bluuebunny/crossref_metadata_2025 huggingface dataset:
Polymeric Semiconductors with a Pre‐Specified Alternation of Conjugated Bonds and Metal Clusters
Authors: Tsetlin Boris L. , Golubev Vladimir N. , Vlasov Alexandr V. , Khokhlov Alexei R. , Vannikov Anatoly V. , Tameev Alek R.
Published: March 2004

Summary:In this work the first samples of polymeric semiconductors of a new structure are produced. Their electric conductivity is of the order ∼10−2Ohm−1 · cm−1and it increases with temperature. Their synthesis includes a stage of radiation grafting of a matrix‐type on stretched polyamide films. Conducting molecular circuits in such materials include fragments with conjugated bonds and metal clusters. The alternation of these fragments is determined by the polyamide matrix.

Plot of voltage versus current determined for new polymer semiconducting films where fragments with conjugated bonds alternate with silver clusters.

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Plot of voltage versus current determined for new polymer semiconducting films where fragments with conjugated bonds alternate with silver clusters.
Atom Transfer Radical Polymerization of N,N‐Dimethylacrylamide
Authors: Ding Shijie , Radosz Maciej , Shen Youqing
Published: March 2004

Summary: The living polymerization of N,N‐dimethylacrylamide was achieved by atom transfer radical polymerization catalyzed by copper chloride complexed with a new ligand, N,N′‐bis(pyridin‐2‐ylmethyl 3‐hexoxo‐3‐oxopropyl)ethane‐1,2‐diamine (BPED). With methyl 2‐chloropropionate as the initiator, the polymerization reached high conversions (> 90%) at 80 °C and 100 °C, producing polymers with $\overline M _{\rm n}$ very close to theoretical values and low polydispersity. The ligand, temperature, and copper halide strongly affected the activity and control of the polymerization.

PDMA molecular weight and polydispersity dependence on the DMA conversion in the DMA bulk polymerizations at different temperatures: DMA/CuCl/MCP/BPED = 100/1/1/1, 100 °C (♦, ⋄); 80 °C (▴, ▵); 60 °C (▪, □); and DMA/CuCl/MCP/BPED = 100/1/1/2, 80 °C (•, ○).

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PDMA molecular weight and polydispersity dependence on the DMA conversion in the DMA bulk polymerizations at different temperatures: DMA/CuCl/MCP/BPED = 100/1/1/1, 100 °C (♦, ⋄); 80 °C (▴, ▵); 60 °C (▪, □); and DMA/CuCl/MCP/BPED = 100/1/1/2, 80 °C (•, ○).
Cover Picture: Macromol. Rapid Commun. 5/2004
Authors: Nishikawa Etsushi , Yamamoto Jun , Yokoyama Hiroshi , Finkelmann Heino
Published: March 2004

Cover: The picture displays the X‐ray pattern of a highly ordered smectic A Liquid Single Crystal Elastomer (LSCE). The higher order reflexes indicate a nearly solidlike state of order.

Further details can be found in the Communication by E. Nishikawa, J. Yamamoto, H. Yokoyama, and H. Finkelmann* on page 611.
Chiral discrimination studies of (+)‐(18‐crown‐6)‐2,3,11,12‐tetracarboxylic acid by high‐performance liquid chromatography and NMR spectroscopy
Authors: Lee Wonjae , Bang Eunjung , Baek Chae‐Sun , Lee Weontae
Published: March 2004

Chiral discrimination studies using (+)‐(18‐crown‐6)‐2,3,11,12‐tetracarboxylic acid (18‐C‐6‐TA) as a chiral selector were performed by high‐performance liquid chromatography (HPLC) and NMR spectroscopy. The enantiomers of alanine (Ala) or alanine methyl ester (Ala‐ME) were well separated on the chiral stationary phases (CSPs) derived from (+)‐18‐C‐6‐TA by HPLC. The chiral selector, (+)‐18‐C‐6‐TA, used in the CSP was also applied for the chiral discrimination of the Ala and Ala‐ME enantiomers, and it discriminated these enantiomers successfully by NMR spectroscopy. The chemical shift differences (Δ Δ δ) of the α‐proton of these enantiomers in the presence of an equimolecular solution of 18‐C‐6‐TA were observed to be 0.10 ppm for Ala in methanol‐d4 containing 10 mM H2SO4 and 0.11 ppm for Ala‐ME in methanol‐d4. The observed NMR results agreed with the chromatographic data on the (+)‐18‐C‐6‐TA‐derived CSP by HPLC in terms of both the elution order and solvents effects. Copyright © 2004 John Wiley & Sons, Ltd.
47, 49Ti NMR spectra of half‐sandwich titanium(IV) complexes
Authors: Erben Milan , Růžička Aleš , Picka Michal , Pavlík Ivan
Published: March 2004

The 47, 49Ti chemical shifts, resonance line half‐widths (Δν1/2) and energies of the first electronic charge‐transfer transitions $(\lambda_{\max}^{\rm 1.CT})$ of Cp′TiX3, where Cp′ = η5‐C5H5 (Cp), η5‐C5H4Me (MeCp), η5‐C5HMe4 (Me4Cp), η5‐C5Me5 (Me5Cp), η5‐C5H4SiMe3 (SiCp), η5‐C5H4SnMe3 (SnCp) and η5‐C5H4SiMe2Cl (Si′Cp) and X = Cl, Br, I and OBut, half‐sandwich complexes are reported. For the compounds studied, a direct linear relationship between δ(49Ti) and $\lambda_{\max}^{\rm 1.CT}$ was found. Copyright © 2004 John Wiley & Sons, Ltd.
Structure elucidation of 11‐amino‐8‐hydroxypentacyclo[5.4.0.02, 6.03, 10.05, 9]undecane‐8,11‐lactam through selective acetylation and complete 1H and 13C NMR spectral assignment of the mono‐, di‐ and triacetates
Authors: Martins F. J. C. , Viljoen A. M. , Kruger H. G. , Wessels P. L.
Published: March 2004

NMR techniques cannot unambiguously distinguish between 11‐amino‐8‐hydroxypentacyclo[5.4.0.02, 6.03, 10.05, 9]undecane‐8,11‐lactam and 8‐amino‐11‐hydroxypentacyclo[5.4.0.02, 6.03, 10.05, 9]undecane‐8,11‐lactam, both of which are possible products during the reaction of pentacyclo[5.4.0.02, 6.03, 10.05, 9]undecane‐8,11‐dione with Strecker reagents. Treatment of 11‐amino‐8‐hydroxy‐pentacyclo[5.4.0.02, 6.03, 10.05, 9]undecane‐8,11‐lactam with acetic anhydride at room temperature produced a monoacetate. With acetic anhydride containing sodium acetate, a triacetate was obtained at reflux temperature. Treatment with acetyl chloride and N,N‐dimethylaniline produced a diacetate. High‐field 1H and 13C NMR techniques were used in the structure elucidation and assignment of the different NMR resonances of these three acetylated compounds. Copyright © 2004 John Wiley & Sons, Ltd.
Phosphorylated amino acids: model compounds for solid‐state 31P NMR spectroscopic studies of proteins
Authors: Iuga Adriana , Brunner Eike
Published: March 2004

Solid‐state 31P NMR spectroscopy was applied to measure the isotropic chemical shifts, chemical shift anisotropies and asymmetry parameters of three phosphorylated amino acids, O‐phospho‐L‐serine, O‐phospho‐L‐threonine and O‐phospho‐L‐tyrosine. The cross‐polarization buildup rates and longitudinal relaxation times of 31P and 1H were‐determined and compared with the values measured for a triphosphate (GppCH2p) bound to a crystalline protein (Ras). It is shown that the phosphorylated amino acids are well‐suited model compounds, e.g. for the optimization of experiments on crystalline proteins. Two‐dimensional exchange experiments on O‐phospho‐L‐tyrosine indicate the existence of an exchange between the two different conformations of the molecule. Copyright © 2004 John Wiley & Sons, Ltd.
Evidence of a phase transition of RbHCO3 from high‐resolution solid‐state 13C and 87Rb NMR by comparison with KHCO3
Authors: Odin Christophe
Published: March 2004

A variable‐temperature high‐resolution 13C and 87Rb solid‐state NMR study of powder rubidium hydrogencarbonate, RbHCO3, is presented for the first time. At ambient temperature, RbHCO3 is formed by centrosymmetric dimers linked by hydrogen bonds, but almost no information is available on this compound concerning proton disorder and the low‐temperature phase. However, potassium hydrogencarbonate, KHCO3, which has an isomorphic structure for the high temperature phase, was well studied: it undergoes a non‐ferroic, non‐ferroelectric phase transition at Tc = 318 K between two monoclinic structures. The protons are disordered in an asymmetric double‐well potential in the low‐temperature phase, and the double‐well potential becomes symmetric in the high‐temperature phase. By comparison with recent solid‐state NMR experimental results on KHCO3, we show that RbHCO3 undergoes a phase transition at Tc ≈ 245 K, and give evidence that the proton dynamic disorder in both compounds is very similar. Copyright © 2004 John Wiley & Sons, Ltd.
Assignment of 13C resonances of a nematic liquid crystal using off‐magic angle spinning
Authors: Vinay Deepak H. S. , Joy Anu , Suryaprakash N. , Ramanathan K. V.
Published: March 2004

A novel method for assigning the resonances in the 13C NMR spectrum of a static liquid crystalline sample in its nematic phase is proposed. The method is based on the fact that the carbon chemical shifts in the isotropic phase and in the oriented phase under static and off‐magic angle spinning (OMAS) conditions are uniquely related by the tensorial property of the CSA tensor, requiring just one OMAS spectrum and the assignment in the isotropic phase. A computational procedure is proposed to take into account deviations arising out of non‐ideal experimental conditions and the assignments are made by identifying the minimum in the differences in the frequencies between calculated and experimental line positions. Practical implementation of the method has also been demonstrated in the case of the liquid crystal N‐(4‐ethoxybenzylidene)‐4‐n‐butylaniline. Copyright © 2004 John Wiley & Sons, Ltd.
Is high‐resolution magic angle spinning NMR a practical speciation tool for cheese samples? Parmigiano Reggiano as a case study
Authors: Shintu Laetitia , Ziarelli Fabio , Caldarelli Stefano
Published: March 2004

High‐resolution magic angle spinning (HRMAS) NMR is probably the most apt NMR method to analyze complex materials involving a solid phase, e.g. foodstuffs. We present here an HRMAS analysis of grated cheese (Parmigiano Reggiano). A full NMR characterization of this cheese allows the identification of the presence of fatty acids (saturated and unsaturated), amino acids and other small organic molecules. Since the presence and relative concentration of these molecules have previously been shown to correlate with organoleptic, origin and age characterization, HRMAS NMR of cheese is likely to provide a good complimentary tool for the analysis of this food material. Copyright © 2004 John Wiley & Sons, Ltd.
Structural elucidation by 1D and 2D NMR of three isomers of a carotenoid lysophosphocholine and its synthetic precursors
Authors: Foss Bente Jeanette , Krane Jostein
Published: March 2004

A carotenoic acid was used to obtain a long‐chain unsaturated lysophosphocholine. The carotenoid lysophosphocholine was synthesized by two methods. The first method resulted in mixtures of regioisomers for each step in the synthetic route. Homo‐ and heteronuclear 1D and 2D NMR methods were employed to elucidate the structures of the individual isomers and their intermediates. The pure regioisomer [1‐(β‐apo‐8′‐carotenoyl)‐2‐lyso‐glycero‐3‐phosphocholine] was obtained by a second method, but in low yield. The 1D 1H NMR subtraction spectrum of the mixture and the pure regioisomer was used to interpret the 1H shifts of the unsaturated acyl moieties. The 1H and 13C signals of the acyl chain show characteristic shifts depending on the positions of the choline and the acyl group attached to the glycerol backbone. Therefore, the unsaturated acyl chain signals have diagnostic values for the identification of isomers of unsaturated (lyso)phosphocholines. Chemical shifts and indirect coupling constants are reported for each of the major components of the mixtures. The methods used were 1D (1H, 13C and 31P) and 2D (H,H‐COSY, HMBC, HSQC and HETCOR) NMR. Copyright © 2004 John Wiley & Sons, Ltd.
Design of adaptive controllers using partial certainty equivalence principle
Authors: Filatov N.M.
Published: March 2004

Optimal stochastic control problem for general non‐linear dynamic system with unknown parameters is considered. An approximative assumption, which has been named partial certainty equivalence (PCE) principle, is suggested for design of adaptive controllers of non‐linear and linear stochastic systems. For derivation of a suboptimal controller with the PCE principle the certainty equivalence (CE) assumption is used only for the part of the system states and unknown parameters. The PCE control policy has a simple form for linear systems with unknown parameters. It is suggested in the present paper to design adaptive dual control using the PCE assumption and bicriterial optimization to derive the adaptive controller with the optimal persistent excitation. Simulated examples are used to demonstrate the potential of the suggested method and its superiority over the generally used CE‐controllers. Copyright © 2004 John Wiley & Sons, Ltd.
Optimal exploitation of renewable resource stocks: necessary conditions
Authors: Baumeister J. , Leitão A.
Published: March 2004

We study a model for the exploitation of renewable stocks developed in Clark et al. (Econometrica 1979; 47:25–47). In this particular control problem, the control law contains a measurable and an impulsive control component. We formulate Pontryagin's maximum principle for this kind of control problems, proving first‐order necessary conditions of optimality. Manipulating the correspondent Lagrange multipliers we are able to define two special switch functions, that allow us to describe the optimal trajectories and control policies nearly completely for all possible initial conditions in the phase plane. Copyright © 2004 John Wiley & Sons, Ltd.
Analysis of factors associated with prescription of a potentially inappropriate combination dermatological medication among US outpatient physicians
Authors: Balkrishnan Rajesh , Cook Jeffrey M. , Shaffer Matthew P. , Saltzberg Felicia B. , Feldman Steven R. , Fleischer Alan B.
Published: March 2004

Purpose

Despite concern associated with the necessity of an additional fluorinated, high potency topical corticosteroid, the clotrimazole/betamethasone diproprionate combination remains a frequently prescribed topical agent in the US. This research was performed to better understand the physician and patient characteristics associated with the prescription of this combination medication in outpatient settings.

Methods

Data from the National Ambulatory Medical Care Survey (1990–2000) were used to determine the patient and physician factors associated with a prescription for clotrimazole/betamethasone diproprionate. The most common diagnoses of patients treated with the drug were also determined.

Results

Family medicine physicians were more than twice as likely (OR: 2.28, 95%CI: 1.56, 3.33) and internists were more than 3 times as likely (OR: 3.10, 95%CI: 1.99, 4.84) to prescribe clotrimazole/betamethasone diproprionate compared to pediatricians, the reference category. Dermatologists were less likely to prescribe these medications compared to pediatricians (OR: 0.35, 95%CI: 0.23, 0.54). Prescription for potentially inappropriate indications was detected across all specialties. Prescription rates of the combination medication were higher among patients of non‐white race (OR: 1.56, CI: 1.08, 2.26).

Conclusions

The increased risk of potentially inappropriate prescription of clotrimazole/betamethasone diproprionate by physicians across all specialties and increased probability of medication receipt in racial minorities is of concern, when safer alternatives such as antifungals or anti‐inflammatory medications without the side effects of the combination medication are easily available. Copyright © 2003 John Wiley & Sons, Ltd.
Reported adverse drug reactions and their determinants in Dutch children outside the hospital
Authors: Schirm Eric , Tobi Hilde , van Puijenbroek Eugène P. , Monster‐Simons Margje H. , de Jong‐van den Berg Lolkje T. W.
Published: March 2004

Purpose

The interpretation of the available studies on adverse drug reactions (ADRs) in children outside the hospital is hampered because none of these studies used a control group. The aim of this study was to describe ADRs in children outside the hospital, controlled for drug use in the paediatric background population.

Methods

Using a case‐control design, we compared drugs on which a suspected ADR was reported to the Netherlands Pharmacovigilance Centre LAREB, and drugs used in the general paediatric population from the InterAction pharmacy database, both in the year 2001, for children aged 0–16 years.

Results

The main findings are that ADRs were disproportionately more often reported on systemic drugs (OR 3.0; [95%CI: 1.9–4.8]), new drugs (2.4; [1.6–2.7]), anti‐infective drugs (1.7; [1.1–2.7]) and nervous system drugs (2.1; [1.3–3.5]), whereas unlicensed drugs (0.1; [0.0–0.4]), frequently used drugs (0.3; [0.2–0.5]) and dermatologicals (0.1; [0.0–0.4]) were less likely to be associated with a reported ADR. Overall, the proportion of off‐label prescriptions did not differ between drugs suspected of an ADR and drugs used by children in a general population.

Conclusions

The pattern of drugs associated with a reported ADR could not be solely explained on the basis of drug utilisation patterns in the general population. Copyright © 2003 John Wiley & Sons, Ltd.
Uptake of COX‐2 selective inhibitors and influence on NSAID prescribing in Northern Ireland
Authors: Girvin Briegeen , Rafferty Thérèse , Stevenson Michael R. , Johnston G. Dennis
Published: March 2004

Purpose

Rofecoxib and celecoxib have been recently introduced and promoted as ‘safer’ non‐steroidal anti‐inflammatory drugs (NSAIDs) regarding gastric toxicity. The primary aim was to measure their uptake and any impact on conventional NSAID prescribing. A secondary aim was to assess any change in proton pump inhibitor (PPI) prescribing.

Methods

Prescribing data in terms of defined daily doses (DDDs) were pooled from 1997 onwards. Linear trends in the data were tested for using regression analyses. Direct comparisons were made between the April–June quarter of the year 1999 (i.e. before the introduction of rofecoxib and celecoxib) and the same quarter 3 years later.

Results

Overall NSAID prescribing in Northern Ireland was found to be increasing linearly at an estimated rate of 154 000 DDDs per quarter since the introduction of celecoxib and rofecoxib. The rate of increase in the volume of prescribing of the two new drugs was found to be four times the rate of decrease in prescribing of the ‘older’ NSAIDs. Overall prescribing of anti‐inflammatory agents had increased from 37.8 to 47.7 DDDs/1000 patients/day over 3 years with no effect on the upward trend in PPI prescribing.

Conclusions

The introduction of rofecoxib and celecoxib has increased prescribing volume of anti‐inflammatory agents by 26% in Northern Ireland over the 3‐year period. This could pose safety problems in the future as more people are being prescribed anti‐inflammatory agents. Copyright © 2003 John Wiley & Sons, Ltd.
Survey of the use of complementary and alternative medicine among Korean diabetes mellitus patients
Authors: Lee Myung‐Suk , Lee Myeong Soo , Lim Hyun‐Ja , Moon Sun‐Rock
Published: March 2004

Purpose

This study was designed to measure the prevalence of complementary and alternative medicine (CAM) use among Korean diabetes mellitus (DM) patients.

Methods

A 23‐question survey on DM was used and included questions on demographic information (7), clinical information (7) and the utilisation of CAM (9).

Results

Of 223 respondents, 145 (65%) had taken CAM products, while 78 (35%) had not. At the suggestion of family members and relatives, 43.5% of the respondents started taking CAM products. A total of 57.9% of the users felt that it was effective, 30.3% considered that it regulated the blood glucose level and 27.6% felt it was effective in achieving psychological relaxation. Of 93 CAM materials used by respondents, 63.7% were various types of plants, 21.6% were animal material and 14.7% were a mixture of both. The majority of DM patients (81.2%) were trying a new type of CAM, and one third of all patients were trying to start using a new type of CAM after consulting with their physicians.

Conclusions

Doctors should recognise that complementary medicines are widely used by diabetic patients and should appreciate that these medicines can cause adverse effects. Doctors should therefore be prepared to question patients to determine what non‐conventional medicines they are using. Copyright © 2003 John Wiley & Sons, Ltd.
Antibiotic use profile at paediatric clinics in two transitional countries
Authors: Palčevski Goran , Ahel Vladimir , Vlahović‐Palčevski Vera , Ratchina Svetlana , Rosovic‐Bazijanac Vesna , Averchenkova L.
Published: March 2004

Purpose

In this study, we evaluated antibiotic utilisation pattern at two paediatric clinics in different European (transitional) countries: Croatia (Rijeka) and Russia (Smolensk).

Methods

Antibiotic utilisation during the year 2000 was observed using the ATC/defined daily doses (DDD) methodology (ATC code‐J01). Drug‐usage data was expressed in numbers of DDD/100 bed‐days and the DU90% profile.

Results

In Rijeka, 35 different systemic antibiotics were used and in Smolensk 22. The overall consumption of antibiotic drugs in Rijeka was more than three times higher than in Smolensk (28.96 vs 8.3 DDD/100 bed‐days). The top five antibiotic drugs used in Smolensk were amoxicillin, mydecamicin, ampicilin, doxycylin, gentamicin; and in Rijeka cefuroxime axetil, ceftriaxone, azytromycin, ceftibuten and amoxicillin.

Conclusion

Differences in antibiotic prescribing patterns are greater than expected. The pattern of antibiotic utilisation in both countries implies that regional control measures and guidelines for antibiotic use in children should be urgently established. Copyright © 2003 John Wiley & Sons, Ltd.
How to estimate the population that is covered by community pharmacies? An evaluation of two methods using drug utilisation information
Authors: Schirm Eric , Monster Taco B. M. , de Vries Robin , van den Berg Paul B. , de Jong‐van den Berg Lolkje T. W. , Tobi Hilde
Published: March 2004

Purpose

Pharmacy‐dispensing data are valuable sources of drug information, but the population that is covered by the pharmacies is often difficult to determine. We evaluated two methods using drug utilisation information to estimate the population size: a drug‐use‐based extrapolation of a known part of the population and a capture‐recapture estimation without any prior knowledge of the population.

Methods

Using pharmacy‐dispensing data of three towns with known populations in the Netherlands, we estimated age‐and‐sex specific population sizes by extrapolating the proportion of drug‐using inhabitants. In addition, we applied two‐source and three‐source capture‐recapture models with all combinations of the following drug groups as different sources: anti‐asthmatics, analgesics, antibiotics and anti‐histamines.

Results

Drug‐use‐based extrapolation resulted in the best estimates with the least variability. All capture‐recapture models provided underestimations of the true population. Three‐source capture‐recapture resulted in better average estimates than two‐source capture‐recapture, but also had more variability.

Conclusions

If a part of the population is known, and if there is reason to assume that drug utilisation patterns do not vary within the region, it is best to use drug‐use‐based extrapolation. In all other situations capture‐recapture may be considered, with as main limitation that we found all models to underestimate the population considerably. Copyright © 2003 John Wiley & Sons, Ltd.
Development of pharmacovigilance system in Ukraine: first results
Authors: Stefanov O. , Sharayeva M. , Jajtchenja V.
Published: March 2004

The article is devoted to the establishment and development of the National Pharmacovigilance system in Ukraine. A drug safety centre of Ukraine started to form a pharmacovigilance system in 1996. It has been operating on a regular basis since 2000 and now provides the regulatory services that include data collection and analysis, database management, education, international contacts, and the publication and dissemination of information. Our ultimate goal is to foster a rational and safe drug use and to improve the quality of pharmacotherapy in Ukraine. Copyright © 2003 John Wiley & Sons, Ltd.
A retrospective survey on the safety of Replenine®, a high‐purity factor IX concentrate
Authors: Gascoigne E. W. , Dash C. H. , Harman C. , Wilmot D.
Published: March 2004

An Erratum has been published for this article in Pharmacoepidemiology and Drug Safety 13(4) 2004, 267.

Purpose

To assess the safety of a plasma‐derived highly purified factor IX concentrate (Replenine®) in routine clinical use.

Methods

Following guidelines entitled Safety Assessment of Marketed Medicines (SAMM), safety data were collected in the UK by retrospective review of the hospital notes of 114 patients who received an estimated 14.8 million IU of Replenine®. Included were 41 patients undergoing 44 surgical procedures or dental extractions.

Results

The study detected a total of nine adverse events (AEs), four of which were possibly product‐related, four that were unrelated to the product and one whose causality was unknown. None of these cases had been notified to the manufacturer through conventional spontaneous reporting procedures. One patient was switched from Replenine® because of infusion site irritation, but no unexpected adverse reactions were noted. There were no reports of virus transmission or new factor IX inhibitor development. The mean factor IX recovery value was 1.44 IU/dl per IU/kg (95%CI: 1.31–1.57 IU/dl per IU/kg).

Conclusions

The study was a practical application of the SAMM guidelines to the collection of pharmacovigilance data on patients with Haemophilia B. Replenine® is well tolerated in routine clinical practice. Published by John Wiley & Sons, Ltd.
Antihypertensive drug therapy and the risk of lower extremity amputations in pharmacologically treated type 2 diabetes patients
Authors: Erkens Joëlle A. , Klungel Olaf H. , Stolk Ronald P. , Spoelstra José A. , Grobbee Diederick E. , Leufkens Hubert G.M.
Published: March 2004

Purpose

The objective of this study was to determine the association between different antihypertensive drug therapies and lower extremity amputations (LEAs) in type 2 diabetes patients.

Methods

Data were obtained from the PHARMO Record Linkage System comprising pharmacy records and data on hospitalisations for all 450 000 residents of eight Dutch cities. In a nested case‐control study among 12 140 type 2 diabetes patients who used antihypertensive drugs, 26 cases with a first LEA and 94 controls without a LEA matched on age, sex and calendar time were identified. Logistic regression was used to estimate the relative risk of LEA and to adjust for potential confounding factors.

Results

Among type 2 diabetes patients who used antihypertensive drugs, subjects who used thiazide diuretics, alone or in combination, had a higher risk of LEA compared to subjects who used Angiotensin Converting Enzyme (ACE) inhibitor monotherapy (crude odds ratio (OR): 6.11 [95% confidence interval (CI): 1.32–28.27]). The use of thiazide diuretics was also associated with an increased risk of LEA when compared to the use of any non‐thiazide antihypertensive drug (adjusted OR: 7.04 [1.10–45.30]). The increased risk of LEA associated with the use of thiazides compared to the use of non‐thiazides depended on the duration of use (adjusted OR≤365 days, 4.82 [0.61–38.34] and adjusted OR>365 days, 26.16 [1.02–674.02], p‐trend = 0.01).

Conclusions

Treatment with thiazide diuretics compared to treatment with other antihypertensive drugs was associated with excess amputations in type 2 diabetes patients. Due to several limitations of this study, our findings do not preclude the use of thiazides in type 2 diabetes mellitus patients as yet. Copyright © 2004 John Wiley & Sons, Ltd.
The psychosocial needs of breast cancer survivors; A qualitative study of the shared and unique needs of younger versus older survivors
Authors: Thewes B. , Butow P. , Girgis A. , Pendlebury S.
Published: March 2004

Due to improvements in medical treatment and survival following breast cancer, researchers have turned their attention to investigating the needs of breast cancer survivors. There is disagreement about the extent to which survivors continue to experience psychological morbidity after treatment ends. Whilst the majority of women adjust well to breast cancer, some may have continued psychosocial needs. Available research suggests that younger pre‐menopausal women are at increased risk of psychological morbidity following breast cancer. The present study aimed to gather preliminary qualitative data on the psychosocial needs of breast cancer survivors and to identify the shared and unique needs of younger versus older survivors. A qualitative methodology was chosen as this was a relatively unexplored area of enquiry. Patients treated for early‐stage breast cancer who had completed their hospital‐based treatment 6–24 months prior to participation were recruited. Sampling was discontinued when informational redundancy was achieved. Eighteen telephone interviews were conducted. A wide variety of on‐going psychosocial and information needs were reported by breast cancer survivors including support needs, psychological needs, practical needs, physical needs and information needs. Younger women reported more needs than their older counterparts. Several needs reported by younger women were directly related to being of younger age or pre‐menopausal at the time of diagnosis. Clinical implications are discussed. Copyright © 2003 John Wiley & Sons, Ltd.
The skull beneath the skin: Cancer survival and awareness of death
Authors: Little Miles , Sayers Emma‐Jane
Published: March 2004

Terror management theory predicts that people made aware of their own mortality (mortality salience) will seek to boost their self‐esteem in order to buffer the anxiety they feel. One common resource to achieve this is strengthening social bonds with an admired in‐group. It would also seem to predict that cancer survivors and those close to them would be driven to a greater closeness. A similar closeness might be predicted between those with terminal illness and their families and other supporters. Some empirical observations suggest that there are other forms of death‐related salience which do not conform to the predictions of terror management theory.

We suggest that some of those who have recovered from cancer may be made death salient, while those close to them remain mortality salient. Death salience seems to turn people inward to the resources and challenges of their deep (subconscious and unconscious) minds, and confronts them with the realities of their deep identities. A third form of salience, dying salience, affects those who have terminal illness. Distinguishing between death salience and mortality salience provides one explanation for the frequency with which close relationships break down after recovery from cancer. The distinctive nature of dying salience raises important questions about the inappropriateness of survivors as providers of support for the dying. Copyright © 2003 John Wiley & Sons, Ltd.
Immune function and adjustment style: Do they predict survival in breast cancer?
Authors: Osborne Richard H. , Sali Avni , Aaronson Neil K. , Elsworth Gerald R. , Mdzewski Bogdan , Sinclair Andrew J.
Published: March 2004

The aim of this study was to investigate the role of immune status and psychosocial factors in survival from early breast cancer (N=61). Baseline assessments included lymphocyte number and function, natural killer cell activity (NKA), plasma cortisol and prolactin level. Psychosocial measures included anxiety, depression and mental adjustment to cancer and social support. Length of follow‐up was 6.1–7.9 years with 14 (23%) breast cancer deaths. In Cox proportional hazards models adjusting for lymph node status two parameters predicted longer survival, low NKA (HR 29 per LLU, p=0.003) and minimizing the illness adjustment (HR 0.64 per scale point, p=0.012). These data provide little evidence for a psychoneuroimmunological mechanism in the survival from breast cancer. While this study is limited due to small sample size, and therefore the possibility of inflated estimates, longer survival in those minimizing the illness is a finding consistent with recent studies; however, the counter‐intuitive finding that high NKA predicts shorter survival may be a marker for current disease or response to treatments. Copyright © 2003 John Wiley & Sons, Ltd.
The quality of life for cancer children (QOLCC) in Taiwan (part I): Reliability and construct validity by confirmatory factor analysis
Authors: Yeh Chao‐Hsing , Chao Kuo‐Yu , Hung Li‐Chen
Published: March 2004

Part 1, the current paper describes the development and testing of a quality‐of‐life (QOL) assessment specifically designed for Taiwanese pediatric cancer patients (7–18 years) and their parents/caregivers. The assessment instrument was established based on a qualitative study, then refined using recognized item‐analysis methods and pilot tested on a group of 25 patients. The final assessment instrument included three versions of the same instrument, a patient self‐report (QOLCC‐7–12, for children aged 7–12 years; QOLCC‐ADO for adolescent aged 13–18 years) and a parent proxy‐report (QOLCC‐PAR). The final seven‐subscale tool has a total of 34 items and was tested among 106 young cancer patients and 106 their parents. Psychometric properties of the measure were tested using item analysis, Cronbach's alpha, and a confirmatory factor analysis. Results suggest acceptable reliability and goodness of fit of this seven‐scale measure. In order to test the factor validity of QOLCC, an independent group of 42 children with cancer participated. The results of confirmatory factor analysis shows the goodness of fit in QOLCC. Copyright © 2003 John Wiley & Sons, Ltd.
The quality of life for cancer children (QOLCC) for Taiwanese children with cancer (part II): Feasibility, cross‐informants variance and clinical validity
Authors: Yeh Chao‐Hsing , Hung Li‐Chen , Chao Kuo‐Yu
Published: March 2004

The quality of life in childhood cancer (QOLCC) is a research instrument that has been developed to assess the quality of life for children and adolescents who suffer from cancer in Taiwan. The current paper is the second of a two‐part series of research reports. Part I is reported in this journal (Yeh et al., 2003). Part II describes the range of measurement, concordance of cross‐informants reports, and clinical validity of Taiwanese pediatric cancer children (7–12 years) and adolescents (13–18 years) and their parents/caregivers. Due to the cognitive ability of children and adolescents, data were analyzed for children and adolescent separately. The validity of cross‐referenced information between parent and child forms was subsequently examined using Pearson product correlation. The feasibility (percentage of missing values per item) and range of measurement [percentage of minimum (floor effect) and maximum (ceiling effect) possible scores] was calculated for the five QOLCC and the total scale score. The findings of medium to high correlation of the patient/parent responses strongly imply that relevant information might be obtainable through parents when children are unable or unwilling to complete the assessment instrument. Feasibility for the QOLCC was very good. Copyright © 2003 John Wiley & Sons, Ltd.
Depressive symptoms after breast cancer surgery: Relationships with global, cancer‐related, and life event stress
Authors: Golden‐Kreutz Deanna M. , Andersen Barbara L.
Published: March 2004

For women with breast cancer, rates of depression are the third highest of any cancer diagnostic group. Stress, defined as life events or perceptions of stress, is associated with depressive symptoms. However, little is known about the relationships between different types of stress and these symptoms in women with breast cancer. This relationship was tested in 210 women assessed after initial surgical treatment for regional breast cancer. Using Hierarchical Multiple Regression, three types of stress were examined: the occurrence of five stressful life events in the year prior to cancer diagnosis, perceptions of global stress, and perceptions of cancer‐related traumatic stress. Other potentially relevant correlates of depressive symptoms were also examined, including the personality trait neuroticism, sociodemographics, and disease/treatment characteristics. Fifty‐three percent of the variance in depressive symptoms was accounted for by three stress variables (perceptions of global and cancer‐related traumatic stress and the life event‐major financial difficulty) and two control variables (neuroticism and racial group). Specifically, global stress perceptions coupled with cancer‐related intrusive thoughts and financial concerns along with the tendency towards negativity (neuroticism) may conspire to heighten a women's risk for depressive symptoms. Assessing multiple sources of stress would improve our ability to identify women ‘at risk’ for depressive symptoms and provide appropriate intervention. Copyright © 2003 John Wiley & Sons, Ltd.
Then and now: quality of life of young breast cancer survivors
Authors: Bloom Joan R. , Stewart Susan L. , Chang Subo , Banks Priscilla J.
Published: March 2004

Background: Women under age 50, a quarter of all cases of breast cancer, are especially vulnerable to physical and psychosocial late effects of their treatment due to having more aggressive treatment and their relative youth.

Methods: In person interviews were conducted with the population‐based sample: 185 women who were under 50 at diagnosis and were cancer‐free 5 years later. Quality of life in the physical, psychological, social, and spiritual domains was assessed and compared with results obtained a few months after diagnosis.

Results: Five years after diagnosis, 92% rated their health as good or excellent, and only 10% said their health had been getting worse. Between baseline and 5 years, there were significant improvements in surgical symptoms, body image, worry about the future, patient–physician communication, intrusiveness of treatment, and all of the SF‐36 measures except for general health. There were significant decreases in emotional support and the size of one's social network. More women were now menopausal (75% due to treatment) and there were fewer children at home. There were no significant changes in employment status, marital/partner status, sexual activity, sexual problems, self‐esteem, and attendance at religious services or frequency of prayer. In multivariate models, a greater increase in physical quality of life was associated with reporting fewer chronic conditions, being employed, having been treated by chemotherapy and fewer had no children under age 18 living at home. A greater increase in mental quality of life was associated with fewer chronic conditions and a smaller decrease in emotional support.

Conclusions: Five years after diagnosis, young breast cancer survivors who remained cancer‐free enjoyed good health and improved quality of life. Nonetheless, physical, social, and psychological concerns must be addressed so that young breast cancer survivors will continue to be resilient as they age. Copyright © 2004 John Wiley & Sons, Ltd.
Factors affecting clinical outcome in gastrostomy‐fed children with cystic fibrosis
Authors: Oliver Mark R. , Heine Ralf G. , Ng Chi Hang , Volders Evelyn , Olinsky Anthony
Published: March 2004

In order to assess the effects of gastrostomy feeding on nutritional status, respiratory function, and survival in children with cystic fibrosis (CF), we studied all patients undergoing gastrostomy between 1989–1997 at the Royal Children's Hospital, Melbourne. Clinical information was collected from medical records, including serial measurements of weight‐for‐age standard deviation scores (WAZ) and forced expired volume in 1 sec (FEV1) (percent predicted). Measurements were compared for 2 years before and 2 years after gastrostomy placement. Data on gastroesophageal reflux (GER), adherence to the gastrostomy feeding program, and sputum culture were also assessed. Of 37 children (22 male; mean age, 11.6 ± 4.8 years; range, 3–20), 11 died during the study period (7 female, 4 male). Female patients were more likely to die within 2 years of gastrostomy placement (OR = 3.9; 95% CI, 0.72–23.2; P = 0.07). Mortality was significantly associated with a WAZ score <−2 (OR = 10.7; 95% CI, 1.07–466.6; P = 0.02) and predicted FEV1 <50% (OR = 10.8; 95% CI, 1.07–512.9; P = 0.02) at time of gastrostomy. Patients with clinical evidence of GER (n = 11) had significantly lower weight gain after gastrostomy (delta WAZ, −0.32 ± 0.26 vs. 0.03 ± 0.39; P = 0.03). In conclusion, the presence of advanced lung disease, GER, and female gender were factors associated with a poor clinical outcome after gastrostomy placement. Pediatr Pulmonol. 2004; 37:324–329. © 2004 Wiely‐Liss, Inc.
Exercise testing and training in German CF centers
Authors: Barker Michael , Hebestreit Alexandra , Gruber Wolfgang , Hebestreit Helge
Published: March 2004

Physical exercise is increasingly recognized as a valuable diagnostic and therapeutic modality for patients with cystic fibrosis (CF). We sought to characterize the use of exercise testing and training as well as the attitude toward both issues through a national survey. A questionnaire was sent to 107 specialized CF centers (caring for a total of 5,231 patients) and 7 inpatient rehabilitation institutions. Answers were available from 62 specialized centers caring for 3,580 patients and from 4 rehabilitation centers with 520 treatment episodes per year. Sixty percent of specialized centers performed some sort of exercise testing at an average frequency of 1 in 2.3 years for patients aged 8 and above. However, protocols and indication criteria were often unstandardized or not specified at all. Equipment availability was no major problem, and the majority of tests were conducted by a physician alone. Nineteen centers had adopted exercise testing as part of their diagnostic routine. Two thirds of caregivers advised their patients to engage in physical activity, but failed to discuss specific modalities and potential hazards. Nevertheless, physical exercise was viewed as “extremely important” or “very important” by 87%. In a rehabilitation setting, an exercise test was conducted 1.1 times per patient stay, and a training program offered in 100% of cases. In conclusion, standardized exercise testing and training programs appear to be underused in German CF centers, despite a high degree of interest in the topic. Supplementary material for this article can be found on the Pediatric Pulmonology website (http//www.interscience.wiley.com/jpages/8755‐6863/suppmat). Pediatr Pulmonol. 2004; 37:351–355. © 2004 Wiely‐Liss, Inc.
Airway inflammation in children with tracheostomy
Authors: Griese M. , Felber J. , Reiter K. , Strong P. , Reid K. , Belohradsky B.H. , Jäger G. , Nicolai T.
Published: March 2004

We hypothesised that long‐term tracheostomy in infants and children may perpetuate chronic airway inflammation and airway remodeling due to easier access to the lungs for microorganisms. Pulmonary surfactant represents an important part of the initial host defense, and in particular, the surfactant proteins (SP) A and D may directly interact with invading microorganisms and also modulate the activity of local immune cells. The goals of this study were to determine the presence and intensity of a peripheral airway inflammation and of potential deficiency states of surfactant proteins in nonsymptomatic children with tracheostomy. Bronchoalveolar lavage (BAL) cell pattern, bacteria and viruses recovered, and concentrations of SP‐A, SP‐B, SP‐C, and SP‐D were assessed in 46 children (4.3 years (1.6–6)) median (range) carrying a tracheostomy for 2.4 years (1.3–4.9), and were compared to 16 children with no lung disease. Children with tracheostomy had an increased total number of cells, increased neutrophils, and more frequently bacteria, but no viruses were recovered. SP‐D concentration was reduced by 50% on average (P = 0.0002). SP‐A, SP‐B, and SP‐C were not different between the two groups. SP‐D was inversely correlated to neutrophils, and high numbers of bacteria were associated with lower SP‐D concentrations. We suggest that bacteria and low SP‐D support neutrophilic inflammation in the lower respiratory tract of nonsymptomatic with children with tracheostomy. Pediatr Pulmonol. 2004; 37:356–361. © 2004 Wiely‐Liss, Inc.
Drug delivery and adherence in young children
Authors: Iqbal Shaikh , Ritson Sue , Prince Ivan , Denyer John , Everard Mark L.
Published: March 2004

The aim of this pilot study was to compare a the HaloLite Paediatric Nebulizer (HPN) with a pressurized metered dose inhaler and valved holding chamber (pMDI VHC, Aerochamber™) in terms of drug delivery, adherence to treatment, compliance with device, true adherence, and acceptability. Fourteen children aged 11–36 months with asthma on regular treatment with inhaled corticosteroids were enrolled into an open, randomized, crossover trial. They received budesonide for 2 weeks with each delivery system. Both devices incorporated a datalogger which recorded information on how the device was used. The HPN was preprogrammed to deliver 25 μg of budesonide to the patient. A single actuation of budesonide 200 μg was used with the pMDI VHC. The median delivered dose of budesonide was 36 μg (range, 31–45 μg; CV, 15%) for the HPN and 53 μg (range, 17–85 μg; CV, 47%) for the pMDI VHC. The median adherence was 68% (range, 11–96%) with the HPN and 71% (range, 11–100%) with the pMDI VHC. The median device compliance was 30% and 51% and the median true adherence was 23% and 36%, respectively. The shape, size, and weight of the HaloLite Paediatric Nebulizer were generally less acceptable than the shape, size, and weight of the pMDI VHC with datalogger. These results indicate that reproducible quantities of drug can be delivered to very young children using AAD™ technology such as that incorporated into the HPN. Drug delivery with the pMDI VHC was more variable, but parents preferred this device. Pediatr Pulmonol. 2004; 37:311–317. © 2004 Wiely‐Liss, Inc.
Cleft sternum: Case report and literature review
Authors: Abel R.M. , Robinson M. , Gibbons P. , Parikh D.H.
Published: March 2004

The isolated sternal cleft is a rare congenital anomaly that presents from birth to adulthood. We describe the late presentation and management in a child with this condition. The modern investigative and operative options are reviewed. Pediatr Pulmonol. 2004; 37:375–377. © 2004 Wiely‐Liss, Inc.
Predicting response to rhDNase and hypertonic saline in children with cystic fibrosis
Authors: Suri Ranjan , Metcalfe Christopher , Wallis Colin , Bush Andrew
Published: March 2004

Daily recombinant human deoxyribonuclease (rhDNase) is an established but expensive treatment in cystic fibrosis (CF). Alternate‐day rhDNase and hypertonic saline (HS) represent potential cheaper alternative therapies. However, not all patients improve on treatment. To assess response, many CF centers have developed formal n‐of‐1 trials of treatment to find out who benefits. Response to daily rhDNase at 3 months has been shown to be a good predictor of response at 1 year. There are no data correlating individual response at a shorter time period with 3‐month response. We assessed whether individual responses to daily rhDNase, alternate‐day rhDNase, and HS could be predicted from lung function response at 6 weeks, thus shortening the n‐of‐1 trial, or from baseline patient characteristics, therefore avoiding the need for an n‐of‐1 trial. In a randomized crossover trial, 48 CF children were allocated consecutively to 12 weeks of once‐daily 2.5‐mg rhDNase, alternate‐day 2.5‐mg rhDNase, and twice‐daily 5 ml of 7% HS. Forced expiratory volume in 1 sec (FEV1) and forced vital capacity (FVC) were measured at baseline and then at 6 and 12 weeks into each treatment period. Lung function response to the drugs at 6 weeks was highly predictive of response at 3 months. There was some evidence that response to HS was worse in patients with lower baseline lung function. However, there was no association between response to alternate‐day or daily rhDNase and baseline characteristics. In conclusion, response to rhDNase and HS at 6 weeks was highly predictive of response at 3 months. For daily and alternate‐day rhDNase, at least, the drug needs to be administered for at most 6 weeks initially to assess long‐term response to treatment. Response to treatment could not be reliably predicted from baseline characteristics. Pediatr Pulmonol. 2004; 37:305–310. © 2004 Wiely‐Liss, Inc.