bluuebunny/crossref_metadata_2025 huggingface dataset:
Insulin Stabilizes Microvascular Endothelial Barrier Function via Phosphatidylinositol 3-Kinase/Akt-Mediated Rac1 Activation
Authors: Gündüz Dursun , Thom Johannes , Hussain Imran , Lopez Diego , Härtel Frauke V. , Erdogan Ali , Grebe Mathias , Sedding Daniel , Piper Hans Michael , Tillmanns Harald , Noll Thomas , Aslam Muhammad
Published: March 2010

Objective—

Insulin is a key regulator of metabolism, but it also confers protective effects on the cardiovascular system. Here, we analyze the mechanism by which insulin stabilizes endothelial barrier function.

Methods and Results—

Insulin reduced basal and antagonized tumor necrosis factor-α–induced macromolecule permeability of rat coronary microvascular endothelial monolayers. It also abolished reperfusion-induced vascular leakage in isolated-perfused rat hearts. Insulin induced dephosphorylation of the regulatory myosin light chains, as well as translocation of actin and vascular endothelial (VE)-cadherin to cell borders, indicating a reduction in contractile activation and stabilization of cell adhesion structures. These protective effects were blocked by genistein or Hydroxy-2-naphthalenylmethylphosphonic acid tris acetoxymethyl ester (HNMPA-[AM]
3
), a pan-tyrosine-kinase or specific insulin-receptor-kinase inhibitor, respectively. Insulin stimulated the phosphatidylinositol 3-kinase (PI3K)/Akt pathway and NO production, and it activated Rac1. Inhibition of PI3K/Akt abrogated Rac1 activation and insulin-induced barrier protection, whereas inhibition of the endothelial nitric oxide synthase/soluble guanylyl cyclase pathway partially inhibited them. Inhibition of Rac1 abrogated the assembly of actin at cell borders. Accordingly, it abolished the protective effect of insulin on barrier function of the cultured endothelial monolayer, as well as the intact coronary system of ischemic-reperfused hearts.

Conclusion—

Insulin stabilizes endothelial barrier via inactivation of the endothelial contractile machinery and enhancement of cell-cell adhesions. These effects are mediated via PI3K/Akt- and NO/cGMP-induced Rac1 activation.
Inhibition of Liver X Receptor/Retinoid X Receptor–Mediated Transcription Contributes to the Proatherogenic Effects of Arsenic in Macrophages In Vitro
Authors: Padovani Alessandra M.S. , Molina Manuel Flores , Mann Koren K.
Published: March 2010

Objective—

To determine whether arsenic inhibits transcriptional activation of the liver X receptor (LXR)/retinoid X receptor (RXR) heterodimers, thereby impairing cholesterol efflux from macrophages and potentially contributing to a proatherogenic phenotype.

Methods and Results—

Arsenic is an important environmental contaminant and has been linked to an increased incidence of atherosclerosis. Previous findings showed that arsenic inhibits transcriptional activation of type 2 nuclear receptors, known to heterodimerize with RXR. Environmentally relevant arsenic doses decrease the LXR/RXR ligand-induced expression of the LXR target genes (
ABCA1
and
SREBP-1c
). Arsenic failed to decrease cAMP-induced ABCA1 expression, suggesting a selective LXR/RXR effect. This selectivity correlated with the ability of arsenic to decrease LXR/RXR ligand-induced, but not cAMP-induced, cholesterol efflux. By using chromatin immunoprecipitation assays, we found that arsenic inhibits the ability of LXR/RXR ligands to induce activation markers on the
ABCA1
and
SREBP-1c
promoters and blocks ligand-induced release of the nuclear receptor coexpressor (NCoR) from the promoter. Arsenic did not alter the ability of LXR to transrepress inflammatory gene transcription, further supporting our hypothesis that RXR is the target for arsenic inhibition.

Conclusion—

Exposure to arsenic enhances the risk of atherosclerosis. We present data that arsenic inhibits the transcriptional activity of the liver X receptor, resulting in decreased cholesterol-induced gene expression and efflux from macrophages. Therefore, arsenic may promote an athersclerotic environment by decreasing the ability of macrophages to efflux excess cholesterol, thereby favoring increased plaque formation.
Nicotinamide Adenine Dinucleotide Phosphate Reduced Oxidase 5 (Nox5) Regulation by Angiotensin II and Endothelin-1 Is Mediated via Calcium/Calmodulin-Dependent, Rac-1-Independent Pathways in Human Endothelial Cells
Authors: Montezano Augusto C. , Burger Dylan , Paravicini Tamara M. , Chignalia Andreia Z. , Yusuf Hiba , Almasri Mahmoud , He Ying , Callera Glaucia E. , He Gang , Krause Karl-Heinz , Lambeth David , Quinn Mark T. , Touyz Rhian M.
Published: March 2010

Rationale
:

Although Nox5 (Nox2 homolog) has been identified in the vasculature, its regulation and functional significance remain unclear.

Objectives
:

We sought to test whether vasoactive agents regulate Nox5 through Ca
2+
/calmodulin-dependent processes and whether Ca
2+
-sensitive Nox5, associated with Rac-1, generates superoxide (O
2
·−
) and activates growth and inflammatory responses via mitogen-activated protein kinases in human endothelial cells (ECs).

Methods and Results
:

Cultured ECs, exposed to angiotensin II (Ang II) and endothelin (ET)-1 in the absence and presence of diltiazem (Ca
2+
channel blocker), calmidazolium (calmodulin inhibitor), and EHT1864 (Rac-1 inhibitor), were studied. Nox5 was downregulated with small interfering RNA. Ang II and ET-1 increased Nox5 expression (mRNA and protein). Effects were inhibited by actinomycin D and cycloheximide and blunted by diltiazem, calmidazolium and low extracellular Ca
2+
([Ca
2+
]
e
). Ang II and ET-1 activated NADPH oxidase, an effect blocked by low [Ca
2+
]
e
, but not by EHT1864. Nox5 knockdown abrogated agonist-stimulated O
2
·−
production and inhibited phosphorylation of extracellular signal-regulated kinase (ERK)1/2, but not p38 MAPK (mitogen-activated protein kinase) or SAPK/JNK (stress-activated protein kinase/c-Jun N-terminal kinase). Nox5 small interfering RNA blunted Ang II-induced, but not ET-1-induced, upregulation of proliferating-cell nuclear antigen and vascular cell adhesion molecule-1, important in growth and inflammation.

Conclusions
:

Human ECs possess functionally active Nox5, regulated by Ang II and ET-1 through Ca
2+
/calmodulin-dependent, Rac-1-independent mechanisms. Nox5 activation by Ang II and ET-1 induces ROS generation and ERK1/2 phosphorylation. Nox5 is involved in ERK1/2-regulated growth and inflammatory signaling by Ang II but not by ET-1. We elucidate novel mechanisms whereby vasoactive peptides regulate Nox5 in human ECs and demonstrate differential Nox5-mediated functional responses by Ang II and ET-1. Such phenomena link Ca
2+
/calmodulin to Nox5 signaling, potentially important in the regulation of endothelial function by Ang II and ET-1.
Trafficking Defects and Gating Abnormalities of a Novel
SCN5A
Mutation Question Gene-Specific Therapy in Long QT Syndrome Type 3
Authors: Ruan Yanfei , Denegri Marco , Liu Nian , Bachetti Tiziana , Seregni Morena , Morotti Stefano , Severi Stefano , Napolitano Carlo , Priori Silvia G.
Published: March 2010

Rationale
:

Sodium channel blockers are used as gene-specific treatments in long-QT syndrome type 3, which is caused by mutations in the sodium channel gene (
SCN5A
). Response to treatment is influenced by biophysical properties of mutations.

Objective
:

We sought to investigate the unexpected deleterious effect of mexiletine in a mutation combining gain-of- function and trafficking abnormalities.

Methods and Results
:

A long-QT syndrome type 3 child experienced paradoxical QT prolongation and worsening of arrhythmias after mexiletine treatment. The
SCN5A
mutation F1473S expressed in HEK293 cells presented a right-ward shift of steady-state inactivation, enlarged window current, and huge sustained sodium current. Unexpectedly, it also reduced the peak sodium current by 80%. Immunostaining showed that mutant Nav1.5 is retained in the cytoplasm. Incubation with 10 μmol/L mexiletine rescued the trafficking defect of F1473S, causing a significant increase in peak current, whereas sustained current was unchanged. Using a Markovian model of the Na channel and a model of human ventricular action potential, we showed that simulated exposure of F1473S to mexiletine paradoxically increased action potential duration, mimicking QT prolongation seen in the index patient on mexiletine treatment.

Conclusions
:

Sodium channel blockers are largely used to shorten QT intervals in carriers of
SCN5A
mutations. We provided evidence that these agents may facilitate trafficking of mutant proteins, thus exacerbating QT prolongation. These data suggest that caution should be used when recommending this class of drugs to carriers of mutations with undefined electrophysiological properties.
Impact of Outdoor Air Pollution on Survival After Stroke
Authors: Maheswaran Ravi , Pearson Tim , Smeeton Nigel C. , Beevers Sean D. , Campbell Michael J. , Wolfe Charles D.
Published: March 2010

Background and Purpose—

The impact of air pollution on survival after stroke is unknown. We examined the impact of outdoor air pollution on stroke survival by studying a population-based cohort.

Methods—

All patients who experienced their first-ever stroke between 1995 and 2005 in a geographically defined part of London, where road traffic contributes to spatial variation in air pollution, were followed up to mid-2006. Outdoor concentrations of nitrogen dioxide and particulate matter <10 μm in diameter modeled at a 20-m grid point resolution for 2002 were linked to residential postal codes. Hazard ratios were adjusted for age, sex, social class, ethnicity, smoking, alcohol consumption, prestroke functional ability, pre-existing medical conditions, stroke subtype and severity, hospital admission, and neighborhood socioeconomic deprivation.

Results—

There were 1856 deaths among 3320 patients. Median survival was 3.7 years (interquartile range, 0.1 to 10.8). Mean exposure levels were 41 μg/m
3
(SD, 3.3; range, 32.2 to 103.2) for nitrogen dioxide and 25 μg/m
3
(SD, 1.3; range, 22.7 to 52) for particulate matter <10 μm in diameter. A 10-μg/m
3
increase in nitrogen dioxide was associated with a 28% (95% CI, 11% to 48%) increase in risk of death. A 10-μg/m
3
increase in particulate matter <10 μm in diameter was associated with a 52% (6% to 118%) increase in risk of death. Reduced survival was apparent throughout the follow-up period, ruling out short-term mortality displacement.

Conclusions—

Survival after stroke was lower among patients living in areas with higher levels of outdoor air pollution. If causal, a 10-μg/m
3
reduction in nitrogen dioxide exposure might be associated with a reduction in mortality comparable to that for stroke units. Improvements in outdoor air quality might contribute to better survival after stroke.
Evaluating a web-based MMR decision aid to support informed decision-making by UK parents: A before-and-after feasibility study
Authors: Jackson Cath , Cheater Francine M , Peacock Rose , Leask Julie , Trevena Lyndal
Published: March 2010

Objective: The objective of this feasibility study was to evaluate the acceptability and potential effectiveness of a web-based MMR decision aid in supporting informed decision-making for the MMR vaccine.

Design: This was a prospective before-and-after evaluation.

Setting: Thirty parents of children eligible for MMR vaccination were recruited from two childcare organizations in a moderately deprived community in a city in the north of England.

Method: Parents completed postal questionnaires at recruitment, one week and three months after using the decision aid. Data on the acceptability of the decision aid, informed decision-making outcome measures and vaccine uptake were collected. Telephone interviews were conducted with five parents. Acceptability data were analysed using simple descriptive statistics. Repeated measures ANOVAs were undertaken for analysing the informed decision-making data. Content analysis of the qualitative data was undertaken.

Results: Twenty six parents (87 per cent) completed all three study questionnaires. The decision aid was found to be acceptable to parents and was considered useful in supporting their informed decision-making. There was a statistically significant increase in parents’ knowledge over time and statistically significant decrease in decisional conflict for the MMR decision. Most parents (88 per cent) reported vaccinating their child.

Conclusions: We cannot extrapolate from our data to infer that the decision aid has changed decision-making outcomes or influenced vaccination uptake. However, findings suggest that it may increase knowledge about MMR and reduce decisional conflict to a level where parents can make an informed decision. A randomized controlled trial is now underway to expand on these findings.
Identifying barriers to promoting healthy nutrition in New Zealand primary schools
Authors: Walton Mat , Waiti Jordan , Signal Louise , Thomson George
Published: March 2010

Background. Schools are often identified as a site for intervention to improve the diets of students, and help prevent excess weight gain and obesity. Rates of overweight and obesity amongst school children have risen in much of the world, including New Zealand, with unequal distribution by ethnicity and socioeconomic status.

Objective. To identify barriers to improving school food environments and promoting healthy nutrition experienced by primary schools in New Zealand.

Methods. Five primary schools (ages 5—10 or 5—12 years) were recruited within Wellington, New Zealand. Data included: interviews with school management; school food policy documents; school lunch/food sales; and location of food outlets and outdoor food advertisements surrounding the schools. A case-comparison approach identified barriers to promoting healthy nutrition within primary schools in New Zealand.

Results. Common barriers in all schools included the high proportion of food brought to school from home, the crowded curriculum and limited resources to implement changes. Barriers that varied across socioeconomic contexts included the ability of home and community settings to support healthy diets, the degree to which schools relied on fundraising, and engagement of parents and families with the school food environment.

Conclusion. New Zealand primary schools face a number of barriers to promoting healthy nutrition related to time and resource constraints, with limited influence on children’s diets in relation to home and community settings. Incremental actions to improve school food environments seem most effective, supported by external agency expertise. The nature of external support should to be tailored to the needs of the individual school.
The WellingTONNE Challenge Toolkit: Using the RE-AIM framework to evaluate a community resource promoting healthy lifestyle behaviours
Authors: Caperchione Cristina , Coulson Fiona
Published: March 2010

Objective: The RE-AIM framework has been recognized as a tool to evaluate the adoption, delivery, and sustainability of an intervention, and estimate its potential public health impact. In this study four dimensions of the RE-AIM framework (adoption, implementation, effectiveness, and maintenance) were used to evaluate the WellingTONNE Challenge Toolkit, a step-by-step resource explaining how to develop, implement and disseminate a healthy lifestyle community intervention.

Design: Process evaluation.

Methods: In association with the Commonwealth Department of Health and Ageing (DHA), a self-report questionnaire was distributed to individuals from health care organizations, local councils and community organizations throughout Australia who had received and/or requested the WellingTONNE Challenge Toolkit from the DHA.

Results: The RE-AIM dimensions revealed a high adoption rate and confirmed that the toolkit was being implemented for what it was intended to be implemented for and was an effective resource for initiating, maintaining and encouraging a healthy lifestyle. Lastly, the evaluation highlighted that most participants would maintain use of the toolkit in future projects.

Conclusion: The RE-AIM framework provided valuable information concerning the uptake, implementation and usability of the WellingTONNE Challenge Toolkit, however, future research should address the behavioural outcomes associated with using the toolkit in order to provide a clearer understanding of how research can be translated into public health practice.
Evidence-based health policy: A preliminary systematic review
Authors: Morgan Gareth
Published: March 2010

Objective: The development of evidence-based health policy is challenging. This study has attempted to identify some of the underpinning factors that promote the development of evidence based health policy.

Methods: A preliminary systematic literature review of published reviews with ‘evidence based health policy’ in their title was conducted using PubMed as a search engine. The identified papers were critically analysed using a ‘realist review’ method, driven by the question ‘What works for whom in what circumstances and in what respects?’.

Results: Eight published reviews met the search criteria. Following the ‘realist review’, six factors that underpin the development of evidence-based health policy were identified. They are: (i) the importance and value of having multi-disciplinary teams; (ii) the need to have a broad evidence base to draw upon; (iii) the circular relationship between research and policy; (iv) the need for policy implementation to be locally sensitive; (v) the benefit of stakeholder involvement; (vi) support by the national Government.

Conclusion: The six factors identified provide a framework for consideration for those whose work involves evidence-based health policy development. As a corollary, the failure to satisfy these factors in evidence-based health policy development may lead to resistance to policy change and further work is warranted.
Comprehension of a colon cancer pamphlet among American adults at least 50 years of age
Authors: Liu Chiung-ju
Published: March 2010

Objective: The purpose of this study was to identify determinants of comprehension of an educational pamphlet on colon cancer, by adults at least 50 years of age living in the United States.

Design: Data were analysed from the 2003 National Assessment of Adult Literacy survey.The survey was designed to assess functional English literacy, which included reading a colon cancer pamphlet, among American adults.

Setting: The survey was carried out at interviewees’ homes.

Method: Data from 1231 adults who were 50 years of age or older were selected for the current study (mean age = 63.22 years).

Results: Multiple regression analysis revealed that comprehension difficulties increased with age ( β = —0.13, p < 0.001). Non-Black minority adults had poorer comprehension than Whites ( β = —0.10, p < 0.001). Adults with a high school or further education had better comprehension than those with lower-level education ( β = 0.22, p < 0.001). Comprehension was higher among adults who often received health information by talking to their health providers ( β = —0.12, p < 0.001), and for adults who had high levels of verbal-reading fluency ( β = 0.24, p < 0.001). In addition, increased English reading habits alone only marginally contributed to comprehension of the pamphlet ( β = —0.06, p = 0.06).

Conclusion: Understanding the pamphlet was related to age, ethnic background, education, reading fluency and experiences in communication with health providers. Increasing communication between health providers and patients or tailoring the written materials to improve adults’ knowledge of colon cancer is recommended.
Development of the Reasonable Accommodation Factor Survey: Results and Implications
Authors: Shengli Dong  , MacDonald-Wilson Kim L. , Fabian Ellen
Published: March 2010

The purpose of this study was (a) to explore the latent factors in the Reasonable Accommodation Factor Survey (RAFS) instrument and (b) to compare scores on the latent factors of the RAFS by participant’s role. Eight latent factors were identified through an exploratory factor analysis with orthogonal rotation. The reliability tests indicated satisfactory reliability scores on each of the eight latent factors of the RAFS. Comparison of scores by roles of stakeholders (employee, employer, and service provider) indicated statistically significant differences in scores on three latent factors: Employee Competence in Reasonable Accommodation, Workplace Impact, and Employee Work Record. Implications for practice and research are discussed.
Neuropsychological and Personality Characteristics of Predatory, Irritable, and Nonviolent Offenders
Authors: Levi Marc D. , Nussbaum David S. , Rich Jill B.
Published: March 2010

This article represents an initial attempt to adapt the three most relevant components of Moyer’s animal aggression typology to humans. These include predatory (unemotional, goal-directed), irritable (anger-based), and defensive (fear-based) aggression. As different brain networks are likely involved, the authors hypothesized that executive function and personality tests could differentiate violent from nonviolent criminals and discriminate the types originally classified on the basis of criminal history. Discriminant analyses correctly classified 80% of the violent and nonviolent groups and 74% of the predatory and irritable groups. Of theoretical salience, the predatory group resembled the unimpaired nonviolent group only on the cognitive Integrated Visual and Auditory Continuous Performance Test but was indistinguishable from the impaired irritable aggression group on the Iowa Gambling, suggesting inhibitory deficits primarily in the face of reward opportunity. Implications for the theory and application to risk assessment are discussed.
Community Corrections Facilities for Juvenile Offenders in Ohio
Authors: Lowenkamp Christopher T. , Makarios Matthew D. , Latessa Edward J. , Lemke Richard , Smith Paula
Published: March 2010

Although prior research suggests that juvenile correctional programs can be effective at reducing recidivism, research has also found that some programs are more effective than others. This suggests that identifying the characteristics of effective correctional programs is an important issue surrounding interventions with juveniles. The current research not only examines the effectiveness of Ohio’s community correctional facilities in reducing recidivism, but it also examines whether measures of treatment integrity are related to recidivism. The findings revealed that programs that scored higher on treatment integrity were more effective at reducing recidivism. Specifically, community corrections facilities that served higher risk youth, targeted dynamic risk factors with cognitive behavioral modalities, and employed trained and qualified staff were found to have stronger effects on recidivism than those that did not.
Priming a sense of security: What goes through people’s minds?
Authors: Carnelley Katherine B. , Rowe Angela C.
Published: March 2010

There is a growing literature charting the positive personal and interpersonal effects of security priming. Security primes enhance self- and relationship views, and even evaluations of outgroups, relative to control primes. We examine how security priming is experienced by individuals and how its effects differ from those produced by other positive affect and relationship-related primes. We analyze the written protocols produced by individuals in different priming conditions for frequency of felt security, care, merging, agency, communion, and nostalgia words. Security priming led to thoughts related to felt security, positive care, a sense of merging with another, positive emotion, and communion; furthermore, the effects of security priming could be distinguished from the effects of positive affect and other relationship-related primes. We discuss several directions for future research.
The Influence of Linguistic Acculturation and Gender on the Initiation of Substance Use Among Mexican Heritage Preadolescents in the Borderlands
Authors: Marsiglia Flavio F. , Yabiku Scott T. , Kulis Stephen , Nieri Tanya , Parsai Monica , Becerra David
Published: March 2010

This article examined the impact of linguistic acculturation and gender on the substance use initiation of a sample of 1,473 Mexican heritage preadolescents attending 30 public schools in Phoenix, Arizona. It was hypothesized that linguistic acculturation operates differently as a risk or protective factor for young children than for older youth. The study used discrete-time event history methods to model the rate at which nonusing children initiate substance use. Alcohol, cigarettes, marijuana, and inhalants were studied separately while inhalant use was examined more closely. Results suggested that while linguistic acculturation is a risk factor for Mexican heritage preadolescents, this association depended on gender, the linguistic acculturation context (family, friends, or media), and the type of substance. For inhalants, higher linguistic acculturation with friends was inversely associated with drug initiation both for boys and girls. Implications for preventive science and future intervention research are discussed.
Social Goal Orientations, Interpersonal Stress, and Depressive Symptoms Among Early Adolescents in Japan: A Test of the Diathesis-Stress Model Using the Trichotomous Framework of Social Goal Orientations
Authors: Kuroda Yuji , Sakurai Shigeo
Published: March 2010

This longitudinal study investigated whether depression among early adolescents (aged 12-14 years, N = 116; 65 girls) can be predicted by interactions between social goal orientations and interpersonal stress. Based on Kuroda and Sakurai (2001), this study applied Elliot and Harackiewicz’s (1996) trichotomous framework of achievement goals to Dweck and Leggett’s (1988) model of social goals and investigated three types of social goals: social learning goals (to grow through interpersonal experiences), social performance-approach goals (to obtain positive evaluations), and social performance-avoidance goals (to avoid negative evaluations). The results indicated that social learning goals reduced the effects of interpersonal stress, thus protecting against depression, whereas social performance-avoidance goals exacerbated the effects of interpersonal stress, thereby developing depression. Social performance-approach goals neither reduced nor exacerbated the effects of interpersonal stress. The nature and functioning of these goals were discussed.
Velocity Response Curves Support the Role of Continuous Entrainment in Circadian Clocks
Authors: Taylor Stephanie R. , Webb Alexis B. , Smith Katherine S. , Petzold Linda R. , Doyle Francis J.
Published: March 2010

Circadian clocks drive endogenous oscillations in organisms across the tree of life. The Earth’s daily light/dark cycle entrains these clocks to the environment. Two major theories of light entrainment have been presented in the literature. The discrete theory emphasizes the instantaneous phase-shifting behavior of short pulses of light, and the continuous theory emphasizes changes to the period of oscillations in constant-light conditions. Historically, the primary tool for predicting and understanding discrete entrainment has been the PRC, which measures discrete adjustments to the clock’s phase. The authors present a unified theory, which relies on a velocity response curve (VRC), similar in shape to a PRC, but that describes continuous adjustments to the clock’s speed. The VRC explains data from both discrete and continuous light experiments and is therefore an invaluable tool to understand entrainment. The authors relate VRC features to specific entrainment behaviors, such as seasonal adjustments to the phase of entrainment. Furthermore, they estimate a VRC from PRC data and successfully reproduce additional PRC data. Finally, they entrain a VRC-based model to natural light/dark cycles, demonstrating the unified theory’s ability to predict clock behavior in the face of a fluctuating signal. The results indicate that a VRC-based model not only provides a comprehensive understanding of entrainment but also has excellent predictive capabilities.
Pediatric Palliative Care, Costa Rica’s Experience
Authors: Irola Moya Juan Carlos , Garro Morales Miriam
Published: March 2010

Background: This article describes the patients and activities of the Pediatric Palliative Care and Pain Control Clinic of the National Children’s Hospital (PPCPCC NCH) in San Jose, Costa Rica Central America, founded in 1990, is the first such clinic in the country. Methods: This study includes all the children and adolescents referred to the PPCPCC NCH from January 2000 to December 2008. This is a quantitative and descriptive study. We used a simple format that included variables such as age, sex, diagnostic, place of reference, pain, and other symptoms. Results: The database initially registered a total of 1470 patients; 25 of these were excluded from the study because of incomplete information, leaving a total of 1445 registered cases for the analysis. The average number of patients admitted was 156 per year. Malignant tumor was the principal diagnosis at the time of admission, followed by central nervous system abnormalities. Pain was the most frequent symptom. Most patients were visited or examined at home and/or the pediatric palliative care day center and died in their own home. Conclusion: The initial analysis enabled us to obtain information and feedback about the work of the PPCPCC. We are now able to understand more fully the needs of pediatric palliative care in Costa Rica such as increasing the coverage of pediatric patients who require palliative care, improving our resources, further defining the criteria for admission of patients to a palliative care program, and developing standards for measuring and recording symptoms besides pain.
Dynamics and Global Stability of Beam-based Electrostatic Microactuators
Authors: Najar F. , Nayfeh A.H. , Abdel-Rahman E.M. , Choura S. , El-Borgi S.
Published: March 2010

We investigate the dynamics and global stability of a beam-based electrostatic microactuator, which is modeled as a first-order approximation of a reduced-order model (ROM) derived using the differential quadrature method (DQM). We show that the ROM dynamics is qualitatively similar to that of a higher-order approximation. We simulate the occurrence of dynamic pull-in for excitations near the first primary resonance using the finite difference method (FDM) and long-time integration. Limit-cycle solutions are obtained using the FDM, the generated frequency- and force-response curves exhibit cyclic-fold, saddle-node, and period-doubling bifurcations. We verify that symmetry breaking is not likely to occur because the orbit is already asymmetric. We identify the basin of attraction of bounded motions using various approximation levels. The simulations reveal that the erosion of the basin of attraction depends heavily on the amplitude and frequency of the AC voltage. We show that smoothness of the boundary of the basin of attraction can be lost and replaced by fractal tongues, which dramatically increase the sensitivity of the microbeam to initial conditions. According to these simulations, the locations of the two fixed points are likely to be disturbed.
On the Control of Two-link Flexible Robot Arm with Nonuniform Cross Section
Authors: Dogan Mustafa , Morgül Ömer
Published: March 2010

We consider the motion of a two-link flexible arm with nonuniform cross section. We obtain the equations of motion by using the extended Hamilton’s principle. These equations consist of coupled partial differential equations and (nonlinear) ordinary differential equations with appropriate boundary conditions. Our control problem is to achieve the given desired link angles and suppress the link vibrations. To solve this problem, we propose a novel control scheme which consists of a dominant control law together with a parallel controller. We show that with the proposed controller, the control objectives are satisfied. Our stability analysis is based on the Lyapunov approach and LaSalle’s invariance principle extended to infinite-dimensional systems. We also present some simulation results, which indicate that large parameter uncertainties such as tip and hub mass changes are also handled effectively by the proposed controller.
The “Jock Body” and the Social Construction of Space: The Performance and Positioning of Cultural Identity
Authors: Sparkes Andrew C. , Brown David H.K. , Partington Elizabeth
Published: March 2010

This article draws on data generated from a 3-year ethnographic study of “jock culture” at one university setting in England to illuminate the ways that specific kinds of bodies are located in social space so as to construct a range of identity positions that facilitate the maintenance of this culture over time. These positions are as follows: the jocks, sport scholars, also-rans, anti-jocks, wannabes, and the non-jocks. The analysis revealed how individuals negotiate an embodied identity within a network of power relations, with the performing jock body occupying the most highly visible, yet taken for granted, central space around which all other bodies are positioned according to their ability to meet the combined sporting and social requirements of this culture. The findings have significance for how we understand the ways in which bodies and space are reciprocally constituted along with the dilemmas this poses for individuals within a cultural setting.
(Re)Producing Country: Mapping Multiple Australian Spaces
Authors: Lambert Anthony
Published: March 2010

This article offers an analysis and description of the notion of Australian space as a country within historical and critical-cultural imaginaries. By moving through Australian spaces as produced, heterotopic spaces and places, country becomes the shorthand for multiple Australias. From the bar to the beach, maps to icons, city to suburbs and beyond, “country” is at once the discursive staging of homogeneity in a postmodern Australia, but at the same time a relationship between nature and human obligation.
A discourse analytic study of ME/CFS (Chronic Fatigue Syndrome) sufferers’ experiences of interactions with doctors
Authors: Guise Jennie , McVittie Chris , McKinlay Andy
Published: March 2010

The aetiology, symptoms, diagnosis and treatment of ME/CFS are controversial. Doctors and sufferers often have opposing perspectives, leading to problematic clinical interactions. We use discourse analysis to explore ME/CFS sufferers’ descriptions of interactions with medical professionals taken from an asynchronous, online sufferers’ support group. Participants described themselves as experiencing limited medical care and attention but restricted criticisms to ‘legitimate’, pragmatic or ancillary matters such as a clinicians’ unwillingness to prescribe untested treatments. Participants also described themselves as active in seeking a resolution to their problems. They thus attended to possible negative attributions of being ‘complaining’ or unmotivated to seek recovery.
Validation of the Food Thought Suppression Inventory
Authors: Barnes Rachel D. , Fisak Brian , Tantleff-Dunn Stacey
Published: March 2010

The Food Thought Suppression Inventory (FTSI) was designed as a domain-specific measure of food-related thought suppression, and the FTSI has been found to be associated with eating pathology, including binge eating. Although initial research in this area is promising, as it may provide understanding of the cognitive processes related to the development of eating pathology and obesity, little is known about the psychometric properties of the FTSI. In the current study, the validity of the FTSI was examined, and the FTSI was found to be a valid, reliable, single factor measure of food thought suppression.
Why Should Men and Women Marry and Have Children?
Authors: Muhammad Ali , Gagnon Alain
Published: March 2010

Using the Canadian Community and Health Survey (2000), this study examines self-perceived stress across marital and parental statuses, adjusting for age, education, work status, income and sense of community belonging. Results show that fatherhood increases perceived stress regardless of marital status, particularly among singles. Motherhood does not affect perceived stress among married or cohabitating women but single and post-married mothers endure the highest levels of stress. Interactions between working and parental or marital statuses are also observed. Community belonging acts as a coping mechanism in lowering stress levels. Results are discussed in the context of changing familial roles.
‘Feelings of Guilt due to Self-inflicted Disease’
Authors: Lindqvist Gunilla , Hallberg Lillemor R-M.
Published: March 2010

The aim of this grounded theory study was to illuminate the main concern of people suffering from chronic obstructive pulmonary disease (COPD) and how they handle their everyday life. Data were collected through interviews with 23 people with COPD at different stages, from mild to severe. A substantive theory was generated showing that the main concern was feelings of guilt due to self-inflicted disease associated with smoking habits. This core category was related to five managing strategies termed making sense of existence, adjusting to bodily restrictions, surrendering to fate, making excuses for the smoking-related cause and creating compliance with daily medication.
Materialized cosmology among ancient Maya commoners
Authors: Lucero Lisa J.
Published: March 2010

Classic Maya inscriptions and iconography reveal more than just royal customs since their origins lie in traditional Maya practices. They provide a key to unlocking how commoners created their own domestic universe. To explore how commoners mapped their cosmology and recorded their history, I discuss domestic ceramic clusters based on color, placement, and association with other artifacts at the minor center of Saturday Creek, Belize. Results show that cached items served to contextualize their place in the cosmos. Commoners may not have had the written word, but they had the means to record their own history, one with which they interacted daily — under their feet, within walls, and under their roof.
International schools as sites of social change
Authors: Dunne Sandra , Edwards Julie
Published: March 2010

This article examines the potential of international schools to act as agents of social transformation in developing countries. The method comprises a case study at two international schools in the Philippines. The case study explored ways in which schools foster host-national students’ sense of social responsibility, particularly through community connections. It found important social links were forged through school service learning programmes that sometimes augmented family or church outreach activities. However, among students in the study, noblesse oblige attitudes prevailed over identification with agency for significant social change.
Teachers’ practices, values and beliefs for successful inquiry-based teaching in the International Baccalaureate Primary Years Programme
Authors: Twigg Vani Veikoso
Published: March 2010

Through narrative inquiry, this study investigated the role of personal and professional aspects of teaching and learning which teachers have developed and practiced, in relation to the dispositions, values, beliefs and knowledge that may assist them in successfully transforming to inquiry-based teaching, specifically in the implementation of the International Baccalaureate (IB) Primary Years Programme (PYP). Narrative analysis using interpretivism and social anthropology supported by a ‘grounded theory’ approach revealed that teachers who have high personal expectations that are reflected in the organization, deliverance and assessment of the programme, in conjunction with evaluation of the teachers and coming to the process as a learner, contributor, reflective practitioner, challenge seeker and simple fun-loving positive person, play an important role in them transforming their practice from traditional didactic methodologies to inquiry-based teaching and learning pedagogies.
Middle school music curricula and the fostering of intercultural awareness
Authors: Field Janet
Published: March 2010

This article focuses on curriculum in the context of international education, examining a particular example: arts education, and specifically music, in the International Baccalaureate (IB) Middle Years Programme (MYP). As one expression of, and agent for, international education, MYP Music supposedly fosters intercultural awareness.The article considers how this is done. Music education, developments within the MYP, ideas about intercultural awareness itself and curriculum design theories all inform the discussion. Several examples of innovative music programmes in non-school settings illustrate a highly contextualized approach which places strong emphasis on intercultural understanding. It is argued that, in addition to disciplinary understanding, an international curriculum should aim for intercultural understanding and international understanding.
Apple Juice Improved Behavioral But Not Cognitive Symptoms in Moderate-to-Late Stage Alzheimer’s Disease in an Open-Label Pilot Study
Authors: Remington Ruth , Chan Amy , Lepore Alicia , Kotlya Elizabeth , Shea Thomas B.
Published: March 2010

Preclinical studies demonstrate that apple juice exerts multiple beneficial effects including reduction of central nervous system oxidative damage, suppression of Alzheimer’s disease (AD) hallmarks, improved cognitive performance, and organized synaptic signaling. Herein, we initiated an open-label clinical trial in which 21 institutionalized individuals with moderate-to-severe AD consumed 2 4-oz glasses of apple juice daily for 1 month. Participants demonstrated no change in the Dementia Rating Scale, and institutional caregivers reported no change in Alzheimer’s Disease Cooperative Study (ADCS)-Activities of Daily Living (ADL) in this brief study. However, caregivers reported an approximate 27% (P < .01) improvement in behavioral and psychotic symptoms associated with dementia as quantified by the Neuropsychiatric Inventory, with the largest changes in anxiety, agitation, and delusion. This pilot study suggests that apple juice may be a useful supplement, perhaps to augment pharmacological approaches, for attenuating the decline in mood that accompanies progression of AD, which may also reduce caregiver burden.
Statistical Modeling of Combat Mortality Events by Using Subject Matter Expert Opinions and Operation Iraqi Freedom Empirical Results from the Navy-Marine Corps Combat Trauma Registry
Authors: Mitchell Ray , Parker Joseph , Galarneau Michael , Konoske Paula
Published: March 2010

In 12 Navy—Marine Corps medical logistics studies and analyses conducted by the Naval Health Research Center (NHRC) and Teledyne Brown Engineering (TBE) over the past 5 years, estimates of battlefield mortality have been a major metric of interest to medical planners. An ongoing concern is how mortality is related to delays in treatment for medical logistics reasons. In this paper, we describe how NHRC and TBE have been developing a statistically based model for mortality since 2003, first starting with panel results from a group of military medical doctors and continuing here with an analysis of empirical injury data from Operation Iraqi Freedom (OIF). The panel results and statistical analysis of life-threatening injury data in OIF from early 2004 to mid-2006 indicate that the Weibull distribution describes the timing of high risk of mortality events in a reasonable manner within surgical medical treatment facilities. The quest for a best-fitting probability distribution with parameters dependent on the casualty flow chain of treatment and evacuation in the theater is ongoing. In reality, combining analytical and subject matter expert (SME) results to model mortality is necessary given the breadth of theater medical delivery systems and general paucity of adequate empirical data in many of the segments of patient flow.
Motivating the unmotivated for health behavior change: a randomized trial of cessation induction for smokers
Authors: Carpenter Matthew J , Alberg Anthony J , Gray Kevin M , Saladin Michael E
Published: March 2010

Background Many smokers remain unwilling or unable to make a quit attempt. For these smokers, novel strategies to induce quit attempts are necessary to achieve further reductions in smoking prevalence.

Purpose This article describes the design and methods of an ongoing nationwide telephone-based clinical trial for cessation induction, the principal aim of which is to test the hypothesis that samples of nicotine replacement therapy (NRT), can induce quit attempts among smokers otherwise unmotivated to quit.

Methods Smokers are recruited proactively through online channels. A ‘behavioral filter’ is used to identify and separate motivated versus unmotivated smokers, the latter of whom (N = 750) are formally entered into the clinical trial. Participants are randomized to one of two treatment conditions designed to promote self-efficacy and motivation to quit: (1) practice quit attempt (PQA) or (2) PQA plus NRT sampling. The primary outcome measure tested over a 6-month follow-up is the incidence of additional quit attempts as well as hypothesized mediators of treatment effects.

Results This study details the challenges of identifying and treating smokers who are unmotivated to quit. Strengths include a novel treatment approach, tested among a group of proactively recruited smokers nationwide, with a unique method of identifying cessation-resistant smokers.

Limitations The omission of a true control group, testing the effect of the PQA itself, is an inherent limitation to the study design. Online recruitment presents additional study challenges, all of which are discussed in detail.

Conclusions The study has translational potential to guide both clinical and policy recommendations for cessation induction. Further, while the focus is on smoking, this trial may serve as an example to researchers and clinicians who focus on other health behaviors, and who themselves are challenged with motivating people who are unmotivated for change. Clinical Trials 2010; 7: 157—166. http://ctj.sagepub.com
Barriers and opportunities for implementation of adaptive designs in pharmaceutical product development
Authors: Quinlan Judith , Gaydos Brenda , Maca Jeff , Krams Michael
Published: March 2010

Background This review discusses barriers to implementing adaptive designs in a pharmaceutical R&D environment and provides recommendations on how to overcome challenges. A summary of findings from a survey conducted through PhRMA’s working group on adaptive designs is followed by a report based on our experience as statistical and clinical consultants to project teams charged with establishing the clinical development strategy for investigational compounds and interested in applying innovative approaches.

Findings and recommendations Adaptive designs require additional work in that clinical trial simulations are needed to develop the design. Some project teams, due to time and resource constraints, are unable to invest the additional effort required to conduct necessary scenario analyses of options through simulation. We recommend formally integrating the planning time for scenario analyses and to incentivize optimal designs (e.g., designs offering the highest information value per resource unit invested). Regardless of the trial design ultimately chosen, quantitatively comparing alternative trial design options through simulation will enable earlier and better decision making in the context of the overall clinical development plan. Adhering to ‘Good Adaptive Practices’ will be key to achieving this goal.

Outlook Implementing adaptive designs efficiently requires top—down and bottom— up support and the willingness to invest into integrated process and information technology infrastructures. Success is conditional on the willingness of the R&D environment to embrace the implementation of adaptive designs as a Change Management Initiative in the spirit of the Critical Path of the Food and Drug Administration. Clinical Trials 2010; 7: 167—173. http://ctj.sagepub.com