bluuebunny/crossref_metadata_2025 huggingface dataset:
COMPUTER-AIDED MOLECULAR DESIGN OF NOVEL HMG-CoA REDUCTASE INHIBITORS FOR THE TREATMENT OF HYPERCHOLESTEROLEMIA
Authors: DA SILVA VINICIUS B. , ANDRIOLI WILLIAN JONIS , CARVALHO IVONE , TAFT CARLTON A. , SILVA CARLOS H. T. P.
Published: November 2007

Elevated cholesterol levels are a primary risk factor for the development of coronary artery disease. Dietary changes associated with drug therapy can reduce high serum cholesterol levels and dramatically decrease the risk of stroke and overall mortality. HMG- CoA reductase is an important molecular target of hypolipemic drugs, known as statins, which are effective in the reduction of cholesterol serum levels, attenuating cholesterol synthesis in-liver by competitive inhibition regarding the substrate HMG- CoA . In this paper, we have focused on computer-aided molecular design using density functional theory, flexible docking, molecular dynamics as well as ADME, and synthetic accessibility analyses in order to propose novel potential HMG- CoA reductase inhibitors, designed by bioisosteric modifications which are promising for the treatment of hypercholesterolemia.
Mediterranean Diet and Essential Tremor
Authors: Scarmeas Nikolaos , Louis Elan D.
Published: November 2007

Background: Higher adherence to the Mediterranean diet (MeDi) has been related to lower Alzheimer’s disease risk. Some dietary factors have been studied in patients with essential tremor (ET), but the MeDi’s effect has not been investigated. Methods: Adherence to the MeDi was calculated from a food frequency questionnaire administered in a case-control study of environmental epidemiology of ET in the New York Tri-State area. Logistic regression models were used to examine whether adherence to the MeDi predicted ET (vs. control) outcome. The models adjusted for age, gender, ethnicity, education, caloric intake, body mass index, smoking, ethanol consumption, coffee intake and blood harmane concentrations. Results: 148 ET cases adhered less to MeDi (0–9 scale with higher scores indicating higher adherence) than 250 controls (mean 4.3 ± 1.7 vs. 4.7 ± 1.7; p = 0.03). Higher adherence to MeDi was associated with lower odds for ET [0.78 (0.61–0.99); p = 0.042]. As compared to subjects at the lowest MeDi adherence tertile, those at the middle tertile had lower ET odds [0.41 (0.16–1.05)], while subjects at the highest tertile had an even lower ET odds [0.29 (0.10–0.82); p for trend 0.021]. Conclusions: Compared to controls, ET cases adhered less to MeDi. The gradual reduction in ET odds with higher MeDi adherence tertiles suggests a possible dose-response effect. The mechanisms that underlie this association merit further study.
Lipid-Lowering Agents and the Risk of Cognitive Impairment That Does Not Meet Criteria for Dementia, in Relation to Apolipoprotein E Status
Authors: Rockwood Kenneth , Howlett Susan , Fisk John , Darvesh Sultan , Tuokko Holly , Hogan David B. , Wolfson Christina , McDowell Ian
Published: November 2007

Lipid-lowering agents (LLAs) might lower the risk of dementia, but any impact on other forms of cognitive impairment is not clear. We examined LLAs in relation to cognitive impairment, no dementia (CIND) and apolipoprotein E4 status. In a case control study from the Canadian Study of Health and Aging, cases (n = 347) had developed CIND between the first and second study waves and controls (n = 693) had no cognitive impairment at either time. LLA use was associated with a lower odds of incident CIND in those <80 years of age (OR 0.37; 95% CI 0.15–0.93) but not for those aged ≧80 years (OR 0.56; 95% CI 0.15–2.10). The reduced risk was significant for statins but not for other LLAs. Adjusting for apolipoprotein E4 status did not change the point estimates of the ORs. The greatest impact of LLAs was seen in the CIND subtype circumscribed memory impairment.
Prenatal Diagnosis of Abnormal Course of Umbilical Vein and Absent Ductus Venosus – Report of Three Cases
Authors: Hajdú J. , Marton T. , Kozsurek M. , Pete B. , Csapó Z. , Beke A. , Papp Z.
Published: November 2007

An abnormal course of the umbilical vein is a rare anomaly. Its association with the congenital absence of the ductus venosus is common. We found 3 cases of an abnormal course of the umbilical vein and an absent ductus venosus. In 2 of these cases, the umbilical vein turned down and continued in the internal iliac vein, and no ductus venosus was found. One of these pregnancies was terminated. From the continued pregnancy a growth-retarded baby was born. At follow-up examinations, mild microcephaly, mildly elevated levels of ammonia, delayed speech and mild muscular hypotonia were found. In the third case, the umbilical vein turned up from the level of umbilical ring and the anterior of the liver above the diaphragma and connected directly into the right atrium. Associated complex congenital heart malformations – transposition of the great arteries, and ventricular septal defect – were diagnosed prenatally. In the umbilical vein from the placenta to the umbilical ring, the flow was low velocity continuous; from the umbilical ring to the right atrium, the flow was biphasic high velocity (90 cm/s). Such an elevated blood flow could be a sign of increased cardiac preload. The long-term neurological follow-up of babies with prenatally diagnosed venous malformations is necessary.
Nonhemorrhagic Primary Obstetric Shock
Authors: Habek Dubravko , Habek Jasna Čerkez
Published: November 2007

Objective: Clinical evaluation of nonhemorrhagic primary obstetric shock (NHPOS). Methods: In a retrospective clinical study, data on 8 cases of NHPOS were analyzed. Data on patient age, parity, week of gestation, comorbidity, possible etiologic trigger, course of disease with clinical picture and laboratory findings of coagulopathy, and patient outcome including autopsy findings in two lethal outcomes were analyzed. Results: These 8 patients were treated in the intensive care unit. One patient died during delivery from cardiopulmonary arrest in the state of irreversible obstetric shock, verified by massive pulmonary thromboembolism at autopsy. Another patient died from stroke and cerebral coma caused by trophoblastic cerebrovascular embolism 5 days after artificial abortion, showing a clinical picture of shock and cardiopulmonary arrest. In 1 patient, severe septic shock developed several hours after premature stillbirth and abruptio placentae in the 26th week of pregnancy, associated with disseminated intravascular coagulopathy. Four patients developed intrapartum NHPOS, with a clinical picture of chest pain, dyspnea, tachycardia, hypotension, cyanosis, and disseminated intravascular coagulopathy, as demonstrated by laboratory findings. Based on clinical picture and laboratory findings, amniotic fluid embolism or trophoblastic embolism was suspected. All these patients survived. One patient developed NHPOS during the third labor stage after vacuum extraction because of a macrosomic child, followed by disseminated intravascular coagulopathy and secondary hemorrhage which necessitated B-Lynch procedures and total hysterectomy for massive bleeding. Hereditary thrombophilia was detected in subsequent patients. Conclusions: NHPOS can be caused by amniotic fluid embolism, trophoblastic embolism or thromboembolism, and sepsis. These conditions may frequently prove fatal due to their abrupt and unexpected course, mostly during pregnancy, delivery, or immediately thereafter.
Possible Association of Amelogenin to High Caries Experience in a Guatemalan-Mayan Population
Authors: Deeley K. , Letra A. , Rose E.K. , Brandon C.A. , Resick J.M. , Marazita M.L. , Vieira A.R.
Published: November 2007

There is evidence for a genetic component in caries susceptibility, but the disease is greatly influenced by environmental factors, which are extremely difficult to control in humans. For the present study, we used DNA samples collected from 110 unrelated, non-cleft individuals older than 12 years of age from Tiquisate, Guatemala: a population with similar cultural, dietary and hygiene habits, similar access to the dentist and fluoride exposure. Forty-four individuals were designated ‘very low caries experience’ (DMFT ≤2), and 66 were designated ‘higher caries experience’ (DMFT ≧3). Single-nucleotide polymorphism markers were genotyped in selected candidate genes (ameloblastin, amelogenin, enamelin, tuftelin-1, and tuftelin interacting protein 11) that influence enamel formation. Having at least one copy of the rare amelogenin marker allele was associated with increased age-adjusted caries experience. This association was stronger in individuals with higher DMFT (DMFT ≧20; p = 0.0000001). Our results suggest that variation in amelogenin may contribute to caries susceptibility in the population studied. The approach of comparing individuals with extremely distinct caries experiences could be valuable for decreasing the potential influence of environmental factors on genetic studies of caries.
Low-Fluoride Dentifrice and Caries Lesion Control in Children with Different Caries Experience: A Randomized Clinical Trial
Authors: Lima T.J. , Ribeiro C.C.C. , Tenuta L.M.A. , Cury J.A.
Published: November 2007

Since there is no consensus on the anticaries effectiveness of low-fluoride (F) dentifrice, this randomized clinical trial evaluated its effect in children at different caries activity status. One hundred and twenty 2- to 4-year-old children, half with and half without active caries lesions, were randomly divided into 2 groups which used 500- or 1,100-µg F/g (NaF) dentifrices during 1 year. Caries progression or regression were evaluated as the number of lesions becoming active/cavities or inactive, respectively. The anticaries effect of the low-F dentifrice was similar to the conventional F dentifrice when used by caries-inactive children. However, in children with active caries lesions the low-F dentifrice was less effective than the 1,100-µg F/g dentifrice in controlling the progression of lesions. The data suggest that the child caries activity may be taken into account to recommend a low-F dentifrice.
Denying Conditionals: Abaelard and the Failure of Boethius' Account of the Hypothetical Syllogism
Authors: Martin Christopher
Published: November 2007

Boethius' treatise De Hypotheticis Syllogismis provided twelfth-century philosophers with an introduction to the logic of conditional and disjunctive sentences but this work is the only part of the logica vetus which is no longer studied in the twelfth century. In this paper I investigate why interest in Boethius acount of hypothetical syllogisms fell off so quickly. I argue that Boethius' account of compound sentences is not an account of propositions and once a proper notion of propositionality is available the argument forms accepted by Boethius are seen to be incoherent. It was Peter Abaelard who first understood the nature of propositionality and propositional connectives and used this to criticise Boethius' claims in De Hypothetics Syllogismis. In place Boethius' confusion Abaelard offered a simple and correct account of the hypothetical syllogism.
“Utrum idem sint dicere et intelligere sive videre in mente”: Robert Kilwardby, Quaestiones in librum primum Sententiarum
Authors: Sirridge Mary
Published: November 2007

In his Questions I, qq. 35-36 Sent. Robert Kilwardby asks whether divine understanding (intelligere) is the same as the divine speaking (dicere), as Anselm says in Monologion, ch. 63, just as for us mental speaking (mentis locutio) is the same as the thinker's examination (inspectio cogitantis) or mental seeing (videre in mente). His answer is that neither for us nor for God is the equation correct, because understanding lacks an essential characteristic of speech, i.e. referentiality, and because speaking is active and understanding passive, which is reflected in the meanings (impositiones) and grammatical functions (modi significandi) of the corresponding expressions. Kilwardby does concede in his discussion of the speech of angels in II Sent. q. 56 that when inner speech does occur, and remains internal, it amounts to thought, though with the additional element of referentiality. I suggest that Kilwardby is unwilling accept Augustine's theory that thought is inner speech, as Anselm does, because it would require him to reject Aristotelian-style philosophical psychology.
Mental Language and Tradition Encounters in Medieval Philosophy: Anselm, Albert and Ockham
Authors: Panaccio Claude
Published: November 2007

Medieval philosophy is often presented as the outcome of a large scale encounter between the Christian tradition and the Greek philosophical one. This picture, however, inappropriately tends to leave out the active role played by the medieval authors themselves and their institutional contexts. The theme of the mental language provides us with an interesting case study in such matters. The paper first introduces a few technical notions—'theme', 'tradition', 'textual chain' and 'textual borrowing'—, and then focuses on precise passages about mental language from Anselm of Canterbury, Albert the Great and William of Ockham. All three authors in effect identify some relevant Augustinian idea (that of 'mental word', most saliently) with some traditional philosophical one (such as that of 'concept' or that of 'logos endiathetos'). But the gist of the operation widely varies along the line and the tradition encounter is staged in each case with specific goals and interests in view. The use of ancient authoritative texts with respect to mental language is thus shown to be radically transformed from the eleventh to the fourteenth century.
Scepticism, Demonstration and the Infinite Regress Argument (Nicholas of Autrecourt and John Buridan)
Authors: Grellard Christophe
Published: November 2007

The aim of this paper is to examine the medieval posterity of the Aristotelian and Pyrrhonian treatments of the infinite regress argument. We show that there are some possible Pyrrhonian elements in Autrecourt's epistemology when he argues that the truth of our principles is merely hypothetical. By contrast, Buridan's criticisms of Autrecourt rely heavily on Aristotelian material. Both exemplify a use of scepticism.
China's Entry into Construction Industries in Africa
Authors: Burke Christopher
Published: November 2007

Construction companies have played a key role as vanguards of China's engagement with Africa. China has a long history of relations with both Tanzania and Zambia, and the privatisation and deregulation of China's construction industry has been accompanied by a steady increase in the number of Chinese companies entering these two African countries. Differences in the construction industries of Tanzania and Zambia reveal interesting patterns in the participation of Chinese firms in these countries’ economies. In Tanzania, the Chinese are not yet in competition with indigenous companies which lack capacity for large-scale projects. The standards of work completed by Chinese companies are considerably higher in Zambia where regulations and building codes are more strictly enforced. The Chinese have little interest in joint ventures, although they regularly subcontract local companies and procure considerable quantities of local materials and labour. Western companies maintain a decreasing advantage in specialised or technical areas of construction; however, the Chinese adapt more readily to the African environment and quickly find their feet. Once established, the only serious competition Chinese companies appear to face is from one another.
Temperature definition and measurement using platinum resistance thermometers
Authors: Atherton A. , Fitton D.R.
Published: November 2007

This article indicates the status of platinum resistance thermometry in temperature definition and measurement and outlines some potential sources of error.

Perhaps the most important factor requiring consideration is the influence of thermometer structural materials on conformity with the IPTS-68. An analysis of calibration measurements, including data reported in earlier work, strengthens the hypothesis that stem heat transmission can contribute discrepancies greater than those that would arise as a result of applying the IPTS-68 to thermometers having low temperature coefficients of resistance (e g, 3.850 x 10-3 per K). Indeed, with the available data it is impossible to discern any systematic effect of temperature coefficient on deviation from the IPTS-68.

Quantitative illustration of the various features discussed is included where appropriate.
A role for system dynamics in modelling the spread of AIDS
Authors: Dangerfield Brian , Roberts Carole
Published: November 2007

System dynamics has a role to play in modelling the spread of infectious diseases. Its utility for this purpose is illustrated through a model of the spread of AIDS in the homosexual population of the UK. By virtue of its constituent diagramming tools, style of equation formulation and special-purpose computer software, system dynamics offers a means of rendering epidemiological models more transparent to the client than many of the mathematical models published to date. In respect of the AIDS spread model, the relative ease of adding (i) a heterogeneous sexual-activity profile, and (ii) a variable infectivity profile onto a base model, is described. Finally, results are reported from an optimisation experiment applied to the most complex model. The 'best fit' obtained allows an estimate of the (unknown) HIV population to be made.
The control and supervision of groups of lifts using the blackboard architecture approach
Authors: Brandin B. , Chen T. , Derventzis C. , Pang G.
Published: November 2007

An artificial-intelligence technique, namely blackboard architecture, is used to confront the problem of controlling and supervising groups of lifts.

With the construction of high-rise buildings, transportation efficiency has become an important consideration in lift systems design. The variety of constraints, and especially the constraints related to traffic, make the design of lift systems and lift traffic supervision and control a complex task.

The paper is divided into two main sections: the first considers the design and development of the shell of the blackboard system presented; the second describes the implementation of the problem solving framework. Simulation results follow as well as a discussion and conclusions.
Cavity modulation coupled with asynchronous source modulation in a microwave cavity spectrometer
Authors: Zhu Z. , Gibson C. , Samuel A.H. , Matthews I.P.
Published: November 2007

This paper reports a novel modulation technique, namely, cavity modulation coupled with asynchronous source modulation, employed in a simple microwave cavity spectrometer system. The feasibility of the technique was successfully demonstrated by determining the output of the system whilst examining one of the absorption peaks of ethylene oxide gas (with centre frequency F0 = 24.923 GHz for the level transition 202 to 211). The variation in the output signal with frequency was as expected to within a standard error of 8.3%. Also, a good linear correlation was demonstrated between the magnitude of the output signal and the concentration of ethylene oxide gas in the gas cell (to within a standard error of 4%). The operation of this system is such that the microwave source frequency, F, sweeps across a given range (F1 to F2) which contains one of the absorption peaks of the analyte gas whilst the cavity resonant frequency, Fr, is oscillated within the profile of the absorption peak. Signal enhancement is achieved by adding a relatively small magnitude high-frequency 'dither' signal to the source frequency sweep pattern. The salient information of the gas absorption due to the oscillation of the resonant frequency of the cavity is carried by the 'dither' signal and then amplified and extracted by a series of tuned amplifiers and demodulators.
Introduction to robust ship track-keeping control design
Authors: Messer A.C. , Grimble M.J.
Published: November 2007

The application of modern robust control techniques to the problem of surface ship track-keeping control will be considered. The system structure will be assessed and a control strategy proposed which exploits the intrinsic characteristics of the dynamics to provide a natural means of scheduling the controller with surge speed. The design philosophy enables the ship autopilot loop to be used with or without the outer track-keeping control action.
Multivariable identification of ship steering and roll motions
Authors: Tiano A. , Blanke M.
Published: November 2007

This paper addresses identification of a multivariable model describing the rudder-induced surge-sway-yaw-roll dynamics of a fast container ship. The identification problem is formulated and is solved numerically by using a random search minimisation method. Such method, which has to carry out the estimation of a large number of unknown parameters, is based on a suitable implementation of Simulated Annealing, Application of the algorithm to a set of simulated data has proved to be quite successful. The results show that the proposed identification method is a very efficient and easy-to-use tool for determination of ship hydrodynamic derivatives on the basis of full-scale sea trials or from towing-tank tests conducted on scale models.
Dynamic properties of a container vessel with low metacentric height
Authors: Blanke Mogens , Jensen Andreas G.
Published: November 2007

Inaccuracy in prediction of manoeuvring and lack of robustness of closed-loop autopilot control have been a surprising experience for several ships with low metacentric height. Until now, effective investigations of these phenomena have been hindered by lack of knowledge on the precise interaction between roll and lateral motions. This was changed with the construction of a unique four-degrees-of-freedom roll planar motion mechanism (RPMM) at the Danish Maritime Institute.

The paper presents complete nonlinear models for a container ship obtained with this facility. Model scale predictions are compared with full scale results and shown to give a good replication of the dynamic properties after tuning of a few parameters to account for model to full scale differences. Dynamic control properties are discussed, and the importance of roll couplings is investigated. Finally, response operators for waves are provided for a relevant range of metacentric heights, and wind data are included to make the characterisation of the vessel complete.
A robust nonlinear control design for remotely operated vehicle depth control systems
Authors: Trebi-Ollennu A. , White B.A.
Published: November 2007

In this paper, an input-output linearisation controller with an adaptive fuzzy outer loop is applied to the depth control of a nonlinear Remotely Operated Vehicle (ROV). The adaptive fuzzy system is added to increase the robustness as well as add 'intelligence' to conventional input-output controllers. The free control parameters are selected using multi-objective fuzzy genetic algorithm optimisation. Simulation results are presented which demonstrate that the proposed control scheme can enhance the closed-loop system performance by reducing the output tracking errors.
An application of model-based fuzzy control to an industrial grain dryer
Authors: Bremner H. , Postlethwaite B.E.
Published: November 2007

Although many fuzzy controller applications have been reported, these have bean exclusively rule-based designs. This paper describes an application of a model-predictive controller, based around a fuzzy relational model, to a grain dryer in a Whisky distillery. The dryer was a particularly difficult system to control since it had a significant dead-time, poorly understood internal mechanisms and large non-linear disturbances. The paper describes the process and the methods used to gather data for identification. The data analysis techniques and methods used to construct the fuzzy relational model are also described. Finally, the results of on-line controller trials are presented and these show that good control performance is achieved, especially when compared with the previous manually controlled system.
A digital pressure transducer
Authors: Lewis C.P. , Hesketh T.G. , Kraft M. , Florescu M.
Published: November 2007

A closed-loop digital pressure transducer is described which employs a quartz sensor embedded into a sigma delta modulator. Limit cycle analysis and test results are included for this nonlinear discrete-data system.
Robust adaptive control of nonlinear systems subjected to system uncertainties
Authors: Chang K.M.
Published: November 2007

In this work, the adaptive control scheme for a class of input-output linearizable nonlinear systems subjected to system uncertainties is presented. An adaptation law is proposed to estimate unknown system parameters such that the effect of the system parameter uncertainties can be reduced and a switching state feedback gain is set in the adaptive control input to treat with unmodelled dynamical uncertainty problems. Then a robust adaptive control scheme in the presence of the above system uncertainties can be ensured. It is further indicated that the proposed adaptive control scheme will be robust asymptotically stable under some modifications. Some computer simulation results are proposed to show the performance of the proposed adaptive control scheme.
Problems and solutions in the classification of compensatory strategies
Authors: Poulisse Nanda
Published: November 2007

It has been common practice to classify communication strategies (CmS) by means of taxonomies which are largely product-oriented. In such taxonomies different types of achievement strategies (also known as compensatory strategies (CpS)) are distinguished on the basis of the resources (source language, target language, gestures) which are used to encode the strategy, and the linguistic structure in which the strategy is couched. In this paper it will be argued that these taxonomies are inadequate for a number of practical and theoretical reasons. As an alternative, a process-oriented approach towards the classification and study of CpS will be proposed. This approach distinguishes between two basic strategy types only, conceptual and linguistic. It will be demonstrated that the choice between these two strategies is largely constrained by the nature of the experimental task and, to a much smaller extent, by the subjects' foreign language proficiency level. It is expected that a systematic study of these constraints in terms of the process-oriented taxonomy described here will increase our ability to explain and predict CpS use.
Negation in early German-English Interlanguage: more Valueless Features in the L2 initial state
Authors: Eubank Lynn
Published: November 2007

In Eubank (1993/94), I argued that the apparent syntactic optionality one observes in, for example, the placement of medial adverbs vis-à-vis thematic verbs in French-English Interlanguage can be explained if one assumes that the relevant parametric values of French do not transfer into the English L2 initial state. What one finds instead is a nonvalue of sorts, which I dubbed . In this article, I extend this view of 'Valueless Features' by examining data from Wode (1981) on the L2 acquisition of English by speakers of German. In fact, what I show here is that, in spite of important differences between the French-English and the German-English data, Valueless Features extends in a fairly natural way. In addition, however, I also examine two views that differ from Valueless Features, namely, the Full Transfer/Full Access Hypothesis of Schwartz and Sprouse (e.g., 1994) and the Minimal Trees of Vainikka and Young-Scholten (1994). Here, a careful review of the acquisitional data - either the French-English data or the German-English data - suggests that these views may not be as straightforward as they may otherwise appear.
Cerebral blood flow determinants and their clinical implications during cardiopulmonary bypass
Authors: Venn GE , Sherry K. , Klinger L. , Newman S. , Harrison M. , Ell PJ , Treasure T.
Published: November 2007

Cerebral blood flow (CBF) was measured in 58 patients undergoing elective coronary artery surgery (CABS) prior to, during and following cardiopulmonary bypass. CBF fell significantly during hypothermic bypass and returned to prebypass levels following the end of bypass. At all times CBF, measured as the initial slope index (ISI), was significantly correlated to arterial carbon dioxide tension (PaCO 2) and cerebral oxygen consumption (CMRO2). There was no significant correlation between CBF and changes in arterial blood pressure or, when on bypass, perfusion flow. This supports the notion that CBF autoregulation is maintained during bypass under the conditions of this study.The index of cerebral oxygen supply to demand (CERO2), which reflects the ratio of oxygen consumed by the brain to that supplied by the cerebral circulation, was appropriately matched prior to and following bypass. During bypass the index fell significantly ( p<0.001) to levels consistent with a mismatch of flow and demand indicating relative cerebral hyperperfusion. Acid base maintenance during bypass was consistent with a 'pH stat' protocol with pH on bypass approximating, following temperature adjustment, to 7.40. The maintenance of pH stat requires a higher PaCO2 than does the maintenance of alphastat. It may be that the adoption of an alphastat acid base management protocol, as seen in poikilotherms rather than hibernating mammals, and the resultant reduction in absolute PaCO2 for any given temperature may result in a lowering of CBF and a return to appropriate matching of CBF and demand during bypass. This may be particularly important in relation to the generation of perfusion related, microembolic, cerebral damage during cardiopulmonary bypass.
Use of an intravascular gas exchanger: is low systemic heparinization safe?
Authors: von Segesser LK , Pasic M. , Tönz M. , Lachat M. , Leskosek B. , Turina MI
Published: November 2007

Extracorporeal membrane oxygenation (ECMO) is a cumbersome procedure. Alternatively, mechanical lung assist can be realized with an intravascular gas exchanger (IVOX). To assess the degree of initial anticoagulation required during intravascular lung assist, we evaluated two regimens of systemic heparinization in 10 bovine experiments. The animals were randomly assigned to two groups with either full systemic heparinization (heparin loading dose 300 IU/kg bodyweight; activated coagulation time (ACT) > 480 s) or low systemic heparinization (heparin loading dose 100 IU/kg bodyweight; ACT > 180 s). The surface heparinized intravascular gas exchanger was placed in the caval axis under fluoroscopic control, and a standard battery of blood samples was drawn before and at regular intervals during the procedure. After six hours of intravascular lung assist the device was explanted, drained, weighed, and carefully analysed. Preassist haematocrit was 25 ± 5% for full versus 24 ± 7% for low (NS) as compared with 23 ± 8% for full versus 26 ± 3% for low (NS) postassist. Platelet levels were 100 ± 25 for full versus 100 ± 21 % for low (NS) preassist as compared with 64 ± 22% for full versus 78 ± 22% for low (NS) postassist. Mean ACT was 157 ± 12 s for full versus 158 ± 18 for low (NS) preassist as compared with 800 ± 244 s versus 219 ± 25 for low (p < 0.05) postassist. Thrombin time was 20 ± 2 s for full versus 23 ± 2 s for low (NS) as compared with > 200 s for both groups after assist. Relative fibrinopeptide A levels were 7.3 ± 1.1 ng/ml for full versus 6.3 ± 1.6 ng/ml for low (NS) preassist as compared with 4.7 ± 4.1 ng/ml for full versus 5.8 ± 0.9 ng/ml for low (NS) postassist. CO2 transfer was 40 ± 10 ml/min for full versus 36 ± 10 ml/min for low (NS) at the begining as compared with 45 ± 25 ml/min for full versus 46 ± 15 for low (NS) at the end. Weight increase due to device deposits (clots) was 14 ± 11 g for full versus 13 ± 10 g for low systemic heparinization (NS). Intravascular lung assist with low versus full systemic heparinization appeared to result in similar activation of the coagulation system, device deposits and gas transfer rates. Considering our clinical experience we can say that application of the device with reduced systemic heparinization is useful in selected patients.
Platelet activation and degradation in an experimental extracorporeal system. A comparison between a silicone membrane and a hollow-fibre oxygenator
Authors: Mellgren K. , Skogby M. , Järnås Å. , Friberg LG , Wadenvik H. , Mellgren G.
Published: November 2007

Blood platelets are rapidly activated in contact with biomaterials and, therefore, can be used as markers of the biocompatibility of various components in an extracorporeal system. In the present work, two different oxygenators, one membrane oxygenator (Avecor) and one hollow-fibre oxygenator ('Lilliput', Dideco) were compared. Complete in vitro extracorporeal membrane oxygenation circuits were perfused with fresh, heparinized human blood for 24 h. Eight experiments were performed with the hollow-fibre oxygenator and five experiments with the membrane oxygenator. Blood gases, electrolytes, glucose and haematocrit were kept within physiological limits. Platelet count, plasma concentration of β-thromboglobulin, platelet serotonin content, platelet membrane glycoprotein Ib and its degradation product glycocalicin, as well as plasma haemoglobin concentration were assayed. As regards most of these variables, significant differences in favour of the hollow- fibre oxygenator were observed.
The role of the palliative care unit in the organization of services to patients with cancer
Authors: Maher EJ , Barton L. , Ashby J. , Dickson R.
Published: November 2007

Each health district in the UK aims to provide services for cancer patients from the time of diagnosis to death. The role of the palliative care unit in district-based cancer management is still developing. This paper presents data which were part of an informal study investigating areas of uncertainty, dissatisfaction and controversy perceived by both patients and health-care professionals about local services for patients with breast cancer within a single health district. In this report we consider attitudes to the provision of terminal care for these patients and discuss implications for the integration of a palliative care unit in district-based cancer management.
Management of bleeding in advanced cancer - a flow diagram
Authors: Regnard Claud , Makin Wendy
Published: November 2007

Bleeding here is defined as any escape of blood from vessels due to causes related to advanced cancer, but excluding surgery or trauma. This flow diagram looks at ways to manage the varied sources and causes of bleeding, and indicates the decisions required.
Ethical issues in palliative care research
Authors: de Raeve Louise
Published: November 2007

Much has been written about the ethics of experimental research upon human subjects, particularly where such subjects can be said to be in a vulnerable position in relation to the researcher. This paper attempts to address such questions with reference to people who are dying. A case is made to defend the view that no research is morally justifiable with this client group. Less extreme views are also explored. One justification for such research activity comes from a rights-based perspective and another from the weighing of benefits and harms. In the process of exploring these issues, the author attempts to demonstrate that no research methodology can be said to be benign.
Services given and help perceived during home care for terminal cancer
Authors: Hinton John
Published: November 2007

Separate accounts of care were recorded weekly from staff, patients and relatives in a randomised sample of patients with terminal cancer referred to a home care service with readily available beds. Various services were involved but nurses made most contacts, 3.0 visits and 2.4 phone calls weekly, rising sharply in the last week. General practitioners averaged 0.4 visits/week but their considerable variation evoked either praise or criticism. Maintaining contact, giving explanations and support were reported to help as often as physical treatments and practical nursing, although staff's and recipients' accounts differed slightly. Help succeeded for many problems, but weakness was common, often grew worse and led to more admissions than pain. Difficulties in relieving fatigue and strain in relatives also curtailed home care. Subsequent home care team reorganisation to strengthen linkage between particular nurses and patients and the improvement of day care services were associated with successive but modest rises from the original 27% to 34% of patients dying at home. Implications of the results for services and skills required for home care are discussed, noting the problems that deserve further attention.
An analytical study of the changing health of a hospice population 1978-89
Authors: Duke S.
Published: November 2007

This study explores the changing characteristics of patients admitted to Sir Michael Sobell House, Oxford, between 1978-89. These dates represent the period between the first available records and the first computerized records. Analysis is between these dates and has been undertaken to enable future comparison between the early life of the unit with more recent developments. Using secondary sources the following areas were compared statistically: information related to general characteristics such as sex and age; information related to referral such as the number of referrals; diagnosis on referral and reasons for referral; information related to problems presented and place of death. Significant findings included an increase in referrals and patient survival; an increase in patients dying at home; a decrease in symptoms presented on referral and fewer referrals for terminal care; and an increase in referral for rehabilitation, assessment and support. Reasons for these changes are suggested.
Identification and Characterization of a New Human DNA Reactive Monoclonal Antibody and a Common Idiotype, WRI 176 Id β
Authors: Blanco F. , Longhurst C. , Watts R. , Kalsi J. , Wiloch H. Winska , Youinou P. , Latchman D.S. , Isenberg D.A.
Published: November 2007

We describe a human monoclonal antibody designated WRI 176 β and a common idiotype that it carries. This antibody was derived from the spleen of a patient with SLE. WRI 176 is an IgM kappa monoclonal reacting with ssDNA, dsDNA, poly(dT) and it is likely that mAb WRI 176 β is a representative of the so-called natural autoantibodies. The common Id designated WRI 176 Id β is located on the heavy chain of the mAb WRI 176 β molecule and appears to be located outside the binding site. Sequence analysis of the WRI 176 β heavy chain showed it to be highly homologous (97.3%) with a germline gene 56PI derived from a human fetus. In a retrospective analysis, although 44% of SLE patients had raised levels of the WRI 176 β no correlation was found with the activity of the disease. The idiotype was also expressed frequently in a range of autoimmune rheumatic and infectious diseases and in some healthy first-degree relatives of SLE patients.
Accuracy of 133-xenon regional cerebral blood flow and quantitative electroencephalography in systemic lupus erythematosus
Authors: Nobili F. , Rodriguez G. , Arrigo A. , Stubinski BM , Rossi E. , Cerri R. , Damasio E. , Rosadini G. , Marmont AA
Published: November 2007

Objective: comparative assessment of sensitivity and specificity of regional Cerebral Blood Flow (rCBF) by 133-Xenon inhalation and quantitative Electroencephalography (qEEG) in patients with Neuropsychiatric Systemic Lupus Erythematosus (NP-SLE).

Methods: Sixty-two combined rCBF and qEEG examinations were performed in fifty-two SLE patients. Group A: 27 SLE patients without NP-SLE; group B: 17 patients with florid (within 1 month) NP-SLE; group C: 12 patients with previous NP-SLE examined in the remission phase (four patients of which already considered in group B). The study also included data deriving from two sets of examinations in ten patients who were observed twice, in different phases of the clinical course of NP-SLE.

Results: in comparison to healthy controls, rCBF was lower (p < .001) in group B only, whereas qEEG showed similar increases of both δ and 0 relative powers together with a reduction of α relative power in groups A-C. As compared to group A, sensitivity and specificity in detecting cerebral abnormalities in group B were 76% and 78% for rCBF, and 59% and 44% for qEEG, respectively. In the ten patients examined twice, rCBF was consis tent with clinical course in 90% of cases and qEEG in 60%.

Conclusion: total accuracy in detecting cerebral functional abnormalities during florid NP-SLE is better by rCBF than by qEEG. rCBF and, in selected cases, qEEG examinations are reliable markers of NP-SLE.
Torture Survivors: a Challenge To Nursing Practice
Authors: Thomsen Karen Strandby
Published: November 2007

Why should all nurses and student nurses receive instruction in the subject of torture, its purpose, methods and sequelae on body and soul? One reason is because torture is an atrocity, the most perverted and disgusting act that exists. Some nurses meet torture survivors and their families in their private lives and at work.

Many countries have ratified codes and declarations in relation to torture, and are therefore obliged to educate some professional groups in the subject. This article describes how the subject 'Torture' is dealt with at the School of Nursing in Aalborg, Denmark. Aspects of how the course is planned, the placement of the subject, teaching objectives, content of the lessons, teaching methods and teaching materials are mentioned. This article also underlines why it is so important to educate student and qualified nurses about torture. The conclusion is that nurses can help to alleviate the effects of torture in a merciless and unfeeling world.
To Feed or To Nourish? Thoughts On the Moral Significance of Meals in Hospital
Authors: de Raeve Louise
Published: November 2007

This paper explores the issue of the serving of food in hospital from both a moral and a philosophical point of view. The concepts of 'having a meal' and of 'feeling nourished by food' are examined; it is suggested that the former is a necessary condition for the latter. The implications of this for nursing care are considered and it is argued that there is a moral imperative for us to try and serve 'meals', rather than simply 'food' to patients. The importance of this is highlighted by current concerns about malnutrition in hospital.
Ethical Aspects of Judging the Alternative Treatment of Children With Cancer
Authors: Enskär Karin
Published: November 2007

In recent decades the improved treatment of childhood cancer has increased the proportion of children being cured. However, the intensive treatment required also implies a heavy burden for the children and their families. The purpose of this article is to judge the ethical aspects of different treatment regimens used for children with cancer by means of a case study. The analysis is based on the ethical model by Beauchamp and Childress. The assessment is based on every person, or group of persons, involved and is on the principles of autonomy, nonmaleficence, beneficence and justice. The analysis shows that intensification of treatment of children with cancer is ethically justified from a deontological point of view. The consequences are more difficult to anticipate from a utilitarian perspective.

Au cours de plusiurs décennies les traitements plus efficaces des cancers des enfants ont augmentés la proportion des enfants guéris. Pourtant, le traitement intensif pose aussi un lourd fardeau aux enfants et leurs familles. Le but de cet article est d'évaluer les implications éthiques des différents traitements utilisés pour enfants souffrants de cancer, à l'aide d'une étude particulière. L'analyse éthique est basée sur le modèle de Beauchamp et Childress. L'évaluation est basée sur chaque personne ou sur les groupes de personnes impliqués, et sur les principes d'autonomie, nonmaléficence, bénéficence et justice. L'analyse montre que l'intensification du traitement des enfants souffrant de cancer est justifié éthiquement du point de vue déontologique. Les conséquences de ces actions sont plus difficiles à prévoir vue d'une perspective utilitaire.

Die verbesserte Behandlung von Kinderkrebs in den vergangenen Jahrzehnten hat die Proportion der geheilten Kinder ansteigen lassen. Die intensive Behandlung bedeutet aber auch eine schwere Belastung für die Kinder und ihre Familien. Der Zweck dieses Artikels ist es, die ethischen Aspekte der verschiedenen Behandlungsmethoden bei Kinderkrebs durch eine Fallstudie abzuwägen. Die ethische Analyse basiert auf dem ethischen Modell von Beauchamp und Childress. Die Beurteilung berücksichtigt jede betroffene Person oder Personengruppe und beruht auf den Prinzipien der Selbstbestimmung, Schädlichkeit bzw. Unschädlichkeit, Nutzen und Verträglichkeit und Gerechtigkeit. Diese Analyse zeigt, dass die Intensivierung der Behandlung von

krebskranken Kindem von einem deontologischen Standpunkt aus ethisch vertretbar ist. Die Folgen der Behandlung sind jedoch vom Nützlichkeitsgesichtspunkt her schwieriger vorauszusehen.
Midwives, Their Employers and the UKCC: an Eternally Unethical Triangle
Authors: Clarke Rachel A
Published: November 2007

The majority of midwives in the UK are employed within the NHS. They are legally bound to fulfil their contractual obligations to their employers. At the same time they are professionally mandated to interpret and act on the UKCC's Code of professional conduct. Midwives have always maintained that they are autonomous practitioners, and the Code is written in a way that endorses this belief. Underlying the Code is the assumption that midwives have moral and professional freedom to act on its imperatives. However, midwives' claim to autonomy is flawed, and therefore the Code's claim to be a source of empowerment is also flawed. Underlying the difficulties is a conflict derived from the imposition of a deontologically-based professional Code on to a workforce that is constrained within and employed by the utilitarian-based NHS.
The Great El Niño of 1789–93 and its Global Consequences: Reconstructing an Extreme Climate Event in World Environmental History
Authors: Grove Richard H.
Published: November 2007

This article explores the global dimensions of an extreme climatic anomaly characterised by a series of El Niño events observable during the late eighteenth century. While similar events, comparable in their extent and severity, can be detected during earlier centuries, archival and physical data available for a later period suggest that the consequences of the El Niño of 1788–96 were most dramatic. Reconstructing this event may be a useful analogue in understanding the effects of comparable phenomena further back in time, especially where data is sparse. This article investigates the shocks triggered off on a global scale by El Niño events that became part of a conjuncture affecting economic systems, intellectual and administrative responses to issues of environment, and popular unrest. The precise relationship between an anomalous climatic situation and revolutionary upheaval, as in the case of France in the late 1780s and 1790s, is still open to discussion. The study of climatic stresses is however important to be able to contextualise a historical phenomenon on a global matrix. It now appears that the history of the Great El Niño of the 1790s can help to illuminate a much larger picture of world history during the last 5,000 years, especially in understanding the connections between El Niño events and the shocks such anomalies have periodically administered to the world economic system.
Risks and Disasters in the History of the Mexico Basin: Are they Climatic or Social?
Authors: García-Acosta Virginia
Published: November 2007

Using primary information coming from the two published volumes of Desastres agrícolas en México. Catálogo histórico (Agricultural Disasters in Mexico. Historical Catalogue), this article explores floods that occurred from the fifteenth to nineteenth centuries in the Mexican Basin, including Tenochtitlan—later Mexico City—and the Valley of Mexico. Through their description and contextualisation it is possible to confirm the social character of disasters associated with natural hazards, be they climatic or environmental that occurred in the core of pre-Hispanic and colonial Mexico.