bluuebunny/crossref_metadata_2025 huggingface dataset:
British HIV Association (BHIVA)/British Association for Sexual Health and HIV (BASHH) guidelines on provision of adherence support to individuals receiving antiretroviral therapy (2003)
Authors: Poppa A , Davidson O , Deutsch J , Godfrey D , Fisher M , Head S , Horne R , Sherr L
Published: July 2004

The widespread use of highly active antiretroviral therapy (HAART) has dramatically reduced HIV‐associated morbidity and mortality where treatment has been made available. Very high levels of adherence to HAART are a prerequisite for a successful virological and immunological response. Low adherence increases the risk of treatment failure and disease progression. It is also likely to lead to further transmission of resistant viruses, and to have a negative impact on the cost effectiveness of HAART. Low adherence is difficult to predict, and this has two key implications for service provision. Firstly, HAART should not be withheld on the basis of assumptions about adherence. Secondly, support with adherence should be provided to all patients prescribed HAART. Our understanding of barriers to and enablers of high adherence, and the evidence base regarding effective interventions, is limited. Meta‐analysis of randomized controlled trials available from the general literature suggests multiple interventions are required to maintain high adherence to chronic therapy. This document recommends a series of measures for adoption within HIV clinical care settings, based on evaluation of existing data. High adherence is a process, not a single event, and therefore adherence support must be integrated into clinical follow up. Every prescribing unit should have a written policy on provision of adherence support, and ensure that staff are appropriately trained to make delivery of such services possible.
Fatherhood and HIV‐positive heterosexual men
Authors: Sherr L , Barry N
Published: July 2004

Objectives

The study of HIV and issues of reproduction is women‐focused. HIV‐positive men are overlooked and understudied. This study examined views on reproduction of heterosexual HIV‐positive men.

Methods

Systematic questionnaire data were gathered from HIV‐positive men (n=32) attending an HIV clinic in London.

Results

Heterosexual men were rarely given medical advice on reproduction (only 9.4%). Few felt fully informed (21.9%), while many felt uninformed (46.9%) or needed more information (28.1%). Over half would value fertility/fathering consultations, up‐to‐date information and quick referral to fertility clinics. Nearly half (43.8%) had considered having children and 37.5% had had a child prior to HIV diagnosis. HIV status affected views on fathering, and the advent of new treatments changed views in over half of the men. Almost half (41%) believed they would experience discrimination if they conceived a baby and a quarter would withhold their HIV status when attending antenatal clinics. The majority (81%) believed that a child gave meaning to life and something to live for – only 3.1% felt a child would be a burden. Most men overestimated potential vertical transmission and would value time to discuss fathering and fatherhood.

Conclusions

There are gaps in provision. The majority of men felt that children gave meaning to life and a reason to live. Reproduction issues are not raised with HIV‐positive men who are uninformed and unclear where to turn for information. Fatherhood should not be shunned as an issue for all HIV‐positive men.
Association of highly active antiretroviral therapy failure with chemokine receptor 5 wild type
Authors: Bogner JR , Lutz B , Klein HG , Pollerer C , Troendle U , Goebel FD
Published: July 2004

Objectives

Approximately 10% of HIV‐infected patients fail to respond properly to highly active antiretroviral therapy (HAART). Among other factors, genetic variants of chemokine receptors have been shown to modify the course and outcome of HIV infection. Our objective was to investigate whether a failure of virological response is associated with polymorphisms of the chemokine receptors or cofactors.

Methods

A total of 256 HIV‐infected patients receiving HAART and 221 healthy controls were analysed for the chemokine receptor 5 (CCR5)‐Δ32‐bp, stromal derived factor 1 (SDF1)‐3′A and chemokine receptor 2 (CCR2)‐64I polymorphisms. Treatment failure was defined as failure to lower the viral load below 50 HIV‐1 RNA copies/mL within the first year of treatment despite good adherence. Genomic DNA was extracted from peripheral blood lymphocytes (PBL) and amplified by polymerase chain reaction (PCR).

Results

Successful treatment was associated with heterozygosity for the CCR5‐Δ32‐bp variant found in 24 of 184 responders (13%) vs. one of 72 nonresponders (1.4%; P=0.004). Eighty‐four of 184 responders (45.7%) vs. 25 of 72 nonresponders (34.7%) were heterozygous for the SDF1‐3′A allele (P=0.073). The CCR2‐64I polymorphism was rare in both groups: 4.9% in responders vs. 1.4% in nonresponders (P=0.175). The odds ratio for successful treatment was 4.7 for individuals who tested positive for at least one variant allele of the three polymorphisms. Comparison of genotype frequencies between HIV‐infected and healthy individuals showed highly significant differences (P<0.001).

Conclusions

Chemokine receptor polymorphisms have a modifying effect on the virological response to HAART. Multivariate analysis demonstrated that heterozygosity for the CCR5‐Δ32‐bp variant is an independent prognostic factor for treatment outcome.
Characteristics of patients diagnosed with AIDS shortly after first detection of HIV antibodies in Lyon University hospitals from 1985 to 2001*
Authors: Baratin D , Marceillac E , Trepo C , Cotte L , Peyramond D , Chidiac C , Touraine J‐L , Livrozet J‐M , Fabry J , Allard R , Vanhems P
Published: July 2004

A diagnosis of AIDS shortly after the detection of HIV antibodies suggests a long‐lasting course of the disease without care. The factors associated with a short delay between the initial HIV‐1‐positive test and the first AIDS‐defining event were identified in 1901 patients from 1985 to 2001 in Lyon University hospitals. A total of 576 individuals (30.3%) had an interval of ≤3 months between the detection of HIV infection and AIDS. The factors independently associated with a delay of ≤3 months were: age from 30 to 44 years [odds ratio (OR) 2.5; 95% confidence interval (CI) 1.9–3.2]; age from 45 to 59 years (OR 5.6; 95% CI 3.9–7.8); age ≥60 years (OR 4.5; 95% CI 2.5–8.1), compared to those<30 years old; heterosexuality (OR 2.4; 95% CI 1.6–3.4); injection drug use (OR 2.1; 95% CI 1.5–2.7); and other exposures (OR 2.4; 95% CI 1.6–3.4), compared to homosexual exposure; two opportunistic infections at AIDS (OR 1.8; 95% CI 1.4–2.4) compared to one; and Pneumocystis carinii pneumonia as initial AIDS event (OR 2.6; 95% CI 1.8–3.7), compared to Kaposi's sarcoma. These results provide opportunities to refocus local public health interventions to reduce delayed access to care.
A prospective multicentre study of discontinuing prophylaxis for opportunistic infections after effective antiretroviral therapy
Authors: Green H , Hay P , Dunn DT , McCormack S ,   on behalf of the STOPIT Investigators
Published: July 2004

Objective

To assess the medium‐term safety of discontinuing prophylaxis (primary or secondary) for opportunistic infections following an effective response to antiretroviral therapy.

Methods

Participating clinical sites prospectively identified patients in whom the discontinuation of prophylaxis for any opportunistic infection was considered to be clinically indicated, although CD4 levels were not predefined. A follow‐up report was subsequently sent every 6 months requesting information on changes in prophylaxis, antiretroviral drugs, new AIDS‐defining events, and CD4 cell count results.

Results

Prophylaxis for Pneumocystis carinii pneumonia (PCP) was withdrawn in 524 patients (426 primary and 98 secondary prophylaxis), prophylaxis for Mycobacterium avium complex (MAC) was withdrawn in 28 patients (13 primary and 15 secondary), and prophylaxis for cytomegalovirus (CMV) retinitis was withdrawn in 10 patients. CD4 counts were generally maintained above accepted prophylaxis threshold levels during the period of follow up (95–98% of the time). Total follow up to last report or re‐continuation of prophylaxis was 680 and 144 person‐years for patients discontinuing primary and secondary PCP prophylaxis, respectively. No cases of PCP were reported, giving incidence rates of 0.0 (upper 95% confidence limit 0.4) and 0.0 (2.1) per 100 person‐years. No cases of MAC were reported, but one patient had a recurrence of CMV retinitis. PCP prophylaxis was restarted in 30 patients; no patients restarted MAC or CMV prophylaxis.

Conclusions

Previous studies have demonstrated a low risk of PCP in the short term following the withdrawal of prophylaxis in patients who have responded well to antiretroviral therapy. The present study suggests a continuing low level of risk with extended follow up, provided adequate CD4 count levels are maintained. The case of recurrent CMV retinitis in a patient with impressive immunological and virological response indicates the need for close monitoring of patients previously diagnosed with this condition.
A randomized study investigating the efficacy and safety of amprenavir in combination with low‐dose ritonavir in protease inhibitor‐experienced HIV‐infected adults
Authors: Pulido F , Katlama C , Marquez M , Thomas R , Clumeck N , De J Pedro R , Cattelan AM , Zhu C , Tymkewycz P
Published: July 2004

Objectives

To compare the safety and efficacy of amprenavir [APV/j Agenerase™; GlaxoSmithKline, [Ware, UK; 600 mg twice a day (bid)] boosted with low‐dose ritonavir (RTV, 100 mg bid) with those of other protease inhibitors (PIs) in PI‐experienced HIV‐infected patients.

Study design

Parallel‐group, randomized, open‐label, multicentre study.

Methods

One hundred and sixty‐three patients with HIV predicted to be sensitive to APV, another PI and a nucleoside reverse transcriptase inhibitor (NRTI) were randomly assigned to receive either APV boosted with low‐dose RTV (APV/r) or a standard of care (SOC) PI with or without low‐dose RTV. The non‐inferiority of APV/r to the SOC PIs was assessed by time‐weighted average change from baseline (AAUCMB) in plasma viral load (vRNA) at week 16.

Results

The antiviral response for APV/r bid was non‐inferior to that for the SOC PI group: the vRNA AAUCMB mean treatment difference was 0.043 log10 HIV‐1 RNA copies/mL [95% confidence interval (CI)−0.250, 0.335]. APV/r bid was generally well tolerated.

Conclusions

Results confirm the antiviral activity, short‐term safety and tolerability of APV/r bid in PI‐experienced patients.
Acute hepatitis C in HIV‐infected men who have sex with men
Authors: Ghosn J , Pierre‐François S , Thibault V , Duvivier C , Tubiana R , Simon A , Valantin MA , Dominguez S , Caumes E , Katlama C
Published: July 2004

Background

Hepatitis C virus (HCV) is usually transmitted via the parenteral route, but there are widely discrepant findings on its possible sexual transmission. Thus there are no recommendations concerning protected sex for couples in which only one partner is HCV‐infected. Whether HIV or other sexually transmitted diseases could favour HCV transmission remains unclear, but recent data suggesting an increasing incidence of acute HCV in HIV‐infected men underline the major public health implications of this issue.

Case reports

Between June 2002 and July 2003, five HIV‐infected homosexually active men presented with primary (n=4) and secondary (n=1) syphilis and concomitant abnormal liver function tests revealing acute asymptomatic HCV seroconversion. Other causes of acute viral hepatitis were inquired into and excluded. Highly at‐risk sexual behaviour, including unprotected anal intercourse and unsafe oral sex, with concomitant syphilis, was found to be the only identifiable important risk factor for transmission of HCV.

Conclusions

Sexual transmission may be fuelling a significant increase in HCV seroconversions among HIV‐infected men who have highly risky sexual behaviours. Given the recent data suggesting the spread of sexually transmitted infections among HIV‐infected gay men, specific recommendations concerning safe sex are urgently needed.
Determination of indinavir and nelfinavir trough plasma concentration efficacy thresholds according to virological response in HIV‐infected patients
Authors: Duval X , Peytavin G , Albert I , Bénoliel S , Ecobichon J‐L , Brun‐Vézinet F , Mentré F , Leport C , Vildé J‐L
Published: July 2004

Background

There is evidence to suggest a pharmacokinetic–pharmacodynamic relationship in HIV‐infected patients receiving protease inhibitor (PI)‐containing highly active antiretroviral therapy (HAART); however, the effective trough PI plasma concentrations achieved have not been precisely determined.

Methods

The relationship between HIV viral load and concomitant PI trough plasma concentration (Ctrough) was evaluated in 101 patients receiving at least 4 months of thrice daily indinavir (IDV)‐containing (n=68) or nelfinavir (NFV)‐containing (n=33) HAART. The more discriminating Ctrough efficacy thresholds were determined statistically for each PI by using the raw Ctrough and the time‐corrected Ctrough, using the precise delay since the last PI intake and the half‐life of each PI.

Results

For IDV (P=0.002) and NFV (P=0.019) median Ctrough levels were higher in patients with undetectable viral load [0.23 mg/L (n=30) and 2.3 mg/L (n=16) respectively] than in patients with detectable viral load [0.11 mg/L (n=38) and 0.6 mg/L (n=17) respectively]. Ctrough levels of IDV (r=−0.45; P<0.0001) and NFV (r=−0.43; P=0.011) were correlated with the concomitant viral load. The more discriminating Ctrough efficacy thresholds were estimated statistically as 0.12 mg/L for IDV and 0.5 mg/L for NFV. When Ctrough values were time‐corrected, the Ctrough efficacy thresholds, 8 h after the last intake, were 0.15 mg/L for IDV and 0.65 mg/L for NFV.

Conclusions

These results support the importance of achieving minimal effective Ctrough to improve the virological efficacy of PI‐containing HAART, and specify the target concentrations for IDV and NFV.
PENTA guidelines for the use of antiretroviral therapy, 2004
Authors: Sharland M , Blanche S , Castelli G , Ramos J , Gibb DM ,   on behalf of the PENTA Steering Committee
Published: July 2004

There have been few major advances in paediatric HIV management over the last 2 years. Decisions about starting antiretroviral therapy can now be based on a recent large meta‐analysis of the predictive value of CD4 and HIV RNA viral load (VL) in nearly 4000 untreated children, which is discussed in these updated guidelines. Risk estimates for progression to AIDS and death using surrogate markers can now be broken down by age, allowing more accurate discussion with families. In addition, there is increasing recognition of the problems of long‐term adherence, drug resistance and cumulative toxicity in adults and children. The controversy over whether to treat asymptomatic infants continues. For older children more data on the efficacy of ritonavir boosted protease inhibitor (PI) regimens suggests that these may be the PI option of first choice. There is still no adult or paediatric trial evidence on which to base decisions about whether to start with PI‐ or non‐nucleoside reverse transcriptase inhbitor (NNRTI)‐ based regimens, but the PENPACT 1 trial, which is addressing this question, is ongoing. There are increasing moves to provide simpler antiretroviral therapy (ART) regimens, including once daily dosing, but these lag behind adult regimens because of the paucity of pharmacokinetic data. Resistance assays should now be performed in all HIV‐infected infants exposed to ART in pregnancy. Therapeutic drug monitoring may be very important in children because of high between‐ and within‐child variability in drug absorption and metabolism. A trial to evaluate this should start shortly in Europe (PENTA 14 trial). The value of resistance tests for choice of second‐line and subsequent choices of ART regimens remain unproven (the PERA trial will report late in 2004), but resistance assays are increasingly being used. The issue of when to switch therapy also remains unanswered and is being addressed within the PENPACT 1 trial. Regular formal assessment of adherence is now the standard of care, and routine monitoring in the clinic for lipodystrophy syndrome (LDS) and other ART toxicities is increasingly important. These guidelines will be updated again in 2006.
Transient groundwater impacts on the development of paleoclimatic lake records in semi‐arid environments
Authors: Urbano L. D. , Person M. , Kelts K. , Hanor J. S.
Published: July 2004

Lacustrine sedimentary deposits are a primary archive of terrestrial paleoclimatic information, and groundwater fluxes under arid climates can dominate water budgets in lake and playa environments. In this paper, we investigate the effects of basin‐scale water table fluctuations on lacustrine paleoclimatic records in arid regions using the hydrogeologic model MWT3D. Boundary conditions for paleo‐recharge over the past 57 ka, land surface topography, the location of lakes, and subsurface geology were based on information available for a 600‐km cross section across the western Murray Basin, Australia. Results indicate the importance of the physical interaction between the water table and the land surface in controlling the location and the timing of formation of paleoclimatic lacustrine records. Lakes in different positions across the watershed preserved different records of climate (wet versus dry), although the same recharge history was applied. Changes in groundwater seepage to the surface lagged behind the climatic signal between 500 and 220 years across the basin. The size of the flow system, specifically the distance from the local discharge point to the adjacent groundwater divide, was the primary control on the time lag. With large fluctuations in water table elevation (>50 m) this distance changes considerably from wet to dry climatic conditions. Our results are largely consistent with observed paleoclimatic records derived from lakes across the Murray Basin.
Temporal change in groundwater level following the 1999 (Mw = 7.5) Chi‐Chi earthquake, Taiwan
Authors: Wang C.‐Y. , Wang C.‐H. , Kuo C.‐H.
Published: July 2004

We examine the post‐seismic change in the groundwater level following the 1999 (Mw = 7.5) Chi‐Chi earthquake in central Taiwan, as recorded by a network of 70 evenly distributed hydrological stations over a large alluvial fan near the epicenter. Four types of post‐seismic responses may be distinguished. In type 1, the groundwater level declined exponentially with time following a coseismic rise. This was the most common response in the study area and occurred in unconsolidated sediments on the Choshui River fan. In type 2, the groundwater level rose exponentially with time following a coseismic fall. This occurred in the deformed and fractured sedimentary rocks in the foothills near the Chelungpu fault that ruptured in the Chi‐Chi earthquake. In type 3, the groundwater level continued to decline with time following a coseismic fall. This also occurred in the deformed and fractured sedimentary rocks near the ruptured fault. Finally, in type 4, the groundwater level, following a coseismic rise, stayed at the same level or even rose with time before it eventually declined. This occurred mostly in unconsolidated sediments along the coast of central Taiwan and along the Peikang Stream. We analyze these post‐seismic responses by using a one‐dimensional model. Together with the results from well test, the analysis show that the type 1 response may be explained by an aquifer model with coseismic recharge and post‐seismic subhorizontal discharge across a length of 500–5000 m; the type 2 response may be explained by a model of coseismic discharge and post‐seismic recharge from surface water; the type 3 response may be explained by a model of coseismic discharge and post‐seismic subhorizontal discharge across a length of 500–5000 m; and the type 4 response may be explained by a model of coseismic recharge and sustained post‐seismic recharge from surface water. The characteristic time for the post‐seismic changes is similar to that for the groundwater‐level decline during dry seasons before the earthquake, suggesting that there was no earthquake‐induced changes in the aquifer properties (i.e. hydraulic conductivity), confirming the earlier results from recession analyses of the post‐seismic streamflow elsewhere after several earthquakes.
The link between fluids and rank variation in the South Wales Coalfield: evidence from fluid inclusions and stable isotopes
Authors: Alderton D. H. M. , Oxtoby N. , Brice H. , Grassineau N. , Bevins R. E.
Published: July 2004

Fluid inclusion and stable isotope data from quartz and carbonate minerals in fracture fillings and ‘ironstone’ nodules from the South Wales Coalfield have been used to characterise the fluids generated during basin evolution and associated coalification. Carbonates grew first, probably at relatively shallow depths and low temperatures (<100°C). The carbonates exhibit a trend of increasing C‐isotopic values across the coalfield, ranging from δ13C = −12‰ VPDB in the SE of the coalfield to 0‰ VPDB in the NW, possibly as a result of increasing methanogenesis in the deeper (NW) parts of the coalfield. Quartz formed at a later stage of basin formation, probably at temperatures between 150 and 200°C. Fluid inclusions in these minerals suggest that burial and coalification of the sediments were associated with mixed aqueous–petroleum fluids. Furthermore, the density of these petroleum fluids decreases towards the NW of the coalfield, where the rank of the associated coal increases to anthracite grade. The study confirms that the composition and temperature of these fluids closely correlate with the variations in coal rank, indicating a possible causal link. The data also give general support to models that propose regional fluid flow in the basin. and are consistent with the erosion of approximately 2 km of section which is not preserved today. A geothermal gradient (at maximum burial) of 45°C km−1 is proposed, and thus no exceptionally anomalous thermal regime is required to explain coal rank variation.
Factors controlling free thermal convection in faults in sedimentary basins: implications for the formation of zinc–lead mineral deposits
Authors: Yang J. , Large R. R. , Bull S. W.
Published: July 2004

Stratiform sediment‐hosted Zn–Pb–Ag mineral deposits constitute about 40% of the Earth's zinc resources (Allen 2001), and in most cases their genesis involves the discharge of basinal brines near or on the seafloor through syndepositional faults (Sangster 2002). From the point of view of base metal exploration, it is therefore essential to identify all possible faults that formerly carried the upwelling ore‐forming solutions during mineralising events. This paper presents a numerical investigation of the relative importance of various physical parameters in controlling fluid discharge, recharge and heat transport in faults. A two‐dimensional, free convection of pure water, hydrogeological model is developed for the McArthur basin in northern Australia based on the surface geology, known stratigraphic and structural relationships and regional geophysical interpretations. Numerical experiments and sensitivity analyses reveal that faults with strong initial heat input, due to depth of penetration or magmatic activity, are the most likely candidates to carry discharge fluids to the sites of metal precipitation. Deeper, wider and more permeable faults are more likely to behave as the fluid discharge pathways, whereas shallow, narrow or less permeable faults act as marine water recharge pathways. Compared with these fault‐related factors, aquifer physical properties are less important in determining fluid flow patterns and the geothermal regime. These results are an important step in understanding hydrothermal fluid flow in sedimentary basins in order to develop effective exploration criteria for the location of stratiform Zn–Pb–Ag deposits.
Mathematical modeling of phase separation of seawater near an igneous dike
Authors: Lewis K. C. , Lowell R. P.
Published: July 2004

We provide a simplified treatment of phase separation of seawater near an igneous dike to obtain rough estimates of the thickness and duration of the two‐phase zone, the volume fractions of vapor and brine formed, and their distribution in the subsurface. Under the assumption that heat transfer occurs mainly by thermal conduction we show that, for a 2‐m wide dike, the maximum width of the two phase zone is approximately 20 cm and that a zone of halite is initially deposited near the dike wall. The two‐phase zone is mainly filled with vapor. For a value of thermal diffusivity of a = 10−6 m2 sec−1, the two‐phase zone begins to disappear at the base of the system after 13 days, and disappears completely by 16 days. For a lower value of thermal diffusivity, the width of the two‐phase region does not change appreciably but its duration increases as a−1. The width of the two‐phase zone determined by this simplified model agrees reasonably well with transient numerical solutions for the analogous two‐phase flow in a pure water system; however the duration of two‐phase flow is matched better using a smaller value of a. We compare the seafloor values of vapor salinity and temperature given by the model with vapor salinity data from the ‘A’ vent at 9–10°N on the East Pacific Rise (EPR) and argue that either non‐equilibrium thermodynamic behavior or near‐surface mixing of brine with vapor in the two‐phase region may explain the discrepancies between model predictions and data.
On the Reconceptualizing of Gender: Implications for Research Design
Authors: Knaak Stephanie
Published: July 2004

This article takes up the concept of gender as a specific case in point of spontaneous sociology. The contributory aim is to set forth a multidimensional framework for addressing gender in research. I summarize key developments in gender theory, tease out their implications for research design, and outline four interlocking strategies for how the conventional “gender=male/female” variable might be reconfigured. The first strategy involves shifting from a biological foundationalist paradigm of gender to a social constructionist one, and is the precondition upon which the other strategies are based. Second, research designs must address gender as multilayered and multivariable, not as a single, simple attribute. Third, more attention needs to be given to gender as active and as an outcome of social forces. Fourth is the suggestion to reconfigure the standard gender variable to one reflecting a continuum of positions. A possible terminological reconfiguration of the standard variable is suggested.
Access Denied: The Relationship between Alcohol Prohibition and Driving under the Influence
Authors: Powers Edward L. , Wilson Janet K.
Published: July 2004

Alcohol prohibition continues to be a policy pursued by more than 10 percent of the counties in the United States. However, many questions exist about the effectiveness of prohibition policies for controlling social maladies such as accidents and fatal injuries related to driving under the influence (DUI). In this research, a situational crime prevention framework is used to evaluate the hypothetical relationship between countywide alcohol prohibition and incidents of DUI. We focus specifically on county‐level comparisons of DUI arrests in Arkansas where slightly more than half of the counties are “dry” (sale of alcohol to the general public is prohibited). Utilizing police reports of DUI arrests we examine whether the dry county distinction is indeed associated with fewer DUI arrests than found in wet counties. Findings indicate that the dry county distinction does not result in significantly lower rates of DUI arrest when law enforcement variables are considered. These findings are analyzed and implications for future research are discussed.
The Impact of Religious Homogeneity on the Rate of Divorce in the United States
Authors: Mullins Larry C. , Brackett Kimberly P. , Bogie Donald W. , Pruett Daniel
Published: July 2004

This study extends the understanding of the relationship between religious homogeneity, that is, the extent to which formal religious groups are concentrated at the county level, and the rate of persons currently divorced in those counties. Linking the research question to Durkheimian precepts of religion as an integrative force in social life, the essential question is, “At the county level, does the rate of currently divorced vary inversely with more concentrated affiliation with formal religious organizations?” We investigate this relationship using data from the 1990 U.S. Census and from the Glenmary Research Center that encompasses 621 counties in the U.S., that is, a 20 percent random sample of counties from each state. As hypothesized, the divorced rate is inversely related to religious homogeneity, even after controlling for a series of factors that have been shown to be correlated with divorce in other studies.
Causes of Early and Later Organizational Adoption: The Case of Corporate Downsizing
Authors: Budros Art
Published: July 2004

While the causes of organizational adoption of new practices often vary across social contexts, organizational theories seldom recognize this fact. One of the few contextual theories on adoption views the causes of adoption as varying according to the timing of adoption: Economic causes should govern early adoption and institutional causes should govern later adoption. Tests of this theory generally have focused on gradual adoption among noneconomic organizations. Recognizing the need to expand our understanding of the timing of organizational adoption, I examine rapid adoption among economic organizations. More specifically, I focus on the adoption of downsizing programs among Fortune 100 firms and report that economic and institutional factors have affected downsizing throughout the downsizing era. Interpretation of these findings sheds light on the genesis and continuation of the downsizing era and on the impact that the rise of investor capitalism has had on shifts in the specific causes of early and later downsizings. I conclude by stressing the theoretical and practical utility of investigating how new practices spread across organizations in different contexts.
Who Cares If Police Become Violent? Explaining Approval of Police Use of Force Using a National Sample
Authors: Thompson Brian L. , Lee James Daniel
Published: July 2004

Understanding police violence is important in part because police violence, if generally tolerated, could transform a society based on law into one governed by political and personal whim. This research asks whether the conflict perspective can explain which groups are more likely to approve of police use of force, and whether several dimensions of power are at issue or just a few. Previous studies have found that race is the most important factor in determining approval of police use of force. Gender, age, class, and other variables have shown mixed results. Using a national sample (1998 General Social Survey), this paper contributes a more comprehensive examination of this issue to the small body of literature in this area. We look at approval of police use of force in five scenarios. Our findings show that minorities and women are more likely to disapprove of police use of force. Supporting a narrow application of conflict theory, other dimensions of power appear not to affect attitudes toward police hitting citizens. Context of violence matters too. When situations are not actively threatening for officers, by near consensus, violence is unacceptable. Disagreement comes from less clear‐cut circumstances.
The Effects of Race and Family Structure on Women's Spatial Relationship to the Labor Market
Authors: Elliott James R. , Joyce Marilyn S.
Published: July 2004

This study examines the intersection of race, family structure, and economic inequality through women's spatial relationships to the labor market. Using survey data from three major metro labor markets, we operationalize spatial relationships in two ways: first, using a conventional measure of commute time, and second, using an indicator of neighborhood job contacts to obtain employment. Results indicate that family structure exerts no direct effect on women's spatial relationship to the labor market. Race, by contrast, plays a strong role, mediating women's reliance on mass transit, their response to teenage kids in the household, and their likelihood of using neighbors to find employment. The result is a situation in which black and Latina women are more likely than white women to rely on localized job networks to obtain employment that requires longer commutes from home.
Brugada and Long QT‐3 Syndromes: Two Phenotypes of the Sodium Channel Disease
Authors: Khan Ijaz A. , Nair Chandra K.
Published: July 2004

Brugada and long QT‐3 syndromes are two allelic diseases caused by different mutations in SCN5A gene inherited by an autosomal dominant pattern with variable penetrance. Both of these syndromes are ion channel diseases of the heart manifest on surface electrocardiogram by ST‐segment elevation in the right precordial leads and prolonged QTc interval, respectively, with predilection for polymorphic ventricular tachycardia and sudden death, which may be the first manifestation of the disease. Brugada syndrome usually manifests during adulthood with male preponderance, whereas long QT3 syndrome usually manifests in teenage years, although it can also manifest in adulthood. Class IA and IC antiarrhythmic drugs increase ST‐segment elevation and predilection for polymorphic ventricular tachycardia and ventricular fibrillation in Brugada syndrome, whereas these agents shorten the repolarization and QTc interval, and thus may be beneficial in long QT‐3 syndrome. Beta‐blockade also increases the ST‐segment elevation in Brugada syndrome but decreases the dispersion of repolarization in long QT‐3 syndrome. Mexiletine, a class IB sodium channel blocker decreases QTc interval as well as dispersion of repolarization in long QT‐3 syndrome but has no effect on Brugada syndrome. The only effective treatment available at this time for Brugada syndrome is implantable cardioverter defibrillator, although repeated episodes of polymorphic ventricular tachycardia can be treated with isoproterenol. In symptomatic patients of long QT‐3 syndrome in whom the torsade de pointes is bradycardia‐dependent or pause‐dependent, a pacemaker could be used to avoid bradycardia and pauses and an implantable cardioverter defibrillator is indicated where arrhythmia is not controlled with pacemaker and beta‐blockade. However, the combination of new devices with pacemaker and cardioverter‐defibrillator capabilities appear promising in these patients warranting further study.
ST‐Depression with Negative T Waves in Leads V4–V5—A Marker of Severe Coronary Artery Disease in Non‐ST Elevation Acute Coronary Syndrome: A Prospective Study of Angina at Rest, with Troponin, Clinical, Electrocardiographic, and Angiographic Correlation
Authors: Nikus Kjell C. , Eskola Markku J. , Virtanen Vesa K. , Vikman Saila , Niemelä Kari O. , Huhtala Heini , Sclarovsky Samuel
Published: July 2004

Background: The significance of ST‐segment depression in acute coronary syndrome has been the subject of debate for many decades. Studies indicate that different manifestations of ST/T changes may have significantly different prognostic implications.

Methods and Results: We studied the correlation of ST/T changes in 12‐lead electrocardiography recorded during pain, to clinical and angiographic findings and in‐hospital prognosis, in patients with non‐ST‐elevation acute coronary syndrome and elevated troponin levels. Fifty consecutive patients could be differentiated into two groups: (1) 25 patients with ST‐segment depression and a negative T wave maximally in leads V4–5, (2) 25 patients with ST‐segment depression and a positive T wave in the precordial lead with maximal ST‐segment depression. Patients in group I had significantly more often left main or left main equivalent coronary artery disease; 76% versus 8% (P < 0.001), heart failure; 40% versus 4% (P = 0.005), and higher in‐hospital mortality; 24% versus 0% (P = 0.02), than patients in group II. The troponin levels did not differ significantly between the groups.

Conclusions: In patients with non‐ST‐elevation acute coronary syndrome and elevated troponin levels two subgroups could be identified. Transient ST‐segment depression and a negative T wave maximally in leads V4–5 during anginal pain predicts left main, left main equivalent, or severe three‐vessel coronary artery disease with high sensitivity and specificity. In patients with ST‐segment depression and a positive T wave, there is a high probability of one‐vessel disease.
Is Baseline Autonomic Tone Associated with New Onset Atrial Fibrillation?: Insights from the Framingham Heart Study
Authors: Singh Jagmeet P. , Larson Martin G. , Levy Daniel , Evans Jane C. , Tsuji Hisako , Benjamin Emelia J.
Published: July 2004

Background: Recent reports have indicated that autonomic tone fluctuations measured by heart rate variability (HRV) precede episodes of paroxysmal atrial fibrillation (AF). Little is known about the impact of baseline autonomic tone and the development of new onset AF in a population‐based cohort. The purpose of this study was to assess the role of HRV as a predictor of new onset AF.

Method: Ambulatory ECG recordings obtained from the Framingham Heart Study subjects attending a routine examination were processed for HRV. The HRV variables analyzed included standard deviation of normal R‐R intervals (SDNN), low frequency power (LF), high frequency power (HF), and LF/HF ratio. There were 1434 women and 1142 men (54 ± 14.1 years) eligible for the study.

Results: In 12 years of follow‐up, 65 women and 67 men had new onset AF. The study had 80% power to detect a hazard ratio (HR) of 1.3 per standard deviation (SD) decrement in HRV. A one SD decrement in log LF/HF was associated with increased risk of developing AF (HR = 1.23; 95% confidence intervals (CI) = 1.06–1.44) in age‐ and sex‐adjusted models; the association was no longer significant (HR = 1.15; 95% CI = 0.98–1.35) after adjusting for potential confounders.

Conclusion: Autonomic dysregulation at baseline, as reflected by an altered HRV is associated with risk of AF; however, this association does not persist after adjusting for potential confounders. Much of the apparent association between HRV and AF is mediated by traditional risk factors.
Detection of Multivessel Disease Post Myocardial Infarction Using an Exercise‐Induced QRS Score
Authors: Michaelides Andreas P. , Papapetrou Dimitris , Aigyptiadou Maria‐Niki K. , Psomadaki Zoi D. , Andrikopoulos George K. , Kartalis Athanasios , Fourlas Christos , Stefanadis Christodoulos I.
Published: July 2004

Objective: The aim of this study was to investigate the ability of Athens QRS score values to detect stenoses in other coronary arteries than the obstructed ones (which caused the myocardial infarction [MI]) in patients with a history of MI.

Methods: We studied 125 patients (93 males and 32 females, mean age 54 ± 7 years [range 45–68 years]) with a history of MI (46 patients with anterior MI, 54 patients with inferior MI, 25 patients with lateral MI). All patients underwent treadmill exercise testing and coronary arteriography.

Results: Athens QRS score values were inversely related to the extent of CAD: −0.5 ± 0.3 mm for patients with 1‐VD (obstructed vessel), −3.4 ± 2.2 mm for patients with 2‐VD (obstructed vessel and stenosis in another vessel), and −5 ± 1.8 mm for patients with 3‐VD (obstructed vessel and stenoses in two more vessels). The ROC curves for the detection of multivessel disease showed that the area under the curve for QRS score values < −3 mm is significantly higher than the curve for ST‐segment depression ≥1 mm (0.948 vs 0.792, P < 0.001).

Conclusions: Values of the Athens QRS score less than −3 may distinguish single‐ from multivessel coronary artery disease in patients with a history of MI.
Decrease/Disappearance of Pacemaker Stimulus “Spikes” Due to Anasarca: Further Proof that the Mechanism of Attenuation of ECG Voltage with Anasarca Is Extracardiac in Origin
Authors: Madias John E.
Published: July 2004

Background: Recent work showed that AN leads to a decrement of the potentials of QRS complexes. Although the mechanism has been thought to be extracardiac in origin, and due to a decrease of the electrical impedance of the volume conductor from water overload, more proof on this will be welcome. It is hypothesized that the pacemaker “spikes” (PS) are independent of heart depolarization, and thus their change at the body surface with AN would be reflective of extracardiac influences. This study was designed to explore the impact of anasarca (AN) on the amplitude of PSs, and to further delineate the mechanism of ECG attenuation with AN.

Methods: The sum of PS measurements in millimeters in the 6 limb leads (ΣPS6), and 12 ECG leads (ΣPS12), and the sum of QRS complexes in the 6 limb leads (ΣQRS6), and 12 ECG leads (ΣQRS12) were computed in six patients fitted with a pacemaker (3 with AN and 3 “controls”), and these variables were correlated with weight change.

Results: Correlation of percentage change in weight and ΣPS12 was excellent (r =−0.88, P = 0.02), but not for ΣPS6 (r =−0.73, P = 0.1). Also, the percentage weight correlated well with ΣQRS6 (r =−0.82, P = 0.046), but not ΣQRS12 (r =−0.61, P = 0.2). Correlation of percentage change in ΣQRS6 and ΣPS6 was excellent (r = 0.91, P = 0.01), but not the percentage change in ΣQRS12 and ΣPS12 (r = 0.72, P = 0.11).

Conclusions: PSs undergo amplitude attenuation in patients developing AN, similar to the one noted in the QRS complexes. Since these changes are independent of the cardiac activation, and are similar in extent to those impacting the QRS complexes, the attenuation of the voltage of the entire ECG curve in AN appears to be extracardiac in origin.
Patterns of QT Dispersion in Athletic and Hypertensive Left Ventricular Hypertrophy
Authors: Lonati Laura Maria , Magnaghi Gaia , Bizzi Caterina , Leonetti Gastone
Published: July 2004

Objective: The objective of this article is to assess whether left ventricular hypertrophy (LVH) due to physical training or of hypertensive patients shows similarities in QT length and QT dispersion.

Methods: A total of 51 subjects were studied: 17 essential hypertensive patients (27.7 ± 5.6 years), 17 athletes involved in agonistic activity (canoeing) (24.8 ± 6.1 years), and 17 normotensive healthy subjects as control group (24.8 ± 3.6 years). The testing protocol consisted of (1) clinic BP measurement, (2) echocardiography, (3) 12‐lead electrocardiographic examination (QT max, QTc max, QT min, QTc min, ΔQT, ΔQTc).

Results: There were no significant differences between the body surface area, height, and age of the three groups. Clinic blood pressure was higher in hypertensives (146.5 ± 45.2/93.5 ± 4.9 mmHg) versus athletes (120.9 ± 10.8/77.1 ± 6.0 mmHg) and controls (123.5 ± 4.8/78.8 ± 2.9 mmHg) by definition. Indexed left ventricular mass (LVM/BSA) was significantly greater in both athletes (148.9 ± 21.1 g/m2) and hypertensives (117.1 ± 15.2 g/m2) versus controls (81.1 ± 14.5 g/m2; P < 0.01), there being no statistical difference among them. LVH (LVMI > 125 g/m2) was observed in all athletes, while the prevalence in hypertensives was 50%. In spite of this large difference in cardiac structure there were no significant differences in QT parameters between athletes and the control group, while hypertensive patients showed a significant increase in QT dispersion versus the two other groups (ΔQT 82 ± 2.1, 48 ± 1.3, 49 ± 2.3 ms; P < 0.01; ΔQTc 88 ± 2.0, 47 ± 1.4, 54 ± 2.7; P < 0.01).

Conclusions: LVH induced by physical training activity is not associated with an increase in QT dispersion, whereas pathological increase in LVM secondary to hypertension is accompanied by an increased QT dispersion.
Abnormalities of the Repolarization Characteristics of Patients with Heart Failure Progress with Symptom Severity
Authors: Lang Christopher C. E. , Neilson James M. M. , Flapan Andrew D.
Published: July 2004

Background: Congestive heart failure is a common condition with high mortality. Many of these deaths are sudden and unexpected. Ventricular action potential, surface repolarization (QT interval), and dispersion of repolarization are prolonged in the failing heart, contributing to arrhythmogenesis and sudden death. We studied the relationship between QT and heart rate (RR interval) from ambulatory recordings using a novel method in patients with ischemic heart disease and varying degrees of left‐ventricular impairment (IHD) and compared them to healthy subjects (HS). We compare the degree of abnormality with the functional impairment and ejection fraction.

Methods: Using a previously described automated method for continuous estimation of the QT/RR characteristic that incorporates a correction formula for compensation of QT adaptation lag (VERDA, Del Mar Reynolds Medical Ltd., Hertford, UK), we compared recordings from 41 IHD patients with age‐matched HS.

Results: IHD Patients have prolonged 24‐hour mean QTo (461 ms vs 426 ms, P < 0.01), and abnormal rate dependence relative to controls (24‐hour mean slope: 0.20 vs 0.14, P < 0.001; J: 0.38 vs 0.28, P < 0.001). There is increased temporal variation in J with respect to HS. These abnormalities of repolarization increase with worsening NYHA class, but do not correlate with ejection fraction.

Conclusions: The use of a universal correction formula to compare dynamic QT data in IHD patients is inappropriate. The observed progressive abnormalities may be responsible for the high incidence of sudden death through promotion of arrhythmias.
Enhanced External Counterpulsation Therapy: Significant Clinical Improvement without Electrophysiologic Remodeling
Authors: Henrikson Charles A. , Chandra‐Strobos Nisha
Published: July 2004

Background: Enhanced external counterpulsation therapy (EECP), in addition to improving coronary flow and increasing the time to ischemia, noninvasively alters hemodynamics in patients with severe coronary artery disease (CAD). Other treatments that alter hemodynamics, for example, balloon valvuloplasty, left ventricular assist devices, and pharmacologic antagonism of the rennin–angiotensin system, promote electrophysiologic remodeling, as evidenced by alterations in the QT interval.

Methods: We studied 28 patients who completed a 7‐week, 35‐hour session of EECP to assess whether such therapy would also result in electrophysiologic remodeling.

Results: All patients had class II–III angina, imaging‐proven ischemia, and severe, near‐inoperable CAD. Of 28 patients, with a mean age 62 ± 13 years (mean ± SD), 78% were male, 46% diabetic, 82% hypertensive, 60% had undergone angioplasty, and 67% had undergone bypass surgery. The mean ejection fraction was 44% (range 25–60%). Following EECP, most patients (82%) had at least a one full class improvement in their anginal pattern. In most patients, there was substantial baseline conduction system disease present: a mean QRS of 105 ± 19 ms. It is to be noted that there was no significant change in heart rate (HR), PR, QRS, or QTc intervals before and after EECP in either clinical responders or nonresponders. When analyzed by response to EECP, ejection fraction, or history of revascularization, there were still no detectable changes in ECG parameters (all P = NS).

Conclusions: While EECP remains an effective treatment for severe CAD, it does not prompt early electrical remodeling of the heart.