bluuebunny/crossref_metadata_2025_split huggingface dataset:
CA9 level in renal cyst fluid: a possible molecular diagnosis of malignant tumours
Authors: Li Guorong , Feng Gang , Cuilleron Muriel , Zhao An , Gentil‐Perret Anne , Cottier Michèle , Genin Christian , Tostain Jacques 
Published: May 2009

Aims:  The preoperative differentiation of malignant renal cystic tumours from benign lesions is critical, and it remains a common diagnostic problem. The aim was to examine if the Carbonic anhydrase 9 (CA9) level in cyst fluid can provide a molecular diagnosis of malignant cyst.Methods and results:  Twenty‐eight patients with a cystic renal mass were included. Fine‐needle aspiration was performed to obtain the fluid. Postoperative pathology confirmed that there were 16 cystic renal cell carcinomas. Twelve benign cystic tumours were used as controls. One hundred microlitres of supernatant of cyst fluid was used to measure the CA9 protein level, which was measured by an enzyme‐linked immunosorbent assay technique. CA9 was strongly detected and considered as positive in the cyst fluid of all 16 cystic malignant tumours (>1000 pg/ml), whereas its expression was negative in 11/12 benign cystic tumours (<300 pg/ml). The difference in percentages of positive CA9 between malignant and benign renal cystic tumours was significant (P < 0.001).Conclusion:  The fluid of malignant cystic renal tumours contains a high level of CA9 protein. The measurement of CA9 level in cyst fluid may be used as a molecular diagnosis for differentiation between malignant and benign renal cystic masses.
Exploring the relationship between skin property and absorbent pad environment
Authors: Shigeta Yoshie , Nakagami Gojiro , Sanada Hiromi , Oba Miho , Fujikawa Junko , Konya Chizuko , Sugama Junko 
Published: May 2009

Aim.  The aim of this study is to identify the related factors of skin lesions found in the surrounding environment of absorbent pads by clinical investigation.Background.  Most older patients with incontinence use absorbent products, therefore causing many patients to have skin lesion in the absorbent pad area. To prevent these skin lesions from occurring, it is necessary to examine the absorbent pad environment of clinical patients since there are many contributing factors that complicate the pathophysiology in this area.Design.  A cross‐sectional design was used.Methods.  One hundred older Japanese patients with faecal and/or urinary incontinence using diapers and absorbent pads participated. Excluding blanchable erythema, the presence of skin lesions in the absorbent pad area was confirmed. Skin pH, hydration level and bacterial cultures were used to assess the skin property. Absorbent pad environment and patient demographics were also investigated.Results.  The overall prevalence of skin lesions was 36%. Forty percent of the skin lesions were contact dermatitis. Multivariate logistic regression analysis revealed that only the presence of diarrhoea independently affected contact dermatitis.Conclusion.  There was a significant relationship between contact dermatitis and the use of absorbent pads when the patient had diarrhoea. Although the factors related to skin lesions in the absorbent pad area are complexly intertwined, this study was the first to be able to determine diarrhoea as one specific factor in clinical setting.Relevance to clinical practice.  This finding suggests that the presence of diarrhoea is significantly related with contact dermatitis. Therefore, when a patient has diarrhoea, health‐care professionals should immediately implement a preventative care program which includes careful skin observation and improved skin care. It is also necessary to develop a more effective absorbent pad to protect the skin of incontinent patients who suffer from the irritating effects of liquid stool.
Delivering ‘Gold Standards’ in end‐of‐life care in care homes: a question of teamwork?
Authors: Hewison Alistair , Badger Frances , Clifford Collette , Thomas Keri 
Published: May 2009

Aim.  This paper reports findings from a study which investigated the introduction of the Gold Standards Framework for improving end‐of‐life care into care homes in England.Background.  The Gold Standards Framework was developed in primary care to improve the care provided for people at the end‐of‐life. Following its successful introduction to this setting it was adapted and implemented in care homes.Design.  A case study approach was appropriate for this study of a care programme into a ‘real life’ setting.Method.  Fourteen managers participated in an initial telephone interview. Ten of these homes participated in the case study phase and 61 staff participated in individual or group interviews. Seven residents and three relatives participated in face to face interviews. Qualitative data were analysed in line with the template approach. Survey data were also analysed and a validated Teamworking Questionnaire was used.Results.  It was found that teamwork is central to the successful introduction of the Gold Standards Framework in Care Homes. Good staffing levels and management support were also perceived to be key factors in homes where the Framework became established.Conclusion.  Effective teamwork was necessary for changes in end‐of‐life care to be achieved in the care homes. If end‐of‐life care and other improvements in practice are to continue, teamwork will need to be supported and developed.Relevance to clinical practice.  Effective teamwork appears to be a pre‐requisite for successful implementation of new programmes of care. Organisations wishing to implement such programmes should assess the quality of teamwork and may need to address this first.
Developing relationships in long term care environments: the contribution of staff
Authors: Wilson Christine Brown , Davies Sue 
Published: May 2009

Aims and objectives.  The aim of this study was to consider how relationships in care homes influence the experience of older people, their families and staff. The main objective reported in this paper considers how these relationships are developed and the contribution that staff make to this process through the routines of care.Background.  Relationships have been found to be integral to experiences of residents, families and staff in care homes but little is known about how these relationships develop. Few studies consider relationships in care homes as their main focus and there is a dearth of studies that consider relationships from the perspective of residents, families and staff within the same care home.Design.  The study employed a constructivist design where the different perspectives held by participants were explored and shared to develop a joint construction of how relationships influenced their experiences.Methods.  Data were collected from three care homes in England over two years between 2003–2005. Participant observation and interviews enabled a hermeneutic circle to be created between residents, families and staff. Data collection and analysis were conducted concurrently using a constant comparative method.Results.  Staff adopted three approaches to care delivery and these influenced the type of relationships that were developed between residents, families and staff. The three approaches were described as individualised task‐centred, resident‐centred and relationship‐centred.Conclusion.  This study progresses our understanding of the development of relationships between staff, residents and families in care homes by considering how the staff may support or constrain these relationships through their approach to care delivery.Relevance to clinical practice.  These findings have implications for developing practice in care homes to improve the experience of older people and their families by encouraging staff to develop a relationship‐based approach to care routines.
Family experience of waiting for living donor liver transplantation: from parental donor perspective
Authors: Chou Chu‐Yi , Chen Yu‐chih , Chen Chao‐Long , Chen Jo‐Lin , Mu Pei‐Fan 
Published: May 2009

Aims and objectives.  The aim of this study was to investigate from the perspectives of the donor parents of children with biliary atresia, the essence of family experiences during the period when waiting for a living donor liver transplant.Background.  Living donor liver transplantation is a new hope for children and families when the child suffers from biliary atresia. It is obvious, during the waiting period, for a family with a child undergoing living donor liver transplantation, that the process has a serious impact and there is a need for them to be well‐prepared.Design.  A descriptive phenomenological design was used in this study.Methods.  Nine donor parents from a medical centre in Taiwan participated in this study. The inclusion criteria were that the parent had a child with biliary atresia, that the child had received living donor liver transplantation over the last year and a half and that the parent was the living donor for child’s liver transplantation. An open in‐depth interview technique encouraged the parents to reflect on their experiences as the process raised their feelings to a conscious level. The data were analysed using the Colaizzi’s approach.Results.  This study explores the essence of families undergoing the waiting period for living donor liver transplantation surgery from the point of view of the donating parents. Five themes emerged: (1) surgery as hope of rebirth, (2) negotiating the decision to have surgery, (3) the selection of the donor to achieve family welfare, (4) preparing and planning for the surgery and (5) worry over the impact of the surgery.Conclusions.  The results demonstrate that the parents’ experiences included a variety of domains: hope of rebirth, mental negotiation while deciding on surgery and choice of donor, coping with the preparation for surgery and the possible impact on the family of the surgery.Relevance to clinical practice.  The findings indicated that nursing professionals should provide family‐centred care to assist the family with the steps needed to move toward surgery.
Identifying trajectories of birth‐related fatigue of expectant fathers
Authors: Tzeng Ya‐Ling , Teng Yu‐Kuei , Chou Fan‐Hao , Tu Hsiu‐Chin 
Published: May 2009

Aims and objectives.  The objectives of this prospective study were to identify birth‐related fatigue trajectories in expectant fathers with the progress of labour and the physiological, psychological and situational factors related to specific trajectory patterns.Background.  An increasing number of fathers participate in their partner’s labour; however, their fatigue experience remains unclear. Previous studies have focused on overall groups without considering the possibility of between‐subject heterogeneity. With an advanced data‐analytic strategy, it is feasible to identify subgroup variation within the population over time.Design.  A prospective, repeated measures design was used.Method.  A convenience sample of 108 Taiwanese expectant fathers was followed throughout the labour process. Data were collected by visual analogue scales and self‐administered questionnaires. The repeated measures of fatigue were analysed by using semi‐parametric, group‐based modelling.Results.  Two distinct groups of individual trajectories among the expectant fathers were identified; the persistent low‐fatigue group (49·2%) and the persistent high‐fatigue group (50·8%). After birth, a moderate level of fatigue persisted in the high‐fatigue group. The fastest period of increasing level in the persistent high‐fatigue group was in the latent phase. The persistent high‐fatigue group also experienced significantly more sleep difficulties prior to labour and more anxiety than the persistent low‐fatigue group.Conclusions.  Identifying and characterising meaningful clusters of trajectories could provide a better understanding of the birth‐related fatigue experience of fathers and contributes to recognising the target client and timing for early intervention.Relevance to clinical practice.  There are points in time at which professional caregiver actions may have an effect on the birth‐related fatigue of fathers. Caregivers should prevent high levels of fatigue, which could accumulate as fathers accompany the women entering the labour phase. Fathers who present with high fatigue at onset of labour should receive early intervention, especially in the rapid‐increasing fatigue period.
Assessing predictive validity of the modified Braden scale for prediction of pressure ulcer risk of orthopaedic patients in an acute care setting
Authors: Chan Wai Shan , Pang Samantha Mei Che , Kwong Enid Wai Yung 
Published: May 2009

Aims and objectives.  To assess and compare the predictive validity of the modified Braden and Braden scales and to identify which of the modified Braden subscales are predictive in assessing pressure ulcer risk among orthopaedic patients in an acute care setting.Background.  Although the Braden scale has better predictive validity, literature has suggested that it can be used in conjunction with other pressure ulcer risk calculators or that some other subscales be added. To increase the predictive power of the Braden scale, a modified Braden scale by adding body build for height and skin type and excluding nutrition was developed.Design.  A prospective cohort study.Method.  A total of 197 subjects in a 106‐bed orthopaedic department of an acute care hospital in Hong Kong were assessed for their risk for pressure ulcer development by the modified Braden and Braden scales. Subsequently, daily skin assessment was performed to detect pressure ulcers. Cases were closed when pressure ulcers were detected.Results.  Out of 197 subjects, 18 patients (9·1%) developed pressure ulcers. The area under the receiver operating characteristic curve for the modified Braden scale was 0·736 and for the Braden scale was 0·648. The modified Braden cut‐off score of 19 showed the best balance of sensitivity (89%) and specificity (62%). Sensory perception (Beta = −1·544, OR=0·214, p = 0·016), body build for height (Beta = −0·755, OR = 0·470, p = 0·030) and skin type (Beta = −1·527, OR = 0·217, p = 0·002) were significantly predictive of pressure ulcer development.Conclusion.  The modified Braden scale is more predictive of pressure ulcer development than the Braden scale.Relevance to clinical practice.  The modified Braden scale can be adopted for predicting pressure ulcer development among orthopaedic patients in an acute care setting. Specific nursing interventions should be provided, with special attention paid to orthopaedic patients with impaired sensory perception, poor skin type and abnormal body build for height.
Identification of ‘hot spots’ of obesity and being underweight in early pregnancy in Liverpool
Authors: Abayomi J. C. , Watkinson H. , Boothby J. , Topping J. , Hackett A. F. 
Published: May 2009

AbstractBackground: Obesity and being underweight in pregnancy are related to an increased risk of maternal and foetal morbidity, yet their prevalence is often unknown. The present study aimed to identify neighbourhoods with a higher than average prevalence or ‘hot spots’ of obesity and/or being underweight among first trimester pregnant women.Methods: A database was compiled consisting of postcode, height and weight for 7981 women who had booked‐in for antenatal care between July 2004 and June 2005 at Liverpool Women’s Hospital. Body mass index (BMI) was calculated and women were categorised accordingly. Postcodes for 6865 cases across Merseyside were converted to geolocations (pin‐points on a map) using conversion software (http://www.census.ac.uk/cdu/).Results: There was a very high prevalence of being overweight (27%) and obesity (17%); 3.8% of women were underweight and probably malnourished (BMI < 18.5 kg m−2); and a further 10.7% of women were possibly malnourished (BMI < 20.0 kg m−2. Deriving case density from the geolocations allowed visualisation and identification of six neighbourhoods with above average levels of obesity and three neighbourhoods had marked concentrations of both being underweight and obesity.Conclusions: These neighbourhoods, particularly those identified as ‘hot spots’ for both being underweight and obesity, include some of the most deprived wards in the UK. As dietetic intervention may help to promote optimal weight gain during pregnancy and improve dietary intake for pregnant women and their families, primary health care providers should target these localities with a high prevalence of low and high BMI as a priority.
Moving beyond policy rhetoric: building a moral community for early psychosis intervention
Authors: WILSON J. HAMILTON 
Published: May 2009

Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. Margaret MeadIt has been my privilege to work in partnership with hundreds of patients experiencing emergent psychosis, in Hamilton, Ontario during the course of my lengthy nursing career. Indeed, the knowledge I have gleaned from both the courageous individuals who have experienced serious mental illness and their resilient families has been monumental. When I first began my career, I was utterly naïve and most certainly held the misguided assumption that to be a mental health nurse required an adherence to a strict set of nursing principles and that the nurse–patient relationship was approached from an objective and ‘safe’ distance. Reflecting on this now, many years later I understand that the therapeutic relationship between nurses and those they serve is foundational to the delivery of safe and ethical mental health care. Although increasingly clinical practice guidelines and evidence‐based interventions serve to inform nursing practice, in my mind it is the embodied experience of relationship that is the real instrument of healing and transformation. Recognizing that early intervention provides an unprecedented opportunity to begin anew with young patients who have no prior experiences with the mental health care system, the purpose of this paper is to serve as a vehicle for discussion and potentially inspire a group of thoughtful, committed nurses to change the world of mental health services by creating a respectful moral community. I propose that relational ethics form the values and ideals of a fully humane early psychosis intervention community in Ontario. Using the foundational tenets of the nurse–patient relationship illustrated through the use of a clinical narrative, I will suggest ways that nurses can proactively take up the early intervention challenge and contribute to an overall culture of optimism and hope. Intervening early is simply not enough. We must first commit to developing comprehensive recovery‐oriented treatments in a coordinated and thoughtful way.
MzrA: a novel modulator of the EnvZ/OmpR two‐component regulon
Authors: Gerken Henri , Charlson Emily S. , Cicirelli Elisha M. , Kenney Linda J. , Misra Rajeev 
Published: May 2009

SummaryAnalysis of suppressors that alleviate the acute envelope stress phenotype of a ΔbamBΔdegP strain of Escherichia coli identified a novel protein MzrA and pleiotropic envZ mutations. Genetic evidence shows that overexpression of MzrA – formerly known as YqjB and EcfM – modulates the activity of EnvZ/OmpR similarly to pleiotropic EnvZ mutants and alter porin expression. However, porin expression in strains devoid of MzrA or overexpressing it is still sensitive to medium osmolarity, pH and procaine, all of which modulate EnvZ/OmpR activities. Thus, MzrA appears to alter the output of the EnvZ/OmpR system but not its ability to receive and respond to various environmental signals. Localization and topology experiments indicate that MzrA is a type II membrane protein, with its N‐terminus exposed in the cytoplasm and C‐terminus in the periplasm. Bacterial two‐hybrid experiments determined that MzrA specifically interacts with EnvZ but not with OmpR or the related membrane sensor kinase, CpxA. This and additional genetic and biochemical evidence suggest that the interaction of MzrA with EnvZ would either enhance EnvZ's kinase activity or reduce its phosphatase activity, thus elevating the steady state levels of OmpR∼P. Furthermore, our data show that MzrA links the two‐component envelope stress response regulators, CpxA/CpxR and EnvZ/OmpR.
Evaluation of essential and variable residues of nukacin ISK‐1 by NNK scanning
Authors: Islam Mohammad R. , Shioya K. , Nagao J. , Nishie M. , Jikuya H. , Zendo T. , Nakayama J. , Sonomoto K. 
Published: May 2009

SummaryNukacin ISK‐1, a type‐A(II) lantibiotic, comprises 27 amino acids with a distinct linear N‐terminal and a globular C‐terminal region. To identify the positional importance or redundancy of individual residues responsible for nukacin ISK‐1 antimicrobial activity, we replaced the native codons of the parent peptide with NNK triplet oligonucleotides in order to generate a bank of nukacin ISK‐1 variants. The bioactivity of each peptide variant was evaluated by colony overlay assay, and hence we identified three Lys residues (Lys1, Lys2 and Lys3) that provided electrostatic interactions with the target membrane and were significantly variable. The ring structure of nukacin ISK‐1 was found to be crucially important as replacing the ring‐forming residues caused a complete loss of bioactivity. In addition to the ring‐forming residues, Gly5, His12, Asp13, Met16, Asn17 and Gln20 residues were found to be essential for antimicrobial activity; Val6, Ile7, Val10, Phe19, Phe21, Val22, Phe23 and Thr24 were relatively variable; and Ser4, Pro8, His15 and Ser27 were extensively variable relative to their positions. We obtained two variants, Asp13Glu and Val22Ile, which exhibited a twofold higher specific activity compared with the wild‐type and are the first reported type‐A(II) lantibiotic mutant peptides with increased potency.
Population of Follicles and Luteal Structures during the Oestrous Cycle of Mares Detected by Three‐Dimensional Internal Structure Microscopy
Authors: Hirano Y. , Kimura J. , Nambo Y. , Yokota H. , Nakamura S. , Takemoto S. , Himeno R. , Mishima T. , Matsui M. , Miyake Y.‐I. 
Published: May 2009

SummaryThe structure of the equine ovary is different from that of other mammals in its extremely large size, the presence of ovarian fossa and the inverted location of its cortex and medulla. A three‐dimensional internal structure microscopy (3D‐ISM), which consists of a computer‐controlled slicer, a CCD camera, a laser disc recorder and a PC, is very useful for the observation of the internal structures in equine ovaries. In addition, the three‐dimensional images of follicles and corpus luteum (CL) reconstructed by the segmentation technique can clarify the spatial arrangement in the equine ovary. In this study, to understand the changes in the ovarian internal structures of the mare during the oestrous cycle, the size and numbers of follicles and luteal structures were analysed by 3D‐ISM in addition to the concentrations of progesterone (P4) and oestradiol‐17β. As a result, many small follicles (<10 mm in diameter) were detected. It was recognized that the luteal structures were distinguished into three types, such as the corpus haemorragicum (CH), which is formed by blood elements at the cavity after ovulation, CL and corpus albican (CA). There were some CHs and CL in the group, which had the concentration of P4 > 1 ng/ml. CHs were also observed in the group, which had low level of P4 (P4 < 1 ng/ml). CAs were found regardless of the P4 level. In conclusion, 3D‐ISM enabled the internal observation of the ovarian structures in detail, and estimation of the stage of the ovarian cycle with complementary physiological information. The findings by 3D‐ISM provide basic information for clinical applications.