bluuebunny/crossref_metadata_2025 huggingface dataset:
Rapid block glides: slide-surface fragmentation in New Zealand's Waikaremoana landslide
Authors: Davies T.R. , McSaveney M.J. , Beetham R.D.
Published: May 2006

Physical modelling of part of prehistoric Waikaremoana landslide shows that the blockslide must have hit the valley wall at
c
. 40 m/s, after sliding 2 km on a 5.5–8° slope, in order to form the 150-m high mound of debris known as Raekahu. Both the blockslide and a distal rock avalanche were in simultaneous motion when the impact occurred. Finely ground rock on the slide plane suggests that a mechanism of dynamic rock fragmentation may explain the low friction necessary for acceleration to 40 m/s. When a rock particle fractures in a confined space, an isotropic dispersive pressure equal to the rock's Hugoniot elastic limit (in the GPa range) at the ambient pressure and strain rate may be exerted on its surroundings. Beneath the 275-m thick block, about one particle in 15–30 or so fragmenting at any instant (with lower density for higher rock strength at higher strain rate), could completely support the weight of the block by fragmentation pressure; but then there would be no frictional resistance (and hence no further fragmentation). Self-regulation of the process may explain the apparent coefficient of friction of
c
. 0.1 in the blockslide. Low friction through dynamic fragmentation may apply widely to blockslides with a basal layer of comminuted rock.
Neurophysiological evaluation of healthy human anorectal sensation
Authors: Harris M. L. , Hobson A. R. , Hamdy S. , Thompson D. G. , Akkermans L. M. , Aziz Q.
Published: May 2006

Patients with functional gastrointestinal disorders often demonstrate abnormal visceral sensation. Currently, rectal sensation is assessed by manual balloon distension or barostat. However, neither test is adaptable for use in the neurophysiological characterization of visceral afferent pathways by sensory evoked potentials. The aim of this study was to assess the reproducibility and quality of sensation evoked by electrical stimulation (ES) and rapid balloon distension (RBD) in the anorectum and to apply the optimum stimulus to examine the visceral afferent pathway with rectal evoked potentials. Healthy subjects ( n = 8, median age 33 yr) were studied on three separate occasions. Variability, tolerance, and stimulus characteristics were assessed with each technique. Overall ES consistently invoked pain and was chosen for measuring rectal evoked potential whereas RBD in all cases induced the strong urge to defecate. Rectal intraclass correlation coefficient (ICC) for ES and RBD (0.82 and 0.72, respectively) demonstrated good reproducibility at pain/maximum tolerated volume but not at sensory threshold. Only sphincter ICC for ES at pain showed acceptable between-study reproducibility (ICC 0.79). Within studies ICC was good (>0.6) for anorectal ES and RBD at both levels of sensation. All subjects reported significantly more unpleasantness during RBD than ES ( P < 0.01). This study demonstrates that ES and RBD are similarly reproducible. However, the sensations experienced with each technique differed markedly, probably reflecting differences in peripheral and/or central processing of the sensory input. This is of relevance in interpreting findings of neuroimaging studies of anorectal sensation and may provide insight into the physiological characteristics of visceral afferent pathways in health and disease.
Quantification of right ventricular afterload in patients with and without pulmonary hypertension
Authors: Lankhaar Jan-Willem , Westerhof Nico , Faes Theo J. C. , Marques Koen M. J. , Marcus J. Tim , Postmus Piet E. , Vonk-Noordegraaf Anton
Published: May 2006

Right ventricular (RV) afterload is commonly defined as pulmonary vascular resistance, but this does not reflect the afterload to pulsatile flow. The purpose of this study was to quantify RV afterload more completely in patients with and without pulmonary hypertension (PH) using a three-element windkessel model. The model consists of peripheral resistance ( R), pulmonary arterial compliance ( C), and characteristic impedance ( Z). Using pulmonary artery pressure from right-heart catheterization and pulmonary artery flow from MRI velocity quantification, we estimated the windkessel parameters in patients with chronic thromboembolic PH (CTEPH; n = 10) and idiopathic pulmonary arterial hypertension (IPAH; n = 9). Patients suspected of PH but in whom PH was not found served as controls (NONPH; n = 10). R and Z were significantly lower and C significantly higher in the NONPH group than in both the CTEPH and IPAH groups ( P < 0.001). R and Z were significantly lower in the CTEPH group than in the IPAH group ( P < 0.05). The parameters R and C of all patients obeyed the relationship C = 0.75/ R ( R2 = 0.77), equivalent to a similar RC time in all patients. Mean pulmonary artery pressure P and C fitted well to C = 69.7/P (i.e., similar pressure dependence in all patients). Our results show that differences in RV afterload among groups with different forms of PH can be quantified with a windkessel model. Furthermore, the data suggest that the RC time and the elastic properties of the large pulmonary arteries remain unchanged in PH.
Simvastatin causes endothelial cell apoptosis and attenuates severe pulmonary hypertension
Authors: Taraseviciene-Stewart Laimute , Scerbavicius Robertas , Choe Kang-Hyeon , Cool Carlyne , Wood Kathy , Tuder Rubin M. , Burns Nana , Kasper Michael , Voelkel Norbert F.
Published: May 2006

Severe pulmonary hypertension (SPH) is characterized by precapillary arteriolar lumen obliteration, dramatic right ventricular hypertrophy, and pericardial effusion. Our recently published rat model of SPH recapitulates major components of the human disease. We used this model to develop new treatment strategies for SPH. SPH in rats was induced using VEGF receptor blockade in combination with chronic hypoxia. A large variety of drugs used in this study, including anticancer drugs (cyclophosphamide and paclitaxel), the angiotensin-converting enzyme inhibitor lisinopril, the antiangiogenic agent thalidomide, and the peroxisome proliferator-actived receptor-γ agonist PGJ2, failed to decrease mean pulmonary artery pressure (PAP) or right ventricular hypertrophy. In contrast, treatment of rats with established SPH with simvastatin markedly reduced mean PAP and right ventricular hypertrophy, and this reduction was associated with caspase-3 activation and pulmonary microvascular endothelial cell apoptosis. Simvastatin partially restored caveolin-1, caveolin-2, and phospho-caveolin expression in vessel walls. In rat primary pulmonary microvascular endothelial cells, simvastatin induced caspase 3 activation and Rac 1 expression while suppressing Rho A and attenuated levels of Akt and ERK phosphorylation. We conclude that simvastatin is effective in inducing apoptosis in hyperproliferative pulmonary vascular lesions and could be considered as a potential drug for treatment of human SPH.
Adrenergic regulation of HSL serine phosphorylation and activity in human skeletal muscle during the onset of exercise
Authors: Talanian Jason L. , Tunstall Rebecca J. , Watt Matthew J. , Duong Mylinh , Perry Christopher G. R. , Steinberg Gregory R. , Kemp Bruce E. , Heigenhauser George J. F. , Spriet Lawrence L.
Published: May 2006

Skeletal muscle hormone-sensitive lipase (HSL) activity is increased by contractions and increases in blood epinephrine (EPI) concentrations and cyclic AMP activation of the adrenergic pathway during prolonged exercise. To determine the importance of hormonal stimulation of HSL activity during the onset of moderate- and high-intensity exercise, nine men [age 24.3 ± 1.2 yr, 80.8 ± 5.0 kg, peak oxygen consumption (V̇o2 peak) 43.9 ± 3.6 ml·kg−1·min−1] cycled for 1 min at ∼65% V̇o2 peak, rested for 60 min, and cycled at ∼90% V̇o2 peak for 1 min. Skeletal muscle biopsies were taken pre- and postexercise, and arterial blood was sampled throughout exercise. Arterial EPI increased ( P < 0.05) postexercise at 65% (0.45 ± 0.10 to 0.78 ± 0.27 nM) and 90% V̇o2 peak (0.57 ± 0.34 to 1.09 ± 0.50 nM). HSL activity increased ( P < 0.05) following 1 min of exercise at 65% V̇o2 peak [1.05 ± 0.39 to 1.78 ± 0.54 mmol·min−1·kg dry muscle (dm)−1] and 90% V̇o2 peak (1.07 ± 0.24 to 1.91 ± 0.62 mmol·min−1·kg dm−1). Cyclic AMP content also increased ( P < 0.05) at both exercise intensities (65%: 1.52 ± 0.67 to 2.75 ± 1.12, 90%: 1.85 ± 0.65 to 2.64 ± 0.93 μmol/kg dm). HSL Ser660 phosphorylation (∼55% increase) and ERK1/2 phosphorylation (∼33% increase) were augmented following exercise at both intensities, whereas HSL Ser563 and Ser565 phosphorylation were not different from rest. The results indicate that increases in arterial EPI concentration during the onset of moderate- and high-intensity exercise increase cyclic AMP content, which results in the phosphorylation of HSL Ser660. This adrenergic stimulation contributes to the increase in HSL activity that occurs in human skeletal muscle in the first minute of exercise at 65% and 90% V̇o2 peak.
Excessive erythrocytosis in adult mice overexpressing erythropoietin leads to hepatic, renal, neuronal, and muscular degeneration
Authors: Heinicke Katja , Baum Oliver , Ogunshola Omolara O. , Vogel Johannes , Stallmach Thomas , Wolfer David P. , Keller Stephan , Weber Klaus , Wagner Peter D. , Gassmann Max , Djonov Valentin
Published: May 2006

To investigate the consequences of inborn excessive erythrocytosis, we made use of our transgenic mouse line (tg6) that constitutively overexpresses erythropoietin (Epo) in a hypoxia-independent manner, thereby reaching hematocrit levels of up to 0.89. We detected expression of human Epo in the brain and, to a lesser extent, in the lung but not in the heart, kidney, or liver of tg6 mice. Although no acute cardiovascular complications are observed, tg6 animals have a reduced lifespan. Decreased swim performance was observed in 5-mo-old tg6 mice. At about 7 mo, several tg6 animals developed spastic contractions of the hindlimbs followed by paralysis. Morphological analysis by light and electron microscopy showed degenerative processes in liver and kidney characterized by increased vascular permeability, chronic progressive inflammation, hemosiderin deposition, and general vasodilatation. Moreover, most of the animals showed severe nerve fiber degeneration of the sciatic nerve, decreased number of neuromuscular junctions, and degeneration of skeletal muscle fibers. Most probably, the developing demyelinating neuropathy resulted in muscular degeneration demonstrated in the extensor digitorum longus muscle. Taken together, chronically increased Epo levels inducing excessive erythrocytosis leads to multiple organ degeneration and reduced life expectancy. This model allows investigation of the impact of excessive erythrocytosis in individuals suffering from polycythemia vera, chronic mountain sickness, or in subjects tempted to abuse Epo by means of gene doping.
Features of glossopharyngeal breathing in breath-hold divers
Authors: Seccombe Leigh M. , Rogers Peter G. , Mai Nghi , Wong Chris K. , Kritharides Leonard , Jenkins Christine R.
Published: May 2006

One technique employed by competitive breath-hold divers to increase diving depth is to hyperinflate the lungs with glossopharyngeal breathing (GPB). Our aim was to assess the relationship between measured volume and pressure changes due to GPB. Seven healthy male breath-hold divers, age 33 ( 8 ) [mean (SD)] years were recruited. Subjects performed baseline body plethysmography (TLCPRE). Plethysmography and mouth relaxation pressure were recorded immediately following a maximal GPB maneuver at total lung capacity (TLC) (TLCGPB) and within 5 min after the final GPB maneuver (TLCPOST). Mean TLC increased from TLCPRE to TLCGPB by 1.95 (0.66) liters and vital capacity (VC) by 1.92 (0.56) liters ( P < 0.0001), with no change in residual volume. There was an increase in TLCPOST compared with TLCPRE of 0.16 liters (0.14) ( P < 0.02). Mean mouth relaxation pressure at TLCGPB was 65 (19) cmH2O and was highly correlated with the percent increase in TLC ( R = 0.96). Breath-hold divers achieve substantial increases in measured lung volumes using GPB primarily from increasing VC. Approximately one-third of the additional air was accommodated by air compression.
Effects of hindlimb unweighting and aging on rat semimembranosus muscle and myosin
Authors: Zhong Sheng , Lowe Dawn A. , Thompson LaDora V.
Published: May 2006

We tested the hypothesis that lower specific force (force/cross-sectional area) generated by type II fibers from hindlimb-unweighted rats resulted from structural changes in myosin (i.e., a change in the ratio of myosin cross bridges in the weak- and strong-binding state during contraction). In addition, we determined whether those changes were age dependent. Permeabilized semimembranosus muscle fibers from young adult and aged rats, some of which were hindlimb unweighted for 3 wk, were studied for Ca2+-activated force generation and maximal unloaded shortening velocity. Fibers were also spin labeled specifically at myosin Cys707 to assess the structural distribution of myosin during maximal isometric contraction using electron paramagnetic resonance spectroscopy. Myosin heavy chain isoform (MHC) expression and the ratio of MHC to actin were evaluated in each fiber. Fibers from the unweighted rats generated 34% less specific force than fibers from weight-bearing rats ( P < 0.001), independent of age. Electron paramagnetic resonance analyses showed that the fraction of myosin heads in the strong-binding structural state during contraction was 11% lower in fibers from the unweighted rats ( P = 0.019), independent of age. More fibers from unweighted rats coexpressed MHC IIB-IIX compared with fibers from weight-bearing rats ( P = 0.049). Unweighting induced a slowing of maximal unloaded shortening velocity and an increase in the ratio of MHC to actin in fibers from young rats only. These data indicate that altered myosin structural distribution during contraction and a preferential loss of actin contribute to unweighting-induced muscle weakness. Furthermore, the age of the rat has an influence on some parameters of changes in muscle contractility that are induced by unweighting.
Matrix Metalloproteinase Inhibition Attenuates Aortic Calcification
Authors: Qin Xiao , Corriere Matthew A. , Matrisian Lynn M. , Guzman Raul J.
Published: May 2006

Objective—

Arterial calcification has been associated with matrix metalloproteinase (MMP)–mediated elastin degradation. In this study, we investigated whether inhibiting MMP activity could reduce calcium accumulation in rodent models of aortic calcification.

Methods and Results—

Aortic calcification was first induced in male Sprague-Dawley rats by administration of vitamin D
3
. Treatment with doxycycline decreased aortic calcium and phosphorus accumulation, and it reduced aortic gelatinase levels; however, it also prevented the bone resorption associated with high doses of vitamin D
3
. Using an in vivo model of localized aortic calcification, systemic doxycycline treatment reduced aortic calcium accumulation without affecting serum calcium levels, suggesting a more specific effect of doxycycline in the arterial wall. In organ culture, doxycycline limited aortic calcification caused by exposure to alkaline phosphatase and inorganic phosphate. When GM6001, a synthetic and specific inhibitor of MMPs, was used instead of doxycycline, it had a similar effect. In vivo, periadventitial delivery of GM6001 to calcifying arteries significantly reduced calcification compared with controls.

Conclusions—

These results suggest that MMPs are involved in aortic calcification, and inhibiting MMP activity could reduce calcium accumulation in the arterial wall.
Gene Variants of VAMP8 and HNRPUL1 Are Associated With Early-Onset Myocardial Infarction
Authors: Shiffman Dov , Rowland Charles M. , Louie Judy Z. , Luke May M. , Bare Lance A. , Bolonick Joel I. , Young Bradford A. , Catanese Joseph J. , Stiggins Charles F. , Pullinger Clive R. , Topol Eric J. , Malloy Mary J. , Kane John P. , Ellis Stephen G. , Devlin James J.
Published: May 2006

Objectives—Identify gene variants associated with early-onset myocardial infarction (MI).

Methods and Results—We tested 11 647 single-nucleotide polymorphisms (SNPs) for association with early-onset MI in a case-control study (study 1 200 cases, 262 controls). To reduce the number of false positives among the 666 SNPs that were nominally associated with early-onset MI (P<0.05) in study 1, we tested these SNPs in study 2 (434 cases, 504 controls). We found that 8 of the 666 SNPs were associated with early-onset MI in study 2 (P<0.05) and had the same risk alleles as in study 1. These 8 SNPs were then tested for association with early-onset MI in study 3 (187 cases, 434 controls). We found that a VAMP8 variant (P=0.025; odds ratio [OR], 1.75; CI, 1.17 to 2.62) and an HNRPUL1 variant (P=0.0043; OR, 1.92; CI, 1.28 to 2.86) were associated with early-onset MI (nominalP<0.05; false discovery rate <10%) and had the same risk alleles in all 3 studies.

Conclusions—Variants in 2 genes were associated with early-onset MI: VAMP8, which is involved in platelet degranulation, and HNRPUL1, which encodes a ribonuclear protein. The identification of these variants could improve understanding of disease mechanisms and suggest novel drug targets.
Oxidized Low-Density Lipoprotein Correlates Positively With Toll-Like Receptor 2 and Interferon Regulatory Factor-1 and Inversely With Superoxide Dismutase-1 Expression
Authors: Holvoet Paul , Davey Penelope C. , De Keyzer Dieuwke , Doukouré Mory , Deridder Els , Bochaton-Piallat Marie-Luce , Gabbiani Giulio , Beaufort Emmanuel , Bishay Karine , Andrieux Nancy , Benhabilès Nora , Marguerie Gérard
Published: May 2006

Background—

Oxidized low-density lipoprotein (LDL) is associated with cardiovascular disease. Macrophages contribute to LDL oxidation, and oxidized LDL (oxLDL) affects macrophage function. We searched for the strongest gene correlates of oxLDL in macrophages in coronary plaques and studied the effect of oxLDL on their expression in THP-1 cells.

Methods and Results—

Gene expression in macrophages isolated from coronary plaque macrophages from hypercholesterolemic swine was measured on Agilent Human cDNA microarrays. Compared with a universal reference, 1653 transcripts were deregulated. The expression of 11 genes correlated positively and the expression of 5 genes correlated negatively with plaque oxLDL. Interferon regulatory factor-1 (
IRF1
;
R
2
=0.69) and toll-like receptor 2 (
TLR2
;
R
2
=0.18) were the strongest positive correlates of oxLDL. Superoxide dismutase 1 (
SOD1
) was the strongest inverse correlate of oxLDL (
R
2
=0.57). Immunohistochemical analysis showed colocalization of IRF1, TLR2, and SOD1 protein in macrophages and confirmed the RNA expression data. OxLDL-induced foam cell formation in THP-1 macrophages was associated with increased expression of
IRF1
and
TLR2
and decreased expression of
SOD1
.

Conclusions—

Our data support the hypothesis that oxLDL is a proinflammatory stimulus that induces the expression of TLR2 and IRF1, 2 important gene regulators of innate immune response, and inhibits the expression of the antioxidant SOD1.
ACE
Polymorphisms
Authors: Sayed-Tabatabaei F.A. , Oostra B.A. , Isaacs A. , van Duijn C.M. , Witteman J.C.M.
Published: May 2006

Angiotensin converting enzyme (ACE) plays an essential role in two physiological systems, one leading to the production of angiotensin II and the other to the degradation of bradykinin. The wide distribution and multifunctional properties of these peptides suggest that ACE could be involved in various pathophysiological conditions. The discovery that ACE levels are under genetic control ushered in a new era of investigation; most studies focused on an insertion/deletion (I/D) polymorphism in intron 16 of the
ACE
gene as a marker for a functional polymorphism. Recently, many single nucleotide polymorphisms were detected in the gene and the search for the locations of functional polymorphisms became a topic of extensive investigation. Nevertheless, association studies on the I/D polymorphism and clinical outcomes continued, mostly with conflicting results. This article reviews the current state of knowledge regarding
ACE
polymorphisms and suggests that a functional polymorphism is most likely located between intron 18 and the 3′ UTR. The potential existence of another functional polymorphism in the 5′ UTR, however, cannot be excluded. This review also presents an overview of ACE function in different pathophysiological systems, and summarizes previous reports on
ACE
and clinical outcomes. Although findings on the I/D polymorphism and disorders like diabetic nephropathy and Alzheimer disease can be considered conclusive, reports on most of the cardiovascular phenotypes are still controversial. Genotypic and phenotypic misclassifications, insufficient power in some studies, and the presence of interaction with other genes or environmental factors are possible explanations for the contradictory findings.
Induction of Cardiogenesis in Embryonic Stem Cells via Downregulation of Notch1 Signaling
Authors: Nemir Mohamed , Croquelois Adrien , Pedrazzini Thierry , Radtke Freddy
Published: May 2006

Embryonic stem cells represent an attractive source of cardiomyocytes for cell-replacement therapies. However, before embryonic stem cells can be successfully used for the treatment of cardiac diseases, the precise molecular mechanisms that underlie their cardiogenic differentiation must be identified. A network of intrinsic and extrinsic factors regulates embryonic stem cell self-renewal and differentiation into a variety of different cell lineages. Here, we show that Notch signaling takes place in some but not all embryonic stem cells and that the Notch pathway is shut down during the course of differentiation concomitantly with downregulation of Notch receptor and ligand expression. Moreover, gain- and loss-of-function experiments for Notch signaling components show that this pathway is a crucial regulator of cardiomyocyte differentiation within ES cells. Differentiation of ES cells into cardiomyocytes is favored by inactivation of the Notch1 receptor, whereas endogenous Notch signaling promotes differentiation of ES cells into the neuronal lineage. We conclude that Notch signaling influences the cell fate decision between mesodermal and the neuroectodermal cell fates during embryonic stem cell differentiation. These findings should help to optimize the production of specific cell types via modulation of the Notch pathways and, in particular, to improve the production of embryonic stem cell-derived cardiomyocytes.
Socioeconomic Status and Stroke Incidence in the US Elderly
Authors: Avendano Mauricio , Kawachi Ichiro , Van Lenthe Frank , Boshuizen Hendriek C. , Mackenbach Johan P. , Van den Bos G.A.M. , Fay Martha E. , Berkman Lisa F.
Published: May 2006

Background and Purpose—

This study assesses the effect of socioeconomic status on stroke incidence in the elderly, and the contribution of risk factors to stroke disparities.

Methods—

Data comprised a sample of 2812 men and women aged 65 years and over from the New Haven cohort of the Established Populations for the Epidemiologic Studies of the Elderly. Individuals provided baseline information on demographics, functioning, cardiovascular and psychosocial risk factors in 1982 and were followed for 12 years. Proportional hazard models were used to model survival from initial interview to first fatal or nonfatal stroke.

Results—

Two hundred and seventy subjects developed incident stroke. At ages 65 to 74, lower socioeconomic status was associated with higher stroke incidence for both education (HR
lowest/highest
=2.07, 95% CI, 1.04 to 4.13) and income (HR
lowest/highest
=2.08, 95% CI, 1.01 to 4.27). Adjustment for race, diabetes, depression, social networks and functioning attenuated hazard ratios to a nonsignificant level, whereas other risk factors did not change associations significantly. Beyond age 75, however, stroke rates were higher among those with the highest education (HR
lowest/highest
=0.42, 95% CI, 0.22 to 0.79) and income (HR
lowest/highest
=0.43, 95% CI, 0.22 to 0.86), which remained largely unchanged after adjustment for risk factors.

Conclusions—

We observed substantial socioeconomic disparities in stroke at ages 65 to 74, whereas a crossover of the association occurred beyond age 75. Policies to improve social and economic resources at early old age, and interventions to improve diabetes management, depression, social networks and functioning in the disadvantaged elderly can contribute to reduce stroke disparities.
d
-Dimer as an Independent Predictor for Poor Outcome After Aneurysmal Subarachnoid Hemorrhage
Authors: Juvela Seppo , Siironen Jari
Published: May 2006

Background and Purpose—

After aneurysmal subarachnoid hemorrhage (SAH), elevated
d
-dimer levels have been associated with poor clinical condition and outcome. We tested prospectively whether
d
-dimer values affect outcome after SAH independently of severity of bleeding.

Methods—

Previous diseases, and clinical as well as radiological variables, were recorded for 136 patients with SAH admitted within 48 hours after bleeding. Plasma
d
-dimer was measured in the morning after aneurysm occlusion and at discharge 10 to 12 days after SAH. Factors predicting poor outcome according to the Glasgow Outcome Scale at 3 months after SAH and appearance of cerebral infarction were tested with multiple logistic regression.

Results—

Patients with poor outcome had higher
d
-dimer values than did those with favorable outcome: after surgery, a median 1250 (25th and 75th percentiles 675 and 2900) μg/L versus 720 (350 and 1119) μg/L (
P
=0.001); and at discharge, 1150 (624 and 2875) μg/L versus 360 (330 and 600) μg/L (
P
<0.001), respectively. In repeated-measures ANOVA,
d
-dimer decreased more rapidly (
P
=0.022) in those with favorable outcome. After simultaneous adjustment for several factors affecting outcome, plasma
d
-dimer after surgery remained a significant predictor for poor outcome (odds ratio, 1.63 per mg/L; 95% CI, 1.03 to 2.60;
P
=0.038) but neither for delayed ischemia nor, on follow-up computed tomography in survivors, for cerebral infarction.

Conclusions—

Elevated plasma
d
-dimer after admission independently predicts poor outcome, suggesting that prolonged excess thrombin generation may impair outcome. Repeated high plasma
d
-dimer values can be useful in discovering patients at increased risk for poor outcome.
Epidemiology of Aphasia Attributable to First Ischemic Stroke
Authors: Engelter Stefan T. , Gostynski Michal , Papa Susanna , Frei Maya , Born Claudia , Ajdacic-Gross Vladeta , Gutzwiller Felix , Lyrer Phillipe A.
Published: May 2006

Background and Purpose—

In a geographically defined population, we assessed incidence and determinants of aphasia attributable to first-ever ischemic stroke (FEIS).

MethodsA 1-year prospective, population-based study among the permanent residents of the canton Basle City, Switzerland, was performed using multiple overlapping sources of information.

Results—

Among 188 015 inhabitants, 269 patients had FEIS, of whom 80 (30%; 95% CI, 24 to 36) had aphasia. The overall incidence rate of aphasia attributable to FEIS amounted to 43 per 100 000 inhabitants (95% CI, 33 to 52). Aphasic stroke patients were older than nonaphasic patients. The risk of aphasia attributable to FEIS increased by 4% (95% CI, 1% to 7%), and after controlling for atrial fibrillation, by 3% (95% CI, 1% to 7%) with each year of patients’ age. Gender had no effect on incidence, severity, or fluency of aphasia. Cardioembolism was more frequent in aphasic stroke patients than in nonaphasic ones (odds ratio [OR], 1.85; 95% CI, 1.07 to 3.20). Aphasic patients sought medical help earlier than nonaphasic stroke patients. Still, after controlling for stroke onset–assessment interval, aphasic stroke patients were more likely to receive thrombolysis than nonaphasics (OR, 3.5; 95% CI, 1.12 to 10.96).

Conclusion—

Annually, 43 of 100 000 inhabitants had aphasia resulting from first ischemic stroke. Advancing age and cardioembolism were associated with an increased risk for aphasia. Severity and fluency of aphasia were not affected by demographic variables.
A Discriminative Prediction Model of Neurological Outcome for Patients Undergoing Surgery of Brain Arteriovenous Malformations
Authors: Spears Julian , TerBrugge Karel G. , Moosavian Mona , Montanera Walter , Willinsky Robert A. , Wallace M. Christopher , Tymianski Michael
Published: May 2006

Background and Purpose—

To develop and validate a discriminative model for predicting neurological morbidity after brain arteriovenous malformation (bAVM) surgery.

Methods—

Of 233 consecutive, prospectively enrolled patients undergoing bAVM surgery, the first 175 were used to derive, and the last 58 to validate, the prediction model. Demographic and angiographic factors were related to modified Rankin Scale scores assigned before, within 72 hours, at 7 days and at ≥1 year after surgery to seek predictors of postoperative neurological deficits (modified Rankin Scale score ≥3). These factors included nidus size, eloquence, venous drainage, diffuseness, white matter configuration, arterial perforator supply and associated aneurysms.

Results—

Brain eloquence, diffuse nidus and deep venous drainage were significant predictors of early disabling neurological deficits (odds ratios of 4.33, 3.49 and 2.38, respectively). The rounded odds ratios form a weighted 9-point prediction model (maximum scores for eloquence+diffuseness+deep drainage=4+3+2). The score discriminated the probability of experiencing both early (first week) and permanently (at ≥1 year) disabling neurological deficits as follows: 0 to 2: 1.8%, 3 to 5: 17.4%, 6 to 7: 31.6%, >7: 52.9% for early and 0 to 2: 1.8%, 3 to 5: 4.4%, 6 to 7: 18.4%, >7: 32.4% for permanently disabling outcomes. The discrimination of the model was 0.80 with 2.8% optimism. Validation in the second patient cohort revealed good performance at risk stratification.

Conclusions—

Relative weights assigned to brain eloquence, diffuse nidus morphology and deep venous drainage of a bAVM provide a simple and discriminative prediction model for neurological outcome after bAVM surgery.
An Experiment in the Internationalization of Planning Education
Authors: Goldstein Harvey A. , Bollens Scott , Feser Edward , Silver Christopher
Published: May 2006

This article describes a new multi-institutional program in international planning education and exchange—the Network for European-U.S. Regional and Urban Studies—within the broader context of the continuing internationalization of graduate-level professional planning curricula. Using student exit interviews and an institutional survey, the outcomes and impacts of this program on participating students, on the departments involved, and on the partner universities are assessed. Program experiences to date in terms of lessons for planning education in an increasingly integrated world economy are highlighted.
Beyond “Soccer Moms”
Authors: Markovich Julia , Hendler Sue
Published: May 2006

This article presents an analysis of the similarities and differences between feminist and new urbanist critical approaches to planning suburbs. Empirical results from a case study and survey of women residents of a Canadian new urbanist community are used to examine whether such communities can uphold feminist planning concerns and whether residents have views that are comparable to those presented in the two literatures. The results suggest that many of the assumptions in new urbanist literature are not being addressed in practice. Furthermore, and from a feminist planning perspective, the opportunities for new urbanist planning to uphold feminist planning principles may be limited.
What Can We Learn from Empirical Studies of Planning Theory? A Comparative Case Analysis of Extant Literature
Authors: Lauria Mickey , Wagner Jacob A.
Published: May 2006

In 1995, Judith Innes recognized the increasing influence of a new type of planning theorist. Adverse to “armchair theorizing,” these theorists have taken a fine-grained analysis of planning practice as the basis for reconstruction of planning theory. Despite the proliferation of this theoretical project, its impact on urban planning has yet to be analyzed in a comprehensive manner. The major impetus for the research is to assess the ways that empirical research in planning practice has informed or failed to inform planning theory. Have empirical studies of planning practice resolved existing theoretical contentions? Or have they generated only more conflicting opinions and a lack of resolution of the existing debates? This article presents a meta-analysis of empirical studies in planning theory.
Public Schools as Public Infrastructure
Authors: Vincent Jeffrey M.
Published: May 2006

Our nation’s public schools are important elements of public social and physical infrastructure. The quality of cities depends on the quality of schools. Likewise, the quality of schools depends on the quality of cities. This article is focused on looking at our public schools as public infrastructure, particularly in the context of inner cities and older suburbs. The article argues that there is a profound and detrimental “cities and schools disconnect,” and as a field, planning has virtually ignored our public schools. City planning scholars need to increase their engagement with public schools and school facilities and think more critically about how development and redevelopment decisions ultimately impact our public schools.
Damage Control Surgery—The Intensivist's Role
Authors: Sagraves Scott G. , Toschlog Eric A. , Rotondo Michael F.
Published: May 2006

“Damage control” surgery has evolved during the past 20 years from an accepted surgical technique in the traumatized, moribund patient to an expanded role in critically ill, nontraumatized patients. Physicians caring for these patients in extremis have begun to recognize a pattern of severe physiologic derangement that prompts an abbreviated laparotomy after hemorrhage and contamination control. Emphasis then shifts from the operating theater to the intensive care unit, where the patient's physiologic deficits are corrected. Once these derangements have been resolved, the patient is taken back to the operating room for definitive, reconstructive surgical care. The purpose of this article is to review the concept of “damage control” in reference to the patient whose pathophysiologic depletion prompts the need for it. Resuscitation in the intensive care unit will be summarized, pitfalls will be identified, and treatment plans will be delineated. Complications such as abdominal compartment syndrome and difficult abdominal wall closures will also be discussed.
Use of Recombinant Activated Factor VII (Novoseven) in Trauma and Surgery: Analysis of Outcomes Reported to an International Registry
Authors: Grounds R. Michael , Seebach Caroline , Knothe Christoph , Paluszkiewicz Piotr , Smith Terry S. , Kasal Eduard , Lecumberri Ramon , Urbanec Rene , Haas Thorsten , Wujtewicz Maria , Rehorkova Dagmar , Pelichovska Martina , Lange Martina , Uranga Maite , Bosman Roman , Rommes J. Hans , Koscielny Juergen
Published: May 2006

The objective was to evaluate the efficacy and safety of recombinant activated factor VII in patients with massive bleeding. Forty-five patients with severe massive hemorrhage requiring= 14 transfusion units of packed red blood cells received recombinant activated factor VII. Postdrug blood loss and transfusion requirements were assessed, and mortality was compared with predicted outcomes. Blood loss was markedly reduced in 40 of 43 (93.0%) patients, and transfusion requirements decreased after recombinant activated factor VII administration. Mortality rate in trauma patients who had massive hemorrhage was significantly reduced compared with predictions using scoring systems. This may be associated with the use of recombinant activated factor VII. This study failed to demonstrate an improvement in surgical patients. The absence of concurrent controls prevents definitive conclusions regarding actual safety or efficacy of recombinant activated factor VII.
Patterns of Cognitive Performance in Middle-Aged and Older Adults: A Cluster Analytic Examination
Authors: Gunstad John , Paul Robert H. , Brickman Adam M. , Cohen Ronald A. , Arns Martijn , Roe Donald , Lawrence Jeffery J. , Gordon Evian
Published: May 2006

Cognitive decline in speeded abilities, executive function, and memory is believed to typify normal aging. However, there is significant variability in cognitive function with advanced age and some reports of relatively intact cognitive function among a subset of older individuals. The present study consists of a cluster analysis to examine the patterns of cognitive function in middle-aged and older individuals. Analyses revealed 3 clusters of middle-aged adults, including an intact group, persons with poor motor speed, and a group with reduced executive function. Three clusters were also identified for older adults, including a group with poor executive function, persons with reduced speed performance (attention, executive function, motor), and a group with global cognitive decline. No evidence emerged for a cluster of older adults with intact performance in all domains or with isolated memory deficits. Findings generally support the frontal aging hypothesis and may provide important information about healthy cognitive aging.
Patterns of Initial Pharmacotherapy for Parkinson’s Disease in the United States
Authors: Huse Daniel M. , Castelli-Haley Jane , Orsini Lucinda S. , Lenhart Gregory , Abdalla Judith A.
Published: May 2006

Data from a mix of employer- and government-funded health plans were used to investigate actual treatment patterns for patients initiating pharmacotherapy for Parkinson’s disease in the United States. Treatment patterns evaluated included type of initial therapy and rates and types of adjunctive and substitute therapies. The study confirms that levodopa remains the most often prescribed initial treatment for Parkinson’s disease regardless of age or drug benefit coverage. The widespread use of levodopa in young Parkinson’s patients (<65 years) with private insurance may indicate that physicians are not overly concerned about or are not fully aware of the association of levodopa with long-term motor complications. It may also indicate that currently available alternatives to levodopa are not sufficiently effective or well tolerated.
Outward-oriented Policy Reforms and Industrialisation
Authors: Athukorala Prema-chandra
Published: May 2006

This article examines Sri Lanka's industrialisation experience following the policy reforms initiated in 1977, with a view to informing the contemporary debate on the role of outward-oriented trade and investment policy in industrialisation in developing countries. There is strong evidence that improved performance of domestic manufacturing through greater export orientation has brought about significant improvement in output and total factor productivity growth, employment generation and terms of trade gains. The Sri Lankan experience also highlights the complementary role of investment liberalisation for ex-ploiting the potential gains from trade liberalisation. The reform outcome is particularly impressive given that it occurred during a period of persistent civil strife and macro-economic instability. Thus, this article, makes a strong case for firm commitment to an export-led growth strategy as the main pillar of national development policy while guarding against possible policy back-sliding emanating from the new-found enthusiasm for state activism.
Rising Insurgency, Faltering Democratisation in Nepal
Authors: Taras Raymond C.
Published: May 2006

The objective is to chart Nepal's recent political history in order to explain how a seemingly anachronistic Maoist movement emerged to pose a threat—not just to Nepal but much of South Asia. The ineffectual political process that failed to resolve the country's most pressing problem—economic development—is examined. The infighting, support base, social grievances, ideology and strategy of the Maoist insurgency are described. The Maoists’ transnational network is identified, as is India's often ambiguous response to the move-ment. Special attention is given to the paradoxical dialectic linking the march of the Maoists with the manoeuvrings of Nepal's king. The conclusion drawn is that democratisation in Nepal has been undermined by an odd combination of Maoist insurgency, dysfunc-tional political parties, the monarchy's putschism, in addition to the widely-acknowledged failure of economic development. In an interdependent world, the result of one small state's descent into political instability—and the rise of insurgency in it—has direct conse-quences for other larger more stable countries.
NGOs, Politics and Grassroots Mobilisation
Authors: Devine Joseph
Published: May 2006

Since the early 1980s non-governmental organisations have become a major phenomenon in development, and a focus of attention for academics and practitioners alike. The study of NGOs tends to emphasise their role in the delivery of welfare services and pays less at-tention to their political significance. This despite numerous claims about the contribution of NGOs to civil society and democracy. The article draws on ethnographic research carried out in Bangladesh to explore in more detail the NGO–politics nexus. It demonstrates that there is a strong but complex link between NGOs and politics. On the one hand it confirms the political nature of NGO intervention and activity. On the other hand it highlights how the organisation of politics through NGOs reproduces clientelistic forms of action. This apparent paradox runs counter to most of the assumptions underpinning NGO research. The article closes by exploring this paradox and offering illustrations of how it may actually be an effective form of social action for the poor.
Thanatophobia and opiophobia of hospice nurses compared with that of other caregivers
Authors: Merrill Joseph M. , Dale Anne , Thornby Jack I.
Published: May 2006

In meeting national needs for our terminally ill, health care educators need to become more aware of their students’ aptitudes for hospice work. For these reasons we measured hospice nurses’ attitudes toward caring for the terminally ill and their views on using opioids, and compared them to those of other health care personnel and their students. Thirty-eight hospice nurses, 64 other nurses, 93 physicians, and 676 senior medical students participated in this study. Our primary measures were scales assessing thanatophobia and opiophobia and a battery of personal and professional role trait measures. Our results indicated that in providing end-of-life care, hospice nurses expressed less discomfort, helplessness, and frustration, and indicated less reluctance to use opioids than did any of the other groups surveyed. Overall, these hospice nurses had 35 percent lower opiophobia and 55 percent lower thanatophobia scores than the other health care professionals. Despite dealing with issues of death and dying on a daily basis, hospice nurses also scored lower on depressed mood. In caring for the terminally ill, hospice nurses’ other personal traits were also less maladaptive than those of the other health professionals. Psychiatrists exhibited the most opiophobia, not only scoring higher than physicians practicing oncology, but also higher than senior medical students. To assure cancer patients that they can expect to live their lives free of pain, medical educators can use these thanatophobia and opiophobia scales to develop better teaching, counseling, and monitoring strategies.
A pilot program to evaluate pain assessment skills of hospice nurses
Authors: Owens Michael R. , McConvey Gayle Gliva , Weeks Dorothy , Zeisberg Laura
Published: May 2006

A program was developed to evaluate pain assessment skills of hospice nurses in the home setting, utilizing standardized patients (SPs). Hospice nurses were sent on a routine visit to a “patient’s” home to evaluate someone dying of pancreatic cancer. They were not informed in advance that the “patient” was actually an SP, who had undergone intensive training from the staff to prepare him for his role. They performed their usual evaluation and then reported back to the referring physician by telephone. The referring physician, who used a written series of evaluation criteria, graded their assessments. The SP also evaluated the assessment skills of each nurse. After the exercise, the nurses were informed of the “patient’s” identity and were provided with the written critique prepared by the SP. A second part of the program included a written examination of their pain assessment and treatment skills, followed by a didactic presentation. This is the first report we know of that has utilized SPs in the home setting to evaluate pain assessment skills in a blind fashion. Our findings indicate that this can be an effective method for measuring pain assessment skills as well as a valuable teaching device.
The needs and supportive networks of the dying: An assessment instrument and mapping procedure for hospice patients
Authors: Early Barbara P. , Smith Elizabeth D. , Todd Linda , Beem Theresa
Published: May 2006

If institutional systems that provide end-of-life care are to survive the demands of managed care, they will need to tie together methods of assessing the needs of the dying, leading to a new understanding of the functioning of a patient’s existing helping networks. This paper presents the preliminary findings of a research project conducted at a Midwest hospice. The study utilized a cross sectional correlational survey of patients’ needs via the Early Risk and Resiliency Inventory (ERRI), while mapping their helping networks with a Circles of Care Ecomap. It addressed the question, “What is the relationship between the needs of the dying and the formal and informal support provided?” Study findings supported the contention that higher need patients utilized the more expensive institutional services rather than relying on available natural networks; and statistical analysis of the study instrument suggested the creation of a new conceptual domain of psychospiritual need.
Factors associated with length of stay in a mid-sized, urban hospice
Authors: Somova Marla J. , Somov Pavel G. , Lawrence Jenifer C. , Frantz Thomas T.
Published: May 2006

A recent study by Frantz et al. investigated the relationship between length of stay (LOS) and several factors in a small, rural hospice and found significant differences in LOS by primary physician specialty, referral source, and diagnosis (American Journal of Hospice & Palliative Care, March/April 1999). The purpose of the present study was to replicate and extend the Frantz et al. study in a mid-sized, urban hospice setting and to examine the relationship of LOS with additional variables, such as living status, discharge status, race, and religion. Significant differences in LOS by gender, diagnosis, physician specialty, referral source, type of insurance, living status, and discharge status were found. No significant differences in LOS were found by race, religion, and place of death. Results are interpreted in the light of previous research findings regarding LOS and in the context of the sample size. Strategies are suggested for increasing patients’ LOS.
The mouth and palliative care
Authors: Sweeney M. Petrina , Bagg Jeremy
Published: May 2006

Oral complications are common among patients with advanced cancer, though relatively little research has been undertaken in this field. This review article discusses the common problem of xerostomia among the terminally ill, together with an overview of oral candidosis, oral viral infections, chemotherapy- and radiotherapy-associated mucositis, and alterations in taste sensation among those with advanced cancer. Suggested management regimes, based on the limited clinical trial data available, are provided where appropriate.