Developing nursing research in the United Arab Emirates: a narrative review.

AIM: This article identified, critically analysed and synthesized the literature on international nursing and midwifery research capacity building and standards. BACKGROUND: The United Arab Emirates is heavily dependent up on expatriate nurses. Only 4% of nurses working within the country are Emirati. The nation is therefore committed to developing nurses and nursing as a profession. INTRODUCTION: The United Arab Emirates' Nursing and Midwifery Council was formed in 2009 and initially focused on regulation, education and specialization. This review was undertaken to inform the work of the Council's newly established Scientific Research Sub-Committee. METHODS: A rapid narrative review was conducted using the Cumulative Index of Nursing and Allied Health Literature database, key words, Boolean operators, parameters and a journal-specific search. An inclusion/exclusion criterion was identified. RESULTS: The search provided 332 articles with 45 included in the final review. The literature on nursing research 'standards' and 'capacity building' is diverse and inconsistent across continents and in approaches. DISCUSSION: Nursing research has evolved to varying degrees across the globe. Nevertheless, irrespective of the locale, there are similar problems encountered in growing research, for example nursing faculty shortage, lack of collaborative research, funding. There are also specific challenges in the Middle East and North Africa region. LIMITATIONS: The review was constrained by time and access. CONCLUSION AND IMPLICATIONS FOR NURSING POLICY: There are specific challenges for the United Arab Emirates. However, the country is well placed to learn from the experiences of colleagues elsewhere. Time and commitment is required to build the solid foundations necessary to ensure robust, sustained growth. Identifying research capacity as both a process and outcome at the outset may also assist. Further, it may be prudent to consider initiating a Gulf Coast Countries' collaborative approach to building research capacity to harness scare resources and create a larger critical mass.

An in vitro human skin test for assessing sensitization potential.

Sensitization to chemicals resulting in an allergy is an important health issue. The current gold-standard method for identification and characterization of skin-sensitizing chemicals was the mouse local lymph node assay (LLNA). However, for a number of reasons there has been an increasing imperative to develop alternative approaches to hazard identification that do not require the use of animals. Here we describe a human in-vitro skin explant test for identification of sensitization hazards and the assessment of relative skin sensitizing potency. This method measures histological damage in human skin as a readout of the immune response induced by the test material. Using this approach we have measured responses to 44 chemicals including skin sensitizers, pre/pro-haptens, respiratory sensitizers, non-sensitizing chemicals (including skin-irritants) and previously misclassified compounds. Based on comparisons with the LLNA, the skin explant test gave 95% specificity, 95% sensitivity, 95% concordance with a correlation coefficient of 0.9. The same specificity and sensitivity were achieved for comparison of results with published human sensitization data with a correlation coefficient of 0.91. The test also successfully identified nickel sulphate as a human skin sensitizer, which was misclassified as negative in the LLNA. In addition, sensitizers and non-sensitizers identified as positive or negative by the skin explant test have induced high/low T cell proliferation and IFNγ production, respectively. Collectively, the data suggests the human in-vitro skin explant test could provide the basis for a novel approach for characterization of the sensitizing activity as a first step in the risk assessment process.

By-products formation during degradation of isoproturon in aqueous solution. I: Ozonation.

The degradation of the herbicide isoproturon during its ozonation in aqueous solution has been investigated with the aim of identifying intermediate as well as final by-products formed. At ambient temperature, phosphate-buffered (pH = 7) isoproturon aqueous solutions (10, 10(-1) and 10(-3) mg/l) were ozonated in a semi-batch reactor, under a continuous flow of ozonated air whose ozone concentration was 9 and 0.9 mg O3/lair for the highest and the two lower herbicide concentrations respectively. Measured steady-state ozone concentrations during the two sets of experiments (i.e. the highest and the lower isoproturon concentration) were 1.9 and 0.7 mg O3/l. Under all of the above conditions, isoproturon was always completely removed in a period ranging between 5 and 15 min, essentially by reacting with molecular ozone. High-performance liquid chromatography-mass spectrometry (HPLC-MS) analyses indicate that primary degradation by-products are formed either by introducing OH groups in the aromatic ring and/or in the side-chain substituents, or by breaking down the isopropyl alkyl chain. The results also show that these primary intermediates are successively degraded yielding low molecular weight compounds such as aldehydes, simple organic acids and alpha-oxo-acids, which have been identified by gas chromatography-electron capture detection (GC-ECD), ion chromatography (IC) and GC-MS, respectively. On the basis of the analytical results, a pathway for the degradation of isoproturon by ozone has been proposed.

By-products formation during degradation of isoproturon in aqueous solution. II: Chlorination.

After a previous study in which the considered oxidant was ozone (Part I), a laboratory investigation has been carried out to study the degradation of the herbicide isoproturon during its reaction with another oxidant, i.e. chlorine, in aqueous solution (Part II; this paper). The specific aim was to identify the by-products formed. The effects of pH and the presence of bromide ions were studied. Reactions have been carried out at room temperature, in phosphate buffered aqueous solutions, at four pHs (6, 7, 8 and 9). By-products identification was first performed using relatively high initial reagent concentrations which were analytically convenient ([isoproturon] = 40 mg/l, [HClO + ClO-] = 160 mg Cl/l, [Br-] = 80 mg/l). In follow-up studies, the by-products identified during this preliminary step were searched for when using concentration values closer to those actually encountered at real water treatment plants ([isoproturon] = 0.4 and 0.004 mg/l, [HClO + ClO-] = 1.6 mg Cl/l, [Br-] = 0.8 and 0.008 mg/l). Under all of the studied conditions, the results showed that isoproturon is completely degraded and that it decays much faster in the presence of bromide. The pH has a negligible influence when bromide ions are absent. On the contrary, if bromide ions are present, the isoproturon decay is slower at higher pH values. High-performance liquid chromatography-mass spectrometry (HPLC-MS) analyses have led to the identification of several by-products as a result of simultaneous oxidation and substitution reactions, both occurring on the aromatic ring of the herbicide. However, the more abundant by-products are those resulting from the oxidation of the isoproturon aromatic ring. As far as halogenated by-products are concerned, the higher the bromide ion concentration the higher the ratio of brominated to chlorinated by-products. On the basis of the analytical results, a pathway for isoproturon degradation under the studied conditions is proposed.

Arabinoxylan fiber from a by-product of wheat flour processing behaves physiologically like a soluble, fermentable fiber in the large bowel of rats.

Arabinoxylan is a major dietary fiber component of many cereals. Its physiological effects in the colon are largely unknown. This study examined the effects of an arabinoxylan-rich fiber (AX) extracted from a by-product of wheat flour processing in the rat colon compared with well-characterized soluble/rapidly fermentable and insoluble/slowly fermentable fibers. Rats were fed diets containing no fiber (NF) or 100 g/kg of total dietary fiber from AX, guar gum (GG) or wheat bran (WB) for 4 wk. Cecal mass and short-chain fatty acid (SCFA) pool were significantly higher while pH was significantly lower in the fiber-supplemented groups, particularly in the AX and GG groups. The pattern of SCFA production in the cecum was altered; AX fiber was a good source for acetate while GG and WB favored propionate and butyrate production, respectively. Fecal output was 7-, 6- and 5-fold higher, respectively, in the AX, GG and WB than in the NF groups (P < 0.01). All epithelial proliferation indices (crypt column height, number of mitotic cells/crypt column and mitotic index) differed significantly across the groups in a descending order of AX > GG > WB > NF. Distal mucosal dipeptidyl peptidase IV activities, which indicate cell differentiation status, were significantly lower in fiber-supplemented groups than in the NF groups. Distal mucosal alkaline phosphatase activities, induced as a response to injury or stress, were significantly higher for the AX and GG groups than for the NF or WB groups (P < 0.001). These results indicate that AX fiber behaves like a rapidly fermentable, soluble fiber in the rat colon.

Relationship of hydrolase activities to epithelial cell turnover in distal colonic mucosa of normal rats.

BACKGROUND: The relationships between changes induced by diet in colonic epithelial kinetics and in the activities of brush border hydrolases are poorly defined. The aims of this study are to define these relationships, as changes in kinetics would be expected to influence differentiation, and to determine whether the type of ingested dietary indigestible carbohydrates influences hydrolase activities. METHODS: Groups of eight rats were fed a low fibre diet +/- supplements of different types of indigestible carbohydrates for 4 weeks. Alkaline phosphatase (ALP) and dipeptidyl peptidase IV (DPPIV) activities and epithelial kinetics were measured in distal colonic mucosa. RESULTS: Median ALP activities correlated positively and DPPIV activity negatively with the median proportion of cells entering metaphase (r = 0.58 and -0.58, respectively; P < 0.05) and number of metaphase arrests per crypt column across the diets (r = 0.59 and 0.58, respectively; P < 0.05). Stepwise regression analysis showed that both hydrolases independently predicted these kinetic indices (R2 > 63% for each). Mucosal ALP activities were markedly elevated during consumption of raw potato starch, guar gum and methylcellulose, while only potato starch caused a significant elevation of DPPIV activities. CONCLUSIONS: The type of indigestible carbohydrate in the diet influences colonic mucosal hydrolase activities. The opposite relationship between kinetics and each of the two hydrolases indicates that these hydrolases do not reflect the same event; dipeptidyl peptidase IV might relate to differentiation status while ALP could also be influenced by epithelial irritation due to changes in luminal conditions.

Cecal intubation model in the rat that facilitates selective in vivo study of colonic epithelial biology: preliminary report.

PURPOSE: A free-living animal model with ready and repetitive access to selected regions of the large bowel and with minimally altered bowel anatomy and physiology would facilitate the in vivo study of luminal factors on the colonic mucosa in a steady-state environment. This study describes a novel model of large-bowel intubation in the rat. METHOD: Four Sprague-Dawley rats (240-260 g) had laparotomy and intubation of the distal colon and the cecum via a cecotomy with the use of two small tubes with restraints and transmural anchors. The tubes were tunneled and anchored to the back for infusion of fluid directly into the colon. Tube positions were studied when the animals were killed. Animals were fed on either a 10 percent fiber diet or a fiber-free diet. Stathmokinetic assessment of the distal colon was performed after one week of infusion with phosphate-buffered saline and sodium n-butyrate. RESULTS: The technique produced an easy access without affecting the weight gain of the animals after recovery. Tube positions were accurate after three weeks at the time the animals were killed. Infusions of phosphate-buffered saline and n-butyrate were well tolerated. n-Butyrate infusions twice daily for a week reversed the atrophy in the colonic mucosa induced by dietary fiber deprivation. CONCLUSION: An in vivo large-bowel intubation model permitting selective delivery of luminal factors provides an effective option for the study of colonic mucosal biology.

Contaminants of food : Prioritisation scheme to identify manufactured organic chemicals as potential contaminants of food.

A scheme has been developed to rank 70 industrial organic chemicals in order of their priority for further study as potential contaminants of food. Numerical scales were developed for the following seven key criteria concerning environmental issues, food and toxicity: -Production volume -Pattern of usage -Possible fate in the environment -Likelihood of chemical entering the food chain -Mechanism of entry into the food chain -Persistence and accumulation in the food chain -Toxicity. Each chemical was assigned a score for the above criteria, which were combined to give an overall ranking for the chemicals.This scheme has been endorsed by the MAFF Steering Group on Chemical Aspects of Food Surveillance. It will be used in the assessment of relative priorities for further non-statutory surveillance for these contaminants in the UK food supply.

Management of perianal sepsis in a district general hospital.

Perianal sepsis remains a common surgical problem. A total of 121 patients undergoing surgery for perianal abscess and/or fistulae over a 2-year period was studied. Of these, 50 patients (41.3%) had suffered from previous perianal sepsis (not necessarily resulting in hospital attendance). Ninety-one patients underwent incision and drainage of abscesses (ischiorectal and perianal) for the first time, whereas eight patients underwent drainage of recurrent abscesses. Fistulae were identified when the abscess was drained in 14 of 91 patients, and a further ten patients subsequently developed fistulae. Twenty-two patients presented with a discharging fistula. A high yield of bowel organisms was present in patients with coexisting fistulae (88%), recurrent abscesses (75%) and in those who subsequently developed fistulae (83%). We confirm that such a growth can be used to identify patients who will benefit from further examinations.

The significance of bleeding patterns in Norplant implant users.

The purpose of this study was to examine the bleeding patterns of 234 Norplant users during 5 years of use and to identify the bleeding patterns of users who conceived. During the first year of use, 26.6% of users had regular bleeding cycles, 66.3% had irregular cycles, and 7.1% were amenorrheic. By the fifth year of use, 62.5% of users had regular cycles, 37.5% had irregular cycles, and none had amenorrhea. Of the ten users who became pregnant, eight had regular menstrual cycles in the 6 months before the diagnosis of pregnancy, one had an irregular pattern, and one did not keep a bleeding record. None had amenorrhea. The 5-years cumulative pregnancy rate for patients with regular cycles was 17.4%; this was significantly higher (P less than .05) than the 5-year cumulative rates of 4.4% in users with irregular cycles and 0% in users with amenorrhea. This study indicates that during the first year of Norplant use, only 26.6% of users have regular cycles, but after the first year, 50-60% of users develop regular cycles. The bleeding patterns of women using Norplant improve after the first year of use, and those with regular cycles are at greatest risk for method failure.

Identification and assessment of hazardous compounds in drinking water.

The identification of organic chemicals in drinking water and their assessment in terms of potential hazardous effects are two very different but closely associated tasks. In relation to both continuous low-level background contamination and specific, often high-level, contamination due to pollution incidents, the identification of contaminants is a pre-requisite to evaluation of significant hazards. Even in the case of the rapidly developing short-term bio-assays which are applied to water to indicate a potential genotoxic hazard (for example Ames tests), identification of the active chemicals is becoming a major factor in the further assessment of the response. Techniques for the identification of low concentrations of organic chemicals in drinking water have developed remarkably since the early 1970s and methods based upon gas chromatography-mass spectrometry (GC-MS) have revolutionised qualitative analysis of water. Such techniques are limited to "volatile" chemicals and these usually constitute a small fraction of the total organic material in water. However, in recent years there have been promising developments in techniques for "non-volatile" chemicals in water. Such techniques include combined high-performance liquid chromatography-mass spectrometry (HPLC-MS) and a variety of MS methods, involving, for example, field desorption, fast atom bombardment and thermospray ionisation techniques. In the paper identification techniques in general are reviewed and likely future developments outlined. The assessment of hazards associated with chemicals identified in drinking and related waters usually centres upon toxicology - an applied science which involves numerous disciplines. The paper examines the toxicological information needed, the quality and deployment of such information and discusses future research needs. Application of short-term bio-assays to drinking water is a developing area and one which is closely involved with, and to some extent dependent on, powerful methods of identification. Recent developments are discussed.

Nonvolatile organic compounds in treated waters.

Over the past decade much information has been published on the analysis of organics extracted from treated water. Certain of these organics have been shown to be by-products of the chlorination disinfection process and to possess harmful effects at high concentrations. This has resulted in increased interest in alternative disinfection processes, particularly ozonation. The data on organics had been largely obtained by using gas chromatography-mass spectrometry, which is only capable of analyzing, at best, 20% of the organics present in treated water. Research in key areas such as mutagenicity testing of water and characterization of chlorination and ozonation by-products has emphasized the need for techniques suitable for analysis of the remaining nonvolatile organics. Several methods for the isolation of nonvolatile organics have been evaluated and, of these, freeze-drying followed by methanol extraction appears the most suitable. Reverse-phase HPLC was used for separation of the methanol extract, but increased resolution for separation of the complex mixtures present is desirable. In this context, high resolution size exclusion chromatography shows promise. Characterization of separated nonvolatiles is possible by the application of state-of-the-art mass spectrometric techniques. Results obtained by these techniques have shown that the nonvolatile organic fraction of chlorinated drinking water consists of many discrete compounds. Among these, some of the chlorinated compounds are almost certainly by-products of disinfection. Studies of the by-products of ozonation of fulvic and humic acids isolated from river waters have indicated a similar proportion of nonvolatile organics. Further, ozonation can result in the release of compounds that are trapped in the macromolecules.

Health related studies of organic compounds in relation to re-use in the United Kingdom.

Approximately one third of the water supplies in the United Kingdom are derived from lowland rivers receiving industrial and domestic effluent and in some cases the level of indirect re-use may be high. Research, funded by the Department of the Environment, is being undertaken to identify any potentially hazardous organic compounds that may be present in such supplies and to determine whether there is evidence of any effects on the health of the relevant populations. Analysis of drinking water from various types of source has shown that a wide variety of organic compounds is present in drinking water derived from groundwater and polluted lowland rivers but with few exceptions concentrations are much higher in the latter case. The mutagenicity screening of water samples as a means of directing analytical effort at the substances of greatest potential health significance is being investigated. In a study of cancer mortality in 29 London boroughs an association between high levels of re-use and cancers of the gastrointestinal and urinary tracts disappeared when socioeconomic characteristics and borough size were taken into account. A national study is now being undertaken.