bluuebunny/crossref_metadata_2025 huggingface dataset:
Metallic stents in large bowel obstruction: experience in a District General Hospital
Authors: Syn Wing‐Kin , Patel M. , Ahmed M. M.
Published: December 2004

Introduction  Metallic stents are used increasingly in the palliation of malignant large bowel obstruction. Stenting has also been used in the setting of acute obstruction, allowing appropriate patient preparation for an elective colectomy.

Methods  Uncovered metallic stents were inserted using a combined endoscopic/radiological technique in patients presenting with large bowel obstruction.

Results  Seventeen patients (10 female, mean age 75.2 years) presented with large bowel obstruction, 14 due to malignancy and 3 secondary to diverticular stricture. Technical success was achieved in 13/17 with clinical success in 12 of these 13. There were no perforations or procedure related deaths. One stented patient had elective surgery. The five patients with clinical/technical failure required emergency surgery.

Conclusion  The result of our preliminary experience in the use of metallic stents is encouraging. Metallic stents should be available in all hospitals as part of a multimodality approach in treating large bowel obstruction.
Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients
Authors: Eriksen M. T. , Wibe A. , Norstein J. , Haffner J. , Wiig J. N. ,   the Norwegian Rectal Cancer Group
Published: December 2004

Objective  Mesorectal excision is successfully implemented as the standard surgical technique for rectal cancer resections in Norway. This technique has been associated with higher rates of anastomotic leakage (AL) and the purpose of this study was to examine AL in a large national cohort of patients.

Methods  This was a prospective national cohort study of 1958 patients undergoing rectal cancer surgery with anterior resection in Norway from November 1993 to December 1999.

Results  The overall rate of AL was 11.6% (228 of 1958 patients). In a multivariate analysis, the risk of AL was significantly higher in males (odds ratio (OR) 1.6, 95% confidence interval (CI) 1.1–2.2), in patients receiving pre‐operative radiotherapy (OR 2.2, CI 1.0–4.7) and in low level (4–6 cm) (OR 3.5, CI 1.6–7.7) and ultra‐low level (≤ 3 cm) anastomoses (OR 5.4, CI 2.3–12.9). The presence of a diverting stoma was associated with a 60% reduction in the risk of AL (OR 0.4, CI 0.3–0.7) for anastomoses 6 cm and below. 30‐day mortality was significantly higher for the patients with AL (7.0%, CI 3.7–10.3) compared with no AL (2.4%, CI 1.7–3.2) AL had no significant effect on local recurrence rate (log rank P = 0.608).

Conclusion  Low anastomoses should be defunctioned to avoid AL and the associated high perioperative mortality. No effect of AL on local recurrence was found in this large cohort.
Multicentre prospective audit of surgical outcomes and acute complications following short course pre‐operative radiotherapy for resectable rectal cancer
Authors: Giridharan S. , Vakkalanka B. , Anwar M. S. , Geh J. I. , Glaholm J. , Churn M. , Adab F. , Grieve R. , McConkey C. , Hartley A.
Published: December 2004

Background  The addition of short course pre‐operative radiotherapy to total mesorectal excision reduces local recurrence in resectable adenocarcinoma of the rectum. In a previous retrospective study potential factors associated with early complications following this combination were identified. The aim of this study was to examine these relationships in a prospective multicentre audit.

Methods  One hundred and seven patients who received short course pre‐operative radiotherapy in four cancer centres between 1 October 2001 and 30 September 2002 were included. Data including patient age, radiotherapy field length, overall treatment time, operation type, surgical outcomes and complications occurring within 3 months of the 1st day of radiotherapy were collected. These were compared and combined with the previously studied cohort of 176 patients treated at one centre between 1st January 1998 and 31st December 1999.

Results  In the prospective cohort only patient age (P = 0.001) was significantly associated with acute complications. However, both the overall treatment time (median 9.0 vs 11.0 days P < 0.0001) and field length (median 16.6 vs 17.0 cm P = 0.03) were significantly shorter in this cohort when compared to the previous retrospective study. In patients from both studies (n = 283), increasing age (P = 0.002) and field length (independent of operation type) (P = 0.02) were independently associated with an increased risk of acute complications.

Conclusions  This study suggests that meticulous selection of patients for short course pre‐operative radiotherapy and smaller planning target volumes may be associated with a lower risk of acute complications. The use of MRI scanning to stage pelvic disease may reduce the number of patients with R1 resections receiving short course pre‐operative radiotherapy.
Laparoscopic anterior resection and uterine manipulation: why make things difficult?
Authors: Varey A. H. R. , Darweish A. , Pandey S. , Dixon A. R.
Published: December 2004

The uterus continues to be a source of difficulty in mobilization of the rectum. These difficulties are compounded in laparoscopic operations, particularly anterior resection, proctectomy and vaginal sacrocolpopexy. Techniques to overcome this have in general proved unsatisfactory. We have adopted a technique of using an extended Vesellum forceps from gynaecological practice and recommend its use by all. The technique is described.
Simple excision and primary closure of pilonidal sinus: a simple modification of conventional technique with excellent results
Authors: Aldean I. , Shankar P. J. , Mathew J. , Safarani N. , Haboubi N. Y.
Published: December 2004

Objective  Pilonidal sinus (PNS) is a common condition, which warrants surgical intervention. A number of surgical options have been suggested with variable recurrence rate. This study proposes a modification of a standard method.

Methods  A total of 51 patients with sacrococcygeal PNS were sequentially treated by the standard method devised by one Consultant Colorectal Surgeon (IA). The principle is based on: 1, after excising the PNS ensure obliteration of the natal cleft by releasing the fat pad from the gluteal fascia; 2, avoid tension and 3, encourage patients to lie on their back immediately after the operation.

Results  Follow‐up was available from 51 patients ranging from 14 to 49 months. All patients were discharged within 48 h. There was only one recurrence, which was successfully treated.

Conclusion  Our results suggest that PNS can be successfully treated by our hitherto undescribed method, patients can be discharged early and there is very low recurrence rate.
Maternal triglyceride levels and newborn weight in pregnant women with normal glucose tolerance
Authors: Di Cianni G. , Miccoli R. , Volpe L. , Lencioni C. , Ghio A. , Giovannitti M. G. , Cuccuru I. , Pellegrini G. , Chatzianagnostou K. , Boldrini A. , Del Prato S.
Published: December 2004

Objective  To determine the predictive value of serum triglyceride levels (TG) for neonatal weight in pregnant women with positive diabetic screening but normal glucose tolerance.

Research design and methods  We enrolled 180 pregnant Caucasian women with positive diabetic screening. All women underwent a 3‐h 100‐g oral glucose tolerance test (OGTT) at 27th ± 4 week of gestation. At the time of OGTT, we measured: fasting plasma glucose, fasting lipids profile and determined ApoE polymorphisms to evaluate the effects on lipid levels. In 83 women with normal glucose tolerance and at term delivery we evaluated the association between maternal serum TG, specific maternal parameters known to affect fetal growth and newborn weight.

Results  Based on OGTT, gestational diabetes mellitus (GDM) was diagnosed in 36 women (20%), impaired glucose tolerance (IGT) in 23 (13%), and normal glucose tolerance (NGT) in 121 (67%). Serum TG concentration was significantly higher in women with GDM (2.47 ± 0.77 mmol/l) as compared with NGT (1.99 ± 0.64 mmol/l) or IGT (1.98 ± 0.81 mmol/l) (P < 0.01). ApoE3 allelic frequency was 86%, ApoE2 and ApoE4 were 5 and 9%, respectively. We found no clear‐cut association between apoE genotype and serum TG concentration. Macrosomia and LGA newborns were more frequent in IGT than in GDM or NGT (P < 0.01). In the 83 women with positive diabetic screening but normal glucose tolerance who delivered at term, the incidence of LGA infants was significantly higher in those with TG levels higher than the 75th percentile (> 2.30 mmol/l) (21%) than in mothers who had normal TG levels (4.5%) (P < 0.05). Pre‐pregnancy BMI (r2 = 0.067), weight gain during pregnancy (r2 = 0.062), fasting serum TG (r2 = 0.09), and 2‐h post‐OGTT glucose levels (r2 = 0.044) were all associated with neonatal body weight (all P < 0.05 or less). However, on a multiple regression analysis, only pre‐pregnancy BMI (F‐test = 7.26, P < 0.01), and fasting serum TG (F‐test = 4.07, P < 0.01) were independently associated with birth weight.

Conclusions  Pre‐pregnancy BMI and fasting maternal serum TG determined in the last trimester of gestation were independently associated with neonatal birth weight in women with normal glucose tolerance, but positive screening test. TG levels measured in the third trimester of pregnancy are independent of the genetic polymorphism of ApoE.
A rational clinical approach to suspected insulin allergy: status after five years and 22 cases
Authors: Bodtger U. , Wittrup M.
Published: December 2004

Aims  Allergy to recombinant human (rDNA) insulin preparations is a rare complication of insulin therapy. However, insulin preparations contain several allergens, and several disorders can resemble insulin allergy. Studies evaluating the diagnostic procedures on suspected insulin allergy are extremely few.

Methods  Since January 1998, we have used a standardized investigative procedure during admittance to the medical ward allowing observation and repeated recording of reactions to intradermal skin test (performed with a commercially available kit containing isolated insulin allergens). Data on all investigated cases until April 2003 were collected retrospectively, and self‐reported efficacy of intervention was compared to clinical data.

Results  Twenty‐two patients were included. In nine (41%) cases, non‐insulin allergic causes were discovered and successfully treated: poor injection technique (n = 5), skin disease (n = 3) and other systemic allergy (n = 1). Nine other patients were found to be allergic to protamine (n = 3) or rDNA insulin (n = 6), and specific treatment was associated with relief in 8 patients (89%). Four patients had local reactions of unknown causes but symptom relief was obtained in three cases by unspecific therapy. Overall, 20 (91%) reported relief of symptoms.

Conclusion  Our standardized investigative procedure of suspected insulin preparation (IP) allergy was associated with relief of symptoms in > 90% of patients. IP allergy was diagnosed in 41%, and intradermal testing with isolated insulin allergens was a prerequisite in identification of culprit allergen and targeting of treatment.
Measurement of insulin sensitivity in Type 2 diabetes mellitus: comparison between KITT and HOMA‐%S indices and evaluation of their relationship with the components of the insulin resistance syndrome
Authors: Inchiostro S.
Published: December 2004

Aims  The identification of alternative methods of the euglycaemic–hyperinsulinaemic clamp to estimate the insulin‐sensitivity is a continuous challenge. The aim of the study was to evaluate the agreement between the short Insulin Tolerance Test (ITT) and the Homeostatic Model Assessment (HOMA), and their relationship with the components of the insulin resistance syndrome, in recently diagnosed Type 2 diabetic patients.

Methods  Two hundred and forty‐seven patients, aged 26–65 years, consecutively recruited, were studied. The subjects underwent the ITT and HOMA tests to calculate the KITT and the HOMA‐%S indices, along with the measurement of the components of the insulin resistance syndrome.

Results  The correlation between KITT and HOMA‐%S was highly significant, but the correlation coefficient and the explained variance were rather low (r = 0.44, R2 = 0.19, P‐value < 0.0001) as well as the agreement among tertiles of the two indices (kappa = 0.26). The strength of the association was similar in subgroups of subjects defined by sex, type of hypoglycaemic therapy, presence of hypertension or antihypertensive therapy, fasting blood glucose, whereas it was better in obese compared with non‐obese patients. Nonetheless, both KITT and HOMA‐%S correlated significantly with the components of the insulin resistance syndrome (P‐value < 0.05–0.001).

Conclusions  The association between HOMA‐%S and KITT was significant but quite low. Therefore the two measures could not be considered interchangeable estimates of insulin sensitivity. However, as both indices showed significant associations with the components of the insulin resistance syndrome, probably they represent different metabolic aspects of the insulin resistance.
Interstitial glucose in skeletal muscle of diabetic patients during an oral glucose tolerance test
Authors: Frossard M. , Blank D. , Joukhadar Ch. , Bayegan K. , Schmid R. , Luger A. , Müller M.
Published: December 2004

Aim  The presence of a transcapillary arterial–interstitial gradient for glucose (AIGglu) in skeletal muscle may be interpreted as a consequence of intact cellular glucose uptake. We hypothesized that the AIGglu decreases in Type 2 diabetes mellitus as a consequence of insulin resistance, whereas it remains intact in Type 1 diabetes.

Methods  Glucose concentrations were measured in serum and interstitial space fluid of skeletal muscle during an oral glucose tolerance test (OGTT) in patients with Type 1 and Type 2 diabetes and in young and middle‐aged healthy volunteers, using microdialysis.

Results  The area under the curve for glucose in serum (AUCSE) was higher than in interstitial space fluid of skeletal muscle (AUCMU) in healthy young (AUCSE = 1147 ± 332 vs. AUCMU = 633 ± 257 mM/min/ml; P = 0.006), healthy middle‐aged volunteers (AUCSE = 1406 ± 186 vs. AUCMU = 1048 ± 229 mM/min/ml; P = 0.001) and in Type 1 diabetic patients (AUCSE = 2273 ± 486 vs. AUCMU = 1655 ± 178 mM/min/ml; P = 0.003). In contrast, in Type 2 diabetic patients AUCSE (2908 ± 1023 mM/min/ml) was not significantly different from AUCMU (2610 ± 722 mM/min/ml; P = NS).

Conclusion  The present data indicate that AIGglu is compromised in Type 2 diabetes in contrast to Type 1 diabetes where it appears to be normal. Because no changes in muscle blood flow were detected, insulin resistance appears to be the main cause for the observed decreased AIGglu in skeletal muscle in Type 2 diabetic patients.
Prevalence of diabetes and impaired glucose regulation in 45‐ to 64‐year‐old individuals in three areas of Finland
Authors: Ylihärsilä H. , Lindström J. , Eriksson J. G. , Jousilahti P. , Valle T. T. , Sundvall J. , Tuomilehto J.
Published: December 2004

Aims  To determine the prevalence of diabetes mellitus (DM), impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) and possible regional differences in Finnish adults aged between 45 and 64 years.

Methods  A population sample of 2642 subjects aged between 45 and 64 years living in three geographical areas in Finland was invited to an oral glucose tolerance test.

Results  The glucose tolerance status of 2087 subjects (79.0%) was determined. The age‐standardized prevalence of DM in men and women was 10.2% and 7.4%, respectively (P = 0.020 for difference between sexes), and that of IGT 10.5% in men and 9.2% in women. IFG in men was more than twice as common as in women (13.5% vs. 5.0%, respectively, P < 0.001). Abnormal glucose tolerance was most common in southern compared with southwestern and eastern Finland. Of all diabetic subjects, 44% were previously undiagnosed.

Conclusions  The age‐standardized prevalence of DM in 45‐ to 64‐year‐old Finns was within the range defined in previous studies on Europid populations. DM and IFG were more common in men than in women. Regional differences in the prevalence of abnormal glucose regulation suggest differences in lifestyle within an ethnically homogenous population.
Chinese Diaspora as a Virtual Nation: Interactive Roles between Economic and Social Capital
Authors: Cheung Gordon C. K.
Published: December 2004

This paper attempts to analyse how and in what ways the Chinese diaspora interacts with globalisation in Southeast Asia through their economic and social capital. It explores the theories of globalisation and contrasts them with the thematic changes of Southeast Asia studies, and it conceptualises the economic power, the geographical dispersal nature and the social networking of Chinese diaspora in order to understand how a virtual nation is being constructed. It then examines empirical studies of that economic power using the specific case of Indonesia; comparative studies of Chinese companies in Southeast Asian countries; and foreign direct investment in China from the Association of Southeast Asian Nations. Finally, it surveys the building of the virtual community through ethnicity, languages, associations and Confucianism, from which social capital has been generated among the Chinese diaspora in Southeast Asia.
The Ambiguities of Reconciliation and Responsibility in South Africa
Authors: Nagy Rosemary
Published: December 2004

This paper traces the ways in which the language of reconciliation promotes and detracts from responsibility. What it means to be responsible and to take responsibility is explored through a reading of J. M. Coetzee's novel, Disgrace. Coetzee provokes a nuanced examination of the nature of reconciliation and responsibility in post-apartheid South Africa, particularly how deep a moral transformation is needed and of whom it should be expected. The tensions between pro forma acknowledgement and deep moral transformation are examined with respect to the competing narratives of reconciliation and responsibility that took place during the Truth and Reconciliation Commission and afterwards in South African civil society. The paper concludes with a warning about the delicate balance between responsibility and vilification, reconciliation and denial.
Rethinking Democratic Procedures: Democracy and Deliberative Experiences in Turkey's LA21 Process
Authors: Doğanay Ülkü
Published: December 2004

This paper attempts to describe the conditions necessary for the furthering of democracy in Turkey by focusing on a certain conception of democratic legitimacy that goes beyond formal arrangements. It argues that the effective participation of citizens in democratic procedures is necessary for the consolidation of democracy in public life. To defend this argument, the theoretical background developed in deliberative models of democracy is followed. The quality of ‘talk’, as a constitutive feature of democracy, is explored by following the critical perspectives in deliberative theory that focus on the discursive mechanisms of exclusion and on power relations intrinsic to deliberative procedures. For this purpose, the deliberative processes in a series of ‘working group meetings’, carried out as a part of the Local Agenda 21 project, are analysed. The democratic capacity of deliberative experiences and public dialogue is analysed by examining the inclusion/exclusion of opposing ideas, different identities and discourse styles during these working groups meetings.
The Universal Welfare State: Theory and the Case of Sweden
Authors: Bergh Andreas
Published: December 2004

In the existing literature on welfare state typologies, the concept of the universal welfare state is not defined precisely enough to allow for comparisons of universality over time and between countries. In this paper, I discuss some problems with the way the term ‘the universal welfare state’ has been used and I suggest possible solutions. Among other things, I propose that the term ‘universality’ be used to describe the provision of a specific welfare benefit independently of individual income and/or other individual characteristics. It should also be used to describe the coverage of welfare benefits rather than their size. Based on the theoretical discussion, a number of possible indicators of universality are applied to the case of Sweden in the 1990s. The conclusion is that, despite its economic crisis, universality in Sweden did not decrease.
Choice, Responsibility and Equality
Authors: Kaufman Alexander
Published: December 2004

Should responsibility for disadvantage constitute a matter of fundamental concern for egalitarians? An important strand of contemporary egalitarian thought – a strand that Elizabeth Anderson calls ‘luck equality’ – argues that responsibility for disadvantage should constitute a decisive concern for any acceptable egalitarian theory. Luck equality therefore requires a defensible account of responsibility; and disagreements regarding the nature and extent of responsibility for disadvantage have become central in the egalitarian literature. Anderson argues that luck equality's focus on responsibility reflects a misunderstanding of the point of equality. If persuasive, her argument would establish that egalitarian thought may do without a defensible account of responsibility. Although she fails to establish this claim, she does argue persuasively that luck equality employs the notion of responsibility overly strenuously. Her critique suggests that egalitarians must qualify their acceptance of the precept that ‘genuine choice excuses otherwise unacceptable inequalities’.
Misoprostol for second trimester pregnancy termination in women with prior caesarean section
Authors: Daskalakis George J. , Mesogitis Spyros A. , Papantoniou Nikolaos E. , Moulopoulos George G. , Papapanagiotou Angeliki A. , Antsaklis Aris J.
Published: December 2004

Objective  To examine whether a previous caesarean section increases the risk for complications in women undergoing a mid‐trimester pregnancy termination by labour induction.

Design  Retrospective analysis of case records between 1997 and 2002.

Setting  Fetal Medicine Unit of a large teaching hospital.

Population  One hundred and eight women with a previous caesarean section (study group) and 216 women without such a history (controls), who underwent a second trimester termination of pregnancy.

Methods  All the terminations were performed between 17 and 24 weeks of gestation by using 400 μg of oral administration of misoprostol in combination with 400 μg of intravaginal misoprostol. The same dose of intravaginal misoprostol was repeated every 6 hours for a maximum of five doses.

Main outcome measures Severe haemorrhage requiring blood transfusion, post‐abortal infection, retained placenta and uterine rupture.

Result  Complications occurred in 16 out of 108 women of the study group (15%) and in 26 out of 216 of the controls (12%), with only one ruptured uterus in the control group.

Conclusion  We found no evidence that a previous caesarean delivery affects the incidence of complications when women with such a history undergo a mid‐trimester pregnancy termination with misoprostol.
Accuracy of fetal echocardiography in the routine detection of congenital heart disease among unselected and low risk populations: a systematic review
Authors: Randall P. , Brealey S. , Hahn S. , Khan K.S. , Parsons J.M.
Published: December 2004

Objective  To determine among unselected and low risk populations the accuracy with which fetal echocardiography during the second trimester detects congenital heart disease.

Design  A systematic review of studies that assess the accuracy of fetal echocardiography.

Setting  District General Hospital and Tertiary referral centres.

Population  Women during the second trimester attending for ultrasound assessment.

Methods  General bibliographic databases (e.g. MEDLINE, EMBASE) and specialist computerised databases (e.g. Cochrane Library, National Research Register), grey literature, manual searching of reference lists of primary and review articles and personal contact with experts were used to identify studies. Studies were included if fetal echocardiography among unselected or low risk pregnant women was compared against a postnatal reference standard. Data were extracted on quality, study design and characteristics, and accuracy data to construct 2 × 2 tables. Data were synthesised qualitatively, and sensitivity and specificity with 95% confidence intervals were calculated.

Main outcome measure  Sensitivity and specificity.

Results  Five primary studies met the inclusion criteria and comprised 60,901 subjects. One study assessed the accuracy of fetal echocardiography among an unselected population and four studies among low risk populations. All eligible studies found that fetal echocardiography helped to correctly diagnose normal fetus among unselected and low risk populations. Correct diagnosis of babies for congenital heart defects was higher among the unselected population (85%) than among the low risk populations (range from 35% to 86%); however, the potential for ascertainment bias and the choice of reference standard limits the validity of this finding. The variation in sensitivity across studies was not explainable by clinical factors such as scanning regime, operator skill and equipment.

Conclusions  The evidence from this review about the accuracy of fetal echocardiography does not lend support to its routine use among unselected and low risk populations during the second trimester to detect congenital heart disease.
Seroprevalence, incidence of prenatal infections and reliability of maternal history of varicella zoster virus, cytomegalovirus, herpes simplex virus and parvovirus B19 infection in South‐Western Finland
Authors: Alanen Anna , Kahala Kaisa , Vahlberg Tero , Koskela Pentti , Vainionpää Raija
Published: December 2004

Objective  To study seroprevalence and incidence and fetal transmission of varicella zoster virus (VZV), cytomegalovirus (CMV), herpes simplex virus (HSV) types 1 and 2 and parvovirus B19 infections during pregnancy and to evaluate the reliability of maternal past history of VZV, HSV and parvovirus infections.

Design  Prospective study of parturient women.

Setting  South‐Western Finland.

Participants  Five hundred and fifty‐eight parturient women.

Methods  IgG and IgM antibodies against VZV, CMV, HSV‐1 and ‐2, and parvovirus B19 were measured from maternal serum in the first trimester and at delivery and from cord serum, mother's own information of her past infections was compared with her serological status.

Main outcome measures  Seroprevalence, seroconversions and fetal transmission of VZV, CMV, HSV and parvovirus B19, reliability of maternal history of VZV, HSV and parvovirus B19.

Results  Seroprevalences were 96.2% for VZV, 56.3% for CMV, 54.3% for HSV, 46.8% for HSV‐1, 9.3% for HSV‐2 and 58.6% for parvovirus B19. Parity was associated with CMV seropositivity, maternal age differed only between HSV‐2 seropositive and seronegative women, while area of residence (urban or rural) had no effect. Six seroconversions were observed: two VZV, one CMV and three parvovirus infections. No cases of primary HSV infections occurred. Fetal transmission was observed in two cases of parvovirus infection. No infants with anti‐CMV IgM antibodies were born to CMV immunised women. False positive history of chickenpox was given only by 1.5% of the women, history of herpes infections was less reliable, and history of parvovirus infection was unreliable.

Conclusions  Seroprevalence and the risk of viral infections during pregnancy cannot be extrapolated from one pregnant population to another.
Smell perception during early pregnancy: no evidence of an adaptive mechanism
Authors: Swallow Brian L. , Lindow Stephen W. , Aye Mo , Masson Ewan A. , Alasalvar Cesarettin , Quantick Peter , Hanna Jon
Published: December 2004

Objective It has been suggested that nausea and vomiting in pregnancy is an evolutionary adaptive mechanism to avoid the ingestion of potentially harmful foods. It has also been suggested that the mechanism that triggers nausea and vomiting in pregnancy may be olfaction and that olfactory senses are invoked to provide this protection. This study aimed to test this theory in a systematic design.

Design Cross sectional study.

Setting The antenatal department of a maternity hospital in the north of England.

Sample Three groups of participants: pregnant women (n= 55), non‐pregnant women (n= 42) and men (n= 48).

Methods Sensitivity was tested towards the odours of six standard stimuli (half safe and half associated with potentially harmful compounds).

Main outcome measures Odour rating of likeness, strength and pleasantness.

Results Pregnant women rated safe and odours with potentially harmful compounds differently but not more so than men or non‐pregnant women. There was no evidence that pregnancy changed the olfactory processes from the non‐pregnant state and only slight differences between pregnant women and men were recorded.

Conclusions There was no evidence that olfactory processes had undergone any adaptation during pregnancy. The ability to differentiate safe from potentially harmful compounds was common to all three groups studied.
Microwave and thermal balloon ablation for heavy menstrual bleeding: a systematic review
Authors: Garside Ruth , Stein Ken , Wyatt Katrina , Round Ali
Published: December 2004

Objective  To compare the effectiveness of two second generation endometrial ablation techniques (microwave and thermal balloon endometrial ablation) with first generation techniques of endometrial ablation to treat heavy menstrual bleeding in women.

Search strategy  We searched the Cochrane Library (issue 3, 2002), the National Research Register, MEDLINE (1966 to August 2002), Embase (1980 to August 2002) and Web of Science Proceedings (all years). We also searched reference lists and contacted experts and manufacturers in the field.

Selection criteria  Randomised controlled trials and controlled trials of microwave endometrial ablation and thermal balloon endometrial ablation versus transcervical resection and rollerball ablation, alone or in combination, to treat heavy menstrual bleeding were included.

Data collection and analysis  Two reviewers independently selected studies for inclusion and extracted data. As there was considerable clinical and methodological heterogeneity among the studies, meta‐analysis was not undertaken and results are presented descriptively.

Results  Two randomised controlled trials of microwave endometrial ablation and eight trials (six randomised controlled trials) of thermal balloon endometrial ablation were included in the review. No significant differences were found between first and second generation techniques in terms of amenorrhoea, bleeding patterns, pre‐menstrual symptoms, patient satisfaction or quality of life. Microwave endometrial ablation and thermal balloon endometrial ablation had significantly shorter operating and theatre times than first generation techniques. Adverse effects were few with all techniques, but there were fewer peri‐operative adverse effects with second generation techniques.

Conclusion  Microwave endometrial ablation and thermal balloon endometrial ablation are alternatives to first generation techniques for treating heavy menstrual bleeding. No head‐to‐head trials of microwave endometrial ablation and thermal balloon endometrial ablation have been undertaken and there is not yet enough evidence of differences in clinical effectiveness between these two techniques.
How useful are ‘millipede’ and other similar porphyroblast microstructures for determining synmetamorphic deformation histories?
Authors: JOHNSON S. E. , BELL T. H.
Published: December 2004

ABSTRACT Oppositely concave microfolds (OCMs) in and adjacent to porphyroblasts can be classified into five nongenetic types. Type 1 OCMs are found in sections through porphyroblasts with spiral‐shaped inclusion trails cut parallel to the spiral axes, and commonly show closed foliation loops. Type 2 OCMs, commonly referred to as ‘millipede’ microstructure, are highly symmetrical, the foliation folded into OCMs being approximately perpendicular to the overprinting foliation. Type 3 OCMs are similar to Type 2, but are asymmetrical, the foliation folded into OCMs being variably oblique to the overprinting foliation. Type 4 OCMs are highly asymmetrical, only one foliation is present, and this foliation is parallel to the local shear plane. Type 5 OCMs result from porphyroblast growth over a microfold interference pattern.

Types 1 and 2 are commonly interpreted as indicating highly noncoaxial and highly coaxial bulk deformation paths, respectively, during porphyroblast growth. However, theoretically they can form by any deformation path intermediate between bulk coaxial shortening and bulk simple shearing. Given particular initial foliation orientation and timing of porphyroblast growth, Type 3 OCMs can also form during these intermediate deformation paths, and are commonly found in the same rocks as Type 2 OCMs. Type 4 OCMs may indicate highly noncoaxial deformation during porphyroblast growth, but may be difficult to distinguish from Type 3 OCMs. Thus, Types 1–3 (and possibly 4) reflect the finite strain state, giving no information about the rotational component of the deformation(s) responsible for their formation. Furthermore, there is a lack of unequivocal independent evidence for the degree of noncoaxiality of deformation (s) during the growth of porphyroblasts containing OCMs. Type 2 OCMs that occur independently of porphyroblasts or other rigid objects might indicate highly coaxial bulk shortening, but there is a lack of supporting physical or computer modelling.

It is possible that microstructures in the matrix around OCMs formed during highly noncoaxial and highly coaxial deformation histories might have specific characteristics that allow them to be distinguished from one another. However, determining degrees of noncoaxiality from rock fabrics is a major, longstanding problem in structural geology.
Petrology of phlogopite‐sapphirine‐bearing Al‐Mg granulites from Ihouhaouene, In Ouzzal, Hoggar, Algeria: an example of phlogopite stability at high temperature
Authors: MOURI H. , GUIRAUD M. , HENSEN B. J.
Published: December 2004

Al‐Mg granulites, with cordierite, garnet, sapphirine, orthopyroxene, sillimanite, spinel, phlogopite, K‐feldspar, plagioclase and variable quartz from Ihouhaouene (In Ouzzal, Algeria), display a range of decompression textures involving the breakdown of orthopyroxene and sillimanite, and of garnet. The succession of parageneses suggests that the P–T–t evolution corresponds to decompression with cooling from peak conditions of about 950°C and 10 kbar. This decompression path is obtained from the paragenetic analysis in the FMAS system. However, according to current KFMASH grids, this P–T–t evolution should take place outside the stability field of phlogopite+quartz; yet this assemblage is probably stable during most of the P‐T evolution, notably during peak metamorphism. This discrepancy is interpreted as the effect of the high content of F in phlogopite which should shift its stability limit towards higher temperature. The consequences of this shift on the phase relationships in the KFeMASH system are investigated and it is concluded that a topological inversion could exist in the F‐bearing system.
An example of ultrahigh‐temperature metamorphism: orthopyroxene–sillimanite–garnet, sapphirine–quartz and spinel–quartz parageneses in Al–Mg granulites from In Hihaou, In Ouzzal, Hoggar
Authors: OUZEGANE K. , BOUMAZA S.
Published: December 2004

Quartz Al–Mg granulites exposed at In Hihaou, In Ouzzal (NW Hoggar), preserve an unusual high‐grade mineral association stable at temperatures up to 1050°C, involving the parageneses orthopyroxene–sillimanite–garnet–quartz, sapphirine–quartz and spinel–quartz. The phase relationships within the FMAS system show that a continuum exists between the earlier prograde reaction textures and those of the later decompressive event. The following mineral reactions involving sillimanite are deduced: (1) Grt+Qtz→Opx+Sil, (2) Opx+Sil→Grt+Spr+Qtz, (3) Grt+Sil+Qtz→Crd, (4) Grt+Sil→Crd+Spr, (5) Grt+Sil+Spr→Crd+Spl, (6) Grt+Sil→Crd+Spl, (7) Grt+Crd+Sil→Spl+Qtz and (8) Grt+Sil→Spl+Qtz. Minerals in quartz Al–Mg granulites display compositional variations consistent with the observed reactions. The Mg/(Mg+Fe2+) range of the main minerals is as follows: cordierite (0.81–0.97), sapphirine (0.77–0.88), orthopyroxene (0.65–0.81), garnet (0.33–0.64) and spinel (0.23–0.56). The reaction textures and the evolution of the mineral assemblages in the quartz Al–Mg granulites indicate a clockwiseP–Ttrajectory characterized by peak conditions of at least 10 kbar and 1050°C, followed by decompression from 10 to 6 kbar at a temperature of at least 900°C.
Trace element and Sm–Nd ‘age’ zoning in garnets from peridotites of the Caledonian and Variscan Mountains and tectonic implications
Authors: BRUECKNER H. K. , BLUSZTAJN J. , BAKUN‐CZUBAROW N.
Published: December 2004

ABSTRACT Ion probe traverses across garnets from peridotites of the Caledonides of Norway and the Variscides of Poland show zoning patterns for Y, V, Zr, Cr, Ti and the REE. The complexly zoned patterns of garnets from the Bystrzyca Górna peridotite, Poland, are interpreted in terms of a changing P–T history (isobaric cooling followed by decompression and cooling). Weak rimward gradients in REE concentrations in garnets from the Almklovdalen and Sandvika peridotites, Norway, may be relicts of the original growth history of the garnets, but the nearly flat Y, V, Zr, Cr and Ti profiles from the same garnets imply a later period of near‐homogenization at uniform P–T. Crushed garnet separates from each body were separated into three or more fractions on the assumption that density and magnetic susceptibility vary with Fe/Mg ratio, and Fe/Mg ratios change from garnet core to rim. Sm‐Nd garnet–clinopyroxene ‘ages’ were determined for each fraction to determine whether they are also zoned. Four garnet fractions from the Góry Sowie peridotite give nearly the same ages (397–412 Ma) that are believed to span the interval of garnet growth. Garnet fractions from the Norwegian peridotites define scattered ages (816–1350 Ma) that are suspect, but hint at a Sveconorwegian equilibration event. The data indicate the Variscan and Norwegian peridotites had different histories, despite superficial mineralogical and tectonic similarities. Norwegian garnet peridotites had a long pre‐Caledonian history and were extracted from a relatively cold mantle whereas the Variscan garnet peridotites had a comparatively short pre‐ or Eo‐Variscan history and were extracted from a hot mantle.
Cleavage of Integrin by μ‐Calpain during Hypoxia in Human Endometrial Cells
Authors: Aoyama Kazufumi , Ozaki Yasuhiko , Nakanishi Tamao , Ogasawara Mayumi S. , Ikuta Katsuo , Aoki Koji , Blomgren Klas , Suzumori Kaoru
Published: December 2004

Problem:  The distribution and activation of μ‐calpain and possible cleavage of integrin in human endometrial cells under hypoxic condition were investigated.

Method of study:  Human endometrial epithelial and stromal cells were subjected to hypoxia, and subsequently used for immunostaining and western blot analysis.

Results:  The proform of μ‐calpain was detected in the cytoplasm of normal cells, and displayed a substantial decrease after hypoxia. Conversely, the active form of μ‐calpain was not detected in normal cells, but was abundant after hypoxia. The cytoplasmic domain of integrin β3 was also detected in the cytoplasm of endometrial cells. Western blot analysis confirmed that both the proform of μ‐calpain and the integrin β3 cytoplasmic domain decreased during hypoxia.

Conclusions:  μ‐Calpain is activated in human endometrial cells during hypoxia and that subsequent cleavage of the integrin β3 cytoplasmic domain may give some adverse effects to the function of human endometrium.
Ecology of Danger‐dependent Cytokine‐boosted Spontaneous Abortion in the CBA × DBA/2 Mouse Model. I. Synergistic Effect of LPS and (TNF‐α + IFN‐γ) on Pregnancy Loss
Authors: Clark David A. , Manuel Justin , Lee Lydia , Chaouat Gerard , Gorczynski Reginald M. , Levy Gary A.
Published: December 2004

Problem:  Previous data have shown ‘danger’ signals, such as bacterial lipopolysaccharide (LPS) acting via toll‐like (tlr) receptors are required for early pregnancy failure in several murine abortion models. Indeed, the abortion rate increased in the CBA × DBA/2 model after a gestation day (gd) 7.5 injection of tumour necrosis factor (TNF)‐α + interferon (IFN)‐γ only if the LPS‐tlr signalling pathway was intact. High rates of cytokine‐boosted abortion >80% loss can be achieved in certain animal colonies, that have a high endogenous (spontaneous) rate of resorption (30–50%). A specific role for LPS has been postulated to determine both the endogenous and cytokine‐boosted losses.

Methods:  To test the role of LPS in spontaneous and cytokine‐boosted abortions, recombinant TNF‐α + IFN‐γ, and LPS were injected in different doses and sequences intraperitoneally (i.p.) into CBA × DBA/2 mated mice in the Toronto General Research Institute animal facility where the endogenous abortion rate is <30%. The effects of poly IC, a tlr3 agonist that induces IFN‐γ that can reverse LPS‐induced tolerance, and effects of anti‐MD‐1 on TNF‐α induction by LPS, poly IC, CPG, or HSP in vitro were also examined.

Results:  A high endogenous rate of loss similar to that seen in Clamart could be achieved by increasing exposure to LPS on the morning after mating (gd 0.5). The magnitude by which the abortion rate could be increased by an i.p. injection of 2000 u TNF‐α + 1000 u IFN‐γ on gd 7.5 was independent of the endogenous rate of loss, and could not be increased by doubling the dose. One microgram of LPS given on day 7.5 achieved a similar rate of loss, and if given with the cytokines, synergistically boosted the rate of loss to near Clamart rates. LPS given 1 day prior to the cytokines abrogated the cytokine effect, whereas LPS given day 0.5 had no significant effect on the response to day 7.5 cytokine injection. Blocking MD‐1 inhibited TNF‐α stimulation by poly IC, LPS, CPG, or HSP in vitro, and reduced abortion rates. Poly IC did not avert LPS‐type tolerance effects in vivo.

Conclusions:  High endogenous rates of abortion in the CBA × DBA/2 model may be explained by exposure to LPS at the time of mating. Increased rates of loss triggered by cytokines later in pregnancy may depend on increased absorption of LPS from intestinal flora.
Comparison of Family and Nonfamily Business: Financial Logic and Personal Preferences
Authors: Gallo Miguel Ángel , Tàpies Josep , Cappuyns Kristin
Published: December 2004

Research has identified important differences between family businesses (FBs) and nonfamily businesses (NFBs). The difficulty, however, lies in explaining the reasons for those differences. In this article, Professors Miguel A. Gallo and Josep Tàpies, and Research Associate Kristin Cappuyns, all of IESE, International Business School, Barcelona, report the results of an investigation into the “peculiar financial logic”of FBs, based on a sample of 305 Spanish firms. After looking at some of the more general differences between the FBs and NFBs in the sample, in terms of company age, sales, employees, capital, and internationalization, the authors compare the financial ratios of the two types of companies. Generally speaking, the FBs are found to be older and to have lower sales, fewer employees, fewer full-time employees on permanent contracts, a smaller share capital, fewer shareholders, and a higher proportion of board members among the shareholders. However, when digging into the financial policies implemented in both types of companies, the differences found indicate that personal preferences concerning growth, risk, and ownership-control may be the driving forces behind the “peculiar financial logic” of FBs. The authors conclude that while many FBs outshine their NFB rivals in many respects, some of them lack a genuine long-term business policy or a commitment to growth and evolution. If the aversion to risk and loss of control is due to the managerowner's personal apprehensions or ambitions, then that manager-owner is, wittingly or unwittingly, spoiling the company's chances of being able to compete in the future.
Interfirm Cooperation Capability in the Context of Networking Family Firms: The Role of Power
Authors: Niemelä Tarja
Published: December 2004

This article is based on theoretical and empirical research exploring interfirm cooperation capability in the context of networking family firms by focusing on the role of power. By developing the model of interfirm cooperation capability this study seeks understanding of the concept of power on the affective, conative, and cognitive capabilities of networking family firms, and on the competitiveness of the network of family firms. The study suggests that the owner-managers need to have capabilities, such as knowledge and skills, motivation and volition (willpower) and “affection,” when using their personal and institutional power as it affects the model of interfirm cooperation capability.
Family Business Research: A Strategic Reflection
Authors: Zahra Shaker A. , Sharma Pramodita
Published: December 2004

As research on family business continues to grow, six key trends have become evident. These trends include a continuing pursuit of a few research topics such as succession, a strong preference for practice-oriented research methods, a tendency to borrow heavily from other disciplines without giving back to these fields, and a strong preference to talk to other researchers conducting research on family firms—failing to communicate with scholars from other disciplines. Therefore, we suggest strategies to expedite the growth of family business research toward better understanding the paradoxes faced by family business managers, deepen insights into the problems they encounter, improve rigor in reported research, find ways to promote a dialog with scholars in sister disciplines, and give back to the disciplines from which we borrow heavily.
Easing the Inferential Leap in Competency Modelling: The Effects of Task‐related Information and Subject Matter Expertise*
Authors: LIEVENS FILIP , SANCHEZ JUAN I. , DE CORTE WILFRIED
Published: December 2004

Despite the rising popularity of the practice of competency modeling, research on competency modeling has lagged behind. This study begins to close this practice–science gap through 3 studies (1 lab study and 2 field studies), which employ generalizability analysis to shed light on (a) the quality of inferences made in competency modeling and (b) the effects of incorporating elements of traditional job analysis into competency modeling to raise the quality of competency inferences. Study 1 showed that competency modeling resulted in poor interrater reliability and poor between‐job discriminant validity amongst inexperienced raters. In contrast, Study 2 suggested that the quality of competency inferences was higher among a variety of job experts in a real organization. Finally, Study 3 showed that blending competency modeling efforts and task‐related information increased both interrater reliability among SMEs and their ability to discriminate among jobs. In general, this set of results highlights that the inferences made in competency modeling should not be taken for granted, and that practitioners can improve competency modeling efforts by incorporating some of the methodological rigor inherent in job analysis.