bluuebunny/crossref_metadata_2025 huggingface dataset:
Mechanisms of Vasculitis: How Pauci-Immune Is ANCA-Associated Renal Vasculitis?
Authors: van Paassen P. , Cohen Tervaert J.W. , Heeringa P.
Published: November 2006

Both the innate and the acquired immune system are involved in the pathophysiology of renal vasculitis. However, anti-neutrophil cytoplasmic antibody (ANCA)-associated renal vasculitis is characterized by a ‘pauci-immune’ pattern of immunofluorescence during kidney biopsy, indicating the relative lack of immunoglobulin and complement deposition within the kidney. On the other hand, evidence is accumulating that ANCA, autoantibodies against constituents of primary granules of neutrophils and the lysosomes of monocytes, play a pathogenic role in renal vasculitis. In this review we will discuss both in vitro and in vivo experimental data providing compelling evidence that ANCA are a primary pathogenic factor in renal vasculitis, mainly by augmenting leukocyte-endothelial interactions. We will also address novel data, pointing at the role of, in addition to ANCA, non-specific proinflammatory signals. Finally, we propose a working hypothesis of the pathogenesis of ANCA-associated renal vasculitis.
Quantitative Ultrasound Assessment of Bone Health in the Neonate
Authors: McDevitt H. , Ahmed S.F.
Published: November 2006

For a number of reasons there is a need to explore reliable non-invasive methods for assessing bone health in neonates and young infants. Epidemiological studies suggest that early events in life may predispose the adult to degenerative diseases such as osteoporosis. Preterm infants have an increased risk of low bone mass because of limited bone mass accretion in utero and a greater need for bone nutrients. Despite improvements in neonatal care fractures still occur. The diagnosis of osteopaenia of prematurity remains difficult as there is no screening test which is both sensitive and specific. Biochemical indices are non-diagnostic, and plain X-rays in the absence of fractures are poor at diagnosing bone disease. Although dual energy X-ray absorptiometry is increasingly used to assess bone mineral status in newborn infants, the size and immobility of the scanner, the length of time to perform the scan and use of ionising radiation make it unsuitable for routine use in the setting of the fragile very low birth weight infant. Quantitative ultrasound (QUS) was first developed in 1984, as a non-ionising, portable and low cost method of assessing bone health. The measurements obtained from QUS are thought to be related not only to the mineral density of the bone but also to reflect parameters of bone quality and strength. Preliminary studies suggest that this technique may be a useful method of assessing changes in bone health in preterm infants, but the data need to be interpreted carefully. This review will concentrate on the methodology of QUS and the studies that have already been performed in neonates.
Effects of Severe Hypocapnia on Expression of Bax and Bcl-2 Proteins, DNA Fragmentation, and Membrane Peroxidation Products in Cerebral Cortical Mitochondria of Newborn Piglets
Authors: Lasso Pirot Anayansi , Fritz Karen I. , Ashraf Qazi M. , Mishra Om P. , Delivoria-Papadopoulos Maria
Published: November 2006

Background: Hypocapnia occurs in the newborn infant inadvertently or as a therapeutic modality and may result in neuronal and mitochondrial alterations in the newborn brain. Since mitochondria regulate apoptosis, these alterations may initiate a cascade of reactions that lead to apoptotic cell death. Objectives: This study tests the hypothesis that hypocapnia results in increased expression of the pro-apoptotic protein Bax, fragmentation of DNA and membrane lipid peroxidation in cerebral cortical mitochondria (mt) of newborn piglets. Methods: Studies were performed in three groups of anesthetized normoxic newborn piglets: hypocapnic (H, n = 5), ventilated at a PaCO2 of 11–15 mm Hg; normocapnic (N, n = 5), ventilated at a PaCO2 of 40 mm Hg; and corrected normocapnic (CN, n = 4), ventilated as H with CO2 added to maintain normocapnia. Tissue ATP and phosphocreatine levels were determined. Mitochondrial membrane proteins were separated, transblotted and probed with antibodies to Bax and Bcl-2. Bands were detected by enhanced chemiluminescence and analyzed by imaging densitometry. mtDNA was isolated. Cell and mitochondrial membrane lipid peroxidation products were measured spectrofluorometrically. Results: ATP and PCr concentrations were similar in the 3 groups. The ratio of Bax/Bcl-2 increased significantly in H compared to N and CN. mtDNA fragmentation was also significantly greater in H compared to N or CN. Membrane lipid peroxidation was higher in H than in N or CN; and in CN compared to N. Conclusions: The data demonstrate that severe hypocapnia results in increased Bax expression, DNA fragmentation, and membrane lipid peroxidation in mitochondria of cerebral cortical neurons of newborn piglets, and may result in apoptotic cell death.
Growth and Development in a Heliox Incubator Environment: A Long-Term Safety Study
Authors: Singhaus Clifford J. , Utidjian Levon H. , Akins Robert E. , Miller Thomas L. , Shaffer Thomas H. , Touch Suzanne M.
Published: November 2006

Background: Neonates exposed to mechanical ventilation may develop bronchopulmonary dysplasia (BPD). BPD neonates exhibit a 25–30% increase in energy expenditure which may decrease the rate of growth and development. Heliox has been shown to improve pulmonary function and may decrease energy expenditure. We hypothesized that heliox would provide a safe environment for sustained growth and development. Objective: To assess the safety of the heliox environment we observed developmental milestones; recorded changes in weight, total length, limb length and head circumference; measured blood chemistries; compared primary organ and muscle weights, and analyzed muscle enzymatic activity. Design/Methods: Four-day-old rabbit pups (n = 27) were randomized into control (21% O2; 79% N2) or heliox (21% O2; 79% He) groups, then raised for 14 days at 26.7°C and 50% relative humidity. Pups were euthanized on day 14, blood drawn and primary organs, diaphragm and gastrocnemius weighed and snap-frozen. Results: All pups thrived in both environments, achieving expected developmental milestones. There were no physiologically significant group differences in weight, growth factors, tissue weight, blood chemistry or muscle enzyme activity. Conclusions: No observed long-term differences in growth or development. Results demonstrated that long-term heliox exposure is safe in this rabbit model. These data suggest that heliox administration may provide time for pulmonary improvement in the BPD population, warranting appropriate clinical trials.
Safety of High-Dose Recombinant Erythropoietin in a Neonatal Rat Model
Authors: McPherson Ronald J. , Demers Eric J. , Juul Sandra E.
Published: November 2006

Background: High-dose recombinant erythropoietin (rEpo) is neuroprotective in neonatal animal models of brain injury, but the long-term consequences of neonatal exposure have not been studied. Objectives: We hypothesized that multiple injections of high-dose rEpo during the neonatal period would be safe, and would improve neurologic outcomes after exposure to neonatal hypoxia or hypoxic-ischemic injury. Methods: Three experimental groups of Sprague-Dawley rats were assessed: (1) normoxia, (2) hypoxia and (3) hypoxia-ischemia. Groups 1 and 2 were given 0, 2,500 or 5,000 U/kg rEpo subcutaneously for the first 5 days of life (P1–P5). Group 2 animals also underwent 2 h of hypoxia (8% O2) daily from P1–P3. Group 3 animals underwent right carotid artery ligation followed by hypoxia (8% O2 × 90 min) on P7, followed by either vehicle or rEpo (2,500 U/kg subcutaneously QD ×3). We evaluated short- and long-term physiologic and behavioral outcomes. Major organs were evaluated grossly and histologically. Results: rEpo treatment transiently raised hematocrit, prevented hypoxia-induced delays in geotaxis and growth, improved forelimb strength, promoted liver growth in males, lowered the adult platelet count, but did not alter other CBC indices or histology. rEpo prevented hypoxia-ischemia-induced learning impairment and substantia nigra neuron loss. Conclusions: Repeated treatment of newborn rats with high-dose rEpo was safe under all conditions tested. rEpo treatment improved the development of hypoxia-exposed newborns and prevented the learning impairment and dopamine neuron loss due to unilateral hypoxic-ischemic brain injury.
Glucagon-Like Peptide-2 in Umbilical Cord Blood from Mature Infants
Authors: Bodé Susan , Hartmann Bolette , Holst Jens J. , Greisen Gorm
Published: November 2006

Background: Glucagon-like peptide-2 (GLP-2) seems to be a highly specific intestinotrophic mediator. From animal studies, GLP-2 is known to increase in the early neonatal period before it falls to adult level. No studies in newborn infants addressing this specific subject have been published so far. Objectives: To measure GLP-2 concentrations in umbilical cord blood from healthy mature infants and to assess any influence from the processes associated with spontaneous birth to GLP-2 production. Subjects: Twenty-one children delivered by elective cesarean section for maternal reasons and 18 children delivered spontaneously vaginally and without complications were included. Gestational age (GA) was median (range) 38.7 (40.7–37.1) weeks and 40.2 (41.9–38) weeks, and birth weight was median (range) 3,210 (4,820–2,100) g and 3,396 (4,225–3,050) g, respectively. The infants had no diagnosed diseases or malformations. Methods: Umbilical cord blood was collected shortly after birth. Plasma was separated and GLP-2 immunoreactivity was measured with a specific NH2-terminal radioimmunoassay. Results: GLP-2 was detected in all samples. Mean values ±SD were 16.7 ± 3.9 pmol/l and range was 32–11 pmol/l, which is comparable to adult fasting levels. No significant correlation to birth weight (p = 0.087) or to cesarean section (p = 0.059) was found. In multiple linear regression analysis (GLP-2 vs. GA + cesarean section), neither vaginal delivery nor GA were statistically significantly related to the level of GLP-2 (p = 0.28 and 0.18), respectively. Conclusions: GLP-2 is present in human cord blood by the time of birth. The level of GLP-2 is comparable to adult fasting levels. Spontaneous birth at most induces a minor increase in GLP-2 in term infants. In the narrow age interval studied, no significant effect of maturation was seen.
Immunomodulatory Effect of Vitamin C on Intracytoplasmic Cytokine Production in Neonatal Cord Blood Cells
Authors: Härtel Christoph , Puzik Alexander , Göpel Wolfgang , Temming Petra , Bucsky Peter , Schultz Christian
Published: November 2006

Background: Vitamin C (ascorbic acid) is an essential water-soluble antioxidant in cells and plasma. Besides metabolic functions, vitamin C is also known to contribute to immune homeostasis. Recently, it has been demonstrated that vitamin C has an inhibitory effect on the expression of pro-inflammatory cytokines such as interleukin (IL)-6 and tumor necrosis factor alpha (TNF-α) in adult whole blood cells in vitro. It has been postulated that vitamin C might be an interesting compound for modulation of an over-exuberant immune response, e.g., in patient cohorts susceptible for the development of systemic inflammatory response syndrome such as neonates. It was the aim of this study to investigate the modulatory effects of vitamin C on the production of inflammatory mediators in neonatal cord blood cells. Methods: The intracytoplasmic production of pro-inflammatory cytokines in neonatal cord blood cells stimulated with lipopolysaccharide or phorbol 12-myristate 13-acetate/ionomycin was assessed by flow-cytometry. Results: In contrast to our previous observations from adult whole blood cells, 20 mM vitamin C mildly stimulated the percentage of neonatal monocytes producing IL-6 after lipopolysaccharide stimulation (e.g., 11.3% increase compared to control, p = 0.005). In the presence of 20 mM vitamin C, even a stronger stimulatory effect was noted for the percentage of IL-8 (e.g., 46.7% increase, p < 0.001) and TNF-α producing neonatal monocytes (e.g., 69.2% increase, p = 0.004; n = 20). In accordance with adult data, the percentage of neonatal lymphocytes producing IL-2 after phorbol 12-myristate 13-acetate/ionomycin stimulation was dose-dependently reduced (e.g., 41.3% inhibition, p = 0.001, 20 mM vitamin C), while the percentage of TNF-α producing lymphocytes was mildly stimulated (e.g., 20.8% increase, p = 0.003, 20 mM vitamin C). Conclusions: Interestingly, vitamin C was demonstrated to enhance pro-inflammatory responses in CD14+ cord blood cells while only intracellular IL-2 production in CD3+ cells was diminished. These data suggest that vitamin C differentially influences intracytoplasmic cytokine production in adults and neonates, and further studies are needed to elucidate the underlying mechanisms of this selective immunomodulation.
Hemoglobin Switch in the Newborn: A Flow Cytometry Analysis
Authors: Amoyal Ilana , Fibach Eitan
Published: November 2006

Background: Hemoglobin (Hb) production switches upon birth from fetal Hb (HbF) to adult Hbs. HbF production is reactivated in sickle cell anemia and β-thalassemia, where increased HbF ameliorates clinical symptoms and HbF-stimulating drugs are used for treatment. Understanding of the switch is therefore of basic interest and important for rational drug design. We studied the switch by determining changes after birth in the frequency and HbF-content of HbF-containing red blood cells (F-RBC) and reticulocytes (F-retics). Methods: Blood samples of neonatal cord, babies in their first year and adults were stained with both phycoerythrin-conjugated anti-human HbF antibodies and the nucleic acid dye thiazol-orange, and analyzed by flow-cytometry. RBC and retics were distinguished by their different thiazol orange-derived fluorescence and their HbF content was determined by the intensity of phycoerythrin-derived fluorescence. Results: The frequency of both F-RBC and F-retics decreases with time after birth. In most cases, the percentage of F-RBC was higher, but their HbF-content was lower than that of retics. The HbF content of the F-RBC and the F-retics showed a gradual decrease with age. Conclusions: The results can be explained by two models: (A) A pool of homogenous stem cells that undergo gradual changes in their globin transcription pattern. (B) A pool of heterogeneous stem cells with varying HbF potentials that become active in an age-dependent manner: first, cells with a high HbF potential and then cells with a gradually lower HbF potential. In both models, these changes are induced by a biological clock and environmental factors.
Oropharyngeal Tumor in the Newborn: A Case Report
Authors: Yossuck Panitan , Williams H. James , Polak Mark J. , Vaughan Richard
Published: November 2006

Background: An oropharyngeal tumor presenting as a protruding mass from the mouth of the newborn infant is very rare. This mass has the potential to obstruct the airway and requires urgent medical management, diagnosis and appropriate surgical management. Objectives: To report a case of a newborn with an oropharyngeal mass presenting at birth and focus on key clinical issues for the physician faced with the care of such an infant. Methods and Results: We describe a newborn infant who was born with a large mass protruding from the oral cavity at birth, without respiratory distress. The mass was surgically removed with no complications. The histology of the mass revealed it to be a pharyngeal dermoid polyp, also called ‘hairy polyp’. The infant did well after tumor removal and was discharged home within a couple of days. Conclusions: We report a case of a newborn with a pharyngeal dermoid polyp presenting as an oropharyngeal mass.
Leakage of Colon Anastomoses: Development of an Experimental Model in Pigs
Authors: Nordentoft Tyge , Sørensen Michael
Published: November 2006

Background: In order to investigate anastomotic leakage, a number of experimental animal studies have been previously carried out. Due to the low frequency of spontaneous anastomotic leakages, there have been studies on gastrointestinal anastomoses with iatrogenically produced leakages. A leakage model has only been developed in one gastric bypass study. The aim of the present study was to develop a leakage model of pig colon anastomoses. This type of study has never been performed before. Materials and Methods: Anastomosis was performed in 22 pigs. In all anastomoses a standardized rupture in the anastomotic line was made. The rupture ranged from 5 mm in the first group of pigs, increasing subsequently to 21 mm in the last group. Autopsy was performed after 7 days. The end points were macroscopic leakage and fecal peritonitis. Results: 6 out of the 6 pigs with a 21-mm rupture developed leakage and fecal peritonitis. In the groups with smaller ruptures, most of the pigs did not develop any signs of leakage or fecal peritonitis. The difference is significant. The group of pigs with peritonitis had significantly fewer adhesions to the anastomoses than the group without peritonitis. Conclusion: A model of anastomotic leakage on pig colon is developed with creation of a 21-mm rupture in the anastomotic line.
Ammonium Homeostasis and Human Rhesus Glycoproteins
Authors: Planelles Gabrielle
Published: November 2006

The brain ammonium production is detoxified by astrocytes, the gut ammonium production is detoxified by hepatic cells, and the renal ammonium production plays a major role in renal acid excretion. As a result of ammonium handling in these organs, the ammonium and pH values are strictly regulated in plasma. Up until recently, it was accepted that mammalian cell transmembrane ammonium transport was due to NH4+ transport by non-specific transporting systems, and to non-ionic NH3 diffusion, whereas lower organisms (such as bacteria, yeasts and plants) were endowed with specific ammonium transporters (Amts). Sequence homologies between Amts and human Rhesus (Rh) glycoproteins (RhAG, from erythroid cells, and RhBG and RhCG from epithelial cells) raised the hypothesis that Rh glycoproteins act as specific ammonium transporters, further sustained by the polarized distribution of RhBG and RhCG in gut, kidney and liver. Results from functional studies agree that Rh glycoproteins are the first ammonium transporters reported in mammals. However, the nature of the transported specie(s) is much debated: in particular, it is proposed that Rh glycoproteins mediate a direct NH3 transport, or that they mediate an indirect NH3 transport (resulting from NH4+ for H+ exchange). Direct NH3 transport (associated or not with NH4+ transport) raises the exciting hypothesis that Rh glycoproteins may also transport other gasses than NH3 (namely, CO2).
The Changing Risk Factor Profile of Participants Enrolled in a Secondary Stroke Prevention Trial: Vitamin Intervention for Stroke Prevention
Authors: Howard Virginia J. , Furie Karen L. , Wang Chin-Hua , Sides Elizabeth G. , Toole James F.
Published: November 2006

Objective: To determine if the stroke risk factor profile of participants in a large, multicenter secondary stroke prevention trial changed over the recruitment period. Methods: The 3,680 participants in the Vitamin Intervention for Stroke Prevention (VISP) were categorized into four groups by enrollment date. Baseline patient characteristics and stroke risk factors were compared across groups. Results: Hypertension and hypercholesterolemia management improved but prevalence of three major stroke risk factors did not change. Patients enrolled later had better Mini-Mental State and lower NIH Stroke Scale scores, higher multivitamin use, lower prevalence of cortical infarctions, cardiac symptoms and prior stroke, and lower serum creatinine levels. Conclusions: Those participants enrolled in the later recruitment periods had a different risk factor profile and risk factors were managed differently compared to those enrolled earlier.
Effects of Demographic Characteristics, Health-Related Behaviors and Lifestyle Factors on the Prevalence of Hypertension for the Middle-Aged and Elderly in the Guangxi Hei Yi Zhuang and Han Populations
Authors: Ruixing Yin , Jiaqiang Deng , Dezhai Yang , Weixiong Lin , Shangling Pan , Jinzhen Wu , Jiandong Huang , Xiuyan Long
Published: November 2006

Background/Aims: Hei Yi (meaning black worship and black dress) Zhuang is the most conservative group among the 43 ethnic subgroups of Zhuang in China due to its unique culture and customs. The prevalence of hypertension in this population has not been well defined. Therefore, the present study was undertaken to compare the effects of the demographic characteristics, health-related behaviors and lifestyle factors on the prevalence of hypertension in the middle-aged and elderly of the Guangxi Hei Yi Zhuang and Han populations. Methods:A total of 657 people of Hei Yi Zhuang aged 40 and over were randomly selected from 7 villages in Napo County of China. Information on the demographic characteristics, health-related behaviors and lifestyle factors was collected by questionnaire. Blood pressure, height, weight, waist circumference, serum lipid and apolipoprotein levels were measured, and body mass index (BMI) was calculated as a measure of weight relative to height. The results were compared with those of 520 Han who live in the same district. Results: The prevalence of hypertension and isolated systolic hypertension in Hei Yi Zhuang was significantly higher than in Han (32.9 vs. 24.6%, p < 0.01, and 16.7 vs. 5.2%, p < 0.001, respectively). The systolic blood pressure levels and pulse pressure in Hei Yi Zhuang were also significantly higher than in Han (129 ± 20.1 vs. 125.8 ± 17.4 mm Hg, p < 0.01, and 51.5 ± 16.1 vs. 47.1 ± 12.0 mm Hg, p < 0.01, respectively). The prevalence of hypertension was positively correlated with triglycerides, male, age, and alcohol consumption in Hei Yi Zhuang, whereas it was positively correlated with total cholesterol, male, age, alcohol consumption and BMI in Han. The rates of awareness, treatment and control in Hei Yi Zhuang and Han are 7.9 vs. 19.5%, 4.2 vs. 13.3% and 1.4 vs. 9.4% (p < 0.01 for all), respectively. Conclusion: The current study reveals a significant difference in the prevalence of hypertension, blood pressure levels, and the relative factors between the Hei Yi Zhuang and Han ethnic groups, which may have been due to differences in geographical characteristics, lifestyle, sodium intake, education levels, and even genetic factors.
Tumor Antigen-Based Immunotherapy and Immunoprevention of Cancer
Authors: Ryan Sean O. , Gantt Kira R. , Finn Olivera J.
Published: November 2006

Any approach to the treatment and prevention of cancer must face the daunting reality that each cancer may be as individual as the patient in whom it has evolved. The challenge is also to develop a therapy that would eradicate that which is abnormal while preserving what is normal. For many years, therapies have been sought that could target a specific abnormal cancerous processes, such as rapid division or increased vascular flow, but with only limited success. Unfortunately, these successes have also been accompanied by varying degrees of toxicity and there is currently no standard therapy that can eradicate clinical disease and prevent recurrence while leaving normal tissue unharmed. However, approaches directed towards manipulating tumor-specific immunity hold promise for effective treatment and lasting cure. These approaches are based on the exceptional specificity of the immune system, the potential for long-term protective memory, and the accumulated evidence that affected individuals have spontaneous immune responses against their own tumors.
Memory T Cell Proliferation in Cow’s Milk Allergy after CD25+ Regulatory T Cell Removal Suggests a Role for Casein-Specific Cellular Immunity in IgE-Mediated but Not in Non-IgE-Mediated Cow’s Milk Allergy
Authors: Sletten Gaynour B.G. , Halvorsen Ragnhild , Egaas Eliann , Halstensen Trond S.
Published: November 2006

Background: Previously reported increased lymphocyte proliferative responses in cow’s milk allergy (CMA) may have been influenced by the lipopolysaccharides (LPS) which contaminate most commercial cow’s milk protein (CMPs). Moreover, peripheral blood mononuclear cells (PBMC) contain both B cells, CD45RA+ naïve T cells, CD25+ regulatory T cells (Tregs) in addition to antigen-specific CD45RA– memory T cells. Methods: PBMC from clinically reactive and tolerised patients with IgE- and non-IgE-mediated CMA were depleted of CD45RA+ T cells and putative CD25+ Tregs. The proliferative index to LPS-depleted α-, β- and ĸ-casein and β-lactoglobulin was compared in the memory T-cell-enriched, Treg-depleted PBMC and in bulk PBMC. Results: Clinically reactive IgE-mediated CMA patients had increased responses to caseins only. Tolerised patients, particularly those with atopic dermatitis, had decreased responses to ĸ-casein which were restored after Treg depletion. Interleukin-4 and interferon-γ were generally not detected in the culture supernatants. No differences were seen between reactive and tolerant delayed non-IgE-mediated CMA patients. Conclusions: Proliferative responses to α-, β- and ĸ-caseins (but not β-lactoglobulin) were observed in clinically reactive IgE-mediated CMA patients only. A markedly decreased proliferative response to ĸ-casein in tolerised IgE-mediated CMA patients with atopic dermatitis, which was abrogated by Treg depletion, suggested a role for ĸ-casein in tolerance induction. Non-IgE-mediated CMA patients had no increased proliferative response to any milk proteins.
A Plague of Plagues: The Problem of Plague Diagnosis in Medieval England
Authors: Theilmann John , Cate Frances
Published: November 2006

Recent works by historians and biologists have called into doubt whether the great epidemic of 1348/49 in England was the plague. Examination of the biological evidence, however, shows their arguments to be faulty. The great epidemic of 1348/49 may have included other diseases, but it was clearly yersinia pestis.
Constitutional Interpretation outside the Courts
Authors: Tushnet Mark
Published: November 2006

David Currie's four volumes about constitutional interpretation in Congress from 1789 to the Civil War provide historians, political scientists, and legal scholars with important insights into American political development. The books shed light on the gradual erosion of Congress' capacity to interpret the Constitution and offer a solid basis for provocative speculation about the strength of the normative case for judicial review.
The Environmental Resonance of Daoist Moving Meditations
Authors: Nixon Denver Vale
Published: November 2006

Rather than focus solely on traditional philosophical categories, as has often been the case in the discourse on Daoism and ecology, this paper explores the connections between a Daoist theory of practice, moving meditations of Daoist origin, and environmental resonance. Major themes explored include internalized action tradeoffs, preventative and integrated health awareness, alternative epistemologies, and an extemporaneous ethic sensitive to ecological change. It is suggested that collectively, Daoist cultivational practices may contribute toward social behaviour that is at least neutral, if not benevolent, toward the non-human world. Autoethnographic journal entries vivify the arguments presented. It is hoped that this practice oriented approach will not only reveal some overlooked connections between Daoism and ecology worthy of further study, but also appreciate the religious heritage of the Daoism to which such practices owe their naissance.
Trust in the Capability of the Welfare State and General Welfare State Support: Sweden 1997-2002
Authors: Edlund Jonas
Published: November 2006

A central component of institutional trust is related to perceptions of state capacity. Claims have been made that if citizens’ experiences with the state tell them that the government is efficacious, fair and trustworthy, then the odds for supporting publicly financed welfare policies are higher compared to a situation when their experiences with government feed feelings of inefficiency, corruption, unfairness and arbitrary discretion. The general question guiding the empirical analysis is the following: Is distrust in institutional capability an important prerequisite for general welfare state support withdrawal? Relying on Swedish nationally representative survey data, this issue is examined using Latent Class Analysis (LCA). Empirical evidence suggests that distrust in the institutional capability of the welfare state has not translated into widespread anti-welfare state sentiments. For some citizens, distrust in the capability of the welfare state is an issue of insufficient resources and they are willing to increase social spending in order to improve social services and benefits. For other citizens, distrust is closely connected with anti-welfare state sentiments. The article discusses the implications of the results for arguments about institutional trust and welfare state support.
The Limits of Social Solidarity
Authors: Bay Ann-Helén , Pedersen Axel West
Published: November 2006

Does mass immigration and increasing ethnic diversity challenge the legitimacy of the universal welfare state? Assuming that basic income can be seen as a radical extension of the universal welfare state, we pursue this question by investigating whether popular reactions towards a basic income proposal are susceptible to persuasion that invokes attitudes towards immigration. The study is based on survey data covering a representative sample of the Norwegian electorate. We find that a comfortable majority express sympathy with the idea of a basic income, and that the structure of initial support for the basic income proposal is well in line with established findings concerning attitudes towards welfare state institutions and redistributive policies more generally. However, by applying a persuasion experiment, we show that negative attitudes towards immigration can be mobilized to significantly reduce the scope of support for a basic income proposal among the Norwegian electorate.
Educational Transitions at Graduate Level
Authors: Mastekaasa Arne
Published: November 2006

The prevailing view in the research literature is that social origin has little impact on educational choices made late in one’s educational career. The article focuses on one very late transition, viz. enrolment in PhD programmes. The most important theoretical point of departure is the Breen and Goldthorpe relative risk aversion (RRA) theory. The analyses show that class origins have an impact, but only in how individuals at the very top of the class hierarchy deviate from the rest. There are also considerable effects of having parents who have themselves taken doctoral degrees and of having parents employed in higher education or research. The results do not support the RRA theory with mobility defined in terms of class, but they are consistent with a modified version in which individuals are assumed to be concerned about their educational mobility irrespective of whether or not additional education affects class position.
Imposing on Napoleon
Authors: Stock Paul
Published: November 2006

This article explores how major British Romantic writers perceived Napoleon in the early nineteenth century: the ideas they associated with him and the images they used to depict him. I argue that these perceptions have relatively little to do with the politics of the various writers, or with the chronology of Napoleon’s career. Instead, interest in Bonaparte is driven by aesthetic and philosophical concerns: especially the question of whether Napoleon is an ordinary man ‘within’ history, or a semi-allegorical personage -a representative of some ideology or concept (like Liberty or Heroism). I also discuss how Napoleon is appended to the Romantic problem of the ‘overreacher’, who fails due to his glorious success, and who thus blurs the boundaries between triumph and failure. Lastly, I show how Napoleon influences Romantic concern about ‘imposing’ ideas onto analysis of the world. In this way, Napoleon exposes insecurities at the heart of Romantic self-perception.
The Anticholinergic Drug Scale as a Measure of Drug‐Related Anticholinergic Burden: Associations With Serum Anticholinergic Activity
Authors: Carnahan Ryan M. , Lund Brian C. , Perry Paul J. , Pollock Bruce G. , Culp Kennith R.
Published: November 2006

Anticholinergic Drug Scale (ADS) scores were previously associated with serum anticholinergic activity (SAA) in a pilot study. To replicate these results, the association between ADS scores and SAA was determined using simple linear regression in subjects from a study of delirium in 201 long‐term care facility residents who were not included in the pilot study. Simple and multiple linear regression models were then used to determine whether the ADS could be modified to more effectively predict SAA in all 297 subjects. In the replication analysis, ADS scores were significantly associated with SAA (R
2 = .0947, P <.0001). In the modification analysis, each model significantly predicted SAA, including ADS scores (R
2 = .0741, P <.0001). The modifications examined did not appear useful in optimizing the ADS. This study replicated findings on the association of the ADS with SAA. Future work will determine whether the ADS is clinically useful for preventing anticholinergic adverse effects.
Effect of Renal Function on the Pharmacokinetics of Palifermin
Authors: Gillespie B. , Zia‐Amirhosseini P. , Salfi M. , Kakkar T. , Wang J. , Gupta S. , Smith B. , Robson R. , Sullivan J. T.
Published: November 2006

Palifermin (ΔN23KGF) decreases the incidence, severity, and duration of oral mucositis. The objectives of this open‐label study were to evaluate the pharmacokinetics of single‐dose palifermin in subjects with varying degrees of renal function. A single 90‐mcg/kg intravenous dose of palifermin was administered to 31 subjects with varying levels of renal function (normal to requiring hemodialysis). Pharmacokinetic analyses were conducted using serum palifermin concentrations. There was considerable overlap in mean palifermin serum clearance among the groups, ranging from 318 to 495 mL/h/kg, indicating that the level of renal function did not affect clearance in humans; thus, no dose adjustment of palifermin is indicated for patients with renal dysfunction.
Dynamics and Kinetics of a Modified‐Release Formulation of Zolpidem: Comparison With Immediate‐Release Standard Zolpidem and Placebo
Authors: Greenblatt David J. , Legangneux Eric , Harmatz Jerold S. , Weinling Estelle , Freeman Jon , Rice Kathleen , Zammit Gary K.
Published: November 2006

Modified‐release (MR) zolpidem was developed to maintain effective plasma concentrations during the 3‐ to 6‐hour post‐dosage interval, corresponding to the middle portion of the typical sleep interval. Modified‐release zolpidem (12.5 mg), standard immediate‐release (IR) zolpidem (10 mg), and placebo were compared in a double‐blind, single‐dose, 3‐way crossover daytime study of healthy volunteers (n = 70 completers). Effect areas for electroencephalographic β amplitude during 0 to 8 hours and 3 to 6 hours after dosage were greater for MR compared to IR (P<.001). The digit‐symbol substitution test and sedation rating scales behaved similarly. MR and IR did not differ in effects at 8 hours post‐dosage nor in half‐life or clearance. Time of peak plasma concentration (tmax) was significantly longer for MR (2.4 vs 2.0 hours,P<.004), and dose‐normalized peak plasma concentration (Cmax) was lower (12.2 vs 14.0 ng/mL/mg,P<.001). MR zolpidem also had greater area under the plasma concentration curve (AUC) during the 3‐ to 6‐hour interval (P<.001). Thus, MR zolpidem produces sustained plasma levels compared to IR, with resulting enhancement of pharmacodynamic effects in the 3‐ to 6‐hour post‐dosage interval.
Evaluation of 227 Drugs for In Vitro Inhibition of Cytochrome P450 2B6
Authors: Walsky Robert L. , Astuccio Angela V. , Obach R. Scott
Published: November 2006

Cytochrome P450 2B6 (CYP2B6) is involved in the metabolism of drugs such as bupropion, efavirenz, propofol, and selegiline, among others. More than 200 commonly prescribed drugs and other xenobiotics were examined for their ability to inhibit CYP2B6‐mediated bupropion hydroxylase activity. Thirty compounds were found exhibiting greater than 50% inhibition at 30 μM. Inhibitors of CYP2B6 were identified from a wide variety of therapeutic classes. The 2 platelet aggregation inhibitors, clopidogrel and ticlopidine, were both identified as potent inhibitors (IC50= 0.0206 and 0.149 μM, respectively). Other inhibitors (IC50< 1 μM) included clotrimazole, itraconazole, sertraline, and raloxifene. These in vitro data were used along with clinical pharmacokinetic information in the prediction of potential drug‐drug interactions that could occur by inhibition of CYP2B6. Although few drugs tested are expected to cause drug interactions, clopidogrel and ticlopidine were identified as being of concern as potential inhibitors of clinical relevance. These findings are discussed in context to potential drug interactions that could be observed between these agents and drugs for which CYP2B6 is involved in metabolism.
Patronage and Representation at the Huviska Vihāra a Kusāna-Period Monastery in Mathurā
Authors: Basu Chandreyi
Published: November 2006

Art and inscriptions from the Jamālpur site in the southern section of Mathurā city help characterize an early Buddhist monastic community and its relationship with lay patrons of non-royal backgrounds. Although named after Huviska, a powerful ruler of the Kusāna dynasty in the mid–second century CE, the monastery at this site was supported by monks, local administrators and members of professional groups such as actors. Monks specialized in textual interpretations, recitations and meditative practices, but were also successful fund raisers who actively influenced Buddhist imagery. Figures of lay worshippers carved in a naturalistic style are privileged in sculptures from this monastery. Visiting monks were instrumental in introducing elements of Kusāna royal symbolism into local art production. The role of this monastery was primarily to help local political elite to gain legitimation through their association with the Kusāna name and royal symbols on the one hand, and on the other, with a local nāga cult. Worshippers of the nāga deity, who otherwise occupied a low position in society, gained recognition by joining the patronage network of the monastery. Certain groups—craftsmen, merchants and agriculturalists—as well as women, however, seem to be conspicuously absent as donors at this site.
Negotiating Identity and Status
Authors: Sharma Sanjay
Published: November 2006

A relatively recent thrust in Indian historiography has been on explorations of the making and functioning of various ideological structures through which the state in early India derived legitimacy. The present article extends the theme to the state under the Gurjara-Pratīhāras of Kanauj, who ruled large parts of north India from the late eighth to the early eleventh century AD. It begins by highlighting how the Pratīhāras of Kanauj made a conscious attempt to distance themselves from their Gurjara identity, through a variety of means. Association with the solar lineage, projection of devotion to a specific brahmanical deity by each Pratīhāra ruler in the copper plates of the family and the use of titles like Ādivarāha were some of the strategies used. The article also delineates the shift in the nature of religious legitimation as the locus of the state shifted from Jalor in southern Rajasthan to Kanauj in Uttar Pradesh. The analysis also indicates a dichotomy between the forms of patronage extended by the sovereign, who had an inclination towards giving grants of land to brāhmanas, and that of the subordinates, who were more involved in temple-building activities, probably to cater to the needs of their local contexts. The article thus attempts to situate the case of the Gurjara-Pratīhāras of Kanauj within the broader historiography on the theme.
Settling the Convict
Authors: Vaidik Aparna
Published: November 2006

The social history of convicts is an area of study which has hitherto remained an uncharted territory. The muted convict voice makes an ephemeral appearance in most colonial histories as ‘convict resistance’, which is seen as the sum total of the convict's life experience. On the other hand, colonial records and monographs oscillate between two extremes in the categorization of the convict's social life. There is either a romanticization of the idyllic penal colonies where the convicts have the appearance of reformed savages, peacefully going about their daily chores, no different from the Indian peasants; or the convicts are seen as conniving brutes obsessed with the idea of ‘escape’, where the state of unfreedom that they are subjected to is seen as the most defining characteristic of their life in the penal settlement. Breaking out of these moulds, this essay has used the colonial project of settling the convict in the penal colony on the Andaman Islands as an entry point into the social life of the convict. The convict, when he arrived in the Andamans was akin to a shipwrecked vessel, severed from all ties and floating without an anchor. The doors of the social world he had inhabited before he set foot on the Andamans were supposed to be closed to him forever. The essay examines the attempt of the state to rebuild the life of such a dispossessed and beleaguered social being. The main denominators of the domestication of the convict were matrimony and setting up of a household. The essay explores the different notions held by the convicts and the state with regard to ‘family’ and ‘marriage’, and the fissures and tensions created in the system thereby. It draws upon government records, colonial monographs, interviews with descendants of convicts, and leaflets out of the lives of the convicts to narrate a social history of the Settlement.
Constructing Boundaries, Contesting Identities
Authors: Sivaramakrishnan Kavita
Published: November 2006

This article examines the process by which an occupational field that consisted of traditional intellectuals, hereditary practitioners and religious specialists attempted to reorder the public status of their learning and began to emerge with a self-conscious, corporate identity. Situated in colonial Punjab in the 1930s, it traces the responses of Ayurvedic practitioners or Vaids to the ideas and assumptions buttressing scientific, Western medicine and its validation of colonial rule. It argues that indigenous practitioners began to construct a discourse on indigenous science in the public sphere in Punjab that was mediated by the vernacular press and by newly formed corporate bodies. The attributes of Ayurvedic learning were gradually recast in the political idiom of language-based alignments and the claims of a tradition of indigenous science in turn legitimized a unified, singular Hindu nation. However, this process was constantly challenged by alternative interpretations of its vocabulary and competing political affiliations and interests.
Physician Practice Patterns: Chest X-Ray Ordering for the Evaluation of Acute Cough Illness in Adults
Authors: Aagaard Eva , Maselli Judy , Gonzales Ralph
Published: November 2006

Objectives. The authors examine which clinical factors contribute to the clinician suspicion of pneumonia, as well as the relationship between clinical factors, clinician suspicion of pneumonia, and ordering chest X-rays (CXR). Methods. Three hundred consecutive adults presenting to the clinic with acute cough in the winter of 2003 were studied. Using standardized encounter forms, data were collected on sociodemographics, illness impact, symptoms, tobacco use, past medical history, vital signs, physical examination findings, chest X-ray result, and clinician diagnoses. Clinicians rated their suspicion of pneumonia on a 5-point Likert scale. Multivariable logistic regression analysis was used to determine independent predictors of clinician suspicion of pneumonia and of ordering of CXRs. Results. Clinician suspicion of pneumonia was low in the majority of patients presenting for evaluation of cough (63%). Higher clinician suspicion of pneumonia was predicted by advanced patient age (odds ratio [OR]: 4.6; 95% confidence interval [CI] [1.2–18.1]), shortness of breath (2.4; [1.0–6.0]), fever (5.5; [1.8–17.5]), tachycardia (3.8; [1.1–13.1]), rales (23.8; [5.7–98.7]), and rhonchi (14.6; [5.2–40.5]). CXRs were ordered in 19% of patients presenting with acute cough. Intermediate clinician suspicion of pneumonia (OR: 7.9; 95% CI: [2.8, 22.5]) (v. low suspicion), advanced patient age ([.greaterequal] 65 years) (9.2; [2.7, 31.6]) (v. ages 18–44 years), and decreased breath sounds on examination (5.1; [1.8, 14.3]) are independent predictors of ordering a CXR. Among patients with a clinical diagnosis of pneumonia (n = 31), CXRs were ordered in only 61%. Conclusions. Advanced patient age and physical findings on chest examination influence clinician practice in obtaining CXRs, beyond their contribution to clinician suspicion of pneumonia. Physicians do not appear to endorse recommendations that the diagnosis of community-acquired pneumonia be based on or confirmed by CXR.
The Impact of Unstable Angina Guidelines in the Triage of Emergency Department Patients with Possible Acute Coronary Syndrome
Authors: Katz David A. , Aufderheide Tom P. , Bogner Mark , Rahko Peter R. , Brown Roger L. , Brown Lisa M. , Prekker Matthew E. , Selker Harry P.
Published: November 2006

Objective. The primary aim of this study is to determine whether implementing the Agency for Health Care Policy and Research (AHCPR) Unstable Angina Practice Guideline improves emergency physician's decision making in patients with symptoms of possible acute coronary syndrome (ACS), including those for whom the diagnosis of unstable angina is uncertain. Methods. The authors conducted a prospective guideline implementation trial with pre-post design in the emergency departments of 1 university hospital and 1 university-affiliated community teaching hospital from January 2000 to May 2001. They enrolled 1140 adults who presented with chest pain or other symptoms of possible ACS. The intervention included the following: 1) physician training in use of the AHCPR risk groups, 2) algorithm for risk stratification, and 3) group feedback. To determine how accurately physicians interpreted the guideline algorithm, the authors compared their risk ratings with actual guideline risk groups. Results. No significant difference in physician triage decisions was observed between baseline and intervention periods. Analysis of physician's risk ratings during the intervention period revealed low overall concordance with actual guideline risk groups (kappa = 0.31); however, physician's risk ratings showed superior discrimination in identifying patients with confirmed ACS (receiver operating characteristic [ROC] area .81 v. .74, P = 0.008). Strict adherence to guideline recommendations would have resulted in hospitalizing 9% more non-ACS patients without lowering the rate of missed ACS. Conclusion. Implementation of the AHCPR guideline did not improve triage decisions in emergency department patients with possible ACS. Assessing physician triage solely based on concordance with the AHCPR guideline may not accurately reflect the quality of patient care.