bluuebunny/crossref_metadata_2025 huggingface dataset:
Nestedness of Southern Ocean island biotas: ecological perspectives on a biogeographical conundrum
Authors: Greve Michelle , Gremmen Niek J. M. , Gaston Kevin J. , Chown Steven L.
Published: December 2004

Aim To use patterns of nestedness in the indigenous and non‐indigenous biotas of the Southern Ocean islands to determine the influence of dispersal ability on biogeographical patterns, and the importance of accounting for variation in dispersal ability in their subsequent interpretation, especially in the context of the Insulantarctic and multi‐regional hypotheses proposed to explain the biogeography of these islands.

Location Southern Ocean islands.

Methods Nestedness was determined using a new metric,d1(a modification of discrepancy), for the indigenous and introduced seabirds, land birds, insects and vascular plants of 26 Southern Ocean islands. To assess the possible confounding effects of spatial autocorrelation on the results, islands were assigned to 11 major island groups and each group was treated as a single island in a following analysis. In addition, nestedness of the six Southern Ocean islands comprising the South Pacific Province (New Zealand islands) was analysed. All analyses were conducted for species and genera, for each of the taxa on its own, and for the complete data sets.

Results Statistically significant nestedness was found in all of the taxa examined, with nestedness declining in the order seabirds > land birds > vascular plants > insects for the indigenous species. Vagility had a marked influence on nestedness and the biogeographical patterns shown by the indigenous species. This influence was borne out by additional analyses of marine taxa and small‐sized terrestrial species, both of which were more nested than the most nested group examined here, the seabirds. Assemblages of non‐indigenous species also showed nestedness, and nestedness was generally more pronounced than in the indigenous species. Surprisingly, vagility had a significant effect on nestedness in these assemblages too.

Main conclusions Nestedness analyses provide a quantitative means of comparing biogeographical patterns for groups differing in vagility. These comparisons revealed that vagility has a considerable influence on biogeographical patterns and should be taken into account in analyses. Here, investigations of more vagile taxa support hypotheses for a single origin of the Southern Ocean island biota (the Insulantarctica scenario), whilst those of less mobile taxa support the more commonly held, multi‐regional hypothesis. All biogeographical analyses across the Southern Ocean (and elsewhere) will be influenced by the effects of dispersal ability, with composite analyses dominated by sedentary groups likely to favour multi‐regional scenarios, and those dominated by mobile groups favouring single origins. Mechanisms underlying nestedness in the region range from nested physiological tolerances in more mobile groups to colonization ability and patterns of speciation in less vagile taxa. Considerable nestedness in the non‐indigenous assemblages is largely a consequence of the fact that many of these species are European weedy species.
The Southern African orchid flora: composition, sources and endemism
Authors: Linder H. P. , Kurzweil H. , Johnson S. D.
Published: December 2004

Aim The Southern African orchid flora is taxonomically well known, but the biogeographical and diversity patterns have not yet been analysed. In particular, we want to establish whether (a) it is, like the Southern African flora in general, more diverse than would be expected from its latitude and area; (b) it is an African flora, or whether it contains palaeoendemic relicts of a Gondwanan orchid flora; (c) the diversity and endemism in the orchid flora is concentrated in particular biomes and habitat types; and (d) the patterns of endemism in the flora can be accounted for by current environmental parameters, or whether we need to invoke historical explanations.

Location Southern Africa.

Methods We used the recent floristic account of the Southern African orchids, in conjunction with a data base of over 14,642 herbarium records, to assign the species and subspecies of Southern African orchids to biomes, habitats, and clades. We explored the relationship between the number and endemism of entities (species, subspecies and varieties) and the biomes and habitats. We compared the richness of this flora with that of 31 other regions from all continents and latitudes, to establish whether the Southern African orchid flora is richer or poorer than expected. We assigned the Southern African orchid species to 16 monophyletic clades and mapped the global distribution of these clades to establish the continental affinities of the flora.

Main conclusions The Southern African orchid flora is not any more diverse than could be expected from its latitude or area, while the two tropical African floras included were less diverse than expected. Latitude is an excellent predictor of regional orchid species richness; this might indicate that available habitat is more important for orchid diversity than gross area available, since latitude is probably correlated with the extent of suitable habitat. The Southern African orchid flora is clearly an African flora, since all clades are also found in tropical Africa, while many of them are absent from the Americas or Asia. Conversely, while most African orchid clades are also found in Southern Africa, both the Americas and Asia contain many clades absent from Africa. The distribution of orchid entities among the biomes in Southern Africa is very uneven, with two of the seven biomes totally devoid of orchids. Habitats and biomes that have no equivalent in tropical Africa are high in endemism, and habitats and biomes which are also well developed in tropical Africa are low in endemism. Endemism appears largely explained in terms of modern habitats. However, two patterns (the high endemism in the Succulent Karoo and the lack of endemism in the southern Cape among epiphytic orchids) may also be explained in terms of Quaternary climatic changes.
Major histocompatibility complex variation at three class II loci in the northern elephant seal
Authors: Weber Diana S. , Stewart Brent S. , Schienman John , Lehman Niles
Published: December 2004

Northern elephant seals were hunted to near extinction in the 19th century, yet have recovered remarkably and now number around 175 000. We surveyed 110 seals for single‐strand conformation polymorphism (SSCP) and sequence variation at three major histocompatibility (MHC) class II loci (DQA, DQB and DRB) to evaluate the genetic consequences of the population bottleneck at these loci vs. other well‐studied genes. We found very few alleles at each MHC locus, significant variation among breeding sites for the DQA locus, and linkage disequilibrium between the DQB and DRB loci. Northern elephant seals are evidently inbred, although there is as yet no evidence of correlative reductions in fitness.
The serine/threonine protein phosphatase SIT4 modulates yeast‐to‐hypha morphogenesis and virulence in Candida albicans
Authors: Lee Chang‐Muk , Nantel André , Jiang Linghuo , Whiteway Malcolm , Shen Shi‐Hsiang
Published: December 2004

SIT4 encodes the multifunctional catalytic subunit of a type 2A‐related protein phosphatase of Saccharomyces cerevisiae and has been implicated in cell cycle regulation and nitrogen sensing. We have identified the Candida albicans homologue of SIT4, and we show that its disruption caused a significant reduction in general growth rate, in hyphal outgrowth and in virulence in a mouse infection model. These phenotypes were reversed by the reintroduction of the wild‐type SIT4 gene. We used glass DNA microarrays to measure the transcriptional profiles of 6287 open reading frames in sit4 cells undergoing the yeast‐to‐hypha transition induced by serum. Although differential expression of many of the hyphae‐specific genes was not affected by the SIT4 deletion, the transcription of two new hyphae‐induced genes, XOG1 and YNR67, was entirely reliant upon Sit4p. Both genes represent glucanases, indicating that SIT4 may play a role in controlling cell wall biogenesis. Furthermore, sit4 cells exhibited a reduced heat shock response to treatment with serum/37°C, suggesting that SIT4 acts to co‐ordinate the stress response signals during morphological switching. Finally, sit4 cells displayed reduced transcript levels for the genes encoding the Hog1p MAP kinase and several modulators of protein biosynthesis. Sit4p thus plays important roles during hyphal growth in Candida albicans through the regulation of cell wall biogenesis, osmosensing and protein translation.
Structure of the OmpA‐like domain of RmpM from Neisseria meningitidis
Authors: Grizot Sylvestre , Buchanan Susan K.
Published: December 2004

RmpM is a putative peptidoglycan binding protein from Neisseria meningitidis that has been shown to interact with integral outer membrane proteins such as porins and TonB‐dependent transporters. Here we report the 1.9 Å crystal structure of the C‐terminal domain of RmpM. The 150‐residue domain adopts a βαβαββ fold, as first identified in Bacillus subtilis chorismate mutase. The C‐terminal RmpM domain is homologous to the periplasmic, C‐terminal domain of Escherichia coli OmpA; these domains are thought to be responsible for non‐covalent interactions with peptidoglycan. From the structure of the OmpA‐like domain of RmpM, we suggest a putative peptidoglycan binding site and identify residues that may be essential for binding. Both the crystal structure and solution experiments indicate that RmpM may exist as a dimer. This would promote more efficient peptidoglycan binding, by allowing RmpM to interact simultaneously with two glycan chains through its C‐terminal, OmpA‐like binding domain, while its (structurally uncharacterized) N‐terminal domain could stabilize oligomers of porins and TonB‐dependent transporters in the outer membrane.
Scrotal ulceration induced by all‐trans retinoic acid in a patient with acute promyelocytic leukemia
Authors: Mourad Yasser Abou , Jabr Fadi , Salem Ziad
Published: December 2004

All‐trans retinoic acid (ATRA) has been shown to improve the outcome in patients with acute promyelocytic leukemia compared with chemotherapy alone, but it is associated with adverse effects. We report the development of scrotal ulcer in a patient with acute promyleocytic leukemia (APL) within 10 days of treatment with ATRA at a dose of 40 mg orally twice daily. The ulcer did not respond to antibiotic treatment and healed shortly after withholding ATRA. The biopsy showed inflammation only, and other microbiological workup was negative.
The value of Doppler ultrasound in diagnosis in 25 cases of furunculoid myiasis
Authors: Quintanilla‐Cedillo Marco R. , León‐Ureña Heberth , Contreras‐Ruiz José , Arenas Roberto
Published: December 2004

Background  The larvae of the botfly Dermatobia hominis cause furunculoid myiasis in endemic areas. Lack of knowledge of this condition outside these areas leads to confusion in diagnosis and delays appropriate treatment.

Objective  To describe the clinical findings of furunculoid myiasis encountered in Quintana Roo, in the south‐east of Mexico.

Materials and methods  We performed an observational study on 25 cases diagnosed over a period of 4 years.

Results  Diagnosis of furunculoid myiasis was made in 14 males and 11 females with an average age of 24.5 years. Most of our patients were students, farmers, or housewives. The number of lesions varied from one to four. In 20% of cases, more than one parasite was present in each lesion. The scalp was the most commonly affected region (40%), followed by the trunk and the extremities. Doppler ultrasound study (DUSG) of the furuncle‐like lesions confirmed the clinical diagnosis in all cases.

Conclusions  Furunculoid myiasis is frequent in the state of Quintana Roo, Mexico. We found no association with occupation, gender, social background or age. DUSG can be used to evaluate the number of parasites per furunculoid lesion avoiding misdiagnoses and treatment delays.
Metamorphic evolution and reworking of the Sleaford Complex metapelites in the southern Eyre Peninsula, South Australia*
Authors: TONG L. , WILSON C. J. L. , VASSALLO J. J.
Published: December 2004

The partial melting processes of Al‐rich and cordierite‐absent garnet–orthopyroxene‐bearing leucosome assemblages in the reworked Archaean Sleaford Complex in southern Eyre Peninsula, South Australia are examined. The Kimban Orogeny produced a pervasive development of garnet–K‐feldspar‐dominated leucosome assemblages. The textural relationships suggest that the peak assemblage garnet–orthopyroxene–K‐feldspar involved a melt phase and formed through the divariant partial melting reaction garnet + biotite = orthopyroxene + K‐feldspar + liquid in the KFMASH system, during a prograde KD1 heating event. A cordierite‐bearing metapelite also preserves the peak KD1 assemblage of garnet–cordierite–orthopyroxene–K‐feldspar, and the textural relationships suggest that peak assemblages formed through the crossing of the univariant partial melting reaction garnet + biotite = orthopyroxene + cordierite + K‐feldspar + liquid in the KFMASH system, during the KD1 prograde heating stage. It is suggested that peak metamorphic P–T conditions reached 850–900°C and 0.9–1.0 GPa, and that the preservation of peak assemblages means that some melt was lost near or during the metamorphic peak. The pervasive interstitial K‐feldspar grains nucleated synchronously with decompression, and the second generation of small euhedral garnets are inferred to have formed through decompression‐generated partial melting during a KD2 high‐strain shear event. The P–T conditions of 700–750°C and 0.5–0.6 GPa were attained during the KD2 high‐grade shear event. The inferred clockwise P–T path from KD1 to KD2 is compatible with a collisional tectonic model during the Kimban Orogeny (ca 1730–1700 Ma), whereas syn‐KD2 decompression‐cooling was a result of rapid tectonic exhumation of the terrain.
Cenozoic stratigraphic succession in southeastern Australia
Authors: McGOWRAN B. , HOLDGATE G. R. , LI Q. , GALLAGHER S. J.
Published: December 2004

Strata of Cenozoic age occur around the southern margin of Australia as thin and discontinuous outcrops, interpolated and fleshed out by economic exploration onshore and offshore. The neritic strata fall into four sequences or allostratigraphic packages of (I) Paleocene – Early Eocene, (II) Middle Eocene – Early Oligocene, (III) Late Oligocene – Middle Miocene, and (IV) Late Miocene – Holocene age: a four‐part pattern that can be seen also in the flanking pelagic and terrestrial realms including regolith deep weathering. Problems of correlation and age determination (predominantly biostratigraphic) have included biogeographical constraints (endemism in neritic molluscs and terrestrial palynomorphs, mid‐latitude assemblages in calcareous plankton), and slow progress in magnetostratigraphy and chemostratigraphy. Sequence I largely repeats the Cretaceous siliciclastic–coal, marginal‐marine facies (carbonate‐poor, with marine and non‐marine palynomorphs and agglutinated foraminifers) punctuated by marine ingressions with microfaunas and sparse macrofaunas. Sequence II contains the first carbonates in the region since the Palaeozoic and the most extensive coals of the Cenozoic anywhere. Sequence III contains the most extensive neritic carbonates and the last major coals. Sequence IV is more strongly siliciclastic than the two preceding. Each of these four second‐order entities (107 years duration) comprises third‐order packages each with an unconformity and marine transgression. These packages hold true right along the southern Australian margin in the sense that the hiatuses and transgression do not display significant diachroneity at the relevant time‐scales (105−106 years). Recognised, delimited and correlated independently of the putatively global Exxon sequences, they are remarkably consistent with the latter, thereby providing a significant regional test. There are two widespread emphases on southern Australian geohistory and biohistory: (i) to regard the regional story as part of the global story of accreting continents, an expiring Tethys, and an episodically cooling planet; and (ii) a somewhat contrary emphasis, with the region being a special case of rapid longitudinal motion towards the equator. Both emphases are plausible with the former being the more heuristic. The stratigraphic record is strongly punctuated, the four sequences being separated by both tectonic and climatic events. Thus: the sequence I/II gap involved extensive plate‐tectonic reorganisation and a new spreading regime from ca 43 Ma, coevally with early growth of Antarctic ice; in the II/III gap, deformation in marginal basins is coeval with a global low in cooling, large ice sheet and falling sea‐level to ca 30 Ma; and the III/IV gap is marked by widespread cessation or contraction of stratal accumulation and withdrawal of thermophilic taxa coevally with the major expansion at ca 14 Ma of the Antarctic ice sheet, onset of intense canyon cutting, and plate‐wide basin inversion.
Wanting to be heard: mental health consumers’ experiences of information about medication
Authors: Happell Brenda , Manias Elizabeth , Roper Cath
Published: December 2004

ABSTRACT:  The complexities accompanying the prescription of antipsychotic medication for people experiencing a mental illness have been extensively documented in the literature. The views and experiences of consumers of mental health services, however, are almost entirely absent. This paper describes the findings of a qualitative study undertaken to examine the experiences of consumers, specifically in relation to education and decision making with regards to medication. The findings from a focus group conducted with consumers (n = 9) revealed an overall dissatisfaction with information provided and the opportunity to participate in decision making. Data analysis revealed four major themes: information to consumers; acknowledgement and recognition of consumers; roles of health professionals; and the experience of wellness and adherence. The findings suggest the need for significant change if the goals of the Third National Mental Health Plan are to be realized.
Mental health services responding to men and their anger
Authors: Stewart Don , Harmon Karen
Published: December 2004

ABSTRACT:  Due to their propensity for acting out with antisocial behaviours, angry men are often regarded as having antisocial personality disorder with little hope for treatment success. Whilst not denying the difficulties in working with angry men, this paper looks to challenge some of the received wisdom in this area. Antisocial personality disorder is compared with borderline personality disorder and the many similarities, including the association with childhood trauma, course of illness, symptoms and rates of occurrence, are discussed. Differences between the two groups may be associated with the internalization or externalization of anger. Some issues related to bias in diagnosis are raised, as is the universal hopelessness implied in the literature related to treatment of antisocial personality disorder. Some issues related to engaging traditional men are discussed. In this paper the term ‘traditional men’ is used to describe men who value stoicism, self‐reliance, strength, work, status and aggression highly whilst denying any vulnerability and exhibiting restricted emotionality. There is a need to reframe the diagnosis in order to recognize the associated behaviours as being an adult manifestation of complex childhood trauma. Further, there is a need for treatment directed towards altering ongoing patterns of retraumatization which characterize the lives of these men. A case study is included to demonstrate a number of the issues involved in working with angry men. These include issues of connection, boundaries, safety and utilization of the general practitioner in setting up a containing structure. The case study is used to illustrate that when issues of connection and anger containment are positively addressed, good therapeutic outcomes are possible.
Research involving mental health consumers and carers: a reference group approach
Authors: Lammers John , Happell Brenda
Published: December 2004

ABSTRACT:  Policy changes within the mental health system are creating an increasing expectation that service providers increase the opportunities for consumer and carer participation in the planning, delivery and evaluation of mental health services. If they are to reflect this change in philosophy, researchers have an obligation to ensure the involvement of consumers and carers, above and beyond involvement as a participant in all relevant mental health research. This paper describes the establishment and function of a reference group, established to guide and assist with the conduct of a research project examining the experiences of consumers and carers with psychiatric disability support services. The formation and operation of, and the valuable contribution made by, the reference group is discussed.
Managing increased demand for mental health services in a public hospital emergency department: A trial of ‘Hospital‐in‐the‐Home’ for mental health consumers
Authors: Kalucy Ross , Thomas Lyndall , Lia Briony , Slattery Terena , Norris Diane
Published: December 2004

ABSTRACT:  Increasing demand from mental health consumers for crisis assessment and intervention in public Emergency Departments (ED) has placed considerable strain on the resources of the ED and long delays awaiting admission are experienced. At Flinders Medical Centre in South Australia, the Psychiatry Department trialled a ‘hospital‐in‐the‐home’ service to relieve the pressure on the ED and enhance inpatient capacity. The trial has been successful in diverting mental health consumers directly to intensive home‐based services from the ED and freeing up beds in the inpatient unit. Evaluation showed that both consumers and their carers were highly satisfied with the hospital‐at‐home service.
Issues and dynamics of sexually assaulted adolescents and their families
Authors: Clements Paul T. , Speck Patricia M. , Crane Patricia A. , Faulkner Martha J.
Published: December 2004

ABSTRACT:  Interpersonal violence such as sexual assault creates a variety of traumatic responses. Adolescents encounter a significantly high rate of exposure to sexual assault. In the aftermath of sexual assault, issues and dynamics related to traumatic responses include ongoing fear and threats to personal safety, stability, and structure of the family and environment. Each issue is of concern for community and health care practitioners. Sexual assault has a detrimental effect on adolescent intrapsychic development and interpersonal relationships. Symptoms are disturbing and disruptive to daily routines, negatively affect adolescent normal growth and development, and can result in post‐traumatic stress disorder. Issues and dynamics regarding sexual assault are explored, with suggestions on how to help adolescents avoid developing a negative world view and long‐term negative health consequences.
Fatigue crack growth model for constant amplitude loading
Authors: PANDEY K. N. , CHAND S.
Published: December 2004

A fatigue crack growth model under constant amplitude loading has been developed considering energy balance during growth of the crack. The plastic energy dissipated during growth of a crack within cyclic plastic zone and area below cyclic stress–strain curve was used in the energy balance. The near crack tip elastic–plastic stress and strain were calculated on the basis of Hutchinson, Rice and Rosengren (HRR) formulations. Fatigue crack growth rate in linear and near threshold region of da/dNversus ΔKcurve can be determined on the basis of the proposed model in terms of low cycle fatigue (LCF) properties determined on smooth specimen. The predictions of the model have been compared with the experimental and theoretical results available in the literature using mechanical and fatigue properties. The model compares well in the threshold and intermediate region of the da/dNversus ΔKcurve for wide range of material tested.
Fatigue behaviour of welded joints with cracks, repaired by hammer peening
Authors: BRANCO C. M. , INFANTE V. , BAPTISTA R.
Published: December 2004

Rehabilitation of a welded structure, which involves repair of cracked joints, is achieved when the local treatment for repair gives a fatigue strength in the joint equal or above the fatigue strength of the uncracked original detail. If the treatment is properly applied the rehabilitation of the detail is assured, and the nature of the weld toe improvement methods can produce a joint, after repair, with a fatigue strength and residual life greater than the initial detail. The paper presents the results obtained on a fatigue study on the rehabilitation of non‐load carrying fillet welded joints loaded in bending at the main plate and with fatigue cracking at the weld toes of the attachment in the main plate and though the plate thickness. Residual stresses were measured at the surface, with X‐ray diffraction. The residual stresses induced by hammer peening at the weld toe were found to be greater along the longitudinal direction of the plate than in the transverse direction. The peak residual stresses near the weld toe were found to be close to yield in compression, justifying the great benefit of hammer peening. Results of a derived gain factor, g, in fatigue life were obtained as a function of the crack depth repaired by hammer peening.
Methodology for fatigue life assessment of the structural integrity of fighter aircraft
Authors: REIS L. , FONSECA A. , DE FREITAS M.
Published: December 2004

This work describes the present methodology used on Portuguese Air Force (PoAF) aircrafts for fatigue life assessment to maintain its structural integrity. This methodology uses experimental flight data collected by airborne instrumentation systems. The recorded data are analysed for the prediction of the crack growth of defects at critical components of the aircraft and this information is then used for planning non‐destructive inspections, maintenance, logistical support and operational usage of the various fleets. This methodology is exemplified by one application on DASSAULT/DORNIER ALPHA‐JET aircraft.
Fatigue life prediction and failure analysis of a gas turbine disc using the finite‐element method
Authors: CLÁUDIO R. A. , BRANCO C. M. , GOMES E. C. , J. BYRNE  , HARRISON G. F. , WINSTONE M. R.
Published: December 2004

A numerical prediction of the life of a gas turbine model disc by means of the finite‐element technique is presented and the solution is compared with an experimental rim‐spinning test. The finite‐element method was used to obtain the K solution for a disc with two types of cracks, both at the notch root of the blade insert and located in the corner and in the centre. A crack aspect ratio of (a/c) = 1 was assumed. The fracture mechanics parameters J‐integral and K were used in the assessment, which were computed with linear elastic and elastic–plastic material behaviour. Using a crack propagation program with appropriate fatigue‐creep crack growth‐rate data, previously obtained in specimens for the nickel‐based superalloy IN718 at 600 °C, fatigue life predictions were made. The predicted life results were checked against experimental data obtained in real model discs. The numerical method, based on experimental fatigue data obtained in small laboratory specimens, shows great potential for development, and may be able to reduce the enormous costs involved in the testing of model and full‐size components.
Tiapride for monosymptomatic hypochondriacal psychosis (dysmorphic delusion subtype) in presenile patients
Authors: MUKAI Taijiro
Published: December 2004

Monosymptomatic hypochondriacal psychosis (dysmorphic delusion subtype) can be seen in people of all ages. It is well known as being difficult to treat, especially in presenile and older patients. In younger patients, it is commonly treated with neuroleptics like pimozide but in presenile and older patients this form of treatment is limited because of the aversive side‐effects of neuroleptics, such as extrapyramidal syndrome. The present study describes a successful course of treatment with tiapride in a presenile patient with monosymptomatic hypochondoriacal psychosis (dysmorphic delusion subtype) without any adverse side‐effects when compared to other treatments and monodelusional disorders in elderly people. It is concluded that tiapride should be considered the treatment of choice for monodelusional disorders in presenile people.
Reaching Target Hemoglobin after Hospitalization for Incident Hemodialysis Patients
Authors: Solid C.A. , Foley R.N. , Gilbertson D.T. , Collins. A.
Published: December 2004

Introduction:  The Kidney Disease Outcomes Quality Initiative (K/DOQI) has established target hemoglobin (Hb) level of 11–12 g/dL for all dialysis patients. For patients who leave an inpatient hospitalization with an Hb under this target, it is hypothesized that several factors contribute to the length of time required to achieve an Hb of 11 g/dL after hospitalization.

Objective:  To identify factors contributing to a decreased likelihood of reaching this target Hb.

Methods:  Using the first hospitalization of patients who initiated HD in 1999 and who were regularly treated with EPO, we identified those with a mean Hb of less than 11 g/dL on EPO claims during the same month as their index hospitalization. Patients were then followed up to see how long it took them to achieve an Hb of 11 g/dL, censored at death, re‐hospitalization, a switch of modality, or suspension of EPO treatment.

Results:  A total of 6050 HD patients were identified. 3 months after hospitalization, 70% had achieved 11 g/dL, and 12% had been censored. For the remaining patients who eventually reached 11 g/dL, the average number of additional months required was 2.69 (SE of 0.09). From proportional hazards regression on the time (in months) to achieving an Hb of 11 g/dL, factors that significantly decreased the likelihood of reaching a target Hb included: a diagnosis on the index hospitalization of CHF or hepatic disease, a low Hb prior to the hospitalization, a high dose of EPO prior to the hospitalization, and a longer hospital stay.

Conclusions:  Patients with anemia after hospitalization are at high risk of both persistent anemia and rehospitalization. It is important to address patient comorbidities, to ensure adequate medication usage, and to monitor patient progress to prevent hospitalizations and potential impact on Hb levels.
Is Dialysis Always Justified? Ethics and Economics
Authors: Oadri M. , Atray N.K. , Vachharajani T.J.
Published: December 2004

Introduction:  Terminally ill patients requiring dialysis present complex ethical and medical dilemma to the nephrologists. With the rising health care costs and futility of care in such cases, the financial burden is a lingering concern.

Methods:  We describe a 77‐year‐old male with lymphoma and prostate cancer admitted for abdominal pain and weight loss. He was found to have metastatic pancreatic adenocarcinoma on laparotomy. His malignancy was deemed inoperable and was offered palliative care. Subsequent hospital course was complicated by sepsis with multiple organ failure resulting in acute renal failure requiring dialysis support. Being aware of his poor prognosis, patient initially declined interventions including dialysis. He was later convinced by his family and agreed to aggressive therapeutic intervention. Anticipating a complicated course, hemodialysis was initiated through cuffed tunneled catheter (CTC). Subsequently, he had multiple episodes of sepsis resulting in removal of CTC, necessitating insertion of 9 temporary dialysis catheters and 3 CTC over a 9‐month period; further complicated by thrombosis of both femoral veins. Eventually, patient's condition progressively deteriorated and dialysis was withdrawn with family's consent 9 months following surgery. Patient was put on comfort care and died 2 days later. He spent a total of 7½ months in ICU, 1 month in skilled care facility, and 2 weeks on regular hospital floor. Total VAMC expenditure was $373,964, which in a private setting would be approximately $1.0 million.

Conclusion:  This case highlights the futility of aggressive management of renal failure in terminally ill elderly patients. Besides its inability to improve quality of life, it adds as a financial burden to the society.
Factors Affecting Flow‐Mediated Vasodilatation in Hemodialysis Patients
Authors: Ryu D.R. , Choi H.Y. , Kang S.W. , Choi K.H. , Lee H.Y. , Han D.S. , Kang E.W. , Oh S.J. , Shin S.K.
Published: December 2004

Clinical manifestation of overt vascular disease may be preceded for years by endothelial dysfunction.

Objective:  This study was undertaken to evaluate endothelial function in ESRD patients and correlation between endothelial function and clinical and biochemical parameters.

Methods:  32 stable ESRD patients (male : female = 16 : 16, average age: 55.2 ± 13.0) on hemodialysis were included. A 10‐MHz ultrasound transducer was used to image the brachial artery. Brachial artery diameter was measured, and reactive hyperemia was induced by inflation to 250 mmHg for 5 min and then deflation of a pneumatic cuff. After release of the cuff, brachial artery diameter was measured.

Results:  In the entire study population and non‐diabetic group, the %FMD (% flow‐mediated dilatation, % change of brachial artery diameter between before and after cuff inflation) did not show any significant correlation with duration of dialysis, age, hypertension, albumin, CRP, total cholesterol, LDL and HDL cholesterol, and triglyceride. However, the %FMD of diabetic patients was lower than that of non‐diabetics. Among the patients with diabetes, the group of patients with FMD of <5.2% showed significant lower serum albumin and significantly higher ln(CRP) levels compared to the group of patients with FMD ≥5.2%. The %FMD showed significant positive correlation with serum albumin level and significant negative correlation with ln(CRP) in diabetic patients.

Conclusion:  These findings suggest that endothelial dysfunction, estimated by FMD, was significantly more prominent in diabetic ESRD, especially with low serum albumin and high CRP levels.
Changes of Plasma Amino Acid Profile in Hemodialysis Patients
Authors: Shin Y.S. , Cho H.M. , Kim Y.O. , Kim Y.S. , Chang Y.S. , Lee M.D. , Bang B.K.
Published: December 2004

Healthy nutritional status is crucial for obtaining favorable hemodialysis (HD) and transplantation results in chronic renal failure (CRF), because there is a high incidence of malnutrition in these patients. In addition, there is a remarkable loss of amino acids (AAs) during HD.

Purpose:  This study examined changes in the serum AA profiles of pre‐ and post‐HD in order to plan a strategy for providing nutritional support to patients on HD.

Method:  Twenty‐nine stable male patients on HD were enrolled in this study. The criteria for patient selection were urine output less than 200 mL/day, 3 times HD a week, and HD treatment for more than 12 months.

Results:  Total plasma AA concentrations of pre‐ and post‐HD were 2948.4 ± 543.1 and 2279.2 ± 400.8 mol/L, the difference being highly significant (p < 0.0001). There was also a significant decrease in the level of essential AAs (EAAs, 774.4 ± 163.8 vs. 643.4 ± 142.5 μmol/L, p < 0.0005) and non‐EAAs (2019.0 ± 411.7 vs. 1539.6 ± 278.3 μmol/L, p < 0.0001) after HD. The ratio of the EAAs to the non‐EAAs increased after HD (0.39 ± 0.07 vs. 0.42 ± 0.07 μmol/L). The level of branched chain AAs (BCAAs) of pre‐ and post‐HD was 323.3 ± 73.7 vs. 286.7 ± 71.2 μmol/L and that of aromatic AAs (AAAs) was 180.9 ± 56.2 vs. 137.5 ± 42.6 μmol/L (p < 0.0005), and the BCCA to AAA ratio increased after HD (1.8 ± 0.41 vs. 2.2 ± 0.57 μmol/L, p = 0.01). Among the abnormal AAs which appear in CRF, the concentrations of β‐aminobutyric acid, citrulline, 1‐methyl histidine, phophoserine, and taurine decreased significantly after HD.

Conclusion:  Patients revealed a large loss of AAs including abnormal‐appearing AAs during HD. The ratios of EAA to non‐EAA and BCAA to AAA increase significantly, which indicates the beneficial effect of HD on the metabolic recovery of the AA profile. But replacing AAs, especially EAAs with high BCAAs, is essential for maintaining nutritional status to compensate the significant loss of AAs during HD.
Relationship of Hypoalbuminemia to Multiple Clinical Factors in Hemodialysis Patients
Authors: Schiro‐Harvey K. , Diamond R. , Jones A. , Buss J.
Published: December 2004

Research shows that low albumin is correlated with higher morbidity and mortality in the dialysis population. The reasons for this are multi‐factorial and may be related to inadequate protein intake, infection and sepsis, inadequate dialysis, or catabolism of uremia. USRDS data show that ESRD Network 16 tends to have lower albumins compared to other ESRD Networks.

Objective:  To evaluate albumin status of HD patients at Puget Sound Kidney Centers, Everett, WA (ESRD Network 16) and identify potential factors that may put patients at risk of hypoalbuminemia.

Methods:  Clinical and biochemical data were collected for 3 months on 221 HD patients. Data included serum albumin (bromcresol purple), calcium, phosphorus, CO2, Hct, % saturation, ferritin, PTH, BUN, Kt/V, URR, nPCR, hours of HD treatment, interdialytic fluid weight gains, DW changes, incidence of infection and hospitalization, catheter use for dialysis access, presence of diabetes and other co‐morbidities, dialyzer reuse, social/psychological status, and use of nutrition supplements. All biochemical data were collected after the longest interdialytic period and analyzed at the same reference laboratory. Data were averaged for each patient for the 3 months and correlations between parameters were determined using Chi‐square analysis.

Results:  25% of all patients had albumins <3.2 g/dL (reference range for normal population 3.5–5.0 g/dL). Patients with lower albumins were significantly more likely to have DM (p < 0.02), use catheters for HD access (p < 0.001), had infections during the previous month (p < 0.001), been hospitalized during the previous month (p < 0.002), have co‐morbid issues (p < 0.001), and use nutrition supplements (p < 0.002). No other factors were significantly correlated with lower albumin.

Conclusion:  Factors other than nutrition seem to be related to hypoalbuminemia. This study has prompted improved protocols for catheter care and use, infection control, and early intervention for nutrition supplement use. Increased screening and monitoring at‐risk patients (those with diabetes and other co‐morbid conditions) has resulted in improved patient care.
The Unsung Heroes (RNS) Battle Against SARS in Hemodialysis Setting
Authors: Rico A. , Mislang J.
Published: December 2004

In early 2003, cases of SARS had surfaced around the world. The vast majority happened in China, Hong Kong, and Canada. In Toronto, the individual who manifested symptoms of SARS after visiting China died on March 22, 2003. A few days later SARS was declared a provincial emergency. Corona virus, the causative agent, is not well known. Its transmission and mutation had to be researched. Shortly thereafter, clusters of people were showing symptoms of the virus. There were 258 probable cases of SARS by May 14. The Ontario Ministry of Health and health care providers took steps to contain the virus, isolating those who were exposed and adopting new infection control procedures. On May 17, the provincial emergency was lifted. On May 25, there was a new wave of SARS cases (2nd outbreak). This was traced back to an RN who worked in a non‐SARS unit. Nurses working directly with SARS were faced with very challenging times. SARS was a huge concern and impacted all health care professionals. The hemodialysis unit was no exception. After all, dialysis patients are already immunocompromised, mostly elderly, and frequent visits to the hospital make them more susceptible to the virus.

Objective:  To identify how hemodialysis nurses were impacted by the SARS outbreak and the nursing management to control the disease.

Method:  Saint Michael's Hospital in Toronto took a leadership role and became one of the SARS Tertiary Response Team. Four hemodialysis nurses were designated as trainers to train the other staff regarding infection prevention and control. Measures were in place such as: (a) strict screening methods for patients, staff, and visitors; (b) mask fitting for all staff; (c) use of PPE (protective protection equipment) (d) use of Hospital ID bar code for staff to declare themselves free of SARS.

Results/Conclusion:  On August 25, there was only one probable case and there was no evidence of transmission of the virus in the hemodialysis unit. As for the nurses and all the unsung heroes who always put the needs and safety of their patients ahead of themselves, they continue to be dedicated in maintaining quality patient care even in the face of crisis or in an environment of fear.
Application of Leininger's Theory of Transcultural Nursing into Practice
Authors: Nemec R. , Carmicheal C.
Published: December 2004

The purpose of the poster was to demonstrate how Leininger's theory of transcultural nursing is utilized daily within the multicultural pediatric population at the hospital for sick children.

Methods:  Within this diverse and challenging population, the hemodialysis nurse is constantly challenged to ensure that the nursing care provided to the patient is reflective and meeting the needs of our pediatric population and their families. Leininger's theory of transcultural nursing has provided an avenue to ensure that the many cultures of our clients are maintained and respected. A case study will be used to show the integration of Leininger's theory. Resources for supporting the cultural values of the hemodialysis patient will also be identified.

Conclusion:  The use of a transcultural nursing model enhances the quality and effectiveness of the patient care provider for the pediatric hemodialysis patient at the hospital for sick children. Utilization of a transcultural nursing model ensures that the patients and their families are respected and supported for their diverse backgrounds by the hemodialysis nurse. The hemodialysis nurses are providing quality nursing care which reflects the needs and concerns of a multicultural population.
Accuracy of Doppler Ultrasonography in Measuring Radial Artery Wall Thickness in Hemodialysis Patients: Comparison with Histologic Examination
Authors: Kim Y.o. , Kim J.i. , Ku Y.m. , Choi Y.j. , Song H.c. , Jin D.c. , Kim S.y. , Choi E.j. , Chang Y.s. , Bang B.k.
Published: December 2004

Increased radial artery wall thickness (RAWT) is considered to be associated with early failure of radiocephalic arteriovenous fistula (AVF) as well as coronary artery atherosclerosis in hemodialysis patients. Therefore, exact measurement of RAWT by noninvasive method before the operation is very important.

Objective:  This study was designed to evaluate accuracy of Doppler ultrasonography in measuring RAWT in hemodialysis patients.

Methods:  This study enrolled 21 hemodialysis patients undergoing radiocephalic AVF operation for the first time. We measured RAWT (intima‐media thickness) using high‐resolution Doppler ultrasonography at the wrist before the AVF operation. We obtained specimens of the radial artery during the AVF operation and then measured RAWT by histologic examination.

Results:  Mean age of the patients was 60 ± 13 years and the number of females was 7 (33.3%). Mean values of RAWT measured by Doppler ultrasonography and histologic examination were 485 ± 93 μm (300–700 μm) and 426 ± 106 μm (300–700 μm), respectively. The value of RAWT of Doppler sonographic measurement well correlated with that of histologic measurement (r = 0.800, p < 0.001).

Conclusion:  Our data suggest that Doppler ultrasonography is an effective tool in measuring RAWT in hemodialysis patients before AVF operation.
Why Do So Many Patients Have a Dialysis Catheter and Not Arteriovenous Fistulae or Grafts?
Authors: Troidle L. , Eisen T. , Finkelstein F.o.
Published: December 2004

The Dialysis Outcome and Quality Initiative has guidelines for vascular access and states that the dialysis catheter (DC) should be limited to less than 20% of the end‐stage renal disease (ESRD) patients. Our center has found this target difficult to achieve.

Objective:  We wondered what the reasons for use of a DC might be.

Methods:  We noted the number of patients with a DC in place and assessed the reasons why the DC was being used on 8/1/03.

Results:  73 of the 170 (42.9%) patients had a DC on 8/1/03. 24 (32.9%) of the patients refused to have initial arteriovenous fistulae or grafts (AVF/G) or a secondary AVF/G revision or replacement procedure performed after initial AVF/G failure. 15 (20.5%) patients had a maturing AVF/G, 12 (16.4%) had significant medical and/or surgical contraindications for AVF/G placement, 9 (12.3%) patients were awaiting surgical thrombectomy, revision or placement of AVF/G, 6 patients (8.2%) were awaiting transfer to CPD therapy, 4 (5.5%) patients were undecided about having an AVF/G placed, and 1 (1.4%) had acute renal failure and early ESRD recovery was expected. Only 2 (2.7%) patients had no access plan by the nephrology team.

Conclusions:  Patients' refusal for an AVF/G placement and patients with a maturing AVF/G or awaiting surgical revision or placement were the most common reasons for the use of a DC in our center. To significantly impact on the high use of the DC, it would be crucial to better understand the reasons for patients’ refusals.
Role of Genetic Factors in Vascular Access Thrombosis in Hemodialysis Patients
Authors: Özdemir F.N. , Atac F.B. , Akçay A. , Ozbek N. , Haberal M.
Published: December 2004

Vascular access thrombosis is a frequent complication in hemodialysis (HD) patients. Genetic mutations, inflammation, and changes in the vascular wall are some factors that are thought to increase thrombosis risk. In this study, we tested for possible relationships between vascular thrombosis and some known thrombophilic mutation/polymorphisms in coagulation factors [factor V Leiden (FVL), prothrombin (Pt) G20210A, methylene tetrahydrofolate reductase (MTHFR C677T), factor XIII (F‐XIII) Val34Leu, alpha‐fibrinogen (AF) Thr312Ala, factor VII (F‐VII) R353Q] and angiotensin I converting enzyme (ACE) gene in our HD patients. Patients who had experienced at least 3 episodes of AVF thrombosis composed of the study group, and patients who had never encountered this complication composed of the control group. None of the patients in either group had a history of diabetes mellitus, atherosclerosis, dialysis‐related amyloidosis, or vasculitis. In order to find the frequency of F‐XIII Val34Leu, AF Thr312Ala, and F‐VII R353Q polymorphisms in our population, we also searched persons without renal disease or history of thrombosis (normal group). Results are summarized in Table. There was a tendency toward thrombotic mutation/polymorphisms in the study group for FVL, Pt G20210A, ACE I/D, and AF Thr312Ala. We suggest that patients who develop recurrent AVF thrombosis should be screened for the above‐mentioned factors and investigated for other possible risk factors. This screening would allow more effective focus on prophylaxis.

Genetic mutation/ polymorphism
Study group
Normal group
Control group

FVL/heterozygous
13 (n = 46)
 7 (n = 81)
24.5 (n = 44)

Pt G20210A/  heterozygous
 8.7 (n = 46)
 2.7 (n = 182)
20 (n = 44)

MTHFR C677T/  heterozygous
 0 (n = 44)
28.8 (n = 66)
22.3 (n = 44)

ACE I/DD/D
44.5 (n = 44)
28.8 (n = 138)
26.2 (n = 29)

I/D
36.3 (n = 44)
47.2 (n = 138)
23.1 (n = 29)

I/I
18.2 (n = 44)
15.4 (n = 138)
27 (n = 29)

F‐XIII/  Val34LeuVal/Val
44.8 (n = 29)
71.5 (n = 112)
52 (n = 25)

 Val/Leu
51.8 (n = 29)
27.6 (n = 112)
48 (n = 25)

 Leu/Leu
 3.4 (n = 29)
 0.9 (n = 112)
 0 (n = 25)

AF Thr312AlaAla/Thr
83 (n = 24)
58 (n = 119)
83.3 (n = 30)

 Thr/Thr
12.5 (n = 24)
32.6 (n = 119)
10 (n = 30)

 Ala/Ala
 4.5 (n = 24)
 8.4 (n = 119)
 6.7 (n = 30)

F‐VII R353QR/R
39 (n = 18)
74.5 (n = 98)
31.8 (n = 22)

 R/Q
34 (n = 18)
23.5 (n = 98)
68.2 (n = 22)

 Q/Q
27 (n = 18)
 2 (n = 98)
 0 (n = 22)

Values are percentages and numbers in parenthesis represent the number of patients/persons studied.