bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychiatric and Psychotherapeutic Literacy: Attitudes To, and Knowledge of, Psychotherapy
Authors: Furnham Adrian
Published: July 2009

Background: Whereas there is now a rapidly emerging literature on psychiatric literacy (Jorm, 2000), there is much less work on the public’s knowledge of, and beliefs about the purpose of, and processes involved in, psychotherapy. This study looked at what lay people think happens during psychotherapy; what the processes and aims are; and the aetiology, treatment and prognosis for a mood and psychotic (bipolar, schizophrenia) and two neurotic (depression, obsessivecompulsive) disorders.

Methods: In total 185 British adults, recruited by a market research company, completed a four-part questionnaire, lasting about 20 minutes.

Results: Participants were generally very positive about psychotherapy believing the experience to be highly beneficial. Schizophrenia was seen to have a biological basis; depression and bipolar disorder were perceived to have family, work and other stress-related causal issues; obsessive-compulsive disorder was seen to be caused by stress and family-related issues. Participants thought psychotherapy a very effective treatment but drug treatments more effective for schizophrenia and bipolar disorder. ‘Talking it over’ was judged highly relevant, specifically to depression. Participants believed that depression had a good chance of cure, and remission, but that neither schizophrenia nor bipolar disorder had much chance of an effective cure.

Conclusion: Lay people show a curious pattern on insight, ignorance and naivety with regard to the cause and cure of mental disorders. They appear to have a modestly realistic but somewhat naive view of the process and efficacy of psychotherapy. This may influence how they react to their own and others’ mental illness. It has clear implications for education in psychiatric literacy.
Crisis Intervention and Acute Psychiatry in Amsterdam, 20 Years of Change: a Historical Comparison of Consultations in 1983 and 2004—2005
Authors: Van Der Post L.F.M. , Dekker J.J.M. , Jonkers J.F.J. , Beekman A.T.F. , Mulder C.L. , De Haan L. , Mulder W.G. , Schoevers R.A.
Published: July 2009

Aim: There has been a striking increase in the number of compulsory admission proceedings in the Netherlands since 1992, to such an extent that treatment in Amsterdam’s psychiatric clinics is in danger of being dominated by coercive treatment. Our aim was to establish a picture of the changes in emergency psychiatry that have contributed to the increase in the number of acute compulsory admissions.

Methods: A cohort ( N = 460) of psychiatric emergency consultations with the city crisis service in 1983 was compared with a similar cohort ( N = 436) in 2004—2005. The study focused on the following variables: patient characteristics, crisis-service procedures and consultation outcomes.

Results: Compared with 1983, there are now more services involved in crisis support in the public domain for psychiatric patients. The number of patients referred by the police has risen from 29% to 63%. In 1983, all consultations took place where the patients were located; at present, 60% take place at the crisis service premises. The number of psychotic patients in the cohort has increased from 52.0% and 63.3 %. There has been an increase in the proportion of compulsory admissions and a sharp decrease in the proportion of voluntary admissions from 61% to 28% of all admissions. Overall, the percentage of consultations leading to a psychiatric admission has fallen from 42% to 27%.

Conclusion: The front-line outreach service of 1983 has changed into a specialist psychiatric emergency department with a less pronounced outreach component. Voluntary admissions to psychiatric hospitals have almost disappeared as a feature of the crisis service.
What Stops Us From Healing the Healers: a Survey of Help-Seeking Behaviour, Stigmatisation and Depression Within the Medical Profession
Authors: Adams Elizabeth F.M. , Lee Alison J. , Pritchard Colin W. , White Rupert J.E.
Published: July 2009

Background: Doctors are poor at help-seeking, particularly for mental ill health; attitudes of colleagues reflecting stigmatisation may be important factors influencing decisions to seek support.

Aims: This article focuses on doctors’ attitudes to depression rather than mental illness in general. It seeks to determine the extent to which doctors perceive depression is stigmatised within the medical profession and whether the level of perceived stigma affects patterns of help-seeking behaviour.

Method: A postal survey was sent to 1488 General Practitioners and 152 psychiatrists in Devon and Cornwall. Questions assessed stigmatising attitudes to depression; help-seeking behaviour and barriers to help-seeking. Prevalence of self-reported depression and time off work was measured.

Results: The response rate was 76.6%. Doctors perceived that many of their profession hold stigmatising views of depression. Some 46.2% of respondents reported that they had suffered an episode of depression. Help-seeking was significantly reduced in those with a history of depression. Barriers to help-seeking were reported as letting colleagues down (73.1%), confidentiality (53.4%), letting patients down (51.9%) and career progression (15.7%). Gender and a history of depression significantly affected help-seeking behaviour and perceived stigmatisation. Higher levels of perceived stigma increased concerns about help-seeking and reduced help-seeking from own GP or colleagues.

Conclusion: Stigma associated with depression in doctors is endemic in the medical profession and the level of perceived stigma is related to reduced help-seeking behaviour. Efforts need to be made by the profession to reduce the stigma anticipated by those who become depressed, to enable appropriate help-seeking and support.
Re-framing the Problem of Workplace Violence Directed Towards Nurses in Mental Health Services in the UK: a Work in Progress
Authors: Paterson Brodie , Leadbetter David , Miller Gail , Bowie Vaughan
Published: July 2009

Background: Research consistently suggests nurses working in mental health settings are more likely to be assaulted than nurses in other settings.

Aims: Belated recognition of the issue in terms of social policy (Elston et al. 2006) has been accompanied by an as yet unexamined contest between confl icting ‘frames’ of the problem, which this paper seeks to make transparent.

Method: Frame analysis.

Results: Two distinct ‘master’ frames are discussed: the ‘individualizing’ and the ‘co-creationist’.

Conclusions: The influence of these frames has influenced the nature of responses to the problem but the recent dominance of the individualizing frame is being challenged by the emergence, or perhaps re-emergence, of co-creationism.
Low Cultural Identification, Low Parental Involvement and Adverse Peer Influences as Risk Factors for Delinquent Behaviour Among Filipino Youth in Hawai‘I
Authors: Guerrero Anthony P.S. , Nishimura Stephanie T. , Chang Janice Y. , Ona Celia , Cunanan Vanessa L. , Hishinuma Earl S.
Published: July 2009

Background: Among Filipino youth in Hawai‘i, low Filipino cultural identification and low family support may be important risk factors for delinquency.

Aims: To examine, in a sample of Filipino youth in Hawai‘i, correlations between delinquent behaviour and the aforementioned — as well as other, potentially mediating — variables.

Methods: A youth risk survey and Filipino Culture Scale were administered to Filipino students ( N = 150) in Hawai‘i. A parent risk survey was administered to available and consenting parents.

Results: Delinquent behaviour correlated positively with acculturative stress, low cultural identification and adverse peer influences; and negatively with total Filipino Culture Scale score. Structural equation modelling suggested that absent/ ineffective adults and adverse peer influences might be more important variables compared to low self-esteem and less religiosity, linking low cultural identification to delinquent behaviour.

Conclusions: Although further studies are warranted, to be effective, efforts to prevent delinquency by enhancing Filipino youths’ cultural connectedness may also need to enhance family connectedness and address adverse peer influences.
Quality of Life of Residents of the Community Hostels of Leros—Greece: Clinical and Social Functioning Profile of the Ex-Patients
Authors: Paxinos Ioannis , Kalantzi-Azizi Anastasia
Published: July 2009

Background: The quality of life experiences of the chronically mentally ill have received increased attention in outcome research lately and constitute a critical outcome of mental health.

Aims: This study evaluated the perceived quality of life of the former psychiatric patients ( N = 103) who have been moved from the Psychiatric Hospital of Leros to community hostels ( N = 19) in Leros Island. In addition, the residents’ clinical and social functioning profiles were examined together with the extent of institutional practices by the staff in residents’ environment.

Method: The present research is a cross-sectional study examining the impact of the transformation programmes Leros I and Leros II on the well-being of long-term psychiatric clients following the move.

Results: The majority of the residents expressed high levels of satisfaction, in almost all variables of quality of life, except the variable of contact with family relations. The level of psychopathology was very low, while the majority of residents expressed low community and social skills. Finally, the staff ( N = 64) allowed in a way, the expression of autonomy in the residents’ environment.

Conclusions: This study suggests that even the most chronic psychiatric population of Greece is able to give valid and reliable responses concerning the manner in which they perceive their present life.
Interventions To Reduce the Use of Seclusion and Restraint in Inpatient Psychiatric Settings: What We Know So Far a Review of the Literature
Authors: Scanlan Justin Newton
Published: July 2009

Introduction: In recent times, much attention has been focused on the reduction of seclusion and restraint in psychiatric settings. This paper analyzes evidence available from evaluations of single seclusion and/or restraint reduction programmes. A total of 29 papers were included in the review.

Results: Seven key strategy types emerged from the analysis: (i) policy change/ leadership; (ii) external review/debriefi ng; (iii) data use; (iv) training; (v) consumer/ family involvement; (vi) increase in staff ratio/crisis response teams; and (vii) programme elements/changes. Outcomes indicate that a range of reduction programmes are successful in reducing the frequency and duration of seclusion and restraint use, while at the same time maintaining a safe environment.

Conclusion: The development of new seclusion and restraint reduction programmes should include strong leadership from local management; external seclusion and restraint review committees or post-incident debriefing and analysis; broad-based staff training and programme changes at a local level. Behavioural and cognitive-behavioural programmes appear to be very useful in child and adolescent services. Further systematic research should be conducted to more fully understand which elements of successful programmes are the most powerful in reducing incidents of seclusion and restraint.
Population Pharmacokinetics of Golimumab, an Anti‐Tumor Necrosis Factor‐α Human Monoclonal Antibody, in Patients With Psoriatic Arthritis
Authors: Xu Zhenhua , Vu Thuy , Lee Howard , Hu Chuanpu , Ling Jie , Yan Hong , Baker Daniel , Beutler Anna , Pendley Charles , Wagner Carrie , Davis Hugh M. , Zhou Honghui
Published: July 2009

The population pharmacokinetics of subcutaneously administered golimumab (50 mg or 100 mg every 4 weeks) were characterized in patients with active psoriatic arthritis (PsA) in GO‐REVEAL, a randomized, double‐blind, placebo‐controlled, phase 3 study. A total of 2029 serum golimumab concentrations from 337 patients were analyzed using NONMEM. A 1‐compartment pharmacokinetic model with first‐order absorption and elimination was chosen to describe the observed concentration‐time data. For a patient of standard weight (70 kg), the population estimates (typical value ± standard error) for golimumab pharmacokinetic parameters were as follows: apparent clearance = 1.38 ± 0.04 L/d, apparent volume of distribution = 24.9 ± 1.04 L, and absorption rate constant = 0.908 ± 0.121 per day. The between‐subject variability was 37.6% in apparent clearance and 37.9% in apparent volume of distribution. Body weight, antibody‐to‐golimumab status, baseline C‐reactive protein level, and smoking status were identified as significant covariates on apparent clearance. Body weight was also a significant covariate on apparent volume of distribution. None of the concomitant medications examined (methotrexate, corticosteroids, and nonsteroidal anti‐inflammatory drugs) were significant covariates on apparent clearance, although the median trough golimumab concentration in patients receiving methotrexate was higher than for those not receiving methotrexate. These significant covariates account for part of the variability in systemic exposure to golimumab observed in patients with PsA.
Online use and information seeking behaviour: institutional and subject comparisons of UK researchers
Authors: Nicholas David , Clark David , Rowlands Ian , Jamali Hamid R.
Published: July 2009

The paper reports on the results of the project ‘Evaluating the usage and impact of e-journals in the UK’. Using deep log analysis techniques, we evaluated the use of the Oxford Journals database in regard to life sciences, economics and history by 10 major UK research institutions. The aim of the study was to investigate researchers’ digital behaviour, and to ascertain whether it varied by subjects and disciplines, or in relation to the institutions. The findings revealed significant subject and institutional differences. Life scientists were the biggest users. Economists made the greatest use of abstracts. Historians proved to be the most active searchers. Research intensive universities were characterized by high volume use and short session times, light sessions, and sessions which utilized few of the search functions available. Open access journals featured strongly in the ranked lists of life sciences and history; and Google was an extremely popular means of accessing journal content, especially so in the case of historians.
Nonspecific Effects in Psychoeducational Intervention Research
Authors: Donovan Heidi S. , Kwekkeboom Kristine L. , Rosenzweig Margaret Q. , Ward Sandra E.
Published: July 2009

Randomized clinical trials support the efficacy of a wide range of psychoeducational interventions. However, the mechanisms through which these interventions improve outcomes are not always clear. At times, the theoretically specified factors within interventions have been shown to have specific effects on patient outcomes. But it has also been argued that other factors not identified in the intervention theory (e.g., “nonspecific” factors such as patient expectations and therapeutic patient—clinician alliances) have powerful nonspecific effects that account for most, if not all, of the observed efficacy of psychoeducational interventions. This article describes important concepts in this debate and discusses key issues in distinguishing between specific and nonspecific effects of psychoeducational nursing interventions. Four examples are used to illustrate potential methods of identifying and controlling for nonspecific effects in clinical intervention trials.
Predicting Hospital Surge after a Large-Scale Anthrax Attack: A Model-Based Analysis of CDC's Cities Readiness Initiative Prophylaxis Recommendations
Authors: Hupert Nathaniel , Wattson Daniel , Cuomo Jason , Hollingsworth Eric , Neukermans Kristof , Xiong Wei
Published: July 2009

Background . After a major bioterrorism attack, the US Centers for Disease Control and Prevention (CDC) Cities Readiness Initiative (CRI) calls for dispensing of medical countermeasures to targeted populations within 48 hours. The authors explore how meeting or missing this 48-hour goal after a hypothetical aerosol anthrax attack would affect hospital surge, in light of the multiple uncertainties surrounding anthrax-related illness and response. Design . The authors created a discrete-time state transition computer model representing the dynamic interaction between disease progression of inhalational anthrax and the rate of dispensing of prophylactic antibiotics in an exposed population. Results . A CRI-compliant prophylaxis campaign starting 2 days after exposure would protect from 86% to 87% of exposed individuals from illness (assuming, in the base case, 90% antibiotic effectiveness and a 95% attack rate). Each additional day needed to complete the campaign would result in, on average, 2.4% to 2.9% more hospitalizations in the exposed population; each additional day's delay to initiating prophylaxis beyond 2 days would result in 5.2% to 6.5% additional hospitalizations. These population protection estimates vary roughly proportionally to antibiotic effectiveness but are relatively insensitive to variations in anthrax incubation period. Conclusion . Delays in detecting and initiating response to large-scale, covert aerosol anthrax releases in a major city would render even highly effective CRI-compliant mass prophylaxis campaigns unable to prevent unsustainable levels of surge hospitalizations. Although outcomes may improve with more rapid epidemiological identification of affected subpopulations and increased collaboration across regional public health and hospital systems, these findings support an increased focus on prevention of this public health threat.
Reinjury after Acute Lateral Ankle Sprains in Elite Track and Field Athletes
Authors: Malliaropoulos Nikolaos , Ntessalen Maria , Papacostas Emmanuel , Giuseppe Longo Umile , Maffulli Nicola
Published: July 2009

Background

Lateral ankle sprains can lead to persistent disability in athletes. The authors studied the effect of a lateral ankle sprain on reinjury occurrence in the same region.

Hypothesis

There will be no difference in reinjury rate between low-grade (grades I and II) and high-grade (IIIA and IIIB) acute lateral ankle sprains.

Study Design

Cohort study (prognosis); Level of evidence, 1.

Methods

From 1996 to 2004, the authors managed 202 elite Greek track and field athletes for an acute lateral ankle sprain. Sprains were classified into 4 degrees (I, II, IIIA, and IIIB). The same rehabilitation protocol was prescribed for all the athletes. The rate of a lateral ankle reinjury was recorded in the 24 months following injury.

Results

At a follow-up of 24 months, 36 of 202 athletes (17.8%) experienced a second lateral ankle sprain. Of the 79 athletes with a grade I injury, 11 (14%) experienced a recurrence during the study period. Of the 81 athletes with a grade II injury, 23 (29%) experienced a recurrence during the study period. Of the 36 athletes with a grade IIIA injury, 2 (5.6%) experienced a recurrence during the study period. Of the 6 athletes with a grade IIIB injury, none experienced a recurrence during the study period.

Conclusion

Athletes with a grade I or II lateral ankle sprain are at higher risk of experiencing a reinjury. Low-grade acute lateral ankle sprains result in a higher risk of reinjury than high-grade acute lateral ankle sprains.
Growth Patterns in Children With Intrauterine Growth Retardation and Their Correlation to Neurocognitive Development
Authors: Fattal-Valevski Aviva , Toledano-Alhadef Hagit , Leitner Yael , Geva Ronny , Eshel Rina , Harel Shaul
Published: July 2009

The relationship between somatic growth and neurocognitive outcome was studied in a cohort of 136 children with intrauterine growth retardation. The children were followed up from birth to 9 to 10 years of age by annual measurements of growth parameters, neurodevelopmental evaluations, and IQ. The rate of catch-up for height between 1 and 2 years of age was significantly higher than the catch-up for weight (P < .001). The cognitive outcome at 9 to 10 years correlated with head circumference at all ages. The neurodevelopmental outcome at 9 to 10 years correlated with weight at all ages. Correlation with head circumference was more significant with IQ, while with weight it was stronger with the neurodevelopmental score. Height at 1 year was a significant predictor for IQ and neurodevelopmental outcome at 9 to 10 years. These findings are of distinct importance for prediction of subsequent neurodevelopmental outcome in children with intrauterine growth retardation.
Mutations in ND Subunits of Complex I Are an Important Genetic Cause of Childhood Mitochondrial Encephalopathies
Authors: Byung Chan Lim  , Jun Dong Park  , Hwang Hee , Ki Joong Kim  , Yong Seung Hwang  , Chae Jong-Hee , Cheon Jung-Eun , In One Kim  , Lee Ran , Han Ku Moon
Published: July 2009

An increasing number of reports on mitochondrial DNA coding regions' mutations, especially in mitochondrial DNA— encoded NADH dehydrogenase (ND) subunit genes of the respiratory chain complex I, have been published recently, making it possible to improve the molecular diagnosis of many mitochondrial diseases in children with variable clinical features. This article describes 2 mitochondrial DNA mutations in the ND3 and ND5 genes in patients showing clinical features of mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes (MELAS)/Leigh syndrome overlap syndrome and atypical Leigh syndrome. These cases add to the increasing number of reports stating that mitochondrial DNA—encoded protein-coding regions are mutation hot spots in pediatric patients with encephalopathies with variable clinical spectra.
Accelerated Head and Body Growth in Infants Later Diagnosed With Autism Spectrum Disorders: A Comparative Study of Optimal Outcome Children
Authors: Mraz Krista D. , Dixon James , Dumont-Mathieu Thyde , Fein Deborah
Published: July 2009

Previous research has demonstrated accelerated head and body growth during infancy in children with autism spectrum disorders. No study has yet examined head growth in children who lose their autism spectrum disorder diagnoses. Head circumference, length, and weight growth during infancy for 24 children who maintained their diagnoses were compared with 15 children who lost their diagnoses, and to 37 typically developing controls. Results showed that head circumference and weight growth were significantly greater in both autism spectrum disorder groups compared with controls, with no significant differences between autism spectrum disorder groups. However, when length and weight were controlled for, accelerated head growth remained significant in the children who lost their diagnoses. Findings suggest that children who lose their autism spectrum disorder diagnoses and children who maintain their diagnoses show similar head circumference, length, and weight growth trajectories during infancy, although subtle differences in body growth between groups may exist.
Review of a Large Clinical Series: Insulin Resistance Despite Tight Glucose Control Is Associated With Mortality in Critically Ill Surgical Patients
Authors: Mowery Nathan T. , Dortch Marcus J. , Dossett Lesly A. , Norris Patrick R. , Diaz Jose J. , Morris John A. , May Addison K.
Published: July 2009

Background: The hyperglycemic state following trauma and surgery is related partially to insulin resistance (IR). The objective is to determine if critically ill surgical patients vary in their extent of IR and is IR associated with mortality. Methods: Prospective observational study in trauma and surgical intensive care units. There were 925 ventilated, critically ill surgical patients who were placed on an automated euglycemia protocol. A mathematic multiplier (M) employed by the protocol was used as a measure of IR. Outcome, phenotypic, laboratory, and treatment variables were analyzed. Results: 54,141 entries for glucose (mg/dl) and M were analyzed. Median glucose was 118mg/dL, with 45% of values between 80-110mg/dL, 81% between 80-150 mg/dL, and 0.2% less than 40 mg/ dL. M varied by 42 fold over the entire population, and by an average of 11-fold among individual patients. The median blood glucose was not different between groups (118 mg/dl for survivors and 118 mg/dl for non-survivors, P = 0.36). The median insulin dose and M were significantly higher in non-survivors (4.1 U/hr versus 3.4 U/hr, P = 0.005; 0.061 versus 0.058, P = 0.02). Conclusions: There was a large amount of variation in insulin resistance, as measured by an adapting multiplier, both across the population and within patients. In the setting of tight glucose control measures of glucose control (median blood glucose and percent in range) do not differentiate between patients who lived and died while measures of insulin resistance (median insulin dose and multiplier) do, suggesting that the insulin resistance is a better predictor of outcome.
Massive Cerebrovascular Infarct Due to the Catastrophic Antiphospholipid Syndrome in a Patient With Idiopathic Thrombocytopenic Purpura
Authors: Modrykamien Ariel , Reddy Anita , Guzman Jorge A. , Farha Samar
Published: July 2009

Catastrophic antiphospholipid syndrome (APS) is caused by thrombotic vascular occlusions that affect both small and large vessels, producing ischemia in the affected organs as well as a systemic inflammatory response syndrome (SIRS). We report a case of a patient with idiopathic thrombocytopenic purpura (ITP) who developed massive cerebral ischemia due to this entity. Prompt and aggressive treatment may prevent and actually resolve lethal complications caused by this devastating syndrome.
Homicide-Suicide in Durban, South Africa
Authors: Roberts Kerry , Wassenaar Douglas , Canetto Silvia Sara , Pillay Anthony
Published: July 2009

This study investigated homicide-suicide in Durban, South Africa, for the years 2000 to 2001. The incidence was 0.89 per 100,000, higher than the international average. A majority of perpetrators (91%) and victims (87%) were Black African, proportional to their representation in the population. Perpetrators were typically men (in 95% of cases), older than, and intimate partners (in 75% of cases) of the female victims (in 100% of cases). Average ages of perpetrators and victims were 32 and 27, respectively. The security sector was overrepresented as an employment category for perpetrators. A firearm was used in 87% of the homicides and 80% of the suicides. The individuals involved in homicide-suicides in Durban are similar to homicide-suicide perpetrators and victims in industrialized countries. The fact that homicide-suicides in South Africa, as in most countries, involve almost exclusively men killing female intimates confirms the importance of examining and challenging social norms enabling male violence against women.
Organizational Citizenship Behavior and Performance
Authors: Nielsen Tjai M. , Hrivnak George A. , Shaw Megan
Published: July 2009

Most of the research on the relationship between organizational citizenship behavior (OCB) and performance has been conducted at the individual level. During the past 10 years, however, group-level research on that relationship has begun to appear. This article meta-analytically reviews 38 independent samples ( N = 3,097) in which the relationship between OCB and performance was studied at the group level. The analyses in this study suggest a positive overall relationship between OCB and performance (ρ = .29), as well as the presence of several moderating variables. The theoretical implications of these findings are discussed, and some suggestions for future research are offered.
Operations Strategy with Paper Boats
Authors: Sumukadas Narendar
Published: July 2009

When participants in introductory business courses encounter the term “operations strategy,” it is not easy for them to appreciate what operations strategy is about, or how it fits with overall business strategy. This game breaks down highfalutin jargon into experiences that participants can readily relate to. While working in teams to make paper boats, and competing with other teams, participants realize that they have intuitively engaged in the formulation and implementation of their team’s operations strategy. They begin to appreciate the interplay between the customer’s requirements, their own team’s strengths, the “competitive priorities” that their team must emphasize, and the tradeoffs inherent in making these decisions.
Rights Variation within a Federalist System: Understanding the Importance of Mobility
Authors: Francis John G. , Francis Leslie P.
Published: July 2009

Cosmopolitanism at the international level—the recognition of an international human rights regime—has been much defended of late. Little attention has been paid, however, to the federalist analogue: should there be insistence on a national rights regime? Or should variation in the recognition of rights be tolerated at the subnational level, as a necessary concession to moral disagreement, as an effort to contain problematic experiments, or as a way to generate progress about rights? This article argues that subnational variation in the recognition of rights represents a second-best solution to the problem of deep moral disagreement about rights. However, federalism provides a second-best solution only on the condition that citizens are able to move from one subnational jurisdiction to another. To the extent that citizens are able to move to rights regimes that are more favorable to them, intranational variation in the recognition of rights may have advantages over international variation, where national borders may pose barriers to migration. However, in the United States, despite the privileges and immunities of national citizenship, there remain impressive legal barriers to such mobility in the case of contested rights. Given these barriers, federalism as it exists in the United States today does not fully realize the advantages of a second-best solution to deep moral disagreements about rights.
Are African Americans Effectively Represented in Congress?
Authors: Griffin John D. , Keane Michael
Published: July 2009

The authors relate the racial composition of districts to five measures of legislative activity and position in the 101st to 106th Congresses: bill introduction, colleague cosponsorship, bill passage, committee portfolio, and party leadership. The authors find that African American constituents generally are represented by less active and less well-positioned legislators on four of the five measures. They also explore the origin of these disparities. Two of the disparities (bill passage and party leadership) are partly explained by the tendency of districts with larger African American populations to be less electorally competitive. A third disparity (committee portfolio) is accounted for by the tendency of larger African American populations to be represented by African American members of Congress.
Influence of Different Hydroxyethyl Starch (HES) Formulations on Fibrinogen Measurement in HES-Diluted Plasma
Authors: Adam Susanne , Karger Ralf , Kretschmer Volker
Published: July 2009

Background: Fibrinogen is the first coagulation factor becoming critical in dilution coagulopathy. Volume replacement in major blood loss is performed with large volumes of crystalloid and colloid solutions. The latter has been shown to compromise accurate photo-optical measurement of fibrinogen. This study determined the influence of different hydroxyethyl starch (HES) formulations. Methods: Citrated plasma samples of 8 healthy volunteers were diluted by 30% or 50% with either HES 10% (200/0.5; HES-200), HES 6% (70/0.5; HES-70), or HES 6% (450/0.7; HES-450). Fibrinogen concentrations were determined by photo-optical measurement (Behring coagulation system [BCS]: derived fibrinogen, or Clauss fibrinogen, calibrated for high [CLS] or low fibrinogen concentrations [CLS-low]) as well as mechanical end point determinations (KC4: CLS-KC4). Measured values were compared with calculated values. Results: On average and across all photo-optical methods, fibrinogen concentrations were overestimated, particularly with HES-200. Hydroxyethyl starch-70 and HES-450 did not differ much from each other. Overestimation was relatively greater for 50% dilutions with all HES formulations. Surprisingly, overestimation was most prominent with CLS-low, the method supposed to most reliably measure low fibrinogen concentrations; overestimation amounted to 92% and 120% with HES-200, 54% and 73% with HES-70, and 51% and 79% with HES-450, for 30% and 50% dilutions, respectively. In contrast, CLS-KC4 always yielded sufficiently accurate results. Conclusions: The study showed that all HES solutions more or less impaired the fibrinogen measurement with the photo-optical method. In particular, overestimation with CLS-low may prevent timely fibrinogen replacement in major blood loss. Hydroxyethyl starch concentration appears to be more relevant for this effect than its molecular size.
Isolation and Characterization of Contaminants in Recalled Unfractionated Heparin and Low-Molecular-Weight Heparin
Authors: Viskov Christian , Bouley E. , Hubert P. , Martinez Celine , Herman F. , Jeske Walter , Hoppensteadt Debra , Walenga Jeanine M. , Fareed Jawed
Published: July 2009

Recently, a contaminant was found in some clinically used unfractionated heparin (UFH) preparations. Administration of this UFH was associated with an increased risk of developing a wide range of adverse effects including death. To further investigate the chemical profile of the contaminant, contaminated batches of UFH were treated by exhaustive nitrous acid depolymerization followed by methanol precipitation to remove heparin oligosaccharides. Because contaminated heparins may have been used as starting material in the production of low-molecular-weight heparins (LMWHs), a similar procedure was carried out using an experimental batch of enoxaparin prepared from contaminated heparin. While high-pressure liquid chromatography (HPLC) analysis of contaminated heparin did not distinguish the presence of the contaminant, it could readily be observed as a high-molecular weight shoulder in the elution profile of contaminated enoxaparin. Digesting contaminated heparin with heparinase-I prior to HPLC analysis showed the presence of a nondigestible component (15%-30% of the mixture). This contaminant was also resistant to degradation by chondroitinases A, B, and C. Proton nuclear magnetic resonance (NMR) indicated that the contaminant was oversulfated chondroitin sulfate (OSCS). Size-exclusion chromatography indicated that the mean molecular weight of the OSCS was 16.8 kD, comparable to that of a synthetic porcine cartilage OSCS preparation that was used as a reference material (17.2 kD). While varying degrees of high-molecular weight dermatan sulfate and other minor impurities were detected, OSCS appeared to be the major contaminant in these preparations. The process involved in the production of enoxaparin does not significantly degrade OSCS.
Stability of irinotecan-loaded drug eluting beads (DC BeadTM) used for transarterial chemoembolization
Authors: Kaiser Jeanette , Thiesen Judith , Krämer Irene
Published: July 2009

Purpose. The aim of this study was to determine the loading efficiency, physicochemical stability, and release of irinotecan-loaded DC BeadsTM (bead size 100—300 μm, 300—500 μm) before and after mixing with nonionic contrast medium (Accupaque® 300, Imeron® 300, Ultravist ® 300) during a prolonged period of time (28 days) when stored at room temperature or refrigerated.

Methods. DC Beads TM were loaded with 50 mg irinotecan (Campto®) per milliliter beads in a 2 h loading period. Drug loading efficiency and stability were determined by measuring the irinotecan concentration in the excess solution. A free-flowing in vitro elution method for a period of 2 h and phosphate buffered solution (PBS, pH 7.2) as elution medium were used to analyze the integrity of the irinotecan-loaded. Stability of irinotecan-loaded beads after mixing with an equal volume of three different nonionic contrast agents was determined by measuring irinotecan concentrations in the excess solutions. Vials with loaded beads were stored protected from light at room temperature. Mixtures with contrast media were stored protected from light under refrigeration (2—8°C). Samples were taken periodically over a 4 week period (day 0, 1, 3, 7 and 28). A reversed phase HPLC assay with ultraviolet detection was utilized to analyze the concentration and purity of irinotecan.

Results. The loading procedure of DC BeadsTM with irinotecan drug solution resulted in a loading percentage of 96% (bead size 100—300 μm) independent of the storage time. No differences in loading levels and no irinotecan degradation products were observed over the period of 28 days, while the test vials were stored light protected at room temperature. Integrity of loaded irinotecan was also given over that same period of time according to the purity and concentration of irinotecan measured after intentional elution with PBS. Mixing of irinotecan-loaded beads (bead size 100—300 μm, 300—500 μm) with nonionic contrast media decreased the irinotecan loading efficiency by ∼5—10% during a maximum period of 24 h. However, no further elution or degradation was observed during a 4-week period when stored protected from light under refrigeration.

Conclusions. Irinotecan-loaded DC BeadsTM are shown to have adequate physicochemical stability over a period of at least 28 days when stored light protected at room temperature. Due to concerns of microbiological overgrowth refrigeration should always be considered. The preparation of admixtures of irinotecan-loaded beads with contrast medium in centralized cytotoxic preparation units is not recommended, because of rapid elution of 5—10% of irinotecan from the loaded beads. Furthermore, physicians see no advantages of admixtures due to the wide variation of mixing ratios of drug-loaded beads with contrast medium. In addition varying volumes of 0.9% sodium chloride solution are to be admixed during the chemoembolization procedure
Multidisciplinary system for detecting medication errors in antineoplastic chemotherapy
Authors: Serrano-Fabiá Amparo , Albert-Marí Asunción , Almenar-Cubells Daniel , Víctor Jiménez-Torres N.
Published: July 2009

Objective. To analyze medication errors (MEs) in a multidisciplinary system with a Computerized Pharmacotherapy Process (CPP) in cancer patients.

Design. A longitudinal, prospective 2-year (January 2003 —to December 2004) cohort study was made in adult patients administered antineoplastic treatment in Services of Oncology and Haematology. MEs were identified by double cross-validation of each stage of the pharmacotherapeutic process (prescription, preparation, dispensing, administration, and follow-up) carried out by the multidisciplinary team (physician, pharmacist, nurse) with CPP assistance.

Variables. Number of MEs per 1000 patient-days, percentage according to the stage of the pharmacotherapeutic process and the severity of intercepted ME (scored from 1 = no damage to the patient, to 5 = patient death).

Results. A total of 1311 patients were receiving treatment, and MEs were identified in 225. Out of a total of 13,158 patient-days, 276 MEs were detected, equivalent to 20.9 MEs per 1000 patient-days; of these, 16.8 MEs per 1000 patient-days (80%) were intercepted and did not affect any patient. The detected ME distribution according to pharmacotherapeutic stage was: prescription 75.7%, preparation 21.0%, dispensing 1.8%, administration 1.1%, and follow-up 0.4%. ME distribution according to severity was: grade 1 : 15.9%, grade 2 : 49.6%, grade 3 : 33.7%, grade 4 : 0.7%, and grade 5 : 0%.

The system intercepted 98.9% of all MEs with severity ≥3 (MEs with a potential for causing patient damage).

Conclusions. The multidisciplinary system with a well-established CPP detects 20.9 MEs per 1000 patient-days and intercepts 98.8% of all MEs with a potential for causing patient damage. J Oncol Pharm Practice (2010) 16: 105—112.
Redefining the Systemic Inflammatory Response
Authors: Landis R. Clive
Published: July 2009

From the first description of the “systemic inflammatory response” in the early 1990s, it has been recognized that this is a multifaceted response of the body to the combined insult of cardiothoracic surgery with bypass, involving causation by “activation of complement, coagulation, fibrinolytic, and kallikrein cascades, activation of neutrophils with degranulation and protease enzyme release, oxygen radical production, and the synthesis of various cytokines from mononuclear cells.” Yet the intervening 15 years have seen a narrowing of research into individual systems and interventions naively targeted at single pathways without achieving clinically meaningful benefits. The time has come to redefine the systemic inflammatory response so that research can be more productively focused on objectively measuring and interdicting this multisystem disorder. A key concept of this new understanding is that translation into a hard adverse event occurs when the systemic imbalance is combined with a localized trigger. Triggers might be inadvertently provided by transient episodes of ischemia/malperfusion to vulnerable organs or handling trauma to major vessels. Future research should be directed at suppressing systemic activation with combinations of drugs and improved circuit coating, whereas changes in clinical practice and continuous monitoring of perfusion parameters can help eliminate localized triggering events.
Endovascular Treatment of Blunt Traumatic Thoracic Aortic Injury
Authors: Nicolaou Georghios
Published: July 2009

Blunt traumatic thoracic aortic injury (BTTAI) is a lethal injury associated with a prehospital mortality of 80% to 90%. Patients arriving in the emergency room and considered appropriate to undergo emergency open surgical repair still have a mortality rate of 15% to 30% because of severe associated injuries. Conventional open surgical repair requires a left thoracotomy, single lung ventilation, aortic-cross clamping and unclamping, with or without the adjunct use of partial or full cardiopulmonary bypass and systemic heparinization. All this leads to significant physiological stress and surgical trauma resulting in perioperative complications such as major blood loss, coagulopathy, myocardial infarction, stroke, respiratory failure, renal failure, bowel infarction, and paraplegia. Despite advances in anesthesia, critical care medicine, and surgical techniques, a recent meta-analysis showed no definite improvement in operative mortality over the past decade, following open surgical repair in patients with BTTAI. Endovascular repair of BTTAI does not require a thoracotomy, single lung ventilation, aorticcross clamping and unclamping, or systemic heparinization. As a result, endovascular repair of BTTAI has emerged as an effective, minimally invasive treatment alternative, especially in patients with severe concomitant injuries, which may be prohibitive to open surgical repair. Recent published studies have shown that endovascular repair of BTTAI is associated with lower morbidity, mortality, stroke, and paraplegia/paraparesis rates, when compared with open surgical repair of BTTAI.
Ambulatory Blood Pressure and Physical Activity in Heart Failure
Authors: Tai Mei-Kuei , Meininger Janet C. , Frazier Lorraine Q. , Chan Wenyaw
Published: July 2009

This observational study used repeated measures over 24 hr to investigate ambulatory blood pressure (BP) and physical activity (PA) profiles in community-based individuals with heart failure (HF). The aims were to (a) compare BP dipping and PA between two groups of HF patients with different functional statuses, and (b) determine whether the strength of the association between ambulatory BP and PA varies by functional status in HF. Ambulatory BP was measured every 30 min with a SpaceLabs 90207; a Basic Motionlogger actigraph was used to measure PA minute-by-minute. Fifty-six participants (54% female, age 66.96 ± 12.35 years) completed data collection. Functional status was based on New York Heart Association (NYHA) ratings. Twenty-seven patients had no limitation of PA (NYHA Class I HF), whereas 29 had some limitation of PA but no discomfort at rest (NYHA Class II or III HF). Patients with Class I HF had a significantly greater degree of BP dipping than those with Class II/III HF after controlling for left ventricular ejection fraction. In a mixed-model analysis, PA was significantly related to ambulatory systolic and diastolic BP and mean arterial pressure. The strength of the association between PA and BP was not significantly different for the two groups of patients. These findings demonstrate differences between Class I and Class II/II HF in BP dipping status and ambulatory BP but not PA. Longitudinal research is recommended to improve understanding of the influence of disease progression on changes in 24-hr PA and BP profiles of patients with HF.
Basic Concepts of Optical Mapping Techniques in Cardiac Electrophysiology
Authors: Attin Mina , Clusin William T.
Published: July 2009

Optical mapping is a tool used in cardiac electrophysiology to study the heart’s normal rhythm and arrhythmias. The optical mapping technique provides a unique opportunity to obtain membrane potential recordings with a higher temporal and spatial resolution than electrical mapping. Additionally, it allows simultaneous recording of membrane potential and calcium transients in the whole heart. This article presents the basic concepts of optical mapping techniques as an introduction for students and investigators in experimental laboratories unfamiliar with it.
Tone-Induced Sleep Fragmentation in Persons with Alzheimer’s Disease: A Feasibility Study
Authors: Cole Catherine S. , Richards Kathy C. , Smith-Olinde Laura , Roberson Paula K. , Sullivan Dennis H.
Published: July 2009

Sleep fragmentation increases as Alzheimer’s disease (AD) progresses. Its effects on cognition, specifically vigilant attention, are profoundly important because vigilant attention is thought to be the first step in memory acquisition. To our knowledge, no one has experimentally studied the effect of sleep fragmentation on vigilant attention in persons with AD. Therefore, this study piloted an experimental method using sound (tones produced by an audiometer) to induce sleep fragmentation. Participants enrolled in the University of Arkansas for Medical Sciences Memory Research Center ([MRC] n + 4) underwent one night of undisturbed and one of fragmented sleep. All participants tolerated the earphone needed for the tone-induced sleep fragmentation (TISF) method, and we were able to score awakenings in real time. However, only 50% of tones produced awakenings. The findings suggest that this experimental method is feasible for use in persons with mild AD. Based on the results, we will increase the duration, intensity, and frequency of tones delivered for optimal result.