bluuebunny/crossref_metadata_2025 huggingface dataset:
Social Work Discharge Planning in Acute Care Hospitals in Israel: Clients’ Evaluation of the Discharge Planning Process and Adequacy
Authors: Soskolne Varda , Kaplan Giora , Ben-Shahar Ilana , Stanger Varda , Auslander Gail. K.
Published: June 2009

Objective: To examine the associations of patients’ characteristics, hospitalization factors, and the patients’ or family assessment of the discharge planning process, with their evaluation of adequacy of the discharge plan. Method: A prospective study. Social workers from 11 acute care hospitals in Israel provided data on 1426 discharged patients. At 2-week postdischarge, 407 patients and 659 family members evaluated the discharge planning process (information received, involvement, influence) and adequacy. Results: More family (77%) than patients (62%) assessed the discharge planning to be adequate. Discharge process variables contributed more than patient or hospitalization characteristics to evaluation of adequacy but had a negligible mediation effect. Factors significantly associated with higher adequacy of plans were: hospital ward, receiving information, high family involvement, and discharge destination among patients; receiving of information and high patient and family involvement among family respondents. Conclusions: Social workers should actively involve patients and family in discharge planning.
Learning Teams and Virtual Communities of Practice: Managing Evidence and Expertise Beyond the Stable State
Authors: Sabah Yekutiel , Cook-Craig Patricia
Published: June 2009

In the past decade, the Israeli Ministry of Social Affairs has been engaged in an ongoing effort to change the capacity of social service organizations and social workers across the country to use and create knowledge in order to achieve the best outcomes for the people they serve. Although there is an ever-growing mandate in Israel to demonstrate outcomes and use effective strategies, social workers have historically experienced unique challenges in accessing and assessing available evidence-based practice when they are available. The first step to addressing these challenges, the intra-organizational phase, was to design, implement, and test a model of organizational learning designed to teach social workers how to use learning to change practice. The second step, the inter-organizational phase, was the introduction of virtual communities of practice as a tool to support workers in the acquisition and dissemination of new knowledge. This paper presents a case study of this effort including a description of the development and implementation of the two phases and an agenda for future research.
Serving Two Masters: Redistricting and Voting in the U.S. House of Representatives
Authors: Crespin Michael H.
Published: June 2009

This article explores the consequences for representation after a redistricting by reexamining the finding that members of Congress will alter their voting behavior to fit their new district. Specifically, it applies partisan theories of congressional organization to test if members are changing their behavior on all or just some votes. The results indicate that representatives adjust their roll call behavior to fit their new districts on votes that are visible to their constituents. However, when it comes to votes that are important to the party for controlling the agenda (i.e., procedural votes), members do not respond to changes in the district.
Oncology pharmacy practice in a teaching hospital in Nepal
Authors: Khanal Saval , Poudel Arjun , Sharan Krishna , Palaian Subish
Published: June 2009

Objective. To highlight the patient care activities performed by pharmacists during their ward rounds in medical oncology ward of a tertiary care hospital in western region of Nepal.

Methods. The study was conducted for 3 months. Two pharmacists joined the clinicians and nurses in the ward rounds every morning as a member of healthcare team. The data used in this study was obtained from different documented files in hospital and were analyzed as per study objectives.

Results. During 3 months (May 20, 2008 to August 20, 2008), pharmacists provided answers to eight queries asked by clinicians and nurses for the patient care purpose. During the same period pharmacists detected four cases of medication errors and provided suggestions on them. A total of 30 adverse drug reaction (ADR) reports were reported to the regional pharmacovigilance center during the study time. Altogether there were 84 types of adverse drug reaction seen on those patients. Most of them were related to hematological system.

Conclusion. The study evaluated the drug information provided by pharmacists, spontaneous reporting of ADRs by the pharmacists, and their intervention on treatment plan of patients during ward round. This suggests pharmacists can play a significant role on patient care when he or she joins round with other healthcare personnel in the oncology ward. J Oncol Pharm Practice (2010) 16: 75—79.
Review Article: Chronobiology: influence of circadian rhythms on the therapy of severe pain
Authors: Junker Uwe , Wirz Stefan
Published: June 2009

Modern pain therapy widely follows the WHO (World Health Organization) guidelines using a three-step ‘ladder’ for pain relief. This escalating step scheme includes the administration in the order nonopioids, mild opioids and strong opioids, and adjuvants at any step. Analgesics should be given ‘by the clock’ rather than ‘on demand’. However, the chronobiological parameters circadian pain rhythm, circadian efficacy of analgesics, and individual circadian need for analgesics are to be considered. The results of a multitude of studies in chronobiology are not consistent. Therefore, further studies with standardized protocols are needed that allow to assign more consistent rhythms to diseases, pain causes, and analgesic efficacy of opioids. In many cases, each patient perceives pain and its intensity individually during the time of day. By administration of analgesics over a constant or continuous dosage time fluctuations in pain perception and the outcomes of many studies in chronobiology are ignored that prove the influence of biological rhythms on the pharmacokinetic and pharmacodynamic aspects of analgesics. As different types of pain show different rhythms (highest pain intensities arising at different times of the day) analgesics should be dosed flexibly. It is also very important that drug therapy can be adjusted individually to the pain rhythm of the patient as well as to the type and cause of pain. In severe pain, therapy should be particularly careful. A flexible dosage depending on pain intensity and rapid dose adjustment are essentials of a modern pain therapy. Therefore, opioids that are flexible to use are better suited to treat the individual pain of the patient than rigid modified release oral or transdermal systems. J Oncol Pharm Practice (2010) 16: 81—87.
Girls With Social and/or Attention Deficits: A Descriptive Study of 100 Clinic Attenders
Authors: Kopp Svenny , Kelly Kristina Berg , Gillberg Christopher
Published: June 2009

Objective: Examine clinical correlates and distinguishing features of autism spectrum disorders (ASD), ADHD, and tic disorders in girls referred for social impairment, attention/academic deficits, and/or tics. Method: One hundred 3- to 18-year-old girls referred for social impairment and attention symptoms were assessed in detail. Sixty of these girls, 7 to 16 years of age (IQ ≥ 80) were compared with age-matched girls (IQ ≥ 80) from the community. Results: Main diagnoses of ASD, ADHD, tic disorders, and “other psychiatric disorder” were made in 46, 46, 3, and 5, respectively, of the referred girls. The ASD and ADHD groups (mean age at diagnosis 8.8 and 13.0 years, respectively) had the same types and high rates of psychiatric comorbidity. Girls with ASD had more problems with global functioning and adaptive levels of daily living skills than girls with ADHD. Differences between these girls referred for investigation and the community sample of girls were very considerable across a range of factors. Conclusions: Girls referred for social and/or attention deficits usually meet diagnostic criteria for either ASD or ADHD. They have severe psychiatric comorbidities and low global levels of functioning.
Fear of Routine Physical Exams in Children With Autism Spectrum Disorders
Authors: Gillis Jennifer M. , Hammond Natof Tammy , Lockshin Stephanie B. , Romanczyk Raymond G.
Published: June 2009

Children with autism spectrum disorders (ASD) have a high prevalence of specific fears, including fear of general medical procedures, but research on the treatment of medical fears has been limited. Two studies are described in this article. The first study involved an assessment of the prevalence of fears associated with physical exams. Caregivers reported that a large proportion of children with ASD demonstrated obvious medical fears. An evaluation of a behavioral intervention designed to address these fears constituted the second study. Graduated in vivo exposure accompanied by reinforced practice and modeling decreased fear-related avoidance behavior in all participants, with 83% of participants completing the intervention successfully.
Cognitive impairment and its relation with disease measures in mildly disabled patients with relapsing–remitting multiple sclerosis: baseline results from the Cognitive Impairment in Multiple Sclerosis (COGIMUS) study
Authors: Patti F , Amato MP , Trojano M , Bastianello S , Tola MR , Goretti B , Caniatti L , Di Monte E , Ferrazza P , Brescia Morra V , Lo Fermo S , Picconi O , Luccichenti G ,   For the COGIMUS Study Group
Published: June 2009

Background

Cognitive impairment is a common symptom of multiple sclerosis (MS), but the association between cognitive impairment and magnetic resonance imaging (MRI) disease measures in patients with relapsing–remitting (RR) MS is unclear.

Objectives

To study the prevalence of cognitive impairment and its relation with MRI disease measures in mildly disabled patients with RRMS.

Methods

Patients aged 18–50 years with RRMS (McDonald criteria) and an Expanded Disability Status Scale (EDSS) score ≤4.0, who were enrolled in the Cognitive Impairment in Multiple Sclerosis (COGIMUS) study, underwent baseline standardized MRI complete neurological examination and neuropsychological testing.

Results

A total of 550 patients were enrolled, 327 of whom underwent MRI assessments. Cognitive impairment (impaired performance in ≥3 cognitive tests) was present in approximately 20% of all patients and in the subgroup who underwent MRI. T2 hyperintense and T1 hypointense lesion volumes were significantly higher in patients with cognitive impairment (defined as impaired performance on at least three tests of the Rao’s battery) than those without. EDSS score was also significantly higher in cognitively impaired than in cognitively preserved patients. Disease duration, depression, and years in formal education did not differ significantly between cognitively impaired and cognitively preserved patients. T2 lesion volume, performance intelligence quotient, and age were significant predictors of cognitive impairment in this population. Weak correlations were found between performance on individual cognitive tests and specific MRI measures, with T1 and T2 lesion volumes correlating with performance on most cognitive tests.

Conclusions

Cognitive impairment occurs in approximately one-fifth of mildly disabled patients with MS and is associated with specific MRI disease measures. Assessment of cognitive function at diagnosis could facilitate the identification of patients who may benefit from therapeutic intervention with disease-modifying therapies to prevent further lesion development.
Multiple sclerosis produces significant changes in urinary bladder innervation which are partially reflected in the lower urinary tract functional status-sensory nerve fibers role in detrusor overactivity
Authors: Radziszewski P , Crayton R , Zaborski J , Członkowska A , Borkowski A , Bossowska A , Majewski M
Published: June 2009

Background

Detrusor overactivity is often observed in patients with multiple sclerosis (MS), and neurotoxins are emerging as second-line therapies albeit with different degrees of success per patient basis.

Objective

To investigate lower urinary tract (LUT) functional status and bladder innervation (calcitonin gene related peptide [CGRP] and substance P [SP] positive nerve fibers) in patients with MS.

Method

Eighteen MS patients with LUT symptoms underwent urodynamic investigations, and six non-MS patients undergoing cystoscopy due to microscopic hematuria served as controls. Cold cut bladder biopsies were taken from the bladder trigone region. Neurotransmitter expression was determined by individual immunohistochemical staining.

Results

Two distinct groups could be distinguished: group 1 with pronounced neurogenic detrusor overactivity and mild outflow obstruction; group 2 with some degree of neurogenic detrusor overactivity, detrusor hypocontractility during voiding, and high degree of an outflow obstruction. The presence of SP and CGRP immunoreactive + fiber density was observed in greater numbers in group 1.

Conclusion

Density of CGRP and SP positive nerve fibers within the urinary bladder of patients with MS may be suggestive of functional status of the lower urinary tract, namely denser innervation is observed in patients with mild outflow obstruction and strong detrusor overactivity. This observation could be useful when planning second-line treatment (neurotoxins) in these patients. Patients with denser innervation probably will respond better to such a therapy.
Rethinking Factionalism
Authors: Boucek Françoise
Published: June 2009

It is time to think again about the conceptualization of factionalism in political science. Following a brief review of scholarly contributions in the field, I argue that the analytical approach based on typologies and categories of subparty groups is not very useful in explaining intra-party behaviour and the process of change because, by their nature, these are static tools. Building on previous contributions to the study of factions, notably Sartori, I suggest focusing on intra-party dynamics instead of on organizational forms of faction. Factionalism should be viewed in non-exclusive terms, i.e. as a dynamic process of subgroup partitioning. It is a multifaceted phenomenon that can transform itself over time in response to incentives. Based on conclusions from case study research of factionalized parties in established democracies, I identify three main faces of factionalism: cooperative, competitive and degenerative. I suggest that the process of change may occur in a cycle that contributes to party disintegration, as illustrated by the case of the Christian Democratic Party in Italy (DC), which imploded in the mid-1990s under the centrifugal pulls of its factions.
It’s About The Benefits
Authors: Brockington David
Published: June 2009

This article approaches the question of turnout by focusing on the benefits term in the classic equation through an examination of the relationship between the quality of the choice environment, ideological proximity and participation in 28 democracies. Using data from the CSES (Comparative Study of Electoral Systems), I find that electoral contexts that feature choice-rich environments, measured both at the individual level by ideological proximity and the contextual level by the coverage of the ideological continuum, are associated with a higher probability that any single voter will participate in an election. These findings hold in the presence of individual and institutional controls, and are confirmed using both robust standard errors and against estimated variance in individual over-reporting of turnout.
Socioeconomic inequalities in the employment impact of ischaemic heart disease: a longitudinal record linkage study in Sweden
Authors: Holland Paula , Burström BO , Möller Ida , Whitehead Margaret
Published: June 2009

Aims: Low socioeconomic status is associated with increased risk of ischaemic heart disease (IHD) in many European and North American countries. We hypothesize that the adverse impact of having IHD may also be heavier in lower socioeconomic groups and may constitute a mechanism for generating or reinforcing social inequalities in health. Methods: Population registers of the 1.8 million residents of Stockholm County were used to assess the employment consequences over five years of having a diagnosis of IHD (600 cases) requiring hospital admission in 1996. We calculated annual age-standardized employment rates and age-adjusted odds of leaving employment during 1997—2001 by social class for in-patients and the general population. Results: Men and women who had an in-patient episode for IHD had lower age-standardized employment rates than the general population. Following hospital admission, the likelihood of patients with IHD leaving employment increased annually, and by 2001 their adjusted odds were almost four times greater (odds ratio 3.95, 95% confidence interval 3.23—4.83) than for the general population. The impact of IHD on employment was more severe with decreasing social class and patients employed in low-skilled manual occupations were significantly more likely to lose employment than professional workers with the same diagnosis. Within each social class patients had significantly higher odds of leaving employment than the general population. Conclusions: In spite of its progressive employment and rehabilitation policies, our study revealed considerable and socially differentiated employment consequences of IHD in Sweden. More account needs to be taken of such differential impact in health and social policy development.
Mortality patterns in geographical areas with a high vs. low Sami population density in Arctic Norway
Authors: Brustad Magritt , Pettersen Torunn , Melhus Marita , Lund Eiliv
Published: June 2009

Aims: The aim of this study was to study mortality patterns in the population in different geographical locations in northern Norway on the basis of Sami population density. Methods: Mortality statistics by sex and age from 1991 to 2006 were obtained from Statistics Norway. Mortality rates, including infant mortality rates, were compared across geographical locations. The data material was divided into within and outside the the geographical areas of the Sami Development Fund (SUF) and into coastal and inland residence. Differences in mortality rates were tested by chi-quadrate tests. Results: Overall, no pronounced difference in mortality rate was found in the population between geographical areas. For men, mortality rates differed only between geographical residence in the time intervals 1991—95 and 1996—2000 for the age groups 45—59 years and 60—74 years, respectively, with outside SUF area, inland having the lowest rate. For women, there were no differences between geographical areas except for the age group 60—74 years in the time period 1991—95, where SUF coast had the highest mortality rate. For the SUF area, men had the lowest probabilities for surviving the age of 74 years and women had among the highest. No geographical difference was found in infant mortality. During the time period 1991—2006, the outside SUF area, inland had an average infant mortality rate of 1.8/1000 per year, and for SUF coast it was 6.2/1000 per year. This difference was, however, not significant (p = 0.08). Conclusions: Overall, mortality rates were similar across geographical areas with low and with high Sami population density. However, indications of geographical differences in infant mortality should be investigated further.
The prevalence of problematic gambling behaviour: A Scandinavian comparison
Authors: Bonke Jens , Borregaard Karen
Published: June 2009

Aims: On the basis of a new large-scale screening for the prevalence of problematic gambling behaviour in Denmark, the aim of the study was: (a) to evaluate the effect of applying different screening tools; and (b) to compare gambling behaviour in Denmark with the prevalence of problematic gambling behaviour in other Scandinavian countries. Methods: The screening tools applied were the internationally validated SOGS-R and NODS. These were used within the same survey, thus allowing for comparison with surveys conducted in other Scandinavian countries where either the one or the other tool has been utilized. Results: The prevalence of at-risk gamblers, problematic gamblers and pathological gamblers was significantly lower in Denmark than in the other Scandinavian countries. This held true for both genders as well as for different age groups in comparisons of Denmark and Norway. Conclusions: There is a considerable variation in the prevalence of problematic gambling between the Scandinavian countries, with Denmark having the smallest number of gamblers with problematic behaviour. The variation might be due to national differences in gambling preferences, access to games, public policies concerning gambling, etc., but investigation of this would require further comparative research.
Best Conventional Therapy Versus Modular Impairment-Oriented Training for Arm Paresis After Stroke: A Single-Blind, Multicenter Randomized Controlled Trial
Authors: Platz Thomas , van Kaick Stefanie , Mehrholz Jan , Leidner Ottmar , Eickhof Christel , Pohl Marcus
Published: June 2009

Background. The study investigated whether passive splinting or active motor training as either individualized best conventional therapy or as standardized impairment-oriented training (IOT) would be superior in promoting motor recovery in subacute stroke patients with mildly or severely paretic arms. Methods. A total of 148 anterior circulation ischemic stroke patients were randomly assigned to 45 minutes of additional daily arm therapy over 3 to 4 weeks as either ( a) passive therapy with inflatable splints or active arm motor therapy as either ( b) individualized best conventional therapy (CONV) or ( c) standardized IOT, that is Arm BASIS training for severe paresis or Arm Ability training for mild paresis. Main outcome measures included the following: Fugl-Meyer arm motor score (severely paretic arms) and the TEMPA time scores (mildly affected arms). Pre—post (immediate effects) and pre—4 weeks follow-up analyses (long-term effects) were performed. Results. Overall improvements were documented (mean baseline and change scores efficacy: Fugl-Meyer, arm motor scores, 24.4, +9.1 points; TEMPA, 119, −26.6 seconds; P < .0001), but with no differential effects between splint therapy and the combined active motor rehabilitation groups. Both efficacy and effectiveness analyses indicated, however, bigger immediate motor improvements after IOT as compared with best conventional therapy (Fugl-Meyer, arm motor scores: IOT +12.3, CONV +9.2 points; TEMPA: IOT −31.1 seconds, CONV −20.5 seconds; P = .0363); for mildly affected patients long-term effects could also be substantiated. Conclusions. Specificity of active training seemed more important for motor recovery than intensity (therapy time). The comprehensive modular IOT approach promoted motor recovery in patients with either severe or mild arm paresis.
Multicenter Randomized Trial of Robot-Assisted Rehabilitation for Chronic Stroke: Methods and Entry Characteristics for VA ROBOTICS
Authors: Lo Albert C. , Guarino Peter , Krebs Hermano I. , Volpe Bruce T. , Bever Christopher T. , Duncan Pamela W. , Ringer Robert J. , Wagner Todd H. , Richards Lorie G. , Bravata Dawn M. , Haselkorn Jodie K. , Wittenberg George F. , Federman Daniel G. , Corn Barbara H. , Maffucci Alysia D. , Peduzzi Peter
Published: June 2009

Background. Chronic upper extremity impairment due to stroke has significant medical, psychosocial, and financial consequences, but few studies have examined the effectiveness of rehabilitation therapy during the chronic stroke period. Objective. To test the safety and efficacy of the MIT-Manus robotic device for chronic upper extremity impairment following stroke. Methods. The VA Cooperative Studies Program initiated a multicenter, randomized, controlled trial in November 2006 (VA ROBOTICS). Participants with upper extremity impairment ≥6 months poststroke were randomized to robot-assisted therapy (RT), intensive comparison therapy (ICT), or usual care (UC). RT and ICT consisted of three 1-hour treatment sessions per week for 12 weeks. The primary outcome was change in the Fugl-Meyer Assessment upper extremity motor function score at 12 weeks relative to baseline. Secondary outcomes included the Wolf Motor Function Test and the Stroke Impact Scale. Results. A total of 127 participants were randomized: 49 to RT, 50 to ICT, and 28 to UC. The majority of participants were male (96%), with a mean age of 65 years. The primary stroke type was ischemic (85%), and 58% of strokes occurred in the anterior circulation. Twenty percent of the participants reported a stroke in addition to their index stroke. The average time from the index stroke to enrollment was 56 months (range, 6 months to 24 years). The mean Fugl-Meyer score at entry was 18.9. Conclusions. VA ROBOTICS demonstrates the feasibility of conducting multicenter clinical trials to rigorously test new rehabilitative devices before their introduction to clinical practice. The results are expected in early 2010.
Collaborative Models for Translational Neuroscience and Rehabilitation Research
Authors: Dobkin Bruce H.
Published: June 2009

Little formal research has been conducted on strategies to structure basic, preclinical, and clinical research to increase the likelihood of discovering efficacious interventions for patients with neurological diseases. How academic research is organized and funded by government agencies and foundations seems likely to affect the quality and rate of production of valued therapeutic agents. Few models for translational biomedical research, however, have been defined and no strategies have been compared. Given the narrow width of expertise and laboratory capacity of individual investigators, the complexity of identifying and manipulating mechanisms of disease components over time, and the demand for solutions from society, our continued reliance on funding therapeutic discovery through standalone investigators and projects seems counterproductive. Models are described for funding collaborations of basic and clinical scientists to work in iterative, adaptable, cross-disciplinary interactions around key progress-limiting questions. Problem-oriented collaborations require leadership, incentives, trust, ongoing assessment, and an efficient infrastructure that overcomes barriers. These models are as testable as the hypotheses that drive scientific research.
The Impact of Institutional Design on the Democratization of School Governance
Authors: Gvirtz Silvina , Minvielle Lucila
Published: June 2009

Nicaragua presents an interesting case study of a society pursuing reform of the democratization of its school governance through citizen participation. A radical transformation with a complex institutional arrangement was put in place within a context of major political change and endemic poverty. In order to achieve our objective of empirically evaluating the actual democratization of school governance that took place in Nicaraguan schools, we offer a detailed description of Nicaragua's Autonomous School Program's (ASP) institutional arrangements, which ran for almost 20 years nationwide. Our conclusion is that the implementation of collegiate governance with ample participation requires much planning and a great deal of caution, since misguided efforts may become the norm generating greater levels of exclusion and autocracy in defiance of democracy and participation. Unfortunately in Nicaragua this was the case.
Increasing Student Voice in High School Reform
Authors: Mitra Dana L. , Gross Steven Jay
Published: June 2009

While we often write about adolescents as full of turmoil and angst, focusing on `student voice' instead highlights ways in which young people can learn democratic principles by sharing their opinions and working to improve school conditions for themselves and others. This article examines the connection between the types of student voice initiatives desired and the contexts in which student voice is pursued. Drawing upon cases from the USA and Australia, we suggest that turbulence theory can influence the way that student voice is received at a school and its ability to achieve desired goals. Student voice can help to increase the tension and focus on pressing issues when needed; it also can help to calm turbulence occurring within individual adolescents and also in school contexts that need resolution.
Struggling for Democracy
Authors: Ryan James , Rottmann Cindy
Published: June 2009

This article describes a study that explores efforts to promote democratic practice in a diverse school context. More specifically, it documents administrative endeavors to include members of the school community—teachers, parents and students—in the various school processes by encouraging inclusive communicative practices. The findings of the study indicate that administrators attempt to achieve such ends by establishing relationships with members of their school community that will enable dialogue. They do their best to display their caring natures, vulnerability and senses of humor. They also make themselves visible and approachable, work on greeting people, understanding them and dismantling the hierarchies that exclude people. In the end, however, their efforts fail to foster meaningful democratic and inclusive practices. Administrators in the study end up bypassing democratic options and drawing on the hierarchical power associated with the bureaucratic system in which they work in order to ensure that the school will be able to attract students in the quasi-market system in which it operates.
Nurturing Democracy
Authors: Woods Philip A. , Gronn Peter
Published: June 2009

This article reviews the comparative merits of distributed leadership and democratic leadership as understandings of, and preferred alternatives to, the leadership of and in organizations. It is particularly concerned that, while distributed leadership may provide a welcome and worthwhile respite from and alternative to the kind of heroic orthodoxy that has been calculated to secure organizational membership control and compliance, distributed leadership entails a democratic deficit. The core components of these two conceptions of leadership, the points of connection and tension between them, the conditions that might facilitate or impede their realization, and the problems and possibilities entailed in their attainment are discussed. Neither the purpose nor the claim of this article is to resolve the complex questions concerned with democracy and leadership in organizations generally, or schools in particular. Its case is that the influential notion of distributed leadership needs to be interrogated critically from the perspective of a concern with building organizations that are more democratic and respectful of the human status of their members and other stakeholders. It concludes by suggesting a multi-stranded approach for educational leaders and policymakers concerned to advance the democratic potential of distributed leadership.
New techniques for laser prostatectomy: an update
Authors: Chung Doreen E. , Te Alexis E.
Published: June 2009

Traditionally, the gold standard for treatment of BPH has been the electrocauterybased TransUrethral Resection of the Prostate (TURP). However, the number of laser techniques being performed is rapidly increasing. Potential advantages of laser therapy over traditional TURP include decreased morbidity and shorter hospital stay. There are several techniques for laser prostatectomy that continue to evolve. The main competing techniques are currently the Holmium Laser Enucleation of the Prostate (HoLEP) and the 80W 532nm laser prostatectomy. The HoLEP, using the Holmium:YAG laser, has been shown to have clinical results similar to TURP and is suitable for patients on anticoagulation as well as those with large prostates. Disadvantages of this technique are the high learning curve and requirement of a morcellator. When used to treat BPH, studies have demonstrated that, like the HoLEP, the 80W KTP laser is safe and effective in patients with large prostates and in those taking oral anticoagulation. Several studies have compared these two techniques to TURP. Frequently reported advantages of the HoLEP over the 80W laser prostatectomy are the availability after the procedure of a pathology specimen and ability to remove a higher percentage of prostate tissue during resection. However, the transurethral laser enucleation of the prostate addresses these concerns and has shown to have durable outcomes at 2-year follow-up. Two new laser systems and techniques, the thulium laser and the 980nm laser, have emerged recently. However, clinical data from these procedures are in their infancy and large long-term studies are required.
Nitriding of titanium and Ti6Al4V alloy in ammonia gas under low pressure
Authors: Januszewicz B. , Klimek L.
Published: June 2009

Results of researches on titanium Ti6Al4V and Ti grade 2 alloys subjected to nitriding in temperature range of 650–850°C in ammonia gas under low pressure are presented in the present paper. Improved hardness and wear resistance of modified substrates were observed. Scanning electron microscope analysis revealed the redistribution of alloying elements in the matrix of treated substrates. Measurements of hydrogen content showed that this element intensively penetrated substrates treated in ammonia atmosphere, with no adverse effect in most cases. Nitriding of titanium substrates in ammonia under low pressure requires further investigations, but the results presented in the present paper seem promising.
Leukocyte proteases cleave von Willebrand factor at or near the ADAMTS13 cleavage site
Authors: Raife Thomas J. , Cao Wenjing , Atkinson Bonnie S. , Bedell Bruce , Montgomery Robert R. , Lentz Steven R. , Johnson George F. , Zheng X. Long
Published: June 2009

The function of von Willebrand factor (VWF) is regulated by proteolysis, which limits its multimeric size and ability to tether platelets. The importance of ADAMTS13 metalloprotease in VWF regulation is demonstrated by the association between severe deficiency of ADAMTS13 and thrombotic thrombocytopenic purpura (TTP). However, ADAMTS13 activity levels do not always correlate with the clinical course of TTP, suggesting that other proteases could be important in regulating VWF. We identified 4 leukocyte proteases that cleave the synthetic VWF substrate FRETS-VWF73 and multimeric VWF. Elastase and proteinase 3 (PR3) cleave multimeric VWF and FRETS-VWF73 at the V1607-T1608 peptide bond; cathepsin G and matrix metalloprotease 9 cleave VWF substrates at the Y1605-M1606 and M1606-V1607 bonds, respectively. Isolated intact human neutrophils cleave FRETS-VWF73 at the V1607-T1608 peptide bond, suggesting that elastase or PR3 expressed on leukocyte surfaces might cleave VWF. In the presence of normal or ADAMTS13-deficient plasma, cleavage of FRETS-VWF73 by resting neutrophils is abolished. However, activated neutrophils retain proteolytic activity toward FRETS-VWF73 in the presence of plasma. Although the in vivo relevance remains to be established, these studies suggest the existence of a “hot spot” of VWF proteolysis in the VWF A2 domain, and support the possibility that activated leukocytes may participate in the proteolytic regulation of VWF.
In essential thrombocythemia, multiple JAK2-V617F clones are present in most mutant-positive patients: a new disease paradigm
Authors: Lambert Jonathan R. , Everington Tamara , Linch David C. , Gale Rosemary E.
Published: June 2009

In essential thrombocythemia (ET), the JAK2-V617F mutation is usually restricted to a subpopulation of neutrophils and platelets, and production of JAK2 wild-type (WT) platelets is not suppressed. Nonmutated precursor cells may, therefore, be susceptible to the acquisition of further JAK2 mutations. We used a common single nucleotide polymorphism (SNP) in the JAK2 coding sequence to genotype V617F alleles obtained either by allele-specific restriction enzyme digestion (RED) or by cloning. Both SNP alleles were detected in JAK2 mutant–positive alleles from neutrophils of 10 of 11 ET patients studied using RED compared with 0 of 5 with polycythemia vera. These results were confirmed in cloned products from 5 ET patients and indicate the occurrence of at least 2 separate JAK2 mutation events in the majority of ET patients investigated. In a further ET patient, JAK2 mutant–positive erythroid colonies with either X-allele inactivated were detected, demonstrating they could not have arisen from a common clonal precursor. These results indicate that at least 2 independent JAK2-V617F events occur commonly in ET patients, and they may arise on a polyclonal background. The presence of a JAK2 mutation in ET patients should not, therefore, be equated with a malignant disease.
Restoration of NET formation by gene therapy in CGD controls aspergillosis
Authors: Bianchi Matteo , Hakkim Abdul , Brinkmann Volker , Siler Ulrich , Seger Reinhard A. , Zychlinsky Arturo , Reichenbach Janine
Published: June 2009

Chronic granulomatous disease (CGD) patients have impaired nicotinamide adenine dinucleotide phosphate (NADPH) oxidase function, resulting in poor antimicrobial activity of neutrophils, including the inability to generate neutrophil extracellular traps (NETs). Invasive aspergillosis is the leading cause of death in patients with CGD; it is unclear how neutrophils control Aspergillus species in healthy persons. The aim of this study was to determine whether gene therapy restores NET formation in CGD by complementation of NADPH oxidase function, and whether NETs have antimicrobial activity against Aspergillus nidulans. Here we show that reconstitution of NET formation by gene therapy in a patient with CGD restores neutrophil elimination of A nidulans conidia and hyphae and is associated with rapid cure of preexisting therapy refractory invasive pulmonary aspergillosis, underlining the role of functional NADPH oxidase in NET formation and antifungal activity.
Pesticide use and adult-onset asthma among male farmers in the Agricultural Health Study
Authors: Hoppin J. A. , Umbach D. M. , London S. J. , Henneberger P. K. , Kullman G. J. , Coble J. , Alavanja M. C. R. , Beane Freeman L. E. , Sandler D. P.
Published: June 2009

Although specific pesticides have been associated with wheeze in farmers, little is known about pesticides and asthma.

Data from 19,704 male farmers in the Agricultural Health Study were used to evaluate lifetime use of 48 pesticides and prevalent adult-onset asthma, defined as doctor-diagnosed asthma after the age of 20 yrs. Asthma cases were categorised as allergic (n = 127) and nonallergic (n = 314) based on their history of eczema or hay fever. Polytomous logistic regression, controlling for age, state, smoking and body mass, was used to assess pesticide associations.

High pesticide exposure events were associated with a doubling of both allergic and nonallergic asthma. For ever-use, 12 individual pesticides were associated with allergic asthma and four with nonallergic asthma. For allergic asthma, coumaphos (OR 2.34; 95% CI 1.49–3.70), heptachlor (OR 2.01; 95% CI 1.30–3.11), parathion (OR 2.05; 95% CI 1.21–3.46), 80/20 mix (carbon tetrachloride/carbon disulfide) (OR 2.15; 95% CI 1.23–3.76) and ethylene dibromide (OR 2.07; 95% CI 1.02–4.20) all showed ORs of >2.0 and significant exposure–response trends. For nonallergic asthma, DDT (dichlorodiphenyltrichloroethane) showed the strongest association (OR 1.41; 95% CI 1.09–1.84), but with little evidence of increasing asthma with increasing use. Current animal handling and farm activities did not confound these results. There was little evidence that allergy alone was driving these associations. In conclusion, pesticides may be an overlooked contributor to asthma risk among farmers.
Multiplex immune serum biomarker profiling in sarcoidosis and systemic sclerosis
Authors: Beirne P. , Pantelidis P. , Charles P. , Wells A. U. , Abraham D. J. , Denton C. P. , Welsh K. I. , Shah P. L. , du Bois R. M. , Kelleher P.
Published: June 2009

Multiplex protein technology has the potential to identify biomarkers for the differentiation, classification and improved understanding of the pathogenesis of interstitial lung disease. The aim of this study was to determine whether a 30-inflammatory biomarker panel could discriminate between healthy controls, sarcoidosis and systemic sclerosis (SSc) patients independently of other clinical indicators. We also evaluated whether a panel of biomarkers could differentiate between the presence or absence of lung fibrosis in SSc patients.

We measured 30 circulating biomarkers in 20 SSc patients, 21 sarcoidosis patients and 20 healthy controls using Luminex bead technology and used Fisher’s discriminant function analysis to establish the groups of classification mediators.

There were significant differences in median concentration measurements between study groups for 20 of the mediators but with considerable range overlap between the groups, limiting group differentiation by single analyte measurements. However, a 17-analyte biomarker model correctly classified 90% of study individuals to their respective group and another 14-biomarker panel correctly identified the presence of lung fibrosis in SSc patients.

These findings, if they are corroborated by independent studies in other centres, have potential for clinical application and may generate novel insights into the modulation of immune profiles during disease evolution.
Troponin T predicts in-hospital and 1-year mortality in patients with pulmonary embolism
Authors: Janata K. M. , Leitner J. M. , Holzer-Richling N. , Janata A. , Laggner A. N. , Jilma B.
Published: June 2009

We aimed to determine the prognostic value of troponin T (TNT) for in-hospital and 1-yr mortality in a large sample of patients with pulmonary embolism (PE).

Patients presenting at the emergency department of a tertiary care centre from January 1998 to December 2006 with PE were included. A blood sample was taken at the time of presentation. To determine in-hospital and 1-yr mortality, data from the hospital records and the national death register were used.

TNT was determined in 563 out of 737 patients with proven PE. TNT was elevated (>0.03ng·mL−1) in 27%. In-hospital survival was 79% in TNT-positive patients compared with 94% in TNT-negative patients (p<0.001). 1-yr survival was 71% in TNT-positive patients compared with 90% in TNT-negative patients (p<0.001). Elevated TNT levels meant a four-times higher risk of in-hospital death and a three-times higher risk of 1-yr mortality, even after adjustment for the other most important risk factors of death in this population.

Elevated TNT independently predicts in-hospital and 1-yr mortality in patients with acute PE.
Incidence, characteristics and outcomes of patients with severe community acquired-MRSA pneumonia
Authors: Vardakas K. Z. , Matthaiou D. K. , Falagas M. E.
Published: June 2009

We evaluated the published data for the incidence, characteristics and outcomes of patients with community-acquired pneumonia (CAP) due to methicillin-resistantStaphylococcus aureus(MRSA). The estimated incidence of MRSA CAP is 0.51–0.64 cases per 100,000.

We identified 74 articles reporting data on 114 patients. Influenza like symptoms was reported in 41% of patients. Pneumonia improved in 59 (54.1%) out of 109 patients; 49 (44.5%) out of 110 patients died. The duration of hospitalisation was 38.1±24.9 and 8.3±11.7 days, respectively. The duration of intensive care unit (ICU) stay was 18.9±13.6 and 6.8±9.7 days, respectively. 76 strains carried the Panton–Valentine leukocidin gene.

The univariate analysis showed that multi-organ failure (p<0.001), leukopenia (p<0.001), admission to ICU (p<0.001), mechanical ventilation (p<0.001), use of aminoglycosides after culture results (p<0.001), shock (p = 0.001), acute respiratory distress syndrome (p = 0.001), influenza like symptoms (p = 0.008), disseminated intravascular coagulation (p = 0.042) and rash (p = 0.04) were the factors associated with death.
Incidence and outcome of weaning from mechanical ventilation according to new categories
Authors: Funk G-C. , Anders S. , Breyer M-K. , Burghuber O. C. , Edelmann G. , Heindl W. , Hinterholzer G. , Kohansal R. , Schuster R. , Schwarzmaier-D'Assie A. , Valentin A. , Hartl S.
Published: June 2009

Weaning from mechanical ventilation was categorised as simple, difficult or prolonged by an international task force of the American Thoracic Society/European Respiratory Society/European Society of Intensive Care Medicine/Society of Critical Care Medicine/Sociéte de Réanimation de Langue Française in 2007. This new classification has not been tested in clinical practice. The objective of the present study was to determine the incidence and outcome of weaning according to the new categories.

We included medical and surgical patients who required mechanical ventilation in a prospective, multicentre, 6-month cohort study.

From an initial cohort of 510 patients, 257 intubated patients started weaning. Of these patients, the cumulative incidences of simple, difficult, and prolonged weaning were 152 (59%), 68 (26%) and 37 (14%), respectively. Hospital mortality was increased in patients with prolonged (32%) but not difficult (9%) weaning in comparison with those with simple weaning (13%), overall p = 0.0205. In a multivariate logistic regression model, prolonged but not difficult weaning was associated with an increased risk of death. Ventilator-free days and intensive care unit (ICU)-free days were decreased in both difficult and prolonged weaning.

In conclusion, the new weaning category prolonged weaning is associated with increased mortality and morbidity in the ICU. The new category difficult to wean was associated with increased morbidity, but not mortality.
Control and severity of asthma during pregnancy are associated with asthma incidence in offspring: two-stage case–control study
Authors: Martel M-J. , Rey É. , Beauchesne M-F. , Malo J-L. , Perreault S. , Forget A. , Blais L.
Published: June 2009

The extent to which childhood asthma incidence is influenced by asthma control and severity during pregnancy is unknown. We have studied this association during the child's first 10 yrs of life.

A two-stage, case–control study, nested in a cohort of 8,226 children of asthmatic mothers, was conducted using three interlinked databases of Quebec, Canada, and mailed questionnaires. A total of 2,681 asthmatic children and 30,318 age-matched controls were selected (≤20 controls·case−1; stage 1), and 3,254 selected mothers were mailed questionnaires to obtain additional information (stage 2). Asthma control and severity was defined using validated indexes and childhood asthma incidence based on at least one asthma-related diagnosis and prescription received within 2 yrs. A total of 44 confounders were considered.

Compared with children of mild controlled asthmatic mothers, children whose mothers had moderate-to-severe uncontrolled asthma during pregnancy had an increased risk of asthma (adjusted OR 1.27, 95% CI 1.06–1.52). No increased risk was observed for children of mild uncontrolled and moderate-to-severe controlled mothers.

Based on one of the largest studies of children of asthmatic mothers, a significant increase in asthma risk was demonstrated among children whose mothers had poor control and increased severity of asthma during pregnancy, indicating that this element should be added to the expanding list of determinants of childhood asthma. As it constitutes a risk factor where pregnant asthmatic females can intervene, it is of great importance for physicians to optimally treat asthmatic females during pregnancy and to encourage females to be adherent to the prescribed asthma medications.