bluuebunny/crossref_metadata_2025 huggingface dataset:
Social capital, age and religiosity in people who are lonely
Authors: Lauder William , Mummery Kerry , Sharkey Siobhan
Published: February 2006

Aims and objectives.  The aims of the study were to (i) investigate age and loneliness, (ii) investigate the association between religiosity and loneliness, and (iii) and explore the relationship between social capital and loneliness.

Background.  Loneliness is the subjective experience of social isolation and is a risk factor for a wide range of health problems including heart disease and depression. Poor self‐rated health, domestic violence and poor economic conditions are associated with greater loneliness.

Design.  The study was a cross‐sectional survey of a random sample of adults aged 18 years and over.

Methods.  A random sample of 1289 subjects was interviewed by computer‐assisted telephone interviewing. This interview included the Loneliness Scale and items from the Social Capital Module of the General Household Survey.

Findings.  Loneliness is more common in men and people without strong religious beliefs. An income‐loneliness gradient is evident. Little support was found for the association between social capital and loneliness.

Conclusion.  The prevalence of loneliness is relatively stable in this population. Loneliness is linked to income and unemployment and as such pathways between socio‐economic factors, loneliness and health need to guide interventions and future research.

Relevance to clinical practice.  Loneliness is linked to a range of social and economic factors. Current Health Visiting practice recognizes the importance of tackling the effects of poverty and social deprivation and places community building at the core of much Health Visiting practice. This broad community level approach can usefully transfer into all community nursing and health promotion activity.
Nurse consultants: organizational influences on role achievement
Authors: Woodward Valerie A , Webb Christine , Prowse Morag
Published: February 2006

Aims.  This paper reports on organizational influences on nurse consultant post holders. The influence of individual characteristics has been the subject of another paper.

Background.  Nurse consultant posts were set up in the United Kingdom from the late 1990s onwards and, therefore, there has been little opportunity to report on evaluations of these innovative initiatives.

Design.  A cross‐sectional design, using a convenience sample, was adopted.

Methods.  Ten nurse consultants working in a variety of settings and specialties participated in in‐depth, tape‐recorded interviews. The data were analysed using the Framework approach.

Findings.  Support systems were important influences on nurse consultants’ role achievement levels. These took the form of internal trust networks, nurse consultant forums and links with higher education institutions. Post holders both gave and received support and acted to empower other nurses. Thus, relationships were vital to successful role integration. The culture and structures of the National Health System were also a powerful influence in terms of local and national modernization policies, and participants had to be careful in their choice of strategies to deal with the traditional medically dominated culture.

Conclusions.  The new nurse consultant role is challenging and innovative, but a major area of contention is how much post holders are expected to take on work previously done by doctors rather than developing their nursing role. Organizational support and commitment are needed if nurse consultants are to maximize the benefits of this innovation.

Relevance to clinical practice.  The findings show that new nursing roles are not always easily accepted in multidisciplinary settings and that holders of such post need to have the appropriate previous knowledge, skills and personal characteristics, as well as the ability to negotiate their way through organizational influences.
The power of hope: patients’ experiences of hope a year after acute spinal cord injury
Authors: Lohne Vibeke , Severinsson Elisabeth
Published: February 2006

Aims and objectives.  The aim of this present study was to explore patients’ experiences of the meaning they attribute to hope and hoping a year after acute spinal cord injury.

Background.  Nursing literature is pointing towards the importance of having hope for a healthful living. However, the concept of hope has preliminarily been defined in an abstract and general way and is therefore difficult to grasp.

Design and methods.  This qualitative study has a longitudinal and descriptive–explorative design. Data were collected by personal interviews (n = 10) one year after acute spinal cord injury. A phenomenological–hermeneutic approach, based on the philosophy of Ricoeur, was used to extract the essences of the patients’ experiences.

Results.  The findings resulted in one main interpretation: ‘The Power of Hope’, and two sub‐themes: ‘Will, Faith and Hope’ and ‘Hoping, Struggling and Growing’. The power of hope was interpreted as the individual having experienced the meaning a year after the injury, mainly expressed through will power.

Conclusions.  This study shows that experiences of hope were important to all participants, providing energy and power to the process of struggling because hope is necessary for further progress and personal development.

Relevance to clinical practice.  Nursing interventions should be mainly directed towards emotional and motivational strategies to promote the will power and personal growth through learning experiences.
Registered Nurses working together with family members of older people
Authors: Weman Karin , Fagerberg Ingegerd
Published: February 2006

Aim.  The aim of the study was to reach a more profound understanding, through looking at nurses’ working situation, of those factors that influence how nurses are able to work together with family members of older people living in nursing homes or similar facilities.

Background.  Working with the care of older people as a Registered Nurse provides a varied job with many challenges. Nurses have to co‐operate with family members of those in community health care. Co‐operation is important and necessary for all involved.

Design.  Nurses working in elder care in a geographically defined area received a questionnaire with three open‐ended questions, on the difficulties and/or problems involved with working together with family members, and the positive or negative aspects of this co‐operation.

Methods.  Analysis was carried out using the latent content analysis method.

Results.  Three themes, problems within the system, interaction with families and caring in nursing work, are presented with categories and their subcategories. The nurses wanted their superior to be a nurse so that their working situation would be better understood. Appreciation from their superior and family members was also a very important part of their work as nurses in community health care. The frequent changes and the lack of time in the work of elder care often put nurses under considerable psychological pressure. For the most part family members are a resource for the elder, but sometimes they will avoid contact, which will make co‐operating difficult.

Conclusion.  Registered Nurses and family members are dependent on each other in their care of the elder.

Relevance to clinical practice.  More attention should be paid to the working situation of Registered Nurses in community health care, and their ability to work together with family members of older people.
Understanding and overcoming the barriers of implementing patient decision aids in clinical practice*
Authors: O'Donnell Siobhan , Cranney Ann , Jacobsen Mary J. , Graham Ian D. , O'Connor Annette M. , Tugwell Peter
Published: February 2006

Patient decision aids (ptDAs) have been developed to assist patients with difficult health‐related decisions. Despite their proven effects on decision quality in numerous efficacy trials, we lack an evidence‐based approach for implementing them as part of the process of care. Pragmatic trials of ptDAs have uncovered a myriad of implementation challenges; therefore we need a better understanding of the barriers and strategies to overcome them to facilitate their widespread uptake. The following paper provides an overview of the barriers related to the uptake of ptDAs within the process of care and the strategies, opportunities and research priorities to overcome them. This report is based on our interpretation of the literature and our collective experience in implementing ptDAs within trials and other contexts.
Acute Activation of Hippocampal Glucocorticoid Receptors Results in Different Waves of Gene Expression Throughout Time
Authors: Morsink M. C. , Steenbergen P. J. , Vos J. B. , Karst H. , Joëls M. , De Kloet E. R. , Datson N. A.
Published: February 2006

Several aspects of hippocampal cell function are influenced by adrenal‐secreted glucocorticoids in a delayed, genomic fashion. Previously, we used Serial Analysis of Gene Expression to identify glucocorticoid receptor (GR)‐induced transcriptional changes in the hippocampus at a fixed time point. However, because changes in mRNA levels are transient and most likely precede the effects on hippocampal cell function, the aim of the current study was to assess the transcriptional changes in a broader time window by generating a time curve of GR‐mediated gene expression changes. Therefore, we used rat hippocampal slices obtained from adrenalectomised rats, substituted in vivo with low corticosterone pellets, predominantly occupying the hippocampal mineralocorticoid receptors. To activate GR, slices were treated in vitro with a high (100 nM) dose of corticosterone and gene expression was profiled 1, 3 and 5 h after GR‐activation. Using Affymetrix GeneChips, a striking pattern with different waves of gene expression was observed, shifting from exclusively down‐regulated genes 1 h after GR‐activation to both up and down regulated genes 3 h after GR‐activation. After 5 h, the response was almost back to baseline. Additionally, real‐time quantitative polymerase chain reaction was used for validation of a selection of responsive genes including genes involved in neurotransmission and synaptic plasticity such as the corticotropin releasing hormone receptor 1, monoamine oxidase A, LIMK1 and calmodulin 2. This permitted confirmation of GR‐responsiveness of 15 out of 18 selected genes. In conclusion, direct activation of GR in hippocampal slices results in transient changes in gene expression. The pattern in which gene expression was modulated suggests that the fast genomic effects of glucocorticoids may be realised via transrepression, preceding a later wave of transactivation. Furthermore, we identified a number of interesting candidate genes which may underlie the glucocorticoid‐mediated effects on hippocampal cell function.
Regulation by Orexin of Feeding Behaviour and Locomotor Activity in the Goldfish
Authors: Nakamachi T. , Matsuda K. , Maruyama K. , Miura T. , Uchiyama M. , Funahashi H. , Sakurai T. , Shioda S.
Published: February 2006

Orexin is a hypothalamic neuropeptide that is implicated in the regulation of feeding behaviour and the sleep‐wakefulness cycle in mammals. However, in spite of a growing body of knowledge concerning orexin in mammals, the orexin system and its function have not been well studied in lower vertebrates. In the present study, we first examined the effect of feeding status on the orexin‐like immunoreactivity (orexin‐LI) and the expression of orexin mRNA in the goldfish brain. The number of cells showing orexin‐LI in the hypothalamus of goldfish brain showed a significant increase in fasted fish and a significant decrease in glucose‐injected fish. The expression level of orexin mRNA in the brains of fasted fish increased compared to that of fed fish. We also examined the effect of an i.c.v. injection of orexin or an anti‐orexin serum on food intake and locomotor activity in the goldfish. Administration of orexin by i.c.v. injection induced a significant increase of food intake and locomotor activity, whereas i.p. injection of glucose or i.c.v. injection of anti‐orexin serum decreased food consumption. These results indicate that the orexin functions as an orexigenic factor in the goldfish brain.
Purinergic Receptor Ligands Stimulate Pro‐Opiomelanocortin Gene Expression in AtT‐20 Pituitary Corticotroph Cells
Authors: Zhao L.‐F. , Iwasaki Y. , Oki Y. , Tsugita M. , Taguchi T. , Nishiyama M. , Takao T. , Kambayashi M. , Hashimoto K.
Published: February 2006

Although recent studies have suggested that purinergic receptors are expressed in the anterior pituitary gland, their involvement in the regulation of pituitary hormone gene expression is not completely understood. In the present study, we examined the expression of purinergic receptors and the effects of purinergic receptor ligands on pro‐opiomelanocortin (POMC) gene expression, in AtT20 mouse corticotroph cells. We identified the expression of most of the purinergic receptor subtypes (A1, A2, P2X1, 3‐7, P2Y1, 2, 4) mRNAs, analysed by the reverse transcriptase‐polymerase chain reaction. We also found that adenosine and ATP, two representative and endogenous agonists of A1‐3 and P2X/P2Y receptors, respectively, stimulated the 5′‐promoter activity of the POMC gene in a dose‐ and time‐related manner. When these ligands were simultaneously used with corticotrophin‐releasing hormone (CRH), effects that were more than additive were observed, suggesting an enhancing role of these compounds in CRH‐mediated adrenocorticotrophic hormone (ACTH) synthesis. These ligands also stimulated the expression of transcription factors involved in the regulation of the POMC gene, but did not enhance ACTH secretion. Finally, the positive effect of adenosine as well as CRH was completely inhibited by the protein kinase A inhibitor H89, whereas that of ATP was not influenced, indicating that different intracellular signalling pathways mediate these effects. Altogether, our results suggest a stimulatory role for these purinergic receptor ligands in the regulation of POMC gene expression in corticotroph cells. Because adenosine and ATP are known to be produced within the pituitary gland, it is possible they may be acting in an autocrine/paracrine fashion.
Ethnic differences in total and cause‐specific infant mortality in the Netherlands
Authors: Troe Ernst‐Jan W. M. , Bos Vivian , Deerenberg Ingeborg M. , Mackenbach Johan P. , Joung Inez M. A.
Published: February 2006

We examined ethnic differences in infant mortality and the contribution of several explanatory variables. Data of Statistics Netherlands from 1995 to 2000 were studied (1 178 949 live borns). Proportional hazard analysis was used to show ethnic dif­ferences in total and cause‐specific infant mortality. Obstetric, demographic and ­geographical variables, and socio‐economic status were considered as possible determinants. The four major ethnic minority groups showed an elevated risk of infant mortality, ranging from 1.28 in Turkish infants to 1.50 in Antillean/Aruban infants. In the early neonatal period, risks were elevated for Surinamese (hazard ratio [HR] 1.48, 95% confidence intervals [CI] 1.23, 1.78) and Antilleans/Arubans (HR 1.43, 95% CI 1.06, 1.92). In the post‐neonatal period, risks were only elevated for Turkish (HR 2.20, 95% CI 1.80, 2.69) and Moroccan infants (HR 2.06, 95% CI 1.67, 2.55). Surinamese and Antillean/Aruban infants had an elevated risk of dying from perinatal causes (HR 1.62, 95% CI 1.33, 1.98 and 1.69, 95% CI 1.24, 2.29 respectively), Turkish and Moroccan infants had an elevated risk of dying from congenital anomalies (HR 1.42, 95% CI 1.16, 1.73 and 1.46, 95% CI 1.20, 1.79 respectively).

Inequalities  as  a  result  of  socio‐economic  position  and  demographic  factors,  such as marital status and maternal age, partially explain the ethnic differences in infant mortality. We conclude that ethnic minority groups in the Netherlands have a higher infant mortality than the native population, which in part seems preventable by reducing inequalities in socio‐economic status. Marital status and age of the mother are important other risk factors of infant mortality.
Parental marijuana use and risk of childhood acute myeloid leukaemia: a report from the Children's Cancer Group (United States and Canada)
Authors: Trivers Katrina F. , Mertens Ann C. , Ross Julie A. , Steinbuch Michael , Olshan Andrew F. , Robison Leslie L.
Published: February 2006

The aetiology of childhood acute myeloid leukaemia (AML) is largely unknown. Maternal marijuana use just before, or during pregnancy has been previously associated with childhood AML. This case–control investigation formally tested the hypothesis that parental marijuana use increases the risk of childhood AML in offspring. Incident cases of AML <18 years of age, diagnosed between 1989 and 1993, and registered with the Children's Cancer Group (a paediatric clinical co‐operative group), were eligible for inclusion. Control children were selected via random digit dialling and individually matched 1:1 to cases on age, race and residential location, except for rare morphological subtypes that were matched 1:2. Parental telephone interviews were conducted to determine exposure and covariate information. Conditional logistic regression was used to estimate matched odds ratios (OR) and 95% confidence intervals [CI] adjusted for household income, parental education and parental age. The analysis included 517 cases and 610 matched controls. A series of sensitivity analyses examined the potential for recall bias.

Ever lifetime use of marijuana by mothers was not associated with childhood AML [OR = 0.89; 95% CI = 0.66, 1.19]. Maternal marijuana use any time during the 3 months before, or during pregnancy was inversely associated with childhood AML [OR = 0.43; 95% CI = 0.23, 0.80]. Paternal use during the same time period was not associated with risk. Assuming a large degree of differential exposure misclassification was present, the corrected ORs ranged between 0.82 and 1.40. The previously reported positive association between maternal marijuana use before or during pregnancy and childhood AML was not confirmed. The decreased ORs observed in this study may be due to recall bias assuming plausibly low values of sensitivity.
Systematic review of adverse outcomes of external cephalic version and persisting breech presentation at term
Authors: Nassar Natasha , Roberts Christine L. , Barratt Alexandra , Bell Jane C. , Olive Emily C. , Peat Brian
Published: February 2006

The aim of this study was to determine the frequency of adverse maternal and fetal outcomes of both external cephalic version (ECV) and persisting breech presentation at term. We conducted a systematic review of the literature using Medline, Embase and All Evidence Based Medicine (EBM) Reviews databases. Data were extracted from studies that compared women who had an ECV from 36 weeks’ gestation with a similar control group of women enrolled at the same gestational age, eligible for, but who did not have an ECV.

Eleven studies with a total of 2503 women were included. Adverse outcomes related to ECV were rarely reported and in most studies there was no evidence that relevant outcomes were ascertained among similar women who did not have an ECV. There was no increased risk of antepartum fetal death associated with ECV, but numbers were small. There were no reported cases of uterine rupture, placental abruption, prelabour rupture of membranes or cord prolapse, but these outcomes were not examined among controls. Onset of labour within 24 h and nuchal cord was non‐significantly higher among women who had an ECV compared with those with a persisting breech. Despite limited reporting and small numbers, the results of our review suggest that adverse maternal and fetal outcomes of both ECV and persisting breech presentation are rare. Only with improved reporting and collection of safety data on ECV and persisting breech presentation can we provide high‐quality information to assist informed decision making by pregnant women with a breech presentation at term.
Risks of repeated miscarriage
Authors: George Lena , Granath Fredrik , Johansson Anna L. V. , Olander Bodil , Cnattingius Sven
Published: February 2006

There is a lack of well‐designed epidemiological studies of possible risk factors for repeated miscarriage. In this Swedish population‐based case–control study, we investigated the association between sociodemographic and anthropometric factors, obstetric history and life‐style factors, with respect to the risks of first‐trimester repeated miscarriage. Information on maternal characteristics was collected through in‐person interviews. Plasma blood samples were analysed for cotinine and folate concentrations. Adjusted odds ratios (OR) with 95% confidence interval [CI] were used to estimate the relative risk of repeated miscarriage.

The risks of repeated miscarriage were increased for women aged ≥35 years (adjusted OR 2.9 [95% CI 1.4, 5.8]), as well as for women aged ≤24 years (OR 2.8 [95% CI 1.1, 6.8]). Women with a history of at least one preceding miscarriage prior to the two index pregnancies, women reporting prolonged time to conceive, and women with a history of myoma, faced a more than fourfold increased risk of repeated miscarriage. Smokers were at an increased risk of repeated miscarriage (OR 2.1 [95% CI 1.1, 4.1]). Among non‐smoking women with high caffeine intake, there was an increased risk of repeated miscarriage, whereas there was no such association among smokers. Low plasma folate levels were not associated with increased risks.
Maternal caffeine consumption and fetal death: a case–control study in Uruguay
Authors: Matijasevich Alicia , Barros Fernando C. , Santos Iná S. , Yemini Alejandra
Published: February 2006

Matijasevich A, Barros FC, Santos IS, Yemini A. Maternal caffeine consumption and fetal death: a case–control study in Uruguay. Paediatric and Perinatal Epidemiology 2006; 20: 100–109.

The objective of this study was to examine the association between caffeine intake during pregnancy and fetal mortality in Montevideo, the capital city of Uruguay, taking into account several potential confounding factors. A population‐based case–control study was conducted between 1 August 2002 and 31 December 2003. A total of 382 cases and 792 controls were recruited. Cases consisted of women hospitalised with a medically confirmed diagnosis of spontaneous antepartum fetal death, in all maternity hospitals during the study period. Antepartum fetal death was defined as a fetal death in which the attending doctor certified that the death occurred prior to the onset of labour. Fetal deaths were included if they were of at least 20 weeks’ gestational age or weighed >350 g. Controls were women who had a live, vigorous and term adequate‐for‐gestational‐age newborn. Multiple gestations and fetuses/newborns with evident congenital malformations were excluded.

Only a small proportion of the mothers (8.1% of the cases and 9.5% of the controls) did not consume caffeine during pregnancy. Among consumers, mate drinking was the most frequent source of caffeine in both cases and controls. After controlling for mother's and her partner's education, history of abortions and/or fetal deaths, vomiting/nausea during the first trimester of gestation and attendance for prenatal care, the category of mean caffeine intake of ≥300 mg/day showed a significantly increased risk of fetal death (OR 2.33 [1.23; 4.41]) compared with no caffeine consumption during pregnancy. The study also found that less‐educated women, mothers who did not attend for prenatal care and women with a history of abortions and fetal death were at an increased risk of fetal death. As mate drinking is highly consumed among pregnant women in Uruguay, the association found with fetal death makes it a preventable risk factor.
Investigating variations in infant mortality in England and Wales by mother's country of birth, 1983–2001
Authors: Collingwood Bakeo Aleks
Published: February 2006

Collingwood Bakeo A. Investigating variations in infant mortality in England and Wales by mother's country of birth, 1983–2001. Paediatric and Perinatal Epidemiology 2006; 20: 127–139.

The aim of this study was to investigate variations in infant mortality from 1983 to 2001 by birthweight, registration status, father's social class, age of mother at birth and cause of death, among babies of mothers born in countries that represent the largest ethnic minority groups in England and Wales. A total of 70 208 infant death registration records linked to their corresponding birth registration records were used. The study focused on infant deaths of babies of mothers born in the UK, Republic of Ireland, Caribbean, West Africa, East Africa, India, Pakistan and Bangladesh. From 1983 to 2001 infant mortality rates decreased overall, and this was also apparent in the rates by mother's country of birth. Overall, babies of mothers born in Pakistan consistently had the highest infant mortality rates. Low‐birthweight babies of mothers born in West Africa had the highest infant, neonatal and postneonatal death rates. Differences were also seen by registration status, mother's age and between manual and non‐manual occupations for all countries from 1983 to 2001. For babies of mothers born in the UK, Caribbean and West Africa, immaturity‐related conditions were the most common cause of infant deaths. The leading cause of infant death among babies of mothers born in Pakistan and Bangladesh was congenital anomalies.
Sensitivity of indirect immunofluorescence and ELISA in detecting intercellular antibodies in endemic pemphigus foliaceus (Fogo Selvagem)
Authors: Cunha Paulo Rowilson , Bystryn Jean‐Claude , Medeiros Emerson Palmeira L. , De Oliveira Josenildo R.
Published: February 2006

Background  Since 1967 dermatology has used the classic technique of indirect immunofluorescence (IFI) for the detection of autoantibodies against antigens of the skin in diseased people with endemic pemphigus foliaceus. Thirty years later enzyme‐linked immunosorbent assays – ELISA (rDsg1 and rDsg3) appeared as a viable option. A group of highly recognized researchers have concluded that ELISA is a simple, sensitive and highly specific method, allowing for diagnostic differentiation between pemphigus vulgaris (PV) and endemic pemphigus foliaceus (EPF). Scientific literature certifies that both ELISA and IIF bear high sensitivity in spite of the fact that a direct comparison between the ELISA and IIF tests has never been performed.

Objectives  This study was conducted to compare the sensitivity of these tests in detecting antibodies in the EPF.

Material and methods  Thirty‐two serum samples were collected from patients with EPF. The control serum of 15 healthy individuals was tested to detect the presence of antibodies of EPF by indirect immunofluorescence and ELISA (rDsg1 and rDsg3). The IIF was performed, taking human skin as a substrate.

Results  Antibodies in patients with EPF were detected more commonly by the ELISA (rDsg1) (91%) compared with IIF (81%).

Conclusions  The ELISA (rDsg1) is slightly more sensitive than IIF in detecting antibodies related to EPV. However, according to our results, we do not currently possess a test with 100% accuracy in differentiating EPF from PV. Although previous studies have associated Dsg3 with PV, the tests performed during this study showed that 12% (4/32) of patients with EPF (cutaneous diseases only) also had Dsg3 antibodies.
Safety of efalizumab in adults with chronic moderate to severe plaque psoriasis: A phase IIIb, randomized, controlled trial
Authors: Papp Kim A. , Bressinck Reni , Fretzin Scott , Goffe Bernard , Kempers Steven , Gordon Kenneth B. , Caro Ivor , Walicke Patricia A. , Wang Xiaolin , Menter Alan ,   the Efalizumab Study Group
Published: February 2006

Background  To provide safety data for efalizumab, a recombinant humanized monoclonal IgG1 antibody, in adults with chronic plaque psoriasis.

Methods  A 12‐week, Phase IIIb, randomized, double‐blind, parallel‐group, placebo‐controlled trial. At 58 study sites in the USA and Canada, 686 patients with moderate to severe chronic plaque psoriasis received an initial conditioning dose of efalizumab 0.7 mg/kg subcutaneously (SC) followed by either 11 weekly doses of efalizumab 1 mg/kg SC or matching placebo. Main outcome measures were safety and tolerability outcomes (primary) and efficacy outcomes (secondary).

Results  During 12 weeks of therapy with efalizumab or placebo, the incidence of clinical adverse events was 82.2% and 72.9%, respectively; the incidence of serious adverse events was 1.8% and 3.4%, respectively; and the incidence of nonserious adverse events leading to withdrawal was 1.8% and 1.7%, respectively. In the efalizumab group, there were no clinically significant changes in vital signs or laboratory parameters and no evidence of end‐organ toxicities. A significantly higher proportion of patients receiving efalizumab than those receiving placebo achieved ≥ 75% improvement in the Psoriasis Area and Severity Index (PASI) (P < 0.001), ≥ 50% improvement in PASI (P < 0.001), and a static Physician's Global Assessment rating of Minimal or Clear (P < 0.001). The mean improvement in the Psoriasis Symptom Assessment was significantly greater in the efalizumab group (P < 0.001).

Conclusions  Efalizumab treatment SC for 12 weeks was safe, well tolerated, and effective in patients with moderate to severe chronic plaque psoriasis.
Peripheral T‐cell lymphoma presenting as lipoatrophy and nodules
Authors: Yiannias James A. , DiCaudo David J. , Maskin Erik
Published: February 2006

Background  Cutaneous lymphomas have many morphologic forms and clinical features. Lymphoma presents rarely with a constellation of nodules, panniculitis, and localized lipoatrophy. The histopathologic similarities of lymphoma and connective tissue disease panniculitis may create a diagnostic challenge.

Methods  We retrospectively reviewed the case of a 47‐year‐old man who presented 15 years earlier with recurrent fevers, fatigue, tender subcutaneous nodules, and facial, trunk, and extremity lipoatrophy.

Results  Initial biopsy of a cutaneous nodule showed lymphohistiocytic panniculitis without atypical inflammatory cells. Serologic tests showed negative connective tissue serologies, yet the initial clinical impression was most consistent with lupus panniculitis. Initially, the patient was treated with oral prednisone; later, steroid‐sparing agents were used with modest improvement evidenced by resolution of his systemic symptoms and stabilization of the cutaneous findings. A decade later, more pronounced facial lipoatrophy, new facial nodules, and posterior thigh pain developed. Laboratory testing showed leukopenia, elevated liver and muscle enzymes, hypertriglyceridemia, and a low level of high‐density lipoprotein. Biopsy of a new chin nodule indicated peripheral T‐cell lymphoma, whereas an evaluation for systemic malignant involvement was negative. The patient was started on chemotherapy, which resulted in stabilization of the lipoatrophy and decreasing size and frequency of the cutaneous nodules, but the posterior thigh pain persisted.

Conclusions  We report a rare case of lymphoma presenting as nodules and profound lipoatrophy, which exemplifies the complexity of lymphomas. Profound lipoatrophy and panniculitis may be an unusual and diagnostically challenging presentation of cutaneous lymphoma.
JTP‐426467 acts as a selective antagonist for peroxisome proliferator‐activated receptor γin vitro and in vivo
Authors: Nishiu J. , Ito M. , Ishida Y. , Kakutani M. , Shibata T. , Matsushita M. , Shindo M.
Published: February 2006

Aim:  JTP‐426467 was identified as a result of screening in search of selective antagonist for peroxisome proliferator‐activated receptor γ (PPARγ). We examined whether JTP‐426467 functioned as a PPARγ antagonist in vitro and in vivo and investigated physiological effects of JTP‐426467.

Methods:  The effect of JTP‐426467 as a PPARγ antagonist was studied in a cell‐based reporter assay and an adipocyte differentiation assay. Target mRNA expression levels were determined by branched DNA (bDNA) assay. To examine the effects as a PPARγ antagonist in vivo, a competitive study between JTP‐426467 and BRL49653 (rosiglitazone), a PPARγ agonist, was performed using KK‐Ay mice. The effects of JTP‐426467 alone after administration to KK‐Ay mice were also explored.

Results:  JTP‐426467 antagonized PPARγ activity in a reporter assay system, but not PPARα. JTP‐426467 inhibited the expression of hormone‐sensitive lipase (HSL) mRNA, an adipocyte‐abundant gene, but not PPARγ itself or cyclophilin mRNA (as constitutive mRNA), and also suppressed triglyceride accumulation in differentiated stromal vascular fraction cells (SVFs). JTP‐426467 antagonized PPARγ agonistic action by BRL49653 in KK‐Ay mice on high‐fat diet, in terms of plasma glucose, body weight gain and interscapular brown adipose tissue (IBAT) weight. JTP‐426467 alone inhibited body weight gain and decreased plasma leptin level in KK‐Ay mice.

Conclusions:  JTP‐426467 acted as a pure and potent PPARγ antagonist in vitro. Interestingly, JTP‐426467 completely antagonized the effects of PPARγ agonist BRL49653 in an obese diabetic model. JTP‐426467 may be a useful tool for the study of PPARγ in biological and physiological function.
Role of leptin in the cardiovascular and endocrine complications of metabolic syndrome
Authors: Correia Marcelo L. G. , Rahmouni Kamal
Published: February 2006

Aim:  To review the potential role of leptin, hyperleptinaemia and leptin resistance in the cardiovascular and endocrine complications of metabolic syndrome.

Methods:  Review of literature listed in Medline.

Results:  Hyperleptinaemia is common in obesity and reflects increased adiposity and leptin resistance. Nevertheless, leptin resistance may not be complete as several actions of leptin, such as cardiovascular sympatho‐activation, might be preserved in obese subjects known to be resistant to the metabolic effects of leptin (i.e. selective leptin resistance). Notably, the renal and sympathetic actions of leptin may play an important role in the pathogenesis of hypertension related to obesity and metabolic syndrome. Furthermore, the lipotoxic effect of leptin resistance may cause insulin resistance and β cell dysfunction, increasing the risk of type 2 diabetes. Leptin has also been shown to possess proliferative, pro‐inflammatory, pro‐thrombotic, and pro‐oxidative actions.

Conclusion:  Hyperleptinaemia and leptin resistance may contribute to hypertension, impaired glucose metabolism, and pro‐atherogenic state in obesity and metabolic syndrome.
Affirmative Action: A German Perspective on the Promotion of Women's Rights with Regard to Employment
Authors: Stock Anke J.
Published: February 2006

This paper discusses affirmative action policies in Germany. After German reunification, women from both east and west had hoped for a new codification of their rights, including positive obligations on the state to promote gender equality. However, the amendments to the Basic Law in November 1994 did not clearly endorse this approach. Opinions still differ as to whether Articles 3(2) and 3(3) of the Constitution allow for affirmative action with regard to women's employment. In 2001 quotas for the public employment sector were finally introduced, but the use of quotas for private sector employment still faces serious opposition. Nevertheless, the concept of affirmative action is not new to the German legal system: since the eighteenth century, quota schemes have been used to ensure the employment of (war‐) disabled persons. This article examines the different approaches to employment quotas for women and disabled persons, and critically evaluates the reasons for divergence.
Preferential Treatment, Social Justice, and the Part‐time Law Student – The Case for the Value‐added Part‐time Law Degree
Authors: Francis Andrew M. , McDonald Iain W.
Published: February 2006

There has been growing pressure to increase diversity in legal education and the legal profession in England and Wales. While this has focused upon the absence of certain groups such as women, ethnic minorities, and the disabled, there has been no specific discussion of part‐time law students. Drawing on questionnaires and focus groups with part‐time law students across England and Wales, this article examines how their background and experiences may hamper their ability to participate and succeed in higher education and legal practice. In response to the consistent omission of part‐time students' needs from attempts to enhance social diversity in universities and the legal profession, it also argues that affirmative action is now necessary and justified in respect of these students. Pragmatic suggestions are made for a contextual approach to affirmative action for part‐time law students which adds value to their degree. Finally, the potential effects of affirmative action on part‐time law students themselves and upon the gatekeepers to the legal profession are explored.
Affirmative Action in the Legal Profession
Authors: Nicolson Donald
Published: February 2006

This article examines whether the legal profession should use quotas and decision‐making preferences in recruitment and promotion in favour of women, ethnic minorities, and those from socially disadvantaged backgrounds. It argues that this is necessary to eradicate current patterns of discrimination and disadvantage. It also argues that quotas and decision‐making preferences do not necessarily conflict with appointment or promotion on merit, and hence that consequent unfairness to other applicants is more apparent than real. Moreover, any potential stigmatization of the beneficiaries of affirmative action is outweighed by the advantages in reversing the under‐representation of women, ethnic minorities, and those from socially disadvantaged background, thereby challenging perceptions of their inferior qualities as lawyers. Finally, practical problems in the implementation of affirmative action are considered and argued to be insufficiently serious to stand in the way of its introduction.
Rethinking the Merit Principle in Judicial Selection
Authors: Malleson Kate
Published: February 2006

Against the background of the continuing lack of diversity in the makeup of the judiciary in England and Wales, this article explores the reasons behind the consistent rejection of affirmative action policies in relation to the judicial appointment process. It examines the relationship between affirmative action and the merit principle in this context and argues that the belief that the two are inherently in tension rests on implicit assumptions about both which are open to question.
Quotas for Women! The Sex Discrimination (Election Candidates) Act 2002
Authors: McHarg Aileen
Published: February 2006

The Sex Discrimination (Election Candidates) Act 2002 is unusual in two respects. First, it is a rare example of the permissible (though not mandatory) use of affirmative action in the United Kingdom, in this case to reduce gender inequality in the selection of election candidates. Secondly, the Act contains a sunset clause and will expire in 2015 unless extended. This article examines the background to the legislation, the forms of affirmative action it permits, and the use so far made of it by political parties. It also considers the justifications for affirmative action to increase women's political representation, asking what sets this apart from other contexts in which women are under‐represented, and whether the temporary nature of the legislation is appropriate.
Minority Business Enterprise Programmes in the United States of America: An Empirical Investigation
Authors: Sweet Martin J.
Published: February 2006

Affirmative action in the United States has generated no shortage of academic, legal, and popular analysis. Yet few ever ask, let alone test, the most fundamental question about affirmative action ‐ whether it actually works. This article provides an historical overview of affirmative action in the United States, briefly reviews its legal status, and then tests the effectiveness of one type of affirmative action in three American cities between 1981 and 2000. It finds that affirmative action in government contracting does not significantly increase minority employment and is statistically insignificant in eradicating discrimination in contracting.
University Choice: What Influences the Decisions of Academically Successful Post‐16 Students?
Authors: Whitehead Joan M. , Raffan John , Deaney Rosemary
Published: February 2006

The questionnaire survey reported in this paper is part of an ongoing evaluation of the effect of a bursary scheme on recruitment to Cambridge University. It sought to identify factors that encouraged or discouraged highly successful A Level students from applying to Cambridge. Findings reveal three main dimensions associated with the decision to apply to Cambridge, the nature of the courses, the prestige of the university and anxiety about the application process combined with fear of failure. Further analyses showed that there were complex interactions between these three dimensions which governed the decision to apply to Cambridge. These findings are relevant to other prestigious universities. The availability of a bursary did appear to influence the decisions of those who were eligible, but its influence was not as great as some of the other factors.
Acupuncture in Migraine Prophylaxis
Authors: Alecrim-Andrade J , Maciel-Júnior JA , Cladellas XC , Correa-Filho HR , Machado HC
Published: February 2006

The purpose of the present trial was to evaluate semi-standardized acupuncture efficacy in migraine prophylaxis. Twenty-eight subjects with migraine were randomized to the real or sham acupuncture groups. Semi-standardized and standardized minimal acupuncture were used, respectively, in the two groups of patients. They were all treated with 16 acupuncture sessions in 12 weeks. Both groups exhibited similar reductions in: percentage of patients with reduction of migraine ≥40% and ≥50% regarding frequency of migraine attacks, days with migraine, frequency of migraine attacks, average duration of a migraine attack, rate of rescue medication used, average headache severity rate and other parameters compared with the baseline period. Associated symptoms, such as nausea and vomiting, also showed equal estimates in both groups. These findings showed that semi-standardized acupuncture shows no difference from sham acupuncture in preventing migraine attacks.
A comparison of auricular, rectal and pulmonary artery thermometry in dogs with anesthesia‐induced hypothermia
Authors: Southward Emily S. , Mann F. A. , Dodam John , Wagner‐Mann Colette C.
Published: February 2006

Objective: To determine if a correlation exists among auricular, rectal and pulmonary artery (PA) temperatures in hypothermic dogs.

Design: Prospective study.

Setting: Angiography suite at a college of veterinary medicine.

Animals: Sexually intact female research hounds (13.9–25.4 kg; n=8).

Measurements and main results: Dogs were anesthetized for instrumentation with a percutaneously placed, thermistor‐tipped, PA catheter. Anesthesia was maintained until the core body temperature decreased to 36.6°C (97.8°F). Anesthesia was discontinued, and auricular and rectal temperatures were obtained every 15 minutes until the PA temperature reached 38.3°C (100.9°F). A strong correlation was noted among the 3 methods of temperature measurement (P<0.001; R≥0.846). No statistical difference was detected among measurement methods at baseline, the minimum temperature attained, nor the median temperature attained. However, at the maximum temperature attained, auricular measurements (37.7±0.4°C or 99.8±0.7°F) were lower than either the rectal (38.3±0.3°C or 100.9±0.5°F) or PA (38.3±0.3°C or 100.9±0.5°F) temperature measurements (P=0.001).

Conclusion: There is a strong correlation among rectal, auricular and PA temperatures. Auricular temperature may be used to monitor core body temperature during postoperative rewarming; however, it might be slightly lower than core temperature as normothermia is reached.
Postoperative pulmonary complications in dogs undergoing laparotomy: frequency, characterization and disease‐related risk factors
Authors: Alwood Amy J. , Brainard Benjamin M. , LaFond Elizabeth , Drobatz Kenneth J. , King Lesley G.
Published: February 2006

Objective:To determine the frequency of postoperative pulmonary complications (PPCs) in dogs following laparotomy, characterize the nature of PPCs, and identify disease‐related risk factors for PPCs in dogs.

Design:Retrospective clinical study.

Setting:University‐affiliated small animal teaching hospital.

Animals:One hundred and sixty‐two dogs without preoperative pulmonary pathology that underwent laparotomy surgery.

Interventions:None.

Measurements and main results:Cases were evaluated for factors including patient signalment, preexisting disease, primary and ancillary surgical procedure(s), development of postoperative pulmonary disease, characteristics of perioperative hospitalization and therapy, and survival. Twenty‐two percent of dogs in the study developed PPCs. PPCs included respiratory arrest (n=4), acute respiratory distress syndrome (ARDS) (n=3), pneumonia (n=8), hypoventilation (n=13), and transient hypoxemia (n=8). Dogs that developed PPCs had a significantly longer duration of oxygen therapy, longer duration of stay in intensive care unit (ICU), and decreased survival. Dogs with perioperative vomiting or regurgitation were more likely to develop PPCs. Animals that underwent exploratory laparotomy for biliary or septic peritonitis were also more likely to develop PPCs.

Conclusions:PPCs occur in dogs following laparotomy and contribute significantly to the morbidity and mortality of these surgical patients. In this patient population, animals with vomiting, regurgitation, or peritonitis may be at a higher risk of developing PPCs. Animals with the identified risk factors should be monitored carefully postoperatively for development of pulmonary complications.
Successful management of severe generalized tetanus in two dogs
Authors: Low Rochelle M. , Lambert Ruth J. , Pesillo S. Anna
Published: February 2006

Objective: To describe the clinical course and successful outcome of severe generalized tetanus in 2 dogs.

Case series summary: Two dogs presenting with severe muscle rigidity, opisthotonus, and trismus were diagnosed with tetanus. In both cases, generalized convulsions, respiratory compromise, and autonomic dysfunction necessitated emergent interventions followed by intensive treatment and monitoring. In the second case, transient mechanical ventilation was required. Both dogs survived and were discharged after 19 days (first case) and 18 days (second case) of hospitalization. Although costly and time‐consuming, treatment for severe generalized tetanus was successful in these 2 dogs.

New information provided: Severe generalized tetanus with convulsions, respiratory compromise, and autonomic dysfunction can have a successful outcome with intensive care and appropriate treatment.