bluuebunny/crossref_metadata_2025 huggingface dataset:
Transient Global Amnesia – Full Recovery without Persistent Cognitive Impairment
Authors: Uttner I. , Weber S. , Freund W. , Schmitz B. , Ramspott M. , Huber R.
Published: July 2007

Transient global amnesia (TGA) is a clinical syndrome of unknown etiology characterized by sudden onset anterograde amnesia, which was thought to resolve completely. However, some authors have also suggested permanent memory impairment. It is unclear whether these results reflect a true persistent damage or a simply too short assessment interval in the context of a prolonged recovery phase after TGA. To evaluate the cognitive long-term outcome, 16 patients who had suffered from TGA at a mean of 3 years before and 15 healthy controls underwent a comprehensive neuropsychological test battery. No significant differences between patients’ and controls’ cognitive performance were found, irrespectively of the analyzed neuropsychological domain. Therefore we hypothesize that TGA usually does not cause persistent cognitive deficits due to a generally transient and prognostic benign character.
Pendred’s Syndrome
Authors: Pearce J.M.S.
Published: July 2007

Vaughan Pendred, whilst still a junior doctor, wrote the original account of familial sensorineural deafness associated with goitre, now known as Pendred’s syndrome. His account is reproduced verbatim.
Relationships between Bereavement and Cognitive Functioning in Older Adults
Authors: Ward L. , Mathias J.L. , Hitchings S.E.
Published: July 2007

Background: Bereavement is often associated with increased levels of depression, anxiety, and stress. The question of whether grief is associated with cognitive deficits in older adults remains largely unanswered. Although Xavier and coworkers (see text) found preliminary evidence that grief, in the absence of depression, impacted on memory in a sample of the oldest-old in Brazil, the impact of bereavement on cognitive functioning, independent of the effects of mood, has not been adequately examined. Objective: To replicate and expand on the work of Xavier and colleagues to examine whether there is an association between bereavement due to spousal loss and performance in a range of cognitive functioning domains in older adults, independent of the effects of depression, stress, and anxiety. Methods: Samples of bereaved (n = 25) and non-bereaved (n = 25) participants, who were aged between 65 and 80 years and who were matched for age, gender, education, premorbid intellectual functioning, and general cognitive ability, were compared on a battery of tests designed to assess attention, verbal fluency, memory, and visuospatial ability. Depression, anxiety, and stress were also assessed, as were the presence of complicated grief and the adequacy of social support in the bereaved group. Cognitive tests that differed between the groups and correlated with depression, stress, or anxiety were analyzed using hierarchical multiple regression. Results: The bereaved groups were more depressed, anxious, and stressed, and performed more poorly on tests assessing attention, information-processing speed, and verbal fluency. With the exception of the attentional switching task, the cognitive measures on which the groups differed were correlated with mood. When mood was controlled statistically, the group differences in these cognitive tests disappeared. Twenty-eight percent of the bereaved group met the criteria for a diagnosis of complicated grief. This subgroup was younger than the other bereaved participants and had higher levels of stress. Conclusion: The evidence suggests that grief associated with death of a spouse has limited associations with cognition beyond those that would be expected to occur as a result of depression, anxiety, and stress.
Interleukin-1α and -1β Promoter Polymorphisms in Taiwanese Patients with Dementia
Authors: Wang Hsiu-Kuan , Hsu Wen-Chuin , Fung Hon-Chung , Lin Jun-Cheng , Hsu Hai-Pei , Wu Yih-Ru , Hsu Yuying , Hu Fen-Ju , Lee-Chen Guey-Jen , Chen Chiung-Mei
Published: July 2007

Background: Inflammatory events may contribute to the pathogenesis of dementia and interleukin-1 (IL-1) may exert both neurotoxic and neuroprotective effects. We investigated whether IL-1α –889 C/T and IL-1β –511 C/T promoter polymorphisms are associated with the risk of Alzheimer’s disease (AD) and vascular dementia (VaD). Methods: AD patients (n = 219) and VaD patients (n = 82), who fulfilled the criteria of the NINCDS-ADRDA and NINDS-AIREN, and ethnic-matched and nondemented controls (n = 209) were analyzed by means of genotype association method. Results: No significant difference in the genotype distribution of the analyzed single nucleotide polymorphisms was found between AD or VaD cases and controls. However, the frequency of the IL-1α –889 CT genotype was notably lower in VaD patients aged over 70 years than the age-matched controls (9.1 vs. 22.9%, p = 0.036) andtheIL-1α –889 CT genotype demonstrated a trend toward decrease in risk of developing VaD (odds ratio: 0.34; 95% confidence interval: 0.12–0.83, p = 0.026). Multivariate analysis revealed that the IL-1β –511T-carrying genotype slightly strengthens the negative association of the IL-1α –889 CT genotype with VaD (odds ratio: 0.26; 95% confidence interval: 0.08–0.79, p = 0.024). Conclusion: Our data suggest a protective role of the IL-1α –889 CT genotype in VaD susceptibility among Taiwanese aged over 70 years.
Coordinated Expression of Ets-1, pERK1/2, and VEGF in Retina of Streptozotocin-Induced Diabetic Rats
Authors: Du Zhao-jiang , Kamei Motohiro , Suzuki Mihoko , Tano Yasuo , Wang Bai-ren , Hui Yan-nian
Published: July 2007

Purpose: To investigate the role played by E26 transformation-specific-1 (Ets-1), a transcription factor, and extracellular signal-regulated kinase 1/2 (ERK1/2) in the expression of vascular endothelial growth factor (VEGF), and the interaction of Ets-1 and ERK1/2 in the retina of diabetic rats. Methods: Diabetes was induced in rats by an intraperitoneal injection of streptozotocin (STZ). To follow the time course in the expression of Ets-1, phosphorylated ERK1/2 (pERK1/2), and VEGF, rats were killed at 1, 2, 4, and 8 weeks after the injection of STZ, and total proteins were extracted from the isolated retinas. An adenovirus vector encoding dominant-negative Ets-1 and an inhibitor of PD98059 was injected intravitreally to investigate the effects of Ets-1 blockade and ERK1/2 inhibition on the expression of VEGF. Four weeks after the first intravitreal injection, total proteins and total RNA were extracted from the retinas for Western blot and Northern blot analyses. Results: The expression of Ets-1, pERK1/2, and VEGF in the retina increased in a time-dependent manner after STZ injection. The phosphorylation of ERK1/2 and protein level of VEGF were significantly reduced following intravitreal Ets-1. Inhibition of ERK1/2 phosphorylation resulted in a significant reduction in the expression of Ets-1 and the level of VEGF protein. Conclusions: These results indicate that in the retina of STZ-induced diabetic rats: (1) the alterations of Ets-1, pERK1/2, and VEGF are approximately synchronized; (2) the phosphorylation of ERK1/2 is regulated by the expression of Ets-1; (3) the production of Ets-1 protein is dependent on the ERK1/2 pathway, and (4) the protein level of VEGF is regulated by both Ets-1 expression and ERK1/2 phosphorylation. We propose that VEGF, Ets-1, and ERK1/2 act synergistically in the development of diabetic retinopathy.
Risk Stratification for Renal Transplantation after Cardiac or Lung Transplantation: Single-Center Experience and Review of the Literature
Authors: Rosenberger Christian , Stein Julia , Jürgensen Jan Steffen , Eibl Nermin , Babel Nina , Bachmann Ulrike , Kemper Dagmar , Knosalla Christoph , Hetzer Roland , Frei Ulrich , Lehmkuhl Hans , Reinke Petra
Published: July 2007

Background: Long-term survival after heart (HTx) or lung (LuTx) transplantation increases the risk for end-stage renal disease (ESRD). After HTx ESRD was reported to enhance mortality, and kidney transplantation (KTx) was shown to improve survival. However, prognostic factors in ESRD after HTx or LuTx are largely unknown. Methods: Single-center observational study in HTx and LuTx patients who accessed the KTx waiting list; baseline characteristics were correlated with mortality. Results: KTx was performed in 15 of 65 study patients. Survival was comparable on the KTx waiting list and in reference patients from the same center without ESRD. KTx significantly improved survival (5 years’ survival 84.6% with KTx vs. 56.5% on the KTx waiting list, p = 0.030). None of the baseline parameters predicted mortality in the KTx group. Only on the KTx waiting list BMI (median 24.7 vs. 20.7; p < 0.05) and left ventricular ejection fraction (LVEF, median 63 vs. 53%, p < 0.008) significantly correlated with survival. Conclusions: The risk for mortality after HTx or LuTx is not increased by ESRD, provided that patients meet access criteria for the KTx waiting list. KTx improves survival in ESRD after HTx or LuTx. BMI and LVEF may predict outcome in HTx/LuTx patients on the KTx waiting list.
The Endothelial Glycocalyx Prefers Albumin for Evoking Shear Stress-Induced, Nitric Oxide-Mediated Coronary Dilatation
Authors: Jacob Matthias , Rehm Markus , Loetsch Michael , Paul Joern O. , Bruegger Dirk , Welsch Ulrich , Conzen Peter , Becker Bernhard F.
Published: July 2007

Background: Shear stress induces coronary dilatation via production of nitric oxide (NO). This should involve the endothelial glycocalyx (EG). A greater effect was expected of albumin versus hydroxyethyl starch (HES) perfusion, because albumin seals coronary leaks more effectively than HES in an EG-dependent way. Methods: Isolated hearts (guinea pigs) were perfused at constant pressure with Krebs-Henseleit buffer augmented with 1/3 volume 5% human albumin or 6% HES (200/0.5 or 450/0.7). Coronary flow was also determined after EG digestion (heparinase) and with nitro-L-arginine (NO-L-Ag). Results: Coronary flow (9.50 ± 1.09, 5.10 ± 0.49, 4.87 ± 1.19 and 4.15 ± 0.09 ml/min/g for ‘albumin’, ‘HES 200’, ‘HES 450’ and ‘control’, respectively, n = 5–6) did not correlate with perfusate viscosity (0.83, 1.02, 1.24 and 0.77 cP, respectively). NO-L-Ag and heparinase diminished dilatation by albumin, but not additively. Alone NO-L-Ag suppressed coronary flow during infusion of HES 450. Electron microscopy revealed a coronary EG of 300 nm, reduced to 20 nm after heparinase. Cultured endothelial cells possessed an EG of 20 nm to begin with. Conclusions: Albumin induces greater endothelial shear stress than HES, despite lower viscosity, provided the EG contains negative groups. HES 450 causes some NO-mediated dilatation via even a rudimentary EG. Cultured endothelial cells express only a rudimentary glycocalyx, limiting their usefulness as a model system.
Effect of Halofuginone, a Collagen α1(I) Inhibitor, on Wound Healing in Normal and Irradiated Skin: Implication for Hematopoietic Stem Cell Transplantation
Authors: Nagler Arnon , Ohana Meir , Leiba Merav , Levdansky Lilia , Gorodetsky Raphael
Published: July 2007

It is a major interest in the field of hematopoietic stem cell transplantation to reduce scarring of healing wounds with overdeposition of collagen due to radiation injury or graft-versus-host disease. Halofuginone (HF) inhibits collagen α1(I) gene expression and overdeposition of collagen. We examined the effect of HF on the healing of full-depth incision wounds inflicted in normal skin or skin areas compromised by local preirradiation with 18 Gy. Preirradiation significantly decreased the tensile strength of the healing wounds at day 14 (by ∼60%, p < 0.0001). In contrast, HF treatment did not significantly decrease the strength of wounds inflicted in both normal and preirradiated skin. Histological evaluation revealed that HF induced moderate thinning of the dermis accompanied by elevated thickness of the epidermis and enhanced rejoining of subdermal muscles in the wound area. HF only minimally reduced total collagen deposition in both groups, with minor changes in the level of more matured fibrillar collagen network. Our study demonstrates that HF does not significantly affect wound strength. This encourages the possible use of HF as an antifibrotic agent with minimal complications for post-hematopoietic stem cell transplantation complications including radiation toxicity and graft-versus-host disease.
Cerebrospinal Fluid Biomarkers Predict Decline in Subjective Cognitive Function over 3 Years in Healthy Elderly
Authors: Stomrud Erik , Hansson Oskar , Blennow Kaj , Minthon Lennart , Londos Elisabet
Published: July 2007

Objective: To investigate whether cerebrospinal fluid (CSF) biomarkers can predict cognitive decline in healthy, elderly individuals as they have been shown to do in cognitively impaired patient samples. Methods: In this study, 57 controls were tested for CSF biomarkers at baseline and then cognitively followed over 3 years. Results: Low levels of baseline β-amyloid 1–42 (Aβ42) were associated with development of subjective memory impairment affecting quality of life (memQoL), with a worse Mini Mental Status Examination score and with inability to live in regular housing at follow-up (p < 0.05). The combination of baseline Aβ42 and phosphorylated tau (P-tau) was found to predict development of pathological memQoL with a sensitivity of 71.4% and a specificity of 75.7 (<0.01). Conclusion: Low Aβ42 and combined Aβ42 and P-tau predicted subjective cognitive decline in healthy individuals. In summary, this study shows that already in the clinically normal population Alzheimer-disease-related biological signs might be detectable.
The Role of Higher-Level Cognitive Function in Gait: Executive Dysfunction Contributes to Fall Risk in Alzheimer’s Disease
Authors: Sheridan Pamela L. , Hausdorff Jeffrey M.
Published: July 2007

Alzheimer’s disease (AD) is generally understood as primarily affecting cognition while sparing motor function, at least until the later stages of the disease. Studies reported over the past 10 years, however, have documented a prevalence of falls in AD patients significantly higher than in age-matched normal elders; also persons with AD have been observed to have different walking patterns with characteristics that increase gait instability. Recent work in cognitive neuroscience has begun to demonstrate the necessity of intact cognition, particularly executive function, for competent motor control. We put the pieces of this puzzle together and review the current state of knowledge about gait and cognition in general along with an exploration of the association between dementia, gait impairment and falls in AD. We also briefly examine the current treatment of gait instability in AD, mainly exercise, and propose a new approach targeting cognition.
Basic Facts about Biosimilars
Authors: Nowicki Michał
Published: July 2007

Biotechnological drugs have become an essential part of modern pharmacotherapy and are expected to reach a 50% share in the pharmaceutical market in the next few years. The expiry of patent protection for many original biotechnological medicines has led to the development of what are called biosimilars or follow-on biologics. Biosimilars attempt to copy the original technology leading to the production of innovative biotechnological medicines to obtain a product which is similar to the original one. The first two biosimilars have recently been approved in the European Union and one application was rejected. Many more biosimilars will likely see approval in the near future. Our experience with biosimilars has been very limited to date and long-term safety data including immunogenicity are not available. Although biosimilars will likely lower the cost of modern therapies there are issues which have to be discussed at this stage among physicians regarding in particular the differences between biosimilars and generics of the classical chemical drugs, need for appropriate regulations as well as identification of potential problems with biosimilars. Other specific problems which will also be addressed in this review are safety of biosimilars, pharmacovigilance, automatic substitution, naming and labeling/prescription rules.
Study on the Association between SOAT1 Polymorphisms, Alzheimer’s Disease Risk and the Level of CSF Biomarkers
Authors: Lämsä R. , Helisalmi S. , Herukka S.-K. , Tapiola T. , Pirttilä T. , Vepsäläinen S. , Hiltunen M. , Soininen H.
Published: July 2007

Background: In Alzheimer’s disease (AD) the beta-amyloid precursor protein is excessively cleaved into Aβ42, causing the abundant amyloid plaque loads in affected brain areas. Sterol O-acyltransferase 1 (SOAT1) has been found to regulate the production of beta-amyloid precursor protein. Methods: Wegenotyped 4 SOAT1 single nucleotide polymorphism (SNP) sites (rs2247071, rs2862616, rs3753526 and rs1044925) in 410 Finnish AD cases and 455 controls and conducted a single allele and genotypic distribution comparison as well as estimating the haplotype frequencies between cases and controls and the level of biomarkers in genotype and haplotype carriers. Results: The CC genotype of rs2247071 was overrepresented in the AD cases (OR = 1.38, 95% CI = 1.01–1.89, p = 0.043, Bonferroni corrected p = 0.172 with 4 tests) independent of gender, age and APOE Ε4 allele carrier status. We did not find any significant differences between Aβ42, tau or ptau levels in different allele, genotype or haplotype carrier cases. Conclusion: Our findings suggest that SOAT1 gene may possibly be only a minor risk factor in AD.
Influenza and Pneumococcal Vaccine Coverages in Geriatric Health Care Settings in France
Authors: Gavazzi Gaëtan , Wazieres Benoit , Lejeune Benoist , Rothan-Tondeur Monique
Published: July 2007

Background: Annual immunization with influenza vaccine is effective in preventing influenza-associated mortality and morbidity in the elderly. Pneumococcal vaccination is also considered as an effective strategy to decrease pneumococcal-associated diseases and mortality, particularly in the geriatric health care setting. However, in France, influenza and pneumococcal vaccination coverage in senior citizens living in long-term care facilities has not been comprehensively evaluated. Objectives: A prospective multicenter study was conducted to measure influenza and pneumococcal vaccine coverage and to assess the existence of local recommendations and the reasons for reluctance to immunize patients in geriatric health care settings in France. Two questionnaires were developed: the initial questionnaire to record the demographic characteristics of patients in health care facilities and to note influenza and pneumococcal vaccine coverage, and a second questionnaire, sent to all responders in June 2003, to record the number and causes of death (December 2002 to April 2003). Questions about the reasons for non-vaccination were added to all settings which had pneumococcal or influenza vaccination coverages below the median levels in the first query. Results: 105 health care facilities measuring vaccine coverage in 7,882 elderly patients participated in the study. Of 105 units, 9 were acute care units (n = 203 patients), 22 rehabilitation care units (n = 923), 68 long-term care facilities (n = 6,458), and 6 nursing homes (n = 315). The median and mean age of patients was 83 (SD 3.5) years. Influenza and pneumococcal vaccine rates were 87.7% (median 90%, range 0–100%) and 21.9% (median 2.8%, range 0–100%), respectively. There were significant differences between the type of setting and wide variability. There was no correlation between vaccine coverage and local recommendations. Mortality was 15.2% and was negatively correlated with influenza vaccine. The reasons for non-vaccination evaluated in 20 units differed for influenza and pneumococcal vaccine. Conclusion: Influenza vaccine coverage is high in long-term care settings but not in other settings. Pneumococcal vaccine coverage is very low in most settings, in part because of the lack of positive recommendations in France. Annual vaccination records are needed and should be a goal for the National Health Care Department. In addition, reasons for failure to administer both vaccines should be precisely evaluated on large populations to improve vaccination coverage.
Genetic Disruption of Dopamine Production Results in Pituitary Adenomas and Severe Prolactinemia
Authors: Hnasko Thomas S. , Hnasko Robert M. , Sotak Bethany N. , Kapur Raj P. , Palmiter Richard D.
Published: July 2007

Background: Dopamine release from tuberoinfundibular dopamine neurons into the median eminence activates dopamine-D2 receptors in the pituitary gland where it inhibits lactotroph function. Methods: We have previously described genetic dopamine-deficient mouse models which lack the ability to synthesize dopamine. Because these animals require daily treatment with 3,4-L-dihydroxyphenylalanine (L-dopa) to survive, it has not been possible to examine the consequences of chronic loss of dopamine on pituitary physiology. We use viral-mediated gene transfer to selectively restore dopamine to the dorsal striatum of dopamine-deficient mice which allows the mice to survive without L-dopa. Results: We find that mice chronically lacking tuberoinfundibular dopamine secrete large amounts of prolactin due to the development of severely enlarged pituitaries composed principally of hyperplastic hypertrophic lactotrophs and multifocal prolactinomas. In addition, these mice have elevated serum growth hormone levels and aged males develop hypertrophy of the seminal vesicles. Conclusion: Our observations are consistent with the hypothesis that hypothalamic dopamine is a critical inhibitor of lactotroph proliferation and suggest additional roles for dopamine in the regulation of pituitary function.
Psychotherapeutic Problems in Connection with Insulin and Electroshock Therapy and Psychosurgery
Authors: Kalinowsky Lothar B.
Published: July 2007

The various somatic treatments offer entirely different problems in connection with psychotherapy. The purpose of this paper is to discuss the relationship between physician and patient during the application of somatic treatments, how far this relationship influences the outcome of these treatments and what the limitations of psychotherapy are in patients who undergo insulin coma treatment electroshock therapy or who have been subjected to psychosurgery.
Errors in Survival Rates Caused by Routinely Used Deterministic Record Linkage Methods
Authors: Oberaigner W.
Published: July 2007

Objective:
It was the objective of this study to assess the impact of applying various record linkage methods to one of the most important outcome measures in oncological epidemiology, namely survival rates.

Methods:
To assess the life status of patients, incidence data published by the Cancer Registry of Tyrol were analyzed with three routinely used methods of record linkage for incidence and mortality data. Of these methods, two were deterministic and the third a probabilistic method developed by the Cancer Registry of Tyrol. We studied the impact of record linkage methods on a simple measure (mortality rate) and a more complex measure (relative survival rate). The analysis was based on the published incidence data for Tyrol for the years 1992 to 1996. Results of deterministic record linkage methodswere simulated.

Results:
The error rates for simple mortality rate and relative survival rate are considerable. For the first deterministic record linkage method, relative differences in mortality rate range from 11.9% to 14.8% (men) and 24.5% to 28.2% (women) and relative differences in relative five-year survival from 11.4% to 16.3% (men) and from 19.3% to 26.4% (women). For the second deterministic record linkage method, relative differences in mortality rate range from 4.8% to 5.9% (men) and from 4.9% to 7.4% (women), while relative differences in relative five-year survival range from 5.1% to 7.0% (men) and from 4.4% to 6.1% (women).

Conclusions:
Our study shows that in order to calculate valid mortality and survival rates a probabilistic method of record linkage must be applied.
Discovery of Factors Influencing the Growth of Geographic Atrophy in Patients with Age-related Macular Degeneration
Authors: Dolar-Szczasny J. , Bindewald A. , Holz F. G. , Mansmann U. , Dreyhaupt J.
Published: July 2007

Objectives:
Identifying factors influencing the growth of geographic atrophy (GA) in patients with age-related macular degeneration (AMD).

Methods:
Data on the natural course and suspected modifying factors were collected as part of the multicenter, longitudinal, observational FAM-study in 178 eyes of 114 patients with atrophic AMD. The endpoint of interest – the size of GA – was measured in fundus autofluorescence images. The influence of different putative riskfactors on progression of GA is investigated with a forward selection procedure based on the likelihood ratio test. In orderto interpret non-significant results of the forward selection procedure, the power of the tests usedwas quantified bya parametric post-hoc bootstrap approach.

Results:
A mean increase in GA of 175 mm2 per year was estimated for the given population (95% CI: [1.46; 2.02]). Patient and eye-specific random effects could be assessed. Neither patient-specific riskfactors nor ocular-specific risk factors show any significant influence on GA growth. The post-hoc bootstrap procedure shows that only very strong effects can be detected on the basis of the given data. For example, the hypercholesteremia which would result in an additional increase of GA by near 4mm2 per year can be detected with a power of 80%.

Conclusions:
The use of linear mixed effects regression models offers a convenient way to explore sources of variation in the natural course of GA. Data from further follow-up examinations and data about other putative riskfactors than those investigated will be needed to further investigate of the GA growth process. The procedure described in this article is easily applicable to other putative risk factors as well as to other fields of application.
The Effect of Interactive Multimedia on Preoperative Knowledge and Postoperative Recovery of Patients Undergoing Laparoscopic Cholecystectomy
Authors: Birbas K. , Katostaras T. , Mantas J. , Stergiopoulou A.
Published: July 2007

Objectives:
Aim of this study is the evaluation of the impact of a multimedia CD (MCD) on preoperative anxiety and postoperative recovery of patients undergoing elective laparoscopic cholecystectomy (LC).

Methods:
Sixty consecutive candidates for elective LC were randomly assigned to four groups. Group A included 15 patients preoperatively informed regarding LC through the MCD presented by Registered Nurse (RN). Patients in group B(n = 15) were informed through a leaflet. Patients in group C(n = 15) were informed verbally from a RN. Finally, the control Group D included 15 patients informed conventionally bythe attending surgeon and anesthesiologist, as every other patient included in groups A, B, and C. Preoperative assessment of knowledge about LC was performed after each informative session through a questionnaire. Evaluation of preoperative anxiety was conducted using APAIS scale. Postoperative pain and nausea scores were measured using an NRS scale, 16 hours after the patient had returned to the ward.

Results:
Statistical processing of the results (single linear regression) showed that patients in groups A, B, and C achieved a higher knowledge score, less preoperative anxiety score and less postoperative pain and nausea, compared to Group D. In multiple regression analysis, group A had a higher knowledge score compared to the four groups (p < 0.001 r2 = 0.41).

Conclusion:
Informative sessions using MCD is an effective means of improving patient’s preoperative knowledge, especially in day-surgery cases, like LC.
Survey on the Status of the Hospital Information Systems in Portugal
Authors: Lapão L. Velez
Published: July 2007

Objectives:
To diagnose the hospital information systems’ situation in Portugal.

Methods:
Developing a survey on HIS department heads.

Results:
Several weaknesses were identified in most HIS departments, such as substantial lackof people and of qualifications to deal with HIS challenges. The Nolan and McFarlan Matrix helped assess the SNS IS maturity at stage 3, characterized by the generalized lackof IS integration.

Conclusions:
The results are very relevant to explain the many delays (and conflicts) in implementing HIS and therefore the actual status of HIS in Portugal. The most successful cases of HIS implementation were recognized as related to the existence of an active CIO. Complexity theory can further define guidelines for the development of HIS that help keep the navigation towards “smart healthcare”.
Stigma and Explanatory Models Among People With Schizophrenia and Their Relatives in Vellore, South India
Authors: Charles Helen , Manoranjitham S.D. , Jacob K.S.
Published: July 2007

Background: Stigma associated with mental illness affects patients and their families. Diverse beliefs about the cause and treatment of schizophrenia are common among patients and their relatives.

Aim: To study the association between stigma and beliefs about illness in patients and their relatives.

Method: Standard instruments were used to assess beliefs about illness and about stigma among patients with schizophrenia and relatives in Vellore, south India.

Results: The majority of the patients and their relatives simultaneously held multiple and contradictory models of illness and its treatment. Stigma among patients with schizophrenia and their relatives is associated with specific beliefs about causes of mental illness.

Conclusions: Beliefs may play a role in mitigating or may aggravate the effects of stigma. The cross-sectional study design precludes definitive conclusions on direction of the causal association.
Social Network Among People With Persistent Mental Illness: Associations With Sociodemographic, Clinical and Health-Related Factors
Authors: Eklund Mona , Hansson Lars
Published: July 2007

Background: Social interaction is crucial for whether a person will successfully accomplish important life tasks.

Aim and method: This study investigated the importance of sociodemographic, clinical and self-perceived health-related factors for social interaction among 103 individuals with persistent mental illness, mainly psychoses, visiting an outpatient unit.

Results: Bivariate analyses pointed to several relationships, especially between the health-related variables and both quantitative and qualitative aspects of the social network. In multivariate analyses, higher levels of quality of life, self-esteem, being a cohabitant, and living in a house were related to higher ratings on different aspects of the social network. Older age was associated with fewer close relationships but more adequate social integration.

Conclusions: The social network appeared to be a function of both self-perceptions and sociodemographic influences. The influence is probably dynamic and, for example, just as a better quality of life may lead to more social interaction, a more developed social network probably promotes better quality of life. Therefore, interventions in mental health care that target social interaction constitute a powerful resource and should be part of the support for people with severe and persistent mental illness.
Attachment Representations in a Sample of Neglected Preschool-Age Children
Authors: Venet Michèle , Bureau Jean-François , Gosselin Catherine , Capuano France
Published: July 2007

A number of studies (see Éthier, 1999) have shown that neglect has a deleterious impact on children's development. However, the effect of neglect on a child's internal representations of their family still needs to be investigated. The aim of this study was to examine the attachment patterns observed in a subsample of neglected children as compared with a control group, using a representational assessment method. The overall sample consisted of 74 preschool-age children, with a clinical group comprised of 39 children referred to social services because of neglect and a control group including 35 children recruited in ordinary kindergartens. Children's attachment representations were assessed with the Doll Play Narrative Classification System (George and Solomon, 1990, 1996, 2000) as well as the complementary Disorganization Scales (George and Solomon, 1998). Mothers' reports consisted of: (1) an in-house socio-demographical questionnaire and (2) the shorter French version of the Parental Stress Index (Bigras et al., 1996). Results showed: (1) a significant difference in attachment representation classifications between the neglected group and the control group even when socio-economic status and maternal stress were controlled for and (2) a significantly higher proportion of avoidant attachment classification in the neglected group. Moreover, neglected avoidant children displayed more overall disorganized markers, and specifically more frightening markers, than normative avoidant children; they also depicted their mother as being less available than normative children. These results are discussed in the light of other findings as well as on theoretical grounds.
Defensive Dysregulation in Preschool Children's Attachment Story Narratives and its Relation to Attachment Classification and Externalizing Behaviour
Authors: Stacks Ann M.
Published: July 2007

This study examines the relationship between disorganized attachment representations, defensive dysregulation in preschool children's doll play story narratives and child externalizing behaviour. Preschool children ( n = 53) participated in the George and Solomon (1990, 1996, 2000) Six-Year Attachment Doll Play Procedure and their mothers completed a measure on child behaviour. Disorganized children's stories contained the most dysregulated content and their behaviour during the doll play interview was the most dysregulated. Ambivalent children exhibited the highest level of externalizing behaviour and dysregulated story content was only associated with externalizing behaviour for children classified as ambivalent. Implications for interventions and teacher—student relationships are discussed.
Attachment Representation of Institutionalized Children in Japan
Authors: Katsurada Emiko
Published: July 2007

This exploratory study represents one of the first attachment investigations of Japanese children who have been institutionalized. Mental representation of attachment was assessed using George and Solomon's (1990, 1996, 2000) Attachment Doll Play Classification System of the Bretherton et al. (1990) doll play story stems. Participants were 32 Japanese children aged 4—6 years old. Sixteen children lived in institutions, while the remaining 16 lived with their biological parents. No secure attachment was found in the institutionalized children, and disorganized attachment was more prevalent in the institutionalized children versus the comparison group. In addition, the type of disorganization was primarily constricted rather than chaotic. Implications for future research are discussed.
The Institutional Entrepreneur as Modern Prince: The Strategic Face of Power in Contested Fields
Authors: Levy David , Scully Maureen
Published: July 2007

This paper develops a theoretical framework that situates institutional entrepreneurship by drawing from Gramsci's concept of hegemony to understand the contingent stabilization of organizational fields, and by employing his discussion of the Modern Prince as the collective agent who organizes and strategizes counter-hegemonic challenges. Our framework makes three contributions. First, we characterize the interlaced material, discursive, and organizational dimensions of field structure. Second, we argue that strategy must be examined more rigorously as the mode of action by which institutional entrepreneurs engage with field structures. Third, we argue that institutional entrepreneurship, in challenging the position of incumbent actors and stable fields, reveals a `strategic face of power', particularly useful for understanding the political nature of contestation in issue-based fields.
Institutional Entrepreneurship in Building an Environmental Protection System for the People's Republic of China
Authors: Child John , Lu Yuan , Tsai Terence
Published: July 2007

This paper examines institutional entrepreneurship in the development of China's environmental protection system (EPS) over a period of almost 30 years. China's EPS evolved in four main stages, the boundaries of which were marked by transition-critical events. Within each stage, institutional entrepreneurs conducted activities that supported trajectories of field development. These activities are analysed according to the way they contributed to the construction of regulative, normative and cognitive institutional system pillars. The formation of the EPS as an organizational field in China was characterized by a `made order' in which the regulative system came first and the state and its agencies dominated the process as the principal institutional entrepreneurs. In this respect it contrasts with the evolution of the same field in the USA.
Stories and the Discursive Dynamics of Institutional Entrepreneurship: The Case of Israeli High-tech after the Bubble
Authors: Zilber Tammar B.
Published: July 2007

Based on an in-depth analysis of a field-wide high-tech conference held in Israel after the dot-com crash of 2000, I examine the role and usage of stories in the discursive dynamics of institutional entrepreneurship. Actors who represented different groups in the field were engaged in constructing a shared story of the crisis that reflected and further strengthened the established institutional order. Concurrently, the same actors were also each telling a counter-story of indictment, blaming other groups for the crisis and calling for changes in the institutional order. Institutional entrepreneurship, then, centered on efforts of sense-making through the narration of stories. The three accounts of the high-tech 2000 fall reflected simultaneous efforts of both collaboration in maintaining the institutional order and contestation that could potentially disrupt it. The delicate balance between these contradictory orientations was carried out by the skillful manipulation of explicit and implicit meanings, which was made possible by the use of stories as the medium of, and resource for, institutional entrepreneurship.
Overcoming Inaction through Collective Institutional Entrepreneurship: Insights from Regime Theory
Authors: Wijen Frank , Ansari Shahzad
Published: July 2007

Studies on institutional change generally pertain to the agency-structure paradox or the ability of institutional entrepreneurs to spearhead change despite constraints. In many complex fields, however, change also needs cooperation from numerous dispersed actors with divergent interests. This presents the additional paradox of ensuring that these actors engage in collective action when individual interests favor lack of cooperation. We draw on complementary insights from institutional and regime theories to identify drivers of collective institutional entrepreneurship and develop an analytical framework. This is applied to the field of global climate policy to illustrate how collective inaction was overcome to realize a global regulatory institution, the Kyoto Protocol.
Reflexivity and the Institutional Entrepreneur: A Historical Exploration
Authors: Mutch Alistair
Published: July 2007

This article sets the idea of the `institutional entrepreneur' in the context of the `autonomous reflexive' as developed in the work of Margaret Archer. It argues that the latter notion provides a helpful approach to the issue of agency that has bedevilled the new institutionalist project. A detailed account, using the lens supplied by the notion of the autonomous reflexive, is given of the formation of Sir Andrew Barclay Walker, a pioneer of directly managed public houses. The article suggests that Walker used taken-for-granted practice, transferred from elsewhere, to develop his managerial systems. The importance of aspects of Walker's Scottish background, such as education and church governance, is stressed. The account of agency supplied by Archer is seen to be a conception of agency that can inform the debate over the nature of institutional entrepreneurship.
Playing games/playing us
Authors: Plant Bob
Published: July 2007

The impact of Foucault's work can still be felt across a range of academic disciplines. It is nevertheless important to remember that, for him, theoretical activity was intimately related to the concrete practices of self-transformation; as he acknowledged: `I write in order to change myself.'1 This avowal is especially pertinent when considering Foucault's work on the relationship between sex and power. For Foucault not only theorized about this topic; he was also actively involved in the S&M subculture of the 1970s. Although his explicit discussions of S&M are somewhat piecemeal, in this article I will show how they provide a useful point of access into his broader conception of power relations. Having first reconstructed Foucault's quasi-Sartrean account of creative self-transformation — specifically through one's sexuality — I will then explain why his defence of S&M (as embodying `strategic' power) is insufficiently sensitive to the inherent ambiguities of this `game'.
Thoracotomy in adults while on ECMO is associated with uncontrollable bleeding
Authors: Marasco Silvana F , Preovolos Arthur , Lim Kiat , Salamonsen Robert F
Published: July 2007

This report details the outcomes of four patients supported by extracorporeal membrane oxygenation (ECMO) who required thoracotomy. All four patients sustained massive bleeding as a result of the operative intervention, which was not controllable in three of the patients who subsequently died. This experience has led us to review the literature of anticoagulation management of patients on ECMO so we can alter our own protocols and allow safer operative intervention in the future. Perfusion (2007) 22, 23-26.
Reduction in blood product usage associated with routine use of mini bypass systems in extracorporeal circulation
Authors: Perthel M. , Klingbeil A. , El-Ayoubi L. , Gerick M. , Laas J.
Published: July 2007

Objective: The objective of this study is to investigate the hypothesis that a reduced prime extracorporeal circulation (ECC) system and ensuing reduction in patient hemodilution can affect blood product use. Methods: We performed a prospective, randomized study from a group of 60 consecutive coronary artery bypass graft (CABG) patients, comparing blood product usage and postoperative bleeding in 30 mini bypass systems (n = 30) to 30 conventional systems (n = 30). The patient demographics in terms of patient weight, height, age, preoperative hemoglobin, preoperative hematocrit, BSA, ejection fraction, and NYHA were not statistically significant. Results: Blood product use, including fresh frozen plasma (FFP) and homolgous blood transfusions was tracked through the operating theater and into the intensive care unit. In the mini bypass group, while no homologous blood transfusions were given in the OR, 27% of the patients received at least one unit of homolgous blood. In the control group, 43% of the patients received at least one unit of blood in the OR or in the ICU and there was a stastistically-significant 38% reduction in homologous blood product use (p = 0.05). For the patients who received homologous blood, there was also a significant reduction in transfused volume (0.53±0.90 units blood mini bypass vs 1.3±1.93 units conventional, p <0.05). In terms of FFP, there was also a stastistically significant difference between the two groups (0 units transfused in mini bypass group vs 3 patients receiving one unit FFP in the control group, p<0.001). Cumulative postoperative bleeding during the ICU stay was also evaluated, yielding a significant reduction (365±495 ml mini bypass vs 825± 975 ml conventional, p <0.05). Conclusion: Mini bypass reduces on-pump hemodilution and, therefore, donor blood usage in routine CABG patients as compared to conventional ECC circuits and can reduce postoperative bleeding as compared to a traditional system. The mini bypass system is safe in routine clinical use and can manage easily the same number of anastomoses as a traditional system and should be considered a favorable alternative to conventional ECC in all revascularization cases. Perfusion (2007) 22, 9-14.
A Critical Misunderstanding
Authors: Zaidi Ali Hassan
Published: July 2007

This article argues that western academia has largely eschewed dialogical understanding in favour of Marxist-inspired accounts and poststructuralist theorizing of the Muslim world. The over-abundance of the critique of ideology, other forms of `ideological demystification' and anti-essentialist theorizing have resulted in the failure of the human sciences to adequately understand the emergence of contemporary Islamic and Islamist fervour and its relationship to modernity. In contrast to much, but not all, of the literature on Islam and modernity, the article develops a reconstructed dialogical theory, which draws upon both Gadamerian hermeneutics and interreligious dialogue, as a means to take more seriously the truth-claims of the Islamic Other. By drawing upon notions of `suspicion' and `silence' from interreligious dialogue, a reconstructed dialogical model can overcome the absence of critique, a charge often levelled against hermeneutic dialogue, without resorting to the Enlightenment mode of critique. Although a reconstructed dialogical framework is not without its own problems, for instance how to overcome the gap between a foundationalist Islamic worldview and an increasingly post-foundationalist secular one, it provides a better prospect for understanding the Other.
Social Factors, Transaction Costs and Industrial Organization
Authors: Yang Tzu-Han
Published: July 2007

This article demonstrates how social factors affect industrial organization by a comparative case study of South Korea and Taiwan. By applying the social networks analysis to the transaction costs measurement, the author argues that the mutual reinforcement between social network and business network has nourished the development of the industrial organizational structure of the two economies. The characteristics of social networks, on the one hand, determine the costs of information and communication, and, on the other hand, control the costs and benefits of force and fraud. Thus the transaction costs vary in different societies. Since trust and reputation can provide valuable services for each transaction, the behaviour of firms is regulated not only by law and morals, but more effectively by the economic incentives derived from social networks.