bluuebunny/crossref_metadata_2025 huggingface dataset:
Ocular involvement of transmissible venereal tumor in a dog
Authors: Boscos C.M. , Ververidis H.N. , Tondis D.K. , Stamou A.I. , Samartzi F.C.
Published: March 2003

A case of metastatic transmissible venereal tumor (TVT), with lesions on the penis, conjunctiva, buccal mucosa and skin (lips and trunk), is presented in this case report. The clinical picture is described along with the cytological and histopathological features of the tumor leading to definitive diagnosis of TVT. Possible reasons for the unusual metastatic behavior of TVT and full recovery of the dog after chemotherapy are discussed.
A dermoid of the eye in a blue‐fronted Amazon parrot (Amazona aestiva)
Authors: Leber  , Bürge
Published: March 2003

A corneo‐conjunctival dermoid is reported in a blue‐fronted Amazon parrot (Amazona aestiva). After laminar keratectomy, histology showed the epidermis with feather follicles and dermal connective tissue with lymph follicles and sebaceous glands.
Extraocular muscle myositis and restrictive strabismus in 10 dogs
Authors: Allgoewer I. , Blair M. , Basher T. , Davidson M. , Hamilton H. , Jandeck C. , Ward D. , Wolfer J. , Shelton G.D.
Published: March 2003

Ten cases of uni‐ or bilateral restrictive ventromedial strabismus in young dogs of different breeds are reported. Clinically, abnormalities were restricted to the extraocular muscles with sparing of the masticatory muscles and limb muscles. This was supported in some cases by imaging studies, electrophysiology, and immunocytochemical assay for antibodies against type 2M fibers. Histologically, there was variable lymphocytic plasmacytic mononuclear cell infiltration and fibrosis. This disorder is similar in many aspects to chronic masticatory myositis with focal myositis and subsequent fibrosis. Surgical correction may restore eye position and vision.
The identity of Elachyglossa gyldenstolpeiAndersson 1916 (Amphibia, Ranidae), with comments on some aspects of statistical support to taxonomy
Authors: Ohler Annemarie , Dubois Alain
Published: March 2003

Morphological and morphometric studies of the holotype of Elachyglossa gyldenstolpeiAndersson 1916, and comparison with specimens of the genus‐group taxa Limnonectes (Limnonectes), Limnonectes (Bourretia), Limnonectes (Fejervarya), Phrynoglossus and Occidozyga, provide evidence that the genus‐group name ElachyglossaAndersson (1916) is a senior subjective synonym of BourretiaDubois (1987)| and that the species‐group name Elachyglossa gyldenstolpei is a senior subjective synonym of Rana pileataBoulenger 1916. This case study supports the statement that univariate (non‐parametric Kruskal–Wallis, Tukey type b analysis) and multivariate (discriminant analysis) data analysis can support taxonomic decision, particularly in the case of taxa known by a single specimen (holotype).
Phylogenetic assessment of the Branchiobdellidae (Annelida, Clitellata) using 18S rDNA, mitochondrial cytochrome c oxidase subunit I and morphological characters
Authors: Gelder Stuart R. , Siddall Mark E.
Published: March 2003

Using 18S rDNA, mitochondrial cytochrome c oxidase subunit I and morphological characters, the Branchiobdellidae (Annelida, Clitellata) were shown to form a monophyletic group distinct from the leeches using two distant ‘oligochaetes’ as outgroups. The study used 20 branchiobdellid species from 14 genera in four subfamilies with these representing each of the taxon’s three distributional regions in the Holarctic realm. No monophyletic groups were found using the gene sequence data that related to either geographical regions or currently recognized subfamilies. However, two monophyletic groups were strongly supported; the two European species of Branchiobdella and the combination of Sathodrilus attenuatus and Xironogiton victoriensis. The latter pair is taxonomically diverse, but sympatric on Signal crayfish, Pacifastacus leniusculus, in California, USA.
A single amino acid change in the coat protein of Maize streak virus abolishes systemic infection, but not interaction with viral DNA or movement protein
Authors: Liu Huanting , Andrew  , Lucy P. , Davies Jeffrey W. , Boulton Margaret I.
Published: March 2003

Functional coat protein (CP) is important for host plant infection by monopartite geminiviruses. We identified a proline‐cysteine‐lysine (PCK) motif at amino acids 180–182 of the maize streak virus (MSV) CP that is conserved in most of the cereal–infecting Mastreviruses. Substitution of the lysine (K) with a valine (V) in the CP of MSV to produce mutant MSVCP182V abolished systemic infection in maize plants, although the mutant replicated around the inoculation site and, unlike other MSV CP mutants, enabled single‐stranded (ss) DNA accumulation in suspension cells. The stability of the mutant protein, CP182V, in infected cells was confirmed by immunoblotting, but virions could not be detected. Like the wild‐type (wt) CP, CP182V localized to the nucleus when expressed in insect and tobacco cells, and the Escherichia coli‐expressed protein bound both ss and double‐stranded DNA and interacted with movement protein in vitro. Taken together, these data suggest that mutation of amino acid 182 affects virion formation of MSV, either by affecting encapsidation per se or by affecting particle stability, and that virions are necessary for the long‐distance movement of MSV in maize plants.
Microsatellite markers reflect intra‐specific relationships between isolates of the vascular wilt pathogen Ceratocystis fimbriata
Authors: Barnes Irene , Gaur Anupama , Burgess Treena , Roux Jolanda , Wingfield Brenda D. , Wingfield Michael J.
Published: March 2003

summary

Ceratocystis fimbriata is a serious wilt and canker stain pathogen with a wide geographical distribution and host range that includes both woody and herbaceous plants. Previous studies using hybridization have shown that isolates of C. fimbriata from different hosts and origins differ in colony morphology, pathogenicity and growth rate, as well as conidial state. It has therefore been suggested that distinct strains, linked to host or geographical origin, are encompassed in C. fimbriata. The aim of this study was to develop PCR‐based microsatellite markers for population studies on C. fimbriata. ISSR‐PCR was used to target specific microsatellite regions of DNA from C. fimbriata. These amplified products were cloned and sequenced. Primer pairs were designed from these sequences to flank the microsatellite regions. From 24 primer pairs, 11 polymorphic primers were selected and tested on a number of C. fimbriata isolates representing a wide host and geographical range. Cluster analyses of the results indicate that these markers clearly distinguish between different geographical and host specific populations of C. fimbriata. The results are concordant with sequence data from the internal transcribed spacer (ITS) region of the rDNA operon of the same isolates. These markers will be useful in future studies of C. fimbriata population structure and diversity.
The staff’s experience of the death of a child and of supporting the family
Authors: Kaunonen M. , Tarkka M.‐T. , Hautamäki K. , Paunonen M.
Published: March 2003

The purpose of the study was to describe how staff members experience the death of a child and how they support the grieving family. The goal is to find means to improve supporting activities in the university hospital. The data for this study were collected with a questionnaire given to the staff who encounter the death of a foetus or infant at their work (n = 102). The questionnaire contained both structured and open‐ended questions. Altogether, 69 members of the staff (68%) answered the questionnaire. The open‐ended questions were analysed using content analysis. The staff experiences of a child’s death manifested themselves in grief, feelings of injustice, experiences of one’s limited resources, and relief. About half (51%) of the respondents estimated that they were able to support families rather well. Education in supporting the grieving family increased the ability to support families. Social support for families included emotional, informational, and concrete support. The majority of the staff expected support from colleagues after the death of a child. The study results show that the hospital staff supports the grieving family, but also recognizes their inadequacy as supporters. The staff also needs support in order to be able to support the grieving family.
Caring as experienced by minority ethnic patients
Authors: Cortis J. D.
Published: March 2003

International nursing literature associates ‘nursing’ as inextricably linked with ‘caring’. However, as Leininger (1995) suggests, although caring is a universal phenomenon, its manifestation is very much dependant on culture. For caring to be effectively received, the conceptualization of caring at both individual and community level needs to be realized in practice. This paper focuses on a qualitative research study on a sample of 20 male and 18 female respondents from Pakistani communities in Bradford, West Yorkshire. UK, using face‐to‐face in‐depth semi‐structured interviews. The significance of ethno–linguistics, or the relationship between language and culture, has been addressed by a number of anthropologists. People associate what is meaningful to them as defined by their culture. By eliciting various linguistic terms used for ‘care’ terms and applied to health and ‘well‐being’, the cultural meanings within an ‘emic’ perspective, as well as variability of the use of the care terms in different contexts, could be discovered. Hence the first stage of this study focused on the respondents’ understanding and perceptions of caring. Care themes and patterns emerged to form seven themes. The same sample was later facilitated in exploring their recent experiences of ‘care’ as delivered by nurses in hospital. The findings suggest that a lack of congruence between patients’ expectations and experiences of caring received from nurses did exist. The paper concludes by suggesting possible strategies to address the identified deficits, for example a cultural knowledge base and enhancing assessment skills in nurses.
A tale of teaching in two cities
Authors: Kater V.
Published: March 2003

Abstract

Internationally, nurses are health care educators, in institutions, clinics and field sites. This article describes a cross‐cultural experience of sharing health care teaching methodologies, between a nurse from Israel and a small group of Ethiopian nurses in Addis Ababa. These nurses were working to prepare groups of Ethiopian Jews, through health education, for the transition to life in Israel. It is a prime example that nursing is without borders. This period of teaching produced a mutual learning experience of great value for the local nursing staff and visiting lecturer, which may provide useful insights for other nurses working in cross‐cultural conditions.
Transformational leadership: moving total quality management to world‐class organizations
Authors: Trofino A. J.
Published: March 2003

Transformational values and competencies will become critically important by the year 2001 if we are to achieve a health system that fosters community well‐being and basic care for all, financed through a combined public–private partnership that is cost effective and uses treatments that unite body, mind and spirit. This article will focus on the use of transformational leadership as a strategy to move health‐care organizations beyond traditional values and approaches by building upon the core values of total quality management (TQM). Learning organizations will emerge and finally world‐class organizations will evolve, combining the characteristics of total quality and learning organizations, and more. A world‐class organization can be described as being the best in its class or better than its competitors in the community, state, nation or world.
Career planning and development for nurses: the time has come
Authors: Donner G. J. , Wheeler M. M.
Published: March 2003

Developments in how the nursing profession is perceived by nurses and by society, along with unparalleled changes in health care systems, have created an environment in which individual nurses must take control of their careers and futures. Educators, employers and professional organizations also have a key role to play in fostering the career planning and development of nurses, usually the largest employee group in most health care organizations. This article provides an overview of what career planning and development is and why it is important for nurses. A career planning and development model is described that provides nurses with a focused strategy to take greater responsibility for engaging in the ongoing planning process that is crucial throughout the major stages of their career. Finally, educators, employers and professional organizations are challenged to collaborate with individual nurses on career‐development activities that will enable nurses to continue to provide high‐quality care in ever‐changing health care systems.
Community development and health project: a 5‐year (1995–1999) experience in Mozambique, Africa
Authors: Ferrell B. J. A. G.
Published: March 2003

Abstract

The Community Development and Health Project (1995–1999) in Mozambique, East Africa, was undertaken to help alleviate the dire circumstances of daily life following years of internal warfare. The project was supported by the International United Methodist Church and was administered by the Mozambique Conference of the United Methodist Church, Chicuque Rural Hospital and Cambine Health Center. The target population, whose daily survival depended on subsistence farming, lived throughout the country, in particular in rural areas, far from health care facilities. The Project Content included the following topics: basic education in personal and environmental hygiene; proper nutrition using locally available food products; methods of agriculture that would ensure the best use of the land for growing nutritious food; economic methods to guarantee a supply of safe drinking water; disease prevention/home treatment; maternal child health; self‐esteem issues; and establishing a representatively inclusive community‐development committee. Indigenous women, the ‘promotoras/os’, were selected from their communities, attended a 4‐week training session and then returned to their homes as ‘Promotoras/os of Community Development and Health’.
Student characteristics and subculture trends in interpersonal skills workshops
Authors: Gilmartin J.
Published: March 2003

The aim of this study was to explore the experiences of student nurses when learning interpersonal skills and to examine the impact of small group work. A qualitative methodology was used. The sample comprised 50 student nurses who were undertaking the preregistration diploma course. In‐depth interviews were employed to collect the data. The findings indicated that many students resisted learning owing to a range of personal characteristics that influenced the learning process. A student typology was constructed which highlighted four types of student characteristics that emerged from the data. Significant characteristics relating to each type of student behaviour are emphasized. This report also combines the student typology with the emergence of three distinct subcultures that frequently both interrupt and enhance learning. In presenting the subcultures the implications for group work are considered in conjunction with study limitations.
A Cross‐Cultural Tool To Identify Continuing Education Needs
Authors: Hennessy Deborah , Hicks Carolyn
Published: March 2003

Cost‐controlled health reforms have created the need for training nurses to provide evidence‐based care in new contexts. Planning for nurses' continuing education must thus target the appropriate personnel and simultaneously consider local healthcare needs and training requirements. To plan such educational programmes, a training needs analysis instrument was developed in the UK and used to compare the training needs of nurses in Australia, the USA and the UK. Below, the findings of this survey.
Heidegger and meaning: implications for phenomenological research
Authors: Johnson Mary E.
Published: March 2003

Abstract Recently the relevance of the philosophy of Martin Heidegger has been critiqued in nursing literature. However, this critique is based primarily upon an appropriation of Heidegger that does not reflect an understanding of meaning as grounded in temporality. Therefore, this paper aims to (1) explicate Heidegger's grounding of meaning, (2) briefly contrast Heidegger's and Husserl's notions of the origin of meaning, (3) describe how Heidegger was first introduced to nursing, and (4) illustrate through examples from a research study how the philosophy of Heidegger might inform the phenomenological researcher.
Trust and trustworthiness in nurse–patient relationships
Authors: Raeve Louise de
Published: March 2003

AbstractThis paper explores the nature of trust in nurse–patient relationships from the perspective of the patient's trust in the nurse and what might be said to then render such a relationship trustworthy, from the patient's point of view. The paper commences with a general examination of the nature of trust, followed by consideration of the nature of professional–patient relationships in healthcare, with emphasis on nurse– patient relationships in particular. The nature of this relationship is used to provide grounds for arguing, both morally and conceptually, that the nature of patients’ trust in those who nurse them is generally such that for the nurse to respond in a trustworthy way, she must careabouther patients, not justforthem. In arriving at this conclusion, the paper deliberately restricts its focus to nurse–patient encounters where patients are adults and a relationship, as opposed to a brief engagement between two people, can be said to have taken place. The context for this focus is public sector health care in the United Kingdom. In the text, gendered pronouns referring to doctors, nurses and patients are meant to be inclusive of both sexes.
Virtues of autonomy: the Kantian ethics of care
Authors: Paley John
Published: March 2003

AbstractThe ethics of care, adopted in much of the nursing literature, is usually framed in opposition to the Kantian ethics of principle. Irrespective of whether the ethics of care is grounded in gender, as with Gilligan and Noddings, or inscribed on Heidegger's ontology, as with Benner, Kant remains the philosophical adversary, honouring reason rather than emotion, universality rather than context, and individual autonomy rather than interdependence. During the past decade, however, a great deal of Kantian scholarship – including feminist scholarship – has rendered this series of oppositions questionable, challenging the view that an ethics of care and Kant's moral law are irreconcilable. This paper therefore re‐examines Kant's writings, drawing on recent scholarship, and argues both that they provide the care ethicists with everything they require, and that they offer something beyond an ethics of care, something that repairs the deficits in philosophies of caring. It concludes by suggesting that a Kantian ethics of care has significant implications for the construction of nursing knowledge.
Ageing in the sun parlour
Authors: Piérard G.E.
Published: March 2003

Synopsis

Photoageing of the dermis was often ascribed to chronic sun exposure. By contrast, it was traditionally thought that a tanning bed was not harmful. However, recent evidence suggests that UVA could contribute to the risk of skin cancers. Furthermore, UVA could affect the dermal structures and modify their physical properties. The objective of this study was to evaluate the effect of iterative sunbed irradiations upon the tensile properties of skin. A computerized suction devise was used to derive measures of skin extensibility, elasticity and hysteresis. The skin colour was assessed using the so‐called individual typology angle (ITA°). The longitudinal study consisted of quarterly measurements performed over 5 years in two groups of 20 women who frequented or did not use tanning salons. Frequent UVA suberythemal irradiations for indoor tanning induced skin slackness corresponding to an increase in extensibility and hysteresis and to a parallel reduction in elasticity. Variations in the two latter rheological parameters were correlated with ITA° values. It is concluded that the unremitting frequentation of a sun parlour fuels a functional decline of the dermis resembling premature ageing.

Le photovieillissement du derme est souvent attribuéà l'exposition chronique à la lumière solaire. Les bancs solaires étaient traditionnellement considérés comme étant sans danger. Cependant, des informations récentes suggèrent que les UVA contribuent aux risques carcinogènes cutanés. Du plus, les UVA peuvent altérer les structures dermiques et modifier leurs propriétés physiques. Le but de cette étude était d'évaluer l'effet d'irradiations itératives par des bancs solaires sur les propriétés mécaniques du revêtement cutané. Un appareillage informatisé exerçant des forces de succion fut utilisé pour mesurer l'extensibilité, l'élasticité et l'hystérésis de la peau. La couleur cutanée fut quantifiée par les mesure de l'angle typologique individuel (ITA°). L'étude a consisté en des évaluations trimestrielles accumulées pendant 5 ans parmi deux groupes de 20 femmes adeptes ou non de salons de bronzage. Des irradiations fréquentes subérythémateuses par les UVA dans le but d'acquérir un teint bronzé se sont avérées induire une laxité cutanée. Celle‐ci correspondait à un accroissement de l'extensibilité et de l'hystérésis alors que l'élasticitéétait réduite. Les variations de ces deux derniers paramètres rhéologiques étaient correlées aux valeurs de ITA°. En conclusion, la fréquentation assidue de salons de bronage alimente une dégradation fonctionnelle du derme qui ressemble à celle d'un vieillissement prématuré. © Rapid Science Ltd. 1998
The Effects of Areca Catechu L Extract on Anti‐Aging
Authors: Lee Kun Kook , Choi Jung‐Do
Published: March 2003

The anti‐aging effects of Areca catechu L extract (CC‐516) on skin were investigate both in vitro and in vivo. The CC‐516 has a high proportion of proline (13%) of free amino acid content. The inhibitory effect of CC‐516 on the elastase exhibited 37 to 90% inhibition by 10 to 250 μg/ml concentration; the IC values with 40.8 μg/ml for porcine pancreatic elastase (PPE) and 48.1 μg/ml for human leukocyte elastase (HLE), respectively. One of the effects of elastase is that it is known to reduce the number of elastin fibers at the level of the enzyme deposition. The number of elastin fibers was increased when we drift from the deposit number of elastase with 100 mg/ml of CC‐516. CC‐516 showed protection of elastic fiber against degradation by the enzyme in an ex vivo assay. The CC‐516 increased proliferation of human fibroblast cell by 85% at 10
concentration, compared with control, whereas the increase by ascorbic acid was 50%. The collagen synthesis was increased by 40% at 10
% concentration of CC‐516. The treatment with CC‐516 improved skin hydration, the skin elasticity, and skin wrinkles. From this study, we suggest that CC‐516 can be used as a new anti‐aging component for cosmetics.
Frictional properties of skin: proposal of a new approach
Authors: Koudine  , Barquins  , Anthoine  , Aubert  , Lévêque
Published: March 2003

Synopsis

Phenomena occurring at the interface between skin and a glass pad, alternatively moved at its surface, are described by direct observation and measured by recording the force on the pad induced by the skin displacement. Static and dynamic friction coefficients are determined as a function of the load applied on the pad. Influence on the recordings of the friction coefficient of some cosmetic treatments applied on the skin are described.

Results show that discontinuous phenomena, due to compression and distortion of the skin microrelief, occur during the beginning of the sliding process. Friction coefficients are depending on the load applied on the pad. Our studies confirm the increase of friction coefficient after hydration of the skin surface and suggest that the fluctuations in the frictional force amplitude could supply an objective, although indirect, measurement of skin smoothness.

Résumé

Un nouveau dispositif expérimental permet à la fois de décrire les phénomènes qui se passent à l’interface entre la peau et une demi‐sphère en verre et de mesurer les forces induites par le déplacement de la peau. Le coefficient de friction (statique et dynamique) peut aussi être mesuré en fonction de la charge appliquée sur la demi‐sphère. Les effets de quelques traitements cosmétiques sur les enregistrements des forces de frottement sont aussi discutés.

Les résultats montrent que des phénomènes discontinus probablement dus à des mécanismes de compression et d’étirement du microrelief cutané, prennent place à l’interface entre la demi‐sphère et la surface de la peau. D’autre part, le coefficient de friction est diminué dans le cas de fortes charges. Nos résultats confirment l’augmentation du coefficient de friction avec l’hydratation de la surface cutanée et suggèrent que l’amplitude des fluctuations de la force de frottement serait une mesure indirecte mais objective de la douceur cutanée.
Formulation and interest of a decorative emulsifier‐free O/W emulsion with a positive zeta potential
Authors: De Clermont‐Gallerande, H. , Doucet, O. , Marsande E. , Fouchard, D. , Orcet A.M. , Zastrow L.
Published: March 2003

Synopsis

The aim of this study was to formulate an emulsifier‐free foundation with a positive zeta potential. This formulation was achieved through a comparative study carried out on 16 cationic hydrogels. Measurements of the cationic activity of those gels were undertaken. Sixteen emulsions, including 0.4% of cationic gel, were formulated and the zeta potential of each was quantified. No correlation between those two measurements could be established.

Pigments introduced in the emulsion to obtain a foundation slightly reduced the zeta potential value of the formula. The skin coloration induced by the application of the formula with a positive electric charge was found more stable than that of classical and transfer‐proof formulae. Moreover, this formula displayed a higher hydrating potential compared to transfer‐proof formulae.

Résumé

Le but de cette étude était de formuler un fond de teint présentant un potentiel zêta positif. Cette formulation a été mise au point à la suite d’une étude comparative menée sur 16 gels cationiques hydrophiles. Les mesures de l’activité cationique de ces gels ont été réalisées. Seize émulsions contenant chacune 0.4% de gel cationique ont été formulées et leur zêta potentiel mesuré. Aucune corrélation n’a pu être établie entre ces 2 types de mesures.

Les pigments, introduits dans l’émulsion pour obtenir un fond de teint, ont faiblement diminué la valeur du potentiel zêta de la formule. La coloration de la peau, induite par l’application de la formule ayant une charge électrique positive, a étée jugée plus stable que celle de formules traditionnelles ou non transferts. Cette formulation présentait de plus, des propriétés hydratantes beaucoup plus importantes que des formules non transferts.
Cosmetic efficacy claims in vitro using a three‐dimensional human skin model
Authors: Schlotmann K. , Kaeten M. , Black A. F. , Damour O. , Waldmann‐Laue M. , Förster T.
Published: March 2003

Synopsis A tissue engineered human skin equivalent is successfully used for the testing of raw materials and cosmetic formulations. This reconstructed skin is supported by a collagen‐glycosaminoglycan‐chitosan biopolymer in which human keratinocytes and dermal fibroblasts were co‐cultured to form a tissue that closely reproduces the in vivo architecture of normal human skin and takes into account the complex interactions between epidermis and dermis. On the other hand, dermal and epidermal responses can be assessed separately in the dermal or skin equivalent.

The three‐dimensional model has important advantages compared to monolayer cell cultures and epidermis models in efficacy testing: (i) the possibility of long‐term cultivation with repeated application of cream formulations containing bioactives and (ii) the similarity to human skin concerning the interaction between dermis and epidermis. These similarities include the expression of keratinocyte differentiation markers such as cytokeratin 10, filaggrin and transglutaminase, as well as proteins of the basal lamina (laminin, collagen type IV) and extracellular matrix proteins such as elastin.

The efficacy of selected bioactives was determined using different endpoints, for example, stimulation of collagen synthesis in the dermal and skin equivalents was shown in comparison to vitamin C as a positive control. On skin equivalents using immunofluorescence techniques we also demonstrated stimulation of the differentiation marker filaggrin, which is important for skin moisturization. The results could be used for claim substantiation, e.g. for the treatment of dry and aged skin.
Isolation of elastin and collagen polypeptides from long cattle tendons as raw material for the cosmetic industry
Authors: Langmaier F. , Mládek M. , Kolomazník K. , Sukop S.
Published: March 2003

Synopsis

Long cattle tendons were enzymatically disposed of lipoid and accompanying nitrogenous substances. Collagenous hydrolysate of average molecular mass Ma = 0.830 ± 1.206 kDa, suitable for application in skin and hair‐care preparations, was obtained through hydrolysis by commercial protease (Bacillus subtilis) under mild conditions. Elastin, hydrolysable with greater difficulty, was subsequently hydrolysed by commercial endopeptidase (Bacillus licheniformis), under more drastic conditions, to a product of average molecular mass Ma = 0.448 ± 1.514 kDa. Purity of both hydrolysates was assessed by hydroxyproline and amide nitrogen contents. Aminosaccharides and glycosamino glycans in hydrolysates were not detected.
Nutrition policies for schools
Authors: McKenna Mary L.
Published: March 2003

In Britain, Canada and the United States, the impetus for initiating school nutrition policies has come primarily from health, not education, agencies. These agencies define the nutrition problems of school students as both under‐ and over‐nutrition, and, to solve them, advocate the development and implementation of policies to combat health and learning problems associated with poor nutrition. Health, rather than educational, agencies are also more likely to formulate school nutrition policies; such policies commonly address the dietary principles of access, adequacy, and moderation. Within countries, the adoption of school nutrition policies varies considerably. Moreover, the degree to which such policies have been implemented is unclear, because of a lack of research to evaluate their process and impact. To enhance the successful development and implementation of school nutrition policies, greater partnership between health and education agencies is recommended throughout the policy process.
Merging the National Food Survey
Authors: Speller Stan
Published: March 2003

Work started in summer 1997 on the possibility of merging the data collection and validation phases of the Family Expenditure Survey and National Food Survey from April 2001. After passing a series of checkpoints, the merger is still on course for April 2001, subject to a successful final pilot study which is now underway. The final decision on whether to proceed with the merger will be made in Autumn 2000, after analysis of the pilot study results. The working name of the survey is the Expenditure and Food Survey (EFS).
Orlistat for the treatment of obesity: rapid review and cost‐effectiveness model
Authors: Foxcroft D. R. , Milne R.
Published: March 2003

The aim of this study is to clarify the potential benefits, disbenefits and costs of Orlistat for the treatment of obesity. The method was a search for relevant systematic reviews and randomized controlled trials, in Medline, Pre‐Medline, Embase and the Cochrane Library, using Orlistat and its synonyms. Identified trials were appraised using a standard appraisal checklist and trial data were extracted for use in cost‐effectiveness modelling. Three large multicentre, randomized placebo controlled trials were included in the rapid review. On average, Orlistat results in obese people losing an additional 3–4% of their initial body weight over diet alone during a 2 year period. There was no strong evidence that this short‐term weight loss would have a longer‐term impact on morbidity and mortality. The cost utility of Orlistat treatment was estimated at around £46 000 per Quality Adjusted Life Year gained (extreme values sensitivity analysis £14 000 to £132 000). This rapid review raises some important questions about the potential value of Orlistat in the treatment of obesity. Further research is needed, not only to clarify the longer‐term impact of Orlistat treatment, but also to uncover the longer‐term impact on mortality and morbidity from short‐term weight loss.
An assessment of the safety and efficacy of sibutramine, an anti‐obesity drug with a novel mechanism of action
Authors: Nisoli E. , Carruba M. O.
Published: March 2003

Sibutramine is a combined serotonin(5‐HT) and noradrenaline (NA)re‐uptake inhibitor. Sibutramine works predominantly through its two pharmacologically active metabolites (i.e. primary and secondary amines) which induce marked weight loss by affecting both food intake and energy expenditure. It is able to enhance the physiological process of satiety, and to stimulate thermogenesis, increasing the efferent sympathetic activity to thermogenically active brown fat. There is a dose‐related reduction in body weight in clinical trials with sibutramine, with weight loss up to 11% below baseline, which can last up to 18 months with continued treatment. When weight loss is induced with a very low calorie diet (VLCDL), patients randomized to the sibutramine treatment continued to lose weight over a 1 year period, reaching 15% below baseline, whereas the placebo‐treated patients regained some weight. Sibutramine improves metabolic fitness, by decreasing the biochemical risk factors associated with obesity, such as plasma triglycerides, total cholesterol and low density lipoprotein (LDL) cholesterol, glucose and insulin, and increasing HDL‐cholesterol. In controlled studies, 84% of sibutramine‐treated patients reported side effects, most commonly including dry mouth, constipation and insomnia, compared with 71% of patients receiving placebo. A small increase in heart rate and blood pressure also occurs and persists for as long as treatment is continued, which, therefore, requires monitoring. Nevertheless, successful treatment of moderately hypertensive obese patients with sibutramine has been demonstrated without undue blood pressure problems and even a mean lowering of blood pressure associated with weight loss. Finally, sibutramine does not have the potential for abuse that is characteristic of amphetamine and it is indistinguishable from placebo in abuse potential studies.
The health at any size paradigm for obesity treatment: the scientific evidence
Authors: Miller W. C. , Jacob A. V.
Published: March 2003

Traditional weight loss (TWL) treatments have been unsuccessful at reducing the prevalence of obesity in the population. Health‐care professionals and consumers have criticized TWL treatments as being detrimental to the obese person's health. Consequently, an alternative approach to obesity treatment, the health at any size (H@AS) paradigm, has been proposed. The H@AS paradigm is based on the philosophy that once diet restrictions and barriers to activity have been removed, the individual will develop healthier eating and activity patterns that lead to a naturally healthy body weight. This paper reviews the philosophical foundation and the scientific data that support and oppose the H@AS paradigm and compares it with that of TWL treatments.
Physical activity and its impact on health outcomes. Paper 1: the impact of physical activity on cardiovascular disease and all‐cause mortality: an historical perspective
Authors: Erlichman J. , Kerbey A. L. , James W. P. T.
Published: March 2003

The modern scientific study of physical activity began soon after World War II and focused on the epidemic of cardiovascular disease that was beginning to engulf the Western world. Early ‘exercise prescriptions’ then specified intense bouts of vigorous activity as the most effective way to maintain cardiovascular fitness and ‘heart health’. Doctors and other health professionals then grew concerned that progressively fewer individuals were heeding this advice at a time when physical activity from manual work was becoming less common. Evidence was also emerging in the late 1980s that the value of accumulated, moderately intense activities, now of increasing importance during leisure time, may have been overlooked, or at least underplayed, in the prevention of heart disease, diabetes and some cancers. Perhaps in population terms adherence to moderate ‘lifestyle’ activities would be better than to the earlier vigorous recommendations. Social policy therefore shifted in the United States in 1996; the US Surgeon General's report set out the basic public health message of ‘30 min of moderate activity five, and preferably all, days of the week’. This recommendation was broadly adopted throughout much of the Western world. How this change in health strategy might impact on unhealthy weight gain and the growing obesity epidemic was given little attention. Here we examine how post‐war public health policy in physical activity developed in an attempt primarily to prevent cardiovascular disease. In the following article we examine why too little attention may have been given to unhealthy weight gain and investigate how this may have happened. Then we consider how much physical activity – and of what kind – is needed to prevent unhealthy weight gain.
Immune restoration disease after the treatment of immunodeficient HIV‐infected patients with highly active antiretroviral therapy
Authors: French M.A. , Lenzo N. , John M. , Mallal S.A. , McKinnon E.J. , James I.R. , Price P. , Flexman J.P. , Tay‐Kearney M‐L.
Published: March 2003

Background To determine if infectious disease events in HIV‐infected patients treated with highly active antiretroviral therapy (HAART) are a consequence of the restoration of pathogen‐specific immune responses, a single‐centre retrospective study of all HIV‐infected patients commencing HAART prior to 1 July 1997 was undertaken to determine the incidence, characteristics and time of onset of disease episodes in HAART responders (decrease in plasma HIV RNA of > 1 log10 copies/mL).

Methods Baseline and post‐therapy changes in CD4 T‐cell counts and HIV RNA were compared in patients with and without disease and delayed‐type hypersensitivity responses to mycobacterial antigens were measured in selected patients.

Results Thirty‐three of 132 HAART responders (25%) exhibited one or more disease episodes after HAART, related to a pre‐existent or subclinical infection by an opportunistic pathogen. Disease episodes were most often related to infections by mycobacteria or herpesviruses but hepatitis C virus (HCV), molluscum contagiosum virus and human papilloma virus were also implicated. They were most common in patients with a baseline CD4 T‐cell count of < 50/uL and occurred most often during the first 2 months of therapy and when CD4 T‐cell counts were increasing. Mycobacteria‐ and HCV‐related diseases were associated with restoration of pathogen‐specific immune responses.

Conclusions We conclude that improved immune function in immunodeficient patients treated with HAART may restore pathogen‐specific immune responses and cause inflammation in tissues infected by those pathogens.
Economic impact of HIV protease inhibitor therapy in the global use of health‐care resources
Authors: Velasco M , Gómez A , Fernández C , Pérez‐Cecilia E , Téllez MJ , Roca V , Fernández‐Cruz A
Published: March 2003

Objective  To evaluate the clinical and economical impact of the introduction of HIV protease inhibitor (PI) therapy in the current clinical care of HIV‐infected patients.

Methods  Cohort study with 155 HIV‐infected patients with a full year of follow‐up before and after the introduction of PI by June 1998. The setting was a large urban tertiary teaching hospital in Madrid, Spain. The main outcomes measures were clinical and immunological evolution, pharmacy, out‐patient, emergency room and in‐patient medical costs evaluated by diagnostic‐related group classification, and the global economic costs of clinical care in HIV‐infected patients (AIDS and non‐AIDS).

Results  The cost of PI therapy was compensated fully by savings related to reduction of the number, length and severity of hospital admissions in AIDS cases. In contrast, more modest clinical effects with increased costs were observed in non‐AIDS cases. Globally, there was an increase of about 20% in the total health‐care costs of HIV‐infected patients (P < 0.01).

Conclusions  PI therapy is highly cost‐effective in AIDS patients. Its value in less severely immunosuppressed patients requires further evaluation.
Drug resistance mutations and outcome of second‐line treatment in patients with first‐line protease inhibitor failure on nelfinavir‐containing HAART
Authors: Røge BT , Katzenstein TL , Nielsen HL , Gerstoft J
Published: March 2003

Objectives

To determine resistance mutations emerging in HIV‐1‐infected patients experiencing their first protease inhibitor (PI)‐failure on nelfinavir‐containing highly active antiretroviral therapy (HAART), and to assess virological response to rescue regimens.

Methods

Plasma HIV‐1 RNA from 24 patients failing nelfinavir‐containing HAART was sequenced. Failure was defined as two consecutive measurements of viral load > 400 HIV‐1 RNA copies/mL. Patients with previous failure on other PIs were excluded. Data on response to second‐line treatment was extracted from patient files.

Results

At failure primary protease mutations were found in 14 patients (58%). Ten patients had D30N (38%), five patients had L90M (19%), two patients had V82A/F (8%) and two patients had M46I/L (8%). Two patients had both D30N and L90M. Pronounced increases of secondary protease mutations were seen at codon 88 (Δ: 33%), codon 36 (Δ: 30%) and codon 71 (Δ: 17%). Of eight patients with N88D, seven also harboured D30N (P < 0.01). Polymorphisms at codon 63 were detected at baseline in all patients who developed primary resistance mutations at failure (P < 0.01). On rescue regimens, 78% achieved viral loads below limit of detection (BLD). The presence of primary protease mutations was not associated with a higher risk of failure on second‐line treatment.

Conclusion

In patients failing nelfinavir‐containing HAART, D30N was detected frequently and L90M occasionally. A pronounced accumulation of the secondary protease mutations N88D, M36I, and A71V/T was found, and D30N was strongly associated with N88D. A high proportion of patients became undetectable on second‐line treatment and the presence of primary resistance mutations did not negatively affect the outcome of rescue regimens.
Pruritic urticarial papules and plaques of pregnancy in twin and triplet pregnancies
Authors: Elling Sv , McKenna P , Powell Fc
Published: March 2003

Background Pruritic urticarial papules and plaques of pregnancy (PUPPP) is a common dermatosis of unknown aetiology. Multiple pregnancies occur frequently in most reported series of PUPPP and increased abdominal distension has been considered a factor in its causation.

Objectives To determine the frequency of PUPPP in twin and triplet pregnancies.

Methods A retrospective review of all the records of patients delivered of twin or triplet pregnancies over an 18‐month period at a busy general maternity hospital.

Results One hundred and thirty‐eight women delivered twins, four of whom developed PUPPP (2.9%). Fourteen women delivered triplet pregnancies, two of whom developed PUPPP (14%). Four of these six multiple pregnancies were conceived by in vitro fertilization.

Conclusions The reported rate of PUPPP in single pregnancies is 1 in 200 (0.5%). Our findings suggest that multiple pregnancies are at a higher risk of developing this cutaneous eruption with 2.9% of twin and 14% of triplet pregnancies affected in our study.
Depigmentation of the normally pigmented patches in universal vitiligo patients by cryotherapy
Authors: Radmanesh Mohammed
Published: March 2003

Background Complete depigmentation may occur, albeit rarely, in patients with universal vitiligo. They usually have one or more pigmented patches that remain normal, most frequently over the malar area of the face and dorsal aspects of forearms. Total repigmentation may not occur in these patients, even after receiving 150 session of PUVA therapy alone or in conjunction with other medical or surgical procedures, and there is possibility of recurrence after cessation of therapy. These patients are usually more interested in depigmentation rather than trying for repigmentation.

Objective Because of the relatively high sensitivity of melanocytes to cryotherapy and the possibility of isomorphic phenomenon in vitiligo patients, removal of the remaining normally pigmented patches was attempted in patients with universal vitiligo using cryotherapy.

Method Five volunteer patients with universal vitiligo were chosen, all of whom wished to have their pigmented patches removed. In all five patients a small area was tested first in order to assure the patients of what the procedure involved and to show its likely result. All pigmented areas were then treated to 1–3 sessions of cryotherapy using a closed contact CO2 cryogun, with 4–6‐week intervals.

Results Complete and permanent depigmentation was achieved in all five patients with excellent cosmetic results and no complications or scarring.

Conclusion Cryotherapy is a cost effective, non‐complicating, easily available procedure which can be used for depigmentation of normally pigmented patches in patients with universal vitiligo.
Isolated granulocytic sarcoma of the skin in an elderly patient: good response to treatment with local radiotherapy and low‐dose methotrexate
Authors: Pulsoni Alessandro , Falcucci Paolo , Anghel Gabriel , Ribersani Michela , Petrucci Maria Teresa , Pescarmona Edoardo , Muscardin Luca
Published: March 2003

Granulocytic sarcoma of the skin is frequently associated with haematological diseases and is rarely isolated. The disease generally develops into acute systemic myeloid leukaemia and is associated with a poor prognosis. We report an elderly patient presenting isolated granulocytic sarcoma of the skin who showed a very good response to treatment with local radiotherapy and low‐dose methotrexate.
Intratracheal metastasis from malignant melanoma
Authors: Koyi Hirsh , Brandén Eva
Published: March 2003

Malignant melanoma is increasing in incidence in most countries. Distant metastases are common but intratracheal metastasis is extremely rare. We report a 54‐year‐old man who presented with increasing dyspnoea. Symptomatic treatment for asthma had been of no effect. Bronchoscopy showed that trachea was nearly occluded by a tumoral mass, and biopsy proved this to be a metastasis of malignant melanoma. The man’s breathing difficulties disappeared after local laser therapy, but 2 months later he presented with symptoms of multiple brain metastases.