bluuebunny/crossref_metadata_2025_split huggingface dataset:
A comparison of the naloxone test with the insulin stress test in patients following transsphenoidal surgery
Authors: McAllister  , McCance  , Hadden  , Bell  , Leslie  , Sheridan  , Atkinson  
Published: July 2002

OBJECTIVETo study the reliability of the naloxone test in assessing the hypothalamic‐pituitary‐adrenal (HPA) axis in patients following transsphenoidal pituitary surgery, by comparison with the insulin stress test (IST). Also, to establish a normal range for the response to naloxone in healthy controls.DESIGNAll patients had the IST performed, soluble insulin 0.1–0.3 U/kg (usually 0.15 U/kg) being administered intravenously, followed by venous sampling for plasma glucose and serum cortisol at 0, 15, 30, 45, 60, 75 and 90 minutes. Naloxone (125 μg/kg body weight) was similarly administered to all patients 6 days later, with sampling at −15, 0, 15, 30, 45, 60, 90 and 120 minutes for plasma glucose, serum cortisol and plasma ACTH. The naloxone test was also performed on control subjects using an identical protocol.SUBJECTSTwenty patients (11F/9M) aged 48.8 ± 2.8 years (mean ± SE) 4–6 weeks following transsphenoidal pituitary surgery. Twelve normal healthy control subjects (6F/6M) aged 31.5 ± 3.0 years.MEASUREMENTSSerum cortisol was measured by radioimmunoassay and plasma ACTH by immunoradiometric assay.RESULTSAdequate hypoglycaemia (≤2.0 mmol/l) was achieved in all patients. Peak cortisol was >550 nmol/l in 17 subjects (range 572–867 nmol/l) and a subnormal response observed in 3 (peak cortisol 163–498 nmol/l). In the 17 patients with a normal cortisol response to hypoglycaemia the response to naloxone was extremely variable, with serum cortisol falling in 4 and an increment of ≤100 nmol/l in 6 others. In the 3 patients who failed the IST, two responded to naloxone and one did not. In normal controls, 3 of the 12 had little or no response to naloxone.CONCLUSIONSAs the naloxone test fails to produce a response in all normal subjects it is impossible to define a ‘normal’ response. The numerous discrepancies with the IST in patients are further evidence of the test's lack of reliability in assessing the HPA‐axis and it is consequently not a viable alternative to traditional dynamic methods such as the IST.
Food availability and the nocturnal vs. diurnal foraging trade‐off in juvenile salmon
Authors: Metcalfe Neil B. , Fraser Neil H. C. , Burns Martin D. 
Published: July 2002

1.Much attention has been devoted to explaining the spatial distribution of foraging animals, but rather little to their temporal distribution (i.e. whether they are diurnal, nocturnal or crepuscular). Many animals face predictable diel cycles of food availability or predation risk, and so the approach of measuring the relative ratio of mortality risk to food gained (the ‘minimize μ/f’ rule) can be applied equally as well to different time periods of the day as to alternative food patches or habitats.2.This method is used here to investigate the diel activity patterns of juvenile Atlantic salmon, which have previously been shown to become increasingly biased towards nocturnal activity in winter, hiding for much of the day in streambed refuges. Calculations based on published data show that nocturnal foraging in winter is far safer per unit of food obtained than is diurnal, despite greatly reduced food capture efficiency at night‐time light levels.3.Using an automated activity monitoring system based on passive integrated transponder (PIT) tags, this study shows that winter diel activity patterns in salmon are dependent on food availability. A change in food density led to a parallel change in time spent in the refuge, but (as predicted by the μ/frule) the effect was greatest at the time of day with the least favourable ratio of predation cost to feeding benefit. Thus an experimental increase in food availability led to a 16% reduction in time spent in nocturnal foraging but a 98% reduction in time spent foraging by day, with fish spending only 0·6% of the daylight hours out of the refuge at the highest food density.4.However, brief daytime foraging bouts had a major impact on growth rates (presumably because feeding efficiency was much greater in daylight), especially when food was scarce. Daytime feeding was thus profitable in terms of rapid food acquisition but normally suboptimal in terms of risk of predation.5.Daily activity patterns are therefore suggested to be the result of a complex trade‐off between growth and survival, which takes account of diel fluctuations in food availability, food capture efficiency and predation risk; individual variation in the extent of diurnal feeding in salmon may result from state‐dependent differences in the benefits of rapid feeding and growth.
Early enhanced enteral nutrition in burned patients is associated with fewer infective complications and shorter hospital stay
Authors: Taylor S. J. 
Published: July 2002

Summary Background: Major burn injury causes a catabolic state associated with depressed immunocompetence and a high incidence of morbidity and mortality. Previous studies have shown that provision of patients’ energy and nitrogen requirements early in the postburn period reduces net catabolism and supports the immune response. Methods: This observational study determined the effect of providing at least 50% of a patient's estimated requirement of energy and nitrogen (‘enhanced enteral nutrition, EN’) in 106 burned patients requiring intravenous fluid resuscitation. Multiple regression was used to determine associations between the delay to enhanced EN and the incidence of death, infection and total complications, and hospital stay. Results: Delay to enhanced EN was associated with infective complications (P=0.01) when adjusted for potential confounding factors. The risk of infection increases from 29% at 24 h to 66% at 48 h (number needed to treat, NNT: 3, and 1.5, respectively). In addition, the delay to enhanced EN was associated with hospital stay (P=0.001, 95% CI 1.5–5.5). A delay of 24 h was associated with an increase in hospital stay of 3.5 days. The associations held in survivors as well as the total group and therefore were not the result of early death causing a reduction in infections and hospital stay. No associations were found with death or total complications. Conclusion: Earlier commencement of EN which meets 50% of estimated energy and nitrogen requirements may reduce the incidence of infection and hospital stay. The potential clinical benefits and cost savings must be confirmed in prospective randomized controlled trials.
Postregistration training and education: the NAGE experience
Authors: Copeman J. , Hyland K. , Oldfield G. 
Published: July 2002

Summary Background: This paper reviews the NAGE postregistration course and describes how it has responded to the changing demands of the major stakeholders in the health and social care sectors. It demonstrates how the course team have fulfilled the stated aims and objectives and sought to provide a rich experience for the course participants while being aware of the changing needs of the National Health Service (NHS) and expectations of dietitians, other health professionals and the wider community, particularly with the formation of Primary Care Groups (PCGs). Evidence to inform this review is drawn from a range of sources including dietetic managers, dietitians working with older people, past participants and course evaluations. Aims: The overall purpose of the course has been to enhance the ability of the participants, i.e. dietitians working with older people, to reflect on their professional practice and become more effective in their membership of the multidisiciplinary team, with the ultimate goal of improving the provision of health care for older people and enhancing their quality of life. This ultimate goal is in line with the government Quality Agenda as reflected in the First Class Service and clinical effectiveness and the future National Service Framework for Older People. Structure: The review is divided into three broad sections: detailed reflection of the courses held; nutrition and dietetic managers views; changes in the external environment that directly and indirectly influence the course.
Management of diabetic retinopathy by Australian optometrists
Authors: Mph Cathy A McCarty PhD , Mph Rob McKay Mbbs , PhD Jill E Keeffe , Distribution The Working Group on Evaluation of Nhmrc Retinopathy Guideli 
Published: July 2002

Purpose: To describe current practices related to the management of diabetic retinopathy by Australian optometrists. Setting and Methods: A two‐page self‐administered questionnaire was mailed to a random sample of 504 Australian optometrists. The survey included questions about the practice (such as size and location); current practice with regard to management of patients with diabetic retinopathy; barriers to use of dilating drops; and a number of patient scenarios related to screening, follow‐up and treatment of diabetic retinopathy. Results: Completed questionnaires were returned by 407 of the 473 eligible optometrists (86%). They had been practising optometry between 1 and 50 years (median 14). Of the 243 optometrists who provided details about the location of their practices, 145 (37%) had at least one of their practices in a rural area. The estimated percentage of patients with diagnosed diabetes ranged from 0.5 to 40% (median = 5.0%). Three‐hundred and twenty‐two optometrists (79%) reported that they would often or almost always ask new patients over the age of 40 whether they have diabetes. The majority of optometrists (n = 387, 95%) would often or almost always ask their new patients with diabetes about their control of blood glucose levels and the majority of optometrists (n = 330, 81%) would often or almost always tell their patients with diabetes about the importance of strict glucose control in delaying retinopathy. The most common barrier to dilated ophthalmoscopy was patients not wanting to be dilated, with 38.1% of optometrists reporting this to be a moderate or major barrier. The next most common barrier was fear of precipitating angle closure glaucoma; 17.1% of optometrists reported this to be a moderate or major barrier. Conclusion: The National Health and Medical Research Council (NHMRC) guidelines for the management of diabetic retinopathy are timely in relation to the expressed desire of Australian optometrists to learn more about management of diabetic retinopathy. These data will be used prospectively to assess changes in management of patients with diabetic retinopathy as a result of the release of the NHMRC guidelines.
Preretinal haemorrhages: an unusual manifestation of intravitreal amikacin toxicity
Authors: Md Atul Kumar , Md Tanuj Dada 
Published: July 2002

Purpose: To report a case with multiple preretinal haemorrhages after intravitreal amikacin. Method: A 58‐year‐old patient developed postoperative endophthalmitis following a routine extracapsular cataract extraction in his left eye. He received two intravitreal injections of cephazoline (2.25 mg) and amikacin (0.4 mg), given 48 h apart. Results: The patient presented to us with large preretinal haemorrhages at the posterior pole. Multiple large areas of blocked fluorescence were seen on fundus fluorescein angiography. Conclusion: Widespread posterior pole preretinal haemorrhages may be an unusual manifestation of intravitreal amikacin toxicity.
Paediatric ureteric calculi: efficacy of primary in situ extracorporeal shock wave lithotripsy
Authors: AL Busaidy  , Prem  , Medhat  , Giriraj  , Gopakumar  , Bhat  
Published: July 2002

Objective To evaluate the efficacy of primary in situ extracorporeal shockwave lithotripsy (ESWL) for the treatment of ureteric calculi in children.Patients and methods The Wolf 2500 Piezolith was used to treat 63 children (aged 4 months to 12 years) with 76 ureteric calculi, including 10 children with impacted calculi. The calculi were located in 14 upper, 13 mid and 44 lower ureters, and the stone burden varied from 4 to 17.8 mm (mean 12.6). All children aged ≤10 years were treated under general anaesthesia; lithotripsy was attempted under intravenous sedation in the older children.Results At the 3‐month follow‐up, there was an overall successful outcome in 55 children (87%), which included 12 of 13, eight of nine (89%) and 35 of 41 (85%) of the children with upper, mid and lower ureteric calculi, respectively, and nine of the 10 with impacted calculi. Re‐treatment was required in 20 (36%) patients, while auxiliary procedures after ESWL were required in three (6%). The major complications encountered were ureteric obstruction with sepsis in two children, bacteraemia in another and urinary retention due to a urethral stone fragment in a fourth child.Conclusions In situ ESWL was an effective treatment modality for ureteric calculi at all levels in children, even when impacted. In the short term, complications were minimal, but the long‐term effects need further assessment.
Severe diabetic ketoacidosis: the need for large doses of insulin
Authors: Fisken R. A. 
Published: July 2002

SummaryA 21‐year‐old female with Type 1 diabetes mellitus (DM) presented in ketoacidosis. She received intravenous normal saline and insulin at 6 U/h and 1.26 % sodium bicarbonate solution. After the blood glucose had fallen to 9.5 mmol/l, the saline infusion was changed to 5 % glucose solution and the insulin infusion rate to 2 to 3 U/h. The next day the patient became more drowsy (Glasgow coma scale 13/15, later falling to 4/15). Computed tomography (CT) scan suggested cerebral oedema and the patient was treated with dexamethasone and mannitol. She remained critically ill for 48 h, eventually making a full recovery. Insulin was given at rates of 8 to 14 U/h, with 10 % or 20 % glucose infusion to maintain the blood glucose above 5 mmol/l; despite this it was not until the fifth day that her serum bicarbonate became normal. Textbooks usually advise starting insulin at 6 U/h and reducing the infusion rate to 1–4 U/h when the blood glucose falls below a certain level. In this case, even with high rates of insulin infusion, it took 5 days before the patient’s serum bicarbonate returned to normal. Thus, in severe diabetic ketoacidosis (DKA), protocols should advise that the insulin infusion be continued at high dose (4 to 6 U/h or more), with appropriate glucose infusion to prevent hypoglycaemia, until the serum bicarbonate is normal or nearly so.Diabet. Med. 16, 347–351 (1999)
Universal vs. risk factor‐based screening for gestational diabetes mellitus: detection rates, gestation at diagnosis and outcome
Authors: Griffin M. E. , Coffey M. , Johnson H. , Scanlon P. , Foley M. , Stronge J. , O’Meara N. M. , Firth R. G. 
Published: July 2002

Summary Aims Gestational diabetes mellitus (GDM) is associated with adverse maternal and fetal outcome. Screening for GDM is therefore recommended but the best screening method remains controversial. This prospective, randomized study compared a risk factor‐based screening programme with a universally based one. Methods Subjects were randomized at booking to one of two groups: the risk factor group had a 3‐h 100‐g oral glucose tolerance test (OGTT) at 32 weeks if any risk factor for GDM was present; the universal group had a 50‐g glucose challenge test performed and if their plasma glucose at 1 h was ≥ 7.8 mmol/l, a formal 3‐h 100‐g OGTT was then performed. Results Universal screening detected a prevalence of GDM of 2.7%, significantly more than the 1.45% detected in the risk factor screened group (P < 0.03). Universal screening facilitated earlier diagnosis than risk factor screening – mean gestation 30 ± 2.6 weeks vs. 33 ± 3.7 weeks (P < 0.05). A higher rate of spontaneous vaginal delivery at term, and lower rates of macrosomia, Caesarean section, prematurity, pre‐eclampsia and admission to neonatal intensive care unit were observed in the universally screened, early diagnosis group. Conclusions Universal screening for GDM is superior to risk factor based screening – detecting more cases, facilitating early diagnosis and is associated with improved pregnancy outcome.
Ultrasonic features of intra‐amniotic ‘unidentified debris’ at 14–16 weeks' gestation
Authors: Zimmer E. Z. , Bronshtein M. 
Published: July 2002

AbstractThe objective of the study was to define the sonographic features of various echogenic materials which have been observed in the amniotic cavity of pregnancies in the early second trimester. The study population consisted of women who underwent a transvaginal ultrasound scan of pregnancy at 14–16 weeks' gestation. Our experience in 6500 examinations performed in both low‐ and high‐risk pregnancies is reported; 249 cases of intra‐amniotic debris were identified in this population. Five different types of echogenic material were observed in the amniotic fluid: small floating particles, round structures, cystic structures, solid and semi‐solid masses and highly echogenic material which looked like calcification. We conclude that intra‐amniotic echogenic material may be observed during early pregnancy. Its origin and clinical significance need further evaluation. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Fourier analysis of video‐keratographic data. A tool for separation of spherical, regular astigmatic and irregular astigmatic corneal power components
Authors: Hjortdal Jesper Ø. , Erdmann Lotte , Bek Toke 
Published: July 2002

SummaryTopographic analysis of the cornea and computation of changes in corneal topography is difficult because of the lack of a standardized concept for analysing topographic information. We have used Fourier series harmonic analysis to decompose the often very complex information given in topographic images (TMS‐1 video‐keratograph). The polar data values arising from each mire were separated into spherical (average power), regular astigmatic (2′ harmonic) and non‐regular astigmatic components. The non‐regular astigmatic components were further divided into a decentration component (1′ harmonic) and a higher order irregular refractive component (root mean square (r.m.s.) of the residual between original data and the sum of spherical, 1′ and 2′ order components). Algorithms for utilizing the Fourier analysis technique on subjective refractive and on keratometric changes in regular astigmatism were also derived. Averages of the separate refractive components were calculated for groups of normal (right and left eye of 25 patients), keratoconic (13 eyes), and transplanted eyes (20 eyes), and average topographic maps were reconstructed and imaged. Changes in the separate topographic refractive components were compared with subjective refractive changes in eyes that had undergone combined myopic‐astigmatic excimer laser ablation (8 eyes). Fourier series analysis was found superior to conventional keratometry in predicting spherical and regular astigmatic changes in subjective refraction. Fourier series analysis seems to be a powerful tool to decompose the information of complex topographic corneal images into rational optical components.
Working Directory of Centers Involved in Research and Applied Work on the Young Child and the Family in Developing Countries and Eastern Europe: International Union of Psychological Science 1998
Authors: Kagitçibasi Çigdem 
Published: July 2002

We are pleased to introduce the Directory of Centers Involved in Research and Applied Work with the Young Child and the Family in Developing Countries and Eastern Europe. This Directory is the product of the “International Network of the Young Child and the Family”, formed within the Executive Committee of the International Union of Psychological Science (IUPsyS). It is the outcome of a stocktaking activity of this Network, based on existing information and drawing further data from various resources.This directory is designed to upgrade existing information on centers involved in research/applied work with the child and the family, in particular women—especially in the developing world. Building up this data base is expected to promote communications, exchange of information and collaborative work among centers in the developing countries, as well as globally.This inventory is prepared for extensive dissemination to the national members of IUPsyS. It is hoped that the national members will disseminate this information further to all who are interested in their own countries and abroad.Several data bases and resources were used in the preparation of this inventory. Foremost among these are the UNESCO International Directory on the Young Child and the Family Environment and Early Childhood Care and Education. The Collaboration of Dr. T.S. Saraswathi is acknowledged, particularly in providing us with the information for India and South East Asia. Inevitably there must be some mistakes and omissions in this inventory. Any feedback you can provide us to correct them would be greatly appreciated.It is our hope that this inventory will be helpful to psychologists and others involved in research and applied work with children and families to make contacts with others with similar interests in other countries. Such extension beyond our immediate surroundings would be expected to contribute to concerted efforts to promote the well‐being of children and families in the developing world.
Does Educational Research Matter?*
Authors: Mortimore Peter 
Published: July 2002

ABSTRACT This article endeavours to set British educational research in the context of national and international economic developments and to take account of national educational policy making and educational practice.It addresses seven questions:
What does the term educational research include?
What are the major tasks of educational research?
What are its successes?
What are its failures?
Why is educational research attacked so frequently?
Would we miss it if it did not exist?
How can we enhance the value of educational research?
It is argued that the scope of educational research is broad, covering different techniques and methodologies and many aspects of the educative process, both formal and informal. Four main tasks emerge: to observe and record systematically; to analyse and draw out implications; to publish findings; and, crucially, to attempt to improve educational processes and outcomes. British educational researchers can point to a substantial corpus of successful work, ranging from large‐scale longitudinal cohort studies to powerful individual case studies; to studies of differential effectiveness, school organisation, curriculum and assessment, inequality and discrimination.Many such studies have influenced policy and practice. But success should not blind the research community to its shortcomings‐the gaps in knowledge, the inaccessibility of some writing, the mediocrity of some work, and the ways in which researchers relate to those involved in, or affected by, research or those whom it is hoped will be influenced by it. Public perceptions of these shortcomings‐some well founded, others driven by prejudice‐underlie many of the attacks to which researchers and their work are regularly subjected. Whilst educational research might not be missed (even gladly dismissed) by some practitioners and policy makers, this paper argues that the work is essential if independent questioning and impartial evaluations of policy and practice are to take place. We should, however, make every effort to enhance our work. To this end we need to take note of the various BERA Codes of Practice, invest in developing our members' repertoires of research techniques and constantly guard against bias in our work. We must also continue our efforts to relate positively to the elected government of the day. In doing all of these things we must hold fast to our BERA values. We must do what we have been trained to do
ask difficult questions
demand evidence, rather than anecdote, for answers
generate, through our research, new knowledge
formulate new theories
speak up for what we believe is right
A democratic society expects‐and deserves‐nothing less.