bluuebunny/crossref_metadata_2025 huggingface dataset:
Activation of human lung mast cells by monomeric immunoglobulin E
Authors: Cruse G. , Kaur D. , Yang W. , Duffy S. M. , Brightling C. E. , Bradding P.
Published: April 2005

The mechanism of chronic mast cell activation in asthma is unclear. Monomeric immunoglobulin (Ig)E in the absence of allergen induces mediator release from rodent mast cells, indicating a possible role for IgE in the continued activation of mast cells within the asthmatic bronchial mucosa. In this study it was investigated whether monomeric IgE induces Ca2+influx and mediator release from human lung mast cells (HLMC).

Purified HLMC were cultured for 4 weeks and then exposed to monomeric human myeloma IgE. Ratiometric Ca2+imaging was performed on single fura-2-loaded cells. Histamine release was measured by radioenzymatic assay; leukotriene C4(LTC4) and interleukin (IL)-8 were measured by ELISA.

At concentrations experiencedin vivo, monomeric IgE induced dose-dependent histamine release, LTC4production and IL-8 synthesis. This was associated with a rise in cytosolic free Ca2+. Enhanced histamine release was still evident 1 week after initial exposure to IgE suggesting that continued exposure maintains enhanced secretion.

Monomeric immunoglobulin E alone activates cultured human lung mast cells initiating Ca2+influx, degranulation, arachidonic acid metabolism and cytokine synthesis. These findings support the hypothesis that immunoglobulin E loading of mast cells within the asthmatic airway contributes to the disordered airway physiology of this disease.
Increased serum concentrations of tissue inhibitor of metalloproteinase-1 in COPD patients
Authors: Higashimoto Y. , Yamagata Y. , Iwata T. , Okada M. , Ishiguchi T. , Sato H. , Masuda M. , Itoh H.
Published: April 2005

Matrix metalloproteinase (MMP)-9 and tissue inhibitors of metalloproteinase (TIMP)-1 concentrations are increased in the sputum of asthma and chronic bronchitis patients, and are thought to be related to airflow obstruction. However, serum concentrations of these enzymes have not been clearly evaluated in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to examine the serum concentrations of these enzymes in COPD and asthmatic patients in order to determine their relationship with airway obstruction.

Serum samples were obtained from 72 patients with COPD: 66 control subjects and 26 patients with asthma. Smoking histories of control subjects were matched with those of COPD patients. Serum concentrations of TIMP-1 and MMP-9 were determined by ELISA.

The circulating TIMP-1 concentration was significantly higher in stable COPD patients than in control and asthmatic subjects, and was significantly negatively correlated with forced expiratory volume in one second/forced vital capacity in COPD patients. The molar ratio between MMP-9 and TIMP-1 was significantly lower in COPD patients than in control subjects. In patients with COPD, the serum TIMP-1 concentration was significantly increased during disease exacerbation.

In conclusion, the current findings suggest that serum tissue inhibitors of metalloproteinase-1 concentration can be used as a serum marker of airway obstruction and exacerbation in chronic obstructive pulmonary disease patients.
Management of multidrug-resistant tuberculosis and patients in retreatment
Authors: Caminero J. A.
Published: April 2005

Retreatment of tuberculosis involves the management of entities as diverse as relapse, failure, treatment after default, and poor patient adherence to the previous treatment. The emergence of conditions for selection of resistance (failure and partial abandonment) is a matter of great concern.

The development of a retreatment regimen for tuberculosis requires consideration of certain basic premises. The importance of a comprehensive and directed history of drugs taken in the past, and the limited reliability of susceptibility tests to many of these drugs, should be kept in mind. Taking this into account, and possessing a thorough knowledge of all anti-tuberculosis medications, it is possible to cure almost all patients with an appropriate retreatment regimen including a minimum of three or four drugs not previously used. Nonetheless, the treatment of these patients is so complex that it should only be carried out by experienced staff.

Concern about treating tuberculosis patients with drug resistance varies greatly depending on the available resources. High-income countries should provide individual treatment regimens adapted to each patient; however, in other settings, restricted resources could justify the implementation of standardised therapeutic guidelines with second-line drugs in order to facilitate management and reduce costs.
Activated CD8+ T-lymphocytes in obstructive sleep apnoea
Authors: Dyugovskaya L. , Lavie P. , Hirsh M. , Lavie L.
Published: April 2005

T-lymphocytes are implicated in the development of atherosclerosis. The aim of this study was to assess whether the CD8+ T-lymphocytes of obstructive sleep apnoea (OSA) patients undergo phenotypic and functional changes that may exaggerate atherogenic sequelae in OSA.

A total of 36 OSA patients, 17 controls and 15 single-night-treated OSA patients were studied. Phenotype and cytotoxicity against K562 target cells were analysed by flow cytometry. Cytotoxicity against human umbilical vein endothelial cells (HUVECs) was assessed by51Cr release assay.

The cytotoxicity of the CD8+ T-lymphocytes of OSA patients against K562 and HUVECs was significantly greater than controls. This increased cytotoxicity directly depended on the presence of perforin and natural killer receptors (CD56, CD16), which were significantly increased in OSA CD8+ T-lymphocytes. Also the percentage of the CD56brightsubset, which mediates initial interactions with vascular endothelium, significantly increased in OSA. Nasal continuous positive airway pressure treatment significantly decreased CD8+ T-cell cytotoxicity and CD56 expression, and was positively correlated with natural killer inhibitory NKB1 receptor expression either after a single-night treatment or after a prolonged treatment.

In conclusion, the CD8+ T-lymphocytes of obstructive sleep apnoea patients undergo phenotypic and functional changes, rendering them cytotoxic to target cellsviaincreased CD56+/perforin+ expression, which can be ameliorated by nasal continuous positive airway pressure treatment. These results are compatible with the current authors' hypothesis of atherogenic sequelae in obstructive sleep apnoea.
Adenosine level in exhaled breath increases during exercise-induced bronchoconstriction
Authors: Csoma Z. , Huszár É. , Vizi É. , Vass G. , Szabó Z. , Herjavecz I. , Kollai M. , Horváth I.
Published: April 2005

In asthmatic patients, airway obstruction provoked by exercise challenge is accompanied by an increase in plasma adenosine level. In this study, the current authors investigated if exercise-induced bronchoconstriction was associated with local changes of adenosine concentration in the airways.

Oral exhaled breath condensate (EBC) collection (5-min duration) and forced expiratory volume in one second (FEV1) measurements were performed at rest (baseline) and 4–8 times after treadmill exercise challenge in healthy and asthmatic subjects. Adenosine concentration in EBC was determined by HPLC.

Observations indicated that physical exercise results in bronchoconstriction together with a significant increase of adenosine level in EBC in asthmatic patients (mean±sdmaximal fall in FEV127±13%; associated increase in adenosine 110±76% as compared to baseline), but not in healthy control subjects. Exercise-induced changes in adenosine concentration correlated significantly with the fall in FEV1values in asthmatic patients.

In conclusion, the observed increase in adenosine concentration of oral exhaled breath condensate most probably reflects changes in the airways during exercise-induced bronchoconstriction. Due to its known bronchoconstrictor property in asthma, adenosine may contribute to the development of bronchospasm.
Prognostic value of the ECG on admission in patients with acute major pulmonary embolism
Authors: Geibel A. , Zehender M. , Kasper W. , Olschewski M. , Klima C. , Konstantinides S. V.
Published: April 2005

A number of ECG abnormalities can be observed in the acute phase of pulmonary embolism (PE). Their prognostic value has not yet been systematically studied in large patient populations.

In 508 patients with acute major PE derived from a large prospective registry, the current authors assessed, on admission, the impact of specific pathological ECG findings on early (30-day) mortality.

Atrial arrhythmias, complete right bundle branch block, peripheral low voltage, pseudoinfarction pattern (Q waves) in leads III and aVF, and ST segment changes (elevation or depression) over the left precordial leads, were all significantly more frequent in patients with a fatal outcome. Overall, 29% of the patients who exhibited at least one of these abnormalities on admission did not survive to hospital discharge, as opposed to only 11% of the patients without a pathological 12-lead ECG. Multivariate analysis revealed that the presence of at least one of the above ECG findings was, besides haemodynamic instability, syncope and pre-existing chronic pulmonary disease, a significant independent predictor of outcome.

In conclusion, ECG may be a useful, simple, non-costly tool for initial risk stratification of patients with acute major pulmonary embolism.
Clade, Country and Region-specific HIV-1 Vaccines: Are they necessary?
Authors: Slobod Karen S , Coleclough Chris , Brown Scott A , Stambas John , Zhan Xiaoyan , Surman Sherri , Jones Bart G , Zirkel Amy , Freiden Pamela J , Brown Brita , Sealy Robert , Bonsignori Mattia , Hurwitz Julia L
Published: April 2005

Today, scientists are often encouraged to custom-design vaccines based on a particular country or clade. Here, we review the scientific literature and then suggest that the overwhelming endeavor to produce a unique vaccine for every world region or virus subtype may not be necessary.
Somatic mutations in the mitochondria of rheumatoid arthritis synoviocytes
Authors: Da Sylva Tanya R , Connor Alison , Mburu Yvonne , Keystone Edward , Wu Gillian E
Published: April 2005

Somatic mutations have a role in the pathogenesis of a number of diseases, particularly cancers. Here we present data supporting a role of mitochondrial somatic mutations in an autoimmune disease, rheumatoid arthritis (RA). RA is a complex, multifactorial disease with a number of predisposition traits, including major histocompatibility complex (MHC) type and early bacterial infection in the joint. Somatic mutations in mitochondrial peptides displayed by MHCs may be recognized as non-self, furthering the destructive immune infiltration of the RA joint. Because many bacterial proteins have mitochondrial homologues, the immune system may be primed against these altered peptides if they mimic bacterial homologues. In addition, somatic mutations may be influencing cellular function, aiding in the acquirement of transformed properties of RA synoviocytes. To test the hypothesis that mutations in mitochondrial DNA (mtDNA) are associated with RA, we focused on the MT-ND1 gene for mitochondrially encoded NADH dehydrogenase 1 (subunit one of complex I – NADH dehydrogenase) of synoviocyte mitochondria from RA patients, using tissue from osteoarthritis (OA) patients for controls. We identified the mutational burden and amino acid changes in potential epitope regions in the two patient groups. RA synoviocyte mtDNA had about twice the number of mutations as the OA group. Furthermore, some of these changes had resulted in potential non-self MHC peptide epitopes. These results provide evidence for a new role for somatic mutations in mtDNA in RA and predict a role in other diseases.
Osteoporosis in experimental postmenopausal polyarthritis: the relative contributions of estrogen deficiency and inflammation
Authors: Jochems Caroline , Islander Ulrika , Erlandsson Malin , Verdrengh Margareta , Ohlsson Claes , Carlsten Hans
Published: April 2005

Generalized osteoporosis in postmenopausal rheumatoid arthritis (RA) is caused both by estrogen deficiency and by the inflammatory disease. The relative importance of each of these factors is unknown. The aim of this study was to establish a murine model of osteoporosis in postmenopausal RA, and to evaluate the relative importance and mechanisms of menopause and arthritis-related osteoporosis. To mimic postmenopausal RA, DBA/1 mice were ovariectomized, followed by the induction of type II collagen-induced arthritis. After the mice had been killed, paws were collected for histology, one femur for bone mineral density (BMD) and sera for analyses of markers of bone resorption (RatLaps; type I collagen cross-links, bone formation (osteocalcin) and cartilage destruction (cartilage oligomeric matrix protein), and for the evaluation of antigen-specific and innate immune responsiveness. Ovariectomized mice displayed more severe arthritis than sham-operated controls. At termination of the experiment, arthritic control mice and non-arthritic ovariectomized mice displayed trabecular bone losses of 26% and 22%, respectively. Ovariectomized mice with arthritis had as much as 58% decrease in trabecular BMD. Interestingly, cortical BMD was decreased by arthritis but was not affected by hormonal status. In addition, markers of bone resorption and cartilage destruction were increased in arthritic mice, whereas markers of bone formation were increased in ovariectomized mice. This study demonstrates that the loss of endogenous estrogen and inflammation contribute additively and equally to osteoporosis in experimental postmenopausal polyarthritis. Markers of bone remodeling and bone marrow lymphocyte phenotypes indicate different mechanisms for the development of osteoporosis caused by ovariectomy and arthritis in this model.
Relations in biomedical ontologies
Authors: Smith Barry , Ceusters Werner , Klagges Bert , Köhler Jacob , Kumar Anand , Lomax Jane , Mungall Chris , Neuhaus Fabian , Rector Alan L , Rosse Cornelius
Published: April 2005

To enhance the treatment of relations in biomedical ontologies we advance a methodology for providing consistent and unambiguous formal definitions of the relational expressions used in such ontologies in a way designed to assist developers and users in avoiding errors in coding and annotation. The resulting Relation Ontology can promote interoperability of ontologies and support new types of automated reasoning about the spatial and temporal dimensions of biological and medical phenomena.
Changing occupational therapy and physiotherapy practice through guidelines and audit in the United Kingdom
Authors: Hammond R , Lennon S , Walker M F , Hoffman A , Irwin P , Lowe D
Published: April 2005

Background: The National Clinical Guidelines for Stroke (NCGS) were produced and three rounds of the National Sentinel Audit of Stroke conducted to improve the quality of stroke care in the UK.

Objective: To compare the results of the occupational therapy and physiotherapy elements of the most recent national sentinel audit with the occupational therapy-and physiotherapy-specific recommendations of the NCGS.

Methods: Retrospective case-note audit.

Results: Over 95% of hospitals/sites who manage stroke in England, Wales and Northern Ireland took part in the most recent round of the sentinel audit. The clinical audit took place from 1 April to 30 June 2001 and incorporated 235 hospitals/sites. The organizational audit took place in January 2002 and incorporated 240 hospitals/sites. Data are presented from the 235 with both clinical and organizational data, under the headings of: approaches to rehabilitation; carers/families; rehabilitation interventions; and transfer to the community. Low rates of compliance with national standards were observed for all domains.

Conclusion: Our findings suggest that occupational therapists and physiotherapists are not fully complying with the national standards for stroke care.
Therapy and support services for people with long-term stroke and aphasia and their relatives: a six-month follow-up study
Authors: van der Gaag Anna , Smith Lesley , Davis Stephanie , Moss Becky , Cornelius Victoria , Laing Susan , Mowles Chris
Published: April 2005

Objective: To evaluate the impact of attending an aphasia therapy centre on quality of life and communication skills in people with stroke and aphasia and their relatives.

Design: Before and after study, six months duration.

Setting: Community-based aphasia therapy centre in the United Kingdom.

Participants: Thirty-eight men and women with aphasia following a stroke, and 22 of their relatives. Mean time since stroke was 33 months (SD 24.1).

Interventions: A range of group therapies for people with aphasia and their relatives and counselling for individuals and couples.

Outcome measures: Quantitative outcome measures were ratings of quality of life and communication for people with aphasia, and relatives' independent ratings of communication and coping with caring. Qualitative outcomes were perceptions of quality of life and communication skills using semi-structured interviews.

Results: Improvement was detected on all outcomes at six months. There were significant changes from baseline on the quality of life measure, mean difference 0.14 (95% confidence interval 0.02, 0.26); and the communication measure assessed by people with aphasia and their relatives, mean difference 12.8 (4.0, 21.5) and 9.7 (3.6, 15.7) respectively. The changes on the coping with caring measure were not significant, though the direction of change was positive. Qualitative interviews revealed a similar pattern of benefit in terms of increased levels of self-confidence and changes in lifestyle and levels of independence.

Conclusions: The results suggest that this therapeutic approach has an impact on quality of life and communication for people with aphasia and their relatives.
‘If only I manage to get home I'll get better’-Interviews with stroke patients after emergency stay in hospital on their experiences and needs
Authors: Olofsson A , Andersson S-O , Carlberg B
Published: April 2005

Objective: To find out about the experiences of stroke patients concerning their falling ill, their stay in hospital, discharge and homecoming.

Design: Qualitative methods using in-depth interviews.

Subjects and setting: Nine strategically chosen patients and in five cases near family members were interviewed in their homes four months post stroke and following care at the Stroke Centre, University Hospital of Northern Sweden, Umea°.

Results: Three main categories with subcategories were brought to the fore from the interviews: ‘Responsible and implicated’, ’Depersonalized object for caring measures’ and ‘The striving for repersonalization and autonomy’. The patients got the most important insights and understanding about their state and the consequences when they came home.

Conclusion: The three main categories that were found mirror the crisis which becoming ill entails and the process gone through when the individual takes control again of his or her life. The patients saw coming home as an important factor for their recovery and rehabilitation. The health care system needs to develop strategies to make use of the power of this attitude with the patients and to use the patients' own milieu in rehabilitation after stroke.
Reliability and validity of arm function assessment with standardized guidelines for the Fugl-Meyer Test, Action Research Arm Test and Box and Block Test: a multicentre study
Authors: Platz Thomas , Pinkowski Cosima , van Wijck Frederike , Kim In-Ha , di Bella Paolo , Johnson Garth
Published: April 2005

Objectives: To establish: (1) inter-rater and test–retest reliability of standardized guidelines for the Fugl-Meyer upper limb section, Action Research Arm Test and Box and Block Test in patients with paresis secondary to stroke, multiple sclerosis or traumatic brain injury and (2) correlation between these arm motor scales and more general measures of impairment and activity limitation.

Design: Multicentre cohort study.

Setting: Three European referral centres for neurorehabilitation.

Subjects: Thirty-seven stroke, 14 multiple sclerosis and five traumatic brain injury patients.

Main measures: Scores of the Fugl-Meyer Test (arm section), Action Research Arm Test, and Box and Block Test derived from video information.

Results: All three motor tests showed very high inter-rater and test–retest reliability (ICC and rho for main variables>0.95). Correlation between the motor scales was very high (rho>0.92). Motor scales correlated moderately highly with the Hemispheric Stroke Scale, a measure of impairment (rho=0.660–0.689), but not with the Modified Barthel Index, a measure of the ability to cope with basic activities of daily living (rho=0.044–0.086).

Conclusions: The standardized guidelines assured comparability of test administration and scoring across clinical facilities. The arm motor scales provided information that was not identical to information from the Hemispheric Stroke Scale or the Modified Barthel Index. Address for correspondence: Priv.-Doz. Dr T Platz, Klinik Berlin, Kladower Damm 223, 14089 Berlin, Germany.
A randomized trial evaluation of the Oswestry Standing Frame for patients after stroke
Authors: Bagley Pam , Hudson Mary , Forster Anne , Smith Jane , Young John
Published: April 2005

Background: Standing is believed to have benefits in addressing motor and sensory impairments after stroke. One device to facilitate standing for severely disabled patients is the Oswestry Standing Frame.

Objective: To evaluate the effectiveness of the Oswestry Standing Frame for severely disabled stroke patients.

Design: A single centre, randomized controlled trial.

Setting: An inpatient stroke rehabilitation unit.

Subjects: Patients were recruited if they had a clinical diagnosis of stroke, were medically stable and unable to achieve any score on the Trunk Control Test or unable to stand in mid-line without the assistance of two therapists.

Intervention: The intervention (n=71) and control (n=69) groups both received usual stroke unit care but the intervention group also received a minimum of 14 consecutive days' treatment using the standing frame.

Main outcome measures: The primary outcome measure was the Rivermead Mobility Index (RMI). Secondary measures included the Barthel Index; the Rivermead Motor Assessment; the balanced sitting and sitting to standing components of the Motor Assessment Scale; the Trunk Control Test and the Hospital Anxiety and Depression Scale. Blind assessment was undertaken at baseline, six weeks, 12 weeks and six months post stroke. Information on resource use was also collected.

Results: There was no statistically significant difference between groups in any of the outcome measures or for resource use. Mann-Whitney U-tests for the RMI change from baseline scores to six weeks, 12 weeks and six months post stroke were p=0.310; p=0.970 and p=0.282, respectively.

Conclusion: Use of the Oswestry Standing Frame did not improve clinical outcome or provide resource savings for this severely disabled patient group.
Decision Making in Paediatric Care: an overview with reference to nursing care
Authors: Hallström Inger , Elander Gunnel
Published: April 2005

The purpose of this overview of published articles on decision making in paediatric care was to identify important aspects of its possible use in clinical practice and to obtain a base for future research. A literature review was undertaken utilizing snowball sampling to identify articles because of the diversity present within the area of decision making in paediatric care. The databases PubMed and CINAHL were used. The search was limited to articles published in English during the period 1994-2004. The analysis entailed a series of comparisons across articles, focusing on major areas of enquiry and patterns of results. Various levels of decision making are described because these seem to form a basis for how decisions are made. Concepts found to be of importance for decision making are described under the following headings: competence, the child’s best interests, knowledge, values and attitudes, roles and partnership, power, and economy. Further research is suggested.
Ethical Care of the Critically Ill Child: a conception of a ‘thick’ bioethics
Authors: Carnevale Franco A
Published: April 2005

In this article I argue for an interpretive approach to bioethics with critically ill children. I begin by highlighting the dominant Anglo-American bioethical framework that defines standards for ethical care in critically ill children and then outline a critique of this framework. Drawing predominantly on the ideas of Charles Taylor, Michael Walzer and Richard Zaner, I call for a reconception of bioethics and propose an interpretive ‘thick’ framework that is centred on culture and context. Finally, I illustrate this interpretive approach through a comparative study of two cases in pediatric intensive care: the narratives of Marc and Larry. These case studies reveal that ethical dilemmas in pediatric critical care can be traced to relational tensions over respect, trust and power rooted in the disparity of moral horizons among the persons involved.
When is Public Disclosure of HIV Seropositivity Acceptable?
Authors: Muula Adamson S , Mfutso-Bengo Joseph M
Published: April 2005

HIV/AIDS is a major public health problem in Africa. Stigmatization, discrimination and lack of appropriate health care are among the commonest challenges that HIV infected persons and their families face. It has been suggested that among the tools available in the fight against stigmatization and discrimination is public disclosure of a person’s HIV seropositive status. While public disclosure of HIV status has a place in the fight against HIV and AIDS, especially by resulting in behavioural change among people who know of an HIV infected person, we argue that such disclosure also has potential attendant harms. The posthumous disclosure of HIV status is particularly problematic. Public disclosure should be accompanied by appropriate individual counselling and preparation of the community to deal with the situation, and should have regard for cultural sensitivity after consideration of the risks and benefits to individuals, families and the community. Health practitioners should keep in mind that their main duty is to the best interest of the patient, the family and the community, in that order.
Why indeed? Invited commentary on… Why aren't depot antipsychotics prescribed more often and what can be done about it?
Authors: Barnes Thomas R. E.
Published: April 2005

A recent review concluded that replicated, evidence-based studies have demonstrated several areas of advantage for long-acting antipsychotics over oral antipsychotics. These include improved global outcome and reduced risk of rehospitalisation, psychopharmacological benefits such as more consistent bioavailabilty and more predictable dose–blood level correlations, an improved pharmacokinetic profile allowing lower dosages to be used with a consequent reduced likelihood of side-effects, and a reduced burden of care when injections are required only every 2–6 weeks (Robert & Geppert, 2004). Further, if a patient relapses despite receiving uninterrupted depot treatment, this indicates the need to consider reasons for deterioration other than poor adherence. However, perhaps the critical advantage over oral preparations is the avoidance of covert non-adherence (Barnes & Curson, 1994). With depot treatment, any decision by the patient not to continue medication will be signalled by failure to attend for, or refusal of, injection. The clinical team can therefore act to intervene appropriately, bearing in mind that non-adherence may be both a cause and consequence of worsening of illness. Lastly, with depot preparations the risk of self-poisoning is reduced.
Epidemiology of mental health problems in adults with learning disability: an update
Authors: Smiley Elita
Published: April 2005

Epidemiological studies measuring prevalence rates and factors associated with mental health problems in adults with learning disability have produced very different and sometimes contradictory results, mainly because of methodological problems. Consequently, much of the epidemiology of mental health problems in this population is still unknown, although improved methodology and additional information are emerging. This article describes the methodological difficulties of studies, the reported prevalence rates in the context of these difficulties and what is currently known about the factors associated with mental health problems in this population.
Whys and hows of patient-based teaching
Authors: Doshi Monica , Brown Nick
Published: April 2005

Recent developments in medical education and in UK government policy for the training and service commitment of junior doctors have highlighted the need to examine clinical teaching. There is growing evidence of the effectiveness of more structured approaches to patient-based teaching. The scope of what can be taught includes the three domains of knowledge, skill and attitudes. There are proven models to deliver teaching not only of patient assessment and management but also of all aspects of the doctor–patient relationship. The application of patient-based teaching is entirely consonant with the rigours of the outcome-based approach to curriculum planning and delivery. The successful, thoughtful adoption of patient-based teaching is part of the ‘professionalisation’ of education in psychiatry that in turn begs questions about the learning, accreditation and reward of those involved as teachers at all levels.
The Danish National Schizophrenia Project: prospective, comparative longitudinal treatment study of first-episode psychosis
Authors: Rosenbaum Bent , Valbak Kristian , Harder Susanne , Knudsen Per , Køster Anne , Lajer Matilde , Lindhardt Anne , Winther Gerda , Petersen Lone , Jørgensen Per , Nordentoft Merete , Andreasen Anne Helms
Published: April 2005

Background

First-episode psychosis intervention may improve the course and outcome of schizophrenic disorders.

Aims

To describe the Danish National Schizophrenia Project and to measure the outcome of two different forms of intervention after 1 year, compared with standard treatment.

Method

A prospective, longitudinal, multicentre investigation included 562 patients, consecutively referred over a 2-year period, with a first episode of psychosis. Patients were allocated to supportive psychodynamic psychotherapy as a supplement to treatment as usual, an integrated, assertive, psychosocial and educational treatment programme or treatment as usual.

Results

There was a non-significant tendency towards greater improvement in social functioning in the integrated treatment group and the supportive psychodynamic psychotherapy group compared with the treatment as usual group. Significance was reached for some measures when the confounding effect of drug and alcohol misuse was included.

Conclusions

Integrated treatment and supportive psychodynamic psychotherapy in addition to treatment as usual may improve outcome after 1 year of treatment for people with first-episode psychosis, compared with treatment as usual alone.
Migration, family dysfunction and psychotic symptoms in children and adolescents
Authors: Patino Luis R. , Selten Jean-Paul , van Engeland Herman , Duyx Jan H. M. , Kahn René S. , Burger Huibert
Published: April 2005

A cross-sectional study of 3426 referred children and adolescents showed that the presence of both migration history and family dysfunction was associated with a fourfold (95% CI 2–9) higher risk of psychotic symptoms compared with the absence of these factors. The relative risk was 2 (95% CI 1–4) for migration history only. Interaction between migration history and family dysfunction accounted for 58% (95% CI 5–91%) of those with psychotic symptoms. These results suggest a relationship between family dysfunction and migration in the development of psychosis.
Assaults by patients on psychiatric trainees: frequency and training issues
Authors: Pieters Guido , Speybrouck Ewoud , De Gucht Véronique , Joos Staf
Published: April 2005

Aims and Method

To conduct a survey on the frequency and severity of assaults by patients on psychiatric trainees, and the availability of training on managing violent patients; a self-report questionnaire developed in the USA was adapted to the Flemish situation. Data were collected from 99 psychiatric trainees from the Dutch speaking part of Belgium, representing a 60% response rate.

Results

As many as 56% of the respondents had been confronted with at least one physical assault by a patient during their residency, whereas 72% had already been threatened by a patient. Only a small minority had received any training related to patient violence.

Clinical Implications

Some formal teaching or training in managing (potentially) violent patients should be incorporated in psychiatric training in Flanders.
The writing is on the wall: use of an LCD projector to aid communication at the ward round
Authors: Baggaley Martin , Inglis Gary , Malizia Andrea
Published: April 2005

A key element of good in-patient psychiatric care is the multidisciplinary review, with accurate and legible recording of the outcome of the discussion. Traditionally, the junior doctor and nurse act as ‘scribes' on the ward rounds, recording the outcomes in the multidisciplinary or separate medical and nursing notes. There are a number of ways in which this process can fail. First, the scribe may simply misunderstand the decision of the team, given the complexity and variety of decisions in a psychiatric setting. Second, the scribe may understand what to record, but what is written may be illegible. Finally, people present at the ward round can have different beliefs about what has been decided, but unless they immediately review what has been written, they may not realise the discrepancy. One or more of these failings can result in serious untoward incidents, such as a patient being allowed off the ward on unescorted leave when the responsible medical officer believed the team had decided against permitting such leave. It is only when there is a serious incident that discrepancies can and do emerge.
Treatment of Advanced Non–Small-Cell Lung Cancer in the Elderly: Results of an International Expert Panel
Authors: Gridelli Cesare , Aapro Matti , Ardizzoni Andrea , Balducci Lodovico , De Marinis Filippo , Kelly Karen , Le Chevalier Thierry , Manegold Christian , Perrone Francesco , Rosell Rafael , Shepherd Frances , De Petris Luigi , Di Maio Massimo , Langer Corey
Published: April 2005

The best treatment for elderly patients with advanced non–small-cell lung cancer (NSCLC) is still debated. To guide clinical management of these patients and suggest the priorities for clinical research in this field, an International Expert Panel met in Naples, Italy, on April 19 to 20, 2004. Results and conclusions based on a review of evidence available in the literature to date are presented in this article. A comprehensive geriatric assessment is recommended to better define prognosis and to predict tolerance to treatment. In the first randomized study dedicated to elderly NSCLC patients, single-agent vinorelbine showed superiority over supportive care alone, both in terms of survival and quality of life. In a large randomized trial, gemcitabine plus vinorelbine failed to show any advantage over either agent alone. Subset analyses suggest that the efficacy of platinum-based combination chemotherapy is similar in fit older and younger patients, with an acceptable increase in toxicity for elderly patients. These data should be interpreted cautiously because retrospective subgroup analyses are encumbered by selection bias; hence, randomized trials dedicated to platinum-based chemotherapy for nonselected elderly patients are warranted. Several promising biologic therapies are under investigation; however, with present data, target-based agents as first-line treatment for elderly NSCLC patients are not yet recommended. Clinical research, with trials specifically designed for elderly patients, is mandatory. With the current evidence, single-agent chemotherapy with a third-generation drug (vinorelbine, gemcitabine, a taxane) should be the recommended option for nonselected elderly patients with advanced NSCLC. Platinum-based chemotherapy is a viable option for fit patients with adequate organ function. Best supportive care remains important, in addition to chemotherapy or as the exclusive option for patients who are unsuitable for more aggressive treatment.
Role of the CDKN2A Locus in Patients With Multiple Primary Melanomas
Authors: Puig Susana , Malvehy Josep , Badenas Cèlia , Ruiz Anna , Jimenez Dolores , Cuellar Francisco , Azon Antoni , Gonzàlez Urbá , Castel Teresa , Campoy Antoni , Herrero Josep , Martí Rosa , Brunet-Vidal Joan , Milà Montserrat
Published: April 2005

Purpose

We have studied a consecutive case series of patients with multiple primary melanoma (MPM) for the involvement of the melanoma susceptibility loci CDKN2A and CDK4.

Patients and Methods

One hundred four MPM patients (81 patients with two primary melanomas, 14 with three, five with four, one with five, two with six, and one with seven) were included.

Results

Seven different CDKN2A germline mutations were identified in 17 patients (16.3%). In total, we identified 15 CDKN2A exon 2, one exon 1α missense mutation, and one exon 1β frameshift mutation. The age of onset was significantly lower and the number of primary melanomas higher in patients with mutations. CDKN2A mutations were more frequent in patients with familial history of melanoma (35.5%) compared with patients without (8.2%), with a relative risk (RR) of 4.32 (95% CI, 1.76 to 10.64; P = .001), and in patients with more than two melanomas (39.1%) compared with patients with only two melanomas (10%) with an RR of 3.29 (95% CI, 1.7 to 6.3; P = .002). The A148T polymorphism was more frequent in patients with MPMs than in the control population (P = .05). A variant of uncertain significance, A127S, was also detected in one patient. No CDK4 mutations were identified, suggesting that it has a low impact in susceptibility to MPM.

Conclusion

MPM patients are good candidates for CDKN2A mutational screening. These patients and some of their siblings should be included in a program of specific follow-up with total body photography and digital dermoscopy, which will result in the early detection of melanoma in this subset of high-risk patients and improve phenotypic characterization.
Shunting of Passenger Train Units in a Railway Station
Authors: Freling Richard , Lentink Ramon M. , Kroon Leo G. , Huisman Dennis
Published: April 2005

In this paper we introduce the problem of shunting passenger train units in a railway station. Shunting occurs whenever train units are temporarily not needed to operate a given timetable. We discuss several aspects of this problem and focus on two subproblems. We propose mathematical models for the problem and both subproblems, one of which is solved with a solution method based on column generation. Furthermore, we introduce a new efficient and speedy solution technique for pricing problems in column generation algorithms. Finally, we present computational results based on real-life instances from Netherlands Railways.
Traveling Salesman Problems with Profits
Authors: Feillet Dominique , Dejax Pierre , Gendreau Michel
Published: April 2005

Traveling salesman problems with profits (TSPs with profits) are a generalization of the traveling salesman problem (TSP), where it is not necessary to visit all vertices. A profit is associated with each vertex. The overall goal is the simultaneous optimization of the collected profit and the travel costs. These two optimization criteria appear either in the objective function or as a constraint. In this paper, a classification of TSPs with profits is proposed, and the existing literature is surveyed. Different classes of applications, modeling approaches, and exact or heuristic solution techniques are identified and compared. Conclusions emphasize the interest of this class of problems, with respect to applications as well as theoretical results.
Shipping Multiple Items by Capacitated Vehicles: An Optimal Dynamic Programming Approach
Authors: Anily Shoshana , Tzur Michal
Published: April 2005

We consider a system in which multiple items are transferred from a warehouse or a plant to a retailer through identical capacitated vehicles, or by identical freight wagons. Any mixture of the items may be loaded onto a vehicle. The retailer is facing dynamic deterministic demand for several items, over a finite planning horizon. A vehicle incurs a fixed cost for each trip made from the warehouse to the retailer. In addition, there exist item-dependent variable shipping costs and inventory holding costs at the retailer, which are both constant over time. The objective is to find a shipment schedule that minimizes the total cost, while satisfying demand on time.

We address and partially resolve the question regarding the problem’s complexity by introducing a dynamic programming algorithm whose complexity is polynomial for a fixed number of items, but exponential otherwise. Our dynamic programming formulation is based on properties satisfied by the optimal solution, and uses an innovative way for partitioning the problem into subproblems.
Pedestrian Behavior at Bottlenecks
Authors: Hoogendoorn Serge P. , Daamen W.
Published: April 2005

Traffic operations in public walking spaces are to a large extent determined by differences in pedestrian traffic demand and infrastructure supply. Congestion occurs when pedestrian traffic demand exceeds the capacity. In turn, the latter is determined by a number of factors, such as the width of the bottleneck and the wall surface, as well as the interaction behavior of the pedestrians passing the bottleneck.

This article discusses experimental findings of microscopic pedestrian behavior in case of bottlenecks. Results for both a narrow bottleneck and a wide bottleneck are discussed and compared to the results of an experiment without a bottleneck. It is shown how pedestrians inside bottlenecks effectively form layers or trails, the distance between which is approximately 45 cm. This is less than the effective width of a single pedestrian, which is around 55 cm. The layers are thus overlapping, a phenomenon which is referred to as the “zipper” effect. The pedestrians within these layers follow each other at 1.3 seconds, irrespective of the considered experiment. For the narrow bottleneck case (width of one meter) two layers are formed; for the wide bottleneck case (width of two meters), four or five layers are formed, although the life span of these layers is rather small.

The zipper effect causes the capacity of the bottleneck to increase in a stepwise fashion with the width of the bottleneck, at least for bottlenecks of moderate width (less than 3 m). This has substantial implications for the design of walking facilities.
"Ciberteca" ou biblioteca virtual: uma perspectiva de gerenciamento de recursos de informação
Authors: Marchiori Patricia Zeni
Published: April 2005

As modificações tecnológicas e as recentes concepções de gerenciamento de recursos de informação têm causado uma quebra no paradigma dos modelos tradicionais de bibliotecas. O conceito de biblioteca virtual se apresenta como uma alternativa para ampliar as condições de busca, disponibilidade e recuperação de informações de maneira globalizada, qualitativa, pertinente e racional, aliando o acesso local ao acesso remoto, com base nas redes de telecomunicação disponíveis. Embora o conceito de biblioteca virtual esteja ainda em construção, um cuidadoso planejamento deve ser elaborado, tendo em vista a transição do modelo tradicional de bibliotecas para o modelo de biblioteca virtual. Alguns passos desta avaliação são apresentados, em especial para bibliotecas especializadas, bem como algumas experiências já em funcionamento em países do Primeiro Mundo. Novos papéis são também exigidos para os profissionais bibliotecários e para o pessoal da biblioteca, visando a um reposicionamento de atitudes e atividades.
Conversão de bases de dados MicroISIS para Internet
Authors: Resmer Maria José , Soares da Costa Olga Maria
Published: April 2005

Apresenta o processo desenvolvido pela Companhia de Informática do Paraná (Celepar) na conversão de uma base de dados bibliográfica de recuperação de informações em MicroISIS, para disponibilização por meio da Internet. Relata quais os passos seguidos nesta conversão, desde a decisão pela utilização de banco de dados não relacional, até sua recuperação por intermédio de páginas web. Mostra como foi o processo de conversão do arquivo mestre do MicroISIS para um arquivo seqüencial, possibilitando assim o acesso a este em ambiente mainframe. Apresenta ainda a estrutura do módulo de pesquisa, especialmente com relação às facilidades do sistema.
Acompanhamento das bibliotecas brasileiras na Internet
Authors: Gonçalves da Silva Luiz Antônio , Márdero Miguel Ángel , Claudio Silvana
Published: April 2005

A biblioteca virtual no Brasil é uma alternativa para se acessar informação através da Internet na Biblioteca Nacional, em bibliotecas especializadas, universitárias, públicas e escolares. Um levantamento preliminar, realizado pelo IBICT, mostra a distribuição de bibliotecas virtuais por estado e sua presença na Internet. Os principais produtos e serviços disponíveis são o acesso a apontadores, obras digitalizadas, catálogos e informações institucionais. A interligação das diversas bibliotecas minimiza esforços e evita duplicação de trabalho.
Programas oficiais para formação dos professores da educação básica
Authors: Melo Maria Teresa Leitão de
Published: April 2005

O artigo analisa a formação dos professores da educação básica destacando dois eventos ocorridos na última década: a Conferência Mundial de Educação para Todos e a Lei de Diretrizes e Bases da Educação Nacional. Avalia os desdobramentos advindos dos referidos eventos e a sua influência nos programas oficiais de formação, criticando a tônica no aperfeiçoamento em serviço restrito a algumas áreas, de conteúdo fragmentado, aligeirado, sem repercussão na carreira docente. Contextualiza a formação no âmbito das políticas de valorização do magistério, categorizando-a como direito do professor. Lança o desafio de construir o perfil e a identidade do profissional da educação, considerando os atores que atuam na escola e têm vínculo com o trabalho educativo: professores e funcionários da educação, portadores do direito a uma formação includente e de qualidade social.
Política de formação profissional para a educação infantil: Pedagogia e Normal Superior
Authors: Kishimoto Tizuko Morchida
Published: April 2005

O texto trata da política de formação profissional para a educação infantil dos anos 90 configurada pelos cursos de pedagogia e normal superior. A pedagogia historicamente ofereceu a formação em nível superior, desde a década de 1930, demonstrando seu projeto político-pedagógico, ao aliar a licenciatura ao bacharelado, em cursos que formam concomitantemente o professor e o profissional da educação infantil, garantindo um espaço pedagógico de interação entre a formação geral e a profissional. O curso normal superior, recriado pela lei 9394/96, traz uma polêmica ao separar a formação docente da universitária, propor um curso com menor tempo de formação, fragmentar o cuidar do educar e desqualificar o quadro de profissionais responsáveis pelo curso.
As licenciaturas e as novas políticas educacionais para a formação docente
Authors: Pereira Júlio Emílio Diniz
Published: April 2005

Neste artigo são apresentadas reflexões e análises a respeito das recentes políticas educacionais para a formação docente no Brasil. O foco são as diferentes questões que envolvem os cursos de licenciatura no país, principalmente, a partir da aprovação da Lei de Diretrizes e Bases da Educação Nacional (lei nº 9.394/96). Mais especificamente, são discutidos os modelos de formação docente - subjacentes às formulações atuais e a serem implementadas -, as demandas para a formação profissional resultantes das mudanças na educação básica brasileira, o locus da preparação de professores e o processo de construção das diretrizes curriculares para as licenciaturas.