bluuebunny/crossref_metadata_2025 huggingface dataset:
Green perspectives and practices: a “comparative logistics” study
Authors: Murphy Paul R. , Poist Richard F.
Published: April 2003

The present paper adds to the relatively limited empirical literature involving green logistics by comparing US and non‐US firms with respect to select propositions regarding environmental issues, practices, and strategies. For a majority of propositions evaluated, the study results indicate that US and non‐US firms tend to share similar perspectives and practices regarding the management of environmental logistics. The study results also tend to confirm literature suggestions that green concerns will broaden the scope of logistics as well as influence the way logistics managers do their jobs.
A generic supplier management tool for outsourcing manufacturing
Authors: Choy K.L. , Lee W.B.
Published: April 2003

A corporation’s global supply chain usually consists of enterprises and manufacturers that are graphically dispersed around the world, whereby each company is involved in a wide variety of supply chain activities such as order fulfilment, international procurement, acquisition of information technology, manufacturing, and customer service. Therefore, continuously tracking performance of suppliers and an appropriate selection mechanism is one of the crucial activities in supply chain management. This paper presents an intelligent generic supplier management tool (GSMT) using the case‐based reasoning (CBR) technique for outsourcing to suppliers and automating the decision making process when selecting them. The development of GSMT and how the CBR technique is applied is then given, followed by an application of GSMT in Honeywell Consumer Products (Hong Kong) Limited.
The commitment and satisfaction of lower‐ranked police officers
Authors: Brunetto Yvonne , Farr‐Wharton Rod
Published: April 2003

This study reports findings about what factors affect the job commitment and satisfaction of lower‐ranked police officers. Over the past decade, there have been significant attempts to reform organisational processes within police services of a number of Western democracies. These reforms have changed the organisational context within which policing takes place and, consequently, the work practices of police officers have changed and, in turn, their commitment and satisfaction may also have been affected. The study used Metcalfe and Dick’s instrument for measuring police commitment and Johlke and Duhan’s instrument for measuring the employees’ satisfaction with communication processes between supervisors and service employees. The findings first suggest a relatively high level of pride in the police service, with reasonable levels of identification with the police service’s goals and increased involvement with rank (from constable to sergeant). On the other hand, there is increasing dissatisfaction with appraisal/promotional procedures and information communication modes as rank increases (from constables to sergeants) and an inverse relationship between rank and organisational commitment overall.
The role of the COPS Office in community policing
Authors: Worrall John L. , Zhao Jihong
Published: April 2003

This paper explores the relationship between community‐policing and grants provided by the Office of Community‐Oriented Policing Services (COPS Office) in the US Justice Department. Community policing data were gathered via a survey of 700 municipal and county law enforcement agencies employing more than 100 full‐time sworn officers/deputies. Grant data were gathered on the same agencies via a Freedom of Information Act request filed with the COPS Office. Census data were used for control purposes. General findings suggest that COPS funding is strongly associated with community‐policing. Specific findings are: first, hiring grants were more associated with community‐policing than grants designed to promote innovative programs and second, agencies with several COPS grants were more likely to report community‐policing programs than agencies with fewer COPS grants.
Shifting paradigms
Authors: McGloin Jean Marie
Published: April 2003

The Good Friday Agreement of 1998 was the explicit base for the politically shared, though tenuous, internal government of Northern Ireland. This ensuing process has highlighted the centrality of the national police, as a country or state attempts to shift towards a contemporary, pluralistic democracy. To clarify, the police force, which was previously an instrument of control, must now become an organization that strives for the consent and support of the public. Using Mawby’s models of policing as an organizational framework, this article focuses attention on the policing paradigms of Northern Ireland over the course of its social history. It puts forth the argument that, despite some strategic changes, it is only upon the heels of the Good Friday Agreement and the consequent governmental change that the police force has begun to shift its operational paradigm away from the colonial model toward an Anglo‐Saxon paradigm.
ABSORPTION CROSS-SECTION IN DE SITTER SPACE
Authors: MYUNG Y. S.
Published: March 2003

We study the wave equation for a minimally coupled massive scalar in three-dimensional de Sitter space. We compute the absorption cross-section to investigate its cosmological horizon in the southern diamond. Although the absorption cross-section is not defined exactly, it can be determined from the fact that the low-energy s(j = 0)-wave absorption cross-section for a massless scalar is given by the area of the cosmological horizon. On the other hand, the low-temperature limit of j ≠ 0-mode absorption cross-section is useful for extracting information surrounding the cosmological horizon. Finally we mention a computation of the absorption cross-section on the CFT-side using the dS/CFT correspondence.
ON THE UBIQUITY OF THE LÉVY INTEGRAL — ITS RELATIONSHIP WITH THE GENERALIZED EULER-JACOBI SERIES AND THEIR ASYMPTOTICS BEYOND ALL ORDERS
Authors: GARONI T. M. , FRANKEL N. E.
Published: March 2003

We present here an overview of the history, applications and important properties of a function which we refer to as the Lévy integral. For certain values of its characteristic parameter, the Lévy integral defines the symmetric Lévy stable probability density function. As we discuss however, the Lévy integral has applications to a number of other fields besides probability, including random matrix theory, number theory and asymptotics beyond all orders. We exhibit a direct relationship between the Lévy integral and a number theoretic series which we refer to as the generalized Euler-Jacobi series. The complete asymptotic expansions for all natural values of its parameter are presented, and in particular it is pointed out that the intricate exponentially small series become dominant for certain parameter values.
ANALYSIS OF CORRELATION PROPERTIES IN GEOELECTRICAL DATA
Authors: COLANGELO GERARDO , LAPENNA VINCENZO , TELESCA LUCIANO
Published: March 2003

This paper considers four geoelectrical time series, measured in a seismic area of Southern Italy. Lomb Periodogram method, Higuchi analysis, Detrended Fluctuation Analysis (DFA) and the mean distance spanned within time L are used to discuss the correlation properties of these signals. The values of the scaling exponents from these methods of the geoelectrical data indicate that the long-range correlations are present. Furthermore, it is found that these correlations are all linear.
Qualcomm in China (B)
Authors: West Joel , Tan Justin
Published: March 2003

Case (B) covers Qualcomm's efforts from the mid 1990s to the present in getting CDMA adopted in the rapidly growing Chinese market. The case was originally designed to highlight the issues of political risk and transparency given the role of the Chinese government in decisions by state-owned enterprises and the highly volatile context of U.S.-China political relations. But the case also presents traditional problems of market entry and the ambiguities inherent during ongoing efforts for telecommunications reform.
BUCKLING ANALYSIS OF CRACKED COLUMN STRUCTURES AND PIEZOELECTRIC-BASED REPAIR AND ENHANCEMENT OF AXIAL LOAD CAPACITY
Authors: WANG Q. , CHASE J. G.
Published: March 2003

Decreased flexural and buckling capacity of composite structures due to the development of fatigue cracks is a serious issue in a variety of fields. This paper discusses the buckling capacity and piezoelectric material enhancement of cracked column structures. A model of the rotational discontinuity at the crack location is used to develop analytical buckling solutions and the effect of crack location and intensity on the buckling capacity of the damaged columns is investigated. Small piezoelectric patches are employed to induce local moments to compensate for the decreased buckling capacity of column structures, using a mechanical model coupled with piezoelectric strain-voltage relations. The voltages required to enhance the buckling capacity are analytically determined and the general relationship between crack location and voltage developed. The primary advantage of the piezoelectric-based repair approach presented is the ability to use a single small patch, with different applied voltages, to repair cracks of a wide variety of depths, intensities and locations passive design solutions would require custom designs to restore the axial load capacity for each case.
ACTIVE CONTOUR MODEL USING WAVELET MODULUS FOR OBJECT SEGMENTATION AND TRACKING IN VIDEO SEQUENCES
Authors: LIU JEN-CHANG , HWANG WEN-LIANG
Published: March 2003

We propose an integrated wavelet-based framework of the active contour model (snake) for segmentation and motion tracking of deformable objects in video sequences. The input image frame is represented by means of wavelet transform. First, the moduli of wavelet transform coefficients are used in a multi-resolution motion estimation process to find the initial snake contour in the current frame. The presented multi-resolution motion estimation methods allow a larger movement of the tracked object than does traditional image-based motion estimation. Secondly, the wavelet transform modulus at each scale is considered in the energy function of the snake model. The snake computation is based on a coarse-to-fine scale continuation method. Application of the proposed methods to biological cell tracking is demonstrated in experiments.
The Anatomy of a Disparity in Infant Mortality
Authors: Wise Paul H.
Published: March 2003

▪ Abstract  This article suggests that while disparities in infant mortality have been longstanding, the mechanisms of disparity creation are undergoing intense change. This dynamic character is explored by first developing an analytic model that examines the interaction between social factors and the public health and clinical capacity to intervene. Disparities in infant mortality are then broken down into their component parts and linked to specific arenas of intervention. Disparities in postneonatal mortality are being shaped by differential access to interventions designed to prevent infant death from congenital anomalies and the Sudden Infant Death Syndrome. Disparities in neonatal mortality are primarily determined by factors that influence the birthrate of extremely premature infants and access to specialized obstetrical and pediatric care. This analysis suggests that the epidemiology and social meaning of disparities in infant mortality are intensely dynamic and increasingly reflect the interaction between social forces and technical innovation.
Violence Prevention and Control Through Environmental Modifications
Authors: Mair Julie Samia , Mair Michael
Published: March 2003

▪ Abstract  Violence traditionally had been considered a problem exclusively within the criminal justice domain, although it is now widely viewed as a public health issue as well. Public health has brought new and complementary tools for understanding and preventing violence. Whereas public health has long recognized the environment as a determinant of disease and injury, it has paid less attention to the environment when considering violence prevention strategies. For several decades though, some criminologists and others have been researching environmental factors in crime prevention. This article aims to discuss the main environmental crime-prevention strategies, provide examples of promising interventions, review public health literature that uses these strategies, discuss what public health can contribute, and suggest public health research to test the hypothesis that violence can be prevented and controlled through environmental modifications.
The Challenge and Potential of Childhood Immunization Registries
Authors: Freeman Victoria A. , DeFriese Gordon H.
Published: March 2003

▪ Abstract  Recent efforts to attain near-complete coverage of child populations by recommended vaccines have included initiatives by federal and state agencies, as well as private foundations, to develop and implement statewide or community-based childhood immunization registries. Plans for a single, national registry have been set aside in favor of a national network of local and state registries linked through the use of common definitions and unique child identifiers. However, both operational/technical and financing difficulties have slowed their development. The experience to date in selected areas has provided useful lessons for further development of a registry system and has underscored the potential of such systems to assure the success of childhood immunization initiatives.
The Role of Health Plans in Tobacco Control
Authors: Manley Marc W. , Griffin Tom , Foldes Steven S. , Link Carolyn C. , Sechrist Rebecca A.J.
Published: March 2003

▪ Abstract  Health plans play an important role in tobacco control. In this chapter we present an overview of the scientific research on health plan involvement in clinical and community interventions regarding tobacco use. Also included are interventions that have been undertaken by health plans to lower smoking rates among their members and the general population. We conclude with a new model that can be used to engage health plans in tobacco control efforts and a case study that outlines how one health plan has implemented this new model.
Redefining the Role of Public Health in Disability
Authors: Lollar Donald J. , Crews John E.
Published: March 2003

▪ Abstract  The stated mission of current public health activities is to prevent mortality, morbidity, and disability. Though this mission is a noble challenge, attention is now being drawn to that group of the public who are not prevented from living with a disability. This chapter seeks to redefine the functions of public health in the field of disability. It describes the changing demographics of disability and provides a framework for addressing the complex issues associated with defining disability. Finally, we outline a strategy for stronger and clearer public health presence to improve the health and well-being of people with disabilities.
Measuring Quality of Care and Performance from a Population Health Care Perspective
Authors: Derose Stephen F. , Petitti Diana B.
Published: March 2003

▪ Abstract  Population health care is health information and clinical services provided to individuals of a defined population. From a population health care perspective, quality of care involves the health status of the entire population, and thus issues of access, cost of care, and efficiency matter. In this paper, we describe the definitions of quality health care and the framework for measuring quality, with emphasis on the performance of organizations involved in the delivery and assurance of population health care. We describe quality measurement sets and systems, criteria for the choice of measures, data sources, and how quality measurements are used to improve health care and outcomes from a population health care perspective.
The Health of U.S. Hired Farm Workers
Authors: Villarejo Don
Published: March 2003

▪ Abstract  Despite a recent surge in knowledge about U.S. hired farm workers, little is known about the health of this population. No national data are available on the size of the population, mortality or morbidity data, or on chronic health indicators. Demographic data show that these workers are mostly Mexican immigrant or migrant males, and nearly two thirds live in poverty. At least half of all current hired farm workers are undocumented. Fewer than one in five have health insurance, either through their employer or through government programs. However, programs targeting women farm workers, such as WIC or, in California, emergency MediCal, are more effective in helping them obtain needed services. The federal Migrant Health Program serves about 13% of the total of workers plus dependent family members. This paper reviews what is known in the following topical areas: (a) mortality and morbidity; (b) access to health care services; (c) control of infectious diseases; (d) maternal and child care; (e) occupational health; (f) violence; and (g) chronic health indicators. It is suggested that future research incorporate a minimal physical examination of all patients or subjects in order to establish baseline information for the population. Such information will be helpful in targeting interventions and measuring their effectiveness.
Managed Care Spillover Effects
Authors: Baker Laurence C.
Published: March 2003

▪ Abstract  In addition to influencing care for patients enrolled in managed care plans, growth in managed care could lead to broad changes in the structure and functioning of the health care system that could ultimately influence care for all patients, even those not covered by managed care plans. This paper summarizes the mechanisms by which these effects could arise, including shifts in the types of services available in markets and changes in physician practice patterns. The paper summarizes available empirical evidence on broad-level effects of managed care, concluding that the literature supports the view that managed care can have generalized effects on health care spending, utilization patterns, and infrastructure, although existing literature has not clearly identified effects on health outcomes.
Aortic Distensibility Independently Affects Exercise Tolerance in Patients With Dilated Cardiomyopathy
Authors: Bonapace Stefano , Rossi Andrea , Cicoira Mariantonietta , Franceschini Lorenzo , Golia Giorgio , Zanolla Luisa , Marino Paolo , Zardini Piero
Published: March 2003

Background—

Peak exercise oxygen consumption (V̇
o
2
) is crucial for the prognostic stratification of patients with congestive heart failure, but its hemodynamic determinants are still not completely understood. Aortic wall elasticity modulates left ventricular function and coronary blood flow. Whether an increased aortic pulse-wave velocity (PWV), a known marker of arterial stiffness, may predict peak V̇
o
2
in patients with dilated cardiomyopathy (DCM) has to be clarified.

Methods and Results—

A total of 78 patients with clinical diagnosis of DCM (aged 62±11 years; female 29%; mean ejection fraction 34±9%) were selected. All patients underwent a complete echocardiographic-Doppler evaluation. Aortic PWV was measured by Doppler ultrasonography immediately before the exercise. A bicycle exercise test with expiratory gas exchange monitoring was performed to determine V̇
o
2
. Plasma concentration of the amino-terminal propeptide of type III procollagen (PIIINP), a marker of extracellular matrix turnover, was determined. Mean PWV was 5.7±2.2 m/s, and V̇
o
2
was 16.5±4.5 mL · kg
−1
· min
−1
. The hemodynamic variables correlated with V̇
o
2
were PWV (
r
=−0.39,
P
=0.0007) and stroke volume (
r
=0.38,
P
=0.002). In a multivariate analysis, PWV (
P
=0.04) and stroke volume (
P
=0.05) were independently correlated with V̇
o
2
, accounting for 34% of its variance. PIIINP levels correlated with PWV (
r
=0.35,
P
=0.002) and a more restrictive diastolic filling pattern (
r
=0.40,
P
=0.02).

Conclusions—

Increased aortic stiffness measured by PWV is an independent predictor of peak V̇
o
2
and could partially explain exercise intolerance in patients with DCM.
Dysfunctional Baroreflex Regulation of Sympathetic Nerve Activity in Patients With Vasovagal Syncope
Authors: Béchir Markus , Binggeli Christian , Corti Roberto , Chenevard Rémy , Spieker Lukas , Ruschitzka Frank , Lüscher Thomas F. , Noll Georg
Published: March 2003

Background—

The interplay of resting muscle sympathetic nerve activity (MSA) and the baroreceptor reflex in patients with vasovagal syncope remains elusive. Hence, the aim of the present study was to investigate MSA, baroreceptor sensitivity, heart rate, and blood pressure under resting conditions and during orthostatic stress in patients with a history of vasovagal syncope.

Methods and Results—

MSA was measured using microneurography at rest and during lower body negative pressure (LBNP) to mimic orthostatic stress in patients with a history of vasovagal syncope (n=10) and in age-matched healthy controls (n=8). Heart rate and blood pressure were simultaneously recorded. Cardiac baroreceptor sensitivity was calculated with the spectral technique (α coefficient). Resting MSA in the patients with syncope was significantly increased as compared with controls (42.4±2.3 versus 26.5±3.6 bursts/min,
P
=0.001), whereas activation of MSA during orthostatic stress in the patient group was significantly blunted (5.1±1.6 versus 15.2±2.1 bursts/min at LBNP −50 mm Hg,
P
=0.002). In the patients with syncope, cardiac baroreceptor sensitivity was significantly reduced under supine resting conditions (8.5±0.7 versus 13.0±1.1 ms/mm Hg,
P
=0.001), as well as under orthostatic stress (7.3±0.7 versus 13.4±1.5 ms/mm Hg,
P
=0.003).

Conclusions—

This study shows that in patients with vasovagal syncope, resting MSA is increased and baroreflex regulation during orthostatic stress is blunted, thus leading to impaired MSA adaptation. These results provide new insights into mechanisms of vasovagal syncope and suggest that pharmacological modulation of baroreceptor sensitivity may represent a promising treatment of neuromediated syncope.
Adipose Tissue α-Linolenic Acid and Nonfatal Acute Myocardial Infarction in Costa Rica
Authors: Baylin Ana , Kabagambe Edmond K. , Ascherio Alberto , Spiegelman Donna , Campos Hannia
Published: March 2003

Background—

α-Linolenic acid may protect against cardiovascular disease. We examined the association between adipose tissue α-linolenic acid and nonfatal acute myocardial infarction (MI) in a population-based case-control study in Costa Rica.

Methods and Results—

The 482 case patients with a first nonfatal acute MI and 482 population control subjects were matched by age, sex, and area of residence. Fatty acids were assessed by gas-liquid chromatography in adipose tissue samples collected from all subjects. ORs and 95% CIs were calculated from multivariate conditional logistic regression models. Subjects in the top quintiles of adipose tissue α-linolenic acid had a lower risk of MI than those in the lowest quintile: OR (95% CI), 1.00; 0.80 (0.52 to 1.24); 0.53 (0.34 to 0.82); 0.44 (0.28 to 0.67); and 0.37 (0.24 to 0.59); test for trend,
P
<0.0001. This association was strengthened after adjustment for established MI risk factors, including smoking, physical activity, income, and adipose tissue linoleic acid and
trans
fatty acids (OR for the top versus lowest quintile, 0.23; 95% CI, 0.10 to 0.50; test for trend,
P
<0.0001). Further adjustment for the intake of saturated fat, fiber, alcohol, and vitamin E did not change this association (OR for the top versus lowest quintile, 0.23; 95% CI, 0.10 to 0.55; test for trend,
P
<0.0001).

Conclusions—

The inverse association observed between α-linolenic acid and nonfatal acute MI suggests that consumption of vegetable oils rich in α-linolenic acid confers important protection against cardiovascular disease.
Mouse Model for Hereditary Hemorrhagic Telangiectasia Has a Generalized Vascular Abnormality
Authors: Torsney Evelyn , Charlton Richard , Diamond Austin G. , Burn John , Soames James V. , Arthur Helen M.
Published: March 2003

Background—

Mutations in endoglin or activin like kinase-1, both involved in the endothelial transforming growth factor-β signaling pathway, cause the autosomal dominant bleeding disorder hereditary hemorrhagic telangiectasia. We and others have reported mouse models for this disease that share the characteristic phenotype of dilated vessels and sporadic hemorrhage. The reasons for the variable phenotype in hereditary hemorrhagic telangiectasia are not understood.

Methods and Results—

After a detailed immunohistochemical analysis of 129/Ola mice, which are heterozygous for a targeted deletion in the endoglin gene, we observed intrinsic abnormalities in the vascular walls throughout the cutaneous vasculature. Postcapillary venules were dilated, and up to 70% of the vascular wall had no smooth muscle cells. The supporting layers of collagens and elastin were irregular, with thin areas, adding to the fragility of these vessels. A variable hemorrhagic phenotype was observed in which local bleeding is associated not only with fragile vessels but also with regions of inflammation.

Conclusions—

These findings have relevance to our understanding of the molecular basis of vascular integrity in a wide range of diseases.
AT
1
Receptor Agonistic Antibodies From Preeclamptic Patients Stimulate NADPH Oxidase
Authors: Dechend Ralf , Viedt Christiane , Müller Dominik N. , Ugele Bernhard , Brandes Ralf P. , Wallukat Gerd , Park Joon-Keun , Janke Jurgen , Barta Peter , Theuer Jurgen , Fiebeler Anette , Homuth Volker , Dietz Rainer , Haller Hermann , Kreuzer Jörg , Luft Friedrich C.
Published: March 2003

Background—

We recently identified agonistic autoantibodies directed against the angiotensin AT1 receptor (AT
1
-AA) in the plasma of preeclamptic women. To elucidate their role further, we studied the effects of AT
1
-AA on reactive oxygen species (ROS), NADPH oxidase expression, and nuclear factor-κB (NF-κB) activation.

Methods and Results—

We investigated human vascular smooth muscle cells (VSMC) and trophoblasts, as well as placentas. AT
1
-AA were isolated from sera of preeclamptic women. Angiotensin II (Ang II) and AT
1
-AA increased ROS production and the NADPH oxidase components, p22, p47, and p67 phox in Western blotting. We next tested if AT
1
-AA lead to NF-κB activation in VSMC and trophoblasts. AT
1
-AA activated NF-κB. Inhibitor-κBα (I-κBα) expression was reduced in response to AT
1
-AA. AT1 receptor blockade with losartan, diphenylene iodonium, tiron, and antisense against p22 phox all reduced ROS production and NF-κB activation. VSMC from p47phox−/− mice showed markedly reduced ROS generation and NF-κB activation in response to Ang II and AT1-AA. The p22, p47, and p67 phox expression in placentas from preeclamptic patients was increased, compared with normal placentas. Furthermore, NF-κB was activated and I-κBα reduced in placentas from preeclamptic women.

Conclusions—

NADPH oxidase is potentially an important source of ROS that may upregulate NF-κB in preeclampsia. We suggest that AT
1
-AA through activation of NADPH oxidase could contribute to ROS production and inflammatory responses in preeclampsia.
Recurrence of Mitral Valve Regurgitation After Mitral Valve Repair in Degenerative Valve Disease
Authors: Flameng Willem , Herijgers Paul , Bogaerts Kris
Published: March 2003

Background—

Durability assessment of mitral valve repair for degenerative valve incompetence is actually limited to reoperation as the primary indicator, with valve-related risk factors for late death as a secondary indicator. We assessed serial echocardiographic follow-up of valve function as an indicator of the durability of mitral valve repair.

Methods and Results—

In 242 patients who had undergone mitral valve repair for degenerative valve incompetence, echocardiographic follow-up of valve function, rate of reoperation, survival, and clinical outcome was studied. At 8 years after repair, clinical outcome was excellent, survival was 90.9±3.2%, freedom from reoperation was 94.2±2.3%, and freedom from anticoagulation bleeding and thromboembolic events was 90.4±2.7%. However, freedom from non-trivial mitral regurgitation (>1/4) was 94.3±1.6% at 1 month, 58.6±4.9% at 5 years, and 27.2±8.6% at 7 years. Freedom from severe mitral regurgitation (>2/4) was 98.3±0.9% at 1 month, 82.8±3.8% at 5 years and 71.1±7.4% at 7 years. The linearized recurrence rate of non-trivial mitral regurgitation (>1/4) was 8.3% per year and of severe mitral regurgitation (>2/4) was 3.7% per year. Inadequate surgical techniques (chordal shortening, no use of annuloplasty ring or sliding plasty) could only partially explain recurrence of regurgitation. In selected patients who did not have these risk factors, linearized recurrence rates were 6.9% per year and 2.5% per year, respectively.

Conclusion—

The durability of a successful mitral reconstruction for degenerative mitral valve disease is not constant, and this should be taken into account when asymptomatic patients are offered early mitral valve repair.
Dobutamine Cardiovascular Magnetic Resonance for the Detection of Myocardial Ischemia With the Use of Myocardial Tagging
Authors: Kuijpers Dirkjan , Ho Kai Yiu J.A.M. , van Dijkman Paul R.M. , Vliegenthart Rozemarijn , Oudkerk Matthijs
Published: March 2003

Background—

The purpose of this study was to assess the value of high-dose dobutamine cardiovascular magnetic resonance (CMR) with myocardial tagging for the detection of wall motion abnormalities as a measure of myocardial ischemia in patients with known or suspected coronary artery disease.

Methods and Results—

Two hundred eleven consecutive patients with chest pain underwent dobutamine-CMR 4 days after antianginal medication was stopped. Dobutamine-CMR was performed at rest and during increasing doses of dobutamine. Cine-images were acquired during breath-hold with and without myocardial tagging at 3 short-axis levels. Regional wall motion was assessed in a 16-segment short-axis model. Patients with new wall motion abnormalities (NWMA) were examined by coronary angiography. Dobutamine-CMR was successfully performed in 194 patients. Dobutamine-CMR without tagging detected NWMA in 58 patients, whereas NWMA were detected in 68 patients with tagging (
P
=0.002, McNemar). Coronary angiography showed coronary artery disease in 65 (96%) of these 68 patients. All but 3 of the 65 patients needed revascularization. In the 112 patients with a negative dobutamine-CMR study, without baseline wall motion abnormalities, the cardiovascular occurrence-free survival rate was 98.2% during the mean follow-up period of 17.3 months (range, 7 to 31).

Conclusions—

Dobutamine-CMR with myocardial tagging detected more NWMA compared with dobutamine-CMR without tagging and reliably separated patients with a normal life expectancy from those at increased risk of major adverse cardiac events.
Quinine as a multidrug resistance inhibitor: a phase 3 multicentric randomized study in adult de novo acute myelogenous leukemia
Authors: Solary Eric , Drenou Bernard , Campos Lydia , de Crémoux Patricia , Mugneret Francine , Moreau Philippe , Lioure Bruno , Falkenrodt Annie , Witz Brigitte , Bernard Marc , Hunault-Berger Mathilde , Delain Martine , Fernandes José , Mounier Christiane , Guilhot François , Garnache Francine , Berthou Christian , Kara-Slimane Fawzi , Harousseau Jean-Luc ,   the Groupe Ouest Est Leucémies Aiguës Myéloblastiques (GOELAMS)
Published: March 2003

Based on our previous demonstration that quinine could be used clinically to reverse P-glycoprotein–mediated resistance, we designed a multicenter, randomized trial aiming to determine whether quinine would improve the survival of adult patients (15-60 years old) with de novo acute myelogenous leukemia (AML). These patients randomly received (n = 213) or did not receive (n = 212) a 30 mg/kg/day continuous intravenous infusion of quinine in combination with induction chemotherapy combining idarubicine and cytarabine and, depending on bone marrow examination at day 20, an additional course of cytarabine and mitoxantrone. The mean steady-state quinine concentration was 7.8 mg/L and the mean multidrug resistance reversing activity of serum was 1.96. Complete remission (CR) was obtained in 344 patients (80.9%) without significant influence of quinine. Of the patients in complete remission, 82 were assigned to receive HLA-matched bone marrow transplants, whereas 262 were assigned to 2 courses of intensive consolidation chemotherapy, with or without quinine, depending on initial randomization. The 4-year actuarial overall survival (OS) of the 425 eligible patients was 42.0% ± 2.5%, without significant influence of quinine. Of 160 patients who could be studied, 54 demonstrated rhodamine 123 efflux. In these patients, quinine significantly improved the CR rate from 12 of 25 (48.0%) to 24 of 29 (82.8%) (P = .01). However, there was no significant difference in OS. Neither mdr1 gene nor P-glycoprotein expression influenced the outcome. We conclude that quinine does not improve the survival of adult patients with de novo AML, even though it improves CR rate in a small subgroup of patients defined by rhodamine 123 efflux.
Hepcidin, a key regulator of iron metabolism and mediator of anemia of inflammation
Authors: Ganz Tomas
Published: March 2003

Human hepcidin, a 25–amino acid peptide made by hepatocytes, may be a new mediator of innate immunity and the long-sought iron-regulatory hormone. The synthesis of hepcidin is greatly stimulated by inflammation or by iron overload. Evidence from transgenic mouse models indicates that hepcidin is the predominant negative regulator of iron absorption in the small intestine, iron transport across the placenta, and iron release from macrophages. The key role of hepcidin is confirmed by the presence of nonsense mutations in the hepcidin gene, homozygous in the affected members, in 2 families with severe juvenile hemochromatosis. Recent evidence shows that deficient hepcidin response to iron loading may contribute to iron overload even in the much milder common form of hemochromatosis, from mutations in the HFE gene. In anemia of inflammation, hepcidin production is increased up to 100-fold and this may account for the defining feature of this condition, sequestration of iron in macrophages. The discovery of hepcidin and its role in iron metabolism could lead to new therapies for hemochromatosis and anemia of inflammation.
Substance use and schizophrenia: effects on symptoms, social functioning and service use
Authors: Cantwell Roch
Published: March 2003

Background

Studies examining the effects of substance use in patients with schizophrenia have produced conflicting results.

Aims

To examine the effects of comorbid substance use on symptoms, social functioning and service use in patients with schizophrenia.

Method

Patients (n=316) with and without substance use problems from three centres participating in the Scottish Comorbidity Study were compared, using research interviews and case note review, on measures of symptoms, social functioning and service use.

Results

Patients with substance use problems were younger, more likely to be male and had shorter duration of illness. They had more police contact and increased self-reported needs, but otherwise showed few differences when compared with those without such problems.

Conclusions

The presence of problem substance use had only modest impact on service use, symptoms or social functioning for this group of patients with schizophrenia. This has important implications for service development to meet the perceived needs of this group.
Development and psychometric properties of the Glasgow Depression Scale for people with a Learning Disability
Authors: Cuthill Fiona M. , Espie Colin A. , Cooper Sally-Anne
Published: March 2003

Background

There is no reliable and valid self-report measure of depressive symptoms for people with learning disabilities.

Aims

To develop a scale for individuals with learning disability, and a supplementary scale for carers.

Method

Items were generated from a range of assessment scales and through focus groups. A draft scale was piloted and field tested using matched groups of people with or without depression, and their carers. The scale was also administered to a group without learning disabilities for criterion validation.

Results

The Glasgow Depression Scale for people with a Learning Disability (GDS–LD) differentiated depression and non-depression groups, correlated with the Beck Depression Inventory – II (r=0.88), had good test – retest reliability (r=0.97) and internal consistency (Cronbach's α=0.90), and a cut-off score (13) yielded 96% sensitivity and 90% specificity. The Carer Supplement was also reliable (r=0.98; α=0.88), correlating with the GDS–LD (r=0.93).

Conclusions

Both scales appear useful for screening, monitoring progress and contributing to outcome appraisal.
Psychiatry and the media: from pitfalls to possibilities
Authors: Salter Mark
Published: March 2003

In war, truth is said to be the first casualty. Something similar may be said for psychiatry. The ability of the media to distort public understanding of mental illness is well described (Wahl, 1995; Philo et al, 1994). Psychiatric disorders, their treatments and those who provide them are all subject to overwhelmingly negative portrayals in the print and broadcast media (Hyler et al, 1991). Dehumanisation, inaccuracy and sensationalism seem to be the media's stock-in-trade. Media professionals make no apology for this, citing the provision of impartial, emotionally-neutral accounts as one of their least pressing concerns (Salter & Byrne, 2000). They also reject the notion that they are responsible for the perpetuation of harmful stereotypes, claiming instead that they merely mirror the values and beliefs of our society (Bolton, 2000). This distorting mirror is of great relevance to psychiatry. It is probably no exaggeration to state that the celebrated cases of Christopher Clunis and Ben Silcock have done more to change the practice of community psychiatry than any College President or Secretary of State over the past 5 decades.
Evaluation of an emergency response service
Authors: Tacchi Mary Jane , Joseph Suresh , Scott Jan
Published: March 2003

Aims and Method

An emergency response service (ERS) was introduced to streamline the assessment of individuals presenting in a crisis in one sector of a large provincial city. Data on service activity, clinical details and outcome were recorded on consecutive referrals to the service over the first 6 months of operation, and all patients were offered the opportunity to complete the Client Satisfaction Questionnaire.

Results

Seventy-five per cent of those referred accepted the offer of assessment, and the majority were seen in their own home within 2 hours. One in ten individuals were not offered any further mental health input and 17% were hospitalised. The number of admissions via primary care fell by 60% after the introduction of this service. However, at its peak of activity the service received an average of only two referrals per day and three each weekend. Only 30% of referrals were received outside of normal office hours. Service users and general practitioners were found to be more satisfied with the service than the staff that provided it.

Clinical Implications

The introduction of the ERS led to a faster, more consistent process of assessment of crisis referrals and assessment undertakings in the community, and appeared to increase the use of alternative treatments for individuals in crisis before resorting to admission. Funding opportunities are restricted for the development of crisis services. The development of emergency response services for the use of current staff from a number of community mental health teams is an option worth considering.
Relatives and their attitude to early detection of schizophrenic psychosis
Authors: Lauber Christoph , Rossler Wulf
Published: March 2003

Aims and Method

To assess the attitudes of relatives of patients with psychosis to early diagnosis, the respective consequences and to specialised out-patient services for early detection, we undertook a postal questionnaire survey.

Results

Eighty-five per cent of the respondents (n=200) would have visited a specialised out-patient service for early detection and 79% would have preferred to find out the diagnosis earlier. Some consequences of an early diagnosis (facing the problems associated with the illness earlier, having more appropriate behaviour towards the affected, earlier contact with other relatives and earlier treatment) are frequently mentioned.

Clinical Implications

Being favourable to both early diagnosis of psychosis and specialised out-patient services, most relatives are a useful source of support for professionals in convincing patients of diagnostic procedures and treatment.
Do patients who receive electroconvulsive therapy in Scotland get better?
Authors: Fergusson Grace , Hendry James , Freeman Chris
Published: March 2003

Aims and Method

We aimed to compare the practice of electroconvulsive therapy (ECT) in Scotland with the recommendations of the Royal College of Psychiatrists, to determine the characteristics of patients who receive ECT, to assess the outcome of ECT given in a routine clinical setting and to develop a system of quality assurance for ECT. Between February 1997 and March 2000, an audit of ECT measured the quality of treatment given at all clinics in Scotland. Audit tools were designed and standards set for the process, and outcome of treatment and interventions were identified to address any variance prior to each audit cycle. An electronic data collection system was developed and a website produced for the purpose of continued audit and information sharing.

Results

The annual rate of ECT in Scotland was 142 individual treatments per 100 000 of the total population. Electroconvulsive therapy was given mainly to White adult patients with a depressive illness who had consented to treatment. Clinical improvement, as measured by at least a 50% reduction in the Montgomery–Åsberg Rating Scale for Depression (MADRS) score, was evident in 71.2% of patients with a depressive episode.

Clinical Implications

The audit of ECT is achievable at a national level, ECT is effective in a routine clinical setting and the standards at ECT in Scotland are higher than the UK average.
Use of the Mental Health (Scotland) Act (1984) in south Glasgow
Authors: Taylor John R. , Idris K. B.
Published: March 2003

Aims and Method

A cross-sectional survey of the use of the Mental Health (Scotland) Act 1984 in a defined urban area. Patients initially detained under civil sections (Sections 24, 25, 26 and 18) between 1 April 1997 and 31 March 1998 were identified using the hospital information system and a hand search of section papers.

Results

There were 283 detentions involving 204 patients that lasted a median of 6 days. A total of 98% of patients were initially detained on a 72-hour ‘emergency section’. A total of 61% had non-organic psychotic disorders (172/283). Less than half of detentions were during the working week. Consent was usually provided by the mental health officer or relatives, but was not provided for 11% of detentions. Patients detained after admission were more likely to be detained for a longer period (29 v. 3 days) and to have their detention extended over 72 hours (64% v. 41%) compared with those detained in the community.

Clinical Implications

This paper provides information on some of the gaps identified by recent reviews of mental health legislation in Scotland and discusses the possible impact of the changes proposed by the Millan Committee. The workload of general adult consultant psychiatrists is likely to increase and the proportion of patients detained without consent could also increase. The study supports the differentiation of patients detained after admission from those detained in the community, as the patterns of detention are different.
Service innovations
Authors: Bisson Jonathan I. , Roberts Neil , Macho Gavin S.
Published: March 2003

There remains uncertainty on how best to respond to the psychological needs of individuals following traumatic events. Various approaches have been tried, but there is now a growing body of research in this area that allows us to plan appropriate responses in an evidence-based and coordinated manner. This paper describes the development of a local initiative through a partnership between the local traumatic stress service and the emergency planning department.
Service innovations
Authors: Tomar Rahul , Brimblecombe Neil , O'Sullivan Geraldine
Published: March 2003

Aims and Method

Demographic and clinical details were recorded for individuals with first-episode psychosis, potentially requiring hospital admission, who were assessed by two home treatment/crisis resolution teams over an 18-month period. The aims were to identify the proportion of such individuals that can be treated at home, factors associated with successful home treatment and reasons for hospitalisation when this took place.

Results

Successful home management was achieved in 20 (54%) of cases. No significant difference was found in any demographic variable, diagnostic category and initial Brief Psychiatric Rating Scale (BPRS) ratings between those who were hospitalised and those who were not. The most common reason recorded for admission was that of risk to self.

Clinical Implications

Many patients with first-episode psychosis otherwise requiring hospitalisation can be managed successfully at home by an intensive home-treatment team. These findings have significant implications for both in-patient and community services, in view of the planned increases in home treatment/crisis resolution services proposed in the NHS Plan.
General adult and old age psychiatry specialist registrar training – crisis looming?
Authors: Cope Denise
Published: March 2003

Aims and Methods

A postal questionnaire was sent to 31 Specialist Registrar Training Programme Directors in general adult and old age psychiatry in England, Scotland and Wales to ascertain the recruitment position on their training scheme and their views on recruitment.

Results

There was no recruitment to 24% of specialist registrar (SpR) posts. A 17% increase in national training numbers in general adult and old age psychiatry had occurred in the schemes surveyed during the past 2 years. An insufficient number of senior house officer (SHO) posts was identified by 42% of respondents and the unattractiveness of general adult psychiatry recorded by 58% of respondents as factors in under-recruitment.

Implications

Under-recruitment at consultant level in general adult and old age psychiatry is being replicated at specialist registrar level. Trainees are not being encouraged into higher psychiatric training by increasing specialist registrar national training numbers. Insufficient SHO posts and the perceived unattractiveness of general adult psychiatry appear as significant factors contributing to poor recruitment at SpR level.