bluuebunny/crossref_metadata_2025 huggingface dataset:
Defining Response and Attaining Therapeutic Goals for Depression
Authors: House Naomi A. , Sommi Roger W.
Published: April 2004

Depression is a cyclic disease with treatment that progresses through an acute, continuation, and maintenance phase, all with different therapeutic goals. Many terms are used to define therapeutic goals and/or treatment response including response, remission, recovery, relapse, and recurrence. For a pharmacist to be effective in working with a patient and their health care team when managing depression, they must have a clear understanding of these terms. A pivotal role for the pharmacist is monitoring a patient’s response to treatment, especially during the acute phase when many stop their therapy. A careful assessment for response is needed 4 to 6 weeks after starting therapy and also 4 weeks after any dosage adjustment or change in antidepressant. Continued assessments for response and or relapse are needed throughout the continuation phase. By understanding the overall approach to treating depression, along with the specific terms associated with response, the pharmacist can make a meaningful contribution to a patient’s treatment strategy.
Antidepressants: Using Pharmacology to Individualize Therapy
Authors: Dugan Daniel J.
Published: April 2004

The pharmacotherapy of depression has undergone significant change in the last two decades. A new generation of antidepressant agents has displaced older drugs as first-line therapies for depression. The clinician that seeks optimal outcomes for treatment of depression must be familiar with all of the available antidepressant agents. This article will discuss the pharmacologic profile of antidepressants currently marketed in the United States, identifying similarities and differences that have clinical relevance in the management of depression. Drug selection with an emphasis on antidepressant receptor affinity will be reviewed.
The Circle of Health
Authors: Saylor Coleen
Published: April 2004

Beginning with a holistic definition in ancient times, the predominant American definition of health now focuses on physical health and disease symptoms. This limited definition of health is an inadequate foundation for holistic health care strategies. This article provides a conceptual model with an expanded definition of health as a basis for holistic and conventional health strategies. The model includes concepts of balance, energy systems, and mind-body integration from non-Western health practices. Aholistic definition of health suggests an expanded range of positive, pleasurable health behaviors. The visual representation of the model can be used by health care professionals and clients to identify disease reduction strategies or a health improvement program for well individuals. Understanding and expanding the conceptualization of health and health improvement strategies offers the possibility of improving client satisfaction and health status outcomes.
“Making Special”
Authors: Gaydos H. Lea Barbato
Published: April 2004

Holistic nurses demonstrate interest in and concern for aesthetics in nursing; however, the relationship of holistic nursing to aesthetics in nursing lacks clarity. Challenges to the study of aesthetics in nursing arise from too little discourse on the topic and lack of consensus on language and methods of inquiry. Nevertheless, aesthetic knowing is a fundamental pattern of knowing in nursing and the one that mediates and integrates all other patterns of knowing in nursing action. A behavioral theory of aesthetics provides a framework for exploring the relationship of holistic nursing to aesthetic knowing and the art of nursing. Synthesis of this framework with holistic nursing core values and standards of practice suggests that holistic nursing is more than perspective; it is an aesthetic.
Professional Corporate Donation Programs in Canada: An Exploratory Study
Authors: Dunn Paul
Published: April 2004

This article reports the results of an exploratory study on corporate philanthropy using a sample of 206 Canadian companies. The results show that a corporation is more likely to have a professional donation program if it is large, privately owned, and the manager of the corporation acts as a volunteer fundraiser for a charitable organization. The second part of the study finds that the level of contributions made is positively related to the size of the organization and whether it has a professional donation program. However, economic constraints, imposed by debt covenant restrictions, reduce the amount donated. Finally, the results indicate a reciprocal relationship between the existence of a professional donation program and the level of philanthropic contributions.
Giving to Secular Causes by the Religious and Nonreligious: An Experimental Test of the Responsiveness of Giving to Subsidies
Authors: Eckel Catherine C. , Grossman Philip J.
Published: April 2004

Although evidence indicates that religious persons are more generous on average than nonreligious persons, little work has been done to determine if this greater generosity is a general pattern or is, rather, specific to church-based institutions. Limited research addresses if, or how, religious and nonreligious givers respond to subsidies. This article uses experimental data to examine differences in the amount and pattern of giving to secular charities in response to subsidies by self-identified religious and nonreligious participants. The results indicate no significant difference in either the amount or pattern of giving or in the response to subsidies by religious and nonreligious participants; however, giving by religious participants is significantly more responsive to income changes than giving by nonreligious participants.
The Challenges of Globalization for Northern International Relief and Development NGOs
Authors: Lindenberg Marc , Dobel J. Patrick
Published: April 2004

This article begins by describing the process and effects of globalization over the past 20 years. With the decline in state capacity, changes in the global economy, and the end of the cold war, the environment within which NGOs operate has been much changed. As a result, NGOs have been forced to face the challenges of globalization of the NGO sector. The authors detail how relief and development organizations have responded to these challenges, both internally and externally, and also propose new possibilities for global NGO cooperation and network building.
The Challenges of Globalization of International Relief and Development
Authors: Biberson Philippe , Jean François
Published: April 2004

This article begins with a look at the role played by Mædecins Sans Frontières (MSF) since its inception in 1971, and then looks at the challenges facing MSF today. It focuses on the confusion of humanitarian and political roles and on the goals MSF has laid out for itself to address this confusion. Humanitarian aid has become the favored response of governments to political crises, and governments have increasingly turned to NGOs to carry out their policies. In turn, NGOs have become increasingly dependent on governments for financial support. These changes have politicized aid delivery and made it difficult for NGOs to maintain their independence. In addition, as the number of NGOs increases and their activities become more specialized, there are pressures toward institutionalization and bureaucratization. To respond to these challenges, MSF has identified several goals, including maintaining organizational independence and flexibility and avoiding bureaucratization.
The Challenges of Globalization: Save the Children
Authors: Gnaerig Burkhard , Maccormack Charles F.
Published: April 2004

International NGOs must change and develop globally to capitalize on the opportunities of globalization and to face new challenges as they emerge. Concepts of national limitation are becoming increasingly incongruous with technological and economic development. There is an urgent need to create a democratic system at a global level. NGOs could push this forward. NGOs attempting to become global players will have to encompass the global community in their governance structures while tailoring their approaches to advocacy, programs, and fund-raising to reflect specific national or regional styles and priorities. To survive and thrive in an environment of continuous change, NGOs will have to develop an internal culture of change. These demands will select all but a handful of highly professional global NGOs, a number of narrowly specialized (inter)national NGOs, and innumerable local neighborhood initiatives, leaving little space for medium-sized or semiprofessional NGOs.
Evolving Global Structures and the Challenges Facing International Relief and Development Organizations
Authors: Foreman Karen
Published: April 2004

Most current executives of the largest international relief and development organizations (NGOs) expect their organizations to move toward more global governance structures that incorporate fully vested partners from the north and south. This article seeks to pre- sent the potential opportunities and challenges of transition to a global governance structure. As NGOs have adapted their governance structures to the pressures of globalization, two variations of the international federation structure have emerged: the donor-member-dominated federation and the global bumblebee federation. The governance histories of World Vision International and Habitat for Humanity International reveal how these two structures may evolve. NGOs considering transition to a global governance structure can expect to deal with management issues such as role conflicts, staff skills, and maintenance costs. Global structures provide the framework within which NGOs can engage multiple stakeholders, but global structures must be accompanied by complementary management systems to fully use their strengths and avoid their weaknesses.
Exploring Organizational Culture: Teaching Notes on Metaphor, Totem, and Archetypal Images
Authors: Starr-Glass David
Published: April 2004

The author introduces an experiential appreciation of organizational culture into a strategic management course. Students were asked to retrieve and to reflect on metaphors, totemic systems, and archetypal imagery associated with their college. Each technique was selected to explore the oblique views of organizational process and dynamics that students possessed. Initially, this encounter was designed to sensitize students to alternative strategic considerations. Although this may have been partially realized, it seems that the experience was more significant in allowing students to realize that they had unconscious impressions of an organizational culture and that these sentiments contributed to their interaction with the college.
Sewers, Garbage, and Environmentalism in Brazil
Authors: Tesh Sylvia N. , Paes-Machado Eduardo
Published: April 2004

Public opinion polls indicate that Brazilians think that urban sanitation isa major environmental problem. Many committed environmentalists agree. And indeed, the majority of Brazilians face unreliable or nonextent garbage collection, scare drinking water, open-air sewers, unpaved streets, and water ways and beaches that are polluted with domestic waste. Despite this situation, Brazilian environmental-movement organizations pay scant attention to sanitation. Most of them emphasize instead the preservation of natural resources and the prevention of industrial pollution. To account for this disjunction between public opinion about environmental problems and the agenda of environmental-movement organizations, we offer three explanations. One focuses on the political context in which the movement was born and on that in which it matured, one focuses on the range of resources movement organizations have at their disposal, and one focuses on the fit between urban sanitation and principles of environmentalism.
Personality Traits and Critical Thinking Skills in College Students
Authors: Clifford Jennifer S. , Boufal Magdalen M. , Kurtz John E.
Published: April 2004

The two-factor theory defines critical thinking skills as a combined effect of cognitive abilities and personality dispositions. Although the available research supports the association between critical thinking and measures of cognitive ability, the specific traits contained in the dispositional factor have not been clearly identified through empirical research. In Study 1, 101 undergraduate students completed the Watson-Glaser Critical Thinking Appraisal (WGCTA), three subtests of the Wechsler Adult Intelligence Scale-Third Edition, and the revised NEO Personality Inventory. Hierarchical multiple regression analyses showed that Openness to Experience scores accounted for significant incremental variance in WGCTA scores beyond that accounted for by Similarities subtest scores. In Study 2, similar analyses of data from 105 students also showed significant incremental effects for Openness to Experience, even after more variance in the cognitive factor was accounted for by the Verbal Comprehension Index. Implications of these findings for the enhancement of critical thinking skills in college students are discussed.
MMPI-2 F Scale as a Predictor of Acute Versus Chronic Disorder Classification
Authors: Cukrowicz Kelly C. , Reardon Maureen Lyons , Donohue Keith F. , Joiner Thomas E.
Published: April 2004

This study examined the relation between elevation of the infrequency (F) scale on the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) and the classification of psychological disorders as chronic or acute in an outpatient mental health setting. MMPI-2 and clinician rating data at time of intake were considered for 158 adult patients from an outpatient clinic. The results indicate that elevation on the F scale is associated with more chronic disorders even after the influence of other variables, such as age and comorbidity of other disorders, is statistically accounted for. These results are discussed in terms of the utility and incremental validity of including the F scale as part of diagnostic screening.
Five-Factor Model Prototypes for Personality Disorders
Authors: Miller Joshua D. , Pilkonis Paul A. , Morse Jennifer Q.
Published: April 2004

The current study examined the prototype-matching technique for using the five-factor model (FFM) of personality to assess personality disorders (PDs) and their correlates. The sample was composed of 69 psychiatric patients, most of whom suffered from affective or anxiety disorders. The participants were predominantly outpatients (78%), Caucasian (94%), and women (58%). NEO Personality Inventory (NEO-PI) data from these patients and informants were available for deriving PD prototype scores. The results supported four conclusions. First, the FFM prototype-matching method is useful for clinical samples. Second, agreement between self-reports and information from significant others (SOs) using this method is good compared to previous results. Third, this agreement varies systematically with the observability of the PD criteria. Fourth, the value of self- and other-reported personality information depends on the rating source of the outcome variables. Other-reported information provides incremental utility in predicting impairment and interpersonal distress rated by clinicians and significant others.
Discriminating Malingered From Genuine Civilian Posttraumatic Stress Disorder
Authors: Elhai Jon D. , Naifeh James A. , Zucker Irene S. , Gold Steven N. , Deitsch Sarah E. , Frueh B. Christopher
Published: April 2004

The Infrequency-Posttraumatic Stress Disorder scale (Fptsd), recently created for the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), has demonstrated incremental validity over other MMPI-2 scales in malingered posttraumatic stress disorder (PTSD) detection. Fptsd was developed with combat-exposed PTSD patients, potentially limiting its use with PTSD patients in general. The current study evaluated the MMPI-2’s F, Infrequency-Psychopathology scale (Fp), and Fptsd scales in discriminating genuine civilian PTSD among 41 adult victims of child sexual abuse from a group of 39 students instructed to simulate PTSD. Analyses demonstrated Fptsd’s incremental validity over F but not over Fp. Based on the two studies examining Fptsd, Fptsd may be more appropriate for combat trauma victims, and Fp may be more appropriate for civilian trauma victims.
A Review of the Literature Examining Linkages between Organizational Factors, Medical Errors, and Patient Safety
Authors: Hoff Timothy , Jameson Lottie , Hannan Edward , Flink Ellen
Published: April 2004

The potential role of organizational factors in enhanced patient safety and medical error prevention is highlighted in the systems approach advocated for by the Institute of Medicine and others. However, little is known about the extent to which these factors have been shown empirically to be associated with these favorable outcomes. The present study conducted an intensive review of the clinical and health services literatures in order to explore this issue. The results of this review support the general conclusion that there is little evidence for asserting the importance of any individual, group, or structural variable in error prevention or enhanced patient safety at the present time. Two major issues bearing on the development of future research in this area involve strengthening the theoretical foundations of organizational research on patient safety and overcoming definitional and observability problems associated with error-focused dependent variables.
Hazards of Hospitalization for Ambulatory Care Sensitive Conditions among Older Women: Evidence of Greater Risks for African Americans and Hispanics
Authors: Laditka James N.
Published: April 2004

Hospitalization for Ambulatory Care Sensitive conditions (ACSH) has been widely accepted as an indicator of the accessibility and overall performance of primary health care. Previous studies have found conflicting evidence about ACSH disparities associated with race or ethnicity for older persons. This study estimates discrete-time ACSH hazards for women aged 69 or older, using longitudinal data with multivariate controls. Data are from the 1984 to 1990 Longitudinal Study of Aging, linked with Medicare claims. The multivariate results are adjusted for age, education, insurance and marital status, and other factors associated with health status and primary care access, and also for important indicators of need that include self-rated health, comorbidities, physical impairments, and previous hospitalizations. Many of these factors are permitted to vary across time for each individual, thus limiting measurement error. Results suggest that older African American and Hispanic women have markedly higher ACSH risks than older non-Hispanic white women.
Collaborative Initiatives: Where the Rubber Meets the Road in Community Partnerships
Authors: Bazzoli Gloria J. , Casey Elizabeth , Alexander Jeffrey A. , Conrad Douglas A. , Shortell Stephen M. , Sofaer Shoshanna , Hasnain-Wynia Romana , Zukoski Ann P.
Published: April 2004

Amajor challenge facing a community partnership is the implementation of its collaborative initiatives. This article examines the progress Community Care Networks (CCNs) made in implementing their initiatives and factors that helped or hindered their progress. Study findings suggest that partnership progress is affected by external market and regulatory factors beyond the control of the partnership, the availability of local community resources to support efforts, the scope and intensity of tasks associated with an initiative, expansion of the partnership to include new members, and the balance of work between partners and paid partnership staff. Implications of study findings for community partnerships include (1) recognizing and anticipating dependency on others, (2) acknowledging that the tasks that lie ahead will be more complicated than imagined, (3) maintaining focus on priorities, and (4) learning to be adaptive and creative, given a constantly changing environment.
The Economies of Scale for Nursing Home Care
Authors: Chen Li-Wu , Shea Dennis G.
Published: April 2004

Using a modified hybrid short-term operating cost function and a national sample of nursing homes in 1994, the authors examined the scale economies of nursing home care. The results show that scale economies exist for Medicare postacute care, with an elasticity of –0.15 and an optimal scale of around 4,000 patient days annually. However, more than 68 percent of nursing homes in the analytic sample produced Medicare days at a level below the optimal scale. The financial pressures resulting from the implementation of a prospective payment system for Medicare skilled nursing facilities may further reduce the quantity of Medicare days served by nursing homes. In addition, the results show that chain-owned nursing homes do not have lower short-term operating costs than do independent facilities. This indicates that the rationale behind recent increasing horizontal integration among nursing homes may not be seeking greater cost efficiency but some other consideration.
Piracy, Policy, and Russia's Emerging Media Market
Authors: Mickiewicz Ellen
Published: April 2004

The birth of a media market in Russia affords a unique opportunity to study the collision of international and national norms and practices. The refraction of globalization—involving, in this case, copyright protection and the program market—through local values and the rather different outcomes of sanctions and market inducements emerge as critical issues. The players in this drama are major and independent U.S. movie studios and trade organizations; U.S. governmental agencies involved in trade and assistance; and Russian movie studios, television stations, legislators, police, and, curiously, dissidents whose early advocacy of piracy helped build a more pluralized media system. Without an adequate framework of domestic laws and enforcement institutions, Russian broadcast television stations nonetheless dramatically curtailed their practice of pirating U.S. films—a result of complex alliances and incentives.
Media Convergence and the Chilling Effect of Broadcast Licensing
Authors: Weare Christopher , Levi Titus , Raphael Jordan
Published: April 2004

Many scholars have lamented the regulation of electronic media as an encroachment on the First Amendment guarantee of press freedom. They argue that the licensing process creates the possibility and means for politicians to meddle with broadcasters' content decisions, and they cite a long history of political interference to support their claims. From this literature, the authors define three specific hypotheses concerning the chilling effect of broadcast regulation: (1) news organizations with broadcast holdings will present more positive coverage of elected officials, (2) news organizations with broadcast holdings will present a narrower range of editorial positions, and (3) these effects will be magnified when political control of the presidency and Congress is united under a single party. These hypotheses are subjected to a rigorous empirical test based on 469 newspaper editorials commenting on presidential State of the Union addresses between 1970 and 1995. The authors predict the expected editorial stance of newspapers as a function of environmental and internal factors and define editorial bias as the difference between their expected and observed editorial stances. Based on these data, support is found for the chilling hypothesis. Newspapers with broadcast holdings systematically write editorials that are more positive, and the difference is statistically significant. They also tend to offer a narrower range of editorial positions, although this difference does not attain standard levels of statistical significance. These effects, however, do not appear to be magnified by unified party control of the executive and legislative branches.
Parties and Campaign Professionals in a Digital Age
Authors: Farrell David M. , Kolodny Robin , Medvic Stephen
Published: April 2004

This article assesses the role of campaign professionals in election campaigns in the Digital Age, with particular reference to their relationship with political parties. In the first section, the authors develop a typology of political consultants and assess the role they play in U.S. elections. This review of the evidence suggests a healthier relationship than has previously been assumed between U.S. parties and consultants. The second section examines comparative trends in Western Europe—which has seen some significant adaptation by the established parties—as well as in new democracies generally. In both cases campaign professionals have become increasingly prominent, indicating a convergence on the U.S. campaign model. Overall, the evidence supports the thesis that election campaigns have outgrown the institutional limitations of political parties, requiring a role for campaign professionals to fill this increasing gap.
Parties' Diminishing Relevance for Campaign Professionals
Authors: Plasser Fritz
Published: April 2004

The decline of parties in the electorate has not only drastically increased the competition in open electoral markets but also thrown into question the central role of political parties as campaign organizations. Instead of relying on the capacity of the party organization to communicate with voters, party elites may be looking for other means of electoral mobilization like television broadcasts, targeted direct mail operations, phone banks, and media-centered campaign activities planned, designed, and produced by professional political consultants and public relations experts. The campaign professional's view of party organizations for successful campaign operations is the central topic of this comparative study, based on data from a worldwide survey of political consultants and leading party managers from forty-three electoral democracies. Between 1998 and 2000, a sample of 592 campaign professionals were interviewed about their professional experience and role definitions. This article deals with the relevance of political parties in the minds of campaign professionals from a global perspective.
Peregrines
Authors: Quetchenbach Bernard W.
Published: April 2004

A sudden opening of landscape, atmosphere, circumstance. What it must be like to encounter a ghost. But that’s not right. Not otherworldly or ethereal, but solid, pushing air out of the way like water stripped of resistance. A moving center, coasting along a vertical plane with a wild echoing shout, then rising effortlessly until just a speck, not even a speck, in the wide sky.
Normal Accident Theory As Frame, Link, and Provocation
Authors: Weick Karl E.
Published: April 2004

In this article, the author offers suggestions as to why Normal Accidents, and the theory it formed, continues to provoke. By placing a meaningful frame around flows of events, normal accident theory allows people to better grasp and analyze the complexity of technological organizations as they face the unexpected.
A Behavioral Intervention to Reduce Child Exposure to Indoor Air Pollution: Identifying Possible Target Behaviors
Authors: Barnes Brendon R. , Mathee Angela , Shafritz Lonna B. , Krieger Laurie , Zimicki Susan
Published: April 2004

Indoor air pollution has been causally linked to acute lower respiratory infections in children younger than 5. The aim of this study was to identify target behaviors for a behavioral intervention to reduce child exposure to indoor air pollution by attempting to answer two research questions: Which behaviors are protective of child respiratory health in the study context? and Which behaviors do mothers recommend to reduce their children’s exposure to indoor air pollution? Observations and interviews were conducted with 67 mother-child combinations. The authors recommend that four behavioral clusters should be considered for the main intervention. These are to improve stove maintenance practices, to increase the duration that two ventilation sources are opened while a fire is burning, to reduce the time that children spend close to burning fires, and to reduce the duration of solid fuel burning.
Views and Preferences of Low-Literate Hispanics Regarding Diabetes Education: Results of Formative Research
Authors: Rosal Milagros C. , Goins Karin Valentine , Carbone Elena T. , Cortes Dharma E.
Published: April 2004

Hispanics are twice as likely as non-Hispanic Whites to have diabetes and are also at higher risk for diabetes-related complications and poorer outcomes. The prevalence of diabetes is inversely related to educational status. Low literacy is common, especially among older Hispanics. Little literature exists on formative research to create diabetes education materials for this audience. Two focus groups assessed views and preferences for diabetes education of low-literate, low-income, non-English-speaking urban Caribbean and Central American Hispanics with diabetes, as well as utility of materials developed specifically for this population, as part of the preliminary work for a pilot study of a diabetes intervention. Implications for practitioners and researchers are discussed.
The International Baccalaureate
Authors: Hill Ian
Published: April 2004

This is a report of a qualitative, historical case study in international education from a policy process perspective. The research explored the characteristics of policy formation and implementation which led to the creation, maintenance and expansion of the IB Diploma Programme and the International Baccalaureate Organization (IBO) from the early 1960s until 1978. This was not a prescriptive study of what was intended; it was a descriptive analysis of what happened.
How Do We Teach and Learn in Times when the Notion of ‘Global Citizenship’ Sounds Like a Cliché?
Authors: Tsolidis Georgina
Published: April 2004

In this article the argument is made that as educators we need to imagine the best for our students. In order to do this and to prepare them for a future where global citizenship is assumed, we need to develop ways of teaching to the cultural fluidity, which characterizes globalization. Following from this there is an exploration of inclusive pedagogies appropriate for global citizenship.
Three-Dimensional Fetal Head
Authors: Dubose Terry J.
Published: April 2004

The fetal head is three dimensional (3D). As 3D sonography becomes a clinical reality, there is a need to describe standard biometric parameters by which the head shape, proportions, and volumes may be measured and analyzed. This particular study presents measurements and methods that are applicable to newer 3D imaging systems. These measurements will provide consistent methods for evaluating the size, shape, and proportions of the fetal skull using orthogonal planes. In this research, three diameters of the fetal skull were measured and analyzed using standard real-time sonographic equipment. The biparietal diameter (BPD) measurements and the three diameters' averages (3D BPD) were compared using at test of paired two-sample means; no significant difference was found ( p = .497, r2 = 0.996). The 3D BPD is equal to the normal BPD, that is, (FOD + BPD + VCD)/3 = BPD. The 3D BPD can be used in any regression or nomogram in place of the BPD to correct for head shape and molding.
Hematoma Mimicking Ruptured Testis After Self-Inflicted Orchiectomy
Authors: Russ Paul D.
Published: April 2004

Testicular rupture is a potentially serious sequela of scrotal trauma. Physical examination is often quite limited in these cases. Sonography contributes significantly by directly visualizing the testis and intrascrotal contents. False-positive sonograms can occur, particularly when a hematocele displaces or distorts the testis beyond recognition or when a hematoma is mistaken for a damaged testis. This report describes the ultrasonographic appearance of a hematoma that mimicked a ruptured testis. The testis had actually been removed by the patient himself, who was suffering from a psychiatric disturbance called Munchausen syndrome.
Transposition of the Great Arteries
Authors: Moon Angela G.
Published: April 2004

Transposition of the great arteries (TGA) is a congenital malformation in which the aorta arises from the morphologic right ventricle and the pulmonary artery from the morphologic left ventricle, resulting in two separate and parallel circulations. TGA occurs during embryology by an abnormal division of the truncus arteriosus into the two great vessels. The incidence of TGA is 5% of all congenital heart diseases. The case report follows a fetus upon diagnosis of TGA at 27 weeks gestation through multiple surgeries and full recovery.
Malignant Phyllodes Tumor of the Breast
Authors: Winter Cindy M.
Published: April 2004

Phyllodes tumors are very rare fibroepithelial tumors that comprise less than 1% of all solid breast lesions. They can be classified as benign, borderline, or malignant. Their appearance is very similar to fibroadenomas by radiographic and sonographic imaging modalities. Biopsy is the only proven course for a definitive diagnosis. Treatment options include but are not limited to wide local excision and mastectomy.
An Australian casemix classification for palliative care: lessons and policy implications of a national study
Authors: Eagar Kathy , Gordon Robert , Green Janette , Smith Michael
Published: April 2004

Objectives: To provide a nontechnical discussion of the development of a palliative care casemix classification and some policy implications of its implementation. Sample: 3866 palliative care patients who, in a three month period, had 4596 episodes of care provided by 58 palliative care services in Australia and New Zealand. Method: A detailed clinical and service utilization profile was collected on each patient with staff time and other resources measured on a daily basis. A statistical summary of the clinical variables was compiled as the first stage of the analysis. Results: Palliative care phase was found to be a good predictor of resource use, with patients fairly evenly distributed across the five categories. Clients treated in an inpatient setting had poorer function and higher symptom severity scores than those treated in an ambulatory setting, a result that is not surprising in this Australian setting. Discussion: Implementation of the resultant AN-SNAP classification has been proceeding since 1998 in some Australian jurisdictions. The development and implementation of a classification such as AN-SNAP provides the possibility of having a consistent approach to collecting palliative care data in Australia as well as a growing body of experience on how to progressively improve the classification over time.
Artificial neural networks and dendroclimatic reconstructions: an example from the Front Range, Colorado, USA
Authors: Woodhouse Connie A.
Published: April 2004

The feasibility of reconstructing total spring precipitation for the South Platte River basin from tree-ring chronologies using artificial neural networks is explored. The use of artificial neural networks allows a comparison of reconstructions resulting from both linear and nonlinear models. Both types of models produced reconstructions that explained more than 40% of the variation in spring precipitation and were well verified with independent data. Although the nonlinear models produced higher R2 values than did the linear model for the calibration period, they performed less well in the independent period. This result and other model evaluation statistics suggest that, in this study, the nonlinear models contain a greater degree of overfit than the linear model, and thus, do not offer a clear improvement over the linear model for the reconstruction of spring precipitation in this region. However, neural networks offer an alternative approach to linear regression techniques and may provide improved dendroclimatic reconstructions in other areas.
Climate change in the Lake Valencia Basin, Venezuela, ~12600 yr BP to present
Authors: Curtis Jason H. , Brenner Mark , Hodell David A.
Published: April 2004

We present a palaeoclimate record for northern South America, extending from the latest Pleistocene (~12600 14C yr BP) to present. Climate reconstruction for the Valencia Basin, Venezuela, was based on sediment geochemistry and δ18O records from ostracod and gastropod shells in a 568 cm sediment core. Sediment chronology was established by AMS 14C dating of terrestrial wood fragments. From ~12600 to ~10000 14C yr BP the Valencia basin was drier than present and the coring site, now under 9.4 m of water, was only intermittently wet. After ~10000 14C yr BP, moisture availability increased and lake level rose, permanently covering the core site. From ~10000 to ~8200 14C yr BP, Lake Valencia was hydrologically closed and the isotope records reflect pronounced variability in the ratio of evaporation to precipitation. During the wetter early to middle Holocene (~8200 to ~3000 14C yr BP), lake level was high and water was lost to outflow. Greater moisture availability at this time may have been caused by increased intensity of the annual cycle (with wetter wet seasons and drier dry seasons), a result of large, orbitally driven differences in seasonal insolation. Two brief periods of lower lake level, at ~7000 and ~3300 14C yr BP, are indicated in the oxygen isotope and calcium carbonate records. Since ~3000 14C yr BP, water level in Lake Valencia has been dropping.
Late-Holocene climate in central West Greenland: meteorological data and rock-glacier isotope evidence
Authors: Humlum Ole
Published: April 2004

The central West Greenland climate during the instrumental period since ad 1873 is analysed con cerning interannual and seasonal variations. A marked temperature rise was experienced from ad 1920 to 1930, especially affecting the winter season, after which the mean annual air temperature for ten years was about 3–5°C higher than during the previous period, effectively changing coastal central West Greenland from having the climatological character of a continuous permafrost region to a discontinuous permafrost region. Since then temperatures have gradually decreased, and are now approaching the Little Ice Age level experienced in the late nineteenth century and early twentieth century. Interannual twentieth-century temperature variations since ad 1923 have been substantial (5–15°C) for the winter season, intermediate (2–7°C) for the spring season, and smaller (1–2°C) regarding summer and autumn seasons. During the instrumental period the overall atmospheric circulation, rather than air temperature, appears to be the primary control on precipitation. A unique personal meteorological record for ad 1807–1808 is presented, outlining an early nineteenth-century central West Greenland climate which appears to have been rather warm, variable, stormy and wet compared to the late twentieth century climate. Analyses of the oxygen isotopic composition of ice samples from a ‘Little Ice Age’ glacier-derived rock glacier in Disko Island indicate a mean annual air temperature 2–4°C below present values, during cold intervals of the ‘Little Ice Age’. The potential of rock-glacier ice oxygen isotope data as a means of obtaining information on past climatic change within cold-climate high-relief areas is discussed. The ‘Little Ice Age’ in central West Greenland was presumably characterized by variable climate punctuated by intervals with severe cold winters, short summers, and glacier expansion during the last several centuries. Palaeoclimatic data like these from coastal Greenland represent supplementary information to ice-core data from the central part of the Greenland Ice Sheet.
Tree-ring-dated‘Little Ice Age’ histories of maritime glaciers from western Prince William Sound, Alaska
Authors: Wiles Gregory C. , Barclay David J. , Calkin Parker E.
Published: April 2004

Tree-ring studies at 13 glacier forefields in western Prince William Sound show‘Little Ice Age’ glacial fluctuations were strongly synchronous on decadal timescales. Cross-dated glacially overrun trees at eight sites indicate ice margins advanced in the early (late twelfth through thirteenth centuries) and middle (seventeenth to early eighteenth centuries)‘Little Ice Age’. Tree-ring dates of 22 moraines at 13 glaciers show two main periods of stabilization. The earlier of these, in the first decades of the eighteenth century, overlaps with the second period of glaciers overrunning trees and marks culmination of this middle‘Little Ice Age’ expansion. Stabilization of moraines on nine of the study forefields in the latter part of the nineteenth century delineates a third interval of‘Little Ice Age’ glacial advance. The detailed‘Little Ice Age’ record from land-terminating glaciers in western Prince William Sound is consistent on a timescale of decades with four other tree-ring-dated glacial histories from across the northern Gulf of Alaska. This coastal northeastern Pacific glacial record reveals the structure of the‘Little Ice Age’ in the region and provides a strong basis for comparison with other proxy climate records spanning the past 1000 years.
Evidence for possible climatic forcing of late-Holocene vegetation changes in Norfolk Broadland floodplain mires, UK
Authors: Wells Colin E. , Wheeler Bryan D.
Published: April 2004

Plant macrofossil analyses of five peat cores from undisturbed fens in the flood-plain of the Ant Valley of the Norfolk Broadland show the sequence of vegetation development during the last two millennia. Macrofossil assemblages have been grouped into five regional phases and are interpreted largely in terms of the response of the vegetation to changes in sea level, climate and management. Phase 1 represents pre-Roman fen woodland communities (>2000 cal. BP); phase 2 represents salt-marsh communities formed during an estuarine phase in Romano-British times ( c. 2000–1600 cal. BP); phase 3 represents ‘tussock-fen’ and carr communities suggestive of drier conditions in the post-Roman to early Medieval period ( c. 1600–800 cal. BP); phase 4 represents aquatic communities indicative of wetter conditions from the late Medieval period to c. 300 cal. BP; phase 5 represents communities comparable with present-day vegetation. The biostratigraphic development of the Ant Valley floodplain mires has analogues in climatically induced humification changes of some British ombrotrophic mires, suggesting a response to similar climatic controls. Widespread human interference and control of the fen vegetation may be a relatively recent phenomenon (beginning possibly,400 cal. BP). Peat-accumulation rates in the undisturbed mire sites suggest that the original Medieval turbaries which later flooded to form the Norfolk Broads may have been at least 0.5 m shallower when dug than their present depth. The wide range of environmental conditions experienced by the mires during the last two millennia is of relevance to the development of strategies for their conservation.
A Holocene CO2 record from the stomatal index of subfossil Salix herbacea L. leaves from northern Sweden
Authors: Rundgren Mats , Beerling David
Published: April 2004

A stomatal-based method of palaeo-CO2 estimation has been applied to a temporally detailed sequence of leaves from a high-latitude lake (68°N) in northern Sweden spanning the last 9000 years. The resulting atmospheric CO2 reconstruction documents the onset of a gradual increase c. 5000 years before present indicating that the carbon cycle has not been in steady state over this time. Stable carbon isotope (δ13C) measurements of the subfossil leaves constrain the interpretation of the inferred changes in the operation of the global carbon cycle. The δ13C data reveal no marked or systematic shifts towards more negative values indicating that the CO2 addition to the atmosphere 5000–1000 yr BP may have been predominantly of oceanic origin.
Localized Pelvic Neuroblastoma: Excellent Survival and Low Morbidity With Tailored Therapy—The 10-Year Experience of the French Society of Pediatric Oncology
Authors: Leclair Marc-David , Hartmann Olivier , Heloury Yves , Fourcade Laurent , Laprie Anne , Mechinaud Françoise , Munzer Caroline , Rubie Herve
Published: April 2004

Purpose

To assess the results and morbidity of treatment of children with localized pelvic neuroblastoma (NB).

Patients and Methods

All consecutive cases of localized pelvic NB registered in the French multicenter prospective studies NBL90 and NBL94 between 1990 and 1999 were reviewed. Resectability was decided on the basis of clinical and radiologic evaluation. In unresectable tumors, primary chemotherapy (combinations of carboplatin-etoposide and vincristine-cyclophosphamide-doxorubicine) was administered before surgery.

Results

Forty-seven children (with 26 resectable tumors and 21 unresectable) were included in this study. At the end of treatment, 31 children were in complete remission (66%). Long-term neurologic sequelae were observed in seven patients (15%), directly attributable to surgery in three cases. After a median follow-up of 48 months (range, 13 to 129 months), 44 patients are alive. Six children experienced local relapse; four of these children achieved subsequent remission. The projected overall survival and event-free survival (EFS) rates at 5 years are, respectively, 93% ± 4% and 84% ± 5%. Survival of children treated with preoperative chemotherapy are similar to those treated by primary surgery (80% and 88% respectively). The extent of surgical resection seemed to have no influence on the outcome (EFS rates 76% and 89% in case of gross residue and complete resection or microscopic residue, respectively).

Conclusion

Our data confirm the excellent survival of localized pelvic NBs. Considering the efficacy of preoperative chemotherapy, patients with pelvic NB should be carefully screened for primary surgery. The risk of neurologic impairment during radical excision should be balanced with the good survival of children with minimal residual disease.
Individuals With an Increased Risk of Colorectal Cancer: Perceived Benefits and Psychological Aspects of Surveillance by Means of Regular Colonoscopies
Authors: Liljegren A. , Lindgren G. , Brandberg Y. , Rotstein S. , Nilsson B. , Hatschek T. , Jaramillo E. , Lindblom A.
Published: April 2004

Purpose

To evaluate the psychological consequences of genetic counseling followed by a surveillance program using colonoscopy among individuals with increased risk of colorectal cancer.

Patients and Methods

Two hundred sixty-five individuals, participating in a surveillance program with colonoscopy, were mailed a survey questionnaire that assessed their experience of the surveillance program and their perception of the risk of colorectal cancer. The Hospital Anxiety and Depression scale and the Swedish Short Form-36 Health Survey was also included.

Results

Two hundred forty individuals completed the questionnaire and were divided into the following risk groups: risk group 1, an individual with a mutation in hMLH1 or hMSH2 and a lifetime colorectal cancer risk of 80% (n = 28); risk group 2, a lifetime colorectal cancer risk of 40% (n = 129); and risk group 3, a lifetime colorectal cancer risk of 20% (n = 83). Among all individuals, the mean for perceived benefit was 8.0, and the perception of discomfort was 3.3 on the visual analog scale (1-10). In risk group 1, 61% underestimated personal risks as being 40% or less. Approximately 50% of the subjects in risk groups 2 and 3 either under- or overestimated their lifetime risk. According to the Swedish Short Form-36 Health Survey and the Hospital Anxiety and Depression scale, the study sample resembled the reference population.

Conclusion

A majority of the study sample understood why they were under surveillance, and regular colonoscopies were well-tolerated. The wide range of risk perception as well as low-risk perception in mutation positive subjects is acceptable, as long as these individuals adhere to surveillance programs and do not demonstrate increased levels of anxiety or depression.