bluuebunny/crossref_metadata_2025 huggingface dataset:
From nation‐building to globalization: an account of the past and present in recent urban studies in Turkey
Authors: Icduygu Ahmet
Published: December 2004

Sema Erder Istanbul'a Bir Kent Kondu, Ümraniye [A City Disembarked to Istanbul, Ümraniye].

Yildiz Sey (ed.) 75 Yilda Degisen Kent ve Mimarlik [Changing city and architecture in 75 years].

Caglar Keyder (ed.) Istanbul, between the global and the local

Sibel Bozdogan Modernism and nation building: Turkish architectural culture in the early Republic

Oguz Isik and Melih Pinarcioglu Nöbetlese yoksulluk, gecekondulasma ve kent yoksullari: Sultanbeyli örnegi [Poverty in turn: squatter housing and urban poor: the example of Sultanbeyli]

Ayse Bugra and Caglar Keyder New poverty and the changing welfare regime of Turkey
Impact of human herpesvirus‐6 after haematopoietic stem cell transplantation
Authors: Hentrich Marcus , Oruzio Daniel , Jäger Gundula , Schlemmer Marcus , Schleuning Michael , Schiel Xaver , Hiddemann Wolfgang , Kolb Hans‐Jochem
Published: December 2004

We studied 228 consecutive stem cell transplant recipients, screened for reactivation of human herpesvirus‐6 (HHV‐6) in peripheral blood and other specimens as clinically indicated by means of qualitative polymerase chain reaction. Among them, 197 received an allograft and 31 autograft. Ninety‐six of 228 patients (42·1%) showed HHV‐6 reactivation in peripheral blood and 129 of 228 (56·6%) demonstrated HHV‐6 in at least one of the specimens tested. 41·9% of patients were asymptomatic when HHV‐6 was identified. Clinical features, noted when HHV‐6 was detected, included interstitial or alveolar pneumonia, gastroduodenal and colorectal disease, bone marrow suppression and liver disease. However, based on clinical and histopathological criteria, HHV‐6 was considered a causal agent in only a minority of patients, in particular, those suffering from bone marrow suppression (n = 11), gastroduodenitis (five), colitis (three), interstitial/alveolar pneumonia (five), skin rash (one), pericarditis (two) and encephalitis (one). HHV‐6 reactivation was significantly associated with the occurrence of graft‐versus‐host disease [odds ratio (OR) 5·31], Epstein–Barr virus coinfection (OR 8·89) and unrelated donor transplantation (OR 5·67) indicating an increased stage of immunosuppression.
Peripheral blood CD34 count in myelofibrosis with myeloid metaplasia: a prospective evaluation of prognostic value in 94 patients
Authors: Arora Brijesh , Sirhan Shireen , Hoyer James D. , Mesa Ruben A. , Tefferi Ayalew
Published: December 2004

In a prospective study, peripheral blood (PB) CD34 count, bone marrow histology and other clinical parameters were concurrently evaluated in 94 patients with myelofibrosis with myeloid metaplasia (MMM) and the study cohort followed for a minimum of 3 years. Median PB CD34 count was 0·0547 × 109/l (range 0–5·345 × 109/l) with 86% of the patients displaying above normal levels (>0·005 × 109/l). In a multivariate analysis, only leucocyte count and PB blast percentage correlated with PB CD34 count in an independent and consistent fashion. After a median follow up of 41 months from PB CD34 analysis, 43 patients (46%) have died with a projected 5‐year survival of 50%. In a univariate analysis, PB CD34 count above 0·1 × 109/l correlated significantly with shortened survival, leukaemic transformation and clinical progression. However, such statistical significance was lost during multivariate analysis, which identified only anaemia and leucocytosis as independent risk factors for shortened survival. Furthermore, sequential analysis of PB CD34 count was performed in 53 patients and 43% of those who progressed clinically did not display a concomitant rise in their PB CD34 count. The current prospective study does not support an independent prognostic value for PB CD34 count in MMM.
A class II‐restricted cytotoxic T‐cell clone recognizes a human minor histocompatibility antigen with a restricted tissue distribution
Authors: Holloway Penny A. , Kaldenhoven Niels , Kok‐Schoemaker Henriette M. , Dijk Mirjam van , Otten Hennie G. , Tilanus Marcel , Postma Saskia , Mutis Tuna , Lokhorst Henk M. , Bloem Andries C.
Published: December 2004

Following a human leucocyte antigen (HLA)‐identical allogeneic stem cell transplantation (allo‐SCT), minor histocompatibility antigens (mHags) play an important role in the induction of graft‐versus‐leukaemia (GvL) and graft‐versus‐myeloma (GvM). Many mHags show ubiquitous tissue expression and are associated with GvL and graft‐versus‐host disease. Here we describe a cytotoxic CD4+ T lymphocyte line and a cytotoxic, CD4+ T cell clone (CTC), 3AB11, which recognized a tissue‐restricted mHag. This CTC was isolated from a multiple myeloma patient with clinical GvM following an HLA‐matched allo‐SCT. CTC 3AB11 was activated in a HLA‐DP*0401 restricted fashion and the antigen was expressed by 27% of HLA‐DP*0401 positive Epstein–Barr virus (EBV)‐transformed B‐cell lines (EBV‐B). Tissue distribution analysis of antigen 3AB11 showed it to be expressed by patient‐derived EBV‐transformed B cell lines (EBVp), the myeloma plasma cell‐line UM9 and monocytes. It was weakly expressed by peripheral blood‐derived phytohaemagglutinin‐induced T‐cell blasts and absent on CD40L stimulated peripheral B (CD40L B) cells and stromal cells. The relatively high prevalence of the HLA class II‐restricted 3AB11 antigen, together with its apparent haematopoietic‐restricted expression, makes it an antigen of interest for cellular immunotherapy.
New insights into the pathophysiology of diabetic nephropathy: from haemodynamics to molecular pathology
Authors: Wolf G.
Published: December 2004

Although debated for many years whether haemodynamic or structural changes are more important in the development of diabetic nephropathy, it is now clear that these processes are interwoven and present two sides of one coin. On a molecular level, hyperglycaemia and proteins altered by high blood glucose such as Amadori products and advanced glycation end‐products (AGEs) are key players in the development of diabetic nephropathy. Recent evidence suggests that an increase in reactive oxygen species (ROS) formation induced by high glucose‐mediated activation of the mitochondrial electron‐transport chain is an early event in the development of diabetic complications. A variety of growth factors and cytokines are then induced through complex signal transduction pathways involving protein kinase C, mitogen‐activated protein kinases, and the transcription factor NF‐κB. High glucose, AGEs, and ROS act in concert to induce growth factors and cytokines. Particularly, TGF‐β is important in the development of renal hypertrophy and accumulation of extracellular matrix components. Activation of the renin‐angiotensin system by high glucose, mechanical stress, and proteinuria with an increase in local formation of angiotensin II (ANG II) causes many of the pathophysiological changes associated with diabetic nephropathy. In fact, it has been shown that angiotensin II is involved in almost every pathophysiological process implicated in the development of diabetic nephropathy (haemodynamic changes, hypertrophy, extracellular matrix accumulation, growth factor/cytokine induction, ROS formation, podocyte damage, proteinuria, interstitial inflammation). Consequently, blocking these deleterious effects of ANG II is an essential part of every therapeutic regiment to prevent and treat diabetic nephropathy. Recent evidence suggests that regression of diabetic nephropathy could be achieved under certain circumstances.
Alcohol and polyphenolic grape extract inhibit platelet adhesion in flowing blood
Authors: Lange D. W. de , Scholman W. L. G. , Kraaijenhagen R. J. , Akkerman J. W. N. , Van De Wiel A.
Published: December 2004

Background  Moderate and prolonged alcohol consumption has been associated with decreased cardiovascular morbidity and mortality. Inhibition of platelet function in suspension attributes to these effects. Whether alcohol, red wine, or polyphenolic grape extracts (PGE) inhibit platelet adhesion is not known. We investigated platelet adhesion to fibrinogen and collagen in whole blood under standardised flow.

Materials and methods  Before perfusion was started, citrated whole blood from 95 volunteers was preincubated for five min with different alcohol concentrations, unfractioned red wine and PGE. Then, blood was perfused in a single‐passage flow chamber over coverslips coated with human fibrinogen or collagen type III at shear rates of 300 s−1 and 1600 s−1.

Results  Alcohol inhibited platelet adhesion to human fibrinogen at high shear rate (concentrations ≥ 0·15‰) and low shear rate (only at a concentration of 4·8‰), whereas red wine (concentrations ≥ 0·15‰) inhibited platelet adhesion to human fibrinogen at both shear rates. In contrast, PGE (concentrations ≥ 0·0225 g L−1) inhibited platelet adhesion to human fibrinogen only at low shear rate. None of these incubations affected adhesion to collagen.

Conclusions  Alcohol, red wine and PGE inhibit adhesion to fibrinogen but not to collagen. This inhibition might contribute to the cardioprotective effects of moderate alcohol consumption.
The rights of blood recipients should supersede any asserted rights of blood donors
Authors: Brooks J. P.
Published: December 2004

Some gay men have argued that the laboratory testing of blood is so accurate that continued deferrals based upon sexual activity are unnecessary and unjust. They also assert that they have a right to donate blood. There has been much debate over altering the rule barring donation from men who have had sex with other men since 1977, with blood organizations disagreeing over the best course of action. Two studies have indicated that changing the rule would increase the risk of human immunodeficiency virus (HIV) transmission. This dilemma is part of a broader issue, namely: what are the responsibilities of blood services to blood donors and recipients? Blood services should base decisions regarding donor suitability on science rather than on their donors’ desires. Blood services must recognize that the rights of blood recipients should supersede any asserted rights of blood donors.
The value of crossmatch tests and panel tests as a screening tool to predict the outcome of platelet transfusion in a non‐selected haematological population of patients
Authors: Levin M.‐D. , Van Der Holt B. , De Veld J. C. , Gratama J. W. , De Vries W. , Van't Veer M. B.
Published: December 2004

Background and Objectives  Alloantibodies against platelets can be detected by using different laboratory tests. Most of these tests, which use panel cells or antigens as a target, perform poorly in non‐selected haematological patients. In relation to these tests, a crossmatch test of transfused platelets and patient's serum may be viewed as the standard and may be superior in predicting donor platelet destruction by alloimmunization.

Materials and Methods  In 95 randomly selected thrombocytopenic patients with haematological malignancies, who were receiving leucodepleted blood products, 184 serum samples were studied in an in vitro crossmatch test by using the technique of the platelet immunofluorescence test (crossmatch‐PIFT), in an in vivo crossmatch test detecting in vivo binding of immunoglobulins to transfused platelets according to the PIFT technique (in vivo‐PIFT), in the indirect PIFT using five random donors as a target (panel‐PIFT) and in an enzyme linked immunosorbent assay using immobilized human leucocyte antigens (HLAs) of 100 standardized donors (ELIHLA). The results of all these methods were related to the recovery at 1 and 16 h post‐transfusion.

Results  The results of the crossmatch‐PIFT were not associated with platelet recovery at 1 and 16 h after transfusion. Even in a subgroup of patients, in whom predefined clinical factors were excluded, no association with platelet recovery was found. The results of the crossmatch‐PIFT correlated with those of the in vivo‐PIFT (P = 0·02); however, 35 (19%) discrepant results were identified between these tests. The results of the crossmatch‐PIFT were not related to the panel‐PIFT (P = 0·25), but did relate to those of the ELIHLA (P = 0·02), still revealing 36 (20%) discrepant results. None of the in vivo‐PIFT, the panel‐PIFT or the ELIHLA was associated with platelet recovery after 1 h, whilst only a positive panel‐PIFT was associated with poor platelet recovery at 16 h after transfusion (P = 0·03).

Conclusions  In a population at low risk for alloimmunization, the correlation of test outcome and platelet recovery is poor. None of these crossmatch tests or screening tests was identified as superior to any other in this population.
Ask your doctor: the construction of smoking in advertising posters produced in 1946 and 2004
Authors: Street Annette F.
Published: December 2004

This paper examines two full‐page A3 poster advertisements in mass magazines produced at two time points over a 60‐year period depicting smoking and its effects, with particular relation to lung cancer. Each poster represents the social and cultural milieu of its time. The writings of Foucault are used to explore the disciplinary technologies of sign systems as depicted in the two posters. The relationships between government, tobacco companies and drug companies and the technologies of production are examined with regard to the development of smoking cessation strategies. The technologies of power are associated with the constructions of risk and lifestyles. The technologies of the self locate smokers as culpable subjects responsible for their individual health. Finally, the meshing of these technologies places the doctor in the frame as ‘authoritative knower’ and representative of expert systems.
ASSESSMENT OF MISS AND INCIDENCE RATES OF NEOPLASTIC POLYPS AT COLONOSCOPY
Authors: Kasugai Kunio , Miyata Mitsuki , Hashimoto Takashi , Todoroki Isami , Tsutsui Shigeru , Nagase Fumitaka , Wada Yuko , Sato Mari , Takahashi Kuniyuki , Tokura Yoshifumi , Kanazawa Tamotsu , Kakumu Shinichi
Published: December 2004

Background:  The incidence rate after a colonoscopic polypectomy includes the true incidence rate of new polyp formation and miss rate of polyps at the initial colonoscopy. It is therefore important to assess accurate incidence rates of polyps as well as those of missing polyps with colocoscopy.

Methods:  Six hundred and eighty‐eight patients who underwent total colonoscopy twice within 30 days were investigated to determine the miss rates of neoplastic polyps under colonoscopy. The cumulative incidence rates of neoplasm were evaluated by the Kaplan‐Meier method in another series of investigations on 864 patients who underwent surveillance total colonoscopy over 31 days.

Results:  In 157 (22.8%) patients out of 688, 200 neoplastic lesions (all adenomas) were missed during the first examination. The miss rate was 16% for adenomas ≤ 5 mm and 2% for adenomas > 10 mm. The miss rates of patients with 0, 1, 2, or > 2 neoplastic polyps on the first examination was 5.3%, 19.6%, 23.5% and 35.5%, respectively. One year cumulative incidence rates of patients with 1, 2, or > 2 neoplastic polyps on the first examination were 18.4%, 21.1% and 34.2%, respectively.

Conclusion:  Detection of multiple neoplasms on index colonoscopy predicts a high miss rate and cumulative incidence rate on surveillance colonoscopy. A substantial proportion of neoplasms detected at nearly 1‐year postpolypectomy surveillance colonoscopy were missed at the initial total colonoscopy.
USEFUL ENDOSCOPIC ULTRASONOGRAPHY TO ASSESS THE EFFICACY OF NEOADJUVANT THERAPY FOR ADVANCED ESOPHAGEAL CARCINOMA: BASED ON THE RESPONSE EVALUATION CRITERIA IN SOLID TUMORS
Authors: Ota Masaho , Murata Yoko , Ide Hiroko , Eguchi Reiki , Nakumura Tsutomu , Hayashi Kazuhiko , Narumiya Kousuke , Oi Itaru , Takasaki Ken
Published: December 2004

Objective:  The aim of the present study was to assess the usefulness of endoscopic ultrasonography (EUS) for evaluating the efficacy of neoadjuvant therapy for advanced esophageal carcinoma based on the Response Evaluation Criteria in Solid Tumors (RECIST).

Patients and Methods:  Sixty‐two patients with advanced esophageal carcinoma underwent surgical resection after neoadjuvant therapy. The maximal tumor thickness was measured by EUS before and after neoadjuvant therapy, and the percent reduction was compared with the pathological response. Based on the RECIST, PD‐SD (progressive disease‐stable disease) was defined as < 30% reduction of tumor thickness on EUS, PR (partial response) as ≥ 30% reduction of tumor thickness, and CR (complete response) as no detectable tumor (100%).

Results:  The percent reduction of the thickness of Grade 0–1, Grade 2 and Grade 3 tumor was 11.5 ± 21.0%, 48.2 ± 17.0% and 74.9 ± 21.1%, respectively. There were significant differences in the extent of reduction among the three groups. Based on the RECIST, 80% of Grade 0–1 cases, 91% of Grade 2 cases and 22% of Grade 3 cases were PD‐SD, PR, and CR according to EUS, respectively. EUS correctly identified 80% of non‐responders and 94% of responders.

Conclusions:  The percentage reduction of tumor thickness on EUS closely reflected the pathological evaluation. EUS evaluation based on the RECIST seems to be useful for monitoring neoadjuvant therapy in patients with esophageal carcinoma.
ACUTE ESOPHAGEAL NECROSIS
Authors: Carneiro Marcos , Lescano Manuel , Romanello Luiza , Módena José , Carneiro Fabiana , Ramalho Leandra , Martinelli Ana , França Alex
Published: December 2004

Acute esophageal necrosis (AEN) is defined as a diffuse blackened aspect of the esophagus observed by upper gastrointestinal endoscopy associated with the histopathological findings of necrosis of the esophageal mucosa. In general, the condition is present in severely compromised patients. Its cause remains unknown but is probably multifactorial. In the present case report we describe the clinical, endoscopic and histopathological characteristics of black esophagus observed in three patients and present a review of the literature.
An evaluation of current perspectives on consciousness and pain in fishes
Authors: Chandroo Kristopher Paul , Yue Stephanie , Moccia Richard David
Published: December 2004

There is growing societal and scientific interest in the welfare status of fish used for commercial enterprise. As animal welfare is primarily concerned with the quality of life of a conscious, sentient organism, the question of whether fishes are even capable of consciousness must first be addressed in order to assess their welfare status. Recently, there has been a resurgence of research investigating the biological basis for human consciousness, and our current understanding of the cognitive mechanisms underlying fish behaviour has likewise improved significantly. Combined, these research perspectives create an opportunity to better comprehend the phylogeny of traits associated with consciousness, as well as the emergence of consciousness itself during vertebrate evolution. Despite the availability of this literature, contemporary reviews or published studies investigating the probability of conscious states occurring in fishes often do so without considering new perspectives or data. In this paper, we review and critique recent publications that report equivocal conclusions favouring the absence or presence of consciousness in various fishes. By introducing other data into these analyses, we demonstrate that there are alternative perspectives which support the existence of consciousness in fishes as a plausible concept. An accurate assessment of the mental capacity of fishes will require enhanced knowledge of their forebrain neuroanatomy, an understanding of how such structures mediate behavioural responses, and an analysis of that information within the context of contemporary theory related to the evolution of consciousness in higher vertebrates.
From small‐scale habitat loopholes to decadal cycles: a habitat‐based hypothesis explaining fluctuation in pelagic fish populations off Peru
Authors: Bertrand Arnaud , Segura Marceliano , Gutiérrez Mariano , Vásquez Luis
Published: December 2004

The Peru‐Humboldt Current system (HCS) supports the world's largest pelagic fisheries. Among the world's eastern boundary current systems, it is the most exposed to high climatic stress and is directly affected by El Niño and La Niña events. In this volatile ecosystem, fish have been led to develop adaptive strategies in space and time. In this paper, we attempt to understand the mechanisms underlying such strategies, focusing on the El Niño 1997–98 in Peru from which an extensive set of hydrographic, capture and acoustic survey data are available. An integrated analysis of the data is crucial, as each has substantial shortcomings individually; for example, both catch data and acoustic surveys may easily lead to wrong conclusions. Existing hypotheses on anchovy and sardine alternations lead us to a ‘habitat‐based’ synthetic hypothesis. Using our data, an integrated approach evaluated how fish responded to habitat variation, and determined the consequences in terms of fish‐population variability. Various factors occurring at a range of different spatio‐temporal scales were considered: interdecadal regime (warm ‘El Viejo’/cool ‘La Vieja’ decadal scale); strength and the duration of the El Niño Southern Oscillation event (interannual scale); population condition before the event (interannual scale); fishing pressure and other predation (annual scale); changes in reproductive behaviour (intra‐annual scale); presence of local upwelling (local scale). During El Niño 1997–98, anchovy was able to exploit a small‐scale temporal and spatial ‘loophole’ inside the general unfavourable conditions. Moreover, sardine did not do better than anchovy during this El Niño and was not able to take advantage of the ‘loophole’ opened by this short‐term event. Our results question the traditional view that El Niño is bad for anchovy and good for sardine.
Intergenerational cost–benefit analysis and marine ecosystem restoration
Authors: Sumaila Ussif Rashid
Published: December 2004

Ghoti papers  Ghoti aims to serve as a forum for stimulating and pertinent ideas. Ghoti publishes succinct commentary and opinion that addresses important areas in fish and fisheries science. Ghoti contributions will be innovative and have a perspective that may lead to fresh and productive insight of concepts, issues and research agendas. All Ghoti contributions will be selected by the editors and peer reviewed.

Etymology of Ghoti  George Bernard Shaw (1856‐1950), polymath, playwright, Nobel prize winner, and the most prolific letter writer in history, was an advocate of English spelling reform. He was reportedly fond of pointing out its absurdities by proving that ‘fish’ could be spelt ‘ghoti’. That is: ‘gh’ as in ‘rough’, ‘o’ as in ‘women’ and ‘ti’ as in palatial.

Conventional cost–benefit analysis (CBA) tends to show that most ecosystem restoration programmes are not worthwhile in economic terms. This is because discounting puts more weight on current net benefits than future ones. I suggest that this is partly because conventional CBA is based on the current generation's time perspective (termed here the ‘discounting clock’). That is, net benefits are discounted starting when the analysis is carried out (the present). To tackle this problem, I propose the use of an intergenerational CBA, which takes into account the fact that current restoration efforts may produce benefits, in particular, fish protein, to future generations, and that these benefits need to be valued using the respective discounting clocks of the generation receiving them. This approach appears to meet the requirements imposed by most management jurisdictions, where there is an explicit or implied requirement to account for benefits to future generations in decision‐making concerning the use and management of marine resources.
Towards a New Standard Employment Relationship in Western Europe
Authors: Bosch Gerhard
Published: December 2004

This paper examines critically the concept of the standard employment relationship (SER), differentiating between form and substance. It explores the social functions served by the SER and its evolution in western Europe. Six major causes underpinning changes in the employment relationship are explored and the contours of a new more flexible SER developed. Two further social functions are added: equal access for men and women to the employment system, and increased internal flexibility in the workplace.
Divergence in Part‐Time Work in New Zealand, the Netherlands and Denmark
Authors: Rasmussen Erling , Lind Jens , Visser Jelle
Published: December 2004

A comparison of developments in part‐time work in New Zealand, the Netherlands and Denmark shows three very different trends. The Dutch are moving towards a ‘part‐time economy’, the decline in Danish part‐time employment confounds the common expectation of rising atypical employment, while the New Zealand case illustrates some of the negative employment outcomes often associated with part‐time employment and provides a contrast to the negotiated, tripartite solutions found in the Netherlands and Denmark. Overall, the diversity in part‐time work patterns raises important theoretical and public policy questions, such as the interaction between institutional and preference changes, gender patterns and union strategies.
The jump‐start of the Holland economy during the late‐medieval crisis, c.1350–c.15001
Authors: Van BAVEL BAS J. P. , Van ZANDEN JAN LUITEN
Published: December 2004

Byc.1500 the Holland economy had already acquired modern traits, as witnessed by the occupational structure and the urbanization rate. This article tries to explain the remarkable development of the Holland economy between 1350 and 1500, linking it to the specific occupation history of the region in the eleventh to thirteenth centuries. The combination of high wages in this frontier economy with increasing difficulties in arable agriculture as a result of the subsidence of peat soils, and the absence of feudal restrictions in production and marketing, resulted in the rise of capital‐intensive industries, benefiting from converging wages and increasing market integration.
Medial temporal lobe atrophy and memory deficits in elderly stroke patients
Authors: Jokinen H. , Kalska H. , Ylikoski R. , Hietanen M. , Mäntylä R. , Pohjasvaara T. , Kaste M. , Erkinjuntti T.
Published: December 2004

Medial temporal lobe atrophy (MTA) and its role in memory deficits have been studied extensively in patients with various dementias and non‐degenerative neurologic diseases. In stroke patients MTA is a significant risk factor for dementia. However, its role in memory decline in non‐demented stroke patients is not yet known. Our aim was to evaluate the relationship between MTA and cognitive functions in a large cohort of elderly patients, who underwent a comprehensive neuropsychologic examination and magnetic resonance imaging 3 months after an ischemic stroke. The study sample (n = 260) was divided into three groups according to the severity of MTA. After adjusting for age, volume of infarcts and cortical atrophy, we found that patients with moderate to severe MTA performed significantly worse in tests of learning, story recall, visual reproduction, block design and mental speed. In contrast, the groups did not differ in tests of digit span, flexibility, verbal fluency and conceptualization. Our conclusion is that in aged stroke patients, MTA is associated with poor performance in specific cognitive domains. The most vulnerable domains are memory and visuospatial functions, whereas verbal and executive functions seem to be unrelated to MTA.
Struggles for autonomy in self‐care: the impact of the physical and socio‐cultural environment in a long‐term care setting
Authors: Sacco‐Peterson Maryanne , Borell Lena
Published: December 2004

Self‐care has great significance in individuals’ lives because it has been shown to support one's health and well‐being in old age. This qualitative study of daily life in a nursing home ward employed an ethnographic design to observe routines and daily activities in the ward. Narrative interviews with the residents and staff were also conducted in order to learn about the environmental experience. The aim was to generate a deeper understanding about how the physical and socio‐cultural environments and residents’ cultural beliefs influenced participation in their own personal‐care activities. The findings demonstrate how the physical and socio‐cultural environment in the nursing home actually required older residents to overcome greater physical and cognitive challenges to maintain their participation, autonomy, and dignity in toileting, bathing, and dressing than would have been expected had the resident been living at home.
Staff's experience of and the management of violent incidents in elderly care
Authors: Åström Sture , Karlsson Stig , Sandvide Åsa , Bucht Gösta , Eisemann Martin , Norberg Astrid , Saveman Britt‐Inger
Published: December 2004

Violence towards staff has become an important issue, since it has been reported to be common in various health care settings. This study aimed to describe emotional reactions among staff being exposed to violence in residential community care for the elderly: to investigate consequences from violent incidents and to describe the management of violent incidents. Data were collected by telephone interviews with nursing staff reporting incidents of violence. During the period of investigation, 97 of 848 staff (11.4%) reported that they had been exposed to violence. More than one‐third of them reported subsequent wound and bruises from the incident and two of the exposed staff consulted a doctor because of the violent incident. The most frequently reported reactions among the staff were aggression, astonishment, and antipathy against the perpetrating care recipient, as well as insufficiency, powerlessness, insult and fear. A majority of the incidents were judged as intentionally perpetuating from the care recipient. Most of the violent incidents were managed by informal discussions in the working team. A low number of the reported incidents of violence involved formal discussions with nurse managers.
Perspectives on corporate social responsibility in the chemical sector: A comparative analysis of the Mexican and South African cases
Authors: Acutt Nicola J. , Medina‐Ross Veronica , O'Riordan Tim
Published: December 2004

In recent years, the debate on corporate responsibility has shifted from a focus on environmental management towards a broader concept of corporate social responsibility (CSR). This article examines the chemical industry's approach to CSR from the perspective of two emerging economies: Mexico and South Africa. The global chemical industry was one of the first to respond to public concerns about environmental pollution, toxic waste and human health by adopting an industry‐wide code of practice, known as Responsible Care. This article examines the extent to which the chemical industry has responded to the broader debate on CSR. On the basis of a comparative case study, this article argues that the response to social issues by Mexican and South African chemical companies has tended to be limited to the ‘community awareness and emergency response’ (CAER) or community dialogue component of the international voluntary management framework, Responsible Care. Similarities and differences in regulatory and institutional conditions, as well as different levels of civil society engagement, reveal additional limitations for CSR, beyond that of the Responsible Care framework. This article argues that the socio‐political context influences the extent to which companies embrace CSR, especially in emerging economies, and highlights several challenges for the chemical industry in moving forward on CSR: credibility, stakeholder engagement, value‐chain accountability, disclosure and transparency. Reflecting on these challenges, the authors conclude by recommending a renewed focus on: (1) developing a broader set of CSR management practices beyond Responsible Care; (2) institutionalizing stronger accountability measures, such as reporting and verification; and (3) developing multi‐stakeholder partnerships that complement regulation and build public sector regulatory and guidance capacity.
Oscillatory Free Surface Displacement of Finite Amplitude in a Small Orifice
Authors: Daniels Brian J. , Liburdy James A.
Published: December 2004

The oscillatory free-surface displacement in an orifice periodically driven at the inlet is studied. The predictions based on a potential flow analysis are investigated in light of viscous and large curvature effects. Viscous effects near the wall are estimated, as are surface viscous energy loss rates. The curvature effect on the modal frequency is shown to become large at the higher modal surface shapes. Experimental results are obtained using water for two orifice diameters, 794 and 1180 μm. Results of surface shapes and modal frequencies are compared to the predictions. Although modal shapes seem to be well predicted by the theory, the experimental results show a significant shift of the associated modal frequencies. A higher-order approximation of the surface curvature is presented, which shows that the modal frequency should, in fact, be reduced from potential flow predictions as is consistent with the large curvature effect. To account for the effect of finite surface displacements an empirical correlation for the modal frequencies is presented.
Investigation of the Role of Polymer on the Delay of Tip Vortex Cavitation
Authors: Latorre R. , Muller A. , Billard J. Y. , Houlier A.
Published: December 2004

Cavitation tunnel measurements have shown tip vortex cavitation inception is delayed when polymers are injected from the hydrofoil tip. Experiments with polymers have also shown that the polymers cause the cavitation to become more violent. To better understand the role of polymer in the delay of tip vortex cavitation, a theoretical analysis of tip vortex cavitation inception in pure water and in polymer solution is presented. The analysis shows that while polymer injection causes instability in small bubbles, its main effect is an increase in tip vortex core radius, resulting in the delay of tip vortex cavitation inception.
Predicting energy response of radiographic film in a x‐ray beam using Monte Carlo calculated fluence spectra and absorbed dose
Authors: Palm Åsa , Kirov Assen S. , LoSasso Thomas
Published: December 2004

The advantage of radiographic film is that it allows two‐dimensional, high‐resolution dose measurement. While there is concern over its photon energy dependence, these problems are considered acceptable within small fields, where the scatter component is small. The application of film dosimetry to intensity modulated radiotherapy (IMRT) raises additional concern since the primary fluence may vary significantly within the field. The varying primary fluence in combination with a large scatter fraction, present for large fields and large depths, causes the spectrum at various points within the IMRT field to differ from the spectrum in the uniform fields typically used for calibrating the film. As a result, significant artifacts are introduced in the measured dose distribution. The purpose of this work is to quantify and develop a method to correct for these artifacts. Two approaches based on Monte Carlo (MC) simulations are examined. In the first method, the film artifact, as quantified by film and ion chamber output measurements in uniform square fields, is derived from the MC calculated ratio of absorbed doses to film and to water. In the second method, the measured film artifact is correlated with MC calculated photon spectra, revealing a strong correlation between the measured artifact and the “scatter”‐to‐“primary” ratio, defined by the ratio of the number of photons below to the number of photons above , independent of field size and depth. These methods are evaluated in high‐ and low‐dose regions of a large intensity‐modulated field created with a central block. The spectral approach is also tested with a clinical IMRT field. The absorbed dose method accurately corrects the measured film dose in the open part of the field and in points under the block and outside the field. The dose error is reduced from as much as 16% of the open field dose to less than 1%, as verified with an ion chamber. The spectral method accurately corrects the measured film dose in the open region of the centrally blocked field, but does not fully correct for the film artifact for points under the block and outside the field, where the spectrum is substantially different. Applied to the clinical field, the corrected film measurement shows good agreement with data obtained with a two‐dimensional diode array.
CSnrc: Correlated sampling Monte Carlo calculations using EGSnrc
Authors: Buckley Lesley A. , Kawrakow I. , Rogers D. W. O.
Published: December 2004

CSnrc, a new user‐code for the EGSnrc Monte Carlo system is described. This user‐code improves the efficiency when calculating ratios of doses from similar geometries. It uses a correlated sampling variance reduction technique. CSnrc is developed from an existing EGSnrc user‐code CAVRZnrc and improves upon the correlated sampling algorithm used in an earlier version of the code written for the EGS4 Monte Carlo system. Improvements over the EGS4 version of the algorithm avoid repetition of sections of particle tracks. The new code includes a rectangular phantom geometry not available in other EGSnrc cylindrical codes. Comparison to CAVRZnrc shows gains in efficiency of up to a factor of 64 for a variety of test geometries when computing the ratio of doses to the cavity for two geometries. CSnrc is well suited to in‐phantom calculations and is used to calculate the central electrode correction factorin high‐energy photon and electron beams. Current dosimetry protocols base the value ofon earlier Monte Carlo calculations. The current CSnrc calculations achieve 0.02% statistical uncertainties on, much lower than those previously published. The current values ofcompare well with the values used in dosimetry protocols for photon beams. For electrons beams, CSnrc calculations are reported at the reference depth used in recent protocols and show up to a 0.2% correction for a graphite electrode, a correction currently ignored by dosimetry protocols. The calculations show that for a 1 mm diameter aluminum central electrode, the correction factor differs somewhat from the values used in both the IAEA TRS‐398 code of practice and the AAPM's TG‐51 protocol.
Monte Carlo dosimetric study of Best Industries and Alpha Omega Ir‐192 brachytherapy seeds
Authors: Ballester F. , Granero D. , Pérez‐Calatayud J. , Casal E. , Puchades V.
Published: December 2004

Ir‐192 seeds are widely used in the USA for low dose rate interstitial brachytherapy. There are two commercially available models: those manufactured by Best Industries filtered with stainless steel, and those manufactured by Alpha‐Omega seeds filtered with Pt. Newly developed 3D correction algorithms for brachytherapy are based on dosimetry data obtained on unbounded phantom size, allowing corrections for heterogeneities and actual tissue boundaries. Published dosimetric datasets for both seeds have been obtained under bounded conditions. The aim of the present study is to obtain dosimetric datasets for these seeds under full scatter conditions. The Monte Carlo GEANT4 code has been used to estimate air–kerma strength and dose rate in water around the Ir‐192 seeds. Functions and parameters following the TG43 formalism are obtained and presented in tabular forms: the dose rate constant, the radial dose function, and the anisotropy function. Tables for the anisotropy factor have been obtained in order to apply punctual approximation. Differences between dose rate distributions for both seeds show that specific dataset must be used for each type of seed in clinical dosimetry. The data in the present study improve on published data in the following aspects: (i) dosimetric data were obtained under full scatter conditions, which affect dose values at distances greater than from the source; (ii) the dose rate tables are given at greater distances from the source; and (iii) the spatial resolution in high dose gradient areas, such as those near the longitudinal source axis, has been improved.
Automatic real‐time surveillance of eye position and gating for stereotactic radiotherapy of uveal melanoma
Authors: Petersch Bernhard , Bogner Joachim , Dieckmann Karin , Pötter Richard , Georg Dietmar
Published: December 2004

A new prototype (hardware and software) for monitoring eye movements using a noninvasive technique for gated linac‐based stereotactic radiotherapy (SRT) of uveal melanoma was developed. The prototype was tested within the scope of a study for 11 patients. Eye immobilization was achieved by having the patient fixate a light source integrated into the system. The system is used in conjunction with a Head&Neck mask system for immobilization, and uses infrared tracking technology for positioning (both BrainLAB AG Heimstetten/Germany). It was used during CT and MR image acquisition as well as during all of five treatment fractions (, to 80% isodose) to guarantee identical patient setup and eye rotational state during treatment planning and treatment delivery. Maximum temporal and angular deviations tolerated during treatment delivery can be chosen by the physician, the radiation then being interrupted automatically and instantaneously if those criteria are being exceeded during irradiation. A graphical user interface displays life video images of the treated eye and information about the current and previous rotational deviation of the eye from its reference treatment position. The physician thus has online access to data directly linked to the success of the treatment and possible side effects. Mean angular deviations during CT/MR scans and treatment deliveries ranged from 1.61° to 3.64° (standard deviations 0.87° to 2.09°) which is in accordance with precision requirements for SRT. Typical situations when preset deviation criteria were exceeded are slow drifts (fatigue), sudden large eye movements (irritation), or if patients closed their eyes (fatigue). In these cases radiation was reliably interrupted by the gating system. In our clinical setup the novel system for computer‐controlled eye movement gated treatments was well tolerated by all patients. The system yields quantitative real‐time information about the eye's rotational state with respect to a reference position (treatment planning situation). Together with the possibility of performing movement‐gated treatments of uveal melanoma, the system thus greatly improves the quality of this treatment.
Transcendence and healing
Authors: Glannon W
Published: December 2004

Healing aims to restore the wholeness of persons by restoring the unity of mind and body disrupted by disease. Transcendence promotes healing by altering or cultivating beliefs that can modulate the body’s response to pain or make sense of pain. This in turn can produce an emotional response that enables people to cope with chronic or terminal illness. I explain transcendence in terms of a monistic rather than dualistic conception of mind and body, which supports the idea of medicine as a healing art as well as a curative science.
Pain does not suffer misprision: an inquiry into the presence and absence that is pain
Authors: Katz J D
Published: December 2004

The reigning questions of metaphysics generate passion. These are questions such as concern death, a hereafter, and the meaning of suffering. They are questions that haunt us. Philosophical inquiries into these topics are often constructed Socratically. In turn, such logical machinations are founded upon the belief that a discernible outcome or answer to metaphysical questions exists. Western thought labours under the tenet that the impasse of “unknowableness” can be bridged with the brute force of intellect. Pain is not only the motivation for metaphysical inquiry; it becomes the universal metaphor for loss. It absorbs displaced fears and becomes a vehicle for expressing a “lack”. The essence of pain, therefore, is negative. It is absence (and hence not an existence). Even though pain is a lack, however, we relate to it as if it were a presence that denies us of our passion for life.
Giselle, madness & death
Authors: Wainwright S P , Williams C
Published: December 2004

In this paper the Romantic balletGiselle(1841) is used as a case study through which to examine the themes of madness and death.Giselleis a heartrending story of the intertwining of love and death. It is argued thatGiselleis an evocative example of narratives of hysteria and suicide, and literature in the field of medical history is drawn upon to demonstrate the relations between the cultural fields of ballet, medicine, and the wider social world at the time ofGiselle. Finally, it is suggested that the notion of the embodiment of vulnerability provides a fruitful way to meld our understandings of the interconnections between the arts, society, and medicine.
“As vast as the world”—reflections onA Very Easy Deathby Simone de Beauvoir
Authors: Brennan F
Published: December 2004

In 1964, Simone de Beauvoir, arguably one of the greatest writers of 20th century Europe, published an account of the final 6 weeks of her mother’s life. It is a beautifully written, raw, honest, and powerful evocation of that period from the viewpoint of a relative. Its themes are universal—love, ambivalence in family ties, loss, and bereavement. Given that the events preceded the modern palliative care movement, reflections are made on differences in medical practice since the book’s publication.
The patient’s lament: hidden key to effective communication: how to recognise and transform
Authors: Bub B
Published: December 2004

“Our dancing is changed into mourning” Lamentations 5:15 to “you turned my lament into dancing” Psalm 30:12.

Numerous studies and well publicised complaints from the public have long revealed a pressing need for physicians to improve their communication skills and their ability to interpret and respond appropriately to what they hear from patients. Rushed and dispirited, physicians are routinely urged to become more compassionate and to spend more time listening. This article challenges the myth that listening is a time consuming art propelled by compassion and demonstrates that it is in fact a highly active professional skill that can be greatly clarified and simplified for practising physicians. The lament is offered as a universally encountered, sometimes masked, expression that patients need to have heard and validated. An intellectual understanding of the lament as a symptom of suffering greatly facilitates the listening process and enables the listener to respond therapeutically. This saves time, improves quality of care, and enhances the wellbeing and satisfaction of both physician and patient.
A literature and medicine special study module run by academics in general practice: two evaluations and the lessons learnt: Table 1
Authors: Jacobson L , Grant A , Hood K , Lewis W , Robling M , Prout H , Cunningham A M
Published: December 2004

This paper describes the design, delivery and evaluation of a nine week special study module on literature and medicine for third year undergraduate medical students, by tutors from an academic department of general practice. Three weeks of taught seminars are followed by three weeks of one on one meetings between individual students and tutors, leading to a seminar led by, and based on, materials prepared by the student. The final three weeks of the course are dedicated to completion of essays about areas chosen by students for in depth study.

The course was evaluated on two separate occasions, using two different techniques: the first evaluation used a focus group technique to identify and explore relevant themes; the second used nominal group theory to assess whether the course worked educationally, and how it could be improved.

In the main, the course was judged to meets its aims, with generally positive student comments, albeit with caveats and reservations. The subject matter was intellectually challenging for students and tutors. Further research into the optimal size for such groups, and a more formal evaluation of tutors’ experiences is required.