bluuebunny/crossref_metadata_2025 huggingface dataset:
Modification of nursing students' performance in blood pressure measurement: an educational retraining programme
Authors: Brokalaki H. , Matziou V. , Gymnopoulou E. , Galanis P. , Brokalaki E. , Theodossiades G.
Published: May 2008

Aim:  To assess the procedure for measuring blood pressure (BP) among nursing students after the basic educational programme and after further supplementary training.

Methods:  One hundred and fifty nursing students participated in the study, which was divided into two phases. During the first phase, students attended the routine educational programme in respect of the technique of measuring BP in the course of the lesson ‘Basic Nursing’. During the next semester (second phase), the same students attended the lesson of ‘Internal Medicine Nursing’. In the course of this lesson, a supplementary educational intervention for BP measurement was introduced for the purpose of this study. In order to perform our study, the university's written approval was given. At the end of the second phase, the 150 participants (volunteers) gave their oral consent for the anonymous publication of the results.

Results:  The results showed an inadequate performance after the basic educational programme, but a significant improvement in the technique of measuring BP after supplementary educational intervention was achieved. This improvement was significant for all the parameters examined.

Conclusion:  Supplementary education of students may be required, as this could significantly improve their technique for the accurate measurement of BP.
Competencies in the context of entry‐level registered nurse practice: a collaborative project in Canada
Authors: Black J. , Allen D. , Redfern L. , Muzio L. , Rushowick B. , Balaski B. , Martens P. , Crawford M. , Conlin‐Saindon K. , Chapman L. , Gautreau G. , Brennan M. , Gosbee B. , Kelly C. , Round B.
Published: May 2008

Aim:  To present the process used by professional staff from 10 Canadian jurisdictional regulatory bodies to develop entry‐level competencies for registered nurse practice.

Background:  Canada is composed of provinces and territories, commonly referred to as jurisdictions with the governmental legal authority to administer the affairs of the area. Each jurisdiction establishes regulatory bodies with the mandate to protect the public.

The Executive Directors of the jurisdictional regulatory bodies initiated this collaborative project to develop entry‐level competencies for registered nurses. The purpose of the project was to enhance the consistency of entry‐level registered nurse competencies, thereby supporting reciprocity of registration and workforce mobility, within Canada. This was the first time that Canadian nursing regulatory bodies have collaborated in a jurisdictional‐driven project of this magnitude for registered nurses exclusively. This initiative has demonstrated how nursing regulatory bodies, working together, can achieve a common goal.

Process:  The project participants worked from 2004 to 2006, developing and refining the competencies. Multiple methods were used to accomplish the task, including monthly teleconferences, frequent E‐mail communications, small group work and face‐to‐face meetings. At various stages in the project, consultation with registered nurses within several participating jurisdictions occurred, depending on where each jurisdiction was in their jurisdictional competency review. This project spanned a 2‐year period and resulted in a comprehensive document that captured the views of the participants and enhanced the resulting document.

Conclusion:  The result is a document stating the core competencies for entry‐level registered nurses in the 10 participating jurisdictions and includes several components that establish the context in which entry‐level competencies are developed and applied. The 119 competency statements are organized in a standard‐based framework of five categories: professional responsibility and accountability; knowledge‐based practice; ethical practice; service to the public; and self‐regulation. The project team plans to follow up on implementation as each jurisdiction decides how to use the competencies within their particular jurisdiction.
Post‐disaster community tourism recovery: the tsunami and Arugam Bay, Sri Lanka
Authors: Robinson Lyn , Jarvie Jim K.
Published: May 2008

Tourism is highly vulnerable to external, non‐controllable events. A natural disaster can affect the local tourism industry in numerous ways, and such events are particularly devastating for small communities whose local economy is heavily dependent on the sector. Loss of infrastructure plus negative media stories can have long‐term ramifications for the destination. In spite of the economic importance of tourism, post‐disaster recovery efforts in this sector are often overlooked by non‐governmental organisations (NGOs), which focus on more traditional livelihoods such as agriculture or fishing. This paper describes Mercy Corps' support of tourism recovery activities in Arugam Bay, a remote village on the east coast of Sri Lanka, following the 2004 tsunami. The local economic base is built largely on two sectors: community tourism and fishing. As many other actors were supporting recovery in the local fishing industry, Mercy Corps concentrated on revitalising the tourism sector.
Coping strategies in Chinese social context
Authors: Hsu Wen‐Yau , Chen Mei‐Chueh , Wang Te‐Hsien , Sun Sung‐Hsien
Published: May 2008

The present study examined whether the scale called Coping Strategies in Chinese Social Context (CSCSC) developed in this paper is better at predicting individual mental health than the COPE Scale, which focuses on ‘active‐passive’ coping. Two hundred and 51 university students were recruited and measured on the CSCSC, COPE and five mental health inventories. The results demonstrated that the CSCSC predicted mental health better than the COPE. ‘Active‐prosocial’ and ‘passive‐prosocial’ are two suitable coping strategies, whereas ‘passive‐antisocial’ is not a suitable coping strategy. Studies exploring coping processes in Chinese culture should consider social interactions and connection with others as a significant aspect of coping.
Entrepreneurship through relationships – navigating from creativity to commercialisation
Authors: Harryson Sigvald J.
Published: May 2008

This paper explores the role of relationships in the emergence of a network's value creation structure. The strategic navigation from creative exploration to global exploitation through the use of so‐called transformation networks is particularly highlighted. The creativity phase requires a creator with visionary leadership. The commercialisation phase, on the other hand, requires technology integration and global marketing excellence. Realising that this requires more than a bright inventor, the creator of Anoto brought in the right complementary assets at distinct phases of the commercialisation process. Our case illustrates how integrator and marketeer profiles were brought into a networked act of entrepreneurship for joint navigation across an ocean of relationships that gave birth to a global standard for digital writing. By combining theories on open innovation and networking, a theoretical framework is developed to analyse the different nature of the networks (or the value creation structure) in which complementary assets can be accessed, transferred and transformed into commercialised innovation. The analysis suggests that the value of complementary assets are embedded in and unlocked by three distinct types of networks: creativity networks, transformation networks and process networks. It also suggests that the ideal approach to accessing complementary assets shifts over the research and development management process, and happens through these three different types and levels of networks, requiring fundamentally different approaches to leadership and relationship management. Current literature describes open and networked innovation as a continuous – not dynamic – process of exploration and exploitation without any distinction of how types and structures of networks evolve and interact in the process.
Legal Validity: An Inferential Analysis*
Authors: SARTOR GIOVANNI
Published: May 2008

Abstract.  I will argue that the concept of (valid) law is a normative notion, irreducible to any factual description. Its conceptual function is that of relating certain (alternative sets of) properties a norm may possess to the conclusion that the norm is legally binding, namely, that it deserves to be endorsed and applied in legal reasoning. Legal validity has to be distinguished from other, more demanding, normative ideas, such as moral bindingness or legal optimality.
Hans Kelsen's Normativist Reductionism
Authors: PATTARO ENRICO
Published: May 2008

Abstract.  This paper discusses Kelsen's attempt at reducing the concept of subjektives Recht (what is subjectively right) to that of objektives Recht (what is objectively right). This attempt fails, it is argued, because in Kelsen's theory the concept of subjektives Recht survives concealed within the concept of individual norm (individuelle Norm), a norm that, pace Kelsen, is not a case of what is objectively right (objektives Recht) but is precisely what is subjectively right (subjektives Recht): We could call it “what is individually right.”
THE UNIVERSALITY OF JEWISH ETHICS: A Rejoinder to Secularist Critics
Authors: Novak David
Published: May 2008

Jewish ethics like Judaism itself has often been charged with being “particularistic,” and in modernity it has been unfavorably compared with the universality of secular ethics. This charge has become acute philosophically when the comparison is made with the ethics of Kant. However, at this level, much of the ethical rejection of Jewish particularism, especially its being beholden to a God who is above the universe to whom this God prescribes moral norms and judges according to them, is also a rejection of Christian (or any other monotheistic) ethics, no matter how otherwise universal. Yet this essay argues that Jewish ethics that prescribes norms for all humans, and that is knowable by all humans, actually constitutes a wider moral universe than does Kantian ethics, because it can include non‐rational human objects and even non‐human objects altogether. This essay also argues that a totally egalitarian moral universe, encompassing all human relations, becomes an infinite, totalizing universe, which can easily become the ideological justification (ratio essendi) of a totalitarian regime.
IS FORGETTING REPREHENSIBLE? Holocaust Remembrance and the Task of Oblivion
Authors: Krondorfer Björn
Published: May 2008

“Forgetting” plays an important role in the lives of individuals and communities. Although a few Holocaust scholars have begun to take forgetting more seriously in relation to the task of remembering—in popular parlance as well as in academic discourse on the Holocaust—forgetting is usually perceived as a negative force. In the decades following 1945, the terms remembering and forgetting have often been used antithetically, with the communities of victims insisting on the duty to remember and a society of perpetrators desiring to forget. Thus, the discourse on Holocaust memory has become entrenched on this issue. This essay counters the swift rejection of forgetting and its labeling as a reprehensible act. It calls attention to two issues: first, it offers a critical argument for different forms of forgetting; second, it concludes with suggestions of how deliberate performative practices of forgetting might benefit communities affected by a genocidal past. Is it possible to conceive of forgetting not as the ugly twin of remembering but as its necessary companion?
PERTURBATIONS OF THE SOUL AND PAINS OF THE BODY: Augustine on Evil Suffered and Done in War
Authors: Carnahan Kevin
Published: May 2008

Many contemporary scholars debate whether war should be conceived as a relative evil or a morally neutral act. The works of Augustine may offer new ways of thinking through the categories of this debate. In an early period, Augustine develops the distinction between evil done and evil suffered. Augustine's early treatments of war locate the saint as detached sage doing only good, and immune from evil suffered. In a middle period, he develops a richer picture of the evil suffered on the occasion of the loss of historical goods but fails to develop the implications of this picture as concerns war. Finally, without abandoning emphasis on the avoidance of doing evil, Augustine comes to highlight how evil suffered in war prevents us from speaking simply of good wars. Augustine's ability to hold together senses of evil and their moral significance provides a useful avenue for new thought on this issue.
BODY POLITICS AND THE POLITICS OF BODIES: Racism and Hauerwasian Theopolitics
Authors: Woodard‐Lehman Derek Alan
Published: May 2008

Today dominative power operates apart from, and exterior to, those state governmentalities that the “body politics” of Stanley Hauerwas disavows as “constantinian” entanglements such as military service, governmental office, and conspicuous expressions of civil religion. This is especially true with respect to those biopolitical modalities David Theo Goldberg names as “racelessness,” by which material inequalities are racially correlated, thereby allowing whiteness to mediate life and ration death. If, as Hauerwas contends, radical ecclesiology is indeed a theopolitical alternative to the nation–state's politics of violence, then it must prove itself resistant to such racialized violence. However, inasmuch as the (largely) uncontested fact of ecclesial segregation recapitulates these broader stratifications and exclusions, the church functions as a passive civil religion and itself participates in the politics of “nonviolent violence.” Thus, Hauerwas must do something that he has been reluctant to do. He must talk about race and racism more directly, specifying how his ecclesiological theopolitics resists such forms of violence; more importantly, he must demonstrate how actual ecclesial congregations instantiate such resistance. In short, to be truly nonviolent, Hauerwas's body politics must become a politics of bodies.
“WHY BE MORAL?” The Cheng Brothers' Neo‐Confucian Answer
Authors: Huang Yong
Published: May 2008

In this article, I present a neo‐Confucian answer, by Cheng Hao and Cheng Yi, to the question, “Why should I be moral?” I argue that this answer is better than some representative answers in the Western philosophical tradition. According to the Chengs, one should be moral because it is a joy to perform moral actions. Sometimes one finds it a pain, instead of a joy, to perform moral actions only because one lacks the necessary genuine moral knowledge—knowledge that is accessible to every common person as long as one makes the effort to learn. One should make the effort to learn such knowledge—to seek joy in performing moral actions—because to be moral is a distinguishing mark of being human. This neo‐Confucian answer seems to be egoistic, as its conception of motivation for morality is based on self‐interest: to seek one's own joy. However, since it emphasizes that one's true self‐interest is to seek joy in things uniquely human, which is to be moral, self‐interest and morality become identical; the more a person seeks one's self‐interest, the more moral the person is, and vice versa.
Involvement of Corticotrophin-Releasing Factor and Orexin-A in Chronic Migraine and Medication-Overuse Headache: Findings From Cerebrospinal Fluid
Authors: Sarchielli P , Rainero I , Coppola F , Rossi C , Mancini ML , Pinessi L , Calabresi P
Published: May 2008

The study set out to investigate the role of corticotrophin-releasing factor (CRF) and orexin-A in chronic migraine (CM) and medication-overuse headache (MOH). Twenty-seven patients affected by CM and 30 with MOH were enrolled. Control CSF specimens were obtained from 20 age-matched subjects who underwent lumbar puncture for diagnostic purposes, and in all of them CSF and blood tests excluded central nervous system or systemic diseases. Orexin-A and CRF were determined by radioimmunoassay methods. Significantly higher levels of orexin-A and CRF were found in the CSF of MOH and to a lesser extent in patients with CM compared with control subjects (orexin-A: P < 0.001 and P < 0.02; CRF: P < 0.002 and P < 0.0003). A significant positive correlation was also found between CSF orexin-A values and those of CRF ( R = 0.71; P < 0.0008), monthly drug intake group ( R = 0.39; P < 0.03) and scores of a self-completion 10-item instrument to measure dependence upon a variety of substances, the Leeds Dependence Questionnaire (LDQ) in the MOH group ( R = 0.68; P < 0.0003). The significantly higher orexin-A levels found in CM and MOH can be interpreted as a compensatory response to chronic head pain or, alternatively, as an expression of hypothalamic response to stress due to chronic pain. A potential role for orexin-A in driving drug seeking in MOH patients through activation of stress pathways in the brain can also be hypothesized.
Determination of the antioxidative capacity of an antioxidant complex and idebenone: an in vitro rapid and sensitive method
Authors: Zhai Hongbo , Cordoba‐Diaz Manuel , Wa Chrystal , Hui Xiaoying , Maibach Howard I
Published: May 2008

Background/aims  The goal of this study was to determine the ability of two putative antioxidant solutions to suppress the formation of superoxide anion radicals created by optical excitation of a photosensitizer and measured by highly sensitive luminometric detection.

Methods/results  Solutions containing 3% antioxidant complex and 1% idebenone were tested.* The antioxidant complex is an aqueous combination of botanical extracts rich in ferulic acid, caffeic acid, and other polyphenols. Idebenone is a lower molecular weight analog of coenzyme Q10 (a potent antioxidant). Each was dissolved in lipid soluble reagents (solutions) and run through a Photochem® (photochemiluminometer system) device. Their antioxidant capacity was expressed as nmol equivalents of synthetic vitamin E. Nine aliquots of each compound were measured. The mean antioxidant capacities for the 3% antioxidant complex and 1% idebenone were 525 ± 23 and 213 ± 14 nmol, respectively, with a statistically significant difference between the two compounds (P < 0.001).

Conclusion  The 3% antioxidant solution possesses a significant antioxidative capacity, which was 2.5 times greater than the known antioxidant idebenone in a 1% solution as shown by the quenching of superoxide anion radicals measured by photochemiluminescence. This method provides rapid, accurate, and sensitive measurement of the antioxidant properties of lipid‐soluble compounds.
The ability of onion extract gel to improve the cosmetic appearance of postsurgical scars
Authors: Draelos Zoe Diana
Published: May 2008

Superior wound healing with excellent cosmesis is critical in superficial dermal wounds created when cosmetically unacceptable lesions are removed from the body. Dermatologists frequently remove seborrheic keratoses, nevi, and angiomas from the body with a superficial shave excision. The excision is designed to minimize dermal scarring while removing the unsightly skin growth. This study was undertaken to evaluate the ability of an onion extract gel to improve the appearance of scars following excision. Sixty subjects with symmetrical seborrheic keratoses at least 8 mm in diameter on the right and left upper chest were enrolled. The lesions were removed with a scalpel shave, following local anesthesia with 2% lidocaine plus epinephrine. The surgical sites were allowed to heal for 2 to 3 weeks, at which time the subjects returned to the research center for randomization to either the onion gel treatment group or the no‐treatment group. Forty‐seven subjects in the active treatment group were further randomized as to the site of study product application. Thirteen control subjects applied nothing to either side. Subjects returned to the study center at weeks 2, 4, 6, and 10 for photography, subject evaluations, and investigator assessments. The study showed that the onion extract gel significantly improved scar softness, redness, texture, and global appearance at the excision site at study weeks 4, 6, and 10 as assessed by the blinded investigator.
Immune protective effect of a moisturizer with DNA repair ingredients
Authors: Lucas Cheré R , Ke Malcolm S , Matsui Mary S , Maes Daniel , Cooper Kevin D , Stevens Seth R , Baron Elma D
Published: May 2008

Ultraviolet (UV) light damages DNA and impairs immune surveillance. The faulty repair of DNA after UV exposure is associated with immune suppression and facilitates photodamage that leads to photoaged skin and the growth of skin cancer. Sunscreens have been developed to filter UV light from entering the skin, but are not beneficial once DNA damage has occurred. Enhancing DNA repair after UV radiation may provide added advantage and prevent UV immunosuppression. This study was performed to determine whether a product with DNA repair ingredients prevents UV‐induced suppression of contact hypersensitivity responses in vivo. Solar simulated radiation was delivered on skin with and without topical treatment with a moisturizer containing DNA repair enzymes (Advanced Night Repair Concentrate). Subjects were then sensitized to the hapten dinitrochlorobenzene, and the level of resultant contact hypersensitivity response was elicited 2 weeks later. Contact hypersensitivity response measured by skin fold thickness was significantly suppressed in untreated UV‐irradiated subjects but not in subjects treated with DNA repair moisturizer after solar simulated radiation. Our results indicate that DNA repair ingredients significantly prevent UV‐induced immune suppression.
Sleep‐Related Problems in Youth with Tourette’s Syndrome and Chronic Tic Disorder
Authors: Storch Eric A. , Milsom Vanessa , Lack Caleb W. , Pence Steven L. , Geffken Gary R. , Jacob Marni L. , Goodman Wayne K. , Murphy Tanya K.
Published: May 2008

This study reports the prevalence and symptom correlates of sleep related problems (SRPs) in a sample of young people with Tourette’s Syndrome (TS) or Chronic Tic Disorder. Fifty‐six young people (and one of their parents) with a tic disorder were administered the Yale Global Tic Severity Scale. Children completed the Pediatric Quality of Life Inventory and Multidimensional Anxiety Scale for Children. Parents completed the Pediatric Quality of Life Inventory – Parent Proxy and Child Behavior Checklist. Overall, SRPs were widely endorsed, with 80.4% experiencing at least one SRP and 19.7% experiencing four or more. SRPs were negatively associated with quality of life and positively associated with internalising and externalising behaviours. Children with comorbid anxiety disorders had more SRPs than those without. We conclude by recommending that SRPs be assessed in young people with tics (particularly when comorbid anxiety is present), and highlight the role of psychotherapeutic and pharmacological intervention in reducing SRPs.
Gender Identity Disorder in Adolescence: A Review of the Literature
Authors: Manners Paula Jean
Published: May 2008

This article reviews the empirical literature on gender identity disorder in Adolescents: one of the most contested diagnoses in DSM. Fourteen studies were identified, a critique is provided and the surrounding controversies explored. This article suggests recommendations for future practice and research.
Potential Savings from an Evidence‐Based Consumer‐Oriented Public Education Campaign on Prescription Drugs
Authors: Donohue Julie M. , Fischer Michael A. , Huskamp Haiden A. , Weissman Joel S.
Published: May 2008

Objective. To estimate potential savings associated with the Consumer Reports Best Buy Drugs program, a national educational program that provides consumers with price and effectiveness information on prescription drugs.

Data Sources. National data on 2006 prescription sales and retail prices paid for angiotensin‐converting enzyme inhibitors (ACEIs), β‐blockers, calcium channel blockers, and 3‐hydroxy‐3‐methylglutaryl coenzyme A (HMG‐coA) reductase inhibitors (statins).

Study Design. We converted national data on aggregate unit sales of drugs in the four classes to defined daily doses (DDD) and estimated a range of potential savings from generic and therapeutic substitution.

Principal Findings. We estimated that $2.76 billion, or 7.83 percent of sales, could be saved if use of the drugs recommended by the educational program was increased. The recommended drugs' prices were 15–65 percent lower per DDD than their therapeutic alternatives. The majority (57.4 percent) of potential savings would be achieved through therapeutic substitution.

Conclusions. Substantial savings can be achieved through greater use of comparatively effective and lower cost drugs recommended by a national consumer education program. However, barriers to dissemination of consumer‐oriented drug information must be addressed before savings can be realized.
Comparison of Web‐Based versus Paper‐and‐Pencil Self‐Administered Questionnaire: Effects on Health Indicators in Dutch Adolescents
Authors: Van De Looij‐Jansen Petra M. , De Wilde Erik Jan
Published: May 2008

Objective. The aim of this study is to investigate differences in responses related to (mental) health and behavior between two methods of data collection: web‐based (web) and paper‐and‐pencil (p&p).

Study Design. Within each participating school all third‐grade classes (mainly 14–15‐year‐old pupils) were randomly assigned to either the Internet condition (n=271) or the paper‐and‐pencil condition (n=261).

Principal Findings. Significant but small differences were found for the strengths and difficulties subscales “emotional symptoms” (p&p>web) and “prosocial behavior” (p&p>web), and carrying a weapon (web>p&p). Perceived level of privacy and confidentiality did not differ between the two modes.

Conclusions. The findings suggest that in a controlled school setting, web‐based administration of health indicators yields almost the same results as paper‐and‐pencil administration. To generalize these findings, we recommend repeated studies in other populations and settings.
Selection Bias and Utilization of the Dual Eligibles in Medicare and Medicaid HMOs
Authors: Zhang Hui , Kane Robert L. , Dowd Bryan , Feldman Roger
Published: May 2008

Objective. To examine the existence of selection bias in the first 3 years of the Minnesota Senior Health Options (MSHO) demonstration and to estimate the MSHO effects on medical services utilization after adjusting for selection bias.

Data Sources. Monthly dual eligibility data and MSHO encounter data of March 1997–December 2000 and Medicaid encounter data of January 1995–December 2000 from the Minnesota Department of Human Services; Medicare fee‐for‐service claims data of January 1995–December 2000 from the Centers for Medicare and Medicaid Services.

Study Design. Quasi‐experimental design comparing utilization between MSHO and control groups; multiple econometric and statistical models were estimated with time‐invariant and time‐varying covariates.

Principal Findings. Favorable MSHO selection was found in the nursing home (NH) and community populations, but selection bias did not substantially affect the findings. Enrollment in MSHO for more than 1 year reduced inpatient hospital admissions and days, emergency room and physician visits for NH residents, and lowered physician visits for community residents.

Conclusions. There was favorable selection in the first 3 years of the MSHO program. Enrollment in MSHO reduced several types of utilization for the NH group and physician visits for community enrollees.
Investigation into A antigen expression on O2 heterozygous group O–labeled red blood cell units
Authors: Yazer Mark H. , Hult Annika K. , Hellberg Åsa , Hosseini‐Maaf Bahram , Palcic Monica M. , Olsson Martin L.
Published: May 2008

BACKGROUND: There are two principal types of group O alleles; deletional alleles feature 261delG leading to nonfunctional truncated protein. Nondeletional alleles have the consensus guanosine at residue 261. The major nondeletional allele, O2, encodes full‐length protein with Gly268Arg. While reports vary, O2 has been proposed to encode weakly functional A‐glycosyltransferase (GTA). The main objective of this study was to evaluate if GTA activity is detectable in O2 donors.

STUDY DESIGN AND METHODS: Donor samples from Pittsburgh and Lund were ABO typed by automated methods. DNA was extracted from 779 group O donors whose red blood cells (RBCs) were available for transfusion. ABO genotyping identified those with O2 alleles. The following tests were performed on randomly selected O2 samples (number): adsorption‐elution with anti‐A (3), flow cytometry (15), plasma enzyme activity (4), and attempts to convert group O RBCs to A (2) with O2 plasma and titration of plasma anti‐A/‐A1 (3).

RESULTS: Forty O2‐heterozygous donors were identified (5.1%). Adsorption‐elution and sensitive flow cytometry did not reveal A antigens on O2 RBCs. Plasma enzyme analysis failed to show GTA activity above baseline; O2 plasma was unable to add measurable A antigens to O RBCs. Titers of anti‐A/‐A1 appeared reduced in O2 plasma but did not cause ABO typing discrepancies. No immediate hemolysis or adverse reactions were reported following transfusion of O2 RBCs to six evaluable group O recipients.

CONCLUSIONS: Other than lower plasma anti‐A titers, GTA activity was not found in these O2 samples. Neither automated blood grouping discrepancies nor clinical problems related to transfusing these O2 units were observed.
Platelet products prepared by different methods of sedimentation undergo platelet activation differently during storage
Authors: Skripchenko Andrey , Kurtz James , Moroff Gary , Wagner Stephen J.
Published: May 2008

BACKGROUND: The activation marker CD40 ligand (CD40L) has recently been demonstrated to be released from the cytoplasm of platelets (PLTs) during storage. CD40L may be associated with some adverse transfusion reactions including febrile responses and transfusion‐related acute lung injury. CD62P has been traditionally measured to assess PLT activation. This study compares the surface levels of CD40L and CD62P and accumulation of the soluble forms of these activation markers in the plasma of stored PLTs, prepared by PLT‐rich plasma (PRP) or buffy coat (BC) methods and with two apheresis instruments.

STUDY DESIGN AND METHODS: Individual PLT concentrates (PCs) were prepared in 100 percent plasma from a pool of two ABO‐identical whole‐blood units. Apheresis PLTs (APs) were prepared in 100 percent plasma using one of two commercially available cell separators (Amicus, Baxter Healthcare; and Trima, Gambro BCT). Surface expression of CD40L and CD62P was measured by flow cytometry, and secretion of soluble CD40L (sCD40L) and soluble CD62 (sCD62) was measured by enzyme‐linked immunosorbent assay during 7 days of PLT storage.

RESULTS: Secretion of sCD40L was greater in Amicus APs than in Trima APs during the first 3 days of storage. It was also greater in the PRP‐PC preparations than in BC‐PC preparations through the first day of storage. Surface expression of CD40L was low in all PLT preparations. Secretion of sCD62P was greater in Amicus APs than in Trima APs during the entire storage period and greater in PRP‐PC than in BC during the first 5 days of storage. The percentage of CD62P‐positive PLTs was greater in Amicus units than Trima units and greater in PRP‐PC than BC‐PC preparations during the first 5 and 3 days of storage, respectively.

CONCLUSION: The kinetics of the secretion of CD40L are influenced by the method used to prepare PLTs for storage. The patterns for CD40L membrane association and secretion are different than those observed for CD62P during storage.
Antibody identification using both automated solid‐phase red cell adherence assay and a tube polyethylene glycol antiglobulin method
Authors: Yamada Chisa , Serrano‐Rahman Leana , Vasovic Ljiljana V. , Mohandas Kala , Uehlinger Joan
Published: May 2008

BACKGROUND: Because antibody identification is labor‐intensive, facilities with high volume and/or marginal technical support could benefit from partial automation.

STUDY DESIGN AND METHODS: After a validation study of automated solid‐phase red cell (RBC) adherence assay (SPRCA; Galileo, Immucor) compared to tube polyethylene glycol antiglobulin antibody identification method (t‐PEG), we evaluated Galileo followed by select RBC panels by t‐PEG. Of 298 consecutive samples in which antibody identifications were performed in a 2‐month period, 160 samples were examined by both Galileo and t‐PEG.

RESULTS: There were concordant results between Galileo and t‐PEG in 120 of 160 (75%) samples including cases with identical alloantibody identification (n = 99), panagglutinin (n = 9), and negative results (n = 12). Of the samples in which alloantibodies were identified, 99 of 108 (91.7%) were identical. In 9 samples with discrepant antibody identifications, 2 samples showed alloantibody specificity by Galileo (possible anti‐K and anti‐Jkb) but were negative by t‐PEG. These antibodies were identifiable by t‐PEG in subsequent samples. One sample showed anti‐E by Galileo, while t‐PEG revealed anti‐Fya and ‐E. Five samples showed alloantibody specificity by t‐PEG and nonspecific reactivity or panagglutinin by Galileo. These included samples with anti‐C (n = 2), anti‐E (n = 2), and anti‐Fya (n = 1). One sample showed anti‐E by t‐PEG but was negative by Galileo. Galileo found a panagglutinin in 23 samples and nonspecific reactivity in 22 samples, whereas t‐PEG found a panagglutinin in 12 samples but no nonspecific reactivity.

CONCLUSIONS: Automated Galileo solid‐phase red cell adherence assay can be a useful adjunct for antibody identification, although it detects more nonspecific reactivity than does t‐PEG.
The Problem with Programs: Multiple Perspectives on Program Structures in Program‐Based Performance‐Oriented Budgets
Authors: BOURDEAUX CAROLYN
Published: May 2008

Often the transition to performance‐based budgeting requires the initial development of a program structure. While a substantial body of literature is available to assist governments in developing performance measures, program development has received little recent attention in the scholarly literature. This research draws on a case study of the State of Georgia's effort to develop a program structure. The problems encountered by Georgia provide the foundation for an analysis that explains how programs interact with competing budgetary purposes and agendas. The analysis in turn suggests ways that budget structures might be adjusted to better balance competing purposes.
Fibrinous Material in a Pericardial Effusion Mimicking Intraatrial Thrombus
Authors: Skolnick Adam H. , Perk Gila , Kronzon Itzhak
Published: May 2008

A 74‐year‐old woman presented with an acute cerebrovascular infarct involving multiple vascular territories, suggestive of an embolic event. The initial transesophageal images create the impression of an echogenic mass in the left atrial appendage. A small pericardial effusion was also seen surrounding the left atrial appendage. After further views were obtained, the echogenic mass appeared to be in this fluid‐filled space rather than in the appendage itself. To confirm this finding, echo contrast (Definity) was administered. After contrast injection, the left atrial appendage was opacified, while the effusion around the appendage and the echodensity within this space were not opacified. Our case highlights the utility of contrast‐enhanced echocardiography in clearly delineating the boundaries of the endocardium in cases, when a pericardial effusion surrounds the left atrial appendage.
Role of Transesophageal Echocardiography in Percutaneous Aortic Valve Replacement with the CoreValve Revalving System
Authors: Berry Colin , Oukerraj Latifa , Asgar Anita , Lamarche Yoan , Marcheix Bertrand , Denault André Y. , Laborde Jean‐Claude , Cartier Raymond , Ducharme Anique , Bonan Raoul , Basmadjian Arsène J.
Published: May 2008

Percutaneous aortic valve replacement (PAVR) is an emerging therapy for nonsurgical patients with severe aortic stenosis (AS). We examined the role of transesophageal echocardiography (TEE) in PAVR. TEE was used initially to assess the native valve and aortic root, and served as a guide during PAVR. Following prosthetic valve deployment, TEE was used to assess valve function. Eleven patients aged 82 ± 10 years with NYHA III–IV underwent PAVR. Periprocedural TEE gave immediate information on prosthetic position and function, LV function, mitral regurgitation, pericardium, and thoracic aorta anatomy. There was excellent visual agreement between fluoroscopic and TEE images of prosthetic positioning and deployment. TEE facilitated the detection and management of procedure‐related complications. Compared with pre‐PAVR, AV area (0.56 ± 0.19 cm2 vs. 1.3 ± 0.4 cm2; P < 0.001) and LVEF (49 ± 17% vs. 56 ± 11%; P < 0.001) increased. TEE provides key anatomical and functional information, and serves as a diagnostic guide for complications, which may arise during PAVR.
The Need for Double‐Sampling Designs in Survival Studies: An Application to Monitor PEPFAR
Authors: An Ming‐Wen , Frangakis Constantine E. , Musick Beverly S. , Yiannoutsos Constantin T.
Published: May 2008

Summary In 2007, there were 33.2 million people around the world living with HIV/AIDS (UNAIDS/WHO, 2007). In May 2003, the U.S. President announced a global program, known as the President's Emergency Plan for AIDS Relief (PEPFAR), to address this epidemic. We seek to estimate patient mortality in PEPFAR in an effort to monitor and evaluate this program. This effort, however, is hampered by loss to follow‐up that occurs at very high rates. As a consequence, standard survival data and analysis on observed nondropout data are generally biased, and provide no objective evidence to correct the potential bias. In this article, we apply double‐sampling designs and methodology to PEPFAR data, and we obtain substantially different and more plausible estimates compared with standard methods (1‐year mortality estimate of 9.6% compared to 1.7%). The results indicate that a double‐sampling design is critical in providing objective evidence of possible nonignorable dropout and, thus, in obtaining accurate data in PEPFAR. Moreover, we show the need for appropriate analysis methods coupled with double‐sampling designs.
Integration of Ranked Lists via Cross Entropy Monte Carlo with Applications to mRNA and microRNA Studies
Authors: Lin Shili , Ding Jie
Published: May 2008

Summary One of the major challenges facing researchers studying complex biological systems is integration of data from ‐omics platforms. Omic‐scale data include DNA variations, transcriptom profiles, and RAomics. Selection of an appropriate approach for a data‐integration task is problem dependent, primarily dictated by the information contained in the data. In situations where modeling of multiple raw datasets jointly might be extremely challenging due to their vast differences, rankings from each dataset would provide a commonality based on which results could be integrated. Aggregation of microRNA targets predicted from different computational algorithms is such a problem. Integration of results from multiple mRNA studies based on different platforms is another example that will be discussed. Formulating the problem of integrating ranked lists as minimizing an objective criterion, we explore the usage of a cross entropy Monte Carlo method for solving such a combinatorial problem. Instead of placing a discrete uniform distribution on all the potential solutions, an iterative importance sampling technique is utilized “to slowly tighten the net” to place most distributional mass on the optimal solution and its neighbors. Extensive simulation studies were performed to assess the performance of the method. With satisfactory simulation results, the method was applied to the microRNA and mRNA problems to illustrate its utility.
Estimating Abundance Using Mark–Resight When Sampling Is with Replacement or the Number of Marked Individuals Is Unknown
Authors: McClintock Brett T. , White Gary C. , Antolin Michael F. , Tripp Daniel W.
Published: May 2008

Summary Although mark–resight methods can often be a less expensive and less invasive means for estimating abundance in long‐term population monitoring programs, two major limitations of the estimators are that they typically require sampling without replacement and/or the number of marked individuals available for resighting to be known exactly. These requirements can often be difficult to achieve. Here we address these limitations by introducing the Poisson log and zero‐truncated Poisson log‐normal mixed effects models (PNE and ZPNE, respectively). The generalized framework of the models allow the efficient use of covariates in modeling resighting rate and individual heterogeneity parameters, information‐theoretic model selection and multimodel inference, and the incorporation of individually unidentified marks. Both models may be implemented using standard statistical computing software, but they have also been added to the mark–recapture freeware package Program MARK. We demonstrate the use and advantages of (Z)PNE using black‐tailed prairie dog data recently collected in Colorado. We also investigate the expected relative performance of the models in simulation experiments. Compared to other available estimators, we generally found (Z)PNE to be more precise with little or no loss in confidence interval coverage. With the recent introduction of the logit‐normal mixed effects model and (Z)PNE, a more flexible and efficient framework for mark–resight abundance estimation is now available for the sampling conditions most commonly encountered in these studies.
Estimation of Rates of Births, Deaths, and Immigration from Mark–Recapture Data
Authors: O'Hara R. B. , Lampila S. , Orell M.
Published: May 2008

Summary The analysis of mark–recapture data is undergoing a period of development and expansion. Here we contribute to that by presenting a model which includes both births and immigration, as well as the usual deaths. Data come from a long‐term study of the willow tit (Parus montanus), where we can assume that all births are recorded, and hence immigrants can also be identified as birds captured as adults for the first time. We model the rates of immigration, birth rate per parent, and death rates of juveniles and adults. Using a hierarchical model allows us to incorporate annual variation in these parameters. The model is fitted to the data using Markov chain Monte Carlo, as a Bayesian analysis. In addition to the model fitting, we also check several aspects of the model fit, in particular whether survival varies with age or immigrant status, and whether capture probability is affected by previous capture history. The latter check is important, as independence of capture histories is a key assumption that simplifies the model considerably. Here we find that the capture probability depends strongly on whether the individual was captured in the previous year.
Independent Evaluation of an Out‐of‐hospital Termination of Resuscitation (TOR) Clinical Decision Rule
Authors: Richman Peter B. , Vadeboncoeur Tyler F. , Chikani Vatsal , Clark Lani , Bobrow Bentley J.
Published: May 2008

Objectives:  Recently, investigators described a clinical decision rule for termination of resuscitation (TOR) designed to help determine whether to terminate emergency medical services (EMS) resuscitative efforts for out‐of‐hospital cardiac arrests (OOHCA). The authors sought to evaluate the hypothesis that TOR would predict no survival for patients in an independent cohort of patients with OOHCA.

Methods:  This was a retrospective cohort analysis conducted in the state of Arizona. Consecutive, adult, OOHCA were prospectively evaluated from October 2004 through October 2006. A statewide OOHCA database utilizing Utstein‐style reporting from 30 different EMS systems was used. Data were abstracted from EMS first care reports and hospital discharge records. The TOR guidelines predict that no survival to hospital discharge will occur if 1) an OOHCA victim does not have return of spontaneous circulation (ROSC), 2) no shocks are administered, and 3) the arrest is not witnessed by EMS personnel. Data were entered into a structured database. Continuous data are presented as means (±standard deviations [SD]) and categorical data as frequency of occurrence, and 95% confidence intervals (CIs) were calculated as appropriate. The primary outcome measure was to determine if any cohort member who met TOR criteria survived to hospital discharge.

Results:  There were 2,239 eligible patients; the study group included 2,180 (97.4%) patients for whom the data were complete; mean age was 64 (±11) years, and 35% were female. The majority of patients in the study group met at least one or more of the TOR criteria. A total of 2,047 (93.8%) patients suffered from cardiac arrest that was unwitnessed by EMS; 1,653 (75.8%) had an unwitnessed arrest and no ROSC. With respect to TOR, 1,160 of 2,180 (53.2%) patients met all three criteria; only one (0.09%; 95% CI = 0% to 0.5%) survived to hospital discharge.

Conclusions:  The authors evaluated TOR guidelines in an independent, statewide OOHCA database. The results are consistent with the findings of the TOR investigation and suggest that this algorithm is a promising tool for TOR decision‐making in the field.
Multicenter Study of Limited Health Literacy in Emergency Department Patients
Authors: Ginde Adit A. , Weiner Scott G. , Pallin Daniel J. , Camargo Jr Carlos A.
Published: May 2008

Objectives:  The objective was to evaluate the prevalence of limited health literacy and its association with sociodemographic variables in emergency department (ED) patients.

Methods:  This was a cross‐sectional survey in three Boston EDs. The authors enrolled consecutive adult patients during two 24‐hour periods at each site. They measured health literacy by the short version of the Test of Functional Health Literacy in Adults (S‐TOFHLA). Using multivariate logistic regression, the authors evaluated associations between sociodemographic variables and limited health literacy, as classified by S‐TOFHLA scores.

Results:  The authors enrolled 300 patients (77% of eligible). Overall, 75 (25%; 95% confidence interval [CI] = 20% to 30%) of participants had limited health literacy. Limited health literacy was independently associated with older age (compared to 18–44 years, odds ratio [OR] 4.3 [95% CI = 2.0 to 9.2] for 45–64 years and OR 3.4 [95% CI = 1.4 to 8.5] for ≥65 years), less education (compared to high school graduates, OR 2.7 [95% CI = 1.1 to 7.3] for some high school or lower and OR 0.43 [95% CI = 0.21 to 0.88] for some college or higher), and lower income (OR 2.8 [95% CI = 1.2 to 6.6] for ≤$40,000 compared to >$40,000). Although ethnicity, race, and language were associated with limited health literacy in unadjusted analyses, the associations were not significant on multivariate analysis.

Conclusions:  In this sample, one‐quarter of ED patients would be expected to have difficulty understanding health materials and following prescribed treatment regimens. Advanced age and low socioeconomic status were independently associated with limited health literacy. The ability of a significant subgroup of ED patients to understand health information, especially during illness or injury, requires further study.