bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Case Notes
Authors: Pierre‐Filho Paulo de Tarso P , Rocha Eduardo Melani , Natalino Renato , Cintra Maria Letícia , Caldato Roberto
Published: July 2004

Melkersson−Rosenthal syndrome is an uncommon disorder of uncertain aetiology characterized by orofacial oedema, facial nerve palsy and lingua plicata. The triad is seldom seen in its complete form, and oligo‐symptomatic or mono‐symptomatic forms are more common. An unusual case of Melkersson−Rosenthal syndrome involving the left upper eyelid is presented. The pathology, clinical features and management of this disorder are discussed.
Clinical Case Notes
Authors: Essex Rohan W , Charles Patrick GP , Allen Penelope J
Published: July 2004

Three cases of post‐traumatic endophthalmitis caused by unusual bacteria are presented. The pathogens identified were: (i) Bacillus cereus and Citrobacter freundii; (ii) Pseudomonas fluorescens; and (iii) Chryseobacterium meningosepticum and Stenotrophomonas maltophilia. Two of these pathogens have not previously been reported to cause endophthalmitis. The available literature regarding the individual cases is summarized and a brief discussion of post‐traumatic endophthalmitis is presented, with reference to a recently published large series at the authors’ institution.
Chediak–Higashi syndrome in the intensive care unit
Authors: Demirkiran Oktay , Utku Tughan , Urkmez Seval , Dikmen Yalim
Published: July 2004

Chediak–Higashi Syndrome is a rare autosomal recessive disease characterized by recurrent infections, giant cytoplasmic granules and oculocutaneous albinism. We describe the clinical and laboratory findings of a patient with Chediak–Higashi syndrome who was diagnosed and treated in the intensive care unit because of bleeding tendency after surgery.
Endoscopic intratracheal carbon dioxide measurements during pediatric flexible bronchoscopy
Authors: Chang Anne B , Moloney Gregory E , Harms Peter J , Brent Masters I
Published: July 2004

Background : CO2 monitoring is recommended for thoracic telescopic procedures and for spontaneous breathing general anesthesia in children. During flexible bronchoscopy (FB) in children, the various currently available methods of CO2 measurements are limited. The CO2 falls and increases have been reported in FB but it is unknown whether airway lesions predispose to CO2 change. The aim of this study was to describe and validate endoscopic intratracheal CO2 measurements in children undergoing FB under spontaneously breathing GA.

Methods : Endtidal CO2 (PECO2) measurements at the start (Start‐CO2) and end (End‐CO2) of FB on 100 consecutive children were performed using a newly designed endoscopic intratracheal method. To validate the method blood gas sampling was simultaneously performed in 28 children and results analyzed using the Bland and Altman method, intraclass correlation and 95% range for repeatability.

Results : End‐CO2 and CO2‐change (End‐CO2 minus Start‐CO2) were significantly different in children with airway lesions (CO2 change: no lesion = 3 mmHg, extrathoracic airway lesion = 4.5, intrathoracic airway lesion = 8, P = 0.038). There was no significant difference in Start‐CO2 values among the groups. CO2‐change in those aged ≤12 months was similar to those >12 months. Intratracheal CO2 measurements were comparable with arterial blood values in the Bland and Altman plots. The intraclass correlation was 0.69 and 95% range for repeatability was 3.7–4.17 mmHg.

Conclusions : Midtracheal PECO2 provides a useful estimate of PaCO2 for monitoring the respiratory status of children undergoing FB. The presence of airway lesions rather than age is associated with significant increased PCO2 rise.
Cuff compliance of pediatric and adult cuffed tracheal tubes: an experimental study
Authors: Devys J.‐M. , Schauvliège F. , Taylor G. , Plaud B.
Published: July 2004

Background : Tracheal mucosal damage related to tracheal intubation has been widely described in pediatric and adult patients. High volume–low pressure cuffs (HVLPC) are being advertised as safe to avoid this particularly unpleasant complication. Compliances of these supposed pediatric and adult HVLPC are not mentioned by manufacturers and still remain unknown.

Methods : The compliance of HVLPC was measured in vitro and defined as the straight portion of the pressure–volume curve. Cuff pressure was measured after incremental 0.1 ml filling volumes of air for sizes 3.0–8.0 of internal diameter of RüschTM and MallinckrodtTM tracheal tubes. Compliances were assessed in air and in a rigid tube. The filling volume to achieve a 25‐mmHg intracuff pressure was also measured.

Results : In air, each 0.1 ml step almost linearly increased cuff pressure by 1 mmHg (size 8.0) to 9 mmHg (size 3). In air, the volume needed to maintain a cuff pressure < 25 mmHg was small for sizes 3–5.5 (0.35–2 ml). The 25 mmHg inflated cuff volume and compliance were decreased within a rigid tube, especially for adult sizes. In a rigid tube simulating a trachea, the compliances of almost every RüschTM tracheal tube were statistically higher than those of the MallinckrodtTM.

Conclusion : We conclude that the tested tracheal tube cuffs have low compliance and cannot be defined as high volume–low pressure.
From east to west: Nepalese women's experiences
Authors: Rolls C. , Chamberlain M.
Published: July 2004

Background:  Nepal is a small mountainous South Asian country located between the nations of India and China. Forty‐two per cent of the 22 million Nepalese people live in poverty. As a result, immigration to a developed country is the dream of many but available to few. Some immigrants from Nepal have arrived in Australia in recent years entering the ‘Skill’ stream of eligibility categories. Nepalese immigrants to Australia are predominantly young married couples with professional education qualifications.

Aim:  To generate knowledge of the childbirth and early experiences of Nepalese women in their mother country and in Australia. The aspect presented here is the immigration experiences of Nepalese women to Australia.

Method:  An ethnographic, grounded theory approach was used to observe and analyse the experiences of 11 Nepalese participants.

Findings:  Analysis of data suggests that Nepalese female immigrants with the ability to comprehend and speak English and a level of education and skill required by Australia can successfully negotiate the change of culture and adapt to their new society. Major benefits of immigration for the women were the opportunities to work, become independent and to share in decision making for their family.

Conclusion and implications for nursing practice:  Severance from the Nepalese joint family, a male dominant hierarchical society, and a new way of life allow a Nepalese woman to become an individual rather than a member of a collective. This study has produced transcultural information from the perspective of the educated professional Nepalese female immigrant that will assist in the provision of midwifery and nursing care.
Trade Liberalization and the Profitability of Domestic Mergers
Authors: Gaudet Gérard , Kanouni Rams
Published: July 2004

It is often thought that a tariff reduction, by opening‐up the domestic market to foreign firms, should lessen the need for a policy aimed at discouraging domestic mergers. This implicitly assumes that the tariff in question is sufficiently high to prevent foreign firms from selling in the domestic market. However, not all tariffs are prohibitive, so that foreign firms may be present in the domestic market before it is abolished. Furthermore, even if the tariff is prohibitive, a merger of domestic firms may render it nonprohibitive, thus inviting foreign firms to penetrate the domestic market. Using a simple example, the authors show that, in the latter two cases, abolishing the tariff may in fact make the domestic merger more profitable. Hence trade liberalization will not necessarily reduce the profitability of domestic mergers.
Do Patent Rights Regimes Matter?
Authors: Co Catherine Y.
Published: July 2004

The paper asks whether exports are affected by importers’ patent rights regimes using a gravity trade equation. US export data to 71 countries from 1970 to 1992 are used. A two‐way random‐effects panel indicates that patent rights regimes per se do not matter; they matter with importing countries’ imitative abilities. For a country with an “average” imitative ability, US R&D‐intensive exports increase by 4–9% for a unit increase in the patent rights index; a unit increase in the patent rights index leads to a drop in US non‐R&D‐intensive exports by about 8–11%.
On Assisting Domestic Industries under Bertrand Competition
Authors: Egli Dominik , Westermann Frank
Published: July 2004

In a homogeneous‐good duopoly game with a home and a foreign firm, which compete on prices, it has been shown that the optimal way to assist the domestic industry is by a production subsidy. The argument here is that the subsidy is used to keep potential competitive pressure on the foreign firm. This paper analyzes under which conditions this threat of entry of a subsidized home firm is credible. It is shown that in markets where the firms move before the government, a subsidy is not credible and dominated by a tariff in terms of welfare.
Job Creation, Job Destruction, and the International Division of Labor
Authors: Jansen Marion , Turrini Alessandro
Published: July 2004

The authors incorporate equilibrium unemployment due to imperfect matching into a model of trade in intermediate inputs. Firms are assumed to be price‐takers and their size is given by technology. Firms enter the market as long as expected profits cover the search cost they incur initially; jobs are endogenously destroyed by random shocks that affect firms’ price–cost margins. Trade increases productivity in the final good and then demand for each intermediate input. Steady‐state unemployment is reduced after trade integration because the rate of job destruction is reduced, which in turn induces an indirect positive effect on job creation. A more volatile environment faced by firms does not necessarily increase unemployment. However, the rate of job destruction unambiguously rises, and rises more under free trade.
Optimal Detection of a Change Point in a Poisson Process for Different Observation Schemes
Authors: Herberts Tina , Jensen Uwe
Published: July 2004

Abstract.  Change point problems are considered where at some unobservable time the intensity of a point process (Tn), n ∈ ℕ, has a jump. For a given reward functional we detect the change point optimally for different information schemes. These schemes differ in the available information. We consider three information levels, namely sequential observation of (Tn), ex post decision after observing the point process up to a fixed time t* and a combination of both observation schemes. In all of these cases the detection problem is viewed as an optimal stopping problem which can be solved by deriving a semimartingale representation of the gain process and applying tools from filtering theory.
Quasi‐Likelihood Regression with Multiple Indices and Smooth Link and Variance Functions
Authors: Chiou Jeng‐Min , Müller Hans‐Georg
Published: July 2004

Abstract.  A flexible semi‐parametric regression model is proposed for modelling the relationship between a response and multivariate predictor variables. The proposed multiple‐index model includes smooth unknown link and variance functions that are estimated non‐parametrically. Data‐adaptive methods for automatic smoothing parameter selection and for the choice of the number of indices M are considered. This model adapts to complex data structures and provides efficient adaptive estimation through the variance function component in the sense that the asymptotic distribution is the same as if the non‐parametric components are known. We develop iterative estimation schemes, which include a constrained projection method for the case where the regression parameter vectors are mutually orthogonal. The proposed methods are illustrated with the analysis of data from a growth bioassay and a reproduction experiment with medflies. Asymptotic properties of the estimated model components are also obtained.
On Parametric Bootstrapping and Bayesian Prediction
Authors: Fushiki Tadayoshi , Komaki Fumiyasu , Aihara Kazuyuki
Published: July 2004

Abstract.  We investigate bootstrapping and Bayesian methods for prediction. The observations and the variable being predicted are distributed according to different distributions. Many important problems can be formulated in this setting. This type of prediction problem appears when we deal with a Poisson process. Regression problems can also be formulated in this setting. First, we show that bootstrap predictive distributions are equivalent to Bayesian predictive distributions in the second‐order expansion when some conditions are satisfied. Next, the performance of predictive distributions is compared with that of a plug‐in distribution with an estimator. The accuracy of prediction is evaluated by using the Kullback–Leibler divergence. Finally, we give some examples.
Local Linear Additive Quantile Regression
Authors: Yu Keming , Lu Zudi
Published: July 2004

Abstract.  We consider non‐parametric additive quantile regression estimation by kernel‐weighted local linear fitting. The estimator is based on localizing the characterization of quantile regression as the minimizer of the appropriate ‘check function’. A backfitting algorithm and a heuristic rule for selecting the smoothing parameter are explored. We also study the estimation of average‐derivative quantile regression under the additive model. The techniques are illustrated by a simulated example and a real data set.
Is the Feldstein–Horioka Puzzle History?
Authors: Coakley Jerry , Fuertes Ana‐Maria , Spagnolo Fabio
Published: July 2004

A country's intertemporal budget constraint implies current account stationarity or that its saving and investment rates should cointegrate. However, such behaviour may not pertain in finite sample spans where the current account could be subject to persistent shocks. Accordingly, this paper reconsiders the Feldstein–Horioka puzzle for a panel of 12 OECD economies 1980I–2000IV using a mean group regression approach that is robust to persistent innovations and accounts for country heterogeneity and cross‐sectional dependence. The mean group estimates are notably smaller than that from the conventional cross‐section estimator and are statistically insignificant. Our findings support the view that capital is highly mobile in the long run for OECD economies despite persistence in the current account.
Job Creators
Authors: Cowling Marc , Taylor Mark , Mitchell Peter
Published: July 2004

Job creation is perhaps the key political and economic issue of our time, yet this is one of only three papers to date to consider the nature of job creation amongst the self‐employed. We develop a utility based model of self‐employment which allows for the self‐employed with employees. The theory predicts that the higher the endowment of human capital the greater the likelihood of the entrepreneur employing additional labour, subject to overcoming any capital constraints. Empirical testing suggests that the decision to hire employees is related to work and lifetime experiences rather than academic achievements.
Non‐Linear Error Correction: Evidence for UK Interest Rates
Authors: McMillan David G.
Published: July 2004

Recent empirical finance research has suggested the potential for series to exhibit non‐linear adjustment to equilibrium. This paper examines a variety of such models and compares their performance with the linear alternative. Using short‐ and long‐term UK interest rates we report evidence that a logistic smooth transition error‐correction model is best able to characterize the data and to provide superior out‐of‐sample forecasts over both linear and non‐linear alternatives. This model suggests that market dynamics differ depending on whether the deviations from long‐run equilibrium are above or below the threshold value. Further, the logistic smooth transition model indicates that agents’ actions imply quicker reversion to equilibrium when the long rate exceeds the short rate, and supports a central bank inflation targeting interpretation of the non‐linearity.
Casual Jobs and Internal Labour Markets
Authors: Green Colin , Leeves Gareth
Published: July 2004

This paper examines the role of casual employment as a route into permanent employment. Using a competing risks framework we compare transitions from casual to permanent employment made within the firm and to other firms. We also examine the wage outcomes and job durations of these two transitions. It is found that internal transitions occur at all occupational levels and display characteristics associated with probationary employment. Thus, as suggested by previous case study evidence, permanent positions at all levels in the firm are open to a degree of external competition.
Changes occurring in cortical NO release and brain NO‐synthases during a paradoxical sleep deprivation and subsequent recovery in the rat
Authors: Clément Pierre , Sarda Nicole , Cespuglio Raymond , Gharib Abdallah
Published: July 2004

Variations occurring in cortical nitric oxide (NO) release were analysed with a voltametric method in rats (i) placed in control conditions, (ii) while being paradoxical sleep deprived (PSD), or (iii) recovering from a PSD. Activities of neuronal (nNOS) and inducible (iNOS) NO‐synthases as well as nNOS expression were also determined in several brain regions. In baseline conditions, circadian variations in nNOS expression and activity were maximal during the dark period and minimal during the light one for all the structures analysed (frontal cortex, pons and medulla). In the same way, cortical NO release occurred through a circadian rhythm exhibiting maxima and minima during dark and light periods, respectively. In the same experimental conditions, iNOS activity did not exhibit time‐dependent changes. The correlative changes observed in baseline conditions between NO release, nNOS expression and activity within the frontal cortex were disrupted during PSD and subsequent recovery. Still again, iNOS activity remained unchanged. Results obtained point out that the tight coupling existing in control conditions between nNOS expression‐activity and NO release is disrupted by a PSD and remains affected during the subsequent 24 h recovery. Their significance is discussed.
Organic anion transporter 3 is involved in the brain‐to‐blood efflux transport of thiopurine nucleobase analogs
Authors: Mori Shinobu , Ohtsuki Sumio , Takanaga Hitomi , Kikkawa Tazuru , Kang Young‐Sook , Terasaki Tetsuya
Published: July 2004

Thiopurines are used as antileukemic drugs. However, during chemotherapy CNS relapses occur due to the proliferation of leukemic cells in the CNS resulting from restricted drug distribution in the brain. The molecular mechanism for this limited cerebral distribution remains unclear. The purpose of this study was to identify the transporter responsible for the brain‐to‐blood transport of thiopurines across the blood–brain barrier (BBB) using the brain efflux index method. [14C]6‐Mercaptopurine (6‐MP) and [3H]6‐thioguanine were eliminated from rat brain in a time‐dependent manner. The elimination of [14C]6‐MP was inhibited by substrates of rat organic anion transporters (rOATs), including indomethacin and benzylpenicillin. rOAT1 and rOAT3 exhibited 6‐MP uptake, while benzylpenicillin inhibited rOAT3‐mediated uptake, but not that by rOAT1. rOAT3‐mediated [14C]6‐MP uptake was also inhibited by other thiopurine derivatives. Although methotrexate inhibited rOAT3‐mediated [14C]6‐MP uptake, the Ki value was 17.5‐fold greater than the estimated brain concentration of methotrexate in patients receiving chemotherapy. Accordingly, 6‐MP would undergo efflux transport by OAT3 from the brain without any inhibitory effect from coadministered methotrexate in the chemotherapy. In conclusion, rOAT3 is involved in the brain‐to‐blood transport of thiopurines at the BBB and is one mechanism of limited cerebral distribution.
Phosphorylated p38MAPK specific antibodies cross‐react with sarkosyl‐insoluble hyperphosphorylated tau proteins
Authors: Sahara Naruhiko , Vega Irving E. , Ishizawa Takashi , Lewis Jada , McGowan Eileen , Hutton Michael , Dickson Dennis , Yen Shu‐Hui
Published: July 2004

Neurofibrillary tangles (NFT) accumulated in Alzheimer's diseases and related disorders contain hyperphosphorylated tau and display immunoreactivity for active forms of various kinases. To understand the role of p38MAPK (mitogen‐activated protein kinase) in NFT formation, we have studied a transgenic (Tg) mouse model of tauopathy, JNPL3, that expresses P301L mutant tau, and bigenic mice, TAPP, generated by cross‐breeding of JNPL3 with Tg2576 mice. Age‐matched non‐Tg mice (NTg), wild‐type human tau Tg mice (JN25), and Tg2576 mice were used as controls. Phosphorylated p38MAPK (active form) immunoreactivity was consistently located in NFT and granulovaculolar degeneration in JNPL3 and TAPP mice older than 5 months of age. Unphosphorylated/total‐p38MAPK was not detectable in spinal cord and brain sections from 2‐ to 11‐month‐old mice, even though JNPL3 mice, but not controls had an age‐dependent increase of total‐p38MAPK by western blotting. Spinal cord/brain extracts from mice and human with tauopathy were demonstrated to have insignificant amount of active‐p38MAPK. However, they contained antiactive‐p38MAPK cross‐reactive proteins insoluble in sarkosyl and similar to phosphorylated tau in size. Consistently, antiactive‐p38MAPK immunoprecipitates displayed tau immunoreactivity, but not total‐p38MAPK, and antitau immunoprecipitates displayed active‐p38MAPK immunoreactivity. Together, the results indicate that the cross‐reactivity of antiactive‐p38MAPK antibody with phosphorylated tau is responsible for the immunolabeling of tau‐positive inclusion.
Regulation of dopamine D1‐receptor activation in vivo by protein phosphatase 2B (calcineurin)
Authors: Adlersberg Mella , Hsiung Shu‐chi , Glickstein Sara B. , Liu Kuo‐peing , Tamir Hadassah , Schmauss Claudia
Published: July 2004

Mice lacking dopamine D2 receptors exhibit a significantly decreased agonist‐promoted forebrain neocortical D1 receptor activation that occurs without changes in D1 receptor expression levels. This raises the possibility that, in brains of D2 mutants, a substantial portion of D1 receptors are uncoupled from their G protein, a phenomenon known as receptor desensitization. To test this, we examined D1‐agonist‐stimulated [35S]GTPγS binding (in the presence and absence of protein phosphatase inhibitors) and cAMP production (in the presence and absence of pertussis toxin) in forebrain neocortical tissues of wild‐type mice and D2‐receptor mutants. These studies revealed a decreased agonist‐stimulated G‐protein activation in D2 mutants. Moreover, whereas protein phosphatase 1/2A (PP1/2A) and 2B (PP2B) inhibitors decrease [35S]GTPγS binding in a concentration‐dependent manner in wild type, they have either no (PP2B) or only partial (PP1/2A) effects in D2 mutants. Furthermore, for D2 mutants, immunoprecipitation experiments revealed increased basal andD1‐agonist‐stimulated phosphorylation of D1‐receptor proteins at serine residues. Finally, D1 immunoprecipitates of both wild type and D2 mutants also contain protein kinase A (PKA) and PP2B immunoreactivities. In D2 mutants, however, the catalytic activity of the immunoprecipitated PP2B is abolished. These data indicate that neocortical D1 receptors are physically linked to PKA and PP2B and that the increased phosphorylation of D1 receptors in brains of D2 mutants is due to defective dephosphorylation of the receptor rather than increasedkinase‐mediated phosphorylation.
Learning and performing care management: experiences of a newly formed interdisciplinary, assessment and rehabilitation team
Authors: Kneafsey Rosie , Long Andrew , Reid Gaynor , Hulme Claire
Published: July 2004

Developments in primary and intermediate care services have enhanced interest in the notion of care management, the processes that it encompasses and the challenges that it poses to practitioners who are more used to working in a uni‐ or multidisciplinary manner. This article explores the way that a set of practitioners, new to care management, coped with the challenges of working within a newly created care‐managed assessment and rehabilitation service for older people in one UK county. Data were gathered via non‐participant observation, and group and individual interviews, as part of a wider action‐research evaluation study. Three themes emerged from the data: the processes of ‘learning’ to become a care manager; ‘doing’ care management; and ‘experiences’ of the role. In order to ‘learn’ care management, staff needed to develop a range of new skills, establish supportive care‐management processes, develop a new identity and work in an interdisciplinary way. ‘Doing’ care management involved working with a small group of patients with complex needs and precarious levels of homeostasis. Problem solving and crisis management were key activities and often required a creative approach to practice. Although care managers derived great satisfaction from their role, their ‘experiences’ were characterized by stress and anxiety. The practitioners from healthcare backgrounds needed more preparation to adapt to their new levels of responsibility and client risk. Successful management of the transition to care manager requires support from the key stakeholders and strong leadership within care manager teams. In‐house competency‐based training and induction programmes, and mentorship, can also play an important role, together with innovative forms of postqualifying education and training, for example, via job exchanges or an apprenticeship model.
Hepatocyte growth factor and c‐Met expression in rat and human liver fibrosis
Authors: Cramer Thorsten , Schuppan Detlef , Bauer Michael , Pfander David , Neuhaus Peter , Herbst Hermann
Published: July 2004

Abstract:  Background: Hepatocyte growth factor (HGF) is a potent mitogen for hepatocytes in vitro.

Aims: Substitution of HGF was suggested for human liver disease on the basis of animal experiments. The cellular sources of HGF and its receptor, c‐Met, in liver disease in vivo are not well defined.

Methods: We characterised HGF and c‐Met expression in normal and cirrhotic human livers and rat livers at various time points after CCl4 administration by in situ hybridisation and immunohistology. HGF transcripts were restricted to resting and activated stellate cells in rat and human liver.

Results: In rat liver, HGF showed peak levels 6–12 h following acute intoxication, and remained increased after repeated CCl4 injury. HGF transcript levels were very low in normal human liver, but excessively raised in fibrosis/cirrhosis. In contrast, HGF immunoreactivity was found not only in perisinusoidal/periductular cells but also in cholangiocytes of proliferating ductules. c‐Met RNA and protein was expressed in hepatocytes, cholangiocytes, and arteriolar endothelial cells.

Conclusions: The HGF‐specific immunostaining of proliferating cholangioles in the absence of HGF RNA suggests c‐Met‐mediated uptake of HGF and paracrine stimulation of cholangiocellular proliferation. Mitogenic effects of HGF on hepatocytes may therefore be accompanied by undesired cholangiogenesis and angiogenesis limiting its therapeutic value in chronic liver disease.
Serum levels of soluble molecules associated with evasion of immune surveillance: a study in biliary disease
Authors: Enjoji Munechika , Yamaguchi Koji , Nakashima Manabu , Ohta Satoshi , Kotoh Kazuhiro , Fukushima Marie , Kuniyoshi Masami , Tanaka Masao , Nakamuta Makoto , Watanabe Takeshi , Nawata Hajime
Published: July 2004

Abstract:  Background: Biliary carcinoma cells produce the transmembrane proteins, Fas, FasL, and RCAS1. It has been demonstrated that the Fas/FasL and RCAS1 systems induce apoptosis of activated immune cells and that the soluble isoforms of these proteins (sFas, sFasL, and sRCAS1) also exhibit this function.

Methods: We measured serum levels of these soluble‐types in patients with biliary disease by ELISA and investigated their clinical significance.

Results: In some cases of cholangitis and autoimmune biliary disease, serum sFasL values were over 0.1 ng/ml but the protein was undetectable in any patients with biliary carcinoma. sFas levels were significantly higher in the autoimmune disease (mean, 6.83 ng/ml) and cancer (mean, 6.42 ng/ml) groups than in the cholangitis group (mean, 4.23 ng/ml) and normal controls (mean, 2.93 ng/ml). However, the sFas values in malignancy did not correlate with the progression of clinical stage. The percentage positive for serum sRCAS1 was 9.7% in benign disease but was 63.4% in cancer.

Conclusions: Our data suggest that serum sFasL in biliary disease may be derived predominantly from activated immune cells and not from cancer cells and that autoimmune biliary disease may be mediated by the Fas/FasL apoptotic system. sRCAS1 is highly tumor‐specific and may be of value in the diagnosis of malignancy.
Obstetric and perinatal outcomes in pregnancies associated with illicit substance abuse
Authors: LUDLOW Joanne P. , EVANS Sharon F. , HULSE Gary
Published: July 2004

Objective:  To determine the obstetric and perinatal outcomes of women using illicit drugs during pregnancy by substance group.

Method:  A retrospective audit of obstetric and perinatal outcomes in women who used opiates or amphetamines during their pregnancy and delivered at King Edward Memorial Hospital (KEMH), Perth, Australia between December 1997 and April 2000 was performed. Maternal, fetal and neonatal parameters were assessed. These were compared with obstetric and perinatal data recorded by the Health Department of Western Australia (HDWA) for the 25 291 deliveries of 25 677 infants in 1998.

Results:  Between December 1997 and April 2000 91 opiate‐using and 50 amphetamine‐using women were identified and included in the analysis. Both groups of drug‐using women were younger (opiates P = 0.001, amphetamines P = 0.001) than the general population. There was a higher incidence of aboriginality (P = 0.001) in the amphetamine group. In the opiate‐using group multiparity (P = 0.0001) and anaemia (P = 0.0001) were higher. Illicit drug‐using women had a higher incidence of hepatitis C (opiates P = 0.001, amphetamines P = 0.003), and a greater need for pharmacological analgesia for labour and delivery (opiates P = 0.007, amphetamines P = 0.042). Their infants were significantly more likely to deliver at less than 37 weeks’ gestation (opiates P = 0.0001, amphetamines P = 0.001), to have a birthweight of less than 2.5 kg (P = 0.0001), be small for gestational age and require admission to the special care nursery (P = 0.0001). Infants born to women in the amphetamine group were more likely to have an Apgar score <7 (P = 0.0001) recorded. Infants of women in the opiate group required more resuscitation (P = 0.05).

Conclusion:  Women who use illicit drugs are more likely to experience adverse obstetric and perinatal outcomes than women in the general population. Differences are seen depending on the type of illicit drug used. These findings need to be replicated in a larger prospective cohort to highlight management requirements of these women and their infants. Further information is required about the effects of amphetamines in pregnancy.
Women's antenatal knowledge and plans regarding intrapartum pain management at the Royal Hospital for Women
Authors: HENRY Amanda , NAND Swaran L.
Published: July 2004

Aims:  To examine women's knowledge and antenatal plans regarding intrapartum pain management options at Royal Hospital for Women (RHW), Sydney, Australia.

Methods:  From October 2002 to January 2003 women aged over 16 who had been in labour were given a questionnaire to complete in the first week post‐partum regarding intrapartum pain management. This included questions regarding their antenatal knowledge and predetermined plans.

Results:  There were 496 participating women (69% response rate). Antenatal pain management information was accessed by 98% of women. Sources most accessed were antenatal classes (55%), multimedia (53%), and friends/relatives (46%). Sixty percent of women felt ‘very well informed’ antenatally. Women felt better informed antenatally if married/defacto, university educated, privately insured, or receiving birth centre care. Antenatally, 80% planned to use intrapartum pain management: ‘natural’ methods were most popular (62% planned to use), and pethidine least (49% planned against). The most common determinant against using medical methods was possible maternal side‐effects. Intrapartum, 19% used ‘unwanted’ pain management, mostly (67%) due to increased labour pain. Increased information access was associated with significantly higher use of both ‘natural’ methods and epidural analgesia, as well as significantly higher satisfaction scores.

Conclusions:  Almost all women at RHW access information antenatally about intrapartum pain management, often from informal sources. Demographic factors affected type of information accessed and women's plans. Adequate access to information affected use of, and satisfaction with, pain management.
Tissue trauma after vaginal hysterectomy and colporrhaphy versus abdominal hysterectomy: A randomised controlled study
Authors: AKA Nurettin , KÖSE Gültekin , GÖNENÇ Isik , API Murat
Published: July 2004

Objective:  As the magnitude of tissue trauma can be detected by measuring the blood levels of acute phase reactants, we aimed to evaluate tissue trauma markers after abdominal hysterectomy (AH) and vaginal hysterectomy (VH). We hypothesised that VH will be associated with a reduced increase in the level of acute phase reactants than AH.

Methods:  Thirty women out of 92 patients scheduled for hysterectomies between June 2002 and June 2003 were randomised into two equal groups (n = 15) of VH and AH. Their levels of C‐reactive protein (CRP), α1‐antitrypsin (α1‐AT) and myoglobin (M) were analysed preoperatively and on the second, fourth and sixth days.

Results:  In both methods of hysterectomy, the operating time (85.3 ± 6.57 min in the VH group vs 69 ± 7.54 min in the AH group, P < 0.0001), and hospital stay duration (7.2 ± 2.5 days in the AH group, 3.1 ± 1.1 days in the VH group, P < 0.0001) were highly significantly different from each other. Demographic parameters and other parameters which may affect tissue trauma markers were not statistically significantly different in each group. Postoperative increases in all markers were markedly high and showed a high statistical difference in both groups (P < 0.05). The postoperative CRP and M values in both groups were significantly higher in the AH group on the second and fourth days and on the sixth day for M only, whereas α1‐AT levels were only statistically different on the second day. The tissue trauma markers returned to normal levels on the sixth postoperative day for M, although there still was a statistically significant difference, but remained higher than normal for α1‐AT and CRP.

Conclusion:  Whenever possible, VH should replace AH because this technique leads to a shorter hospital stay and less tissue trauma, enabling patients to return to their normal lives.
Self‐Disclosure of Personal Constructs
Authors: WARING EDWARD M.
Published: July 2004

Sidney Jourard's (19) description of the role of self‐disclosure in marriage is reviewed. George Kelly's (20) theory of personal constructs is described in an effort to explain the complexity of successful marriages and strong families. A kind of marital therapy based on the technique of self‐disclosure and the rationale that couple pathology results from erroneous personal constructs is described. The idea that these faulty schemas largely derive from the observation of and experience with one's parents' marriage is discussed. The self‐disclosure of personal constructs may provide a distinctive approach to family therapy.
Clinical Controversy and the Domains of Scientific Evidence
Authors: SADLER JOHN Z. , HULGUS YOSAF F.
Published: July 2004

The diversity of mental health care “schools” or therapeutic perspectives poses problems in selecting and using any single therapeutic perspective. This article describes the genesis of clinical controversy—that is, how two or more therapeutic perspectives of the same clinical situation can be so different yet not necessarily differ in outcome. Ideas drawn from contemporary philosophy of science show how different “schools” derive separate, incompatible sets of scientific evidence from the same clinical situation. The school or theory determines (in part) not just what evidence is used, but what evidence is actually perceived. The authors conclude by recommending a pluralistic approach to mental health care; they map out some consequences of this pluralism and suggest some strategies for minimizing the disadvantages of “mixing and matching” therapeutic perspectives.
Tyranny and Freedom: Looking at Ideas in the Practice of Family Therapy
Authors: FINE MARSHALL , TURNER JEAN
Published: July 2004

This article comments upon recent “second‐order” family therapy concerns about the nature of the therapeutic relationship, and explores how ideas held by therapists may rule and restrict therapeutic conversations. Ideas are examined in the light of how adherence to them might open space (free) or close space (tyrannize) with respect to the therapeutic relationship. The authors propose a philosophical viewpoint, a methodology, and practical suggestions for therapists wishing to maintain a stance of relative freedom with respect to ideas in their work with clients.
Family Interaction and Caregivers of Alzheimer's Disease Patients: Correlates of Depression
Authors: SHIELDS CLEVELAND G.
Published: July 2004

Depression is ubiquitous in primary family caregivers of Alzheimer's Disease (AD) patients, but its relationship to the overall behavior patterns of these families has received little attention thus far. The focus of the exploratory study reported here was on one aspect of this issue — affective responses between caregiver and other family members as they relate to level of depressive symptoms in the primary caregivers. Family affective responses, especially negative responses, have proven of particular salience in studies of major psychiatric disorders. Would they be equally salient in a study of depressive symptoms in primary caregivers of Alzheimer's patients? Apparently so. Thirty caregivers and extended family members participated in problem‐solving family interaction tasks that were videotaped, transcribed, and coded on affect. Two variables representing angry and sad responses of extended family members to the caregiver accounted for over 44% of the variance in caregiver depressive symptoms. The relevance of these findings for treatment approaches and future research efforts are discussed.
Perceived Family Criticism and Primary Care Utilization: Psychosocial and Biomedical Pathways
Authors: FISCELLA KEVIN , FRANKS PETER , SHIELDS CLEVELAND G.
Published: July 2004

We explored the relationship of perceived family criticism to subsequent healthcare utilization in patients attending a family medicine center. We examined: a) the relationship of perceived criticism to subsequent utilization for biomedical and psychosocial/somatic problems; b) the mediating effects of self‐rated mental health and physical function; and c) the mediating effects of social support. The analyses were adjusted for age, sex, race, education, health insurance, and marital status. Higher perceived criticism predicted more psychosocial/somatic and biomedical visits. The relationship of perceived criticism with psychosocial/somatic visits was entirely mediated through self‐rated mental health. The relationship of perceived criticism with biomedical visits was partly mediated through self‐rated physical function and, in part, independent. Social support played no role in explaining these relationships. Further research is needed to determine whether lowering perceived family criticism lowers primary care utilization.
Factors in Chinese Marital Process: Relationship to Marital Adjustment
Authors: LEWINSOHN MARK A. , WERNER PAUL D.
Published: July 2004

This research examined the applicability, in Taiwan Chinese groups, of western approaches to conceptualizing and assessing aspects of marital relations. Chinese translations of American measures of marital adjustment (the Marital Adjustment Test) and marital process (the California Inventory for Family Assessment, mea‐ suring respondents' perceptions of their spouses' behavior) were developed to study a Taiwan Chinese sample of husbands and wives (N = 104 in Taiwan and N = 54 in the United States). These translations were found to be reliable and for the most part to relate as expected. In accordance with Green and Werner's (1996) reconceptualization of the cohesion‐enmeshment domain, factor analytic results yielded independent dimensions consistent with the western constructs of intrusiveness and closeness‐caregiving. Results also suggested aspects of marital process that may distinguish Taiwan Chinese marriages from those among western cultures. These findings were interpreted with reference to the impact of modernization on Chinese marital relations.
A Brief Scale for Assessing Parental Child‐Rearing Practice: Psychometric Properties and Psychosocial Correlates
Authors: GEORGE ELIZABETH L. , BLOOM BERNARD L.
Published: July 2004

The development and initial validation of the 20‐item Colorado Parental Child‐Rearing Scale (CPCRS) is described, based on three studies of college students, including one study that obtained data from students and their parents. The scale comprises four 5‐item subscales that are largely uncorrelated and that reliably assess parental affection, punitiveness, control, and lax discipline. The first three of these subscales have been repeatedly found in previous studies of parental child‐rearing, while the fourth subscale has been found somewhat less commonly. Many previously identified relationships linking parental child‐rearing practice and respondent personality and demographic characteristics were confirmed in the present study. Data obtained from parents and siblings yielded descriptions of parental child‐rearing practice that were generally significantly correlated with those obtained from index students. Suggestions for additional investigation of parental child‐rearing practice are proposed.
Mapping and/or Discovering Meaning in Family Therapy: An E‐Mail Conversation
Authors: BEELS C. CHRISTIAN , KOGAN STEVEN M. , GALE JERRY E.
Published: July 2004

Editor's Note: Because of the provocative and stimulating nature of the study reported on by Steven Kogan and Jerry Gale in their article “Decentering Therapy,” I have invited one of our Advisory Editors, Chris Beels, to provide some comments about the study and its implications. However, rather than use the standard for mat of a formal “Commentary,” followed by an “Authors' Response,” Beels, Kogan, and Gale have instead carried out a series of e‐mail exchanges, with reactions and responses going back and forth in the form of a dialogue. What follows is a slightly edited version of their conversation. As you will see, this exchange has afforded Beels, Kogan, and Gale the opportunity not only to critique each other's ideas, but also to raise questions and to puzzle together about the linkages that might be forged between the Kogan and Gale study and earlier therapy process research carried out by Beels using Scheflen's context analysis techniques. The use of a conversation format seemed more consonant with the research being discussed, research that urges a stance of openness and curiosity rather than formal hypothesis testing and closure. Hence my decision to endorse this experiment in “commentary as conversation,” rather than “commentary as debate.” What follows is the first three rounds of this “conversation,” with the “roughess” of ordinary e‐mail communications retained, but with some minor editing in order to facilitate clarity and narrative flow.
Treating Inner‐City Families of Homicide Victims: A Contextually Oriented Approach
Authors: TEMPLE SCOTT
Published: July 2004

Violence, including youth homicide, has assumed near epidemic proportions in US inner cities, with few signs that such violence is abating. Professionals working with families after the murder of a family member, are faced with the task of helping such families achieve a meaningful restoration of functioning. At the same time, there is a need to prevent retaliatory violence by surviving siblings and other family members. A treatment model will be discussed that uses the basic, theoretical principles of Boszormenyi‐Nagy's Contextual Therapy (CT) while incorporating White and Epston's technique of “therapeutic certificates” in work with young people coping with loss via homicide. Case examples, drawn from the author's work at a unique, predominantly African American agency in an urban inner city will be used to illustrate applications of CT principles, and to show how therapeutic certificates can provide tools to clinicians working with this deeply troubling problem.
Believing in Make‐Believe: Looking at Theater as a Metaphor for Psychotherapy
Authors: MacCORMACK TERRY
Published: July 2004

In this essay, I explore the theatrical dimensions of psychotherapy. I argue that many of the historical, practice‐related, and conceptual connections between theater and therapy often are only alluded to in the literature, but rarely made explicit. In doing so, however, it seems apparent that, as a metaphor for psychotherapy, theater perhaps offers a more appropriate fit than those narrative and conversational metaphors that have been employed so far. Proposing that theater is, in fact, the metaphor on which psychotherapy bases itself, I briefly examine some of its implications for how therapy might be conceptualized and performed. I conclude by inviting other therapists to consider — by openly acknowledging theater as a metaphor for psychotherapy — if they might then become more engaging, creative, and imaginative in their work.
Overt and Covert Coparenting Processes in the Family
Authors: McHALE JAMES P.
Published: July 2004

This article introduces a new self‐report instrument designed to measure the frequency of parental behaviors thought to promote or undermine children's sense of family. Members of 103 married couples rated their behavior in both public (all family members present) and private (alone with child) contexts. Factor analyses of these data revealed four distinct factors indexing: behaviors in the service of promoting a sense of Family Integrity; largely covert parent‐to‐child communications undermining, or conveying Disparagement of, the coparental partner; overt interparental Conflict in the presence of the child; and coparental disciplinary activities (Reprimand). Significant husband‐wife correlations were found on each of the four individual subscales. Construct‐specific intercorrelations also obtained between like scales on the new measure and on the Family Environment Scale and Quality of Coparenting Scale. Cluster analyses of husbands' and wives' scores on the four Coparenting Scale factors suggested five “types” of coparenting families: Disconnected, Supportive, Average, Distressed‐Conflicted, and Passionate. These clusters, along with the value of self‐report instruments in assessing coparenting behaviors that may be largely clandestine in nature, are discussed.