bluuebunny/crossref_metadata_2025_split huggingface dataset:
The educator inside the patient: students’ insights into the use of high fidelity silicone patient simulation
Authors: Reid‐Searl Kerry , Eaton Anne , Vieth Lea , Happell Brenda 
Published: August 2011

Aim and objective.  To explore undergraduate nursing students’ experiences of High Fidelity Patient Silicone Simulation.Background.  Use of simulation as an educational tool is rapidly gaining popularity. Simulation provides a safe learning environment and helps overcome difficulties securing sufficient clinical placements. However, several limitations have been identified with this approach, particularly in relation to cost and authenticity.Design.  Exploratory qualitative methodology informed the development of knowledge in this under‐researched area.Methods.  Focus group interviews were conducted with 21 nursing students and first year graduates. Participants had experienced High Fidelity Patient Silicone Simulation during the program. This involved their lecturer simulating a patient by adopting mannerisms and behaviours of a person, based on a predeveloped character and using masks and appropriate clothing to establish the visual image of a simulated patient. Thematic analysis was undertaken to identify main areas of interest to participants.Results.  Two main themes are reported in this paper: ‘realism of the character’ and ‘skills of the teacher’. Characters presented to students were viewed as realistic which enabled participants to engage with the character and take the process seriously. Knowledge and skill of the teacher was used to direct student learning experience and maximise learning benefits to be gained.Conclusion.  High Fidelity Patient Silicone Simulation was perceived by student participants as a highly effective teaching tool. Participants found the experience positive and believe it impacted on the quality of learning experiences.Relevance to clinical practice.  Clinical experience is necessary for the development of safe and competent registered nurses. Simulation has been acknowledged as a useful adjunct to clinical experience, particularly when placements are limited. High Fidelity Patient Silicone Simulation may be used to promote realism, enhance student learning and contribute to an increase in clinical competence and confidence in nursing students.
Calm, irritated or infected? The experience of the inflammatory states and symptoms of pin site infection and irritation during external fixation: a grounded theory study
Authors: Santy‐Tomlinson Julie , Vincent Maria , Glossop Nicola , Jomeen Julie , Pearcey Patricia 
Published: August 2011

Aim.  To explore patients’ experiences of the symptoms of suspected wound infection in external fixator pin sites.Background.  Pin site infection is painful and distressing and can threaten the success of treatment. It is difficult for patients and clinicians to differentiate between pin site infection and irritation or foreign body reaction to the pin. There is no validated outcome measure for infection that enables the success of interventions for prevention and management to be evaluated. There is a need to develop accurate patient‐orientated assessment criteria.Design.  Qualitative design, using grounded theory.Method.  Following written informed consent, a theoretical sample of 16 adults with an external fixation device that had been in situ for at least 12 weeks was recruited. They had experienced a pin site infection in the previous four weeks. Data were collected using semistructured interviews, and data collection was stopped when saturation was achieved. Analysis took place using constant comparative analysis.Results.  Participants described three ‘clinical states’ of pin site wounds: calm, irritated and infected. They described the differences in each state in relation to pain, redness, swelling, discharge and general symptoms. Symptoms were absent or varied in intensity depending on whether the pin sites were calm, irritated or infected.Conclusion.  This study provides insight into patients’ experiences of the symptoms of pin site infection resulting in an emerging theory based on conceptualisation of this experience, which is that of dimensions of inflammatory pin site states. The detail given will enable clinicians and researchers to be more accurate in recognising infection and begins to clarify the difference between a wound that is irritated and a wound that is infected. The findings will enable the development of a patient‐orientated outcome questionnaire for pin site infection.Relevance to clinical practice.  There is a need for patients and clinicians to be able to differentiate between infected, not infected and irritated pin sites.
The effects of a sacrococcygeal pilonidal sinus wound on activities of living: thematic analysis of participant interviews
Authors: Stewart Ann M , Baker Jacqueline D , Elliott Doug 
Published: August 2011

Aims and objective.  To describe the effects sacrococcygeal pilonidal sinus wounds had on participants’ activities of living.Background.  A sacrococcygeal pilonidal sinus commonly occurs in healthy young people and is associated with considerable morbidity and discomfort. Surgery is frequently required, and patients are often discharged home with large open wounds. Most research has addressed the technical aspects of surgery and treatment.Design.  An interpretive descriptive approach guided by The Model of Living framework.Methods.  Purposive sampling was used to recruit four women and seven men, age range 17–39 years, from a metropolitan hospital in NSW, Australia. Data were collected through semi‐structured interviews that were audio‐taped, transcribed verbatim and analysed using thematic analysis.Results.  Three themes and eight subthemes emerged from the analysis: (1) ‘Adaption’ included subthemes, learning to live with the wound, difficulty living with the wound and living life despite the wound; (2) ‘Perception’ embraced subthemes, embarrassment, lack of understanding and changed body image; and (3) ‘Control’ included subthemes, loss of control and gaining control. Participants whose pain was not managed, who were unprepared for the postoperative recovery at home or experienced delayed wound healing had most difficulty with activities of living.Conclusions.  This research gives some insight into the pilonidal wound experience from the person’s perspective. All activities of living were affected by the pilonidal sinus wound. The effect was variable and influenced by pain, embarrassment and a general lack of understanding about the condition and the care of the wound. The specific wound location was an underlying factor causing problems for participants.Relevance to clinical practice.  Individualised care will help in reducing discomfort and improving life experiences following surgery. Patients who are prepared for the postoperative recovery at home, have adequate analgesia and do not experience delayed wound healing are more likely to manage activities of living.
Plasticity in leaf and stem nutrient resorption proficiency potentially reinforces plant–soil feedbacks and microscale heterogeneity in a semi‐arid grassland
Authors: Lü Xiao‐Tao , Freschet Grégoire T. , Flynn Dan F. B. , Han Xing‐Guo 
Published: August 2011

Summary1. The potential resorption of substantial amounts of nutrients from all vegetative organs of plants has large implications for the plant nutrient economy and for biogeochemical cycles. So far, most studies have focused on leaf nutrient resorption only. Besides, while evidence is growing that soil fertility changes impact on leaf nutrient resorption at a large spatial scale, hardly anything is known of such coupling at a small spatial scale.2. Here we show that nitrogen (N) in culms of four dominant grasses of northern Chinese steppes contributed from 17% to 36% to the total pool of N resorbed from above‐ground senescing parts and accounted for 25–52% of above‐ground litter N. These results demonstrate the tremendous importance of non‐leaf organs for plant nutrient economy and ecosystem nutrient cycling.3. More importantly, we found that even microscale variations in resource availability (soil inorganic N; soil moisture) can strongly impact on both leaf and culm N resorption proficiencies (RP) and absolute leaf N resorption of grasses. Moreover, plasticity was responsible for 86% and 43% of within‐site variance in leaf and culm RP, respectively, with the remainder owing to interspecific differences between the four grasses. These results imply a much larger role of plant plasticity in driving ecosystem functioning than previously assumed.4. Synthesis. Our results suggest that plant litter quality varies even at the microscale with heterogeneity in soil resource availability, thereby potentially feeding back on soil properties and sustaining microscale soil fertility patchiness. In parallel, plants of more fertile patches resorbed a greater absolute amount of N, likely benefiting their competitive and reproductive abilities.
Competition, species interaction and ageing control tree mortality in boreal forests
Authors: Luo Yong , Chen Han Y. H. 
Published: August 2011

Summary1. Tree mortality has important influences on forest structure and composition, but the mechanisms that cause tree mortality are not well understood. Asymmetric competition is known to be a dominant cause of plant mortality, but this idea has not received much attention in studies of long‐lived trees.2. We hypothesised that while tree mortality is dependent on size relative to neighbours as a result of asymmetric competition, tree mortality of shade‐tolerant species varies little with size because of their physiological and morphological adaptations to shaded environments. Furthermore, we hypothesised that tree mortality is higher in more crowded stands because of higher average resource competition, in conspecific stands because of potential negative intra‐specific interactions, and in older stands because of the physiological limitations and susceptibility to minor disturbances of large trees.3. Using data from repeatedly measured permanent sampling plots that covered a wide range of tree sizes, stand developmental stages and stand compositions in boreal forests, we simultaneously tested, by boosted regression tree models, the effects of an individual’s relative size, stand crowding, species interaction and ageing on mortality of Pinus banksiana, Populus tremuloides, Betula papyrifera and Picea mariana.4. Mortality increased strongly with decreasing relative size for all study species, and the size‐dependent mortality was stronger for shade‐intolerant than for shade‐tolerant species. With increasing stand basal area, mortality increased for Pinus banksiana, Populus tremuloides and Picea mariana but decreased for Betula papyrifera. Mortality was higher in stands with more conspecific neighbours for Populus tremuloides, Betula papyrifera and Picea mariana, but was slightly lower for Pinus banksiana. Mortality also increased with stand age for all species. Furthermore, the size‐dependent mortality was generally stronger in more crowded stands.5. Synthesis. Our findings show that tree mortality over a wide range of tree sizes, stand developmental stages and stand compositions in non‐equilibrium boreal forests was strongly controlled by competition, but species interactions and ageing were also important mechanisms. Furthermore, the relative importance of these mechanisms to tree mortality differed with the shade tolerance of species.
Health policy, patient‐centred care and clinical ethics
Authors: McClimans Leah. M. , Dunn Michael , Slowther Anne‐Marie 
Published: August 2011

AbstractRationale, aims and objectives  Patient‐centred care has been a central part of US and UK health policy for over a decade, but, despite its importance, the policy literature often fails to provide an adequate theoretical justification for why and how we should value it. This omission is problematic because it renders the status, content and appropriate evaluation of patient‐centredness unclear. In this paper we aim to examine two different accounts of patient‐centred care.Method  We draw upon methods of conceptual and ethical analysis.Results  We argue that neither of the two accounts of patient‐centred care identified appropriately grounds patient‐centredness because neither of them takes into account the inherently moral nature of terms such as ‘respect’ and ‘dignity’, terms that are central to discussions of patient‐centred care.Conclusions  We suggest that clinical ethics can help to provide a theoretical justification for patient‐centred care, and that clinical ethical practices can further patient‐centred initiatives through ethics consultation, education and policy development and review.
Effect of leukotriene inhibitors on evolution of experimental brain contusions
Authors: Voigt C. , Donat C. K. , Hartig W. , Förschler A. , Skardelly M. , Stichtenoth D. , Arendt T. , Meixensberger J. , Schuhmann M. U. 
Published: August 2011

C. Voigt, C. K. Donat, W. Hartig, A. Förschler, M. Skardelly, D. Stichtenoth, T. Arendt, J. Meixensberger and M. U. Schuhmann (2012) Neuropathology and Applied Neurobiology38, 354–366Effect of leukotriene inhibitors on evolution of experimental brain contusionsAims: Leukotriene levels increase in cerebrospinal fluid (CSF) following controlled cortical impact (CCI) injury in rats. We investigated the impact of two different leukotriene inhibitors in the CCI model on CSF leukotriene levels, brain water content (BWC), brain swelling (BS) contusion size and cellular response. Methods: 134 male Sprague Dawley rats were investigated at 4, 24 and 72 h after CCI for CSF leukotriene levels and BWC/BS, lesion size in T2‐weighted magnetic resonance imaging and immunohistochemistry. Animals received vehicle, MK‐886, an inhibitor of 5‐lipoxygenase activating protein, or Boscari®, a mixture of boswellic acids, acting as competitive nonredox 5‐lipoxygenase inhibitors before trauma and then every 8 h until sacrifice. Results: The intracranial pressure (ICP) was unaffected by treatment. Boscari treatment reduced CSF leukotriene C4 increase by −45% at 4 h (P < 0.03) and increase of BWC and BS by 49% (P < 0.05) and −58% at 24 h. Treatment with both substances showed a reduction of lesion volume at 72 h by −21% (P < 0.01) in T2‐weighted magnetic resonance imaging, which was reflected in a smaller lesion area determined from a NeuN labelled section (−17% to −20%, P < 0.05). Triple immunofluorescence and Fluoro‐Jade B staining showed rarefaction of neurones, glia and vasculature in the contusion core, whereas in the pericontusional zone astro‐ and microglia were upregulated in the presence of dying neurones. Treatment resulted in an improved survival of NeuN labelled neurones in the pericontusional cortex (+15% to +20%, P < 0.05). Conclusions: Leukotriene inhibition should be further investigated as therapeutic option to counteract secondary growth of traumatic brain contusions and to possibly improve pericontusional neuronal survival.
Self‐report versus medical record – perinatal factors in a study of infant leukaemia: a study from the Children's Oncology Group
Authors: Jurek Anne M. , Greenland Sander , Spector Logan G. , Roesler Michelle A. , Robison Leslie L. , Ross Julie A. 
Published: August 2011

SummaryJurek AM, Greenland S, Spector LG, Roesler MA, Robison LL, Ross JA. Self‐report versus medical record – perinatal factors in a study of infant leukaemia: a study from the Children's Oncology Group. Paediatric and Perinatal Epidemiology 2011; 25: 540–548.In a case–control study of infant leukaemia, we assessed agreement between medical records and mother's self‐reported pregnancy‐related conditions and procedures and infant treatments. Interview and medical record data were available for 234 case and 215 control mothers. Sensitivity, specificity and predictive values for maternal report were estimated for case and control mothers separately, taking the medical record as correct. For most perinatal conditions, sensitivity and specificity were over 75%. Low sensitivity was observed for maternal protein or albumin in the urine (cases: 12% [95% exact confidence interval (CI) 8%, 18%]; controls: 11% [95% CI 7%, 17%]) and infant supplemental oxygen use (cases: 25% [95% CI 11%, 43%]; controls: 24% [95% CI 13%, 37%]). Low specificity was found for peripheral oedema (cases: 47% [95% CI 37%, 58%]; controls: 54% [95% CI 43%, 64%]). Sensitivity for maternal hypertension appeared much lower for cases (cases: 46% [95% CI 28%, 66%]; controls: 90% [95% CI 70%, 99%]; P = 0.003). We did not detect other case–control differences in recall (differentiality), even though the average time between childbirth and interview was 2.7 years for case and 3.7 years for control mothers. Many conditions exhibited notable differences between interview and records. We recommend use of multiple measurement sources to allow both cross‐checking and synthesis of results into more accurate measures.
Maternal prenatal cigarette, alcohol and illicit drug use and risk of infant leukaemia: a report from the Children's Oncology Group
Authors: Slater Megan E. , Linabery Amy M. , Blair Cindy K. , Spector Logan G. , Heerema Nyla A. , Robison Leslie L. , Ross Julie A. 
Published: August 2011

SummarySlater ME, Linabery AM, Blair CK, Spector LG, Heerema NA, Robison LL, Ross JA. Maternal prenatal cigarette, alcohol and illicit drug use and risk of infant leukaemia: a report from the Children's Oncology Group. Paediatric and Perinatal Epidemiology 2011; 25: 559–565.Several case–control studies have evaluated associations between maternal smoking, alcohol consumption and illicit drug use during pregnancy and risk of childhood leukaemia. Few studies have specifically focused on infants (<1 year) with leukaemia, a group that is biologically and clinically distinct from older children. We present data from a Children's Oncology Group case–control study of 443 infants diagnosed with acute leukaemia [including acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML)] between 1996 and 2006 and 324 population controls. Mothers were queried about their cigarette, alcohol and illicit drug use 1 year before and throughout pregnancy. Odds ratios (ORs) and 95% confidence intervals [CI] were calculated using adjusted unconditional logistic regression models. Maternal smoking (>1 cigarette/day) and illicit drug use (any amount) before and/or during pregnancy were not significantly associated with infant leukaemia. Alcohol use (>1 drink/week) during pregnancy was inversely associated with infant leukaemia overall [OR = 0.64; 95% CI 0.43, 0.94], AML [OR = 0.49; 95% CI 0.28, 0.87], and leukaemia with mixed lineage leukaemia gene rearrangements (‘MLL+’) [OR = 0.59; 95% CI 0.36, 0.97]. While our results agree with the fairly consistent evidence that maternal cigarette smoking is not associated with childhood leukaemia, the data regarding alcohol and illicit drug use are not consistent with prior reports and are difficult to interpret. It is possible that unhealthy maternal behaviours during pregnancy, some of which carry potential legal consequences, may not be adequately measured using only self‐report. Future case–control studies of childhood leukaemia that pursue these exposures may benefit from incorporation of validated instruments and/or biomarkers when feasible.
The role of the transmembrane domain in determining the targeting of membrane proteins to either the inner envelope or thylakoid membrane
Authors: Froehlich John E. , Keegstra Kenneth 
Published: August 2011

SummaryChloroplastic membrane proteins can be targeted to any of three distinct membrane systems, i.e. the outer envelope membrane (OEM), inner envelope membrane (IEM), and thylakoid membrane. This complex structure of chloroplasts adds significantly to the challenge of studying protein targeting to various membrane sub‐compartments within a chloroplast. In this investigation, we examined the role played by the transmembrane domain (TMD) in directing membrane proteins to either the IEM or thylakoid membrane. Using the IEM protein, Arc6 (Accumulation and Replication of Chloroplasts 6), we exchanged the stop‐transfer TMD of Arc6 with various TMDs derived from different IEM and thylakoid membrane proteins and monitored the subcellular localization of these Arc6‐hybrid proteins. We showed that when the Arc6 TMD was replaced with a TMD derived from various thylakoid membrane proteins, these Arc6(thylTMD) hybrid proteins could be directed to the thylakoid membrane rather than to the IEM. Conversely, when the TMD of the thylakoid membrane proteins, STN8 (State Transition protein kinase 8) or Plsp1 (Plastidic type I signal peptidase 1), was replaced with the stop‐transfer TMD of Arc6, STN8 and Plsp1 were halted at the IEM. From our investigation, we conclude that the TMD plays a critical role in targeting integral membrane proteins to either the IEM or thylakoid membrane.
Antiretroviral treatment uptake and attrition among HIV‐positive patients with tuberculosis in Kibera, Kenya
Authors: Tayler‐Smith K. , Zachariah R. , Manzi M. , Kizito W. , Vandenbulcke A. , Sitienei J. , Chakaya J. , Harries A. D. 
Published: August 2011

SummaryUsing data of human immunodeficiency virus‐positive patients with tuberculosis from three primary care clinics in Kibera slums, Nairobi, Kenya, we report on the proportion that started antiretroviral treatment (ART) and attrition (deaths, lost to follow‐up and stopped treatment) before and while on ART. Of 427 ART eligible patients, enrolled between January 2004 and December 2008, 70% started ART, 19% were lost to attrition and 11% had not initiated ART. Of those who started ART, 14% were lost to attrition, making a cumulative pre‐ART and ART attrition of 33%. ART uptake among patients with TB was relatively good, but programme attrition was high and needs urgent addressing.
Parental views on informed consent for expanded newborn screening
Authors: Moody Louise , Choudhry Kubra 
Published: August 2011

AbstractBackground  An increasing array of rare inherited conditions can be detected as part of the universal newborn screening programme. The introduction and evaluation of these service developments require consideration of the ethical issues involved and appropriate mechanisms for informing parents and gaining consent if required. Exploration of parental views is needed to inform the debate and specifically consider whether more flexible protocols are needed to fit with the public perception of new developments in this context.Objective  This study has been undertaken to explore perceptions and attitudes of parents and future parents to an expanded newborn screening programme in the United Kingdom and the necessary information provision and consent processes.Design and participants  A mixed methods study involving focus groups (n = 29) and a web‐survey (n = 142) undertaken with parents and future parents.Results and conclusions  Parents want guaranteed information provision with clear decision‐making powers and an awareness of the choices available to them. The difference between existing screening provision and expanded screening was not considered to be significant enough by participants to warrant formal written, informed consent for expanded screening. It is argued that the ethical review processes need to be more flexible towards the provision of information and consent processes for service developments in newborn screening.