bluuebunny/crossref_metadata_2025 huggingface dataset:
After the reforms: how have public science research organisations changed?
Authors: Simpson Barbara
Published: May 2004

Throughout the Western world, the provision of public good science research has undergone dramatic reforms over the past two decades. In the aftermath of these reforms, this paper asks whether the organisations engaged in science research and knowledge production have actually changed, and if so, how? Archetype analysis is used to explore the deep structures of four comparable case study organisations drawn from the New Zealand science sector. The study concludes that no new, stable organisational archetype has emerged following the reforms, but that in fact, a dynamic style of organisation that is in a state of endless transition is the most appropriate response to contemporary demands for knowledge production. The role of organisational leaders in this context is not only to make sense of the organisation's ever‐changing situation, but also to translate this sense into the actions of organisational members and other stakeholders.
New models for measuring the R&D performance and identifying the productivity of public research institutes
Authors: Coccia Mario
Published: May 2004

Research evaluation of public institutes is important for measuring the performance of the science sector and improving the cost effectiveness and efficiency of public resource allocation. The purpose of this article is to construct a means of classifying publicly‐funded R&D institutions and their performance (high or low). The main findings are two research performance functions, created using discriminant analysis with direct and Wilks methods, which have been successfully applied to 200 public research institutes belonging to the Italian National Research Council. The large number of indicators used within the models creates a macro index that produce, as output, the research performance score. The data analysed is from the 2001 period. The results show that 22.5% of public labs fall into the ‘high performance institute’ bracket and that they have a site larger than ‘low performance institutes’. The models are useful tools for decision making within the research bodies and for reducing X‐inefficiency.
The role of predevelopment activities in the relationship between market orientation and performance
Authors: Langerak Fred , Jan Hultink Erik , Robben Henry S. J.
Published: May 2004

To determine how critical predevelopment activities are for a market‐oriented firm to achieve superior performance, our study uses data from 126 firms in The Netherlands to investigate the structural relationships among market orientation, the proficiency in predevelopment activities, new product performance, and organizational performance. The results provide evidence that market orientation is positively related to the proficiency in strategic planning, idea generation and idea screening. Strategic planning and idea generation are positively related to new product performance, which in itself is positively related to organizational performance. Market orientation has no direct relationship with new product performance and organizational performance. Another interesting finding is that the links between market orientation and new product performance, and between market orientation and organizational performance are not moderated by the characteristics of the market environment.
Networks and innovation: sustainable technologies in Scottish social housing
Authors: Dewick Paul , Miozzo Marcela
Published: May 2004

The process of innovation often involves the participation of several firms and organisations in a network. This paper improves our understanding of the role of inter‐organisational relations in such networks. It assesses how sustainable technologies in the Scottish social housing sector are introduced and diffused. Drawing on detailed interviews, the paper shows that despite policy initiatives by the National Housing Agency to encourage sustainable technologies and processes, a number of factors related to the organisational structure of the construction industry militate against the achievement of this objective. The different aims of the parties involved in the construction chain may not be easily reconciled and traditional approaches to construction may reinforce these differences, hindering efforts to introduce innovation.
Book Reviews
Authors: McDonough Edward F , Daisley Peter A. , Ball Alasdair
Published: May 2004

Book Reviewed:

Knut Holt, Market Oriented Product Innovation

Barrie G. Dale, Managing Quality

Henry Chesborough, Open Innovation
Reduced reactivation rate in mutant CuZnSOD and progression rate of amyotrophic lateral sclerosis
Authors: Völkel H. , Selzle M. , Walk T. , Jung G. , Link J. , Ludolph A. C. , Reuter A.
Published: May 2004

Mutations in the SOD1 gene are associated with familial amyotrophic lateral sclerosis (fALS). The mechanisms by which these mutations lead to anterior horn cell loss are unknown, however, increased binding of Hsps on the demetallated mutant SOD1 has been described which would make the HSPs unavailable for other purposes, and reduce the SOD1 concentration in mitochondria, thereby creating a proapoptotic situation finally leading to motor neuron death. Here we report the recombinant expression of four human copper/zinc superoxide dismutase (CuZnSOD) variants, including the wild‐type enzyme and mutant proteins associated with familial ALS. The bacterial expression level of soluble mutated proteins was influenced by the mutations leading to drastically reduced levels of soluble CuZnSOD. Simultaneously, increasing levels of insoluble and probably aggregated mutated CuZnSOD were identified in bacterial cell pellets. In addition, altered reactivation kinetics of the purified mutant apoproteins after expression in bacterial culture was shown. Biophysical and biochemical analysis showed that zinc incorporation is severely reduced in the CuZnSOD proteins associated with the most severely forms of fALS (A4V, G93A). These data indicate that a reduced holoenzyme formation rate of mutant enzymes may be a critical factor in the etiopathology of fALS.
‘Keeping Quiet’ or ‘Going Nuts’: Strategies Used by Young, Black, Men in Custody
Authors: Wilson David
Published: May 2004

Abstract: This article presents findings from an ethnographic study of 45 young, black, men in three young offender institutions in England and Wales, and seeks to give them a ‘voice’ about being ‘young’, ‘black’ and in custody. As such it builds on previously published work in the Howard Journal that presented ‘emerging findings’ from this research. Both the ‘emerging findings’ and this article suggest that these young, black, men adapt a strategy that they have used in dealing with the police in the community to the reality of prison life, a strategy which they describe as ‘the Game’, which involves either ‘keeping quiet’ or ‘going nuts’ and which transcends the Prison Service's formal monitoring and complaints procedures about race.
Efficacy of Granulocytapheresis and Leukocytapheresis for the Treatment of Microscopic Polyangiitis
Authors: Hasegawa Midori , Kawamura Nahoko , Murase Masamitsu , Koide Shigehisa , Kushimoto Hiroko , Murakami Kazutaka , Tomita Makoto , Hiki Yoshiyuki , Shikano Masahiko , Sugiyama Satoshi
Published: May 2004

Abstract:  We evaluated the efficacy of granulocytaperesis and leukocytapheresis for the treatment of rapidly progressive glomerulonephritis (RPGN) and lung hemorrhage caused by microscopic polyangiitis. Three patients with RPGN were treated by granulocytapheresis (GCAP) and five patients with RPGN were treated by leukocytapheresis (LCAP). The prednisolone dose was 0.4 ± 0.2 g/kg/day (mean ± SD; range 0.2–0.8 g/kg/day). Pre‐treatment serum creatinine was 3.2 ± 1.4 mg/dL (1.4–5.1 mg/dL). The patients were followed for a mean period of 15 ± 6 months (6–23 months). Renal function improved in five of the eight RPGN patients. Three lung hemorrhage episodes in two different patients were treated with GCAP and one lung hemorrhage episode was treated with LCAP combined with various doses of corticosteroids. All four lung hemorrhage episodes were ameliorated. We concluded that combined therapy of GCAP or LCAP and corticosteroids is effective for the treatment of RPGN and lung hemorrhage due to microscopic polyangiitis.
Filtration Leukocytapheresis Therapy in the Treatment of Rheumatoid Arthritis Patients Resistant To or Failed with Methotrexate
Authors: Kempe Kazuo , Tsuda Hiroshi , Yang Kwangseok , Yamaji Ken , Kanai Yoshinori , Hashimoto Hiroshi
Published: May 2004

Abstract:  Filtration leukocytapheresis (LCP) is a treatment for abnormal autoimmune states, which removes responsible leukocytes from the peripheral blood. To examine the efficacy of LCP therapy in the treatment of rheumatoid arthritis (RA), nine patients were selected, who were either resistant to methotrexate, or failed with methotrexate due to drug ineffectiveness or adverse side effects. For these patients, LCP therapy was performed once a week for five weeks. After five LCP treatments, the patients were observed for 12 weeks, to test the efficacy of the treatment. The definition of improvement given by the American College of Rheumatology (ACR core set) was used for efficacy evaluation of LCP therapy. As the result, 77.8% of the patients showed an ACR 20% response and 44.4% of the patients showed an ACR 50% response. With improvement of joint symptoms, IL‐6 was significantly decreased at 8 weeks and 12 weeks after the treatment. The expression of adhesion molecules CD11a, CD11b, and CD18 on granulocytes decreased directly after the LCP treatment. No adverse side effect was monitored during the study period. These results indicates that LCP treatment is a useful treatment for RA patients who were resistant to methotrexate, or failed with methotrexate due to  ineffectiveness  or  side effects  of  the  drug.
The Role of Apheresis Therapy in Living Donor Liver Transplantation
Authors: Kozaki Koichi , Fukatsu Atsushi , Kasahara Mureo , Ogura Yasuhiro , Egawa Hiroto , Tanaka Koichi
Published: May 2004

Abstract:  Liver transplantation is a radical therapy for end‐stage liver disease. The severe shortage of transplantable organs is, however, a big problem, not only in liver transplantation but also other organ transplants. Although in Japan, transplantation of organs obtained from brain‐dead donors (BDD) has been allowed since October 1997, to date only 27 BDD have been obtained. It has become difficult to procure liver grafts from BDD, therefore we must use liver grafts from living donors. The living‐donor liver transplantation (LDLT) program started in 1990 in Japan, and is still the major form of liver transplantation because of the scarcity of cadaveric donors. In the Department of Transplant Surgery, Kyoto Hospital (Kyoto, Japan), the accumulated number of LDLT cases exceeded 955 up to October 2003. In order to perform LDLT under safer conditions, apheresis plays a major role in Japan due to the prevalence of LDLT where later retransplantation is difficult. Clinical indications of apheresis for LDLT are mainly use as a bridge before transplantation, and liver support after transplantation. We describe the effect of apheresis therapy for LDLT patients with nephritic and hepatic problems.
Tryptophan‐immobilized Column‐based Immunoadsorption as the Choice Method for Plasmapheresis in Guillain–Barré Syndrome
Authors: Okamiya Satoshi , Ogino Mieko , Ogino Yutaka , Irie Sachiko , Kanazawa Naomi , Saito Toyokazu , Sakai Fumihiko
Published: May 2004

Abstract:  Plasmapheresis is widely performed as treatment for patients with Guillain–Barré syndrome (GBS) in the acute phase. As tryptophan‐immobilized column‐based immunoadsorption (Tr‐IA) is a safer method than either double‐filtration plasmapheresis (DFPP) or plasma exchange (PE), we investigated whether or not Tr‐IA is as effective as other methods, and should be selected as the procedure of choice in patients with GBS. We retrospectively compared clinical outcomes, using Hughes grading, in GBS patients treated with Tr‐IA, DFPP or PE. The outcome in the Tr‐IA group was also compared historically with patients treated by PE in seven previous studies. We studied 34 patients with GBS: 20 were treated with Tr‐IA, 11 with DFPP, and 3 with PE. The age, sex, duration from onset to initiation of treatment, and Hughes grade at entry did not differ among the Tr‐IA, DFPP and PE groups. There was no significant difference in outcomes among these three groups, nor was there a significant difference between the outcomes in the Tr‐IA and DFPP groups with respect to subgroups of Hughes grade at entry. Also, our Tr‐IA group did not show a different outcome from the previously reported patients treated with PE. The frequency of complications in our Tr‐IA group is significantly lower than that in both our DFPP group, and in the previously reported cases of patients treated with PE. Tr‐IA, DFPP and PE have almost the same efficacy in patients with GBS, but Tr‐IA is recommended as the plasmapheresis method of choice because of its safety.
A Possible Involvement of the Carboxymethylation Process in Carpal Tunnel Syndrome in Hemodialysis Patients
Authors: Imai Kotomi , Yoshinaka Mitsuhiro , Iwamoto Hisahiko , Higashi Takuya , Masuda Mari , Motomiya Yoshihiro
Published: May 2004

Abstract:  A median motor nerve latency (DML) is generally prolonged in the carpal tunnel syndrome (CTS) of hemodialysis patients. Meanwhile, the advanced glycation process of proteins has been reported to be involved in the pathogenesis of the dialysis related amyloidosis. To investigate the role of carboxymethylation in dialysis related CTS, we measured a circulating carboxymethyllysine‐hemoglobin (CML‐Hb) level and nerve conduction velocity in 44 hemodialysis patients. The circulating CML‐Hb level was 6.56 ± 3.18 nmol CML/mg Hb, median motor nerve conduction velocity (NCV) was 49.8 ± 4.64 m/s, median DML was 4.44 ± 1.06 ms, and difference between median DML and ulnar DML (Δ DML) was 1.68 ± 1.09 ms. Median and ulnar nerve NCV showed no correlation with circulating CML‐Hb level. Both median DML and Δ DML were significantly correlated with CML‐Hb (r = 0.429, P = 0.003, r = 0.472, P = 0.001). This study provided additional clinical evidence of an involvement of an advanced glycation process in the pathogenesis in CTS in hemodialysis patients.
Twice Daily Plasma Exchange in Refractory Thrombotic Thrombocytopenic Purpura
Authors: Kahwash Eiad , Lockwood William B
Published: May 2004

Abstract:  Thrombotic thrombocytopenic purpura (TTP) usually responds to daily single total plasma exchange (TPE) or to plasma infusion. However, some cases are refractory to total plasma exchange, and additional efficacious treatment may not be available. A 34‐year‐old white male diagnosed with TTP was found to be refractory to single TPE. Steroids and twice daily TPE, in addition to splenectomy and vincristine, worked well to prevent further clinical deterioration. Laboratory values were normalized at the completion of treatment protocol. Cases of TTP refractory to single TPE/day may benefit from early treatment of twice‐daily TPE in addition to a combination therapy  of  steroids,  splenectomy,  and  vincristine.
Treatment of Multiple Organ Failure through Sepsis by Surgery and Blood Purification
Authors: Asanuma Yoshihiro , Sato Tsutomu , Kotanagi Hitoshi , Yamamoto Yuzo , Nakae Hajime
Published: May 2004

Abstract:  For the treatment of multiple organ failure (MOF) through sepsis, we have commonly applied various blood purification modalities during the perioperative period. From January 1996 to December 2000, 33 patients with MOF through sepsis were admitted and operated on in the First Department of Surgery, Akita University School of Medicine, and 21 of these 33 patients were treated using various blood purification modalities during the perioperative period: endotoxin‐adsorbing therapy using polymyxin B (PMX) in 17 patients, continuous hemofiltration (CHF)/continuous hemodiafiltration (CHDF) in 15 patients, and plasma exchange (PE) and CHDF in 3 patients. Of the outcome of these 33 patients with MOF through sepsis, 17 survived and 16 died (48% mortality). Of the 21 patients with MOF through sepsis treated by surgery and blood purification, 12 survived and 9 died (43% mortality). We evaluated APACHE II and the number of failed organs before operation. Amongst the group with 12 survivors and 9 deaths, Acute Physiology and Chronic Health Evaluation II (APACHE II) was 15 ± 5, 23 ± 2 and the number of failed organs was 2.7 ± 0.7, 3.9 ± 0.8, respectively. An increased APACHE II score and number of failed organs were significantly associated with mortality. As to the treatment of MOF through sepsis due to acute peritonitis, patients with APACHE II scores ranging from 15 to 20, and those with 2–3 failed organs seem to be the candidates for the application of blood purification during the perioperative period.
Selective Adsorption of Human CD4+ T Cells
Authors: Matsuo Hidenori , Goto Hirofumi , Kambara Chiaki , Fukudome Takayasu , Mizota Takamitsu , Onodera Hirokazu , Yoshida Makoto , Shibuya Noritoshi
Published: May 2004

Abstract:  The pathogenesis of most autoimmune diseases directly involves CD4+ helper T cells. To remove CD4+ T cells selectively from the circulation, we designed a new column in which an anti‐CD4 monoclonal antibody was immobilized on the activated substance. Nearly 90% of CD4+ T cells were selectively adsorbed from whole blood with a single passage through the column in vitro, resulting in depletion of the antigen‐specific T cell responses. We conclude that this new column would be potentially useful for treatment of T cell‐mediated autoimmune diseases.
Analysis for the Optimal Blood Draw Speed to Collect Sufficient Peripheral Blood Mononuclear Cells by COBE Spectra
Authors: Shimizu N , Asai T
Published: May 2004

Abstract:  In recent years the procedures for peripheral blood mononuclear cell (PBMNC) harvests have gradually been increasing. These PBMNCs are collected for several treatments, for example, donor lymphocyte infusion (DLI), immunotherapy for solid carcinoma, and regeneration therapy for ischemic limbs. In order to analyze the optimal procedure for collecting PBMNCs safely and efficiently, we evaluated 129 PBMNC apheresis procedures from April 1996 to May 2003, without hemopoietic stem cell mobilization by G‐CSF. In every case, PBMNC collections were performed with a COBE Spectra cell separator (Gambro BCT). The median apheresis volume was 5550 mL. The median of blood draw speed was 48.1 mL/min. The median TNC (total nuclear cell) number in products was 50.4 ×  103/µL. In the regression analysis, no significant correlation was seen between the blood draw speed and the concentrations of TNC in products (Y = aX + b, a = 0.842497, b = 17.11352, r = 0.222032, P = 0.012464). A positive correlation was seen between WBC on apheresis day and the concentrations of TNC (Y = aX + b, a = 0.009822, b = 3.224679, r = 0.550431, P = 2.93 × 10−11). A significantly higher correlation was seen between the MNC (mononuclear cells) on apheresis day and the concentrations of TNC (Y = aX + b, a = 0.028278, b = 13.09266, r = 0.696988, P = 9.486 × 10−9). This study has shown evidence that a higher increment of blood draw speed does not provide a higher concentration of products. An adequate apheresis speed is about 40 mL/min. If we want to obtain sufficient cell counts, it is very important to obtain sufficient volume with a moderate blood draw speed, therefore protecting against side‐effects.
Study of Plasma Exchange for Liver Failure: Beneficial and Harmful Effects
Authors: Abe Takaya , Kobata Hirotsugu , Hanba Yoshiyuki , Kitabata Yukiko , Narukawa Nobuhiko , Hasegawa Hirohito , Abe Tomiya , Fukagawa Masafumi
Published: May 2004

Abstract:  Plasma exchange (PE) is often performed in combination with hemodialysis (HD) or hemodiafiltration. However, most methods were developed for the treatment of renal failure, so various problems may arise during treatment of liver failure (LF). In this study, we investigated the impact of PE alone and in combination with HD, and we assessed the complications of using PE + HD for the treatment of LF. After the exchange of 1 L of fresh frozen plasma (FFP), we measured serum electrolytes, HCO3–, citrate, and acetate at 3 points in the circuit: A) the plasma separator inflow; B) after mixing of FFP/the dialyzer inflow; and C) the dialyzer outflow. Serum levels of human hepatocyte growth factor (HGF), acetate, and citrate were also measured before and after PE + HD. The levels of K+, Ca++, HCO3–, and acetate were significantly decreased, and citrate was increased, between A and B. K+ and citrate were decreased, while Ca++, HCO3–, and acetate showed an increase between B and C. Comparison of A with C revealed insufficient correction of the Ca++ and citrate levels by HD. After PE + HD, serum levels of acetate and citrate were increased, while HGF was decreased. We concluded that i) when PE is performed, HD is also necessary for correction, but achieves insufficient correction of Ca++ and citrate, ii) PE is non‐selective and not only removes toxins but also beneficial substances such as HGF, iii) accumulation of acetate occurred, even with bicarbonate dialysate, since it also contains acetate for acidification.
Functional Modulation of Activated Lymphocytes by Time‐varying Magnetic Fields
Authors: Murabayashi S , Yoshikawa A , Mitamura Y
Published: May 2004

Abstract:  Time‐varying magnetic fields (TVMF), especially those of extremely low frequency (below 250 Hz), have been reported to have profound effects on biological systems due to the induced currents since the biological systems consist of electrolyte solution. We have been interested in utilizing TVMF for cellular immunomodulations, and have shown that the TVMF could augment macrophage activation. In this study, the effect of TVMF on lymphocyte activation was studied. Murine spleen lymphocytes were isolated from DDY mice and incubated in the presence of Concanavalin A (ConA) for 72 h. The lymphocytes were exposed to TVMF for various durations, from 20 min to 2 h. The proliferation activities of lymphocytes were assayed by ELISA by use of 5‐bromo‐2′‐deoxy‐uridine Labeling and Detection Kit III (Roche Diagnostic Corp. Indianapolis, IN, USA). The IL1β and IL2 concentrations in the culture medium were measured by ELISA assay. The IL2 receptor expression on the lymphocytes was evaluated by FACS analysis by use of FITC‐conjugated monoclonal antibody. The proliferation activities were significantly enhanced by the TVMF for up to 40 min exposure from the initiation of ConA stimulation. The degree of augmentation effects, defined by the ratio of activation index of with and without TVMF, was varied from 1.1 to 2.7, and related to the lymphocyte responsiveness to the ConA. The less responsive cells showed more TVMF augmentation effects. The TVMF exposure after 40 min from ConA addition showed no effect, suggesting that the TVMF effects are most likely related to the Ca ion influx. The prolonged exposure of TVMF depressed the augmentation effects, which was caused by the depressed IL‐2 receptor expression although both IL1‐β  and  IL‐2  productions  were  not  affected.
A Case Report of the Efficacy of Apheresis for Refractory Autoimmune Thrombocytopenia in a Patient with Systemic Lupus Erythematosus Associated Hemolytic Anemia
Authors: Yamaji Ken , Tsuda Hiroshi , Hashimoto Hiroshi
Published: May 2004

Abstract:  Autoantibodies against platelets are found in patients with autoimmune thrombocytopenic purpura (AITP) as well as in thrombocytopenia associated with systemic lupus erythematosus (SLE). The high titer of platelet associated immunoglobulin G (PA IgG) suggests the presence of antibodies against platelets. Platelet associated antibodies are thought to play a major role in the pathogenesis of autoimmune thrombocytopenia. There is a possibility that double filtration plasmapheresis (DFPP) is effective in removing the antibodies against platelets from the peripheral blood. It is suggested that DFPP may reinforce the efforts of the conventional treatment, especially high‐dose intravenous immunoglobulin therapy (IVIg). DFPP was performed for severe thrombocytopenia on a SLE patient with high PA IgG value, refractory to the conventional therapy including corticosteroid therapy and IVIg. The patient underwent three sessions of DFPP combined with IVIg and the corticosteroid therapy immediately before the initiation of IVIg. The severe thrombocytopenia improved drastically after the combination treatment, accompanied with  the  decrease  of  the  PA IgG  titer.  It  was  suggested that DFPP combined with corticosteroid and IVIg was effective for severe autoimmune thrombocytopenia on SLE patients refractory to the conventional therapies.
Potentially Inappropriate Prescribing in Ontario Community‐Dwelling Older Adults and Nursing Home Residents
Authors: Lane Christopher J. , Bronskill Susan E. , Sykora Kathy , Dhalla Irfan A. , Anderson Geoffrey M. , Mamdani Muhammad M. , Gill Sudeep S. , Gurwitz Jerry H. , Rochon Paula A.
Published: May 2004

Objectives: To compare patterns of potentially inappropriate drug therapy prescribing in community‐dwelling older adults and nursing home residents in Ontario, Canada.

Design: A retrospective cohort study using administrative databases.

Setting: Ontario community and nursing home facilities.

Participants: All 1,275,619 older adults aged 66 and older in Ontario (1,216,900 community‐dwelling and 58,719 nursing home residents) who were dispensed at least one prescription from the comprehensive provincial drug plan in 2001. In Ontario, the provision of clinical pharmacy services is mandated in the nursing home setting. No comparable program exists for older adults in the community setting.

Measurements: Potentially inappropriate drug prescribing was compared between community‐dwelling and nursing home residents in two categories: those to always avoid and therapies considered rarely appropriate to prescribe.

Results: Of the 1,275,619 adults in the cohort, nursing home residents were older (mean age±standard deviation=84.2±7.6 vs 75.0±6.5, P<.001), included more women (73.3% vs 57.7%, P<.001), had higher comorbidity scores (measured by the number of distinct drug therapies dispensed in the prior year (10.7±6.8 vs 7.2±5.7, P<.001) and Charlson comorbidity scores (1.4±1.6 vs 0.9±1.5, P<.001)) than community‐dwelling individuals.

Community‐dwelling older adults were significantly more likely to be dispensed at least one drug therapy in the always avoid or rarely appropriate category than nursing home residents (3.3% vs 2.3%, P<.001). Using a logistic regression model that controlled for age, sex, and comorbidity (number of distinct drug therapies dispensed in the prior year), nursing home residents were close to half as likely to be dispensed one of these potentially inappropriate drug therapies as community‐dwelling older adults (odds ratio=0.52, 95% confidence interval=0.49–0.55, P<.001).

Conclusion: Potentially inappropriate drug therapy in the always avoid and rarely indicated categories is dispensed less often to nursing home residents than to older community‐dwelling adults. Clinical pharmacist services, which are mandated in the nursing home setting, may be responsible for these differences in Ontario, Canada.
Persistent Nonmalignant Pain and Analgesic Prescribing Patterns in Elderly Nursing Home Residents
Authors: Won Aida B. , Lapane Kate L. , Vallow Sue , Schein Jeff , Morris John N. , Lipsitz Lewis A.
Published: May 2004

Objectives: To determine the prevalence of analgesics used, their prescribing patterns, and associations with particular diagnoses and medications in patients with persistent pain.

Design: Cross‐sectional study.

Setting: Nursing homes from 10 U.S. states.

Participants: A total of 21,380 nursing home residents aged 65 and older with persistent pain.

Measurements: Minimum Data Set (MDS) assessments on pain, analgesics, cognitive, functional, and emotional status were summarized. Logistic regression models identified diagnoses associated with different analgesic classes.

Results: Persistent pain as determined using the MDS was identified in 49% of residents with an average age of 83; 83% were female. Persistent pain was prevalent in patients with a history of fractures (62.9%) or surgery (63.6%) in the past 6 months. One‐quarter received no analgesics. The most common analgesics were acetaminophen (37.2%), propoxyphene (18.2%), hydrocodone (6.8%), and tramadol (5.4%). Only 46.9% of all analgesics were given as standing doses. Acetaminophen was usually prescribed as needed (65.6%), at doses less than 1,300 mg per day. Nonsteroidal antiinflammatory drugs (NSAIDs) were prescribed as a standing dose more than 70% of the time, and one‐third of NSAIDs were prescribed at high doses.

Conclusion: In nursing home residents, persistent pain is highly prevalent, there is suboptimal compliance with geriatric prescribing recommendations, and acute pain may be an important contributing source of persistent pain. More effective provider education and research is needed to determine whether treatment of acute pain could prevent persistent pain.
Incidence of Tooth Loss and Prosthodontic Dental Care: Effect on Chewing Difficulty Onset, a Component of Oral Health–Related Quality of Life
Authors: Gilbert Gregg H. , Meng Xiaoxian , Duncan R. Paul , Shelton Brent J.
Published: May 2004

Objectives: To quantify incidence of tooth loss, prosthodontic dental restoration, and chewing difficulty onset and the effect of tooth loss and prosthodontic restoration on chewing difficulty onset.

Design: A prospective cohort study of oral health and related behaviors with in‐person interviews and clinical examinations conducted at baseline and 24 months. Telephone interviews were conducted every 6 months between these sessions.

Setting: A community‐based sample of four counties in north Florida.

Participants: Eight hundred seventy‐three persons who had at least one tooth and were aged 45 and older at baseline.

Measurements: Persons were queried regarding onset of chewing difficulty, an important component of oral health–related quality of life (OHRQoL). The chewing index of Leake, with minor revision, was the primary outcome of interest. Tooth loss was measured using direct clinical examination. Dental care use was reported during each interview.

Results: Approximately 22% of participants reported tooth loss during follow‐up. Fixed prosthodontics (crowns and bridges) was the most common form of new prosthodontic treatment. People who reported tooth loss were 2.7 times more likely to report chewing difficulty onset than people without tooth loss (P<.001). Having fewer occluding pairs of teeth at baseline was significantly associated with an increased probability of chewing difficulty onset. People who received removable prosthodontic treatment were much less likely to report chewing difficulty onset than people who did not (P<.01).

Conclusion: Incident tooth loss and removable prosthodontic restoration strongly predicted chewing difficulty, an important component of OHRQoL.
Lipoprotein Levels Are Associated with Incident Hypertension in Older Adults
Authors: Wildman Rachel P. , Sutton‐Tyrrell Kim , Newman Anne B. , Bostom Andrew , Brockwell Sarah , Kuller Lewis H.
Published: May 2004

Objectives:To determine the relationship between baseline measures of serum lipoproteins and incident hypertension in older adults.

Design:Prospective cohort study.

Setting:Pittsburgh, Pennsylvania, site of Systolic Hypertension in the Elderly Program (SHEP).

Participants:One hundred eighty‐seven men and women (mean age 71.3), normotensive (systolic blood pressure (SBP) <160 mmHg, diastolic blood pressure (DBP) <90 mmHg) at baseline, were followed annually over 8 years as an ancillary study to the SHEP.

Measurements:Hypertension development, defined as initiation of antihypertensive therapy or SBP greater than 160 mmHg or DBP greater than 90 mmHg. Lipoprotein measures included total cholesterol, low‐density lipoprotein cholesterol, high‐density lipoprotein cholesterol (HDL‐C), HDL2‐C, HDL3‐C, triglycerides, and apolipoproteins 1, 2, and B.

Results:Over 8 years, 44 participants developed hypertension, for a Kaplan‐Meier cumulative incidence rate of 31% (95% confidence interval (CI)=23–39%). Cumulative incidence rates were highly associated with baseline SBP, ranging from 8% in those with baseline SBP less than 120 mmHg to 70% in those with SBP of 140 to 159 mmHg. Other univariate associations included higher DBP, pulse pressure (P< .01 for both), triglycerides (P=.03), apolipoprotein B (P=.03), and lower HDL‐C (P=.04) and HDL3‐C (P=.02). In multivariate Cox regression analysis, higher baseline SBP (relative risk (RR)=1.8 per 10 mmHg, 95% CI=1.5–2.3) and lower HDL3‐C (RR=0.8 per 5 mg/dL, 95% CI=0.42–1.0) remained significant independent predictors of time to hypertension.

Conclusion:Older adults with abnormal serum lipoproteins are at increased risk of developing hypertension. Clinical trials exploring the effects of the modification of lipoprotein levels on hypertension incidence rates are needed.
Peripheral Arterial Disease in African Americans: Clinical Characteristics, Leg Symptoms, and Lower Extremity Functioning
Authors: Rucker‐Whitaker Cheryl , Greenland Philip , Liu Kiang , Chan Cheeling , Guralnik Jack M. , Criqui Michael H. , Taylor Lloyd , Pearce William H. , McGraeMcDermott Mary
Published: May 2004

Objectives: The describe peripheral arterial disease (PAD) in African Americans, and compare findings in African Americans and whites with PAD.

Design: Cross‐sectional.

Setting: Three academic medical centers.

Participants: Three hundred sixty‐six whites and 76 African Americans with PAD (as defined by an ankle brachial index (ABI) <0.90) aged 55 and older identified from lower extremity arterial studies performed between 1996 and the fall of 1999.

Measurements: Comprehensive medical interview, body mass index, and neuropathy score. Functional measurements included the 6‐minute walk distance, 4‐m walking velocity, and the summary performance score.

Results: Age‐ and sex‐adjusted results showed that African Americans had a lower mean ABI than whites (0.60 vs 0.66, P=.001), were less likely to be college graduates (13.7% vs 44.4%, P<.001), and had nearly twice the prevalence of diabetes mellitus (46.8% vs 28.0%, P=.001). After adjusting for age, sex, education level, and ABI, African Americans had a higher prevalence of no exertional leg pain (28.0% vs 18.2%, P=.044) and leg pain with exertion and rest (30.0% vs 17.3%, P=.023). African Americans had a shorter 6‐minute walk distance (989 vs 1,156 ft, P<.001), a slower normal‐pace 4‐m walking velocity (0.79 vs 0.89 m/s, P<.001), a slower fast‐pace 4‐m walking velocity (1.12 vs 1.20 m/s, P=.012), and a lower summary performance score (8.8 vs 9.6, P=.018) than whites. These differences in functioning were attenuated after adjusting for age, sex, ABI, education, and leg symptoms.

Conclusion: Poorer lower extremity functioning in African Americans was largely explained by differences in leg symptoms and, to a somewhat lesser degree, lower ABI levels and poorer education in African Americans than in whites. Further study is needed to determine whether these findings affect racial treatment disparities and poorer outcomes previously reported in African Americans than in whites with PAD.
The Effects of Staffing on In‐Bed Times of Nursing Home Residents
Authors: Bates‐Jensen Barbara M. , Schnelle John F. , Alessi Cathy A. , Al‐Samarrai Nahla R. , Levy‐Storms Lené
Published: May 2004

Objectives: To examine the effect of staffing level on time observed in bed during the daytime in nursing home (NH) residents.

Design: Descriptive, cross‐sectional study.

Setting: Thirty‐four southern California NHs.

Participants: A total of 882 NH residents: 837 had hourly observation data, 777 had mealtime observations, 837 completed interviews, and 817 completed a physical performance test.

Measurements: Cross‐sectional data collected from participants at each NH site included direct observations (hourly and mealtime), resident interviews, medical record review, and physical performance tests.

Results: In multivariate analyses, staffing level remained the strongest predictor of time observed in bed after controlling for resident functional measures (odds ratio=4.89; P=.042). Residents observed in bed during the daytime in more than 50% of hourly observations were observed also to experience increased daytime sleeping (P<.001) and less social engagement (P=.026) and consumed less food and fluids during mealtimes than those observed in bed in less than 50% of observations, after adjusting for resident function (P<.001).

Conclusion: In this sample of NHs, resident functional measures and NH staffing level predicted observed time in bed according to hourly observations, with staffing level the most powerful predictor. Neither of these predictors justifies the excessive in‐bed times observed in this study. Staff care practices relevant to encouraging residents to be out of bed and resident preferences for being in bed should be examined and improved. Practice recommendations regarding in‐bed time should be considered, and further research should seek to inform the development of such recommendations.
Effects of Aging, Menopause, and Hormone Replacement Therapy on Forearm Skin Elasticity in Women
Authors: Sumino Hiroyuki , Ichikawa Shuichi , Abe Masatoshi , Endo Yukie , Ishikawa Osamu , Kurabayashi Masahiko
Published: May 2004

Objectives: To investigate the decline per year in skin elasticity in postmenopausal women and how much hormone replacement therapy (HRT) increased elasticity over 12 months.

Design:

Observational study of convenience sample.

Setting: The Cardiovascular Hospital of Central Japan, a cardiovascular medical center.

Participants: One hundred seventy‐six postmenopausal subjects, mean age±standard deviation=61.3±9.1.

Measurements: In Study 1, skin elasticity was measured in the right forearm using a suction device. Comparisons also were made with 45 premenopausal subjects (aged 34.5±9.9). Skin elasticity in the right forearm was measured using the same device at baseline and 12 months after initiation of HRT.

Interventions: In Study 2, 12 postmenopausal subjects (mean age=57.1±7.4, range 49–71) received conjugated equine estrogen (0.625 mg/d) in combination with medroxyprogesterone acetate (2.5 mg/d) for 12 months.

Results: In Study 1, significant negative correlations between skin elasticity and age and years since menopause were found (r=−0.60, P<.001 for each), as well as a 0.55% decline per year in skin elasticity. In Study 2, 12 months of HRT significantly increased skin elasticity in postmenopausal subjects, by 5.2%.

Conclusion: After menopause, skin elasticity declined 0.55% per year; 12 months of HRT increased elasticity by 5.2%.
Identification of Strategies Used to Cope with Chronic Pain in Older Persons Receiving Primary Care from a Veterans Affairs Medical Center
Authors: Barry Lisa C. , Kerns Robert D. , Guo Zhenchao , Duong Bao D. , Iannone Lynne P. , Carrington Reid M.
Published: May 2004

Objectives: To identify the strategies used by older persons to cope with chronic noncancer pain, determine the perceived effectiveness of the strategies, and ascertain factors associated with their use.

Design: Cross‐sectional telephone survey.

Setting: Primary care practice located at a Veterans Affairs Medical Center in New England.

Participants: Two hundred forty‐five patients (aged 65–90) with chronic pain.

Measurements: Qualitative methods were used to ascertain participants' coping strategies, and their effectiveness was determined using a five‐category response scale (1=not at all effective to 5=extremely effective). In multivariate analyses, associations between participants' demographic, medical, psychosocial, and pain characteristics and prevalent coping strategies were assessed.

Results: Participants had a mean age±standard deviation of 75±5.1; 84% were male. Overall, 240 (98%) participants had employed at least one coping strategy in the previous month; the mean number used per participant was 2.8±1.4. Prevalent coping strategies included analgesic medications (used by 187/240=78% participants), exercise (35%), cognitive methods (37%), religious activities (21%), and activity restriction (20%). The proportion of participants who used a given strategy and rated it quite a bit or extremely effective exceeded 50% for only five of the 15 identified strategies. Women were more likely than men to use cognitive coping methods (odds ratio (OR)=3.2, 95% confidence interval (CI)=1.5–6.8) and religious activities (OR=2.6, 95% CI=1.2–5.7). Participants with chronic pain due to a musculoskeletal cause were more likely to use analgesic medications than those with pain due to all other causes (OR=3.2, 95% CI=1.6–6.4), whereas those with trauma‐related pain were less likely to use exercise than those with pain due to all other causes (OR=0.2, 95% CI=0.1–0.7).

Conclusion: Older primary care patients use a broad variety of coping strategies to cope with chronic pain. Studies are needed to confirm these findings in other older populations and to characterize the longitudinal effects of the coping strategies. Given the finding that the perceived effectiveness of most coping strategies was modest, efforts to increase their effectiveness in older persons are indicated.
Sleep‐Disordered Breathing and Nocturia in Older Adults
Authors: Endeshaw Yohannes W. , Johnson Theodore M. , Kutner Michael H. , Ouslander Joseph G. , Bliwise Donald L.
Published: May 2004

Objectives: To investigate the relationship between sleep‐disordered breathing (SDB) and nocturia episodes in community‐dwelling older adults.

Design: A cross‐sectional study.

Setting: Community.

Participants: Community‐dwelling older adults (N=72) recruited from independent living facilities and adult learning centers in Atlanta, Georgia.

Measurements: Three‐day voiding diary, ambulatory sleep recording, focused physical examination, Epworth Sleepiness Scale, and Geriatric Depression Scale.

Results: Fifty‐eight of the 72 subjects completed the study. The mean age±standard deviation was 77.7±6.7; 44 (76%) were female. Of the 58 subjects, 26 (45%) had an apnea‐hypopnea index (AHI) of less than 10 per hour of sleep, 21 (36%) had an AHI between 10 and 24 per hour sleep, and 11 (19%) had an AHI of 25 or higher per hour of sleep. The mean nocturia episodes were 1.7±1.1, 1.6±0.9, and 2.6±1.4 for subjects in these groups, respectively (F=3.82; P=.028). Those with an AHI of 25 or higher had more nocturia episodes, higher mean arterial blood pressure, and higher body mass index than those with a lower AHI.

Conclusion: These results suggest that older adults with severe SDB have a greater number of nocturia episodes. These findings underscore the importance of considering SDB as a differential diagnosis in the evaluation of older patients with nocturia.
Antihypertensive Medications and Differences in Muscle Mass in Older Persons: The Health, Aging and Body Composition Study
Authors: Di Bari Mauro , Van De Poll‐Franse Lonneke V. , Onder Graziano , Kritchevsky Stephen B. , Newman Anne , Harris Tamara B. , Williamson Jeff D. , Marchionni Niccoló , Pahor Marco
Published: May 2004

Objectives: To evaluate whether older persons using angiotensin‐converting enzyme (ACE) inhibitors have a larger lower extremity muscle mass (LEMM) than users of other antihypertensive drugs.

Design: Cross‐sectional analysis of data from the Health, Aging and Body Composition (Health ABC) Study.

Setting: University of Tennessee, Memphis, and University of Pittsburgh clinics.

Participants: A community‐based sample of 2,431 well functioning participants of the Health ABC, aged 70 to 79, who were free of heart failure, were selected according to use of antihypertensive medications: ACE inhibitors (n=197), β‐blockers (n=169), thiazides (n=216), calcium‐channel blockers (n=340), or none (n=1,509).

Measurements: LEMM, assessed using dual‐energy x‐ray absorptiometry, compared by index drug in analysis of variance models unadjusted and adjusted for demographics, study site, height, body fat, physical activity, blood pressure, coronary artery disease, diabetes mellitus, and chronic pulmonary disease.

Results: LEMM significantly differed across the study groups, being larger in users of ACE inhibitors than in users of other drugs (unadjusted and adjusted models). LEMM was comparable in users of ACE inhibitors and no drug users. A trend toward larger LEMM was also observed in sex‐ and ethnicity‐stratified analyses and in the subgroup of noncoronary hypertensive participants.

Conclusion: In older persons, use of ACE inhibitors is associated cross‐sectionally with larger LEMM. This finding suggests a possible explanation of the benefits of ACE inhibitors in wasting syndromes. If confirmed in longitudinal studies, this pharmacological action might have important implications for the prevention of physical disability in older patients with hypertension.
Reliability of the 400‐M Usual‐Pace Walk Test as an Assessment of Mobility Limitation in Older Adults
Authors: Rolland Yves M. , Cesari Matteo , Miller Michael E. , Penninx Brenda W. , Atkinson Hal H. , Pahor Marco
Published: May 2004

Objectives: To assess the test‐retest reliability of the 400‐m usual‐pace walk test (400‐MWT), and to determine whether the 4‐m walk test predicts inability to walk 400 m.

Design: Observational.

Setting: Community, 20‐m tract course.

Participants: Sixty study participants (aged≥65) were enrolled from the community and met the following eligibility criteria: self‐reported difficulty in two or more of four functional domains (mobility and exercise tolerance, upper extremity function, basic self‐care, higher functional tasks of independent living) and a score of 18 or higher on the Mini‐Mental State Examination.

Methods: The 400‐MWT and 4‐m walk test were each repeated within 7 days.

Results: The mean age±standard deviation of the study population was 84.3±6.3; 88.3% were women. Nineteen participants (31.7%) failed both 400‐MWTs, and 41 successfully completed both tests (kappa=1). Mean walking speed for the 4‐m test was 0.87±0.18 m/s for those who completed the 400‐MWT and 0.53±0.17 m/s for those who failed (P<.001). The Spearman correlation coefficient between 4‐m and 400‐m walking speeds was 0.93. The estimated area under the receiver operating characteristic curve between 4‐m walking speed and the ability to perform the 400‐MWT was 0.91. The 4‐m gait speed averaged less than 0.6 m/s in 80% of subjects who failed the 400‐MWT.

Conclusion: The test‐retest reliability for inability to complete the 400‐MWT is high. Four‐m walking speed is highly predictive of ability to perform the 400‐MWT. These findings may prove useful to future clinical trials and observational studies that involve assessment of mobility limitations in older adults.