bluuebunny/crossref_metadata_2025_split huggingface dataset:
Developing services to support parents caring for a technology‐dependent child at home
Authors: Kirk S. , Glendinning C. 
Published: April 2004

AbstractBackground  A group of children with complex health care needs have emerged as a result of medical advances and government policies emphasizing the community as the arena for care. Some of these children remain dependent on the medical technology that enabled them to survive and require care of a complex and intensive nature to be carried out by their parents at home.Aims  To explore the experiences of families caring at home for a technology‐dependent child; to examine their needs for practical and other support; and to examine how far services are currently meeting these needs.Methods  In‐depth interviews were conducted with the parents of 24 technology‐dependent children and with 44 health, social care and other professionals.Results  Services in the community were not sufficiently developed to support this group of families. Major problems were identified in the purchasing and provision of both short‐term care/home support services and specialist equipment/therapies in the community. Service provision could be poorly planned and co‐ordinated at an operational level and few families had a designated key worker. Parents felt that professionals did not always recognize either the emotional costs entailed in providing care of this nature or their expertise in caregiving. Information‐giving to parents was often described as poor and participants reported that hospital professionals failed to negotiate the transfer of caregiving responsibility to parents.Conclusions  Services need to work in partnership with families and with each other at both strategic and operational levels, to develop integrated and co‐ordinated services that can meet the needs of this group of families.
Classification of Leptospira from the Eyes of Horses Suffering from Recurrent Uveitis
Authors: Hartskeerl R. A. , Goris M. G. A. , Brem S. , Meyer P. , Kopp H. , Gerhards H. , Wollanke B. 
Published: April 2004

SummaryThe pathogenesis of equine recurrent uveitis (ERU) is not completely understood. Persistent infection of pathogenic leptospires in the eyes is the probable primary cause. Consistently, we isolated and characterized in this study leptospires from 32.2% of the intraocular samples collected from 501 horses from the following Western European countries: Germany, Switzerland, Austria, The Netherlands, Luxembourg, Great Britain, Italy and Poland. The vast majority of the leptospiral isolates belonged to serogroup Grippotyphosa (78.2%). The other isolates belonged to the Australis group (14.2%), the Sejroe group (3.6%), the Pomona group (2.5%) and the Javanica group (1.5%). Apart from three isolates that likely belong to Leptospira kirschneri, serovar Dadas, all Grippotyphosa group isolates belonged to L. kirschneri, serovar Grippotyphosa. Analysis with monoclonal antibodies revealed that the isolates differed from Moskva V, the reference strain of serovar Grippotyphosa. However, the Grippotyphosa isolates closely resembled serovar Grippotyphosa, strain Duyster, which has been isolated from a Dutch patient. Because of apparent phenotypic and genotypic differences between the strains Moskva V and Duyster, we propose two different types within serovar Grippotyphosa, namely type Moskva and type Duyster. Distribution of type Duyster is restricted to Western Europe. Strikingly, only a few serovars were isolated from the eyes of horses with ERU. A number of other commonly occurring serovars, such as Copenhageni, were not found, whereas the presence of antibodies in blood and eye fluids against such serovars suggests that infection occurs. Therefore, we hypothesize that, while many pathogenic serovars might be able to penetrate the eyes, only few are capable to persist.
Purification and Characterization of a novel Staphylococcus chromogenes Exfoliative Toxin
Authors: Sato H. , Hirose K. , Terauchi R. , Abe S. , Moromizato I. , Kurokawa S. , Maehara N. 
Published: April 2004

Summary Staphylococcus chromogenes strains were isolated in pure culture from six to eight adult pigs affected with exudative epidermitis (EE), while those were isolated from healthy adult pigs, piglets affected with EE and healthy piglets at low rate. The culture filtrates (CFs) of the above isolates caused rounding effect on cultured cells and exfoliation in 1‐day‐old chickens. The exfoliative toxin was isolated from CF of a strain (PC‐16) possessed strong toxic activity and designated S. chromogenes exfoliative toxin (SCET). The SCET was purified by gel filtration on a Sephadex G‐75 column, and sodium dodecyl sulphate‐polyacrylamide gel electrophoresis (SDS‐PAGE). The purified SCET caused exfoliation in 1‐day‐old chickens. The SCET has no caseinolytic protease activity. The SCET was serologically different from S. aureus exfoliative toxins (ETA, ETB and ETC), S. hyicus exfoliative toxins (SHETA and SHETB), and S. intermedius exfoliative toxin (SIET). The molecular weights of SCET (30 kDa) were slightly larger than those of ETs (27 kDa) and SHETs (27 kDa), but almost same as SIET. The SCET caused exfoliation in 1‐day‐old chickens, but not in suckling mice. The SCET was a heat‐stable toxin as well as a S. aureus exfoliative toxin A (ETA). When SCET was inoculated subcutaneously into piglets, the exfoliation were observed in the skin of piglets after 24 h of injection.
Coral reef cascades and the indirect effects of predator removal by exploitation
Authors: Dulvy Nicholas K. , Freckleton Robert P. , Polunin Nicholas V. C. 
Published: April 2004

AbstractFisheries exploitation provides the opportunity to examine the ecosystem‐scale biodiversity consequences of predator removal. We document predatory reef fish densities, coral‐eating starfish densities and coral reef structure along a 13‐island gradient of subsistence exploitation in Fiji. Along the fishing intensity gradient, predator densities declined by 61% and starfish densities increased by three orders of magnitude. Reef‐building corals and coralline algae declined by 35% and were replaced by non‐reef building taxa (mainly filamentous algae), as a result of starfish predation. Starfish populations exhibited thresholds and Allee‐type dynamics: population growth was negative under light fishing intensities and high predator densities, and positive on islands with higher fishing intensities and low predator densities. These results suggest the depletion of functionally important consumer species by exploitation can indirectly influence coral reef ecosystem structure and function at the scale of islands.
Usable Knowledge in Public Policy
Authors: Adams David 
Published: April 2004

The range of usable information for public policy is complex and distributed but policy debate is still dominated by instrumental and centralised information constructed and controlled by functional and managerial experts—the creed of expertise. In recent years other types of ‘usable’ knowledge has begun to flow back into policy streams and in particular local knowledge (sometimes called community knowledge) is staging a major revival. This inductive knowledge is now being merged with the deductive paradigms of new public management.In the first section I illustrate the key features of expert‐based knowledge and how it pervades our thinking about how policy happens and the valued content of policy. Then I outline the types of usable information that flows into government and therefore constitutes the basic building blocks for knowledge. Finally, I drill down to expand on the idea of community knowledge and illustrate what it actually looks like.
Not Just Steering but Weaving: Relevant Knowledge and the Craft of Building Policy Capacity and Coherence
Authors: Parsons Wayne 
Published: April 2004

The whole process of royal weaving is comprised—never to allow temperate natures to be separated from the brave, but to weave them together, like the warp and the woof, by common sentiments and honour and reputation, and by the giving of pledges to one another; and out of them forming one smooth and even web, to entrust to them the offices of State.(Plato 1892:517–8)
This paper explores the theory and practice of building policy capacity and coherence and in particular focuses on its epistemological and ontological aspects and assumptions. It argues that designing for capacity and coherence has been overwhelmingly concerned with improving the instrumental rationality of policy‐making through a more systematic and strategic use of knowledge. However, I argue that this instrumentalism has meant that designing has worked within a very tightly constructed epistemological regime which has tended to neglect non‐instrumentalist approaches to policy knowledge and learning. I review some of these non‐instrumentalist approaches and suggest that they provide both a critique of the dominant paradigm and offer alternative ways of framing the problem of building policy capacity and coherence.
Biomechanical Evaluation of Suture Pullout from Canine Arytenoid Cartilages: Effects of Hole Diameter, Suture Configuration, Suture Size, and Distraction Rate
Authors: Mathews Kyle G. , Roe Simon , Stebbins Marty , Barnes Roy , Mente Peter L. 
Published: April 2004

Objective—To evaluate the mechanical properties of canine arytenoid cartilage–suture constructs.Study Design—Experimental study.Sample Population—Eighty canine cadaveric larynges.Methods—Arytenoid cartilage–suture constructs were loaded to failure on a materials testing machine. The effect of hole size, suture configuration, suture size, and rate of distraction on load at failure, displacement at failure, energy to failure, and construct stiffness were evaluated. Polypropylene sutures were used exclusively. Specific variables evaluated were: (1) hole size—SH needle, 22, 20, and 18 ga hypodermic needles; (2) suture configurations—single dorsal and ventral articular sutures, double sutures, horizontal mattress, locking loop, and single non‐articular sutures; (3) suture size—1, 0, 2‐0, and 3‐0; and (4) distraction rate—0.83 and 36.66 mm/s.Results—Hole size had no effect on any biomechanical variable. Double suture and horizontal mattress configurations had the highest median load and energy at failure. Single dorsal suture configurations that did not include the arcuate crest had the lowest median load at failure. Larger suture sizes tended to result in stiffer constructs. Cartilage–suture constructs behaved in a viscoelastic manner where load at failure, energy at failure, and stiffness increased when distraction rate was increased, whereas displacement at failure did not. Most constructs failed by suture pullout regardless of distraction rate, although 50% of horizontal mattress configurations failed by avulsion of the muscular process.Conclusion—Suture and hole sizes appear to have few effects on the biomechanical performance of arytenoid–suture constructs. Double‐suture and horizontal mattress suture patterns had the best overall mechanical properties for arytenoid lateralization. Single‐suture techniques, which do not incorporate the arcuate crest, were biomechanically inferior.Clinical Relevance—Cumbersome large‐diameter sutures offer no advantage over smaller sutures when performing arytenoid lateralization. The cross‐sectional geometry of the muscular process should be taken into account when placing sutures in the arytenoid cartilages. Single‐suture techniques that do not incorporate the arcuate crest should be avoided.
Survey of Prokinetic Use in Horses with Gastrointestinal Injury
Authors: Van Hoogmoed Linda M. , Nieto Jorge E. , Snyder Jack R. , Harmon Faye A. 
Published: April 2004

Objective—To report prokinetic strategies used to manage horses after gastrointestinal surgery.Design—Electronic questionnaire.Sample Population—Diplomates of the American College of Veterinary Surgeons (ACVS) who perform equine intestinal surgeryProcedure—A survey (21 questions) designed to determine use of prokinetic agents was sent electronically to 112 ACVS Diplomates known to perform equine intestinal surgery. Several clinical scenarios were also described to determine which, if any, prokinetic agent respondents would select.Results—Responses were obtained from 58 (52%) surgeons from 44 clinics. Selection of prokinetic agent for specific gastrointestinal conditions was relatively uniform whereas there was considerable variation in dose administered. For postoperative ileus (POI) associated with most intestinal lesions, 2% lidocaine was most commonly selected. Other prokinetics in decreasing frequency of use were erythromycin lactobionate, metoclopramide, and cisapride. Prokinetic agents were more commonly administered after small intestine strangulating obstructions and less commonly for large intestinal lesions. No novel agents were identified by respondents.Conclusions—Prokinetic drugs are commonly used for the management and/or attenuation of POI in horses, but dosages and routes of administration are variable.Clinical Relevance—Although prokinetics are commonly used for management of POI in horses there is clearly a need for more controlled studies to define efficacious dosing and a need to develop new prokinetic drugs.
Evaluation of a Technique for Collection of Cancellous Bone Graft from the Proximal Humerus in Horses
Authors: Harriss Fiona K. , Galuppo Larry D. , Decock Hilde E. V. , Mcduffee Laurie A. , Macdonald Melinda H. 
Published: April 2004

Objectives— To describe a technique for collecting cancellous bone graft from the proximal humerus in horses.Study design— Prospective evaluation of an experimental bone graft collection techniqueAnimal population— Eight horses, 3–15 years, weighing 495–605 kg.Methods— Horses were anesthetized and positioned in lateral recumbency. The lateral aspect of the proximal humerus was exposed by a 7–10‐cm incision extending distally from the greater humeral tubercle, followed by sharp dissection through the omotransversarius muscle and between the infraspinatus and deltoideus muscles. A 12‐mm cortical defect was incrementally created in the lateral proximal humerus. Human bone graft harvesting equipment (Acumed®, Beaverton, OR) was drilled through this defect to collect a core of cancellous bone. In five horses additional cancellous bone was then collected with conventional instruments. Bone samples were weighed and histologically examined. Horses were monitored and graded for quality of anesthetic recovery, incisional complications, and postoperative lameness.Results— Total mean (±SD) surgical time for harvesting bone with the Acumed® system and traditional techniques (n=5) was 38±6 minutes (range, 32–47 minutes). Mean cancellous bone weight collected with the Acumed® system was 3.6±0.8 g (range, 2.0–4.6 g), and cancellous bone collected conventionally was 25.6±7.5 g (range, 16.8–34.2 g). Minimal incisional complications or postoperative lameness were observed. Mortality was 12.5%; one horse fractured the operated humerus during anesthetic recovery.Conclusion— The Acumed® system provided limited cancellous bone when used with the technique described. However, the quantity of cancellous bone collected with traditional harvesting instruments was comparable to other sites used in horses. The procedure was associated with minimal postoperative incisional complications or lameness, but because one horse suffered a catastrophic humeral fracture further research is required to assess the effects of this procedure on humeral breaking strength.Clinical Relevance— Based on the risk of catastrophic fracture, this technique cannot be recommended for use in clinical cases, especially if an unassisted recovery from general anesthesia is planned.
Integrated Literature Review of Continuity of Care: Part 1, Conceptual Issues
Authors: Sparbel Kathleen J. H. , Anderson Mary Ann 
Published: April 2004

Purpose: Continuity of patient care is a fundamental tenet of professional nursing, yet comprehension of the concept and related issues remains elusive. The purpose of this study was to explore issues associated with definitions, related concepts, and research methods of continuity of care through systematic literature‐based study. In Part 1 of this two‐part series, definitions and related concepts, factors, and variables associated with continuity of care were explored.Design: Qualitative, integrated literature review of a sample of 38 nursing research articles about continuity of care, 1990–1995.Methods: Ganong's (1987) stages of an integrative research review guided this study. A data collection tool was developed and pilot tested, and rules for data analysis and interpretation were established. Research articles were systematically analyzed and reported using descriptive analysis.Findings and conclusions: No consensus was found in the literature about the conceptual definition of continuity of care. Continuity of patient care is a multifactorial concept affected by environmental influences, communication, patient, professional, and system factors.
Nursing Education at an Art Gallery
Authors: Wikström Britt‐Maj 
Published: April 2004

Purpose: To introduce an experiential teaching‐learning method in nursing education based on art gallery visits. Works of art communicate a broad spectrum of human experiences and thoughts, and can be useful when studying interpersonal relations.Design: Theoretical framework on experiential learning was based on writings of Dewey and Burnard. Data were collected from nursing students (N = 206) at a university college of health sciences in Sweden during a 3‐year period, 1995–1998.Method: The pedagogical approach was experiential and based on three phases: observation, conceptualisation, and reflection. When students visited the art gallery, they were encouraged to look for metaphoric expressions of interpersonal relations. Students were asked to interpret the art, report findings to fellow‐students, and evaluate the program.Findings: Studying works of art was a powerful teaching‐learning method for understanding interpersonal relations. Students related interpretations of a work of art to interpersonal relations in nursing.Conclusions: Nursing students' observations and understanding of interpersonal relations were enhanced by the art gallery program.
End‐of‐Life Decision Making for Nursing Home Residents with Dementia
Authors: Forbes Sarah , Bern‐Klug Mercedes , Gessert Charles 
Published: April 2004

Purpose: To describe families' decision‐making processes, both cognitive and affective, regarding end‐of‐life treatments for nursing home residents with moderately severe to very severe dementia.Design: Naturalistic inquiry provided the framework for this descriptive, qualitative study.Methods: Four focus groups were conducted in selected nursing homes, in the central part of the United States for a qualitative study. Twenty‐eight family members of residents with moderately severe to severe dementia shared their decision‐making experiences. Open‐ended questions were asked in each focus group. Data were analyzed using content analysis.Findings: Five themes were identified that describe the context of decision making: emotional effect, insult‐to‐life story, two faces of death, values and goals regarding end‐of‐life treatments, and the unrecognized trajectory of dying. Family members made decisions in an emotional climate of overwhelming burden and guilt, because their loved one's life had been robbed of personhood, the changes associated with decline from a dementia‐related illness were unrecognized as part of a trajectory of dying, death was both a tragedy and a blessing.Conclusions: Family members had poignant, unresolved emotional needs stemming from their loved one's illness and nursing home placement. Participants were unprepared to make end‐of‐life treatment decisions and lacked the informational and emotional support of a consistent provider to help with decisions. Family members need assistance in processing difficult and painful emotions, understanding the trajectory of disease, what decisions might impede a natural death, and comfort or palliative care options.
Nursing and Health Policy
Authors: Gebbie Kristine M. , Wakefield Mary , Kerfoot Karlene 
Published: April 2004

Purpose: To describe ways nurses are and are not effective in the development of health policy in the United States today, and to provide useful information for those interested in making nursing a more vital part of the policy arena.Design: Qualitative examination of the career experiences and observations of a purposive sample of 27 American nurses currently active in health policy at the national, state, local, or organizational level.Method: Semi‐structured interviews regarding career path, contributing resources improvement of resources available to nurses, and the strengths and weaknesses of currently available information for policy work.Findings: For nurse participants, policy involvement meant speaking for patients in arenas where those need of care have limited voice. Participation occured after assessment, diagnosis, and planning revealed the need for change in the way resources were allocated. Strong belief in the capacity and importance of people caring for themselves distinguished nurses in their policy roles. Policy makers responded to the experiences and determinants of health and illness as presented by nurses.Conclusion: Once engaged, nurses seldom turned their backs on the world of policy‐making. However, they did not report significant use of nursing research or information in policy making. Further investigation and testing of systems to connect nurse policymakers with nurse scholars are recommended.
Effects of Home Visits to Vulnerable Young Families
Authors: Kearney Margaret H. , York Ruth , Deatrick Janet A. 
Published: April 2004

Purpose:Nurses' home visits to new parents have been replaced in many high‐need communities by nonprofessional visits without clear evidence of effectiveness. Previous reviews of home visiting research have combined nurse and non‐nurse interventions and have pooled studies from the US, where home visiting is mainly limited to low‐income families, with those from nations where home visiting is a universal service. This integrative review was focused on nurse‐delivered interventions in the US and Canada to identify the nursing‐specific models with the greatest effect in this cultural context. Evaluation of support for social ecology theory was a secondary aim.Design:The sample consisted of 20 experimental and quasi‐experimental studies of home nursing interventions for families of newborn infants who were vulnerable because of poverty, social risks, or prematurity.Methods:Each report was examined systematically using specific rules of inference and a scoring system for methodological quality. Intervention effects on five outcome domains were described.Findings:Maternal outcomes, maternal‐infant interaction, and parenting were more often influenced than was child development, except in preterm infants. Well‐child health care did not improve. Effective programs generally began in pregnancy, included frequent visits for more than a year, had well‐educated nurses, and were focused on building a trusting relationship and coaching maternal‐infant interaction. Social ecology theory was partially supported.Conclusions:Future nurse home‐visiting research should test a combination of these effective components. Nurses can use this information to seek funding of nurse‐delivered interventions for vulnerable families.