bluuebunny/crossref_metadata_2025 huggingface dataset:
Magnetic resonance imaging in suspected rectal cancer: determining tumor localization, stage, and sphincter-saving resectability at 3-Tesla-sustained high resolution
Authors: Winter L. , Bruhn H. , Langrehr J. , Neuhaus P. , Felix R. , Hänninen Lopez E.
Published: May 2007

Purpose: To assess image quality and overall accuracy of 3-Tesla (3T)-sustained high-resolution magnetic resonance (MR) imaging for diagnostic preoperative workup in suspected rectal carcinoma.

Material and Methods: Twenty-three patients with suspected rectal cancer underwent unenhanced and contrast-enhanced fat-suppressed pelvic high-resolution MR imaging using a four-channel phased-array pelvic coil at 3T. Image quality, tumor stage, distance from the anorectal margin, and sphincter-saving resectability were prospectively assessed by two blinded readers. The results were correlated with clinical, surgical, and histopathologic findings.

Results: In all 23 patients, MR images were of diagnostic quality, and malignancy was correctly identified in 21 patients. The accuracy for determining sphincter-saving resectability was 100% (19/19). T stage and N stage were correctly diagnosed in 95% and 91%, respectively. MRI allowed correct identification of tumor extension and its relation to surgically relevant pelvic structures including the anorectal margin and mesorectal fascia. Transverse T2-weighted fast spin-echo images compared superiorly to all other sequences for the diagnosis of mesorectal infiltration and lymph node involvement. Moreover, transverse fat-suppressed contrast-enhanced T1-weighted images were valuable for identifying tumor infiltration, while sagittal sections were useful for the detection of longitudinal tumor extension.

Conclusion: MR imaging with phased-array receiver coils at 3T facilitated both visualization of different pathologic conditions of the rectum and accurate determination of tumor stage in rectal carcinomas. Thus, this noninvasive diagnostic approach appeared highly suitable for the assessment of patients with suspected rectal carcinoma.
Contrast-enhanced magnetic resonance cholangiography with Gd-BOPTA and Gd-EOB-DTPA in healthy subjects
Authors: Dahlström N. , Persson A. , Albiin N. , Smedby Ö. , Brismar T. B.
Published: May 2007

Purpose: To evaluate the biliary enhancement dynamics of the two gadolinium chelates Gd-BOPTA (MultiHance®) and Gd-EOB-DTPA (Primovist®) in normal healthy subjects.

Material and Methods: Ten healthy volunteers were evaluated with both agents by magnetic resonance (MR) imaging at 1.5T using a breath-hold gradient-echo T1-weighted VIBE sequence. The relative signal intensity (SI) differences between the common hepatic duct (CHD) and liver parenchyma were measured before and 10, 20, 30, 40, 130, 240, and 300 min after contrast medium injection.

Results: Biliary enhancement was obvious 10 min post-injection for Gd-EOB-DTPA and was noted at 20 min for Gd-BOPTA. At 40 min delay, Gd-BOPTA reached its peak biliary enhancement, but at neither 30 nor 40 min delay was there any significant difference compared with that of Gd-EOB-DTPA. At later delays, the contrast between CHD and liver continued to increase for Gd-EOB-DTPA, whereas it decreased for Gd-BOPTA.

Conclusion: The earlier onset and longer duration of a high contrast between CHD and liver for Gd-EOB-DTPA facilitates examination of hepatobiliary excretion. Therefore, Gd-EOB-DTPA may provide adequate hepatobiliary imaging within a shorter time span than Gd-BOPTA and facilitate scheduling at the MR unit. Further studies in patients are required to compare the imaging advantages of Gd-EOB-DTPA and Gd-BOPTA in clinical practice.
Radiological findings and their clinical correlations in nephropathia epidemica
Authors: Paakkala A. , Mustonen J.
Published: May 2007

Nephropathia epidemica (NE) is a mild form of hemorrhagic fever with renal syndrome (HFRS). Its course varies from asymptomatic to fatal. The etiologic agent, Puumala virus, belongs to the Hantavirus genus of the Bunyaviridae family. Respiratory symptoms, from common cold to respiratory distress, occur in NE. Acute renal failure (ARF) is evident in over 90% of hospital-treated NE patients. In this review article, special attention is paid to radiological lung and renal involvement to investigate the occurrence and type of manifestations during the acute phase of infection and recovery.
Factors predicting complete necrosis rate after ultrasound-guided percutaneous laser thermoablation of small hepatocellular carcinoma tumors in cirrhotic patients: a multivariate analysis
Authors: Francica G. , Iodice G. , Delle Cave M. , Sarrantonio R. , Lapiccirella G. , Molese V. , Smeraldo D. , Scarano F. , De Marino F.
Published: May 2007

Purpose: To assess factors affecting the effectiveness of percutaneous laser ablation (PLA) under ultrasound (US) guidance in terms of complete ablation achievement.

Material and Methods: The clinical records of 86 hepatocellular carcinoma (HCC) tumors (mean diameter 23.7 mm) in 60 cirrhotic patients (mean age 68.3 years; 36 males; 57 HCV+; 53 Child's class A, seven Child's class B) treated by means of PLA were reviewed. PLA was performed with a continuous-wave Nd:YAG laser by a single operator who positioned two to four 300-µm optic fibers advanced in 21-gauge needles into target lesions under US guidance. Triphasic computed tomography (CT) studies were used to verify treatment effectiveness 1 month after PLA completion. The association between characteristics of the lesion and outcome (complete or incomplete ablation) was evaluated by logistic regression, taking into account the following predictive factors: tumor size, pattern of growth (infiltrating or not) at imaging, location, first diagnosis of HCC (naïve tumors vs. non-naïve tumors), number of sessions (1/>1), total delivered energy, and years of treatment in 2001–2002 (first period) vs. 2003–2004 (second period).

Results: Complete ablation was obtained in 62 nodules (72%). Statistically significant predictors of incomplete ablation after the first PLA course at both univariate and multivariate analysis included: infiltrating growth pattern (odds ratio (OR) 12.3, P<0.002), non-naïve tumors (OR 8.7, P<0.001), and first period of treatment (OR 10.3, P<0.002).

Conclusion: The effectiveness of US-guided PLA for HCC tumors ⩽4 cm turned out to be negatively affected by both operator-related (the beginning of the operator's experience with the technique) and tumor-related factors (non-naïve, infiltrating HCC tumors).
Magnetic resonance elastography of brain tumors: preliminary results
Authors: Xu L. , Lin Y. , Han J. C. , Xi Z. N. , Shen H. , Gao P. Y.
Published: May 2007

Purpose: To investigate the potential value of magnetic resonance elastography (MRE) in evaluating the consistency of brain tumors.

Material and Methods: Six patients with known solid brain tumor underwent brain MRE studies. Consistency of brain tumors was evaluated at surgery. Correspondence of MRE evaluation with operative result was studied.

Results: The elasticity of tumors in six patients evaluated by MRE agreed with the tumor consistency given by the operative results.

Conclusion: MRE could be used as an imaging technique for noninvasive assessment of the consistency of brain tumor in vivo.
Diffusion-weighted magnetic resonance imaging in rhombencephalitis due to listeria monocytogenes
Authors: Hatipoglu H. G. , Onbasioglu Gurbuz M. , Sakman B. , Yuksel E.
Published: May 2007

We present diffusion-weighted imaging findings of a case of rhombencephalitis due to Listeria monocytogenes. It is a rare, life-threatening disorder. The diagnosis is difficult by clinical findings only. In this report, we aim to draw attention to the role of conventional and diffusion-weighted magnetic resonance imaging findings. To our knowledge, this is the first case report in the literature with apparent diffusion coefficient values of diseased brain parenchyma.
Bilateral severe mammary duct ectasia
Authors: Hari S. , Kumar J. , Kumar A. , Chumber S.
Published: May 2007

We present the imaging findings of severe bilateral mammary duct ectasia in a postmenopausal woman. Mammographic, ultrasonographic, and magnetic resonance findings are described. Needle biopsy was used to confirm the diagnosis. Etiology, clinical significance, and management strategies for this lesion are discussed.
Regionally specific compensation for bone loss in the tibial trabeculae of estrogen-deficient rats
Authors: Sheng Z. F. , Dai R. C. , Wu X. P. , Fang L. N. , Fan H. J. , Liao E. Y.
Published: May 2007

Background: Bone mineral density (BMD) and microstructural variations have been extensively investigated in recent years; however, the compensation for bone loss between different regions is still unclear.

Purpose: To fully characterize regional variations in bone mineral density (BMD) as well as the microstructure and dynamic changes of rat tibial trabeculae that occur with bone loss associated with estrogen deficiency.

Material and Methods: Female Sprague-Dawley rats were ovariectomized (OVX), sham-operated (sham), or left unoperated (baseline control). The left tibiae were harvested at baseline, and at postoperative weeks 3 and 15. High-resolution micro-computed tomography (µCT) was used to identify the densitometric and microstructural properties of trabeculae in the proximal ends of the rat tibia, specifically the epiphysis and metaphysis.

Results: Volumetric BMDs at the organ (organ BMD) and tissue (tissue BMD) levels were significantly higher for trabeculae at the epiphysis than metaphysis. Moreover, trabeculae at the epiphysis were thicker, and fewer in number and connectivity than those at the metaphysis, which were more rod like. Trabeculae at the metaphysis were more susceptible to bone loss induced by estrogen deprivation than at the epiphysis, and the regions varied greatly in their adaptation to this loss. At the metaphysis, trabecular tissue BMD and thickness were unexpectedly higher at postoperative week 15 than week 3 or baseline. In contrast, at the epiphysis, tissue BMD did not change with time, but trabecular thickness significantly increased at week 15 compared to baseline and was also greater in OVX compared to sham rats.

Conclusion: Metaphyseal and epiphyseal trabeculae show regionally specific variations in BMD and microstructure. The former are more susceptible to bone loss induced by estrogen deficiency and would be strengthened by either hypertrophy or hypermineralization, while epiphyseal trabeculae are mainly strengthened by thickening.
Contrast-enhanced FDG-PET/CT vs. spio-enhanced MRI vs. FDG-PET vs. CT in patients with liver metastases from colorectal cancer: a prospective study with intraoperative confirmation
Authors: Rappeport E. D. , Loft A. , Berthelsen A. K. , von der Recke P. , Noergaard Larsen P. , Mellon Mogensen A. , Wettergren A. , Rasmussen A. , Hillingsoe J. , Kirkegaard P. , Thomsen C.
Published: May 2007

Background: The choice of imaging before liver surgery is debated regarding the use of magnetic resonance (MR) imaging, computed tomography (CT), and positron emission tomography (PET). No studies have compared contrast-enhanced PET/CT with superparamagnetic iron oxide (SPIO)-enhanced MR imaging.

Purpose: To compare PET/CT with superparamagnetic iron oxide (SPIO)-enhanced MR imaging, PET, and CT in the detection of liver metastases (LM) and extrahepatic tumor from colorectal cancer (CRC).

Material and Methods: Thirty-five patients with suspected LM underwent PET/CT with a contrast-enhanced CT protocol and SPIO-enhanced MR imaging. Readers independently analyzed images from MR imaging, PET/CT, and the CT part and PET part of the PET/CT study. Imaging findings were compared with surgical and histological findings.

Results: Lesion-by-lesion sensitivity and accuracy for liver lesions was 54% and 77% for PET alone, 66% and 83% for PET/CT, 82% and 82% for SPIO-enhanced MR imaging, and 89% and 77% for CT alone, respectively. CT and SPIO-enhanced MR imaging were less specific but significantly more sensitive than PET ( P<0.0001). For extrahepatic tumor, sensitivity and specificity was 83% and 96% for PET/CT and 58% and 87% for CT, respectively.

Conclusion: CT and SPIO-enhanced MR imaging are more sensitive but less specific than PET in the detection of LM. PET/CT can detect more patients with extrahepatic tumor than CT alone.
Thin-section diffusion-weighted magnetic resonance imaging of the brain with parallel imaging
Authors: Oner A. Y. , Celik H. , Tali T. , Akpek S. , Tokgoz N.
Published: May 2007

Background: Thin-section diffusion-weighted imaging (DWI) is known to improve lesion detectability, with long imaging time as a drawback. Parallel imaging (PI) is a technique that takes advantage of spatial sensitivity information inherent in an array of multiple-receiver surface coils to partially replace time-consuming spatial encoding and reduce imaging time.

Purpose: To prospectively evaluate a 3-mm-thin-section DWI technique combined with PI by means of qualitative and quantitative measurements.

Material and Methods: 30 patients underwent conventional echo-planar (EPI) DWI (5-mm section thickness, 1-mm intersection gap) without parallel imaging, and thin-section EPI-DWI with PI (3-mm section thickness, 0-mm intersection gap) for a b value of 1000 s/mm2, with an imaging time of 40 and 80 s, respectively. Signal-to-noise ratio (SNR), relative signal intensity (rSI), and apparent diffusion coefficient (ADC) values were measured over a lesion-free cerebral region on both series by two radiologists. A quality score was assigned for each set of images to assess the image quality. When a brain lesion was present, contrast-to-noise ratio (CNR) and corresponding ADC were also measured. Student t-tests were used for statistical analysis.

Results: Mean SNR values of the normal brain were 33.61±4.35 and 32.98±7.19 for conventional and thin-slice DWI ( P>0.05), respectively. Relative signal intensities were significantly higher on thin-section DWI ( P<0.05). Mean ADCs of the brain obtained by both techniques were comparable ( P>0.05). Quality scores and overall lesion CNR were found to be higher in thin-section DWI with parallel imaging.

Conclusion: A thin-section technique combined with PI improves rSI, CNR, and image quality without compromising SNR and ADC measurements in an acceptable imaging time.
Neural mechanism of cognitive control impairment in patients with hepatic cirrhosis: a functional magnetic resonance imaging study
Authors: Zhang Long Jiang , Yang Guifen , Yin Jianzhong , Liu Yawu , Qi Ji
Published: May 2007

Background: Many studies have claimed the existence of attention alterations in cirrhotic patients without overt hepatic encephalopathy (HE). No functional magnetic resonance imaging (fMRI) study in this respect has been published.

Purpose: To investigate the neural basis of cognitive control deficiency in cirrhotic patients using fMRI.

Material and Methods: 14 patients with hepatic cirrhosis and 14 healthy volunteers were included in the study. A modified Stroop task with Chinese characters was used as the target stimulus, and block-design fMRI was used to acquire resource data, including four stimulus blocks and five control blocks, each presented alternatively. Image analysis was performed using statistical parametric mapping 99. After fMRI examinations were complete, behavior tests of Stroop interference were performed for all subjects. Overall reaction time and error numbers were recorded.

Results: Both healthy volunteers and patients with hepatic cirrhosis had Stroop interference effects. Patients with hepatic cirrhosis had more errors and longer reaction time in performing an incongruous color-naming task than healthy volunteers ( P<0.001); there was no significant difference in performing an incongruous word-reading task ( P = 0.066). Compared with controls, patients with hepatic cirrhosis had greater activation of the bilateral prefrontal cortex and parietal cortex when performing the incongruous word-reading task. With increased conflict, activation of the anterior cingulate cortex (ACC), bilateral prefrontal cortex (PFC), parietal lobe, and temporal fusiform gyrus (TFG) was decreased when patients with hepatic cirrhosis performed the incongruous color-naming task.

Conclusion: This study demonstrates that patients with hepatic cirrhostic have cognitive control deficiency. The abnormal brain network of the ACC–PFC–parietal lobe–TFG is the neural basis of cognitive control impairment in cirrhotic patients.
Magnetic resonance imaging findings in diffuse lymphangiomatosis: neuroradiological manifestations
Authors: Ozturk A. , Yousem D. M.
Published: May 2007

We report magnetic resonance (MR) findings in a patient with histologically proven lymphangiomatosis with a history of chylothorax, diffuse lung infiltrates, spinal involvement, cystic lesions of the mediastinum, and mesentery thickening. The patient also had diffuse infiltration of the right brachial plexus, with similar imaging findings as the spinal lesions. Although osseous and extraosseous involvement may be seen frequently with lymphangiomatosis, involvement of the brachial plexus has not been previously reported.
Changing Concepts of Articulation: Political Stakes in South Africa Today
Authors: Hart Gillian
Published: May 2007

Intense struggles are currently underway within and between the African National Congress and its Alliance partners. In an effort to make sense of these struggles, this essay revisits earlier South African debates over race, class, and the national democratic revolution. Its focus is on multiple and changing concepts of articulation and their political stakes. The first part of the essay traces important shifts in the concept in Harold Wolpe's work, relating these shifts to struggles and conditions at the time, as well as to conceptual developments by Stuart Hall in a broader debate with Laclau's work on populism, and with Laclau and Mouffe who take the concept in a problematic post-marxist direction. I then put a specifically Gramscian concept of articulation to work to explore how the ruling bloc in the ANC has articulated shared meanings and memories of struggles for national liberation to its hegemonic project – and how a popular sense of betrayal is playing into support for Jacob Zuma.
The Radicalised State: Zimbabwe's Interrupted Revolution
Authors: Moyo Sam , Yeros Paris
Published: May 2007

This article conceptualises the revolutionary situation that gripped Zimbabwe from the late 1990s. That was the moment in which the two political questions that historically have galvanized peripheral capitalism – the agrarian and the national – were returned to the forefront of political life. We argue that the revolutionary situation resulted neither in a revolution, nor in mediocre reformism, nor in restoration. It resulted in an interrupted revolution, marked by a radical agrarian reform and a radicalised state – the first on the continent since the end of the Cold War.
The South African Communist Party (SACP) in the Post–apartheid Period
Authors: Thomas David
                      P.
Published: May 2007

This article examines the SACP and its role in contesting the hegemonic project of neoliberalism in the post-apartheid period (1994-2004). I discuss the Party's written attacks on neoliberalism, support for the Congress of South African Trade Union's (Cosatu's) campaigns against privatisation, the formation of the Young Communist League (YCL), and the current campaigns surrounding cooperatives and financial sector reform. As the SACP is embedded within the ruling African National Congress (ANC), the Party's attempts to critique and fight neoliberalism have remained rhetorical and ineffective. Rather than directly confronting the neoliberal policies of the ANC, the SACP has instead cooperated with the ANC, hoping to pull it more to the ‘left’. The SACP's dedication to influencing the ANC has come at the expense of building a mass base of support that opposes neoliberalism. This approach has ultimately resulted in an accommodation to neoliberalism, and exposes many difficult contradictions for the SACP.
The Making of Liberia
Authors: Posthumus Bram
Published: May 2007

BIBLE IN HAND, THE AMERICAN COLONISERS PROMISED A HOME FIT FOR FREED SLAVES — AND CREATED A WILDERNESS
Don't Call It Slavery
Authors: Arvanitidis Barbara
Published: May 2007

ETHICAL DILEMMAS AND OBFUSCATION AS A FILM CREW TRIES TO RECORD THE REALITY OF CHILD SLAVERY TODAY
Pipe Dream or Necessary Atonement?
Authors: Gifford Anthony
Published: May 2007

IF THE TRANSATLANTIC SLAVE TRADE WAS A CRIME AGAINST HUMANITY, IT WAS A CRIME IN INTERNATIONAL LAW AND A SUITABLE CASE FOR REPARATIONS
The Edge of the Volcano
Authors: Maryniak Irena
Published: May 2007

TRAFFICKING IN FORCED LABOUR GENERATES UP TO US$15.5 BILLION IN THE INDUSTRIALISED WORLD. IT ATTRACTS LITTLE ATTENTION AND IS WIDESPREAD IN EUROPE
Mind Forged Manacles
Authors: Say Mitchell Dreda
Published: May 2007

POOR ACHIEVEMENT, LOW EXPECTATIONS AND BAD PUPIL-TEACHER RELATIONSHIPS REFLECT ATTITUDES MUCH OLDER THAN THE LIBERAL SMALL-TALK IN GOVERNMENT REPORTS
Shooting Black Britain
Authors: Karamath Joel
Published: May 2007

WHATEVER HAPPENED TO BLACK BRITISH CINEMA? WITH FEW EXCEPTIONS, IT REMAINS A MINORITY PURSUIT, DOGGED BY THE LACK OF A VIABLE DOMESTIC AUDIENCE AND SWEPT AWAY IN THE HOLLYWOOD SLIPSTREAM
A Road To Be Travelled
Authors: Sealy Mark
Published: May 2007

CELEBRATIONS PLANNED TO COMMEMORATE THE ABOLITION OF THE SLAVE TRADE 200 YEARS AGO WILL DO LITTLE TO HIGHLIGHT THE GLOBAL GROWTH OF THE TRADE TODAY
The Tyranny of Moderation
Authors: Kamm Oliver
Published: May 2007

RESPECT AND CIVILITY ARE THE ENEMIES OF FREE SPEECH — YOU CAN’T LEGISLATE FOR PEOPLE’S FEELINGS
Rules of the Game
Authors: Shleinov Roman , Maryniak Irena
Published: May 2007

IF YOU’RE A RUSSIAN JOURNALIST, IT’S NOT CRITICISING THE KREMLIN THAT WILL GET YOU INTO TROUBLE — BUT CHALLENGING AND EXPOSING THE SYSTEM
The Prince and the Paper
Authors: Wright Peter
Published: May 2007

THE MAIL ON SUNDAY’S BATTLE TO PUBLISH PRINCE CHARLES’S JOURNALS IS A STAND FOR PRESS FREEDOM
Redefining Terror
Authors: Lester Anthony
Published: May 2007

NEW SPEECH CRIMES BROADEN THE MEANING OF TERRORISM AND ARE A THREAT TO FREE EXPRESSION
Secrets and Sources
Authors: Bright Martin
Published: May 2007

WHITEHALL LEAKS ARE A BOON FOR JOURNALISTS, AN EMBARRASSMENT FOR GOVERNMENT — WHISTLEBLOWERS REMAIN UNPROTECTED IN A NEW PUSH FOR SECRECY
Public Nuisance
Authors: Leigh David
Published: May 2007

ATTEMPTS TO NEUTER THE FREEDOM OF INFORMATION ACT BETRAY WHITEHALL’S RESISTANCE TO OUR RIGHT TO KNOW
‘But now I feel I want to give it a try’: formative assessment, self‐esteem and a sense of competence
Authors: Miller David , Lavin Fiona
Published: May 2007

It is accepted that formative assessment can lead to gains in attainment. Although claims have also been made that these techniques bring benefits in terms of self‐esteem and motivation, the evidence here is limited. This article reports an exploratory study which focused on formative assessment techniques and primary children's views of themselves as individuals and learners; 370 upper‐primary school children (aged 10–12 years) and sixteen teachers participated in the study. The teachers employed a range of formative assessment techniques in the course of their day‐to‐day teaching. Employing triangulation of data and methodology, information was gathered via standardized questionnaires, individual interviews and group discussions. There was a degree of consistency in the findings from different sources, indicating improvements in children's self‐perceptions in several areas. Gains were seen in self‐esteem and in beliefs about competence. Differences were found in relation to gender, ability groups and in those who lacked confidence in their ability. The data suggest that the benefits in terms of self‐perception may not be seen in the short term, but are more likely to be evidenced after a longer period of employing formative assessment. Information from small‐group discussions with children and interviews conducted with class teachers provided further insights as to the processes at work.
Educational reform and primary and secondary teachers' conceptions of assessment: the Spanish instance, building upon Black and Wiliam (2005)
Authors: Remesal Ana
Published: May 2007

The author intends to add one particular national point of view to a previous comparative reflection done by Black and Wiliam (2005), whose thesis is the need to study particular cases before making general proposals addressing the implementation of formative assessment practices. Teachers' conceptions about assessment are considered to be one important factor of pedagogical reform in classrooms. The structure of the educational system is recognized as another important element to be looked at. Fifty teachers from Barcelona city and the surrounding area were interviewed, thirty from primary schools and twenty from secondary schools. Additionally, classroom material which the teachers felt to be significantly representative of their daily assessment practices was demanded from them. A qualitative content analysis allowed the author to define five conceptions about assessment along one continuum, containing four different dimensions. Results reveal important differences between primary and secondary teachers as to their conceptions of assessment, which the author links to the structural changes of the national educational system back in the early 1990s. These differences should be taken into account if significant changes towards a generalization of formative assessment are expected to happen.
A problem‐based learning model: showcasing an educational paradigm shift
Authors: Kumar Muthu , Natarajan Uma
Published: May 2007

This article examines the components of a theoretical problem‐based learning framework adopted by a reform‐minded tertiary institution in Singapore in order to shift away from traditional models of didactic instruction. The goals of this framework are to enhance the ways in which students think and augment knowledge building within authentic problem‐solving contexts. Students' reflections of their experiences in operating within the problem‐based learning environment are descriptively analysed to draw insights into the pedagogical implications of this framework. Both the underlying strengths and shortcomings of this innovative framework as perceived by students are documented to better understand the potential value of implementation of a problem‐based learning paradigm.
Increasing socioeconomic inequalities in male cirrhosis of the liver mortality: Australia 1981–2002
Authors: NAJMAN JAKE M. , WILLIAMS GAIL M. , ROOM ROBIN
Published: May 2007

Liver cirrhosis mortality is an indicator of harms associated with high levels of alcohol consumption. There is good evidence that changes in political and economic systems can lead to changing patterns of liver cirrhosis mortality. Socioeconomic inequalities in liver cirrhosis mortality have been periodically reported but there are few studies of changes in socioeconomic inequalities in liver cirrhosis mortality over time. This paper examines changes in socioeconomic inequalities in liver cirrhosis mortality in Australia for the period 1981–2002. Age standardised, liver cirrhosis mortality rates were calculated for occupational groupings for Australia 1981–2002. Occupations were grouped into non‐manual and manual categories, and there was imputation for missing data. Despite decreasing overall liver cirrhosis mortality rates over time, liver cirrhosis mortality continues to account for about 3% of all deaths. Manual workers have consistently experienced liver cirrhosis mortality rates which are twice or more the rate experienced by non‐manual workers. These inequalities appear to have increased in recent years and currently appear to be at historic highs (manual workers have mortality rates of about 2.5 times those of non‐manual workers). Increasing socioeconomic inequalities in liver cirrhosis mortality in Australia suggest that lower SES groups have, over time, increased their level of harmful alcohol consumption relative to middle and higher SES groups. It is suggested that this might be attributed to a relative improvement in the affordability of alcohol over time.
Clinical supervision in the alcohol and other drugs field: an imperative or an option?
Authors: ROCHE ANN M. , TODD CHELSEA L. , O'CONNOR JOHN
Published: May 2007

There is a growing interest in Clinical Supervision (CS) as a central workforce development (WFD) strategy. This paper provides a definition of and rationale for CS, characterises its various forms, identifies selection and training issues, and advises on policy and implementation issues central to redressing shortcomings in supervision practice within the alcohol and other drugs (AOD) field. Relevant selective literature is reviewed. Key conceptual issues were identified, and strategies developed to address implementation barriers and facilitate relevant policy. There is a common conceptual confusion between administrative supervision and CS. Clarification of the role, function and implementation of CS is required. Priority issues for the AOD field include: enhancing belief in CS; ensuring adequate resource allocation; developing evaluation protocols; and addressing specific arrangements under which supervision should occur. CS has been underutilised to date but holds considerable potential as a WFD strategy. It is fundamental to workers' professional development, can contribute to worker satisfaction and retention, and may improve client outcomes. Critical next steps are to establish the generalisability to the AOD field of the benefits observed from CS in other disciplines, and evaluate longer‐term gains of CS programs.
Overview of Psychiatric Ethics I: Professional Ethics and Psychiatry
Authors: Robertson Michael , Walter Garry
Published: May 2007

Objective: The aim of this paper is to describe the current status of psychiatric ethics as a form of professional ethics and apply this approach to a common clinical situation.

Conclusion: Psychiatry is a profession and, like all professions, comprises a set of specific skills and knowledge that are applied for the ‘common good’ of society. Such a proposition places the psychiatrist in a position of tension between contractarian and Hippocratic ideals of ethical conduct, in that there is an assumption of moral equivalence between the law and ethics. The supposition that legally defensible behaviours are the same as ethically defensible behaviours is integral to the definition of professional ethics. This frequently places psychiatrists at odds with the ‘do no harm’ principle.
Involving Carers in Mental Health Service Development
Authors: Hayman Faye , Fahey Anne
Published: May 2007

Objective: A project designed to enhance carer participation in a mental health service is described.

Method: Carers of people with a mental illness were involved in reviewing and developing policies, and developing a carer rights and responsibilities booklet.

Results: Policies relevant to carers of people with a mental illness were reviewed and updated, and new policies developed to cover existing gaps. Carer and staff awareness of policies was increased. A carer rights and responsibilities booklet was developed.

Conclusions: Involving carers at this level of service development enhances carer awareness and understanding of the processes involved in a mental health service, and improves staff understanding of carer issues and viewpoints. This process is valuable for mental health services, resulting in positive outcomes.
Consumer Participation in Mental Health Research: Articulating a Model to Guide Practice
Authors: Happell Brenda , Roper Cath
Published: May 2007

Objective: Consumer involvement in mental health research is considered both a right and a benefit, despite the identified barriers to forming effective collaborative relationships. The purpose of this paper is to examine the literature relating to consumer involvement in mental health research with a view to articulating a model to guide this process.

Method: A qualitative review of the relevant literature was undertaken. Literature referring to consumer roles in research was accessed and reviewed with the aim of articulating the benefits of, and barriers to, consumer participation in research.

Results: The literature has identified a number of important benefits and some significant barriers to consumer involvement in mental health research. However, a clear model to articulate definitions of involvement is lacking. Four distinct levels of involvement were articulated.

Conclusions: The identification of clearly defined models for consumer involvement in mental health research is important in order to facilitate collaboration and avoid tokenism. Research is required in order to determine the applicability of these models within actual research projects.
Irving Fisher and Financial Economics: The Equity Premium Puzzle, the Predictability of Stock Prices, and Intertemporal Allocation Under Risk
Authors: Dimand Robert W.
Published: May 2007

Irving Fisher is renowned as the pundit who declared in October 1929 that stock prices appeared to have reached a permanently high plateau and who, having amassed a net worth of ten million dollars in the boom of the 1920s, proceeded to lose eleven million dollars of that fortune in the crash, which, as John Kenneth Galbraith (1977, p. 192) remarked, “was a substantial sum, even for an economics professor.” Along with the Dow-Jones index, Fisher's reputation for understanding financial markets declined relative to that of Roger Babson, the stock forecaster, amateur economist, and founder of Babson College, who presciently predicted the stock market crash of autumn 1929 (and, with less prescience, the stock market crashes of 1926, 1927, and 1928, and the stock market recovery of 1930). An editorial inThe Commercial and Financial Chronicle(November 9, 1929) declared of Fisher: “The learned professor is wrong as he usually is when he talks about the stock market” (quoted by Galbraith 1972, p. 151).
Substance Use among ADHD Adults: Implications of Late Onset and Subthreshold Diagnoses
Authors: Faraone Stephen V. , Wilens Timothy E. , Petty Carter , Antshel Kevin , Spencer Thomas , Biederman Joseph
Published: May 2007

Diagnosing ADHD in adults is difficult when the diagnostician cannot establish an onset prior to the DSM‐IV criterion of age seven or if the number of symptoms does not achieve the DSM threshold for diagnosis. These diagnostic issues are an even larger concern for clinicians faced with adults with substance use disorders (SUD). The present study compared four groups of adults: full ADHD subjects who met all DSM‐IV criteria for childhood onset ADHD, late onset ADHD subjects who met all criteria except the age at onset criterion, subthreshold ADHD subjects who did not meet full symptom criteria, and non‐ADHD subjects who did not meet any of the above criteria. Diagnoses were by the Structured Clinical Interview for DSM‐IV, and the Drug Use Severity Index (DUSI) was used for self‐report of substance use. Cigarette and marijuana use was significantly greater in all ADHD groups relative to non‐ADHD controls. Although usage rates of other drugs failed to reach significance, the ADHD groups were more likely to have used each drug (except alcohol) compared with the non‐ADHD group. The late onset and full ADHD groups were more likely to have endorsed ever having a problem due to use of cigarettes, alcohol, or marijuana and reported more trouble resisting use of drugs or alcohol. The full ADHD group was more likely than the other groups to have reported “getting high” as their reason for using their preferred drug. Adults with ADHD have elevated rates of substance use and related impairment. Data about late onset ADHD provides further support for the idea that the DSM‐IV age at onset criterion is too stringent. In contrast, subthreshold ADHD seems to be a milder form of the disorder, or perhaps a heterogeneous group of true ADHD cases and false positives.
The Relationship of Self‐Esteem and Self‐Efficacy to Treatment Outcomes of Alcohol‐Dependent Men and Women
Authors: Trucco Elisa M. , Connery Hilary Smith , Griffin Margaret L. , Greenfield Shelly F.
Published: May 2007

This study investigates whether self‐esteem is associated with clinical and demographic characteristics, self‐efficacy expectancies, and post‐treatment drinking outcomes. Forty‐one (40.6%) women and 60 (59.4%) men were recruited during inpatient alcohol dependence treatment. At baseline, lower self‐esteem was significantly associated with current depression and other psychiatric disorders. Self‐esteem was not related to gender, relapse, other one‐year drinking outcomes, or self‐efficacy. Age and psychiatric disorders were strong predictors of self‐esteem at follow‐up. This study suggests that different perceptions of the self have unique roles in recovery from alcohol use disorders.
Sexual Abuse and the Outcome of Addiction Treatment
Authors: Charney Dara A. , Palacios‐Boix Jorge , Gill Kathryn J.
Published: May 2007

The objective of this prospective follow‐up study was to examine the effects of sexual abuse on substance use disorder patients' clinical presentation and course in treatment. Consecutive admissions to the MUHC's Addictions Unit were assessed at intake (N = 206) and six‐month follow‐up (n = 172). Assessments evaluated socio‐demographic and psychiatric characteristics, addiction severity, and physical and/or sexual abuse histories. Upon entering treatment, 23% reported prior sexual abuse with or without physical abuse. Patients with a sexual abuse history had higher rates of psychological problems, stronger family histories of substance use disorders, and more impaired family relationships. At six months, there were no differences between patients with and without sexual abuse histories in their response to treatment, or their utilization of treatment services. The current study failed to show that prior sexual abuse compromised short‐term treatment outcomes.
Correlates of Severity of Smoking Among Persons with Severe Mental Illness
Authors: Dixon Lisa , Medoff Deborah R. , Wohlheiter Karen , DiClemente Carlo , Goldberg Richard , Kreyenbuhl Julie , Adams Curtis , Lucksted Alicia , Davin Colleen
Published: May 2007

Individuals with schizophrenia and severe mental illness smoke cigarettes at rates that well exceed the general population. Little is known about the correlates and sequelae of increased smoking severity on persons with severe mental illness. A total of 304 smokers from six community mental health centers were assessed for smoking history, psychiatric symptoms, co‐occurring disorders, subjective quality of life, and expired carbon monoxide (CO). Statistical analyses identified correlates of smoking severity, as assessed by number of cigarettes smoked per week. The average number of cigarettes smoked per week was 136±83. Increased smoking was associated with higher levels of expired CO and being Caucasian, and with a greater likelihood of a current diagnosis of hypertension and oral/gum disease. Greater smoking severity was also associated with greater perceived stress, poorer overall subjective quality of life, and lower satisfaction with finances, health, leisure activities, and social relationships. This study confirms high rates of heavy smoking among persons with severe mental illness. The association of increased quantity of cigarettes smoked with being Caucasian is consistent with previous reports in mentally ill and non‐mentally ill populations. The linkage of heavy smoking with poorer quality of life and co‐occurring medical disorders suggests the importance of smoking reduction and cessation strategies to reduce smoking and decrease patients' total pack years of smoking.
High Abstinence Rates in Heroin Addicts by a New Comprehensive Treatment Approach
Authors: De Jong Cor A.J. , Roozen Hendrik G. , Van Rossum Leo G.M. , Krabbe Paul F.M. , Kerkhof Ad J.F.M.
Published: May 2007

In this multi‐center, naturalistic study, the effectiveness of naltrexone maintenance combined with the Community Reinforcement Approach (CRA) was investigated in detoxified, opioid‐dependent patients (N = 272). Patients were recruited from methadone maintenance programs. With intention‐to‐treat analysis, 10 months of treatment yielded abstinence rates of 28% and 32% at 10 and 16 months after detoxification. The cumulative abstinence rate at 16 months was 24%. Quality of life, craving, general psychopathology, use of other psychoactive substances, and addiction severity of the abstinent group significantly improved when compared to the relapsed group. This abstinence‐oriented approach appears to be a feasible goal, and remains an important option next to long‐term methadone maintenance in the management of opioid dependence.
Stepped Care for Mandated College Students: A Pilot Study
Authors: Borsari Brian , Tevyaw Tracy O'Leary , Barnett Nancy P. , Kahler Christopher W. , Monti Peter M.
Published: May 2007

In the past decade, colleges and universities have seen a large increase in the number of students referred for the violation of alcohol policies. Stepped care assigns individuals to different levels of care according to treatment response, thereby maximizing efficiency. This pilot study implemented stepped care with students mandated to attend an alcohol program at a private northeastern university. High retention rates and participant satisfaction ratings suggest the promise of implementing stepped care with this population. Considerations for future applications of stepped care with mandated students are discussed.
Noninvasive Measure of Microvascular Nitric Oxide Function in Humans Using Very Low‐Frequency Cutaneous Laser Doppler Flow Spectra
Authors: Stewart Julian M. , Taneja Indu , Goligorsky Michael S. , Medow Marvin S.
Published: May 2007

ABSTRACT

Objective: While higher frequency oscillations (0.021–0.6 Hz) in cutaneous blood flow measured by laser Doppler flowmetry (LDF) relate to oscillations in blood pressure and sympathetic nerve activity, very low‐frequency oscillations (VLF, 0.0095–0.021 Hz) do not. The authors investigated whether VLF LDF power is nitric oxide (NO) specific.

Methods: LDF combined with intradermal microdialysis was used in the calves of 22 healthy volunteers aged 19–27 years. LDF power spectral analysis was performed by windowed fast Fourier transform. The authors tested whether the NO synthesis inhibitor nitro‐l‐arginine (NLA) produced selective decreases in VLF power before and after stimulation with acetylcholine.

Results: NLA alone did not alter total power but selectively reduced VLF power by approximately 50%. LDF and spectral power increased markedly across all spectra with acetylcholine. This increase was blunted by NLA, which selectively reduced VLF power by approximately 50%. Conclusions: The data suggest that VLF oscillations in the laser Doppler signal are NO dependent, increase with cholinergic stimulation, and have potential as a noninvasive marker for NO‐dependent microvascular reactivity.
Computational Network Model Prediction of Hemodynamic Alterations Due to Arteriolar Remodeling in Interval Sprint Trained Skeletal Muscle
Authors: Binder Kyle W. , Murfee Walter L. , Song Ji , Laughlin M. Harold , Price Richard J.
Published: May 2007

ABSTRACT

Objectives: Exercise training is known to enhance skeletal muscle blood flow capacity, with high‐intensity interval sprint training (IST) primarily affecting muscles with a high proportion of fast twitch glycolytic fibers. The objective of this study was to determine the relative contributions of new arteriole formation and lumenal arteriolar remodeling to enhanced flow capacity and the impact of these adaptations on local microvascular hemodynamics deep within the muscle.

Methods: The authors studied arteriolar adaptation in the white/mixed‐fiber portion of gastrocnemius muscles of IST (6 bouts of running/day; 2.5 min/bout; 60 m/min speed; 15% grade; 4.5 min rest between bouts; 5 training days/wk; 10 wks total) and sedentary (SED) control rats using whole‐muscle Microfil casts. Dimensional and topological data were then used to construct a series of computational hemodynamic network models that incorporated physiological red blood cell distributions and hematocrit and diameter dependent apparent viscosities.

Results: In comparison to SED controls, IST elicited a significant increase in arterioles/order in the 3A through 6A generations. Predicted IST and SED flows through the 2A generation agreed closely with in vivo measurements made in a previous study, illustrating the accuracy of the model. IST shifted the bulk of the pressure drop across the network from the 3As to the 4As and 5As, and flow capacity increased from 0.7 mL/min in SED to 1.5 mL/min in IST when a driving pressure of 80 mmHg was applied.

Conclusions: The primary adaptation to IST is an increase in arterioles in the 3A through 6A generations, which, in turn, creates an approximate doubling of flow capacity and a deeper penetration of high pressure into the arteriolar network.
An Imaging Spectroscopy Approach for Measurement of Oxygen Saturation and Hematocrit During Intravital Microscopy
Authors: Styp‐Rekowska B. , Disassa N. Mecha , Reglin B. , Ulm L. , Kuppe H. , Secomb T. W. , Pries A. R.
Published: May 2007

ABSTRACT

Objective: Oxygen supply and partial pressure are key determinants of tissue metabolic status and are also regulators of vascular function including production of reactive oxygen species, vascular remodeling, and angiogenesis. The objective of this study was to develop an approach for the determination of oxygen saturation and hematocrit for individual microvessels in trans‐ and epi‐illumination intravital microscopy.

Methods: A spectral approach was used, taking advantage of the availability of commercial imaging systems that allow digital recording of intravital images at a number of predetermined wavelengths within a relatively short time. The dependence of validity and precision of saturation measurements on critical experimental variables (reference spectra, number and selection of wavelengths, exposure time, analysis area, analysis model) was evaluated. In addition, a software approach for two‐dimensional analysis of images was developed.

Results: Exposure times per wavelength of about 200 ms and use of up to 50 wavelengths evenly spaced from 500 to 598 nm allow automatic discrimination of microvessels from tissue background (segmentation) with reliable determination of oxygen saturation (in trans‐ and epi‐illumination) and hematocrit (in transillumination).

Conclusions: The present imaging spectroscopy approach allows detailed assessment of oxygen transport and other functional parameters at the microcirculatory level.