bluuebunny/crossref_metadata_2025 huggingface dataset:
Patch testing with fine fragrances: comparison with fragrance mix, balsam of Peru and a fragrance series
Authors: Trattner A. , David M.
Published: March 2004

High frequencies of contact allergy to fragrance ingredients have been reported in recent years. Only approximately 70–80% are detected by fragrance allergens in the standard patch test series. This investigation compares the patch test reactions to fine fragrances with reactions to fragrance mix (FM), balsam of Peru (BP) (Myroxylon pereirae resin) and a fragrance series. 641 consecutive patients with eczema were patch tested with the European standard series and with selected fine fragrances. Those who were positive to 1 of the fine fragrances or the FM or BP were also tested with the fragrance series. 95 (14.8%) patients were found to have a positive patch test reaction to FM or BP; 41 (6.4%) had positive results to fragrance no. 1 and 29 (4.5%) to no. 2. 9 (9.5% of the 95 positive patients) had a positive reaction to fine fragrances and a negative reaction to all other fragrance allergens in the standard series. These findings indicate that testing with fine fragrances can add to our evaluation of fragrance‐sensitive patients.
Fixed drug eruption from sodium benzoate
Authors: Vilaplana J. , Romaguera C.
Published: March 2004

We report a fixed drug eruption caused by a syrup containing sodium benzoate. Our patient gave a positive reaction to a patch test and to a provocation test after 15 h ingestion, but no patch test reaction in the interdigital area where the patient had previous lesions.
Responsive corneosurfametry following in vivo skin preconditioning
Authors: Uhoda E. , Goffin V. , Pierard G. E.
Published: March 2004

Skin is subjected to many environmental threats, some of which altering the structure and function of the stratum corneum. Among them, surfactants are recognized factors that may influence irritant contact dermatitis. The present study was conducted to compare the variations in skin capacitance and corneosurfametry (CSM) reactivity before and after skin exposure to repeated subclinical injuries by 2 hand dishwashing liquids. A forearm immersion test was performed on 30 healthy volunteers. 2 daily soak sessions were performed for 5 days. At inclusion and the day following the last soak session, skin capacitance was measured and cyanoacrylate skin‐surface strippings were harvested. The latter specimens were used for the ex vivo microwave CSM. Both types of assessments clearly differentiated the 2 hand dishwashing liquids. The forearm immersion test allowed the discriminant sensitivity of CSM to increase. Intact skin capacitance did not predict CSM data. By contrast, a significant correlation was found between the post‐test conductance and the corresponding CSM data. In conclusion, a forearm immersion test under realistic conditions can discriminate the irritation potential between surfactant‐based products by measuring skin conductance and performing CSM. In vivo skin preconditioning by surfactants increases CSM sensitivity to the same surfactants.
Foot dermatitis caused by the textile dye Basic Red 46 in acrylic blend socks
Authors: Opie Jacinta , Lee Adriene , Frowen Kathryn , Fewings John , Nixon Rosemary
Published: March 2004

17 male subjects are described with foot dermatitis in association with positive patch test reactions to the textile dye Basic Red 46. Chromatographic analysis of the socks of 2 affected patients confirmed the presence of Basic Red 46. Withdrawal of the acrylic blend socks suspected of having been dyed with Basic Red 46 resulted in the improvement of symptoms in 12 of 17 patients (70.6%). However, equivocal or negative patch test results to their own socks were frequently noted in those patients. A highly significant association between the presence of foot dermatitis and a positive Basic Red 46 patch test reaction was noted in 555 patients from a patch test clinic population (P < 0.001). The prevalence of positive patch test reactions to Basic Red 46 was 1.2%. We suggest that patients with foot dermatitis be routinely patch tested for textile dyes. In particular, testing with Basic Red 46 should be considered in those with a history of use of dark‐coloured acrylic and/or acrylic blend socks.
Social Determinants and Their Unequal Distribution: Clarifying Policy Understandings
Authors: GRAHAM HILARY
Published: March 2004

Public health policy in older industrialized societies is being reconfigured to improve population health and to address inequalities in the social distribution of health. The concept of social determinants is central to these policies, with tackling the social influences on health seen as a way to reduce health inequalities. But the social factors promoting and undermining the health of individuals and populations should not be confused with the social processes underlying their unequal distribution. This distinction is important because, despite better health and improvement in health determinants, social disparities persist. The article argues that more emphasis on social inequalities is required for a determinants‐oriented approach to be able to inform policies to address health inequalities.
Addressing the “Risk Environment” for Injection Drug Users: The Mysterious Case of the Missing Cop
Authors: BURRIS SCOTT , BLANKENSHIP KIM M. , DONOGHOE MARTIN , SHERMAN SUSAN , VERNICK JON S. , CASE PATRICIA , LAZZARINI ZITA , KOESTER STEPHEN
Published: March 2004

Ecological models of the determinants of health and the consequent importance of structural interventions have been widely accepted, but using these models in research and practice has been challenging. Examining the role of criminal law enforcement in the “risk environment” of injection drug users (IDUs) provides an opportunity to apply structural thinking to the health problems associated with drug use. This article reviews international evidence that laws and law enforcement practices influence IDU risk. It argues that more research is needed at four levels—laws; management of law enforcement agencies; knowledge, attitudes, beliefs, and practices of frontline officers; and attitudes and experiences of IDUs—and that such research can be the basis of interventions within law enforcement to enhance IDU health.
Changes in Elderly Disability Rates and the Implications for Health Care Utilization and Cost
Authors: SPILLMAN BRENDA C.
Published: March 2004

Recent research indicates declining age‐adjusted chronic disability among older Americans, which might moderate health care costs in the coming decades. This study examines the trend's underlying components using data from the 1984–1999 National Long‐Term Care Surveys to better understand the reasons for the declines and potential implications for acute and long‐term care. The reductions occurred primarily for activities like financial management and shopping. Assistance with personal care activities associated with greater frailty fell less, and independence with assistive devices rose. Institutional residence was stable. More needs to be known about the extent to which these declines reflect environmental improvements allowing greater independence at any level of health, rather than improvements in health, before concluding that the declines will mean lower costs.
Kant's Empirical Realism
Authors: Bird Graham
Published: March 2004

Books Reviewed:

Paul Abela
Nietzsche and the Transcendental Tradition
Authors: Doyle Tsarina
Published: March 2004

Books Reviewed:

Michael Steven Green
The Mind's Affective Life: A Psychoanalytic and Philosophical Inquiry
Authors: Redding Paul
Published: March 2004

Books Reviewed:

Gemma Corradi Fiumara
Kant und die Berliner Aufklärung. Akten des IX. Internationalen Kantkongresses
Authors: Schlösser Ulrich
Published: March 2004

Books Reviewed:

Volker Gerhardt, Rolf‐Peter Horstmann and Ralph Schumacher
Vom Zweifel zur Verzweiflung: Grundbegriffe der Existenzphilosophie Sören Kierkegaards
Authors: Schönbaumsfeld Genia
Published: March 2004

Books Reviewed:

Kristin Kaufmann,

Annemarie Pieper, Søren Kierkegaard
Zwischen Recht und Moral: Neuere Ansätze der Rechts‐ und Demokratietheorie. Mit Grundtexten von Karl‐Otto Apel und Ingeborg Maus
Authors: Thomassen Lasse
Published: March 2004

Books Reviewed:

René von Schomberg and Peter Niesen
The Genealogy of Aesthetics
Authors: Townsend Dabney
Published: March 2004

Books Reviewed:

Ekbert Faas
On Clear and Confused Ideas: An Essay about Substance Concepts
Authors: Wenzel Christian Helmut
Published: March 2004

Books Reviewed:

Ruth Garrett Millikan
Audit Fees and Market Segmentation – Further Evidence on How Client Size Matters within the Context of Audit Fee Models
Authors: Carson Elizabeth , Fargher Neil , Simon Daniel T. , Taylor Mark H.
Published: March 2004

The purpose of this paper is to examine the audit fee premium to the Big 6 brand in the small and large client segments of the market for audit services. We use a sample of Australian fee data for the five‐year period 1995 to 1999. We find evidence of price premiums to Big 6 auditors in the small client segment. We do not find evidence of fee premiums in the large client segment. We also present evidence that audit fees are not linearly related to client size as is typically assumed in audit fee models.
The Impact of Generating Initial Hypothesis Sets of Different Sizes on the Quality of the Initial Set, and the Resulting Time Efficiency and Final Judgment Accuracy
Authors: Bhattacharjee Sudip , Machuga Susan
Published: March 2004

This study examines the impact of generating initial hypothesis sets of different sizes on the quality of the hypotheses generated (i.e., the ability to consider both the direction and accounts that are over‐ or understated). We also examine the time efficiency, information search effectiveness, and the final judgment accuracy, conditional on the quality of the initial hypothesis set. Sixty auditors performed an analytical procedures task where they were asked to generate and test either a specific number of initial hypotheses (one, three, or six), or any number of hypotheses desired in order to uncover an error seeded in the financial statements. The results indicate that the three hypotheses group initially generated hypotheses of the highest quality and maintained the hypothesis quality after efficiently searching information and generating additional causes. The one hypothesis group improved the quality of their hypotheses only after generating and testing several causes. However, auditors who generated six hypotheses or any number desired (as in audit practice) considered hypotheses of lower quality in the initial set, and did not improve the hypotheses quality after going through the information search stage. These results suggest that the size of the initial hypothesis set can lead to differences in the gains that accrue from the hypothesis generation and information search stages of diagnostic decisions.
Does the Adoption of a Business Risk Audit Approach Change Internal Control Documentation and Testing Practices?
Authors: Bierstaker James Lloyd , Wright Arnold
Published: March 2004

The purpose of this study is to investigate the impact of the adoption of a business risk audit approach on internal control documentation and testing. Data were collected from senior auditors before and after a change to a new business risk approach to determine if auditors’ preferred internal control documentation format, as well as the number of formats commonly used, had changed. In addition, corroborating data were collected from 23 experienced managers and partners regarding preferred documentation format and extent of control testing and reasons for changes in control evaluation and testing approaches.

The results suggest that auditors use narratives significantly more often and rely on other formats significantly less than previously. In addition, results indicate that the primary reason auditors choose to rely on narratives is to enhance audit efficiency, and second, because the flexibility of this format works well with the new audit approach adopted. These findings have implications for audit effectiveness, since recent research suggests that significant internal control deficiencies may be overlooked if auditors rely on a single format. Finally, auditors indicated that the frequency of testing of controls has significantly increased as a result of the enhanced audit focus on business processes.
The Role of Quality Auditing in the Continuous Improvement of Quality: Lessons from Pakistani Experience
Authors: Bhatti M. Ishaq , Awan Hayat M.
Published: March 2004

Internal auditing is widely recognized as an important business tool in the area of quality management. This article examines the technique and role of internal audits in the continuous improvement of the quality of the sports goods industry in Pakistan. Toward this goal, a survey of 100 ISO 9000 certified companies was conducted at the end of 2001 and 88 usable questionnaires were obtained. It was observed that about 70 percent of the firms have established internal quality audit departments with an average duration of 2.5 years. Since then, the rejection rate has been reduced to an average 2.8 percent from the initial 7.9 percent defects. Moreover, the internal auditors are well trained, their professional skills are highly rated and they enjoy good relations with the production staff and/or auditees. The management of the sports goods industry benefited in terms of reduction in cost, defects, non‐conformity, rejection and also better and improved ways of doing their routine work. It is anticipated that the finding of this study will work as a benchmark for other industries in the region.
The Role and Functions of Audit Committees in the Indian Corporate Governance: Empirical Findings
Authors: Al‐Mudhaki Jawaher , Joshi P. L.
Published: March 2004

This paper examines the composition, focus and functions of audit committees (ACs), the effects of meetings and the criteria used in the selection of members by Indian listed companies from 73 questionnaire responses. The survey was carried out during February–March, 2002. The study reveals that so far only 56.2% of companies have established an AC despite the fact that it is now mandatory. Of those companies which have ACs, 68.3% have between three and six members on ACs. However, only 14.6% of companies have independent non‐executive directors on the committee, while 90.2% have non‐executive directors. This shows a lack of independent representation on the committees. The functions of ACs are quite diverse and are classified in three areas: financial statements and reporting, audit planning, and internal control and evaluation. The review of annual audited financial statements, discussion and recommendations of audit fees and review of the effectiveness of internal control were rated very highly by the respondents. The review of note disclosure and scope of external audit work are other important functions performed by ACs. The most important areas for focus are compliance with the standards and regulatory bodies, probing material items and undisclosed liabilities. However, there are statistical differences between medium and large sized companies in the performance of their role. The main criteria used for membership of an AC are: experience and knowledge of business, experience of holding similar positions and accounting and finance expertise. Ownership in the company was not perceived as an important criterion. The majority of companies’ AC meetings are held monthly or quarterly. MANOVA analysis reveals that the frequency of AC meetings has an effect on the internal control functions. The study concludes that the concept of an AC is not new in India but their formation is slow and their composition lacks independence. AC functions are still concentrated in the traditional areas of accounting and their role is not changing fast enough to make the corporate governance more effective.
A Grounded Theory Model of Auditor‐Client Negotiations
Authors: Beattie Vivien , Fearnley Stella , Brandt Richard
Published: March 2004

The central research question addressed in this paper is ‘How do companies and their auditors resolve important audit issues?’ In‐depth interviews are conducted with the audit partners and finance directors of a varied group of six major UK listed companies who had recently experienced audit interactions involving 22 significant accounting issues. A grounded theory model is developed of the negotiation process and the factors that influence the nature of the outcome of interactions. This model identifies, as principal analytical categories, a range of general relationship factors and specific accounting issue factors that influence aspects of the negotiation process. These aspects include the parties involved, the strategies adopted, the quality of the financial reporting outcome and the ease with which it is achieved. A secondary outcome of the research is that distinct categories of audit engagement partner are identified, termed the crusader, the safe pair of hands, the accommodator and the truster.
The tenth rib line as a new landmark of the lumbar vertebral level during spinal block
Authors: Jung C.‐W. , Bahk J.‐H. , Lee J.‐H. , Lim Y.‐J.
Published: March 2004

The purpose of this study was to assess whether the tenth rib line (an imaginary line that joins the lowest points of the rib cage on the flanks) could be used as a marker of the lumbar vertebral level. Simple X‐rays (n = 100) were taken with radiopaque markers attached on the lowest points of the rib cage and the uppermost points of the iliac crests on both flanks. The spinous process or interspinous space that the tenth rib or Tuffier's lines crossed was identified and recorded, respectively, in the neutral and fully flexed positions. With lumbar flexion, the tenth rib line (median (25th to 75th percentiles)) moved upward (L2 (L1−2 − L2) vs. L1–2 (L1–2 – L1–2); p < 0.01), but Tuffier's line moved downward (L4−5 (L4 − L4−5) vs. L4−5 (L4 − L5); p < 0.01). Because the ease of palpating the tenth rib line and its distribution patterns are comparable to those of the Tuffier's line, the tenth rib line may be useful as a new landmark of the lumbar vertebral level as well as a safeguard to prevent spinal puncture from being mistakenly performed at a dangerously high level.
Dantrolene – A review of its pharmacology, therapeutic use and new developments
Authors: Krause T. , Gerbershagen M. U. , Fiege M. , Weißhorn R. , Wappler F.
Published: March 2004

Human malignant hyperthermia is a life‐threatening genetic sensitivity of skeletal muscles to volatile anaesthetics and depolarizing neuromuscular blocking drugs occurring during or after anaesthesia. The skeletal muscle relaxant dantrolene is the only currently available drug for specific and effective therapy of this syndrome in man. After its introduction, the mortality of malignant hyperthermia decreased from 80% in the 1960s to < 10% today. It was soon discovered that dantrolene depresses the intrinsic mechanisms of excitation–contraction coupling in skeletal muscle. However, its precise mechanism of action and its molecular targets are still incompletely known. Recent studies have identified the ryanodine receptor as a dantrolene‐binding site. A direct or indirect inhibition of the ryanodine receptor, the major calcium release channel of the skeletal muscle sarcoplasmic reticulum, is thought to be fundamental in the molecular action of dantrolene in decreasing intracellular calcium concentration. Dantrolene is not only used for the treatment of malignant hyperthermia, but also in the management of neuroleptic malignant syndrome, spasticity and Ecstasy intoxication. The main disadvantage of dantrolene is its poor water solubility, and hence difficulties are experienced in rapidly preparing intravenous solutions in emergency situations. Due to economic considerations, no other similar drugs have been introduced into routine clinical practice.
Haemodynamic effects of a milrinone infusion without a bolus in patients undergoing off‐pump coronary artery bypass graft surgery
Authors: Kwak Y. L. , Oh Y. J. , Shinn H. K. , Yoo K. J. , Kim S. H. , Hong Y. W.
Published: March 2004

The haemodynamic effects of a continuous infusion of milrinone without an initial bolus dose were evaluated in patients undergoing off‐pump coronary artery bypass graft surgery. After internal mammary artery harvest, milrinone 0.5 μg.min−1.kg−1 (29 patients) or a normal saline infusion (33 patients) was started and continued until all graft anastomoses were completed. Haemodynamic variables were recorded before application of the tissue stabiliser, at 1, 3, 5 and 10 min after the application of the stabiliser, and after its removal. The administration of a milrinone infusion was associated with a smaller decrease in cardiac output and mixed venous oxygen saturation during all the coronary artery anastomoses, with no severe complications and a decreased dose of norepinephrine infused to maintain systemic arterial pressure.
Peri‐operative troponin I concentration as a marker of long‐term postoperative adverse cardiac outcomes – A study in high‐risk surgical patients
Authors: Higham H. , Sear J. W. , Sear Y. M. , Kemp M. , Hooper R. J. L. , Foex P.
Published: March 2004

We have previously demonstrated that the peri‐operative measurement of increased serum concentrations of the cardiac markers troponins I and T and creatine kinase‐MB can be predictors of major cardiovascular outcomes (including cardiac death) at 3 months after surgery. In the present study, we have followed the postoperative course of 157 patients undergoing major vascular surgery or major joint arthroplasty to 1 year using a patient questionnaire, general practitioner follow‐up and case‐notes review. Increased postoperative marker concentrations were defined as values greater than the upper reference limit. Increases in troponin I and troponin T concentrations, as well as a single elevated creatine kinase‐MB and two successively elevated creatine kinase‐MB concentrations were measured in 12, 13, 33 and 15 patients respectively. Thirty‐nine major adverse cardiac outcomes were recorded (cardiac death, myocardial ischaemia, congestive cardiac failure, unstable angina, cerebrovascular accident and major arrhythmias needing active treatment). There was no association between increases in any of these cardiac markers and cardiac death to 1 year. However, increases in troponin I and both a single elevated creatine kinase‐MB and two successively elevated creatine kinase‐MB concentrations were associated with an increased incidence of major cardiac outcomes, including cardiac death, to 1 year (odds ratio [95% confidence intervals] = 4.19 [1.16–14.87], 3.97 [1.65–9.44] and 5.19 [1.60–16.22], respectively).
Pre‐operative information and patient‐controlled analgesia: much ado about nothing
Authors: Chumbley G. M. , Ward L. , Hall G. M. , Salmon P.
Published: March 2004

We examined whether pre‐operative information benefited patients receiving patient‐controlled analgesia (PCA) after major surgery. We investigated whether patients felt better informed about PCA and also whether pre‐operative information altered the use of PCA, the adequacy of pain relief, worries about addiction and safety, and knowledge of side‐effects. We investigated the effectiveness of information provided in two ways, namely by a patient‐determined leaflet or an interview by a trained nurse from the pain team, compared with routine pre‐operative information. We studied 225 patients, 75 in each group. Patients in the leaflet group were better informed about PCA, became familiar with using PCA more quickly and were less confused about PCA than the control group. However, there were no effects on pain relief, worries about addiction and safety, and knowledge of side effects. The pre‐operative interview resulted in no benefits. Our findings indicate that the detailed provision of pre‐operative information failed to improve patients' experiences of PCA.
Disruption of cleft palate repair following the use of the laryngeal mask airway
Authors: Somerville N. S. , Fenlon S. , Boorman J. , Abbot M.
Published: March 2004

A 55‐year‐old man was admitted for routine examination of ears with insertion of grommets under general anaesthesia. At 2 years of age he had undergone successful repair of cleft lip and palate. A reinforced laryngeal mask airway was employed to maintain the airway. Postoperatively, it was evident he had suffered complete disruption of the soft palate repair, leading to velopharyngeal insufficiency with nasal regurgitation of fluids. We discuss the possible aetiology, having found no such reported injury pattern documented in the literature.
Cerebral and extracerebral release of protein S100B in cardiac surgical patients
Authors: Snyder‐Ramos S. A. , Gruhlke T. , Bauer H. , Bauer M. , Luntz A. P. , Motsch J. , Martin E. , Vahl C. F. , Missler U. , Wiesmann M. , Böttiger B. W.
Published: March 2004

Although several clinical studies have shown that increased serum concentrations of protein S100B predict ischaemic brain damage after cardiac surgery, S100B may also be released from the heart or other injured tissue. We therefore investigated the correlation between serum S100B levels and those of the specific cardiac marker troponin I in order to assess the cerebral vs. extracerebral origin of S100B. In 64 cardiac surgical patients, serial blood samples were drawn for the measurement of S100B and troponin I before surgery and for seven days after surgery. Neurological function was assessed before with the National Institutes of Health Stroke Scale and the Folstein Mini Mental Test. The data show that a sustained increase in serum S100B levels is associated with neurological dysfunction, as witnessed by a positive correlation between S100B values and the results of the neuropsychological tests. In contrast, the early postoperative increased levels of protein S100B derive from cardiac tissue, as shown by the positive correlation between S100B and cardiac troponin I levels.
Sleep disruption in critically ill patients – pharmacological considerations
Authors: Bourne R. S. , Mills G. H.
Published: March 2004

Sleep disturbances are common in critically ill patients and contribute to morbidity. Environmental factors, patient care activities and acute illness are all potential causes of disrupted sleep. Additionally, it is important to consider drug therapy as a contributing factor to this adverse experience, which patients perceive as particularly stressful. Sedative and analgesic combinations used to facilitate mechanical ventilation are among the most sleep disruptive drugs. Cardiovascular, gastric protection, anti‐asthma, anti‐infective, antidepressant and anticonvulsant drugs have also been reported to cause a variety of sleep disorders. Withdrawal reactions to prescribed and occasionally recreational drugs should also be considered as possible triggers for sleep disruption. Tricyclic antidepressants and benzodiazepines are commonly prescribed in the treatment of sleep disorders, but have problems with decreasing slow wave and rapid eye movement sleep phases. Newer non‐benzodiazepine hypnotics offer little practical advantage. Melatonin and atypical antipsychotics require further investigation before their routine use can be recommended.
The effect of epidural analgesia in labour on maternal respiratory function*
Authors: Von Ungern‐Sternberg B. S. , Regli A. , Bucher E. , Reber A. , Schneider M. C.
Published: March 2004

Lumbar epidural analgesia during labour has gained widespread acceptance. The impact of epidural analgesia based on mixtures of low‐dose local anaesthetic solutions and lipophilic opioids on most clinically relevant obstetric outcomes is minimal. Since the pregnant state per se is associated with important alterations in respiration, we assessed whether a subtle degree of motor blockade brought about by epidural analgesia might compromise respiratory function as assessed by spirometry. Sixty consenting parturients receiving epidural analgesia were consecutively included in this prospective study. We performed spirometry during the antepartum visit and in labour after effective epidural analgesia was established; at both assessments the women were pain‐free. Values were within normal ranges but increased significantly after effective epidural analgesia; median (IQR [range]) increase for vital capacity 7.4 (3.0–13 [−12–27])% (p < 0.001); forced vital capacity 4.4 (1.7–9.8 [−13–26])% (p < 0.001); forced expiratory volume in 1 s 5.5 (1.7–8.6 [−14–28])% (p < 0.001); and peak expiratory flow rate 2.3 (−1.6–5.8 [−18–16])% (p = 0.01)). We conclude that epidural analgesia for labour significantly improved respiratory function.
Evaluation of a new continuous cardiac output monitor in off‐pump coronary artery surgery
Authors: Leather H. A. , Vuylsteke A. , Bert C. , M'Fam W. , Segers P. , Sergeant P. , Vandermeersch E. , Wouters P. F.
Published: March 2004

We evaluated a new, ultra‐fast response continuous cardiac output monitor in 34 adult patients undergoing off‐pump coronary artery bypass graft surgery. Cardiac output was measured with the TruCCOMS® continuous cardiac output monitor (Aortech International plc, Lanarkshire, UK), using triplicate cold bolus thermodilution as the criterion standard, at fixed time points during surgery and during dobutamine infusion. The two techniques were compared using linear regression and Bland‐Altman analysis. Overall, the study device displayed a bias of 0.4 l.min−1 with limits of agreement of +2.5 l.min−1 and −1.7 l.min−1. The study device failed to detect the change in cardiac output caused by dobutamine accurately (y = 0.18x + 0.45; r2 = 0.13), with an error linearly related to the magnitude of the change measured. We conclude that the device's failure to detect changes in cardiac output could be a major limitation in its clinical use in its current form.
The short, tragic life of Robert M. Glover
Authors: Defalque R. J. , Wright A. J.
Published: March 2004

Robert Mortimer Glover (1815–1859) was a contemporary of John Snow and James Young Simpson. Although he did not reach the standing of those two giants, his researches, writings and lectures were important contributions to the early development of British anaesthesia. Glover was the first to explore the physiological action of chloroform in the laboratory and to discover its anaesthetic effect in 1842. He helped Sir John Fife in Hannah Greener's autopsy in January 1848 and influenced Fife's conclusions on the cause of the young girl's death. His numerous and extensive articles reviewing the history, chemistry, pharmacology and clinical applications of various anaesthetics were widely read and quoted by his colleagues, including John Snow. While in Edinburgh and Newcastle, Glover was recognised as a remarkably astute physician, original researcher, prolific writer and enthusiastic lecturer with an enormous knowledge of medicine, the physical sciences, mathematics and philosophy. His brilliant career deteriorated after his arrival in London and, especially, after his return from the Crimea, although he continued to publish until the week before his death. The causes of his decline remain obscure. The last year of his life was ruined by his addiction to chloroform, to whose development he had contributed so much, and which killed him at the early age of 43.
Forehead SpO2 monitoring compared to finger SpO2 recording in emergency transport
Authors: Nuhr M. , Hoerauf K. , Joldzo A. , Frickey N. , Barker R. , Gorove L. , Puskas T. , Kober A.
Published: March 2004

Continuous peripheral oxygen saturation monitoring using a finger pulse oximeter is standard in prehospital emergency medicine. Forehead peripheral oxygen saturation monitoring has been enhanced for better performance during movement and in cold ambient temperatures, both of which are common during emergency transport. We compared a new forehead monitor with standard finger pulse oximeter. The forehead technique had significantly fewer mean (SD) alarms per patient (3.0 (2.2)) than the finger pulse oximeter (7.8 (4.0)) and shorter durations of malfunction (76 (60) s compared to 333 (170) s) when using the finger pulse oximeter. We conclude that measuring peripheral oxygen saturation monitoring with a forehead sensor provides better monitoring quality in emergency care.
Second and subsequent surgical operations within 12 months of a first operation
Authors: Haden R. M. , Scott P. V.
Published: March 2004

In a retrospective study, all patients having anaesthetic procedures within a 3‐month period were identified and followed up to establish if they had further procedures within a calendar year. The procedures undertaken on these patients were then identified to establish if a relationship existed between the procedures and what that relationship was. 11% of all patients returned for further procedures, 80% of which were within the same surgery speciality. In the overwhelming majority, the subsequent procedures were related to the first either as planned courses of treatment or by complications of the surgery or the disease process. The relationship between the procedures and their time intervals is discussed.
Odour identification as a marker for postoperative cognitive dysfunction: A pilot study*
Authors: Rentowl P. , Hanning C. D.
Published: March 2004

The onset of postoperative cognitive dysfunction is delayed in some elderly surgical patients and the condition may persist. Increasing age is a risk factor for both postoperative cognitive dysfunction and dementia. Major surgery may unmask an underlying dementia; we report findings of a pilot study designed to inform this hypothesis. Impaired odour identification ability is a characteristic of the preclinical phase of some neuro‐degenerative diseases. This pilot study was designed to establish whether odour identification deficit is a marker for postoperative cognitive dysfunction, particularly in elderly patients genetically predisposed to develop late‐onset Alzheimer's disease. We found no association between odour identification ability and postoperative cognitive dysfunction in 53 patients aged 62–86, undergoing major non‐cardiac surgery under general anaesthesia. Our pilot study showed that a high number of patients genetically predisposed to develop Alzheimer's disease is required to test the utility of odour identification as a marker for postoperative cognitive dysfunction.
Are caregivers’ reports of motivation valid? Reliability and validity of the Reiss Profile MR/DD
Authors: Lecavalier L. , Havercamp S. M.
Published: March 2004

Background  Sensitivity theory proposes that there are wide individual differences in what motivates people with intellectual disability. The Reiss Profile MR/DD is a rating scale that measures 15 fundamental motives. This study examined the internal consistency and interrater reliability of the 15 subscales as well as the validity of motivational profiles.

Method  The study consisted of two distinct but related steps. First, the interrater reliability of the rating scale was established by having pairs of raters evaluate 48 individuals. Second, raters were presented with three different motivational profiles and asked to identify which one corresponded to the individual they had rated 4 weeks earlier.

Results  Results indicated good internal consistency (average alpha = 0.84), significant variability in the interrater reliability (average intraclass correlation coefficient = 0.52), and excellent validity (95% of the correct profiles were chosen). Average discrepancies between pairs of raters are presented.

Conclusions  Interrater reliability is an important topic for professionals working in the field of intellectual disability and results are discussed in terms of the factors that affect it. This is the first published study to report on the interrater reliability of the Reiss Profile MR/DD.
Burnout in direct care staff in intellectual disability services: a factor analytic study of the Maslach Burnout Inventory
Authors: Hastings R. P. , Horne S. , Mitchell G.
Published: March 2004

Background  There is gathering research interest in the well‐being of staff working in services for people with intellectual disability (ID), including the assessment of burnout and its correlates. However, no previous studies have considered the applicability of the main three dimensions of burnout to staff in ID services.

Methods  Data were analysed from two samples of staff (total n = 184) who participated in research studies that included completion of the Maslach Burnout Inventory (MBI).

Results  Nineteen of the MBI items loaded clearly onto factors closely resembling the three original subscales: emotional exhaustion, depersonalization and personal accomplishment. Internal consistency for the three MBI subscales was fair to good (range 0.68–0.87).

Conclusions  The original three MBI dimensions were found to be highly relevant to the present sample of staff. The analyses support the construct validity and reliability of the MBI for staff in ID services.
Smoking prevalence and knowledge of associated risks in adult attenders at day centres for people with learning disabilities
Authors: Taylor N. S. , Standen P. J. , Cutajar P. , Fox D. , Wilson D. N.
Published: March 2004

Background  Increased longevity among people with learning disabilities is accompanied by an increase in morbidity. A possible explanation is that living in the community and a move to greater independence may bring higher health risks through obesity and smoking. The study aimed to see if rates of smoking have increased from earlier published rates and to ascertain the awareness of the risks of smoking among people with learning disabilities.

Methods  A total of 435 people attending four social services day centres in a large urban area were assisted to complete a questionnaire.

Results  Twenty‐seven (6.2%) reported that they currently smoked. Those with mild disabilities were much more likely to smoke than those with more severe disabilities and they also reported smoking more heavily. For those with mild levels of learning disability, a higher than expected proportion living in hospital and staffed housing smoked, a lower proportion living with parents smoked but for those living independently the proportion who smoked was no higher than expected. Smokers were more knowledgeable about the risks than non‐smokers even if the level of learning disability was controlled for. Only a third of smokers were concerned about the risks.

Conclusions  The study provides no evidence that rates of smoking are increasing among people with learning disabilities nor that those living independently were more likely to smoke. Knowledge of health risks is poor across the group, but higher among the smokers who were unlikely to express concern about the risks. This may indicate that more support may be needed along with health education in this group.
Effectiveness of immediate verbal feedback on trainer behaviour during communication training with individuals with intellectual disability
Authors: Van Vonderen A.
Published: March 2004

The effect of immediate verbal feedback on trainer behaviour during communication training sessions with individuals with intellectual disability (ID) was assessed. Trainers were six undergraduate university students majoring in psychology. The procedure consisted of interrupting the sequence of trials of training by the supervisor and then giving brief corrective feedback. Feedback was focused on the accuracy of the following procedural aspects: (1) entry behaviour; (2) prompt level and order of presenting response prompts; (3) use of reinforcement; (4) pace of presenting trials; and (5) if this occurred, handling trainee's disruptive behaviour during training. Data were collected in a nonconcurrent multiple baseline design. Results indicated a statistically significant increase of the percentage correct trainer behaviour as compared to the baseline phase. Maintenance of effect of feedback was recorded during post‐training and follow‐up.
An exploratory study into health care policy for persons with intellectual disabilities in Taiwan
Authors: Lin J. D. , Wu J. L. , Yen C. F.
Published: March 2004

Background  Although Taiwan has already had a higher quality of health care compared with other countries, there still is a need to review the quality and effectiveness of services provided. The lack of health care policy for persons with disabilities is a reflection of health care provision in Taiwan. Health care provision problems will limit persons with disabilities in their access to the health care system. The purpose of the present study was to examine the general beliefs about the current health care policies for persons with intellectual disabilities (ID) in Taiwan.

Methods  Data were obtained from two sources, namely government policies analysis and interviews with representatives for key stakeholders in the field of ID.

Results  The results illustrate that health care service problems for persons with ID include: how to enforce the discovery system and early intervention service, disability evaluation system, National Health Insurance medical payment and medical care resource development are still confining their quality of care. Furthermore, the links between social welfare, education and health care have been lost because the different roles and perspectives of people in these fields are fundamentally at odds with one another. Health care professionals have become less reform‐minded as a consequence of the conditions of their work. Consequently, a complete and coordinated health care policy for persons with ID has become unattainable in society. The present paper draws on evidence from research and policies to explore the problems and potential of service development for persons with ID, and to identify review and action points for managing its implementation.
The concept of quality of life: what we know and do not know
Authors: Schalock R. L.
Published: March 2004

Background Over the past two decades the concept of quality of life (QOL) has increasingly become a focus for research and application in the fields of education/special education, health care (physical and behavioural), social services (disabilities and ageing), and families.

Methods This article summarizes our current understanding of the construct of individual QOL as it pertains to persons with intellectual disabilities (ID). The article's three major sections discuss what we know, what we are beginning to understand, and what we still do not know about the QOL construct.

Results We currently know the importance of the QOL construct as a service delivery principle, along with its current use and multidimensional nature. We are beginning to understand the importance of methodological pluralism in the assessment of QOL, the multiple uses of quality indicators, the predictors of assessed QOL, the effects of different data collection strategies, and the etic (universal) and emic (culture‐bound) properties of the construct. We have yet to understand fully the use of QOL‐related outcomes in programme change, how to best evaluate the outcomes of QOL‐related services, and how to use the concept of QOL to impact public and disability reform.

Conclusion The article concludes with a brief discussion of future challenges related to demonstrating the concept's social validity and positive impact on the lives of persons with ID.
Autism and intellectual disability: a study of prevalence on a sample of the Italian population
Authors: La Malfa G. , Lassi S. , Bertelli M. , Salvini R. , Placidi G. F.
Published: March 2004

Background  In 1994, the American Association on Mental Retardation with the DSM‐IV has come to a final definition of pervasive developmental disorders (PDD), in agreement with the ICD‐10. Prevalence of PDD in the general population is 0.1–0.15% according to the DSM‐IV. PDD are more frequent in people with severe intellectual disability (ID). There is a strict relationship between ID and autism: 40% of people with ID also present a PDD, on the other hand, nearly 70% of people with PDD also have ID. We believe that in Italy PDD are underestimated because there is no agreement about the classification system and diagnostic instruments.

Method  Our aim is to assess the prevalence of PDD in the Italian population with ID. The Scale of Pervasive Developmental Disorder in Mentally Retarded Persons (PDD‐MRS) seems to be a very good instrument for classifying and diagnosing PDD.

Results  The application of the PDD‐MRS and a clinical review of every individual case on a sample of 166 Italian people with ID raised the prevalence of PDD in this population from 7.8% to 39.2%.

Conclusions  The study confirms the relationship between ID and autism and suggests a new approach in the study of ID in order to elaborate a new integrated model for people with ID.
Predictors of parent–child language during novel task play: a comparison between typically developing children and individuals with Down syndrome
Authors: Johnson‐Glenberg M. C. , Chapman R. S.
Published: March 2004

Three questions were asked that explored the linguistic fine‐tuning hypothesis and how parents might model language: (i) do parents significantly tune to their children's productive language or non‐verbal cognition during play? (ii) is the level of the linguistic tuning different in the Down syndrome (DS) population compared to a typically developing (TD)‐match group population? and (iii) do the two populations differ in requests for labels and the scaffolding responses to the requests? In an exploratory play condition, parents of children with DS used a mean length of utterance (MLU) significantly higher than the MLU used by the parents of younger TD children who were matched for MLU. Thus, the DS parents have a higher baseline MLU, but the non‐significant correlations in the DS group do not support parental MLU tuning. There was evidence, however, for parental tuning to the children's lexicon using a number of different words when the DS children were at lower and average levels of receptive syntax and non‐verbal cognition. In addition, DS and TD parents requested labels for novel toys with the same frequency, perhaps indicting that all groups of parents are still probing and building their children's lexicons. This is an important finding because it may help to explain why adolescents and young adults with DS have vocabulary comprehension skills greater than one would predict from measures of their production and non‐verbal cognition.
Filarial chyluria: Long‐term experience of a university hospital in India
Authors: TANDON VIPUL , SINGH HARBANS , DWIVEDI U S , MAHMOOD MUFTI , SINGH P B
Published: March 2004

Background: Filariasis is an endemic problem in various Indian states. We evaluated the results of long‐term follow up (10–20 years) of patients with filarial chyluria.

Methods: We conducted a retrospective analysis of 160 patients treated for filarial chyluria who presented to the Banaras Hindu University Hospital from 1982 to 1992. Eighty‐four patients (52.5%) were treated using diethylcarbamazine (DEC) and a fat restricted diet and 76 patients (47.5%) underwent surgery. To examine the long‐term effects of filarial chyluria we analysed data on post‐treatment recurrence, weight gain, dietary freedom, chyluria free period and a number of other associated factors.

Results: Previous history of filariasis or its complication was documented in 19% of patients. In 71% of cases, cystoscopy showed that chylous efflux was predominant in the left ureteric orifice. The long‐term remission rate was 62% in the conservatively managed group (DEC + fat restricted diet), whereas 90% of patients in the operated group were cured. Postoperative recurrence rate was 10%. There was more weight gain and dietary freedom along with a longer chyluria free period in the operated group relative to the conservatively managed group.

Conclusions: Definitive surgical ablation of lymphatic urinary fistula is better than conservative medical management because it has a higher success rate, more dietary freedom and, therefore, better patient acceptability.