bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetorheological Valve for Hybrid Electrohydrostatic Actuation
Authors: Nosse David T. , Dapino Marcelo J.
Published: February 2007

There is an increasing demand for compact actuators capable of producing large deflections, large forces, and broad frequency bandwidths. Due to their solid state nature, smart materials can enable novel actuator solutions that compete favorably with established technologies based on electric, hydraulic, or pneumatic motors. However, in all existing active materials, large force and broadband responses are obtained at small displacements and methods for transmitting very short transducer element motion to large deformations need to be developed. We present a new hybrid actuator which operates on the principle of rectification of magnetostrictive vibrations by means of magnetorheological (MR) flow control. Experiments and theoretical calculations are aimed at substantiating the feasibility of the hybrid actuator and establishing design criteria for the development of an effective MR valve. The experiments presented here demonstrate the ability of the valve to completely block the flow due to the combined action of a pressure differential and MR fluid activation. For characterization purposes, two variations of the main valve concept are considered, one with moving coils and the other with fixed coils. Actuation measurements conducted on the complete actuator show deflections of 6.5 in. in response to fluid inputs produced with a hydraulic piston in combination with an applied quasistatic voltage of amplitude 5 V. A system-level model is presented which is developed by treating the system as an RLC equivalent electrical circuit with operation across electrical, mechanical, and fluid domains. Attributes and shortcomings of the model are discussed through comparison of model results with experimental data.
Vibration Reduction and Power Generation with Piezoceramic Sheets Mounted to a Flexible Shaft
Authors: Sloetjes P.J. , De Boer A.
Published: February 2007

A flexible shaft with surface-mounted piezoceramic sheets and strain sensors is considered which suffers from resonance and self-excited vibration. Frequency domain models, time domain simulations, and control experiments are used to analyze active modal damping and active modal balancing methods. The generation of electric power from cyclic straining of rotor-fixed piezoelectric material is studied and several self-powering devices for condition monitoring and vibration control are proposed.
Patterns of Knowing as a Foundation for Action-Sensitive Pedagogy
Authors: Averill Jennifer B. , Clements Paul T.
Published: February 2007

Graduate students in the health sciences often juggle full-time careers, demanding programs of study, and family responsibilities. Frustration, a perception of limited caring on the part of role models, and a sense of disengagement, or even despair, are common features of postbaccalaureate study for many of them. Nursing has long recognized the value of multiple perspectives in knowledge development. Previous work involving patterns of knowing not only has advanced the disciplinary knowledge base but has also encouraged innovative applications of the patterns to philosophy, evidence-based practice, and research aimed at reducing health disparities. In an effort to both extend the dialogue about ways of knowing and humanize the experience of graduate education for nursing students, the authors propose six patterns of knowing as a foundation for effective, action-sensitive pedagogy.
Crossing Multidisciplinary Divides: Exploring Professional Hierarchies and Boundaries in Focus Groups
Authors: Clavering Emma K. , McLaughlin Janice
Published: February 2007

Focus groups are an important element of qualitative health research, valued for the forms of knowledge and understanding that emerge from interactions among participants. Common advice for focus groups within health research is to limit the level of variation among respondents to generate comprehensive discussion and shared knowledge. In this article, the authors critically examine this advice, proposing instead that it is useful to acknowledge and, at times, consciously build in heterogeneity across categories of those present. The benefit of doing this is that the interaction thus generated can be used as a space within which to explore differing professional positions and interpretations of issues under discussion. Using research they have done, they explore the practical issues involved in getting different health and social care professionals together and go on to discuss the value and significance of using focus groups to explore the production of professional hierarchies and boundaries.
Representations of the Patient: Conflicts of Expertise in a Psychiatric Emergency Department
Authors: Messinger Seth D.
Published: February 2007

Representations are the socially and textually produced patients as presented in clinical discussion and the clinical chart. An understudied aspect of representations in medicine is the way in which they are used to highlight contests of expertise and authority between clinicians, which have consequences over control of critical hospital resources. The author uses ethnographic research in a public urban hospital psychiatry department in New York City to examine the rounds meetings of a psychiatric emergency room, exploring the way in which representatives of a variety of occupational groups portray patients as they present and debate alternative diagnoses. He uses narratives of rounds meetings to illustrate the interactions, debates, and work of psychiatric and nonpsychiatric clinicians as they struggle to diagnose and develop treatment plans for patients. The enhanced authority of nonpsychiatrist clinicians that emerges from successful contests of representations illustrates a possible future for psychiatry as a multidisciplinary medical specialty.
Voting on Tax Policy Design
Authors: Ackert Lucy F. , Gillette Ann B. , Martinez-Vazquez Jorge , Rider Mark
Published: February 2007

The authors build on the work of Engelmann and Strobel and of Ackert, Martinez-Vazquez, and Rider to examine the potential role of social preferences in tax policy design. They randomly assign each participant in a session to a group with five members. The payoffs to participants are determined by majority vote of the participants in a given group. The authors randomly assign each participant a pretax income that remains the same throughout the experiment to control for the potential confounding effect of risk-pooling equilibria. On the basis of statistical analysis of the data generated by these experiments, they find support for the hypothesis that the minimax preferences of Rawls or the inequality aversion model of Fehr and Schmidt help explain individual choices over alternative tax structures.
Reducing Fear of Crime
Authors: Renauer Brian C.
Published: February 2007

This study addresses whether residents' perceptions of informal neighborhood social control or police and government activities in their neighborhood provides a stronger explanation of their emotional fear of crime. Survey data from 505 residents from 10 diverse neighborhoods are used to test the relationship between informal and formal social control and individual fear of crime. The results indicate both informal control, especially social cohesion, and formal social control—a fear of police encounters and police effectiveness—explain emotional fear of crime. Discussion of citizen, police, and government responsibilities for reducing fear of crime is undertaken.
Police Chiefs, Anomia, and Leadership
Authors: Hays Kraig L. , Regoli Robert M. , Hewitt John D.
Published: February 2007

This research assesses a potentially harmful condition among police chiefs: anomia. The article analyzes a large (N = 1,120) stratified sample survey of American police chiefs. Nine hypotheses are tested using multiple regressions. Results show relatively little anomia (as defined by Srole's 5-point Likert-type scale) among the respondents. Data analysis reveals little relationship between anomia and the following four variables: age, being a chief in a previous jurisdiction, race/ethnicity, and internal hire. However, the analysis also reveals significant negative relationships between anomia and education, merit selection, and years in law enforcement and between anomia and size of department and tenure as chief. Regression analysis reveals that the posited model explains only a small amount of variance in anomia. Suggestions for future research in the area of upper level policing executives are discussed.
Association of improvement of brachial artery flow-mediated vasodilation with cardiovascular events
Authors: Suessenbacher Alois , Frick Matthias , Alber Hannes F , Barbieri Verena , Pachinger Otmar , Weidinger Franz
Published: February 2007

The aim of this pilot study was to test the prognostic value of serial measurements of peripheral endothelial function, assessed by brachial artery flow-mediated dilation (FMD), in patients with angiographically proven coronary artery disease. In 68 patients, FMD was measured on the day after coronary angiography and again after a mean of 14 ± 12 months. Patients were divided into two groups: absolute improvement in FMD ≥ 3% (FMD-improver += FMD-i) and <3% (FMD-non-improver = FMD-ni). After a mean follow-up of 44 ± 12 months, cardiovascular events were recorded. Baseline characteristics were similar between groups, except the number of risk factors which was smaller in FMD-i (1.6 ± 0.7 vs 2.1 ± 0.9, p < 0.02). Cardiovascular events were more frequent in FMD-ni (9 vs 1 event; p < 0.05). In Kaplan–Meier analysis, a trend towards a better outcome in patients with improved FMD was found using the log-rank test (p = 0.08). The single baseline FMD showed no relationship with late cardiovascular events. Thus, ‘delta-FMD’ may be more closely related to prognosis than a single FMD measurement.
Turning on Default Reasons
Authors: McKeever Sean , Ridge Michael
Published: February 2007

Particularism takes an extremely ecumenical view of what considerations might count as reasons and thereby threatens to ‘flatten the moral landscape’ by making it seem that there is no deep difference between, for example, pain, and shoelace color. After all, particularists have claimed, either could provide a reason provided a suitable moral context. To avoid this result, some particularists draw a distinction between default and non-default reasons. The present paper argues that all but the most deflationary ways of drawing this distinction are either implausible or else insufficient to help the particularist avoid flattening the moral landscape. The difficulty can be avoided, however, if we reject particularism's extremely ecumenical view of reasons.
The Structure of Empathy
Authors: Deonna Julien
Published: February 2007

If Sam empathizes with Maria, then it is true of Sam that (1) Sam is aware of Maria's emotion, and (2) Sam ‘feels in tune’ with Maria. On what I call thetransparency conception of how they interact when instantiated, I argue that these two conditions are collectively necessary and sufficient for empathy. I first clarify the ‘awareness’ and ‘feeling in tune’ conditions, and go on to examine different candidate models that explain the manner in which these two conditions might come to be concomitantly instantiated in a subject. I dismiss what I call theparallel and oscillation models for not satisfying the transparency condition, i.e. for failing to capture that, if Sam empathizes with Maria, then Sam's own emotional experience towards the object of Maria's emotion has to be mediated by Maria's own emotional experience. I conclude in favour the fusion model as the only model capable of satisfying the transparency condition, and I argue that the suggested proposal illuminates the difference between it and other ways in which we understand the emotions of others. Finally, I expand and clarify the conception of empathy as transparency through responses to obvious objections that the view raises.
Moderation of the platelet releasate response by aspirin
Authors: Coppinger Judith A. , O'Connor Roisin , Wynne Kieran , Flanagan Michelle , Sullivan Matthew , Maguire Patricia B. , Fitzgerald Desmond J. , Cagney Gerard
Published: February 2007

Modulation of the proteins released during activation is one mechanism whereby aspirin may influence platelet-mediated human disease. We investigated the effect of aspirin on the platelet releasate using mass spectrometry and found that different agonists evoked different releasate profiles, with aspirin having a general moderating effect on the amount of protein released regardless of the agonist. These observations were confirmed for several cytokines using an antibody array approach.
Geographical variation in radiological services: a nationwide survey
Authors: Lysdahl Kristin Bakke , Børretzen Ingelin
Published: February 2007

Background

Geographical variation in health care services challenges the basic principle of fair allocation of health care resources. This study aimed to investigate geographical variation in the use of X-ray, CT, MRI and Ultrasound examinations in Norway, the contribution from public and private institutions, and the impact of accessibility and socioeconomic factors on variation in examination rates.

Methods

A nationwide survey of activity in all radiological institutions for the year 2002 was used to compare the rates per thousand of examinations in the counties. The data format was files/printouts where the examinations were recorded according to a code system.

Results

Overall rates per thousand of radiological examinations varied by a factor of 2.4. The use of MRI varied from 170 to 2, and CT from 216 to 56 examinations per 1000 inhabitants. Single MRI examinations (knee, cervical spine and head/brain) ranged high in variation, as did certain other spine examinations. For examination of specific organs, the counties' use of one modality was positively correlated with the use of other modalities. Private institutions accounted for 28% of all examinations, and tended towards performing a higher proportion of single examinations with high variability. Indicators of accessibility correlated positively to variation in examination rates, partly due to the figures from the county of Oslo. Correlations between examination rates and socioeconomic factors were also highly influenced by the figures from this county.

Conclusion

The counties use of radiological services varied substantially, especially CT and MRI examinations. A likely cause of the variation is differences in accessibility. The coexistence of public and private institutions may be a source of variability, along with socioeconomic factors. The findings represent a challenge to the objective of equality in access to health care services, and indicate a potential for better allocation of overall health care resources.

Previous publication

The data applied in this article was originally published in Norwegian in: Børretzen I, Lysdahl KB, Olerud HM: Radiologi i Noreg – undersøkingsfrekvens per 2002, tidstrendar, geografisk variasjon og befolkningsdose. StrålevernRapport 2006:6. Østerås: The Norwegian Radiation Protection Authority. The Norwegian Radiation Protection Authority has given the authors permission to republish the data.
Managed care and patient ratings of the quality of specialty care among patients with pain or depressive symptoms
Authors: Grembowski David , Paschane David , Diehr Paula , Katon Wayne , Martin Diane , Patrick Donald L
Published: February 2007

Background

Managed care efforts to regulate access to specialists and reduce costs may lower quality of care. Few studies have examined whether managed care is associated with patient perceptions of the quality of care provided by physician and non-physician specialists. Aim is to determine whether associations exist between managed care controls and patient ratings of the quality of specialty care among primary care patients with pain and depressive symptoms who received specialty care for those conditions.

Methods

A prospective cohort study design was conducted in the offices of 261 primary physicians in private practice in Seattle in 1997. Patients (N = 17,187) were screened in waiting rooms, yielding a sample of 1,514 patients with pain only, 575 patients with depressive symptoms only, and 761 patients with pain and depressive symptoms. Patients (n = 1,995) completed a 6-month follow-up survey. Of these, 691 patients received specialty care for pain, and 356 patients saw mental health specialists. For each patient, managed care was measured by the intensity of managed care controls in the patient's health plan and primary care office. Quality of specialty care at follow-up was measured by patient rating of care provided by the specialists. Outcomes were pain interference and bothersomeness, Symptom Checklist for Depression, and restricted activity days.

Results

The intensity of managed care controls in health plans and primary care offices was generally not associated with patient ratings of the quality of specialty care. However, pain patients in more-managed primary care offices had lower ratings of the quality of specialty care from physician specialists and ancillary providers.

Conclusion

For primary care patients with pain or depressive symptoms and who see specialists, managed care controls may influence ratings of specialty care for patients with pain but not patients with depressive symptoms.
Applying the compound Poisson process model to the reporting of injury-related mortality rates
Authors: Kegler Scott R
Published: February 2007

Injury-related mortality rate estimates are often analyzed under the assumption that case counts follow a Poisson distribution. Certain types of injury incidents occasionally involve multiple fatalities, however, resulting in dependencies between cases that are not reflected in the simple Poisson model and which can affect even basic statistical analyses. This paper explores the compound Poisson process model as an alternative, emphasizing adjustments to some commonly used interval estimators for population-based rates and rate ratios. The adjusted estimators involve relatively simple closed-form computations, which in the absence of multiple-case incidents reduce to familiar estimators based on the simpler Poisson model. Summary data from the National Violent Death Reporting System are referenced in several examples demonstrating application of the proposed methodology.
An evaluation of LSU rDNA D1-D2 sequences for their use in species identification
Authors: Sonnenberg Rainer , Nolte Arne W , Tautz Diethard
Published: February 2007

Background

Identification of species via DNA sequences is the basis for DNA taxonomy and DNA barcoding. Currently there is a strong focus on using a mitochondrial marker for this purpose, in particular a fragment from the cytochrome oxidase I gene (COI). While there is ample evidence that this marker is indeed suitable across a broad taxonomic range to delineate species, it has also become clear that a complementation by a nuclear marker system could be advantageous. Ribosomal RNA genes could be suitable for this purpose, because of their global occurrence and the possibility to design universal primers. However, it has so far been assumed that these genes are too highly conserved to allow resolution at, or even beyond the species level. On the other hand, it is known that ribosomal gene regions harbour also highly divergent parts. We explore here the information content of two adjacent divergence regions of the large subunit ribosomal gene, the D1-D2 region.

Results

Universal primers were designed to amplify the D1-D2 region from all metazoa. We show that amplification products in the size between 800–1300 bp can be obtained across a broad range of animal taxa, provided some optimizations of the PCR procedure are implemented. Although the ribosomal genes occur in multiple copies in the genomes, we find generally very little intra-individual polymorphism (<< 0.1% on average) indicating that concerted evolution is very effective in most cases. Studies in two fish taxa (genus Cottus and genus Aphyosemion) show that the D1-D2 LSU sequence can resolve even very closely related species with the same fidelity as COI sequences. In one case we can even show that a mitochondrial transfer must have occurred, since the nuclear sequence confirms the taxonomic assignment, while the mitochondrial sequence would have led to the wrong classification. We have further explored whether hybrids between species can be detected with the nuclear sequence and we show for a test case of natural hybrids among cyprinid fish species (Alburnus alburnus and Rutilus rutilus) that this is indeed possible.

Conclusion

The D1-D2 LSU region is a suitable marker region for applications in DNA based species identification and should be considered to be routinely used as a marker complementing broad scale studies based on mitochondrial markers.
A pragmatic cluster randomised controlled trial of a Diabetes REcall And Management system: the DREAM trial
Authors: Eccles Martin P , Whitty Paula M , Speed Chris , Steen Ian N , Vanoli Alessandra , Hawthorne Gillian C , Grimshaw Jeremy M , Wood Linda J , McDowell David
Published: February 2007

Background

Following the introduction of a computerised diabetes register in part of the northeast of England, care initially improved but then plateaued. We therefore enhanced the existing diabetes register to address these problems. The aim of the trial was to evaluate the effectiveness and efficiency of an area wide 'extended,' computerised diabetes register incorporating a full structured recall and management system, including individualised patient management prompts to primary care clinicians based on locally-adapted, evidence-based guidelines.

Methods

The study design was a pragmatic, cluster randomised controlled trial, with the general practice as the unit of randomisation. Set in 58 general practices in three Primary Care Trusts in the northeast of England, the study outcomes were the clinical process and outcome variables held on the diabetes register, patient-reported outcomes, and service and patient costs. The effect of the intervention was estimated using generalised linear models with an appropriate error structure. To allow for the clustering of patients within practices, population averaged models were estimated using generalized estimating equations.

Results

Patients in intervention practices were more likely to have at least one diabetes appointment recorded (OR 2.00, 95% CI 1.02, 3.91), to have a recording of a foot check (OR 1.87, 95% CI 1.09, 3.21), have a recording of receiving dietary advice (OR 2.77, 95% CI 1.22, 6.29), and have a recording of blood pressure (BP) (OR 2.14, 95% CI 1.06, 4.36). There was no difference in mean HbA1c or BP levels, but the mean cholesterol level in patients from intervention practices was significantly lower (-0.15 mmol/l, 95% CI -0.25, -0.06). There were no differences in patient-reported outcomes or in patient-reported use of drugs, or uptake of health services. The average cost per patient was not significantly different between the intervention and control groups. Costs incurred in administering the system at the register and in general practice were in addition to these.

Conclusion

This study has shown benefits from an area-wide, computerised diabetes register incorporating a full structured recall and individualised patient management system. However, these benefits were achieved at a cost. In future, these costs may fall as electronic data exchange becomes a reliable reality.

Trial registration: International Standard Randomised Controlled Trial Number (ISRCTN) Register, ISRCTN32042030.
Oestrogen receptor negative breast cancers exhibit high cytokine content
Authors: Chavey Carine , Bibeau Frédéric , Gourgou-Bourgade Sophie , Burlinchon Sandrine , Boissière Florence , Laune Daniel , Roques Sylvie , Lazennec Gwendal
Published: February 2007

Introduction

An emerging hypothesis suggests that cytokines could play an important role in cancer as potential modulators of angiogenesis and leucocyte infiltration.

Methods

A novel multiplexed flow cytometry technology was used to measure the expression of 17 cytokines (IL-1β, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-12 [p70], IL-13, IL-17, granulocyte colony-stimulating factor [CSF], granulocyte-macrophage CSF, IFN-γ, monocyte chemoattractant protein [MCP]-1, macrophage inflammatory protein [MIP]-1β, tumour necrosis factor [TNF]-α) at the protein level in 105 breast carcinoma. B lymphocyte, T lymphocyte and macrophage levels were determined by immunohistochemistry.

Results

Fourteen of the 17 cytokines were expressed in breast carcinoma, whereas only nine cytokines could be detected in normal breast. Most cytokines were more abundant in breast carcinoma than in normal breast, with IL-6, IL-8, granulocyte CSF, IFN-γ, MCP-1 and MIP-1β being very abundant. IL-2, IL-6, IL-8, IL-10, IFN-γ, MCP-1, MIP-1β and TNF-α, and to a lesser extent IL-1β and IL-13 exhibited levels of expression that were inversely correlated to oestrogen receptor and progesterone receptor status. Most cytokines were not correlated with age at cancer diagnosis, tumour size, histological type, or lymph node status. However, IL-1β, IL-6, IL-8, IL-10, IL-12, MCP-1 and MIP-1β were more abundant in high-grade tumours than in low-grade tumours. In addition, IL-8 and MIP-1β were expressed to a greater degree in HER2-positive than in HER2-negative patients. The expression of most of the studied cytokines was correlated to levels of activator protein-1, which is known to regulate numerous cytokines. Overexpression of MCP-1 and MIP-1β were linked to B lymphocyte, T lymphocyte and macrophage infiltration, whereas high levels of IL-8 were correlated with high macrophage content in tumour. Moreover, IL-8 positive tumours exhibited increased vascularization.

Conclusion

We found that multiple cytokines were overexpressed in oestrogen receptor negative breast carcinoma, and that the three major cytokines – MCP-1, MIP-1β and IL-8 – were correlated with inflammatory cell component, which could account for the aggressiveness of these tumours.
Effect of mode of hydrocortisone administration on glycemic control in patients with septic shock: a prospective randomized trial
Authors: Loisa Pekka , Parviainen Ilkka , Tenhunen Jyrki , Hovilehto Seppo , Ruokonen Esko
Published: February 2007

Introduction

Low-dose hydrocortisone treatment is widely accepted therapy for the treatment of vasopressor-dependent septic shock. The question of whether corticosteroids should be given to septic shock patients by continuous or by bolus infusion is still unanswered. Hydrocortisone induces hyperglycemia and it is possible that continuous hydrocortisone infusion would reduce the fluctuations in blood glucose levels and that tight blood glucose control could be better achieved with this approach.

Methods

In this prospective randomized study, we compared the blood glucose profiles, insulin requirements, amount of nursing workload needed, and shock reversal in 48 septic shock patients who received hydrocortisone treatment either by bolus or by continuous infusion with equivalent dose (200 mg/day). Duration of hydrocortisone treatment was five days.

Results

The mean blood glucose levels were similar in the two groups, but the number of hyperglycemic episodes was significantly higher in those patients who received bolus therapy (15.7 ± 8.5 versus 10.5 ± 8.6 episodes per patient, p = 0.039). Also, more changes in insulin infusion rate were needed to maintain strict normoglycemia in the bolus group (4.7 ± 2.2 versus 3.4 ± 1.9 adjustments per patient per day, p = 0.038). Hypoglycemic episodes were rare in both groups. No difference was seen in shock reversal.

Conclusion

Strict normoglycemia is more easily achieved if the hydrocortisone therapy is given to septic shock patients by continuous infusion. This approach also reduces nursing workload needed to maintain tight blood glucose control.

Trial Registration Number

ISRCTN98820688
Inhalation injury in severely burned children does not augment the systemic inflammatory response
Authors: Finnerty Celeste C , Herndon David N , Jeschke Marc G
Published: February 2007

Introduction

Inhalation injury in combination with a severe thermal injury increases mortality. Alterations in inflammatory mediators, such as cytokines, contribute to the incidence of multi-organ failure and mortality. The aim of the present study was to determine the effect of inhalation injury on cytokine expression in severely burned children.

Methods

Thirty severely burned pediatric patients with inhalation injury and 42 severely burned children without inhalation injury were enrolled in the study. Inhalation injury was diagnosed by bronchoscopy during the first operation. Blood was collected within 24 hours of admission and again at five to seven days following admission. Cytokine expression was profiled using multi-plex antibody-coated beads. Significance was accepted at a p value of less than 0.05.

Results

The mean percentages of total body surface area burned were 67% ± 4% (56% ± 6%, third-degree burns) in the inhalation injury group and 60% ± 3% (45% ± 3%, third-degree burns) in the non-inhalation injury group (p value not significant [NS]). Mean age was 9 ± 1 years in the inhalation injury group and 8 ± 1 years in the non-inhalation injury group (p value NS). Time from burn to admission in the inhalation injury group was 2 ± 1 days compared to 3 ± 1 days in the non-inhalation injury group (p value NS). Mortalities were 40% in the inhalation injury group and 12% in the non-inhalation injury group (p < 0.05). At the time of admission, serum interleukin (IL)-7 was significantly increased in the non-inhalation injury group, whereas IL-12p70 was significantly increased in the inhalation injury group compared to the non-inhalation injury group (p < 0.05). There were no other significant differences between groups. Five to seven days following admission, all cytokines decreased with no differences between the inhalation injury and non-inhalation injury cohorts.

Conclusion

In the present study, we show that an inhalation injury causes alterations in IL-7 and IL-12p70. There were no increased levels of pro-inflammatory cytokines, indicating that an inhalation injury in addition to a burn injury does not augment the systemic inflammatory response early after burn.
Presence or Absence of Menstruation in Young Girls
Authors: REES MARGARET
Published: February 2007

Abstract:  Menstruation is a periodic discharge of sanguinous fluid and sloughing of the uterine lining in the female. It is an event characteristic of the reproductive cycle in humans and most subhuman primates and has no known biological function. However, it is an integral part of a woman's experience throughout her reproductive life. This article will examine menstrual patterns and concerns in young girls. The section on absent menstruation will concentrate on premature ovarian failure.
Safety Issues of Hysteroscopic Surgery
Authors: PASCHOPOULOS MINAS , POLYZOS NIKOLAOS P. , LAVASIDIS LAZAROS G. , VREKOUSSIS THOMAS , DALKALITSIS NIKOLAOS , PARASKEVAIDIS EVANGELOS
Published: February 2007

Abstract:  The term hysteroscopy is used to determine the procedure during which an endoscopic view of the endometrial cavity is achieved with the help of a type of endoscopic device called “the hysteroscope.” Hysteroscopy is used to assist the diagnosis for a series of female pathology. Apart from its diagnostic value, hysteroscopy can also be used for operative procedures including ablation and resection. Both diagnostic and operative hysteroscopy have been used for a number of years and various studies have been published to describe their success and complication rates throughout this period. Diagnostic hysteroscopy is relatively safe, whereas complications occur more frequently when operative hysteroscopy is used. These complications include uterine perforation, hemorrhage, fluid overload, gas embolization, and hyponatremia. The rate in the appearance of these complications is dependent on the type of the hysteroscopic procedure, the distending medium, and the experience of the hysteroscopist. To avoid any problems concerning the application of hysteroscopic procedures, it is important to take the necessary precautions both preoperatively and intraoperatively. For example, the preoperative use of thinning agents of the endometrium and the reduction of the operating time, or the avoidance of cutting too deeply into the myometrium, are some of the parameters to be considered when hysteroscopy is in argument.
The Fetus That Is Small for Gestational Age
Authors: VRACHNIS NIKOLAOS , BOTSIS DIMITRIOS , ILIODROMITI ZOE
Published: February 2007

Abstract:  The symmetric small for gestational age (SGA) fetus presents a complex management problem for the obstetrician, but the growth restriction affects morbidity and mortality at all stages of life.
The differential diagnosis in symmetric growth aberration includes the constitutionally small fetus, the fetus with pathology, and the cases with incorrect dating of pregnancy. The ultrasonographic examination focuses in the detection of anomalies, signs of intrauterine infection, and serial assessment of fetal growth. Accuracy of fetal biometry may be improved by using individualized fetal growth curves. From the available surveillance tools, the uterine artery Doppler has a value in predicting poor perinatal outcome. Magnetic resonance imaging is also useful in the evaluation of anomalies. Cesarean section is not justified for all symmetric SGA fetuses that may carry a guarded prognosis.
Myomectomy during Cesarean Section
Authors: HASSIAKOS D. , CHRISTOPOULOS P. , VITORATOS N. , XARCHOULAKOU E. , VAGGOS G. , PAPADIAS K.
Published: February 2007

Abstract:  A patient's frequent request is the simultaneous surgical removal of a previously diagnosed myoma during cesarean section. The aim of this study was to evaluate the safety and efficacy of myomectomy during cesarean section. From January 1995 until December 2004, 47 pregnant women with coexisting uterine myomas underwent cesarean section and simultaneous myomectomy. All cesarean sections were performed by residents while myomectomies were conducted by the senior staff. Intraoperative and postoperative complications such as blood loss were estimated and compared with 94 women with uterine myomas who underwent surgical delivery without removal of the fibroids. Furthermore, the length of hospitalization was compared between the two groups. Myomectomy added a mean time of 15 min to the operative time of cesarean section. No hysterectomy was performed at the time of the cesarean section. No complications were developed during the puerperium. The difference between the preoperative and postoperative hemoglobin mean value was statistically significant (P= 0.001) but did not differ between isolated cesarean and myomectomy‐combined cesarean groups. None of the patients received blood transfusion. The length of hospitalization was comparable between the two groups. Despite controversial literature data, we suggest that myomectomy during cesarean section could be generally recommended. Depending on size and location of myomas, the associated risks are similar to those of isolated cesarean section.
Possible Early Prediction of Preterm Birth by Determination of Novel Proinflammatory Factors in Midtrimester Amniotic Fluid
Authors: MALAMITSI‐PUCHNER ARIADNE , VRACHNIS NIKOLAOS , SAMOLI EVI , BAKA STAVROULA , ILIODROMITI ZOE , PUCHNER KARL‐PHILIPP , MALLIGIANIS PANTELIS , HASSIAKOS DIMITRIOS
Published: February 2007

Abstract:  Interferon‐γ‐inducible T cell‐α chemoattractant (ITAC) is a chemokine, directing activated T lymphocytes toward sites of inflammation. ADAM‐8 (A disintegrin and metalloprotease‐8) is a glycoprotein expressed in cells promoting inflammation. Elastase, a protease targeting at the degradation of intra‐ or extracellular proteins, is inhibited by secretory leukocyte proteinase inhibitor (SLPI), which protects against microbial invasion. Adhesion molecules (soluble intercellular adhesion molecule—sICAM‐1 and soluble vascular cell adhesion molecule—sVCAM‐1) serve as markers of inflammation or tissue damage. We hypothesized that elevated midtrimester amniotic fluid concentrations of above substances, and decreased levels of SLPI could possibly be useful predictors of asymptomatic intra‐amniotic inflammation and/or infection, eventually resulting in preterm labor and delivery. The study involved 312 women undergoing midtrimester amniocentesis. Thirteen cases, progressing to preterm delivery (<37 weeks), were matched with 21 controls (delivering >37 weeks) for age, parity, and gestational age at amniocentesis. Amniotic fluid levels of the above substances were measured by enzyme‐linked immunosorbent assay (ELISA). Only amniotic fluid ITAC and ADAM‐8 levels were significantly higher (P= 0.005 and P < 0.02, respectively) in women delivering at <37 weeks than at >37 weeks. SLPI concentrations significantly increased in women going into labor without ruptured membranes irrespective of pre‐ or term delivery (P < 0.007, P < 0.001, respectively) and correlated with elastase (r= 0.508, P < 0.002). In conclusion, elevated midtrimester amniotic fluid levels of ITAC and ADAM‐8 could predict occult infections/inflammations, possibly resulting in preterm birth.
A Cost-Effectiveness Analysis of Adjuvant Trastuzumab Regimens in Early HER2/neu–Positive Breast Cancer
Authors: Kurian Allison W. , Thompson Rebecca Newton , Gaw Allison F. , Arai Sally , Ortiz Rafael , Garber Alan M.
Published: February 2007

Purpose

One-year adjuvant trastuzumab (AT) therapy, with or without anthracyclines, increases disease-free and overall survival in early-stage HER2/neu-positive breast cancer. We sought to evaluate the cost effectiveness of these regimens, which are expensive and potentially toxic.

Methods

We used a Markov health-state transition model to simulate three adjuvant therapy options for a cohort of 49-year-old women with HER2/neu-positive early-stage breast cancer: conventional chemotherapy without trastuzumab; anthracycline-based AT regimens used in the National Surgical Adjuvant Breast and Bowel Project B-31 and North Central Cancer Treatment Group N9831 trials; and the nonanthracycline AT regimen used in the Breast Cancer International Research group 006 trial. The base case used treatment efficacy measures reported in the randomized clinical trials of AT. We measured health outcomes in quality-adjusted life-years (QALYs) and costs in 2005 United States dollars (US$) and subjected results to probabilistic sensitivity analysis.

Results

In the base case, the anthracycline-based AT arm has an incremental cost-effectiveness ratio (ICER) of $39,982/QALY, whereas the nonanthracycline AT arm is more expensive and less effective; this result is insensitive to changes in recurrence rates, but if there is no benefit after 4 years, ICERs exceed $100,000/QALY for both AT arms. Results are moderately sensitive to variation in breast cancer survival rates and trastuzumab cost, and less sensitive to variations in cardiac toxicity.

Conclusion

AT has an ICER comparable to those for other widely used interventions. Longer clinical follow-up is warranted to evaluate the long-term efficacy and toxicity of different AT regimens.
Cost Effectiveness of Adjuvant Trastuzumab in Human Epidermal Growth Factor Receptor 2–Positive Breast Cancer
Authors: Liberato Nicola Lucio , Marchetti Monia , Barosi Giovanni
Published: February 2007

Purpose

To evaluate the cost-effectiveness of 12-month adjuvant trastuzumab therapy in women with high-risk human epidermal growth factor receptor 2 (HER2) –positive early breast cancer.

Methods

A Markov model tracked quarterly patients’ transitions between five health states: disease free, local relapse, disease free after local relapse, metastatic disease, and death. Patients were allowed to incur symptomatic or asymptomatic transient cardiac dysfunction during trastuzumab administration. Probabilities were derived mainly from the combined report of the National Surgical Adjuvant Breast and Bowel Project B-31 and the North Central Cancer Treatment Group N9831 trials (95% node positive) and a meta-analysis by the Early Breast Cancer Trialists’ Collaborative Group. Costs were estimated from the perspective of the Italian and US health care systems. The analysis was run during a 15-year time horizon. A 3% yearly discount rate was applied to both costs and life-years. Second-order Monte-Carlo and probabilistic sensitivity analyses were performed.

Results

Adjuvant trastuzumab increases life expectancy by 1.54 (1.18 discounted) quality-adjusted life-years (QALYs). At a cost of €675 and $767 per weekly dose in the Italian and US setting, respectively, trastuzumab achieves its clinical benefit at a cost of €14,861 (95% CI, €3,917 to €44,028) and $18,970 (95% CI, $6,014 to $45,621) per QALY saved. The incremental cost effectiveness was higher than €50,000/QALY (or $60,000/QALY) at time horizons shorter than 7.8 years and for patients older than 76 years or with a 10-year risk of relapse lower than 15%. The results confirmed the cost effectiveness when simulating a Herceptin Adjuvant Trial (HERA) -like scenario at multiway sensitivity analysis.

Conclusion

In a long-term horizon, adjuvant trastuzumab is a cost-effective therapy for patients with HER2-positive, high-risk, early breast cancer.
Double-Blinded Randomized Study of High-Dose Calcitriol Plus Docetaxel Compared With Placebo Plus Docetaxel in Androgen-Independent Prostate Cancer: A Report From the ASCENT Investigators
Authors: Beer Tomasz M. , Ryan Christopher W. , Venner Peter M. , Petrylak Daniel P. , Chatta Gurkamal S. , Ruether J. Dean , Redfern Charles H. , Fehrenbacher Louis , Saleh Mansoor N. , Waterhouse David M. , Carducci Michael A. , Vicario Daniel , Dreicer Robert , Higano Celestia S. , Ahmann Frederick R. , Chi Kim N. , Henner W. David , Arroyo Alan , Clow Fong W.
Published: February 2007

Purpose

To compare the safety and activity of DN-101, a new high-dose oral formulation of calcitriol designed for cancer therapy, and docetaxel with placebo and docetaxel.

Patients and Methods

Patients with progressive metastatic androgen-independent prostate cancer and adequate organ function received weekly docetaxel 36 mg/m2 intravenously for 3 weeks of a 4-week cycle combined with either 45 μg DN-101 or placebo taken orally 1 day before docetaxel. The primary end point was prostate-specific antigen (PSA) response within 6 months of enrollment, defined as a 50% reduction confirmed at least 4 weeks later.

Results

Two hundred fifty patients were randomly assigned. Baseline characteristics were similar in both arms. Within 6 months, PSA responses were seen in 58% in DN-101 patients and 49% in placebo patients (P = .16). Overall, PSA response rates were 63% (DN-101) and 52% (placebo), P = .07. Patients in the DN-101 group had a hazard ratio for death of 0.67 (P = .04) in a multivariate analysis that included baseline hemoglobin and performance status. Median survival has not been reached for the DN-101 arm and is estimated to be 24.5 months using the hazard ratio, compared with 16.4 months for placebo. Grade 3/4 adverse events occurred in 58% of DN-101 patients and in 70% of placebo-treated patients (P = .07). Most common grade 3/4 toxicities for DN-101 versus placebo were neutropenia (10% v 8%), fatigue (8% v 16%), infection (8% v 13%), and hyperglycemia (6% v 12%).

Conclusion

This study suggests that DN-101 treatment was associated with improved survival, but this will require confirmation because survival was not a primary end point. The addition of weekly DN-101 did not increase the toxicity of weekly docetaxel.
HOXB13-to-IL17BR Expression Ratio Is Related With Tumor Aggressiveness and Response to Tamoxifen of Recurrent Breast Cancer: A Retrospective Study
Authors: Jansen Maurice P.H.M. , Sieuwerts Anieta M. , Look Maxime P. , Ritstier Kirsten , Meijer-van Gelder Marion E. , van Staveren Iris L. , Klijn Jan G.M. , Foekens John A. , Berns Els M.J.J.
Published: February 2007

Purpose

A HOXB13-to-IL17BR expression ratio was previously identified to predict clinical outcome of breast cancer patients treated with adjuvant tamoxifen. However, this ratio may predict a tumor's response to tamoxifen, its intrinsic aggressiveness, or both.

Patients and Methods

We have measured the HOXB13 and IL17BR expression levels by real-time polymerase chain reaction in 1,252 primary breast tumor specimens. Expression levels were normalized to housekeeper gene levels and related to clinicopathologic factors for all patients. The primary objective of this study was to determine the relationship of a HOXB13-to-IL17BR ratio with tumor aggressiveness and/or with response to tamoxifen therapy in estrogen receptor (ER) -positive disease. We selected ER-positive tumors, and clinical end points for the HOXB13-to-IL17BR ratio were disease-free survival (DFS) in patients with primary breast cancer (N = 619) and progression-free survival (PFS) in patients with recurrent breast cancer treated with first-line tamoxifen monotherapy (N = 193). The odds ratio (OR) and hazard ratio (HR) and their 95% CI were calculated, and all P values were two-sided.

Results

The HOXB13-to-IL17BR ratio was significantly associated with DFS and PFS. In multivariate analysis, HOXB13-to-IL17BR ratio expression levels were associated with a shorter DFS for node-negative patients only. Corrected for traditional predictive factors, the dichotomized HOXB13-to-IL17BR ratio was the strongest predictor in multivariate analysis for a poor response to tamoxifen therapy (OR = 0.16; 95% CI, 0.06 to 0.45; P < .001) and a shorter PFS (HR = 2.97; 95% CI, 1.82 to 4.86; P < .001).

Conclusion

High HOXB13-to-IL17BR ratio expression levels associate with both tumor aggressiveness and tamoxifen therapy failure.
Alteration of Glucose Homeostasis in V1a Vasopressin Receptor-Deficient Mice
Authors: Aoyagi Toshinori , Birumachi Jun-ichi , Hiroyama Masami , Fujiwara Yoko , Sanbe Atsushi , Yamauchi Junji , Tanoue Akito
Published: February 2007

Arginine-vasopressin (AVP) is known to be involved in maintaining glucose homeostasis, and AVP-resistance is observed in poorly controlled non-insulin-dependent diabetes mellitus subjects, resulting in a lowered plasma volume. Recently we reported that V1a vasopressin receptor-deficient (V1aR−/−) mice exhibited a decreased circulating blood volume and hypermetabolism of fat accompanied with impaired insulin-signaling. Here we further investigated the roles of the AVP/V1a receptor in regulating glucose homeostasis and plasma volume using V1aR−/− mice. The plasma glucose levels at the baseline or during a glucose tolerance test were higher in V1aR−/− than wild-type (WT) mice. Moreover, a hyperinsulinemic-euglycemic clamp revealed that the glucose infusion rate was significantly lower in V1aR−/− mice than in WT mice and that hepatic glucose production was higher in V1aR−/− mice than WT mice. In contrast to the increased hepatic glucose production, the liver glycogen content was decreased in the mutant mice. These results indicated that the mutant mice had impaired glucose tolerance. Furthermore, feeding V1aR−/− mice a high-fat diet accompanied by increased calorie intake resulted in significantly overt obesity in comparison with WT mice. In addition, we found that the circulating plasma volume and aldosterone level were decreased in V1aR−/− mice, although the plasma AVP level was increased. These results suggested that the effect of AVP on water recruitment was disturbed in V1aR−/− mice. Thus, we demonstrated that one of the AVP-resistance conditions resulting from deficiency of the V1a receptor leads to decreased plasma volume as well as impaired glucose homeostasis, which can progress to obesity under conditions of increased calorie intake.