bluuebunny/crossref_metadata_2025 huggingface dataset:
Radial Extracorporeal Shock Wave Therapy is Safe and Effective in the Treatment of Chronic Recalcitrant Plantar Fasciitis
Authors: Gerdesmeyer Ludger , Frey Carol , Vester Johannes , Maier Markus , Lowell Weil , Weil Lowell , Russlies Martin , Stienstra John , Scurran Barry , Fedder Keith , Diehl Peter , Lohrer Heinz , Henne Mark , Gollwitzer Hans
Published: October 2008

Background

Radial extracorporeal shock wave therapy is an effective treatment for chronic plantar fasciitis that can be administered to outpatients without anesthesia but has not yet been evaluated in controlled trials.

Hypothesis

There is no difference in effectiveness between radial extracorporeal shock wave therapy and placebo in the treatment of chronic plantar fasciitis.

Study Design

Randomized, controlled trial; Level of evidence, 1.

Methods

Three interventions of radial extracorporeal shock wave therapy (0.16 mJ/mm2; 2000 impulses) compared with placebo were studied in 245 patients with chronic plantar fasciitis. Primary endpoints were changes in visual analog scale composite score from baseline to 12 weeks’ follow-up, overall success rates, and success rates of the single visual analog scale scores (heel pain at first steps in the morning, during daily activities, during standardized pressure force). Secondary endpoints were single changes in visual analog scale scores, success rates, Roles and Maudsley score, SF-36, and patients’ and investigators’ global judgment of effectiveness 12 weeks and 12 months after extracorporeal shock wave therapy.

Results

Radial extracorporeal shock wave therapy proved significantly superior to placebo with a reduction of the visual analog scale composite score of 72.1% compared with 44.7% ( P = .0220), and an overall success rate of 61.0% compared with 42.2% in the placebo group ( P = .0020) at 12 weeks. Superiority was even more pronounced at 12 months, and all secondary outcome measures supported radial extracorporeal shock wave therapy to be significantly superior to placebo ( P < .025, 1-sided). No relevant side effects were observed.

Conclusion

Radial extracorporeal shock wave therapy significantly improves pain, function, and quality of life compared with placebo in patients with recalcitrant plantar fasciitis.
Examining What Caregivers Do During Respite Time to Make Respite More Effective
Authors: Lund Dale A. , Utz Rebecca , Caserta Michael S. , Wright Scott D.
Published: October 2008

Research on respite services for caregivers has been extensive over the past 25 years; however, findings regarding the effectiveness for improving their well-being have shown only moderate or mixed support. Missing from this research has been an examination of what caregivers do during their respite time. We studied 52 family caregivers who used adult day services and examined the consistency between their desired and actual respite activities and its relation to well-being outcomes. We concluded that (a) caregivers pursued a wide range of respite activities; (b) 46% were only somewhat or not very satisfied with how they spent their time; (c) those who were inconsistent in their desired versus actual respite activities and also dissatisfied with their use of time were more depressed, more negative in dimensions of burden, and less satisfied with caregiving; and (d) facilitators should be used to work individually with caregivers to identify activities and goals for respite time that are most likely to improve their well-being.
The Impact of Social Embarrassment on Caregiving Distress in a Multicultural Sample of Caregivers
Authors: Montoro-Rodríguez Julián , Kosloski Karl , Kercher Kyle , Montgomery Rhonda J. V.
Published: October 2008

The purpose of this study was to gauge the impact of social embarrassment on caregivers of Alzheimer's patients. Two hypotheses were tested: First, social embarrassment adds a unique component of distress to caregivers of Alzheimer's patients, controlling for other factors known to cause depression; second, the negativity of the embarrassment varies according to the caregiver's race/ethnicity. Using data from the Alzheimer's Disease Demonstration Grants to States program ( N = 1,183), the caregiver's perceived depression was regressed on culturally situated variables and a set of covariates that included characteristics of both caregiver and care receiver. Results indicate that social embarrassment exerts a substantial effect on caregiver depression, but the effect does not vary meaningfully across cultural groups. In addition to social embarrassment, the health of the caregiver, the certainty of the Alzheimer's diagnosis, and the caregiver's perceived duty to care all uniquely contribute to the caregiver's level of depression.
Homeland Security in the Heartland
Authors: Giblin Matthew J. , Schafer Joseph A. , Burruss George W.
Published: October 2008

This study examines the perceived risk of a terrorist attack, terrorism preparedness activities, and organizational capacity in over 500 Illinois law enforcement agencies. Survey results show that the perceived risk of an attack is relatively low but organizations are taking steps to prepare for large-scale emergencies. The study also found that perceptions of risk predicted the level of preparedness activities and that an organizational leader's confidence in his or her organization's ability to respond to a terrorist incident is influenced by the number of preparedness measures taken. Implications of the research are explored.
Social policy in Europe: paradigms of change
Authors: Room Graham
Published: October 2008

Social policy research deploys a variety of approaches for analysing processes of dynamic change but these face major limitations. This article argues for an institutionally grounded complexity analysis, bringing together the historical institutionalism of Pierson (2004) and Crouch (2005) and the treatment of dynamically coupled adaptive systems by Kauffman (1993; 1995) and Potts (2000). It concludes that, at the very least, social policy researchers will need to make a considered assessment of these complexity-based approaches, as they invade an increasing area of the social sciences.
When a solution becomes the problem: the causes of policy reversal on early exit from the labour force
Authors: Hartlapp Miriam , Kemmerling Achim
Published: October 2008

Whereas governments had previously designed early exit policies to unburden labour markets, they have come increasingly to regard them as problematic. We investigate the reasons for this policy reversal, focusing on two key actors: governments and trade unions. Our mixed-methods approach entails two major steps: first, we embed approaches to policy reform in a common framework to show the empirical relevance of the two major actors in most OECD countries. We find that both government ideology and union representativeness matter. In a second step, we investigate reform processes in two countries in more detail. Belgium and the Netherlands have much in common as regards government and interest groups but differ in terms of the reversal of early exit policies. We see that both the configuration of electoral and welfare state institutions have shaped the specific strategic environment of the two actors in both countries.
The Europeanization of Swedish alcohol policy: the case of ECAS
Authors: Örnberg Jenny Cisneros
Published: October 2008

The recent changes in Swedish alcohol policy have mainly been described by researchers and politicians in terms of a Swedish implementation of EU rules. The European Comparative Alcohol Study (ECAS), however, shows the complexity of Europeanization and can function as an example of the possibilities for the reverse influence. The project was an initiative by the Swedish Ministry of Health and Social Affairs and was presented as a comparative study that could serve as a basis for further discussions about common measures in European alcohol policy. The article analyses how ECAS has been perceived and used politically at national and EU levels. The results show that ECAS was the first attempt from Sweden and Finland to influence EU on the alcohol question, and the expressed political purpose mainly focused on the possibilities to work internationally. The article indicates that ECAS has been quite influential within the research community and within the public health frame. However, the impact within other frames has been more or less limited to the slow process of moulding public opinion.
The prostate cancer screening debate: public reaction to medical controversy in the media
Authors: Dixon Helen , Scully Maree , Wakefield Melanie , Murphy Michael
Published: October 2008

This study explored older men's and their partners' reactions to a television news program on the medical debate surrounding the use of the prostate-specific antigen (PSA) test for prostate cancer screening. Six focus groups, split by gender and socio-economic status (SES), were conducted with men aged 50 years or older ( n = 28) and female partners of such men ( n = 13). A self-completion questionnaire was also used to yield quantitative indices. In general, viewers appeared to appreciate from the debate that there was controversy surrounding prostate cancer screening, and they recognized that PSA testing is more applicable to certain subgroups of men. Although there were differences by SES and gender, the results suggest that exposing health consumers to medical uncertainty and “expert” conflict can help raise awareness of the issue and complexities involved. However, there was evidence to suggest that health consumers may be better able to negotiate conflicting medical information if the different sides of the argument are plainly noted and a clear distinction is made between opinion and evidence. This study has broader relevance to the management of media coverage of medical controversies by public health organizations.
“Public” perceptions of gamete donation: a research review
Authors: Hudson Nicky , Culley Lorraine , Rapport Frances , Johnson Mark , Bharadwaj Aditya
Published: October 2008

This paper reviews the literature on “public” perceptions of the practice of gamete (egg and sperm) donation in the treatment of infertility. Despite regular “consultation” exercises in the UK on the manner in which infertility treatments should be regulated, there is little sense of how a range of public groups respond to developments in this area. The key themes from thirty-three articles, chapters and reports are discussed. The review reveals the limited nature of our current knowledge of public understandings of and attitudes towards gamete donation as a form of infertility treatment which has been readily available and widely practiced for many years. The review is critical of the methodological and epistemological basis of much of the work in this area and argues that there is a strong case for social scientific research to attempt to capture the perceptions of a wider range of people who are rarely included in formal public consultations and often similarly excluded from research studies.
Discussing dialogue: perspectives on the value of science dialogue events that do not inform policy
Authors: Davies Sarah , McCallie Ellen , Simonsson Elin , Lehr Jane L. , Duensing Sally
Published: October 2008

While theoretical work and empirical research have examined science policy-informing “dialogue events,” dialogue events that do not seek to inform public policy are under-theorized and under-researched, even though they are common and growing in popularity in the UK. We describe how, from a critical perspective, it may initially appear that such events cannot be justified without returning to the deficit model. But with this paper, we seek to open up a discussion about these non policy-informing events by arguing that there are in fact further ways to understand and frame them. We deliberately draw on different literatures and seek to make use of practitioner expertise within our discussion, in order to display several perspectives on the value of non-policy dialogue on science as sites of symmetrical individual or small-scale learning —rather than institutional learning—through social processes .
The (im)balance of nature: a public perception time-lag?
Authors: Ladle Richard J. , Gillson Lindsey
Published: October 2008

The last two decades have seen a conceptual shift within environmental and social sciences from an emphasis on ecosystem stability and balance to an acknowledgement of the importance of flux and change in the natural world. This has profound implications for conservation management and policy and has driven an (incomplete) transition from managing to maintain (bio)diversity and ecological stability at some historically derived “optimum” to managing to maintain important ecosystem and evolutionary processes such as nutrient cycles and migration. Here, we investigate whether this change from a “balance of nature” metaphor to a more dynamic perspective (“flux of nature”) is reflected in the representation of conservation and ecosystem management in the news media, the Internet, and the academic literature. We found that the media and the global Internet community still portray the aim of conservation science and of conservationists as being one of maintaining stability, harmony and balance.
Opening the black box: scientists’ views on the role of the news media in the nanotechnology debate
Authors: Petersen Alan , Anderson Alison , Allan Stuart , Wilkinson Clare
Published: October 2008

Increasingly, scientists and policy makers have come to recognize that if nanotechnologies are to achieve wide public acceptance, it is essential to engage publics during the early phase of technology development. The media, situated at the interface between scientists and lay publics, possess the potential to play a significant role in public engagement in this field. This article, drawing on data from a recent survey and interview-based study, examines how scientists perceive and evaluate the production and coverage of news on nanotechnologies. Scientists acknowledged the significance of the media in shaping public perceptions of nanotechnologies and saw a role for the media in public engagement efforts. Most had criticisms of media coverage and offered suggestions as to how it could be improved. However, their comments often revealed a one-dimensional conception of science mediation that overlooked the influence of their own claims. Any efforts to enrich public dialogue about nanotechnologies must endeavor to advance understanding among scientists about the operations of the media and their own role in news production.
Long-Term Effects of Political Violence: Narrative Inquiry Across a 20-Year Period
Authors: Dillenburger Karola , Fargas Montserrat , Akhonzada Rym
Published: October 2008

The study of long-term effects of political violence generally concentrates on effects of a single event or period of violence on individuals or groups of individuals and commonly relies on recollections from those who experienced violence a long time after the event. Against the backdrop of Northern Ireland's Troubles, in this article we use narrative inquiry methodology to explore the long-term effects of violence across a 20-year period on a different level. Using two sets of interview data, one collected 20 years ago during a period of intense violence and the other collected recently, after the ceasefires when levels of community violence had decreased, we allow for comparisons of contemporaneous experiences and personal narratives that illustrate differences and similarities across a 20-year period. Personal accounts of violent experiences, individual coping and psychological health, social support needs and provision, and political and cultural change mirrored fluctuating levels of community violence across time, showed growing levels of societal awareness of victims' issues and increasing levels of service provision, and illustrated the effects of postceasefire violence.
Team Meetings in Specialist Palliative Care: Asking Questions as a Strategy Within Interprofessional Interaction
Authors: Arber Anne
Published: October 2008

In this article, I explore what happens when specialist palliative care staff meet together to discuss patients under their care. Many studies (e.g., Atkinson) have discussed how health care practitioners in various settings use rhetorical strategies when presenting cases in situations such as ward rounds and team meetings. Strategies for arguing and persuading are central to medical practice in the interprofessional context. The context of specialist palliative care is an interesting place for research, as there is a history of patient-centered holistic approaches to care, within a multidisciplinary context, that is interdisciplinary in its focus, structure, and practice (e.g., Saunders). This article examines the rhetorical accomplishment of teamwork in specialist palliative care settings.
“I am not a robot!” Interpreters' Views of Their Roles in Health Care Settings
Authors: Hsieh Elaine
Published: October 2008

In this study, I examined interpreters' self-perceived roles and their corresponding communicative goals and strategies. Twenty-six professional interpreters (of 17 languages), 4 patients, and 12 health care providers were recruited for this study, which involved participant observation of medical encounters and in-depth interviews. Constant comparative analysis was used to generate a typology of interpreters' self-perceived roles, which are different from the roles they learned in their training. Different roles reflect differences in interpreters' concern for other participants' goals, institutional goals, and their own communicative goals. Interpreters' desire to maintain neutrality during the medical encounters influences the communicative strategies they adopt when assuming other roles. I conclude the article with the theoretical and practical implications of interpreters' self-perceived roles.
Evolution of Solitary and Group Transport Behaviors for Autonomous Robots Capable of Self-Assembling
Authors: Groβ Roderich , Dorigo Marco
Published: October 2008

Group transport is performed in many natural systems and has become a canonical task for studying cooperation in robotics. We simulate a system of simple, insect-like robots that can move autonomously and grasp objects as well as each other. We use artificial evolution to produce solitary transport and group transport behaviors. We show that robots, even though not aware of each other, can be effective in group transport. Group transport can even be performed by robots that behave as in solitary transport. Still, robots engaged in group transport can benefit from behaving differently from robots engaged in solitary transport. The best group transport behaviors yielded by half of the evolutions let robots organize into self-assembled structures. This provides evidence that self-assembly can provide adaptive value to individuals that compete in an artificial evolution based on task performance. We conclude the article by discussing potential implications for evolutionary biology and robotics.
A Simple Aplysia-Like Spiking Neural Network to Generate Adaptive Behavior in Autonomous Robots
Authors: Alnajjar Fady , Murase Kazuyuki
Published: October 2008

In this article, we describe an adaptive controller for an autonomous mobile robot with a simple structure. Sensorimotor connections were made using a three-layered spiking neural network (SNN) with only one hidden-layer neuron and synapses with spike timing-dependent plasticity (STDP). In the SNN controller, synapses from the hidden-layer neuron to the motor neurons received presynaptic modulation signals from sensory neurons, a mechanism similar to that of the withdrawal reflex circuit of the sea slug, Aplysia. The synaptic weights were modified dependent on the firing rates of the presynaptic modulation signal and that of the hidden-layer neuron by STDP. In experiments using a real robot, which uses a similar simple SNN controller, the robot adapted quickly to the given environment in a single trial by organizing the weights, acquired navigation and obstacle-avoidance behavior. In addition, it followed dynamical changes in the environment. This associative learning scheme can be a new strategy for constructing adaptive agents with minimal structures, and may be utilized as an essential mechanism of an SNN ensemble that binds multiple sensory inputs and generates multiple motor outputs.
The Human Dimension of Elections
Authors: Hall Thad E. , Quin Monson J. , Patterson Kelly D.
Published: October 2008

Voting technologies received considerable scrutiny after the 2000 election. However, the voter—poll worker interaction is also of critical importance. Poll workers exercise discretion and implement policies in ways that directly affect the voting experience. The authors examine the relationship between voters’ perceptions of the poll worker job performance and measures of voter confidence. In an ordered logit model, the perception of poll workers is a significant predictor of voter confidence even in the presence of numerous controls. The results suggest that overlooking the recruitment and training of competent poll workers can have a detrimental effect on voter confidence.
The First Homozygous Family for Prothrombin G20210A Polymorphism Reported in Latin America
Authors: Roman-Gonzalez Alejandro , Cardona Henry , Cardona-Maya Walter , Alvarez Leonor , Castaneda Serguei , Martinez Juliana , Torres Jose D. , Tobon Luis , Bedoya Gabriel , Cadavid Angela
Published: October 2008

The 20210A allele of the prothrombin gene is associated with increased risk of venous thromboembolism. In this study, we described manifestations of thrombosis in four generations of a Colombian family, with four 20210A homozygous carriers and six 20210G/A heterozygous carriers for polymorphism as well as unrelated participants from the same population. The levels of prothrombin in the 20210A homozygote patients were higher than in the normal 20210G homozygotes (133 + 11% and 92.3 + 12.4%, respectively, P < .01) and the 20210G/A heterozygotes (133 + 11% vs. 114.8 + 24%, P < .05). About 2 out of 4 20210A homozygotes and 5 out of 6 20210G/A heterozygous members of this family did not have venous thromboembolism or any other thrombotic manifestation even though one of them had been exposed to thrombotic risk factors. Thus, we posit the effect of 20210A on the thrombotic phenotype in this family seems to be weak.
Primary Care Physicians' Evaluation and Treatment of Depression
Authors: Epstein Steven A. , Hooper Lisa M. , Weinfurt Kevin P. , DePuy Venita , Cooper Lisa A. , Harless William G. , Tracy Cynthia M.
Published: October 2008

Little is known about how patient and primary care physician characteristics are associated with quality of depression care. The authors conducted structured interviews of 404 randomly selected primary care physicians after their interaction with CD-ROM vignettes of actors portraying depressed patients. Vignettes varied along the dimensions of medical comorbidity, attributions regarding the cause of depression, style, race/ethnicity, and gender. Results show that physicians showed wide variation in treatment decisions; for example, most did not inquire about suicidal ideation, and most did not state that they would inform the patient that there can be a delay before an antidepressant is therapeutic. Several physician characteristics were significantly associated with management decisions. Notably, physician age was inversely correlated with a number of quality-of-care measures. In conclusion, quality of care varies among primary care physicians and appears to be associated with physician characteristics to a greater extent than patient characteristics.
Children's and Adolescents' Use of Mental Health Care Is a Family Matter
Authors: Gaskin Darrell J. , Kouzis Anthony , Richard Patrick
Published: October 2008

This article discusses the influence of family structure on children's use of mental health services and explores whether a family's dependency on government assistance compensates for the effect of family income on children's use of services. Children in nontraditional families are at greater risk of using mental health services and have more mental health visits. Family participation in government subsidies programs offsets the influence of family income on the use of mental health services.
Allostatic Load and Frailty in the Women's Health and Aging Studies
Authors: Szanton S.L. , Allen J.K. , Seplaki C.L. , Bandeen-Roche K. , Fried L.P.
Published: October 2008

Background: Frailty involves decrements in many physiologic systems, is prevalent in older ages, and is characterized by increased vulnerability to disability and mortality. It is yet unclear how this geriatric syndrome relates to a preclinical cumulative marker of multisystem dysregulation. The purpose of this study was to evaluate whether allostatic load (AL) was associated with the geriatric syndrome of frailty in older community-dwelling women. Methods: We examined the cross-sectional relationship between AL and a validated measure of frailty in the baseline examination of two complementary population-based cohort studies, the Women's Health and Aging studies (WHAS) I and II. This sample of 728 women had an age range of 70—79. We used ordinal logistic regression to estimate the relationship between AL and frailty controlling for covariates. Results: About 10% of women were frail and 46% were prefrail. AL ranged from 0 to 8 with 91% of participants scoring between 0 and 4. Regression models showed that a unit increase in the AL score was associated with increasing levels of frailty (OR = 1.16, 95% CI = 1.04—1.28) controlling for race, age, education, smoking status, and comorbidities. Conclusion: This study suggests that frailty is associated with AL. The observed relationship provides some support for the hypothesis that accumulation of physiological dysregulation may be related to the loss of reserve characterized by frailty.
Mortality and Diabetes Mellitus in Amputations of the Lower Limbs for Gas Gangrene: A Case Report
Authors: Pereira de Godoy José Maria , Vasconcelos Ribeiro Janalice , Caracanhas Lívia Andrioli
Published: October 2008

The aim of this study was to examine any association between the presence of diabetes in patients with gas gangrene of the legs and mortality following major lower limb amputation. In a retrospective study, patients submitted to amputation of lower limbs for anaerobic infections were evaluated in the period from January 2005 to January 2007 in the University Hospital de Base in Sao Jose do Rio Preto. All the patients were hospitalized for the treatment of ulcerated lesions of the leg. The study sample consisted of 30 men and 10 women aged between 46 and 87 years (mean 69 years) suffering from anaerobic infections. During treatment, the presence of crepitation in the skin was observed as was gas by radiological examination. Amputation was performed within 2 to 6 hours after diagnosis. Diabetes was identified in 33 patients and death occurred within the perioperative period in 12 cases. Diabetes is associated with the necessity of amputation for gas gangrene resulting in a high mortality rate.
Risk Factors for Surgical-Site Infection Following Common Femoral Artery Endarterectomy
Authors: Derksen Wouter J. M. , Verhoeven Bart A. N. , van de Mortel Rob H. W. , Moll Frans L. , de Vries Jean-Paul P. M.
Published: October 2008

Surgical-site infection is a major complication following endarterectomy of the common femoral artery. The aim of this single-center study was to determine risk factors for surgical-site infection after endarterectomy of the common femoral artery and especially the possible association between patch type (venous, bovine, or prosthetic) and the occurrence of groin infection. Retrospectively 140 patients who underwent an endarterectomy of the common femoral artery between 2003 and 2006 were reviewed. About 20 patients (14%) suffered from a surgical-site infection (12 superficial and 8 deep, of which 2 with involvement of the patch). All infections occurred within 30 days postoperatively. There was no statistically significant difference between type of patch and surgical-site infection. However, using multivariate analysis, previous arterial surgery in the groin (P = .013) and a wound drain left postoperatively (P = .016) were independent variables for the development of a surgical-site infection after endarterectomy of the common femoral artery.
Radiofrequency Energy Delivery to the Lower Esophageal Sphincter (Stretta Procedure) Does Not Provide Long-term Symptom Control
Authors: Dundon John M. , Davis Steven S. , Hazey Jeffrey W. , Narula Vimal , Muscarella Peter , Melvin William Scott
Published: October 2008

The Stretta procedure (radiofrequency energy application to the lower esophageal sphincter) is a unique endoluminal technique for the management of gastroesophageal reflux. This article reports on the long-term effectiveness of the Stretta procedure in patients with significant gastroesophageal reflux disease (GERD) referred to a surgical practice. Patients who underwent Stretta with a minimum of 36 months follow-up were included. Thirty-two patients with an average follow-up of 53 months were included; 19 proceeded to anti-reflux surgery. Those not undergoing surgery showed a significant improvement in their GERD satisfaction from 3.14 to 1.46 ( P = .0006) but had significantly lower preprocedure heartburn scores (2.43) than those who proceeded to surgery (3.66, P = .0401). The Stretta procedure was effective in reducing symptoms in 40% of patients. Responders had less severe preoperative heartburn. Radiofrequency energy delivery to the lower esophageal sphincter may be effective in selected patients for the treatment of gastroesophageal reflux.
Influence of the Velocity, Local Position, and Relative Humidity of Moist Air on the Convective Mass Transfer Coefficient in a Rectangular Tunnel — Theory and Experiments
Authors: Talev Goce , Gustavsen Arild , Næss Erling
Published: October 2008

This paper explores the effect of the relative humidity (RH) of moist air as well as velocity on the convective mass transfer coefficients (CMTC) at different positions. Experiments determined the local mass transfer coefficients of three water samples mounted in line with the bottom wind tunnel surface. The experiments were carried out at a temperature of 20°C, relative humidities of 30, 50, and 70%, and velocities between 0.1 and 5m/s. The experimental data show that the convective mass transfer coefficient is a function of velocity, the RH of the air and the local position. The experimental results are compared to expressions for the convective mass coefficients from the literature.
Influences of Air Exchange Effectiveness and its Rate on Thermal Comfort: Naturally Ventilated Office
Authors: Daghigh R. , Adam N.M. , Sahari B.B. , Sopian K. , Alghoul M.A.
Published: October 2008

This article presents the effects of air exchange rate (ACH) and air exchange effectiveness (AEE) on thermal comfort level of a naturally ventilated office room. The study was conducted in an office at UPM, Malaysia. Influence of ACH and AEE on thermal comfort has not been investigated and is, therefore, not well understood. The main objective of this research is to investigate and assess these influences through the variable windows-door opening arrangements. To determine the windows-door opening performance in terms of ventilation air flow rate, 14 opening configurations have been considered. Thermal comfort variables were measured at the same time when ACH and AEE were evaluated. Through these data, the thermal comfort Fanger's indices (Predicted Mean Vote (PMV) and Predicted Percentage Dissatisfied (PPD)), ACH and AEE were calculated. These results showed that for a naturally ventilated office room three linear regression equations of PMV versus ACH and three linear regression equations of PMV versus AEE can be derived.
Cysteinyl leukotriene receptor 1 gene variation and risk of asthma
Authors: Hong X. , Zhou H. , Tsai H-J. , Wang X. , Liu X. , Wang B. , Xu X. , Xu X.
Published: October 2008

Although it has been recognised that genetics plays an important role in the development of asthma, important causal loci remain to be identified. The aim of the present study was to examine the association of known and novel candidate genes with asthma.

Two independent samples, including 170 asthmatic cases and 347 controls in the initial sample, and 202 asthmatic cases and 332 controls in the confirmation sample, were recruited from the same region of China. Functional single nucleotide polymorphisms (SNPs; n = 129) from 105 genes were genotyped using MassARRAY technology, and 119 SNPs were used for the subsequent analysis.

In the initial sample, three SNPs, rs320995 in the cysteinyl leukotriene receptor 1 gene, rs1047266 in the tumour necrosis factor receptor superfamily, member 10b, gene and rs40401 in the interleukin-3 gene, were associated with risk of asthma. Notably, under the recessive genetic model, subjects without the thymidine allele in SNP rs320995 had a 3.1 times higher risk of asthma, which remained significant after accounting for multiple testing. This association was replicated in the confirmation sample and validated by meta-analysis. Further, sex-specific analysis was performed, but no sex difference was found.

The present study provided coherent evidence that cysteinyl leukotriene receptor 1 gene variation is associated with risk of asthma.
MMP expression and abnormal lung permeability are important determinants of outcome in IPF
Authors: McKeown S. , Richter A. G. , O'Kane C. , McAuley D. F. , Thickett D. R.
Published: October 2008

Matrix metalloproteinases (MMPs) degrade all of the extracellular matrix components of the intersititium and may play a role in abnormal alveolar permeability, which is a feature of idiopathic pulmonary fibrosis (IPF). The aims of the present study were to evaluate MMP protein levels in patients with IPF and determine any relationship to treatment and markers of permeability.

In total, 20 patients with IPF and eight normal controls underwent bronchoalveolar lavage. MMP, tissue inhibitor of metalloproteinase, and vascular endothelial growth factor (VEGF) levels were related to clinical outcome and protein permeability index.

MMP-3, -7, -8 and -9 were elevated in IPF lavage fluid and levels remained high despite treatment. Levels of MMP-3, -7, -8 and -9, VEGF and protein permeability index were higher in those who died early during follow-up. VEGF, and MMP-8 and -9 levels were higher in those with a rapidly declining lung function over 1 yr. Levels of MMP-3, -7, -8 and -9 correlated with an increased permeability index.

Matrix metalloproteinase levels were elevated in idiopathic pulmonary fibrosis patients and were not modulated by current standard treatment. Matrix metalloproteinase production through an interaction with the known vascular permogen, vascular endothelial growth factor, was potentially associated with abnormal capillary permeability and may have potentiated the neo-angiogenesis seen in idiopathic pulmonary fibrosis. The changes were greatest in those who died or progressed during follow-up, suggesting that drugs targeting vascular endothelial growth factor or matrix metalloproteinase activity warrant assessment as novel therapy for idiopathic pulmonary fibrosis.
Reciprocal regulation of iNOS and PARP-1 during allergen-induced eosinophilia
Authors: Naura A. S. , Datta R. , Hans C. P. , Zerfaoui M. , Rezk B. M. , Errami Y. , Oumouna M. , Matrougui K. , Boulares A. H.
Published: October 2008

Inducible nitric oxide synthase (iNOS) inhibition was recently shown to exert no effect on allergen challenge in human asthma, raising serious concerns about the role of the protein in the disease. The present study investigated the role of iNOS in ovalbumin-induced eosinophilia from the perspective of its relationship with poly(ADP-ribose) polymerase-1 (PARP-1) and oxidative DNA damage.

A mouse model of ovalbumin-induced eosinophilia was used to conduct the studies.

iNOS-associated protein nitration and tissue damage were partially responsible for allergen-induced eosinophilia. iNOS expression was required for oxidative DNA damage and PARP-1 activation upon allergen challenge. PARP-1 was required for iNOS expression and protein nitration, and this requirement was connected to nuclear factor-κB. PARP-1 was an important substrate for iNOS-associated by-products after ovalbumin-challenge. PARP-1 nitration blocked its poly(ADP-ribosyl)ation activity. Interleukin-5 re-establishment in ovalbumin-exposed PARP-1-/-mice reversed eosinophilia and partial mucus production without a reversal of iNOS expression, concomitant protein nitration or associated DNA damage.

The present results demonstrate a reciprocal relationship between inducible nitric oxide synthase and poly(ADP-ribose) polymerase-1 and suggest that expression of inducible nitric oxide synthase may be dispensable for eosinophilia after interleukin-5 production. Inducible nitric oxide synthase may be required for oxidative DNA damage and full manifestation of mucus production. Such dispensability may explain, in part, the reported ineffectiveness of inducible nitric oxide synthase inhibition in preventing allergen-induced inflammation in humans.
Mechanisms of heteroresistance to isoniazid and rifampin ofMycobacterium tuberculosisin Tashkent, Uzbekistan
Authors: Hofmann-Thiel S. , van Ingen J. , Feldmann K. , Turaev L. , Uzakova G. T. , Murmusaeva G. , van Soolingen D. , Hoffmann H.
Published: October 2008

Heteroresistance ofMycobacterium tuberculosis(MTB) is defined as the coexistence of susceptible and resistant organisms to anti-tuberculosis (TB) drugs in the same patient. Heteroresistance of MTB is considered a preliminary stage to full resistance. To date, no mechanism causing heteroresistance of MTB has been proven.

Clinical specimens and cultures from 35 TB patients from Tashkent, Uzbekistan, were analysed using the Genotype MTBDR assay (Hain Lifescience, Nehren, Germany), which is designed to detect genetic mutations associated with resistance to rifampin and isoniazid. Cases of heteroresistance were further subjected to genotyping using mycobacterial interspersed repetitive unit-variable-number tandem repeat typing, spoligotyping and IS6110fingerprinting.

Heteroresistance to rifampin and/or isoniazid was found in seven cases (20%). In five of them, heteroresistance was caused by two different strains and in two by a single strain of the Beijing genotype. The latter cases had a history of relapse of their TB.

For the first time, two different mechanisms of heteroresistance in tuberculosis have been proven using a stepwise molecular-biological approach: 1) superinfection with two different strains, which is of interest for clinical infection control practitioners; and 2) splitting of a single strain into susceptible and resistant organisms. The latter mechanism is most likely to be related to poor treatment quality and could serve as a quality marker for tuberculosis therapy programmes in the future.
Prognostic and aetiological factors in chronic thromboembolic pulmonary hypertension
Authors: Condliffe R. , Kiely D. G. , Gibbs J. S. R. , Corris P. A. , Peacock A. J. , Jenkins D. P. , Goldsmith K. , Coghlan J. G. , Pepke-Zaba J.
Published: October 2008

Several prognostic variables have previously been identified in patients with chronic thromboembolic pulmonary hypertension (CTEPH). Specific medical conditions have also been associated with the development and prognosis of CTEPH. Using a national registry, the current authors have assessed the prognostic value of a larger number of variables and have also attempted to validate the clinical importance of previously identified aetiological factors.

Baseline information for all 469 CTEPH patients diagnosed in the UK pulmonary hypertension service between January 2001 and June 2006 was collected from hospital records.

Although univariate analysis confirmed the prognostic importance of pulmonary resistance, in multivariate analysis gas transfer and exercise capacity predicted pulmonary endarterectomy perioperative mortality. Cardiac index and exercise capacity independently predicted outcome in patients with nonoperable disease. Previous splenectomy was noted in 6.7% of patients, being significantly more common in patients with nonoperable than operable disease (13.7versus3.6%). Medical risk factors were not found to predict mortality.

In a large national cohort, predictors of outcome in patients with both operable and nonoperable chronic thromboembolic pulmonary hypertension have been identified. These may be useful in planning treatment. The aetiological importance of previously identified medical risk factors has been confirmed, although the current authors were unable to validate their prognostic strength.
Recurrence of tuberculosis in a low-incidence setting
Authors: Dobler C. C. , Crawford A. B. H. , Jelfs P. J. , Gilbert G. L. , Marks G. B.
Published: October 2008

Recurrence of active tuberculosis following treatment of an initial disease episode can occur due to endogenous re-activation or exogenous re-infection.

Cases of recurrent tuberculosis in the Australian state of New South Wales between 1994 and 2006 were identified by data linkage analysis with confirmatory review of case notes. Patients with more than one culture-positive disease episode during that time period who had completed treatment for the initial disease episode were included. Genotyping ofMycobacterium tuberculosiswas used to determine whether recurrence was likely to be due to re-activation or re-infection.

There were 5,723 tuberculosis notifications between 1994 and 2006, 3,731 of which were culture-positive. Fifteen (0.4%) patients had recurrent culture-positive disease over a mean 5.7 yrs of follow-up (crude annual incidence 71 per 100,000 population). Recurrent tuberculosis was attributable to re-activation (indistinguishable strains) in 11 (73%) cases and to re-infection (different strains) in four (27%).

In a low-incidence setting of tuberculosis, a control programme incorporating directly observed therapy for active disease resulted in a very low rate of recurrent tuberculosis over a long period of follow-up. Re-infection is less likely than re-activation, but still contributes significantly to the number of cases with recurrent disease.
Computed tomographic emphysema distribution: relationship to clinical features in a cohort of smokers
Authors: Mair G. , Miller J. J. , McAllister D. , Maclay J. , Connell M. , Murchison J. T. , MacNee W.
Published: October 2008

Computed tomography (CT) scanning allows precise assessment of both the extent and distribution of emphysema. There has been little work on the relationship between the distribution of emphysema and clinical features of the disease. The current study investigated the association between clinical features and distribution of emphysema.

A total of 129 patients with smoking-related chronic obstructive pulmonary disease underwent CT assessment of the extent and distribution of their emphysema (core/rind and upper/lower zone predominance).

Emphysema was found predominantly in the upper/core zone and this distribution was related to the extent of disease. Core predominance was associated with lower forced expiratory volume in one second (FEV1), FEV1/forced vital capacity ratio and body mass index (BMI); and with higher BODE (BMI, airflow obstruction, dyspnoea and exercise capacity) index and Medical Research Council dyspnoea score. Upper-zone predominance was associated with female sex and an increased total St George’s Respiratory Questionnaire score. Using multiple linear regression age, sex and whole lung emphysema severity were independently associated with core/rind distribution, while sex and whole lung emphysema severity were independently related to upper/lower distribution.

Distribution of emphysema related best to clinical features when divided into core/rind predominance. However, the effects were not independent of the extent of emphysema. Increased age and female sex were related to disease distribution independent of emphysema severity. These findings may be related to differences in development of emphysema.
Assessing response to treatment of exacerbations of bronchiectasis in adults
Authors: Murray M. P. , Turnbull K. , MacQuarrie S. , Hill A. T.
Published: October 2008

The present study aimed to assess the effect of intravenous antibiotic therapy on clinical and laboratory end-points in exacerbations of noncystic fibrosis bronchiectasis and to determine whether the outcomes were influenced by the pathogenic organism isolated.

A prospective cohort study was conducted from November 2006 to March 2008 of exacerbations requiring intravenous antibiotics. End-points included 24-h sputum volume, forced expiratory volume in one second (FEV1), forced vital capacity (FVC), incremental shuttle walk test, qualitative sputum microbiology, white cell count, erythrocyte sedimentation rate, C-reactive protein (CRP) and St George's Respiratory Questionnaire (SGRQ). Exacerbations due toPseudomonas aeruginosawere compared with exacerbations due to other potential pathogenic organisms.

In total, 32 exacerbations were studied. Following 14 days of intravenous antibiotics, all outcomes significantly improved independent of a pathogenic organism, except FEV1and FVC. The most responsive markers were: 24-h sputum volume (reduced in all patients and 80% had ≥50% reduction); sputum bacterial clearance (78.1%); CRP (≥75% reduction in 62.5%) and SGRQ (≥4 unit improvement in 89.7%). CRP, 24-h sputum volume and SGRQ improved independent of microbial clearance.

In the current study, 24-h sputum volume, microbial clearance, C-reactive protein and St George’s Respiratory Questionnaire were the most useful parameters to assess response to treatment of exacerbations of bronchiectasis. Outcomes were similar independent of the pathogenic organism with the exception of forced expiratory volume in one second and forced vital capacity.
The role of neutropenia on outcomes of cancer patients with community-acquired pneumonia
Authors: Aliberti S. , Myers J. A. , Peyrani P. , Blasi F. , Menendez R. , Rossi P. , Cosentini R. , Lopardo G. , de Vedia L. , Ramirez J. A.
Published: October 2008

Although the presence of neutropenia may predispose cancer patients to develop community-acquired pneumonia, the role of neutropenia on their outcomes has not been investigated. The purpose of the present study was to compare clinical outcomes of cancer community-acquired pneumonia patients with and without neutropenia.

Patients with cancer, identified in the Community-Acquired Pneumonia Organization database, were divided into two groups according to the type of cancer and the presence of neutropenia: patients with solid cancer without neutropeniaversusthose with functional or absolute neutropenia. Among the 3,106 community-acquired pneumonia patients enrolled, 135 had cancer without neutropenia and 75 had cancer with neutropenia.

No significant difference was found between patients with and without neutropenia regarding mean time to clinical stability (5.4±2.7versus4.9±2.7 days, respectively), mean length of hospital stay (9.2±7.7versus9.9±9.6 days) and in-hospital mortality (18versus15%, respectively). Using a multiple logistic regression model, neutropenia was not associated with mortality in cancer patients when adjusting for significant covariates (odds ratio 1.30).

Lack of neutropenia, during the initial evaluation of a cancer community-acquired pneumonia patient, should not be considered an indicator of better clinical outcome.