bluuebunny/crossref_metadata_2025_split huggingface dataset:
Persistence of climate changes due to a range of greenhouse gases
Authors: Solomon Susan , Daniel John S. , Sanford Todd J. , Murphy Daniel M. , Plattner Gian-Kasper , Knutti Reto , Friedlingstein Pierre 
Published: October 2010

Emissions of a broad range of greenhouse gases of varying lifetimes contribute to global climate change. Carbon dioxide displays exceptional persistence that renders its warming nearly irreversible for more than 1,000 y. Here we show that the warming due to non-CO
2
greenhouse gases, although not irreversible, persists notably longer than the anthropogenic changes in the greenhouse gas concentrations themselves. We explore why the persistence of warming depends not just on the decay of a given greenhouse gas concentration but also on climate system behavior, particularly the timescales of heat transfer linked to the ocean. For carbon dioxide and methane, nonlinear optical absorption effects also play a smaller but significant role in prolonging the warming. In effect, dampening factors that slow temperature increase during periods of increasing concentration also slow the loss of energy from the Earth’s climate system if radiative forcing is reduced. Approaches to climate change mitigation options through reduction of greenhouse gas or aerosol emissions therefore should not be expected to decrease climate change impacts as rapidly as the gas or aerosol lifetime, even for short-lived species; such actions can have their greatest effect if undertaken soon enough to avoid transfer of heat to the deep ocean.
Structure and mechanism of the complex between cytochrome P4503A4 and ritonavir
Authors: Sevrioukova Irina F. , Poulos Thomas L. 
Published: October 2010

Ritonavir is a HIV protease inhibitor routinely prescribed to HIV patients that also potently inactivates cytochrome P4503A4 (CYP3A4), the major human drug-metabolizing enzyme. By inhibiting CYP3A4, ritonavir increases plasma concentrations of other anti-HIV drugs oxidized by CYP3A4 thereby improving clinical efficacy. Despite the importance and wide use of ritonavir in anti-HIV therapy, the precise mechanism of CYP3A4 inhibition remains unclear. The available data are inconsistent and suggest that ritonavir acts as a mechanism-based, competitive or mixed competitive-noncompetitive CYP3A4 inactivator. To resolve this controversy and gain functional and structural insights into the mechanism of CYP3A4 inhibition, we investigated the ritonavir binding reaction by kinetic and equilibrium analysis, elucidated how the drug affects redox properties of the hemoprotein, and determined the 2.0 Å X-ray structure of the CYP3A4-ritonavir complex. Our results show that ritonavir is a type II ligand that perfectly fits into the CYP3A4 active site cavity and irreversibly binds to the heme iron via the thiazole nitrogen, which decreases the redox potential of the protein and precludes its reduction with the redox partner, cytochrome P450 reductase.
Asymptotic analysis of small-angle scattering intensities of plane columnar layers
Authors: Ciccariello Salvino 
Published: October 2010

The asymptotic behaviour, at large scattering vectorq, of the small-angle scattering intensities of isotropic plane samples is similar to that of three-dimensional samples. In fact, its expression, limited to the first two leading terms, isc1γ(1)(0)/q3 + c3γ(3)(0)/q5, wherec1andc3are appropriate numerical constants, and γ(1)(0) and γ(3)(0) the values, at the origin, of the first and third derivatives, respectively, of the two-dimensional correlation function. These values are proportional to the specific length and to the mean square reciprocal curvature radius of the interface curve. The angularity of the latter can also be determined, while the presence of oscillations in the appropriate Porod plot is related to a parallelism condition obeyed by the interface curve. These results are useful for analysing the small-angle scattering intensities collected under grazing incidence and diffused by film samples that are a collection of homogeneous cylinders of arbitrary right sections.
Blood transfusion and the anaesthetist: management of massive haemorrhage
Authors: Thomas D , Wee M , Clyburn P , Walker I , Brohi K , Collins P , Doughty H , Isaac J , Mahoney PF , Shewry L 
Published: October 2010

Summary 1. Hospitals must have a major haemorrhage protocol in place and this should include clinical, laboratory and logistic responses. 2. Immediate control of obvious bleeding is of paramount importance (pressure, tourniquet, haemostatic dressings). 3. The major haemorrhage protocol must be mobilised immediately when a massive haemorrhage situation is declared. 4. A fibrinogen < 1 g.l−1 or a prothrombin time (PT) and activated partial thromboplastin time (aPTT) of > 1.5 times normal represents established haemostatic failure and is predictive of microvascular bleeding. Early infusion of fresh frozen plasma (FFP; 15 ml.kg−1) should be used to prevent this occurring if a senior clinician anticipates a massive haemorrhage. 5. Established coagulopathy will require more than 15 ml.kg−1 of FFP to correct. The most effective way to achieve fibrinogen replacement rapidly is by giving fibrinogen concentrate or cryoprecipitate if fibrinogen is unavailable. 6. 1:1:1 red cell:FFP:platelet regimens, as used by the military, are reserved for the most severely traumatised patients. 7. A minimum target platelet count of 75 × 109.l−1 is appropriate in this clinical situation. 8. Group‐specific blood can be issued without performing an antibody screen because patients will have minimal circulating antibodies. O negative blood should only be used if blood is needed immediately. 9. In hospitals where the need to treat massive haemorrhage is frequent, the use of locally developed shock packs may be helpful.10. Standard venous thromboprophylaxis should be commenced as soon as possible after haemostasis has been secured as patients develop a prothrombotic state following massive haemorrhage.
Exploring the components of metabolic syndrome with respect to gender difference and its relationship to health‐promoting lifestyle behaviour: a study in Taiwanese urban communities
Authors: Chen Yu‐Chi , Wu Hui‐Ping , Hwang Shinn‐Jang , Li I‐Chuan 
Published: October 2010

Aims.  The aim was to explore the prevalence of five components of metabolic syndrome with respect to gender and health‐promoting lifestyle behaviours.Background.  Age‐ and gender‐specific strategies might be useful as an approach to controlling metabolic syndrome. Prevention or delaying the onset of metabolic syndrome is of utmost importance in terms of chronic disease care in Taiwan.Design.  This was a cross‐sectional study.Method.  Participants self‐completed a questionnaire and replied via mail.Results.  The overall prevalence rate of metabolic syndrome was 24·07%, with men showing a higher rate than women. High blood pressure was the first abnormal component. The genders were significantly different in the prevalence of high blood pressure, hypertriglyceridemia and decreased HDL‐C. Age was also a significant determinant and positively correlated to the total Health‐Promoting Lifestyle Profile II (HPLP II) scale score (r = 0·11*), nutrition (r = 0·14**), physical activity (r = −0·16**) and health responsibility (r = 0·12**).Conclusions.  Young, employed adult men were most at risk for having metabolic syndrome. It would seem that it is essential to control blood pressure and abdominal obesity to prevent metabolic syndrome; however, accomplishing this by trying to improve the level of physical activity does not seem to be a viable solution. Moreover, lifestyle modification has been proposed using gender‐, age‐ and location‐specific interventions. Nurses should not only strive to investigate the factors that lead to the adoption of unhealthy lifestyle behaviours by using the system approach, but also to empower people to participate in designing health programmes.Relevance to clinical practice.  By understanding the components of metabolic syndrome, it will be possible to develop more effective strategies for its prevention. Based on this, it will help if healthcare providers focus their efforts on the specific components of metabolic syndrome and on the individuals who are at the greatest risk of developing metabolic syndrome.
The impact of nursing leadership on patient safety in a developing country
Authors: Stewart Lee , Usher Kim 
Published: October 2010

Aim.  This article is a report of a study to identify the ways nursing leaders and managers in a developing country have an impact on patient safety.Background.  The attempt to address the problem of patient safety in health care is a global issue. Literature addressing the significant impact that nursing leadership has on patient safety is extensive and focuses almost exclusively on the developed world.Design.  A critical ethnography was conducted with senior registered nursing leaders and managers throughout the Fiji Islands, specifically those in the Head Office of the Fiji Ministry of Health and the most senior nurse in a hospital or community health service.Method.  Semi‐structured interviews were conducted with senior nursing leaders and managers in Fiji. Thematic analysis of the interviews was undertaken from a critical theory perspective, with reference to the macro socio‐political system of the Fiji Ministry of Health.Results.  Four interrelated issues regarding the nursing leaders and managers’ impact on patient safety emerged from the study. Empowerment of nursing leaders and managers, an increased focus on the patient, the necessity to explore conditions for front‐line nurses and the direct relationship between improved nursing conditions and increased patient safety mirrored literature from developed countries.Conclusion.  The findings have significant implications for developing countries and it is crucial that support for patient safety in developing countries become a focus for the international nursing community.Relevance to clinical practice.  Nursing leaders and managers’ increased focus on their own place in the hierarchy of the health care system and on nursing conditions as these affect patient safety could decrease adverse patient outcomes. The findings could assist the global nursing community to better support developing countries in pursuing a patient safety agenda.
Attitudes to the use of seclusion: has contemporary mental health policy made a difference?
Authors: Happell Brenda , Koehn Stefan 
Published: October 2010

Background.  The use of seclusion in mental health services is controversial, and recent Government policy has identified the reduction and, if possible, elimination of seclusion as a national safety priority. As the professional group most likely to initiate seclusion, the attitudes of nurses will influence the extent to which policy translates to practice.Design.  The Survey of Nurses’ Attitudes to Seclusion Survey was completed by nurses (n = 123) from eight mental health services from Queensland, Australia.Methods.  Data were analysed using SPSS to provide descriptive statistics for nurses’ attitudes according to the scale. Correlation analysis was used to examine associations between demographic variables and attitudes towards seclusion.Results.  Participants recognised the negative impact of seclusion on consumers; however, they continue to support its use, particularly in cases of threatened or actual violence to staff and other consumers. The impact of seclusion room on consumers was viewed as significant and yet most participants did not recommend changes other than painting the room for a calming effect. Demographic factors had limited impact on attitudes.Conclusions.  The continued support of the use of seclusion despite acknowledgement of its detrimental effects appears to reflect a lack of alternative approaches to the management of consumer behaviours such as violence and aggression.Relevance to clinical practice.  While nurses continue to view seclusion as a necessary intervention, the success of strategies aimed at reducing its use will be limited. The implementation and evaluation of alternative approaches to the care of consumers is necessary to reduce reliance and seclusion and introduce changes to practice.
Feeding with cross‐cut teats has better sucking effects and oxygenation in preterm infants with chronic lung disease
Authors: Kao Hui‐Mei , Lin Chyi‐Her , Chang Ying‐Ju 
Published: October 2010

Aim. To compare effects of single‐hole and cross‐cut teats on feeding performance, oral movement and cardiorespiratory parameters in preterm infants with chronic lung disease.Background. Infants’ feeding performance and physiological stability are affected by the shape and hole size of teats because of varied milk flow. The single‐hole teat could facilitate efficient milk intake in healthy preterm infants. In preterm infants with chronic lung disease, few studies have determined which type of teat is suitable for feeding.Design. A crossover study design was conducted.Methods. Twenty preterm infants with chronic lung disease were studied in a neonatal intensive care unit. During the early stage in transitional period of oral feeding, each infant was provided with a small single‐hole, an intermediate single‐hole and a cross‐cut teat with diameters of 0·45–0·5 mm, 0·7–0·8 mm and 2·0 mm, respectively, for three consecutive feeds in a random order. Feeding performance, oral movement, heart rate, respiratory rate and oxygen saturation (SpO2) were measured.Results. Infants fed with single‐hole teats had a shorter duration of feeding time (p < 0·001) and higher feeding efficiency (p < 0·001) compared with the cross‐cut teats. However, infants fed with cross‐cut teats had a higher sucking pressure (p < 0·001), more sucks (p < 0·001) and bursts (p < 0·001), longer sucking duration (p = 0·002) and higher respiratory rate (p = 0·005) and SpO2 (p = 0·014) than infants fed with single‐hole teats.Conclusions. For preterm infants with chronic lung disease, cross‐cut teats facilitate feeding coordination and physiological stability during the early stage of the transition from tube to oral feeding.Relevance to clinical practice. Cross‐cut teat can be considered for preterm infants with chronic lung disease to increase safety and self‐regulation in the early stage of the transition from tube to oral feeding.
Inter‐rater and intra‐rater reliability of nursing process records for patients with schizophrenia
Authors: Chung Min‐Huey , Chiang I‐Jen , Chou Kuei‐Ru , Chu Hsin , Chang Hsiu‐Ju 
Published: October 2010

Aims.  This study explored the inter‐rater and intra‐rater reliability to evaluate the consistency of nursing process records for patients with schizophrenia.Background.  By writing accurate and complete nursing process records, nurses can quickly communicate the care that has been delivered. However, little is known about the accuracy of nursing records to reflect the patients’ problems, especially in psychiatry.Design.  A prospective observational study.Methods.  Two nurses with similar work experience in psychiatric wards assessed patient records produced by 14 psychiatric nurses to compute inter‐rater reliability of nursing diagnoses and their defining characteristics. Collecting the records and the time spans between the first and the second data collection took one month to compute the intra‐reliability of the nursing diagnoses by the same nurse.Results.  The greatest intra‐rater consistency was in identifying ‘disturbed thought processes’ (kappa = 0·77, 95% CI: 0·56–0·98). A moderate level of inter‐rater agreement among nurses was observed for the nursing diagnoses of ‘disturbed thought process’ and ‘disturbed sleep pattern’ from 0·41–0·53. Furthermore, the inter‐rater agreement of among nurses with less work experience (less than four years) showed greater higher consistency on ‘disturbed thought process’ (kappa = 0·56, 95% CI: 0·23–0·89) and ‘disturbed sleep pattern’ (kappa = 0·41, 95% CI: 0·07–0·73) than that observed among nurses with more work experience (more than four years).Conclusions.  Overall, intra‐rater reliability was greater than inter‐rater reliability for psychiatric nursing process records. Furthermore, more inter‐rater and intra‐rater agreement were observed among records from less experienced nurses than among records produced by more experienced ones. To evaluate the consistency of nursing process records, both the intra‐rater reliability and the inter‐rater reliability show the importance of using standardised terms and more detailed nursing records.Relevance to clinical practice.  Our results clearly indicate that using standardised terms to describe patient symptoms and more detailed descriptions of the nursing process could improve the accuracy of nursing records.
Barriers to research utilisation among nurses in Turkey
Authors: Uysal Aynur , Temel Ayla Bayik , Ardahan Melek , Ozkahraman Sukran 
Published: October 2010

Aim and objective.  This study was conducted to identify barriers to research utilisation in practice among nurses in Turkey.Background.  It is clear from the nursing literature that there are several factors that can impede the use of research in practice. It is important that these are identified and addressed.Design.  Survey.Method.  This descriptive study was carried out with 216 nurses from government and private hospitals in Izmir between January–April 2007. The data collection instrument used for the study consisted of the Barriers to Research Utilization Scale and a self‐administered questionnaire form that contained demographic data, educational background and nurses’ involvement in research activities.Results.  More than half of the nurses did not receive research education before graduation, and 85·2% did not receive an in‐service education. Only 58·3% of nurses give great importance to research, and 24·5% are interested in research. Involvement in research activities is inadequate. Five out of the top 10 barriers were related to ‘setting’, three to ‘nurse’ and two to ‘presentation’. Educational level, undergraduate research education and involvement in research activities were predictor factors of perceived barriers to research utilisation.Conclusions.  Identifying the barriers to research utilisation is the first step in overcoming the barriers. It is hoped that research capability in the health care field in Turkey can be enhanced. Creating an organisational climate that values research use and supports nurses to participate in such activities is crucial.Relevance to clinical practice.  The study findings provide key factors and the top barriers to research utilisation to nurse administrators in developing strategies to increase the utilisation of research findings in clinical practices.
The modified self: family caregivers’ experiences of caring for a dying family member at home
Authors: Carlander Ida , Sahlberg‐Blom Eva , Hellström Ingrid , Ternestedt Britt‐Marie 
Published: October 2010

Aim.  The aim of this study was to explore situations in daily life that challenge caregivers’ self‐image when caring for a dying family member at home.Background.  Caregiving affects the health and daily lives of family caregivers. Patterns of challenging situations may provide insight into the home caregiving experience, thus contributing to our understanding of the influence it has on the caregivers’ self‐image.Design.  Qualitative descriptive study.Methods.  Ten family caregivers who cared for a dying family member at home with support from an advanced home care team were interviewed 6–12 months after the death of the family member. The interviews were analysed with interpretive description.Result.  Three patterns characterised the experiences of caregivers’ daily lives in caring for a dying family member at home: challenged ideals, stretched limits and interdependency. These patterns formed the core theme, the modified self. Situations that challenged the caregivers’ self‐image were connected to experiences such as ‘forbidden thoughts’, intimacy and decreasing personal space.Conclusions.  The caregivers met challenging situations in their daily lives that created a modified image of self. It is important to recognise the impact of caring for a dying family member at home.Relevance to clinical practice.  This study argues for supporting family caregivers to maximise their potential to handle the demanding everyday life with a dying family member at home. This study contributes to understanding situations in the home that may challenge caregivers’ self‐image and points out the importance of talking about caregiving experiences. From a clinical perspective, this study emphasises the significance of creating a climate, which allows family caregivers to express thoughts and feelings. Sharing experiences such as ‘forbidden thoughts’ can be one way of handling the profoundly changed every day life.
An exploration of factors affecting Hong Kong ICU nurses in providing oral care
Authors: Yeung Ka Yi , Chui Ying Yu 
Published: October 2010

Aim and objectives.  This paper aims to explore the factors that affect Hong Kong intensive care unit nurses in providing oral care.Background.  The literature shows that evidence‐based oral care prevents ventilator‐associated pneumonia. Nevertheless, not all intensive care unit nurses provide such care. Although several studies have been undertaken to identify factors that affecting the provision of oral care, none of these studies looked at the situation in Hong Kong.Design.  An exploratory qualitative design was adopted, with audio‐taped interviews.Methods.  A convenience sample of 10 registered nurses with 3–14 years of intensive care unit working experience was recruited from the intensive care unit of one regional hospital in Hong Kong. Transcribed interviews were analysed by means of content analysis.Results.  The participants’ descriptions of their oral care practices covered oral health assessment, cleansing the oral cavity and care of the surrounding areas. Findings revealed the following significant factors that influenced intensive care unit nurses in providing oral care: their perceptions of the purpose of oral care; their fears about providing it; the priority of oral care; and inadequate support for oral care.Conclusions.  The findings indicate that nurses’ oral care practices were not evidence based. Factors that affected the provision of oral care were consistent with those found in previous studies.Relevance to clinical practice.  Study findings indicate that present oral care training should be revised. The findings also highlight the influence of ward culture on nurses’ priorities in providing oral care. Appropriate materials, adequate staffing levels and the establishment of an evidence‐based oral care protocol may facilitate the provision of oral care in the intensive care unit.