bluuebunny/crossref_metadata_2025_split huggingface dataset:
Junior doctors prescribing: enhancing their learning in practice
Authors: Rothwell Charlotte , Burford Bryan , Morrison Jill , Morrow Gill , Allen Maggie , Davies Carol , Baldauf Beate , Spencer John , Johnson Neil , Peile Ed , Illing Jan 
Published: July 2011

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• A large proportion of medical graduates do not feel prepared for practice.• Prescribing is one of the biggest steps up from being a student to practising as a doctor.WHAT THIS STUDY ADDS• The lack of preparedness of graduates for practice is related to a lack of exposure and preparation for clinical practice. Preparedness may be improved by increasing the number of opportunities to develop the skill‐based, applied aspects of prescribing in a controlled, ‘real’ environment. Simulated activity could provide this experience to undergraduates, or writing prescriptions and drug charts to be checked and signed by a doctor on clinical placements.AIM This aim of this paper was to explore new doctors' preparedness for prescribing.METHODS This was a multiple methods study including face‐to‐face and telephone interviews, questionnaires and secondary data from a safe prescribing assessment (n= 284). Three medical schools with differing curricula and cohorts were included: Newcastle (systems‐based, integrated curriculum); Warwick (graduate entry) and Glasgow [problem‐based learning (PBL)], with graduates entering F1 in their local deanery. The primary sample consisted of final year medical students, stratified by academic quartile (n= 65) from each of the three UK medical schools. In addition an anonymous cohort questionnaire was distributed at each site (n= 480), triangulating interviews were conducted with 92 clinicians and questionnaire data were collected from 80 clinicians who had worked with F1s.RESULTS Data from the primary sample and cohort data highlighted that graduates entering F1 felt under‐prepared for prescribing. However there was improvement over the F1 year through practical experience and support. Triangulating data reinforced the primary sample findings. Participants reported that learning in an applied setting would be helpful and increase confidence in prescribing. No clear differences were found in preparedness to prescribe between graduates of the three medical schools.CONCLUSION The results form part of a larger study ‘Are medical graduates fully prepared for practice?’. Prescribing was found to be the weakest area of practice in all sources of data. There is a need for more applied learning to develop skill‐based, applied aspects of prescribing which would help to improve preparedness for prescribing.
Family‐related predictors of body weight and weight‐related behaviours among children and adolescents: a systematic umbrella review
Authors: Cislak A. , Safron M. , Pratt M. , Gaspar T. , Luszczynska A. 
Published: July 2011

AbstractThis umbrella review analysed the relationships between family variables and child/adolescent body weight, diet and physical activity. In line with theories of health behaviour change, it was assumed that behaviour‐specific family variables (i.e. beliefs, perceptions and practices referring to food intake or physical activity) would have stronger support than more general family variables (i.e. socio‐economic status or general parental practices). Data obtained from 18 systematic reviews (examining 375 quantitative studies) were analysed. Reviews of experimental trials generally supported the effectiveness of reward/positive reinforcement parental strategies, parental involvement in treatment or prevention programmes, and cognitive–behavioural treatment in reducing child/adolescent body mass and/or obesity. Results across reviews of correlational studies indicated that healthy nutrition of children/adolescents was related to only one parental practice (parental monitoring), but was associated with several behaviour‐specific family variables (e.g. a lack of restrictive control over food choices, high intake of healthy foods and low intake of unhealthy foods by parents and siblings, low pressure to consume foods). With regard to adolescent physical activity, stronger support was also found for behaviour‐specific variables (e.g. physical activity of siblings), and for certain socio‐economic variables (e.g. parental education). Child and adolescent obesity prevention programmes should account for behaviour‐specific family variables.
Asthma control with extrafine‐particle hydrofluoroalkane–beclometasone vs. large‐particle chlorofluorocarbon–beclometasone: a real‐world observational study
Authors: Barnes N. , Price D. , Colice G. , Chisholm A. , Dorinsky P. , Hillyer E. V. , Burden A. , Lee A. J. , Martin R. J. , Roche N. , von Ziegenweidt J. , Israel E. 
Published: July 2011

Summary
Background The extrafine‐particle formulation of hydrofluoroalkane–beclometasone (EF HFA–BDP; Qvar®) demonstrates improved total and small airway deposition compared with large‐particle chlorofluorocarbon (CFC)–BDP. In some short‐term studies, EF HFA–BDP provides greater effects on lung function than CFC–BDP, and hence is recommended to be prescribed at a lower dose, but whether there are differences in asthma outcomes during long‐term treatment is unknown.
Objective To compare the effectiveness of EF HFA–BDP vs. CFC–BDP over 1 year.
Methods This retrospective matched cohort study examined outcomes in a large primary care database for patients aged 5–60 years with asthma receiving their first inhaled corticosteroid (ICS) prescription (initiation population) or first ICS dose increase (step‐up population) by a pressurized metered‐dose inhaler (pMDI) as EF HFA–BDP or CFC–BDP. Patients were matched on baseline demographic and asthma severity measures in EF HFA–BDP:CFC–BDP ratios of 1 : 3 and 1 : 2 for initiation and step‐up populations, respectively. Step‐up patients were matched also on ICS dose during a baseline year. Co‐primary endpoints were asthma control (composite measure comprising no recorded hospital attendance for asthma, oral corticosteroids, or antibiotics for lower respiratory infection) and exacerbation rate during the outcome year.
Results For the initiation population (EF HFA–BDP n=2882; CFC–BDP n=8646), adjusted odds of achieving asthma control with EF HFA–BDP vs. CFC–BDP was 1.15 (95% CI 1.02–1.28). For the step‐up population (n=258 and 516), adjusted odds of asthma control with EF HFA–BDP was 1.72 (95% CI 1.14–2.56). EF HFA–BDP was prescribed at a median dose half that of CFC–BDP.
Conclusion and Clinical Relevance During 1 year after initiating or stepping up ICS therapy by pMDI, patients who received EF HFA–BDP were more likely to achieve asthma control than those receiving CFC–BDP. These findings suggest that ICS formulation, particle size, and deposition characteristics play important roles in real‐life effectiveness of asthma therapy. This study shows that an EF‐particle formulation of beclometasone can be used at half the dose of the large‐particle formulation with at least as good clinical outcomes.
Cite this as: N. Barnes, D. Price, G. Colice, A. Chisholm, P. Dorinsky, E. V. Hillyer, A. Burden, A. J. Lee, R. J. Martin, N. Roche, J. von Ziegenweidt and E. Israel, Clinical & Experimental Allergy, 2011 (41) 1521–1532.
Why is achieving good ecological outcomes in rivers so difficult?
Authors: HARRIS GRAHAM P. , HEATHWAITE A. LOUISE 
Published: July 2011

Summary1. Considerable evidence from around the world shows that achieving good ecological outcomes in rivers from programmes of measures in catchments is difficult. There are a number of reasons for this, which we discuss, but here we focus primarily on the question, ‘Is the knowledge base adequate?’2. We develop further the thesis that catchments and receiving waters are truly complex systems in which there are fundamental limits to knowledge. Our sampling and data analysis practices come with strong biases and inbuilt ‘framing’ assumptions about the nature and values of ecosystem processes that underestimate complexity and uncertainty.3. If we reframe our assumptions to think of the problem in terms of the properties of complex systems, then we can rethink our attitudes to uncertainty, causal thickets (multiple stressors) and cross‐scale effects, and we can begin to develop new definitions of what constitutes a ‘good’ ecological outcome. Dealing with inherent variability in data then becomes less of a problem with controlling ‘noise’ and more of a problem of understanding system dynamics. The presence of adaptive dynamics and self‐organisation in complex systems means that uncertainties will always be large and knowledge will be partial and that such systems are fundamentally not computable.4. We show that small‐scale ‘noise’ in ecosystems is an inherent property of non‐equilibrium systems with predominant advection, reaction–diffusion dynamics. Flow paths in catchments and the dynamics of receiving waters have fractal properties. Fractal dynamics indicate that multiple, cross‐scale interactions are a characteristic of these systems. Small‐scale connectivity is an important (and, from a management point of view, underused) aspect of pattern and process in such systems.5. In an environment of such complexity, models will be flawed and predictions uncertain. It is therefore necessary to develop new indicators of connectivity and ecological complexity so that indicators of system‐level progress may be found to assist with an improved process of adaptive management that is trend‐orientated as well as outcome‐orientated.
Adherence to the guideline ‘Triage in emergency departments’: a survey of Dutch emergency departments
Authors: Janssen Maaike AP , van Achterberg Theo , Adriaansen Marian JM , Kampshoff Caroline S , Mintjes‐de Groot Joke 
Published: July 2011

Aims and objectives.  The aim of this study was to evaluate the adherence to the 2004 guideline Triage in emergency departments three years after dissemination in Dutch emergency departments.Background.  In 2004, a Dutch guideline Triage in emergency departments was developed. Triage is the first step performed by nurses when a patient arrives at an emergency department. It includes the prioritisation of patients to ensure that doctors see patients with the highest medical needs first. Although the national guideline was developed and disseminated in 2004, three years on there was no insight into the level of implementation of the guideline in practice.Design.  A cross‐sectional descriptive design.Methods.  In February 2007, data were collected from ward managers and triage nurses at all emergency departments in the Netherlands (n = 108), using a questionnaire that was based on the recommendations and performance indicators of the guideline.Results.  In total, 79% of all 108 Dutch emergency departments responded. The main findings showed that over 31% of the emergency departments did not use a triage system. Emergency departments using the Manchester Triage System had a mean adherence rate of 61% of the guideline’s recommendations and emergency departments using the Emergency System Index adhered to a mean of 65%.Conclusion.  The guideline Triage in emergency departments was disseminated in 2004, but results from this study indicate that an improvement in adherence to this guideline is required.Relevance to clinical practice.  Adherence to guidelines is important to standardise practice to ensure that patients receive the appropriate treatment and to improve quality of care.
Clinical learning environment and supervision: experiences of Norwegian nursing students – a questionnaire survey
Authors: Skaalvik Mari Wolff , Normann Hans Ketil , Henriksen Nils 
Published: July 2011

Aim and objective.  To measure nursing students’ experiences and satisfaction with their clinical learning environments. The primary interest was to compare the results between students with respect to clinical practice in nursing homes and hospital wards.Background.  Clinical learning environments are important for the learning processes of nursing students and for preferences for future workplaces. Working with older people is the least preferred area of practice among nursing students in Norway.Design.  A cross‐sectional design.Methods.  A validated questionnaire was distributed to all nursing students from five non‐randomly selected university colleges in Norway. A total of 511 nursing students completed a Norwegian version of the questionnaire, Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) evaluation scale in 2009. Data including descriptive statistics were analysed using the Statistical Program for the Social Sciences. Factor structure was analysed by principal component analysis. Differences across sub‐groups were tested with chi‐square tests and Mann–Whitney U test for categorical variables and t‐tests for continuous variables. Ordinal logistic regression analysis of perceptions of the ward as a good learning environment was performed with supervisory relationships and institutional contexts as independent variables, controlling for age, sex and study year.Results.  The participating nursing students with clinical placements in nursing homes assessed their clinical learning environment significantly more negatively than those with hospital placements on nearby all sub‐dimensions.Conclusions.  The evidence found in this study indicates that measures should be taken to strengthen nursing homes as learning environments for nursing students.Relevance to clinical practice.  To recruit more graduated nurses to work in nursing homes, actions to improve the learning environment are needed.
Lrp–DNA complex stability determines the level of ON cells in type P fimbriae phase variation
Authors: Graveline Richard , Mourez Michaël , Hancock Mark A. , Martin Christine , Boisclair Stéphanie , Harel Josée 
Published: July 2011

SummaryF1651 and the pyelonephritis‐associated pili (Pap) are two members of the type P family of adhesive factors that play a key role in the establishment of disease caused by extraintestinal Escherichia coli (ExPEC) strains. They are both under the control of an epigenetic and reversible switch that defines the number of fimbriated (ON) and afimbriated (OFF) cells within a clonal population. Our present study demonstrates that the high level of ON cells found during F1651 phase variation is due to altered stability of the DNA complex formed by the leucine‐responsive regulatory protein (Lrp) at its repressor binding sites 1–3; after each cell cycle, complex formation is also modulated by the local regulator FooI (homologue to PapI) which promotes the transit of Lrp towards its activator binding sites 4–6. Furthermore, we identified two nucleotides (T490, G508) surrounding the Lrp binding site 1 that are critical to maintaining a high OFF to ON switch rate during F1651 phase variation, as well as switching Pap fimbriae towards the OFF state.
The novel putative transporter NPT1 plays a critical role in early stages of Plasmodium berghei sexual development
Authors: Boisson Bertrand , Lacroix Céline , Bischoff Emmanuel , Gueirard Pascale , Bargieri Daniel Y. , Franke‐Fayard Blandine , Janse Chris J. , Ménard Robert , Baldacci Patricia 
Published: July 2011

SummaryTransmission of Plasmodium species from a mammalian host to the mosquito vector requires the uptake, during an infected blood meal, of gametocytes, the precursor cells of the gametes. Relatively little is known about the molecular mechanisms involved in the developmental switch from asexual development to sexual differentiation or the maturation and survival of gametocytes. Here, we show that a gene coding for a novel putative transporter, NPT1, plays a crucial role in the development of Plasmodium berghei gametocytes. Parasites lacking NPT1 are severely compromised in the production of gametocytes and the rare gametocytes produced are unable to differentiate into fertile gametes. This is the earliest block in gametocytogenesis obtained by reverse genetics and the first to demonstrate the role of a protein with a putative transport function in sexual development. These results and the high degree of conservation of NPT1 in Plasmodium species suggest that this protein could be an attractive target for the development of novel drugs to block the spread of malaria.
GLP‐2 receptor expression in excitatory and inhibitory enteric neurons and its role in mouse duodenum contractility
Authors: Cinci L. , Faussone‐Pellegrini M. S. , Rotondo A. , Mulè F. , Vannucchi M. G. 
Published: July 2011

AbstractBackground  Glucagon‐like peptide 2 (GLP‐2), a nutrient‐responsive hormone, exerts various actions in the gastrointestinal tract that are mediated by a G‐protein coupled receptor called GLP‐2R. A little information is available on GLP‐2R expression in enteric neurons and nothing on the interstitial cells of Cajal (ICC).Methods  We investigated presence and distribution of the GLP‐2R in the mouse duodenum by immunohistochemistry and the potential motor effects of GLP‐2 on the spontaneous and neurally evoked mechanical activity.Key Results  The GLP‐2R was expressed by the myenteric and submucosal neurons. Labelling was also present in nerve varicosities within the circular muscular layer and at the deep muscular plexus (DMP). No immunoreactive nerve fiber was seen within the longitudinal muscle layer. The GLP‐2R‐positive neurons were either excitatory (SP‐ and choline‐acetyltransferase‐positive) or inhibitory (vasoactive intestinal polypeptide and nNOS‐positive). The ICC, both at the myenteric plexus and at the DMP, never expressed GLP‐2R but, especially those at the DMP, were surrounded by GLP‐2R‐positive nerve varicosities co‐expressing either excitatory or inhibitory neurotransmitters. Quantitative analysis demonstrated a consistent prevalence of GLP‐2R on the excitatory pathways. In agreement, the functional results showed that the administration of GLP‐2 in vitro caused decrease of the spontaneous contractions mediated by nitric oxide release and reduction of the evoked cholinergic contractions.Conclusions & Inferences  The present findings indicate that the GLP‐2R is expressed by inhibitory and excitatory neurons, the GLP‐2 inhibits the muscle contractility likely decreasing cholinergic neurotransmission and increasing nitric oxide production, and this effect is possibly mediated by the ICC‐DMP recruitment.
Gene discovery in cereals through quantitative trait loci and expression analysis in water‐use efficiency measured by carbon isotope discrimination
Authors: CHEN JING , CHANG SCOTT X. , ANYIA ANTHONY O. 
Published: July 2011

ABSTRACTDrought continues to be a major constraint on cereal production in many areas, and the frequency of drought is likely to increase in most arid and semi‐arid regions under future climate change scenarios. Considerable research and breeding efforts have been devoted to investigating crop responses to drought at various levels and producing drought‐resistant genotypes. Plant physiology has provided new insights to yield improvement in drought‐prone environments. Crop performance could be improved through increases in water use, water‐use efficiency (WUE) and harvest index. Greater WUE can be achieved by coordination between photosynthesis and transpiration. Carbon isotope discrimination (Δ13C) has been demonstrated to be a simple but reliable measure of WUE, and negative correlation between them has been used to indirectly estimate WUE under selected environments. New tools, such as quantitative trait loci (QTL) mapping and gene expression profiling, are playing vital roles in dissecting drought resistance‐related traits. The combination of gene expression and association mapping could help identify candidate genes underlying the QTL of interest and complement map‐based cloning and marker‐assisted selection. Eventually, improved cultivars can be produced through genetic engineering. Future efficient and effective breeding progress in cereals under targeted drought environments will come from the integrated knowledge of physiology and genomics.
Temperature response of mesophyll conductance in cultivated and wild Oryza species with contrasting mesophyll cell wall thickness
Authors: SCAFARO ANDREW P. , VON CAEMMERER SUSANNE , EVANS JOHN R. , ATWELL BRIAN J. 
Published: July 2011

ABSTRACTA critical component of photosynthetic capacity is the conductance of CO2 from intercellular airspaces to the sites of CO2 fixation in the stroma of chloroplasts, termed mesophyll conductance (gm). Leaf anatomy has been identified as an important determinant of gm. There are few studies of the temperature response of gm and none has examined the implications of leaf anatomy. Hence, we compared a cultivar of Oryza sativa with two wild Oryza relatives endemic to the hot northern savannah of Australia, namely Oryza meridionalis and Oryza australiensis. All three species had similar leaf anatomical properties, except that the wild relatives had significantly thicker mesophyll cell walls than O. sativa. Thicker mesophyll cell walls in the wild rice species are likely to have contributed to the reduction in gm, which was associated with a greater drawdown of CO2 into chloroplasts (Ci–Cc) compared with O. sativa. Mesophyll conductance increased at higher temperatures, whereas the rate of CO2 assimilation was relatively stable between 20 and 40 °C. Consequently, Ci–Cc decreased for all three species as temperature increased.
Vented sediments and tsunami deposits in the Puget Lowland, Washington – differentiating sedimentary processes
Authors: MARTIN MARIA ELIZABETH , BOURGEOIS JOANNE 
Published: July 2011

AbstractThe sandy deposits produced by tsunamis and liquefaction share many sedimentary features, and distinctions between the two are important in seismically active coastal zones. Both types of deposits are present in the wetlands bordering Puget Sound, where one or more earthquakes about 1100 years ago caused both tsunami flooding and sediment venting. This co‐occurrence allows an examination of the resulting deposits and a comparison with tsunami and liquefaction features of modern events. Vented sediments occur at four of five wetland field localities and tsunami deposits at two. In comparison with tsunami deposits, vented sediments in this study and from other studies tend to be thicker (although they can be thin). Vented sediments also have more variable thickness at both outcrop and map scale, are associated with injected dykes and contain clasts derived from underlying deposits. Further, vented sediments tend to contain a greater variety of sedimentary structures, and these structures vary laterally over metres. Tsunami deposits compared with vented sediments are commonly thinner, fine and thin landward more consistently, have more uniform thickness on outcrop and map scales, and have the potential of containing coarser clasts, up to boulders. For both tsunami deposits and vented sediments, the availability and grain size of source material condition the characteristics of the deposit. In the cases presented in this paper, both foraminifera and diatom assemblages within tsunami deposits and vented sediments consisted of brackish and marine species, and no distinction between processes could be made based on microfossils. In summary, this study indicates a need for more careful analysis and mapping of coastal sediments associated with earthquakes to avoid misidentification of processes and misevaluation of hazards.