bluuebunny/crossref_metadata_2025 huggingface dataset:
Karyomegaly of tubular kidney cells in human chronic interstitial nephropathy in Tunisia: respective role of Ochratoxin a and possible genetic predisposition
Authors: Hassen Wafa , Abid-Essafi Salwa , Achour Abdellatif , Guezzah Noureddine , Zakhama Abdelfettah , Ellouz Farielle , Creppy Edmond E , Bacha Hassen
Published: July 2004

Karyomegalic nephropathy associated to bizarre enlargement of nuclei in renal tubular epithelial cells was first described by Mihatch in 1979. We present herein additional cases occurring in three siblings suffering from chronic interstitial nephropathy (CIN) of unknown aetiology where the renal biopsies showed numerous enlarged and hyperchromatic nuclei. CIN of unknown aetiology has been previously characterized and showed striking similarities with Balkan Endemic Nephropathy (BEN).

Ochratoxin A (OTA) is a nephrotoxic mycotoxin suspected to be the causal agent of the BEN as well as the Tunisian CIN of unknown aetiology. OTA is incriminated in the onset of these disclosed cases of karyomegalic nephropathy since high OTA concentrations were found in blood (505.83 ng/ml, 102.63 ng/ml and 1023 ng/ml) and in urine (94.40 ng/ml and 10.18 ng/ml) of two of them. Moreover, we have investigated OTA in blood and urine as well as in food samples of the entire household (21 people). Our findings suggest (i) a link between OTA and the outcome of this karyomegalic nephropathy, and (ii) the possible involvement of a genetic factor since the three cases have the same haplotype B27/35.
Arsenic trioxide poisoning: a description of two acute overdoses
Authors: Isbister Geoffrey K , Dawson Andrew H , Whyte Ian M
Published: July 2004

Arsenic is a traditional poison that has a history extending back into ancient times, as a medicinal agent, a homicidal poison and more recently in deliberate and unintentional self-poisoning. We report two cases of acute poisoning with an unwettable formulation of arsenic trioxide. Both patients had early gastrointestinal toxicity and were treated with early whole bowel irrigation (WBI). Chelation therapy with dimercaptosuccinic acid (dimercaptosuccinate, DMSA) was commenced within 24 hours and serial blood and urine arsenic concentrations were measured. Neither patient suffered any adverse outcome in spite of very high blood and urine concentrations of arsenic. Arsenic quantification in blood, urine and faeces suggested that enhanced gastrointestinal decontamination was minimally effective for decontamination and that DMSA for at least two weeks was required.
Characteristics of acute adult poisoning cases admitted to a university hospital in Istanbul
Authors: Tüfekçi Işil Bavunoğlu , Çurgunlu A. , Şirin Feridun
Published: July 2004

Background: The aim of this retrospective study was to analyse the characteristics of acute adult poisoning cases admitted to a university hospital in Istanbul, Turkey. Patients and methods: All cases admitted to the Emergency Unit of the Istanbul University Cerrahpaşa Medical Faculty Hospital, between January 2001 and December 2001, were included in this study. We analysed the clinical charts for aetiological and demographical characteristics of the acutely poisoned patients. Results: There were 284 poisoning cases (207 females and 77 males) among 11 834 patients admitted to the Emergency Unit. This was 2.4% of all emergency admissions. The female-to-male ratio was 3:1. The mean age was 27±12 years (age range 15–87) and the majority of the patients (73.94%) were below the age of 30 years. The median age was 24 years. Medicinal drugs were the major cause (69.37%) of the cases, followed by inhalation of gases (14.44%), alcohol (5.99%), alcohol together with illicit drugs (4.23%), food (3.17%), corrosives (1.76%) and pesticides (1.06%). The route of administration was as follows: 84.51% orally, 14.44% by inhalation and 1.06% by intravenous injection. Seventy-one per cent of acute poisonings were self-inflicted and 88% occurred at home. The most frequently involved medicinal drugs were antidepressants and analgesics. In 32.04% of cases, there was more than one medicinal drug responsible for the poisoning. The seasonal distribution in poisoning patients suggested a peak in summer (31.7% of presentations) and winter (30.9%) and lower numbers in spring (22.9%) and autumn (14.5%). The follow-up period of the patients were 1–12 hours for 42 cases (15%), 13–24 hours for 134 cases (47%) and more than 24 hours for 108 cases (38%). Two of the 284 cases with acute poisonings were fatal. This was a university hospital-based study, so these results may not be representative of the general population. Despite this drawback, these data still provide important information about the characteristics of poisoning in the largest city of the country.
Human exposures to acrylamide are below the threshold for carcinogenesis
Authors: Thulesius Olav , Waddell William J
Published: July 2004

Dose-response calculations for a threshold of carcinogenesis in animal studies do not support the notion that acrylamide (ACR) with the present status of consumption in food is carcinogenic for humans. This is in agreement with the recent reassuring epidemiological studies which have shown a lack of correlation between exposure to ACR in food and the incidence of cancer.
A genetic screen in zebrafish identifies cilia genes as a principal cause of cystic kidney
Authors: Sun Zhaoxia , Amsterdam Adam , Pazour Gregory J. , Cole Douglas G. , Miller Mark S. , Hopkins Nancy
Published: July 2004

Polycystic kidney disease (PKD) is a common human genetic illness. It is characterized by the formation of multiple kidney cysts that are thought to result from over-proliferation of epithelial cells. Zebrafish larvae can also develop kidney cysts. In an insertional mutagenesis screen in zebrafish, we identified 12 genes that can cause cysts in the glomerular-tubular region when mutated and we cloned 10 of these genes. Two of these genes, vhnf1(tcf2) and pkd2, are already associated with human cystic kidney diseases. Recently, defects in primary cilia have been linked to PKD. Strikingly, three out of the 10 genes cloned in this screen are homologues of Chlamydomonas genes that encode components of intraflagellar transport (IFT) particles involved in cilia formation. Mutation in a fourth blocks ciliary assembly by an unknown mechanism. These results provide compelling support for the connection between cilia and cystogenesis. Our results also suggest that lesions in genes involved in cilia formation and function are the predominant cause of cystic kidney disease, and that the genes identified here are excellent candidates for novel human PKD genes.
Signaling dynamics of feather tract formation from the chick somatopleure
Authors: Fliniaux Ingrid , Viallet Jean P. , Dhouailly Danielle
Published: July 2004

In the chick, most feathers are restricted to specific areas of the skin,the feather tracts or pterylae, while other areas, such as the apteria, remain bare. In the embryo, the expansion and closure of the somatopleure leads to the juxtaposition of the ventral pteryla, midventral apterium and amnion. The embryonic proximal somatopleural mesoderm is determined to form a feather-forming dermis at 2 days of incubation (E2), while the embryonic distal and the extra-embryonic somatopleure remain open to determination. We found a progressive, lateral expression of Noggin in the embryonic area, and downregulation of Msx1, a BMP4 target gene, with Msx1 expression being ultimately restricted to the most distal embryonic and extra-embryonic somatopleural mesoderm. Msx1downregulation thus correlates with the formation of the pterylae, and its maintenance to that of the apterium. Suspecting that the inhibition of BMP4 signaling might be linked to the determination of a feather-forming dermis, we grafted Noggin-expressing cells in the distal somatopleure at E2. This elicited the formation of a supplementary pteryla in the midventral apterium. Endogenous Noggin, which is secreted by the intermediate mesoderm at E2, then by the proximal somatopleure at E4, could be sufficient to suppress BMP4 signaling in the proximal somatopleural mesoderm and then in part of the distal somatopleure, thus in turn allowing the formation of the dense dermis of the future pterylae. The same result was obtained with the graft of Shh-producing cells, but Noggin and Shh are both required in order to change the future amnion into a feather-bearing skin. A possible synergistic role of endogenous Shh from the embryonic endoderm remains to be confirmed.
Signalling by the FGFR-like tyrosine kinase, Kringelchen, is essential for bud detachment inHydra vulgaris
Authors: Sudhop Stefanie , Coulier Francois , Bieller Annette , Vogt Angelika , Hotz Tobias , Hassel Monika
Published: July 2004

Signalling through fibroblast growth factors (FGFR) is essential for proper morphogenesis in higher evolved triploblastic organisms. By screening for genes induced during morphogenesis in the diploblastic Hydra, we identified a receptor tyrosine kinase (kringelchen) with high similarity to FGFR tyrosine kinases. The gene is dynamically upregulated during budding, the asexual propagation of Hydra. Activation occurs in body regions, in which the intrinsic positional value changes. During tissue displacement in the early bud, kringelchen RNA is transiently present ubiquitously. A few hours later – coincident with the acquisition of organiser properties by the bud tip – a few cells in the apical tip express the gene strongly. About 20 hours after the onset of evagination, expression is switched on in a ring of cells surrounding the bud base, and shortly thereafter vanishes from the apical expression zone. The basal ring persists in the parent during tissue contraction and foot formation in the young polyp, until several hours after bud detachment. Inhibition of bud detachment by head regeneration results in severe distortion, disruption or even complete loss of the well-defined ring-like expression zone. Inhibition of FGFR signalling by SU5402 or, alternatively, inhibition of translation by phosphorothioate antisense oligonucleotides inhibited detachment of buds, indicating that, despite the dynamic expression pattern,the crucial phase for FGFR signalling in Hydra morphogenesis lies in bud detachment. Although Kringelchen groups with the FGFR family, it is not known whether this protein is able to bind FGFs, which have not been isolated from Hydra so far.
The homeobox geneGsh2is required for retinoid production in the embryonic mouse telencephalon
Authors: Waclaw Ronald R. , Wang Bei , Campbell Kenneth
Published: July 2004

We have examined the role of the homeobox gene Gsh2 in retinoid production and signaling within the ventral telencephalon of mouse embryos. Gsh2 mutants exhibit altered ventral telencephalic development,including a smaller striatum with fewer DARPP-32 neurons than wild types. We show that the expression of the retinoic acid (RA) synthesis enzyme,retinaldehyde dehydrogenase 3 (Raldh3, also known as Aldh1a3), is reduced in the lateral ganglionic eminence (LGE) of Gsh2 mutants. Moreover,using a retinoid reporter cell assay, we found that retinoid production in the Gsh2 mutants is markedly reduced. The striatal defects in Gsh2 mutants are thought to result from ectopic expression of Pax6 in the LGE. Previously, we had shown that removal of Pax6 from the Gsh2 mutant background improves the molecular identity of the LGE in these double mutants; however, Raldh3 expression is not improved. The Pax6;Gsh2 double mutants possess a larger striatum than the Gsh2 mutants, but the disproportionate reduction in DARPP-32 neurons is not improved. These findings suggest that reduced retinoid production in the Gsh2 mutant contributes to the striatal differentiation defects. As RA promotes the expression of DARPP-32 in differentiating LGE cells in vitro, we examined whether exogenous RA can improve striatal neuron differentiation in the Gsh2 mutants. Indeed,RA supplementation of Gsh2 mutants, during the period of striatal neurogenesis, results in a significant increase in DARPP-32 expression. Thus,in addition to the previously described role for Gsh2 to maintain correct molecular identity in the LGE, our results demonstrate a novel requirement of this gene for retinoid production within the ventral telencephalon.
Sra-1 interacts with Kette and Wasp and is required for neuronal and bristle development inDrosophila
Authors: Bogdan Sven , Grewe Oliver , Strunk Mareike , Mertens Alexandra , Klämbt Christian
Published: July 2004

Regulation of growth cone and cell motility involves the coordinated control of F-actin dynamics. An important regulator of F-actin formation is the Arp2/3 complex, which in turn is activated by Wasp and Wave. A complex comprising Kette/Nap1, Sra-1/Pir121/CYFIP, Abi and HSPC300 modulates the activity of Wave and Wasp. We present the characterization of Drosophila Sra-1 (specifically Rac1-associated protein 1). sra-1 and kette are spatially and temporally co-expressed,and both encoded proteins interact in vivo. During late embryonic and larval development, the Sra-1 protein is found in the neuropile. Outgrowing photoreceptor neurons express high levels of Sra-1 also in growth cones. Expression of double stranded sra-1 RNA in photoreceptor neurons leads to a stalling of axonal growth. Following knockdown of sra-1function in motoneurons, we noted abnormal neuromuscular junctions similar to what we determined for hypomorphic kette mutations. Similar mutant phenotypes were induced after expression of membrane-bound Sra-1 that lacks the Kette-binding domain, suggesting that sra-1 function is mediated through kette. Furthermore, we could show that both proteins stabilize each other and directly control the regulation of the F-actin cytoskeleton in a Wasp-dependent manner.
Repression of the vertebrate organizer by Wnt8 is mediated by Vent and Vox
Authors: Ramel Marie-Christine , Lekven Arne C.
Published: July 2004

Dorsoventral (DV) patterning of vertebrate embryos requires the concerted action of the Bone Morphogenetic Protein (BMP) and Wnt signaling pathways. In contrast to our understanding of the role of BMP in establishing ventral fates, our understanding of the role of Wnts in ventralizing embryos is less complete. Wnt8 is required for ventral patterning in both Xenopus and zebrafish; however, its mechanism of action remains unclear. We have used the zebrafish to address the requirement for Wnt8 in restricting the size of the dorsal organizer. Epistasis experiments suggest that Wnt8 achieves this restriction by regulating the early expression of the transcriptional repressors Vent and Vox. Our data show that vent and vox are direct transcriptional targets of Wnt8/β-catenin. Additionally, we show that Wnt8 and Bmp2b co-regulate vent and vox in a dynamic fashion. Thus, whereas both Wnt8 and zygotic BMP are ventralizing agents that regulate common target genes, their temporally different modes of action are necessary to pattern the embryo harmoniously along its DV axis.
PETAL LOSS, a trihelix transcription factor gene, regulates perianth architecture in theArabidopsisflower
Authors: Brewer Philip B. , Howles Paul A. , Dorian Kristen , Griffith Megan E. , Ishida Tetsuya , Kaplan-Levy Ruth N. , Kilinc Aydin , Smyth David R.
Published: July 2004

Perianth development is specifically disrupted in mutants of the PETAL LOSS (PTL) gene, particularly petal initiation and orientation. We have cloned PTL and show that it encodes a plant-specific trihelix transcription factor, one of a family previously known only as regulators of light-controlled genes. PTL transcripts were detected in the early-developing flower, in four zones between the initiating sepals and in their developing margins. Strong misexpression of PTL in a range of tissues universally results in inhibition of growth, indicating that its normal role is to suppress growth between initiating sepals, ensuring that they remain separate. Consistent with this, sepals are sometimes fused in ptl single mutants, but much more frequently in double mutants with either of the organ boundary genes cup-shaped cotyledon1 or 2. Expression of PTL within the newly arising sepals is apparently prevented by the PINOID auxin-response gene. Surprisingly, PTL expression could not be detected in petals during the early stages of their development, so petal defects associated with PTLloss of function may be indirect, perhaps involving disruption to signalling processes caused by overgrowth in the region. PTL-driven reporter gene expression was also detected at later stages in the margins of expanding sepals, petals and stamens, and in the leaf margins; thus, PTL may redundantly dampen lateral outgrowth of these organs, helping define their final shape.
Statistical mechanics of nucleation: A review
Authors: Ford I J
Published: July 2004

The principles of statistical mechanics have been used to develop a theory of the nucleation of a phase transition, but a number of subtle questions remain and are highlighted in this review. A central issue is the cluster definition, the mathematical scheme which distinguishes a molecular cluster from a collection of separate molecules. There is also the question of whether thermodynamic transition state theory is suitable to describe the process, or whether the development of kinetic rate equations describing cluster growth and decay is a better approach. The classical theory of nucleation is flawed but appears to provide useful estimates in some cases, including water. Phenomenological extensions of the classical theory can improve matters. However, improvements in the theory from microscopic considerations are not simple to apply, require major computational effort and suffer from uncertainties due to lack of knowledge of the fundamental intermolecular interactions. Calculations of the nucleation rate of water droplets are especially difficult since this substance is notoriously difficult to model. Nevertheless, as capabilities improve, accurate calculations should come within reach, which will offer better understanding of the process for practical applications such as the transition from dry to wet steam.
Droplet deposition in steam turbines
Authors: Crane R I
Published: July 2004

Research since the 1960s on the deposition of droplets from wet steam is reviewed, concentrating mainly on low-pressure turbines but also covering the limited work related to nuclear high-pressure turbines. The context is first set, outlining the motivation in terms of blade erosion and, to a lesser extent, wetness losses. Details of measurements in turbines and in simulated turbine flows are followed by descriptions of theoretical work on the main inertial and turbulent deposition mechanisms; possible additional contributory mechanisms are summarized. A major combined experimental and computational effort in the 1980s led to broad agreement between measured and calculated fog deposition fractions in low-pressure turbine final stages, attributed largely to the development of more accurate droplet size measurement and computational fluid dynamics techniques. An attempt has been made to correlate advances with the history of steam turbine development and to speculate on the future of deposition studies in the light of recent theoretical developments and trends in power generation.
Studies of nucleating and wet steam flows in two-dimensional cascades
Authors: Mashmoushy H , Mahpeykar M R , Bakhtar F
Published: July 2004

Many of the problems resulting from the formation and behaviour of the liquid phase in steam turbine blading can be more easily investigated in two-dimensional cascades. To reproduce turbine nucleating and wet steam conditions realistically requires a supply of supercooled steam. The paper is a review article, giving the features of a blow-down cascade tunnel constructed for the purpose and summarizes the results reported. Results obtained in steady supersonic tunnels are also discussed.
Dynamics of jet streaks in a stratified quasi‐geostrophic atmosphere: Steady‐state representations
Authors: Cunningham Philip , Keyser Daniel
Published: July 2004

The structure and dynamics of jet streaks in the extratropical upper troposphere are examined in the context of a continuously stratified quasi‐geostrophic (QG) framework. It is hypothesized that jet streaks may result from the superposition of monopolar or dipolar vortices of mesoscale dimensions with the enhanced potential‐vorticity gradients constituting the tropopause. Based on this hypothesis, steady‐state monopolar and dipolar vortices in a uniform zonal background flow on an f‐plane are investigated for their applicability as idealized dynamical representations of jet streaks. The representations of jet streaks satisfy the nonlinear governing equations of the continuously stratified QG framework: the monopolar vortex is specified in terms of axisymmetric distributions of QG potential vorticity in the interior of the domain and perturbation potential temperature on upper (tropopause) and lower (surface) boundaries, whereas the dipolar vortex is adapted from a closed‐form analytical solution for the geostrophic stream function. Through the incorporation of vertical structure and divergent circulations, these representations of jet streaks extend those presented previously by the authors using a non‐divergent barotropic model.

It is shown that these vortex representations display characteristic signatures similar to those observed in atmospheric jet streaks. In particular, both the monopole and the dipole exhibit an ageostrophic wind directed towards lower geopotential height in the entrance region of the streak and towards higher geopotential height in the exit region. For the monopole, this ageostrophic wind is entirely rotational and there is no vertical motion. For the dipole, the rotational part of the ageostrophic wind dominates the divergent part; the latter is associated with a four‐cell pattern of vertical velocity similar to that described in conceptual models of straight jet streaks. For both the monopole and the dipole, the jet streak is induced by the vortex structure such that the wind speed maximum translates at the same speed as the individual vortices; this translation speed is slower than the maximum wind speed in the core of the speed maximum, consistent with observations of jet streaks.

It is proposed that the above representations provide a formal theoretical foundation for the conceptual models of jet streaks prevalent in the literature; these conceptual models typically are based on heuristic kinematic or parcel arguments and not on consistent solutions to a physically plausible set of equations. The representations also provide a foundation upon which to explore the unsteady behaviour of jet streaks in terms of the superposition of monopolar and dipolar vortices with non‐uniform zonal background flows. Copyright © 2004 Royal Meteorological Society.
Pareto-Improving Campaign Finance Policy
Authors: Coate Stephen
Published: July 2004

This paper argues that campaign finance policy, in the form of contribution limits and matching public financing, can be Pareto improving even under very optimistic assumptions concerning the role of campaign advertising and the rationality of voters. The optimistic assumptions are that candidates use campaign contributions to convey truthful information to voters about their qualifications for office and that voters update their beliefs rationally on the basis of the information they have seen.The argument also assumes that campaign contributions are provided by interest groups and that candidates can offer to provide policy favors to attract higher contributions.
What's in a Grade? School Report Cards and the Housing Market
Authors: Figlio David N , Lucas Maurice E
Published: July 2004

This paper investigates whether the housing market responds to the information incorporated in state-administered school grades. We study whether school grades affect families' residential locations and house prices. Using detailed data on repeated sales of individual residential properties in the state of Florida, we find evidence that there is an independent effect of these grades on house prices and residential location, above and beyond the estimated effects of test scores and the other components of the school grades. Because these grades have a large stochastic component, however, we find that over time the estimated effects of the grades has diminished.
The Effects of Social Networks on Employment and Inequality
Authors: Calvó-Armengol Antoni , Jackson Matthew O
Published: July 2004

We develop a model where agents obtain information about job opportunities through an explicitly modeled network of social contacts. We show that employment is positively correlated across time and agents. Moreover, unemployment exhibits duration dependence: the probability of obtaining a job decreases in the length of time that an agent has been unemployed. Finally, we examine inequality between two groups. If staying in the labor market is costly and one group starts with a worse employment status, then that group's drop-out rate will be higher and their employment prospects will be persistently below that of the other group.
Energy Policies and Climate Change Mitigation in Turkey
Authors: Kaygusuz Kamil
Published: July 2004

The overall objectives of energy-related environmental policies in Turkey are to ensure sufficient, reliable and economic energy supplies to support sustainable economical and social development while protecting and improving the environment. The country's environmental policy considers that energy policy should take into account environmental problems and that a balance should be found between increases in energy demand are required for economic development and environmental concerns. Turkey's high rate of energy-related carbon emissions growth is expected to accelerate, with emissions climbing from 60 million tons in 2002 to almost 220 million tons in 2020. Carbon intensity in Turkey is higher than the western developed country average. Energy-intensive, inefficient industries remain under government control with soft budged constraints, contributing to undisciplined energy use. Planned industrial privatisations may close the oldest and most inefficient operations and modernize surviving ones. Elimination of energy price subsidies could stimulate energy conservation, reducing energy and emissions growth below current projections. This paper reviews energy consumption and climate change mitigation in Turkey.
Information Overload and the Message Dynamics of Online Interaction Spaces: A Theoretical Model and Empirical Exploration
Authors: Jones Quentin , Ravid Gilad , Rafaeli Sheizaf
Published: July 2004

Online spaces that enable shared public interpersonal communications are of significant social, organizational, and economic importance. In this paper, a theoretical model and associated unobtrusive method are proposed for researching the relationship between online spaces and the behavior they host. The model focuses on the collective impact that individual information-overload coping strategies have on the dynamics of open, interactive public online group discourse. Empirical research was undertaken to assess the validity of both the method and the model, based on the analysis of over 2.65 million postings to 600 Usenet newsgroups over a 6-month period. Our findings support the assertion that individual strategies for coping with “information overload” have an observable impact on large-scale online group discourse. Evidence was found for the hypotheses that: (1) users are more likely to respond to simpler messages in overloaded mass interaction; (2) users are more likely to end active participation as the overloading of mass interaction increases; and (3) users are more likely to generate simpler responses as the overloading of mass interaction grows.

The theoretical model outlined offers insight into aspects of computer-mediated communication tool usability, technology design, and provides a road map for future empirical research.
Social trust: individual and cross-national approaches
Authors: Newton Kenneth
Published: July 2004

Social trust is often said to be the essence of social capital. Trusting citizens are good citizens. Theorists argue that voluntary associations are crucial to the association between trust and social capital, on the one hand, and vibrant and stable democracy, on the other. Unfortunately, there is not a great deal of convincing evidence to support this important theory. At the individual level, it is rather hard to explain the origins of trust insofar as it is not closely associated with many of the usual array of social characteristics such as education, income, class, race, age, or gender. Most research deals with social trust at the individual level. However, there are theoretical reasons to expect social capital to operate at the societal level of social systems - local, regional, or national. If we turn our attention to the cross-national comparison of countries then we do discover a close association between measures of social capital and democratic development. Comparing 60 countries covered by the third wave of the World Values Study shows that social trust is strongly associated with a range of societal characteristics that underpin democratic development and stability.
What kind of civil society is best for democracy?
Authors: Warren Mark E.
Published: July 2004

The correlation between civil society and democracy and civil society has been so striking that we now see them as reinforcing one another. But as we look more closely at civil societies, we find they can grow in ways that undermine democracy. This was the case in Weimar Germany, and it appears that many of the newest democracies are threatened by growing nationalism and religious sectarianism. Many new democracies are only nominally democratic, maintaining veneers of democratic institutions that mask authoritarian realities. While each case has its own logic and history, a political theorist’s responsibility is conceptual: Can we distinguish between civil societies that are good for democracy and those that are not? I argue that we can and must: by conceiving the multiple requirements of democracy and as well as differing associations that might serve these requirements, we can distinguish between civil societies that are good for democracy and those that are not. If we can make these distinctions, we might also understand how to design institutions that encourage and protect those features of civil society that underwrite democracy.
Me and Oscar Micheaux: An Interview with LeRoy Collins
Authors: McGilligan Patrick
Published: July 2004

Abstract The mystique of pioneering African-American novelist and film director Oscar Micheaux has never been greater, 50 years after his death. His last film, The Betrayal, was made in 1947, and all prints are lost, but Patrick McGilligan tracked down the star of the epic-length film, who played a character based on Micheaux himself, for a revealing interview about the Jackie Robinson of American film.
Hong Sangsoo's Lines of Inquiry, Communication, Defense, and Escape
Authors: Lippit Akira Mizuta
Published: July 2004

Abstract This article looks at the first four films of contemporary Korean filmmaker Hong Sangsoo. It seeks in particular to explore Hong's use of “lines” as geographical and behavioral figures that chart the contemporary landscape of South Korea at a complex moment in its history. The lines that traverse Hong's world produce a cinema of tangled webs and knotted relations.
Buster's Hat
Authors: McKee Al
Published: July 2004

Abstract The collaboration of Samuel Beckett and Buster Keaton on the 1964 short Film is one of those match-ups that sound rich with promise. But their marriage proved brief and problematic. This article examines how creative cross-purposes turned Beckett's only movie and one of Keaton's last into an absurdist comedy of talents misapplied.
Oscar Micheaux and Leo Frank: Cinematic Justice Across the Color Line
Authors: Bernstein Matthew
Published: July 2004

Abstract This essay analyzes, for the first time, Oscar Micheaux's selective use of unmistakable details from the notorious, racially charged Mary Phagan/Leo Frank 1913 murder case for narrative material in his 1936 film Murder in Harlem. Readers thus gain new insights into Micheaux's creativity and use of public history.
Implicit Religion as Commitment Process
Authors: Hunter Rodney J.
Published: July 2004

The concept of implicit religion is closely associated with the idea of commitment, so it would seem useful for students of implicit religion to examine what is known about personal commitment from social psychological studies. This article does so by focusing on what is arguably the major social psychological theory of commitment, Philip Brickman’s Commitment, Conflict, and Caring (1987), which derives fundamental processes and patterns describing the development, maintenance, and dissolution of commitments from cognitive dissonance theory. The article concludes that the Brickman theory offers important supplemental insight into the formative processes of everyday transcendence or implicit religion. At the same time Edward Bailey’s empirical findings in implicit religion challenge and illuminate Brickman’s theory with respect to Bailey’s central discovery of a deep commitment to humanity, including a commitment to the self, within contemporary implicit religion. The author also notes several practical and ethical implications of his analysis.
Anticoagulant Prophylaxis in Medical Patients: An Objective Assessment
Authors: Deitelzweig Steven , Groce James B. ,   Heparin Consensus Group
Published: July 2004

Venous thromboembolism (VTE) is a clinically silent and potentially fatal disease that manifests as deep vein thrombosis (DVT) and pulmonary embolism. Venous thromboembolism remains a serious public health challenge, with an ever‐increasing odds ratio of occurrence given the aging population in the United States. This article reviews the epidemiology of VTE; risk factor identification and stratification as a means of advancing awareness, prevention, and detection of VTE; and prophylaxis options and their outcomes, particularly administration of unfractionated heparin (UFH) 5000 U subcutaneously every 12 versus 8 hours in the at‐risk medical patient population. The important studies comparing outcomes of these different UFH dosing regimens compared with placebo and low‐molecular‐weight heparins also are discussed. Consensus recommendations shaping contemporary clinical practice guidelines in this setting are highlighted. A systemwide approach to treatment of all medical patients who are risk stratified and receiving appropriate pharmacologic prophylaxis is recommended.
Unfractionated Heparin Dosing Nomograms: Road Maps to Where?
Authors: Dobesh Paul P. ,   Heparin Consensus Group
Published: July 2004

Weight‐adjusted nomograms have been a significant advance in the use of unfractionated heparin (UFH). Clinical trials have demonstrated the ability of weight‐adjusted nomograms to achieve a therapeutic activated partial thromboplastin time (aPTT) more rapidly than with standard UFH dosing. Despite this advantage, a significant number of patients have subtherapeutic and supratherapeutic aPTTs. Real‐world experiences also corroborate the inability to keep UFH therapeutic with the use of nomograms. Despite the limitations of UFH nomograms, they have been used in several different types of venous and arterial thrombosis treatment settings. Unfortunately, these nomograms are not all consistent and require a considerable amount of time for training health care professionals on their use in order to limit the potential for medication errors. Although UFH nomograms have provided advancement over standard UFH dosing, their limitations still generate the desire for a more predictable anticoagulant.
Unfractionated Heparin: Focus on a High‐Alert Drug
Authors: Niccolai Cynthia S. , Hicks Rodney W. , Oertel Lynn , Francis John L. ,   Heparin Consensus Group
Published: July 2004

Unfractionated heparin (UFH) is associated with a high rate of drug‐related problems due to either its inherent pharmacologic properties or an extension of these properties often caused by medication errors. The drug‐related problems associated with UFH can significantly hinder the success of therapy and negatively affect the overall cost of care. Unfractionated heparin has been classified as a high‐alert drug by the Institute for Safe Medication Practices. Approximately 2.1% of the total records submitted to the MedMARx national error database were related to UFH; 4.5–5.5% of these errors reported were harmful. With this high potential for error, it is essential that all health care providers adopt a collaborative or systems approach to identify solutions to reduce the occurrence of these medication errors. The Joint Commission on Accreditation of Healthcare Organizations has published national patient safety goals for improving the safety of patient care, many of which are applicable to UFH therapy. Unfractionated heparin drug‐related problems not necessarily related to medication errors include heparin‐induced thrombocytopenia, bleeding events, and osteopenia. Heparin‐induced thrombocytopenia is a serious complication of heparin therapy and remains seriously undiagnosed. Bleeding events often occur with therapeutic as well as prophylactic UFH administration even when monitoring indexes are within the therapeutic range. However, due to the variability associated with UFH monitoring methods, definitive guidelines are lacking to assist in avoiding such serious events. Osteopenia has been associated with long‐term UFH therapy; one third of patients experience reductions in bone density, potentially leading to fractures. Today, safer alternative anticoagulation therapies are available, such as the low‐molecular‐weight heparins. When compared with UFH, these alternative therapies provide equivalent or superior efficacy for numerous indications.
Achieving Target Antifactor Xa Activity with a Heparin Protocol Based on Sex, Age, Height, and Weight
Authors: Rosborough Terry K. , Shepherd Michele F.
Published: July 2004

Study Objectives. To develop and validate an improved unfractionated heparin (UFH) dosage protocol, using antifactor Xa levels as the outcome variable.

Design. Prospective case series.

Setting. A 625‐bed, adults‐only, private, tertiary care teaching hospital.

Patients. Three hundred seventy‐two patients receiving UFH for eight different indications were in the protocol derivation group. One hundred ninety‐seven patients were in the final validation group.

Intervention. Variables that predicted successful UFH treatment were determined by analysis of variance and regression.

Measurements and Main Results. Sex, age, height, weight, UFH dosage, and antifactor Xa levels were variables. A regression model using sex, age, height, and weight was superior to a weight‐only model in predicting UFH dosage. Target‐range antifactor Xa levels were achieved with the new protocol in 122 (87%) of 140 patients within 24 hours of start of therapy.

Conclusion. A UFH dosage protocol based on patient sex, age, height, and weight produced improved initial target antifactor Xa levels compared with a weight‐based protocol. The protocol is computerized and easy to apply.
Racial Differences in Patients' Potassium Concentrations During Spironolactone Therapy for Heart Failure
Authors: Cavallari Larisa H. , Fashingbauer Lucy A. , Beitelshees Amber L. , Groo Vicki L. , Southworth Mary R. , Viana Marlos A. G. , Williams Randall E. , Dunlap Stephanie H.
Published: July 2004

Study Objective. To determine whether the effects of spironolactone on potassium homeostasis vary by race by comparing serum potassium concentrations and potassium supplement use in African‐American and Caucasian patients receiving spironolactone for heart failure.

Design. Retrospective medical record review.

Setting. Two heart failure centers.

Patients. Fifty African‐American and 67 Caucasian patients with heart failure who were receiving a stable dosage of spironolactone in addition to standard heart failure therapy with an angiotensin‐converting enzyme (ACE) inhibitor or angiotensin receptor blocker.

Measurements and Main Results. Medical records of eligible patients were reviewed by pharmacists and physicians who specialize in heart failure management. No significant differences were observed in diuretic therapy or renal function between racial groups; however, African‐Americans were receiving higher doses of ACE inhibitors. African‐Americans had lower serum potassium concentrations (4.2 ± 0.4 vs 4.5 ± 0.5 mEq/L, p<0.01) and a higher prevalence of potassium supplementation (48% vs 15%, p<0.01). In a subset of patients, spironolactone therapy was associated with a 2‐fold greater increase in serum potassium concentration and a 3‐fold greater reduction in potassium supplement use among Caucasians than African‐Americans.

Conclusion. Our findings suggest that a large percentage of patients with heart failure, particularly African‐Americans, still require potassium supplementation despite treatment with spironolactone and standard vasodilator therapy.
Meperidine Is Alive and Well in the New Millennium: Evaluation of Meperidine Usage Patterns and Frequency of Adverse Drug Reactions
Authors: Seifert Charles F. , Kennedy Shalyn
Published: July 2004

Study Objectives. To report a classic case of normeperidine toxicity, and to present institution‐specific data on meperidine usage patterns and the frequency of adverse drug reactions (ADRs).

Methods. A chart review was conducted of patients at high risk for ADRs. High‐risk patients were identified through the pharmacy computer system as those with renal insufficiency (creatinine clearance ≤ 50 ml/min), those receiving meperidine with patient‐controlled analgesia (PCA), or those receiving more than 200 mg/day of intravenous meperidine for multiple days.

Results. Twenty‐five percent of patients who received meperidine had some degree of renal insufficiency. The average daily dose of meperidine was 230 mg; cumulative doses ranged from 10–7200 mg. Adverse drug reactions documented in 20 (14%) of 141 patients were confusion, anxiety, nervousness, hallucinations, twitching, and seizure. Sixteen of the 20 patients received meperidine by PCA pump or a combination of PCA and intravenous administration. Patients with ADRs to meperidine were older (58.5 vs 46.4 yrs, p=0.004), received more concomitant benzodiazepines (65.0% vs 4.1%, p<0.0001), and had a longer hospital stay (median 9.5 vs 4.6 days, p<0.001) than those who did not experience an ADR. A significant difference was found in cumulative PCA doses between patients with and without documented ADRs (median meperidine dose 863 and 455 mg, respectively, p=0.0157). Doses were directly correlated with both renal function (p<0.05) and length of stay (p<0.008). Dosing, duration, and frequency of ADRs for patients using PCA differed significantly between prescribing services (p<0.01).

Conclusion. Patients using PCA meperidine are at particularly high risk of experiencing ADRs based on cumulative doses and duration of treatment. Adverse drug reactions were documented in approximately 14% of patients. Our results warrant restriction of PCA meperidine and evaluation of meperidine usage policies to improve pain management services and decrease the frequency of ADRs.
The Effect of Deinsuring Chlorpropamide on the Prescribing of Oral Antihyperglycemics for Nova Scotia Seniors' Pharmacare Beneficiaries
Authors: Sketris Ingrid S. , Kephart George C. , Frail Dawn M. , Skedgel Chris , Allen Michael J.
Published: July 2004

On behalf of the Nova Scotia Seniors' Pharmacare Program, the Drug Evaluation Alliance of Nova Scotia developed a multicomponent intervention plan to facilitate the removal of chlorpropamide as an insured benefit. Chlorpropamide has caused serious hypoglycemia in seniors to a greater extent than some other agents. Pharmacy administrative claims were used to compute monthly use rates for insulin and each oral antihyperglycemic drug from January 1, 2000–December 30, 2002, in an intervention cohort (patients receiving chlorpropamide) and a control cohort (patients receiving an antihyperglycemic agent other than chlorpropamide). Initially, 630 patients were receiving chlorpropamide therapy. By the time chlorpropamide was deinsured, only 10% of the treatment cohort continued receiving chlorpropamide; shortly after deinsurance, no beneficiaries continued receiving the drug. The antihyperglycemics with the greatest increase in prescription were glyburide and gliclazide. The deinsuring of chlorpropamide and the educational strategies that accompanied it resulted in the selection of more appropriate antihyperglycemics for Nova Scotia seniors.
Intravenous Amiodarone for Conversion of Atrial Fibrillation: Misled by Meta‐Analysis?
Authors: Slavik Richard S. , Zed Peter J.
Published: July 2004

Therapeutic goals for atrial fibrillation (AF) include ventricular rate control, stroke prevention, conversion to normal sinus rhythm, and maintenance of normal sinus rhythm. The optimal strategy of rate versus rhythm control for acute management of patients with AF is a continuing debate. However, selected patients may require acute treatment with antiarrhythmic agents for conversion of symptomatic AF episodes to normal sinus rhythm. Recently published randomized controlled trials, qualitative systematic reviews, meta‐analyses, and evidence‐based international consensus guidelines have addressed the controversy regarding acute conversion of AF using antiarrhythmic therapy. Although meta‐analyses often provide the highest level of evidence, the validity and application of their results are based on the quality of their methodology and accuracy of reporting. Authors of the most recent meta‐analysis of amiodarone for conversion of AF state that the drug is effective and relatively rapid acting in converting AF to normal sinus rhythm in a wide range of patients, and they recommend it as a first‐line drug. We feel that these conclusions are overstated and potentially misleading due to methodologic limitations of the analysis. The results of this meta‐analysis and others concerning acute conversion of AF should be viewed as hypothesis generating and not the definitive answer to this question. Ultimately, well‐designed, adequately powered, randomized placebo‐ or rate‐controlled trials are needed in specific patient populations with AF to determine the absolute benefit of intravenous amiodarone for conversion of AF to normal sinus rhythm. Until more data are available, intravenous amiodarone cannot be promoted as a first‐line agent for this purpose.
A Retrospective Analysis of the Short‐Term Effects of Olanzapine and Quetiapine on Weight and Body Mass Index in Children and Adolescents
Authors: Patel Nick C. , Kistler Jennifer S. , James Elizabeth B. , Crismon M. Lynn
Published: July 2004

Study Objective.To evaluate changes in short‐term weight and body mass index (BMI) in children and adolescents receiving olanzapine or quetiapine.

Design. Retrospective study.

Setting. Austin State Hospital, Austin, Texas.

Patients. One hundred three patients younger than 18 years who were admitted to the hospital and treated with olanzapine (50 patients) or quetiapine (53) for at least 2 weeks between October 1, 1997, and October 31, 2001.

Intervention. Treatment with at least 2 weeks of olanzapine or quetiapine.

Measurements and Main Results. Mean ± SD daily doses of olanzapine and quetiapine were 13.9 ± 7.3 and 510.9 ± 250.3 mg, respectively. Weight and height were measured at baseline and 14 or more days after baseline. Body mass index (in kg/m2) was calculated using serial measurements of weight and height, and change in BMI was determined. The olanzapine group gained an average of 3.8 kg, the quetiapine group 0.03 kg. In the olanzapine group, BMI increased by an average of 1.3 kg/m2; in the quetiapine group, BMI decreased by 0.2 kg/m2. After controlling for baseline differences, significant between‐group differences in weight and BMI change were noted. Change in BMI correlated significantly with baseline BMI in quetiapine‐treated girls.

Conclusion. Patients taking olanzapine had greater increases in weight and BMI than those taking quetiapine. Further studies are necessary to determine the relative risk, magnitude, and time course of antipsychotic‐induced weight gain in this patient population.