bluuebunny/crossref_metadata_2025 huggingface dataset:
Signal-Dependent Protein Synthesis by Activated Platelets
Authors: Zimmerman Guy A. , Weyrich Andrew S.
Published: February 2008

New biologic activities of platelets continue to be discovered, indicating that concepts of platelet function in hemostasis, thrombosis, and inflammation require reconsideration as new paradigms evolve. Studies done over 3 decades ago demonstrated that mature circulating platelets have protein synthetic capacity, but it was thought to be low level and inconsequential. In contrast, recent discoveries demonstrate that platelets synthesize protein products with important biologic activities in a rapid and sustained fashion in response to cellular activation. This process, termed signal-dependent translation, uses a constitutive transcriptome and specialized pathways, and can alter platelet phenotype and functions in a fashion that can have clinical relevance. Signal-dependent translation and consequent protein synthesis are examples of a diverse group of posttranscriptural mechanisms in activated platelets that are now being revealed.
GIT1 Mediates HDAC5 Activation by Angiotensin II in Vascular Smooth Muscle Cells
Authors: Pang Jinjiang , Yan Chen , Natarajan Kanchana , Cavet Megan E. , Massett Michael P. , Yin Guoyong , Berk Bradford C.
Published: February 2008

Objective—

The G protein-coupled receptor (GPCR)-kinase2 interacting protein1 (GIT1) is a scaffold protein involved in angiotensin II (Ang II) signaling. Histone deacetylase-5 (HDAC5) has emerged as an important substrate of calcium/calmodulin-dependent protein kinase II (CamK II) in GPCR signaling. Here we investigated the hypothesis that Ang II-mediated vascular smooth muscle cell (VSMC) gene transcription involves GIT1-CamK II-dependent phosphorylation of HDAC5.

Methods and Results—

Ang II rapidly stimulated phosphorylation of HDAC5 at Ser498 in VSMCs. Knockdown of GIT1 significantly decreased HDAC5 phosphorylation induced by Ang II. The involvement of Src, phospholipase γ (PLCγ), and CamK II in GIT1-mediated HDAC5 phosphorylation was demonstrated. The association of GIT1 and CamK II was constitutive but increased after stimulation with Ang II. Moreover, the interaction of GIT1 and CamK II through the ARF GTPase-activating protein (ARF-GAP) and coiled-coil domains of GIT1 was essential for the phosphorylation of HDAC5. Finally, knockdown of GIT1 decreased myocyte enhancer factor 2 transcriptional activity induced by Ang II.

Conclusions—

This study identifies a novel function for GIT1 as a mediator of Ang II-induced VSMC gene transcription via a Src-PLCγ-CamK II-HDAC5 signaling pathway.
New Anticoagulants for Treatment of Venous Thromboembolism
Authors: Gross Peter L. , Weitz Jeffrey I.
Published: February 2008

Anticoagulant therapy is the cornerstone of treatment of venous thromboembolism (VTE). Such treatment is divided into 2 stages: Rapid initial anticoagulation is given to minimize the risk of thrombus extension and fatal pulmonary embolism, whereas extended anticoagulation is aimed at preventing recurrent VTE, thereby reducing the risk of postphlebitic syndrome. With currently available drugs, immediate anticoagulation can only be achieved with parenteral agents, such as heparin, low-molecular-weight heparin, or fondaparinux. Extended treatment usually involves the administration of vitamin K antagonists, such as warfarin. Emerging anticoagulants have the potential to streamline VTE treatment. These agents include idraparinux, a long-acting synthetic pentasaccharide that is given subcutaneously on a once-weekly basis, and new oral anticoagulants that target thrombin or factor Xa. This article (1) reviews the pharmacology of these agents, (2) outlines their potential strengths and weaknesses, (3) describes the results of clinical trials with these new drugs, and (4) identifies the evolving role of new anticoagulants in the management of VTE.
Adiponectin Protects Against Angiotensin II or Tumor Necrosis Factor α–Induced Endothelial Cell Monolayer Hyperpermeability
Authors: Xu Shi-Qiong , Mahadev Kalyankar , Wu Xiangdong , Fuchsel Lauren , Donnelly Sylvia , Scalia Rosario G. , Goldstein Barry J.
Published: February 2008

Objective—

Angiotensin II (Ang II) and tumor necrosis factor (TNF)-α levels increase endothelial permeability, and we hypothesized that adiponectin suppressed these responses in a cAMP-dependent manner.

Methods and Results—

The effect of adiponectin on transendothelial electric resistance (TEER) and diffusion of albumin through human umbilical vein and bovine aortic endothelial cell monolayers induced by Ang II (100 nmol/L) or TNF-α (5 ng/mL) was measured. Treatment with the globular domain of adiponectin (3 μg/mL) for 16 hours abrogated the adverse TEER effect of TNF-α (−35 versus −12 Ω/cm
2
at 45 minutes,
P
<0.05) and Ang II (−25 versus −5 Ω/cm
2
at 45 minutes,
P
<0.01) and partially suppressed the increased diffusion of albumin with Ang II (40% versus 10% change,
P
<0.05) or TNF-α (40% versus 20% change,
P
<0.05). Full-length adiponectin also suppressed Ang II–induced monolayer hyperpermeability. Adiponectin treatment also suppressed Ang II–induced increased actin stress fiber development, intercellular gap formation, and β-tubulin disassembly. Adiponectin increased cAMP levels, and its effects were abrogated by inhibition of adenylyl cyclase or cAMP-dependent protein kinase signaling.

Conclusions—

Adiponectin protects the endothelial monolayer from Ang II or TNF-α-induced hyperpermeability by modulating microtubule and cytoskeleton stability via a cAMP/ PKA signaling cascade.
Gender Differences in Stroke Examined in a 10-Year Cohort of Patients Admitted to a Canadian Teaching Hospital
Authors: Reid John M. , Dai Dingwei , Gubitz Gord J. , Kapral Moira K. , Christian Christine , Phillips Stephen J.
Published: February 2008

Background and Purpose—

Studies suggest that women with stroke are investigated less aggressively and receive tissue plasminogen activator less frequently than men. We tested whether gender differences in the investigation, treatment, and outcome of stroke are due to confounding factors.

Methods—

Gender differences in the use of investigations, trial enrollment, treatment with intravenous tissue plasminogen activator, and in-hospital outcomes were examined in data from our prospective registry using multivariate analysis to adjust for age, prestroke functional status, stroke subtype and severity, and atrial fibrillation.

Results—

Of 2725 consecutive hospitalized patients (1996 to 2006), 88% had ischemic stroke and 48% were women. Women were older (median age, 77 versus 70 years), had more severe strokes, and were less likely to be independent prestroke (78% versus 87%) compared with men (all
P
<0.001). The proportion of women, but not men, aged ≥80 years, increased significantly between 1996 to 1997 and 2005 to 2006. After adjustment for confounding, women were less likely to have infratentorial strokes (OR, 0.78; 95% CI, 0.62 to 0.97), be able to walk unaided on admission (OR, 0.69; 95% CI, 0.54 to 0.87), be treated with tissue plasminogen activator (OR, 0.51; 95% CI, 0.35 to 0.72), experience pneumonia (OR, 0.38; 95% CI, 0.26 to 0.55), achieve a discharge Barthel Index of ≥95 (OR, 0.75; 95% CI, 0.61 to 0.94, and were more likely to experience a urinary tract infection (OR, 2.06; 95% CI, 1.61 to 2.64). There was no gender difference in adjusted use of investigations.

Conclusion—

The majority of the gender differences in stroke were explained by confounding. More research is required to understand gender differences in stroke pathophysiology and the utilization of thrombolytic therapy.
Vasomotion in Multiple Spontaneous Cervical Artery Dissections
Authors: Baracchini Claudio , Tonello Simone , Vitaliani Roberta , Giometto Bruno , Meneghetti Giorgio , Ballotta Enzo
Published: February 2008

Background and Purpose—

The etiology of spontaneous cervical artery dissection (sCAD) is still unknown, even though an underlying arteriopathy impairing vasomotion has often been suspected. This study was undertaken to investigate: (1) spontaneous, (2) endothelial-dependent, and (3) endothelial-independent vasodilation in patients with multiple sCAD.

Methods—

In 19 consecutive patients with multiple carotid or vertebral artery dissections high-resolution ultrasound was used to assess spontaneous and endothelial-independent dilations (isosorbide dinitrate-mediated) in the common carotid, vertebral and brachial arteries, and endothelial-dependent dilation (flow-mediated arterial dilation) in the brachial arteries alone. The same parameters were measured in 19 healthy subjects matched for age, sex, and height (controls). Ultrasound studies were performed by one investigator, and off-line analysis by another investigator who was blinded to the clinical data and study status (patient or control).

Results—

Spontaneous and endothelial-independent dilations were significantly impaired in the carotid (
P
=0.0006 and
P
<0.0001, respectively) and vertebral arteries (
P
=0.0121 and
P
=0.0047, respectively) of patients as compared with controls, whereas no statistically significant differences were found in the brachial arteries; conversely, endothelial-dependent dilation of the brachial arteries was significantly lower in patients as compared with controls (
P
<0.0001).

Conclusions—

Patients with multiple sCADs have a significantly impaired vasomotion, which may predispose to dissection.
Predictors of Emotional Distress After Stroke
Authors: Thomas Shirley A. , Lincoln Nadina B.
Published: February 2008

Background and Purpose—

The aim of this prospective longitudinal study was to identify factors relating to emotional distress in the first 6 months after stroke in a sample including patients with aphasia.

Methods—

One hundred patients who were in hospital at 1 month after stroke were recruited and assessed on measures of communication impairment (Sheffield Screening Test), personal activities of daily living (Barthel Index), and emotional distress (Visual Analogue Self-Esteem Scale). Demographic and stroke characteristics were recorded. Patients (n=92) were reassessed on the same measures 6 months after stroke, in addition to assessing extended activities of daily living (Nottingham Extended Activities of Daily Living Scale).

Results—

Patients were aged 44 to 86 years (51 men), and 21 were classified as having aphasia. Multiple linear regression showed that expressive communication impairment and dependence in personal activities of daily living were significant predictors of emotional distress at 1 month after stroke (
R
2
=24%). Expressive communication impairment, emotional distress at 1 month after stroke, and having a more severe stroke were significant predictors of emotional distress at 6 months after stroke (
R
2
=55%). Distress levels were similar at 1 month and 6 months after stroke. Demographic characteristics and side of lesion were unrelated to distress.

Conclusions—

Expressive communication impairment and level of disability in personal activities of daily living were related to distress. Distress was persistent in the first 6 months after stroke. Appropriate treatment strategies need to be developed and evaluated for patients who have communication impairments.
Association Between Serum Ferritin Level and Perihematoma Edema Volume in Patients With Spontaneous Intracerebral Hemorrhage
Authors: Mehdiratta Manu , Kumar Sandeep , Hackney David , Schlaug Gottfried , Selim Magdy
Published: February 2008

Background and Purpose—

Preclinical evidence indicates that iron plays a key role in mediating neuronal injury and edema formation after intracerebral hemorrhage (ICH). However, the clinical role of iron in patients with ICH has not been well studied. We undertook this exploratory study to investigate the association of serum ferritin, as an indicator of body iron load, with perihematoma edema after ICH.

Methods—

We retrospectively reviewed prospectively-collected clinical and laboratory data from 23 consecutive patients with acute spontaneous ICH who had a CT scan and serum ferritin checked on admission, and a follow-up CT scan 3 to 4 days afterward. We measured hematoma and edema volumes on admission and follow-up scans, and calculated the relative edema volume to correct for hematoma volume. We used Spearman correlation coefficient to determine the association of various variables with relative perihematoma edema volume.

Results—

Whereas the median hematoma volume increased by approximately 28% from baseline to day 3 to 4, the relative edema volume almost doubled during this time period. We observed a significant positive correlation between serum ferritin and relative perihematoma edema volume on day 3 to 4 (
r
=0.78;
P
=0.002), but not at baseline; and little correlation between the changes in hematoma volumes and corresponding relative edema volumes (
r
=0.14). There was a trend for a positive correlation between body temperature and relative edema volumes.

Conclusions—

Our findings support the notion that delayed iron toxicity plays a role in causing brain injury and edema formation after ICH. These findings are preliminary and need to be further investigated in future studies.
Interexaminer Difference in Infarct Volume Measurements on MRI
Authors: Ay Hakan , Arsava E. Murat , Vangel Mark , Oner Banu , Zhu Mingwang , Wu Ona , Singhal Aneesh , Koroshetz Walter J. , Sorensen A. Gregory
Published: February 2008

Background and Purpose—

The measurement of ischemic lesion volume on diffusion- (DWI) and perfusion-weighted MRI (PWI) is examiner dependent. We sought to quantify the variance imposed by measurement error in DWI and PWI lesion volume measurements in ischemic stroke.

Methods—

Fifty-eight consecutive patients with DWI and PWI within 12 hours of symptom onset and follow-up MRI on ≥ day-5 were studied. Two radiologists blinded to each other measured lesion volumes by manual outlining on each image. Interexaminer reliability was evaluated by intraclass correlation coefficients (ICC) and relative paired difference or RPD (ratio of difference between 2 measurements to their mean). The ratio of between-examiner variability to between-subject variability (variance ratio) was calculated for each imaging parameter.

Results—

The correlation (ICC) between examiners ranged from 0.93 to 0.99. The median RPD was 10.0% for DWI, 14.1% for mean transit time, 18.9% for cerebral blood flow, 21.0% for cerebral blood volume, 16.8% for DWI/MTT mismatch, and 6.3% for chronic T2-weighted images. There was negative correlation between RPD and lesion volume in all but chronic T2-weighted images. The variance ratio ranged between 0.02 and 0.10.

Conclusion—

Despite high correlation between volume measurements of abnormal regions on DWI and PWI by different examiners, substantial differences in individual measurements can still occur. The magnitude of variance from measurement error is primarily determined by the type of imaging and lesion volume. Minimizing this source of variance will better enable imaging to deliver on its promise of smaller sample size.
How Accurate Is CT Angiography in Evaluating Intracranial Atherosclerotic Disease?
Authors: Nguyen-Huynh Mai N. , Wintermark Max , English Joey , Lam Jack , Vittinghoff Eric , Smith Wade S. , Johnston S. Claiborne
Published: February 2008

Background and Purpose—

Digital subtraction angiography (DSA) is regarded as the gold standard in assessing degree of stenosis in intracranial vessels. However, it is invasive and can only be carried out at specialized centers. We sought to compare CT angiography (CTA) to DSA for detection and measurement of stenosis in large intracranial arteries.

Methods—

-We identified all subjects admitted with ischemic stroke or transient ischemic attack and with CTA and DSA studies of good quality completed within 30 days of each other between April 2000 and May 2006 at a single medical center. Two readers blinded to clinical information reviewed each CTA and DSA independently. Each reader located and measured stenosis of 15 prespecified large intracranial arterial segments per study at the same level of magnification. These stenotic lesions were most likely atherosclerotic in etiology. All measurements were made with Wiha digiMax 6“ digital calipers. The degree of stenosis was calculated using the published method for the Warfarin-Aspirin Symptomatic Intracranial Disease study. All disagreements of greater than 10% were reviewed by a third reader who decided between the 2 prior measurements. Segments were excluded from analyses if they were judged to be congenitally hypoplastic or seen only through collaterals or cross-filling. Intraclass correlation, sensitivity, and specificity were calculated using DSA as the reference standard.

Results—

Forty-one pairs of CTA and DSAs from 41 patients were reviewed. CTAs were completed within 28 days before 13 days after DSA, with a median of 1 day. A total of 475 pairs of major intracranial arterial segment were analyzed. Intraclass correlation between degree of stenosis based on CTA and DSA for all segments was 0.98 (
P
=0.001). CTA detected large arterial occlusion with 100% sensitivity and specificity. For detection of ≥50% stenosis, CTA had 97.1% sensitivity and 99.5% specificity. To detect all lesions ≥50% as determined by DSA, the cut off point on CTA appeared to be at ≥30%, with a false-positive rate of 2.4%.

Conclusions—

Compared to DSA, CTA has high sensitivity and specificity for detecting ≥50% stenosis of large intracranial arterial segments. CTA is minimally invasive and may be a useful screening tool for intracranial arterial disease and occlusion.
Marie De France's Eliduc: the Play of Aventure
Authors: Whittaker Eve M.
Published: February 2008

This work proposes that for Eliduc, the culminating statement of her Lais, Marie de France selected a metaphor which was then new to Christianity: the game of chess. Eliduc is a "chess morality," marking the transition between the Muslim game and its varieties in western Europe. Like its Muslim ancestor, but explicating a central Christian text, it teaches philosophical consideration of human life in this world. This paper demonstrates the correspondences between the story of Eliduc and the twelfth century game of chess-its ancestry, objectives, strategies, and equipment, and then describes the game, as it proceeds, of the adult lives of three people.
King Alfonso and the Wild West: Medieval Hispanic Law On the U.S. Frontier
Authors: Burns Robert I.
Published: February 2008

"Medieval Encounters" include not only interaction between cultures, but also within cultures between widely separated time periods, and even influence by a medieval past upon a present culture or subculture. This can take the form of an evolution from past technologies or mentalities into the present, or even the development of merely analogous modern patterns quite different from the medieval to surface observation. One such artifact was the massive thirteenth-century Romanized law code of Alfonso X the Learned of Castile, called the Siete partidas, that survived within and alongside later Romanized codes throughout the Spanish empire, to acquire "the widest territorial force ever enjoyed by any law book." The medieval Partidas also became a living and formative presence even within the contrasting system of Common Law prevailing in U.S. jurisprudence, particularly in large regions like California, Texas, and Louisiana. This medieval artifact has variously manifested itself during the past century and still emerges in surprising ways in our courts, a relatively invisible ghost from the ancient past inviting study by both medievalists and Americanists, with implications for environmentalism, women's rights, and resource control.
With Heart, Tongue, and Limbs: Ibn Hazm On the Essence of Faith
Authors: Coope Jessica A.
Published: February 2008

In the Kitāb al-īmān or Book of Faith, a section from Ibn Hazm of Córdoba's major treatise on religions and heresies entitled Al-fasl fi al-milal wa al-ahwā' wa al-nihal, the author uses the exegetic techniques of Zāhirism to lay out what he believes are the essential characteristics that make one a Muslim. Those characteristics fall into three categories: belief held in the heart (tasdīq bi al-qalb), profession of belief with the tongue (iqrār bi al-lisān), and pious work of the body (amal al-jawārih). His intent in the Kitāb al-īmān is to attack the concept of religious tolerance and to reaffirm that being a Muslim means being different from Jews and Christians in thought, word, and deed. His use of Zāhirism as a guide to reading scripture directly supports his attack on Christianity and Judaism.
Observed and WRF-Simulated Low-Level Winds in a High-Ozone Episode during the Central California Ozone Study
Authors: Bao J-W. , Michelson S. A. , Persson P. O. G. , Djalalova I. V. , Wilczak J. M.
Published: February 2008

A case study is carried out for the 29 July–3 August 2000 episode of the Central California Ozone Study (CCOS), a typical summertime high-ozone event in the Central Valley of California. The focus of the study is on the low-level winds that control the transport and dispersion of pollutants in the Central Valley. An analysis of surface and wind profiler observations from the CCOS field experiment indicates a number of important low-level flows in the Central Valley: 1) the incoming low-level marine airflow through the Carquinez Strait into the Sacramento River delta, 2) the diurnal cycle of upslope–downslope flows, 3) the up- and down-valley flow in the Sacramento Valley, 4) the nocturnal low-level jet in the San Joaquin Valley, and 5) the orographically induced mesoscale eddies (the Fresno and Schultz eddies). A numerical simulation using the advanced research version of the Weather Research and Forecasting Model (WRF) reproduces the overall pattern of the observed low-level flows. The physical reasons behind the quantitative differences between the observed and simulated low-level winds are also analyzed and discussed, although not enough observations are available to diagnose thoroughly the model-error sources. In particular, hodograph analysis is applied to provide physical insight into the impact of the large-scale, upper-level winds on the locally forced low-level winds. It is found that the diurnal rotation of the observed and simulated hodographs of the local winds varies spatially in the Central Valley, resulting from the combining effect of topographically induced local forcing and the interaction between the upper-level winds and the aforementioned low-level flows. The trajectory analysis not only further confirms that WRF reproduces the observed low-level transport processes reasonably well but also shows that the simulated upper-level winds have noticeable errors. The results from this study strongly suggest that the errors in the WRF-simulated low-level winds are related not only to the errors in the model’s surface conditions and atmospheric boundary layer physics but also to the errors in the upper-level forcing mostly prescribed in the model’s lateral boundary conditions.
Regression-Based Methods for Finding Coupled Patterns
Authors: Tippett Michael K. , DelSole Timothy , Mason Simon J. , Barnston Anthony G.
Published: February 2008

There are a variety of multivariate statistical methods for analyzing the relations between two datasets. Two commonly used methods are canonical correlation analysis (CCA) and maximum covariance analysis (MCA), which find the projections of the data onto coupled patterns with maximum correlation and covariance, respectively. These projections are often used in linear prediction models. Redundancy analysis and principal predictor analysis construct projections that maximize the explained variance and the sum of squared correlations of regression models. This paper shows that the above pattern methods are equivalent to different diagonalizations of the regression between the two datasets. The different diagonalizations are computed using the singular value decomposition of the regression matrix developed using data that are suitably transformed for each method. This common framework for the pattern methods permits easy comparison of their properties. Principal component regression is shown to be a special case of CCA-based regression. A commonly used linear prediction model constructed from MCA patterns does not give a least squares estimate since correlations among MCA predictors are neglected. A variation, denoted least squares estimate (LSE)-MCA, is suggested that uses the same patterns but minimizes squared error. Since the different pattern methods correspond to diagonalizations of the same regression matrix, they all produce the same regression model when a complete set of patterns is used. Different prediction models are obtained when an incomplete set of patterns is used, with each method optimizing different properties of the regression. Some key points are illustrated in two idealized examples, and the methods are applied to statistical downscaling of rainfall over the northeast of Brazil.
Comments on “Decadal Changes in the North Atlantic and Pacific Meridional Overturning Circulation and Heat Flux”
Authors: Saunders Peter M. , Cunningham Stuart A. , de Cuevas Beverly A. , Coward Andrew C.
Published: February 2008

It is demonstrated that current level models, both with and without assimilation, generate too shallow an overturning in the North Atlantic (just like their predecessors) because they do not reproduce the descent of plumes of cold water from the Greenland and Norwegian Seas. Consequently, the prediction of decadal change from one such model reported by C. Wunsch and P. Heimbach is queried.
First Results of Experimental Tests of the Newly Developed NARL Phased-Array Doppler Sodar
Authors: Anandan V. K. , Kumar M. Shravan , Rao I. Srinivasa
Published: February 2008

A multifrequency phased-array Doppler sodar system has been installed recently at the National Atmospheric Research Laboratory (NARL) for the continuous observation of the lower atmosphere from near ground to the atmospheric boundary layer (ABL). The NARL sodar, developed in technical collaboration with the Society for Applied Microwave Electronics Engineering and Research (SAMEER), was built using piezoceramic tweeters, which are capable of generating 100-W acoustic power. In favorable atmospheric conditions, the sodar gives wind profiles up to 1 km. The performance evaluation is one of the most important aspects for quality assurance of sodar operations. This paper presents the first results of experimental observations of the NARL sodar system and its scientific validation. The NARL sodar has been validated using the simultaneous observation of another sodar system (Scintec model MFAS64). Various physical parameters of the atmosphere are derived using the results obtained from both of the systems. Comparison of simultaneous measurements by both of the sodars, located about 100 m apart, shows good agreement on wind speed, wind direction, and vertical wind variance. The correlation coefficient of more than 0.80 in wind speed and direction between the sodars shows the usefulness of the system for observing the atmosphere and deriving physical parameters below the ABL.
Calculating the Ocean’s Mean Dynamic Topography from a Mean Sea Surface and a Geoid
Authors: Bingham Rory J. , Haines Keith , Hughes Chris W.
Published: February 2008

In principle the global mean geostrophic surface circulation of the ocean can be diagnosed by subtracting a geoid from a mean sea surface (MSS). However, because the resulting mean dynamic topography (MDT) is approximately two orders of magnitude smaller than either of the constituent surfaces, and because the geoid is most naturally expressed as a spectral model while the MSS is a gridded product, in practice complications arise. Two algorithms for combining MSS and satellite-derived geoid data to determine the ocean’s mean dynamic topography (MDT) are considered in this paper: a pointwise approach, whereby the gridded geoid height field is subtracted from the gridded MSS; and a spectral approach, whereby the spherical harmonic coefficients of the geoid are subtracted from an equivalent set of coefficients representing the MSS, from which the gridded MDT is then obtained. The essential difference is that with the latter approach the MSS is truncated, a form of filtering, just as with the geoid. This ensures that errors of omission resulting from the truncation of the geoid, which are small in comparison to the geoid but large in comparison to the MDT, are matched, and therefore negated, by similar errors of omission in the MSS. The MDTs produced by both methods require additional filtering. However, the spectral MDT requires less filtering to remove noise, and therefore it retains more oceanographic information than its pointwise equivalent. The spectral method also results in a more realistic MDT at coastlines.
Calculated Height Tendencies in Two Southern Hemisphere Blocking and Cyclone Events: The Contribution of Diabatic Heating to Block Intensification
Authors: Tilly Douglas E. , Lupo Anthony R. , Melick Christopher J. , Market Patrick S.
Published: February 2008

The Zwack–Okossi vorticity tendency equation was used to calculate 500-hPa height tendencies in two intensifying Southern Hemisphere blocking events. The National Centers for Environmental Prediction–National Center for Atmospheric Research gridded reanalyses were used to make each of these calculations. The block intensification period for each event was associated with a deepening surface cyclone during a 48-h period beginning at 1200 UTC 28 July and 1200 UTC 8 August 1986, respectively. These results demonstrate that the diabatic heating forces height rises through the sensible and latent heating terms in these two Southern Hemisphere blocking events. The sensible heating was the larger contributor, second only to (about the same as) the vorticity advection term in the first (second) event. The vorticity advection term has been shown by several studies to be associated with block intensification.
Social Welfare Contracts as Networks
Authors: Johnston Jocelyn M. , Romzek Barbara S.
Published: February 2008

This analysis of state social service contracts identifies sources of system instability and explores the impacts of instability on service delivery networks. The authors examine social welfare service contracts explicitly as networks and assess the effects of network instability on the management of contracts, contract effectiveness, the performance of network organizations, and clients. They offer observable patterns and detailed examples that indicate that instability imposes significant costs on service delivery networks—costs that impair organizational and network performance and that divert resources from services for vulnerable clients. The high costs associated with instability undermine arguments for more market-based service delivery.
Wife Beating in South Africa
Authors: Choi Susanne Y. P. , Ting Kwok-Fai
Published: February 2008

This article develops an imbalance theory to explain physical violence against women in intimate relationships in South Africa. The theory proposes four typologies: dependence, compensation, submission, and transgression, through which imbalances in resource contribution and power distribution between spouses are hypothesized to contribute to violence. The dependence hypothesis suggests that economic dependence of the wife will lead to more violence. The compensation hypothesis argues that the husband will use force to compensate for his inability to live up to the male-provider norm. The submission hypothesis suggests that violence will increase due to the submission of women in male-dominated families. Finally, the transgression hypothesis argues that men in female-dominated families will use force to punish their wives for supposedly transgressing the gender norm of male dominance. Empirical evidence provided some support for the dependence, submission, and transgression hypotheses.
Treating Low-Income and Minority Women With Posttraumatic Stress Disorder
Authors: Feske Ulrike
Published: February 2008

Twenty-one female psychiatric outpatients with chronic posttraumatic stress disorder (PTSD) are randomly assigned to prolonged exposure (PE; n = 9) for PTSD or treatment as usual (TAU; n = 12). Participants are predominately low income and African American with complex trauma and psychiatric histories. Treatment is delivered by community therapists with no prior training in behavior therapy for anxiety disorders. Clients who completed PE show a greater improvement in PTSD symptoms, general anxiety, and depression than clients who completed TAU. These findings provide preliminary evidence suggesting that PE is an effective treatment for core PTSD symptoms, even when delivered by community therapists in a front-line services clinic.
Posttraumatic Stress Disorder Following Ethnoreligious Conflict in Jos, Nigeria
Authors: Obilom Rose E. , Thacher Tom D.
Published: February 2008

In September 2001, ethnoreligious rioting occurred in Jos, Nigeria. Using a multistage cluster sampling technique, 290 respondents were recruited in Jos 7 to 9 months after the riots. Data were collected regarding demographics, exposure to traumatic events, and psychological symptoms. Resting pulse and blood pressure were recorded. A total of 145 (52.5%) witnessed or were victims of personal attacks, 165 (59.6%) lost their possessions, 56 (20.7%) had their homes burned, 44 (16.2%) witnessed relatives' deaths, and 8 (2.9%) were robbed. A total of 252 (89.7%) of the respondents met reexperiencing criteria, 138 (49.1%) met avoidance criteria, and 236 (84.0%) met arousal criteria for posttraumatic stress disorder (PTSD). A total of 116 (41%, 95% confidence interval [CI] = 36% to 47%) met all three categories for PTSD. Only personal attacks (adjusted odds ratio = 2.8, 95% CI = 1.7 to 4.7) and a heart rate of 90 beats/min or more (adjusted odds ratio = 2.8, 95% CI = 1.4 to 5.8) were significantly related to PTSD in a multivariate model.
Gabapentin for Intractable Hiccups in Palliative Care
Authors: Tegeler Monica L. , Baumrucker Steven J.
Published: February 2008

Intractable hiccups are not common in the general population or in the palliative care population but can adversely impact quality of life and cause other complications such as weight loss and sleep disturbance. Many treatments have been proposed for intractable hiccups, but there is little consensus regarding treatment in the medical literature. This is partly because hiccups are relatively uncommon and many of the proposed treatments are unproven or have long-term side effects. Pharmacologic treatments rather than home remedies or surgical treatments are more appropriate for the palliative care patient. Gabapentin is a promising medication for the treatment of intractable hiccups for its safety, lack of serious side effects, and rapid onset of action. Further research is indicated to determine whether gabapentin is consistently effective.
A Day in the Life: A Case Series of Acute Care Palliative Medicine—The Cleveland Model
Authors: Lagman Ruth , Walsh Declan , Heintz Jessica , LeGrand Susan B. , Davis Mellar P.
Published: February 2008

Palliative care in advanced disease is complex. Knowledge and experience of symptom control and management of multiple complications are essential. An interdisciplinary team is also required to meet the medical and psychosocial needs in life-limiting illness. Acute care palliative medicine is a new concept in the spectrum of palliative care services. Acute care palliative medicine, integrated into a tertiary academic medical center, provides expert medical management and specialized care as part of the spectrum of acute medical care services to this challenging patient population. The authors describe a case series to provide a snapshot of a typical day in an acute care inpatient palliative medicine unit. The cases illustrate the sophisticated medical care involved for each individual and the important skill sets of the palliative medicine specialist required to provide high-quality acute medical care for the very ill.
Challenges of Noncancer Patients Transitioning to Hospice
Authors: Brunker Cherie P.
Published: February 2008

The traditional model of hospice care based on the course of incurable cancer with rapid decline and death does not apply to chronic diseases. Cancer also may take a chronic course and no longer accounts for the majority of admissions to hospice. Hospice admissions now include a majority of noncancer diagnoses. The second challenge is the wide disparity between chronic disease courses. Case examples of people with different diagnoses demonstrate a variety of contrasting trajectories of illness. With ever-increasing advances in medical care, the indications for intensive treatments have never overlapped so much with the indications for hospice referral. This represents the third challenge. In addition, some treatments and medications that improve symptoms and quality of life may significantly prolong life, thus contradicting the traditional expectation of “foregoing life-sustaining treatment” in favor of enrolling in hospice. Finally, a description of various assessment tools helps in identifying the indications for hospice.
Bereavement Care in Home Care and Hospice
Authors: Ashton Joyce Marsden
Published: February 2008

The diagnosis of a chronic or terminal illness causes a variety of emotions for the patient and the care giver. Often bereavement and grief are not addressed by health care professionals. This article seeks to assist the health care provider in understanding the grief process and in offering interventions to aid the ill and dying.
The Effects of a Disease Management Program on Self-Reported Health Behaviors and Health Outcomes: Evidence From the “Florida: A Healthy State (FAHS)” Medicaid Program
Authors: Morisky Donald E. , Kominski Gerald F. , Afifi Abdelmonem A. , Kotlerman Jenny B.
Published: February 2008

Premature morbidity and mortality from chronic diseases account for a major proportion of expenditures for health care cost in the United States. The purpose of this study was to measure the effects of a disease management program on physiological and behavioral health indicators for Medicaid patients in Florida. A two-year prospective study of 15,275 patients with one or more chronic illnesses (congestive heart failure, hypertension, diabetes, or asthma) was undertaken. Control of hypertension improved from baseline to Year 1 (adjusted odds ratio = 1.60, p < .05), with maintenance at Year 2. Adjusted cholesterol declined by 6.41 mg/dl from baseline to Year 1 and by 12.41 mg/dl ( p < .01) from baseline to Year 2. Adjusted average medication compliance increased by 0.19 points ( p < .01) in Year 1 and 0.29 points ( p < .01) in Year 2. Patients in the disease management program benefited in terms of controlling hypertension, asthma symptoms, and cholesterol and blood glucose levels.
Using Mixed Methods for Evaluating an Integrative Approach to Cancer Care: A Case Study
Authors: Brazier Alison , Cooke Karen , Moravan Veronika
Published: February 2008

Objective. To evaluate the impact of participating in an integrative cancer care program at the Centre for Integrated Healing in Vancouver, British Columbia, on patients' lifestyle, quality of life, and overall well-being. Study Design. A mixed-methods case study with a pre- and posttest design. No control group was utilized. Methods. All new patients starting at the Centre for Integrated Healing between May and September of 2004 were invited to join the study. Forty-six of 77 new patients agreed to participate. Quantitative data measuring quality of life, social support, anxiety and depression, locus of control, and hope were assessed at baseline (pre-program start) and at 6 weeks and 5 months from the start of the program. Qualitative data in the form of focus groups and interviews were collected midway through the follow-up period to further explore program impacts. Results. No statistically significant improvements or declines were noted on the quantitative measures between baseline and the 5-month follow-up point. The qualitative findings revealed a theme of patients' active engagement in their cancer care involving empowered decision making and creating personal change. Facilitators of active patient engagement in their own care from the integrative program included healing partnerships with practitioners, information and resources, managing the integration of complementary and conventional therapies, emotional support, and a sense of hope. Discussion. This case study was a first attempt at documenting the impact of an integrative cancer care program at the Centre for Integrated Healing. Study limitations included a small sample size, which limited power to detect quantitative changes on the questionnaires and a lack of a control group. Qualitative findings indicated that patients found value in the “person-oriented” holistic approach to care, which encouraged patients to take an active role in decision making and self-care. The use of a mixed-methods research design proved to be an effective approach to not only evaluating outcomes but also examining process issues of the experience. Additional research is greatly needed to better understand potential impacts of integrative approaches to cancer care.
Clinical Encounter Experiences of Patients With Nasopharyngeal Carcinoma
Authors: Lee Edwin W. C. , Twinn Sheila , Moore Ann P. , Jones Mark P. , Leung S.F.
Published: February 2008

Nasopharyngeal carcinoma (NPC) is a commonly occurring cancer among Hong Kong Chinese, especially in the relatively young population group. Since the disease carries a favorable prognosis, sequelae following treatment have become an important concern for patients suffering from NPC, particularly because of the strong interplay of psychological, social, and biological issues during their rehabilitation. In this qualitative study, in-depth, semistructured audiotaped interviews were undertaken with 32 patients receiving rehabilitation at the physiotherapy department of a regional teaching hospital in Hong Kong. The objective of the study was to examine the rehabilitation experiences of NPC survivors to identify factors that contributed to a satisfying clinical encounter experience. During the study, data collection and analysis using a grounded theory approach were concurrently conducted. The 3 main themes that shaped the rehabilitation experiences of NPC survivors were the patient-clinician relationship, participation in therapeutic alliance, and quality rehabilitation service provision. These, together with the identified needs of the participants, contributed to the participants' perceived health-related quality of life. A constructive clinical experience was perceived when their needs were met. The findings highlight the importance of patient-centeredness in the treatment delivery and a multifaceted role of clinicians in meeting the needs of this group of cancer survivors.
Biophytum sensitivum (L.) DC Inhibits Tumor Cell Invasion and Metastasis Through a Mechanism Involving Regulation of MMPs, Prolyl Hydroxylase, Lysyl Oxidase, nm23, ERK-1, ERK-2, STAT-1, and Proinflammatory Cytokine Gene Expression in Metastatic Lung Tissue
Authors: Guruvayoorappan Chandrasekharan , Kuttan Girija
Published: February 2008

Biophytum sensitivum is a traditional oriental herbal medicine that is known for its immunostimulatory and antitumor effects. Tumor metastasis is the most important cause of cancer death. Although B sensitivum was shown to inhibit metastasis, the mechanism underlying this action is not well understood. In the present report, the authors had studied the effect of B sensitivum on the invasion and motility of B16F-10 melanoma cells and investigate the regulatory effect on the expression of matrix metalloproteases (MMPs), prolyl hydoxylase, lysyl oxidase, nm23, extracellular signal-regulated kinase (ERK)—1, ERK-2, signal transducer and activator of transcription (STAT)—1, and proinflammatory cytokines in metastatic tumor-bearing lungs. B sensitivum inhibited the invasion and motility of B16F-10 cells in a dose-dependent manner. B sensitivum inhibited the expression of MMP-2 and MMP-9, whereas it activated STAT-1 expression in metastatic tumor-bearing lungs. Similarly, inhibition of prolyl hydroxylase, lysyl oxidase, ERK-1, ERK-2, and vascular endothelial growth factor (VEGF) expression but activation of nm23 by B sensitivum was observed in metastatic tumor-bearing lungs. B sensitivum treatment also downregulated the expression of tumor necrosis factor—α, interleukin (IL)—1β, IL-6, and granulocyte monocyte—colony stimulating factor in metastatic tumor-bearing lungs. In B16F-10 cells, B sensitivum also inhibited the production of proinflammatory cytokines. Overall, the results indicate that B sensitivum exhibits antimetastatic effects through the inhibition of invasion and motility. The results also suggest that MMPs, prolyl hydroxylase, lysyl oxidase, nm23, ERKs, VEGF, STAT, and proinflammatory cytokines are critical regulators of the B sensitivum—mediated antimetastatic effect.
Roles of Sonographers in the Management of Diabetes A Proposed Framework
Authors: Ugwu A.C. , Udo B.E. , Njoku C.O. , Eteudo A.N.
Published: February 2008

Sonography plays an invaluable role in health care delivery worldwide. In Nigeria, most people involved in the sonography practice are medical imaging scientists (BSc radiographers). Ways in which sonographers can support the management of diabetes are explored in this article.
Antenatal Diagnosis of a Choledochal Cyst
Authors: Sorensen Teresa
Published: February 2008

A woman in her early 30s was referred for assessment of a midline cystic mass in her 22-week fetus that was discovered on a routine detailed sonogram. Sonography and magnetic resonance imaging confirmed a midline cystic mass separate from the fetal bladder and stomach in an otherwise normal fetus. The diagnosis of a type I choledochal cyst was made.
Increasing the Detection Rate of Normal Fetal Cardiac Structures: A Real-Time Approach
Authors: Scott Ted , Swan Hans , Moran Gerald , Mondal Tapas , Jones Judy , Guram Karm , Huff Jaime
Published: February 2008

The purpose of this study was to determine if acquiring real-time sweeps of the fetal heart would be a more effective method of identifying normal cardiac structures compared with using static images during routine second-trimester obstetric sonograms. Subjects were scanned using three different techniques. The static image acquisition (protocol A) included three images of the fetal heart. Protocol B used two gray-scale sweeps through the fetal heart. Protocol C acquired three color loops of the fetal heart. The sweeps demonstrated a complete normal cardiac assessment in 71% of studies, compared with the static image and color Doppler techniques that completed a normal cardiac assessment in only 39% of studies, respectively. The real-time technique detected four chambers, the left ventricular outflow tract (LVOT), the right ventricular outflow tract (RVOT), the LVOT/RVOT crossover, and size and axis of the heart with a greater frequency than the static images and color loops in all cases. In addition, the real-time technique was able to demonstrate the pulmonary veins in 56% of cases compared with 3.6% for static images. The color Doppler acquisition demonstrated blood flow through the atrial-ventricular and semilunar valves in 86% of cases.