bluuebunny/crossref_metadata_2025 huggingface dataset:
Training Teams for the Perioperative Environment: A Research Agenda
Authors: Entin Eileen B. , Lai Fuji , Barach Paul
Published: June 2007

A research agenda for investigating the impact of team-work training on patient safety in the perioperative environment is presented. The current status of teamwork training is reviewed briefly, and conclusions based on existing research are presented. We present a roadmap for future research on how teamwork training should be structured, delivered, and evaluated to optimize patient safety in the operating room. For teamwork skills to be assessed and have credibility, team performance measures must be grounded in team theory, account for individual and team-level performance, capture team process and outcomes, adhere to standards for reliability and validity, and address real or perceived barriers to measurement. The interdisciplinary nature of work in the perioperative environment and the necessity of cooperation among team members play an important role in enabling patient safety and avoiding errors. Teams make fewer mistakes than do individuals, especially when each team member knows his or her responsibilities, as well as those of other team members. However, simply installing a team structure without addressing the organizational context of care—the culture—does not automatically ensure it will operate effectively. Factors associated with the design of teamwork training, measures of training effectiveness, and the assessment process that should be explored in near-term work (1 to 2 years) are addressed. We also address the impact of the organizational environment, including the role of institutional support and culture, that need to be explored in longer term research (3 to 5 years).
Advanced Laparoscopic Surgery in a Free-Standing Ambulatory Setting
Authors: Gagné Jean-Pierre , Al-Obeed Omar , Tadros Shaheer , Moonje Vijay , Yelle Jean-Denis , Poulin Eric C.
Published: June 2007

To decrease the impact and cost of surgery, there is a trend toward developing treatment models for complex conditions on a fully outpatient basis. This is a retrospective study of the initial experience of advanced laparoscopic procedures performed on a same-day outpatient basis in the ambulatory campus of a university hospital. Over 3 years, 55 patients underwent 50 Nissen fundoplications and 5 adrenalectomies. There were 2 intraoperative complications, with no mortality and no conversion. The median postoperative stay was 4.5 hours. Readmission at 1 month was 11%. Data on the nursing postoperative telephone follow-up were available for 50 patients; 34 (62%) were successfully contacted.Twenty four (70%) had no complaint. Preliminary high-level cost data indicate a cost advantage. Advanced laparoscopic procedures can be done safely in a pure ambulatory setting; the current readmission rate can be reduced with improved pain management and better telephone follow-up strategies. Cost savings are likely.
Virtual Colonoscopy in Colorectal Cancer Screening
Authors: Torres Carlos , Szomstein Samuel , Wexner Steven D.
Published: June 2007

Colorectal cancer is the third most commonly diagnosed tumor in both males and females in the United States. Current modalities for colorectal cancer screening include fecal occult blood testing, flexible sigmoidoscopy, double-contrast barium enema, and colonoscopy. Virtual colonoscopy is a promising new method for assessing the entire colon. Vining and Gelfand first described this technique in 1994. Since then, virtual colonoscopy has been shown to be extremely safe and well tolerated by patients. Indications for virtual colonoscopy include screening for polyps, incomplete or failed colonoscopy, and preoperative assessment of the colon proximal to an occlusive cancer or even redundant fixed or stenotic colon that cannot be endoscopically traversed. Virtual colonoscopy may dramatically increase patient participation in screening programs, leading to early diagnosis of colorectal cancer. Although virtual colonoscopy seems a potentially attractive screening method for colorectal cancer, the cost-effectiveness of this method is yet to be determined.
Beliefs and Social Norms About Sildenafil Citrate (Viagra) Misuse and Perceived Consequences Among Houstonian Teenage Males
Authors: Peters Ronald J. , Johnson Regina J. , Kelder Steve , Meshack Angela F. , Jefferson Troy
Published: June 2007

In the current study, a qualitative approach was used to investigate relevant beliefs and norms associated with sildenafil citrate (Viagra) consumption, initiation, and perceived consequences. Focus groups were conducted with 43 young men aged 18 and 19 years who identified themselves as lifetime sildenafil citrate users. The majority of focus group participants believed that “curiosity” and “peer pressure” contributed to their initial use. Most revealed that they first heard about sildenafil citrate from television advertisements, family members, friends, or sporting events, and they were able to obtain the drug from their friends and family members or they stole it from their father or grandfather. These findings may highlight the relative importance of exposure to prescription drug messages among those to whom the message is not specifically targeted, that is, young men. It is possible that the sildenafil citrate television messages are recalled by not only older male audiences but also by teenagers and younger men, producing similar cognitive processing and curiosity in both age cohorts.
Exercise Prescriptions in the Pediatrician's Office: Feasibility or Folly?
Authors: Rowland Thomas , Carlin Stephanie , Nordstrom Leif
Published: June 2007

The recognition that adverse health outcomes are related to a sedentary lifestyle has created an opportunity for physicians to promote regular exercise in the office setting. The role of pediatricians in exercise guidance is indicated by the long-term salutary effects of exercise that begins in childhood and adolescence. However, a number of obstacles have prevented pediatricians from playing a role in delivering physical activity guidance for their young patients. These include the lack of an evidence-based means of creating an activity prescription, lack of expertise and time, and questions of reimbursement. This review addresses this issue, suggesting a number of alternative approaches for pediatricians in activity counseling. Whether these can be effectively delivered in the office setting, however, remains to be determined.
Exercise and Immune Function in Children
Authors: Timmons Brian W.
Published: June 2007

Exercise immunology is one of the fastest growing disciplines of the past 2 decades. Unfortunately, the number of investigations devoted to the pediatric population remains low, and our understanding of the interaction between acute and chronic exercise and the immune system in youth is relatively deficient. In general, healthy children experience smaller overall perturbations to the immune system in response to an acute bout of exercise as compared with adults, and they demonstrate a faster recovery of the immune system following exercise. There is only limited evidence to suggest that moderate to high levels of habitual physical activity are associated with a reduction in the incidence of infection and illness in youth. Special consideration should be made for the young athlete training and competing during an illness or infection. Some of the unique exercise responses of the immune system in children may have important clinical relevance, but much more work is required in this area.
Anglicans Gathering for God's Mission: A Missiological Ecclesiology for the Anglican Communion
Authors: Douglas Ian T.
Published: June 2007

These are difficult times for the Anglican Communion. The crisis in global Anglicanism is not so much over human sexuality but rather over questions of identity and authority. Some church leaders are advocating structural and canonical solutions to maintain the integrity of the Anglican Communion. A missiological perspective, however, sees communion as a gift from God fostered through relationships in mission across difference. The Decade of Evangelism and pan-Anglican efforts to address international debt and the HIV/AIDS pandemic are examples of communion in mission relationships. A missiological ecclesiology for the Anglican Communion will lift up, celebrate, and encourage more meaningful relationships in God's mission. The Anglican Congresses of 1908, 1954 and 1963 are expressions of such a missiological ecclesiology. The proposed 2008 Anglican Congress or Gathering will unite and foster a deeper sense of communion across Anglicanism through enlivened mission relationships.
An Unfortunate Lex Orandi? Some Comments on Episcopacy Envisioned in the 1979 ECUSA Ordinal
Authors: Spinks Bryan D.
Published: June 2007

Since the Anglican Church has neither a teaching Magisterium of the Roman model, nor a binding Confession of Faith as in some Lutheran and Reformed traditions, it has become commonplace to invoke the dictum Lex orandi, Lex credendi and claim that Anglican doctrine is enshrined in its liturgy. This of course may have made some sense when all Anglican Prayer Books had not wandered far from the 1662, or even 1637/1764 texts, but it becomes much more problematic today, when, even with ‘guidelines’ issued by the International Anglican Liturgical Consultation (which have only the authority a Province wishes to give them), Provincial liturgies grow further and further away from any common prayer texts. This is particularly pertinent in an ecumenical context with regard to the Anglican understanding of its threefold ministry. The Preface to the Ordinal (1550, 1552 and 1662) stated: ‘It is evident unto all men diligently reading the Holy Scriptures and ancient authors that from the Apostles' time there have been these orders of Ministers in Christ's Church, Bishops, Priests and Deacons’.
Essentialism and Anti-Essentialism in Feminist Philosophy
Authors: Stone Alison
Published: June 2007

This article revisits the ethical and political questions raised by feminist debates over essentialism, the belief that there are properties essential to women and which all women share. Feminists’ widespread rejection of essentialism has threatened to undermine feminist politics. Re-evaluating two responses to this problem—‘strategic’ essentialism and Iris Marion Young’s idea that women are an internally diverse ‘series’—I argue that both unsatisfactorily retain essentialism as a descriptive claim about the social reality of women’s lives. I argue instead that women have a ‘ genealogy’: women always acquire femininity by appropriating and reworking existing cultural interpretations of femininity, so that all women become situated within a history of overlapping chains of interpretation. Because all women are located within this complex history, they are identifiable as belonging to a determinate social group, despite sharing no common understanding or experience of femininity. The idea that women have a genealogy thus reconciles anti-essentialism with feminist politics.
Politics and the Economist-King: Is Rational Choice Theory the Science of Choice?
Authors: Landemore HÉlÈne
Published: June 2007

This article is another unapologetic contribution to ‘the gentle art of rational choice bashing’. The debate over rational choice theory (RCT) may appear to have tired out; yet RCT is as dominant in political sciences as ever. The reason is that critics typically take aim at the symptoms of RCT’s failings, rather than their root cause: RCT’s very ambition of being the ‘science of choice’. In this article I argue that RCT fails twice, first as a science ofchoiceand then as ascienceof choice. Both failures suggest that political sciences need an epistemologic (re)conversion away from the Platonic ideal of a deductive and universal science of choice toward a more inductive and pluralist paradigm. While advocates of RCT rightly insist that ‘you can’t beat something with nothing’, I take their advice, with a grain of salt: in order for alternatives to appear, the frame of references needs to be modified. I draw a few perspectives for the political sciences.
The Integration of Immigrants
Authors: Carens Joseph
Published: June 2007

This paper considers normative questions about the integration of legally resident immigrants into contemporary liberal democratic states. First, I ask to what extent immigrants should enjoy the same rights as citizens and on what terms they should have access to citizenship itself. I defend two general principles: (1) differential treatment requires justi.cation; (2) the longer immigrants have lived in the receiving society, the stronger their claim to equal rights and eventually to full citizenship. Second, I explore additional forms of economic, cultural, social, and political integration. I argue that the integration of immigrants depends upon a process of mutual, but asymmetrical adaptation and that it is precisely because the immigrants have to adapt more that the receiving society bears a greater responsibility to take steps to promote equality between the immigrants and the existing population.
Evidence of cultural hybridity in responses to epilepsy among Pakistani Muslims living in the UK
Authors: Small Neil , Ismail Hanif , Rhodes Penny , Wright John
Published: June 2007

Objectives: To examine how people from Bradford's Pakistani Muslim community experience living with epilepsy. Specifically, the paper addresses social interactions and negotiations with care providers and considers how different understandings of epilepsy are integrated.

Methods: Interviews were conducted with a sample of Bradford's Pakistani Muslim community ( n=20). Interviews were analysed to identify themes and significant areas of shared concern.

Results: This paper identifies popular, professional and folk sectors contributing to an individual's `health system'. Where sectors overlap, zones of hybridity are created: that is, a person might simultaneously seek help from a doctor and from a religious healer, or might offer explanations for seizures that include neurological and spiritual components.

Discussion: While there are many similarities between the experiences of these minority ethnic community members and published work on the lived experience of epilepsy in other communities, there are also important differences that service providers need to recognize and respond to. Differences include forms of cultural expression and specific language needs. Improving communication between professionals and persons with epilepsy needs to be prioritized.
Review Paper: Measuring outcomes for neurological disorders: a review of disease-specific health status instruments for three degenerative neurological conditions
Authors: Heffernan Catherine , Jenkinson Crispin
Published: June 2007

Health-related quality-of-life measures have been increasingly used in research into neurological disorders in recent years. The aim of this paper is to provide an objective appraisal of the evidence in regard to disease-specific quality-of-life measures used in research on health interventions for three degenerative neurological disorders: multiple sclerosis, motor neurone disease/amyotrophic lateral sclerosis and Parkinson's disease. A comprehensive search strategy was developed to include nine relevant electronic databases. Only studies pertaining to patient-based outcome measurements in multiple sclerosis, motor neurone disease and Parkinson's disease were included. We identified 76 eligible studies. As studies consisted of descriptive and cross-sectional survey study designs, results were reported qualitatively rather than in the form of a meta-analysis. Four disease-specific measures were found for Parkinson's disease, 11 for multiple sclerosis and one for motor neurone disease. We conclude that health-related quality-of-life measures are useful in assessing the impact of treatments and interventions for neurological disorders. However, further research is needed on the development of instruments using psychometric methods and on the validation, utilization and responsiveness of instruments to change.
Cognitive—behavioural stress management with HIV-positive homosexual men: mechanisms of sustained reductions in depressive symptoms
Authors: Carrico Adam W. , Antoni Michael H. , Weaver Kathryn E. , Lechner Suzanne C. , Schneiderman Neil
Published: June 2007

Background: We examined the sustained efficacy of a group-based cognitive—behavioural stress management (CBSM) intervention in comparison to a modified wait-list control condition on measures of mood, coping and social support in mildly symptomatic HIV-positive homosexual and bisexual men. Participants were recruited largely during the era prior to highly active antiretroviral therapy (HAART; 1992—1997).

Methods: Men were randomized to either a 10-week, group-based CBSM intervention ( n=83) or a psycho-educational seminar group ( n=46). All participants completed a battery of psychosocial questionnaires administered by a research assistant at baseline, immediately following the 10-week CBSM intervention period, and at a 6-month follow-up.

Results: Men in the CBSM group maintained previously observed effects on depressive symptoms and perceived social support. These sustained effects of CBSM on depressive symptoms were mediated by 10-week increases in cognitive coping (i.e. positive reframing).

Discussion: CBSM appears to be a potentially efficacious treatment that reduces and maintains lower levels of depressive symptoms and enhances social support in HIV-positive homosexual and bisexual men. In particular, changes in positive reframing during the 10-week intervention period remain a crucial factor contributing to sustained reductions in depressive symptoms.
Service providers' reflections on the affective domain and its influence on decision-making about treatments for chronic pain
Authors: Brown Cary A.
Published: June 2007

Objectives: This study sought to explore why service providers, working within the complex area of chronic pain, do not believe that the affective domain influences their decision-making about treatments.

Methods: These results were extrapolated from a larger multistage study based on a series of iterative postal questionnaires. Stage 1 of the large study identified, via postal survey, what treatment components service providers identified as `important'. In stage 2, a constructivist framework was used to develop an iterative Delphi questionnaire to explore service providers' rationale for these choices. Stage 3 also employed a Delphi process and asked participants to reflect on their previous comments. Stages 2 and 3 used postal questionnaires and summary reports from preceding rounds for background information.

Results: Most service providers clearly felt that `affect' and `self-image' had little influence on their decision-making compared to `coherence' and `purposiveness'. This report presents the findings of the Stage 3 questionnaire, in which participants were asked to reflect and comment on this low level of endorsement for the influence of affect and self-image. Seven themes emerged from the coded data: professionalism, self-protection, affect and experience, lack of reflective skills, ethos of altruism, lack of understanding, and model of practice. Analysis of these themes indicates a tension between what service providers feel they should do and what they actually do.

Discussion: Service providers felt that affect and self-image had little influence on their decision-making. However, there is growing evidence in the literature to suggest that it is not possible, or preferable, to divorce emotion from the clinical encounter. Chronic illnesses are complex systems that do not respond optimally to linear problem-solving. Access to a wide range of information, including the affective domain, is important for effective decision-making.
Depressive symptoms, intrusive thoughts, sleep quality and sexual quality of life in women co-infected with human immunodeficiency virus and human papillomavirus
Authors: Rose Rachel C. , Peake Michele R. , Ennis Nicole , Pereira Deidre B. , Antoni Michael H.
Published: June 2007

Background: Women infected with human immunodeficiency virus (HIV) experience major challenges and often report marked decreases in sexual functioning and quality of life (QOL). HIV-infected women also face challenges concerned with other commonly observed concomitant sexually transmitted organisms, such as human papillomavirus (HPV), which may further affect sexual QOL. Despite advances made in understanding factors that predict sexual functioning and QOL in men with HIV, relatively little is understood about the role of behavioural and emotional factors in women.

Methods: As a preliminary inquiry into this question, this study related depressive symptoms, AIDS-related intrusive thoughts and sleep quality with sexual QOL reports in 21 HIV+HPV+women.

Results: We found that depressive symptoms, intrusive thoughts and sleep quality individually predicted poorer sexual QOL. Further analyses suggested that depression mediated the relationship between intrusive thoughts and sexual QOL.

Discussion: Implications for further work and clinical interventions to address depressive symptoms in this population are discussed.
Pain management in sickle cell disease
Authors: Booker Matthew J. , Blethyn Kate L. , Wright Christine J. , Greenfield Sheila M.
Published: June 2007

Objectives: Sickle cell disease (SCD) is an inherited blood disorder characterized by recurrent `crisis' pain, which is the most common reason for repeated hospital admission. The nature of this pain, however, is poorly understood, and the pain is often sub-optimally managed.

Methods: A focus group format, interpreted using thematic analysis, was used to gain a greater understanding of the barriers that SCD patients face in managing their pain and their perceptions of the treatment that they receive from healthcare professionals.

Results: Key issues emerging from the focus groups that adversely affected participants' pain management included: feeling isolated by their experience of `crisis' pain, not being listened to, and limitations to social support networks. Specific issues relating to seeking medical care included lack of understanding about SCD by non-specialist clinicians, feelings of being low priority due to the `invisible' nature of their pain, and feeling mistrusted by medical staff when seeking analgesia.

Discussion: Feelings of isolation may drive maladaptive coping strategies and manifest in anger, aggression and active avoidance of service use. Suggested service improvements include the active targeting of isolated individuals in the form of pain discussion groups or self-help groups, and greater provision of specialised services.
Researching chronic childhood illness: the example of childhood cancer
Authors: Dixon-Woods Mary , Young Bridget , Ross Emma
Published: June 2007

Objectives: To provide an overview of issues raised by conducting research in the area of chronic childhood illness, using the example of childhood cancer.

Methods: This literature review used informal methods.

Results: Children with cancer and their families may participate in a wide variety of studies in different research traditions, including social science studies, epidemiological, biological and genetic research, and clinical trials. Different concerns about research participation have been raised in these different contexts. Sociological debate has tended to characterize exclusion from research as a manifestation of assumptions of poor competence on the part of children, and to see inclusion in research as a means of restoring proper balance in power relations and giving children a voice. The ethical imperative within clinical research, on the other hand, has been in favour of protection of individuals from risk or direct harm. Lack of consensus on issues such as the status of children's consent for research participation persists, in part because debates have taken place within rather than across disciplinary boundaries, and in part because of a tendency to debate issues as ethical principles in an empirical vacuum. The lack of research on the experiences and views of those asked to take part in childhood cancer research is striking.

Discussion: It is important that debates about the involvement of children in research are informed by high-quality social science research and by interdisciplinary dialogue.
Self-managing and managing self: practical and moral dilemmas in accounts of living with chronic illness
Authors: Townsend Anne , Wyke Sally , Hunt Kate
Published: June 2007

Background: Patient education self-management programmes draw on sociological understanding of experiencing single chronic illnesses, but health practitioners do not always recognize the tensions and ambiguities permeating individuals' management experiences, particularly for those with multiple morbidity. The aim of this study was to illuminate how people negotiate multiple chronic illness, and everyday life.

Methods: A sample of 23 people in their early 50s was recruited from a community health survey in Scotland. The participants had four or more chronic illnesses and were interviewed twice. The qualitative data that were generated highlighted the impact of illness and associated management strategies, as people attempted to continue familiar lives. Analysis was based on constant comparison and informed by a narrative approach.

Results: People used multiple techniques to manage symptoms and conveyed a moral obligation to manage `well'. However, maintaining valued social roles, coherent identities and a `normal life' were prioritized, sometimes over symptom containment. This led to tensions, and participants faced moral dilemmas as they self-managed.

Discussion: Self-management policies, programmes and healthcare practitioners need to recognize the tensions that people experience as they negotiate symptoms, valued social roles, positive identities, and daily life. Addressing these issues may improve opportunities to support patients in particular contexts, and enhance self-management.
Lay-led self-management in chronic illness: a review of the evidence
Authors: Newbould Jennifer , Taylor David , Bury Michael
Published: June 2007

Objectives: In this paper, we seek to clarify what is known about self-care in chronic illness and the impact of lay-led self-management programmes. The main focus of the paper is the specific `lay-led' interventions developed by Kate Lorig and her collaborators in the USA, and in the context of the English Expert Patients Programme (EPP).

Methods: A systematic search of relevant databases was undertaken.

Results: Seventeen articles and two conference papers met the criteria set. These papers documented the use of condition-specific lay-led self-management programmes and generic lay-led self-management programmes.

Discussion: Despite the potential benefits of enhanced self-management, the review of the literature presented here suggests several possible problems associated with the presentation and implementation of initiatives such as the EPP programme. These include the possibility that advocates of public service improvements have on occasion been tempted to overstate the evidence for the relative and absolute effectiveness of lay-led self-management programmes. In addition, the varied experiences of those living with a chronic illness warn against promulgating rigid prescriptions about what patients — should think and do. The evidence to date is indicative of short-term benefits being derived from the provision of lay-led self-management programmes.
The rural context and women's self-management of chronic health conditions
Authors: Winters Charlene A. , Cudney Shirley A. , Sullivan Therese , Thuesen Alta
Published: June 2007

Objective: To examine the rural context and describe its influence on the self-management of chronic illness by women living in a rural setting.

Methods: The Women to Women (WTW) project is a research-based computer intervention that provides health education and peer support to rural women with chronic health conditions. Messages posted to the online support and health education chat rooms were examined to determine the characteristics of the rural context in relation to the women's illness self-management.

Results: `Distance' was the overarching characteristic of the rural context that influenced the women's ability to self-manage their chronic health problems. The effect of distance was woven throughout each of the four predominant themes that emerged from the data as having influence — physical setting, social/cultural/economic environment, nature of women's work, and accessibility/quality of healthcare. These influences affected the women's self-management abilities both negatively and positively.

Discussion: The rural context profoundly influenced the ability of rural women to self-manage their chronic conditions. From the data, health professionals and policy-makers can glean information about the barriers to healthcare faced by rural women who are trying to manage their chronic health problems in comparative isolation.
Social Influences on Fertility
Authors: Bernardi Laura , Keim Sylvia , von der Lippe Holger
Published: June 2007

This article uses a mixed methods design to investigate the effects of social influence on family formation in a sample of eastern and western German young adults at an early stage of their family formation. Theoretical propositions on the importance of informal interaction for fertility and family behavior are still rarely supported by systematic empirical evidence. Major problems are the correct identification of salient relationships and the comparability of social networks across population subgroups. This article addresses the two issues through a combination of qualitative and quantitative data collection and analysis. In-depth interviewing, network charts, and network grids are used to map individual personal relationships and their influence on family formation decisions. In addition, an analysis of friendship dyads is provided.
Basic Abdominal Sonography
Authors: Fatchett John
Published: June 2007

In this article, a procedural overview of basic abdominal sonography in the average patient is provided. Patient preparation (i.e., fasting) for specific examinations is discussed. Transducer selection on the basis of the body habitus of the patient, as well as the examination to be performed, is reviewed. Use of patient history and communication in decisions regarding the anatomy to be evaluated is discussed. A detailed technical review of scanning techniques to image the liver, gallbladder, pancreas, spleen, and kidneys is also provided.
The efficacy of indapamid in different cardiovascular outcome – Meta-analysis
Authors: Brodszky Valentin , Nagy Viktor , Farsang Csaba , Kárpáti Krisztián , Gulácsi László
Published: June 2007

Bevezetés:
Az első vonalba tartozó vérnyomáscsökkentőktől elvárható, hogy csökkentsék a cardiovascularis morbiditást és mortalitást. A thiazid vízhajtók ez irányú hatékonyságát több metaanalízisben leírták. Az indapamid hatásosságát bár számos tanulmány vizsgálja, eddig nem készült az összes adatot összefoglaló elemzés.
Célkitűzés:
az indapamid hatásosságát vizsgáló összes randomizált kontrollált vizsgálat adatainak szintézise. A tanulmányok eredményeit a különböző cardiovascularis és biztonsági végpontok szerint elemezzük.
Módszer:
A MEDLINE adatbázisban megkerestük az összes randomizált kontrollált indapamidvizsgálatot 1995 és 2005 között. Csak a kettős vak-, párhuzamos lebonyolítású vizsgálatokat vontuk be. Az adatok metaanalízisét állandó és véletlen hatású modellekben is elvégeztük, az eredményeket Mantel–Haenzel-próbával, inverz varianciapróbával teszteltük.
Eredmények:
9 vizsgálat és 10 108 beteg adatait elemeztük. 48, stroke-on átesett beteg indapamidkezelésével megelőzhető egy újabb stroke-esemény (NNT = 47,8; 95%; KI: 29,6–126,6). 5 vizsgálatban 7085 beteg adatai alapján az indapamid a szisztolés vérnyomást 7,28 (95%; KI: 6,37–8,19), a diasztolés vérnyomást 3,50 Hgmm-rel (95%; KI 2,99–4,01) nagyobb mértékben csökkentette, mint a placebo. 5 vizsgálatban 2856 beteg szisztolés vérnyomását az indapamid 1,30 Hgmm-rel (95%; KI: 0,28–2,31) nagyobb mértékben csökkentette, mint az aktív kontroll, a diasztolés vérnyomáscsökkentés esetében nem volt szignifikáns különbség. 505 beteg adatai alapján az indapamid 6,50 g/m
2
-rel (95%; KI: 0,81–12,9) nagyobb mértékben csökkenti a bal kamrai izomtömegindexet, mint az enalapril. 6206 beteg követése során a gyógyszerhez köthető mellékhatások előfordulásának gyakorisága hasonló a placebóéhoz (rr = 0,97; 95%; KI: 0,76–1,22).
Következtetések:
Az indapamid hatásos az újabb stroke megelőzésében, hatékonyan csökkenti a vérnyomást és a bal kamrai izomtömegindexet. A kezelés biztonságosan alkalmazható.
Clinical-Scale Expansion of a Mixed Population of Bone Marrow-Derived Stem and Progenitor Cells for Potential Use in Bone Tissue Regeneration
Authors: Dennis James E. , Esterly Kelly , Awadallah Amad , Parrish Christopher R. , Poynter Gregory M. , Goltry Kristin L.
Published: June 2007

Preclinical and clinical studies have demonstrated the ability of bone marrow derived stem and progenitor cells to regenerate many tissues, including bone. Methods to expand or enrich progenitors from bone marrow are common; however, these methods include many steps not amenable to clinical use. A closed automated cell production culture system was developed for clinical-scale ex vivo production of bone marrow-derived stem and progenitor cells for hematopoietic reconstitution. The current study tested the ability of this bioreactor system to produce progenitor cells, termed tissue repair cells (TRC), possessing osteogenic potential. Three TRC formulations were evaluated: (a) cells cultured without exogenous cytokines (TRC); (b) cells cultured with exogenous cytokines (TRC-C); and (c) an adherent subset of TRC-C (TRC-CAd). Starting human bone marrow mononuclear cells (BM MNC) and TRC products were characterized for the expression of cell surface markers, in vitro colony forming ability, and in vivo osteogenic potential. Results showed significant expansion of mesenchymal progenitors (CD90+, CD105+, and CD166+) in each TRC formulation. In vivo bone formation, measured by histology, was highest in the TRC group, followed by TRC-CAd and TRC-C. The TRC product outperformed starting BM MNC and had equivalent bone forming potential to purified MSCs at the same cell dose. Post hoc analysis revealed that the presence of CD90+, CD105+, and CD166+ correlated strongly with in vivo bone formation scores (r2 > .95). These results demonstrate that this bioreactor system can be used to generate, in a single step, a population of progenitor cells with potent osteogenic potential.

Disclosure of potential conflicts of interest is found at the end of this article.
Acute Adverse Effects of the Indenopyridine CDB‐4022 on the Ultrastructure of Sertoli Cells, Spermatocytes, and Spermatids in Rat Testes: Comparison to the Known Sertoli Cell Toxicant Di‐n‐pentylphthalate (DPP)
Authors: Hild Sheri Ann , Reel Jerry R. , Dykstra Michael J. , Mann Peter C. , Marshall Gary R.
Published: June 2007

ABSTRACT: Acute effects of CDB‐4022 on testicular ultrastructure were determined. Rats were treated orally with vehicle or a maximally effective single dose of CDB‐4022 or Di‐n‐pentylphthalate (DPP). Preserved testes were processed for transmission electron microscopy. Sertoli and germ cells of vehicle‐treated rats demonstrated normal morphological characteristics. Disruption of Sertoli cell ultrastructure was apparent in CDB‐4022‐treated rats by 3 hours. A decrease in the presence of nucleoli, an increase in the amount and diameter of swollen smooth endoplasmic reticulum, and decreases in cytoplasmic ground substance were observed. The severity of these degenerative effects increased at 6 and 12 hours: Vacuoles were apparent; increased cellular debris, swollen mitochondria, and phagocytic structures were observed; and membranes became more disorganized. Similar ultrastructural changes were observed in the Sertoli cells of DPP‐treated rats. By 3 hours, spermatocytes and spermatids were adversely affected by CDB‐4022 treatment with swelling of the nuclear envelope. The Step 8 spermatids were especially noteworthy; chromatin was more diffuse and rarefied, the nuclear envelopes were incomplete or broken, and the position of the spermatid nucleus within the cell and relative to Sertoli cell cytoplasm was unusual. Fusion of spermatids to form giant cells was observed by 12 hours. CDB‐4022 acts acutely on Sertoli cells to induce marked cellular rarefaction and degeneration, but not necrosis. A rapid and direct effect of CDB‐4022 on spermatocytes and spermatids was observed. The antispermatogenic activity of CDB‐4022 appears to be a consequence of direct effects on Sertoli and germ cells.
Effects of the Chemotherapeutic Agents for Non‐Hodgkin Lymphoma, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone (CHOP), on the Male Rat Reproductive System and Progeny Outcome
Authors: Vaisheva Farida , Delbes Geraldine , Hales Barbara F. , Robaire Bernard
Published: June 2007

ABSTRACT: Chemotherapy of non‐Hodgkin lymphoma (NHL) with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) is associated with significant gonadal damage. Our goal was to determine the impact of CHOP chemotherapy on the male reproductive system, fertility, and progeny outcome in the rat model. Adult male Sprague‐Dawley rats received saline or CHOP, 4 cycles of 3 weeks each, at doses analogous to 1/3×, 2/3×, or 1× the human dose; males were mated to evaluate effects on progeny outcome. Reproductive organ weights were significantly decreased in the 1× CHOP—exposed group. The spermatozoal contents of the testes and epididymides were decreased in 1× CHOP—treated males; the 1/3× and 2/3× doses also affected testicular sperm contents. Seminiferous tubule diameters were decreased by 20% in 1× CHOP—treated males. Damage ranged from the presence of small vacuoles in the epithelium to tubules deprived of spermatocytes and spermatids and was accompanied by an increased incidence of germ cell apoptosis. The acridine orange assay revealed a significant increase in sperm with abnormal DNA integrity profiles in the 1× CHOP group. Despite effects on germ cell number and quality, CHOP‐exposed rats remained fertile. However, a 50% decrease in live fetuses was observed in litters sired by 1× CHOP—treated males due to a significant increase in both pre‐implantation and postimplantation losses; postimplantation loss was also elevated among litters sired by 2/3× CHOP—treated males. Thus, CHOP treatment affected both the quantity and quality of male germ cells; conceptal loss is a sensitive measure of the integrity of the male genome.
Chronic Exposure to Low Levels of Dibromoacetic Acid, a Water Disinfection By‐product, Adversely Affects Reproductive Function in Male Rabbits
Authors: Veeramachaneni D. N. R. , Palmer J. S. , Klinefelter G. R.
Published: June 2007

ABSTRACT: Four groups (minimum of 10/dose group) of male Dutch‐belted rabbits were treated daily with dibromoacetic acid (DBA) via drinking water beginning in utero from gestation day 15 to adulthood; target dosages were 1, 5, and 50 mg DBA/kg body weight. Developmental, prepubertal as well as postpubertal reproductive sequelae were evaluated. One (out of 22), 2 (out of 32), and 1 (out of 21) male offspring in the 1, 5, and 50 mg DBA/kg groups were unilaterally cryptorchid. There were no significant differences in serum follicle‐stimulating hormone, luteinizing hormone, and testosterone (basal concentrations or in response to exogenous gonadotropin‐releasing hormone) in both prepubertal and adult rabbits. Chronic exposure to DBA adversely affected the mating abilities of some rabbits. The number of sperm produced was not affected, but spermiogenesis was disrupted, resulting in unique sperm acrosomal‐nuclear malformations even at the 1‐mg dose level. Concentrations of SP22, a specific sperm membrane fertility protein, in detergent extracts of ejaculated sperm were significantly lower (P < .05) in all DBA‐treated groups compared with controls. The conception rates following artificial insemination of a constant number of sperm for 1, 5, and 50 mg DBA/kg groups were 55% (10/18), 65% (13/20), and 55% (9/16), respectively, vs 85% (17/20) for control group. Histologic lesions in testes characterized by spermatogenic arrest predominantly at the round spermatid stage, pyknosis of differentiating germ cells, and ultimate degeneration and desquamation leaving focal vacuolation in seminiferous epithelium were evident in DBA‐treated groups. Thus, male rabbits exhibit reproductive toxicity with exposure to DBA during reproductive development at dosages as low as 1 mg/kg body weight.
Adolescents' Perceptions and Negotiations of Literacy Practices in After-School Read and Talk Clubs
Authors: Alvermann Donna E. , Young Josephine P. , Green Colin , Wisenbaker Joseph M.
Published: June 2007

This study reports how adolescents' perceptions and negotiations of after-school talk about a variety of texts in a public library setting were shaped by (and helped to shape) the larger institutional and societal contexts that regularly influence young people's actions and interactions with peers and adults. The study's theoretical framework conceives of literacy and discourse as critical social practices and locates such practices in the interplay within and across three contexts. Twenty adolescents and two adults met for 15 weeks as members of four after-school Read & Talk (R & T) Clubs. Analyses of the field notes, club discussions, and interviews with participants and their parents indicated the adolescents viewed the R & T Clubs as social outlets and stages on which to try out new subject positions within sanctioned literacy events involving a community of their peers.
Lessons and Dilemmas Derived From the Literacy Instruction of Two Latina/o Teachers
Authors: Jiménez Robert T. , Gersten Russell
Published: June 2007

We examine the practice of two Latina/o teachers and then develop three issues with potential for improving the literacy instruction of Latina/o students. First, we contrast the approaches of infusion and reform. The concept of infusion was used to describe one of the teachers who integrated newer conceptualizations of literacy instruction into her repertoire of teaching methods, whereas the second teacher's instructional approach was more aligned with reform efforts, most notably the adoption of cognitively oriented methods. We also examine Latina/o cultural influences on these teachers' instruction. We used the qualitative methods of observation, interviews, and document analysis, We concluded that infusion resulted in a balanced approach to literacy learning, that more extensive reform efforts allowed for strong rapport with students and served as the basis for engaging in culturally relevant activities, and that the teachers' Latina/o identity influenced their instructional approaches in multiple ways that have ramifications for European-American teachers of Latina/o students.
Anti-Immigrant Legislation, Social Justice, and the Right to Equal Educational Opportunity
Authors: Petronicolos Loucas , New William S.
Published: June 2007

In the debates over policies seeking to exclude illegal immigrant youth from public education, complex issues related to the human and legal rights of this group have often been reduced to cost-benefit analyses, to partisan polemics about multiculturalism and national identity, and to campaign posturing about tax burdens and crime. This article presents a contextual analysis of such policies and the related legal standards, with a focus on social justice and equality issues that are raised by the exclusion of any distinct group of children from educational opportunity. Our main thesis is that every individual's interest in meaningful public education is fundamental, in a constitutional sense, and that this interest does not depend on citizenship or economic status. We begin with an analysis of California's Proposition 187 and related Supreme Court decisions, most notably Plyler v. Doe (1982) and San Antonio v. Rodriguez (1973), and move to connections with school finance litigation. We continue with an appraisal of the potential of current federal and state case law to address issues of justice that legislation such as Proposition 187 might raise in the future. Finally, we present an argument for the strengthening of Fourteenth Amendment protections in the domain of education and give special attention to the formulations o f Justice Thurgood Marshall in several pertinent cases.
Comer's School Development Program in Prince George's County, Maryland: A Theory-Based Evaluation
Authors: Cook Thomas D. , Habib Farah-Naaz , Phillips Meredith , Settersten Richard A. , Shagle Shobha C. , Degirmencioglu Serdar M.
Published: June 2007

A randomized experiment of Comer's School Development Program was conducted in 23 middle schools in Prince George's County, Maryland. The school population is predominantly African American, with considerable internal variation in household socioeconomic standing. This study involved repeated measurement with more than 12,000 students and 2,000 staff a survey of more than 1,000 parents, and extensive access to student records. It showed that Comer schools implemented some of the program's central elements better than control schools, but not all or even most of them. This shortfall in program implementation may have been responsible for students in the experimental schools not changing any more than controls. Quasi-experimental analyses showed that the program theory may be correct in many of its predictions about student changes in psychological and social outcomes, but not achievement. However, achievement gains were found in schools with a more explicit academic focus, suggesting that improving this focus should be as central to Comer's program theory as improving a school's social climate. Even more needed, though, are ways to improve program implementability, the sine qua non for student change.
Mathematics Performance Assessment in the Classroom: Effects on Teacher Planning and Student Problem Solving
Authors: Fuchs Lynn S. , Fuchs Douglas , Karns Kathy , Hamlett Carol L. , Katzaroff Michelle
Published: June 2007

The purpose of this study was to examine effects of classroom-based performance-assessment (PA)-driven instruction. Sixteen teachers were randomly assigned to PA and no-PA conditions. PA teachers attended a workshop, administered 3 PAs over several months, and met with colleagues to score PAs and share ideas for providing student feedback and instruction. PA teachers' knowledge about PA increased; their curriculum shifted toward problem solving; and they reported relying on varied strategies to promote problem solving. Compared to no-PA students, above-grade PA students sh'owed stronger problem solving on all measures,, at-grade PA students, on 2 of 3 measures; below-grade students, on only 1 dimension of 1 measure. Professional development needs to promote mathematical problem solving among all students are discussed.
The Relational Zone: The Role of Caring Relationships in the Co-Construction of Mind
Authors: Goldstein Lisa S.
Published: June 2007

The literature rooted in Vygotsky's theories has focused on the more strictly cognitive aspects of the process of the co-construction of mind, leaving the affective nature of these interactions unexplored. The purpose of this article is to describe the affective, volitional face of the zone of proximal development. By drawing on Nel Noddings's work on the ethic of care, I argue that the interpersonal character of the zone of proximal development closely resembles a caring encounter. In merging caring and the notion of the co-construction of knowledge, I intend to broaden our conception of the teaching-learning process and to enhance our understanding of the roles played by affect, volition, and relationship in cognitive development.