bluuebunny/crossref_metadata_2025 huggingface dataset:
Controversies in Maternity Care: Where Do Physicians, Nurses, and Midwives Stand?
Authors: Blais Régis , Lambert Jean , Maheux Brigitte , Loiselle Jacinthe , Gauthier Nathalie , Framarin Alicia
Published: April 2007

Through a mail survey in 1991, we compared the opinions of 597 physicians practicing obstetrics, 723 maternity care nurses, and 70 midwives from the province of Quebec, Canada, about selected maternity care issues, including the practice of midwifery. Results showed that divergent points of view existed between and within the three groups on many maternity care issues. Physicians were more divided over the routine use of obstetric intervention than the approach to care or their opinion about midwives. Midwives held more client‐centered and less interventionist attitudes than nurses or physicians. Nurses were much more open to midwives than physicians, but 20 to 30 percent of physicians saw some advantages in legalizing the practice of midwifery. Physicians and nurses generally considered midwives as a greater professional threat to the other group than to themselves. The fact that many physicians were critical of current maternity care is difjcult to reconcile with their general opposition to midwives. How and to what extent physicians will respond to women's desire for more humanized and less interventionist care remains an open question. Given the problems facing maternity care in North America, expanding midwifery services is an alternative to examine seriously. (BIRTH 21:2, June 1994)
What Makes a Mother? Interviews With Women Involved in Egg Donatfon and Surrogacy
Authors: Snowdon Claire
Published: April 2007

ABSTRACT: In recent years it has become possible to use eggs from one woman to bring about a pregnancy in another. This led to new dejinitions of who can be considered the mother of a child. Despite much speculation about the problems that may ensue from this situation, it is not at all clear that the women who have made the active decision to involve themselves in egg donation or gestational surrogacy will share these concerns. This paper reports on the interpretive frameworks used by 13 women who experienced either egg donation or gestational surrogacy, to defne their relationships to any children (actual or potential) conceived as a result of their actions. (BIRTH 21:2, June 1994)
Exercise and Pregnancy: A Review
Authors: Bell Robin , O'Neill Maureen , Rehab Grad Dip Ex
Published: April 2007

ABSTRACT: The effects of pregnancy on the maternal cardiorespiratory system include increases in oxygen consumption, cardiac output, heart rate, stroke volume, and plasma volume. The increase in oxygen reserve seen in early pregnancy is reduced later, suggesting that maternal exercise may present a greater physiologic stress in the third trimester. Evidence suggests that weight‐bearing exercise produces a greater decrease in oxygen reserve than nonweight‐bearing exercise. Furthermore, to maintain a heart rate below 140 beats per minute during pregnancy, the intensity of weight‐bearing exercise must be reduced. Nonweight‐bearing, water‐based exercise results in smaller fetal heart rate changes and a lower maternal heart rate than the same exercise performed on land. Exercising in the supine position in late pregnancy has raised concerns because cardiac output in the supine position is lower than in the lateral position at rest, presumably because the gravid uterus partially obstructs the inferior vena cava. Sustained exercise produces a training effect on the mother, although reported associations between this effect and the experience of labor are not consistent. Short‐term changes in fetal heart rate provide circumstantial evidence that physical activity can influence the fetus. Acute effects of exercise that can potentially affect the fetus include hyperthermia, changes in uteroplacental flow, reduced levels of maternal glucose, and increased uterine contractions. Moderate to high levels of sustained maternal exercise have been associated with reduced birthweight. Much research remains to be done on the effects of specexercise regimens during pregnancy, the effects on previously sedentary women, and the long‐term health consequences to the offspring of women who perform vigorous exercise during pregnancy. (BIRTH 21:2, June 1994)
Licensed Midwife‐Attended, Out‐of‐Hospital Births in Washington State: Are They Safe?
Authors: Janssen Patricia A. , Holt Victoria L , Myers Susan J.
Published: April 2007

ABSTRACT: The safety of out‐of‐hospital births attended by midwives who are licensed according to international standards has not been established in the United States. To address this issue, outcomes of births attended out of hospital by licensed midwives in Washington state were compared with those attended by physicians and certified nurse‐midwives in hospital and certified nurse‐midwives out of hospital between 1981 and 1990. Outcomes measured included low birthweight, low five‐minute Apgar scores, and neonatal and postneonatal mortality. Associations between attendant and outcomes were measured using odds ratios to estimate relative risks. Multivariate analysis using logistic regression controlled for confounding variables. Overall, births attended by licensed midwives out of hospital had a significantly lower risk for low birthweight than those attended in hospital by certified nurse‐midwives, but no significant differences were found between licensed midwives and any of the comparison groups on any other outcomes measured. When the analysis was limited to low‐risk women, certified nurse‐midwives were no more likely to deliver low‐birthweight infants than were licensed midwives, but births attended by physicians had a higher risk of low birthweight. The results of this study indicate that in Washington state the practice of licensed nonnurse‐midwives, whose training meets standards set by international professional organizations, may be as safe as that of physicians in hospital and certified nurse‐midwives in and out of hospital.
Postpartum Depression: How Much Do Obstetric Nurses and Obstetricians Know?
Authors: Lepper Heidi S. , DiMatteo M. Robin , Tinsley Barbara J.
Published: April 2007

ABSTRACT: Postpartum depression affects 10 to 15 percent of all mothers. A study of 725 obstetric nurses and 204 obstetricians was conducted using a reliable two‐factor scale to measure their knowledge and awareness of postpartum depression. Nurses were more aware than physicians of the emotional impact of postpartum depression. Nurses who demonstrated more empathy and who believed education of postpartum depression does not increase a mother's risk were more aware of the postpartum phenomenon than nurses who were less empathic and who did not hold the same belief. Younger and women physicians recognized the psychosocial antecedents to postpartum depression to a greater degree than did older and men physicians. These findings offer potential use in the training of perinatal health care professionals and in the education of pregnant women about postpartum depression.
Miscarriage: A Historical Perspective
Authors: Kuller Jeffrey A. , Katz Vem L.
Published: April 2007

ABSTRACT: Ancient cultures have applied a variety of fascinating therapies to prevent the occurrence and reoccurrence of miscarriage. Ceremonies of ritual purification, special prayers, and a variety of medicinal therapies were employed throughout the ages to prevent this feared event. Rituals to memorialize and help mourn the lost pregnancy were developed in many cultures. These rituals reinforce how deeply men and women are affected by early pregnancy loss.
Infant Formula Distribution and Advertising in Pregnancy: A Hospital Survey
Authors: Howard Cynthia R. , Howard Fred M. , Weitzman Michael L.
Published: April 2007

ABSTRACT: A survey was conducted at a 526–bed community hospital in Rochester, New York, to determine the prevalence of formula advertising and distribution during pregnancy to 136 consecutive intrapartum patients. Women answered a questionnaire about their choice of infant feeding methods and prenatal exposure to formula advertising. Of those who received printed information on infant feeding, 78 percent reported that it was published by a formula company, and 65 percent recalled receiving offers for free formula during their pregnancy. The likelihood of having received such offers was the same in women who planned to breastfeed as in those who planned to formula feed. Thirty‐eight percent of women obtained formula through a free offer before their infant's birth. Women who were privately cared for were more likely to have received offers for free formula (p < 0.001) than were women cared for in hospital‐affiliated clinics. Ninety percent of women who received free formula prenatally reported their prenatal caregiver as a source of samples. Of samples that women obtained prenatally, 93 percent were from companies that advertise only indirectly through hospitals and physicians, whereas 7 percent were from companies that advertise directly to patients. The prevalence of formula company advertising during the prenatal care of women who to deliver in this hospital is high. The continued participation of prenatal caregivers in promotion efforts of formula companies provides a negative or mixed message about the importance of breastfeeding and may be a barrier to its success.
Denial of Pregnancy: A Review and Case Reports
Authors: Spielvogel Anna M. , Hohener Heidi C.
Published: April 2007

ABSTRACT: This paper describes the characteristics of women who deny awareness of their pregnancies, the underlying causes and conflicts, and specific interventions required to address these issues. Case reports illustrate this complication of pregnancy. The absence of many physical symptoms of pregnancy, inexperience, general inattentiveness to bodily cues, intense psychological conflicts about the pregnancy, and external stresses can contribute to the denial in otherwise well‐adjusted women. Assessment should include the possible contribution of painful reactivation of memories concerning childhood or adult trauma and the effect of dissociative states on the development of denial of pregnancy. Psychotherapy is recommended to resolve these conflicts, and to prevent future pregnancy denials and child abuse or neglect. Denial of pregnancy is easier to understand in women with psychosis or serious cognitive impairment than in those without such disorders. The underlying illness requires treatment by a psychiatrist. Psychological conflicts also exist in psychotic women, such as the intense wish to have a baby while fearing loss of the infant to child‐protection services. Acknowledging the conflict and supporting the mother despite her puzzling behavior is an important task for health caregivers.
Changes in Cesarean Delivery in the United States, 1988 and 1993
Authors: Clarke Sally C. , Tafil Selma
Published: April 2007

ABSTRACT: The rate of cesarean delivery in the United States (22.8% in 1993) has remained stable since the mid‐1980s after dramatic increases during the 1970s and early 1980s. The primary cesarean rate (16.3 cesareans in 1993 per 100 women with no history of previous cesarean delivery) was also stable from 1988 to 1993. During this same period, the rate of vaginal birth after previous cesarean (VBAC) doubled, from 12.6 to 25.4 percent. In both 1988 and 1993, rates of cesarean delivery were higher in the South than in other regions, for mothers 35 years or older than for younger women, for proprietary than for nonprofit or state and local government hospitals, and for women with private insurance than for women with Medicaid or self‐pay as the expected source of payment. Even if VBAC rates continue to increase at the same rate as in the past, the Year 2000 goal of an overall cesarean rate of 15 percent cannot be met without reducing the primary cesarean rate by 50 percent.
Effective Care in Pregnancy and Childbirth: A Synopsis
Authors: Enkin Murray W. , Keirse Marc J.N.C. , Renfrew Mary J. , Neilson James P.
Published: April 2007

PREAMBLE: Evidence about the effects of care practices is not a sufficient guide to the most appropriate care. Those who provide care, who receive care, who advocate care, or who pay for care must choose on the basis of many factors: personal experience, personal preference, personal values, availability of resources and facilities, and a myriad of other considerations, among which knowledge of the effects of care is certainly important. This knowledge is essential for choices to be properly informed.

The most reliable evidence about the effects of care is provided by randomized controlled trials. Unfortunately, this evidence is not readily accessible. It is scattered through a large number of journals throughout the world, and is hidden among a mass of weak, inadequate, and sometimes frankly misleading studies. Those who wish to use all the valid evidence must rely on properly prepared, up‐to‐date, systematic reviews. The Cochrane Collaboration has taken on the task of preparing, maintaining, and disseminating reviews of randomized trials of health care, published electronically as the Cochrane Database of Systematic Reviews. The reviews are provided by a number of Collaborative Review Groups, and the Cochrane Pregnancy and Childbirth Database is the first specialty database to appear. It is regularly updated to incorporate data that have become available since the previous issue.

The recommendations in the tables that follow are reprinted from the second edition of A Guide to Effective Care in Pregnancy and Childbirth. They are based on evidence from the two‐volume work, Effective Care in Pregnancy and Childbirth, updated by the current (at the time of going to press) disk issue of The Cochrane Pregnancy and Childbirth Database.
Pica and Olfactory Craving of Pregnancy: How Deep Are the Secrets?
Authors: Cooksey Nancy Rumsey
Published: April 2007

ABSTRACT: The practice of pica during pregnancy is described in contemporary literature as the ingestion of nonfood substances and food staples in response to craving. A previously unnamed practice, olfactory craving of pregnancy, is the smelling by pregnant women of selected substances in response to craving, which may occur alone or with pica. Observations and descriptions of women's experiences of pica and olfactory craving were documented during individualized postpartum bedside instruction of 300 women at a midwestern hospital between 1992 and 1994. Most women were African American and low income. Eight themes about pica of pregnancy were keeping practices secret, singularity of the experience, obtaining the craved substance, fears for effects on the fetus, yielding or not yielding to cravings, use of substances as medication, pica and food intake, and sensory experiences other than taste. Three themes about olfactory craving of pregnancy were changes in sense of smell during pregnancy, types of craved substances and settings, and escalation in use during pregnancy. The clinical stages of pica and olfactory craving require further investigation, and perinatal caregivers have to seek and remove the barriers that cause pregnant women to isolate themselves with the practices that stem from these cravings.
Evaluation of Antenatal and Postnatal Support to Overcome Postnatal Depression: A Randomized, Controlled Trial
Authors: Stamp Georgina E. , Williams Anne Sved , Crowther Caroline A.
Published: April 2007

ABSTRACT: This randomized, controlled trial tested the hypothesis that women identified as more vulnerable to developing postnatal depression who attended two specific antenatal groups and one postnatal group have a reduced frequency of postnatal depression from 37 to 15 percent at 6 weeks, 12 weeks, and 6 months postpartum. A modified antenatal screening questionnaire was completed, and women identified as more vulnerable to postnatal depression were stratified by parity and randomly allocated to receive extra support groups or to a control group. The Edinburgh Postnatal Depression Scale (EPDS) was used to detect postnatal depression. Attendance at the support groups was low, 31 percent overall. At six weeks, in the intervention group, 8 (13%) of 64 women scored high (>12) on the EPDS, compared with 11 (17%) controls. Similarly, at 12 weeks 7 (11%) of 63 versus 10 (15%) of 65 women scored higher than 12, and at 6 months, 9 (15%) of 60 versus 6 (10%) of 64 women scored higher than 12, indicating that the intervention did not reduce postnatal depression. It is possible that the method of applying the intervention, using groups separate from the standard antenatal classes, may have affected attendance. More research is required into ways of reaching and supporting women who may become depressed.
Supportive Care by Maternity Nurses: A Work Sampling Study in an Intrapartum Unit
Authors: Gagnon Anita J. , Waghorn Kathy
Published: April 2007

ABSTRACT: Background: This work sampling study examined how much time intrapartum unit nurses spend providing supportive care overall and during weekday and weekend shifts, and by patient and staff characteristics at a university hospital with 4000 births per year in Montréal, Québec. Methods: Four‐hour observation periods were randomly selected to represent each shift and day of the week. Within each period, eight 15‐minute observation times were randomly selected. Observers located each nurse assigned to the unit at that time and recorded her activity. Supportive activities included physical comfort, emotional support, instruction, and advocacy. Results: The percentage of time spent in supportive care was 6.1 percent (95% confidence interval 5.3%, 6.9%), based on 3367 observations. The time providing supportive care was similar for weekday and weekend shifts. Nurses with less than seven years of intrapartum experience spent 2.7 percent (0.9, 4.5) more time providing supportive care than nurses with seven years of experience or more. Supportive care was 9.2 percent (0.7, 17.7) greater for nulliparous than for parous women, and supportive care of women with epidural anesthesia was similar to those without it. Conclusions: We concluded that intrapartum unit nurses spent a small amount of time providing supportive care to women in labor. This suggests the need for perinatal caregivers and hospital administrators to reexamine how nurses spend their time, given the evidence from randomized trials showing the beneficial effects of continuous support on labor and birth outcomes.
Early versus Late Prenatal Care in New Mexico: Barriers and Motivators
Authors: Rogers Catherine , Schiff Melissa
Published: April 2007

ABSTRACT: Background: Adequate prenatal care is important for ensuring a good outcome for pregnant women and their children, and its initiation in the first trimester is a major component. We investigated barriers and motivators for women receiving early versus late prenatal care. Methods: A self‐administered questionnaire was distributed to 205 women who began prenatal care at the University of New Mexico Hospital Obstetrics Clinic in Albuquerque, New Mexico. The questionnaire assessed demographic information, insurance status, feelings about the pregnancy, health behaviors, and barriers and motivators to initiating prenatal care. The participants were Hispanic (41%) and non‐Hispanic white (46%), low‐income women with Medicaid (42%) or no health insurance (41%). They were divided into early (1st trimester 67%) and late (after 1st trimester 33%) care groups. Results: Ethnicity, education, income, and age did not predict initiation of prenatal care. Late initiators cited financial problems (26%), not being aware of the pregnancy (15%), and dislike of going to doctors (14%) as reasons for the delay in seeking prenatal care. Over two‐thirds of the pregnancies were unplanned, but 82 percent of the women felt positive about the pregnancy. Conclusions: Our study documents the continuing need for public health efforts to encourage women to seek early prenatal care. Specific attention should be directed toward women's perceived reasons for not initiating early care.
The Effects of Whirlpool Baths in Labor: A Randomized, Controlled Trial
Authors: Rush Janet , Burlock Susan , Lambert Kim , Loosley‐Millman Margot , Hutchison Brian , Enkin Murray
Published: April 2007

ABSTRACT: Background: Showers and tubs in labor were not generally used in our center: When three whirlpool baths (Jacuzzis) were ordered as part of our renovations, a randomized, controlled trial was initiated to explore their effects on narcotic and epidural requirements. Methods: This study employed an intent‐to‐treat design, and the sample size was estimated to account for the fact that some women would be unable to use the tub. The experimental group of 393 women was offered the tub during labor and the control group of 392 women received conventional care. Results: No births occurred in the tub. The tub group required fewer pharmacologic agents than controls (66% vs 59%, p = 0.06), experienced fewer deliveries by forceps and vacuum (p = 0.019), and were more likely to have an intact perineum than the standard‐care group (p = 0.019). Labor was longer for the tub group (p = 0.003), who coincidentally were more primiparous and in earlier labor on admission. No differences were noted in the low rates of maternal and newborn signs of infection in women with ruptured membranes. A subset of mothers expressed satisfaction with the tub experience and labor support. The cesarean rate among both groups was lower (8.9%) than our overall rate (16.6%) during the study period. Conclusions: Whirlpool baths in labor have positive effects on analgesia requirements, instrumentation rates, condition of the perineum, and personal satisfaction. Further study of the effects on labor length, pain, influence of labor support, and psychological outcomes is being planned.
Ten Steps to Successful Breastfeeding: A Summary of the Rationale and Scientific Evidence
Authors: Saadeh Randa , Akré James
Published: April 2007

ABSTRACT:b

Ample evidence is available on the impact of health care practices and hospital routines and procedures on breastfeeding. Good practices enhance successful initiation and establishment of breastfeeding and contribute to increased duration, just as inappropriate practices, and failure to support and encourage mothers, have the opposite effect. In 1991 the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) jointly launched the Baby‐Friendly Hospital Initiative, which aims to give every baby the best start in life by ensuring a health care environment where breastfeeding is the norm. The initiative is based on the principles summarized in a joint statement issued by the two organizations in 1989 on the role of maternity services in protecting, promoting, and supporting breastfeeding. To become truly baby‐friendly, hospitals and maternity wards around the world are giving practical effect to the principles described in the joint WHO/UNICEF statement that have been synthesized into Ten Steps To Successful Breastfeeding. This summary of the rationale and scientific basis for the Ten Steps is presented in the light of cumulative experience demonstrating the crucial importance of these principles for the successful initiation and establishment of breastfeeding.
A Comparison of Topical Agents to Relieve Nipple Pain and Enhance Breastfeeding
Authors: Pugh Linda C. , Buchko Barbara L. , Bishop Beverly A. , Cochran Janet F. , Smith LuAnn R. , Lerew Donna J.
Published: April 2007

Background: Nipple soreness is one reason why breastfeeding women wean their infants. This study examined the effectiveness of three topical agents—USP‐modified lanolin, warm water compresses, and expressed breast milk with air drying—in alleviating nipple pain, and if early predictors of breastfeeding at six weeks could be determined.Methods:One hundred seventy‐seven breastfeeding, primiparous women were randomly assigned to one of four groups. All women received education about breastfeeding technique. Numeric rating scales were used to discriminate levels of pain intensity, pain affect, and strength of sucking on day 1. Participants were interviewed by telephone on postpartum days 4, 7, and 14, and during week 6 using the same scales.Results:No significant differences were found among groups for pain intensity, pain affect, or duration of breastfeeding. Results of a logistic regression indicated that older mothers and those who were exclusively breastfeeding (no supplemental feeding) were most likely to be breastfeeding six weeks postpartum. Raw scores supported the use of warm compresses.Conclusion:Further investigation is required into ways of supporting young mothers and how caregivers provide support to breastfeeding mothers in the early weeks after childbirth.
The Effect of Discharge Pack Formula and Breast Pumps on Breastfeeding Duration and Choice of Infant Feeding Method
Authors: Campbell Bliss Mary , Wilkie Joy , Acredolo Curt , Berman Susan , Phillips Tebb Kathleen
Published: April 2007

Background:

A study of breastfeeding mothers was conducted from October 1993 through July 1994 in the western United States to determine the influence of components of hospital discharge packs on the duration of breastfeeding.

Method:

On discharge from the hospital, over 1600 breastfeeding mothers were given one of four free discharge packs, identical in all ways except that one contained a can of powdered formula, one a manual breast pump, one both formula and pump, and one neither. During the following 6 months, mothers were interviewed by telephone three times by an independent research firm to determine how and what they were feeding their infants. Analysis of the independent and interactive effects of both formula and pump was performed, and the moderating effects of age, ethnicity, marital and insurance status, prebirth feeding plan, and the effect of returning to outside employment or school were examined.

Results:

Across the entire sample, the contents of the discharge packs had a negligible effect on feeding method and breastfeeding duration. Examination of select subgroups revealed modest discharge pack effects, wherein the presence of discharge pack formula increased the likelihood of introducing supplementation during the first 6 weeks whereas receipt of pumps prolonged full breastfeeding. Even in these select groups, however, no effect was observed on the overall duration of breastfeeding.

Conclusion:

Relative to other known influences on the choice of feeding method and on breastfeeding duration, discharge pack contents do not merit great concern. (BIRTH 24:2, June 1997)
Depression After Childbirth: The Views of Medical Students and Women Compared
Authors: Small Rhonda , Johnston Vanessa , Orr Annabel
Published: April 2007

Background:

Little research has been conducted on the views of health professionals about women's experiences of depression after childbirth. This study compared the views held by undergraduate medical students about postnatal depression with those of women who had themselves experienced it.

Methods:

Fourth‐ and sixth‐year medical students at one Australian university were surveyed (n =134). Their views about prevalence, duration, contributing factors, and advice for dealing with postnatal depression were compared with the findings from 60 women in a population‐based study of mothers who gave birth in Victoria in 1989, in which women scoring as depressed 8 to 9 months after birth on the Edinburgh Postnatal Depression Scale were interviewed 12 to 18 months later about their experiences of depression and their advice to other mothers.

Results:

Women's and students' views differed markedly, with students much more likely to view hormonal and biologic factors and a “tendency to depression” as playing an important role than women who identified a wide range of social, physical health, and life event factors as contributing to their experience of depression. Fourth‐year students tended to overestimate the prevalence of depression and sixth‐year students to underestimate it. Both groups underestimated the duration of depression compared with women's actual experiences.

Conclusion:

Medical students need to develop a broader understanding of maternal depression after the birth of a baby, and women's own views of the experience can and should make an important contribution to medical teaching on this topic. (BIRTH 24:2, June 1997)
Breastfeeding and the Use of Pacifiers
Authors: Righard Lennart , Alade Margaret O.
Published: April 2007

Background:

This study was designed to test the hypothesis that incorrect sucking technique and pacifier use are factors contributing to breastfeeding failure.

Method:

The nursing patterns of 82 exclusively breastfeeding mother‐infant pairs were observed 4 to 5 days postpartum on the maternity ward at University Hospital in Malmö, Sweden. The breastfeeding outcome and pacifier use was assessed by regular telephone contacts during a 4‐month follow‐up.

Results:

The breastfeeding rate at 4 months was 91 percent in the nonpacifier group and 44 percent in the pacifier group (p =0.03). An incorrect superficial nipple‐sucking technique at the breast from the start combined with pacifier use resulted in early weaning in most cases.

Conclusion:

To promote successful breastfeeding and to reduce nursing problems, an incorrect sucking technique should be prevented or corrected, and the use of pacifiers should be avoided or restricted. (BIRTH 24:2, June 1997)
KN‐62: A Specific Ca2+/calmodulin‐dependent Protein Kinase Inhibitor as a Putative Function‐searching Probe for Intracellular Signal Transduction
Authors: Hidaka Hiroyoshi , Okazaki Katsuo
Published: April 2007

The relationship between changes in intracellular free calcium concentration (Cai2+) and cell functions is becoming more clear, since it has become possible to measure Cai2+ in a living cell. There are, however, still unsolved questions concerning the role of Ca2+ in cellular signal transmission. It is not easy to relate Ca2+ signalling to the functions of a living cell. It is possible to control the amount of Ca2+ using calcium channel blockers, but it is still almost impossible to elucidate the relationship between Ca2+ and cellular functions by controlling Ca2+ signalling.

One approach to solving this problem is to develop and use protein kinase inhibitors. Inhibitors specific to Ca2+/calmodulin‐dependent protein phosphorylation, which is one of the important network systems of the Ca2+ signalling, attract interest among many researchers. The substances that can control Ca2+ signalling include: 1) calcium channel blockers, 2) calmodulin antagonists, and 3) Ca2+/calmodulin‐dependent protein kinase inhibitors. Each substance has a different site of action.

In this article, the action of KN‐62, an inhibitor specific for Ca2+/calmodulin protein kinases (CaM kinases) will be described.
Bayesian Adaptive Regression Splines for Hierarchical Data
Authors: Bigelow Jamie L. , Dunson David B.
Published: April 2007

Summary This article considers methodology for hierarchical functional data analysis, motivated by studies of reproductive hormone profiles in the menstrual cycle. Current methods standardize the cycle lengths and ignore the timing of ovulation within the cycle, both of which are biologically informative. Methods are needed that avoid standardization, while flexibly incorporating information on covariates and the timing of reference events, such as ovulation and onset of menses. In addition, it is necessary to account for within‐woman dependency when data are collected for multiple cycles. We propose an approach based on a hierarchical generalization of Bayesian multivariate adaptive regression splines. Our formulation allows for an unknown set of basis functions characterizing the population‐averaged and woman‐specific trajectories in relation to covariates. A reversible jump Markov chain Monte Carlo algorithm is developed for posterior computation. Applying the methods to data from the North Carolina Early Pregnancy Study, we investigate differences in urinary progesterone profiles between conception and nonconception cycles.
Sharp Simultaneous Confidence Intervals for the Means of Selected Populations with Application to Microarray Data Analysis
Authors: Qiu Jing , Gene Hwang J. T.
Published: April 2007

Summary Simultaneous inference for a large number, N, of parameters is a challenge. In some situations, such as microarray experiments, researchers are only interested in making inference for the K parameters corresponding to the K most extreme estimates. Hence it seems important to construct simultaneous confidence intervals for these K parameters. The naïve simultaneous confidence intervals for the K means (applied directly without taking into account the selection) have low coverage probabilities. We take an empirical Bayes approach (or an approach based on the random effect model) to construct simultaneous confidence intervals with good coverage probabilities. For N= 10,000 and K= 100, typical for microarray data, our confidence intervals could be 77% shorter than the naïve K‐dimensional simultaneous intervals.
Designs for Phase I Clinical Trials with Multiple Courses of Subjects at Different Doses
Authors: Fan Shenghua K , Wang You‐Gan
Published: April 2007

Summary The goal of this article is to provide a new design framework and its corresponding estimation for phase I trials. Existing phase I designs assign each subject to one dose level based on responses from previous subjects. Yet it is possible that subjects with neither toxicity nor efficacy responses can be treated at higher dose levels, and their subsequent responses to higher doses will provide more information. In addition, for some trials, it might be possible to obtain multiple responses (repeated measures) from a subject at different dose levels. In this article, a nonparametric estimation method is developed for such studies. We also explore how the designs of multiple doses per subject can be implemented to improve design efficiency. The gain of efficiency from “single dose per subject” to “multiple doses per subject” is evaluated for several scenarios. Our numerical study shows that using “multiple doses per subject” and the proposed estimation method together increases the efficiency substantially.
Estimating Population Size for a Continuous Time Frailty Model with Covariates in a Capture–Recapture Study
Authors: Xu Ying , Liu Liping , You Na , Pan Hungyu , Yip Paul
Published: April 2007

SummaryA continuous time frailty capture–recapture model is proposed for estimating population size of a closed population with the use of observed covariates to explain individuals' heterogeneity in presence of a random effect. A conditional likelihood approach is used to derive the estimate of parameters, and the Horvitz–Thompson estimator is adopted to estimate the unknown population size. Asymptotic normality of the estimates is obtained. Simulation results and a real example show that the proposed method works satisfactorily.
A Note on Permutation Tests for Variance Components in Multilevel Generalized Linear Mixed Models
Authors: Fitzmaurice Garrett M. , Lipsitz Stuart R. , Ibrahim Joseph G.
Published: April 2007

Summary In many applications of generalized linear mixed models to multilevel data, it is of interest to test whether a random effects variance component is zero. It is well known that the usual asymptotic chi‐square distribution of the likelihood ratio and score statistics under the null does not necessarily hold. In this note we propose a permutation test, based on randomly permuting the indices associated with a given level of the model, that has the correct Type I error rate under the null. Results from a simulation study suggest that it is more powerful than tests based on mixtures of chi‐square distributions. The proposed test is illustrated using data on the familial aggregation of sleep disturbance.
Longterm oculomotor and visual function in spina bifida cystica: a population‐based study
Authors: Caines Elizabeth , Dahl Margareta , Holmström Gerd
Published: April 2007

Purpose:  To document and describe the development from birth of visual and oculomotor functions in a group of children with spina bifida cystica (myelomeningocele and myeloschisis [MMC]). The emphasis in this study is on findings at 12–14 year follow‐up.

Methods:  Twenty children aged 12–14 years with myelomeningocele and Chiari‐related malformations were examined by an orthoptist and a paediatric ophthalmologist. A further child who did not wish to participate actively in the study is also reported. Visual acuity for near and distance, refractometer readings in cycloplegia, the presence of ocular motility disorders and nystagmus were recorded. Accommodation, convergence, colour vision and stereo acuity were assessed and the fundus and media were examined.

Results:  Six children (29%) in the study group had subnormal vision, although no child was visually impaired. Eleven (52%) showed manifest strabismus and 17 (81%) had a significant refractive error. Near visual acuity was normal in nearly all the children, but accommodation was defective in 10. Nine children had nystagmus and two had optic atrophy. No visual field defects were found.

Conclusions:  The high incidence of ocular disturbances in children with spina bifida highlights the importance of regular ophthalmological investigation and follow‐up.
High infusion pressure in conjunction with vitreous surgery alters the morphology and function of the retina of rabbits
Authors: Minami Masahiro , Oku Hidehiro , Okuno Takashi , Fukuhara Masayuki , Ikeda Tsunehiko
Published: April 2007

Purpose:  To investigate the effects of high infusion pressure in conjunction with pars plana vitrectomy (PPV) on retinal morphology and function in rabbits.

Methods:  Pars plana vitrectomy was performed under urethane (0.8 mg/kg) anaesthesia in the right eye of albino rabbits following phacoemulsification and aspiration (PEA). The left eyes were not touched. After PEA, the animals were divided into two groups. In six eyes, intraocular pressure (IOP) was increased to 80 mmHg for 30 mins (high‐pressure group) and in five eyes IOP was maintained at 40 mmHg for 30 mins (low‐pressure group). The IOPs were regulated by the height of the bottle of balanced salt solution (BSS) and monitored with a pressure transducer. After the pressure elevation, vitreous fluid was collected to measure the glutamate concentration. Then, PPV was performed for 15 mins in both groups under an infusion pressure of 40 mmHg. In five additional rabbits, PEA alone was performed in the right eye, and vitreous fluid was collected (PEA group). Functional alterations were assessed by recording visual evoked potentials (VEPs) and electroretinograms (ERGs). Ten days after the IOP changes, the animals were killed with intravenous pentobarbital sodium and the eyes were prepared for histological analysis. Damage to retinal ganglion cells (RGCs) was quantified by counting the number of cells in the ganglion cell layer (GCL). The contralateral eyes in the high‐pressure group served as controls (n = 6).

Results:  The mean implicit time (IT) of the VEPs in the high‐pressure group was significantly longer than that before the IOP elevation, by 114−124% (p < 0.05, paired t‐test), and also than that of control eyes (p < 0.05, anova followed by t‐test). No significant changes in the VEPs were detected in either the low‐pressure group or the PEA group. There were significantly fewer cells in the GCL in the high‐pressure group (24.7/mm) than in the control animals (41.4/mm; p < 0.05, Dunnett's test). The number of cells in the GCL in the low‐pressure and PEA groups did not significantly differ to that in the controls. The amplitudes of the ERG a‐ and b‐waves were not significantly changed (p > 0.05, paired t‐test).

Conclusions:  These results suggest that high infusion pressure in conjunction with PPV leads to morphological and functional changes in the retina. The absence of ERG changes and presence of VEP changes suggest that these changes were due to damage to RGCs, which supports the morphological observations.
Opposite effects of TGF‐β1 and IFN‐γ on transdifferentiation of myofibroblast in human gingival cell cultures
Authors: Sobral Lays M. , Montan Patrick F. , Martelli‐Junior Hercílio , Graner Edgard , Coletta Ricardo D.
Published: April 2007

Background/Aim: Previously, we have shown that myofibroblasts, the main cell type associated with interstitial fibrosis, may be implicated with the gingival overgrowth observed in hereditary gingival fibromatosis (HGF) patients. The goal of this study was to determine whether transforming growth factor‐β1 (TGF‐β1) stimulates myofibroblast generation in gingival fibroblast cultures. Moreover, we analysed how interferon‐γ (IFN‐γ) interferes in this process.

Material and Methods: Fibroblast cultures from normal gingiva and myofibroblast cells from HGF were included in this study. To determine the effects of TGF‐β1 and IFN‐γ stimulation in these cells, the expression of the specific myofibroblast marker smooth muscle isoform of α‐actin (α‐SMA) was examined by semi‐quantitative reverse transcriptase‐polymerase chain reaction (RT‐PCR), Western blot and immunofluorescence. Enzyme‐linked immunosorbent assay (ELISA) for type I collagen was performed to measure the myofibroblast activity.

Results: Our results demonstrated that TGF‐β1 promotes a dose‐ and time‐dependent increase in the expression of α‐SMA, whereas IFN‐γ blocks it and markedly prevents the fibroblast–myofibroblast switch induced by TGF‐β1 on normal gingiva cultures. IFN‐γ altered HGF myofibroblasts metabolism with a decrease of both α‐SMA and type I collagen expression. Additionally, IFN‐γ treatment stimulated SMAD7 expression and inhibited connective tissue growth factor, which has been considered a key molecule to promote the transdifferentiation of myofibroblasts via TGF‐β1 activation.

Conclusions: These findings demonstrate that TGF‐β1 induces gingival fibroblast–myofibroblast transdifferentiation, whereas IFN‐γ blocks this process. More importantly, this study suggests that IFN‐γ may be clinically effective in attenuating excessive accumulation of extracellular matrix produced by myofibroblasts in HGF.
Obesity and periodontitis in 60–70‐year‐old men
Authors: Linden Gerry , Patterson Chris , Evans Alun , Kee Frank
Published: April 2007

Objective: The aim was to investigate whether there was an association between obesity and periodontitis in a homogeneous group of 60–70‐year‐old Western European men. The study also explored whether a high body mass index (BMI) in early life predicted poor periodontal status in later life.

Methodology: A representative sample of the male population of UK, who were enrolled in a cohort study of cardiovascular disease, was examined between 2001 and 2003. A total of 1362 men with six or more teeth completed a questionnaire, had a clinical periodontal examination and had their weight and height recorded. Multivariable analysis was carried out using logistic regression with adjustment for possible confounders. Models were constructed with low‐ and high‐ threshold periodontitis as dependent variables and with BMI as a categorical predictor variable. Low‐threshold periodontitis was identified when at least two teeth had 6 mm loss of attachment and at least one site had a pocket of 5 mm. High‐threshold periodontitis was identified when 15% of sites had 6 mm loss of attachment and there was deep pocketing (6 mm). Modelling was repeated for other predictor variables including BMI at 21 years of age and change in weight since 21 years of age.

Results: Two hundred and ninety‐eight (21.9%) of the men studied, who had a BMI of >30 kg/m2, were classified as obese. Obesity was associated with low‐threshold periodontitis, odds ratio (OR)=1.77 (p=0.004) after adjustment for confounders. The BMI at 21 years of age did not predict periodontitis in the men investigated. Participants who had experienced a large (>30%) increase in weight during adulthood had an increased risk of poor periodontal condition; however, this was attenuated and no longer significant after adjustment for confounders.

Conclusions: It is concluded that obesity was associated with periodontitis in the homogeneous group of 60–70‐year‐old European men investigated. High BMI levels in early life did not predict periodontitis in later life in the men studied.
Une lecture du Mystère du Jour du Jugement portant sur l'imagination allégorique
Authors: Kjær Jonna
Published: April 2007

Le mystère du Jour du Jugement datant du XIVe siècle traite de l’Apocalypse, donc de l'avènement d'Antéchrist et du Jugement dernier. C'est un texte de 2800 vers environ (2438 vers conservés), mais qui doit être joué par non moins que 94 personnages ou groupes de personnages. La disposition scénique a dûêtre celle du «théâtre en rond », avec six mansions ou lieux . Au milieu de ce «cercle magique » est situé le Cimetière, ce qui illustre l'importance du thème de la mort.

L'article examine plusieurs traits qui pourront s'interpréter comme des signaux révélateurs d'une conscience – ou d'une imagination ‐ allégorique. C'est le personnage curieux du «mauvais évêque » qui invite surtout à une lecture allégorique qui voit dans le mystère une psychomachia, c'est‐à‐dire un combat entre le Bien et le Mal pour l’âme de l'Homme au moment de la mort.

L'autre texte du codex, le Testament de Jean de Meun, est présenté et commenté, et la conclusion établit un rapport possible entre le mystère du Jour du Jugement et le dit allégorique du Plait de l'Evesque et de Droit de Jean le Court dit Brisebare.
BOOK REVIEWS
Authors: Bruce William F. , CLAYTON A. S. , Woelfel Norman , BERKSON ISAAC B.
Published: April 2007

ESSAYS IN TEACHING. Edited by Harold Taylor. New York: Harper and Brothers, 1950. 239 pp.

Two Essays On A Prize‐Winning Book EDUCATION AND MORALS. By John L. Chills. New York: Appleton‐Century ‐ Crofts, 1950. 293 pp. $2.75.

PHILOSOPHICAL NARCISSISM

PATTERNS OF EDUCATIONAL PHILOSOPHY: A DEMOCRATIC INTERPRETATION. By Theodore Brameld. Y onkers‐on‐Hudson, New York: World Book Company, 1950. 824 pp.
Book Reviews
Authors: Bruce William F.
Published: April 2007

THE WALL OF SEPARATION BETWEEN CHURCH AND STATE.
BOOK REVIEW
Authors: BRUCE WILLIAM F.
Published: April 2007

RELIGIOUS PERSPECTIVES IN COLLEGE TEACHING. Selected essays: “In the Preparation of Teachers” by Robert Ulich; “In Philosophy” by Theodore M. Greene; “In Experimental Psychology,” by Robert B. MacLoed; and “In Economics” by Kenneth E. Boulding. New Haven, Conn.: The Edward W. Hazen Foundation.
BOOK REVIEWS
Authors: LIEBERMAN MYRON , MOLINARO LEO A.
Published: April 2007

THE FORMS OF VALUE. By A. L. Hillard.

CREATIVE LEADERSHIP OF ADULT EDUCATION. By Paul L. Essert

CULTURAL SCIENCES: THEIR ORIGIN AND DEVELOPMENT. By Florian Znaniecki.
BOOK REVIEWS
Authors: GOOD H. G. , ELLIS FREDERICK E. , CLAYTOX A. S. , ARNSTEIN GEORGE E.
Published: April 2007

The Great Thinkers. By Rupert Lodge.

Moral and Spritual Values in Education. By William Clayton Bower.

Great Books: Panacea or What? By Edward A. Fitzpatrick.
BOOK REVIEWS
Authors: Schuman R. Baird , Ulich Mary Ewen , Shoemaker F. L. , WALSH JOHN E.
Published: April 2007

EDUCATIONAL PHILOSOPHIES AND DEMOCRATIC FAITH. By James W. Skelton.

ADULT EDUCATION. By P. H. Sheats, C. D. Jayne, and R. B. Spence.

PHILOSOPHY AND THE IDEOLOGICAL CONFLICT. By Charles S. Seely.

GANDHI: HIS LIFE AND MESSAGE FOR THE WORLD. By Louis Fischer.
BOOK REVIEWS
Authors: Shoemaker F. L. , Newman Floyd W. , Furness Edna Lue , Levit Martin , Cappon Alexander P. , Krash Otto , Shoemaker F. L.
Published: April 2007

COMMUNITY IN CRISIS: THE ELIMINATION OF SEGREGATION FROM A PUBLIC SCHOOL SYSTEM. By James H. Tipton.

THE MEANING OF THE GLORIOUS KORAN. Translated by Mohammed Marmaduke Pickthall.

PUBLIC EDUCATION UNDER CRITICISM.M. Hill. New York: Prentice‐Hall, 1954. 414 pages. $6.35. Edited by W. Winfield Scott and Clyde

INQUIRY INTO INQUIRIES: ESSAYS IN SOCIAL THEORY. By Arthur F. Bentley.

POWER OF WORDS. By Stuart Chase in collaboration with Marian T. Chase.

GREAT HUMAN ISSUES OF OUR TJMES. By Harold Benjamin, Kenneth Cooper, Willard Gosh, Clifton L. Hall, Claude Chadwick, James L. Hymes, Jr., Henry H.Hill and William Van Til.

PUBLIC EDUCATION AND ITS CRITICS. New York: The Mac‐millan Company, 1954. 170 pp. $2.50. (Kappa Delta Phi Lecture.) By V. T. Thayer.