bluuebunny/crossref_metadata_2025 huggingface dataset:
Performance of the Hail Differential Reflectivity (HDR) Polarimetric Radar Hail Indicator
Authors: Depue Tracy K. , Kennedy Patrick C. , Rutledge Steven A.
Published: August 2007

A series of poststorm surveys were conducted in the wake of hailstorms observed by the Colorado State University–University of Chicago–Illinois State Water Survey (CSU-CHILL) S-Band polarimetric radar. Information on hail characteristics (maximum diameter, building damage, apparent hailstone density, etc.) was solicited from the general-public storm observers that were contacted during the surveys; the locations of their observations were determined using GPS equipment. Low-elevation angle radar measurements of reflectivity, differential reflectivity ZDR, and linear depolarization ratio (LDR) were interpolated to the ground-observer locations. Relationships between the hail differential reflectivity parameter HDR and the observer-reported hail characteristics were examined. It was found that HDR thresholds of 21 and 30 dB were reasonably successful (critical success index values of ∼0.77) in respectively identifying regions where large (>19 mm in diameter) and structurally damaging hail were observed. The LDR characteristics in the observed hail areas were also examined. Because of sensitivities to variations in the hailstone bulk ice density, degree of surface wetness, and shape irregularities, the basic correlation between LDR magnitude and hail diameter was poor. However, when the reported hail diameters exceeded ∼25 mm, LDR levels below ∼−24 dB were uncommon.
Long-Range Transport of Anthropogenically and Naturally Produced Particulate Matter in the Mediterranean and North Atlantic: Current State of Knowledge
Authors: Kallos George , Astitha Marina , Katsafados Petros , Spyrou Chris
Published: August 2007

During the past 20 years, organized experimental campaigns as well as continuous development and implementation of air-pollution modeling have led to significant gains in the understanding of the paths and scales of pollutant transport and transformation in the greater Mediterranean region (GMR). The work presented in this paper has two major objectives: 1) to summarize the existing knowledge on the transport paths of particulate matter (PM) in the GMR and 2) to illustrate some new findings related to the transport and transformation properties of PM in the GMR. Findings from previous studies indicate that anthropogenically produced air pollutants from European sources can be transported over long distances, reaching Africa, the Atlantic Ocean, and North America. The PM of natural origin, like Saharan dust, can be transported toward the Atlantic Ocean and North America mostly during the warm period of the year. Recent model simulations and studies in the area indicate that specific long-range transport patterns of aerosols, such as the transport from Asia and the Indian Ocean, central Africa, or America, have negligible or at best limited contribution to air-quality degradation in the GMR when compared with the other sources. Also, new findings from this work suggest that the imposed European Union limits on PM cannot be applicable for southern Europe unless the origin (natural or anthropogenic) of the PM is taken into account. The impacts of high PM levels in the GMR are not limited only to air quality, but also include serious implications for the water budget and the regional climate. These are issues that require extensive investigation because the processes involved are complex, and further model development is needed to include the relevant physicochemical processes properly.
Examining Photolysis Rates with a Prototype Online Photolysis Module in CMAQ
Authors: Binkowski Francis S. , Arunachalam Saravanan , Adelman Zachariah , Pinto Joseph P.
Published: August 2007

A prototype online photolysis module has been developed for the Community Multiscale Air Quality (CMAQ) modeling system. The module calculates actinic fluxes and photolysis rates (j values) at every vertical level in each of seven wavelength intervals from 291 to 850 nm, as well as the total surface irradiance and aerosol optical depth within each interval. The module incorporates updated opacity at each time step, based on changes in local ozone, nitrogen dioxide, and particle concentrations. The module is computationally efficient and requires less than 5% more central processing unit time than using the existing CMAQ “lookup” table method for calculating j values. The main focus of the work presented here is to describe the new online module as well as to highlight the differences between the effective cross sections from the lookup-table method currently being used and the updated effective cross sections from the new online approach. Comparisons of the vertical profiles for the photolysis rates for nitrogen dioxide (NO2) and ozone (O3) from the new online module with those using the effective cross sections from a standard CMAQ simulation show increases in the rates of both NO2 and O3 photolysis.
Multiview Cloud-Top Height and Wind Retrieval with Photogrammetric Methods: Application to Meteosat-8 HRV Observations
Authors: Seiz Gabriela , Tjemkes Stephen , Watts Philip
Published: August 2007

The European Organisation for the Exploitation of Meteorological Satellites (EUMETSAT) currently operates three geostationary satellites: Meteosat-5, Meteosat-7, and Meteosat-8. Observations by Meteosat-5 can be combined with observations from either Meteosat-7 or Meteosat-8 to allow geostationary stereo height retrievals within the overlap area over the Indian Ocean and east Africa. This paper aims to demonstrate the capabilities of the geostationary stereophotogrammetric cloud-top height retrieval—in particular, with the new high-resolution visible channel (HRV) of Meteosat-8. Conceived as a proof-of-concept study, the retrieval was limited to four distinct cloud areas in northeast Africa. The effects of the geolocation, spatial resolution, satellite position, and acquisition time on the cloud-top height accuracy were studied. It is demonstrated that the matching accuracy is sensitive to the acquisition-time difference and spatial resolution. As a result, there is only a marginal benefit from the good spatial resolution offered by the Meteosat-8 HRV channel because of the low spatial resolution of Meteosat-5 and the poor time synchronization between the observations of the two satellites. On the contrary, the good time synchronization between Meteosat-5 and Meteosat-7 observations offsets the errors in the height assignment resulting from the relatively coarse spatial resolution, if the geolocation accuracy is locally enhanced with additional landmarks from higher-resolution images. With the geolocation correction and the newly implemented time information in the Meteosat-5 and -7 header information, the stereo cloud-top height assignment for the Meteosat-5/-7 and Meteosat-5/-8 HRV combination resulted in about the same accuracy of approximately ±1 km. For the Meteosat-5/-8 HRV combination, the time differences of up to 7.5 min preclude higher accuracy. To validate the cloud-top heights, observations by the Multiangle Imaging Spectroradiometer (MISR) and Moderate Resolution Imaging Spectroradiometer (MODIS) were used.
The next stages in researching water fluoridation: Evaluation and surveillance
Authors: Downer Martin C , Blinkhorn Anthony S
Published: August 2007

Objective (1) to provide a commentary on a conference held at the University of Manchester entitled Researching Water Fluoridation: Evaluation and Surveillance; (2) to synthesize from the proceedings of the meeting suggestions for future research and public health surveillance. Method The main points and problematic issues raised by the speakers were documented and, together with information from other sources, used to construct an operational framework for the next stages in developing fluoridation research/ surveillance.

Results Critical areas were identified from the speakers' presentations and plenary discussions for which suggested ways forward were proposed. Important areas needing to be covered in future research/surveillance were then abstracted and tabulated. These included: participants, interventions, outcomes, sampling (sample frame and strategy), stratification, sample size, minimization of bias (blinding, examiner consistency), statistical methods, confounding variables, data requirements for ancillary analyses, and principal measurable adverse events.

Conclusions Covering the full range of criteria for comprehensive evaluation and surveillance would involve a number of complex, logistically demanding and costly procedures, including dietary intake monitoring and medical/dental clinical investigations. These would call for positive consent and compliance of target populations. It is suggested that a piecemeal research strategy, involving pilot studies and a series of separate, though probably linked, projects would be the optimum approach. The extent to which all the identified research/surveillance requirements could be met would depend on the availability of the necessary financial resources.
Does certificate of need really contain hospital costs in the United States?
Authors: Rivers Patrick A , Fottler Myron D , Younis Mustafa Zeedan
Published: August 2007

Objective This study examines the impact of certificate of need (CON) regulation on hospital costs.

Design A modified structure—conduct—performance paradigm was applied to a national sample of US hospitals in order to investigate the impact of CON regulation on hospital costs.

Methods Secondary data for 1957 US acute care hospitals in 301 standard metropolitan statistical areas (SMSAs) from the American Hospital Association's Annual Survey of Hospitals in 1991 were used. The dependent variable was hospital costs per adjusted admission in 1991. Predictor variables were the existence of a CON law in each hospital's state and the dollar limit (if any) required for CON approval. Control variables were environmental, market, and institutional characteristics. Associations between predictor and dependent variables were investigated using multiple regression analyses.

Results The results indicate that CON laws had a positive, statistically significant relationship to hospital costs per adjusted admission. Conclusion These findings suggest not only that CON do not really contain hospital costs, but may actually increase them by reducing competition. Implications for public policy are discussed.
Icebreaker: The evaluation
Authors: Peerbhoy Denise , Bourke Cathriona
Published: August 2007

Objective To document young people's and teachers' responses to Icebreaker, a Theatre in Education (TIE) performance exploring themes of sexual health and relationships, in relation to Healthy Arts' objectives.

Design Data reported here were part of a wider evaluation of a government funded scheme.

Setting Data was collected from nine schools across Liverpool (UK) for young people in year groups 8, 9 and 10.

Method Observation of 14 performances measuring success against specific criteria. Distribution of Health Development Agency questionnaires and bespoke questionnaires to obtain feedback on the performance.

Results The tour succeeded in engaging pupils, but did not always push reflection and learning around sexual and emotional health. This was due to time restrictions and other constraints of partnership working.

Conclusion The TIE performance presented a viable way for young people to explore sensitive issues, yet partnership working requires strengthening in order to maximize project impact. Evaluation was seen as significant in informing future practice.
An evaluation of a community health intervention programme aimed at improving health and wellbeing
Authors: Strachan G. , Wright G.D. , Hancock E.
Published: August 2007

Objective The objective of this evaluation was to examine the extent to which participants in the Tailor Made Leisure Package programme experienced any improvement in their health and wellbeing. Design A quantitative survey.

Setting The Healthy Living Centre initiative is an example of a community-based intervention which was formalized as part of the British government's health policy. The purpose of this initiative is to reduce inequalities in health and promote good health and wellbeing. The programme was offered by a Healthy Living Centre located in Scotland.

Method The benefits of the initiative were investigated through the use of a postal questionnaire which was used to examine the perceived benefits of the Tailor Made Leisure Package programme. This was distributed to a total of 177 people who had applied to take part in the programme during the period February 2004 to February 2005.

Results Of the 177 people surveyed 90 returned completed questionnaires giving a response rate of 51 per cent. Of these, 70 people started the programme. Those who started the programme took part in a variety of activities including the gym, GP Referral programme and complementary therapies. The reported benefits were that individuals felt fitter and healthier, they were taking part in additional leisure activities and that they were socializing more frequently. Those participants who had complementary therapy reported a relief of symptoms associated with their particular health condition. All of these benefits are important in the process of improving health and wellbeing. The 20 individuals who did not start their programme reported that personal circumstances, health reasons, transport problems, financial difficulties and the activities/programme being inappropriate were the main reasons for not starting the programme.

Conclusion The results of the evaluation suggest that an initiative such as this is worthwhile in promoting positive health and wellbeing.
An Assessment of Criminal Thinking Among Incarcerated Youths in Three States
Authors: Dembo Richard , Turner Charles W. , Jainchill Nancy
Published: August 2007

The Texas Christian University Criminal Thinking Scales (CTS) instrument has been shown to predict outcomes for institutionalized adult offenders. This article examines responses among male ( n = 151) and female ( n = 52) incarcerated adolescents, and they were compared to norms for incarcerated adult offenders. The results indicated that the adolescent sample had higher scores on four scales (Entitlement, Justification, Personal Irresponsibility, Power of Orientation) but not on Criminal Rationalization. Scores did not differ by gender or ethnicity of respondents. The results provide convergent validity indicating that the scores for adolescents were correlated with prior history of criminal behavior, substance use, family dysfunction, and Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition diagnoses of conduct disorder and oppositional defiant disorder. Thus, the CTS may provide useful diagnostic information to help identify youth with a constellation of problem behaviors that predict poor outcomes following incarceration. It also may prove helpful in accounting for individual variations in response to treatment for incarcerated adolescents who receive treatment during reentry back into the community.
Tempest in a TC
Authors: Saum Christine A. , O'Connell Daniel J. , Martin Steven S. , Hiller Matthew L. , Bacon Grant A. , Simpson D. Dwayne
Published: August 2007

Corrections officials frequently use private contractors to operate in-prison, therapeutic community (TC) treatment programs. However, the recurrent competitive bidding process inherent in state agencies contracting for services sometimes results in a treatment-provider change. Few studies have focused on whether this change leads to better or worse treatment motivation and engagement for clients and how it might be evaluated. Using data collected during the larger Criminal Justice Drug Abuse Treatment Studies Performance Indicators for Corrections study, quantitative assessments of client functioning were made at two points in time. Changing to new treatment providers in three in-prison TC treatment facilities caused significant disruptions, leading to decreased client—counselor rapport and peer support as well as lower levels of treatment readiness, participation, and satisfaction of clients. Qualitative client and staff interviews provided further insight relevant for correctional administrators and treatment providers who may be considering similar changes. General recommendations for provider transition planning are offered.
The Inmate Prerelease Assessment for Reentry Planning
Authors: Farabee David , Knight Kevin , Garner Bryan R. , Calhoun Stacy
Published: August 2007

The Inmate Prerelease Assessment (IPASS) was developed specifically as a measure of postrelease risk for prison-based treatment graduates. By taking into account historical drug use and criminal activity of inmates as well as their performance during prison-based treatment, the IPASS provides a “priority” score indicating the relative need for more (versus less) intensive treatment services on release. The present study used data from offenders paroling from prisons in a southwest ( N = 127) and midwest ( N = 75) state to examine the psychometric properties of the IPASS subscales. With regard to construct validity, psychometric properties ranged from good to excellent. The IPASS scales also showed strong internal consistency, with coefficient alphas greater than .80 for the Texas Christian University Drug Screen, Client Evaluation of Treatment, and Counselor Evaluation of Client scales. Further research will explore alternatives on how the Client and Counselor scales are optimally incorporated into the IPASS priority score and will examine the score in relation to aftercare participation and postrelease outcomes.
Screening, Assessment, and Referral Practices in Adult Correctional Settings
Authors: Taxman Faye S. , Cropsey Karen L. , Young Douglas W. , Wexler Harry
Published: August 2007

The use of screening and assessment tools to gauge substance abuse disorders and the risk for recidivism are two widely recommended practices. A national survey of adult prisons, jails, and community correctional agencies was conducted to examine the practices used to place offenders in appropriate treatment services. Study findings indicate that 58.2% of the surveyed respondents report the use of a standardized substance abuse-screening tool, and that 34.2% use an actuarial risk tool. The provision of higher intensity treatment programs, the use of standardized risk tools, and the provision of more community referral services were all independently associated with the use of a standardized substance abuse-screening tool. Because practices vary considerably, agencies desiring to improve correctional programming should consider different dissemination, implementation, and technology transfer strategies.
A Tale of Two Communication Modes
Authors: Berger Charles R.
Published: August 2007

Cognitive-experiential self-theory proposes that individuals use two systems to process information, a highly conscious and analytical rational system and a preconscious, intuitive experiential system. These two systems operate in parallel and synchronistically but sometimes one may dominate the other. Findings from several experiments demonstrate that when information about threatening phenomena are presented in statistical or graphical form and require cognitive judgments, the rational system exerts primary influence in determining the nature of the judgment. Those who are skilled at and favor analytical thinking tend to minimize the seriousness of the threat. When exposed to emotionally evocative, anecdotal accounts of threatening events, both experientiality and rationality are related to the amount of apprehension individuals report. The experiential system may act to promote greater apprehension among highly rational individuals while at the same time dampen apprehension among low rationals.
Conversational Expectations as a Basis for Order Effects in Persuasion
Authors: Igou Eric R. , Bless Herbert
Published: August 2007

The current study demonstrates the role of conversational processes in order effects in persuasive communications. Conversational rules guide individuals' expectations about the position of the most important arguments within a persuasive message. We argue that these expectations contribute to the influence of arguments on attitude change, that is, if the important arguments are expected at a certain position, they become more influential than the other arguments of the persuasive message. In the current study, we presented participants with a persuasive message in which the order of arguments was experimentally manipulated. An order effect occurred when the conversational expectation regarding the order of arguments was applicable. However, no reliable order effect was observed when the conversational expectation was discredited. Importantly, consistent with the explanation of conversational order effects, the interactive effects of argument order and conversational expectation on the attitude was mediated by the perceived importance of the arguments.
Emotional Expression Online
Authors: Provine Robert R. , Spencer Robert J. , Mandell Darcy L.
Published: August 2007

Laughter “punctuates” speech, occurring during pauses, at phrase boundaries, and before and after statements and questions—the places where punctuation would be placed in a transcript of a conversation. Such punctuation indicates that language is dominant over laughter in competition for the vocal tract because laughter seldom interrupts spoken phrases. The punctuation effect is shown here to extend to emoticon placement in website text messages, a nonvocal linguistic medium. As in earlier studies of speaking and manual signing, the phrase structure of language was preserved, indicating the regulation of emotional expression by a common, higher-order linguistic process.
Defining Acute Renal Failure: The RIFLE Criteria
Authors: Venkataraman Ramesh , Kellum John A.
Published: August 2007

Acute renal failure is common among critically ill patients and carries significant morbidity and mortality. The reported incidence and the attributed morbidity and mortality of acute renal failure vary widely, largely owing to the use of a wide variety of definitions for acute renal failure. Until recently, no consensus existed about how to best define, characterize, and study acute renal failure. This lack of a standard definition has been a major impediment to the progress of clinical and basic research in this field. This review outlines some of the physiologic principles that may help us better understand and define acute renal failure and describes the RIFLE criteria (an acronym comprising Risk, Injury, and Failure; and Loss, and End-stage kidney disease), a recent consensus method of defining and stratifying acute renal failure. Also discussed are many of the challenges and controversies associated with achieving consensus and developing a classification for acute renal dysfunction.
Lumbar Puncture and Brain Herniation in Acute Bacterial Meningitis: A Review
Authors: Joffe Ari R.
Published: August 2007

There has been controversy regarding the risk of cerebral herniation caused by a lumbar puncture (LP) in acute bacterial meningitis (ABM). This review discusses in detail the issues involved in this controversy. Cerebral herniation occurs in about 5% of patients with ABM, accounting for about 30% of the mortality. In many reports, LP is temporally strongly associated with this event of herniation and is most likely causative based on pathophysiologic arguments. Although a computed tomography (CT) scan of the head is useful to find contraindications to an LP, a normal CT scan in ABM does not mean that an LP is safe. Clinical signs of “impending” herniation are the best predictors of when to delay an LP because of the risk of precipitating herniation, even with a normal CT scan. Some of these clinical signs to be considered are deteriorating level of consciousness (particularly to a Glasgow Coma Scale of ≤ 11), brainstem signs (including pupillary changes, posturing, or irregular respirations), and a very recent seizure. The risk of not doing an LP when it is contraindicated because of concern of the risk of herniation is extremely small. In those considered high risk for herniation, interventions to control intracranial pressure, such as attention to airway, breathing, and circulation, with a mannitol infusion and antibiotics started, should be the priorities, followed by an urgent CT scan and not an LP.
Complications of Emergency Tracheal Intubation: Immediate Airway-related Consequences: Part II
Authors: Mort Thomas C.
Published: August 2007

Airway management in the stable, elective operating room patient is typically exceptionally safe. Conversely, the acute deterioration of an intensive care unit or floor patient being rescued by a clinician unfamiliar with the patient's past and current history combined with an incomplete physical examination places the critically ill patient in a precarious, potentially life-threatening position. Emergency airway management in remote locations outside the confines of the operating room is complex and stressful due to immense airway challenges coupled with the high risk of hemodynamic and airway complications. Despite the commonality of difficulties with mask ventilation, laryngoscopy, and tracheal intubation in this population, relatively sparse literature deals with these subjects. Consequences of airway management should be openly discussed as a first step toward improving airway safety. This is the second of 2 reviews, “Complications of Emergency Tracheal Intubation,” and focuses on the immediate airway-related consequences during emergency tracheal intubation in the remote location.
Vasopressin Dysregulation and Hyponatremia in Hospitalized Patients
Authors: Multz Alan S.
Published: August 2007

Hyponatremia, which is often due to dysregulation of arginine vasopressin, occurs frequently in hospitalized patients and is associated with increased morbidity and mortality. Nonosmotic secretion of arginine vasopressin is central to the pathophysiology of hyponatremia in patients with euvolemic hyponatremia (due to, for example, the syndrome of inappropriate secretion of antidiuretic hormone) and those with hypervolemic hyponatremia secondary to congestive heart failure or cirrhosis with ascites. Arginine vasopressin-receptor antagonists, a novel class of agents that block the action of arginine vasopressin on V2 receptors in the renal collecting ducts, may provide specific correction of sodium and water imbalance in hyponatremia by promoting free water clearance while sparing electrolytes (aquaresis). Arginine vasopressin antagonism would treat hyponatremia directly, as opposed to other therapies that do not address the effects of arginine vasopressin dysregulation directly.
Survival of Ethnic Chinese With Alzheimer's Disease: A 5-Year Longitudinal Study in Taiwan
Authors: Tsai Ping-Huang , Chen Shih-Pin , Lin Ker-Neng , Wang Pei-Ning , Wang Hsiao-Chien , Liu Chia-Yih , Hong Chen-Jee , Liu Hsiu-Chih
Published: August 2007

Survival time and mortality risk factors in patients with Alzheimer's disease (AD) have been documented in Western countries, but comparable information on the ethnic Chinese is scarce. We consecutively recruited 159 AD patients and 145 control subjects from the Memory Clinic of Taipei Veterans General Hospital. After admission to the study, each subject received clinical, neuropsychological, and psychiatric evaluation and apolipoprotein E genotyping. Survival status was followed for 5 years. Forty-six AD patients (28.9%) and 3 control subjects (2.1%) died during the 5-year follow-up period. The mean survival time for AD patients was 4.48 years (SD = 0.1 years) after the time of enrollment. Among individuals with AD, those with severe disease, older patients, and those experiencing hallucinations were at greater risk for increased mortality. As expected, AD shortened life expectancy in these patients. The factors found to correlate with a shorter life span may suggest effective health care strategies for AD patients. ( J Geriatr Psychiatry Neurol 2007;20:172—177)
Depression and Physical Function: Results From the Aging and Longevity Study in the Sirente Geographic Area (ilSIRENTE Study)
Authors: Russo Andrea , Cesari Matteo , Onder Graziano , Zamboni Valentina , Barillaro Christian , Pahor Marco , Bernabei Roberto , Landi Francesco
Published: August 2007

Depression in older persons represents a major issue because of its relevant prevalence and the associated higher risk of adverse health-related events. The aim of this study was to evaluate the relationship of depressive symptoms with measures of physical performance, muscle strength, and functional status. Data are from baseline evaluation of the ilSIRENTE Study (n = 364). Physical performance was assessed using the Short Physical Performance Battery and the 4-meter walking test. Muscle strength was measured by hand-grip strength. Functional performance was assessed using Basic and Instrumental Activities of Daily Living. Depression was defined by analyzing the different depressive manifestations included in the Minimum Data Set for Home Care Form: verbal expression of sad and/or anxious mood and demonstrated signs of mental distress. Analyses of covariance and linear regressions were performed to evaluate the relationship between depression and physical function. Participants with depression showed significantly worse results in all of the physical function tests. Subjects with depression presented significantly lower adjusted mean results for the 4-meter walking test (0.41 m/s; SE, 0.03) and the Short Physical Performance Battery score (5.68; SE, 0.38) compared with those without depression (0.50 m/s; SE, 0.01 and 6.93; SE, 0.21; all P < .01, respectively). Participants with depressed mood also presented a higher number of impaired instrumental activities of daily living (3.69; SE, 0.25) compared with participants with less than 3 depressive symptoms (2.85; SE, 0.14; P = .005). No significant difference was reported for the hand-grip strength and the Basic Activities of Daily Living scale. In conclusion, physical performance and functional status measures are significantly and negatively influenced by the presence of depression in community-dwelling older persons aged 80 years and older. ( J Geriatr Psychiatry Neurol 2007;20:131-137)
Characterization of the Lipid Profile in Dementia and Depression in the Elderly
Authors: Dimopoulos Nikolaos , Piperi Christina , Salonicioti Aristea , Psarra Vassiliki , Mitsonis Charalampos , Liappas Ioannis , Lea Robert W. , Kalofoutis Anastasios
Published: August 2007

The purpose of the study was to examine the association of plasma lipid concentrations with changes in cognitive function and depressive states in elderly Greek individuals. The study population consisted of 3 groups: A) 37 subjects with dementia, B) 33 subjects with depression, and C) 33 controls. All individuals were screened with the Mini-Mental State Examination (MMSE), the Geriatric Depression Scale (GDS), and an evaluation of their psychiatric state. Lipid profile was assessed in all subjects, and the results were statistically evaluated at P < .05 level of significance. Groups A and B had significantly lower levels of total plasma cholesterol and HDL cholesterol than group C ( P < .01). Triglyceride levels did not differ significantly between groups A and C, although they were significantly higher in group B. The results of this study suggest that an association does exist between the plasma concentration of cholesterol and HDL-C and depression and/or cognitive impairment. Further studies are required to explore the significance of these observations and establish if lipid levels could serve as markers for diagnostic and therapeutic purposes. ( J Geriatr Psychiatry Neurol 2007;20:138-144)
Clozapine for Treatment-Resistant Agitation in Dementia
Authors: Lee Hochang B. , Hanner Jennifer A. , Yokley Jessica L. , Appleby Brian , Hurowitz Lisa , Lyketsos Constantine G.
Published: August 2007

Few studies have examined the potential role of clozapine in treatment of agitation in dementia patients who have previously failed to respond to standard pharmacotherapy. We conducted a systematic chart review of all elderly patients admitted to our inpatient unit between 2001 and 2004. Of them, 16 dementia patients were treated with clozapine for treatment-resistant agitation, and their charts were blindly rated by 3 clinicians on the Clinical Global Impression (CGI) Scale, Brief Agitation Rating Scale (BARS), and the Cohen-Mansfield Agitation Inventory-Short Form (CMAI-SF). Overall, clozapine therapy seemed beneficial in treatment-resistant agitation in dementia patients. ( J Geriatr Psychiatry Neurol 2007;20:178—182)
Symptom Profile of Delirium in Older People With and Without Dementia
Authors: Edlund Agneta , Lundström Maria , Sandberg Olov , Bucht Gösta , Brännström Benny , Gustafson Yngve
Published: August 2007

Clinical profiles of delirium in 717 older people with and without dementia age 75 years and older in 4 different types of care were studied. Delirium and dementia were diagnosed according to DSM-IV criteria. Delirious demented participants (n = 135) had more often had previous delirium episodes and were more often being treated with analgesics compared to delirious participants without dementia (n = 180). The clinical profile of delirium in the participants with dementia was more frequently characterized by aggressivity, latency in reaction to verbal stimuli, restlessness and agitation, delusions, anxiousness, hallucinations, and a poorer orientation and recognition. Delirium among demented participants more often had a fluctuating course during the day and was more common in the evening and at night. In conclusion, clinical profiles of delirium in participants with and without dementia are different, which might indicate a different etiology or pathophysiology, or both, and a need for different treatment strategies. ( J Geriatr Psychiatry Neurol 2007;20:166—171)
A Repeated Measures Investigation of the First-Year Adaptation Experiences of the Female Expatriate Spouse Living in Turkey
Authors: Bikos Lynette H. , Çiftçi Ayşe , Güneri Oya Yerin , Demir Cennet Engin , Sümer Zeynep Hatipoglu , Danielson Sharrie , DeVries Shelly , Bilgen Wendy A.
Published: August 2007

Using a 1-year longitudinal-panel design, 32 American, female expatriate spouses who relocated to Ankara, Turkey, completed measures of global functioning and were interviewed at just-arrived, 3-, 6-, 9-, and 12-month stages. Because of the mixed methods approach of this project, results of the Naturalistic Inquiry are reported in a companion manuscript (Bikos et al., 2007, this issue). Differences in the importance and expectation of life roles (i.e., occupational, parent, marital, homecare) were found. Quantitative results indicated no differences in life roles importance, alcohol use, marital satisfaction, or mental health functioning as a function of time-in-country. Analyses do not support the culture shock/ U-curve model as a predictable pattern of adaptation. The authors conclude that time-in-country is only one of a myriad of variables that could be used to predict adaptation. Future expatriate research should use models that offer greater complexity.
A Longitudinal, Naturalistic Inquiry of the Adaptation Experiences of the Female Expatriate Spouse Living in Turkey
Authors: Bikos Lynette H. , Çiftçi Ayşe , Güneri Oya Yerin , Demir Cennet Engin , Sümer Zeynep Hatipoglu , Danielson Sharrie , DeVries Shelly , Bilgen Wendy A.
Published: August 2007

Using a one-year longitudinal-panel design, 32 American, female, expatriate spouses who relocated to Ankara, Turkey, were interviewed at just-arrived, 3-, 6-, 9-, and 12-months stages. This project utilized mixed methods research design. Results of the quantitative, repeated measures component is reported in Bikos et al. (2007, this issue). Results of the Naturalistic Inquiry provided rich, thick descriptions of eight themes as they unfolded through the first year of this expatriate assignment. The resulting themes included predeparture preparation, settling in, impact of expatriation on the wife's life roles, social emotional functioning, approaches to coping, supportive systems, language, and interaction with the host culture. The authors interpreted the results in light of the life role salience and career adaptability constructs of Super's Life-Span, Life-Space approach to career development. In addition, results of this project integrated well with previous research about expatriate spouse adjustment.
Pharmacists' Attitude to the Introduction of Automated Techniques in the Delivery of Pharmaceutical Services in Selected Nigerian Teaching Hospitals
Authors: Olubunmi Afolabi M. , Oyedepo Oyebisi T.
Published: August 2007

This study has investigated the attitude of hospital pharmacists toward the introduction of automated techniques in the delivery of pharmaceutical services in three Nigerian Teaching Hospitals. The results obtained from this survey showed that pharmacists have a good understanding of the various forms of automated techniques in pharmacy operations. The general perception showed that these techniques will impact positively on different aspects of the pharmacists' functions including routine dispensing, drug inventory management, and administrative tasks. Computerization of the appropriate database and ease of accessibility including an online communication network within the health system would ease the pharmacists' administrative functions. The respondents felt that their pharmaceutical care functions would be enhanced greatly as the routine manual tasks are taken care of with the automation. In particular, the pharmacists' time would be released for a close monitoring of patient drug therapy and provision of drug information services. The general consensus was that appropriate training workshops and continuing pharmacy education programs would provide practicing pharmacists with the required skill to manage automated pharmacy systems.
Valproic Acid—Induced Hyperammonemia in a Patient With Schizoaffective Disorder
Authors: Ott Carol A. , Campbell Noll , Dworek Elayne A.
Published: August 2007

Valproic acid is used in psychiatry as a mood stabilizer and can be very effective in reducing symptoms of agitation. Valproic acid may cause hyperammonemia through carnitine deficiency created by its inhibition of mitochondrial enzymes in the urea cycle. Clinical presentation of hyperammonemia usually involves lethargy and somnolence, which may also be noted with therapeutic serum concentration during valproic acid therapy. The diagnosis of hyperammonemia is often overlooked due to a clinical presentation that may include normal liver enzyme tests and serum valproate levels that are within the therapeutic range. Treatment modalities may include discontinuation of valproic acid therapy, lactulose, naloxone, and hemodialysis. Carnitine supplementation, for both prevention and acute treatment of hyperammonemia, has been anecdotally reported and may be considered. This article illustrates a case of an adult male with schizoaffective disorder who was treated with valproic acid and subsequently developed hyperammonemia, despite therapeutic valproic acid serum levels and normal liver enzyme tests. Possible causes of hyperammonemia and current treatment options will be described, as well as suggestions for monitoring for this adverse event in the clinical setting.
Pain Management in Elderly Patients
Authors: Hix Meri D.
Published: August 2007

In elderly patients, persistent pain negatively impacts quality of life. An interdisciplinary approach to pain management and emphasis on quality improvement will help to achieve better therapeutic outcomes. Managing pain in the geriatric population is challenging because of age-related changes in pain perception, cognition, pharmacokinetics, and drug effects. Improvement and maintenance of physical and emotional function is the goal. Pharmacotherapy should be initiated conservatively and titrated to effective doses with minimal adverse effects. Milder pain should be treated with non-opioid analgesics with a progression toward opioids and/or adjuvant medications as the pain intensifies. Acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), opioids, and adjuvant medications represent most of the analgesic agents used in pain management. Knowing the underlying mechanism of pain will help guide pharmacologic therapy. The patient should be monitored initially, with every dose change, and periodically to assess efficacy and severity of adverse effects.
Treatment of Cognitive Decline and Psychiatric Disturbances Associated With Alzheimer's Dementia
Authors: Blaszczyk Amie T. , Mathys Monica
Published: August 2007

Alzheimer's dementia (AD) is the most common type of dementia. In addition to the cognitive and functional disturbances that happen as the disease progresses, other psychological disturbances may manifest. Depression, insomnia, anxiety, and psychosis are among several psychological conditions which can occur concomitantly with AD. These changes can result in decreased quality of life for both patients and caregivers, increase caregiver burden, and impact the decision to place a patient with AD into a long-term care facility. An evidence-based review of the literature was performed to ascertain if a specific recommendation for pharmacotherapy can be made based on current research in this specific patient population.
Changes in Pharmacokinetics and Pharmacodynamics in the Elderly Patient
Authors: Hutchison Lisa C. , O'Brien Catherine E.
Published: August 2007

The use of pharmacologic agents in elderly patients is one of the most difficult aspects of patient care. An understanding of the common physiologic changes expected with aging is helpful to anticipate changes expected in pharmacokinetic parameters. Distribution, metabolism, and excretion are significantly altered for many drugs. In addition, pharmacodynamic variations in elderly patients may increase or decrease sensitivity to a medication independent of pharmacokinetic changes. These alterations are particularly noteworthy with cardiovascular and central nervous system agents. Current controversies regarding the application of estimation of renal function to drug dosing and use of the Beers criteria of medications potentially inappropriate in the elderly are discussed.
The State and Children's Fate
Authors: Leinaweaver Jessaca B. , Fonseca Claudia
Published: August 2007

This article introduces a special issue on the meaning of children in violent, uncertain times. It is framed in terms of the political-economy aspects of adoption, focusing on the local occurrences that make international adoption possible, from legal determinations of abandonment to wartime and postwar parenting. The article argues that government and civil institutions contain and shape children in the context of the dual oppressions of violence and socioeconomic inequality, and works to destabilize normative depictions of social reproduction, outlining a programme of study where aspects of children's lives are understood in line with their complex historical conditions.
Abandonment, Adoption and Reproductive Disruption
Authors: Blum Ann S.
Published: August 2007

To explore meanings attached to children in Mexican society, this article examines two changing aspects of child circulation, a widespread reproductive disruption to the families of Mexico City's working poor. In the late 1890s, a rapid rise in admissions to the public foundling home was matched by a striking increase in retrievals. At the other end of the social spectrum, growing preference for adopting infants and young children indicates that adoption was becoming an acceptable means of forming families among the middle and upper classes. Changes in welfare policy encouraged both trends. This convergence of family practice and public policy illuminates transitions in concepts of infancy and early childhood informed by a consolidating ethic of protected childhood. These dynamics prefigured the emergence of child protection legislation in the 1910s and the expansion of welfare services in the 1920s and 1930s.
Available Motherhood
Authors: Mookherjee Nayanika
Published: August 2007

This article takes an ethnographical approach to explore the `state of exception' through which legal technologies of abortion and adoption of `war-babies' (children born as a result of wartime rapes) in the Bangladesh war enabled the dekinning and elimination of certain childhoods while the raped women were rekinned within legitimate heterosexual motherhoods. The role of the law in guaranteeing an erasure of blood relations ensured the regulation and availability of women's reproductive capacity and the categorization of the child by the state. Through this process, the Bangladeshi family planning programme was institutionalized, in the context of bilateral foreign aid relating to population control.
Scarcity and Surplus
Authors: Tully Sheila R.
Published: August 2007

This article explores the multiple meanings of children and childhood in Nicaragua during periods of dramatic sociopolitical and economic transitions. The article compares the state's responsibilities to Nicaraguan children and their families during the decade of revolution and first year of the post-revolutionary period. It argues that each state supported a particular construction of childhood that produced a certain ideal of the Nicaraguan child.
Choosing to Move
Authors: Leinaweaver Jessaca B.
Published: August 2007

This article links research into constructions of childhood and child agency to anthropological studies of young people's informal adoption and state involvement in family arrangements. It analyses the life history of a young Peruvian woman who deliberately chose to move into an orphanage. The multiple points at which individual and family plans and efforts are shaped by broader political economic matters are addressed in a discussion of how urban Andean families, and in particular their children, use local orphanages as a part of their strategies for individual and family advancement.
Review: Making the diagnosis of systemic lupus erythematosus in children and adolescents
Authors: Tucker LB
Published: August 2007

Approximately 15% of patients with systemic lupus erythematosus (SLE) will have the onset of their disease in childhood or adolescence. Due to the broad range of possible clinical features of SLE, the diagnosis may be difficult to make in a general pediatric or community setting. The common symptoms of SLE in children and adolescents include fever, fatigue, weight loss, arthritis, rash and renal disease. SLE is more common in non-Caucasian ethnic groups and should be considered in the differential diagnosis of a multisystem disease in these patients. In this article, the classification criteria for SLE are discussed, and an approach to making an accurate and timely diagnosis of this disease is considered. Lupus (2007) 16, 546—549.
Review: Familial lupus and antiphospholipid syndrome
Authors: Sestak AL , O'Neil KM
Published: August 2007

The occurrence of systemic lupus erythematosus (SLE) in several members of a family has spurred intense efforts to identify susceptibility genes predisposing to the disease. As a result, a number of candidate association genes in different ethnic groups have been identified, and some genes have been linked to specific lupus manifestations. Particularly where familial disease occurs in childhood, and especially when it occurs prior to puberty, complement deficiencies and other immunologic defects should be explored. Evidence of other forms of autoimmunity, including autoimmune thyroiditis and antiphospholipid syndrome (APS), is common in families with SLE. Familial APS is uncommon in the absence of other thrombophilic defects, but occasionally is seen with apparent autosomal dominant inheritance. Thus far, no firm gene associations have been identified for APS, in part because of the rarity of multiplex families to study. A search for other familial causes of thrombotic disease should be performed when APS occurs in more than one family member. Lupus (2007) 16, 556—563.