bluuebunny/crossref_metadata_2025_split huggingface dataset:
Children with chronic renal failure have reduced numbers of memory B cells
Authors: BOUTS A H M , DAVIN J C , KREDIET R T , MONNENS L A H , NAUTA J , SCHRÖDER C H , VAN LIER R A W , OUT T A 
Published: August 2004

SUMMARYReduced serum IgG and subclass levels have been demonstrated in children with chronic renal failure. To study possible causes of this reduction, we analysed B cell subset composition, T helper cell frequencies and immunoglobulin (Ig) production capacity in vitro in children with chronic renal failure, with or without dialysis treatment. B cell subsets were characterized by determining CD27, IgM, IgD and CD5 expression within the CD19+ population. Intracellular expression of interferon (IFN)-γ, interleukin (IL)-2 and IL-4 in PMA/ionomycin-stimulated peripheral blood mononuclear cells (PBMC) was used to evaluate T helper frequencies. The capacity of B cells to secrete Ig in vitro was determined by measuring IgG1, IgG2 and IgM in culture supernatants of anti-CD2/CD28 monoclonal antibody (MoAb)- or SAC/IL-2-stimulated PBMC. Memory B cell numbers (identified as percentage or absolute number of CD19+ IgM¯IgD¯ or CD19+CD27+ lymphocytes) were lower in children treated with haemodialysis (HD), peritoneal dialysis (PD) and children with chronic renal failure before starting dialysis treatment (CRF) compared to healthy controls (HC) (P &lt; 0·05). Compared with HC, CD5+ (naive) B cells were reduced in HD-treated patients but not for PD or for children with chronic renal failure before starting dialysis treatment (CRF). No significant differences in CD4+ T helper cell subsets were found between the groups. However, CRF children had a higher percentage of IFN-γ producing CD8+ T lymphocytes compared to HC (P = 0·02). Finally, IgG1, IgG2 and IgM production in vitro was similar in the four groups. In conclusion, significantly lower numbers of memory type B cells were found in children with chronic renal failure compared to healthy controls. This reduction may contribute to the low Ig levels found in these children.
B cell epitope specificity in ANCA-associated vasculitis: does it matter?
Authors: VAN DER GELD Y M , STEGEMAN C A , KALLENBERG C G M 
Published: August 2004

SUMMARYPauci-immune idiopathic small-vessel vasculitis is strongly associated with the presence of antineutrophil cytoplasm autoantibodies (ANCA). Antibodies to PR3 predominate in patients with Wegener's granulomatosis; antibodies to myeloperoxidase (MPO) are found more frequently in patients with microscopic polyangiitis. There is increasing in vivo and in vitro evidence for a pathogenic role of ANCA in systemic vasculitis based on associations of ANCA with disease activity. If ANCA are pathogenic, why is the course of disease different from one patient to another? Antibodies can recognize different binding sites (epitopes) on their corresponding antigens. Differences in binding specificity may influence the pathogenic potential of the antibodies. Differences between epitope specificity of ANCA between patients or changes in epitope specificity of ANCA in time in an individual patient may, accordingly, result in differences in disease expression. This review will focus on epitope specificity of autoantibodies in systemic autoimmune diseases and especially on the epitope specificity of PR3– and MPO–ANCA. We will discuss whether PR3–ANCA or MPO–ANCA recognize different epitopes on PR3 and MPO, respectively, and whether the epitopes recognized by ANCA change in parallel with the disease activity of ANCA-associated vasculitis. Finally, we will speculate if the direct pathogenic role of ANCA can be ascribed to one relapse- or disease-inducing epitope. Characterization of relapse- or disease-inducing epitopes bound by PR3–ANCA and MPO–ANCA is significant for understanding initiation and reactivation of ANCA-associated vasculitis. Elucidating a disease-inducing epitope bound by ANCA may lead to the development of epitope-specific therapeutic strategies.
Lower concentration of serum soluble CD8 in severe Hashimoto's disease
Authors: YAMAMOTO N , WATANABE M , MATSUZUKA F , MIYAUCHI A , IWATANI Y 
Published: August 2004

SUMMARYTo investigate the roles of soluble CD4 (sCD4) and CD8 (sCD8) in the severity of autoimmune thyroid diseases, we examined serum concentrations of sCD4 and sCD8 in various degrees of severity of Hashimoto's disease (HD) and Graves’ disease (GD) by enzyme immunoassay. The serum concentration of sCD8 was lower in euthyroid patients with HD undergoing treatment for hypothyroidism (severe HD) than in untreated, euthyroid patients with HD (mild HD), but the sCD4 concentration did not differ between patients with severe and mild HD. The serum sCD8 concentration was negatively correlated with the proportion of CD25+ cells in CD8+ cells in patients with severe HD. Serum sCD4 and sCD8 concentrations did not differ between euthyroid patients with GD in remission and those with intractable GD. These results indicate that serum sCD8 is involved in the severity of HD, possibly by down-regulating the function of cytotoxic T cells.
Effect of tamoxifen on serum IL-18, vascular endothelial growth factor and nitric oxide activities in breast carcinoma patients
Authors: COSKUN U , GUNEL N , SANCAK B , ONUK E , BAYRAM M , CIHAN A 
Published: August 2004

SUMMARY
Vascular endothelial growth factor (VEGF) is a multi-functional cytokine that has been suggested to be a major angiogenic factor in breast cancer. Nitric oxide (NO) is a potent biological molecule that partipicates in the multi-step process of carcinogenesis. Interleukin (IL)-18 has been shown to have potent anti-tumour effects. In this study, we investigated the effect of tamoxifen therapy on serum VEGF, NO and IL-18 activity in breast cancer patients. Serum levels of VEGF, nitrate + nitrite and IL-18 were measured in 34 postmenopausal breast cancer patients before and 3 months after the tamoxifen therapy. Both serum VEGF and IL-18 levels decreased after tamoxifen therapy (P = 0·051, P &lt; 0·05, respectively). Serum VEGF levels increased in patients with endometrial thickness, while patients without endometrial thickness had a significant reduction in serum VEGF levels after therapy (P &lt; 0·05). Serum nitrate + nitrite levels increased after the therapy, but this was not statistically significant (P &gt; 0·05). A decrease in serum VEGF levels with tamoxifen therapy may be a reflection of reduced angiogenic activity in patients without endometrial thickness. The negative effect of tamoxifen therapy on IL-18, which is known to have a potent antitumour activity, may be related to the decreased tumour growth by induction of NO and reduction of VEGF activity as a feedback mechanism.
Prevalence of SAP gene defects in male patients diagnosed with common variable immunodeficiency
Authors: EASTWOOD D , GILMOUR K C , NISTALA K , MEANEY C , CHAPEL H , SHERRELL Z , WEBSTER A D , DAVIES E G , JONES A , GASPAR H B 
Published: August 2004

SUMMARY
The molecular basis of common variable immunodeficiency (CVID) is undefined, and diagnosis requires exclusion of other diseases including X-linked lymphoproliferative disease (XLP). This rare disorder of immunedysregulation presents typically after Epstein–Barr virus infection and results from defects in the SAP (SLAM associated protein) gene. SAP mutations have been found in a few patients diagnosed previously as CVID, suggesting that XLP may mimic CVID, but no large-scale analysis of CVID patients has been undertaken. We therefore analysed 60 male CVID and hypogammaglobulinaemic patients for abnormalities in SAP protein expression and for mutations in the SAP gene. In this study only one individual, who was found later to have an X-linked family history, was found to have a genomic mutation leading to abnormal SAP cDNA and protein expression. These results demonstrate that SAP defects are rarely observed in CVID patients. We suggest that routine screening of SAP may only be necessary in patients with other suggestive clinical features.
HIV-infected children with moderate/severe immune-suppression: changes in the immune system after highly active antiretroviral therapy
Authors: RESINO S , GALÁN I , PÉREZ A , LEÓN J A , SEOANE E , GURBINDO D , ÁNGELES MUÑOZ-FERNÁNDEZ M 
Published: August 2004

SUMMARYThe objective of this study was to monitor the changes in the immune system of HIV-infected children with moderate or severe immunodeficiency after highly active antiretroviral therapy (HAART), comprising a follow-up study in 14 HIV-infected children on HAART at two time points separated approximately by 11·8 ± 0·4 (9·9; 15·4) months. HIV-infected children had significantly lower TREC levels than the control group, but 1 year after HAART the levels increased significantly (P &lt; 0·05). In contrast, viral load (VL) did not change significantly. A positive correlation between T cell receptor excision circle (TREC) levels and both CD4+ T cell absolute counts (r = 0·558; P = 0·05) and percentages (r = 0·625; P = 0·030) was found. During follow-up on HAART, the percentages and absolute counts of naive CD4+ and CD8+ T cell subsets were increased significantly (P &lt; 0·05). CD4+ CD45RAhi+ CD62L+, CD4+ CD45RA+ and CD4+ CD38+ percentages, and the CD8+ CD45RAhi+ CD62L+ counts reached similar values to the control group. Also, CD8+ CD45RO+ CD38+ and CD8+ CD45RO+ percentages, and CD8+ CD45RO+ CD38+ absolute counts (P &lt; 0·05) decreased with respect to the baseline. Lymphoproliferative responses to pokeweed mitogen (PWM) before HAART were lower in HIV-infected children than the control group, but they recovered to normal levels after a year on HAART. Tumour necrosis factor (TNF)-α and interferon (IFN)-γ production by PHA-activated peripheral blood mononuclear cells (PBMC) was lower before HAART (P &lt; 0·001), but reached similar levels to the control group 1 year after HAART. In HIV-infected children IgG, IgG1 and IgG3 plasma levels decreased significantly after HAART. The immune system reconstitution induced by HAART in HIV-infected children seems to be the consequence of decreased immune system activation and naive T cell reconstitution, mainly of thymic origin.
Examining health visiting expertise: combining simulation, interview and observation
Authors: Bryans Alison N. 
Published: August 2004

Background.  Resource constraints and the drive towards evidence‐based practice are currently prompting the review of health visiting services, which are a costly element of community health services in the United Kingdom. There is a shortage of evidence about effective domiciliary health visiting practice that can inform local and national decisions about developing and reforming this service.Aims.  This paper is based on a study which aimed to articulate the health visiting expertise involved in recognizing and responding to client need during home visits. The paper describes the innovative, multi‐method approach used to articulate this expertise, and presents the rationale for this unusual approach.Discussion.  The study used the complementary methods of a 20‐minute simulated visit to an actress‐client, a postsimulation focused interview and subsequent observation of actual home visits with 15 study participants. Data‐gathering took place between 2001 and 2002. The rationale, strengths and limitations of the methodology are discussed, and recommendations made for further development based on the work.Conclusions.  The findings confirmed the utility of this unusual combination of methods, with their blend of control and naturalism, for articulating the knowledge and expertise which underpins assessment practice. Further research using a similar approach is recommended for the systematic examination of professional expertise in nursing and multi‐disciplinary contexts.
Expertise or performance? Questioning the rhetoric of contemporary narrative use in nursing
Authors: Nelson Sioban , McGillion Michael 
Published: August 2004

Background.  In the early 1980s there emerged in nursing a self‐conscious and well‐articulated concern to articulate nursing's contribution to patient care. This has fostered the production of a large volume of practice narratives that today form the basis of professional self‐understanding. First‐person practice narratives are now widely used as the evidence base for nursing expertise, not only in their natural home, the world of interpretative research, but also in the bureaucratic‐judicial domain of professional regulation, health care organizations, trades unions and professional associations.Aim.  The aim of this paper is to question the use of individual narrative accounts of nursing practice as evidence of nursing expertise.Method.  We examine the model, method, and continuing consequences of these discursive formations of practice. First, we present a methodological discussion of how personal narratives are produced by the interplay between discourse and subjectivity. Second, we explore clinical narratives of expertise in the work of Patricia Benner and others to uncover the common template for contemporary narrative.Discussion.  Narrative production in nursing has led to particular constructions, rather than free representations of practice. It is these particular constructions that we call into question. Rather than viewing these narratives as revelatory of nursing practice, we argue that they place a ‘spotlight’ on the individual actor – the nurse – with an absence of structural practice context.Conclusion.  We make the case that treatment of these narratives as individual evidence of expertise fundamentally misunderstands their function and purpose, and reduces the constitution of nursing expertise to the performance of a palatable and highly desirable discourse for a nursing audience.
Teaching qualitative research: a metaphorical approach
Authors: Cook Stephen H. , Frances Gordon M. 
Published: August 2004

Background.  In the Western tradition, drawing attention to the linguistic significance of analogy and metaphor can be traced back to the writings of the early Greek philosophers Plato and Aristotle. More recently, philosophers of science have drawn attention to the role of analogy and metaphor in the development of scientific theory. Also, linguists and psychologists now suggest that, in addition to being distinctive uses of language with various rhetorical functions, metaphors constitute fundamental processes of thought with basic epistemological functions.Aim.  Drawing on numerous sources from outside the nursing literature, this paper seeks to show the implications of current theory relating to analogy and metaphor for nursing and educational practice. It also seeks to demonstrate, using a practical example, how this theory can be applied to the teaching of qualitative research.Method.  Using reflection on our experiences of using analogy and metaphor in teaching the qualitative research process on a Master's degree programme, we assess the potential for using analogy and metaphor as a teaching strategy. This experience is also used to explore and discuss the wider implications of the use of analogy and metaphor in health and educational practices.Discussion.  While analogies and metaphors can help students make creative and imaginative links between existing conceptual frameworks and those associated with new knowledge, thereby facilitating its assimilation, the use of analogy and metaphor remains an under‐researched area of nursing and educational practice. The cultural specificity of a metaphor does not necessarily prevent its usefulness cross culturally. The use of metaphor and analogy can also facilitate the injection of humour to a subject students frequently find ‘dry’ and intimidating.Conclusion.  Analogies and metaphors are potentially powerful teaching and learning strategies. However, much is still not known about how they work at the cognitive level. Consequently, there is considerable scope for further research in this area in nurse education and clinical practice.
Child protection and public health: nurses’ responsibilities
Authors: Crisp Beth R. , Lister Pam Green 
Published: August 2004

Background.  Health care workers have been recognized as having a key role in the protection and care of Scotland's children, particularly in respect of identification and detection of child abuse. Nurses, especially health visitors, are often the first professionals to suspect that child abuse has taken place. While previous research has found that health visitors have primarily perceived their role as that of providing support and advice to vulnerable families, there are pressures on them to fulfil a more narrow surveillance role. Concurrent with a lack of clarity about the role of health visitors in child protection, there has been increasing recognition that other nurses can also make an important contribution, including those who do not work directly with children.Aims.  The aim of the study was to explore nurses’ understanding of their professional responsibilities in relation to child protection, and the potential for nurses to be involved in the protection of children from abuse.Methods.  A qualitative interview‐based design was used, and 99 nurses working in an National Health Service trust in a Scottish city were interviewed, either individually or in groups, about their professional involvements in child protection issues. Interview data were subjected to thematic analysis.Findings.  There was lack of consensus among interviewees about the nursing remit in child protection issues, particularly with respect to the extent to which nurses should actively seek to detect cases of child abuse. An emphasis on identification and detection was not easily accepted by many nurses, and was perceived by some to be a change from their more traditional role of supporting families, as well as being potentially in conflict with some public health responsibilities.Conclusion.  In spite of the perception of some nurses that there is a sharp divide between child protection work and public health interventions, many of the child protection roles identified by nurses, such as supporting families, parenting education and service development, are clearly within the ambit of contemporary notions of public health. Furthermore, it is clear that there is a role in child protection for a much wider group of nurses than health visitors.
Nurses who work outside nursing
Authors: Duffield Christine , Pallas Linda O'Brien , Aitken Leanne M. 
Published: August 2004

Background.  The desire to care for people, a family history of professional health care work, and security in career choice are documented reasons for entering nursing. Reasons for leaving include workload, unsafe work environments and harassment. The relationship between these factors and the time nurses spend in the profession has not been explored.Aim.  This paper reports a study with people who have left nursing, to investigate why they became a nurse, how long they stayed in nursing, and their reasons for leaving.Method.  A questionnaire was mailed to Registered Nurses currently working outside nursing, seeking respondents’ reasons for entering and leaving nursing, and perceptions of the skills gained from nursing and the ease of adjustment to working in a non‐nursing environment. Data analysis included descriptive statistics, exploratory and confirmatory factor analysis, correlational analysis and linear and multiple regression analysis.Results.  A model incorporating the factors ‘altruistic reasons’, ‘default choice’ and ‘stepping stone’ explained 36·2% of the variance in reasons for becoming a nurse. A model incorporating the factors ‘legal and employer’, ‘external values and beliefs about nursing’, ‘professional practice’, ‘work life/home life’ and ‘contract requirements’ explained 55·4% of the variance in reasons for leaving nursing. Forty‐eight per cent of the variance in tenure in nursing practice was explained through personal characteristics of nurses (36%), reasons for becoming a nurse (7%) and reasons for leaving (6%).Conclusion.  The reasons why nurses entered or left the profession were varied and complex. While personal characteristics accounted for a large component of tenure in nursing, those managing the nursing workforce should consider professional practice issues and the balance between work life and home life.
The organizational and performance effects of nurse practitioner roles
Authors: van Offenbeek Marjolein A.G. , Knip Marrig 
Published: August 2004

Background.  Most studies evaluating the roles of Nurse Practitioners have compared the care delivered by individual Nurse Practitioners with that provided by other professionals. These studies should be complemented by research focusing on a higher unit of analysis, namely the organization of the care process for a specific patient group. The most important reason is that Nurse Practitioners are increasingly involved in direct, multiprofessional care in complex health care organizations and networks. In these work settings, their roles may, in both positive and negative ways, lead to changes in the organization of the entire care delivery system.Aim.  The aim of this paper is to stimulate awareness and evaluation of these organizational changes and their potential impact on the effectiveness of the care process.Approach.  A conceptual model based on patterned systems contingency theory is proposed. With the help of this model, attention is drawn to issues at the level of the organization and the effectiveness of the care processes that merit attention when Nurse Practitioner positions are being introduced. These issues are derived from case studies in Dutch hospitals.Results.  According to the model, a Nurse Practitioner position will change the work structure of the care process involved. Therefore, the effectiveness of a Nurse Practitioner position will be dependent on the changes realized in the work structure. The resulting structure should fit the task characteristics of the care services demanded by the specific patient group. On the basis of this model and the examples presented, questions for further study are formulated.Conclusions.  Nurse Practitioner roles can only enhance the effectiveness of care processes when embedded in a work structure that is internally consistent and adjusted to the task environment and available skill‐mix. A structural contingency framework may be helpful in identifying relevant organizational issues. To determine the effects of Nurse Practitioner roles, cross‐sectional as well as longitudinal studies are needed.
Schizophrenia: problems of separation in families
Authors: Jungbauer Johannes , Stelling Kirsten , Dietrich Sandra , Angermeyer Matthias C. 
Published: August 2004

Background.  In the past, family relationships of people with schizophrenia have mainly been investigated from a clinical viewpoint. The perspective of family development has generally been overlooked in this area of research.Aim.  This paper reports a study exploring problems of development and detachment in families with an adult child with schizophrenia.Method.  Using in‐depth interviews, 51 parents of people with schizophrenia were questioned about their living situations and relationships with patients.Findings.  Spatial separation from the family home was often complicated or even prevented entirely, with patients permanently living in their parents’ household or in the same neighbourhood. Many patients remained dependent on their parents’ emotional, practical and financial support. Typically, the parent–child relationship was re‐intensified, often with a concurrent loss of social contacts outside the family. From a biographical point of view, schizophrenia often caused problems for families by making parenthood permanent and lifelong parental support necessary. Many parents had to revise their expectations of both their ill child's development and their own personal plans.Conclusion.  From the viewpoint of family psychology, schizophrenia is a serious obstacle to development that affects both patients and their parents. Family‐related support should increasingly take into account the issue of the difficult detachment of patients from their parents.