bluuebunny/crossref_metadata_2025 huggingface dataset:
Developmental phenotypes and causal pathways in attention deficit/hyperactivity disorder: potential targets for early intervention?
Authors: Sonuga‐Barke Edmund J.S. , Halperin Jeffrey M.
Published: March 2010

Early intervention approaches have rarely been implemented for the prevention of attention deficit/hyperactivity disorder (ADHD). In this paper we explore whether such an approach may represent an important new direction for therapeutic innovation. We propose that such an approach is most likely to be of value when grounded in and informed by developmental models of the dynamic, complex and heterogeneous nature of the condition. First, we set out a rationale for early intervention grounded in the science of ADHD viewed through developmental models. Second, we re‐examine the concept of disorder‐onset from the perspective of developmental trajectories and phenotypes. Third, we examine potential causal pathways to ADHD with regard to originating risk, pathophysiological mediators, environmental moderators and developmental continuities. Finally, we explore the potential value of strategies for identifying young children at risk for ADHD, and implementing interventions in ways that can target these underlying pathogenic processes. The utility of such an approach represents an important area for future research but still requires ‘proof of concept’. Therefore prior to widespread clinical implementation, far greater knowledge is required of (i) developmental pathways into ADHD, (ii) the value of identifying neuropsychological mediators of these pathways, and (iii) the extent to which targeting mediating mechanisms will improve treatment outcomes for children with ADHD.
Intraregional Migration, Direct Action Land Reform, and New Land Settlements in the Brazilian Amazon
Authors: PERZ STEPHEN G. , LEITE FLAVIA , SIMMONS CYNTHIA , WALKER ROBERT , ALDRICH STEPHEN , CALDAS MARCELLUS
Published: March 2010

This article analyses migration histories of residents in rural settlements of the Brazilian Amazon that resulted from direct action land reform (DALR), which involves organised land occupations. Our analysis evaluates two hypotheses. The ‘urban migration’ expectation asserts that urban experience is important for DALR participation, which links rural and urban areas via migration for land occupations. The ‘DALR efficacy’ hypothesis argues that migration and DALR are complementary livelihood strategies, such that participation in DALR obviates the need for further migration. Our findings support both hypotheses and bear implications for regional development and environmental change in the Amazon.
Comparison of Fascal cheese produced with natural, commercial or autochthonous cultures
Authors: NESPOLO CASSIA R , CORREA ANA PF , RITTER ANA C , BRANDELLI ADRIANO
Published: March 2010

Lactic acid bacteria were isolated from raw ovine milk and Fascal cheese and used as two alternative inoculants for production of this Brazilian cheese. Microbiological counts and moisture of these cheeses were comparable to those observed in cheese made with a commercial starter. All cheeses showed absence of Salmonella spp., tolerable counts of coliforms, but coagulase‐positive staphylococci counts exceeded the standard values. Cheeses produced with Lactobacillus plantarum LCN 28 and Lactobacillus rhamnosus LCN 43 showed better results than those observed for the other experimental combinations. Autochthonous cultures could be beneficial to the manufacture of high quality typical raw milk cheese.
A Biaxial Fatigue Specimen for Uniaxial Loading
Authors: Bellett D. , Morel F. , Morel A. , Lebrun J.‐L.
Published: March 2010

Abstract:  The aim of this paper is to present a novel un‐notched fatigue test specimen in which a biaxial stress state is achieved using a uniaxial loading condition. This allows the problem of multi‐axial fatigue to be studied using relatively common one‐axis servo‐hydraulic testing machines. In addition the specimen presented here is very compact and can be made using a small volume of material (100 × 40 × 4.5 mm). For this specimen, the degree of biaxiality, defined by the parameter is equal to approximately 0.45. The specimen geometry was optimised using the Dang Van multi‐axial fatigue criterion. In addition to use as a fatigue specimen, it has been demonstrated that the biaxial specimen presented here is also suitable for biaxial tensile tests, to determine the rupture strength of a material in a biaxial stress state. Two different materials have been investigated: The first was wrought aluminium 2024‐O in the form of 5 mm sheets. The second was a cast aluminium‐silicon alloy AlSi7Cu0.5Mg0.3, commonly used in automotive and aeronautical applications. The fatigue strengths were determined at 2 × 106 cycles and at various R‐ratios using a staircase procedure. For the aluminium 2024, it is shown that the biaxial stress state increases the maximum permissible first principal stress when compared to the uniaxial condition. However, in terms of the cast aluminium alloy, it has been demonstrated that this type of fatigue specimen is not suitable for materials containing casting defects, in particular micro‐shrinkage pores, because the volume of material, in which the stress state is biaxial, is not large enough.
A Particular Instability of Unilaterally Supported Thin Plates Under Transversal Load: Effect of the Residual Stresses Induced by Vitreous Enameling
Authors: Zucchelli A. , Minak G. , Ghelli D.
Published: March 2010

Abstract:  Simply supported rectangular thin plates under transversal load, concentrated at the centre of the plate, can show a particular kind of instability at one or two edges depending on their dimensions. If only small displacements are considered, the problem is one of pure bending and instability does not occur; on the contrary this instability is induced by the compressive membrane stresses due to large displacements. Vitreous enamel coatings, generally used to improve anti corrosion properties, increment the load value required to induce the instability by inducing residual tensile stresses on the plate. This paper compares and discusses experimental tests on steel and enamelled steel plates and the results obtained by a non linear numerical model taking into account residual stresses. By both experimental and numerical analysis it was possible to conclude that the presence of residual stresses caused an increment of the values of force and work at which the instability took place with respect to the case where residual stresses were not present.
Spatial indeterminacy and the construction of environmental knowledge
Authors: JIUSTO SCOTT
Published: March 2010

As concern about the sustainability of industrialised economies has increased, analysts have developed various indicator‐based methodologies to explore environmental policy implications of human consumption and production activities. Critical and social constructivist theorists have challenged the presumption of objectivity underlying such research, however, by highlighting the role that social process and tacit assumptions play in accounts of human–environment interactions. While the ‘science wars’ hostility between realists and constructivists has abated and many in both camps agree that environmental analysts should be more open and reflexive about the empirical limitations of their work and its potential to encode social, political and cultural bias, practical guidance and clear examples for doing so remain rare. This paper is situated within this gap: it is at once an attempt by an environmental analyst to show what a ‘self‐reflexive’ approach to environmental assessment might look like and a rumination on the opportunities and challenges that such an undertaking entails. At the same time, the paper makes traditional scientific claims to creating new knowledge and advancing methodological sophistication by identifying a general problem of spatial indeterminacy that limits the empirical basis of all manner of place‐based environmental assessment. The paper uses a climate change‐related case study regarding the attribution of carbon emissions from electricity use to various US states to show the strong, though generally unrecognised, representational and political implications that can be introduced through the common methodological responses to spatial indeterminacy. I argue that in such cases both positivist and constructivist approaches to understanding human–environmental relations are needed to thoughtfully navigate options for constructing indicators and analysing policy options.
Cucurbitacin B, a novel in vivo potentiator of gemcitabine with low toxicity in the treatment of pancreatic cancer
Authors: Iwanski Gabriela B , Lee Dhong H , En‐Gal Shlomit , Doan Ngan B , Castor Brandon , Vogt Marco , Toh Melvin , Bokemeyer Carsten , Said Jonathan W , Thoennissen Nils H , Koeffler H Phillip
Published: March 2010

Background and purpose:  Pancreatic cancer is a highly aggressive malignancy, and improvement in systemic therapy is necessary to treat this frequently encountered metastatic disease. The current targeted agents used in combination with gemcitabine improved objective response rates, but with little or no improvements in survival and also increased toxicities in pancreatic cancer patients. Recently, we showed that the triterpenoid cucurbitacin B inhibited tumour growth in pancreatic cancer cells by inhibition of the JAK/STAT pathway, and synergistically increased antiproliferative effects of gemcitabine in vitro.

Experimental approach:  The anti‐tumour effects and toxicities of cucurbitacin B in combination with gemcitabine were tested against human pancreatic cancer cells in a murine xenograft model.

Key results:  Combined therapy with cucurbitacin B and gemcitabine at relatively low doses (0.5 mg·kg−1 and 25 mg·kg−1 respectively) resulted in highly significant tumour growth inhibition of pancreatic cancer xenografts (up to 79%). Remarkably, this therapy was well tolerated by the animals, as shown by histology of visceral organs, analysis of serum chemistry, full blood counts and bone marrow colony numbers. Western blot analysis of the tumour samples of mice who received both cucurbitacin B and gemcitabine, revealed stronger inhibition of Bcl‐XL, Bcl‐2 and c‐myc, and higher activation of the caspase cascades, than mice treated with either agent alone.

Conclusions and implications:  Combination of cucurbitacin B and gemcitabine had profound anti‐proliferative effects in vivo against xenografts of human pancreatic cancer cells, without any significant signs of toxicity. This promising combination should be examined in therapeutic trials of pancreatic cancer.
Kinetic analysis of novel mono‐ and multivalent VHH‐fragments and their application for molecular imaging of brain tumours
Authors: Iqbal U , Trojahn U , Albaghdadi H , Zhang J , O'Connor‐McCourt M , Stanimirovic D , Tomanek B , Sutherland G , Abulrob A
Published: March 2010

Background and purpose:  The overexpression of epidermal growth factor receptor (EGFR) and its mutated variant EGFRvIII occurs in 50% of glioblastoma multiforme. We developed antibody fragments against EGFR/EGFRvIII for molecular imaging and/or therapeutic targeting applications.

Experimental approach:  An anti–EGFR/EGFRvIII llama single‐domain antibody (EG2) and two higher valency format constructs, bivalent EG2‐hFc and pentavalent V2C‐EG2 sdAbs, were analysed in vitro for their binding affinities using surface plasmon resonance and cell binding studies, and in vivo using pharmacokinetic, biodistribution, optical imaging and fluorescent microscopy studies.

Key results:  Kinetic binding analyses by surface plasmon resonance revealed intrinsic affinities of 55 nM and 97 nM for the monovalent EG2 to immobilized extracellular domains of EGFR and EGFRvIII, respectively, and a 10‐ to 600‐fold increases in apparent affinities for the multivalent binders, V2C‐EG2 and EG2‐hFc, respectively. In vivo pharmacokinetic and biodistribution studies in mice revealed plasma half‐lives for EG2, V2C‐EG2 and EG2‐hFc of 41 min, 80 min and 12.5 h, respectively, as well as a significantly higher retention of EG2‐hFc compared to the other two constructs in EGFR/EGFRvIII‐expressing orthotopic brain tumours, resulting in the highest signal in the tumour region in optical imaging studies. Time domain volumetric optical imaging fusion with high‐resolution micro‐computed tomography of microvascular brain network confirmed EG2‐hFc selective accumulation/retention in anatomically defined tumour regions.

Conclusions:  Single domain antibodies can be optimized for molecular imaging applications by methods that improve their apparent affinity and prolong plasma half‐life and, at the same time, preserve their ability to penetrate tumour parenchyma.
Phytocannabinoids beyond theCannabisplant – do they exist?
Authors: Gertsch Jürg , Pertwee Roger G , Di Marzo Vincenzo
Published: March 2010

It is intriguing that during human cultural evolution man has detected plant natural products that appear to target key protein receptors of important physiological systems rather selectively. Plants containing such secondary metabolites usually belong to unique chemotaxa, induce potent pharmacological effects and have typically been used for recreational and medicinal purposes or as poisons.Cannabis sativaL. has a long history as a medicinal plant and was fundamental in the discovery of the endocannabinoid system. The major psychoactiveCannabisconstituent Δ9‐tetrahydrocannabinol (Δ9‐THC) potently activates the G‐protein‐coupled cannabinoid receptor CB1and also modulates the cannabinoid receptor CB2. In the last few years, several other non‐cannabinoid plant constituents have been reported to bind to and functionally interact with CB receptors. Moreover, certain plant natural products, from bothCannabisand other plants, also target other proteins of the endocannabinoid system, such as hydrolytic enzymes that control endocannabinoid levels. In this commentary we summarize and critically discuss recent findings.

This article is part of a themed issue on Cannabinoids. To view the editorial for this themed issue visithttp://dx.doi.org/10.1111/j.1476‐5381.2010.00831.x
Latent Extinction and Invasion Risk of Crayfishes in the Southeastern United States
Authors: LARSON ERIC R. , OLDEN JULIAN D.
Published: March 2010

Abstract:  Crayfishes are both a highly imperiled invertebrate group as well as one that has produced many invasive species, which have negatively affected freshwater ecosystems throughout the world. We performed a trait analysis for 77 crayfishes from the southeastern United States in an attempt to understand which biological and ecological traits make these species prone to imperilment or invasion, and to predict which species may face extinction or become invasive in the future. We evaluated biological and ecological traits with principal coordinate analysis and classification trees. Invasive and imperiled crayfishes occupied different positions in multivariate trait space, although crayfishes invasive at different scales (extraregional vs. extralimital) were also distinct. Extraregional crayfishes (large, high fecundity, habitat generalists) were most distinct from imperiled crayfishes (small, low fecundity, habitat specialists), thus supporting the “two sides of the same coin” hypothesis. Correct classification rates for assignment of crayfishes as invasive or imperiled were high (70–80%), even when excluding the highly predictive but potentially confounding trait of range size (75–90%). We identified a number of species that, although not currently listed as imperiled or found outside their native range, possess many of the life‐history and ecological traits characteristic of currently invasive or imperiled taxa. Such species exhibit a high latent risk of extinction or invasion and consequently should be the focus of proactive conservation or management strategies. Our results illustrate the utility of trait‐based approaches for taxonomic groups such as invertebrates, for which detailed species‐specific data are rare and conservation resources are chronically limited.
Moral and Religious Convictions and Intentions to Vote in the 2008 Presidential Election
Authors: Morgan G. Scott , Skitka Linda J. , Wisneski Daniel C.
Published: March 2010

The current research investigated whether people's issue‐specific moral and religious convictions had distinct or redundant effects on their intentions to vote in the 2008 presidential election. Participants reported their levels of moral and religious conviction about the issue that they perceived as most important to the 2008 presidential election and their intentions to vote. Results indicated that stronger issue‐specific moral convictions and weaker issue‐specific religious convictions were associated with increased intentions to vote. In short, people's moral and religious convictions had distinct and dissimilar effects on their intentions to vote in the 2008 presidential election.
Favorable Glucose Tolerance and Lower Prevalence of Metabolic Syndrome in Offspring without Diabetes Mellitus of Nonagenarian Siblings: The Leiden Longevity Study
Authors: Rozing Maarten P. , Westendorp Rudi G. J. , de Craen Anton J. M. , Frölich Marijke , de Goeij Moniek C. M. , Heijmans Bastiaan T. , Beekman Marian , Wijsman Carolien A. , Mooijaart Simon P. , Blauw Gerard‐Jan , Slagboom P. Eline , van Heemst Diana ,   on behalf of the Leiden Longevity Study Group
Published: March 2010

OBJECTIVES: To explore measures of metabolic syndrome and glucose metabolism in families with exceptional longevity.

DESIGN: Case–control study.

SETTING: A university hospital in Leiden, the Netherlands.

PARTICIPANTS: One hundred twenty‐one offspring of nonagenarian siblings, who were enriched for familial factors promoting longevity, and 113 of their partners. No subject had diabetes mellitus.

MEASUREMENTS: Prevalence of metabolic syndrome was determined according to the criteria of the Third Report of the National Cholesterol Education Program. Glucose tolerance was assessed according to a 2‐hour oral glucose tolerance test.

RESULTS: The offspring of nonagenarians siblings had a lower prevalence of metabolic syndrome (P=.03), similar body composition, lower mean fasting blood glucose levels (4.99 vs 5.16 mmol/L; P=.01), lower mean fasting insulin levels (5.81 vs 6.75 mU/L; P=.04), a higher mean homeostasis model assessment of insulin sensitivity (0.78 vs 0.65; P=.02), and a more‐favorable glucose tolerance (mean area under the receiver operating characteristic curve for glucose (13.2 vs 14.3; P=.007) than their partners. No significant differences were observed between the offspring and their partners in β‐cell function (insulogenic index 13.6 vs 12.5; P=.38).

CONCLUSION: Despite similar body composition, the offspring of nonagenarian siblings showed a lower prevalence of metabolic syndrome and better glucose tolerance than their partners, centralizing the role of favorable glucose metabolism in familial longevity.
Choice of Initial Antiepileptic Drug for Older Veterans: Possible Pharmacokinetic Drug Interactions with Existing Medications
Authors: Pugh Mary Jo V. , VanCott Anne C. , Steinman Michael A. , Mortensen Eric M. , Amuan Megan E. , Wang Chen‐Pin , Knoefel Janice E. , Berlowitz Dan R.
Published: March 2010

OBJECTIVES: To identify clinically meaningful potential drug–drug interactions (PDIs) with antiepileptic drugs (AEDs), the AEDs and co‐administered drugs commonly associated with AED‐PDIs, and characteristics of patients with high likelihood of AED‐PDI exposure.

DESIGN: Five‐year retrospective cohort study of veterans with new‐onset epilepsy.

SETTING: National Veterans Affairs and Medicare databases.

PARTICIPANTS: Veterans aged 66 and older with a new diagnosis of epilepsy between October 1, 1999, and September 30, 2004 (N=9,682).

MEASUREMENTS: AED‐PDI was restricted to clinically meaningful PDIs identified using prior literature review. AED‐PDIs were identified using participants' date of initial AED prescription and overlapping concomitant medications. Logistic regression analysis identified factors associated with AED‐PDI, including demographic characteristics, chronic disease states, and diagnostic setting.

RESULTS: AED‐PDI exposure was found in 45.5% (4,406/9,682); phenytoin, a drug with many PDIs, was the most commonly prescribed AED. Cardiovascular drugs, lipid‐lowering medications, and psychotropic agents were the most commonly co‐administered AED‐PDI medications. Individuals with AED‐PDI exposure were more likely to have hypertension (odds ratio (OR)=1.46, 99% confidence interval (CI)=1.24–1.82) and hypercholesterolemia (OR=1.40, 99% CI=1.24–1.57) than those without and to be diagnosed in an emergency or primary care setting than a neurology setting (emergency: OR=1.30, 99% CI=1.08–1.58; primary care: OR=1.29 99% CI=1.12–1.49).

CONCLUSION: Exposure to AED‐PDI was substantial but less common in patients with epilepsy diagnosed in a neurology setting. Because potential outcomes associated with AED‐PDI include stroke and myocardial infarction in a population already at high risk, clinicians should closely monitor blood pressure, coagulation, and lipid measures to minimize adverse effects of AED‐PDIs. Interventions to reduce AED‐PDIs may improve patient outcomes.
Frequency and Correlates of Caregiver‐Reported Sleep Disturbances in a Sample of Persons with Early Dementia
Authors: Rongve Arvid , Boeve Bradley F. , Aarsland Dag
Published: March 2010

OBJECTIVES: To identify sleep disturbances in participants with subtypes of dementia and explore clinical correlates.

DESIGN: Cross‐sectional.

SETTING: Outpatient clinics in western Norway and the Mayo Clinic Study of Aging, Olmsted County, Minnesota.

PARTICIPANTS: One hundred fifty‐one community‐dwelling western Norway residents referred for geriatric medicine, geriatric psychiatry or neurology evaluation and 420 participants without dementia from the Mayo Clinic Study of Aging.

MEASUREMENTS: Dementia was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. The Mayo Sleep Questionnaire, an interview to detect sleep disturbances, was administered to diagnose probable rapid eye movement (REM) sleep behavior disorder, probable periodic leg movements during sleep, probable restless legs syndrome, probable sleepwalking, probable sleep‐related leg cramps, probable obstructive sleep apnea, and excessive daytime sleepiness. Insomnia was assessed using the Neuropsychiatric Inventory, an interview to detect neuropsychiatric symptoms in dementia.

RESULTS: Seventy‐one percent of the participants with dementia and 55.7% of control participants had sleep disturbances (P=.001). Most frequently reported in the mild dementia participants were insomnia (29.9%), probable sleep‐related leg cramps (24.1%), excessive daytime sleepiness (22.6%), probable restless legs syndrome (20.7%), and probable REM sleep behavior disorder (18.5%). There were more sleep‐related problems reported in participants with Lewy body dementias (LBD) (dementia with Lewy bodies and Parkinson's disease dementia) than in those with Alzheimer's disease (P=.008). Having any sleep disorder correlated with depression (P=.03) and anxiety (P=.02).

CONCLUSION: Sleep problems are common in dementia, particularly in subjects with LBD, and are associated with psychiatric symptoms. Further research is needed to understand these associations and identify treatment strategies.
Quality‐of‐Life Trajectories at the End of Life: Assessments over Time by Patients with and without Cancer
Authors: Downey Lois , Engelberg Ruth A.
Published: March 2010

OBJECTIVES: To compare quality‐of‐life (QOL) ratings of terminally ill patients with and without cancer over time.

DESIGN: Secondary analysis of prospective data from a randomized clinical trial.

SETTING: Trial conducted with terminally ill patients in Seattle, Washington, testing the efficacy of massage and guided meditation in improving patients' QOL.

PARTICIPANTS: One hundred sixty‐seven trial participants, of whom 127 provided follow‐up data and died before data analysis.

MEASUREMENTS: At enrollment, participants reported demographic characteristics, symptom distress, QOL, and primary life‐limiting diagnosis. At enrollment and at follow‐up interviews after every two study‐provided treatment sessions, participants rated their perceived quality of life on a scale from 0 (no quality of life) to 10 (perfect quality). At the end of the study, the investigators added measures of patient's survival status, number of days between study enrollment and death, and receipt of hospice services to the data set.

RESULTS: Multilevel models showed significantly steeper QOL declines for patients with cancer than for those without after adjustment for time between study enrollment and death. Over a 4‐month before‐death period, the average patient without cancer was estimated to experience a QOL decline of approximately 0.6 on a scale from 0 to 10, compared with a 1.2‐point decline for patients with cancer.

CONCLUSION: Patients with cancer face more‐precipitous end‐of‐life challenges to quality of life than do other terminally ill persons. Therefore, clinicians must address QOL issues—not just symptom burden and distress. By introducing and discussing expected QOL declines at the end of life, clinicians may help to prepare, support, and reassure patients and their families.
Pragmatic, Cluster Randomized Trial of a Policy to Introduce Low‐Low Beds to Hospital Wards for the Prevention of Falls and Fall Injuries
Authors: Haines Terry P. , Bell Rebecca A.R. , Varghese Paul N.
Published: March 2010

OBJECTIVES: To evaluate the efficacy of a policy to introduce low‐low beds for the prevention of falls and fall injuries on wards that had not previously accessed low‐low beds.

DESIGN: This was a pragmatic, matched, cluster randomized trial with wards paired according to rate of falls. Intervention and control wards were observed for a 6‐month period after implementation of the low‐low beds on the intervention wards. Data from a 6‐month period before this were also collected and included in analyses to ensure comparability between intervention and control group wards.

SETTING: Public hospitals located in Queensland, Australia.

PARTICIPANTS: Patients of 18 public hospital wards.

INTERVENTION: Provision of one low‐low bed for every 12 on a hospital ward, with written guidance for identifying patients at greatest risk of falls.

MEASUREMENTS: Falls and fall injuries in the hospital measured using a computerized incident reporting system.

RESULTS: There were 10,937 admissions to control and intervention wards combined during the pre‐intervention period. There was no significant difference in the rate of falls per 1,000 occupied bed days between intervention and control group wards after the introduction of the low‐low beds (generalized estimating equation coefficient=0.23, 95% confidence interval=−0.18–0.65, P=.28). The rate of bed falls, falls resulting in injury, and falls resulting in fracture also did not differ between groups. Some difficulties were encountered in intervention group wards in using the low‐low beds as directed.

CONCLUSION: A policy for the introduction of low‐low beds did not appear to reduce falls or falls with injury, although larger studies would be required to determine their effect on fall‐related fractures.
Frequency and Pattern of Emergency Department Visits by Long‐Term Care Residents—A Population‐Based Study
Authors: Gruneir Andrea , Bell Chaim M. , Bronskill Susan E. , Schull Michael , Anderson Geoffrey M. , Rochon Paula A.
Published: March 2010

OBJECTIVES: To obtain population‐based estimates of emergency department (ED) visits by long‐term care (LTC) residents.

DESIGN: Retrospective cohort study using administrative data.

SETTING: All LTC facilities in Ontario, Canada.

PARTICIPANTS: All LTC residents who visited an ED at least once during a 6‐month period.

MEASUREMENTS: All ED visits were described using the National Ambulatory Care Reporting System. Two distinct visit types were defined. Potentially preventable visits were defined as those for any ambulatory care sensitive condition; these are conditions for which exacerbations that result in hospital use suggest lack of access to adequate primary care. Low‐acuity visits were defined as those triaged as nonurgent at ED registration and ended with return to the LTC facility without hospital admission.

RESULTS: Nearly one‐quarter of LTC residents visited the ED at least once in 6 months. Of all visits, 24.6% were for a potentially preventable reason, most commonly pneumonia, urinary tract infection, and congestive heart failure. These visits had a high frequency of ambulance transport (90.4%), emergent triage (35.3%), hospital admission (62.4%), and death within 30 days (23.6%). Of all visits, 11.0% were low acuity. Fall‐related injury was the most common cause. Low‐acuity visits were the shortest (mean length 4.5 ± 4.0 hours) and had the lowest frequency of death within 30 days (4.3%).

CONCLUSION: LTC residents made frequent visits to the ED. The visit types showed distinct patterns that suggest a need for better access to medical care for common conditions and a greater emphasis on fall prevention in LTC.
Screening for Abuse and Neglect of People with Dementia
Authors: Wiglesworth Aileen , Mosqueda Laura , Mulnard Ruth , Liao Solomon , Gibbs Lisa , Fitzgerald William
Published: March 2010

OBJECTIVE: To investigate characteristics of people with dementia and their caregivers (CGs) that are associated with mistreatment in order to inform clinicians about screening for mistreatment.

DESIGN: A convenience sample of CG–care recipient (CR) dyads were assessed for literature‐supported factors associated with mistreatment, and evidence of mistreatment for the prior year was collected. An expert panel considered the evidence and decided on occurrences of psychological abuse, physical abuse, and neglect based on criteria adopted before data collection.

SETTING: Participants' homes.

PARTICIPANTS: One hundred twenty‐nine persons with dementia and their CGs.

MEASUREMENTS: CG and CR characteristics (demographic, health, and psychosocial variables), relationship characteristics, and three elder abuse and neglect detection instruments.

RESULTS: Mistreatment was detected in 47.3%. Variables associated with different kinds and combinations of mistreatment types included the CG's anxiety, depressive symptoms, social contacts, perceived burden, emotional status, and role limitations due to emotional problems and the CR's psychological aggression and physical assault behaviors. The combination of CR's physical assault and psychological aggression provided the best sensitivity (75.4%) and specificity (70.6%) for elder mistreatment as defined by the expert panel. This finding has potential to be useful as a clinical screen for detecting mistreatment.

CONCLUSIONS: The findings suggest important characteristics of older adults with dementia and their CGs that have potential for use in a clinical screening tool for elder mistreatment. Potential screening questions to be asked of CGs of people with dementia are suggested.
Serum Lipid Levels and Cognitive Change in Late Life
Authors: Reynolds Chandra A. , Gatz Margaret , Prince Jonathan A. , Berg Stig , Pedersen Nancy L.
Published: March 2010

OBJECTIVES: To assess the effect of lipids and lipoproteins on longitudinal cognitive performance and cognitive health in late life and to consider moderating factors such as age and sex that may clarify conflicting prior evidence.

DESIGN: Prospective cohort study.

SETTING: A 16‐year longitudinal study of health and cognitive aging.

PARTICIPANTS: Eight hundred nineteen adults from the Swedish Adoption Twin Study of Aging aged 50 and older at first cognitive testing, including 21 twin pairs discordant for dementia.

MEASUREMENTS: Up to five occasions of cognitive measurements encompassing verbal, spatial, memory, and perceptual speed domains across a 16‐year span; baseline serum lipids and lipoproteins including high‐density lipoprotein cholesterol (HDL‐C), apolipoprotein (apo)A1, apoB, total serum cholesterol, and triglycerides.

RESULTS: The effect of lipids on cognitive change was most evident before age 65. In women, higher HDL‐C and lower apoB and triglycerides predicted better maintenance of cognitive abilities, particularly verbal ability and perceptual speed, than age. Lipid values were less predictive of cognitive trajectories in men and, where observed, were in the contrary direction (i.e., higher total cholesterol and apoB values predicted better perceptual speed performance though faster rates of decline). In twin pairs discordant for dementia, higher total cholesterol and apoB levels were observed in the twin who subsequently developed dementia.

CONCLUSION: High lipid levels may constitute a more important risk factor for cognitive health before age 65 than after. Findings for women are consistent with clinical recommendations, whereas for men, the findings correspond with earlier age‐associated shifts in lipid profiles and the importance of lipid homeostasis to cognitive health.
Comfort Feeding Only: A Proposal to Bring Clarity to Decision‐Making Regarding Difficulty with Eating for Persons with Advanced Dementia
Authors: Palecek Eric J. , Teno Joan M. , Casarett David J. , Hanson Laura C. , Rhodes Ramona L. , Mitchell Susan L.
Published: March 2010

Feeding and eating difficulties leading to weight loss are common in the advanced stages of dementia. When such problems arise, family members are often faced with making a decision regarding the placement of a percutaneous endoscopic gastrostomy tube. The existing evidence based on observational studies suggests that feeding tubes do not improve survival or reduce the risk of aspiration, yet the use of feeding tubes is prevalent in patients with dementia, and the majority of nursing home residents do not have orders documenting their wishes about the use of artificial hydration and nutrition. One reason is that orders to forgo artificial hydration and nutrition get wrongly interpreted as “do not feed,” resulting in a reluctance of families to agree to them. Furthermore, nursing homes fear regulatory scrutiny of weight loss and wrongly believe that the use of feeding tubes signifies that everything possible is being done. These challenges might be overcome with the creation of clear language that stresses the patient's goals of care. A new order, “comfort feeding only,” that states what steps are to be taken to ensure the patient's comfort through an individualized feeding care plan, is proposed. Comfort feeding only through careful hand feeding, if possible, offers a clear goal‐oriented alternative to tube feeding and eliminates the apparent care–no care dichotomy imposed by current orders to forgo artificial hydration and nutrition.
The Diagnosis and Treatment of Elderly Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease and Chronic Bronchitis
Authors: Albertson Timothy E. , Louie Samuel , Chan Andrew L.
Published: March 2010

The syndrome of chronic obstructive pulmonary disease (COPD) consists of chronic bronchitis (CB), bronchiectasis, emphysema, and reversible airway disease that combine uniquely in an individual patient. Older patients are at risk for COPD and its components—emphysema, CB, and bronchiectasis. Bacterial and viral infections play a role in acute exacerbations of COPD (AECOPD) and in acute exacerbations of CB (AECB) without features of COPD. Older patients are at risk for resistant bacterial organisms during their episodes of AECOPD and AECB. Organisms include the more‐common bacteria implicated in AECOPD/AECB such as Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae. Less‐common nonenteric, gram‐negative organisms including Pseudomonas aeruginosa, gram‐positive organisms including Staphylococcus aureus, and strains of nontuberculosis Mycobacteria are more often seen in AECOPD/AECB episodes involving elderly patients with frequent episodes of CB or those with bronchiectasis. Risk‐stratified antibiotic treatment guidelines appear useful for purulent episodes of AECOPD and episodes of AECB. These guidelines have not been prospectively validated for the general population and especially not for the elderly population. Using a risk‐stratification approach for elderly patients, first‐line antibiotics (e.g., amoxicillin, ampicillin, pivampicillin, trimethoprim/sulfamethoxazole, and doxycycline), with a more‐limited spectrum of antibacterial coverage, are used in patients who are likely to have a low probability of resistant organisms during AECOPD/AECB. Second‐line antibiotics (e.g., amoxicillin/clavulanic acid, second‐ or third‐generation cephalosporins, and respiratory fluoroquinolones) with a broader spectrum of coverage are reserved for patients with significant risk factors for resistant organisms and those who have failed initial antibiotic treatment.
The Effect of Printed Educational Material from the Coroner in Victoria, Australia, on Changing Aged Care Health Professional Practice: A Subscriber Survey
Authors: Ibrahim Joseph E. , Ehsani Jonathon P. , McInnes Judith A.
Published: March 2010

There are substantial knowledge and research gaps about the effects of printed educational material on professional practice. This study has examined whether the Residential Aged Care Coronial (RACC) Communiqué, an electronic newsletter of narrative case reports about lessons learned from deaths in residential aged care settings reported to the coroner in Victoria, Australia, prompted subscribers to initiate change in professional practice to improve care. An anonymous electronic survey was distributed to all registered subscribers of the RACC Communiqué to collect information about self‐reported changes in professional practice, respondent characteristics, reading behavior, and an assessment of effect and content of the publication. Researchers from the Victoria Institute of Forensic Medicine, Victoria, Australia, conducted the study in 2008. Of 778 subscribers invited to participate in the study, 426 (54.8%) provided valid responses. The majority of respondents were aged 45 and older, female, and working at a residential aged care facility in a management role. Half of the survey respondents reported making a change to their professional practice as a result of reading the RACC Communiqué, with one‐fifth of these respondents agreeing that they would not have made the self‐reported change if they had not read this publication. These findings are greater than the previously reported small effects of education through printed education material and make an important contribution to understanding the use of printed education material for initiating professional practice change.
Influence of Microwave Disinfection on the Dimensional Stability of Denture Reline Polymers
Authors: Basso Michael Frederico Manzolli , Giampaolo Eunice Teresinha , Vergani Carlos Eduardo , Machado Ana Lúcia , Pavarina Ana Cláudia , Ribeiro Roberta Chuqui
Published: March 2010

Purpose: The purpose of this study was to evaluate the effect of microwave disinfection (3 minutes at 650 W) on the dimensional stability of hard chairside reline resins (Kooliner, Tokuyama Rebase II, Ufi Gel hard, New Truliner) and one heat‐polymerizing denture base resin (Lucitone 550).

Materials and Methods: A split mold with reference points was used to make specimens (50.0‐mm diameter, 0.5‐mm thick) from each material, divided into five test groups (n = 8). The distances between the points on the mold were measured (gold standard), and compared with those obtained from the specimens after polymerization (baseline readings) after one, two, three, and four cycles of disinfection by microwave irradiation.

Results: ANOVA and Tukey tests (α= 0.05) showed that Kooliner was significantly affected by all disinfection cycles (p < 0.05) when compared with baseline measurements. New Truliner resin was significantly affected by three and four cycles of microwave disinfection when compared with baseline measurements (p < 0.05). For Tokuyama Rebase II, Ufi Gel hard, and Lucitone 550, no significant dimensional changes were found.

Conclusions: Microwave disinfection promoted shrinkage of Kooliner and New Truliner. The dimensional stability of Tokuyama Rebase II, Ufi Gel Hard, and Lucitone 550 was not affected by microwave disinfection.
The Semiparametric Case‐Only Estimator
Authors: Tchetgen Tchetgen Eric J. , Robins James
Published: March 2010

Summary We propose a semiparametric case‐only estimator of multiplicative gene–environment or gene–gene interactions, under the assumption of conditional independence of the two factors given a vector of potential confounding variables. Our estimator yields valid inferences on the interaction function if either but not necessarily both of two unknown baseline functions of the confounders is correctly modeled. Furthermore, when both models are correct, our estimator has the smallest possible asymptotic variance for estimating the interaction parameter in a semiparametric model that assumes that at least one but not necessarily both baseline models are correct.
Development and utility of a multi‐dimensional grid to assess individual mineral metabolism control in hemodialysis patients: A potential aid for therapeutic decision making?
Authors: MORTON A. Ross , MURPHY Sean , HIRSCH David , LEBLANC Martine , BARRÉ Paul , LOK Charmaine , HERCZ Gavril , HODSMAN Anthony , RESLEROVA Martina , LEVIN Adeera
Published: March 2010

A grid was developed to evaluate control of serum calcium, phosphate, and parathyroid hormone levels in hemodialysis patients, based on guideline recommendations (National Kidney Foundation Kidney Disease Outcomes Quality Initiative and Canadian Society of Nephrology), and its face validity was examined in a representative sample of Canadian patients. A retrospective chart review was undertaken in hemodialysis patients from 7 Canadian units. Patients >18 years, on hemodialysis for ≥12 months, and ≥3 parathyroid hormone levels measured ≥1 month apart were included. The grid classified mineral metabolism control as optimal, suboptimal, or poor (mean of 3 measurements). Medication use, hospitalization, and Emergency Department visits were evaluated in relation to grid occupancy. A second comparative analysis of grid occupancy was undertaken on prevalent hemodialysis cases in British Columbia in 2008. Data from 268 patients (mean age 62.3 years) were analyzed. Using National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines, 17.5%, 28.8%, and 53.7% of patients had optimal, suboptimal, and poor control, respectively, of all 3 parameters (calcium, phosphate, and parathyroid hormone). Using Canadian Society of Nephrology criteria, optimal, suboptimal, and poor control rates were 6.3%, 4.2%, and 89.5%, respectively. Poor control was a possible or a probable cause of hospitalization or Emergency Department attendance in 8 patients. Data from British Columbia in 2008 (n=1858) show optimal, suboptimal, and poor control rates of 15.8%, 24.5%, and 59.7%, respectively. Poor mineral metabolism control among Canadian hemodialysis patients is not showing improvement. The therapeutic grid is a valid tool and may help guide therapeutic decisions, quality control initiatives, and patient counseling. http://www.ukidney.com/bone‐and‐mineral‐metabolism‐resource.
Luminescent Properties of Eu3+‐Doped BaLn2ZnO5 (Ln=La, Gd, and Y) Phosphors by the Sol–Gel Method
Authors: Guo Chongfeng , Ding Xu , Xu Yan
Published: March 2010

Three series of Eu3+‐doped BaLn2−xEuxZnO5 (Ln=Y, Gd, and La) phosphor powders were prepared by the sol–gel process. Parameters that affect the photoluminescence (PL) intensity of phosphors were investigated in detail. The phase formation and identification of samples were characterized by thermogravimetry and differential thermal analysis and X‐ray diffraction (XRD), respectively. The morphologies of the phosphor particles and the spectra of the as‐prepared phosphors were investigated by means of field‐emission scanning electron microscopy (FE‐SEM) and PL measurements. The XRD results reveal that the sample adopts a tetragonal structure for BaLa2−xEuxZnO5 and the other two samples adopt an orthorhombic structure in our experimental ranges, and the formation temperature of the pure phase increases with the decreasing of the radius of Ln3+ ions. The FE‐SEM images indicate that the size and the shape of phosphor particles are regular. The PL spectra of phosphors BaLn2−xEuxZnO5 (Ln=Y, Gd, and La) show the characteristic emissions of Eu3+. And the emission color of phosphors BaLn2−xEuxZnO5 (Ln=Y, Gd) could be tuned from white to red by changing the concentration of Eu3+, but the BaLa2−xEuxZnO5 only shows red emission and was independent to the concentration of Eu3+.
Mechanism and Role of Mechanochemical Activation in the Synthesis of (K,Na,Li)(Nb,Ta)O3 Ceramics
Authors: Rojac Tadej , Benčan Andreja , Kosec Marija
Published: March 2010

Using mechanochemical activation, a homogeneous (K0.485Na0.485Li0.03)(Nb0.8Ta0.2)O3 (KNLNT) solid solution can be obtained after subsequent calcination and sintering. The present study aims to elucidate the origin of the high homogeneity of the activated powder and its relation to the synthesis of KNLNT ceramics. To investigate the effect of the milling conditions, the high‐energy milling experiments were performed under different regimes, distinguished by the extent of the impact and frictional force components acting on the powder particles. In addition to this, each one of the starting compounds were also activated separately and then mixed together so as to avoid mechanochemical interactions. This enables us to verify whether the reaction between the constituents during high‐energy milling has an effect on the synthesis of KNLNT. The results show that during the activation of the mixture, the symmetry of the CO32− ions, present initially in K2CO3 and Na2CO3, is lowered. This is induced mechanochemically by the reaction with Nb2O5 and Ta2O5. As a result, an amorphous carbonato complex is formed, which plays a crucial role in obtaining highly homogeneous KNLNT ceramics.
New Insights Into the Effect of Calcium Hydroxide Precipitation on the Kinetics of Tricalcium Silicate Hydration
Authors: Bullard Jeffrey W. , Flatt Robert J.
Published: March 2010

After decades of research, there still is no universal agreement on the basic mechanisms that are responsible for the induction period (Stage 2) in cement hydration at early times. This paper surveys several theories and critical experimental data on early‐age hydration kinetics of tricalcium silicate, the most abundant phase in Portland cement clinker. Using HydratiCA, a kinetic cellular automaton model of cement hydration and microstructure development, we investigate two of the leading hypotheses on the mechanism of slow hydration in Stage 2, and see for each one the implications of suppressing the growth of calcium hydroxide formation. Each hypothesized mechanism leads to quite different kinetic behavior when calcium hydroxide is suppressed, a result which indicates a line of future experimental inquiry that could decisively determine the Stage 2 mechanism. Furthermore, the simulations demonstrate how the early theory of calcium hydroxide triggering might be reconciled to the more modern theoretical models and to the experimental data.
Sr4−mLamTim−1Ta4−mO12 (m=1, 2, 3): A Novel Series of A4B3O12‐Type Microwave Ceramics with a High Q and Low τf
Authors: Fang Liang , Li Chunchun , Peng Xiyang , Hu Changzheng , Wu Bolin
Published: March 2010

A novel series of single‐phase polycrystalline ceramics Sr4−mLamTim−1Ta4−mO12 (m=1, 2, 3) were prepared through the solid‐state ceramic route. All of them adopt A4B3O12‐type cation‐deficient hexagonal perovskite structure. The microwave dielectric properties can be tuned by controlling the composition or the value of m. As m increases, the dielectric constant (ɛr) of the ceramic increases from 30 to 40.1 and the quality factor (Q×f) enhances from 16 050 to 42 130 GHz, and the temperature coefficient of resonant frequency (τf) improves from −43 to −8 ppm/°C.