bluuebunny/crossref_metadata_2025 huggingface dataset:
Just shopping?
Authors: Brusdal Ragnhild , Lavik Randi
Published: January 2009

There is a lot of concern about young people and shopping. Sometimes it is even argued that all young people do is shop and spend money while neglecting school and doing little else. This article takes a closer look at shopping and what characterizes different shoppers. Our analysis indicates that shopping is part of everyday life for most young people, that it is one of many activities that young people are involved in. Age is of little importance when we look at shopping frequency, but it has a stronger impact when it comes to the money spent. Our study shows that shopping is a gendered activity. Girls are the big shoppers, but the boys are closing in. We also find that money spent on clothes increases with shopping frequency but whether you are oriented towards friends or home and family has an impact on the amount of money spent on clothes.

The data material is drawn from the rather comprehensive survey ‘Young in Norway 2002’ collected by NOVA, Norwegian Social Research. Approximately 12,000 pupils were included in the survey; 6,048 respondents in Norwegian secondary school (ages 13–15) and 5,880 in high school (ages 16–19).
Negotiating the filial self
Authors: Liu Fengshu
Published: January 2009

This article explores how a group of first–generation young–adult only–children negotiate the filial self in the specific socio–cultural context of today's China and with their cultural baggage as only–children. The article draws upon in–depth interviews with 22 young adults, both women and men from various backgrounds. In their narratives, the young people unanimously indicated an imperativeness to be dutiful to their parents in old age. They offered both normative and practical explanations for such a ‘choice’. However, the construction of the filial self, and their overall meaning–making in relation to their parents, is done not without negotiation between the individual self and the collective–familial entity, which is embedded in the specific socio–cultural context of today's China. The construction of the filial self in relation to the collective–familial is meanwhile heavily framed by one's only–child status, often in interaction with one's family's economic condition. It further shows that due to their singleton status, the women only–children have become ‘substitute sons’ who are to assume the filial duty traditionally prescribed for sons.
Reconciling accountability and development needs in heritage language education: A communication challenge for the evaluation consultant
Authors: Elder Catherine
Published: January 2009

The paper offers a retrospective evaluation of recent evaluative studies of bilingual programs in the Australian state of Victoria, in an attempt to determine how successfully the evaluation process met the dual criteria of external accountability and development. The programs in question were located in primary or secondary government schools and involved partial immersion in a heritage language. Data for the paper are drawn from the following: (a) the consultant's recollections of the evaluation context and process, and (b) the evaluative reports relating to three different programs (Vietnamese—English, Chinese—English and Arabic—English respectively). In hindsight it appears that the effectiveness of each evaluation may have depended in part on the degree of fit between the school and the consultant's views about the function of the evaluation initiative, as well as on her ability to communicate findings in terms which were both academically defensible and meaningful for teachers and program administrators. While the task of bridging the gap between the accountability and ameliorative functions of each evaluation was challenging for all parties (and possibly exacerbated by linguistic and cultural divides), it is argued that the former is not necessarily at the expense of the latter. The requirement that outcomes be reported objectively to an external stakeholder can, if appropriately handled, generate insights among program participants which can be harnessed for program improvement. The paper concludes with an account of the lessons learned from the evaluations, in the hope that these help will evaluation consultants in forging more productive relationships and better communications with program participants.
Small answers to the big question: Learning from language programme evaluation
Authors: Kiely Richard
Published: January 2009

This paper explores why the learning posited as an intrinsic dimension of evaluation practice and use has been difficult to achieve, and how it might be more effectively realized. In recent decades language programme evaluation has evolved from focused studies of teaching methods inspired by language learning theories to a curriculum management enterprise with a focus on quality assurance and enhancement. There has been a parallel development from evaluation as a research-type study, where the findings are disseminated through publications, to evaluation as a dialogue within programmes for ongoing improvement of learning opportunities. These changes raise issues about learning from evaluation. Who should learn from programme evaluation? What should they learn? And how? The argument in this paper is for a synthesis of these conceptions of programme evaluation, so that the research-type knowledge-building enterprise and the ongoing quality management processes are mutually informing, and programme evaluation becomes a socially-situated cycle of enquiry, dialogue, and action. To facilitate the integration of research and management perspectives, three aspects of programme development are explored: innovation, teachers at work, and the quality of the learning experience of students. These are aspects of programmes which have not always had attention in evaluation theory and practice, but are central to understanding how language programmes work and develop. The significance of these issues is explored in episodes from the evaluation of materials used in an English for Academic Purposes (EAP) programme.
Understanding class blogs as a tool for language development
Authors: de Almeida Soares Doris
Published: January 2009

Web 2.0 has allowed for the development of cyber spaces where any computer user can create their own public pages to share knowledge, feelings and thoughts inviting linguistic interactions with people around the globe. This innovation has caught the attention of language practitioners who wish to experiment with blogging to enhance the teaching and learning experience. In 2007 I set up a class blog with my nine pre-intermediate EFL students in a language school in Brazil. This experience gave rise to two central questions: a) did my students see our blog as a learning tool? and b) what was blogging like in other language teaching contexts? To answer the first question I carried out some Exploratory Practice for three months. As for the second question, I designed an online survey which was answered by 16 members of a community of practice called the Webheads. Ultimately I learned that my students saw our blog as a learning tool and that blogs are being used in different ways around the world. This article presents the rationale behind using blogs in language classes, describes my research process and discusses the understanding my students and I have gained from exploring our own practices.
Phonological acquisition in Malta: A bilingual language learning context
Authors: Grech Helen , Dodd Barbara
Published: January 2009

A total of 241 Maltese children aged 2;0—6;0 years, drawn randomly from the public registry of births, were assessed on a picture naming task to evaluate phone articulation, phonology and consistency of word production. Children were allowed to use the language they chose (either Maltese or English). Ninety-three children (38.6%) were reported by parents to speak both Maltese and English at home, 137 (56.9%) were reported to speak Maltese and 11 (4.7%) only English at home. The data gained were analyzed for percent consonants and vowels correct, adult phonemes absent, developmental speech error patterns, number of English and Maltese words used, and the percentage of children using translation equivalents. The children who were reported to be only exposed to English at home were not compared statistically with other children because of the small number in that group. The data showed an increase in phonological competence over the age range and differences between children reported to be exposed to one as opposed to two languages at home. Many children, irrespective of reported home language context, used both English and Maltese during assessment. The results were interpreted as showing independent phonological systems that nevertheless interacted; a bilingual language learning context affected word naming language choice.
Speaking Hebrew with an accent: Empathic capacity or other nonpersonal factors
Authors: Ibrahim Raphiq , Eviatar Zohar , Leikin Mark
Published: January 2009

The study examines a hypothesis that the degree of accent in L2 is related to a measure of ego permeability. Native Hebrew speakers, native Russian-speaking immigrants, and Arabic-speaking Israeli natives participated. All were students at the University of Haifa, where the language of instruction is Hebrew. The participants were recorded producing two speech segments and the recorded segments of speech were played to a group of 20 native Hebrew speakers, who rated the degree of accent in each segment on a scale from 1 (no accent) to 5 (heavy accent). These participants also completed the Interpersonal Reactivity Index (IRI) developed by Davis (1980), which has been translated into Hebrew and validated (Even, 1993). The scale yields a single numerical score that is a reflection of empathic capacity. We looked at the correlations between the “heaviness” of the accent of L2 speakers and a measure of empathy. These revealed strong correlations between degree of accent and empathy scores in the Russian-speaking group, but not in the Arabic-speaking group. The sociolinguistic implications of these findings are discussed.
The time cost of mixed-language processing: an investigation
Authors: Cheng Yu-Lin , Howard David
Published: January 2009

Does it take bilinguals longer to process mixed-language information? This study explores, in two reaction time experiments, the hypothesis that there is only a cost to language switching when the switch is unexpected in the context. Prior to the experiments, an on-line language test and a linguistic background questionnaire were employed to select the bilingual participants. In experiment 1, the subjects, who were Mandarin Chinese-Taiwanese bilinguals, were led to think that Mandarin Chinese was the contextually appropriate language, and were slower to respond on a language switch trial. In experiment 2, the participants were led to think that both languages were contextually appropriate, and were not slower to respond on a language switch trial. The data support Grosjean's language mode hypothesis on the mixed-language processing cost, and show that the cost is a result of context rather than an inevitable consequence of a switch.
Health Promotion and Illness Demotion at Prostate Cancer Support Groups
Authors: Oliffe John L. , Gerbrandt Julieta S. , Bottorff Joan L. , Hislop T. Gregory
Published: January 2009

Although health promotion programs can positively influence health practices, men typically react to symptoms, rather than maintain their health, and are more likely to deny than discuss illness-related issues. Prostate cancer support groups (PCSGs) provide an intriguing exception to these practices, in that men routinely discuss ordinarily private illness experiences and engage with self-health. This article draws on individual interview data from 52 men, and participant observations conducted at the meetings of 15 groups in British Columbia, Canada to provide insights to how groups simultaneously facilitate health promotion and illness demotion. The study findings reveal how an environment conducive to men’s talk was established to normalize prostate cancer and promote the individual and collective health of group members. From a gendered perspective, men both disrupted and embodied dominant ideals of masculinity in how they engaged with their health at PCSGs.
Be a Fit Kid: Nutrition and Physical Activity for the Fourth Grade
Authors: Slawta Jennifer N. , DeNeui Daniel
Published: January 2009

This article describes the inclusion of Be a Fit Kid in the fourth-grade curriculum. Be a Fit Kid is a fitness-emphasized physical activity and heart-healthy nutrition education program for elementary school children. Five parent—education lessons were offered and nutrition workbooks were distributed to parents. Following the 10-week intervention, significant improvements in fitness, body fat, nutrition knowledge, dietary habits, and levels of lipids and lipoproteins were observed in the intervention group compared with baseline levels. Changes in fitness, body fat, and nutrition knowledge were significant compared with the control group. These findings suggest that comprehensive physical activity and nutrition programs included in the school curriculum may be effective for improving cardiovascular health and reducing future risk for lifestyle-related diseases.
WALK Community Grants Scheme: Lessons Learned in Developing and Administering a Health Promotion Microgrants Program
Authors: Caperchione Cristina , Mummery W. Kerry , Joyner Kelly
Published: January 2009

The Women’s Active Living Kits (WALK) Community Grant Scheme was a key component of a federally funded Australian initiative aimed at increasing local capacity to promote and engage priority women’s groups in health-related physical activity. Under the program, community groups and organizations were provided with the opportunity to apply and receive small grants to support the development of women’s walking groups with the aim of increasing physical activity participation levels in women, supporting innovative community ideas for increasing women’s physical activity by improving social structures and environments, or both. This article describes the development and administration of the WALK Community Grant Scheme, outlines challenges and barriers encountered throughout the grant program process, and provides practical insights for replicating this initiative.
Using the Chronic Care Model to Address Tobacco in Health Care Delivery Organizations: A Pilot Experience in Washington State
Authors: Carlini Beatriz H. , Schauer Gillian , Zbikowski Susan , Thompson Juliet
Published: January 2009

This article describes a Washington State—based Systems Change Pilot Project in which the chronic care model and the model for improvement were used as tools to promote tobacco cessation—related changes within a health care system. Three diverse sites participated in the pilot. Site teams tailored plan-do-study-act tests to site circumstances, addressing current resources and barriers to implementing change. Teams tested system changes that incorporated tobacco use documentation into the routine health services provided. Findings from this pilot suggest that (a) even simple changes with minimal disruption of services can make a difference in improving documentation of tobacco use status; (b) changes to routine practices of health organizations may not be sustainable if ongoing quality assurance mechanisms are not developed; and (c) systems implemented for other disease states within the same organization or patient population are not instinctively applied to tobacco, because of a multitude of factors.
Delivering Culturally Sensitive Health Messages: The Process of Adapting Brochures for Grandparents Raising Grandchildren in Hawai‘i
Authors: Yancura Loriena A.
Published: January 2009

The efficacy of programs to reduce health disparities depends on their ability to deliver messages in a culturally sensitive manner. This article describes the process of designing a series of brochures for grandparents raising grandchildren. National source material on topics important to grandparents (self-care, service use, addiction, and grandchildren’s difficult behaviors) was put into draft brochures and pilot tested in two focus groups drawn from Native Hawaiian Asian and Pacific Islander populations. Elements of surface and deep levels directed the form and content of the final brochures. On a surface level, these brochures reflect local culture through pictures and language. On a deep level, which integrates cultural beliefs and practices, they reflect the importance of indirect communication and harmonious relationships. The final brochures have been received favorably in the community. The process of adapting educational material with attention to surface and deep levels can serve as a guide for other health promotion materials.
Providing Optimal Special Education Services to Hispanic Children and Their Families
Authors: Langdon Henriette W.
Published: January 2009

The U.S. Census Bureau reported that 44.3 million people living in the United States in 2006 were of Hispanic descent. This population is far from homogeneous and includes seven major subgroups based on their origin, each with its own characteristics, which are briefly discussed. Of the 5.1 million children identified as English language learners, 79% speak Spanish as their first language based on 2004-2005 school records. This article presents several areas to be considered by education personnel when working with the Hispanic population, including rearing and communication patterns, families' experiences attaining literacy and school resources, facilitating communication with Hispanic families, and how families understand and react to various educational and medical disabilities. Three case studies illustrate scenarios of children of various ages and challenges and ways in which their families might ensure that they receive optimal educational opportunities. The article ends with a list of suggestions for school personnel.
Are Three Points for a Win Really Better Than Two?
Authors: Dilger Alexander , Geyer Hannah
Published: January 2009

The effects of the three-point rule in the first league German soccer are tested empirically and compared to games from the German cup competition. The inclusion of cup games ensures that changes in league games can be attributed to the three-point rule. As a result of their relative devaluation, the number of draws should decrease. Furthermore, an increase in the number of close wins is expected. The strategy of a leading team becomes more defensive, resulting in fewer goal shootings by that team, as well as fewer shooting opportunities for the opponent. Empirical evidence supporting these effects is found.
Short-form Tai Chi Improves Standing Balance of People With Chronic Stroke
Authors: Au-Yeung Stephanie S. Y. , Hui-Chan Christina W. Y. , Tang Jervis C. S.
Published: January 2009

Background and Objective. Our previous findings showed that 4 weeks of intensive Tai Chi practice improved standing balance in healthy seniors. This study set out to investigate whether Tai Chi could improve standing balance in subjects with chronic stroke. Methods. One hundred thirty-six subjects >6 months after stroke were randomly assigned to a control group (n = 62) practicing general exercises or a Tai Chi group (n = 74) for 12 weeks of training. Each week, 1 hour of group practice was supplemented by 3 hours of self-practice. We used a short-form of Tai Chi consisting of 12 forms that require whole-body movements to be performed in a continuous sequence and demands concentration. A blinded assessor examined subjects at baseline, 6 weeks (mid-program), 12 weeks (end-program), and 18 weeks (follow-up). The 3 outcome measures were (1) dynamic standing balance evaluated by the center of gravity (COG) excursion during self-initiated body leaning in 4 directions, (2) standing equilibrium evaluated in sensory challenged conditions, and (3) functional mobility assessed by Timed-up-and-go score. Mixed model repeated-measures analysis of variance was used to examine between-group differences. Results. When compared with the controls, the Tai Chi group showed greater COG excursion amplitude in leaning forward, backward, and toward the affected and nonaffected sides ( P < .05), as well as faster reaction time in moving the COG toward the nonaffected side ( P = .014) in the end-program and follow-up assessments. The Tai Chi group also demonstrated better reliance on vestibular integration for balance control at end-program ( P = .038). However, neither group improved significantly in Timed-up-and-go scores. Conclusions. Twelve weeks of short-form Tai Chi produced specific standing balance improvements in people with chronic stroke that outlasted training for 6 weeks.
The Effect of Rotational Malalignment on X-rays of the Wrist
Authors: CAPO J. T. , ACCOUSTI K. , JACOB G. , TAN V.
Published: January 2009

This study evaluates the effect of rotational malposition of the wrist on measured radiographic parameters of the distal radius and carpus. Ten wrists from five healthy volunteers were imaged in varying degrees of rotation. The wrists were placed in a custom, calibrated jig and images were taken in 5° increments to a maximum pronation and supination of 20°. The results demonstrate the following: a steady decrease in the scapholunate and radioscaphoid angles with extremes of supination; an increase in palmar tilt with supination and a decrease in palmar tilt with pronation. The palmar tilt varied from −4° to 15° and the scapholunate angle ranged from 48° to 29° at the extremes of rotation. These results demonstrate how malrotation in X-ray positioning can have a significant effect on the apparent alignment of the distal radius and carpal bones. Measurements taken from poor X-rays typically fall outside the normal range and could adversely effect treatment decisions.
The “Open Book” Flap: A Heterodigital Cross-Finger Skin Flap and Adipofascial Flap for Coverage of a Circumferential Soft Tissue Defect of a Digit
Authors: TADIPARTHI S. , AKALI A. , FELBERG L.
Published: January 2009

A case of circumferential digital skin loss with exposed tendons from the proximal phalanx to the distal interphalangeal joint is presented. This was treated with a two-layer heterodigital cross-finger (“open book”) flap from the adjacent digit, utilising a skin-only cross-finger flap to cover the palmar defect and an adipofascial flap to cover the dorsal defect.
Use of Nerve Conduction Studies and the Pressure-Specified Sensory Device in the Diagnosis of Carpal Tunnel Syndrome
Authors: SLUTSKY D. J.
Published: January 2009

Sixty-nine patients with signs of carpal tunnel syndrome (CTS) underwent nerve conduction studies (NCS) and testing with the Pressure-Specified Sensory Device (PSSD). A total of 102 tests were performed (28 bilateral). Twenty patients underwent a carpal tunnel release and were retested after 4 to 6 months. The Symptom Severity Score (SSS) was calculated before and after surgery. A control group of 20 hands in 10 asymptomatic volunteers underwent identical testing. The NCS sensitivity was 87% with a specificity of 90% whereas the PSSD sensitivity was 81% with a specificity of 65%. The combined sensitivity of the two tests was 93%. In the operative group the SSS improved from a mean of 3.34 pre-operatively to 1.95 postoperatively. The NCS improved in 19/21 hands whereas the PSSD improved in 16/19 hands. The non-invasive SSS and PSSD can increase the diagnostic yield in CTS, especially when the NCS are normal.
Forces Transmitted Along Human Flexor Tendons – The Effect of Extending the Fingers Against the Resistance Provided by Rubber Bands
Authors: POWELL E. S. , TRAIL I. A.
Published: January 2009

We wished to test the hypothesis that postoperative extension of repaired flexor tendons against rubber bands will reduce the stress on the repairs, and therefore the risk of rupture. During 24 routine carpal tunnel decompression operations the force in flexor tendons was measured using a load cell. The patients flexed and extended their fingers with and without a rubber band providing resistance to extension. We found no statistically significant difference between the force measured in the tendon with or without the presence of rubber bands. To conclude, we have shown that if the application of rubber band dynamic splintage after flexor tendon repair has any advantage, it is not by reducing the forces transmitted along the tendon during resisted extension or by aiding flexion.
Age- and Gender-Specific Normative Data of Grip and Pinch Strength in a Healthy Adult Swiss Population
Authors: WERLE S. , GOLDHAHN J. , DRERUP S. , SIMMEN B. R. , SPROTT H. , HERREN D. B.
Published: January 2009

Assessment of hand strength is used in a wide range of clinical settings especially during treatment of diseases affecting the function of the hand. This investigation aimed to determine age- and gender-specific reference values for grip and pinch strength in a normal Swiss population with special regard to old and very old subjects as well as to different levels of occupational demand. Hand strength data were collected using a Jamar dynamometer and a pinch gauge with standard testing position, protocol and instructions.

Analysis of the data from 1023 tested subjects between 18 and 96 years revealed a curvilinear relationship of grip and pinch strength to age, a correlation to height, weight and significant differences between occupational groups. Hand strength values differed significantly from those of other populations, confirming the thesis that applying normative data internationally is questionable. Age- and gender-specific reference values for grip and pinch strength are presented.
The “Transverse Intraosseous Loop Technique” (Tilt) to Re-Insert Flexor Tendons in Zone 1
Authors: TRIPATHI A. K. , MEE S. N. J , MARTIN D. L. , KATSARMA E.
Published: January 2009

Flexor tendon divisions in Zone 1 need to be re-inserted to the distal phalanx. This paper describes the Transverse Intraosseous Loop Technique (TILT) of re-inserting the profundus tendon to the distal phalanx in which an internally placed suture is looped through the bone and tendon interface. It provides a strong repair, which permits the desired tensioning and can be performed in children. Ten of 12 patients’ re-insertions using this technique achieved full recovery while two developed fixed flexion contractures.
Single Injection Digital Block: Is a Transthecal Injection Necessary?
Authors: SONOHATA M. , ASAMI A. , OGAWA K. , NAGAMINE S. , HOTOKEBUCHI T.
Published: January 2009

Three different methods of injection to obtain digital block anaesthesia were performed on 15 healthy volunteers to evaluate the success and extent of anaesthesia. We found that the traditional transthecal injection technique was inaccurate and the injected agent mainly flowed into the subcutaneous space, and did not remain within the sheath. The deep transthecal single injection kept the anaesthetic agent within the flexor tendon sheath, as intended. The duration of anaesthesia and the area anaesthetised by the subcutaneous injection and the traditional transthecal injection was similar and satisfactory. However, the anaesthetic area after the deep transthecal injection was significantly smaller than that of the other two techniques ( P<0.01). A transthecal digital block offers no advantage over a simple subcutaneous digital block.
The Deep (Motor) Branch of the Ulnar Nerve: A Detailed Examination of its Course and the Clinical Significance of its Damage
Authors: ATKINS S. E. , LOGAN B. , MCGROUTHER D. A.
Published: January 2009

The deep (motor) branch of the ulnar nerve is not frequently seen during surgery, but is vulnerable to penetrating injury and may be injured during surgery. Its anatomy is poorly described and its three-dimensional configuration is poorly appreciated.

In this study, dissections of ten cadaveric specimens have been performed to demonstrate the branching pattern of the nerve and its skeletal relations have been clarified by superimposing images on radiographs. The deep branch passes downwards (anatomical posterior) through a hypothenar fibro-muscular tunnel and courses radially on the surface of the interossei. It has four major divisions that are consistent and readily identifiable. Twenty branches were documented supplying hypothenar muscles, medial two lumbricals, interossei, adductor pollicis, all the carpometacarpal and the ring and little metacarpophalangeal joints, and opponens pollicis in 40% and flexor pollicis brevis in 20% of subjects.
Gene expression profiling of ATL patients: compilation of disease-related genes and evidence for TCF4 involvement in BIRC5 gene expression and cell viability
Authors: Pise-Masison Cynthia A. , Radonovich Michael , Dohoney Kathleen , Morris John C. , O'Mahony Deirdre , Lee Min-Jung , Trepel Jane , Waldmann Thomas A. , Janik John E. , Brady John N.
Published: January 2009

Adult T-cell leukemia/lymphoma (ATL) is an aggressive and fatal disease. We have examined 32 patients with smoldering, chronic, lymphoma and acute leukemia using Affymetrix HG-U133A2.0 arrays. Using the BRB array program, we identified genes differentially expressed in leukemia cells compared with normal lymphocytes. Several unique genes were identified that were overexpressed in leukemic cells, including TNFSF11, RGS13, MAFb, CSPG2, C/EBP-α, and TCF4; 200 of the most highly overexpressed ATL genes were analyzed by the Pathway Studio, version 4.0 program. ATL leukemia cells were characterized by an increase in genes linked to “central” genes CDC2/cyclin B1, SYK/LYN, proliferating cell nuclear antigen, and BIRC5. Because of its potential therapeutic importance, we focused our studies on the regulation and function of BIRC5, whose expression was increased in 13 of 14 leukemia samples. TCF4 reporter assays and transfection of DN-TCF4 demonstrated that TCF4 regulates BIRC5 gene expression. Functionally, transfection of ATL cells with BIRC5 shRNA decreased BIRC5 expression and cell viability 80%. Clinical treatment of ATL patients with Zenapax or bortezomib decreased BIRC5 expression and cell viability. These experiments represent the first direct experimental evidence that BIRC5 plays an important role in ATL cell viability and provides important insight into ATL genesis and potential targeted therapies.
The role of cytogenetic abnormalities as a prognostic marker in primary myelofibrosis: applicability at the time of diagnosis and later during disease course
Authors: Tam Constantine S. , Abruzzo Lynne V. , Lin Katherine I. , Cortes Jorge , Lynn Alice , Keating Michael J. , Thomas Deborah A. , Pierce Sherry , Kantarjian Hagop , Verstovsek Srdan
Published: January 2009

Although cytogenetic abnormalities are important prognostic factors in myeloid malignancies, they are not included in current prognostic scores for primary myelofibrosis (PMF). To determine their relevance in PMF, we retrospectively examined the impact of cytogenetic abnormalities and karyotypic evolution on the outcome of 256 patients. Baseline cytogenetic status impacted significantly on survival: patients with favorable abnormalities (sole deletions in 13q or 20q, or trisomy 9 ± one other abnormality) had survivals similar to those with normal diploid karyotypes (median, 63 and 46 months, respectively), whereas patients with unfavorable abnormalities (rearrangement of chromosome 5 or 7, or ≥ 3 abnormalities) had a poor median survival of 15 months. Patients with abnormalities of chromosome 17 had a median survival of only 5 months. A model containing karyotypic abnormalities, hemoglobin, platelet count, and performance status effectively risk-stratified patients at initial evaluation. Among 73 patients assessable for clonal evolution during stable chronic phase, those who developed unfavorable or chromosome 17 abnormalities had median survivals of 18 and 9 months, respectively, suggesting the potential role of cytogenetics as a risk factor applicable at any time in the disease course. Dynamic prognostic significance of cytogenetic abnormalities in PMF should be further prospectively evaluated.
Compliance in sleep apnoea therapy: influence of home care support and pressure mode
Authors: Damjanovic D. , Fluck A. , Bremer H. , Müller-Quernheim J. , Idzko M. , Sorichter S.
Published: January 2009

Continuous positive airway pressure (CPAP) is an effective treatment for obstructive sleep apnoea syndrom (OSAS) but therapy adherence is often low. The hypothesis that CPAP-adherence and clinical outcomes can be improved by either using an autoadjusting-CPAP (APAP) device or an intensive support was tested.

A controlled parallel group study was performed with 100 newly diagnosed OSAS patients, randomised into 4 groups (n = 25 each): standard or intensive support plus either APAP or CPAP. Intensive support included education and monthly home visits for 6 months. Clinical outcome was monitored by polysomnography at CPAP initiation and, after 3 and 9 months, compliance data were downloaded from the CPAP devices.

After 9 months, intensively supported patients returned for follow-up in 88versus68% in the standard-support-group. Daily usage (mean±sem5.7±0.2 for intensive supportversus4.6±0.4 h for standard support), percentage of days used (80.4±2.8versus57.0±5.9%) and proportion of individual sleep time (80.6±3.2versus64.9±6.2%) were also higher. There was no significant difference between APAP or CPAP, (daily usage 5.2±0.4versus5.1±0.3 h, percentage of days 67.9±5.0versus69.2±4.9%, proportion of sleep time 72.5±5.0%versus72.1±5.2%, for APAP and CPAP) but retention rate was higher with CPAP.

In summary, intensive support after continuous positive airway pressure initiation, rather than the application of autoadjusting-continuous positive airway pressure, increased therapy adherence.
Inspiratory duty cycle responses to flow limitation predict nocturnal hypoventilation
Authors: Schneider H. , Krishnan V. , Pichard L. E. , Patil S. P. , Smith P. L. , Schwartz A. R.
Published: January 2009

Upper airway obstruction (UAO) can elicit neuromuscular responses that mitigate and/or compensate for the obstruction. It was hypothesised that flow-limited breathing elicits specific timing responses that can preserve ventilation due to increases in inspiratory duty cycle rather than respiratory rate.

By altering nasal pressure during non-rapid eye movement (non-REM) sleep, similar degrees of UAO were induced in healthy males and females (n = 10 each). Inspiratory duty cycle, respiratory rate and minute ventilation were determined for each degree of UAO during non-REM sleep and compared with the baseline nonflow-limited condition.

A dose-dependent increase in the inspiratory duty cycle and respiratory rate was observed in response to increasing severity of UAO. Increases in the inspiratory duty cycle, but not respiratory rate, helped to acutely maintain ventilation. Heterogeneity in these responses was associated with variable degrees of ventilatory compensation, allowing for the segregation of individuals at risk for hypoventilation during periods of inspiratory airflow limitation.

Upper airway obstruction constitutes a unique load on the respiratory system. The inspiratory duty cycle, but not the respiratory rate, determine the individual's ability to compensate for inspiratory airflow limitation during sleep, and may represent a quantitative phenotype for obstructive sleep apnoea susceptibility.
Proactive integrated care improves quality of life in patients with COPD
Authors: Koff P. B. , Jones R. H. , Cashman J. M. , Voelkel N. F. , Vandivier R. W.
Published: January 2009

Self-management strategies improve a variety of health-related outcomes for patients with chronic obstructive pulmonary disease (COPD). These strategies, however, are primarily designed to improve chronic disease management and have not focused on early detection and early treatment of exacerbations. In COPD, the majority of exacerbations go unreported and treatment is frequently delayed, resulting in worsened outcomes. Therefore, a randomised clinical trial was designed to determine whether integration of self-management education with proactive remote disease monitoring would improve health-related outcomes.

A total of 40 Global Initiative for Chronic Obstructive Lung Disease stage 3 or 4 COPD patients were randomised to receive proactive integrated care (PIC) or usual care (UC) over a 3-month period. The primary and secondary outcomes were change in quality of life, measured by the St George’s Respiratory Questionnaire (SGRQ), and change in healthcare costs.

PIC dramatically improved SGRQ by 10.3 units, compared to 0.6 units in the UC group. Healthcare costs declined in the PIC group by US$1,401, compared with an increase of US$1,709 in the UC group, but this was not statistically significant. PIC uncovered nine exacerbations, seven of which were unreported.

Therefore, proactive integrated care has the potential to improve outcomes in chronic obstructive pulmonary disease patients through effects of self-management, as well as early detection and treatment of exacerbations.
Indeterminate results of QuantiFERON TB-2G test performed in routine clinical practice
Authors: Kobashi Y. , Sugiu T. , Mouri K. , Obase Y. , Miyashita N. , Oka M.
Published: January 2009

The present authors assessed risk factors that can promote indeterminate results of QuantiFERON TB-2G (QFT-2G; Cellestis Ltd, Carnegie, Australia) tests.

The subjects were 704 patients with suspected tuberculosis (TB) and latent TB infection between January 2005 and December 2007. The QFT-2G test and the tuberculin skin test (TST) were performed for all subjects. If the results of the QFT-2G test were indeterminate, the test was repeated within 1 month.

In total, 72 (10.2%) patients showed indeterminate results on the QFT-2G test. Indeterminate results were due to positive control failure in 68 (88.9%) patients and negative control failure in four patients. The results of the TST were negative for 64 patients showing indeterminate results, the remaining eight patients showed a positive response to the TST. Indeterminate results were significantly associated with elderly and immunocompromised patients. Lymphocytopaenia and hypoalbuminaemia were significantly associated with indeterminate laboratory findings. When the QFT-2G test was repeated for all patients showing indeterminate results, 12 (16.7%) patients demonstrated determinate results on the subsequent test.

Indeterminate results of the QuantiFERON TB-2G test under routine clinical practice are not infrequent. When scoring QuantiFERON TB-2G test results for elderly and immunocompromised patients, one must be careful because the possibility of obtaining determinate results may be low even if the test is repeated.
Cigarette smoke extract reduces VEGF in primary human airway epithelial cells
Authors: Thaikoottathil J. V. , Martin R. J. , Zdunek J. , Weinberger A. , Rino J. G. , Chu H. W.
Published: January 2009

Reduced vascular endothelial growth factor (VEGF) has been reported in bronchoalveolar lavage fluid and lungs of severe emphysema patients. Airway epithelial cells (AEC) are exposed to various environmental insults like cigarette smoke and bacterial infections, but their direct effect on VEGF production in well-differentiated primary human AEC remains unclear.

The current authors determined the effect of cigarette smoke extract (CSE) alone and in combination withMycoplasma pneumoniae(Mp) on VEGF production in well-differentiated primary normal human bronchial epithelial (NHBE) and small airway epithelial cells (SAEC) in air–liquid interface cultures. Secretion and expression of VEGF were determined by ELISA and real-time RT-PCR, respectively. Cell growth, apoptosis, extracellular signal-regulated kinase (ERK)1/2 and protein kinase (PK)C signalling pathways were evaluated to further dissect VEGF regulation under CSE treatment.

CSE significantly reduced VEGF secretion in NHBE and SAEC. In SAEC,Mpalone significantly increased the VEGF, while the presence of CSE attenuatedMp-induced VEGF production. While ERK inhibitor reduced VEGF secretion only in NHBE, a PKC inhibitor significantly decreased VEGF secretion in both NHBE and SAEC.

In conclusion, direct cigarette smoke extract exposure significantly reduced vascular endothelial growth factor production in well-differentiated primary human airway epithelial cells, in part through modifying extracellular signal-regulated kinase 1/2 and protein kinase C signalling pathways.
Prevalence and Risk Factors of Allergies in Turkey (PARFAIT): results of a multicentre cross-sectional study in adults
Authors: Kurt E. , Metintas S. , Basyigit I. , Bulut I. , Coskun E. , Dabak S. , Deveci F. , Fidan F. , Kaynar H. , Uzaslan E.Kunt , Onbasi K. , Ozkurt S. , Karakis G.Pasaoglu , Sahan S. , Sahin U. , Oguzulgen K. , Yildiz F. , Mungan D. , Yorgancioglu A. , Gemicioglu B. ,   A.Fuat Kalyoncu for the PARFAIT Study of the Turkish Thoracic Society Asthma and Allergy Working Group
Published: January 2009

The Prevalence and Risk Factors of Allergies in Turkey (PARFAIT) study was planned to evaluate the prevalence of and risk factors for asthma and allergic diseases in Turkey.

The present analysis used data from 25,843 parents of primary school children, obtained from a cross-sectional questionnaire-based study.

A total of 25,843 questionnaires from 14 centres were evaluated. In rural areas, the prevalences asthma, wheezing, allergic rhinitis and eczema in males were: 8.5% (95% confidence interval (CI) 7.9–9.1%), 13.5% (95% CI 12.8–14.2%), 17.5% (95% CI 16.7–18.2%) and 10.8% (95% CI 10.2–11.4%), respectively; and in females were: 11.2% (95% CI 10.9–11.8%), 14.7% (95% CI 14.3–15.1%), 21.2% (95% CI 20.4–22.0%) and 13.1% (95% CI 12.4–13.8%), respectively. In urban areas, the corresponding prevalences in males were: 6.2% (95% CI 5.8–6.6%), 10.8% (95% CI 10.3–11.3%), 11.7% (95% CI 11.4–12.0%) and 6.6% (95% CI 6.2–7.0%), respectively; and in females were: 7.5 % (95% CI 7.9–7.1%), 12.0% (95% CI 11.7–12.3%), 17.0% (95% CI 16.4–17.6%) and 7.3% (95% CI 6.9–7.7%), respectively. Having an atopic first-degree relative or any other atopic diseases had significant effects on the prevalence of allergic diseases. Housing conditions, such as living in a shanty-type house, visible moulds at home and use of wood or biomass as heating or cooking material were associated with one or more allergic diseases.

Although genetic susceptibility is strongly associated, country- and population-based environmental factors may contribute to increased prevalence rates of allergic diseases.
Quality control ofDL,COinstruments in global clinical trials
Authors: Jensen R. , Leyk M. , Crapo R. , Muchmore D. , Berclaz P. Y.
Published: January 2009

High inter- and intra-laboratory variability exists for the single-breath diffusing capacity of the lung for carbon monoxide (DL,CO) test. To detect small changes in diffusing capacity in multicentre clinical trials, accurate measurements are essential. The present study assessed whether regularDL,COsimulator testing maintained or improved instrument accuracy and reduced variability in multicentre trials.

The 125 pulmonary function testing laboratories that participated in clinical trials for AIR® Inhaled Insulin validated and monitored the accuracy of theirDL,COmeasuring devices using aDL,COsimulator, which creates known target values for any device. Devices measuring a simulatedDL,COdifferent from target by >3 mL·min-1·mmHg−1failed testing and were serviced. Device accuracy was assessed over time and with respect to differences in several variables.

Initially, 31 (25%) laboratories had aDL,COdevice that failed simulator testing. After fixing or replacing devices, 124 (99%) laboratories had passing devices. The percentage of failed tests significantly decreased over time. Differences in geographical region, device type, breath-hold time, temperature and pressure were not associated with meaningful differences inDL,COdevice accuracy.

Regular diffusing capacity of the lung for carbon monoxide simulator testing allows pulmonary function testing laboratories to maintain the accuracy of their diffusing capacity measurements, leading to reduced variability across laboratories in multicentre clinical trials.
Different respiratory phenotypes are associated with isocyanate exposure in spray painters
Authors: Pronk A. , Preller L. , Doekes G. , Wouters I. M. , Rooijackers J. , Lammers J-W. , Heederik D.
Published: January 2009

Associations have been observed between exposure to isocyanates, consisting mainly of oligomers, and respiratory symptoms and isocyanate specific sensitisation in spray painters. The aim of the present study was to assess associations between isocyanate exposure and more objective respiratory effect measures such as bronchial hyperresponsiveness (BHR), baseline spirometry and exhaled nitric oxide (eNO) in a subset of spray painters.

Methacholine challenge and eNO measurements were performed in 229 workers. Questionnaires and blood samples were obtained. Specific immunoglobulin (Ig)E and IgG to hexamethylene di-isocyanate were assessed in serum using various assays. Personal exposure was estimated by combining personal task-based inhalatory exposure measurements and time-activity information.

Workers with higher isocyanate exposure were more often hyperresponsive (prevalence ratio comparing the 75thversus25th percentile of exposure 1.8). In addition, significant exposure-related decreased forced expiratory volume in one second (FEV1), FEV1/forced vital capacity ratio and flow–volume parameters independent of BHR were found. BHR was more prevalent among sensitised workers. This was statistically significant for only IgG-ImmunoCAP (Phadia, Uppsala, Sweden) positive workers. eNO was not associated with exposure although slightly elevated eNO levels in specific IgG positive subjects were found.

The current study provides evidence that exposure to isocyanate oligomers is related to asthma with bronchial hyperresponsiveness as a hallmark, but also shows independent chronic obstructive respiratory effects resulting from isocyanate exposure.
Pleural plaques and asbestosis: dose– and time–response relationships based on HRCT data
Authors: Paris C. , Thierry S. , Brochard P. , Letourneux M. , Schorle E. , Stoufflet A. , Ameille J. , Conso F. , Pairon J. C. ,   the National APEXS Members
Published: January 2009

Most studies on asbestos-related diseases are based on chest radiographs, and dose–response relationships are still controversial. The aim of this study was to describe the most relevant parameters of asbestos exposure linked to pleural plaques and asbestosis diagnosed by high-resolution computed tomography (HRCT).

A large screening programme including systematic HRCT examinations was organised from 2003 to 2005 in France for formerly asbestos-exposed workers. The time since first exposure (TSFE), level, duration and cumulative exposure to asbestos were used in adjusted unconditional logistic regression to model the relationships of the two diseases.

Analysis of a population of 5,545 subjects demonstrated that TSFE (p<0.0001) and cumulative exposure (p = 0.02) (or level, depending on the models used), were independently associated with the frequency of pleural plaques. Only cumulative exposure (p<0.0001) or level of exposure (p = 0.02) were significantly associated with asbestosis. All trend tests were significant for these parameters.

To date and to our knowledge, this study is the largest programme based on HRCT for the screening of asbestos-exposed subjects. Both time–response and dose–response relationships were demonstrated for pleural plaques, while only dose–response relationships were demonstrated for asbestosis. These parameters must be included in the definition of high-risk populations for HRCT-based screening programmes.