bluuebunny/crossref_metadata_2025 huggingface dataset:
Improvement after inspection
Authors: Perryman Jane
Published: August 2010

This article is based on a case study of one English secondary school in the three years following its release from Special Measures. Having followed the school’s successful improvement (in inspection terms) while under Special Measures, I was interested to know if the school would be able to sustain its improvement once the inspectors had departed. Data used are from interviews with middle and senior management detailing responses to the essential question ‘is the school improving?’. I found that, although in many respects the school was maintaining its improvement, some middle and senior managers were suspicious about the long-term effects of becoming an institution so seemingly built around passing inspection.
Multiple ‘black boxes’: inquiry into learning within a professional development project
Authors: Parr Judy M. , Timperley Helen S.
Published: August 2010

This article develops the analogy of the ‘black box’ in relation to different levels of a professional development project to understand the nature of learning that results in higher student achievement. Principles of formative assessment are used to frame the on-going, evidence-informed inquiry into learning that operated at each level of the system involved: policy, project delivery, including expert facilitators, and school. Data collected throughout the two-year project cycle (of which there were three), included student achievement in reading or writing; student interviews; classroom observations and responses from teachers to scenarios; interviews, and taped examples of facilitator practice. There were considerable effect size gains in student achievement in each of the three, two-year cohorts of schools. To understand these gains the project and its various contexts for learning are examined. Examples of how inquiry into learning at one level impacted on practice at others are discussed.
Welcoming intergenerational communication and senior citizen volunteers in schools
Authors: Spudich Dimana , Spudich Christine
Published: August 2010

This article focuses on intergenerational communication and provides a practical approach for how teachers and administrators can implement intergenerational programs in their schools. A discussion of the social and cultural implications of intergenerational communication is offered, and a review of literature regarding intergenerational programs is provided along with expertise offered from known leaders in the communication and intergenerational fields. The noted benefits as well as the disadvantages of senior citizens as volunteers are described, and the necessary steps prior to incorporating senior citizens into school settings are given. The necessary steps include recruitment, identifying volunteer duties, screening volunteers, recognizing their efforts, and evaluating their progress. Five intergenerational activities are offered for educators to enhance intergenerational communication in their schools. The activities include guest speakers, family nights, pen pal programs, books shares and interview sessions.
Professional learning communities and system improvement
Authors: Harris Alma , Jones Michelle
Published: August 2010

This article outlines the progress and impact of professional learning communities within, between and across schools, as part of the implementation of whole system reform in Wales. It describes the way in which professional learning communities are being developed to support improvement and change across the education system in Wales. The article focuses on a group of schools that piloted a model of professional learning communities that subsequently have become a key part of the reform process in Wales and it highlights some of the challenges faced by the schools in establishing and sustaining professional learning communities. The article concludes by suggesting that professional learning communities offer one way of generating changed professional practice that can positively contribute to system-wide improvement.
‘Brothers 30,000, sisters 20,000; nephews 15,000, nieces 10,000’: Akan funeral ledgers’ kinship and value negotiations, and their limits
Authors: Boni Stefano
Published: August 2010

This article compares indigenous conceptualizations, as expressed in ledgers recording the collection of funeral offerings, with academic knowledge on kinship and value negotiation in the Akan area of West Africa. Donors are inserted in social circuits defining their residential belonging (in villages and households), parental affiliation (with specific offerings for matrilineal kin, patrilateral kin and in-laws), as well as gender and seniority. Funeral offerings, moreover, vary proportionally to value: the amount provided by the donor expresses his/her value and the total cost of the funeral indicates the value of the deceased and of her/his family. The intricacies of mortuary offerings — expressed through elaborate calculations — reveal shared and structured taxonomies that enable affirming and negotiating the value of the deceased and that of the donor as well as the relation between donor and deceased. Anthropological theories and definitions are confronted with these locally elaborated representations.
Pride, shame and stigma in private spaces
Authors: Warren Carol AB
Published: August 2010

Private spaces are one locus of public faces. Those who do not wish to be judged by others may close off their homes from observation. Conversely, those who wish intensely to be judged by others may open up their homes to scrutiny by all. In this ethnography of a wealthy ‘marina’ community in Southern California, private homes, boats and automobiles are the sites of pride, shame and stigma on the part of owners and residents, in ways that reflect gender, class, ethnicity, sexuality and age as well as enduring, general cultural norms (pride goeth before a fall).
Preparing the Nursing Workforce of the Future
Authors: Ellenbecker Carol H.
Published: August 2010

Nurse shortages coupled with the need for national healthcare reform present a challenge. We are not preparing enough nurses nor are we preparing nurses with the right skills to fully participate in a reformed healthcare system. Historical forces in nursing education have resulted in multiple levels of entry into nursing practice and an inadequate nursing workforce. Today’s environment of expanding knowledge, the call for interdisciplinary healthcare delivery teams, and evidence of the relationship between nurse education and improved patient outcomes strongly indicate the need for nurses prepared at the baccalaureate level. Requiring a baccalaureate degree for entry into nursing practice, and as the initial degree of nursing education would prepare nurses earlier for graduate education and the much needed roles of educator, researcher and advanced practice nurse. The nursing profession should take the lead in advocating for educational policies that would adequately prepare the nurse workforce of the future.
The landscape of human genes involved in the immune response to parasitic worms
Authors: Fumagalli Matteo , Pozzoli Uberto , Cagliani Rachele , Comi Giacomo P , Bresolin Nereo , Clerici Mario , Sironi Manuela
Published: August 2010

Background

More than 2 billion individuals worldwide suffer from helminth infections. The highest parasite burdens occur in children and helminth infection during pregnancy is a risk factor for preterm delivery and reduced birth weight. Therefore, helminth infections can be regarded as a strong selective pressure.

Results

Here we propose that candidate susceptibility genes for parasitic worm infections can be identified by searching for SNPs that display a strong correlation with the diversity of helminth species/genera transmitted in different geographic areas. By a genome-wide search we identified 3478 variants that correlate with helminth diversity. These SNPs map to 810 distinct human genes including loci involved in regulatory T cell function and in macrophage activation, as well as leukocyte integrins and co-inhibitory molecules. Analysis of functional relationships among these genes identified complex interaction networks centred around Th2 cytokines. Finally, several genes carrying candidate targets for helminth-driven selective pressure also harbour susceptibility alleles for asthma/allergy or are involved in airway hyper-responsiveness, therefore expanding the known parallelism between these conditions and parasitic infections.

Conclusions

Our data provide a landscape of human genes that modulate susceptibility to helminths and indicate parasitic worms as one of the major selective forces in humans.
A complete DNA sequence map of the ovine Major Histocompatibility Complex
Authors: Gao Jianfeng , Liu Ka , Liu Haibo , Blair Hugh T , Li Gang , Chen Chuangfu , Tan Pingping , Ma Runlin Z
Published: August 2010

Background

The ovine Major Histocompatibility Complex (MHC) harbors clusters of genes involved in overall resistance/susceptibility of an animal to infectious pathogens. However, only a limited number of ovine MHC genes have been identified and no adequate sequence information is available, as compared to those of swine and bovine. We previously constructed a BAC clone-based physical map that covers entire class I, class II and class III region of ovine MHC. Here we describe the assembling of a complete DNA sequence map for the ovine MHC by shotgun sequencing of 26 overlapping BAC clones.

Results

DNA shotgun sequencing generated approximately 8-fold genome equivalent data that were successfully assembled into a finished sequence map of the ovine MHC. The sequence map spans approximately 2,434,000 nucleotides in length, covering almost all of the MHC loci currently known in the sheep and cattle. Gene annotation resulted in the identification of 177 protein-coding genes/ORFs, among which 145 were not previously reported in the sheep, and 10 were ovine species specific, absent in cattle or other mammals. A comparative sequence analyses among human, sheep and cattle revealed a high conservation in the MHC structure and loci order except for the class II, which were divided into IIa and IIb subregions in the sheep and cattle, separated by a large piece of non-MHC autosome of approximately 18.5 Mb. In addition, a total of 18 non-protein-coding microRNAs were predicted in the ovine MHC region for the first time.

Conclusion

An ovine MHC DNA sequence map was successfully assembled by shotgun sequencing of 26 overlapping BAC clone. This makes the sheep the second ruminant species for which the complete MHC sequence information is available for evolution and functional studies, following that of the bovine. The results of the comparative analysis support a hypothesis that an inversion of the ancestral chromosome containing the MHC has shaped the MHC structures of ruminants, as we currently observed in the sheep and cattle. Identification of relative large numbers of microRNAs in the ovine MHC region helps to provide evidence that microRNAs are actively involved in the regulation of MHC gene expression and function.
Mechanosensitivity during lower extremity neurodynamic testing is diminished in individuals with Type 2 Diabetes Mellitus and peripheral neuropathy: a cross sectional study
Authors: Boyd Benjamin S , Wanek Linda , Gray Andrew T , Topp Kimberly S
Published: August 2010

Background

Type 2 Diabetes Mellitus (T2DM) and diabetic symmetrical polyneuropathy (DSP) impact multiple modalities of sensation including light touch, temperature, position sense and vibration perception. No study to date has examined the mechanosensitivity of peripheral nerves during limb movement in this population. The objective was to determine the unique effects T2DM and DSP have on nerve mechanosensitivity in the lower extremity.

Methods

This cross-sectional study included 43 people with T2DM. Straight leg raise neurodynamic tests were performed with ankle plantar flexion (PF/SLR) and dorsiflexion (DF/SLR). Hip flexion range of motion (ROM), lower extremity muscle activity and symptom profile, intensity and location were measured at rest, first onset of symptoms (P1) and maximally tolerated symptoms (P2).

Results

The addition of ankle dorsiflexion during SLR testing reduced the hip flexion ROM by 4.3° ± 6.5° at P1 and by 5.4° ± 4.9° at P2. Individuals in the T2DM group with signs of severe DSP (n = 9) had no difference in hip flexion ROM between PF/SLR and DF/SLR at P1 (1.4° ± 4.2°; paired t-test p = 0.34) or P2 (0.9° ± 2.5°; paired t-test p = 0.31). Movement induced muscle activity was absent during SLR with the exception of the tibialis anterior during DF/SLR testing. Increases in symptom intensity during SLR testing were similar for both PF/SLR and DF/SLR. The addition of ankle dorsiflexion induced more frequent posterior leg symptoms when taken to P2.

Conclusions

Consistent with previous recommendations in the literature, P1 is an appropriate test end point for SLR neurodynamic testing in people with T2DM. However, our findings suggest that people with T2DM and severe DSP have limited responses to SLR neurodynamic testing, and thus may be at risk for harm from nerve overstretch and the information gathered will be of limited clinical value.
Bisphosphonate treatment of aggressive primary, recurrent and metastatic Giant Cell Tumour of Bone
Authors: Balke Maurice , Campanacci Laura , Gebert Carsten , Picci Piero , Gibbons Max , Taylor Richard , Hogendoorn Pancras , Kroep Judith , Wass John , Athanasou Nicholas
Published: August 2010

Background

Giant cell tumour of bone (GCTB) is an expansile osteolytic tumour which contains numerous osteoclast-like giant cells. GCTB frequently recurs and can produce metastatic lesions in the lungs. Bisphosphonates are anti-resorptive drugs which act mainly on osteoclasts.

Method

In this study, we have examined clinical and radiological outcomes of treatment with aminobisphosphonates on 25 cases of aggressive primary, recurrent and metastatic GCTB derived from four European centres. We also analysed in vitro the inhibitory effect of zoledronic acid on osteoclasts isolated from GCTBs.

Results

Treatment protocols differed with several different aminobisphosphonates being employed, but stabilisation of disease was achieved in most of these cases which were refractory to conventional treatment. Most inoperable sacral/pelvic tumours did not increase in size and no further recurrence was seen in GCTBs that had repeatedly recurred in bone and soft tissues. Lung metastases did not increase in size or number following treatment. Zoledronic acid markedly inhibited lacunar resorption by GCTB-derived osteoclasts in vitro.

Conclusion

Our findings suggest that bisphosphonates may be useful in controlling disease progression in GCTB and that these agents directly inhibit GCTB - derived osteoclast resorption. These studies highlight the need for the establishment of standardised protocols to assess the efficacy of bisphosphonate treatment of GCTB.
CYP1A1gene polymorphisms increase lung cancer risk in a high-incidence region of Spain: a case control study
Authors: San Jose Carmen , Cabanillas Agustin , Benitez Julio , Carrillo Juan Antonio , Jimenez Mercedes , Gervasini Guillermo
Published: August 2010

Background

A rural region in south-west Spain has one of the highest lung cancer incidence rates of the country, as revealed by a previous epidemiological 10-year follow-up study. The present work was undertaken to ascertain the role ofCYP1A1gene polymorphisms and their interaction with tobacco smoking in the development of the disease in this location.

Methods

One-hundred-and-three cases of lung cancer and 265 controls participated in the study. The participants were screened for the presence of fourCYP1A1polymorphisms, namelyMspI, Ile462Val, T3205C, and Thr461Asn. Lung cancer risk was estimated as odds ratios (OR) and 95% confidence intervals (CI) using unconditional logistic regression models adjusting for age, sex, and smoking.

Results

The distribution of the variantCYP1A1alleles was different from that described for other Caucasian populations, withCYP1A1*2Ashowing an uncommonly high frequency (p < 0.01). TheCYP1A1*2Ballele (carryingMspIand Ile462Val mutations) was strongly associated with high lung cancer risk (OR = 4.59, CI:1.4-12.6,p<0.01). The Ile462Val polymorphism was also shown to increase the risk for the disease (OR = 4.51, CI:1.8-11.9;p<0.01) and particularly for squamous-cell (OR = 5.01; CI: 1.6-14.3, p < 0.01) and small-cell lung carcinoma (SCLC) (OR = 6.97, CI: 1.2-81.3;p= 0.04). Moreover, the Thr461Asn polymorphism was found to be associated with SCLC in a Caucasian population for the first time to our knowledge (OR = 8.33, CI: 1.3-15.2,p= 0.04).

Conclusion

The results suggest thatCYP1A1polymorphisms contribute to increase lung cancer susceptibility in an area with an uncommon high incidence rate.
COX-2 inhibition improves immunotherapy and is associated with decreased numbers of myeloid-derived suppressor cells in mesothelioma. Celecoxib influences MDSC function
Authors: Veltman Joris D , Lambers Margaretha EH , van Nimwegen Menno , Hendriks Rudi W , Hoogsteden Henk C , Aerts Joachim GJV , Hegmans Joost PJJ
Published: August 2010

Background

Myeloid-derived suppressor cells (MDSC) are a heterogeneous population of immature cells that accumulates in tumour-bearing hosts. These cells are induced by tumour-derived factors (e.g. prostaglandins) and have a critical role in immune suppression. MDSC suppress T and NK cell function via increased expression of arginase I and production of reactive oxygen species (ROS) and nitric oxide (NO). Immune suppression by MDSC was found to be one of the main factors for immunotherapy insufficiency. Here we investigate if the in vivo immunoregulatory function of MDSC can be reversed by inhibiting prostaglandin synthesis by specific COX-2 inhibition focussing on ROS production by MDSC subtypes. In addition, we determined if dietary celecoxib treatment leads to refinement of immunotherapeutic strategies.

Methods

MDSC numbers and function were analysed during tumour progression in a murine model for mesothelioma. Mice were inoculated with mesothelioma tumour cells and treated with cyclooxygenase-2 (COX-2) inhibitor celecoxib, either as single agent or in combination with dendritic cell-based immunotherapy.

Results

We found that large numbers of infiltrating MDSC co-localise with COX-2 expression in those areas where tumour growth takes place. Celecoxib reduced prostaglandin E2 levels in vitro and in vivo. Treatment of tumour-bearing mice with dietary celecoxib prevented the local and systemic expansion of all MDSC subtypes. The function of MDSC was impaired as was noticed by reduced levels of ROS and NO and reversal of T cell tolerance; resulting in refinement of immunotherapy.

Conclusions

We conclude that celecoxib is a powerful tool to improve dendritic cell-based immunotherapy and is associated with a reduction in the numbers and suppressive function of MDSC. These data suggest that immunotherapy approaches benefit from simultaneously blocking cyclooxygenase-2 activity.
Validity and test-retest reliability of manual goniometers for measuring passive hip range of motion in femoroacetabular impingement patients.
Authors: Nussbaumer Silvio , Leunig Michael , Glatthorn Julia F , Stauffacher Simone , Gerber Hans , Maffiuletti Nicola A
Published: August 2010

Background

The aims of this study were to evaluate the construct validity (known group), concurrent validity (criterion based) and test-retest (intra-rater) reliability of manual goniometers to measure passive hip range of motion (ROM) in femoroacetabular impingement patients and healthy controls.

Methods

Passive hip flexion, abduction, adduction, internal and external rotation ROMs were simultaneously measured with a conventional goniometer and an electromagnetic tracking system (ETS) on two different testing sessions. A total of 15 patients and 15 sex- and age-matched healthy controls participated in the study.

Results

The goniometer provided greater hip ROM values compared to the ETS (range 2.0-18.9 degrees;P< 0.001); good concurrent validity was only achieved for hip abduction and internal rotation, with intraclass correlation coefficients (ICC) of 0.94 and 0.88, respectively. Both devices detected lower hip abduction ROM in patients compared to controls (P< 0.01). Test-retest reliability was good with ICCs higher 0.90, except for hip adduction (0.82-0.84). Reliability estimates did not differ between the goniometer and the ETS.

Conclusions

The present study suggests that goniometer-based assessments considerably overestimate hip joint ROM by measuring intersegmental angles (e.g., thigh flexion on trunk for hip flexion) rather than true hip ROM. It is likely that uncontrolled pelvic rotation and tilt due to difficulties in placing the goniometer properly and in performing the anatomically correct ROM contribute to the overrating of the arc of these motions. Nevertheless, conventional manual goniometers can be used with confidence for longitudinal assessments in the clinic.
Anti-folate drug resistance in Africa: meta-analysis of reported dihydrofolate reductase (dhfr) and dihydropteroate synthase (dhps) mutant genotype frequencies in African Plasmodium falciparum parasite populations
Authors: Sridaran Sankar , McClintock Shannon K , Syphard Luke M , Herman Karen M , Barnwell John W , Udhayakumar Venkatachalam
Published: August 2010

Background

Mutations in the dihydrofolate reductase (dhfr) and dihydropteroate synthase (dhps) genes of Plasmodium falciparum are associated with resistance to anti-folate drugs, most notably sulphadoxine-pyrimethamine (SP). Molecular studies document the prevalence of these mutations in parasite populations across the African continent. However, there is no systematic review examining the collective epidemiological significance of these studies. This meta-analysis attempts to: 1) summarize genotype frequency data that are critical for molecular surveillance of anti-folate resistance and 2) identify the specific challenges facing the development of future molecular databases.

Methods

This review consists of 220 studies published prior to 2009 that report the frequency of select dhfr and dhps mutations in 31 African countries. Maps were created to summarize the location and prevalence of the highly resistant dhfr triple mutant (N51I, C59R, S108N) genotype and dhps double mutant (A437G and K540E) genotype in Africa. A hierarchical mixed effects logistic regression was used to examine the influence of various factors on reported mutant genotype frequency. These factors include: year and location of study, age and clinical status of sampled population, and reporting conventions for mixed genotype data.

Results

A database consisting of dhfr and dhps mutant genotype frequencies from all African studies that met selection criteria was created for this analysis. The map illustrates particularly high prevalence of both the dhfr triple and dhps double mutant genotypes along the Kenya-Tanzania border and Malawi. The regression model shows a statistically significant increase in the prevalence of both the dhfr triple and dhps double mutant genotypes in Africa.

Conclusion

Increasing prevalence of the dhfr triple mutant and dhps double mutant genotypes in Africa are consistent with the loss of efficacy of SP for treatment of clinical malaria in most parts of this continent. Continued assessment of the effectiveness of SP for the treatment of clinical malaria and intermittent preventive treatment in pregnancy is needed. The creation of a centralized resistance data network, such as the one proposed by the WorldWide Antimalarial Resistance Network (WWARN), will become a valuable resource for planning timely actions to combat drug resistant malaria.
An ovine tracheal explant culture model for allergic airway inflammation
Authors: Abeynaike Latasha , Meeusen Els NT , Bischof Robert J
Published: August 2010

Background

The airway epithelium is thought to play an important role in the pathogenesis of asthmatic disease. However, much of our understanding of airway epithelial cell function in asthma has been derived from in vitro studies that may not accurately reflect the interactive cellular and molecular pathways active between different tissue constituents in vivo.

Methods

Using a sheep model of allergic asthma, tracheal explants from normal sheep and allergic sheep exposed to house dust mite (HDM) allergen were established to investigate airway mucosal responses ex vivo. Explants were cultured for up to 48 h and tissues were stained to identify apoptotic cells, goblet cells, mast cells and eosinophils. The release of cytokines (IL-1α, IL-6 and TNF-α) by cultured tracheal explants, was assessed by ELISA.

Results

The general morphology and epithelial structure of the tracheal explants was well maintained in culture although evidence of advanced apoptosis within the mucosal layer was noted after culture for 48 h. The number of alcian blue/PAS positive mucus-secreting cells within the epithelial layer was reduced in all cultured explants compared with pre-cultured (0 h) explants, but the loss of staining was most evident in allergic tissues. Mast cell and eosinophil numbers were elevated in the allergic tracheal tissues compared to naïve controls, and in the allergic tissues there was a significant decline in mast cells after 24 h culture in the presence or absence of HDM allergen. IL-6 was released by allergic tracheal explants in culture but was undetected in cultured control explants.

Conclusions

Sheep tracheal explants maintain characteristics of the airway mucosa that may not be replicated when studying isolated cell populations in vitro. There were key differences identified in explants from allergic compared to control airways and in their responses in culture for 24 h. Importantly, this study establishes the potential for the application of tracheal explant cultures in relevant ex vivo investigations on the therapeutic and mechanistic modalities of asthmatic disease.
Effect of an armed conflict on relative socioeconomic position of rural households: case study from western Côte d'Ivoire
Authors: Fürst Thomas , Tschannen Andres B , Raso Giovanna , Acka Cinthia A , de Savigny Don , Girardin Olivier , N'Goran Eliézer K , Utzinger Jürg
Published: August 2010

Background

Current conceptual frameworks on the interrelationship between armed conflict and poverty are based primarily on aggregated macro-level data and/or qualitative evidence and usually focus on adherents of warring factions. In contrast, there is a paucity of quantitative studies about the socioeconomic consequences of armed conflict at the micro-level, i.e., noncommitted local households and civilians.

Methods

We conducted a secondary analysis of data pertaining to risk factors for malaria and neglected tropical diseases. Standardized questionnaires were administered to 182 households in a rural part of western Côte d'Ivoire in August 2002 and again in early 2004. Between the two surveys, the area was subject to intensive fighting in the Ivorian civil war. Principal component analysis was applied at the two time points for constructing an asset-based wealth-index and categorizing the households in wealth quintiles. Based on quintile changes, the households were labeled as 'worse-off', 'even' or 'better-off'. Statistical analysis tested for significant associations between the socioeconomic fates of households and head of household characteristics, household composition, village characteristics and self-reported events associated with the armed conflict. Most-poor/least-poor ratios and concentration indices were calculated to assess equity changes in households' asset possession.

Results

Of 203 households initially included in the first survey, 21 were lost to follow-up. The population in the remaining 182 households shrunk from 1,749 to 1,625 persons due to migration and natural population changes. However, only weak socioeconomic dynamics were observed; every seventh household was defined as 'worse-off' or 'better-off' despite the war-time circumstances. Analysis of other reported demographic and economic characteristics did not clearly identify more or less resilient households, and only subtle equity shifts were noted.

However, the results indicate significant changes in livelihood strategies with a significant return to agricultural production and a decrease in the diversity of socioeconomic activities.

Conclusion

Situational constraints and methodological obstacles are inherent in conflict settings and hamper conflict-related socioeconomic research. Furthermore, sensitive methods to assess and meaningfully interpret longitudinal micro-level wealth data from low-income countries are lacking. Despite compelling evidence of socioeconomic dynamics triggered by armed conflicts at the macro-level, we could not identify similar effects at the micro-level. A deeper understanding of household profiles that are more resilient to armed conflict could help to better prevent and/or alleviate adverse conflict-related and increasingly civilian-borne socioeconomic effects.
Clinical and histologic features of botryoid odontogenic cyst: a case report
Authors: Farina Vitor H , Brandão Adriana AH , Almeida Janete D , Cabral Luiz AG
Published: August 2010

Introduction

The lateral periodontal cyst, as the name implies, occurs on a lateral periodontal location and is of developmental origin, arising from cystic degeneration of clear cells of the dental lamina. A botryoid odontogenic cyst is considered to be a rare multilocular variant of a lateral periodontal cyst.

Case presentation

We report the clinical and histopathologic features of a rare case of botryoid odontogenic cyst found in an edentulous area corresponding to the right lower canine of a 64-year-old African-American woman. A multilocular radiolucency was observed, and surgical removal of the lesion revealed a nodule of rubber-like consistency measuring about 1.5 cm in diameter. Cross-sectioning of the nodule showed that it consisted of various cystic compartments. Histologically, various voluminous periodic acid-Schiff-negative clear cells randomly distributed throughout the cystic epithelium were observed, as well as cell layers showing thickenings generally formed by oval, sometimes entangled plaques. The capsule consisted of fibrous connective tissue and showed rare and discrete foci of a perivascular mononuclear inflammatory infiltrate and reactive bone-tissue fragments. The final diagnosis was botryoid odontogenic cyst.

Conclusion

We provide data that allow the reader to establish the differences between botryoid odontogenic cyst, glandular odontogenic cyst, and lateral periodontal cyst, helping with the differential diagnosis. The reader will have the opportunity to review botryoid odontogenic cyst clinical and histopathologic features, including treatment.
Lack of germline A339V mutation in thyroid transcription factor-1 (TITF-1/NKX2.1) gene in familial papillary thyroid cancer
Authors: Cantara Silvia , Capuano Serena , Formichi Caterina , Pisu Milena , Capezzone Marco , Pacini Furio
Published: August 2010

Thyroid cancer may have a familial predisposition but a specific germline alteration responsible for the disease has not been discovered yet. We have shown that familial papillary thyroid cancer (FPTC) patients have an imbalance in telomere-telomerase complex with short telomeres and increased telomerase activity. A germline mutation (A339V) in thyroid transcription factor-1 has been described in patients with multinodular goiter and papillary thyroid cancer. In this report, the presence of the A339V mutation and the telomere length has been studied in FPTC patients and unaffected family members. All samples analyzed displayed a pattern typical of the homozygous wild type revealing the absence of the A339V mutation. Shortening of telomeres was confirmed in all patients. We concluded that the A339V mutation in thyroid transcription factor-1 (TITF-1/NKX2.1) is not correlated with the familial form of PTC, even when the tumor was in the context of multinodular goiter.
Violence in older people with mental illness
Authors: O'Callaghan Charlotte E. , Richman Anna V. , Majumdar Biswadeep
Published: August 2010

Aggression is common in older people with mental illness, with 15–43% of community referrals to old age psychiatry services and 44–65% of older people with Alzheimer's disease living in the community exhibiting such behaviour. In psychiatric in-patient units, assaults on staff are most common on wards for elderly people with organic mental illness. There is little high-quality research into the management of aggressive behaviour in dementia. We consider the available literature, which has shown certain behavioural measures and different classes of medication to be of benefit. We discuss factors associated with violence in elderly people with mental illness and potential management options.
Pernicious anaemia presenting as catatonia without signs of anaemia or macrocytosis
Authors: Jauhar S. , Blackett A. , Srireddy P. , McKenna P. J.
Published: August 2010

Pernicious anaemia can present with psychiatric symptoms before haematological or neurological manifestations appear. We describe a young woman who presented with insidious onset catatonia without evidence of psychosis or depression. Blood count and mean cell volume were normal and neurological findings were equivocal. Low B12 levels and intrinsic factor antibodies were found only by chance when they were included in a battery of further investigations. B12 replacement was followed by prompt improvement. This case provides an argument for wider screening for B12 deficiency in certain individuals with psychiatric disorders.
Social intervention for British Pakistani women with depression: randomised controlled trial
Authors: Gater Richard , Waheed Waquas , Husain Nusrat , Tomenson Barbara , Aseem Saadia , Creed Francis
Published: August 2010

Background

British Pakistani women have a high prevalence of depression. There are no reported psychosocial interventions for depression in ethnic minorities in the UK.

Aims

To determine the efficacy of a social group intervention compared with antidepressants, and whether the combination of the two is more efficacious than either alone.

Method

A total of 123 women with depression participated in the primary care-based cluster randomised controlled trial (ISRCTN19172148). Outcome measures were severity of depression (Hamilton Rating Scale for Depression), social functioning and satisfaction at 3 and 9 months.

Results

Greater improvement in depression in the social intervention group and the combined treatment group compared with those receiving antidepressants alone fell short of significance. There was significantly greater improvement in social functioning in the social intervention and combined treatment groups than in the antidepressant group at both 3 and 9 months.

Conclusions

Pakistani women with depression found the social groups acceptable and their social function and satisfaction improved if they received social treatment compared with the receipt of antidepressants alone.
Ethnic differences in self-harm, rates, characteristics and service provision: three-city cohort study
Authors: Cooper Jayne , Murphy Elizabeth , Webb Roger , Hawton Keith , Bergen Helen , Waters Keith , Kapur Navneet
Published: August 2010

Background

Studies of self-harm in Black and minority ethnic (BME) groups have been restricted to single geographical areas, with few studies of Black people.

Aims

To calculate age- and gender-specific rates of self-harm by ethnic group in three cities and compare characteristics and outcomes.

Method

A population-based self-harm cohort presenting to five emergency departments in three English cities during 2001 to 2006.

Results

A total of 20 574 individuals (16–64 years) presented with self-harm; ethnicity data were available for 75%. Rates of self-harm were highest in young Black females (16–34 years) in all three cities. Risk of self-harm in young South Asian people varied between cities. Black and minority ethnic groups were less likely to receive a psychiatric assessment and to re-present with self-harm.

Conclusions

Despite the increased risk of self-harm in young Black females fewer receive psychiatric care. Our findings have implications for assessment and appropriate management for some BME groups following self-harm.
Role of media reports in completed and prevented suicide: Werther v. Papageno effects
Authors: Niederkrotenthaler Thomas , Voracek Martin , Herberth Arno , Till Benedikt , Strauss Markus , Etzersdorfer Elmar , Eisenwort Brigitte , Sonneck Gernot
Published: August 2010

Background

Media reporting of suicide has repeatedly been shown to trigger suicidal behaviour. Few studies have investigated the associations between specific media content and suicide rates. Even less is known about the possible preventive effects of suicide-related media content.

Aims

To test the hypotheses that certain media content is associated with an increase in suicide, suggesting a so-called Werther effect, and that other content is associated with a decrease in suicide, conceptualised as a Papageno effect. Further, to identify classes of media articles with similar reporting profiles and to test for associations between these classes and suicide.

Method

Content analysis and latent class analysis (LCA) of 497 suicide-related print media reports published in Austria between 1 January and 30 June 2005. Ecological study to identify associations between media item content and short-term changes in suicide rates.

Results

Repetitive reporting of the same suicide and the reporting of suicide myths were positively associated with suicide rates. Coverage of individual suicidal ideation not accompanied by suicidal behaviour was negatively associated with suicide rates. The LCA yielded four classes of media reports, of which the mastery of crisis class (articles on individuals who adopted coping strategies other than suicidal behaviour in adverse circumstances) was negatively associated with suicide, whereas the expert opinion class and the epidemiological facts class were positively associated with suicide.

Conclusions

The impact of suicide reporting may not be restricted to harmful effects; rather, coverage of positive coping in adverse circumstances, as covered in media items about suicidal ideation, may have protective effects.
Psychiatric disorders in women prisoners who have engaged in near-lethal self-harm: case–control study
Authors: Marzano Lisa , Fazel Seena , Rivlin Adrienne , Hawton Keith
Published: August 2010

Background

Female prisoners are 20 times more likely to die by suicide than women of the same age in the general population. However, risk factors and indicators of vulnerability for suicide in this group are not well-known.

Aims

We investigated prevalence of psychiatric disorders in women prisoners who had recently engaged in near-lethal self-harm (cases) and others who had never carried out near-lethal attempts in prison (controls).

Method

We interviewed 60 cases and 60 controls from all closed female prison establishments in England and Wales. In addition to gathering details of sociodemographic, criminological and clinical history, we assessed participants' current and lifetime disorders using the Mini-International Neuropsychiatric Interview. Associations between near-lethal self-harm and psychiatric disorders were adjusted for age, educational qualifications (any v. none) and remand status (sentenced v. unsentenced).

Results

At the time of their near-lethal self-harm, 53 cases (88%) were on ACCT (Assessment, Care in Custody and Teamwork), the system for the care of prisoners at risk of suicide and self-harm in England and Wales. Cases had significantly greater levels of psychiatric morbidity than controls, and more comorbidity. The strongest associations with near-lethal self-harm were with current depression (age-adjusted odds ratio (OR) = 23.7, 95% CI 9.0–62.3), the presence of two or more diagnoses (age-adjusted OR = 18.3, 95% CI 5.9–56.9), a history of psychiatric in-patient treatment (OR = 25.4, 95% CI 5.7–113.5) and previous attempted suicide, especially in prison (OR = 129, 95% CI 27–611). The only tested diagnoses not associated with near-lethal self-harm were antisocial personality disorder, substance use and eating disorders. Adjusting for sociodemographic and criminological variables did not significantly alter any of these findings.

Conclusions

This research underlines the importance of psychiatric risk factors for suicide in custody and in particular comorbidity. The finding that a formal care plan was in place for most cases at the time of their near-lethal act is indicative of good risk detection, but also suggests high levels of unmet need. Given the potential complexity of their mental health needs, interventions incorporating pharmacological and psychological treatments should be considered for at-risk prisoners.
Neurodevelopmental marker for limbic maldevelopment in antisocial personality disorder and psychopathy
Authors: Raine Adrian , Lee Lydia , Yang Yaling , Colletti Patrick
Published: August 2010

Background

Antisocial personality disorder and psychopathy have been hypothesised to have a neurodevelopmental basis, but this proposition has not been formally tested.

Aims

This study tests the hypothesis that individuals with cavum septum pellucidum (CSP), a marker of limbic neural maldevelopment, will show higher levels of psychopathy and antisocial personality.

Method

Cavum septum pellucidum was assessed using anatomical magnetic resonance imaging in a community sample. Those with CSP (n = 19) were compared with those lacking CSP (n = 68) on antisocial personality, psychopathy and criminal offending.

Results

Those with CSP had significantly higher levels of antisocial personality, psychopathy, arrests and convictions compared with controls. The pervasiveness of this association was indicated by the fact that those lacking a diagnosis of antisocial personality disorder, but who were charged or convicted for an offence, had a more extensive CSP than non-antisocial controls. Results could not be attributed to prior trauma exposure, head injury, demographic factors or comorbid psychiatric conditions.

Conclusions

Our findings appear to be the first to provide evidence for a neurodevelopmental brain abnormality in those with antisocial personality disorder and psychopathy, and support the hypothesis that early maldevelopment of limbic and septal structures predisposes to the spectrum of antisocial behaviours.
Valuing knowledge of the cost and cost-effectiveness of medicines
Authors: Byford Sarah , Molosankwe Iris
Published: August 2010

Knowledge of the cost of pharmaceuticals is an important step towards cost-effective prescribing, yet evidence presented by Singh and colleagues highlights a lack of awareness of the cost of psychotropic medication among doctors in one NHS foundation trust and failures in the dissemination of cost data. These findings support the existence of substantial barriers to the success of cost-effective prescribing strategies in the UK. The next, and more challenging step, is to explore knowledge of the relative cost-effectiveness of pharmaceuticals, since knowledge of cost alone is inadequate to ensure prescribing practices make a meaningful constribution to the efficient use of scarce health service resources.
Impact of Hospice Disenrollment on Health Care Use and Medicare Expenditures for Patients With Cancer
Authors: Carlson Melissa D.A. , Herrin Jeph , Du Qingling , Epstein Andrew J. , Barry Colleen L. , Morrison R. Sean , Back Anthony L. , Bradley Elizabeth H.
Published: August 2010

Purpose

Patients with cancer represent the largest diagnostic group of hospice users, with 560,000 referred for hospice in 2008. Oncologists rely on hospice teams to provide care for patients who have completed disease-directed treatment and desire to remain at home. However, 11% to 15% of hospice users disenroll from hospice, and little is known about their health care use and Medicare expenditures.

Patients and Methods

We used Surveillance, Epidemiology and End Results–Medicare data for hospice users who died as a result of cancer between 1998 and 2002 (N = 90,826) to compare rates of hospitalization, emergency department, and intensive care unit admission and hospital death for hospice disenrollees and those who remained with hospice until death. We also compared per-day and total Medicare expenditures across the two groups.

Results

Patients with cancer who disenrolled from hospice were more likely to be hospitalized (39.8% v 1.6%; P < .001), more likely to be admitted to the emergency department (33.9% v 3.1%; P < .001) or intensive care unit (5.7% v 0.1%; P < .001), and more likely to die in the hospital (9.6% v 0.2%; P < .001). Patients who disenrolled from hospice died a median of 24 days following disenrollment, suggesting that the reason for hospice disenrollment was not improved health. In multivariable analyses, hospice disenrollees incurred higher per-day Medicare expenditures than patients who remained with hospice until death (higher per-day expenditures of $124; P < .001).

Conclusion

Hospice disenrollment is a marker for higher health care use and expenditures for care. Strategies to manage a patient's care and support family caregivers following hospice disenrollment may be beneficial and should be explored.
External aortic root support for Marfan syndrome: early clinical results in the first 20 recipients with a bespoke implant
Authors: Pepper John , John Chan KM , Gavino Jemyrr , Golesworthy Tal , Mohiaddin Raad , Treasure Tom
Published: August 2010

Summary

Objectives

Fatal aortic dissection occurs at young age in Marfan syndrome. Prevention relies on elective replacement of the aortic root. The placement of an external aortic root support, tailored to the anatomy of the individual patient has been proposed as a feasible alternative.

Design, setting and main outcome measures

External aortic root support was offered to patients with Marfan syndrome with aortic root diameter of 40–55 mm and without aortic regurgitation. By computer-aided design, a model of the individual patient's aorta was created from cardiac magnetic resonance images and a bespoke external aortic support was manufactured. Comparative measurements were made of the ascending aorta at the level of closure of the aortic valve cusps from magnetic resonance imaging studies taken preoperatively, at first follow-up, and at most recent follow-up. For patients having aortic root surgery at the same institution, in the same time frame as the first 10 patients, clinical data were retrieved on Marfan and other patients having aortic root replacement to serve as a reference data.

Results

Twenty patients were operated upon from May 2004 to October 2009, 13 men and 7 women, median age 33 years. All 20 patients are alive and well at the time of last follow-up. Preoperative aortic diameters were 40–54 mm. All postoperative images were satisfactory with an overall reduction in aortic root dimensions. The surgery took half the time of other aortic root surgery. Cardiopulmonary bypass was used only in the first patient, myocardial ischemia was not required in any patient, and no postoperative anticoagulation is mandated.

Conclusions

The primary objective of this surgery was fully achieved in 19 of the 20 patients, reinforcing the ascending aorta while leaving the native aortic valve intact and conserving the blood/endothelium interface.