bluuebunny/crossref_metadata_2025 huggingface dataset:
Five‐ to six‐year outcome and its prediction for children with ODD/CD treated with parent training
Authors: Drugli May Britt , Larsson Bo , Fossum Sturla , Mørch Willy‐Tore
Published: April 2010

Background:  While short‐term effects of parent training (PT) have been extensively evaluated, long‐term outcome and present predictors of a diagnosis for children with ODD/CD treated with parent training are very limited.

Method:  In the present study, diagnostic status as outcome and predictors of treatment response were examined in a 5–6‐year follow‐up. Out of 99 children who had been treated in a randomised controlled trial evaluating the effects of The Incredible Years parent training (PT) or combined parent training and child treatment (PT+CT) programme, 54.5% participated in the 5–6‐year follow‐up study. Their diagnostic status was determined with the Kiddie‐SADS interview.

Results:  While all children qualified for a diagnosis of ODD/CD before treatment, 5–6 years later, two‐thirds no longer received such a diagnosis, the same proportion as found at the 1‐year follow‐up. The most powerful pre‐treatment predictors of diagnostic status at the 5–6‐year follow‐up were living with mother only and being a girl. At post‐treatment the most powerful predictor was found to be high levels of child externalising problems.

Conclusion:  The findings of the study support the maintenance of positive long‐term results for young children treated with parent training because of serious conduct problems, and identify characteristics of children and families in need of added support to parent training programmes.
The Changing Fortunes of Early Medieval Bavaria to 907 ad
Authors: Couser Jonathan
Published: April 2010

This essay surveys the political historiography of the early medieval principality of Bavaria, particularly in three periods; that of the Bavarians’ emergence in the sixth century, the time of a complex interrelationship between Bavarians and Franks and their Agilolfing and Carolingian ruling houses in the eighth century, and the transitions of power from Charlemagne’s takeover of Bavaria in 788 and the transfer to a new Luitpolding duchy in 907. The Bavarian case serves as a useful counternarrative to those of larger peoples like the Franks or Lombards, and illustrates that the inheritance of Roman tradition, the relationship between rulers and ruled, and the creation and maintenance of ethnic identities could be flexible and complex in the early Middle Ages.
Trends in the Nigerian Auto/biography
Authors: Dasylva Ademola O. , Oriaku Remy
Published: April 2010

Every society has its means and methods of chronicling events, and lives, in a way peculiar to it. Despite the considerable shift in contextual paradigms that foreground the quill of the non‐literate era and the cursor of the twenty‐first century, the Nigerian auto/biography as life‐portrait has stuck to and remained faithful to its traditional role of projecting a major personage, as well as archiving and documenting key social and historical events. So far studies in the Nigerian auto/biography have continued to lay emphasis on its prose narrative form. This paper argues that by virtue of its idiosyncrasies, auto/biographical narratives are not limited to the prose (non‐fictional) literary sub‐genre. Rather, auto/biographies are to be found in other generic forms of literature. It argues further that this sub‐generic form of literature pre‐dates the colonial era, and that most, if not all, forms of Nigerian literature, oral and written, are either steeped in auto/biography or characterized by it. The argument in this paper is that because auto/biographies focus on the lives of significant persons in society they reflect the cultural values, aesthetic trends and practices of the people as well as their socio‐historical epochs. It concludes by demonstrating how the tilt towards self‐presentation makes this form reflect the dissonance in points of views and the myriad conflicts that characterize the Nigerian society at the same time that it enhances dialogue between the author/subjects of auto/biography and the public.
Validation of the WHOQOL‐BREF among women following childbirth
Authors: WEBSTER Joan , NICHOLAS Catherine , VELACOTT Catherine , CRIDLAND Noelle , FAWCETT Lisa
Published: April 2010

Background:  There is increasing interest in measuring quality of life (QOL) in clinical settings and in clinical trials. None of the commonly used QOL instruments has been validated for use postnatally.

Aim:  To assess the psychometric properties of the 26‐item WHOQOL‐BREF (short version of the World Health Organization Quality of Life assessment) among women following childbirth.

Methods:  Using a prospective cohort design, we recruited 320 women within the first few days of childbirth. At six weeks postpartum, participants were asked to complete the WHOQOL‐BREF, the Edinburgh Postnatal Depression Index and the Australian Unity Wellbeing Index. Validation of the WHOQOL‐BREF included an analysis of internal consistency, discriminate validity, convergent validity and an examination of the domain structure.

Results:  In all, 221 (69.1%) women returned their six‐week questionnaire. All domains of the WHOQOL‐BREF met reliability standards (alpha coefficient exceeding 0.70). The questionnaire discriminated well between known groups (depressed women and non‐depressed women. P ≤ 0.000) and demonstrated satisfactory correlations with the Australian Unity Wellbeing index (r ≥ 0.45). The domain structure of the WHOQOL‐BREF was also valid in this population of new mothers, with moderate‐to‐high correlation between individual items and the domain structure to which the items were originally assigned.

Conclusion:  The WHOQOL‐BRF is a well‐accepted and valid instrument in this population and may be used in postnatal clinical settings or for assessing intervention effects in research studies.
Long‐term outcomes of patients who failed to attend following midurethral sling surgery – A comparative study and analysis of risk factors for non‐attendance
Authors: STAV Kobi , DWYER Peter L. , ROSAMILIA Anna , LEE Joseph
Published: April 2010

Background and aims:  To assess long‐term subjective cure and subjective complication rates of women who underwent midurethral sling (MUS) for stress urinary incontinence (SUI) in those who failed to attend (FTA) versus those who attended for postoperative follow‐up. Predictive factors for non‐attendance were identified.

Methods:  A total of 1225 consecutive women with urodynamic SUI had a synthetic MUS at our institution between 1999 and 2007. Patients were interviewed via phone call with a structured questionnaire. Comparison between FTA and non‐FTA patients was performed and multivariate analysis was utilised to identify risk factors for non‐attendance.

Results:  Univariate analysis revealed that the FTA rate was lower in patients who underwent concomitant prolapse surgery (29% vs. 84%, P < 0.001), FTA patients were younger (mean age 56 vs. 67 years, P < 0.001) and more depressed (14% vs. 4%, P < 0.05). At a mean follow‐up of 50 ± 24 months, the subjective cure rate was similar between the two groups (84% vs. 86%, NS). The incidence of overactive bladder symptoms was significantly higher in the non‐FTA patients (34% vs. 6%P < 0.001). Isolated sling procedure (OR = 2.71, P < 0.01) and age <50 years (OR = 3.15, P < 0.05) were significant predictors for failed attendance.

Conclusions:  Our results indicate that the subjective cure rate is similar between non‐FTA and FTA patients subsequent to a MUS procedure. However, the rate of overactive bladder symptoms is higher in the non‐FTA patients. Isolated MUS procedure and younger age are significant risk factors of failure to attend in the longer term.
Is there a correlation between bacterial vaginosis and preterm labour in women in the Otago region of New Zealand?
Authors: LIM Kah Heng , BROOKS Heather , MCDOUGAL Rebecca , BURTON Jeremy , DEVENISH Celia , DE SILVA Thilinie
Published: April 2010

Context:  While an association between bacterial vaginosis and preterm labour has been established, the relative contribution of this condition remains controversial.

Objective:  To determine whether bacterial vaginosis is likely to be an important contributing factor in preterm births in Otago, New Zealand, a region with a historically high rate of such births.

Design and setting:  Women receiving antenatal care from Queen Mary Maternity Services were studied prospectively. Cases were women presenting with preterm labour or premature rupture of membranes. Controls had uncomplicated pregnancies and delivered at term.

Patients and methods:  Vaginal swabs from 44 cases and 72 controls were examined by amplification of bacterial 16S rRNA genes followed by denaturing gel gradient electrophoresis. Atopobium vaginae, a bacterial vaginosis‐associated bacterium, was detected in a separate polymerase chain reaction. Nugent Gram stain scoring of vaginal swabs from 44 cases and 69 controls was also carried out.

Results:  Denaturing gel gradient electrophoresis revealed three major types of band profiles corresponding to normal, intermediate and bacterial vaginosis microflorae. There were significantly more cases with bacterial vaginosis band profiles compared with controls (P = 0.024). More cases had intermediate or bacterial vaginosis Nugent scores compared with controls (P = 0.022). Conversely, controls were more likely to have normal scores than cases (P = 0.022). Atopobium vaginae was equally distributed between the cases and controls.

Conclusions:  Women in the Otago region undergoing preterm labour were approximately twice as likely to have a bacterial vaginosis type vaginal microflora as controls. In preterm labour, the incidence of bacterial vaginosis was comparable with that found elsewhere, suggesting that current guidelines for treatment and detection of this condition are appropriate.
FLOW‐CYTOMETRIC CHARACTERIZATION OF THE CELL‐SURFACE GLYCANS OF SYMBIOTIC DINOFLAGELLATES (SYMBIODINIUM SPP.)1
Authors: Logan Daniel D. K. , LaFlamme Anne C. , Weis Virginia M. , Davy Simon K.
Published: April 2010

Symbiodinium spp. dinoflagellates are common symbionts of marine invertebrates. The cell‐surface glycan profile may determine whether a particular Symbiodinium is able to establish and maintain a stable symbiotic relationship. To characterize this profile, eight Symbiodinium cultures were examined using eight glycan‐specific fluorescent lectin probes. Confocal imaging and flow‐cytometric analysis were used to determine significant levels of binding of each probe to the cell surface. No significant variation in glycan profile was seen within each Symbiodinium culture, either over time or over growth phase. No cladal trends in glycan profile were found, but of note, two different Symbiodinium cultures (from clades A and B) isolated from one host species had very similar profiles, and two other cultures (from clades B and F) from different host species had identical profiles. Two lectin probes were particularly interesting: concanavalin A (ConA) and Griffonia simplicifolia‐II (GS‐II). The ConA probe showed significant binding to all Symbiodinium cultures, suggesting the widespread presence of cell‐surface mannose residues, while the GS‐II probe, which is specific for glycans possessing N‐acetyl groups, showed significant binding to six of eight Symbiodinium cultures. Other probes showed significant binding to the following percentage of Symbiodinium cultures examined: wheat germ agglutinin (WGA), 37.5%; peanut agglutinin (PNA), 50%; Helix pomatia agglutinin (HPA), 50%; phytohemagglutinin‐L (PHA‐L), 62.5%; soybean agglutinin (SBA), 50%; and Griffonia simplicifolia‐IB4 (GS‐IB4), 12.5%. This study highlights the complexity of cell‐surface glycan assemblages and their potential role in the discrimination of different dinoflagellate symbionts by cnidarian hosts.
CELL‐WALL POLYMER MAPPING IN THE COENOCYTIC MACROALGA CODIUM VERMILARA (BRYOPSIDALES, CHLOROPHYTA)1
Authors: Fernández Paula V. , Ciancia Marina , Miravalles Alicia B. , Estevez José Manuel
Published: April 2010

Cell walls in the coenocytic green seaweed Codium vermilara (Olivi) Chiaje (Bryopsidales, Chlorophyta) are composed of ∼32% (w/w) β‐(1→4)‐d‐mannans, ∼12% sulfated polysaccharides (SPs), and small amounts of hydroxyproline‐rich glycoprotein‐like (HRGP‐L) compounds of the arabinogalactan proteins (AGPs) and arabinosides (extensins). Similar quantities of mannans and SPs were reported previously in the related seaweed C. fragile (Suringar) Hariot. Overall, both seaweed cell walls comprise ∼40%–44% of their dry weights. Within the SP group, a variety of polysaccharide structures from pyruvylated arabinogalactan sulfate and pyruvylated galactan sulfate to pyranosic arabinan sulfate are present in Codium cell walls. In this paper, the in situ distribution of the main cell‐wall polymers in the green seaweed C. vermilara was studied, comparing their arrangements with those observed in cell walls from C. fragile. The utricle cell wall in C. vermilara showed by TEM a sandwich structure of two fibrillar‐like layers of similar width delimiting a middle amorphous‐like zone. By immuno‐ and chemical imaging, the in situ distribution of β‐(1→4)‐d‐mannans and HRGP‐like epitopes was shown to consist of two distinct cell‐wall layers, whereas SPs are distributed in the middle area of the wall. The overall cell‐wall polymer arrangement of the SPs, HRGP‐like epitopes, and mannans in the utricles of C. vermilara is different from the ubiquitous green algae C. fragile, in spite of both being phylogenetically very close. In addition, a preliminary cell‐wall model of the utricle moiety is proposed for both seaweeds, C. fragile and C. vermilara.
PREY SPECIFICITY AND FEEDING OF THE THECATE MIXOTROPHIC DINOFLAGELLATE FRAGILIDIUM DUPLOCAMPANAEFORME1
Authors: Park Myung Gil , Kim Miran
Published: April 2010

In summer to autumn of 2008, a recently described thecate mixotrophic dinoflagellate, Fragilidium duplocampanaeforme Nézan et Chomérat, occurred in Masan Bay, Korea, where it frequently contained bright‐orange fluorescent inclusions. Using cultures of F. duplocampanaeforme isolated from Masan Bay, we investigated feeding, digestion, and prey specificity of this mixotroph. F. duplocampanaeforme fed exclusively on Dinophysis spp. when offered a variety of prey including dinoflagellates, a raphidophyte, a cryptophyte, a ciliate, and diatoms separately. In addition, F. duplocampanaeforme had allelopathic effects on other organisms, including cell immobilization/motility decrease (in Dinophysis acuminata, D. caudata, D. fortii, D. infundibulus, Gonyaulax polygramma, Heterocapsa triquetra, and Prorocentrum triestinum), breaking of cell chains (in Cochlodinium polykrikoides), cell death (in Prorocentrum minimum), and temporary cyst formation (in Scrippsiella trochoidea). F. duplocampanaeforme engulfed whole Dinophysis cells through the sulcus. About 1 h after ingestion, F. duplocampanaeforme became immobile and shed all thecal plates. The ecdysal cyst persisted for ∼7 h, during which the ingested prey was gradually digested. These observations suggest that F. duplocampanaeforme may play an important role in the Dinophysis population dynamics in the field.
POLYSACCHARIDE RELEASE BY APHANOTHECE HALOPHYTICA INHIBITS CYANOBACTERIA/CLAY FLOCCULATION1
Authors: Chen Li , Men Xiao , Ma Meirong , Li Pengfu , Jiao Qingcai , Lu Shan , Kong Fanxiang , Wu Shengcai
Published: April 2010

Many microalgae release polysaccharides, but the effects of the polysaccharides on mutual flocculation of microalgae and clay in aquatic environments have not been well studied. Aphanothece halophytica Frémy is a bloom‐forming cyanobacterium in salterns and can release large amounts of polysaccharide (AH‐RPS). In the present study, we investigated the effect of AH‐RPS on mutual flocculation of cyanobacterium and clay and further explored the mechanisms by which AH‐RPS affected mutual flocculation. We determined that AH‐RPS possessed clay‐dispersing activity as defined as the ability to inhibit the flocculation and sedimentation of clay suspensions in water. Supplementation of AH‐RPS in cyanobacterial cell suspensions and in the culture media containing the same kaolin clay concentration dose dependently decreased flocculation of cyanobacterial cells and increased clay‐dispersing activity. These findings indicate that the clay‐dispersing activity of AH‐RPS was related to its inhibitory effect on mutual flocculation of cyanobacterial cells and clay particles. Moreover, the clay‐dispersing activity of AH‐RPS was stable from pH 3 to pH 10 and was increased by adding NaCl, MgCl2, CaCl2, or low concentrations of KCl (up to 0.4 M). Taken together, our data suggest that AH‐RPS might maintain its clay‐dispersing activity and inhibit mutual flocculation of microalgae and suspended clay in saltern brine.
Potentially Avoidable Hospitalizations of Nursing Home Residents: Frequency, Causes, and Costs
Authors: Ouslander Joseph G. , Lamb Gerri , Perloe Mary , Givens JoVonn H. , Kluge Linda , Rutland Tracy , Atherly Adam , Saliba Debra
Published: April 2010

OBJECTIVES: To examine the frequency and reasons for potentially avoidable hospitalizations of nursing home (NH) residents.

DESIGN: Medical records were reviewed as a component of a project designed to develop and pilot test clinical practice tools for reducing potentially avoidable hospitalization.

SETTING: NHs in Georgia.

PARTICIPANTS: In 10 NHs with high and 10 with low hospitalization rates, 10 hospitalizations were randomly selected, including long‐ and short‐stay residents.

MEASUREMENTS: Ratings using a structured review by expert NH clinicians.

RESULTS: Of the 200 hospitalizations, 134 (67.0%) were rated as potentially avoidable. Panel members cited lack of on‐site availability of primary care clinicians, inability to obtain timely laboratory tests and intravenous fluids, problems with quality of care in assessing acute changes, and uncertain benefits of hospitalization as causes of these potentially avoidable hospitalizations.

CONCLUSION: In this sample of NH residents, experienced long‐term care clinicians commonly rated hospitalizations as potentially avoidable. Support for NH infrastructure, clinical practice and communication tools for health professionals, increased attention to reducing the frequency of medically futile care, and financial and other incentives for NHs and their affiliated hospitals are needed to improve care, reduce avoidable hospitalizations, and avoid unnecessary healthcare expenditures in this population.
Place of Death of Older Persons with Dementia. A Study in Five European Countries
Authors: Houttekier Dirk , Cohen Joachim , Bilsen Johan , Addington‐Hall Julia , Onwuteaka‐Philipsen Bregje D. , Deliens Luc
Published: April 2010

The aging of the European population will lead to a rapid increase in dementia cases in the coming decades, posing challenges for the organization and provision of end‐of‐life care. Studying the place of death of patients with dementia, and what determines it, is relevant in this context. Using death certificates, the deaths of people aged 65 and older whose underlying cause of death was a dementia‐related disease was studied in Belgium, the Netherlands, England, Scotland, and Wales. Between 50% (Wales) and 92% (Netherlands) of patients with dementia died in a nursing home and between 3% (Netherlands) and 46% (Wales) in hospital. Home death was rare (3–5%) except in Belgium (11%). Multivariate analysis showed that place of death was related to age, sex, available hospital and nursing home beds, and country of residence. Although availability of hospital and nursing home beds partially explained the variation between countries, considerable variation remained even after controlling for that, plus age, sex, and social support. Place of death from dementia differed significantly between the countries studied. In all countries, a majority of patients with dementia died in a long‐term care facility. The provision of appropriate long‐term care facilities with appropriate staffing could be the primary policy instrument that could help patients with dementia avoid dying in the hospital and ensure quality of end‐of‐life care in Europe.
Workshop on Immunizations in Older Adults: Identifying Future Research Agendas
Authors: High Kevin P. , D'Aquila Richard T. , Fuldner Rebecca A. , Gerding Dale N. , Halter Jeffrey B. , Haynes Laura , Hazzard William R. , Jackson Lisa A. , Janoff Edward , Levin Myron J. , Nayfield Susan G. , Nichol Kristin L. , Prabhudas Mercy , Talbot Helen K. , Clayton Charles P. , Henderson Randi , Scott Catherine M. , Tarver Erika D. , Woolard Nancy F. , Schmader Kenneth E.
Published: April 2010

Goals for immunization in older adults may differ from those in young adults and children, in whom complete prevention of disease is the objective. Often, reduced hospitalization and death but also averting exacerbation of underlying chronic illness, functional decline, and frailty are important goals in the older age group. Because of the effect of age on dendritic cell function, T cell‐mediated immune suppression, reduced proliferative capacity of T cells, and other immune responses, the efficacy of vaccines often wanes with advanced age. This article summarizes the discussion and proceedings of a workshop organized by the Association of Specialty Professors, the Infectious Diseases Society of America, the American Geriatrics Society, the National Institute on Aging, and the National Institute of Allergy and Infectious Diseases. Leading researchers and clinicians in the fields of immunology, epidemiology, infectious diseases, geriatrics, and gerontology reviewed the current status of vaccines in older adults, identified knowledge gaps, and suggest priority areas for future research. The goal of the workshop was to identify what is known about immunizations (efficacy, effect, and current schedule) in older adults and to recommend priorities for future research. Investigation in the areas identified has the potential to enhance understanding of the immune process in aging individuals, inform vaccine development, and lead to more‐effective strategies to reduce the risk of vaccine‐preventable illness in older adults.
Adiponectin Isoforms in Elderly Patients with or without Coronary Artery Disease
Authors: Rizza Stefano , Gigli Fabrizio , Galli Angelica , Micchelini Barbara , Lauro Davide , Lauro Renato , Federici Massimo
Published: April 2010

OBJECTIVES: To study the distribution of adiponectin isoforms in a group of very old patients.

DESIGN: Cross‐sectional.

SETTING: Geriatric ambulatory clinic of the Department of Medicine at Policlinico “Tor Vergata.”

PARTICIPANTS: One hundred eight elderly adults (mean age 85.0±3.2) with or without a history of a previous myocardial infarction as proof of established coronary artery disease (CAD) at least 3 months before entry into the study. Accordingly, subjects were divided into CAD positive (CAD+, n=50) and CAD negative (CAD−, n=58).

MEASUREMENT: Assessment of adiponectin isoforms along with metabolic, lipid, and inflammatory profiles.

RESULTS: CAD+ subjects had significantly higher levels of total adiponectin (Tot‐Ad) and low‐molecular‐weight adiponectin (LMW‐Ad) than CAD− subjects (P=.008 for both). LMW‐Ad and high‐sensitivity C‐reactive protein were positively correlated, even after adjustment for waist circumference, sex, glomerular filtration rate, and presence of diabetes mellitus (correlation coefficient (r)=0.25, P=.05). This association was not confirmed when CAD+ subjects were analyzed alone. A positive association was found in CAD+ subjects between brain natriuretic peptide (BNP), high‐molecular‐weight adiponectin (HMW‐Ad), and Tot‐Ad (r=0.798 and r=0.795, P<.001 for all) but not LMW‐Ad.

CONCLUSION: Distribution of adiponectin isoforms differed in populations of elderly subjects according to the presence of coronary atherosclerosis. The data support the hypothesis for a protective role of LMW‐Ad during aging, although additional studies are needed to definitively clarify whether LMW‐Ad plays a protective role in older people with a history of CAD.
A Fourth‐Year Medical School Clerkship That Addressed Negative Attitudes Toward Geriatric Medicine
Authors: Golden Adam G. , van Zuilen Maria H. , Mintzer Michael J. , Issenberg S. Barry , Silverman Michael A. , Roos Bernard A.
Published: April 2010

Despite extensive educational efforts, many medical students still have negative attitudes toward the field of geriatric medicine and the care of older adult patients. This article describes a fourth‐year geriatric clerkship that addressed this issue by providing opportunities for students to actively discuss many of the negative stereotypes that exist regarding geriatric medicine. Emphasis was also placed on personalizing the course content to show the relevance of geriatric medicine to all medical students. During the 2008/09 academic year, 150 students completed the rotation. Although no students expressed an interest in pursuing a career as a geriatrician, they expressed a highly favorable evaluation of this personalized geriatric clerkship and voted this clerkship “the most outstanding clinical course” at the medical school.
Immigrant Status and Intention to Leave of Nursing Assistants in U.S. Nursing Homes
Authors: Sloane Philip D. , Williams Christianna S. , Zimmerman Sheryl
Published: April 2010

OBJECTIVES: To better understand the characteristics and perceptions of immigrants working as nursing assistants in U.S. nursing homes and to determine whether immigrant status is linked to job turnover.

DESIGN: Analysis of interview data from a nationally representative sample of nursing assistants working in U.S. nursing homes.

SETTING: Five hundred eighty‐two nursing homes included in the 2004 National Nursing Assistant Survey.

PARTICIPANTS: Two thousand eight hundred eighty‐one nursing assistants.

MEASUREMENTS: Proportion of respondents who were non‐U.S. born or naturalized citizens and relationship between these characteristics and measures of job satisfaction and intention to leave within the subsequent year.

RESULTS: Fourteen percent (13.9%) of nursing assistants employed in U.S. nursing homes were immigrants. Immigrants tended to be better educated; more often male, nonwhite, and Hispanic; and concentrated in large, urban facilities than nonimmigrants. They reported feeling less respected by residents and families but not less respected by supervisors, and they were more likely to report intention to leave the job within 1 year. In multivariate analyses, demographic factors, length of time on the job, and noncitizen status were independently associated with plans to leave within a year.

CONCLUSION: Attention to the unique factors associated with immigrant status, such as the need to improve communication and garner respect from patients and families, can assist policy‐makers, facility administrators, and medical directors in more effectively attracting, training, and supporting this growing segment of the nursing assistant labor pool.
Tooth Loss and Periodontal Disease Predict Poor Cognitive Function in Older Men
Authors: Kaye Elizabeth Krall , Valencia Aileen , Baba Nivine , Spiro Avron , Dietrich Thomas , Garcia Raul I.
Published: April 2010

OBJECTIVES: To determine whether rates of tooth loss, periodontal disease progression, and caries incidence predict cognitive decline in men.

DESIGN: Prospective study.

SETTING: Community‐dwelling men enrolled in the Veterans Affairs Dental Longitudinal Study.

PARTICIPANTS: Five hundred ninety‐seven dentate men aged 28 to 70 at study baseline who have been followed up to 32 years.

MEASUREMENTS: Oral examinations were conducted approximately every 3 years. Periodontal disease measures included probing pocket depth and radiographic alveolar bone height. Participants underwent cognitive testing beginning in 1993. Low cognitive status was defined as less than 25 points or less than 90% of the age‐ and education‐specific median on the Mini‐Mental State Examination (MMSE) and less than 10 points on a spatial copying task.

RESULTS: Each tooth lost per decade since the baseline dental examination increased the risks of low MMSE score (hazard ratio (HR)=1.09, 95% confidence interval (CI)=1.01–1.18) and low spatial copying score (HR=1.12, CI=1.05–1.18). Risks were greater per additional tooth with progression of alveolar bone loss (spatial copying: HR=1.03, CI=1.01–1.06), probing pocket depth (MMSE: HR=1.04, CI=1.01–1.09; spatial copying: HR=1.04, CI=1.01–1.06), and caries (spatial copying: HR=1.05, CI=1.01–1.08). Risks were consistently higher in men who were older than 45.5 at baseline than in younger men.

CONCLUSION: Risk of cognitive decline in older men increases as more teeth are lost. Periodontal disease and caries, major reasons for tooth loss, are also related to cognitive decline.
Understanding Interest in the Second Year of Life
Authors: MacPherson Amy C. , Moore Chris
Published: April 2010

Infants (n = 24, mean age 13 months and n = 24, mean age 19 months) were tested on an extension of the method introduced by Tomasello and Haberl (2003) to examine the understanding of another person’s interest in a novel object. Four objects were presented serially. For two objects, infants played with an experimenter. The infant played with one object alone, and the experimenter played with one object alone. Finally, all four objects were presented together, and the experimenter excitedly asked for one without indicating which. Results showed that younger infants tended to chose the object that they had not yet played with, whereas older infants were significantly more likely to choose the object that the experimenter had not yet played with. These results are discussed in the context of research on the development of understanding diversity of simple object‐directed attitudes in the second year of life.
Neural Correlates of Encoding Predict Infants’ Memory in the Paired‐Comparison Procedure
Authors: Snyder Kelly A.
Published: April 2010

The present study used event‐related potentials (ERPs) to monitor infant brain activity during the initial encoding of a previously novel visual stimulus, and examined whether ERP measures of encoding predicted infants’ subsequent performance on a visual memory task (i.e., the paired‐comparison task). A late slow wave component of the ERP measured at encoding predicted infants’ immediate performance in the paired‐comparison task: amplitude of the late slow wave at right‐central and temporal leads decreased with stimulus repetition, and greater decreases at right‐anterior‐temporal leads during encoding were associated with better memory performance at test. By contrast, neither the amplitude nor latency of the negative central (Nc) component predicted infants’ subsequent performance in the paired‐comparison task. These findings are discussed with respect to a biased competition model of visual attention and memory.
Stress Pattern Preference in Spanish‐Learning Infants: The Role of Syllable Weight
Authors: Pons Ferran , Bosch Laura
Published: April 2010

As a result of exposure, infants acquire biases that conform to the rhythmic properties of their native language. Previous lexical stress preference studies have shown that English‐ and German‐, but not French‐learning infants, show a bias toward trochaic words. The present study explores Spanish‐learning infants' lexical stress preferential patterns and the role of syllable weight at 9 months of age. Spanish is a syllable‐timed language with no vowel reduction and variable stress. Around 50% of the word types in Spanish are disyllabic, with a superior proportion of trochees than iambs (60% and 40%, respectively). Experiment 1 with CV.CV pseudo‐words failed to reveal a clear trochaic bias in 9‐month‐old Spanish‐learning infants. However, when preference was explored with items containing a heavy syllable (CVC.CV and CV.CVC, respectively), both a trochaic (Experiment 2) and an iambic preference (Experiment 3) could be elicited. These results suggest that knowledge about the close and highly regular link between heavy syllables and stress assignment in Spanish can be easily acquired and determines infants' preference at 9 months of age, while for CV.CV items, the trochaic bias appears to be weak. Our results broaden the current knowledge on the factors that determine the emergence of rhythmic biases.
Isolation and Identification of Three By‐products Found in Methylamphetamine Synthesized by the Emde Route
Authors: Salouros Helen , Collins Michael , George Adrian V. , Davies Stephen
Published: April 2010

This article describes the isolation and structural elucidation of three compounds produced during the synthesis of methylamphetamine by the so‐called “Emde” procedure. The “Emde” procedure involves the preparation of the intermediate chloropseudoephedrine or chloroephedrine from ephedrine or pseudoephedrine, respectively. The intermediates are then reduced to methylamphetamine with hydrogen under pressure in the presence of a catalyst. The by‐product compounds were isolated from methylamphetamine by column chromatography and liquid chromatography (LC). Proton nuclear magnetic resonance spectroscopy (1H NMR), carbon nuclear magnetic resonance spectroscopy (13C NMR), and nanospray quadrupole‐time of flight‐mass spectrometry (Q‐TOF‐MS) were used to identify them as two stereoisomers of the compound N, N′‐dimethyl‐3,4‐diphenylhexane‐2,5‐diamine and N‐methyl‐1‐{4‐[2‐(methylamino)propyl]phenyl}‐1‐phenylpropan‐2‐amine.
Aspergillus PCR testing: results from a prospective PCR study within the AmBiLoad trial
Authors: Hummel Margit , Spiess Birgit , Cornely Oliver A. , Dittmer Martin , Mörz Handan , Buchheidt Dieter
Published: April 2010

Objectives:  Invasive fungal infection (IFI) is a major cause of morbidity and mortality in severely immunocompromised patients and is difficult to diagnose. The significance of molecular methods for diagnosis of IFI is still controversial. In a subset of patients treated within the AmBiLoad Trial, samples were investigated prospectively by a nested Aspergillus PCR assay to re‐evaluate the significance of PCR in this setting.

Patients and methods:  In the randomized, prospective multicenter AmBiLoad trial, patients with proven or probable IFI were randomized to receive liposomal amphotericin B (L‐AMB) 3 or 10 mg/kg QD for 14 d followed by L‐AMB 3 mg/kg QD. From 91 patients, 459 serial samples (98% blood samples) were investigated by a nested PCR assay for Aspergillus DNA. All samples were investigated in our laboratory with a previously described nested and a quantitative PCR assay. As required by the study protocol, serial Aspergillus antigen galactomannan was performed. IFI was defined according to modified EORTC/MSG 2002 criteria as applied in the AmBiLoad trial.

Results:  Seven and 52 patients had proven and probable IFI according to modified EORTC/MSG criteria, respectively. The median number of samples investigated per patient was 4. Seventy percent of samples were obtained during treatment with antifungal study medication. Forty‐three samples gave positive PCR results. Patients with an unfavorable outcome had a significantly higher rate of positive PCR results (48% versus 21%).

Conclusions:  The sensitivity of Aspergillus PCR testing is limited during antifungal therapy. The tendency for persistently positive PCR results to indicate a poor prognosis has to be confirmed in further studies.
Understanding the Effects of Sildenafil Treatment on Erection Maintenance and Erection Hardness
Authors: Claes Hubert I.M. , Goldstein Irwin , Althof Stanley E. , Berner Michael M. , Cappelleri Joseph C. , Bushmakin Andrew G. , Symonds Tara , Schnetzler Gabriel
Published: April 2010

Introduction

Erectile dysfunction (ED) is defined as the inability to attain and/or maintain penile erection sufficient for satisfactory sexual performance. Although intuitively related, the link between erection hardness and erection maintenance has not been formally established and quantified.

Aim

To understand the components of erection maintenance through statistical modeling.

Methods

Data from a double-blind placebo-controlled trial of fixed-dose sildenafil (100 or 50 mg, 8 weeks) with open-label extension of flexible-dose sildenafil (100 and 50 mg, 4 weeks) were analyzed. Erection maintenance was assessed with item 4 (how often erection was maintained) or item 5 (difficulty in maintaining erection) of the International Index of Erectile Function (IIEF). Erection hardness was assessed with the Erection Hardness Score.

Main Outcome Measures

Longitudinal modeling estimated mean treatment differences averaged over the double-blind phase for sildenafil 100 mg vs. placebo and 50 mg vs. placebo. Statistical mediation analysis was applied to partition the effect of sildenafil (pooled into one treatment group) on erection maintenance directly and indirectly through erection hardness.

Results

Longitudinal mean differences for sildenafil 100 and 50 mg vs. placebo were high (P <0.0001 for each), with large standardized effect sizes (>0.8). Mediation modeling showed that sildenafil treatment affected maintenance directly as well as indirectly via erection hardness, when measured by IIEF item 4 (direct effect, 44.6%; indirect effect, 55.4%) or IIEF item 5 (direct effect, 56.9%; indirect effect, 43.1%).

Conclusions

Sildenafil treatment significantly improved erection maintenance, a physiologic requirement for satisfactory sexual performance. According to our model, only approximately half of the effect of sildenafil on erection maintenance was estimated to be driven through direct effects. Rather, the effect of sildenafil on erection maintenance seems to be substantially driven by erection hardness. Therefore, achievement of optimal initial erection hardness appears to be an important treatment goal for enhancing erection maintenance and achieving successful ED treatment.
Angiotensin-Converting Enzyme Polymorphism and Erectile Dysfunction Complaints in the Brazilian Population
Authors: Andersen Monica L. , Guindalini Camila , Santos-Silva Rogerio , Bittencourt Lia R.A. , Tufik Sergio
Published: April 2010

Introduction

Angiotensin-converting enzyme (ACE) is the major regulator of circulatory homeostasis. An insertion/deletion (I/D) polymorphism in the ACE gene has been associated with marked differences in serum ACE levels and with various cardiovascular diseases. Limited and conflicting data have been published on the influence of this genetic variant on the pathophysiology of erectile dysfunction (ED).

Aim

To evaluate a potential association between ACE gene polymorphism and ED complaints in a population-based sample in São Paulo, Brazil.

Main Outcome Measures

The prevalence of ED complaints was estimated according to previously validated 8 item questionnaire.

Methods

A total of 449 men were enrolled in the Epidemiologic Sleep Study and answered an 8-item questionnaire to ascertain sexual performance/ED and satisfaction. ACE gene polymorphism were genotyped using a standard polymerase chain reaction method.

Results

No significant case–control difference was observed for the ACE gene I/D polymorphism either by genotype or allele-wise. Because age is a significant risk factor for ED complaints in our sample, we carried out analyses stratifying the sample by age group. The ID and II genotypes were significantly more frequent in ED complaint cases (88.9%) compared with controls (57.1%) in the men between 40 and 55 years of age. The frequency of the I allele was also significantly higher in individuals complaining of ED (66.7%) compared with men with no complaints (39.0%) (odds ratio=3.12; 95% confidence interval=1.48–6.59). Correction for potential confounding variables, including genetic ancestry, did not affect the strength of the association.

Conclusions

The findings of the present study suggest that the I/D polymorphism or another variant in close linkage disequilibrium with it may play a role in the development of ED in a specific age group and provides progress towards the understanding of the interaction between genetic factors and the risk of ED.
Transglanular Repair of Impending Penile Prosthetic Cylinder Extrusion
Authors: Shindel Alan W. , Brant Will O. , Mwamukonda Kuwong , Bella Anthony J. , Lue Tom F.
Published: April 2010

Introduction

Penile prosthetic devices are highly satisfactory in the management of erectile dysfunction but carry a number of risks including the potential for erosion. In some cases, impending extrusion can be identified and managed before frank erosion occurs.

Aims

To report our results using a transglanular approach for management of impending distal erosion of penile prosthetic devices.

Methods

Patients who presented with impending erosion of penile prosthetics were identified by retrospective chart review. Patients who were managed with a transglanular surgical approach constitute the study group.

Main Outcome Measures

Clinical data were culled from the charts. Identified patients were contacted and were asked a battery of questions regarding their subjective assessment of the treatment’s efficacy.

Results

Six men were identified. Mean age at time of surgery was 56 years. Four men had had implants placed within the past 2 years and two had implants that had been in place for greater than 12 years. Mean operative time was 25 minutes. Four patients were successfully managed with a single repair procedure. Two men required repeat revision surgery. Of men that were available for additional postoperative contact, three of four reported satisfaction with the procedure.

Conclusions

The transglanular approach for repair of impending distal erosion of penile prosthetics is a quick and minimally morbid procedure that produces satisfactory results in the majority of patients. Further refinements of technique will likely lead to greater overall improvement in outcomes.
Postoperative fever: A normal inflammatory response or cause for concern
Authors: Burke Lindsay
Published: April 2010

Purpose: To devise a systematic diagnostic strategy displayed in algorithm format to assist advanced practice registered nurses (APRNs) in determining when postoperative fever is simply a normal inflammatory response and when further investigation is needed to rule out infection or other serious noninfectious causes of fever.

Data sources: Selected research and clinical articles.

Conclusions: Postoperative fever is often a normal inflammatory response to surgery, but it can also be a manifestation of a serious underlying infectious or noninfectious etiology. Therefore, it is important to approach each instance of postoperative fever in a systematic manner.

Implications for practice: The role of the APRN in managing surgical patients requires being able to accurately assess and evaluate the cause of postoperative fever and take action accordingly. That means taking into account a variety of factors (e.g., patient's medical history, physical examination findings, and type of surgery), so that appropriate diagnostic tests can be ordered to evaluate the cause of the postoperative fever. By being aware of the causes of postoperative fever, the APRN can also take prophylactic action to decrease the risk associated with many of these potential febrile causes.
Sickle‐cell anemia and pulmonary hypertension
Authors: Ninkovich Glenda M. , Miller Sally K. , Alpert Patricia T.
Published: April 2010

Purpose: To provide nurse practitioners (NPs) information about sickle‐cell disease (SCD) and pulmonary hypertension (PHTN) as a complication. A case study is presented to illustrate the diagnosis of PHTN in a patient with SCD. Clinical manifestations, diagnosis, and interventions for both SCD and PHTN are also discussed.

Data source: A literature search to support this case review was conducted in PubMed and SCOPUS using key search words. Specific information for the case study was obtained from a patient in a primary care setting.

Conclusion: Pulmonary hypertension is frequently diagnosed secondary to hemoglobinopathies such as SCD. Patients with sickle‐cell anemia, a lifelong hereditary hemoglobinopathy, are now surviving into adulthood because of the advances made in treatment. About one third of these patients develop pulmonary hypertension, a complication that carries a 40% mortality rate. Delayed diagnosis can affect the patient's quality of life. Timely diagnosis and referral is imperative, but only if the advanced practitioner is able to recognize this common complication.

Implications for practice: Many patients with SCD are seen in primary care practices. Such is the situation for the patient in this case study. Familiarity with pulmonary hypertension secondary to SCD can increase the awareness of NPs of this potential consequence and initiate early diagnostic evaluation.
Radiation exposure and diagnostic imaging
Authors: Richardson Luann
Published: April 2010

Purpose: The purpose of this article is to increase clinician awareness of current radiation exposures of diagnostic testing, discuss current practice patterns, and suggest strategies to address issues at the systems level, institution level, and the healthcare provider level.

Data sources: Evidence‐based literature including interdisciplinary peer‐reviewed articles in the biological and health‐related fields.

Conclusions: Radiation exposure related to diagnostic testing is often higher than anticipated for both the clinician and the patient. Strategies to address radiation exposure need to be implemented at many different levels in the system. Best practice initiatives are surfacing and will require a team approach for success.

Implications for practice: Nurse practitioners need to be aware of the benefits and risks of diagnostic testing involving radiation exposure. Patients should also be informed of potential risks and benefits. Alternative imaging should be considered and repetitive testing should be monitored closely.
Nurse practitioners as an underutilized resource for health reform: Evidence‐based demonstrations of cost‐effectiveness
Authors: Bauer Jeffrey C.
Published: April 2010

Healthcare reform in 2009 was motivated by an imperative to reduce the relentless increase in spending on medical care. Many efforts to solve the problem focused on applying proven principles of evidence‐based practice and cost‐effectiveness to find the least‐expensive way to produce a specific clinical service of acceptable quality. This paper combines economic analysis and reviews published literature to show how the goals of healthcare reform can be accomplished by allowing independently licensed nurse practitioners to provide their wide range of services directly to patients in a variety of clinical settings. The paper presents extensive, consistent evidence that nurse practitioners provide care of equal or better quality at lower cost than comparable services provided by other qualified health professionals.
The Evaluation of Rural Development Policy in the EU L’évaluation de la politique de développement rural dans l’Union européenne Die Evaluation der Politik zur Entwicklung des ländlichen Raums in der EU
Authors: Bradley Dylan , Dwyer Janet , Hill Berkeley
Published: April 2010

The Evaluation of Rural Development Policy in the EU

Evaluation is firmly established as part of rural development policymaking in the EU. A requirement to evaluate is set out in the Rural Development Regulation, the legal basis for spending EU funds on agreed aspects of rural development, which also stipulates the process to be used. Member States are responsible for ensuring that independent ex ante, mid‐term and ex post evaluations are carried out for each seven‐year Rural Development Programme (RDP), but with inputs from the Commission, notably on common evaluation questions to be used in all countries. Such a heavily structured system has both advantages and disadvantages. Consistency of approach enables synthesis of evaluation results at the EU level and provides a degree of quality control. However, it constrains the ability of evaluators to pursue issues which may be of importance locally or to other stakeholders. Technical details, especially the timing of evaluation stages, also diminish the ability to learn from past programmes. Data availability remains an important issue. Nevertheless, our experience is that it is both possible and important to learn from evaluating RDPs, not only to measure their apparent achievements, but also to enhance the quality of the policy process, at all levels.