bluuebunny/crossref_metadata_2025 huggingface dataset:
The Powerful Relational Language of ‘Family’: Togetherness, Belonging and Personhood
Authors: McCarthy Jane Ribbens
Published: March 2012

This article examines the notion of ‘family’ to consider how it may be understood in people's everyday lives. Certain recurrent and powerful motifs are apparent, notably themes of togetherness and belonging, in the context of a unit that the person can be ‘part of’. At the same time, there may be important variations in the meanings given to individuality and family, evoking differing understandings of the self and personhood. I consider these ideas further through globally relevant but variable cultural themes of autonomy and relationality, suggesting the term ‘social person’ as a heuristic device to distinguish the sense of ‘close-knit selves’ that may be involved in some understandings of personhood. I argue that this version of personhood may be powerfully expressed through ‘family’ meanings, with a significance which can be at least provisionally mapped along lines of inequality and disadvantage within and between societies around the world. These forms of connectedness may be hard to grasp through those theoretical and methodological frameworks which emphasize the (relational) individual. I argue that, in affluent English speaking societies, 1 there may be little alternative to the language of ‘family’ for expressing such forms of relationality and connection.
The Consequences of Love: Young People and Family Practices in Difficult Circumstances
Authors: Wilson Sarah , Cunningham-Burley Sarah , Bancroft Angus , Backett-Milburn Kathryn
Published: March 2012

In recent years, there has been a resurgence of sociological work exploring the importance and meaning of kinship. Much of this work has criticized the ‘individualization’ thesis according to which changes in family structures over time have been interpreted as reflecting a fundamental decline in family values. Highlighting continuities as well as change in family life, this work has also suggested ways to move beyond the individualization debate and to develop alternative frameworks for the study of contemporary families and personal life, notably through the analysis of related practices. For various reasons, this recent work has focused primarily on the experience and practices of adults in ‘ordinary’ rather than more difficult family circumstances. This article aims to complement this work by focusing on the difficult family experiences of young people affected by parental substance use. It is argued that it is important not to lose sight of such experiences in order that sociological thinking reflect the diversity of family practices and the resources available to support them, including at younger ages. In addition, the importance of developing concepts or a language facilitating the exploration and communication of the emotional and symbolic significance of these practices is emphasized.
Equity Between Overlapping Generations
Authors: QUIGGIN JOHN
Published: March 2012

This note is a demonstration that, in the presence of overlapping generations and under standard conditions for a social welfare ordering (Pareto optimality, transitivity, and independence), the only ordering consistent with utilitarianism for all people currently alive at any given point in time is one based on weighting all people equally, regardless of their date of birth. In particular, this implies that, under reasonable conditions, the pure rate of social time preference is zero.
First‐Person Authority: An Epistemic‐Pragmatic Account
Authors: MANSON NEIL C.
Published: March 2012

Some self‐ascriptions of belief, desire and other attitudes exhibit first‐person authority. The aim here is to offer a novel account of this kind of first‐person authority. The account is a development of Robert Gordon's ascent routine theory but is framed in terms of our ability to bring it about thatothersknow of our attitudes via speech acts which do not deploy attitudinal vocabulary but which nonetheless ‘show’ our attitudes to others. Unlike Gordon's ascent routine theory, the theory readily applies to attitudes other than belief, avoids a need to appeal to processes of making up one's mind, and does not rest upon a distinction between ‘outward looking’ and ‘inward looking’ processes.
COMING TO JUDGMENT: METHODOLOGICAL REFLECTIONS ON THE RELATIONSHIP BETWEEN ECCLESIOLOGY, ETHNOGRAPHY AND POLITICAL THEORY
Authors: BRETHERTON LUKE
Published: March 2012

This essay theoretically frames the inter‐relationship between ecclesial and political life and suggests how the ethnographic study of this intersection might generate theological conceptualisations of both. It argues there is a dialectical relationship between conceptualisations of ecclesial and political life and that their proper study requires attention to practice in order to generate judgments on both. The key issue here is the kind of rationality from which judgments on practice are derived. A case is made for practical reason as having priority over theoretical reason when thinking about politics and the need to move beyond interpretation to judgment.
THE CONFESSIONS OF STANLEY: ACCOUNTING FOR A HUMAN LIFE LIVED BEFORE GOD
Authors: GREGGS TOM
Published: March 2012

This discussion of Stanley Hauerwas’Hannah's Child examines the implications of the book for the disciplines of historical and doctrinal theology. Locating the success of theological biography and autobiography in its description of God in relation to lived human existence, the article considers certain points of contact between Hannah's Child and St Augustine's Confessions. Building from this description of the task of theological autobiography, the article makes three points for historical and doctrinal theology arising from Hannah's Child: first that historical theology is primarily a theological discipline; second that it is significant and important, nevertheless, for historical theology to retain its historical accidence; third that doctrine involves teaching and learning the Christian faith and is thereby of ethical significance.
Transcranial direct current stimulation of the affected hemisphere does not accelerate recovery of acute stroke patients
Authors: Rossi C. , Sallustio F. , Di Legge S. , Stanzione P. , Koch G.
Published: March 2012

Background and purpose:  Transcranial direct current stimulation (TDCS) is a potential tool to improve motor deficits in chronic stroke patients. Safety and efficacy of this procedure in acute stroke patients have not yet been addressed.

Methods:  We performed in our stroke unit a single‐centre randomized, double‐blind, sham‐controlled study to investigate safety and efficacy of anodal TDCS of the affected hemisphere in acute stroke patients. The second day from stroke onset, 50 acute stroke patients received either five‐daily sessions of anodal (n = 25) at 2 mA for 20 min or sham TDCS (n = 25) to the ipsilesional primary motor cortex (M1). Motor deficit was assessed by the short form of the Fugl–Meyer motor scale (FM) and overall neurological deficit by the National Institute of Health Stroke Scale (NIHSS) at onset, at 5 days after stroke and after 3 months.

Results:  No side effects were detected during either TDCS or sham. In both groups, there was a significant improvement in NIHSS and FM scores, which did not significantly differ when comparing TDCS and sham.

Conclusions:  Five‐daily sessions of anodal TDCS to the ipsilesional M1 appear to be safe in acute stroke patients but do not improve clinical outcome.
Successful outcome of episodes of status epilepticus after vagus nerve stimulation: a multicenter study
Authors: Sierra‐Marcos A. , Maestro I. , Rodríguez‐Osorio X. , Miró J. , Donaire A. , Aparicio J. , Rumiá J. , Forcadas M. , Garamendi I. , Pardo J. , López J. , Prieto Á. , Plans G. , Falip M. , Carreño M.
Published: March 2012

Background and purpose:  Vagus nerve stimulation (VNS) has been reported to be a safe and effective treatment for drug‐resistant epilepsy. The aim of this study is to describe the effect of VNS in patients with a history of repeated episodes of status epilepticus (SE) before implantation.

Methods:  From a total of 83 adult patients with drug‐resistant epilepsy who had VNS implanted in four tertiary centers in Spain between 2000 and 2010, eight had a previous history of repeated episodes of SE. We performed a retrospective observational study analyzing the outcome of seizures and episodes of SE after implantation. Stimulation was started at the usual settings, and intensity increased according to clinical response and tolerability.

Results:  Regarding the eight patients with a history of SE, the mean age at time of VNS implantation was 25.1 [14–40] years. Duration of epilepsy until the implantation was 21.7 [7–39.5] years, and they had been treated with a mean of 12 antiepileptic drugs [10–16]. Mean follow‐up since implantation was 4.15 [2–7.5] years. Average seizure frequency decreased from 46 to 8.2 per month. Interestingly, four of the eight patients remained free of new episodes of SE after implantation, and in two additional patients, the frequency decreased by >75%. Adverse effects were mild or moderate in intensity and included mainly coughing and dysphonia.

Conclusion:  In those patients with refractory epilepsy and history of SE who are not surgical candidates, VNS is a safe and effective method to reduce seizure frequency and episodes of SE.
Tripartite adjudication—an endangered species
Authors: Corby Susan , Latreille Paul
Published: March 2012

This article focuses on the role of lay members in tripartite employment tribunals, arguing that tribunals' legitimacy has been undermined by restrictions on the use of members' workplace experience, by the growth of the law, by changes to the method of lay member appointment and because judges now decide certain cases alone.
Obstacles to transnational trade union cooperation in Europe—results from a European survey
Authors: Larsson Bengt
Published: March 2012

This article analyses obstacles to transnational union cooperation within Europe. It is based on a survey of unions in 14 European countries and all members of the European Trade Union Confederation. The result shows that ‘hard’ industrial relations factors are generally more important obstacles to transnational cooperation than ‘softer’ factors such as cultural, linguistic, ideological and religious differences and that there are sectoral differences in experiences of obstacles to transnational union cooperation: unions in the manufacturing sector tend to emphasise differences in industrial relations and a lack of organisational resources for transnational union cooperation, whereas low organisational priorities are held to be of more importance in the services sector and for unions for professional workers.
Prevalent founder mutation c.736T>A of LIPH in autosomal recessive woolly hair of Japanese leads to variable severity of hypotrichosis in adulthood
Authors: Tanahashi K. , Sugiura K. , Takeichi T. , Takama H. , Shinkuma S. , Shimizu H. , Akiyama M.
Published: March 2012

Background  Mutations in LIPH are a cause of autosomal recessive woolly hair (ARWH). Homozygous c.736T>A (p.Cys246Ser), and compound heterozygous c.736T>A and c.742C>A (p.His248Asn) have been reported in 5 and 7 Japanese children with ARWH respectively. The severity of hypotrichosis is known to be able to change in the clinical course, and the mutation patterns of LIPH do not always correlate with the severity of hypotrichosis in ARWH caused by other mutation sites of LIPH. However, all 12 Japanese children previously reported to have ARWH have shown similar severity of hypotrichosis.

Objective  In this study, we investigated the clinical features and molecular basis of ARWH in patients including three adults (three adults and two children) from five non‐related Japanese families.

Methods  Five families of Japanese origin that presented with woolly hair were studied. The phenotype was confirmed by clinical examination. Direct automated DNA sequencing of the LIPH gene was performed to identify the mutations in our probands.

Results  All patients had had woolly hair since birth. Homozygous c.736T>A mutations were found in four patients, including three adult cases, and compound heterozygous c.736T>A and c.742C>A mutations were found in one child patient. The two adults and two children had only sparse scalp hair, although one adult woman had mild hypotrichosis with long hairs.

Conclusion  Some patients with homozygous c.736T>A can have a mild hypotrichosis phenotype with long hairs in adulthood.
Nail penetration and predicted mycological efficacy of an innovative hydrosoluble ciclopirox nail lacquer vs. a standard amorolfine lacquer in healthy subjects
Authors: Monti D. , Herranz U. , Dal Bo L. , Subissi A.
Published: March 2012

Background  In a previous study a new hydrosoluble nail lacquer (P‐3051) containing 8% ciclopirox (CPX) showed higher nail penetration compared to a water‐insoluble 5% amorolfine (MRF) lacquer. To our knowledge, in vivo human data on a similar topic are not available.

Objectives  To compare fingernail penetration of P‐3051 with that of MRF reference in humans and to evaluate their predicted efficacy against Trichophyton rubrum and Candida parapsilosis.

Methods  Single centre, randomized, multiple dose, open label, within subjects study. Test and reference were self‐applied to all fingernails of either hand for 28 days. At baseline and after 15 and 25 days, the nail free edge was collected for analysis. Efficiency coefficients were calculated for T. rubrum and C. parapsilosis as ratios of nail concentration/minimum inhibitory concentration. The coefficients were classified as very high, high or poor.

Results  Nail concentrations after 15 days were 2.82 ± 0.58 μg/mg for CPX and 0.64 ± 0.11 μg/mg for MRF. At day 25 there was a non‐significant decline (1.85 ± 0.31 μg/mg, P = 0.077) for CPX and a highly significant (0.13  ± 0.03 μg/mg, P = 0.0002) 80% decline for MRF. Efficiency coefficients were very high/high in all subjects treated with P‐3051 against both T. rubrum and C. parapsilosis; they were significantly lower for MRF reference against both pathogens at both observation points.

Conclusions  P‐3051 exhibited better penetration and higher predicted efficacy after in vivo multiple application to human fingernails when compared to MRF reference. These in vivo data are in good agreement with our previous in vitro study.
Dermoscopy guided scalp biopsy in cicatricial alopecia
Authors: Miteva M. , Tosti A.
Published: March 2012

Background  Scalp biopsies are crucial for the diagnosis of cicatricial alopecia. However, the pathologic interpretation may not be diagnostic if biopsy is not obtained from the correct site. This is particularly relevant for cicatricial alopecia as the disease may be focal and disease activity difficult to appreciate by the naked eye.

Objective  To report a new simple technique to select the optimal biopsy site in cicatricial alopecia.

Methods  In the last 2 years we performed dermoscopy guided scalp biopsies using handled dermatoscopes in 80 patients with different forms of cicatricial alopecia. Biopsy site was selected based on presence of the following dermatoscopic features: perifollicular concentric white scales in lichen planopilaris, frontal fibrosing alopecia (FFA) and discoid lupus erythematosus (DLE); hair tufts in folliculitis decalvans, hairs surrounded by a peripilar grey‐white halo in central centrifugal cicatricial alopecia and follicular red dots or keratotic plugs in DLE.

Results  The dermoscopy guided biopsies yielded a definitive pathological diagnosis in 95% of the cases.

Comment  The advantage of this method is that it is a fast, precise way to identify even individually affected follicles in early or focal cicatricial alopecia. It also allows for the morphologic characterization of particular follicular structures.
Enabling Self‐determination for Older Workers with Intellectual Disabilities in Supported Employment in Australia
Authors: McDermott Shannon , Edwards Robyn
Published: March 2012

Background  Promoting self‐determination is recognized to be an essential element of disability service provision; however, the extent to which older people with intellectual disability working in supported employment are enabled to make intentional decisions about retirement is not well understood.

Methods  This research explored the views of older people with disability and service providers to understand the elements that impact on people’s decision to retire. Seventy‐six people participated in semi‐structured interviews, including 33 older people with intellectual disability working in supported employment, 10 people who had retired and 30 service providers.

Results  Service providers strongly supported the right of people to retire; however, people with disability almost never reported the ability to make self‐determined choices about retirement. Barriers to self‐determination included an association between retirement, poor health and meaningless activities, which was perpetuated through structural service gaps.

Conclusion  Although disability services and service providers emphasize the importance of promoting self‐determination for people with disability, those working in supported employment are not currently enabled to make self‐directed choices about retirement. To address this requires more flexible services, better information about retirement, exposure to real experiences and assistance to express preferences and participate in problem solving throughout the lifespan.
Time‐bubbles of nationalism: dynamics of solidarity ritual in lived time
Authors: Collins Randall
Published: March 2012

The growth of modern nationalism can be attributed to structural causes, especially the growth of the strong bureaucratic state that penetrates society, creating cultural uniformity and national identity. But structurally based nationalism need not be very intense, or constant; even when institutionalised in periodic formal rituals, it can be routine, low in emotion – even boring. We need to explain sudden upsurges in popular nationalism, but also their persistence and fading in medium‐length periods of time. Nationalist surges are connected with geopolitical rises and falls in the power‐prestige of states: strong and expanding states absorb smaller particularistic identities into a prestigious whole; weaker and defeated states suffer delegitimation of the dominant nationality and fragment in sudden upsurges of localising nationalities. Passing from macro‐patterns to micro‐sociological mechanisms, conflict producing solidarity is a key mechanism: dramatic events focus widespread attention and assemble crowds into spontaneous ‘natural rituals’ – mass‐participation interaction rituals, as distinct from formal rituals. Evidence from public assemblies and the display of national symbols following the terrorist attacks of 11 September 2001 (9/11) shows an intense period of three months, then gradual return to normal internal divisions by around six months. Spontaneous rituals of national solidarity are produced not only by external conflict but by internal uprisings, where an emotional upsurge of national identity is used to legitimate insurgent crowds and discredit regimes. Although participants experience momentary feelings of historic shifts, conflict‐mobilised national solidarity lives in a 3–6‐month time‐bubble, and needs to institutionalise its successes rapidly to have long‐term effects.
Changes in global longitudinal strain during rest and exercise in patients treated with cardiac resynchronization therapy
Authors: Valzania Cinzia , Gadler Fredrik , Boriani Giuseppe , Eriksson Maria J.
Published: March 2012

Relatively few data have been reported on prospective changes in global longitudinal strain (GLS) following cardiac resynchronization therapy (CRT), and none are available on GLS during physical exercise. We investigated the effects of CRT on GLS, assessed by speckle tracking two‐dimensional (2D) echocardiography, at rest and during exercise after a mid‐term follow‐up. Twenty consecutive CRT patients (45% ischaemic) were assessed prospectively by speckle tracking 2D echocardiography before implant (at rest) and at mid‐term follow‐up (during rest and bicycle exercise). GLS, septum and lateral wall longitudinal strain, left ventricular ejection fraction (LVEF), and conventional functional variables were evaluated at baseline and follow‐up. All patients completed the study protocol at rest. Exercise images were available in 90% of the patients. At follow‐up, GLS improved at rest from −7·1 ± 2·6% to −9·1 ± 4·5% (P<0·01), with a further increase to −11 ± 5·1% during exercise (P<0·001). Longitudinal strain increased at rest both in the septum and in the lateral wall, with an additional increase during exercise in the lateral wall (P<0·05). GLS correlated with LVEF both at rest (r = −0·55 and r = −0·91 at baseline and 3 months, respectively; P<0·05) and during exercise (r = −0·89, P<0·05). Improvement in GLS during rest and exercise can be observed in CRT patients at mid‐term follow‐up and seems to correlate with changes in LVEF. GLS may be a valuable method to assess left ventricular function during rest and exercise.
Biophysical properties of Nav1.8/Nav1.2 chimeras and inhibition by µO‐conotoxin MrVIB
Authors: Knapp O , Nevin ST , Yasuda T , Lawrence N , Lewis RJ , Adams DJ
Published: March 2012

BACKGROUND AND PURPOSE Voltage‐gated sodium channels are expressed primarily in excitable cells and play a pivotal role in the initiation and propagation of action potentials. Nine subtypes of the pore‐forming α‐subunit have been identified, each with a distinct tissue distribution, biophysical properties and sensitivity to tetrodotoxin (TTX). Nav1.8, a TTX‐resistant (TTX‐R) subtype, is selectively expressed in sensory neurons and plays a pathophysiological role in neuropathic pain. In comparison with TTX‐sensitive (TTX‐S) Navα‐subtypes in neurons, Nav1.8 is most strongly inhibited by the µO‐conotoxin MrVIB from Conus marmoreus. To determine which domain confers Nav1.8 α‐subunit its biophysical properties and MrVIB binding, we constructed various chimeric channels incorporating sequence from Nav1.8 and the TTX‐S Nav1.2 using a domain exchange strategy.

EXPERIMENTAL APPROACH Wild‐type and chimeric Nav channels were expressed in Xenopus oocytes, and depolarization‐activated Na+ currents were recorded using the two‐electrode voltage clamp technique.

KEY RESULTS MrVIB (1 µM) reduced Nav1.2 current amplitude to 69 ± 12%, whereas Nav1.8 current was reduced to 31 ± 3%, confirming that MrVIB has a binding preference for Nav1.8. A similar reduction in Na+ current amplitude was observed when MrVIB was applied to chimeras containing the region extending from S6 segment of domain I through the S5‐S6 linker of domain II of Nav1.8. In contrast, MrVIB had only a small effect on Na+ current for chimeras containing the corresponding region of Nav1.2.

CONCLUSIONS AND IMPLICATIONS Taken together, these results suggest that domain II of Nav1.8 is an important determinant of MrVIB affinity, highlighting a region of the α‐subunit that may allow further nociceptor‐specific ligand targeting.
The Role of Ownership in Determining the Rural Economic Benefits of On‐shore Wind Farms
Authors: Phimister Euan , Roberts Deborah
Published: March 2012

The development of the wind energy sector is often promoted as a means of supporting rural economies. This paper focuses on how the ownership structure of on‐shore wind power plants (external, farmer or community) affects the size and distribution of impacts within the rural part of a region. Empirical analysis is based on a regional computable general equilibrium model of North East Scotland with the results compared to those generated from a standard social accounting matrix multiplier analysis. With no local ownership, while rural GDP increases, there is almost no effect on household incomes due to the limited direct linkages of the on‐shore wind sector. Local ownership increases the household income benefits but there are still limited positive spill‐over effects on the wider economy unless factor income is re‐invested in local capital. With re‐investment, farm household ownership gives rise to the largest increase in total household income but community ownership gives rise to the largest increase in rural (non‐farm) household incomes and welfare. The results contribute to the on‐going debate about the opportunity cost of external asset ownership in rural areas.
Lamivudine plus adefovir vs. entecavir in HBeAg‐positive hepatitis B with sequential treatment failure of lamivudine and adefovir
Authors: Son Chang Young , Ryu Han Jak , Lee Jung Min , Ahn Sang Hoon , Kim Do Young , Lee Myoung Ha , Han Kwang Hyub , Chon Chae Yoon , Park Jun Yong
Published: March 2012

Background and Aims

Few studies have adequately examined the efficacy of lamivudine plus adefovir (LAM+ADV) combination therapy vs. entecavir (ETV) monotherapy in HBeAg‐positive hepatitis B patients who fail to respond to sequential treatment with LAM and ADV. We compared directly the efficacy of LAM+ADV vs. ETV in such patients and assessed prognostic factors associated with a virologic response at month 12.

Methods

In total, 72 HBeAg‐positive patients who showed resistance (n = 33) or a suboptimal virologic response (n = 39) to ADV monotherapy with resistance to LAM therapy underwent rescue therapy (31 LAM+ADV and 41 ETV). All patients were followed for at least 12 months.

Results

Following 12 months of treatment, in the LAM+ADV and ETV groups, a virologic response was observed in 7/31 (22.6%) and 8/41 (19.5%; P = 0.777) patients; ALT normalization occurred in 11/13 (84.6%) and 16/18 (88.9%; P = 0.566); HBeAg seroconversion in 1/31 (2.3%) and 4/41 (9.8%; P = 0.341) and a virologic breakthrough in 3/31 (9.0%) and 5/41 (12.1%; P = 0.452) respectively. Independent prognostic factors associated with a virologic response were the baseline HBV‐DNA level (OR = 0.37; 95% CI 0.17–0.80; P = 0.011) and the duration of prior ADV monotherapy (OR = 0.89; 95% CI 0.83–0.95; P = 0.044).

Conclusions

Neither LAM+ADV nor ETV was adequately effective in patients with sequential LAM and ADV treatment failure. Thus, when chronic hepatitis B patients show resistance or suboptimal response to ADV monotherapy, early modification of treatment should be considered.
Cardiac Catheterization in the Dialysis Population in 2012: We Know More, but Much Remains Unknown
Authors: Costa Salvatore P. , Jayne John E. , Friedman Scott E. , Lentine Krista L.
Published: March 2012

Chronic kidney disease is now widely accepted as an independent risk factor for coronary disease and the dialysis population may represent the highest risk subgroup. Among all dialysis patients, a cardiac cause of mortality has been estimated at 40%. In addition, prior studies have demonstrated that when cardiac catheterization is obtained in a consecutive series of asymptomatic diabetic patients on dialysis the rates of coronary disease can approach 50%. However, the ability to define the problem continues to be greater than the ability to treat or prevent it. Coronary revascularization strategies have limitations in the general population which are amplified in the dialysis population. The ability to accurately diagnose an acute coronary syndrome is more difficult, clinical outcomes have a smaller margin of benefit, and technical challenges result in higher complication rates. Recent data demonstrate an inverse relationship between glomerular filtration rate and the risk of presenting with an acute myocardial infarction rather than unstable angina suggesting that patients with CKD may have a unique pathophysiologic profile that is more prone to plaque rupture. However, these “vulnerable” plaques typically are associated with stenoses <50% prior to rupture and are thus poor targets for revascularization and perhaps best treated with medical therapy. Although the benefits of revascularization may continue to outweigh the risks in the context of acute coronary syndromes, preventive strategies would have to overcome the lower margin of benefit and higher complication rates.
Sudden Cardiac Death in Dialysis: Do Current Guidelines for Implantable Cardioverter Defibrillator Therapy Apply to Patients with End‐stage Kidney Disease?
Authors: O’Shaughnessy Michelle M. , Lappin David W. , Reddan Donal N.
Published: March 2012

Arrhythmic mechanisms account for one in four deaths in end‐stage kidney disease. Large‐scale randomized controlled trials have demonstrated a mortality benefit from implantable cardioverter defibrillator therapy in carefully selected patient groups at high risk for sudden cardiac death. Unfortunately, patients with end‐stage kidney disease were systematically excluded from these trials. Consequently, the applicability of American College of Cardiology (ACC)/American Heart Association (AHA)/Heart Rhythm Society (HRS) guidelines on implantable cardioverter defibrillator therapy to dialysis patients remains uncertain. Observational data suggest that secondary preventative implantable cardioverter defibrillator therapy following resuscitated cardiac arrest prolongs the lives of dialysis patients. This intervention may also offer a survival advantage as a primary preventative strategy in end‐stage kidney disease. However, competing risk from co‐morbidity can negate any perceived benefit. Device‐related complications also negatively impact outcome. The recommendation that primary preventative device implantation be reserved for patients with severely impaired left ventricular function may be excessively restrictive in this high‐risk population. Trials of implantable cardioverter defibrillator therapy that include dialysis patients are required to validate existing device eligibility criteria in this unique population. Novel indications for this intervention in dialysis patients should also be identified.
Development of a Public Health Nursing Data Infrastructure
Authors: Monsen Karen A. , Bekemeier Betty , P. Newhouse Robin , Scutchfield F. Douglas
Published: March 2012

An invited group of national public health nursing (PHN) scholars, practitioners, policymakers, and other stakeholders met in October 2010 identifying a critical need for a national PHN data infrastructure to support PHN research. This article summarizes the strengths, limitations, and gaps specific to PHN data and proposes a research agenda for development of a PHN data infrastructure. Future implications are suggested, such as issues related to the development of the proposed PHN data infrastructure and future research possibilities enabled by the infrastructure. Such a data infrastructure has potential to improve accountability and measurement, to demonstrate the value of PHN services, and to improve population health.
Conceptual Models for Population‐focused Public Health Nursing Interventions and Outcomes: The State of the Art
Authors: Bigbee Jeri L. , Issel L. Michele
Published: March 2012

The conceptual basis of public health nursing (PHN) has evolved particularly over the past three decades. InOctober 2010, a national research agenda setting conference was held with grant support from theAgency forHealthcareResearch andQuality. From the conference, public health nursing intervention models emerged as one of four top priorities. The need for a stronger theoretic base that can guide population‐focused nursing practice and research was strongly emphasized. The purpose of this review, in concert with this priority, is to analyze the current status ofPHNconceptual models. Based on the review, a set of recommendations is presented related to future conceptual development and testing, with an emphasis onPHNinterventions and outcomes. A key recommendation is the refinement of the existing conceptual models with perhaps some consolidation of models, thereby establishing strong grand, middle‐range and practice theories that include explicitPHNintervention and outcome components. Another recommendation calls for rigorous comparative analysis and testing. Professional support from thePHNcommunity along with funding agencies will be needed to implement the recommendations related toPHNtheory development and testing.
Single‐Lead Percutaneous Peripheral Nerve Stimulation for the Treatment of Hemiplegic Shoulder Pain: A Case Series
Authors: Chae John , Wilson Richard D. , Bennett Maria E. , Lechman Tina E. , Stager Kathryn W.
Published: March 2012

Objective:  Previous studies demonstrated the efficacy of Intramuscular Nerve (IMN) therapy with a 4‐lead percutaneous, peripheral nerve stimulation (PNS) system in reducing hemiplegic shoulder pain (HSP). This case series investigates the feasibility of a less complex, single‐lead approach in reducing HSP.

Methods:  Eight participants received one percutaneous intramuscular lead in the hemiparetic deltoid muscle and were then treated 6 hours/day for 3 weeks. The primary outcome measure was the Brief Pain Inventory (Short‐Form) Question 3 (BPI3), which queries worst pain in the last week on a 0 to 10 numeric rating scale. Secondary outcomes included pain interference (BPI9) and Medical Outcomes Study Short‐Form 36 (SF‐36v2). Primary and secondary outcomes were assessed at the end of treatment (EOT) and 1 and 4 weeks after the EOT.

Results:  All participants tolerated the treatment well with 96% compliance. All leads remained infection‐free and were removed intact at the EOT. On average, participants exhibited 70% reduction in BPI3 at the EOT and 61% reduction at 4 weeks after the EOT. All participants satisfied the success criterion of at least a 2‐point reduction in BPI3 at the EOT. Longitudinal analysis revealed significant treatment effect for BPI3 (F = 14.0, P < 0.001), BPI9 (F = 5.9, P < 0.01), and the bodily pain domain of SF‐36v2 (F = 12.8, P < 0.001).

Conclusion:  This case series demonstrates the feasibility of a single‐lead, 3‐week IMN therapy for the treatment of chronic HSP. Additional studies are needed to further demonstrate safety, efficacy, and long‐term benefit, define optimal prescriptive parameters and dose, and expand clinical indications.
Yoga Spinal Flexion Positions and Vertebral Compression Fracture in Osteopenia or Osteoporosis of Spine: Case Series
Authors: Sinaki Mehrsheed
Published: March 2012

Objective:  The objective of this report is to raise awareness of the effect of strenuous yoga flexion exercises on osteopenic or osteoporotic spines. We previously described subjects with known osteoporosis in whom vertebral compression fractures (VCFs) developed after spinal flexion exercise (SFE) and recommended that SFEs not be prescribed in patients with spinal osteoporosis.

Methods:  This report describes 3 healthy persons with low bone mass and yoga‐induced pain or fracture.

Results:  All 3 patients had osteopenia, were in good health and pain‐free, and had started yoga exercises to improve their musculoskeletal health. New pain and fracture areas occurred after participation in yoga flexion exercises.

Conclusions:  The development of pain and complications with some flexion yoga positions in the patients with osteopenia leads to concern that fracture risk would increase even further in osteoporosis. Although exercise has been shown to be effective for improving bone mineral density and decreasing fracture risk, our subjects had development of VCFs and neck and back pain with yoga exercises. This finding suggests that factors other than bone mass should be considered for exercise counseling in patients with bone loss. The increased torque pressure applied to vertebral bodies during SFEs may be a risk. Exercise is effective and important for treatment of osteopenia and osteoporosis and should be prescribed for patients with vertebral bone loss. Some yoga positions can contribute to extreme strain on spines with bone loss. Assessment of fracture risk in older persons performing SFEs and other high‐impact exercises is an important clinical consideration.
Transdermal Opioid Patches for Pain Treatment in Ancient Greece
Authors: Harrison Adrian P. , Hansen Steen H. , Bartels Else M.
Published: March 2012

Abstract:  Pain treatment in ancient Greece, and through the middle ages in Europe, was to a great extent based on the expertise of the Greek physician Galen (c. 129–200 A.D.). Galen makes particular reference to “Olympic Victor’s Dark Ointment” (OVDO), which is listed with a number of collyria. Galen states that OVDO can be useful for treating extreme pain and swellings, forming one of the best eye salves.

Olympic Victor’s Dark Ointment, an opium‐based treatment, forms a “patch” when applied externally as an ointment, because it quickly dries to cover a localized region but still retains its elastic properties.

This study has recreated OVDO and applied the ointment to abdominal mouse skin, in vitro. To assess the efficacy of OVDO, the transdermal transfer of morphine was measured when given as OVDO and compared to morphine administered in the form of a solution of Opium + PBS (ringer).

Olympic Victor’s Dark Ointment showed a transdermal transfer of morphine over time comparable to 25% of the most efficient modern transdermal opioid patches, while hardly any morphine was able to penetrate the skin when applied mixed in PBS.

We conclude that OVDO is very efficient in its composition and may carry some forgotten abilities in terms of drug delivery, which could be transferred to modern medicine. Indeed, this may lead to a better choice of morphine use and controlled management in individual patient cases, taking both pain relief and anti‐inflammatory aspects into account.
Preventing transfusion‐transmitted babesiosis: preliminary experience of the first laboratory‐based blood donor screening program
Authors: Young Carolyn , Chawla Anjulika , Berardi Victor , Padbury James , Skowron Gail , Krause Peter J. ,   the Babesia Testing Investigational Containment Study Group
Published: March 2012

BACKGROUND: Babesiosis is the most common transfusion‐transmitted infection reported to the Food and Drug Administration (FDA). We developed and implemented the first laboratory‐based blood donor screening program for Babesia microti to help reduce and prevent transfusion‐transmitted babesiosis (TTB) and report results for the initial year.

STUDY DESIGN AND METHODS: Selective B. microti donor screening was performed using real‐time polymerase chain reaction (PCR) and indirect immunofluorescence assay (IFA) to reduce the incidence of TTB in neonates and pediatric sickle cell and thalassemia patients under an FDA‐approved investigational new drug application. We compared the reports of TTB in these patients in the first 12 months of the study with those of patients who received unscreened blood from 2005 to 2010.

RESULTS: There were 2113 units tested with 2086 negative results, 26 positive IFA results (1.23%), and one indeterminate PCR result (0.05%). No reported case of TTB occurred with any B. microti–screened unit transfused to the targeted patients (0/787 units) or to any patient who received the screened units (0/2086 units). Before screening, there were seven cases of TTB in neonates, sickle cell, and thalassemia patients from 6500 unscreened units (one case/929 units) and 24 cases in the total transfused population from 496,545 units distributed (one case/20,686 units).

CONCLUSION: Implementation of B. microti IFA and PCR screening is compatible with blood center operations to provide tested units. While the results after 1 year are not powered to demonstrate a change in the rate of TTB after testing, they are encouraging.
Do Shareholders Really Prefer Their Executives to Maximize the Equity Value? A Newsvendor Case*
Authors: Berman Oded , Sanajian Nima , Abouee‐Mehrizi Hossein
Published: March 2012

In this article, we study how the operational decisions of a firm manager depend on her own incentives, the capital structure, and financial decisions in the context of the newsvendor framework. We establish a relationship between the firm’s cost of raising funds and the riskiness of the inventory decisions of the manager. We consider four types of managers, namely, profit, equity, firm value, and profit‐equity maximizers, and initially assume that they may raise funds to increase the inventory level only by issuing debt. We show that the shareholders are indifferent between the different types of managers when the coefficient of variation (CV) of demand is low. However, this is not the case when the CV of demand is high. Based on the demand and the firm’s specific characteristics such as profitability, leverage, and bankruptcy costs, the shareholders might be better off with the manager whose compensation package is tied to the firm value as opposed to the equity value. We, then, extend our model by allowing the manager to raise the required funds by issuing both debt and equity. For this case we focus on the equity and firm value maximizer managers and show that our earlier results (for the debt only case) still hold subject to the cost of issuing equity. However the benefit of the firm value maximizer manager over the equity maximizer manager for shareholders is considerably less in this case compared to the case where the manager can only issue debt. The Board of Directors can take these factors into consideration when establishing/modifying the right incentive package for the managers. We also incorporate the notion of the asymmetric information to capture its impact on the board of directors’ decision about the managers’ incentive package.
Interactions between a Left Ventricular Assist Device and Implantable Cardioverter‐Defibrillator
Authors: NETZLER PETER C. , VASUKI NAGAVARDHAN , PEURA JENNIFER L. , GOLD MICHAEL R.
Published: March 2012

Left ventricular assist devices (LVADs) are approved for both a bridge to cardiac transplantation as well as for destination therapy. Most patients with LVADs have implantable cardioverter‐defibrillators (ICDs) and several interactions between LVADs and ICDs have been reported. In the present case, we describe an interaction of an approved LVAD with remote telemetry of a previously implanted Sorin ICD (Sorin Group, Milan, Italy) that could not be resolved with standard shielding techniques. (PACE 2012; 35:e272–e273)
Adverse Effects of Long‐Term Right Ventricular Apical Pacing and Identification of Patients at Risk of Atrial Fibrillation and Heart Failure
Authors: SISTI ANTONIO DE , MÁRQUEZ MANLIO F. , TONET JOELCI , BONNY AIM , FRANK ROBERT , HIDDEN‐LUCET FRANÇOISE
Published: March 2012

In patients needing a pacemaker (PM) for bradycardia indications, the amount of right ventricular (RV) apical pacing has been correlated with atrial fibrillation (AFib) and heart failure (HF) in both DDD and VVI mode. RV pacing was linked with left ventricular (LV) dyssynchrony in almost 50% of patients with PM implantation and atrioventricular (AV) node ablation for AFib. In patients with normal systolic function needing a PM, apical RV pacing resulted in LV ejection fraction (LVEF) reduction. These negative effects were prevented by cardiac resynchronization therapy (CRT). Algorithms favoring physiological AV conduction are possible useful tools able to maintain both atrial and ventricular support and limit RV pacing. However, when chronic RV pacing cannot be avoided, it appears necessary to reconsider the cut‐off value of basic LVEF for CRT.

In HF patients, RV pacing can induce greater LV dyssynchrony, enhanced by underlying conduction diseases. In this context, a more deleterious effect of RV pacing in implantable cardioverter‐defibrillator (ICD) patients with low LVEF can be expected. In some major ICD trials, DDD mode was correlated with increased mortality/HF. This negative impact was attributed to unnecessary RV pacing >40–50%, virtually absent in VVI‐40 mode. However, some data suggest that avoiding RV pacing may also not be the best option for patients requiring an ICD. In patients with impaired LV function, AV synchrony should therefore be ensured. The best pacing mode in ICD patients with HF should be defined on an individual basis.

(PACE 2012; 35:1035–1043)
Radiofrequency and Cryoablation Therapies for Supraventricular Arrhythmias in the Young: Five‐Year Review of Efficacies
Authors: BUDDHE SUJATHA , SINGH HARINDER , DU WEI , KARPAWICH PETER P.
Published: March 2012

Background:

Cryoablation (Cryo) has augmented radiofrequency (RF) as the ablation energy choice for most supraventricular tachycardias (SVT). Although initial acute results and more recent, but limited, 3–36‐month follow‐up studies have been reported, more longer follow‐up information is required to determine actual efficacy.

Methods:

Data from patients with structurally normal hearts who underwent reentrant forms of SVT ablation at our institution from January 2005 to December 2009 were reviewed. These included demographics, clinical and electrophysiologic findings, and ablative energies used. Following apparent acute success, all patients were then reevaluated for any potential recurrences of SVT or preexcitation up to 5 years later.

Results:

A total of 155 patients (83 male) were reviewed (mean age 13.4 ± 3.7 years). Ablations were predominantly right‐sided (75%). Atrioventricular reciprocating tachycardia was seen in 74% and atrioventricular node reciprocating tachycardia (AVNRT) in 17% of patients. For concerns of atrioventricular node integrity, Cryo ± RF was user‐preferred for anteroseptal accessory fiber locations and AVNRT. Acute success rate was 98% and chronic 83.2% over the next 5 years. Among patients with accessory pathways, recurrence was pathway number and location dependent: significantly higher (P < 0.05) if they were right anterior‐anteroseptal, multiple, or with a broad‐distribution pattern. There were no significant differences in recurrence rates with use of RF or its combination with Cryo.

Conclusion:

Radiofrequency ablation and Cryo are both effective therapies for pediatric patients. Although use of Cryo with RF in combination may enhance safety while affording comparable success, risk of recurrence still persists in the current era among patients depending on accessory pathways connection location and characteristics. (PACE 2012; 35:711–717)
Questionnaire Survey of Cardiologists’ Knowledge, Attitudes, and Guideline Application of Implantable Cardioverter Defibrillator Therapy
Authors: SADARMIN PRAVEEN P. , WONG KELVIN C. K. , RAJAPPAN KIM , BASHIR YAVER , BETTS TIMOTHY R.
Published: March 2012

Introduction:

There are little data on cardiologists’ knowledge and application of current implantable cardioverter defibrillator (ICD) guidelines, attitudes to risk, and how these may influence ICD prescription.

Methods:

A questionnaire survey was sent to UK cardiologists to test their knowledge and application of ICD guidelines and their estimate of the clinical benefits gained in different clinical scenarios. They were questioned on the minimum absolute risk reduction (ARR) required to justify an ICD implant and factors that influenced their decision making.

Results:

Sixty responses from 23 implanters and 37 nonimplanters were obtained. Eighty‐three percent implanters and 43% nonimplanters were fully aware of UK ICD National Institute of Clinical Excellence guidelines. Only 7% responders had a screening program to identify primary prevention (PP) candidates. Although the mean estimate of ARR in PP scenarios was similar to trial data, the range of estimates was very wide. The benefit in secondary prevention (SP) scenarios was overestimated by both implanters and nonimplanters. Three‐year ARR believed to justify PP and SP ICDs were heavily influenced by patients’ age but in patients <80 years, age was compatible with trial results. Implanters and nonimplanters correctly applied guidelines in SP scenarios with younger patients but often withheld an ICD in elderly patients. Correct application did not correlate with full awareness of guidelines.

Conclusion:

Lack of knowledge of guidelines (particularly in nonimplanters), failure of nonimplanters to offer ICDs to appropriate PP patients, age bias, and a lack of screening programs appear to be the greatest barriers to uptake of ICDs in the United Kingdom, rather than financial concerns. (PACE 2012; 35:672–680)