bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ozone exposure over two growing seasons alters root‐to‐shoot ratio and chemical composition of birch (Betula pendula Roth)
Authors: Yamaji K. , Julkunen‐Tiitto R. , Rousi M. , Freiwald V. , Oksanen E. 
Published: October 2003

AbstractPhysiological and chemical responses of 17 birch (Betula pendula Roth) clones to 1.5–1.7 × ambient ozone were studied in an open‐field experiment over two growing seasons. The saplings were studied for growth, foliar visible injuries, net photosynthesis, stomatal conductance, and chlorophyll, carotenoid, Rubisco, total soluble protein, macronutrient and phenolic concentrations in leaves. Elevated ozone resulted in growth enhancement, changes in shoot‐to‐root (s/r) ratio, visible foliar injuries, reduced stomatal conductance, lower late‐season net photosynthesis, foliar nutrient imbalance, changes in phenolic composition, and reductions in pigment, Rubisco and soluble protein contents indicating accelerated leaf senescence. Majority of clones responded to ozone by changing C allocation towards roots, by stomatal closure (reduced ozone uptake), and by investment in low‐cost foliar antioxidants to avoid and tolerate ozone stress. A third of clones, showing increased s/r ratio, relied on inducible efficient high‐cost antioxidants, and enhanced leaf production to compensate ozone‐caused decline in leaf‐level net photosynthesis. However, the best ozone tolerance was found in two s/r ratio‐unaffected clones showing a high constitutive amount of total phenolics, investment in low‐cost antioxidants and N distribution to leaves, and lower stomatal conductance under ozone stress. The results highlight the importance of phenolic compounds in ozone defence mechanisms in the birch population. Depending on the genotype, ozone detoxification was improved by an increase in either efficient high‐cost or less efficient low‐cost antioxidative phenolics, with close connections to whole‐plant physiology.
Molecular analysis of methanogenic archaeal communities in managed and natural upland pasture soils
Authors: Nicol Graeme W. , Glover L. Anne , Prosser James I. 
Published: October 2003

AbstractGrassland management influences soil archaeal communities, which appear to be dominated by nonthermophilic crenarchaeotes. To determine whether methanogenic Archaea associated with the Euryarchaeota lineage are also present in grassland soils, anaerobic microcosms containing both managed (improved) and natural (unimproved) grassland rhizosphere soils were incubated for 28 days to encourage the growth of anaerobic Archaea. The contribution of potential methanogenic organisms to the archaeal community was assessed by the molecular analysis of RNA extracted from soil, using primers targeting all Archaea and Euryarchaeota. Archaeal RT‐PCR products were obtained from all anaerobic microcosms. However, euryarchaeal RT‐PCR products (of putative methanogen origin) were obtained only from anaerobic microcosms of improved soil, their presence coinciding with detectable methane production. Sequence analysis of excised denaturing gradient gel electrophoresis (DGGE) bands revealed the presence of euryarchaeal organisms that could not be detected before anaerobic enrichment. These data indicate that nonmethanogenic Crenarchaeota dominate archaeal communities in grassland soil and suggest that management practices encourage euryarchaeal methanogenic activity.
Global terrestrial carbon storage and uncertainties in its temperature sensitivity examined with a simple model
Authors: Lenton Timothy M. , Huntingford Christopher 
Published: October 2003

AbstractThe future of the land carbon sink is a significant uncertainty in global change projections. Here, key controls on global terrestrial carbon storage are examined using a simple model of vegetation and soil. Equilibrium solutions are derived as a function of atmospheric CO2 and global temperature, these environmental variables are then linked in an idealized global change trajectory, and the lag between the dynamic and equilibrium solutions is derived for different linear rates of increase in atmospheric CO2. Terrestrial carbon storage is departing significantly from equilibrium because CO2 and temperature are increasing on a similar timescale to ecosystem change, and the lag is found to be proportional to the rate of forcing. Thus peak sizes of the land carbon sink, and any future land carbon source, are proportional to the rate of increase of CO2. A switch from a land carbon sink to a source occurs at a higher CO2 and temperature under more rapid forcing. The effects of parameter uncertainty in temperature sensitivities of photosynthesis, plant respiration and soil respiration, and structural uncertainty through the effect of fixing the ratio of plant respiration to photosynthesis are explored. In each case, the CO2 fertilization effect on photosynthesis is constrained to reproduce the 1990 atmospheric CO2 concentration within a closed global model. New literature compilations are presented for the temperature sensitivities of plant and soil respiration. A lower limit, Q10=1.29, for soil respiration significantly increases future land carbon storage. An upper limit, Q10=3.63, for soil respiration underpredicts the increase in carbon storage since the Last Glacial Maximum. Fixing the ratio of plant respiration to photosynthesis (R/P) at 0.5 generates the largest and most persistent land carbon sink, followed by the weakest land carbon source.
Dementia – involving patients and their caregivers in a drama programme: the caregivers' experiences
Authors: Lepp Margret , Ringsberg Karin C. , Holm Ann‐Kristin , Sellersjö Gunilla 
Published: October 2003

Summary• A cultural drama programme was designed for patients with dementia and was led by teachers trained in drama in education and storytelling. The focus was on dance, rhythm, song, storytelling and conversations.• The aim of this study was to describe how a drama programme for patients with dementia and their caregivers was experienced by the caregivers.• Twelve strategically selected patients, 10 women and two men, with moderate and severe dementia, and their seven female caregivers participated in the programme. Sessions were held for one and a half hour, weekly once for 2 months. A focus group interview was held with the caregivers 1 month after the programme had ended. The interview and analysis of data were carried out according to the principles of phenomenography.• Two categories, ‘interaction’ and ‘professional growth’, and five subcategories emerged in the analysis. In these, the caregivers described how fellowship developed between the participants and how they shared joy and sorrow. The patients communicated with each other and the leaders, and the programme seemed to help the patients to remember and make associations with situations experienced earlier in their lives. The patients also showed knowledge and ability in things about which the caregivers were unaware until the time of the drama programme. In other daily life situations, the patients showed their feelings, both joy and sorrow, more openly, their self‐confidence grew and they showed greater interest in their surroundings. The caregivers furthermore expressed that they felt confirmed in their roles as caregivers. The programme prompted them to reflect upon their roles as caregivers.• In conclusion, a drama programme with cultural features seems to increase the quality of life in patients with dementia and strengthen the caregivers in their profession.
Burnout among nursing staff in accident and emergency and acute medicine: a comparative study
Authors: Gillespie Mark , Melby Vidar 
Published: October 2003

Summary• This study was designed to identify the prevalence of burnout among nurses working in Accident and Emergency (A & E) and acute medicine, to establish factors that contribute to stress and burnout, to determine the experiences of nurses affected by it and highlight its effects on patient care and to determine if stress and burnout have any effects on individuals outside the clinical setting.• A triangulated research design was used incorporating quantitative and qualitative methods.• Maslach Burnout Inventory was used.• Nurses working in acute medicine experienced higher levels of emotional exhaustion than their A & E counterparts. The overall level of depersonalization was low. High levels of personal accomplishment were experienced less by junior members of staff.• Stress and burnout have far reaching effects both for nurses in their clinical practice and personal lives. If nurses continue to work in their current environment without issues being tackled, then burnout will result. The science of nursing does not have to be painful, but by recognition of the existence of stress and burnout we can take the first steps towards their prevention.
Health promotion and health education viewed as symbiotic paradigms: bridging the theory and practice gap between them
Authors: Whitehead Dean 
Published: October 2003

Summary• A recognized ‘paradigm war’ exists between the two distinct approaches of health education and health promotion practice. This tension is both unhealthy and unhelpful and is known to have a profound effect on nursing activity.• Leading health promotionalists have begun to acknowledge the futility of the stated paradigm tension, realizing that health education and health promotion interventions are not that dissimilar in their origins and intentions. Progressive health education and health promotion programmes acknowledge the interrelatedness of both approaches and seek to incorporate favourable aspects of the two.• The aim of this article is to present arguments and stances that help to diffuse/avoid the stated paradigm conflict, as a basis for health education and health promotion reform in nursing. It also seeks to clarify the nature of both health education and health promotion practice so as to avoid contextual confusion. In doing so, this article draws significantly from the author's previous work.• This article concludes that the constructive review of any intended health education/health promotion programme lies in the consideration of each approach according to its own relative merits, what is required of the programme, and the nature of the setting in which the intervention takes place.
Paediatric day surgery: impact on Hong Kong Chinese children and their parents
Authors: Li Ho Cheung William , Lam Ho Yan Angie 
Published: October 2003

Summary• Paediatric day surgery is a potentially stressful and threatening experience for children and parents.• The purposes of this study were to investigate the effects of paediatric day surgery on anxiety level of Hong Kong Chinese children and their parents, and to examine the relationship between children's preoperative anxiety and their level of cooperation during induction and postoperative periods.• A total of 112 children admitted for circumcision with their parents in a day surgery unit were recruited. The state anxiety level for both children and parents was assessed at the time of admission and again at 4 hours after operation. Children's level of cooperation during the induction and the postoperative periods were also assessed.• The results showed that the preoperative anxiety level for both children and their parents was relatively high. Children with high preoperative anxiety levels were associated with lower levels of cooperation during induction and postoperative periods. The results also indicated that parents’ high state anxiety was associated with their children's high state anxiety.• This study designated that preoperative intervention to minimize children and parents’ anxiety is crucial and that there is still room for improvement.
Hospital in the home: constructions of the nursing role – a literature review
Authors: Duke Maxine , Street Annette 
Published: October 2003

Summary• Acute medical and nursing treatment in the home is increasingly seen as an alternative to hospitalization. Models such as hospital in the home (HITH) or acute home care are said to provide a safe, comfortable environment for patients that is conducive to healing.• A review of the literature reveals the embryonic nature of the research and discussion related to this alternative care delivery model. In general, the benefits of hospital in the home programmes are presented in an uncritical manner.• Medical practitioners have embraced the move to home care as a means of expanding the use of advanced technologies and improved drug regimes beyond the hospital walls.• The nursing response has been mechanistic and recipe‐like while advancing the HITH nursing role as an opportunity for speciality practice by virtue of the increased autonomy and independence required.• This review demonstrates the influence of a professional mandate for specialization, and the ideological and scientific interests that have influenced the role of the nurse.
Dementia and aggressiveness: video recorded morning care from different care units
Authors: Skovdahl Kirsti , Kihlgren Annica Larsson , Kihlgren Mona 
Published: October 2003

Summary• The aim of the study was to illuminate, from video recorded sequences, interactions between individuals with dementia and aggressive behaviour and caregivers who reported problems dealing with such behaviour and caregivers who did not. Nine caregivers and two residents participated.• The video recordings were later transcribed into text and analysed by using a phenomenological hermeneutic approach, inspired by Ricoeur's philosophy.• The main themes that emerged from the analysis were ‘Being involved and developing a positive interaction’ and ‘Being confined to routines and remaining in negative interaction’.• The findings indicated the interactions either to be in a positive or negative spiral. Caregivers who had reported problems dealing with behavioural and psychiatric symptoms in dementia focused on accomplishing the task, where the main focus was on ‘the goal itself’. In other sequences with caregivers who had been satisfied with their capability the focus was placed on ‘how’ the caregivers could reach their goal.• Power was central in the material, in different ways, either as a possible way to handle the situation or as a possible way of defending oneself. Parts of Kitwood's framework and Fromm's theory about power ‘over’ and power ‘to’, has been used in the comprehensive understanding.• Our conclusion is that caregivers should use power ‘to’ when they have to help persons with dementia and aggressive behaviour, as a part of behavioural and psychiatric symptoms of dementia, for being able to give help in the best possible way. They should also act in a sensitive and reflective manner, with the individual in focus.
Information provided to patients undergoing gastroscopy procedures
Authors: Thompson Kate , Melby Vidar , Parahoo Kader , Ridley Tanya , Humphreys William G. 
Published: October 2003

Summary• This study aimed to investigate the information provided to patients undergoing gastroscopy procedures in Northern Ireland.• Questionnaires were developed by the authors and were completed by 402 patients (RR = 43.8%) and 62 nurses (RR = 75.6%).• Patients received most of the procedural information from nurses, and they recognized the importance of providing sensory information. Patients were generally satisfied with the information provided.• There is clear evidence of fragmented care, and major changes are required to ensure that patients receive holistic information that includes procedural and sensory aspects.• Nurses and doctors must realize that their role in information giving is to ensure that comprehensive information is provided by the appropriate professional at the appropriate time.
Patient anxiety and modern elective surgery: a literature review
Authors: Mark Mitchell 
Published: October 2003

Summary• Medical advances have led to a considerable rise in the level of elective surgery undertaken as day‐case surgery and with minimal hospital stay. However, amid such advances, preoperative psychological care has remained relatively static.• A considerable number of patients are very anxious prior to elective surgery and little formal care is undertaken to address this major issue. A review of the literature from 1990 to 2002 was therefore undertaken in order to assess the present level of knowledge and interventions concerning patient anxiety when undergoing modern, intermediate surgical intervention.• Thirty‐four studies embracing data from 3754 patients undergoing both inpatient and day‐case procedures were reviewed. Three main themes emerged – causes of anxiety, clinical concerns and measurement, and anxiety management.• Each theme is discussed alongside details extracted from the relevant studies. Finally, the main issues arising are summarized and future research challenges identified.
Clinical supervision – factors defined by nurses as influential upon the development of competence and skills in supervision
Authors: Landmark Bjørg Th. , Hansen Grethe Storm , Bjones IngebjØrg , BØhler Ann 
Published: October 2003

Summary• The aim of this study was to describe factors defined by nurses as influential upon the development of competence and skills in supervision.• Although clinical supervision has been widely studied and described during the last decade, influential factors regarding the development of supervisory competence, as defined by clinical supervisors themselves, is little documented.• Focus group interviews were analysed using methods of qualitative content analysis as described by Kvale.• Factors related to three areas of importance for the development of competence and skills in student supervision are defined by nurses in this study. They are didactics, role functions and organizational framework. Didactic factors described included: integration of theory and practice; reflection on clinical situations; clarification of supervision aims and student evaluation. Role function factors were described as: feelings of security and awareness in supervision, differentiation between student and supervisor roles and the meaning attached to being a role model. Framework factors included nursing faculty and clinical field expectations.• An understanding of how nurses describe what they need to support their development as clinical supervisors gives a basis for the development of postgraduate education in clinical supervision. Competent clinical supervisors can be better able to support students as they build bridges between theory and practice.
Corticosteroid use and risk of hip fracture: a population‐based case–control study in Denmark
Authors: Vestergaard P. , Olsen M. L. , Paaske Johnsen S. , Rejnmark L. , Toft Sørensen H. , Mosekilde L. 
Published: October 2003

Abstract.Vestergaard P, Olsen ML, Paaske Johnsen S, Rejnmark L, Toft Sørensen H, Mosekilde L (Aarhus University Hospital, Denmark; and Aarhus and Aalborg University Hospitals; Aarhus, Denmark). Corticosteroid use and risk of hip fracture: a population‐based case–control study in Denmark. J Intern Med 2003; 254: 486–493.Background. Corticosteroids (CS) are used in a wide range of conditions but have several possible adverse effects including an increased risk of osteoporotic fractures.Objective. To examine the association between cumulative CS dose and risk of hip fracture.Design. Population‐based case–control design.Subjects and methods. A total of 6660 subjects with hip fracture and 33 272 age‐matched population controls were identified using the County Hospital Discharge Registry in North Jutland County, Denmark and the Danish Central Personal Registry, respectively. Data on redeemed prescriptions for CS within the last 5 years before the index date were retrieved from a population‐based prescription database, and recalculated to prednisolone equivalents. Cases and controls were categorized according to cumulative CS dose: (i) no use; (ii) <130 mg (e.g. equivalent to 30 mg of prednisolone for 4 days given for an acute exacerbation of asthma); (iii) 130–499 mg (e.g. equivalent to a short course of prednisolone of 450 mg for acute asthma); (iv) 500–1499 mg (e.g. equivalent to 7.5 mg prednisolone daily for 6 months or 800 μg day−1 of inhaled budesonide for 1 year); and (v) ≥1500 mg (e.g. equivalent to >4.1 mg day−1 for 1 year, a long‐term high dose). Data were analysed using conditional logistic regression adjusted for potential confounders including gender, redeemed prescriptions for hormone replacement therapy, antiosteoporotic, anxiolytic, antipsychotic and antidepressant drugs.Results. Compared with never users, an increased risk of hip fracture was found for CS users, with increasing cumulative doses of any type of CS use during the preceding 5 years [adjusted odds ratio (OR) = 0.96, 95% confidence interval (CI) = 0.89–1.04] for <130 mg prednisolone; OR = 1.17 (CI = 1.01–1.35) for 130–499 mg; OR = 1.36 (CI = 1.19–1.56) for 500–1499 mg; and OR = 1.65 (CI = 1.43–1.92) for ≥1500 mg. An increased risk was also found when the study population was stratified according to gender, age and type of CS (systemic or topical).Conclusions. Even a limited daily dose of CS (more than an average dose of approximately 71 μg prednisolone per day) was associated with an increased risk of hip fracture.
Homocysteine and its relation to B‐vitamins in Graves’ disease before and after treatment: effect modification by smoking
Authors: Nedrebø B. G. , Hustad S. , Schneede J. , Ueland P. M. , Vollset S. E. , Holm P. I. , Aanderud S. , Lien E. A. 
Published: October 2003

Abstract. Nedrebø BG, Hustad S, Schneede J, Ueland PM, Vollset SE, Holm PI, Aanderud S, Lien EA (University of Bergen; Haukeland University Hospital, Bergen; and Haugesund Hospital, Haugesund; Norway). Homocysteine and its relation to B‐vitamins in Graves’ disease before and after treatment: effect modification by smoking. J Intern Med 2003; 254: 504–512.Objectives. To investigate plasma total homocysteine levels and its relation to B‐vitamins and smoking in Graves’ disease before and after antithyroid therapy.Design. A longitudinal study taking place at four hospitals in Norway.Methods and subjects. Plasma total homocysteine, serum folate, serum cobalamin and riboflavin, flavin mononucleotide and flavin adenine dinucleotide in plasma were investigated in 182 patients with hyperthyroidism before treatment. The same parameters were reinvestigated in 112 of these patients after attaining euthyroid state.Results. In hyperthyroidism, plasma total homocysteine was low, and inversely related to folate, cobalamin and riboflavin, and positively related to serum creatinine and age. Following antithyroid therapy, total homocysteine increased and the concentration of folate, cobalamin, riboflavin, flavin mononucleotide and flavin adenine dinucleotide decreased significantly. The most pronounced reduction (35%) was observed for flavin mononucleotide. In the hyperthyroid state, smokers had lower levels of folate and flavin mononucleotide than non‐smokers. After restoration of euthyroidism, both folate and riboflavin were significantly lower in smokers than non‐smokers. Plasma total homocysteine increased according to decreasing quartiles of B‐vitamins. For riboflavin, this relation was confined to smokers.Conclusion. Plasma total homocysteine changes according to thyroid status. These changes may be partly attributable to altered folate, cobalamin but also riboflavin status, particulary in smokers.