bluuebunny/crossref_metadata_2025 huggingface dataset:
Psychometric Properties of the Eating Disorders Inventory-2 among Women Seeking Treatment for Binge Eating Disorder
Authors: Tasca Giorgio A. , Illing Vanessa , Lybanon-Daigle Vanessa , Bissada Hany , Balfour Louise
Published: September 2003

Psychometric properties of the Eating Disorders Inventory-2 (EDI-2) when used for women with Binge Eating Disorder (BED) are assessed. The EDI-2 was administered to 144 outpatients seeking treatment for BED and 152 outpatients seeking treatment for Bulimia Nervosa (BN). Most EDI-2 scales had acceptable internal consistence for both the BED and BN samples. EDI-2 scales demonstrated adequate stability within a subsample of those with BED who were retested. Confirmatory factor analyses revealed a hypothesized second-order two-factor structure for the original EDI scales for the BED group but not for those with BN. When the provisional EDI-2 scales were included, a two-factor structure was not supported for any group. Some scales differentiated the BED from the BN sample, and the second-order factors correlated with measures of similar constructs. The original EDI scales can be used reliably for those with BED.
Empirical Correlates of Common MMPI-2 Two-Point Codes in Male Psychiatric Inpatients
Authors: Arbisi Paul A. , Ben-Porath Yossef S. , McNulty John L.
Published: September 2003

Empirical correlates of common Minnesota Multiphasic Personality Inventory-2 (MMPI-2) 2-point codes were identified for a sample of 1,213 inpatient men. A comprehensive standardized review of the hospital record was undertaken, and clinically relevant demographic, diagnostic, and behavioral information was extracted from intake summaries obtained prior to administration of the MMPI-2. Nonmutually exclusive psychiatric diagnoses found in the sample included substance abuse or dependence, schizophrenia, depression, bipolar affective disorder, post-traumatic stress disorder, and other anxiety disorders as well as personality disorders. Subsamples consisting of the five most frequently obtained well-defined 2-point code types were selected, and empirical correlates of each code type were then identified and described. Remarkable consistency was found between the empirical correlates of the code types obtained in this study and the correlates of the same code types described by other investigators 40 years ago.
The Relationship of Anger and Social Skills to Psychological Symptoms
Authors: Conger Judith C. , Conger Anthony J. , Edmondson Christine , Tescher Beth , Smolin James
Published: September 2003

The link between anger, social skills, and psychological symptoms was investigated in a college population. Seven hundred and nine individuals were administered the State Trait Anger Expression Inventory, the Anger Inventory, the Social Problem Solving Inventory, the Social Skills Inventory, and a series of questions about the degree to which anger affected their lives. Symptomatology was measured by the Brief Symptom Inventory and served as the criterion measure for a series of multiple regression analyses. Results indicated that both anger and social factors related to measures of psychological distress. Implications of the relationship between anger, social skills, and psychological symptoms are discussed in terms of research and assessment of individuals who may suffer from anger problems.
Three Factors of the Comprehensive System for the Rorschach and their Relationship to Wechsler IQ Scores in an Adolescent Sample
Authors: Wood James M. , Krishnamurthy Radhika , Archer Robert P.
Published: September 2003

Principal axis factor analyses of the Rorschach Comprehensive System (CS) in a clinical sample of 152 adolescents yielded three clearly defined factors: Synthesized Complexity (de-fined by Zf, DQ+, and F%), Productivity (defined by R, D, and Dd), and Form Quality (de-fined by X+%, F+%, and X-%). Variables on the Synthesized Complexity and Form Quality factors were generally correlated with Wechsler Full Scale IQ, Verbal IQ, and Performance IQ scores. Overall, the factors in this adolescent sample replicated factors identified in earlier studies with adults. Implications for clinical practice are discussed.
Normal Range MMPI-A Profiles among Psychiatric Inpatients
Authors: Hilts Darolyn , Moore James M.
Published: September 2003

The present study examined the base rates of normal range Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A) profiles in an inpatient sample and examined the differences between adolescents with apparently valid normal range profiles (all clinical scale T-scores < 60) and those with elevated profiles on prior interventions, reported internalizing and externalizing symptoms, and MMPI-A validity scale scores and other indexes of underreporting. Normal range profiles cannot be adequately explained by a less pathological history prior to hospitalization or by defensiveness. Thirty percent of male and 25% of female adolescents produced valid MMPI-A profiles in which none of the clinical scales were elevated. Both male and female adolescents with normal range profiles were generally less likely to report internalizing symptoms than those with elevated profiles, but both groups report externalizing symptoms. Neither the standard MMPI-A validity scales nor additional validity scales discriminated between profile groups. Clinicians should not assume that normal range profiles indicate an absence of problems.
The Tourette's Disorder Scale (TODS)
Authors: Shytle R. Douglas , Silver Archie A. , Sheehan Kathy Harnett , Wilkinson Berney J. , Newman Mary , Sanberg Paul R. , Sheehan David
Published: September 2003

To address the lack of a simple and standardized instrument to assess overall illness severity of Tourette's disorder (TD), the authors developed and tested a 15-item scale to measure a broad range of common symptoms including tics, inattention, hyperactivity, obsessions, compulsions, aggression, and emotional symptoms. Independent investigators used the 15-item Tourette's Disorder Scale (TODS) to assess 60 TD patients who were taking part in a double-blind placebo-controlled multicenter 8-week treatment study. Interrater reliability, internal consistency, convergent and discriminant validity, and sensitivity to change were examined. The TODS was associated with good interrater reliability, excellent internal consistency, and favorable levels of validity and sensitivity to change. Individual TODS items showed good convergent and discriminant validity against other measures. The TODS is a simple, efficient way for clinicians and parents to rate the severity of multiple symptoms commonly found in patients with Tourette's disorder.
MMPI-2 Validity Scale Characteristics in a Correctional Sample
Authors: McNulty John L. , Forbey Johnathan D. , Graham John R. , Ben-Porath Yossef S. , Black Maureen S. , Anderson Stephen V. , Burlew A. Kathleen
Published: September 2003

The current study investigated the proportion of content-nonresponsive and content-responsive faking Minnesota Multiphasic Personality Inventory-2 (MMPI-2) protocols in a state corrections sample. Participants were 51,486 inmates who completed the MMPI-2 at the time they entered the Ohio Department of Rehabilitation and Correction system. Overall, approximately 79% of the study participants produced valid profiles. Of the entire study sample, 11.3% produced content-nonresponsive profiles, and 9.4% produced content-responsive faking profiles. African Americans produced a higher proportion of content-nonresponsive profiles than Caucasians, and women were slightly more likely than men to produce content-responsive faking profiles. Differences in level of education between African Americans and Caucasians did not account for the disparity in content-nonresponsive profiles. Implications for current practice and future research are discussed.
Sensitivity and Specificity of MMPI-2 Neurologic Correction Factors
Authors: Glassmire David M. , Kinney Dominique I. , Greene Roger L. , Stolberg Ronald A. , Berry David T. R. , Cripe Lloyd
Published: September 2003

A number of Minnesota Multiphasic Personality Inventory-2 (MMPI-2) items have been hypothesized to reflect neurologic symptomatology, rather than psychopathology, among closed-head-injury (CHI) patients. Some investigators have proposed a correction factor interpretive approach, which involves the deletion of such items from the MMPI-2 profile, as a method of reducing the probability of artificial clinical scale elevations due to the symptoms of CHI. The present study employed receiver operating characteristic (ROC) analysis to evaluate the sensitivity and specificity of three correction factors. All three factors demonstrated strong sensitivity when discriminating CHI patients from normal individuals but demonstrated poor specificity when discriminating CHI patients from psychiatric patients. These findings suggest that caution should be applied in using MMPI-2 neurologic correction factors, particularly with patients who might have comorbid psychiatric conditions.
Limiting Inpatient Substance Use Treatment: What are the Consequences?
Authors: Dickey Barbara , Normand Sharon-Lise T. , Drake Robert , Weiss Roger D. , Azeni Hocine , Hanson Annette
Published: September 2003

This study tested whether a managed care policy of substituting outpatient for inpatient treatment of substance use disorders shifted treatment costs to psychiatric providers. This was an observational study, based on administrative data of 25,450 adult disabled Medicaid beneficiaries treated for schizophrenia and major affective disorders. Eighteen percent had a diagnosis of substance use disorder. Multivariate regression was used to determine the odds of having a hospital admission and the relationship of managed care to hospital length of stay and total per person treatment expenditures. Hospital admissions and length of stay for both substance use disorder and psychiatric treatment were reduced, but adults with a dual diagnosis had higher annual expenditures compared to those with only a psychiatric diagnosis. There was no evidence of cost shifting. Although emphasis on outpatient treatment did not result in cost shifting, the combination of sub-stance use disorder and psychiatric illness remains an expensive public health problem.
Nursing Home Staffing, Turnover, and Case Mix
Authors: Harrington Charlene , Swan James H.
Published: September 2003

This study examined the predictors of total nurse and registered nurse (RN) staffing hours per resident day separately in all free-standing California nursing homes (1,155), using staffing data from state cost reports in 1999. This study used a two-stage least squares model, taking into account nursing turnover rates, resident case mix levels, and other factors. As expected, total nurse and RN staffing hours were negatively associated with nurse staff turnover rates and positively associated with resident case mix. Facilities were resource dependent in that a high proportion of Medicare residents predicted higher staffing hours, and a higher proportion of Medicaid residents predicted lower staffing hours and higher turnover rates. Nursing assistant wages were positively associated with total nurse staffing hours. For-profit facilities and high-occupancy rate facilities had lower total nurse and RN staffing hours. Medicaid reimbursement rates and multifacility organizations were positively associated with RN staffing hours.
The Costs and Outcomes of Multifaceted Interventions Designed to Improve the Care of Congestive Heart Failure in the Inpatient Setting: A Review of the Literature
Authors: Balinsky Warren , Muennig Peter
Published: September 2003

Various multifaceted interventions have been developed in response to the overwhelming burden of congestive heart failure and its costs. These interventions range from improvements in the delivery of inpatient care (e.g., by assigning multidisciplinary teams to the care of a patient or ensuring that clinical practice guidelines are followed) to comprehensive discharge planning that includes home health care. While it is intuitive that such interventions improve care, few have been evaluated in randomized controlled trials and fewer still include data on costs. In this article, the authors review the findings of randomized controlled trials of interventions designed to improve the quality of life, decrease hospital admissions, and decrease costs associated with heart disease. They conclude that inpatient-based multifaceted interventions appear to be effective and inexpensive. Future studies should attempt to tease interventions apart to ascertain which are the most effective. Formal cost-effectiveness analyses are also needed.
Is the Promise of Cancer-Screening Programs Being Compromised? Quality of Follow-Up Care after Abnormal Screening Results
Authors: Yabroff K. Robin , Washington Kathleen Shakira , Leader Amy , Neilson Elizabeth , Mandelblatt Jeanne
Published: September 2003

Cancer screening has increased dramatically in the United States, yet in some populations, particularly racial minorities or the poor, advanced disease at diagnosis remains high. One potential explanation is that follow-up of abnormal tests is suboptimal, and the benefits of screening are not being realized. The authors used a conceptual model of access to care and integrated constructs from models of provider and patient health behaviors to review published literature on follow-up care. Most studies reported that fewer than 75 percent of patients received some follow-up care, indicating that the promise of screening may be compromised. They identified pervasive barriers to follow-up at the provider, patient, and health care system levels. Interventions that address these barriers appear to be effective. Improvement of data infrastructure and reporting will be important objectives for policy makers, and further use of conceptual models by researchers may improve intervention development and, ultimately, cancer control.
A Paradigm Shift in Patient Satisfaction Assessment
Authors: Otani Koichiro , Harris Lisa E. , Tierney William M.
Published: September 2003

The authors investigated the relationships between patients' reactions to health care attributes and their overall satisfaction with primary care. The study found the following: (1) patients' overall satisfaction levels are disproportionately influenced by low levels of their reactions (less satisfied) to the primary care attribute, rather than simply aver-aged out among attribute reactions. This is a noncompensatory relationship. (2) The marginal impact of primary care attributes on overall satisfaction decreases at higher levels of patients' reactions (more satisfied) to primary care attributes, indicating a nonlinear relationship. Patients combine their reactions to the health care attributes by means of noncompensatory and nonlinear models to form their overall satisfaction. Decision makers should selectively concentrate training resources on those areas of attributes showing high dissatisfaction rather than attempt to improve an attribute that showed the largest parameter estimate. This approach would not only save resources but result in better out-comes of patient satisfaction.
A Comparative Historical Explanation of the Environmental Policies of Two Woodworkers' Unions in Canada
Authors: Simon Alexander
Published: September 2003

The Industrial Wood and Allied Workers of Canada (IWA) has cooperated with timber corporations in engaging in an anti-environmentalist campaign in British Columbia. In contrast, the Pulp Paper and Woodworkers of Canada (PPWC) has, on occasion, cooperated with environmental organizations. It is contended here that the IWA's history of purging radicals from its ranks, its longstanding policy of cooperating with management, and its relatively undemocratic political structure are the primary reasons for its anti-environmentalist policies. Conversely, the PPWC has never expelled radicals from leadership positions; it has always maintained an adversarial relationship with management; and its political structure is very democratic. Thus, the specific histories and political structures of the PPWC and the IWA are the primary reasons for their different environmental policies. Therefore, it is argued that there is nothing inherent in woodworkers or woodworkers' unions that would preclude them from cooperating with the environmental movement.
Environmental Sociology and the Explanation of Environmental Reform
Authors: Buttel Frederick H.
Published: September 2003

This article makes the case that environmental sociology is in the midst of a significant shift of problematics, from the explanation of environmental degradation to the explanation of environmental reform. In this article, the author suggests that there are four basic mechanisms of environmental reform or improvement: environmental activism/movements, state environmental regulation, ecological modernization, and international environmental governance. He suggests further that although `green consumerism' is one of the most frequently discussed mechanisms of environmental improvement within environmental sociology and in movement discourse, green consumerist arguments generally tend to rest on one or more of the other four mechanisms of environmental reform. One of the main tasks of environmental sociology will be to assess which of these four mechanisms is the most fundamental to environmental reform. The author concludes with the hypothesis that environmental movements and activism are ultimately the most fundamental pillars of environmental reform.
Key Challenges to Ecological Modernization Theory
Authors: York Richard , Rosa Eugene A.
Published: September 2003

We raise four challenges to the claim of ecological modernization theory (EMT) that continued modernization is necessary for ecological sustainability. First, EMT needs to go beyond merely demonstrating that societies modify their institutions in reaction to environmental problems and show that such modifications lead to ecological improvements. Second, EMT must show that late stages of modernizing processes lead to the ecological transformation of production and consumption at relatively high frequency. Third, EMT must demonstrate that industries or firms that are reducing their direct impact on the environment are not contributing to the expansion of negative impacts by other industries or firms. Fourth, EMT must show not only that economies are becoming more resource efficient but also that the pace of increase in efficiency exceeds the pace of increase in overall production. In this article, we review the existing evidence and find that EMT has insufficiently addressed these four issues.
Taxation, License Fees, and New Car Registrations
Authors: Beck John H. , Bennett Randall W.
Published: September 2003

The structure of taxes and license fees on motor vehicles varies widely across the states. In 1997, automobile owners in 12 states and the District of Columbia paid only a fixed license fee independent of the age or value of the vehicle. But statewide license fees in 15 states declined as the value of the car declined, and fees in 6 states declined as the age of the car increased. Furthermore, local personal property taxes based on value applied to automobiles in 17 states. Taxes and license fees based on age or value raise the user cost of newer automobiles compared to older cars. Therefore, people are expected to substitute older model cars for new cars. The authors test this hypothesis by estimating a regression with the ratio of new car registrations to total registered automobiles as the dependent variable, using cross-sectional data for 1997 car registrations. The empirical results confirm their hypothesis.
The Uneasy Case Against Discriminatory Excise Taxation: Soft Drink Taxes in Ireland
Authors: Bahl Roy , Bird Richard , Walker Mary Beth
Published: September 2003

This study uses an empirical case study to investigate the revenue implications of reducing a discriminatory excise tax. The case study is Ireland, which provides a natural experiment because it has both imposed and removed such a discriminatory tax (on soft drinks) in the past two decades. The authors find that soft drink consumption is price elastic, income elastic, and sensitive to weather. They estimate that 30% of the amount of surrendered excise tax revenue is recaptured by the value-added tax and income tax. The remaining 70% loss is further reduced by a small reduction in welfare costs, elimination of administration costs, and reduced compliance costs. The rate-revenue curve has a negative slope, even though demand is price elastic, presumably because marginal costs are rising and the tax reduction is not fully captured in the price reduction. In effect, the authors find undershifting and no evidence of a Laffer effect.
The Efficiency of Race- and Gender-Targeted Income Transfers
Authors: Cushing Matthew J. , McGarvey Mary G.
Published: September 2003

In this article, the authors quantify the potential efficiency gains from moving toward an income redistribution system that bases transfers on membership in demographic groups such as race and gender. They compute four measures of the marginal efficiency cost (MEC) of redistribution under a standard linear income tax and under a policy that tags specific demographic groups. The authors find that a tagging system can significantly lower the MEC of redistribution. At the margin, a system of tagging demographic groups achieves the goal of greater income equality at a significantly lower cost in terms of lost output.
Jacking Up the Jackpot: Are Lotto Consumers Fooled by Annuity Payments?
Authors: Matheson Victor A. , Grote Kent R.
Published: September 2003

State lotteries typically pay lotto jackpot winners with annuity payments over a 20- to 30-year period. Because lottery associations advertise the jackpot to be the nominal sum of these payments, lottery associations can increase the size of the advertised jackpot simply by increasing the annuity length. Because ticket sales increase with the size of the advertised jackpot, longer annuity lengths should lead to higher ticket sales. The results suggest that lotto players are not fooled by this sleight of hand so that lottery associations cannot increase revenues by artificially inflating the advertised jackpot in this manner.
Benefit-Cost Analysis: A Pedagogical Note
Authors: Cohn Elchanan
Published: September 2003

All major pubic finance texts offer some treatment of benefit-cost analysis. The typical treatment, however, glosses over the welfare economic foundations of modern benefit-cost analysis and therefore denies the student a broader view of the subject. The student might be misled to believe that, although some difficulties arise in the application of the benefit-cost techniques, the basic idea of conducting benefit-cost analysis is relatively noncontroversial. In addition, almost all textbooks give an incomplete treatment to the ranking of alternative projects, comparisons of alternative decision criteria, and other problems associated with benefit-cost analysis. This article attempts to address some of these gaps.
Quality of Life Measurement and its Use in the Field of Learning Disabilities
Authors: Lefort Shelley , Fraser Mary
Published: September 2003

Quality of life (QOL) is currently a popular and challenging concept within the field of learning disabilities. In this article the measurement of QOL and the challenges involved are examined through Raphael's debates. This includes detailed discussion on objective and subjective measures, value-based and value-free approaches, and traditional versus participatory approaches. The major issue of using self-reports or proxies to gather and measure QOL data is discussed. A short case study demonstrates the authors' experience of administering a particular QOL instrument. The article concludes with a brief review of the future of QOL, and emphasizes the belief that research and practice should involve all individuals concerned.
The Impact of Training and Staff Attributions on Staff Practice in Learning Disability Services
Authors: McKenzie Karen , Sharp Kirstin , Paxton Donna , Murray George C.
Published: September 2003

The present study examines the impact of a training course which has previously been found to significantly increase the knowledge of staff working in learning disability services on staff attributions and practice. No significant changes were found in staff (n = 39) attributional dimensions following training. However, a decrease in the use of the attributional category `communication deficit' was found 8 weeks after training. Staff rated their knowledge levels as higher both immediately following training and 8 weeks later. The subgroup (n = 14) of staff who were examined in relation to staff practice were found to change their practice significantly from baseline to follow-ups 4 and 5 months later. Methodological limitations and implications of the study are discussed.
Challenging Behaviours among Children with Intellectual Disability
Authors: Padencheri Seema , Russell Paul S. S.
Published: September 2003

Hope helps in coping among parents with intellectually disabled children. This study compared the level of hope among parents of such children with and without challenging behaviour. The participants were parents of children with multiple, single and no challenging behaviours. These three groups were compared for their total and subscale hope scores with analysis of variance. Multiple regression analysis was conducted with the total hope score as the dependent variable. The results showed that hopelessness was related to challenging behaviour. The post hoc test showed different levels of hopelessness between parents in challenging behaviour groups in relation to the control group. In particular, only the parents of intellectually disabled children who had multiple challenging behaviours had significantly lower hope scores than the other two groups. Multimodal parental attitude intervention models should address the role challenging behaviours play in contributing to hopelessness among parents.
Time Spent Caregiving for Persons with the Dual Disability of Down's Syndrome and Alzheimer's Dementia
Authors: Mccarron M. , Gill M. , Lawlor B. , Begley C.
Published: September 2003

Persons with Down's syndrome (DS) are at increased risk of Alzheimer's type dementia (AD) compared with the general population. Little attention has been paid to the current and future impact of AD on caregivers and clients in residential and community settings. The present study sought to test if the Caregiver Activity Survey-Intellectual Disability (CAS-ID) would be useful in measuring time spent by professional caregivers aiding persons with DS and AD. Preliminary findings suggest that staff caregiving time increases significantly when a person with DS experiences symptoms of dementia. No significant differences were reported in time spent caregiving for subjects at mid-stage versus end-stage dementia; however, the nature and tasks of caregiving change as dementia progresses. This study supports the utility of the CAS-ID in measuring time spent caregiving for persons with AD and DS. Care providers must plan appropriate models of health and social care to effectively address these needs.
Staff Attributions about the Causes of Challenging Behaviours
Authors: Grey Ian M. , McClean Brian , Barnes-Holmes Dermot
Published: September 2003

Staff attributions for challenging behaviour are purported to relate to staff responses to such behaviour. To elucidate this relationship, much recent work has relied on eliciting staff attributions to written descriptions of a client engaging in challenging behaviour. However, current attribution theory suggests that eliciting attributions in relation to written descriptions is likely to be qualitatively different from attributions to known clients with challenging behaviour. Thirty-four staff completed the Challenging Behaviour Attribution Scale (CHABA) with respect to a client with whom they worked before, during and after completing a longitudinal course in assessment and intervention for challenging behaviour. Significantly more staff attributed challenging behaviour to negative reinforcement and self-stimulation after training. There was a significant reduction in the number of staff attributing challenging behaviour to positive reinforcement after training. However, a number of deficiencies in the CHABA were identified which may render interpretations inconclusive.
The Perceptions of Experienced Community Learning Disability Nurses of their Roles and Ways of Working
Authors: Boarder John H.
Published: September 2003

In Wales, 20 experienced Community Learning Disability Nurses (CLDNs) each with over 5 years of working in community settings were interviewed in order to ascertain how they perceived their roles and ways of working. They described a diverse range of activities that included addressing the health, social, psychological and educational needs of people with learning disabilities. Whereas job satisfaction appeared high, a need to better communicate their role to others was identified, along with the need for a more targeted approach to their practice. They reported an aim to establish a stronger health identity with closer links to the Primary Health Care Team. Whereas it was felt that the CLDN role was valuable, some of those interviewed were unsure as to its long-term survival. It was also noted that there was an inconsistency across localities as to how the skills of CLDNs were being used, for example, in relation to the provision of residential services and services for children.
Th1, Th2, and activated T-cell marker and clinical prognosis in peripheral T-cell lymphoma, unspecified: comparison with AILD, ALCL, lymphoblastic lymphoma, and ATLL
Authors: Tsuchiya Takeshi , Ohshima Koichi , Karube Kennosuke , Yamaguchi Takahiro , Suefuji Hiroaki , Hamasaki Makoto , Kawasaki Chika , Suzumiya Junji , Tomonaga Masao , Kikuchi Masahiro
Published: September 2003

A new World Health Organization classification was recently proposed. However, classification of peripheral T-cell lymphomas remains to be clarified. Particularly, unspecified type was considered as a heterogeneous category. Here we studied the expressions of chemokine receptors, Th1-associated CXCR3 and CCR5 and Th2-associated marker ST2(L), and activated T-cell receptor OX40/CD134 in 185 patients with nodal T-cell lymphoma, and evaluated the relationship to prognosis. Their expression patterns correlated with the specific subtype of nodal T-cell lymphoma, such as angioimmunoblastic T-cell lymphoma (AILD), anaplastic large cell lymphoma (ALCL), and in peripheral T-cell lymphoma (PTCL), unspecified. In AILD, almost all cases were immunoreactive for OX40/CD134 (96%) and for CXCR3 (89%). In ALCL, all cases were immunonegative for OX40/CD134, and only a few cases (24%) were immunoreactive for CXCR3, whereas almost all cases (94%) were positive for ST2(L). Cases of PTCL, unspecified, were divided into 2 groups; group 1 (cases positive for either ST2(L), CCR5, or CXCR3) tended to show favorable prognosis compared with group 2 (cases negative for ST2(L), CCR5, and CXCR3). Our results indicate that further subtyping of PTCL, unspecified, into groups 1 and 2 could be significant for evaluating prognosis and understanding the functional role of these tumors.
Graft-versus-leukemia reactions in allogeneic chimeras
Authors: Kolb Hans-Jochem , Schmid Christoph , Barrett A. John , Schendel Dolores J.
Published: September 2003

There is a strong graft-versus-leukemia (GVL) effect of allogeneic stem cell transplantation (SCT) due to elimination of tumor cells by alloimmune effector lymphocytes. When leukemia relapses after allogeneic SCT, donor lymphocyte transfusions (DLTs) can induce sustained remissions in some patients. This review summarizes the current status on clinical use of DLT, the basis of GVL reactions, problems associated with this therapy, and new strategies to improve DLT. Several multicenter surveys demonstrated that the GVL effect of DLT is most effective in chronic myelogenous leukemia (CML), whereas it is less pronounced in acute leukemia and myeloma. Cytokine stimulation to induce differentiation of myeloid progenitor cells or to up-regulate costimulatory molecules on tumor cells may improve the efficacy of DLT. Infections and graft-versus-host disease (GVHD) are major complications of DLT. Control of GVHD may be improved using suicide gene–modified T cells for DLT, allowing T-cell elimination if severe GVHD develops. Hopefully, in the future, GVL effect can be separated from GVHD through adoptive transfer of selected T cells that recognize leukemia-specific antigens or minor histocompatibility antigens, which are expressed predominantly on hematopoietic cells, thereby precluding attack of normal tissues. In patients with leukemia and lymphomas with fast progression, tumor growth may outpace development of effector T cells. Here it may be preferable to select stem cell transplant donors with HLA-mismatches that allow alloreactive natural killer cells, which appear early after transplantation, to retain their cytolytic function. New approaches for adoptive immune therapy of leukemia, which promise a better prognosis for these patients, are being developed.
Neutrophil-derived MMP-9 mediates synergistic mobilization of hematopoietic stem and progenitor cells by the combination of G-CSF and the chemokines GROβ/CXCL2 and GROβT /CXCL2Δ4
Authors: Pelus Louis M. , Bian Huimin , King Andrew G. , Fukuda Seiji
Published: September 2003

Mobilized peripheral blood stem cells (PBSCs) are widely used for transplantation, but mechanisms mediating their release from marrow are poorly understood. We previously demonstrated that the chemokines GROβ/CXCL2 and GROβT/CXCL2Δ4 rapidly mobilize PBSC equivalent to granulocyte colony-stimulating factor (G-CSF) and are synergistic with G-CSF. We now show that mobilization by GROβ/GROβT and G-CSF, alone or in combination, requires polymorphonuclear neutrophil (PMN)–derived proteases. Mobilization induced by GROβ/GROβT is associated with elevated levels of plasma and marrow matrix metalloproteinase 9 (MMP-9) and mobilization and MMP-9 are absent in neutrophil-depleted mice. G-CSF mobilization correlates with elevated neutrophil elastase (NE), cathepsin G (CG), and MMP-9 levels within marrow and is partially blocked by either anti–MMP-9 or the NE inhibitor MeOSuc-Ala-Ala-Pro-Val-CMK. Mobilization and protease accumulation are absent in neutrophil-depleted mice. Synergistic PBSC mobilization observed when G-CSF and GROβ/GROβT are combined correlates with a synergistic rise in the level of plasma MMP-9, reduction in marrow NE, CG, and MMP-9 levels, and a coincident increase in peripheral blood PMNs but decrease in marrow PMNs compared to G-CSF. Synergistic mobilization is completely blocked by anti–MMP-9 but not MeOSuc-Ala-Ala-Pro-Val-CMK and absent in MMP-9–deficient or PMN-depleted mice. Our results indicate that PMNs are a common target for G-CSF and GROβ/GROβT-mediated PBSC mobilization and, importantly, that synergistic mobilization by G-CSF plus GROβ/GROβT is mediated by PMN-derived plasma MMP-9.
The Accuracy of Predicting Cardiac Arrest by Emergency Medical Services Dispatchers: The Calling Party Effect
Authors: Garza Alex G. , Gratton Matthew C. , Chen John J. , Carlson Brent
Published: September 2003

Objectives: To analyze the accuracy of paramedic emergency medical services (EMS) dispatchers in predicting cardiac arrest and to assess the effect of the caller party on dispatcher accuracy in an advanced life support, public utility model EMS system, with greater than 90,000 calls and greater than 60,000 transports per year. Methods: This was a retrospective analysis from January 1, 2000, through June 30, 2000, of 911 calls with dispatcher‐assigned presumptive patient condition (PPC) or field diagnosis of cardiac arrest. Sensitivity and positive predictive value (PPV) of the PPC code for cardiac arrest by calling parties were calculated. Homogeneity of sensitivity and PPV of the PPC code for cardiac arrest by calling parties was studied with chi‐square analysis. Relevant proportions, relative risk ratios, and associated 95% confidence intervals (95% CIs) were calculated. Student's t‐test was used to compare quality assurance scores between calling parties. Results: There were 506 patients included in the study. Overall sensitivity for dispatcher‐assigned PPC of cardiac arrest was 68.3% (95% CI = 63.3% to 73.0%) with a PPV of 65.0% (95% CI = 60.0% to 69.7%). There was a significant difference in the PPV for the EMS dispatcher diagnosis of cardiac arrest depending on the type of caller (χ2= 17.34, p < 0.001). Conclusions: A higher level of medical training may improve dispatch accuracy for predicting cardiac arrest. The type of calling party influenced the PPV of dispatcher‐assigned condition.
Accuracy of Emergency Physician Assessment of Left Ventricular Ejection Fraction and Central Venous Pressure Using Echocardiography
Authors: Randazzo Marco R. , Snoey Eric R. , Levitt M. Andrew , Binder Kevin
Published: September 2003

Objectives: Emergency department (ED) bedside echocardiography may offer useful information on cardiac function and volume status. The authors evaluated the accuracy of emergency physician (EP) performance of echocardiography in the assessment of left ventricular ejection fraction (LVEF) and central venous pressure (CVP). Methods: The authors conducted a cross‐sectional observational study at an urban teaching ED, involving a convenience sample of patients presenting to the ED between September 2000 and February 2001. Level III–credentialed EP sonographers who had undergone a three‐hour training session in limited echocardiography, focusing on LVEF and CVP measurement, performed echocardiograms. Vital signs and indication for echocardiography were documented on a study data sheet. LVEF was rated as poor (<30%), moderate (30%–55%), or normal (>55%) and an absolute percentage. Central venous pressure categories included low (<5 cm), moderate (5–10 cm), and high (>10 cm). Formal echocardiograms were obtained within a four‐hour window on all patients and interpreted by a staff cardiologist. Correlation analysis was performed using the κ correlation coefficient for LVEF and CVP categories and a Pearson correlation coefficient for LVEF measurement. Results: A total of 115 patients were assessed for LVEF, and 94 patients had complete information for CVP. Indications for echocardiography included chest pain (45.1%), congestive heart failure (38.1%), dyspnea (5.7%), and endocarditis (10.6%). Results showed a LVEF correlation of r2= 0.712 with 86.1% overall agreement. Subgroup analysis revealed the highest agreement (92.3%) between EP and formal echocardiograms within the normal LVEF category, followed by 70.4% agreement in the poor LVEF category and 47.8% in the moderate LVEF category. Central venous pressure measurements resulted in 70.2% overall raw agreement between EP and formal echocardiograms. Subgroup analysis revealed the highest agreement (83.3%) within the high CVP category followed by 66.6% in the moderate and 20% in the low categories. Conclusions: Experienced EP sonographers with a small amount of focused additional training in limited bedside echocardiography can assess LVEF accurately in the ED.
Classroom Injuries in Utah Public Schools
Authors: Kramer Michael D. , Lightfoot Amy C. , Knight Stacey , Cazier Calvert F. , Olson Lenora M.
Published: September 2003

Objectives: School injuries are a serious public health problem, yet classroom injuries have received little attention. The purpose of this study was to describe the epidemiology of classroom injuries in Utah public schools. Methods: Utah statewide school injury data on kindergarten through 12th grade students for 1996 through 1998 were used. The data were generated from a standardized Student Injury Report (SIR) form completed by school personnel for injuries that (1) caused loss of at least one half of a day of school or (2) warranted medical attention and treatment. Injuries occurring in laboratories, shop, and physical education classes were excluded. To determine the medical outcome and charges associated with classroom injuries, the authors probabilistically linked the SIR database to Utah statewide emergency department (ED) records and Utah statewide hospital inpatients discharge records for 1996 through 1998. Results: During the period 1996 through 1998, there were 1,366 classroom injuries. Nearly two thirds of the injuries occurred to male students. More than half the classroom injuries were related to equipment use. Weapon use was rare. Twenty percent of students injured in the classroom obtained treatment in an ED, where 71% of these injuries were determined to involve the head, neck, and upper extremity. Two incidents, one involving carbon monoxide and the other tear gas, accounted for 11% of the ED admissions. Conclusions: Classroom injuries are not sufficiently frequent, severe, or costly to justify special studies focused solely on acute injuries in standard classrooms. This does not negate the need for continued surveillance of classroom injuries along with other school injuries.
American Society of Clinical Oncology 2003 Update on the Role of Bisphosphonates and Bone Health Issues in Women With Breast Cancer
Authors: Hillner Bruce E. , Ingle James N. , Chlebowski Rowan T. , Gralow Julie , Yee Gary C. , Janjan Nora A. , Cauley Jane A. , Blumenstein Brent A. , Albain Kathy S. , Lipton Allan , Brown Susan
Published: September 2003

Purpose: To update the 2000 ASCO guidelines on the role of bisphosphonates in women with breast cancer and address the subject of bone health in these women.

Results: For patients with plain radiographic evidence of bone destruction, intravenous pamidronate 90 mg delivered over 2 hours or zoledronic acid 4 mg over 15 minutes every 3 to 4 weeks is recommended. There is insufficient evidence supporting the efficacy of one bisphosphonate over the other. Starting bisphosphonates in women who demonstrate bone destruction through imaging but who have normal plain radiographs is considered reasonable treatment. Starting bisphosphonates in women with only an abnormal bone scan but without evidence of bone destruction is not recommended. The presence or absence of bone pain should not be a factor in initiating bisphosphonates.

In patients with a serum creatinine less than 3.0 mg/dL (265 μmol/L), no change in dosage, infusion time, or interval is required. Infusion times less than 2 hours with pamidronate or less than 15 minutes with zoledronic acid should be avoided. Creatinine should be monitored before each dose of either agent in accordance with US Food and Drug Administration (FDA) labeling.

Oncology professionals, especially medical oncologists, need to take an expanded role in the routine and regular assessment of the osteoporosis risk in women with breast cancer. The panel recommends an algorithm for patient management to maintain bone health.

Conclusion: Bisphosphonates provide a supportive, albeit expensive and non–life-prolonging, benefit to many patients with bone metastases. Current research is focusing on bisphosphonates as adjuvant therapy. Although new data addressing when to stop therapy, alternative doses or schedules for administration, and how to best coordinate bisphosphonates with other palliative therapies are needed, they are not currently being investigated.
Epidermal Growth Factor Receptor in Non–Small-Cell Lung Carcinomas: Correlation Between Gene Copy Number and Protein Expression and Impact on Prognosis
Authors: Hirsch Fred R. , Varella-Garcia Marileila , Bunn Paul A. , Di Maria Michael V. , Veve Robert , Bremnes Roy M. , Barón Anna E. , Zeng Chan , Franklin Wilbur A.
Published: September 2003

Purpose: The epidermal growth factor receptor (EGFR) is frequently overexpressed in non–small-cell lung carcinoma (NSCLC), and EGFR inhibitors are promising new therapeutic agents. The molecular mechanisms responsible for EGFR overexpression are poorly understood.

Materials and Methods: Gene copy number and protein status of EGFR were investigated in microarrayed tumors from 183 NSCLC patients, including squamous cell carcinoma (SCC; 89 patients) and non-SCC (94 patients) histologies. Protein expression was assessed by immunohistochemistry on a scale from 0 to 400 (percentage of positive cells × staining intensity). Gene and chromosome 7 copy numbers were identified by fluorescent in situ hybridization (FISH).

Results: EGFR protein overexpression was observed in 62% of the NSCLC (25% scored 201 to 300; 37% scored 301 to 400), more frequently in SCC than non-SCC (82% v 44%; P < .001), and in 80% of the bronchioloalveolar carcinomas. The prevalent FISH patterns were balanced disomy (40%) and trisomy (38%) for EGFR gene and chromosome 7 (40%), whereas balanced polysomy was seen in 13% and gene amplification was seen in 9% of the patients. Gene copy number correlated with protein expression (r = 0.4; P < .001). EGFR overexpression or high gene copy numbers had no significant influence on prognosis.

Conclusion: EGFR overexpression is frequent in NSCLC, is most prominent in SCC, and correlates with increased gene copy number per cell. High gene copy numbers per cell showed a trend toward poor prognosis. It will be important to evaluate EGFR gene and EGFR protein status and signal protein expression to properly interpret future clinical trials using EGFR inhibitors.
Manipulation of stem cell proliferation and lineage commitment:visualisation of label-retaining cells in wholemounts of mouse epidermis
Authors: Braun Kristin M. , Niemann Catherin , Jensen Uffe B. , Sundberg John P. , Silva-Vargas Violeta , Watt Fiona M.
Published: September 2003

Mammalian epidermis is maintained by stem cells that have the ability to self-renew and generate daughter cells that differentiate along the lineages of the hair follicles, interfollicular epidermis and sebaceous gland. As stem cells divide infrequently in adult mouse epidermis, they can be visualised as DNA label-retaining cells (LRC). With whole-mount labelling, we can examine large areas of interfollicular epidermis and many hair follicles simultaneously, enabling us to evaluate stem cell markers and examine the effects of different stimuli on the LRC population. LRC are not confined to the hair follicle, but also lie in sebaceous glands and interfollicular epidermis. LRC reside throughout the permanent region of the hair follicle,where they express keratin 15 and lie in a region of high α6β4 integrin expression. LRC are not significantly depleted by successive hair growth cycles. They can, nevertheless, be stimulated to divide by treatment with phorbol ester, resulting in near complete loss of LRC within 12 days. Activation of Myc stimulates epidermal proliferation without depleting LRC and induces differentiation of sebocytes within the interfollicular epidermis. Expression of N-terminally truncated Lef1 to block β-catenin signalling induces transdifferentiation of hair follicles into interfollicular epidermis and sebocytes and causes loss of LRC primarily through proliferation. We conclude that LRC are more sensitive to some proliferative stimuli than others and that changes in lineage can occur with or without recruitment of LRC into cycle.
Maternalmacho-1is an intrinsic factor that makes cell response to the same FGF signal differ between mesenchyme and notochord induction in ascidian embryos
Authors: Kobayashi Kenji , Sawada Kaichiro , Yamamoto Hiroki , Wada Shuichi , Saiga Hidetoshi , Nishida Hiroki
Published: September 2003

An extracellular signaling molecule acts on several types of cells, evoking characteristic and different responses depending on intrinsic factors in the signal-receiving cells. In ascidian embryos, notochord and mesenchyme are induced in the anterior and posterior margins, respectively, of the vegetal hemisphere by the same FGF signal emanating from endoderm precursors. The difference in the responsiveness depends on the inheritance of the posterior-vegetal egg cytoplasm. We show that macho-1, first identified as a localized muscle determinant, is also required for mesenchyme induction, and that it plays a role in making the cell response differ between notochord and mesenchyme induction. A zygotic event involving snailexpression downstream of maternal macho-1 mediates the suppression of notochord induction in mesenchyme precursors.