bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of mesalazine, metronidazole and gentamicin on bacterial translocation in experimental colitis
Authors: YIGITLER CENGIZHAN , GULEC BULENT , AYDOGAN HAKAN , OZCAN AYHAN , KILINC METIN , YIGIT TANER , KOZAK ORHAN , PEKCAN MESUT
Published: December 2004

Background and Aim:  In inflammatory bowel disease it has been established that enteric microorganisms are present in the final stage of the active inflammatory process. The purpose of the present study was to investigate the effects of mesalazine, and metronidazole–gentamicin combination, on bacterial translocation in an animal colitis model.

Methods:  Fifty rats were stratified into five groups. The control group (group NC) was given only 2 mL saline enema and the remaining four groups were given 2 mL acetic acid enema. Group CC was the diseased control group. The treatment regimens started on the fifth day: mesalazine enema in group MesC, metronidazole–gentamicin in group MGC, and mesalazine + metronidazole + gentamicin in group MesMGC. After death on day 10, 2.5‐cm colonic segments from all groups were weighed separately. In all rats, histopathological scoring was done, and samples from feces, blood, liver and spleen underwent microbiological analyses.

Results:  For all diseased rats, both mean weight loss and colonic segment weight/bodyweight ratio was significantly higher than that in the sham group. As compared with other groups, body and colonic segment changes as well as histopathological scoring in rats receiving mesalazine enema either solely or in combination with the antibiotics were lower. No bacterial growth was found in the blood, liver and spleen of the rats in the control group while enteric bacteria, mainly Escherichia coli (35%) were the most common bacteria translocated to that in the latter. Antibiotic combination, alone or in combination with mesalazine was effective in reducing the bacterial translocation while mesalazine administration did not properly influence its regression.

Conclusions:  Gram‐negative enteric bacteria, predominantly E. coli, was the most common bacteria isolated in bacterial translocation occurring in acetic acid‐induced colitis. This trial showed that mesalazine alone did not incorporate the reduction of infectious events, despite its beneficial effect on inflammatory changes in experimental colitis. Metronidazole and gentamicin combination given intraperitoneally was more effective than topical mesalazine in decreasing bacterial translocation.
Biliary microlithiasis in patients with idiopathic acute pancreatitis and unexplained biliary pain: Response to therapy
Authors: SARASWAT VIVEK A , SHARMA BARJESH C , AGARWAL DEEPAK K , KUMAR RAKESH , NEGI TAJESHWAR S , TANDON RAKESH K
Published: December 2004

Background and Aims:  Microlithiasis has been suspected to cause acute pancreatitis and biliary pain. We studied the frequency of microlithiasis and response to treatment in recurrent idiopathic acute pancreatitis (RIAP) and unexplained biliary pain.

Methods:  Gallbladder bile was examined microscopically for cholesterol monohydrate crystals (CMC) and calcium bilirubinate granules (CBG) in patients with RAIP (n = 24; mean age 36 years, range 18–56 years; 14 men), unexplained biliary pain (n = 12; mean age 32 years, range 22–55 years; six men), gallstones (n = 22; mean age 40 years, range 30–58 years; 12 men) and patients without clinical or imaging evidence of gallstone disease (n = 12; mean age 32 years, range 14–54 years; six men). The presence of a single CMC or >25 CBG/slide was considered abnormal.

Results:  Bile microscopy was abnormal in 75% patients with RAIP (18/24; CMC in 10, CBG in six, CMC and CBG in two), 83.3% patients with unexplained biliary pain (10/12; CMC in seven, CBG in one, CMC and CBG in two) and 95.4% patients with gallstones (21/22; CMC in 12, CBG in one, CMC and CBG in eight). None of the controls without gallstone disease had CMC while three patients had low counts of CBG. Twenty‐eight patients with RAIP and biliary pain having microlithiasis agreed to be treated with cholecystectomy (n = 2), endoscopic sphincterotomy (n = 21) or ursodeoxycholic acid (UDCA; n = 5). The 23 patients treated with cholecystectomy or sphincterotomy remained asymptomatic during follow up (mean 23 months, range 6–48 months). Four of five patients treated with UDCA remained asymptomatic for a follow‐up period of 9, 10, 11 and 18 months, respectively. One patient who had refused cholecystectomy or sphincterotomy continued to experience pain at the same frequency as before during a follow‐up period of 12 months. One patient, who was asymptomatic on UDCA for 9 months, agreed to undergo sphincterotomy and remained asymptomatic over a follow‐up period of 14 months.

Conclusions:  Microlithiasis is a common cause for idiopathic acute pancreatitis and unexplained biliary pain. Lasting relief is obtained in most patients after treatment with UDCA, cholecystectomy or sphincterotomy.
Decreased expression of B7 costimulatory molecules and major histocompatibility complex class‐I in human hepatocellular carcinoma
Authors: FUJIWARA KEISHI , HIGASHI TOSHIHIRO , NOUSO KAZUHIRO , NAKATSUKASA HARUSHIGE , KOBAYASHI YOSHIYUKI , UEMURA MASAYUKI , NAKAMURA SHIN‐ICHIRO , SATO SHUICHIRO , HANAFUSA TADASHI , YUMOTO YASUHIRO , NAITO ICHIRO , SHIRATORI YASUSHI
Published: December 2004

Background and Aim:  We analyzed the expression of antigen‐processing and antigen‐presenting molecules in surgically resected fresh samples of human hepatocellular carcinoma (HCC) tissue to elucidate a mechanism of immune escape. We also examined the expression of interleukin (IL)‐10 protein, which might act to downregulate expression of antigen‐processing and antigen‐presenting molecules.

Methods:  Twenty‐eight HCC samples obtained by surgical resection were analyzed for the expression of β2‐microglobulin, heat‐shock protein (HSP)‐70, human leukocyte antigen (HLA) class‐I, CD80 (B7‐1), CD86 (B7‐2) and IL‐10 by immunostaining.

Results:  β2‐Microglobulin and HSP‐70 were preserved in all samples. In contrast, the expression of HLA class‐I molecules was significantly reduced according to lowering in the histological grading of tumor differentiation (P = 0.024). Furthermore, B7‐1 and B7‐2 expression was reduced in tumor cells compared with corresponding areas of liver tissue without malignant involvement irrespective of the histological grading of tumors (21% and 36%, respectively). Although IL‐10 protein was expressed in 54% of HCC, no relationship between the expression of IL‐10 and downregulation of B7‐1, B7‐2, and HLA class‐I was evident.

Conclusion:  These findings suggest the potential role of B7 co‐stimulatory molecules and HLA class‐I molecules in facilitating HCC escape from immune surveillance without the involvement of IL‐10.
Heterotopic gastric mucosa in the cervical esophagus (inlet patch): Endoscopic prevalence, histological and clinical characteristics
Authors: AKBAYIR NİHAT , ALKIM CANAN , ERDEM LEVENT , SÖKMEN H MEHMET , SUNGUN AYŞİM , BAŞAK TÜLAY , TURGUT SUAT , MUNGAN ZEYNEL
Published: December 2004

Background and Aim:  Heterotopic gastric mucosal patch, which has a 0.1–10% frequency, is encountered when the cervical esophagus is examined carefully during endoscopy. In this study, we aimed to determine the prevalence of the patch in the cervical esophagus, to identify its macroscopic and histological characteristics and to evaluate demographic and clinical features.

Methods:  Six hundred and sixty patients (317 male, 343 female; mean age 50.28 years, range 14–90) with upper gastrointestinal symptoms had elective esophagogastroduodenoscopy and the cervical esophagus was examined for the patch during withdrawal of the endoscope. Biopsies were obtained from the antrum and the patch. Helicobacter pylori was assessed using an immunohistochemical method.

Results:  The patch was found in 11 patients of 660, with a prevalence of 1.67%. Patch size ranged between 5 and 30 mm, appeared as a single patch in nine patients and as twin patches in two patients. Mean age and male : female ratio were not significantly different from the patient population without patches, but the female sex was predominant (three men, eight women; mean age 43.6 years, range 32–64). In five of 11 patients, the upper esophageal and laryngopharyngeal symptoms were remarkable. Eight patients in whom histological confirmation was carried out showed three fundic and five antral‐type mucosa. Two of five patients with antral H. pylori also had the bacteria in the patch. H. pylori prevalence in the patch was 25%.

Conclusion:  Heterotopic gastric mucosal patches in the proximal esophagus should not be overlooked during endoscopy because they may lead to important complications in relation to their acid secretion, which may vary according to their parietal cell mass.
Estimation of the location and exponent of the spectral singularity of a long memory process
Authors: Hidalgo Javier , Soulier Philippe
Published: December 2004

Abstract.  We consider the estimation of the location of the pole and memory parameter ω0 and d of a covariance stationary process with spectral density
image

We investigate optimal rates of convergence for the estimators of ω0 and d, and the consequence that the lack of knowledge of ω0 has on the estimation of the memory parameter d. We present estimators which achieve the optimal rates. A small Monte‐Carlo study is included to illustrate the finite sample performance of our estimators.
EYES WIDE SHUT: A RESPONSE TO JEAN‐LUC MARION's ACCOUNT OF THE JOURNEY TO EMMAUS
Authors: MACKINLAY SHANE
Published: December 2004

In “ ‘They Recognised Him; and He Became Invisible to Them’ ” (Modern Theology, Vol. 18 no. 2 April 2002, pp. 145–152), Marion uses the gospel account of the journey to Emmaus to argue that faith provides a conceptual interpretation of revelation after it has occurred. This response to Marion argues that what he describes is only a derivative sense of faith. In its primary sense, faith is hermeneutic; faith is an existential commitment that makes it possible for revelation to be made manifest. Contra Marion, revelation does not simply impose itself on us; rather, it must be actively received and recognised in the meaning‐filled world of a recipient's faith.
Incomplete Citizens: Changing Images of Post‐Separation Children
Authors: Kaganas Felicity , Diduck Alison
Published: December 2004

The image of the child as the victim of separation or divorce is well‐established in legal, socio‐legal and popular discourse. However, the authors argue, alongside this traditional image of the child, there is a different image of the child emerging, that of the autonomous, responsible child. This is apparent in academic discourse, policy documents and legal pronouncements. This child is included in the project of ‘remoralising’ the family by building the ‘good’ post‐separation family. The ‘good’ child of separation or divorce is responsible for safeguarding his or her own welfare and is expected to make those choices that are assumed to best protect his or her best interests. In order to ensure that the child makes the ‘right’ decisions, he or she, like the adults concerned, is the target of education, information and therapeutic intervention. There is a blending of paradigms in which the ideal child is both an autonomous social actor and a vulnerable object of concern.
Apology and Retraction: Questioning Fundamentals: Leyland Daf and the “Ownership” of Charged Property
Authors: Selvam Vijay S. V.
Published: December 2004

Forward Links to Citing Articles
 
 
Retraction. Modern Law Review 67: 5, 832‐843. Online publication date: 1‐Sept‐2004.

The note entitled ‘Questioning Fundamentals: Leyland Daf and the “Ownership” of Charged Property’,1 which appeared in the September issue of the Review has, through the sole fault of the author, failed to acknowledge the use of an article written by Dr Riz Mokal entitled ‘Liquidation Expenses and Floating Charges: The Separate Funds Fallacy’2 posted on the SSRN Electronic Library in April 2004. Any views that appear similar between these articles belong to Dr Mokal. It is sincerely hoped that Dr Mokal will accept this apology for the lapse in properly acknowledging his views.
The evolution of C4photosynthesis
Authors: Sage Rowan F.
Published: December 2004

C4photosynthesis is a series of anatomical and biochemical modifications that concentrate CO2around the carboxylating enzyme Rubisco, thereby increasing photosynthetic efficiency in conditions promoting high rates of photorespiration. The C4pathway independently evolved over 45 times in 19 families of angiosperms, and thus represents one of the most convergent of evolutionary phenomena. Most origins of C4photosynthesis occurred in the dicots, with at least 30 lineages. C4photosynthesis first arose in grasses, probably during the Oligocene epoch (24–35 million yr ago). The earliest C4dicots are likely members of the Chenopodiaceae dating back 15–21 million yr; however, most C4dicot lineages are estimated to have appeared relatively recently, perhaps less than 5 million yr ago. C4photosynthesis in the dicots originated in arid regions of low latitude, implicating combined effects of heat, drought and/or salinity as important conditions promoting C4evolution. Low atmospheric CO2is a significant contributing factor, because it is required for high rates of photorespiration. Consistently, the appearance of C4plants in the evolutionary record coincides with periods of increasing global aridification and declining atmospheric CO2. Gene duplication followed by neo‐ and nonfunctionalization are the leading mechanisms for creating C4genomes, with selection for carbon conservation traits under conditions promoting high photorespiration being the ultimate factor behind the origin of C4photosynthesis.

ContentsSummary341I.Introduction342II.What is C4photosynthesis?343III.Why did C4photosynthesis evolve?347IV.Evolutionary lineages of C4photosynthesis348V.Where did C4photosynthesis evolve?350VI.How did C4photosynthesis evolve?352VII.Molecular evolution of C4photosynthesis361VIII.When did C4photosynthesis evolve362IX.The rise of C4photosynthesis in relation to climate and CO2363X.Final thoughts: the future evolution of C4photosynthesis365Acknowledgements365References365
A 6‐month follow‐up of successful refits from daily disposable soft contact lenses to continuous wear of high‐Dk silicone‐hydrogel lenses
Authors: Aakre Bente Monica , Ystenaes Ann E. , Doughty Michael J. , Austrheim Øyvind , Westerfjell Björn , Lie Monica T.
Published: December 2004

Purpose:  To compare, in routine optometric practice, the outcome of keeping successful soft contact lens (SCL) wearers in their lenses to re‐fitting them with continuous wear of silicone hydrogel (SiH) lenses.

Methods:  Forty‐nine successful daily disposable lens wearers were recruited; 19 continued to wear daily SCLs and 30 were refitted with high‐Dk SiH lenses on a 30‐day/night schedule. Patients were assessed at baseline, 3 and 6 months by slit lamp examination along with the Efron grading scales, and central corneal thickness (CCT) and the corneal endothelium were assessed by non‐contact specular microscopy.

Results:  No substantial changes in subjective vision, refraction, visual acuity or overall lens comfort occurred for those completing the study, although five SiH lens wearers did discontinue due to reduced comfort, eyelid problems or seasonal allergy. Contact lens induced peripheral ulcers (CLPU) were observed in three patients in the first 3 months in the SiH lens group and these were also discontinued. Over the 6 month period, a complete set of records was obtained for 16 in each group. For those completing the study, lens dryness scores were variable, but there was a slight improvement in favour of SiH lenses. Small, but statistically significant, reductions in corneal staining, bulbar hyperaemia, and limbal neovascularisation in favour of the SiH lenses were also evident but mainly because of further increases in the daily lens wearers. Contact lens induced papillary conjunctivitis (CLPC) and corneal endothelial polymegethism were mild to moderate and showed slight increases in the daily lens wearers at 6 months.

Conclusions:  The present studies confirm that the continuous wear of SiH lenses for up to 30 days can be considered as an alternative to daily disposable soft lens wear, but is not suitable for everyone.
The optometric correlates of migraine
Authors: Harle Deacon E. , Evans Bruce J. W.
Published: December 2004

Migraine is a common, chronic, multi‐factorial, neuro‐vascular disorder typically characterised by recurrent attacks of unilateral, pulsating headache and autonomic nervous system dysfunction. Migraine may additionally be associated with aura; those focal neurological symptoms that may precede or sometimes accompany the headache. This review describes the optometric aspects of migraine headache. There have been claims of a relationship between migraine headaches and errors of refraction, binocular vision anomalies, pupil anomalies, visual field changes and pattern glare. The quality of the evidence for a relationship between errors of refraction and binocular vision and migraine is poor. The quality of the evidence to suggest a relationship between migraine headache and pupil anomalies, visual field defects and pattern glare is stronger. In particular the link between migraine headache and pattern glare is striking. The therapeutic use of precision‐tinted spectacles to reduce pattern glare (visual stress) and to help some migraine sufferers is described.
The Effect of Dementia on Outcomes and Process of Care for Medicare Beneficiaries Admitted with Acute Myocardial Infarction
Authors: Sloan Frank A. , Trogdon Justin G. , Curtis Lesley H. , Schulman Kevin A.
Published: December 2004

Objectives: To determine differences in mortality after admission for acute myocardial infarction (AMI) and in use of noninvasive and invasive treatments for AMI between patients with and without dementia.

Design: Retrospective chart review.

Setting: Cooperative Cardiovascular Project.

Patients: Medicare patients admitted for AMI (N=129,092) in 1994 and 1995.

Measurements: Dementia noted on medical chart as history of dementia, Alzheimer's disease, chronic confusion, or senility. Outcome measures included mortality at 30 days and 1‐year postadmission; use of aspirin, beta‐blocker, angiotensin‐converting enzyme (ACE) inhibitor, thrombolytic therapy, cardiac catheterization, coronary angioplasty, and cardiac bypass surgery compared by dementia status.

Results: Dementia was associated with higher mortality at 30 days (relative risk (RR)=1.16, 95% confidence interval (CI)=1.09–1.22) and at 1‐year postadmission (RR=1.18, 95% CI=1.13–1.23). There were few to no differences in the use of aspirin and beta‐blockers between patients with and without a history of dementia. Patients with a history of dementia were less likely to receive ACE inhibitors during the stay (RR=0.89, 95% CI=0.86–0.93) or at discharge (RR=0.90, 95% CI=0.86–0.95), thrombolytic therapy (RR=0.82, 95% CI=0.74–0.90), catheterization (RR=0.51, 95% CI=0.47–0.55), coronary angioplasty (RR=0.58, 95% CI=0.51–0.66), and cardiac bypass surgery (RR=0.41, 95% CI=0.33–0.50) than patients without a history of dementia.

Conclusion: The results imply that the presence of dementia had a major effect on mortality and care patterns for this condition.
Is Chronic Nonmalignant Pain Associated with Decreased Appetite in Older Adults? Preliminary Evidence
Authors: Bosley Brooke N. , Weiner Debra K. , Rudy Thomas E. , Granieri Evelyn
Published: December 2004

Objectives: To examine the association between self‐reported appetite impairment and pain intensity in community‐dwelling older adults with chronic nonmalignant pain.

Design: Cross‐sectional survey.

Setting: An outpatient pain clinic at the University of Pittsburgh.

Participants: A convenience sample of 65 older adults with chronic nonmalignant pain.

Measurements: Demographics, pain intensity (short‐form McGill Pain Questionnaire), self‐reported appetite impairment using a newly developed instrument, mood (30‐item Geriatric Depression Scale, (GDS)), cognitive status (Folstein Mini‐Mental State Examination), dependence in feeding, dependence in grocery shopping and meal preparation, and comorbidities (Cumulative Illness Rating Scale). Medication information was classified as total number of medications, number of analgesics, number of opioids, and number of potential appetite‐impairing side effects.

Results: Univariate analyses revealed that those who reported pain‐related appetite impairment had higher pain intensity than those who reported no appetite impairment (P<.001). Comparison of subjects with and without pain‐related appetite impairment revealed a significant difference in GDS scores (P=.027), number of analgesics (P=.015), and number of opioids (P=.014). None of the other variables was statistically significant. The relationship between pain intensity and perceived pain‐related appetite impairment was maintained in an analysis of covariance that controlled for GDS score, number of analgesics, and presence of opioids (P=.004).

Conclusion: Chronic pain is associated with self‐reported appetite impairment in older adults, but examination of the influence of reduction in pain intensity on appetite improvement is needed to establish a causal relationship between chronic pain and diminished appetite.
Resilience of Community‐Dwelling Older Persons
Authors: Hardy Susan E. , Concato John , Gill Thomas M.
Published: December 2004

Objectives:  To assess resilience of community‐dwelling older persons using a new scale based on response to a stressful life event and to identify the demographic, clinical, functional, and psychosocial factors associated with high resilience.

Design:  Cross‐sectional study.

Setting:  Community.

Participants:  Five hundred forty‐six nondisabled persons aged 70 and older who had experienced a stressful life event.

Measurements:  Resilience (as assessed using a simple six‐item scale), demographic factors, chronic conditions, medications, cognitive status, grip strength, functional status, physical activity, self‐efficacy, depressive symptoms, self‐rated health, and social support.

Results:  Participants showed a wide range of resilience in response to a stressful event, with a mean score±standard deviation of 8.9±4.0 on an 18‐point scale. In bivariate analyses, male sex, living with others, high grip strength, independence in instrumental activities of daily living (IADLs), having few depressive symptoms, and having good to excellent self‐rated health were associated with high resilience, defined as a score in the best tertile (>10). Independence in IADLs (relative risk (RR)=1.36, 95% confidence interval (CI)=1.05–1.69), having few depressive symptoms (RR=1.59, 95% CI=1.13–2.11), and good to excellent self‐rated health (RR=1.38, 95% CI=1.01–1.79) remained independently associated with high resilience in multivariate analysis. Depressive symptoms and self‐rated health remained associated with high resilience after controlling for the perceived stressfulness of the event.

Conclusion:  Functional and psychosocial factors are associated with high resilience. Further research is needed to determine the relationship between resilience and future well‐being.
The Identification of Seniors At Risk Screening Tool: Further Evidence of Concurrent and Predictive Validity
Authors: Dendukuri Nandini , McCusker Jane , Belzile Eric
Published: December 2004

Objectives: To evaluate the validity of the Identification of Seniors at Risk (ISAR) screening tool for detecting severe functional impairment and depression and predicting increased depressive symptoms and increased utilization of health services.

Setting: Four university‐affiliated hospitals in Montreal.

Design: Data from two previous studies were available: Study 1, in which the ISAR scale was developed (n=1,122), and Study 2, in which it was used to identify patients for a randomized trial of a nursing intervention (n=1,889 with administrative data, of which 520 also had clinical data).

Participants: Patients aged 65 and older who were to be released from an emergency department (ED).

Measurements: Baseline validation criteria included premorbid functional status in both studies and depression in Study 2 only. Increase in depressive symptoms at 4‐month follow‐up was assessed in Study 2. Information on health services utilization during the 5 months after the ED visit (repeat ED visits and hospitalization in both studies, visits to community health centers in Study 2) was available by linkage with administrative databases.

Results: Estimates of the area under the receiver operating characteristic curve (AUC) for concurrent validity of the ISAR scale for severe functional impairment and depression ranged from 0.65 to 0.86. Estimates of the AUC for predictive validity for increased depressive symptoms and high utilization of health services ranged from 0.61 to 0.71.

Conclusion: The ISAR scale has acceptable to excellent concurrent and predictive validity for a variety of outcomes, including clinical measures and utilization of health services.
Predictors of Adherence to the Use of Hip Protectors in Nursing Home Residents
Authors: Warnke Andrea , Meyer Gabriele , Bender Ralf , Mühlhauser Ingrid
Published: December 2004

Objectives: To assess predictors of hip‐protector use in nursing home residents under usual‐care conditions and after intervention consisting of structured education of nurses and nursing home residents and provision of free hip protectors.

Design: Nested cohort analyses within a cluster randomized, controlled trial with 18 months follow‐up.

Setting: Forty‐nine nursing home clusters in Hamburg, Germany.

Participants: Residents with at least one fall during the study period (intervention group, n=237; usual‐care group, n=274).

Measurements: Use of hip protector while falling. Regression analyses were performed for each of the two cohorts of fallers using the time to the first fall without hip protector as the dependent variable. Predefined nursing home cluster‐related parameters (center, staffing ratio, proportion of registered nurses in nursing staff, hip‐protector use before study period) and resident‐related parameters (sex, history of falls and fractures, fear of falling, urinary incontinence, use of walking aid, degree of disablement) were considered as explanatory variables.

Results: Under usual care, 97% of fallers (n=266), compared with 62% (n=148) in the intervention group, experienced at least one fall without hip protection. Using Cox proportional hazards models with and without frailty parameter (random cluster effect), the following predictors were identified: intervention group: use of walking aid, hazard ratio (HR)=1.53 (95% confidence interval (CI):0.98–2.39) and no urinary incontinence, HR=1.47 (95% CI:1.03–2.09); usual care: nursing staff per 10 residents, HR=0.78 (95% CI=0.63–0.96); high degree of disablement, HR=1.38 (95% CI=1.06–1.80); strong fear of falling, HR=0.78 (95% CI=0.60–1.02). The nursing home cluster was a significant predictor in the control group (P=.029), but not in the intervention group (P=.100).

Conclusion:  Only a few and weak predictors of hip‐protector use of questionable relevance could be identified in both groups. Future research should concentrate on the implementation of interventions of proven efficacy, such as provision of hip protectors combined with structured education of staff and residents.
Effect of Widowhood on Disability Onset in Elderly Men from Three European Countries
Authors: Van Den Brink Carolien L. , Tijhuis Marja , Van Den Bos Geertrudis A.M. , Giampaoli Simona , Kivinen Paula , Nissinen Aulikki , Kromhout Daan
Published: December 2004

Objectives: To investigate in different countries the effects of becoming widowed, duration of widowhood, and household composition of widowed men on disability onset in different disability domains.

Design: Longitudinal data from a cohort study collected around 1990, 1995, and 2000.

Setting: Three cohorts from Finland, the Netherlands, and Italy.

Participants: Seven hundred thirty‐six men, aged 70 and older at baseline.

Measurements: Disability was measured using standardized questionnaire on activities of daily living (ADLs). Three domains were assessed: instrumental ADLs (IADLs), mobility, and basic ADLs (BADLs). Duration of widowhood was divided into less than 5 years and 5 or more years and household composition into living alone and living with family or in an institution.

Results: Men who became widowed developed more IADL disabilities (odds ratio (OR)=2.15; 95% confidence interval (CI)=1.22–3.81) and mobility (OR=1.84; 95% CI=1.15–2.96) than men who were still married. Men who had been widowed for less than 5 years developed more IADL disabilities than those who had been widowed for 5 years or more (OR=2.27; 95% CI=1.14–4.54). Widowed men living alone showed fewer disabilities in mobility (OR=0.25; 95% CI=0.09–0.73) and BADLs (OR=0.02; 95% CI=0.001–0.33) than those living with others. The effects on disability onset did not differ between countries.

Conclusion: Widowhood in elderly men is a risk factor for dependency in IADLs and mobility. The growth in the number of widowers may lead to higher demands on family care and professional care.
The National Pressure Ulcer Long‐Term Care Study: Pressure Ulcer Development in Long‐Term Care Residents
Authors: Horn Susan D. , Bender Stacy A. , Ferguson Maree L. , Smout Randall J. , Bergstrom Nancy , Taler George , Cook Abby S. , Sharkey Siobhan S. , Voss Anne Coble
Published: December 2004

Objectives: To identify resident, treatment, and facility characteristics associated with pressure ulcer (PU) development in long‐term care residents.

Design: Retrospective cohort study with convenience sampling.

Setting: Ninety‐five long‐term care facilities participating in the National Pressure Ulcer Long‐Term Care Study throughout the United States.

Participants: A total of 1,524 residents aged 18 and older, with length of stay of 14 days or longer, who did not have an existing PU but were at risk of developing a PU, as defined by a Braden Scale for Predicting Pressure Sore Risk score of 17 or less, on study entry.

Measurements: Data collected for each resident over a 12‐week period included resident characteristics (e.g., demographics, medical history, severity of illness using the Comprehensive Severity Index, Braden Scale scores, nutritional factors), treatment characteristics (nutritional interventions, pressure management strategies, incontinence treatments, medications), staffing ratios and other facility characteristics, and outcome (PU development during study period). Data were obtained from medical records, Minimum Data Set, and other written records (e.g., physician orders, medication logs).

Results: Seventy‐one percent of subjects (n=1,081) did not develop a PU during the 12‐week study period; the remaining 29% of residents (n=443) developed a new PU. Resident, treatment, and facility characteristics associated with greater likelihood of developing a Stage I to IV PU included higher initial severity of illness, history of recent PU, significant weight loss, oral eating problems, use of catheters, and use of positioning devices. Characteristics associated with decreased likelihood of developing a Stage I to IV PU included new resident, nutritional intervention (e.g., use of oral medical nutritional supplements and tube feeding for >21 days), antidepressant use, use of disposable briefs for more than 14 days, registered nurse hours of 0.25 hours per resident per day or more, nurses' aide hours of 2 hours per resident per day or more, and licensed practical nurse turnover rate of less than 25%. When Stage I PUs were excluded from the analyses, the same variables were significant, with the addition of fluid orders associated with decreased likelihood of developing a PU.

Conclusion: A broad range of factors, including nutritional interventions, fluid orders, medications, and staffing patterns, are associated with prevention of PUs in long‐term care residents. Research‐based PU prevention protocols need to be developed that include these factors and target interventions for reducing risk factors.
Large‐Artery Stiffness Contributes to the Greater Prevalence of Systolic Hypertension in Elderly Women
Authors: Berry Karen L. , Cameron James D. , Dart Anthony M. , Dewar Elizabeth M. , Gatzka Christoph D. , Jennings Garry L. , Liang Yu‐Lu , Reid Chris M. , Kingwell Bronwyn A.
Published: December 2004

Objectives: To determine whether sex differences in large‐artery stiffness contribute to the greater prevalence of systolic hypertension in elderly women than in elderly men.

Design: During a single visit arterial stiffness was assessed in the unmedicated state using four parameters.

Participants: Three hundred seventy‐four women with a mean age±standard deviation of 72±5 and 296 men aged 71±5 participated.

Setting: Hypertensive patients were recruited from general practice as part of the second Australian National Blood Pressure Study in Melbourne, Australia.

Measurements: Large‐artery stiffness was assessed using multiple methodologies, including aortic arch stiffness (β‐index) using M‐mode ultrasound and arterial compliance and augmentation index using noninvasive carotid pressure and aortic flow measurements.

Results: Women had greater carotid and brachial pulse pressure (PP) than men (P<.001), despite higher mean arterial pressure in men. Mean arterial compliance was lower in women (0.20±0.12 vs 0.28±0.16 mL/mmHg, P<.001) even after correction for aortic area, and aortic arch stiffness was higher (30±36 vs 23±22; P<.01). Consistent with both a stiffer proximal circulation and a shorter distance to reflection sites, women had higher augmentation index (38±11% vs 29±12%, P<.001). In multivariate analysis, sex was an independent determinant of all arterial stiffness indices.

Conclusion: Independently of known confounders, elderly hypertensive women have stiffer large arteries, greater central wave reflection, and higher PP than elderly men. Stiffer large arteries likely contribute to the greater prevalence of systolic hypertension in elderly women and may partly explain the acceleration in postmenopausal cerebrovascular and cardiac complications.
Effect of State Medicaid Reimbursement Rates on Hospitalizations from Nursing Homes
Authors: Intrator Orna , Mor Vincent
Published: December 2004

Objectives: To estimate the effect of state Medicaid nursing home reimbursement rates on hospitalizations of nursing home residents.

Design: Cross‐sectional sample of nongovernment‐owned nursing homes with 25 beds or more in one Metropolitan Statistical Area in each of 10 states in 1993, with 6 months follow‐up on mortality and hospitalizations.

Setting: Two hundred fifty‐three nursing homes.

Participants: Eight to 16 randomly selected residents from each facility, totaling 2,080.

Measurements: Minimum Data Set assessments conducted by research nurses at baseline. A three‐category 6‐month outcome was defined as (1) any hospitalization; for those not hospitalized, (2) death versus (3) alive in the facility.

Results: Using multinomial logistic regression, adjusted to survey design, controlling for resident and facility characteristics, a $10 increase in 1993 Medicaid reimbursement rate above the mean rate of approximately $75 resulted in a 9% reduction in a resident's risk of hospitalization (P<.05).

Conclusion: State Medicaid reimbursement rates appear to affect clinical decisions regarding the need for hospital admission and thresholds for nursing home use. The findings from this study reemphasize the importance of properly aligning state Medicaid and federal Medicare long‐term care policies because, currently, states have no incentive to increase reimbursement rates to avoid hospitalization.
Diverse Effect of Inflammatory Markers on Insulin Resistance and Insulin‐Resistance Syndrome in the Elderly
Authors: Abbatecola Angela M. , Ferrucci Luigi , Grella Rodolfo , Bandinelli Stefania , Bonafè Massimiliano , Barbieri Michelangela , Corsi Anna M. , Lauretani Fulvio , Franceschi Claudio , Paolisso Giuseppe
Published: December 2004

Objectives: To evaluate the potential association between different inflammatory markers and insulin resistance (IR), as well as insulin‐resistance syndrome (IRS) in a large, population‐based study of older, nondiabetic persons.

Design: Cross‐sectional study.

Setting: Outpatient clinic in Greve in Chianti and Bagno a Ripoli (Italy).

Participants: One thousand one hundred forty‐six nondiabetic subjects ranging in age from 22 to 104.

Measurements: Anthropometric measurements; plasma fasting levels of glucose, insulin, and cholesterol (total, high‐density lipoprotein, low‐density lipoprotein); homeostasis model assessment to estimate degree of insulin resistance; tumor necrosis factor α (TNF‐α), interleukin 6 (IL‐6), soluble IL‐6 receptor (sIL‐6R), interleukin receptor antagonist (IL‐1ra), and C‐reactive protein (CRP) plasma concentrations; diastolic, systolic, and mean arterial blood pressure; and echo‐color‐Doppler duplex scanning examination of carotid arteries.

Results: Insulin resistance correlated with age (r=0.102; P<.001) and plasma levels of TNF‐α (r=0.082; P=.007), IL‐1ra (r=0.147; P<.001), IL‐6 (r=0.133; P<.001), sIL‐6R (r=−0.156; P<.001), and CRP (r=0.83; P<.001). Subjects in the upper tertile of IR degree were older and had higher serum levels of TNF‐α, IL‐1ra, and IL‐6 and lower levels of sIL‐6R than subjects in the lowest tertile. Independent of age, sex, body mass index, waist‐to‐hip ratio, triglycerides, drug intake, diastolic blood pressure, smoking habit, and carotid atherosclerotic plaques, higher IL‐6 (t=2.987; P=.003) serum concentrations were associated with higher IR, whereas sIL‐6R levels (t=−5.651; P<.001) were associated with lower IR. Furthermore, IL‐1ra concentrations (t=2.448; P=.015) were associated with IRS, and higher sIL‐6R plasma levels continued to correlate negatively with IRS.

Conclusion: Different inflammatory markers are associated with a diverse effect on IR and IRS in elderly nondiabetic subjects.
Potentially Inappropriate Antiepileptic Drugs for Elderly Patients with Epilepsy
Authors: Pugh Mary Jo V. , Cramer Joyce , Knoefel Janice , Charbonneau Andrea , Mandell Alan , Kazis Lewis , Berlowitz Dan
Published: December 2004

Objectives: To describe prescribing patterns for older veterans with epilepsy, determine whether disparity exists between these patterns and clinical recommendations, and describe those at greatest risk of receiving potentially inappropriate antiepileptic drugs (AEDs).

Design: Retrospective administrative database analysis.

Setting: All outpatient facilities within the Department of Veterans Affairs (VA).

Participants: All veterans aged 65 and older who had epilepsy diagnosed before the end of fiscal year 1999 (FY99) and who received AEDs from the VA in FY99 (N=21,435).

Measurements: National VA pharmacy data were used to determine the AED regimen based on the AEDs patients received during the year. Administrative data were used to describe demographic variables and to gauge disease severity and epilepsy onset.

Results: Approximately 17% of patients received phenobarbital and 54% phenytoin. Patients classified as having newly diagnosed disease were less likely to receive phenobarbital monotherapy and combination therapy and more likely to receive gabapentin or lamotrigine monotherapy (χ2=288.90, P<.001). Logistic regression analyses indicated that, for all patients, those with more severe disease were less likely to receive phenobarbital monotherapy than other monotherapy and phenobarbital combinations than other combinations. Those who received specialty consultation were less likely to receive phenytoin monotherapy than AED monotherapy, which is consistent with clinical recommendations.

Conclusion: Most older veterans received potentially inappropriate AED therapy. Hence, the standard of care for older patients with epilepsy should be reevaluated, although the vast use of phenytoin in this population suggests that change in practice patterns may be difficult.
Direct metal pattern writing by VUV photodissociation
Authors: Yan Jianxun , Gupta Mool C.
Published: December 2004

An efficient process for direct pattern writing of thin metallic films has been developed using a 121.6nm vacuum ultraviolet source by photodissociation of metalorganic materials. The optical reflection, crystal structure, and surface morphology of photodissociated palladium thin films were studied using a spectrophotometer, x-ray diffraction, and scanning electron microscopy. A pattern of 5μm palladium lines separated by 5μm spaces was produced on glass substrate by contact printing lithography.
Single ion implantation with scanning probe alignment
Authors: Persaud A. , Allen F. I. , Gicquel F. , Park S. J. , Liddle J. A. , Schenkel T. , Ivanov Tzv. , Ivanova K. , Rangelow I. W. , Bokor J.
Published: December 2004

We present results from our development of a single ion implantation technique integrated with a scanning force microscope. Accurate alignment at the 5nm level is a crucial requirement for reliable single ion placement. We address this through integration of the ion beam with a scanning probe tip containing an aperture. Single ion registration is based on detection of secondary electron bursts from single, high charge state ions. We describe formation of scanning probe tips with holes and sensing poles by focused ion and electron beam processing (drilling and thin film deposition). Ion transport studies through apertures show stable transmission for >10h with 1nA scale beam intensities on precollimators.
Ultrathin membrane masks for electron projection lithography
Authors: Wood O. R. , Trybula W. J. , Greschner J. , Kalt S. , Bayer T. , Shimizu S. , Yamamoto H. , Suzuki K. , Gordon M. S. , Robinson C. F. , Dhaliwal R. S. , Thiel C. W. , Caldwell N. , Lawliss M. S. , Huang C.
Published: December 2004

Electron projection lithography (EPL) is one of the leading candidates for next-generation lithography at the 65-nm lithography node, particularly for contact levels. EPL has traditionally employed either an open stencil mask with a single patterned (perforated) scattering layer or a continuous membrane mask with a patterned scattering layer supported by an un-perforated membrane. This article reports on an experimental study of a type of EPL mask developed by Team Nanotec that employs a continuous ultrathin membrane (UTM) comprised of a trilayer of carbon, silicon nitride, and carbon. These UTM masks combine all of the benefits of continuous membrane masks with the higher energy throughput (and the smaller chromatic aberration) of an open stencil mask.
Liquid immersion lithography: Why, how, and when?
Authors: Rothschild M. , Bloomstein T. M. , Kunz R. R. , Liberman V. , Switkes M. , Palmacci S. T. , Sedlacek J. H. C. , Hardy D. , Grenville A.
Published: December 2004

Liquid immersion lithography, especially at 193nm, is a serious candidate for extending projection optical lithography to the 65nm node and beyond. This article reviews the status of this technology, the potential pitfalls that it may still encounter, and also the potential to extend it to 157nm and to higher-index liquids. At 193nm, no fundamental obstacles have been found yet, although defect control and materials compatibility must still be worked out. At 157nm, significant progress has been made in developing suitable liquids. The next hurdle is to increase their refractive index, in order to make the transition in wavelengths cost-effective.
Investigation of surface modifications of 193 and 248nm photoresist materials during low-pressure plasma etching
Authors: Ling L. , Hua X. , Li X. , Oehrlein G. S. , Hudson E. A. , Lazzeri P. , Anderle M.
Published: December 2004

Plasma-based pattern transfer of lithographically produced nanoscale patterns in advanced photoresist materials is often accompanied by photoresist surface roughening and line edge roughening due to factors which are not well understood. We have studied the evolution of surface roughening in prototypical 193 and 248nm photoresist materials during plasma processing as a function of plasma operating parameters. We used real-time ellipsometry and mass spectrometry, along with atomic force microscopy, x-ray photoemission spectroscopy and time-of-flight secondary ion mass spectrometry in an effort to understand the morphological and chemical changes of the photoresist materials as a function of plasma–surface interactions parameters, e.g., maximum ion energy, total energy flux, and plasma chemistry, and photoresist material. A comparison of 248nm photoresist with 193nm photoresist shows that significantly more surface roughness is introduced in the 193nm photoresist for most plasma processing conditions investigated. We also find a dramatic dependence of surface roughening on the chemistry of the plasma process, e.g., for Ar–C4F8 a modified photoresist surface layer with an extent of about 50nm is produced in 193nm photoresist, whereas for C4F8 discharges the surface modification is much less for otherwise similar conditions. We show that one important reason for these differences may be ion-enhanced selective volatilization of carbonyl groups of the 193nm photoresist polymer backbone which is absent for the 248nm material, along with modulation of the ion-interaction with the photoresist material by fluorocarbon surface passivation.
Fabrication of masters for nanoimprint, step and flash, and soft lithography using hydrogen silsesquioxane and x-ray lithography
Authors: Junarsa Ivan , Nealey Paul F.
Published: December 2004

A technique for fabricating masters for nanoimprint lithography, step and flash lithography, and soft lithography has been demonstrated through direct patterning of hydrogen silsesquioxane (HSQ) using x-ray lithography. Patterns that are replicated by nanoimprint, step and flash, and other soft lithographic strategies are often originally written on masters with electron beam lithography. In this article we demonstrate that if the original pattern is written with electron beam lithography to make an x-ray mask, then masters with very well-defined three-dimensional relief structures can be easily produced by direct patterning of hydrogen silsesquioxane using x-ray lithography. Direct patterning of HSQ eliminates silicon or oxide etches associated with the current fabrication techniques, providing better critical dimension and aspect ratio control of the structures on the masters. A low surface energy release agent, tridecafluoro-1,1,2,2-tetrahydrooctyl trichlorosilane, can also be applied onto the patterned HSQ to prevent the imprinted substrates from sticking to the masters. Thousands of masters can be produced from a single x-ray mask, and the x-ray mask pattern can be stepped to make large masters from a single small patterned area on the x-ray mask. The HSQ masters were successfully applied to imprint structures onto a polymeric resist substrate and poly(dimethylsiloxane).
Molecular-beam-epitaxy growth of high-quality InGaAsN∕GaAs quantum well lasers emitting at 1.3μm
Authors: Wang J. S. , Hsiao R. S. , Lin G. , Lin K. F. , Liu H. Y. , Lai C. M. , Wei L. , Liang C. Y. , Chi J. Y. , Kovsh A. R. , Maleev N. A. , Livshits D. A. , Chen J. F. , Yu H. C. , Ustinov V. M.
Published: December 2004

Molecular-beam-epitaxy growth of high structural and optical-quality InGaAsN∕GaAs quantum wells (QW) has been investigated. The material quality can be improved significantly by using low-temperature growth to suppress the phase separation. High-performance ridge-waveguide InGaAsN∕GaAs single QW lasers emitting at 1.3μm have been demonstrated. Infinite-cavity-length threshold-current density of 400A∕cm2, internal quantum efficiency of 96%, and a slope efficiency of 0.67W∕A for a cavity length L=1mm were obtained. A TO46 packaging laser shows single lateral-mode kink-free output power of more than 200mW with a maximum total wallplug efficiency of 29% at room temperature under continuous wave (cw) operation. Moreover, 1.3μm InGaAsN∕GaAs QW vertical-cavity surface-emitting lasers with a threshold current density lower than 2KA∕cm2 at room temperature have been achieved. We obtained multimode cw output power and slope efficiency in excess of 1mW and 0.15W∕A, respectively.