bluuebunny/crossref_metadata_2025 huggingface dataset:
Historians and Moral Evaluations
Authors: VANN RICHARD T.
Published: November 2004

In dem Gebiet der Geschichte liegt die ganze moralische Welt.

–Schiller

The reappearance of the question of moral judgments by historians makes a reappraisal of the issues timely. Almost all that has been written on the subject addresses only the propriety of moral judgments (or morally charged language) in the written texts historians produce. However, historians have to make moral choices when selecting a subject upon which to write; and they make a tacit moral commitment to write and teach honestly.

Historians usually dislike making explicit moral evaluations, and have little or no training in how to do so. They can argue it's not their job; they are only finders of fact. Historians holding a determinist view of actions do not think it appropriate to blame people for doing what they couldn't help doing; for those believing there is an overall pattern to history, individual morality is beside the point. Finally, since earlier cultures had values different from ours, it seems unjust to hold them to contemporary standards.

This essay modifies or rejects these arguments. Some historians have manifested ambivalence, acknowledging it is difficult or impossible to avoid making moral evaluations (and sometimes appropriate to make them). Ordinary‐language philosophers, noting that historiography has no specialized vocabulary, see it as saturated by the values inherent in everyday speech and thought.

I argue that the historicist argument about the inevitably time‐bound limitation of all values is exaggerated. Historians who believe in the religious grounding of values (like Lord Acton) obviously disagree with it; but even on a secular level, morals are often confused with mores. If historians inevitably make moral evaluations, they should examine what philosophical ethicists—virtue ethicists, deontologists, and consequentialists—have said about how to make them; and even if they find no satisfactory grounding for their own moral attitudes, it is a brute fact that they have them.

I end with an argument for “strong evaluations”—neither treating them as a troublesome residue in historiography nor, having despaired of finding a solid philosophical ground for moral evaluations, concluding that they are merely matters of taste. I believe historians should embrace the role of moral commentators, but that they should be aware that their evaluations are, like all historical judgments, subject to the criticisms of their colleagues and readers. Historians run little risk of being censorious and self‐righteous; the far greater danger is acquiescing in or contributing to moral confusion and timidity.
The changing union and bargaining landscape: union concentration and collective bargaining trends
Authors: Ebbinghaus Bernhard
Published: November 2004

Unions in Western Europe have tended to merge in larger organisations, straddling across traditional bargaining demarcations. Despite the trend towards union concentration, cross‐national differences remain in the degree of fragmentation and the balance across private and public sectors. In the past years, wage moderation was common to nearly all bargaining systems, partly as a result of coordinated incomes policies or pattern‐setting wage settlements. Tripartite concertation has proven more difficult because of increased dissatisfaction with modest pay increases and insufficient employment effects.
Qualitätssicherung in der volkswirtschaftlichen Auftragsforschung: Eine Fallstudie und ein Vorschlag
Authors: Bönte Werner , Lucke Bernd
Published: November 2004

This paper presents a case study on commissioned economic research in Germany. We find deplorable methodological and empirical shortcomings in a prominent study by Munich’s ifo-Institute, on aspects of horizontal fiscal revenue sharing between German states. We suspect that this may not be an exceptional case but may point out problems of quality control in economic consultancy as a whole. Therefore, we suggest establishing a certified referee system in order to improve research quality.
„Nachhaltige Entwicklung“ – Zur Ökonomik des Bangens und des Hoffens
Authors: Endres Alfred
Published: November 2004

The paper starts with a critical assessment of attempts to measure sustainability. Moreover, incentives for the present generation to follow a sustainable path are a key issue. Sustainability is threatened by discounting and by the open access structure of the relationship between present and future generations. On the other hand, there are economic causes for optimism. Particularly if the present generation corrects market failures, positive intertemporal externalities are generated. In addition to this “main stream” economic reasoning, the paper investigates whether sustainability is more likely if decision makers are not guided by the rules of homo oeconomicus.
Practice in focus: A hermeneutic approach to research ethics
Authors: Clegg Jennifer
Published: November 2004

This article argues that the interpretative and negotiating approach of hermeneutic ethics can inform research into the experiences of people with learning disability more usefully than bioethics. Terms and ideas are defined; philosophers and researchers who have employed them are described; arguments for and against the proposition are considered; it concludes by summarizing the position and its implications. Two final reflections pose questions researchers may find it fruitful to consider, or to discuss with users, carers and professionals.
Ascertaining the views of people with profound and multiple learning disabilities
Authors: Ware Jean
Published: November 2004

There has been a welcome recent shift towards taking account of the views of those who have traditionally been seen as lacking competence, including those with learning disabilities. Innovative methods have been devised to help people express their views and research demonstrates that people with learning disabilities can be taught this skill. However, none of this work has involved people with profound and multiple learning disabilities and serious doubts have been raised about the extent to which it is possible to ascertain the views of this group. Those operating at a preintentional level may not express, or have, views in the usually understood sense. Methods which attempt to ascertain the views of this group are highly inferential and it is often only possible to infer immediate preferences. It is important that the limitations of such methods are acknowledged. A case study is used to demonstrate that, in relation to major life decisions, taking account of a wide range of assessment information may give a clearer picture of the preferences of someone with profound and multiple learning disabilities than subjective interpretations of their behaviour or proxies. This should be combined with a focus on teaching the person so that they acquire as much control over their own lives as possible.
Putting words into their mouths? Interviewing people with learning disabilities and little/no speech
Authors: Brewster Stephanie J.
Published: November 2004

People with learning disabilities who are unable to speak are often excluded from research. Techniques to support interviewing, such as Talking Mats, can help to improve the quality of research in which such people could not otherwise participate. Talking Mats, in common with many techniques which augment communication, relies on someone else selecting the vocabulary to be made available. This paper outlines the Talking Mats framework, and discusses various methods of vocabulary selection. In particular it reports on empirical work with two effective communication aid users, who were invited to advise on vocabulary. It is proposed that many of the difficulties of research involving people with limited communication, can be ameliorated by viewing the process of accessing their views not as a one off event, but as an ongoing process.
The association of socio‐economic position across the life course and age at menopause: the British Women's Heart and Health Study
Authors: Lawlor Debbie A. , Ebrahim Shah , Smith George Davey
Published: November 2004

ObjectiveTo assess the association of indicators of adverse socio‐economic position from across the life course with age at menopause.

DesignCross sectional study as part of the British Women's Heart and Health Study.

Setting23 British towns.

PopulationThree thousand and five hundred and thirteen women aged 60–79 years from a total cohort of 4286. Women who underwent a hysterectomy or oophorectomy prior to their ‘natural’ menopause or who were taking hormone replacement therapy around the perimenopausal period and for whom a biological age at menopause could not be calculated were excluded from this study.

Main outcome measureAge at menopause.

ResultsMost of the 10 indicators of adverse socio‐economic position from childhood through to adulthood were linearly associated with a younger age at menopause. In age adjusted analyses, women from manual social classes in childhood began their menopause on average 0.68 years (95% confidence interval [CI] 0.11, 1.3) earlier than those from non‐manual social classes. Those who lived in a house as a child without a bathroom began their menopause 0.47 years (95% CI 0.12, 0.82) earlier than those with a bathroom. Those who shared a bedroom began 0.36 years (95% CI 0.03, 0.70) earlier than those who had their own bedroom and finally those who lived in a household with no access to a car as a child began their menopause 0.47 years (95% CI 0.02, 0.95) earlier than those with access to a car. Adult indicators of adverse socio‐economic position were similarly associated with earlier age at menopause. Age at completing full time education was not substantively associated with age at menopause. The inverse associations between each of the indicators of both childhood and adult socio‐economic position and age at menopause were not importantly affected by adjustment for other reproductive factors but they attenuated by between 6% and 21% with adjustment for adult smoking and body mass index. The inverse associations between each of the childhood indicators of socio‐economic position only and age at menopause attenuated markedly (between 12% and 70%) with adjustment for adult leg length. There was a cumulative effect of disadvantage across the life course demonstrated by a strong linear trend between a composite score of the 10 socio‐economic indicators and young age at menopause. The age at onset of menopause for women who had 9 or 10 adverse socio‐economic indicators was on average 1.70 years (95% CI 0.36, 3.0) younger than that of women with none or only one indicator.

ConclusionsAdverse socio‐economic circumstances in childhood, as well as in adulthood, are associated with an earlier age at menopause. The association between childhood deprivation and early menopause may at least in part be mediated via exposures, such as childhood diet, which affect both linear growth and age at menopause.
Randomised controlled study comparing oral and vaginal misoprostol for cervical priming prior to surgical termination of pregnancy
Authors: Ashok Premila W. , Hamoda Haitham , Nathani Fatima , Flett Gillian M.M. , Templeton Allan
Published: November 2004

Objective
To compare the effectiveness of oral misoprostol with vaginal misoprostol as a cervical priming agent prior to first trimester vacuum aspiration.

Design
Randomised study.

Setting
Scottish teaching hospital.

Population
Primigravid women at gestations up to 91 days requesting surgical abortion under the 1967 Abortion Act.

Methods
Sixty‐four women were randomised to receive misoprostol 400 μg orally at home or vaginally in hospital 2–4 hours pre‐operatively for cervical priming.

Main outcome measures
The main outcome measures were cumulative force required to dilate the cervix to 9 mm, baseline cervical dilatation, intra‐operative blood loss and patient and staff acceptability.

Results
There was no significant difference in baseline cervical dilatation, peak force required to dilate the cervix at 8 and 9 mm and cumulative force required between the two groups. Operating time and intra‐operative blood loss were not significantly different between the two groups. The priming to abortion interval was significantly longer with oral misoprostol when compared with the vaginal group (P < 0.0001). Women receiving oral misoprostol were significantly more likely to experience nausea (OR: 3.9, 95% CI: 1.3 to 11.2), while women receiving vaginal misoprostol were more likely to complain of tiredness (OR: 0.2, 95% CI: 0.1 to 0.7) with no significant differences in other side effects between the two groups. There was no significant difference in patient acceptability in relation to the priming agent between the two groups (P= 0.96). However, majority of the nursing staff (83%) admitting women preferred the oral route of administration.

Conclusion
Cervical priming with oral misoprostol at home is effective with high patient and staff acceptability.
Modulation of cerebral vascular tone by activated glia: involvement of nitric oxide
Authors: Chisari M. , Salomone S. , Laureanti F. , Copani A. , Sortino M. A.
Published: November 2004

The ability of activated glia to affect cerebral vascular tone has been evaluated using an in vitro experimental system in which basilar arteries were incubated with glial cultures activated by treatment with lipopolysaccharide (LPS). Vascular tone was measured with an isometric myograph. Contraction in response to high KCl and serotonin was reduced in arteries co‐incubated for 24 h with LPS‐activated glia, whereas the response to acetylcholine was not modified. The reduced contraction was prevented when the nitric oxide synthase (NOS) inhibitor l‐N‐nitro‐arginine (L‐NNA) was added throughout the whole incubation time (activation of glial cells with LPS + co‐incubation of glial cells with cerebral arteries). Under these conditions, nitrite levels were drastically reduced. A reduced contraction to KCl was also observed after treatment of the cerebral vessel with sodium nitroprusside. In contrast, L‐NNA added to the vessel did not modify the response to contracting stimuli and the expression of endothelial NOS was not modified in cerebral arteries pre‐incubated with activated glia. These results suggest that activated glia, which finds an in vivo correlate in several neuropathological conditions, can contribute to changes of vascular tone by modifying the levels of nitric oxide (NO) to which the vessel is exposed.
Differential regulation of GLAST immunoreactivity and activity by protein kinase C: evidence for modification of amino and carboxyl termini
Authors: Susarla Bala T. S. , Seal Rebecca P. , Zelenaia Olga , Watson Deborah J. , Wolfe John H. , Amara Susan G. , Robinson Michael B.
Published: November 2004

Many neurotransmitter transporters, including the GLT‐1 and EAAC1 subtypes of the glutamate transporter, are regulated by protein kinase C (PKC) and these effects are associated with changes in cell surface expression. In the present study, the effects of PKC activation on the glutamate aspartate transporter (GLAST) subtype of glutamate transporter were examined in primary astrocyte cultures. Acute (30 min) exposure to the phorbol 12‐myristate 13‐acetate (PMA) increased (approximately 20%) transport activity but had the opposite effect on both total and cell surface immunoreactivity. Chronic treatment (6 or 24 h) with PMA had no effect on transport activity but caused an even larger decrease in total and cell surface immunoreactivity. This loss of immunoreactivity was observed using antibodies directed against three different cytoplasmic epitopes, and was blocked by the PKC antagonist, bisindolylmaleimide II. We provide biochemical and pharmacological evidence that the activity observed after treatment with PMA is mediated by GLAST. Two different flag‐tagged variants of the human homolog of GLAST were introduced into astrocytes using lentiviral vectors. Although treatment with PMA caused a loss of transporter immunoreactivity, flag immunoreactivity did not change in amount or size. Together, these studies suggest that activation of PKC acutely up‐regulates GLAST activity, but also results in modification of several different intracellular epitopes so that they are no longer recognized by anti‐GLAST antibodies. We found that exposure of primary cultures of neurons/astrocytes to transient hypoxia/glucose deprivation also caused a loss of GLAST immunoreactivity that was attenuated by the PKC antagonist, bisindolylmaleimide II, suggesting that some acute insults previously thought to cause a loss of GLAST protein may mimic the phenomenon observed in the present study.
Invited review: the evolution of antidepressant mechanisms
Authors: Slattery D.A. , Hudson A.L. , Nutt D.J.
Published: November 2004

Present antidepressants are all descendents of the serendipitous findings in the 1950s that the monoamine oxidase inhibitor iproniazid and the tricyclic antidepressant imipramine were effective antidepressants. The identification of their mechanism of action, and those of reserpine and amphetamine, in the 1960s, led to the monoamine theories of depression being postulated; first, with noradrenaline then 5‐hydroxytryptamine being considered the more important amine. These monoamine theories of depression predominated both industrial and academic research for four decades. Recently, in attempts to design new drugs with faster onsets of action and more universal therapeutic action, downstream alterations common to current antidepressants are being examined as potential antidepressants. Additionally, the use of animal models has identified a number of novel targets some of which have been subjected to clinical trials in humans. However, monoamine antidepressants remain the best current medications and it may be some time before they are dislodged as the market leaders.
Effective HIV Treatment and the Employment of HIV+ Adults
Authors: Goldman Dana P. , Bao Yuhua
Published: November 2004

Objective. To examine whether highly active antiretroviral therapy (HAART) helps HIV‐infected patients return to work, remain employed, and maintain hours of work.

Data Source. Longitudinal data from a national probability sample of HIV+ patients older than 18 years old who made at least one visit in the contiguous United States in early 1996.

Study Design. We consider the effect of HAART on three employment outcomes: (1) returning to work within six months of treatment, conditional on not working pretreatment; (2) remaining employed within six months of treatment, conditional on working pretreatment; (3) hours of work conditional on working at the second follow‐up survey. We use a bivariate probit model to jointly model employment and treatment with HAART for the first two outcomes and the two‐stage least squares method for hours of work. State policies regarding prescription drug coverage are used as instrumental variables for HAART to account for a key source of potential bias—the more severely ill tend to have the most difficulty working, but are also the most likely to be on HAART.

Principal Findings. Our results indicate that HAART increases the probability of remaining employed by HIV patients and hours of work for those working within six months of treatment. In the case of remaining employed, the employment effect (an increase from 58 percent to 94 percent in the probability of remaining employed) is statistically significant and the related incremental income is sizable compared to the incremental costs of HAART. Sensitivity analyses demonstrate that the results are robust to different specifications for insurance coverage.

Conclusions. Patients who are working are more likely to remain employed because of treatment with HAART. HAART prescribed to patients in less advanced stages of the infection may lead to the greatest gain in employment.
Identifying and Accommodating Statistical Outliers When Setting Prospective Payment Rates for Inpatient Rehabilitation Facilities
Authors: Paddock Susan M. , Wynn Barbara O. , Carter Grace M. , Buntin Melinda Beeuwkes
Published: November 2004

Objective. To demonstrate how a Bayesian outlier accommodation model identifies and accommodates statistical outlier hospitals when developing facility payment adjustments for Medicare's prospective payment system for inpatient rehabilitation care.

Data Sources/Study Setting. Administrative data on costs and facility characteristics of inpatient rehabilitation facilities (IRFs) for calendar years 1998 and 1999.

Study Design. Compare standard linear regression and the Bayesian outlier accommodation model for developing facility payment adjustors for a prospective payment system.

Data Collection. Variables describing facility average cost per case and facility characteristics were derived from several administrative data sources.

Principal Findings. Evidence was found of non‐normality of regression errors in the data used to develop facility payment adjustments for the inpatient rehabilitation facilities prospective payment system (IRF PPS). The Bayesian outlier accommodation model is shown to be appropriate for these data, but the model is largely consistent with the standard linear regression used in the development of the IRF PPS payment adjustors.

Conclusions. The Bayesian outlier accommodation model is more robust to statistical outlier IRFs than standard linear regression for developing facility payment adjustments. It also allows for easy interpretation of model parameters, making it a viable policy alternative to standard regression in setting payment rates.
Cost Convergence between Public and For‐Profit Hospitals under Prospective Payment and High Competition in Taiwan
Authors: Xirasagar Sudha , Lin Herng‐Ching
Published: November 2004

Objective.To test the hypotheses that: (1) average adjusted costs per discharge are higher in high‐competition relative to low‐competition markets, and (2) increased competition is associated with cost convergence between public and for‐profit (FP) hospitals for case payment diagnoses, but not for cost‐plus reimbursed diagnoses.

Data Sources.Taiwan's National Health Insurance database; 325,851 inpatient claims for cesarean section, vaginal delivery, prostatectomy, and thyroidectomy (all case payment), and bronchial asthma and cholelithiasis (both cost‐based payment).

Study Design.Retrospective population‐based, cross‐sectional study.

Data Analysis.Diagnosis‐wise regression analyses were done to explore associations between cost per discharge and hospital ownership under high and low competition, adjusted for clinical severity and institutional characteristics.

Principal Findings.Adjusted costs per discharge are higher for all diagnoses in high‐competition markets. For case payment diagnoses, the magnitudes of adjusted cost differences between public and FP hospitals are lower under high competition relative to low competition. This is not so for the cost‐based diagnoses.

Conclusions.We find that the empirical evidence supports both our hypotheses.
Validation of a Cantonese Version of the Children's Dermatology Life Quality Index
Authors: Chuh Antonio A. T.
Published: November 2004

Abstract:  My goal was to assess the validity and reliability of a Cantonese version of the Children's Dermatology Life Quality Index (CDLQI). To do so, I invited four translators to produce a proper Cantonese translation of the CDLQI. I asked five children to complete this version and made adjustments as necessary. I then requested 30 children with skin problems and 30 children consulting for problems unrelated to the skin in a primary care setting to complete the questionnaire before their consultation. A physician assessed the severity of the skin problem using a visual analog scale. Some children from both groups completed the questionnaire again 7 days later. The CDLQI scores are strongly (γs = 0.850) and significantly (p < 0.01) correlated with physician‐rated disease severity. The Cantonese CDLQI scores were similar to those of the English version for individual skin problems. Correlation of test‐retest results is strong (γs = 0.958, p < 0.01). Cronbach's alpha is 0.83. I concluded that the Cantonese CDLQI is a valid and reliable tool for assessing the effects of skin problems on quality of life in children.
Epidemiology of Pediatric Dermatology and Allergology in the Region of Aargau, Switzerland
Authors: Wenk Christine , Itin Peter H.
Published: November 2004

Abstract:  Pediatric dermatology is a new topic and no epidemiologic data exist from Switzerland. Therefore we performed a survey of the pediatric population referred to the hospital of Aarau, Switzerland, between 1998 and 2001. All inpatients and outpatients less than 16 years old with a dermatologic diagnosis were included prospectively in our study. Demographic data (age, mean age, sex distribution), referral method, pattern and frequency of the different diagnoses in various age groups, diagnostic pattern, and therapy were analyzed. A total of 1105 children were included, with a slightly higher proportion of girls (53.8% versus 46.2%). The average age was 6.8 years and infants and school children represented 60% of the study population. Half of the patients (51%) were external referrals, almost one‐third (29%) presented spontaneously, and the remaining 20% were sent from other hospital departments. With a frequency of 25.9%, atopic dermatitis was the most frequent diagnosis, followed by pigmented nevi (9.1%) and warts (5.0%). Local therapy was prescribed in 66% of patients and systemic therapy in 18.6%. Other treatments such as curettage, surgery, cryotherapy, ultraviolet therapy, and electrotherapy were rarely performed (2%). We found that atopic dermatitis was the most frequent skin disorder seen in all age groups. As this was a dermatologic subspecialty clinic, higher frequencies of chronic and uncommon dermatoses such as genetic and autoimmune diseases were seen, whereas frequent diagnoses such as diaper rash and miliaria were rarely seen and the frequencies of other common skin disorders such as scabies, pediculosis, impetigo contagiosa, warts, and molluscum contagiosum were expected to be higher compared with the figures in the literature. In our study these dermatoses are underreported, as most patients are treated by general practitioners and pediatricians. Our survey documents the most common skin diseases in childhood primarily seen by pediatricians. We emphasize that dermatologic education of medical students, primary care physicians, and pediatricians should focus on allergic skin diseases, skin infections, pigmentary disorders, and vascular lesions.
Kawasaki Disease with Facial Nerve Paralysis
Authors: Larralde Margarita , Santos‐Muñoz Andrea , Rutiman Ricardo
Published: November 2004

Abstract:  Kawasaki disease (KD) is a multisystem disorder with varying clinical expression. We describe an instance of facial nerve paralysis in a patient with KD. A 5‐month‐old boy developed fever, irritability, and diarrhea, treated 8 days later with cefaclor and ibuprofen. Three days later a confluent, erythematous and papular rash appeared, his lips were reddened and swollen, and his white blood count and platelet count were 20,900/mm3 and 558,000/mm3, respectively. He was admitted to the hospital with a diagnosis of KD, and an echocardiogram showed a right coronary aneurysm. The patient then developed an acute, right‐sided, facial nerve peripheral paralysis that resolved over the next 6 weeks. He was treated with intravenous immune globulin (IVIG) 2 g/kg and aspirin 100 mg/kg/day with improvement of signs and symptoms. This report documents facial nerve paralysis as an uncommon complication of KD and points out that it may be a marker of increased risk of cardiovascular disease in this disorder.
Chemokine Levels in the Jugular Venous Blood of Migraine Without Aura Patients During Attacks
Authors: Sarchielli Paola , Alberti Andrea , Vaianella Luana , Pierguidi Laura , Floridi Alessandro , Mazzotta Giovanni , Floridi Ardesio , Gallai Virgilio
Published: November 2004

Objective.—To investigate changes in the levels of calcitonin gene‐related peptide and its intracellular messenger cyclic adenosine monophosphate in serial samples of internal jugular blood taken from migraine patients without aura assessed during attacks, and to assess their relationship with the levels of IL‐8, MCP‐1, and RANTES in the same samples.

Background.—Calcitonin gene‐related peptide, the marker of trigeminovascular activation, is released in both the internal and external jugular venous blood of migraine patients during attacks. Experimental evidence demonstrated that when released from C‐type sensory neurons in inflammatory pain models, it differentially induced expression of neutrophil chemotactic chemokine IL‐8, but not monocyte chemotactic chemokine MCP‐1 or lymphocyte chemotactic chemokine RANTES. These chemokines were never investigated in migraine.

Design/Methods.—Eight migraine without aura patients were admitted to the hospital during the attacks. Internal jugular venous blood samples were taken immediately after catheter insertion, at the 1st, 2nd, and 4th hours after attack onset, and within 2 hours from its cessation. The levels of the sensory neuropeptide calcitonin gene‐related peptide and the messenger cyclic adenosine monophosphate were measured by RIA method, and those of IL‐8, MCP‐1, and RANTES were measured by ELISA method.

Results.—Higher calcitonin gene‐related peptide levels were found in the internal jugular venous blood of migraine without aura patients compared with the time of catheter insertion (ANOVA: P < .0001) with a peak at the first hour (52.6 ± 9.2 ng/mL). A transient increase in IL‐8 was observed at the 2nd and 4th hours (P < .01 and P < .002, respectively), whereas no changes in the levels of MCP‐1 and RANTES were found at any time of the study. The increase in IL‐8 was accompanied by a parallel increase in cyclic adenosine monophosphate.

Conclusions.—The present study confirms previous findings of an increase in calcitonin gene‐related peptide in internal jugular venous blood of migraine without aura patients during attacks. The transient increase in the levels of IL‐8 concurs with the results of recent experimental research showing a calcitonin gene‐related peptide‐induced activation of IL‐8 gene expression, but not RANTES and MCP‐1, via the transcriptional factor AP‐2, which mediates transduction in response to cyclic adenosine monophosphate. Although IL‐8 is transiently increased during migraine attacks, an accumulation of leukocytes secondary to neurogenic inflammation is unlikely, as it is for other inflammatory events, because they are self limiting. Other events, including nitric oxide production, may contribute to counteract meningeal transvascular leukocyte migration during migraine attacks, as suggested by the model of sterile inflammation.
Individualizing Treatment With Verapamil for Cluster Headache Patients
Authors: Blau Joseph N. , Engel Hans O.
Published: November 2004

Background.—Verapamil is currently the best available prophylactic drug for patients experiencing cluster headaches (CHs). Published papers usually state 240 to 480 mg taken in three divided doses give good results, ranging from 50% to 80%; others mention higher doses—720, even 1200 mg per day. In clinical practice we found we needed to adapt dosage to individual's time of attacks, in particular giving higher doses before going to bed to suppress severe nocturnal episodes. A few only required 120 mg daily. We therefore evolved a scheme for steady and progressive drug increase until satisfactory control had been achieved.

Objective.—To find the minimum dose of verapamil required to prevent episodic and chronic cluster headaches by supervising each individual and adjusting the dosage accordingly.

Methods.—Consecutive patients with episodic or chronic CH (satisfying International Headache Society (IHS) criteria) were started on verapamil 40 mg in the morning, 80 mg early afternoon, and 80 mg before going to bed. Patients kept a diary of all attacks, recording times of onset, duration, and severity. They were advised, verbally and in writing, to add 40 mg verapamil on alternate days, depending on their attack timing: with nocturnal episodes the first increase was the evening dose and next the afternoon one; when attacks occurred on or soon after waking, we advised setting an alarm clock 2 hours before the usual waking time and then taking the medication.

Patients were followed‐up at weekly intervals until attacks were controlled. They were also reviewed when a cluster period had ended, and advised to continue on the same dose for a further 2 weeks before starting systematic reduction.

Chronic cluster patients were reviewed as often as necessary.

Results.—Seventy consecutive patients, 52 with episodic CH during cluster periods and 18 with chronic CH, were all treated with verapamil as above. Complete relief from headaches was obtained in 49 (94%) of 52 with episodic, and 10 (55%) of 18 with chronic CH; the majority needed 200 to 480 mg, but 9 in the episodic, and 3 in the chronic group, needed 520 to 960 mg for control. Ten, 2 in the episodic and 8 in the chronic group, with incomplete relief, required additional therapy—lithium, sumatriptan, or sodium valproate. One patient withdrew because verapamil made her too tired, another developed Stevens‐Johnson syndrome, and the drug was withdrawn.

Conclusions.—Providing the dosage for each individual is adequate, preventing CH with verapamil is highly effective, taken three (occasionally with higher doses, four) times a day. In the majority (94%) with episodic CH steady dose increase under supervision, totally suppressed attacks. However in the chronic variety only 55% were completely relieved, 69% men, but only 20% women. In both groups, for those with partial attack suppression, additional prophylactic drugs or acute treatment was necessary.
Trigeminal Neuralgia Due to Pontine Infarction
Authors: Peker Selcuk , Akansel Gur , Sun Ibrahim , Pamir Necmettin M.
Published: November 2004

Trigeminal neuralgia (TN) is most commonly caused by vascular compression of the trigeminal nerve root entry zone. Secondary trigeminal neuralgia due to ischemic lesion of the pons is very rare. Here we report a patient with a pontine infarct transecting the central trigeminal pathways resulting with trigeminal neuralgia.
New Onset Migraine With Aura Following Head Injury: A Case Report
Authors: Husid Marc S.
Published: November 2004

A patient is described who developed recurrent headaches following a traumatic injury in the vicinity of the right greater occipital nerve (GON) that fulfill IHS criteria for migraine with aura. Both aura and headache can be triggered by pressure over the GON and relieved by local anesthetic blockade.
Expanding Entrepreneurial Cognition's Toolbox: Potential Contributions from the Field of Cognitive Science
Authors: Baron Robert A. , Ward Thomas B.
Published: November 2004

Several measures and methods developed by the field of cognitive science may prove useful to researchers investigating various aspects of entrepreneurial cognition. These techniques include ones that have not, as yet, been applied to entrepreneurial cognition, such as reaction time, priming, measures of working memory, and measures of creative cognition. Because the questions addressed by any field are shaped, to an important degree, by the tools at its disposal, incorporating these measures into the study of entrepreneurial cognition may help to broaden the scope of this ongoing work. Specifically, these techniques may provide researchers with tools useful in exploring issues that have not previously been investigated in detail (e.g., the nature of entrepreneurs’ knowledge structures; their characteristic modes of thought). This, in turn, may enhance our understanding of the cognitive factors that influence key aspects of the entrepreneurial process.
Evaluation of the Early Hemodynamic Changes in Carotid Arteries During Ventricular and Dual Chamber Pacing
Authors: SOYLU MUSTAFA , OZDEMIR OZCAN , GEYIK BILAL , OZBAKIR CEMAL , DEMIR AHMET DURAN , DURU ERDAL , OZBAL SERRA , HEKIMOGLU BAKI , OZER TULAY , ARDA KEMAL
Published: November 2004

In spite of a wide choice of pacemakers, there are some problems in making more rational clinical decisions for individual patients since mode selection and programming is usually performed on the basis of a clinical hunch. The aim of this study was to measure the differences in carotid flow in patients with a pacemaker programmed in the dual chamber and in the single chamber pacing modes. Sixty patients with implanted bipolar DDD pacemakers were enrolled in this study. Blood peak systolic velocity (PSV) and end‐diastolic velocity (EDV), cross‐sectional area, resistive index (RI), and pulsatility index (PI) were measured in the common (CCA), internal (ICA), and external (ECA) carotid arteries before pacemaker implantation and after dual chamber and ventricular pacing at 60 beats/min. PSVs in the left CCA (79.3 ± 24.9 cm/s) and right CCA (84.1 ± 18.7) were shown to significantly decrease after VVI pacing (60.1 ± 16.6 and 62.1 ± 20.0, respectively). There was also a similar significant decrease in PSV in the left and right ICAs and ECAs. Besides PSV, RI, and PI in the left and right CCAs, ICAs, and ECAs significantly decreased after VVI pacing. There was no similar decrease after DDD pacing. Cross‐sectional area and flow volume in the CCA, ICA, and ECA were similar after DDD and VVI pacing and before pacemaker implantation suggesting that cardiac output was similar when the measurements were recorded. Carotid artery PSVs, pulsatility, and RIs were found to be significantly decreased during VVI pacing compared to baseline and DDD pacing. The greater incidence of adverse cerebral outcomes in patients with VVI rather than DDD pacing may be partly due to decreased carotid PSVs.
Which Parameter Should Be Chosen as Primary Endpoint for Randomized Drug‐Eluting Stent Studies?
Authors: SILBER SIGMUND
Published: November 2004

In Europe, 1,108 percutaneous coronary interventions (PCIs) per one Mio inhabitants are currently annually performed, most of them with stent implantation. Drug‐eluting stents have been the focus of attention of interventional coronary therapy since the RAVEL study was first presented in September 2001 at the European Society of Cardiology Meeting. Ever since, numerous studies have assessed the effects of various antiproliferative and anti‐inflammatory substances and a variety of different stents was used as platform, either covered with polymer carriers of different chemical and physical properties or without a polymer carrier. CE‐ or FDA‐certified drug‐eluting stents are increasingly replacing the use of bare metal stents to reduce in‐stent restenosis. Today, physicians have a choice of several approved drug‐eluting stents and, therefore, need some evidence‐based guidance through the “jungle of information” to make the right decisions. Even when focusing on randomized trials, differences between the studies regarding primary endpoints and sample sizes exist, making it difficult to compare the various drug‐eluting stent studies. Randomized studies use either nonclinical (i.e., angiographic diameter stenosis, in‐stent MLD, or in‐stent late lumen loss) or clinical (i.e., TVF, TVR, and MACE) parameters as primary endpoints. Choosing an angiographic parameter as primary endpoint results in two major limitations: first, a significant improvement of an angiographic „surrogate” parameter does not necessarily translate into a better clinical outcome (DELIVER‐I); second, conclusions regarding possible improvements of clinical outcome are underpowered, because the sample size calculation is based on the primary endpoint. Usually the number of patients needed is lower for angiographic than for clinical endpoints. Until today, only three trials with a primary clinical endpoint have shown a significantly positive impact on patients' outcome: the SIRIUS trial (Cypher stent) with its reduction of primary endpoint TVF (21.0% vs 8.6%), the TAXUS‐IV trial (Taxus stent) with its reduction of primary endpoint TVR (12.0% vs 4.7%) and TAXUS‐VI in long lesions with its reduction of primary endpoint TVR (19.4% vs 9.1%). Although the angiographic results of other drug‐eluting stents are encouraging, they will have to prove their clinical impact based on adequately powered randomized trials with a primary clinical endpoint at an adequate time interval.
Carotid Artery Stenting:
Authors: RABE KASJA , SIEVERT HORST
Published: November 2004

Carotid artery stenting (CAS) is growing as an alternative to carotid artery endarterectomy. Nowadays, it is performed routinely in many centers worldwide. Still, it is discussed controversially although several clinical trials have shown equivalency or superiority of catheter treatment at least in high‐risk patients. What is still missing is a randomized trial in non‐high‐risk patients. This is an overview about the completed and ongoing trials as well as the current stent and embolic protection technology.
Abdominal Aortic Aneurysm:
Authors: KAMINENI RAGHUNANDAN , HEUSER RICHARD R.
Published: November 2004

Abdominal aortic aneurysm (AAA) carries a high mortality if left untreated. Until recently, most patients with AAA were treated with surgical repair. However, endoluminal graft treatment is rapidly becoming an alternative to surgical repair due to lower morbidity and comparable perioperative mortality rates. Despite this optimism patients and operators should keep in mind the palliative nature of these endovascular repairs and the lifelong need for surveillance, before embarking on these procedures. Endoleaks remain to be a significant problem leading to aneurysm expansion and occasionally rupture. Durability of the existing endograft devices remains to be seen. Careful patient selection is critical to success with these procedures. With future advancements in the endograft device technology, methods of patient surveillance, and patient care, there may be a shift from conventional surgical approaches to endovascular repair for the treatment of AAA.
A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years
Authors: Pjetursson Bjarni E. , Tan Ken , Lang Niklaus P. , Brägger Urs , Egger Matthias , Zwahlen Marcel
Published: November 2004

Objectives: The objective of this systematic review was to assess the 5‐ and 10‐year survival of implant supported fixed partial dentures (FPDs) and to describe the incidence of biological and technical complications.

Methods: An electronic MEDLINE search complemented by manual searching was conducted to identify prospective and retrospective cohort studies on FPDs with a mean follow‐up time of at least 5 years. Patients had to have been examined clinically at the follow‐up visit. Assessment of the identified studies and data abstraction was performed independently by two reviewers. Failure and complication rates were analyzed using random‐effects Poisson regression models to obtain summary estimates of 5‐ and 10‐year survival proportions.

Results: The search provided 3844 titles and 560 abstracts. Full‐text analysis was performed for 176 articles resulting in 21 studies that met the inclusion criteria. Meta‐analysis of these studies indicated an estimated survival of implants in implant‐supported FPDs of 95.4% (95 percent confidence interval (95% CI): 93.9–96.5%) after 5 and 92.8% (95% CI: 90–94.8%) after 10 years. The survival rate of FPDs supported by implants was 95% (95% CI: 92.2–96.8%) after 5 and 86.7% (95% CI: 82.8–89.8%) after 10 years of function. Only 61.3% (95% CI: 55.3–66.8%) of the patients were free of any complications after 5 years. Peri‐implantitis and soft tissue complications occurred in 8.6% (95% CI: 5.1–14.1%) of FPDs after 5 years. Technical complications included implant fractures, connection‐related and suprastructure‐related complications. The cumulative incidence of implant fractures after 5 years was 0.4% (95% CI: 0.1–1.2%). After 5 years, the cumulative incidence of connection‐related complications (screw loosening or fracture) was 7.3% and 14% for suprastructure‐related complications (veneer and framework fracture).

Conclusion: Despite a high survival of FPDs, biological and technical complications are frequent. This, in turn, means that substantial amounts of chair time have to be accepted by the clinician following the incorporation of implant‐supported FPDs. More studies with follow‐up times of 10 and more years are needed as only few studies have described the long‐term outcomes.
A systematic review of the survival and complication rates of fixed partial dentures (FPDs) after an observation period of at least 5 years
Authors: Pjetursson Bjarni E. , Tan Ken , Lang Niklaus P. , Brägger Urs , Egger Matthias , Zwahlen Marcel
Published: November 2004

Objectives: The objective of this systematic review was to assess the survival of cantilever fixed partial dentures (FPDs) and the incidence of biological and technical complications.

Methods: An electronic MEDLINE search supplemented by manual searching was conducted to identify prospective and retrospective cohort studies on FPDs with a mean follow‐up time of at least 5 years. Patients had to have been examined clinically at the follow‐up visit. Assessment of the identified studies and data abstraction was performed independently by two reviewers. Failure and complication rates were analyzed using random‐effects Poisson regression to obtain summary estimates of 10‐year survival proportions.

Results: From a yield of 3658 titles and 211 abstracts, 81 articles were selected for full‐text analysis, finally resulting in 13 studies that met the inclusion criteria. Meta‐analysis of these studies resulted in an estimated survival rate of cantilever FPDs of 81.8% (95 percent confidence interval (95% CI): 78.2–84.9%) and success rate (free of all complications) of 63% (95% CI: 54.7–70.2%) after 10 years. The most common biological complication was loss of pulp vitality (32.6%) followed by caries at abutment teeth (9.1%). After a 10‐year observation period 2.6% of the FPDs were lost as a result of dental caries and 1% due to recurrent periodontitis. The most frequent technical complication was loss of retention (16.1%) followed by material fractures (5.9%). The cumulative incidence of fractures of abutment teeth was 2.9% and 2.4% of the FPDs were lost as a result of abutment tooth fracture after an observation period of 10 years.

Conclusion: This systematic review on cantilever fixed partial dentures indicated that survival and success rates of cantilever fixed partial dentures were lower than those of conventional end‐abutment supported FPDs described in a review by Tan et al. (2004) and biological and technical complications were frequent.
Spatial and quantitative patterns of movement in large bull trout (Salvelinus confluentus) from a watershed in north‐western British Columbia, Canada, are due to habitat selection and not differences in life history
Authors: Bahr M. A. , Shrimpton J. M.
Published: November 2004

Abstract – Movement and habitat use by bull trout (Salvelinus confluentus) was examined using radio telemetry in the Morice River watershed, north‐western British Columbia, between April 2000 and November 2001. Bull trout principally utilised mainstem habitat. Throughout the watershed, little movement was observed during the winter months. From June to September, movement increased and was correlated with migration into tributaries. We directly observed spawning bull trout only in tributaries of the Morice River and never in the mainstem. Many of the fish (N = 48) migrated to the nearest potential spawning sites, but a few fish (N = 7) made extensive migrations to other regions of the watershed to spawn. Fish that spawned in both years of the study returned to the same spawning location. Variation in spatial and movement data, therefore, appears to be linked to availability of suitable habitat and not differences in life history that have been observed in large bull trout.