bluuebunny/crossref_metadata_2025 huggingface dataset:
Hearing Loss Related to Ototoxicity in Children With Cancer
Authors: Landier Wendy
Published: October 2007

Children undergoing treatment for cancer often receive agents that put them at risk for ototoxicity. Platinum-based chemotherapy, aminoglycoside antibiotics, loop diuretics, and radiotherapy are all capable of inducing inner ear damage, which may result in significant sensorineural hearing loss. Frequent audiological monitoring is necessary for the early detection of changes in hearing thresholds. Age-appropriate modification of audiological testing is essential to obtain accurate results and provide maximum comfort for pediatric patients. When hearing loss is identified promptly, consideration may be given to treatment modification and/or early intervention with hearing aids and other assistive devices. The consequences of hearing loss differ depending on the developmental stage of the child at the time that hearing loss occurs. Language acquisition may be affected in very young children, whereas educational and psychosocial concerns are paramount for the older child. The pediatric oncology nurse is instrumental in assisting the child and family who are coping with hearing loss related to cancer treatment.
A Survey of Pain Services for Pediatric Oncology Patients: Their Composition and Function
Authors: Tyc Vida L. , Bieberich Andrea A. , Hinds Pamela , Sifford Luanne
Published: October 2007

The purpose of this survey was to examine the composition and function of pain services/teams at facilities that provide pain management services to pediatric oncology patients across the United States. A questionnaire was mailed to facilities identified by the 1994 Pain Facilities Directory as providing pain services to cancer patients. Thirty-five facilities that identified oncology patients as one of the primary pediatric populations treated at their institution were the focus of this study. Eight facilities that managed bone marrow aspirations and/or lumbar punctures for pediatric oncology patients also participated in a telephone interview regarding analgesia/sedation practices for procedure-related pain. Provision of direct patient care was a primary function of the pain services surveyed, although delivery of services varied across settings. Postoperative and chronic pain were the most frequent reasons for referral. Only 17% and 3% of facilities had established written standard guidelines for pharmacological and nonpharmacological approaches to pain management, respectively. Most facilities reported using a local anesthetic and conscious sedation to manage bone marrow aspiration and lumbar punctures. Implications from these findings and recommendations for provision of pediatric pain services are discussed.
Preferences for Participation in Treatment Decision Making and Information Needs of Parents of Children With Cancer: A Pilot Study
Authors: Pyke-Grimm Kimberly A. , Degner Lesley , Small Acita , Mueller Bryan
Published: October 2007

This study was performed to obtain information on parents of children with cancer: (a) what role parents preferred to assume in treatment decision making (TDM); (b) parents' priority information needs; (c) if a relationship existed between TDM preferences and information needs; and (d) if sociodemographic, disease and treatment variables predicted TDM preferences or information needs. A cross-sectional survey was conducted with a convenience sample of 58 parents who had a child less than 13 years of age diagnosed with cancer in the previous year. Instruments included a Sociodemographic, Disease, and Treatment Questionnaire; the Control Preferences Scale for Pediatrics, and an Information Needs Questionnaire. The results showed that parents had systematic preferences about TDM, preferring collaborative followed by passive and active roles. Nine priorities in information needs (highest to lowest) were found: (a) treatments and tests, (b) cure, (c) caring for my child, (d) emotional impact, (e) side effects, (f) physical impact, (g) disease, (h) coping with painful procedures, and (i) impact on the family. Sociodemographic, disease and treatment variables were not predictive of preferences for TDM or information needs. Concrete informational needs take precedence over issues of emotional or family impact or pain. A low Kendall's coefficient (0.07) indicated that parents as a group do not have uniform information needs. Information giving must be individualized.
Conceptual Understanding of Resilience in the Adolescent With Cancer: Part I
Authors: Woodgate Roberta L.
Published: October 2007

During the past two decades, increased research attention has been directed toward understanding the adolescent who is confronted with challenges such as poverty or substance abuse. Accordingly, pediatric oncology nurse researchers and clinicians are increasingly becoming interested in understanding the experience of resilience in the adolescent with cancer. Research and clinical reports have shown that many adolescents with cancer are resilient even though they experience multiple stressors. That is, even in the face of adversity, they develop into well-adapted individuals. The purpose of this article is to develop a conceptual understanding of resilience in adolescents with cancer. Areas that are addressed include the following: (a) an historical overview of the major theoretical paradigms used to understand the pediatric cancer experience; (b) a summary of definitional issues related to the construct of resilience; and (c) a conceptual model of resilience. New insights are provided that may lead pediatric oncology nurse researchers and clinicians to examine resilience in the adolescent with cancer from a variety of perspectives.
Becoming a Cancer Patient: A Study of Families of Children With Acute Lymphocytic Leukemia
Authors: Tarr Jill , Pickler Rita H.
Published: October 2007

This grounded theory study was designed to explore the process by which families of children with acute lymphocytic leukemia (ALL) "become" cancer patients. Data were obtained through interviews with four families and three professional caregivers and were analyzed for processes by which families experience the illness of ALL. The central process of "becoming" was defined as trying to live as "normally" as possible; accepting that life is not the same; understanding what you have to do; and accepting what you can't change/living with dissatisfactions. This process was mediated by families' external contexts, including marital relationships and support networks, experiential contexts, including positive and negative experiences during treatment and previous illness experiences, and internal contexts, including personal survival strategies and personal outlooks and attitudes. The process illustrates the pattern of experience that occurs in families faced with the diagnosis of their child's ALL. Understanding this process may be useful to care providers when treating children with cancer.
Swimming and Central Venous Catheter-Related Infections in the Child With Cancer
Authors: Robbins Jacqueline , Cromwell Philene , Korones David N.
Published: October 2007

Although there have been many studies evaluating risk factors for catheter-related infections in children with cancer, none have examined whether swimming presents such a risk. Families of children with cancer were asked about specific swimming practices and central line care to determine whether there is an association between swimming and infection. Parents completed a self-report questionnaire and medical records were reviewed to document catheter-related intraluminal, tunnel, and exit-site infections. Ninety-one children with a total of 101 tunneled catheters participated in the study. Forty-nine children with a total of 50 catheters were swimmers; 46 children with 51 catheters were nonswimmers (four children had two catheters and swam with one catheter but not the other, therefore, these children were counted twice). There were no statistically significant differences in rates of catheter-related infections between the two groups (0.04/catheter-month in swimmers versus 0.25/in non-swimmers, relative risk; RR = 1.6, p = .16). When the analysis was confined to summertime infections per summertime catheter month, there were no significant differences in the rates of infections per summer month (0.06 for swimmers vs. 0.05 for non-swimmers, RR = 1.4; p = .50). When the analyses were performed to compare frequent swimmers with infrequent/non-swimmers, once again there were no differences found in rates of catheter-related infections between the two groups. These results suggest that swimming does not increase the risk of catheter-related infections in children with tunneled catheters.
Changes in the Activities, Functions, and Roles of Public Health Educators
Authors: Bowman Robert A.
Published: October 2007

Accounts of early activities of public health educators, statements of the American Public Health Association on the qualifications and functions of these educators, and studies concerned with their responsibilities, functions, work, or roles are reviewed. These point up the three major foci in public health education over time in the U.S., viz, dissemination of information, community organization, and health behavior and program planning. Functions of public health educators in emerging settings for practice are presented and the implications of this movement (i.e., movement of health educators into non-traditional settings) for the public health education profession are discussed
Preparation of Manpower for Health Education: A Comparative View
Authors: Baric Leo
Published: October 2007

Differences between various models in the organization of health education services are explored. New developments in health education approaches used in training, career structures, and job definitions in some European countries are summarized. Problem areas have been defined and recommendations have been produced by numerous activities of the World Health Organization in recent years. At a 1974 symposium, it became obvious that no planned manpower development is feasible without a job definition of the health educator as an educational product. The need to specify the aims of future developments requires taking a critical view of past developments and spelling out existing differences.
The Role of the Clinical Health Educator
Authors: Zimering Stanley , McTernan Edmund J.
Published: October 2007

A combination of forces favor the expansion of health education efforts in hospitals. This article describes four areas of health education in clinical settings: the justification for a health educator in this setting; his preparation; his role as a member of the health care team; and the extended role of the educator in the community, with voluntary and official agencies, and with families of patients.
Men’s Choices and Masculine Duties
Authors: Vuori Jaana
Published: October 2007

This article analyzes the debate among family experts about fathering in Finland from the 1980s to recent years. The controversy is whether shared parenting between women and men is good for children and for men themselves or whether a gendered division of parenting should be advocated instead. Both discourses perceive men as important as fathers but disagree on the care of babies and very young children. Irrespective of position, experts stress that the choices made by men regarding fatherhood are individual and have wide-ranging consequences in their lives and the lives of their children, especially of boys. Experts view motherhood as a societal duty, and fatherhood as personal and elective. If fathers’ choices are stressed as a moral issue, it is because fathers are seen as masculine actors, not as nurturers. The author argues that the radical societal ethos of shared parenting seems to have weakened, or even disappeared.
Attitudes Towards Women Physicians in a Nigerian Community
Authors: Ogedengbe R.O.
Published: October 2007

The extent of discrimination against female physicians by the general public has been sketchily researched upon in Nigeria. Recent programmes that were initiated to improve the lot of women and also encourage females to enter into male-dominated professions call for investigation into sex bias in medical practice. This paper examines the extent of discrimination against female physicians among the Yoruba of South Western Nigeria. Although the findings revealed that the respondents were more favourably disposed towards female physicians than was hitherto reported in earlier studies, the issue of sex bias was made obvious when the respondents were confronted with choosing physicians for specialised procedures. Certain socio-cultural beliefs that could be responsible were discussed and suggestions were made on the basis of the observed findings.
The Future of Environmental Health in Scotland
Authors: Stewart Kenneth M.
Published: October 2007

This paper reviews the considerable progress which the environmental health profession has achieved, particularly during the course of the past 10-20 years. The future of the profession is considered particularly in relation to the development of higher degree opportunities and progress of research, the expanding use of support and associate specialist staff, and the thorny area of meat inspection.

Further re-organisation of local government is inevitable and the paper suggests the development of a broader based environmental health and public safety service within local government, mirrored nationally by a similar department at the Scottish Office. The key roles of the Environmental Health (Scotland) Unit and the Royal Environmental Health Institute of Scotland in the future development of the profession are highlighted.
Perplexing Features in the Occurrence of Dental Caries and Its Relationship to Sugar Intake
Authors: Walker A.R.P. , Walker B.F. , Glatthaar I.I.
Published: October 2007

Epidemiologically, there are numerous perplexing features, insufficiently appreciated, in the occurrences of degenerative diseases, and in the roles of their risk factors. This applies particularly to dental caries, the commonest of all diseases, and the risk factor, sugar intake. In some contexts, caries scores are much lower, or are much higher, than expected. Moreover, even in contexts where outwardly the same risk factors are widespread, ranges of scores are much wider than would be expected. In all contexts, among groups and more especially among individuals, the association of caries experience and dietary intakes, particularly that of sugar intake, is limited. Accordingly, caution must be exercised in the over-blaming of sugar and in the overclaiming of benefits to be derived from reducing intake.
Characteristics of p-Aramid Fibers in Friction and Sealing Materials
Authors: Hahn Christoph
Published: October 2007

Aramid fibers are common asbestos replacement materials for friction and sealing products.

In brake pads, friction papers, as well as in static gaskets highly fibrillated short cut fibers, the aramid pulp is used. The aramid pulp not only serves as processing aid in the manufacturing process but also has great impact on the performance of the products. The following article describes the manufacture, properties, and performance data of para-aramid pulp and its function in friction materials and static gaskets.
Lack of Practice Effects on Neuropsychological Tests as Early Cognitive Markers of Alzheimer Disease?
Authors: Zehnder Antoinette E. , Bläsi Stafan , Berres Manfred , Spiegel Rene , Monsch Andreas U.
Published: October 2007

Reliable assessment of change from previous cognitive functioning is a prerequisite for determining the possible presence of neurodegenerative diseases such as Alzheimer's disease (AD). We investigated whether standardized change scores on the German version of the Consortium to Establish a Registry for Alzheimer's Disease-Neuropsychological Assessment Battery (CERAD-NAB) could be used for early diagnosis of AD and whether change scores on the CERAD-NAB are superior in this respect to scores recorded on 1 occasion only. Three hundred seventy-four normal control subjects were assessed twice. Data from 95 patients with mostly mild probable AD were collected at their first entry to a memory clinic and an average of 1.1 ± 0.24 years later. It is concluded that repeated testing with the CERAD-NAB does not generally add to improved diagnostic accuracy for mild and very mild AD and cannot, therefore, be recommended as a routine clinical procedure.
Can You Have Dementia With an MMSE Score of 30?
Authors: Shiroky Jonah S. , Schipper Hyman M. , Bergman Howard , Chertkow Howard
Published: October 2007

Objective. To investigate the possibility that a patient with a diagnosis oF probable Alzheimer's disease (AD) can still obtain a score oF 30/30 on the Mini-Mental State Exam (MMSE). Design. Chart review. Setting. The McGill University/Jewish General Hospital Memory Clinic. Participants. Participants were selected From the Memory Clinic's patient database. All underwent comprehensive evaluations, including relevant blood work and a computed tomographic scan or a magnetic resonance imaging scan oF the brain to rule out other causes oF dementia. Measurements. All patients had one or more neuropsychological evaluation. Data oF all psychometric testing, including the MMSE, were gathered From these visits. Results. Eight patients were Found to meet the criteria oF AD although achieving a score oF 30/30 on the MMSE. Four oF 8 patients achieved this score although they were taking cholinesterase inhibitors. Conclusion. Although rare, it is possible to achieve a score oF 30/30 on the MMSE even iF a subject is suFFering From a dementing illness.
Effect of Exercise on Mood in Nursing Home Residents With Alzheimer's Disease
Authors: Williams Christine L. , Tappen Ruth M.
Published: October 2007

The purpose oF this study was to examine the eFFects oF 3 behavioral interventions on aFFect and mood in nursing home residents with Alzheimer's disease. In a pre—post design, 90 residents with Alzheimer's disease were randomized to 3 groups: supervised walking, comprehensive exercise (walking plus strength training, balance, and Flexibility exercises), and social conversation (casual rather than therapeutic themes). Interventions were provided 5 days a week and progressed up to 30 minutes per session over 16 weeks. Interventions were conducted primarily indoors. Outcome measures included the Lawton Observed AFFect Scale, Alzheimer Mood Scale, and Dementia Mood Assessment. At posttest, participants receiving comprehensive exercise exhibited higher positive and lower negative aFFect and mood. The social conversation group exhibited the least positive and most negative mood and aFFect. Results suggest that exercise programs be emphasized in long-term care, particularly whole-body involvement rather than walking alone.
Regulation of angiogenesis through a microRNA (miR-130a) that down-regulates antiangiogenic homeobox genes GAX and HOXA5
Authors: Chen Yun , Gorski David H.
Published: October 2007

Angiogenesis is critical to tumor progression. The homeobox gene GAX inhibits angiogenesis in vascular endothelial cells (ECs). We have identified a microRNA (miR-130a) that regulates GAX expression and hypothesized that it plays a major role in modulating GAX activity in ECs. A 280-bp fragment from the GAX 3′-untranslated region (3′-UTR) containing 2 miR-130a targeting sites was observed to be required for the rapid down-regulation of GAX expression by serum and proangiogenic factors, whereas the activity of the GAX promoter did not vary with exposure to serum or proangiogenic factors. This same 280-bp sequence in the GAX 3′-UTR cloned into the psiCHECK2-Luciferase vector mediated serum-induced down-regulation of the reporter gene when placed 3′ of it. Finally, forced expression of miR-130a inhibits GAX expression through this specific GAX 3′-UTR sequence. A genome-wide search for other possible miR-130a binding sites revealed an miR-130a targeting site in the 3′-UTR of the antiangiogenic homeobox gene HOXA5, the expression and antiangiogenic activity of which are also inhibited by miR-130a. From these data, we conclude that miR-130a is a regulator of the angiogenic phenotype of vascular ECs largely through its ability to modulate the expression of GAX and HOXA5.
The impact of FLT3 internal tandem duplication mutant level, number, size, and interaction with NPM1 mutations in a large cohort of young adult patients with acute myeloid leukemia
Authors: Gale Rosemary E. , Green Claire , Allen Christopher , Mead Adam J. , Burnett Alan K. , Hills Robert K. , Linch David C.
Published: October 2007

An internal tandem duplication in the fms-like tyrosine kinase 3 gene (FLT3/ITD) is associated with poor prognosis in acute myeloid leukemia (AML), but the impact of mutant level, size, and interaction with nucleophosmin 1 (NPM1) mutations remains controversial. We evaluated these characteristics in a large cohort of young adult AML patients. There was a highly significant trend for worsening in relapse risk (RR) and overall survival (OS) with increasing FLT3/ITD mutant level (P < .001 for both), and even in the low level mutant group (1%-24% of total FLT3 alleles), RR was significantly worse than in the FLT3 wild-type (WT) group (P < .001). In multivariate analysis, mutant level was the most powerful prognostic factor for RR. Mutant size and number had no significant impact on outcome. The beneficial impact of an NPM1 mutation on RR and OS was seen in FLT3/ITD+ as well as FLT3/WT patients; both markers were highly significant independent predictors of outcome (P < .001). Stratification using both markers identified 3 prognostic groups: good (FLT3/ITD−NPM1+), intermediate (FLT3/ITD−NPM1− or FLT3/ITD+NPM1+), and poor (FLT3/ITD+NPM1−). Patients with high FLT3/ITD mutant level (greater than 50%) or FLT3/ITD+ in the absence of an NPM1 mutation may be good candidates for more experimental therapeutic approaches.
Elevated expression of adenosine A1receptor in bronchial biopsy specimens from asthmatic subjects
Authors: Brown R. A. , Clarke G. W. , Ledbetter C. L. , Hurle M. J. , Denyer J. C. , Simcock D. E. , Coote J. E. , Savage T. J. , Murdoch R. D. , Page C. P. , Spina D. , O’Connor B. J.
Published: October 2007

Asthmatics, unlike healthy subjects, experience bronchoconstriction in response to inhaled adenosine, and extracellular adenosine concentrations are elevated in the bronchoalveolar lavage fluid and exhaled breath condensate of asthmatic subjects. However, little is known about the location and expression of adenosine receptors in asthmatic airways. The aim of the present study was to investigate the distribution of adenosine A1receptors in bronchial biopsy specimens from mildly asthmatic steroid-naïve subjects and then compare the degree of expression with that of healthy subjects.

Biopsy sections were immunostained using an adenosine A1receptor antibody, the selectivity of which was validated in specific experiments. Image analysis was then performed in order to determine differences in immunostaining intensity.

Immunostaining of biopsy sections from the asthmatic subjects revealed strong expression of the A1receptor, located predominantly in the bronchial epithelium and bronchial smooth muscle. In comparison, very weak immunostaining was observed in biopsy specimens obtained from healthy subjects. Image analysis revealed that the intensity of positive staining of the asthmatic bronchial epithelium and smooth muscle regions was significantly greater than that observed for the healthy epithelium and smooth muscle.

In conclusion, the sensitivity of asthmatics to inhaled adenosine coupled with increased adenosine A1receptor expression implies that these receptors play a role in the pathophysiology of this disease.
Increased activation of p38 MAPK in COPD
Authors: Renda T. , Baraldo S. , Pelaia G. , Bazzan E. , Turato G. , Papi A. , Maestrelli P. , Maselli R. , Vatrella A. , Fabbri L. M. , Zuin R. , Marsico S. A. , Saetta M.
Published: October 2007

Inflammation, oxidative stress and apoptosis, which are involved in chronic obstructive pulmonary disease (COPD) pathogenesis, may activate the p38 subgroup of mitogen-activated protein kinases (MAPKs). Therefore, the aim of the present study was to evaluate the expression of the phosphorylated, active form of p38 MAPK (phospho-p38) in the lungs of COPD patients.

Surgical specimens were obtained from 18 smokers with COPD at different stages of disease severity, plus nine smoking and eight nonsmoking subjects with normal lung function. Phospho-p38+ cells were quantified by immunohistochemistry in both alveolar spaces and alveolar walls. Moreover, a Western blot analysis of phospho-p38 and total p38α isoform expressed by alveolar macrophages was performed.

Phospho-p38+ alveolar macrophages and phospho-p38+ cells in alveolar walls were increased in patients with severe and mild/moderate COPD, compared with smoking and nonsmoking controls. Moreover, they were inversely correlated to values of forced expiratory volume in one second (FEV1) and FEV1/forced vital capacity. Western blot analysis showed that phosphorylated p38, but not the total p38α isoform, was specifically increased in alveolar macrophages from COPD patients.

Activation of the p38 mitogen-activated protein kinase pathway appears to be involved in the pathogenesis of chronic obstructive pulmonary disease. The present findings suggest that this protein may be a suitable pharmacological target for therapeutic intervention.
Suboptimal asthma control: prevalence, detection and consequences in general practice
Authors: Chapman K. R. , Boulet L. P. , Rea R. M. , Franssen E.
Published: October 2007

Telephone surveys describing suboptimal asthma control may be biased by low response rates.

In order to obtain an unbiased assessment of asthma control and assess its impact in primary care, primary care physicians used a 1-page control questionnaire in 50 consecutive asthma patients.

Of the 10,428 patients assessed by 354 physicians, 59% were uncontrolled, 19% well-controlled and 23% totally controlled. Physicians overestimated control, regarding only 42% of patients as uncontrolled. Physicians were more likely to report plans to alter the regimens of uncontrolled patients than controlled patients (1.29versus0.20 medication changes per patient) doing so in a fashion consistent with guideline recommendations. Of the uncontrolled patients, 59% required one or more urgent care or specialist visitsversus26 and 15% of well-controlled or totally controlled patients, respectively. Patients were more likely to report short-term symptom control when they had not required urgent or specialist care (odds ratio 5.68; 95% confidence interval 4.91–6.58).

The majority of asthma patients treated in general practice are uncontrolled. Lack of control can be recognised by physicians who are likely to consider appropriate changes to therapy. A lack of short-term symptom control of asthma is associated with excess healthcare utilisation.
Procalcitonin predicts patients at low risk of death from community-acquired pneumonia across all CRB-65 classes
Authors: Krüger S. , Ewig S. , Marre R. , Papassotiriou J. , Richter K. , von Baum H. , Suttorp N. , Welte T.
Published: October 2007

The aim of the present study was to investigate the prognostic value, in patients with community-acquired pneumonia (CAP), of procalcitonin (PCT) compared with the established inflammatory markers C-reactive protein (CRP) and leukocyte (WBC) count alone or in combination with the CRB-65 (confusion, respiratory rate ≥30 breaths·min−1, low blood pressure (systolic value <90 mmHg or diastolic value ≤60 mmHg) and age ≥65 yrs) score.

In total, 1,671 patients with proven CAP were enrolled in the study. PCT, CRP, WBC and CRB-65 score were all determined on admission and patients were followed-up for 28 days for survival.

In contrast to CRP and WBC, PCT levels markedly increased with the severity of CAP, as measured by the CRB-65 score. In 70 patients who died during follow-up, PCT levels on admission were significantly higher compared with levels in survivors. In receiver operating characteristic analysis for survival, the area under the curve (95% confidence interval) for PCT and CRB-65 was comparable (0.80 (0.75–0.84)versus0.79 (0.74–0.84)), but each significantly higher compared with CRP (0.62 (0.54–0.68)) and WBC (0.61 (0.54–0.68)). PCT identified low-risk patients across CRB classes 0–4.

In conclusion, procalcitonin levels on admission predict the severity and outcome of community-acquired pneumonia with a similar prognostic accuracy as the CRB-65 score and a higher prognostic accuracy compared with C-reactive protein and leukocyte count. Procalcitonin levels can provide independent identification of patients at low risk of death within CRB-65 (confusion, respiratory rate ≥30 breaths·min−1, low blood pressure (systolic value <90 mmHg or diastolic value ≤60 mmHg) and age ≥65 yrs) risk classes.
The expiration reflex from the trachea and bronchi
Authors: Tatar M. , Hanacek J. , Widdicombe J.
Published: October 2007

The expiration reflex (ER) is a forced expiratory effort against a closed glottis that subsequently opens to eject laryngeal debris and prevent aspiration of material. It is distinct from the cough reflex. Its source is usually assumed to be restricted to the larynx and vocal folds, and its possible origin from the tracheobronchial (TB) tree has been suggested but never studied.

The current authors re-analysed previous records with mechanical or chemical stimulation of the TB tree to see if an ER can consistently be elicited, and to see whether it has properties similar to that from the larynx and vocal folds. A random review was made of some of the extensive literature on TB “cough” to see if it confirmed the authors’ conclusions. The TBER was consistently seen in cats and rabbits, either alone or followed by cough. These results are consistent with many studies in other species, including humans. It was enhanced, relative to cough, by inflation of the lungs and by general anaesthesia.

Tracheobronchial expiration reflex occurs frequently with mechanical stimulation of the tracheobronchial tree. It differs fundamentally from many of the properties of “true” cough. Its features similar to the laryngeal expiration reflex suggest that both should be labelled “expiration reflexes” and not cough. Its existence should be taken into account in experimental, and possibly clinical, studies on tracheobronchial cough.
Household chemicals, persistent wheezing and lung function: effect modification by atopy?
Authors: Henderson J. , Sherriff A. , Farrow A. , Ayres J. G.
Published: October 2007

The aims of the present study were to assess the effects of maternal use of domestic chemicals during pregnancy on wheezing and lung function in children aged ≤8.5 yrs and to explore the potential modifying effect of atopy.

In the Avon Longitudinal Study of Parents and Children, a cohort study, a maternal composite household chemical exposure (CHCE) score was derived. Wheezing phenotypes from birth to age 7 yrs were assigned on the basis of reported wheeze. Lung function (forced expiratory volume in one second (FEV1), forced vital capacity (FVC), forced midexpiratory flow between 25 and 75% of FVC (FEF25–75%)) was measured at age 8.5 yrs; and atopy by skin-prick tests at age 7.5 yrs. Multinomial logistic and linear regression models assessed the relationship between wheezing outcomes, lung function and CHCE score, and interactions with atopy.

Increased CHCE score was associated with early- (<18 months) and intermediate- (18–30 months) persistent and late-onset (>30 months) wheezing in nonatopic children (adjusted odds ratio per z-score of CHCE (95% confidence interval) 1.41 (1.13–1.76), 1.43 (1.02–2.13) and 1.69 (1.19–2.41), respectively). Increasing CHCE score was associated with decrements in FEV1and FEF25–75%.

Higher domestic chemical exposure during pregnancy was associated with persistent wheeze and lung function abnormalities in nonatopic children. This may result from pre-natal developmental effects or post-natal irritant effects on the developing airway, but is unlikely to be mediated through increased hygiene in the home.
Pulmonary arterial hypertension associated with fenfluramine exposure: report of 109 cases
Authors: Souza R. , Humbert M. , Sztrymf B. , Jaïs X. , Yaïci A. , Le Pavec J. , Parent F. , Hervé P. , Soubrier F. , Sitbon O. , Simonneau G.
Published: October 2007

The aim of the present study was to describe a large cohort of fenfluramine-associated pulmonary arterial hypertension (fen-PAH) and its possible prognostic markers.

The records of all patients with a diagnosis of fen-PAH evaluated at the present authors’ centre from 1986–2004 were retrospectively studied. Baseline clinical and haemodynamic data were collected, as well as survival times.

The median duration of fenfluramine exposure was 6 months, with a median of 4.5 yrs between exposure and onset of symptoms. Nine (22.5%) out of 40 patients evaluated resulted positive for the presence of germline bone morphogenetic protein receptor (BMPR)type 2 mutations. In these patients, the duration of exposure to fenfluramine was significantly lower than in patients without mutation. The median survival was 6.4 yrs, without significant difference between fen-PAH and a control group of idiopathic and familial pulmonary arterial hypertension patients referred to the present authors’ centre during the same time frame and treated identically. Duration of fenfluramine exposure showed no relation to survival, while cardiac index was the only independent predictor of multivariate analysis.

Fenfluramine-associated pulmonary arterial hypertension shares clinical, functional, haemodynamic and genetic features with idiopathic pulmonary arterial hypertension, as well as overall survival rates. Therefore, the present authors conclude that fenfluramine exposure characterises a potent trigger for pulmonary arterial hypertension without influencing its clinical course.
Impact of statins and angiotensin-converting enzyme inhibitors on mortality of subjects hospitalised with pneumonia
Authors: Mortensen E. M. , Pugh M. J. , Copeland L. A. , Restrepo M. I. , Cornell J. E. , Anzueto A. , Pugh J. A.
Published: October 2007

Recent studies suggest that statins and angiotensin-converting enzyme (ACE) inhibitors may have beneficial effects for some types of infections. The present study aimed to examine the association of outpatient use of these medications on 30-day mortality for subjects aged >65 yrs and hospitalised with community-acquired pneumonia.

A retrospective national cohort study was conducted using the Department of Veterans Affairs administrative data including subjects aged ≥65 yrs hospitalised with community-acquired pneumonia, and having ≥1 yr of prior Veterans Affairs outpatient care.

In total, 8,652 subjects were identified with a mean age of 75 yrs, 98.6% were male, and 9.9% of subjects died within 30 days of presentation. In this cohort, 18.1% of subjects were using statins and 33.9% were using ACE inhibitors. After adjusting for potential confounders, current statin use (odds ratio (OR) 0.54, 95% confidence interval (CI) 0.42–0.70) and ACE inhibitor use (OR 0.80, 95% CI 0.68–0.89) were significantly associated with decreased 30-day mortality.

Use of statins and angiotensin-converting enzyme inhibitors prior to admission is associated with decreased mortality in subjects hospitalised with community-acquired pneumonia. Randomised controlled trials are needed to examine whether the use of these medications in patients hospitalised with community-acquired pneumonia may be beneficial.
The perception of healthcare quality of elderly in the city of Bari, South Italy
Authors: Prato Rosa , Martinelli Domenico , Fusco Annarita , Panebianco Annarita , Lopalco Pietro Luigi , Germinario Cinzia Annatea , Quarto Michele
Published: October 2007

Background

In recent decades in Italy, as in all the industrialized nations, the proportion of elderly subjects in the total population is constantly on the increase. However the increased life expectancy is not always paralleled by a true improvement in the quality of life.

In this context, it is essential to analyze elderly real health needs and the responses to these needs, especially in terms of healthcare, that the territorial services are perceived to offer.

Methods

In the period from June to September 2006 we selected randomly one General Practitioner (GP) for each district of the Bari Municipal Area and, form each GP, we randomly chose 25 patients over 65 years old (YO). We conducted phone interviews using a standard data collection questionnaire and, for each of the recruited subjects, the GP filled a data collection sheet.

Results

Although the mean age (73.6 years) of the population under study was quite high, the general state of health was judged good both by the G P- and by their elderly patients (>75%).

Notably, the great majority of elderly patients considered the healthcare they receive to be satisfactory (>60%): in particular, the GP was the true point of reference for this slice of the population for strictly medical problems as well as for advice. On the contrary, the patients attributed little value to social services, which were poorly known and scarcely used (8.5%). Public hospital facilities played a central role in second level healthcare in more than 30% of cases; private facilities covered by public health insurance were also very important. As possible solutions to the problem of loneliness, 36.6% of the patients declared that they approved of nursing homes.

Conclusion

Decision makers need to create services supporting the key role played by General Practitioners, who are well aware that their assistance is not sufficient to satisfy the health needs of the elderly.
Secondary breast lymphoma diagnosed by vacuum-assisted breast biopsy: a case report
Authors: Zagouri Flora , Sergentanis Theodoros N , Nonni Afroditi , Koulocheri Dimitra , Domeyer Philip , Dardamanis Dimitrios , Michalopoulos Nikolaos V , Pararas Nikolaos , Gounaris Antonia , Zografos George C
Published: October 2007

Introduction

Breast lymphoma, either as a manifestation of primary extranodal disease or as secondary involvement, is a rare malignancy, and its diagnosis, prognosis, and treatment have not been clearly defined. On the other hand, Vacuum-assisted breast biopsy (VABB) is a minimally invasive technique with ever-growing use for the diagnosis of mammographically detected, non-palpable breast lesions.

Case presentation

A symptom-free, 56-year-old woman presented with a non-palpable BI-RADS 4B lesion without microcalcifications. She had a positive family history for breast cancer and a history of atypical ductal hyperplasia in the ipsilateral breast four years ago. She reported having been treated for non-Hodgkin lymphoma 12 years ago. With the suspicion of breast cancer, mammographically guided VABB with 11-gauge probe (on the stereotactic Fisher's table) was performed. VABB made the diagnosis of a non-Hodgkin, grade II, B-cell germinal-center lymphoma. VABB yielded enough tissue for immunohistochemistry/WHO classification.

Conclusion

This is the first case in the literature demonstrating the successful diagnosis of breast lymphoma by VABB, irrespectively of the level of clinical suspicion. It should be stressed that VABB was able to yield enough tissue for WHO classification. In general, lymphoma should never be omitted in the differential diagnosis, since no pathognomonic radiologic findings exist for its diagnosis.
Delamination of cells from neurogenic placodes does not involve an epithelial-to-mesenchymal transition
Authors: Graham Anthony , Blentic Aida , Duque Sandra , Begbie Jo
Published: October 2007

Neurogenic placodes are specialized regions of embryonic ectoderm that generate the majority of the neurons of the cranial sensory ganglia. Here we examine in chick the mechanism underlying the delamination of cells from the epibranchial placodal ectoderm. We show that the placodal epithelium has a distinctive morphology, reflecting a change in cell shape, and is associated with a breach in the underlying basal lamina. Placodal cell delamination is distinct from neural crest cell delamination. In particular, exit of neuroblasts from the epithelium is not associated with the expression of Snail/Snail2 or of the Rho family GTPases required for the epithelial-to-mesenchymal transition seen in neural crest cell delamination. Indeed, cells leaving the placodes do not assume a mesenchymal morphology but migrate from the epithelium as neuronal cells. We further show that the placodal epithelium has a pseudostratified appearance. Examination of proliferation shows that the placodal epithelium is mitotically quiescent,with few phosphohistone H3-positive cells being identified. Where division does occur within the epithelium it is restricted to the apical surface. The neurogenic placodes thus represent specialized ectodermal niches that generate neuroblasts over a protracted period.
Multiscale similarity characterization of abraded surfaces
Authors: Bigerelle M , Dalla-Costa M , Najjar D
Published: October 2007

Many surface properties are related to their topography. The characteristics of an engineering surface can be recorded as a roughness profile characterized by calculation of roughness parameters. The supposed relevant parameters are used to characterize the surface and to tailor similar surfaces with the same characteristics. The aim of this paper is to propose an alternative method based on information theory to avoid roughness parameters calculation in quantifying the similarity of two roughness profiles. The relevance of this method is emphasized using experimental profiles.
Multiscale morphology of high-precision turning process surfaces
Authors: Bigerelle M , Van Gorp A , Gautier A , Revel P
Published: October 2007

The characterization of functional surfaces is done mainly by roughness which can be quantified by many parameters. In order to select relevant roughness parameters, a multiscale discriminant method is proposed and applied to characterize high-precision turned surfaces. First, surfaces are characterized by a single roughness parameter and secondly by a pair of roughness parameters. In all cases, the most relevant evaluation length is also determined for each parameter. The results obtained on four different samples show that the most relevant roughness parameter is Rk estimated on a 10μm evaluation length. The best pair of parameters is Δa and Ri, estimated respectively on 20μm and 100μm evaluation lengths. Rk well characterizes the microroughness, which seems to be mainly representative of the roughness of high-precision machined surfaces. However, only multiscale analyses with a pair of roughness parameters can characterize both the macroscopic and microscopic morphologies of machined surfaces.
State-of-the-art in product-service systems
Authors: Baines T S , Lightfoot H W , Evans S , Neely A , Greenough R , Peppard J , Roy R , Shehab E , Braganza A , Tiwari A , Alcock J R , Angus J P , Bastl M , Cousens A , Irving P , Johnson M , Kingston J , Lockett H , Martinez V , Michele P , Tranfield D , Walton I M , Wilson H
Published: October 2007

A Product-Service System (PSS) is an integrated combination of products and services. This Western concept embraces a service-led competitive strategy, environmental sustainability, and the basis to differentiate from competitors who simply offer lower priced products. This paper aims to report the state-of-the-art of PSS research by presenting a clinical review of literature currently available on this topic. The literature is classified and the major outcomes of each study are addressed and analysed. On this basis, this paper defines the PSS concept, reports on its origin and features, gives examples of applications along with potential benefits and barriers to adoption, summarizes available tools and methodologies, and identifies future research challenges.
Multi-echelon inventory management in supply chains with uncertain demand and lead times: Literature review from an operational research perspective
Authors: Gümüs A Taskin , Güneri A Fuat
Published: October 2007

Historically, the echelons of the supply chain, warehouse, distributors, retailers, etc., have been managed independently, buffered by large inventories. Increasing competitive pressures and market globalization are forcing firms to develop supply chains that can quickly respond to customer needs. To remain competitive and decrease inventory, these firms must use multi-echelon inventory management interactively, while reducing operating costs and improving customer service. The current paper reviews the literature, addressing multiechelon inventory management in supply chains from 1996 to 2005. The behaviour of the papers against demand and lead-time uncertainty is the key analysis point of the literature review presented here and it is conducted from an operational research point of view. Finally, directions for future research are suggested.
Ligand-induced folding of the guanine-sensing riboswitch is controlled by a combined predetermined–induced fit mechanism
Authors: Ottink Otmar M. , Rampersad Sumientra M. , Tessari Marco , Zaman Guido J.R. , Heus Hans A. , Wijmenga Sybren S.
Published: October 2007

All known guanine-sensing riboswitches regulate gene expression by specifically binding to guanine (G) or related analogs with high affinity to switch off transcription. The aptamers of this class of riboswitches are characterized by three helices (P1–P3), surrounding a central core of phylogenetically conserved nucleotides and a long-range loop–loop interaction. To gain more insight into the switching mechanism, we present here a comparison between the solution-state structures of the G-free and G-bound forms of the guanine aptamer from the xpt-pbuX operon of Bacillus subtilis, as derived from NMR chemical shifts and magnetic-field-induced residual dipolar couplings. The high-resolution NMR analysis shows the G-free aptamer is highly structured with parallel P2 and P3 helices and the long-range loop–loop interaction already present, implying that the structure is largely preformed to bind the ligand. Structural changes upon guanine binding are found to be localized to the central core. In the free state, the G-quadruple interaction and two base pairs of the P1 stem flanking the central core appear to be largely disordered. The ligand thus binds via a combined predetermined–induced fit mechanism, involving a previously unstructured five-residue loop of the J2–3 junction that folds over the ligand. These limited additional interactions within a preorganized setting possibly explain how the aptamer rapidly responds to ligand binding, which is necessary to switch the structural state of the expression platform within a narrow time frame before the RNA polymerase escapes the 5′-UTR.
miRRim: A novel system to find conserved miRNAs with high sensitivity and specificity
Authors: Terai Goro , Komori Takashi , Asai Kiyoshi , Kin Taishin
Published: October 2007

The identification of novel miRNAs has significant biological and clinical importance. However, none of the known miRNA features alone is sufficient for accurately detecting novel miRNAs. The aim of this paper is to integrate these features in a straightforward manner for detecting miRNAs with better accuracy. Since most miRNA regions are highly conserved among vertebrates for the ability to form stable hairpin structures, we implemented a hidden Markov model that outputs multidimensional feature vectors composed of both evolutionary features and secondary structural ones. The proposed method, called miRRim, outperformed existing ones in terms of detection/prediction performance: The total number of predictions was smaller than with existing methods when the number of miRNAs detected was adjusted to be the same. Moreover, there were several candidates predicted only by our method that are clustered with the known miRNAs, suggesting that our method is able to detect novel miRNAs. Genomic coordinates of predicted miRNA can be obtained from http://mirrim.ncrna.org/.