bluuebunny/crossref_metadata_2025 huggingface dataset:
Radon Levels in Dwellings of New Mirpur Azad Kashmir, Sub-Himalayas, Pakistan
Authors: Iqbal Arshid , Mirza Shahid Baig  , Akram Muhammad , Kazmi Asma , Saleem Sobia , Abdul Aziz Qureshi
Published: September 2008

Radon concentrations were measured in kucha, semi-kucha and pucka houses located on the sedimentary rocks of Early Pleistocene-Pliocene Soan Formation, Pleistocene Mirpur conglomerate and recent deposits. The radon concentration was measured using CN 85 nuclear tracks etch detectors in box type dosimeters installed in the bedrooms and kitchens of the houses. It was found to vary from 14 ± 7 Bqm-3 to 258 ± 28 Bqm-3 with an average of 105 ± 17 Bqm-3. The average radon concentration in the kucha, semi-kucha and pucka houses was 78 ± 15 Bqm-3, 108 ± 18 Bqm-3 and 108± 18 Bqm -3 respectively. The increase in radon concentration from kucha to pucka houses was attributed to the type of house, differing humidity related to the Mangla Dam, temperature, bed rock geology, structures (joints, fractures and faults), aggregates and uranium-bearing sand. This study shows that the average radon level is within the accepted safe health limit (200 Bqm -3) for the inhabitants of New Mirpur Azad Kashmir, Pakistan.
Is It Really Clear?
Authors: Levinger Miriam , Ronen Tammie
Published: September 2008

• Summary: The methodological challenge of adapting research tools to the needs of the study population takes on paramount importance when participants have cultural, social, cognitive, or other needs rendering commonly used questionnaires problematic. This article describes research tools' exploratory adaptation to a sample of Israeli deaf adults, during a comparative study of 101 deaf adults aged 28 to 51 years and 57 hearing adults aged 24 to 52. Levinger (2003) conducted a large study on this sample, investigating the links between adults' personal, familial, and societal variables and their ability to separate from parents and establish spousal intimacy.

• Findings: The present article is a sub-study focusing on the adaptation of the larger study's design of specific tools to examine the deaf population. It describes the tools' preparation, administration, and analysis, including examination of the various versions' compatibility and the versions' cultural and linguistic adaptation to the participants' needs. The study included five research tools containing 125 questions altogether. To minimize the biasing risks due to deaf adults' reading comprehension difficulties or misinterpretations of questions' intent, we prepared three versions for each of the tools except for the 30-item demographic questionnaire: a) the original written version in regular Hebrew, matched to participants for gender, b) a revised written version in easy language (adapted to the deaf population and gender-matched), and c) a videotaped sign language version. Taking part in preparing the various versions were deaf representatives of the deaf community and hearing translators into Israeli Sign Language.

• Applications : This article discusses methodological repercussions of these adaptations; compares the choices made by participants regarding the various adaptations offered them; and highlights the importance of familiarity with participants' characteristics and unique needs.
Three Principles Psychology: Applications in Leadership Development and Coaching
Authors: Polsfuss Craig , Ardichvili Alexandre
Published: September 2008

The problem and the solution. Three Principles Psychology (TPP) is a psycho-educational approach gaining increasing popularity among leadership development professionals. This article describes the principles underlying this approach and it reports results of a qualitative case study of TPP practitioners and business executives who have participated in related coaching and/or training. Based on the analysis of interview results from the case, the article discusses, among other things, the following issues: TPP's role in improving leadership effectiveness; major strengths and potential shortcomings of TPP as a leadership development approach; and attempts to implement TPP as an operating philosophy of organizations. The article concludes with recommendations for further research and human resource development (HRD) practice. It should be noted that through its earlier developmental stages Three Principles Psychology has also been known as Psychology of Mind, Neo-Cognitive Psychology, and Health Realization.
Creating Greater Success in Succession Planning
Authors: Barnett Robert , Davis Sandra
Published: September 2008

The problem and the solution .The prevalence of formalized succession planning practices in organizations appears to be increasing, largely due to changing demographic and related trends. However, many organization leaders report low levels of confidence in their succession planning systems and processes. Best succession and talent management practices can help organizations achieve significant benefits, including improved financial performance. A practical, five-step approach to succession planning is proposed that incorporates both best practices and an innovative application of role theory. The approach should help organizations look to and prepare for the future more effectively, including better specifying the future requirements they will have for their leaders. Implications for human resource development (HRD) professionals and recommendations for further research are discussed.
A multi-center, randomized, double blind placebo-controlled trial of estrogens to prevent Alzheimer's disease and loss of memory in women: design and baseline characteristics
Authors: Sano Mary , Jacobs Diane , Andrews Howard , Bell Karen , Graff-Radford Neill , Lucas John , Rabins Peter , Bolla Karen , Tsai Wei-Yan , Cross Peter , Andrews Karen , Costa Rosann , Xiaodong Luo
Published: September 2008

Background Observational studies and small clinical trials suggested that hormone replacement therapy (HRT) decreases risk of cognitive loss and Alzheimer's disease (AD) in postmenopausal women and may have value in primary prevention. Purpose A clinical trial was designed to determine if HRT delays AD or memory loss. This report describes the rationale and original design of the trial and details extensive modifications that were required to respond to unanticipated findings that emerged from other studies during the course of the trial.

Methods The trial was designed as a multi-center, placebo-controlled primary prevention trial for women 65 years of age or older with a family history of dementia. Recruitment from local sites was supplemented by centralized efforts to use names of Medicare beneficiaries. Inclusion criteria included good general health and intact memory functioning. Participants were randomized to HRT or placebo in a 1:1 ratio. Assignment was stratified by hysterectomy status and site. The primary outcomes were incident AD and memory decline on neuropsychological testing.

Results Enrollment began in March 1998. In response to the Women's Health Initiative (WHI) May 2002 report of increased incidence of heart disease, stroke, pulmonary embolism, and breast cancer among women randomized to HRT, participants were re-consented with a revised consent form. Procedural modifications, including discontinuation of study medication and a modification of the planned primary outcome based on a final enrollment below the target enrollment (N = 477), were enacted in response to the subsequent WHI Memory Study report of increased risk of dementia and poorer cognitive function with HRT. The mean length of treatment exposure prior to discontinuation was 2.14 years. Participants' mean age at baseline was 72.8; mean education was 14.2 years. Minority participation was 19% and 34% had a hysterectomy. The study continues to follow these participants for a total of 5 years blind to the original medication assignment.

Limitations Results reported from the WHI during the course of this study mandated extensive procedural modifications, including discontinuing recruitment before completion and halting study medication. Alternative strategies for study redesign that were considered are discussed. Clinical Trials 2008; 5: 523—533. http://ctj.sagepub.com
Microparticles as tissue engineering scaffolds: Manufacture, modification and manipulation
Authors: Chau D. Y. S. , Agashi K. , Shakesheff K. M.
Published: September 2008

Tissue engineering, a field which focusses on the replacement, repair and regeneration of damaged or diseased tissue by the application of biomaterials, cells and associated biological molecules, has advanced rapidly due to the intense demand for tissue substitutes. A key principle in tissue engineering involves growing the appropriate cells in vitro for the desired application before delivery into the body of a patient. The implantable devices, biological constructs or scaffolds, developed in tissue engineering aim to provide the initial architecture required for supporting the cells as well as define the micro and macrostructure of the final engineered product. Furthermore, these scaffolds may be exploited to release drugs and/or growth factors in a controlled manner, thus facilitating the repair and regeneration of the target tissue. Microparticles, spherical carrier scaffolds, have recently received extensive interest for their potential therapeutic applications in a diverse range of clinical and regenerative medical settings. Not only can these versatile subunits be used as cell culture scaffolds, their innate structure reduces the degradation of encapsulated biologically active molecules and also allows their exploitation as a localised injectable delivery system. The purpose of the present article is to review the tissue engineering applications of these microparticles and to provide a brief overview of the critical factors considered during their formulation and use – including the range of materials used and the different modification protocols and technologies exploited to improve and enhance their mechanical properties and biocompatibility for regenerative medicine.
Mechanical improvement of zein protein as scaffold for bone tissue engineering
Authors: Wang H.-J. , Gong S.-J. , Wang J.-Y.
Published: September 2008

Although extensive efforts have been put into the development of porous scaffolds from natural materials for bone regeneration with encouraging results, they still have a common limitation: the inherent lack of strength associated with porosity. That is to say, they are not strong enough to meet the specific requirements of load bearing applications. The authors have reported a series studies on possible application of a natural material, zein protein from maize, as a new kind of biomaterial for tissue engineering. The result showed a good cell compatibility and biodegradability in tissue within eight months. To improve its mechanical property (especially the brittleness), stearic acid or oleic acid was added. The mechanical properties, especially the tensile and flexible properties were improved significantly. The possible mechanism is discussed.
Chitosan as scaffold matrix for tissue engineering
Authors: Thein-Han W. W. , Kitiyanant Y. , Misra R. D. K.
Published: September 2008

Tissue engineering (TE) is an interdisciplinary field involving principles of engineering and biological sciences to fabricate new tissue and organs using cells and scaffolds. It is expected to play an important role in the therapeutic approach in the current and future medicine. In the coming years, there will be an increased emphasis on the usage of biomaterials that can be integrated forming a renewable interface with prosthetic implants for regenerated medicine and cell based TE on a long term basis. In this regard, significant consideration is being given to natural cationic chitosan as a matrix for TE. Chitosan is a linear polysaccharide, produced from crustacean sources. Recent studies suggest that chitosan based matrixes are promising for TE applications. The authors describe here the uniqueness and versatility of chitosan in bone and cartilage TE in terms of structure–property relationship of chitosan scaffolds.
Design and preparation of bionanocomposites based on layered solids with functional and structural properties
Authors: Darder M. , Aranda P. , Ruiz A. I. , Fernandes F. M. , Ruiz-Hitzky E.
Published: September 2008

Biopolymers such as chitosan, pectin, alginate, ı-carrageenan and gelatin, can be assembled to layered solids by direct intercalation via ion exchange in the case of smectites or a ‘co-organised assembly’ method in the case of layered double hydroxides (LDHs). Layered perovskites can be delaminated and combined with the biopolymers following a delamination/restacking procedure. The starting cationic exchange ability of smectites such as montmorillonite is turned into an anionic exchange capacity due to the intercalated chitosan excess, while an opposite effect is observed in the case of the LDHs after incorporation of alginate, pectin or ı-carrageenan. This fact, combined with the good mechanical properties of these bionanocomposites, allows their use as the sensing phase of potentiometric sensors applied to the recognition of cationic or anionic species in aqueous solution. Besides, perovskite–gelatin bionanocomposites can be processed as robust translucent films with highly oriented two-dimensional particles exhibiting elevated dielectric permittivity values.
Design and manufacture of microporous polymeric materials with hierarchal complex structure for biomedical application
Authors: Guarino V. , Causa F. , Salerno A. , Ambrosio L. , Netti P. A.
Published: September 2008

Porous biodegradable polymeric scaffolds are essential for tissue engineering application since they should provide the adequate three-dimensional structure for cellular attachment and tissue development. In particular, pore size and shape and overall porosity are key structural features in controlling neotissue formation. Since scaffolds structural properties play a relevant role in all processes involved in tissue genesis including cell adhesion, migration, proliferation, growth, differentiation and biosynthesis, an accurate control over the pore size and its distribution, pore shape, pore interconnectivity, and overall porosity of scaffolds is mandatory for the success of any tissue engineering approach. Several methods have been proposed to tailor make porous scaffolds to obtain the desired pore structure. Here, three techniques to emboss a controlled pattern of porosity in biodegradable polymers, particulate leaching, phase separation and gas foaming along with their combinations, are critically reviewed highlighting process–structure–property relationship.
A key role for G-CSF–induced neutrophil production and trafficking during inflammatory arthritis
Authors: Eyles Jo L. , Hickey Michael J. , Norman M. Ursula , Croker Ben A. , Roberts Andrew W. , Drake Sarah F. , James Will G. , Metcalf Donald , Campbell Ian K. , Wicks Ian P.
Published: September 2008

We have previously shown that G-CSF–deficient (G-CSF−/−) mice are markedly protected from collagen-induced arthritis (CIA), which is the major murine model of rheumatoid arthritis, and now investigate the mechanisms by which G-CSF can promote inflammatory disease. Serum G-CSF levels were significantly elevated during CIA. Reciprocal bone marrow chimeras using G-CSF−/−, G-CSFR−/−, and wild-type (WT) mice identified nonhematopoietic cells as the major producers of G-CSF and hematopoietic cells as the major responders to G-CSF during CIA. Protection against CIA was associated with relative neutropenia. Depletion of neutrophils or blockade of the neutrophil adhesion molecule, Mac-1, dramatically attenuated the progression of established CIA in WT mice. Intravital microscopy of the microcirculation showed that both local and systemic administration of G-CSF significantly increased leukocyte trafficking into tissues in vivo. G-CSF–induced trafficking was Mac-1 dependent, and G-CSF up-regulated CD11b expression on neutrophils. Multiphoton microscopy of synovial vessels in the knee joint during CIA revealed significantly fewer adherent Gr-1+ neutrophils in G-CSF−/− mice compared with WT mice. These data confirm a central proinflammatory role for G-CSF in the pathogenesis of inflammatory arthritis, which may be due to the promotion of neutrophil trafficking into inflamed joints, in addition to G-CSF–induced neutrophil production.
Intermittent hypoxia and sleep-disordered breathing: current concepts and perspectives
Authors: Lévy P. , Pépin J-L. , Arnaud C. , Tamisier R. , Borel J-C. , Dematteis M. , Godin-Ribuot D. , Ribuot C.
Published: September 2008

There are three major types of sleep-disordered breathing (SDB) with respect to prevalence and health consequences,i.e.obstructive sleep apnoea syndrome (OSAS), Cheyne–Stokes respiration and central sleep apnoea (CSR-CSA) in chronic heart failure, and obesity hypoventilation syndrome (OHS). In all three conditions, hypoxia appears to affect body functioning in different ways. Most of the molecular and cellular mechanisms that occur in response to SDB-related hypoxia remain unknown.

In OSAS, an inflammatory cascade mainly dependent upon intermittent hypoxia has been described. There is a strong interaction between haemodynamic and inflammatory changes in promoting vascular remodelling. Moreover, during OSAS, most organ, tissue or functional impairment is related to the severity of nocturnal hypoxia. CSR-CSA occurring during heart failure is primarily a consequence of cardiac impairment. CSR-CSA has deleterious consequences for cardiac prognosis and mortality since it favours sympathetic activation, ventricular ectopy and atrial fibrillation. Although correction of CSR-CSA seems to be critical, there is a need to establish therapy guidelines in large randomised controlled trials.

Finally, OHS is a growing health concern, owing to the worldwide obesity epidemic and OHS morbidities. The pathophysiology of OHS remains largely unknown. However, resistance to leptin, obesity and severe nocturnal hypoxia lead to insulin resistance and endothelial dysfunction. In addition, several adipokines may be triggered by hypoxia and explain, at least in part, OHS morbidity and mortality.

Overall, chronic intermittent hypoxia appears to have specific genomic effects that differ notably from continuous hypoxia. Further research is required to fully elucidate the molecular and cellular mechanisms.
Lung hyperinflation: foe or friend?
Authors: Eichinger M. , Walterspacher S. , Scholz T. , Tetzlaff K. , Röcker K. , Muth C-M. , Puderbach M. , Kauczor H-U. , Sorichter S.
Published: September 2008

Breath-hold divers employ glossopharyngeal insufflation (GI) in order to prevent the lungs from compressing at great depth and to increase intrapulmonary oxygen stores, thus increasing breath-hold time.

The presented case study shows the physiological data and dynamic magnetic resonance imaging (dMRI) findings of acute hyperinflation, deliberately induced by GI, in a breath-hold diver and discusses the current state of knowledge regarding the associated hazards of this unique competitive sport.

Static and dynamic lung volumes and expiratory flows were within the normal range, with vital capacity and peak expiratory flow being higher than the predicted values. Airway resistance and diffusing capacity of the lung for carbon monoxide were normal. Static compliance was normal and increased five-fold with hyperinflation. dMRI revealed a preserved shape of the thorax and diaphragm with hyperinflation. A herniation of the lung beneath the sternum and enlargement of the costodiaphragmatic angle were additional findings during the GI manoeuvre. After expiration, complete resolution to baseline was demonstrated.

Hyperinflation can be physiological and even protective under abnormal physical conditions in the sense of acute adaptation to deep breath-hold diving. Dynamic magnetic resonance imaging is adequate for visualisation of the sequence of the glossopharyngeal insufflation manoeuvre and the complete reversibility of deliberate hyperinflation.
Molecular architecture of the fruit fly's airway epithelial immune system
Authors: Wagner Christina , Isermann Kerstin , Fehrenbach Heinz , Roeder Thomas
Published: September 2008

Background

Airway epithelial cells not only constitute a physical barrier, but also the first line of defence against airborne pathogens. At the same time, they are constantly exposed to reactive oxygen species. Therefore, airway epithelia cells have to possess a sophisticated innate immune system and a molecular armamentarium to detoxify reactive oxygen species. It has become apparent that deregulation of epithelial innate immunity is a major reason for the development of chronic inflammatory lung diseases. To elucidate the molecular architecture of the innate immune system of airway epithelial cells, we choose the fruit fly Drosophila melanogaster as a model, because it has the simplest type of airways, consisting of epithelial cells only. Elucidating the structure of the innate immune system of this "airway epithelial cell culture" might enable us to understand why deregulatory processes in innate immune signalling cascades lead to long lasting inflammatory events.

Results

All airway epithelial cells of the fruit fly are able to launch an immune response. They contain only one functional signal transduction pathway that converges onto NF-κB factors, namely the IMD-pathway, which is homologous to the TNF-α receptor pathway. Although vital parts of the Toll-pathway are missing, dorsal and dif, the NF-κB factors dedicated to this signalling system, are present. Other pathways involved in immune regulation, such as the JNK- and the JAK/STAT-pathway, are completely functional in these cells. In addition, most peptidoglycan recognition proteins, representing the almost complete collection of pattern recognition receptors, are part of the epithelial cells equipment. Potential effector molecules are different antimicrobial peptides and lysozymes, but also transferrin that can inhibit bacterial growth through iron-depletion. Reactive oxygen species can be inactivated through the almost complete armamentarium of enzymatic antioxidants that has the fly to its disposal.

Conclusion

The innate immune system of the fly's airway epithelium has a very peculiar organization. A great variety of pattern recognition receptors as well as of potential effector molecules are conspicuous, whereas signalling presumably occurs through a single NF-κB activating pathway. This architecture will allow reacting if confronted with different bacterial or fungal elicitors by activation of a multitude of effectors.
A standard procedure for creating a frailty index
Authors: Searle Samuel D , Mitnitski Arnold , Gahbauer Evelyne A , Gill Thomas M , Rockwood Kenneth
Published: September 2008

Background

Frailty can be measured in relation to the accumulation of deficits using a frailty index. A frailty index can be developed from most ageing databases. Our objective is to systematically describe a standard procedure for constructing a frailty index.

Methods

This is a secondary analysis of the Yale Precipitating Events Project cohort study, based in New Haven CT. Non-disabled people aged 70 years or older (n = 754) were enrolled and re-contacted every 18 months. The database includes variables on function, cognition, co-morbidity, health attitudes and practices and physical performance measures. Data came from the baseline cohort and those available at the first 18-month follow-up assessment.

Results

Procedures for selecting health variables as candidate deficits were applied to yield 40 deficits. Recoding procedures were applied for categorical, ordinal and interval variables such that they could be mapped to the interval 0–1, where 0 = absence of a deficit, and 1= full expression of the deficit. These individual deficit scores were combined in an index, where 0= no deficit present, and 1= all 40 deficits present. The values of the index were well fit by a gamma distribution. Between the baseline and follow-up cohorts, the age-related slope of deficit accumulation increased from 0.020 (95% confidence interval, 0.014–0.026) to 0.026 (0.020–0.032). The 99% limit to deficit accumulation was 0.6 in the baseline cohort and 0.7 in the follow-up cohort. Multivariate Cox analysis showed the frailty index, age and sex to be significant predictors of mortality.

Conclusion

A systematic process for creating a frailty index, which relates deficit accumulation to the individual risk of death, showed reproducible properties in the Yale Precipitating Events Project cohort study. This method of quantifying frailty can aid our understanding of frailty-related health characteristics in older adults.
The -786T>C promoter polymorphism of the NOS3gene is associated with prostate cancer progression
Authors: Marangoni Karina , Araújo Thaíse G , Neves Adriana F , Goulart Luiz R
Published: September 2008

Background

There is no biological or epidemiological data on the association between NOS3 promoter polymorphisms and prostate cancer. The polymorphisms in the promoter region of NOS3 gene may be responsible for variations in the plasma NO, which may promote cancer progression by providing a selective growth advantage to tumor cells by angiogenic stimulus and by direct DNA damage.

Methods

This study aimed evaluating the NOS3 promoter polymorphisms by PCR-SSCP and sequencing, associating genotypes and haplotypes with NOS3 expression levels through semi-quantitative RT-PCR, and with PCA3 mRNA detection, a specific tumor biomarker, in the peripheral blood of pre-surgical samples from 177 patients; 83 PCa and 94 BPH.

Results

Three novel SNPs were identified -764A>G, -714G>T and -649G>A in the NOS3 gene promoter region, which together with the -786T>C generated four haplotypes (N, T, C, A). NOS3 gene expression levels were affected by the -786T>C polymorphism, and there was a 2-fold increase in NOS3 levels favored by the incorporation of each C allele. NOS3 levels higher than 80% of the constitutive gene expression level (B2M) presented a 4-fold increase in PCa occurrence.

Conclusion

The -786T>C polymorphism was the most important promoter alteration of the NOS3 gene that may affect the PCa progression, but not its occurrence, and the incorporation of the C allele is associated with increased levels of NOS3 transcripts. The NOS3 transcript levels presented a bimodal behavior in tumor development and may be used as a biomarker together with the PCA3 marker for molecular staging of the prostate cancer.
Country differences in the diagnosis and management of coronary heart disease – a comparison between the US, the UK and Germany
Authors: von dem Knesebeck Olaf , Bönte Markus , Siegrist Johannes , Marceau Lisa , Link Carol , Arber Sara , Adams Ann , McKinlay John
Published: September 2008

Background

The way patients with coronary heart disease (CHD) are treated is partly determined by non-medical factors. There is a solid body of evidence that patient and physician characteristics influence doctors' management decisions. Relatively little is known about the role of structural issues in the decision making process. This study focuses on the question whether doctors' diagnostic and therapeutic decisions are influenced by the health care system in which they take place. This non-medical determinant of medical decision-making was investigated in an international research project in the US, the UK and Germany.

Methods

Videotaped patients within an experimental study design were used. Experienced actors played the role of patients with symptoms of CHD. Several alternative versions were taped featuring the same script with patients of different sex, age and social status. The videotapes were shown to 384 randomly selected primary care physicians in the three countries under study. The sample was stratified on gender and duration of professional experience. Physicians were asked how they would diagnose and manage the patient after watching the video vignette using a questionnaire with standardised and open-ended questions.

Results

Results show only small differences in decision making between British and American physicians in essential aspects of care. About 90% of the UK and US doctors identified CHD as one of the possible diagnoses. Further similarities were found in test ordering and lifestyle advice. Some differences between the US and UK were found in the certainty of the diagnoses, prescribed medications and referral behaviour. There are numerous significant differences between Germany and the other two countries. German physicians would ask fewer questions, they would order fewer tests, prescribe fewer medications and give less lifestyle advice.

Conclusion

Although all physicians in the three countries under study were presented exactly the same patient, some disparities in the diagnostic and patient management decisions were evident. Since other possible influences on doctors treatment decisions are controlled within the experimental design, characteristics of the health care system seem to be a crucial factor within the decision making process.
Costs and cost-effectiveness of delivering intermittent preventive treatment through schools in western Kenya
Authors: Temperley Matilda , Mueller Dirk H , Njagi J Kiambo , Akhwale Willis , Clarke Siân E , Jukes Matthew CH , Estambale Benson BA , Brooker Simon
Published: September 2008

Background

Awareness of the potential impact of malaria among school-age children has stimulated investigation into malaria interventions that can be delivered through schools. However, little evidence is available on the costs and cost-effectiveness of intervention options. This paper evaluates the costs and cost-effectiveness of intermittent preventive treatment (IPT) as delivered by teachers in schools in western Kenya.

Methods

Information on actual drug and non-drug associated costs were collected from expenditure and salary records, government budgets and interviews with key district and national officials. Effectiveness data were derived from a cluster-randomised-controlled trial of IPT where a single dose of sulphadoxine-pyrimethamine and three daily doses of amodiaquine were provided three times in year (once termly). Both financial and economic costs were estimated from a provider perspective, and effectiveness was estimated in terms of anaemia cases averted. A sensitivity analysis was conducted to assess the impact of key assumptions on estimated cost-effectiveness.

Results

The delivery of IPT by teachers was estimated to cost US$ 1.88 per child treated per year, with drug and teacher training costs constituting the largest cost components. Set-up costs accounted for 13.2% of overall costs (equivalent to US$ 0.25 per child) whilst recurrent costs accounted for 86.8% (US$ 1.63 per child per year). The estimated cost per anaemia case averted was US$ 29.84 and the cost per case ofPlasmodium falciparumparasitaemia averted was US$ 5.36, respectively. The cost per case of anaemia averted ranged between US$ 24.60 and 40.32 when the prices of antimalarial drugs and delivery costs were varied. Cost-effectiveness was most influenced by effectiveness of IPT and the background prevalence of anaemia. In settings where 30% and 50% of schoolchildren were anaemic, cost-effectiveness ratios were US$ 12.53 and 7.52, respectively.

Conclusion

This study provides the first evidence that IPT administered by teachers is a cost-effective school-based malaria intervention and merits investigation in other settings.
Rac1 GTPase and the Rac1 exchange factor Tiam1 associate with Wnt-responsive promoters to enhance beta-catenin/TCF-dependent transcription in colorectal cancer cells
Authors: Buongiorno Pinella , Pethe Vaijayanti V , Charames George S , Esufali Susmita , Bapat Bharati
Published: September 2008

Background

β-catenin is a key mediator of the canonical Wnt pathway as it associates with members of the T-cell factor (TCF) family at Wnt-responsive promoters to drive the transcription of Wnt target genes. Recently, we showed that Rac1 GTPase synergizes with β-catenin to increase the activity of a TCF-responsive reporter. This synergy was dependent on the nuclear presence of Rac1, since inhibition of its nuclear localization effectively abolished the stimulatory effect of Rac1 on TCF-responsive reporter activity. We hypothesised that Rac1 plays a direct role in enhancing the transcription of endogenous Wnt target genes by modulating the β-catenin/TCF transcription factor complex.

Results

We employed chromatin immunoprecipitation studies to demonstrate that Rac1 associates with the β-catenin/TCF complex at Wnt-responsive promoters of target genes. This association served to facilitate transcription, since overexpression of active Rac1 augmented Wnt target gene activation, whereas depletion of endogenous Rac1 by RNA interference abrogated this effect. In addition, the Rac1-specific exchange factor, Tiam1, potentiated the stimulatory effects of Rac1 on the canonical Wnt pathway. Tiam1 promoted the formation of a complex containing Rac1 and β-catenin. Furthermore, endogenous Tiam1 associated with endogenous β-catenin, and this interaction was enhanced in response to Wnt3a stimulation. Intriguingly, Tiam1 was recruited to Wnt-responsive promoters upon Wnt3a stimulation, whereas Rac1 was tethered to TCF binding elements in a Wnt-independent manner.

Conclusion

Taken together, our results suggest that Rac1 and the Rac1-specific activator Tiam1 are components of transcriptionally active β-catenin/TCF complexes at Wnt-responsive promoters, and the presence of Rac1 and Tiam1 within these complexes serves to enhance target gene transcription. Our results demonstrate a novel functional mechanism underlying the cross-talk between Rac1 and the canonical Wnt signalling pathway.
Improvement of quality of life, anxiety and depression after surgery in patients with stress urinary incontinence: Results of a longitudinal short-term follow-up
Authors: Innerkofler Petra C , Guenther Verena , Rehder Peter , Kopp Martin , Nguyen-Van-Tam Dominic P , Giesinger Johannes M , Holzner Bernhard
Published: September 2008

Objective

The objective of this study was to compare the effect of incontinence surgery and pelvic floor training on quality of life (QOL), anxiety and depression in patients with stress urinary incontinence (SUI).

Methods

In a prospective longitudinal study, females with proven SUI were asked to complete a set of standardized questionnaires (sociodemographic data sheet, FACT-G, I-QOL, HADS) before and eight weeks after treatment. The comparison groups consisted of a surgical treatment group and a conservative group that underwent supervised pelvic floor training for eight weeks.

Results

From the 67 female patients included in the study a number of 53 patients completed both assessment time points (mean age 57.4, mean years of SUI 7.6). The surgical treatment group consisted of 32 patients of which 21 patients received a modified Burch colposuspension and 11 patients a tension-free mid-urethral tape suspension. The 21 patients in the conservative group attended eight once-weekly supervised pelvic floor training sessions.

After treatment the surgical intervention group showed a significantly higher improvement of QOL (FACT-G and I-QOL) and anxiety (HADS) than the pelvic floor training group.

Conclusion

For female patients with SUI surgery yielded a better outcome than pelvic floor training with regard to quality of life and anxiety.
Transplantation of vascular cells derived from human embryonic stem cells contributes to vascular regeneration after stroke in mice
Authors: Oyamada Naofumi , Itoh Hiroshi , Sone Masakatsu , Yamahara Kenichi , Miyashita Kazutoshi , Park Kwijun , Taura Daisuke , Inuzuka Megumi , Sonoyama Takuhiro , Tsujimoto Hirokazu , Fukunaga Yasutomo , Tamura Naohisa , Nakao Kazuwa
Published: September 2008

Background

We previously demonstrated that vascular endothelial growth factor receptor type 2 (VEGF-R2)-positive cells induced from mouse embryonic stem (ES) cells can differentiate into both endothelial cells (ECs) and mural cells (MCs) and these vascular cells construct blood vessel structures in vitro. Recently, we have also established a method for the large-scale expansion of ECs and MCs derived from human ES cells. We examined the potential of vascular cells derived from human ES cells to contribute to vascular regeneration and to provide therapeutic benefit for the ischemic brain.

Methods

Phosphate buffered saline, human peripheral blood mononuclear cells (hMNCs), ECs-, MCs-, or the mixture of ECs and MCs derived from human ES cells were intra-arterially transplanted into mice after transient middle cerebral artery occlusion (MCAo).

Results

Transplanted ECs were successfully incorporated into host capillaries and MCs were distributed in the areas surrounding endothelial tubes. The cerebral blood flow and the vascular density in the ischemic striatum on day 28 after MCAo had significantly improved in ECs-, MCs- and ECs+MCs-transplanted mice compared to that of mice injected with saline or transplanted with hMNCs. Moreover, compared to saline-injected or hMNC-transplanted mice, significant reduction of the infarct volume and of apoptosis as well as acceleration of neurological recovery were observed on day 28 after MCAo in the cell mixture-transplanted mice.

Conclusion

Transplantation of ECs and MCs derived from undifferentiated human ES cells have a potential to contribute to therapeutic vascular regeneration and consequently reduction of infarct area after stroke.
Differential Regulation of Morphine Antinociceptive Effects by Endogenous Enkephalinergic System in the Forebrain of Mice
Authors: Chen Tsung-Chieh , Cheng Ying-Ying , Sun Wei-Zen , Shyu Bai-Chuang
Published: September 2008

Background:

Mice lacking the preproenkephalin ( ppENK) gene are hyperalgesic and show more anxiety and aggression than wild-type (WT) mice. The marked behavioral changes in ppENK knock-out (KO) mice appeared to occur in supraspinal response to painful stimuli. However the functional role of enkephalins in the supraspinal nociceptive processing and their underlying mechanism is not clear. The aim of present study was to compare supraspinal nociceptive and morphine antinociceptive responses between WT and ppENK KO mice.

Results:

The genotypes of bred KO mice were confirmed by PCR. Met-enkephalin immunoreactive neurons were labeled in the caudate-putamen, intermediated part of lateral septum, lateral globus pallidus, intermediated part of lateral septum, hypothalamus, and amygdala of WT mice. Met-enkephalin immunoreactive neurons were not found in the same brain areas in KO mice. Tail withdrawal and von Frey test results did not differ between WT and KO mice. KO mice had shorter latency to start paw licking than WT mice in the hot plate test. The maximal percent effect of morphine treatments (5 mg/kg and 10 mg/kg, i.p.) differed between WT and KO mice in hot plate test. The current source density (CSD) profiles evoked by peripheral noxious stimuli in the primary somatosenstory cortex (S1) and anterior cingulate cortex (ACC) were similar in WT and KO mice. After morphine injection, the amplitude of the laser-evoked sink currents was decreased in S1 while the amplitude of electrical-evoked sink currents was increased in the ACC. These differential morphine effects in S1 and ACC were enhanced in KO mice. Facilitation of synaptic currents in the ACC is mediated by GABA inhibitory interneurons in the local circuitry. Percent increases in opioid receptor binding in S1 and ACC were 5.1% and 5.8%, respectively.

Conclusion:

The present results indicate that the endogenous enkephalin system is not involved in acute nociceptive transmission in the spinal cord, S1, and ACC. However, morphine preferentially suppressed supraspinal related nociceptive behavior in KO mice. This effect was reflected in the potentiated differential effects of morphine in the S1 and ACC in KO mice. This potentiation may be due to an up-regulation of opioid receptors. Thus these findings strongly suggest an antagonistic interaction between the endogenous enkephalinergic system and exogenous opioid analgesic actions in the supraspinal brain structures.
Severe adult ileosigmoid intussusception prolapsing from the rectum: A case report
Authors: Chen Rongrong , Zhao Haitao , Sang Xinting , Mao Yilei , Lu Xin , Yang Yifan
Published: September 2008

Intussusception is a pediatric condition that rarely presents in adults. In this article, we report a case of a 36 year-old man initially presenting with abdominal pain and rectal prolapse, however, surgical reduction of the rectal prolapse did no relief his symptoms. Physical examination, abdominal plain film, barium enema and colonoscopy confirmed the presence of a large intra-abdominal mass, but the origin of the mass was revealed only upon laparotomy. During the surgery, it was noted that the ileum and the sigmoid colon was connected by a 15 cm × 12cm mass, covered by an extremely dilated intestinal tissue. The resected tissue pathology demonstrated a 9 cm × 6 cm × 5 cm submucosal lipoma at the ileocecal junction without evidence of malignancy. The patient's post-surgical course was uneventful. Diagnostic and therapeutic problems related to adult intussusception are reviewed.
The 'cardiac-lung mass' artifact: an echocardiographic sign of lung atelectasis and/or pleural effusion
Authors: Karabinis Andreas , Saranteas Theodosios , Karakitsos Dimitrios , Lichtenstein Daniel , Poularas John , Yang Clifford , Stefanadis Christodoulos
Published: September 2008

Introduction

We conducted an ultrasound study to investigate echocardiographic artifacts in mechanically ventilated patients with lung pathology.

Methods

A total of 205 mechanically ventilated patients who exhibited lung atelectasis and/or pleural effusion were included in this 36-month study. The patients underwent lung echography and transthoracic echocardiography, with a linear 5 to 10 MHz and with a 1.5 to 3.6 MHz wide-angle phased-array transducer, respectively. Patients were examined by two experienced observers who were blinded to each other's interpretation.

Results

A total of 124 patients (60,48%) were hospitalized because of multiple trauma; 60 patients (29,26%) because of respiratory insufficiency, and 21 (10,24%) because of recent postoperative surgery. The mean duration ( ± standard deviation) of hospitalization was 35 ± 27 days. An intracardiac artifact was documented in 17 out of 205 patients (8.29%) by echocardiography. It was visible only in the apical views, whereas subsequent transesophageal echocardiography revealed no abnormalities. The artifact consisted of a mobile component that exhibited, on M-mode, a pattern of respiratory variation similar to the lung 'sinusoid sign'. Lung echography revealed lung atelectasis and/or pleural effusion adjacent to the heart, and a similar M-mode pattern was observed. The artifact was recorded within the left cardiac chambers in 11 cases and within the right cardiac chambers in six.

Conclusions

Lung atelectasis and/or pleural effusion may create a mirror image, intracardiac artifact in mechanically ventilated patients. The latter was named the 'cardiac-lung mass' artifact to underline the important diagnostic role of both echocardiography and lung echography in these patients.

Trial registration

This trial is ISRCTN registered: ISRCTN 49216096.
Relationship between gross domestic product and duration of
untreated psychosis in low- and middle-income countries
Authors: Large Matthew , Farooq Saeed , Nielssen Olav , Slade Tim
Published: September 2008

Background

The duration of untreated psychosis (DUP), the period between the first
onset of psychotic symptoms and treatment, has an important influence on
the outcome of schizophrenia.

Aims

To compare the published studies of DUP in low- and middle-income (LAMI)
countries with the DUP of high-income countries, and examine a possible
association between DUP and per capita income.

Method

We used six search strategies to locate studies of the DUP from LAMI
countries published between January 1975 and January 2008. We then
examined the relationship between DUP and measures of economic activity,
which was assessed using the LAMI classification of countries and gross
domestic product (GDP) purchasing power parity.

Results

The average mean DUP in studies from LAMI countries was 125.0 weeks
compared with 63.4 weeks in studies from high-income countries
(P=0.012). Within the studies from LAMI countries,
mean DUP fell by 6 weeks for every $1000 of GDP purchasing power
parity.

Conclusions

There appears to be an inverse relationship between income and DUP in
LAMI countries. The cost of treatment is an impediment to care and
subsidised antipsychotic medication would improve the access to treatment
and the outcome of psychotic illness in LAMI countries.
Tobacco smoking as a risk factor for major depressive disorder: population-based study
Authors: Pasco Julie A. , Williams Lana J. , Jacka Felice N. , Ng Felicity , Henry Margaret J. , Nicholson Geoffrey C. , Kotowicz Mark A. , Berk Michael
Published: September 2008

Background

Smoking is disproportionately prevalent among people with psychiatric illness.

Aims

To investigate smoking as a risk factor for major depressive disorder.

Method

A population-based sample of women was studied using case–control and retrospective cohort study designs. Exposure to smoking was self-reported, and major depressive disorder diagnosed using the Structured Clinical Interview for DSM–IV–TR (SCID–I/NP).

Results

Among 165 people with major depressive disorder and 806 controls, smoking was associated with increased odds for major depressive disorder (age-adjusted odds ratio (OR)=1.46, 95% CI 1.03–2.07). Compared with non-smokers, odds for major depressive disorder more than doubled for heavy smokers (>20 cigarettes/day). Among 671 women with no history of major depressive disorder at baseline, 13 of 87 smokers and 38 of 584 non-smokers developedde novomajor depressive disorder during a decade of follow-up. Smoking increased major depressive disorder risk by 93% (hazard ratio (HR)=1.93, 95% CI 1.02–3.69); this was not explained by physical activity or alcohol consumption.

Conclusions

Evidence from cross-sectional and longitudinal data suggests that smoking increases the risk of major depressive disorder in women.
Injectable opiate prescribing in Cornwall
Authors: White Rupert , Shearman Lizzie
Published: September 2008

Aims and Method

To compare local practice with national guidelines, examine the areas of divergence, and establish complication rates for methadone and diamorphine. Fifty-one patients from Cornwall treated with injectable methadone or diamorphine were interviewed using a standard questionnaire.

Results

Fewer problems were reported by individuals using injectable diamorphine, though for both drugs intramuscular injection was more problematic than intravenous injection. Injections into the groin were common, as was problem drinking.

Clinical Implications

Intramuscular administration of medications may be more likely to cause abcesses or cellulitis. Ongoing groin injecting and alcohol misuse is common, but should probably be tolerated if other harm reduction benefits accrue. It may be prohibitively expensive to set up injecting rooms in rural parts of the UK and future policy should reflect this.
Survey of long-stay patients on acute psychiatric wards
Authors: Commander Martin , Rooprai Dharjinder
Published: September 2008

Aims and Method

To describe the profile of patients staying on acute wards for longer than 6 months and to compare staff appraisals of accommodation needs with patients' placements at 2 years.

Results

Long-stay patients consistently occupied around a fifth of all acute beds. the nursing and medical staff recommendations and patients' placements at 2 years showed only moderate agreement. Aside from remaining in hospital, patients were most likely to be living in a residential or nursing home at follow-up.

Clinical Implications

There is a need to sharpen the focus of mental health strategy on non-acute hospital provision and 24-h-staffed community facilities. In particular, it is important to recognise the contribution of clinical expertise to the assessment and placement of long-stay in-patients.