bluuebunny/crossref_metadata_2025 huggingface dataset:
Lack of flow mediated dilation and enhanced angiotensin II-induced constriction in skeletal muscle arterioles of lupus-prone autoimmune mice
Authors: Bagi Z , Hamar P , Kardos M , Koller A
Published: June 2006

Systemic lupus erythematosus (SLE) is associated with disturbances in the microcirculation of various tissues, yet the nature of arteriolar dysfunction has not been characterized. Thus, changes in diameter of isolated, pressurized skeletal muscle arterioles of mice with systemic autoimmune disease (lupus prone, MRL/lpr four-month old female) and control (MRL) mice were investigated by video-microscopy. Arteriolar responses to changes in intraluminal pressure, flow, and to vasoactive agents with known mechanisms of action were compared. The active and passive (in Ca2+ free solution) diameter of MRL/lpr arterioles were not significantly different compared to MRL and morphometric changes were not apparent. Compared to MRL mice the endothelium-dependent dilations to increase in flow, acetylcholine and bradykinin were markedly reduced in arterioles of MRL/lpr mice. Endothelium-independent dilations to sodium-nitroprusside and adenosine were similar in MRL and MRL/lpr arterioles. Furthermore, angiotensin II elicited greater constrictions in MRL/lpr arterioles, whereas serotonin-induced constrictions were similar in both groups. Thus, in arterioles of MRL/lpr mice endothelium-dependent dilator mechanisms are impaired and constriction to angiotensin II is enhanced, suggesting specific alterations in the vasomotor function of microvessels that are likely contribute to the disturbance of skeletal muscle blood flow observed in systemic lupus erythematosus.
The renin-angiotensin system in lupus: physiology, genes and practice, in animals and humans
Authors: Teplitsky V , Shoenfeld Y , Tanay A
Published: June 2006

Although multiple studies suggest a potential role for angiotensin II in inflammation, most were performed either in vitro or in animals with non-immune-complex-mediated diseases. Extrapolation of these findings to humans, particularly patients with lupus, which involves multiple immunoregulatory pathways, is unclear. In autoimmune-prone MRL/lpr mice, angiotensin-converting-enzyme (ACE) inhibition improved survival although to a lesser degree than cyclophosphamide and diminished the glomerular histopathologic damage, proteinuria, lymphoid hyperplasia, dermatitis, and hypergammaglobulinemia, with a reduction in TGF-beta1 and beta 2 expression in the kidneys and renal chemokine mRNA expression. Spleen levels of IL-4 and IL-10 were also reduced. Uncontrolled studies in patients with treatment-refractory lupus nephritis showed a significant reduction in proteinuria with ACE-inhibitors and Angiotensin receptor blockers treatment. The ‘masking’ effect of ACE-inhibitors should be taken into consideration, as an exacerbation of lupus nephritis may be missed when estimated by the magnitude of proteinuria, which is decreased by these treatments. No single ACE genotype was consistently associated with subsets of SLE patients. In retrospective analyses, ACE-inhibitor use predicted a favourable outcome in 94 cases of pauci-immune vasculitis. The attenuating effect of angiotensin II inhibitors on the progression of chronic renal disease is well recognized. The data on the role of this intervention in lupus is limited.
Quality of life comparison between corticosteroidand-mycofenolate mofetil and corticosteroidand-oral cyclophosphamide in the treatment of severe lupus nephritis
Authors: Tse K C , Tang C SO , Lio W I , Lam M F , Chan T M
Published: June 2006

There is accumulating evidence that mycophenolate mofetil (MMF), when combined with corticosteroid, is an effective induction treatment for severe proliferative lupus nephritis and is associated with fewer adverse effects compared to cyclophosphamide (CTX), but the quality of life (QOL) associated with these regimens as perceived by the patient has not been compared.

This study included patients who had experienced both treatment regimens, for distinct episodes of diffuse proliferative lupus nephritis. QOL parameters during the first six months of each treatment were assessed through SF36 and WHOQOL questionnaires.

Twelve patients and 24 episodes of severe lupus nephritis were studied. CTX-treated and MMF-treated episodes showed comparable baseline characteristics and response rate, with complete remission occurring in 83.3%. MMF treatment was associated with higher numerical scores for all domains across both QOL instruments than CTX. MMF treatment was associated with significantly less fatigue, less impediment of physical and social functioning, and better psychological well being compared to CTX. When each patient served as her/his own control, most patients ascribed higher QOL domain scores to the MMF-treated episode. Seventy-five percent of patients found MMF treatment more acceptable and preferred when compared with CTX, and the complications that most concerned them included Cushingoid features, alopecia, menstrual disturbance and infections.

These data showed that MMF-based induction immunosuppression for severe lupus nephritis was associated with better QOL than CTX as perceived by patients, which was most likely attributed to the reduced side-effects during MMF treatment.
Anti-dsDNA antibody subtypes and anti-C1q antibodies: toward a more reliable diagnosis and monitoring of systemic lupus erythematosus and lupus nephritis
Authors: Jaekel H-P , Trabandt A , Grobe N , Werle E
Published: June 2006

The putative distinct diagnostic and pathogenic potential of aDNA-Ab subtypes, differing in their affinity or epitope specificity, was subject of several studies with controversial results. Comparing five assays, characterized by different reaction conditions and nature/source of dsDNA, we investigated the abovementioned problem in a retrospective study on 100 systemic lupus erythematosus (SLE) patients and 100 controls (other CTD, autoimmune hepatopathies). As demonstrated, only assay 3 (Farrzyme, TBS, UK) and 5 (Farr-RIA, Trinity Biotech, Ireland) are really suitable to detect primarily high avidity aDNA-Ab. Both were significantly linked to lupus nephritis (specificity 84%) and highly specific for SLE (95 and 96%). Thereby, assay 3 was found to be the first solid phase ELISA probably suitable to replace the Farr-RIA. Classical ELISAs (assay 1, Orgentec, Germany, and 2, Bindazyme, TBS, UK), detecting aDNA-Ab more or less independent from their avidity, or tests with only intermediate specificity for high avidity Ab (assay 4, ELIAdn, Sweden Diagnostics, Germany), were less specific for SLE (83, 79, 91%, respectively) and not associated with renal involvement (specificity 54-57%). At least in the patients studied here, obvious antigen-related differences could not be observed. With slight differences, all assays were suitable to monitor disease activity and therapy in SLE, agreeing with the ECLAM score in about 70-80% of cases. For lupus nephritis, aC1q-Ab are as specific as high avidity aDNA-Ab and capable to close a diagnostic gap in some cases. Thus, to enhance the specificity (up to 98%) and to consider the distinct diagnostic/pathogenic potential of aDNA-Ab subtypes in SLE, under routine clinical laboratory conditions it should be recommended to combine a sensitive screening test with a more specific second assay.
Ro52, Ro60 and La IgG autoantibody levels and Ro52 IgG subclass profiles longitudinally throughout pregnancy in congenital heart block risk pregnancies
Authors: Strandberg L , Salomonsson S , Bremme K , Sonesson S-E , Wahren-Herlenius M
Published: June 2006

Congenital heart block occurs in fetuses of Ro/SSA and La/SSB positive women. To investigate the stability of maternal autoantibody levels during pregnancy, we followed Ro52, Ro60 and La autoantibody IgG level variation and Ro52 subclass profiles longitudinally in selected congenital heart block risk pregnancies. Serum samples were obtained from 12 Ro/La positive women diagnosed with a systemic rheumatic disease and followed on average 60 months (range two to 84) which included 13 pregnancies. Seven children were affected by neonatal lupus, whereof four developed complete congenital heart block. Serum was also collected from the babies at birth. Ro52, Ro60 and La IgG as well as subclass antibodies were analysed by ELISA using recombinant antigens. Six Ro/La negative rheumatic patients were included as controls for antibody levels during pregnancy.

Ro52, Ro60 and La IgG levels decreased progressively from early to late pregnancy, significantly for Ro52 and Ro60 ( P < 0.01). No peaks or persistent elevation of antibody levels were noted in any of the CHB risk pregnancies. Ro52 IgG1 antibody levels were significantly higher than IgG2 ( P < 0.01), IgG3 ( P < 0.01) and IgG4 ( P < 0.05) levels in the mothers during pregnancy. Ro52 IgG1 and IgG4 levels decreased significantly from early to late pregnancy ( P = 0.02), while levels of IgG2 and IgG3 were low and the decrease was not significant. All IgG subclasses were transferred to the children. We conclude that maternal levels of Ro52, Ro60 and La autoantibodies tended rather to decrease than to increase during pregnancy.
Prevention of steroid-induced osteonecrosis of femoral head in systemic lupus erythematosus by anti-coagulant
Authors: Nagasawa K , Tada Y , Koarada S , Tsukamoto H , Horiuchi T , Yoshizawa S , Murai K , Ueda A , Haruta Y , Ohta A
Published: June 2006

Although osteonecrosis of femoral head (ONF) is one of the serious complications in systemic lupus erythematosus (SLE) associated with corticosteroid therapy, there has been few trials of prevention of ONF described. We aimed to prevent ONF in steroid-treated SLE patients using anticoagulant, warfarin, conducting a multicenter prospective study. Sixty newly diagnosed SLE patients requiring 40 mg/day or more prednisolone were alternately assigned to either of two groups; a warfarin group and a control one. Warfarin (1 ∼ 5 mg/day) was started together with the beginning of steroid therapy and continued at least for three months. Patients were observed for the development of silent ONF by magnetic resonance imaging (MRI) and symptomatic ONF by plain radiography for over five years. The warfarin group consisted of 31 patients (62 hips) and the control one 29 patients (58 hips). Silent ONF developed in 13 hips (21%) and 19 hips (33%) in the warfarin group and the control group, respectively ( P = 0.13). On the other hand, warfarin tended to prevent symptomatic ONF; only three hips of 62 (4.8%) in the warfarin group and eight hips of 58 (14%) in the control group ( P = 0.08) developed silent ONF. It was also found that silent ONF developed, if it did, very early; within three months in 16 of 18 patients (89%). Among risk factors for silent ONF, steroid pulse therapy was most outstanding and it seemed to overcome the effect of warfarin. Taken together, for the time being, anticoagulant therapy, if not significantly sufficient, may be of use for the prevention of steroid-induced ONF in SLE. We consider that this study added to important evidence for the pathogenesis and prevention of ONF.
Hydroxychloroquine use predicts complete renal remission within 12 months among patients treated with mycophenolate mofetil therapy for membranous lupus nephritis
Authors: Kasitanon N , Fine D M , Haas M , Magder L S , Petri M
Published: June 2006

The objective of this study was to identify clinical predictors of response to initial mycophenolate mofetil (MMF) therapy for membranous lupus nephritis (MLN). We observed the clinical outcomes of patients in the Hopkins Lupus Cohort within the first year of initiation of treatment with MMF therapy for newly diagnosed MLN, classified according to the new International Society of Nephrology/Renal Pathology Society (ISN/RPS) 2003 classification. Complete renal remission was defined as proteinuria less than 500 mg/24 hours. Demographic, clinical, treatment and laboratory data were examined for their association with renal remission. Twenty-nine MLN patients treated with MMF were identified. Eleven (38%) patients achieved complete renal remission by 12 months. Of those taking hydroxychloroquine, 7/11 (64%) were in remission within 12 months compared to only 4/18 (22%) of those not on hyroxychloroquine ( P 0.036 based on a log-rank test). This association persisted after controlling for the presence of anti-ds-DNA ( P 0.026). Our results provide evidence that hydroxychloroquine has a benefit for renal remission when MMF is used as the initial therapy for MLN. Although hydroxychloroquine is frequently stopped in patients with lupus nephritis, this study suggests it should be started or maintained.
Necrotizing fasciitis in rheumatic diseases
Authors: Mok M Y , Wong S Y , Chan T M , Tang W M , Wong W S , Lau C S
Published: June 2006

Necrotizing fasciitis is an uncommon but life-threatening complication in immunocompromised hosts. We reported four patients with rheumatic diseases complicated by necrotizing fasciitis and reviewed 14 others from literature search. Most patients were on corticosteroid treatment. Septic shock, disseminated intravascular coagulopathy and acute renal deterioration were common giving rise to an overall mortality rate of 27.8%. Septic arthritis may also complicate the condition. Statistical analysis on the series showed the lack of major surgical debridement as the only risk factor associated with increased mortality (RR 7.5, 95% CI 2.1-27.3, P = 0.01). Timely debridement of necrotic tissue is important for reducing mortality.
A peptide that mimics the Vth region of β2glycoprotein I reverses antiphospholipid-mediated thrombosis in mice
Authors: Ostertag M Vega , Liu X , Henderson V , Pierangeli S S
Published: June 2006

Antiphospholipid (aPL) antibodies bind to 2glycoprotein I (2GPI) and cause endothelial cell (EC) activation and thrombosis in mice. 2GPI binds to EC through its Vth domain and induces their activation. TIFI is a 20 amino acid synthetic peptide that shares similarity with the Vth domain of 2GPI. Our objectives were to examine the ability of TIFI to affect aPL-mediated thrombosis in mice and the interactions of TIFI, 2GPI with phospholipid surfaces and target cells. CD1 mice were injected with IgG from a patient with antiphospholipid syndrome (IgG-APS) or with control IgGNHS and with either TIFI or with control peptide (VITT). Size of induced thrombi was determined. Inhibition and competition studies were done using aPL antibodies, cardiolipin (CL) liposomes in the presence of varying amounts of TIFI and 2GPI. Binding of fluorescinated 2GPI to human ECs and to murine macrophages in the presence or absence of TIFI, was also examined. TIFI significantly decreased thrombus size in mice injected with IgG-APS. TIFI reverted the 2GPI-dependent binding of aPL antibodies to CL liposomes in a dose-dependent fashion. This effect was abrogated by addition of 2GPI, suggesting that TIFI displaces the binding of 2GPI to phospholipids. TIFI inhibited the binding of fluorescinated 2GPI to human EC and to murine macrophages. The data indicate that TIFI abrogates thrombogenic properties of aPL in mice by competing with 2GPI and preventing its binding to target cells. This may be important in designing new modalities for the treatment of thrombosis in APS.
Histiocytic necrotizing lymphadenitis (Kikuchi-Fujimoto’s disease) mimicking systemic lupus erythematosus: a review of two cases
Authors: Yilmaz M , Camci C , Sari I , Okan V , Sevinc A , Onat A M , Buyukhatipoglu H
Published: June 2006

Kikuchi-Fujimoto’s disease (KFD), or histiocytic necrotizing lymphadenitis, is a benign and self-limited lymphadenitis commonly found in young women. It often shares clinical features with systemic lupus erythematosus (SLE), such as arthralgias, fever and leukopenia. The etiology of KFD remains unknown and controversial. Clinical course is favorable, with spontaneous remission in less than four months in almost all cases. Herein, we present two cases. The former is a 53-year old woman presenting with cervical lymphadenopathy, arthralgia, pancytopenia and positive antinuclear antibody (ANA). Lymph node biopsy revealed histopathological features compatible with Kikuchi-Fujimoto histiocytic necrotizing lymphadenitis. The latter patient was a 20-year old woman presenting with left cervical lympadenopathy, a butterfly rash that was reminiscent of SLE, and a positive antinuclear antibody. Based upon clinical, histological and laboratory findings, the diagnosis of SLE was excluded. Careful attention should be paid to differentiating between KFD and SLE, because of their similar presentations, yet different clinical courses and therapeutic requirements.
Profiles in Patient Safety: Antibiotic Timing in Pneumonia and Pay‐for‐performance
Authors: Pines Jesse M.
Published: June 2006

The delivery of antibiotics within four hours of hospital arrival for patients who are admitted with pneumonia, as mandated by the Joint Commission for the Accreditation of Healthcare Organizations and the Centers for Medicare and Medicaid Services, has gained considerable attention recently because of the plan to implement pay‐for‐performance for adherence to this standard. Although early antibiotic administration has been associated with improved survival for patients with pneumonia in two large retrospective studies, the effect on actual patient care and outcomes for patients with pneumonia and other emergency department patients of providing financial incentives and disincentives to hospitals for performance on this measure currently is unknown. This article provides an in‐depth case‐based description of the evidence behind antibiotic timing in pneumonia, discusses potential program effects, and analyzes how the practical implementation of pay‐for‐performance for pneumonia conforms to American Medical Association guidelines on pay‐for‐performance.
Blood Cultures Do Not Change Management in Hospitalized Patients with Community‐acquired Pneumonia
Authors: Ramanujam Prasanthi , Rathlev Niels K.
Published: June 2006

Objectives:
To determine if blood cultures identify organisms that are not appropriately treated with initial empiric antibiotics in hospitalized patients with community‐acquired pneumonia, and to calculate the costs of blood cultures and cost savings realized by changing to narrower‐spectrum antibiotics based on the results.

Methods:
This was a retrospective observational study conducted in an urban academic emergency department (ED). Patients with an ED and final diagnosis of community‐acquired pneumonia admitted between January 1, 2001, and August 30, 2003, were eligible when the results of at least one set of blood cultures obtained in the ED were available. Exclusion criteria included documented human immunodeficiency virus infection, immunosuppressive illness, chronic renal failure, chronic corticosteroid therapy, documented hospitalization within seven days before ED visit, transfer from another hospital, nursing home residency, and suspected aspiration pneumonia. The cost of blood cultures in all patients was calculated. The cost of the antibiotic regimens administered was compared with narrower‐spectrum and less expensive alternatives based on the results.

Results:
A total of 480 patients were eligible, and 191 were excluded. Thirteen (4.5%) of the 289 enrolled patients had true bacteremia; the organisms isolated were sensitive to the empiric antibiotics initially administered in all 13 cases (100%; 95% confidence interval = 75% to 100%). Streptococcus pneumoniae and Haemophilus influenzae were isolated in 11 and two patients, respectively. The potential savings of changing the antibiotic regimens to narrower‐spectrum alternatives was only 170.

Conclusions:
Appropriate empiric antibiotics were administered in all bacteremic patients. Antibiotic regimens were rarely changed based on blood culture results, and the potential savings from changes were minimal.
Met5‐enkephalin‐Arg6‐Phe7 (MEAP): A Cardioprotective Hormonal Opioid
Authors: Dickson Eric W. , Ludwig Paula S. , Ackermann Laynez W. , Buresh Christopher T. , Denning Gerene M.
Published: June 2006

Background:
Acute myocardial ischemia is an important cause of morbidity and mortality worldwide. The heart and other organs can be rendered more resistant to the deleterious effects of ischemia through a variety of preconditioning strategies, including treadmill exercise and brief ischemia of skeletal muscle. Some of the beneficial effects of these preconditioning strategies appear to be mediated by as‐of‐yet unidentified hormonal opioids.

Objectives:
To test the hypothesis that endogenous opioids of the enkephalin class are capable of improving ischemic tolerance and acting in a hormonal manner.

Methods:
In phase one of the investigation, the authors assessed the cardioprotective potential of all four known enkephalins. This was achieved by subjecting isolated buffer‐perfused rabbit hearts to a 25‐minute period of test ischemia and two hours of reperfusion (protocol 1) after receiving treatment with either saline vehicle (controls) or increasing concentrations of purified enkephalins. On the basis of results from these initial studies, the authors performed additional experiments (protocol 2) to determine whether Met5‐enkephalin‐Arg6‐Phe7 (MEAP) could be absorbed from skeletal muscle and exert a cardioprotective effect. Specifically, MEAP or vehicle (controls) was given intramuscularly 24 hours before the hearts were harvested. A similar assessment of ischemic tolerance as described in protocol 1 was then performed. Postischemic myocardial viability (infarct size) was assessed in all cases by triphenyltetrazolium chloride (TTC) staining. Hemodynamic parameters and infarct sizes for concentration‐dependence studies were compared by two‐way analysis of variance, and infarct sizes from protocol 2 studies were compared by using Student's t‐test (significance set at p ≤ 0.05).

Results:
Mean infarct size in control hearts (± SEM) was 33% (± 4%) and 36% (± 6%) for protocol 1 and 2, respectively. Of the four enkephalins tested in protocol 1, only MEAP treatment showed a tendency toward cardioprotection. Interestingly, an alternative enkephalin, methionine5‐enkephalin‐Arg6‐Gly7‐Leu8, tended to exert an injurious effect. In protocol 2, MEAP treatment 24 hours before ischemia significantly reduced infarct size (14%± 4%) compared with controls, suggesting that it can be released from muscle and exert a distant cardioprotective effect.

Conclusions:
When given either directly to the heart or absorbed from a distant tissue, MEAP induces cardioprotection, supporting the hypothesis that it can act as a hormonal modulator of ischemic tolerance.
Bedside Teaching in the Emergency Department
Authors: Aldeen Amer Z. , Gisondi Michael A.
Published: June 2006

Bedside teaching is a valuable instructional method that facilitates the development of history and physical examination skills, the modeling of professional behaviors, and the direct observation of learners. The emergency department (ED) is an ideal environment for the practice of bedside teaching, because its high patient volume, increased acuity of illness, and variety of pathology provide plentiful patient‐centered teaching opportunities. Unfortunately, the pressures of ED overcrowding at many institutions now limit the available time for formal bedside teaching per patient. This article will discuss the historical decline of bedside teaching on the wards, address obstacles to its use in the ED, and reestablish its specific benefits as a unique educational tool. The authors propose several practical strategies to increase bedside teaching by academic emergency physicians (EPs). These techniques emphasize careful preparation and a focused teaching approach to overcome the inherent challenges of a typically busy ED shift.
A Trial of Therapeutic Hypothermia via Endovascular Approach in Awake Patients with Acute Ischemic Stroke: Methodology
Authors: Guluma Kama Z. , Hemmen Thomas M. , Olsen Scott E. , Rapp Karen S. , Lyden Patrick D.
Published: June 2006

Background:
Therapeutic hypothermia has been shown to be of benefit in improving neurological outcome in cardiac arrest. It now is being investigated in acute stroke and myocardial infarction. The majority of the literature describes its use in intubated, pharmacologically paralyzed patients, using surface cooling techniques that are susceptible to patient shivering, imprecise temperature control, time lag to target‐temperature acquisition, and rebound hyperthermia.

Objectives:
To develop a method of inducing therapeutic hypothermia in a rapid, precise, and tolerable fashion in awake, nonintubated patients.

Methods:
This method was developed for an ongoing clinical trial investigating a combination of therapeutic hypothermia and intravenous thrombolysis for acute ischemic stroke. In the protocol, an endovascular cooling device is placed in the inferior vena cava of a patient, and a combination of buspirone, meperidine, and cutaneous warming with a heating blanket is used to suppress shivering as the patient is cooled to a target temperature of 33°C, kept there for a total of 24 hours from hypothermia initiation, and then rewarmed in a controlled fashion during the next 12 hours.

Results:
Ten patients underwent the therapeutic hypothermia protocol. The median pretreatment core temperature was 36.1°C (interquartile range [IQR]: 35.8°C–36.4°C). On initiation of cooling, the core temperatures dropped rapidly and then leveled off, approaching a median plateau value of 33.4°C (IQR: 33.2°C–33.9°C) in a mean time of 1.7 (± 0.7) hours from cooling initiation, with a median average postplateau temperature during the cooling phase of 33.8°C (IQR: 33.3°C–34.6°C), and a median lowest temperature of 33.1°C (IQR: 33.0°C–33.3°C). The procedure was well tolerated, with minimal shivering and no rebound hyperthermia.

Conclusions:
This is a method by which a rapid and precise therapeutic decrease in core temperature can be achieved without the necessity for intubation or neuromuscular blockade and with minimal patient discomfort or shivering.
The Association between Emergency Department Crowding and Hospital Performance on Antibiotic Timing for Pneumonia and Percutaneous Intervention for Myocardial Infarction
Authors: Pines Jesse M. , Hollander Judd E. , Localio A. Russell , Metlay Joshua P.
Published: June 2006

Background:
Antibiotics within four hours of arrival for patients with pneumonia and percutaneous intervention (PCI) within two hours for patients with acute myocardial infarction (AMI) are standard measures of emergency department (ED) quality.

Objectives:
To assess the institutional‐level association between measures of ED crowding and process measures for pneumonia and AMI.

Methods:
The authors used summary data from 24 academic hospitals in the University Health Consortium. Analysis included the 2004 ED cycle time survey and performance data from January to December 2004 regarding the Joint Commission for Accreditation of Healthcare Organizations' PN‐5b (initial antibiotic administration within four hours) for pneumonia and AMI‐8a (PCI received within 120 minutes). Spearman correlation coefficients were used to determine associations between crowding and performance measures.

Results:
Across all institutions, 59% (range 43%–77%) of pneumonia patients received antibiotics within four hours, and 57% (range 22%–95%) of AMI patients received PCI within two hours. An increase in overall ED length of stay (−0.44, p = 0.04) and for admitted patients (−0.37, p = 0.08) was associated with a decrease in the proportion of pneumonia patients receiving antibiotics within four hours. An increase in chest x‐ray turnaround time (−0.83, p < 0.001) and an increase in the left‐without‐being‐seen rate (−0.51, p = 0.01) were also associated with a decrease in the proportion of pneumonia patients receiving antibiotics within four hours. No measures of crowding exhibited an association with time to PCI for AMI patients.

Conclusions:
Administrative measures of ED crowding showed an association with poorer performance on pneumonia quality of care measures but not with AMI quality of care measures. Hospitals might consider improving ED throughput, reducing boarding times for admitted patients, and reducing chest x‐ray turnaround times to improve pneumonia care.
Cervical screening in 20–24-year olds
Authors: Rieck GC , Tristram A , Hauke A , Fielder H , Fiander AN
Published: June 2006

Background: In 2003 the NHS Cervical Screening Programme in England changed the age at which women are first invited for cervical screening from 20 to 25 years. The aim of this review was to assess the evidence for benefit and harm of undertaking cervical screening in Wales for women aged 20–24 years.

Method: A literature review looking for evidence of the effectiveness and potential harmful effects of cervical screening was undertaken. Welsh data for the number of cases of high-grade cervical intraepithelial neoplasia (CIN3) were examined and rates of invasive cervical cancer (1981–2003) for young women calculated. The medical notes of women less than 25 years old diagnosed with cervical cancer were reviewed and a cost analysis was performed.

Results: The literature review failed to identify any randomized controlled studies of the effectiveness of cervical screening in young women, but demonstrated that organized screening programmes result in a decrease in the incidence of cervical carcinoma. Following the introduction of the Welsh organized call/recall cervical screening programme in 1988, cervical cancer has been reduced by 58% in women aged 20–24 years and 45% in women aged 25–29 years (mean age-specific rate per 100,000 women aged 20–24 years: 4.2 in 1981–88 compared with 2.2 in 1989–2003). If these changes can be attributed to the screening of women aged 20–24, then the costs of at least £82,500 are estimated to prevent one cervical cancer in this age group.

Conclusions: The incidence of cervical cancer in young women has halved since the introduction of the Welsh-organized call–recall cervical screening programme. In Wales we recommend that women continue to be invited for cervical screening from 20 years of age. This will provide the information required to compare the incidence and stage at diagnosis of cervical cancer in young women invited for first time cervical screening at different ages across the UK.
Prognostic importance of palpability as a feature of screen-detected breast cancers
Authors: Gill Grantley , Luke Colin , Roder David
Published: June 2006

Objectives: To determine epidemiological characteristics of palpability as a feature of asymptomatic invasive breast cancers detected through screening mammography, and to determine whether palpability is predictive of case survival after adjusting for conventional prognostic indicators such as diameter, grade and nodal status.

Setting: The University of Adelaide, South Australian Department of Health, and The Cancer Council South Australia, Adelaide, South Australia.

Methods: Sociodemographic and clinical characteristics of 2108 screen-detected invasive breast cancers were compared by tumour palpability using univariate and multiple logistic regression analysis. Survival outcomes from breast cancer were compared using Kaplan–Meier product-limit estimates. Multivariable proportional hazard regression was employed to assess the association of palpability with survival after adjusting for conventional prognostic indicators.

Results: Palpability was associated with year of diagnosis, ductal histology type, and unfavourable prognostic indicators such as larger tumour diameter, higher grade and nodal involvement. After adjusting for these variables, no associations were found with age at diagnosis, place of residence or socioeconomic status, or with presence of multifocal disease or presence of an extensive in situ component. Palpability was predictive of death from breast cancer in an unadjusted analysis, the relative risk (95% confidence limits) being 1.75 (1.12, 2.74). After adjusting for nodal involvement and larger tumour size, the relative risk no longer was elevated, reducing to 0.99 (0.60, 1.64).

Discussion: Palpability is associated with unfavourable prognostic indicators, such as larger diameter, higher grade and nodal involvement, and is not an independent indicator of survival outcome for screen-detected female-breast cancers after accounting for nodal involvement and diameter.
Neonatal haemoglobinopathy screening: review of a 10-year programme in Brussels
Authors: Gulbis Béatrice , Ferster Alina , Cotton Frédéric , Lebouchard Marie-Philippe , Cochaux Pascale , Vertongen Fanchon
Published: June 2006

Since 1994, a neonatal screening programme for major haemoglobinopathies has been conducted in Brussels. We performed a 10-year re-evaluation of the incidence of haemoglobinopathies in Brussels and found that of the 118,366 newborns screened, 64 were diagnosed with a sickle cell syndrome, six had β-thalassaemia major, four had a haemoglobin C disease and three had a haemoglobin H disease. Of the 64 babies with a sickle cell disease, two died before the age of two years and two did not present at the first neonatal visit. Of the six babies suffering from β-thalassaemia major, all are alive and two have undergone a haematopoietic stem cell transplantation. The universal neonatal screening programme for haemoglobinopathies should be maintained in Brussels.
Towards comprehensive population-based screening for diabetic retinopathy: operation of the North Wales diabetic retinopathy screening programme using a central patient register and various screening methods
Authors: Harvey JN , Craney L , Nagendran S , Ng CS
Published: June 2006

Objectives: To examine whether population-based retinopathy screening using a central diabetes register and employing various screening methods can achieve a high degree of population coverage to meet National Screening Committee (NSC) targets. To identify the main barriers to achieving comprehensive population coverage. To analyse referrals to ophthalmology and their outcome as a measure of previously unmet need. To assess the influence of modality of screening.

Setting: Three local health board areas in North Wales.

Methods: Establishment of a district diabetes register to hold records of all patients and subserve call–recall of general practitioner (GP) sole-care patients for screening by optometrists or digital photography. Hospital attenders were screened in diabetic clinic by direct ophthalmoscopy. Data were collected for years 1 and 2 of operation of the scheme.

Results: The system held a screening record for 86% of diabetic patients after year 1 and 93% after year 2. Failure to attend was the major barrier to comprehensive population screening, but this improved in year 2 ( P<0.001). Both optometrists and photography identified substantial unmet need: 1% of all GP sole-care patients required immediate laser treatment. Photography was more sensitive than optometrist screening, but the additional retinopathy identified was mostly minor not requiring treatment.

Conclusions: Lack of screening is much more important than modality of screening as a cause of missed sight-threatening retinopathy. A central, district-based patient register system identifies those patients not screened for further follow-up and can produce a high level of population coverage, close to NSC targets. Such schemes are needed, particularly to support primary care diabetes management.
The agreement between self-reported cervical smear abnormalities and screening programme records
Authors: Canfell Karen , Beral Valerie , Green Jane , Cameron Rebecca , Baker Krys , Brown Anna
Published: June 2006

Setting: The Million Women Study is a cohort study of women aged 50–64 years in England and Scotland. As a component of the follow-up questionnaire, participants were asked to indicate if they had an abnormal cervical smear in the previous five years. This study compared self-reported cervical abnormalities with screening records obtained from the National Health Service Cervical Screening Programme.

Methods: For 1944 randomly selected Million Women Study participants in Oxfordshire, screening records were assessed over a six-year period prior to the date of self-reporting. The six-year period was chosen to allow for errors in the recall of timing of abnormal smears.

Results: A total of 68 women (3.5%) had a record of at least one equivocal or abnormal smear within the last six years, whereas 49 women (2.5%) self-reported an abnormality. There was a strong trend for an increased probability of self-reporting a history of an abnormal smear as the severity of the recorded abnormality increased ( P <0.001). For women with an NHS record of borderline dyskaryosis, mild dyskaryosis, or moderate dyskaryosis/severe dyskaryosis/invasive cancer, the proportions reporting an abnormality were 40%, 58% and 77%, respectively. For women with negative and inadequate smears, the proportion self-reporting an abnormality were 0.6% and 0.7%, respectively.

Conclusions: These results indicate that among women whose screening programme records show an abnormal smear, the proportion self-reporting an abnormality increases with the severity of the recorded lesion. Almost all women with a record of negative or inadequate smear(s) correctly interpret the result and do not self-report an abnormality.
Impacts of License Choice and Organizational Sponsorship on User Interest and Development Activity in Open Source Software Projects
Authors: Stewart Katherine J. , Ammeter Anthony P. , Maruping Likoebe M.
Published: June 2006

What differentiates successful from unsuccessful open source software projects? This paper develops and tests a model of the impacts of license restrictiveness and organizational sponsorship on two indicators of success: user interest in, and development activity on, open source software development projects. Using data gathered from Freshmeat.net and project home pages, the main conclusions derived from the analysis are that (1) license restrictiveness and organizational sponsorship interact to influence user perceptions of the likely utility of open source software in such a way that users are most attracted to projects that are sponsored by nonmarket organizations and that employ nonrestrictive licenses, and (2) licensing and sponsorship address complementary developer motivations such that the influence of licensing on development activity depends on what kind of organizational sponsor a project has. Theoretical and practical implications are discussed, and the paper outlines several avenues for future research.
Research Note—Information Technology, Contract Completeness, and Buyer-Supplier Relationships
Authors: Banker Rajiv D. , Kalvenes Joakim , Patterson Raymond A.
Published: June 2006

The theory of incomplete contracts has been used to study the relationship between buyers and suppliers following the deployment of modern information technology to facilitate coordination between them. Previous research has sought to explain anecdotal evidence from some industries on the recent reduction in the number of suppliers selected to do business with buyers by appealing to relationship-specific costs that suppliers may incur. In contrast, this paper emphasizes that information technology enables greater completeness of buyer-supplier contracts through more economical monitoring of additional dimensions of supplier performance. The number of terms included in the contract is an imperfect substitute for the number of suppliers. Based on this idea, alternative conditions are identified under which increased use of information technology leads to a reduction in the number of suppliers without invoking relationship-specific costs. We find that a substantial increase in contract completeness due to reduced cost of information technology could increase the cost per supplier even though the cost of coordination and the cost per term monitored decrease. Such an increase in the cost per supplier leads to a reduction in the number of suppliers with whom the buyer chooses to do business. Similarly, we find that if coordination cost is reduced when more information technology is deployed so that the number of suppliers in the buyer’s pool increases substantially, the buyer might choose to make the supplier contracts less complete, instead relying on a more market-oriented approach to finding a supplier with good fit.
Issues and Opinions—Publication Opportunities in Premier Business Outlets: How Level Is the Playing Field?
Authors: Valacich Joseph S. , Fuller Mark A. , Schneider Christoph , Dennis Alan R.
Published: June 2006

This paper reports an analysis of the proportion of faculty publishing articles in premier business journals (i.e., the ratio of authors of premier business journal articles to total faculty of a discipline) across the disciplines of accounting, finance, management, marketing, and information systems (IS) for the years 1994–2003. This analysis revealed that over this period the management discipline had on average the highest proportion of faculty publishing in premier journals (12.7 authors per 100 management faculty), followed by finance (9.4 authors per 100 faculty), marketing (9.2 authors per 100 faculty), IS (5.5 authors per 100 faculty), and accounting (4.8 authors per 100 faculty). A further analysis examined these ratios for the different disciplines over time, finding that the ratios of authors to faculty have actually decreased for the disciplines of marketing and IS over this time period but have remained stable for the disciplines of accounting, management, and finance. Given steady growth in faculty size of all disciplines, the proportion of faculty publishing articles in premier journals in 2003 for all disciplines is lower than their 10-year averages, with IS having the lowest proportion in 2003. A sensitivity analysis reveals that without substantial changes that would allow more IS faculty to publish in the premier journals (e.g., by increasing publication cycles, number of premier outlets, and so on), IS will continue to lag far below the average of other disciplines. The implications of these findings for IS researchers, for institutions and administrators of IS programs, and for the IS academic discipline are examined. Based on these implications, recommendations for the IS discipline are presented.
Lillie Devereux Blake: Retracing a Life Erased (review)
Authors: Mills Angela
Published: June 2006

Grace Farrell's Lillie Devereux Blake: Retracing a Life Erased (2002) explores the life and work of a once influential woman's rights activist and writer, seemingly lost to history. The biography establishes Blake's power both as an activist whose vision of woman's rights extended far beyond the objectives of the National American Woman Suffrage Association and as a writer whose fiction became increasingly direct in its depiction of the physical, psychological, and social mistreatment of women within nine-teenth-century America. Equally important and resonant in Farrell's study of Blake, however, is the thoughtful exploration of the impetuses behind and mechanisms by which Blake was ultimately silenced in her own era and relegated to obscurity in ours. Lillie Devereux Blake: Retracing a Life Erased (2002), de Grace Farrell, explore la vie et l'œuvre d'une femme qui a joué un rôle important pour les droits des femmes, mais dont l'histoire a apparemment perdu la trace. Cette biographie montre l'influence de Blake, aussi bien comme activiste dont la vision des droits des femmes allait bien au delà des objectifs de l'Association nationale pour le Vote des femmes américaines (la National American Woman Suffrage Association, ou NAWSA), que comme écrivaine dont les romans représentaient de plus en plus explicitement les mauvais traitements physiques, psychologiques et sociaux infligés aux femmes dans l'Amérique du dix-neuvième siècle. Ce qui est tout aussi important et évocateur dans l'étude que fait Farrell de Blake, cependant, c'est l'analyse sérieuse des motivations et des mécanismes qui sont entrés en jeu pour réduire Blake au silence à son époque et la reléguer à l'oubli dans la nôtre.
A "Long and Winding Road": Bill Clinton and the 1960s
Authors: Abbott Philip
Published: June 2006

President Clinton's status as "poster child" of the 1960s in the 1990s is examined through autobiographical attempts to preserve or revise the collective memory of the Sixties. The emerging image is then compared to Clinton's own political persona as a candidate, as a president, and finally as an autobiographer himself. His circumstances and reactions bear a remarkable resemblance to another president, Richard Nixon, who also struggled with associations from another decade. This unlikely linkage suggests that similar unstable patterns of pride and resentment emerge when presidential rhetoric is driven by the controversies of past decades.
"Has Your Courage Rusted?": National Security and the Contested Rhetorical Norms of Republicanism in Post-Revolutionary America, 1798-1801
Authors: Hartnett Stephen J , Mercieca Jennifer Rose
Published: June 2006

By considering the XYZ Affair and the Alien and Sedition Acts of 1798, the presidential campaign of 1800, and the post-election public address of 1801, this essay examines how the contested rhetorical norms of post-Revolutionary republicanism were influenced by threats—some real, others manufactured—to national security. Interweaving the challenges of rising international capitalism, the communicative opportunities created by mass-produced media, and the fallout from local political feuds, this essay offers an interdisciplinary analysis of a foundational moment in American history, when our forebears negotiated the relationships among free speech, national security, party allegiance, and commerce while trying to define republicanism as both a daily practice and a guiding political philosophy.
Reagan at the Brandenburg Gate: Moral Clarity Tempered by Pragmatism
Authors: Rowland Robert C. , Jones John M
Published: June 2006

This study examines Ronald Reagan's June 12, 1987, address at the Brandenburg Gate. We argue that the speech coupled ideological and moral clarity with pragmatism. Reagan, through what Richard M. Weaver called "argument by definition," critiqued the Soviet system and called for the destruction of the Berlin Wall. Simultaneously, the president recognized that times and contexts had changed and displayed pragmatism by expressing a willingness to work with the Soviets. We use a close analysis of the speech along with materials from the Ronald Reagan Presidential Library relevant to the drafting process to make this argument.
Book review
Authors: Kassai T.
Published: June 2006

J. Eckert, K. T. Friedhoff, H. Zahner and P. Deplazes:

Lehrbuch der Parasitologie für die Tiermedizin.
(Textbook of Parasitology for Veterinary Medicine). Enke Verlag,Stuttgart, 2005. 575 pages, 435 figures, of which 54 are life cycle schemes of parasite species, 113 tables, 19.5 × 27.0 cm. ISBN 3-8304-1032-8. Price: 89.95 €.
Failed Attendances at Hospital Dental Clinics among Young Patients with Cleft Lip and Palate
Authors: Rodd Helen D. , Clark Emma L. , Stern Melanie R. , Baker Sarah R.
Published: June 2006

Objective:

To determine the frequency of missed dental appointments among children with a cleft lip and/or palate (CL/P).

Design:

A prospective study of failed appointments over a 12-month period.

Setting:

Three different CL/P clinics within a British dental hospital.

Patients:

Forty-five CL/P children (mean age of 8.8 years) and 45 age-matched, gender-matched, and postal code–matched noncleft patients.

Main outcome measures:

The overall percentage of missed appointments at three different clinics by CL/P patients and the difference in attendance rates at the pediatric dentistry clinic between CL/P and non-CL/P children.

Results:

Pediatric dentistry had the highest rate of missed appointments (22.4%), followed by the multidisciplinary cleft clinic (9.2%) and the orthodontic clinic (8.8%). CL/P patients missed a significantly greater proportion of their pediatric dentistry appointments than noncleft children (22.4% versus 11.9%). Patients with a bilateral CL/P were significantly more likely to miss an appointment than patients with a unilateral CL/P. Age, gender, medical history, and distance traveled had no significant effect on attendance rates.

Conclusions:

Further work is needed to identify risk factors for poor attendance and to develop strategies to reduce the frequency of missed appointments in this vulnerable group.