bluuebunny/crossref_metadata_2025 huggingface dataset:
Latitudinal patterns in the phenological responses of leaf colouring and leaf fall to climate change in Japan
Authors: Doi Hideyuki , Takahashi Mayumi
Published: May 2008

Aim  To estimate the potential effect of global climate change on the phenological responses of plants it is necessary to estimate spatial variations at larger scales. However, previous studies have not estimated latitudinal patterns in the phenological response directly. We hypothesized that the phenological response of plants varies with latitude, and estimated the phenological response to long‐term climate change using autumn phenological events that have been delayed by recent climate change.

Location  Japan.

Methods  We used a 53‐year data set to document the latitudinal patterns in the climate responses of the timing of autumn leaf colouring and fall for two tree species over a wide range of latitudes in Japan (31 to 44° N). We calculated single regression slopes for leaf phenological timing and air temperature across Japan and tested their latitudinal patterns using regression models. The effects of latitude, time and their interaction on the responses of the phenological timings were also estimated using generalized linear mixed models.

Results  Our results showed that single regression slopes of leaf phenological timing and air temperature in autumn were positive at most stations. Higher temperatures can delay the timing of leaf phenology. Negative relationships were found between the phenological response of leaves to temperature and latitude. Single regression slopes of the phenological responses at lower latitudes were larger than those at higher latitudes.

Main conclusions  We found negative relationships between leaf phenological responsiveness and latitude. These findings will be important for predicting phenological timing with global climate change.
The health effects of bioactive plant components in food: results and opinions of the EU COST 926 action
Authors: Van Dokkum W. , Frølich W. , Saltmarsh M. , Gee J.
Published: May 2008

Summary  COST (European Cooperation in the field of Scientific and Technical Research) Action 926 is a networking partnership funded by the European Union through the European Science Foundation. Scientists involved have evaluated whether or not the new ‘omic’ technologies can offer a means of obtaining the scientific evidence to underpin the established consensus that increased consumption of fruit, vegetables and wholegrain products is beneficial to human health. The effects of processing on the bioavailability of bioactive components in food have also been reviewed in this paper and recommendations made to ensure that maximum benefit is obtained from the diet.
The effect of chewing gum on learning as measured by test performance
Authors: Allen K. L. , Norman R. G. , Katz R. V.
Published: May 2008

Summary  This research project investigated the relationship between chewing gum and short‐term learning, as prior studies had reported conflicting results. Incoming first‐year dental students were assigned by stratified randomisation to either a group who chewed gum during lectures and examinations or a group that did not chew gum. The research subjects listened to a taped lecture on dental anatomy and then completed two examinations: (1) a test of specific knowledge which was a multiple‐choice test on the dental anatomy lecture material; and (2) a test of generalised knowledge which was a standardised reading comprehension exam. Statistical analysis of the results showed that in a group of graduate students with a history of high academic performance, there was no difference in learning between research subjects who chewed gum compared with those who did not chew gum, as measured by performance on either test.
Trade Unions and Democracy in South Africa: Union Organizational Challenges and Solidarities in a Time of Transformation
Authors: Buhlungu Sakhela , Brookes Mick , Wood Geoffrey
Published: May 2008

Based on a nationwide survey, this article focuses on the perceptions of Congress of South African Trade Unions (COSATU) members on two of the central issues that have dominated debates on the South African labour movement: the advisability of COSATU's Alliance with the African National Congress (ANC) and the extent of internal union democracy. The survey revealed that the ANC‐Alliance continues to enjoy mass support, while internal democracy remains robust. At the same time, the federation faces the challenges of coping with — and contesting — neoliberal reforms, retaining and re‐energizing rank and file in the post‐apartheid era, and in reaching out to potential members in the informal sector and other areas of insecure work.
Internationalization and the Spaces of Temporary Labour: The Global Assembly of a Local Workforce
Authors: McDowell Linda , Batnitzky Adina , Dyer Sarah
Published: May 2008

An increasing number of low‐status consumer service jobs in the UK are undertaken by economic migrants, who are often recruited through the aegis of employment agencies. This article explores the use of migrant agency workers by a London hotel and a hospital, looking at the ways in which such a labour force is recruited and assembled in parts of the service sector in Greater London. It argues that even in the most locally‐based of service‐sector jobs, typically involving face to face interactions, new sets of transnational connections are producing a globalized labour force.
ON THE ERGODICITY OF BILINEAR TIME SERIES MODELS
Authors: Akamanam S. I. , Rao M. Bhaskara , Subramanyam K.
Published: May 2008

Abstract. Existence, strict stationarity and ergodicity of Bilinear Time Series Models for a given input White Noise and parameter values are studied in detail in this paper. The use of ergodicity in the estimation of parameters is also hinted at in this article.
Précis of The Architecture of the Mind: Massive Modularity and the Flexibility of Thought
Authors: CARRUTHERS PETER
Published: May 2008

Abstract:  This article outlines the main themes and motivations of Carruthers, 2006. Its purpose is to provide some background for the critical commentaries of Cowie, Machery, and Wilson (this volume).
The Drink You Have When You’re Not Having a Drink
Authors: WILSON ROBERT A.
Published: May 2008

Abstract: The Architecture of the Mindis itself built on foundations that deserve probing. In this brief commentary I focus on these foundations—Carruthers’ conception of modularity, his arguments for thinking that the mind is massively modular in structure, and his view of human cognitive architecture.
Real Narrow Content
Authors: KRIEGEL URIAH
Published: May 2008

Abstract: The purpose of the present paper is to develop and defend an account of narrow content that would neutralize the commonplace charge that narrow content ‘is not real content’. On the account I offer, a concept’s narrow content consists in its bearing the right relation to the right sort of response‐dependent property.
Exploring the Social Face of Urban Mobility: Daily Mobility as Part of the Social Structure in Spain
Authors: CAMARERO LUIS A. , OLIVA JESÚS
Published: May 2008

This article considers the social aspects of daily mobility, which is studied as a social product, based on significant family strategies and social practices. Our analysis shows the importance of variables such as the lifecycle of households, class trends and family networks as well as class, gender and generational sub‐cultures. The different forms of daily mobility are seen to be linked to other social strategies (residential, labour, sociability, etc.) that create a varying range of social situations. Urban and mobility policies, urban dispersion, greater automobile use and new trends in the socio‐technical organization of cities exert a great influence on these unequal social positions, promoting new forms of exclusion and social risks. Based on the study of a medium‐sized city in Southern Europe (Pamplona‐Iruñea, the regional capital of Navarra), which is developing fast from a concentrated pattern to one of residential dispersion based on greater automobile use, an analysis is carried out into how family mobility strategies tie in with different sociological profiles. The study aims to provide interesting theoretical and methodological reflections on mobility that will be of use to professionals, institutions and civil movements working in the field of mobility regulation.

Resumé

Cet article s’intéresse aux aspects sociaux de la mobilité quotidienne, laquelle est étudiée en tant que produit social, en fonction de stratégies familiales et de pratiques sociales significatives. L’analyse montre l’importance de variables telles que le cycle de vie des ménages, les tendances de classe et les réseaux familiaux, ou encore les sous‐cultures de classe, de genre et générationnelles. Les différentes formes de mobilité quotidienne apparaissent liées à d’autres stratégies sociales (résidence, travail, sociabilité, etc.), celles‐ci créant toute une variété de situations sociales. Les politiques de la ville et de la mobilité, la dispersion urbaine, l’usage accru de l’automobile, ainsi que de nouvelles tendances dans l’organisation sociotechnique des villes, influent considérablement sur ces situations sociales inégales, tout en favorisant de nouvelles formes d’exclusion et de risques sociaux. A partir de l’étude d’une ville moyenne du sud de l’Europe (Iruñea‐Pamplune, capitale régionale de la Navarre) qui évolue rapidement d’un schéma concentré vers une dispersion résidentielle grâce à un usage accru de l’automobile, une analyse examine comment les stratégies de mobilité des familles rejoignent différents profils sociologiques. Ce travail vise à produire des réflexions théoriques et méthodologiques sur la mobilité qui soient intéressantes et pertinentes pour les experts, les institutions et les mouvements civils impliqués dans la régulation de la mobilité.
Making Class Politics Possible: Organizing Contract Cleaners in London
Authors: WILLS JANE
Published: May 2008

This article tells the story of community and union‐led efforts to re‐regulate the contract cleaning sector and to organize cleaners at Canary Wharf and in the City of London. It provides a historical overview of the campaign and highlights its innovative responses to subcontracted employment in the city today. The article starts by outlining anti‐essentialist approaches to the politics of class before using the campaign to flesh out what such politics might look like. In this case, the successful prosecution of class politics has depended upon the politics of class moving far beyond any particular workplace. Workplace issues have been recast as matters for the wider community engaging a diverse set of actors including workers, community organizations, contractors, clients, the media and London's politicians.

Cet article relate une initiative communautaire et syndicale visant à re‐réguler le secteur des services de nettoyage et à en organiser le personnel dans les deux quartiers londoniens de Canary Wharf et de la City. Après un historique de la campagne, l’article souligne toute la nouveauté des réponses apportées à l’emploi sous‐traité dans la ville actuellement. Il expose d’abord les approches anti‐essentialistes de la politique de classe avant d’utiliser la campagne pour préciser ce à quoi cette politique pourrait ressembler. En l’occurrence, l’exercice réussi d’une politique de classe a tenu au fait que cette politique a transcendé tout lieu de travail spécifique. Les aspects propres au lieu de travail ont été refondus en thèmes concernant l’ensemble de la communauté et impliquant un ensemble diversifié d’acteurs, notamment les employés, les organisations représentatives de la communauté, les fournisseurs de services, les clients, les média et des hommes politiques londoniens.
Philippa Russell
Authors: Holman Andrew
Published: May 2008

Philippa Russell has a son with a learning disability.

She has been involved in lots of work and campaigns to make things better for people with learning disabilities.

Philippa believes people with learning disabilities and carers should work together.

She is now head of a new commission for carers that should change things for the better.
Reference values for clinical chemistry tests during normal pregnancy
Authors: Larsson A , Palm M , Hansson L‐O , Axelsson O
Published: May 2008

Objective  Reference values are usually defined based on blood samples from healthy men or nonpregnant women. This is not optimal as many biological markers changes during pregnancy and adequate reference values are of importance for correct clinical decisions. There are only few studies on the variations of laboratory tests during normal pregnancies, especially during the first two trimesters. It is thus a need to establish such reference values.

Design  Longitudinal study of laboratory markers in normal pregnancies.

Setting  Uppsala University Hospital, Sweden.

Population  Healthy pregnant females.

Methods  We have studied 25 frequently used laboratory tests during 52 normal pregnancies. Each woman was sampled up to nine times and the samples were divided according to collection time into the following groups: gestational week 7–17; week 17–24; week 24– 28; week 28–31; week 31–34; week 34–38; predelivery (0–2 weeks before delivery) and postpartum (>6 weeks after delivery). The 2.5 and 97.5 percentiles for these markers were calculated according to the recommendations of the International Federation of Clinical Chemistry on the statistical treatment of reference values.

Results  Reference intervals are reported for plasma alanine aminotransferase, albumin, alkaline phosphatase, pancreas amylase, apolipoprotein A1, apolipoprotein B, aspartate aminotransferase, bilirubin, calcium, chloride, creatinine, cystatin C, ferritin, γ‐glutamyltransferase, iron, lactate dehydrogenase, magnesium, phosphate, potassium, sodium, transferrin, triglycerides, thyroid‐stimulating hormone, urate and urea during these pregnancy periods.

Conclusions  Most of the analytes change during normal pregnancy. It is thus of importance to use special reference values during pregnancy.
The prognostic value of ultrasound abnormalities and biological parameters in blood of fetuses infected with cytomegalovirus
Authors: Benoist G , Salomon LJ , Jacquemard F , Daffos F , Ville Y
Published: May 2008

Objective  To evaluate the prognostic value of ultrasound abnormalities and of selected biological parameters in blood of fetuses infected with cytomegalovirus (CMV).

Design  Retrospective observational study.

Setting  Two fetal medicine units in Paris, France.

Population  All fetuses infected with CMV referred between 1998 and 2006.

Methods  We retrospectively analysed data collected prospectively in 73 fetuses infected by CMV with a positive CMV polymerase chain reaction in amniotic fluid. Fetal blood sampling (FBS) was performed for evaluation of platelet count, plasma levels of aminotransferases and gamma‐glutamyl transpeptidases (GGT), presence of viraemia and specific fetal immunoglobulin M. Targeted ultrasound examination was performed every fortnight. Ultrasound findings were categorised into normal examination and any ultrasound abnormality, which was further grouped as ultrasound abnormality of the fetal brain and noncerebral ultrasound abnormality.

Main outcome measures  A combination of histological findings after termination of pregnancy and evidence of cytomegalic inclusion disease at birth when pregnancies were continued. Clinical symptoms at birth or histological lesions attributable to CMV were considered as poor outcome. Statistical analysis was conducted to determine the value of each parameter to predict outcome. Logistic regression was used to build up a multivariate model combining the relevant parameters.

Results  In univariate analysis, only thrombocytopenia and the presence of any ultrasound abnormality were associated with a poor outcome (P < 10−4 for both abnormalities). In the multivariate analysis, both thrombocytopenia and the presence of ultrasound abnormalities remained significant independent predictors of a poor outcome. Based on univariate logistic regression, odds ratio for a poor outcome were 1.24, 7.2, 22.5 and 25.5 for each 10 000/mm3 decrease in platelet count, the presence of noncerebral, any ultrasound and cerebral ultrasound abnormalities, respectively.

Conclusions  The prognosis of CMV‐infected fetuses relies independently on both targeted ultrasound examination and fetal platelet count. FBS for platelet count may therefore justify FBS in infected fetuses even in the absence of ultrasound. features of brain involvement.
The relationship between sonographic fetal thymus size and the components of the systemic fetal inflammatory response syndrome in women with preterm prelabour rupture of membranes
Authors: El‐Haieg DO , Zidan AA , El‐Nemr MM
Published: May 2008

Objective  To assess the relation between sonographic fetal thymus size and the components of fetal inflammatory response syndrome (FIRS) in women with preterm prelabour rupture of membranes (PPROM).

Design  Prospective cohort study.

Setting  University hospital from January through October 2006.

Population  Fifty‐six women with PPROM.

Methods  In these women, fetal thymus perimeter was measured sonographically. At birth, cord venous plasma interleukin‐6 (IL‐6) level estimation and histopathological examination of the placentas and umbilical cords were performed.

Main outcome measures  Small thymus size (<5th percentile for gestational age) and its association with FIRS.

Results  From the 56 women with PPROM, 54% had chorioamnionitis (CA), 23% had funisitis. IL‐6 level was >11 pg/ml in 52% of women and >18 pg/ml in 41%. A small thymus was more associated with male fetuses, shorter preterm prelabour rupture of membranes delivery interval, higher IL‐6 level, higher frequency of funisitis and CA. When data were regressed for confounding, only IL‐6 level and funisitis remained significant independent factors that influence the thymus size. In the subset of women (n = 19) who delivered within 1 week of first measurements, a small thymus had sensitivity and positive predictive value of 93%, specificity and negative predictive value of 75% and accuracy of 89% in the identification of FIRS (IL‐6 >18 pg/ml and/or funisitis).

Conclusions  An association exists between fetal thymic involution and components of FIRS in women with PPROM. Small fetal thymus size may be considered a reliable sonographic marker of fetal involvement in the inflammatory response.
The accurate staging of ovarian cancer using 3T magnetic resonance imaging – a realistic option
Authors: Booth SJ , Turnbull LW , Poole DR , Richmond I
Published: May 2008

Objectives The aim of the study was to determine whether staging primary ovarian cancer using 3.0 Tesla (3T) magnetic resonance imaging (MRI) is comparable to surgical staging of the disease.

Design A retrospective study consisting of a search of the pathology database to identify women with ovarian pathology from May 2004 to January 2007.

Setting All women treated for suspected ovarian cancer in our cancer centre region.

Sample All women suspected of ovarian pathology who underwent 3T MRI prior to primary surgical intervention between May 2004 and January 2007.

Methods All women found to have ovarian pathology, both benign and malignant, were then cross checked with the magnetic resonance (MR) database to identify those who had undergone 3T MRI prior to surgery. The resulting group of women underwent comparison of the MR, surgical and histopathological findings for each individual including diagnosis of benign or malignant disease and International Federation of Gynecology and Obstetrics (FIGO) staging where appropriate.

Main outcome measures Comparisons were made between the staging accuracy of 3T MRI and surgical staging compared with histopathological findings and FIGO stage using weighted kappa. Sensitivity, specificity and accuracy were calculated for diagnosing malignant ovarian disease with 3T MRI.

Results A total of 191 women identified as having ovarian pathology underwent imaging with 3T MR and primary surgical intervention. In 19 of these women, the ovarian disease was an incidental finding. The group for which staging methods were compared consisted of 77 women of primary ovarian malignancy (20 of whom had borderline tumours). 3T MRI was able to detect ovarian malignancy with a sensitivity of 92% and a specificity of 76%. The overall accuracy in detecting malignancy with 3T MRI was 84%, with a positive predictive value of 80% and negative predictive value of 90%. Statistical analysis of the two methods of staging using weighted kappa, gave aKvalue of 0.926 (SE ±0.121) for surgical staging and 0.866 (SE ±0.119) for MR staging. A further analysis of the staging data for ovarian cancers alone, excluding borderline tumours resulted in aKvalue of 0.931 (SE ±0.136) for histopathological staging versus MR staging and 0.958 (±0.140) for histopathological stage versus surgical staging.

Conclusion Our study has shown that MRI can achieve staging of ovarian cancer comparable with the accuracy seen with surgical staging. No previous studies comparing different modalities have used the higher field strength 3T MRI. In addition, all other studies comparing radiological assessment of ovarian cancer have grouped the stages into I, II, III and IV rather than the more clinically appropriate a, b and c subgroups.
Accuracy and correlates of maternal recall of birthweight and gestational age
Authors: Adegboye ARA , Heitmann BL
Published: May 2008

Objective  To determine the accuracy of maternal recall of children birthweight (BW) and gestational age (GA), using the Danish Medical Birth Register (DBR) as reference and to examine the reliability of recalled BW and its potential correlates.

Design  Comparison of data from the DBR and the European Youth Heart Study (EYHS).

Setting  Schools in Odense, Denmark.

Population  A total of 1271 and 678 mothers of school children participated with information in the accuracy studies of BW and GA, respectively. The reliability sample of BW was composed of 359 women.

Method  The agreement between the two sources was evaluated by mean differences (MD), intraclass correlation coefficient (ICC) and Bland–Altman’s plots. The misclassification of the various BW and GA categories were also estimated.

Main outcome measures  Differences between recalled and registered BW and GA.

Results  There was high agreement between recalled and registered BW (MD =−0.2 g; ICC = 0.94) and GA (MD = 0.3 weeks; ICC = 0.76). Only 1.6% of BW would have been misclassified into low, normal or high BW and 16.5% of GA would have been misclassified into preterm, term or post‐term based on maternal recall. The logistic regression revealed that the most important variables in the discordance between recalled and registered BW were ethnicity and parity. Maternal recall of BW was highly reliable (MD =−5.5 g; ICC = 0.93), and reliability remained high across subgroups.

Conclusion  Maternal recall of BW and GA seems to be sufficiently accurate for clinical and epidemiological use.
Reviews of Exhibitions
Authors: Dieckvoss Stephanie M. , Childs John
Published: May 2008

Book reviewed in this article:

Renaissance Art in Berlin: A Celebration of Wilhelm von Bode?

The Royal Armouries Museum at Leeds, opened 30 March 1996
Zolpidem Generalization and Antagonism in Male and Female Cynomolgus Monkeys Trained to Discriminate 1.0 or 2.0 g / kg Ethanol
Authors: Helms Christa M. , Rogers Laura S.M. , Waters Courtney A. , Grant Kathleen A.
Published: May 2008

Background: The subtypes ofγ‐aminobutyric acid (GABA)Areceptors mediating the discriminative stimulus effects of ethanol in nonhuman primates are not completely identified. The GABAAreceptor positive modulator zolpidem has high, intermediate, and low activity at receptors containingα1,α2/3, andα5subunits, respectively, and partially generalizes from ethanol in several species. The partial inverse agonist Ro15‐4513 has the greatest affinity forα4/6‐containing receptors, higher affinity forα5‐ and lower, but equal, affinity forα1‐ andα2/3‐, containing GABAAreceptors, and antagonizes the discriminative stimulus effects of ethanol.

Methods: This study assessed Ro15‐4513 antagonism of the generalization of zolpidem from ethanol in male (n = 9) and female (n = 8) cynomolgus monkeys (Macaca fascicularis) trained to discriminate 1.0 g/kg (n = 10) or 2.0 g/kg (n = 7) ethanol (i.g.) from water with a 30‐minute pretreatment interval.

Results: Zolpidem (0.017 to 5.6 mg/kg, i.m.) completely generalized from ethanol (≥80% of total session responses on the ethanol‐appropriate lever) for 6/7 monkeys trained to discriminate 2.0 g/kg and 4/10 monkeys trained to discriminate 1.0 g/kg ethanol. Zolpidem partially generalized from 1.0 or 2.0 g/kg ethanol in 6/7 remaining monkeys. Ro15‐4513 (0.003 to 0.30 mg/kg, i.m., 5‐minute pretreatment) shifted the zolpidem dose–response curve to the right in all monkeys showing generalization. Analysis of apparent pKBfrom antagonism tests suggested that the discriminative stimulus effects of ethanol common with zolpidem are mediated by low‐affinity Ro15‐4513 binding sites. Main effects of sex and training dose indicated greater potency of Ro15‐4513 in males and in monkeys trained to discriminate 1.0 g/kg ethanol.

Conclusions: Ethanol and zolpidem share similar discriminative stimulus effects most likely through GABAAreceptors that containα1subunits, however, antagonism by Ro15‐4513 of zolpidem generalization from the lower training dose of ethanol (1.0 g/kg) may involve additional zolpidem‐sensitive GABAAreceptor subtypes (e.g.,α2/3andα5).
Rapid Tolerance and Locomotor Sensitization in Ethanol‐Naïve Adolescent Rhesus Macaques
Authors: Schwandt Melanie L. , Higley James D. , Suomi Stephen J. , Heilig Markus , Barr Christina S.
Published: May 2008

Background:  Acute and chronic tolerance, as well as locomotor sensitization, have been linked to ethanol intake. This study examined the change in response between 2 acutely administered doses of ethanol in adolescent rhesus macaques, with the objective of investigating rapid tolerance and locomotor sensitization to the behavioral effects of ethanol, and whether these phenomena are related to voluntary ethanol consumption in nonhuman primates.

Methods:  Rhesus macaques (n = 109, 42 males, 67 females) were administered 2 sequential intravenous doses of ethanol (2.2 g/kg for males, 2.0 g/kg for females) separated by a period of 5 to 30 days. Following each injection, subjects underwent a 30‐minute behavior assessment. Behavioral data were summarized using factor analysis, and compared between the 2 doses using repeated measures ANOVA. The relationship between behavioral response measures and the number of days between doses was analyzed using regression analyses. Following the second ethanol dose, subjects were given free access to an aspartame‐sweetened 8.4% ethanol solution for 1 hour a day for 4 weeks. Percent change in behavioral response measures from dose 1 to dose 2 was analyzed for associations with ethanol consumption using multiple regression analyses.

Results:  Factor analysis yielded 3 factors: ataxia, stimulation, and jumping. From dose 1 to dose 2 there was a significant decrease in ataxia and a significant increase in stimulation. Peak blood ethanol concentration did not differ between doses. There were no significant associations between the number of days between doses and the magnitude of change in response for any of the behavioral measures. Percent change in stimulation from dose 1 to dose 2 was positively associated with subsequent oral ethanol consumption only in females tested in a social setting.

Conclusions:  Adolescent rhesus macaques develop rapid tolerance to the motor‐impairing effects of alcohol, while at the same time developing locomotor sensitization. These changes in response are not necessarily short lived, and may persist for some time following the first ethanol dose. Clear and consistent associations between rapid tolerance and locomotor sensitization and ethanol intake levels have yet to be demonstrated, however.
Episodic and Working Memory Deficits in Alcoholic Korsakoff Patients: The Continuity Theory Revisited
Authors: Pitel Anne Lise , Beaunieux Hélène , Witkowski Thomas , Vabret François , De La Sayette Vincent , Viader Fausto , Desgranges Béatrice , Eustache Francis
Published: May 2008

Background:  The exact nature of episodic and working memory impairments in alcoholic Korsakoff patients (KS) remains unclear, as does the specificity of these neuropsychological deficits compared with those of non‐Korsakoff alcoholics (AL). The goals of the present study were therefore to (1) specify the nature of episodic and working memory impairments in KS, (2) determine the specificity of the KS neuropsychological profile compared with the AL profile, and (3) observe the distribution of individual performances within the 2 patient groups.

Methods:  We investigated episodic memory (encoding and retrieval abilities, contextual memory and state of consciousness associated with memories), the slave systems of working memory (phonological loop, visuospatial sketchpad and episodic buffer) and executive functions (inhibition, flexibility, updating and integration abilities) in 14 strictly selected KS, 40 AL and 55 control subjects (CS).

Results:  Compared with CS, KS displayed impairments of episodic memory encoding and retrieval, contextual memory, recollection, the slave systems of working memory and executive functions. Although episodic memory was more severely impaired in KS than in AL, the single specificity of the KS profile was a disproportionately large encoding deficit. Apart from organizational and updating abilities, the slave systems of working memory and inhibition, flexibility and integration abilities were impaired to the same extent in both alcoholic groups. However, some KS were unable to complete the most difficult executive tasks. There was only a partial overlap of individual performances by KS and AL for episodic memory and a total mixture of the 2 groups for working memory.

Conclusions:  Korsakoff’s syndrome encompasses impairments of the different episodic and working memory components. AL and KS displayed similar profiles of episodic and working memory deficits, in accordance with neuroimaging investigations showing similar patterns of brain damage in both alcoholic groups.
Dependence‐Induced Alcohol Drinking by Alcohol‐Preferring (P) Rats and Outbred Wistar Rats
Authors: Gilpin N. W. , Richardson H. N. , Lumeng L. , Koob G. F.
Published: May 2008

Background:  Chronic intermittent alcohol vapor exposure and selective breeding procedures have been used separately for many years to model specific aspects of alcohol dependence. The purpose of the present investigation was to combine these 2 approaches by exposing alcohol‐preferring (P) rats to chronic intermittent alcohol vapor for extended periods of time and then testing them for operant alcohol responding in parallel with a group of outbred Wistar rats at multiple time points following the termination of vapor exposure.

Methods:  P rats (n = 20) and Wistar rats (n = 18) were trained to respond for 10% (w/v) ethanol in an operant situation, then divided into groups matched for intake levels. Animals were then exposed to chronic intermittent alcohol vapor (14 hours ON/10 hours OFF) or air for 8 weeks. Rats were then tested for operant alcohol responding under various conditions and at multiple time points during alcohol withdrawal (6 hours) and protracted abstinence (1 to 15 days).

Results:  Chronic alcohol vapor exposure produced similar increases in operant alcohol responding in P rats and Wistar rats during acute withdrawal and protracted abstinence.

Conclusions:  These results illustrate the separate and combined effects of genetic selection for high alcohol preference and dependence on alcohol drinking behavior. Furthermore, these results confirm past findings that dependent rats consume more alcohol than nondependent controls well into abstinence following extended periods of alcohol vapor exposure.
Using Topiramate or Naltrexone for the Treatment of Alcohol‐Dependent Patients
Authors: Flórez Gerardo , García‐Portilla Paz , Álvarez Sandra , Saiz Pilar A. , Nogueiras Luis , Bobes Julio
Published: May 2008

Background:  To compare topiramate versus naltrexone in the treatment of alcohol dependence.

Methods:  A 6‐month naturalistic, randomized and open‐label, trial of topiramate versus naltrexone, with assessments at enrollment and after 3 and 6 months of treatment. The setting was an outpatient alcohol clinic. One hundred and two alcohol‐dependent patients who had been drinking heavily during the past month were included. Two randomized groups were created. In one, naltrexone was used as the therapeutic agent and, in the other, topiramate was chosen as the therapeutic agent. Both groups received psychological relapse prevention therapy. Outcome was measured using tools that assessed alcohol intake, cravings, disability, and quality of life; changes in biomarkers of alcohol intake were also used. With all the data, a secondary composite measure was created in order to assess each patient’s global alcohol intake and its consequences.

Results:  Both groups showed substantial reduction in their drinking. Naltrexone patients had higher nicotine consumption throughout the study. Topiramate was better at reducing alcohol‐related cravings throughout the study. Both treatments had a similar mean cost throughout the study.

Conclusions:  Both topiramate and naltrexone were efficacious in the treatment of alcohol dependence, and the treatment costs were similar. There is a trend for topiramate to be superior to naltrexone on critical measures of drinking; however, the study did not have adequate statistical power to establish this fact.
Naltrexone Alone and With Sertraline for the Treatment of Alcohol Dependence in Alaska Natives and Non‐Natives Residing in Rural Settings: A Randomized Controlled Trial
Authors: O’Malley Stephanie S. , Robin Robert W. , Levenson Aryeh L. , GreyWolf Iva , Chance Lawrence E. , Hodgkinson Colin A. , Romano Denise , Robinson Jane , Meandzija Boris , Stillner Verner , Wu Ran , Goldman David
Published: May 2008

Background:  Access to specialty alcoholism treatment in rural environments is limited and new treatment approaches are needed. The objective was to evaluate the efficacy of naltrexone alone and in combination with sertraline among Alaska Natives and other Alaskans living in rural settings. An exploratory aim examined whether the Asn40Asp polymorphism of the μ‐opioid receptor gene (OPRM1) predicted response to naltrexone, as had been reported in Caucasians.

Methods:  Randomized, controlled trial enrolling 101 Alaskans with alcohol dependence, including 68 American Indians/Alaska Natives. Participants received 16 weeks of either (1) placebo (placebo naltrexone + placebo sertraline), (2) naltrexone monotherapy (50 mg naltrexone + sertraline placebo) and (3) naltrexone + sertraline (100 mg) plus nine sessions of medical management and supportive advice. Primary outcomes included Time to First Heavy Drinking Day and Total Abstinence.

Results:  Naltrexone monotherapy demonstrated significantly higher total abstinence (35%) compared with placebo (12%, p = 0027) and longer, but not statistically different, Time to First Heavy Drinking Day (p = 0.093). On secondary measures, naltrexone compared with placebo demonstrated significant improvements in percent days abstinent (p = 0.024) and drinking‐related consequences (p = 0.02). Combined sertraline and naltrexone did not differ from naltrexone alone. The pattern of findings was generally similar for the American Indian/Alaska Native subsample. Naltrexone treatment response was significant within the group of 75 individuals who were homozygous for OPRM1 Asn40 allele. There was a small number of Asp40 carriers, precluding statistical testing of the effect of this allele on response.

Conclusions:  Naltrexone can be used effectively to treat alcoholism in remote and rural communities, with evidence of benefit for American Indians and Alaska Natives. New models of care incorporating pharmacotherapy could reduce important health disparities related to alcoholism.
Hyperglycemia as a Predictor of In‐Hospital Mortality in Elderly Patients without Diabetes Mellitus Admitted to a Sub‐Intensive Care Unit
Authors: Sleiman Intissar , Morandi Alessandro , Sabatini Tony , Ranhoff Anette , Ricci Antonella , Rozzini Renzo , Trabucchi Marco
Published: May 2008

OBJECTIVES: To investigate the association between hyperglycemia and in‐hospital and 45‐day mortality in acutely ill elderly patients.

DESIGN: Retrospective cohort.

SETTING: Hospital medical patients admitted to a sub‐intensive care unit (sub‐ICU) for elderly patients, which is a level of care between ordinary wards and intensive care.

PARTICIPANTS: One thousand two hundred twenty‐nine patients (mean age 79.6±8.4) admitted to the sub‐ICU from January 2003 to January 2006. Forty patients with acute myocardial infarction and 34 patients with extreme fasting glucose values (<60 or >500 mg/dL) were excluded. Eight hundred twenty‐two patients without a history of diabetes mellitus (DM) and 333 patients with a diagnosis of DM were selected and subdivided into three categories according to serum fasting blood glucose: 60 to 126 mg/dL (Group A), 127 to 180 mg/dL (Group B), and 181 to 500 mg/dL (Group C).

MEASUREMENTS: Age, sex, mental and functional status, Acute Physiology Score, comorbid conditions, serum albumin, serum cholesterol, fasting serum glucose, and length of stay. In‐hospital mortality was the primary outcome, and 45‐day mortality was the secondary outcome.

RESULTS: Total in‐hospital mortality was 14.5%. In patients with and without DM, mortality was 8.8% and 11.3%, respectively, in Group A; 13.6% and 17.3% in Group B, and 12.6% and 34.3% in Group C. After controlling for confounders, newly recognized hyperglycemia (>181 mg/dL) was independently associated with in‐hospital mortality (adjusted odds ratio=2.7, 95% confidence interval=1.6–4.8). Forty‐five‐day mortality in newly recognized hyperglycemic patients was 17.5%, 25.7%, and 42% in Groups A, B, and C, respectively, whereas it was 21.2% in patients with DM.

CONCLUSION: In elderly patients, newly recognized hyperglycemia was associated with a higher mortality rate than in those with a prior history of DM. These data suggest that further randomized clinical trials are needed to assess the efficacy and the risk of a target glucose of greater than 180 mg/dL.
The Effect of the Geriatrics Education for Emergency Medical Services Training Program in a Rural Community
Authors: Shah Manish N. , Rajasekaran Karthik , Sheahan William D. , Wimbush Tracy , Karuza Jurgis
Published: May 2008

The Geriatrics Education for Emergency Medical Service (EMS) (GEMS) course provides continuing education for EMS providers. This study evaluated the effect of the course on EMS providers in a rural county by performing a prospective cohort study using a pre‐postsurvey design. The Geriatric Attitude Scale, the GEMS knowledge posttest, a class satisfaction survey, and a survey evaluating EMS providers' comfort in caring for older adults were used to measure the classes' effect. Eighty‐eight EMS providers participated. All passed the course and were very satisfied with it. Follow‐up was completed with 77 (80%). No significant change in attitude score was identified (P=.09). Median comfort scores significantly increased for the domains of communications, medical care, abuse evaluation, and falls evaluation. Providing the GEMS course to EMS providers in a rural community resulted in students passing a posttest evaluating their knowledge regarding caring for older adults and resulted in an increase in their comfort level for the care of older adults. The effect of the training on patient outcomes needs to be identified.
Prevention of Falls in Nursing Homes: Subgroup Analyses of a Randomized Fall Prevention Trial
Authors: Rapp Kilian , Lamb Sarah E. , Büchele Gisela , Lall Ranjit , Lindemann Ulrich , Becker Clemens
Published: May 2008

OBJECTIVES: To evaluate the effectiveness of a multifactorial fall prevention program in prespecified subgroups of nursing home residents.

DESIGN: Secondary analysis of a cluster‐randomized, controlled trial.

SETTING: Six nursing homes in Germany.

PARTICIPANTS: Seven hundred twenty‐five long‐stay residents; median age 86; 80% female.

INTERVENTION: Staff and resident education on fall prevention, advice on environmental adaptations, recommendation to wear hip protectors, and progressive balance and resistance training.

MEASUREMENTS: Time to first fall and the number of falls. Falls were assessed during the 12‐month intervention period. Univariate regression analyses were performed, including a confirmatory test of interaction.

RESULTS: The intervention was more effective in people with cognitive impairment (hazard ratio (HR)=0.49, 95% confidence interval (CI)=0.35–0.69) than in those who were cognitively intact (HR=0.91, 95% CI=0.68–1.22), in people with a prior history of falls (HR=0.47, 95% CI=0.33–0.67) than in those with no prior fall history (HR=0.77, 95% CI=0.58–1.01), in people with urinary incontinence (HR=0.59, 95% CI=0.45–0.77) than in those with no urinary incontinence (HR=0.98, 95% CI=0.68–1.42), and in people with no mood problems (incidence rate ratio (IRR)=0.41, 95% CI=0.27–0.61) than in those with mood problems (IRR=0.74, 95% CI=0.51–1.09).

CONCLUSION: The effectiveness of a multifactorial fall prevention program differed between subgroups of nursing home residents. Cognitive impairment, a history of falls, urinary incontinence, and depressed mood were important in determining response.
Successful Aging: The Contribution of Early‐Life and Midlife Risk Factors
Authors: Britton Annie , Shipley Martin , Singh‐Manoux Archana , Marmot Michael G.
Published: May 2008

OBJECTIVES: To test whether early‐life factors (education, height, father's social position) and midlife social, behavioral, and psychosocial factors were associated with entering older age without disease and with good functioning.

DESIGN: A longitudinal, British civil service–based cohort study. Participants were followed for 17 years to assess successful aging. This was defined as being free of major disease and in the top tertile of physical and cognitive functioning measured in 2002 to 2004.

SETTING: Twenty London‐based Civil Service departments.

PARTICIPANTS: Four thousand, one hundred forty men and 1,823 women, free of major disease at baseline in 1985 to 1988 (mean age 44, range 35–55).

MEASUREMENTS: Behavioral, biological, and psychosocial risk factors; physical and cognitive functioning; and disease outcomes.

RESULTS: Five hundred forty eight (12.8%) men and 246 (14.6%) women were successfully aging at follow‐up. Midlife socioeconomic position strongly predicted this (age‐adjusted odds ratio, highest vs lowest=7.1, 95% CI=3.4–14.6, for men and 7.7, 95% CI=4.9–12.1, for women). Height, education (in men), not smoking, diet, exercise, moderate alcohol (in women), and work support (in men) were related to a favorable older life after adjustment for age and socioeconomic position.

CONCLUSION: Interventions to promote healthy adult behavior may attenuate harmful effects of less‐modifiable risk factors and reduce social inequalities.
Integrating Palliative Medicine into the Care of Persons with Advanced Dementia: Identifying Appropriate Medication Use
Authors: Holmes Holly M. , Sachs Greg A. , Shega Joseph W. , Hougham Gavin W. , Cox Hayley Deon , Dale William
Published: May 2008

OBJECTIVES: To evaluate the feasibility of developing consensus recommendations for appropriate prescribing for patients with advanced dementia using a new conceptual framework and to determine the frequency of inappropriate medication use based on these recommendations in a small sample of patients with advanced dementia.

DESIGN: Medication data were obtained using chart review. Recommendations for appropriate prescribing were achieved using a modified Delphi consensus panel.

SETTING: Three long‐term care facilities.

PARTICIPANTS: Thirty‐four patients with advanced dementia enrolled in the Palliative Excellence in Alzheimer Care Efforts Program were selected to evaluate medication use. Twelve geriatricians at the University of Chicago participated in the modified Delphi consensus panel.

MEASUREMENTS: Prescription and over‐the‐counter medications were recorded for the 34 patients. Following the modified Delphi process, medications were characterized into one of four categories for use in palliative care patients with advanced dementia: never appropriate, rarely appropriate, sometimes appropriate, or always appropriate.

RESULTS: Patients were taking an average of 6.5 medications at enrollment. Six patients were taking 10 or more medications daily. Consensus was reached ranking the appropriateness of 69 of 81 medication classes for patients with advanced dementia. Overall, 5% of the 221 medications prescribed at enrollment were considered to be never appropriate, and 10 of 34 patients (29%) had been taking a medication considered to be never appropriate.

CONCLUSION: Based on these preliminary findings, consensus criteria for prescribing in advanced dementia are needed to decrease polypharmacy and reduce the use of medications that are of minimal benefit or high risk.
Learning While Having Fun: The Use of Video Gaming to Teach Geriatric House Calls to Medical Students
Authors: Duque Gustavo , Fung Shek , Mallet Louise , Posel Nancy , Fleiszer David
Published: May 2008

Although most health professionals perform home visits, there is not a structured method for performing them. In addition, in‐training health professionals' exposure to home visits is limited for logistical reasons. A new method for medical students to learn how to perform an effective home visit was developed using an instructional video game. It was expected that students would learn the principles of a home visit using a video game while identifying the usefulness of video gaming (edutainment) in geriatrics education. A video game was created simulating a patient's house that the students were able to explore. Students played against time and distracters while being expected to click on those elements that they considered to be risk factors for falls or harmful for the patient. At the end of the game, the students received feedback on the chosen elements that were right or wrong. Finally, evaluation of the tool was obtained using pre‐ and posttests and pre‐ and postexposure feedback surveys. Fifty‐six fourth‐year medical students used the video game and completed the tests and the feedback surveys. This method showed a high level of engagement that is associated with improvement in knowledge. Additionally, users' feedback indicated that it was an innovative approach to the teaching of health sciences. In summary, this method provides medical students with a fun and structured experience that has an effect not only on their learning, but also on their understanding of the particular needs of the elderly population.