bluuebunny/crossref_metadata_2025 huggingface dataset:
Bronchodilator reversibility in Australian adults with chronic obstructive pulmonary disease
Authors: Reid D. W. , Soltani A. , Johns D. P. , Bish R. , Williams T. J. , Burns G. P. , Walters E. H.
Published: December 2003

Abstract

Background and aims:  Bronchodilator reversibility (BDR) and inhaled corticosteroid (ICS) use were assessed for volunteers who responded to an advertisement requesting current or ex‐smokers who were experiencing breathlessness to attend for lung function testing.

Methods:  One hundred and fifty‐four volunteers responded. Forced expiratory volume (FEV1) was measured before and after 400 µg of salbutamol. Significant BDR was assessed according to guidelines of: (i) the American Thoracic Society (≥12% plus 200 mL of baseline FEV1 or forced vital capacity), (ii) the British ­Thoracic Society (BTS) (≥15% plus 200 mL of baseline FEV1), (iii) the European Thoracic Society (≥10% predicted FEV1), and (iv) the most commonly used criteria in Australia and New Zealand (≥15% of baseline FEV1).

Results: One hundred and twenty‐three subjects (33 female; 40 current smokers; median pack years 48 (range 5−144)) were suitable for analysis (i.e. had no history of asthma, demonstrable airflow limitation and a forced expiratory ratio (FER) of <70%). Twenty (16%) patients had an FEV1 within the normal range but FER of <70%, 24 (20%) patients had mild disease (FEV1 60−80% predicted), 31 (24%) patients had moderate disease (FEV1 40−59% predicted), and 48 (39%) patients had severe disease (FEV1 <40% predicted), according to BTS criteria. Significant BDR was evident in: (i) 58 (47%) subjects by American criteria, (ii) 26 (21%) subjects by British criteria, (iii) 19 (15%) subjects by European criteria and (iv) 36 (29%) subjects by Australasian criteria. ICS use was reported by 71 (58%) subjects overall and was weakly, but significantly, related to poorer FEV1 (r = −0.2; P < 0.01), and greater BDR (r = 0.3; P < 0.005).

Conclusion: Chronic obstructive pulmonary disease in Australian volunteers with no history of asthma encompasses many individuals with significant BDR. Interestingly, most volunteers reported ICS use and this was related to poorer spirometry and greater BDR. However, until the underlying immuno­pathology has been determined they cannot be assumed to have ‘asthma’ or even an ‘asthmatic element’. (Intern Med J 2003; 33: 572−577)
The Sylvia and Charles Viertel Charitable Foundation: a decade of support for medical research in Australia
Authors: Whitworth J. A.
Published: December 2003

Abstract

The Sylvia and Charles Viertel Charitable Foundation (http://www.alfredresearch.orgexternalviertel.htm) recently celebrated its first decade of support for medical research in Australia. Its contribution to Australian medical research has centred on support of outstanding young people through Senior Medical Research Fellowships and a unique grant‐in‐aid programme for clinical investigators. (Intern Med J 2003; 33: 610−612)
Australasian haematologist referral patterns to palliative care: lack of consensus on when and why
Authors: Auret K. , Bulsara C. , Joske D.
Published: December 2003

Abstract

Background:  Patients with haematological malignancies are not referred to palliative care services as frequently as those with solid cancers (non haematological malignancies).

Aims:  The present study surveyed haematologists in Australia and New Zealand. We aimed to record theoret­ical referral times, identify problems with referral to palliative care and clarify elements used to decide whether a patient was ‘terminally ill’.

Methods: A questionnaire based on the case‐histories of three patients (with acute leukaemia, lymphoma or mul­tiple myeloma) was distributed at the Haematology Society of Australia and New Zealand Congress 2000, Perth, Australia. Each case was divided into stages by transitional points in the illness to include issues or prognostic variables that may stimulate referral to ­palliative care. Questions were asked about: (i) referral ­triggers, (ii) problems previously experienced, (iii) definition of when the patient was ‘terminally ill’, (iv) prognostication difficulties and (v) communication about prognosis.

Results: The response rate was 11%, which may represent up to 32% of Australian specialists. Eighty per cent had access to all types of palliative care services and refer for symptom control, regardless of illness stage. Twenty‐nine per cent had experienced difficulties in referring. There was a variation as to exactly when referral would occur and when each case was considered ‘terminally ill’. Reasons for early or later referral were explored. Prognostication difficulties were common.

Conclusions: In theory there is a willingness to refer to palliative care, however this has yet to be translated to day‐to‐day practice. This may be due to prognostication difficulties, logistical factors and medical concerns. Models of referral are suggested for further study. (Intern Med J 2003; 33: 566−571)
Impact of an integrated approach to diabetes care at the Rumbalara Aboriginal Health Service
Authors: Simmons D.
Published: December 2003

Abstract

Aims:  To describe the effectiveness of an integrated ­primary−secondary care diabetes clinic on metabolic control among indigenous patients in a rural community

Methods:  A retrospective audit of attendance to the clinic over 2 years (2 August 1999 to 31 August 2001). The service included a weekly specialist diabetes clinic integrated with the primary care team at the Rumbalara Aboriginal Health Service, Mooroopna, Victoria, Australia. Between clinics, follow up was provided by the Aboriginal health worker and other members of the integrated care team. Of the 47 patients seen, 20 had an HbA1c persistently ≥9.0% (of 21 patients identified in the community) and seven had gestational diabetes.

Results:  Among 40 patients without gestational diabetes, microalbuminuria or proteinuria were present in 62%, retinopathy was present in 50%, neuropathy was present in 50% and at least one past cardiac or vascular event/surgical procedure had occurred in 25%. Of these, the 30 patients seen more than once increased their self glucose monitoring (baseline (53.3%) vs. last visit (90%); P = 0.003) and reduced their HbA1c (10.4 ± 2.2%vs. 7.9 ± 1.9%; P < 0.001), systolic blood pressure (138 ± 20 vs. 127 ± 18 mmHg; P = 0.003) and diastolic blood pressure (78 ± 11 vs. 73 ± 12 mmHg; P = 0.037) and total cholesterol (6.1 ± 1.7 vs. 5.1 ± 1.6 mmol/L; P = 0.002), but not their weight, smoking or triglycerides.

Conclusion: The introduction of an integrated diabetes care service in an Aboriginal health service can overcome many of the pre‐existing barriers to achieving metabolic targets. Poor metabolic control in Aboriginal patients is often due to lack of resources and inappropriateness of approach, rather than ‘compliance’. (Intern Med J 2003; 33: 581−585)
Diagnosis of malaria aided by polymerase chain reaction in two cases with low‐level parasitaemia
Authors: Speers D. J. , Ryan S. , Harnett G. , Chidlow G.
Published: December 2003

Abstract

Light microscopy of thick and thin blood smears is the mainstay of malaria diagnosis. In situations of low‐level parasitaemia such as drug‐modified disease, however, this may be difficult making clinical management problematic. Polymerase chain reaction (PCR) methods have shown high sensitivity for the diagnosis of malaria and are able to differentiate the Plasmodium species involved. Two cases are presented in the present study, which illustrate how a PCR method can aid light microscopic malaria diagnosis and species differentiation in returned travellers with low‐level parasitaemia. Plasmodium vivax was detected by PCR prior to the light microscopy becoming positive in one case, and in the second case Plasmodium malariae was detected when light micro­s­copy was unable to speciate the causative Plasmodium species. (Intern Med J 2003; 33: 613−615)
Resampling with Excel
Authors: Christie Derek
Published: December 2003

Standard Microsoft Excel functions and the Excel Data Table facility are used in randomization applications using resampling with and without replacement.
Useful Data for Teaching Statistics from Hockey World Cup Matches
Authors: Cholkar C. P. , Deshpande M. N.
Published: December 2003

This article presents some data from a major sports event that can be used in common statistical analyses.
In All Probability, Probability is not All
Authors: Helman Danny
Published: December 2003

The national lottery is often portrayed as a game of pure chance with no room for strategy. This misperception seems to stem from the application of probability instead of expectancy considerations, and can be utilized to introduce the statistical concept of expectation.
Water Quality Statistics
Authors: Hodgson Ted , Andersen Lyle , Robison‐Cox Jim , Jones Clain
Published: December 2003

Water quality experiments, especially the use of macroinvertebrates as indicators of water quality, offer an ideal context for connecting statistics and science. In the STAR program for secondary students and teachers, water quality experiments were also used as a context for teaching statistics. In this article, we trace one activity that uses virtual streams and repeated sampling to develop the notion of a hypothesis test for one proportion.
The Generalized Mean
Authors: Sheldon Neil
Published: December 2003

This article defines the generalized mean and shows how it relates to such statistics as the arithmetic, geometric and harmonic means.
Sensory characteristics of fufu prepared with cassava roots (Manihot esculenta Crantz) stored in polyethylene sacks
Authors: Opare‐Obisaw Clara , Asante Isaac Kojo , Annan Ekua Koba
Published: December 2003

This study was carried out to assess the effect of storage of cassava roots in polyethylene sacks for periods of 2, 4, 6 and 8 weeks on the sensory characteristics of cassava fufu, a popular Ghanaian dish. Freshly harvested cassava roots were dipped in tap water and packed into polyethylene sacks in 2‐kg batches and stored at room temperature (25°C ± 1°C). Samples of fresh cassava fufu were evaluated and then at two weekly intervals for a period of 8 weeks. Attributes evaluated were colour, smell, elasticity, smoothness and taste. A structured six‐point ranking scale ranging from 6 (excellent) to 1 (very poor) was used for the evaluation. The data were analysed using analysis of variance, and the least significance difference test at P < 0.05 was used to determine differences between means. The results showed that storage of cassava roots for up to 8 weeks did not significantly affect the colour, smell, elasticity and taste of cassava fufu. However, smoothness of fufu prepared with cassava stored for 6 and 8 weeks was significantly different from the samples of the fresh cassava, and those stored for 2 and 4 weeks. It was concluded that cassava roots stored for periods up to 8 weeks in polyethylene sacks produced fufu of similar characteristics as fresh cassava fufu. This method is therefore recommended for use by homemakers, food service operators, cassava retailers and processors to save them time, energy and money used for the frequent trips for purchases. The method would also reduce post‐harvest losses to a large extent.
The acceptability of different types of soymilks available in Cape Town in consumers from high and low socio‐economic areas
Authors: Hinze Astrid , Karg Cheryl , Van Zyl Maryke , Mohamed Nazreen , Steyn Nelia P.
Published: December 2003

The aim of this study was to determine the knowledge and acceptability of soymilk (defined as consumption pattern/usage and taste) by adult consumers, residing in different socio‐economic areas (low vs. high) in Cape Town. The study population of 214 participants were selected using convenience sampling. A questionnaire was developed in order to obtain demographic data (four items); basic general knowledge of soymilk (four items); and acceptability of the tested products (consumption patterns and taste) (eight items). There was a significant difference between the two groups (P = 0.000) regarding basic knowledge of soymilk, with significantly more in the high socio‐economic area (HSEA) having a score of at least 75%. Gender (P = 0.082) and age (P = 0.122) did not have a significant impact on the consumption patterns of soymilk. There was no significant difference between the two groups with respect to current usage (P = 0.228) and frequency of use (P = 0.213) of soymilk. However, a significantly smaller group (P = 0.000) of participants in the low socio‐economic area had previously tasted soymilk compared with those in the HSEA (16.7% vs. 41.5%; P = 0.000). In conclusion, socio‐economic status appeared to be associated with knowledge of soymilk. No significant differences with regard to gender, age or current usage in the two groups studied were noted.
The effect of the length of soaking time on trypsin inhibitor, crude protein and phosphorus contents of soybeans (Glycine max)
Authors: Mumba P.P. , Chilera F. , Alinafe G.
Published: December 2003

A study to determine the effect of soaking soybeans (Glycine max) at different periods of time on trypsin inhibitor, crude protein and phosphorus contents was carried out. The results showed that the length of soaking period had significant effect (P < 0.05) on trypsin inhibitor and crude protein contents. The activities of the trypsin inhibitor were 10% in roasted soybeans, 27.5% in raw and a range of 26.6% for those soaked in water for 24 h to 17.7% for soybeans soaked for 96 h or more, with a standard error of 6.56 on each of the values. The crude protein contents were 41.58% in raw, 31.43% in roasted and a range of 40.05–30.64% for those soaked in water for 24–120 h. The standard error on each value was 5.09%. On the other hand, length of soaking period had no significant effect on phosphorus content. It can be concluded from this that soaking soybeans in water can effectively remove the anti‐nutritional factors. While roasting is better, the use of fire wood may not be encouraged as it has caused a lot of deforestation with consequent occurrence of floods and hence food shortages. Such a good animal husbandry practice can help to improve the health of animals, which can in turn help to improve the health of the population.
A consumer education programme based on the Transtheoretical Model of Change
Authors: Xiao Jing Jian , O'Neill Barbara , Prochaska Janice M. , Kerbel Claudia M. , Brennan Patricia , Bristow Barbara J.
Published: December 2003

MONEY 2000™ is a successful consumer education programme that was implemented by Cooperative Extension personnel in over two dozen states of the USA between 1996 and 2002. One of the unique features of this programme is that it was based on the Transtheoretical Model of Change (TTM), a framework that has been widely used to study health‐related behaviour changes such as smoking cessation. This paper first describes how the MONEY 2000™ programme was developed around major constructs contained within the TTM. Findings are reported from a survey conducted with participants in the first two states that delivered the programme. The findings suggest that several change processes used by MONEY 2000™ participants are associated with specific stages of change. In addition, there may be differences in behavioural changes between participants who increased their savings and those who reduced their debts.
Fashion groups, gender, and boredom proneness
Authors: Studak Cathryn M. , Workman Jane E.
Published: December 2003

This study examined differences between men and women and among fashion consumer groups (fashion innovators, fashion opinion leaders, innovative communicators, and fashion followers) in propensity toward boredom. Participants (126 male, 130 female university students) completed questionnaires measuring fashion group membership, boredom proneness, and demographics.anovarevealed significant effects for fashion group for two dimensions of boredom proneness: internal stimulation and constraint. Innovative communicators indicated lower propensity for boredom because of need for internal stimulation but more propensity for boredom because of constraint than fashion followers. Men indicated greater propensity for boredom because of need for external stimulation than women did.
The development of consumer protection in Saudi Arabia
Authors: Morris David , Al Dabbagh Maha
Published: December 2003

The development of consumer protection in Saudi Arabia is of interest for a number of reasons. First, Saudi Arabia presents a unique combination of size, stage of development of the economy and wealth, coupled with strictness of Islamic observance. Second, consumer protection in the Saudi context has received very little attention from researchers. Despite the richness of Islamic teachings on the conduct of business and trade, very little has been written on consumer protection in Islamic societies other than discussions of financial markets and consumer credit and monopoly. This article briefly explores the background to the emergence of consumer protection in Saudi Arabia. Consumer credit and financial markets are excluded from the discussion. Islamic (Shari’ah) law is analysed as a basis for the regulation of consumer affairs; this system of law is then compared in its major outcomes for consumers with legal systems in advanced Western economies. The development of secular commercial law during recent times in Saudi Arabia is also considered as a parallel development to those in Shari’ah. Both strands of development are then set in the context of Saudi Arabia's 5‐year development plans and the changing position of consumer policy issues is tracked through successive plans. The institutional location of consumer policy within the Saudi government system is discussed before finally considering the changing nature of the Saudi consumer and the possible future for consumer protection in the country.
Modelling purchasing decisions of seafood products: a case study of Mumbai, India
Authors: Redkar Soumil Bharat , Bose Shekar
Published: December 2003

This study investigated the factors affecting the purchase decisions of seafood consumers in selected urban areas of Mumbai, India. The primary data were analysed using binary choice modelling techniques. It was found that taste, religion, size of household and age of family member were significant factors at a 95% confidence level. The Indian seafood industry may find this baseline study useful to encourage further consumer‐based research to promote the growth of the domestic seafood market.
Exploring the relationship between money attitudes and Maslow's hierarchy of needs
Authors: Oleson Mark
Published: December 2003

This study explores the relationship between basic human needs and money attitudes in a university‐age cohort utilizing Maslow's theory of hierarchical needs. Results confirmed relationships between needs and money attitudes. Specifically, all of Maslow's needs appear to be strongly related to the money attitudes of evaluation and anxiety. In addition, men's and women's needs are highly correlated with obsession, budget, anxiety and particularly evaluation. Findings support existing literature and point to the importance of understanding money attitudes and level of need satisfaction among individuals and families, particularly from a counselling and educational standpoint. Implications and possible areas for future research are discussed.
Historical vs. ecological factors influencing global patterns of scarabaeine dung beetle diversity
Authors: Davis Adrian L. V. , Scholtz Clarke H.
Published: December 2003

Abstract. There has been much debate concerning the relative influence on biodiversity of historical vs. current ecological factors. Although both are important, we suggest that historical influences might be greater at higher taxonomic level, since one is looking further back into evolutionary history than at lower taxonomic level. Although we are unable to separate ecological from historical effects in the present global study on scarabaeine dung beetles, we are able to demonstrate differences in correlations between major environmental influences (climatic area, numbers of dung types) and major components of diversity (taxon richness, taxon diversity, functional composition) at different taxonomic levels (tribe, genus, species). Current global variation in taxon richness is correlated strongly to current biogeographical variation in the area of suitable climate at all three taxonomic levels. However, generic and species richness is correlated most strongly to climatic combinations which include tropical and warm summer rainfall climate types (I, II). In contrast, tribal richness is correlated most strongly to climatic combinations which include both warm summer rainfall and temperate climate types (II, VI, X). Regional variation in the number of available dung types shows a strong positive correlation to regional variation in taxon richness at higher tribal level but not at lower generic and species levels. Similarly, biogeographical differences in the number of available dung types show a strong negative correlation to dominance indices for taxon diversity at tribal level (distribution of generic numbers between tribes) but none at generic level (species numbers per genus). As functional diversification is linked closely to taxonomic diversification at tribal level, proportions of both ball‐rolling genera and ball‐rolling species also show strong negative correlations to the number of dung types available in each region. In conclusion, the presence of dung type correlations only at higher taxonomic level may reflect historical effects on scarabaeine taxon diversification, whereas differences in correlations to climate type with taxonomic level may reflect both current ecological and historical effects.
Taxonomic diversity gradients through geological time
Authors: Crame J. Alistair
Published: December 2003

Abstract. There is evidence from the fossil record to suggest that latitudinal gradients in taxonomic diversity may be time‐invariant features, although almost certainly not on the same scale as that seen at the present day. It is now apparent that both latitudinal and longitudinal gradients increased dramatically in strength through the Cenozoic era (i.e. the last 65 my) to become more pronounced today than at any time in the geological past. Present‐day taxonomic diversity gradients, in both the marine and terrestrial realms, are underpinned by the tropical radiations of a comparatively small number of species‐rich clades. Quite why these particular taxa proliferated through the Cenozoic is uncertain, but it could be that at least part of the explanation involves the phenomenon of evolutionary escalation. This is, in essence, a theory of biological diversification through evolutionary feedback mechanisms between predators and prey; first one develops an adaptive advantage, and then the other. However, there may also have been some form of extrinsic control on the process of tropical diversification, and this was most likely centred on the phenomenon of global climate change. This is especially so over the last 15 my Various Late Cenozoic (Neogene) vicariant events effectively partitioned the tropics into a series of high diversity centres, or foci. It has been suggested that, in the largest of these in the marine realm (the Indo‐West Pacific or IWP centre), a critical patterns of islands acted as a template for rapid speciation during glacioeustatic sea level cycles. The same process occurred in the Atlantic, Caribbean and East Pacific (ACEP) centre, though on a lesser scale. Tropical terrestrial diversity may also have been promoted by rapid range expansions and contractions in concert with glacial cycles (a modified refugium hypothesis). We are beginning to appreciate that an integrated sequence of Neogene tectonic and climatic events greatly influenced the formation of contemporary taxonomic diversity patterns.
Palaeoecological perspectives on pattern and process in plant diversity and distribution adjustments: a comment on recent developments*
Authors: Odgaard Bent Vad
Published: December 2003

Two developments in the understanding of the relationship between sedimentary pollen assemblages, vegetation and plant diversity are discussed. The Prentice model of vegetation–pollen relationships has improved our understanding of how and at what scale sedimentary pollen records vegetation. The modelling framework allows improved palaeoecological study designs that may, potentially, give important new insights into processes of plant migrations in response to climate change. Also, reconstructions of plant communities and landscape openness may be improved. Competing hypotheses for the relationship between vegetation and palynological diversity are discussed and it is concluded that more attention should be focused on evenness aspects of palynological diversity and on hypothesis testing.
Team‐Level Antecedents of Individuals' Knowledge Networks*
Authors: Hoegl Martin , Parboteeah K. Praveen , Munson Charles L.
Published: December 2003

Individuals' knowledge networks are widely considered to contribute substantially to the effectiveness and efficiency of organizations. While the positive effects of knowledge networks as a primary driver of social capital have recently received considerable research attention, potential determinants of individuals' network building have not yet been adequately addressed. In this study, we investigate how certain team‐level properties affect team members' development of knowledge networks through the course of a team project. Using data from 430 team leaders and team members pertaining to 145 software development projects, we test cross‐level hypotheses using hierarchical linear modeling (HLM). The results indicate that the team's perception of the organizational knowledge‐sharing climate, the team's networking preference, and the team's perceived importance of networking for project success positively affect individuals' network building. Furthermore, a team's perception of the adequacy of its technical competency and a team's perception of the adequacy of its material resources inhibit team members' individual network development. Theoretical and managerial implications are discussed.
The Effect of Team Leader Characteristics on Learning, Knowledge Application, and Performance of Cross‐Functional New Product Development Teams
Authors: Sarin Shikhar , McDermott Christopher
Published: December 2003

This study examines how leadership characteristics in new product development teams affect the learning, knowledge application, and subsequently the performance of these teams. Using data from a study of 229 members from 52 high‐tech new product projects, we empirically demonstrate that team learning has a strong positive effect on the innovativeness and speed to market of the new products. Moreover, a democratic leadership style, initiation of goal structure by the team leader, and his or her position within the organization were positively related to team learning. Managerial implications of these results are discussed.
Modeling Network Latency and Parallel Processing in Distributed Database Design
Authors: Johansson Jesper M. , March Salvatore T. , Naumann J. David
Published: December 2003

The design of responsive distributed database systems is a key concern for information systems managers. In high bandwidth networks latency and local processing are the most significant factors in query and update response time. Parallel processing can be used to minimize their effects, particularly if it is considered at design time. It is the judicious replication and placement of data within a network that enable parallelism to be effectively used. However, latency and parallel processing have largely been ignored in previous distributed database design approaches. We present a comprehensive approach to distributed database design that develops efficient combinations of data allocation and query processing strategies that take full advantage of parallelism. We use a genetic algorithm to enable the simultaneous optimization of data allocation and query processing strategies. We demonstrate that ignoring the effects of latency and parallelism at design time can result in the selection of unresponsive distributed database designs.
Strategic Decisions of New Technology Adoption under Asymmetric Information: A Game‐Theoretic Model*
Authors: Zhu Kevin , Weyant John P.
Published: December 2003

In this paper we explore strategic decision making in new technology adoption by using economic analysis. We show how asymmetric information affects firms' decisions to adopt the technology. We do so in a two‐stage game‐theoretic model where the first‐stage investment results in the acquisition of a new technology that, in the second stage, may give the firm a competitive advantage in the product market. We compare two information structures under which two competing firms have asymmetric information about the future performance (i.e., postadoption costs) of the new technology. We find that equilibrium strategies under asymmetric information are quite different from those under symmetric information. Information asymmetry leads to different incentives and strategic behaviors in the technology adoption game. In contrast to conventional wisdom, our model shows that market uncertainty may actually induce firms to act more aggressively under certain conditions. We also show that having better information is not always a good thing. These results illustrate a key departure from established decision theory.
A Note on Interpersonal and Communication Skills for IS Professionals: Evidence of Positive Influence
Authors: Jiang James J. , Klein Gary , Slyke Craig Van , Cheney Paul
Published: December 2003

A recent article by Byrd and Turner (2001) reported that interpersonal skills on the part of information systems personnel had a negative influence on the success of systems as measured by competitive advantage. Several reasons were forwarded to account for this unexpected result, including lack of richness in the measure of these skills, the use of strategic success measures, the true complexity of interpersonal relations within an organization, and the sample of CIOs who may have a bias in favor of technical skills. We address these concerns by incorporating a set of communication skills into the interpersonal skills set, sampling users for a different set of stakeholders, and employing a more complex model based on theories of expectation. The results indicate that the impacts of interpersonal skills on system success is not a simple function of the perceived level of the IS staff's skill proficiency but is also determined by the understood expectations of skill requirements.
Why Total Quality Management Programs Do Not Persist: The Role of Management Quality and Implications for Leading a TQM Transformation*
Authors: Beer Michael
Published: December 2003

Top‐down total quality management (TQM) programs often fail to create deep and sustained change in organizations. They become a fad soon replaced by another fad. Failure to institutionalize TQM can be attributed to a gap between top management's rhetoric about their intentions for TQM and the reality of implementation in various subunits of the organization. The gap varies from subunit to subunit due to the quality of management in each. By quality of management is meant the capacity of senior team to (1) develop commitment to the new TQM direction and behave and make decisions that are consistent with it, (2) develop the cross‐functional mechanisms, leadership skills, and team culture needed for TQM implementation, and (3) create a climate of open dialogues about progress in the TQM transformation that will enable learning and further change. The TQM transformations will persist only if top management requires and ultimately institutionalizes an honest organizational‐wide conversation that surfaces valid data about the quality of management in each subunit of the firm and leads to changes in management quality or replacement of managers.
Epstein‐Barr virus‐related lymph node lesion resembling autoimmune disease‐like clinicopathological findings in elderly patients Report of three cases
Authors: KOJIMA MASARU , YAMANE YUKO , ITOH HIDEAKI , TANAKA HIROSHI , SUGIHARA SHIRO , MASAWA NOBUHIDE , NAKAMURA SHIGEO
Published: December 2003

Three cases of Epstein‐Barr virus (EBV)‐related lymphoproliferative disorders in elderly patients showing autoimmune disease‐associated lymphadenopathy‐like clinicopathological findings have been reported. Clinically, they were characterized by systemic lymphadenopathy, “B” symptoms, polyclonal hypergammaglobulinemia, elevated serum LDH and transient presence of various autoantibodies, and absence of atypical lymphocytosis in peripheral blood. One case was associated with idiopathic thrombocytopenic purpura. The clinical course was self‐limiting. Histologically, they exhibited numerous lymphoid follicles with hyperplastic germinal centers and atypical interfollicular widening with prominent vascular proliferation. In the paracortical area, there was a mixed infiltrate comprising small to medium‐sized lymphocytes and plasma cells, and variable numbers of eosinophils and T‐ and B‐immunoblasts. In situ hybridization demonstrated a varying number of EBV‐infected lymphocytes in the germinal center as well as in the interfollicular area. Polymerase chain reaction demonstrated that neither clonal rearrangement of T‐cell receptor γ‐gene nor immunoglobulin heavy‐chain rearrangement was detected in two of the cases examined. Although acute EBV infection rarely occurs in older adults, EBV related to reactive lymphoproliferative disorder should be added to the differential diagnosis of autoimmune disease‐associated lymphadenopathy and node‐based peripheral T‐cell lymphoma in elderly patients.
Cancer of unknown primary: clinicopathologic correlations
Authors: BLASZYK HAGEN , HARTMANN ARNDT , BJÖRNSSON JOHANNES
Published: December 2003

Cancer of unknown primary origin (CUP) accounts for 5–10% of all malignant tumors at presentation and remains the death certificate diagnosis in 0.5–5% of patients. We investigated CUP patients whose primary site remained unknown throughout the entire clinical course. We reviewed 9,436 consecutive autopsies performed between 1984 and 1999 at the Mayo Clinic, matched with 177,167 cancer patients treated in the same time period. Sixty‐four patients who died of CUP underwent postmortem examination. Antemortem pathologic diagnoses were obtained in 57 patients, agreed with postmortem diagnoses in 98%, and included adenocarcinoma (n=44), undifferentiated carcinoma (n=7), squamous cell carcinoma (n=3), and others (n=3). Autopsy located the primary site in 35 patients (55%). Common primary sites were lung (n=8), the pancreaticobiliary (n=13) and GI tracts (n=9). Of 43 patients evaluated for tumor‐specific therapy, only six received no further oncologic treatment and untreated patients survived a median of 57 (range 10–280) days, compared with 225 (range 19–1,129) days for patients treated with chemotherapy and/or radiotherapy (n=37). Our findings show that (1) autopsy studies provide a valuable tool for quality control in the setting of CUP, and (2) treated patients have a small but significant survival benefit.
Elevated number of cells secreting transforming growth factor β in Guillain‐Barré syndrome
Authors: DAHLE C. , KVARNSTRÖM M. , EKERFELT C. , SAMUELSSON M. , ERNERUDH J.
Published: December 2003

We used ELISPOT and cell ELISA to study secretion of IL‐4, IFN‐γ, TGF‐β, IL‐6, and TNF‐α by circulating mononuclear cells during the course of Guillain‐Barré syndrome (GBS). Compared to healthy controls, patients with GBS had higher numbers of TGF‐β‐secreting cells and the number of individuals with myelin‐peptide‐induced IL‐4 and TGF‐β secretion was higher in the GBS group. No significant differences were seen concerning the predominantly pro‐inflammatory cytokines IFN‐γ, IL‐6 or TNF‐α. Our findings indicate a down‐regulatory role for TGF‐β and IL‐4 in GBS.
Increased sensitivity of Mycobacterium tuberculosis Cobas Amplicor PCR following brief incubation of tissue samples on Löwenstein‐Jensen substrate
Authors: FERNSTRÖM MARIANA CRISTEA , DAHLGREN LENA , RÅNBY MARIA , FORSGREN ARNE , PETRINI BJÖRN
Published: December 2003

The sensitivity of Mycobacterium tuberculosis Cobas Amplicor PCR (MTB‐PCR) is considerably lower for tissue than for airway samples, depending on both lower bacterial content and presence of inhibitory substances in tissues. The aim of this study was to improve the sensitivity of MTB‐PCR in inhibiting biopsy samples. A brief‐culture method was applied to 33 inhibitory tissue samples out of 356 obtained in Laboratory I, and compared with 44/197 such samples treated by dilution in Laboratory II. We found that 2–3 days' incubation on Löwenstein‐Jensen substrate (LJ) significantly increased the sensitivity of MTB‐PCR in samples exerting PCR inhibition. Sensitivity was 63% before and 92% following brief‐culture of inhibitory tissue samples in Lab I, compared to 46% and 50%, respectively, with dilution in Lab II. Thus, dilution did not significantly increase sensitivity in inhibiting samples. Specificities were 99.4/99.4 and 99.2/98.2, respectively. The higher sensitivity attained by the LJ‐method was probably due to diffusion of inhibiting substances into the substrate, as well as to increase in numbers of bacteria after the brief‐culture. This method adds substantially to the value of MTB‐PCR of biopsy material.
The endocrine pancreas in non‐diabetic rats after short‐term and long‐term treatment with the long‐acting GLP‐1 derivative NN2211
Authors: BOCK TROELS , PAKKENBERG BENTE , BUSCHARD KARSTEN
Published: December 2003

Glucagon‐like peptide 1 (GLP‐1) and GLP‐1 receptor agonists increase the beta‐cell mass in rodent models of type 2 diabetes and enhance the proliferation rate of beta cells in vitro, while the long‐term effect in vivo in non‐diabetic animals is unknown. We studied the endocrine pancreas in non‐diabetic Sprague‐Dawley rats after short‐ and long‐term treatment with NN2211, an acetylated long‐acting derivative of GLP‐1. Four groups of rats (n=6 for each group) received two daily injections with either NN2211 or vehicle for 1 or 6 weeks. NN2211‐treated rats displayed a 10% lower body weight after both 1 week (p<0.001) and 6 weeks (p<0.005) of treatment. The mean beta‐cell mass in NN2211‐treated rats was increased by 19% after 1 week of treatment (p<0.05), but normalized after 6 weeks of treatment. No difference in alpha‐cell mass, volume‐weighted mean islet volume, or pancreas mass was found after 1 or 6 weeks of treatment. We conclude that NN2211 treatment of non‐diabetic rats induces a sustained lower body weight, and an only temporary increase in the beta‐cell mass, while the alpha‐cell mass and the volume‐weighted mean islet volume are unaffected by the treatment.
Granulocytic sarcoma presenting with lymph node infarction at disease onset
Authors: KOJIMA MASARU , NAKAMURA SHIGEO , SHIMIZU KAZUHIKO , YAMANE YUKO , ITOH HIDEAKI , MASAWA NOBUHIDE
Published: December 2003

A completely infarcted lymph node is an unusual event. However, lymph node infarction should alert the pathologist to the considerable likelihood of malignant lymphoma. We report two unusual cases of acute myeloid leukemia presenting with granulocytic sarcoma at disease onset with a lymph node lesion exhibiting extensive lymph node infarction. The infarcted tissue contained numerous eosinophilic cell ghosts. There were some islands of degenerated, pyknotic medium‐sized nuclei resembling lymphoblasts present in the necrotic area. By immunohistochemistry, these medium sized cells were CD3−, CD20−, CD34+, CD43+, CD45RO−, CD68−, CD79a− and myeloperoxidase+ in both cases. Differentiation of granulocytic sarcoma from malignant lymphomas is important for adequate therapy. The present cases indicate that granulocytic sarcoma should be added to the list of differential diagnoses for lymph node infarction.
High expression of nitric oxide synthases is a favorable prognostic sign in non‐small cell lung carcinoma
Authors: PUHAKKA AIRI , KINNULA VUOKKO , NÄPÄNKANGAS ULLA , SÄILY MARJAANA , KOISTINEN PIRJO , PÄÄKKÖ PAAVO , SOINI YLERMI
Published: December 2003

Immunohistochemical expression of neuronal (n), endothelial (e), and inducible (i) NOS and their association with the type, grade, apoptotic index, proliferation of tumors and the survival of patients were investigated in 89 biopsies of non‐small cell lung carcinoma (NSCLC). In tumor cells, expression of iNOS was detected in 35/89 (40%) cases, while 79/89 (89%) and 72/89 (81%) cases showed weak to intense positivity for eNOS and nNOS, respectively. Strong eNOS staining was seen significantly more often in adenocarcinomas than in squamous cells carcinomas (p=0.016), and iNOS immunoreactivity was seen more often in grade I‐II tumors than in grade III tumors (p=0.024). There was no significant difference between the low and high apoptotic indexes or between the low and high proliferation rates of tumors in any instance of NOS staining. The patients with tumors showing high nNOS expression tended to have better survival than the others (p=0.06, log‐rank; p=0.04, Bresow; p=0.048, Tarone‐Ware). Similarly, the patients with tumors showing high expression of iNOS, eNOS and nNOS, as determined by a combined sum index, had a better survival than those with a low sum index for these enzymes (p<0.05). The results show intense expression of eNOS and nNOS, and moderate expression of iNOS in tumor cells of non‐small cell carcinoma. Intense NOSs expression seems to be a favorable prognostic sign in non‐small cell lung carcinoma.
Zinc ions in β‐cells of obese, insulin‐resistant, and type 2 diabetic rats traced by autometallography
Authors: SØNDERGAARD L. G. , STOLTENBERG M. , FLYVBJERG A. , BROCK B. , SCHMITZ O. , DANSCHER G. , RUNGBY J.
Published: December 2003

Zinc ions in the secretory granules of β‐cells are known to glue insulin molecules, creating osmotically stable hexamers. When the secretory granules open to the surface, the zinc ion pressure decreases rapidly and pH levels change from acid to physiological, which results in free insulin monomers and zinc ions. The released zinc ions have been suggested to be involved in a paracrine regulation of α‐ and β‐cells. Since zinc is intimately involved in insulin metabolism and because zinc homeostasis is known to be disturbed in type 2 diabetes, we decided to study the ultrastructural localisation of zinc ions in insulin‐resistant and type 2 diabetic rats as compared to controls. By means of autometallography, the only method available for demonstrating zinc ions at ultrastructural levels, we found zinc ions in the secretory granules and adjacent to the plasma membrane. The membrane‐related staining outside the plasma membrane reflects release of zinc ions during exocytosis. No apparent difference was found in the ultrastructural localisation of zinc ions when we compared the obese Zucker (fa/fa) rats, representing the insulin resistance syndrome, and the GK rats, representing type 2 diabetes, with controls. This suggests that the ultrastructural localisation of zinc ions is unaffected by the development of type 2 diabetes in rats in a steady state of glycaemia.
Basolateral Na+‐dependent HCO3− transporter NBCn1‐mediated HCO3− influx in rat medullary thick ascending limb
Authors: Odgaard Elvin , Jakobsen Jakob K. , Frische Sebastian , Praetorius Jeppe , Nielsen Søren , Aalkjær Christian , Leipziger Jens
Published: December 2003

The electroneutral Na+‐dependent HCO3− transporter NBCn1 is strongly expressed in the basolateral membrane of rat medullary thick ascending limb cells (mTAL) and is up‐regulated during NH4+‐induced metabolic acidosis. Here we used in vitro perfusion and BCECF video‐imaging of mTAL tubules to investigate functional localization and regulation of Na+‐dependent HCO3− influx during NH4+‐induced metabolic acidosis. Tubule acidification was induced by removing luminal Na+ (ΔpHi: 0.88 ± 0.11 pH units, n= 10). Subsequently the basolateral perfusion solution was changed to CO2/HCO3− buffer with and without Na+. Basolateral Na+–H+ exchange function was inhibited with amiloride. Na+‐dependent HCO3− influx was determined by calculating initial base flux of Na+‐mediated re‐alkalinization. In untreated animals base flux was 8.4 ± 0.9 pmol min−1 mm−1. A 2.4‐fold increase of base flux to 21.8 ± 3.2 pmol min−1 mm−1 was measured in NH4+‐treated animals (11 days, n= 11). Na+‐dependent re‐alkalinization was significantly larger when compared to control animals (0.38 ± 0.03 versus 0.22 ± 0.02 pH units, n= 10). In addition, Na+‐dependent HCO3− influx was of similar magnitude in chloride‐free medium and also up‐regulated after NH4+ loading. Na+‐dependent HCO3− influx was not inhibited by 400 μm DIDS. A strong up‐regulation of NBCn1 staining was confirmed in immunolabelling experiments. RT‐PCR analysis revealed no evidence for the Na+‐dependent HCO3− transporter NBC4 or the two Na+‐dependent CI−/HCO3− exchangers NCBE and NDCBE. These data strongly indicate that rat mTAL tubules functionally express basolateral DIDS‐insensitive NBCn1. Function and protein are strongly up‐regulated during NH4+‐induced metabolic acidosis. We suggest that NBCn1‐mediated basolateral HCO3− influx is important for basolateral NH3 exit and thus NH4+ excretion by means of setting pHi to a more alkaline value.
Synapse‐specific mGluR1‐dependent long‐term potentiation in interneurones regulates mouse hippocampal inhibition
Authors: Lapointe Valérie , Morin France , Ratté Stéphanie , Croce Ariane , Conquet François , Lacaille Jean‐Claude
Published: December 2003

Hippocampal CA1 inhibitory interneurones control the excitability and synchronization of pyramidal cells, and participate in hippocampal synaptic plasticity. Pairing theta‐burst stimulation (TBS) with postsynaptic depolarization, we induced long‐term potentiation (LTP) of putative single‐fibre excitatory postsynaptic currents (EPSCs) in stratum oriens/alveus (O/A) interneurones of mouse hippocampal slices. LTP induction was absent in metabotropic glutamate receptor 1 (mGluR1) knockout mice, was correlated with the postsynaptic presence of mGluR1a, and required a postsynaptic Ca2+ rise. Changes in paired‐pulse facilitation and coefficient of variation indicated that LTP expression involved presynaptic mechanisms. LTP was synapse specific, occurring selectively at synapses modulated by presynaptic group II, but not group III, mGluRs. Furthermore, the TBS protocol applied in O/A induced a long‐term increase of polysynaptic inhibitory responses in CA1 pyramidal cells, that was absent in mGluR1 knockout mice. These results uncover the mechanisms of a novel form of interneurone synaptic plasticity that can adaptively regulate inhibition of hippocampal pyramidal cells.