bluuebunny/crossref_metadata_2025 huggingface dataset:
Cochlear Implantation in 3 Patients with Osteogenesis Imperfecta: Imaging, Surgery and Programming Issues
Authors: Rotteveel Liselotte J.C. , Beynon Andy J. , Mens Lucas H.M. , Snik Ad F.M. , Mulder Jef J. , Mylanus Emmanuel A.M.
Published: November 2007

Osteogenesis imperfecta (OI) is a heterogeneous disease of the connective tissue caused by a defective gene that is responsible for the production of collagen type I, leading to defective bone matrix and connective tissue. Hearing loss affects 35–60% of the patients and will progress to deafness in 2–11% of OI patients for whom cochlear implantation may become the only remaining treatment option. Three patients with OI were retrieved from the Nijmegen Cochlear Implant Centre’s database. Most of the specific observations in ear surgery on patients with OI, such as brittle scutum, sclerotic thickening of the cochlea, hyperplastic mucosa in the middle ear and persistent bleeding, were encountered in these 3 patients. In case 3, with severe deformities on the CT scan, misplacement of the electrode array into the horizontal semicircular canal occurred. In all 3 cases, programming was hindered by nonauditory stimulation. Even after reimplantation, nonauditory sensations lead to case 3 becoming a nonuser. Averaged electrode voltages in case 3 were deviant in accordance with an abnormally conductive otic capsule. Spatial spread of neural excitation responses in cases 1 and 2 suggested intracochlear channel interaction for several electrodes, often in combination with facial nerve stimulation (FNS). In case 1, the estimated pitch of the electrodes that caused FNS varied consistently. Despite the electrophysiological changes, after 1-year follow-up, open set phoneme scores of 81% and 78% were reached in cases 1 and 2, respectively. When aware and prepared for the specific changes of the temporal bone in OI, cochlear implantation can be a safe and feasible procedure. Preoperative imaging is recommended to be fully informed on the morphology of the petrosal bone. In case of severe deformities on the CT scan, during counseling the possibility of misplacement should be mentioned. Rehabilitation is often hindered by FNS requiring frequent refitting.
The Benefits of Combining Acoustic and Electric Stimulation for the Recognition of Speech, Voice and Melodies
Authors: Dorman Michael F. , Gifford Rene H. , Spahr Anthony J. , McKarns Sharon A.
Published: November 2007

Fifteen patients fit with a cochlear implant in one ear and a hearing aid in the other ear were presented with tests of speech and melody recognition and voice discrimination under conditions of electric (E) stimulation, acoustic (A) stimulation and combined electric and acoustic stimulation (EAS). When acoustic information was added to electrically stimulated information performance increased by 17–23 percentage points on tests of word and sentence recognition in quiet and sentence recognition in noise. On average, the EAS patients achieved higher scores on CNC words than patients fit with a unilateral cochlear implant. While the best EAS patients did not outperform the best patients fit with a unilateral cochlear implant, proportionally more EAS patients achieved very high scores on tests of speech recognition than unilateral cochlear implant patients.
Central Auditory Impairment in Unilateral Diencephalic and Telencephalic Lesions
Authors: Biedermann Franziska , Bungert Peggy , Dörrscheidt Gerd Joachim , von Cramon D. Yves , Rübsamen Rudolf
Published: November 2007

The extent of perceptual impairment following unilateral lesions in the auditory cortex, its thalamic or callosal afferents was studied with psychoacoustic tests. Thresholds for the discrimination of signal frequency, intensity and duration were acquired under three different conditions of headphone stimulation (‘monaural’, ‘interaural’, and ‘dichotic signal/noise tests’) using the three-alternative forced-choice procedure. The different test alternatives generated distinct auditory percepts, which is in accordance with the assumption of specific signal processing at the level of the auditory brainstem and at thalamocortical auditory areas. Twenty-one patients from neurology were studied who suffered from unilateral lesions in the auditory cortex, the auditory thalamus, or the acoustic radiation. Location and extent of the lesions were assessed by magnetic resonance imaging. Monaural tests of either ear revealed no deficits in auditory performance. The patients showed impaired discrimination of signal frequency, intensity and duration in the dichotic signal/noise tests, when the signals were presented to the ear contralateral and the noise ipsilateral to the lesion. With inverted signal and noise stimulation, however, the thresholds were in the range of age-matched controls. All patients were able to master the interaural tests, which indicates the preserved ability to lateralize sound sources to the left and to the right with either one of the auditory cortices left intact. Another 24 patients were studied who had lesions mostly close to but sparing the before-mentioned auditory structures. All of them showed unimpaired performance in all test alternatives. The results indicate the specificity of the dichotic signal/noise tests for the identification of unilateral lesions in thalamocortical auditory structures. In addition, the results also point to the capacity of each telencephalic hemisphere to process the full range of auditory lateralization from left to right.
Management of Complicated Choledochal Cysts
Authors: Lal Richa , Agarwal Shaleen , Shivhare Rakesh , Kumar Ashok , Sikora Sadiq S. , Kapoor Vinay K. , Saxena Rajan
Published: November 2007

Objectives: The presentation of choledochal cysts (CDCs) is altered by complications such as acute severe cholangitis, hepatolithiasis, spontaneous perforation, portal hypertension, pancreatitis, malignancy of the biliary tract and previous surgery in the form of internal drainage of the cyst. The management and the outcome of such complicated cysts differ from that of an uncomplicated CDC. This presentation is an analysis of our experience with complicated CDCs. Patients and Methods: One hundred and forty-four patients with CDCs were managed at a tertiary level referral hospital in North India, between January 1989 and June 2004. Thirty-three (23%) CDCs were associated with complicating factors: severe cholangitis requiring a biliary drainage procedure prior to definitive operative procedure (n = 11), spontaneous perforation (n = 3), hepatolithiasis (n = 6), acute cholecystitis (n = 1), recurrent acute pancreatitis (n = 1), chronic pancreatitis (n = 1), gastric outlet obstruction (n = 1), portal hypertension (n = 6), biliary tract malignancy (n = 4) and previous internal drainage of the cyst (n = 5). Five patients had more than one complication. The management outcome of complicated CDCs was compared with that of uncomplicated CDCs. Results: Complicated CDCs were significantly more common with type IV-A anatomy. Endoscopic, percutaneous or external surgical biliary drainage procedure was performed in 14 complicated CDCs prior to cyst excision. Desired definitive surgical procedure could be performed in 26/33 (79%) patients with complicated CDCs as compared to 107/111 (96%) patients with uncomplicated CDCs. Four (12%) patients with complicated CDCs had early postoperative complications as compared to 9/111 (8%) patients with uncomplicated CDCs. During a median follow-up of 13 months (2 months to 8 years), 2 patients with complicated CDCs died due to advanced secondary biliary cirrhosis and advanced gall bladder cancer, respectively. Six patients reported complications. Of the 6 patients, 3 required reoperation for a strictured hepaticojejunostomy (n = 2) and hepatolithiasis (n = 1). In contrast, there was no disease-related mortality and only 1 out of 111 patients with uncomplicated cysts had a complication during follow-up. Conclusion: Complicated CDCs merit a carefully planned management strategy including percutaneous, endoscopic and surgical procedures. The management may have to be staged. The outcome depends on the nature of complication and the management strategy adopted.
Long-Term Adherence to Interferon β Therapy in Relapsing-Remitting Multiple Sclerosis
Authors: Portaccio E. , Zipoli V. , Siracusa G. , Sorbi S. , Amato M.P.
Published: November 2007

Background/Aims: To assess the proportion and the reasons of drop-outs in relapsing-remitting multiple sclerosis patients treated with interferon-β (IFNB) and the outcome of switching subjects. Methods: Patients stopping IFNB were classified according to the reason of drop-out: perceived lack of efficacy (PLE) side effects (SE) and other reasons. Long-term adherence was described using the Kaplan-Meier curves. Results: We evaluated 225 subjects (158 women; age = 36.6 ± 9.2 years, disease duration = 8.0 ± 6.1 years, Expanded Disability Status Scale score = 1.9 ± 1.2) who received Betaferon (46), Avonex (88) and Rebif (91) therapy. The mean follow-up duration was 4.2 ± 2.7 years. Forty-six percent of patients suspended therapy, 29% because of PLE, 15% because of SE and the remaining 2% due to other reasons. Twenty-five out of 33 subjects who suspended IFNB because of SE and 62 out of 65 patients who suspended the therapy due to PLE were switched to another disease-modifying drug. At the end of the follow-up, the majority of these patients could continue the treatment. Conclusions: When starting IFNB therapy in relapsing-remitting multiple sclerosis, a relatively high proportion of discontinuation is to be expected over time. Switching from a treatment to another taking into account the reasons of drop-out and the disease activity is a suitable option.
Prevalence and Severity of Multiple-Sclerosis-Associated Fatigue in Treated and Untreated Patients
Authors: Putzki Norman , Katsarava Zaza , Vago Susanne , Diener H.C. , Limmroth Volker
Published: November 2007

Fatigue is one of the most frequent and most disabling symptoms in multiple sclerosis (MS). We investigated the possible association of the MS-related fatigue syndrome with the available disease-modifying therapies and the main disease characteristics in a cross-sectional study on 320 consecutive patients. The prevalence of severe fatigue (Fatigue Severity Scale score ≧5) was 50%. In a multivariate regression model controlling for age, disease subtype, duration and disability we did not find a significant association between the use of immunosuppressive or immunomodulatory drugs compared to no treatment (OR = 1.34, p = 0.38 for immunosuppressants; OR = 0.95, p = 0.85 for immune-modulating agents). Although all used disease-modifying agents successfully reduce disease activity and inflammation, they do not appear to exhibit a significant effect on MS-related fatigue.
Toward a Further Elucidation: Role of Vertebral Artery Hypoplasia in Migraine with Aura
Authors: Chuang Yu-Ming , Hwang Yuan-Chung , Lin Ching-Po , Liu Chih-Yang
Published: November 2007

A higher frequency of hypoplasic vertebral artery (VA) in patients with migraine with aura than in normal controls has been documented. However, the role of a hypoplasic VA in a migraine attack remains unclear. The aim of our work was to measure the net VA flow volume and related spectral parameters in patients with migraine with aura and a hypoplasic VA. From January 2005 to October 2005 we reviewed the records of 250 migraine outpatients (108 men and 142 women; mean age = 30.8 ± 14.0 years, range = 25–55). Ninety-two patients with migraine with aura were selected. Among these patients, 26 had a hypoplasic VA that was delineated by cervical magnetic resonance angiography. We performed a case-control study that included these 26 migrainous patients. Duplex color-coded ultrasonography was utilized to calculate the spectral parameters during attacks and headache-free periods. The net VA flow volume did not decrease during attacks. A reduction in the resistance index of the hypoplasic VA was noted during attacks in subjects who had migraine with aura. Our observation of VA vasomotor alteration during migraine attacks extends the understanding of the role of a hypoplasic VA. Vasomotor regulation of the VA could be neurogenic in origin. We hypothesize that VA hypoplasia contributes to migraine through complex neurovascular pathways rather than through its low flow volume.
Sex Differences in Acute Stroke Care in a Statewide Stroke Registry
Authors: Gargano Julia Warner , Wehner Susan , Reeves Mathew
Published: November 2007

Background and Purpose—

Many studies have reported poorer stroke outcomes in women, and some studies have reported sex differences in care. We analyzed data from a hospital-based stroke registry to determine whether acute stroke care and discharge status differed by sex.

Methods—

Detailed chart-level information was collected on 2566 subjects admitted for acute stroke or transient ischemic attack to 15 Michigan hospitals in 2002. Sex differences in stroke care and patient status at discharge (in-hospital mortality and modified Rankin Scale score) were assessed after adjusting for differences in demographics, clinical characteristics, and comorbidities by multivariable models. Modified Rankin Scale score data were analyzed by proportional-odds models.

Results—

Women were older than men (70 vs 67 years) and were more likely to have congestive heart failure and hypertension. Men were more likely to smoke and have a history of heart disease and dyslipidemia. After multivariable adjustment, women were less likely to receive thrombolytic therapy (odds ratio [OR]=0.56; 95% CI, 0.37 to 0.86) or lipid testing (OR=0.76; 95% CI, 0.61 to 0.94) and were more likely to suffer urinary tract infections (OR=2.57; 95% CI, 1.87 to 3.54). In-hospital mortality was similar in women and men (9% vs 8%); however, women had poorer discharge modified Rankin Scale scores (OR=1.17; 95% CI, 1.01 to 1.35).

Conclusions—

Although considerable parity exists in many aspects of acute stroke care, women were less likely than men to receive thrombolytic treatment and lipid testing, even after adjustment. However, given the largely similar care observed, it is unlikely that differences in care explain the poorer functional outcomes in female stroke survivors.
Church Politics and the Genocide in Rwanda
Authors: Longman Timothy
Published: November 2007

Christian churches were deeply implicated in the 1994 genocide of ethnic Tutsi in Rwanda. Churches were a major site for massacres, and many Christians participated in the slaughter, including church personnel and lay leaders. Church involvement in the genocide can be explained in part because of the historic link between church and state and the acceptance of ethnic discrimination among church officials. In addition, just as political officials chose genocide as a means of reasserting their authority in the face of challenges from a democracy movement and civil war, struggles over power within Rwanda's Christian churches led some church leaders to accept the genocide as a means of eliminating challenges to their own authority within the churches.
Modern Religiousness : Extrinsic , Intrinsic or quest?
Authors: Kalbheim Boris , Ziebertz Hans-Georg , Feeser-Lichterfeld Ulrich , Schlöder Bernd
Published: November 2007

The authors examine the religiousness of theology students and students in other disciplines at several German universities in a context of religious differentiation and pluralisation. Based on Batson's model, religiousness is classified into intrinsic, extrinsic and quest orientations. The religiousness of students of theology and students in other fields was found to differ significantly in the three dimensions. Non-theologians tended to ascribe negative value to the extrinsic and the intrinsic dimensions, with the intrinsic dimension being valued more negatively. At the same time they ascribed a slightly positive value to the quest orientation. Theology students valued all three dimensions positively, with especially strong positive value attached to the quest orientation. Using cluster analysis, four types of religiousness were developed: a "conventionally religious" type, a type described as "not religious in a Christian sense", a "questioning and religious" type, and a "strongly religious" type. Theology students fit mainly into the "strongly religious" and "questioning and religious" types. Students in other fields were concentrated in the "conventionally religious" and "not religious in a Christian sense" categories. At the end, the results are discussed from the perspective of practical theology.
Authorship and Teamwork Around the Cimento Academy: Mathematics, Anatomy, Experimental Philosophy
Authors: BERTOLONI MELI Domenico
Published: November 2007

Multiple authorship is so common and pervasive in our world that it is tempting to take it for granted. Prior to the twentieth century, however, multiple authorship was exceedingly rare. This essay addresses the issue of whether in the past
Heilige Als Patrone Gegen Den Schlaganfall1
Authors: Karenberg Axel , Peter Moog Ferdinand
Published: November 2007

In Christian Europe of the High Middle Ages, saints played a central role in the everyday life of the ailing. Alongside healing attempts which involved magic and/or scientifically-based medicine, the invocation of specific patron saints for protection against evils or for the curing of ailments was a widespread practise. A large choice of patron saints was "available" for a wide range of diseases, especially those nowadays classified as neurologic or psychiatric. For the falling sickness alone, e.g., there is evidence of some twenty patron saints reputed to have a particular involvement. Surprisingly, there is no evidence of a comparable devotion to patrons for apoplectics. This "negative result" is confirmed by a thorough examination of medieval sources. St. Wolfgang and St. Andreas Avellino are the only two proven stroke patrons. Both, however, were only known within their respective locations. The absence of a specific supportive Christian figure for stroke victims deserves particular analysis: The high fatality rate of apoplexy and the lack of commercial interest on the part of the Christian places of pilgrimage may serve as possible explanations.
Pilgerfahrt – Weg und Bewegung
Authors: Haab Barbara
Published: November 2007

This article investigates the subject of pilgrimage and change, regarding the pilgrimage to Santiago de Compostela from a pilgrim's perspective. Two aspects of change are being looked at more closely: 1. The inner transformation of today's pilgrims during their pilgrimage, as well as the factors leading to their transformation, and 2. The occurance of recent structural changes of the pilgrimage and their background. These changes also reflect the tensions between pilgrimage and tourism, and the pilgrims and the politics of pilgrimage respectively.
Das Sator-Quadrat
Authors: Stein Herbert
Published: November 2007

The Sator square is a widespread palindrome: It may be read like a grid from left to right and vice versa, from top to bottom and vice versa. For nearly 2,000 years, it has been serving above all for magic purposes, among other things for healing sick persons, furthermore as a magic fire extinguisher. The sequence of letters was a riddle and invited contradictory attempts to solve it. The author pleads for not taking it only as a challenge for the riddle-solving mind, but also for reading it in the bustrophedon way, i.e. bidirectionally, as the ox turns when ploughing. Doing so, a swaying rhythm would result. The cruciform middle as a cosmological cross, however, would symbolise absolute stability, and thus the complex unity would lead to „mountains moving“ faith. In research with the random generator working with Strontium 90, the Schmidt-machine, resulted that such a mental state is indeed favourable for psychokinetic effects (von Lucadou). So far, magic can be accompanied by science today. But the mystic consciousness expressed by the central TENET remains out of the positivistic science's reach and demands a different kind of religious psychology for its articulation.
Accessing the Forgiveness Construct
Authors: Scobie G.E.W. , Scobie E.D.
Published: November 2007

During the last few years forgiveness has been seen as an important element in psychological health. The development of forgiveness therapy and its application by psychotherapists to areas like family therapy attests to its growing significance. As a consequence it is important to investigate what people understand by forgiveness and in what circumstances this knowledge structure is retrieved.

The present study forms part of ongoing research to access and measure a person's construct of forgiveness. Two studies are compared across three dimensions: semantics, questionnaire instructions and five methods of accessing a forgiveness knowledge structure. In the first study, 49 students from the University of Glasgow were presented with descriptions or videoed scenarios of an act of infidelity. After each presentation they completed the Scobie Forgiveness Scale (SFS, 1996). In the second study, 315 students from the University of Glasgow completed four measures, only the SFS is used in the current study.

A comparison of the studies suggests that minor word changes and questionnaire instructions may not exert a significant influence on participants’ responses. However, different methods of accessing knowledge structures may have an effect on an individual's construct of forgiveness. The results suggest that different methodologies (video, descriptive scenarios, personal experience, experience of friend/relative or fictional character), affect participants’ responses in both the forgiver and the forgiven mode. The findings may have implications for the general accessing of knowledge systems and for the measurement of forgiveness.
Clinical Psychology of Religion: A Training Model
Authors: van Uden Marinus , Pieper Jos
Published: November 2007

In this paper we will show you a part of a course “Clinical Psychology of Religion” that has been developed in the Netherlands for introducing mental health professionals in the field of clinical psychology of religion. Clinical psychology of religion applies insights from general psychology of religion to the field of the clinical psychologist. Clinical psychology of religion can be defined as that part of the psychology of religion dealing with the relation between religion, worldview and mental health. Like the clinical psychologist, the clinical psychologist of religion deals with psychodiagnostics and psychotherapy, but concentrates on the role religion or worldview plays in mental health problems. The relation between religion and mental health has been a subject for study since the start of the psychology of religion at the end of the last century. A number of authors have elaborated on the ways in which religion can be beneficial or detrimental to psychological health. In recent research we have found that there is a great need among psychotherapists to become better equipped in this field.
The Bible and Multiscripturality in South Africa: Moving Beyond the Boon-or-Bane Debate1
Authors: Punt Jeremy
Published: November 2007

A nominally Christian country, South Africa abounds with varieties of Christianity, all of which ultimately subscribe to the Bible as foundation document. Often, however, the appropriation of the Bible as a symbol is as much a problem as different and radically opposing interpretations of it: ownership of the Bible is widely contested and biblical hermeneutics is truly a site of struggle. However, not only is the need for an ecumenical approach to the Bible becoming increasingly pronounced, but ecumenicity will have to be broadened out to include multiscripturality as well. South Africa is simply also a multi-religious country with a number of other religions with their scriptures in close attendance. This demands a reappropriation of the Christian Bible as scripture amidst many other scriptures, and requires the development of an adequate, responsible and relevant multiscripturality. At the same time, it is necessary to move beyond over-simplified 'realist' options for conceptualising scripture and its role in religion. Perceiving scripture as activity rather than texts allows for investigating the interrelationship between scripture and identity, within a more adequate theology of scripture.
Die God Is Onse God ...1 Hymns, Hymnals and the National Identity of the Afrikaner2
Authors: Kloppers Elsabé
Published: November 2007

In this article the convergence of the religion and national identity of the Afrikaner is examined and related to the influence of these views on the hymnological tradition of the Afrikaner. It is argued that some metrical psalms used to be particularly popular especially because of the parallels seen between Israel of the Bible and the Afrikaner nation. The hymns or metrical psalms usually sung on the Day of the Covenant are significant in indicating the `national' hymns - hymns or metrical psalms that played a role in promoting national identity. Folk hymn tunes that may be seen as part of the national heritage, and the influence of hymnals in Afrikaans on the national identity are discussed. It is shown that an overbearing demand for preservation and protection of the national heritage' has hampered the development of a true Afrikaans hymnody and that an inspired new Afrikaans hymnody is still to be developed.
An Ethical Appraisal of the Third World Debt Crisis
Authors: Motlhabi Mokgethi B.G.
Published: November 2007

The aim of this article is not to investigate the Third World debt crisis in detail. Rather, it is to determine the work that has been done so far to provide an ethical perspective to or critique of the crisis and to make a personal assessment of this crisis. To achieve this goal, only some of those aspects of the debt crisis are highlighted which appear to be of ethical significance. Thousands of books have been written on the debt issue in general and the debt crisis itself, in particular. However, the amount of work that has been done to address the issue specifically from an ethical or theological perspective is quite negligible. It is hoped that this paper will make a small contribution to filling some of this gap.
Crossan's Historical Jesus as Healer, Exorcist and Miracle Worker
Authors: Craffert Pieter F.
Published: November 2007

No single Jesus profile in the last decade has generated more scholarly discussion and public interest than that of John Dominic Crossan. It is, however, not generally emphasised, that in his construction Jesus was also a healer, exorcist and miracle worker. This study consists of a critical discussion of the evidence, method and interpretive framework employed by Crossan. From an alternative construction of cross-cultural interpretation by means of medical anthropology, it is argued that on the basis of Crossan's evidence, it is impossible to conclude that Jesus was a healer or exorcist. However, such research provides a framework for appreciating the historicity of the type of healing, exorcistic and miracle stories ascribed to Jesus.
The Use of English Textbooks for Teaching English to 'Vocational' Students in Singapore Secondary Schools
Authors: Lee Rachel N. F. , Bathmaker Ann-Marie
Published: November 2007

■ This study explores teachers' beliefs in the use of English textbooks for teaching English in the upper secondary Normal Technical (NT) stream in Singapore. The NT stream in Singapore is a form of `vocational' pathway; pupils streamed into the NT classes are considered to be academically 'weakest' amongst all three streams in the secondary level. Using a semi-structured questionnaire, the study aims to identify factors influencing teachers' perceptions toward the roles the textbook plays in language teaching and learning. The findings are used to infer a relationship between teachers' use of textbooks and their attitudes towards the less academically - inclined' NT pupils. The results show that teachers' beliefs are related to factors that exist within and beyond the classroom. Among the factors identified, those related to the institution and classroom tended to have a greater influence in the way teachers used their textbooks. In particular teachers refer to the demands of meeting the stipulated pass rate in English examinations and NT students' cognitive weakness and behavioural problems. Besides pointing to the need for further research, the discussion brings out implications for curriculum and assessment review and teacher education in the technical-vocational streams in Singapore.
Visualizing Tourism Trends: A Combination of ATLAS.ti and BiPlot
Authors: Pan Steve , Chon Kaye , Song Haiyan
Published: November 2007

By analyzing 766 articles from travel trade magazines published in 2005, this article aims to identify tourism trends in the Asia—Pacific region. The qualitative analysis sketches a holistic conceptual network of relationships among trends, whereas the quantitative analysis visually presents the trends' commonalities or differences among four subregions (Northeast Asia, Southeast Asia, South Asia, and Oceania). This article differs from previous studies in that it counts the frequencies of quotations associated with codes rather than the commonly used keywords. Quotations are composed of sentences and paragraphs that provide a deeper and richer understanding of the context. And as the title implies, it visualizes the relationships among trends and between trends and sub-regions. Through visualizing the qualitative data holistically and individually, this approach is intended to “see the forest for the trees.”
A Model of Strategic Evaluation of a Tourism Destination Based on Internal and Relational Capabilities
Authors: Rodríguez-Díaz Manuel , Espino-Rodríguez Tomás F.
Published: November 2007

The complex reality of a tourist destination requires it to be managed as an integrated system. This work presents a strategic evaluation model of tourist destinations that permits their reality at a given moment to be visualized from an overall perspective. To that end, the model, which focuses on tourism supply chain management, specifies the principal attributes determining destination competitiveness. On that basis, this work analyzes the internal and relational capabilities of each attribute represented in a matrix according to their strategic value. This theoretical framework is empirically tested by means of a study to evaluate the tourist destination of Gran Canaria, which reflects the competitive reality of a mature destination. The results indicate that integrating measures based on sustainability must be taken to be able to re-launch the destination.
The New Environmental Paradigm and Nature-Based Tourism Motivation
Authors: Luo Yanju , Deng Jinyang
Published: November 2007

This study examines the relationship between environmental attitudes as measured by the new environmental paradigm (NEP) and nature-based tourism (NBT) motivations based on data gathered from a national forest park in China. The results indicate that tourists' environmental attitudes are heterogeneous across all four tourism motivations. Specifically, those who are more supportive of limits to growth and who are more concerned about ecocrisis tend to have a higher desire to be close to nature, to learn about nature, and to escape from routine and issues associated with cities. In addition, those whose motivations are oriented to develop skills and abilities or seek to experience new things, environments, and social contact tend to be more supportive of the notion of human over nature. Thus, it can be concluded that environmental attitudes and NBT motivations are closely and positively related. Research limits, theoretical and practical implications, and future research needs of the study are discussed.
Mortality and preoperative cardiac function in vascular amputees: an N-terminal pro-brain natriuretic peptide (NT-proBNP) pilot study
Authors: Riemersma Marcel , Dijkstra Pieter U. , van Veldhuisen Dirk Jan , Muskiet Frits A.J. , van den Dungen Jan A.M.M. , Geertzen Jan H.B.
Published: November 2007

Objective: To determine preoperative ventricular function in vascular amputees by measuring N-terminal pro-brain natriuretic peptide (NT-proBNP) and to analyse the relationship between NT-proBNP levels and 30-day postoperative mortality. Design: Prospective pilot study.

Subjects and methods: In 19 patients planned for a lower limb amputation for non-reconstructable peripheral arterial disease NT-proBNP was measured the day before amputation.

Results: Four amputees died within 30 days after the amputation. In 17 of 19 patients NT-proBNP values were found more than 2 standard deviations above the age corrected reference value. Pre-amputation NT-proBNP levels did not differ significantly between non-survivors and survivors (P = 0.162).

Conclusion: Preoperative NT-proBNP levels are not significantly related to 30-day mortality after lower limb amputation procedure. Preoperative NT-proBNP levels are very high, indicating that serious ventricular dysfunction may be present in vascular amputees.
Treatment of Acute Seizures and Status Epilepticus
Authors: Costello Daniel J. , Cole Andrew J.
Published: November 2007

Overt status epilepticus and persistent obtundation after a witnessed clinical seizure are neurologic emergencies. Early recognition and intervention in the electroclinical syndrome of status epilepticus reduces morbidity, although treatment of the underlying etiology is also critical. This review outlines key concepts related to status epilepticus, delineates an approach to the early management of status epilepticus, and highlights novel but practical approaches in the evaluation and treatment of refractory status epilepticus, emphasizing the use of a treatment algorithm. This review is written from the perspective of the intensive care unit clinician, and the approach and opinions expressed stem from clinical experience and review of the current literature. Particular attention is given to an overall approach to the management of convulsive status epilepticus in adults and older children as well as exploring novel approaches and diagnostic tools that may prove useful in difficult-to-control status epilepticus.
Implementation of a Handheld Electronic Point-of-Care Billing System Improved Efficiency in the Critical Care Unit
Authors: Fahy Brenda G. , Ketzler Jonathan T.
Published: November 2007

Coding and billing are time consuming and important considerations for critical care practitioners. A 1-year prospective, observational study incorporated the use of a personal digital assistant and MDeverywhere software (Hauppauge, New York) for patient coding and billing. Twelve months of data were examined before electronic implementation (pre-elec) and compared with a 12-month period after implementation (post-elec) by using an unpaired t test or z test with P < .05 considered significant. The total number of charges was 2479 pre-elec and 2243 post-elec. The days from date of service to billing for services significantly decreased from 37.8 pre-elec to 12.4 post-elec ( P < .001); days in accounts receivable significantly decreased from 92.0 to 73.0 ( P < .001). The net collection rate increased from 44.7% pre-elec to 49.3% post-elec ( P < .001). Duplicate charges significantly decreased from 5.0% pre-elec to 1.4% post-elec ( P < .001). The return on investment was 1.97-fold (197%). The initiation of personal digital assistant technology to facilitate billing and coding resulted in significant improvements.
Developing Cultural Competence as a Framework for Anti-heterosexist Social Work Practice
Authors: Charnley Helen M. , Langley Jackie
Published: November 2007

• Summary: This article examines the continuing marginalization of sexual orientation in social work practice. Taking the findings and recommendations of a small scale exploratory study as our starting point, we review United Kingdom (UK) research on social work and sexual orientation and illustrate the contradictions and constraints in implementing effective strategies for change. We explore the potential of cultural competence as a framework for developing anti-heterosexist practice.

• Findings: Current cultural competence frameworks have potential for developing anti-heterosexist practice through attention to awareness and understanding of attitudes, knowledge and skills. But they are limited by weak attention to underpinning theory, to the application of principles in practice, the complex reality of multi-cultural membership and the application of cultural competence at an organizational level.

• Applications : These findings have utility for social work students, educators and trainers, for the development of professional standards, for social work practice and supervision, and for organizations in creating inclusive learning and working environments and resisting heterosexism in social work.
The Relevance of Bourdieu for Social Work
Authors: Garrett Paul Michael
Published: November 2007

• Summary: The article welcomes social work's seemingly new interest in Pierre Bourdieu. However, it is important to recognize the problems inherent in his mammoth contribution.

• Findings: First, Bourdieu can often present his readers with challenges which make it difficult to grasp his core arguments. Here, major obstacles include: Bourdieu's prose style; the sheer scale of his `output' and related matters; the fact that most readers (perhaps especially those situated outside the French intellectual field and its associated cultural milieu) might fail to recognize key contextual factors only hinted at in his work; the misleading labels frequently attached to Bourdieu (for example, `Marxist' or `postmodernist'). The second area of difficulty relates to aspects of the theoretical content of Bourdieu's contribution. It is argued that his lack of engagement, even flawed contributions, relating to issues pivoting on multiculturalism, `race' and ethnicity is important. Furthermore, Bourdieu's conceptual apparatus possibly lays too great an emphasis on the dulled passivity of social actors, particularly the working class. Finally, his ideas on the function of the state can be viewed as problematic.

• Applications : If social work is going to evolve a more Bourdieusian form of theory and practice then there is a need to take into account the insights which his work provides and to address the problems which it presents.
Wound Fluids: A Window Into the Wound Environment?
Authors: Yager Dorne R. , Kulina Robert A. , Gilman Laura A.
Published: November 2007

Wound healing of the skin is a complex biologic process involving temporal interactions between numerous types of cells, extracellular matrix molecules, and soluble factors. The process of repair can be viewed as involving 3 or 4 phases: homeostasis, inflammation, synthesis, and remodeling. These phases occur at different times and differ in their cellular, biochemical, and physiologic requirements. Disruption of one or more of these interactions can significantly interfere with the repair process. Such comorbidities as age, nutrition, immune status, and underlying disease status (eg, diabetes or venous stasis) contribute additional intricacy to the repair process. Because of this complexity, care of chronic wounds remains highly individualized, and it should not come as a surprise that treatment of these wounds as a group with single target therapies have met with only modest success. A major hurdle in the progression toward improved treatment regimens has been the lack of objective biochemical and physiological landmarks that can be used to assess wound status. Collection and biochemical characterization of wound fluids presents the opportunity to noninvasively obtain information reflecting the status of the wound and of specific biomarkers. This review discusses the collection of wound fluid and highlights biomarkers that may be useful to this end.
Chemopreventive Potential of Aloe vera Against 7,12-Dimethylbenz(a)anthracene— Induced Skin Papillomagenesis in Mice
Authors: Chaudhary Geeta , Mali Ram Saini  , Pradeep Kumar Goyal
Published: November 2007

The present investigation was undertaken to explore the antitumor-promoting activity of Aloe vera on 2-stage skin carcinogenesis, induced by a single topical application of 7,12-dimethylbenz(a)anthracene and promoted by treatment of croton oil for 16 weeks in Swiss albino mice. Oral administration of aloe leaf extract at a dose of 1000 mg/kg body weight/d and aloe gel treatment at a dose of 1 mL/ 9 cm2/mice/d was found to be effective in decreasing the number and size of the papillomas. A significant reduction in tumor incidence (40.00 ± 5.10, 30.00 ± 3.25, and 40.00 ± 4.12 for aloe gel, aloe gel and aloe leaf extract combined, and aloe leaf extract alone, respectively) was observed in animals in the aloe extract— and aloe gel—treated groups compared with 100% tumor incidence in the control group. The cumulative number of papillomas during an observation period of 16 weeks was significantly reduced in the aloe-treated groups (8.0 ± 0.34, 6.00 ± 1.10, and 9.00 ± 1.41 for aloe gel, aloe gel and leaf extract, and aloe leaf extract, respectively) compared with a 36 ± 0.98 cumulative number of papillomas in the control group. The average latent period was significantly increased from 4.9 ± 0.10 weeks in the control group to 6.37 ± 0.12, 6.8 ± 0.25, and 6.2 ± 0.21 weeks in the aloe-treated groups, respectively. The tumor burden and tumor yield were significantly decreased (2.0 ± 0.25, 2.00 ± 0.30, and 2.25 ± 0.2 and 0.8 ± 0.25, 0.6 ± 0.32, and 0.9 ± 0.28, respectively) as compared with the 7,12-dimethylbenz(a)anthracene—treated control group (3.6 ± 0.10 and 3.6 ± 0.19). Furthermore, treatment with aloe gel and/or extract by topical and/or oral administration resulted in a significant increase in the reduced glutathione ( P < .05), DNA ( P < .001), catalase ( P < .05), and protein ( P < .001) in the skin of mice. Conversely, lipid peroxidation levels were significantly decreased ( P < .001) in the skin of mice.
Lesson From Comparison of CAM Use by Women With Female-Specific Cancers to Others: It's Time to Focus on Interaction Risks With CAM Therapies
Authors: Eschiti Valerie S.
Published: November 2007

There has been no examination as to whether the prevalence of complementary and alternative medicine (CAM) use, as well as personal factors associated with CAM use and predictive of CAM use for women with female-specific cancers, is similar to those in other diagnostic groups. The purpose of this review is to compare CAM use and personal factors associated with and predictive of CAM use by women with female-specific cancers to samples of other diagnostic groups. If it is the case that CAM use is similar across various types of samples, then it may be unnecessary to continue to study detailed CAM use by those in separate diagnostic groups and instead focus energies on the examination of CAM therapies that may have risks for interaction with conventional therapies, such as biologically based therapies. The researcher concludes that we are now in an era in which we need to use our restricted time, human resources, and finances to examine biologically based CAM use that may carry high risks for interactions or toxicities for specific groups under examination, rather than examine global CAM use, unless the situation warrants such all-inclusive study.
Assessing the Role of Evidence in Patients' Evaluation of Complementary Therapies: A Quality Study
Authors: Verhoef Marja J. , Mulkins Andrea , Carlson Linda E. , Hilsden Robert J. , Kania Anna
Published: November 2007

Background: Making the decision to use complementary and alternative medicine (CAM) for cancer treatment is difficult in light of the limited available evidence for these treatments. It is unclear how patients use evidence to make these decisions. Objectives: (1) Describe the type of information about CAM that cancer patients use in their decision making; (2) understand why certain types of information about CAM are accepted as evidence by cancer patients; and (3) explore the role of scientific evidence in treatment decision making. Methods: A qualitative study design using in-depth semistructured interviews with cancer patients attending 4 conventional and integrative health care institutions in Alberta and British Columbia, Canada, was used. Results: Twenty-seven patients were interviewed. Patients sought CAM information from a range of sources, including the Internet, health care providers, friends, relatives, and newspapers. Many expressed frustration about the overwhelming amount of available information and found it difficult to identify reliable information. Information was described as reliable if it supported them in arriving at a decision about CAM. Types of information participants identified included anecdotes, expert opinion, gut feeling, popular literature, scientific evidence, testimonials, advertising and trial and error. Profound differences were found between new CAM users, experienced CAM users, and users with late-stage cancer in type of information sought, the role of scientific evidence in decision making, and overall information needs. Conclusion: Although this was a relatively small qualitative study, the results suggest that (1) many patients do not value scientific evidence as highly as conventional providers and (2) it is important for clinicians and other information providers to be aware of the different types of information that patients seek out and access when making choices and decisions regarding CAM treatments and why they seek out these sources.
Apoptotic Effect of Biophytum sensitivum on B16F-10 Cells and Its Regulatory Effects on Nitric Oxide and Cytokine Production on Tumor-Associated Macrophages
Authors: Guruvayoorappan C. , Kuttan Girija
Published: November 2007

The present study is part of a large-scale investigation of the antitumor effects of Biophytum sensitivum on B16F-10 melanoma cells. The investigation involved the regulatory effect of B sensitivum on nitric oxide and cytokine production in B16F-10 cells, tumor-associated macrophages, and peritoneal macrophages as well as on the apoptotic process in B16F-10 melanoma cells. B sensitivum at a concentration of 10 µg/mL could significantly ( P < .001) inhibit production of nitric oxide and proinflammatory cytokines such as interleukin-1β, interleukin-6, granulocyte monocyte-colony stimulating factor, and tumor necrosis factor-α in B16F-10 cells, tumor-associated macrophages, and peritoneal macrophages. Incubation of B16F-10 cells with B sensitivum showed the presence of apoptotic bodies and induced DNA fragmentation. Furthermore, B sensitivum showed an inhibitory effect on inducible nitric oxide synthase as well as bcl-2 expression, and up-regulated p53 and caspase-3 messenger RNA expression in B16F-10 melanoma cells. The observed results suggest that regulation of proinflammatory cytokine production by tumor cells, tumor-associated macrophages, and resident macrophages accompanied by altered inducible nitric oxide synthase, bcl-2, caspase-3, and p53 messenger RNA expression by B sensitivum methanol extract induces apoptosis in B16F-10 melanoma cells.