bluuebunny/crossref_metadata_2025_split huggingface dataset:
Mental health issues in primary healthcare
Authors: RUSSELL GRAHAM , POTTER LORNA 
Published: March 2003

• This article describes a project that was designed to explore mental health issues arising in primary care, as a basis for understanding primary care professionals' mental health training needs.• Whilst recent UK government initiatives, such as the National Service Framework for Mental Health, have emphasized the need to enhance mental healthcare in the general population, the capacity to respond effectively is likely to be dependent upon primary care professionals acquiring the relevant skills. To achieve this, a thorough understanding of the issues inherent in dealing with mental health problems in primary care is required.• Given that the mental health issues facing primary care professionals may differ from those that confront mainstream mental health professionals, logic dictates that primary care professionals may require a discrete set of skills and a special approach to mental health training.• The principal aim of this project was, hence, to identify mental health issues arising in clinical practice, as a first step towards identifying primary care training needs.• A series of focus groups and semi‐structured interviews was used to gather information about mental health issues arising in primary care, based on the experiences of primary care professionals and users' representatives.• The findings suggest that primary care professionals are confronted by a wide range of mental health issues, many of which lie outside of the scope of the current National Service Framework for Mental Health. The article discusses the implications for mental health training in primary care practice and future research.
An exploration of the potential risks associated with using pet therapy in healthcare settings
Authors: BRODIE SARAH J. , BILEY FRANCIS C. , SHEWRING MICHAEL 
Published: March 2003

• The widespread inclusion of companion animals into the homes and lives of humans has prompted a considerable amount of research into the health benefits of such relationships.• Findings seem to confirm that if humans interact with companion animals they are likely to experience various health benefits.• Programmes that encourage and facilitate pet visiting schemes in hospitals have developed and animals can often be found in in‐patient and long‐term care facilities, with the aim of contributing towards a positive therapeutic milieu.• Despite supportive research evidence, the adoption of such a therapeutic activity may have been restricted by the belief that client safety could be compromised by an increase in the risk of infection acquired from animals, allergic responses and bites.• This paper explores the literature on these risks and concludes that, in a controlled health care environment in urban Europe or North America and with responsible human behaviour the potential benefits of sharing our lives with companion animals, either at home or hospital, far outweigh the apparently insignificant risks.• Recommendations aimed at limiting the potential risk of infection and guidelines for the safe management of pet therapy are developed.
Cultural conflict: the impact of western feminism(s) on nurses caring for women of non‐English speaking background
Authors: Blackford Jeanine , Street Annette 
Published: March 2003

Summary• Much research has been conducted for understanding the health needs of people of different cultural backgrounds and the problems they experience in seeking health care. In Australia, despite such research, it is argued that there remains an exclusionary health care culture that continues to affect equity and access for people of non‐English speaking background. There was a need for research in which health professionals examined their own Anglo‐Australian culture and its impact on other ethnic communities.• Such concerns provided the impetus for a feminist praxis study to engage nurses in understanding and improving care for migrant women. This study was conducted with 26 nurses in a paediatric hospital in Melbourne, Australia. Five collaborative research groups were formed, each consisting of four to six nurses who were co‐researchers. Together, the nurses and researchers explored the health care experiences of migrant women, using a variety of quantitative and qualitative data collection strategies.• This paper explores a major finding of the study, which was the impact of liberal feminist approaches on the practices of Australian nurses who cared for women of different ethnicity and race.• The study found that the efforts of liberal feminist nurses to ‘treat all people the same’ meant that women from different cultural backgrounds did not always receive equity in care. Through the feminist praxis process the nurses were able to explore contradictions in their practice and focus on equity in care to meet the specific gendered and racially constructed needs of women of different cultural backgrounds.• A number of strategies were adopted that included regular use of female health interpreters and provision of privacy for migrant women when caring for their children.
Using cost‐effectiveness analysis to compare Hospital at Home and in‐patient interventions. Part 2
Authors: Jester Rebecca , Hicks Carolyn 
Published: March 2003

Summary•  An economic analysis was conducted as an integral part of a comparison of the effectiveness and suitability of Hospital at Home (HaH) and in‐patient interventions. The sample comprised 109 adult primary total joint replacement patients and 21 of their co‐resident informal carers.•  Part 2 is principally a methodology paper and describes how nurses may use a variety of methods to compare cost between treatment modalities. A Cost‐Effectiveness Analysis framework uses the data from Paper 1 to calculate the economic feasibility of HaH compared with traditional in‐patient interventions as a worked example of how the principles of economic analysis can be used within health care research. The basic information for calculating cost of both interventions was obtained by multiplying the mean length of total treatment days by the cost per treatment day. However calculating and comparing cost for in‐patient and HaH modalities was multifaceted and included costs incurred by patients and families as well as any shift in cost from tertiary to community and outpatient services.•  Application of the cost‐effectiveness analysis framework demonstrated that not only was HaH more effective than in‐patient care in several aspects, but also it was less costly because of a mean reduction in length of stay of 0.9 days per patient and a significant reduction in cost per treatment day because of removal of hospital overhead costs and reduced special duty payments even when offset against additional transport, community and outpatient costs.
A review of the newer aromatase inhibitors in the management of metastatic breast cancer
Authors: Reddy  
Published: March 2003

Background:
Breast cancer remains a major cause of morbidity and mortality world‐wide. While aminoglutethimide, a first‐generation aromatase inhibitor, has equivalent efficacy to first‐line tamoxifen in the palliative treatment of metastatic breast cancer, its toxicity profile has relegated this drug to a second‐ or third‐line agent in this setting. Recently, several aromatase inhibitors have been released onto the market while others are in phase II and III clinical trials
Aim:
To review the role of the new aromatase inhibitors in the management of metastatic breast cancer
Methods:
Current literature, abstracts from meetings and information from pharmaceutical manufacturers have been summarizedContent: A review of the clinical pharmacology of the new aromatase inhibitors has been provided in addition to a synopsis of phase III clinical studies
Conclusion:
The newer aromatase inhibitors have several advantages compared to aminoglutethimide and are a useful addition to the armamentarium of therapies employed in the palliative management of advanced breast cancer
Prospective investigation of a subcutaneous, implantable central venous access device for therapeutic plasma exchange in adults with neurological disorders
Authors: Pertiné Basilio , Razvi Syed A. , Weinstein Robert 
Published: March 2003

AbstractStandard alternatives to antecubital access for long‐term therapeutic plasma exchange, including percutaneous polyurethane or tunneled silicone catheters, are associated with complications and inconvenience for the patient. We have investigated the Bard CathLink® 20, a subcutaneously implantable central venous access device, as an alternative for outpatient plasma exchange. The CathLink® 20 consists of a funnel‐shaped titanium port connected to a soft polyurethane‐derived catheter and is accessed percutaneously using an 18‐gauge catheter‐over‐needle Angiocath®. Six patients with paraproteinemic polyneuropathies underwent 64 outpatient plasma exchanges using the CathLink® 20 for access, 31 using 2 CathLink® 20's (draw and return), 20 using a single CathLink® 20 as the draw site and 13 using a single CathLink® 20 as the return site. Mean (± SD) plasma removed was 3,680 ± 551 ml in 115.2 ± 25.3 min. Apheresis personnel were able to access the ports in 1.23 ± 0.6 attempts per port per procedure. Six of 70 planned procedures were aborted: 3 because of failure of an antecubital access site and 3 because of catheter occlusion resolved using a thrombolytic agent. Whole blood flow rate was approximately 54 ml/min, and plasma flow rate was about 32 ml/min for 135 min. Access pressures were stable at −150 to −200 torr (P = 0.1395). Return line pressures varied between 90 and 130 torr (P = 0.0147). No patient required hospitalization during the study. Though not optimized for apheresis, the CathLink® 20 provides a reasonable option for chronic apheresis patients who lack adequate peripheral venous access. J. Clin. Apheresis 17:1–6, 2002. © 2002 Wiley‐Liss, 2002.
Benefits of plant diversity to ecosystems: immediate, filter and founder effects
Authors: Grime J. P. 
Published: March 2003

1 It is useful to distinguish between the immediate effects of species richness on ecosystems and those which become apparent on a longer time scale, described here as filter and founder effects. 2 Relationships between plant diversity and ecosystem properties can be explored by classifying component species into three categories – dominants, subordinates and transients. Dominants recur in particular vegetation types, are relatively large, exhibit coarse‐grained foraging for resources and, as individual species, make a substantial contribution to the plant biomass. Subordinates also show high fidelity of association with particular vegetation types but they are smaller in stature, forage on a more restricted scale and tend to occupy microhabitats delimited by the architecture and phenology of their associated dominants. Transients comprise a heterogeneous assortment of species of low abundance and persistence; a high proportion are juveniles of species that occur as dominants or subordinates in neighbouring ecosystems. 3 A ‘mass ratio’ theory proposes that immediate controls are in proportion to inputs to primary production, are determined to an overwhelming extent by the traits and functional diversity of the dominant plants and are relatively insensitive to the richness of subordinates and transients. Recent experiments support the mass ratio hypothesis and the conclusion of Huston (1997) that claims of immediate benefits of high species richness to ecosystem functions arise from misinterpretation of data. 4 Attribution of immediate control to dominants does not exclude subordinates and transients from involvement in the determination of ecosystem function and sustainability. Both are suspected to play a crucial, if intermittent, role by influencing the recruitment of dominants. Some subordinates may act as a filter influencing regeneration by dominants following major perturbations. 5 Transients originate from the seed rain and seed banks and provide an index of the pool of potential dominants and subordinates at specific sites. Where the landscape carousel operates against a background of declining diversity in the reservoir of colonizing transients, we may predict that a progressive loss of ecosystem functions will arise from the decline in the precision with which dominants can engage in the re‐assembly and relocation of ecosystems.
Interspecific differences in above‐ground growth patterns result in spatial and temporal partitioning of light among species in a tall‐grass meadow
Authors: Anten Niels P. R. , Hirose Tadaki 
Published: March 2003

1 We compared allometric growth patterns, canopy structure and light interception for individual shoots of different species in a tall‐grass meadow. 2 The vertical distributions of above‐ground biomass, leaf area, height and leaf angles were measured, both early and late in the season, for individual shoots of Miscanthus sinensis (the dominant species), Lespedeza bicolor, Lysimachia clethroides, Astilbe thunbergii and Potentilla freyniana. A canopy model was developed to calculate light absorption by individual shoots. Light absorption per unit mass (Φmass) was used to quantify the efficiency with which plants utilized biomass to capture light. 3 The leaf mass ratio (LMR), average specific leaf area (SLA) and therefore the leaf area ratio (LAR) decreased with shoot height and light availability. Light absorption per unit leaf area (Φarea) increased with shoot height, and this increase was observed to be much stronger at greater than at smaller shoot heights. 4 In the taller species (Miscanthus and Lespedeza) Φmass (the product of LAR and Φarea) increased, while in the shortest species (Potentilla) it decreased with shoot height. Clones of Miscanthus and Lespedeza may thus increase total light capture by allocating shoot biomass among fewer taller shoots, and a clone of Potentilla by producing a larger number of shorter shoots. 5 Shoots of the shorter species were equally efficient in capturing light (i.e. they had similar Φmass) early in the season, but less efficient later in the season than shoots of the taller species. Shorter species appear to be able to use the earlier part of the season for efficient light capture, while shoots of taller species gain an advantage from their height later in the season. 6 This study shows how different above‐ground growth patterns of the species in a tall‐grass meadow allow them to use different positions in vertical space and different periods of the season to absorb light efficiently. This is a clear example of niche separation and helps to explain the coexistence of these species.
Dioecy‐induced spatial patterns of two codominant tree species,Podocarpus nagiandNeolitsea aciculata
Authors: Nanami Satoshi , Kawaguchi Hideyuki , Yamakura Takuo 
Published: March 2003

Summary1 Spatial patterns of two codominant dioecious tree species,Podocarpus nagiandNeolitsea aciculata, were analysed at Mt. Mikasa, Nara City, Japan.Podocarpus nagihas a higher shade tolerance but a narrower seed dispersal range thanN. aciculata.We examined the effects of dioecy on regeneration and coexistence of the two species.2 Seeds ofP. nagiare dispersed by gravity around female trees. Young plants ofP. nagiwere clumped and showed significant attraction to large female trees and significant repulsion from large male trees. Dioecy therefore affected the spatial heterogeneity of plant density in theP. nagipopulation.3 Seeds ofN. aciculataare widely dispersed by birds, and young plants ofN. aciculatatherefore showed no significant attraction to female trees. This wide dispersal of seeds moderated the effects of dioecy on the spatial pattern inN. aciculata.4 LargeN. aciculatatrees were clumped and showed significant attraction to large maleP. nagitrees, suggesting that growth ofN. aciculatais facilitated where youngP. nagiplants are uncommon and competition is therefore less intense.5 One effect of dioecy may be to produce a population structure forP. nagithat promotes its coexistence withN. aciculata.
Using spatial pattern analysis to distinguish causes of mortality: an example from kelp in north‐eastern New Zealand
Authors: Cole Russell G. , Syms Craig 
Published: March 2003

Summary1 Spatial analysis techniques were used to differentiate between climate‐induced and pathogen‐induced mass mortalities of the kelpEcklonia radiatain north‐eastern New Zealand. We predicted that climate‐induced effects would generate broad‐scale patterns, whereas pathogen‐induced mortality would be traceable among neighbouring thalli.2 Spatial autocorrelation analysis was performed on the proportion ofE. radiataaffected by dieback in quadrats during an initial mortality event in 1991. The absence of any consistent spatial scale of affected thalli between 10 and 100 m suggested that small‐scale spread of an agent might be occurring.3 Individual thalli were therefore mapped at two sites during a subsequent mortality event in 1992/93, and the degree of damage recorded. Spatial analyses found little evidence of aggregation of either intact or affected thalli at scales of 1–150 cm.4 The relative spatial patterns of healthy and affected plants in mapped quadrats during the 1992/93 mortality provided little evidence of spatial association or repulsion between these broad damage categories.5 The large‐scale mortality of 1992/93 was consistent with a physiological response to broad‐scale light deprivation, although other agents, perhaps both a virus and amphipod grazing, might also have been involved. Potentially complex interactions among the candidate agents render interpretation of the spatial patterns difficult.
Vascular plant species richness in Alaskan arctic tundra: the importance of soil pH
Authors: Gough Laura , Shaver Gaius R. , Carroll Jenny , Royer Dana L. , Laundre James A. 
Published: March 2003

Summary1 Species diversity in the Arctic varies dramatically across abiotic gradients, including topography, moisture, pH and nutrient availability. We hypothesized that vascular plant species density, richness and diversity in Alaskan tundra would be correlated with: (i) site age, (ii) soil pH, (iii) above‐ground productivity and biomass, and (iv) spatial heterogeneity. We sampled moist tussock, snowbed and watertrack communities in three sites that differed in substrate age (11 000–4.5 million years since deglaciation) for a variety of environmental and vegetation data over one growing season.2 Productivity, biomass and heterogeneity were not consistently correlated with species density. However, variation in canopy height was correlated with species density and richness in a unimodal fashion, suggesting that heterogeneity of the light regime may be important for maintaining higher species numbers.3 The 11 000‐year‐old site supported more vascular plant species than the two older sites, primarily due to greater numbers of forb species on the youngest site.4 Soil pH was significantly positively correlated with species richness (R2 = 0.82) and species density (R2 = 0.61). In general the species found on acidic substrates (pH < 5.5) also occurred on non‐acidic substrates (pH > 5.5).5 This pattern of higher richness with higher pH occurs across other tundra types throughout the Arctic, suggesting that soil pH is an important filter of the regional species pool within northern regions, although other factors may become more important at local scales.
Precipitation, decomposition and litter decomposability ofMetrosideros polymorphain native forests on Hawai’i
Authors: Austin Amy T. , Vitousek Peter M. 
Published: March 2003

Summary1 The effects of precipitation on litter quality and surface litter decomposition were evaluated across a natural rainfall gradient, ranging from 500 to 5500 mm mean annual precipitation, on the island of Hawai’i.2 Litter ofMetrosideros polymorphafrom the driest (500 mm) and wettest (5500 mm) extremes of the gradient was decomposed at five sites along the precipitation gradient. Metrosideros polymorphalitter collected from all sites was also decomposed at a single common site (2500 mm), andM. polymorphalitter collected from each site was decomposed at the site of collection (in situ).3 Initial litter quality varied significantly with precipitation at the site. Leaf mass per area (LMA) and phosphorus content decreased, while lignin and nitrogen content both increased, with increasing site precipitation.4 Mass loss of all common litter types increased with increasing precipitation, as didin situdecomposition, which gavek‐values ranging from 0.22 to 1.06. When decomposition at the same site was evaluated, litter from the driest site decomposed up to 2.5 times more rapidly than wet‐site litter.5 Decomposition at the common site showed an inverse correlation between inherent decomposability of litter (i.e. litter quality) and precipitation at the site from which litter originated, withk‐values ranging from 0.71 for litter from the driest site to 0.28 for litter from the wettest site. Decomposability correlated strongly and inversely with initial lignin concentrations.6 Proportional nutrient release fromin situlitter was slower than mass loss, but nitrogen and phosphorus mineralization generally increased with increasing precipitation.7 At the common site, there was an inverse relationship between rate of nutrient release and precipitation at the site where litter was collected. The systematic variation in litter decomposability due to changes in annual precipitation appears to buffer the direct effects of precipitation on carbon and nutrient turnover.
Changes in allozyme frequencies inFestuca ovinapopulations after a 9‐year nutrient/water experiment
Authors: Prentice Honor C. , Lönn Mikael , Lager Helena , Rosén Ejvind , Van Der Maarel Eddy 
Published: March 2003

Summary1 The grassFestuca ovinais an important constituent of the species‐rich ‘alvar’ grasslands on the Baltic island of Öland. Levels of allozyme polymorphism are high and variation is known to be correlated with habitat variation (soil moisture, pH and depth).2 A 9‐year field experiment on species diversity provided replicate plots (in three sites) that had been subjected to six different experimental treatments (control; N + P + K; P + K; N + K; K; water).3 Samples ofF. ovinawere collected and analyses of deviance were used to investigate associations between allele frequencies, at each of four polymorphic loci, and the nutrient/water treatments. We also used the models to estimate predicted values for the alleles in different nutrient/water treatments and in interactions involving the nutrient/water treatments and additional explanatory variables (vegetation height and clipping).4 There were significant allozyme frequency differences between samples ofF. ovinafrom the six different nutrient/water treatments in the grassland experiment. Frequencies in the fertilized or watered plots had diverged from those in the control plots. There were also significant allele–habitat associations (after the removal of site effects), especially at the Pgi‐2 locus.5 Soil moisture was the only variable that was common to this study and an earlier study of variation inF. ovinain natural habitats. In natural populations, the Pgi‐2‐2 allele was significantly associated with soil moisture and was more common in dry habitats. Our findings that the frequency of the Pgi‐2‐2 allele was significantly affected by the nutrient/water treatments, and that it was rarest in the treatment that involved the addition of extra water, were therefore as predicted.6 The study supports the conclusion, from an earlier study of populations in unmanipulated grassland habitats, that selection is contributing to the fine‐scale patterning of genetic variation in the alvar populations ofF. ovina.