bluuebunny/crossref_metadata_2025 huggingface dataset:
ENDOSCOPIC IDENTIFICATION OF HELICOBACTER PYLORI GASTRITIS IN CHILDREN
Authors: Hidaka Nao , Nakayama Yoshiko , Horiuchi Akira , Kato Sawako , Sano Kenji
Published: March 2010

Aim:  The role of endoscopic findings in deciding whether to biopsy the gastric mucosa of children remains unclear. The present study attempted, for the first time, to identify the value of endoscopic features for diagnosis of Helicobacter pylori (Hp) infection in children.

Methods:  Hp status of consecutive children receiving esophagogastroduodenoscopy (EGD) was established by combinations of histology, 13C‐urea breath test, and serum Hp immunoglobulin (Ig)G antibody. After routine EGD using a conventional endoscope, the presence of RAC (regular arrangement of collecting venules) was scored by close observation, which was carried out at two sites of lower corpus lesser curvature and upper corpus greater curvature. RAC‐positive was defined as the presence of minute red points in a regular pattern. Antral nodularity was also scored as present/absent.

Results:  Eighty‐seven consecutive children (38 boys, median age 13 years, range 9–15 years) were evaluated; 25 (29%) were Hp positive. Antral nodularity was seen in 21 (84%) all of whom were Hp positive. The RAC‐negative pattern based on examination of the upper and lower corpus yielded a sensitivity, specificity, positive predictive value and negative predictive value for the presence of Hp infection of 100%, 90%, 81%, and 100%. Magnifying endoscopy confirmed that the RAC pattern corresponded to collecting venules in the gastric corpus.

Conclusions:  The absence of RAC pattern suggests that gastric mucosa biopsies should be taken despite otherwise normal‐appearing gastric mucosa for the diagnosis of Hp infection in children.
ENDOSCOPIC ULTRASOUND‐GUIDED CHOLEDOCHODUODENOSTOMY
Authors: Hara Kazuo , Yamao Kenji , Mizuno Nobumasa , Sawaki Akira , Takagi Tadayuki , Bhatia Vikram
Published: March 2010

Endoscopic biliary drainage (EBD) may be unsuccessful in some patients, because of failed biliary cannulation or tumor infiltration, limiting endoscopic access to major papilla. The alternative method of percutaneous transhepatic biliary drainage carries a risk of complications, such as bleeding, portal vein thrombus, portal vein occlusion and intra‐ or extra‐abdominal bile leakage. Recently, endoscopic ultrasonography (EUS)‐guided biliary stent placement has been described in patients with malignant biliary obstruction. Technically, EUS‐guided biliary drainage is possible via transgastric or transduodenal routes or through the small intestine using a direct access or rendezvous technique. We describe herein a technique for direct stent insertion from the duodenal bulb for the management of patients with jaundice caused by malignant obstruction of the lower extrahepatic bile duct. We think transduodenal direct access is the best treatment in patients with jaundice caused by inoperable malignant obstruction of the lower extrahepatic bile duct when EBD fails.
ENDOSCOPIC SUBMUCOSAL DISSECTION WITH SHEATH‐ASSISTED COUNTER TRACTION FOR EARLY GASTRIC CANCERS
Authors: Hijikata Yasutaka , Ogasawara Naotaka , Sasaki Makoto , Mizuno Mari , Masui Ryuta , Tokudome Kentaro , Iida Akihito , Miyashita Masayuki , Funaki Yasushi , Kasugai Kunio
Published: March 2010

Aim:  Endoscopic submucosal dissection (ESD) is associated with frequent complications, such as bleeding and perforation. The procedure is technically difficult, requires considerable skill and is longer than conventional endoscopic mucosal resection (EMR). Thus, non‐invasive tools and methods are needed to facilitate direct visualization of the submucosal layer during ESD.

Methods:  An insulation‐tipped (IT) knife was inserted into one channel, and a conventional injection sheath was inserted to the other channel of a double‐channel fiberscope. The submucosal layer was lifted via a circumferential incision using the conventional injection sheath for visualizing cutting lines, and the submucosal layer under the lesion was directly dissected from the underlying muscularis propria.

Results:  Sheath‐assisted traction resulted in successful ESD with en bloc resection in all 25 patients. Hemostasis and manipulation of blood vessels were uncomplicated and dissection was completed safely, without either bleeding or perforation. The movement of the sheath was not suppressed while lifting the submucosal layer and the IT knife could be moved freely, which allowed submucosal dissection independently of the sheath movement.

Conclusion:  Sheath‐assisted traction ESD, using simple materials and methods, has several advantages over other standard traction methods. Our procedure is straightforward, safe, non‐invasive, cost‐effective and uses readily available instruments to enhance visualization of cutting lines.
Results of percutaneous transhepatic cholecystostomy for high surgical risk patients with acute cholecystitis
Authors: Chok Kenneth S. H. , Chu Ferdinand S. K. , Cheung Tan To , Lam Vincent W. T. , Yuen Wai Key , Ng Kelvin K. C. , Chan See Ching , Poon Ronnie T. P. , Yeung Chun , Lo Chung Mau , Fan Sheung Tat
Published: March 2010

Aim:  To assess the efficacy and safety of percutaneous transhepatic cholecystostomy (PTC) in treatment for acute cholecystitis in high surgical risk patients.

Patients and methods:  A retrospective review was carried out from January 1999 to June 2007 on 23 patients, 11 males and 12 females, who underwent PTC for the management of acute cholecystitis at the Department of Surgery, Queen Mary Hospital, Hong Kong, China. The mean age of the patients was 83. They all had either clinical or radiological evidence of acute cholecystitis and had significant pre‐morbid diseases. The median follow‐up period on them was 35 months.

Results:  All the PTCs performed were technically successful. One patient died from procedure‐related haemoperitoneum, while 87% (n= 20) of all the patients had clinical resolution of sepsis by 20 h after PTC. Eight patients underwent elective cholecystectomy afterwards (62.5% with the laparoscopic approach). Eight patients had dislodgement of the PTC catheter and one of them developed recurrent acute cholecystitis 3 months after PTC. That patient was treated conservatively. Four patients died from their pre‐morbid conditions during the follow‐up period.

Conclusion:  PTC was a safe and effective alternative for treating acute cholecystitis in this group of patients. Thirteen of them without elective cholecystectomy performed did not have recurrent acute cholecystitis after a single session of PTC. It may be considered as a definitive treatment for this group of patients.
Review of anatomy education in Australian and New Zealand medical schools
Authors: Craig Steven , Tait Noel , Boers David , McAndrew Darryl
Published: March 2010

Anatomy instruction at Australian and New Zealand medical schools has been the subject of considerable debate recently. Many commentators have lamented the gradual devaluation of anatomy as core knowledge in medical courses. To date, much of this debate has been speculative or anecdotal and lacking reliable supporting data. To provide a basis for better understanding and more informed discussion, this study analyses how anatomy is currently taught and assessed in Australian and New Zealand medical schools.

A mailed questionnaire survey was sent to each of the 19 Australian and 2 New Zealand medical schools, examining the time allocation, content, delivery and assessment of anatomy for the 2008 academic year.

Nineteen of the 21 (90.5%) universities invited to participate completed the survey. There was considerable variability in the time allocation, content, delivery and assessment of anatomy in Australasian medical schools. The average total hours of anatomy teaching for all courses was 171 h (SD ± 116.7, range 56/560).

Historical data indicate a major decline in anatomy teaching hours within medical courses in Australia and New Zealand. Our results reveal that as there is no national curriculum for anatomy instruction, the curriculum content, instruction methodology and assessment is highly variable between individual institutions. Such variability in anatomy teaching and assessment raises an important question: is there also variable depth of understanding of anatomy between graduates of different medical courses?
The need for patellar resurfacing in total knee arthroplasty: a literature review
Authors: Swan John D. , Stoney James D. , Lim Keith , Dowsey Michelle M. , Choong Peter F.M.
Published: March 2010

The controversy over whether or not to routinely resurface the patella during a total knee arthroplasty has persisted despite three decades of successful joint replacement procedures. Advocates for routine patellar resurfacing admit the occasional need for secondary patellar resurfacing and declare increased incidence of anterior knee pain in patients with non‐resurfaced patellae as a cause for worry. Surgeons that leave the patella unresurfaced cite avoidance of complications that include patellar fracture, avascular necrosis, patellar tendon injury and instability. This review discusses the available literature on patellar resurfacing through an evidence‐based analysis of randomized and pseudo‐randomized controlled trials and published meta‐analyses to date. The published literature seems to favour resurfacing the patellar routinely. Selective patellar resurfacing would be the ideal solution if sound pre‐operative criteria could be established. So far, a method for accurately predicting which patients can avoid patellar resurfacing has not been found. Future research looking at patellar resurfacing should concentrate on developing criteria for selecting those patients that would benefit from patellar resurfacing and those that would do as well without resurfacing, and thus, limiting potential surgical complications.
Functional and proteomic analysis of serum and cerebrospinal fluid derived from patients with traumatic brain injury: a pilot study
Authors: Cadosch Dieter , Thyer Matthew , Gautschi Oliver P. , Lochnit Günter , Frey Sönke P. , Zellweger René , Filgueira Luis , Skirving Allan P.
Published: March 2010

Background:  An enhanced fracture healing response has been reported in patients with traumatic brain injury (TBI). This has been attributed to circulating humoral factors that are thought to be proteins produced and released by the injured brain. However, these factors remain unknown. The aim of this study was to identify osteogenic factors in serum and cerebrospinal fluid (CSF) from TBI patients. This was carried out using in vitro proliferation assays with the human foetal osteoblastic 1.19 cell line (hFOB) combined with a novel proteomic approach.

Methods:  Serum was collected from brain‐injured (n = 12) and non‐brain‐injured (n = 9) patients with a comorbid femur shaft fracture. Similarly, CSF was obtained from TBI (n = 7) and non‐TBI (n = 9) patients. The osteoinductive potential of these samples was determined by measuring the in vitro proliferation rate of hFOB cells. Highly osteogenic serum and CSF samples of TBI patients were chosen for protein analysis and were compared to those of non‐brain‐injured patients. A new hFOB cell‐based method was used to enrich the proteins in these samples, which had a functional affinity for these osteoprogenitor cells. These enriched protein fractions were mapped using two‐dimensional gel electrophoresis and protein imaging methods displaying serum and CSF proteins of brain‐injured and control subjects that had an affinity for human osteoprogenitor cells.

Results:  Serum and CSF derived from brain‐injured patients demonstrated a greater osteoinductive potential (P < 0.05) than their non‐brain‐injured counterparts. Clear‐cut differences in the pattern of proteins in two‐dimensional gels were detected between TBI and control patients. Fourteen proteins were exclusively present in the serum of TBI patients, while other proteins were either up‐ or downregulated in samples collected from TBI patients (P < 0.05).

Conclusion:  Osteoinductive factors are present in the serum and CSF of brain‐injured patients. These may include one or more of those proteins identified as having an affinity for osteoprogenitor cells that are either exclusively present or up‐ or downregulated in the serum and CSF of brain‐injured patients.
N‐methyl‐d‐aspartate, hyperpolarization‐activated cation current (Ih) and γ‐aminobutyric acid conductances govern the risk of epileptogenesis following febrile seizures in rat hippocampus
Authors: Ouardouz Mohamed , Lema Pablo , Awad Patricia N. , Di Cristo Graziella , Carmant Lionel
Published: March 2010

Febrile seizures are the most common types of seizure in children, and are generally considered to be benign. However, febrile seizures in children with dysgenesis have been associated with the development of temporal lobe epilepsy. We have previously shown in a rat model of dysgenesis (cortical freeze lesion) and hyperthermia‐induced seizures that 86% of these animals developed recurrent seizures in adulthood. The cellular changes underlying the increased risk of epileptogenesis in this model are not known. Using whole cell patch‐clamp recordings from CA1 hippocampal pyramidal cells, we found a more pronounced increase in excitability in rats with both hyperthermic seizures and dysgenesis than in rats with hyperthermic seizures alone or dysgenesis alone. The change was found to be secondary to an increase in N‐methyl‐d‐aspartate (NMDA) receptor‐mediated excitatory postsynaptic currents (EPSCs). Inversely, hyperpolarization‐activated cation current was more pronounced in naïve rats with hyperthermic seizures than in rats with dysgenesis and hyperthermic seizures or with dysgenesis alone. The increase in GABAA‐mediated inhibition observed was comparable in rats with or without dysgenesis after hyperthermic seizures, whereas no changes were observed in rats with dysgenesis alone. Our work indicates that in this two‐hit model, changes in NMDA receptor‐mediated EPSCs may facilitate epileptogenesis following febrile seizures. Changes in the hyperpolarization‐activated cation currents may represent a protective reaction and act by damping the NMDA receptor‐mediated hyperexcitability, rather than converting inhibition into excitation. These findings provide a new hypothesis of cellular changes following hyperthermic seizures in predisposed individuals, and may help in the design of therapeutic strategies to prevent epileptogenesis following prolonged febrile seizures.
Evidence for the persistence of contextual fear memories following immediate extinction
Authors: Archbold Georgina E. B. , Bouton Mark E. , Nader Karim
Published: March 2010

Evidence suggests that extinction, the suppression of a learned response to a Pavlovian signal that is produced by exposure to the signal alone after conditioning, is a consequence of new inhibitory learning. However, it has been proposed that extinction given immediately after conditioning reflects memory ‘erasure’. Using contextual fear conditioning, we examine the nature of extinction further using a novel behavioral paradigm that probes for the absence or presence of a memory. Rats received a context paired with one of three different shock intensities (0.8, 1.2 or 1.6 mA) and then received extinction either immediately (15 min) or after a delay (24 h). Spontaneous recovery was roughly equivalent in the immediate and delayed extinction groups when they were tested at 24 h after extinction. To further test the status of the original memory trace, we exploited the effect that only the first, but not second, learning of contextual fear requires N‐methyl‐D‐aspartate receptors (NMDArs) in the dorsal hippocampus [M.J. Sanders & M.S. Fanselow (2003)Neurobiology of Learning and Memory80,123–129]. Here we use this property of second learning to determine if memory of an immediately extinguished fear also persists. Rats received bilateral infusions of the NMDAr antagonist DL‐2‐amino‐5‐phosphonopentanoic acid into the dorsal hippocampus prior to training in a novel second context. Memory for the second learning is not affected by NMDAr blockade in either group, suggesting that the extinguished memory is not erased but inhibited. Overall, the results provide little evidence that extinction conducted immediately after conditioning destroys or erases the original memory trace.
Long‐term function after ileal pouch‐anal anastomosis –Function does not deteriorate with time
Authors: Wasmuth H. H. , Tranø G. , Midtgård T. M. , Wibe A. , Endreseth B. H. , Myrvold H. E.
Published: March 2010

Aim  There are conflicting reports regarding long term function after ileal pouch‐anal anastomosis (IPAA). The aim of the present prospective study was to investigate the influence of duration as an independent factor on long‐term function results.

Method  Between 1984 and 2007, 315 patients underwent IPAA and were followed by a standardised interview and endoscopy protocol. There were 1802 interviews. Two hundred and thirty‐five patients had three or more visits and these data were analysed by Time‐Series‐Cross‐Section multivariate regression analysis. The mean time follow up was 12 years and the mean interval between visits was 34.5 months.

Results  Mean frequency of defecation was 5.2 in the day and 0.55 at night. This did not change with time. Daytime and night incontinence occurred in 13% and 21%. There was no change in incontinence, urgency, soiling or perineal excoriation with time. After 24 years the cumulative incidence of pouchitis was 43.5%. Twenty patients had chronic pouchitis (6.3%).

Conclusion  The interval from IPAA did not influence the long‐term functional outcome.
BqR‐Tree: A Data Structure for Flights and Walkthroughs in Urban Scenes with Mobile Elements
Authors: Pina J.L. , Seron F. , Cerezo E.
Published: March 2010

BqR‐Tree, the data structure presented in this paper is an improved R‐Tree data structure based on a quadtree spatial partitioning which improves the rendering speed of the usual R‐trees when view‐culling is implemented, especially in urban scenes. The city is split by means of a spatial quadtree partition and the block is adopted as the basic urban unit. One advantage of blocks is that they can be easily identified in any urban environment, regardless of the origins and structure of the input data. The aim of the structure is to accelerate the visualization of complex scenes containing not only static but dynamic elements. The usefulness of the structure has been tested with low structured data, which makes its application appropriate to almost all city data. The results of the tests show that when using the BqR‐Tree structure to perform walkthroughs and flights, rendering times vastly improve in comparison to the data structures which have yielded best results to date, with average improvements of around 30%.
Some asymptotic results of a non‐parametric conditional mode estimator for functional time‐series data
Authors: Ezzahrioui M'hamed , Saïd Elias Ould
Published: March 2010

We consider the estimation of the conditional mode function when the covariates take values in some abstract function space. The main goal of this paper was to establish the almost complete convergence and the asymptotic normality of the kernel estimator of the conditional mode when the process is assumed to be strongly mixing and under the concentration property over the functional regressors. Some applications are given. This approach can be applied in time‐series analysis to the prediction and confidence band building. We illustrate our methodology by using El Nio data.
Icelandic exclamatives and the structure of the CP layer*
Authors: Jónsson Jóhannes Gísli
Published: March 2010

Abstract.  This paper discusses the rich array of clausal exclamatives in Icelandic. It is shown here that Icelandic has three kinds of simple exclamatives (Wh‐exclamatives, XP‐exclamatives and M‐exclamatives) as well as various combinations of these three types. A structural analysis of clausal exclamatives in Icelandic is proposed, according to which they involve up to three functional projections in the CP layer: ExclP (Exclamative Phrase), HDegP (High Degree Phrase) and WhP (Wh Phrase). Clausal exclamatives are also shown to fall into two groups with respect to the possibility of subject‐verb inversion and the use of the complementizer sem.
CLUSTERS: A MESMERISING MANTRA
Authors: TAYLOR MICHAEL
Published: March 2010

This paper argues that the cluster model of local economic growth is model that became a message that is now a mantra. It is an approach that has extended its explanatory reach through the accretion of layers of contingency. The paper suggests seven major limitations that undermine the explanatory power of what is now a mesmeric policy prescription for local economic development. It neglects the imperatives of capitalism, underestimates of the impact of unequal power relations on business relationships, fails to incorporate time, fetishises proximity, treats entrepreneurship simplistically, promotes the chaotic concept of institutional thickness, and is limited by the chaotic concept of social capital. It is concluded that a more nuanced and empirically grounded approach to agglomerated local growth is needed and a set of research questions is suggested.
Exports and Profitability: First Evidence for German Manufacturing Firms
Authors: Fryges Helmut , Wagner Joachim
Published: March 2010

Using unique recently released nationally representative high‐quality longitudinal enterprise‐level data for Germany, this paper presents the first comprehensive evidence on the relationship between exports and profitability. It documents that the positive profitability differential of exporters compared to non‐exporters is statistically significant, though rather small, when observed firm characteristics and unobserved firm‐specific effects are controlled for. In contrast to nearly all empirical studies on the relationship between productivity and exports we do not find any evidence for self‐selection of more profitable firms into export markets. Due to the sampling frame of the data used we cannot test the hypothesis that firms which start exporting perform better in the years after the start than their counterparts which do not start. Instead, we use a newly developed continuous treatment approach and show that exporting improves the profitability almost over the whole range of the export–sales ratio. Only firms that generate 90 per cent and more of their total sales abroad do not benefit from exporting in terms of an increased rate of profit. This means that the usually observed higher productivity of exporters is not completely absorbed by the extra costs of exporting or by higher wages paid by internationally active firms.
Firms in International Trade: Importers’ and Exporters’ Heterogeneity in Italian Manufacturing Industry
Authors: Castellani Davide , Serti Francesco , Tomasi Chiara
Published: March 2010

Combining data on structural characteristics and economic performance for a large sample of Italian firms with data on exporting and importing activity, we uncover evidence supporting recent theories on firm heterogeneity and international trade, together with some new facts. In particular, we find that importing is associated with substantial firm heterogeneity. First, we document that trade is more concentrated than employment and sales, and show that importing is even more concentrated than exporting both within sectors and along the sector‐ and country‐extensive margins. Second, while supporting the fact that firms involved in both are the best performers, we also find that firms involved only in importing activities perform better than those involved only in exporting. Our evidence suggests there is a strong self‐selection effect in the case of importers and the performance premia of internationalised firms correlate relatively more with the degree of geographical and sectoral diversification of imports.
Imports, Productivity and Origin Markets: The Role of Knowledge‐intensive Economies
Authors: Lööf Hans , Andersson Martin
Published: March 2010

We investigate the impact of international knowledge transfers on productivity at the firm level. The flow of knowledge across borders is measured through imports from different markets. Using a dynamic panel GMM estimation on Swedish manufacturing firms with 10 or more employees over the period 1997–2004, three important results emerge. First, there is an instantaneous positive effect of imports on productivity. Second, the evidence points towards a distinct role of imports from the G7 countries, which accounts for 80 per cent of global R&D. Third, sensitivity analyses show that G7 imports are also important for small and non‐affiliated firms.
Foreign Sourcing and Productivity: Evidence at the Firm Level
Authors: Fariñas José C. , Martín‐Marcos Ana
Published: March 2010

The objective of this paper is to explore the relationship between foreign sourcing and productivity at the firm level. To organise the empirical work, we rely on Antràs and Helpman’s model (2004), which predicts that high‐productivity firms engage in trade (foreign sourcing) and low‐productivity firms do not source abroad. The paper performs productivity comparisons between groups of firms sourcing abroad and firms which do not source abroad, applying non‐parametric procedures to a sample of Spanish manufacturing firms. Our results indicate the existence of large and significant differences in productivity between firms that source abroad and those that do not. The productivity premium of foreign sourcing firms is robust to other characteristics that are associated with firm productivity. Furthermore, the evidence reported is consistent with self‐selection of the most productive firms into the practice of sourcing abroad. The ex ante productivity distribution of firms that engage in foreign sourcing stochastically dominates the distribution of firms which do not source abroad. Finally, our estimates suggest that changing the intensity of foreign sourcing is a technology shifter for firms, and this has a direct impact on their total factor productivity.
Religion in American Life
Authors: Gabriel Ralph H.
Published: March 2010

A Review of Religion in American Life, edited by James Ward Smith and A. Leland Jamison, Vols. I, II, IV, Princeton University Press, 1961
Measures of site resourcing predict virologic suppression, immunologic response and HIV disease progression following highly active antiretroviral therapy (HAART) in the TREAT Asia HIV Observational Database (TAHOD)
Authors: Oyomopito R , Lee MP , Phanuphak P , Lim PL , Ditangco R , Zhou J , Sirisanthana T , Chen YMA , Pujari S , Kumarasamy N , Sungkanuparph S , Lee CKC , Kamarulzaman A , Oka S , Zhang FJ , Mean CV , Merati T , Tau G , Smith J , Li PCK ,   on behalf of The TREAT Asia HIV Observational Database
Published: March 2010

Objectives

Surrogate markers of HIV disease progression are HIV RNA in plasma viral load (VL) and CD4 cell count (immune function). Despite improved international access to antiretrovirals, surrogate marker diagnostics are not routinely available in resource‐limited settings. Therefore, the objective was to assess effects of economic and diagnostic resourcing on patient treatment outcomes.

Methods

Analyses were based on 2333 patients initiating highly active antiretroviral therapy (HAART) from 2000 onwards. Sites were categorized by World Bank country income criteria (high/low) and annual frequency of VL (≥3, 1–2 or <1) or CD4 (≥3 or <3) testing. Endpoints were time to AIDS/death and change in CD4 cell count and VL suppression (<400 HIV‐1 RNA copies/mL) at 12 months. Demographics, Centers for Disease Control and Prevention (CDC) classification, baseline VL/CD4 cell counts, hepatitis B/C coinfections and HAART regimen were covariates. Time to AIDS/death was analysed by proportional hazards models. CD4 and VL endpoints were analysed using linear and logistic regression, respectively.

Results

Increased disease progression was associated with site‐reported VL testing less than once per year [hazard ratio (HR)=1.4; P=0.032], severely symptomatic HIV infection (HR=1.4; P=0.003) and hepatitis C virus coinfection (HR=1.8; P=0.011). A total of 1120 patients (48.2%) had change in CD4 cell count data. Smaller increases were associated with older age (P<0.001) and ‘Other’ HIV source exposures, including injecting drug use and blood products (P=0.043). A total of 785 patients (33.7%) contributed to the VL suppression analyses. Patients from sites with VL testing less than once per year [odds ratio (OR)=0.30; P<0.001] and reporting ‘Other’ HIV exposures experienced reduced suppression (OR=0.28; P<0.001).

Conclusion

Low measures of site resourcing were associated with less favourable patient outcomes, including a 35% increase in disease progression in patients from sites with VL testing less than once per year.
Predictors of growth and body composition in HIV‐infected children beginning or changing antiretroviral therapy
Authors: Chantry CJ , Cervia JS , Hughes MD , Alvero C , Hodge J , Borum P , Moye J ,   for the PACTG 1010 Team
Published: March 2010

Objectives

The aim of the study was to describe growth and body composition changes in HIV‐positive children after they had initiated or changed antiretroviral therapy (ART) and to correlate these with viral, immune and treatment parameters.

Methods

Ninety‐seven prepubertal HIV‐positive children were observed over 48 weeks upon beginning or changing ART. Anthropometry and bioelectrical impedance analysis results were compared with results from the National Health and Nutrition Examination Survey 1999–2002 (NHANES) to generate z‐scores and with results for HIV‐exposed, uninfected children from the Women and Infants Transmission Study (WITS). Multivariate analysis was used to evaluate associations between growth and body composition and disease parameters.

Results

All baseline lean and fat mass measures were below those of controls from NHANES. Weight, height and fat free mass (FFM) index (FFM/height2) z‐scores increased over time (P=0.004, 0.037 and 0.027, respectively) and the waist:height ratio z‐score decreased (P=0.045), but body mass index and per cent body fat z‐scores did not change. Measures did not increase more than in uninfected WITS controls. In multivariate analysis, baseline height, mid‐thigh circumference and FFM z‐scores related to CD4 percentage (P=0.029, P=0.008 and 0.020, respectively) and change in FFM and FFM index z‐scores to CD4 percentage increase (P=0.010 and 0.011, respectively). Compared with WITS controls, baseline differences in height and mid‐thigh muscle circumference were also associated with CD4 percentage. Case–control differences in change in both subscapular skinfold (SSF) thickness and the SSF:triceps skinfold ratio were inversely associated with viral suppression. No measures related to ART class(es) at baseline or over time.

Conclusions

In these HIV‐positive children, beginning or changing ART was associated with improved growth and lean body mass (LBM), as indicated by FFM index. Height and LBM related to CD4 percentage at baseline and over time. Altered fat distribution and greater central adiposity were associated with detectable virus but not ART class(es) received.
Police, Probation and the Bifurcation of Community
Authors: FITZGIBBON WENDY , LEA JOHN
Published: March 2010

Abstract: The police and probation services are agencies that have traditionally had close relations with the communities in which they work. Both agencies exhibit tensions in their relations with the community: in policing, in the relation between centralised targets and community needs, and in probation in the role of the community in the process of rehabilitation and desistance. We argue that these tensions mirror deeper contradictions within current urban and social policy concerning the role envisaged for community in the process of urban renewal.
Quality of life: a survey of parents of children/adults with an intellectual disability who are availing of respite care
Authors: Caples Maria , Sweeney John
Published: March 2010

Accessible summary

This article describes the findings of a small‐scale survey investigating the quality of life of parents of children and adults with an intellectual disability who are availing respite care with a response rate of 38% (n = 49). The findings of the study which was conducted in 2008 on parents’ experience of respite care in an Irish setting indicated that:

Demand exceeds supply and many parents face a lengthy wait gaining access to respite care

Respite care was not necessarily associated with parental desire for an improvement in quality of life

The majority of parents reported that their quality of life was either ‘good’ or ‘excellent’

Further studies need to be conducted to establish what services are deemed most valuable to parents

Two‐thirds of the people registered on the Irish National Intellectual Disability Database (NIDD) reside at home with family members frequently supporting them (Kelly et al., National Intellectual Disability Database Committee Annual Report 2006, Health Research, 2007). Use of respite care services by parents with a child/adult with an intellectual disability (ID) in Ireland is growing in the context of social policy initiatives for greater social inclusion of people with disabilities. Irish parents who care for their child/adult with an ID at home are not asking for the care of their child/adult to be taken away from them, but to assist them in this role and to help them to meet the demands of personal, family, social and work life, they need to be supported with reliable, flexible and responsive services (Redmond & Richardson, J Appl Res Intellect Disabil, 2003; 16: 205–218). Parents often have to negotiate complex barriers to access support services such as respite, health or social care (Sloper, Child Care Health Dev, 1999; 25: 85–99). Chadwick et al, (Child Adolesc Ment Health 2002; 7: 66–72) suggest that respite care was primarily regarded as a service that was provided to relieve parental burdens. This article draws on a recent study that investigated the quality of life of parents of children/adults who have an intellectual disability and who are availing of respite care. The findings suggest that parents are experiencing ‘good’ to ‘excellent’ quality of life and that demand exceeds supply. More work needs to be carried out to establish what services are deemed most valuable to parents and to show how their needs can be met to the best of the Health Service Providers ability.
Emergency Contraception and Conscientious Objection
Authors: KELLEHER J. PAUL
Published: March 2010

abstract

Emergency contraception — also known as the morning after pill — is marketed and sold, under various brand names, in over one hundred countries around the world. In some countries, customers can purchase the drug without a prescription. In others, a prescription must be presented to a licensed pharmacist. In virtually all of these countries, pharmacists are the last link in the chain of delivery. This article examines and ultimately rejects several standard moves in the bioethics literature on the right of pharmacists conscientiously to refuse to dispense emergency contraception. Its central thesis is that the standard ‘moderate’ solution to this problem is mistaken. Thus, when all publicly relevant interests are given their due, it is not acceptable to allow refusals in the big city, where pharmacies are plentiful, but forbid them in rural settings, where pharmacies are scarce. Rather, there should be strong public policy requiring that all pharmacists dispense emergency contraception to customers who request it, regardless of pharmacists' moral or religious objections.
Fluid‐induced processes: metasomatism and metamorphism
Authors: PUTNIS A. , AUSTRHEIM H.
Published: March 2010

Geofluids (2010) 10, 254–269

Metamorphism and metasomatism both involve the reequilibration of mineral assemblages due to changes in pressure, temperature and/or chemical environment. Both processes involve material transport but on different length scales, so every metamorphic reaction is metasomatic on a local scale. Fluids provide a transport mechanism which is orders of magnitude faster than solid state diffusion and induce reequilibration through dissolution of parent phases and reprecipitation of products. Chemical weathering (kaolinitization and serpentinization), and albitization are used as examples to describe the coupling between dissolution and precipitation. Albitization of feldspars in nature and in experiments is a pseudomorphic replacement which generates porosity in the albite. Porosity generation associated with interface‐coupled dissolution‐precipitation allows rapid material transport and together with fluid induced fracturing, is the mechanism of pervasive fluid flow through reacting crystals. Examples of metamorphic reactions in granulite‐eclogite rocks illustrate the role of fluids in inducing chemical changes along fluid pathways. Microstructural criteria for a metamorphic event (i.e. change in P, T) are critically reviewed by describing the corona formed by reaction between kyanite and garnet, as well as partial replacement textures. We conclude that both corona structures and partial replacement textures are equally indicative of a metasomatic reaction (driven by a fluid‐induced compositional change) as they may be of a metamorphic reaction driven by a change in P and/or T. This raises the question of the extent to which fluids play not only a catalytic role but also a thermodynamic role in determining the course of a metamorphic reaction.
Identification of children with the same level of impairment as children on the autistic spectrum, and analysis of their service use
Authors: Russell Ginny , Ford Tamsin , Steer Colin , Golding Jean
Published: March 2010

Background:  Data from epidemiology have consistently highlighted a disparity between the true prevalence of childhood psychiatric disorders and their recognition as defined by receiving a clinical diagnosis. Few studies have looked specifically at the level of unidentified autistic spectrum disorder (ASD) in the population.

Method:  Logistic regression was used to determine the behavioural traits associated with receiving a diagnosis of ASD using data from the Avon Longitudinal Study of Parents and Children (ALSPAC). A composite score was derived to measure levels of autistic traits; undiagnosed children with scores matching those diagnosed with ASD were identified. Levels of educational provision beyond that provided by standard schooling were examined.

Results:  Fifty‐five percent of children with autistic traits at the same levels as those who had an autism diagnosis had not been identified as needing extra support from education or specialised health services. Of those who were identified as having special needs, 37.5% had been formally diagnosed with an ASD. For children with impairment at the same level as that associated with Asperger’s syndrome, 57% had no special provision at school, and were not accessing specialised health services. Twenty‐six percent of those who did have special provision at school had an ASD diagnosis.

Conclusions:  The results suggest that there may be a substantial proportion of children on the autistic spectrum who are never identified by services.
Longitudinal dimensionality of adolescent psychopathology: testing the differentiation hypothesis
Authors: Sterba Sonya K. , Copeland William , Egger Helen L. , Jane Costello E. , Erkanli Alaattin , Angold Adrian
Published: March 2010

Background:  The differentiation hypothesis posits that the underlying liability distribution for psychopathology is of low dimensionality in young children, inflating diagnostic comorbidity rates, but increases in dimensionality with age as latent syndromes become less correlated. This hypothesis has not been adequately tested with longitudinal psychiatric symptom data.

Methods:  Confirmatory factor analyses of DSM‐IV symptoms from seven common Axis I syndromes – major depression, generalized anxiety, separation anxiety, social anxiety, attention deficient hyperactivity, conduct, and oppositional defiant disorders – were conducted longitudinally, from ages 9 to 16, using the general‐population Great Smoky Mountains Study sample.

Results:  An eight‐syndrome model fit well at all ages, and in both genders. It included social anxiety, separation anxiety, oppositional defiant, and conduct syndromes, along with a multidimensional attention deficit‐hyperactivity syndrome (i.e., inattention, hyperactivity, and impulsivity) and a unidimensional major depression/generalized anxiety syndrome. A high degree of measurement invariance across age was found for all syndromes, except for major depression/generalized anxiety. Major depression and generalized anxiety syndromes slightly diverged at age 14–16, when they also began to explain more symptom variance. Additionally, correlations between some emotional and disruptive syndromes showed slight differentiation.

Conclusions:  Marked developmental differentiation of psychopathology, as implied by the orthogenetic principle, is not a prominent cause of preadolescent and adolescent psychiatric comorbidity.
Cognitive behavioral treatment for childhood anxiety disorders: long‐term effects on anxiety and secondary disorders in young adulthood
Authors: Saavedra Lissette M. , Silverman Wendy K. , Morgan‐Lopez Antonio A. , Kurtines William M.
Published: March 2010

Background:  The present study’s aim was to examine the long‐term effects (8 to 13 years post‐treatment; M = 9.83 years; SD = 1.71) of the most widely used treatment approaches of exposure‐based cognitive behavioral treatment for phobic and anxiety disorders in children and adolescents (i.e., group treatment and two variants of individual treatment). An additional aim was to compare the relative long‐term efficacy of the treatment approaches.

Method:  At long‐term follow‐up, participants (N = 67) were between 16 and 26 years of age (M = 19.43 years, SD = 3.02). Primary outcome was the targeted anxiety disorder and targeted symptoms. Secondary outcomes were other disorders and symptoms not directly targeted in the treatments including (1) other anxiety disorders and symptoms, (2) depressive disorders and symptoms, and (3) substance use disorders and symptoms.

Results:  Long‐term remission for anxiety disorders and symptoms targeted in the treatments was evident 8 to 13 years post‐treatment. Long‐term remission also was found for the secondary outcomes. There were more similarities than differences in the long‐term gains when comparing the treatment approaches.

Conclusions:  Consistent with past research, the study’s findings provide further evidence that the short‐term benefits of exposure‐based CBT for childhood phobic and anxiety disorders using both group and individual treatment may extend into the critical transition years of young adulthood.
The Arabidopsis acbp1acbp2 double mutant lacking acyl‐CoA‐binding proteins ACBP1 and ACBP2 is embryo lethal
Authors: Chen Qin‐Fang , Xiao Shi , Qi Wenqing , Mishra Girish , Ma Jinyu , Wang Mingfu , Chye Mee‐Len
Published: March 2010

Commentary p 781
Predicting drug‐induced slowing of conduction and pro‐arrhythmia: identifying the ‘bad’ sodium current blockers
Authors: Lu Hua Rong , Rohrbacher Jutta , Vlaminckx Eddy , Van Ammel Karel , Yan Gan‐Xin , Gallacher David J
Published: March 2010

Background and purpose:  The regulatory guidelines (ICHS7B) for the identification of only drug‐induced long QT and pro‐arrhythmias have certain limitations.

Experimental approach:  Conduction time (CT) was measured in isolated Purkinje fibres, left ventricular perfused wedges and perfused hearts from rabbits, and sodium current was measured in Chinese hamster ovary cells, transfected with Nav1.5 channels.

Key results:  A total of 355 compounds were screened for their effects on CT: 32% of these compounds slowed conduction, 65% had no effect and 3% accelerated conduction. Lidocaine and flecainide, which slow conduction, were tested in more detail as reference compounds. In isolated Purkinje fibres, flecainide largely slowed conduction and markedly increased triangulation, while lidocaine slightly slowed conduction and did not produce significant triangulation. Also in isolated left ventricular wedge preparations, flecainide largely slowed conduction in a rate‐dependent manner, and elicited ventricular tachycardia (VT). Lidocaine slightly slowed conduction, reduced Tp–Te and did not induce VT. Similarly in isolated hearts, flecainide markedly slowed conduction, increased Tp–Te and elicited VT or ventricular fibrillation (VF). The slowing of conduction and induction of VT/VF with flecainide was much more evident in a condition of ischaemia/reperfusion. Lidocaine abolished ischaemia/reperfusion‐induced VT/VF. Flecainide blocked sodium current (INa) preferentially in the activated state (i.e. open channel) with slow binding and dissociation rates in a use‐dependent manner, and lidocaine weakly blocked INa.

Conclusion and implications:  Slowing conduction by blocking INa could be potentially pro‐arrhythmic. It is possible to differentiate between compounds with ‘good’ (lidocaine‐like) and ‘bad’ (flecainide‐like) INa blocking activities in these models.
Enhancement of mesenteric artery contraction to 5‐HT depends on Rho kinase and Src kinase pathways in theob/obmouse model of type 2 diabetes
Authors: Matsumoto Takayuki , Kobayashi Tsuneo , Ishida Keiko , Taguchi Kumiko , Kamata Katsuo
Published: March 2010

Background and purpose: Arteries from hypertensive subjects are reportedly hyperresponsive to 5‐hydroxytryptamine (5‐HT), but it remains unclear whether this is true in chronic type 2 diabetes. We have assessed responses to 5‐HT shown by mesenteric arteries from type 2 diabeticob/obmice (27–32 weeks old) and have identified the molecular mechanisms involved.

Experimental approach: Contractions of mesenteric rings to 5‐HT were examinedin vitro. Activation of mesenteric RhoA, Rho kinase and Src was measured by Western blotting or by modified enzyme‐linked immunosorbent assay.

Key results: Concentration‐dependent contractions to 5‐HT were greater in mesenteric rings from theob/obthan in those from the age‐matched control (‘Lean’) group. In each group, there was no significant change in the 5‐HT‐induced contractions after inhibition of nitric oxide synthase (with NG‐nitro‐L‐arginine), of cyclooxygenase (with indomethacin) or of protein kinase C (with chelerythrine). However inhibition of the MEK/ERK pathway (with PD98059) decreased the response to 5‐HT. Although the diabetes‐related enhancement of the 5‐HT response was preserved with each of these inhibitors, enhancement was abolished by a Rho kinase inhibitor (Y27632) and by Src kinase inhibitors (PP1 analogue or Src kinase inhibitor I). 5‐HT‐induced activation of RhoA, Rho kinase and Src kinase in mesenteric arteries was greater in theob/obthan in the Lean group, but the expression of RhoA, Rho kinase isoforms and Src did not differ between these groups.

Conclusions and implications: These results suggest that the enhancement of 5‐HT‐induced contraction in mesenteric arteries fromob/obmice may be attributable to increased activation of RhoA/Rho kinase and Src kinase.