bluuebunny/crossref_metadata_2025 huggingface dataset:
An Inquiry Into Latino Caregivers' Experience Caring for Older Adults With Alzheimer's Disease and Related Dementias
Authors: Borrayo Evelinn A. , Goldwaser Gali , Vacha-Haase Tammi , Hepburn Kenneth W.
Published: October 2007

The literature on the experiences of Latino caregivers of older adults with Alzheimer's disease and related disorders (ADRD) is scarce. Shedding light on ethnocultural influences may facilitate providing more culturally appropriate services. The purpose of this study is to explore Latino caregivers' cultural explanatory models of caring for an older adult with ADRD. Seven focus groups are conducted with 33 Spanish-speaking Latino caregivers in three U.S. states: Florida, Colorado, and Minnesota. Standardized focus group interviews are audiotaped, transcribed, translated into English, and systematically examined using grounded theory techniques. The qualitative findings answer three primary research questions about (a) the meanings of caregiving and caregiver self-definitions, (b) overall experience of Latino caregivers, and (c) caregivers' understanding of ADRD and the skills needed to manage the disease. The experience of Latino caregivers is described for each of the research questions, followed by a discussion in the context of the existent literature.
Tai Chi and Low Impact Exercise: Effects on the Physical Functioning and Psychological Well-Being of Older People
Authors: Frye Brian , Scheinthal Stephen , Kemarskaya Tatyana , Pruchno Rachel
Published: October 2007

The effects of tai chi (TC) and low impact exercise (LIE) interventions on physical functioning and psychological well-being of sedentary older people were contrasted. Participants were randomized to TC, LIE, or non-exercise control groups with interventions running for 12 weeks. Post-intervention assessments with 72 participants who completed the study revealed that participants in both exercise groups improved with respect to upper body strength, balance, cardiovascular endurance, lower body strength, sleep disturbances, and anxiety. Participants in the LIE group reported better functional ability while those in the TC group reported better subjective health. Findings suggest that tai chi and low impact exercise are safe, cost-effective ways to improve both physical and psychological functioning of older people.
Electrospun Nanofibers Surface-modified with Fluorescent Proteins
Authors: Suk Choi Ji , Sang Yoo Hyuk
Published: October 2007

Electrospun nanofiber surfaces are modified with proteins to control protein release. A mixture of poly(ε-caprolactone) (PCL) and PCL—PEG block copolymers is electrospun to prepare amine-terminated block copolymers. The amount of surface exposed amine groups increases as the blend ratio of block copolymer increases. Cell attachments on the nanofibers change according to the ratio of the block copolymer in the blend; this indicates that the PEG moiety plays a significant role in enhancing and decreasing biocompatibility of nanofibers. Fluorescent proteins are immobilized on the surface of nanofibers by conjugating activated carboxylic groups of the protein to the surface exposed amine groups of nanofibers in an aqueous environment. The number of amine groups increases as the ratio of block copolymers increases. Proteins that are chemically associated with the nanofibers show an attenuated release profile while most of the proteins physically associated with the nanofibers are released in 1 day. These results show that the protein-immobilized nanofibers can be potentially applied to tissue engineering scaffolds and wound healing materials with bioactive protein being slowly released over a long period of time.
Chitosan/Carboxymethyl Cellulose Polyelectrolyte Complex Scaffolds for Pulp Cells Regeneration
Authors: Chen Huangqin , Fan Mingwen
Published: October 2007

Novel polyelectrolyte complex (PEC) chitosan/carboxymethyl cellulose (CMC) scaffolds are prepared using a freeze-dry process. The microstructure is characterized by SEM and the average pore diameters and internal porosities are calculated. The morphology and distribution of pulp cells on these three-dimensional scaffolds are investigated by SEM and confocal laser scanning microscopy (CLSM). The expression of osteonectin (ON) and dentin sialophosphoprotein (DSPP) is detected by reverse transcription polymerase chain reaction (RT-PCR). The scaffolds are then implanted subcutaneously into BALB/c mice. The addition of CMC to chitosan decreases the pore diameter and increases internal porosity. The pulp cells co-cultured in these PEC scaffolds show improved adhesion, spreading, cell capacity, and three-dimensional configurations compared to pure chitosan scaffolds. Based on the data obtained, the chitosan/CMC complex provides an improved scaffold material for pulp tissue engineering.
Chitin Nanofibrils Linked to Chitosan Glycolate as Spray, Gel, and Gauze Preparations for Wound Repair
Authors: Mattioli-Belmonte M. , Zizzi A. , Lucarini G. , Giantomassi F. , Biagini G. , Tucci G. , Orlando F. , Provinciali M. , Carezzi F. , Morganti P.
Published: October 2007

Recent advances in process chemistry have made it possible to make chitosan and chitin nanofibril materials more flexible and useful for the development of new biorelated products. In this study, the effectiveness of three chitin nanofibril/chitosan glycolate-based preparations, a spray (Chit-A), a gel (Chit-B), and a gauze (Chit-C), in healing cutaneous lesions are assessed macroscopically and by light microscopy immunohistochemistry. These evaluations are compared to the results obtained using a laser co-treatment. The wound repair provided by the three preparations is clearly evident even without the synergistic effect of the laser co-treatment. These results confirm the effectiveness of chitin nanofibril/chitosan glycolate-based products in restoring subcutaneous architecture. The spray seems to be most effective in healing superficial lesions, including extensive ones; the gel is more effective in repairing shallow lesions as well as an aesthetic factor while the gauze is effective in slow-healing dermo-epidermal wounds.
Effect of Hydrolysis Pretreatment on the Formation of Bone-like Apatite on Poly(L-lactide) by Mineralization in Simulated Body Fluids
Authors: Jiao Yanpeng , Liu Zonghua , Cui Fuzhai , Zhou Changren
Published: October 2007

A bone-like apatite-coated surface that mediates a positive interaction between materials and bone is key to the development of desirable bone substitute materials. To incorporate apatite-coating on poly(L-lactide) (PLLA) surfaces, the effect of the hydrolysis of PLLA surfaces on the formation ability of bone-like apatite was investigated in this study.PLLA films and porous PLLA scaffolds were hydrolyzed for different time periods in alkaline solution and the hydrolyzed PLLA surfaces were characterized with X-ray photoelectron spectroscopy, atomic force microscopy, contact angle, and the measurement of carboxyl density. An apatite coating was formed by mineralizing the hydrolyzed PLLA in simulated body fluids (SBF) for 3 weeks and characterized. The hydrolyzed PLLA surfaces were rich in COOH and OH; the hydrophilicity, surface roughness, and carboxyl density increased with the hydrolysis time. After the incubation in SBF, a bone-like apatite layer with different morphology and composition was formed on the PLLA surfaces. The apatite formation on PLLA surfaces was promoted by the hydrolysis pretreatment and this increases with hydrolysis time. In addition, the compression module of the apatite-coated PLLA scaffolds increased compared with the pure PLLA scaffolds and increased with the hydrolysis time. The hydrolysis pretreatment was important in functionalizing the PLLA surfaces, facilitating subsequent apatite nucleation and apatite growth.
Joint attention, language, social relating, and stereotypical behaviours in children with autistic disorder
Authors: Delinicolas Erin K. , Young Robyn L.
Published: October 2007

This study aimed to investigate the relationships between abilities to initiate and respond to joint attention and symptoms of autism that have, and have not, been theoretically linked to joint attention. Participants were 51 boys and five girls with autistic disorder, aged between 2 years and 6 years 5 months. Measures of joint attention behaviours, language, social relating, and stereotypical behaviour were administered during a single assessment. As predicted, the correlations between joint attention and the two behaviours theoretically linked to joint attention (i.e. social relating and language) were significantly stronger than those between joint attention and the behaviour not theoretically linked (i.e. stereotypical behaviour). While causation cannot be inferred from this study, these results support the suggestion that difficulties with joint attention behaviours commonly found among children with autism are linked to language and social relating, beyond what might be expected simply due to their co-occurrence as symptoms.
The economic consequences of autistic spectrum disorder among children in a Swedish municipality
Authors: Järbrink Krister
Published: October 2007

In this study, the societal economic consequences of autistic spectrum disorder were investigated using a sample of parents of children identified with the disorder and living in a Swedish municipality. Cost information was collected using a postal questionnaire that was developed through experiences gained from an earlier study. Using conservative assumptions, the additional societal cost due to the disorder was estimated to be approximately 50,000 annually per child. Parents of children with the disorder spent an average of about 1000 hours per year additionally caring for and supporting their child. The study indicates that the major cost drivers for autistic spectrum disorder among children can be found within the community for support and schooling, while the major impact on relatives is on time spent and thereby quality of life rather than a financial burden.
Evaluation of the Relationship Development Intervention Program
Authors: Gutstein Steven E. , Burgess Audrey F. , Montfort Ken
Published: October 2007

This study is the second in a series evaluating the effectiveness of Relationship Development Intervention (RDI) to address unique deficits inherent in autism spectrum disorders. RDI is a parent-based, cognitive-developmental approach, in which primary caregivers are trained to provide daily opportunities for successful functioning in increasingly challenging dynamic systems. This study reviewed the progress of 16 children who participated in RDI between 2000 and 2005. Changes in the Autism Diagnostic Observation Schedule (ADOS) and Autism Diagnostic Interview—Revised (ADI—R), flexibility, and school placement were compared prior to treatment and at a minimum 30 month follow-up period. While all children met ADOS/ADI—R criteria for autism prior to treatment, no child met criteria at follow-up. Similar positive results were found in relation to flexibility and educational placement. Generalizability of current findings is limited by the lack of a control or comparison group, constraints on age and IQ of treated children, parent self-selection, and parent education conducted through a single clinic setting.
The relationship between executive functioning, central coherence, and repetitive behaviors in the high-functioning autism spectrum
Authors: South Mikle , Ozonoff Sally , Mcmahon William M.
Published: October 2007

This study examined the relationship between everyday repetitive behavior (primary symptoms of autism) and performance on neuropsychological tests of executive function and central coherence (secondary symptoms). It was hypothesized that the frequency and intensity of repetitive behavior would be positively correlated with laboratory measures of cognitive rigidity and weak central coherence. Participants included 19 individuals (ages 10—19) with high-functioning autism spectrum disorders (ASD group) and 18 age- and IQ-matched typically developing controls (TD group). There was partial support in the ASD group for the link between repetitive behavior and executive performance (the Wisconsin Card Sorting Task). There was no support for a link between repetitive behavior and measures of central coherence (a Gestalt Closure test and the Embedded Figures Test). Further research on repetitive behaviors in autism may benefit from a focus on narrow behavioral and cognitive constructs rather than general categories.
Screening for Indoor air Quality of Air-Conditioned Offices
Authors: Wong L.T. , Mui K.W. , Hui P.S.
Published: October 2007

It would be costly to sample all toxic air pollutants to which an entire community is exposed. In Hong Kong, a voluntary Indoor Air Quality (IAQ) certification scheme for IAQ assessment in workplaces proposes the measurement of the levels of 12 parameters: carbon dioxide, carbon monoxide, respirable suspended particulates, nitrogen dioxide, ozone, formaldehyde, total volatile organic compounds, radon, airborne bacteria count, temperature, relative humidity and air velocity. This study investigates the feasibility of a screening process for presumptive detection of unrecognised IAQ problems in an indoor environment. From the full IAQ assessment results of 422 air-conditioned offices in Hong Kong, three of nine listed common air pollutants are selected as ``representative'' pollutants for an overall ``satisfactory IAQ''. In particular, an ``IAQ index'' using the average fractional dose corresponding to given exposure limits of the representative pollutants as a simple screening test for asymptomatic IAQ problems in air-conditioned offices is proposed. The index was evaluated in terms of test sensitivity, specificity and predictive value. Such a screening test would be a useful tool for policymakers, building owners and professionals to identify offices with probable IAQ problems. Making better decisions regarding resources for an IAQ surveillance programme could help to ensure a healthy and safe workplace.
Determining Photosensor Conditions of a Daylight Dimming Control System Using Different Double-skin Envelope Configurations
Authors: Kim S.Y. , Song K.D.
Published: October 2007

Daylight responsive dimming control systems are analysed in a small office with a double-skin envelope to recommend better control alternatives for achieving target illuminance and better energy savings. Computer simulations are performed for photosensors positioned at three different locations in three different shielding conditions. These are applied in both northwards and southwards facing rooms. Daylight conditions included three sky types at different times of the day and year. Shading device conditions are: a horizontal blind on the external envelope, a combination of a horizontal blind on an external envelope and a retractable shading device on an internal envelope. A partially-shielded condition generally achieved good dimming performance under clear and intermediate cloudy skies. Regardless of position, the unshielded photosensors generally fails to achieve target illuminance, providing excessive dimming levels for all tested daylight conditions. Reasonable lighting energy savings are achieved. The savings were not critically influenced by the photosensor positions, but rather are impacted significantly by the sky conditions. Linear prediction models are studied to determine the relationship between photosensor signals and workplane illuminance according to photosensor conditions. The models are acceptable with low significance levels. The linear correlation is best for the partially-shielded condition, but the correlation is weaker for the fully-shielded photosensor.
Assessment of the Emission Characteristics of VOCs from Interior Furniture Materials during the Construction Process
Authors: Pang S.K. , Cho Hyun , Sohn J.Y. , Song K.D.
Published: October 2007

In this study, the indoor concentrations of pollutants from different materials that are used in kitchens and living rooms are measured during the construction process. The measurements are carried out in three households: the first is built using only conventional materials, the second household uses some environmentally sound materials and the last uses nothing but environmentally sound materials. The construction stage that had the greatest effect on indoor pollutant concentration is evaluated after installing all of the materials and measuring the indoor concentrations throughout the construction process. The pollutant concentration is measured 10 times at different stages of construction and in the days following the completion of construction. Results show that the living room and kitchen furniture made of particle board and MDF emits the largest amounts of pollutants. In addition, of all the pollutants measured, including benzene, toluene, ethylbenzene, styrene, 1,4-dichloro-benzene and formaldehyde, only toluene did not satisfy the Indoor Air Quality Management Act of Korea. The toluene concentration increase rapidly after the introduction of kitchen and living room indoor furniture. This is due to the material of which the furniture is composed and these results are validated using a small chamber method.
Assessment of Bioaerosols in the Public Buildings of Korea
Authors: Kim Ki-Youn , Park Jae-Beom , Jang Gyu-Yeob , Kim Chi-Nyon , Lee Kyung-Jong
Published: October 2007

The concentration of airborne bacteria and fungi in public buildings is regulated by law in Korea. Levels are investigated during the moderate seasons, spring (March—May) and autumn (September—November), using a six-stage cascade impactor. Total concentrations of airborne bacteria and fungi range from 290 to 940 cfu · m-3 and 330 to 540 cfu · m -3, respectively. The levels of airborne bacteria and fungi are significantly highest in a kindergarten building and lowest in an elderly welfare facility ( p<0.05). The ratio of respirable to total concentration range from 30 to 40% for airborne bacteria and from 55 to 70% for airborne fungi but there is no significant difference among the public buildings examined ( p>0.05). The mean ratios of indoor and outdoor concentrations of airborne bacteria and fungi are below 1.0 regardless of the fraction of particle size and building type. The indoor concentration of airborne bacteria and fungi do not correlate significantly with indoor temperature and relative humidity ( p>0.05). However, this does have a significant positive correlation with CO2 and the number of people per area of the sampling site ( p<0.05), which implies that the activity of residents has considerable effect on the levels of both airborne bacteria and fungi.
Review: Indoor Nitrogen Dioxide and VOC Exposures: Summary of Evidence for an Association with Childhood Asthma and a Case for the Inclusion of Indoor Ultrafine Particle Measures in Future Studies
Authors: Weichenthal Scott , Dufresne Andre , Infante-Rivard Claire
Published: October 2007

Childhood asthma is a complex disease having both genetic and environmental risk factors. As such, it is important to identify indoor exposures that may contribute to asthma symptoms in order to minimise the likelihood of disease onset or exacerbation. Here we summarise epidemiological evidence regarding the potential relationship between indoor nitrogen dioxide, volatile organic compounds (VOCs) and childhood asthma. In general, VOC exposure studies have been more consistent in demonstrating a significant relationship with asthma or related symptoms, and studies of indoor nitrogen dioxide exposure are limited in that most do not control for indoor VOC exposures. Therefore, when possible, future studies should include both types of exposure measures as well as those for other potential risk factors such as ultrafine particles that have been shown to contribute to airway inflammation.
An Adaptive Demand-Controlled Ventilation Strategy with Zone Temperature Reset for Multi-Zone Air-Conditioning Systems
Authors: Xu Xinhua , Wang Shengwei
Published: October 2007

In air-conditioning systems serving multiple zones, conventional ventilation strategies often result in over-ventilation in some zones with under-ventilation in the other zones when the heating/cooling load and occupancy profiles of zones differ greatly. This article presents an adaptive demand-controlled ventilation (DCV) strategy for multi-zone air-conditioning systems, which employs real-time occupancy identification using the dynamic multi-zone ventilation equation and zone temperature set-point reset of critical zones. The strategy identifies the critical zones, and fully considers the outdoor air demand of critical zones and the unvitiated outdoor air in the re-circulated air from the other zones. The air temperature reset of critical zones results in the increase of their supply air fractions and therefore the amount of outdoor air delivered to the critical zones. Consequently the total outdoor airflow demand and the overall energy consumption are reduced while the ventilation of critical zones is satisfied. This adaptive DCV strategy is validated by comparing its energy and environmental performances with other typical ventilation strategies under various weather conditions.
Comparison of the Energy, Time and Water Usage Required for Maintaining Carpets and Hard Floors
Authors: McCall R.A. , McNeil S.J.
Published: October 2007

The energy, time and water usage required for cleaning carpets and hard floors (solid vinyls, wood and wood laminates) in commercial buildings are compared. The electrical energy requirements for both types of flooring are similar for areas with heavier traffic volumes. For all other areas, carpets require slightly more electrical energy, but less human energy, water and time to clean than hard floors. The greatest difference is in the consumption of water, with hard floors requiring up to 40 times more than carpet, depending on the amount of traffic. This work has shown that maintaining carpets has a lower overall environmental impact than maintaining hard floors.
An Indoor Environmental Quality Investigation of the Fayette County (Pennsylvania) Courthouse
Authors: Martin Stephen B. , Coffey Christopher C.
Published: October 2007

The National Institute for Occupational Safety and Health (NIOSH) conducted a health hazard evaluation (HHE) investigation in the basement of the Fayette County Courthouse in Uniontown, Pennsylvania. Employees had reported a variety of health complaints including headaches, throat irritation, eye irritation, nausea, fatigue and nasal/sinus symptoms. Potential causes of the complaints included excessive mould/ mildew, lack of air flow, odours and high dust levels. A number of locations showing signs of water incursion or leakage were found to have mould growth. The air flow provided by the ventilation systems in most areas was inadequate, although temperature, relative humidity and carbon dioxide levels largely met published recommendations. Levels of common volatile organic compounds were all below established exposure limits, and only toluene was found in concentrations above established odour thresholds.
A Method for Calculating a Ventilation Bypass Factor
Authors: Liu Zhe , Zhao Bin , Yang Xudong
Published: October 2007

The ventilation bypass factor (marked as S) is a simple and straightforward indicator describing the fraction of the supply air that bypasses the occupied zone of a ventilated room. Except for some special circumstances, this factor is very difficult to estimate quantitatively. In this article, a method for calculating S by computational fluid dynamics tools is proposed. Fine particles with small inertia that can be regarded as moving integrally with air are released at the air supply inlet to represent the air path lines. S is calculated by stating the trajectories of the particles that enters/bypasses the occupied zone. A ventilation situation is modelled numerically to demonstrate the detailed procedure of the method. This new method makes it possible to estimate quantitatively the ventilation bypass factor and use it as a guide for ventilation design.
Watching paint dry: the sequentiality of idiomatic expressions in NS-NS and NS-NNS talk-in-interaction
Authors: Eerdmans Susan L. , Di Candia Micaela
Published: October 2007

Conversation analysis research on naturally occurring NS-NS talk-in-interaction (Drew and Holt, 1988, 1995, 1998; Holt and Drew, 2005) has revealed that participants observably orient to shared expectations of the socio-interactional role of idiomatic expressions, particularly with regard to topic termination and transition. This study has analysed NS-NNS, as well as NS-NS, spontaneous conversation in order to evaluate and uncover recurrent features associated with the use of such expressions. Two main sequential patterns have been observed: one, occurring in both NS-NS and NS-NNS talk, is connected with topic termination and transition, in some (NS-NS) cases being extended to allow for the negotiation of interactional alignment between participants; the other, a `negotiative metatalk sequence', follows idiomatic expressions at points of possible topic conclusion and deals with NS-NNS trouble spots in which conversational participants' lack of shared understanding triggers coordinated negotiatory action that clears the way for the introduction of a new topic.
Managing affect: integration of empathy and problem-solving in health care encounters
Authors: Ruusuvuori Johanna
Published: October 2007

This study describes the ways in which professionals in two contexts of health care: general practice and homeopathic consultations, respond to patients' affective expressions of a trouble or a problem. The focus is on the turns of professionals that display understanding, compassion or agreement with the patient's account. Different types of affiliative turns are described and their consequences for the following interaction are scrutinized in relation to the institutional task of solving the patients' health-related problems. It is shown that in both contexts, affiliation is oriented to as working towards closing the sequence of troubles-telling and serves to shift back to problem-solving activity, whilst in homeopathy, it may also serve as a means to problem-solving and thus help to complete the institutional task at hand. Some implications of these observations for professional—client interaction will be described. To conclude, the role of emotion in institutional interaction will also be discussed.
Moral stance in the workplace narratives of novices
Authors: Vásquez Camilla
Published: October 2007

Recent work on workplace narratives as a site for the discursive construction of professional identities has focused on speakers who can be considered experienced and knowledgeable experts in their fields (e.g. university professors, business managers). The present study, in contrast, explores two types of workplace narratives — reflective and relational narratives — produced by a group of professionals who are non-experts: in this case, novice language teachers. Specifically, the article illustrates how the moral stance that a novice constructs within a narrative may be formulated in uncertain terms, may be destabilized by the primary narrator, or may be subject to revision by other participants. Finally, the study highlights the relationship between the narrative dimensions of moral stance and tellership, and suggests that participant structure, participants' role relationships, and institutional power asymmetry are especially relevant factors to consider in any further analyses of novices' workplace narratives.
From informational to emotive use: meiyou (`no') as a discourse marker in Taiwan Mandarin conversation
Authors: Wang Yu-Fang , Tsai Pi-Hua , Ling Meng-Ying
Published: October 2007

Discourse marker analysis has been widely studied, leading Fraser (1998: 301) to call this subject `a growth market in linguistics'. In our present research, we extended the study of discourse markers to the Chinese marker meiyou, which has traditionally been treated as a negator (e.g. Biq, 1989; Teng, 1973a, 1973b, 1975). The corpus studied here contains 40 conversations, totaling 482'27”. The analytical framework adopted in the study was drawn from van Dijk's model (1979), which mainly consists of a semantic/textual level (i.e. sequences of utterances/propositions) and a pragmatic/interactional level (i.e. speech-acts). A total of 141 occurrences of meiyou were identified as discourse markers in the corpus: 13 of them occur at the textual level and 128 of them at the interactional level. Thus, meiyou occurs more frequently at the interactional level than at the textual level. At the textual level, meiyou introduces an answer to a self-inquiry or self-correction. At the interactional level, meiyou mainly serves as a response to provide information, as a marker of correction/clarification or evasion, and as a response to praise or gratitude. In particular, with respect to meiyou's interactive functions, we use the concepts of preference structure (Sacks et al., 1974) and face-threatening acts (Brown and Levinson, [1978] 1987) to analyze the collected data. We further demonstrate that intersubjectification (Traugott and Dasher, 2002), a mechanism whereby meanings become more centered on the addressee, is involved in the development of the discourse marker meiyou.
Simulated presence therapy, attachment and separation amongst people with dementia
Authors: Cheston Richard , Thorne Kirsty , Whitby Paul , Peak Jennifer
Published: October 2007

This article examines the impact of Simulated Presence Therapy (SPT) on the behaviour of six people with moderate or severe levels of dementia. Twenty-one sessions involving both SPT and a control condition (usual care) were carried out. SPT interventions were associated with lowered levels of both distressed behaviour and efforts to return home.
Consulting with stakeholders: Using the expertise of researchers, professionals, carers and older people in systematic reviews
Authors: Moriarty JO , Manthorpe Jill , Wilcock Jane , Iliffe Steve
Published: October 2007

This article describes a consultation event held as part of the process of reviewing the qualitative evidence for the National Institute for Clinical Excellence (NICE) and Social Care Institute for Excellence Guidelines (SCIE) on dementia (2006). It shows how events such as these can provide valuable information to be included in systematic reviews but also help identify research priorities for the future.
Two Days in December
Authors: Dartington Tim
Published: October 2007

Tim Dartington has drawn on contemporaneous documents, diary notes and more recently a blog, in putting together this account of two days out of six years. Anna was a psychotherapist and writer on adolescence until she took early retirement in 2000 and underwent tests for Alzheimer's disease. She died at home in May 2007. In his description of his own thought processes and associations to the progression of the disease, Tim has included detail from his observation of ways that Anna managed herself in relation to the illness, and also her verbatim comment. Anna has written her own account of the illness, `My Unfaithful Brain' (Davenhill, 2007).
`Making mistakes'
Authors: Keady John , Williams Sion , Hughes - Roberts John
Published: October 2007

This paper outlines the use of a new qualitative research approach, Co-Constructed Inquiry, to develop a personal theory of the experience of living and adjusting to an early diagnosis of Alzheimer's disease. The personal theory was developed over a 21-month period (March 2004—December 2005) between Sarah, a person with Alzheimer's disease, and a clinical nurse specialist at a memory clinic in North Wales, John Hughes-Roberts. The resulting work suggested that Sarah co-constructed her experience of living with the onset of Alzheimer's disease as a process of `making mistakes' and that her life story was a powerful influence in mediating and enhancing her coping behaviour. Moreover, a sequence of `balancing' acts, i.e. losing balance — finding balance — keeping balance, which Sarah visualised as the `up and down' motion of a see-saw, both conceptualised and diagrammed her early adjustment experience. Sarah's personal theory has implications for practice and research development.
Living with dementia
Authors: Crichton Jonathan , Koch Tina
Published: October 2007

This article describes an ongoing interdisciplinary research study1 with community-dwelling people living with dementia. The article focuses on one person living with dementia, her family and support group. Seven people were interviewed and their stories woven into one narrative. Our interest is in her self-identity, which we explore through a participatory story-telling approach. In gathering stories with all people who are significant in her life we have observed that what is driving the stories is an ethical imperative that is shared across her social network. We have described this as an imperative to `curate' her self-identity. `Curation' combines telling `about', `for' and potentially `with' the person living with dementia in interactions which reproduce and reconfirm her self-identity. We propose that the notion of curation offers a way in which people, research participants, significant others and health care professionals, can think differently about living with dementia. In particular, we argue that curation enables the person to be acknowledged in interaction as an individual with a coherent, evolving identity which spans past, present and future.
Sustaining `couplehood'
Authors: Hellström Ingrid , Nolan Mike , Lundh Ulla
Published: October 2007

This article explores the strategies that spouses use in order to live positively when one partner has dementia. Data were collected from 152 interviews with 20 couples conducted over a period of five years. Using a constructivist grounded theory methodology, data were analysed to capture the main processes involved and charted how these changed over time. Three main phases were identified termed: `sustaining couplehood'; `maintaining involvement'; and `moving on', that operated in an iterative rather than linear fashion. The data highlight the very active role played by both partners, especially in the early stages of the disease, as they strive to maintain the quality and closeness of their relationship by creating what we term a `nurturative relational context'. The diverse strategies that the couples adopt are presented, and the gradual way in which the person with dementia `hands over' or `let's go' of responsibility to their partner is described. The article provides several new insights into the nature of spousal relationships in dementia and the ways in which they seek to maximize their quality of life, and, wherever possible, sustain couplehood.
Working together with persons with early stage dementia and their family members to design a user-friendly technology-based support service
Authors: Hanson Elizabeth , Magnusson Lennart , Arvidsson Helene , Claesson Anette , Keady John , Nolan Mike
Published: October 2007

This article describes how researchers, practitioners and technicians in West Sweden worked together with older people with early stage dementia and their family members to develop a user-friendly technology-based information, education and support service, based on the generic ACTION participatory design model. Ways of working in partnership with older people with early stage dementia and their family members are explored, and key lessons learned are highlighted. The overriding message is that elders with early stage dementia can be actively involved throughout the entire research and development process. Essential prerequisites are time and ongoing support by skilled practitioners and family members. Preliminary findings reveal that older people with early stage dementia can learn and benefit from user-friendly technology, especially when used together with others in a similar situation.
Pseudoaneurysm After Patch-free Carotid Bifurcation Endarterectomy: A Case Report
Authors: De Filippo Carlo Maria , Modugno Pietro , Nasso Giuseppe , Canosa Carlo , Spatuzza Paola , Testa Nicola , Calvo Eugenio , Giuffreda Matteo , Anselmi Amedeo , Alessandrini Francesco
Published: October 2007

The purpose of this report is to present the case of a 59-year-old man affected by multivessel coronary artery disease and sterile pseudoaneurysm of the right carotid bifurcation presenting as a pulsating neck mass 1 month after patch-free carotid endarterectomy. The surgical approach included median sternotomy and incision parallel to the anterior margin of the right sternocleidomastoid muscle. The pseudoaneurysm was excised after control of the brachiocefalic trunk and insertion of a Pruit-Inahara shunt, and the carotid vessels were directly sutured without using any prosthetic or autologous material. Concomitant coronary bypass grafting was performed. The postoperative course was uneventful and there was no evidence of recurrence of pseudoaneurysm at 6-month follow-up. On the basis of this experience and of pertinent literature, the options for the management of such rare entities are discussed.
Combined Surgical and Endovascular Repair of a Ruptured Bilateral Aortoiliac Aneurysm
Authors: Riera del Moral L. , Gutierrez Nistal M. , Stefanov Kiuri S. , Fernandez Alonso S. , Garzon Moll A. , Riera de Cubas L.
Published: October 2007

Aortoiliac aneurysms are frequent entities that have very important clinical implications, especially in the younger patients. We are asked not only to save lives by preventing the rupture or repairing those that are already ruptured but also to provide an acceptable quality of life in the postoperative period. Endovascular approaches certainly give us such an expectative but are not clearly indicated in our younger patients and cannot be used routinely in those aneurysms with a yuxtarrenal origin. This is the case report of a young man with a yuxtarrenal aortoiliac inflammatory aneurysm that was treated by the interposition of an aortobifemoral bypass with the addition of endovascular devices in the hypogastric vessels to preserve the pelvic blood flow; they contribute to seal the common iliac aneurysms. This approach was useful to avoid complications during a difficult iliac dissection and was permeable within 1 year of the operation. Durability must be assessed.
Percutaneous Recanalization of the Occluded Iliac Artery: Examples, Techniques, and Complications
Authors: Amankwah Kwame S. , Costanza Michael J. , Gahtan Vivian
Published: October 2007

Recanalization of an occluded iliac artery represents a technically challenging endovascular technique. Prior to attempting recanalization, the operator must have an approach in mind and understand the risks and complications associated with this endeavor. In this article, the authors provide 2 cases and review the techniques and complications associated with iliac artery recanalization.
Changes in Blood Flow of Anterior and Middle Cerebral Arteries Following Carotid Endarterectomy: A Transcranial Doppler Study
Authors: Maltezos C.K. , Papanas N. , Papas T.T. , Georgiadis G.S. , Dragoumanis C.K. , Marakis J. , Maltezos E. , Lazarides M.K.
Published: October 2007

Aim: The aim of the present study was to evaluate the changes in blood flow of anterior and middle cerebral arteries following carotid endarterectomy, using transcranial Doppler (TCD) flow studies.

Patients and methods: This study included 100 patients (72 men, mean age 65 years) who underwent carotid endarterectomy because of high-grade carotid stenosis or symptoms of ischemic stroke. Endarterectomy was performed by a distal shunt between the common carotid and internal carotid arteries. Blood flow in the anterior and middle cerebral arteries was assessed by TCD preoperatively and also in the postoperative period (1st and 4th day; 1st, 6th, and 12th month). Collateral circulation in the Willis circle was evaluated by common carotid compression.

Results: Patients with bilateral carotid stenosis ≥70% exhibited a significantly increased flow velocity in the ipsilateral anterior cerebral artery (ACA), middle cerebral artery (MCA), and in the contralateral ACA. Patients with entirely occluded contralateral internal carotid artery showed the most pronounced changes in cerebral hemodynamics. Blood flow velocities returned to the preoperative values at 1 to 12 months following endarterectomy. Hyperperfusion syndrome was manifested in 14 patients, who exhibited significantly higher flow velocities in the ipsilateral MCA compared with asymptomatic patients.

Conclusions: A transient bilateral increase of blood flow velocity in the anterior part of the Willis circle may often occur in the immediate postoperative period following carotid endarterectomy. Although its clinical significance is not entirely understood, this increase may be associated with cerebral hyperperfusion syndrome.
Nonatherosclerotic Pathology of the Neck Vessels: Prevalence and Flow Patterns
Authors: Labropoulos Nicos , Leon Luis R. , Gonzalez-Fajardo Jose A. , Mansour Ashraf M. , Kang Steven S.
Published: October 2007

Objectives: To determine the prevalence and flow characteristics of nonatherosclerotic pathologies of the cervical vessels.

Design: From 1997 to 2003, 11 480 ultrasound tests were performed for neck vessel evaluation on patients with cerebrovascular symptoms and trauma, and on asymptomatic patients with a bruit, cervical mass, or prior to aortocoronary bypass. When necessary, these findings were confirmed by other imaging modalities.

Results: A total of 3010 repeated tests were excluded, leaving 8470 patients. The prevalence of nonatherosclerotic pathologies (n = 55) was 0.65%. The most common was thromboembolism (n = 19, 0.22%), followed by dissection (n = 16, 0.19%), carotid body tumors (n = 5, 0.06%), aneurysms (n = 4, 0.05%), fibromuscular dysplasia (n = 4, 0.05%), Takayasu's arteritis (n = 1, 0.01%), pseudoaneurysms (n = 5, 0.06%), and arteriovenous fistulae (n = 1, 0.01%). Cerebrovascular symptoms were present in 27 patients (49%).

Conclusion: Nonatherosclerotic pathology accounts for 0.65% of patients referred for neck vessel evaluation. About half of them are symptomatic. Diagnosis of these pathologies and knowledge of their flow characteristics is important for patient management.
Abdominal Aortic Aneurysm With Ectopic Renal Artery Origins: A Case Report
Authors: Kotsis T. , Mylonas S. , Katsenis K. , Arapoglou V. , Dimakakos P.
Published: October 2007

The coexistense of an abdominal aortic aneurysm with ectopic main renal vasculature complicates aortic surgery and mandates a focused imaging evaluation and a carefully planned operation to minimize renal ischemia. We present the case of a 75-year-old man with an abdominal aortic aneurysm and a right kidney with two ectopic main renal arteries, one originating from the aneurysmal distal aorta and the other from the right common iliac artery; the patient underwent a surgical repair and followed an uneventful course with no deterioration of renal function. The preoperative and intraoperative details are reported, along with a review of the literature.
The Effects of Toradol on Postoperative Intimal Hyperplasia in a Rat Carotid Endarterectomy Model: Laboratory Research
Authors: Kalapatapu Venkat R. , Satterfield Leighton , Brown Aliza T. , Hongjiang Chen  , Ercal Nuran , Price Tulin O. , Jie Gao  , Ibrahim Khalil , Moursi Mohammed M.
Published: October 2007

Carotid endarterectomy (CEA) and more recently carotid artery stenting are the treatments of choice for atherosclerotic disease of the extracranial carotid arteries; however, early restenosis caused by neointimal hyperplasia confounds surgical therapy. Oxidative stress has been implicated in the progression of intimal hyperplasia. The authors hypothesized that ketorolac tromethamine (Toradol), a nonsteroidal antiinflammatory drug that is a potent cyclooxygenase inhibitor, would decrease oxidative stress and thereby reduce intimal hyperplasia in a rat CEA model. Twenty-nine male Sprague-Dawley rats underwent CEA and were divided into 3 treatment groups as follows: (1) control (placebo), (2) 7.5 mg/kg Toradol, and (3) 10 mg/kg Toradol. Toradol treatment began 2 days before CEA and continued for 2 weeks. Two weeks after endarterectomy, carotid arteries were fixed, harvested, and examined for platelet activity (platelet reactive units), oxidative stress (malondialdehyde and glutathione), and intimal hyperplasia (measured as percentage of luminal stenosis). Platelet activity, malondialdehyde and glutathione, and intimal hyperplasia were all significantly lowered in both 7.5- and 10-mg/kg doses of Toradol versus control. Toradol given daily beginning 2 days before CEA and ending 2 weeks after the procedure was effective at significantly reducing platelet activity, oxidative stress, and intimal hyperplasia development in the rat without any increase in bleeding. Although the mechanism of action of this reduction is not completely understood, one possible explanation may be through the inhibition of reactive oxygen species production.
A Diagnostic Dilemma: Does Peri Stent-Graft Air After Thoracic Aortic Endografting Necessarily Imply Infection?
Authors: Leon Luis R.
Published: October 2007

The radiographic finding of air bubbles around a surgically placed prosthetic graft is traditionally assumed to be a sign of infection until proven otherwise. Direct delivery of atmospheric air bubbles, shown in an imaging study performed very soon after a surgical intervention, or percutaneously introduced during an endovascular procedure could be possible causes of air bubble presence and not necessarily infection. However, if air around a prosthetic aortic graft is identified in an imaging study after a previous one did not document its presence, or if the amount of air is increasing on serial imaging studies, the suspicion level should increase. The case presented here is of a 49-year-old male who underwent an endovascular repair of a possible symptomatic penetrating aortic ulcer, who was found to have peri stent-graft air 3 weeks after intervention. Previous imaging postoperative studies did not reveal air around the aortic prosthesis. The diagnosis of endovascular stent-graft infection was very difficult due to several challenging factors that are herein presented.
Diagnosis of Abdominal Aortic Prosthesis Infection With FDG-PET/CT
Authors: Balink Hans , Reijnen Michel M. P. J.
Published: October 2007

A 79-year-old man was referred with recurrent periods of fever and chills. Six years earlier an aortic bifurcation graft had been implanted. Blood examination showed elevated infection parameters. A regular computed tomographic (CT) scan in the previous hospital showed no signs of graft infection. When blood cultures revealed multiple enteric bacteria, a 2-deoxy-2-[F18]fluoro- d-glucose-positron emission tomographic/CT (FDG- PET/CT) scan was performed that demonstrated ring-shaped pathological uptake at the proximal anastomosis. The patient was operated on and an infected graft was found, with a 1-cm defect in the distal part of the duodenum. Bacterial cultures of the explanted graft were positive. The patient recovered well from surgery and is on a regimen of prolonged antibiotic and antimycotic treatment.
Outcome Analysis of Carotid Artery Occlusion
Authors: Alexander J. Jeffrey , Moawad John , Super Dennis
Published: October 2007

The outcome of carotid artery occlusion was studied through the retrospective identification of 115 affected patients. The majority were white (77%) males (61%) with multiple atherogenic risk factors and suffering ipsilateral stroke (57%). Those patients presenting with stroke were not distinguished by demographic features, risk factors, lipid profile, medical regimen, or subsequent mortality when compared with those without. Overall, 36 patients (31%) required contralateral carotid endarterectomy (CEA), with one (2.8%) perioperative stroke, whereas 4 (3%) underwent ipsilateral external CEA without incident. With 81% follow-up (mean 3.9 years), the overall mortality of the group was 46%; the annualized risk of ipsilateral stroke was 1.6%. This study documents a significant risk of stroke and contralateral occlusive disease with ipsilateral carotid artery occlusion, which cannot be reliably predicted by clinical criteria. Duplex surveillance is valuable, but flow velocity measurements alone may be misleading. Surgical endarterectomy can be performed with an acceptable rate of perioperative stroke.