bluuebunny/crossref_metadata_2025 huggingface dataset:
U.S. press: bright new dawn
Authors: Downie Leonard
Published: September 2008

The outgoing executive editor of the Washington Post predicts a bright future for United States newspapers, writing: "The future of newspaper newsrooms is especially important to the future of accountability journalism in the United States because they still produce the most original reporting, compared to stand-alone websites, local television stations or even the big broadcast and cable networks. But they also must cope with high fixed costs of production and distribution of printed newspapers. How they restructure their economic models, take better advantage of the internet and define their public service missions in a time of enormous stress will determine the future of the accountability journalism that is so important in a representative democracy."
Crisis? What crisis? But it's great TV
Authors: Wilson Michael
Published: September 2008

Sky TV business and economics editor Wilson writes that City commentators may have no idea what's going on, or when it will end, but the credit crunch has brought a new element to television coverage: pictures. "But suddenly, for once, here was the real thing - anxious punters queuing around the block to get their money out of Northern Rock. This was not supposed to happen. But it was happening, not in a banana republic but in a leading industrialised country whose administration had been selling the "financial stability" story for ten years. This was in a town near you. The story had marched right in through the front door, to you and your family. And that really is the nub of the whole affair. A year ago the credit crisis was still very much business-page material, mere back-of-the-book stuff. The journalistic task, then, was to find the first indicators that a financial problem had spilled into the real economy. Well, we found them."
Positive Psychology
Authors: Becker Dana , Marecek Jeanne
Published: September 2008

Positive psychology has figured itself as no less than a revolutionary reorientation of psychology, one that makes individual `flourishing' the primary object of study and intervention. There are clear comparisons to be made between this movement and earlier ones that have embraced both individualism and an ethos of adjustment, such as the popular mind cures of the late 19th century and the influential mental hygiene movement of the early 20th century. We argue for a focus beyond the individual in isolation, a perspective that takes in the totality of the social environment and an ethical stance that values social engagement and activism. We further call for more nuanced conceptions of happiness, virtue, and strengths, as well as for more socially informed theorizing about human flourishing. Finally, we suggest that positive psychology, with its growing assortment of applied uses, serves to address the acute market pressures facing clinical psychologists today.
Positive Psychology and Philosophy of Social Science
Authors: Richardson Frank C. , Guignon Charles B.
Published: September 2008

Many of the shortcomings of `positive psychology' seem to stem from its unreflectively perpetuating key assumptions of the very mainstream social science it censures for being too `negative.' Philosophical hermeneutics and related social theory perspectives allow us to identify and critically examine such assumptions, including a one-sided individualism and narrow instrumentalism. Hermeneutics allows us to make sense of the `disguised ideology' that imbues positive psychology and much modern social science, suggests that social inquiry is best seen as a kind of dialogic understanding, and may allow us to take the measure of deep human limitations without falling into cynicism or despair.
From Continence to Virtue
Authors: Fowers Blaine J.
Published: September 2008

Character is central to positive psychology's efforts to understand and promote human flourishing. Despite the importance of character and ubiquitous references to Aristotle, virtue theory remains underdeveloped in positive psychology. This article elaborates three key aspects of virtue ethics for understanding flourishing: goodness, the unity of character, and character types. Positive psychologists have not developed a substantial concept of what is good, which is essential because virtues are defined as the enduring personal qualities necessary for pursuing particular goods. Positive psychologists present virtue in a fragmented manner, focusing on a few `signature strengths,' whereas virtue ethicists generally emphasize the unity of character and the development of a full range of virtues. Because positive psychologists have not recognized the four character types in addition to virtuous character, they often misconstrue the continent character as virtuous, and many of their descriptors of the good life do not differentiate well between the virtuous and the vicious character types.
Disclosure and Truth in Physician–Patient Communication An Exploratory Analysis in Argentina, Brazil, India and the United States
Authors: Torres Maria Beatriz , Rao Nagesh
Published: September 2008

This article is the result of exploratory research on the communication/relationship between physicians and patients conducted in Argentina, Brazil, India and the United States. The study sheds light on the different strategies, 109 physicians from these four countries use when they tell a patient that s/he has leukaemia. Results from the United States suggest that the American physicians, on an average, tend to tell patients directly and explicitly that s/he has leukemia. In Argentina, Brazil and India, however, data indicate that physicians tend to share the same news with a patient in small doses over time and/or tell a family member before telling the patient. A physician in Brazil referred to this strategy as using ‘halftruths’ strategies when communicating bad news to their patients. The notion of ‘truth’ in physician– patient interaction is analyzed in this article focusing on disclosure, deception, legal, ethical and cultural implications to the topic.
Democracy and Policy Games The New Information Panchayats
Authors: Singh Ranjit , Atluri Ravi Kiran
Published: September 2008

This article attempts at creating ways of contextualizing and visualizing the statistical information such as the census and surveys conducted by Bhasha, an Non-Governmental Organization (NGO) working in the tribal belt of Gujarat to construct a critique on the policy making processes. Looking at policy making processes as the methodologies that are used while deciding the relevant measures to be taken for policy formulation and implementation, one will have to try to elaborate on a set of cause and effect modules to determine the reasoning behind the decisions that are made. The reciprocity of these modules will eventually try to bring out the interconnectivity of the cause and effect of policy making. Working with the tabular construct of statistical information, one will initially try to visualize this information for the purpose of drawing inferences out of the data. Once the visualization part has been accomplished, one could proceed towards effective contextualization of these inferences to create a critique on the indices of the Quality of Life (QoL) of the people. These indices would then create the necessary context within which the policy directives could be constructed. It is the transformation of information from the statistical construct to a visual one that could enable broader participation of people in policy making. Looking at the changes in these visualizations in time would warrant a critique on the cause and effect model of policy directives. At the foundational level, the entire process is an exercise in understanding effective ways of communicating the necessity for change and tracing it within the domain of policy making.
Emerging Victorious Against an Outbreak
Authors: Karan Kavita , Aileen Lee , Leng Elaine Pong Yin
Published: September 2008

The emergence of new infectious diseases and the increased emphasis on prevention have expanded the role of communication as a vital component of public health practice. This study examines the integrated crisis management approach, the coverage given by the media, the models of health communication used in dealing with the health crisis as well as the control and preventive measures used in creating awareness and socially responsible behaviour. The study employs the case study, content analysis and survey approaches to investigate these issues. The success of the Singapore Government in battling Severe Acute Respiratory Syndrome (SARS) is an example of an effective integrated crisis management approach in dealing with national crises which can be emulated in other countries. In the wake of recent natural disasters and spread of diseases world over, this model of health management can be usefully adapted by other countries as their systematic approach to reduce uncertainties and better manage crises.
Metastasis of Malignant Peritoneal Epithelioid Mesothelioma in Endoscopic Gastric Biopsy: A Diagnostic Pitfall
Authors: Daniele Lorenzo , Righi Alberto , Ferraris Andrea , Macrì Luigia , Asioli Sofia
Published: September 2008

Aim To describe a case of metastasis of malignant peritoneal epithelioid mesothelioma in gastric antral mucosa in a patient with a cryptogenic liver cirrhosis associated with esophageal varices, abdominal pain and distension, ascites, and weight loss. Materials and method The patient underwent esophageal gastric endoscopy for varices, and a biopsy of a polypoid antral lesion was performed. The latter revealed a proliferation of polygonal cells with moderately atypical nuclei and pale eosinophilic, peripherally condensed cytoplasm infiltrating into the lamina propria between the normal mucosal glands of the antrum. The tumor cells were diffusely positive to anticalretinin antibody, whereas anti—claudin 4 and anti-CEA antisera were negative. Conclusions Metastases of malignant peritoneal mesotheliomas are unusual, and a predominantly gastrointestinal localization is rare. Pathologists should be aware of this possibility to avoid misdiagnosis, particularly in small biopsy specimens.
Caseworker Judgments and Substantiation
Authors: Cross Theodore P. , Casanueva Cecilia
Published: September 2008

Substantiation can have an important effect on what interventions are pursued for children investigated for maltreatment, but researchers lack knowledge about how the decision to substantiate is made. Using information from 4,515 children from a national probability study of children investigated for maltreatment, this study examined how caseworker judgments of harm, risk, and evidence predicted substantiation. The substantiation rate was 29.9%, but the majority of cases were substantiated when caseworkers reported at least moderate harm, at least moderate risk, and/or probably to clearly sufficient evidence. Each judgment variable significantly predicted substantiation in a multivariable model, with evidence the strongest predictor. Child gender and age were significant predictors beyond harm, risk, and evidence, suggesting that other judgments also influence substantiation. In 9 of 100 cases, reports were not substantiated despite moderate to severe harm. Thus, substantiation is generally based on judgments of harm, risk, and evidence but not exclusively. The findings underline previous researchers' conclusions that substantiation is a flawed measure of child maltreatment and suggest that policy and practice related to substantiation are due for a fresh appraisal by state child welfare service agencies.
Bioactive Compounds and Antioxidant Capacity of Exotic Fruits and Commercial Frozen Pulps from Brazil
Authors: Genovese M.I. , Da Silva Pinto M. , De Souza Schmidt Gonçalves A.E. , Lajolo F.M.
Published: September 2008

The objective of this work was to characterize exotic fruits (cambuci, araça-boi, camu-camu, jaracatia, araça) and commercial frozen pulps (araça, cambuci, umbu, coquinho, pana, native passion fruit, cagaita) from Brazil in relation to their bioactive compounds contents and antioxidant capacity. Camu-camu (Myrciaria dubia) presented the highest vitamin C and total phenolics contents (397 and 1797 mg/100 gf.w., respectively) and the highest DPPH• scavenging capacity. Coquinho (Butia capitata) also showed a significant vitamin C content (43 mg/100 gf.w.). Among the commercial frozen pulps, cagaita presented the higher DPPH scavenging activity and inhibition of β-carotene bleaching. A good correlation between total phenols and DPPH scavenging activity was found for fruits (r = 0.997) and commercial frozen pulps (r = 0.738). However, no correlation was found for total phenols and inhibition of β-carotene bleaching. Quercetin and kaempferol derivatives were the main flavonoids present in all samples and cyanidin derivatives were detected only in camu-camu. Camu-camu and araça (Psidium guineensis) showed the highest total ellagic acid contents (48 and 63.5 mg/100 gf.w.). All commercial frozen pulps presented lower contents of bioactive compounds and antioxidant capacity than their respective fruits. According to our results, camu-camu and araça might be sources of bioactive compounds.
Impingement Cooking of Meat Products: Effect of Variability on Final Temperature
Authors: Cronin K. , Caro-Corrales J. , Tobin J. , Kerry J.
Published: September 2008

Heat transfer coefficient (HTC) for chicken fillets and beef burgers were determined at a number of product-to-tube distances in an impingement air unit. The coefficient varied from < 100 W/m2 K to over 200 W/m2 K depending on the input parameter settings. The level of variation in the coefficient between adjacent product items in the oven has been quantified as ±20 W/m 2 K. Models of sheat transfer for both food products have been developed. Parameter of the models indicated that depending on the product, either dimensional variation in the product or dispersion in the HTC between products can make the dominant contribution to dispersion in final product temperature.
Immobilization of Endoproteases from Crude Extract of Cynara cardunculus L. Flowers
Authors: Sales-Gomes M. , Lima-Costa M.E.
Published: September 2008

The cardoon (Cynara cardunculus L.) is a variety of thistle which grows wild and abundantly in uncultivated areas of many regions of Portugal. Its dried flowers are used as a milk coagulant in the manufacture of traditional cheeses, due to its high content in aspartic proteases, namely cardosins A and B. In general, proteases can be immobilized without significant loss of their catalytic activity and their use as milk coagulant offers several advantages over their soluble counterparts, namely simplified protocols, long term stability of the coagulant and successful reutilization. Since proteases are often expensive, especially at high degrees of purity, immobilization may increase their industrial applicability. In this work, aqueous extracts of cardoon were immobilized on celite by adsorption. The properties of free and immobilized extracts from cardoon (kinetic parameters, pH effects, activation energy, ionic effects, clotting time) were compared. Optima pH and temperature were 5.0 and 60 °C, respectively, for extracts in both forms. Upon immobilization, a 60—70% loss of enzyme activity, as well as a decrease in the specificity constants (up to 90%) were observed. Immobilized biocatalyst was evaluated for bovine and caprine caseins, at a laboratory scale, showing a higher specificity towards the latter.
Inter-laboratory Trial to Validate the Direct Solvent Extraction Method for the Identification of 2-dodecylcyclobutanone in Irradiated Chicken and Whole Liquid Egg
Authors: Tewfik I.
Published: September 2008

The main objective of this interlaboratory trial was to assess the qualitative performance of new rapid direct solvent extraction (DSE) method as potential detection method to differentiate between irradiated and unirradiated food samples. The trial was designed and carried out between four European laboratories that agreed to use 2-dodecylcyclobutanone (DCB) as radiolytic marker to detect irradiated minced chicken and liquid whole egg. Chicken samples were irradiated at 3 and 7 kGys while egg samples were irradiated at 3 and 6 kGys. Every laboratory had received 12-blind coded `unknown' and 4-known coded samples to be analyzed. All four laboratories were able to correctly identify all 12-blind coded samples as either irradiated (at medium and/or high doses) or unirradiated samples. The tested DSE method is regarded as fast, cheap, suitable and recommended for use in laboratories which are involved in screening large number of food samples for irradiation.
Moving in transition
Authors: Cairns David
Published: September 2008

This article explores the geographical mobility of young people in Northern Ireland. Utilizing the results of recent empirical research conducted with a sample of university students drawn from four different academic disciplines, an overview is presented of mobility experiences in terms of where these young people are going, their main reasons for travel and the main characteristics of mobile youth. Indications of future mobility intentions are also explored, revealing that a majority of these young people (55 per cent) have intentions to live outside Northern Ireland at some stage in the future. The various forms of travel and the significance of these mobility experiences are subsequently discussed in more depth through the use of emblematic case studies, highlighting the importance of mobility in both the education-to-work transition and personal development.
The socialization of hierarchic self-interest
Authors: Hadjar Andreas , Baier Dirk , Boehnke Klaus
Published: September 2008

The article reports research on family socialization of dominance values among adolescents. Dominance values were studied as expressed in Hierarchic Self-Interest (HSI), a value pattern that is typical for highly competitive market-oriented societies and has negative behavioural consequences. In analyzing socialization, the study concentrates on authoritarian and achievement-focused parenting, as well as structural and ideological predictors thereof. The relevance of HSI for attitudes and behaviours is studied by considering xenophobia and delinquency as its consequences. Using panel data of 443 families (mothers, fathers, and adolescent offspring) from Berlin (Germany), a structural equation model is estimated. Results show that adolescent HSI can be traced back to social-structural variables and parenting modes, but also develops through intergenerational value transmission. It has assumed negative consequences.
Young Estonians and Danes as online shoppers
Authors: Raamat Reelika , Keller Margit , Martensen Anne , Tufte Birgitte
Published: September 2008

In this study, interpretations of young Danes’ and Estonians’ online shopping are compared based on interviews with 23 Danes and 24 Estonians aged 12–18 years. The findings show that young Danes are more familiar with online shopping and buying, and view it more positively than do young Estonians. This is well reflected by the fact that Estonians focus mainly on the risks of online shopping, expressing various forms of distrust, while young Danes tend to emphasize benefits. Yet, both countries’ respondents show more confidence in regular shops with face-to-face contact than in online stores which are considered to be abstract and disembedded. Differences in representations of online shopping are related to a complex set of system and agential resources: different cultural contexts, institutional and economic factors, and social networks.
Youth cultural styles
Authors: Wel Frits Van , Maarsingh Willemijn , Bogt Tom Ter , Raaijmakers Quinten
Published: September 2008

This research examines whether opposition between higher and lower forms of youth culture still contributes to the emergence of groups with different cultural tastes. Do youth at higher levels of secondary education (for example, pre-university education) tend to display ‘omnivorous’ tastes nowadays (Peterson, 1992), just as highly educated adults do? A sample of Dutch adolescents (N = 226) completed a questionnaire concerning their preferences in several cultural domains (music, film and television, light reading and literature, receptive cultural participation). Four groups or clusters representing cultural styles were identified: omnivores, moderate omnivores, a group interested primarily in popular culture, and a culturally disinterested group; each group comprised about a quarter of the sample. Whereas girls were overrepresented in the first two groups, boys were more common in the latter two groups. The two groups with omnivorous tastes appear to fit the profile of ‘normal’ youth. Otherwise, the four cultural groups could not be linked to specific youth subcultures.
Quiet contradictions of celebrity
Authors: Dauncey Hugh , Morrey Douglas
Published: September 2008

A B S T R A C T • The French soccer-player Zinedine Zidane is an emblematic sport star whose celebrity persona nevertheless remains opaque and open to debate. As a French citizen of Algerian origin, Zidane has come to embody many current French concerns over the integration of ethnic minorities and has, particularly since the World Cup Finals of 1998 and 2006, been subjected to intense scrutiny and interpretation. Despite such attention, however, he remains quietly inscrutable, the contradicting claims on his identity and celebrity persona compounding his own lack of self-reflection in a complex negotiation of significance. Assessing Zidane through the interlinkages of his hybrid identity, ethnicity, masculinity, morality and nationality reveals how he and his celebrity persona struggle to establish coherent or consistent meaning, and an analysis of his high-cultural representation in two recent French art-works throws light on how his sometimes violent behaviour in soccer and his emblematic celebrity ultimately interrogate causality and agency, as well as the sociocultural significance of sport stars. •
Elizabeth Garrett Anderson and the professionalism of medical publicity
Authors: Brock Claire
Published: September 2008

A B S T R A C T • This article examines how early women doctors managed their professional and public images in the second half of the nineteenth century through a case study of the career of the first medical woman to qualify in Britain: Elizabeth Garrett Anderson (1836—1917). In fighting for their cause, Victorian women doctors had to negotiate the medical profession's disdain for what it considered 'unprofessional advertising', which it aligned with quackery, while, at the same time, attempting to publicize the medical women's movement to the wider world. Through close analysis of Garrett Anderson's public image and private correspondence, I argue that she achieved medical fame through the careful maintenance both of public confidence and professional respect, promoting her cause through a subtle sleight-of-hand. While Elizabeth Garrett Anderson appeared, on the surface, to subvert her sex beneath her profession, in doing so she in fact emphasized simultaneously the right of women to a professional occupation and corresponding renown. •
Lord Byron and the end of fame
Authors: Mole Tom
Published: September 2008

A B S T R A C T • This article sketches a theory of celebrity culture that relies on taking a longer view of its history than has been customary in Cultural Studies. While a number of cultural theorists have analysed contemporary celebrity, and a number of film historians have connected the cultural history of celebrity to the rise of modern cinema, this essay suggests that modern celebrity culture has its roots in the late eighteenth- and early nineteenth-century industrialization of print. It argues that a celebrity's branded identity circulates so extensively in part because it can be appropriated so easily. In order to trace in greater detail the processes of appropriation that drive celebrity culture, the essay takes the reception of Lord Byron (1788—1824) as a case study. The article surveys a number of nineteenth-century commentators who predicted that Byron's work would be unread after his death. It examines in detail the posthumous reprinting of one stanza from Byron's poem Childe Harold in travel guides, school anthologies and elocution manuals, showing how some fragments of Byron's writing were given renewed currency, in part, by becoming embedded in new contexts and refitted for new ideological purposes. It suggests that by understanding the infrastructure of citation, appropriation and redeployment that can turn celebrities from earlier ages into canonical figures for later ones, we can grasp how their original celebrity becomes obscured, and with it the long history of celebrity culture, which seems perpetually to be a recent innovation.
Ethics policy as audit in Canadian clinical settings: exiling the ethnographic method
Authors: Gotlib Conn Lesley
Published: September 2008

In the 1990s, institutional research ethics boards (REBs) impacted the relationship between researchers and their participants by formalizing the ethics requirements to conduct research involving human subjects. While exceptions are made in some ethics policies for research that crosses international borders — for example, where obtaining written consent is not culturally acceptable — there are no such exceptions for research that crosses interdisciplinary domains. Consequently, when conducting anthropological fieldwork in a Canadian clinical setting, the requirements of the standardized ethics policy proves to mesh poorly with the ethnographic and general anthropological approach to research, distorting the process and meaning of obtaining informant consent in the anthropological sense. This article documents one neophyte ethnographer's complicated journey into the land of the REB, raising some important questions about the audit-type nature of the ethics review process and the potential exile of ethnography that may result.
Predicting Hand Motor Recovery in Severe Stroke: The Role of Motor Evoked Potentials in Relation to Early Clinical Assessment
Authors: van Kuijk Annette A. , Pasman Jaco W. , Hendricks Henk T. , Zwarts Machiel J. , Geurts Alexander C. H.
Published: September 2008

Objective. The primary aim of this study was to compare the predictive value of motor evoked potentials (MEPs) and early clinical assessment with regard to long-term hand motor recovery in patients with profound hemiplegia after stroke. Methods. The sample was an inception cohort of 39 stroke patients with an acute, ischemic, supratentorial stroke and an initial upper-extremity paralysis admitted to an academic hospital. Hand motor function recovery was defined at 26 weeks poststroke as a Fugl–Meyer Motor Assessment (FMA) hand score >3 points. The following prognostic factors were compared at week 1 and week 3 poststroke: motor functions as assessed by the FMA upper-extremity and lower-extremity subscores, and the presence of an MEP in the abductor digiti minimi and biceps brachii muscle. Results. Both the presence of an abductor digiti minimi–MEP and any motor recovery in the FMA upper-extremity subscore showed a positive predictive value of 1.00 at weeks 1 and 3. The FMA lower-extremity subscore showed the best negative predictive value (0.90; 95% CI 0.78-1.00 at week 1 and 0.95; 95% CI 0.87-1.00 at week 3). Conclusions. In stroke patients with an initial paralysis of the upper extremity the presence or absence of an MEP has similar predictive value compared with early clinical assessment with regard to long-term hand motor recovery.
Letter to (Fellow) Young Doctors: More Kairos With Less Chronos
Authors: Cunningham Steven C. , Sutton Erica R. H.
Published: September 2008

Current restrictions on work hours have presented residents with a dilemma: how to derive the same or improved surgical experience and expertise but with less time to do so? The answer clearly must include an increase in efficiency, defined here simply as doing more with less time. Ancient Greek distinguished 2 words for time: chronos, chronological, linear, quantitative time as measured by clocks and calendars; and kairos: qualitative time, time in relation to human activity, a moment of indeterminate duration in which something happens. Our goal as residents should be to gain more kairos given limited chronos. Here we review various tools, both concrete and abstract, useful to maximize efficiency and effectiveness in surgical education. We suggest that residents equipped with adequate tools should be able to benefit from more kairos.
Perceived control moderated the self-efficacy-enhancing effects of a chronic illness self-management intervention
Authors: Jerant Anthony , Moore Monique , Lorig Kate , Franks Peter
Published: September 2008

Objective: Identifying moderators of the effects of self-efficacy-enhancing interventions could improve their efficiency. We examined the effects of a home-based variant of the Chronic Disease Self-Management Program on self-efficacy, and explored the moderating effects of perceived control over self-management (PCSM).

Methods: In a randomized controlled trial, patients ( N= 415) aged>40 years with various chronic conditions plus basic activity impairment and/or significant depressive symptoms were randomized to one of three groups: intervention provided in homes or by telephone, v. usual care control. We used mixed effects linear models for repeated measures to examine effects on self-management self-efficacy at 6-month follow-up and explore moderation by PCSM.

Results: Only the home intervention had a significant self-efficacy-enhancing effect (Wald test, χ 2 = 13.8, p = 0.008; effect size = 0.3). The effect was moderated by PCSM, considered as a continuous [effective in subjects with lower PCSM (Wald test, χ2 = 13.4, p = 0.009)] or categorical (effective only for subjects in the lowest tercile) variable.

Conclusions: People with lower PCSM appear more likely to experience enhanced self-efficacy from chronic illness self-management training than those with higher PCSM. These findings, although preliminary, suggest that office-based measurement of PCSM might identify those chronically ill patients likely to benefit most from self-management training.
Limited stair-climbing ability and weight control in family medicine patients
Authors: Rohrer James E. , Barnes Darryl E. , Adamson Steven C. , Altrichter Paul M. , Yapuncich Victor P.
Published: September 2008

Objective: To assess the association between self-assessed stair-climbing limitation and weight control among family medicine patients, after adjustment for age, gender, marital status, body mass index (BMI), and co-morbidity.

Methods: This study was a retrospective analysis of a cohort of 840 adult family medicine patient records drawn from a large family medicine department in Rochester, Minnesota. Weight control was measured as no change or decline in BMI over approximately 1 year.

Results: Adjusting for co-morbidity and other confounders using multiple logistic regression analysis revealed that limited stair-climbing ability was unrelated to weight control over approximately 1 year. Instead, patients with BMI ≥ 30 were more likely to control their weight (p<0.01), and age exhibited a non-linear relationship with weight control. The odds of weight control were lower for patients between the ages of 36 and 45 years than for those aged 18—35 years (p<0.01).

Conclusions: In our sample of family medicine patients, self-assessed stair-climbing limitations did not preclude weight control. Weight gain prevention programmes might be targeted at patients who are entering middle age.
Adaptive coping with rheumatoid arthritis: the transforming nature of response shift
Authors: Sinclair Vaughn G. , Blackburn Donna S.
Published: September 2008

Objective: Qualitative investigations of patients' perspectives of coping can offer insights into a wide array of adaptive coping patterns selectively used to deal with illness-related challenges. The purpose of this qualitative study was to examine adaptive coping patterns reported by a sample of women with rheumatoid arthritis (RA).

Methods: Using thematic analysis, interviews from 19 participants were analysed until theoretical saturation was achieved. The interviews were coded, with narrative excerpts collated within each code, sorted by codes into potential themes, and then collated within identified themes. These themes were then further defined, providing specific adaptive coping strategies for each major theme.

Results: Major themes included accepting role limitations, reclaiming control, reframing their situation, and bolstering courage. Women described accepting more realistic performance standards, accepting their limitations and dependence on others, and altering their basis of self-worth. They reclaimed control of their lives by changing priorities, pacing themselves, being flexible, delegating to others, and setting appropriate boundaries. Reframing their situation enabled them to change their perspective, minimize threats from RA, re-prioritize their values, and find meaning and positive changes associated with their suffering. To bolster courage, they turned to a variety of sources for encouragement, including confidence from past successes, inspiring role models, and social support.

Conclusions: The data reflect adaptive strategies similar to response shift processes. A link between response shift processes and higher levels of perceived control is discussed.
Cell functions impaired by frataxin deficiency are restored by drug-mediated iron relocation
Authors: Kakhlon Or , Manning Hila , Breuer William , Melamed-Book Naomi , Lu Chunye , Cortopassi Gino , Munnich Arnold , Cabantchik Z. Ioav
Published: September 2008

Various human disorders are associated with misdistribution of iron within or across cells. Friedreich ataxia (FRDA), a deficiency in the mitochondrial iron-chaperone frataxin, results in defective use of iron and its misdistribution between mitochondria and cytosol. We assessed the possibility of functionally correcting the cellular properties affected by frataxin deficiency with a siderophore capable of relocating iron and facilitating its metabolic use. Adding the chelator deferiprone at clinical concentrations to inducibly frataxin-deficient HEK-293 cells resulted in chelation of mitochondrial labile iron involved in oxidative stress and in reactivation of iron-depleted aconitase. These led to (1) restoration of impaired mitochondrial membrane and redox potentials, (2) increased adenosine triphosphate production and oxygen consumption, and (3) attenuation of mitochondrial DNA damage and reversal of hypersensitivity to staurosporine-induced apoptosis. Permeant chelators of higher affinity than deferiprone were not as efficient in restoring affected functions. Thus, although iron chelation might protect cells from iron toxicity, rendering the chelated iron bioavailable might underlie the capacity of deferiprone to restore cell functions affected by frataxin deficiency, as also observed in FRDA patients. The siderophore-like properties of deferiprone provide a rational basis for treating diseases of iron misdistribution, such as FRDA, anemia of chronic disease, and X-linked sideroblastic anemia with ataxia.
Noninvasive ventilation in acute exacerbations of COPD
Authors: Elliott M. W.
Published: September 2008

Noninvasive ventilation has been a major advance in the management of acute exacerbations of chronic obstructive pulmonary disease, reducing the need for endotracheal intubation, thereby reducing complications and hospital costs, as well as improving survival. It has been used in a variety of different clinical environments including the emergency room, on general wards, in intermediate respiratory care units and in the intensive care unit. It should now be regarded as part of standard therapy for patients who continue to have a respiratory acidosis after standard medical therapy.
Impacting patient-centred outcomes in COPD: breathlessness and exercise tolerance
Authors: O'Donnell D. E.
Published: September 2008

The physiological hallmark of chronic obstructive pulmonary disease (COPD) is expiratory flow limitation. However, it is the resultant air trapping and associated increases in lung volume (hyperinflation) that provide a mechanistic link between the physiological impairment and the characteristic symptoms of COPD, such as dyspnoea (breathlessness), exercise intolerance and reduced health-related quality of life (HRQoL).

During exercise, the negative consequences of hyperinflation are particularly apparent. Delayed lung emptying and increased end-expiratory lung volume are aggravated, and tidal volume cannot rise to meet the increased ventilatory demands. Dyspnoea intensity rises abruptly to intolerable levels, and further increases in ventilation can only be achieved by rapid breathing. This rebounds to cause greater hyperinflation in a vicious cycle. As a result, patients with COPD often prematurely stop or avoid activity, leading to deconditioning, increased dyspnoea, worsening of disease and, ultimately, reduced HRQoL.

The Global Initiative for Chronic Obstructive Lung Disease guidelines recommend long-acting bronchodilators as first-line maintenance treatment in COPD.

Once-daily tiotropium 18 µg, a long-acting anticholinergic agent with 24-h efficacy, has been consistently shown to relieve dyspnoea and improve exercise tolerance and health status. These improvements may allow patients with chronic obstructive pulmonary disease to increase their daily activities, thereby reversing the cycle of chronic inactivity and muscle deconditioning.
Impacting patient-centred outcomes in COPD: exacerbations and hospitalisations
Authors: Rodríguez-Roisin R.
Published: September 2008

Patients with chronic obstructive pulmonary disease (COPD) frequently develop exacerbations, leading to major clinical and healthcare utilisation ramifications. Exacerbations, especially those that result in hospitalisation, are the main cost driver in COPD and frequent exacerbations are associated with increased mortality, impaired health-related quality of life (HRQoL) and perhaps a more rapid decline in lung function over time. Prevention and treatment of exacerbations is, therefore, an important goal of maintenance therapy in COPD.

The impact of tiotropium, a long-acting anticholinergic agent, on exacerbations and associated healthcare utilisation has been studied in five randomised, controlled clinical trials of ≥6 months' duration involving >5,000 patients.

Analyses of adverse events reports submitted during three long-term efficacy and safety trials showed that tiotropium significantly reduced the incidence of exacerbations and delayed the time to first exacerbation, compared with either placebo or the short-acting anticholinergic agent, ipratropium. More recent prospective data confirmed previous findings.

Collectively, the results of these studies support the role of tiotropium as maintenance therapy in chronic obstructive pulmonary disease, demonstrating that this agent can provide significant reductions in the incidence of exacerbations and associated healthcare utilisation.
Dynamic hyperinflation and pulmonary inflammation: a potentially relevant relationship?: FIGURE 1.
Authors: Agusti A. , Soriano J. B.
Published: September 2008

In patients with moderate-to-severe chronic obstructive pulmonary disease (COPD), end-expiratory lung volume increases under conditions of greater minute ventilation (e.g.exercise). This abnormal response is termed dynamic hyperinflation (DH) and has now been recognised as a key determinant of symptomatology and exercise intolerance in COPD. Reduced elastic recoil, loss of alveolar attachments and increased airway resistance are the mechanical factors traditionally invoked to explain the occurrence of DH in COPD. An abnormal inflammatory response to, most frequently, tobacco smoking is a key pathophysiological component of COPD, but its potential relationship with DH has not been directly investigated and is poorly understood. The present article discusses, first, the mechanisms by which DH can enhance inflammation in COPD (including cellular stretching, tissue damage and danger signals, hyperventilation and hypoxia). It then reviews how the abnormal inflammatory response that characterises the disease can augment DH (oedema and increased airway resistance, increased mucus production and alveolar destruction). Finally, it speculates that if these relationships eventually prove to be real, then the use of long-acting bronchodilators may help reduce the inflammatory load of these patients and, conversely, the use of anti-inflammatory therapy can contribute to the reduction of DH.
Exercise and dyspnoea in COPD
Authors: Calverley P. M. A.
Published: September 2008

Dyspnoea provoked either by exercise or during a disease exacerbation is one of the most feared symptoms of the chronic obstructive pulmonary disease (COPD) patient. It contributes to impaired quality of life and patients who are more limited by exertional dyspnoea are more likely to die. The physiological mechanisms responsible for these two outcomes vary in different settings, but in both situations, changes in the resting lung volume and increased activation of the respiratory muscles relative to their maximum capacity is the final common pathway.

Although increased metabolic carbon dioxide production from weak or poorly conditioned muscles is an important cofactor, most patients limited by exertional dyspnoea exhibit dynamic hyperinflation that parallels their symptom intensity. This results from the longer respiratory time constant of the lungs in COPD and coexisting expiratory flow limitation during tidal breathing. The response of the chest wall muscles to this change in lung volume is variable: most patients with more severe COPD allow chest wall volume to increase, while others try to defend chest wall volume. The latter is not a good breathing strategy as the patient’s exercise capacity is very limited.

Treatment with bronchodilators reduces operating lung volumes and delays the time until tidal volume is mechanically limited by the inspiratory reserve volume. Breathing oxygen and heliox gas mixtures further increases exercise endurance and slows the rate at which end-expiratory lung volume increases.

During exacerbations there is a consistent increase in end-expiratory lung volume and this parallels the reduction in forced vital capacity. This suggests that gas trapping due to airway closure is the main mechanism involved here, although changes in lung volume still track the symptomatic improvement in dyspnoea reported by patients both as the episode resolves and after nebulised bronchodilator treatment.
Lung hyperinflation in COPD: the impact of pharmacotherapy
Authors: O'Donnell D. E. , Laveneziana P.
Published: September 2008

Improvement in airway function in response to bronchodilator therapy is generally confirmed by simple spirometry. However, improvements in maximal expiratory flow rates have been shown to correlate poorly with important patient-centred outcomes, such as reduced exertional dyspnoea and improved exercise performance. Recent studies have suggested that attendant reductions in end-expiratory lung volume as a result of bronchodilator-induced improvements in lung emptying may be more closely associated with symptom relief and increased exercise capacity than traditional spirometric indices. To the extent that chronic lung hyperinflation and the superimposition of acute dynamic hyperinflation (in response to increased ventilation or expiratory flow limitation) result in excessive loading and weakening of the inspiratory muscles, then pharmacological lung volume reduction should have important mechanical and sensory benefits for the patient.

The present article will examine the mechanisms of lung deflation following short-term bronchodilator therapy. The physiological links between reduced hyperinflation, improved dyspnoea and exercise endurance will be examined, and the emerging evidence for the additive effects of combining various modern pharmacological therapies will be reviewed.
Surgical procedures in emphysema: any impact on dynamic hyperinflation?
Authors: Polkey M. I.
Published: September 2008

Bullectomy, lung volume reduction surgery and transplantation can palliate dyspnoea in emphysema. The available data suggest that their mode of action, at least with regard to pulmonary mechanics, includes beneficial effects on dynamic hyperinflation. In single lung transplant recipients, this may be asymmetric, causing native lung hyperinflation.
Asthma: a comparison of animal models using stereological methods
Authors: Hyde D. M. , Miller L. A. , Schelegle E. S. , Fanucchi M. V. , Van Winkle L. S. , Tyler N. K. , Avdalovic M. V. , Evans M. J. , Kajekar R. , Buckpitt A. R. , Pinkerton K. E. , Joad J. P. , Gershwin L. J. , Wu R. , Plopper C. G.
Published: September 2008

Asthma is a worldwide health problem that affects 300 million people, as estimated by the World Health Organization. A key question in light of this statistic is: “what is the most appropriate laboratory animal model for human asthma?”

The present authors used stereological methods to assess airways in adults and during post-natal development, and their response to inhaled allergens to compare rodents and nonhuman primates to responses in humans.

An epithelial–mesenchymal trophic unit was defined in which all of the compartments interact with each other. Asthma manifests itself by altering not only the epithelial compartment but also other compartments (e.g.interstitial, vascular, immunological and nervous). All of these compartments show significant alteration in an airway generation-specific manner in rhesus monkeys but are limited to the proximal airways in mice. The rhesus monkey model shares many of the key features of human allergic asthma including the following: 1) allergen-specific immunoglobulin (Ig)E and skin-test positivity; 2) eosinophils and IgE+ cells in airways; 3) a T-helper type 2 cytokine profile in airways; 4) mucus cell hyperplasia; 5) subepithelial fibrosis; 6) basement membrane thickening; and 7) persistent baseline hyperreactivity to histamine or methacholine.

In conclusion, the unique responses to inhaled allergens shown in rhesus monkeys make it the most appropriate animal model of human asthma.
Quantitative morphology using bronchial biopsies: FIGURE 1.
Authors: Woodruff P. G. , Innes A. L.
Published: September 2008

Bronchoscopy with bronchial biopsies allows sampling of airway tissue in prospective clinical studies and is increasingly applied for the study of airway inflammation and remodelling.

It is important to recognise that there are limitations inherent to the use of bronchial biopsies, including the inability to randomly sample the airway and susceptibility to the “reference trap”. Nonetheless, certain stereological principles can be applied to the analysis of these specimens, which may improve the validity of the results obtained. These principles relate to choice of reference space, adequacy of sampling and treatment of tissue orientation in the estimation of thickness and surface area.

With attention to these principles, the present authors have developed protocols for the assessment of multiple measures of airway remodelling in bronchial biopsies, including airway epithelial mucin content, epithelial goblet cell size, reticular basement membrane thickness and smooth muscle morphological outcomes. They have also developed protocols for the enumeration of inflammatory cells important in the study of asthma and chronic obstructive pulmonary disease, including eosinophils and neutrophils.

In the present article, relevant stereological principles and the details of these specific protocols will be reviewed.