bluuebunny/crossref_metadata_2025 huggingface dataset:
Rebirthing the Clinic
Authors: Latimer Joanna , Featherstone Katie , Atkinson Paul , Clarke Angus , Pilz Daniela T. , Shaw Alison
Published: August 2006

The article reconsiders the nature and location of science in the development of genetic classification. Drawing on field studies of medical genetics, we explore how patient categorization is accomplished in between the clinic and laboratory. We focus on dysmorphology, a specialism concerned with complex syndromes that impair physical development. We show that dys-morphology is about more than fitting patients into prefixed diagnostic categories and that diagnostic process is marked by moments of uncertainty, ambiguity, and deferral. We describe how different forms of evidence are brought into play and how patterns of physical features are identified as genetic or not. We suggest that clinical categorical work helps articulate the genetic as an emergent domain of medical classification and that moments of ambiguity and deferral create an imperative space that helps legitimate the need for more technoscience, and consequently, more clinical judgment with which to fix the genetic future.
The Influence of Basic Conditioning Factors on Healthy Behaviors, Self-Efficacy, and Self-Care in Adults
Authors: Callaghan Donna
Published: August 2006

This article presents secondary statistical analyses of data from a 2003 study by the author investigating the relationships among health-promoting self-care behaviors, self-care self-efficacy, and self-care agency in an adult population. The purpose of this article is to identify the influences of selected basic conditioning factors on the practice of healthy behaviors, self-efficacy beliefs, and ability for self-care. The sample consisted of 379 adult participants who completed four research instruments: Health-Promoting Lifestyle Profile II Scale, Self-Rated Abilities for Health Practices Scale, Exercise of Self-Care Agency Scale, and a demographic questionnaire assessing basic conditioning factors. Statistically significant relationships were found between the following basic conditioning factors and the study variables: age, gender, income, marital status, education, race, and routine practice of religion. These results give direction for nursing interventions that promote self-care and holistic health in an adult population.
Delivering psychosocial interventions for people with dementia in primary care
Authors: Iliffe Steve , Wilcock Jane , Haworth Deborah
Published: August 2006

Psychosocial interventions are emerging as potentially important therapies for primary care, partly to fill a therapy ‘vacuum’ and partly because the evidence base for their effectiveness is growing. They can be labour-intensive and their effectiveness depends on the skills of those working with people with dementia. This creates an immediate problem, since the workforce necessary to extend psychosocial interventions beyond innovative schemes does not exist. The existing workforce in health and social care in the UK is already too small to implement all of the changes required by the National Service Framework for Older People and National Service Framework for Mental Health. This has clear implications for the labour-intensive work of dementia care. If the job categories cannot expand as fast as is needed, the tasks of dementia care will have to be redistributed, suggesting that skills will have to be shared and transferred between different disciplines. The question for service commissioners and providers is: how can smarter working be achieved? This article attempts to answer this question with a qualitative study in general practice settings and with specialist informants. A triangulation approach to data collection was used, involving nominal groups, individual interviews and participant observation. We identified five skills that appear key in primary care: pattern recognition; deductive synthesis to reduce uncertainty; dialogue and disclosure; disability perspectives; and case management with shared care. The paucity of understanding of psychosocial interventions across disciplines who offer dementia care in the community is, we suggest, a major problem for those attempting to deploy such interventions in primary care settings. The pervasive tendency to frame the tasks of dementia care in terms of a medical management model brings responses that can undermine the view that people with dementia may in fact have a tractable disability. We use our findings to suggest solutions to this problem.
Extraction-Dependent Effects of American Ginseng (Panax quinquefolium) on Human Breast Cancer Cell Proliferation and Estrogen Receptor Activation
Authors: King Mandy L. , Adler Stuart R. , Murphy Laura L.
Published: August 2006

Hypothesis: Ginseng root extracts and the biologically active ginsenosides have been shown to inhibit proliferation of human cancer cell lines, including breast cancer. However, there are conflicting data that suggest that ginseng extracts (GEs) may or may not have estrogenic action, which might be contraindicated in individuals with estrogen-dependent cancers. The current study was designed to address the hypothesis that the extraction method of American ginseng ( Panax quinquefolium) root will dictate its ability to produce an estrogenic response using the estrogen receptor (ER)-positive MCF-7 human breast cancer cell model. Methods: MCF-7 cells were treated with a wide concentration range of either methanol-(alc-GE) or water-extracted (w-GE) ginseng root for 6 days. Cells were grown in media containing either normal or charcoal-stripped fetal calf serum to limit exposure to exogenous estrogen. Thus, an increase in MCF-7 cell proliferation by GE indicated potential estrogenicity. This was confirmed by blocking GE-induced MCF-7 cell proliferation with ER antagonists ICI 182,780 (1 nM) and 4-hydroxytamoxifen (0.1 μM). Furthermore, the ability of GE to bind ERα or ERβ and stimulate estrogen-responsive genes was examined. Results: Alc-GE, but not w-GE, was able to increase MCF-7 cell proliferation at low concentrations (5-100 μg/mL) when cells were maintained under low-estrogen conditions. The stimulatory effect of alc-GE on MCF-7 cell proliferation was blocked by the ER antagonists ICI 182,780 or 4-hydroxyta-moxifen. At higher concentrations of GE, both extracts inhibited MCF-7 and ER-negative MDA-MB-231 cell proliferation regardless of media conditions. Binding assays demonstrated that alc-GE, but not w-GE, was able to bind ERα and ERβ. Alc-GE (50 μg/mL) also induced an approximate 2.5-fold increase in expression of the estrogen-responsive pS2 gene, as well as progesterone receptor (PgR) gene expression, whereas w-GE was without effect. Conclusion: These data indicate that low concentrations of alc-GE, but not w-GE, elicit estrogenic effects, as evidenced by increased MCF-7 cell proliferation, in a manner antagonized by ER antagonists, interactions of alc-GE with estrogen receptors, and increased expression of estrogen-responsive genes by alc-GE. Thus, discrepant results between different laboratories may be due to the type of GE being analyzed for estrogenic activity.
Adoption of a Plant-Based Diet by Patients with Recurrent Prostate Cancer
Authors: Nguyen Jacquelyn Y. , Major Jacqueline M. , Knott Cynthia J. , Freeman Karen M. , Downs Tracy M. , Saxe Gordon A.
Published: August 2006

The Western diet has been associated with prostate cancer incidence as well as risk of disease progression after treatment. Conversely, plant-based diets have been associated with decreased risks. A pilot clinical trial of a 6-month dietary change and stress reduction intervention for asymptomatic, hormonally untreated patients experiencing a consistently rising PSA level, the first sign of recurrence of prostate cancer after surgery or radiation therapy, was conducted to investigate the level of intake of plant-based foods and the relationship between intake and the change in the rate of PSA rise. A pre-post design was employed in which each patient served as his own control. In this multifaceted intervention, patients and their spouses were encouraged to adopt and maintain a plant-based diet. The prestudy rate of PSA rise (from the time of posttreatment recurrence to the start of the study) was ascertained by review of patients’ medical records. Dietary assessments were performed and prostate-specific antigen (PSA) levels ascertained at baseline, prior to the start of intervention, and at 3 and 6 months. Changes in numbers of servings of plant-based food groups were calculated and compared with rates of PSA rise over the corresponding time intervals. Median intake of whole grains increased from 1.7 servings/d at baseline to 6.9 and 5.0 servings/d at 3 and 6 months, respectively. Median intake of vegetables increased from 2.8 servings/d at baseline to 5.0 and 4.8 servings/d at 3 and 6 months, respectively. The rate of PSA rise decreased when comparing the prestudy period (0.059) to the period from 0 to 3 months (-0.002, P < .01) and increased slightly, though not significantly, when comparing the period from 0 to 3 months to the period from 3 to 6 months (0.029, P = .4316). These results provide preliminary evidence that adoption of a plant-based diet is possible to achieve as well as to maintain for several months in patients with recurrent prostate cancer. Changes in the rate of rise in PSA, an indicator of disease progression, were in the opposite direction as changes in the intake of plant-based food groups, raising the provocative possibility that PSA may have inversely tracked intake of these foods and suggesting that adoption of a plant-based diet may have therapeutic potential in the management of this condition.
Nef interference with HIV-1–specific CTL antiviral activity is epitope specific
Authors: Adnan Sama , Balamurugan Arumugam , Trocha Alicja , Bennett Michael S. , Ng Hwee L. , Ali Ayub , Brander Christian , Yang Otto O.
Published: August 2006

HIV-1 Nef and HIV-1–specific cytotoxic T lymphocytes (CTLs) have important and opposing roles in the immunopathogenesis of HIV-1 infection. Nef-mediated down-modulation of HLA class I on infected cells can confer resistance to CTL clearance, but the factors determining the efficiency of this process are unknown. This study examines the impact of Nef on the antiviral activity of several CTL clones recognizing epitopes from early and late HIV-1 proteins, restricted by HLA-A, -B, and -C molecules. CTL-targeting epitopes in early proteins remained susceptible to the effects of Nef, although possibly to a lesser degree than CTL-targeting late protein epitopes, indicating that significant Nef-mediated HLA down-regulation can precede even the presentation of early protein-derived epitopes. However, HLA-C–restricted CTLs were unaffected by Nef, consistent with down-regulation of cell-surface HLA-A and -B but not HLA-C molecules. Thus, CTLs vary dramatically in their susceptibility to Nef interference, suggesting differences in the relative importance of HLA-A– and HLA-B– versus HLA-C–restricted CTLs in vivo. The data thus indicate that HLA-C–restricted CTLs may have an under-appreciated antiviral role in the setting of Nef in vivo and suggest a benefit of promoting HLA-C–restricted CTLs for immunotherapy or vaccine development.
Optimization of immunomagnetic separation for cord blood-derived hematopoietic stem cells
Authors: Kekarainen Tuija , Mannelin Sirkka , Laine Jarmo , Jaatinen Taina
Published: August 2006

Background

There is a growing interest in cord blood as a source of primitive stem cells with the capacity for multilineage differentiation. Pure cell fractions are needed for the characterization and in vitro expansion of stem cells as well as for their use in preclinical research. However, enrichment of stem cells is challenging due to the lack of stem cell-specific markers and gentle protocols for the isolation of highly pure stem cell fractions. Protocols developed for the enrichment of peripheral blood-derived stem cells have been found to be suboptimal for cord blood.

Results

In this study, immunomagnetic cell sorting protocols to purify CD34+, CD133+ and Lin- cells from fresh and cryopreserved cord blood were optimized. Reproducible purities of up to 97% were reached. The selected cells were highly viable having substantial colony-forming potential.

Conclusion

The optimized protocols enable rapid enrichment of highly pure hematopoietic stem cells from both fresh and cryopreserved cord blood.
Inspiratory resistances facilitate the diaphragm response to transcranial stimulation in humans
Authors: Locher Chrystèle , Raux Mathieu , Fiamma Marie-Noelle , Morélot-Panzini Capucine , Zelter Marc , Derenne Jean-Philippe , Similowski Thomas , Straus Christian
Published: August 2006

Background

Breathing in humans is dually controlled for metabolic (brainstem commands) and behavioral purposes (suprapontine commands) with reciprocal modulation through spinal integration. Whereas the ventilatory response to chemical stimuli arises from the brainstem, the compensation of mechanical loads in awake humans is thought to involve suprapontine mechanisms. The aim of this study was to test this hypothesis by examining the effects of inspiratory resistive loading on the response of the diaphragm to transcranial magnetic stimulation.

Results

Six healthy volunteers breathed room air without load (R0) and then against inspiratory resistances (5 and 20 cmH2O/L/s, R5 and R20). Ventilatory variables were recorded. Transcranial magnetic stimulation (TMS) was performed during early inspiration (I) or late expiration (E), giving rise to motor evoked potentials (MEPs) in the diaphragm (Di) and abductor pollicis brevis (APB). Breathing frequency significantly decreased during R20 without any other change. Resistive breathing had no effect on the amplitude of Di MEPs, but shortened their latency (R20: -0.903 ms, p = 0.03) when TMS was superimposed on inspiration. There was no change in APB MEPs.

Conclusion

Inspiratory resistive breathing facilitates the diaphragm response to TMS while it does not increase the automatic drive to breathe. We interpret these findings as a neurophysiological substratum of the suprapontine nature of inspiratory load compensation in awake humans.
Factors affecting left ventricular remodeling after valve replacement for aortic stenosis. An overview
Authors: Villa Emmanuel , Troise Giovanni , Cirillo Marco , Brunelli Federico , Tomba Margherita Dalla , Mhagna Zen , Tasca Giordano , Quaini Eugenio
Published: August 2006

Although a small percentage of patients with critical aortic stenosis do not develop left ventricle hypertrophy, increased ventricular mass is widely observed in conditions of increased afterload. There is growing epidemiological evidence that hypertrophy is associated with excess cardiac mortality and morbidity not only in patients with arterial hypertension, but also in those undergoing aortic valve replacement. Valve replacement surgery relieves the aortic obstruction and prolongs the life of many patients, but favorable or adverse left ventricular remodeling is affected by a large number of factors whose specific roles are still a subject of debate. Age, gender, hemodynamic factors, prosthetic valve types, myocyte alterations, interstitial structures, blood pressure control and ethnicity can all influence the process of left ventricle mass regression, and myocardial metabolism and coronary artery circulation are also involved in the changes occurring after aortic valve replacement. The aim of this overview is to analyze these factors in the light of our experience, elucidate the important question of prosthesis-patient mismatch by considering the method of effective orifice area, and discuss surgical timings and techniques that can improve the management of patients with aortic valve stenosis and maximize the probability of mass regression.
Predictors of self-rated health: a 12-month prospective study of IT and media workers
Authors: Hasson Dan , Arnetz Bengt B , Theorell Töres , Anderberg Ulla Maria
Published: August 2006

Objective

The aim of the present study was to determine health-related risk and salutogenic factors and to use these to construct prediction models for future self-rated health (SRH), i.e. find possible characteristics predicting individuals improving or worsening in SRH over time (0–12 months).

Methods

A prospective study was conducted with measurements (physiological markers and self-ratings) at 0, 6 and 12 months, involving 303 employees (187 men and 116 women, age 23–64) from four information technology and two media companies.

Results

There were a multitude of statistically significant cross-sectional correlations (Spearman's Rho) between SRH and other self-ratings as well as physiological markers. Predictors of future SRH were baseline ratings of SRH, self-esteem and social support (logistic regression), and SRH, sleep quality and sense of coherence (linear regression).

Conclusion

The results of the present study indicate that baseline SRH and other self-ratings are predictive of future SRH. It is cautiously implied that SRH, self-esteem, social support, sleep quality and sense of coherence might be predictors of future SRH and therefore possibly also of various future health outcomes.
Parietal function in good and poor readers
Authors: Laycock Robin , Crewther Sheila G. , Kiely Patricia M. , Crewther David P.
Published: August 2006

Background

While there are many psychophysical reports of impaired magnocellular pathway function in developmental dyslexia (DD), few have investigated parietal function, the major projection of this pathway, in good and poor readers closely matched for nonverbal intelligence. In view of new feedforward-feedback theories of visual processing, impaired magnocellular function raises the question of whether all visually-driven functions or only those associated with parietal cortex functions are equally impaired and if so, whether parietal performance is more closely related to general ability levels than reading ability.

Methods

Reading accuracy and performance on psychophysical tasks purported to selectively activate parietal cortex such as motion sensitivity, attentional tracking, and spatial localization was compared in 17 children with DD, 16 younger reading-age matched (RA) control children, and 46 good readers of similar chronological-age (CA) divided into CA-HighIQ and a CA-LowIQ matched to DD group nonverbal IQ.

Results

In the age-matched groups no significant differences were found between DD and CA controls on any of the tasks relating to parietal function, although performance of the DD group and their nonverbal IQ scores was always lower. As expected, CA and RA group comparisons indicated purported parietal functioning improves with age. No difference in performance was seen on any of the parietally driven tasks between the DD and age-nonverbal IQ matched groups, whereas performance differentiated the DD group from the age-matched, higher nonverbal IQ group on several such tasks. An unexpected statistical difference in performance between lower reading age (DD and RA children) and all higher reading age (CA) children was seen on a test of chromatic sensitivity, whereas when high and low nonverbal IQ normal readers were compared performance was not different

Conclusion

The results indicate that performance on purported parietal functions improves with age and may be more associated with nonverbal mentation than reading accuracy. Performance on a cognitively demanding task, traditionally considered to rely on ventral stream functions, was more related to reading accuracy.
Pediatric defibrillation after cardiac arrest: initial response and outcome
Authors: Rodríguez-Núñez Antonio , López-Herce Jesús , García Cristina , Domínguez Pedro , Carrillo Angel , Bellón Jose María ,   the Spanish Study Group of Cardiopulmonary Arrest in Children
Published: August 2006

Introduction

Shockable rhythms are rare in pediatric cardiac arrest and the results of defibrillation are uncertain. The objective of this study was to analyze the results of cardiopulmonary resuscitation that included defibrillation in children.

Methods

Forty-four out of 241 children (18.2%) who were resuscitated from inhospital or out-of-hospital cardiac arrest had been treated with manual defibrillation. Data were recorded according to the Utstein style. Outcome variables were a sustained return of spontaneous circulation (ROSC) and one-year survival. Characteristics of patients and of resuscitation were evaluated.

Results

Cardiac disease was the major cause of arrest in this group. Ventricular fibrillation (VF) or pulseless ventricular tachycardia (PVT) was the first documented electrocardiogram rhythm in 19 patients (43.2%). A shockable rhythm developed during resuscitation in 25 patients (56.8%). The first shock (dose, 2 J/kg) terminated VF or PVT in eight patients (18.1%). Seventeen children (38.6%) needed more than three shocks to solve VF or PVT. ROSC was achieved in 28 cases (63.6%) and it was sustained in 19 patients (43.2%). Only three patients (6.8%), however, survived at 1-year follow-up. Children with VF or PVT as the first documented rhythm had better ROSC, better initial survival and better final survival than children with subsequent VF or PVT. Children who survived were older than the finally dead patients. No significant differences in response rate were observed when first and second shocks were compared. The survival rate was higher in patients treated with a second shock dose of 2 J/kg than in those who received higher doses. Outcome was not related to the cause or the location of arrest. The survival rate was inversely related to the duration of cardiopulmonary resuscitation.

Conclusion

Defibrillation is necessary in 18% of children who suffer cardiac arrest. Termination of VF or PVT after the first defibrillation dose is achieved in a low percentage of cases. Despite a sustained ROSC being obtained in more than one-third of cases, the final survival remains low. The outcome is very poor when a shockable rhythm develops during resuscitation efforts. New studies are needed to ascertain whether the new international guidelines will contribute to improve the outcome of pediatric cardiac arrest.
Z39Ig is expressed on macrophages and may mediate inflammatory reactions in arthritis and atherosclerosis
Authors: Lee Min-Young , Kim Won-Jung , Kang Yoon-Joong , Jung Young-Mi , Kang Young-Mo , Suk Kyoungho , Park Jeong-Euy , Choi Eun-Mi , Choi Beom-Kyu , Kwon Byoung S , Lee Won-Ha
Published: August 2006

Z39Ig is a transmembrane protein containing two Ig homology domains with unknown functions. Immunohistochemical analyses of human carotid atherosclerotic plaques detected Z39Ig staining in areas rich in foamy macrophages. Z39Ig staining was also observed in macrophages in the lining layers and sublining areas of rheumatoid arthritis synovium. Z39Ig staining in the osteoarthritis synovium was restricted to macrophages in the lining layers. To identify the role(s) of Z39Ig in the function of macrophages, we used human monocytic cell lines TF-1A (Z39Ig-negative) and THP-1 (Z39Ig-positive). The expression of Z39Ig was induced in TF-1A cells, when they were differentiated into macrophages by treatment with PMA. The stimulation of PMA-treated TF-1A or THP-1 cells with immobilized anti-Z39Ig mAb induced the secretion of IL-8 and matrix metalloproteinase (MMP)-9, which was dependent on NF-κB activation. These data indicate that the macrophage Z39Ig is involved in the pathogenesis of inflammatory diseases through chemokine induction, which will promote the migration of inflammatory cells into the lesion area, and MMP-9 induction, which will contribute to cartilage destruction or extracellular matrix degradation.
Response to guidance on use of olanzapine and risperidone: a community-based study of primary and secondary care
Authors: Franks Karen L.
Published: August 2006

Aims and Method

The aim of the study was to assess the response to the guidance from the Committee on Safety of Medicines (CSM) on prescribing olanzapine and risperidone for older adults. Information on 96 older patients who were prescribed olanzapine or risperidone was gathered from psychiatric case notes, general practitioners and care homes. Data were gathered 10 weeks after the CSM guidance (Time 1) and again 6 months later (Time 2).

Results

At Time 1, 71 out of 96 patients (74%) had been reviewed and 90 (94%) by Time 2. By 6 months after the guidance 34 of 52 patients with dementia (65%) and 10 of 35 patients with functional diagnoses had been withdrawn from medication; 29% (14/49) of those withdrawn from medication had significant problems associated with withdrawal. In many cases medication was continued following risk–benefit decisions taken at review and despite CSM guidance.

Clinical Implications

Guidance has prompted review of prescribing in existing patients and some re-referrals, which has increased workload. The guidance has changed the management of existing patients, but there has been a high rate of associated clinical problems and numerous patients remain on, or return to, olanzapine or risperidone.
The Verbal Numeric Pain Scale: Effects of Patient Education on Self‐reports of Pain
Authors: Marco Catherine A. , Marco Alan P. , Plewa Michael C. , Buderer Nancy , Bowles Jameson , Lee Jennifer
Published: August 2006

Background:
Emergency department (ED) patients are frequently asked to provide a self‐report of the level of pain experienced using a verbal numeric rating scale.

Objectives:
To determine the effects of patient education regarding the verbal numeric rating scale on self‐reports of pain among ED patients.

Methods:
In this prospective, interventional study, 310 eligible ED patients with pain, aged 18 years and older, were randomized to view either a novel educational video (n= 155) or a novel print brochure (n= 155) as an educational intervention, both developed to deliver educational information about the verbal numeric pain scale and its use. Participants initially rated their pain on a scale from 0 to 10 and then were administered the educational intervention. Following the educational intervention, participants completed a survey that included demographic information, postinterventional pain score, prior pain experience, and subjective rating of the helpfulness of the educational intervention. Fifty‐five consecutive participants were enrolled as controls and received no educational intervention but gave a self‐reported triage pain score and a second pain score at an equivalent time interval. Clinical significance was defined as a decrease in pain of 2 or more points following the education.

Results:
Following the educational interventions, there were statistically significant, although not clinically significant, decreases in mean pain scores within each intervention group (video: mean change, 1 point [95% confidence interval [CI] = 0.7 to 1.2]; printed brochure: mean change, 0.6 points [95% CI = 0.4 to 0.8]). For participants in the control group (no intervention), there was no significant change (mean change, 0.2 points [95% CI =−0.2 to 0.5]). A clinically significant decrease in pain was seen in 28% of the video group, 23% of the brochure group, and 5% of controls. Most patients had no change (71% of the video group, 73% of the brochure group, and 89% of controls). Participants rated the helpfulness of the video educational intervention as 7.1 (95% CI = 6.7 to 7.5) and the print educational intervention as 6.7 (95% CI = 6.2 to 7.1) on a scale from 0 (least effective) to 10 (most helpful).

Conclusions:
Among ED participants with pain, both educational interventions (video and printed brochure) resulted in statistically and clinically significant decreased self‐reported pain scores by 2 or more points in 26% of participants compared with 5% of controls. The educational interventions were rated as helpful by participants, with no appreciable difference between the two intervention groups.
Characteristics of Pediatric Patients at Risk of Poor Emergency Department Aftercare
Authors: Wang N. Ewen , Kiernan Michaela , Golzari Mana , Gisondi Michael A.
Published: August 2006

Objectives:
To identify and characterize subgroups of a pediatric population at risk of poor emergency department (ED) aftercare compliance.

Methods:
This was a prospective, cohort study conducted at a university hospital ED with a 2003 pediatric census of 11,040 patients. A convenience sample of 461 children was enrolled. The study follow‐up rate was 97%. The primary outcomes were guardian compliance with instructions for physician follow‐up appointment and with obtaining prescribed medications. Predictors of compliance outcomes were analyzed by using recursive partitioning to describe population subgroups at risk of poor compliance.

Results:
Only 60.4% of patient guardians followed up with instructions to see a physician. Children with private insurance were more likely to follow up than were children without private insurance (76.8% vs. 46.5%, p < 0.001). Of children with private insurance, those with high‐acuity diagnoses were more likely to follow up than were patients with low‐acuity diagnoses (80.0% vs. 38.5%, p < 0.001). Of children who were considered underinsured (defined as publicly insured or uninsured), those with English‐speaking guardians were more likely to follow up than were those with non–English‐speaking guardians (58.0% vs. 40.0%, p < 0.05). Only 63.3% of patient guardians obtained prescribed medications. Privately insured children were more likely to obtain medications than were underinsured children (71.0% vs. 58.0%, p < 0.05). Descriptive profiles of the subgroups revealed that those with lower socioeconomic status were at greatest risk of poor aftercare compliance.

Conclusions:
Compliance with ED aftercare instructions remains a challenge. Health insurance disparities are associated with poor ED aftercare compliance in our pediatric population. Interventions aimed at improving compliance could be targeted to specific subgroups on the basis of their descriptive profiles.
A Novel Missense Mutation in Human TTF-2 (FKHL15) Gene Associated with Congenital Hypothyroidism But Not Athyreosis
Authors: Barış İ. , Arısoy A. E. , Smith A. , Agostini M. , Mitchell C. S. , Park S. M. , Halefoğlu A. M. , Zengin E. , Chatterjee V. K. , Battaloğlu E.
Published: August 2006

Background: Thyroid dysgenesis is the most frequent cause of congenital hypothyroidism (CH), and its genetic basis is largely unknown. Hitherto, two mutations in the human thyroid transcription factor 2 (TTF-2) gene have been described in unrelated cases of CH with cleft palate, spiky hair, variable choanal atresia, and complete thyroid agenesis. Here, we describe a novel TTF-2 mutation in a female child resulting in syndromic CH in the absence of thyroid agenesis.

Results: The index case is homozygous for an arginine to cysteine mutation (R102C) of a highly conserved residue within the forkhead, DNA binding domain of TTF-2. Her consanguineous, heterozygous parents are unaffected, and the mutation was not detected in 100 control chromosomes. Consonant with its location, the R102C mutant TTF-2 protein showed loss of DNA binding and was transcriptionally inactive. CH in the proposita was associated with cleft palate, spiky hair, and bilateral choanal atresia. However, radiological studies showed the presence of thyroid tissue in a eutopic location.

Conclusion: Our findings indicate that human thyroid development can occur despite loss of TTF-2 function and suggest that TTF-2 gene defects should also be considered in cases of syndromic CH without total athyreosis.
Photochemical Reaction in Chlorinated Solvents in the Presence of Halogenated p-Benzoquinones. I Photochemically Induced Acidification of Solution and Protonation on Octaethylporphyrin in Dichloromethane or Chloroform
Authors: Nakano Taku , Mori Yoshihiro
Published: August 2006

Irradiation of visible light on a dichloromethane or chloroform solution in the presence of halogenated p-benzoquinones, such as fluoranil, chloranil, and bromanil, caused the formation of an acid, HCl. In the presence of octaethylporphyrin in those solutions, the photoinduced protonations of porphyrins were observed. Stepwise spectral changes suggested the formations of monocationic and dicationic species and an “intermediate” which had a spectrum with maximum wavelength at 717 nm. The unstable intermediate was suggested to be octaethylphlorin. But the trial to isolate the intermediate gave octaethylbilindione. Dioxygen was found to exert both negative and positive effects on the acidification of solvents and on the protonation on porphyrin in the octaethylporphyrin–bromanil systems. The mechanisms of these photochemically induced reactions are discussed.
Multinuclear Magnetic Resonance Spectroscopic and Semiempirical Molecular Orbital (AM1) Studies of Substituted Anisoles
Authors: Pandiarajan Karuppiah , Kabilan Senthamaraikannan , Sankar Punnaivanam , Kolehmainen Erkki , Nevalainen Tapio , Kauppinen Reijo
Published: August 2006

13C, 15N, and 17O NMR spectra have been recorded for 4-nitroanisole (1), its 2-methyl-, 2-chloro-, 2-bromo-, 2-iodo-, 2,6-dimethyl-, 2,6-dichloro-, 2,6-dibromo-, and 2,6-diiodo-derivatives 2—9, also nitrobenzene (1a), its 3-methyl-, 3-chloro-, 3-bromo-, and 3-iodo-derivatives 2a—5a and 3,5-dichloro- and 3,5-dibromo-derivatives 7a and 8a. Analysis of the chemical shifts of carbon bearing nitro group and nitro oxygens in these compounds suggests that presence of one substituent ortho- to the methoxyl group enhances its resonance interaction with the benzene ring whereas presence of two ortho-substituents inhibits this resonance. However, in no case the resonance is completely inhibited. The extent of enhancement or inhibition is almost independent of the nature of the ortho-substituent. This conclusion has also been arrived by analyzing the reported chemical shifts of the para-carbons in anisoles 1b—9b and the corresponding carbons in benzene derivatives 1c—9c. Though evidence could not be obtained for steric enhancement of resonance using methoxyl oxygen chemical shifts, analysis of these chemical shifts in di-ortho-substituted anisoles 6—9 and 6a furnishes evidence for steric inhibition of resonance. However, 15N chemical shifts are of no use in studying these phenomena. Semiempirical molecular orbital calculations using AM1 Hamiltonian suggest that the methoxyl group is coplanar with the benzene ring in anisole, 4-nitroanisole and 2-substituted-4-nitroanisoles but is perpendicular to the benzene ring in 2,6-disubstituted-4-nitroanisoles. Moreover, in 2-substituted-4-nitroanisoles the O-methyl group is anti to the 2-substituent.
Kinetics and Mechanisms of the Copper(II)-Catalyzed Oxidation of Iodide Ion in the Presence of Molecular Oxygen in Aqueous Acid Media
Authors: Kimura Masaru , Tokuda Mari , Tsukahara Keiichi
Published: August 2006

Traces of copper(II) ion in 10−7—10−5 M (M = mol dm−3) catalytically accelerated the oxidation reactions of iodide ion to iodine in relatively strong acid solutions (pH ≤ 2) in the presence of molecular oxygen under conditions containing relatively high concentrations of I−. When a copper(II) solution was mixed with an iodide solution, after a rapid formation of iodine, it gradually increased according to the reaction times. For about 5 min after mixing, plots of [I3−]formed vs. t showed a good straight line; the formation rate of I2 (or I3−) increased proportionally with increasing concentrations of copper(II) ion and oxygen, with increasing concentrations of hydrogen ion and iodide ion, and with increasing temperature and with decreasing the ionic strength in the reaction solution. The formation rate of I2 was extremely inhibited by the presence of either radical scavengers or ethylenediaminetetraacetic acid (EDTA). A chain mechanism is presented to account for the obtained results.
Preparation and Some Properties of Cobalt(III) Complexes with 1-Thio-β-d-glucose (H5tg). Crystal Structure of ΔD-[Co(H3tg-O,S)(en)2]NO3
Authors: Okamoto Ken-ichi , Arashi Kenji , Hidaka Jinsai , Konno Takumi
Published: August 2006

Cobalt(III) complexes with 1-thio-β-d-glucose (H5tg), [Co(H4tg-S)2{(en)2 or (tren)}]+ and [Co(H3tg-O,S){(en)2 or (tren)}]+, were newly prepared; where en and tren denote ethylenediamine and tris(2-aminoethyl)amine, respectively. The oxidation products of [Co(H3tg-O,S){(en)2 or (tren)}]+ were prepared by the addition of H2O2. These complexes were separated into their isomers by column chromatography. The crystal structure of -[Co(H3tg-O,S)(en)2]NO3·H2O was determined by X-ray diffraction: This complex, chemical formula CoC10H16O8N5S, crystallizes in orthorhombic, space group P212121, a = 14.328(1), b = 14.617(1), c = 8.605(1) Å, V = 1802.2(3) Å3, Z = 4, and R = 0.055. The geometry around the cobalt atom is approximately octahedral, coordinated by one 1-thio-β-d-glucose and two en ligands. 1-Thio-β-d-glucose takes the cyclic chair form and coordinates to cobalt(III) ion through the close-neighboring sulfur and oxygen atoms. This isomer takes the Δ configuration. The other complexes were characterized by their absorption, CD, 13C NMR spectra. For all of the isomers, the Δ configuration will be more preferentially formed than the Λ one.
Effects of Copper(II) Ions on the SO4−• Radical Induced Oxidation of Cytosine and Its Derivatives
Authors: Chabita Kanakam , Mandal Parikshit C , Bhattacharyya Sudhindra N
Published: August 2006

The reactions of SO4−• radicals with cytosine and its derivatives have been studied in dilute aqueous solutions. The results show that the nature of the group attached to N-1 of the base greatly influences the reaction sequences. Presence of copper(II) ions greatly affects the reaction pathways, where it is observed that the substrate consumption increases drastically indicating initiation of some chain reactions. Release of unaltered base from cytidine and deoxycytidine also increases under these conditions.
Effect of the Binding Sites of Human Serum Albumin on the Efficiency and Photostationary State Isomer Ratios of the Photoisomerization of Bilirubin
Authors: Kanna Yoko , Arai Tatsuo , Tokumaru Katsumi
Published: August 2006

The quantum yields of the isomerization and photostationary state isomer ratios of the photoisomerization of (4Z,15Z)-bilirubin IXα (ZZ-BR) were determined in an aqueous buffered solution in the presence of human serum albumin (HSA) at a molar ratio of [ZZ-BR]/[HSA] from 0.5 to 2. The BR isomer compositions in the photostationary state were constant at [BR]/[HSA] = 0.5—0.7. With increasing [ZZ-BR]/[HSA] from 0.8 to 2, the ZZ-BR composition in the photostationary state increased from 58 to 75%, but the ZE-BR composition decreased from 39 to 22%. The quantum yields in the isomerization of ZZ-BR to ZE-BR (ΦZZ→ZE) and a cyclized product, lumirubin (LR), (ΦZZ→LR), remained unvaried up to [ZZ–BR]/[HSA] = 1, but ΦZZ→ZE decreased while ΦZZ→LR increased along with a further increase of [ZZ-BR]/[HSA]. These results are explained by the existence of two binding sites, a first-class site and a second-class site, for bilirubin binding to HSA; ΦZZ→ZE in the second-class site (= 0.035) was as low as 1/3 of that in the first-class site (= 0.11), but ΦZZ→LR in the second-class site (= 4.2 × 10−3) was nearly two-times higher than that in the first-class site (= 2.4 × 10−3).
Preparation of New 7-Silanorbornene Derivatives and Their Reaction with Some Nucleophiles
Authors: Terunuma Daiyo , Kumano Kayo , Motoyama Yuuki
Published: August 2006

Reduction of the 7-silanorbornene derivatives obtained from Diels–Alder reactions of 1,1,3,4-tetramethylsilacyclopenta-2,4-diene (1a), and 2,3-dimethyl-5-silaspiro[4.4]nona-1,3-diene (1b) with maleic anhydride was carried out by lithium aluminum hydride (LAH) to give diol derivatives. Attempts to substitute the hydroxyl groups with chlorine using various chlorination agents such as thionyl chloride and triphenylphosphine in carbon tetrachloride were unsuccessful. The latter reaction, however, gave a corresponding ether derivative as a result of intramolecular cyclization. Reactions of the 7-silanorbornene derivatives with some nucleophiles such as LAH, (n-Bu)4NF, n-BuLi, and PhLi were also investigated.
A Novel Synthesis of Cyclohexanol Derivatives by the Catalytic Hydrogenation of Benzene with Acid Additives
Authors: Yasuhara Yutaka , Nishino Masaki
Published: August 2006

The hydrogenation of benzene over a platinum group metal in the presence of various strong acids was carried out. Cyclohexanol derivatives (C6H11X, X = OH, OAc, Cl, Br) were found to be produced by the catalytic hydrogenation of benzene with acid additives. The following two sequences of adsorption strength were observed between platinum metals (adsorbent) and additive reagents (adsorbate) :

When a weak adsorbate, such as acetic acid or water, was used as an additive reagent, ruthenium, the strongest adsorbent, exhibited the best selectivity. When hydrogen chloride, a strong adsorbate in the sequence (II), was used an additive reagent, palladium or rhodium, moderately strong adsorbent, exhibited excellent selectivity. By the reaction of 2 ml of benzene, 5 ml of 35% HCl and 0.2 g of 5% Pd/SiO2, under 10 atm-G (P atm-G = 1.013(P + 1) × 105 Pa) hydrogen at 100 °C for 20 h, 8.4% of the yield of chlorocyclohexane was obtained at 64.2% of the selectivity (13.1% of the conversion of benzene).
Restricted Rotation Involving the Tetrahedral Carbon. LXII. Rotational Isomerism, Structure, and Isolation of Triptycene Rotamers that Carry Secondary Alkyl Group at 9-Position
Authors: Oki Michinori , Matsusue Masaki , Akinaga Tadashi , Matsumoto Yoshinobu , Toyota Shinji
Published: August 2006

As an example of a set of rotational isomers of triptycenes that carry a secondary alkyl group at the 9-position, 9-alkyl-1,8-difluorotriptycenes (alkyl = isopropyl or 3-hydroxy-1-methylpropyl) were synthesized and their rotational isomerism was examined by means of NMR spectroscopy. For the isopropyl compound, the ap and sc isomers were observed in a 6.2 : 1 ratio in chloroform-d, but the two diastereomeric rotamers were inseparable. X-Ray analysis of the compound reveals that all molecules take ap conformation about the C9–Calkyl bond in crystal. In contrast three rotamers of 3-hydroxy-1-methylpropyl compound could be isolated by HPLC as stable entities at room temperature. Barriers to rotation in chloroform-d were found to be 26.6, 26.3, 25.0, 24.6, 24.8, and 24.9 kcal mol−1 for sc*(S*) → ap(R*), sc*(S*) → sc*(R*), ap(R*) → sc*(S*), ap(R*) → sc*(R*), sc*(R*) → ap(R*), and sc*(R*) → sc*(S*) processes, respectively, at 39.5 °C.
The Surface Activity of N,N′-Polymethylenebis(trialkylammonium) Dibromides in Aqueous Solutions
Authors: Tamaki Kunio , Ohara Yoko , Ogawa Nanae , Domae Yoichiro , Kurokawa Tetsuya
Published: August 2006

The surface tensions are reported for aqueous solutions of four series of homologous N,N′ -polymethylenebis(trialkylammonium) dibromides [(CmH2m+1)3N(CH2)nN(CmH2m+1)3]Br2 (m = 1—4) at 25 °C. The experimental results are discussed with emphasis on the behavior of these salts in water. It is generally recognized that the structure-breaking solutes are surface inactive in aqueous solutions, whereas hydrophobic structure-making solutes are surface active in aqueous solutions. The critical micelle concentration for [(C4H9)3N(CH2)12N(C4H9)3]Br2 is estimated to be 0.07 mol dm−3.
Thermal and Lewis Acid-Promoted Hetero Diels–Alder Reactions of α,β : γ,δ-Unsaturated Carbodithioic Esters and Carbothioic O-Esters; 5,6-Dihydro-2H-naphtho[1,2-b]thiopyran-3-carbodithioates and -carbothioic O-Esters
Authors: Moriyama Satoshi , Mochizuki Takahiro , Ohshima Yasuko , Saito Takao
Published: August 2006

Phenyl esters of 2-substituted 5,6-dihydro-2H-naphtho[1,2-b]thiopyran-3-carbodithioic acids (2) reacted with 2-norbornene, dimethyl acetylenedicarboxylate, diethyl azodicarboxylate, N-phenylmaleimide, dimethyl fumarate, 2-chloroacrylonitrile, methyl acrylate, and styrene in refluxing benzene to give the [4+2]cycloadducts, while the thermal cycloaddition reaction of O-methyl esters of 2-substituted 5,6-dihydro-2H-naphtho[1,2-b]thiopyran-3-carbothioic acids (3) was successful only with the triple-bonded dienophiles such as dimethyl acetylenedicarboxylate and ethyl propiolate. In the presence of a Lewis acid (AlCl3 or EtAlCl2), the reactions of both 2 and 3 were found to proceed efficiently even at room temperature.
Cation-Exchanged Montmorillonite-Catalyzed Friedel–Crafts Transannular Alkylation with (Z,Z)-1,5-Cyclooctadiene
Authors: Tateiwa Jun-ichi , Horiuchi Hiroki , Suama Masakazu , Uemura Sakae
Published: August 2006

The five isomers of phenylbicyclooctanes were produced by Friedel–Crafts transannular alkylation of benzene with (Z,Z)-1,5-cyclooctadiene (1,5-COD) in the presence of a cation-exchanged montmorillonite (Mn+-mont). Mn+-Mont could be used repeatedly to provide the same products in good yields.
Characterization and Thiophene Hydrodesulfurization Activity of NaX Zeolite Supported Molybdena Catalysts
Authors: Das Debasish , Duttagupta Maya , Palit Sunanda K
Published: August 2006

A series of NaX zeolite supported molybdena catalysts containing 1—15 wt% MoO3 has been prepared by impregnation method. They have been characterized by X-ray diffraction (XRD), infrared spectroscopy (IR), temperature-programmed reduction (TPR), scanning electron microscopy (SEM), surface area, pore volume, Mo dispersion, and Mo extraction measurements. Zeolite crystallinity was found to be affected greatly only at 15 wt% MoO3 loading. XRD and SEM studies showed absence of any crystalline MoO3 phase. However, presence of bulk MoO3, particularly at higher loadings, was indicated by TPR and Mo extraction results. Tetrahedral surface molybdenum species are formed through strong interaction between molybdena and zeolite lattice through oxygen atoms. A direct relationship between Mo dispersion on the oxidic catalysts and their thiophene conversion activity was observed. In addition to Mo dispersion, acidity of the catalysts was also found to play an important role at high reaction temperature.
Solvent Isotope Effect on the Complexation of Cyclodextrins in Aqueous Solutions
Authors: Wang An Sheng , Matsui Yoshihisa
Published: August 2006

The replacement of H2O by D2O as a solvent resulted in an appreciable increase in the binding constants (Kb) for complexes of native and modified cyclodextrins with such typical guests as p-nitrophenol, the p-nitrophenolate ion, Methyl Orange, phenolphthalein, and inorganic anions. The observed increase in Kb was attributed mainly to a solvent H/D isotope effect on hydrophobic and electrostatic interactions between the hosts and guests.
Pseudo-Point Groups for Symmetry Characterization and Combinatorial Enumeration of Nonrigid Compounds
Authors: Fujita Shinsaku
Published: August 2006

The concept of equi-axial transformations is proposed to characterize conformational changes of flexible compounds such as the inversion of ammonia and the ring-flipping of 1,3,5-trioxane. In order to discuss the symmetries of the equi-axial transformations, pseudo-point groups are introduced after the definition of a pseudo-dihedral rotation. Pseudo-point groups are classified into anisoenergetic and isoenergetic groups. In the light of this classification, orbits generated by a pseudo-point group are characterized by the concept of chronality, which is defined by examining coset representations. Thus, the terms homochronal, enantiochronal, and hemichronal are coined for the characterization of orbits. The enumeration methods of the USCI (unit-subduced-cycle-index) approach are applied to the ammonia and 1,3,5-trioxane cases by using the pseude-point group .