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Kinds of Titres Selected AbstractsToward a US Shift from Agricultural to Rural Development Policy: Forces of Challenge and Change Auf einen Wechsel von der US-Agrarpolitik zu einer Politik des ländlichen Raums hinarbeiten: Die Triebkräfte der Herausforderung und des Wandels Vers une transition des politiques agricoles vers des politiques de développement rural aux États-Unis: Les forces du défi et du changementEUROCHOICES, Issue 1 2008Charles W. Fluharty Toward a US Shift from Agricultural to Rural Development Policy: Forces of Challenge and Change On the 5th of November 2007, Iowa Senator Tom Harkin, Chairman of the US Senate Committee on Agriculture, Forestry and Nutrition, in opening the floor debate on the 2007 Farm Bill, urged a new US commitment to rural policy, keeping in mind that nearly 85 per cent of total farm household income is now generated off-farm. Recent institutional developments, moreover, evidence the success of a decade-long effort to increase focus on the rural development Title of the Farm Bill. One result was the formation of the Alliance for Sensible Agriculture Policies (ASAP), a loose federation of over 30 national organizations, representing the entire political spectrum. It remains highly active in support of Farm Bill reform. Currently, the Senate Bill contains a US$ 400 million increase in mandatory rural development funding. As we move toward an end-game, however, members of both the Senate and the House of Representatives will face the unbridled power of commodity organizations. It is likely that this will again overwhelm public sentiment and wise public choice. Despite overwhelming odds, a new commitment to a more innovative rural policy framework is emerging in the United States. I believe that this Farm Bill will ultimately be viewed as the beginning of a landscape-changing legislative framework for rural people and places in America. Vers une transition des politiques agricoles vers des politiques de développement rural aux États-Unis: Les forces du défi et du changement Le 5 novembre 2007, le Sénateur de l'Iowa Tom Harkin, Président du Comité du Sénat des États-Unis sur l'Agriculture, la Forêt et la Nutrition, en ouverture du débat sur la loi agricole 2007, a appeléà un nouvel engagement pour la politique rurale, en gardant à l'esprit que presque 85 pour cent du revenu total des ménages agricoles provient de sources non agricoles. En outre, les évolutions institutionnelles récentes on mis en évidence les succès d'une décennie d'efforts pour attirer l'attention sur le Titre "développement rural" de la loi agricole. Un résultat a été la formation d'une alliance pour des politiques agricoles raisonnables (Alliance for Sensible Agriculture Policies, ASAP), une fédération large de plus de 30 organisations nationales représentant la totalité du spectre politique. Elle reste très active pour soutenir la réforme de la loi agricole. A l'heure actuelle, la loi proposée par le Sénat prévoit une hausse de 400 millions de dollars des fonds obligatoirement destinés au développement rural. Cependant, à mesure que l'on s'approche de la décision finale, les membres du Sénat et de la Chambre des représentants seront confrontés au pouvoir sans frein des organisations de soutien des produits agricoles. Il est probable que cela va de nouveau dominer les sentiments du public et les choix sensés en matière d'action. En dépit des conditions dominantes, émerge aux États-Unis un nouvel engagement pour un cadre plus innovant pour les politiques de développement rural,.Je crois que cette loi agricole sera considérée comme un point d'inflexion dans le paysage pour les populations et les territoires ruraux aux États-Unis. Auf einen Wechsel von der US-Agrarpolitik zu einer Politik des ländlichen Raums hinarbeiten: Die Triebkräfte der Herausforderung und des Wandels Am 5. November 2007 forderte Tom Harkin, US-Senator aus dem Bundesstaat Iowa und Vorsitzender des Komitees für Landwirtschaft, Forstwirtschaft und Ernährung (US Senate Committee on Agriculture, Forestry and Nutrition), ein größeres Engagement der USA im Hinblick auf die Politik des ländlichen Raums, als er die Plenardebatte über das Landwirtschaftsgesetz von 2007 eröffnete. Dabei hatte er vor Augen, dass mittlerweile beinahe 85 Prozent des gesamten Haushaltseinkommens der landwirtschaftlichen Betriebe aus außerlandwirtschaftlichen Aktivitäten stammt. Zudem belegen die jüngsten institutionellen Entwicklungen den Erfolg der jahrzehntelangen Bemühungen, die Aufmerksamkeit auf den Titel über die Entwicklung des ländlichen Raums im Landwirtschaftsgesetz zu lenken. Als Folge dessen wurde u.a. die Allianz für vernünftige Agrarpolitikmaßnahmen (Alliance for Sensible Agriculture Policies, ASAP) ins Leben gerufen, ein freier Verband von über 30 nationalen Organisationen, die das gesamte politische Spektrum vertreten. Die Allianz setzt sich immer noch sehr für die Reform des Landwirtschaftsgesetzes ein. Derzeit sieht das Gesetz im Senat eine Budgeterhöhung von $ 400 Millionen zur Finanzierung der verbindlichen Entwicklung des ländlichen Raums vor. Da wir jedoch auf die Endphase zusteuern, werden sowohl Mitglieder des Senats als auch des Abgeordnetenhauses der ungezügelten Macht der Rohstofforganisationen gegenüberstehen. Wahrscheinlich wird dies wieder einmal die Stimmung und die weise Entscheidung der Öffentlichkeit maßgeblich beeinflussen. Ungeachtet dessen entwickelt sich in den USA zurzeit ein neues Engagement hin zu einem innovativeren Rahmenprogramm in Bezug auf die Politik des ländlichen Raums. Ich bin der Ansicht, dass dieses Landwirtschaftsgesetz der Landbevölkerung als Zeitpunkt des Landschaftswechsels in Erinnerung bleiben wird. [source] Distribution of infectious pancreatic necrosis virus (IPNV) in wild marine fish from Scottish waters with respect to clinically infected aquaculture sites producing Atlantic salmon, Salmo salar L.JOURNAL OF FISH DISEASES, Issue 3 2008I S Wallace Abstract This study represents the first large-scale investigation of IPNV in Scottish wild marine fish. Kidney samples were taken from 30 627 fish comprising 37 species and 45 isolations were made from nine different species, illustrating these as reservoirs of IPNV in Scottish waters. The estimated prevalence of IPNV in the Scottish marine environment was low at 0.15% (90% confidence intervals, (CI) of 0.11,0.19%). This was significantly greater in fish caught less than 5.0 km from IPN-positive fish farms in Shetland, at 0.58% (90% CI of 0.45,0.77%). This prevalence persisted and did not significantly decrease over the 16-month period of study. The estimated prevalence of IPNV for each positive species was less than 1% with the statistically non-significant exceptions of flounder, Platichthys flesus (L.), at 12.5% (90% CI of 0.64,47.06%) and saithe, Pollachius virens (L.), at 1.11% (90% CI of 0.49,2.19%). The 45 isolates were titrated and all but two were below the detection limit of the test (<55 PFU g,1). Titres of 3.8 × 102 PFU g,1 and 2.8 × 101 PFU g,1 were calculated from common dab, Limanda limanda (L.), and saithe, respectively. This study provides evidence that clinical outbreaks of IPN in farmed Atlantic salmon may cause a localized small increase in the prevalence of IPNV in wild marine fish. [source] Titres of naturally occurring alloantibodies against feline blood group antigens in Turkish Van catsJOURNAL OF SMALL ANIMAL PRACTICE, Issue 6 2004S. Arikan Seventy-eight Turkish Van cats were examined for alloantibody titres, of which 42·3 per cent had type A blood and 57·7 per cent had type B blood. No type AB cats were found. All type B cats (n=45) showed gross evidence of agglutinating anti-A antibody, with titres ranging from 2 to 256. Sixty-seven per cent of type B cats had anti-A antibody in their plasma, with titres ranging from 8 to 32. However, 13 per cent of type B cats had plasma alloantibody titres of less than 8 and 20 per cent had titres that were higher than 32. A total of 33 type A cats were also tested for anti-B alloantibody titres in their plasma. Among the type A plasma, gross agglutination at titres of 2 and greater than 2 were determined in 24 per cent and 36 per cent of samples, respectively. Microscopic agglutination was seen in an additional 18 per cent of plasma samples. There was no significant association between gender and plasma alloantibody titres of cats (P>0·05). [source] The islet autoantibody titres: their clinical relevance in latent autoimmune diabetes in adults (LADA) and the classification of diabetes mellitusDIABETIC MEDICINE, Issue 2 2008A. W. Van Deutekom Abstract Latent autoimmune diabetes in the adult (LADA) is a slowly progressive form of autoimmune diabetes, characterized by diabetes-associated autoantibody positivity. A recent hypothesis proposes that LADA consists of a heterogeneous population, wherein several subgroups can be identified based on their autoimmune status. A systematic review of the literature was carried out to appraise whether the clinical characteristics of LADA patients correlate with the titre and numbers of diabetes-associated autoantibodies. We found that the simultaneous presence of multiple autoantibodies and/or a high-titre anti-glutamic acid decarboxylase (GAD),compared with single and low-titre autoantibody,is associated with an early age of onset, low fasting C-peptide values as a marker of reduced pancreatic B-cell function, a high predictive value for future insulin requirement, the presence of other autoimmune disorders, a low prevalence of markers of the metabolic syndrome including high body mass index, hypertension and dyslipidaemia, and a high prevalence of the genotype known to increase the risk of Type 1 diabetes. We propose a more continuous classification of diabetes mellitus, based on the finding that the clinical characteristics gradually change from classic Type 1 diabetes to LADA and finally to Type 2 diabetes. Future studies should focus on determining optimal cut-off points of anti-GAD for differentiating clinically relevant diabetes mellitus subgroups. [source] Evidence for low-titre infections in insect symbiosis: Wolbachia in the bark beetle Pityogenes chalcographus (Coleoptera, Scolytinae)ENVIRONMENTAL MICROBIOLOGY, Issue 8 2009Arthofer Wolfgang Summary Wolbachia are obligatory endosymbiotic ,-proteobacteria found in many insect species. They are maternally transmitted and often exhibit reproductive phenotypes like cytoplasmic incompatibility. Pityogenes chalcographus is a bark beetle causing severe damage in spruce stands. Its European populations are divided into several mitochondrial clades separated by partial crossing barriers. In this study, we tested a large sample set covering the natural range of the beetle in Europe for the presence of Wolbachia and associations between infection pattern and mitotypes using a highly sensitive nested PCR technique. 35.5% of the individuals were infected with the endosymbiont and two distinct strains were identified. Both strains occur in low titre not accessible by conventional detection methods. The infections are present all over Europe, unlikely to cause the partial crossing barriers in this host and uncoupled from mitochondrial clades. This pattern is indicative for populations evolving towards endosymbiont loss and for repeated intraspecific horizontal transfer of Wolbachia. Alternatively, the low-titre infections found in P. chalcographus are yet another example for Wolbachia that can persist in host species at low densities and frequencies. [source] Intralesional bovine papillomavirus DNA loads reflect severity of equine sarcoid diseaseEQUINE VETERINARY JOURNAL, Issue 4 2010R. HARALAMBUS Summary Reasons for performing study: Sarcoids are nonmetastasising, yet locally aggressive skin tumours that constitute the most frequent neoplasm in equids. Infection by bovine papillomaviruses types 1 and 2 (BPV-1, BPV-2) has been recognised as major causative factor in sarcoid pathogenesis, but a possible correlation of intralesional virus load with disease severity has not been established thus far. Hypothesis: Given the pathogenic role of BPV-1 and BPV-2 in sarcoid disease, we suggest that intralesional viral DNA concentration may reflect the degree of affection. Methods: Severity of disease was addressed by recording the tumour growth kinetics, lesion number and tumour type for 37 sarcoid-bearing horses and one donkey. Viral load was estimated via quantitative real-time PCR (qPCR) of the E2, E5, L1 and L2 genes from the BPV-1/-2 genome for one randomly selected lesion per horse and correlated with disease severity. Results: Quantitative PCR against E2 identified viral DNA concentrations ranging from 0,556 copies/tumour cell. Of 16 horses affected by quiescent, slowly growing single tumours or multiple mild-type lesions, 15 showed a viral load up to 1.4 copies per cell. In stark contrast, all equids (22/22) bearing rapidly growing and/or multiple aggressive sarcoids had a viral load between 3 and 569 copies per cell. Consistent results were obtained with qPCR against E5, L1 and L2. Conclusions: While tumours of the same clinical type carried variable virus load, confirming that viral titre does not determine clinical appearance, we identified a highly significant correlation between intralesional viral load and disease severity. Potential relevance: The rapid determination of BPV viral load will give a reliable marker for disease severity and may also be considered when establishing a therapeutic strategy. [source] The CAP for Turkey?EUROCHOICES, Issue 2 2005Budgetary Implications, Potential Market Effects EU accession negotiations with Turkey are scheduled to start in October 2005. The period of accession negotiations will probably last for ten years or longer, but the effects of applying the Common Agricultural Policy (CAP) to Turkey are currently a controversial discussion in the EU. Effects of Turkish accession on EU agricultural markets are likely to be small. The EU would gain additional export opportunities for cereals and animal products. On the other hand, Turkish agricultural exports to the EU are projected to increase for only a few fruit and vegetable products. EU budgetary outlays for the application of the CAP to Turkey could total between £3.5 and £6.3 billion in 2015 , depending on whether direct payments are phased in or not , and £5.4 billion in 2025. Most of these outlays would be for direct payments to agricultural producers and that may not be in Turkey's best interest. This is because direct payments tend to be capitalized in land prices and may thus inhibit the necessary process of improving the Turkish agricultural structure. Transfers under the second pillar of the CAP may hold more interest for Turkey, because they can be targeted at improving productivity and thereby income. Projected outlays for the CAP take a backseat to projected transfers to Turkey under the structural policy of the EU. Les négociations sur l'adhésion de la Turquie à l'UE doivent commencer en octobre 2005. Les préliminaires vont sans doute durer au moins une dizaine d'années, mais les effets de l'application de la Politique Agricole Commune (PAC) à la Turquie font déjà l'objet de controverses au sein de l'UE. Sur les marchés, on s'attend à des effets plutôt faibles. L'UE gagnerait certaines possibilités d'exportation de céréales et de produits animaux. Par ailleurs, les exportations de la Turquie vers l'UE ne s'accroîtraient que pour quelques fruits et légumes. Les dépenses budgétaires totales qui résulteraient pour l'UE de l'application de la PAC à la Turquie se situeraient en 2015 entre 3,5 et 6,3 milliards d'Euros, selon que les paiements directs seront ou ne seront pas progressivement éliminés. Elles atteindraient 5,4 milliards en 2025. Il s'agirait pour l'essentiel de paiements directs aux producteurs agricoles, ce qui ne correspondrait pas forcément à l'intérêt bien compris de la Turquie. De fait, les paiements directs tendent àêtre capitalisés en valeurs foncières. Ils pourraient par conséquent inhiber le processus d'amélioration des structures, pourtant bien nécessaire. Les transferts liés au second pilier de la PAC pourraient être plus utiles, parce qu'ils peuvent être ciblés sur les accroissements de productivité et donc de revenus. C'est pourquoi il y a lieu d'envisager des transferts à la Turquie au titre des politiques d'amélioration de structures en arrière plan des budgets prévisionnels pour la PAC. Im Oktober 2005 sollen die EU-Beitrittsverhandlungen mit der Türkei beginnen. Diese Verhandlungen werden wahrscheinlich über einen Zeitraum von zehn Jahren oder länger geführt werden, die Auswirkungen der Gemeinsamen Agrarpolitik (GAP) auf die Türkei werden im Moment in der EU jedoch kontrovers diskutiert. Der EU-Beitritt der Türkei wird sich wahrscheinlich nur geringfügig auf die EU-Agrarmärkte auswirken. Die EU erhielte zusätzliche Exportmöglichkeiten für Getreide und tierische Erzeugnisse. Die Agrarexporte der Türkei in die EU hingegen würden vermutlich nur bei einigen wenigen Obstund Gemüseprodukten zunehmen. Durch die Anwendung der GAP auf die Türkei würde der EU-Haushalt im Jahr 2015 mit 3,5 bis 6,3 Milliarden Euro (je nachdem, ob die Direktzahlungen schrittweise eingeführt werden oder nicht) und im Jahr 2025 mit 5,4 Milliarden Euro belastet. Der grö,te Teil dieser Kosten entstünde aufgrund von Direktzahlungen an landwirtschaftliche Erzeuger. Dies dürfte für die Türkei nicht die bestmögliche Alternative darstellen, da Direktzahlungen zumeist in den Bodenpreisen kapitalisiert werden, wodurch der notwendige Prozess zur Verbesserung der türkischen Agrarstruktur ins Stocken geraten könnte. Transferleistungen im Rahmen der zweiten Säule der GAP dürften für die Türkei interessanter sein, da sie auf eine Produktivitätssteigerung ausgerichtet werden könnten, um so die Einkommenssituation zu verbessern. Die zu erwartenden Ausgaben für die GAP im Rahmen der Strukturpolitik der EU spielen im Vergleich zu den zu erwartenden Transferleistungen an die Türkei eine untergeordnete Rolle. [source] Influence of clinical factors on the haemolysis marker haptoglobinEUROPEAN JOURNAL OF CLINICAL INVESTIGATION, Issue 3 2006G. F. Körmöczi Abstract Background, Plasma haptoglobin determination is clinically used as parameter for haemolysis. To date, however, the influence of the mode of haemolysis (extravascular vs. intravascular) and of nonhaemolytic conditions on haptoglobin concentration and its reliability as a haemolysis marker remain poorly defined. Materials and methods, In a total of 479 individuals, the influence of haemolytic and nonhaemolytic conditions on plasma haptoglobin levels was investigated. Results, All studied types of haemolytic disease (n = 16) were associated with markedly decreased plasma haptoglobin levels, without significant differences between intravascular vs. predominantly extravascular haemolysis. Diminished haptoglobin values were also observed in patients with liver cirrhosis, which normalized after liver transplantation. In contrast, markedly increased haptoglobin levels were found in patients with inflammation. In patients with haemolysis and a concomitant acute-phase response, however, haemolysis-dependent haptoglobin depletion was not attenuated. Interestingly, patients with a strongly positive direct antiglobulin test or high cold agglutinin titre but no further evidence for haemolysis had normal haptoglobin values. Likewise, anaemia owing to bone marrow failure, acute gastrointestinal or chronic diffuse blood loss, and end-stage kidney disease were associated with normal haptoglobin levels. Conclusions, Plasma haptoglobin depletion is a reliable marker for the instant diagnosis of accelerated red cell destruction irrespective of the site of haemolysis or the presence of inflammation. The capacity of this parameter to predict haemolysis appears to be limited in patients with liver cirrhosis and decreased haptoglobin production only. [source] Dynamics of a Transgene Expression in Acute Rat Brain Slices Transfected with Adenoviral VectorsEXPERIMENTAL PHYSIOLOGY, Issue 4 2003C. E. L. Stokes We present a quantitative account of the expression dynamics of a transgene (enhanced green fluorescent protein, EGFP) in acute brain slices transfected with an adenoviral vector (AVV) under control of the human cytomegalovirus (HCMV) promoter. Micromolar concentrations of EGFP could be detected in brainstem and hippocampal slices as early as 7 h after in vitro transfection with a viral titre of 4.4 × 109 plaque-forming units (pfu) ml,1. Although initially EGFP appeared mainly in glia, it could be detected in neurones with longer incubation times of 10-12 h. However, fluorescence was never detected within some populations of neurones, such as hippocampal pyramidal cells, or within the hypoglossal motor nucleus. The density of cells expressing EGFP peaked at 10 h and then decreased, possibly suggesting that high concentrations of EGFP are toxic. The age of the animal significantly affected the speed of EGFP accumulation: after 10 h of incubation in 30-day-old rats only 4.88 ± 0.51 cells/10 000 ,m2 were fluorescent compared to 7.28 ± 0.39 cells/10 000 ,m2 in 12-day-old rats (P < 0.05). HCMV promoter-driven transgene expression depended on the activity of protein kinase A, and was depressed with a cAMP/protein kinase A antagonist (20 ,M Rp-cAMPS; P < 0.0005). This indicates that expression of HCMV-driven constructs is likely to be skewed towards cellular populations where cAMP-dependent signalling pathways are active. We conclude that acute transfection of brain slices with AVVs within hours causes EGFP expression in micromolar concentrations and that such transfected cells may remain viable for use in physiological experiments. [source] In vitro response to Candida albicans in cultures of whole human blood from young and aged donorsFEMS IMMUNOLOGY & MEDICAL MICROBIOLOGY, Issue 2 2007Celia Murciano Abstract Invasive infections with opportunistic fungi, such as Candida albicans, have become an increasing problem in aged adults in recent years. This work investigates the influence of human ageing on C. albicans recognition by toll-like receptors (TLRs), essential components of the innate immune system, using a cohort of 96 young (15,42 years) and aged (>70 years) human volunteers. No significant differences between aged and young donors were observed on (1) cell surface TLR2, TLR6 and TLR4 expression on lymphocytes, monocytes and granulocytes, (2) production of cytokines [IL-8, IL-1,, IL-6, IL-10, tumour necrosis factor (TNF)-, and IL-12p70] and prostaglandin E2 (PGE2) by whole human blood in response to C. albicans and (3) fungicidal activity of whole blood. A statistically significant higher titre of natural anti- C. albicans antibodies was found in plasma of volunteers between 80 and 95 years old when compared with other age groups, probably as a consequence of the increased levels of serum Ig that has been described in elderly subjects. Therefore, the results indicate that the increased susceptibility to C. albicans infections in the elderly is not a consequence of defects in TLRs expression or signalling, nor of an impaired fungicidal activity of blood. [source] Safety and preliminary immunogenicity of MenC/P64k, a meningococcal serogroup C conjugate vaccine with a new recombinant carrierFEMS IMMUNOLOGY & MEDICAL MICROBIOLOGY, Issue 3 2006Antonio E. Pérez Abstract This study reports the preliminary assessment of the safety and immunogenicity of the first serogroup C conjugate vaccine candidate that includes meningococcal P64k recombinant protein as the carrier (MenC/P64k). Twenty volunteers were recruited for a double-blind, randomized, controlled phase I clinical trial, receiving a single dose of MenC/P64k (study group) and a single dose of the commercial polysaccharide vaccine AC (control group). Only mild reactions were observed. No statistical differences were detected between the antipolysaccharide C IgG responses of both groups as well as between bactericidal serum titre (P>0.05). The MenC/P64k vaccine was found to have a good safety profile, to be well tolerated and immunogenic. [source] Properties of a concentrated minipool solvent-detergent treated cryoprecipitate processed in single-use bag systemsHAEMOPHILIA, Issue 5 2008T. BURNOUF Summary., Cryoprecipitate is still used to treat factor VIII (FVIII), von Willebrand factor (VWF) and/or fibrinogen deficiency. Recently a solvent-detergent (S/D) process of minipools of cryoprecipitate performed in a closed bag system has been designed to improve its viral safety. Still, cryoprecipitate has other drawbacks, including low concentration in active proteins, and presence of haemolytic isoagglutinins. We report here the biochemical evaluation of S/D-treated minipools of cryoprecipitates depleted of cryo-poor plasma. Cryoprecipitates were solubilized by 8 mL of a sterile glucose/saline solution, pooled in batches of 40 donations and subjected to S/D treatment in a plastic bag system using either 2% TnBP or 1% TnBP-1%Triton X-45, followed by oil extractions (n = 10). Mean (±SD) FVIII and fibrinogen content was 8.86 (±1.29) IU mL,1 and 16.02 (±1.98) mg mL,1, and 8.92 (±1.05) IU mL,1 in cryoprecipitate minipools treated with 2% TnBP, and 17.26 (±1.71) mg mL,1, in those treated by TnBP-Triton X-45, respectively. The WWF antigen, ristocetin cofactor and collagen binding activities were close to 10, 7 and 8 IU mL,1, respectively, and were not affected by either SD treatment. VWF multimeric pattern of SD-treated cryoprecipitates were similar to that of normal plasma, and the >15 mers and >10 mers content was identical to that of the starting cryoprecipitates. The anti-A and anti-B titre was 0,1 and 0,1/8, respectively. Therefore, it is possible to prepare virally inactivated cryoprecipitate minipools depleted of isoagglutinins and enriched in functional FVIII, VWF and clottable fibrinogen. [source] One-stage replacement of infected knee prosthesis in a patient with haemophilia A and high titre of inhibitorsHAEMOPHILIA, Issue 2 2008R. SARTORI No abstract is available for this article. [source] Cyclosporin A can achieve immune tolerance in a patient with severe haemophilia B and refractory inhibitorsHAEMOPHILIA, Issue 1 2007D. C. A. CROSS Summary., Immune tolerance induction (ITI) is described in a patient with severe haemophilia B complicated by the presence of an inhibitor. A number of ITI regimes were attempted without success and the patient suffered from frequent relapses and bleeding episodes. Successful ITI was achieved with the additional use of cyclosporin A. The patient developed nephrotic syndrome although had a negative Bethesda titre at this time. When cyclosporin A therapy was ceased, the inhibitor titre rose and the patient suffered again from bleeding episodes. Cyclosporin A was reintroduced at a lower dose. The patient has now received cyclosporin A for 10 years, during which time he has relapsed three times for short periods (2 weeks). He is also on prophylaxis with factor IX three times a week with preinfusion levels >1% and without bleeding. [source] Tyr2105Cys mutation in exon 22 of FVIII gene is a risk factor for the development of inhibitors in patients with mild/moderate haemophilia AHAEMOPHILIA, Issue 4 2006M. FRANCHINI Summary., We report the case of a patient with mild haemophilia A, due to a Tyr2105Cys mutation in exon 22 of the C1 domain, who developed a high-titre factor VIII inhibitor (maximum titre 1600 BU) with recurrent severe haemorrhages and fatal intracranial bleeding. Based on published data, it appears that although this mutation occurs rarely in patients with mild or moderate haemophilia A, it is frequently associated with the development of high-titre inhibitors. [source] Optimization of storage conditions for diluted working solutions of porcine factor VIII and performance of the Bethesda assay for the determination of antiporcine FVIII inhibitor titresHAEMOPHILIA, Issue 1 2003R. Winikoff Summary. The use of porcine factor VIII (FVIII) (Hyate:C, Ipsen) has proven to be very successful in treating patients with FVIII inhibitors. The best way to predict the usefulness of porcine FVIII therapy, and/or to estimate the appropriate treatment dose in a given patient, is to measure the patient inhibitor titre against porcine FVIII with the Bethesda assay, using porcine FVIII as the source of FVIII in the assay. The goals of the present study were to (1) find the optimal storage temperature, diluent and concentration for a working solution of porcine FVIII to be used as the source of FVIII for the porcine Bethesda assay, (2) assess the reliability of the labelled FVIII units in the preparation of such working solutions of porcine FVIII and (3) compare the inhibitor titres determined by the Bethesda assay using both porcine and human standard reference curves for measuring residual FVIII. The results of the present study demonstrate that a ready-to-use working solution of 1 U mL,1 of Hyate:C diluted in human FVIII deficient plasma, either containing or deficient in von Willebrand factor antigen, is stable for up to 12 months, at ,20 °C. The preparation of the 1 U mL,1 working solution could be reliably calculated based on the units indicated on the vial label. Finally, using the human standard curve yields similar results to using the porcine standard curve for measuring any titre of allo- or auto-antibody against FVIII in the Bethesda assay, using Hyate:C as the source of FVIII. These findings are of practical value when performing a porcine FVIII-based Bethesda assay. [source] Successful use of recombinant factor VIIa in a patient with inhibitor secondary to severe factor XI deficiencyHAEMOPHILIA, Issue 2 2002P. LAWLER Factor XI (FXI) inhibitors are a rare complication of inherited FXI deficiency. We report the successful use of recombinant factor VIIa (FVIIa) in a patient with a high-responding inhibitor undergoing cataract extraction. At the time of surgery there were limited available data on the optimal management of patients with FXI deficiency. A 62-year-old Ashkenazi Jewish woman had a lifelong history of excessive bleeding secondary to severe FXI deficiency (2 U dL,1), and received FXI concentrate (FXI:C) when she underwent a colposuspension procedure. She was subsequently diagnosed with a FXI inhibitor of 16 Bethesda units (BU) when she developed a poor response to FXI:C at the time of total hip replacement. Two months later she was admitted for cataract extraction. The FXI level was < 1 U dL,1 with an inhibitor titre of 48 BU. She received 90 ,g kg,1 of FVIIa immediately preoperatively followed by continuous infusion at a rate of 20 ,g kg,1 h,1 for 24 h. The cataract extraction was successful and there was no excess bleeding during surgery or in the postoperative period. Mutation analysis of the FXI gene showed that the patient was homozygous for the type II genotype [exon 5, Glu117,Ter]. The reason for the low prevalence of inhibitor formation in patients with FXI deficiency is unclear but may reflect a number of factors including reporting bias, the rarity of absent circulating FXI:C activity, and the infrequent use of FXI replacement therapy. [source] Management of spontaneous inhibitors in children with porcine factor VIIIHAEMOPHILIA, Issue 2002N.L. Kobrinsky Acquired factor VIII (FVIII) inhibitors are rare, typically occurring in the postpartum period or in the elderly. Their occurrence in childhood is distinctly unusual. Acquired FVIII inhibitors are often life-threatening and refractory to treatment with high doses of human FVIII concentrate. Alternative strategies for control of haemostasis include the use of products with FVIII ,bypassing' activity or porcine FVIII (pFVIII) concentrate if the pFVIII titre is sufficiently low (<10,20 porcine Bethesda Units). Corticosteriods and other immunosuppressive therapies are inconsistently effective in eliminating FVIII inhibitors. Accordingly, acquired FVIII inhibi-tors often require long-term haemostatic management. [source] Viral safety of a pasteurized, monoclonal antibody-purified factor VIII concentrate in previously untreated haemophilia A patientsHAEMOPHILIA, Issue 2 2001C. S. Philipp The efficacy and viral safety of a pasteurized, immunoaffinity-purified procoagulant factor VIII protein (FVIII:C; Monoclate-P) was studied in two multicentre, prospective, open-label trials in 30 previously untreated patients, 18 with severe (< 1% FVIII:C activity), and 12 with moderate (1% to 5% FVIII:C activity) haemophilia A. Clinical assessments, performed at screening and regularly thereafter for 6 to > 24 months (maximum 34 months), showed that none of 24 assessable patients acquired illnesses consistent with monitored transfusion-transmissible diseases. No patients acquired hepatitis B surface antigen, or antibodies against hepatitis B core antigen, hepatitis C, or human immunodeficiency virus. Likewise, no patients acquired treatment-related hepatitis A antibodies or sustained elevations of alanine aminotransferase levels. The safety profile for Monoclate-P is brought about by a multi-step safety system that incorporates viral inactivation (through a combination of immunoaffinity chromatography and pasteurization) plus donor screening, plasma testing, and quality assurance. The inhibitor development rate (13% low titre, 10% high titre) was similar to that reported in the literature for other FVIII concentrates (24% to 52%). The most frequently reported adverse events were related to typical infant and childhood diseases. Monoclate-P was effective in all patients treated according to protocol, except in two, who developed inhibitors. [source] High-titre factor VIII inhibitor in two children with mild haemophilia AHAEMOPHILIA, Issue 2 2001J. J. Puetz A frequently encountered complication of therapy given to patients with severe haemophilia A is the development of antibodies to infused factor VIII. While much less common, inhibitors also occur in patients with mild or moderate severity haemophilia A. Often thought to be of low titre and transient, several cases of high-titre inhibitors have been described in patients with mild or moderate haemophilia A. Generally these occur in adults or adolescents following significant infused factor VIII exposure. A review of reported cases revealed only two cases of high-titre inhibitor formation in mild haemophilia A patients younger than 10 years of age. We wish to report our experience with an additional two children with mild haemophilia A and high titre inhibitors, and offer suggestions for the management of these children. [source] The hinge region fragment of immunoglobulin G improves immunogenicity of recombinant gonadotrophin-releasing hormone conjugated to the T-helper epitope in designing peptide vaccinesIMMUNOLOGY, Issue 1pt2 2009Jinshu Xu Summary In our previous study, the hinge fragment (225,232/225,,232,) of human immunoglobulin G1 (IgG1) was used as a space peptide linker for synthesizing the GnRH3,hinge,MVP chimeric peptide, whereby three repeated gonadotrophin-releasing hormone (GnRH) units and a T-cell epitope from measles virus fusion protein (MVP) were amide-bond-linked at the N and C terminus, respectively, to the hinge peptide for producing anti-GnRH antibody responses. To investigate whether or not the hinge region fragment can improve the immunogenicity of GnRH, we further synthesized and purified GnRH3,hinge,MVP, GnRH3,hinge and GnRH3,MVP using recombinant DNA technology. Under high pH conditions, GnRH3,hinge,MVP was capable of forming double-chain structures. Immunization of male mice with the immunogens of GnRH3,hinge,MVP resulted in the generation of high-titre antibodies specific for GnRH. The synthetic GnRH3,hinge and GnRH3,MVP induced a lower titre of anti-GnRH antibody than GnRH3,hinge,MVP. This was followed by a decrease in serum testosterone levels, which resulted in a low level of expression of the relaxin-like factor gene in the testis. Our data suggest that peptide and T-cell epitopes oriented at the N-terminus or C-terminus of hinge peptides simplify the antigenic peptide conjugates and may be considered as potential synthetic immunogens. [source] Defective T-cell function leading to reduced antibody production in a kleisin-, mutant mouseIMMUNOLOGY, Issue 2 2008Katharine M. Gosling Summary The recently described nessy (Ncaph2nes/nes) mutant mouse strain has a defect in T-cell development caused by a mutation in the ubiquitous kleisin-, (also known as Ncaph2). Kleisin- , is a subunit of the condensin II complex involved in chromosome condensation during mitosis. The nessy phenotype is characterized by CD44hi CD8+ peripheral T cells, 10,20% of normal thymocyte numbers and 2·5-fold fewer ,, T cells in the spleen compared with wild-type mice. In this study we examined the effect of the nessy mutation in kleisin-, on the immune response by challenging mice with an attenuated strain of Salmonella. Results showed that nessy mice control bacterial load as effectively as wild-type mice but exhibit a reduced antibody titre. Further experiments revealed that while the T-dependent antibody response was diminished in nessy mice the T-independent response was normal, suggesting that the defect was the result of T-cell function and not B-cell function. In vitro activation assays showed that nessy T cells have a lower capacity to up-regulate the early activation marker CD69 than wild-type T cells. Upon transfer into RAG,/, mice, nessy and wild-type CD4 T cells showed equivalent homeostatic proliferation, while nessy CD8 T cells proliferated more than their wild-type counterparts. When cultured with anti-T-cell receptor , or concanavalin A, nessy T cells were found to die faster than wild-type T cells. These data indicate that kleisin-, is required for a normal immune response, and represent the first demonstration of a role for kleisin-, in T-cell function. [source] Induction of potent cellular immune response in mice by hepatitis C virus NS3 protein with double-stranded RNAIMMUNOLOGY, Issue 1 2007Bo Jin Summary Double-stranded RNA is produced during virus replication and, together with the viral antigen, is responsible for inducing host antivirus immunity. The hepatitis C virus (HCV) non-structural protein-3 (NS3) has been implicated in the immune evasion of HCV, and is one of the prime targets for inducing immunity against HCV infection. Mice were immunized with recombinant NS3 protein (rNS3) and poly (I:C) emulsified in Montanide ISA 720 (M720). Cytokine production was assayed by enzyme-linked immunospot assay, and CD4+ IFN-,+ T helper (Th) cells or CD8+ IFN-,+ cytotoxic T lymphocytes were detected by flow cytometry. Anti-NS3 titre and immunoglobulin G2a (IgG2a) and IgG1 levels were monitored by enzyme-linked immunosorbent assay. Administration of rNS3 formulated in poly (I:C) and M720 induced anti-NS3 titres with a predominantly IgG2a isotype comparable to those induced by rNS3 in CpG-ODN and M720. The cytokine profiles showed that this formulation induced a Th1-biased immune response with several-fold more interferon-, (IFN-,)-producing cells than interleukin-4-producing cells. In contrast, rNS3 in M720 induced a Th2-biased immune response. The frequency of IFN-,-producing CD4+ and CD8+ cells induced by rNS3 in poly (I:C) and M720 was significantly higher than that induced by rNS3, rNS3 in M720, or rNS3 in poly (I:C), and was comparable to that induced by rNS3 in CpG-ODN with M720. The antigen-specific CD8+ T-cell immune response persisted for up to 7 months after immunization. In conclusion, poly (I:C) with rNS3 in M720 can elicit a strong and persistent Th1-biased immune response and a cytotoxic T-lymphocyte response through cross-priming in mice. This study highlighted a promising formulation for inducing an efficient cellular immune response against HCV that has potential for HCV vaccine development. [source] The lack of RNA-dependent protein kinase enhances susceptibility of mice to genital herpes simplex virus type 2 infectionIMMUNOLOGY, Issue 4 2006Daniel J. J. Carr Summary Mice deficient in RNA-dependent protein kinase (PKR,/,) or deficient in PKR and a functional 2,,5,-oligoadenylate synthetase (OAS) pathway (PKR/RL,/,) are more susceptible to genital herpes simplex virus type 2 (HSV-2) infection than wild-type mice or mice that are deficient only in a functional OAS pathway (RL,/,) as measured by survival over 30 days. The increase in susceptibility correlated with an increase in virus titre recovered from vaginal tissue or brainstem of infected mice during acute infection. There was also an increase in CD45+ cells and CD8+ T cells residing in the central nervous system of HSV-2-infected PKR/RL,/, mice in comparison with RL,/, or wild-type control animals. In contrast, there was a reduction in the HSV-specific CD8+ T cells within the draining lymph node of the PKR/RL,/, mice. Collectively, activation of PKR, but not of OAS, contributes significantly to the local control and spread of HSV-2 following genital infection. [source] The ecdysteroidogenic P450 Cyp302a1/disembodied from the silkworm, Bombyx mori, is transcriptionally regulated by prothoracicotropic hormoneINSECT MOLECULAR BIOLOGY, Issue 5 2005R. Niwa Abstract During larval and pupal development of insects, ecdysone is synthesized in the prothoracic gland (PG). Although several Drosophila genes, including Halloween P450 genes, are known to be important for ecdysteroidogenesis in PG, little is known of the ecdysteroidogenic genes in other insects. Here we report on Cyp302a1/disembodied (dib-Bm), one of the Halloween P450s in the silkworm Bombyx mori that is a carbon-22 hydroxylase. dib-Bm is predominantly expressed in PG and its developmental expression profile is correlated with a change in the ecdysteroid titre in the haemolymph. Furthermore, dib-Bm expression in cultured PGs is significantly induced by treatment with prothoracicotropic hormone. This is the first report on the transcriptional induction of a steroidogenic gene by the tropic hormone in insects. [source] Intravenous iron attenuates postvaccination anti-HBsAg titres after quadruple hepatitis B vaccination in dialysis patients with erythropoietin therapyINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 3 2009J.-H. Liu Summary Background:, Anaemia in patients with end-stage renal disease (ESRD) is commonly treated with recombinant human erythropoietin (rHuEPO), often in combination with an adjuvant iron supplement. There is much evidence that rHuEPO can influence the immune response by its effect on lymphocytes. Also, iron catalyses the formation of radicals and increases the risk of major infections by negatively affecting the immune system. The relationship between antibodies to hepatitis B surface antigen (anti-HBsAg) responsiveness after hepatitis B vaccination and rHuEPO/adjuvant iron supplementation has not been reported before. Aim:, To determine the effects of subcutaneous erythropoietin and intravenous (i.v.) iron therapy on the responsiveness of anti-HBsAg after quadruple hepatitis B vaccination among ESRD patients. Methods:, Retrospective medical records were reviewed in a hospital with a tertiary teaching facility. Eighty-three ESRD patients, including 51 who underwent haemodialysis and 32 who underwent peritoneal dialysis therapy, received a quadruple recombinant hepatitis B vaccine. We investigated anti-HBsAg titres in those patients who either received rHuEPO alone (n = 50) or rHuEPO in combination with i.v. iron (n = 33). Results:, We found that the postvaccination anti-HBsAg titre was significantly lower in the rHuEPO plus i.v. iron group when compared with the group with rHuEPO alone (p < 0.05). The increment of anti-HBsAg between the initial month and the seventh month was positively correlated with therapeutic rHuEPO dosages in the group with rHuEPO alone (r = 0.303, p = 0.033). This relationship was not present in the rHuEPO with i.v. iron group (r = ,0.289, p = 0.229). Conclusions:, The levels of anti-HBsAg after hepatitis B vaccination are positively correlated with the dose of rHuEPO treatment during the vaccinated period among ESRD patients without i.v. iron supplementation. Also, i.v. iron negatively impacts the responsiveness of anti-HBsAg titre after hepatitis B vaccination in ESRD patients who have undergone rHuEPO therapy. [source] Efficacy and long-term immunogenicity of hepatitis B vaccine in haemodialysis patientsINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 3 2009A. Ramezani Summary Background:, Hepatitis B vaccine is effective in protection against hepatitis B virus (HBV) infection in haemodialysis (HD) patients, but the antibody response is variable in this population and the persistence of immunity in them remains largely unknown. In this study we aimed to evaluate the efficacy and long-term immunogenicity of hepatitis B vaccine in HD patients. Methods:, In this study, we initially offered HBV vaccination as double dose, four vaccine series schedule (40 ,g injections intramuscularly in the deltoid muscle at 0, 1, 2 and 6 months) to 54 HD patients who were negative for hepatitis B core antibody and did not receive any dose of HBV vaccine previously. Serum levels of hepatitis B surface antibody (anti-HBs) tested 1,2 months after completion of vaccination. Then we follow the patients up to 1 year after primary vaccination to evaluate the persistence of immunity (as indicated by serum levels of anti-HBs higher than or equal to 10 IU/l). Results:, After primary vaccination, 87% of patients developed anti-HBs levels above 10 IU/l. 27.8% and 59.2% of them were weak responders and high responders respectively. 13% of patients were non-responders. After 1-year follow-up, 18.18% of responders had lost their anti-HBs (transient responders). All of them were initially in weak responders group and had lower anti-HBs levels. Conclusion:, We found an average percentage of seroconversion after primary HBV vaccination in HD patients. Our study also supported this fact that an antibody titre above 100 IU/l following primary vaccination is necessary to maintain that level of antibody 1 year later. [source] Anticardiolipin antibody and Taiwanese chronic haemodialysis patients with recurrent vascular access thrombosisINTERNATIONAL JOURNAL OF CLINICAL PRACTICE, Issue 7 2005F-R Chuang Summary Vascular access failure is a major cause of morbidity in chronic haemodialysis (HD) patients. However, some factors (such as homocysteine levels) are known regarding the risk factors predisposing certain HD patients to vascular access thrombosis (VAT). Immunoglobulin-G anticardiolipin antibody (IgG-ACA) is strongly associated with venous and arterial thrombosis in patients with normal renal function. Previous investigations have reported the characteristics of patients with raised IgG-ACA titre and recurrent VAT of HD in Western countries, but few equivalent studies exist for Taiwan. This retrospective study attempts to determine whether raised IgG-ACA titres are associated with an increased risk of recurrent VAT in chronic HD patients. This study enrolled 483 patients undergoing HD. IgG-ACA titre and hepatitis B&C marker were measured for all patients. A history of recurrent (VAT more than one) and/or VAT was elicited by using information from the patient questionnaires and was verified by means of careful inpatient and outpatient chart review. Raised IgG-ACA titres were present in 21.7% (105/483) of patients. In both groups (raised IgG-ACA and normal IgG-ACA), the type of shunt differed significantly (p = 0.029). In predicting for more or one episodes of VAT by using multiple logistic regression with all significant factors, synthetic graft was also a significant factor (p < 0.0001). The 105 raised IgG-ACA titres and 378 normal IgG-ACA titres were associated between chronic HD patients and recurrent VAT (p = 0.034). In predicting for more or one episode of VAT by using multiple logistic regression with all significant factors, raised IgG-ACA titre was a non-significant factor (p = 0.336). The presence of hepatitis C had a higher percentage in group with raised IgG-ACA titres of HD patients (p = 0.042). In predicting for more or one episode of VAT by using multiple logistic regression with all significant factors, the presence of hepatitis C was also a significant factor (p = 0.022). In conclusion, the prevalence of raised IgG-ACA titres was 21.7% among HD patients. There was a weak association between raised IgG-ACA titre and recurrent VAT and this finding may be the consequence of pathogenetic role of raised IgG-ACA titres in the development of VAT status for chronic HD patients. The presence of hepatitis C was a cofactor. [source] Blocked D phenomenon, a rare condition with Rh D haemolytic disease of newborn , a case reportINTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 3 2008P. V. SULOCHANA Summary Accurate Rh testing can be difficult if the red cells are heavily coated with IgG anti D antibodies , a phenomenon called blocked D. Repeatedly, Rh D negative blood group report was obtained in a newborn male baby with severe haemolytic disease and features of kernicterus born to a 2nd gravida B Rh D negative mother. On investigation, the baby was grouped as B Rh D negative by direct grouping, but after elution, D antigen was detected and phenotyped as CcDe. Antibody was identified as anti D. All D antigens of the baby were fully saturated with anti D leaving any antigen to bind with antisera. Direct Coombs test was strongly positive even after three exchange transfusions. The baby also had free antibody apart from the red cell bound and the red cell eluate, gave a titre of 512. The mother was grouped as B Rh D negative and phenotyped as ce. She had IgM and IgG class of anti D with titres 32 and 1024 respectively. She also had IgM anti C (only in neat) and IgG anti-A with a titre of 512. [source] Ineffective Family Participation in Professional Care: A Concept Analysis of a Proposed Nursing DiagnosisINTERNATIONAL JOURNAL OF NURSING TERMINOLOGIES AND CLASSIFICATION, Issue 1 2002Aeran Lee MS PURPOSE. To discuss the label, definition, defining characteristics, and related factors of a proposed nursing diagnosis, "ineffective family participation in professional care." DATA SOURCES. Published research articles, clinical handbooks, textbooks. DATA SYNTHESIS. Although a number of familyrelated nursing diagnoses exist, none really addresses the problems encountered if family members are unwilling or unable to participate in patient care. This is critical because the bulk of care occurs outside the hospital setting. CONCLUSIONS. A new nursing diagnosis, "Ineffective family participation in professional care" is needed. This diagnosis has been submitted to the Nursing Diagnosis Extension and Classification for consideration. PRACTICE IMPLICATIONS. With this diagnosis nurses could encourage family participation in care more effectively by focusing on assessment and interventions. Participation familiale inefficace aux soins professionnels: Analyse conceptuelle d'un diagnostic infirmier proposé BUTS. Discuter du titre, de la définition, des caractéristiques et des facteurs favorisants d'un nouveau diagnostic infirmier: "participation familiale inefficace aux soins professionnels". SOURCES. Articles de recherche, extraits d'ouvrages cliniques. RÉSULTATS. Malgré la présence d'un certain nombre de diagnostics infirmiers centrés sur la famille, aucun d'entre eux ne désigne les problèmes posés par les familles qui ne souhaitent pas ou ne sont pas capables de participer aux soins du patient. Ce phénomène est important, compte tenu de la grande quantité de soins extrahospitaliers. CONCLUSIONS. II semble nécessaire de disposer d'un nouveau diagnostic infirmier "Participation familiale inefficace aux soins professionnels". Ce diagnostic a été soumis au Groupe d'Extension et de Classification des Diagnostics Infirmiers, afin qu'il soit étudié. IMPLICATIONS PRATIQUES. L'utilisation de ce diagnostic devrait permettre aux infirmières de focaliser l'évaluation et les interventions de soins, afin d'impliquer plus efficacement la famille dans les soins. Participação familiar ineficaz no cuidado profissional: Análise de conceito de um diagnóstico de enfermagem proposto OBJETIVO. Discutir o titulo, definição, características definidoras e fatores relacionados de um diagnóstico de enfermagem proposto, "participação familiar ineficaz no cuidado profissional". FONTES DE DADOS.Artigos de pesquisa publicados, manuais clínicos, livros-texto. ACHADOS.Embora exista um certo número de diagnósticos de enfermagem relacionados à família, nenhum deles trata realmente dos problemas encontrados quando membros da família não desejam ou não conseguem participar do cuidado do paciente. Isto é crítico, porque uma grande parte dos cuidados ocorre fora do ambiente hospitalar. CONCLUSãO.É necessário um novo diagnóstico de "Participação familiar eficaz no cuidado profissional". Este diagnóstico foi submetido à apreciação da Extensão e Classificação de Diagnósticos de Enfermagem. IMPLICAÇõES PARA A PRÁTICA.Com este diagnóstico, as enfermeiras podem encorajar a participação da família no cuidado de maneira mais efetiva, com enfoque em levantamento de dados e intervenções. Palavras para busca:Análise de conceito, diagnóstico de enfermagem, participação familiar Participación familiar ineficaz en cuidados profesionales: Análisis de concepto de este diagnóstico enfermero que se ha propuesto PROPÓSITO.Discutir la etiqueta, definición, características definitorias y factores relacionados del diagnóstico propuesto "participation familiar ineficaz en cuidados profesionales." FUENTES DE DATOS.Artículos de investigación publicados, manuales clínicos, libros de texto. RESULTADOS.Aunque existen varios diagnóstics enfermeros relacionados con la familia, ninguno realmente enfoca los problemas encontrados, si las familias no quieren o no pueden participar en el cuidado del paciente. Esto es crítico, porque la mayor parte de los cuidados tienen lugarfuera del entorno del hospital. CONCLUSIONES.Se necesita un nuevo diagnóstico de enfermería "participación familiar ineficaz en cuidados profesionales". Este diagnóstico ha sido presentado a Nursing Diagnosis Extension and Classification para su consideración. IMPLICACIONES PARA LA PRÁCTICA.Con este diagnóstico, las enfermeras podrían animar la participación familiar en los cuidados más eficazmente, centrándose en la valoración y las intervenciones. Términos de búsqueda:Análisis de concepto, diagnóstico enfermero, participación familiar [source] | ||||||||||||||||||||||||||||||||||||||||||||||