bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development, implementation and evaluation of a new nurse‐led continence service: a pilot study
Authors: Williams Kate S. , Assassa R. Phil , Smith Nigel K. G. , Jagger Carol , Perry Sarah , Shaw Christine , Dallosso Helen , McGrother Catherine , Clarke Michael , Brittain Katherine R. , Castleden C. Mark , Mayne Christopher 
Published: March 2003

• The Leicestershire Medical Research Council (MRC) Incontinence Study is a series of interrelated studies exploring the epidemiology of urinary symptoms, including incontinence, and evaluating service provision and treatment options for these symptoms.• This paper describes one aspect of the Leicestershire MRC Incontinence Study, namely the development, implementation and evaluation of a new nurse‐led continence service.• When developing a new service it is important to determine its acceptability and suitability to the target population.• The new mode of service delivery was dependent on specially trained Continence Nurse Practitioners (CNP) delivering predefined evidence‐based treatment interventions.• Objective and subjective outcome measures were used to evaluate the service.• The service was shown to be effective in reducing urinary symptoms and led to high levels of patient satisfaction.• This service is currently being evaluated in a randomized controlled trial.
The dialysis diet and fluid non‐adherence questionnaire: validity testing of a self‐report instrument for clinical practice INFORMATION POINT: Kendall’s Tau
Authors: Vlaminck Hans , Maes Bart , Jacobs An , Reyntjens Stefanie , Evers Georges 
Published: March 2003

• This study evaluated the validity of the dialysis diet and fluid non‐adherence questionnaire (DDFQ) as a self‐report instrument for clinical practice. The DDFQ was designed to measure non‐adherence behaviour with diet and fluid guidelines in patients treated with hospital‐based haemodialysis in Flanders (Belgium).• In a multicentre cross‐sectional study design, 564 patients from 10 dialysis centres in Flanders completed the DDFQ. Criterion and construct validity of the instrument were substantiated using correlation techniques between the DDFQ and biochemical and biological ratings of non‐adherence.• The results of this study suggest that the DDFQ is a valid self‐report instrument to assess non‐adherence behaviour in haemodialysis patients in Flanders and probably also in other cultures.
Health promotion practices of older adults: testing an individualized approach
Authors: Resnick Barbara 
Published: March 2003

Summary• The world's population is getting older. Consequently, the World Health Organization has focused efforts on health promotion activities for these individuals.• The purpose of this study was to explore the factors that influence health promotion behaviours and to describe the impact of an individualized approach to decision‐making with regard to health promotion activities in a group of older adults living in a continuing care retirement community.• The study used a single group pre‐ and post‐test design that included a total of 134 residents. Descriptive statistics were used to describe the sample. A McNemar test was used to compare health promotion activities pre‐ and postintervention. Regression analysis was used to consider the factors that influenced health promotion activities in these individuals.• The survey included questions about health promotion activities and both mental and physical health status. In the year between baseline and follow‐up testing a geriatric nurse practitioner provided both formal and informal education about health promotion activities.• With the exception of monitoring dietary fat intake, there was not a statistically significant difference in primary and secondary health promotion behaviours pre‐ and post‐testing. There was, however, a decline in smoking and alcohol use, an increase in physical activity and a slight decline in the percentage of older adults who engaged in cancer screenings.• An individualized approach may be a useful way to help older adults make health decisions and engage in those health promotion activities that will increase their quality of life.
Studying food tastes among young adults using Bourdieu's theory
Authors: Øygard Lisbet 
Published: March 2003

AbstractThe purpose of this study was to study the relationship between social position and food tastes. The empirical data stem from a survey carried out in 1991 on 703 people aged 23–26 years. Bourdieu's theory of the relationship between social position and consumption was used as a theoretical framework. Bourdieu attacks the position often expressed by economists that consumers are similar in most respects except for their economic capital. He introduced the concept ‘cultural capital’ when describing different consumption practices and emphasizes the relationship between gender and food tastes. The social position variables in this study include economic and cultural capital, and gender. Participants were asked to evaluate exotic, healthy, filling, inexpensive and traditional food. Two dimensions of food orientations were observed: food as form and food as function. Economic capital was of importance concerning the costs of food and its filling functions. Groups rich in cultural capital were more interested in healthy and exotic food and less interested in filling food than those possessing less cultural capital. Women were more concerned about healthy food than men. Cultural capital had an independent effect when economic capital was constant.
Use and knowledge of food labels of shoppers in a city with a high proportion of heart disease
Authors: Tessier Sophie , Edwards Christine A. , Morris Susan Eley 
Published: March 2003

AbstractThis study aimed to assess consumers’ use and understanding of food labelling and the improvements that they would like. Systematically selected supermarket shoppers were interviewed using a questionnaire. Data showed that the use of food labels was low. Among those who read food labels, at least occasionally, use‐by‐date was the most reported information looked at. Understanding of the content of five nutrients on a standard food label provided was poor. Although a high proportion of participants claimed to have no problem with the current format, those who had problems wanted food labels that were ‘bigger’, ‘highlighted’ or written in ‘plain English’. These results suggest that before improved food labels can have an impact on consumers’ food choice, strategies to encourage shoppers to read them are needed.
Reproductive allocation and the long‐term costs of reproduction in Siparuna grandiflora, a dioecious neo‐tropical shrub
Authors: Nicotra A. B. 
Published: March 2003

1 Using a combination of observational and experimental approaches, both allocation of resources to reproduction (often called the direct cost of reproduction) and the subsequent long‐term costs (the indirect, delayed or demographic cost) associated with reproductive allocation to male and female function in Siparuna grandiflora (Siparunaceae), a tropical dioecious shrub, were examined. 2 The objectives were to determine whether females allocate more biomass or nitrogen per reproductive episode than males, and whether there is a long‐term cost of reproduction in terms of subsequent growth or reproduction for either sex. If there is no long‐term cost of reproduction, then reproduction may be viewed as free in an evolutionary sense. 3 As is generally the case in dioecious species, females allocated more biomass and nitrogen to reproduction than males. Females also showed delayed costs of reproduction in terms of decreased growth and subsequent reproduction, whereas males did not. 4 The lack of measurable delayed costs in males suggests that with the evolution of dioecy, selection has reduced delayed costs of reproduction in S. grandiflora males. In contrast, females that were prevented from reproducing were able to re‐allocate resources to growth, and produced more stem length on average than males. This re‐allocation response may have evolved to reduce delayed costs of reproduction in females over time frames longer than that considered in the present study.
Size and spatial pattern of Festuca rubra genets in a mountain grassland: its relevance to genet establishment and dynamics
Authors: Suzuki Jun‐Ichirou , Herben Tomáš , Krahulec František , Hara Toshihiko 
Published: March 2003

Summary 1 For many clonal plant species, the density of shoot populations makes it almost impossible to determine genet natality directly. We identified genets by a randomly amplified polymorphic DNA (RAPD) method and used their size and spatial pattern, together with demographic parameters (genet spreading rate and mortality rate of shoots) determined in the field to estimate natality rates for Festuca rubra (red fescue). 2 In each of two sites (a species‐rich and a species‐poor site in a mountain grassland) three plots were established. Each plot contained two 1 m × 3.3 cm transects, composed of 3.3 × 3.3 cm square cells. Estimates of genet number per plot (18–49 and 27–33, respectively, in the two sites) were based on a randomization test. Mean genet size (1.2–1.6 cells) was not significantly different between the sites, nor was the spatial pattern of genets significantly different from random at either site. Interactions between genets therefore appeared to be negligible. 3 A spatial simulation model was developed for the genet population. Values estimated from the growth and demographic data over several years for the genet spreading rate (0.2–0.3) and for the mortality rate of shoots per cell (0.2–0.3) were among those used in the simulation. When a constant genet natality rate of 3–7 genets m–2 year–1 was included in the model, the simulation generated numbers and size frequency distributions of genets that were similar to those found in the field. 4 In this mountain grassland, F. rubra appeared to show repeated seedling recruitment, instead of the initial seedling recruitment following disturbance that is thought to be typical of many grasses. Founder effects were immaterial at the rates of seedling recruitment apparent in these populations. A stable population was achieved with the values of genet spreading rate and mortality rate of shoots per cell observed in the field, and repeated seedling recruitment. However, genet natality rates may vary if environmental conditions fluctuate.
Life span and biomass allocation of stunted black spruce clones in the subarctic environment
Authors: Laberge Marie‐Josée , Payette Serge , Bousquet Jean 
Published: March 2003

Summary 1
Slow growth, maintenance of a high leaf : wood ratio and adoption of a clonal growth habit, more than size per se, may increase the life span in trees species. The longevity of black spruce (Picea mariana (Mill.) BSP.) is increased from 200 to 300 years, when it grows as a clonal shrub. 2
We measured the surface area and above‐ and below‐ground biomass of 25 postfire, stunted black spruce clones identified from RAPDs markers. The maximum age of each clone was deduced from tree‐ring dating or by radiocarbon dating of charcoal fragments. The oldest clone was > 1800 years of age. The total surface area of the clones increased with age, ranging from 2.8 to 691.3 m2. The ratio of living aerial parts to the total surface area decreased from 100% to < 50% with postfire stand age, reflecting fragmentation of clones into many autonomous or potentially autonomous rooted branches (layers). The number of layers increased with age from 12 layers in a 100‐year‐old individual to more than 80 in a 1800‐year‐old clone. 3  Biomass allocation and fragmentation can explain the maintenance of a relatively stable leaf : wood ratio of approximately 10% through time in stunted black spruce clones. The fragmentation of layers is the main mechanism ensuring the great longevity of prostrate clones in exposed sites. In the absence of perturbation, stunted black spruce clones may perpetuate for centuries or even millennia.
Lower limits of Spartina densiflora and S. maritima in a Mediterranean salt marsh determined by different ecophysiological tolerances
Authors: Castillo J. M. , Fernández‐Baco L. , Castellanos E. M. , Luque C. J. , FigUeroa M. E. , Davy A. J. 
Published: March 2003

Summary 1 Salt marshes in south‐west Spain are being invaded by Spartina densiflora, a South American introduction, although the native S. maritima still dominates many lower marshes. A transplant experiment was used to investigate the means by which physical and chemical factors may determine lower vegetation limits in the tidal frame. Both species were transplanted from a mid‐level marsh to lower, unvegetated tidal flats. 2 The survival and growth of transplanted clumps and their constituent tillers were monitored on an elevational gradient. The photosynthetic competence of transplants was assessed by measurements of leaf gas exchange and the fast kinetics of chlorophyll fluorescence. Submergence period, salinity, redox potential and sulphide concentration in the sediment were also examined at the transplant sites. 3 Neither species survived for a year at the lowest transplant point (+ 1.04 m relative to Spanish Hydrographic Zero). At + 1.41 m elevation, S. maritima survived well but all clumps of S. densiflora died. At higher elevations (+ 1.46–1.67 m), clumps of both species had high survival rates. Tiller growth rates in surviving clumps of both species increased with elevation, but that of S. densiflora was more sensitive to low elevation. 4 S. maritima showed no impairment of photosynthetic performance, even at the lowest elevation; its rates of gas exchange were independent of elevation, as were its chlorophyll fluorescence parameters. In contrast, in S. densiflora the rate of CO2 uptake declined and stress to photosystem II (Fv/Fp) increased at lower elevations; both of these photosynthetic measurements were linearly related to sediment redox potential. Stomatal conductance did not vary with elevation. 5 S. maritima has a potentially wide elevational tolerance and an absolute lower limit substantially below that of S. densiflora. The progressively reduced growth and survival of S. densiflora at lower levels appear to result primarily from impairment of photosynthesis when root conditions are hypoxic. This effect is mediated through effects on the photochemical apparatus rather than on stomatal resistance to CO2 uptake. 6 These studies define lower limits to the fundamental niches of the two species in a Mediterranean‐type salt marsh and thus provide a basis for future investigations of interactions between them. The correlation between chlorophyll fluorescence and long‐term survival of S. densiflora suggests that this short‐term measure may be a valuable tool.
Leaf area renewal, root retention and carbohydrate reserves in a clonal tree species following above‐ground disturbance
Authors: Landhäusser Simon M. , Lieffers Victor J. 
Published: March 2003

Summary

Removal of the above‐ground portion of clonally regenerating trees results in a massive imbalance in the ratio of root to leaf area. We investigated the resilience of clones following above‐ground disturbance in terms of root carbohydrates, leaf area renewal and root retention.
In a 2 × 2 factorial experiment, 40 Populus tremuloides saplings were cut at times of high (late fall) or low (spring after leaf flush) root carbohydrate reserves. Leaf area renewal was manipulated by allowing either only one or all root suckers to re‐grow.
Root starch concentrations were 10 times higher at the time of cutting in the fall compared with the spring, whereas sugar concentrations were only 10% higher. When saplings were cut in fall and all suckers were allowed to develop (FA treatment), suckers were taller, and had more biomass and leaf area and higher leaf area ratio than all other treatments. In particular, leaf area and leaf area ratio recovered within a year to near pre‐treatment levels compared with at least a 50% reduction in the other treatments.
At the end of the first season after cutting FA saplings also had the greatest root mass and lowest amount of dead root mass, and root starch concentrations of these saplings had returned to pre‐treatment values, compared with a 20% recovery for spring‐cut saplings with a single sucker. Root mass and root starch concentrations were correlated with leaf mass in all treatments.
Adequate carbohydrate reserves at the time of disturbance and rapid redevelopment of leaf area by extensive sprouting seem critical for resilience of the clone and allow for the retention of the clonal root system and a rapid rebuilding of carbohydrate reserves. Clones with poor sucker and leaf area development showed extensive root mortality and reduced carbohydrate reserves and their prospects for growth in the following year were comparatively poor.
Experimental assessment of Heliconia acuminata growth in a fragmented Amazonian landscape
Authors: Bruna Emilio M. , Nardy Olavo , Strauss Sharon Y. , Harrison Susan 
Published: March 2003

Summary

Fragmentation severely alters physical conditions in forest understories, but few studies have connected these changes to demographic impacts on forest species using detailed experimental examination at the individual and population levels.
Using a 32‐month, reciprocal‐transplant experiment, we show that individuals of the Amazonian understory herb Heliconia acuminata transplanted into forest fragments lost over 20% of their vegetative shoots, while those transplanted to continuous forest showed a slight gain. The leaf area of plants in fragments also increased at half the rate it did in continuous forest sites.
It appears that the normal dry season stresses to which forest understorey plants are exposed are greatly exacerbated in fragments, causing plants to shed shoots and leaves.
The observed shifts in size could help explain why populations in fragments are more skewed towards smaller demographic stage classes than those in continuous forest. These shifts in size structure could also result in reduced abundances of flowering plants, as reproduction in H. acuminata is positively correlated with shoot number.
Fragmentation‐related changes in growth rates resulting from abiotic stress may have significant demographic consequences.
Patterns of invasion within a grassland community
Authors: Kolb A. , Alpert P. , Enters D. , Holzapfel C. 
Published: March 2003

SummaryRelatively few studies have looked for patterns of invasion by non‐native species within communities. We tested the hypotheses that: (i) some types of microhabitats within a community are more invasible than others; (ii) microhabitat types that differ in invasion also differ in resource availability; and (iii) invasibility is mediated by effects of these resources on competition between native and non‐native species.To test the first two hypotheses, we measured plant cover and soils in a coastal grassland in northern California. Consistent with these hypotheses, cover of non‐native plants was consistently high where nitrogen‐fixing shrubs had recently grown, in the bottoms and sides of gullies and on deep soils, and these microhabitats tended to have relatively high nitrogen or water availability.Cover and number of native species tended to be lower where cover of non‐native species was higher, indicating that non‐native species as a group negatively affected native species. However, the number of non‐native species also tended to be lower where the total cover of non‐natives was higher. This suggests that a few non‐native species excluded natives and other non‐natives alike.To test the third hypothesis, we grew a common non‐native, the annual grassLolium multiflorum, and a common native, the perennial grassHordeum brachyantherum, at different levels of water and nitrogen. The relative competitive ability of the native was higher at lower nitrogen availability but not at lower water availability. When 10‐week‐old native plants were grown with non‐native seedlings and nitrogen was relatively low, the native out‐competed the non‐native. However, the non‐native out‐competed the native at all resource levels when species were both grown as seedlings. Competition between native and non‐native grasses in this system may thus help prevent invasion by non‐natives in microhabitats where nitrogen availability is low, but invasion may be relatively irreversible.
Challenges in using rater judgements in medical education
Authors: A. Albanese Mark 
Published: March 2003

AbstractChanges in the healthcare environment are putting increasing pressure on medical schools to make faculty accountable and to document the quality of the medical education they provide. Faculty’s ratings of students’ performances and students’ ratings of faculty’s teaching are important elements in these efforts to document educational quality. This article discusses selected research related to factors affecting raters’ judgements, analyses how changes in the health care environment are influencing such judgements, offers some suggestions to moderate some of the effects and links these influences to the system that upholds professional standards. Ratings are known to have a positive bias (generosity error), provide limited discrimination and often fail to document serious deficits. The potential sources of these problems relate to the mechanics of the rating task, the system used to obtain ratings and factors affecting rater judgement. As managed care demands reduce the time faculty have for teaching, as system‐wide disincentives to provide negative ratings proliferate and as social engineering challenges, such as the Americans with Disabilities Act, impose differential standards for students, the natural tendency to avoid giving negative ratings becomes even harder to resist. Ultimately, these forces compromise the capability of faculty to uphold the standards of the profession. The author calls for a national effort to stem the erosion of those standards.
Improving the quality of care of patients with asthma: the example of patients with severely symptomatic disease
Authors: Liu Xiaofeng , Farinpour Roxanna , Sennett Cary , PharmD Brian W. Bowers , Legorreta Antonio P. 
Published: March 2003

AbstractThe increasing economic burden of asthma care is incurred partly by patients with more severe symptoms. However, little is known about the characteristics of these severe asthma patients. This study examined sociodemographic, disease‐specific characteristics and health care utilization that are related to asthma disease severity, for the purpose of identifying areas for treatment improvement. A total of 2927 asthma patients (12 years or older), who were continuously enrolled in one of three participating health plans for a 6‐month study period and who responded to an asthma survey, were included in the study. Univariate and multivariate analyses were performed to examine the sociodemographic, disease‐specific characteristics and health care utilization by asthma severity. About 25% of the patients reported experiencing severe asthma symptoms. They were more likely to be African‐Americans, Hispanics, women, patients with less than a college education, residents in the south‐west, current smokers, and those receiving care from non‐specialists. Severe asthmatics reported having less of an understanding of the clinical manifestation of asthma and the means to manage asthma exacerbation. Outpatient contacts did not differ significantly between severe and other patients, although their utilization of emergency room and inpatient care was significantly greater. This study suggests that a significant proportion of asthma patients is experiencing severe symptoms and barriers other than access to care prevent appropriate control of asthma. Poor control appears to be related to smoking, deficits in knowledge about self‐care, not receiving medical care from a specialist, and inadequate use of medications.