bluuebunny/crossref_metadata_2025 huggingface dataset:
Does Bicarbonate Transfer Have Relevant Hemodynamic Consequences in Standard Hemodialysis?
Authors: Gabutti Luca , Ross Vanessa , Duchini Francesca , Mombelli Giorgio , Marone Claudio
Published: July 2005

Background: In a previous study we demonstrated that mild metabolic alkalosis resulting from standard bicarbonate hemodialysis induces hypotension. This study aimed to compare hemodynamic consequences of either a decrease in the dialysate bicarbonate from 32 to 26 mmol/l or an increase in the dialysate calcium of 0.25 mmol/l and to verify whether the calcium shift secondary to alkalemia explains the consequences on blood pressure. Methods: In this randomized controlled trial with a single-blind, cross-over design, we used dialysis liquids with two different bicarbonate (32 mmol/l in modalities A and C, and 26 mmol/l in modality B) and calcium (1.25 mmol/l in modalities A and B, and 1.50 mmol/l in modality C) concentrations, and in 27 patients, 243 dialysis sessions, compared blood pressure, heart rate and the incidence of hypotension. Results: No significant differences were seen between A and B while an increase in systolic and diastolic blood pressures and a decrease in the incidence of hypotension (10.5 vs. 1.2%, p < 0.05) were documented in C. The subgroup of patients who with A showed a lower mean systolic blood pressure received more angiotensin-converting enzyme inhibitors or angiotensin II type-1 receptor blockers (36 vs. 0%, p <0.05) and in C showed a less important increase in systolic and diastolic pressures, but the incidence of hypotensive episodes between A and B was not significantly different (9.1 vs. 15.1%). Conclusions: In the present study it was not possible to demonstrate hemo dynamic instability associated with mild metabolic alkalosis. Even in the subgroup showing a lower blood pressure with a higher dialysate bicarbonate, significant hemodynamic or clinical consequences were not noticed. The calcium shift (0.05 mmol/l) related to alkalemia would justify a mean decrease in systolic blood pressure of only about 1 mm Hg.
The Pro Children Intervention: Applying the Intervention Mapping Protocol to Develop a School-Based Fruit and Vegetable Promotion Programme
Authors: Pérez-Rodrigo Carmen , Wind Marianne , Hildonen Christina , Bjelland Mona , Aranceta Javier , Klepp Knut-Inge , Brug Johannes
Published: July 2005

Background/Aims: The importance of careful theory-based intervention planning is recognized for fruit and vegetable promotion. This paper describes the application of the Intervention Mapping (IM) protocol to develop the Pro Children intervention to promote consumption of fruit and vegetable among 10- to 13-year-old schoolchildren. Methods: Based on a needs assessment, promotion of intake of fruit and vegetable was split into performance objectives and related personal, social and environmental determinants. Crossing the performance objectives with related important and changeable determinants resulted in a matrix of learning and change objectives for which appropriate educational strategies were identified. Theoretically similar but culturally relevant interventions were designed, implemented and evaluated in Norway, the Netherlands and Spain during 2 school years. Results: Programme activities included provision of fruits and vegetables in the schools, guided classroom activities, computer-tailored feedback and advice for children, and activities to be completed at home with the family. Additionally, optional intervention components for community reinforcement included incorporation of mass media, school health services or grocery stores. School project committees were supported. Conclusion: The Pro Children intervention was carefully developed based on the IM protocol that resulted in a comprehensive school-based fruit and vegetable promotion programme, but culturally sensible and locally relevant.
Biomechanical Determinants of Abdominal Aortic Aneurysm Rupture
Authors: Vorp David A. , Geest Jonathan P. Vande
Published: July 2005

Rupture of abdominal aortic aneurysm (AAA) represents a significant clinical event, having a mortality rate of 90% and being currently ranked as the 13th leading cause of death in the US. The ability to reliably evaluate the susceptibility of a particular AAA to rupture on a case-specific basis could vastly improve the clinical management of these patients. Because AAA rupture represents a mechanical failure of the degenerated aortic wall, biomechanical considerations are important to understand this process and to improve our predictions of its occurrence. Presented here is an overview of research to date related to the biomechanics of AAA rupture. This includes a summary of results related to ex vivo and in vivo mechanical testing, noninvasive AAA wall stress estimations, and potential mechanisms of AAA wall weakening. We conclude with a demonstration of a biomechanics-based approach to predicting AAA rupture on a patient-specific basis, which may ultimately prove to be superior to the widely and currently used maximum diameter criterion.
Tissue Plasminogen Activator Promotes Matrix Metalloproteinase-9 Upregulation After Focal Cerebral Ischemia
Authors: Tsuji Kiyoshi , Aoki Toshiaki , Tejima Emiri , Arai Ken , Lee Sun-Ryung , Atochin Dmitriy N. , Huang Paul L. , Wang Xiaoying , Montaner Joan , Lo Eng H.
Published: July 2005

Background and Purpose—

Thrombolytic therapy with tissue plasminogen activator (tPA) in ischemic stroke is limited by increased risks of cerebral hemorrhage and brain injury. In part, these phenomena may be related to neurovascular proteolysis mediated by matrix metalloproteinases (MMPs). Here, we used a combination of pharmacological and genetic approaches to show that tPA promotes MMP-9 levels in stroke in vivo.

Methods—

In the first experiment, spontaneously hypertensive rats were subjected to 3 hours of transient focal cerebral ischemia. The effects of tPA (10 mg/kg IV) on ischemic brain MMP-9 levels were assessed by zymography. In the second experiment, wild-type (WT) and tPA knockout mice were subjected to 2 hours of transient focal cerebral ischemia, and MMP-9 levels and brain edema during reperfusion were assessed. Phenotype rescue was performed by administering tPA to the tPA knockout mice.

Results—

In the first experiment, exogenous tPA did not change infarct size but amplified MMP-9 levels in ischemic rat brain at 24 hours. Coinfusion of the plasmin inhibitor tranexamic acid (300 mg/kg) did not ameliorate this effect, suggesting that it was independent of plasmin. In the second experiment, ischemic MMP-9 levels, infarct size, and brain edema in tPA knockouts were significantly lower than WT mice. Administration of exogenous tPA (10 mg/kg IV) did not alter infarction but reinstated the ischemic MMP-9 response back up to WT levels and correspondingly worsened edema.

Conclusions—

These data demonstrate that tPA upregulates brain MMP-9 levels in stroke in vivo, and suggest that combination therapies targeting MMPs may improve tPA therapy.
Impact of Hypertension and Apolipoprotein E4 on Poststroke Cognition in Subjects >75 Years of Age
Authors: Rowan E. , Morris C.M. , Stephens S. , Ballard C. , Dickinson H. , Rao H. , Saxby B.K. , McLaren A.T. , Kalaria R.N. , Kenny R.A.
Published: July 2005

Background and Purpose—

The apolipoprotein E4 allele (APOE4) associates with increased dementia risk, and hypertension may associate with mild cognitive deficits. We examined whether nondemented stroke patients with (1) a prestroke history of hypertension and (2) APOE4 were more cognitively impaired at 3 months after stroke.

Methods—

A total of 257 participants were genotyped and outcomes from neuropsychological evaluations analyzed using regression.

Results—

Total Cambridge Assessment for Mental Disorders in the Elderly (CAMCOG) and speed of working memory significantly associated with hypertension. No outcomes significantly associated with APOE4.

Conclusions—

Subjects with prestroke hypertension had more impaired global cognition and slower access to information held in working memory.
Polyglycolide/Polylactide-Coated Platinum Coils for Patients With Ruptured and Unruptured Cerebral Aneurysms
Authors: Linfante Italo , Akkawi Nabil M. , Perlow Alain , Andreone Vincenzo , Wakhloo Ajay K.
Published: July 2005

Background and Purpose—

Recanalization of cerebral aneurysm is a limitation of bare platinum coils (BPCs). In a swine aneurysm model, polyglycolide/polylactide (a polymer)-coated platinum coils (Matrix) accelerated clot fibrosis and reduced recanalization rate and aneurysmal volume. We aimed to evaluate the safety of Matrix coils in patients with intracranial aneurysm.

Methods—

This is a single-center, prospective study of patients with intracranial aneurysms treated with Matrix alone or in combination with BPCs. Follow-up evaluation included a 1-month clinical evaluation and a 6- and 12-month clinical and angiographic examination. Primary adverse events included death, stroke, and permanent neurological deficits.

Results—

Between May 2002 and January 2004, 52 patients (range 34 to 79 years of age; 38 females) were treated for 54 aneurysms (size 7.9±4.6 mm; neck 3.9±1.5 mm; 26 ruptured). Matrix alone was used in 13 aneurysms. In 39, we used a combination of Matrix and BPCs. Twenty-one aneurysms had a 6-month follow-up examination (11 Matrix; 10 Matrix combined with bare platinum), and 11 completed the 12-month follow-up evaluation (Matrix only). Adverse events not related to the procedure were 2 deaths (ruptured basilar aneurysms) and 1 stroke at day 10 postcoiling secondary to vasospasm. Procedure-related adverse events were 2 strokes. At 6-month follow-up (n=21) evaluation, 2 of 3 recanalizations needed retreatment. At 12-month follow-up (n=11), there was no recanalization in patients treated with Matrix alone and no significant reduction in aneurysmal size.

Conclusions—

Polyglycolide/polylactide-coated coils had a satisfactory safety profile. Significant aneurysmal size reduction after coiling was not observed.
Pressure for Relevancy at Top-Tier Business Schools
Authors: Zell Deone
Published: August 2005

After decades of attempts to bring scientific rigor to the business school community, market forces are pressuring these institutions to produce research that is relevant as well as scientifically rigorous. At least three factors are responsible for this shift: the ongoing pursuit of revenues, the arrival of media rankings, and the emergence of student as customer. This essay revisits these pressures, which have shown no sign of abating since they were first studied in the late 1990s. Meeting the dual demands of rigor and relevancy is difficult, and faculty who can do so are rare. One solution is to publish performance research that attempts to address both sets of demands. Such research is controversial, however, and its viability is open to debate.
Serving Public Interests in Educational Accountability: Alternative Approaches to Democratic Evaluation
Authors: Ryan Katherine E.
Published: August 2005

Today, educational evaluation theory and practice face a critical juncture with the kind of educational accountability evaluation legislated by No Child Left Behind. While the goal of this kind of educational accountability is to improve education, it is characterized by a hierarchical, top-down approach to improving educational achievement reflecting a climate of control and efficiency. Democratic evaluation is intended for contexts in which there are concerns about top-down control of management and education (MacDonald, B. & Kushner, S. (2004). Democratic evaluation. In S. Mathison (Ed.), The encyclopedia of evaluation. Thousand Oaks, CA: Sage). This paper examines democratic evaluation approaches to see how these approaches might contribute to making educational accountability more democratic. Suggestions about how evaluators can serve public interests in developing a more democratic accountability are presented.
A Wiz of a Way to Remember the Five Guiding Principles for Evaluators
Authors: Knott Tara D.
Published: August 2005

The five guiding principles were developed in 1994 by an AEA Board of Director’s appointed Task Force to help evaluators become more thoughtful and serious professionals. The tenets considered and articulated by the Task Force serve to clarify the role of evaluation for evaluators and their clients and to provide standards or ethical statements to help guide the conduct of professional evaluators. However, in order for many evaluators to actually use these principles, they must first be able to remember them. The present article suggests that the principles can be better remembered via a mnemonic device which employs the familiar characters from Frank Baum’s Wizard of Oz. For example, the Cowardly Lion lacks courage and can be associated with the evaluator’s need to consider his or her own courage in following the principle of integrity/honesty. Similarly, the Scarecrow and the Tin Man can help remind evaluators of the other principles. And if it is easier to remember the Guiding Principles, it will be easier to employ them in our work.
Critical Challenges Confronting Certification of Evaluators
Authors: Worthen Blaine R.
Published: August 2005

There are many clear-cut reasons why it would be desirable to have a certification process for evaluators, both to help improve the practice of evaluation and to further the field’s maturation into a full-fledged profession. But there are also many strong arguments against attempting to launch an evaluator certification system, at least at this time. The arguments for and against AEA attempting to set up an evaluator certification system are discussed, including two contextual changes that have led to a significant shift in my thinking on this topic over the last three decades. Also presented are four major challenges that would need to be overcome in any effort to develop a viable evaluator certification system. In light of these challenges, I argue that the development and implementation of a certification process can succeed only if pursued patiently and incrementally, with adequate time for AEA to test the feasibility of each of the definitional and procedural processes that would need to undergird such a system. Finally, an agenda of steps is suggested that AEA might take to determine if our field and our collective wisdom have matured sufficiently for us to succeed in such an important undertaking.
The energy-less red blood cell is lost: erythrocyte enzyme abnormalities of glycolysis
Authors: van Wijk Richard , van Solinge Wouter W.
Published: July 2005

The red blood cell depends solely on the anaerobic conversion of glucose by the Embden-Meyerhof pathway for the generation and storage of high-energy phosphates, which is necessary for the maintenance of a number of vital functions. Many red blood cell enzymopathies have been described that disturb the erythrocyte's integrity, shorten its cellular survival, and result in hemolytic anemia. By far the majority of these enzymopathies are hereditary in nature. In this review, we summarize the current knowledge regarding the genetic, biochemical, and structural features of clinically relevant red blood cell enzymopathies involved in the Embden-Meyerhof pathway and the Rapoport-Luebering shunt.
Effect of bronchial thermoplasty on airway distensibility
Authors: Brown R. H. , Wizeman W. , Danek C. , Mitzner W.
Published: July 2005

Recent studies have reported that the application of thermal energy delivered through a bronchoscope (bronchial thermoplasty) impairs the ability of airways to narrow in response to methacholine. How such altered smooth muscle affects the response of airways to lung inflation may have important clinical implications, particularly as it relates to the abnormal response of asthmatic subjects to lung inflation and deep inspiration. The aim of this study was to examine whether bronchial thermoplasty affected airway distension with lung inflation in relaxed and contracted airways.

A total of 230 airways were studied, ranging 2.5–15 mm, in six dogs. These airways were divided into two groups: an untreated (control) population and a bronchial thermoplasty-treated population.

Prior to treatment, the airway pressure-area curves in the two groups of airways were identical. In contrast, the relaxed and contracted airway pressure-area curves in treated airways were shifted upward at all points, showing increased airway area at both 3 and 5 weeks post-treatment.

In conclusion, these results show that reducing that amount of functional smooth muscle with bronchial thermoplasty leads to increased airway size in both relaxed and contracted states over a normal range of inflation pressures.
A dynamic population model of disease progression in COPD
Authors: Hoogendoorn M. , Rutten-van Mölken M. P. M. H. , Hoogenveen R. T. , van Genugten M. L. L. , Buist A. S. , Wouters E. F. M. , Feenstra T. L.
Published: July 2005

To contribute to evidence-based policy making, a dynamic Dutch population model of chronic obstructive pulmonary disease (COPD) progression was developed.

The model projects incidence, prevalence, mortality, progression and costs of diagnosed COPD by the Global Initiative for Chronic Obstructive Lung Disease-severity stage for 2000–2025, taking into account population dynamics and changes in smoking prevalence over time. It was estimated that of all diagnosed COPD patients in 2000, 27% had mild, 55% moderate, 15% severe and 3% very severe COPD. The severity distribution of COPD incidence was computed to be 40% mild, 55% moderate, 4% severe and 0.1% very severe COPD. Disease progression was modelled as decline in forced expiratory voume in one second (FEV1) % predicted depending on sex, age, smoking and FEV1% pred. The relative mortality risk of a 10-unit decrease in FEV1% pred was estimated at 1.2. Projections of current practice were compared with projections assuming that each year 25% of all COPD patients receive either minimal smoking cessation counselling or intensive counselling plus bupropion.

In the projections of current practice, prevalence rates between 2000–2025 changed from 5.1 to 11 per 1,000 inhabitants for mild, 11 to 14 per 1,000 for moderate, 3.0 to 3.9 per 1,000 for severe and from 0.5 to 1.3 per 1,000 for very severe COPD. Costs per inhabitant increased from \#8364;1.40 to 3.10 for mild, \#8364;6.50 to 9.00 for moderate, \#8364;6.20 to 8.50 for severe and from \#8364;3.40 to 9.40 for very severe COPD (price level 2000). Both smoking cessation scenarios were cost-effective with minimal counselling generating net savings.

In conclusion, the chronic obstructive pulmonary disease progression model is a useful instrument to give detailed information about the future burden of chronic obstructive pulmonary disease and to assess the long-term impact of interventions on this burden.
Tuberculosis, HIV seroprevalence and intravenous drug abuse in prisoners
Authors: Drobniewski F. A. , Balabanova Y. M. , Ruddy M. C. , Graham C. , Kuznetzov S. I. , Gusarova G. I. , Zakharova S. M. , Melentyev A. S. , Fedorin I. M.
Published: July 2005

High rates of tuberculosis (TB) and HIV are believed to exist in Russian prisons. Prisoners with TB were studied in order to identify the following: 1) prevalence of HIV, and risk factors for HIV and other blood-borne virus infections; and 2) clinical and social factors that might compromise TB treatment effectiveness and/or patient adherence and, hence, encourage treatment failure.

A 1-yr cross-sectional prevalence study of 1,345 prisoners with TB was conducted at an in-patient TB facility in Samara, Russian Federation.

HIV and hepatitis B and/or C co-infection occurred in 12.2% and 24.1% of prisoners, respectively, and rates were significantly higher than in civilians. Overall, 48.6% of prisoners used drugs, of which 88.3% were intravenous users. Prisoners were more likely to be intravenous drug users and HIV positive compared with civilians with TB, and 40.2% of prisoners shared needles. Two-thirds of prisoners (68.6%) had received previous TB drug therapy (frequently multiple, interrupted courses) and were significantly more likely than civilians to have had previous therapy consistent with the high drug-resistance rates seen.

Prisons are major drivers of the tuberculosis and HIV epidemics. Novel strategies are needed to reduce the spread of blood borne diseases, particularly in intravenous drug users.
Cyclooxygenase-1 gene polymorphisms in patients with different asthma phenotypes and atopy
Authors: Shi J. , Misso N. L. A. , Duffy D. L. , Bradley B. , Beard R. , Thompson P. J. , Kedda M-A.
Published: July 2005

Cyclooxygenase-1 (COX-1) regulates the biosynthesis of prostaglandins, which are important mediators in asthma. The possible association of COX-1 gene polymorphisms with asthma has not been investigated.

The allele frequencies of 20 COX-1 polymorphisms were determined in a random Australian Caucasian population using MassARRAY technology. Informative and potentially functional promoter (c.8592C>T, c.1676C>T) and coding region (c.22C>T, c.50C>T) polymorphisms were investigated in carefully phenotyped patients with mild (n = 316), moderate (n = 241), severe (n = 86) or aspirin-intolerant asthma (AIA) (n = 58), and in nonasthmatic subjects (n = 477).

There were no allelic, genotypic or haplotypic associations between these four polymorphisms and asthma or asthma severity. Over-representation of the c.50TT genotype among AIA patients (3.4%) compared with aspirin-tolerant patients (0.8%), and a global haplotype association with AIA did not reach statistical significance. The c.22TT genotype was less frequent among atopic (0.1%) rather than nonatopic individuals (1.2%; odds ratio = 9.05, 95% confidence interval 1.01–81.29).

In conclusion, the present investigation of cyclooxygenase-1 polymorphisms in asthma indicates that they do not appear to play a substantial role in genetic pre-disposition for asthma or asthma severity. However, the c.22TT genotype confers a small protective effect against atopy. Potential associations with aspirin-intolerant asthma were identified and warrant further investigation in a larger population of aspirin-intolerant asthma patients.
The SPHERE Study. Secondary prevention of heart disease in general practice: protocol of a randomised controlled trial of tailored practice and patient care plans with parallel qualitative, economic and policy analyses. [ISRCTN24081411]
Authors: Murphy Andrew W , Cupples Margaret E , Smith Susan M , Byrne Molly , Leathem Claire , Byrne Mary C
Published: July 2005

Background

The aim of the SPHERE study is to design, implement and evaluate tailored practice and personal care plans to improve the process of care and objective clinical outcomes for patients with established coronary heart disease (CHD) in general practice across two different health systems on the island of Ireland.

CHD is a common cause of death and a significant cause of morbidity in Ireland. Secondary prevention has been recommended as a key strategy for reducing levels of CHD mortality and general practice has been highlighted as an ideal setting for secondary prevention initiatives. Current indications suggest that there is considerable room for improvement in the provision of secondary prevention for patients with established heart disease on the island of Ireland. The review literature recommends structured programmes with continued support and follow-up of patients; the provision of training, tailored to practice needs of access to evidence of effectiveness of secondary prevention; structured recall programmes that also take account of individual practice needs; and patient-centred consultations accompanied by attention to disease management guidelines.

Methods

SPHERE is a cluster randomised controlled trial, with practice-level randomisation to intervention and control groups, recruiting 960 patients from 48 practices in three study centres (Belfast, Dublin and Galway). Primary outcomes are blood pressure, total cholesterol, physical and mental health status (SF-12) and hospital re-admissions.

The intervention takes place over two years and data is collected at baseline, one-year and two-year follow-up. Data is obtained from medical charts, consultations with practitioners, and patient postal questionnaires.

The SPHERE intervention involves the implementation of a structured systematic programme of care for patients with CHD attending general practice. It is a multi-faceted intervention that has been developed to respond to barriers and solutions to optimal secondary prevention identified in preliminary qualitative research with practitioners and patients. General practitioners and practice nurses attend training sessions in facilitating behaviour change and medication prescribing guidelines for secondary prevention of CHD. Patients are invited to attend regular four-monthly consultations over two years, during which targets and goals for secondary prevention are set and reviewed. The analysis will be strengthened by economic, policy and qualitative components.
The influence of in-pregnancy smoking cessation programmes on partner quitting and women's social support mobilization: a randomized controlled trial [ISRCTN89131885]
Authors: Aveyard Paul , Lawrence Terry , Evans Olga , Cheng KK
Published: July 2005

Background

Smoking cessation interventions in pregnancy could influence a woman's social behaviour and her partner's smoking behaviour, but this has not been examined in any published randomized trials.

Method

918 women smoking at booking for antenatal care were enrolled in a cluster-randomized trial of three interventions: standard care, self-help manual and enhanced stage-based counselling, or self-help manual, enhanced stage-based counselling and use of an interactive computer program. The outcomes were change in social support received by women between booking for maternity care and 30 weeks gestation and 10 days postpartum and reported cessation in the woman's partner at these times.

Results

Few pregnant women's partners stopped smoking (4.1% at 30 weeks of gestation and 5.8% at 10 days postpartum) and the probability of quitting did not differ significantly by trial arm. Women's scores on the Inventory of Socially Supportive Behaviors showed a slight decline from booking to 30 weeks gestation, and a slight increase to 10 days postpartum, but these changes did not differ significantly by trial arm.

Conclusion

The stage-based interventions tested in this trial aimed partly to influence women's mobilization of support and might have influenced partners' quitting, but there was no evidence that they did so. Given that women and their partners often stopped smoking together, future interventions to prevent smoking in pregnant women could encourage both partners to quit together.
Managing variability in the summary and comparison of gait data
Authors: Chau Tom , Young Scott , Redekop Sue
Published: July 2005

Variability in quantitative gait data arises from many potential sources, including natural temporal dynamics of neuromotor control, pathologies of the neurological or musculoskeletal systems, the effects of aging, as well as variations in the external environment, assistive devices, instrumentation or data collection methodologies. In light of this variability, unidimensional, cycle-based gait variables such as stride period should be viewed as random variables and prototypical single-cycle kinematic or kinetic curves ought to be considered as random functions of time. Within this framework, we exemplify some practical solutions to a number of commonly encountered analytical challenges in dealing with gait variability. On the topic of univariate gait variables, robust estimation is proposed as a means of coping with contaminated gait data, and the summary of non-normally distributed gait data is demonstrated by way of empirical examples. On the summary of gait curves, we discuss methods to manage undesirable phase variation and non-robust spread estimates. To overcome the limitations of conventional comparisons among curve landmarks or parameters, we propose as a viable alternative, the combination of curve registration, robust estimation, and formal statistical testing of curves as coherent units. On the basis of these discussions, we provide heuristic guidelines for the summary of gait variables and the comparison of gait curves.
Globalisation, health and foreign policy: emerging linkages and interests
Authors: Owen John Wyn , Roberts Olivia
Published: July 2005

A discussion of the growing links between the issues of globalisation, health and foreign policy. This article examines the effect this has on health, development and foreign policy communities in the UK and internationally and considers what steps the policy community must take to address the challenges and opportunities of this new relationship.
The Australian National Sub-acute and Non-acute Patient Casemix Classification (AN-SNAP): its application and value in a stroke rehabilitation programme
Authors: Lowthian Peter , Disler Peter , Ma Sam , Eagar Kathy , Green Janette , de Graaff Stephen
Published: August 2005

Objective: To investigate whether the Australian National Sub-acute and Non-acute Patient Casemix Classification (SNAP) and Functional Independence Measure and Functional Related Group (Version 2) (FIM-FRG2) casemix systems can be used to predict functional outcome, and reduce the variance of length of stay (LOS) of patients undergoing rehabilitation after strokes.

Design and setting: The study comprised a retrospective analysis of the records of patients admitted to the Cedar Court Healthsouth Rehabilitation Hospital for rehabilitation after stroke.

Subjects: The sample included 547 patients (83.3% of those admitted with stroke during this period). Patient data were stratified for analysis into the five SNAP or nine FIM-FRG2 groups, on the basis of the admission FIM scores and age.

Main outcomes: The AN-SNAP classification accounted for a 30.7% reduction of the variance of LOS, and 44.2% of motor FIM, and the FIM-FRG2 accounts for 33.5% and 56.4% reduction respectively. Comparison of the Cedar Court with the national AN-SNAP data showed differences in the LOS and functional outcomes of older, severely disabled patients. Intensive rehabilitation in selected patients of this type appears to have positive effects, albeit with a slightly longer period of inpatient rehabilitation.

Conclusions: Casemix classifications can be powerful management tools. Although FIM-FRG2 accounts for more reduction in variance than SNAP, division into nine groups meant that some contained few subjects. This paper supports the introduction of AN-SNAP as the standard casemix tool for rehabilitation in Australia, which will hopefully lead to rational, adequate funding of the rehabilitation phase of care.
Clinical standards for specialist community rehabilitation services in the UK
Authors: Turner-Stokes Lynne , Williams Heather , Abraham Rachel
Published: August 2005

Objective: To develop a set of clinical standards for specialist community rehabilitation services in the UK and to undertake a preliminary survey of consultants who provide those services.

Design and methods: The proposed set of standards was adapted from the previously published standards for inpatient services, by a working party of the British Society for Rehabilitation Medicine (BSRM). Consensus was then achieved by an iterative consultation process in five rounds. A postal survey was conducted on behalf of the BSRM amongst its consultant members providing community rehabilitation services in the UK, who were asked to assess their services in relation to these standards, and to comment on the standards themselves, their usefulness and applicability.

Results: Fifty consultants who ran specialist community rehabilitation services agreed to participate, of whom 29 (58%) actually responded. Overall, the standards appeared to be acceptable to most, and mainly struck the right level, being attained by the majority of services. Twenty-five (89%) felt the standards were helpful and 26 (93%) felt that they covered the main aspects of specialist community rehabilitation services: 23 (79%) found them at least partially applicable to their own service.

Conclusions: Proposed clinical standards have been developed for specialist community rehabilitation services in the UK. It is likely that they will require further refinement with time, and modification is required to adapt them to different subspecialities and settings.
On group sequential procedures under variance heterogeneity
Authors: Hussein A , Carriere K C
Published: August 2005

In this paper, we consider group sequential procedures for clinical trials under variance heterogeneity. Group sequential procedures typically involve small samples at each interim analysis. We advocate Welch’s correction for variance heterogeneity, and present a natural application of the significance level method for such situations. Currently available procedures are based on a large sample method, with no allowance for corrections of heterogeneity. Unless the sample size is large, the results are not valid. On the basis of simulation studies, comparing their abilities to control Type I error rates, we recommend using Welch’s correction for sequential trials involving small samples under variance heterogeneity.
Lifetime prevalence and impact of stalking in a European population
Authors: Dressing Harald , Kuehner Christine , Gass Peter
Published: July 2005

Background

There is a lack of community-based studies on prevalence rates of stalking and the impact of stalking on victims in European countries.

Aims

To examine lifetime and point prevalence rates of stalking, behavioural and psychological consequences for victims, and the impact of stalking on current psychological well-being in a German community sample.

Method

A postal survey was conducted with a sample randomly selected from the population of a middle-sized German city; 679 people (400 women, 279 men) responded. The survey included a stalking questionnaire and the WHO–5 well-being scale.

Results

Almost 12% of the respondents (n=78, 68 women, 10 men) reported having been stalked. A multiple regression analysis revealed a significant effect of victimisation on psychological well-being.

Conclusions

This study identified a high lifetime prevalence of stalking in the community. Effects on victims' psychological health are significant, suggesting that the phenomenon deserves more attention in future community mental health research.
Effect of psychiatric disorders on outcome of cognitive-behavioural therapy for chronic fatigue syndrome
Authors: Prins Judith , Bleijenberg Gijs , Rouweler Eufride Klein , Van Der Meer Jos
Published: July 2005

Psychiatric disorders have been associated with poor outcome in individuals with chronic fatigue syndrome (CFS). This study examines the impact of psychiatric disorders on outcome of cognitive-behavioural therapy (CBT). Psychiatric diagnoses were assessed with a structured psychiatric interview in a CBT trial of 270 people with CFS. Lifetime and current psychiatric disorders were found in 50 and 32% respectively. No significant differences in fatigue severity and functional impairment following treatment were found between participants with and without psychiatric diagnoses.
International clinical practice guidelines for early psychosis
Authors:   INTERNATIONAL EARLY PSYCHOSIS ASSOCIATION WRITING GROUP
Published: July 2005

These international clinical practice guidelines were developed with detailed input from 29 invited international consultants, who provided content as well as detailed feedback on draft versions. The final draft of the guidelines was ratified by the Executive of the International Early Psychosis Association and presented and formally endorsed at the Third International Conference on Early Psychosis held in Copenhagen, September 2002. They have been revised slightly to include medications that were not available in 2002, although a fully comprehensive process of update has not yet been conducted. The final version is published in this Supplement with the aim of encouraging further discussion as well as providing practical guidance to clinicians and researchers. A second edition is planned for publication in 2008.
Predictors of schizophrenia
Authors: Isohanni Matti , Lauronen Erika , Moilanen Kristiina , Isohanni Irene , Kemppainen Liisa , Koponen Hannu , Miettunen Jouko , Mäki Pirjo , Räsänen Sami , Veijola Juha , Tienari Pekka , Wahlberg Karl-Erik , Murray Graham K.
Published: July 2005

Background

Subtle motor, emotional, cognitive and behavioural abnormalities are often present in apparently healthy individuals who later develop schizophrenia, suggesting that some aspects of causation are established before overt psychosis.

Aims

To outline the development of schizophrenia.

Method

We drew on evidence from The Northern Finland 1966 Birth Cohort supplemented by selected findings from other relevant literature.

Results

The main known risk factors in development of schizophrenia are genetic causes, pregnancy and delivery complications, slow neuromotor development, and deviant cognitive and academic performance. However, their effect size and predictive power are small.

Conclusions

No powerful risk factor, premorbid sign or risk indicator has been identified that is useful for the prediction of schizophrenia in the general population.
Interventions in the initial prodromal states of psychosis in Germany: concept and recruitment
Authors: Bechdolf Andreas , Ruhrmann Stephan , Wagner Michael , Kühn Kai Uwe , Janssen Birgit , Bottlender Ronald , Wieneke Anke , Schulze-Lutter Frauke , Maier Wolfgang , Klosterkötter Joachim
Published: July 2005

Background

The Early Detection and Intervention Programme of the German Research Network on Schizophrenia (GRNS) investigates the initial prodromal phase of psychosis in a multidimensional approach. Two intervention strategies are being studied by two large-scale multicentre projects.

Aims

To present the concept of the intervention studies, and to provide an interim report of the recruitment procedure.

Method

Comprehensive cognitive-behavioural therapy has been developed for patients in the ‘early initial prodromal state’. For patients in the ‘late initial prodromal state’ the atypical neuroleptic amisulpride is explored. Both interventions are evaluated in randomised controlled trials using clinical management as the control condition.

Results

Between January 2001 and March 2003, 1212 individuals seeking help for mental health problems were screened for putative prodromal symptoms at four university centres. More than 388 individuals fulfilled criteria for both interventions and 188 (48. 5%) gave informed consent to participate in the trials.

Conclusions

The screening procedure appears to be feasible and trial participation seems to be acceptable to a relevant proportion of people at increased risk of developing psychosis.
Integrating non-drug treatments in early schizophrenia
Authors: Lewis Shôn W. , Tarrier Nicolas , Drake Richard James
Published: July 2005

There is a range of psychological interventions for established schizophrenia. These include family interventions, motivational interventions for substance misuse and for non-adherence to medication, cognitive remediation for neurocognitive deficits and cognitive–behavioural therapy for symptoms. Psychological interventions may explicitly target risk factors for poor outcome, such as substance use, or protective factors, such as adherence to medication, or be directed at specific symptoms or deficits. There is emerging evidence for efficacy of psychological treatments during, following and even prior to the first episode. Important areas for further study are how different treatment modalities can interact productively and patient and carer preferences for treatment. Many trials of psychological treatments have design flaws and this tends to overestimate the treatment effect.
A survey of admissions following self-poisoning
Authors: Leslie Stephen J. , Greig Lynn , Mackie Rhona , Gotz Michael , Morrison Douglas
Published: July 2005

Aims and Method

Patients who self-poison are at increased risk of future self-poisoning and early death. Admission patterns and effective treatment strategies are unclear although psychosocial assessment may reduce readmissions. This study aimed to determine admission patterns and the proportion of patients receiving a psychiatric assessment in 4220 consecutive admissions.

Results

The average age was 34 years (s.d.=13, range 13–94); most were female (56 v. 44%, P<50.001). Twelve per cent of patients were aged 13–18 years, again the majority were female (70 v. 30%, P<50.001). Twenty per cent of patients had multiple admissions, accounting for 42% of the total admissions. There were slightly more admissions per day at the weekend (Friday, Saturday and Sunday; P<0.002). As many as 245 patients were either not referred or ‘self-discharged’ before they were assessed by the liaison psychiatry service.

Clinical Implications

These findings may help target medical resources, suggesting that consistent numbers of staff are required during all days of the week.
Measuring Corticosterone Metabolites in Droppings of Capercaillies (Tetrao urogallus)
Authors: THIEL DOMINIK , JENNI‐EIERMANN SUSANNE , PALME RUPERT
Published: July 2005

Abstract:The capercaillie (Tetrao urogallus), the largest grouse species in the world, is decreasing in numbers in major parts of its distribution range. Disturbances by human outdoor activities are discussed as a possible reason for this population decline. An indicator for disturbances is the increase of the glucocorticoid corticosterone, a stress hormone, which helps to cope with life‐threatening situations. However, repeated disturbances might result in a long‐term increase of the basal corticosterone concentration, which can result in detrimental effects like reduced fitness and survival of an animal. To measure corticosterone metabolites (CMs) noninvasively in the droppings of free‐living capercaillies, first an enzyme immunoassay (EIA) in captive birds had to be selected and validated. Therefore, the excretion pattern of intravenously injected radiolabeled corticosterone was determined and3H metabolites were characterized. High‐performance liquid chromatography (HPLC) separations of the samples containing peak concentrations revealed that corticosterone was extensively metabolized. The HPLC fractions were tested in several EIAs for glucocorticoid metabolites. The physiological relevance of this method was proved after pharmacological stimulation of the adrenocortical activity. Only the recently established cortisone assay, measuring CMs with a 3,11‐dione structure, detected an expressed increase of concentrations following ACTH stimulation. To set up a sampling protocol suited for the field, we examined the influence of various storage conditions and time of day on concentrations of CMs.
Pregnancy-Specific Modulatory Role of Mitochondria on Adenosine 5′-Triphosphate-Induced Cytosolic [Ca2+] Signaling in Uterine Artery Endothelial Cells
Authors: Yi Fu-Xian , Bird Ian M.
Published: July 2005

Vascular endothelial cells respond to extracellular ATP by inositol 1,4,5-trisphosphate-mediated Ca2+ release from the endoplasmic reticulum followed by Ca2+ influx and subsequent synthesis of vasodilators. In this study, the contribution of mitochondria in shaping the ATP-induced Ca2+ increase was examined in ovine uterine artery endothelial cells from nonpregnant and pregnant (late gestation) ewes (NP- and P-UAEC, passage 4). The mitochondrial protonophore carbonyl cyanide m-chlorophenylhydrazone (CCCP) induced a rapid mitochondrial depolarization. CCCP also slowly increased cytosolic [Ca2+] ([Ca2+]c), which then gradually declined to 10–20 nm above resting level. Pretreatment with CCCP for 30 min significantly inhibited both ATP and thapsigargin-induced [Ca2+]c, with inhibition in NP-UAEC more effective than in P-UAEC. Pretreatment of mitochondrial permeability transition pore inhibitor cyclosporine A did not affect CCCP-induced mitochondrial depolarization, but delayed CCCP-induced [Ca2+]c for about 12–15 min (we termed this the “window of time”). During the cyclosporine A-delayed window of time of CCCP-induced [Ca2+]c, ATP induced a normal Ca2+ response, but after this window of time, ATP-induced [Ca2+]c was significantly inhibited. Pretreatment of oligomycin B to prevent intracellular ATP depletion by F0F1-ATPase did not reduce the inhibition of ATP-induced [Ca2+]c by CCCP. Ruthenium red, a mitochondrial Ca2+ uptake blocker, did not mimic the inhibition of Ca2+ signaling by CCCP. In conclusion, our data show that mitochondrial Ca2+ depletion after dissipation of mitochondrial membrane potential with CCCP inhibits ATP-induced [Ca2+]c, mediated at the level of Ca2+ release from the endoplasmic reticulum. Moreover, our data revealed that P-UAEC is more resistant to the inhibitory effect of CCCP on [Ca2+]c than NP-UAEC.
A major role for zygotichunchbackin patterning theNasoniaembryo
Authors: Pultz Mary Anne , Westendorf Lori , Gale Samuel D. , Hawkins Kyle , Lynch Jeremy , Pitt Jason N. , Reeves Nick L. , Yao Jennifer C. Y. , Small Stephen , Desplan Claude , Leaf David S.
Published: August 2005

Developmental genetic analysis has shown that embryos of the parasitoid wasp Nasonia vitripennis depend more on zygotic gene products to direct axial patterning than do Drosophila embryos. In Drosophila, anterior axial patterning is largely established by bicoid, a rapidly evolving maternal-effect gene, working with hunchback, which is expressed both maternally and zygotically. Here,we focus on a comparative analysis of Nasonia hunchback function and expression. We find that a lesion in Nasonia hunchback is responsible for the severe zygotic headless mutant phenotype, in which most head structures and the thorax are deleted, as are the three most posterior abdominal segments. This defines a major role for zygotic Nasonia hunchback in anterior patterning, more extensive than the functions described for hunchback in Drosophila or Tribolium. Despite the major zygotic role of Nasonia hunchback, we find that it is strongly expressed maternally, as well as zygotically. NasoniaHunchback embryonic expression appears to be generally conserved; however, the mRNA expression differs from that of Drosophila hunchback in the early blastoderm. We also find that the maternal hunchback message decays at an earlier developmental stage in Nasonia than in Drosophila, which could reduce the relative influence of maternal products in Nasonia embryos. Finally, we extend the comparisons of Nasonia and Drosophila hunchback mutant phenotypes, and propose that the more severe Nasonia hunchback mutant phenotype may be a consequence of differences in functionally overlapping regulatory circuitry.
More than just water channels: unexpected cellular roles of aquaporins
Authors: Verkman A. S.
Published: August 2005

Aquaporins (AQPs) are membrane proteins that transport water and, in some cases, also small solutes such as glycerol. AQPs are expressed in many fluid-transporting tissues, such as kidney tubules and glandular epithelia, as well as in non-fluid-transporting tissues, such as epidermis, adipose tissue and astroglia. Their classical role in facilitating trans-epithelial fluid transport is well understood, as in the urinary concentrating mechanism and gland fluid secretion. AQPs are also involved in swelling of tissues under stress, as in the injured cornea and the brain in stroke, tumor and infection. Recent analysis of AQP-knockout mice has revealed unexpected cellular roles of AQPs. AQPs facilitate cell migration, as manifested by reduced tumor angiogenesis in AQP1-knockout mice, by a mechanism that might involve facilitated water transport in lamellipodia of migrating cells. AQPs that transport both glycerol and water regulate glycerol content in epidermis and fat, and consequently skin hydration/biosynthesis and fat metabolism. AQPs might also be involved in neural signal transduction, cell volume regulation and organellar physiology. The many roles of AQPs could be exploited for clinical benefit; for example, treatments that modulate AQP expression/function could be used as diuretics, and in the treatment of brain swelling, glaucoma, epilepsy, obesity and cancer.