bluuebunny/crossref_metadata_2025 huggingface dataset:
The pregnant surgeon
Authors: Cross KLR
Published: March 2006

With increasing numbers of women in surgery, and greater numbers becoming surgical registrars, pregnancy in surgical trainees is something surgical directorates and medical staffing are having to deal with. As one of the first female registrars to present the large district general hospital that I was working at with this 'problem', I found there was little information available on risk assessment of the job and advice on what was safe and acceptable practice. More concerning, however, was the negative feedback I received from my peers. In this article I have tried to highlight some of the evidence and guidelines for safe working practice in surgery.
Postgraduate programmes leading to recognised credit-rated qualifications
Authors: Drake Sharon
Published: March 2006

There is a growing recognition by healthcare professionals of the need to ensure their skills are kept up to date. While mandatory continuing professional development has enforced this to some extent within dentistry, the numbers of practitioners going on to undertake further postgraduate education and training through the completion of credit-rated certificates, diplomas and Master of Science degrees is increasing.
Specialist development or cheap locum?
Authors: Freudmann Matt
Published: March 2006

Many of us find it increasingly difficult to follow the plans for the 'reform' and development of the medical profession and surgical training in particular. Luckily, there are those among us who continue to follow these plans. We are again indebted to Matt Freudmann, president of the British Orthopaedic Trainees Association (BOTA), for keeping us informed. The BOTA website can be found at http://www.bota.org.uk/. This month's article concerns the new Specialist Development Scheme, a 12-month service appointment with some training activity and supervision. The individuals will work at specialist or consultant level. Mr Freudmann explores some of the opportunities and threats that such a scheme may bring.
Policy responses to crisis: the case of the UK firefighters’ dispute
Authors: Dinan William , Ford Allison , McConnell Allan , Pyper Robert
Published: March 2006

English

This article seeks to examine the UK government's policy responses to the 2002–04 firefighters’ dispute, a prolonged crisis which necessitated the activation of the central government's contingency planning procedures for a public safety emergency. The framework for analysis draws on a set of key criteria against which governmental and organisational policy responses to crises can be categorised: agenda management, centralisation of policy responses, decentralisation of policy responses, bureaucratic politics and strategic evasion. The article shows that the sum total of all these patterns is a strong Westminster-centric response, rather than one that is more differentiated or ‘hollowed out’.
Traumatised by peace? A critique of five assumptions in the theory and practice of conflict-related trauma policy in Northern Ireland
Authors: Gilligan Chris
Published: March 2006

English

In recent years there has been a growing international recognition of the impact of violent conflict on mental health and a growth in interventions to deal with what have come to be referred to as the psychosocial dimensions of conflict. Mental health interventions are widely understood to be a crucial feature of contemporary peace building. This article critically examines the intersection of these two developments – peace building and psychosocial dimensions of conflict – as they have been articulated in relation to dealing with conflict-related trauma during the peace process in Northern Ireland.
The revaluation of council tax bands: more than rearranging the deck chairs
Authors: Jones Colin , Leishman Chris , Orr Allison M.
Published: March 2006

English

The article contributes to debate on the future of the council tax by focusing on the revaluation of council tax bands. Originally, no revaluations were foreseen and as yet none has occurred in Britain. The article argues there is a strong equity argument for frequent revaluations. An assessment of the potential impact of a revaluation is undertaken for a sample area of 11 local authority areas in Scotland. This research finds that, while addressing the equity issue, a revaluation is likely to create more disruption to local government, personal finances and the housing market than revaluations within a capital value-based tax system.
Change in the policy community of human genetics: a pragmatic approach to open governance
Authors: Salter Brian , Jones Mavis
Published: March 2006

English

The 1999 Review of biotechnology regulation required the policy community of human genetics to introduce a new and open approach to governance. In implementing this policy of self-reform, the policy community is obliged to reconcile conflicting political demands from the policy networks of civil society, science and industry as it seeks to establish and maintain the legitimacy of the new regulatory apparatus. Drawing on documentary and interview evidence, this article explores how policy community change may be limited and structured by its existing culture and policy networks in ways not predicted by existing theory.
Getting a policy to ‘stick’: centralising control of social rent setting in England
Authors: Marsh Alex , Walker Bruce
Published: March 2006

English

The attempts of English central government to control the rents that social housing landlords set for individual properties offer a fruitful example of the role that context and content play in shaping policy implementation. Since the early 1970s there have been three initiatives to assert greater central control over this policy variable. Using a modified version of the conceptual framework proposed by van Meter and van Horn (1975), this article identifies the factors influencing the implementation of each initiative. It concludes by highlighting the role of context, as opposed to the policy design or communication, in getting a policy to ‘stick’.
Developing the public health workforce: a ‘communities of practice’ perspective
Authors: Mallinson Sara , Popay Jennie , Kowarzik Ute , Mackian Sara
Published: March 2006

English

The qualitative research described in this article aims to explore the dynamics of routine public health practice and policy within two local health systems. Using a theoretical framework drawn from social science and management literatures on ‘communities of practice’ (Wenger, 1998), we seek to illuminate the values and ideas that shape the way in which public health practice and policy making is ‘done’ on a routine basis. In particular, we suggest that people's narratives about their daily work resonate with the concepts of engagement, peripheral participation and marginalisation used in the communities of practice literature.
Workforce diversity in the public sector: an evaluation of the performance of English local authorities
Authors: Andrews Rhys , Boyne George A. , Walker Richard M.
Published: March 2006

English

The increased recognition of diversity within Western democracies has resulted in particular attention being paid to the representativeness of staff within public organisations. However, little systematic research has been conducted into workforce diversity in public organisations in the UK. In this article we develop criteria of performance on workforce diversity, and analyse the Best Value Performance Indicators for 2001–03 to evaluate whether employment in English local government is equitable with respect to gender, minority ethnicity and disability. Our analysis shows that the relative performance of councils varies markedly, depending on the dimension of diversity and the criterion of performance that is applied.
Policy process, governance and democracy in the EU: the case of the Open Method of Coordination on social inclusion in Germany
Authors: Friedrich Dawid
Published: March 2006

English

Many scholars attach normative expectations to the Open Method of Coordination (OMC), a new European governance instrument, with regard to its ability to decrease the EU's democratic deficit by creating a participatory policy process. This article argues that the existing OMC literature insufficiently relates the normative expectations with empirical research by scrutinising the policy process of the OMC on social inclusion with regard to their openness and participative character, taking the National Action Plans in Germany as an example. The empirical results are discussed in light of the normative expectations on the OMC's democratic potential.
Why the spontaneous images created by the hands during talk can help make TV advertisements more effective
Authors: Beattie Geoffrey , Shovelton Heather
Published: March 2006

The design of effective communications depends upon an adequate model of the communication process. The traditional model is that speech conveys semantic information and bodily movement conveys information about emotion and interpersonal attitudes. But McNeill (2000) argues that this model is fundamentally wrong and that some bodily movements, namely spontaneous hand movements generated during talk (iconic gestures), are integral to semantic communication. But can we increase the effectiveness of communication using this new theory? Focusing on advertising we found that advertisements in which the message was split between speech and iconic gesture (possible on TV) were significantly more effective than advertisements in which meaning resided purely in speech or language (radio/ newspaper). We also found that the significant differences in communicative effectiveness were maintained across five consecutive trials. We compared the communicative power of professionally made TV advertisements in which a spoken message was accompanied either by iconic gestures or by pictorial images, and found the iconic gestures to be more effective. We hypothesized that iconic gestures are so effective because they illustrate and isolate just the core semantic properties of a product. This research suggests that TV advertisements can be made more effective by incorporating iconic gestures with exactly the right temporal and semantic properties.
Assessing the Requirement for the 6-Hour Interval between Specimens in the American Heart Association Classification of Myocardial Infarction in Epidemiology and Clinical Research Studies
Authors: MacRae Andrew R , Kavsak Peter A , Lustig Viliam , Bhargava Rakesh , Vandersluis Rudy , Palomaki Glenn E , Yerna Marie-Jeanne , Jaffe Allan S
Published: March 2006

Background: The American Heart Association (AHA) case definition for acute myocardial infarction (AMI) requires an “adequate set” of biomarkers: 2 measurements of the same marker at least 6 h apart. A sensitive troponin assay might detect significant changes in concentration earlier. We determined AMI prevalence, using protocols with shorter intervals between measurements, with and without incorporating the time from onset of symptoms.

Methods: The AHA case definition was used to retrospectively assign a diagnosis in 258 patients presenting to the emergency department with symptoms of cardiac ischemia. AMI was diagnosed if either specimen in an adequate set had a cardiac troponin I (cTnI) above the 99th percentile (AccuTnI® >0.04 μg/L; Beckman Coulter) with a ≥20% change in concentration between specimens. We assessed positivity for AMI after progressively decreasing the time interval between specimens in specimen sets. In addition, for each patient, 2 additional specimen pairs were selected: pairs collected at least 1 h apart with 1 specimen being either ≥3 h after onset or ≥6 h after onset.

Results: When we used the AHA definition, the AMI prevalence was 35.7%. Prevalence was not significantly diminished when the interval between specimens was ≥5, ≥4, or ≥3 h (36.4%, 34.5%, and 33.7%, respectively) compared with the AHA ≥6 h interval. When the time from onset of symptoms was included in the specimen selection algorithm, a 1-h interval was sufficient provided that at least one specimen was collected ≥6 h after onset (prevalence, 34.1%; P = 0.48 vs AHA definition).

Conclusion: A sensitive cTnI assay in specimen sets with time intervals ≥3 h, or having one specimen ≥6 h after onset, gave an AMI prevalence equivalent to the AHA definition.
Comparison of the Corrosion Fatigue Characteristics of 23Mn-21Cr-1Mo Low Nickel, 22Cr-13Ni-5Mn, and 18Cr-14Ni-2.5Mo Stainless Steels
Authors: Roach MD , Williamson RS , Zardiackas LD
Published: March 2006

The purpose of this study was to evaluate and compare the notched corrosion fatigue (CF) characteristics of a series of stainless steel alloys including 18Cr-14Ni-2.5Mo (ASTM F 138), 22Cr-13Ni-5Mn (ASTM F 1314), and 23Mn-21Cr-1Mo low nickel stainless steel (ASTM F 2229). Evaluation of alloy composition, microstructure, static single cycle mechanical properties, stress corrosion cracking, and smooth sample corrosion fatigue was performed on the same lots of each material in a previous study in our laboratories. Notched CF tensile samples of each alloy were machined using low stress grind techniques to a 2.5 mm notch root diameter (Kt=3.2) and tested at 1 Hz according to ASTM F 1801 in Ringer's solution at 37°C. A minimum of three samples was tested at five tension-tension sinusoidal load levels including a run-out level at 106 cycles. SEM analysis was performed on the fractured surfaces of representative samples of each alloy to characterize and compare the failure mechanisms. Previous evaluation of corrosion fatigue on smooth samples of these alloys found no significant differences in the fracture modes or cycles to failure between the samples run in distilled deionized water and those run in Ringer's solution indicating corrosion fatigue mechanisms were not in effect. However, a significant lowering of fatigue strength was observed for the notched samples of each alloy compared to the smooth samples previously tested. This suggests that even though the notch sensitivity of these alloys under static single cycle conditions has been shown to be acceptable, a notch under dynamic fatigue mechanisms may cause a substantial reduction in strength and implant life. Despite this reduction in fatigue strength, in high strength applications where the implant must be bent during surgery or may be scratched during implantation BioDur 108 proved to be the best alternative. For lower strength applications, 316LS revealed the least fatigue notch sensitivity of any of the alloys tested.
Thermal Residual Stress Relaxation in Powder Metal IN100 Superalloy
Authors: Buchanan DJ , John R , Ashbaugh NE
Published: March 2006

Relaxation of shot peen induced compressive residual stresses due to thermal exposure was measured using X-ray diffraction. The material used in this study was a hot isostatically pressed (HIP) powder metal (PM) IN100 nickel base superalloy. A total of 14 IN100 samples were shot peened to an Almen intensity of 6A using MI-170-R shot with 125 % coverage. The sample dimensions were nominally 16×13×4-mm thick with an irradiated X-ray region of 8×5 mm. Residual stress measurements were made at the surface and at nominal depths of 12, 25, 50, 75, 125, 175, 250, and 350 microns. The shot peened samples were thermal exposed at two temperatures (650, 704°C) and a range of exposure times (0.5–300 h). Residual stress measurements on shot peened samples without thermal exposure were used as a basis for comparison. The relaxation of shot peened compressive residual stresses under purely thermal loading was examined. The residual stresses exhibited an initial rapid decrease on the surface and in the depth at both temperatures. However, continued thermal exposure produced little or no change in surface residual stresses while peak compressive stresses in the depth continued to relax with time at both temperatures. In all cases of this study the retained peak compressive residual stress after thermal exposure was greater than 50 % of the baseline value.
Experimental Evaluation of the J or C* Parameter for a Range of Cracked Geometries
Authors: Davies CM , Kourmpetis M , O'Dowd NP , Nikbin KM
Published: March 2006

In the current ASTM Standard Test Method for Measurement of Creep Crack Growth Rates in Metals (E 1457) the experimental C* parameter is related to the load and creep load line displacement rate through the geometry related η factor. In this work η factors for a range of geometries are presented. The geometries examined are the compact tension specimen, C(T), single edge notch specimen in tension, SEN(T), and bending, SEN(B), double edge notch specimen in tension, DEN(T), middle crack specimen in tension, M(T) and the C-shaped specimen in tension CS(T). Calculations have been performed for a linear elastic-power law hardening material but the resulting η factors are applicable to either power law plastic or power law creeping materials. Values for ηLLD and ηCMOD, based on the load line displacement and crack mouth opening displacement, respectively, have been determined. A wide range of crack depths, 0.1⩽a/W⩽0.7, where a is crack length and W is specimen width, and hardening exponents, 3 ⩽N ⩽10, under plane stress and plane strain conditions have been examined using the finite element method. The influence of specimen length, crack length, material properties and out of plane stress state on the η factor has also been considered. It has been found that for shallow cracks the value of η depends quite strongly on the exponent, N in the material power law, regardless of whether η is defined based on the load line displacement or crack mouth opening displacement. The ηLLD factor has also been found to be strongly sensitive to plane stress/strain conditions imposed, a/W and specimen length, whereas ηCMOD depends more weakly on a/W and is almost independent of specimen length for the cases examined. There is, however, no clear trend in these variations over the range of specimen geometries and a/W examined. These results are found to be consistent with those in the literature. Recommendations are made regarding the most appropriate values for η, depending on the specimen type and geometry while taking into account the variability due to the material properties, out of plane stress state and variations between the numerical analyses.
Residue Analysis on Implants
Authors: Luginbuehl R , Gasser B , Frauchiger V
Published: March 2006

Process agent residues on implant surfaces have become the center of attention after implant failures that were clearly attributed to problems of contamination and cleanliness during manufacturing. The success of modern implants depends strongly on the quality control after manufacturing since a minor degree of contamination may generate increased inflammation of the wound. Therefore, process and quality control requires tools to identify and quantify contaminations on implant surfaces. We evaluated a series of analytical methods, including gas chromatography and mass spectrometry analysis, thin layer chromatography, total organic carbon, and x-ray photoelectron spectroscopy, regarding their suitability for the different type of residues. The focus was put on extraction of soluble non-polar organic agents and subsequent analysis. All methods were assessed with internal standard contamination oil that contains a variety of surface-active agents used in common commercial cutting oils and emulsions for medical device machining.
Analysis by cDNA microarrays of gene expression patterns of human adrenocortical tumors
Authors: Slater E P , Diehl S M , Langer P , Samans B , Ramaswamy A , Zielke A , Bartsch D K
Published: March 2006

Objectives: Adrenocortical carcinoma (ACC) is a rare malignant neoplasm with extremely poor prognosis. The molecular mechanisms of adrenocortical tumorigenesis are still not well understood. The comparative analysis by cDNA microarrays of gene-expression patterns of benign and malignant adrenocortical tumors allows us to identify new tumor-suppressor genes and proto-oncogenes underlying adrenocortical tumorigenesis.

Design and methods: Total RNA from fresh-frozen tissue of 10 ACC and 10 benign adrenocortical adenomas was isolated after histologic confirmation of neoplastic cellularity of at least 85%. The reference consisted of pooled RNA of 10 normal adrenal cortex samples. Amplified RNA of tumor and reference was used to synthesize Cy3- and Cy5-fluorescently labeled cDNA in a flip-color technique. D-chips containing 11 540 DNA spots were hybridized and scanned and the images were analyzed by ImaGene 3.0 software.

Results: The comparative analysis of gene expression revealed many genes with more than fourfold expression difference between ACC and normal tissue (42 genes), cortical adenoma and normal tissue (11 genes), and ACC and cortical adenoma (21 genes) respectively. As confirmed by real-time PCR, the IGF2 gene was significantly upregulated in ACCs versus cortical adenomas and normal cortical tissue. Genes that were downregulated in adrenocortical tumors included chromogranin B and early growth response factor 1.

Conclusions: Comprehensive expression profiling of adrenocortical tumors by the cDNA microarray technique is a very powerful tool to elucidate the molecular steps associated with the tumorigenesis of these ill-defined neoplasms. To evaluate the role of identified genes, further detailed analyses, including correlation with clinical data, are required.
Increased micronucleus frequencies in peripheral blood lymphocytes in women with polycystic ovary syndrome
Authors: Yesilada Elif , Sahin Ibrahim , Ozcan Hamdi , Yildirim Ibrahim Halil , Yologlu Saim , Taskapan Cagatay
Published: March 2006

Objective: We aimed to assess possible genomic instability in women with polycystic ovary syndrome (PCOS).

Design: The frequency of micronuclei in cultured peripheral lymphocytes was used as a biomarker of genomic instability in somatic cells.

Methods: Nineteen women, diagnosed with PCOS and 19 healthy female volunteers of corresponding ages and body-mass index (BMI) were included in the study. Micronuclei frequencies were assessed in cytokinesis-blocked lymphocytes.

Results: The frequency of micronucleated cells (per thousand) was 9.00 (5.00) (interquartile range in parentheses) for patient group and 3.0 (3.0) for the control group (P < 0.0001, Mann-Whitney U-test). The serum levels of follicle-stimulating hormone (FSH), estradiol, prolactin, glucose and dehydroepiandrosterone sulfate (DHEAS) and the homeostasis model of assessment of insulin resistance (HOMA-IR) were not different between the two groups (P > 0.05). Serum total testosterone, luteinizing hormone (LH) and insulin levels and hirsutism score in the PCOS group were significantly (P = 0.007, P < 0.0001, P = 0.009 and P < 0.0001 respectively) higher than those of the control group (2.3 (2.1) nmol/l vs 1.7 (0.4) nmol/l; 8.5 (5.88) mU/ml vs 4.8 (4.4) mU/ml; 6.8 (5.1) μU/ml vs 9.7 (4.2) μU/ml; 19.5 (6.5) vs 4.0 (2.5) respectively). However, the mean level of sex hormone-binding globulin (SHBG) in PCOS group was significantly (P = 0.004) lower than in control group (36.4(22.6) nmol/l vs 48.6(25.2) nmol/l respectively).

Conclusion: These findings suggest that women with PCOS have a high incidence of genomic instability, and this condition is positively correlated with the hirsutism score, BMI, LH and serum total testosterone and insulin levels, and is negatively correlated with SHBG.
Long term control of hypercortisolism with fluconazole: case report and in vitro studies
Authors: Riedl Michaela , Maier Christina , Zettinig Georg , Nowotny Peter , Schima Wolfgang , Luger Anton
Published: March 2006

Objectives: To evaluate the efficacy of fluconazole as an alternative treatment for controlling hypercortisolism in Cushing’s syndrome and to determine its effect on glucocorticoid production in vitro.

Design: Case report and in vitro study in a University Clinic.

Case: An 83 year old patient presented with recurrence of Cushing’s syndrome due to pulmonary metastases three years after unilateral adrenalectomy. During a near fatal episode of sepsis she was started on fluconazole 200 mg/day intravenously which normalised cortisol excretion. The therapy was continued orally for 18 months. Upon temporary discontinuation and reintroduction of treatment, cortisol levels increased and normalized, respectively. At month 16, fluconazole had to be increased to a dose of 400 mg/day to keep cortisol excretion in the normal range. Disease progression was slow and no side effects occurred.

In vitro results: Fluconazole in a concentration of 500 μM nearly abolished corticosterone production over 24 h from the adrenal adenoma cell line Y-1 (8.6 ± 0.5% compared with control, P < 0.0001) and significantly reduced corticosterone production in concentrations of 50 μM (48.3 ± 1.9% vs. control, P < 0.0001) and 5 μM (80.5 ± 8.5% vs. control, P < 0.05).

Conclusion: These results demonstrate for the first time that fluconazole normalises cortisol concentrations in vivo in a patient with Cushing’s syndrome with adrenal carcinoma and inhibit glucocorticoid production in vitro in a cell line. Thus, fluconazole might be useful in controlling glucocorticoid excess in Cushing’s syndrome and because of its lower toxicity might be preferable to ketoconazole.
Pediatric renal allograft transplantation does not normalize the increased cortisol/cortisone ratios of chronic renal failure
Authors: Schroth Michael , Plank Christian , Rauh Manfred , Dörr Helmuth-Günther , Rascher Wolfgang , Dötsch Jörg
Published: March 2006

Objective: The conversion of cortisol (F) to cortisone (E) is catalyzed by 11beta-hydroxysteroid dehydrogenase type 2 (11β-HSD2). Children suffering from chronic renal failure (CRF) have a decreased activity of 11β-HSD2 contributing to increased arterial blood pressure. The objective was to investigate whether a normal conversion of F to E is achieved after renal transplantation (TX) in children.

Methods: Fifteen children with CRF, 17 children with steroid-free immunosuppression after TX, and 18 healthy controls (CO) were enrolled. The activity of 11β-HSD2 in plasma was calculated using the ratio of F/E determined by tandem mass spectrometry, the ratio of tetrahydrocortisol (THF) +5α-tetrahydrocortisol (5αTHF) in urine determined by gas chromatography/mass spectrometry, and the ratio of (THF +5αTHF)/tetrahydrocortisone (THE) in urine determined by tandem mass spectrometry.

Results: The F/E ratio (mean ± s.d./s.e.m.) was significantly higher in CRF and TX (5.6 ± 1.9/0.6, 7.12 ± 3.1/0.9) than in CO (1.18 ± 0.2/0.03, P < 0.0001) groups. The (THF + 5αTHF)/THE ratio in CRF (1.19 ± 1.1/0.5) and TX (1.19 ± 0.1/0.5) groups was significantly higher than in controls (0.21 ± 0.05/0.18, P < 0.0001). Positive correlations between plasma and urinary ratios (P = 0.0004. R2 = 0.73 in CRF, P = 0.0013, R2 = 0.56 in TX, P < 0.0001, R2 = 0.66 in CO) were found, whereas significant correlations between F/E or (THF + 5αTHF)/THE ratios and blood pressure, the number of antihypertensive drugs taken or creatinine clearance could not be found.

Conclusions: In all children with chronic renal failure plasma and urinary cortisol/cortisone ratios are elevated and do not return to normal levels after renal allograft transplantation. This suggests that renal transplantation does not normalize 11β-HSD2 activity.
Bexarotene increases uptake of radioiodide in metastases of differentiated thyroid carcinoma
Authors: Liu Ying Y , Stokkel Marcel P , Pereira Alberto M , Corssmit Eleonora P , Morreau Hans A , Romijn Johannes A , Smit Johannes W A
Published: March 2006

Objective: Treatment options for metastases of differentiated thyroid carcinoma (DTC) are limited due to decreased uptake of radioiodide (I-131). Therefore, strategies to improve I-131 uptake are mandatory. It has been suggested that retinoids have beneficial effects on iodide uptake in vitro and in humans. However, to date, only studies with 13-cis-retinoic acid have been performed in humans. We therefore decided to study the effects of 6 weeks of treatment with the retinoid X receptor activator bexarotene on I-131 uptake in patients with metastatic DTC.

Design: Open prospective intervention study.

Methods: Twelve patients with metastases of DTC, with insufficient uptake of I-131, received 6 weeks of treatment with 300 mg bexarotene/day. Prior to, and after this intervention, I-131 uptake was measured by whole-body scintigraphy and single photon emission tomography (SPECT) 3 days after 185 MBq I-131. Diagnostic imaging was preceded by two consecutive injections of recombinant human TSH.

Results: Bexarotene treatment induced I-131 uptake in metastases of 8 out of 11 patients (one patient died for reasons not related to the study). However, uptake was only discernable at SPECT and had incomplete matching with metastases as visualized by CT scanning.

Conclusions: Bexarotene partially restores I-131 uptake in metastases of DTC. The clinical relevance of this observation may be limited due to the differential responses of the different metastases within each patient and the low intensity of I-131 uptake.
Quality of life in patients with benign thyroid disorders. A review
Authors: Watt Torquil , Groenvold Mogens , Rasmussen Åse Krogh , Bonnema Steen Joop , Hegedüs Laszlo , Bjorner Jakob Bue , Feldt-Rasmussen Ulla
Published: March 2006

The importance of patient-reported outcomes such as health-related quality of life (HRQL) in clinical research is increasingly acknowledged. In order to yield valid results, the measurement properties of HRQL questionnaires must be thoroughly investigated. One aspect of such a validation process is the demonstration of content validity, i.e. that the questionnaire covers all relevant aspects. We review studies reporting on consequences of thyroid disorders and present the frequency of identified aspects, both overall HRQL issues and classical thyroid symptoms, in order to evaluate which issues are relevant for patients with thyroid diseases. Furthermore, existing questionnaires for thyroid patients are reviewed. A systematic search was performed in the Medline, Cinahl and Psycinfo databases and the reference lists of the relevant articles were hand-searched. Seventy-five relevant studies were identified. According to these studies, patients with untreated thyroid disease suffer from a wide range of symptoms and have major impairment in most areas of HRQL. Furthermore, the studies indicate that impairments in HRQL are also frequent in the long term. Six HRQL questionnaires for thyroid patients were identified. Generally, data supporting the validity of these questionnaires were sparse. According to the available literature, the quality of life of thyroid patients is substantially impaired over a wide range of aspects of HRQL in the untreated phase and continues to be so in many patients also in the long term. Studies systematically exploring the relative importance of these various aspects to thyroid patients are lacking, as is a comprehensive, validated thyroid-specific HRQL questionnaire.
Positive effects of a physiological dose of GH on markers of atherogenesis: a placebo-controlled study in patients with adult-onset GH deficiency
Authors: Bollerslev Jens , Ueland Thor , Jørgensen Anders P , Fougner Kristian J , Wergeland Ragnhild , Schreiner Thomas , Burman Pia
Published: March 2006

Objective: GH deficiency is associated with an increased cardiovascular mortality. Fifty-five patients with adult-onset GH deficiency (AO-GHD) (24 female, 31 male, mean age 49 years) were enrolled in a placebo-controlled double-blind crossover study to investigate the effects of GH therapy on a variety of cardiovascular risk factors representing different aspects of atherogenesis, including apolipo-proteins (Apo A-1, Apo B), markers of subclinical inflammation (high-sensitivity C-reactive protein (CRP) and interleukin-6) and markers of endothelial function (intercellular adhesion molecule-1, von Willebrand factor and sCD40L (a pro-atherogenic factor and marker for plaque destabilization)).

Methods: GH therapy was individually dosed to obtain an IGF-I concentration within the normal range for age and sex. GH and placebo were administered for 9 months each, separated by a 4 month washout period.

Results: The final mean dose of GH was 50% higher for women and IGF-I increased to the same level in both sexes. Compared with placebo, substitution with GH showed a significant effect on Apo B (mean change −0.15 (−0.22 to −0.08) mg/l) and CRP (−1.8 (−3.3 to −0.3) mg/l). The baseline level of and change in IGF-I during treatment with GH contributed significantly to the improvement in both markers. No effects were found on interleukin-6 or Apo A-1, or on markers of endothelial function. No gender differences were observed for any of the markers at baseline or following intervention.

Conclusions: GH substitution to naïve patients with AO-GHD at a low, individually titrated dose aiming at normalizing IGF-I was followed by significant reductions in Apo B and CRP, indicating a positive effect of GH on cardiovascular risk.
The effects of the aromatase inhibitor anastrozole on bone metabolism and cardiovascular risk indices in ovariectomized, androgen-treated female-to-male transsexuals
Authors: Bunck Mathijs C M , Toorians Arno W F T , Lips Paul , Gooren Louis J G
Published: March 2006

Objective: Cases of men with estrogen resistance and aromatase deficiency have highlighted the effects of estrogens on bone metabolism, the cardiovascular system and biochemical variables of the metabolic syndrome. In eugonadal men, administration of an aromatase inhibitor induces a substantial elevation of LH and testosterone due to the decreased negative-feedback signal of estrogen and may thwart the interpretation of results. As there is no gonad for LH to act on, no increase of serum testosterone concentration will be seen in female-to-male transssexuals. The aim of this study was to investigate the effects of estrogen deprivation on bone metabolism and vascular parameters without the interference of counter-regulatory effects as seen in eugonadal men.

Design: Thirty ovariectomized female-to-male transsexuals participated in this double-blind, randomized trial. During 3 months, subjects received the aromatase inhibitor anastrozole 1 mg/day (n = 16) or a placebo (n = 14) in addition to parenteral testosterone esters (Sustanon 250 every 2 weeks).

Results: Serum 17β-estradiol (E2) concentration fell significantly from 134.0 ± 78.8 to 77.7 ± 130.6 pmol/l compared with placebo (P < 0.01). LH and FSH levels rose without the rise of testosterone levels observed in eugonadal men. Within the placebo group, E2 remained at baseline levels. Of the endpoint variables measured (bone metabolism and vascular parameters) no significant changes were observed compared with placebo, or within the anastrozole-treated group.

Conclusions: These results may indicate that the negative effects of estrogen deprivation in men only become manifest when the concentration falls below the levels induced by our intervention with anastrozole (77 pmol/l). This assumption is supported by the observation in the anastrozole group that, although effects of the reduction of serum E2 on vascular parameters could not be demonstrated in subjects as a group, there was a correlation between individual serum E2 and several vascular parameters.
Effect of a 4 week physical training program on plasma concentrations of inflammatory markers in patients with abnormal glucose tolerance
Authors: Oberbach Andreas , Tönjes Anke , Klöting Nora , Fasshauer Mathias , Kratzsch Jürgen , Busse Martin W , Paschke Ralf , Stumvoll Michael , Blüher Matthias
Published: March 2006

Objective: Subclinical chronic inflammation could be a unifying factor linking type 2 diabetes (T2D) and atherosclerosis. The beneficial effects of physical activity on a reduced risk of coronary heart disease could at least in part be mediated by improved markers of inflammation.

Research design and methods: The aim of this study was to determine the effect of 4 weeks of physical training on plasma concentrations of interleukin (IL)-6, C-reactive protein (CRP), adiponectin and IL-10 in 60 individuals with normal glucose tolerance, impaired glucose tolerance (IGT) or T2D.

Results: In patients with IGT and T2D, significant improvement in body fat, fitness level, glucose metabolism and insulin sensitivity after 4 weeks of physical training was associated with significantly improved plasma concentrations of adiponectin and CRP, but not IL-6. Regression analysis demonstrated only for the anti-inflammatory parameters adiponectin and IL-10 a significant relationship with the decrease in fasting plasma glucose, whereas changes in IL-6 and CRP were not significantly related to changes in fasting plasma glucose, body fat, maximal oxygen uptake, or insulin sensitivity. In a multivariate linear regression analysis, only changes in circulating adiponectin, fasting plasma glucose and percentage body fat were determinants of changes in insulin sensitivity.

Conclusions: Physical training was associated with a near normalization of adiponectin and CRP plasma concentrations in subjects with IGT and T2D. Increased insulin sensitivity after training was most strongly related to changes in adiponectin plasma concentrations, in fasting plasma glucose and percentage body fat, whereas changes in IL-6, IL-10 and CRP plasma concentrations did not significantly contribute to improved insulin sensitivity.
UV Effects on Marine Planktonic Food Webs: A Synthesis of Results from Mesocosm Studies
Authors: Belzile Claude , Demers Serge , Ferreyra Gustavo A. , Schloss Irene , Nozais Christian , Lacoste Karine , Mostajir Behzad , Roy Suzanne , Gosselin Michel , Pelletier Emilien , Gianesella Sônia M. F. , Vernet Maria
Published: March 2006

UV irradiance has a broad range of effects on marine planktonic organisms. Direct and indirect effects on individual organisms have complex impacts on food‐web structure and dynamics, with implications for carbon and nutrient cycling. Mesocosm experiments are well suited for the study of such complex interrelationships. Mesocosms offer the possibility to conduct well‐controlled experiments with intact planktonic communities in physical, chemical and light conditions mimicking those of the natural environment. In allowing the manipulation of UV intensities and light spectral composition, the experimental mesocosm approach has proven to be especially useful in assessing the impacts at the community level. This review of mesocosm studies shows that, although a UV increase even well above natural intensities often has subtle effects on bulk biomass (carbon and chlorophyll), it can significantly impact the food‐web structure because of different sensitivity to UV among planktonic organisms. Given the complexity of UV impacts, as evidenced by results of mesocosm studies, interactions between UV and changing environmental conditions (e.g. eutrophication and climate change) are likely to have significant effects on the function of marine ecosystems.
A Comparative Pilot Study on Ultraviolet‐induced Skin Changes Assessed by Noninvasive Imaging Techniques in Vivo
Authors: Gambichler Thilo , Huyn Julia , Tomi Nordwig S. , Moussa Georg , Moll Cornelia , Sommer Anna , Altmeyer Peter , Hoffmann Klaus
Published: March 2006

The effects of acute and chronic ultraviolet (UV) on the morphology of human skin have been extensively studied ex vivo by means of histological investigations. However, innovative skin imaging techniques enable visualization of micromorphological structures in vivo. We aimed to perform a correlation study evaluating in vivo dose and time dependent skin changes following solar‐simulated irradiation using noninvasive techniques such as optical coherence tomography (OCT) and confocal laser scanning microscopy (CLSM). The forearms of 10 healthy subjects were exposed to 1 minimal erythema dose (MED) and 3 MED of solar‐simulated radiation. Noninvasive measurements were performed before and 24 h and 72 h after UV exposures. We demonstrate definite OCT and CLSM findings obtained from UV‐exposed skin, including an increase in epidermal thickness (hyper‐proliferation, acanthosis), a reduction in dermal reflectivity (dermal edema), an increase in brightness of the basal layer (pigmentation), and an increase in vessel diameter within the dermal papillae (vasodilatation). A moderate to strong linear association between the methods employed was observed. In conclusion, noninvasive high‐resolution imaging techniques such as OCT and CLSM may be promising tools for photobiological studies aimed at assessing photoadaptive and/or phototoxic processes in vivo. However, larger studies are needed to demonstrate the applicability of the findings presented in this pilot study.
Influence of Planarity and Size on Guest Binding with Sodium Cholate Aggregates
Authors: Waissbluth Oscar L. , Morales Marlene C. , Bohne Cornelia
Published: March 2006

Bile salt aggregates are supramolecular structures with two types of binding sites, called primary and secondary sites. The objective of this work was to explore how the nonplanarity and size of guests (biphenyl [BP], 1‐1′‐binaphthyl [BNP] and dibenz[b,f]oxepin [DBX]) affected their binding affinity and dynamics to sodium cholate (NaC) aggregates. Fluorescence and laser‐flash photolysis experiments were performed to obtain information on the binding environment for the guests, the accessibility of quenchers to guests in the aggregate and the dissociation rate constants of the guests from the aggregates. All guests were bound to the more hydrophobic primary aggregate, showing that this site can accommodate nonplanar molecules. However, the structure of the guest affects the structure of the primary aggregates, leading to changes in the accessibility of anions to aggregate‐bound guests and to changes for the guest dissociation rate constants from the aggregates.
Creating demand for urban sanitation in sub-Saharan Africa
Authors: Obika A. E. U. , Cotton A. P. , Mkanga M.
Published: March 2006

Every hour, over 500 children die in Africa mainly due to diarrhoeal diseases. Human excreta is the principal cause of diarrhoea, which can be prevented by the installation and use of hygienic latrines, improved water supplies and hygiene practices. The number of people without access to basic sanitation facilities globally is over 2·6 billion, mainly in sub-Saharan Africa and Asia. The impact and public health risk of poor sanitation are more acute in urban communities as these tend to be more populated with less space to dispose of excreta and wastewater. Rapid urbanisation in sub-Saharan Africa has made the task of providing sanitation even more challenging for municipal engineers and other professionals. An action research project aimed at applying a marketing approach to the promotion of household sanitation was carried out between 2002 and 2004, with a pilot project in Dar es Salaam, Tanzania. This paper is one of three papers on sanitation marketing and discusses consumer research for the marketing of household sanitation. It outlines the process that could be used by municipal engineers, non-government organisations and others to understand the demand for sanitation in order to improve public health, particularly in low-income urban settlements. The paper concludes that understanding consumer motivations, constraints and preferences for sanitation is a key factor in increasing the demand and uptake of improved latrines.
Public health reform: lessons from history
Authors: Fisher J. , Cotton A. , Reed B.
Published: March 2006

This is an historical review of the drivers behind the slow development of safe water and sanitation services that took place in Britain during the nineteenth century. Widespread social concern about the living conditions of the poor was combined with more powerful economic incentives to maintain an efficient workforce, and so public health reform was brought about through the joint forces of political reform and specific legislation. Today, the Millennium Development Goals aim to halve by 2015 the one sixth of the world's population that does not have safe water, and the one fifth that has no basic sanitation facilities. An understanding of the historical drivers for change, rather then simply ‘good will’, will help to ensure that these efforts are based on experience, rather than experiment.
Sars and the built environment in Hong Kong
Authors: Baldwin A. N.
Published: March 2006

This paper outlines the chronology and issues relating to the severe acute respiratory syndrome (Sars) epidemic in Hong Kong in 2003. It includes findings from the Sars Expert Committee established by the Government of the Hong Kong Special Administrative Region to review the epidemic. An overview is given of built environment related research that was proposed following the epidemic and outlines of a number of subsequent research initiatives. These initiatives include a major research project that was jointly funded by the Construction Industry Institute of Hong Kong and the Faculty of Construction and Land Use of the Hong Kong Polytechnic University. These findings are reported in more detail. A perspective is given of how the epidemic has changed attitudes to a ‘healthy environment’ in Hong Kong.
Drainage design: factors contributing to Sars transmission
Authors: Jack L.
Published: March 2006

The water-based appliance trap seal is viewed as a standard component within any building drainage system, and provides adequate protection from the miasma present within the network and sewer connection pipework. Suitable system design ensures that the pressure response of the system does not result in excursions from atmospheric that might jeopardise recommended retention levels. Underperformance, as a result of poor system design or maintenance, is typically characterised by the ingress of foul odour—an event that, although unpleasant, was not normally associated with any particular risk to health until the severe acute respiratory syndrome (Sars) outbreak in Hong Kong where 42 fatalities were attributed to transmission facilitated by the building drainage system. A method-of-characteristics-based numerical simulation model that draws upon system specification and operation to predict airflow, transient network pressures and trap seal retention levels, and facilitates an assessment of the factors that contributed to the transmission of the Sars virus, is presented. This paper thus highlights the suitability of unsteady flow simulations as a tool for the prediction of future risk.
Mock‐suspects' decisions to confess: the accuracy of eyewitness evidence is critical
Authors: Kebbell Mark R. , Hurren Emily J. , Roberts Shannon
Published: March 2006

Forty participants were asked to commit a mock‐crime that involved them stealing a cell‐phone. Later the mock‐offenders were questioned and evidence was presented to them from a witness who was said to have seen the offence. Participants were randomly assigned to one of two conditions in which they were presented with a witness statement that either contained detailed information concerning their description and their actions, or not‐detailed information. For half the participants in each condition the information was correct, while for the other half some of the information was incorrect. The results show that participants were more likely to confess if the evidence against them was accurate, but the level of detail of the evidence made no difference. Participants who had accurate evidence presented against them felt more guilty than those who had less accurate evidence against them. The results are discussed in relation to police interviewing techniques. Copyright © 2005 John Wiley & Sons, Ltd.