bluuebunny/crossref_metadata_2025 huggingface dataset:
Historical issues in intervention research: Hidden knowledge and facilitating techniques in Denmark
Authors: von Tetzchner Stephen
Published: November 2007

ABSTRACTS

Facilitating techniques have recently both gained wider popularity and stirred considerable controversy. They are usually assumed to originate in Australia but the present paper documents that similar techniques created a major public event in Denmark and appeared occasionally in the USA in the 1960s and 1970s. However, in spite of the dramatic claims made by proponents of the techniques, their use did not spread widely and the international network has remained tenuous. It is argued that the ‘discovery’ of facilitating techniques as a means to disclose unexpected literacy depends on the use of hand guidance and a context of professional beliefs where responses of unclear origin may be attributed to the person whose hand is being guided.

Les techniques de facilitation ont gagné récemment en popularité, cependant qu'elles soulevaient des controverses considérables. L'on pense d'habitude que leurs origines se situent en Australie, mais il est montré ici que des techniques analogues avaient eu un retentissement considérable au Danemark et qu'elles ont été utilisées à l'occasion aux Etats‐Unis lors des années soixante et soixante‐dix. Malgré tout, en dépit des déclarations spectaculaires des tenants de ces techniques, leur usage ne s'est pas beaucoup répandu et leur réseau international est resté limité. L'on avance ici l'idée que la ‘découverte’ des techniques de facilitation comme moyen de révéler une capacité inattendue de lire et d'écrire dépend de la façon dont la main est guidée et d'un contexte de croyances chez les professionnels selon lesquelles des réactions d'origine mal établie peuvent ětre attribuées à la personne dont la main est guidée.

Die Anwedung von ‘vermittelnden Methoden’ (facilitating techniques) hat in letzter Zeit zugenommen aber gleichzeitig eine beträchtliche Kontroverse erweckt. Es wird ublicherweise angenommen, daß sie Australien stammen, aber in diesem Artikel wird dokumentiert, daß ähnliche Methoden öffentliches Aufsehen in Dänemark verursachten und gelegenlich in den 60er und 70er Jahren in den USA in Erscheinung traten. Aber trotz der dramatischen Anspruche, die Verfechter dieser Methoden stellen, hat sich ihre Anwendung nicht sehr stark ausgeweitet und das internationale Netz ist schwach ausgeprägt. Es wird hier argumentiert, daß die ‘Entdeckung’ von vermittelnden Techniken als Methode der Erschließung unerwarteter Lesefähigkeiten von der Verwendung von Handführung und vom Kontext professioneller Überzeugung abhängt, wo Antworten unbestimmter Herkunft der Person zugeschrieben werden können, deren Hand geführt wird.
Remediation of communication problems through facilitated communication training: A case study
Authors: Crossley Rosemary
Published: November 2007

ABSTRACTS

Facilitated communication training (FCT) is an educational technique intended to allow people who cannot speak or sign fluently to develop the hand skills necessary to use other non‐speech communication strategies. It involves support to the arm, wrist or hand of the student, who is thus enabled to control his pointing, and has recently been the subject of considerable debate. Critics of the technique have cast doubt on the existence of any language problem remediable by touch. This study discusses the case of a person who had a language problem that did not appear to be connected with overt neuromotor impairment, was not accompanied by behavioural disturbance, and was remediable by touch alone. The case raises some interesting questions about the relation of physical prompts to language use.

L'entraǐnement à la communication facilitée (Facilitated communication training — FCT) est une technique éducative destinée à permettre à ceux qui n ‘ont pas les moyens de s'exprimer couramment per la parole ou par signes de développer les automatismes de leurs mains qui leur permettront d'utiliser d'autres stratégies de communication indépendantes de la parole. Le procédé consiste à soutenir le bras, le poignet ou la main de l'apprenant qui est ainsi capable de contro˘ler la direction dans laquelle il pointe; récemment ce procédé a été l'objet d'une controverse considérable. Ses critiques ont mis en doute l'idée qu'il existe un problème de langage auquel on puisse remédier par le toucher. Cette étude traite du cas d'une personne souffrant d'un problème de langage qui ne semblait pas lié à un déficit neuromoteur évident, que n accompagnait aucun trouble du comportement, et auquel seul le toucher pouvait porter remède. Ce cas soulève des questions intéressantes sur le rapport entre le guidage physique et l'utilisation du langage.

Vermitteltes Kommunikationstraining ('facilitated communication training' = FCT) ist ein Unter‐richtsansatz, der das Ziel verfolgt, Menschen, die weder flüssig sprechen noch flüssig zeichnen können, den Erwerb von gesturalen Handfertigkeiten zu ermöglichen, die für andere nichtverbale Kommunikations‐strategien nötig sind. Es beinhaltet das Stützen des Armes, des Handgelenks oder der Hand der Person, die so in der Lage ist, ihre Zeigegesten besser zu steuern. Die Methode ist in letzter Zeit in beträchtlichem Maße debattiert worden. Kritiker der Methode haben die Existenz von Sprachproblemen, die durch Tastsinn zu beheben wären, in Frage gestellt. In dieser Studie wird der Fall einer Person mit einem Sprachproblem vorgestellt, das zu keiner erkennbaren neuromotorischen Störung in Beziehung stand, mit keiner Verhaltensstörung in Zusammenhang zu bringen war und allien im Tastbereich behoben werden konnte. Der Fall stellt einige interessante Fragen hinsichtlich der Beziehung zwischen physischen Stimuli und Sprachverhalten.
A study of the relationship of storytelling ability and reading comprehension in fourth and sixth grade African‐American children
Authors: Klecan‐Aker Joan S. , Caraway Teresa H.
Published: November 2007

ABSTRACTS

The purpose of the present investigation was to examine the relation of storytelling skills to achievement in reading comprehension in African‐American children. Socioeconomic status (SES), gender and developmental level of children's stories were examined as predictors of reading achievement. A total of 80 children in the fourth and sixth grades served as subjects. Results indicated that correlations of the narrative variables with reading achievement were significant for story level (0.37) and clauses per T‐unit (0.33). These results are discussed relative to the effect of oral language on academic achievement and the importance of examining this relationship in culturally and linguistically diverse groups.

La recherche présentée ici a eu pour but d'examiner le rapport entre les capacités de conter des histoires et le niveau atteint en compréhension à la lecture chez des enfants afroaméricains. Le statut socioéconomique, le sexe et le niveau de développement des histoires des enfants ont été examinés en tant que variables explicatives du niveau atteint en lecture. Quatre‐vingts enfants en quatrième et sixième années de scolarité ont servi de sujets. Les résultats ont indiqué que les corrélations des variables de narration avec le niveau atteint en lecture étaient significatives en ce qui concernait le niveau de l'histoire (0,37) et le nombre de clauses par unité de thème (0,33). La discussion de ces résultats porte sur l'influence du langage oral sur le niveau atteint lors des études et sur l'importance qu'il y a à examiner ce rapport quand on s'interesse à des groupes différents des points de vue culturel et linguistique.

Gegenstand dieser Untersuchung war die Beziehung zwischen Erzählfähigkeiten in afroamerikanischen Kindern und ihrem Verständnis beim Lesen. Als Prädiktoren für die Lese‐Verständnisleistung dienten der sozio‐ökonomische Status, das Geschlecht der Kinder sowie das Entwicklungsniveau der von den Kindern erzählten Geschichten. Insgesamt wurden 80 Kinder aus der vierten und der sechsten Schulklasse untersucht. Die Ergebnisse zeigten, daß die Korrelation zwischen narrativen Variablen und Leseleistung für dos Niveau der Geschichte (0,37) und für die Anzahl der Sätze pro T‐Einheit (0,33) signifikant waren. Diese Ergebnisse werden hinsichtlich der Bedeutung oraler Sprachfänigkeit für die schulische Leistung und hinsichtlich der Wichtigkeit, diese Beziehung in kulturell und sprachlich verschiedenen Gruppen zu unteruchen, erörtert.
Electrostatic Properties of Ideal and Non‐ideal Polar Organic Monolayers: Implications for Electronic Devices
Authors: Natan A. , Kronik L. , Haick H. , Tung R. T.
Published: November 2007

Molecules in (or as) electronic devices are attractive because the variety and flexibility inherent in organic chemistry can be harnessed towards a systematic design of electrical properties. Specifically, monolayers of polar molecules introduce a net dipole, which controls surface and interface barriers and enables chemical sensing via dipole modification. Due to the long range of electrostatic phenomena, polar monolayer properties are determined not only by the type of molecules and/or bonding configuration to the substrate, but also by size, (dis‐)order, and adsorption patterns within the monolayer. Thus, a comprehensive understanding of polar monolayer characteristics and their influence on electronic devices requires an approach that transcends typical chemical designs, i.e., one that incorporates long‐range effects, in addition to short‐range effects due to local chemistry. We review and explain the main uses of polar organic monolayers in shaping electronic device properties, with an emphasis on long‐range cooperative effects and on the differences between electrical properties of uniform and non‐uniform monolayers.
Cover Picture: Reversible Control of Ordering Transitions at Aqueous/Liquid Crystal Interfaces Using Functional Amphiphilic Polymers (Adv. Mater. 23/2007)
Authors: Kinsinger M. I. , Sun B. , Abbott N. L. , Lynn D. M.
Published: November 2007

On page 4208, Nicholas L. Abbott, David M. Lynn, and coworkers from the University of Wisconsin report amphiphilic polymers that assemble at interfaces between a nematic liquid crystal and immiscible aqueous phases and trigger ordering transitions that result in changes in the optical birefringence of the liquid crystal (as shown). The resulting polymer‐functionalized interfaces respond reversibly to changes in the pH of aqueous solutions and suggest approaches to the design of fluid interfaces that can sense, report on, or respond reversibly to a broad range of environmental stimuli.
Resemblance of osteophytes in experimental osteoarthritis to transforming growth factor β–induced osteophytes: Limited role of bone morphogenetic protein in early osteoarthritic osteophyte formation
Authors: Davidson E. N. Blaney , Vitters E. L. , van Beuningen H. M. , van de Loo F. A. J. , van den Berg W. B. , van der Kraan P. M.
Published: November 2007

Objective

Osteoarthritis (OA) is characterized by cartilage damage, synovial fibrosis, and osteophyte formation. Both transforming growth factor β (TGFβ) and bone morphogenetic protein 2 (BMP‐2) can induce the formation of osteophytes during OA, but their specific role in this process is unclear. The purpose of this study was to investigate the respective contributions of TGFβ and BMP‐2 to OA.

Methods

Mouse knee joints injected with adenovirus (Ad‐TGFβ or Ad‐BMP‐2) were compared histologically with knee joints from murine models of OA (joints injected with collagenase and joints from STR/Ort mice with spontaneous OA). To further investigate the role of BMP during osteophyte formation, adenovirus Ad‐Gremlin was injected into knee joints that had previously been injected with Ad‐TGFβ or collagenase.

Results

BMP‐2 induced early osteophytes, which bulged from the growth plates on the femur and grew on top of the patella, whereas TGFβ induced early osteophyte formation on the bone shaft beneath the collateral ligament on the femur as well as on top of the patella. The pattern of osteophyte formation during experimental OA closely resembled that of TGFβ‐induced osteophyte formation, but differed from the pattern induced by BMP‐2. Ad‐Gremlin proved to be able to totally block BMP‐2–induced osteophyte formation. However, blocking BMP activity inhibited neither TGFβ‐induced nor experimental OA–associated osteophyte formation.

Conclusion

Our findings demonstrate that the role of BMP during the onset of TGFβ‐induced and experimental OA–induced osteophyte formation is limited. The latter finding does not rule out a role of BMP during osteophyte maturation.
Acute Kawasaki disease is associated with reverse regulation of soluble receptor for advance glycation end products and its proinflammatory ligand S100A12
Authors: Wittkowski Helmut , Hirono Keiichi , Ichida Fukiko , Vogl Thomas , Ye Fei , Yanlin Xing , Saito Kazuyoshi , Uese Keiichiro , Miyawaki Toshio , Viemann Dorothee , Roth Johannes , Foell Dirk
Published: November 2007

Objective

Receptor for advanced glycation end products (RAGE) serves as a pattern recognition receptor for several endogenous ligands that are potent inducers of inflammation. By activating endothelial cells and leukocytes, RAGE augments recruitment of leukocytes to sites of inflammation, which is a key process, especially in vasculitis. Soluble RAGE (sRAGE) acts as a naturally occurring inhibitor of RAGE by neutralizing proinflammatory ligands, e.g., S100A12. This neutrophil‐derived protein has been reported to be associated with Kawasaki disease (KD) and to provoke proinflammatory responses. The aim of this study was to investigate circulating sRAGE in an acute inflammatory disorder and to compare these data directly with concentrations of the proinflammatory RAGE ligand S100A12.

Methods

Serum concentrations of sRAGE and S100A12 were analyzed by specific enzyme‐linked immunosorbent assays in 50 children with KD, and additionally in 39 patients with juvenile idiopathic arthritis (JIA). In 28 of the patients with KD, levels were analyzed longitudinally over the course of the disease.

Results

Patients with KD and those with systemic‐onset JIA had decreased levels of sRAGE during active disease, especially those patients with KD who were more severely affected and not responding to treatment. In addition, the level of sRAGE correlated negatively with the level of proinflammatory S100A12. After intravenous immunoglobulin (IVIG) therapy in patients with KD, the S100A12:sRAGE ratio was significantly different between responders and nonresponders.

Conclusion

Inverse regulation of both sRAGE and its proinflammatory ligand S100A12 seems to be a relevant molecular mechanism promoting systemic inflammation. Calculating the S100A12:sRAGE ratio might help to detect patients with KD who are at risk of being unresponsive to IVIG therapy.
Augmented interferon‐α pathway activation in patients with Sjögren's syndrome treated with etanercept
Authors: Mavragani Clio P. , Niewold Timothy B. , Moutsopoulos Niki M. , Pillemer Stanley R. , Wahl Sharon M. , Crow Mary K.
Published: November 2007

Objective

Recent clinical trials suggest that etanercept is ineffective in controlling Sjögren's syndrome (SS). To address the hypothesis that tumor necrosis factor blockade can result in increased levels of interferon‐α (IFNα) and BAFF, we quantified those mediators in plasma from etanercept‐ and placebo‐treated SS patients.

Methods

We studied plasma samples from 20 patients with SS treated with etanercept (25 mg twice weekly) or placebo in a 12‐week, randomized, double‐blind clinical trial. In addition, we studied plasma samples from 29 healthy controls. IFNα activity was determined by reporter cell assay, and BAFF levels were determined by enzyme‐linked immunosorbent assay.

Results

Baseline IFNα plasma activity and BAFF levels were increased in SS patients compared with healthy controls (mean ± SD IFNα plasma activity score 4.43 ± 2.60 versus 2.08 ± 0.91; P < 0.0001) (mean ± SD BAFF level 0.83 ± 0.27 ng/ml versus 0.60 ± 0.15 ng/ml; P = 0.008). A significant increase in IFNα activity was detected after 12 weeks of treatment in the etanercept group, but not in the placebo group (P = 0.04 and P = 0.58, respectively). Furthermore, a statistically significant increase in BAFF levels was noted in patients receiving etanercept, but not in those receiving placebo (P = 0.01 and P = 0.56, respectively). In vitro culture of control peripheral blood mononuclear cells with etanercept resulted in a dose‐dependent increase in the expression of IFNα and the IFNα‐inducible genes IFN‐induced protein with tetratricopeptide repeats 1 and BAFF.

Conclusion

IFNα activity and BAFF levels are elevated in the plasma of patients with SS compared with healthy controls. Etanercept treatment exacerbates IFNα and BAFF overexpression, providing a possible explanation for the lack of efficacy of this agent in SS.
Collagen‐induced arthritis as a model of hyperalgesia: Functional and cellular analysis of the analgesic actions of tumor necrosis factor blockade
Authors: Inglis Julia J. , Notley Clare A. , Essex David , Wilson Alex W. , Feldmann Marc , Anand Praveen , Williams Richard
Published: November 2007

Objective

There is a disparity in the animal models used to study pain in rheumatoid arthritis (RA), which tends to be acute in nature, and models used to assess the pathogenesis of RA. The latter models, like human RA, are lymphocyte‐driven and polyarthritic. We assessed pain behavior and mechanisms in collagen‐induced arthritis (CIA), the model of preclinical arthritis used most commonly in the field of immunology. We then validated the model using anti–tumor necrosis factor (anti‐TNF) therapy, which has analgesic effects in models of inflammation as well as in human RA.

Methods

CIA was induced in DBA/1 mice by immunization with type II collagen at the base of the tail. Swelling and mechanical and thermal hyperalgesia were assessed before and for 28 days after the onset of arthritis. Spontaneous behavior was assessed using an automated activity monitor. Glial activity was assessed by glial fibrillary acidic protein expression, and nerve damage was evaluated by activating transcription factor 3 expression. The actions of anti‐TNF therapy on nociception were then evaluated.

Results

Arthritis resulted in a decrease in the threshold for thermal and mechanical stimuli, beginning on the day of onset. Decreased spontaneous activity was also observed. A significant increase in the number of hyperplasic spinal cord astrocytes was observed beginning 10 days after the onset of arthritis. Anti‐TNF therapy was profoundly analgesic, with an efficacy similar to that of cyclooxygenase 2 inhibition, and reduced astrocyte activity in CIA.

Conclusion

This study shows that the CIA model is suitable for testing not only antiinflammatory but also analgesic drugs for potential use in RA, and highlights the importance of using appropriate disease models to assess relevant pain pathways.
Type IV collagen α‐chain composition in synovial lining from trauma patients and patients with rheumatoid arthritis
Authors: Poduval P. , Sillat T. , Beklen A. , Kouri V. P. , Virtanen I. , Konttinen Y. T.
Published: November 2007

Objective

Normal synovial lining is composed of macrophage‐like type A and fibroblast‐like type B lining cells. This sheet‐like structure lacks a basement membrane, but its intercellular substance contains some basement membrane components, including type IV collagen. We undertook this study to determine the α‐chain composition of type IV collagen in normal and arthritic synovial lining, using monoclonal α‐chain antibodies.

Methods

Samples were analyzed using avidin–biotin–peroxidase complex staining for the presence of collagen α1/2(IV), α3(IV), α4(IV), α5(IV), α6(IV), matrix metalloproteinase 2 (MMP‐2), and MMP‐9, and the enzyme activity was detected using gelatin zymography. Double immunofluorescence was performed for type IV collagen/MMP‐9 and type IV collagen/CD68. Synovial fibroblasts were studied using quantitative reverse transcriptase–polymerase chain reaction.

Results

In mildly inflamed synovium from 5 trauma patients, α1/2(IV) chains were strongly stained, but α5(IV) and α6(IV) chains were weakly stained. Coding messenger RNA was shown in cultured synovial fibroblasts. Basement membranes of blood vessels contained all α(IV) chains and served as useful positive sample controls. In the synovial lining from 5 patients with rheumatoid arthritis (RA), all α‐chains were absent/very weakly stained. This was coupled with numerous type A lining cells containing MMP‐9 (type IV collagenase), also found in synovial fluid.

Conclusion

Synovial lining has a unique and very limited α‐chain composition, different from that of the vascular basement membrane, which contains all α‐chains. This special composition and lack of nidogen are probably of relevance for the bidirectional translining diffusion. Such tentative α‐chain–dependent adhesive and transport‐regulating properties seem to be deranged in RA, probably in part due to type IV collagenases produced in the lining and/or released by transmigrating or synovial fluid neutrophils.
Rates of infiltration by macrophages and dendritic cells and expression of interleukin‐18 and interleukin‐12 in the chronic inflammatory lesions of Sjögren's syndrome: Correlation with certain features of immune hyperactivity and factors associated with high risk of lymphoma development
Authors: Manoussakis M. N. , Boiu S. , Korkolopoulou P. , Kapsogeorgou E. K. , Kavantzas N. , Ziakas P. , Patsouris E. , Moutsopoulos H. M.
Published: November 2007

Objective

To evaluate the expression profile of infiltrating macrophages and dendritic cells (DCs) as well as of interleukin‐18 (IL‐18) and IL‐12 in the minor salivary gland (MSG) lesions of patients with Sjögren's syndrome (SS), and to assess the relationship of these factors with disease parameters.

Methods

Macrophages, DCs, T cells, B cells, proIL‐18, mature IL‐18, and IL‐12 were detected by single‐ and double‐labeling immunohistochemistry in MSG specimens from 21 patients with primary SS (13 of 21 tested for IL‐12), 7 patients with secondary SS, and 9 disease control patients. Expression profiles were assessed for correlations with various disease parameters, including adverse predictors of lymphoma development.

Results

MSGs from patients with SS (but not from disease controls) manifested increased infiltration by macrophages and DCs, strong expression of IL‐18 by macrophages (particularly in B cell–rich areas and in germinal center–like structures in primary SS), and expression of IL‐12 by mononuclear cell infiltrates. In primary SS, high infiltration by macrophages correlated with SG enlargement (P = 0.01). The DC infiltration rate correlated positively with the macrophage infiltration rate (P = 0.04), occurrence of SG enlargement (P = 0.03), and presence of C4 hypocomplementemia (P = 0.05), and inversely with serum C4 complement levels (P = 0.001). The rate of infiltration by IL‐18–expressing cells correlated positively with biopsy focus scores (P < 0.001), larger infiltrates of macrophages (P = 0.01), DCs (P = 0.01), and B cells (P = 0.02), and SG enlargement (P = 0.02), and negatively with serum C4 complement levels (P = 0.02). The rate of infiltration by IL‐12–expressing cells correlated inversely with that by IL‐18–expressing cells (P = 0.001), biopsy focus scores (P = 0.003), and SG enlargement (P = 0.01), and positively with serum C4 complement levels (P = 0.05).

Conclusion

In patients with primary SS, infiltration of the SG by macrophages and DCs and expression of IL‐18 and IL‐12 appear to play active roles in the expansion and organization of infiltrative injuries and have a correlation with certain predictors of lymphoma development.
Circulating levels of tumor necrosis factor receptors are highly predictive of mortality in patients with rheumatoid arthritis
Authors: Mattey Derek L. , Glossop John R. , Nixon Nicola B. , Dawes Peter T.
Published: November 2007

Objective

To investigate whether circulating levels of soluble tumor necrosis factor receptors (sTNFR) are predictive of mortality in rheumatoid arthritis (RA).

Methods

Levels of sTNFRI and sTNFRII at study entry were quantified using enzyme‐linked immunosorbent assays in sera from 401 white patients with RA followed up for 13 years. Patients were tracked via the National Health Service Central Register, and the relationship between sTNFR levels and mortality was analyzed using a Cox proportional hazards regression model. Hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated.

Results

At the end of the followup period, 132 (32.9%) of 401 patients had died. Of these, 64 (48.5%) died of cardiovascular disease (CVD). Significant associations between all‐cause mortality and baseline levels of sTNFRI and sTNFRII were identified in men (HR 1.7 [95% CI 1.2–2.4] and HR 1.18 [95% CI 1.05–1.32], respectively) and women (HR 1.33 [95% CI 0.99–1.8] and HR 1.14 [95% CI 1.02–1.28], respectively). Analysis including levels of both sTNFRI and sTNFRII indicated that the sTNFRII level was the best overall predictor of mortality. Multivariate analysis also revealed that the sTNFRII level was a predictor of all‐cause and CVD mortality independently of age, sex, disease duration, C‐reactive protein level, erythrocyte sedimentation rate, rheumatoid factor, nodular disease, modified Health Assessment Questionnaire score, taking CVD drugs, and smoking.

Conclusion

Our data indicate that serum levels of sTNFR are powerful predictors of mortality in RA. Elevated levels are particularly associated with mortality due to CVD and may be useful for identifying patients at increased risk of premature death.
High titer of anti–phosphatidylserine‐prothrombin complex antibodies in patients with cutaneous polyarteritis nodosa
Authors: Kawakami Tamihiro , Yamazaki Masahide , Mizoguchi Masako , Soma Yoshinao
Published: November 2007

Objective

To investigate possible correlations between cutaneous polyarteritis nodosa (CPN) and antiphospholipid syndrome–associated antibodies.

Methods

Sixteen patients were referred with CPN features. To investigate the possible role of antiphospholipid antibodies (aPL) in CPN, we measured serum lupus anticoagulant (LAC), IgG and IgM anticardiolipin (aCL) and anti–phosphatidylserine‐prothrombin complex (anti‐PS/PT) antibodies, and anti–β2‐glycoprotein I–dependent cardiolipin (anti‐β2GPI/CL) antibodies in the 16 CPN patients, 8 microscopic polyangiitis (MPA) patients, 33 systemic lupus erythematosus (SLE) patients, and 23 healthy controls. LAC was determined according to the Subcommittee on Lupus Anticoagulant/Phospholipid Dependent Antibody guidelines. Anti‐PS/PT, aCL, and anti‐β2GPI/CL antibodies were measured by enzyme‐linked immunosorbent assay.

Results

Anti‐PS/PT antibodies and/or LAC were detected in all CPN patients, but not in any controls. Serum IgM anti‐PS/PT antibody was found in 13 (81.3%) CPN patients. The mean ± SD serum anti‐PS/PT IgM level (19.9 ± 12.4 units/ml) in CPN patients was significantly elevated compared with SLE patients (5.7 ± 5.9 units/ml). IgG anti‐PS/PT antibody was detected in 5 (31.3%) CPN patients, but not in any controls. The IgG PS/PT antibody titers were similar in CPN patients (12.3 ± 12.0 units/ml) and SLE patients (13.8 ± 14.3 units/ml). Three (18.8%) CPN patients were positive for IgG aCL antibody and 2 (12.5%) for IgM aCL antibody. No MPA patients had aPL. CPN skin manifestations included livedo reticularis (14 [87.5%]). Direct immunofluorescence (DIF) revealed C3 within the affected vessels in 7 (77.8%) of 9 CPN patients.

Conclusion

Our study demonstrated that presence of anti‐PS/PT antibodies and/or LAC could serve as markers in CPN patients. CPN could be dependently associated with the presence of anti‐PS/PT antibody. Clinicians need to recognize these titers to permit early accurate diagnosis and treatment. We believe that anti‐PS/PT antibodies will become widely recognized as a new factor when diagnosing CPN.
Reproducibility of the measurement of knee joint proprioception in patients with osteoarthritis of the knee
Authors: Hurkmans E. J. , van der Esch M. , Ostelo R. W. J. G. , Knol D. , Dekker J. , Steultjens M. P. M.
Published: November 2007

Objective

To estimate the inter‐ and intrarater reliability and agreement of instrumented knee joint proprioception measurement in subjects with knee osteoarthritis (OA) and healthy subjects; to assess the effect of variations in the measurement procedure on agreement parameters.

Methods

Proprioception was measured by a computer‐controlled knee angular motion‐detecting device in a movement‐detecting task. The angular displacement between the starting position and the position at the instant of movement detection by the subject was recorded. Two raters independently assessed knee joint proprioception. After 14 days the assessment was repeated. Complete data were obtained from 24 subjects with knee OA and 26 healthy subjects. The inter‐ and intrarater reliability coefficients (intraclass correlation coefficients [ICC]) and inter‐ and intrarater agreement measures (standard error of measurement [SEM] and minimal detectable difference [MDD]) were calculated. Additionally, the effect of changing the velocity of angular displacement and applying headphone music during the measurement on the absolute error (i.e., SEM and MDD) was estimated at the second occasion.

Results

Interrater reliability was good in subjects with knee OA and healthy subjects (ICC 0.91 and 0.89, respectively). Interrater agreement was higher in subjects with knee OA than in healthy subjects (SEM 2.13° versus 0.43°, MDD 5.90° versus 1.19°). Intrarater reliability was good in subjects with knee OA and healthy subjects (ICC 0.91 and 0.86, respectively). Intrarater agreement (SEM and MDD) was 2.26° and 6.26° in subjects with knee OA and 0.39° and 1.08° in healthy subjects. The original measurement and the 2 variations in measurement showed comparable measurement errors for subjects with knee OA and healthy subjects.

Conclusion

In knee OA subjects and healthy subjects, knee proprioception measurement shows adequate intra‐ and interreliability. However, the absolute measurement error is rather high. Therefore, this measurement has limited value in the assessment of individual subjects, but can be recommended for scientific research in groups of individuals.
Factors associated with restricted mobility outside the home in community‐dwelling adults ages fifty years and older with knee pain: An example of use of the International Classification of Functioning to investigate participation restriction
Authors: Wilkie Ross , Peat George , Thomas Elaine , Croft Peter
Published: November 2007

Objective

To investigate the links between knee pain characteristics and restricted mobility outside the home, and how these are influenced by mobility‐specific activity limitation, age, sex, socioeconomic status, environmental factors, and comorbidity.

Methods

We conducted a cross‐sectional survey of community‐dwelling adults age ≥50 years. A total of 2,252 responders reporting pain in and around the knee in the last year were eligible. The primary outcome was self‐reported restricted mobility outside the home in the previous 4 weeks (dichotomized as present or absent).

Results

Knee pain severity was strongly associated with restricted mobility outside the home, an association largely mediated by perceived limitation in walking. After adjusting for demographic and socioeconomic characteristics, individual contributions from selected comorbidities, knee pain severity, limitation in walking, and specific environmental factors remained. These environmental factors included perceived need of aids and assistance (adjusted odds ratio [OR] 3.1, 95% confidence interval [95% CI] 2.2–4.4), poor access to public transportation (adjusted OR 2.3, 95% CI 1.4–3.9), and having no access to a car (adjusted OR 1.6, 95% CI 1.1–2.4).

Conclusion

There are a range of potential health and social targets that, if addressed, might reduce restricted mobility outside the home in middle‐aged and older individuals with knee pain. Our results suggest that, in addition to treating the knee symptoms, such targets might include comorbidity, walking ability, and environmental barriers such as poor access to public transportation. Moreover, removing environmental barriers may reduce immobility outside the home even in the continued presence of osteoarthritis symptoms and specific activity limitations.
Racial/ethnic disparities in patient‐reported nonsteroidal antiinflammatory drug (NSAID) risk awareness, patient‐doctor NSAID risk communication, and NSAID risk behavior
Authors: Fry Rachel B. , Ray Midge N. , Cobaugh Daniel J. , Weissman Norman W. , Kiefe Catarina I. , Shewchuk Richard M. , Saag Kenneth G. , Curtis Jeffrey R. , Allison Jeroan J.
Published: November 2007

Objective

Nonsteroidal antiinflammatory drugs (NSAIDs) are commonly used and frequently lead to serious adverse events. Little is known about NSAID‐related ethnic/racial disparities. We focused on differences in patient NSAID risk awareness, patient‐doctor NSAID risk communication, and NSAID risk‐avoidance behavior.

Methods

We performed a cross‐sectional analysis of survey data from the Alabama NSAID Patient Safety Study. Eligible patients were ≥65 years old and currently taking prescription NSAIDs (Rx NSAIDS). Generalized linear latent and mixed models accounted for nesting of patients within physicians.

Results

Of all 404 participants, 32% were African American and 73% were female. The mean ± SD age was 72.8 ± 7.5 years, and 64% reported an annual household income <$20,000. African American patients were less likely than white patients to recognize any risk associated with over‐the‐counter (OTC) NSAIDs (13.3% versus 29.3%; P = 0.001) and Rx NSAIDs (31.3% versus 49.6%; P = 0.001), report that their doctor discussed possible NSAID‐related gastrointestinal problems (38.0% versus 52.4%; P = 0.007), and take medications to reduce ulcer risk (30.5% versus 50.2%; P = 0.001). Patients with lower income and education reported significantly less risk awareness for OTC and Rx NSAIDs. Racial/ethnic differences persisted after adjusting for multiple confounders.

Conclusion

In this community‐based study of low income elderly individuals receiving NSAIDs, we identified important racial/ethnic differences in risk awareness, communication, and behavior. Additional efforts are needed to promote safe NSAID use and reduce ethnic/racial disparities.
Vasculitides associated with malignancies: Analysis of sixty patients
Authors: Fain Olivier , Hamidou Mohamed , Cacoub Patrice , Godeau Bertrand , Wechsler Bertrand , ParIès Jacques , Stirnemann Jérôme , Morin Anne‐Sophie , Gatfosse Marc , Hanslik Thomas , Belmatoug Nadia , Blétry Olivier , Cevallos Ramiro , Delevaux Isabelle , Fisher Evelyne , Hayem Gilles , Kaplan Gérard , Le hello Claire , Mouthon Luc , Larroche Claire , Lemaire Véra , Piette Anne‐Marie , Piette Jean‐Charles , Ponge Thierry , Puechal Xavier , Rossert Jérôme , Sarrot‐Reynauld Françoise , Sicard Didier , Ziza Jean‐Marc , Kahn Marcel‐Francis , Guillevin Loïc
Published: November 2007

Objective

To describe characteristics and outcomes of vasculitides associated with malignancies.

Methods

The requirement for inclusion in this retrospective, 10‐year study was development of vasculitis in patients with a progressing malignancy. Malignancies secondary to immunosuppressants used to treat vasculitis were excluded. The main characteristics of vasculitides were analyzed and compared according to the type of malignancy.

Results

Sixty patients were included (male/female sex ratio 2.53, mean age 62.4 years). Mean followup duration was 45.2 months. Vasculitides were cutaneous leukocytoclastic (45%), polyarteritis nodosa (36.7%), Wegener's granulomatosis (6.7%), microscopic polyangiitis (5%), and Henoch‐Schönlein purpura (5%). Malignancies were distributed as follows: hematologic in 63.1%, myelodysplastic syndrome (MDS) in 32.3%, lymphoid in 29.2%, and solid tumor in 36.9%. Vasculitides were diagnosed concurrently with malignancy in 38% of the cases. Manifestations of vasculitides were fever (41.7%), cutaneous involvement (78.3%), arthralgias (46.7%), peripheral neuropathy (31.7%), renal involvement (23.3%; 11.7% glomerulonephritis, 11.7% microaneurysms, 6.7% renal insufficiency), and antineutrophil cytoplasmic antibody (20.4%). Vasculitis treatments were corticosteroids (78.3%) and immunosuppressant(s) (41.7%). Vasculitis was cured in 65% of patients, but 58.3% died, with 1 death secondary to vasculitis. Independent of subtype, patients with vasculitides associated with MDS more frequently had renal manifestations (P = 0.02) and steroid dependence (P = 0.04) and achieved complete remission less often (P = 0.04) than patients with vasculitides associated with other malignancies. Patients with vasculitides associated with a solid tumor more frequently had peripheral neurologic involvement (P = 0.05). Patients with vasculitides associated with lymphoid malignancy had less frequent arthralgias (P = 0.01) and renal involvement (P = 0.02).

Conclusion

Vasculitides occurring during malignancies present distinctive features according to the vasculitis subtype and nature of the malignancy.
Impact of memory impairment on employment status in persons with systemic lupus erythematosus
Authors: Panopalis Pantelis , Julian Laura , Yazdany Jinoos , Gillis Joann Zell , Trupin Laura , Hersh Aimee , Criswell Lindsey A. , Katz Patricia , Yelin Edward
Published: November 2007

Objective

To assess the specific contribution of memory impairment to employment status in persons with systemic lupus erythematosus (SLE).

Methods

A total of 832 patients with SLE were surveyed and data collected on demographics, SLE symptoms and activity, health status, depression, medications, health resource utilization, and current employment status. Participants underwent screening for memory impairment and based on their scores were categorized to 3 levels of memory function: intact, mild‐moderate impairment, and severe impairment. Employment status was compared across impairment levels using multivariate logistic regression, adjusting for sociodemographic characteristics (i.e., age, sex, race, education, and marital status), employment status at year of diagnosis, disease activity, disease duration, and depression.

Results

In the intact memory function group, 54.2% were employed, versus 40.6% in the mild‐moderate impairment group and 31.0% in the severe impairment group. In the intact memory function group, 29.2% were unable to work, versus 40.6% in the mild‐moderate impairment group and 56.3% in the severe impairment group. After multivariate adjustment, increasing levels of memory impairment predicted a decreased likelihood of being employed: odds ratio (OR) 0.70, 95% confidence interval (95% CI) 0.48–1.02 for the mild‐moderate impairment group and OR 0.57, 95% CI 0.32–1.00 for the severe impairment group. Participants with memory impairment were more likely to report being unable to work: OR 1.36, 95% CI 0.90–2.04 for the mild‐moderate impairment group, and OR 1.99, 95% CI 1.12–3.55 for the severe impairment group. These findings were statistically significant only in the severe impairment groups.

Conclusion

The findings suggest that severe memory impairment is an important factor associated with employment status in persons with SLE.
Prognosis of hip pain in general practice: A prospective followup study
Authors: Lievense Annet M. , Koes Bart W. , Verhaar Jan A. N. , Bohnen Arthur M. , Bierma‐Zeinstra Sita M. A.
Published: November 2007

Objective

Hip pain in the elderly is the main feature of osteoarthritis of the hip. In this prospective followup study, we wanted to determine which patients with hip pain show disease progression, and what the incidence of total hip replacement (THR) is in this group of patients after 3 and 6 years of followup.

Methods

Within general practices in the area of Rotterdam (The Netherlands), persons age ≥50 years with incident hip pain were included. After 3 and 6 years, progression of hip pain was assessed.

Results

A total of 224 patients were included. After 3 years disease progressed in 29 (15%) patients and 23 (12%) received a THR. After 6 years disease progressed in 45 (28%) patients and 36 (22%) received a THR. The prognostic variables for a THR after 3 and 6 years related to history taking were age ≥60 years, morning stiffness, and pain in the groin/medial thigh; variables related to physical examination were decreased extension/adduction, painful internal rotation, and a body mass index ≤30 kg/m2; and the variable related to radiologic findings was a Kellgren/Lawrence grade of 2 or higher.

Conclusion

In this study population, ∼12% of patients presenting with hip pain to their general practitioner will undergo a THR within 3 years, and ∼22% after 6 years. Using the variables obtained from history taking, physical examination, and radiologic findings enables better identification of persons at high risk for a THR.
Subspecialty choice: Why did you become a rheumatologist?
Authors: Kolasinski Sharon L. , Bass Anne R. , Kane‐Wanger Gwendolyn F. , Libman Bonita S. , Sandorfi Nora , Utset Tammy
Published: November 2007

Objective

To determine the reasons trainees choose rheumatology as a subspecialty and to review the literature on career choices among physicians, particularly regarding the choice of subspecialty.

Methods

A questionnaire was designed to identify and analyze factors that influence rheumatology fellows to join the field of rheumatology. The questionnaire was administered online and answers were collated through the American College of Rheumatology Training and Workforce Committee, Subcommittee on Medical Student and Resident Recruitment. We reviewed the medical literature, using Medline and PubMed to find references to career choice among medical trainees.

Results

The majority of rheumatology fellows had their initial exposure to rheumatology as second‐year and third‐year medical students, and >75% solidified their decision during internship and residency. Clinical rotations in rheumatology and exposure to role models and mentors were the most influential factors. Approximately 40% of rheumatology fellows cite their intellectual interest in the field as the most important contributor to their decision.

Conclusion

Career decision‐making occurs throughout medical training. Exposure to clinical experiences and mentors are particularly influential and may have an impact during medical school, as well as during internal medicine residency training. These findings suggest that there are a variety of opportunities throughout medical training to influence career decision‐making and improve recruitment into rheumatology. Additional financial resources that support recruitment efforts may be required, and followup studies assessing the effects of these efforts should be done.
Long‐term outcome following total hip arthroplasty: A controlled longitudinal study
Authors: Cushnaghan Janet , Coggon David , Reading Isabel , Croft Peter , Byng Patricia , Cox Ken , Dieppe Paul , Cooper Cyrus
Published: November 2007

Objective

To assess long‐term outcome and predictors of prognosis following total hip arthroplasty (THA) for osteoarthritis (OA).

Methods

We studied 282 patients from 2 English health districts ∼8 years after THA, along with 295 controls selected from the general population. Baseline data were collected by interview and examination, on sex, age, comorbidity, body mass index (BMI), and Short Form 36 (SF‐36) functional status, and preoperative radiographic severity of OA was graded. Functional status was reassessed at followup by postal questionnaire. Predictors of change in physical functioning were analyzed by linear regression.

Results

Over followup, cases who had THA reported a median improvement of 10 points in SF‐36 score for physical functioning, whereas in controls there was a median deterioration of 10 points (P < 0.0001). Mental health improved by a median of 12 points in both cases and controls. Change in physical functioning was significantly worse in women and at older ages among both cases and controls. In cases, Croft grade 5 OA was associated with a physical functioning score improvement 19.4 points (95% confidence interval 7.7, 31.2) greater than the improvement in grades 0–3, but BMI was unrelated to change in physical functioning.

Conclusion

Improvements in physical functioning following THA for OA are sustained in the long term and are more frequent in patients with more severe radiographic features preoperatively. We found no indication that patients who are overweight benefit less from THA, but further evidence is needed on the prognostic influence of more severe obesity.
Diagnostic and prognostic relevance of neuromuscular biopsy in primary Sjögren's syndrome–related neuropathy
Authors: Terrier Benjamin , Lacroix Catherine , Guillevin Loïc , Hatron Pierre‐Yves , Dhote Robin , Maillot François , Diot Elisabeth , Sarrot‐Reynauld Françoise , Sordet Christelle , Dubourg Odile , Meyer Laurence , Mariette Xavier , Gottenberg Jacques‐Eric ,   Club Rhumatismes et Inflammation
Published: November 2007

Objective

To evaluate the clinicobiologic presentation in patients with primary Sjögren's syndrome (SS)–related peripheral neuropathy, the histologic results of neuromuscular biopsy (NMB), and clinical outcome, and to identify prognostic factors.

Methods

We retrospectively studied clinical and biologic presentation of 40 patients with primary SS–related neuropathy who underwent NMB. Prognostic factors of clinical outcome were assessed by univariate and multivariate analysis.

Results

Patients with vasculitis (lymphocytic [n = 8] or necrotizing [n = 14]) had a higher prevalence of acute‐onset neuropathy, multiple mononeuropathy, sensorimotor involvement, vascular purpura, general symptoms, increased C‐reactive protein level, positivity for rheumatoid factor, hypocomplementemia, and monoclonal gammopathy compared with those without vasculitis (n = 18). Comparison between patients with necrotizing or lymphocytic vasculitis did not reveal significant differences in clinical or biologic presentation except for the presence of general symptoms and rheumatoid factor. Regarding clinical evolution, the results of NMB (P < 0.0001), in particular the presence of necrotizing vasculitis (P < 0.001), an acute neuropathy onset (P < 0.0001), general symptoms (P < 0.0001), multiple mononeuropathy (P = 0.0007), presence of sensorimotor involvement (P = 0.002), and increased C‐reactive protein level (P = 0.008), were significantly associated with a better outcome in univariate analysis. In multivariate analysis, NMB resulting in the identification of patients with necrotizing vasculitis was the only variable that remained significantly associated with a better outcome (P = 0.01).

Conclusion

NMB is necessary to identify patients with necrotizing vasculitis, who have a better response to immunosuppressive therapy. NMB might therefore have both a diagnostic and prognostic relevance in primary SS–related neuropathy.