bluuebunny/crossref_metadata_2025 huggingface dataset:
Public Health Nursing Practice Guidelines: An Evalution of Dissemination and Use
Authors: Lia‐Hoagberg Betty , Schaffer Marjorie , Strohschein Susan
Published: March 2003

Public health nursing needs to build a practice on research‐based knowledge. Public health guidelines are one strategy to achieve this goal. Using research‐based knowledge, the Minnesota Practice Enhancement Project (MPEP) developed positive parenting and family violence prevention guidelines for public health nurses (PHNs). The purpose of this study was to evaluate the dissemination and use of the MPEP guidelines using a survey of PHNs and telephone interviews of public health nursing directors. Results indicated that respondents viewed the guidelines as important, but identified numerous barriers to integrating the guidelines into their practice. Major barriers included lack of time in their work day, complex guideline structure, and competing agency demands and priorities. Findings were consistent with Roger's Diffusion of Innovations theory, which describes factors associated with the adoption of a new idea or practice. Recommendations for effective dissemination include administrative support and structure to increase PHN intentional use of practice guidelines, a simplified guideline format, and mentorship in guideline use.
What to Do When the End Is Near: Ethical Issues in Home Health Care Nursing
Authors: Ladd Rosalind Ekman , Pasquerella Lynn , Smith Sheri
Published: March 2003

As managed care shortens the length of hospital stays, home settings for the practice of nursing will become increasingly important. In spite of community health nursing's long tradition of family‐centered care delivered in the home, many discussions of the nurse/patient relationship in the medical ethics literature assume the hospital setting for the practice of nursing and seem to neglect the impact of family and significant others for the nurse/patient relationship. Through a case‐based analysis, this article highlights the special ethical and legal issues encountered in caring for patients who are dying at home.

This analysis demonstrates that traditional frameworks for the nurse/patient relationship are inadequate for capturing the richness of the relationship the home health care nurse has with both patient and family. By developing a new framework for the nurse/patient/family relationship that (a) recognizes the patient's decision‐making authority and autonomy, (b) allows the exercise of the nurse's moral rights, and (c) recognizes the patient's relationships to significant others, the authors attempt to resolve some challenging legal and ethical questions concerning who should be allowed to decide what to do when the end is near. The discussion details the implications of this framework for nursing assessment in the home care setting.
Teen‐Focused Care Versus Adult‐Focused Care for the High‐Risk Pregnant Adolescent: An Outcomes Evaluation
Authors: Bensussen‐Walls Wendy , Saewyc Elizabeth M.
Published: March 2003

The purpose of this retrospective, matched‐case comparison study was to compare outcomes and cost‐effectiveness of comprehensive, interdisciplinary teen‐centered prenatal care clinics (Young Women's Clinic & Teen Pregnancy and Parenting Clinic) with “traditional” adult‐centered obstetric services (University of Washington Medical Center & Group Health Cooperative) in a university medical center and a staff‐model HMO. The sample (n= 106) included 27 index teens from Young Women's Clinic and matched cases from the other three clinics, matched on nine risk variables. Findings showed that teen‐clinic clients missed fewer appointments (0.96 vs. 2.29, p < 0.05), were more likely to be enrolled in the supplemental Medicaid program First Steps (p < 0.001) and WIC (p < 0.01), were more likely to have vaginal deliveries (90% vs. 75%, p < 0.05) and higher birth weight infants (3330 vs. 3084 g, p < 0.05), and were more likely to attend 2‐week (p < 0.001) and 6‐week postpartum exams (p < 0.05). Postpartum data were missing for the majority of adult‐clinic subjects; teen‐clinic postpartum outcomes included high contraception rates (87.5%), breastfeeding (62%), school return postpartum (63%), and long‐term follow‐up. Costs were lower for teen clinics based on outcomes; cost savings related to preterm labor were similar.
Acute Generalized Varicella Zoster in the Setting of Preexisting Generalized Erythema
Authors: Egan Conleth A. , O'Reilly Margretta A. , Vanderhooft Sheryll L. , Rallis Tena M.
Published: March 2003

We report a 5‐year‐old girl who initially had generalized erythema from scarlet fever. Four days later she developed sheets of monomorphous vesicles in the areas of erythema. A Tzanck smear of a vesicle base showed multinucleated giant cells, and viral culture grew varicella zoster virus, confirming a clinical diagnosis of varicella. This case illustrates that, with a background of preexisting erythema, varicella may present in an atypical manner.
Monilethrix—Improvement by Hormonal Influences?
Authors: Gebhardt M. , Fischer T. , Claussen U. , Wollina U. , Elsner P.
Published: March 2003

Abstract: Monilethrix is a hereditary hair disorder that occurs monosymptomatically or as a monilethrix syndrome combined with other ectodermal anomalies. We report two siblings with the triple combination of monilethrix, keratosis pilaris, and koilonychia. In one of our patients, the hair disorder improved, with maximum hair growth up to 8 cm in length after her first menstrual period occurred, suggesting that hormonal influences may improve the hair disorders in monilethrix.
Psoriasiform Acral Dermatitis: A Peculiar Clinical Presentation of Psoriasis in Children
Authors: Patrizi Annalisa , Bardazzi Federico , Neri Iria , Fanti Pier Alessandro
Published: March 2003

Abstract: Recently an unusual chronic dermatosis, considered a new clinical entity and closely resembling psoriasis, has been described in the literature under the term psoriasiform acral dermatitis (PAD). It is characterized by cutaneous involvement of the digits without nail dystrophy. We describe three young patients, ages 6 to 8 years, in whom this condition was associated with psoriasis. Two children were affected by psoriasis vulgaris, while the third had a palmoplantar psoriasis. All laboratory investigations performed were within normal limits. Skin biopsy specimens taken from the fingers of two patients revealed the pathologic features of subacute spongiotic dermatitis. Histologic examination of a biopsy specimen taken from an erythematous squamous patch confirmed the clinical diagnosis of psoriasis in two patients. The dermatitis showed a fluctuating course in all three patients, with only a moderate to strong improvement with therapy with calcipotriol ointment (50 μg/g). During follow‐up, two patients experienced marked spontaneous, persistent improvement, while the disease slightly worsened in the third. The children had features similar to those described in PAD, but were also suffering from psoriasis. Whether PAD is a distinctive entity or just a clinical manifestation of psoriasis in children is still an open question. We strongly believe this latter hypothesis, although further studies are needed to confirm it.
Keratin 9 Mutations in the Coil 1A Region in Epidermolytic Palmoplantar Keratoderma
Authors: Szalai S. , Szalai C. , Becker K. , Török E.
Published: March 2003

Abstract: The palmoplantar keratodermas (PPK) are a heterogeneous group of conditions, most frequently inherited in autosomal dominant fashion. A few are well‐documented autosomal recessive disorders; other are acquired in association with certain metabolic disorders and malignancies. Recently different point mutations of the keratin 9 (K9) gene have been identified in unrelated families with epidermolytic palmoplantar keratoderma (EPPK). We investigated two unrelated Hungarian families with EPPK. In one, a mutation consisting of a G→A transversion at nucleotide position 551, which changes codon arginine to glutamine at codon 162 (R162Q), was found. In the other, we observed a novel mutation at nucleotide position 571, which changes codon 169 lysine (AAG) into the amber stop codon (TAG) (K169X). Each found mutation is present in the highly conserved coil 1A region of the rod domain. In the case of a stop codon type of mutation, it is questionable whether it really results in a clinical phenotype, but segregation analysis revealed cosegregation of the PPK phenotype with the mutant allele.
Prominent Pruritic Periumbilical Papules: A Diagnostic Sign in Pediatric Atopic Dermatitis
Authors: Rencic Adrienne , Cohen Bernard A.
Published: March 2003

Abstract: Establishment of diagnostic criteria for atopic dermatitis has been a subject of controversy and frequent reevaluation. The diagnostic criteria of Hanifin and Rajka are those most frequently cited. In order to fit the diagnosis, a patient must demonstrate three major criteria plus four or more minor criteria. Although individually the minor criteria are not diagnostic, their presence suggests the possibility of atopic dermatitis. Recently we evaluated several children who developed prominent periumbilical papules as a major component of their atopic dermatitis. This finding, while not present in all children with atopic dermatitis, can provide a specific clue to diagnosis and should be considered as a new minor criterion for atopic dermatitis in children.
A Newborn with Nodular Ulcerated Lesion on a Giant Congenital Nevus
Authors: Borbujo J. , Jara M. , Cortes L. , Sanchez de Leon L.
Published: March 2003

Abstract: The proliferative nodule is a lesion that develops within a congenital nevus. It is usually small (less than 5 mm), sometimes multiple, with a slow growth rate, and has a black or dark brown, smooth, shiny surface. It usually involutes spontaneously. We report a newborn infant who, at birth, had a giant congenital nevus with a nodular, ulcerative, hemorrhagic lesion within it. Physical and neurologic examinations were normal. Radiologic studies at birth and subsequently were normal. A fragment of the lesion was biopsied and histologic findings were compatible with a diagnosis of proliferative nodule in a giant congenital nevus. The rest of the nodule regressed spontaneously after 4 months.
Pseudopili Annulati in a Dark‐Haired Individual: A Light and Electron Microscopic Study
Authors: Lee Siong‐See Joyce , Lee Yoke‐Sun , Giam Yoke‐Chin
Published: March 2003

Abstract: We report pseudopili annulati for the first time in a dark‐haired Chinese girl. The hair was elliptical in shape and twisted along its long axis. The banded or ringed appearance was due to incident light being reflected by the flattened segments. Banding was also noted under polarized light but was not present under transmitted light. Under transmitted light the whole length of the hair appeared dark and the thickness varied at regular intervals, giving rise to fusiform segments due to the twisted nature of the hair shaft. Scanning and transmission electron microscopic examinations revealed no abnormalities in the cuticle and cortex.
Giant Congenital Nevus with Progressive Sclerodermoid Reaction in a Newborn
Authors: Pattee Sean F. , Hansen Ronald C. , Bangert Jerry L. , Joganic Edward F.
Published: March 2003

Giant congenital melanocytic nevi are a rare occurrence in the pediatric population. The risk of malignant transformation associated with these lesions has been well established; however, the management strategies for giant congenital nevi remain controversial. We report an unusual sclerodermoid reaction in a giant congenital nevus in a 6‐week‐old Caucasian girl. Given its abnormal clinical appearance, the entire lesion was excised. The histology was consistent with an atypical compound/sclerosing spindle and epithelioid cell congenital nevus. No evidence of malignant change was seen histologically. The incidence of malignant transformation in giant congenital nevi has been difficult to calculate. Review of the literature yields an incidence of between 4 and 9%, favoring surgical excision of these lesions where possible. Atypical presentations of giant congenital nevi are rare, and we have found no other reported cases with a stromal change similar to that seen in our patient. We hypothesize that this change may represent an atypical host reaction to the nevus cells.
Cutaneous Focal Mucinosis: A Case Report
Authors: Nebrida Ma. Lourdes Anna , Tay Yong–Kwang
Published: March 2003

Cutaneous or dermal mucinoses are a heterogeneous group of connective tissue disorders in which there is an accumulation of mucin in the skin or within the hair follicle. They have a number of different morphologic presentations and can often be confused with other diseases. We report a 12‐year‐old Chinese girl with a 1‐year history of a well‐defined, hypopigmented plaque on her chin, consistent with cutaneous focal mucinosis, a rare condition in children.
Nail Involvement in Lichen Striatus
Authors: Kavak Ayse , Kutluay Lale
Published: March 2003

Nail involvement in lichen striatus is nearly always accompanied by skin lesions. A case of childhood lichen striatus involving the thumb nail is presented.
Two Siblings Born Preterm With Large Ears and Hypopigmented Hair Who Developed Palmoplantar Keratoderma and Frontal Skull Bossing: A New Syndrome?
Authors: Abdullah Alfadley , Rosalind M. Parkes
Published: March 2003

Abstract: This article discusses two children with an unknown syndrome characterized by palmoplantar keratoderma (PPK), hypopigmented hair, large ears, and frontal bossing. The children were both born preterm, with low birthweights, to consanguineous parents. They developed PPK shortly after birth. In addition, the younger child also has esotropia affecting the right eye. We made a thorough review of the literature but were unable to find a syndrome with all the features described above. To the best of our knowledge, we believe we describe a new syndrome with an autosomal recessive mode of inheritance.
Tufted Angioma: A Report of Five Cases
Authors: Wong Su‐Ni , Tay Yong‐Kwang
Published: March 2003

Abstract: Tufted angioma is a rare, benign, vascular tumor, characterized histologically by tufts of capillary‐sized vessels in the dermis. Five patients were diagnosed over a 10‐year period. All developed the lesions within the first year of life. Four were Chinese and one was Indian. There was no sex predilection. All the lesions occurred on the limbs, mainly proximally, with 40% affecting the upper and 60% the lower limbs. The appearance ranged from erythematous, indurated, annular nodules to plaques. In two patients the lesions had overlying red papules, and hypertrichosis was present in three cases. The lesions were tender in all patients. No complications such as ulceration, bleeding, or Kasabach–Merritt syndrome occurred. All were treated conservatively, with improvement in tenderness in three of four patients after a period of 5 months to 4 years. Decrease in size occurred in one of four patients after 2 years. Our series differs from previous ones in that all the patients developed the lesions before the age of 1 year, all lesions occurred on the limbs, and all were tender. Tenderness and hypertrichosis, in addition to induration, may be useful in the clinical differentiation from common hemangioma.
Miller Fisher Syndrome with Central Involvement: Successful Treatment with Plasmapheresis
Authors: Yeh Jiann‐Horng , Chen Wei‐Hung , Chen Jiunn‐Rong , Chiu Hou‐Chang
Published: March 2003

Miller Fisher syndrome is characterized by external ophthalmoplegia, ataxia, and areflexia. Most researchers favor a peripheral origin while others suggest a brainstem inflammatory lesion or a combination of central and peripheral demyelination. We report 2 cases of Miller Fisher syndrome with the typical triad of ataxia, areflexia, and ophthalmoplegia. Strong clinical evidence of central involvement included initial drowsiness, bilateral Babinski sign, and quadriparesis. Evoked potential studies showed prolongation of central conduction time. Plasmapheresis was performed to relieve respiratory failure in Patient 1 and to shorten the duration of nasogastric tube feeding due to severe bulbar palsy in Patient 2. Significant improvement of electrophysiologic parameters was recorded after plasmapheresis. Abnormal evoked potentials, together with clinical evidence of central nervous system abnormalities, support the hypothesis that there is a combination of peripheral and central involvement in Miller Fisher syndrome in our patients. Plasmapheresis is highly effective in relieving the profound neurological deficits of this atypical syndrome.
In Vitro Cell Culture Systems as the Basis for an Extracorporeal Blood Purification Strategy In Multiorgan Failure Treatment
Authors: Mitteregger Regina , White Adrienne , Weber Christoph , Rossmanith Eva , Mohr Thomas , Micksche Michael , Falkenhagen Dieter
Published: March 2003

Multiorgan failure (MOF) based on septic processes is very common but prognostically an extremely severe disease that has to be treated exclusively under intensive care conditions. Extracorporeal blood purification (ECBP) using specific and efficient systems such as the microspheres based detoxification system (MDS) (Artif Organs 1996;20:420) could improve significantly the situation of MOF in terms of the efficient removal of endotoxins as well as key mediators such as tumor necrosis factor alpha (TNFα). The purpose of the study was to test the effectiveness of endotoxin and cytokine removal to blunt cellular response. In terms of the in vitro principle methodology, isolated peripheral blood mononuclear cells (PBMC) were incubated with endotoxins and a selective endotoxin adsorbent, which was added at various times (immediately or 30, 60, 120, 240, or 360 min) after the onset of incubation. TNFα release of monocytes was measured following a standard procedure after 20 h. Human TNFα was incubated with cultured human endothelial cells with and without a specific TNFα adsorbent (polyclonal antibodies coated on polystyrene particles). The results showed that after the initial addition of endotoxins, the activation of monocytes can be stopped within 120 min by addition of endotoxin adsorbents. In addition, specific TNFα adsorbents are able to prevent intercellular adhesion molecule 1 (ICAM‐1) expression of endothelial cells, therefore avoiding activation of endothelial cells. In conclusion, cell culture models are suitable to simulate cell interaction in MOF. Specific adsorbents are able to reduce or block pathophysiologically relevant cell interactions, and the time frame for effective ECBP seems to be very short, and therefore, efficiency must be high.
Immunoadsorption in Dilated Cardiomyopathy
Authors: Dörffel Wolf V. , Wallukat Gert , Baumann Gert , Felix Stephan B.
Published: March 2003

Abstract: The prognosis for patients suffering from advanced stages of dilated cardiomyopathy (DCM) is poor. Recent studies have shown that immunoadsorption (IA) may represent an effective alternative therapeutic approach for other kinds of autoimmune diseases with circulating autoantibodies. The objective of this pilot study was to ascertain the short‐term hemodynamic effects of IA in patients with idiopathic DCM and circulating autoantibodies. Our study included 9 patients with circulating β1‐adrenoreceptor antibodies who suffered from idiopathic DCM as well as severe heart failure (left ventricular ejection fraction <30%). Immunoadsorption was performed on 5 consecutive days using an adsorber against immunoglobulins (Ig Therasorb, Baxter, Unterschleissheim, Germany). Substitution of 0.5 g/kg of polyclonal immunoglobulin took place after the final IA session. During IA, the cardiac index and stroke volume index increased from 2.0 ± 0.42 to 2.9 ± 0.79 L/min−1/ m−2, p < 0.01, and from 24.0 ± 7.4 to 35.9 ± 10.3 ml/m2, p < 0.05, respectively. In addition to drug therapy, IA may represent a promising alternative therapeutic possibility for hemodynamic stabilization of patients with severe idiopathic DCM.
Do Automated Red Cell Exchanges Relieve Priapism In Patients with Sickle Cell Anemia?
Authors: McCarthy L.J. , Vattuone J. , Weidner J. , Skipworth E. , Fernandez C. , Jackson L. , Rothenberger S. , Waxman D. , Miraglia C. , Porcu P. , Danielson C.F.M.
Published: March 2003

Abstract: Priapism is a dramatic, painful complication for some men afflicted by sickle cell anemia. Although the natural history remains unclear, many believe replacing the patient's abnormal red blood cells (RBCs) with normal RBCs by apheresis is effective. However, no controlled trials have demonstrated its effectiveness. We exchanged 7 men after medical management failed. All procedures reduced sickle hemoglobin levels to < 30%. Two patients underwent emergency automated red cell exchanges without any detumescence or reduction of pain. The remaining 5 patients were exchanged non‐emergently; 4 experienced no detumescence or relief of pain. One adult experienced resolution 8 h postexchange. However, he had a history of “stuttering” priapism. All required decompression procedures. Automated RBC exchanges were not effective in achieving detumescence or reducing pain.
Clinical Thermofiltration: Initial Application
Authors: Nosé Yukihiko , Usami Makoto , Malchesky Paul S. , Emura Muneo , Horiuchi Takashi , Sakamoto Hiroyuki , Smith James W.
Published: March 2003

Guest Editor's Introduction: This paper was submitted for publication in June 1985 and published in the “Thought and Progress” section of Artificial Organs, Vol. 9, No. 4, 1985, pages 425–427. The first clinical thermofiltration procedures (plasma filtration near and above normal physiologic temperature) were performed on a secondary hypercholesterolemia patient. The intent of this filtration scheme is the selective removal of low density lipoprotins (LDL) and maintenance of high density limpoproteins (HDL) and other essential plasma proteins including albumin. The EVAL 4A filter, at a filtration temperature of 37°C, was selected for on‐line thermofiltration. The sieving coefficients of LDL + very low density lipoproteins (VLDL) cholesterol, HDL cholesterol, and albumin were 0.02, 0.75, and 0.78, respectively. These results were comparable to in vitro filtration tests using the plasma of the same patient. This system is simple to apply and does not require replacement solution. Compared with plasma exchange, a high return of HDL and other essential plasma solutes can be returned to the patient by this method.

Abstract: The first clinical thermofiltration procedures (plasma filtration near or above normal physiologic temperature) were performed on a secondary hypercholesterolemia patient. The intent of this filtration scheme is the selective removal of low density lipoproteins (LDL) and maintenance of high density lipoproteins (HDL) and other essential plasma proteins including albumin. The EVAL 4A filter, at a filtration temperature of 37°C, was selected for on‐line thermofiltration. The sieving coefficients of LDL + very low density lipoproteins (VLDL) cholesterol, HDL cholesterol, and albumin were 0.02, 0.75, and 0.78, respectively. These results are comparable to in vitro filtration tests using the plasma of the same patient. This system is simple to apply and does not require replacement solution. Compared with plasma exchange, a high return of HDL and other essential plasma solutes can be returned to the patient by this method.
Therapeutic Apheresis in Myasthenia Gravis
Authors: Batocchi Anna Paola , Evoli Amelia , Di Schino Chiara , Tonali Pietro
Published: March 2003

Abstract: Plasma exchange (PE) is an easily applicable technique for rapid and massive removal of antibodies, and its beneficial role is well established in the management of myasthenia gravis (MG), an antibody‐mediated disorder of the neuromuscular junction. PE is useful in myasthenic crisis, in most severe forms of MG before thymectomy, in the early postoperative period, and in cases of symptom worsening during tapering or initiation of immunosuppressive therapy. Clinical efficacy varies from 55% to 100%, and improvement rarely persists for more than 4–10 weeks; thus immunosuppressive therapy has to be associated. New apheretic techniques (double filtration plasmapheresis, immunoadsorption systems with staphylococcal protein A columns or thryptophan‐polyvinyl alcohol gel columns) that allow the selective removal of IgG and anti‐AChR antibody were recently used in the management of MG with positive effects. Whether their therapeutic effect and cost effect prove more favorable than those obtained by PE still must be demonstrated.
Affinity Hemodialysis for Antiviral Therapy. I. Removal of HIV‐1 from Cell Culture Supernatants, Plasma, and Blood
Authors: Tullis Richard H. , Duffin R. Paul , Zech Marvin , Ambrus Julian L.
Published: March 2003

Abstract: We tested an affinity hemodialysis technique designed to efficiently remove HIV and toxic viral proteins from blood. Miniature polyethersulfone hollow‐fiber dialysis cartridges (200–500 nm pore) were packed with anti‐HIV antibodies covalently coupled to agarose beads and sealed inside the cartridge. Cell culture fluids, plasma, or infected blood (7–15 ml) containing HIV‐1 were circulated over the cartridge at 0.7–10 ml/min and the rate of removal of HIV measured by PCR and p24 ELISA. The technique removed up to 98% of HIV‐1 particles from cell culture supernatants. Affinity hemodialysis also efficiently captured cultured HIV from human blood plasma (90%) and native HIV from infected blood (83% to 100%). Viral capture followed first‐order kinetics (t1/2 = 2.8 h). Variations in antibody type, matrix linkage (protein G versus direct coupling), bead pore size, and temperature of operation (25–37°C) had only small effects. Although some binding was nonspecific, direct binding to the immobilized antibodies appeared to be the predominant mechanism.
In Vitro Evaluation of Dextran Sulfate Cellulose Beads for Whole Blood Infusion Low‐Density Lipoprotein‐Hemoperfusion
Authors: Kobayashi Akira , Nakatani Masaru , Furuyoshi Shigeo , Tani Nobutaka
Published: March 2003

Abstract: We describe results from a feasibility study of a newly developed low‐density lipoprotein (LDL) adsorbent designed for use in whole‐blood infusion LDL‐hemoperfusion. The adsorbent has almost the same chemical structure as the Liposorber adsorbent (dextran sulfate cellulose beads) but has a larger particle size. In whole‐blood perfusion tests, the adsorbent adsorbed atherogenic LDL cholesterol directly from whole blood but left concentrations of high‐density lipoprotein cholesterol largely unchanged. In whole‐blood perfusion tests using fresh human donor blood or bovine blood anticoagulated with acid citrate dextrose solution or sodium citrate, the adsorbent showed minimal side effects in terms of blood cell activation, complement activation, and blood cell loss, suggesting that it has excellent blood compatibility. In addition, the adsorbent showed mechanical stability and absence of hemolysis. In conclusion, the new adsorbent showed the appropriate characteristics for an LDL adsorbent column for use in whole‐blood infusion LDL‐hemoperfusion.
Continuous Hemofiltration/Hemodiafiltration in Critical Care
Authors: Oda Shigeto , Hirasawa Hiroyuki , Shiga Hidetoshi , Nakanishi Kazuya , Matsuda Ken‐ichi , Nakamura Masataka
Published: March 2003

Abstract: Continuous hemofiltration and continuous hemodiafiltration (CHF/CHDF) were developed as continuous renal replacement therapy for patients with severe conditons and has come to be widely performed mainly in critical care, taking the place of intermittent hemodialysis. The membrane pore size of a hemofilter used for CHF/CHDF allows passage of substances ranging from 30,000 to 50,000 Da, and the method for solute removal in CHF/CHDF employs the principle of convection, which is advantageous for removing middle‐ to high‐molecular‐weight substances. As apheresis therapy to remove pathogenic substances in blood, CHF/CHDF is therefore being investigated for its possible effect on various morbid conditions. It has recently been found that CHF/CHDF removes humoral mediators including cytokines, particularly in severe systemic inflammatory response syndromes such as septic shock and severe acute pancreatitis. CHF/CHDF is thus beginning to be performed for the prevention and treatment of organ dysfunction secondary to septic shock, trauma, or acute pancreatitis. CHF/CHDF is also efficacious as artificial liver support in preventing adverse effects caused by plasma exchange (PE) and for continuous removal of hepatic coma‐inducing substances. CHF/CHDF is effective for various morbid conditions not only as renal replacement therapy, but also as apheresis therapy and is expected to be applied more widely in critical care in the future.
Birth of the Concept and the Development of Extracorporeal Immunomodulation
Authors: Agishi Tetsuzo
Published: March 2003

Abstract: Extracorporeal immunomodulation is a term that presents the concept and techniques of a group of therapeutic procedures by which immunological circumstances in a patient's body, suppression or activation, drastically are altered by applying extracorporeal circulation. This had been achieved only by administration of the pharmacological agents, such as immunosuppressive agents before the introduction of extracorporeal immunomodulation. From the view of removal of the pathogenic substances in the circulating blood, it is regarded as belonging to the blood purification procedures. In respect to the technology, plasmapheresis is an important and a key procedure in most of the cases. The concept and current clinical practices are described in the text.
Vegetation Monitoring of Created Dune Swale Wetlands, Vandenberg Air Force Base, California
Authors: Parikh Anuja , Gale Nathan
Published: March 2003

A monitoring program was established on San Antonio Terrace at Vandenberg Air Force Base to compare vegetation development at two created wetland sites and six nearby natural wetlands. The reference wetlands were chosen to represent a range of habitats in dune swale wetlands on the Terrace. Vegetation in the reference wetland plant communities varies from low‐growing herbaceous marsh species with open canopies to closed canopies dominated by shrub or tree species. Transects and plots for long‐term vegetation monitoring were established in all the wetlands, stratified by plant communities in the reference wetlands and by geomorphic location in the newly created wetlands. Quantitative vegetation and environmental data were collected at all the sites; measures included species distributions, species cover, and topographical elevations. Over the first three years of monitoring, variations in groundwater depth at different geomorphic locations in the created wetlands resulted in a variety of physical conditions for plant growth. In the first year, more than 100 plant species were observed, the majority being natives. During the next two years, species richness at the created wetland sites remained relatively stable and was higher than at the reference sites. Statistical comparisons of vegetation parameters by analysis of variance and hierarchical clustering exhibited patterns of increasing similarity between the created and reference wetlands. Long‐term monitoring will be continued to track the progress of vegetation at the created sites, and to assess their development relative to the reference wetlands.
Restoration and Rehabilitation of Species‐Rich Grassland Ecosystems in France: a Review
Authors: Muller S. , Dutoit T. , Alard D. , Grévilliot F.
Published: March 2003

In France the alteration of species‐rich grasslands is due mainly to agriculture and civil engineering projects (roadways, dams, ski resorts, etc.). The restoration of such ecosystems has been tested in many regions and after many sorts of degradation. According to the level of initial degradation, different responses can be envisioned. Some variations are presented of a general model of restoration and rehabilitation: (1) rejuvenation of fallow land by grazing with rustic animal breeds in wetlands or chalk grasslands in south and northwestern France, (2) restoration by recovery of extensive agricultural management in intensive agricultural areas such as the Rhône or Meuse Valleys, and (3) rehabilitation by appropriate ecological engineering carried out in grasslands degraded by intensification, ski‐track, or civil engineering installations. Despite some positive results, these undertakings have not always had the expected effects and therefore should not provide alibis for the destruction of natural grasslands. In general, the success of such undertakings depends on the maintenance in the surrounding areas of protected seed source reservoirs and on the persistence of a diversified landscape pattern permitting connectivity between these seed sources and the restoration or rehabilitation sites.
Nitrogen Addition Could Shift Plant Community Composition in a Restored California Salt Marsh
Authors: Boyer Katharyn E. , Zedler Joy B.
Published: March 2003

At a salt marsh restoration site, fertilizer trials to improve height growth of Spartina foliosa (a C4 perennial grass that can reach 140 cm) appeared to favor Salicornia bigelovii (an annual C3 succulent under 40 cm tall) where the two species co‐occurred on the marsh plain. This observation prompted a field experiment to examine the potential for nitrogen (N) addition to shift community composition. Without N addition, total stem length and stem density of S. foliosa did not respond to the presence or absence of S. bigelovii. But where N was added, S. foliosa growth increased only where S. bigelovii was removed from plots. S. bigelovii responded strongly to fertilizer, with mean heights matching those of S. foliosa and 600% increases in biomass, branching, and seed production (to more than 1 million seeds/m2). Soil N also increased seasonally where S. bigelovii was present, suggesting that this species may aid accumulation of N at restoration sites with poor soils. S. foliosa growth is greatest at lower elevations along tidal creeks where it occurs alone. Beyond creek edges, where S. bigelovii and other potential competitors occur, S. foliosa is unlikely to grow tall even with N addition. Thus, there is little point in trying to force mixed‐species stands to provide tall S. foliosa for nesting by an endangered bird, Rallus longirostris levipes (the Light‐footed Clapper Rail). A marsh construction design that maximizes tidal creek edges is thus recommended when restoration goals include providing habitat for clapper rails.
Comparative Study of Ant Communities of Rehabilitated Mineral Sand Mines and Heathland, Western Australia
Authors: Bisevac L. , Majer J. D.
Published: March 2003

We conducted a survey of ants in April 1997 in seven rehabilitated (2‐ to 20‐year‐old) and three native heathland reference sites of the Renison Goldfields Corporation (RGC) Mineral Sands operations at Eneabba, Western Australia. We employed a variety of collecting methods, including pitfall trapping, litter and soil sampling, sweeping and beating of vegetation, and collecting by hand in the day and after dark, replicating those used by previous researchers in a similar study conducted in the same area in 1980. We found a total of 96 ant species representing 30 genera in 1997, compared with 46 species from 18 genera in 1980. Ant species richness increased with age of rehabilitation and exceeded that of heath controls by the time it reached 11 years. Ant species richness related to rehabilitation age was represented by a logarithmic curve, and the slope for current rehabilitation was steeper than that for the earlier rehabilitation studied in 1980. This probably reflects improved rehabilitation practices. Ordination of the sites in terms of ant species composition indicated differences between ant species in the rehabilitated sites studied in 1980 and 1997, and also between all rehabilitated sites and heath controls. Classification of the sites in terms of the distribution of ants across functional groups also indicated differences between rehabilitation and heath control sites. According to species composition and functional group profiles from rehabilitated and control sites, we concluded that although the current rehabilitation allows for a rapid return of ant species, even after 20 years the fauna still had not attained the composition of the original heath fauna.
The Role of White Clover in the Loss of Diversity in Grassland Habitat Restoration
Authors: Warren John M.
Published: March 2003

A field experiment was designed to recreate a species‐rich mesotrophic grassland community of conservation worth. Trifolium repens (white clover) was observed to increase significantly in both frequency and abundance in sown plots grazed by cattle, but not in plots cut in June and subsequently grazed by cattle. In both these treatments permanent quadrats containing clover patches were found to be lower in species richness than were quadrats without clover. In both treatments botanical diversity was seen to decline over time. In the grazed‐only treatment the loss of diversity may be linked to the increase in clover. In the cut and grazed plots, T. repens did not become so abundant but diversity was still seen to decline, possibly due to the loss of low growing species from the taller sward. A pot experiment which varied the sowing density of a mix of seven wild flower species in full factorial combination with cutting frequency was established on soils from an arable field also sown with a single density of clover. T. repens was seen to decline from initial high cover estimates in infrequently cut and uncut treatments. In the pot experiment where a grass component to the vegetation was absent, clover was seen to have less impact on the other forbs than it did in the field. It is suggested that, being a nitrogen fixer, T. repens may have a competitive edge in ex‐arable soils low in available nitrogen. The observed reduction in botanical diversity may be a result of this increase in available nitrogen, facilitating the spread of the sown grasses and preventing the recovery of the sown forbs that were excluded by the invasion of T. repens. It is suggested that reducing the proportion of grass in the seed mixtures during grassland habitat creation on these soils may help reduce or delay this effect.
Logs and Fern Patches as Recruitment Sites in a Tropical Pasture
Authors: Slocum Matthew G.
Published: March 2003

Forest recovery in degraded pastures is often highly variable, possibly due to variation in the availability of adequate recruitment sites. In an actively grazed pasture in northeastern Costa Rica, this study examines how recruitment of woody species in patches of the fern Nephrolepsis sp. and near logs compares with recruitment in grassy areas. Fern patches and logs had five and eight times higher densities of woody recruits, respectively, as grassy areas. They also had more than twice the species richness and growth as grassy areas. Grass apparently presents a competitive barrier against invading woody recruits, and also attracts cattle that may trample and/or consume recruits. Both logs and patches of fern appeared to provide superior conditions for establishment and growth of woody species, and they did not attract cattle. This study suggests that fern patches and logs can be managed to accelerate forest succession.
Seed Availability as a Limiting Factor in Forest Recovery Processes in Costa Rica
Authors: Wijdeven Sander M. J. , Kuzee Mirjam E.
Published: March 2003

Abandoned pastures and secondary forests are increasingly prominent features of tropical landscapes. Forest regrowth on abandoned pastures is generally slow and virtually limited to regeneration from seeds from external sources, since agricultural activities alter site conditions. We hypothesize that seed availability is a major limiting factor in forest recovery on abandoned pastures. This hypothesis was tested by studying the seed bank, seed rain, and seed predation in a small pasture (1 ha) situated in a forest‐pasture mosaic in northwestern Costa Rica. The tree seed density in the pasture seed bank was much lower (21/m2) than the density in the seed bank of a neighboring secondary forest (402/m2). Within a period of five weeks, 23 tree seeds entered the pasture by seed rain. This number is low compared to densities found in closed forests but higher than densities reported in other studies where virtually no seeds were found beyond 20 m from the forest edge. Possibly the small size of the pasture with seed sources nearby and the small‐scale landscape mosaic enhance seed dispersal. Predation limits the seed density in pastures, with 42% of the woody species consumed by predators. The low seed density in the seed bank, and hampered recruitment combined with significant losses, pose severe restrictions to forest recovery on abandoned pastures. Moderate land use, and small sized clearings with seed sources nearby may increase the pace of recovery. Nevertheless, forest establishment may still take a considerable time. Thus, enlarging the available pool of species may be a worthwhile management strategy.
Determining the Pattern of Oak Woodland Regeneration for a Cleared Watershed in Northwest California: A Necessary First Step for Restoration
Authors: Brooks Colin N. , Merenlender Adina M.
Published: March 2003

Historically, oak woodlands of northern California have been subject to intensive tree and brush removal efforts to improve land for livestock grazing. As a result of this tree removal, these watersheds are susceptible to soil erosion and stream degradation. Therefore, planting woody vegetation is often required to restore watershed function. Prior to such actions, a thorough understanding of natural vegetation regeneration patterns is essential. The physical and biological attributes of natural vegetation regeneration in a cleared watershed were characterized using remote sensing, a Geographic Information System, and field surveys. A 79‐ha watershed at the University of California's Hopland Research and Extension Center was examined because the clearing of vegetation was part of a well‐documented experiment in the early 1960s, providing essential baseline data. The results of this study reveal that significantly more oak regeneration, consisting mostly of evergreen oaks, occurred on moister and steeper northerly slopes. Deciduous oaks, located primarily on drier and less steep southerly slopes, have not regenerated. Hardwood regeneration was associated with Josephine, Los Gatos, and Maymen soils. The distribution of hardwood regeneration is clustered, suggesting that the presence of other trees may promote regeneration. These results also suggest that without active restoration efforts such as tree planting and seedling protection, southerly slopes will most likely remain barren and erosion will continue, while northerly slopes and riparian areas will recover under the current land management practices. Despite some woody plant regeneration, the once densely forested watershed is now predominantly grassland, emphasizing the need to minimize clearing of California oak woodlands.
Problems, Approaches, and Results in Restoration of Dutch Calcareous Grassland During the Last 30 Years
Authors: Willems J. H.
Published: March 2003

This paper is based on research of the restoration of species‐rich calcareous grasslands in The Netherlands, over the last 30 years. Chalk grassland is a semi‐natural vegetation with a high density of species at a small scale. This type of vegetation was once widespread in Western Europe as common grazing land, mainly for flocks of sheep for which the main function was dung production. In some regions of Central Europe, these grasslands were also used for hay production. The dung was used to maintain arable field production at a reasonable level. In the chalk district in the southernmost part of The Netherlands some 25 sites of this vegetation, varying in area from 0.05–4.5 ha, are still present. Chalk grassland completely lost its significance for modern agricultural production after the wide application of artificial fertilizer following World War II. This grassland has a high conservation value both for plants and animal species, of which a large number of species are exclusively restricted to this biotope. When conservation activities started at a large scale in the early 1960s, three different types of restoration activities could be distinguished: (1) restoration of fertilized sites; (2) restoration of abandoned grasslands; and (3) recreation of chalk grassland on former arable fields. The main aim of the restoration attempt is to create and/or improve sustainable conditions for both plant and animal species characteristic of the chalk grassland ecosystem. In the process of restoration, several phases of different activities can be distinguished: (1) pre‐restoration phase, during which information of the land use history is collected and, based on these data, clear restoration goals are established; (2) initial restoration phase, during which effects of former, non‐conservational land use has to be undone in order to stimulate germination and establishment of target species originating from soil seed bank and species pool; (3) consolidation phase, including the introduction and continuation of a regular management system for sustainable conservation; and (4) long‐term conservation strategy, including measures to prevent disturbance from the outside and genetic erosion and extinction of locally endangered plant populations.
Restoration of Fragmented Landscapes for the Conservation of Birds: A General Framework and Specific Recommendations for Urbanizing Landscapes
Authors: Marzluff John M. , Ewing Kern
Published: March 2003

Humans fragment landscapes to the detriment of wildlife. We review why fragmentation is detrimental to wildlife (especially birds), review the effects of urbanization on birds inhabiting nearby native habitats, suggest how restoration ecologists can minimize these effects, and discuss future research needs. We emphasize the importance of individual fitness to determining community composition. This means that reproduction, survivorship, and dispersal (not simply community composition) must be maintained, restored, and monitored. We suggest that the severity of the effects of fragmentation are determined by (1) the natural disturbance regime, (2) the similarity of the anthropogenic matrix to the natural matrix, and (3) the persistence of the anthropogenic change. As a result, urbanization is likely to produce greater effects of fragmentation than either agriculture or timber harvest. Restoration ecologists, land managers, and urban planners can help maintain native birds in fragmented landscapes by a combination of short‐ and long‐term actions designed to restore ecological function (not just shape and structure) to fragments, including: (1) maintaining native vegetation, deadwood, and other nesting structures in the fragment, (2) managing the landscape surrounding the fragment (matrix), not just the fragment, (3) making the matrix more like the native habitat fragments, (4) increasing the foliage height diversity within fragments, (5) designing buffers that reduce penetration of undesirable agents from the matrix, (6) recognizing that human activity is not compatible with interior conditions, (7) actively managing mammal populations in fragments, (8) discouraging open lawn on public and private property, (9) providing statutory recognition of the value of complexes of small wetlands, (10) integrating urban parks into the native habitat system, (11) anticipating urbanization and seeking creative ways to increase native habitat and manage it collectively, (12) reducing the growing effects of urbanization on once remote natural areas, (13) realizing that fragments may be best suited to conserve only a few species, (14) developing monitoring programs that measure fitness, and (15) developing a new educational paradigm.