appeared only when inhibition of return was observed. A second study confirmed the link between these ERP components and mechanisms involved in inhibition of return.
Vigilance to a persisting personal threat: Unmasking cardiovascular consequences in adolescents with the Social Competence Interview
Authors: Ewart Craig K. , Jorgensen Randall S. , Schroder Kerstin E. , Suchday Sonia , Sherwood Andrew
Published: August 2004

We report the first systematic study of hemodynamic responses to the Social Competence Interview, using the original Ewart protocol, which focuses attention on a persisting personal threat. Physiologic changes in 212 African American and Caucasian urban adolescents during the Social Competence Interview, mirror tracing, and reaction time tasks showed that the Social Competence Interview elicits a pronounced vasoconstrictive response pattern, with diminished cardiac activity, that is more typical of alert mental vigilance than of active coping. This pattern was observed in all race and gender subgroups. Results suggest that the Social Competence Interview may be a broadly useful procedure for investigating the role of threat‐induced vigilance in cardiovascular and other diseases.
Effects of task difficulty and invested mental effort on peripheral vasoconstriction
Authors: Iani Cristina , Gopher Daniel , Lavie Peretz
Published: August 2004

We ran two experiments to investigate whether peripheral arterial tone reflects changes in mental effort. Finger pulse wave amplitude, interpulse interval, and pulse variability in the mid‐ and high‐frequency bands were recorded by means of a newly developed finger plethysmograph during both rest and cognitive performance. Using a modified version of the Sternberg memory task, we selectively manipulated either the difficulty of the task (Experiment 1) or the subjects' level of engagement in the task (Experiment 2). We found a significant difference in finger pulse wave amplitude between rest and task periods, suggesting that the measure reflects changes in sympathetic activity due to task engagement. In addition, our results suggest that reduced pulse wave amplitude, signaling vasoconstriction, occurs when subjects are investing effort.
Central and parietal event‐related lateralizations in a flanker task
Authors: Willemssen Rita , Hoormann Jöorg , Hohnsbein Joachim , Falkenstein Michael
Published: August 2004

Recently Wascher et al. (1999) reported that in a flanker task with arrow stimuli not only the known lateralized readiness potential (LRP) that reflects lateralized response activation was induced, but also a parietal lateralized activation (direction encoding lateralization; DEL) that was interpreted as reflecting an earlier coding of a response side. However, the Wascher study did not exclude that the DEL could have also been due to lateralized stimulus‐ or attention‐related factors. In the present study we used vertically directed arrow stimuli, and had our subjects perform responses in the vertical dimension. To separate flanker‐induced from target‐induced lateralizations the delay between the presentations of irrelevant and relevant stimuli (stimulus onset asynchrony; SOA) was manipulated. Apart from the usual LRPs we obtained clear DELs that varied in a similar way with the experimental variables, but peaked earlier and had a more posterior topography than the LRP. These results indicate that the DEL reflects premotor response representation.
Gender differences in hemispheric asymmetry of syllable processing: Left‐lateralized magnetic N100 varies with syllable categorization in females
Authors: Obleser Jonas , Rockstroh Brigitte , Eulitz Carsten
Published: August 2004

The present study used magnetic source imaging to examine gender differences in the functional hemispheric asymmetry of auditory processing. The auditory evoked N100m was examined in male and female subjects in response to natural syllables with varying consonant and vowel as well as nonspeech noise. In an additional task subjects had to categorize different syllables from the first 35 ms of syllables, that is, the plosive and the formant transition. Syllable‐evoked N100m activity was larger in the left than in the right hemisphere in female but not in male subjects. This gender‐specific hemispheric asymmetry was speech specific, that is, absent when processing meaningless noise. Only in females did the degree of left‐lateralization predict successful syllable categorization from short syllable bursts: Results suggest gender‐specific differences in spectro‐temporal analysis of speech.
P50 and acoustic startle gating are not related in healthy participants
Authors: Brenner Colleen A. , Edwards Chad R. , Carroll Christine A. , Kieffaber Paul D. , Hetrick William P.
Published: August 2004

Although P50 event‐related potential (ERP) suppression and acoustic startle prepulse inhibition are conceptualized as measures of sensory and sensorimotor gating, respectively, the relationship between these measures is unclear. In the present study, P50 and prepulse inhibition trials were interleaved in a single testing session to determine their relationship. Thirty‐one healthy participants were presented with startle‐ and P50‐eliciting stimuli across six trial blocks. Lead stimuli (i.e., the prepulse to the acoustic startle and the first click in the dual click ERP paradigm) resulted in significant gating, or amplitude attenuation, of responses to the startle probe and second paired click. There were no meaningful correlations between the P50 and prepulse inhibition variables, indicating that P50 suppression and acoustic startle prepulse inhibition measure distinct neural mechanisms. The implications of these findings for operationally defining the psychological construct of gating with these psychophysiological measures are discussed.
From symbols to sounds: Visual symbolic information activates sound representations
Authors: Widmann Andreas , Kujala Teija , Tervaniemi Mari , Kujala Anu , Schröger Erich
Published: August 2004

Expectations on forthcoming sounds can speed up responding to environmental changes and can, thus, be a basis for successful adaptation. The present study investigated event‐related brain potential (ERP) effects in situations where particular sounds were predicted on the basis of preceding visual information. Subjects had to map scorelike visual symbols to corresponding sounds. The sounds could be either congruent or occasionally incongruent with the corresponding symbol. When the auditory stimulation was incongruent with the visual information, a brain response was elicited starting as early as about 100 ms from the onset of the auditory stimulus. It had a bilateral frontal distribution and a polarity inversion at the mastoids compatible with the assumption of sources in auditory cortex. These results suggest that the auditory system can establish a representation of an expected stimulus on the basis of visual symbolic information.
A survey of the information management and technology training needs of doctors in an acute NHS trust in the United Kingdom
Authors: Devitt Nicola , Murphy Jeannette
Published: August 2004

Background:  Doctors need information skills to deliver health care in the 21st century. There is concern that those who trained before the ‘information age’ will be inadequately equipped for their work.

Objectives:  To assess doctors’ use of computers for clinical tasks, and their knowledge and skills in health information management and technology.

Design:  Questionnaire survey.

Setting:  An acute NHS trust in the UK.

Participants:  96 (83%) of all doctors in the trust responded.

Main outcome measures:  Proportion of respondents reporting the following: use of computer‐based systems for clinical tasks, knowledge in eight health informatics topics, skills in using specific hardware and software applications. Also comparison of reported skills between senior and junior staff; proportion of doctors identifying specific training needs.

Results:  All but one (1%) of the responding doctors used a computer regularly. Over three quarters of respondents reported they were semi‐skilled or fully skilled in basic office applications, though the juniors scored significantly more highly than the seniors for some applications. However, 44% of doctors reported no skills in database software, identifying this as a training need.

Around half of the doctors were unaware of health informatics topics, including electronic patient records, the Caldicott report and data protection law. In each case the senior doctors were significantly more aware than the juniors of the topic in question.

Conclusion:  Both junior and senior doctors have basic computer literacy, but nearly half of this population identify the use of database software as a training need. In addition, there are several health informatics topics of which a large proportion of doctors, particularly the juniors, have little knowledge, but which have not been identified as training needs. Some recommendations are made for provision of in‐house health informatics education for doctors.

Key Messages

Implications for Policy

Junior doctors need education about electronic health records and data protection.

Senior doctors are in a good position to include such health informatics training in regular post graduate education meetings.

Implications for Practice

Most doctors have acquired basic computer skills by self‐directed learning: there appears to be no need for catch‐up training for senior doctors who graduated before the computer age.
Clinical librarianship in the UK: temporary trend or permanent profession? Part I: a review of the role of the clinical librarian
Authors: Sargeant Sally J. E. , Harrison Janet
Published: August 2004

Background:  This paper is the first of a two‐part series of articles presenting the role of the clinical librarian (CL) in the UK today. It situates the CL concept historically, and specifically reports the findings from a study in 2002 (Skinner, The Role of the Clinical Librarian in the UK. MSc Dissertation. Loughborough University: Department of Information Science).

Relevance:  The impetus for the 2002 study was the awareness of an increase in job advertisements within the NHS for roles seeking to enhance the practice of evidence‐based medicine, which included elements of clinical librarianship. Therefore the research was undertaken to establish whether this increase was coincidental, or the beginning of a new professional role for librarians.

Methods:  A content analysis of CL job advertisements, examining job titles and duties was undertaken. Twenty‐three advertisements were scrutinized, and these results are presented here. As a complementary investigation, a postal questionnaire was sent to a sample of practising CLs in the UK.

Results:  Several duties can be classified as core to the role of the CL. However there is a great diversity of duties attached to this core, reflecting an absence of nationally accepted practice.

Conclusion:  Further work was necessary to assess current practice and how clinical librarianship can continue to grow at local and national levels. This is addressed in Part Two of this series.

Key Messages

Policy

Acceptance of diversifying role in medical information provision

Logistical considerations of CL personnel and their physical positioning within acute settings

Implications for practice

Establishing national professional guidelines for CLs

Establishing consistency in nomenclature
Evaluation of methodological search filters—a review
Authors: Jenkins Michelle
Published: August 2004

Objectives:  The objectives of the study were: to provide an overview of approaches to methodological search filter development; to identify and critically review the stages of methodological search filter development; to devise a search filter appraisal checklist based on the review.

Methods:  An iterative approach to searching was employed utilizing health and library databases, the world wide web and citation searching. Further systematic methods included hand searching of key journals in the field of search filter development, contacting known experts in the field and scanning reference lists of relevant papers to identify additional studies. Altogether, 51 potentially relevant papers were found, of which 20 met the inclusion criteria.

Results:  Four stages of search filter development were identified from the literature (search term selection, identification of a gold standard, evaluation and validation). Variations in the methods used to approach these four stages were identified, most importantly in the extent to which search filters are tested and validated.

Conclusion:  Awareness of the process and limitations involved in search filter development is essential to make an informed decision on the applicability and validity of search filters. The findings of this review indicate a considerable agenda for future research, in particular, to improve the quality of reporting of search filters and to inform users on their use and application. Based on the review, guidance in the appraisal process of search filters is given in the form of a checklist.

Key Messages

Implications for Policy

Improvements are needed in the quality of reporting of search filters

Further research is warranted investigating the methods used to develop search filters

Evaluation and impact of search filters on end‐user searching outcome is essential to establish the effectiveness of search filters

Implications for Practice

Appraisal of search filters for applicability and validity is required

Clearer guidance for end‐users (librarians, clinicians) on the use of search filters is needed
Family Resilience: A Framework for Clinical Practice
Authors: Walsh Froma
Published: August 2004

This article presents an overview of a family resilience framework developed for clinical practice, and describes its advantages. Drawing together findings from studies of individual resilience and research on effective family functioning, key processes in family resilience are outlined in three domains: family belief systems, organizational patterns, and communication/problem‐solving. Clinical practice applications are described briefly to suggest the broad utility of this conceptual framework for intervention and prevention efforts to strengthen families facing serious life challenges.