bluuebunny/crossref_metadata_2025_split huggingface dataset:
Persistent Frenulum of the Epiglottis in Four Foals
Authors: Yarbrough Tom B. , Voss ED , Herrgesell Eric J. , Shaw Michelle 
Published: October 2010

Objective— To report the clinical signs and management of 4 foals with persistent frenulum of the epiglottis.Study Design— Case report.Animals— Four newborn foals.Methods— Foals were admitted with a complaint of oronasal reflux after nursing. Variable systemic signs of aspiration pneumonia were evident. Nasal endoscopy confirmed persistent dorsal displacement of the soft palate. Persistent frenulum of the epiglottis, confirmed by oral endoscopic examination, was transected.Results— After surgery, all foals had the epiglottis positioned normally, dorsal to the soft palate. Clinical signs of oronasal reflux resolved by the second nursing attempt in 3 foals, whereas this was difficult to assess in one foal that was nursed intermittently because of the mares behavior. This foal died 2 days later. The other 3 foals have had normal epiglottic function for 2–4 years.Conclusions— Persistent frenulum of the epiglottis should be considered in foals with oronasal reflux from birth. With appropriate medical and surgical management the prognosis for resolution should be good.
Unfolding free energy of a two-domain transmembrane sugar transport protein
Authors: Findlay Heather E. , Rutherford Nicholas G. , Henderson Peter J. F. , Booth Paula J. 
Published: October 2010

Understanding how an amino acid sequence folds into a functional, three-dimensional structure has proved to be a formidable challenge in biological research, especially for transmembrane proteins with multiple alpha helical domains. Mechanistic folding studies on helical membrane proteins have been limited to unusually stable, single domain proteins such as bacteriorhodopsin. Here, we extend such work to flexible, multidomain proteins and one of the most widespread membrane transporter families, the major facilitator superfamily, thus showing that more complex membrane proteins can be successfully refolded to recover native substrate binding. We determine the unfolding free energy of the two-domain,
Escherichia coli
galactose transporter, GalP; a bacterial homologue of human glucose transporters. GalP is reversibly unfolded by urea. Urea causes loss of substrate binding and a significant reduction in alpha helical content. Full recovery of helical structure and substrate binding occurs in dodecylmaltoside micelles, and the unfolding free energy can be determined. A linear dependence of this free energy on urea concentration allows the free energy of unfolding in the absence of urea to be determined as +2.5 kcal·mol
-1
. Urea has often been found to be a poor denaturant for transmembrane helical structures. We attribute the denaturation of GalP helices by urea to the dynamic nature of the transporter structure allowing denaturant access via the substrate binding pocket, as well as to helical structure that extends beyond the membrane. This study gives insight into the final, critical folding step involving recovery of ligand binding for a multidomain membrane transporter.
The Dynamics of Informal Responses to Covariate Shocks
Authors: Balgah R. A. , Buchenrieder G. 
Published: October 2010

ABSTRACTMicroeconomic theory suggests differential resilience of formal and informal instruments to natural and man-made shocks. Informal risk instruments effective in managing idiosyncratic risks are predicted to collapse in the wake of covariate shocks. This position leads to two hypotheses:
Integrated Cerebral Protection Combined Antegrade and Retrograde Cerebral Perfusion during Deep Hypothermic Circulatory Arrest
Authors: Gammie James S. , Landree Britney , Griffith Bartley P. 
Published: October 2010

Objective Aortic arch surgery requires temporary interruption of cerebral perfusion. Hypothermic circulatory arrest (HCA) is an established method of central nervous system protection for limited periods of absent cerebral blood flow. Adjuncts to increase the safe duration of circulatory arrest include either retrograde cerebral perfusion (RCP) or antegrade cerebral perfusion (ACP), with most complex aortic operations now performed using HCA with ACP. We reasoned that optimal cerebral protection might be achieved with a combination of ACP and RCP (integrated brain protection) and present an early clinical experience that supports this approach. Methods The integrated brain protection strategy included sequential overlapping periods of RCP, ACP, and RCP during HCA. Moderate systemic hypothermia (25°C) was used. Patient data were gathered through retrospective chart review. Results Between 2008 and 2009, six consecutive patients underwent ascending aortic graft replacement for acute type A dissection using HCA and integrated brain protection. The mean minimum systemic temperature was 22.9 ± 1.8°C, the mean total HCA time was 34 ± 5 minutes, and the mean duration of ACP and RCP was 22 ± 6 and 7 ± 5 minutes, respectively. Patients were awake and followed commands 10.1 ± 3.4 (range, 5–13) hours after operation, and there was no evidence of temporary neurologic dysfunction. There was no operative mortality. Conclusions Integrated brain protection using both RCP and ACP during HCA is a promising approach for the safe performance of complex aortic surgery and is worthy of evaluation in larger clinical series.
Peripheral Insertion Techniques for the Impella 5.0 Circulatory Support System
Authors: Bashir Jamil , Klas Matt , Cheung Anson 
Published: October 2010

Objective The Impella 5.0 is a peripherally inserted short-term left ventricular assist device. It is typically inserted through a large peripheral artery such as the common femoral artery. We describe both a graft technique and a purse-string technique in detail. Methods In the course of introducing this technology to our hospital, we independently developed two techniques for the insertion of the device. These novel insertion techniques are different from those described by the manufacturer. Results The techniques described have distinct advantages that may be helpful to physicians inserting the device. Common areas of difficulty with insertion of the device and solutions to these problems are also described. Conclusions Insertion techniques for the Impella 5.0 are described in detail.
A simulation‐based evaluation of two proposed alternatives to Luer devices for use in neuraxial anaesthesia*
Authors: Cook T. M. , Payne S. , Skryabina E. , Hurford D. , Clow E. , Georgiou A. 
Published: October 2010

SummaryThe National Patient Safety Agency has issued a Patient Safety Alert with the aim of eliminating Luer connectors from equipment for lumbar puncture and subarachnoid injections by 1 April 2011, and from all neuraxial and regional anaesthesia equipment in 2013. B‐link (UK) Ltd and InterVene Ltd have produced non‐Luer connectors for neuraxial devices: the Neurax® and Spinalok® respectively. Using an adult spinal simulator, 59 experienced clinicians performed neuraxial procedures using these devices and reported on specific performance characteristics and overall usability. Cross‐connectivity between non‐Luer and Luer connectors was also examined. The median (IQR [range]) overall assessment scores (0–10 scale) of usability for the standard, Neurax and Spinalok systems were 8 (8–9 [7–10]), 6 (5–7 [0–8]) and 7 (6–8 [1–9]) for spinal procedures and 8 (8–9 [6–10]), 7 (5–8 [1–9]) and 4 (3–6 [0–9]) for epidural procedures, respectively. Both study systems scored significantly lower than standard equipment for overall performance of spinal and epidural procedures, although the performance of non‐Luer devices was mostly rated ‘adequate’ or better. Both non‐Luer connectors could cross‐connect with one or more Luer connectors. Following feedback to the manufacturers, both systems have been modified and cross‐connectivity apparently has been eliminated. Our results indicate that clinicians may not find non‐Luer devices immediately ‘user‐friendly’. More importantly, some cross‐connectivity with Luer devices was possible. Our findings illustrate that introducing equipment that is fully compliant with the National Patient Safety Agency alert poses a significant challenge to manufacturers and clinicians. We conclude that before introducing any non‐Luer device into widespread use, independent, formal evaluation should be carried out.
Ocean distribution and habitat associations of yearling coho (Oncorhynchus kisutch) and Chinook (O. tshawytscha) salmon in the northern California Current
Authors: PETERSON WILLIAM T. , MORGAN CHERYL A. , FISHER JOSEPH P. , CASILLAS EDMUNDO 
Published: October 2010

AbstractYearling juvenile coho and Chinook salmon were sampled on 28 cruises in June and September 1981–85 and 1998–07 in continental shelf and oceanic waters off the Pacific Northwest. Oceanographic variables measured included temperature, salinity, water depth, and chlorophyll concentration (all cruises) and copepod biomass during the cruises from 1998–07. Juvenile salmonids were found almost exclusively in continental shelf waters, and showed a patchy distribution: half were collected in ∼5% of the collections and none were collected in ∼40% of the collections. Variance‐to‐mean ratios of the catches were high, also indicating patchy spatial distributions for both species. The salmon were most abundant in the vicinity of the Columbia River and the Washington coast in June; by September, both were less abundant, although still found mainly off Washington. In June, the geographic center‐of‐mass of the distribution for each species was located off Grays Harbor, WA, near the northern end of our sampling grid, but in September, it shifted southward and inshore. Coho salmon ranged further offshore than Chinook salmon: in June, the average median depth where they were caught was 85.6 and 55.0 m, respectively, and in September it was 65.5 and 43.7 m, respectively. Abundances of both species were significantly correlated with water depth (negatively), chlorophyll (positively) and copepod biomass (positively). Abundances of yearling Chinook salmon, but not of yearling coho salmon, were correlated with temperature (negatively). We discuss the potential role of coastal upwelling, submarine canyons and krill in determining the spatial distributions of the salmon.
Differential expression of odorant receptor genes involved in the sexual isolation of two Heliothis moths
Authors: Vásquez G. M. , Fischer P. , Grozinger C. M. , Gould F. 
Published: October 2010

AbstractMoth sexual communication systems are highly diverse, but the mechanisms underlying their evolutionary diversification remain unclear. Recently, genes coding for odorant receptors (ORs) OR6, OR14, OR15 and OR16 have been genetically associated with species‐specific male response to female pheromone blends in Heliothis virescens (Hv) and Heliothis subflexa (Hs). Quantitative real‐time PCR analysis indicates that expression of HvOR6, HsOR6, HvOR14, HsOR14, HvOR15 and HsOR15 is male biased, which supports the hypothesis that they have a role in mediating female sex pheromone detection. The genes HvOR14, HvOR15 and HvOR16 are expressed at higher levels than their corresponding orthologues HsOR14, HsOR15 and HsOR16 in male antennae, while HvOR6 and HsOR6 transcripts are equally abundant in male antennae. The lack of higher expression of any of the receptor genes in H. subflexa antennae suggests that interspecific sequence differences, rather than gene regulation differences, underly the species‐specific male response to pheromone components.
Nurses’ medication work: what do nurses know?
Authors: Folkmann Louise , Rankin Janet 
Published: October 2010

Aims.  The aim of this study is to provide an overview of the way that medication work is conceptualised in the literature and introduce a cautionary note into the enthusiasm with which nurses’ medication work is currently being reformed.Background.  This article is an overview outlining how nurses’ medication work is discursively organised and known about authoritatively. There is a great deal of safety and coordination work that nurses undertake in relation to the ‘task’ of administering medications that remains hidden and misunderstood in the dominant ways that knowledge about medication administration is structured. Technological innovations are eagerly embraced, but we posit that these strategies may be having an impact on nursing work with medications in unknown and potentially deleterious ways. We develop a critical analysis of the discursively limiting frameworks of biomedical science, law, management and safety through which nurses’ medication practices are currently framed. This analysis provides insight into the ideologies and power relations that are taken up by nurses. The analytic work presented here informs an institutional ethnographic study that, at the time of this publication, is currently in the first stage of data collection. The study promises to contribute new knowledge about medication work as nurses know it.Design.  A discursive paper including a selective critical analysis of the descriptive, theoretical and empirical literature.Methods.  Databases were searched using the keywords medication work, medication administration and medication error.Conclusion.  The enthusiasm with which technological innovations are being introduced must be tempered with equal attention to the impact that this has on nursing work.Relevance to clinical practice.  The way that medication work is conceptualised is constraining and covers over much of what actually happens in everyday nursing practice. Technological innovations change practice, often in unintended or unknown ways. Explicating the actuality of medication work offers an enhanced understanding and allows nurses to appraise critically the ways their work has been transformed.
Factors which influence nurse practitioners ability to carry out physical examination skills in the clinical area after a degree level module – an electronic Delphi study
Authors: McElhinney Evelyn 
Published: October 2010

Aims and objectives. The aim of the study was to identify the factors that influence nurse practitioners ability to practice physical examination skills in the clinical area.Background. The changing health care needs of the population require new ways of working for many health professionals. Physical examination (core skills of inspection, palpation, percussion and auscultation) of patients is a fairly new role for nurses in secondary care in the United Kingdom. However, implementing new roles in the clinical area can be challenging for the practitioners involved, and several factors have been identified which are seen to help or hinder their success.Design. A Delphi study was undertaken using blind copy email over six weeks in 2008.Method. The participants included a purposive sample of 21 nurses from 10 clinical areas who had completed a degree level module in physical examination as part of a nurse practitioner pathway.Results. This study generated valuable opinion of factors that can help or hinder the ability of nurses to practice physical examination in the clinical area. The results highlight the importance of individual self‐confidence, role clarity, effective educational preparation and support from other disciplines to the nurse practitioners ability to carry out this new role.Conclusion. Several factors reported by the participants concur and add to factors reported in previous studies of new role implementation. There appears to be a continued need for clear job descriptions, role clarity, authority and autonomy to practice for nurse practitioners undertaking physical examination.Relevance to clinical practice. Physical examination knowledge and skills are part of the role of nurse practitioners. This study highlights several factors which need to be addressed to ensure practitioners are able to carry out this new role on return to the clinical area.
Depression among Chinese stroke survivors six months after discharge from a rehabilitation hospital
Authors: Chau Janita P‐C , Thompson David R , Chang Anne M , Woo Jean , Twinn Sheila , Cheung Sze K , Kwok Timothy 
Published: October 2010

Aim and objective.  The primary aim was to examine the prevalence of poststroke depression in Chinese stroke survivors six months after discharge from a rehabilitation hospital. A second aim was to determine whether six‐month poststroke depression was associated with psychological, social and physical outcomes and demographic variables.Background.  There has been increasing recognition of the influence of depression on poststroke recovery. While some previous studies report associations between depression and social, psychological, physical and clinical outcomes, few studies had sufficient sample sizes for regression analysis thereby limiting the clinical applicability of their findings.Design.  A cross‐sectional design was used.Method.  Data were collected from 124 male and 86 female stroke survivors (mean age 71·7, SD 10·2 years). The Geriatric Depression Scale was used to measure depression, the State Self‐esteem Scale to measure state self‐esteem, the London Handicap Scale to measure participation restriction, the Social Support Questionnaire to measure satisfaction with social support and the Modified Barthel Index to measure functional ability.Results.  Forty‐two survivors (20·5%) reported mild and 33 (16·1%) reported severe depression. The presence of depression was associated with low levels of state self‐esteem, social support satisfaction and functional ability. Logistic regression analysis revealed that these variables were statistically significant in predicting the probability of having depression (p < 0·05).Conclusions.  Analyses in the present study revealed distinct patterns of correlates of depression, and the results were in agreement with prior studies that depression has a consistent positive association with physical disability, living arrangements and social support and no significant association with the different types of brain lesion.Relevance to clinical practice.  There is a need, routinely, to assess stroke survivors for depression and, where necessary, to intervene with the aim of enhancing psychological and social well‐being.
A critical review of the literature on early rehabilitation of patients with post‐traumatic amnesia in acute care
Authors: Langhorn Leanne , Sorensen Jens C , Pedersen Preben U 
Published: October 2010

Aims and objectives.  To identify the effect of early rehabilitation of patients with post‐traumatic amnesia in patients with traumatic brain injury, to review and critically assess evidence related to the timing of intervention and to identify the effect on outcome of a specific neurological rehabilitation in acute care.Background.  Up to 70% of patients with traumatic brain injury will experience post‐traumatic amnesia. Although duration of post‐traumatic amnesia is correlated negatively with outcome for patients with traumatic brain injury, there is limited evidence relating to what influence timing and effect may have on enhancing early rehabilitation patient outcomes.Design.  A critical literature review.Methods.  Searches for systematic reviews were undertaken in Medline, CINAHL, Cochrane, PSYC INFO and Neurotraume databases. The efficacy of intervention and timing was classified based on a hierarchy of study designs for questions about health care interventions based on soundness of design.Results.  Six reviews and 11 original studies were included and comprised the review. Many studies used weak designs and small sample size, thus limiting their ability to control confusing variables and outcomes. Few studies included papers with the information about timing and effect of early post‐traumatic amnesia intervention. Only one study showed an effect of a reality orientation programme in acute care. Although there was no significant detail reported on the possibility of reducing the post‐traumatic amnesia period, the study showed clinical relevance.Conclusion.  This review highlights the limited evidence of the effect of early rehabilitation of patients with post‐traumatic amnesia. Future research should be conducted to identify the effectiveness of early intervention.Relevance to clinical practice.  Although nurses are treating patients with post‐traumatic amnesia without systematic assessment, the limited evidence available does little to direct nurses as to the best approach to start early rehabilitation of post‐traumatic amnesia to promote good outcomes.
Predictors of disability in Taiwanese patients with rheumatoid arthritis
Authors: Lee Hui‐Chen , Tsai Yun‐Fang , Luo Shue‐Fen , Tsay Pei‐Kwei 
Published: October 2010

Aim.  The purpose of this study was to explore predictors of disability in patients with rheumatoid arthritis in Taiwan.Background.  Rheumatoid arthritis is a chronic inflammatory disease affecting mainly the joints. However, little information is currently available on the disability of Asian patients with rheumatoid arthritis.Design.  Cross‐sectional survey.Method.  Patients (150) were recruited by convenience sampling from those regularly visiting rheumatologic outpatient clinics at three teaching hospitals and a medical centre in northern Taiwan. Data were collected on demographic and disease‐related characteristics, depressive tendency, pain and disability using a basic patient‐information form, the Center for Epidemiological Survey Depression Scale, Chinese version of the Brief Pain Inventory‐short form and the Chinese version of the Health Assessment Questionnaire, respectively.Results.  Our sample had moderate pain severity (Mean = 4·32, SD 1·68) and pain disturbance (Mean = 3·49, SD 2·15). The mean disability score was 0·61 (SD 0·66), representing mild disability. Regression analysis revealed that patients’ disability was significantly predicted by disease stage (stage IV, III, or II), depressive tendency, duration of disease and education level (primary school), explaining 79·2% of the total variance in disability.Conclusion.  The results of this study not only provide clinicians with predictive information of disability from rheumatoid arthritis, but also help them take suitable action on patients’ depressive status according to their disability condition.Relevance to clinical practice.  The controllable predictor of disability in this study was depressive tendency. Thus, the authors recommend that clinicians regularly screen patients with rheumatoid arthritis for depressive tendency and teach self‐care methods to minimise depressive symptoms.