bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Infection in the Pathogenesis of Cardiovascular Disease
Authors: Zebrack James S. , Anderson Jeffrey L.
Published: February 2007

Atherosclerosis is a complex, multifactorial disease. Recently, research has intensified to identify the role of various infections in the pathogenesis of atherosclerosis. Specific agents have been proposed as direct initiators or accelerators of atherosclerosis, while other infectious agents have been proposed as accelerators of atherosclerosis through nonspecific stimulation of the inflammatory cascade. Recently, the total pathogen burden concept has suggested that while each specific infection contributes only slightly to the pathogenesis of atherosclerosis, the cumulative effects of infectious agents contribute greatly. Several randomized trials evaluating antibiotic therapy in the prevention of cardiovascular events have now been completed, although results have been conflicting. This manuscript summarizes current understanding of the role of infectious agents as a trigger of inflammation, as a contributor to atherosclerosis, and the potential role of antibiotic therapy in the treatment of atherosclerosis.
Predictors of Quality of Life in Women 1 Year After Myocardial Infarction
Authors: Rankin Sally H. , Fukuoka Yoshimi
Published: February 2007

In an analysis of 30 African American and Caucasian women, the authors describe changes in the various quality‐of‐life domains (health, family, socioeconomic, psychosocial, and spiritual) and predictors of quality of life for a group of women more than 1 year postacute myocardial infarction (MI). Data reported represent three recovery points post‐MI (before hospital discharge, 6‐weeks post‐MI, and 12‐months post‐MI). Matched pairttests indicated significant changes in all five domains of quality of life/cardiac, and through a multiple regression analysis 45% of the variance in quality of life could be explained by mood states and social support. The finding that social support and mood states were the only predictors of quality of life for this cohort of women at 1‐year post‐MI suggests that health care professionals should mobilize and reinforce social support networks and make mental health referrals for the most vulnerable women. Further study should be conducted on the unique needs of African American women, since insufficient numbers were available at 1 year to determine their unique patterns of recovery.
Aldosterone Receptor Antagonists: Focus on Eplerenone
Authors: Lamb Robert E. , Folstad Jon
Published: February 2007

Despite the development of hypertension treatment guidelines, blood pressure control in the general population remains inadequate, indicating the need for ongoing re‐evaluation of treatment strategies to further improve blood pressure control. Hypertension results from alterations in cardiac output and/or peripheral resistance. The renin‐angiotensin‐aldosterone system may be responsible, at least in part, for these alterations. Despite pharmacologic intervention with angiotensin‐converting enzyme inhibitors and angiotensin type‐1 receptor antagonists, aldosterone continues to be produced. Therapeutic modalities for treating hypertension directed toward antagonizing aldosterone might more effectively control blood pressure. Eplerenone, a new selective aldosterone receptor antagonist, recently received approval from the US Food and Drug Administration for the treatment of hypertension, either alone or in combination with other antihypertensive agents. The objective of this review is to summarize the renin‐angiotensin‐aldosterone system, emphasizing the role for aldosterone antagonism in the management of hypertension, with a focus on eplerenone.
Noncompliance in Heart Transplantation: A Role for the Advanced Practice Nurse
Authors: Sherry Daisy C. , Simmons Barbara , Wung Shu Fen , Zerwic Julie Johnson
Published: February 2007

Many organ transplant recipients experience organ rejection because they are noncompliant with the requirements of the health care regimen. The advanced practice nurse is in an ideal position to assess predictors of noncompliance as well as to implement interventions to enhance patient compliance. The purpose of this paper is to present a case study of a young female heart transplant recipient whose death due to organ rejection was related to noncompliance. The role of the advanced practice nurse in reducing noncompliance is identified and relevant nursing interventions are discussed.
Predictors of Women's Attendance at Cardiac Rehabilitation Programs
Authors: Gallagher Robyn , McKinley Sharon , Dracup Kathleen
Published: February 2007

This descriptive study was conducted to identify the factors that influence women's attendance at cardiac rehabilitation programs and women's adherence to risk factor modification following a cardiac event. Women (N=196) admitted to hospital for a cardiac event were followed‐up at 12 weeks postdischarge. Despite eligibility, only 64% (n=112) had been referred to cardiac rehabilitation programs. By 12 weeks postdischarge only 32% of the total sample (n=57) attended programs and 12% of the total sample (n=21) had dropped out before completion. The odds of a woman attending cardiac rehabilitation were decreased by myocardial infarction diagnosis, lack of employment, <55 years or >70 years, and experiencing a personal stressful event during followup. Women were likely to adhere to smoking, medication, and stress modification guidelines but unlikely to adhere to modification guidelines for diet and exercise.
Perceptions of Activity and Vocational Status in Women With Cardiac Illness
Authors: Sue Wingate , Loscalzo Frances , Hozdic Theresa
Published: February 2007

The purpose of this descriptive study was to determine the perceptions of activity and vocational status in women with cardiac illness. A convenience sample of 20 women with the diagnosis of coronary heart disease or hypertrophic cardiomyopathy participated. Subjects underwent an audiotaped interview, using a semistructured interview guide, which was then transcribed into the Ethnograph software program (Qualis Research Associates, Salt Lake City, UT). Transcripts were analyzed for common themes via content analysis. There were four themes identified for activity: variable activity patterns, fatigue, guilt, and depression. There were four themes identified for vocational status: desire to work, social aspects of work, unpaid work, and struggle to maintain the status quo. In conclusion, the themes of fatigue, guilt over unmet activity expectations, and the common occurrence of unpaid work validated prior research findings. The themes of variable patterns of activity management, feelings of depression about lowered activity levels, the desire to return to a prior vocation, the importance of the social nature of work, and the struggle to balance both home and work roles were new findings.
Adjunctive Effects of Exercise Training in Heart Failure Patients Receiving Maximum Pharmacologic Therapy
Authors: Bunny Pozehl , Duncan Kathleen , Krueger Steven , VerMaas Patricia
Published: February 2007

The purpose of this pilot study was to test the adjunctive effects of a 12‐week exercise training intervention vs. standard pharmacologic therapy on quality of life, functional status, and mood in heart failure patients. A randomized, two‐group repeated measures design was used to test outcomes at baseline and 12 weeks in 23 subjects (ejection fraction=40%, standard pharmacologic therapy [diuretics, angiotensin‐converting enzyme inhibitors,βblockers, and digoxin] and no change in medical therapy for 30 days). The exercise group had significantly higher adjusted means on the role physical, role emotional, and mental functioning subscales of the Medical Outcomes Study 36‐item Short‐Form Health Survey compared with the control group.

Confusion/bewilderment (Profile of Mood States subscale) adjusted mean scores were significantly lower for the exercise group, indicating better mood compared with the control group. Exercise training provided adjunctive benefit in terms of role and mental functioning for these heart failure patients.
The Effects of Obesity on the Cardiopulmonary System: Implications for Critical Care Nursing
Authors: Garrett Kim , Lauer Kathy , Christopher Beth‐Anne
Published: February 2007

Obesity has risen at epidemic rates over the last 20 years. This increase crosses all ages, genders, racial/ethnic groups, and income and educational levels. A variety of genetic, environmental, physiological, psychological, and sociocultural factors influence the development of obesity. Increased morbidity and mortality are associated with obesity. Most healthrelated problems and the increased risk of death in obesity are due to cardiopulmonary compromise. This paper addresses the physiologic effects of obesity on the cardiopulmonary system and the impact obesity has on the critically ill patient. Suggestions for alterations in cardiovascular and pulmonary assessment techniques are discussed. Nursing practice interventions are presented for maximizing cardiopulmonary function and preventing complications. The advocacy role of the nurse is addressed as a critical component in working to develop a culture of understanding and acceptance for the obese patient.
Obstructive Hypertrophic Cardiomyopathy
Authors: Graham‐Cryan Melissa A. , Rowe Gina , Hathaway Londa , Biddle Susan , Tripodi Dorothy , Fananapazir Lameh
Published: February 2007

Hypertrophic cardiomyopathy (HCM) is a primary disease of cardiac muscle characterized by a thickening of the left ventricular wall and often predominantly affecting the interventricular septum. This paper presents a case study of a 53‐year‐old female with a dynamic and obstructive form of HCM. The study includes a case presentation, clinical findings, investigations, and management. Patient findings were obtained before and after alcohol septal ablation, a novel interventional therapy. The article reviews the various forms of HCM and describes the currently available treatment modalities for obstructive HCM. Further research will be necessary to determine the comparative efficacy between past, present, and future therapies.
Acculturation and Cardiovascular Disease Risk in Midlife Immigrant Women From the Former Soviet Union
Authors: Miller Arlene Michaels , Chandler Peggy J. , Wilbur JoEllen , Sorokin Olga
Published: February 2007

This study examines relationships among acculturation, depression, and cardiovascular risk factors in midlife women from the former Soviet Union and identifies factors predicting Framingham Risk Scores. Data were collected at baseline and 1 year later from 218 participants in a longitudinal study of postimmigration health. The leading risk factors were obesity, dyslipidemia, and depression. Older women had lower American Behavioral Acculturation subscale scores, higher Russian Behavioral Acculturation subscale scores, and higher depression scores. Length of residence was significantly correlated with American behavioral acculturation but not Russian behavioral acculturation. Baseline body mass index, both acculturation scores, and depression scores predicted Framingham Risk Scores after 1 year, but serum glucose did not. The results suggest that contrary to findings in other immigrant groups, women from the former Soviet Union may decrease their risk for coronary heart disease as they assume a more American lifestyle. Nursing interventions to address the high cardiovascular disease risk in this population are suggested.
Differences Between Frontier and Urban Elders With Chronic Heart Failure
Authors: Wagnild Gail , Rowland Jo , Dimmler Laura , Peters Deborah
Published: February 2007

The purpose of this study was to compare 136 frontier and 148 urban patients with chronic heart failure who were aged 60 years and older. Medical records from 2000 to 2002 were reviewed from a regional tertiary hospital in Montana. While the two groups did not differ with respect to New York Heart Association functional class and number of comorbid conditions, the frontier sample was more likely to be male, married, and younger. Frontier patients were more depressed and scored significantly lower on quality‐of‐life measures. Among those who had died, frontier patients survived an average of 7.7 months, in contrast to urban patients who survived an average of 13.4 months following index hospitalization. Frontier patients have few available health care services and providers may not treat patients as expertly or aggressively as urban providers. Frontier patients tend to be isolated due to illness, lack of transportation, travel distances, and weather‐related barriers. Many may be falling through the cracks.
Sleep‐Disordered Breathing and the Association With Cardiovascular Risk
Authors: Merritt Sharon L.
Published: February 2007

Breathing‐related sleep disorders, particularly obstructive sleep apnea, have been largely undiagnosed in people with cardiovascular disease, probably due to limited health care provider awareness of the association between the two conditions. Solid evidence is emerging that the apneic events that occur during sleep lead to acute and chronic hemodynamic changes during wake time, including elevated sympathetic tone, decreased stroke volume and cardiac output, increased heart rate, and changes in circulating hormones that regulate blood pressure, fluid volume, vasoconstriction, and vasodilation. Obstructive sleep apnea is associated with known cardiovascular risk factors such as obesity and hyperlipidemia, and is considered by many sleep clinicians to be an independent risk factor for hypertension. Additionally, sleep apnea has been implicated in the pathogenesis of heart failure and stroke. Treatment with positive airway pressure during sleep eliminates the apneic events and the ensuing acute hemodynamic changes. Improvements in daytime blood pressure and left ventricular function also have been noted in persons with hypertension and heart failure. Because effective treatment is available for sleep apnea, this condition needs to be diagnosed and treated in persons with cardiovascular disease.
Predictors of Physical Function in Patients With Peripherial Arterial Disease and Claudication
Authors: Oka Roberta K. , Szuba Andrzej , Giacomini John C. , Cooke John P.
Published: February 2007

Limitation of walking due to claudication is the hallmark of peripheral arterial disease. The purpose of this secondary analysis was to identify biobehavioral predictors of physical function in peripheral arterial disease patients that included walking ability, gender, age, disease severity, environmental factors (social support), and medical comorbidity (arthritis). All subjects performed an exercise treadmill test to determine initial and absolute claudication distance. The sample consisted of 97 peripheral arterial disease patients, 71 (73%) men and 26 (27%) women, with a mean age of 73±8 years (range 52–90 years). Initial claudication distance occurred at 171.88±136.35 m. Absolute claudication distance was 421.03±286.37 m. A simultaneous multiple regression analysis was performed to determine predictors of physical function. The model accounted for 35% of the variance (p<0.001) and included personal characteristics (age, gender, years of education), severity of disease by ankle‐brachial index, environmental factors of social support (marital status), absolute claudication distance, and arthritis. Education (p=0.011), absolute claudication distance (p=0.014), social support (p=0.026), arthritis (p=0.028),and age (p=0.033) were the strongest predictors of physical function. This study identifies biobehavioral factors that place peripheral arterial disease patients at greater risk for reduced physical function and provides a rationale for interventions that improve walking ability.
AN ANALYSIS OF PULMONARY COMPLICATIONS FOLLOWING ANESTHESIA AND ANALGESIA IN 2,064 CONSECUTIVE CASES
Authors: HOLMES F.
Published: February 2007

1. In 2,064 consecutive unselected cases pulmonary atelectasis and acute bronchitis were common post‐operative complications while consolidation was comparatively rare.

2. The type of patient most frequently affected was the male in early middle life.

3. The operations most commonly followed by these complications were herniotomy and appendicectomy.

4. Oblique wounds may interfere to a greater extent with the abdominal component in the mechanism of respiration than do paramedian and mid‐line incisions. Excessive tightening of muscles of the abdominal wall during hernial repair may lead to reduced pulmonary ventilation in the post‐operative period and so predispose to respiratory morbidity.

5. The method of anæsthesia employed did not appear to affect the incidence of these complications, and spinal analgesia does not reduce their occurrence.
INTRACISTERNAL INJECTION OF PROCAINE
Authors: WOOLMER RONALD
Published: February 2007

A case of intracisternal injection of procaine, which ended fatally, is recorded.

The effect of similar injections in experimental animals is considered, and the reaction of the vital centres is discussed.
BENZEDRINE, CORAMINE AND PICROTOXIN
Authors: THOMAS D. VERNON
Published: February 2007

A comparative clinical study has been made of the efficiency of benzedrine, coramine and picrotoxin in reducing the period of unconsciousness following intravenous thiopentone anæsthesia in 48 cases.

The mean recovery times after each analeptic drug were less than the corresponding times for the control group.

Picrotoxin was the most, and coramine the least, effective drug.

I am indebted to Dr. N. J. S. Nathan, Medical Superintendent at Staincliffe County Hospital, for helpful co‐operation.
The role of the neurologist in the decline of stroke
Authors: Whisnant Jack P.
Published: February 2007

Mortality from stroke in the United States has been declining since 1900. In the population of Rochester, Minnesota the primary cause of the decline was shown to be the decrease in the incidence of new cases of stroke from 1945 through 1979. The neurologist's primary contribution to stroke prevention is the identification and management of patients who have had transient focal cerebral ischemic attacks. Although the presence of these attacks is a powerful risk for stroke occurrence, their low prevalence and the lack of clearly effective medical or surgical treatment make it unlikely that management of transient focal cerebral ischemic attacks accounts for much of the decline in the incidence or mortality of stroke.
Polyneuropathy in nonmalignant IgM plasma cell dyscrasia: A Morphological study
Authors: Nemni Rafaello , Galassi Giuliana , Latov Norman , Sherman William H. , Olarte Marcelo R. , Hays Arthur P.
Published: February 2007

Six patients had peripheral neuropathy and nonmalignant IgM plasma cell dyscrasia. In two of them, immunological studies indicated that the monoclonal immunoglobulin reacted with myelin‐associated glycoprotein, a constituent of peripheral nerve myelin. Sural nerve biopsy specimens from both patients showed morphological signs of primary damage to the myelin sheath. In the other four patients, two of whom had a monoclonal IgMk reactive with chondroitin sulfate C, the axon rather than the myelin sheath was considered the chief site of nerve injury. The morphological findings suggest that the pathogenesis of peripheral neuropathies in IgM plasma cell dyscrasia is heterogeneous. Moreover, the observations are consistent with a pathogenic interaction of the IgM paraprotein with autoantigens in peripheral nerve in some instances.
Herpes zoster ophthalmicus with contralateral hemiplegia: Identification of cause
Authors: Doyle Patrick W. , Gibson Gillian , Dolman Clarisse L.
Published: February 2007

A patient with herpes zoster ophthalmicus developed hemiparesis that at first responded to steroids but, when these were reduced, culminated in massive cerebral infarction and death. The cause was an extensive necrotizing arteritis of large and small cerebral arteries. Herpeslike virions were identified in smooth muscle cells of the middle cerebral artery.
Doppler ultrasonography in the determination of neonatal brain death
Authors: McMenamin Joseph B. , Volpe Joseph J.
Published: February 2007

Both clinical and electroencephalographic criteria for brain death have limited value in the newborn. A simple test to determine the cessation of cerebral blood flow would be a useful adjunct to the determination of brain death in this population. In contrast to the invasive techniques used in older patients to estimate cerebral blood flow, the Doppler technique to estimate cerebral blood flow velocity from the anterior fontanelle of the newborn is noninvasive and can be used at bedside. In this study we define the changes in the flow velocity pattern in the anterior cerebral and the common carotid arteries in six newborn infants with clinical criteria for brain death: coma, absent brainstem function, and dependence on mechanical ventilation. A characteristic sequence of deterioration of the flow velocity waveform in both vessels was defined. This sequence consisted of (1) loss of diastolic flow, (2) appearance of retrograde flow during diastole, (3) diminution in systolic flow in the anterior cerebral artery, and, ultimately, (4) no detectable flow in the anterior cerebral artery, despite considerable flow in the common carotid artery. This constellation of findings suggests a progressive increase in cerebrovascular resistance and a progressive decrease in cerebral perfusion, compatible with the diffuse cerebral necrosis and edema documented postmortem. We conclude that the transcutaneous Doppler technique is a useful complement to other noninvasive methods, especially clinical assessment, in the determination of brain death in the newborn.
Postoperative jaundice in children
Authors: WARK H. J.
Published: February 2007

At the Hospital for Sick Children, Great Ormond Street, during the 23‐year period 1957 to 1979, 165400 anaesthetics were administered. Almost all of the patients anaesthetised during this time would have been exposed to halothane. Seventy‐four patients became jaundiced for the first time in the postoperative period. Halothane‐associated hepatitis was excluded as the cause of the postoperative jaundice in all but two of the 74 patients. In these two patients in whom the diagnosis of halothane‐associated hepatitis was possible the hepatitic illness was mild and both patients made an uneventful recovery. In this survey the risk of a patient becoming jaundiced due to halothane associated hepatitis was greater than I in 82000. It would seem that in children halothane can be used whenever it is warranted and can be used repeatedly.
Endothelin receptor B2 (EDNRB2) is associated with the panda plumage colour mutation in Japanese quail
Authors: Miwa M. , Inoue‐Murayama M. , Aoki H. , Kunisada T. , Hiragaki T. , Mizutani M. , Ito S.
Published: February 2007

The panda mutant in Japanese quail (Coturnix japonica) displays spots of wild‐type plumage on a white background and is controlled by an autosomal recessive allele (s). The dotted white is controlled by a third allele (sdw) of the s locus with sdw/sdw quail having less pigmentation than s/s quail. We mapped the s locus to the Japanese quail chromosome 4 (CJA04) in a previous study. The orthologous region of the chicken (Gallus gallus) genome includes endothelin receptor B2 (EDNRB2), an avian‐specific paralog of endothelin receptor B (EDNRB). EDNRB mutations in mammals retard the migration of neural crest cells (NCCs), which results in a spotted coat colour and an enteric nervous defect. In the present study, we investigated the association between the s locus and EDNRB2 in Japanese quail. Sequence comparison among transcripts from livers of wild‐type, panda and dotted white quail revealed a nucleotide substitution (c.995G>A) leading to a p.R332H amino acid change that was specific to panda, whereas no amino acid substitution was found in dotted white birds. The amino acid position 332 is located in the sixth transmembrane domain and is highly conserved in both avian and mammalian endothelin receptors. The A allele at nucleotide position 995 was specific to panda (s/s) birds among 10 strains, and was mapped to the same chromosomal region as the s locus. Quantitative RT‐PCR revealed that EDNRB2 transcripts were reduced in both panda and dotted white mutants compared with wild‐type. However, there was no difference between the early embryos of wild‐type and panda with respect to the migration of NCCs. The genetic association of EDNRB2 with plumage colour in birds was found for the first time in this study.
Post‐glacial migration of silver fir (Abies albaMill.) in the south‐western Alps
Authors: Muller Serge D. , Nakagawa Takeshi , De Beaulieu Jacques‐Louis , Court‐Picon Mona , Carcaillet Christopher , Miramont Cécile , Roiron Paul , Boutterin Clément , Ali Adam A. , Bruneton Hélène
Published: February 2007

Aim Previous studies have failed to reconstruct the regional post‐glacial migration pattern ofAbies albain southern France. Based on the first exhaustive compilation of palaeoecological data in this region, we present the state‐of‐the‐art and attempt to synthesize the available information concerning glacial refugia and post‐glacial migration, and analyse the information with regard to climate and orography.

Location South‐western Alps and adjacent areas, southern France.

Methods The work compiles the available palaeoecological data in the south‐western Alps (52 sites, 290 radiocarbon dates). The post‐glacial migration pattern ofAbies albais reconstructed based on 22 selected palynological analyses (11 well‐dated reference sites and 11 supplementary ones).

Results The geographical patterns of approaching area limit, immigration and expansion are reconstructed at the scale of the southern French Alps.

Main conclusions Despite previous assertions, the evidence of refugia in southern France is non‐existent. The late‐glacial records of fir pollen, previously interpreted in French Mediterranean regions and on adjacent foot‐hills as possibly reflecting regional refugia, most probably correspond to reworking phenomena or long‐distance pollen transport. Fir migration, originating in the Apennine refugia and through the south‐western extremity of the Alps, was extremely rapid in the southern French Alps, only spanning a few centuries between 10,100 and 9800 cal. yrbp. The subsequent spread of fir populations was controlled by local parameters, such as the aridity of the inner valleys, which resulted in a delayed expansion in comparison to other regions.Abiesalmost disappeared from the south‐western Alps during the Roman era, around 2000 cal. yrbp.
The distribution of genetic variation in Norway spruce (Picea abies Karst.) populations in the western Alps
Authors: Meloni Marilena , Perini Davide , Binelli Giorgio
Published: February 2007

Aim  In order to look for a possible centre of survival for the Norway spruce (Picea abies Karst.) in the south‐western Alps, six natural populations of this area were investigated by means of genetic markers in order to assess the degree and the distribution of genetic diversity within the species.

Location  Western and South‐western Alps.

Methods  Populations were genotyped using seven simple sequence repeat (SSR) markers. Basic population genetics parameters were estimated and the amount of genetic differentiation calculated.

Results  A large amount of variability was found (0.59 < He < 0.67); genetic differentiation as measured by FST was 0.05, close to other similar studies; no isolation by distance was detected by a Mantel test. Analysis of molecular variance confirmed a high degree of variability within populations and a low degree of variability among populations. Finally, the number of populations from which those observed could have arisen was estimated by Bayesian analysis.

Main conclusions  The results presented here suggest that the present populations derive their genetic make‐up from three inferred clusters. The possible existence in this area of a relict/refuge population during the last glaciation is discussed.
Competence of Romanian nurses after their first six months in Italy: a descriptive study
Authors: Palese Alvisa , Barba Maria , Borghi Gianni , Mesaglio Maura , Brusaferro Silvio
Published: February 2007

Aims and objectives.  Aims of this study were to describe (a) the Romanian nurses’ reasons for emigration and the difficulties experienced in the first six months of integration, (b) their perception of the level of professional independence and competence gained in the first six months of working and (c) the strategies that either facilitated or impeded their development of professional independence at a teaching hospital.

Background.  The international recruitment of nursing staff is a strategy adopted by the Italian State to confront nursing shortages. Although the critical aspects and the opportunities available have been reported for many years, little has been written about the professional autonomy perceived by these nurses six months after their placement in the host country.

Design.  A descriptive study involving Romanian nurses working at the Udine University Training Hospital (Italy) was used.

Methods.  The participants were interviewed using anonymous questionnaires, which contained eight open and 20 closed questions. With their consent, the interview was done in the ward and took on average 45 minutes (from 30–60 minutes). Given a choice of language to use by the bilingual researcher, half the participants chose Romanian.

Results.  The small, homogenous group of Romanian nurses used as the sample and employed at the University Training Hospital, felt satisfied (in the areas of culture/placement/integration) and recorded similar facilitating factors and obstacles as those documented by other authors. By the sixth month following placement they felt they had a sufficient level of autonomy, but this was not the case in many skills, which are an essential part of Italian nursing.

Conclusions.  The expectations of the hospitals involved in international recruitment are higher than the Romanian nurses can guarantee, especially in the first six months. Integration obviously needs substantial investment, less ‘red‐tape’ and a longer period of time for adjustment.

Relevance to clinical pratice.  It is necessary to help and support the placement of these nurses into the Italian workforce with programmes where their practical work is supervised by permanent trained staff, allowing them to develop autonomy and ensuring an optimal standard of nursing care for the patients. It would be necessary to continue these programmes for more than six months.
School’s Out: pathways for young people with intellectual disabilities from out‐of‐area residential schools or colleges
Authors: Heslop P. , Abbott D.
Published: February 2007

Background  Previous research, and official guidance, has suggested that planning for the transition between children’s and adults’ services is failing young people with intellectual disabilities and their families in the UK. Youngsters placed away from home in residential schools or colleges are likely to be at even greater risk of poor transition planning and outcomes, yet there is little understanding of what factors parents consider contribute to a smoother transition and what a satisfactory outcome would be.

Method  The parents of 15 young people from five areas of the UK were interviewed about what they thought contributed to a satisfactory pathway for their son or daughter from an out‐of‐area residential school or college on to the next phase of their life.

Results  Parents identified four main process issues: being well‐connected with other parents or with key professionals; being proactive; having sufficient information; and good forward planning. Most considered a good outcome to be if the young person was happy, fulfilled and stimulated.

Conclusions  Parents were clear about what they thought helped, and there was little disagreement between their views. While some of these factors have been previously identified regarding the transition of disabled youngsters, they raise some unique issues for families with a youngster educated in an out‐of‐area residential school or college.
Fifteen‐year follow‐up of 92 hospitalized adults with Down’s syndrome: incidence of cognitive decline, its relationship to age and neuropathology
Authors: Margallo‐Lana M. L. , Moore P. B. , Kay D. W. K. , Perry R. H. , Reid B. E. , Berney T. P. , Tyrer S. P.
Published: February 2007

Background  The clinical and neuropathological features associated with dementia in Down’s syndrome (DS) are not well established.

Aims  To examine clinico‐pathological correlations and the incidence of cognitive decline in a cohort of adults with DS.

Method  A total of 92 hospitalized persons with DS were followed up from 1985 to December 2000. At outset, 87 participants were dementia‐free, with a median age of 38 years. Assessments included the Prudhoe Cognitive Function Test (PCFT) and the Adaptive Behavior Scale (ABS), to measure cognitive and behavioural deterioration. Dementia was diagnosed from case records and caregivers’ reports.

Results  Eighteen (21%) patients developed dementia during follow‐up, with a median age of onset 55.5 years (range 45–74). The PCFT demonstrated cognitive decline among those with a less severe intellectual disability (mild and moderate) but not among the profoundly disabled people (severe and profound). Clinical dementia was associated with neuropathological features of Alzheimer’s disease, and correlated with neocortical neurofibrillary tangle densities. At the age of 60 years and above, a little more than 50% of patients still alive had clinical evidence of dementia.

Conclusions  Clinical dementia associated with measurable cognitive and functional decline is frequent in people with DS after middle age, and can be readily diagnosed among less severely intellectually disabled persons using measures of cognitive function such as the PCFT and behavioural scales such as the ABS. In the more profoundly disabled people, the diagnosis of dementia is facilitated by the use of behavioural and neurological criteria. In this study, the largest prospective DS series including neuropathology on deceased patients, the density of neurofibrillary tangles related more closely to the dementia of DS than senile plaques. In people with DS surviving to middle and old age, the development of dementia of Alzheimer type is frequent but not inevitable, and some people with DS reach old age without clinical features of dementia.
Correlations between incisor and condylar movements during lateral excursion in children with primary dentition
Authors: SAITOH I. , TOKUTOMI J. , HAYASAKI H. , IWASE Y. , RAOQUIG H. , YAMASAKI Y. , NONAKA K.
Published: February 2007

Summary  The purpose of this study was to look for associations between lower incisor movement and working and balancing condylar movement during lateral excursion in children with primary dentition and adults with permanent dentition. Mandibular movement was recorded using a TRI‐MET (an optoelectronic analysis system with six degrees‐of‐freedom) at a sampling frequency of 100 Hz. The movement data was transferred to a graphics workstation for analysis. Subjects were categorized by age into two groups. The primary dentition group consisted of 19 children (mean age: 5 years and 5 months, s.d.: 8·7 months), and the permanent dentition group consisted of 22 women (mean age: 20 years and 5 months, s.d.: 26·3 months). The occlusion and TMJ in both groups were normal, with no history of orthodontic treatment. Three orthogonal excursive ranges and the 3D linear distance of the incisal and balancing and working condylar points, along with inter‐ and intra‐individual correlations between the incisor and the balancing and working condyles during lateral excursion, were estimated by using multilevel statistical models. Lateral excursion in children with primary dentition was characterized by smaller incisor excursive ranges and 3D linear distance than in adults, and stronger inter‐ and intra‐individual correlations between incisor and balancing condylar movements than in adults. In both children and adults the lateral excursion of the incisor was a good indicator of the extent of balancing condylar movement, but not working condylar movement.
The nature of the outflow in gamma-ray bursts
Authors: Kumar P. , McMahon E. , Panaitescu A. , Willingale R. , O'Brien P. , Burrows D. , Cummings J. , Gehrels N. , Holland S. , Pandey S. B. , Vanden Berk D. , Zane S.
Published: February 2007

The Swift satellite has enabled us to follow the evolution of gamma-ray burst (GRB) fireballs from the prompt γ-ray emission to the afterglow phase. The early-time X-ray and optical data for GRBs obtained by telescopes aboard the Swift satellite show that the source for prompt γ-ray emission, the emission that heralds these bursts, is short lived, and is distinct from the source for the long-lived afterglow emission that follows the initial burst. Using these data we determine the distance of the γ-ray source from the centre of the explosion. We find this distance to be 1015–1016 cm for most bursts, and show that this is within a factor of about 10 of the radius of the shock heated circumstellar medium (CSM) producing the X-ray photons. Furthermore, using the early γ-ray, X-ray and optical data we show that the prompt gamma-ray emission cannot be produced in internal shocks nor can it be produced in the external shock; in a more general sense γ-ray generation mechanisms based on shock physics have problems explaining the GRB data for ten Swift bursts analyzed in this work. A magnetic field dominated outflow model for GRBs has a number of attractive features, although evidence in its favour is inconclusive. Finally, the X-ray and optical data allow us to provide an upper limit on the density of the CSM of about 10 protons cm−3 at a distance of ∼5 × 1016 cm from the centre of explosion.
Multiple rapid swallowing in idiopathic achalasia: evidence for patients’ heterogeneity*
Authors: Savojardo D. , Mangano M. , Cantù P. , Penagini R.
Published: February 2007

Abstract  In order to evaluate the function of inhibitory neural pathways in achalasia, we compared the response of the oesophageal body and lower oesophageal sphincter (LOS) to single swallows (SS) and multiple rapid swallowing (MRS) in 20 consecutive patients with untreated idiopathic achalasia (10 men, aged 23–81 years) and in 20 control patients without dysphagia (nine men, aged 31–73 years), using sleeve manometry; 277 SS and 85 MRS were analysed. In the control group, MRS inhibited motor activity in the oesophageal body and induced a slightly lower (P < 0.05) nadir LOS pressure compared with SS. In the achalasia patients, MRS induced a variable response: eight patients had simultaneous motor activity during all MRS although onset was delayed compared with SS [median (interquartile range), 3.5 s (1.7–6.1) vs 1.4 s (0.8–3.9); P < 0.05], whereas eight patients showed motor inhibition which occurred during all MRS in four of them, and the remaining four had no motor activity both after SS and during MRS. Overall MRS did not decrease nadir LOS pressure compared with SS [12 mmHg (5–20) vs 16 mmHg (7–22); P > 0.1]; however, it induced complete LOS relaxation in three of the patients. MRS gives further evidence of functional heterogeneity among achalasia patients.
Identification of a novel HLA‐DPB1 allele (DPB1*1902) by haplotype‐specific extraction and nucleotide sequencing†
Authors: Dapprich J. , Magira E. , Samonte M. A. , Rosenman K. , Monos D.
Published: February 2007

The DPB1*1902 allele resulted from a single‐nucleotide substitution at codon 35 (TTC → CTC/F → L) of exon 2 of DPB1*0402 or 0602.
Research on HLA‐G: an update†
Authors: Favier B. , LeMaoult J. , Rouas‐Freiss N. , Moreau P. , Menier C. , Carosella E. D.
Published: February 2007

Human leukocyte antigen (HLA)‐G is a nonclassical HLA class I molecule from the major histocompatibility complex, which was initially shown to confer protection to the fetus from her mother’s immune system. The Third International Conference on HLA‐G, held in 2003, showed that beyond its role in fetal–maternal tolerance, HLA‐G exerts tolerogenic functions involved in transplant acceptance as well as in tumoral and viral immune escape. The Fourth International Conference, which took place in Paris on July 2006, counted 72 oral presentations and about 200 attendees from 25 countries. The reports presented brought new insight into HLA‐G research, and we summarize here the major advances on the HLA‐G biology that were reported. Abstracts for all presentations can be found in volume 68 issue number 4 of Tissue Antigens.
Analysis of KIR gene frequencies in HLA class I characterised bladder, colorectal and laryngeal tumours
Authors: Middleton D. , Vilchez J. R. , Cabrera T. , Meenagh A. , Williams F. , Halfpenny I. , Maleno I. , Ruiz‐Cabello F. , Lopez‐Nevot M. A. , Garrido F.
Published: February 2007

Three cohorts of patients with laryngeal, bladder or colorectal tumours were investigated for frequency of killer immunoglobulin‐like receptor (KIR) genes compared with a normal control population. The frequency of KIR3DL1 and KIR2DS4 was significantly increased (but not after correction for number of comparisons made) in patients with bladder tumour compared with controls. No other significant differences were found in gene frequencies or in the frequencies of those KIR genes with and without their human leucocyte antigen (HLA) ligands. Furthermore, no significant differences were found in KIR gene frequencies, taking into consideration the type of loss of HLA expression in the individual tumours. Finally, in the group of colorectal carcinomas, there was an overall significant difference in the frequencies of C group heterozygosity and homozygosity with HLA alterations on the tumour.
Analysis of the BTNL2 truncating splice site mutation in tuberculosis, leprosy and Crohn’s disease
Authors: Johnson C. M. , Traherne J. A. , Jamieson S. E. , Tremelling M. , Bingham S. , Parkes M. , Blackwell J. M. , Trowsdale J.
Published: February 2007

The region on chromosome 6 encoding the major histocompatibility complex (MHC) is associated with a number of autoimmune and infectious diseases. Primary susceptibility to many of these has been localized to a region containing the human leukocyte antigen (HLA)‐DR and ‐DQ genes. A recent study of sarcoidosis has provided evidence of an independent effect, associated with a truncating single nucleotide polymorphism (SNP) of a nearby gene, BTNL2. This gene may encode an immune receptor involved in costimulation. Sarcoidosis, tuberculoid leprosy, tuberculosis (TB) and Crohn’s disease all have similar immunological features, including a Th1 response with granuloma formation. In addition mycobacteria have been identified or suggested to be causative pathogens in such conditions. We genotyped the truncating BTNL2 SNP in 92 TB and 72 leprosy families from Brazil and carried out family‐based association studies. We could not find evidence of overtransmission of the truncating allele in TB. There was an association with susceptibility to leprosy (P = 0.04), however, this is most likely due to linkage disequilibrium with HLA‐DR. We also genotyped 476 UK Caucasian cases of Crohn’s disease with 760 geographically matched controls and found no evidence of a disease association. We conclude that the truncating BTNL2 SNP is not important in this group of Th1 dominated granulomatous diseases.
Association of CD22 gene polymorphism with susceptibility to limited cutaneous systemic sclerosis
Authors: Hitomi Y. , Tsuchiya N. , Hasegawa M. , Fujimoto M. , Takehara K. , Tokunaga K. , Sato S.
Published: February 2007

Activating and inhibitory signal transducers, CD19 and CD22, have been substantially implicated both in human systemic sclerosis (SSc) and tight‐skin mouse, a model for SSc. We previously showed that a single nucleotide polymorphism (SNP) in CD19 promoter region was significantly associated with increased CD19 expression level and with susceptibility to SSc. In the present study, we examined whether CD22 polymorphisms were associated with susceptibility to SSc. CD22 variations were genotyped in 126 Japanese patients with SSc [47 diffuse cutaneous SSc and 79 limited cutaneous SSc (lcSSc)] and 93 unrelated healthy controls. At the c.2304C > A SNP coding for a synonymous substitution in exon 13, A/A genotype was observed in six patients with SSc (4.8 %) but none in the controls (P = 0.040). All six patients with A/A genotype belonged to the lcSSc subgroup (7.6%, P = 0.008 vs controls). Surface expression level of CD22 tended to be lower in B cells from the patients with A/A genotype (n = 5) as compared with C/A (n = 7) or C/C (n = 14) genotype (17% decrease, P = 0.0032). Taken together with our previous observation on CD19 polymorphism, intrinsic difference in the expression level of CD19 and CD22 was suggested to play a causative role in a proportion of patients with lcSSc.
Effect of changing the age criteria for blood donors
Authors: Goldman M. , Fournier E. , Cameron‐Choi K. , Steed T.
Published: February 2007

Background and Objectives  The upper age limit for allogeneic blood donation varies among countries and blood operators. We assessed the impact of the removal of the upper age limit for donation in Canada from December 2004 to January 2006.

Materials and Methods  Starting in December 2004, regular donors were permitted to continue whole blood or apheresis donation past their 71st birthday, provided an annual external medical assessment was performed by their family physician. Regular donors aged from 70 to 74 were sent a letter about the change in criteria, and encouraged to continue donations. Rates of donor adverse reactions and deferrals were calculated for these donors and donors in other age groups.

Results  In the 13‐month period following implementation of the new criteria, 961 (54%) of regular donors who had received a letter initiated a medical inquiry, and 862 inquiries were completed and returned to Canadian Blood Services. In 98% of cases, the donors’ family physician approved ongoing donation. Of the 659 donors who presented to donate, 93% successfully donated. There was only one moderate/severe donor reaction out of 3137 donor attendances for donors aged 71 and older. This rate was not statistically different from the rate in the overall donor population. No donors were deferred for high‐risk activities or had positive infectious disease test results.

Conclusion  Regular blood donors may safely continue to donate past their 71st birthday. Extra steps in the donation process, such as an external medical inquiry, may not be necessary.
Application of neem seed kernel extracts result in mouthpart deformities and subsequent mortality in Nezara viridula (L.) (Hem: Pentatomidae)
Authors: Singha A. , Thareja V. , Singh A. K.
Published: February 2007

Abstract:  The effect of topical application of neem seed kernel aqueous suspension (NSKAS) and neem seed kernel hexane extract (NSKHE) on 2‐day‐old fourth instar nymphs of Nezara viridula (L.) was studied under laboratory conditions. The applications resulted in loosening of the proboscis, along with separation and deformation of mouthparts, predominantly in the stylets in fifth instar nymphs, adults and in inter‐stadial moults. This rendered the insects incapable of feeding and led them to death. Application of NSKAS at 2.5% concentration led to 100% mortality, of which 40% was due to mouthpart deformities. Application of NSKHE at 2.5% concentration led to only 70% mortality, of which 3.33% was due to mouthpart deformities. At 5% concentration, mortality was again 100% for NSKAS and reached close to 100% for the NSKHE application. Dose‐dependent mortality was observed for both the applications. However, dose‐dependent mouthpart deformities were observed only for NSKAS, the highest being 60% at the 5% concentration. Moreover, for both the applications, more than 50% of the total mortality was observed up to the fifth instar at almost all the concentrations. The LC50 values for NSKAS and NSKHE applications, for mortality up to the fifth instar were 0.36% and 5.22%, and for mortality to the adult stage (10 days old) they were 0.23% and 1.32% respectively. The percentage of bugs showing mouthpart deformities and toxicity was higher for NSKAS than NSKHE, and indicated that NSKAS was more potent than NSKHE.