bluuebunny/crossref_metadata_2025 huggingface dataset:
A comparison of the biological features between prostate cancers arising in the transition and peripheral zones
Authors: Sakai Iori , Harada Ken‐Ichi , Hara Isao , Eto Hiroshi , Miyake Hideaki
Published: August 2005

OBJECTIVES

To investigate differences in the biological features of prostate cancer according to the zonal origin.

PATIENTS AND METHODS

Among 172 consecutive patients who had a radical prostatectomy (RP), the study included 124 diagnosed as having either transition zone (TZ) or peripheral zone (PZ) cancer, defined according to whether there was > 70% of the cancer area in the TZ or PZ, respectively. The clinicopathological features were then compared between these groups. In addition, the RP specimens were stained immunohistochemically with antibodies to Ki‐67, Bcl‐2, matrix metalloproteinase‐2 (MMP‐2), MMP‐9 and vascular endothelial growth factor (VEGF).

RESULTS

Twenty‐four patients were diagnosed as having TZ cancer and the remaining 100 as having PZ cancer. Prostate specific antigen (PSA) values in patients with TZ cancer were significantly higher than in those with PZ cancer. Tumour volume in TZ cancer was significantly greater than that in PZ cancer, but there was no significant difference in biochemical recurrence‐free survival between the groups. Immunohistochemistry showed that despite there being no differences in Bcl‐2 and VEGF expression between TZ and PZ cancers, there was significantly greater expression of Ki‐67, MMP‐2 and MMP‐9 in PZ than TZ cancers.

CONCLUSIONS

Despite there being no significant difference in biochemical recurrence‐free survival after RP between patients with TZ and PZ cancers, there was less cell proliferation and biomarker levels related to invasive potential in TZ than in PZ cancers.
Local steroid application during nerve‐sparing radical retropubic prostatectomy
Authors: Deliveliotis Charalambos , Delis Athanasios , Papatsoris Athanasios , Antoniou Nikos , Varkarakis Ioannis M.
Published: August 2005

OBJECTIVE

To evaluate the effect on potency rates after surgery of applying local steroids to the neurovascular bundles (NVBs) of the prostate after bilateral nerve‐sparing radical retropubic prostatectomy (BNS‐RRP).

PATIENTS AND METHODS

Sixty potent men undergoing BNS‐RRP for clinically localized prostate cancer were prospectively randomized equally into two groups. In group 1, 10 mL of betamethasone cream 0.1% was applied locally to both NVBs, and group 2 had only the usual BNS‐RRP with no corticoid cream. Complications and potency were evaluated at 3, 6 and 12 months in all patients and compared between the groups.

RESULTS

At 12 months, 57% and 60% of patients were potent in group 1 and 2, respectively; the respective mean International Index of Erectile Function (5‐item) scores were 14.76 and 15.43 (P = 0.59). Potency rates at 3, 6 and 12 months were not significantly different between the groups, and the continence rates at 12 months were also similar, with 93% and 90% of patients in groups 1 and 2 being continent, respectively. Ten and five patients in groups 1 and 2, respectively, required a blood transfusion (P = 0.23). There were no fistulae, wound dehiscence or rectal perforations. One patient in group 2 presented 4 months after RRP with a bladder neck contracture.

CONCLUSIONS

Local application of betamethasone does not improve or expedite the recovery of erectile function after BNS‐RRP, but there were no complications associated with its use.
Assessing regional hypoxia in human renal tumours using 18F‐fluoromisonidazole positron emission tomography
Authors: Lawrentschuk Nathan , Poon Aurora M.T. , Foo Serene S. , Putra Lydia G. Johns , Murone Carmel , Davis Ian D. , Bolton Damien M. , Scott Andrew M.
Published: August 2005

OBJECTIVE

To assess renal tumours for hypoxic regions using 18F‐fluoromisonidazole (18F‐FMISO) positron emission tomography (PET), a recognized noninvasive method for detecting hypoxia in tumours, as renal cell carcinoma (RCC) can be potentially cured with nephrectomy but recurrence develops in most patients, who then respond poorly to treatments such as chemotherapy, and hypoxia is known to confer resistance to radiotherapy and chemotherapy in many solid tumours.

PATIENTS AND METHODS

In all, 17 patients had 18F‐FMISO PET scans before nephrectomy for presumed RCC. Specimens were examined histologically, and immunohistochemistry was used to compare the microvessel density (MVD) as an indicator of angiogenesis in the tumour and normal parenchyma, in 15 patients. Tumour oxygenation was measured invasively in three patients using a polarographic oxygen sensor probe.

RESULTS

Of the 15 patients with histological results, 11 had RCC and four had other tumours. Although there was a trend there was no statistically significant (P = 0.14) difference in the maximum standardized uptake value (SUVmax) when comparing the region of the kidney involved with RCC; the mean (95% confidence interval) SUVmax in the tumours was 1.3 (0.15), whilst that in the normal contralateral kidney was 1.1 (0.22). The MVD was greater in RCC, at 13.7 (3.1) mean vessels per high‐power field than in normal tissue, at 6.9 (1.9). Hypoxia as measured polarographically was detected in three RCCs (median pO2 9.6 mmHg) compared to normal parenchyma at 37.6 mmHg.

CONCLUSIONS

Although 18F‐FMISO scans showed significant uptake in other solid tumours, there was only mild 18F‐FMISO uptake in the present RCCs. The invasive measurements indicated that there was hypoxia in RCC, but the median pO2 did not fall below 9.5 mmHg. Further direct studies of renal tumour oxygenation combined with therapies directed towards hypoxia may allow a better understanding of the relationship between 18F‐FMISO results and the biological significance of hypoxia in RCC.
Detection of human telomerase RNA in the tumour‐surrounding mucosa of bladder carcinomas as a marker for premalignant transformation
Authors: Leuenroth Sven , Riethdorf Sabine , Erbersdobler Andreas , Riethdorf Lutz , Löning Thomas , Huland Hartwig , Friedrich Martin G.
Published: August 2005

OBJECTIVES

To investigate tumour tissue and non‐malignant tumour‐surrounding bladder mucosa (NTSBM) for expression of human telomerase RNA (hTR) as a possible marker for premalignant transformation of urothelial cells.

MATERIAL AND METHODS

From 67 patients with superficial transitional cell carcinoma (TCC), sections with representative tumour tissue and NTSBM were selected for evaluation. Sections with moderate or severe dysplasia were omitted from evaluation. hTR expression was detected with in situ hybridization using a 35S‐UTP‐labelled riboprobe, and analysed semiquantitatively by counting the hybridization signals.

RESULTS

In 45 of the 67 patients hTR expression was moderate or strong in tumour tissue, and in 20 hTR expression was moderate or strong in NTSBM. Moderate or strong hTR expression was detected in the NTSBM from 19 of 60 patients with pTa/pT1 tumours. Of the 56 patients who were treated conservatively, eight had tumour recurrence, of whom five had moderate or strong hTR expression in the TSBM, compared with only 14 of 48 patients without tumour recurrence.

CONCLUSION

Detecting hTR expression and the morphological distribution of hTR hybridization signals in NTSBM by in situ hybridization might indicate premalignant alterations involved in tumour recurrence.
Comparison of tamsulosin and naftopidil for efficacy and safety in the treatment of benign prostatic hyperplasia: a randomized controlled trial
Authors: Gotoh Momokazu , Kamihira Osamu , Kinukawa Tsuneo , Ono Yoshinari , Ohshima Shinichi , Origasa Hideki ,   the Tokai Urological Clinical Trial Group
Published: August 2005

OBJECTIVES

To compare the efficacy and safety of two α1a/α1d adrenoceptor (AR) antagonists with different affinity for the α1AR subtypes, tamsulosin and naftopidil, in the treatment of benign prostatic hyperplasia (BPH).

PATIENTS AND METHODS

Patients with BPH were randomized to receive either tamsulosin or naftopidil. The primary efficacy variables were the changes in the total International Prostate Symptom Score (IPSS), maximum flow rate on free uroflowmetry, and residual urine volume. The secondary efficacy variables were average flow rate, changes in the IPSS storage score, IPSS voiding score, and quality‐of‐life (QoL) Index score, from baseline to endpoint (12 weeks). Data on all randomized patients were included in the safety analyses for adverse effects and changes in blood pressure.

RESULTS

Of the 185 patients enrolled data for 144 who were eligible for inclusion in the efficacy analysis were analysed (75 from the tamsulosin and 69 from the naftopidil group). There was no significant difference in any variable at baseline between the groups. There were satistically significant improvements for all primary and secondary variables in both groups, except for residual urine in the tamsulosin group. However, there was no significant intergroup difference in the improvement of any efficacy variable between the groups. The adverse effects were comparable, with no significant differences in systolic and diastolic blood pressure after treatment in both groups.

CONCLUSIONS

This study suggests that naftopidil is as effective and safe as tamsulosin. Both drugs were effective in improving storage and voiding symptoms. However, there was no difference in clinical efficacy or adverse effects between the α1 AR antagonists with different affinity to α1 subtypes, α1a and α1d.
Treatment of incontinence after prostatectomy using a new minimally invasive device: adjustable continence therapy
Authors: Hübner Wilhelm A. , Schlarp Oliver M.
Published: August 2005

OBJECTIVE

To evaluate the safety and efficacy of a new minimally invasive urological implant for incontinence after prostatectomy.

PATIENTS AND METHODS

The adjustable continence therapy device (ProACTTM, Uromedica, Plymouth, MN, USA) consists of two balloons placed via a perineal approach bilaterally at the bladder neck in patients after prostatectomy. Titanium ports, attached via discrete tubing to each balloon, are placed in the scrotum, allowing for separate volume adjustments of the balloons at any time during and after surgery. Changes in a quality‐of‐life questionnaire (I‐QoL), pad usage and a subjective continence grading score were assessed in 117 consecutive men after implanting the Pro‐ACT, at baseline and at 1, 3, 6, 12 and 24 months.

RESULTS

After a mean (range) follow‐up of 13 (3–54) months and with a mean of 3 (0–15) adjustments, 67% of men were dry, using at most one ‘security’ pad daily; 92% were significantly improved, and 8% showed no improvement. The I‐QoL score improved from a median of 34.7 to 66.3 after 2 years (42 men; P < 0.001), the daily pad count decreased from a mean of 6 (1–24)/day to 1 (0–6)/day at 2 years (P < 0.001). Continence achieved at ≤ 6 months after implantation through incremental adjustment remained durable at ≥ 2 years in most patients. There were complications during and after surgery in 54 patients, mostly minor and decreasing with increasing expertise, primarily reflecting the development and refinement of the new surgical technique and its instrumentation. Re‐implantation for complications was required in 32 patients, with a 75% success rate.

CONCLUSIONS

The ProACT peri‐urethral prosthesis produces durable outcomes equivalent or better than other minimally invasive treatments for incontinence after prostatectomy. Its unique design allows for easy adjustment after surgery to achieve the desired urethral resistance, with no further surgical intervention, thus allowing for an optimum balance between voiding pressures and continence. The promising results reported here suggest that this may be an appropriate, effective and durable first‐line treatment to offer men with stress urinary incontinence after prostatectomy.
Prospective analysis of outcomes after microsurgical intussusception vasoepididymostomy
Authors: Chan Peter T.K. , Brandell Roy A. , Goldstein Marc
Published: August 2005

OBJECTIVE

To prospectively analyse the outcomes of microsurgical vasoepididymostomy using the intussusception technique, as vasoepididymostomy is considered the most challenging reconstructive microsurgery in urology.

PATIENTS AND METHODS

From 1998 to 2003, of 324 men with obstructive azoospermia who had undergone microsurgical reconstruction of the reproductive tracts, 68 (21%) had intussusception vasoepididymostomy bilaterally or unilaterally in a functionally solitary testis. The outcomes of these patients were analysed prospectively.

RESULTS

The mean age was 39.8 years for the men and 31.8 years for their partners. The causes of obstruction were after vasectomy in 31%, infection in 22%, iatrogenic in 19%, trauma in 1.5%, and idiopathic in 27%. The median duration of obstruction was 18.8 years; 37% of patients had had previous failed attempts at reconstruction. The mean (range) follow‐up was 15.2 (1–36) months. The overall patency (>10 000 sperm/mL) rate was 84% (53/63). Patency was achieved in 60% (38/63) of men at 1 month after surgery. The mean best sperm count was 12.8 (0.01–80) × 106/mL, with a 21 (0–30)% motility. Among patients with a follow‐up of > 1 year, the natural paternity rate was 40%. The median time to achieve a natural pregnancy was 14.3 (3–30) months. Pregnancy was achieved with in vitro fertilization or intracytoplasmic sperm injection in 31% of cases, all using fresh ejaculated sperm.

CONCLUSIONS

A favourable patency and pregnancy rate can be achieved using microsurgical intussusception vasoepididymostomy. Even when assisted‐reproductive technology is needed, fresh ejaculated sperm can be used without requiring a subsequent sperm retrieval procedure. Thus, microsurgical reconstruction of the reproductive tract should be primary therapeutic method in cases of azoospermia from epididymal obstruction.
Should the upper tracts be imaged for microscopic haematuria?
Authors: Feldstein Murray S. , Hentz Joseph G. , Gillett Michael D. , Novicki Donald E.
Published: August 2005

OBJECTIVE

To determine the relative prevalence of various definitions of microscopic haematuria (MH) in patients with renal neoplasms and controls, and to predict the likely outcome of renal imaging for those definitions.

PATIENTS AND METHODS

In a retrospective case‐control study 278 adult men and woman seen between 1998 and 2003 with untreated renal neoplasms were compared to controls matched for age and sex. All cases and controls had renal imaging within 6 months of a urine analysis. Patients were excluded for gross haematuria or other conditions associated with MH but not relevant to upper tract imaging. Adjusted odds ratios (OR) computed for 13 definitions of MH by conditional logistic regression were the primary outcome measures. Additional outcome measures were ORs in selected subsets. Hypothetical performance characteristics of a positive urine analysis were then derived to predict the likely results of detecting renal neoplasms for each definition of MH.

RESULTS

The OR (95% confidence interval) for the entire series of cases and controls, both symptomatic and asymptomatic, was 2.0 (1.02–3.92, P = 0.04) for MH defined as ≥ 4 red blood cells per high‐power field (RBC/HPF) and 2.2 (1.09–4.52, P = 0.03) for ≥ 5 RBC/HPF. No significant OR was calculated for ≤ 3 RBC/HPF, nor for a subgroup of patients with MH in a routine urine analysis obtained during a periodic health examination. Symptomatic patients had an OR of 13.68 (1.6–117.1, P = 0.02) for MH defined as ≥ 5 RBC/HPF. The sensitivity of a positive test decreased from 24.8% to 5.04% as the definition for MH became more stringent. The theoretical positive predictive value (assuming a prevalence of renal cell neoplasms of 0.25%) of the most stringent definition of MH was 0.58%.

CONCLUSIONS

Patients with renal neoplasms have about twice the prevalence of MH with ≥ 4 or 5 RBC/HPF in a single urine sample compared with matched controls, but this difference has little impact on the hypothetical detection rate of renal cancer. Imaging the kidney for low‐grade MH in a routine urine analysis discovered at a periodic health examination in an otherwise asymptomatic patient is tantamount to screening without cause, and can be deferred for selected patients. The clinical context is as important as the degree of MH when deciding to image the kidneys.
Apoptosis and proliferation in human undescended testes
Authors: Ofordeme Kenechukwu G. , Aslan Ahmet R. , Nazir Talat M. , Hayner‐Buchan Alida , Kogan Barry A.
Published: August 2005

OBJECTIVE

To study apoptosis and proliferation in the testes of children with undescended testes; the degree to which undescended testes contributes to a patient's ultimate fertility is debatable, but undescended testes have fewer germ cells, and some have proposed that apoptosis is an important cause.

PATIENTS AND METHODS

Testis biopsies were taken at the time of orchidopexy in a consecutive series of children undergoing surgical repair for undescended testes. Immunohistological techniques were used to detect apoptosis and proliferation, and the numbers of cells undergoing apoptosis or proliferation per 50 seminiferous tubules were recorded.

RESULTS

Inguinal testes had less apoptosis than abdominal testes, with a mean (sd) of 0.71 (1.31) vs 1.63 (1.95) apoptotic cells per 50 seminiferous tubules (P < 0.02). Similarly, there was less apoptosis in children aged > 1 years than in children aged < 1 years (0.68 (1.40) vs 1.35 (1.56); P < 0.03). Proliferation was very limited in all cryptorchid testes. In contrast to cryptorchid testes, five autopsy controls had many more apoptotic cells, (10.60 (1.34) per 50 seminiferous tubules), and many more proliferating cells, (8.40 (6.43) per 50 seminiferous tubules).

CONCLUSION

In contrast to animal studies, neither apoptosis nor proliferation was common in undescended testes from 6 months of age onward. However, apoptosis was more common in abdominal testes and in children aged < 1 year. It is likely that, if substantial apoptosis occurs in human undescended testes, it occurs before 6 months of age.
Precautionary Maybe, but What's the Principle? The Precautionary Principle, the Regulation of Risk, and the Public Domain
Authors: Feintuck Mike
Published: August 2005

The ‘precautionary principle’, originating in the field of environmental protection but now widely applied, is a major point for discussion in the regulation of risk. Though promising proactive and pre‐emptive intervention to prevent potentially irreversible harm, its precise meaning remains somewhat unclear. Legal systems tend to view it as procedural rather than substantive, and debates abound regarding its ‘stronger’ or ‘weaker’ versions and, indeed, the very concept of ‘risk’. It is also necessary to discuss how the principle operates in varying administrative and constitutional contexts but the key task is to clarify the principle's fundamental value base. If its essentially collective orientation is highlighted, it may better ensure that democratic and non‐pecuniary interests are given due prominence in regulatory contexts otherwise dominated by economic interests and technological imperatives, and it may then play an important role in reasserting the values of the public domain in the face of powerful private interests.
(Re)constructing the Head Teacher: Legal Narratives and the Politics of School Exclusions
Authors: Monk Daniel
Published: August 2005

School exclusions are a site of political and social contestation and in recent years statutory reforms and popular demands have focused on increasing the autonomy of head teachers. This article explores this trend and questions why, in a culture of human and children's rights, head teachers have such extensive powers within their schools and why law has, to a large extent, failed to provide a check on these powers. It does so not by doctrinal analysis of domestic and human rights law but, rather, by enquiring into how legal narratives construct the role of the head teacher and by locating the practice of exclusions within a broader social and political context. It suggests that demanding that the head teacher be unfettered in his or her decisions relating to exclusions ought not to be understood as a policy of ‘non‐intervention’ or a return to a ‘reassuring’ past but, rather, as a contemporary policy that reinforces the construction of excluded pupils as marginalized non‐citizens.
Citizenship and the Biopolitics of Post‐nationalist Ireland
Authors: Harrington John A.
Published: August 2005

In June 2004 voters in the Republic of Ireland endorsed a constitutional amendment to deprive children born on the island of Ireland of their previously automatic right to Irish citizenship. This change came amid increasing immigration and so‐called ‘baby tourism’, whereby non‐national mothers were alleged to be coming to Ireland to give birth for the sole purpose of bestowing Irish citizenship on their children. This article sets the referendum in its historical and contemporary context. Along with recent jurisprudence of the Irish Supreme Court, the amendment betokens a distinctive biopolitics orchestrated according to neo‐liberal themes consonant with Ireland's membership of the European Union and its foreign direct investment strategy. As such, the amendment confirms the shift in Irish constitutional history from autarkic nationalism to cosmopolitan post‐nationalism embodied in the Belfast Agreement of 1998.
The Empire Strikes Back: Press Judges and Communication Advisers in Dutch Courts
Authors: Gies Lieve
Published: August 2005

Judges in many jurisdictions are today prepared to utilize the media to promote a better public understanding of their role. Understandably, they wish not to be perceived as ‘spin doctors’ intent on a cynical manipulation of public opinion. Judges' professional reputation, their public image, and public confidence in their role hinge on a belief in their neutrality and impartiality. Court communicators are also aware that their success in the media arena depends on a degree of skill and strategizing to ensure that the integrity and complexity of their message are preserved in media reports. This paper discusses how press judges (judges who also act as media spokesperson) and communication advisers in Dutch courts address this. It is argued that the media liaison function embraced by Dutch courts may be an expansion of law's empire or, at least, a possible attempt by law's empire to strike back against the pressures of an increasingly inquisitive media.
Postmodern Professions? The Fragmentation of Legal Education and the Legal Profession
Authors: Boon Andy , Flood John , Webb Julian
Published: August 2005

This article considers the institutional dimensions of professionalism and the legal profession's struggle with the challenges of post‐modernity. An aspect of this is the Law Society's Training Framework Review (TFR) which promises changes to solicitors' education from ‘cradle to grave’. The first part of the article analyses the structure and drivers of the TFR, their origins, and how they will be articulated. Secondly, the TFR is considered in the context of the political economy of higher education and its role in the new capitalism. Finally, we examine the potential effects of the TFR for the legal profession in the context of increasing practice segmentation and the threat of deprofessionalization, and also for the Law Society itself, whether it can retain a key role in the life course of the legal profession.
Central and Eastern European Agriculture and Environment: The Challenges of Governance at Multiple Levels
Authors: Gatzweiler Franz
Published: August 2005

Building institutions of sustainability which are able to govern the many resource problems in Central and Eastern European agriculture and environment requires time and coordination. Time is needed to respond to the complexity and diversity of agri‐environmental resource problems and coordination is required to make the institutions work across different levels of decision‐making. The efforts for building such institutions took place within the field of tension between accession and evolution. Accession related institutional change took place within the time frame foreseen by politicians to meet accession criteria. Most local agri‐environmental problems, however, require more time for matching agri‐environmental conditions, with the interests, goals and skills of the different actors involved. Such problems of multiple governance have been successfully addressed in many Western European countries, which calls for an exchange of knowledge between Western and Eastern European resource managers. Partnership is recommended as a particularly useful concept during transition for solving many of the problems faced by the different actors and authorities involved in the challenge of sustainable resource management. This paper demonstrates the challenges of governance at different levels of decision‐making and identifies factors which hamper and promot this process
Agri‐Environment Problems Before and During Transition
Authors: Sumelius John , Bäckman Stefan , Sipiläinen Timo
Published: August 2005

An of overview how agri‐environmental problems in 12 central and eastern european countries (CEECs) changed between 1989 and1998 is provided and related to changes in land ownership. Three groups of countries according to land ownership are identified. The change in environmental problems relating to soil, water, biodiversity, and landscape is described. Referring to quantitative data collected in the CEECs, the main trends and new problems that have emerged during the transition process are identified. Possible links between the organizational character of farms and environmental problems are suggested.
Reviving Pre‐Socialist Cooperative Traditions: The Case of Water Syndicates in Bulgaria
Authors: Theesfeld Insa , Boevsky Ivan
Published: August 2005

During the post‐Socialist transition period, the Bulgarian irrigation facilities deteriorated to a large extent and no longer meet the needs of the new landowner and agricultural production structure. The Bulgarian government therefore enacted two new laws to encourage collective action and to establish water user associations in order to achieve sustainable water management. In this article, we will question the frequent argument that water user associations could easily be established in Bulgaria, because they are rooted in the water syndicates. The analysis of the historical cooperative movement in Bulgaria shows that the water syndicates were enforced by a top‐down approach and thus these pseudo cooperatives do not represent collective action and hence do not serve as examples for the establishment of water user associations. Besides, empirical findings from village case studies reveal that limited collective memory exists today about former water syndicates' rules‐in‐use and patterns of action. We will explain this breach of tradition by the migration from villages to cities, the suppression of pre‐communist so‐called capitalist behaviour, and the length of the socialist period.
Parameter Estimation and Subset Selection for Separable lower Triangular Bilinear Models
Authors: Wang Hai‐Bin
Published: August 2005

Abstract. Parameter estimation and subset selection for separable lower triangular bilinear (SLTBL) models are considered. Under a flat prior, we present an expectation–maximization (EM) algorithm to obtain the maximum likelihood estimation. Furthermore, two sub‐procedures are designed to select the best subset model after an initial fitting. Example with two simulated and one real data set illustrate the feasibility and validity of the proposed methods.
Growing Up? A History of CAMHS (1987–2005)
Authors: Cottrell David , Kraam Abdullah
Published: August 2005

A brief history of child and adolescent mental health services (CAMHS) from 1987 to 2005 is presented. Events of the last 20 years are organised around the two key themes of changes and development in policy and in clinical practice. This has been a period of great change in CAMHS and we attempt to highlight what we believe are the significant changes in what is, inevitably a personal view of recent history.
Hospitalization for Pneumonia in the Cardiovascular Health Study: Incidence, Mortality, and Influence on Longer‐Term Survival
Authors: O'Meara Ellen S. , White Mark , Siscovick David S. , Lyles Mary F. , Kuller Lewis H.
Published: August 2005

Objectives: To estimate the rate of hospitalization for pneumonia in community‐dwelling older adults and to assess its risk factors and contribution to mortality.

Design: Prospective observational study.

Setting: The Cardiovascular Health Study (CHS) in four U.S. communities.

Participants: Five thousand eight hundred eighty‐eight men and women aged 65 and older who were followed for a median 10.7 years.

Measurements: Participants were interviewed about medical history and demographics; evaluated for lung, physical, and cognitive function; and followed for hospitalizations, cardiovascular disease, and death.

Results: Nearly 10% of the cohort was hospitalized for pneumonia, for a rate of 11.1 per 1,000 person‐years (95% confidence interval (CI)=10.2–12.0). Risk factors included older age, male sex, current and past smoking, poor physical and lung function, and history of cardiovascular disease and chronic obstructive pulmonary disease. Ten percent of participants died during their incident pneumonia hospitalization, and death rates were high in those who survived to discharge. Compared with participants who had not been hospitalized for pneumonia, the relative risk of total mortality was 4.9 (95% CI=4.1–6.0) during the first year after hospitalization and 2.6 (95% CI=2.2–3.1) thereafter, adjusted for age, sex, and race. The respective relative risks were 3.9 (95% CI=3.1–4.8) and 2.0 (95% CI=1.6–2.4) after further adjustment for baseline history of cardiovascular disease; diabetes mellitus; smoking; and measures of lung, physical, and cognitive function.

Conclusion: In older people, hospitalization for pneumonia is common and is associated with an elevated risk of death, as shown in this population‐based, prospective cohort.
Elder Financial Abuse: An Evaluation Framework and Supporting Evidence
Authors: Kemp Bryan J. , Mosqueda Laura A.
Published: August 2005

Objectives: To develop a valid and reliable framework for evaluating cases of alleged elder financial abuse.

Design: Experienced experts in elder financial abuse rated a framework with eight elements.

Setting: Professionals attending an advanced training course on elder abuse.

Participants: Deputy district attorneys (n=44), senior law enforcement detectives (n=59), Adult Protective Service workers, and public guardians and victim advocates (n=56) who had a combined total of 1,985 years of experience and who had investigated a total of 3,225 cases (mean of 13.1 years and 21.2 cases) were included.

Measurements: These experienced professionals were asked to rate how well an evaluative framework matched their experience with elder financial abuse using a 5‐point rating scale ranging from very little to almost entirely.

Results: The mean rating for the model was 4.4 out of 5. About 90% of the sample rated it as almost entirely or very much matching their experience. There were no differences between professions. The reliability measure was 0.85.

Conclusion: These results suggest a reliable and valid framework for evaluating cases of possible elder financial abuse.
End‐of‐Life Care in Black and White: Race Matters for Medical Care of Dying Patients and their Families
Authors: Welch Lisa C. , Teno Joan M. , Mor Vincent
Published: August 2005

Objectives: To compare the end‐of‐life medical care experienced by African‐American and white decedents and their families.

Design: Cross‐sectional, retrospective survey with weighted results based on a two‐stage probability sampling design.

Setting: Hospitals, nursing homes, and home‐based medical services across the United States.

Participants: Surrogates (N=1,447; primarily family members) for decedents from 22 states.

Measurements: Validated end‐of‐life care outcomes concerning symptom management, decision‐making, informing and supporting families, individualized care, coordination, service utilization, and financial impact.

Results: Family members of African‐American decedents were less likely than those of white decedents to rate the care received as excellent or very good (odds ratio (OR)=0.4). They were more likely to report absent (OR=2.4) or problematic (OR=1.9) physician communication, concerns with being informed (OR=2.5), and concerns with family support (OR=2.6). Family members of African Americans were less likely than those of whites to report that the decedent had treatment wishes (OR=0.3) or written advance care planning documents (OR=0.4). These differences persist when limiting the sample to respondents whose expectations for life‐sustaining treatments matched treatments received. Family members of African‐American decedents also were more likely to report financial hardship due to savings depletion (OR=2.1) or difficulty paying for care (OR=2.0) and that family/friends (OR=2.0) or home health workers (OR=1.9) provided home care.

Conclusion: This national study brings evidence that racial disparities persist into end‐of‐life care, particularly regarding communication and family needs. Results also suggest different home care patterns and levels of financial impact.
Historical Perspective on Pressure Ulcers: The Decubitus Ominosus of Jean‐Martin Charcot
Authors: Levine Jeffrey M.
Published: August 2005

Jean‐Martin Charcot was a towering figure in the French medical community in the 19th century. Among the diseases he studied was the decubitus, or pressure ulcer, as it is commonly called today. He did not believe that pressure or local irritation were causative factors for the decubitus but rather subscribed to the “neurotrophic theory,” which held that damage to the central nervous system led directly to its occurrence. Charcot observed that many patients who developed eschar of the sacrum and buttocks died soon afterwards, and referred to this lesion as the decubitus ominosus, implying that its occurrence heralded impending death. His description of the evolving decubitus is extraordinarily detailed and accurate and includes complications that are seldom seen today, such as gangrenous metastases to the lung and invasion of the spinal cord. Charcot's therapeutic nihilism is largely a product of the limited medical technology of his day. The importance of risk factor assessment and timely intervention for persons at risk is now understood. In addition, it is recognized that not all pressure ulcers are unavoidable and that many ulcers, particularly those in early stages, can be reversed. Comparing Charcot's view of the decubitus with our own, insight is provided into the way medicine is practiced today.
Functional Incidental Training: A Randomized, Controlled, Crossover Trial in Veterans Affairs Nursing Homes
Authors: Ouslander Joseph G. , Griffiths Patricia C. , McConnell Eleanor , Riolo Lisa , Kutner Michael , Schnelle John
Published: August 2005

Objectives: To test the effects of a rehabilitative intervention directed at continence, mobility, endurance, and strength (Functional Incidental Training (FIT)) in older patients in Department of Veterans Affairs (VA) nursing homes.

Design: Randomized, controlled, crossover trial.

Setting: Four VA nursing homes.

Participants: All 528 patients in the nursing homes were screened; 178 were eligible, and 107 were randomized to an immediate intervention group (Group 1; n=52) and a delayed intervention group (Group 2; n=55).

Intervention: Trained research staff provided the FIT intervention, which included prompted voiding combined with individualized, functionally oriented endurance and strength‐training exercises offered four times per day, 5 days per week, for 8 weeks. Group 1 received the intervention while Group 2 served as a control group; then Group 2 received the intervention while Group 1 crossed over to no intervention. A total of 64 subjects completed the intervention phase of the trial.

Measurements: Timed measures of walking or wheeling a wheelchair (mobility), sit‐to‐stand exercises, independence in locomotion and toileting as assessed using the Functional Independence Measure (FIM), one‐repetition maximum weight for several measures of upper and lower body strength, frequency of urine and stool incontinence, and appropriate toileting ratios.

Results: There was a significant effect of the FIT intervention on virtually all measures of endurance, strength, and urinary incontinence but not on the FIM for locomotion or toileting. The effects of FIT were observed when Group 1 received the intervention and was compared with the control group and when Group 2 crossed over to the intervention. Group 1 deteriorated in all measures during the 8‐week crossover period. Within‐person comparisons also demonstrated significant effects on all measures in the 64 participants who completed the intervention; 43 (67%) of these participants were “responders” based on maintenance or improvement in at least one measure of endurance, strength, and urinary incontinence. No adverse events related to FIT occurred during the study period.

Conclusion: FIT improves endurance, strength, and urinary incontinence in older patients residing in VA nursing homes. Translating these positive benefits achieved under research conditions into practice will be challenging because of the implications of the intervention for staff workload and thereby the costs of care.
Do Age and Comorbidity Affect Intensity of Pharmacological Therapy for Poorly Controlled Diabetes Mellitus?
Authors: Chaudhry Sarwat I. , Berlowitz Dan R. , Concato John
Published: August 2005

Objectives: To examine the influence of age and comorbidity on intensification of medical therapy for patients with poorly controlled diabetes mellitus (DM).

Design: Observational cohort study using data from Department of Veterans Affairs (VA) national databases.

Setting: Thirteen VA medical centers in New England, Florida, and Puerto Rico.

Participants: Veterans (N=5,317) with poorly controlled DM receiving regular medical care

Measurements: An increase in hypoglycemic medications, or intensification of therapy, was considered present at the visit if a new hypoglycemic medication was started or the dosage of an existing medication was increased.

Results: The overall rate of intensification of therapy was 20.8% (1,106/5,317). The rate of intensification was highest in the youngest patients without comorbidity (24.5%) and lowest in the oldest patients with comorbidity (15.7%) (P<.001).

Conclusion: Rates of intensification at a single clinic visit were quite low in all groups and were lowest in older patients with comorbidity.
Community‐Acquired Thoracic Empyema in Older People
Authors: Tsai Tzu‐Hsiu , Jerng Jih‐Shuin , Chen Kuan‐Yu , Yu Chong‐Jen , Yang Pan‐Chyr
Published: August 2005

Objectives: To compare the clinical characteristics of community‐acquired thoracic empyema in older and younger patients and to analyze the effect of various factors on outcome.

Design: A retrospective, comparative observational study.

Setting: A university‐affiliated tertiary medical center.

Participants: Forty‐six patients aged 65 and older (older group) and 86 patients aged 18 to 64 (younger group).

Measurements: Demographic, clinical, and microbiological data were reviewed.

Results: Older patients were more likely to have dyspnea but less likely to have chest pain or fever (P<.05 for all). The causative organisms were similar between the two groups, with anaerobes and facultative streptococci the most common pathogens. Older patients had increased morbidity and longer hospital stay (median 29.5 vs 20 days, P<.001), but the in‐hospital mortality was not significantly different between the two groups (13% vs 8%, P=.37). Multivariate analysis showed that coexisting malignancy (odds ratio (OR)=10.33, P=.01), lack of fever higher than 38°C (OR=17.97, P=.03), and isolation of fungi from pleural fluid (OR=32.66, P=.01) were independently and significantly associated with in‐hospital deaths.

Conclusion: The microbiology and mortality of community‐acquired thoracic empyema were similar between the two age groups. Difference in chronological age did not explain in‐hospital death. This finding highlights the importance of effective treatment to obtain better outcomes for older patients.
Reduction in Fear of Falling Through Intense Tai Chi Exercise Training in Older, Transitionally Frail Adults
Authors: Sattin Richard W. , Easley Kirk A. , Wolf Steven L. , Chen Ying , Kutner Michael H.
Published: August 2005

Objectives: To determine whether an intense tai chi exercise program could reduce fear of falling better than a wellness education (WE) program in older adults who had fallen previously and meet criteria for transitioning to frailty.

Design: Cluster‐randomized, controlled trial of 48 weeks' duration.

Setting: Ten matched pairs of congregate living facilities in the greater Atlanta area.

Participants: Sample of 291 women and 20 men, aged 70 to 97.

Measurements: Activity‐related fear of falling using the Activities‐Specific Balance Confidence Scale (ABC) and the Fall Efficacy Scale at baseline and every 4 months for 1 year. Demographics, time to first fall and all subsequent falls, functional measures, Centers for Epidemiologic Studies Depression Scale, medication use, level of physical activity, comorbidities, and adherence to interventions.

Results: Mean ABC was similar in both cohort groups at the time of randomization but became significantly higher (decreased fear) in the tai chi cohort at 8 months (57.9 vs 49.0, P<.001) and at study end (59.2 vs 47.9, P<.001). After adjusting for covariates, the mean ABC after 12 months of intervention was significantly greater in the tai chi group than in the WE group, with the differences increasing with time (mean difference at 12 months=9.5 points, 95% confidence interval=4.8–14.2, P<.001).

Conclusion: Tai chi led to a significantly greater reduction in fear of falling than a WE program in transitionally frail older adults. The mean percentage change in ABC scores widened between tai chi and WE participants over the trial period. Tai chi should be considered in any program designed to reduce falling and fear of falling in transitionally frail older adults.
Bar None: Extending Affirmative Action to Higher Education in Prison
Authors: Torre María Elena , Fine Michelle
Published: August 2005

Recognizing the intent of Affirmative Action to include historically marginalized citizens into institutions of higher learning, we stretch the limits of Affirmative Action to consider the role of higher education in prison. We present empirical findings of a 4‐year, qualitative and quantitative participatory action research study of the impact of college in prison. Evidence is drawn from participant observations; individual and focus group interviews with participants of the college program, former inmates, prison administrators, corrections officers, and children of inmates; faculty surveys; and a quantitative analysis of recidivism rates. We address the psychological, academic, and crime‐related impacts of higher education on women in prison, and document the benefits of broad‐based access for inmates, prison environments, children of prisoners, and society‐at‐large.
Multichannel Data Acquisition System for Mapping the Electrical Activity of the Heart
Authors: CIACCIO EDWARD J. , SALTMAN ADAM E. , HERNANDEZ OSCAR M. , BORNHOLDT REIDAR J. , COROMILAS JAMES
Published: August 2005

Background: Details of the electrical conduction pattern of the heart are revealed to the electrophysiologist when multichannel data are used for activation mapping. Commercial electronic systems are available for simultaneous acquisition of many surface electrograms; however, the cost of these systems may be prohibitive and they can be mostly inflexible for adaptation to other research projects. Furthermore, the hardware and software design is often proprietary. In this article we describe the in‐house design and implementation of a 320‐multichannel acquisition system for animal electrophysiologic research.

Method and Results: Several modules comprise this system. The multichannel data are first preprocessed by amplification, filtering, and analog multiplexing. An algorithm for automatic adjustment of signal gains is implemented to maximize the voltage resolution and minimize noise pickup. Signals are then digitized, and sequenced to order the multichannel data and to add markers required for analysis. The digital data are streamed to archival storage media. Additionally, the electrocardiogram (ECG), blood pressure, and stimulus channel signals are stored simultaneously. Selected signals are then displayed in real‐time for measurement and analysis and as a check of the system integrity. Examples of multielectrode arrays and surface recordings are provided. Costs for building such a system are estimated.

Conclusions: Multichannel data acquisition systems that are designed and constructed in‐house have several advantages over turnkey commercial systems, including the potential for considerable cost savings, flexibility in acquiring data, and the ability to subsequently add additional components.
Understanding Atrial Symptom Reports: Objective versus Subjective Predictors
Authors: SEARS SAMUEL F. , SERBER EVA R. , ALVAREZ LUIS G. , SCHWARTZMAN DAVID S. , HOYT ROBERT H. , UJHELYI MICHAEL R.
Published: August 2005

Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with a variety of symptoms such as dizziness, palpitations, shortness of breath, and other signs of heart failure, which in turn impact quality of life (QOL). Implantable cardioverter defibrillators with atrial therapies (ICDs‐ATs) have been shown to reduce AF symptoms and improve QOL in select AF samples.

Method: This study examined the strength of relationships between objective (device‐detected AF events) versus subjective (emotional symptoms) data and AF symptoms (number) reported as part of the Patient Atrial Shock Survey of Acceptance and Tolerance Study (N = 96, 72% men, M age = 65, SD = 12). Depression and anxiety were assessed via the Center for Epidemiological Studies—Depression Scale and the‐State Trait Anxiety Inventory. AF disease burden was measured via a number of device‐detected AF episodes and the Atrial Tachyarrhythmia Symptom Severity Scale.

Results: Hierarchical multiple regression analysis indicated that negative emotions accounted for a significant 13.2% of unique variance in AF symptom score (F change (1, 54) = 9.625, P = 0.003). On the other hand, the number of device‐detected AF episodes accounted for non‐significant 8.2% of unique variance in the AF symptom score (P = 0.167). The full model explained 25.7% of the variance in AF symptom score (F(6, 54) = 3.110, P = 0.011). Specifically, greater number of treated AF episodes (β= 0.251, P = 0.043) and higher levels of negative emotions (β= 0.369, P = 0.003) predicted greater number of reported AF symptoms.

Conclusion: Therefore, psychological distress may be a significant confounding factor affecting patient's report of AF symptoms rather than the actual experience of recurrent AF episodes.