bluuebunny/crossref_metadata_2025 huggingface dataset:
The Prevalence and Characteristics of Different Types of Headache in Patients With Behçet's Disease, a Case–Control Study
Authors: Haghighi Afshin Borhani , Aflaki Elham , Ketabchi Leila
Published: February 2008

Background.— Headache is one of the most common neurologic symptoms of Behçet's disease (BD) that may be due to migraine, tension‐type headache, uveitis, or direct consequence of neuro‐Behçet's disease (NBD) or other causes.

Objective.— To study the prevalence and characteristics of different types of headache in patients with BD.

Method.— Subjects were recruited as consecutive patients who referred to Behçet's Clinic at the Nemazee Hospital, Shiraz, Southern Iran, from March 2004 to March 2006. All patients fulfilled the International Study Group criteria for BD. Each patient was interviewed for history of BD and headache. Neurological examinations and, if necessary, ancillary investigations were performed for each patient. Control group was an age‐ and sex‐matched population. Headache entities fulfilled the International Headache Society criteria.

Results.— In total, 35% (63/180) of patients had no headache. Migraine with and without aura was the cause of headache in 1.7% (3/180) and 25.6% (46/180) of patients, respectively. Tension‐type headache was found in 23.9% (43/180) of patients. In 8.3% (15/180) of patients, headache could be justified by NBD. Headache due to uveitis was observed in 3.3% (6/180) of patients and 4 patients (2.2%) had other causes of headache. Migraine was significantly more common in patients than the control group (OR: 2.9, P < .0001). Considering the effect of gender, migraine was also significantly more frequent in patients than in the control group both in females (OR: 3.1, P < .0001) and males (OR: 3.2, P = .006).

Conclusion.— Migraine and tension‐type headaches are the most prevalent types of headaches in Behçet's patients. NBD must be meticulously investigated in patients with BD who presented with headache.
In Vivo Time‐Course Changes in Ethanol Levels Sampled With Subcutaneous Microdialysis
Authors: Engleman Eric A. , Ingraham Cynthia M. , Franklin Kelle M. , Keith Carrie M. , McClaren Joseph A. , Schultz Jonathan A. , Morzorati Sandra L. , O’Connor Sean , Thielen Richard J. , Murphy James M. , McBride William J.
Published: February 2008

Background:  The objective of this study was to determine time‐course changes in in vivo ethanol (EtOH) concentrations using a novel subcutaneous (s.c.) microdialysis sampling technique. The hypothesis to be tested was that EtOH concentrations in the s.c. fluid would reflect blood EtOH concentrations. If this is the case, then s.c. microdialysis could allow a more detailed analysis of changes in in vivo levels of EtOH under different drinking paradigms.

Methods:  Adult male and female Wistar rats and male alcohol‐preferring (P) rats were used in this study. A loop‐style microdialysis probe was designed for s.c. applications. After initial in vitro characterization, probes were implanted under the skin between the shoulder blades. Animals were allowed to recover 4 to 24 hours prior to microdialysis collection (2.0 μl/min flow rate with isotonic saline). In vivo microdialysis experiments were then conducted to determine (i) the extraction fraction (or clearance) using EtOH no‐net‐flux (NNF) coupled with the alcohol clamp method, (ii) the dose–response and time‐course effects after systemic EtOH administration and to compare with blood EtOH levels, and (iii) the time‐course changes in EtOH levels during and after an EtOH drinking episode.

Results:  In vivo probe recovery (extraction fraction) obtained using the alcohol clamp method was 69 ± 3%, and was comparable to the in vitro recovery of 73 ± 2%. For the EtOH dose–response experiment, rats injected i.p. with 0.5, 1.0, or 2.0 g/kg EtOH showed a clear dose–response effect in the s.c. dialysate samples. Peak concentrations (70, 123, and 203 mg%, respectively) were reached by 15 minutes after injection. In an experiment comparing levels of EtOH in s.c. dialysis and arterial blood samples in rats administered 1.0 g/kg EtOH, similar time‐course changes in in vivo EtOH concentrations were observed with both i.g. and i.p. EtOH administration. In P rats drinking 15% EtOH during a 1‐hour scheduled access period, EtOH levels in s.c. microdialysates rose rapidly over the session and peaked at approximately 50 mg% at 60 to 80 minutes.

Conclusions:  Overall, these experiments indicate that s.c. EtOH and blood EtOH concentrations follow a similar time course. Moreover, s.c. microdialysis can be useful as an experimental approach for determining detailed time‐course changes in in vivo EtOH concentrations associated with alcohol drinking episodes.
Alcohol Inhibits Spontaneous Activity of Basolateral Amygdala Projection Neurons in the Rat: Involvement of the Endocannabinoid System
Authors: Perra Simona , Pillolla Giuliano , Luchicchi Antonio , Pistis Marco
Published: February 2008

Background:  A large body of evidence indicates that the limbic system is involved in the neural processing underlying drug addiction. Among limbic regions, the basolateral nucleus of amygdala (BLA) is implicated in some aspects of the neurobiological mechanisms of drugs of abuse, including alcohol and cannabinoids. It is recently emerging that the endocannabinoid system is involved in many pharmacological and behavioral effects of alcohol. The BLA possesses a very high density of CB1 cannabinoid receptors, and endocannabinoids modulate forms of synaptic plasticity in this region. The aims of our study were first to investigate in vivo the sensitivity of BLA pyramidal neurons to alcohol and second to determine the role of the endocannabinoid system in the acute effects of alcohol.

Methods:  We utilized extracellular single cell recordings in urethane anesthetized rats from BLA principal neurons, antidromically identified from their projection site in the nucleus accumbens.

Results:  Alcohol (0.25 to 2.0 g/kg i.v.) induced a marked decrease in the spontaneous firing rate of BLA projecting neurons (51.1 ± 16% of baseline at 0.5 g/kg alcohol, p < 0.0001). The involvement of the endogenous cannabinoid system was investigated by administering the CB1 receptor antagonist SR141716A (rimonabant, SR) (1.0 mg/kg i.v.) before alcohol. SR per se did not significantly affect firing rate of BLA neurons, but it prevented the inhibition produced by alcohol (98 ± 18% of baseline firing at 0.5 g/kg alcohol, p < 0.01). Then, we studied the actions of alcohol following a chronic treatment with the CB1 agonist WIN55212‐2 (WIN). Animals were administered WIN for 6.5 days (2.0 mg/kg, i.p. twice daily) and alcohol dose–response curves were carried out on firing rate of BLA neurons 24 hours following the last injection of the cannabinoid agonist. In WIN‐treated animals the inhibitory effect of alcohol was significantly reduced as compared with controls (95 ± 16% of baseline firing at 0.5 g/kg, p < 0.05).

Conclusions:  Our results provide evidence of the involvement of the endocannabinoid system in the effects of alcohol on BLA projection neurons. They also further point to the endocannabinoid system as a possible molecular target in the treatment of alcoholism.
Insulin But Not Insulin Growth Factor‐1 Correlates With Craving in Currently Drinking Alcohol‐Dependent Patients
Authors: Leggio Lorenzo , Ferrulli Anna , Malandrino Noemi , Miceli Antonio , Capristo Esmeralda , Gasbarrini Giovanni , Addolorato Giovanni
Published: February 2008

Background:  Preclinical data suggest that brain insulin and insulin growth factor‐1 (IGF‐1) may contribute to the development of addiction. The aim of this clinical study was to evaluate the relationships between insulin and IGF‐1 plasma concentrations and alcohol craving.

Methods:  The correlations between insulin and craving in actively drinking alcoholics were evaluated in the experiment 1 retrospectively and in the experiment 2 in a case‐control study. Experiment 3 evaluated the correlations between insulin and craving in 12‐weeks abstinent alcoholics in a longitudinal study. C‐peptide and IGF‐1 were also investigated in experiments 2–3. Alcohol craving was evaluated by the Obsessive–Compulsive Drinking Scale (OCDS).

Results:  Significant positive correlations between insulin concentrations and craving scores were found in actively drinkers (p < 0.05). Specifically, in the first experiment insulin significantly correlated with the compulsive scores. In the second experiment and in an analysis of experiments 1–2 together, insulin plasma concentration correlated with total OCDS craving (p < 0.05) and compulsive craving (p < 0.05) and showed a trend of correlation with the obsessive craving. At 12 weeks no correlation was found between insulin and craving scores. In all the experiments the correlations between C‐peptide and craving were close to the ones between insulin and craving while IGF‐1 never correlated with craving.

Conclusions:  This study suggests that insulin could be involved in the neurobiology of alcohol craving and addiction. This characteristic seems specific of insulin since similar data were found on C‐peptide but not on IGF‐1. Future confirming studies on larger samples are needed, also to investigate possible therapeutic implications.
Trauma and PTSD in Patients With Alcohol, Drug, or Dual Dependence: A Multi‐Center Study
Authors: Driessen Martin , Schulte Silke , Luedecke Christel , Schaefer Ingo , Sutmann Frauke , Ohlmeier Martin , Kemper Ulrich , Koesters Gertrud , Chodzinski Claudia , Schneider Udo , Broese Thomas , Dette Christian , Havemann‐Reinicke Ulla ,   the TRAUMAB‐Study Group
Published: February 2008

Background:  We investigated (1) the prevalence of posttraumatic stress disorder (PTSD) in treatment‐seeking subjects with substance use dependence (SUD), (2) the association between comorbid PTSD and the severity and course of addiction and psychopathology, and (3) this association in patients with subsyndromal PTSD, and in trauma exposure without PTSD.

Methods:  In this cross‐sectional study, 459 subjects in 14 German addiction treatment centers participated with alcohol‐dependence (A) in 39.7%, drug‐dependence (D) in 33.6%, or both (AD) 26.8%. The diagnostic measures included the International Diagnostic Checklists (IDCL), Posttraumatic Diagnostic Scale (PDS), Addiction Severity Index (ASI), and the Brief Psychiatric Rating Scale (BPRS). Associations between independent characteristics and outcomes were analysed by univariate and multivariate statistics.

Results:  25.3% of the subjects had PTSD confirmed by both IDCL and PDS with higher rates in the AD (34.1%) and D (29.9%) groups compared with group A (15.4%, p < 0.001). In 22.8%, PTSD was subsyndromal (either IDCL or PDS positive) without significant differences between SUD groups, and 18.3% met PTSD trauma criteria A without PTSD (exposure). After controlling for SUD and gender, trauma subgroups significantly differed regarding the onset of alcohol‐related symptoms (p < 0.02), numbers of previous admissions (p < 0.03), severity of SUD (p < 0.001), current craving (p < 0.02), and psychopathology (p < 0.001). We observed the worst outcome in PTSD, while trauma exposure had no effects.

Conclusions:  The prevalence of PTSD is higher in drug than in alcohol dependence. The more strictly PTSD is diagnosed (by interviewer and questionnaire) the more clearly are associations with characteristics of SUD. PTSD seems to be an independent risk factor for an unfavorable outcome of SUD.
Effects of Topiramate on Urge to Drink and the Subjective Effects of Alcohol: A Preliminary Laboratory Study
Authors: Miranda Jr Robert , MacKillop James , Monti Peter M. , Rohsenow Damaris J. , Tidey Jennifer , Gwaltney Chad , Swift Robert , Ray Lara , McGeary John
Published: February 2008

Background:  Topiramate was recently reported to be efficacious in reducing drinking rates and craving among individuals with alcohol dependence in a randomized controlled trial, but dose effects could not be determined. This laboratory study systematically examined the dose‐dependent effects of topiramate on cue‐elicited craving and other putative mechanisms of its pharmacotherapeutic effects on drinking.

Methods:  Male and female heavy drinkers (n = 61) were randomized to 1 of 3 medication conditions (200 mg/d; 300 mg/d; placebo) in a double‐blind study. Participants reached the target dose after a 32‐day titration period, then were stabilized for approximately 1 week. All then participated in a laboratory assessment of alcohol cue reactivity and of the subjective effects of a moderate dose of alcohol.

Results:  Both doses of topiramate reduced the frequency of heavy drinking during the titration period as compared to placebo. However, topiramate did not affect self‐reported craving for alcohol during the titration period, during the cue reactivity protocol, or in response to the alcohol challenge procedure. Topiramate reduced the stimulating effects of alcohol ingestion compared to placebo, but only in the 200 mg group.

Conclusions:  The results of this study support previous findings that topiramate reduces drinking, but the behavioral mechanism underlying this effect does not appear to be attenuation of craving for alcohol as measured using the approaches employed in this study. Rather, the results tentatively suggest that topiramate may exert its beneficial effects by altering the subjective experiences of alcohol consumption. Limitations of the current study are discussed and complementary methods are recommended for future studies, such as the use of behavioral economic paradigms and ecological momentary assessment.
Where, With Whom, and How Much Alcohol Is Consumed on Drinking Events Involving Aggression? Event‐Level Associations in a Canadian National Survey of University Students
Authors: Wells Samantha , Mihic Ljiljana , Tremblay Paul F. , Graham Kathryn , Demers Andrée
Published: February 2008

Background: Epidemiological research using event‐level data can provide a better understanding of the association between alcohol consumption, characteristics of drinking contexts, and the likelihood of aggressive behavior. The present research assessed whether alcohol intake and characteristics of the drinking context were associated with the likelihood of aggression within individuals across 3 drinking events based on a national sample of university students, taking into account individual characteristics and university level variables. Additionally, we determined whether individual characteristics, particularly drinking pattern, were associated with alcohol‐related aggression controlling for drinking event characteristics, and whether relations of aggression to alcohol and drinking contexts differed by gender.

Methods: Secondary analyses of the 2004 Canadian Campus Survey (CCS), a national survey of 6,282 university students (41% response rate) at 40 Canadian universities, were conducted. Respondents were asked about their three most recent drinking events, including whether they were in an argument or fight with someone, number of drinks consumed, and characteristics of the drinking context as well as their usual drinking frequency and heavy episodic drinking. We used multi‐level analyses to account for the nested structure of the data (i.e., drinking events nested within individuals who were nested within universities).

Results: The number of drinks consumed was positively associated with aggression. Drinking contexts found to be positively associated with aggression included being at a party, at a fraternity/sorority and/or residence, at three or more drinking places (versus 1 or 2), and having a partner present whereas having a meal reduced the likelihood of aggression. A significant interaction was found between gender and being at a party, with a significant effect found for women but not for men.

Conclusions: These results support experimental evidence indicating a direct role of alcohol in aggression and point to characteristics of the drinking context that might be targeted in future prevention initiatives.
Neonatal Alcohol Exposure Differentially Alters Clock Gene Oscillations Within the Suprachiasmatic Nucleus, Cerebellum, and Liver of Adult Rats
Authors: Farnell Yuhua Z. , Allen Gregg C. , Nahm Sang‐Soep , Neuendorff Nichole , West James R. , Chen Wei‐Jung A. , Earnest David J.
Published: February 2008

Background:  In rats, alcohol exposure during the period of rapid brain growth produces long‐term changes in the free‐running period, photoentrainment and phase‐shifting responses of the circadian rhythm in wheel‐running behavior. To determine whether these alterations in circadian behavior are associated with permanent damage to the circadian timekeeping mechanism or reconfiguration of its molecular components, we examined the long‐term effects of neonatal alcohol exposure on clock gene rhythms in the pacemaker located in the suprachiasmatic nucleus (SCN) and in other brain or peripheral tissues of adult rats.

Methods:  Artificially reared male rat pups were exposed to alcohol (4.5 g/kg/d) or isocaloric milk formula (gastrostomy control; GC) on postnatal days 4 to 9. At 3 months of age, animals were exposed to constant darkness and then SCN, cerebellum, and liver tissue were harvested at 6‐hour intervals for subsequent analysis of Period1 (Per1), Per2, Cryptochrome1 (Cry1), Bmal1, and Rev‐erbα mRNA levels by quantitative PCR.

Results:  In the SCN, cerebellum and liver, Per1, Per2, Cry1, Bmal1, and Rev‐erbα expression oscillated with a similar amplitude (peak‐to‐trough differences of 2‐ to 9‐fold) and phase in the suckle control (SC) and GC groups. These clock gene rhythms in control animals were marked by peak expression of Per1, Per2, Cry1, and Rev‐erbα during the subjective day and of Bmal1 during the subjective night. The EtOH group was distinguished by altered rhythms in the expression of specific clock genes within the SCN, cerebellum and liver. In EtOH‐treated rats, the SCN rhythm in Cry1 expression was strongly damped and the Per2 rhythms in the cerebellum and liver were phase‐advanced such that peak expression occurred during the mid‐subjective day.

Conclusions:  These results demonstrate alcohol exposure during the brain growth spurt alters the circadian regulation of some molecular components of the clock mechanism in the rat SCN, cerebellum, and liver. The observed alterations in the temporal configuration of essential “gears” of the molecular clockworks may play a role in the long‐term effects of neonatal alcohol exposure on the regulation of circadian behavior.
Brain Activation, Response Inhibition, and Increased Risk for Substance Use Disorder
Authors: McNamee Rebecca L. , Dunfee Kathryn L. , Luna Beatriz , Clark Duncan B. , Eddy William F. , Tarter Ralph E.
Published: February 2008

Background: Youth at high risk for developing substance use disorders (SUDs) often exhibit differences which suggest inhibitory impairments when compared to average risk youth.

Methods: To examine the underlying neural activity related to these impairments, functional MRI (fMRI) was employed in adolescents during an antisaccade task requiring inhibition of an eye movement response. Each subject’s level of neurobehavioral disinhibition (ND) was assessed using a multi‐informant, multi‐method approach, which has been shown to be highly predictive of SUD onset. The fMRI data was categorized into neural regions of interest according to total frontal, parietal, occipital, and temporal lobe activation.

Results: Results demonstrated that ND score was negatively correlated with total amount of frontal activation, but was not significantly correlated with total activation in any other neural region.

Conclusions: These results indicate deficits in frontal activation in youth with high amounts of ND, suggesting a possible developmental delay of executive processes in high‐risk youth.
Shared Family Activities and the Transition From Childhood Into Adolescence
Authors: Crosnoe Robert , Trinitapoli Jenny
Published: February 2008

Drawing on time use data from the Child Development Supplement of the Panel Study of Income Dynamics, this study identified five different profiles of shared time between parents and young people at different stages of development. In childhood, all profiles had high rates of shared television viewing, but some were oriented toward in‐home activities and others toward activities outside the home (e.g., cultural events). These latter profiles tended to be higher in socioeconomic advantage, and the young people in them tended to demonstrate greater gains in math, but not reading, achievement across the transition into adolescence. In adolescence, shared activity profiles favored low amounts of shared time between parents and adolescents across activities and disfavored shared time in public domains.
Is Being Popular a Risky Proposition?
Authors: Mayeux Lara , Sandstrom Marlene J. , Cillessen Antonius H. N.
Published: February 2008

Longitudinal associations between social preference, perceived popularity, and risk behaviors (smoking, alcohol use, and sexual activity) were examined in a sample of high school students. Social preference did not predict any of the risk behaviors assessed, although the interaction between gender and social preference was predictive of sexual behavior. Perceived popularity in Grade 10 was predictive of increased alcohol use and sexual activity in Grade 12 for both boys and girls. A reciprocal relationship was found for boys, in which smoking in Grade 10 also predicted gains in perceived popularity over time. Furthermore, results suggested that gains in perceived popularity may be associated with subsequent losses in social preference over time, lending support for the “cycle of popularity” observed by Eder. Implications are discussed, including the personal impact of risk behaviors on perceived popular teens, as well as the broader influence their behavior may have on their less popular counterparts.
Social Competence and Antisocial Behavior: Continuity and Distinctiveness Across Early Adolescence
Authors: Sørlie Mari‐Anne , Hagen Kristine Amlund , Ogden Terje
Published: February 2008

The degree of continuity and distinctiveness in social competence and antisocial behavior was examined in a longitudinal structural equation model. Participants were 391 typically developing Norwegian middle school students (51% boys), their parents, and teachers and were assessed when they were approximately 13 years of age (a school cohort in 8th grade) and again 17 months later, when they were about 15 years old (in 10th grade). Social competence showed considerable stability across middle school, more than did antisocial behavior. Low social competence at age 13 predicted antisocial behavior at age 15, over and above the variance explained by the earlier assessment of antisocial behavior. While social competence and antisocial behavior both showed a relatively strong negative association concurrently and demonstrated considerable overlap, results suggested that the two constructs should be considered separate dimensions. Findings are presented within a transactional framework and implications for prevention efforts and directions for future research are discussed.
The Continued Importance of Quality Parent–Adolescent Relationships During Late Adolescence
Authors: Hair Elizabeth C. , Moore Kristin A. , Garrett Sarah B. , Ling Thomson , Cleveland Kevin
Published: February 2008

The quality of adolescents' relationships with residential parents has been found to predict many different health and behavioral youth outcomes; strong associations have also been found between these outcomes and family processes, and between relationship quality and family processes. Data from Rounds 1–5 of the National Longitudinal Survey of Youth, 1997 were used to examine hypotheses about the influence of the parent–adolescent relationship on subsequent adolescent mental well‐being and delinquency, as mediated by family processes. Using structural equation modeling, we found that the influence of a positive residential parent–adolescent relationship on better mental well‐being and fewer delinquency was entirely mediated by family routines, parental monitoring, and parental supportiveness, net of sociodemographic controls.
Novel antithrombotic agents and the risk of bleeding
Authors: Van Der Linden Jan
Published: February 2008

Many coronary patients on antiplatelet (PLT) drugs require coronary artery bypass grafting surgery under conditions that may not allow sufficient time for or warrant discontinuation of anti‐PLT treatment. Recent clinical data show that intraoperative aprotinin significantly reduces postoperative bleeding and transfusion requirements in this patient population. If surgical bleeding persists, the administration of Factor VIIa should be considered.
Clockwise Loop of the Ablation Catheter in the Left Atrium: An Easy and Safe Approach Facilitating Substrate Modulation in the Setting of Atrial Fibrillation Ablation
Authors: BORTONE AGUSTÍN , BOVEDA SERGE , COMBES NICOLAS , ALBENQUE JEAN‐PAUL
Published: February 2008

In the context of chronic atrial fibrillation (AF) ablation, substrate modulation has demonstrated its efficacy and its positive impact both into conversion of the AF either directly to sinus rhythm (SR) or to atrial tachycardia (AT) and into SR maintenance. However, substrate modulation, which can be performed either by linear lesions deployment or/and by targeting complex and fractionated atrial electrograms (CFAEs), can be a difficult task. We present a safe and non time‐consuming technique conceived in our center which we think is of interest for substrate modulation purpose in the AF ablation framework. This technique named the “clockwise loop approach” may permit both extensive and accurate mapping of a great amount of the LA and facilitation of LA linear lesions deployment.
AGEs‐RAGE System Mediates Atrial Structural Remodeling in the Diabetic Rat
Authors: KATO TAKESHI , YAMASHITA TAKESHI , SEKIGUCHI AKIKO , TSUNEDA TAKAYUKI , SAGARA KOUICHI , TAKAMURA MASAYUKI , KANEKO SHUICHI , AIZAWA TADANORI , FU LONG‐TAI
Published: February 2008

Background: Diabetes mellitus (DM) is one of the independent risk factors for atrial fibrillation (AF). Our previous study has indicated that DM causes atrial structural remodeling with intraatrial conduction disturbances. We tested the hypothesis that the advanced glycation end products (AGEs) and the receptor for AGE (RAGE), which have been implicated in diabetic complications, are responsible for the atrial structural remodeling.

Methods and Results: Diabetes was induced by streptozotocin (65 mg/kg i.p.) in 8‐week‐old female Sprague–Dawley rats. When 24 weeks old, their atria were subjected to histology, Western blotting, and immunohistochemistry. The HbA1c value of induced‐DM rats was significantly higher than that of control rats. Histological and immunohistochemical examinations revealed that the atria of diabetic rats showed remarkable structural changes characterized by diffuse interstitial fibrosis with abundant expressions of RAGE and connective tissue growth factor (CTGF), which findings were also confirmed by Western blotting analysis. This diabetes‐induced atrial fibrosis was remarkably prevented by administration of an inhibitor of AGEs formation, OPB‐9195, along with reduction of CTGF expression.

Conclusions: DM promoted atrial structural remodeling via the activation of the AGEs‐RAGE system with upregulating CTGF. The inhibition of AGEs formation could be a novel upstream therapeutic approach for diabetes‐related atrial fibrosis.
Is Defibrillation Testing Still Necessary? A Decision Analysis and Markov Model
Authors: GULA LORNE J. , MASSEL DAVID , KRAHN ANDREW D. , YEE RAYMOND , SKANES ALLAN C. , KLEIN GEORGE J.
Published: February 2008

Objective: To assess the impact of defibrillation threshold (DFT) testing of implanted cardioverter‐defibrillators (ICDs) on survival.

Background: DFT testing is generally performed during implantation of ICDs to assess sensing and termination of ventricular fibrillation. It is common clinical practice to defibrillate ventricular fibrillation twice at an output at least 10 J below the maximum output of the device, providing a 10 J safety margin. However, there are few data regarding impact of DFT testing on outcomes.

Methods: Decision analysis and Monte Carlo simulation were used to assess expected outcomes of DFT testing. Survival of a hypothetical cohort of patients was assessed according to two strategies—routine DFT testing at time of ICD implant versus no DFT testing. Assumptions in the model were varied over a range of reasonable values to assess outcomes under a variety of scenarios.

Results: Five‐year survival with DFT and no‐DFT strategies were similar at 59.72% and 59.36%, respectively. The results were not sensitive to changing risk estimates for arrhythmia incidence and safety margin. Results of the Monte Carlo simulation were qualitatively similar to the base case scenario and consistent with a small and nonsignificant survival advantage with routine DFT testing.

Conclusions: The impact of DFT testing on 5‐year survival in ICD patients, if it exists, is small. Survival appears higher with DFT testing as long as annual risk of lethal arrhythmia or the risk of a narrow safety margin is at least 5%, although the incremental benefit is marginal and 95% confidence intervals cross zero. A prospective randomized study of DFT testing in modern devices is warranted.
Coronary Sinus Side Branches for Cardiac Resynchronization Therapy: Prospective Evaluation of Availability, Implant Success, and Procedural Determinants
Authors: DURAY GABOR Z. , HOHNLOSER STEFAN H. , ISRAEL CARSTEN W.
Published: February 2008

Introduction:
There are only sparse data concerning individual coronary side branch (CS‐SB) anatomy with respect to LV lead implantation for cardiac resynchronization therapy (CRT).

Methods:
In patients (pts) undergoing CRT device implantation, a detailed venogram was obtained, and the CS‐SB of first, second, third, and fourth choices for CS‐lead implantation was defined. Study endpoints included successful LV lead implantation in the first choice CS‐SB, number of CS‐SB potentially available, implantation success in selected CS‐SB, procedural variables, and 6‐month response to CRT.

Results:
CRT defibrillator implantation was attempted in 77 pts. Only 1 suitable CS‐SB was present in 3 (4%), 2 in 20 (26%), 3 in 36 (47%), and 4 CS‐SB in 18 patients (23%). The LV lead was implanted in the first choice CS‐SB in 71% of patients, in the second choice in 16%, in the third choice in 3%. In 4 patients (5%) no LV lead could be implanted. Implant success was similar for different CS‐SB regions (P = ns). Successful LV lead implantation in the CS‐SB of first choice was associated with median fluoroscopy and procedure times of 20 ± 13 and 143 ± 41 minutes. Corresponding times for the CS‐SB of ≥ second choice were 38 ± 21 (P = 0.002) and 179 ± 47 minutes (P = 0.002). Response rate at 6 months was 64% for patients with LV leads in the first target CS‐SB.

Conclusions:
In 70% of patients undergoing CRT device implantation, at least three suitable CS‐SBs are available. Implant success in the CS‐SB of first choice is 71% without significant differences for any particular CS‐SB region.
Context and Contingency in the History of Post World War II Nursing Scholarship in the United States
Authors: Fairman Julie
Published: February 2008

Purpose:

To examine the context for the development of nursing scholarship post World War II.

Methods:

Historiographical analysis of the social, political, and cultural context of nursing scholarship in the postwar period, with an understanding of how this context shaped nursing scholarship.

Findings:

The development of nursing scholarship was influenced by three contextual strands: Nurses' use of experiential clinical knowledge to situate practice questions in the changing clinical care milieu of the 1950s to the 1970s; The development of an intellectual genealogy through new educational opportunities at the baccalaureate and graduate level from the 1960s to the 1980s that provided the foundation for reintegrating practice and education; and the creation of a growing cadre of nurse scholars and their political influence on the relationship between power, knowledge, and clinical practice. These formulations are critical for understanding how scholarship changed over time and help us understand contemporary clinical practice, its authority structure, how it helps us define a body of knowledge from which practice proceeds, and then, how it responds to public demands.

Conclusions

: Nursing scholarship is nested in a particular social, political, economic, and cultural context. This context also determines how and why it is generated, debated, and used. Its production does not always follow a rational, logical pattern. Nursing knowledge development is influenced as much by the political underpinnings of health care as it is by social, economic, cultural, and scientific foundations.
Couple Decision Making and Use of Cultural Scripts in Malawi
Authors: Mbweza Ellen , Norr Kathleen F. , McElmurry Beverly
Published: February 2008

Purpose: To examine the decision‐making processes of husband and wife dyads in matrilineal and patrilineal marriage traditions of Malawi in the areas of money, food, pregnancy, contraception, and sexual relations.

Methods: Qualitative grounded theory using simultaneous interviews of 60 husbands and wives (30 couples). Data were analyzed according to the guidelines of simultaneous data collection and analysis. The analysis resulted in development of core categories and categories of decision‐making process. Data matrixes were used to identify similarities and differences within couples and across cases.

Findings: Most couples reported using a mix of final decision‐making approaches: husband‐dominated, wife‐dominated, and shared. Gender based and nongender based cultural scripts provided rationales for their approaches to decision making. Gender based cultural scripts (husband‐dominant and wife‐dominant) were used to justify decision‐making approaches. Non‐gender based cultural scripts (communicating openly, maintaining harmony, and children's welfare) supported shared decision making. Gender based cultural scripts were used in decision making more often among couples from the district with a patrilineal marriage tradition and where the husband had less than secondary school education and was not formally employed.

Conclusions: Nongender based cultural scripts to encourage shared decision making can be used in designing culturally tailored reproductive health interventions for couples.

Clinical Relevance: Nurses who work with women and families should be aware of the variations that occur in actual couple decision‐making approaches. Shared decision making can be used to encourage the involvement of men in reproductive health programs.
Expanding the Comfort of Postmastectomy Patients Using the Papilla Gown
Authors: Cho Ho Soon Michelle , Paek Jae Un , Davis Gail , Fedric Tara
Published: February 2008

Purpose

: To determine whether the Papilla Gown designed specifically to meet the needs of postmastectomy patients with a closed drainage system in place is more comfortable than is a typical hospital gown.

Background

: The closed wound drainage system used for breast cancer patients immediately following mastectomy requires external drainage tubes that connect to a pouch. The pins that are usually used to attach the drains to a patient's gown create problems. The Papilla Gown® (Papilla is the Latin term for breast) was designed with safety pouches for supporting the drains.

Methods

: A convenience sample of 13 postmastectomy patients participated in this preliminary study of the gown's use. Participants were taught how to properly wear the typical hospital gown and Papilla Gown before surgery. Patients were discharged with the gowns and two questionnaires that were to be returned approximately 1 week following surgery. Thirteen of the 38 (34%) who agreed to participate submitted usable forms. The Wilcoxon signed‐ranks test was used for comparing the comfort scores of the Papilla with the hospital gown.

Findings

: Participants reported significantly higher scores (p<.003) for the Papilla Gown on all of Comfort Questionnaire's 10 items, except one (p=.337) related to fear of pulling out the drainage tubes. Specifically, patients felt more comfortable about their appearance in the gowns, their ability to move, and the support of the drainage tubes.

Conclusion

: The newly designed Papilla Gown shows promise for meeting the purpose of increasing the comfort of postmastectomy patients with closed drainage systems.

Clinical Relevance

: The Papilla Gown was designed to address the comfort, mobility, and body image issues that patients face during the first week following a mastectomy, when they are dealing with such issues as the cancer diagnosis, loss of a breast, and managing drainage tubes. Preliminary results show that nurses can improve patient satisfaction by providing clothing that is comfortable, attractive, and supports the drainage system in place during this critical time.
Computer‐Mediated Support Group Intervention for Parents
Authors: Bragadóttir Helga
Published: February 2008

Purpose

: The purpose of this study was to evaluate the feasibility of a computer‐mediated support group (CMSG) intervention for parents whose children had been diagnosed with cancer.

Design and Methods

: An evaluative one‐group, before‐and‐after research design. A CMSG, an unstructured listserve group where participants used their E‐mail for communication, was conducted over a 4‐month period. Participation in the CMSG was offered to parents in Iceland whose children had completed cancer treatment in the past 5 years. Outcome measures were done: before the intervention (Time 1), after 2 months of intervention (Time 2) and after 4 months of intervention (Time 3) when the project ended. Measures included: demographic and background variables; health related vulnerability factors of parents: anxiety, depression, somatization, and stress; perceived mutual support; and use of the CMSG. Data were collected from November 2002 to June 2003. Twenty‐one of 58 eligible parents participated in the study, with 71% retention rate for both post‐tests.

Findings

: Mothers' depression decreased significantly from Time 2 to Time 3 (p<.03). Fathers' anxiety decreased significantly from Time 1 to Time 3 (p<.01). Fathers' stress decreased significantly from Time 2 to Time 3 (p<.02). To some extent, mothers and fathers perceived mutual support from participating in the CMSG. Both mothers and fathers used the CMSG by reading messages. Messages were primarily written by mothers.

Conclusions

:
Study findings support further development of CMSGs for parents whose children have been diagnosed with cancer.

Clinical Relevance

: Using computer technology for support is particularly useful for dispersed populations and groups that have restrictions on their time. Computer‐mediated support groups have been shown to be a valuable addition to, or substitute for, a traditional face‐to‐face mutual support group and might suit both genders equally.
Job Satisfaction and Acculturation Among Filipino Registered Nurses
Authors: Ea Emerson E. , Griffin Mary Quinn , L'Eplattenier Nora , Fitzpatrick Joyce J.
Published: February 2008

Purpose

: To determine the (a) levels of acculturation and job satisfaction, (b) relationship between acculturation and job satisfaction, and (c) effects of select sociodemographic variables in predicting job satisfaction among Filipino RNs educated in the Philippines who are working in the US.

Design

: Descriptive correlational. A convenience sample of Filipino RNs (N=96) present during the PNAA Eastern Regional Conference in Baltimore, MD was conducted.

Methods

: A survey was conducted using A Short Acculturation Scale for Filipino Americans (ASASFA) to measure acculturation, Part B of the Index of Work Satisfaction Scale (IWS) to assess job satisfaction, and a participant demographic questionnaire. Data were analyzed using A Pearson correlation coefficient and multiple regression analysis.

Findings

: Participants had a moderate level of job satisfaction that was positively correlated to a level of acculturation that was closer to American than to Filipino culture. Furthermore, age, length of U.S. residency, and acculturation significantly predicted perception of job satisfaction among this group of Filipino RNs.

Conclusions

: Job satisfaction among Filipino nurses is related to acculturation and select sociodemographic variables. Further research to determine how best to improve acculturation may lead to improved retention rates of Filipino nurses in countries to which they have migrated.
Uncertainty in Breast, Prostate, and Colorectal Cancer: Implications for Supportive Care
Authors: Shaha Maya , Cox Carol L. , Talman Kirsi , Kelly Daniel
Published: February 2008

Purpose:

The aim of this paper was to identify and explore the literature for key aspects of uncertainty experienced by patients who have been diagnosed with breast, prostate, or colorectal cancer.

Organizing Construct

: Throughout the cancer journey important decisions are made about treatments, symptom control, and supportive care and many approaches have been adopted to examine coping and uncertainty associated with a cancer diagnosis. Uncertainty and its associated attributes, such as stress or anxiety, fluctuate across the disease trajectory. To appreciate the changing nature of uncertainty one should consider its effect on specific patient groups by considering the available evidence.

Methods

: A comprehensive literature search that was focused on reviews and studies about uncertainty in cancer patients was conducted in PubMed and CINAHL. In total, 40 articles were identified that indicated uncertainty in patients with breast, prostate, or colorectal cancer, although the emphasis in each differed according to the nature and treatment of the disease.

Findings

: Uncertainty was found to comprise three main themes: uncertainty because of limited or lack of information, uncertainty concerning the course and treatment choices related to the disease, and uncertainty related to everyday life and coping with the disease.

Conclusions

: Uncertainty influences patients' experiences of their cancer and their coping. Whilst it might be impossible to avoid uncertainty entirely, its negative effects might be ameliorated by understanding patients' specific needs along the disease trajectory of breast, prostate, and colorectal cancer.
A Nursing‐Specific Model of EPR Documentation: Organizational and Professional Requirements
Authors: Von Krogh Gunn , Nåden Dagfinn
Published: February 2008

Purpose:

To present the Norwegian documentation KPO model (quality assurance, problem solving, and caring). To present the requirements and multiple electronic patient record (EPR) functions the model is designed to address.

Methods:

The model's professional substance, a conceptual framework for nursing practice is developed by examining, reorganizing, and completing existing frameworks. The model's methodology, an information management system, is developed using an expert group. Both model elements were clinically tested over a period of 1 year.

Results:

The model is designed for nursing documentation in step with statutory, organizational, and professional requirements. Complete documentation is arranged for by incorporating the Nursing Minimum Data Set. A systematic and comprehensive documentation is arranged for by establishing categories as provided in the model's framework domains. Consistent documentation is arranged for by incorporating NANDA‐I Nursing Diagnoses, Nursing Intervention Classification, and Nursing Outcome Classification.

Conclusions:

The model can be used as a tool in cooperation with vendors to ensure the interests of the nursing profession is met when developing EPR solutions in healthcare.

Clinical Relevance:

The model can provide clinicians with a framework for documentation in step with legal and organizational requirements and at the same time retain the ability to record all aspects of clinical nursing.
Household Composition and Fatal Unintentional Injuries Related to Child Maltreatment
Authors: Schnitzer Patricia G. , Ewigman Bernard G.
Published: February 2008

Purpose

: To determine if household composition is an independent risk factor for fatal unintentional injuries related to child maltreatment.

Design

: A population‐based, case‐control study using data from the Missouri Child Fatality Review Program for 1992–1999.

Methods

: Children under age five who died during the 8‐year study period were eligible for study. Cases were defined as children who died of an unintentional injury that occurred when a parent or other adult caregiver: (a) was not present, (b) was present but not capable of protecting the child, (c) placed the child in an unsafe sleep environment, or (d) failed to use legally mandated safety devices. Controls were randomly selected from children who died of natural causes. Household composition was classified based on relationship of the adults living in the household to the deceased child. The five household composition categories were households with: (a) two biologic parents and no other adults, (b) one biologic parent and no other adults, (c) one or two biologic parents and another adult relative, (d) stepparents or foster parents, and (e) one or two biologic parents and another unrelated adult. Logistic regression analyses were conducted and odds ratios estimating the risk of maltreatment‐related unintentional death associated with each household category compared to the reference households: those with two biologic parents and no other adults.

Findings

: Three hundred eighty children met the case definition. Children residing within households with adults unrelated to them had nearly six times the risk of dying of maltreatment‐related unintentional injury (adjusted odds ratio [aOR] 5.9; 95% confidence interval [95% CI] 1.9–17.6). Children residing with step or foster parents and those living with other, related adults were also at increased risk of maltreatment death (aOR 2.6, 95% CI 1.0–6.5; and aOR 2.1, 95% CI 1.0–4.5, respectively). Risk was not elevated for children in households with a single biologic parent and no other adults in residence.

Conclusions

: Young children residing in households with unrelated adults, step‐parents, or foster parents are at increased risk of fatal unintentional injury related to maltreatment. Nurses can use the findings of this study to facilitate injury prevention by identifying families at risk for fatal unintentional injuries and providing these families with targeted education or referral.
Dielectric Characteristics of Perovskite‐Structured High‐Temperature Relaxor Ferroelectrics: The BiScO3–Pb(Mg1/3Nb2/3)O3–PbTiO3 Ternary System
Authors: Stringer Craig J. , Donnelly Niall J. , Shrout Thomas R. , Randall Clive A. , Alberta Edward F. , Hackenberger Wesley S.
Published: February 2008

A new compositional family of relaxor ferroelectrics was investigated based on the high‐temperature Bi(Me)O3–PbTiO3 ferroelectric perovskite family. Compositions were fabricated near an estimated morphotropic phase boundary (MPB) of the xBiScO3–yPb(Mg1/3Nb2/3)O3–zPbTiO3 (xBS–yPMN–zPT) ternary system exhibiting high‐temperature relaxor properties of Tmax∼250°–350°C and ɛmax∼10 000–24 000 at 1 kHz. Analysis of the low‐field a.c. permittivity by a Vogel–Fulcher type dependence enabled key parameters of activation energy, EA, and freezing temperature, Tf, to be determined. The remanent polarization was studied over a broad temperature range and was observed to show classical ferroelectric square loop hysteresis behavior at temperatures T<Tf while slim loop hysteresis behavior was observed at temperatures Tf<T<Tmax. Pyroelectric current measurements were made and integrated to determine macroscopic polarization‐temperature dependence, and were in excellent agreement with the hysteresis data. The macroscopic polarization was found to drop off rapidly near the freezing temperature, Tf. At temperatures T>Tmax, the deviation temperature, TD, was obtained from Curie–Weiss analysis and found to be ∼600°C. A comparison of characteristic electrical properties was made between the high‐temperature perovskite relaxors and the classical complex lead relaxor compound, Pb(Mg1/3Nb2/3)O3 (PMN).