bluuebunny/crossref_metadata_2025 huggingface dataset:
Pregnancy in women with Type 2 diabetes: who takes metformin and what is the outcome?
Authors: Hughes R. C. E. , Rowan J. A.
Published: February 2006

Aims  To review pregnancy outcomes in women with Type 2 diabetes (Type 2 DM), comparing women treated with those not treated with metformin.

Methods  Data were collected by case‐note review for all pregnancies in women with Type 2 DM over a 6‐year period (1998–2003) at the National Women's Hospital. Two hundred and fourteen pregnancies were included, metformin was taken in 93 pregnancies and continued until delivery in 32; the remaining 121 pregnancies comprised the control group. The principal outcome measures were preeclampsia, perinatal loss and neonatal morbidity.

Results  Baseline characteristics differed between groups: women in the metformin group had greater mean (sd) body mass index [35.5(7.6) vs. 33.5(6.6) kg/m2, P < 0.05], more chronic hypertension (19% vs. 7%, P < 0.05) and higher mean (sd) first trimester glycated haemoglobin (HbA1c) levels [8.3(1.9)% vs. 7.5(1.7)%, P < 0.005]. There was no difference between metformin and control groups, respectively, in the rate of preeclampsia (13% vs. 14%, P = 0.84), perinatal loss (3% vs. 2%, P = 0.65) or neonatal morbidity, including rate of prematurity (23% vs. 22%, P = 0.7), admission to the neonatal unit (40% vs. 48%, P = 0.27), respiratory distress (9% vs. 18%, P = 0.07) and treatment with intravenous dextrose (20% vs. 31%, P = 0.08).

Conclusions  Pregnant women with Type 2 DM who were treated with metformin had more risk factors for adverse pregnancy outcomes, but no differences in outcomes were seen compared with women not taking metformin. We need randomized trials to address potential benefits of metformin treatment in this population that may be masked by current practice.
Pioglitazone increases circulating adiponectin levels and subsequently reduces TNF‐α levels in Type 2 diabetic patients: a randomized study
Authors: Shimizu H. , Oh‐I S. , Tsuchiya T. , Ohtani K.‐I. , Okada S. , Mori M.
Published: February 2006

Background   Adipocytokines are involved in the development of insulin resistance and endothelial dysfunction in diabetic patients. However, the relationship between these factors remains unclear. We observed a chronological change in circulating adipocytokines and blood pressure levels with administration of oral hypoglycaemic agents in Type 2 diabetic (T2DM) subjects.

Methods   Thirty poorly controlled T2DM subjects (aged 60.1 ± 1.5 years, 11 males and 19 females) were randomized into two groups: voglibose (initial dose 0.6 mg/day, increased to 0.9 mg/day) and pioglitazone (initial dose 15 mg/day, increased to 30 mg/day).

Results   Both treatment groups showed a similar improvement in glycaemic control. In pioglitazone‐treated patients, circulating adiponectin levels were significantly increased from 4 weeks after the start of treatment, and until the end of the study at 12 weeks. Plasma tumour necrosis factor‐α (TNF‐α) levels were significantly decreased only at 12 weeks. In contrast, no significant changes in plasma adiponectin or TNF‐α levels were observed in voglibose‐treated patients. Plasma PAI‐1 and leptin levels were not significantly changed at 12 weeks in either treatment group. Pioglitazone significantly decreased systolic and diastolic blood pressure levels at 12 weeks, but voglibose had no effect.

Conclusion   In summary, pioglitazone caused an immediate increase in circulating adiponectin levels, followed by a reduction of TNF‐α. The observed increase in circulating adiponectin could be related to decreases in both systolic and diastolic blood pressure.
Effect of the oral hypoglycaemic sulphonylurea glibenclamide, a blocker of ATP‐sensitive potassium channels, on walking distance in patients with intermittent claudication
Authors: Mortensen U. M. , Nielsen‐Kudsk J. E. , Sondergaard H. M. , Jakobsen P. , Jensen B. S. , Schmitz O. , Nielsen T. T.
Published: February 2006

Aims  The oral hypoglycaemic sulphonylurea glibenclamide stimulates endogenous insulin secretion through blockade of ATP‐sensitive potassium (KATP) channels on pancreatic β cells, but also blocks cardiovascular KATP channels, leading to increased peripheral vascular resistance and reduced peripheral blood flow in non‐diabetic subjects. Therefore, this study examined whether a single oral dose of glibenclamide adversely affected the pain‐free or maximal walking distance in patients with intermittent claudication.

Methods  In a double‐blind, randomized crossover study, 12 non‐diabetic patients with intermittent claudication were given a single oral dose of glibenclamide (5.25 mg) or placebo separated by a washout period of 1 week. A treadmill test was carried out 180 min after glibenclamide/placebo intake for determination of pain‐free and maximal walking distance. Plasma glucose concentrations were kept constant by an euglycemic clamp. Changes in ankle/brachial blood pressure index (ABI), serum insulin, and serum glibenclamide were also assessed.

Results  The pain‐free walking distance was 62.8 ± 9.8 metres (mean ± sem) after glibenclamide and 52.6 ± 5.9 metres after placebo (P = 0.52). The maximal walking distance was 142.7 ± 18.7 metres after glibenclamide and 132.6 ± 16.6 metres after placebo (P = 0.23). The ABI was not significantly changed by glibenclamide compared with placebo. Serum glibenclamide was 0.51 ± 0.08 µm 180 min after administration of the drug. Glibenclamide produced an 8‐fold increase in circulating insulin compared with placebo (P < 0.001).

Conclusions  Glibenclamide given as a single oral dose commonly used in glucose‐lowering drug therapy does not reduce pain‐free or maximal walking distance in non‐diabetic patients with intermittent claudication.
Familial factors in diabetic nephropathy: an offspring study
Authors: Agius E. , Attard G. , Shakespeare L. , Clark P. , Vidya M.‐A. , Hattersley A. T. , Fava S.
Published: February 2006

Aims  Familial clustering of diabetic nephropathy in patients with Type 2 diabetes suggests that inherited factors predispose to diabetic nephropathy, but the nature of these factors is uncertain. The aim of the study was to compare the prevalence of known risk factors for nephropathy in non‐diabetic offspring of Type 2 diabetic patients with and without nephropathy and in control subjects.

Methods  Three groups of patients were recruited with 40 or 41 subjects in each group. These were subjects having one Type 2 diabetic parent with nephropathy (DN); subjects having one parent with Type 2 diabetes without nephropathy (DnoN), and non‐diabetic unrelated control subjects with no personal or parental history of diabetes (Control subjects).

Results  The median (interquartile range) albumin/creatinine ratio (ACR) was 1.40 (0.96–2.90) mg/mmol in DN; 0.94 (0.50–1.46) mg/mmol in DnoN and 1.22 (0.66–1.83) mg/mmol in Controls (anova: P = 0.03). ACR was higher in group DN than in DnoN (P < 0.006) and in Control subjects (P < 0.03), but there was no difference between DnoN and Control subjects. Twenty‐four‐hour ambulatory blood pressure monitoring showed mean daytime systolic blood pressure to be significantly higher in group DN than in DnoN (P < 0.02) or Control subjects (P < 0.01) (anova: P = 0.004). Fasting insulin, HOMA‐IR, interleukin‐6 (IL‐6) and C‐reactive protein (CRP) were similar in the three groups.

Conclusion  Our data provide further evidence that genetic factors are important in determining urinary albumin excretion and renal disease associated with Type 2 diabetes and suggest that genes that affect systemic arterial blood pressure but not those relating to insulin resistance or inflammation are likely to be implicated.
Metformin use and diabetic pregnancy—has its time come?
Authors: Hawthorne G.
Published: February 2006

The prevalence of Type 2 diabetes in women of childbearing age continues to grow as the incidence of Type 2 diabetes increases. Recent evidence shows that treatment of gestational diabetes ensures the best possible outcome for pregnancy complicated by gestational diabetes. Metformin is a logical treatment in these circumstances but there has always been concern about its safety for the fetus, particularly as it crosses the placenta and it may increase the risk of teratogenesis. Although evidence is accumulating that metformin is useful and has a role in polycystic ovary syndrome, a condition of insulin resistance, it is not yet accepted as treatment for Type 2 diabetes in pregnancy and gestational diabetes. Observational data supports the use of metformin in Type 2 diabetes in pregnancy and its role in gestational diabetes is currently under investigation. Metformin may become an important treatment for women with either gestational or Type 2 diabetes in pregnancy and indeed may have additional important benefits for women, including reducing insulin resistance, body weight and long‐term risk of diabetes. There is a need for a randomized controlled trial in women with Type 2 diabetes in pregnancy with long‐term follow‐up of both mothers and children. Until then the best advice remains that optimized glycaemic control prior to conception and during pregnancy is the most important intervention for best possible pregnancy outcome.
Employee Financial Participation and Productivity: An Empirical Reappraisal
Authors: Robinson Andrew M. , Wilson Nicholas
Published: February 2006

Avner Ben‐Ner and Derek Jones cast doubt on the notion of a simple causal link between financial participation (FP) and productivity, and consequently on the validity of much of the empirical literature that has sought to quantify this relationship. This paper is an attempt to investigate this proposition. Our empirical reappraisal revealed that the route through which employee share ownership and profit‐sharing schemes achieve these gains is quite separate and more involved than either the theory or prior empirical research suggests. This is particularly evident by extending the complementarities thesis beyond purely participatory bundles to embrace firm‐specific and organizational variables. Our analysis also addressed recent calls to aid the interpretation of the observed effects of FP by creating a link between the use and operation of FP and its impact on productivity.
AGAINST OPTIMALITY: LOGICAL FOUNDATIONS FOR DECISION‐THEORETIC PLANNING IN AUTONOMOUS AGENTS
Authors: Pollock John L.
Published: February 2006

This paper investigates decision‐theoretic planning in sophisticated autonomous agents operating in environments of real‐world complexity. An example might be a planetary rover exploring a largely unknown planet. It is argued that existing algorithms for decision‐theoretic planning are based on a logically incorrect theory of rational decision making. Plans cannot be evaluated directly in terms of their expected values, because plans can be of different scopes, and they can interact with other previously adopted plans. Furthermore, in the real world, the search for optimal plans is completely intractable. An alternative theory of rational decision making is proposed, called “locally global planning.”
NONMONOTONIC LOGIC AND STATISTICAL INFERENCE*
Authors: Kyburg, Jr. Henry E. , Teng Choh Man
Published: February 2006

Classical statistical inference is nonmonotonic: obtaining more evidence or obtaining more knowledge about the evidence one has can lead to the replacement of one statistical conclusion by another, or the complete withdrawal of the original conclusion. While it has long been argued that not all nonmonotonic inference can be accounted for in terms of relative frequencies or objective probabilities, there is no doubt that much nonmonotonic inference can be accounted for in this way. Here we seek to explore the close connection between classical statistical inference and default logic, treating statistical inference within the framework of default logic, and showing that nonmonotonic logic in general, and default logic in particular, needs to take account of certain features of statistical inference. Default logic must take account of statistics, but at the same time statistics can throw light on problematic cases of default inference.
Taxonomic selectivity in amphibians: ignorance, geography or biology?
Authors: Bielby J. , Cunningham A. A. , Purvis A.
Published: February 2006

Many taxa, including amphibians, have been shown to have a taxonomically non‐random distribution of threatened species. There are three possible non‐exclusive reasons for this selectivity: non‐random knowledge of species conservation status, clades endemic to different regions experiencing different intensities of threatening process and the effects of clade‐specific biological attributes on the susceptibility of species to these processes. This paper tests the sufficiency of the first two explanations using extinction risk evaluations from the 2004 Global Amphibian Assessment. Our results indicate that they cannot alone account for the degree of non‐randomness in extinction risk among amphibian families. The overall distribution of threatened amphibians remained taxonomically non‐random when species of unknown conservation status were omitted, and significant selectivity was detected not only at a global geographic scale but also in country‐ and site‐specific data sets. Furthermore, the same families tend to be over‐ or underthreatened within different countries. Together, these results suggest that biological differences among amphibian families play an important role in determining species' susceptibility to anthropogenic threatening processes.
Temperament and developmental psychopathology
Authors: Nigg Joel T.
Published: February 2006

This review discusses conceptual issues in relating temperament to psychopathology, including the disputed relation of temperament to personality in children. A potential integrative framework is discussed that links trait and biological markers of temperament (reactive, incentive–response tendencies) with regulatory processes. This framework is utilized to highlight potential temperamental pathways to specific forms of psychopathology, noting that in some instances their relations may reflect a spectrum model (with psychopathology closely related as an extreme of a temperament‐based trait), but in many instances it likely reflects a vulnerability‐transaction set of processes. Conduct disorder involves at least two temperamental paths, one emanating from low fear response and one from either high incentive approach or high anger reactivity. Attention deficit hyperactivity disorder also involves at least two temperament pathways, one involving extremely low effortful control and the other likely involving strong approach. Anxiety disorders appear to result from the confluence of high negative emotionality and low effortful control. Hypotheses for future research are presented and limitations discussed.
The fashion‐conscious behaviours of mature female consumers
Authors: Nam Jinhee , Hamlin Reagan , Gam Hae Jin , Kang Ji Hye , Kim Jiyoung , Kumphai Pimpawan , Starr Cathy , Richards Lynne
Published: February 2006

Under‐appreciation of mature consumers as a numerous and comparatively wealthy market segment has resulted in not only lost revenues for business, but also lost consumption and service opportunities for the elderly. In response to expressed needs for more research into actual and desired consumption by older consumers, this study examined the apparel and shopping preferences of mature women in America. Independent living residents were surveyed concerning fashion consciousness, fashion information sources and shopping behaviours. Young and mature consumers’ reactions to female apparel ensembles were compared. Mature subjects purchased apparel for pleasure or need, but less for conformity. Decisions were influenced more by fit and comfort than by fashion, despite suggestions that dressing stylishly was important. New fashions were encountered via catalogue illustrations, social gatherings and window displays. Subjects high in fashion consciousness had greater financial and social involvement with fashion, greater chronological‐to‐cognitive age differences and larger clothing budgets. Young and mature consumers’ responses to apparel illustrations differed significantly. As the mature market expands, attention to age‐divergent definitions of fashion (such as those based upon admiration of comfort) will determine the success of apparel businesses. Assessment of cognitive age will facilitate identification of those mature consumers most predisposed toward fashion consumption.
Consumer reaction to product recalls: factors influencing product judgement and behavioural intentions
Authors: De Matos Celso Augusto , Rossi Carlos Alberto Vargas
Published: February 2006

In order to evaluate the factors influencing consumers’ responses to product recalls, two surveys were conducted among Brazilian automobile owners and two regression models tested. Results indicated that (i) product judgement was significantly affected by corporate social responsibility (CSR), blame attributed to the company and whether or not consumers had a car made by the brand considered; and (ii) behavioural intentions were significantly affected by CSR, consumers’ involvement with the message, perceived danger, product judgement and whether or not consumers had a car made by the brand considered. Findings revealed, however, that CSR is a better predictor of the product judgement than of the behavioural intentions, in accordance with recent studies indicating that CSR affects consumer judgements and behaviour differently. Finally, these two models are discussed and compared with previous research.
Determinants and adequacy of food consumption of children in La Trinidad, the Philippines
Authors: Blijham Nienke , De Kan Lieke , Niehof Anke
Published: February 2006

In the Philippines, vitamin A and vitamin C deficiencies, particularly among children, is a pressing health problem. This article reports the results of a research project that aimed at gaining insight into the factors in the household context that influence food intake of children and the role these factors play in vitamin A and vitamin C deficiencies. The research was carried out in La Trinidad, an urban area in the Philippines, where sufficient nutritious foods proved to be available. The results show that household income has only a minor impact on nutritional status. The nutritional status of children seems to be primarily influenced by their food preferences and the level of parental control on their food intake.
Website evaluation criteria among US college student consumers with different shopping orientations and Internet channel usage
Authors: Seock Yoo‐Kyoung , Chen‐Yu Jessie H.
Published: February 2006

The purpose of this study was to compare the website evaluation criteria among college student consumers in the US with different shopping orientations and Internet channel usage (i.e. online information searchers, online purchasers). The sample for this research was 414 college students, non‐married and aged 18–22 who have experience in visiting websites selling apparel products. Five apparel website evaluation criteria were identified by factor analysis (i.e. product information, customer service, privacy/security, navigation, auditory experience/comparison shopping). Based on shopping orientation factors, cluster analysis revealed three shopping orientation clusters (i.e. Hesitant In‐home Shoppers, Practical Clothing Shoppers, Involved Clothing Shoppers). Factorial manova showed that website evaluation criteria were significantly different among college student consumers with different shopping orientations and between online information searchers and online purchasers. Implications and limitations of the study are discussed.
Laparoscopic vaginoplasty: alternative techniques in vaginal reconstruction
Authors: Ismail IS , Cutner AS , Creighton SM
Published: February 2006

Construction of a neovagina is the next step for women with an absent vagina who have failed vaginal dilator therapy. Traditional operative techniques such as skin grafting or intestinal substitution have major disadvantages including prolonged recovery time and significant scarring. Laparoscopic vaginoplasty is performed widely throughout Europe but has not been available in the UK until now. We report on five women who underwent laparoscopic vaginoplasty. Three women underwent a laparoscopic Vecchietti procedure and two underwent a laparoscopic Davydov procedure. Details were recorded on preoperative features, perioperative problems and early postoperative outcome. Laparoscopic vaginoplasty is a safe treatment for vaginal agenesis, and short‐term results are encouraging.
Career choices for obstetrics and gynaecology: national surveys of graduates of 1974–2002 from UK medical schools
Authors: Turner G , Lambert TW , Goldacre MJ , Barlow D
Published: February 2006

Objective  To report the trends in career choices for obstetrics and gynaecology among UK medical graduates.

Design  Postal questionnaire surveys of qualifiers from all UK medical schools in nine qualification years since 1974.

Setting  United Kingdom.

Population  All graduates from UK medical schools in 1974, 1977, 1980, 1983, 1993, 1996, 1999, 2000 and 2002.

Methods  Postal questionnaire surveys.

Main outcome measures  Career choices for obstetrics and gynaecology and factors influencing career choices for obstetrics and gynaecology.

Results  Seventy‐four percent (24 623/33 417) and 73% (20 709/28 468) of doctors responded at 1 and 3 years after qualification. Choices for obstetrics and gynaecology fell sharply during the 1990s from 4.2% of 1996 qualifiers to 2.2% of 1999 qualifiers, and rose slightly to 2.8% of 2002 qualifiers. Only 0.8% of male graduates of 2002 chose obstetrics and gynaecology compared with 4.1% of women. Forty‐six percent of those who chose obstetrics and gynaecology 1 year after qualification were working in it 10 years after qualifying. Experience of the subject as a student, and the influence of a particular teacher or department, affected long‐term career choices more for obstetrics and gynaecology than for other careers.

Conclusions  The unwillingness of young doctors to enter obstetrics and gynaecology may be attributable to concerns about workforce planning and career progression problems, rather than any lack of enthusiasm for the specialty. The number of men choosing obstetrics and gynaecology is now very small; the reasons and the future role of men in the specialty need to be debated.
The use of ultrasound‐based ‘soft markers’ for the prediction of pelvic pathology in women with chronic pelvic pain—can we reduce the need for laparoscopy?
Authors: Okaro E , Condous G , Khalid A , Timmerman D , Ameye L , Huffel SV , Bourne T
Published: February 2006

Objective  To assess the accuracy of new transvaginal ultrasound‐scan‐based markers and to compare them to conventional ultrasound methods used in the detection of common pelvic pathology in women with chronic pelvic pain (CPP).

Design  A prospective observational study.

Setting  Teaching hospital.

Population  A total of 120 consecutive women with CPP undergoing transvaginal ultrasonography before either diagnostic or operative laparoscopy.

Methods  Anatomical abnormalities, e.g. endometrioma or hydrosalpinx (hard markers), were documented. The woman was then assessed for the presence or absence of ‘soft markers’ (reduced ovarian mobility and site‐specific pelvic tenderness).

Main outcome measure  Presence or absence of pelvic pathology noted during laparoscopy.

Results  Seventy women had pelvic pathology, of whom 51 had endometriosis alone, 7 both endometriosis and pelvic adhesions, 6 pelvic adhesions, 1 hydrosalpinx with endometriosis and 5 hydrosalpinx and pelvic adhesions. The likelihood ratio for the hard markers was infinity (specificity was 100%), for the soft makers 1.9 (95% CI 1.2–3.1) and for a ‘normal’ ultrasound 0.18 (0.09–0.34). The pre‐test probability of pelvic disease in our population of women with CPP was 58%, and this probability of disease was raised to 100% with the presence of hard markers and to 73% with the presence of soft markers. The pre‐test probability of 58% fell to 20% when ultrasound finding was found to be normal.

Conclusion  This new approach improves the detection and exclusion of significant pathology in women with CPP and may lead to a reduction in the number of unnecessary laparoscopies carried out on women with CPP.
Absence of conception after caesarean section: voluntary or involuntary?
Authors: Bhattacharya S , Porter M , Harrild K , Naji A , Mollison J , Van Teijlingen E , Campbell DM , Hall MH , Templeton A
Published: February 2006

Background  Women who deliver by caesarean section have been shown to be less likely to have a subsequent pregnancy. It is not clear whether this is due to a direct effect of the procedure on future fertility or due to deliberate avoidance of a future pregnancy.

Objective  To investigate whether absence of conception following caesarean section is voluntary or involuntary.

Design  Follow up of a population‐based retrospective cohort.

Setting  Grampian region, Scotland.

Population  Women who had no further viable pregnancies within 5 years of an initial delivery.

Methods  Cases included women who delivered their first child by caesarean section between 1980 and 1995 but had no further viable pregnancies by December 2000. Controls included women who delivered their first child during the same period, by means of either spontaneous vaginal delivery (SVD) or instrumental vaginal delivery (IVD), and who had no further viable pregnancies by December 2000. Eligible women were identified from the Aberdeen Maternity and Neonatal Databank (AMND) and sent postal questionnaires to determine the extent to which not conceiving after first delivery was voluntary and the reasons for avoiding further pregnancies. Characteristics of the different mode of delivery groups were compared using univariate techniques.

Main outcome measures  Extent to which absence of conception following an initial delivery by caesarean section is voluntary.

Results  Questionnaires were returned by 3204 (60%) of 5300 women identified from the AMND. Of these, 1675 women had not conceived at all during the follow‐up period (median duration = 13 years). Absence of conception was voluntary in 488 (69%; 95% CI 66–73%) women following caesarean section, 340 (71%; 95% CI 67–76%) following SVD and 354 (72%; 95% CI 68–76%) following IVD. Few women considered seeking fertility treatment (caesarean section = 72 [10%], SVD = 50 [11%], IVD = 39 [8%]). Of the women who decided to delay or avoid a further pregnancy, fewer women who delivered by SVD reported that the birth experience influenced their decision (caesarean section = 163 [32%], SVD = 67 [18%], IVD = 136 [35%]; P < 0.001).

Conclusions  Irrespective of mode of delivery, not conceiving following the birth of the first child is mainly voluntary. The experience of the previous birth is one of several factors affecting women's decisions to avoid a subsequent pregnancy.
The role of childbirth in the aetiology of rectocele
Authors: Dietz HP , Steensma AB
Published: February 2006

Objective  Clinically, rectocele is common in parous women and assumed to be due to distension or tearing of the rectovaginal septum in labour. In a prospective study, we examined the prevalence of such defects in primiparae before and after childbearing in order to define the role of childbearing in the aetiology of rectocele.

Design  Prospective observational study.

Setting  Tertiary urogynaecological clinic.

Population  A total of 68 nulliparous women between 35 + 6 and 40 + 1 weeks of gestation.

Methods  Participants underwent a standardised interview and were assessed by translabial ultrasound. Presence and depth of a rectocele was determined on maximal Valsalva, as was descent of the rectal ampulla. Fifty‐two women were reassessed 2–6 months postpartum.

Main outcome measures  Presence of a true rectocele, rectal descent.

Results  True rectoceles were identified in 2 of the 68 women before childbirth and in 8 of the 52 women after childbirth (P= 0.02). After childbirth, the ampulla descended >22 mm further than before (P < 0.0001 on paired t test). Symptoms such as digitation (n= 2), straining at stool (n= 10) and incomplete emptying (n= 11) were not uncommon 2–6 months postpartum; but out of eight rectoceles, four were asymptomatic.

Conclusions  True rectoceles occur in young nulliparae. However, childbirth is associated with an increase in prevalence and size of such defects.
Post‐traumatic stress disorder after childbirth in Nigerian women: prevalence and risk factors
Authors: Adewuya AO , Ologun YA , Ibigbami OS
Published: February 2006

Objective  To estimate the prevalence of post‐traumatic stress disorder (PTSD) after childbirth in a group of postpartum Nigerian women and to examine any associated factors.

Design  A cross‐sectional survey.

Setting  Postnatal clinics and infant immunisation clinics of the five health centres in Ilesa Township, Nigeria.

Population  A total of 876 women at 6 weeks postpartum.

Methods  The postpartum women were assessed for PTSD at 6 weeks. Other data collected were demographic characteristics, details of pregnancy and delivery and neonatal outcome. Additionally, the following measures were used: the MINI International Neuropsychiatric Interview to assess PTSD, the Index of Marital Satisfaction to measure the degree of problem a spouse encounters in the marital relationship, the Medical Outcome Study Social Support Survey to measure social support, the Life Events Scale to measure the life stress covering the preceding 12 months and the Labour Agentry Scale that measures the maternal experiences of control during childbirth.

Main outcome measures  Prevalence of PTSD in this population of postpartum Nigerian women, and how this prevalence related to other maternal and neonatal characteristics.

Results  The prevalence of PTSD was 5.9%. The factors independently associated with PTSD after childbirth include hospital admission due to pregnancy complications (OR 11.86, 95% CI 6.36–22.10), instrumental delivery (OR 7.94, 95% CI 3.91–16.15), emergency caesarean section (OR 7.31, 95% CI 3.53–15.10), manual removal of placenta (OR 4.96, 95% CI 2.43–10.14) and poor maternal experience of control during childbirth (OR 5.05, 95% CI 2.69–9.48).

Conclusions  The prevalence of PTSD after childbirth in Nigerian women is slightly higher than those found in western culture. An effective model for the prediction of the development of PTSD after childbirth needs to be developed and evaluated, and interventions aimed at reducing the incidence of PTSD after childbirth need further research.
A randomised trial comparing the levonorgestrel intrauterine system and thermal balloon ablation for heavy menstrual bleeding
Authors: Busfield RA , Farquhar CM , Sowter MC , Lethaby A , Sprecher M , Yu Y , Sadler LC , Brown P , Johnson N
Published: February 2006

Objective  To compare the levonorgestrel intrauterine system (LNG‐IUS) (Mirena®; Schering Co., Turku, Finland) and thermal balloon ablation (Thermachoice™; Gynecare Inc., Menlo Park, CA, USA) for the treatment of heavy menstrual bleeding.

Design  An open, pragmatic, prospective randomised trial.

Setting  A menstrual disorders clinic at National Women's Hospital, Auckland, New Zealand.

Population  Seventy‐nine women with heavy menstrual bleeding randomised to the LNG‐IUS (40 women) or the thermal balloon ablation (39 women).

Methods  Women were randomised to treatment with the LNG‐IUS or thermal balloon ablation and followed up by a postal and telephone questionnaire.

Main outcome measures  Menstrual loss measured by a pictorial bleeding assessment chart (PBAC) at 3, 6, 12 and 24 months. Patient satisfaction, quality of life and menstrual symptoms were assessed by questionnaire administered at 3, 6, 12 and 24 months. Treatment side effects and treatment failures were also recorded.

Results  Both the treatments resulted in a significant reduction in PBAC scores. At 12 and 24 months, median PBAC scores were significantly lower in women treated with the LNG‐IUS compared with women treated by thermal balloon ablation (11.5 versus 60.0 at 12 months [P= 0.002]; 12.0 versus 56.5 [P= 0.002] at 24 months). At 24 months, nine (35%) women still using the LNG‐IUS had amenorrhoea compared with one (5%) woman successfully treated by thermal balloon ablation (P= 0.025). There were no significant differences in patient satisfaction between two treatments during follow up. Treatment failed in 11 (28%) women using the LNG‐IUS and in 10 (26%) women treated with thermal balloon ablation. Overall, women in both groups showed an increased quality of life as a result of the treatment, with Short Form‐36 scores increasing from 63.7 at randomisation to 76.1 at 24 months.

Conclusions  At 12 and 24 months of follow up, women with heavy menstrual bleeding treated with the LNG‐IUS have significantly lower PBAC scores than women treated with thermal balloon ablation. Both the treatments resulted in a significant increase in overall quality of life, but there were no significant differences between either treatment in quality of life, patient satisfaction or the number of women requesting an alternative treatment during 24 months of follow up.
Nine polymorphic microsatellite loci for the parasitic wasp Neotypus melanocephalus (Hymenoptera: Ichneumonidae)
Authors: ANTON CHRISTIAN , SETTELE JOSEF , DURKA WALTER
Published: February 2006

Nine polymorphic microsatellite loci were isolated from Neotypus melanocephalus (Gmelin), a parasitoid of the parasitic large blue butterfly Maculinea nausithous. Allelic diversity and heterozygosity were quantified in samples from the Upper Rhine valley in Southwest Germany.
Microsatellite loci for population and behavioural studies of grey‐crowned babblers (Pomatostomus temporalis: Aves)
Authors: BLACKMORE C. J. , ADCOCK G. J. , EBERT D. , HEINSOHN R.
Published: February 2006

Sixteen polymorphic microsatellite loci were isolated in the cooperatively breeding grey‐crowned babbler (Pomatostomus temporalis). The number of alleles per locus ranged from two to eight, and observed heterozygosity from 0.07 to 0.88. Two loci showed a significant heterozygote deficiency, one of which appears to be sex‐linked. The exclusion probability for eight unlinked loci was 0.9996 with the other parent known. These loci will be used to analyse population genetic structure and the mating system of this vulnerable species.
Fast fuelling but light flight in Broad‐billed Sandpipers Limicola falcinellus: stopover ecology at a final take‐off site in spring (Sivash, Ukraine)
Authors: VERKUIL YVONNE , VAN DER HAVE TOM M. , VAN DER WINDEN JAN , KEIJL GUIDO O. , RUITERS PAUL S. , KOOLHAAS ANITA , DEKINGA ANNE , CHERNICHKO IOSIF I.
Published: February 2006

We studied phenology, staging time and refuelling in Broad‐billed Sandpipers Limicola falcinellus stopping over during spring migration in the Sivash (Black Sea, Ukraine) in May 1991–94. In the study area, peak staging numbers of 2000–2500 individuals occurred in the third week of May. In May 1993, 460 birds were marked with a yellow dye and 126 of these were colour‐ringed. Before 28 May no departure of birds dyed yellow could be detected; by 3 June all birds had departed. Colour‐ringed adults in mid May 1993 staged for a minimum of 8.2 days. After the observed departure of large flocks (24 May and later) the staging time of colour‐ringed birds decreased significantly with body mass at the time of capture. Of birds mist‐netted in 1991–94, 99.3% were in full summer plumage and 89% were adults. In second‐year birds, fuel deposition rate (measured between individuals) was 0.44 g/day. In adults caught from early May to 24 May, overall fuel deposition rate was 1.04 g/day (3.4% of lean body mass). Mean adult body mass in early May was 34.8 g, increasing to 45.5 g after 24 May. Estimated body mass at departure was 51 g. Departure body mass and flight range estimates suggest that although birds refuelled quickly, fuel loads are only just sufficient for an unbroken flight to Scandinavia and the Kola Peninsula. We suggest that Broad‐billed Sandpipers use the Sivash as a crucial final take‐off stopover site, and that they follow a ‘jumping’ migration strategy, performed under narrow time constraints.
Biomimetic Bilayered Gelatin‐Chondroitin 6 Sulfate‐Hyaluronic Acid Biopolymer as a Scaffold for Skin Equivalent Tissue Engineering
Authors: Wang Tzu‐Wei , Wu Hsi‐Chin , Huang Yi‐Chau , Sun Jui‐Sheng , Lin Feng‐Huei
Published: February 2006

Abstract:  In order to develop an adequate scaffold for skin tissue engineering, a bilayered gelatin‐chondroitin 6 sulfate‐hyaluronic acid membrane with a different pore size on either side was prepared. A rete ridges‐like topographic microporous structure, which provided the paracrine crosstalk in the epithelial–mesenchymal interactions, was formed. Chondroitin‐6‐sulfate and hyaluronic acid were incorporated within the gelatin membrane to mimic skin composition and create an appropriate microenvironment for cell proliferation, differentiation, and migration. In the study, the lower layer of the membrane (pore size: 150 µm) was seeded with dermal fibroblasts and acted as the feeder layer for keratinocyte inoculation. Meanwhile, the upper layer (pore size: 20–50 µm) was seeded with keratinocytes for epidermalization. The dermal fibroblasts were dynamically seeded in a self‐designed spinner flask for more even cell distribution. The keratinocytes were cultured in submerged conditions for 5 days and then in an air–liquid interface condition for further differentiation. After being cultured for 21 days, the upper layer, seeded with keratinocytes, developed into an epidermis‐like structure while the lower part, which was seeded with dermal fibroblasts developed into a dermis‐like structure. A histological examination and immunostain were used to prove that keratinocytes maintain their phenotype and stratified epidermis layers were formed within 21 days. In brief, the bilayered skin substitute with biological dermal analog and epidermal structure was successfully fabricated. From this study, we can suggest that the culture model is suitable for autologous skin equivalent preparation.
Computational and Experimental Evaluation of the Fluid Dynamics and Hemocompatibility of the CentriMag Blood Pump
Authors: Zhang Juntao , Gellman Barry , Koert Andrew , Dasse Kurt A. , Gilbert Richard J. , Griffith Bartley P. , Wu Zhongjun J.
Published: February 2006

Abstract:  The CentriMag centrifugal blood pump is a newly developed ventricular assist device based on magnetically levitated bearingless rotor technology. A combined computational and experimental study was conducted to characterize the hemodynamic and hemocompatibility performances of this novel blood pump. Both the three‐dimensional flow features of the CentriMag blood pump and its hemolytic characteristics were analyzed using computational fluid dynamics (CFD)‐based modeling. The hydraulic pump performance and hemolysis level were quantified experimentally. The CFD simulation demonstrated a clean and streamlined flow field in the main components of the CentriMag blood pump. The predicted results by hemolysis model indicated no significant high shear stress regions in the pump. A comparison of CFD predictions and experimental results showed good agreements. The relatively large gap passages (1.5 mm) between the outer rotor walls and the lower housing cavity walls provide a very good surface washing through a secondary flow path while the shear stresses in the secondary flow paths are reduced, resulting in a low rate of hemolysis ([Normalized Index of Hemolysis] NIH = 0.0029 ± 0.006) without a decrease of the pump’s hydrodynamic performance (pressure head: 352 mm Hg at a flow rate of 5.0 L/min and a rotational speed of 4000 rpm).
Acetaminophen, Aspirin, and Caffeine in Combination Versus Ibuprofen for Acute Migraine: Results From a Multicenter, Double‐Blind, Randomized, Parallel‐Group, Single‐Dose, Placebo‐Controlled Study
Authors: Goldstein Jerome , Silberstein Stephen D. , Saper Joel R. , Ryan Robert E. , Lipton Richard B.
Published: February 2006

Objective.—Compare the effectiveness of a combination analgesic containing acetaminophen, aspirin, and caffeine to that of ibuprofen in the treatment of migraine.

Methods.—Multicenter, double‐blind, randomized, parallel‐group, placebo‐controlled, single‐dose study. A total of 1555 migraineurs were included in the analysis. No patients were excluded solely because of severity of symptoms or degree of disability. A single 2‐tablet dose for each of the 3 treatment groups: a combination product containing acetaminophen 250 mg, aspirin 250 mg, and caffeine 65 mg per tablet (AAC); ibuprofen 200 mg per tablet (IB); or matching placebo. The primary efficacy endpoint was the weighted sum of pain relief (PAR) scores at 2 hours postdose (TOTPAR2) and an important secondary endpoint was the time to onset of meaningful relief.

Results.—There were 669 patients in the AAC group, 666 patients in the IB group, and 220 patients in the placebo group. The 3 treatment groups had similar demographic profiles, migraine histories, and baseline symptom profiles. While both active treatments were significantly better than placebo in relieving the pain and associated symptoms of migraine, AAC was superior to IB for TOTPAR2, as well as for PAR, time to onset of meaningful PAR, pain intensity reduction, headache response, and pain free. The mean TOTPAR2 scores for AAC, IB, and placebo were 2.7, 2.4, and 2.0, respectively (AAC vs. IB, P < .03). The median time to meaningful PAR for AAC was 20 minutes earlier than that of IB (P < .036).

Conclusion.—AAC and IB are safe, cost‐effective treatments for migraine; AAC provides significantly superior efficacy and speed of onset compared with IB.
Whole‐blood leukoreduction filters are a source for cryopreserved cells for phenotypic and functional investigations on peripheral blood lymphocytes
Authors: Néron Sonia , Dussault Nathalie , Racine Claudia
Published: February 2006

BACKGROUND:  Leukoreduction of blood is now widely performed by blood banks, and the possibility of recovering 108 to 109 white blood cells (WBCs) from leukoreduction filters, which are usually discarded, represents a promising source for normal human cells. Previous studies with these filters to prepare WBCs have performed their experimentation with fresh cells only. Whether these filter‐derived cells could also be used to prepare frozen cell banks to facilitate work organization and open new avenues for their utilization as references in physiological studies and clinical investigations was investigated.

STUDY DESIGN AND METHODS:  Blood samples or whole‐blood leukoreduction filters were obtained, after informed consent, from volunteers or blood donors, respectively. The proportions of CD3+, CD14+, CD16+, CD19+, and CD45+ cells within peripheral blood mononuclear cells (PBMNCs) were determined by flow cytometry from all samples. B cells were isolated and their functional responses were evaluated in vitro.

RESULTS:  The yield of PBMNCs recovered from whole‐blood leukoreduction filters was lower (50%) than the one with fresh blood samples but still provided 2 × 108 to 4 × 108 PBMNCs per unit. After one cycle of freezing‐thawing, the proportions of B‐ and T‐cell populations were similar to normal blood values. Purified B cells issued from whole‐blood leukoreduction filters displayed normal phenotypes and functions.

CONCLUSION:  Leukoreduction filters represent a valuable source of PBMNCs. These cells could be easily recovered to prepare frozen cell banks useful in basic phenotypic and functional analyses involving the main subsets of B cells and the global T‐cell population.
Understanding Judicial Hierarchy: Reversals and the Behavior of Intermediate Appellate Judges
Authors: Scott Kevin M.
Published: February 2006

One of the central controversies in the judicial behavior literature is the extent to which judges' ability to act according to their ideological preferences is affected by their location in the judicial hierarchy. Judges on intermediate appellate courts have different decisionmaking environments than high court judges. As a result, the goals of lower appellate court judges may differ from those of their superiors: the quest for legal accuracy may compete with the desire to pursue policy preferences. Analysis of the reversal rate of the U.S. circuit courts of appeals offers insight into the extent to which these judges balance the pressures of their own policy preferences with the desire to achieve the legally accurate result in cases they decide.
The Heterogeneous State and Legal Pluralism in Mozambique
Authors: de Sousa Santos Boaventura
Published: February 2006

This article analyzes some of the most salient features of the state and the legal system in Mozambique. I propose the concept of the heterogeneous state to highlight the breakdown of the modern equation between the unity of the state, on the one hand, and the unity of its legal and administrative operation, on the other. The centrality of legal pluralism is analyzed in light of an empirical research focused on community courts and traditional authorities. I use the concept of legal hybridization with the purpose of showing the porosity of the boundaries of the different legal orders and cultures in Mozambique and the deep cross-fertilizations or cross-contaminations among them. Special attention is given to the multicultural plurality resulting from the interaction between modern law and traditional law, the latter conceived here as an alternative modernity.
Legal Autonomy as Political Engagement: The Ladakhi Village in the Wider World
Authors: Pirie Fernanda
Published: February 2006

Local systems of law are constantly forced to adapt to powerful external legal orders. As well as employing tactics of resistance and accommodation, some communities respond by maintaining boundaries around their legal sphere, safeguarding a measure of judicial autonomy. This article examines one such instance, from the Indian Himalayas. It argues that, much more complex than a case of domination and resistance, this autonomy represents a long history of deference and distance toward external forces. The maintenance of legal autonomy ultimately represents community ontology, but it is also a means of engaging with wider forces within the modern world.
Do Rankings Matter? The Effects of U.S. News & World Report Rankings on the Admissions Process of Law Schools
Authors: Sauder Michael , Lancaster Ryon
Published: February 2006

In recent years, there has been a tremendous proliferation of quantitative evaluative social measures in the field of law as well as society generally. One of these measures, the U.S. News & World Report rankings of law schools, has become an almost obsessive concern of the law school community, generating a great deal of speculation about the effects of these rankings on legal education. However, there has been no attempt to systematically ascertain what, if any, effects these rankings have on the decisionmaking of students and schools in the admission process. This article documents some of these effects by conceptualizing rankings as a signal of law school quality, investigating (1) whether students and schools use this signal to make decisions about where to apply and whom to admit, and (2) whether the creation of this signal distorts the phenomenon—law school quality—that it purports to measure. Using data for U.S. law schools from 1996 to 2003, we find that schools' rankings have significant effects on both the decisions of prospective students and the decisions schools make in the admissions process. In addition, we present evidence that the rankings can become a self-fulfilling prophecy for some schools, as the effects of rank described above alter the profile of their student bodies, affecting their future rank. Cumulatively, these findings suggest that the rankings help create rather than simply reflect differences among law schools through the magnification of the small, and statistically random, distinctions produced by the measurement apparatus.