bluuebunny/crossref_metadata_2025 huggingface dataset:
Role of type I collagen C telopeptide, bone‐specific alkaline phosphatase and osteocalcin in the assessment of bone status in postmenopausal women
Authors: Trento Laura K. , Pietropolli Adalgisa , Ticconi Carlo , Gravotta Enrica , De Martino Massimo U. , Fabbri Andrea , Piccione Emilio
Published: August 2008

Aim:  To investigate the clinical role of the bone turnover markers type I collagen C telopeptide (CTX), osteocalcin (OC) and bone‐specific alkaline phosphatase (BAP) in the assessment of bone status in women with postmenopausal osteoporosis.

Methods:  Serum CTX (s‐CTX), OC and BAP were measured in 200 healthy menopausal women at their initial visit and were correlated with spine and femur bone mineral density (BMD), determined on dual‐energy X‐ray absorptiometry. The relationship between biochemical markers of bone turnover and age, age at menopause, body mass index (BMI) and BMD was analyzed using linear correlation. A receiver operating characteristic (ROC) curve was constructed for each serum marker versus both femur and vertebral BMD.

Results:  No correlation was found between serum levels of OC and BAP and vertebral or femur BMD. A statistically significant inverse correlation was found between s‐CTX and BMD at spine and femur. S‐CTX levels were higher in women with osteoporosis than in women with normal or moderately low (osteopenic) values of BMD. The sensitivity and specificity versus spine BMD were 73.9% and 41.6% for s‐CTX, 40.4% and 80.6% for BAP, and 68.3% and 39% for OC, respectively. The sensitivity and specificity versus femur BMD were 76.9% and 40.4% for s‐CTX, 23.8% and 88.3% for BAP, and 80.4% and 53.3% for OC, respectively.

Conclusions:  Determination of s‐CTX, BAP and OC is of limited clinical value in the initial evaluation of bone status in menopausal women.
Preoperative evaluation and triage of women with suspicious adnexal masses using risk of malignancy index
Authors: Enakpene Christopher A. , Omigbodun Akinyinka O. , Goecke Tamme W. , Odukogbe Akin‐Tunde , Beckmann Mathias W.
Published: August 2008

Aims:  To test the accuracy of risk of malignancy index (RMI) in preoperative prediction of malignancy and treatment of adnexal masses.

Methods:  A total of 302 women with ultrasound diagnosed adnexal masses, and serum measurement of cancer‐associated antigen CA‐125 levels, were studied. They all had surgical exploration between October 2001 and September 2005 at the Friedrich‐Alexander University Women's Hospital, Erlangen, Germany. The RMI was based on menopausal status, ultrasound morphology of adnexal masses and absolute level of serum CA‐125. A cut‐off of 250 was chosen as the threshold for determining the type of surgical operations (laparotomy versus laparoscopy) and the skill of the surgeons (gynecological oncologist versus general gynecologist). The data obtained were analyzed for baseline characteristics using χ2 test and analysis of variance (ANOVA). P < 0.05 were statistically significant. The various testing methods were evaluated for sensitivity, specificity, positive and negative predictive values.

Results:  The best individual performance was found in RMI at a cut‐off of 250 with a sensitivity of 88.2%, specificity of 74.3%, positive predictive value of 71.3% and negative predictive value of 90%. When RMI was used to triage patient treatment, 81.5% of patients who had laparoscopy had histological diagnosis of benign ovarian tumor and 7.5% had malignant tumor. In contrast, 74.4% of patients who had laparotomy had histological diagnosis of malignant ovarian tumor and 16% had benign tumor.

Conclusion:  Risk of malignant index is a reliable, cheap, readily available and cost‐effective method of preoperative discrimination of benign from malignant adnexal masses. It is also helpful in triaging patients to different treatment groups.
Characteristics and perinatal course of prenatally diagnosed fetal abdominal wall defects managed in a tertiary center in Japan
Authors: Hidaka Nobuhiro , Murata Masaharu , Yumoto Yasuo , Hojo Satoshi , Fujita Yasuyuki , Masumoto Kouji , Taguchi Tomoaki , Tsukimori Kiyomi , Wake Norio
Published: August 2008

Aims:  To identify the clinical characteristics of fetal abdominal wall defects managed at a single institution and to provide information regarding the most likely clinical course of the affected fetuses.

Methods:  A retrospective review was conducted of 44 fetuses prenatally diagnosed with abdominal wall defects at Kyushu University Hospital between 1990 and 2006.

Results:  A total of 11 cases of gastroschisis and 33 cases of omphalocele were found. Preterm delivery was observed in eight of 11 fetuses (72.7%) with gastroschisis and in 14 of 27 fetuses (51.9%) with omphalocele who were not artificially aborted. Intrauterine growth restriction (IUGR) was identified in four of 11 fetuses (36.4%) with gastroschisis and in 13 of 27 fetuses (48.1%) with omphalocele who were not aborted artificially. There was a high rate of associated structural anomalies with omphalocele (26/33). Karyotypic abnormalities were observed in eight of 29 tested fetuses with omphalocele (27.6%). The prognosis for a chromosomally normal fetus with omphalocele appeared to largely depend on the associated structural abnormalities and the gestational age at delivery. Despite the frequent presence of IUGR, the outcome of neonates with gastroschisis was good.

Conclusions:  The possibility of preterm delivery and IUGR should be considered during the management of both omphalocele and gastroschisis. For the management of omphaloceles, chromosomal abnormalities and respiratory insufficiency after birth must also be considered. Timely prenatal diagnosis and the subsequent identification of associated anomalies will improve patient care and will enable clinicians to provide appropriate counseling about the expected course.
Required length of follow‐up after transanal advancement flap repair of high transsphincteric fistulas
Authors: Mitalas L. E. , Gosselink M. P. , Oom D. M. J. , Zimmerman D. D. E. , Schouten W. R.
Published: August 2008

Objective  Repair of high perianal fistulas presents a major surgical challenge. Transanal advancement flap repair (TAFR) provides a useful tool in the treatment of these fistulas. Initially promising results have been reported. More recent studies indicate that TAFR fails in one out of three patients. The aim of the present study was to determine the appropriate length of follow‐up needed to assess the healing rate after TAFR of high transsphincteric fistulas.

Method  Between 1992 and 2000 a consecutive series of 80 patients with a high transsphincteric fistula of cryptoglandular origin underwent TAFR. Medical records of all patients were studied. The initial healing rate and the median healing time were assessed. The initial outcome was successful in 54 patients. The medical records revealed that only one of these patients presented with a recurrent fistula after 28 months. The other 53 patients were sent a questionnaire in 2006 aimed to determine whether they had any complaints or signs of a recurrent fistula.

Results  The initial healing rate was 68%. The median healing time was 3.6 months. The completed questionnaire was returned by 48 patients. None of these patients reported any complaints or signs of a recurrent fistula. Median duration of follow‐up in these patients was 92 months.

Conclusion  At a median time interval of 3.6 months fistula healing was observed in 54 patients (68%). Only one patient (2%) encountered a recurrence. The length of follow‐up can be restricted to the healing time.
An interim analysis of recruitment to the COLOFOL trial
Authors: Wille‐Jørgensen P. , Laurberg S. , Påhlman L. , Carriquiry L. , Lundqvist N. , Smedh K. , Svanfeldt M. , Bengtson J.
Published: August 2008

Objective  To analyse the ongoing process of recruiting patients into a multicenter randomized trial on follow‐up after curative surgery for colorectal cancer. The trial is registered in Clinical Trials Registration.

Method  Prospective registration of all operated patients as well as inclusions (curative resection, stage II or III disease, ≤ 75 years, clean colonand exclusions of the individual patients in eight participating departments.

Results  Between January 2006 and September 2007, 1309 patients have been operated upon. Of these 502 (38.3 %) met the inclusion criteria, 148 (29.5%) had exclusion criteria. Of the final eligible patients 241 (68.1 %) were randomized. No specific barriers to inclusion were identified.

Conclusion  Of an overall population of patients operated for colorectal cancer about one in five were randomized. Bearing the rigorous inclusion and exclusion criteria in mind, this is considered satisfactory, and the investigated population may be representative of patients meeting the inclusion criteria.
The value of auditing negative lower GI investigations preceding a final diagnosis of colorectal cancer
Authors: Somasekar A. , James L. , Stephenson B. M. , Thompson I. W. , Vellacott K. D. , Allison M. C.
Published: August 2008

Objective  To review all preceding ‘negative’ large bowel investigations in patients with a final diagnosis of colorectal cancer, and to examine whether delayed diagnosis was associated with worse outcome.

Method  Details were gathered on all patients with a new diagnosis of colorectal adenocarcinoma presenting over 4.5 years. For each patient the hospital’s clinical workstation and radiology and endoscopy databases were interrogated for all flexible sigmoidoscopies, colonoscopies and barium enemas during the 5 years prior to diagnosis.

Results  Among the 570 patients, 28 (5%) had undergone colonoscopy and/or flexible sigmoidoscopy that had not shown colorectal cancer during the 5 years preceding final diagnosis, and a further 28 (5%) had undergone ‘negative’ barium enemas. Polyp surveillance might have missed four lesions destined to become malignant. Correspondingly there were three patients undergoing IBD surveillance found to have CRC, having had a negative complete colonoscopy within the preceding 5 years. Among patients undergoing de novo colonoscopy for diagnosis the true miss rate was only one patient per year. At August 2007, 29 (58%) of those with delayed diagnosis were still alive, compared with 216 (42%) of those diagnosed during initial investigation (χ2 = 5.04, P < 0.05).

Conclusions  Colonoscopic miss rates are in line with previous studies. The application of simple clinical ground rules will avoid most pitfalls. The methodology described herein may assist in auditing the quality assurance of lower gastrointestinal diagnostic services. Despite the delay, late diagnosis was found to be associated with improved survival and a lower likelihood of metastatic disease.
Sacral nerve stimulation for faecal incontinence: long‐term outcome
Authors: Matzel K. E. , Lux P. , Heuer S. , Besendörfer M. , Zhang W.
Published: August 2008

Aim  The efficacy of sacral nerve stimulation (SNS) to treat faecal incontinence has been demonstrated in the short‐ and mid‐term. We analysed SNS outcome in the first patients with a permanent neurostimulator in whom follow‐up ranges up to 14 years.

Method  Of 12 patients who underwent SNS from 1994 to 1999, 9 were eligible for long‐term analysis (defined as a minimum of 7 years). In 3 the device had to be removed because of pain or neurological disease. Functional outcome was monitored prospectively by standardized questionnaire. For efficacy, the recorded frequency of incontinent episodes over 2‐week periods and the Wexner Score were obtained yearly after implant. Quality of life measures (FIQL scale [QoL]) were introduced in 1998. Stimulation parameter adjustments, battery longevity, and complications were documented.

Results  Mean follow‐up in the nine patients was 9.8 years (range 7–14), over which time efficacy persisted. Clinical improvement was significant (baseline vs last follow‐up): median percentage of incontinent bowel movements/week 40% (range 9–100) vs 0% (0–60%; P = 0.008), median number of incontinent episodes/week, 9 (range 2–58) vs 0 (0–29; P = 0.012); median Cleveland Clinic Score, 17 (range 12–19) vs 10 (3–14; P < 0.007); QoL improved in all categories. Pulse generator exchange was required in eight of the nine patients after a mean of 7.4 years for battery fatigue (mean 2.1 V). Complications occurred in five of the original 12 and were therapy‐related, but not technique‐related, in four patients.

Conclusion  Sacral nerve stimulation is an effective and safe long‐term treatment for faecal incontinence. Clinical outcome is stable over time.
Colorectal cancer: presentation and outcome in British South Asians
Authors: Norwood M. G. A. , Mann C. D. , Hemingway D. , Miller A. S.
Published: August 2008

Aim  Colorectal cancer (CRC) has a lower incidence in patients of South Asian origin compared with British Caucasians. There are however little data available regarding the demographics of these patients, their presentation and outcome. Leicester has a high South Asian immigrant population, and we aim to define any potential differences in presentation, pathogenesis and outcome between our Caucasian and South Asian ethnic groups.

Method  All patients of South Asian origin were identified from the Leicester CRC database between June 1998 and April 2007. Data were analysed regarding the patients’ demographics, the presentation and treatment details, tumour characteristics and clinical outcome. Data were compared with Caucasian patients from the same database. Patients from an ethnic background other than South Asia or Caucasians were excluded from analysis.

Results  3435 patients were included in the analysis, of which 134 (3.9%) were of South Asian ethnicity. 61.9% of South Asian patients were male compared with 56% of Caucasians. South Asians were significantly younger at presentation (61.4 vs 70.6 years, P < 0.001). South Asian patients had significantly more rectal tumours than their Caucasian counterparts (P = 0.002). South Asian patients were more likely to require initial oncological therapy, and were less likely to have resectional surgery than Caucasians (P = 0.006). Of the patients undergoing resectional surgery, the ASA grade, mode of surgery, tumour characteristics and Dukes’ stage were similar. There was no difference in 5‐year survival between the South Asian and Caucasian patients.

Conclusion  Patients of South Asian ethnicity are younger at their age of presentation and have a higher proportion of rectal tumours compared with British Caucasian patients. They are more likely to require initial oncological treatment and are less likely to undergo resectional surgery, therefore suggesting more advanced disease at presentation. Overall 5‐year survival is the similar.
Can elderly patients with colorectal cancer tolerate planned surgical treatment? A practical approach to a common dilemma
Authors: Ugolini G. , Rosati G. , Montroni I. , Zanotti S. , Manaresi A. , Giampaolo L. , Friederike Blume J. , Taffurelli M.
Published: August 2008

Aim  Analysing the effectiveness of a surgical procedure is mandatory in every modern health‐care system. The aging of the population stresses the need for a good standard of care. This study tests the hypothesis that porthsmouth‐physiologic operative severity score for enumeration of morbidity and mortality (P‐POSSUM) and colorectal‐POSSUM (CR‐POSSUM) would be useful clinical auditing tools in colorectal cancer surgery for aged patients.

Method  One hundred and seventy‐seven consecutive patients over 70 years of age underwent emergency or elective surgery from January 2003 to December 2005. Demographic, clinical and surgical information, score systems’ prediction, complications and 30‐day mortality data were prospectively entered in a comprehensive database. The observed over expected morbidity and mortality rate was calculated.

Results  Thirty‐day observed mortality was 10.3% (19/177) while P‐POSSUM and CR‐POSSUM expected mortality were, respectively, 11.21% (P = NS) and 13.08% (P = NS). Overall observed morbidity was 42.7%, P‐POSSUM prediction was 59.3% (P = 0.002). Morbidity and mortality data were analysed for specific subgroups of patients (resection and anastomosis/resection and stoma/palliative; emergency/elective).

Conclusion  P‐POSSUM and CR‐POSSUM are useful tools to predict mortality in elderly patients. P‐POSSUM significantly overestimated the risk of complications. A more accurate tool for preoperative assessment for aged patients is probably needed to predict the post‐surgical outcome.
Extracorporeal shock wave lithotripsy in children: equivalent clearance rates to adults is achieved with fewer and lower energy shock waves
Authors: Kurien Abraham , Symons Stephanie , Manohar Thimmegowda , Desai Mahesh
Published: August 2008

OBJECTIVE

To compare the outcome, safety and efficiency of extracorporeal shock wave lithotripsy (ESWL) using an electromagnetic lithotripter for upper urinary tract stones in children and adults.

PATIENTS AND METHODS

We retrospectively reviewed data over a 5‐year period for patients with solitary, renal and upper ureteric stones measuring <2 cm in whom ESWL was the treatment method. Group A consisted of 44 children (mean [sd] age 5.9 [4.4] years) and group B of 562 adults (mean [sd] age 40.9 [13.1] years). The number and energy of SWs used was not predetermined and was tailored until adequate fragmentation was achieved. Initial stone reassessment was performed at 48 h and monthly thereafter. The number of SWs, intensity of SWs, stone‐free rate, auxiliary procedure rate, re‐treatment rate, complication rate and effectiveness quotient (EQ) were assessed in each group.

RESULTS

The stone‐free rate with ESWL was 84% in children and 87% in adults (P = 0.78). The EQ was 77% and 75% in children and adults, respectively (P = 0.56). The mean (sd) number of SWs and energy required per session was 950 (349) and 11.83 (0.48) kV in children and 1262 (454) and 12.36 (0.34) kV in adults (P < 0.001). The re‐treatment, auxiliary procedure and complication rates were similar in both groups.

CONCLUSION

ESWL is as safe and effective in children as in adults for solitary renal and upper ureteric stones that are <2 cm. Children required significantly fewer and lower energy SWs to achieve equivalent results.
Development of a screening tool in Arabic for respiratory health problems
Authors: Shishani K.
Published: August 2008

Aim:  The objective of this study was to develop a tool in the Arabic language for screening of respiratory health problems in air polluted areas. This was the first stage in a multistage study.

Design:  A descriptive design was utilized.

Sample:  One hundred adults aged 18 years or more living in an air polluted area in Jordan were recruited using a convenience sampling technique.

Results:  The Respiratory Risk Profile, generated from a synthesis of international epidemiological studies, had excellent reliability coefficients with an internal consistency coefficient (Cronbach's alpha) of 0.92. The strong item–scale correlations (0.48–0.76) showed that all of the items contributed to the measurement of the respiratory symptoms. Construct validity was assessed by a factor analysis, and a two‐factor model had a good fit to the data. The two factors (upper respiratory symptoms and lower respiratory symptoms) explained 50% and 12% of the total variance, respectively.

Conclusion:  Approximately half of the study participants (49%) complained of difficulty breathing in the past 3 months. About 10% of the respondents reported that they were currently taking asthma medications. The present psychometric analyses showed that the Respiratory Risk Profile is a valid and reliable screening tool for respiratory health problems in adult populations living in polluted areas.
Hong Kong enrolled nurses' perceptions of spirituality and spiritual care
Authors: Wong K.F. , Lee L.Y.K. , Lee J.K.L.
Published: August 2008

Aim:  To explore Hong Kong nurses' perceptions of spirituality and spiritual care, and to investigate the relationship between their perceptions and their demographic characteristics.

Background:  Many studies suggest that spirituality is the essence of human being and plays an important role in people's lives. Although studies have documented the positive relationship between spiritual care and patients' health outcomes, it has also been shown that the implementation of spiritual care is uncommon in nursing practice. Furthermore, there is little discussion on practising nurses' perception of spirituality and spiritual care in Hong Kong.

Methods:  This study adopted a cross‐sectional descriptive design to investigate nurses' perception of spirituality and spiritual care in Hong Kong. A convenience sample of 429 practising enrolled nurses were invited to complete the Spirituality and Spiritual Care Rating Scale (SSCRS) (response rate 91%).

Findings:  Subjects showed satisfactory understanding of spirituality and appreciated providing spiritual care to patients. The mean scores for the SSCRS and its four subscales were greater than half of the maximum score. There were significant differences in the perceptions of spirituality between subjects with different education levels and religious affiliations.

Conclusions:  The findings suggest increasing the emphasis of spirituality both in undergraduate education and in continuing‐development levels. Recommendations are also made regarding the implementation of spiritual care in nursing practice. Despite having a convenience sample, the present study has contributed to stimulating awareness and discussion among nurses on spirituality and spiritual care.
Human trafficking of Amerindian women in Guyana: challenges and strategies
Authors: Mantini L.
Published: August 2008

Aim:  This human‐interest article aims to increase awareness of the root causes of Guyanese Amerindian vulnerability.

Background:  In 2000, while working among the Wai Wai, Makushi and Wapishana tribes in the Rupununi, the author made a promise to a tribal Captain never to forget his people. Not only are the Amerindian people remembered, but their plight is being recognized and shared in an effort to end the exploitation of Guyanese Amerindian women. Every year, international humanitarian teams gain permission to provide health care and health education in Amerindian villages in Guyana. Ensuring that international health teams are informed about current Amerindian issues is vital to mission success. Lack of indigenous awareness with regard to human trafficking is evidence that Guyana's trafficking awareness campaign did not effectively reach the interior and therefore, international teams can be instrumental in bringing awareness to those most vulnerable to human traffickers. Improving indigenous and international awareness has the potential to reduce vulnerability, and to reduce the risk of humanitarian teams unknowingly sending silent victims back into a life of forced labour and sexual exploitation.

Methods:  Emphasis is placed on discriminatory institutional and cultural factors impacting on young indigenous women increasing the likelihood of exploitation by human traffickers. Policy and service activities are examined to ascertain Guyana's current capacity to address human trafficking and meet the needs of victims.

Conclusion:  Building institutional and community capacity, and empowering indigenous peoples to take ownership for individual, family and community awareness and action against human trafficking are important steps to take in reducing vulnerability, ending human rights violations and improving the status of indigenous women.
Breast cancer risk factors in Korean women: a literature review
Authors: Lee S.‐M. , Park J.‐H. , Park H.‐J.
Published: August 2008

Aim:  To compile a complete list of risk factors from the Korean breast cancer studies to obtain relevant predictor information essential in developing a predictive model for breast cancer.

Background:  Breast cancer is the most commonly diagnosed female cancer in Korea. However, the breast cancer‐screening rate in Korea is relatively low compared with that in other countries. In order to promote early health screening, there is a need to identify those individuals who are most likely to develop breast cancer by using an accurate predictive model.

Methods:  Thirty‐four breast cancer studies were selected from MEDLINE and two Korean literature databases. Two researchers summarized the risk factors and their effects in each article using a checklist.

Findings:  Most of the studies were case–control studies conducted after 2000. In 34 articles, a total of 84 risk factors for breast cancer in Korean women were identified; of these, 58 factors were determined as statistically significant factors. The factors identified most often were body mass index, menarche, menopause, family history, pregnancy and delivery, breastfeeding, alcohol use, smoking habits, diet, education and use of oral contraceptives. None of 34 studies looked at stress as a risk factor of which influence on cancer has been reported in other populations.

Conclusion:  The next steps will be to construct a questionnaire consisting of relevant variables based on these study results and to develop a predictive model. This would be used to encourage those Koreans who are more likely to develop breast cancer to have early check‐ups.
Factors influencing Chinese undergraduate nursing students' perceptions of the nursing profession
Authors: Zhang M.F. , Petrini M.A.
Published: August 2008

Background:  In recent years, with the rapid development of nursing in China, the number of undergraduate nursing students has increased significantly. As professional perception has a great influence on the development of nursing students and the future quality of nursing, exploring factors that influence this perception are very important.

Aim:  To describe undergraduate nursing students' attitudes towards nursing and to explore if their perceptions of nursing are influenced by demographic characteristics, clinical experience and/or different curriculum designs.

Methods:  A cross‐sectional descriptive study was carried out in two nursing schools: one with a traditional curriculum and one that had undertaken curriculum reform. Following institutional approval, 176 (92.6%) of the targeted population of 190 students responded to a demographic questionnaire with two semi‐structured questions and the Attitude Towards the Nursing Profession Scale. The results were analysed using descriptive statistics, t‐test and Spearman correlation analysis.

Findings:  No correlations were found between nursing students' attitudes towards nursing and their demographic characteristics. Clinical experience apparently had no impact on nursing students' professional perception. However, the curriculum design appears to play an important role in forming the students' attitudes towards nursing. Significant implications and suggestions for nursing educators and nursing managers are presented.
Australian nurses seize a collaborative model to shape the future with the International Council of Nurses
Authors: Foley E.R.
Published: August 2008

Aim:  To showcase a successful collaborative model under the International Council of Nurses (ICN) membership models, which enables Australian nurses to more fully participate across all ICN activities.

Background:  When ICN approved new models of membership in 2001, Royal College of Nursing, Australia, saw an opportunity for creating greater unity for Australian nursing. The College had established an agreement nationally with the Australian Nursing Federation, the union, to maximize influence on national nursing policy. Flowing from the ICN's objective of inclusivity, a collaborative partnership under the College's membership of ICN was a logical and mutually beneficial next step. Members of the two peak Australian national nursing organizations, together with the profession at large, have favourably received this demonstration of unity. In a time of constant change and uncertainty in professional circles and upheaval in the global community, this collaborative effort by the premier professional and industrial groups has sounded a strong note of stability for working towards a robust future for nursing. With the influence of often‐unknown external forces, it is not always possible to predict what lies ahead for our profession. However, a strong collaborative partnership can better plan for, and have greater influence on, national and international issues.

Conclusion:  The College, having taken the unprecedented step of inviting a colleague organization to engage in international level collaboration, encourages other ICN member associations to form similar alliances. A stronger ICN will strengthen nurses' endeavours at the forefront of global health and create an unbeatable force for dealing with the unexpected.
Furthering the development of standardized nursing terminology through an ENP®‐ICNP® cross‐mapping
Authors: Wieteck P.
Published: August 2008

Purpose:  To examine the completeness and validity of the terms used in ENP® in describing nursing diagnoses using a cross‐mapping to ICNP®.

Methods:  The mapping procedure was carried out using the parallel mapping method.

Results:  The interrater reliability showed good to very good results. The percentage of agreement of the rating results for the ICNP® phenomenon axes was between 73% and 99%, and the randomly adjusted Cohen's Kappa value was 0.88 on the ICNP® focus axis.

Discussion:  The results of the mapping show that both classifications, ENP® and INCP®, are not yet complete for illustrating all aspects of nursing. Both classifications use a large proportion of overlapping terms (75%), and a small proportion of terms (25%) which describe different dimensions of nursing in both ENP® and ICNP®.

Conclusion:  The results of the mapping are discussed in consideration of the nurse's perspective. The main focus is on the difference between pre‐combined systems, like ENP®, and post‐combined, like ICNP®, and their implications on the use of nursing classifications in practice for the illustration of the nursing process.
Estimating nurses' workload using the Diagnosis Procedure Combination in Japan
Authors: Kamijo Y. , Kanda K.
Published: August 2008

Aim:  To examine the methods used to estimate nurse staffing levels in acute care settings with Diagnosis Related Groups, which in Japan are called the Diagnosis Procedure Combination (DPC).

Methods:  For estimating staffing requirements, the study used four DPC groups: (1) acute or recurrent myocardial infarction (AMI) with stenting, (2) angina pectoris with coronary artery bypass grafting (CABG), (3) sub‐arachnoid haemorrhage (SAH) with clipping surgery, and (4) cerebral infarction with carotid endarterectomy (CEA). Registered nurses with more than 3‐year nursing experience in nine university hospitals in the Tokyo metropolitan area completed self‐report questionnaires in order to obtain nursing care time and care intensity per each DPC. The concordance rate was measured by Kendall's coefficient of concordance. The relationship between the care time and the care intensity was examined by a time series graph per DPC. Care intensity consisted of professional judgement, mental effort for helping patients, professional skill, physical effort for providing activities of daily living support, and nurse stress, based on the Hsiao and colleagues' model of resource‐based relative value scale.

Results:  Twenty‐five nurses in nine university hospitals answered for a hypothetical typical patient with AMI and with CABG, and 28 nurses in nine university hospitals answered for a hypothetical typical patient with SAH and with CEA. Kendall's coefficient of concordance was 0.896 for AMI, 0.855 for CABG, 0.848 for SAH, 0.854 for CEA. The time series data of the care time and the care intensity items showed different patterns for each DPC.

Conclusion:  The DPC for cardiovascular and cerebral surgical procedures can be used for estimating nurses' workload.
Policy, progress and occupational health
Authors: Wilkinson C.
Published: August 2008

In 2003, the Department of Health in England launched a new policy, which encourages occupational nurses to take on dimensions within their role linked to a public health ethos. This article is intended to explore one dimension of public health through the vehicle of health promotion. Suggestions are made regarding the development of the role of the occupational health nurse, particularly in relation to research, evaluation and information sharing through regional and national networks.
The impact of the use of response pad system on the learning of secondary school physics concepts: A Singapore quasi‐experiment study
Authors: Mun Wong Kin , Hew Khe Foon , Cheung Wing Sum
Published: August 2008

Although a number of researchers have examined response pad systems (RPSs) in higher education, there has been very little research at the K‐12 level. This paper investigated the impact of using an RPS in the learning of physics concepts in a secondary school in Singapore. Two classes (n = 35 students in each class) of secondary five students participated in this study. One of the classes used an RPS while the other did not. Both classes completed a pretest and a posttest which tested the students in the application of the physics concepts taught. Results suggested that the class that used an RPS performed better in the posttest compared to the class that did not use the system. In addition, we explored the teacher and students' perceptions of using the RPS.
Private and Public Sector Models for Strategies in Universities*
Authors: Buckland Roger
Published: August 2008

Increasing formalization of disciplined management of UK universities over the last 30 years has been accompanied by moves to articulate universities' strategies, by attempts to connect organizations' plans and management of activity to those strategies and by a desire to measure how well outcomes are fitted to universities' goals. In this complex change in the orientation of universities' management, lessons have been drawn from the contemporary development of the analysis of strategy and strategic process in commercial and, latterly, in public sector settings. It is argued that there have been very significant errors and weaknesses in the importation of such models of strategy, especially in the stress on strategicplanningrather than strategicprocessand in the insensitivity of universities' planning to the underlying strategy process of the typical university. Most universities, it is argued, mistake planning – and even budgeting – for strategy itself, having failed to make proper sense of their own organizations' processes of generating strategies and putting them into practice. They have typically missed the crucialcontextof strategy and change. It is argued that there are crucial lessons to be learned from recent advances in theorizing about strategy in the private or commercial sector, particularly in relation to the development of modelling complex and path‐dependent systems; and it is argued strongly that universities' strategic process can fruitfully be analysed through the perspectives of real options analysis. This can also accommodate the richness of universities' traditions of strategy formation and implementation within ‘loose‐coupled’ organizations.
Glass Cliffs Are Not So Easily Scaled: On the Precariousness of Female CEOs' Positions
Authors: Ryan Michelle K. , Alexander Haslam S.
Published: August 2008

Adams, Gupta and Leeth (British Journal of Management, 2008) question the universality of the glass cliff after finding no differences in US companies' financial performance either before or after the appointment of male and female CEOs. We agree that glass cliffs are neither universal nor ineluctable, but urge caution in interpreting this null result. This is because the nature and significance of women's precarious leadership positions becomes more apparent when one goes beyond archival financial data and compares the broad circumstances of male and female leaders. Here multiple strands of research suggest that above the glass ceiling the playing field for men and women is far from level.
Chinese children's constructive activity and text comprehension
Authors: Law Yin‐Kum
Published: August 2008

This study investigated how constructive activities are involved when Chinese students are performing reading tasks that require deeper levels of understanding. Forty students from Grade 5 (19 boys and 21 girls), and 42 students from Grade 6 (20 boys and 22 girls) participated in this study. To reveal the children's constructive processes in reading, they were asked to think aloud while responding to a text. Analyses of the children's protocols identified five levels of constructive activity. Analyses further indicated that the Grade 6 children performed better than the Grade 5 children, and skilled readers outperformed less skilled readers in higher levels of constructivist activity and text understanding tasks. Implications of the important roles of constructivist activity in children's learning from texts were discussed.
The Role of Community in Migration Dynamics
Authors: Vergalli Sergio
Published: August 2008

Abstract.  In this paper, I have presented a theoretical model that investigates the observable hysteresis process in migration dynamics. In the model the migration choice depends not only on wage differential, but also on a U‐shaped benefit function of a community of homogenous ethnic individuals, according to the ‘theory of clubs’. The results, based on real option theory, explain that observable ‘jumps’ in migration flows could depend not only on exogenous shocks, but also on two endogenous variables: the number of coordinated immigrants and the dimension of the community. Indeed, migration choice is delayed until a critical mass of immigrants is reached and possible rigidities of optimal district size could magnify this hysteresis process.
Macroeconomic Conditions and the Distribution of Income in Spain
Authors: Farré Lídia , Vella Francis
Published: August 2008

Abstract.  This paper analyses the impact of changes in macroeconomic con ditions on the income distribution in Spain. Using household data from the Encuesta Continuada de Presupuestos Familiares (ECPF) from 1985 to 1996 we disentangle the effect of aggregate variables on the income distribution by estimating counterfactual densities conditional on different macroeconomic scenarios. In estimation, we use a semi‐parametric least squares procedure that allows a flexible interaction between the level of income and a first index of individual characteristics and a second index that captures the role of macroeconomic variables. We find that although inequality displays a decreasing trend over the earlier part of the period examined, the poor performance of the Spanish economy during the early 1990s appears to have reversed this trend. We also conclude that while inflation appears to have no impact on the distribution of income for the period examined, there were important redistributive roles for unemployment, government expenditure, and the level of GDP.
Unions, Firing Costs, and Unemployment
Authors: Modesto Leonor
Published: August 2008

Abstract.  We study the effects of firing costs in unionized economies with heterogeneous workers. We consider an overlapping generations model where workers participate in the labour market both when young and when old. All workers belong to the same union that sets wages unilaterally. We find that at given wages firing costs increase youth unemployment and decrease old‐age unemployment. However, once the wage response is considered, firing costs increase both youth and old‐age unemployment. Indeed, knowing that when firing costs are higher firms refrain from firing, the union increases the wage of old workers, and, therefore, old‐age unemployment increases.
Segmental Acquisition in Adult ESL Learners: A Longitudinal Study of Vowel Production
Authors: Munro Murray J. , Derwing Tracey M.
Published: August 2008

Research on second language (L2) phonetic learning indicates that, even in adults, segmental acquisition remains possible through L2 experience. However, the findings of previous cross‐sectional studies of vowel and consonant learning have proved difficult to interpret. In this longitudinal investigation of 44 recent arrivals in Canada, productions of 10 English vowels in CVC context were elicited at 2‐month intervals and evaluated by trained and untrained listeners. Improved intelligibility was observed, even in the absence of focused instruction on vowels. The results support the proposal that L2 phonetic learning is initially rapid but tends to plateau within a few months. However, this finding is complicated by different learning trajectories across vowels, differential L1 influences, and possible effects of word frequency.
Gender Agreement in Adult Second Language Learners and Spanish Heritage Speakers: The Effects of Age and Context of Acquisition
Authors: Montrul Silvina , Foote Rebecca , Perpiñán Silvia
Published: August 2008

This study investigates knowledge of gender agreement in Spanish L2 learners and heritage speakers, who differ in age and context/mode of acquisition. On some current theoretical accounts, persistent difficulty with grammatical gender in adult L2 acquisition is due to age. These accounts predict that heritage speakers should be more accurate on gender agreement than L2 learners, because their Spanish language acquisition started in infancy. Sixty‐nine heritage speakers, 72 second language (L2) learners, and 22 native Spanish speakers were tested on their oral production, written comprehension, and written recognition of Spanish gender agreement. Results showed advantages for L2 learners in written tasks but advantages for heritage speakers in the oral task. We discuss the significance of these findings for SLA and heritage language acquisition.
Attention to Form and Meaning Revisited
Authors: Leow Ronald P. , Hsieh Hui‐Chen , Moreno Nina
Published: August 2008

The present study revisited the issue of simultaneous attention to form and meaning from a methodological perspective that addressed several potential methodological issues of previous research in this strand of inquiry. Seventy‐two second‐semester‐level participants were randomly assigned to one of five experimental groups, including a control, and requested to read a Spanish text and also circle one of four targeted forms (10 occurrences each) in the input. To measure comprehension, a 10‐item multiple‐choice test was administered immediately after the reading. Both qualitative (think‐aloud protocols) and quantitative analyses were conducted to address the following research question: Does type of attentional condition have a differential effect on adult second language reading comprehension? The quantitative analysis revealed no significant difference in comprehension among all five groups. To explicate the findings, the quantitative and qualitative data and analyses are discussed with regard to the issues of modality, depth or level of processing, and research methodology.
A novel presenilin 2 mutation (V393M) in early‐onset dementia with profound language impairment
Authors: Lindquist S. G. , Hasholt L. , Bahl J. M. C. , Heegaard N. H. H. , Andersen B. B. , Nørremølle A. , Stokholm J. , Schwartz M. , Batbayli M. , Laursen H. , Pardossi‐Piquard R. , Chen F. , St George‐Hyslop P. , Waldemar G. , Nielsen J. E.
Published: August 2008

Background:  Mutations in the Presenilin 2 gene (PSEN2) are rare causes of Alzheimer’s disease (AD). Pathogenic mutations in the genes associated with autosomal dominant inherited AD have been shown to alter processing of the amyloid precursor protein (APP) resulting in a relative increase of the amount of Aβ42 peptide.

Methods and results:  We present a patient with neuropathologically confirmed early‐onset AD characterized by profound language impairment. The patient was heterozygous for a novel missense mutation in exon 11 of the PSEN2 gene leading to a predicted amino acid substitution from valine to methionine in position 393, a conserved residue. However, in vitro expression of PSEN2 V393M cDNA did not result in detectable increase of the secreted Aβ42/40 peptide ratio. The mutation was not found in 384 control individuals tested.

Conclusions:  The possible pathogenic nature of the mutation is not clarified. We discuss the limitations of functional PSEN2 studies and the challenges associated with genetic counselling of family members at risk.
Use of three‐dimensional kinematic analysis following upper limb botulinum toxin A for children with hemiplegia
Authors: Mackey A. H. , Miller F. , Walt S. E. , Waugh M.‐C. , Stott N. S.
Published: August 2008

Background and purpose:  To examine whether three‐dimensional (3‐D) kinematic analysis can detect changes in upper limb tasks (reach and hand‐to‐mouth) in children with hemiplegia, following upper limb botulinum toxin A injections.

Methods:  Ten children with hemiplegic cerebral palsy (7 males, 3 females, aged 9–17 years). Subjects received botulinum toxin A (Botox) injections into elbow forearm muscles combined with 6 weeks of occupational therapy. Participants completed a 3‐D kinematic analysis of two upper limb tasks, Melbourne Assessment of Unilateral Upper Limb Function and modified Ashworth scores measured at baseline, 2, 6 and 12 weeks post‐injection.

Results:  Post‐injections, elbow flexor muscle tone was reduced for 12 weeks (p < 0.05). Group differences in active range of motion during 3‐D analysis tasks could not be demonstrated at any time post‐intervention. However, individual analyses found that at 2 weeks post‐injection, three subjects had >15 degrees increases in active elbow extension and six subjects showed an increase of >25 degrees in forearm supination during performance of the reach and hand‐to‐mouth tasks, respectively.

Conclusions:  3‐D kinematics can detect changes in active movements during functional tasks following botulinum toxin A injections, suggesting this could be a potential objective outcome measure in a clinical trial.
One-Year Course of Paediatric Headache in Children and Adolescents Aged 8-15 Years
Authors: Gaßmann J , Morris L , Heinrich M , Kröner-Herwig B
Published: August 2008

The aims of the present study were the assessment of headache (HA) prevalence in German children and adolescents in the second year of a 4-year longitudinal study and the analysis of headache status change from year 1 to year 2. The original sample consisted of 8800 households with a child aged 7-14 years. A total of 4159 households responded in both year 1 and year 2, yielding 3984 valid parent questionnaires. Data regarding various aspects of the child's HA history and general health were gathered via mailed questionnaires from the parents. Of the households returning valid parent questionnaires at survey 2, 48.9± reported their child to have experienced headaches during the previous 6 months (53± at survey 1). Weekly HA was reported for 6.5± of the children, monthly or less frequent HA for 16.5± and 25.9±, respectively. With regard to headache diagnosis, 55.0± of the children and adolescents with HA experienced tension-type HA (TTH) and 11.3± migraine with or without aura (M). For more than half of the children and adolescents with HA (57.0±) the frequency of head pain remained stable over the period of 1 year (i.e. same frequency category in years 1 and 2). Improved and worsened HA status regarding frequency of occurrence was found in 22.3± and 20.7± of the subjects, respectively. Thus, there was no definite trend towards an increase of HA episodes over the course of 1 year regarding the individual child or adolescent. The most stable type of HA was TTH.