bluuebunny/crossref_metadata_2025 huggingface dataset:
Systematic multidisciplinary approach to reporting perinatal mortality: Lessons from a five‐year regional review
Authors: KENT Alison L. , DAHLSTROM Jane E. , ELLWOOD David , BOURNE Maureen ,   for the ACT Perinatal Mortality Committee
Published: August 2009

Background:  Because of differences in reporting criteria throughout the world, comparing perinatal mortality rates and identifying areas of concern can be complicated and imprecise.

Aims:  To detail the systematic approach to reporting perinatal deaths and to identify any significant differences in outcomes in the Australian Capital Territory (ACT).

Methods:  Review of perinatal deaths from 2001 to 2005 in the ACT using the Australian and New Zealand Antecedent Classification of Perinatal Mortality (ANZACPM) and the Australian and New Zealand Neonatal Death Classification (ANZNDC) systems.

Results:  ACT residents’ perinatal mortality rate was 10.6 per 1000 total births, fetal death rate 7.5 per 1000 total births and neonatal death rate 3.2 per 1000 live births. The three leading antecedent causes of perinatal death were congenital anomalies, spontaneous preterm birth and unexplained antepartum death. The three leading causes of neonatal death were extreme prematurity, cardiorespiratory disorders and congenital anomalies. Multiple births attributed to 20% (65 of 321) of perinatal deaths. Perinatal autopsy was performed in 50% of cases, but in only 64% of unexplained antepartum deaths.

Conclusions:  Causes of perinatal death for the ACT and surrounding New South Wales region are similar to other states using this classification system. The following are considered important lessons to promote accurate perinatal mortality reporting: (i) a universal reporting system for Australia utilising a multidisciplinary team; (ii) a high perinatal autopsy rate, especially in the critical area of antepartum death with no identifiable cause; and (iii) standardised definitions for avoidability. Attention to these areas may prompt further research and changes in practice to further reduce perinatal mortality.
PROGRESS IN UREMIC TOXIN RESEARCH: Conservative Treatment of the Uremic Syndrome
Authors: Vanholder Raymond , Argilés Angel , Beige Joachim , Brunet Philippe , Drüeke Tilman B. , Fliser Danilo , Herget‐Rosenthal Stefan , Hörl Walter H. , Jörres Achim , Perna Alessandra , Rodriguez‐Portillo Mariano , Spasovski Goce , Stegmayr Bernd , Stenvinkel Peter , Wanner Christoph , Wiecek Andrzej , Massy Ziad A.
Published: August 2009

In addition to extracorporeal renal replacement strategies, which in chronic kidney disease (CKD) are largely reserved for the treatment of end‐stage kidney failure, conservative measures can be taken to reduce concentration, effects, or both concentration and effects of uremic retention solutes. In this overview, we will focus on those therapies, which are aimed at preventing or delaying cardio‐vascular disease, retarding or halting the progression of CKD, or both. We will discuss, consecutively, inhibitors of the renin–angiotensin–aldosterone axis, beta‐blockers, calcium‐channel antagonists, anti‐inflammatory drugs, intestinal sorbents, calcimimetics, and glitazones. Some of these approaches could lead to a therapeutic breakthrough in the future. In addition, comprehensive tables will be provided for more traditional therapeutic approaches, such as lifestyle changes and other pharmaceutical treatments.
Typology of High Users of Health Services Among a Rural Medicaid Population
Authors: Macnee Carol L. , McCabe Susan , Clarke Pamela N. , Fiske Marilyn , Campbell Sara
Published: August 2009

ABSTRACT
Objectives: To identify a typology for high system users among a rural Medicaid population that could assist policy makers and providers in better and more efficiently serving this population.

Design and Sample: Exploratory secondary data analysis of a large integrated Medicaid database in a western state. Five hundred and thirty‐nine Medicaid recipients receiving 2 or more state services and receiving 10 or more unique medications.

Measures: Data analysis examining health care use, medication use, and demographic characteristics using SAS to identify patterns of use of services in the population. Results were confirmed with a statewide sample of 2,287 Medicaid users.

Results: 3 characteristics—(1) use of 36 or more health care services in a year; (2) no gap in health care service use over the entire year; and (3) use of >12 health care services in 1 month—describe high‐risk groups of Medicaid users.

Conclusions: Public health nurses, particularly as case managers and program planners, can look at service use patterns through client histories and their own agency records, in order to identify high‐risk groups who may benefit the most from programs that address their support, education, and coordination of health care needs.
Contextual Factors Influencing the Evolution of Nurses' Roles in a Primary Health Care Clinic
Authors: Paterson Barbara L. , Duffett‐Leger Linda , Cruttenden Kathleen
Published: August 2009

ABSTRACT Objectives:The purpose of the research was to explore the everyday experiences and responses of stakeholders of a university‐sponsored nurse‐managed clinic (CHC) in regard to how nurses' roles in the clinic changed over time and the factors that influenced this change.

Design and Sample:The research used a qualitative interpretive description design to interpret participants' accounts of their experience and perspectives as constructed narratives. The participants (N=23) included clients, community members who were volunteers at the CHC, staff of other community agencies or organizations, and nursing or social work students who had a clinical learning experience at the CHC.

Measures:Data collection involved two interviews, one semistructured, face‐to‐face interview at the location selected by the participant, and a group interview held in a boardroom at the CHC. Each interview lasted approximately 60–90 min.

Results:The research findings revealed the profound effects of the social, political, and economic context in determining nurses' roles within a nurse‐managed primary health care clinic. The evolution of nursing roles occurred in reaction to these effects, causing the nurses within the CHC to juggle their priorities and commitments.

Conclusions:The study provides a contemporary example of the political activism work of nurses that is often invisible and illustrates how the commitment of primary health care nurses to social justice contributes in a significant way to the resolution of health inequities experienced by marginalized populations.
Pediatric convulsive status epilepticus in Honduras, Central America
Authors: Molinero Marco R. , Holden Kenton R. , Rodriguez Luis C. , Collins Julianne S. , Samra Jose A. , Shinnar Shlomo
Published: August 2009

Convulsive status epilepticus (SE) in children is an important public health problem, particularly in low‐resource countries. A surveillance study was performed with consecutive enrollment of all children presenting with convulsive SE to Hospital Escuela Materno‐Infantil Emergency Department in Tegucigalpa, Honduras over a 13‐week period in 2003. In the 47 children with SE, the mean age was 4.5 years and the median seizure duration was 95 min. Mortality and morbidity were higher in children from rural locations, with all six deaths and three cases of new neurologic abnormalities occurring in rural children who had acute symptomatic SE. We conclude that childhood SE is common in the low‐resource developing country of Honduras. Given the long delays in obtaining initial treatment in pediatric emergency facilities, availability of prehospital treatment may be of particular importance in this setting.
HLA Class I markers in Japanese patients with carbamazepine‐induced cutaneous adverse reactions
Authors: Ikeda Hiroko , Takahashi Yukitoshi , Yamazaki Etsuko , Fujiwara Tateki , Kaniwa Nahoko , Saito Yoshiro , Aihara Michiko , Kashiwagi Mariko , Muramatsu Masaaki
Published: August 2009

Carbamazepine (CBZ) is frequently used for treating epilepsy, but this drug causes cutaneous adverse drug reactions (cADRs) that may range from mild to severe. It is reported recently that the human leukocyte antigen HLA‐B*1502 is associated with Stevens‐Johnson syndrome (SJS) induced by CBZ in Han Chinese. We examined HLA class I in 15 Japanese patients who fulfilled the diagnostic criteria for CBZ‐induced cADRs (mild in 10 and severe = SJS in 5). HLA‐B*1518, HLA‐B*5901 and HLA‐C*0704 alleles showed higher relative risks (above 10.0) for severe cADRs. The haplotype (HLA‐A*2402‐B*5901‐C*0102) had high relative risk (16.09) for severe cADRs. In patients with severe cADRs, frequencies of HLA‐A*1101, HLA‐A*3303, HLA‐B*1501, HLA‐B*4403, HLA‐B*5101, HLA‐B*5201, HLA‐C*0702, and HLA‐C*1202 alleles are relatively lower than in the Japanese population. These data may suggest that HLA‐B*5901 is one of the candidate markers for CBZ‐induced SJS in Japanese.
Middle short gyrus of the insula implicated in speech production: Intracerebral electric stimulation of patients with epilepsy
Authors: Afif Afif , Minotti Lorella , Kahane Philippe , Hoffmann Dominique
Published: August 2009

Purpose:  Different lines of evidence have suggested an involvement of the insular cortex in speech production. These have included results from lesion studies, functional imaging techniques, and electrical stimulation of the human insular cortex during invasive evaluation of epileptic patients.

Methods:  We evaluated 25 patients who had drug refractory focal epilepsy with at least one electrode stereotactically implanted in the insular cortex.

Results:  Eight responses to insular cortex electrical stimulation were reported by five patients as speech arrest (five responses) and a lowering of voice intensity (three responses).

Conclusions:  Data from this study implicate the middle short gyrus of the insula in the production of speech and show the importance of intrainsular electrode implantation during invasive pre‐resection evaluation by stereo‐electroencephalography (SEEG) when speech arrest occurs early in seizure semiology.
In vivo imaging of dopamine receptors in a model of temporal lobe epilepsy
Authors: Yakushev Igor Y. , Dupont Erwan , Buchholz Hans‐Georg , Tillmanns Julia , Debus Fabian , Cumming Paul , Heimann Axel , Fellgiebel Andreas , Luhmann Heiko J. , Landvogt Christian , Werhahn Konrad J. , Schreckenberger Mathias , Potschka Heidrun , Bartenstein Peter
Published: August 2009

Purpose: Alterations in dopamine neurotransmission in animal models of epilepsies have been frequently demonstrated using invasive neuroscience or ex vivo techniques. We aimed to test whether corresponding alterations could be detected by noninvasive in vivo brain imaging with positron emission tomography (PET) in the chronic phase of the rat pilocarpine model of temporal lobe epilepsy.

Methods: Six pilocarpine‐treated Wistar rats exhibiting spontaneous recurrent seizures and nine control rats were studied with PET using [18F]‐fallypride, a high‐affinity dopamine D2/3receptor ligand. Parametric images of [18F]‐fallypride specific binding were calculated using a reference tissue method, and the two groups were contrasted by whole‐brain voxel‐based analysis implemented in statistical parametric mapping (SPM5).

Results: Dopamine D2/3receptor availability was 27% lower in the bilateral anterior caudate‐putamen of pilocarpine‐treated rats as compared to controls (p < 0.05), but binding was unaffected in other striatal or extrastriatal regions.

Conclusions: The finding of substantially reduced availability of dopamine D2/3receptors in the anterior caudate‐putamen of rats during the chronic phase of the pilocarpine model is in agreement with results of invasive (microinjection, microdialysis) animal studies that have revealed increased dopamine tonus and a D2/3receptor–mediated anticonvulsant action of dopamine in the anterior segment of the rat striatum. The present PET approach could be prospectively applied for monitoring dopamine receptor changes longitudinally, that is, at different phases of the epileptogenic process, and opens perspectives for testing dopaminergic agents as potential antiepileptogenic drugs.
Antiepileptic drugs abolish ictal but not interictal epileptiform discharges in vitro
Authors: D’Antuono Margherita , Köhling Rüdiger , Ricalzone Serena , Gotman Jean , Biagini Giuseppe , Avoli Massimo
Published: August 2009

Purpose:  We established the effects of the antiepileptic drugs (AEDs) carbamazepine (CBZ), topiramate (TPM), and valproic acid (VPA) on the epileptiform activity induced by 4‐aminopyridine (4AP) in the rat entorhinal cortex (EC) in an in vitro brain slice preparation.

Methods:  Brain slices were obtained from Sprague‐Dawley rats (200–250 g). Field and intracellular recordings were made from the EC during bath application of 4AP (50 μm). AEDs, and in some experiments, picrotoxin were bath applied concomitantly.

Results:  Prolonged (>3 s), ictal‐like epileptiform events were abolished by CBZ (50 μm), TPM (50 μm), and VPA (1 mm), whereas shorter (<3 s) interictal‐like discharges continued to occur, even at concentrations up to 4‐fold as high. γ‐Aminobutyric acid (GABA)A–receptor antagonism changed the 4AP‐induced activity into recurrent interictal‐like events that were not affected by CBZ or TPM, even at the highest concentrations. To establish whether these findings reflected the temporal features of the epileptiform discharges, we tested CBZ and TPM on 4AP‐induced epileptiform activity driven by stimuli delivered at 100‐, 10‐, and 5‐s intervals; these AEDs reduced ictal‐like responses to stimuli at 100‐s intervals at nearly therapeutic concentrations, but did not influence shorter interictal‐like events elicited by stimuli delivered every 10 or 5 s.

Conclusions:  We conclude that the AED ability to control epileptiform synchronization in vitro depends mainly on activity‐dependent characteristics such as discharge duration. Our data are in keeping with clinical evidence indicating that interictal activity is unaffected by AED levels that are effective to stop seizures.
Depressive symptoms among mothers of children with epilepsy: A review of prevalence, associated factors, and impact on children
Authors: Ferro Mark A. , Speechley Kathy N.
Published: August 2009

The impact of epilepsy is not limited to the child experiencing seizures, but affects all members of the family. As primary caregivers, mothers are particularly at risk for experiencing increased depressive symptoms and risk for clinical depression. The objective of this systematic review was to critically assess available evidence regarding the prevalence, associated factors, and impact of maternal depressive symptoms on child outcomes in epilepsy. Using a modified version of the Quality Index, studies were rigorously evaluated in terms of reporting, external validity, and internal validity. Limitations in the study designs and analytic techniques of previous research are discussed, and study methods to overcome these barriers are presented in order to advance this research area. Up to 50% of mothers of children with epilepsy are at risk for clinical depression. Correlates of maternal depressive symptoms include a number of modifiable risk factors such as role ambiguity, worry, and satisfaction with relationships. In addition, studies suggest that depressive symptoms in mothers have a negative impact on child outcomes in epilepsy including behavior problems and health‐related quality of life. The overall mean score on the Quality Index was 9.7, indicating a midrange quality score, suggesting a need for more methodologically robust studies.
Life Cycle Attribute Assessment
Authors: Andrews Evan , Lesage Pascal , Benoît Catherine , Parent Julie , Norris Gregory , Revéret Jean‐Pierre
Published: August 2009

Practitioners of life cycle assessment (LCA) have recently turned their attention to social issues in the supply chain. The United Nations life cycle initiative's social LCA task force has completed its guidelines for social life cycle assessment of products, and awareness of managing upstream corporate social responsibility (CSR) issues has risen due to the growing popularity of LCA.

This article explores one approach to assessing social issues in the supply chain—life cycle attribute assessment (LCAA). The approach was originally proposed by Gregory Norris in 2006, and we present here a case study. LCAA builds on the theoretical structure of environmental LCA to construct a supply chain model. Instead of calculating quantitative impacts, however, it asks the question “What percentage of my supply chain has attribute X?” X may represent a certification from a CSR body or a self‐defined attribute, such as “is locally produced.” We believe LCAA may serve as an aid to discussions of how current and popular CSR indicators may be integrated into a supply chain model.

The case study demonstrates the structure of LCAA, which is very similar to that of traditional environmental LCA. A labor hours data set was developed as a satellite matrix to determine number of worker hours in a greenhouse tomato supply. Data from the Quebec tomato producer were used to analyze how the company performed on eight sample LCAA indicators, and conclusions were drawn about where the company should focus CSR efforts.
Assessing Acute Ventricular Volume Changes by Intracardiac Impedance in a Chronic Heart Failure Animal Model
Authors: STAHL CARSTEN , WALKER TOBIAS , STRAUB ANDREAS , KETTERING KLAUS , KNUBBEN KAROLIN , GREINER TIM O. , PAULE STEFAN , LIPPERT MICHAEL , CZYGAN GERALD , SCHWEIKA OLIVER , KÜHLKAMP VOLKER
Published: August 2009

Background: Implantable device diagnostics may play an essential role in simplifying the care of heart failure patients by providing fundamental insights into their complex clinical patterns. Early recognition of heart failure progression by a continuous hemodynamic monitoring would allow for timely therapeutic interventions to prevent decompensation and hospitalization. In this study, the feasibility of assessing ventricular volume changes by implant‐based measurements of intracardiac impedance was tested in a heart failure animal model.

Methods: Heart failure was induced in five minipigs by high‐rate pacing over 3 weeks. During a final open‐chest examination a graded dobutamine stress test was performed. Stroke volume (SV) was measured by an ultrasonic flow probe at the ascending aorta. End diastolic pressure (EDP) and maximum pressure slope (dP/dtmax) were calculated from a left ventricular microtip catheter signal. Impedance was measured by an implanted pacemaker between biventricular leads. Stroke impedance (SZ) was calculated as the difference between end‐systolic and end‐diastolic impedance (EDZ).

Results: Administration of dobutamine led to an increase in SV (55 ± 16%), dP/dtmax (107 ± 89%), and SZ (56 ± 30%). EDP changed by 37 ± 21% whereas EDZ changed by 7.4 ± 4%. Significant correlations were found between SZ and SV (r = 0.88), and between EDZ and EDP (r =−0.82).

Conclusion: The strong correlation with SV allows the application of intracardiac impedance measurements for an implant‐based continuous monitoring of cardiac function. Impedance may also be used for hemodynamic optimization of cardiac resynchronization therapy.
Endocardial Electrogram Analysis after Intramyocardial Injection of Mesenchymal Stem Cells in the Chronic Ischemic Myocardium
Authors: KRAUSE KORFF , SCHNEIDER CARSTEN , LANGE CLAUDIA , KOKTURK BULENT , BOCZOR SIGRID , GEIDEL STEPHAN , SALHI AHMED , ALASER JUSUF , ZANDER AXEL R. , KUCK KARL‐HEINZ , JAQUET KAI
Published: August 2009

Background: Cell injection therapies have been introduced for the treatment of patients with coronary heart disease. However, intramyocardial injection of bone marrow (BM)‐derived cells may generate proarrhythmogenicity.

Methods: Two weeks after the placement of a circumflex artery‐ameroid constrictor, 21 pigs received mesenchymal stem cells (MSC, n = 9), mononuclear (BM)‐derived stem cells (MNC, n = 6), and placebo (n = 6) using a electromechanical mapping (EMM)‐guided percutaneous transendocardial injection catheter. At week 6, EMM was repeated and the injected areas were analyzed in detail to evaluate local bipolar electrogram fragmentation, duration, and amplitude. Myocardial fibrosis was evaluated by a quantitative histological analysis.

Results: At week 6, the injection of MSC or MNC did not increase local electrogram fragmentation (MSC group: 1.4 ± 0.3 vs. 1.3 ± 0.2; MNC group: 1.4 ± 0.2 vs. 1.3 ± 0.2; P = NS), prolong electrogram duration (MSC group: 27.1 ± 7.8 ms vs. 23.7 ± 2.0 ms; MNC group: 27.8 ± 3.5 ms vs. 26.8 ± 5.6 ms; P = NS), or decrease bipolar voltages (MSC group 2.7 ± 0.9 mV vs. 2.8 ± 1.0 mV; MNC group 2.0 ± 1.0 mV vs. 1.7 ± 0.4 mV). From week 2 to week 6, mean left ventricular ejection fraction increased in the MSC group (37.9 ± 4.2% vs. 45.9 ± 2.2%; P = 0.039) only. Histological analysis of the ischemic regions revealed 17.6 ± 5% myocardial fibrosis in the MNC group vs. 13.6 ± 3.4% MSC vs. 28.7 ± 8.7% in the control group (P = 0.038 and P = 0.013). No death occurred in any animal after the injection procedure.

Conclusion: Intramyocardial injection of MSC or MNC do not increase fragmentation and duration of endocardial electrograms in the injected ischemic myocardium but attenuate ischemic damage and therefore may not create an electrophysiological substrate for reentry tachycardias
Are Implantable Loop Recorders Useful in Detecting Arrhythmias in Children with Unexplained Syncope?
Authors: AL DHAHRI KHALID N. , POTTS JAMES E. , CHIU CHRISTINE C. , HAMILTON ROBERT M. , SANATANI SHUBHAYAN
Published: August 2009

Introduction: Syncope and presyncope are symptoms that occur infrequently in children, are unpredictable, and represent a diagnostic challenge to the physician. Conventional diagnostic investigations are often unable to establish a diagnosis, making it difficult to determine patient risk and direct appropriate therapy. The implantable loop recorder (ILR) is a medical device that was created for prolonged monitoring of heart rate and rhythm and has been used in a limited number of pediatric studies in which the cause of the syncope is unknown.

Methods: This is a retrospective review of the clinical, surgical, and follow‐up data of patients who had ILR devices implanted after conventional testing failed to identify a cause for their symptoms.

Results: The diagnostic yield of the ILR device in unmasking the cause for symptoms in our patient cohort was 64%. In our study, manually activated events accounted for 71% of all documented episodes and 68% of the cases involving hemodynamically important arrhythmias or transient rhythm changes. The ILR device can be safely implanted and explanted in children without significant morbidity, in most cases. None of our patients experienced any long‐term adverse events associated with placement of the device and all were alive at last follow‐up.

Conclusions: The use of the ILR device is a useful tool to help unmask arrhythmias as a cause of unexplained syncope in children. Patient selection for who should and should not have an ILR device implanted will continue to influence its diagnostic utility and generate controversy among stakeholders.
Development of a biological control‐based Integrated Pest Management method forBemisia tabacifor protected sweet pepper crops
Authors: Calvo F. J. , Bolckmans K. , Belda J. E.
Published: August 2009

The tobacco whitefly,Bemisia tabaciGennadius (Hemiptera: Aleyrodidae), is a key pest in commercial sweet pepper crops in southeast Spain. Its biological control is currently based on augmentative introductions of the parasitic waspEretmocerus mundusMercet (Hymenoptera: Aphelinidae), which need to be occasionally supplemented with pesticide applications. These pesticides can be harmful for the biological control agents. Therefore, it is important to improve the current strategy by reducing dependency on pesticides. Two potential solutions are conceivable: addition of another effective biocontrol agent or application of pesticide prior to the release of biocontrol agents. The mirid bugNesidiocoris tenuisReuter (Heteroptera: Miridae) and the predatory miteAmblyseius swirskiiAthias‐Henriot (Acari: Phytoseiidae) are promising candidates as additional biocontrol agents. The aim of the present study was to test these possible solutions in two subsequent trials, i.e., a ‘selection’ and an ‘improvement’ experiment. In the selection experiment, four treatments were compared:E. mundus,N. tenuis + E. mundus,A. swirskii + E. mundus, andA. swirskii + N. tenuis + E. mundus.Amblyseius swirskiiappeared able to significantly increase effectiveness against the pest, in contrast toN. tenuis,which did not contribute to whitefly control. The best strategy was the combination ofE. mundusandA. swirskii. In the improvement experiment, three treatments were compared:E. mundus,A. swirskii + E. mundus, andA. swirskii + E. mundus + pesticides.Amblyseius swirskiiagain proved capable of significantly reducing whitefly populations, and the implementation of pesticides before the release of the biocontrol agents was shown to increase the effectiveness against the pest even more.
Modeling linkages between climate policy and land use: an overview
Authors: Van Der Werf Edwin , Peterson Sonja
Published: August 2009

Agriculture and forestry play an important role in emitting and storing greenhouse gases. For an efficient and cost‐effective climate policy, it is therefore important to include land use, land‐use change, and forestry (LULUCF) explicitly in economy‐climate models. This article gives an overview and assessment of existing approaches to include LULUCF into partial and general equilibrium economy‐climate models. For each class of models, we describe different examples, their treatment of land, and their potential for and applicability to policy analysis, as well as their shortcomings. We identify data requirements and conceptual problems, and provide suggestions for future research.
Estimating the supply response of cotton and cereal crops in smallholder production systems: recent evidence from Mali
Authors: Vitale Jeffrey D. , Djourra Hamady , Sidibé Aminata
Published: August 2009

Cotton is one of the most important crops in West Africa and is a major catalyst of economic development in rural areas, but the sector has suffered from a decline in the world cotton price after 1999. This article exploits an unusual data set following 82 farmers over 14 years, from 1994 through 2007, to estimate a Nerlovian supply response model for cotton, maize, sorghum, and millet in long‐term rotation. The resulting system of equations is estimated with two‐stage least squares (2SLS), showing that this sample of Malian cotton producers have responded to prices in a relatively inelastic manner, with supply elasticities only about one‐half of those estimated for producers in developed countries. Policy reforms could help producers respond more easily to prices changes, as well as to raise average productivity levels.
Do they always say no? German consumers and second‐generation GM foods
Authors: Hartl Jochen , Herrmann Roland
Published: August 2009

European consumers and, in particular, German consumers are known to be very critical toward the introduction of genetically modified (GM) foods. It is analyzed here whether German consumers do reject second‐generation GM foods, too. Whereas first‐generation GM crops induced producer‐related benefits, second‐generation GM crops are associated with consumer‐oriented benefits like an improvement of nutritional quality. The determinants of demand for second‐generation GM rapeseed oil are investigated within an online survey of 1,556 German consumers. It is elaborated how two functional properties of the product matter; that is, long‐chain omega‐3 fatty acids and the cholesterol‐lowering effect of phytosterols. It turns out that GM rapeseed oil is neglected by 74% of all respondents. Output traits, however, will increase the probability of purchases of GM rapeseed oil. This is more the case for long‐chain omega‐3 fatty acids than for phytosterols.
Soil quality and fertilizer use rates among smallholder farmers in western Kenya
Authors: Marenya Paswel P. , Barrett Christopher B.
Published: August 2009

Studies of fertilizer use in sub‐Saharan Africa have been dominated by analyses of economic and market factors having to do with infrastructure, institutions, and incentives that prevent or foster increased fertilizer demand, largely ignoring how soil fertility status conditions farmer demand for fertilizer. We apply a switching regression model to data from 260 farm households in western Kenya in order to allow for the possibility of discontinuities in fertilizer demand based on a soil carbon content (SCC) threshold. We find that the usual factors reflecting liquidity and quasi‐fixed inputs are important on high‐SCC plots but not on those with poorer soils. External inputs become less effective on soils with low SCC, hence the discernible shift in behaviors across soil quality regimes. For many farmers, improved fertilizer market conditions alone may be insufficient to stimulate increased fertilizer use without complementary improvements in the biophysical conditions that affect conditional factor demand.
Long‐term consequences of short‐term precipitation shocks: evidence from Brazilian migrant households
Authors: Mueller Valerie A. , Osgood Daniel E.
Published: August 2009

We find that large short‐term precipitation shocks damage the long‐term income of households that have permanently migrated from rural to urban areas. This outcome is consistent with the behavior of credit‐constrained rural households who are willing to accept lower long‐term income in urban areas following the depletion of their productive assets during an adverse shock. Our empirical evidence suggests that there may be a link between large precipitation shocks in rural areas and urban poverty. Further exploration is warranted on the mechanisms by which natural disasters cause these long‐term losses.
Economic efficiency in farm households: trends, explanatory factors, and estimation methods
Authors: Olson Kent , Vu Linh
Published: August 2009

Factors explaining differences in economic efficiency between farms are of major interest to owners, managers, and other stakeholders as they strive to improve earnings and improve the chances of firm survival. This study is undertaken to improve our understanding of interfarm differences in, and opportunities to improve, farm household efficiency in utilizing their land, labor, and capital resources to achieve household objectives. The technical, allocative, and scale efficiencies of farm households are estimated using a nonparametric, output‐based data envelopment analysis (DEA) of a panel data set from 1993 to 2006. Single and double bootstrapping procedures are used to estimate technical efficiency. Initial technical efficiency assuming variable returns to scale (TEV) is estimated to be 0.83. Using single bootstrapping, the average bias‐corrected TEV estimate is 0.70; using double bootstrapping, the TEV estimate is 0.72. Allocative efficiency is estimated to be 0.81. Scale efficiency is estimated to be 0.93. The only factor that is consistently associated with higher technical efficiency across analysis methods and years is larger farm size (as measured by the log of farm income). The significance of other factors changes with analysis methods.
Relative vs. absolute measures of benefit and risk: what’s the difference?
Authors: Citrome L.
Published: August 2009

Citrome L. Relative vs. absolute measures of benefit and risk: what’s the difference?

Objective:  When appraising evidence clinicians are confronted with two types of comparisons: ratios, such as relative risk, and absolute differences, such as number needed to treat (NNT) or number needed to harm (NNH).

Method:  A review of the definition, calculation and interpretation of relative measures such as relative risk, odds ratio and the hazard ratio, and how they are different from absolute measures such as NNT and NNH.

Results:  Relative and absolute measures provide different perspectives. Ratios can be misleading and exaggerate clinical differences, but NNT can appear to trivialize the risk of potentially important adverse events.

Conclusion:  There is a need to understand both relative and absolute differences in order to make informed decisions.
Impulsive aggression in adults with attention‐deficit/hyperactivity disorder
Authors: Dowson J. H. , Blackwell A. D.
Published: August 2009

Dowson JH, Blackwell AD. Impulsive aggression in adults with attention‐deficit/hyperactivity disorder.

Objective:  DSM‐IV criteria for attention‐deficit/hyperactivity disorder (ADHD) include examples of ‘impulsivity’. This term can refer to various dysfunctional behaviours, including some examples of aggressive behaviour. However, impulsive aggression is not included in the DSM‐IV criteria for ADHD. The associations of impulsive aggression with ADHD were investigated.

Method:  Seventy‐three male adults with DSM‐IV ADHD, and their informants, completed questionnaires. Impulsive aggression was assessed by ratings of two criteria for borderline personality disorder (BPD), involving hot temper and/or self‐harm.

Results:  Logistic regression indicated that features of DSM‐IV ADHD were predictors of comorbid impulsive aggression. However, compared with ADHD features, verbal IQ and comorbid psychopathology were more strongly associated with impulsive aggression.

Conclusion:  The findings support the inclusion of features of impulsive aggression, such as hot temper/short fuse, in the ADHD syndrome in adults. These overlap with features of BPD. The findings inform the selection of research samples.
Cost‐of‐illness studies of dementia: a systematic review focusing on stage dependency of costs
Authors: Quentin W. , Riedel‐Heller S. G. , Luppa M. , Rudolph A. , König H.‐H.
Published: August 2009

Quentin W, Riedel‐Heller SG, Luppa M, Rudolph A, König H‐H. Cost‐of‐illness studies of dementia: a systematic review focusing on stage dependency of costs.

Objective: To review cost‐of‐illness (COI) studies of dementia from Europe and North America which report costs per patient by disease stage.

Method: A systematic literature search was performed in electronic databases. Studies were classified according to important determinants of costs. Results were converted into year 2006 USD‐PPP, and summarized as costs for formal and informal care in mild, moderate and severe dementia.

Results: 28 studies were evaluated. They used a wide range of methods. Costs more than doubled from mild to severe dementia. Patterns and size of estimated costs depended primarily on study objectives (estimation of total costs–net costs), living arrangements of patients (community‐dwelling–institutionalized) and inclusion of informal care.

Conclusion: This review is the first to have focused on costs in different stages of dementia. The stage is an important determinant of costs. However, characteristics of individual studies need to be considered, when making use of their results.
Serum adiponectin and resistin levels in major depressive disorder
Authors: Lehto S. M. , Huotari A. , Niskanen L. , Tolmunen T. , Koivumaa‐Honkanen H. , Honkalampi K. , Ruotsalainen H. , Herzig K.‐H. , Viinamäki H. , Hintikka J.
Published: August 2009

Lehto SM, Huotari A, Niskanen L, Tolmunen T, Koivumaa‐Honkanen H, Honkalampi K, Ruotsalainen H, Herzig K‐H, Viinamäki H, Hintikka J. Serum adiponectin and resistin levels in major depressive disorder.

Objective:  To examine the role of the adipose‐tissue‐derived low‐grade inflammation markers adiponectin and resistin in major depressive disorder (MDD) in a population‐based sample.

Method:  Serum levels of adiponectin and resistin were measured from 70 DSM‐IV MDD subjects and 70 healthy controls. Depression severity was assessed with the 29‐item Hamilton Depression Rating Scale.

Results:  The MDD group had lowered serum adiponectin levels. Regression modelling with adjustments for age, gender, overweight, several socioeconomic and lifestyle factors, coronary heart disease and metabolic syndrome showed that each 5.0 μg/ml decrease in serum adiponectin increased the likelihood of MDD by approximately 20% (P = 0.01). The resistin levels correlated with atypical (P = 0.02), but not with typical depressive symptoms (P = 0.12).

Conclusion:  Our findings suggest that the lowered adiponectin levels in MDD are depression‐specific and not explained by conventional low adiponectin‐related factors such as such as coronary heart disease and metabolic disorders.
Treatment of unipolar psychotic depression: a randomized, double‐blind study comparing imipramine, venlafaxine, and venlafaxine plus quetiapine
Authors: Wijkstra J. , Burger H. , Van Den Broek W. W. , Birkenhäger T. K. , Janzing J. G. E. , Boks M. P. M. , Bruijn J. A. , Van Der Loos M. L. M. , Breteler L. M. T. , Ramaekers G. M. G. I. , Verkes R. J. , Nolen W. A.
Published: August 2009

Wijkstra J, Burger H, van den Broek WW, Birkenhäger TK, Janzing JGE, Boks MPM, Bruijn JA, van der Loos MLM, Breteler LMT, Ramaekers GMGI, Verkes RJ, Nolen WA. Treatment of unipolar psychotic depression: a randomized, double‐blind study comparing imipramine, venlafaxine, and venlafaxine plus quetiapine.

Objective:  It remains unclear whether unipolar psychotic depression should be treated with an antidepressant and an antipsychotic or with an antidepressant alone.

Method:  In a multi‐center RCT, 122 patients (18–65 years) with DSM‐IV‐TR psychotic major depression and HAM‐D‐17 ≥ 18 were randomized to 7 weeks imipramine (plasma‐levels 200–300 μg/l), venlafaxine (375 mg/day) or venlafaxine–quetiapine (375 mg/day, 600 mg/day). Primary outcome was response on HAM‐D‐17. Secondary outcomes were response on CGI and remission (HAM‐D‐17).

Results:  Venlafaxine–quetiapine was more effective than venlafaxine with no significant differences between venlafaxine–quetiapine and imipramine, or between imipramine and venlafaxine. Secondary outcomes followed the same pattern.

Conclusion:  That unipolar psychotic depression should be treated with a combination of an antidepressant and an antipsychotic and not with an antidepressant alone, can be considered evidence based with regard to venlafaxine–quetiapine vs. venlafaxine monotherapy. Whether this is also the case for imipramine monotherapy is likely, but cannot be concluded from the data.
Perceived parental rearing in subjects with obsessive–compulsive disorder and their siblings
Authors: Lennertz L. , Grabe H. J. , Ruhrmann S. , Rampacher F. , Vogeley A. , Schulze‐Rauschenbach S. , Ettelt S. , Meyer K. , Kraft S. , Reck C. , Pukrop R. , John U. , Freyberger H. J. , Klosterkötter J. , Maier W. , Falkai P. , Wagner M.
Published: August 2009

Lennertz L, Grabe HJ, Ruhrmann S, Rampacher F, Vogeley A, Schulze‐Rauschenbach S, Ettelt S, Meyer K, Kraft S, Reck C, Pukrop R, John U, Freyberger HJ, Klosterkötter J, Maier W, Falkai P, Wagner M. Perceived parental rearing in subjects with obsessive–compulsive disorder and their siblings.

Objective:  Perceived parenting in patients suffering from obsessive–compulsive disorder (OCD) is examined. We attempted to overcome some methodological limitations of prior studies by taking age of onset, parental OCD and comorbid depression into consideration. In addition, we included data from unaffected siblings to corroborate information on parental rearing.

Method:  One hundred and twenty‐two cases with OCD and 41 of their siblings as well as 59 healthy controls and 45 of their siblings completed the German short‐version of the EMBU (FEE).

Results:  Obsessive–compulsive disorder cases reported less parental warmth and more parental rejection and control. Further analyses indicated that parenting is also associated with OCD in cases with late onset and cases without parents affected by OCD. OCD cases with comorbid depression described their parents particularly negatively. Data from siblings indicated good validity of perceived parenting in OCD.

Conclusion:  This study provides further evidence for dysfunctional child rearing being relevant to the development of OCD and depression.
Nodular mucinosis of the breast in a supernumerary nipple: case report and review of the literature
Authors: Manglik Niti , Berlingeri‐Ramos Alma C. , Boroumand Nahal , Eltorky Mahmoud
Published: August 2009

Nodular mucinosis is an extraordinary stromal lesion of the breast. The usual clinical presentation is that of an oozing, slow‐growing, soft, non‐tender, lobulated mass in the subareolar region. Histologically, it is a non‐encapsulated myxoid/mucinous lesion with a sparse infiltrate of spindle cells within a collagenized stroma. The histogenesis of nodular mucinosis is undetermined but the pattern of staining of the spindle cells suggests it might be of myofibroblastic origin. We herein report for the first time in the English literature a case of nodular mucinosis occurring in a supernumerary nipple. We also discuss the main differential diagnoses and review the literature of previously published cases of this entity.

Manglik N, Berlingeri‐Ramos AC, Boroumand N, Eltorky M. Nodular mucinosis of the breast in a supernumerary nipple: case report and review of the literature.
Endurance exercise induces mRNA expression of oxidative enzymes in human skeletal muscle late in recovery
Authors: Leick L. , Plomgaard P. , Grønlykke L. , Al‐Abaiji F. , Wojtaszewski J. F. P. , Pilegaard H.
Published: August 2009

Exercise‐induced adaptations in skeletal muscle oxidative enzymes are suggested to result from the cumulative effects of transient changes in gene expression after each single exercise session. However, for several oxidative enzymes, no changes in mRNA expression are detected up to 8 h after exercise. To test the hypothesis that mRNA expression of many oxidative enzymes is up‐regulated late in recovery (10–24 h) after exercise, male subjects (n=8) performed a 90‐min cycling exercise (70% VO2‐max), with muscle biopsies obtained before exercise (pre), and after 10, 18 and 24 h of recovery. The mRNA expression of carnitine‐palmitoyltransferase (CPT)I, CD36, 3‐hydroxyacyl‐CoA‐dehydrogenase (HAD), cytochrome (Cyt)c, aminolevulinate‐delta‐synthase (ALAS)1 and GLUT4 was 100–200% higher at 10–24 h of recovery from exercise than in a control trial. Exercise induced a 100–300% increase in peroxisome proliferator‐activated receptor γ co‐activator (PGC)‐1α, citrate synthase (CS), CPTI, CD36, HAD and ALAS1 mRNA contents at 10–24 h of recovery relative to before exercise. No protein changes were detected in Cytc, ALAS1 or GLUT4. This shows that mRNA expression of several training‐responsive oxidative enzymes is up‐regulated in human skeletal muscle at 10–24 h of recovery, supporting that exercise‐induced adaptations of these oxidative enzymes can be the result of the cumulative effects of transient changes in mRNA expression.
ORIGINAL ARTICLE: Urocortin Increases IL‐4 and IL‐10 Secretion and Reverses LPS‐induced TNF‐α Release from Human Trophoblast Primary Cells
Authors: Torricelli Michela , Voltolini Chiara , Bloise Enrrico , Biliotti Giulia , Giovannelli Alessia , De Bonis Maria , Imperatore Alberto , Petraglia Felice
Published: August 2009

Problem  As urocortin (Ucn) is a placental peptide belonging to the corticotrophin‐releasing hormone (CRH) family that modulates immune function in other biological models, this study evaluated Ucn effects on cytokines secretion from cultured human trophoblast cells.

Method of study  Placentas were collected from normal term pregnancies after elective caesarean section, and primary trophoblast culture was prepared followed by the treatment of Ucn and/or CRH selective antagonists, antalarmin and astressin 2b. The anti‐inflammatory cytokines IL‐4 and IL‐10 and the pro‐inflammatory cytokine TNF‐α were measured by ELISA.

Results  Urocortin treatment induced a significant and dose‐dependent increase of IL‐4 and IL‐10, whereas it did not affect TNF‐α secretion. When incubated in the presence of LPS, Ucn reversed LPS‐induced TNF‐α release from cultured trophoblast cells, an effect that was blocked by the CRH‐R2 selective antagonist, astressin 2b.

Conclusion  Urocortin stimulates IL‐4 and IL‐10 secretion and reverses LPS‐induced TNF‐α release from trophoblast cells through action on CRH‐R2 receptors, suggesting that this peptide may play a possible role as an anti‐inflammatory agent.
ORIGINAL ARTICLE: Human Serum Complement C3 and Factor H in the Syndrome of Hemolysis, Elevated Liver Enzymes, and Low Platelet Count
Authors: Ari Elif , Yilmaz Yusuf , Gul Ahmet , Alahdab Yesim Ozen , Kedrah Alla Eldeen , Macunluoglu Beyza , Aydin Atakan , Arikan Hakki , Ozener Cetin
Published: August 2009

Problem  Hemolysis, elevated liver enzymes, and low platelet count syndrome (HELLP syndrome) is a life‐threatening variant of severe pre‐eclampsia in pregnant women. The complement system may play a role in the pathogenesis of this condition. We sought to determine serum complement 3 (C3) levels and its regulatory protein complement factor H (FH) in the HELLP syndrome.

Method of study  Twenty‐two pre‐eclamptic patients with HELLP syndrome (mean age: 27.8 ± 6.2 years), 21 pre‐eclamptic patients without HELLP syndrome (mean age: 27.5 ± 6.8 years) and 24 normotensive, healthy pregnant women (mean age: 26.1 ± 4.4 years) were included in this study. Serum concentrations of C3 and FH were measured in all participants.

Results  Concentrations of C3 and FH did not differ significantly between the study groups. In patients with the HELLP syndrome, FH levels were positively associated with platelet count.

Conclusion  These findings did not support a major role of complement activation in the HELLP syndrome. In patients with HELLP, lower levels of FH are correlated with a reduced platelet count.
ORIGINAL ARTICLE: A Retrospective Analysis of Fondaparinux Versus Enoxaparin Treatment in Women with Infertility or Pregnancy Loss
Authors: Winger Edward E. , Reed Jane L.
Published: August 2009

Problem  We compared the pregnancy success rates and safety parameters of fondaparinux versus enoxaparin, combined with immunotherapy, in patients with a history of miscarriage and/or infertility and coagulant defects.

Method of study  A total of 127 pregnancies in 110 patients with a history of miscarriage and/or infertility were retrospectively evaluated. Of these, 29 pregnancies used fondaparinux 2.5 mg daily and 98 pregnancies used enoxaparin 30 mg twice daily.

Results  The pregnancy success rate was 59% (17/29; 95% CI, 41–75%) for patients receiving fondaparinux and 58% (57/98; 95% CI, 48–68%) for patients receiving enoxaparin. No difference was detected in birth weight (2.7 ± 0.8 and 2.9 ± 0.6 kg, respectively) or gestational age at delivery (37.3 ± 2.2 and 37.7 ± 2.1 weeks, respectively). No birth defects, severe bleeding‐related complications, or serious allergic reactions were observed.

Conclusion  In patients with a history of miscarriage, infertility, and coagulant defects receiving immunotherapy, fondaparinux resulted in successful pregnancy outcomes comparable with enoxaparin therapy. Although no difference in outcome was observed in our analysis, a much larger study is required to achieve statistical power.
Repeatability of the low‐dose ACTH test in asthmatic children on inhaled corticosteroids
Authors: Gupta Atul , Cheetham Tim , Jaffray Clare , Ullman Denise , Gibb Ian , Spencer David A
Published: August 2009

Aim:  To assess the repeatability of low‐dose Synacthen test (LDST) in asthmatic children receiving high‐dose fluticasone propionate (FP).

Methods:  Low‐dose Synacthen test was performed on 18 children with stable chronic asthma treated with FP at a constant daily dose of ≥500 μg and repeated 1 month later. Repeatability was assessed using the Kappa statistic for categorical variables.

Results:  Fifteen patients had consistent results (either two normal or two abnormal responses) and three patients had inconsistent results (one normal and one abnormal response). The Kappa statistic was 0.56 indicating fair to good agreement between the tests.

Conclusion:  The results of adrenal function testing in patients on inhaled steroids can have major implications for patient management, making it important to use a test with excellent repeatability. The LDST conducted using our protocol does not fulfil this criterion.