bluuebunny/crossref_metadata_2025 huggingface dataset:
Excessive CD4+ T cells co-expressing interleukin-17 and interferon-γ in patients with Behçet's disease
Authors: Shimizu J , Takai K , Fujiwara N , Arimitsu N , Ueda Y , Wakisaka S , Yoshikawa H , Kaneko F , Suzuki T , Suzuki N
Published: December 2011

Excessive T helper type 1 (Th1) cell activity has been reported in Behçet's disease (BD). Recently, association of Th17 cells with certain autoimmune diseases was reported, and we thus investigated circulating Th17 cells in BD. CD4+CD45RO– (naive) T cells were cultured with Th0-, Th1-, Th2- and Th17-related cytokines and antibodies, and their mRNA was studied by real-time polymerase chain reaction (PCR). When naive CD4+ T cells were cultured with Th1- and Th17-related cytokines, interferon (IFN)-γ mRNA and interleukin (IL)-17 mRNA were up-regulated, respectively, in BD patients. Naive CD4+ T cells cultured in a Th17 cell-inducing condition expressed IL-23 receptor (IL-23R) mRNA excessively. IL-17 mRNA expression was induced only when naive CD4+T cells were cultured in the presence of IL-23. CD4+ T cells cultured with Th17 cytokines expressed excessive RAR-related orphan receptor C (RORC) mRNA. Using intracellular cytokine staining, we found that CD45RO+(memory) CD4+ T cells producing IL-17 and IFN-γ simultaneously were increased significantly. Memory CD4+ T cells producing IFN-γ but not IL-17 decreased profoundly in BD patients. CD4+ T cells producing IL-17 and IFN-γ simultaneously were found in BD skin lesions. Collectively, we found excessive CD4+ T cells producing IL-17 and IFN-γ (Th1/Th17) cells in patients with BD, and possible involvement of IL-23/IL-23R pathway for the appearance of excessive Th1/Th17 cells.
Tree species compositional change and conservation implications in the white‐water flooded forests of the Brazilian Amazon
Authors: Albernaz Ana Luisa , Pressey Robert L. , Costa Luiz R.F. , Moreira Marcelo P. , Ramos José Ferreira , Assunção Paulo A. , Franciscon Carlos H.
Published: December 2011

Aim  The aim of this study was to use compositional changes in tree species along the Amazon River floodplain in Brazil to identify and characterize biogeographic regions that would serve as broad surrogates for conservation planning.

Location  The main course of the Amazon River in Brazil, covering a river distance of approximately 2800 km.

Methods  Two sampling methods were employed at specific sites: standardized transects and/or individual‐based samples. Seventy‐three samples were collected from 26 sites at approximately 100‐km intervals along the floodplain. Biogeographic regions were identified by non‐metric multidimensional scaling (NMDS) ordination and by a hierarchical cluster analysis. The relative influence of environmental components (flood depths, annual rainfall, and length of the dry season) on tree species composition and one spatial component (longitude) were analysed by multiple regressions against a one‐dimensional NMDS ordination axis.

Results  Based on tree species composition, three main biogeographic regions were identified: a western region between Tabatinga and the Negro River confluence; a central region from the Negro River confluence to the Xingu confluence; and an estuarine region from the Xingu confluence to Santana. The regions identified were consistent using different data sets and analytical techniques. Mixed environmental and spatial effects explained most of the variation, but the spatial effect alone had a greater influence on species composition than environmental effects alone.

Main conclusions  The regions delimited in the analyses differed from those based on geomorphology or World Wildlife Fund (WWF) ecoregions. These results reinforce the need for surrogates to be tested against biological data before they are used to shape approaches to conservation planning. Although a protected area coverage of 25% gives the impression of extensive conservation management on the floodplain, less than 1% of the Amazon’s floodplain in Brazil is strictly protected. The significant compositional differences between regions and the strong spatial variation along the Amazon indicate that strict protection areas should be distributed much more evenly within and between regions.
Suffering and smiling: West African immigrant women’s experience of intimate partner violence
Authors: Ogunsiji Olayide , Wilkes Lesley , Jackson Debra , Peters Kath
Published: December 2011

Aims and objectives.  This study reports the intimate partner violence experiences of West African women living in Australia.

Background.  Increasing diversity in Australia’s population presents new and complex challenges to nurses and other health care providers, particularly in relation to the health needs of immigrant women.

Design.  A qualitative naturalistic inquiry design was used.

Method.  A convenience sample of 21 West African immigrant women in Australia who were 18 years and over were engaged in face‐to‐face, in‐depth interviews and asked to talk about their health experiences. The interviews were transcribed verbatim and analysed thematically. Intimate partner violence was revealed as a major theme in this analysis.

Results.  Data revealed that eighteen of the women had experienced intimate partner violence. The women’s accounts of intimate partner violence were dominated by two subthemes ‘suffering in silence’ and ‘reluctance to seek help.’

Conclusion.  Findings revealed intimate partner violence as a significant issue for the newly migrated African women who participated in this study.

Relevance to clinical practice.  Intimate partner violence is associated with significant adverse physical and psychological health outcomes. It is important that nurses understand the cultural barriers that can impede immigrant women’s ability to seek out and receive appropriate support and intervention and provide opportunities for women to disclose experiences of intimate partner violence.
The effects of perceived stress and ways of coping in a sample of Portuguese health workers
Authors: Laranjeira Carlos A
Published: December 2011

Aim.  The goal of this study is to clarify the association between perceived stress in work and the types of coping strategies used by Portuguese nurses.

Background.  The healthcare work environment as a source of overwork and stress has been implicated in today’s nursing shortage. Staff nurses play a pivotal role in creating work environments, but little is known about the nature of Portuguese nurses’ work.

Design.  A descriptive correlational design and a cross‐sectional approach were used for this study.

Method.  A total of 102 registered nurses, in three Portuguese hospitals, were selected. The Perceived Stress Scale and the Ways of Coping Questionnaire were used to measure job stress and coping strategies, respectively.

Results.  High levels of stress were reported by 52·2% of respondents. The results showed that the main stressful factors for nurses are patient death and dying (32·8%), followed by emergency situations (22·8%) and low supportive relationships (18·0%). The most frequently used coping strategy was self‐controlling, followed by planful problem‐solving and seeking social support. Pearson’s correlation tests indicated that the total score of the Perceived Stress Scale significantly negatively correlated with the subscales of the use of coping strategies of seeking social support, self‐controlling, planful problem‐solving, distancing and escape‐avoidance, indicating that those who were more distressed showed lower levels in mentioned coping subscales.

Conclusion.  Stress in nursing can be best reduced through the application of the control cycle approach and risk assessment/risk management techniques. Stress management of nurses may improve their productivity and quality of life.

Relevance to clinical practice.  A change in leadership styles from the managerial level and reallocation of personnel may help reduce job stress. It is important for clinical practitioners to understand theoretical research concerning human stress responses, appraisal and coping to apply knowledge in practice when dealing with a client who has experienced a crisis.
An international eDelphi study identifying the research and education priorities in wound management and tissue repair
Authors: Cowman Seamus , Gethin Georgina , Clarke Eric , Moore Zena , Craig Gerardine , Jordan‐O’Brien Julie , McLain Niamh , Strapp Helen
Published: December 2011

Aim.  To incorporate an international and multidisciplinary consensus in the determination of the research and education priorities for wound healing and tissue repair.

Background.  A compelling reason for the study is the lack of an agreed list of priorities for wound care research and education. Furthermore, there is a growth in the prevalence of chronic wounds, a growth in wound care products and marketing, and an increase in clinician attendance at conferences and education programmes.

Design.  The study used a survey method.

Methods.  A four‐round eDelphi technique was used to collect responses from an international population of health professionals across 24 countries.

Results.  Responses were obtained from 360 professionals representing many health care settings. The top education priorities related to the standardisation of all foundation education programmes in wound care, the inclusion of wound care in all professional undergraduate and postgraduate education programmes, selecting dressings and the prevention of pressure ulcers. The top research priorities related to the dressing selection, pressure ulcer prevention and wound infection.

Conclusion.  Professionals from different backgrounds and countries who are engaged in wound management share a common set of priorities for research and education. Most notably, the priorities identified relate to long‐established clinical challenges in wound care and underpin the principles of good patient care practices. The priorities are closely allied to an ageing population and identify many challenges ahead for practitioners engaged in wound management services.

Relevance to clinical practice.  The provision of wound care is a major investment of health service resources and remains a clinical challenge today. Research is essential to building evidence‐based practice and fundamental to development of quality in standards of practice; education is central to achieving competence to deliver effective care. The determination of research and education priorities is therefore an absolute requirement in developing services.
Moving between rooms – moving between life and death: nurses’ experiences of caring for terminally ill patients in hospitals
Authors: Johansson Kristina , Lindahl Berit
Published: December 2011

Aim.  This study describes the meanings of generalist registered nurses’ experiences of caring for palliative care patients on general wards in hospitals.

Background.  Earlier research shows that work with patients in palliative care is demanding. More research concerning palliative care is undertaken in oncological care, in hospice and in home‐care settings than in general wards. It is therefore important to examine the palliative care in the context of acute‐care settings to discover more about this phenomenon, to understand the experiences of nurses in this situation and to develop patient care.

Design.  Qualitative, descriptive and interpretive study.

Method.  Eight registered nurses in two different hospitals in Sweden were interviewed. The patients on these wards suffered from surgical and medical conditions, i.e. both curative and palliative care were administered. The interviews were analysed using a phenomenological hermeneutical approach inspired by Ricoeur’s philosophy.

Results.  The registered nurses’ experiences are presented as seven themes and a comprehensive, interpreted whole. This latter revealed the significance of contrasts, contradictions and movement between the material and psychological experiences of the room and nursing care in this care context.

Conclusions.  The registered nurses say that something momentous occurred during the care process and they showed a strong determination and commitment to being part of the ending of the patient’s life circle, despite the situation often being one of stress.

Relevance to clinical practice.  The findings highlight the need for various forms of support for the nurses to meet their need for new and updated knowledge and support in existential matters. This may promote a better quality of care and confirm the nurses in their caring practice. Moreover, there is a need to introduce the hospice philosophy into acute‐care settings in hospitals.
Diverse Roles of G‐Protein Coupled Receptors in the Regulation of Neurohypophyseal Hormone Secretion
Authors: Sladek C. D. , Song Z.
Published: December 2011

The magnocellular neurones in the supraoptic nucleus project to the neural lobe and release vasopressin and oxytocin into the peripheral circulation, where they act on the kidney to promote fluid retention or stimulate smooth muscles in the vasculature, uterus and mammary glands to support blood pressure, promote parturition or induce milk let‐down, respectively. Hormone release is regulated by complex afferent pathways carrying information about plasma osmolality, blood pressure and volume, cervical stretch, and suckling. These afferent pathways utilise a broad array of neurotransmitters and peptides that activate both ligand‐gated ion channels and G‐protein coupled receptors (GPCRs). The ligand‐gated ion channels induce rapid changes in membrane potential resulting in the generation of action potentials, initiation of exocytosis and the release of hormone into the periphery. By contrast, the GPCRs activate a host of diverse signalling cascades that modulate action potential firing and regulate other cellular functions required to support hormone release (e.g. hormone synthesis, processing, packaging and trafficking). The diversity of these actions is critical for integration of the distinct regulatory signals into a response appropriate for maintaining homeostasis. This review describes several diverse roles of GPCRs in magnocellular neurones, focusing primarily on adrenergic, purinergic and peptidergic (neurokinin and angiotensin) receptors.
Universality of phloem transport in seed plants
Authors: JENSEN KÅRE HARTVIG , LIESCHE JOHANNES , BOHR TOMAS , SCHULZ ALEXANDER
Published: December 2011

Since Münch in the 1920s proposed that sugar transport in the phloem vascular system is driven by osmotic pressure gradients, his hypothesis has been strongly supported by evidence from herbaceous angiosperms. Experimental constraints made it difficult to test this proposal in large trees, where the distance between source and sink might prove incompatible with the hypothesis. Recently, the theoretical optimization of the Münch mechanism was shown to lead to surprisingly simple predictions for the dimensions of the phloem sieve elements in relation to that of fast growing angiosperms. These results can be obtained in a very transparent way using a simple coupled resistor model. To test the universality of the Münch mechanism, we compiled anatomical data for 32 angiosperm and 38 gymnosperm trees with heights spanning 0.1–50 m. The species studied showed a remarkable correlation with the scaling predictions. The compiled data allowed calculating stem sieve element conductivity and predicting phloem sap flow velocity. The central finding of this work is that all vascular plants seem to have evolved efficient osmotic pumping units, despite their huge disparity in size and morphology. This contribution extends the physical understanding of phloem transport, and will facilitate detailed comparison between theory and field experiments.
Earthquake sequences of the last millennium in L’Aquila and surrounding regions (central Italy)
Authors: Amato Alessandro , Ciaccio Maria Grazia
Published: December 2011

Terra Nova, 24, 52–61, 2012

We have analysed the history of seismic activity in the region of L'Aquila to compare the 2009 sequence with previous ones. Historical catalogues are exhaustive for large shocks, but not for small earthquakes and swarms. Our original compilation highlights repeated seismic sequences from 1315 adto present. In the 20th century, at least 23 sequences affected the Abruzzi region, 8 of which were very close to L'Aquila. In previous centuries, we found evidence of at least 13 sequences around L'Aquila, with maximum magnitude ∼4 to ∼5. Only three sequences were followed by stronger shocks (1461, 1703 and 2009). However, many strong events of the region (1349, 1762, 1915, 1950) were not preceded by foreshocks. We describe here the last of these sequences (1985) showing its strong similarity with the 2009 one, except its final evolution (no large event in 1985). Our analysis suggests that seismic sequences alone cannot be considered straight forerunners of incoming strong events.
Permian granites in the Pyrenees: the Aya pluton (Basque Country)
Authors: Denèle Yoann , Paquette Jean‐Louis , Olivier Philippe , Barbey Pierre
Published: December 2011

Terra Nova, 24, 105–113, 2012

We show that the Permian volcanism in the Pyrenees was accompanied with emplacement of granite plutons with transitional chemistry. Reassessment of age, structure and petrological characteristics of the Aya pluton, intrusive in the Cinco Villas massif (Basque Country), indicates that it was emplaced at 267.1 ± 1.1 Ma in a dextral transtensive context and that it marks a transition between the high‐K calcalkaline and the alkaline emissions of the first and second Permian volcanic cycles, respectively. This age is close to that of c. 267 Ma reported for lamprophyres dykes of the Pyrenean Axial Zone. These data characterize a period of transition between the Variscan orogeny and the subsequent Alpine cycle in the Pyrenees, with an earlier extensive regime that became widespread in the Pyrenees during the Mesozoic times.
Incidence of second malignancies after external beam radiotherapy for clinical stage I testicular seminoma
Authors: Lewinshtein Dan , Gulati Roman , Nelson Peter S. , Porter Christopher R.
Published: December 2011

Study Type – Harm (case series)

Level of Evidence 4

What's known on the subject? and What does the study add?

We know that radiation therapy is associated with an increased risk of second malignancies in patients with testicular cancer. However, we know that radiation is being used very commonly in patients with clinical stage I seminoma, despite evidence that it is not required. Moreover, we have now identified which specific second malignancies occur in these patients after radiotherapy.

OBJECTIVES

To determine the use of adjuvant external beam radiotherapy (EBRT) for patients with clinical stage I testicular seminoma in the USA.

To quantify the risk of specific second primary malignancies (SPMs) associated with radiation exposure in these patients.

PATIENTS AND METHODS

We used the Surveillance, Epidemiology and End Results database to identify patients diagnosed with clinical stage I testicular seminoma between 1973 and 2000.

We evaluated the use of EBRT in these patients.

We calculated standardized incidence ratios of specific SPMs in these patients.

We stratified the incidence of SPMs based on age at seminoma diagnosis and time to SPM from initial seminoma diagnosis.

RESULTS

Adjuvant EBRT use declined from the first decade of the study period to the last decade of the study period (80.6% vs 70.2%).

Overall, there was a 19% increase in SPMs in patients exposed to EBRT (observed/expected, O/E, 1.51; 95% CI, 1.08–1.31) compared to the general population.

Specifically, significantly increased risks were observed for thyroid cancer (O/E, 2.32; 95% CI, 1.16–4.16), pancreatic cancer (O/E, 2.38; 95% CI, 1.43–3.72), non‐bladder urothelial malignancies (O/E, 4.27; 95% CI, 1.57–9.29), bladder cancer (O/E, 1.47; 95% CI, 1.01–2.28), all haematological malignancies (O/E, 1.44; 95% CI, 1.08–1.89) and non‐Hodgkin's lymphoma (O/E, 1.77; 95% CI, 1.22–2.48).

Patients had a persistently elevated risk of SPMs 15 years from the time of initial clinical stage I testicular seminoma diagnosis (O/E, 1.29; 95% CI, 1.10–1.49).

CONCLUSIONS

We confirmed the increased risk of SPMs after EBRT for seminoma, and we identified the specific types of SPMs that develop.

The risk of EBRT‐associated SPM persists for years after the initial seminoma diagnosis, and patients should be informed about these long‐term risks.
Sport in Modern European History: Trajectories, Constellations, Conjunctures1
Authors: TOMLINSON ALAN , YOUNG CHRISTOPHER
Published: December 2011

This essay reviews sport‐related articles that have previously appeared in the JHS, alongside a range of other historical works, and in so doing recognizes the importance of persisting themes in the socio‐cultural, historical analysis of sport. Such themes have appeared in wide‐ranging socio‐historical and figurational work, and also underpin the contributions to this special issue: they include the dynamics of cultural importation, diffusion and appropriation; and the cultural significance of sport in wider status and power relations. Emphasizing the compatibility of the historical and the sociological imaginations, and confirming recent positions on the integration of the cultural and the social in historical work, the article goes on to contextualize the place of sport in Europe in the period from the later decades of the nineteenth century into the fourth decade of the twentieth century. Referencing classic debates on historical method and periodization – particularly Braudel's discussions of event, conjuncture, and longue durée– the article identifies core conjunctural features of European sport in the period: internationalism/early globalization; increasing forms of mediatization; emergent individualism; and commercialized consumption and celebrity.
“A Straight Left against a Slogging Ruffian”: National Boxing Styles in the Years Preceding the First World War
Authors: BODDY KASIA
Published: December 2011

The complicated shifts in power and status that took place between Britain, France and the United States in the years immediately preceding the First World War resulted in anxious self‐examination and a series of identity crises whose social, cultural and political ramifications would be felt for decades to come. This was also a boom time for boxing, and one that was distinguished by a lively debate about the pros and cons of the “English” and “American” styles. This paper argues that these detailed deliberations about sporting technique often exposed a more general disquiet about national strengths and vulnerabilities and about the pre‐war balance of power. A consideration of straight lefts and slogging ruffians tells us something about the issues at stake.
The Culture of Sports
Authors: PATTERSON ORLANDO , TOMLINSON ALAN , YOUNG CHRISTOPHER
Published: December 2011

In conversation with Orlando Patterson, the editors of this special issue reflected and speculated on the nature of the historical sociologist's task and challenge. We agreed that any historical sociology concentrated upon particular events or single sports, but overlooking comparative cultural and social contexts, was narrow and over‐focused. Recalling early contributions, Patterson notes how in cricket in the Caribbean there could be found an “intense distillation of every kind of problem and emotional baggage” carried by a society at a particular socio‐historical moment. Patterson advocates the dual focus upon time/place and socio‐cultural historical influence that is at the heart of the historical sociologist's enterprise; and that shows how cricket, for instance, is both constituted by the legacies of a specific historical past, and constituting of a potentially different future.
Habermas and Oakeshott on Rationalism, Morality and Democratic Politics
Authors: Khan Gulshan Ara
Published: December 2011

In this article I compare Michael Oakeshott's and Jürgen Habermas' respective accounts of morality, rationality and politics. I show that they both theorise the conditions of the modern political community as a ‘civil association’, and I argue that this comparison enables us to challenge predominant understandings of each thinker and to address criticisms levelled against them. I demonstrate that the contextualist and Hegelian aspects of Habermas' earlier work are carried over into his later work on discourse ethics and that he puts forward a more situated understanding of rationality and morality than is usually acknowledged. I also show that Oakeshott is not a straightforward conservative and in some respect he can be seen as a forerunner of deliberative politics. However, this comparison takes us beyond an exercise in interpretation, and I also draw attention to the practical possibilities residing in the work of Oakeshott and Habermas. Indeed, it is my contention that each of their approaches has much to offer in addressing the challenges of pluralism characteristic of contemporary multicultural societies and that their respective works can contribute to a contemporary theory of critical republicanism.
The Euler Equations of Spatial Gasdynamics and the Integrable Heisenberg Spin Equation
Authors: Schief W. K. , Rogers C.
Published: December 2011

The Euler equations for an inviscid and thermally nonconducting gas are investigated with a view to isolating particular integrable structure. A natural physical constraint is imposed and it is demonstrated that, in the generic case, the steady Euler equations are equivalent to an integrable Heisenberg spin equation subject to a volume‐preserving constraint. A limiting case in which this constraint is not present is indicated.
OPTIMAL EDUCATION POLICIES AND COMPARATIVE ADVANTAGE
Authors: BOUGHEAS SPIROS , KNELLER RICHARD , RIEZMAN RAYMOND
Published: December 2011

We consider the optimal education policies of a small economy whose government has a limited budget. Initially, the economy is closed and the government chooses its education policy to maximize welfare under autarky. When the economy trades with the rest of the world the government chooses a new education policy that maximizes welfare under trade. Is it ever optimal for the government to choose its new policy so that it reverses the economy's comparative advantage? We find that if the budget stays fixed when it is optimal to ‘move up the skills chain’ it is not feasible. In such a case, a foreign loan is welfare improving. A move in the opposite direction can be optimal, and when it is optimal it is also feasible.
CROSS‐BORDER M&A INFLOWS AND QUALITY OF COUNTRY GOVERNANCE: DEVELOPING VERSUS DEVELOPED COUNTRIES
Authors: HUR JUNG , PARINDURI RASYAD A. , RIYANTO YOHANES E.
Published: December 2011

This paper provides an empirical explanation to the observed disparity in cross‐border merger and acquisition inflows to developing and developed countries over the past two decades. We show two main results. First, the disparity can be attributed to the difference in the quality of institutions between the two groups of countries. Second, the gain from reforming institutions in developing countries is smaller than that in developed countries. These findings suggest that, with the current speed of institutional reforms in some developing countries, the disparity in cross‐border merger and acquisition inflows is likely to persist.
Deep Ecology's contributions to social work: A ten‐year retrospective
Authors: Besthorn Fred H.
Published: December 2011

Besthorn FH. Deep Ecology's contributions to social work: A ten‐year retrospective

In the last decade, a new generation of social workers have made great strides incorporating environmental awareness into their theoretical formulations and practice modalities. This is a welcome development for a profession often conspicuously absent in the emerging international consensus that Earth's capacity to support life is in deep trouble. Beginning in the 1980s and 1990s, a few intrepid North American social workers began to raise the alarm concerning the scope and extent of environmental decline. Several social work scholars implored the profession to play a more active role in raising ecological awareness and take a seat at policy and practice forums debating environmental issues. Deep Ecology, founded by the late Norwegian philosopher Arne Naess, offers a comprehensive philosophical framework upon which social work might draw in the development of its conceptual orientations. This article examines the current manifestations of Deep Ecology as a philosophy and socio‐political movement. It briefly assesses the evolution of social work's nascent interest in the natural environmental, examines historical precursors influencing Deep Ecology, reviews several key concepts of Deep Ecology, discusses ongoing applications of deep ecological ideas to several disciplines and suggests how deep ecological ideas might help inform social work's understanding of social justice.
Getting down to earth: Finding a place for nature in social work practice
Authors: Heinsch Milena
Published: December 2011

Heinsch M. Getting down to earth: Finding a place for nature in social work practice

According to Wilson's biophilia hypothesis, people have an innate need to associate with the natural world, and this connection can enhance their physical and psychological well‐being. This hypothesis has sparked an interest in the health benefits of human connection with non‐human nature across a wide range of disciplines backed by evidence of the role of the natural environment in enhancing human well‐being. This article summarises the literature on the health benefits of nature, arguing for the application and positive impact of a nature‐based approach in social work. It challenges practitioners to recognise and articulate the role of the physical environment in their day‐to‐day practice. Implications for social work are identified in recommendations for enhancing opportunities to include non‐human nature in future social work practice.
A description of a mother's play guidance for her child with autism in the process of playing by the rules
Authors: Ökcün Meral Çilem , Akçin Nur
Published: December 2011

The purpose of this study is to describe the strategies used by a mother with a child with autism during games activities with peers to provide the child with social skills.

The research method of this study is ‘a qualitative single‐subject case study’. The participants in this research are a mother and her 9‐year‐old child with autism, one brother and three typically developing peers. The research data were collected through field notes, interviews, audio and videotape recordings during natural interactions between the mother and her child.

The strategies the mother used were analysed using video records during games activities in a natural park. The interactions of the mother with her child were examined in the context of a hide‐and‐seek game. Micro‐ethnographic‐analysis techniques were used in the analysis of the video records. According to the research data, it was found that the mother with a child with autism made extensive use of 13 different verbal strategies and seven different non‐verbal strategies. It was observed that the mother guided her child and the group during the hide‐and‐seek game, arranged the environment of the games, carried out routine activities both at the beginning and at the end of the games and arranged the games in accordance with the abilities and preferences of the child. These applications bear a resemblance to the model of integrated game groups.

As a result, the data from the present research reveal that a mother having a child with autism acts as a guide during the games and uses verbal and non‐verbal interaction strategies in this guidance process and by doing so contributes to the process of participation in the games by the child with autism and in the child's social interaction with his peers.
An analysis of legal issues relating to the least restrictive environment standards
Authors: Alquraini Turki Abdullah
Published: December 2011

The lack of clear language in the Individuals with Disabilities Education Act (IDEA), which is the federal law that governs the provision of special education and related services to children with disabilities in the USA, has led to inconsistencies in school districts' decisions regarding the least restrictive environment (LRE). This uncertainty in determining an appropriate LRE has become a significant obstacle to educating students with disabilities. Therefore, this paper examines a number of court cases that have challenged school districts to provide the LRE for students with disabilities and have handed down decisions that define specific standards that are useful for school teams to implement the mandate of the LRE. Through the synthesis of these cases, the author provides criteria for determining the LRE for students with disabilities that could enhance inclusive education for these students. Finally, the author suggests that legislators should reconsider the language of LRE, make it more specific regarding the determination of LRE, and apply the standards defined in these cases and others to state a clear formula for developing LRE that could be utilised in school districts throughout the country.
Protecting a single endangered species and meeting multiple conservation goals: an approach with Guaiacum sanctum in Yucatan Peninsula, Mexico
Authors: Lopez‐Toledo Leonel , Ibarra‐Manríquez Guillermo , Burslem David F.R.P. , Martínez‐Salas Esteban , Pineda‐García Fernando , Martínez‐Ramos Miguel
Published: December 2011

Aim  New protected areas should consider safeguarding high conservation value sites based on multiple criteria and not just the presence of a single endangered or charismatic species. However, the extent to which complementary criteria coincide is usually unknown. We use the case of Guaiacum sanctum (Zygopyllaceae), an endangered timber tree species, to explore whether the protection of forests where this species is most abundant would meet other complementary conservation goals, such as capturing regional plant biodiversity, protecting other threatened/endemic species or safeguarding ecosystem services.

Location  Yucatan Peninsula, southern Mexico.

Methods  We conducted an analysis of the structure, composition and diversity of tree communities (including stems ≥5 cm dbh) at eight G. sanctum forest sites. We identified endemic and threatened tree species and quantified above‐ground tree biomass and carbon storage in these G. sanctum forests.

Results  Guaiacum sanctum forests contain 35–59 tree species on plots as small as 1000 m2. The species composition of tree communities changed rapidly (high β‐diversity) across soil boundaries and rainfall regimes. Twenty‐one endemic and eight threatened tree species were recorded in our inventories. Individuals of G. sanctum represented up to 55% of the above‐ground carbon for trees ≥5 cm dbh. The high basal area of G. sanctum forests plus the high wood density, abundance, large size and longevity (more than 500 years) of G. sanctum and other tree species enhance the potential importance of these forests for carbon storage.

Main conclusions  A conservation strategy focused on protecting important populations of G. sanctum in the Yucatan Peninsula would have significant co‐benefits for conservation of regional tree species biodiversity and provision of critical ecosystem services. Our study illustrates a multiple criteria approach useful for the selection of areas with high conservation value on the basis of endemic, threatened species, species richness and ecosystem services.
TNF‐α genetic polymorphism −308G/A and antituberculosis drug‐induced hepatitis
Authors: Kim Sang‐Heon , Kim Sang‐Hoon , Yoon Ho Joo , Shin Dong Ho , Park Sung Soo , Kim Youn‐Seup , Park Jae‐Seuk , Jee Young‐Koo
Published: December 2011

Background

While the mechanisms underlying the development of drug‐induced liver injury are not clear, there is evidence to suggest that tumor necrosis factor‐α (TNF‐α) plays an important role in drug‐ or drug metabolite‐induced immune responses. We hypothesized that polymorphisms in the TNF‐α gene are associated with anti‐tuberculosis drug (ATD)‐induced hepatitis.

Methods

Patients who suffered from ATD‐induced hepatitis were enrolled in the study. ATD‐induced hepatitis was defined as an increase in liver transaminase levels that were more than three times the upper limit of normal. ATD‐tolerant patients were used as a control. Patients were treated with first line ATD therapies including isoniazid, rifampicin, ethambutol, and pyrazinamide. We compared the genotype frequencies of the TNF‐α polymorphism ‐308G/A in 77 patients with ATD‐induced hepatitis and 229 ATD‐tolerant patients.

Results

The frequency of carrying the variant allele (AG or AA) was significantly higher in patients with ATD‐induced hepatitis compared with ATD‐tolerant patients [26.0% vs. 15.3%, P = 0.034, OR (95% CI) = 1.94 (1.043.64)] and the frequency of the A allele was significantly different between the two groups [0.143 vs. 0.079, P = 0.018, OR (95% CI) = 1.95 (1.113.44)].

Conclusion

These results reveal that the TNF‐α genetic polymorphism ‐308G/A is significantly associated with ATD‐induced hepatitis. This genetic variant may be a risk factor for ATD‐induced hepatitis in individuals from Korea.
Timolol Maleate 0.5% or 0.1% Gel‐Forming Solution for Infantile Hemangiomas: A Retrospective, Multicenter, Cohort Study
Authors: Chakkittakandiyil Ajith , Phillips Rod , Frieden Ilona J. , Siegfried Elaine , Lara‐Corrales Irene , Lam Joseph , Bergmann James , Bekhor Philip , Poorsattar Solmaz , Pope Elena
Published: December 2011

Abstract:  Therapeutic options for superficial infantile hemangiomas (IH) are limited. Recently, timolol maleate gel, a topical nonselective beta‐blocker, has been reported as a potentially effective treatment for superficial IH. This study is an extension of a previously published pilot study designed to further investigate the efficacy and safety and to identify predictors of good response of topical 0.5% or 0.1% timolol maleate gel‐forming solution. This was a retrospective cohort study including patients enrolled from five centers. Patients were included if they were treated with timolol maleate 0.1% or 0.5% gel‐forming solution and had photographic documentation of the IH and at least one follow‐up visit. Patients with concomitant active treatment using other IH treatments were excluded. The primary endpoint was change in the appearance of IH as evaluated using a visual analog scale (VAS). Data from 73 subjects were available for final analysis. Timolol maleate gel‐forming solution 0.5% was used in 85% (62/73) of patients, the remainder being treated with 0.1%. The median age at treatment initiation was 4.27 months (interquartile range [IQR] 2.63–7.21 mos), and patients were treated for a mean of 3.4 ± 2.7 months. All patients except one improved, with a mean improvement of 45 ± 29.5%. Predictors of better response were superficial type of hemangioma (p = 0.01), 0.5% timolol concentration (p = 0.01), and duration of use longer than 3 months (p = 0.04). Sleeping disturbance was noted in one patient. This study further demonstrates the efficacy and tolerability of topical timolol maleate and gradual improvement with longer treatment in patients with superficial IH.
Impaired consciousness in epilepsy investigated by a prospective responsiveness in epilepsy scale (RES)
Authors: Yang Li , Shklyar Irina , Lee Hyang Woon , Ezeani Celestine C. , Anaya Joseph , Balakirsky Samantha , Han Xiao , Enamandram Sheila , Men Clara , Cheng Joyce Y. , Nunn Abigail , Mayer Tanya , Francois Czestochowa , Albrecht Molly , Hutchison Alan L. , Yap Ee‐Lynn , Ing Kevin , Didebulidze Gvantsa , Xiao Bo , Hamid Hamada , Farooque Pue , Detyniecki Kamil , Giacino Joseph T. , Blumenfeld Hal
Published: December 2011

Purpose:  Impaired consciousness in epileptic seizures has a major negative impact on patient quality of life. Prior work on epileptic unconsciousness has mainly used retrospective and nonstandardized methods. Our goal was to validate and to obtain initial data using a standardized prospective testing battery.

Methods:  The responsiveness in epilepsy scale (RES) was used on 52 patients during continuous video–electroencephalography (EEG) monitoring. RES begins with higher‐level questions and commands, and switches adaptively to more basic sensorimotor responses depending on patient performance. RES continues after seizures and includes postictal memory testing. Scoring was conducted based on video review.

Key Findings:  Testing on standardized seizure simulations yielded good intrarater and interrater reliability. We captured 59 seizures from 18 patients (35% of participants) during 1,420 h of RES monitoring. RES impairment was greatest during and after tonic–clonic seizures, less in partial seizures, and minimal in auras and subclinical seizures. In partial seizures, ictal RES impairment was significantly greater if EEG changes were present. Maximum RES impairment (lowest ictal score) was also significantly correlated with long postictal recovery time, and poor postictal memory.

Significance:  We found that prospective testing of responsiveness during seizures is feasible and reliable. RES impairment was related to EEG changes during seizures, as well as to postictal memory deficits and recovery time. With a larger patient sample it is hoped that this approach can identify brain networks underlying specific components of impaired consciousness in seizures. This may allow the development of improved treatments targeted at preventing dysfunction in these networks.
Diastolic Cardiac Function Is Synonymous with Long‐Axis Systolic Function: A Novel Concept in Cardiac Function
Authors: Kurita Akihiro , Kono Koichi , Morita Hiroshi
Published: December 2011

Aims: There has been recent speculation on the relationship between diastolic cardiac function and long‐axis cardiac function. The goal of this study was to obtain conclusive evidence regarding the relationship between these parameters. Methods: Echocardiography and cardiac magnetic resonance imaging were performed consecutively in 33 subjects. Longitudinal fractional shortening and fractional shortening of the left ventricular wall length were measured in each procedure and the relationships with diastolic cardiac function were assessed. Results: Diastolic cardiac function and long‐axis systolic function in each procedure were significantly correlated. Spearman coefficients for correlations between longitudinal fractional shortening measured echocardiographically and diastolic cardiac function parameters were 0.76 (P < 0.0001) for E/A, −0.77 (P < 0.0001) for E/e′, 0.87 (P < 0.0001) for e′, and 0.91 (P < 0.0001) for e′/a′. Conclusions: Long‐axis cardiac function correlates well with diastolic cardiac function. e′/a′ showed a strong correlation with longitudinal fractional shortening and is a good candidate for use as an index for assessment of long‐axis cardiac function. (Echocardiography 2012;29:397‐402)
Underestimation of Left Atrial Volume by Three‐Dimensional Echocardiography Validated by Magnetic Resonance Imaging: A Meta‐Analysis and Investigation of the Source of Bias
Authors: Shimada Yuichi J. , Shiota Takahiro
Published: December 2011

Background: Left atrial volume (LAV) is a fundamental prognostic factor in a variety of cardiac diseases including atrial fibrillation, heart failure, and valvular diseases. Developing a repeatable, noninvasive, and accurate method of measuring LAV is crucial. Three‐dimensional echocardiography (3DE) has achieved better estimation of LAV than two‐dimensional echocardiography. However, underestimation of LAV by 3DE has often been reported and no previous study has synthesized these data. The present study aimed at revealing existence and extent of bias in LAV measurement by 3DE and investigating related factors affecting the bias. Methods: Studies comparing LAV between 3DE and magnetic resonance imaging published before August 15, 2011 were eligible. A meta‐analysis with random effects model was performed to evaluate the systematic bias. Factors affecting the bias were investigated by univariate followed by multivariate analysis. Results: A total of 14 studies including 395 subjects revealed underestimation of LAV by 3DE (−9.4 mL; 95% confidence interval, −13.2 to −5.6mL; P < 0.00001, Fig. 2). Existence of cardiac disease led to more underestimation, whereas increasing the number of plane included in the analysis counteracted the underestimation (P < 0.00001 for each comparison). Conclusions: Only by synthesizing a number of small studies as a meta‐analysis could we display underestimation of LAV by 3DE and factors influencing the systematic bias. These data provide a more detailed basis for analyzing and improving the accuracy of 3DE, an indispensable step toward further clinical application in LAV assessment. (Echocardiography 2012;29:385‐390)

Meta‐analysis of difference in left atrial volume between 3D‐echocardiography and magnetic resonance imaging. Note the significant underestimation of left atrial volume by 3D‐echocardiography. 3DE = three‐dimensional echocardiography; CI = confidence interval; Max = maximal volume; Min = minimal volume; MRI = magnetic resonance imaging; Nl = normal subjects; pl = planes; Pt = patients.

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Measurement of Effective Aortic Valve Area Using Three‐Dimensional Echocardiography in Children Undergoing Aortic Balloon Valvuloplasty for Aortic Stenosis
Authors: Bharucha Tara , Fernandes Fernanda , Slorach Cameron , Mertens Luc , Friedberg Mark Kevin
Published: December 2011

Aims: Pressure gradient is used for timing of balloon aortic valvuloplasty for aortic stenosis (AS) in children, but does not correlate well with outcome and is limited if ventricular function is poor. In adults, effective orifice area (EOA) is used to assess AS severity, but EOA by continuity equation or 2D echo is unreliable in children. Three‐dimensional echocardiography (3DE) may reliably assess EOA but has not been studied in children. We assessed measurement of aortic valve EOA by 3DE in children with AS before and after balloon aortic valvuloplasty and compared results with change in aortic valve gradient. Methods: 3DE was performed at time of catheterization before and after balloon aortic valvuloplasty. Using 3DE multiplanar review mode, valve annulus diameter, area, and EOA were measured and compared with change in aortic gradient and degree of aortic insufficiency. Results: Twenty‐four 3DE studies in 12 children (mean age 4.4 ± 5.0 years) were analyzed. EOA was measurable in all. Catheter peak gradient decreased from 45 ± 10 to 26 ± 17 mmHg (P = 0.0018). 3DE EOA increased after balloon aortic valvuloplasty (0.59 ± 0.52 cm2 vs 0.80 ± 0.70 cm2; P = 0.03), without change in valve diameter. EOA change correlated with change in peak (r = 0.77; P = 0.005) and mean (r = 0.60; P = 0.03) aortic valve gradient post balloon aortic valvuloplasty. Conclusion: 3DE facilitates EOA measurement in pediatric AS and correlates with change in aortic valve gradient after balloon valvuloplasty. (Echocardiography 2012;29:484‐491)