bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors Influencing the Benefit of Adjunctive Devices during Percutaneous Coronary Intervention in ST‐Segment Elevation Myocardial Infarction: Meta‐Analysis and Meta‐Regression
Authors: AMIN AMIT P. , MAMTANI MANJU R. , KULKARNI HEMANT
Published: December 2008

Background:
Routine use of adjunctive devices to percutaneous coronary intervention (PCI) for the treatment of patients of ST‐segment elevation myocardial infarction (STEMI) is questionable. Also, the clinical characteristics of STEMI patients that can modulate the treatment benefits of adjunctive devices are not fully understood.

Objective:
To synthesize the existing literature to summarize the therapeutic benefit of the adjunctive devices and to identify the patient characteristics which relate to this therapeutic benefit.

Methods:
We conducted (i) meta‐analyses of the randomized controlled trials (RCT) comparing the performance of the adjunctive devices with PCI for three reperfusion‐related outcomes: myocardial blush grade (MBG) < 3, failed ST‐segment resolution (STR), and Thrombolysis In Myocardial Infarction (TIMI) flow grade < 3; (ii) stepwise meta‐regressions of the effect of trial characteristics on between‐trial heterogeneity; and (iii) analyses to examine whether the reperfusion‐related end‐points explained the between‐trial difference in cardiac death and major adverse cardiac events (MACE).

Results:
Our meta‐analyses represent data from 23 RCT and 5,728 subjects. The overall therapeutic benefit attributable ranged from 32 to 35% for the reperfusion‐related outcomes, and thrombectomy devices were more beneficial than the distal protection devices. Meta‐regression identified gender, receipt of glycoprotein (GP) IIb/IIIa inhibitor, and baseline TIMI flow grade as significant predictors of improved reperfusion across trials. The available clinical trials were individually underpowered and not designed to detect the influence of adjunctive devices on death or MACE.

Conclusions:
Routine use of adjunctive devices cannot be recommended. Thrombus burden, treatment with GP IIb/IIIa inhibitors, and gender may modify the reperfusion benefit of adjunctive devices.
Engagement and retention in specialist services for people with personality disorder
Authors: Crawford M. J. , Price K. , Gordon F. , Josson M. , Taylor B. , Bateman A. , Fonagy P. , Tyrer P. , Moran P.
Published: December 2008

Objective:  To quantify levels of engagement and retention in specialist services for people with personality disorder (PD).

Method:  Demographic and clinical data were collected on referrals to 10 specialist services for people with PD. Follow‐up data on retention and drop‐out from services were collected over the following 30 months.

Results:  Seven hundred and thirteen (60.1%) of 1186 people referred to services were taken by them, of whom 164 (23.0%) subsequently dropped out prior to the completion of an episode of care. Men, younger people and those with higher levels of personality disturbance were less likely to complete a package of care.

Conclusion:  Specialist community‐based services for adults with PD are able to engage most of those that are referred to them, but further efforts need to be made to find ways to engage younger people and men with PD.
Pathological dissociation and neuropsychological functioning in borderline personality disorder
Authors: Haaland V. Ø. , Landrø N. I.
Published: December 2008

Objective:  Transient, stress‐related severe dissociative symptoms or paranoid ideation is one of the criteria defining the borderline personality disorder (BPD). Examinations of the neuropsychological correlates of BPD reveal various findings. The purpose of this study was to investigate the association between dissociation and neuropsychological functioning in patients with BPD.

Method:  The performance on an extensive neuropsychological battery of patients with BPD with (n = 10) and without (n = 20) pathological dissociation was compared with that of healthy controls (n = 30).

Results:  Patients with pathological dissociation were found to have reduced functioning on every neuropsychological domain when compared with healthy controls. Patients without pathological dissociation were found to have reduced executive functioning, but no other differences were found.

Conclusion:  Pathological dissociation is a clinical variable that differentiates patients with BPD with regard to cognitive functioning.
Testicular cancer before and after cisplatin: a 30‐year view
Authors: Ansell Wendy , Shamash Jonathan
Published: December 2008

Exciting changes have been made in the management of testicular germ cell cancers over the past 30 years. Today, more than 80% of men who present with metastatic disease are cured compared with about 15% in the early 1970s. This means that there are a large number of survivors and many of them have willingly provided information that can be used in shaping the management of other malignancies. The paper aims to summarize the current management of testicular germ cell cancers comparing the situation in the pre‐platinum era with that today and to consider current and future developments in the management of this disease.
Prostate cancer with bone metastasis: an overview of pain assessment and management
Authors: Osborne Sue
Published: December 2008

The challenges of assessing and assisting men with chronic progressive metastatic bone pain secondary to prostate cancer can be immense. All patients have a right to have their pain assessed and relieved by knowledgeable health professionals, yet many urology outpatient clinic nurses come from a surgical background and have limited skills and knowledge in this area. This article aims to enhance the knowledge of urology nurses, by critically analysing and discussing components of current pain management practice, for men with painful bone metastasis. To this end, the pathophysiology of metastatic bone pain is briefly outlined followed by pain definitions from literature and information pertaining to assessment of bone pain. Barriers to effective pain assessment are identified, along with a brief discussion on the impact of factors like fatigue, anxiety and depression on pain. A review is undertaken of selected pharmacological and non‐pharmacological strategies for the management of bone pain, as reported in published literature. Knowledge of the WHO analgesic ladder for cancer pain and the actions of pain‐relieving medications and their adjuncts will better equip nurses to educate patients regarding their effective use. Insights gained into potentially effective non‐pharmacological strategies for the reduction of the experience of pain should prompt nurses to investigate what modalities are on offer at their place of work and within their local community. Written resources can then be created to share this information with patients if they are not already in existence.
Gynaecomastia: a case study review of the effect of hormone therapy in the management of prostate cancer
Authors: Drudge‐Coates Lawrence , Roberts Jonathan , Thompson Peter
Published: December 2008

In the management of prostate cancer, gynaecomastia and breast pain can be a significant problem for men treated with hormonal therapy, affecting not just their physical but also their psychological and sexual well‐being. Prompt recognition, evaluation and management are therefore essential. Urology nurses involved in the assessment, treatment and follow‐up of this patient group across the patient pathway can play a key part in identifying the problem and addressing the issue of gynaecomastia, which may positively affect subsequent patients outcomes. This paper examines the causes, evaluation and current management of gynaecomastia culminating in a case study review.
Assessing Influences of Hydrology, Physicochemistry, and Habitat on Stream Fish Assemblages Across a Changing Landscape1
Authors: Helms Brian S. , Schoonover Jon E. , Feminella Jack W.
Published: December 2008

Abstract:  We evaluated the impact of land cover on fish assemblages by examining relationships between stream hydrology, physicochemistry, and instream habitat and their association with fish responses in streams draining 18 watersheds of the Lower Piedmont of western Georgia. Several important relationships between land use and physicochemical, hydrological, and habitat parameters were observed, particularly higher frequency of spate flows, water temperatures, and lower dissolved oxygen (DO) with percentage impervious surface (IS) cover, higher habitat quality with percentage forest cover, and elevated suspended solid concentrations with percentage pasture cover. Fish assemblages were largely explained by physicochemical and hydrological rather than habitat variables. Specifically, fish species diversity, richness, and biotic integrity were lower in streams that received high frequency of spate flows. Also, overall fish assemblage structure as determined by nonmetric multidimensional scaling was best described by total dissolved solids (TDS) and DO, with high TDS and low DO streams containing sunfish‐based assemblages and low TDS and high DO streams containing minnow‐based assemblages. Our results suggest that altered hydrological and physicochemical conditions, induced largely by IS, may be a strong determinant of fish assemblage structure in these lowland streams and allow for a more mechanistic understanding of how land use ultimately affects these systems.
Quantifying Reductions of Mass‐Failure Frequency and Sediment Loadings From Streambanks Using Toe Protection and Other Means: Lake Tahoe, United States1
Authors: Simon Andrew , Pollen‐Bankhead Natasha , Mahacek Virginia , Langendoen Eddy
Published: December 2008

Abstract:  Streambank erosion by mass‐failure processes represents an important form of channel adjustment and a significant source of sediment in disturbed streams. Mass failures regularly occur by a combination of hydraulic processes that undercut bank toes and geotechnical processes that cause bank collapse by gravity. Little if any quantitative information is available on the effectiveness of bank treatments on reducing erosion. To evaluate potential reduction in sediment loadings emanating from streambanks, the hydraulic and geotechnical processes responsible for mass failure were simulated under existing and mitigated conditions using a Bank‐Stability and Toe‐Erosion Model (BSTEM). Two critical erosion sites were selected from each of the three watersheds known to contribute the greatest amounts of fine sediment by streambank processes in the Lake Tahoe Basin. A typical high‐flow annual hydrograph was selected for analysis. Bank‐material strength data were collected for each layer as were species‐specific root‐reinforcement values. The effects of the first flow event on bank‐toe erosion were simulated using an excess shear‐stress approach. The resulting geometry was then exported into the bank‐stability submodel to test for the relative stability of the bank under peak flow and drawdown conditions. In this way, BSTEM was used iteratively for all flow events for both existing and mitigated conditions. On average, 13.6% of the material was eroded by hydraulic shear, the remainder by mass failures, which occurred about five times over the simulation period. Simulations with 1.0 m‐high rock‐toe protection showed a dramatic reduction in streambank erosion (69‐100%). Failure frequency for the simulation period was reduced in most cases to a single episode. Thus, an almost 90% reduction in streambank loadings was achieved by virtually eliminating the erosion of only 14% of the material that was entrained by hydraulic forces. Consequently, simulations show average load reductions of about an order of magnitude. Results stress the critical importance of protecting the bank toe‐region from steepening by hydraulic forces that would otherwise entrain previously failed and in situ bank materials, thereby allowing the upper bank to flatten (by failure) to a stable slope.
A Depth‐Proportional Intake Device for Automatic Water Samplers1
Authors: Lecce Scott A.
Published: December 2008

Abstract:  This paper describes the construction and testing of a device for pumping water samplers that collects suspended sediment samples by moving the intake vertically to keep it at the same proportion of flow depth. The device uses a simple sprocket mechanism that can be mounted vertically on the downstream side of culverts and bridge pilings to protect against damage from floating debris during storms. Suspended sediment samples collected from an urban stream with the depth‐proportional device were compared with manual samples taken with a depth‐integrated sampler. Scatter in the relationship between pumped and manual samples (R2 = 0.76) are probably explained by horizontal variability in concentrations, poor mixing associated with lateral sediment inputs from construction site erosion, the downstream orientation of the intake, and the failure of the concentration at 60% of the flow depth to match the average vertical concentration.
Predicting Debris Yield From Burned Watersheds: Comparison of Statistical and Artificial Neural Network Models1
Authors: Pak Jang Hyuk , Kou Zhiqing , Kwon Hyuk Jae , Lee Jiin‐Jen
Published: December 2008

Abstract:  Alluvial fans in southern California are continuously being developed for residential, industrial, commercial, and agricultural purposes. Development and alteration of alluvial fans often require consideration of mud and debris flows from burned mountain watersheds. Accurate prediction of sediment (hyper‐concentrated sediment or debris) yield is essential for the design, operation, and maintenance of debris basins to safeguard properly the general population. This paper presents results based on a statistical model and Artificial Neural Network (ANN) models. The models predict sediment yield caused by storms following wildfire events in burned mountainous watersheds. Both sediment yield prediction models have been developed for use in relatively small watersheds (50‐800 ha) in the greater Los Angeles area. The statistical model was developed using multiple regression analysis on sediment yield data collected from 1938 to 1983. Following the multiple regression analysis, a method for multi‐sequence sediment yield prediction under burned watershed conditions was developed. The statistical model was then calibrated based on 17 years of sediment yield, fire, and precipitation data collected between 1984 and 2000. The present study also evaluated ANN models created to predict the sediment yields. The training of the ANN models utilized single storm event data generated for the 17‐year period between 1984 and 2000 as the training input data. Training patterns and neural network architectures were varied to further study the ANN performance. Results from these models were compared with the available field data obtained from several debris basins within Los Angeles County. Both predictive models were then applied for hind‐casting the sediment prediction of several post 2000 events. Both the statistical and ANN models yield remarkably consistent results when compared with the measured field data. The results show that these models are very useful tools for predicting sediment yield sequences. The results can be used for scheduling cleanout operation of debris basins. It can be of great help in the planning of emergency response for burned areas to minimize the damage to properties and lives.
Reappraisal of linoleic acid requirement of the young infant, with particular regard to use of modified cows' milk formulae.
Authors: Naismith D J , Deeprose S P , Supramaniam G , Williams M J
Published: December 2008

Most infants in the UK are bottle fed with cows' milk formulae that are alleged to provide less than the minimum requirement for linoleic acid, i.e. 1% of the total dietary energy. 20 term infants fed solely on a modified cows' milk formula that provided 0.55% of the energy from linoleic acid were therefore examined for evidence of deficiency. Rates of growth in length and weight, measured during the first 3 months of life, were identical with those of 20 wholly breast-fed infants. Voluntary food intakes (kcal/kg per day) followed the normal pattern. The fatty acid composition of the plasma lipids showed changes characteristic of a low intake of linoleic acid, but triene:tetraene ratios did not indicate a deficiency state, and clinical signs of deficiency were not observed. These findings suggest that the requirement for linoleic acid is substantially less than was formerly believed. The small amount of alpha-linolenic acid present in cows' milk may however exert a sparing effect on linoleic acid.
Evaluation of methods of assisted ventilation in hyaline membrane disease.
Authors: Manginello F P , Grassi A E , Schechner S , Krauss A N , Auld P A
Published: December 2008

Two methods of providing assisted ventilation were compared in infants severely ill with hyaline membrane disease (HMD). 10 infants were assigned to each group. One group received ventilation with a volume-cycled respirator, and the other was ventilated using a pressure-limited ventilator and reversed I:E ratio. Both groups were well matched for severity of illness in terms of pH and blood gases. pH and PO2 were quickly corrected by both ventilators. However, the pressure-cycled ventilator group had higher survival and lower complication rates. PAO2 after one hour was substantially improved at the same FIO2 in the pressure-limited group and after 8 hours the FIO2 required to maintain a PaO2 of 50--70 mmHg (6.6--9.3 kPa) was significantly decreased compared with the volume-cycled group. No effects on blood pressure were detected in either group. The study shows that the pressure-limited method is significantly better.
Aneurysmal bone cyst: a report of three cases.
Authors: Pullan C R , Alexander F W , Halse P C
Published: December 2008

Three children presenting with aneurysmal bone cysts are described. The first patient was 10 months old with a cyst of the scapula. The second was more typical but his cyst was treated initially as a malignant tumour. In the third child the second cervical vertebra was affected which posed considerable problems of management; it was treated by radiotherapy. Despite the problems all 3 children have made a good recovery.
Starting neonatal screening for haemoglobinopathies in The Netherlands
Authors: Giordano P C
Published: December 2008

Neonatal screening for haemoglobinopathies started in The Netherlands on 1 January 2007. The method of choice, high-performance liquid chromatography, and the universal setting have shown that the predicted incidence is indeed present in the country. Patients and carriers are reported in order to prevent morbidity, and for the primary prevention of serious haemoglobinopathies. Background, preceding discussion, health gain, implementation, provisional results and ethics issues are discussed, as well as matters concerning technology, know-how, and ongoing and future developments.
Haemoglobinopathies and newborn haemoglobinopathy screening in Germany
Authors: Dickerhoff R , Genzel-Boroviczeny O , Kohne E
Published: December 2008

Germany has been an immigration country since the early 1950s. In December 2007, 6.7 million non-German citizens lived in the country. However, the total number of citizens with a migration background is 15–20 million, about 9 million of whom come from countries where sickle cell disease and thalassaemias are frequent. In a country with 82 million inhabitants health authorities are not worried by the presence of probably 1000–1500 sickle cell and 450 transfusion-dependent thalassaemia patients, and therefore no screening or preventive measures have been taken so far on a national scale. There are plans for a pilot project (1 year) to screen all newborns for sickle cell disease in obstetric hospitals in 4–5 cities with more than 20% migrants. Funding and lack of an infrastructure to provide counselling are major problems.
An audit of immunisation status of sickle cell patients in Coventry, UK
Authors: Howard-Jones M , Randall L , Bailey-Squire B , Clayton J , Jackson N
Published: December 2008

Protection against infection is a key aim of any care programme for patients with sickle cell disorders, and is one of the stated objectives of the UK national neonatal screening programme. An audit of the immunisation status of the 58 sickle cell patients living in Coventry was carried out against UK national guidance (2006). Among 25 children (aged ⩽16 years), 14 (56%) had complete immunisation against pneumococcus,Haemophilus influenzaetype b (Hib) and meningococcus group C (MenC), with eight (32%) having some coverage, and three (12%) having none at all. Among 33 adults, only four patients (12%) had complete coverage, with up-to-date coverage against pneumococcus 21%, Hib 18% and MenC 15%. Current (ie, within the last year) immunisation against viral influenza was found in only 12% of adults and 8% of children. These rates are similar to those found in other UK studies. If the potential benefits of neonatal screening are to be realised, an effective immunisation programme is essential. There are key roles for haemoglobinopathy nurse specialists, and the proposed national haemoglobinopathy database, in improving the rates of immunisation coverage.
p63 Protein expression in high risk diffuse large B-cell lymphoma
Authors: Hallack Neto A E , Siqueira S A C , Dulley F L , Ruiz M A , Chamone D A F , Pereira J
Published: December 2008

Background:

p63 gene is a p53 homologue that encodes proteins with transactivation, DNA-binding and tetramerisation domains. The isoforms TAp63 and TAp73 transactivate p53 target genes and induce apoptosis, whereas the isoforms ΔNp63 and ΔNp73 lack transactivation and might have dominant-negative effects in p53 family members. p63 is expressed in germinal centre lymphocytes and can be related to the development of the lymphoma, but the prognostic significance of its expression in the survival of patients with diffuse large B-cell lymphoma (DLBCL) remains unclear.

Aims:

To determine whether quantitative immunohistochemical (IHC) analysis of p63 protein expression correlates with CD10 antigen, Bcl-6 antigen and IRF4 antigen expression and to determine whether p63 is a surrogate predictor of overall survival in high–intermediate and high risk DLBCL populations.

Methods:

CD10, Bcl-6 and IRF4 expression were retrospectively evaluated by IHC in 73 samples of high–intermediate and high risk DLBCL and were used to divide the lymphomas into subgroups of germinal centre B-cell-like (GCB) and activate B-cell-like (ABC) DLBCL. Similarly, p63 expression was evaluated by IHC and the results were compared with subgroups of DLBCL origin and with the survival rates for these patients.

Results:

p63 was expressed in more than 50% of malignant cells in 11 patients and did not show correlation with subgroups of GCB-like DLBCL or ABC-like DLBCL, but p63(+) patients had better disease-free survival (DFS) than those who were negative (p = 0.01).

Conclusions:

p63(+) high–intermediate and high risk DLBCL patients have a better DFS than negative cases.
Optimising the documentation practices of an Ethics Consultation Service
Authors: Bramstedt K A , Jonsen A R , Andereck W S , McGaughey J W , Neidich A B
Published: December 2008

A formal Ethics Consultation Service (ECS) can provide significant help to patients, families and hospital staff. As with any other form of clinical consultation, documentation of the process and the advice rendered is very important. Upon review of the published consult documentation practices of other ECSs, we judged that none of them were sufficiently detailed or structured to meet the needs and purposes of a clinical ethics consultation. Thus, we decided to share our method in order to advance the practice of ethics consultation. Here, we describe a method of ECS documentation practice, including use of a formal consult report template, as well as a log for maintaining a chronological record of the consultations performed. These two documents facilitate order and organisation of the ECS. They also enable the ECS to keep an account of professional time and experience, enable quick consult trend assessments (by consult theme or ward, for example) and establish a potential registry of consults for future research study. This method of documentation, we believe, not only contributes significantly to the primary purpose of the consultation—namely, the evincing and sharing of ethical opinion about a case—but also enables consultants to improve their practice and to pursue research on clinical ethics consultation.
Just health responsibility
Authors: Schmidt H
Published: December 2008

Although the responsibility for health debate has intensified in several ways between Norman Daniels’ 1985Just healthcareandJust health: meeting health needs fairlyof 2008, comparatively little space is dedicated to the issue inJust health, and Daniels notes repeatedly that his account “says nothing about personal responsibility for health”.

Daniels considers health responsibility mainly in a particular luck-egalitarian version which he rejects because of its potentially unfeasible, penalising and inhumane character. But I show that he nonetheless acknowledges and endorses explicitly other dimensions of health responsibility.

I develop a wider, more nuanced and less punitive concept of health responsibility, which expands Daniels’ brief consideration and is compatible with the overall approach set out inJust health. In its application to preventative medicine and health promotion in particular, the concept is suited to support and complement the notion that “health is special”, which is central inJust health.

The concept ofhealth responsibility as co-responsibilityspecifies the subjects and objects of health responsibilities. It permits the attribution of responsibility without blame and disconnects the question of assigning responsibility from decisions about entitlement to treatment or different status in prioritisation decisions. This approach secures conceptual plausibility and clarity of the concept of health responsibility, is of use in policy making, and can help reduce political tensions.
Just care: should doctors give priority to patients of low socioeconomic status?
Authors: Hurst S A
Published: December 2008

Growing data on the socioeconomic determinants of health pose a challenge to analysis and application of fairness in health. InJust health: meeting health needs fairly, Norman Daniels argues for a change in the population end of our thinking about just health. What about clinical care? Given our knowledge of the importance of wealth, education or social status to health, is fairness in medicine served better by continuing to avoid considering our patients’ social status in setting clinical priorities, or by attempting to equalise existing health inequalities by giving priority to the socioeconomically disadvantaged at the point of care? In this article, I argue that doctors should not attempt the latter. Granted, giving priority to low status would go some way towards compensating unjust health inequalities and the impression of being left aside in other social spaces. It would represent reverse discrimination, but could still be justified inasmuch as disadvantaged groups could be identifiable, and as long as the intent was compensation rather than retribution. However, under current circumstances such priority would risk being attributed arbitrarily, would represent a form of medical proselytising, risk leaving the worst-off with less by alienating the powerful, and require teaching doctors to act in strongly counter-cultural ways—possibly at great cost. Crucially, however, we protect both equal health and equal regard by treating all alike: priority to low status would promote the first somewhat, but at the expense of sacrificing the second.
The multiple self objection to the prudential lifespan account
Authors: Schefczyk M
Published: December 2008

Multiple self approaches purport that to have equal concern about all stages of one’s life is not a requirement of rationality. This poses a challenge to the prudential lifespan account which Norman Daniels advocates inJust health: meeting health needs fairly. Daniels has criticised the multiple self approach in earlier works, most extensively inAm I my parents keeper?InJust health, he only takes up the issue except in one footnote, presumably because he is convinced that his preceding discussions settled the matter. This article argues that Daniels underestimates the force of the multiple self objection to prudential lifespan account.
Age rationing and prudential lifespan account in Norman Daniels’Just health
Authors: Brauer S
Published: December 2008

Could age be a valid criterion for rationing? InJust health,Norman Daniels argues that under certain circumstances age rationing is prudent, and therefore a morally permissible strategy to tackle the problem of resource scarcity. Crucial to his argument is the distinction between two problem-settings of intergenerational equity: equity among age groups and equity among birth cohorts. While fairness between age groups can involve unequal benefit treatment in different life stages, fairness between birth cohorts implies enjoying approximate equality in benefit ratios. Although both questions of fairness are distinct, the resolution of the one depends on resolution of the other. In this paper, I investigate whether Daniels’ account of age rationing could be defended as a fair way of setting limits to healthcare entitlements. I will focus on two main points. First, I will consider whether the age group problem could be resolved without appealing to a conception of the good. Second, I will demonstrate that the connection between the age group problem and the birth cohort problem runs deeper than Daniels initially thought—and that it ultimately suggests a method for prioritisation in problem solving strategies.
Not so special after all? Daniels and the social determinants of health
Authors: Wilson J
Published: December 2008

Just health: meeting health needs fairlyis an ambitious book, in which Norman Daniels attempts to bring together in a single framework all his work on health and justice from the past 25 years. One major aim is to reconcile his earlier work on the special moral importance of healthcare with his later work on the social determinants of health. In his earlier work, Daniels argued that healthcare is of special moral importance because it protects opportunity. In this later work, Daniels argues that the social determinants of health (which in fact tend to have a larger effect on health outcomes than healthcare does) should also be considered special. This paper argues that it is a mistake to base a theory of justice for health on the claim that health (or the social determinants of health) are “special”, for three reasons. First, once we realise that health is to a large part socially determined by features such as distribution of income, which are also of independent importance for justice, we cannot talk about a theory of justice for health in isolation from an overall theory of justice. Second, when we are trying to work out the place of health in a general theory of justice, being told that health (or the social determinants of health) is special is unhelpful. The relevant starting point should rather be whether health matters in a fundamental way for justice, or whether it matters merely for the effects it has on those goods which are of fundamental importance for justice. Third, treating the social determinants of health as special would in fact be counterproductive in terms of the broad approach to justice Daniels favours.
Justice and procedure: how does “accountability for reasonableness” result in fair limit-setting decisions?
Authors: Rid A
Published: December 2008

Norman Daniels’ theory of justice and health faces a serious practical problem: his theory can ground the special moral importance of health and allows distinguishing just from unjust health inequalities, but it provides little practical guidance for allocating resources when they are especially scarce. Daniels’ solution to this problem is a fair process that he specifies as “accountability for reasonableness”. Daniels claims that accountability for reasonableness makes limit-setting decisions in healthcare not only legitimate, but also fair. This paper assesses the latter claim. Does accountability for reasonableness result infairlimit-setting decisions? It is argued that the answer to this question is not a clear yes. Daniels is remarkably unclear about the criterion of fairness that accountability for reasonableness satisfies. The paper discusses different options for resolving this lack of clarity and examines how they apply to Daniels’ accountability for reasonableness framework. It is concluded, first, that accountability for reasonableness is not a paradigm case of any of the classic notions of procedural justice; second, that what might be called “constrained pure procedural justice” best reflects how accountability for reasonableness results in fair limit-setting decisions; and third, that the procedural conditions of accountability for reasonableness must be further specified and amended to better achieve a fair process, and hence fair limit-setting decisions.
Can a moral reasoning exercise improve response quality to surveys of healthcare priorities?
Authors: Johri M , Damschroder L J , Zikmund-Fisher B J , Kim S Y H , Ubel P A
Published: December 2008

Objective:

To determine whether a moral reasoning exercise can improve response quality to surveys of healthcare priorities

Methods:

A randomised internet survey focussing on patient age in healthcare allocation was repeated twice. From 2574 internet panel members from the USA and Canada, 2020 (79%) completed the baseline survey and 1247 (62%) completed the follow-up. We elicited respondent preferences for age via five allocation scenarios. In each scenario, a hypothetical health planner made a decision to fund one of two programmes identical except for average patient age (35 vs 65 years). Half of the respondents (intervention group) were randomly assigned to receive an additional moral reasoning exercise. Responses were elicited again 7 weeks later. Numerical scores ranging from –5 (strongest preference for younger patients) to +5 (strongest preference for older patients); 0 indicates no age preference. Response quality was assessed by propensity to choose extreme or neutral values, internal consistency, temporal stability and appeal to prejudicial factors.

Results:

With the exception of a scenario offering palliative care, respondents preferred offering scarce resources to younger patients in all clinical contexts. This preference for younger patients was weaker in the intervention group. Indicators of response quality favoured the intervention group.

Conclusions:

Although people generally prefer allocating scarce resources to young patients over older ones, these preferences are significantly reduced when participants are encouraged to reflect carefully on a wide range of moral principles. A moral reasoning exercise is a promising strategy to improve response quality to surveys of healthcare priorities.
An interaction of medical and statistical ethics
Authors: Finney D J
Published: December 2008

It is argued that the practice of omitting outliers when calibrating thromboplastin time, as recommended by the World Health Organization, should not continue unless it can be justified statistically and that possible harmful effects of omitting such data should be investigated.
Just health: replies and further thoughts
Authors: Daniels N
Published: December 2008

This paper responds to discussion and criticism contained in a mini-symposium onJust health: meeting health needs fairly. The replies clarify existing positions and modify or develop others, specifically in response to the following: Thomas Schramme criticises the claim that health is of special importance because of its impact on opportunity, and James Wilson argues that healthcare is not of special importance if social determinants of health have a major causal impact on population health. Annette Rid is concerned that the relevance condition in accountability for reasonableness is unclear and does little work. Harald Schmidt aims to flesh out where an account of responsibility for health should go since one is under-developed inJust health. Michael Schefczyk and Susanne Brauer challenge aspects of the prudential lifespan account. Samia Hurst asks what impact a population view should have on clinician obligations.
The Royal Philanthropic Expedition of the Vaccine: a landmark in the history of public health
Authors: Soto-Pérez-de-Celis E
Published: December 2008

In 1979, smallpox officially became the first disease ever to be eradicated by mankind. The global efforts to defeat this dreadful pandemic, however, started almost two centuries before. One of the most important, and sometimes forgotten, events in the fight against smallpox was the Royal Philanthropic Expedition of the Vaccine, commissioned by Charles IV of Spain to physicians Francisco Xavier Balmis y Berenguer and Jose Salvany in 1804. The aim of this expedition was to take the smallpox vaccine, discovered by Jenner, to Spain's territories in the Americas and in the Far East. After several years of vaccination in modern day Puerto Rico, Cuba, Venezuela, Ecuador, Peru, Bolivia, Chile, Mexico and the Philippines, the expedition returned to Europe. To this day, the Balmis and Salvany expedition remains a great example of international cooperation, and a landmark in the history of public health.
Peristaltic Flow of a Magneto‐Micropolar Fluid: Effect of Induced Magnetic Field
Authors: Mekheimer Kh. S.
Published: December 2008

We carry out the effect of the induced magnetic field on peristaltic transport of an incompressible conducting micropolar fluid in a symmetric channel. The flow analysis has been developed for low Reynolds number and long wavelength approximation. Exact solutions have been established for the axial velocity, microrotation component, stream function, magnetic‐force function, axial‐induced magnetic field, and current distribution across the channel. Expressions for the shear stresses are also obtained. The effects of pertinent parameters on the pressure rise per wavelength are investigated by means of numerical integrations, also we study the effect of these parameters on the axial pressure gradient, axial‐induced magnetic field, as well as current distribution across the channel
and the nonsymmetric shear stresses. The phenomena of trapping and magnetic‐force lines are further discussed.
Processing of Dielectric Optical Coatings by Nanosecond and Femtosecond UV Laser Ablation
Authors: Ihlemann J. , Békési J. , Klein-Wiele J.-H. , Simon P.
Published: December 2008

Microprocessing of dielectric optical coatings by UV laser ablation is demonstrated. Excimer laser ablation at deep UV wavelengths (248 nm, 193 nm) is used for the patterning of thin oxide films or layer stacks. The layer removal over extended areas as well as sub-μm-structuring is possible. The ablation of SiO2, Al2O3, HfO2, and Ta2O5 layers and layer systems has been investigated. Due to their optical, chemical, and thermal stability, these inorganic film materials are well suited for optical applications, even if UV-transparency is required. Transparent patterned films of SiO2 are produced by patterning a UV-absorbing precursor SiOx suboxide layer and oxidizing it afterwards to SiO2. In contrast to laser ablation of bulk material, in the case of thin films, the layer-layer or layer-substrate boundaries act as predetermined end points, so that precise depth control and a very smooth surface can be achieved. For large area ablation, nanosecond lasers are well suited; for patterning with submicron resolution, femtosecond excimer lasers are applied. Thus the fabrication of optical elements like dielectric masks, pixelated diffractive elements, and gratings can be accomplished.
Switching from Epoetin Alpha to Darbepoetin Alpha in Japanese Hemodialysis Patients: Dose Conversion Ratio
Authors: Hirai Takayuki , Sugiya Naoko , Nakashima Ayumu , Takasugi Norihisa , Yorioka Noriaki
Published: December 2008

Background/Aims: Darbepoetin alpha is an erythropoietic agent with a 3-fold longer elimination half-life than epoetin. The recommended conversion ratio from epoetin to darbepoetin alpha is 1:200 (1 μg of darbepoetin alpha = 200 IU of epoetin), but several observations have suggested that this ratio overestimates the required dose of darbepoetin alpha. This study assessed the actual conversion ratio for stable Japanese hemodialysis patients and investigated whether darbepoetin alpha promotes uniform erythropoiesis. Methods: A total of 104 hemodialysis patients who were stable on epoetin alpha therapy at Hakuai Clinic in Japan were switched to intravenous darbepoetin alpha according to the 1:200 rule. They were followed for 24 weeks to assess changes of hemoglobin and the dose of darbepoetin alpha, as well as changes of the reticulocyte count. Results: One hundred patients completed the 24-week study and the final conversion ratio was 1:350.5. Darbepoetin alpha showed a similar effect in diabetics and nondiabetics. Data on the reticulocyte count demonstrated that darbepoetin alpha had a sustained effect on erythropoiesis. Conclusion: Darbepoetin alpha is effective for Japanese dialysis patients at a lower dose than expected.
Jobs, Sex, Love and Lifestyle: When Nonstutterers Assume the Roles of Stutterers
Authors: Zhang Jianliang , Saltuklaroglu Tim , Hough Monica , Kalinowski Joseph
Published: December 2008

Purpose: This study assessed the impact of stuttering via a questionnaire in which fluent individuals were asked to assume the mindset of persons who stutter (PWS) in various life aspects, including vocation, romance, daily activities, friends/social life, family and general lifestyle. The perceived impact of stuttering through the mind’s eyes of nonstutterers is supposed to reflect respondents’ abilities to impart ‘theory of mind’ in addressing social penalties related to stuttering. Method: Ninety-one university students answered a questionnaire containing 56 statements on a 7-point Likert scale. Forty-four participants (mean age = 20.4, SD = 4.4) were randomly selected to assume a stuttering identity and 47 respondents (mean age = 20.5, SD = 3.1) to assume their normally fluent identity. Results: Significant differences between groups were found in more than two thirds of items regarding employment, romance, and daily activities, and in fewer than half of items regarding family, friend/social life, and general life style (p <0.001). Conclusions: The social penalties associated with stuttering appear to be apparent to fluent individuals, especially in areas of vocation, romance, and daily activities, suggesting that nonstuttering individuals, when assuming the role of PWS, are capable of at least temporarily feeling the negative impact of stuttering.
Immunohistochemical Localization of Fibrillin-1 Protein in the Cells of Chick Corneal and Conjunctival Epithelia during Pre- and Postnatal Development
Authors: Maestro de las Casas Carmen , Peña-Melian Angel , Martínez-Álvarez Concepción , Martínez-Sanz Elena , Pérez-Miguelsanz Juliana
Published: December 2008

Fibrillin-1 protein is a microfibrillar glycoprotein component of the extracellular matrix, widely distributed in ocular connective tissues. In this work, we show for the first time the expression pattern of fibrillin-1 protein in the corneal and conjunctival epithelia and in stromal keratocytes during embryo development. After hatching, protein expression was maintained in the corneal epithelium cells and nonsecreting epithelium cells of the conjunctiva and disappeared in the stromal keratocytes. In the limbus region, the basal cells were negative, while superficial cells were positive for the antibody. The expression in corneal epithelial cells suggests a role for fibrillin in development and disease. Therefore, some basal cells of the limbus region do not show fibrillin-1 immunolocalization, and this may be correlated with stem cell or stem-like properties.
Immunosuppressive Property of Dried Human Amniotic Membrane
Authors: Park Choul Yong , Kohanim Sahar , Zhu Lei , Gehlbach Peter L. , Chuck Roy S.
Published: December 2008

Purpose: To report the immunosuppressive property of dry human amniotic membrane (dHAM). Methods: Mouse splenocytes harvested from Balb/c mice were stimulated using functional-grade anti-CD3e antibodies for 4 days either with or without either of 2 commercial types of dHAM (Ambiodry 1 & 2, IOP Inc., Costa Mesa, Calif., USA) added to the culture media. The cell proliferation assay was performed to analyze the extent of splenocyte proliferation. Results: dHAMs significantly suppressed mouse splenocyte proliferation compared to control. The suppression by dHAM with intact amniotic epithelium (Ambiodry 2) was significantly stronger than dHAM without epithelium (Ambiodry 1). Conclusion: The immunosuppressive property of dHAM was demonstrated using an alloreactive splenocyte proliferation assay.
Backscatter Lidar Observations of Lower Tropospheric Dynamics during Southern California Wildfires
Authors: Beck Steven , Stoker David , Hecht James , Walterscheid Richard
Published: December 2008

Wavelike features suggesting gravity waves were revealed by lidar observations (from El Segundo, California) of smoke layers produced by large wildfires in the Southern California region during a Santa Ana event. Unique features of the observations were multiple thin layers that enabled precise determinations of wave frequency, amplitude, and vertical structure. The data revealed persistent wavelike oscillations that showed no phase variation with altitude, an amplitude of 20 m, and a period near 12 min. The observations were averaged over 1.5 min with a vertical resolution of 3 m and were obtained over a period of 5 h on 25 October and 8 h on 26 October 2007. Vertical profiles of temperature and winds from the Aircraft Communication Addressing and Reporting System (ACARS) of commercial aircraft departing Los Angeles International Airport (LAX) were selected for temporal and spatial coincidence with the lidar observations. In addition, satellite images of the smoke distribution over the Los Angeles Basin and the coastal areas (including coastal waters) to the south were obtained from Moderate Resolution Imaging Spectroradiometer (MODIS) data from overflights 5.5 h prior to the lidar observation window. The images show wavelike features with horizontal wavelengths of ∼10 km or less. The temperature data showed an inversion layer topped at 500-m altitude. The wind data were consistent with a residual sea breeze near the surface and Santa Ana easterlies above. A simple model of wave ducting showed that the observed features were the evanescent extension of resonant waves ducted in the lower stable inversion layer. These are the first detailed observations, including vertical structure, of ducted waves associated with Santa Ana conditions. It is suggested that such waves should be a common feature in conditions occurring during Santa Ana events.