bluuebunny/crossref_metadata_2025 huggingface dataset:
Expression of Bruton's tyrosine kinase in B lymphoblastoid cell lines from X-linked agammaglobulinaemia patients
Authors: DE WEERS M , DINGJAN G M , BROUNS G S , KRAAKMAN M E M , MENSINK R G J , LOVERING R C , SCHUURMAN R K B , BORST J , HENDRIKS R W
Published: December 2003

X-linked agammaglobulinaemia (XLA) is an immunodeficiency caused by mutations in Bruton's tyrosine kinase (Btk) and is characterized by an almost complete arrest of B cell development. We analysed expression of Btk in B lymphoblastoid cell lines (BLCL) derived from four unrelated XLA patients. In one patient, with a 3.5 kb genomic deletion encompassing the first (untranslated) exon, mRNA levels and in vitro kinase activities were very low. The patient manifested a mild phenotype with a delayed onset of the disease. Another mutation, in which the intron 3 donor splice site is lost, was also associated with very low mRNA levels and an absence of detectable Btk protein. Patients with this mutation showed extensive heterogeneity of the immunological phenotype. In the BLCL of a third patient, with an Arg288 substitution in the SH2 domain, the mutation did not appear to affect the expression level, nor to abrogate in vitro phosphorylation activity. In the BLCL of the fourth patient, with an Arg28 mutation in the PH domain, tyrosine kinase activity in BTK precipitates appeared to be decreased compared with control BLCL.
Impaired hepatosplenic elimination of circulating cryoglobulins in patients with essential mixed cryoglobulinaemia and hepatitis C virus (HCV) infection
Authors: ROCCATELLO D , MORSICA G , PICCIOTTO G , CESANO G , ROPOLO R , BERNARDI M T , CACACE G , CAVALLI G , SENA L M , LAZZARIN A , PICCOLI G , RIFAI A
Published: December 2003

The pathogenic mechanisms that lead to renal deposition of the cryoprecipitable IgM rheumatoid factor–IgG complexes in essential mixed cryoglobulinaemia (EMC) are unknown. Defective removal of cryoprecipitable complexes from the circulation has been postulated in EMC-associated nephritis. To test this hypothesis, the kinetics and fate of a trace dose of 123I-radiolabelled autologous cryoglobulins were analysed in 13 patients with EMC grouped according to renal involvement. The time course of radioactivity distribution in the blood and organ uptake were measured by gamma camera scintigraphy. In blood sampled 30–300 s after injection, only a minor fraction (< 15%) of the circulating cryoglobulins bound to the erythrocytes, suggesting the elimination mechanisms are independent of binding to CR1 on erythrocytes. The overall blood disappearance curve showed a fast (≤ 1 min) and slow (> 4 h) biphasic pattern. In patients with quiescent or mild nepthritis, the liver and to a lesser extent the spleen were the major organs that mediated the rapid uptake and processing of the cryoglobulins from the circulation. In contrast, patients with active mesangiocapillary glomerulonephritis showed significantly (P < 0.001) less hepatic uptake, low liver-to-precordium ratio, and slower processing of cryoglobulins, prolonged liver mean transit time, than quiescent patients or mild nephritis patients. To elucidate the role and influence of HCV infection in the pathogenesis of EMC-nephritis, sera and cryoglobulins from all patients were assayed for HCV. None of the control group cases without nephritis showed any evidence of HCV-RNA in serum or cryoglobulin pellet. In contrast, all 10 EMC-nephritis patients' sera, and eight corresponding cryoglobulin pellets contained HCV-RNA. Collectively, these findings suggest an impaired reticuloendothelial system removal of IgM–IgG–HCV complexes may underlie their renal deposition.
Anti-CD2 (OX34) MoAb treatment of adjuvant arthritic rats: attenuation of established arthritis, selective depletion of CD4+ T cells, and CD2 down-modulation
Authors: HOFFMANN J C , HERKLOTZ C , ZEIDLER H , BAYER B , WESTERMANN J
Published: December 2003

Anti-CD2 MoAbs have previously been shown to induce tolerance and to block B cell differentiation, T cell and monocyte activation. Since these immune functions are important in joint inflammation, we asked whether administration of the anti-CD2 MoAb OX34 has a beneficial effect on established rat adjuvant arthritis, a model of human rheumatoid arthritis, and how it affects CD2-bearing leucocyte subsets. Female Lewis rats with established adjuvant arthritis received a total of 5 mg OX34 or isotype-matched control MoAb starting on day 15 after adjuvant injection. Weight and arthritis score (AS) were measured in a blinded fashion. Peripheral blood cells were analysed for numbers of leucocyte subsets at various time points. Animals were killed on day 30 and lymphatic organs were processed for immunohistology. Clinically, OX34 treatment led to increased body weight and reduced AS. Although OX34 binds to CD4+ and CD8+ T cells in a comparable fashion, OX34 treatment reduced CD4+ T cells, but not CD8+ T cells. Among CD4+ T cells CD45RC+ (‘naive’) T cells virtually disappeared; CD45RC− (‘recently activated’) T cells were slightly reduced. A reduction of CD4+ T cells was also found in the lung, liver, bone marrow, spleen and lymph nodes. Down-modulation of the CD2 molecule by OX34, again, affected CD4+ T cells, suggesting a specific signal for CD4+ but not CD8+ T cells. In conclusion, the anti-CD2 MoAb OX34 attenuates established rat adjuvant arthritis. In spite of similar binding to CD4+ and CD8+ T cells, OX34 depletes only CD4+ T cells and down-modulates the CD2 molecule on these cells. These results suggest a therapeutic benefit from CD2-directed therapy for chronic types of arthritis.
CTLA-4 gene polymorphism confers susceptibility to insulin-dependent diabetes mellitus (IDDM) independently from age and from other genetic or immune disease markers
Authors:   THE BELGIAN DIABETES REGISTRY, VAN DER AUWERA B J , VANDEWALLE C L , SCHUIT F C , WINNOCK F , DE LEEUW I H , VAN IMSCHOOT S , LAMBERIGTS G , GORUS F K
Published: December 2003

Apart from genes in the HLA complex (IDDM1) and the variable number of tandem repeats in the 5′ region of the insulin gene (INS VNTR, IDDM2), several other loci have been proposed to contribute to IDDM susceptibility. Recently, linkage and association have been shown between the cytotoxic T lymphocyte-associated protein 4 (CTLA-4) gene on chromosome 2q and IDDM. In a registry-based group of 525 recent-onset IDDM patients < 40 years old we investigated the possible interactions of a CTLA-4 gene A-to-G transition polymorphism with age at clinical disease onset and with the presence or absence of established genetic (HLA-DQ, INS VNTR) and immune disease markers (autoantibodies against islet cell cytoplasm (ICA); insulin (IAA); glutamate decarboxylase (GAD65-Ab); IA-2 protein tyrosine phosphatase (IA-2-Ab)) determined within the first week of insulin treatment. In new-onset IDDM patients, G-allele-containing CTLA-4 genotypes (relative risk (RR) = 1.5; 95% confidence interval (CI) = 1.2–2.0; P < 0.005) were not preferentially associated with age at clinical presentation or with the presence of other genetic (HLA-DR3 or DR4 alleles; HLA-DQA1*0301-DQB1*0302 and/or DQA1*0501-DQB1*0201 risk haplotypes; INS VNTR I/I risk genotype) or immune (ICA, IAA, IA-2-Ab, GAD65-Ab) markers of diabetes. For 151 patients, thyrogastric autoantibodies (anti-thyroid peroxidase, anti-thyroid-stimulating hormone (TSH) receptor, anti-parietal cell, anti-intrinsic factor) were determined, but association between CTLA-4 risk genotypes and markers of polyendocrine autoimmunity could not be demonstrated before or after stratification for HLA- or INS-linked risk. In conclusion, the presence of a G-containing CTLA-4 genotype confers a moderate but significant RR for IDDM that is independent of age and genetic or immune disease markers.
Microbiological and rheological studies on Portuguese kefir grains
Authors: Pintado Manuela E. , Da Silva J. A. Lopes , Fernandes Paulo B. , Malcata F. Xavier , Hogg Tim A.
Published: December 2003

The native bacteria and yeasts present in Portuguese kefir grains stored under four distinct sets of environmental conditions have been isolated and identified on the basis of morphology and biochemical tests. The microbial population of the kefir grains as a whole has been characterized in terms of rates of biomass production and formation of lactic acid and ethanol. The rheological properties of the purified polysaccharide (kefiran) produced by the microflora of the grains and accumulated therein were studied in a low water activity solvent and as a component of a binary gel containing either κ‐carrageenan or xanthan gum.
Pilot scale preparation of wheat gluten protein fractions: II. Technological properties of the fractions
Authors: Bérot Serge , Chiron Hubert , Nicolas Michel , Gautier Sylvie , Godon Bernard , Popineau Yves
Published: December 2003

Fractions differing in prolamin compositions were obtained on a pilot scale when wheat gluten proteins were separated by differential extraction in dilute acetic acid. The soluble fractions were enriched in gliadins and the insoluble ones were richer in glutenins. The effects of the gluten fractions on the technological properties of wheat flours were investigated using an alveographic test and a comparison was made with gluten‐added flours. Gliadin‐rich fractions increased the extensibility of the dough and reduced its resistance to deformation. On the other hand, glutenin‐rich fractions had an opposite effect and increased the dough resistance more than that of equally‐concentrated whole gluten. The magnitude of the effects was strongly related to the gliadin and glutenin contents of the fractions. Prediction of technological effects is thus possible using composition analyses based on protein extractibility or size‐exclusion chromatography. Finally, the improving effects of the gliadin‐rich and of the glutenin‐rich fractions were observed at different stages of the breadmaking process.
The effect of sugars on the extrusion of maize grits: I. The role of the glass transition in determining product density and shape
Authors: Fan Jintian , Mitchell John R. , Blanshard John M. V.
Published: December 2003

The effects of sugars (sucrose, glucose, fructose, xylose, lactose and maltose) on both sectional (radial) and longitudinal expansion and subsequent shrinkage of maize extrudates have been investigated. Sugars reduced the sectional expansion, monosaccharides more than disaccharides. Reduced sectional expansion and increased density with sugar content was interpreted as a combination of a reduction in bubble growth and an increase in the degree of shrinkage on leaving the die. The decrease in bubble growth was considered to be the result of a temperature reduced driving force for bubble growth and reduced bubble wall extension before rupture caused by less starch conversion with increasing sugar content. Shrinkage stops when the temperature decreases to approximately Tg+ 30°C, where Tg is the glass transition temperature. The addition of sugars and water will reduce the glass transition temperature (Tg) of the melt and hence increase the temperature range over which the extrudate will shrink. The driving force for shrinkage is the release of stored elastic energy following bubble rupture and the pressure difference between the interior of closed cells in the product and atmospheric pressure.
A mathematical model to describe flavour release from gelatine gels
Authors: Harrison Marcus , Hills Brian P.
Published: December 2003

A theory of flavour release from gelatine‐sucrose gels has been developed based on combined interfacial mass and heat transport. The driving force for flavour release is shown to depend on the bulk melting temperature of the gel, which depends on the gelatine and sucrose concentrations. For gels possessing melting points below the mouth temperature, the driving force for flavour release is the rate at which heat can diffuse into the gels matrix and initiate melting. For harder gels with melting points above mouth temperature the diffusion of sucrose from the surface of the gel into the adjacent saliva phase is the rate limiting step for flavour release, because this lowers the melting temperature of the surface layer. The theoretical model gives good agreement with in vitro release experiments using gelatine gels containing sucrose and dye.
Removing the Roadblocks to Medical and Health Student Training in Rural Hospitals in Victoria
Authors: Jones Graeme I. , Alford Katrina A. , Russell Ursula J. , Simmons David
Published: December 2003

Objective:  To assess the extent of undergraduate health student placements in regional hospitals in northern Victoria in 1999, prior to substantial changes in rural undergraduate medical education in Australia.

Method:  Cross sectional postal survey with telephone follow‐up in north‐east Victoria. Subjects were all 17 regional and rural hospitals involved in health student teaching in North‐east Victoria. Main outcome measures were the numbers, duration and discipline of health students placements and reported barriers to such placements.

Results:  Large regional hospitals accounted for two‐thirds of all undergraduate health student placements. Smaller sites placed few allied health students. Barriers to a larger, more sustainable system of rural placements and rotations included accommodation shortages and funding constraints, particularly in smaller rural hospitals.

Conclusions:  Adequate resourcing of placements of a meaningful duration, stronger institutional support, and improved resourcing of regional accommodation is required to facilitate a larger, more systematic and sustainable system of medical and health student placements in rural areas.

What is already known:  The extent of training of health professionals in rural Australia is increasing rapidly. Fears have been expressed that the capacity to deliver quality experience in rural practice may be limited.

What this study adds:  This cross sectional survey of rural Victorian hospitals shows that there is a major untapped potential in rural hospitals of all sizes to assist with training in rural practice, but that a number of barriers to such training need to be removed to reach full capacity.
Rural General Practitioner Apprehension About Work Related Violence in Australia
Authors: Tolhurst Helen , Talbot Jane , Baker Louise , Bell Pam , Murray Gillian , Sutton Amber , Dean Sarah , Treloar Carla , Harris Gillian
Published: December 2003

Aims:  To identify levels of Australian rural general practitioners’ apprehension about violence, factors effecting apprehension and the effect of apprehension on service provision.

Method:  Six focus groups were held with rural GPs from Western Australia, New South Wales and Victoria. A questionnaire was developed on the basis of the focus group data and all GPs in these three areas were surveyed.

Results:  The results indicated GPs were more apprehensive about providing after hours care than during business hours. Significant gender differences were found with women being more often apprehensive than men and more likely to withdraw after hours services.

Conclusion:  This study shows that that levels of apprehension about violence affect GPs’ willingness to provide after hours services. Future provision of general practice after hours services and home visits in rural areas requires the availability of a safe working environment to reduce GPs’ apprehension about workplace violence.

What Is Already Known:  Overseas research has shown that many GPs are apprehensive about workplace violence and that female GPs are more likely to be apprehensive about it than male GPs. No Australian studies about GPs’ levels of apprehension about workplace violence have previously been undertaken.

What this study adds:  This study showed that many Australian rural GP respondents feel apprehensive about work‐related violence especially after hours and when undertaking home visits after hours. Female respondents were significantly more likely to feel apprehensive about workplace violence than male respondents and to make changes to services because of the risk of violence than male GPs, most commonly by not providing services such as home visits or after hours surgery attendances.
Evidence‐Based Practice in Rural and Remote Clinical Practice: Where is the Evidence?
Authors: Parsons Jacqueline E. , Merlin Tracy L. , Taylor Judy E. , Wilkinson David , Hiller Janet E.
Published: December 2003

Objective:  To critically review the evidence regarding barriers to implementing research findings in rural and remote settings, and the ways those barriers have been addressed.

Design:  A systematic review that included searching several electronic databases, Internet sites and reference lists of relevant articles, assessment of methodological quality of the studies, and data extraction and analysis where possible. Eligibility for the review was not limited by study design.

Settings/Participants:  Studies that reported on: (1) barriers to the implementation of evidence by health professionals in rural and remote areas, or (2) interventions for implementing evidence‐based practice or an element of evidence‐based practice in rural and remote areas.

Results:  There were no experimental data available on the implementation of research findings in rural and remote clinical settings. The small amounts of empirical research undertaken (surveys) showed that some of the problems experienced by general practitioners were exacerbated by rural and remote location, particularly with relation to isolation, lack of time and locum cover, and poor information technology infrastructure.

Conclusion:  There is a paucity of empirical literature on implementing evidence‐based practice in rural and remote settings. This is in contrast to the large amount of literature available on implementing evidence in other clinical settings. A clear finding from the literature was that getting evidence into practice needs to be context‐specific and yet very little research has been conducted into the rural and remote context. Research is needed into how evidence can be implemented in contextually specific ways in rural and remote areas.

What is already known:  There is a substantial body of literature about the barriers to implementing research findings into clinical practice and how to address these barriers. This literature includes many systematic reviews and even overviews of systematic reviews. One of the consistent findings of the literature is that the implementation of research findings needs to be context‐specific to have any chance of making lasting and worthwhile changes to practice. There is little work, however, on the context of rural and remote clinical practice.

What this study adds:  This study aimed to review the literature on the implementation of evidence based practice in rural and remote settings. No experimental studies were found and the limited empirical evidence from surveys found that the rural and remote context exacerbated some of the problems experienced by health professionals in other settings, particularly those related to lack of time, inability to get locum cover and poor and unreliable information technology infrastructure. More research is required to isolate the aspects of rural and remote practice that influence the uptake of research findings.
Sulforaphane inhibits growth of a colon cancer cell line
Authors: Frydoonfar H. R. , McGrath D. R. , Spigelman A. D.
Published: December 2003

Objective  The consumption of cruciferous vegetables has a protective effect on the development of colorectal cancer. The phytochemical Sulforaphane is an isothiocyanate found almost exclusively in cruciferous vegetables. We have studied the effect of Sulforaphane on cell proliferation of an HT‐29 colon cancer cell line.

Materials and methods  HT‐29 colon cancer cells were cultured in 96‐well microtitre plates. Sulforaphane (in concentrations ranging from 0.01 to 0.1 mmol) were added to the wells. Cell proliferation was measured using the colourimetric assay technique.

Results  The proliferation of colon cancer cells was significantly reduced by Sulforaphane at concentrations of ≥0.02 mmol.

Conclusion  These findings may help explain the epidemiologically proven protective effect of vegetables against colon cancer.
Colo‐rectal anastomotic leakage often masquerades as a cardiac complication
Authors: Sutton C. D. , Marshall L. J. , Williams N. , Berry D. P. , Thomas W. M. , Kelly M. J.
Published: December 2003

Objective  The aim of this study was to identify the mode of presentation of patients with clinical anastomotic leaks following restorative colorectal resection for carcinoma.

Patients and methods  Prospective information was collected on all patients having restorative resection of colorectal cancer. These data were reviewed for a five‐year period (1994–1998) to identify all patients who had suffered a clinical anastomotic leak and their notes were retrieved and reviewed.

Results  Three hundred and seventy‐nine patients underwent restorative resection for colorectal cancer during the study period (178 female, 201 male), mean age 70 years (range 36–94). There were 22 (6%) clinical anastomotic leaks. Seven (32%) patients presented with obvious abdominal peritonitis. The remaining 15 (68%) were initially misdiagnosed. Thirteen (59%) patients were treated for cardiac symptoms, 1 (5%) patient for obstruction and 1 (5%) for ascites. The delay in diagnosis ranged from 0 to 11 days (mean 4 days). For the whole series of 379 there were 30 patients who suffered cardiac symptoms (8%) 13(43%) of whom had an anastomotic leak.

Conclusion  Patients who develop cardiac symptoms following restorative colorectal resection for carcinoma should have a water soluble enema as there is a 40% chance that they will have an anastomotic leak.
Open‐magnet MR defaecography compared with evacuation proctography in the diagnosis and management of patients with rectal intussusception
Authors: Dvorkin L. S. , Hetzer F. , Scott S M. , Williams N. S. , Gedroyc W. , Lunniss P. J.
Published: December 2003

Objective  The aim of this study was to determine whether open‐magnet magnetic resonance (MR) defaecography could provide more useful clinical information than evacuation proctography (EP) alone in the evaluation of a cohort of patients with full‐thickness rectal intussusception and could assist in decisions concerning management.

Methods  Ten patients (4 male; median age 43, range 30–65) with symptomatic circumferential rectal intussusception diagnosed on EP, underwent open‐magnet MR defaecography. Pathologies visible with each technique were recorded and 12 parameters of anorectal configuration and morphology measured and compared.

Results  There was discordance in the diagnosis of rectal intussusception in three cases. In another two patients, MR defaecography demonstrated mucosal descent only. Measurements of anorectal configuration and morphology were similar between techniques; only rectal size and lateral dimensions of the rectocoele were significantly different, being smaller on MR defaecography than EP. Two patients were shown on MR defaecography to have significant bladder descent and two female patients had significant vaginal descent.

Conclusion  EP remains the first line investigation for the diagnosis of rectal intussusception, but may not distinguish mucosal from full‐thickness descent. MR defaecography further complements EP by giving information on movements of the whole pelvic floor, 30% of the patients studied having associated abnormal anterior and/or middle pelvic organ descent. If surgery is planned for patients with rectal intussusception, MR defaecography provides useful information regarding the presence and degree of anterior pelvic compartment descent that may need to be addressed if a good functional outcome is to be achieved.
Strategies as Discursive Constructions: The Case of Airline Alliances
Authors: Vaara Eero , Kleymann Birgit , Seristö Hannu
Published: December 2003

ABSTRACT  In this paper, we argue that by examining the discursive elements in strategy talk we can contribute to our understanding of the myriad of micro‐processes and practices that make up strategies. We focus on airline alliances as a particularly illustrative case. Based on a critical discourse analysis of an extensive material of strategy talk on airline alliances, we point to five types of discursive practices that characterize strategizing in this context in 1995–2000: (1) problematization of traditional strategies; (2) rationalization, objectification and factualization of alliance benefits; (3) fixation of ambiguous independence concerns; (4) reframing of cooperation problems as ‘implementation’ issues; and (5) naturalization of alliance strategies. While we want to emphasize the context‐specificity of these practices, we claim that similar types of discursive practices are also likely to be an inherent part of strategizing in other settings.
A Knowledge Accessing Theory of Strategic Alliances
Authors: Grant Robert M. , Baden‐Fuller Charles
Published: December 2003

ABSTRACT The emerging knowledge‐based view of the firm offers new insight into the causes and management of interfirm alliances. However, the development of an effective knowledge‐based theory of alliance formation has been inhibited by a simplistic view of alliances as vehicles for organizational learning in which strategic alliances have presumed to be motivated by firms’ desire to acquire knowledge from one another. We argue that the primary advantage of alliances over both firms and markets is inaccessingrather thanacquiringknowledge. Building upon the distinction between the knowledge generation (‘exploration’) and knowledge application (‘exploitation’), we show that alliances contribute to the efficiency in the application of knowledge; first, by improving the efficiency with which knowledge is integrated into the production of complex goods and services, and second, by increasing the efficiency with which knowledge is utilized. These static efficiency advantages of alliances are enhanced where there is uncertainty over future knowledge requirements and where new products offer early‐mover advantages. Compared with alternative learning‐based approaches to alliance formation, our proposed knowledge‐accessing theory of alliances offers the advantages of greater theoretical rigour and consistency with general trends in alliance activity and corporate strategy.
Coordination Networks Within and Across Organizations: A Multi‐level Framework*
Authors: Gittell Jody Hoffer , Weiss Leigh
Published: December 2003

ABSTRACT  There are important organizational phenomena that cannot be fruitfully examined without crossing levels of analysis, as others have shown. We argue that coordination of patient care in the current institutional environment is one such phenomenon. As organizations vertically disintegrate and outsource services that were once produced internally, coordination with external organizations becomes increasingly important for achieving desired performance outcomes. We describe the efforts of one hospital to extend the intra‐organizational coordination of patient care to encompass coordination with its external partners. The organization design and network perspectives are both conducive to spanning multiple levels of analysis. We show that the two perspectives together serve as a useful vehicle for developing a framework that links intra‐ and inter‐organizational coordination.
Edith Penrose's Contributions to the Resource‐based View: An Alternative Perspective
Authors: Lockett Andy , Thompson Steve
Published: December 2003

ABSTRACT  Edith Penrose's work has been widely acknowledged to have played a central role in providing the intellectual foundations of the resource‐based view. This position, however, was recently challenged in a paper by Rugman and Verbeke (2002). In this paper we address the three main arguments of Rugman and Verbeke and, by drawing on her writings, demonstrate that their arguments are materially incorrect. While readily conceding that Penrose's primary goal was to explain the growth of firms, we show that her analysis of path‐dependent firm evolution anticipated many key propositions of the resource‐based view.
A Final Word on Edith Penrose
Authors: Rugman Alan M. , Verbeke Alain
Published: December 2003

ABSTRACT Rugman and Verbeke (2002) established that Edith Penrose's contribution to the resource‐based view in strategic management has been misunderstood by many scholars in the field. The present paper augments this analysis, and demonstrates that Penrose did not view the pursuit of rents as a worthwhile endeavour. Penrose did build on a number of conceptual foundations of neo‐classical economics, and accepted the profit‐maximizing assumption as largely consistent with the pursuit of an optimal growth path. But optimal growth, not the pursuit of rents, was the focus of her analysis. In addition, Edith Penrose's real normative agenda was the increase of societal welfare at the macro‐level through innovation at the firm‐level. Penrose's work on multinational enterprises shows that she had a strong preference for eliminating rents that would accrue to large multinational firms at the expense of local firms in host countries.
Defining the Divine
Authors: Richardson Carol M.
Published: December 2003

Books reviewed in this article:

Rona Goffen, Renaissance Rivals: Michelangelo, Leonardo, Raphael, Titian

Francis Ames‐Lewis and Paul Joannides (eds), Reactions to the Master: Michelangelo's Effect on Art and Artists in the Sixteenth Century

Cristina Acidini et al. The Medici, Michelangelo, and the Art of Late Renaissance Florence

Jack Wasserman, Michelangelo's Florence Pietà
Hospitable Kinship in Theological Education: Cross‐Cultural Perspectives on Teaching and Learning as Gift Exchange
Authors: Wimberly Anne E. Streaty
Published: December 2003

Abstract.  Using an autobiographical approach for pedagogical reflection, the author raises questions about how to include “hospitable kinship” and “gift exchange” in teaching and learning. Her experience with a Zimbabwean community circle of hospitable kinship has prompted her to consider how this method of community formation might be employed in classroom situations. Definitions for hospitable kinship and gift exchange are woven throughout the narrative. Attention to the role of the teacher as host is provided as well. The essay prompts readers to turn their attention toward specific strategies that will aid in the formation of classroom community.
Reviewing Faculty Competency and Educational Outcomes: The Case of Doctor of Ministry Education
Authors: Lincoln Timothy D.
Published: December 2003

Abstract.  This research report interprets data from a 1902 survey of directors of Doctor of Ministry (D.Min.) programs regarding the competency of faculty members viewed through the interpretive lens of peer review. According to directors, faculty members are more competent in teaching theological reflection than in teaching social science methods, despite the expectation that such methods are part of D.Min. education. The article discusses implications of the data for improving faculty performance, and suggests how the concept of critical friendship might assist those who teach in religious studies to give and receive criticism from peers. The article concludes with suggestions for further research in D.Min. education.
Teaching Students to Interpret Religious Poetry (and to Expand their Avenues of Thinking)
Authors: Jacobson Rolf A.
Published: December 2003

Abstract.  Teaching religion and theology requires interpretation of the vast corpus of religious poetry that is found in every religious tradition, but students are generally ill‐equipped to interpret this material. Therefore teachers would do well to teach the students how to interpret religious poetry. This article discusses some of the challenges of teaching this material to students and discusses techniques and exercises that have been found useful in teaching students how to navigate the terrain of religious poetry.
Prognosis of Migraine with Aura
Authors: Eriksen MK , Thomsen LL , Russell MB
Published: December 2003

The present study is a 16-year follow-up study assessing the long-term outcome of migraine with aura (MA). Additionally possible predictive factors in the prognosis of MA were evaluated. Patients were recruited from the files of Danish headache clinics. A total of 53 patients (11M:42F) with MA (IHS criteria) participated in a follow-up interview. At follow-up attacks had ceased (no MA for 2 years) in 36% of patients. Attacks had ceased in 55% of males and 31% of females ( P = 0.17). Attacks had ceased in 41% of patients with visual aura without other aura symptoms and in 25% of those with sensory or aphasic aura besides their visual aura ( P = 0.36). Among those with attacks of MA at follow-up frequency of attacks and headache intensity was improved in 44% and 41% of the patients, respectively. The results point to a favourable evolution of MA and suggest possible predictive factors.
Characteristics of Postictal Headache in Patients with Partial Epilepsy
Authors: Ito M , Adachi N , Nakamura F , Koyama T , Okamura T , Kato M , Kanemoto K , Nakano T , Matsuura M , Hara S
Published: December 2003

Migraine-like features sometimes characterize the headache that follows epileptic seizure (postictal headache, PIH). We compared patients with different types of epilepsy to investigate the association between migraine-like PIH and seizure type. Subjects comprised 364 patients with partial epilepsy. Epilepsy types were temporal lobe epilepsy (TLE, n = 177), frontal lobe epilepsy (FLE, n = 116), and occipital lobe epilepsy (OLE, n = 71). Patients participated in a structured interview pertaining to PIH as well as interictal headache and family history of migraine. Headaches were classified according to the International Headache Society criteria, which was modified for this study. Forty percent had PIH and 26% of these patients had migraine-like PIH. Migraine-like PIH occurred significantly more often in cases of TLE and OLE than in cases of FLE. In addition, the incidence of interictal migraine headache was significantly higher in patients with migraine-like PIH. These results suggest that migraine-like PIH is related to particular regions of epileptogenic focus and that susceptibility to migraine headache predisposes to migraine-like PIH.
Physiotherapy for Tension-Type Headache: A Controlled Study
Authors: Torelli P , Jensen R , Olesen J
Published: December 2003

The role of non-pharmacological therapies in the preventive treatment of tension-type headache (TTH) is still an object of debate. The primary aim of this study was therefore to investigate the therapeutic effect of physiotherapy in properly classified patients with TTH in a controlled trial. Fifty patients with TTH, 26 with episodic, frequent (ETTH) and 24 with chronic TTH (CTTH) fulfilling the International Headache Society classification criteria were included in the study. After a 4-week run-in period, they were randomized to either an 8-week period of standardized physiotherapy (group 1) or to an 8-week observation period followed by an identical course of physiotherapy (group 2); after the physiotherapy all patients were followed for a 12-week follow-up period. We then evaluated the number of days with headache, severity and duration of the headache attacks, and drug consumption for symptomatic treatment before and after the course of physiotherapy. Forty-eight patients completed the study. The average number of days with headache per 4-week period was reduced from 16.3 days at baseline to 12.3 days in the last 4 weeks of treatment [from 14.5 days to 10.5 days ( P < 0.001) in group 1 and from 18.1 days to 14.1 days ( P < 0.001) in group 2]. Severity and duration of headache as well as drug consumption were unchanged throughout the study. Analysing the response to treatment separately in the various subgroups, we found that the number of responders was significantly higher among patients with CTTH vs. patients with ETTH ( P < 0.002) and in females vs. males ( P < 0.02). No differences were found between patients with and without disorder of pericranial muscles. We conclude that a standardized physiotherapy programme has a good therapeutic effect, albeit on a restricted group of patients.
Non-Lateralized Pain in a Case of Chronic Paroxysmal Hemicrania?
Authors: Mulder LJMM , Spierings ELH
Published: December 2003

We describe a man with chronic paroxysmal hemicrania, who remained free of headaches on indomethacin, 25 mg once or twice daily. However, in this case, in contrast to typical cases of paroxysmal hemicrania, the pain of the headaches was nonlateralized and was located in the centre of the forehead. The headaches were not associated with local autonomic symptoms or signs involving the eyes or nose. Initially, the pain of the headaches lasted for seconds only and was brought on by coughing.
Effects of Acute or Chronic Administration of Anti-Migraine Drugs Sumatriptan and Zolmitriptan on Serotonin Synthesis in the Rat Brain
Authors: Dobson CF , Tohyama Y , Diksic M , Hamel E
Published: December 2003

Triptans are 5-HT1 receptor agonists used as anti-migraine drugs. They act primarily on meningeal blood vessels and on trigeminovascular afferents, but they may also exert central effects. We studied the regional effects of acute and chronic treatment with sumatriptan or zolmitriptan on the rate of serotonin (5-HT) synthesis in the rat brain, using the α-14C-methyl-L-tryptophan quantitative autoradiographic method. Sumatriptan at low (300 μg/kg, s.c.) and high (1 mg/kg) doses, as well as zolmitriptan (100 μg/kg), acutely decreased (15-40%, P < 0.05-0.001) 5-HT synthetic rate in many brain regions, including the dorsal raphe nucleus. Chronically, sumatriptan (21 days, approximately 300 μg/kg per day via osmotic minipumps) induced significant increases in the 5-HT synthesis rate in many projection areas but had no effect in the dorsal raphe nucleus. The acute effects on 5-HT synthesis rate would be compatible with activation of 5-HT1 autoreceptors that inhibit serotonin release. In contrast, the increased 5-HT synthesis rate observed after chronic sumatriptan might possibly result from a down-regulation/desensitization of 5-HT1 receptors and/or unmasking of excitatory triptan-sensitive 5-HT receptors. Overall, the present findings indicate that not only zolmitriptan but also sumatriptan affect brain serotonergic neurotransmission.
The effect of an intrauterine application of two percent lignocaine gel on pain perception during Vabra endometrial sampling: a randomised double‐blind, placebo‐controlled trial
Authors: Kozman Ezzat , Collins Peter , Howard Ann , Akanmu Tolu , Gibbs Alan , Frazer Malcolm
Published: December 2003

Objective To determine whether two percent lignocaine gel can reduce the perception of pain during Vabra endometrial aspiration.

Design Randomised, double‐blind placebo‐controlled trial.

Setting Women's Health Directorate, Warrington Hospital NHS Trust.

Population Women were referred to the endometrial sampling clinic for the investigation of pre and postmenopausal vaginal bleeding.

Methods Randomisation to either pre‐sampling intrauterine two percent lignocaine gel or an inert gel. Patients, recruiters and assessors were blinded to the gel used.

Main outcome measures The difference between the study groups in the proportion of women who, after Vabra sampling, recorded a pain score of ≥6 out of 10 on a visual analogue scale.

Results Three hundred and eight women were randomised, 284 (92%) completed a pain scale before and immediately after the procedure. After the procedure, 84 women (30%) recorded a pain score of ≥6, 38 (26%) received anaesthetic and 46 (33%) an inert gel. The difference in the proportion of women recording a pain score of 6 or above between the two study groups was not significant (relative risk (RR) for the anaesthetic gel=0.79 95% CI, 0.55, 1.14).

Conclusions Intrauterine application of 2% lignocaine gel did not significantly reduce the frequency with which women experienced unacceptable levels of pain or anxiety during endometrial aspiration compared with placebo.
Evaluating ambulatory urodynamics: a prospective study in asymptomatic women
Authors: Salvatore Stefano , Khullar Vik , Cardozo Linda , Anders Kate , Zocchi Gaia , Soligo Marco
Published: December 2003

Objective
To identify abnormal detrusor contractions in asymptomatic women undergoing ambulatory urodynamics, to standardise the investigation technique for women with urinary symptoms for clinical practice.

Design
Prospective observational study.

Setting
Two tertiary referral urogynaecology units: one in London, UK and one in Varese, Italy.

Methods
Women without urinary symptoms were recruited into the study. Ambulatory urodynamics was performed according to the King's College Hospital protocol. All the traces were analysed in four different ways: 1. without the second bladder transducer measurements displayed on the screen and without the diary; 2. as in 1. but with the diary; 3. with the second bladder sensor displayed on the screen but without the diary; 4. as in 3. but with the diary. The diary was always interpreted at the end of the test with the woman present. For each method we reported the total number of detrusor contractions and whether the woman would have been diagnosed as having abnormal detrusor contraction. Cochran's Q test was used for statistical analysis.

Results
Twenty‐six women (mean age 31.7 years) were recruited. Ambulatory urodynamic testing lasted an average of 3.57 hour. The diagnosis of abnormal detrusor contraction varied by 65.4% depending on the method of analysis used. The diary and the women's symptoms during the test were the most discriminating factors. A significant difference between the diagnoses was obtained when comparing the four different ways of analysis. According to our protocol only three women (11.5%) had abnormal detrusor contractions.

Conclusions
Using our protocol almost 90% of asymptomatic women have a stable bladder on ambulatory urodynamics. This is similar to the results of labouratory urodynamic testing of asymptomatic women but is in contrast to previous reports of ambulatory urodynamics of asymptomatic women. The technique used during ambulatory urodynamics determines the tests ability to detect detrusor instability with an accurate symptom diary being the most important.
The effectiveness of the levonorgestrel‐releasing intrauterine system in menorrhagia: a systematic review
Authors: Stewart Antony , Cummins Carole , Gold Lisa , Jordan Rachel , Phillips Wendy
Published: December 2003

Objective To determine whether the levonorgestrel‐releasing intrauterine device (LNG‐IUS), licensed at present for contraceptive use, may reduce menstrual blood loss with few side effects. If effective, surgery could be avoided with consequent resource savings.

Methods A systematic review addressing the effectiveness and cost effectiveness of the LNG‐IUS for menorrhagia was undertaken.

Results Five controlled trials and five case series were found which measured menstrual blood loss. Nine studies recorded statistically significant average menstrual blood loss reductions with LNG‐IUS (range 74%–97%). Another showed reduction in menstrual disturbance score. The LNG‐IUS was more effective than tranexamic acid, but slightly less effective than endometrial resection at reducing menstrual blood loss. In one study, 64% of women cancelled surgery at six months, compared with 14% of control group women. In another, 82% were taken off surgical waiting lists at one year. No cost effectiveness studies were found.

Discussion Small studies of moderate quality indicate the LNG‐IUS is an effective treatment for menorrhagia. Costs may be less than for tranexamic acid in primary and secondary care. Although its use may reduce surgical waiting lists, cost effectiveness assessment requires longer follow up.

Conclusion Effectiveness and cost effectiveness relative to other treatments and the effect on surgical waiting lists can only be established in larger trials measuring patient‐centred outcomes in women with menorrhagia.
A randomised trial comparing single dose systemic methotrexate and laparoscopic surgery for the treatment of unruptured tubal pregnancy
Authors: Sowter Martin C. , Farquhar Cindy M. , Petrie Keith J. , Gudex Guy
Published: December 2003

Objective To compare single dose systemic methotrexate (50 mg/m2) with laparoscopic surgery for the treatment of unruptured tubal pregnancy.

Design An open, pragmatic, prospective randomised trial.

Setting Departments of obstetrics and gynaecology at three hospitals in Auckland, New Zealand.

Participants Clinically stable women with an unruptured tubal pregnancy diagnosed by transvaginal ultrasound and quantitative serum β‐hCG measurement. Inclusion criteria included a serum β‐hCG concentration < 5000 IU/L, and a tubal pregnancy of < 3.5 cm diameter.

Main outcome measures Treatment success, physical and psychological functioning, side effects, and subsequent ipsilateral tubal patency.

Results Two hundred and eighteen women with ectopic pregnancies were seen at the three hospitals. 79 women (36% eligibility rate) were eligible for trial entry and 62 women (78% recruitment rate) were recruited. Twenty‐six of the 28 women (93%) randomised to laparoscopic surgery required no further treatment, compared with 22 of the 34 women (65%) randomised to methotrexate (95% CI of difference in success rate 10 ‐ 47%; P<0.01). Two women (7%) in the laparoscopic surgery group had persistent trophoblast. Nine women (26%) in the methotrexate group required more than one dose of methotrexate and five women (15%) underwent laparoscopy during follow up. In the laparoscopy group three women (11%) had negative laparoscopies and two women (7%) had were found to have a ruptured fallopian tube at the time of surgery. Women treated with methotrexate had significantly better objective physical functioning scores but there were no differences in any other psychological outcomes. Women treated with methotrexate experienced greater and more prolonged vaginal bleeding. The likelihood of methotrexate treatment failure was greater at higher serum β‐hCG concentrations. Ipsilateral tubal patency rates were similar in each group.

Conclusion This trial shows that in the treatment of tubal pregnancy single dose systemic methotrexate is a less effective treatment than laparoscopic salpingotomy. It is well tolerated, but should only be offered as an alternative to surgery to women who have mild symptoms and present at low serum β‐hCG concentrations. In our population this likely to be no more than a quarter of women presenting with a tubal pregnancy.