bluuebunny/crossref_metadata_2025 huggingface dataset:
The Relationship between Legal Status, Perceived Pressure and Motivation in Treatment for Drug Dependence: Results from a European Study of Quasi-Compulsory Treatment
Authors: Stevens Alex , Berto Daniele , Frick Ulrich , Hunt Neil , Kerschl Viktoria , McSweeney Tim , Oeuvray Kerrie , Puppo Irene , Santa Maria Alberto , Schaaf Susanne , Trinkl Barbara , Uchtenhagen Ambros , Werdenich Wolfgang
Published: September 2006

This paper reports on intake data from Quasi-Compulsory Treatment in Europe, a study of quasi-compulsory treatment (QCT) for drug dependent offenders. It explores the link between formal legal coercion, perceived pressure to be in treatment and motivation amongst a sample of 845 people who entered treatment for drug dependence in five European countries, half of them in quasi-compulsory treatment and half ‘voluntarily’. Using both quantitative and qualitative data, it suggests that those who enter treatment under QCT do perceive greater pressure to be in treatment, but that this does not necessarily lead to higher or lower motivation than ‘volunteers’. Many drug-dependent offenders value QCT as an opportunity to get treatment. Motivation is mutable and can be developed or diminished by the quality of support and services offered to drug-dependent offenders.
Perfusion-Weighted Magnetic Resonance Imaging in Acute Intracerebral Hemorrhage at Baseline and during the 1st and 2nd Week: A Longitudinal Study
Authors: Pascual Ana M. , López-Mut Jose V. , Benlloch Vicente , Chamarro Raquel , Soler Jose , Láinez Miguel J.A.
Published: September 2006

Background and Purpose: Ischemic penumbra has been suggested as a contributing mechanism to secondary neuronal injury in intracerebral hemorrhage (ICH). Preliminary data suggest the presence of perihematomal hypoperfusion within the first hours after acute ICH. Our objective was to elucidate perfusion changes in the perihematomal region over time using magnetic resonance imaging (MRI). Methods: Two perfusion-weighted MRIs were studied prospectively in 18 ICH patients. All patients had an acute perfusion-weighted MRI within 24 h of the onset of symptoms (time 0); 11 patients had a follow-up study on day 7 (time 1), and 7 patients on days 10–14 (time 2). The region of interest (ROI) was placed over the penumbral area, on high-intensity FLAIR and perfusion overlapping map imaging. Clinical data were assessed at baseline (National Institutes of Health Stroke Scale) and on day 90 (Canadian Scale, modified Rankin Scale). Results: The average hematoma volume was 56 (9–140) ml; 10 were located deeply, and 8 were lobar. When we compared the perfusion changes (mean transit time prolongation) in the perihematomal area (lesion ROI) relative to itself over time, we found significant differences only between times 0 and 2 (p = 0.05). There were also significant differences in mean transit time between the lesion ROI and the contralateral mirror ROI in the baseline study (p = 0.001), with a trend to significance for time 1. Conclusions: Our data confirm the presence of hypoperfusion around an acute ICH and demonstrate that this change disappears completely after the first week. These data suggest that further evaluation of this feature of acute ICH is warranted, as its confirmation may lead to modifications in the current therapeutic approach.
Is 15 mm Size Criterion for Lacunar Infarction Still Valid? A Study on Strictly Subcortical Middle Cerebral Artery Territory Infarction Using Diffusion-Weighted MRI
Authors: Cho A-Hyun , Kang Dong-Wha , Kwon Sun U. , Kim Jong S.
Published: September 2006

Background and Purpose: The ‘lacunar hypothesis’ has been challenged, since small (diameter <15 mm) subcortical infarcts can be produced by middle cerebral artery disease (MCAD) or cardioembolism (CE), while a larger infarct can occur without evidence of MCAD or CE. We sought to assess whether the lacunar hypothesis based on size is still valid. Methods: We studied 118 patients who were admitted within 72 h after stroke onset and had acute deep subcortical MCA territory infarcts detected by diffusion-weighted MRI, and who had undergone angiography (mostly MR angiography). Stroke mechanisms were arbitrarily categorized regardless of lesion size: (1) MCAD when there was a corresponding MCA lesion; (2) internal carotid artery disease (ICAD) when there was a significant (>50%) ipsilateral ICAD; (3) CE when there was emboligenic heart disease without MCAD or ICAD, and (4) small vessel disease (SVD) when there was neither CE nor MCAD. SVD was further divided into definite SVD (dSVD, longest diameter <15 mm) or probable SVD (pSVD, longest diameter ≧15 mm). Results: Seventy-three patients (62%) had SVD, of which 38 (32%) had pSVD and 35 (30%) dSVD. Thirty-three patients (28%) had MCAD, five (4%) CE, and seven (6%) ICAD. The infarct diameter in MCAD was not larger than in SVD (p = 0.35), and there was no difference in clinical features or risk factors between MCAD and SVD, or between pSVD and dSVD. CE was distinguished from SVD by its larger size and cortical symptoms. Conclusions: There are no clinical and lesion-size differences between MCAD and SVD, suggesting that there seems to be no rationale for the 15 mm size criterion for lacunar or small-vessel infarction.
Asymmetric Cerebral Embolic Load and Postoperative Cognitive Dysfunction in Cardiac Surgery
Authors: Bokeriia Leo A. , Golukhova Elena Z. , Breskina Nataliya Y. , Polunina Anna G. , Davydov Dmitry M. , Begachev Alexey V. , Kazanovskaya Svetlana N.
Published: September 2006

Background: The aim of the study was to determine the effects of asymmetric cerebral embolic load on cognitive functions. Methods: Thirty-six open heart surgery (OH) and 26 coronary artery bypass grafting (CABG) patients were evaluated by neuropsychological and transcranial Doppler tests. Results: OH was associated with a significantly larger microembolic load in comparison to CABG. In OH patients, the microembolic load at the left middle cerebral artery correlated with a verbal memory decline, whereas the microembolic load at the right middle cerebral artery correlated with a nonverbal memory deficit. CABG patients also showed a postoperative verbal memory decline which correlated with cardiopulmonary bypass length but not with microembolic load. Conclusion: Massive microembolic load during OH induces specific cognitive impairment in accordance to the brain region to which they are delivered. In atherosclerotic patients, the left temporal region is especially prone to perioperative ischemia.
In vivo Effects of Mitoxantrone on the Production of Pro- and Anti-Inflammatory Cytokines by Peripheral Blood Mononuclear Cells of Secondary Progressive Multiple Sclerosis Patients
Authors: Angelucci Francesco , Batocchi Anna Paola , Caggiula Marcella , Frisullo Giovanni , Patanella Katia , Sancricca Cristina , Nociti Viviana , Tonali Pietro Attilio , Mirabella Massimiliano
Published: September 2006

Objective: Mitoxantrone is an antineoplastic agent also used for the treatment of multiple sclerosis (MS). However, despite its efficacy, few data are available on its mechanism of action.The current study was designed to evaluate the short-term (1 month) and long-term (12 months) in vivo effects of mitoxantrone on pro- and anti-inflammatory cytokine production by the peripheral blood mononuclear cells (PBMC) of secondary progressive MS patients. Methods: Eighteen patients with secondary progressive MS underwent mitoxantrone therapy (at a dose of 12 mg/m2 once every 3 months) over a 1-year period. Blood samples were obtained at baseline, after 1 month and after 12 months of treatment. The production of cytokines in the PBMC was measured by enzyme-linked immunosorbent assay. Results: There were no significant effects of mitoxantrone on proinflammatory cytokines [interleukin (IL) 6 and IL-12p40] and anti-inflammatory cytokines (IL-10 and transforming growth factor-β) in our patients. Patients who showed no signs of therapeutic response were characterized by a higher basal PBMC production of IL-6 compared with that of the responding patients (p < 0.05) and mitoxantrone reduced this production after 12 months of treatment (p < 0.05). In the responding patients, IL-10 was significantly increased by mitoxantrone after 12 months of treatment (p < 0.05). Conclusion: These findings provide additional information useful in the selection of the patient population suitable for mitoxantrone treatment and suggest that most probably the therapeutic action of mitoxantrone in MS is not entirely mediated by its immunosuppressant effects.
A Qualitative Examination of the Experience of ‘Depression’ in Hospitalized Medically Ill Patients
Authors: Clarke David M. , Cook Kay E. , Coleman K. John , Smith Graeme C.
Published: September 2006

Background: Research into depression in the medically ill has progressed without sufficient attention being given to the validity, in this group, of the taxonomic categories. We aimed to describe, using qualitative interviews, the experience of ‘being depressed’, separating experiences that are unique to depression from experiences that are common to being ill and in hospital. Method: Forty-nine patients hospitalized for medical illness underwent a 30-min interview in which they were asked to ‘Describe how you have been unwell and, in particular, how that has made you feel.’ From the transcripts, a ‘folk’ taxonomy was constructed using a phenomenological framework involving four steps: frame elicitation to identify the important themes, componential analysis to systematically cluster the attributes into domains, a comparison of the experiences of patients screening depressed and not-depressed, and a theoretical analysis comparing the resulting taxonomy with currently used theoretical constructs. Results: Experiences common to all patients were being in hospital, being ill or in pain, adjusting to not being able to do things, and having time to think. In addition, all participants described being depressed, down or sad. Patients who were identified by screening as being depressed described unique experiences of depression, which included ‘having to think about things’ (a forceful intrusive thinking), ‘not being able to sleep’, ‘having to rely on others’, ‘being a burden’ to others (with associated shame and guilt), feelings of ‘not getting better’ and ‘feeling like giving up’. Theoretical analysis suggested that this experience of depression fitted well with the concept of demoralization described by Jerome Frank. Conclusions: Demoralization, which involves feelings of being unable to cope, helplessness, hopelessness and diminished personal esteem, characterizes much of the depression seen in hospitalized medically ill patients.
Oral Clonidine Provocative Test in the Diagnosis of Growth Hormone Deficiency in Childhood: Should We Make the Timing Uniform?
Authors: Galluzzi Fiorella , Stagi Stefano , Parpagnoli Maria , Losi Stefania , Pagnini Ilaria , Favelli Federica , Chiarelli Francesco , Salti Roberto , Seminara Salvatore
Published: September 2006

Introduction: Oral clonidine is one of the most frequent drugs used for the diagnosis of growth hormone deficiency (GHD), but the duration of the test, depending on which European centres use it, is not uniform and can vary from 120 to 150 min or even 180 min. Subjects and Methods: To standardize this test, evaluating the possibility to shorten it to 90 min, we investigated the response of GH to the oral clonidine test in 291 children evaluated for short stature (height <–2 SD). Of these, 164 were diagnosed as idiopathic short stature (ISS) and 127 as GHD. In these patients, we calculated: (1) the frequency distribution of the GH peaks to clonidine in GHD and in ISS at various times; (2) the percentage of GH peaks to clonidine before and after 90 min in all and in ISS children; (3) the percentage of the first GH value ≧10 ng/ml before 90 min and after 90 min in ISS. Results: GH peak distribution varied between 30 and 180 min, even though the vast majority of peaks occurred between 30 and 60 min. There was no significant difference (p > 0.05) in the peak distribution between ISS and GHD children. The percentages of GH peaks within 90 min were 92.1% in all children and 95.7% in ISS. If considering the first value of GH ≧10 ng/ml this last percentage reaches 96.3%. Conclusion: Our study suggests that the oral clonidine test can be administered for only 90 min without significantly changing its validity. This test should be standardized at 90 min in European protocols just as in those currently used in the USA in order to reduce the discomfort of patients and the cost of this diagnostic procedure.
Prevention and Reversal of Diabetic Nephropathy in db/db Mice Treated with Alagebrium (ALT-711)
Authors: Peppa Melpomeni , Brem Harold , Cai Weijing , Zhang Jiang-Gang , Basgen John , Li Zhu , Vlassara Helen , Uribarri Jaime
Published: September 2006

Background: Alagebrium (ALT-711) has been shown to improve renal dysfunction in animal models of diabetes. Methods: To test its effects in diabetic nephropathy (DN), ALT-711 was administered (1 mg/kg daily i.p.) to 9-week-old female db/db mice (n = 15, group A1) for 3 weeks and to 3-month-old (n = 15, group A2), 7-month-old (n = 7, group A3), and 12-month-old (n = 5, group A4) female db/db mice for 12 weeks, while a similar number of diabetic and nondiabetic mice were used as controls. The ΕN-carboxymethyllysine (CML) levels in serum, urine, skin, and kidney tissue were measured by enzyme-linked immunosorbent assay. The renal morphometric parameters were assessed by electron and light microscopy. Results: By the 3rd week of treatment, the serum CML level decreased by 41%, and the urinary CML concentration increased by 138% from baseline, while the urinary albumin/creatinine ratio was lower (p < 0.05) in diabetic and nondiabetic group A1 mice. After 3 months of treatment, serum, skin, and kidney CML levels and urinary albumin/creatinine ratio were lower (p < 0.05) and the urinary CML levels higher (p < 0.05) in treated group A2, A3, and A4 animals compared with groups which received phosphate-buffered saline, with a similar pattern observed in nondiabetic mice. The renal morphological parameters characteristic of DN decreased in treated compared with untreated mice. Conclusion: Alagebrium may prevent, delay, and/or reverse established DN in db/db mice by reducing the systemic advanced glycation end product pools and facilitating the urinary excretion of advanced glycation end products.
Reforming Reforms: Changing Incentives in Education Finance in Vermont
Authors: Schmidt Stephen J. , Scott Karen
Published: September 2006

In 1997, Vermont passed Act 60, which reformed its education finance system to achieve greater equality of spending. The reform encouraged wealthy towns to reduce spending; it was politically unpopular and was replaced, in 2004, by Act 68. We analyze the spending incentives created by the two acts and estimate the effects the changewill have on spending inequality. Act 68 reduces tax prices for education spending in all towns, but reduces them disproportionately for wealthy towns. It increases education spending in Vermont but also increases inequality of spending. Because spending is inelastic with respect to tax prices, the increase in inequality is small relative to existing inequality. Our findings demonstrate that understanding the way towns respond to financial incentives, economically and politically, is critical in designing successful reforms. They suggest that it is difficult to maintain finance systems that give wealthy towns strong incentives to spend less or subsidize poorer towns. Using state revenues to subsidize schools achieves nearly asmuch equality as more explicit attempts to force wealthy districts to share resources.
Improving the Efficiency of Fiber Steered Composite Joints using Load Path Trajectories
Authors: Li R. , Kelly D. , Crosky A. , Schoen H. , Smollich L.
Published: September 2006

A fiber steering technique using load path trajectories is applied to the manufacture of carbon fiber composite joints. This increased the initial failure strength in quasi-isotropic laminate joints by 12%, while the ultimate failure strength is increased by 33%. Moreover, the technique is able to provide more than double the efficiency of carbon laminate joints by reducing the ratio of joint width to bolthole diameter, w/d, from the standard value of 5 to a more compact value of 2.5, simultaneously maintaining the bearing strength of the laminate.
Analytical Prediction of Low-velocity Impact Response of Composite Sandwich Panels using New TDOF Spring–mass–damper Model
Authors: Malekzadeh K. , Khalili M. R. , Mittal R. K.
Published: September 2006

A new equivalent three-degree-of-freedom (TDOF) spring–mass– damper (SMD) model has proposed to predict the low-velocity impact response of composite sandwich panels with transversely flexible core. Impacts are assumed to occur normally over the top face-sheet with the arbitrary different impactor masses and initial velocities. The interaction between the impactor and the panel is modeled with the help of a new proposed system having TDOF consisting of springs, damper, and masses. An analytical procedure that includes the transverse flexibility and structural damping of the core has not yet been dealt with. In the present model, the effects of transverse flexibility of the core and structural damping of the panel are considered analytically. The analysis yields analytic functions describing the history of contact force, displacements of the impactor and the panel in the transverse direction etc. The effects of some physical and geometrical parameters such as initial potential energy of the impactor, the aspect ratio of the panel, location of the impacted point on the panel and the material density of the core on dynamic response of composite sandwich panels have been discussed.
A Methodology for the Optimal Configuration of TCP Traffic in Network Simulations under Link Load Constraints
Authors: He Qi , Dovrolis Constantinos , Ammar Mostafa
Published: September 2006

Given that more than 90% of the Internet load is carried by TCP, most network simulation studies use TCP flows to generate the background traffic. A basic, but unresolved, question, however, is the following: how can one decide how many TCP flows to simulate from one network node to another? Simulating too many flows on a link can cause an unrealistically high loss rate on that link, while simulating too few flows can result in undesirably light load conditions. Similarly, to simulate realistic network conditions, one has to carefully control the load distribution on various network links (e.g., edge vs. core links), as well as the hop count (path length) of the simulated TCP flows. Previous simulation studies have dealt with these issues in a trial-and-error manner, experimenting with several traffic configurations until a realistic distribution of link load and loss rate is achieved. In this article, the authors present a methodology that determines the number of TCP flows that should be simulated between each pair of nodes in a network based on the network topology, a specification of the utilization and loss rate for certain links, and an average number of hops for the TCP flows. The proposed methodology is based on a linear program formulation that, while meeting the utilization and loss rate specifications, minimizes the number of required TCP flows. This optimization criterion minimizes the memory requirement of the simulation. The evaluations show that the proposed methodology can closely approximate the specified link conditions in terms of utilization and loss rate. The authors also analyze the largest approximation errors and reveal their causes.
Simulation Verification and Validation by Dynamic Policy Specification and Enforcement
Authors: Tsai W. T. , Chen Yinong , Paul Ray , Zhou Xinyu , Fan Chun
Published: September 2006

This article presents a new verification and validation technique for simulation using dynamic policy specification and enforcement. Security requirements, certain functional requirements, and constraints can be formally specified as policies, and they are used to check at runtime whether the behaviors of the system under simulation are within the given constraints. A policy violation reveals a potential design error of the system under simulation. This article also presents the policy specification language and the policy development framework that are used to specify policies, to verify their completeness and consistency of policies, to translate them into executable representations, and to enforce them at runtime. The policy specification language and the policy development framework are fully integrated into the simulation infrastructure. An example is used throughout the article to illustrate the policy specification and enforcement processes. The article discusses different algorithms of policy enforcement and their space and time complexity.
An Analysis of a Unified Pricing Model for Multiservice Networks
Authors: Chang Woan Sun , Simon Robert
Published: September 2006

There has been recent interest in employing unified pricing schemes for supporting both quality-of-service (QoS) and best-effort traffic within multiservice networks. This article presents an analytical approach for the design and analysis of this class of network pricing control. In particular, the authors propose an approximation method to estimate overall user value arising from all traffic types, given the routes for QoS traffic. Their approach considers admission control as both a resource allocation issue and a pricing control decision for QoS traffic in a combined QoS and best-effort environment. The authors show how to convert the price-based admission control decision to a resource-based blocking problem. The experimental results showed that the proposed analytical model is quite accurate as compared to simulation results. The authors also present the numerical results of performance analysis for multiservice networks using their proposed approximation method. Their approach can be used to predict the performance and parameter settings for a wide range of combined QoS and best-effort pricing schemes.
Performance Evaluation and Comparison of Multicast Feedback Control Mechanisms
Authors: Wu Shuju , Banerjee Sujata , Hou Xiaobing
Published: September 2006

In reliable multicast applications, packet loss needs to be reported by having group members send feedback messages. This results in the well-known feedback implosion problem. The available feedback control mechanisms can be classified as timer based, hierarchy based, and router assisted, among which the timer-based approach is more preferable due to its simplicity and flexibility. This article compares a set of feedback suppression schemes—namely, the traditional timer-based feedback control and a combination of the traditional timers and some representatives. The authors analyze the performance of these schemes in standard star and chain topologies and then evaluate them using more realistic network topology through simulation studies. They investigate how the use of representatives and deterministic timers improves feedback control performance.
A Study of Uranium, Radium, Radon Exhalation Rate and Indoor Radon in the Environs of Some Areas of the Malwa Region, Punjab
Authors: Mehra Rohit , Singh Surinder , Singh Kulwant
Published: September 2006

Indoor radon measurements in dwellings in the Malwa region, Punjab, were carried out, using LR-115 type II cellulose nitrate films in the bare mode. The annual average indoor radon value in the study area varied from 54Bq·m-3to 168Bq·m-3, which is well within the recommended action level given by International Commission on Radiological Protection. Uranium, radium and radon exhalation studies were also carried out in soil samples collected from these areas. A good correlation was obtained between uranium concentration in soil and indoor radon in dwellings. The indoor radon values obtained in the present investigation are higher than the world average of 40Bq·m-3.
Natural Radionuclides in the Building Materials used in Manisa City, Turkey
Authors: Erees F. S. , Dayanıklı S. A. , Çam S.
Published: September 2006

The activity concentrations of 238U, 232Th and 40K in brick, cement and sand samples used as building materials in Manisa province were analysed by a gamma-ray spectroscopy coupled with a NaI (Tl) detector. Doses received by the citizens living in Manisa due to these building materials were also calculated. The highest activity concentrations of 238U, 232Th and 40K found in the sand samples were 1559.10Bq·kg-1, 142.48Bq·kg-1 and 1711.47Bq·kg-1, respectively. The maximum mean of radium equivalent activity Raeq was 945Bq·kg-1 calculated for levels in sand, gravel and stone samples.
Using the Real-time Radon-222 Profile to Quantify the Specific Radon Production Rate in an Air-conditioned Building
Authors: Tung Thomas C.W. , Burnett J. , Chan Daniel W.T.
Published: September 2006

The real-time indoor and outdoor radon-222 profiles on the fourth floor of a university library were measured through five consecutive days, with the Heating, Ventilating and Air Conditioning (HVAC) system operating on part load. The premises were served by a main air-handling unit (AHU-1) and a subordinate unit (AHU-2) of the HVAC system, but AHU-2 was shut down for maintenance. It required full operation of AHU-1 for 1.7h to reduce the radon concentration from the overnight peak down to the recommended action level (200Bq·m-3). Clear characteristics of indoor radon profiles were observed, with the diurnal variations of indoor radon concentrations strongly coupled to the operation schedule of AHU-1. The specific radon production (value-Φ) of the site could be quantified from the characteristic profiles. This can be used to investigate the radon emission rate of a site, as well as to simulate the indoor radon concentrations at different ventilation rates. The value-Φ was 21.0Bqh-1·m-3, with a standard deviation of 0.6Bqh-1·m-3. Furthermore, it was found that a morning purge, by the fresh air intake fan operating for 2h before library opening hours, could not effectively remove the overnight accumulation of the pollutant.
Designing a Simple Tool Kit and Protocol for the Investigation of the Indoor Environment in Homes
Authors: Richardson George , Eick Susan Ann , Shaw Stephen Richard
Published: September 2006

Monitoring indoor environments can be complicated, time consuming and expensive. The objective of this study was to pinpoint indoor environmental variables that are essential for providing an assessment of the condition of the indoor environment in homes. The Statistical Package for Social Statistics was used to conduct principal component analysis on data from three existing housing and health studies - two UK studies using 38 (n 124 homes) and 49 (n 88 homes) variables and one Swedish study using 104 (n 60 homes) variables. The analyses highlighted 18 components, which represented the variables from all three studies. The 18 components were further reduced to 14 because of considerations of expense and time. The 14 components were: temperature; humidity; dampness; number of people; number of pets; dust mites; airborne microbes; plant related microbes; carbon dioxide (CO2); volatile organic compounds; particles; weather data; ventilation; and information about the dwelling. These components form the basis for an indoor assessment that can be used in environmental studies of people’s homes by non-environmental scientists.
Surface EMG Evaluation of Sonographer Scanning Postures
Authors: Murphey Susan L. , Milkowski Andy
Published: September 2006

This article presents a technique for quantitative evaluation of musculoskeletal impact using postural tests to assess two specific muscle groups: the left upper trapezius and the right suprascapular fossa. The muscular activity of these regions of the neck and shoulder was quantitatively evaluated using surface electromyography in 22 sonographer subjects. This study shows statistically significant reductions in muscle activity by modifying scanning technique and workstation arrangement. Left upper trapezius muscle activity decreased 65% from a 50-degree forward shoulder flexion (reach) to neutral (0-degree reach) position. Right suprascapular fossa activity decreased 46% between a 75-degree abduction and 30-degree abduction, as well as 78% when support under the forearm at the same 30-degree abduction was provided, resulting in a total reduction from the first position to the third position of 88%. These results illustrate the benefit of optimized scanning technique, workstation utilization, and use of adjustable workstation equipment.
IL-15 and dermal fibroblasts induce proliferation of natural regulatory T cells isolated from human skin
Authors: Clark Rachael A. , Kupper Thomas S.
Published: September 2006

Regulatory T cells (Tregs) are crucial for the induction and maintenance of self-tolerance and are present in peripheral tissues such as skin and gut under normal, noninflamed conditions. We report isolation and expansion of the Treg population resident in normal human skin. Cutaneous Tregs expressed high levels of CD25, L-selectin, GITR, FOXP3, and intracellular CTLA-4, low levels of CD69, and high levels of the skin-homing addressins CLA, CCR4, and CCR6. Skin Tregs suppressed the proliferation of CD25lo T cells from the same skin sample in response to CD3 and CD28 antibodies. Suppression was dependent on cell contact and not affected by neutralizing antibodies to interleukin-10 (IL-10) and transforming growth factor-β (TGF-β). Surprisingly, cutaneous Tregs proliferated in an antigen-independent manner when cultured in contact with dermal fibroblasts and IL-15, conditions similar to those found in chronically inflamed skin. We hypothesize that local proliferation of Tregs may occur within inflamed skin and could serve as a brake for cutaneous inflammation as well as a mechanism for the homeostatic proliferation of natural Tregs that has been observed within intact organisms.
Discoidin domain receptor 1 contributes to eosinophil survival in an NF-κB–dependent manner in Churg-Strauss syndrome
Authors: Matsuyama Wataru , Mitsuyama Hideo , Ono Mikiko , Shirahama Yuko , Higashimoto Ikkou , Osame Mituhiro , Arimura Kimiyoshi
Published: September 2006

Churg-Strauss syndrome (CSS) is a systemic disease that shows marked eosinophilia along with eosinophil infiltration in the tissue. Prolonged eosinophil survival plays an important role in the pathogenesis of CSS; however, its detailed molecular mechanism remains unclear. Discoidin domain receptor 1 (DDR1) is a receptor tyrosine kinase, and its ligand is collagen. DDR1 was expressed in human leukocytes and fibroblasts, and it plays an important role in leukocyte cytokine production and fibroblast survival in an NF-κB–dependent manner. In this study, we examined in vitro and in vivo eosinophil DDR1 expression and its function in CSS patients. The expression level of DDR1 was significantly higher in the eosinophils of CSS patients, and the predominant isoform was DDR1b. Immunohistochemical findings revealed that the tissue-infiltrating eosinophils expressed endogenous DDR1. In CSS patients, DDR1 activation inhibited Fas agonistic antibody–induced apoptosis and up-regulated Fas agonistic antibody–induced cytokine production of eosinophils in an NF-κB–dependent manner. Suppression of DDR1 expression in the eosinophils by using RNA interference and addition of the DDR1-blocking protein abolished these effects. We propose that DDR1 contributes to the eosinophil survival in the tissue microenvironment of CSS and that it might be involved in the development of CSS.
Differentiation of CD1a− and CD1a+ monocyte-derived dendritic cells is biased by lipid environment and PPARγ
Authors: Gogolak Peter , Rethi Bence , Szatmari Istvan , Lanyi Arpad , Dezso Balazs , Nagy Laszlo , Rajnavolgyi Eva
Published: September 2006

Accumulating data have shown that the microenvironment of dendritic cells modulates subtype differentiation and CD1 expression, but the mechanisms by which exogenous factors confer these effects are poorly understood. Here we describe the dependence of CD1a− monocyte-derived dendritic cell (moDC) development on lipids associated with the expression of peroxisome proliferator-activated receptor–gamma (PPARγ). We also show the consecutive differentiation of immature CD1a−PPARγ+ moDCs to CD1a+PPARγ− cells limited by serum lipoproteins and terminated by proinflammatory cytokines. Immature CD1a− moDCs possess higher internalizing capacity than CD1a+ cells, whereas both activated subtypes have similar migratory potential but differ in their cytokine and chemokine profiles, which translates to distinct T-lymphocyte–polarizing capacities. CD1a+ moDCs stand out by their capability to secrete high amounts of IL-12p70 and CCL1. As lipoproteins skew moDC differentiation toward the generation of CD1a−PPARγ+ cells and inhibit the development of CD1a+PPARγ− cells, we suggest that the uptake of lipids results in endogenous PPARγ agonists that induce a cascade of gene transcription coordinating lipid metabolism, the expression of lipid-presenting CD1 molecules, subtype dichotomy, and function. The presence of CD1a−PPARγ+ and CD1a+PPARγ− DCs in lymph nodes and in pulmonary Langerhans cell histiocytosis confirms the functional relevance of these DC subsets in vivo.
Relationship of expression of aquaglyceroporin 9 with arsenic uptake and sensitivity in leukemia cells
Authors: Leung Jordy , Pang Annie , Yuen Wai-Hung , Kwong Yok-Lam , Tse Eric W. C.
Published: September 2006

Arsenic trioxide (As2O3) is highly efficacious in acute promyelocytic leukemia (APL). Aquaglyceroporin 9 (AQP9) is a transmembrane protein that may be involved in arsenic uptake. In 10 of 11 myeloid and lymphoid leukemia lines, quantitative polymerase chain reaction (Q-PCR) and Western blotting showed that AQP9 expression correlated positively with As2O3-induced cytotoxicity. As a proof-of-principle, transfection of EGFP-tagged AQP9 to the hepatoma line Hep3B, not expressing AQP9 and As2O3 insensitive, led to membrane AQP9 expression and increased As2O3-induced cytotoxicity. Similarly, the chronic myeloid leukemia line K562 expressed low levels of AQP9 and was As2O3 insensitive. The K562EGFP-AQP9 transfectant accumulated significantly higher levels of intracellular arsenic than control K562EGFP when incubated with As2O3, resulting in significantly increased As2O3-induced cytotoxicity. Pretreatment of the myeloid leukemia line HL-60 with all-trans retinoic acid (ATRA) up-regulated AQP9, leading to a significantly increased arsenic uptake and As2O3-induced cytotoxicity on incubation with As2O3, which might explain the synergism between ATRA and As2O3. Therefore, AQP9 controlled arsenic transport and might determine As2O3 sensitivity. Q-PCR showed that primary APL cells expressed AQP9 significantly (2-3 logs) higher than other acute myeloid leukemias (AMLs), which might explain their exquisite As2O3 sensitivity. However, APL and AML with maturation expressed comparable AQP9 levels, suggesting that AQP9 expression was related to granulocytic maturation.
Clustering of smoking, alcohol drinking and cannabis use in adolescents in a rapidly developing country
Authors: Faeh David , Viswanathan Bharathi , Chiolero Arnaud , Warren Wick , Bovet Pascal
Published: September 2006

Background

Smoking, alcohol drinking and cannabis use ("risk behaviors") are often initiated at a young age but few epidemiological studies have assessed their joined prevalence in children in developing countries. This study aims at examining the joint prevalence of these behaviors in adolescents in the Seychelles, a rapidly developing country in the Indian Ocean.

Methods

Cross-sectional survey in a representative sample of secondary school students using an anonymous self-administered questionnaire (Global Youth Tobacco Survey). The questionnaire was completed by 1,321 (92%) of 1,442 eligible students aged 11 to 17 years. Main variables of interest included smoking cigarettes on ≥1 day in the past 30 days; drinking any alcohol beverage on ≥1 day in the past 30 days and using cannabis at least once in the past 12 months.

Results

In boys and girls, respectively, prevalence (95% CI) was 30% (26–34)/21% (18–25) for smoking, 49% (45–54)/48% (43–52) for drinking, and 17% (15–20)/8% (6–10) for cannabis use. The prevalence of all these behaviors increased with age. Smokers were two times more likely than non-smokers to drink and nine times more likely to use cannabis. Drinkers were three times more likely than non-drinkers to smoke or to use cannabis. Comparison of observed versus expected frequencies of combination categories demonstrated clustering of these risk behaviors in students (P < 0.001).

Conclusion

Smoking, drinking and cannabis use were common and clustered among adolescents of a rapidly developing country. These findings stress the need for early and integrated prevention programs.
A prospective, multi-method, multi-disciplinary, multi-level, collaborative, social-organisational design for researching health sector accreditation [LP0560737]
Authors: Braithwaite Jeffrey , Westbrook Johanna , Pawsey Marjorie , Greenfield David , Naylor Justine , Iedema Rick , Runciman Bill , Redman Sally , Jorm Christine , Robinson Maureen , Nathan Sally , Gibberd Robert
Published: September 2006

Background

Accreditation has become ubiquitous across the international health care landscape. Award of full accreditation status in health care is viewed, as it is in other sectors, as a valid indicator of high quality organisational performance. However, few studies have empirically demonstrated this assertion. The value of accreditation, therefore, remains uncertain, and this persists as a central legitimacy problem for accreditation providers, policymakers and researchers. The question arises as to how best to research the validity, impact and value of accreditation processes in health care. Most health care organisations participate in some sort of accreditation process and thus it is not possible to study its merits using a randomised controlled strategy. Further, tools and processes for accreditation and organisational performance are multifaceted.

Methods/design

To understand the relationship between them a multi-method research approach is required which incorporates both quantitative and qualitative data. The generic nature of accreditation standard development and inspection within different sectors enhances the extent to which the findings of in-depth study of accreditation process in one industry can be generalised to other industries. This paper presents a research design which comprises a prospective, multi-method, multi-level, multi-disciplinary approach to assess the validity, impact and value of accreditation.

Discussion

The accreditation program which assesses over 1,000 health services in Australia is used as an exemplar for testing this design. The paper proposes this design as a framework suitable for application to future international research into accreditation. Our aim is to stimulate debate on the role of accreditation and how to research it.
Factors influencing general practitioner referral of patients developing end-stage renal failure: a standardised case-analysis study
Authors: Montgomery Anthony J , McGee Hannah M , Shannon William , Donohoe John
Published: September 2006

Background

To understand why treatment referral rates for ESRF are lower in Ireland than in other European countries, an investigation of factors influencing general practitioner referral of patients developing ESRF was conducted.

Method

Randomly selected general practitioners (N = 51) were interviewed using 32 standardised written patient scenarios to elicit referral strategies. Main outcome measures: General practitioner referral levels and thresholds for patients developing end-stage renal disease; referral routes (nephrologist vs other physicians); influence of patient age, marital status and co-morbidity on referral.

Results

Referral levels varied widely with the full range of cases (0–32; median = 15) referred by different doctors after consideration of first laboratory results. Less than half (44%) of cases were referred to a nephrologist. Patient age (40 vs 70 years), marital status, co-morbidity (none vs rheumatoid arthritis) and general practitioner prior specialist renal training (yes or no) did not influence referral rates. Many patients were not referred to a specialist at creatinine levels of 129 μmol/l (47% not referred) or 250 μmol/l (45%). While all patients were referred at higher levels (350 and 480 μmol/l), referral to a nephrologist decreased in likelihood as scenarios became more complex; 28% at 129 μmol/l creatinine; 28% at 250 μmol/l; 18% at 350 μmol/l and 14% at 480 μmol/l. Referral levels and routes were not influenced by general practitioner age, sex or practice location. Most general practitioners had little current contact with chronic renal patients (mean number in practice = 0.7, s.d. = 1.3).

Conclusion

The very divergent management patterns identified highlight the need for guidance to general practitioners on appropriate management of this serious condition.
Ethnic minorities and prescription medication; concordance between self-reports and medical records
Authors: Uiters Ellen , van Dijk Liset , Devillé Walter , Foets Marleen , Spreeuwenberg Peter , Groenewegen Peter P
Published: September 2006

Background

Ethnic differences in health care utilisation are frequently reported in research. Little is known about the concordance between different methods of data collection among ethnic minorities. The aim of this study was to examine to which extent ethnic differences between self-reported data and data based on electronic medical records (EMR) from general practitioners (GPs) might be a validity issue or reflect a lower compliance among minority groups.

Methods

A cross-sectional, national representative general practice study, using EMR data from 195 GPs. The study population consisted of Dutch, Turks, Surinamese, Antilleans and Morrocans. Self-reported data were collected through face-to-face interviews and could be linked to the EMR of GPs. The main outcome measures were the level of agreement between annual prescribing rate based on the EMRs of GPs and the self-reported receipt and use of prescriptions during the preceding 14 days.

Results

The pattern of ethnic differences in receipt and use of prescription medication depended on whether self-reported data or EMR data were used. Ethnic differences based on self-reports were not consistently reflected in EMR data. The percentage of agreement above chance between EMR data and self-reported receipt was in general relative low.

Conclusion

Ethnic differences between self-reported data and EMR data might not be fully perceived as a cross-cultural validity issue. At least for Moroccans and Turks, compliance with the prescribed medication by the GP is suggested not to be optimal.
Predictors of colorectal cancer screening in diverse primary care practices
Authors: Zimmerman Richard K , Nowalk Mary Patricia , Tabbarah Melissa , Grufferman Seymour
Published: September 2006

Background

To explain why rates of colorectal cancer (CRC) screening including fecal occult blood testing (FOBT), flexible sigmoidoscopy (FS), colonoscopy (CS), and barium enema (BE), are low, this study assessed determinants of CRC screening from medical records.

Methods

Data were abstracted from patients aged ≥64 years selected from each clinician from 30 diverse primary care practices (n = 981). Measurements included the rates of annual FOBT, ever receiving FOBT, ever receiving FS/CS/BE under a combination variable, endoscopy/barium enema (EBE).

Results

Over five years, 8% had received annual FOBT, 53% had ever received FOBT and 22% had ever received EBE. Annual FOBT was negatively associated with female gender, odds ratio (OR) = .23; 95% confidence interval = .12–.44 and positively associated with routinely receiving influenza vaccine, OR = 2.55 (1.45–4.47); and more office visits: 3 to <5 visits/year, OR = 2.78 (1.41–5.51), and ≥5 visits/year, OR = 3.35 (1.52-7.42). Ever receiving EBE was negatively associated with age ≥75 years, OR = .66 (.46–.95); being widowed, OR = .59 (.38–.92); and positively associated with more office visits: 3 to <5 visits/year, OR = 1.83 (1.18–2.82) and ≥5 visits/year, OR = 2.01 (1.14–3.55).

Conclusion

Overall CRC screening rates were low, but were related to the number of primary care office visits. FOBT was related to immunization status, suggesting the possible benefit of linking these preventive services.
Developing and testing an instrument for identifying performance incentives in the Greek health care sector
Authors: Paleologou Victoria , Kontodimopoulos Nick , Stamouli Aggeliki , Aletras Vassilis , Niakas Dimitris
Published: September 2006

Background

In the era of cost containment, managers are constantly pursuing increased organizational performance and productivity by aiming at the obvious target, i.e. the workforce. The health care sector, in which production processes are more complicated compared to other industries, is not an exception. In light of recent legislation in Greece in which efficiency improvement and achievement of specific performance targets are identified as undisputable health system goals, the purpose of this study was to develop a reliable and valid instrument for investigating the attitudes of Greek physicians, nurses and administrative personnel towards job-related aspects, and the extent to which these motivate them to improve performance and increase productivity.

Methods

A methodological exploratory design was employed in three phases: a) content development and assessment, which resulted in a 28-item instrument, b) pilot testing (N = 74) and c) field testing (N = 353). Internal consistency reliability was tested via Cronbach's alpha coefficient and factor analysis was used to identify the underlying constructs. Tests of scaling assumptions, according to the Multitrait-Multimethod Matrix, were used to confirm the hypothesized component structure.

Results

Four components, referring to intrinsic individual needs and external job-related aspects, were revealed and explain 59.61% of the variability. They were subsequently labeled: job attributes, remuneration, co-workers and achievement. Nine items not meeting item-scale criteria were removed, resulting in a 19-item instrument. Scale reliability ranged from 0.782 to 0.901 and internal item consistency and discriminant validity criteria were satisfied.

Conclusion

Overall, the instrument appears to be a promising tool for hospital administrations in their attempt to identify job-related factors, which motivate their employees. The psychometric properties were good and warrant administration to a larger sample of employees in the Greek healthcare system.