bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient participation in collective healthcare decision making: the Dutch model
Authors: Van De Bovenkamp Hester M. , Trappenburg Margo J. , Grit Kor J.
Published: August 2009

Objective  To study whether the Dutch participation model is a good model of participation.

Background  Patient participation is on the agenda, both on the individual and the collective level. In this study, we focus on the latter by looking at the Dutch model in which patient organizations are involved in many formal decision‐making processes. This model can be described as neo‐corporatist.

Design  We did 52 interviews with actors in the healthcare field, 35 of which were interviews with representatives of patient organizations and 17 with actors that involved patient organizations in their decision making.

Results  Dutch patient organizations have many opportunities to participate in formal healthcare decision making and, as a result, have become institutionalized. Although there were several examples identified in which patient organizations were able to influence decision making, patient organizations remain in a dependent position, which they try to overcome through professionalization.

Discussion  Although this model of participation gives patient organizations many opportunities to participate, it also causes important tensions. Many organizations cannot cope with all the participation possibilities attributed to them. This participation abundance can therefore cause redistribution effects. Furthermore, their dependent position leads to the danger of being put to instrumental use. Moreover, professionalization causes tensions concerning empowerment possibilities and representativeness.

Conclusion  Although the Dutch model tries to make patient organizations an equal party in healthcare decision making, this goal is not reached in practice. It is therefore important to study more closely which subjects patients can and should contribute to, and in what way.
Cognitive features in euthymic bipolar patients in old age
Authors: Delaloye Christophe , Moy Guenaël , Baudois Sandra , De Bilbao Fabienne , Remund Corinne Dubois , Hofer Françoise , Paquier Claire Ragno , Campos Leticia , Weber Kerstin , Gold Gabriel , Moussa Abba , Meiler Corina Carmen , Giannakopoulos Panteleimon
Published: August 2009

Objectives:  Studies of cognition in bipolar disorder (BD) have reported impairments in processing speed, working memory, episodic memory, and executive function, but they have primarily focused on young and middle‐aged adults. In such studies, the severity of cognitive deficits increases with the duration of illness. Therefore, one would expect more pronounced deficits in patients with longstanding BD. The first aim of the present study was to determine the pattern and the magnitude of cognitive impairment in older euthymic BD patients. The second aim was to explore the interrelationship between these cognitive deficits and determine whether they reflect a single core impairment or the co‐occurrence of independent cognitive deficits.

Methods:  Twenty‐two euthymic elderly BD patients and 22 controls, matched for gender, age, and education, underwent a comprehensive neuropsychological assessment.

Results:  Compared to controls, BD patients had significantly reduced performance in processing speed, working memory, verbal fluency, and episodic memory, but not in executive function. Hierarchical regression analyses showed that verbal fluency and working memory impairments were fully mediated by changes in processing speed. This was not the case for the episodic memory dysfunction.

Conclusion:  The cognitive profile in older euthymic BD cases is similar to the one described in younger BD cohorts. Our results further suggest that impaired processing speed plays a major role in the cognitive changes observed in BD patients except for deficits in episodic memory, thus providing strong evidence that processing speed and episodic memory are two core deficits in elderly BD patients.
Causation in occupational injury
Authors: Kennelly J. , Gorman D.
Published: August 2009

Assessment for compensation of occupational injury forms is commonplace for occupational medicine specialists and less frequently for other health‐care providers. There is no specific training to understand the legal system that forms the basis of any compensation system. This paper sets out a process for judging medical scientific evidence in cases of suspected occupational injury or disease. The process is confusing for medical and legal professionals because of the lack of a common understanding. Understanding the concepts of balance of probabilities and scientific probability is essential for clarity of approach. There is an inevitable conclusion that cause of occupational injury or disease in each case will rest on a sequential consideration of general and specific cause.
Coexistence of B‐cell non‐Hodgkin lymphoma and cutaneous T‐cell lymphoma in a patient with chronic hepatitis C and cryoglobulinaemia
Authors: Girtovitis F. , Papadopoulos A. , Ntaios G. , Kaloutsi V. , Kotoula V. , Kaiafa G.
Published: August 2009

The coexistence of chronic active hepatitis C with cryoglobulinemia and B‐cell lymphoma has been presented in numerous case reports. However, the combination of these conditions with T‐cell lymphoma has never been described before. We present the case of a patient who suffered chronic active hepatitis C, cryoglobulinaemia and B‐cell lymphoma and was later complicated by cutaneous T‐cell lymphoma (CTCL).
Changes in cognitive functions of patients with dementia of the Alzheimer type following long‐term administration of donepezil hydrochloride: Relating to changes attributable to differences in apolipoprotein E phenotype
Authors: Kanaya Kiyoshi , Abe Shine , Sakai Minoru , Fujii Hiroko , Iwamoto Toshihiko
Published: August 2009

Aim:  We conducted a study of changes in cognitive functions by long‐term monitoring of dementia of Alzheimer type (DAT) patients to investigate the relationship between the progression of DAT symptoms and the presence of apolipoprotein (ApoE)4.

Methods:  The subjects consisted of 40 DAT patients who had been treated with donepezil for 3 years or more. The Mini‐Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale – Cognitive Subscale Japanese version (ADAS‐Jcog), were conducted annually. The patients were categorized into ApoE4+ and ApoE4‐ groups. Changes in initial cognitive function assessment score (0 years) were then studied longitudinally at each stage of the observation period (1, 2, 3 years) (Wilcoxon's signed‐rank test). Moreover, the scores at each time period were compared cross‐sectionally between the two groups (Mann–Whitney U‐test).

Results:  Significant decreases in MMSE scores were observed at the three time periods in both groups (P < 0.01) in the cross‐sectional study. In the longitudinal study, the ApoE4+ group demonstrated a lower trend (P < 0.1) after 1 year only. Significantly poorer ADAS‐Jcog scores were observed in the ApoE4+ group at the 3‐year point both in the longitudinal and in the cross‐sectional study (P < 0.05). For ADAS‐Jcog sub‐items, in the longitudinal study, orientation was demonstrated to be significantly poorer in the ApoE4+ group in the third year (P < 0.05).

Conclusion:  ApoE4 was suggested to not only be a risk factor for disease onset, but also a risk factor for exacerbation of symptoms with respect to long‐term prognosis.
Contrasting ability to take up leucine and thymidine among freshwater bacterial groups: implications for bacterial production measurements
Authors: Pérez María Teresa , Hörtnagl Paul , Sommaruga Ruben
Published: August 2009

We examined the ability of different freshwater bacterial groups to take up leucine and thymidine in two lakes. Utilization of both substrates by freshwater bacteria was examined at the community level by looking at bulk incorporation rates and at the single‐cell level by combining fluorescent in situ hybridization and signal amplification by catalysed reporter deposition with microautoradiography. Our results showed that leucine was taken up by 70–80% of Bacteria‐positive cells, whereas only 15–43% of Bacteria‐positive cells were able to take up thymidine. When a saturating substrate concentration in combination with a short incubation was used, 80–90% of Betaproteobacteria and 67–79% of Actinobacteria were positive for leucine uptake, whereas thymidine was taken up by < 10% of Betaproteobacteria and by < 1% of the R‐BT subgroup that dominated this bacterial group. Bacterial abundance was a good predictor of the relative contribution of bacterial groups to leucine uptake, whereas when thymidine was used Actinobacteria represented the large majority (> 80%) of the cells taking up this substrate. Increasing the substrate concentration to 100 nM did not affect the percentage of R‐BT cells taking up leucine (> 90% even at low concentrations), but moderately increased the fraction of thymidine‐positive R‐BT cells to a maximum of 35% of the hybridized cells. Our results show that even at very high concentrations, thymidine is not taken up by all, otherwise active, bacterial cells.
Penile rehabilitation protocol after robot‐assisted radical prostatectomy: assessment of compliance with phosphodiesterase type 5 inhibitor therapy and effect on early potency
Authors: Lee Daniel J. , Cheetham Philippa , Badani Ketan K.
Published: August 2009

Study Type – Therapy (case series) Level of Evidence 4

OBJECTIVE

To evaluate factors that affect compliance in men who enrol in a phosphodiesterase type 5 inhibitor (PDE5I) protocol after nerve‐sparing robot‐assisted prostatectomy (RAP), and report on short‐term outcomes, as PDE5Is may help restore erectile function after RAP and patient adherence to the regimen is a factor that potentially can affect outcome.

PATIENT AND METHODS

We prospectively followed 77 men who had nerve‐sparing RAP and enrolled in a postoperative penile rehabilitation protocol. The men received either sildenafil citrate or tadalafil three times weekly. The minimum follow‐up was 8 weeks. Potency was defined as erection adequate for penetration and complete intercourse. Compliance was defined as men adhering to the regimen for ≥2 months.

RESULTS

The mean age of the cohort was 57.8 years and the median follow‐up was 8 months. In all, 32% of the men discontinued the therapy <2 months after RAP and were deemed noncompliant with an additional 39% discontinuing therapy by 6 months, with the high cost of medication being the primary reason (65%). Long‐term compliance and preoperative erectile dysfunction were independent predictors of potency return after adjusting for age and nerve sparing.

CONCLUSIONS

The high cost of medication remains a significant barrier to maintaining therapy. Noncompliance to PDE5I therapy in a tertiary care centre was much higher than reported in clinical trial settings. With longer‐term follow‐up, we need to further define the factors that improve overall recovery of sexual function after RAP.
Mid‐urethral synthetic slings in the treatment of urodynamic female stress urinary incontinence without concomitant pelvic prolapse repair: 4‐year health‐related quality of life outcomes
Authors: Chung Eric , Tse Vincent , Chan Lewis
Published: August 2009

Study Type – Therapy (outcomes research) Level of Evidence 2c

OBJECTIVE

To report 4‐year health‐related quality of life (HRQL) outcome data after retropubic mid‐urethral synthetic sling (MUS) surgery without concomitant prolapse repair for treating female stress urinary incontinence (SUI) in a single institution.

PATIENTS AND METHODS

The data were prospectively collected, which yielded 21 consecutive patients with a mean (range) age of 67.6 (41–81) years who underwent retropubic MUS with ≥4 years follow‐up. Before surgery, all patients underwent history, examination, pad usage, and multichannel fluoroscopic urodynamics according to International Continence Society standards. In all, 19 patients had urethral hypermobility with an abdominal leak‐point pressure (ALPP) of >90 cmH20 and two had intrinsic sphincter deficiency with an ALPP of <60 cmH20. The MUS were all placed under no tension. All patients were cystoscoped with both 30 and 70° lens at the end of the procedure with a fully distended bladder to exclude bladder or urethral injury. The validated Kings Health Questionnaire (KHQ) was used both before and after surgery to assess HRQL measures. All patients were assessed at 3 months, and then at least three times thereafter.

RESULTS

The paired Student’s t‐test was used on the mean KHQ scores before and after MUS surgery (4 years follow‐up). There were statistically significant improvements in all nine domains on the KHQ between preoperative and 3 months after MUS surgery (P < 0.01), with the most significant being in ‘General Health Perceptions’, ‘Incontinence Impact’, ‘Physical Limitations’, and ‘Role Limitations’. Improvement in HRQL persisted up to 4 years in all domains. Bladder perforation occurred in two patients with uneventful resolution. Two patients required very short‐term catheterization (<5 days). In the present series, there was no sling revision, division, infection or erosion. No patients developed de novo urgency or urge UI after MUS surgery. The pad‐free rate in the present series was 85.7%.

CONCLUSION

In our institution, HRQL improvement at 3 months after retropubic MUS surgery predicts persistence of improvement at 4 years. This is useful clinically in counselling our patients for treatment efficacy. Tension‐free placement is associated with minimal risk of postoperative retention or de novo overactive bladder. Although patient numbers are modest, these data contribute to the scarce longer term (≥4 years) HRQL data on the MUS, which is a safe and durable procedure with a minimal complication profile.
Structured Bellicosity: Was the Israeli‐Arab Conflict Originally Inevitable?
Authors: LEVY YAGIL
Published: August 2009

Subsequent to its inception and the conclusion of the 1948 War, Israel stood at a crossroads. It could choose either to embark on belligerency vis‐à‐vis the surrounding Arab world or pursue peaceful solutions. Israel opted for bellocisty. Why? It is argued that the political structure that gave precedence to the use of force is traceable to the Israeli type of state building with regard to the strategy the state adopted to absorb the mass Mizrachi immigration from Arab countries. The challenge was absorption without jeopardizing the dominance of the veteran Ashkenazim. The chosen track inevitably created the conditions for bellicosity. Exclusionary arrangements in the labor market by forcibly distancing the cheap Palestinian laborforce, the empowerment of the military as a nation builder, and the enabling of a high level of resource mobilization by a centralized state were all mechanisms that made bellicosity possible and even preferable.
Analysing Democracy in Third‐Party Government: Business Improvement Districts in the US and UK
Authors: JUSTICE JONATHAN B. , SKELCHER CHRIS
Published: August 2009

Institutional designs for third‐party governance have proliferated in the US and Europe, but there has been little systematic analysis of their democratic performance. A comparative analysis of business improvement districts (BIDs) in the US and UK documents an approach to the democratic analysis of third‐party public governance institutions and finds variation in institutional designs and democratic performance within — as well as between — countries. BIDs accommodate the democratic imperatives for legitimacy, consent and accountability in different ways. In many ways, the democratic aspects of the BID design reflect those found in a private membership organization, but there is also evidence of actual and potential engagement with residents and local governments in BID governance. US BIDs continue a tradition of informally privileging business interests in local governance, but may potentially increase democratic purchase. UK BIDs may have the potential to increase the role of businesses in local governance at the cost of democratic performance.

Les concepts institutionnels répondant à une third‐party governance ont proliféré aux États‐Unis et en Europe, mais rares ont été les analyses systématiques de leur performance démocratique. Une analyse comparative des Business Improvement Districts (BID) aux États‐Unis et au Royaume‐Uni présente une approche de l’analyse, sur le plan démocratique, des institutions de gouvernance publique ‘avec des tiers’, et dévoile des variantes dans les concepts institutionnels et la performance démocratique à l’intérieur des pays, et d’un pays à l’autre. Les BID adaptent de différentes manières les impératifs démocratiques de légitimité, consentement et responsabilité. De bien des façons, les aspects démocratiques du concept de BID correspondent à ceux d’une association privée de membres. Pourtant, dans une gouvernance de BID, se manifeste aussi un engagement réel et potentiel à l’égard des habitants et des gouvernements locaux. Les BID américains perpétuent une tendance informelle à privilégier les intérêts économiques dans une gouvernance locale, mais sont susceptibles d’accroître leur gain démocratique. Les BID anglais disposent éventuellement du potentiel de renforcer le rôle des entreprises dans la gouvernance locale aux dépens de la performance démocratique.
The UK Space Economy as Practised by Advanced Producer Service Firms: Identifying Two Distinctive Polycentric City‐Regional Processes in Contemporary Britain
Authors: TAYLOR PETER J. , EVANS DAVID M. , HOYLER MICHAEL , DERUDDER BEN , PAIN KATHY
Published: August 2009

Cities and city regions are back on the research agenda in the UK. Taking the world city literature as a guide, this article uses advanced producer service firms to study contemporary inter‐city relations in the UK space economy. We employ an interlocking network model, initially developed for global scale analysis, to assess signs that recent globalization is effecting a revival outside the London region, and to identify leading urban areas in the UK national economy. Two different analyses are presented: a connectivity analysis, which indicates how well cities and towns are linked into the UK space economy, and a fuzzy clustering analysis, which classifies the cities and towns in order to search out hierarchical and regional tendencies. From these findings, we identify two distinctive polycentric city‐regional processes in contemporary Britain: a Jacobs‐style polycentric mega‐city regional process out of London, which creates new important service centres and reaches selected smaller cities and towns; and a polycentric multi‐city regional process beyond London, which mainly enhances the service capacities of selected larger cities. A concluding section considers the implications of the two processes for spatial planning in the UK.

Les villes et régions urbaines reviennent en force dans la recherche britannique. Orienté par les publications sur les villes mondiales, ce travail utilise les entreprises de services avancés à la production pour étudier les relations contemporaines entre villes dans l’économie spatiale britannique. À l’aide d’un modèle de maillage, mis au point à l’origine pour une analyse à l’échelon mondial, nous mesurons les signes indiquant que la récente mondialisation provoque une relance hors de la région de Londres et nous identifions les zones urbaines dominantes de l’économie nationale. Sont présentées deux analyses différentes: une analyse de la connectivité, montrant dans quelle mesure les villes et grandes villes sont reliées au sein de l’économie spatiale britannique, et une analyse des groupements flous qui classe villes et grandes villes afin de trouver les tendances hiérarchiques et régionales. À partir de ces résultats, sont identifiés deux processus distincts de région urbaine polycentrique dans la Grande‐Bretagne contemporaine: un processus de méga‐région urbaine polycentrique, proche de la description de Jacobs, à la périphérie de Londres, qui crée de nouveaux centres de services importants et atteint certaines villes et grandes villes plus petites; un processus de multi‐région urbaine polycentrique au‐delà de Londres, qui renforce principalement les capacités de services de certaines grandes villes. La conclusion étudie les implications des deux processus sur l’aménagement spatial au Royaume‐Uni.
Changes in collagen fibril network organization and proteoglycan distribution in equine articular cartilage during maturation and growth
Authors: Hyttinen Mika M. , Holopainen Jaakko , René van Weeren P. , Firth Elwyn C. , Helminen Heikki J. , Brama Pieter A. J.
Published: August 2009

The aim of this study was to record growth‐related changes in collagen network organization and proteoglycan distribution in intermittently peak‐loaded and continuously lower‐level‐loaded articular cartilage. Cartilage from the proximal phalangeal bone of the equine metacarpophalangeal joint at birth, at 5, 11 and 18 months, and at 6–10 years of age was collected from two sites. Site 1, at the joint margin, is unloaded at slow gaits but is subjected to high‐intensity loading during athletic activity; site 2 is a continuously but less intensively loaded site in the centre of the joint. The degree of collagen parallelism was determined with quantitative polarized light microscopy and the parallelism index for collagen fibrils was computed from the cartilage surface to the osteochondral junction. Concurrent changes in the proteoglycan distribution were quantified with digital densitometry. We found that the parallelism index increased significantly with age (up to 90%). At birth, site 2 exhibited a more organized collagen network than site 1. In adult horses this situation was reversed. The superficial and intermediate zones exhibited the greatest reorganization of collagen. Site 1 had a higher proteoglycan content than site 2 at birth but here too the situation was reversed in adult horses. We conclude that large changes in joint loading during growth and maturation in the period from birth to adulthood profoundly affect the architecture of the collagen network in equine cartilage. In addition, the distribution and content of proteoglycans are modified significantly by altered joint use. Intermittent peak‐loading with shear seems to induce higher collagen parallelism and a lower proteoglycan content in cartilage than more constant weight‐bearing. Therefore, we hypothesize that the formation of mature articular cartilage with a highly parallel collagen network and relatively low proteoglycan content in the peak‐loaded area of a joint is needed to withstand intermittent stress and shear, whereas a constantly weight‐bearing joint area benefits from lower collagen parallelism and a higher proteoglycan content.
Language lateralization in children using functional transcranial Doppler sonography
Authors: HAAG ANJA , MOELLER NICOLA , KNAKE SUSANNE , HERMSEN ANKE , OERTEL WOLFGANG H , ROSENOW FELIX , HAMER HAJO M
Published: August 2009

Aim  Language lateralization with functional transcranial Doppler sonography (fTCD) and lexical word generation has been shown to have high concordance with the Wada test and functional magnetic resonance imaging in adults. We evaluated a nonlexical paradigm to determine language dominance in children.

Method  In 23 right‐handed children (12 females, 11 males; age range 6–11y; mean age 8y 4mo, SD 1y 7mo) and in 22 adolescents (14 females, 8 males; age range 12–18y; mean age 14y 8mo, SD 2y 5 mo) cerebral blood flow velocity (CBFV) was measured in both middle cerebral arteries during picture description and in adolescents additionally during lexical word generation. For each individual/paradigm a lateralization index (LI; side difference in CBFV during mental activity) and its standard error of the mean (SEM; representing variability of the LI throughout task repetition) were computed.

Results  Fourteen of 23 children (mean LI=0.74, SD 4.22; SEM 1.05, SD 0.51) and 14 of 21 adolescents (LI=2.35, SD 4.65; SEM 1.09, SD 0.61) showed left hemispheric dominance during picture description compared with 20 of 21 adolescents during word generation (LI=3.72 SD 1.93; SEM 0.99, SD 0.41). Indicated by similarity in mean SEM, variability of the LI throughout task repetition did not differ between age groups or paradigms.

Interpretation  Functional TCD proved to be well tolerated in children, with similar data quality as in adolescents. However, the picture description paradigm failed to show left hemispheric dominance in a substantial number of participants. This emphasizes the need to evaluate further paradigms for fTCD language lateralization in children.
Disrupting specific PDZ domain‐mediated interactions for therapeutic benefit
Authors: Houslay Miles D
Published: August 2009

The past two decades have seen an immense increase in our appreciation of the vast range of signalling processes and supporting machinery that occur in cells. Pivotal to this is the notion of signal compartmentalization (compartmentation). Targeting by protein domains is critical in allowing signalling complexes to be assembled at defined intracellular locales so as to confer correct function. This issue of the BJP contains two intriguing articles that address functional protein–protein interactions involving PDZ domains [Post‐synaptic density protein‐95 (PSD95), Drosophila disc large tumour suppressor (DlgA) and Zonula occludens‐1 protein (zo‐1)] and their implications for signalling. One involves targeting of neuronal nitric oxide synthase to the N‐methyl D‐aspartic acid (NMDA) receptor via the PDZ‐containing signal scaffold, PSD95. The other involves controlling multiple receptor inputs into regulation of epithelial Na+K+‐ATPase through the PDZ‐containing signal scaffold Pals‐associated tight junction. Highlighted is not only the use of dominant‐negative strategies to identify the importance of targeting at specific types of PDZ domains but also the exciting notion that small molecule disruptors of interaction at specific PDZ domains can be generated for potential therapeutic application.
Aminoethyl nitrate – the novel super nitrate?
Authors: Bauersachs Johann
Published: August 2009

Long‐term use of most organic nitrates is limited by development of tolerance, induction of oxidative stress and endothelial dysfunction. In this issue of the BJP, Schuhmacher et al. characterized a novel class of organic nitrates with amino moieties (aminoalkyl nitrates). Aminoethyl nitrate was identified as a novel organic mononitrate with high potency but devoid of induction of mitochondrial oxidative stress. Cross‐tolerance to nitroglycerin or the endothelium‐dependent agonist acetylcholine after in vivo treatment was not observed. Like all nitrates, aminoethyl nitrate induced vasorelaxation by activation of soluble guanylate cyclase. Thus, in contrast to the prevailing view, high potency in an organic nitrate is not necessarily accompanied by induction of oxidative stress or endothelial dysfunction. This work from Daiber's group is an important step forward in the understanding of nitrate bioactivation, tolerance phenomena and towards the development of better organic nitrates for clinical use.
Editorial
Authors: Wainwright CL , McGrath JC
Published: August 2009

A themed section in this issue of Br J Pharmacol, on ‘Advances in Nutritional Pharmacology’, provides a valuable and timely update on progress in this area.

The value of dietary components to improvement in health and, particularly, to prevention of cardiovascular disease and cancer, is frequently reported in the media and therefore often captures the attention of the wider public. Understanding the pharmacological mechanisms by which nutritional elements confer their health benefits enables us to keep the public informed, but also aids in the identification of new targets for drug development. In recent years there has been significant progress in this field.

Four rapidly developing areas are reviewed. Vosper (2009) covers the identification of a receptor for niacin and the subsequent development of selective agonists as lipid lowering agents. Wu‐Wong (2009) describes the development of new Vitamin D analogues for the treatment of cardiovascular disease. de Roos et al. (2009) provide detailed insight into how omega‐3 fatty acids, also known as longchain n‐3 polyunsaturated fatty acids (PUFAs) protect against cardiovascular disease. Zhou et al. (2009) cover the mechanisms underlying the beneficial effects of resveretrol in protection against cancer.

These reviews are complimented by three key original articles focusing on endogenous mechanisms of weight control involving endocannabinoids (Izzo et al., 2009), a circulating protein, the soluble leptin receptor (Zhang & Scarpace, 2009) and a treatment, zinc plus cyclo‐(His‐Pro) (CHP), known to increase insulin metabolism (Song et al., 2009).
Risk‐Reducing Legal Documents: Controlling Personal Health and Financial Resources
Authors: Greenberg Michael R. , Weiner Marc , Greenberg Gwendolyn B.
Published: August 2009

Every adult can eliminate the risk of losing control of personal health decisions and financial resources by having a last will and testament, health proxy, power of attorney, and living trust. Yet evidence suggests that less than a majority of adult Americans have these documents. We surveyed 900 adult Americans (25 plus years old) to determine what factors predict the possession of these risk‐reducing documents. In total, 46% had a living will and testament, 32% a durable power of attorney, 30% a health proxy, and 18% a living trust. Events that prompt people with wealth to secure these documents, such as increasing age, getting married, having children, and experiencing a life‐threatening event were the strongest predictors of having a will. These were also among the strongest predictors of having a health proxy, along with a personal history of being proactive, and a family history that fostered trust of attorneys. Affluence, age, and education were the strongest predictors of having a living trust, and the strongest correlate of having a durable power of attorney was having faced a life‐threatening event, positive experiences with attorneys, and higher educational achievement.
The Role of Environmental Accidental Risk Assessment in the Process of Granting Development Consent
Authors: Kontic Branko , Gerbec Marko
Published: August 2009

Environmental impact assessment (EIA) is a procedure that must be followed for certain types of development before they are granted development consent. The procedure requires the developer to compile an environmental impact report (EIR) describing the likely significant effects of the project on the environment. A regulatory requirement in Slovenia is that an accidental risk assessment for a new installation should be a part of an EIR. The article shows how risk assessment (RA) related to accidental release of methylene diphenyl diisocyanate (MDI) or a polyvalent alcohol mixture from a new planned unit of a chemical factory in the Alpine region of Slovenia was performed in the framework of an EIA for the purpose of obtaining a construction permit. Two accidental scenarios were considered: (a) a spill of 20 m3 of MDI or polyvalent alcohol mixture into the river Soča (the river runs close to the chemical factory) and (b) a fire in the warehouse storing the raw material, where emission of toxic gases HCN, NOx, and CO is expected during combustion of MDI. One of the most important results of this case is the agreement among the developer, the competent authority, and a consultant in the field of EIA and RA to positively conclude the licensing process despite the absence of formal (regulatory) limit values for risk. It has been approved that transparent, reasonably uncertain, and semi‐quantitative environmental risk assessment is an inevitable component of an EIA, and an essential factor in informed, licensing‐related decision making.
Right Ventricular Remodeling after Transcatheter Closure of Atrial Septal Defect
Authors: Ding Jiandong , Ma Genshan , Huang Yaoyao , Wang Chen , Zhang Xiaoli , Zhu Jian , Lu Fengxiang
Published: August 2009

Background: Right ventricular (RV) volume overload is a well‐known cardiac consequence of atrial septal defect (ASD) shunt, accounting for most of its long‐term complications. Thus cardiac volumetric unloading is a major aim of transcatheter ASD closure. We set to study the right ventricular remodeling after transcatheter ASD closure in patients with secundum ASD. Methods: We enrolled 46 patients who underwent successful transcatheter closure of ASD. We performed routine transthoracic echocardiographic studies, including three‐dimensional echocardiography and right ventricular myocardial performance index (RVMPI), before transcatheter ASD closure, and 3 days, 1 month after transcatheter ASD closure. Results: We found that: (1) the right ventricular end‐diastolic volume (RVEDV) and right ventricular end‐systolic volume (RVESV) (respectively 106.54±25.97 vs 69.78±10.46 mL, P < 0.05; 59.73±17.59 vs 33.84±7.18 mL, P < 0.05) were enlarged in patients with ASD compared with those in control subjects, resulting in a marked decrease of the right ventricular ejection fraction (RVEF) (44.82%±4.51% vs 54.11%±5.89%, P < 0.05) from normal values; (2) the isovolumic relaxation and isovolumic contraction times (respectively [77.61±16.49] ms vs (64.09±11.82) ms, P < 0.05; [28.04±9.57] ms vs [20.45±6.53] ms, P < 0.05) were prolonged and ejection time ([250.02±24.21] ms vs [272.73±20.51] ms, P < 0.05) was shortened in patients with ASD compared with that in control subjects, resulting in a marked increase of the MPI (0.41±0.07 vs 0.31±0.05, P < 0.05) from normal values; and (3) after transcatheter closure, the RVEDV and RVESV decreased and the RVEF increased markedly and RVMPI decreased markedly. Conclusions: Transcatheter closure of ASD results in rapid normalization of RV volume overload and improvement of RV function. (ECHOCARDIOGRAPHY, Volume 26, November 2009)
Left Atrial Compliance and Pulmonary Venous Flow Velocities Are Related to Functional Status in Patients with Moderate‐to‐Severe Mitral Stenosis
Authors: Güray Yeşim , Demirkan Burcu , Karan Adnan , Güray Ümit , Boyacı Ayça , Korkmaz Şule
Published: August 2009

Aim: In mitral stenosis (MS), left atrial (LA) compliance plays a crucial role in the occurrence of symptoms and pulmonary arterial hypertension and can alter pulmonary venous flows (PVF). The aim of present study is to compare LA compliance (net atrioventricular compliance‐Cn) and PVF velocities in patients with different functional status despite similar mitral valve area (MVA). Additionally, the relationships of the same variables with each other and other echocardiographic parameters showing the hemodynamic severity of mitral stenosis were investigated. Methods: Thirty‐one patients with moderate to severe mitral stenosis were studied. The patients were divided into two groups according to their NYHA functional classes (FC). The patients with lower FC (NYHA FC1 and FC2) were included in Group I(n = 15), and those with FC ≥ 3 included in Group II (n = 16). All patients underwent comprehensive transthoracic and transesophageal echo Doppler examination. Results: Despite similar LA size, MVA, and transmitral diastolic pressure gradients, systolic pulmonary artery pressure (SPAP) was significantly higher and LA compliance was significantly lower in Group II as compared to group I. Also, systolic PVF velocity (PVs), diastolic PVF velocity (PVd), and PVs/PVd ratio were significantly lower in Group II as compared to Group I. In whole group, significant positive correlations between LA compliance and PVs (r = 0.38, P = 0.035), as well as PVd (r = 0.40, P = 0.023) and, significant negative correlation between LA compliance and SPAP (r =– 0.36, P = 0.047) were noted. Conclusion: Our findings suggested that in patients with MS, when there is inconsistency between symptomatic status and conventional echocardiographic variables, simple and noninvasive Doppler parameters, LA compliance, and PVF could be measured before cardiac catheterization for more accurate and complete evaluation of patients. (ECHOCARDIOGRAPHY, Volume 26, November 2009)
Effect of Continuous Positive Airway Pressure Therapy on Aortic Stiffness in Patients with Obstructive Sleep Apnea Syndrome
Authors: Keles Telat , Durmaz Tahir , Bayram Nihal Akar , Ciftci Bulent , Yeter Ekrem , Akcay Murat , Bozkurt Engin
Published: August 2009

Objective: The most significant complications seen in patients with obstructive sleep apnea syndrome (OSAS) are associated with the cardiovascular system. The present study assessed aortic stiffness in patients with OSAS and evaluated the effect of continuous positive airway pressure (CPAP) therapy on aortic stiffness. Method: Twenty‐four patients with newly diagnosed, previously untreated, moderate or severe OSAS (apnea‐hypopnea index > 15) and a control group of 17 healthy patients were included in the study. M‐mode recordings of the ascending aorta were taken from the parasternal long axis by echocardiograhy, and systolic and diastolic diameters of the aorta were measured. Aortic elastic parameters, aortic strain, and distensibility were calculated. Measurements were repeated after 6 months of CPAP therapy in patients with OSAS and were compared with baseline values. Results: In patients with OSAS, compared with the control group, aortic strain (6.7%± 2.1% vs. 12.4%± 3.1%; P < 0.001) and aortic distensibility (2.8 ± 0.9 × 10−6 cm2 dyn−1 vs. 5.5 ± 1.7 × 10−6 cm2 dyn−1; P < 0.001) were evidently lower, and there was a significant correlation between aortic elastic parameters and AHI. After a 6‐month course of CPAP therapy, significant increases were observed in aortic strain (6.1%± 1.5% vs. 7.3%± 1.7%; P < 0.001) and aortic distensibility (2.5 ± 0.7 × 10−6 cm2 dyn−1 vs. 3.1 ± 0.9 × 10−6 cm2 dyn−1; P < 0.001) in patients with OSAS. Conclusion: Aortic strain and distensibility were lower in patients with OSAS than in control patients, and CPAP treatment provided improvement in aortic elastic parameters. (ECHOCARDIOGRAPHY, Volume 26, November 2009)
Mysterious PTH values after parathyroidectomy in a patient on maintenance dialysis
Authors: THOMPSON Marla , SCHILLER Brigitte
Published: August 2009

A 25‐year‐old patient with end‐stage renal disease on maintenance peritoneal dialysis underwent parathyroidectomy when his secondary hyperparathyroidism did not respond to medical management. However, over the subsequent months he developed extremely raised parathyroid hormone (PTH) levels. When surgical removal of the autotransplant was considered, preoperative work‐up revealed a PTH level within the target range. It became apparent that the very high PTH values were due to the location of the blood draw close to the autotransplant, thus measuring a local rather than the systemic PTH value. The multiple causes of varying PTH measurements other than clinical and physiological reasons are reviewed.
Reliability of Vision Screening Tests for School Children
Authors: Ore Liora , Tamir Ada , Stein Nili , Cohen‐Dar Michal
Published: August 2009

Purpose: Estimate the reliability of the E‐chart as used with Israeli school children.

Design: Cross‐sectional, population‐based study conducted among 751 Israeli students of the Northern District, aged 6‐ and 7‐year‐olds and 13‐ and 14‐years‐old in 30 schools in 2003.

Methods: Each student was screened separately by two public health nurses using the illiterate E‐chart. Collected data included the students’ vision and demographic characteristics, the nurses’ professional background, and whether they referred students for medical testing. The reliabilities of vision testing and of the recommendations were determined using total, positive, and negative percentages of agreement and Kappa coefficients.

Findings: Total percentage of agreement on vision (combined findings for both eyes) was 78.2% (Kappa 0.47, 95%CI 0.41–0.53). Logistic regression models to predict agreement on vision abnormality showed a higher percentage of agreement among females and 13‐ and 14‐year‐old students than among males and 6‐ and 7‐year old students. Total agreement of 85.8% was found in referral recommendations (Kappa 0.58, 95%CI 0.51–0.65). Significant relationships were noted with student age, ethnicity, subdistrict of residence, nurse seniority, and agreement on vision findings.

Conclusions: Improvement in school vision‐screening reliability is needed, especially among 6‐ and 7‐year‐old students. To this end, the determinants of fair reliability should be investigated and training programs planned. Reasons for differences in the reliability of nurses’ recommendations detected among subdistricts must be further studied, together with careful supervision, to ensure better performance and adherence to PHS guidelines. Implications for nurses and nursing should be considered.

Clinical Relevance: Demographic characteristics were found to predict reliability, which can guide nurses in selecting students who need more careful attention or closer supervision during vision testing.
Supervisors are Central to Work Characteristics Affecting Nurse Outcomes
Authors: Rodwell John , Noblet Andrew , Demir Defne , Steane Peter
Published: August 2009

Purpose: To examine the predictive capability of the demand‐control‐support (DCS) model, augmented by organizational justice variables, on attitudinal‐ and health‐related outcomes for nurses caring for elderly patients.

Design: The study is based on a cross‐sectional survey design and involved 168 nurses working with elderly patients in facilities of a medium to large Australian organization.

Method: Participants were asked to complete a questionnaire consisting of scales designed for measuring independent (e.g., demand, control, support, organizational justice) and dependent (e.g., job satisfaction, organizational commitment, wellbeing and psychological distress) variables. Multiple regression analyses were undertaken to identify significant predictors of the outcome variables.

Findings: The DCS model explains the largest amount of variance across both the attitudinal and health outcomes with 27% of job satisfaction and 49% of organizational commitment, and 33% of psychological distress and 35% of wellbeing, respectively. Additional variance was explained by the justice variables for job satisfaction (5%), organizational commitment (4%), and psychological distress (23%).

Conclusions: Using organizational justice variables to augment the DCS model was valuable in better understanding the work conditions experienced by nurses caring for elderly patients. Inclusion of curvilinear effects added clarity to the potentially artifactual nature of certain interaction variables.

Clinical Relevance: The results indicated practical implications for managers of nurses caring for elderly patients in terms of developing and maintaining levels of job control, support, and fairness, as well as monitoring levels of job demands. The results particularly show the importance of nurses’ immediate supervisors.
Expression pattern of GATA‐3 in embryonic and fetal human skin suggests a role in epidermal and follicular morphogenesis
Authors: Sellheyer Klaus , Krahl Dieter
Published: August 2009

Background: The transcription factor GATA‐3 was recently identified as a master regulator in the specification of the inner root sheath. Additionally, it seems to play a role in skin barrier physiology. p63 binds and transactivates the GATA‐3 promoter. While the expression profile of GATA‐3 is delineated for the mouse, little is known about its expression in the adult human hair follicle and no studies are published about its distribution during human cutaneous embryogenesis.

Methods: We examined samples from embryonic, fetal and adult human skin for the expression of GATA‐3 using immunohistochemistry.

Results: GATA‐3 is expressed late during human skin development. Its expression pattern is comparable to the mouse and confined to the Huxley layer and inner root sheath cuticle but sparing the Henle layer. In addition, GATA‐3 localizes to the spinous cell layer of the interfollicular epidermis.

Conclusions: From the described expression pattern, it is highly probable that GATA‐3 plays a role in follicular and epidermal morphogenesis. What the anatomically confined expression of GATA‐3 to the spinous layer means biologically for the physiology of the skin is still unclear. Likewise, it still needs to be shown if GATA‐3 could be exploited in the diagnosis of adnexal neoplasms.

Sellheyer K, Krahl, D. Expression pattern of GATA‐3 in embryonic and fetal human skin suggests a role in epidermal and follicular morphogenesis.
Taxonomic diversity as complementary information to assess plant species diversity in secondary vegetation and primary tropical deciduous forest
Authors: Moreno Claudia E. , Castillo‐Campos Gonzalo , Verdú José R.
Published: August 2009

Question: Species diversity is commonly expressed as the number of species present in an area, but this unique value assumes that all species contribute equally to the area's biodiversity. Can taxonomic diversity be used as a complementary measure for species richness in order to assess plant biodiversity in remnants of primary forest and patches of secondary vegetation?

Location: Veracruz, Mexico.

Methods: Using data from six sampling transects of each vegetation type in an elevation gradient (400‐900 m a.s.l.), we compare the point, mean and cumulative floristic diversity of primary forest and secondary vegetation in a tropical deciduous landscape, using species richness and two measures of taxonomic diversity: average taxonomic distinctness (Δ+) and variation in taxonomic distinctness (Λ+). We performed a randomization test to detect differences in the observed taxonomic diversity, from the expected values derived from the species pool of each vegetation type.

Results: We found that the species of secondary vegetation are more closely related at low taxonomic levels (lower Δ+ value) than the species of primary forest remnants. Also, in secondary vegetation the distribution of species is uneven among the taxonomic levels and units (high Λ+ value). These patterns are consistent for point, mean and cumulative taxonomic diversity. Families Asteraceae, Euphorbiaceae, Fabaceae and Poaceae are over‐represented, while families Bromeliaceae, Cactaceae, Orchidaceae and Pteridaceae are under‐represented in secondary vegetation.

Conclusions: Although in a previous paper we concluded that secondary vegetation is more alpha‐diverse than primary forest (in terms of both cumulative and mean species richness), and beta‐diversity between vegetation types is notoriously high, we now provide a wider view by highlighting the importance of taxonomic diversity in primary forest remnants. Our data indicate that to measure biodiversity accurately, we should seek to capture its different facets. This will allow us to make conservation recommendations based on a broader view, and not on a single dimension.
How Contraceptive Use Affects Birth Intervals: Results of a Literature Review
Authors: Yeakey Marissa Pine , Muntifering Carie J. , Ramachandran Daesha V. , Myint YeMon , Creanga Andreea A. , Tsui Amy O.
Published: August 2009

Short birth intervals can have adverse consequences for maternal and infant outcomes. Optimal birth spacing is often presumed to be achieved through the practice of family planning and use of contraceptives, yet most of the available research does not address explicitly the contribution of contraceptive‐method use to birth spacing or maternal and infant survival. We conducted a systematic literature review to assess the body of evidence linking contraceptive use to birth‐interval length. Fourteen studies published in English between 1980 and 2008 met our eligibility criteria for inclusion. The findings from these studies are mixed but suggest that the use of contraceptives is protective against short birth intervals. Although results are favorable, many of the studies and methodologies employed are dated. More current research is needed to determine the impact of contraceptive‐method use on birth‐interval length in order to inform the promotion of family planning for reducing maternal and infant morbidity and mortality through birth spacing.