bluuebunny/crossref_metadata_2025 huggingface dataset:
Long-Term Stability of Improved Language Functions in Chronic Aphasia After Constraint-Induced Aphasia Therapy
Authors: Meinzer Marcus , Djundja Daniela , Barthel Gabriela , Elbert Thomas , Rockstroh Brigitte
Published: June 2005

Background and Purpose—

In response to the established notion that improvement of language functions in chronic aphasia only can be achieved through long-term treatment, we examined the efficacy of a short-term, intensive language training, constraint-induced aphasia therapy (CIAT). This program is founded on the learning principles of prevention of compensatory communication (constraint), massed practice, and shaping (induced).

Methods—

Twenty-seven patients with chronic aphasia received 30 hours of training over 10 days. Twelve patients were trained with the CIAT program. For 15 patients the training included a module of written language and an additional training in everyday communication, which involved the assistance of family members (CIATplus). Outcome measures included standardized neurolinguistic testing and ratings of the quality and the amount of daily communication.

Results—

Language functions improved significantly after training for both groups and remained stable over a 6-month follow-up period. Single case analyses revealed statistically significant improvements in 85% of the patients. Patients and relatives of both groups rated the quality and amount of communication as improved after therapy. This increase was more pronounced for patients of the group CIATplus in the follow-up.

Conclusions—

Results confirm that a short-term intense language training, based on learning principles, can lead to substantial and lasting improvements in language functions in chronic aphasia. The use of family and friends in the training provides an additional valuable element. This effective intervention can be successfully used in the rehabilitation of chronic aphasia patients. Additionally, its short-term design makes it economically attractive for service providers.
Matched Case-Control Study on Factor V Leiden and the Prothrombin G20210A Mutation in Patients With Ischemic Stroke/Transient Ischemic Attack Up to the Age of 60 Years
Authors: Lalouschek Wolfgang , Schillinger Martin , Hsieh Kety , Endler Georg , Tentschert Susanne , Lang Wilfried , Cheng Suzanne , Mannhalter Christine
Published: June 2005

Background and Purpose—

The role of the factor V Leiden mutation (
FVL
) and the G20210A mutation of the prothrombin (
factor II [FII]
) gene for arterial thrombosis is not clear.

Methods—

We investigated the prevalence of these mutations in 468 patients with an acute stroke or transient ischemic attack (TIA) before the age of 60 years and in a healthy control population individually matched for age and gender. We also analyzed interactions between the mutations, gender, standard vascular risk factors, and stroke risk.

Results—

The prevalence of the
FVL
did not differ significantly between patients and control subjects. However, we found a significant interaction between the
FVL
, smoking, and risk of stroke in women: female smokers without
FVL
had a somewhat increased risk of stroke of 2.6 (95% CI, 1.5 to 4.6;
P
=0.001) compared with nonsmoking noncarriers of the
FVL
. Stroke risk was markedly higher in female smokers who had the
FVL
(OR, 8.8; 95% CI, 2.0 to 38.0;
P
=0.004) after multivariate adjustment. No such interaction was observed in men. In contrast, the frequency of the
FII
G20210A mutation was significantly higher in male patients compared with controls (6% versus 1%; adjusted OR, 6.1; 95% CI, 1.3 to 28.3;
P
=0.021). In females, the prevalence of the mutation was 3% in both groups. We found no significant interactions of the
FII
G20210A mutation with other vascular risk factors and stroke risk.

Conclusions—

Our data indicate a highly increased risk of ischemic cerebrovascular events in women up to 60 years who smoke and have
FVL
. We also found evidence for an increased risk of stroke/TIA in men who have the
FII
G20210A mutation but not in women in this age group.
Reorganization of Motor Execution Rather Than Preparation in Poststroke Hemiparesis
Authors: Wiese Holger , Stude Philipp , Sarge Robert , Nebel Katharina , Diener Hans-Christoph , Keidel Matthias
Published: June 2005

Background and Purpose—

The aim of the present study was to examine movement-related potentials (MRPs) in patients in the “chronic” stage after cortical stroke with recovered hemiparesis compared with healthy control subjects.

Methods—

Right index finger MRPs were derived from 12 patients ≥1 year after infarction in the territory of the left middle cerebral artery as well as from 12 control subjects. MRP components were compared between groups.

Results—

In the patient group, the component directly preceding movement onset (negative slope [NS]) was significantly reduced over the lesioned hemisphere contralateral to the movement. Furthermore, increased motor potentials (MPs) were observed over the contralesional hemisphere during movement execution. No changes in the early MRP (Bereitschaftspotential) reflecting movement preparation were found.

Conclusions—

Because the NS is supposed to be generated by the primary motor cortex, the decreased component over the lesioned hemisphere is interpreted to represent impaired contralateral M1 functioning in stroke patients. Contralesional activity has been reported as a probable sign of brain plasticity by functional imaging studies. Our results broaden these findings, giving new insights into the temporal course of movement-related brain activity in recovered cortical stroke patients. The data point to a functional reorganization of motor execution rather than preparation in poststroke hemiparesis.
A Matrix Metalloproteinase Protein Array Reveals a Strong Relation Between MMP-9 and MMP-13 With Diffusion-Weighted Image Lesion Increase in Human Stroke
Authors: Rosell Anna , Alvarez-Sabín José , Arenillas Juan F. , Rovira Alex , Delgado Pilar , Fernández-Cadenas Israel , Penalba Anna , Molina Carlos A. , Montaner Joan
Published: June 2005

Background and Purpose—

Matrix metalloproteinases (MMPs) are involved in tissue destruction produced by the neuroinflammatory response that follows ischemic stroke. In the present study we use an MMP array to investigate the blood levels of several MMPs in stroke patients and its relation with brain tissue damage and neurological outcome.

Methods—

Twenty-four patients with middle cerebral artery occlusion who received thrombolytic therapy were included. Blood samples were drawn before tissue plasminogen activator treatment and an MMP array (multiplex enzyme-linked immunosorbent assay [ELISA]) was performed including gelatinases (MMP-2 and MMP-9), collagenases (MMP-1, MMP-8, and MMP-13), stromelysines (MMP-3 and MMP-10), and MMP endogen inhibitors (TIMP-1 and TIMP-2). To assess tissue lesion a serial multimodal MRI study was performed (pretreatment and at 24 hours).

Results—

Neither initial diffusion lesion nor hypoperfused volume was associated with metalloproteinase expression within the first 3 hours after stroke onset. Nevertheless, a strong correlation was found between MMP-9 and MMP-13 with diffusion-weighted image (DWI) lesion expansion (
r
=0.54,
P
=0.05 and
r
=0.60,
P
=0.017, respectively). Baseline levels of both MMP-9 (OR, 14;95% CI, 1.5 to 131;
P
=0.019) and MMP-13 (OR, 73; 95% CI, 3.9 to 1388;
P
=0.004) were independent predictors of final increase in brain infarct volume at 24 hours.

Conclusions—

Our results demonstrate that within the neuroinflammatory response, high levels of MMP-9 and MMP-13 are involved in DWI lesion growth despite thrombolytic therapy, suggesting its ultra-early role in brain injury.
Avoiding Central Nervous System Bleeding During Antithrombotic Therapy
Authors: Hart Robert G. , Tonarelli Silvina B. , Pearce Lesly A.
Published: June 2005

Background—

Approximately 7000 intracerebral hemorrhages (ICHs) annually in the US are caused by use of antithrombotic therapies. We review the incidence, risk factors, and predictors of ICH in patients receiving long-term anticoagulation or antiplatelet therapy.

Summary of Review—

ICH rates range from 0.3% to 0.6% per year during oral anticoagulation in recent reports. Major risk factors are advanced patient age, elevated blood pressure, intensity of anticoagulation, and previous cerebral ischemia. Combining antiplatelet agents with anticoagulation and the combined use of aspirin plus clopidogrel appear to increase ICH risk. Modest blood pressure-lowering halves the frequency of ICH during antiplatelet therapy.

Conclusion—

ICH is an uncommon, but often fatal, complication of antithrombotic therapy that particularly afflicts patients with previous stroke. Recent data support that keeping international normalized ratio ≤3.0, control of hypertension, and avoiding the combination of aspirin with warfarin reduce its frequency.
Thrombotic Risk Factors In Primary Antiphospholipid Syndrome
Authors: Turiel Maurizio , Sarzi-Puttini Piercarlo , Peretti Rossana , Rossi Edoardo , Atzeni Fabiola , Parsons Wendy , Doria Andrea
Published: June 2005

Background and Purpose—

Because thromboembolic events are frequently observed in primary antiphospholipid syndrome (PAPS), we assessed the risk factors for new thrombotic episodes.

Methods—

Fifty-six PAPS patients (mean age, 37±10 years) were prospectively studied for 5 years. The preliminary Sapporo classification criteria for antiphospholipid syndrome (APS; a medium–high anticardiolipin antibody [aCL] titer and/or a positive lupus anticoagulant [LA] test in the presence of vascular thrombosis and/or pregnancy morbidity) were used to confirm the diagnosis. Thrombotic episodes or pregnancy losses before a diagnosis of PAPS were considered events, and any new disease manifestation other than thrombocytopenia was considered a recurrent event. Only patients with objectively verified thrombotic events were included in the study.

Results—

Twenty-one new thrombotic events were observed in 15 subjects (26.8%), including 3 (5.4%) who died during the follow-up. The patients with IgG aCL levels of >40 IgG phospholipid unit (GPL-U) showed a higher incidence of new thrombotic events (43.3%) than those with levels of ≤40 GPL-U (7.7%). Univariate analysis identified a history of recurrent clinical events (
P
=0.004), a highly positive aCL titer (
P
=0.007), and the presence of cardiac abnormalities (
P
=0.036) as significant risk factors for new thrombotic events. A multivariate regression model confirmed that an IgG aCL titer of >40 GPL-U was an independent risk factor for thrombosis (odds ratio, 9.17; 95% confidence interval, 1.83 to 46.05).

Conclusions—

A high IgG aCL titer is the strongest predictor of new thrombotic events in PAPS patients.
Influenza Vaccination Is Associated With a Reduced Risk of Stroke
Authors: Grau Armin J. , Fischer Beate , Barth Cordula , Ling Paul , Lichy Christoph , Buggle Florian
Published: June 2005

Background and Purpose—

Vascular death rates and hospitalizations for stroke are increased during influenza epidemics. Influenza vaccination may prevent stroke. We investigated whether influenza vaccination is associated independently with reduced odds of stroke and whether effects are confined to stroke subgroups and winter seasons and shared by other vaccinations.

Methods—

During 18 months, we performed standardized interviews assessing vaccination status, risk factors, health-related behavior, and socioeconomic factors in 370 consecutive patients with ischemic or hemorrhagic stroke or transient ischemic attack (TIA) and 370 age- and sex-matched control subjects selected randomly from the population.

Results—

Influenza vaccination during the last vaccination campaign was less common in patients (19.2%) than control subjects (31.4%;
P
<0.0001). After adjustment for vascular risk factors, education, health-related behavior and other factors, influenza vaccination (odds ratio [OR], 0.46; 95% CI, 0.28 to 0.77) but not other combined recent vaccinations (OR, 0.80; 95% CI, 0.42 to 1.43) were associated with reduced odds of stroke/TIA. Significant effects were found in men, older subjects (>65 years), subjects with previous vascular diseases, and regarding ischemic stroke; nonsignificant trends existed in women, younger subjects, and regarding hemorrhagic stroke. In etiologic subgroups of cerebral ischemia, similar effects were found. No protective effects were found during summer months; however, results also varied considerably between both winter seasons examined.

Conclusions—

These results support the hypothesis that influenza vaccination may be associated with reduced stroke risk. However, residual confounding cannot be excluded, and interventional studies are required to evaluate the role of influenza vaccination in stroke prevention.
Plasma B-Type Natriuretic Peptide Levels Are Associated With Early Cardiac Dysfunction After Subarachnoid Hemorrhage
Authors: Tung Poyee P. , Olmsted Elise , Kopelnik Alexander , Banki Nader M. , Drew Barbara J. , Ko Nerissa , Lawton Michael T. , Smith Wade , Foster Elyse , Young William L. , Zaroff Jonathan G.
Published: June 2005

Background and Purpose—

Serum B-type natriuretic peptide (BNP) is elevated after subarachnoid hemorrhage (SAH), as well as in the setting of congestive heart failure and myocardial infarction. The aim of this study was to prospectively quantify the relationship between BNP levels and cardiac outcomes after SAH.

Methods—

Plasma was collected for BNP measurements as soon as possible after enrollment; a mean of 5±4 days after SAH symptom onset. On days 1, 3, and 6 after enrollment, troponin I (cTi) was measured and 2-dimensional echocardiography was performed. The following cardiac variables were collected and treated dichotomously: left ventricular ejection fraction (LVEF), regional wall motion abnormalities (RWMA), diastolic dysfunction, pulmonary edema, and cTi.

Results—

There were 57 subjects. The median BNP level was 141 pg/mL (range, 0.8 to 3330 pg/mL). Higher mean BNP levels were present in those with RWMA (550 versus 261 pg/mL;
P
=0.012), diastolic dysfunction (360 versus 44;
P
=0.011), pulmonary edema (719 versus 204;
P
=0.016), elevated cTi (662 versus 240;
P
=0.004), and LVEF <50% (644 versus 281;
P
=0.015).

Conclusion—

Early after SAH, elevated BNP levels are associated with myocardial necrosis, pulmonary edema, and both systolic and diastolic dysfunction of the left ventricle. These findings support the hypothesis that the heart releases BNP into the systemic circulation early after SAH.
Factors Influencing Stroke Survivors’ Quality of Life During Subacute Recovery
Authors: Nichols-Larsen Deborah S. , Clark P.C. , Zeringue Angelique , Greenspan Arlene , Blanton Sarah
Published: June 2005

Background and Purpose—

Health-related quality of life (HRQOL) is an important index of outcome after stroke and may facilitate a broader description of stroke recovery. This study examined the relationship of individual and clinical characteristics to HRQOL in stroke survivors with mild to moderate stroke during subacute recovery.

Methods—

Two hundred twenty-nine participants 3 to 9 months poststroke were enrolled in a national multisite clinical trial (Extremity Constraint-Induced Therapy Evaluation). HRQOL was assessed using the Stroke Impact Scale (SIS), Version 3.0. The Wolf Motor Function Test documented functional recovery of the hemiplegic upper extremity. Multiple analysis of variance and regression models examined the influence of demographic and clinical variables across SIS domains.

Results—

Age, gender, education level, stroke type, concordance (paretic arm=dominant hand), upper extremity motor function (Wolf Motor Function Test), and comorbidities were associated across SIS domains. Poorer HRQOL in the physical domain was associated with age, nonwhite race, more comorbidities, and reduced upper-extremity function. Stroke survivors with more comorbidities reported poorer HRQOL in the area of memory and thinking, and those with an ischemic stroke and concordance reported poorer communication.

Conclusions—

Although results may not generalize to lower functioning stroke survivors, individual characteristics of persons with mild to moderate stroke may be important to consider in developing comprehensive, targeted interventions designed to maximize recovery and improve HRQOL.
Prediction of the Clinical Outcome of Pediatric Moyamoya Disease With Postoperative Basal/Acetazolamide Stress Brain Perfusion SPECT After Revascularization Surgery
Authors: So Young , Lee Ho-Young , Kim Seung-Ki , Lee Jae Sung , Wang Kyu-Chang , Cho Byung-Kyu , Kang Eunjoo , Lee Dong Soo
Published: June 2005

Background and Purpose—

We evaluated whether basal/acetazolamide stress brain perfusion SPECT performed after revascularization surgery can predict the further clinical outcome of patients with pediatric moyamoya disease.

Methods—

A total of 77 (31 males, 46 females, age 6.6±3.2 years) patients with postoperative pediatric moyamoya disease who underwent basal/acetazolamide stress brain perfusion SPECT 6 to 12 months after revascularization surgery and who were followed-up >12 months after SPECT were included. Mean follow-up period after SPECT was 36±19 months. Sixty-two patients underwent bilateral ribbon encephaloduroarteriosynangiosis (EDAS), 14 bilateral EDAS, and 1 unilateral EDAS. Ordinal logistic regression analysis using 5 independent variables (infarction on preoperative MRI, age at the first operation, highest Suzuki stage on cerebral angiography, and regional cerebrovascular reserve on postoperative SPECT) against postoperative clinical outcomes was performed.

Results—

Fifty-one patients had preserved reserve on postoperative SPECT and their clinical outcomes were excellent (30), good (15), fair (4), and poor (2); 26 patients had decreased reserve (excellent, 1; good, 7; fair, 14; poor, 4). On ordinal logistic regression analysis, age at the first operation (
P
=0.033) and reserve on postoperative SPECT (
P
<0.001) were statistically significant.

Conclusion—

Basal/acetazolamide stress brain perfusion SPECT performed at 6 to 12 months after the indirect bypass operation could predict the further clinical outcome of pediatric patients with moyamoya disease. Patients with decreased cerebrovascular reserve will have remaining neurological deficit and ischemic attacks on follow-up.
From Science to Multiculturalism: Postmodern Trends in Environmental Organizations
Authors: Ignatow Gabriel
Published: June 2005

Postmodern social theory has had little impact on studies of global environmental activism and politics, and has often been treated with suspicion. Yet, in this article, I argue that social science theories of both postmodernization and cultural modernization can provide insights into how globalizing processes have affected environmental politics. Where current perspectives on globalization and environmental politics tend to focus on globalization's homogenizing effects, postmodernization arguments suggest that globalization and postmodern social trends have given rise to hybrid, multicultural politics. In the environmental realm, these trends have challenged environmentalists whose claims are based on science and encouraged hybrid forms of environmental activism linking ecological issues to issues of race, ethnicity, religion, and gender. To explore these shifts in environmental politics worldwide, I examine two categories of nonprofit environmental organizations: environmental science organizations and multicultural environmental organizations. Results of an event count analysis show that, for nations, public education predicts the establishment of environmental science organizations. Multicultural environmental organizations were established later, in the 1980s and onward, and tended to be established in countries with preexisting environmental science organizations. I argue that social science theories of cultural modernization and postmodernization can best explain these patterns.
Explaining the Gaps between Mandate and Performance: Agency Theory and World Bank Environmental Reform
Authors: Gutner Tamar
Published: June 2005

This article seeks to explain why the World Bank's environmental performance is so uneven despite numerous reform efforts. I argue that a principal-agent model offers a potentially powerful tool for analyzing gaps between the mandates and performance of international organizations (IOs) such as the World Bank. The model is particularly useful when it is calibrated to recognize problems of antinomic delegation and the dual role an IO may have as both agent and principal. Antinomic delegation occurs when states ask IOs to take on complex tasks that are difficult to institutionalize. Recognizing that many IOs may be principal and agent at different stages of the policy process reveals more opportunities for agency slack that are not well addressed by the IO literature. This article presents these modifications to the principal-agent model and applies the model to the case of the World Bank. The case study demonstrates that the nature of the tasks being delegated and the incentives shaping both sides of the principal-agent relationship are key sources of disconnect between the institution's stated goals and its performance.
Norm Entrapment and Preference Change: The Evolution of the European Union Position on International Emissions Trading
Authors: Cass Loren
Published: June 2005

The European Union's position on the incorporation of emissions trading into the Kyoto Protocol presents an interesting puzzle. The EU opposed American efforts to integrate international emissions trading into the Protocol. However, after 1998 the EU gradually emerged as one of the primary innovators in developing both its internal trading program as well as the international one. How do we explain the transformation of the EU position on trading? The conflict over emissions trading was intimately tied to normative debates surrounding the appropriateness of mechanisms to achieve GHG emission reductions. The EU advocated a norm requiring states to undertake domestic policy changes as the only legitimate mechanisms to reduce domestic emissions. The United States on the other hand argued that the international response had to be guided by the principle of economic efficiency. By 1998, the European Union and most of its member states had accepted that emissions trading offered a viable mechanism to reduce the costs of achieving emission reductions. However, its prior efforts to frame international emissions trading as an illegitimate mechanism constrained the EU's ability to alter its position. It was only after the United States rejected the Kyoto Protocol that the EU was able to promote emissions trading as a legitimate strategy to meet the Kyoto target. The EU reframed the issue of emissions trading from an illegitimate American attempt to shirk domestic responsibilities into a legitimate strategy to salvage the Kyoto Protocol without American participation. This shift in framing was a necessary condition to permit the EU to establish a leading position in the development of the international emissions trading mechanism. This case study of preference change offers evidence of the important role that international normative debates and issue framing can play in international environmental policy.
Questioning the Motivations for International Repositories for Nuclear Waste
Authors: Marshall Alan
Published: June 2005

Because national nuclear waste management schemes have proven to be unsuccessful, an international nuclear waste scheme has been seriously entertained by numerous individuals and agencies. In this article I bring into question the range of motivating forces have been offered by such proponents. I conclude that the motivations for international repositories are so inflected with social, ethical and political problems that they hardly serve to contribute to a sound solution to the nuclear waste management.
Political Ideas and a Political Science for Policy
Authors: Prewitt Kenneth
Published: June 2005

Early in its development, political science established itself as part of modern secular authority, with something to say about government and politics. This achievement did not, though, lead to much noticeable impact on governance and policy, with the exception of administrative reforms. The past five decades have witnessed impressive growth in influence, as political science self-confidently embraced an idea-driven policy science. Political behaviorism, fashioned as a response to the loss of Enlightenment naiveté, was a political as well as a science project, and its successes, on both fronts, drew many to a new type of policy science. A leading example is neoconservatism, whose practioner political scientists linked new political ideas with applied social science as a basis for challenging assumptions of the regulatory welfare state. By the end of the twentieth century, political science had returned to its earliest mission(s)—building a better science and strengthening democratic practice.
International Relations as a Social Science: Rigor and Relevance
Authors: Frieden Jeffry A. , Lake David A.
Published: June 2005

Progress in the study of international politics depends on systematic, rigorous theory and empirical testing. International Relations is most useful when scholars can identify with some confidence the causal forces that drive foreign policy and international interactions, not when they use their detailed empirical knowledge to offer opinions, however intelligent and well informed. Deterrence theory, the democratic peace research program, and the political economy of trade policy demonstrate the importance of both theory and empirical research in enhancing the understanding of international relations. The bargaining theory of war and open economy politics are the current frontiers of research on international relations and promise even greater understanding in the future.
The Use and Usefulness of Criminology, 1751-2005: Enlightened Justice and Its Failures
Authors: Sherman Lawrence W.
Published: June 2005

After a useful beginning in the eighteenth-century Enlightenment as both an experimental and analytic social science, criminology sank into two centuries of torpor. Its resurrection in the late twentieth century crime wave successfully returned criminology to the forefront of discovering useful, if not always used, facts about prevailing crime patterns and responses to crime. Criminology’s failures of “use” in creating justice more enlightened by knowledge of its effects is linked to the still limited usefulness of criminology, which lacks a comprehensive body of evidence to guide sanctioning decisions. Yet that knowledge is rapidly growing, with experimental (as distinct from analytic) criminology now more prominent than at any time since Henry Fielding founded criminology while inventing the police. The future of criminology may thus soon resemble medicine more than economics.
Reminiscing and Predicting: Rogers’s beyond Words Speech and Commentary
Authors: Rogers Carl R. , Cornelius-White Jeffrey H. D. , Cornelius-White Cecily F.
Published: June 2005

In his “Beyond Words Symposium” at the Chicago Counseling and Psychotherapy Center in 1986, Carl Rogers offers reminiscences commemorating the 40th anniversary of the founding of the University of Chicago Counseling Center. He recalls the individuals whose work contributed to the birth of client-centered therapy and offers commentary not only on the development of the counseling center but also on the foundations of his own therapy process research, encounter group trainings, and person-centered education. Rogers’s symposium is peppered with individual stories and fond caricatures of his many colleagues, and he offers a variety of insights on the direction and scope of the person-centered movement. Rogers concludes with a discussion of the global need for person-centered expansion and offers a call to clinicians everywhere to continue to ride the “growing edge” of the client-centered movement.
Therapeutic Communities, Family Therapy, and Humanistic Psychology: History and Current Examples
Authors: Soyez Veerle , Broekaert Eric
Published: June 2005

This article discusses the use of residential therapeutic communities (TCs) to help addicts recover. The European and American antecedents of the TC and the model’s further evolution and dispersion are described. The increasing openness of the TC toward the outside world and its changed attitude toward family involvement have played important roles in the evolution of the TC. In this context, the article also pays attention to the family approach in the early TC and the major family therapeutic schools that influenced the model, specifically contextual therapy. A renewed attention to its humanistic roots can preserve the TC from becoming just another substance abuse treatment modality. However, good functioning of the TC as humanistic organization also requires openness, professionalism, and scientific input. Those elements are as safeguards against destructive charismatic leadership and insularity.
Client Perspectives on what Contributes to Symptom Relief in Psychotherapy: A Qualitative Outcome Study
Authors: Gallegos Nico
Published: June 2005

Assessing psychotherapy outcome with post-therapy questionnaires and self-report instruments does not adequately capture the richness and complexity of change during psychotherapy and relies too heavily on quantitative analysis. This qualitative study explored the lived experience of symptom relief in psychotherapy as perceived by client participants and treats their subjective accounts as credible data. The scientific phenomenological method developed by A. Giorgi was used to conduct in-depth interviews with 3 participants who experienced symptom relief during the course of psychotherapy.
Psychiatry Fraud and Force? A Commentary on E. Fuller Torrey and Thomas Szasz
Authors: Schwartz Michael Alan , Wiggins Osborne P.
Published: June 2005

In a pair of articles in the Journal of Humanistic Psychology, E. Fuller Torrey’s psychiatry is castigated by Thomas Szasz. In return, Torrey dismisses Szasz’s criticism as “increasingly anachronistic.” The current exchange clarifies the early ties between the two and their subsequent unraveling. Apparently at opposite ends of the psychiatric spectrum, Szasz and Torrey actually have much in common and share foundational assumptions about mind and body, the definition of “disease,” and the nature of medical practice and medical science. Their presuppositions, all readily challenged, are problematic for all of medicine including psychiatry. Physicians treat persons, not diseases; people go to the doctor with ailments and illnesses, not diseases; mental illnesses are not necessarily diseases; medicine is a social response to human need, not a pure science; medical science is a practical, not a pure, science. What is true for medicine in general is, of course, also true for psychiatry.
Effect of Simulated Microgravity on the Disposition and Tissue Penetration of Ciprofloxacin in Healthy Volunteers
Authors: Schuck Edgar L. , Grant Maria , Derendorf Hartmut
Published: June 2005

This study evaluated the effects of simulated microgravity (sμG) on the pharmacokinetics of ciprofloxacin. Six healthy volunteers participated in a crossover study to compare the pharmacokinetics of ciprofloxacin after a single 250‐mg oral dose in normal gravity (1G) and sμG. Plasma and urine samples were collected, and in vivo microdialysis was employed to obtain the free interstitial concentrations in the thigh muscle. Tissue penetration (f) was determined as the ratio of the free tissue area under the concentration versus time curve (AUCtiss,free)/AUCplasma,free. Plasma and free interstitial ciprofloxacin concentrations were simultaneously fit to a 1‐compartment body model after correction for protein binding and tissue penetration. Total and free plasma concentrations were very similar in sμG and 1G. Tissue penetration in sμG (f = 0.61 ± 0.36) was slightly lower than in 1G (f = 0.92 ± 0.63); however, the difference was not significant. The authors conclude that the disposition of ciprofloxacin was not affected by simulated microgravity.
Long‐Acting Octreotide and Prolonged‐Release Lanreotide Formulations Have Different Pharmacokinetic Profiles
Authors: Astruc Beatrice , Marbach Peter , Bouterfa Hakim , Denot Caroline , Safari Mitra , Vitaliti Alessandra , Sheppard Michael
Published: June 2005

Single‐dose pharmacokinetic (PK) profiles and multiple‐dose PK modeling were compared for long‐acting octreotide (20 or 60 mg) and prolonged‐release lanreotide (90 or 120 mg) over 91 days; steady‐state profiles were simulated. All treatments were well tolerated. Octreotide 20‐mg profile showed increased concentration on day 1, lag from days 2 to 6, then prolonged plateau phase (days 11–41); 60‐mg PK was dose proportional. Lanreotide 90‐mg profile showed Cmax on day 1 then elimination (apparent t1/2 25.5 days); 120‐mg profile was underproportional. Steady‐state PK of octreotide 20 mg/28 d suggested a Cmean of 1216 pg/mL (range, 1065–1585) with low fluctuation index (43%). Steady‐state PK of lanreotide 90 mg/28 d suggested a Cmean of 4455 ρg/mL (range, 2499–9279) with high fluctuation index (152%). Long‐acting octreotide had more predictable PK than prolonged‐release lanreotide. Simulated steady‐state profiles suggest long‐acting octreotide could be optimized to meet individual patient needs. In contrast, prolonged‐release lanreotide requires exposure constantly above the therapeutic target to enable monthly longterm therapy.
An Evaluation of an Optimal Sampling Strategy for Meropenem in Febrile Neutropenics
Authors: Ariano Robert E. , Zelenitsky Sheryl A. , MD Anna Nyhlén , Sitar Daniel S.
Published: June 2005

Optimal sampling design with nonparametric population modeling offers the opportunity to determine pharmacokinetic parameters for patients in whom blood sampling is restricted. This approach was compared to a standard individualized modeling method for meropenem pharmacokinetics in febrile neutropenic patients. The population modeling program, nonparametric approach of expectation maximization (NPEM), with a full data set was compared to a sparse data set selected by D‐optimal sampling design. The authors demonstrated that the D‐optimal sampling strategy, when applied to this clinical population, provided good pharmacokinetic parameter estimates along with their variability. Four individualized and optimally selected sampling time points provided the same parameter estimates as more intensive sampling regimens using traditional and population modeling techniques. The different modeling methods were considerably consistent, except for the estimation of CLd with sparse sampling. The findings suggest that D‐optimal sparse sampling is a reasonable approach to population pharmacokinetic/pharmacodynamic studies during drug development when limited sampling is necessary.
Rheumatoid Arthritis: An Overview of New and Emerging Therapies
Authors: Doan Tanya , Massarotti Elena
Published: June 2005

Rheumatoid arthritis (RA) is a chronic, inflammatory, systemic autoimmune disorder characterized by symmetric inflammation of synovial joints leading to progressive erosion of cartilage and bone. The aim of treatment is to mitigate joint destruction, preserve function, and prevent disability. The American College of Rheumatology guidelines for the treatment of RA recommend that newly diagnosed patients with RA begin treatment with disease‐modifying antirheumatic drugs (DMARDs) within 3 months of diagnosis. Methotrexate remains the most commonly prescribed DMARD and is the standard by which recent new and emerging therapies are measured. Increasing knowledge regarding the immunologic basis of RA and advances in biotechnology have resulted in new, targeted biological therapies against proinflammatory cytokines that have dramatically changed the treatment paradigm and outcomes of patients with RA. This article reviews the pharmacological rationale underlying RA therapy, with a focus on currently available biological therapies and new therapies in development.
The New Year’s Eve Dinner and Wormwood Meal
Authors: Wu Xu
Published: June 2005

The pattern of local people’s self-consciousness in Enshi prefecture has two important aspects: regional identity and lineage identity. At the local level, an inclusive regional identity often contains several exclusive lineage identities. The customs related to the expression of lineage identity are highly resistant to change and cannot be shared even by neighboring lineages that officially belong to the same ethnic group, while the commonly shared customs related to the expression of regional identity cannot be assigned to any specific ethnic group. The analysis suggests that since the officially recognized ethnic boundaries cover people belonging to different regions and unrelated lineages, the official ethnic categories are not the proper analytic units for cultural studies of areas like Enshi.
Wang Luobin: Folk Song King of the Northwest or Song Thief?
Authors: Harris Rachel
Published: June 2005

This article discusses the controversy surrounding the feted twentieth-century Chinese composer and folk song collector Wang Luobin. Wang’s relationship with the peoples and music of the Xinjiang Uyghur Autonomous Region illuminates several aspects of Han-minority relations, in particular the consumption of Otherness and the contesting of identities. The controversy also illuminates problems surrounding the transformation of traditional or folk music intoa tangible commodity: problems of ownership and authenticity, in particular legal issues of copyright (who has the right to profit) and more emotive issues of moral authority (who has the right to represent). These issues have recently come to the fore in China as it undergoes its uneasy transformation into a socialist market economy, and they have special ramifications because of the state’s extensive and ongoing manipulation of folk music for political ends.
Culture and Diverging Views of Social Events
Authors: Chua Hannah Faye , Leu Janxin , Nisbett Richard E.
Published: June 2005

The authors compared East Asians’ and Americans’ views of everyday social events. Research suggests that Americans tend to focus more on the self and to have a greater sense of personal agency than East Asians. The authors assessed whether, compared to East Asians, Americans emphasize main characters even when events do not involve the self and whether they see more agency or intentionality in actions, even when the actions are not their own. Whether East Asians would observe more emotions in everyday scenarios than would Americans also was investigated. In Study 1, Chinese and Americans read alleged diary entries of another person. Americans did focus more on main characters and on characters’ intentionality. Study 2 replicated these results comparing Taiwanese and Americans on free recall of events concerning the self and of narratives and videos concerning others. Study 2 also found that Taiwanese made more comments about the emotional states of characters.
The Role of Affect in Determining the Attributional Weight of Immoral Behaviors
Authors: Trafimow David , Bromgard Irina K. , Finlay Krystina A. , Ketelaar Timothy
Published: June 2005

Theories about why immoral behaviors carry a large amount of attributional weight tend to emphasize traditional cognitive variables. In contrast, the authors propose that the degree of negative affect that these behaviors induce in observers is largely responsible for their attributional weight. Studies 1 and 2 demonstrate an association between the amount of negative affect induced by immoral behaviors and their attributional weight. Studies 3 and 4 provide causal evidence for this idea by either “adding in” or “taking away” the negative affect associated with immoral behaviors to influence their attributional weight. Finally, Study 5 demonstrates that negative affect can be induced through a variety of negative emotions (disgust, sadness, and fear), with similar results. It is argued that it is difficult to account for these data solely on the basis of traditional cognitive variables, and so a theory that includes an emphasis on affect as a causal variable is desirable.
Effective Leadership in Salient Groups: Revisiting Leader-Member Exchange Theory From the Perspective of the Social Identity Theory of Leadership
Authors: Hogg Michael A. , Martin Robin , Epitropaki Olga , Mankad Aditi , Svensson Alicia , Weeden Karen
Published: June 2005

Two studies compared leader-member exchange (LMX) theory and the social identity theory of leadership. Study 1 surveyed 439 employees of organizations in Wales, measuring work group salience, leader-member relations, and perceived leadership effectiveness. Study 2 surveyed 128 members of organizations in India, measuring identification not salience and also individualism/collectivism. Both studies provided good support for social identity predictions. Depersonalized leader-member relations were associated with greater leadership effectiveness among high-than low-salient groups (Study 1) and among high than low identifiers (Study 2). Personalized leadership effectiveness was less affected by salience (Study 1) and unaffected by identification (Study 2). Low-salience groups preferred personalized leadership more than did high-salience groups (Study 1). Low identifiers showed no preference but high identifiers preferred depersonalized leadership (Study 2). In Study 2, collectivists did not prefer depersonalized as opposed to personalized leadership, whereas individualists did, probably because collectivists focus more on the relational self.
Contesting Masculinity’s Makeover: Queer Eye, Consumer Masculinity, and “Straight-Acting” Gays
Authors: Clarkson Jay
Published: June 2005

This article analyzes conflicting and competing discourses about gay masculinities in and about Bravo’s Queer Eye for the Straight Guy. The author analyzes Queer Eye’s normalization of consumer masculinity, which rejects aspects of traditional masculinity and depends on vanity consumption. The author argues that consumer masculinity is at odds with the masculinities that the gay men on StraightActing.com are attempting to uphold. Their interpretations of Queer Eye differ significantly from academic media critic Kylo-Patrick Hart’s interpretation that Queer Eye is the most positive representation of gay men ever. It is in the struggle over mediated masculinity that the men of StraightActing.com find themselves paradoxically aligned with radical conservatives in fearing the impact of Queer Eye on heterosexual audiences but for completely contradictory reasons.
Metonymy and the Metropolis: Television Show Settings and the Image of New York City
Authors: Sadler William J. , Haskins Ekaterina V.
Published: June 2005

This article argues that contemporary portrayals of cityscapes on television create a “postcard effect,” a way of seeing that affords the viewer the pleasureofa tourist gaze. This disposition both reflects and legitimizes a fragmented experience of visiting a location without immersing oneself in the intricacies of its politics and geography. Building on critical urban studies, film theory, semiotics, and critical ethnography, this article analyzes depictions of New York City in five television shows (Seinfeld, Friends, Sex and the City, Felicity, and The Sopranos) to demonstrate how metonymic representations of the city produce a narrative of a tourist destination on display.
Mammographers’ Perception of Women’s Breast Cancer Risk
Authors: Egger Joseph R. , Cutter Gary R. , Carney Patricia A. , Taplin Stephen H. , Barlow William E. , Hendrick R. Edward , D’Orsi Carl J. , Fosse Jessica S. , Abraham Linn , Elmore Joann G.
Published: June 2005

Objective. To understand mammographers’ perception of individual women’s breast cancer risk. Materials and Methods. Radiologists interpreting screening mammography examinations completed a mailed survey consisting of questions pertaining to demographic and clinical practice characteristics, as well as 2 vignettes describing different risk profiles of women. Respondents were asked to estimate the probability of a breast cancer diagnosis in the next 5 years for each vignette. Vignette responses were plotted against mean recall rates in actual clinical practice. Results. The survey was returned by 77% of eligible radiologists. Ninety-three percent of radiologists overestimated risk in the vignette involving a 70-year-old woman; 96% overestimated risk in the vignette involving a 41-year-old woman. Radiologists who more accurately estimated breast cancer risk were younger, worked full-time, were affiliated with an academic medical center, had fellowship training, had fewer than 10 years experience interpreting mammograms, and worked more than 40% of the time in breast imaging. However, only age was statistically significant. No association was found between radiologists’ risk estimate and their recall rate. Conclusion. U.S. radiologists have a heightened perception of breast cancer risk.
How Much Does It Cost to Change the Behavior of Health Professionals? A Mathematical Model and an Application to Academic Detailing
Authors: Gandjour Afschin , Lauterbach Karl Wilhelm
Published: June 2005

Several strategies have shown to be effective at enhancing the implementation of research findings in daily practice. These implementation strategies improve the delivery of preventive or therapeutic care by successfully educating health professionals. On the other hand, little is known about the costs of these implementation strategies. The goal of this article is to present a mathematical model that predicts implementation costs by using published data. As an important feature, the model portrays the relationship between the degree of treatment underuse and implementation costs. Two application examples of outreach programs for the prevention of stroke and coronary disease analyze the relevance of implementation costs with respect to the cost-effectiveness ratio and total costs. They demonstrate that implementation costs may have little impact on the cost-effectiveness ratio but may nevertheless be relevant to a 3rd-party payer who needs to stay within the budget and ensure that care is provided to a large underserved population. The model and its consideration of implementation costs may contribute to a more efficient use of health care resources.
The Cost-Effectiveness of Raising the Legal Smoking Age in California
Authors: Ahmad Sajjad
Published: June 2005

Given evidence that most smokers start smoking before the age of 18 and that smokers who start earlier in life are less likely to quit, policies that reduce or delay initiation could have a large impact on public health. Raising the legal minimum purchase age of cigarettes to 21 may be an effective way for states to reduce youth smoking by making it harder for teens to buy cigarettes from stores and by reducing the number of legal buyers they encounter in their normal social circles. To inform the ongoing debate over this policy option in California, this study provides an evaluation of the cost-effectiveness of raising the state’s legal smoking age to 21. Costs and benefits were estimated from a societal perspective using a dynamic computer simulation model that simulates changes to the California population in age, composition, and smoking behavior over time. Secondary data for model parameters were obtained from publicly available sources. Population health impacts were estimated in terms of smoking prevalence and the change in cumulative quality-adjusted life years (QALYs) to the California population over a 50-year period. Economic impacts were measured in monetary terms for medical cost savings, cost of law enforcement, and cost of checking identification. Compared to a status quo simulation, raising the smoking age to 21 would result in a drop in teen (ages 14-17) smoking prevalence from 13.3% to 2.4% (82% reduction). The policy would generate no net costs, in fact saving the state and its inhabitants a total of $24 billion over the next 50 years with a gain of 1.47 million QALYs compared to status quo. This research should prove useful to California’s policy makers as they contemplate legislation to raise the state’s legal smoking age.