bluuebunny/crossref_metadata_2025 huggingface dataset:
Delayed Adulthood, Delayed Desistance? Trends in the Age Distribution of Problem Behaviors
Authors: Hayford Sarah R. , Furstenberg Frank F.
Published: May 2008

As the transition to adulthood becomes more protracted and less orderly, fewer young people occupy adult roles and experience the social control associated with these roles. One might therefore expect behaviors associated with the teenage years to spill over into older age groups, reflecting postponed entrance into full social adulthood. We test this hypothesis by examining trends over time in the age distribution of crime, substance use, and violent death. We find little evidence that behaviors typical of adolescence are moving upward to older ages. Although the achievement of adult roles is being pushed to older ages, this stretching of the transition to adulthood is not reflected in the observed patterns of substance use, violent death, and arrests.
Second‐Generation Effects of Chicago's Gautreaux Residential Mobility Program on Children's Participation in Crime
Authors: Keels Micere
Published: May 2008

Data from the Gautreaux residential mobility program, which relocated low‐income African American families from high poverty, segregated inner‐city, Chicago neighborhoods into mostly European American, suburban neighborhoods, and mostly European American or mostly African American neighborhoods within Chicago, are used to assess whether children's later involvement with the Illinois criminal justice system is associated with the characteristics of their placement neighborhoods. I find that suburban placement provides a strong protective benefit for boys, primarily for drug offenses. Conversely, girls placed in suburban neighborhoods were more likely to be convicted of a criminal offense. Qualitative data indicate that children placed in the suburbs experienced a dramatic reduction in direct exposure to gangs and drugs. Children placed in higher SES neighborhoods within Chicago still attended lower performing schools and the surrounding neighborhoods offered many opportunities for participation in delinquent activities.
Cognitive Self‐Regulation and Depression: Examining Academic Self‐Efficacy and Goal Characteristics in Youth of a Northern Plains Tribe
Authors: Scott Walter D. , Dearing Eric , Reynolds W. Rusty , Lindsay Julie E. , Baird Grayson L. , Hamill Sarah
Published: May 2008

The relationship between cognitive self‐regulatory processes and depression was examined in American Indian adolescents from a Northern Plains tribe. Students completed measures of negative life events, self‐efficacy, goals, and depressive symptoms. Results indicated that academic self‐efficacy was strongly associated with depression. Academic self‐efficacy also correlated with intrinsically motivating goal representations, such that students who indicated high academic self‐efficacy had goals that were more important to them, goals they thought more about, and goals they viewed as wanted by the self instead of as imposed on by others. However, we did not find the hypothesized mediational model in which academic self‐efficacy influenced depression indirectly by influencing goal characteristics. Rather, this indirect model varied by grade, and differed from what we expected. Specifically, for older adolescents, higher levels of academic self‐efficacy predicted goals that were more likely to be identified as the adolescent's own, and in turn, these self‐ as opposed to other‐oriented goals predicted higher levels of depressive symptoms. Results are discussed as providing support for continued investigations into the role of specific cognitive self‐regulatory processes in youth adjustment.
Major Innovation as a Dynamic Capability: A Systems Approach*
Authors: O'Connor Gina Colarelli
Published: May 2008

Major innovation (MI), composed of both radical and really new innovation, is an important mechanism for enabling the growth and renewal of an enterprise. Yet it is poorly managed in most established firms, and success stories are rare. This conceptual article draws on systems theory, recent advances in dynamic capabilities theory, and the management of innovation literature to offer a framework for building an MI dynamic capability. The framework is composed of seven elements that together form a management system rather than a process‐based approach to nurturing radical innovation. These system elements are (1) an identifiable organization structure; (2) interface mechanisms with the mainstream organization, some of which are tightly coupled and others of which are loose; (3) exploratory processes; (4) requisite skills and talent development, given that entrepreneurial talent is not present in most organizations; (5) governance and decision‐making mechanisms at the project, MI portfolio, and MI system levels; (6) appropriate performance metrics; and (7) an appropriate culture and leadership context. It is argued that dynamic capabilities for phenomena as complex as MI must be considered in a systems fashion rather than as operating routines and repeatable processes as the literature currently suggests. A set of propositions is offered regarding how each element should play out in this parallel management system. Finally, each element's role in the major innovation system is justified in terms of four criteria required by systems theory: (1) The system is identifiable, and its elements are interdependent; (2) the effect of the whole is greater than the sum of the parts; (3) homeostasis is achieved through interaction and networking with the larger organization; and (4) there is a clear purpose in the larger system in which the MI management system is embedded. Examples are given to demonstrate these criteria. Systems theory offers a new way of thinking about dynamic capability development and management.
Exploring Mediating and Moderating Influences on the Links among Cycle Time, Proficiency in Entry Timing, and New Product Profitability*
Authors: Langerak Fred , Hultink Erik Jan , Griffin Abbie
Published: May 2008

Development cycle time is the elapsed time from the beginning of idea generation to the moment that the new product is ready for market introduction. Market‐entry timing is contingent upon the new product's cycle time. Only when the product is completed can a firm decide whether and when to enter the market to exploit the new product's window of opportunity. To determine the right moment of entry a firm needs to correctly balance the risks of premature entry and the missed opportunity of late entry. Proficient market‐entry timing is therefore defined as the firm's ability to get the market‐entry timing right (i.e., neither too early nor too late). The literature has produced divergent evidence with regard to the effects of development cycle time and proficiency in market‐entry timing on new product profitability. To explain these disparities this study (1) explores the mediating roles of development costs and sales volume in the relationships among development cycle time, proficiency in market‐entry timing, and new product profitability, respectively; and it (2) explores the moderating influence of product newness on the relationship between development cycle time and development costs and that of new product advantage on the link between proficiency in market‐entry timing and sales volume. The results from a survey‐based study of 72 manufacturers of industrial products in the Netherlands suggest that development costs mediate the relationship between development cycle time and new product profitability and that sales volume mediates the link between proficiency in market‐entry timing and new product profitability. In addition, the findings indicate that new product advantage strengthens the positive relationship between proficiency in market‐entry timing and sales volume. The results provide no evidence for a moderating effect of product newness. These results have important implications because to maximize new product profitability managers need to distinguish between costs and demand side effects of development cycle time and market‐entry timing on new product profitability. Keeping this distinction in mind should help them to better determine the relative profit impact of investments in cycle time reduction or improved entry timing. Moreover, the findings suggest that highly advantaged products that enter the market at the right time may have a highly attenuated sales volume. It also implies that new products with lower advantage may have very little leeway in hitting the “sweet spot” in market. The message is that “doing the right thing” (i.e., to develop a highly advantaged new product) may be at least as important as correctly balancing the risks of premature entry and the missed opportunity of late entry.
Lean Product and Process Development by Allen C. Ward
Authors: Reinertsen Donald
Published: May 2008

Books reviewed in this issue:

Lean Product and Process Development

Open Business Models: How to Thrive in the New Innovation Landscape

Putting Hope to Work: Five Principles to Activate Your Organization's Most Powerful Resource

Catalyst Code: The Strategies behind the World's Most Dynamic Companies

Invisible Engines: How Software Platforms Drive Innovation and Transform Industries
Acceptance and Expressed Emotion in Mexican American Caregivers of Relatives with Schizophrenia
Authors: DORIAN MARINA , RAMÍREZ GARCÍA JORGE I. , LÓPEZ STEVEN R. , HERNÁNDEZ BRENDA
Published: May 2008

The relation between Expressed Emotion (EE) and caregiver acceptance was tested with the use of video‐recorded interactions between 31 Mexican American family caregivers and their relatives with schizophrenia. Borrowing the concept from Integrative Behavioral Couple Therapy, acceptance was defined as caregiver's engagement with the ill relative along with low levels of expectations for behavioral change. Three aspects of caregiver acceptance were measured: global acceptance of the patient, unified detachment (i.e., nonblaming but engaged problem discussion), and low aversive responses to patient behavior (e.g., criticisms and demanding change). Relative to high EE caregivers, low EE caregivers were consistently more accepting of their ill relatives across the three measures of acceptance. Unified detachment was negatively associated with emotional overinvolvement and aversive responses were positively related to criticism. Warmth was not related to acceptance. The findings suggest that the study of acceptance in family caregivers is a heuristic avenue for future research due to its potential to shed light on specifically what family members do in caring for their ill relatives with schizophrenia.
Dry‐eye syndrome after allogeneic stem‐cell transplantation in children
Authors: Fahnehjelm Kristina Teär , Törnquist Alba‐Lucia , Winiarski Jacek
Published: May 2008

Purpose:  To report the prevalence of dry‐eye syndrome (DES) in children and young adults treated with allogeneic stem‐cell transplantation (SCT) during childhood; to relate DES to conditioning regimes, including total body irradiation (TBI) and chemotherapy, and to immunosuppressive drugs and graft‐versus‐host disease (GVHD).

Methods:  This cross‐sectional study included 60 children/young adults transplanted because of leukaemia, various haematological disorders and inborn errors of metabolism between 1986 and 2004, with a follow‐up time of 7.0 years (median, range 2–18). Clinical assessments, performed at a median age of 15.6 years (range 5.5–23.5), included an inquiry form on dry‐eye symptoms, corneal status including fluorescein staining, ‘break‐up time’ (BUT) and Schirmer test.

Results:  A total of 37 of 60 patients had DES defined as presence of corneal epithelial lesions with a pathological BUT and/or Schirmer test. Twenty‐nine had had staining <1–10% of the corneal surface while eight patients had staining ≥10–25% of the corneal surface. All 37 patients with objective signs of DES, graded and not graded, had significant associations to subjective symptoms of dry eyes including dry eyes, red eyes, ocular irritation, secretion and sensitivity to light. Frequent occasions (above median; n = 7) of high cyclosporine A trough levels above 250 ng/ml were associated significantly with DES (P = 0.002). However, there was no association between DES and conditioning with single‐dose (s‐TBI) or fractionated TBI (f‐TBI), busulfan or other chemotherapy. There were no associations between prolonged corticosteroid treatment or chronic GVHD and DES in the present study. DES was more common in patients with malignant diseases (P = 0.02). Malignant disease increased the risk of DES in girls but not in boys. Increased age at SCT increased the risk for DES in boys but not in girls (P = 0.02). Although severe keratitis occurred in three patients, nobody suffered corneal perforation.

Conclusion:  DES with epithelial punctata keratopathy was common in children/young adults treated with SCT and more common if the patients were exposed to repeated high trough levels of cyclosporine A; however, DES was not associated with irradiation, corticosteroids or GVHD in the present study. Patients with objective DES also had subjective symptoms of dry eyes, which facilitate diagnosis. Girls with malignant diseases and boys who underwent SCT at later ages seem to demand higher attention and more frequent check‐ups regarding DES. Patients with diagnosed severe DES needed frequent and continuous ophthalmological care to maintain treatment motivation.
Ocular characteristics in 10 children with long‐chain 3‐hydroxyacyl‐CoA dehydrogenase deficiency: a cross‐sectional study with long‐term follow‐up
Authors: Fahnehjelm Kristina Teär , Holmström Gerd , Ying Liu , Haglind Charlotte Bieneck , Nordenström Anna , Halldin Maria , Alm Jan , Nemeth Antal , Von Döbeln Ulrika
Published: May 2008

Purpose:  To present long‐term ocular complications and electroretinographic (ERG) findings in children with long‐chain 3‐hydroxyacyl‐CoA dehydrogenase (LCHAD) deficiency – a life‐threatening metabolic disease – and the relation to age at diagnosis, treatment and other clinical parameters.

Methods:  Ten children with LCHAD deficiency underwent repeated ophthalmological evaluations including ERG.

Results:  All 10 children developed chorioretinal pathology. Regardless of age at diagnosis, initiation of treatment and age at examination, inter‐individual differences were present. Profound chorioretinal atrophy, severe visual impairment and progressive myopia had developed in two teenagers. Milder chorioretinopathy with or without subnormal visual acuity was present in all other children. ERG was pathological in seven children. The chorioretinopathy often started in the peripapillary or perimacular areas. In one patient, unilateral visual impairment was associated with fibrosis.

Conclusion:  Early diagnosis and adequate therapy might delay but not prevent the progression of retinal complications. Late diagnosis with severe symptoms at diagnosis, neonatal hypoglycaemia and frequent decompensations may increase the progression rate of the chorioretinopathy.

LCHAD deficiency, a potentially lethal disease, is sometimes difficult to diagnose. Unusual chorioretinal findings should alert the ophthalmologist to the long‐chain 3‐hydroxyacyl‐CoA dehydrogenase deficiency, especially if there is a history of neonatal hypoglycaemia or failure to thrive.
Atypical Microsporum canis variant in an immunosuppressed child
Authors: Anemüller Waltraud , Baumgartner Sabine , Brasch Jochen
Published: May 2008

A 10‐year old boy with X‐chromosomal adrenoleukodystrophy presented with scaly patches on the scalp and diffuse effluvium. He was on immunosuppressive therapy because of a chronic graft‐versus‐host‐reaction after allogenic bone marrow transplantation. At home he had been in contact with cats, rabbits and guinea pigs. Through Wood light and KOH examination, we confirmed the diagnosis of tinea capitis and started antimycotic therapy.

The morphology of the culture first suggested Epidermophyton floccosum, Trichophyton mentagrophytes var. nodulare or Trichophyton tonsurans as possible causes for this infection. Further studies, however, revealed an atypical form of Microsporum canis infection.
Determinants of treatment goals and satisfaction of patients with atopic eczema
Authors: Schmitt Jochen , Csötönyi Friederike , Bauer Andrea , Meurer Michael
Published: May 2008

Background: Despite the high prevalence, morbidity, and economic burden of atopic eczema,data on patients' treatment goals and treatment satisfaction are missing.

Methods: A cross‐sectional study was performed with standardized survey of all adult patients treated between 01/2004 and 03/2006 in the atopic eczema outpatient unit of the Department of Dermatology, TU Dresden, Germany. Assessed were disease‐specific characteristics (age at onset, treatment, disease severity, quality of life impact), and aspects of health services research (treatment goals, patients' self‐treatment competence, treatment satisfaction). Treatment satisfaction was assessed on a 100 mm visual analog scale with 0 reflecting “very dissatisfied”, and 100 “highly satisfied”. Based on an a priori model we analyzed the impact of sociodemographic and disease‐specific factors on treatment satisfaction (primary endpoint) using multivariate regression modeling.

Results: Of the 267 patients asked to participate, 226 (85 %) agreed. Mean treatment satisfaction was 59.6 (± 30.8). Age and sex were not significantly associated with treatment satisfaction. Professional competence of the treating physician was the most important determinant of treatment satisfaction, followed by physician's sensitivity, disease severity, education about the condition, and patient's competence to adjust treatment to disease activity. Reduction of itching and burning, as well as complete clearing of all skin changes, were the most important treatment goals.

Conclusions: For adult patients with atopic eczema the impression of professional competence of the treating physician has highest priority. Disease severity only explains 20 % of the total variance of treatment satisfaction. Comprehensive information about the condition and reinforcement of patients' treatment competence should be better integrated in clinical practice.
Catholics Using Contraceptives: Religion, Family Planning, and Interpretive Agency in Rural Mexico
Authors: Hirsch Jennifer S.
Published: May 2008

Research on how religion shapes contraceptive practices and fertility has paid insufficient attention to how people interpret religious teachings. This study draws on ethnographic fieldwork in Degollado, Mexico, to describe generational and social‐contextual differences in how women interpret and use religious doctrine to achieve their fertility desires without jeopardizing their standing as devout Catholics. Contrasting the family planning beliefs and practices of young Mexican women with those of older women (many of whom are the younger women's parents and in‐laws), in a rural town in which the religious regulation of everyday life is pervasive, reveals how a common set of religious teachings and principles can be used to guide two different generational strategies for fertility regulation. The ethnographic data presented here highlight the creativity with which people use religious frameworks to justify their behavior. Research exploring how religion—and culture more broadly—influences fertility and contraceptive use should give greater attention to the dynamic interplay between cultural beliefs and institutions, social context, and interpretive agency.
Fertility Transitions in Developing Countries: Progress or Stagnation?
Authors: Bongaarts John
Published: May 2008

Over the past quarter‐century, fertility has declined rapidly in many developing countries. Projections typically assume that this trend will continue until replacement level is reached. Recent evidence suggests, however, that ongoing fertility declines may have slowed or stalled in a number of countries in transition. This study examines the pace of fertility change in developing countries that have multiple Demographic and Health Surveys to determine whether ongoing transitions are decelerating or stalling. The main findings are that in sub‐Saharan African countries, the average pace of decline in fertility was lower around 2000 than in the mid‐1990s and that more than half the countries in transition in this region have stalled.
Rates of Induced Abortion in Iran: The Roles of Contraceptive Use and Religiosity
Authors: Erfani Amir , McQuillan Kevin
Published: May 2008

Iran has experienced a dramatic decline in fertility in recent decades, but limited access to legal abortion continues to lead many women whose pregnancies are unwanted or mistimed to undergo clandestine, unsafe abortions. No official data on the abortion rate in Iran have been collected, however. This study uses the 2000 Iran Demographic and Health Survey to estimate the abortion rate for the country as a whole and for specific regions, and to explore the role of contraceptive use and religiosity in explaining regional variations in abortion rates. We estimate the total abortion rate for the country to be 0.26 abortions per married woman, and the annual general abortion rate to be 7.5 abortions per 1,000 married women aged 15–49. We find that the negative effect of modern contraceptive use on the abortion rate is 31 percent greater than the negative effect of religiosity, and we highlight the implications of these findings for policies on reproductive health and family planning.
House ofMirrors: Textual Variation and theMirror for Magistrates
Authors: Human Elizabeth M. A.
Published: May 2008

Lily B. Campbell's 1938 edition has decisively shaped current scholarship on theMirror for Magistrates, a sixteenth/seventeenth‐century poem taking as its subject British history. Though sixteen texts calling themselves theMirror for Magistrates(or some variation thereon) were published between 1554/5 and 1620, under the leadership of several editors (William Baldwin, John Higgins, Thomas Blenerhasset, and Richard Niccols), Campbell focuses on the earlier versions, selectively including the 1554/5–1587 editions (the material edited by or connected to Baldwin), and excluding the seventeenth‐century texts entirely. My essay endeavors first to illuminate this complex textual history, and to suggest that a reckoning with theMirrorwhole opens on to some crucial concerns for the literary history of the period, such as the role of the printer in producing the text, the uses of history in public discourse, and the status of the author in the late sixteenth and early seventeenth centuries.
‘a mixed Parenthesis’: John Donne'sLetters to Severall Persons of Honour
Authors: Hester M. Thomas
Published: May 2008

This paper is part of the secondLiterature Compasspanel cluster arising fromThe Texas A&M John Donne Collection: A Symposium and Exhibition. [Correction added after online publication 24 October 2008: ‘This paper introduces the secondLiterature Compasspanel cluster’ changed to ‘This paper is part of the secondLiterature Compasspanel cluster’.] Comprising an introduction by Gary Stringer and three of the papers presented at the symposium, this cluster seeks to examine the current state of Donne Studies and aims to provide a snapshot of the field. The symposium was held April 6–7, 2006.

The cluster is made up of the following articles:

‘Introduction to the Second Donne Cluster: Three Papers fromThe Texas A&M John Donne Collection: A Symposium and Exhibition’, Gary A. Stringer,Literature Compass5 (2008), DOI:10.1111/j.1741-4113.2008.00551.x.

‘Donne into Print: The Seventeenth‐Century Collected Editions of Donne's Poetry’, Ted‐Larry Pebworth,Literature Compass5 (2008), DOI:10.1111/j.1741-4113.2008.00552.x.

‘“a mixed Parenthesis”: John Donne'sLetters to Severall Persons of Honour’, M. Thomas Hester,Literature Compass5 (2008), DOI:10.1111/j.1741-4113.2008.00553.x.

‘What We Think About Donne: A History of Donne Criticism in Twenty Minutes’, Paul A. Parrish,Literature Compass5 (2008), DOI:10.1111/j.1741-4113.2008.00554.x.

***

This 1651 (rpt. 1654) edition of 129 letters composed by John Donne (1572–1631) presents the witty poet and preacher in many of his most significant styles and roles; ‘conveyors of me to you’, he called them. Despite the ‘tampering’ of many of the letters by its editor or collector, the letters yet maintain an overall impression of the ‘vitality of mind’ and ‘purposeful mental recourse’ for which this Renaissance poet and preacher was known. Attacks on the corruption of the court are balanced in the volume overall by its many meditative considerations; the portrait here of Donne the family man and loving father and husband is set beside the clever writer who declared friendship to be his ‘second religion’; and these revealing insights into his public and private self are balanced by letters affirming his life‐long assertion that ‘There is no Vertue, but Religion’. Letters about the ongoing religious conflicts in Europe are followed often by newsless letters he called ‘ghosts’ and ‘apparitions’, both examples of his epistolary art expressed in those dexterous conceits that characterize his vibrant poetry and prose. This varied collection of Donne's letters seems often, that is, to be framed to illustrate his understanding of that ancient and Renaissance adage,Stylus virum arguit: ‘Style argues the man’.
The Poetics of Place and Space: Wordsworth, Norman Nicholson and the Lake District
Authors: Cooper David
Published: May 2008

This article draws upon the ‘spatial turn’ in critical practice to open up thinking about Romantic and post‐Romantic representations of geo‐specific space. The opening section maps out the philosophical foundations for spatial literary criticism by tracing two main strands of spatial theory: one which emerges out of Heideggerian phenomenology; and the other which is based on the Marxist cultural analysis of Henri Lefebvre. The article then highlights some ways in which these spatial theories have been used to offer new readings of Romantic texts. The second half of the essay roots this spatial thinking by focusing on literary representations of the Lake District. It shows how notions of boundary and boundedness are central to Wordsworth's spatial configuration of his native region; alongside this, it indicates how Wordsworth's mapping of the area has influenced later constructions of the landscape as a ‘social space’. The final section points towards further thinking by briefly examining the work of the twentieth‐century Cumbrian writer, Norman Nicholson (1914–87), and highlighting the tensions in his development of a site‐specific, post‐Romantic poetics of place and space.
The Quest for Utopia in the Eighteenth Century
Authors: Pohl Nicole
Published: May 2008

This article reviews critical scholarship on eighteenth‐century utopias and utopianism over the last ten years. It suggests that, in the light of current debates about Enlightenment discourses, eighteenth‐century utopias and utopianism reflect accurately the multitude of discourses on gender, sexuality, colonialism and politics that make the Enlightenment so contentious.
John Skelton and the New Fifteenth Century
Authors: Tonry Kathleen
Published: May 2008

John Skelton's writing career took place roughly between 1488 and 1528, years that straddle two centuries and, most awkwardly, two epochs. Perhaps because of that awkwardness he has been a poet marginalized in our literary histories and critical discourse until quite recently. This overview essay suggests that to re‐engage Skelton is to test alternative literary histories that think beyond the fifteenth century as a merely transitional moment and that put into play methodologies flexible enough to accommodate inter‐related notions of aesthetics and context. This essay traces Skelton's critical tradition as a series of perspectives on the poet's own nimble engagements with form and history. The first section follows the story of formalist and historicist approaches to Skelton working in tension up until the last part of the twentieth century. The second section explores the interventions of the new Skelton scholars. The third and final sections speculate briefly about fresh directions in Skelton scholarship, noticing that many of the themes and questions raised around Skelton over the past century remain open for more extensive development.
Regulation of luteinizing hormone receptor mRNA expression by mevalonate kinase – role of the catalytic center in mRNA recognition
Authors: Nair Anil K. , Young Matthew A. , Menon K. M. J.
Published: May 2008

We have shown that hormone‐induced downregulation of luteinizing hormone receptor (LHR) in the ovary is post‐transcriptionally regulated by an mRNA binding protein. This protein, later identified as mevalonate kinase (MVK), binds to the coding region of LHR mRNA, suppresses its translation, and the resulting ribonucleoprotein complex is targeted for degradation. Mutagenesis and crystallographic studies of rat MVK have established Ser146, Glu193, Asp204 and Lys13 as being crucial for its catalytic function. The present study examined the structural aspects of MVK required for LHR mRNA recognition and translational suppression. Single MVK mutants (S146A, E193Q, D204N and K13A) were overexpressed in 293T cells. Cytosolic fractions were examined for LHR mRNA binding activities by RNA electrophoretic mobility shift analysis. All the single MVK mutants showed decreased LHR mRNA binding activity compared with the wild‐type MVK. Double mutants (S146A & E193Q, E193Q & D204N and E193Q & K13A) of MVK also showed a significant decrease in binding to LHR mRNA, suggesting that the residues required for catalytic function are also involved in LHR mRNA recognition. Mutation of the residues outside the catalytic site (D316A and S314A) did not cause any change in LHR mRNA binding activity of MVK when compared with wild‐type MVK. To examine the biological effects of these mutants on LHR mRNA expression, a full‐length capped rat LHR mRNA was synthesized and translated using a rabbit reticulocyte lysate system in the presence or absence of the MVK mutant proteins. The results showed that mutations of the active site residues of MVK abrogated the inhibitory effect on LHR mRNA translation. Therefore, these data indicate that an intact active site of MVK is required for its binding to rat LHR mRNA and for its translational suppressor function.
Vacuum‐assisted closure therapy for deep sternal wound infections: the impact of learning curve on survival and predictors for late mortality
Authors: Sjögren Johan , Mokhtari Arash , Gustafsson Ronny , Malmsjö Malin , Nilsson Johan , Ingemansson Richard
Published: May 2008

The aim of this study was to evaluate the possible learning curve effects on survival during the introduction of vacuum‐assisted closure (VAC) therapy in patients with deep sternal wound infection (DSWI). Furthermore, predictors of late mortality were analysed and causes of late death were examined. Fifty‐three patients (early Group, n = 26, January 1999 to July 2001 versus late group, n = 27, August 2001 to March 2003) were all treated with VAC for DSWI. A follow‐up was carried out in September 2006. Multivariate analyses were used to evaluate the predictors of late mortality. The 90‐day mortality was 0% in both groups. The survival rates at 5 years were 69·2 ± 9·1% (early group) versus 58·5 ± 11·7% (late group), P = ns (non significant). The time interval from cardiac surgery to diagnosis of DSWI and prolonged VAC therapy were identified as independent predictors of late mortality. Our concept for VAC therapy in DSWI seems to be readily introduced in clinical practice. There was no difference in survival between our initial cases and later cases. Late diagnosis and prolonged wound therapy were identified as predictors for late mortality.
Non healing leg ulcers and the nurse–patient relationship. Part 1: the patient’s perspective
Authors: Morgan Philip A , Moffatt Christine J
Published: May 2008

This paper reports on a study that explored the relationship between patients with non healing leg ulcers and the nurses providing their care in a community setting. Qualitative data were collected from five patients whose leg ulcers were healing and who had been identified as experiencing difficulty with adhering to treatment. Single semi‐structured interviews were used and participants were asked to share key events in their care prompted by the question ‘how are you coping with your leg ulcer?’ Striving to maintain balance by developing strategies to cope with the physical effects of an unhealed ulcer as well as ensuring the care they received met their unique needs was central to the experience of participants. From the participant’s perspective, however, nurses often showed little understanding of the complex issues patients were grappling with. Patients, in viewing nurse behaviour, often concluded that leg ulceration was an insignificant problem that nurses had little interest in. The need to establish and to maintain a trusting therapeutic relationship with patients is essential if they are to feel they matter, that they are important as individuals and that their suffering can be eased by sensitive collaboration.
The impact of Manuka honey dressings on the surface pH of chronic wounds
Authors: Gethin Georgina T , Cowman Seamus , Conroy Ronan M
Published: May 2008

Chronic non healing wounds have an elevated alkaline environment. The acidic pH of Manuka honey makes it a potential treatment for lowering wound pH, but the duration of effect is unknown. Lowering wound pH can potentially reduce protease activity, increase fibroblast activity and increase oxygen release consequently aiding wound healing. The aim of this study was to analyse the changes in surface pH and size of non healing ulcers following application of Manuka honey dressing after 2 weeks. The study was an open label, non randomised prospective study. Patients presenting consecutively with non healing chronic superficial ulcers, determined by aetiology and no reduction in wound size in previous 3 weeks. Single pH measurements recorded using Blueline 27 glass surface electrode and R 315 pH meter set (Reagecon/Alkem, Co. Clare Ireland). Area determined using Visitrak (Smith & Nephew, Mull, UK) digital planimetry. Apinate® (Manuka honey) (Comvita, Slough, UK) applied to wounds for 2 weeks after which wounds re‐evaluated. Eight males and nine females with 20 ulcers (3 bilateral) were included: venous, 50% (n = 10); mixed aetiology, 35% (n = 7); arterial, 10% (n = 2) and pressure ulcer, 5% (n = 1). Reduction in wound pH after 2 weeks was statistically significant (P < 0·001). Wounds with pH ≥ 8·0 did not decrease in size and wounds with pH ≤ 7·6 had a 30% decrease in size. A reduction in 0·1 pH unit was associated with an 8·1% reduction in wound size (P < 0·012). The use of Manuka honey dressings was associated with a statistically significant decrease in wound pH and a reduction in wound size. Elevated pH readings at the start were associated with minimal reduction in size. Surface wound pH measurements may contribute to objective wound assessments, but further research is necessary to determine its exact contribution.
Wound healing in radiated skin: pathophysiology and treatment options
Authors: Olascoaga Andrea , Vilar‐Compte Diana , Poitevin‐Chacón Adela , Contreras‐Ruiz Jose
Published: May 2008

Ulcers in radiated skin continue to be a challenge for health care practitioners. Healing impairment in the setting of radiation‐damaged tissue will most of the time lead to chronic wounds that reduce the patient’s quality of life. In this review, we present an update of the pathophysiology of tissue damage caused by radiation that leads to chronic ulceration. We also explore the evidence available on the different prevention and treatment modalities that have been reported in the literature. The evidence for most preventive measures is inconclusive; however, sucralfate and amifostine seem to be the adequate recommendations for prophylaxis. As for treatment of ulcerated patients, the strongest level of evidence found was for the use of pentoxifylline, but proper trials are still scarce to be considered standard adjuvant therapy. Hyperbaric oxygen, cytokines and other growth factors and surgical interventions have shown some benefit in case reports and case series only. Other therapies show promise based on their mechanism of action but need to be tested in human studies and clinical trials.
Hip fracture and pressure ulcers – the Pan‐European Pressure Ulcer Study – intrinsic and extrinsic risk factors*
Authors: Lindholm Christina , Sterner Eila , Romanelli Marco , Pina Elaine , Torra y Bou Joan , Hietanen Helvi , Iivanainen Ansa , Gunningberg Lena , Hommel Ami , Klang Birgitta , Dealey Carol
Published: May 2008

Pressure ulcers (PU) in patients with hip fracture remain a problem. Incidence of between 8·8% and 55% have been reported. There are few studies focusing on the specific patient‐, surgery‐ and care‐related risk indicators in this group. The aims of the study were

to investigate prevalence and incidence of PU upon arrival and at discharge from hospital and to identify potential intrinsic and extrinsic risk factors for development of PU in patients admitted for hip fracture surgery.

to illuminate potential differences in patient logistics, surgery, PU prevalence and incidence and care between Northern and Southern Europe. Consecutive patients with hip fracture in six countries, Sweden, Finland, UK (North) and Spain, Italy and Portugal (South), were included. The patients were followed from Accident and Emergency Department and until discharge or 7 days. Prevalence, PU at discharge and incidence were investigated, and intrinsic and extrinsic risk indicators, including waiting time for surgery and duration of surgery were recorded. Of the 635 patients, 10% had PU upon arrival and 22% at discharge (26% North and 16% South). The majority of ulcers were grade 1 and none was grade 4. Cervical fractures were more common in the North and trochanteric in the South. Waiting time for surgery and duration of surgery were significantly longer in the South. Traction was more common in the South and perioperative warming in the North. Risk factors of statistical significance correlated to PU at discharge were age ≥71 (P = 0·020), dehydration (P = 0·005), moist skin (P = 0·004) and total Braden score (P = 0·050) as well as subscores for friction (P = 0·020), nutrition (P = 0·020) and sensory perception (P = 0·040). Comorbid conditions of statistical significance for development of PU were diabetes (P = 0·005) and pulmonary disease (P = 0·006). Waiting time for surgery, duration of surgery, warming or non warming perioperatively, type of anaesthesia, traction and type of fracture were not significantly correlated with development of PU.
Variability of pressure provided by sustained compression
Authors: Moffatt Christine
Published: May 2008

Compression therapy is the cornerstone of treatment for patients with venous leg ulcers (VLUs). Although it is generally accepted that the therapeutic outcomes are directly related to the quality of compression therapy, delivering precise and sustained compression therapy is an ongoing challenge for health care professionals. Several factors influence quality of compression therapy: physical structure and elastomeric properties of the compression system, size and shape of the leg, skill and technique of the bandager and physical activity undertaken by the patient. Graduated compression is achieved by applying a bandage at the same tension from ankle to knee, providing the shape of the leg is normal. Many patients with VLUs have distorted legs, challenging the delivery of a desired pressure gradient. Poor bandaging technique can result in little or no benefit or may deliver too high a pressure causing a detrimental effect to the wearer. If the wearer is unable to tolerate the compression, patient concordance and effectiveness are affected. Training has been shown to reduce variability of sub‐bandage pressure. Sub‐bandage pressure increases during standing and walking. These pressure changes are related to the elastomeric properties of the compression systems. Health care professionals need to understand the properties of the available compression systems and how their application technique must be adjusted.
Dressing‐related pain in patients with chronic wounds: an international patient perspective
Authors: Price Patricia E , Fagervik‐Morton Hilde , Mudge Elizabeth J , Beele Hilde , Ruiz Jose Contreras , Nystrøm Theis Huldt , Lindholm Christina , Maume Sylvie , Melby‐Østergaard Britta , Peter Yolanda , Romanelli Marco , Seppänen Salla , Serena Thomas E , Sibbald Gary , Soriano Jose Verdú , White Wendy , Wollina Uwe , Woo Kevin Y , Wyndham‐White Carolyn , Harding Keith G
Published: May 2008

This cross‐sectional international survey assessed patients’ perceptions of their wound pain. A total of 2018 patients (57% female) from 15 different countries with a mean age of 68·6 years (SD = 15·4) participated. The wounds were categorised into ten different types with a mean wound duration of 19·6 months (SD = 51·8). For 2018 patients, 3361 dressings/compression systems were being used, with antimicrobials being reported most frequently (n= 605). Frequency of wound‐related pain was reported as 32·2%, ‘never’ or ‘rarely’, 31·1%, ‘quite often’ and 36·6%, ‘most’ or ‘all of the time’, with venous and arterial ulcers associated with more frequent pain (P= 0·002). All patients reported that ‘the wound itself’ was the most painful location (n= 1840). When asked if they experienced dressing‐related pain, 286 (14·7%) replied ‘most of the time’ and 334 (17·2%) reported pain ‘all of the time’; venous, mixed and arterial ulcers were associated with more frequent pain at dressing change (P < 0·001). Eight hundred and twelve (40·2%) patients reported that it took <1 hour for the pain to subside after a dressing change, for 449 (22·2%) it took 1–2 hours, for 192 (9·5%) it took 3–5 hours and for 154 (7·6%) patients it took more than 5 hours. Pain intensity was measured using a visual analogue scale (VAS) (0–100) giving a mean score of 44·5 (SD = 30·5, n= 1981). Of the 1141 who reported that they generally took pain relief, 21% indicated that they did not feel it was effective. Patients were asked to rate six symptoms associated with living with a chronic wound; ‘pain’ was given the highest mean score of 3·1 (n= 1898). In terms of different types of daily activities, ‘overdoing things’ was associated with the highest mean score (mean = 2·6, n= 1916). During the stages of the dressing change procedure; ‘touching/handling the wound’ was given the highest mean score of 2·9, followed by cleansing and dressing removal (n= 1944). One thousand four hundred and eighty‐five (80·15%) patients responded that they liked to be actively involved in their dressing changes, 1141 (58·15%) responded that they were concerned about the long‐term side‐effects of medication, 790 (40·3%) of patient indicated that the pain at dressing change was the worst part of living with a wound. This study adds substantially to our knowledge of how patients experience wound pain and gives us the opportunity to explore cultural differences in more detail.
Assessment and management of persistent (chronic) and total wound pain
Authors: Woo Kevin , Sibbald Gary , Fogh Karsten , Glynn Chris , Krasner Diane , Leaper David , Österbrink Jurgen , Price Patricia , Teot Luc
Published: May 2008

Persistent (chronic) wound‐related pain is a common experience that requires appropriate assessment and treatment. It is no longer adequate for health care professionals to concentrate on the acute (temporary) pain during dressing change alone. The study provides useful recommendations and statements for assessing and managing total wound‐related pain for patients, health care professionals and other policymakers. The recommendations have been developed with the involvement of an interprofessional panel of health care professionals from around the world.
Evaluation of the impact of restructuring wound management practices in a community care provider in Niagara, Canada
Authors: Hurd Theresa , Zuiliani Nancy , Posnett John
Published: May 2008

The burden of chronic wounds is substantial, and this burden is set to increase as the population ages. The challenge for community health services is significant. Wound care is labour intensive, and demand for services is set to increase at a time when the availability of nursing resources is likely to be severely limited. In March 2005, the Niagara community health care provider implemented a radical reorganisation of wound management practices designed to ensure that available resources, particularly nurse time, were being used in the most efficient way. An evaluation of the impact of the reorganisation has shown improvements in clinical practice and better patient outcomes. The use of traditional wound care products reduced from 75% in 2005 to 20% in 2007 in line with best practice recommendations, and frequency of daily dressing changes reduced from 48% in 2005 to 15% in 2007. In a comparison of patients treated in 2005 and 2006, average time to healing was 51·5 weeks in 2005 compared with 20·9 weeks in 2006. Total treatment cost was lower in 2006 by $10 700 (75%) per patient. Overall, improvements in wound management practice led to a net saving of $3·8 million in the Niagara wound care budget.
Low Levels of Androgens in Men with Erectile Dysfunction and Obesity
Authors: Corona Giovanni , Mannucci Edoardo , Fisher Alessandra D. , Lotti Francesco , Petrone Luisa , Balercia Giancarlo , Bandini Elisa , Forti Gianni , Maggi Mario
Published: May 2008

Introduction

The relationship between obesity and erectile dysfunction (ED) has not been completely clarified.

Aim

The aim of this study is to investigate the association between different obesity class (the World Health Organization definition) with several hormonal and instrumental parameters, in a large sample of patients with ED.

Methods

A consecutive series of 2,435 (mean age 52.1 ± 13.0 years) male patients with ED was investigated.

Main Outcome Measures

Several hormonal and biochemical parameters were studied, along with a structured interview on erectile dysfunction (SIEDY), a psychometric questionnaire (Middle Hospital Questionnaire), and penile doppler ultrasound (PDU).

Results

Among patients studied, 41.5% were normal weight, while 42.4%, 12.1% and 4.0% showed a BMI of 25–29.9, 30–34.9 and 35 kg/m2 or higher, respectively. Androgen levels (including sex hormone-binding globuline bound and unbound testosterone) decreased as a function of obesity class, while luteinising hormone levels did not show any significant change. Obesity was significantly associated with a higher organic contribution to ED (as assessed by SIEDY scale 1 score), and worse PDU parameters. At multivariate linear regression analysis, after adjustment for confounders (including metabolic syndrome), low androgens remained associated with BMI, while both basal and dynamic (after prostaglandin E1 [PGE1] stimulation) peak systolic velocity (PSV) at PDU resulted significantly associated with age and elevated blood pressure (Adj. r = −0.179, −0.285 and −0.094, −0.071 for age, hypertension and for basal and dynamic PSV, respectively; all P < 0.05).

Conclusion

Obesity is characterized by low levels of androgens in men with ED, after adjustment for comorbidities. Obesity associated comorbidities, particularly hypertension, are the most important determinants of arteriogenic obesity–associated ED.