bluuebunny/crossref_metadata_2025 huggingface dataset:
Dysregulation of systemic iron metabolism in alcoholic liver diseases
Authors: Kohgo Yutaka , Ohtake Takaaki , Ikuta Katsuya , Suzuki Yasuaki , Torimoto Yoshihiro , Kato Junji
Published: March 2008

Alcoholic liver diseases (ALD) are frequently associated with iron overload. Until recently, the effects of ethanol in hepatic iron uptake and intestinal iron absorption have not been clarified in detail. Two possible mechanisms for iron overload are the uptake of iron into hepatocytes in a specific manner through the increased expression of transferrin receptor (TfR) 1; and increased intestinal iron absorption by the lowering of hepcidin. It is worthwhile to examine whether a similar mechanism is present in the development of steatosis and non‐alcoholic steatohepatitis (NASH). Hepatocytes have several iron uptake pathways. Ethanol increases transferrin (Tf)‐mediated uptake via a receptor‐dependent manner, but downregulates the non‐Tf‐bound iron uptake. According to immunohistochemical study, TfR1 was increased in hepatocytes in 80% of hepatic tissues of patients with ALD, but was not detected in normal hepatic tissues. In an experimental model, ethanol exposure to the primary cultured‐hepatocytes in the presence of iron increased TfR1 expression and 59Fe‐labeled Tf uptake. In patients with ALD, intestinal iron absorption is increased by oral iron uptake assay. The regulatory hormone for iron homeostasis, hepcidin is downregulated in ethanol‐loaded mice liver. As well as ALD, a similar mechanism was present in the mouse model fed with a high‐fat diet, a model of the initial phenomenon of steatosis. The common mechanism for hepatic iron deposition and the triggering role of iron may be present in the development of ALD and non‐alcoholic fatty liver disease/NASH.
Pancreatic stellate cells: Molecular mechanism of pancreatic fibrosis
Authors: Shimizu Kyoko
Published: March 2008

Pancreatic stellate cells (PSC) are known to play a crucial role in pancreatic fibrogenesis in chronic pancreatitis and in the desmoplastic reaction of pancreatic cancer. When PSC are stimulated by oxidative stress, the phenotype of quiescent fat‐storing cells converts to myofibroblast‐like activated PSC that then produce extracellular matrix (ECM), adhesion molecules, and various chemokines in response to inflammatory cytokines, chemokines, and growth factors. Platelet‐derived growth factor (PDGF) is a potent stimulator of PSC proliferation, and transforming growth factor‐β, PDGF, and basic fibroblast growth factor stimulate ECM synthesis by PSC. As induction of acinar cell apoptosis and necrosis is a major mechanism in the pathogenesis of mild to severe acute pancreatitis, the rapid removal of apoptotic acinar cells may be helpful in preventing the release of toxic intracellular materials, preventing further progression of the inflammation, and restoring normal tissue homeostasis. Although PSC are not professional phagocytes, we have demonstrated that PSC engulf apoptotic polymorphonuclear neutrophils (PMN) and necrotic acinar cells. Apoptotic PMN are ingested into the cytoplasm of the PSC, and troglitazone induces a dose‐dependent increase in both phagocytic activity and expression of CD36, which is a representative scavenger receptor for phagocytic function. Engulfment of necrotic acinar cells by PSC induced PSC death and inhibited PSC activation in an in vitro study, suggesting that engulfment of necrotic acinar cells by PSC may inhibit the progression of fibrogenesis. These findings suggest that engulfment of damaged cells by PSC may be one of the mechanisms that prevent the progression of pancreatitis and restore tissue homeostasis.
Examining lower urinary tract symptom constellations using cluster analysis
Authors: Coyne Karin S. , Matza Louis S. , Kopp Zoe S. , Thompson Christine , Henry David , Irwin Debra E. , Artibani Walter , Herschorn Sender , Milsom Ian
Published: March 2008

OBJECTIVE

To gain a better understanding of how patients experience lower urinary tract symptoms (LUTS) and to determine whether particular symptoms cluster together, as LUTS seldom occur alone.

SUBJECTS AND METHODS

A secondary analysis of a cross‐sectional, population‐based survey of adults in Sweden, Italy, Germany, UK and Canada was undertaken to examine the presence of LUTS groups. Of the 19 165 telephone surveys, 13 519 respondents reported at least one LUTS and were included in the analysis. All respondents were asked about the presence of 14 LUTS (International Prostate Symptom Score plus seven additional LUTS). K‐means cluster analyses, a statistical method for sorting objects into groups so that similar objects are grouped together, was used to identify groups of people based on their symptoms. Men and women were analysed separately. A split‐half random sample was selected from the dataset so that exploratory analyses could be conducted in one half and confirmed in the second. On model confirmation, the sample was analysed in its entirety.

RESULTS

Included in this analysis were 5014 men (mean age 49.8 years; 95% white) and 8505 women (mean age 50.4 years; 96% white). Among both men and women, six distinct symptom cluster groups were identified and the symptom patterns of each cluster were examined. For both, the largest cluster consisted of respondents with minimal symptoms (i.e. reporting essentially one symptom), 56% of men and 57% of women. The remaining five clusters for men and women were labelled based on their predominant symptoms. For men, the clusters were nocturia of twice or more per night (12%); terminal dribble (11%); urgency (10%); multiple symptoms (9%); and postvoid incontinence (5%). For women, the clusters were nocturia of twice or more per night (12%); terminal dribble (10%); urgency (8%); stress incontinence (8%); and multiple symptoms (5%). The multiple‐symptom groups had several and varied LUTS, were older, and had more comorbidities. Clusters of terminal dribble and male postvoid incontinence had a lower prevalence of all other LUTS, but were fairly common (11% and 5% of men).

CONCLUSIONS

This analysis provides an empirical approach to examining the presentation of multiple LUTS and suggests it is possible to identify subgroups of patients with LUTS based on their symptom presentation. These analyses need to be replicated to evaluate the clinical relevance of these findings.
Gains from Trade: Implications for Labour Market Adjustment and Poverty Reduction in Africa
Authors: Kwasi Fosu Augustin , Mold Andrew
Published: March 2008

Abstract:  This paper reassesses the gains from trade for sub‐Saharan Africa, and draws their implications for labour market adjustment and poverty reduction. It reviews previous studies on multilateral liberalization, focusing on the findings from Computable General Equilibrium (CGE) models with relevance to African economies. The implications of these findings for poverty reduction are discussed. Our own CGE exercise supports the hypothesis that African countries cannot expect substantial gains from further multilateral liberalization. Moreover, given the sharp contraction of import‐competing sectors in response to trade liberalization in many African economies, coupled with insufficient compensation through labour market adjustments in other sectors, this study suggests that the ultimate impact on poverty reduction is likely to be small or even negative.
The Effect of the Liberalization of Investment Policies on Employment and Investment of Multinational Corporations in Africa
Authors: Asiedu Elizabeth , Gyimah‐Brempong Kwabena
Published: March 2008

Abstract:  There has been a remarkable shift in the attitudes towards globalization. Specifically, the discussion among academics and policymakers has shifted from whether globalization should be encouraged to how countries can position themselves to benefit from globalization. This paper focuses on one aspect of globalization — the liberalization of investment policies — and analyzes its impact on employment and investments by multinational corporations in Africa. We use data for 33 countries over the period 1984–2003 and we employ a dynamic panel estimator for our analysis. There are two major findings. First, liberalization has a significant and positive effect on investment. Second, liberalization does not have a direct impact on multinational employment — the effect is indirect: liberalization stimulates multinational investments which in turn increases multinational employment. By increasing investment and employment from multinational firms, these liberalization programs contribute to poverty alleviation.
WITTGENSTEIN AND DEFINING CRITERIA
Authors: BENNETT PHILIP W.
Published: March 2008

Let us introduce two antithetical terms in order to avoid certain elementary confusions: To the question “How do you know that so‐and‐so is the case?”, we sometimes answer by giving ‘criteria’ and sometimes by giving ‘symptoms. If medical science calls angina an inflammation caused by a particular bacillus, and we ask in a particular case “Why do you say this man has got angina?” then the answer “I have found the bacillus so‐and‐so in his blood” gives us the criterion, or what we may call the defining criterion of angina. If on the other hand the answer was, “His throat is inflamed”, this might give us a symptom of angina, I call “sympton” a phenomenon of which experience has taught us that it coincided, in some way or other, with the phenomenon which is our defining criterion, Then to say “A man has angina if this bacillus is found in him” is a tautology or it is a loose way of stating the definition of “angina”. But to say, “A man has angina whenever he has an inflamed throat” is to make a hypothesis. (BB, pp. 24–25)1
A CROSS‐CULTURAL PLIGHT
Authors: YUDKIN MARCIA
Published: March 2008

The late Dr. Stutterheim, Government Archeologist in Java, used to tell the following story: Somewhat before the advent of the white man, there was a storm on the Javanese coast In the neighborhood of one of the capitals. After the storm the people went down to the beach and found, washed up by the waves and almost dead, a large white monkey of unknown species. The religious experts explained that this monkey had been cast out by the god whose anger was expressed in the storm. The Rajah gave orders that the white monkey from the sea should be kept alive, chained to a certain stone. This was done. Dr. Stutterheim told me that he had seen the stone and that roughly scratched on it in Latin, Dutch, and English were the name of a man and a statement of his shipwreck. Apparently this trilingual sailor never established verbal communication with his captors. He was surely unaware of the premises in their minds which labelled him as a white monkey and therefore not a potential recipient of verbal messages: it probably never occurred to him that they could doubt his humanity. He may have doubted theirs. 1
A REAPPRAISAL OF LEIBNIZ'S VIEWS ON SPACE, TIME, AND MOTION
Authors: COOK JOHN W.
Published: March 2008

Leibniz has been widely praised for maintaining against the Newtonians of his day the view that space and time are relative. At the same time, he has been roundly criticized for allowing that we can distinguish absolute from merely relative motion. This distribution of applause and criticism, I will argue, is in a measure unjustified. For on the one hand, those arguments, found in his correspondence with Clarke, by which Leibniz seeks to reject the view that space and time are “something absolute” are for the most part unsatisfactory, and on the other hand, Leibniz was not so naive as his critics have supposed in allowing absolute motions. Sections I ‐ V of this essay will be concerned with the former issue; Leibniz's views on motion will be taken up in Section VI. The chief interest in all of this for present‐day philosophers may lie, not so much in the historical issues concerning Leibniz and the Newtonians, but in a meta‐philosophical question which inevitably arises from the historical issues, namely, the question whether developments in science can undermine the soundness of philosophical arguments which appeal to ordinary usage.
CRITICAL NOTICE
Authors: Hertzberg Lars
Published: March 2008

Good and Evil: an Absolute Conception, Raimond Gaita, Macmillan 1991. (Swansea Studies in Philosophy.)
The Churchlands' Eliminative Materialism: or The Result of Impatience
Authors: Hunter Geoffrey
Published: March 2008

In the mid‐seventies I discovered that my patience with most main‐stream philosophy had run out. What had instead begun to seem promising was the new wave in philosophical method, which ceased to pander to “ordinary language” and which began in earnest to reverse the antiscientific bias typical of “linguistic analysis”… Since I was a materialist and hence believed that the mind is the brain.
MULTINATIONAL ENTERPRISE AND THE NATION STATE: PROJECT REPORT FROM THE HARVARD BUSINESS SCHOOL
Authors: Vernon Raymond
Published: March 2008

This is the third annual progress report relating to the study of multinational enterprises at the Harvard Business School. This report, like its predecessors, is drafted in such a way as to provide an up‐to‐date picture of the state of the project without reference to prior reports.

From the first, the project was conceived as the opening phase of a long‐run effort to understand certain aspects of the operations of the multinational enterprise. The original plan was to complete this phase by the summer of 1969. By that time, a dozen doctors' theses and perhaps twenty articles will have appeared. In addition, completed first drafts of three of the four books relating to this phase of the project are scheduled to be in hand; a fifth volume, synthesizing and extending the others, is to be written in the year following.

Collectively, these publications are expected to illuminate the problems of the multinational enterprise in the fields of finance, marketing, organization, and business‐government relations. In addition, new light will have been shed upon the role of multinational enterprises in international trade, capital movements, and technological transfers. Perhaps the most telling contribution of the project in the long run—one that had not been clearly contemplated at the time that the project was first conceived—will be the development and dissemination of an historical file tracing the history of some 12,000 subsidiaries of U.S. parents since 1900. This file, generated as a by‐product of the analytical work being undertaken by the project, is being designed so that researchers at other institutions may have access to some of its contents, within the limits imposed by confidentiality commitments.
THE EFFECTS OF ECONOMIC INTEGRATION ON TRADE
Authors: Mayes David G.
Published: March 2008

This article provides a critical analysis of the models and methods which have been used to estimate the effects of economic integration on trade and suggests the most fruitful lines of further development. Both the problem of the examination of the effects of past events and problems in the prediction of future changes are tackled. In particular the drawbacks of the method of estimation of the effects of previous integration as a residual from models which explain what would have happened had the integration not taken place are shown. It is concluded that the most fruitful avenue of approach lies in the estimation of models which provide an economic explanation of trade flows and their changes, and can hence be used for both the explanation of the effects of previous integration and the prediction of future events.
THE MEDIEVAL EUROPEAN COMMUNITY
Authors: Mowat Robin
Published: March 2008

The Medieval European Community, by D. J. A. Matthew. Batsford, London, 1977
The European Monetary System and the International Monetary System
Authors: UNGERER HORST
Published: March 2008

The article examines first the European Monetary System (EMS) experience and whether it can be applied to the International Monetary System (IMS). The EMS has particular features: it is not simply a regional Bretton Woods, and it also has a dimension going beyond the monetary field.

Countries participating in the EMS exchange rate mechanism (ERM) have achieved a substantial reduction in exchange rate variability and a high degree of convergence toward cost and price stability. On a worldwide scale, things would be different: general political events have great influence on exchange rates, and large capital shifts are more likely. Whether the same degree of convergence of monetary policies can be achieved worldwide is doubtful. In the absence of a common political interest in integration, short‐term and domestic policy considerations will probably dominate policy decisions.

In the second section the article addresses the relationship between the ERM currencies and the US dollar. There have been suggestions for a ‘common dollar policy’. However, advance agreement on a common policy is difficult to imagine, in view of the differing interests of individual ERM countries, as well as the United States. The main problem for the relationship between ERM currencies, the dollar, the yen, and pound sterling lies in the need for more convergence of developments and compatibility of policies.

The achievements of the EMS do not lead to the conclusion that a system of stabilized exchange rates would work satisfactorily on a worldwide scale. A high degree of policy co‐ordination, not only of monetary policy, but also of other economic policies, would be needed.
The Public Policy Role of the European Investment Bank within the EU
Authors: HONOHAN PATRICK
Published: March 2008

Despite the increasing sophistication of private financial markets in Europe, the European Investment Bank (EIB) has been expanding as never before. Is the Bank just one among many large banks prepared to provide project finance in Europe, or does it have a distinct public policy role? We argue that its main distinguishing role to date has been to bring competition and efficiency to the less efficient banking markets. But new initiatives envisage a move to more EIB involvement in loan guarantees and equity investment. We review the potential here and offer some cautionary remarks.
Norway and Europe: 1972 and Now
Authors: SOGNER INGRID , ARCHER CLIVE
Published: March 2008

The Norwegian electorate's rejection of European Union (EU) membership in November 1994 is seen here in the context of a struggle lasting 30 years or so within that country over its relations with the European integration process. The membership application by Norway to the EU is placed in the context of previous unfulfilled attempts to join the European Communities (EC), especially that terminated by a referendum in 1972. Relations with the EC since then are described, especially their culmination in the European Economic Area (EM) agreement. The negotiations with the EU are covered, as is the 1994 referendum campaign and its outcome. In the end, the 1994 vote, like that in 1972, reopened the old territorial and cultural cleavages in Norway.
International Integration or Internal Politics? Anatomy of a Single Market Measure
Authors: ASPINWALL MARK
Published: March 2008

The question of who is responsible for integrative outcomes has bedevilled scholars since the creation of the European Coal and Steel Community in 1952. Theories of integration from international relations focus on the influence of the state, and how that may be eroded by non‐governmental and supranational actors. Comparatives, on the other hand, have applied lessons from domestic politics to the integration process. This is an attempt to bridge the two through a detailed case study of one Single Market measure: the first stage of a Common Shipping Policy (CSP).

Shipping, while extremely important economically, is a relatively obscure sector politically. Pressure groups, therefore, are important sources of motivation for both Member States and the supranational institutions. A number of independent variables leading to agreement on the policy are spelled out, and a tentative hypothesis is offered to explain the conditions under which interstate cleavages are superseded by inter‐group cleavages, leading to the sort of bargaining one sees in a domestic polity.
Parties at the European Level and the Legitimacy of EU Socio‐Economic Policy
Authors: HIX SIMON
Published: March 2008

Article 138A of the Treaty on European Union envisages ‘parties at the European level’ as integrators in the EU system. However, this conception is unrealistic. Firstly, the relationship between parties and legitimacy in advanced democracies has fundamentally changed. And, secondly, transnational parties are limited by the EU institutional structure and the dominance of national‐territorial interests in EU politics. Accepting these constraints, however, the transnational party federations have begun to focus only on socio‐economic issues, and to compete over the setting of the medium‐term agenda on these questions in the European Council.
The European Union and Forms of State: Westphalian, Regulatory or Post‐Modern?
Authors: Caporaso James A
Published: March 2008

This article sets out to chart the evolving institutional structure of the EU, in the context of theories about forms of state. ‘Forms of state’ are taken to be conceptually possible expressions of political authority organized at the national and transnational levels, here dealt with as emphases and qualities to be accented rather than phenomena to be sorted into categories. The EU is examined in the light of three stylized state forms ‐ the Westphalian state, the regulatory state and the post‐modem state. Each of these captures important elements of the evolution of the EU, and provides support for analysis of its development as a form of ‘international state’. Such an analysis implies attention not only to forms of state, but also to related concepts such as government and governance which give leverage on the exploration of ‘international state forms’. Conclusions are drawn about the power of the three ‘metaphors’ used, and the relationship to possible empirical studies.
The Politics of Identity and Political Order in Europe
Authors: Laffan Brigid
Published: March 2008

This article explores the link between identity, legitimacy and political order in Europe. The central argument is that the politics of identity have enormous salience in the new Europe and for the European Union at this juncture of its development, because the Union is moving from issues of instrumental problem‐solving to fundamental questions about its nature as a part‐formed polity. Problems of identity are raised by the politicization of immigration, the fragmentation of the post‐war order, regionalism, the revival of the ultra Right and the process of European integration itself. The article concludes with an assessment of the affective dimension of integration.
European Security Identities
Authors: Wæver Ole
Published: March 2008

This article undertakes a reading of political identifications in Europe from the security perspective. Who or what exist politically in Europe? This is investigated through the test of whether and how different units are able to carry out the move characteristic of ‘security’: that is, to say ‘our survival is threatened, therefore we have a right to use extraordinary measures against this particular threat’. Europe as an area is marked by a complex presence of different overlapping political subjectivities ‐ security can be carried out most importantly with nation, state, Europe or the environment as referent object. ‘Europe’ itself is a security referent in a truly original way, where integration through a security argument becomes a matter of survival for ‘Europe’. Europe, security, integration and identity have been tied together in a specific narrative. Strikingly, the seemingly purely academic term ‘security identity’ has a political appearance exactly at this intersection.
Tuning the Transport Properties of HIV‐1 Tat Arginine‐Rich Motif in Living Cells
Authors: Cardarelli Francesco , Serresi Michela , Bizzarri Ranieri , Beltram Fabio
Published: March 2008

A large body of work is currently devoted to the rational design of new molecular carriers for the controlled delivery of cargoes (e.g. proteins or nucleic acids) to relevant subcellular domains, particularly the nucleus. In this article, we show that rational mutagenesis of the human immunodeficiency virus type 1 Tat‐derived peptide (YGRKKRRQRRR) affords variants with finely tuned intercompartmental dynamics and controllable transport mechanisms. Our findings are made possible by the demonstration that the Tat peptide possesses two competing functionalities capable of active nuclear targeting and additional binding to intracellular moieties. By altering the competition between these two functions, we show how to control cargo localization of Tat peptide chimeras. Our investigation provides a unified, coherent description of previous conflicting in vivo and in vitro results and lets the true nature of the Tat peptide emerge.
A Conformational Change in the α‐subunit of Coatomer Induced by Ligand Binding to γ‐COP Revealed by Single‐pair FRET
Authors: Langer Julian D. , Roth Christian M. , Béthune Julien , Stoops Emily H. , Brügger Britta , Herten Dirk‐Peter , Wieland Felix T.
Published: March 2008

Formation of transport vesicles involves polymerization of cytoplasmic coat proteins (COP). In COPI vesicle biogenesis, the heptameric complex coatomer is recruited to donor membranes by the interaction of multiple coatomer subunits with the budding machinery. Specific binding to the trunk domain of γ‐COP by the Golgi membrane protein p23 induces a conformational change that causes polymerization of the complex. Using single‐pair fluorescence resonance energy transfer, we find that this conformational change takes place in individual coatomer complexes, independent of each other, and that the conformational rearrangement induced in γ‐COP is transmitted within the complex to its α‐subunit. We suggest that capture of membrane protein machinery triggers cage formation in the COPI system.
Implementation and outcomes of group medical appointments in an outpatient specialty care clinic
Authors: De Vries Beth , Darling‐Fisher Cynthia , Thomas Anne C. , Belanger‐Shugart Elizabeth B.
Published: March 2008

Purpose: To describe the outcomes of a nurse practitioner (NP)‐facilitated group medical appointment (GMA) intervention for chronic obstructive pulmonary disease (COPD) clients in a pulmonary practice in the Midwest.

Data sources: Medical records from a convenience sample of six established pulmonary patients in a Midwest specialty clinic who received care in a group format were retrospectively audited. Outcome measures included examination of changes in the utilization of healthcare services, exercise tolerance, and use of nonpharmacological and pharmacological interventions pre‐ and postparticipation in the GMA program.

Conclusions: NP‐facilitated GMAs are feasible and can help improve health outcomes. Results showed a significant increase in exercise tolerance measured by 6‐min walk distance. Anecdotally, patient and provider response to the GMA was very positive.

Implications for practice: The GMA format is an innovative solution for the management of chronic disease patients that is comprehensive, time efficient, reimbursable, and well suited to NP practice. GMAs can be implemented in most practice settings.
A comparison of microbial growth in alfaxalone, propofol and thiopental
Authors: Strachan F. A. , Mansel J. C. , Clutton R. E.
Published: March 2008

Objectives: To compare the growth of Staphylococcus aureus and Escherichia coli in alfaxalone with that in propofol and thiopental and to evaluate contaminant microbial growth in these agents under two different conditions of storage and handling.

Methods: Known quanta of S aureus and E coli were inoculated into separate 5 ml samples of propofol, thiopental and alfaxalone. Quantitative bacterial analysis was performed at intervals over a 14 day period. Commercial preparations of propofol, thiopental and alfaxalone were stored and handled using “dirty” or “clean” techniques. Microbial quantification and identification was performed over a 14 day period.

Results:
S aureus and E coli grew rapidly in propofol after six hours. Both bacteria were killed by thiopental. S aureus numbers slowly declined in alfaxalone; E coli growth was rapid after 24 hours. In “dirty” and “clean” groups of intravenous anaesthetics, 9·3 and 7·4 per cent of samples, respectively, were positive for microbial growth; none were considered to represent colonisation of bottles.

Clinical Significance: Alfaxalone supports growth of some microorganisms but less readily than propofol. Bacterial colonisation of intravenous anaesthetic bottles is uncommon, but contamination as syringes are prepared for injection occurs regardless of storage and handling technique.
Oral surgical consideration of the aged
Authors: CHOW GERALD
Published: March 2008

This paper won first place in the first annual Arthur Elfenbaum Essay Contest, sponsored by the American Society for Geriatric Dentistry.
Aging—an overview
Authors: Gambert Steven R.
Published: March 2008

Caring for the elderly mandates recognition of their special problems and needs. The health provider must be patient and compassionate when caring for to plan ahead, to become more knowledgeable about all aspects of the elderly, and to work toward ensuring a high quality of life for everyone regardless of age. The elderly, and well versed in the basic principles of aging. Careful consideration must be given to physiological functions, and to the elderly person's psychological and social needs. The demographic imperative we now face embodies the past and future growth of the elderly, the expected change in the percentage of the working elderly, and economic problems that must be solved to provide optimal social and health care services for the elderly. Now is the time
Preventive dentistry for the elderly
Authors: Mandel Irwin D.
Published: March 2008

Preventive dentistry for the elderly must be concerned with the four levels of prevention: initiation of disease, progression and recurrence, loss of function, and loss of life. The areas of greatest pertinence to the elderly are: caries, erosion and abrasion, periodontal disease, special considerations in restorative dentistry, oral cancer, systemic diseases with oral manifestations, and hazards within the dental office.

The major problem in preventive dentistry has been the tendency by many practitioners to view it in a very narrow way, as essentially plaque control. I n many offices it is relegated to a separate alcove, taking on the trappings of a religious rite. To be effective, preventive dentistry has to be the philosophic base of a dental practice. Similarly, dentistry for the elderly should not be considered as the palliative treatment of terminal oral disease. We must recognize that there are a range of clinical entities and multiple levels of prevention as well as treatment. Elderly people have many needS. We have the capability of serving them with an ordered set of responses that recognize both the communality and the special aspects of their oral concerns.
University of Mississippi Dental Care Unit: toothbrushing for the handicapped
Authors: Rommerdale Eric H. , Comer Robert W. , Caughman W. Frank
Published: March 2008

This unit satisfactorily helps to maintain dental health, and also gives the handi‐ capped a sense of independence. This has tremendous psychological value for the individual who may have relied on others to provide routine oral hygiene functions. It may also have therapeutic effects by providing the patient with a useful and important personal task.

Because of special circumstances, certain handicapped individuals must recognize their need for dental health. For the quadriplegic, the mouth assumes the functions of the impaired limbs. For example, the mouthstick and the sip and puff wheelchair are con‐ trolled by the mouth. Therefore, it is important for the quadriplegic to maintain healthy dentition and oral tissue and not compound the problems by also b e coming dentally handicapped.

Until the development of the University of Mississippi Dental Care Unit, the quadriplegic was dependent on others to manage his dental hygiene. Reliance on others is sometimes unsatis‐ factory because of the inconvenience and the inability of one individual to ad‐ equately dean another's teeth. Several the participants in the development of the prototypic unit stated that: “It is very difficult for someone else to do a good job brushing your teeth, and that after using the dentalcareunit, my teeth “felt really clean for the first time since my accident.
SnF2 as an adjunct to toothbrushing in an elderly institutionalized population
Authors: POTTER DALE E. , MANWELL MARY A. , DESS ROBERT , LEVINE ERIC , TINANOFF NORMAN
Published: March 2008

This study examined whether tooth brushing with 0.4% SnF2 gel altered the oral microflora or improved the gingival health of an elderly institutionalized population. The trial included a 2‐week initial preparation period, two sequential experimental periods during which active agent and placebo were “crossed over,” and a 1‐week interim between the experimental periods.
Private practice preventive dentistry for the special patient
Authors: Entwistle Beverly
Published: March 2008

A framework for developing and implementing preventive programs for handicapped persons in clinical settings has been described. The first portion of this framework requires a working knowledge of dental epidemiology in terms of reviewing the literature on disease prevalence in persons with handicapping conditions and collecting clinicai data on individual patients. The second aspect requires integration of clinical and historical assessment procedures into the office routine. After all data are analyzed, an individualized preventive program that is feasible, efficient, and cost‐effective for the patient and the practice can be developed. A knowledge of preventive approaches for individuais with handicapping conditions reported in the dental literature is essential. The final aspect of the framework is program implementation and follow‐up. By using this framework, I believe dental professionals can begin to build a knowledge base about dental disease and appropriate preventive measures for persons with handicapping conditions seeking outpatient dental care. Without this knowledge base, a rational approach to treatment planning will not be forthcoming.
Safety of hospital dental treatment for the high‐risk patient
Authors: SETO BRADLEY G. , LYNCH STEVEN
Published: March 2008

A total of 100 hospital dental cases were reviewed. No significant long‐term complications were seen that resulted from the anesthesia or operative procedures. Most of the minor postoperative changes that we saw were related to the operative procedures. In this study, few minor changes could be related to the anesthesia techniques or duration of the surgery. This is probably related to optimizing preoperative health and proper intra‐ and postoperative care. However, the results could also be related to the age of our patients, because younger age groups are less likely to have postoperative complications. Despite the potentially high‐risk patient population, dental treatment in the hospital environment is a safe procedure.
The dental hygienist as dental care advocate for persons with disabilities
Authors: LANCIAL LYNETTE A.
Published: March 2008

Although there is a trend towards reduction in the severity of dental disease in persons with disabilities, gaps in the provision of dental services remain. As an advocate of dental care for persons with disabilities, the dental hygienist can personalize the provision of dental services and assist in removing barriers to care. Currently, hygienists function as dental advocates in primary, secondary, and tertiary care settings to various degrees. However, the impact they have is affected by a number of factors, including limited numbers of trained personnel, lack of dental awareness of the public and other health professionals, and access issues such as the cost of dental services, transportation difficulties, and the poor design of office buildings and dental offices. As the dental needs of underserved individuals are increasingly emphasized, it should be expected that educational institutions will prepare more dental hygienists to serve persons with disabilities. This emphasis and the efforts of dental hygienist advocates currently working with other health service providers, health planners, legislators, and health financiers may help persons with disabilities receive needed dental services.
Mitral valve prolapse: a significant cardiac defect in the development of infective endocarditis
Authors: KERPEN STEVEN J. , KERPEN HOWARD O. , SACHS STEPHEN A.
Published: March 2008

Because mitral valve prolapse is relatively common, and can underlie the development of infective endocarditis, it is important for the dental practitioner to understand and recognize the signs and symptoms of this condition. Dental treatment for a patient who is suspected of having MVP should be delayed until the patient has been medically evaluated. To avoid bacteremia and the development of endocarditis, antibiotic prophylaxis is mandatory for patients who have been diagnosed as having MVP.
Cost containment: is hospital‐based dentistry affected?
Authors: Ostenberg Paul R. Van
Published: March 2008

Cost containment, watchwords of the 80s, has resulted in an alphabet soup of alternatives: HMOs, PPOs, and DRGs. According to the three hospital administrators who participated in this Special Concern, cost containment, and traditional sources of reimbursement for hospital‐based dental care, will require hospital dental administrators to become financial managers as well as clinicians.

The administrators believe that hospital dental departments can become and remain financially viable if they rethink the types of services offered, the settings in which these services are provided, and patient mix.

Finally, the question of whether different payment systems will affect rationing or quality of care is addressed from three different viewpoints.
Pretreatment for the cardiovascularly compromised geriatric dental patient: Geriatric Dentistry
Authors: MULLIGAN ROSEANN
Published: March 2008

As more elderly patients seek dental care, dentists will increasingly be confronted with growing numbers of ill patients on multiple medication regimes. Because cardiovascular disease is the largest disease entity in this age group and the greatest cause of morbidity and mortality, this paper has focused on the major types of cardiovascular disease, and the cardiac medications routinely prescribed. Possible interactions with dental procedures or medications and alternative dental treatments and medications are discussed. The need for the dentist to continually assess the stability of the patient's health and compliance with his or her prescribed treatment regimen is stressed, because through an awareness of the patient's medical status and level of compliance the dentist can determine a course of dental treatment that will not jeopardize the geriatric patient's already compromised cardiovascular health.
The long‐term effect of mouthsticks on periodontal support
Authors: RODEGHERO PAUL , CLAMAN LEWIS , CELLIER STEPHEN , LOTZ J. WENDELL
Published: March 2008

After reviewing the records for two patients, using the 15 guidelines listed earlier, there was no obvious evidence of primary trauma from occlusion caused by an oral orthosis during 13 years of use. The patients were able to maintain good oral hygiene with the help of attendants and the recall system at the Ohio State Dental Clinic. The absence of secondary occlusal trauma can possibly be attributed to this lack of significant attachment loss. It is, therefore, our opinion that a properly fitted occlusal orthosis, together with proper home care, has the capacity of producing no deleterious effects on the periodontium, teeth, and the associated musculoskeletal system over an extended period.
The changing institutions
Authors: CASAMASSIMO PAUL S.
Published: March 2008

Public and professional interest in community‐based care for persons with handicapping conditions seems to have reached equilibrium, and the new problems faced by those who provide institutional dental care should be scrutinized.
Fiber optics in dentistry for the homebound
Authors: OLSEN RICHARD A. , WEISS LEONARD P. , CARLSON MARILYN R.
Published: March 2008

Adequate intraoral illumination has remained one of the major obstacles in providing high‐quality care in nontraditional settings. After trying to adapt various light sources, we found that a portable fiberoptic light unit meets our criteria. An added benefit not initially considered is the ability to use the light to cure composite resin materials. The fiberoptic unit has been an excellent addition to our dental home care program.
Gerodontics: an epidemiologic perspective
Authors: MERSEL A. , BERENHOLC R. H. , FIEZ‐VANDAL A.
Published: March 2008

A review of current epidemiologic data provides an overview of the dental status of older adults.
Dental diagnosis and treatment for musicians
Authors: PRENSKY H. DAVID , SHAPIRO GERALD I. , SILVERMAN SIDNEY I.
Published: March 2008

Oral health maintenance for the musical performer is an essential component of the training and experience. Normal tooth and dental arch development permit vocalists. and players of wind instruments and chin‐held wind instruments to achieve their optimum acoustic and esthetic musical performance. Dental disease or disorders that high‐quality performance years of vocalists and instrumentalists.
The dental management of patients with schizophrenia
Authors: FRIEDLANDER ARTHUR H. , BRILL NORMAN Q.
Published: March 2008

A significant portion of the US population has been diagnosed as having schizophrenia. Within this report, the psychopathology of the disorder and the American Psychiatric Association's diagnostic criteria for schizophrenia are reviewed. The medical/pharmacological methods of treatment and the interrelationship between the disease process, the medical therapy, and the incidence of dental disease are described; the appropriate nomenclature can help the dentist obtain meaningful consultative advice. Necessary precautions must be taken when an individual, who is receiving certain psychotropic drugs, is to receive dental treatment.
Dental office access for patients with disabling conditions
Authors: BILL DANIEL J. , WEDDELL JAMES A.
Published: March 2008

Today's professional health care centers are becoming more accessible to patients with handicapping conditions each year. The increase in numbers of these persons in society, along with their desire to be treated locally, will result in a much higher influx of persons with disabling conditions seeking professional services. Dental professionals should be aware and make appropriate responses to the needs of these special patients. State codes for facilities access vary widely, but are clearly becoming more defined as federal legislation and federal regulations continue to support the rights of persons with disabling conditions to access work, study, leisure, and services.

The dental profession has an opportunity to demonstrate leadership in handicapped access in both the private and public professional sectors without direct governmental mandates. The American Dental Association and constituent state associations can further accomplish this by setting accessibility guidelines for the dental environment.

Dr. Bill is executive director. Northeastern Center. Inc. Kendallville, IN, and is a consultant in the field of handicapped accessibility planning. Dr. Weddell is associate professor, pediatric dentistry; director, dental services. James Whitcomb Riley Children's Hospital; and is in private practice, pediatric dentistry, Indianapolis. Address requests for reprints to Dr. Bill, 815 Elmwood Circle, Noblesville, IN 40660.
Phenytoin‐induced gingival hyperplasia of edentulous spaces: a case report
Authors: POPPELL TIMOTHY D. , COLLINS J. FRANK
Published: March 2008

This case report shows that phenytoin‐induced gingival hyperplasia can occur in edentulous spaces within a dentulous arch. The hyperplasia may occur after removal of the teeth in a segment of the arch or it may not resolve following tooth extraction. Careful consideration must be given to these areas if prosthodontic replacement is planned.
Dental sequelae of chronic rumination: report of cases
Authors: BURTNER A. PAUL , POPPELL TIMOTHY D.
Published: March 2008

Rumination is a maladaptive behavior most commonly found in individuals with mentally handicapping conditions who live in long‐term care facilities. Chronic rumination can have severe medical and dental sequelae. Treatment of dental sequelae of chronic rumination is discussed. Two case reports are presented.
Oral treatment needs for patients requiring heart surgery
Authors: GARFUNKEL ADI A. , MASSOT SHMUEL , GALILI DAN
Published: March 2008

A study based on a group of 184 patients was conducted to evaluate the needs for dental treatment for patients requiring heart surgery. Acquired cardiac disease was more common in the adult population, whereas congenital heart conditions were more common in the young group. A positive history of infectious endocarditis was detected in 16% of the Jewish group, but in only 8% of the Arab population. The extent of dental disease showed a significant difference between the groups with or without infectious endocarditis, 84% compared with 77.4% had dental disease per se. Periodontal disease was shown in 80% of the patients with a positive history of infectious endocarditis, but in only 53% among the patients with a negative history of infectious endocarditis. Dental treatments given to our patients followed prophylactic administration of antibiotics according to the AHA recommendations.

The importance of special programs designed for treating patients before heart surgery was discussed and the need for hospital‐based dental departments was suggested.
Treatment planning considerations for the patient with developmentally disabling conditions
Authors: WOEHRLEN ARTHUR E. , SIKORA GERALD J.
Published: March 2008

Treatment of patients with developmentally disabling conditions presents significant problems to the general practitioner. Oral and intravenous sedation techniques are often adequate to control the behavior of these individuals. General anesthesia provides a safe and convenient aid. Contemporary guidelines are presented to help the dentist manage these special patients.
Duchenne muscular dystrophy: a report of case
Authors: PETTY TREY L. , CRESPI PAUL
Published: March 2008

Duchenne muscular dystrophy is a debilitating disease that includes significant medically and physically disabling conditions that have an effect on the dental treatment of these patients. The dental treatment considerations for the patient with Duchenne muscular dystrophy include: the current status of the disease; the progressive nature of the disease; lack of ambulation; poor muscular control and muscle weakness; muscle contractures; respiratory and cardiac complications; relative contraindication of general anesthesia; and the oral health needs of the patient. In the case reported, these problems were considered and appropriate treatment modalities selected. With appropriate medical consultation and ample consideration of the patient's physically disabling conditions, dental therapy can be modified to provide a satisfactory level of oral health for the patient with Duchenne muscular dystrophy.
Multidisciplinary treatment of a young child with hypohidrotic ectodermal dysplasia
Authors: WAGGONER WILLIAM F.
Published: March 2008

A clinical report of case of a young child with hypohidrotic ectodermal dysplasia with unusual radiographic findings is presented. Permanent first molar buds are seen developing in an arch that shows anodontia of all primary and permanent teeth. The multidisciplinary treatment involving esthetic restructuring of teeth, orthodontic movement of primary teeth, and complete and partial removable prosthodontics is discussed. Phased treatment began when the child was 20 months old and dentures were constructed and placed when the child was 38 months old. Successes and limitations of treatment administered at this age are reviewed.