bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring the Right to Secession
Authors: Chandhoke Neera
Published: February 2008

One of the most intractable problems confronting South Asian states and societies has been the presence of secessionist movements and insistent demands for a state of one's own. Though societies and states tend to react violently when faced with such demands, many serious issues are embedded in secessionist demands, as well as in the responses to these demands, above all issues of justice and injustice. The present article seeks to trace out the key issues involved in demands for secession, exploring reasons for why and when such demands arise in the first place. Examined within the wider context of international law, specific scenarios in South Asia are considered to propel a debate about whether secession can be argued to be a right, and in what circumstances. It is proposed that the concept of secession has, in effect, to be extricated from narrow agendas of national security, war against terror, and military strategy, and placed within the wider domain of normative political theory, which can indeed find justifications for demanding secession.
An Evaluation of the Press and Communication Reforms of the Prodi Commission of 1999—2004
Authors: Anderson Peter J. , Price John
Published: February 2008

A B S T R A C T ■ The Commission's press and communication service plays a central role in the EU's dealings with news organizations. However, following the fall of the Santer Commission, even the service's own press officials admitted the organization was failing and constantly on the defensive against an increasingly hostile media. It was in this context that Santer's successor, former Commission president Romano Prodi, pledged radical reform, making the goal of a `modern and professional' press service a priority. The Prodi Commission concluded that it needed a much more positive and proactive way of working. At a time when the Barroso Commission is proposing its own programme of change in communication policy, this article assesses the inheritance that the Prodi reforms left behind, with particular reference to their impact as seen by journalists from one of the member states in which traditionally it has been most difficult to communicate a positive image of the EU. ■
Turkey and the European Union
Authors: Negrine Ralph , Kejanlioglu Beybin , Aissaoui Rabah , Papathanassopoulos Stylianos
Published: February 2008

A B S T R A C T ■ This article examines how the press in four countries — three EU members (France, Britain, Greece) and Turkey — covered the run-up to the discussions surrounding Turkey's bid to become a member of the European Union in October and December 2004. Given contemporary debates about the nature of Europe and European identity, the prospect of Turkey — a large, poor, Muslim country — joining the EU was likely to generate much discussion. The data show important differences in the coverage from one country to the next, with some countries reflecting significant concerns about differences between Europe and Turkey and others much less so. Overall, many of the differences in coverage that were found in the analysis could be attributed to the ways in which the press in different countries reflected domestic political, cultural and historical considerations. Such differences, it is argued, may not be surprising given the complexity of the subject matter and need not necessarily be seen as antithetical to the construction of a European public sphere or a European identity. ■
Globalization and the Call Center Industry
Authors: Abraham Margaret
Published: February 2008

The call center industry is one of the most rapidly growing areas of work globally. Drawing upon a multidisciplinary and collaborative approach to studying call centers, the book and report reviewed here provide sociological insights on the process of globalization and the transformation of work and labor relations. Issues addressed include resource strategies, managers and management, jobs and job skills, women's careers in call centers, worker control and autonomy, and union organizing. The studies illuminate the need to rethink some of the logic that drives work organization in the call center industry and offer strategies for collective mobilization, including the role of unions in protecting the rights of workers within and across nations.
Recovery of the Menisci and Articular Cartilage of Runners after Cessation of Exercise
Authors: Kessler Markus A. , Glaser Christian , Tittel Sylvia , Reiser Maximilian , Imhoff Andreas B.
Published: February 2008

Background

It is still unclear whether long-distance running has a deleterious effect on joint health; therefore, this study was undertaken to examine the rate of recovery from alterations occurring at the knee joint in marathon runners due to loading.

Hypothesis

Tibial, patellar, and meniscal cartilaginous volumes are able to recover adequately from changes due to repeated loading immediately after cessation.

Study Design

Controlled laboratory study.

Methods

Twenty knees of male athletes were studied (mean age, 38 ± 14 years). The participants ran 20 km around a predetermined and precisely measured course. Cartilaginous volume was measured by magnetic resonance imaging before the run (60-min rest before exercise), immediately after the run (3-min delay), and after a recovery period of 1 hour.

Results

After the 20-km run, there was a significant transient decrease in cartilage volume. After 1 hour of rest, no significant reduction of cartilage volume was measured for the patella (−2.1 %), the tibia (−1.2%), the lateral meniscus (−3.2%), or the medial meniscus (−5.9%). However, the values recorded for the menisci were borderline, which indicates that recovery of meniscus volume lags behind that of articular cartilage.

Conclusion

Our data indicate a clear tendency toward rapid recovery of the cartilaginous and meniscal volumes at the knee. The results of this study lead to the assumption that the cartilage and the menisci are well able to adapt to the loads caused by running. Investigation of more subtle changes would require more specific magnetic resonance imaging techniques, including T2-weighted mapping and T1-weighted rho sequences, to assess cartilage biochemistry.

Clinical Relevance

The articular structures were investigated on a general magnetic resonance imaging level and were found to recover rapidly so that exercise could be continued after a short time without reservation.
Effects of an Undergraduate Career Class on Men's and Women's Career Decision-Making Self-Efficacy and Vocational Identity
Authors: Scott Anne B. , Ciani Keith D.
Published: February 2008

The current study hypothesized that undergraduates enrolled in a career explorations course would report significant gains in career decision-making self-efficacy and vocational identity during a semester. A repeated measures MANOVA was used to assess 88 students' precourse and postcourse self-efficacy for five tasks related to career decision making. Results revealed that students reported significantly more adaptive self-efficacy beliefs following the career course. Furthermore, a time by gender interaction indicated the course was especially effective for increasing women's judgments of efficacy for career planning and problem solving. Subsequent analyses indicated that students also reported a stronger sense of vocational identity following the course. Results from this study contribute to current research and practice by revealing how interventions may affect undergraduates' career-related beliefs.
The neurobiological interpretation of the mental functions in the work of Santiago Ramón y Cajal
Authors: López-Muñoz Francisco , Alamo Cecilio , Rubio Gabriel
Published: February 2008

Cajal (1852—1934) first had contact with the fields of psychiatry and psychology through the experimental study of hypnotism. He interpreted this phenomenon as an aberrant failure of the machinery of the brain. It may be that Cajal's initial interest in the theory of hypnotic suggestion eventually led him to study the biological phenomena related to sleep and dreams, in the neurophysiological explanation of which he disagreed openly with Freud's postulates. Finally, Cajal studied the histophysiological mechanisms of the higher mental functions (thought, intelligence, memory, perception, etc.). He proposed that the pyramidal cells of the cerebral cortex, which he called `psychic cells', formed the substrate of these functions; he proposed the law of `avalanche conduction', and he speculated on the possibility of a phenomenon of neuronal plasticity in relation to learning processes. After being awarded the Nobel Prize in 1906, Cajal's interests in psychological aspects began to decline.
Karl Ludwig Kahlbaum by Dr. Ewald Hecker (1899)
Authors: Kraam Abdullah
Published: February 2008

The chaotic psychiatric nosology of the late nineteenth century needed a strong and new foundation, but when Kahlbaum died in 1899, some German psychiatrists realized that a great opportunity had been missed: his proposal to classify psychiatric disorders according to their course and cross-sectional symptomatology had largely been ignored by the psychiatric establishment. Kahlbaum died in coma diabeticum without the official recognition for his academic achievements that he longed for: the award of the professorship which was granted a few years later to his disciple Ewald Hecker.
Three centuries of annual area burned variability in northwestern North America inferred from tree rings
Authors: Girardin Martin P. , Sauchyn Dave
Published: February 2008

Annual area burned (AAB) variability in northwestern North America was inferred from 38 tree-ring width chronologies widely distributed across boreal regions and spanning the past 300 years and the minimum 1833—1998 interval. AAB estimates accounted for up to 61% of the variance in AAB observed from 1959 to 1998, and were verified using a split sample calibration-verification scheme. Spatial correlation maps of gridded temperature and precipitation data provided an indication of the reliability of the reconstruction to approximate fire-conducive climate variability beyond the period of calibration. Singular spectrum analysis and analysis of variance suggested that AAB has significantly changed during the course of the past 150 years toward increasing variance. Recent 1959—1998 decadal changes in AAB of northwestern North America fitted well within an oscillatory mode centred on 26.7 years and accounting for 21.1% of the variance in the reconstruction. As in previous studies, the current findings suggest that AAB is correlated to seasonal land/ocean temperature variability and that future warming could lead to greater AAB. However, the study has the weakness of not accounting for complex interactions between climate and ecosystem processes and thus its results should be interpreted with caution. We suggest that a calibration model conducted on multiple types of fire proxies (tree rings, charcoal data, fire scars and stand-establishment records) could be relevant for addressing these weaknesses.
Chironomid response to environmental drivers during the Holocene in a shallow treeline lake in northwestern Fennoscandia
Authors: Nyman Marjut , Weckström Jan , Korhola Atte
Published: February 2008

The significance of different environmental drivers for the chironomid compositional changes during the Holocene was assessed using partial redundancy analysis. These drivers included pollen-inferred mean July air temperature, vegetation cover as pollen percentages, diatom-inferred water pH and total organic carbon (TOC), and sediment properties as loss on iginition (LOI). Variance partitioning showed that on the Holocene timescale, chironomid assemblages were significantly responding to changes in Betula percentages. This is explained by the co-occurring response of chironomids to the Holocene climatic development, which has also been responsible for the development of vegetation in the catchment. However, during the very early Holocene period from 10 500 cal. yr BP to 8300 cal. yr BP chironomids were responding more directly to the changes in water quality, ie, pH. During the latter part of the Holocene, no environmental variable appeared to be significant in explaining the variation in chironomid assemblages. This may be due to the underestimation of the actual water TOC by the diatom-based TOC model. However, for the latter part of the Holocene, from 5000 cal. yr BP to the present, the importance of limnological changes attributed to the development of marginal mires on the midges is evident. Our study shows that factors other than climate may have had more direct influence on the chironomid abundances at certain time periods. Although these factors are probably indirectly connected to climate through catchment processes, more understanding of the catchment-mediated climate effects on lake ecology and chironomids in high latitudes is needed, in addition to careful site selection, in order to better understand the environmental reconstructions.
The ebb-tidal delta of the Venice Lagoon, Italy
Authors: Donda F. , Brancolini G. , Tosi L. , Kovačević V. , Baradello L. , Gačić M. , Rizzetto F.
Published: February 2008

Very high-resolution seismic lines were collected offshore the Venice Lagoon in the framework of the Co.Ri.La `New very high resolution seismic methods to study the Venice Lagoon subsoil' project. The 140 km boomer profiles led to the identification of a convex-upward, lens-shaped body just outside the Lido inlet, one of the three lagoon inlets, which has been interpreted as an ebb-tidal delta. The comparison between the seismostratigraphic setting of this deposit, as revealed by the seismic lines, and the analyses of historical bathymetric maps highlighted the key role of human interventions in the formation and evolution of the Lido inlet ebb-tidal delta. To preserve the lagoon environment but also to ensure a navigable way, human interventions at the Lido inlet, performed since the fourteenth century, caused profound variations in the inlet dynamics, leading to a progressive increase in the sediment dispersion from the lagoon interior towards the sea. The ebb-tidal delta of the Lido inlet is thus a very recent feature compared with the formation of the Venice lagoon and formed mainly as a consequence of the construction of the two jetties that have bound the inlet from AD 1886 to the present day.
The late-Holocene vegetation history of the Central Caspian (Hyrcanian) forests of northern Iran
Authors: Ramezani Elias , Marvie Mohadjer Mohammad R. , Knapp Hans-Dieter , Ahmadi Hassan , Joosten Hans
Published: February 2008

Pollen analysis of the peat in a small mire on the northern slope of the Alborz Mountains (550 m a.s.l.) in the Central Caspian forests of Iran reveals changes in forest and wetland vegetation during the last millennium. A forest, principally of Alnus and Carpinus occurred over almost the whole period. Quercus, Ulmus and Parrotia were less common, while Fagus, Pterocarya, Acer and Diospyros fluctuated as a probable result of human interference and/or climatic change. Two phases of clay deposition in the mire can be dated to the `Mediaeval Climatic Anomaly' (AD 1100) and the beginning of the `Little Ice Age' (AD 1560—1600). Although human activity seems to have persisted in the region during the whole of the past millennium, increased NAP values point to intensified human interference since the beginning of the nineteenth century.
Pollen productivity estimates from the forest—tundra ecotone in west-central Sweden: implications for vegetation reconstruction at the limits of the boreal forest
Authors: von Stedingk Henrik , Fyfe Ralph M. , Allard Anna
Published: February 2008

Successful reconstruction of vegetation from fossil pollen data in the arctic and alpine tundra, and at the forest—tundra ecotone, is hampered by low pollen production of the major taxa in these environments and the likely dominance of the background pollen component. New approaches to the quantification of vegetation from pollen data (the REVEALS and LOVE models) rely on quantification of background and local pollen by applying models of pollen dispersal and deposition to modern pollen— vegetation survey work. To date, research within this emerging area has focused on lowland environments. This paper presents pollen productivity estimates (PPEs) from the forest—tundra ecotone derived from west central Sweden, discusses the relevant source area of pollen (RSAP) in this environment and estimates the background pollen contribution. The results suggest that the RSAP for moss polsters at the forest—tundra ecotone is c. 500 m, and that PPEs for the major forest tundra ecotone taxa show significant differences compared with previous studies from southern Sweden. Proximity to range limits (controlled by climatic factors) appears to be the main factor causing generally lower pollen production; however, individual taxa respond in different ways, depending on differences in growth behaviour, reproductive strategy and the species and subspecies that represent the pollen taxa. The background pollen component was dominated by arboreal taxa, and contributed c. 60% of the total pollen loading. Graminoids dominated the local component. The PPEs presented here are to date the most appropriate parameters to use for quantification of vegetation at the tundra treeline; however, the data demonstrate that caution needs to be exercised with regards to selection of appropriate PPEs for accurate quantification of taxa at their ecological range.
The First Year Post–Heart Transplantation: Use of Immunosuppressive Drugs and Early Complications
Authors: Sulemanjee Nasir Z. , Merla Ramanna , Lick Scott D. , Aunon Serena M. , Taylor Melissa , Manson Melissa , Czer Lawrence S.C. , Schwarz Ernst R.
Published: February 2008

A large number of heart transplants are performed annually in different transplant centers in the United States. This is partly because of the improved survival of patients who undergo cardiac transplantation, thus making it a more viable option in the management of end-stage heart failure. The survival benefit after heart transplantation is a result of newer immunosuppressive drug regimens and a better understanding of their effects and interactions. Several studies, mostly involving a small number of patients, describe use and comparison of the many distinct immunosuppressive drugs available to date. Interestingly, many transplant centers perform in-house typical induction treatment regimens because of their own experience and intra-institutional preference. This review summarizes current practices of immunosuppressive drug therapy in the first year post–heart transplant based on the available clinical evidence and discusses future options of heart transplant immunosuppressive drug therapies.
Pretreatment With High-Dose Statin, But Not Low-Dose Statin, Ezetimibe, or the Combination of Low-Dose Statin and Ezetimibe, Limits Infarct Size in the Rat
Authors: Birnbaum Yochai , Lin Yu , Ye Yumei , Merla Ramanna , Perez-Polo Jose R. , Uretsky Barry F.
Published: February 2008

Statins reduce infarct size by upregulating nitric oxide synthases and PGI2 production. In this article, the infarct size-limiting effect of low-dose simvastatin + ezetimibe, ezetimibe, and high-dose statins were compared. Rats received 3-day water, atorvastatin (10 mg/kg/d), simvastatin (10 mg/kg/d), simvastatin (2 mg/kg/d), simvastatin (2 mg/kg/d) + ezetimibe (1 mg/kg/d), or ezetimibe. Rats underwent 30-minute coronary artery occlusion and 4-hour reperfusion. Atorvastatin and simvastatin 10 reduced infarct size, whereas simvastatin 2, ezetimibe, and simvastatin 2 + ezetimibe had no effect. Atorvastatin and simvastatin 10 increased nitric oxide synthases activity, whereas simvastatin-2, ezetimibe, and simvastatin-2 + ezetimibe had only a small effect. Atorvastatin and simvastatin 10 significantly increased myocardial 6-ketoprostaglandin F1α levels, whereas simvastatin 2, ezetimibe, and simvastatin 2 + ezetimibe had no effect. High-dose statin is required to decrease infarct size, upregulate myocardial nitric oxide synthases activities, and increase 6-keto prostaglandin F1α levels. Combination of ezetimibe and low-dose statin is ineffective in modulating myocardial biochemical changes associated with cardioprotection.
Beyond the Campus
Authors: Littleton Heather , Radecki Breitkopf Carmen , Berenson Abbey
Published: February 2008

Studies of college rape victims have found that many are unacknowledged; that is, they do not label their experience rape. The current study investigated factors associated with unacknowledged rape among low-income women. Out of a sample of 1,033 women, 167 reported having experienced rape. Unacknowledged victims, relative to acknowledged victims, reported less violent assaults and more alcohol use before the assault and were more likely to have been assaulted by a romantic partner. Unacknowledged victims also disclosed less often and reported fewer feelings of stigma. Implications of the work for future studies of unacknowledged rape are discussed.
The Relationship Between Joint Attention and Language in Children With Autism Spectrum Disorders
Authors: Murray Donna S. , Creaghead Nancy A. , Manning-Courtney Patricia , Shear Paula K. , Bean Judy , Prendeville Jo-Anne
Published: February 2008

The relationship between initiation of and response to joint attention and components of receptive and expressive language in 20 children with autism between the ages of 3 and 5 years were examined. Receptive language skills were assessed using the Mullen Scales of Early Learning (MSEL). Expressive language skills were evaluated by examining Mean Length of Utterance and Type Token Ratio. These variables, along with data on responses to joint attention bids and initiation of joint attention were analyzed using Spearman calculations. The ability to respond to the joint attention bids of others was positively correlated with receptive language scores on the MSEL and mean length of utterance in children with autism. There was no relationship between the ability to initiate joint attention and the selected components of language examined.
Promoting Social Interactions Between Students With Autism Spectrum Disorders and Their Peers in Inclusive School Settings
Authors: Owen-DeSchryver Jamie S. , Carr Edward G. , Cale Sanja I. , Blakeley-Smith Audrey
Published: February 2008

This study evaluated the impact of a peer training intervention on social interactions among three students with autism spectrum disorders (ASD) and their typical peers. Two second graders and one fourth grader with ASD participated. For each student with ASD, two to four typical peers participated in training sessions that targeted increased social interactions. Data collected during lunchtime and recess showed that the peer training intervention generally resulted in increased initiations by trained peers as well as increased initiations and responses by students with ASD. Unexpectedly, untrained peers also showed increased initiations. Future research directions are discussed, including characteristics of the peers selected for training (e.g., gender, popularity) and measurement of qualitative changes in social relationships and opportunities.
Redistribution, Horizontal Inequity, and Reranking
Authors: Urban Ivica , Lambert Peter J.
Published: February 2008

The decomposition of the Gini-based index of redistributive effect of an income tax into vertical, horizontal, and reranking contributions according to the model of Aronson, Johnson, and Lambert (AJL) is revisited. When close equals groups are used, rather than the exact equals groups on which the model is predicated, problems arise. A new measurement system is proposed, in which three distinct forms of reranking are disentangled and the vertical and horizontal contributions are redefined. Other approaches to measuring equity in tax systems are set in context. Findings are briefly applied to Croatian data, and recommendations for users of the AJL methodology are given.
Ankle fractures in adults: an overview
Authors: Westerman R.W. , Porter K.
Published: February 2008

Before attempting to treat ankle fractures it is vital to appreciate the normal functional anatomy of this complex joint. The objectives of treatment, as with all fracture management, are to restore the anatomy and return normal function to the injured joint. This article describes the functional anatomy of the ankle and the epidemiology, assessment and definitive management required for a routine ankle fracture.
Does pre-hospital ventilation effect outcome after significant brain injury?
Authors: Warner Keir J , Bulger Eileen M
Published: February 2008

Traumatic brain injury has a devastating impact on society, utilizing many resources and disproportionately affecting the young. Recent evidence demonstrates the early care of the brain injured patient impacts patient outcomes. While prevention of systolic hypotension and hypoxia are mainstays of prehospital management of the injured patient ventilatory management performed in the prehospital environment has recently been shown to impact outcomes. Hypocapnea from hyperventilation has been shown in several trials to cause deleterious effects from cerebral vasoconstriction and ischemia. The importance of balancing the prevention of both hypocapnea and hypercapnea has led to the idea of a target ventilation range for arterial carbon dioxide tension, the ideal way to achieve this balance in the prehospital setting remains elusive. This article reviews the background, physiologic effects, impact on outcomes, and implications for prehospital care of prehospital ventilation.
Echocardiographic Visualization of Multiple Cardiac Rhabdomyomas in a Neonate
Authors: Polito Helen
Published: February 2008

Cardiac rhabdomyomas are the most common benign cardiac tumors in children. These tumors may cause obstruction to flow, valvular insufficiency, arrhythmias, and sudden cardiac death. This case report explores an incidental finding of multiple cardiac rhabdomyomas and obstruction of the left ventricular outflow tract, detected by 2D echocardiography.
Testicular Adrenal Rest Tumors Associated With Congenital Adrenal Hyperplasia
Authors: Kopecky Nora , Michael Kim
Published: February 2008

Congenital adrenal hyperplasia is an autosomal recessive disorder that impairs the production of two essential hormones, cortisol and aldosterone. This deficiency results in the overproduction of adrenocorticotropic hormone and overgrowth of the adrenal tissue. Specific forms of congenital adrenal hyperplasia can result in ambiguous genitalia, precocious puberty, short stature, and testicular adrenal rest tumors. Common sonographic findings of testicular rest tissue are multifocal hypoechoic lesions and a spokelike vascularity with multiple peripheral vessels. The sonographer needs to understand the correlation between congenital adrenal hyperplasia and testicular adrenal rest tumors so the testicular masses are not misdiagnosed.
A Simplified Explanation of Deconvolution
Authors: Hedrick Wayne
Published: February 2008

An overview of the mathematical technique of deconvolution as applied to coded excitation is presented. Knowledge of the coded transmission waveform in conjunction with the received echo wavetrain allows the reflectors along the beam path to be identified. Multiple illustrative examples demonstrate the application of deconvolution to real-time image formation.
Ciclesonide improves measures of small airway involvement in asthma
Authors: Cohen J. , Douma W. R. , ten Hacken N. H. T. , Vonk J. M. , Oudkerk M. , Postma D. S.
Published: February 2008

Ciclesonide is delivered as a small-particle inhaled corticosteroid and improves lung function and airway hyperresponsiveness. The objective of the present study was to assess whether ciclesonide can specifically improve small airway function in asthma.

A total of 16 mild-to-moderate asthma patients (seven males; median (range) age 39 (19–56) yrs and forced expiratory volume in one second (FEV1) 89 (62–120)% predicted) were randomised to 5 weeks’ treatment with placebo or 320 μg ciclesonide once daily. The following small airway parameters were assessed: mean forced expiratory flow between 25 and 75% of forced vital capacity (FVC), percentage fall in FVC at provocative dose of adenosine-5′-monophosphate and of methacholine (MCh) causing a 20% fall in FEV1, expiratory lung volume on computed tomography (CT) scan after MCh challenge, single-breath nitrogen closing volume and alveolar exhaled nitric oxide (eNO).

Seven subjects received placebo and nine received ciclesonide. Both alveolar eNO and CT measurements of expiratory lung volume after MCh challenge decreased significantly with ciclesonide (median (range) decrease 4.4 (54.8–1.4) ppb and 59 (1,569– -117) mL, respectively), and compared with placebo (-0.4 (7.3– -3.4) ppb and -121 (20– -236) mL respectively). Ciclesonide did not significantly improve other small airways parameters.

Inflammation and patency of small airways, reflected by alveolar exhaled nitric oxide and air trapping on computed tomography scan, both improve with ciclesonide even in this small number of patients. This indicates that ciclesonide exerts anti-inflammatory effects on small airways.
Outcome of community-acquired pneumonia: influence of age, residence status and antimicrobial treatment
Authors: Kothe H. , Bauer T. , Marre R. , Suttorp N. , Welte T. , Dalhoff K. ,   the Competence Network for Community-Acquired Pneumonia study group
Published: February 2008

Community-acquired pneumonia remains a major cause of mortality in developed countries. There is much discrepancy in the literature regarding factors influencing the outcome in the elderly population.

Data were derived from a multicentre prospective study initiated by the German Competence Network for Community-Acquired Pneumonia. Patients with community-acquired pneumonia (n = 2,647; 1,298 aged <65 yrs and 1,349 aged ≥65 yrs) were evaluated, of whom 72.3% were hospitalised and 27.7% treated in the community. Clinical history, residence status, course of disease and antimicrobial treatment were prospectively documented. Microbiological investigations included cultures and PCR of respiratory samples and blood cultures. Factors related to mortality were included in multivariate analyses.

The overall 30-day mortality was 6.3%. Elderly patients exhibited a significantly higher mortality rate that was independently associated with the following: age; residence status; confusion, urea, respiratory frequency and blood pressure (CURB) score; comorbid conditions; and failure of initial therapy. Increasing age remained predictive of death in the elderly. Nursing home residents showed a four-fold increased mortality rate and an increased rate of Gram-negative bacillary infections compared with patients dwelling in the community. The CURB score and cerebrovascular disease were confirmed as independent predictors of death in this subgroup.

Age and residence status are independent risk factors for mortality after controlling for comorbid conditions and disease severity. Failure of initial therapy was the only modifiable prognostic factor.
High levels of Epstein–Barr virus in COPD
Authors: McManus T. E. , Marley A-M. , Baxter N. , Christie S. N. , Elborn J. S. , O'Neill H. J. , Coyle P. V. , Kidney J. C.
Published: February 2008

Latent viral infection has been implicated in the pathophysiology of chronic obstructive pulmonary disease (COPD). Epstein–Barr virus (EBV) is known to be important in pulmonary fibrosis. The current authors hypothesised that EBV is associated with the pathogenesis of COPD.

Sputum samples were collected from patients both during exacerbations of COPD and when stable. A control group of smokers who did not have airways obstruction also had their sputum examined. The presence of EBV DNA was established and quantified using a real-time nucleic acid amplification assay.

A total of 136 patients with COPD were recruited during an acute exacerbation and a total of 68 when stable. EBV was detected in 65 (48%) exacerbation cases and 31 (46%) stable patients. In the comparison group of 16 nonobstructed smokers, EBV was demonstrated in only one (6%) case. Risk of COPD in patients with EBV and who are smokers confers an odds ratio of 12.6.

Epstein–Barr virus DNA is more frequently identified in the respiratory tract of chronic obstructive pulmonary disease patients in comparison with unaffected smokers. It is present both during exacerbation and when stable, suggesting that infection is persistent. Smokers who do not develop chronic obstructive pulmonary disease rarely have Epstein–Barr virus in their sputum. This finding may be of importance in the pathogenesis of chronic obstructive pulmonary disease.
Children at high altitude have less nocturnal periodic breathing than adults
Authors: Kohler M. , Kriemler S. , Wilhelm E. M. , Brunner-LaRocca H. , Zehnder M. , Bloch K. E.
Published: February 2008

Although children commonly travel to high altitudes, their respiratory adaptation to hypoxia remains elusive. Therefore, in the present study respiratory inductive plethysmography, pulse oximetry (Sp,O2) and end-tidal CO2tension (PET,CO2) were recorded in 20 pre-pubertal children (aged 9–12 yrs) and their fathers during 1 night in Zurich (490 m) and 2 nights at the Swiss Jungfrau-Joch research station (3,450 m) following ascent by train within <3 h.

In children, mean±sdnocturnalSp,O2fell from 98±1% at 490 m to 85±4 and 86±4% at 3,450 m (nights 1 and 2, respectively);PET,CO2decreased significantly from 37±6 to 32±3 and 33±4 mmHg (3,450versus490 m). In adults, changes in nocturnalSp,O2andPET,CO2at 3,450 m were similar to those in children.

Children spent less time in periodic breathing at 3,450 m during night 1 and 2 (8±11 and 9±13%, respectively) than adults (34±24 and 22±17%, respectively), and their apnoea threshold for CO2was lower compared with adults (27±2 and 30±2 mmHg, respectively, both nights).Sp,O2,PET,CO2and time in periodic breathing at altitude were not correlated between children and their fathers.

In conclusion, children revealed a similarly reduced nocturnal O2saturation and associated hyperventilation at high altitude as adults but their breathing pattern was more stable, possibly related to a lower apnoea threshold for CO2.
Adrenal function in patients with community-acquired pneumonia
Authors: Gotoh S. , Nishimura N. , Takahashi O. , Shiratsuka H. , Horinouchi H. , Ono H. , Uchiyama N. , Chohnabayashi N.
Published: February 2008

Adrenal insufficiency is believed to occur frequently in severe sepsis and septic shock. The aim of the present study was to determine whether adrenal function is also related to the severity of community-acquired pneumonia (CAP).

In total, 64 Japanese patients with CAP were consecutively enrolled in the present study, which was carried out during 2005–2006. Serum adrenocorticotropic hormone (ACTH) and cortisol were measured in each subject, as was the response of cortisol secretion when 250 μg of cosyntropin was administered. Analyses were performed comparing these values with the score calculated according to the Pneumonia Patient Outcomes Research Team (PORT) cohort study, the number of in-hospital deaths and the length of hospital stay.

As the PORT score increased, serum ACTH and cortisol also increased, while the response of cortisol secretion to the administration of cosyntropin decreased. In the analysis by receiver operating characteristic curves, adrenal dysfunction was related significantly to both the number of in-hospital deaths and the length of hospital stay.

Adrenal dysfunction was shown to correlate with the Pneumonia Patient Outcomes Research Team score and the clinical outcomes, while adrenal insufficiency defined by the cosyntropin stimulation test was rare in the present study.
Coverage and yield of entry and follow-up screening for tuberculosis among new immigrants
Authors: Erkens C. , Slump E. , Kamphorst M. , Keizer S. , van Gerven P. J. H. J. , Bwire R. , Berkel M. , Borgdorff M. W. , Verver S.
Published: February 2008

The aim of the present study was to determine the effectiveness of entry screening for tuberculosis and biannual follow-up screening among new immigrants in the Netherlands.

To achieve this, the present authors analysed screening, prevalence and incidence data of 68,122 immigrants, who were followed for 29 months. Patients diagnosed within 5 months and 6–29 months after entry screening were considered to be detected at entry and during the follow-up period, respectively.

Coverage of the second to fifth screening rounds was 59, 46, 36 and 34%, respectively. Yield of entry screening was 119 per 100,000 individuals, and prevalence at entry was 131 per 100,000. Average yield of follow-up screening was highest among immigrants with abnormalities on chest radiography (CXR) at entry (902 per 100,000 individuals). When excluding these, yield of follow-up screening was 9, 37 and 97 per 100,000 screenings for immigrants from countries with tuberculosis incidences of <100, 100–200 and >200 per 100,000, respectively. The incidence during follow-up in individuals with a normal CXR was 11, 58 and 145 per 100,000 person-yrs follow-up in these groups. The proportion of cases detected through screening declined per screening round from 91 to 31%.

Yield of entry screening was high. Overall coverage and yield of follow-up screening was low. Follow-up screening of immigrants with a normal chest radiograph from countries with an incidence of <200 per 100,000 individuals was therefore discontinued.
Initiation of breastfeeding within 120 minutes after birth is associated with breastfeeding at four months among Japanese women: A self-administered questionnaire survey
Authors: Nakao Yuko , Moji Kazuhiko , Honda Sumihisa , Oishi Kazuyo
Published: February 2008

Background

The proportion of mothers in Japan who breastfeed exclusively has been low since the 1970s. The purpose of this study was to examine the association between the time of first breastfeed after birth and the proportion of mothers fully breastfeeding up to four months postpartum.

Methods

A survey was conducted using a self-administered questionnaire. The participants were 318 mothers who participated in a physical examination of their four month old infants in Nagasaki City, Japan in 2003.

Results

The time of first breastfeeding up to 120 minutes was significantly associated with the proportion of mothers fully breastfeeding during their stay in the clinic/hospital (p = 0.006), at one month (p = 0.004) and at four months after birth (p = 0.003). There was no significant difference in the proportion of full breastfeeding in mothers who first breastfed between the period of less 30 minutes after birth and that of between 31 and 120 minutes after birth. Logistic regression analysis indicated that the proportion of mothers who continued full breastfeeding at four months was significantly higher in those who breastfed their baby within 120 minutes compared with more than 120 minutes (OR 2.5, p = 0.01), but was not significantly different in those who breastfed within 30 minutes compared with more than 30 minutes (OR 1.8, p = 0.06). Early breastfeeding was affected by caesarean section, premature delivery and severe bleeding during delivery.

Conclusion

Commencement of early breastfeeding was associated with the proportion of mothers who fully breastfed their infants up to four months. Early breastfeeding, especially within two hours, is recommended for child and maternal health.
Transient axonal glycoprotein-1 (TAG-1) and laminin-α1 regulate dynamic growth cone behaviors and initial axon direction in vivo
Authors: Wolman Marc A , Sittaramane Vinoth K , Essner Jeffrey J , Yost H Joseph , Chandrasekhar Anand , Halloran Mary C
Published: February 2008

Background

How axon guidance signals regulate growth cone behavior and guidance decisions in the complex in vivo environment of the central nervous system is not well understood. We have taken advantage of the unique features of the zebrafish embryo to visualize dynamic growth cone behaviors and analyze guidance mechanisms of axons emerging from a central brain nucleus in vivo.

Results

We investigated axons of the nucleus of the medial longitudinal fascicle (nucMLF), which are the first axons to extend in the zebrafish midbrain. Using in vivo time-lapse imaging, we show that both positive axon-axon interactions and guidance by surrounding tissue control initial nucMLF axon guidance. We further show that two guidance molecules, transient axonal glycoprotein-1 (TAG-1) and laminin-α1, are essential for the initial directional extension of nucMLF axons and their subsequent convergence into a tight fascicle. Fixed tissue analysis shows that TAG-1 knockdown causes errors in nucMLF axon pathfinding similar to those seen in a laminin-α1 mutant. However, in vivo time-lapse imaging reveals that while some defects in dynamic growth cone behavior are similar, there are also defects unique to the loss of each gene. Loss of either TAG-1 or laminin-α1 causes nucMLF axons to extend into surrounding tissue in incorrect directions and reduces axonal growth rate, resulting in stunted nucMLF axons that fail to extend beyond the hindbrain. However, defects in axon-axon interactions were found only after TAG-1 knockdown, while defects in initial nucMLF axon polarity and excessive branching of nucMLF axons occurred only in laminin-α1 mutants.

Conclusion

These results demonstrate how two guidance cues, TAG-1 and laminin-α1, influence the behavior of growth cones during axon pathfinding in vivo. Our data suggest that TAG-1 functions to allow growth cones to sense environmental cues and mediates positive axon-axon interactions. Laminin-α1 does not regulate axon-axon interactions, but does influence neuronal polarity and directional guidance.
Combined didactic and scenario-based education improves the ability of intensive care unit staff to recognize delirium at the bedside
Authors: Devlin John W , Marquis Francois , Riker Richard R , Robbins Tracey , Garpestad Erik , Fong Jeffrey J , Didomenico Dorothy , Skrobik Yoanna
Published: February 2008

Background

While nurses play a key role in identifying delirium, several authors have noted variability in their ability to recognize delirium. We sought to measure the impact of a simple educational intervention on the ability of intensive care unit (ICU) nurses to clinically identify delirium and to use a standardized delirium scale correctly.

Methods

Fifty ICU nurses from two different hospitals (university medical and community teaching) evaluated an ICU patient for pain, level of sedation and presence of delirium before and after an educational intervention. The same patient was concomitantly, but independently, evaluated by a validated judge (ρ = 0.98) who acted as the reference standard in all cases. The education consisted of two script concordance case scenarios, a slide presentation regarding scale-based delirium assessment, and two further cases.

Results

Nurses' clinical recognition of delirium was poor in the before-education period as only 24% of nurses reported the presence or absence of delirium and only 16% were correct compared with the judge. After education, the number of nurses able to evaluate delirium using any scale (12% vs 82%, P < 0.0005) and use it correctly (8% vs 62%, P < 0.0005) increased significantly. While judge-nurse agreement (Spearman ρ) for the presence of delirium was relatively high for both the before-education period (r = 0.74, P = 0.262) and after-education period (r = 0.71, P < 0.0005), the low number of nurses evaluating delirium before education lead to statistical significance only after education. Education did not alter nurses' self-reported evaluation of delirium (before 76% vs after 100%, P = 0.125).

Conclusion

A simple composite educational intervention incorporating script concordance theory improves the capacity for ICU nurses to screen for delirium nearly as well as experts. Self-reporting by nurses of completion of delirium screening may not constitute an adequate quality assurance process.
Vasopressin impairs brain, heart and kidney perfusion: an experimental study in pigs after transient myocardial ischemia
Authors: Müller Stig , How Ole-Jakob , Hermansen Stig Eggen , Stenberg Thor Allan , Sager Georg , Myrmel Truls
Published: February 2008

Introduction

Arginine vasopressin (AVP) is increasingly used to restore mean arterial pressure (MAP) in low-pressure shock states unresponsive to conventional inotropes. This is potentially deleterious since AVP is also known to reduce cardiac output by increasing vascular resistance. The effects of AVP on blood flow to vital organs and cardiac performance in a circulation altered by cardiac ischemia are still not sufficiently clarified. We hypothesised that restoring MAP by low dose, therapeutic level AVP would reduce vital organ blood flow in a setting of experimental acute left ventricular dysfunction.

Methods

Cardiac output (CO) and arterial blood flow to the brain, heart, kidney and liver were measured in nine pigs using transit-time flow probes. Left ventricular pressure-volume catheter and central arterial and venous catheters were used for haemodynamic recordings and blood sampling. Transient left ventricular ischemia was induced by intermittent left coronary occlusions resulting in a 17% reduction in cardiac output and a drop in MAP from 87 ± 3 to 67 ± 4 mmHg (p < 0.001). A low-dose therapeutic level of AVP (0.005 U/kg/min) was used to restore MAP to pre-ischemic values (93 ± 4 mmHg).

Results

AVP further impaired systemic perfusion (CO and brain, heart and kidney blood flow reduced by 29, 18, 23 and 34%, respectively) due to a 2.0-, 2.2-, 1.9- and 2.1-fold increase in systemic, brain, heart and kidney specific vascular resistances. The hypoperfusion induced by AVP was associated with an increased systemic oxygen extraction. Oxygen saturation in blood drawn from the great cardiac vein fell from 29 ± 1 to 21 ± 3% (p = 0.01). Finally, these effects were reversed 40 min after AVP was withdrawn.

Conclusion

Low dose AVP induced a pronounced reduction in vital organ blood flow in pigs after transient cardiac ischemia. This indicates a potentially deleterious effect of AVP in patients with heart failure or cardiogenic shock due to impaired coronary perfusion.
Computational identification of the normal and perturbed genetic networks involved in myeloid differentiation and acute promyelocytic leukemia
Authors: Chang Li Wei , Payton Jacqueline E , Yuan Wenlin , Ley Timothy J , Nagarajan Rakesh , Stormo Gary D
Published: February 2008

Background

Acute myeloid leukemia (AML) comprises a group of diseases characterized by the abnormal development of malignant myeloid cells. Recent studies have demonstrated an important role for aberrant transcriptional regulation in AML pathophysiology. Although several transcription factors (TFs) involved in myeloid development and leukemia have been studied extensively and independently, how these TFs coordinate with others and how their dysregulation perturbs the genetic circuitry underlying myeloid differentiation is not yet known. We propose an integrated approach for mammalian genetic network construction by combining the analysis of gene expression profiling data and the identification of TF binding sites.

Results

We utilized our approach to construct the genetic circuitries operating in normal myeloid differentiation versus acute promyelocytic leukemia (APL), a subtype of AML. In the normal and disease networks, we found that multiple transcriptional regulatory cascades converge on the TFs Rora and Rxra, respectively. Furthermore, the TFs dysregulated in APL participate in a common regulatory pathway and may perturb the normal network through Fos. Finally, a model of APL pathogenesis is proposed in which the chimeric TF PML-RARα activates the dysregulation in APL through six mediator TFs.

Conclusion

This report demonstrates the utility of our approach to construct mammalian genetic networks, and to obtain new insights regarding regulatory circuitries operating in complex diseases in humans.