bluuebunny/crossref_metadata_2025 huggingface dataset:
Non‐invasive RNA‐based determination of fetal Rhesus D type: a prospective study based on 96 pregnancies
Authors: Cunningham Joan , Yates Zoë , Hamlington Jeanette , Mason Gerald , Mueller Robert , Miller David
Published: August 2005

Objectives
To develop a non–invasive method for determining fetal RhD status in order to provide improved care for women most at risk.

Design
A prospective study.

Methods
Fetal erythroblasts were enriched from the peripheral circulation of 96 RhD negative women with pregnancies at various stages in gestation using discontinuous density gradients. Amplification of RhD–specific mRNAs was carried out by reverse transcription–polymerase chain reaction assay. RNA, rather than DNA, was selected for amplification because it rarely contaminates samples, thus resulting in fewer false positives; moreover, its presence in multiple copies per cell should enhance the sensitivity of the assay, resulting in fewer false negatives. The study was prospective, relying on postnatal serological confirmation of RhD phenotype.

Results
The assay was 75% accurate at predicting fetal RhD status, comparing favourably with standard genomic DNA–based assays. However, we found that accuracy dropped from 85% (29134) in the third trimester of pregnancy, to 82% (32/39) in the second and 48% (11/23) in the first trimester. Discordant data were due to false negatives in the majority (78%) of cases.

Conclusions
We suggest that reverse transcription may be a useful and perhaps more sensitive alternative to standard genomic polymerase chain reaction in the majority of cases. However, under certain circumstances the absence or reduction of fetal erythroblasts or possibly RhD mRNA in some preparations may compromise the accuracy of the assay.
Fetal karyotyping by chorionic villus sampling after the first trimester
Authors: Carroll Stephen G. M. , Davies Teresa , Kyle Phillipa M. , Abdel‐Fattah Sherif , Soothill Peter W.
Published: August 2005

Objective
To evaluate chorionic villus sampling (CVS) as a technique for karyotyping after the first trimester by examining the incidence of result failure, confined placental mosaicism, and false positive or negative results at different gestational ages.

Methods
During a nine year period between 1989 and 1997, all results of CVS between 8 and 37 weeks of gestation provided by the Regional Cytogenetics Centre were analysed retrospectively by examining indications for CVS, weights of tissue received, gestational age at sampling and karyotype results.

Results
There were 2424 chorionic villus samples analysed by the direct method and or cell culture. In 1548 cases CVS was performed before 14 weeks (Group 1), in 685 between 15 and 20 weeks (Group 2), in 160 between 21 and 28 weeks (Group 3) and in 31 cases after 29 weeks (Group 4). Although there was a trend for an increasing rate of failed direct preparation results from Groups 1 to 4 which were 3.8%, 4.7%, 5.6% and 6.6%, respectively; these results were not significantly different. There were 19 cases of confined placental mosaicism and the incidence was significantly greater in Group 3 compared with Group 1 (P < 0.05), and in Groups 3 and 4 combined compared with Group 1. There were six false positive and one false negative result following direct analysis with no significant differences between gestational ages.

Conclusions
CVS is a useful test after the first trimester, especially when a fast result is clinically required. However, after 20 weeks, when cordocentesis is available, the higher rate of cytogenetic discordancy between the placenta and the fetus means that cordocentesis may be preferable.
Postpartum bone mineral density following antenatal dexamethasone therapy
Authors: Ogueh Onome , Khastgir Gautam , Studd John W. W. , King Hilary , Johnson Mark Richard
Published: August 2005

The aim of this study was to determine whether the changes in bone metabolism, which we have demonstrated previously with antenatal dexamethasone therapy, are associated with a lower bone mineral density. We assessed bone mineral density in the proximal femur and lumbar spine using dual photon X‐ray absorptiometry after delivery in 15 women who received dexamethasone therapy for fetal lung maturation, and in 30 women who did not have dexamethasone therapy in pregnancy. The absolute bone mineral density, T scores and 2 scores at the proximal femur and lumbar spine were similar, and the median values of T and Z scores were positive in both groups. We conclude that antenatal dexamethasone therapy has no long term effect on bone mineral density.
Isolated fetal echogenic intracardiac foci or golf balls: is karyotyping for Down's syndrome indicated?
Authors: Thilaganathan Baskaran , Olawaiye Alexander , Sairam Shanthi , Harrington Kevin
Published: August 2005

Objective
To determine the prevalence of isolated echogenic intracardiac foci and the subsequent risk for Down's syndrome at 18–23 weeks in an unselected obstetric population.

Design
Prospective study.

Setting
A district general hospital serving a routine obstetric population.

Participants
16,917 pregnant women who underwent a routine ultrasound screening at 18–23 weeks of gestation between November 1994 and August 1998.

Methods
All women were offered screening for Down's syndrome by nuchal translucency or maternal serum biochemistry. The prevalence of isolated echogenic intracardiac foci was determined and the relative risk for Down's syndrome was calculated for different ultrasound findings.

Results
The combined sensitivity of age, nuchal translucency and maternal serum biochemistry for Down's syndrome was 84% (27/32). The relative risk for Down's syndrome was 0.17 (95% CI 0.07–0.41) for the women with normal scan findings at 18–23 weeks. The prevalence of isolated echogenic intracardiac foci at 18–23 weeks was 0.9% (144/16,917). None of these pregnancies were affected by Down's syndrome.

Conclusion
The significance of the association between isolated echogenic intracardiac foci and Down's syndrome is a matter of ongoing debate. The data of this study suggest that in an unselected obstetric population with prior, effective, routine Down's syndrome screening, the association between isolated echogenic intracardiac foci and Down's syndrome is no longer significant.
Serum activin A and inhibin A elevated in pre–eclampsia: no relation to insulin sensitivity
Authors: Laivuori Hannele , Kaaja Risto , Turpeinen Ursula , Stenman Ulf‐Håkan , Ylikorkala Olavi
Published: August 2005

Objective
To assess the possible role of serum levels of activin A, inhibin A and pro‐αC inhibin (pro‐Design αC) in insulin sensitivity in pre‐eclampsia.

Design
A prospective study.

Setting
Helsinki University Central Hospital.

Participants
Twenty‐two nulliparous women with proteinuric pre‐eclampsia and 16 healthy nulliparous controls in the third trimester of pregnancy.

Methods
Serum samples were collected before and after intravenous injection of glucose (0.3 g/kg) and insulin (0.03 IU/kg) (the minimal model for testing insulin sensitivity), and were assayed for activin A, inhibin A and pro–αC.

Main outcome measures
Comparison of the levels of activin A, inhibin A and pro‐αC between pre‐eclamptic and healthy pregnant women, and the association of these proteins with insulin sensitivity.

Results
In pre‐eclampsia elevated levels of activin A (139%, P = 0.0001), inhibin A (39%, P= 0.003), and pro‐αC (92%, P= 0.0008) were observed. The amount of proteinuria (0.3–10.5 g/day) correlated positively with serum concentrations of activin A (P= 0.01) and inhibin A (P= 0.02). These glycol‐proteins were not associated with insulin sensitivity either in women with pre‐eclampsia or controls. A 2.9‐fold rise in blood glucose and a 52.5‐fold rise in insulin during testing using the minimal model were not accompanied by any significant changes in activin A, inhibin A, and pro‐αC.

Conclusion
Activin A, inhibin A, and pro–αC are elevated in pre‐eclampsia but do not appear to relate to the insulin sensitivity in pre‐eclamptic or normal pregnancies.
Calculating correct Down's syndrome risks
Authors: Cuckle Howard , Sehmi Indera
Published: August 2005

Women having both first trimester nuchal translucency and second trimester serum screening tests are likely to receive two different Down's syndrome risks. Neither will be correct, and we describe how to calculate a valid combined risk. This uses the reported serum‐based risk and a likelihood ratio derived from the nuchal translucency report. Tables, figures and examples are provided to aid the calculation of the likelihood ratio from either the nuchal translucency in multiples of the normal median, the nuchal translucency and crown‐rump length in millimetres, or the reported prior and nuchal translucency‐based risks.
Biochemical markers of bone turnover do not decline after menopause in healthy women
Authors: Takahashi Masaaki , Kushida Kazuhiro , Hoshino Hironobu , Ohishi Tsuyoshi , Inoue Tetsuo
Published: August 2005

Objectives
To investigate the duration of high bone turnover after menopause in normal healthy women.

Design
Study recruited from three screening studies for health care in the elderly held in the area of Hamamatsu city.

Setting
Department of Orthopaedic Surgery, Hospital at Hamamatsu University School of Medicine, Hamamatsu.

Participants
Ninety‐two healthy postmenopausal women aged 47–81 years and 18 premenopausal women.

Main outcome measures
Bone mass was determined by densitometry of the spine and the os calcis, or by ultrasound of the os calcis. Biochemical markers of bone turnover were measured including total and bone‐specific alkaline phosphatase, osteocalcin, C‐terminal propeptide of type I procollagen, free deoxypyridinoline and urinary degredation products of type I collagen.

Results
All markers except the C‐terminal propeptide of type I procollagen were significantly higher in early postmenopausal women than in premenopausal women. Postmenopausal women were divided into four groups according to years since menopause. There was no difference in biochemical markers among those women in whom years since menopause were 1 to 5, 6 to 15, 16 to 25 and >26. There were no correlations between biochemical markers and age in postmenopausal women. When the postmenopausal women were divided into three groups according to t‐scores of bone mass, there was no significant difference in the biochemical markers among the groups.

Conclusions
High bone turnover occuring after menopause lasts for >25 years during the postmenopausal period.
Routine antenatal Rhesus D immunoglobulin prophylaxis: the results of a prospective 10 year study
Authors: MacKenzie I. Z. , Bowell Peter , Gregory Helen , Pratt Geoff , Guest Claire , Entwistle C. C.
Published: August 2005

Objective
To assess the clinical and financial impact, and identify the problems, of providing routine antenatal RhD immunoglobulin prophylaxis for Rhesus D negative nulliparae.

Design
A retrospective (1980–1986) and prospective (1987–1996) comparison between two similar populations, one population with nulliparae offered routine RhD immunoglobulin 500 IU prophylaxis at 28 and 34 weeks of gestation part way through the study period, and the other population not offered prophylaxis at any time.

Setting
Obstetric units in two counties (three health districts) with similar annual numbers of matemities and the Regional Blood Transfusion Service antenatal serology laboratory.

Participants
Non‐sentisitised Rhesus D negative pregnant nulliparae.

Interventions
Intramuscular RhD immunoglobulin 500 IU at 28 and 34 weeks of gestation to eligible women booked for confinement in one county; the intervention not offered in the other county.

Main outcome measures
1. Rhesus D sensitised second pregnancy rate; 2. success in providing prophylaxis to eligible women; 3. serology laboratory activity changes; 4. potential savings from the prophylaxis programme.

Results
Prophylaxis significantly reduced iso‐immunisation in the next pregnancy when compared with historical (OR 0.28, CI 0.14–0.53; P < 0.0001) and contemporary controls (OR 0.43, CI 0.22–0.86; P= 0.02). However, success at achieving comprehensive prophylaxis was disappointing, with only 89% of eligible women receiving the first injection, 74% both injections, and for only 29% were both at the correct gestation. Fifty‐two percent of women delivered after 40 weeks of gestation, beyond the period of adequate prophylaxis protection. The savings in antenatal interventions, neonatal care and possible long term ill‐health that result from very preterm birth should be considerable.

Conclusion
Routine prophylaxis for nulliparae significantly reduces the incidence of sensitised next pregnancies with consequent savings, and its adoption nationwide should be encouraged. A programme offering antenatal prophylaxis for all Rhesus D negative women is unlikely to be economic. Improvement in uptake of prophylaxis is needed; alternative administration strategies should be explored.
31P magnetic resonance spectroscopy of the liver in HELLP syndrome
Authors: Magee Laura A. , Dixon Ruth M. , Kemp Graham J. , Redman Christopher W. G. , Styles Peter
Published: August 2005

Objectives
Using magnetic resonance spectroscopy (MRS) to measure phosphorus‐containing metabolites in the liver, this study aimed to investigate non‐invasively whether or not women with haemolysis, elevated liver enzymes and low platelets (HELLP) have detectable abnormalities of hepatic energetics.

Setting
John Radcliffe Hospital, Oxford.

Design
Prospective study.

Methods
After giving informed consent, patients with HELLP syndrome (n= 7) and controls with severe Pre‐eclampsia (n= 3), were studied by 31P MRS of the liver as soon as possible after delivery (range 2–4 days) and compared with normal nonpregnant controls (n= 6). Haematological and biochemical tests were performed serially and on the day of the MRS in all pregnant patients.

Results
The severity of HELLP varied as follows: peak aspartate aminotransferase (range 129–2574), peak gamma glutamyl transferase (range 28–96), peak lactate dehydrogenase (range 305–2820), nadir platelets (range 25–1 14), peak international normalised ratio for prothrombin time (before fresh frozen plasma) (range 0.9–1.9). One pregnancy was terminated but all others resulted in live births and all mothers made uneventful, rapid recoveries. MRS‐determined relative hepatic concentrations of phosphorus–containing metabolites and absolute concentrations of adenosine triphosphate did not differ significantly between groups. One patient with the most clinically severe HELLP syndrome (by laboratory criteria) exhibited magnetic resonance spectra which showed a relative increase in phomonoester and an absolute decrease in hepatic adenosine triphosphate (to 62% of control).

Conclusions
Enthusiasm for the conservative management of HELLP syndrome that develops remote from term has been tempered by the inability to identify patients at risk for progression to hepatic necrosis. We found that most patients with HELLP syndrome had normal liver metabolism as assessed by MRS. However, clinically severe HELLP syndrome can be associated with disturbed hepatic metabolism consistent with that seen in hepatic ischaemia and or granulocytic infiltration of the liver.
Tissue factor levels and high ratio of fibrinopeptide A:D‐dimer as a measure of endothelial procoagulant disorder in pre‐eclampsia
Authors: Bellart Jordi , Gilabert Rosa , Anglès Anna , Piera Veronica , Miralles Ramón M. , Monasterio Jasone , Cabero Lluis
Published: August 2005

To assess coagulation activation and endothelial cell injury in normotensive and pre‐eclamptic pregnant women, a comparision was made of plama levels of tissue factor, fibronectin, fibrinopeptide A and D‐dimer. Samples were taken from 50 nonpregnant women, 40 normotensive pregnant women in the third trimester and 27 women with pre‐eclampsia after diagnosis and before treatment. High levels of fibrinopeptide A and D‐dimer were found in pre‐eclampsia women. Moreover, the ratio fibrinopeptide A:D‐dimer was much greater in the pre‐eclampsia group than in normotensive pregnant women. The levels of fibronectin and tissue factor were also higher in the pre‐eclampsia group. The increase of tissue factor levels suggests an alteration of the extrinsir coagulation pathway in pre‐eclampsia. The increase of fibrinopeptide A:D dimer ratio shows that the activation of coagulation is associated with a relative hypofibrinolysis in pre‐eclampsia.
Information Technology for postgraduate education: survey of facilities and skills in the South West Deanery
Authors: Draycott Tim , Cook Julian , Fox Robert , Jenkins Julian
Published: August 2005

Objective
To determine the Information Technology (IT) infrastructure available to, and IT skills of, obstetric specialiast registrars across the South West Denery.

Design
Open prospective study.

Setting
NHS Hospitals in the South West Deanery.

Methods
two separate surveys. Firstly, the computer equipment available to trainees was determined at each hospital in the deanery on site using a software programme. Secondly, IT skills of a sample of 22 specialist registrars were assessed using a checklist at a series of four workshops.

Main outcome measures
Computers with sufficient specification to use CD‐ROMs, to access the Inter‐ net, and to support data‐, audio‐ and video‐conferencing. The number of trainees with IT skills to use a computer‐aided learning package and the Internet.

Results
Sixty‐six percent of trainees have access to a computer with a CD‐ROM drive. Sixty‐six percent also have access to the Internet at their place of work. Thirteen percent have access to data‐conferencing but there were no computers in the Deanery able to support audio‐ or video‐conferencing. lbenty‐five percent of trainees have no IT skills and require basic training in the use of computers. Thirty‐six percent of our sample would require training to be able to use computer‐based tutorials programs. Seventy‐ seven percent of trainees require training to be able to use the Internet without assistance.

Conclusion
A significant minority of trainees do not have access to computers with sufficient specification to run basic tutorial programmes or access the Internet. Similarly, a large minority of trainees do not even have a basic knowledge of computer technology and IT training is required for the majority of trainees for them to reap the potential benefits which computer‐based tutorials systems and the Internet can give.
Misoprostol for induction of labour at term: a more effective agent than dinoprostone vaginal gel
Authors: Danielian Peter , Porter Belinda , Ferri Natalia , Summers Jenny , Templeton Allan
Published: August 2005

Objective
To compare the efficacy of vaginal misoprostol and dinoprostone vaginal gel for induction of labour at term.

Design
A single‐blind randomised comparative trial.

Setting
Induction and labour wards of a UK teaching hospital.

Participants
Two hundred and eleven pregnant women at term in whom induction of labour was indicated, and with no contra‐indication to the use of prostaglandins for the induction of labour.

Intervention
The women were randomly assigned to receive vaginal administration of either misoprostol 50 pg four hourly (to a maximum of four doses) or dinoprostone gel 1 mg six hourly (to a maximum of three doses).

Main outcome measures
Time from induction to delivery, oxytocin requirement in labour, analgesic requirement, mode of delivery, neonatal outcome.

Results
The misoprostol group had a highly significant reduction in median induction‐delivery interval compared with the dinoprostone group (14.4 hours vs 22.9 hours; P < 0.00001). In addition, more women delivered after only one dose (77% w 49%; P < 0.0001, OR 3.51, 95% CI 1.94–6.35), and within 12 and 24 hours. There was a reduced need for oxytocin augmentation in labour (21 %vs 47%; P < 0–0001, OR 0.30,95% CI 0.16–0.54). There was no difference in analgesia requirement in labour, or in mode of delivery. There were no adverse neonatal outcomes associated with the use of misoprostol. Women in the misoprostol group experienced more pain in the interval between induction and being given analgesia in labour, but this did not reach statistical significance.

Conclusions
Misoprostol 50 μg vaginally is a more effective induction agent than 1 mg dinoprostone vaginal gel, with no apparent adverse effects on mode of delivery, or on the fetus. The higher pain scores in the misoprostol group must be balanced against the reduction in time spent having labour induced, and the reduction in need for intravenous oxytocin augmentation. Further randomised studies must continue to exclude the possibility of rare adverse side effects.
Withholding consent to participate in clinical trials: decisions of pregnant women
Authors: Mohanna Kay , Tuna Kate
Published: August 2005

Objective
To identify factors affecting the decision of pregnant women to withhold their consent to Design A qualitative, cross‐sectional, retrospective study using semi‐structured interviews with

Setting
Patients' homes.

Participants
Eighteen women who had been invited previously to participate in a clinical trial in pregnancy, but who had declined.

Results
The invitation to participate in a clinical trial when pregnant has different implications for different women, and the meanings they ascribe to the invitation to participate will affect the likelihood of them participating. A pregnant woman may feel the pressure of conflicting duties: a protective duty to the fetus and to be a ‘good citizen’ when asked to participate in research. The sharing of information during the recruitment phase has a crucial bearing on how the invitation will be received. The design of the trial, the type and style of information available, the manner in which it is conveyed, the timing and process of the invitation and by whom it is made all affect the likelihood of a woman agreeing to take part.

Conclusion
By asking for the contribution of these women, this study identified factors that can influence the chances of an individual entering a trial or not. Contextualising and personalising risk is important in the consent process as recruiting women when pregnant can be difficult and hinder research. From these comments recommendations for future research involving pregnant women have been drawn up.
A Model for Management of Delirious Postacute Care Patients
Authors: Bergmann Margaret A. , Murphy Katharine M. , Kiely Dan K. , Jones Richard N. , Marcantonio Edward R.
Published: August 2005

Although delirium has been shown to be a common, morbid, and costly problem for hospitalized older people, evidence has mounted that it may persist for weeks or months. Therefore, concern about delirium can no longer be confined to acute care. After an acute hospitalization, many older people are discharged to postacute care (PAC) facilities—rehabilitation hospitals and skilled nursing facilities. Although several models designed to prevent delirium in the hospital setting have been described, there have been few such efforts in the PAC setting.

This article describes the development of a multifactorial delirium abatement program (DAP), a new model of care for older patients admitted to the postacute skilled nursing facility with delirium. The DAP is a nurse‐led, unit‐based intervention. The program consists of four modules based on best practices as defined by the peer‐reviewed literature: standardized screening for symptoms and signs of delirium upon admission to the PAC unit, assessment and treatment of possible causes of and contributors to delirium, prevention and management of common delirium complications, and restoration of patient cognitive and self‐care function.

This article also presents the process of facility introduction, staff education on DAP content, and multidisciplinary outreach. Key strategies for DAP implementation are reviewed. Program adoption challenges and corresponding model refinements to enhance adherence and overall care quality are highlighted. Last, clinical adaptation of this research‐derived program is discussed.
Predictors of Overall Quality of Care Provided to Vulnerable Older People
Authors: Min Lillian C. , Reuben David B. , MacLean Catherine H. , Shekelle Paul G. , Solomon David H. , Higashi Takahiro , Chang John T. , Roth Carol P. , Kamberg Caren J. , Adams John , Young Roy T. , Wenger Neil S.
Published: August 2005

Objectives: Prior research shows that the quality of care provided to vulnerable older persons is suboptimal, but little is known about the factors associated with care quality for this group. In this study, the influences of clinical conditions, types of care processes, and sociodemographic characteristics on the quality of care received by vulnerable older people were evaluated.

Design: Observational cohort study.

Setting: Two senior managed care plans.

Participants: Three hundred sixty‐two community‐dwelling patients aged 65 and older identified as vulnerable by the Vulnerable Elder Survey (VES‐13).

Measurements: Outcome variable: patients' observed‐minus‐expected overall quality score. Predictor variables: types of care processes, types and number of clinical conditions, sex, age, VES‐13 score (composite score of function and self‐rated health), income, education, mental health status, and number of quality indicators triggered.

Results: Patients whose conditions required more history‐taking, counseling, and medication‐prescribing care processes and patients with diabetes mellitus received lower‐than‐expected quality of care. A greater number of comorbid conditions was associated with higher‐than‐expected quality of care. Age, sex, VES‐13 score, and other sociodemographic variables were not associated with quality of care.

Conclusion: Complexity, vulnerability, and age do not predispose older persons to receive poorer‐quality care. In contrast, older patients whose care requires time‐consuming processes such as history taking and counseling are at risk for worse quality of care and should be a target for intervention to improve care.
Weight Change and Lower Body Disability in Older Mexican Americans
Authors: Snih Soham Al , Raji Mukaila A. , Markides Kyriakos S. , Ottenbacher Kenneth J. , Goodwin James S.
Published: August 2005

Objectives: To examine the association between 2‐year weight change and onset of lower body disability over time in older Mexican Americans.

Design: Data were from the Hispanic Established Population for the Epidemiological Study of the Elderly (1993–2001). Weight change was examined by comparing baseline weight to weight at 2‐year follow‐up. Incidence of lower body disability was studied from the end of this period through an additional 5 years.

Setting: Five southwestern states: Texas, New Mexico, Colorado, Arizona, and California.

Participants: One thousand seven hundred thirty‐seven noninstitutionalized Mexican‐American men and women aged 65 and older who reported no limitation in activities of daily living (ADLs) and were able to perform the walk test at 2‐year follow‐up.

Measurements: In‐home interviews assessed sociodemographic factors, self‐reported physician diagnoses of medical conditions (arthritis, diabetes mellitus, heart attack, stroke, hip fracture, and cancer), self‐reported ADLs, depressive symptoms, and number of hospitalizations. Cognitive function, handgrip muscle strength, and body mass index (BMI) were obtained. The outcomes were any limitation of lower body ADL (walking across a small room, bathing, transferring from a bed to a chair, and using the toilet) and limitation on the walk test over subsequent 5‐year follow‐up period. General Estimation Equation (GEE) was used to estimate lower body disability over time.

Results: Weight change of 5% or more occurred in 42.3% of the participants; 21.7% lost weight, 20.6% gained weight, and 57.7% had stable weight. Using GEE analysis, with stable weight as the reference, weight loss of 5% or more was associated with greater risk of any lower body ADL limitation (odds ratio (OR)=1.43, 95% confidence interval (CI)=1.06–1.95) and walking limitation (OR=1.35, 95% CI=1.03–1.76) after controlling for sociodemographic variables and BMI at baseline. Weight gain of 5% or more was associated with greater risk of any lower body ADL limitation (OR=1.39, 95% CI=1.02–1.89), after controlling for sociodemographic variables and BMI at baseline. When medical conditions, handgrip muscle strength, high depressive symptomatology, cognitive function, and hospitalization were added to the equation, the relationship between 2‐year weight change (>5% loss or >5% gain) and lower body disability decreased.

Conclusion: Health conditions and muscle strength partially mediate the association between weight loss or gain and future loss of ability to walk and independently perform ADLs.
Symptom Interactions as Mechanisms Underlying Symptom Pairs and Clusters
Authors: Parker Kathy P. , Kimble Laura P. , Dunbar Sandra B. , Clark Patricia C.
Published: August 2005

Purpose:

To present a summary of the potential shared or interactive mechanisms underlying an exemplar symptom pair: sleep disturbances and pain.

Organizing Construct:

Understanding of the multidimensional shared and interactive mechanisms underlying symptoms pairs and clusters has the potential to enhance symptom management.

Methods:

Reviews of the literature were conducted to search for information on shared or interactive mechanisms underlying sleep disturbances and pain; minimal data were available. Relevant information about individual symptoms was outlined and categorized in areas often used to describe the multidimensional nature of symptoms, including the physiological, psychological, behavioral, and sociocultural domains. This information was examined for relationships and commonalities.

Conclusions:

Many potential shared and interactive mechanisms underlying the symptom pair of sleep disturbances and pain were identified. These results indicate the need for further work and theory development in this area. The symptom interactional framework is a beginning conceptual perspective designed to facilitate this work. Implications for interdisciplinary translational research designed to optimize symptom management are discussed.
Mechanical Activation of Heterogeneous Sol–Gel Precursors for Synthesis of MgAl2O4 Spinel
Authors: Ye Guotian , Troczynski Tom
Published: August 2005

MgAl2O4 spinel precursor was prepared using a heterogeneous sol–gel process. The effect of high‐energy milling on the precursor decomposition and spinel formation was investigated. The milling decreased the Al(OH)3 dehydroxylation temperature from 190° to about 130°C. The activation energy for spinel formation decreased from 688 kJ/mol for the as‐prepared precursors to 468 kJ/mol for the precursors milled for 5 h. Milling of the precursor lowered the incipient temperature of spinel formation from 900° to 800°C, and the temperature of complete MgAl2O4 spinel formation from >1280° to ∼900°C.
Relationship Between Water Mobility and Viscosity of Nanometric Alumina Suspensions
Authors: Li Chuanping , Akinc Mufit , Wiench Jerzy , Pruski Marek , Schilling Christopher H.
Published: August 2005

Addition of fructose has been shown to reduce the viscosity of aqueous suspensions of nanometric alumina powders. Highly concentrated and flowable aqueous nanometric alumina suspensions were achieved by fructose addition. Oxygen‐17 nuclear magnetic resonance spectroscopy was used to investigate the relaxation time and the molecular mobility of water in the suspensions with and without fructose. It was found that a significant fraction of water is bound to the surface with lower mobility. Average water mobility increases and the viscosity of the suspension decreases with fructose addition, both of which are because of displacement of water from the alumina surface by fructose molecules. The results were related to rheological behavior of the suspensions.
Finite‐Element Simulations of Cracks Near Interfaces: Effects of Thermal, Elastic, and Plastic Mismatch
Authors: Tilbrook Matthew T. , Hoffman Mark , Reimanis Ivar E.
Published: August 2005

Cracks situated parallel to, and very near, the interface in layered, ductile‐brittle composite specimens were investigated with finite‐element analysis. Elastic, plastic and thermal properties previously obtained from experiments were utilized in the model. A routine was employed for automatic crack extension and remeshing, enabling simulation of incremental crack propagation. The elastic, thermal and plastic contributions to crack propagation behavior were investigated, along with the variation of these with crack length and crack‐tip position. Thermal residual stresses are shown to have a large influence on crack path, although this is mitigated to some extent by plasticity. The implications on the inherent reliability of joints and layered materials containing brittle constituents are discussed.
Mechanosynthesis of Gadolinium Iron Garnet
Authors: Zanatta S. C. , Cótica L. F. , Paesano A. , de Medeiros S. N. , da Cunha J. B. M. , Hallouche B.
Published: August 2005

We investigated the mechanosynthesis of gadolinium iron garnet by high‐energy ball milling stoichiometry amounts of α‐Fe2O3 and Gd2O3, followed by short thermal annealings conducted at moderate temperatures. X‐ray diffraction and Mössbauer spectroscopy results revealed, for the as‐milled samples, the formation of the GdFeO3 perovskite phase, in relative amounts that depend on the milling time. The formation of the Gd3Fe5O12 garnet phase was observed in 1000°C/2 h or 1100°C/3 h as‐annealed samples. The occurrence of a milling time was verified in which the relative amount of garnet phase formed by further annealing is maximized.
The ZrB2 Volatility Diagram
Authors: Fahrenholtz William G.
Published: August 2005

A volatility diagram was calculated for temperatures of 1000, 1800, and 2500 K to understand the oxidation of ZrB2. Applying the diagram, it can be seen that exposure of ZrB2 to air produces ZrO2 (cr) and B2O3 (l) over the temperature range considered. The pressure of the predominant vapor species was predicted to increase from ∼10−6 Pa at 1000 K, to 344 Pa at 1800 K, and to ∼105 Pa at 2500 K. Predictions were consistent with experimental observations that ZrB2 exhibits passive oxidation below 1200 K, but undergoes active oxidation at higher temperatures due to B2O3 (l) evaporation.
Photoschädigung und Photoalterung – Prävention und Behandlung
Authors: Grether‐Beck Susanne , Wlaschek Meinhard , Krutmann Jean , Scharffetter‐Kochanek Karin
Published: August 2005

Die Belastung der Haut mit natürlicher und künstlicher UV‐Strahlung hat in den letzten Jahren nicht nur durch die verstärkte solare Strahlung als Folge der Ozonabnahme in der Stratosphäre, sondern auch durch ein Freizeitverhalten mit dem Wunsch nach gebräunter Haut deutlich zugenommen. Dieser Wunsch wird nicht nur durch Reisen in die sonnigen Gebiete der Erde, sondern auch durch den häufigen Besuch von Solarien umgesetzt. Hinzu kommt die gestiegene Lebenserwartung in den Industrienationen, die mit einer gesteigerten kumulativen UV‐Belastung korreliert. Konsequenz daraus ist zusätzlich zu Immunsuppression und Hautkarzinogenese auch die Photo‐ oder Lichtalterung der Haut durch den photooxidativen Schaden an Zellen, subzellulären Kompartimenten und Makromolekülen, der durch die Absorption von Photonen in einer sauerstoffreichen Umgebung entsteht. Klinisch manifestiert sich die Photoalterung der Haut in Faltenbildung, Gewebeschlaffheit, ledrigem Erscheinungsbild mit Fragilität, Verletzbarkeit und eingeschränkter Wundheilung. Strategien zur Vermeidung oder Minimierung dieser photooxidativen Langzeitschäden umfassen effektiven UV‐Schutz und das Aufrechterhalten eines oxidativ‐antioxidativen Gleichgewichtes in Zellen und Geweben. Neuere Therapieentwicklungen wie der Einsatz von DNA‐Reparaturenzymen werden ebenfalls diskutiert.
Epidemiologie von chronischen Lichtschäden
Authors: Diepgen Thomas L.
Published: August 2005

Während insbesondere in Australien die hohe Inzidenz von UV‐Licht‐induzierten Hautkrebserkrankungen und chronischen Lichtschäden epidemiologisch gut belegt ist, fehlen vergleichbare Zahlen aus Europa und insbesondere auch aus Deutschland. Vermutlich werden die Prävalenz und Inzidenz von aktinischen Keratosen, Basaliomen und Plattenepithelkarzinomen deutlich unterschätzt. Der hohe Stellenwert chronischer Hautschäden wird anhand neuerer international publizierter epidemiologischer Studien diskutiert. Mit einem in Deutschland zunehmenden Anteil der älteren Bevölkerung wird auch die therapeutische und präventivmedizinische Bedeutung chronischer Lichtschäden in den nächsten Jahren weiter an Bedeutung gewinnen.
A difference in inward rectification and polyamine block and permeation between the Kir2.1 and Kir3.1/Kir3.4 K+ channels
Authors: Makary Samy M. Y. , Claydon Tom W. , Enkvetchakul Decha , Nichols Colin G. , Boyett Mark R.
Published: August 2005

Inward rectification is caused by voltage‐dependent block of the channel pore by intracellular Mg2+ and polyamines such as spermine. In the present study, we compared inward rectification in the Kir3.1/Kir3.4 channel, which underlies the cardiac current IK,ACh, and the Kir2.1 channel, which underlies the cardiac current IK,1. Sustained outward current at potentials positive to the K+ reversal potential was observed through Kir3.1/Kir3.4, but not Kir2.1, demonstrating that Kir3.1/Kir3.4 exhibits weaker inward rectification than Kir2.1. We show that Kir3.1/Kir3.4 is more sensitive to extracellular spermine block than Kir2.1, and that intracellular and extracellular polyamines can permeate Kir3.1/Kir3.4, but not Kir2.1, to a limited extent. We describe a simple kinetic model in which polyamines act as permeant blockers of Kir3.1/Kir3.4, but as relatively impermeant blockers of Kir2.1. The model shows the difference in sensitivity to extracellular spermine block, as well as the difference in the extent of inward rectification between the two channels. This suggests that Kir3.1/Kir3.4 exhibits weaker inward rectification than Kir2.1 because of the difference in the balance of polyamine block and permeation of the two channels.
Mitral annular myocardial velocity assessment of segmental left ventricular diastolic function after prolonged exercise in humans
Authors: George Keith , Oxborough David , Forster Jan , Whyte Greg , Shave Robert , Dawson Ellen , Stephenson Claire , Dugdill Lindsey , Edwards Ben , Gaze David
Published: August 2005

We assessed segmental and global left ventricular (LV) diastolic function via tissue‐Doppler imaging (TDI) as well as Doppler flow variables before and after a marathon race to extend our knowledge of exercise‐induced changes in cardiac function. Twenty‐nine subjects (age 18–62 year) volunteered to participate and were assessed pre‐ and post‐race. Measurements of longitudinal plane TDI myocardial diastolic velocities at five sites on the mitral annulus included peak early myocardial tissue velocity (E′), peak late (or atrial) myocardial tissue velocity (A′) and the ratio E′/A′. Standard pulsed‐wave Doppler transmitral and pulmonary vein flow indices were also recorded along with measurements of body mass, heart rate, blood pressures and cardiac troponin T (cTnT), a biomarker of myocyte damage. Pre‐ to post‐race changes in LV diastolic function were analysed by repeated measures ANOVA. Delta scores for LV diastolic function were correlated with each other and alterations in indices of LV loading. Diastolic longitudinal segmental and mean TDI data were altered post‐race such that the mean E′/A′ ratio was significantly depressed (1.51 ± 0.34 to 1.16 ± 0.35, P < 0.05). Changes in segmental and global TDI data were not related to an elevated post‐race HR, a decreased post‐race pre‐load or an elevated cTnT. The pulsed wave Doppler ratio of peak early transmitral flow velocity (E)/peak late (or atrial) flow velocity (A) was also significantly reduced post‐race (1.75 ± 0.46 to 1.05 ± 0.30, P < 0.05); however, it was significantly correlated with post‐race changes in heart rate. The lack of change in E/E′ from pre‐ to post‐race (3.4 ± 0.8 and 3.3 ± 0.7, respectively) suggests that the depression in diastolic function is likely to be due to altered relaxation of the left ventricle; however, the exact aetiology of this change remains to be determined.
Concurrent Design of Vibration Absorbers and Input Shapers
Authors: Fortgang Joel , Singhose William
Published: August 2005

Systems with flexible dynamics often vibrate due to external disturbances, as well as from changes in the reference command. Feedback control is an obvious choice to deal with these vibrations, but in many cases, it is insufficient or difficult to implement. A technique that does not rely on high performance feedback control is presented here. It utilizes a combination of vibration absorbers and input shapers. Vibration absorbers have been used extensively to reduce vibration from sinusoidal disturbances, but they can also be implemented to reduce the response from transient functions. Input shaping has proven beneficial for reducing vibration that is caused by changes in the reference command. However, input shaping does not deal with vibration excited by external disturbances. In this paper, vibration absorbers and input shapers are designed sequentially and concurrently to reduce vibration from both the reference command and from external disturbances. The usefulness of this approach is demonstrated through computer simulations and experimental results.
Sliding-Mode Observer as a Time-Variant Estimator for Control of Pneumatic Systems
Authors: Bigras Pascal
Published: August 2005

The force and position of pneumatic actuators are difficult to control, since their nonlinear model includes unknown variables such as temperature and the discharge coefficient. This paper presents a specific sliding-mode observer to estimate these unknown time-variant quantities. The stability of the estimation error is studied, and real-time results show that the proposed approach combined with a feedback linearization controller performs better than a standard sliding-mode controller.
Rollover Warning for Articulated Heavy Vehicles Based on a Time-to-Rollover Metric
Authors: Chen Bo-Chiuan , Peng Huei
Published: August 2005

A Time-To-Rollover (TTR) metric is proposed as the basis to assess rollover threat for an articulated heavy vehicle. The TTR metric accurately “counts-down” toward rollover regardless of vehicle speed and steering patterns, so that the level of rollover threat is accurately assessed. There are two conflicting requirements in the implementation of TTR. On the one hand, a model significantly faster than real-time is needed. On the other hand, the TTR predicted by this model needs to be accurate enough under all driving scenarios. An innovative approach is proposed in this paper to solve this dilemma and the design process is illustrated in an example. First, a simple yet reasonably accurate yaw∕roll model is identified. A Neural Network (NN) is then developed to mitigate the accuracy problem of this simple model. The NN takes the TTR generated by the simple model, vehicle roll angle, and change of roll angle to generate an enhanced NN-TTR index. The NN was trained and verified under a variety of driving patterns. It was found that an accurate TTR is achieved across all the driving scenarios we tested.
Cell Surface Heparan Sulfate Promotes Replication of
Toxoplasma gondii
Authors: Bishop Joseph R. , Crawford Brett E. , Esko Jeffrey D.
Published: August 2005

Previous work suggests that cell surface heparan sulfate acts as a receptor for the Apicomplexan parasite
Toxoplasma gondii
. Using Chinese hamster ovary cell mutants defective in heparan sulfate biosynthesis, we show that heparan sulfate is necessary and sufficient for infectivity. Further, we demonstrate that the parasite requires N sulfation of heparan sulfate initiated by
N
-deacetylase/
N
-sulfotransferase-1, but 2-O sulfation and 6-O sulfation appear to be dispensable. In order to study the role of heparan sulfate in other cell types, we created a conditional allele for
N
-deacetylase/
N
-sulfotransferase-1 by using Cre-loxP technology. Mammary tumor cells lacking
N
-deacetylase/
N
-sulfotransferase-1 exhibited reduced toxoplasma infectivity like Chinese hamster ovary cell mutants. Surprisingly, heparin, chemically modified heparinoids, and monoclonal antibodies to heparan sulfate had no effect on toxoplasma infection.
T. gondii
attachment and invasion were unchanged in
N
-deacetylase/
N
-sulfotransferase-1-inactivated cells as well, but replication was reduced. Thus, heparan sulfate does not appear to function as a receptor for
T. gondii
but instead facilitates parasite replication postinvasion.
Correlates of Immune Protection in Chickens Vaccinated with
Mycoplasma gallisepticum
Strain GT5 following Challenge with Pathogenic
M. gallisepticum
Strain R
low
Authors: Javed Mohammed A. , Frasca Salvatore , Rood Debra , Cecchini Katharine , Gladd Martha , Geary Steven J. , Silbart Lawrence K.
Published: August 2005

Colonization of the avian respiratory tract with
Mycoplasma gallisepticum
results in a profound inflammatory response in the trachea, air sacs, conjunctiva, and lungs. A live attenuated
M. gallisepticum
vaccine strain, GT5, was previously shown to be protective in chickens upon challenge; however, the mechanisms by which this vaccine and others confer protection remain largely unknown. The current study evaluated several potential correlates of GT5 vaccine-mediated immune protection following challenge with the pathogenic
M. gallisepticum
strain R
low
. GT5-vaccinated chickens developed mild tracheal lesions, consisting of few and scattered, discrete, lymphofollicular aggregates in the lamina propria. In addition, low numbers of aggregated B, CD4
+
, and CD8
+
cells were observed to infiltrate the trachea, in stark contrast to the large numbers infiltrating the tracheas of sham-vaccinated chickens challenged with R
low
. Lymphofollicular aggregates were rarely observed prior to day 12 postchallenge in sham-vaccinated chickens. Instead, they contained an increasingly more cellular inflammatory response characterized by expansion of the lamina propria by lymphoplasmacytic and histiocytic infiltrates. This was due in part to expansion of interfollicular zones by large numbers of infiltrating CD4
+
and CD8
+
cells and a sizeable population of immunoglobulin A (IgA)- and IgG-secreting plasma cells. GT5-vaccinated chickens also had higher serum IgG concentrations, and significantly higher numbers of
M. gallisepticum
-specific IgG- and IgA-secreting plasma/B cells within the trachea, than did sham-vaccinated chickens. These responses were observed as early as day 4 postchallenge, indicating the importance of antibody-mediated clearance of mycoplasma in GT5-vaccinated chickens.
Involvement of Toll-Like Receptor 2 in Experimental Invasive Pulmonary Aspergillosis
Authors: Balloy Viviane , Si-Tahar Mustapha , Takeuchi Osamu , Philippe Bruno , Nahori Marie-Anne , Tanguy Myriam , Huerre Michel , Akira Shizuo , Latgé Jean-Paul , Chignard Michel
Published: August 2005

Aspergillus fumigatus, an opportunistic fungal pathogen, causes severe and usually fatal invasive pulmonary aspergillosis in immunocompromised hosts. Interestingly,Drosophilacells lacking the Toll protein are prone toA. fumigatusinfection. In the current study, we looked for the involvement of Toll-like receptor 2 (TLR2) in the recognition ofA. fumigatusby analyzing the in vivo and ex vivo responses of immunocompromised TLR2−/−and TLR2+/+mice to this fungus. Upon intratracheal administration of conidia, survival and tumor necrosis factor alpha (TNF-α), interleukin-12, and macrophage inhibitory protein-2 alpha concentrations in the airspaces of TLR2−/−mice were significantly lower than those of TLR2+/+animals. In vitro analysis of TNF-α production by conidia-challenged alveolar macrophages from TLR2−/−revealed a significant deficiency in comparison with macrophages from TLR2+/+mice. Infected TLR2−/−mice also have a higher respiratory distress and a higher pathogen burden than TLR2+/+mice. These data demonstrate that TLR2 plays a significant role in the defense of the host againstA. fumigatusinfection.