bluuebunny/crossref_metadata_2025 huggingface dataset:
PATIENT'S SEXUAL HEALTH: DO WE CARE ENOUGH?
Authors: Ho T.M. , Fernández M.
Published: July 2012

It is well documented that sexual problems often accompany chronic health conditions, for example: chronic renal failure, hypertension and diabetes mellitus. One of the responsibilities of a nurse is to provide patients with information concerning their health and treatment to achieve optimum outcomes, thus enhancing patients' quality of life. However, the authors observed that the nursing clinical pathways in their practice seldom reflect the attention given to patient's sexuality.

This paper aims to confirm the hypothesis that health professionals do not give sufficient care to patient's sexual health and to define the causes.

A descriptive study consisted of close‐ended questionnaire was employed. The medical and nursing staff of a Nephrology Department were included in the study (92.6% response rate). Professionals' opinions on the importance of patient's sexual health, difficulty in addressing this issue and attitude were explored.

Staff's opinion on the importance of patient's sexual health is moderately high. However, 86% admit that they do not give sufficient attention and 92% never initiate to address sexual issues to patients. The results reveal the impediment being in relation to awkwardness and deficient sex education in dealing with this subject. Some staff have expressed other deterring factors.

This study confirms that professionals do not render sufficient care to patient's sexual health due to their conservative attitude and lack of skill in addressing sexuality. The authors therefore suggest some ways in helping to bridge this gap.
MULTIDISCIPLINARY APPROACH FOR PRESCRIPTIVE MANAGEMENT OF MINERAL AND BONE METABOLISM IN CHRONIC KIDNEY DISEASE: DEVELOPMENT OF A DIETETIC LED PROTOCOL
Authors: Casey J. , Li Chui Han , Johnson V. , Sluman C. , McClelland P.
Published: July 2012

Background — A number of mineral metabolism abnormalities occur as kidney function declines, these include hyperphosphatemia, hyperparathyroidism and altered vitamin D metabolism. These derangements are associated with increased morbidity and mortality amongst the chronic kidney disease patient group. Treatment requires a multidisciplinary team approach in which the dietitian plays a pivotal role.

Objectives — The development of protocols to aid implementation of various international, national and local treatment strategies is described. Audit the protocol to evaluate their clinical effectiveness.

Results — A prescriptive Protocol for the management of mineral and bone metabolism abnormalities in chronic kidney disease was developed and implemented. Initial audit findings suggest the protocol has had a positive effect on the control of phosphate, corrected calcium and parathyroid (PTH) levels.

Conclusion — The development and implementation of a dietetic‐led prescriptive therapy protocol allows dietitians and clinicians to adopt an integrated approach for the diagnosis and timely management of these complicated conditions.
DIETARY STRATEGIES TO HALT THE PROGRESSION OF CHRONIC KIDNEY DISEASE
Authors: Clements L. , Ashurst I.
Published: July 2012

Chronic kidney disease is fast becoming a worldwide epidemic. There is an estimated annual increase of 8% with an associated economical and clinical burden. Recent research into lifestyle factors has confirmed different dietary attributes play a part in slowing the progression of chronic nephropathies. This has important implications and a potentially cost‐saving way, to help reduce the progression of the disease. The roles of obesity, lipids, protein, diabetes and blood pressure are discussed to show how the current literature reflects how to modify the dietary aspects of these. The mechanisms behind these are not fully understood, but the message remains the same that there is an increased need for dietary advice in the pre‐dialysis population.
RE‐TRAINING AND SWITCHING OF PD SYSTEM TO REDUCE RECURRENT GRAM‐POSITIVE PD PERITONITIS
Authors: Cox S.D. , Steddon S. , Mallinder S. , Fan S.L.‐S. , Punzalan S.
Published: July 2012

Intensive training and re‐education of peritoneal dialysis (PD) exchange technique has been advocated to minimize peritonitis rate. However, re‐education of patients that are established on PD for some years can be difficult and a minority of patients on PD remain susceptible to repeated episodes of peritonitis. The UV Flash Compact system (Baxter Healthcare) automates patient connection and disconnection during the PD exchange procedure and uses bactericidal UV irradiation to minimise the effects of touch contamination. We have explored the efficacy of retraining patients using this system for reducing peritonitis rates in a cohort of 10 patients in who repeated episodes of peritonitis due to gram +ve organisms suggest irrevocable breaches in sterile technique. These patients were converted from their existing PD system (6 Staysafe [Fresenius Medical Care], 4 Mini‐solo [Baxter]). Mean follow up post‐conversion was 10 months. There was a striking reduction in peritonitis caused by gram +ve pathogens from 1 in 8.5 to 1 in 50.5 months. Although it is not possible in this study to differentiate the impact of the UV Flash Compact as opposed to the effect of re‐training, we advocate that patients with a high peritonitis burden from gram +ve organisms should be considered for conversion to the UV Compact system.
MANAGING PERITONEAL DIALYSIS (PD) — FACTORS THAT INFLUENCE PATIENTS' MODIFICATION OF THEIR RECOMMENDED DIALYSIS REGIMEN. A EUROPEAN STUDY OF 376 PATIENTS
Authors: Hollis J.L , Harman W. , Goovearts T. , Paris V. , Chivers G. , Hooper J.M. , Begg S. , Curtis L.
Published: July 2012

Objectives — The purpose of the study was to assess the prevalence and extent of missed peritoneal dialysis (PD) exchanges and to identify possible predictors for regimen modification.

Design — The study was a cross sectional postal survey of PD patients. Patients were asked to complete a single questionnaire looking at factors that influenced their management of the prescribed regimen.

Patients − 551 patients were invited to participate in the study from 17 centres across three European countries; 10 centres from Belgium, 5 from Italy and 2 from the UK. Patients on continuous ambulatory peritoneal dialysis (CAPD), CAPD and Quantum, or automated peritoneal dialysis (APD) for more than three months and at least 18 years old were included in the study. 376 out of 551 questionnaires were completed; a response rate of 68%. Results − 20% (n=67) of those who responded to the questionnaire admitted to modifying their treatment in the previous month. Those who were more likely to modify their treatment were younger, employed, had greater contact with the PD team, were on APD 10 hours or longer and were less satisfied with their APD treatment.

Conclusion — Many of the patients self‐reported modifying their dialysis regimen and possible predictors were highlighted from this study. By trying to identifying individual patients who do modify treatment healthcare professionals can target information that can support the patient in making safer treatment modification choices.
PLASMAPHERESIS IN THE TREATMENT OF ACUTE VASCULAR REJECTION: AN EXPERIENCE ON A DIALYSIS UNIT
Authors: White B.
Published: July 2012

Despite numerous the advances made in transplantation, acute rejection remains a major complication. Recent studies have shown that the use of plasmapheresis in the treatment of acute vascular rejection improves the chances of graft survival. In 1997 the plasmapheresis was transferred to the management of the renal unit, because we could offer a 24‐hour service for all acute cases in our hospital. The number of cases has steadily increased, incorporating not only plasmapheresis, but also stemcellpheresis and red blood cell exchanges. Since July 2003, we have started using plasmapheresis in the treatment of acute vascular rejection in renal transplants.

When a biopsy shows acute vascular rejection (A.V.R), combined with a decreased urine production, the patient commences therapy. Treatment consists of consecutive sessions, alternating between two sessions using saline/albumin followed by one session using fresh frozen plasma. Depending on the lymphocyte count, therapy is carried out in conjunction with a course of Antithymocyte globulin (A.T.G.) between July 2003 and October 2004, 124 transplants were carried out, 15 suffered from acute rejection. Six were diagnosed with A.V.R, of these six; five were successfully treated with plasmapheresis and A.T.G. One patient only needed plasmapheresis to ensure a reversal of acute vascular rejection. We encountered no problem with the technique itself and although plasmapheresis seems to improve the outcome of graft survival, we need to ask ourselves, as demand increases: “Do we have the capacity to treat these patients on our unit in the future and is it our domain?”
PRE‐DIALYSIS EDUCATION AND PATIENT CHOICE: Summary of the EDTNA|ERCA Journal Club discussion spring 2006
Authors: Lindley Elizabeth J. , Thomas Nicki , Hanna Linda , Walker Diane , Milo Elisheva , Koupatsiari Thomy , De Vos Jean‐Yves , Sedgewick John , Pugh‐Clarke Karen , O'Kane Frankie , Treloar Gillian , Pegoraro Marisa , Marti Anna , Muroma‐Karttunen Riitta , Murcutt Gareth , Shaldon Stanley , Hoenich Nic , Brooks Don , Pilley Ken , Küntzle Waltraud , Goovaerts Tony
Published: July 2012

The discussion was initiated by a paper on the influence of a pre‐dialysis education programme on the mode of renal replacement therapy by Goovaerts et al (NDT 2005). Barriers to the uptake of self‐care treatment modalities, including late referral, limited availability of treatment options, reimbursement, support from staff and families, the requirement for a helper and the length of the training programmes for home haemodialysis (HD) were discussed by 21 participants from 12 countries.

The ‘take‐home’ messages from the discussion were that to optimise the uptake of self‐care modalities, renal units should try to ensure the all patients who are able to choose are fully informed before starting dialysis, even if they are referred to the unit very late. Offering a wide range of treatment options to new patients, and allowing (or encouraging) home HD without a helper, may also increase the number of patients who start and stay on a self‐care modality. It should be possible to provide an acceptable level of training, without compromising on safety, within 3 weeks if the patient is confident with needling.
MONITORING OF DIALYSIS WATER SYSTEMS — IS THERE A NEED FOR INCREASED SAMPLING?
Authors: James R.
Published: July 2012

Water quality is one of the most important aspects of ensuring a safe and effective delivery of haemodialysis. An extensive microbiological survey of several water systems highlighted a contamination problem which routine sampling had failed to detect.

Current guidelines suggest that samples for microbiological and endotoxin analysis should be taken from the outlet of water treatment plant and points expected to have the highest bacterial load, normally the end of the distribution loop and connections to the dialysis machines, where the flow is at its lowest. The survey extended sampling to include a large number of machine connection points.

Four systems were investigated. The samples from routine test points generally returned results within our operational limits (<10 CFU/ml and <0.06 IU/ml). However, results from several machine connection points exceeded these limits by a large margin. Several disinfection cycles were required in order to achieve results in keeping with our operational limits.

The conclusion is that sample results from the end of the distribution loop may give a false sense of security by not indicating a contamination problem at the machine connection points. Increasing the number and frequency of machine connection points tested should provide greater security in detecting contamination and allow for remedial action at an earlier stage.
THE EFFECT OF PROGRESSIVE MUSCLE RELAXATION TRAINING ON ANXIETY LEVELS AND QUALITY OF LIFE IN DIALYSIS PATIENTS
Authors: Yildirim Y.K , Fadiloglu C.
Published: July 2012

Aim — To determine the effect of progressive muscle relaxation training (PMRT) on anxiety levels and quality of life (QoL) in dialysis patients.

Methods — A total of 46 patients who had been treated with dialysis in the Dialysis Center of Ege University Medical Faculty Hospital were recruited. Data were collected by means of a questionnaire. Patients' Recognition Form (PRF), State and Trait Anxiety Inventory (STAI), and QoL‐index for dialysis patients (QoLI‐dialysis) were used to collect the necessary data. All three forms were utilised prior to PMRT and 6 weeks after completion of PMRT.

Results — The mean state‐anxiety score before and after PMRT was found as 43.4±4.3 and 28.9±2.8, respectively (P<0.001). Similarly, the mean trait‐anxiety scores before and after PMRT were found as 43.6±9.5 and 31.1±6.5, respectively (P<0.001). When the QoLI‐dialysis score was examined it was 28.7±3.2 before PMRT and 29.6±2.3 after PMRT (P<0.01).

Conclusion — The results of the study demonstrate that PMRT for dialysis patients helps decrease state‐ and trait‐anxiety levels and has a positive impact on QoL.
SYMPTOM MANAGEMENT IN PATIENTS WITH ESTABLISHED RENAL FAILURE MANAGED WITHOUT DIALYSIS
Authors: Murtagh F.E.M. , Addington‐Hall J.M. , Donohoe P. , Higginson I.J.
Published: July 2012

Increasing numbers of patients with chronic kidney disease Stage 5 (GFR <15ml/minute) are being managed without dialysis, either through their own preference or because dialysis is unlikely to benefit them. This growing group of patients has extensive health care needs. Their overall symptom burden is high, and symptom prevalence matches or exceeds that in other end of life populations, both with cancer and other non‐cancer diagnoses. These symptoms may often go unrecognised and under‐treated. Regular symptom assessment is necessary, together with pro‐active management of identified symptoms.

Pain can be managed using the principles of the World Health Organisation analgesic ladder. Not all opioid medications are recommended for these patients. Paracetamol, tramadol, and fentanyl are the most appropriate medications for steps 1, 2 and 3 respectively. There is limited evidence on the use of buprenorphine, oxycodone and hydromorphone. Methadone is safe but should only be prescribed by a clinician experienced in its use. Morphine and diamorphine are not recommended because of metabolite accumulation.

Pruritus is also challenging to manage. The evidence for pharmacological interventions to alleviate pruritus is summarized, and a pragmatic approach to management suggested. Emollients, capsaisin cream, antihistamines, thalidomide and ondansetron may be helpful, according to the extent and pattern of pruritus. Symptoms may frequently be due to co‐morbid conditions, not renal disease itself, and managing them is difficult because of the constraints on the use of medication which kidney failure imposes. Collaboration between renal and palliative specialists can help identify ways to achieve best care for these patients.
RENAL SPECIFIC SECONDARY HYPERTENSION
Authors: Kalra P.A.
Published: July 2012

Chronic kidney disease (CKD) is now understood to affect over 5% of all adult patients and it conveys a risk of reduced survival in those affected. At least 80% of those patients with stages 3–5 CKD (i.e. GFR <60 ml/min) suffer with hypertension, and in most the major cause is due to pertubation of an important renal endocrine system, the renin‐angiotensin‐aldosterone (RAA) axis. In this article the epidemiology of renal‐related hypertension and its importance in pre‐disposing to the increased cardiovascular risk in renal disease are discussed. Hypertension is known to be a major cause of progressive loss of renal function in CKD, particularly because of activation of the RAA, and hence the case for blockade of this system with ACE inhibitors and Angiotensin receptor blockers is highlighted.
EDUCATION OF TRANSPLANTED WOMEN FOR PREVENTION OF UNPLANNED PREGNANCY FOLLOWING KIDNEY TRANSPLANTATION
Authors: Calic M. , Grego K. , Kersnic B. , Jovanovic E. , Svetlin M. , Kandus A.
Published: July 2012

Reproductive function in female patients (pts) with advanced kidney disease is decreased and characterised by diminished libido, ovulation and infertility. The underlying cause is hypothalamic‐hypophysis‐gonadal axis dysfunction in women with chronic kidney disease which usually results in high levels of prolactin and.ammenorrhea In women with end stage kidney disease requiring replacement therapy in fertile period conception is very rare. Even in case of conception successful pregnancy and delivery are not likely, on most occasions spontaneous abortion occurs. Should a newly pregnant woman on haemodialysis wish to deliver the baby, intensive dialysis is required, everyday until childbirth. In the haemodialysis center in University Clinical Center in Ljubljana, only one woman in the chronic dialysis programme gave birth, in 1996.
DIALYSIS NURSES FOR PALLIATIVE CARE
Authors: Madar H. , Gilad G. , Elenhoren E. , Schwarz L.
Published: July 2012

The palliative approach offers significant and practical care throughout the treatment of the dialysis patient until death. Varied aspects of quality of life for patients can be improved. It is possible to relieve symptoms such as sleep disorders, pain, constipation and pruritus, which, according to the present survey, are common symptoms. The treatment of dying dialysis patients or the possibility and legitimization of discontinuing treatment are complex, controversial issues with ethical and legal implications. But these issues have not yet been adequately dealt with by the nephrological community. The nurses who encounter patients daily, who constantly deal with great suffering and who lack tools to help, can lead the practice in this field within the framework of inter‐disciplinary team work. In light of the obvious need for progress in this area, appropriate training courses should be considered. The implementation of the palliative approach in dialysis units could be a challenge for all of us in the coming years.
THE NEED FOR CARE CO‐ORDINATION IN AN AGEING DIALYSIS POPULATION
Authors: Witkowski E. , Vanstraelen E. , De Moor B. , Hardy F.
Published: July 2012

Over the past ten year period, there has been a sharp increase in the age distribution of dialysis patients. The mean age of patients entering dialysis therapy in 1995 was 69 years, rising to 75 years by 2005 (Figure 1). Of this group of patients, there is a 20% mortality rate within 6 months of commencing dialysis (Figure 2). Renal replacement therapy (RRT) is considered a bridge to transplantation. However, what if the patient is not eligible for transplantation because of age, co‐morbidity or refusal?
MICROBIOLOGICAL MONITORING OF DIALYSIS WATER SYSTEMS — WHICH CULTURE METHOD?
Authors: James Ray
Published: July 2012

Problem — Assurance of adequate water quality is one of the most important aspects of ensuring a safe and effective delivery of haemodialysis. There are several different culture methods recommended in the various guidelines on the microbiological testing of water for dialysis.

Aims — The aim was to investigate whether or not there was a significant difference in the microbiological results obtained using the various recommended culture methods.

Methods — Current guidelines suggest that samples for microbiological analysis should be cultured using a low nutrient media such as Reasoner's 2A but vary in recommending temperature and time. Over a six month period, samples were sent to an independent laboratory and cultured using three different times and temperatures. Samples were cultured at 22°C for 7 days (ERA‐ERCA, EDTNA‐ERCA), 37°C for 2 days (AAMI and ISO) and 30°C for 5 days (ISO, EP).

Results — The bacterial culture method used was R2A media at the incubation temperatures and times indicated. During an extensive microbiological survey of several water systems, the results from the laboratory gave conflicting results for the three methods. Results showed that several of sample sets returned results with a difference in recovery by a factor of between 10 and 1000.

Conclusions — Culturing using the stated temperature and times produces large variations in reported levels of contamination. Culturing at the different temperatures and incubation times can produce results which may give a false sense of security by not indicating a contamination problem. Standardising on a single method is desirable in order to produce consistently valid results.
KIDNEY FAILURE STABILIZES AFTER AN INCREASE OVER 2 DECADES
Authors: Cravedi Paolo , Ruggenenti Piero , Remuzzi Giuseppe
Published: July 2012

The level of proteinuria is one of the most important predictors for progressive renal function loss in kidney disease. Reduction of urinary protein levels by renin‐angiotensin‐system (RAS) inhibitors limits renal function decline in patients with non‐diabetic and diabetic nephropathies to the point that remission of the disease and regression of renal lesions have been reported. The increasing use of these drugs is possibly at the basis of the stabilization of rates of new cases of kidney failure reported to the US Renal Data System after a 2‐decade period of progressive increases.

RAS inhibition, however, may not be effective to the same degree in all patients. For those patients who do not reach a complete remission of proteinuria, treatment procedures to implement renoprotection should include strict blood pressure control (and metabolic control in diabetics), lowering of blood lipids, and lifestyle modifications. Early intervention may be important to maximize renoprotection, especially in diabetics.
HYDROXYETHYLSTARCH SOLUTIONS VERSUS SALINE FOR THE TREATMENT OF INTRADIALYTIC HYPOTENSION
Authors: Konings Magda , Wolters Evelien , Betjes Michiel GH
Published: July 2012

Background — It is unknown whether the colloid solutions hydroxyethylstarch (HES) 6% and 10% are equally effective as compared to saline alone for the treatment of intradialytic hypotension.

Methods − 44 stable patients treated with chronic intermittent haemodialysis were divided in two equally sized groups (Group I and Group II). When symptomatic hypotension occurred, patients received 100 ml 0,9% NaCl in Group I and 100 ml HES 6% in Group II. In the second month of the study, patients in Group I received HES 6% and saline was given in Group II. In the third and fourth month this treatment schedule was repeated, but now HES10% instead of HES6% was given.

Results and conclusion — HES solutions of 6% and 10% and saline were equally effective for the reversal of the intradialytic hypotension, but patients receiving HES10% had a significant lower incidence of recurrent hypotension.
THE CHALLENGES ENCOUNTERED DURING A COLLABORATIVE RESEARCH PROJECT
Authors: McCann Ms. Margaret
Published: July 2012

Collaborative research in the clinical environment ensures that research questions are valued and relevant to health care professionals who are based in the clinical setting. This form of research is not without its difficulties and can present numerous challenges and conflicts. For successful collaboration, research teams need to invest a considerable amount of commitment and energy into team functioning and relationships. In addition, the team needs to work together through the pooling of resources, interests and talents. This includes the sharing of tasks that are time consuming and work intensive. Using the experiences gained from the pilot phase of a collaborative study this paper will offer solutions to a number of challenges that emerged from this study.
CHANGING EUROPEAN CKD TRENDS: A CALL TO ACTION
Authors: Bennett Lesley
Published: July 2012

Increasing numbers of patients with chronic kidney disease (CKD) who require renal replacement therapy threaten to overwhelm nephrologists, nephrology nurses, and haemodialysis units in many European countries. Health care costs are increasing more rapidly than corresponding budgets. These changing trends mandate new policies to provide continued quality care for more patients at international, national, and local levels. Although individual countries have different requirements regarding health care systems, approaches must be taken that improve structure, process, and outcome. Common issues include improving professional education, increasing collaboration among health care providers and specialists, and the acquisition and allocation of funds. Solutions identified by some countries provide examples of model programs that could be adapted for others. The impending crisis that more and older patients with serious comorbidities and CKD will impose on health care delivery must be addressed now in a proactive manner by the nephrology health care community.
POLYSOMNOGRAPHIC EVIDENCE OF SLEEP APNOEA DISORDERS IN LEAN AND OVERWEIGHT HAEMODIALYSIS PATIENTS
Authors: Sakkas Giorgos K , Karatzaferi Christina , Liakopoulos Vassilios , Maridaki Maria D , Lavdas Eleftherios , Giannaki Christoforos D , Gourgoulianis Konstantinos I , Stefanidis Ioannis
Published: July 2012

Background — Sleep apnoea disorders affect a large proportion of patients with renal failure. However, it is unknown whether body composition and visceral adiposity predispose haemodialysis patients to sleep apnoea disorders.

Methods — Forty‐one dialysis patients were divided in two groups according to the BMI score as; the Lean group (N=21, 1F/20M, BMI = 21.3 ± 2.1) and the Overweight group (N=20, 9F/11M, BMI =28.3 ± 2.8). Sleep disturbances assessed by a full polysomnography (PSG), visceral adipose tissue (VAT), calculated by computed tomography, the quality of life, assessed by the SF‐36, and the body composition, measured by DEXA.

Results — None of the PSG parameters were different between the two groups. Only visceral adiposity was correlated significantly with sleep apnoea disorders.

Conclusions — BMI and percent of total body fat do not seem to predispose for sleep apnoea disorders. Rather it is the increased fat deposition in abdominal area that plays the pivotal role.
PATIENT EDUCATION IN PERITONEAL DIALYSIS: AN OBSERVATIONAL STUDY IN ITALY
Authors: Bordin Gabriella , Casati Monica , Sicolo Nicola , Zuccherato Nicoletta , Eduati Vincenzina
Published: July 2012

This observational study describes the characteristics of the education programmes used in Italian PD‐centres, evaluating a possible relationship between programmes and peritonitis rates. The survey involved 150 non‐paediatric public dialysis centres in Italy. The data were collected by a questionnaire and evaluated with SPSS software. Descriptive statistics of synthesis were calculated, Kruskal‐Wallis, Wilcoxon's test were used to verify the differences in the replies, and association between variables was tested with Pearson correlation and Pearson's X 2 test. 120 dialysis centres took part in the survey and reported a median incidence of peritonitis of 1/29 months. Training occurs in all the centres, while pre‐dialysis education, home visits and re‐training take place in 38.3%, 50% and 44.2% respectively. A lower peritonitis rates proves to be correlated to these activities rather than to presence of specialised personnel, to ratio nurses‐patients or training time.
ADDRESSING THE CHALLENGES OF RENAL ANAEMIA: HOW NURSES CAN MAKE A DIFFERENCE
Authors: Macdonald J.
Published: July 2012

Nephrology nurses play a central and wide‐ranging role in renal care. However, they have inadequate time to manage their responsibilities as patient volume increases due to earlier diagnosis and improved survival, and patient care becomes more complex. The challenge to achieve and maintain target haemoglobin levels with current agents compounds nursing workload.

Early recognition and treatment of anaemia, a multidisciplinary approach and patient management algorithms can improve outcomes and nursing time utilisation. Innovative erythropoietic agents produce stable haemoglobin levels at extended administration intervals, offering time‐savings. Such initiatives may allow nurses more time to focus on other aspects of patient care.
Restoring Psychology's Role in Peptic Ulcer
Authors: Overmier J. Bruce , Murison Robert
Published: July 2012

This paper reviews the history of the transition from the belief that gastrointestinal ulcers are caused primarily by psychological factors to the current state of belief that they are caused primarily by infection and argues that neither is fully accurate. We argue that psychological factors play a significant role as predisposing to vulnerability, modulating of precipitation, and sustaining of gastric ulceration. We review data that challenge the assumption of a simple infectious disease model and adduce recent preclinical data that confirm the predisposing, modulatory, and sustaining roles for psychological factors. We note that others, too, are now challenging the adequacy of the contemporary simple bacterial infection model. We hope to replace the competition between psychology and medicine with cooperation in understanding and treating patients suffering gastric ulceration and ulcer.
Pitavastatin ameliorated the progression of steatohepatitis in ovariectomized mice fed a high fat and high cholesterol diet
Authors: Kamada Yoshihiro , Kiso Shinichi , Yoshida Yuichi , Chatani Norihiro , Kizu Takashi , Hamano Mina , Egawa Mayumi , Takemura Takayo , Ezaki Hisao , Furuta Kunimaro , Hayashi Norio , Takehara Tetsuo
Published: July 2012

Aim

Many studies indicate an accelerated progression of non‐alcoholic steatohepatitis (NASH) in postmenopausal women. Very recently, we reported that estrogen deficiency enhanced the progression of steatohepatitis in mice fed a high fat and high cholesterol (HFHC) diet. Hypercholesterolemia is often observed in postmenopausal women, and recent studies indicate it to be an important risk factor for the progression of NASH. Statins can slow NASH progression in the estrogen‐deficient state but the precise mechanisms of their effects are still unclear.

Methods

We investigated the effects of pitavastatin on steatohepatitis progression using ovariectomized (OVX) mice fed a HFHC diet or HFHC + pitava diet (containing 5 p.p.m. pitavastatin) for 6 weeks.

Results

Serum alanine aminotransferase and cholesterol levels significantly decreased in mice fed the HFHC + pitava diet compared with mice fed the HFHC diet. Real‐time reverse transcription polymerase chain reaction representing hepatic inflammatory gene expressions significantly decreased in mice fed the HFHC + pitava diet compared with the HFHC‐fed mice. Pitavastatin treatment also decreased both hepatic macrophage infiltration and hepatocyte chemokine (C‐C motif) ligand 2 expression and improved the liver fibrosis condition when compared with the mice fed the HFHC diet. In addition, the enhanced spleen monocyte chemokine (C‐C motif) receptor 2 expression in ovariectomized mice fed the HFHC diet was also decreased by pitavastatin administration.

Conclusion

Our study demonstrated that the exacerbated steatohepatitis progression in OVX mice fed a HFHC diet could be attenuated by pitavastatin treatment at least through inhibition of hepatic macrophage infiltration. We concluded that statins should be useful for treating NASH in postmenopausal women.
Delayed Differentiation for Multiple Lifecycle Products
Authors: Abbey James D. , Guide V. Daniel R. , Souza Gilvan C.
Published: July 2012

Modular design allows several generations of products to co‐exist in the installed base as product designs change to take advantage of improved performance via modular upgrades. Use of a common base platform and modular design approach allows a firm to offer updates for improved performance and flexibility via remanufacturing when products have multiple lifecycles. However, as the product evolves through multiple lifecycles, the large pool of product variants leads to the curse of product proliferation. In practice, product proliferation causes high levels of line congestion and results in longer lead times, higher inventory levels, and lower levels of customer service. To offer insights into the product proliferation problem, the authors employ a delayed differentiation model in a multiple lifecycle context. The delayed differentiation model gives flexibility to balance trade‐offs between disassembly and reassembly costs by adaptively changing the push‐pull boundary. An adaptive, evolving push‐pull boundary provides flexibility for a remanufacturing firm to meet changing customer demands. The delayed differentiation model includes both a mixed‐integer linear program and an analytical investigation of the evolutionary nature of the push‐pull boundary. Both field observations and experimental results show that the nature of product proliferation and changing demand structures play significant roles in the cost and flexibility of the evolving delayed differentiation system.
The Effect of Single Rater Bias in Multi‐Stakeholder Research: A Methodological Evaluation of Buyer‐Supplier Relationships
Authors: Roh Joseph A. , Whipple Judith M. , Boyer Kenneth K.
Published: July 2012

As the global competitive landscape intensifies, firms have looked to their supply chain organizations to improve cost, visibility, and cycle time performance across functions, products, and markets. As a result, the scope of supply chain related operations have increasingly cut across organizational boundaries. To understand and capture such cross‐organizational activities, researchers have broadened the focus of their studies and included multiple stakeholders in their analysis (e.g., integration, sustainability, and buyer‐supplier relationships). However, multi‐stakeholder research has also increased the complexity and effort required to conduct studies across organizational boundaries. Unfortunately, many studies that use multi‐stakeholder constructs fail to fully address their multi‐sided nature during both construct conceptualization and data collection. Several studies suggest that neglecting the multi‐sided nature of certain constructs can affect the research validity and reliability and may invalidate research inferences and results, although such concerns have not been empirically demonstrated. The current study addresses this gap by performing a series of tests using data from 105 matched pairs of buyers and their suppliers to illustrate key methodological considerations for conducting multi‐stakeholder research. This study also offers practical guidance regarding assumptions routinely made in single rater research and proposes when single rater data may be appropriate for multi‐stakeholder research.
The Impact of Information Sharing on Supply Chain Performance under Asymmetric Information
Authors: Inderfurth Karl , Sadrieh Abdolkarim , Voigt Guido
Published: July 2012

The use of screening contracts is a common approach to solve supply chain coordination problems under asymmetric information. One main assumption in this context is that managers without specific incentives would rather use their private information strategically than reveal it truthfully. This harms supply chain performance. This study investigates the impact of information sharing in a principal‐agent setting that is typical for many supply chain transactions. We conduct a laboratory experiment to test whether information sharing has an influence on supply chain coordination. We find that information sharing within the supply chain has two positive effects. First, information sharing reduces the inefficiencies resulting from information deficits if there is a certain amount of trust in the supply chain. Second, communication can limit out‐of‐equilibrium behavior with a small impact on the firm's own payoff, but a large impact on the supply chain partner. Furthermore, we find that both effects are amplified when communication takes place in an environment that allows the less informed supply chain party to punish or to reward the better informed party. Although our extended mechanisms substantially enhance the poor performance of the theoretically optimal coordination contract menu, we find no mechanism that implements supply chain performance superior to the theoretically predicted second‐best level.
Supplier–Buyer Negotiation Games: Equilibrium Conditions and Supply Chain Efficiency
Authors: Martínez‐de‐Albéniz Victor , Simchi‐Levi David
Published: July 2012

In a decentralized supply chain, supplier–buyer negotiations have a dynamic aspect that requires both players to consider the impact of their decisions on future decisions made by their counterpart. The interaction generally couples strongly the price decision of the supplier and the quantity decision of the buyer. We propose a basic model for a repeated supplier–buyer interaction, during several rounds. In each round, the supplier first quotes a price, and the buyer places an order at that price. We find conditions for existence and uniqueness of a well‐behaved subgame‐perfect equilibrium in the dynamic game. When costs are stationary and there are no holding costs, we identify some demand distributions for which these conditions are met, examine the efficiency of the equilibrium, and show that, as the number of rounds increases, the profits of the supply chain increase towards the supply chain optimum. In contrast, when costs vary over time or holding costs are present, the benefit from multi‐period interactions is reduced and after a finite number of time periods, supply chain profits stay constant even when the number of rounds increases.
Finding and Implementing Energy Efficiency Projects in Industrial Facilities
Authors: Aflaki Sam , Kleindorfer Paul R. , deMiera Polvorinos Victor Sáenz
Published: July 2012

This study addresses the challenges of finding and implementing profitable energy efficiency (EE) projects, a critical foundation for sustainable operations. We focus on manufacturing enterprises, but many of our findings apply also to the back office of service operations. Our starting point is that, in nearly every industrial enterprise, there are many profitable EE projects that could be implemented but are not. An oft‐cited hindrance to implementation is the lack of an internal management framework in which to find, value, and execute these projects. Using a conceptual approach, we rely on proven sustainable operations tools to develop such a framework. We identify three major value drivers of EE projects: savings intensity, “green” image, and project complexity. We then describe a framework for understanding the context of EE projects in industry, with an underlying analytic foundation in optimal portfolio analysis. A case study of a large manufacturing site is used to illustrate emerging best practices—based on Kaizen management principles—for integrating EE project management with operations, engineering, and strategy.
An (U‐Th)/He age for the shallow‐marine Wetumpka impact structure, Alabama, USA
Authors: WARTHO Jo‐Anne , VAN SOEST Matthijs C. , KING David T. , PETRUNY Lucille W.
Published: July 2012

Abstract– Single crystal (U‐Th)/He dating was applied to 24 apatite and 23 zircon grains from the Wetumpka impact structure, Alabama, USA. This small approximately 5–7.6 km impact crater was formed in a shallow marine environment, with no known preserved impact melt, thus offering a challenge to common geochronological techniques. A mean (U‐Th)/He apatite and zircon age of 84.4 ± 1.4 Ma (2σ) was obtained, which is within error of the previously estimated Late Cretaceous impact age of approximately 83.5 Ma. In addition, helium diffusion modeling of apatite and zircon grains during fireball/contact, shock metamorphism, and hydrothermal events was undertaken, to show the influence of these individual thermal processes on resetting (U‐Th)/He ages in the Wetumpka samples. This study has shown that the (U‐Th)/He geochronological technique has real potential for dating impact structures, especially smaller and eroded impact structures that lack impact melt lithologies.
Increased arterial stiffness is closely associated with hyperglycemia and improved by glycemic control in diabetic patients
Authors: Ibata Junko , Sasaki Hideyuki , Hanabusa Tadashi , Wakasaki Hisao , Furuta Hiroto , Nishi Masahiro , Akamizu Takashi , Nanjo Kishio
Published: July 2012

Aims/Introduction

Although arteriosclerotic diseases have been reported to be frequently complicated by diabetes mellitus (DM), a detailed relationship between hyperglycemia and arterial stiffness has not been fully clarified. We investigated the influence of hyperglycemia on arterial stiffness using the cardio‐ankle vascular index (CAVI), which is a new method for estimating arterial stiffness.

Materials and Methods

CAVI values of 52 early‐staged DM patients (duration <5 years, no microangiopathies) were compared with those of 43 age‐matched non‐diabetic (NDM) subjects. The association between CAVI and clinical background factors was evaluated. The effect of glycemic improvement on CAVI was examined in 36 DM patients who were hospitalized for 2 weeks to treat hyperglycemia. CAVI and clinical parameters were measured twice during hospitalization and again after 8 weeks. Additionally, we measured CAVI before and 2 h after breakfast in five DM and five NDM subjects.

Results

The CAVI of DM patients was significantly higher than that of NDM subjects. Multiple regression analysis showed that neither hypertension, obesity nor dyslipidemia, but aging and hemoglobin A1c (HbA1c) were significantly related to CAVI elevation. The CAVI, HbA1c and total cholesterol (TC) had significantly improved. Improvement of CAVI was significantly associated with HbA1c improvement. In contrast, no significant association was observed between the improvements of TC and CAVI. CAVI values before and after breakfast did not change significantly.

Conclusions

CAVI elevation seems to be a sensitive arteriosclerotic marker, which is closely associated with hyperglycemia and improved by glycemic control.
PEGylation enhancement of pH stability of uricase via inhibitive tetramer dissociation
Authors: Tian Hong , Guo Yuan , Gao Xiangdong , Yao Wenbing
Published: July 2012

Objectives

Previously, PEGylated uricase was demonstrated to maintain catalytic activity at pH 5.8, the isoelectric point of uricase, where native uricase ceases to function. To find out whether PEGylation could enhance pH stability of uricase, the enzyme activity to pH curve was completely characterized.

Methods

Complete characterization of the enzyme activity to pH curve, indicating an inverted bell-shaped relationship not previously documented, is presented. PEGylation enhancement of uricase stability at a pH lower than that commonly found in the liver, can be explored by dynamic dissociation of uricase using ultrafiltration and size-exclusion chromatography.

Key findings

The results suggest the role of PEGylation in enhanced pH stability is via inhibition of subunit disintegration. The mechanism of this effect is characterized by the wrapping of PEG chains around uricase, providing a flexible shell preventing subunit disintegration. The presence of notable PEGylation-induced changes in uricase supports this mechanism and include improved enzyme-substrate affinity and elevated thermal stability.

Conclusions

Characterization of PEGylated uricase provides a basis for the rational design of therapeutic PEGylated proteins.
Chirality plays critical roles in enhancing the aqueous solubility of nocathiacin I by block copolymer micelles
Authors: Feng Kun , Wang Shuzhen , Ma Hairong , Chen Yijun
Published: July 2012

Objectives

Although drug solubilization by block copolymer micelles has been extensively studied, the rationale behind the choice of appropriate block copolymer micelles for various poorly water-soluble drugs has been of relatively less concern. The objective of this study was to use methoxy-poly(ethylene glycol)-polylactate micelles (MPEG-PLA) to solubilize glycosylated antibiotic nocathiacin I and to compare the effects of chirality on the enhancement of aqueous solubility.

Methods

Nocathiacin I-loaded MPEG-PLA micelles with opposite optical property in PLA were synthesized and characterized. The drug release profile, micelle stability and preliminary safety properties of MPEG-PLA micelles were evaluated. Meanwhile, three other poorly water-soluble chiral compound-loaded micelles were also prepared and compared.

Key findings

The aqueous solubility of nocathiacin I was greatly enhanced by both l- and d-copolymers, with the degree of enhancement appearing to depend on the chirality of the copolymers. Comparison of different chiral compounds confirmed the trend that aqueous solubility of chiral compounds can be more effectively enhanced by block copolymer micelles with specific stereochemical configuration.

Conclusions

The present study introduced chiral concept on the selection and preparation of block copolymer micelles for the enhancement of aqueous solubility of poorly water-soluble drugs.
Nanosecond Laser Induced Periodic Surface Structures on Drug Elution Profiles in Stents
Authors: Buehler Michelle , Molian Pal
Published: July 2012

Drug-eluting stents (DESs) have profoundly affected the field of interventional cardiology as a transformative technology by dramatically reducing the problem of in-stent restenosis. However, the development of adverse, late stent thrombosis (LST) raises the question of the safety profile of the DES. The aim of the study is to develop better DESs that can increase the amount of drug (sirolimus) loading while slowing down the drug release rate and potentially eliminating the polymer, all of which are expected to aid in the prevention of LST. Nanosecond pulsed laser texturing of Nitinol stent surfaces was first performed and the surface topography was analyzed using an optical profilometer. The results showed that the surface texture parameters such as surface area ratio, its roughness, volume of fluid retained per unit area, and mean valley slope suitable for drug adhesion, retention, and elution were significantly increased due to laser texturing. Subsequently, the drug elution profiles were studied for four different types of stents: laser-textured and untreated stents coated with the drug only and the drug-polymer. Laser texturing reduced the cumulative sirolimus release from 73% to 25% in drug only coated stents and from 93% to 45% in drug-polymer coated stents and showed promise for applying polymer-free drug coatings on the DES.