bluuebunny/crossref_metadata_2025 huggingface dataset:
Defibrotide Therapy for Thrombophlebitis -Controlled Clinical Trial
Authors: Di Perri T. , Vittoria A. , Messa G.L. , Cappelli R.
Published: April 2009

Deep venous thrombosis is a common disease with significant danger of both acute and chronic complications. Widely accepted therapies are based on anticoagulant (heparin and/or anticoagulant agents) or early fibrinolytic therapy. All these therapies frequently have severe side effects. Defibrotide is a new drug with antithrombotic and profibrinolytic activities but without anticoagulant activity and major side effects. To evaluate the efficacy of this drug against acute thrombophlebitis, we treated a group of 10 patients with 200 mg defibrotide intravenously three times a day for 15 days. Fibrinolysis parameters were monitored every other day. The indices of venous function by strain-gauge plethysmography and venous occlusion were evaluated every 7 days.The drug induced a significant improvement in plethysmographic indices and a significant profibrinolytic activity. Defibrotide-treated patients showed a fast disappearance of clinical and instrumental signs of thrombophlebitis. No side effects were reported during the study.
Use of Defibrotide in Renal Transplantation in Man
Authors: Bonomini V. , Vangelista A. , Stefoni S. , Scolari M.P. , Frascà G.M. , Raimondi C.
Published: April 2009

In transplanted patients graft rejection is the most frequent complication in the first year after surgery. Vascular lesions (necrosis, intimal proliferation, thrombosis) are signs of poor prognosis and lead to irreversible loss of renal function and graft removal in most cases. The problem of vascular rejection is still not solved and the results of therapy unsatisfactory, both because of inadequacy of diagnosis and/or inadequacy of available therapy. The role of prevention, very likely the best approach, is still sub judice. In an attempt to explore the validity of prevention, 22 transplanted patients (group A) were given a new antithrombotic agent (defibrotide) immediately after surgery, and the results were compared with those of a well-matched group of 30 patients on dipyridamole (group B). Follow-up lasted 6–19 months (mean 9.9) for group A; 5–21 months (mean 12) for group B. In group A, 8 patients (36%) had rejection episodes. Antirejection therapy was followed by recovery of renal function in all cases. In group B, 9 patients (29%) had rejection crises and graft removal was necessary in 7 instances due to severe vascular lesions. At the end of follow-up, all patients treated with defibrotide had normally functioning grafts: among the 30 patients on dipyridamole, 22 (73%) had satisfactory graft function.
Effects of Defibrotide in Acute Renal Failure due to Thrombotic Microangiopathy
Authors: Vangelista A. , Frascà G.M. , Raimondi C. , Liviano-D’Arcangelo G. , Bonomini V.
Published: April 2009

Thrombotic microangiopathy (TMA) can occur whenever pathogenetic events lead to fibrin deposition in the microcirculation. It has been suggested that intravascular coagulation is important in the development of renal as well as cerebral lesions. The mortality rate in adults varies from 50 to 70%; chronic or progressive renal failure occurs in approximately two thirds of children over 2 years of age. Poor success may be due to therapy being initiated too late or to inappropriate use of antagonistic drugs, or both. In the last 2 years we have treated 8 patients with TMA (5 with thrombotic thrombocytopenic purpura; 3 with hemolytic uremic syndrome) with defibrotide, a new antithrombotic agent extracted from mammalian lungs. At admission all patients had severe renal involvement (serum creatinine 5.3–14.9 mg/dl) and coagulation abnormalities (low platelet count; high levels of circulating fibrin degradation products). There were neurological manifestations in 6 patients. Defibrotide administration was followed in 6 patients by recovery of renal function.In all patients, defibrotide therapy induced the disappearance of neurological manifestations and normalization of coagulation abnormalities. Defibrotide caused no side effects. All patients are alive after 7–22 months of follow-up.
Clinical Evaluation of Short-Term Defibrotide Treatment of Patients with Atherosclerosis obliterans of the Lower Limbs
Authors: Avellone G. , Mandalà V. , Pinto A. , Martino A. , Strano A.
Published: April 2009

Ten patients with atherosclerosis obliterans of the lower limbs (Fontaine stage IV) were studied under basal conditions during and after short-term administration of defíbrotide (800 mg/day intravenously from day 1 to 10 and then 400 mg/day intramuscularly from day 11 to 30). The clinical effectiveness of defíbrotide was evaluated not only clinically (subjective and objective symptomatology) but also by Doppler velocimetry (Windsor’s Index (WI)) and primary antiplasmin activity.Seven patients (70%) showed improvement in subjective and objective symptomatology. There were increases in WI at the end of intravenous treatment in 6 patients (60%). In the remaining 40%, WI did not change from basal values. All patients showed normalization of primary antiplasmin activity versus basal values (55.62%, 17.75 SD) at the end of both intravenous and intramuscular treatment (101.37%, 15.71 SD and 102.5%, 13.86 SD, respectively). Therefore, we think that defíbrotide may be useful for therapy of atherosclerosis obliterans of the lower limbs.
Preliminary Experience with Defibrotide in Severe Lower Limb Ischaemia
Authors: Gelister J.S.K. , James W.E. , Fox J.A.
Published: April 2009

Eight patients with severe lower limb ischaemia, aged 65–80, received defibrotide intravenously for periods from 5 to 21 days (mean 13 days). All patients had intractable rest pain. Five had ischaemic ulcers and 3 had minor gangrene. Five had previous arterial surgery and 6 lumbar sympathetic ganglion injections. Pretreatment ankle pressure indices ranged from 0 to 0.5 (mean 0.19). Rest pain, sleep disturbance and analgesic requirement were assessed on a nominal scale. Rest pain improved in 4 and sleeping pattern in 2 patients. One patient showed a diminution in analgesic requirement. Pressure indices improved in 5 patients. Amputation was performed in 4 patients. Adverse reactions included vomiting and diarrhoea (2), thrombophlebitis at infusion site (3) and generalized skin reaction (1). All patients had ‘end-stage’ peripheral vascular disease but some showed symptomatic benefit. Further evaluation of defibrotide is indicated.
Heparin and Its Low Molecular Weight Derivatives: Anticoagulant and Antithrombotic Properties
Authors: Holmer E. , Söderberg K. , Bergqvist D. , Lindahl U.
Published: April 2009

The anticoagulant and antithrombotic effect of heparin has been known for many decades. Nevertheless, the knowledge of structure-activity relationships and its mechanisms of action has been rather limited. However, in recent years important progress has been made and our understanding of how heparin works has increased significantly. Based on this information, attempts have been made to modify heparin to get improved pharmacological properties. The present communication summarizes the recent development. It is shown that certain heparin derivatives of low molecular weight are highly interesting compounds from a clinical point of view. Biochemical and pharmacological properties of such a preparation named Fragmin are presented.
Pharmacokinetics of Intravenously and Subcutaneously Administered Fragmin in Healthy Volunteers
Authors: Lockner D. , Bratt G. , Törnebohm E. , Åberg W.
Published: April 2009

Studies in 8 healthy volunteers showed that the low molecular weight heparin Fragmin KabiVitrum is eliminated according to first order kinetics without dose dependency after intravenous injection of doses between 40 and 120 anti-Xa U/kg. Fragmin remains in the circulation more than twice as long as unfractionated heparin (UFH). Fragmin administered subcutaneously has a bioavailability which is much greater than that of UFH. Fragmin administered subcutaneously twice a day results in a significant anti-Xa activity and provides an alternative to intravenous infusions.
Prospective Double-Blind Comparison between Fragmin and Conventional Low-Dose Heparin: Thromboprophylactic Effect and Bleeding Complications
Authors: Bergqvist David , Burmark Ulla Stina , Frisell Jan , Hallböök Torgil , Lindblad Bengt , Risberg Bo , Törngren Staffan , Wallin Göran
Published: April 2009

In a randomized, prospective, double-blind multicenter trial, the effect of low-dose conventional heparin (5,000 IU/12 h) was compared to a low molecular weight (LMW) heparin fragment (5,000 antifactor Xa U/24 h). 432 patients 40 years or older undergoing elective abdominal surgery were included, 382 correctly treated. 45% had malignant diseases. The groups did not differ in risk factors. Analysis was made both on the basis of intention to treat and correct prophylaxis. No difference in results between these 2 groups was seen. Deep vein thrombosis (125I-fibrinogen) occurred in 4.3% of the low-dose heparin group and in 6.4 of the LMW heparin group. There was a significant delay in the onset of deep vein thrombosis in the LMW heparin group. Mortality, peroperative blood loss, transfusions or infectious complications did not differ. Hemorrhagic complications occurred significantly more often in the LMW heparin group (11.6%) than in the low-dose heparin group (4.6%). Significantly fewer patients experienced local injection pain in the LMW heparin group. APTT and AT III were similar in both groups, but anti-Xa activity was significantly higher in the LMW heparin group. Single daily LMW heparin injection reduced the frequency of deep vein thrombosis to the same level as low-dose heparin twice daily. The dose or administration interval of LMW heparin in this study caused significantly more bleeding complications.
Intravenous and Subcutaneous Administration of Fragmin in Deep Venous Thrombosis
Authors: Lockner D. , Bratt G. , Törnebohm E. , Åberg W. , Granqvist S.
Published: April 2009

54 patients with venographically verified deep venous thrombosis (DVT) were randomized to treatment with either intravenous infusions of 240 anti-Xa U/kg/l2h unfractionated heparin (UFH) or 240 or 120 anti-Xa U/kg/l2 h of the low molecular weight heparin Fragmin. Repeated venographies showed improvement in 48% of the UFH-treated patients and 50 and 77%, respectively, in the Fragmin-treated patients. Progression was seen only in the UFH-treated patients and was observed in 11 %. Two bleeding complications were seen in the Fragmin group in 2 patients receiving the very high dose of 240 anti-Xa U/kg/l2h. Anti-Xa activity in plasma and activated partial thromboplastin time (APTT) does not correlate in the Fragmin-treated patients. Fragmin was as effective as UFH in preventing the progress of thrombosis in DVT.In another study 120 anti-Xa U/kg Fragmin given subcutaneously 2 times daily to 13 patients with DVT resulted in adequate anti-Xa activity but with a tendency for accumulation of the Fragmin-induced activity. Subcutaneous injections of Fragmin 2 times daily also appears to prevent the progression of thrombosis effectively.
On the Evaluation of Heparin and Low Molecular Weight Heparin in Haemodialysis for Chronic Renal Failure
Authors: Lane D.A. , Flynn A. , Ireland H. , Anastassiades E. , Curtis J.R.
Published: April 2009

Anticoagulation during haemodialysis for chronic renal failure can be assessed by measurement of plasma fibrinopeptide A (FPA) levels as an objective method of monitoring the initial step in fibrin formation, in conjunction with visual inspection of the dialyser circuit for fibrin clot deposition. Employing this approach, unfractionated commercial heparin administered as an intravenous bolus followed by an intravenous maintenance dose (5,000 IU + 1,500 IU/h) was found to suppress almost completely fibrin formation and deposition during prolonged dialysis. Comparison of a low molecular weight heparin, Kabi 2165, revealed that it can inhibit fibrin formation in the extracorporeal circulation, that this property is largely reflected in its anti-factor Xa activity in plasma, and that a useful and effective dose of Kabi 2165 for haemodialysis may be 4,000 anti-factor Xa U intravenous bolus + 750 anti-factor Xa U/h intravenous maintenance infusion. This dose only minimally alters the KCCT and corresponds to approximately 60% of that of unfractionated heparin, which may be important in the long-term use of heparin in these patients.
Comparison of Unfractionated Heparin and Low Molecular Weight Heparin during Long-Term Use in Chronic Haemodialysis and Haemofiltration Patients
Authors: Schrader J. , Kandt M. , Zürcher C. , Köstering H. , Scheler F.
Published: April 2009

Antithrombotic activity, necessary doses and effects on coagulation and lipid variables of the low molecular weight heparin derivative Fragmin were compared to unfractionated (UF) heparin in long-term multicentre trials. Results of more than 10,000 dialyses are reported. On the basis of preliminary studies, UF heparin and Fragmin doses were used that lead to anti-Xa activities of more than 0.5 U/ml. With this dose, sufficient antithrombotic activity was achieved with both heparins. Bleeding complications were not noticed. Partial thromboplastin time (PTT) and thrombin time were only marginally increased by Fragmin (5–8 s) in contrast to UF heparin (PTT 90–120 s, thrombin time 230–260 s). Surprisingly, the elevated levels of factor VIII strongly decreased during the 6-month treatment period with Fragmin and increased again during the following 6-month treatment period with UF heparin. Creatinine, urea, haemoglobin and transaminases did not change in both heparin groups: this excluded reduced dialysis efficiency or occult blood loss. Additionally, 15 patients with acute renal failure and high bleeding risk were dialysed with low doses of Fragmin (anti-FXa: 0.2–0.3 U/ml). No severe bleeding occurred. A continuous ambulant peritoneal dialysis patient with deep vein thrombosis was treated effectively with intraperitoneal application of Fragmin for 6 months without any problems.
Quantitative Trait Locus Analysis of Neointimal Formation in an Intercross Between C57BL/6 and C3H/HeJ Apolipoprotein E–Deficient Mice
Authors: Yuan Zuobiao , Pei Hong , Roberts Drew J. , Zhang Zhimin , Rowlan Jessica S. , Matsumoto Alan H. , Shi Weibin
Published: April 2009

Background—

Inbred mouse strains C57BL/6J (B6) and C3H/HeJ (C3H) exhibit marked differences in neointimal formation after arterial injury when deficient in apolipoprotein E (apoE
−/−
) and fed a Western diet. Quantitative trait locus analysis was performed on an intercross between B6.apoE
−/−
and C3H.apoE
−/−
mice to determine genetic factors contributing to the phenotype.

Methods and Results—

Female B6.apoE
−/−
mice were crossed with male C3H.apoE
−/−
mice to generate F
1
s, which were intercrossed to generate 204 male F
2
progeny. At 10 weeks of age, F
2
s underwent endothelium denudation injury to the left common carotid artery. Mice were fed a Western diet for 1 week before and 4 weeks after injury and analyzed for neointimal lesion size, plasma lipid, and membrane cofactor protein (MCP)-1 levels. One significant quantitative trait locus, named
Nih1
(61 cM; LOD score, 5.02), on chromosome 12 and a suggestive locus on chromosome 13 (35 cM; LOD score, 2.67) were identified to influence lesion size. One significant quantitative trait locus on distal chromosome 1 accounted for major variations in plasma non–high-density lipoprotein cholesterol and triglyceride levels. Four suggestive quantitative trait locis on chromosomes 1, 2, and 3 were detected for circulating MCP-1 levels. No correlations were observed between neointimal lesion size and plasma lipid levels or between lesion size and plasma MCP-1 levels.

Conclusions—

Neointimal formation is controlled by genetic factors independent of those affecting plasma lipid levels and circulating MCP-1 levels in the B6 and C3H mouse model.
Impact of Adding a Single Allele in the 9p21 Locus to Traditional Risk Factors on Reclassification of Coronary Heart Disease Risk and Implications for Lipid-Modifying Therapy in the Atherosclerosis Risk in Communities Study
Authors: Brautbar Ariel , Ballantyne Christie M. , Lawson Kim , Nambi Vijay , Chambless Lloyd , Folsom Aaron R. , Willerson James T. , Boerwinkle Eric
Published: April 2009

Background—

A single-nucleotide polymorphism on chromosome 9p21, rs10757274 (9p21 allele), has been shown to predict coronary heart disease (CHD) in whites. We evaluated whether adding the 9p21 allele to traditional risk factors (RFs) improved CHD risk prediction in whites from the Atherosclerosis Risk in Communities study and whether changes in risk prediction would modify lipid therapy recommendations.

Methods and Results—

Whites (n=9998) in the Atherosclerosis Risk in Communities study for whom the 9p21 genotype and traditional RF information was available were included. Using Cox proportional hazards models, the Atherosclerosis Risk in Communities Cardiovascular Risk Score, which is based on traditional RFs, was determined. A total of 1349 individuals (13.5%) developed incident CHD events during a period of 14.6 years. Adding the 9p21 allele to traditional RFs was associated with a hazard ratio of incident CHD of 1.2 per allele (
P
<0.000003) and a significant increase in the area under the curve of the receiver operating characteristic from 0.782 to 0.786 (95% CI, 0.001, 0.007). The 9p21 allele’s greatest influence to the Atherosclerosis Risk in Communities Cardiovascular Risk Score was observed in the intermediate-low (>5% to ≤10% 10-year CHD risk) and intermediate-high (>10% to ≤20% 10-year CHD risk) categories, with 12.1% and 12.6% reclassified, respectively. This may impact therapy because 90% of these reclassified individuals had low-density lipoprotein cholesterol >100 mg/dL.

Conclusion—

Adding the 9p21 allele to traditional RFs in whites in the Atherosclerosis Risk in Communities study modestly improved CHD risk prediction in the intermediate categories.
Noncardiac Surgery and Bleeding After Percutaneous Coronary Intervention
Authors: To Andrew C.Y. , Armstrong Guy , Zeng Irene , Webster Mark W.I.
Published: April 2009

Background—

The decision on whether to implant a drug-eluting or bare-metal stent during percutaneous coronary intervention (PCI) depends in part on the perceived likelihood of the patient developing late stent thrombosis. Noncardiac surgery and bleeding are associated with discontinuation of dual antiplatelet therapy and with increased stent thrombosis. We assessed the incidence of and predictors for subsequent noncardiac surgery and bleeding episodes in patients who had undergone PCI.

Methods and Results—

Hospital discharge coding data were used to identify all adult patients undergoing public hospital PCI in New Zealand from 1996 to 2001. Hospital admissions during the ensuing 5 years were analyzed for noncardiac surgery and bleeding episodes. Eleven thousand one hundred fifty-one patients (age, 62�11 years; 30% women) underwent PCI, mainly for an acute coronary syndrome (73%). During the 5-year follow-up, 26% of the population underwent at least 1 noncardiac surgical procedure (23% orthopedic, 20% abdominal, 12% urologic, 10% vascular, 35% others) and 8.6% had at least 1 bleeding episode either requiring or occurring during hospitalization. Of those, half were gastrointestinal, and one quarter of bleeding events required blood transfusion. The main clinical predictors of noncardiac surgery were advanced age, previous noncardiac surgery, osteoarthritis, and peripheral vascular disease. A previous bleeding admission and age were the strongest predictors of subsequent bleeding.

Conclusions—

Noncardiac surgery is required frequently after PCI, whereas bleeding is less common. Before implanting a drug-eluting or bare-metal stent, individual patient risk stratification by the interventional cardiologist should include assessment of whether there is an increased likelihood of needing noncardiac surgery or developing bleeding.
Extended Follow-Up by Serial Angioscopic Observation for Bare-Metal Stents in Native Coronary Arteries
Authors: Yokoyama Shinya , Takano Masamichi , Yamamoto Masanori , Inami Shigenobu , Sakai Shunta , Okamatsu Kentaro , Okuni Shinichi , Seimiya Koji , Murakami Daisuke , Ohba Takayoshi , Uemura Ryota , Seino Yoshihiko , Hata Noritake , Mizuno Kyoichi
Published: April 2009

Background—

Although coronary angiograms after bare-metal stent (BMS) implantation show late luminal narrowing beyond 4 years, the detailed changes inside the BMS have not yet been fully elucidated.

Methods and Results—

Serial angiographic and angioscopic examinations were performed immediately (baseline), 6 to 12 months (first follow-up), and ≥4 years (second follow-up) after stenting without target lesion revascularization in 26 segments of 26 patients who received BMS deployment for their native coronary arteries. Angioscopic observation showed atherosclerotic yellow plaque crushed out by stent struts in 22 patients (85%) and mural thrombus in 21 patients (81%) at baseline. At first follow-up, white neointimal hyperplasia was almost completely buried inside the struts, and both yellow plaque and thrombus had decreased in comparison with baseline (12% and 4%, respectively;
P
<0.001). The frequencies of yellow plaque and thrombus increased from the first to second follow-ups (58% and 31%, respectively;
P
<0.05). All of the yellow plaques in the second follow-up were located not exterior to the struts but protruding from the vessel wall into the lumen. Late luminal narrowing, defined as an increasing of percent diameter stenosis between the first and second follow-ups, was greater in segments with yellow plaque than in those without yellow plaque (18.4�17.3% versus 3.6�4.2%, respectively;
P
=0.011).

Conclusions—

This angiographic and angioscopic study suggests that white neointima of the BMS may often change into yellow plaque over an extended period of time, and atherosclerotic progression inside the BMS may contribute to late luminal narrowing.
Apollinaire's “Zone,” Catholicism, and the Paradox of French Modernity
Authors: Mitroi Anca
Published: April 2009

Since at least the Enlightenment and the French Revolution, modernity in France has been understood primarily in terms of a rupture with Catholicism. Through a close reading of the poem “Zone,” this article shows how Guillaume Apollinaire's poetics challenges the conventional notion of modernity-as-rupture by exposing Catholicism's persistent residuality into the modern era. Instead of breaking with France's Catholic past, Apollinaire's modernism poetically displaces it, thereby holding in suspension both modernity's desire for rupture and the object with which it seeks to break.
“Who Would Believe What We Have Heard?”: Christian Spirituality and Images from the Passion in Religious Art of New Spain
Authors: Greeley June-Ann
Published: April 2009

The colonial art of New Spain/Mexico provides the viewer with a locus of examination into the robust Christianity that emerged over time out of a native spirituality newly laden with the contours and images from the Old World theology of late medieval/early Catholic Reformation Spain. Franciscan and especially Jesuit missionaries, impelled by a devotional zealotry, championed an apocalyptic vision of hope and suffering that was well suited for artistic expression. Religious art, whether or not patronized by European colonizers, became an instrument for the missionaries to teach and for the native artists to interrogate religious doctrine, and some artists, consciously or not, created their art as a response to that catechesis, a subtle fusion of ancient passion with the dramatic intensity of the new Catholic faith. One array of images in particular, that of the dolorous Passion of the Christ, was especially vibrant in the imaginations of the native artists and in the contemplation of the European missionaries and patrons. The image of the Suffering Servant resonated in the hearts and in the daily lives of the people just as it humbled missionary ardor, and excited a spiritual enthusiasm that forged an art of stunning doctrinal intimacy.
Icons' Spirited Love
Authors: Peers Glenn
Published: April 2009

This article examines three instances of Byzantine icons' declaration and demonstration of love: the Mandylion, the miraculous self-portrait of Christ, which arrived in Edessa in part as a veil that transfigured the wearer, the apostle Thaddaeus, and recipient, king Abgar; the icon of St. Paul that St. John Chrysostom kept by him when he wrote, which guaranteed the presence of that holy figure, as witnessed by John's peeping-tom assistant Proclus; and the icon of St. Macarius the Great and his Cherub that shows the fellow-love of that saint projected into the apparition of the Cherub. The writings of Pseudo-Dionysius the Areopagite are the underpinning for the love these objects respond to and generate: love here is the desire to be unified with the divine and the good, and this unity is always brought about through human desire.
Parenting Gifted and Talented Children: Conceptual and Empirical Foundations
Authors: Morawska Alina , Sanders Matthew R.
Published: April 2009

There is a paucity of research focusing on the needs of gifted children and their families, in particular, there is a lack of empirically supported parenting strategies to help parents in parenting their gifted child. This article provides an overview of the literature on difficulties experienced by parents of gifted and talented children, followed by a description of the development of a parenting program designed specifically for this population. Qualitative data from a survey of parents of gifted and talented children are presented to identify key themes for supporting and assisting parents. Gifted and Talented Triple P is a customized version of Triple P—Positive Parenting Program, consisting of nine sessions, specifically tailored for the needs of parents of gifted and talented children. The program is described and the clinical implications and future research directions in assisting parents in parenting their gifted and talented child are discussed.

Putting the Research to Use: The results of this study provide some key insights into the specific aspects of raising a gifted and talented child which parents struggle with, and the sorts of information they would like to receive to assist them in their role. The findings have led to the development and tailoring of a parenting intervention for parents of gifted and talented children, and have the potential to inform further research to support parents.
A Randomized Trial of a Church-Based Diabetes Self-management Program for African Americans With Type 2 Diabetes
Authors: Samuel-Hodge Carmen D. , Keyserling Thomas C. , Park Sola , Johnston Larry F. , Gizlice Ziya , Bangdiwala Shrikant I.
Published: April 2009

Purpose

This study developed and tested a culturally appropriate, church-based intervention to improve diabetes self-management.

Research Design and Methods

This was a randomized trial conducted at 24 African American churches in central North Carolina. Churches were randomized to receive the special intervention (SI; 13 churches, 117 participants) or the minimal intervention (MI; 11 churches, 84 participants). The SI included an 8-month intensive phase, consisting of 1 individual counseling visit, 12 group sessions, monthly phone contacts, and 3 encouragement postcards, followed by a 4-month reinforcement phase including monthly phone contacts. The MI received standard educational pamphlets by mail. Outcomes were assessed at 8 and 12 months; the primary outcome was comparison of 8-month A1C levels.

Results

At baseline, the mean age was 59 years, A1C 7.8%, and body mass index 35.0 kg/m2; 64% of participants were female. For the 174 (87%) participants returning for 8-month measures, mean A1C (adjusted for baseline and group randomization) was 7.4% for SI and 7.8% for MI, with a difference of 0.4% (95% confidence interval [CI], 0.1-0.6, P = .009). In a larger model adjusting for additional variables, the difference was 0.5% (95% CI, 0.2-0.7, P < .001). At 12 months, the difference between groups was not significant. Diabetes knowledge and diabetes-related quality of life significantly improved in the SI group compared with the MI group. Among SI participants completing an acceptability questionnaire, intervention components and materials were rated as highly acceptable.

Conclusions

The church-based intervention was well received by participants and improved short-term metabolic control.
The Impact of Federal Bioterrorism Funding Programs on Local Health Department Preparedness Activities
Authors: Avery George H. , Zabriskie-Timmerman Jennifer
Published: April 2009

Using the 2005 National Association of County and City Health Officers Profile of Local Health Departments data set, bivariate probit and Heckman selection models were used to test the hypothesis that the level of federal funding received for bioterrorism preparedness is related to the preparedness activities undertaken by local health departments. Overall budget, leadership, and crisis experience are found to be the most important determinants of local preparedness activity, but Centers for Disease Control and Prevention preparedness funding plays a mediating role by building capacity through the hiring of one key leadership position, the emergency preparedness coordinator. Additional research is needed to determine the potential impact of these funds on other aspects of the local public health system, such as the scope of services delivered, to determine secondary effects of the program.
The Social Construction of ``Evidence-Based'' Drug Prevention Programs
Authors: Gorman Dennis M. , Huber J. Charles
Published: April 2009

This study explores the possibility that any drug prevention program might be considered ``evidence-based'' given the use of data analysis procedures that optimize the chance of producing statistically significant results by reanalyzing data from a Drug Abuse Resistance Education (DARE) program evaluation. The analysis produced a number of statistically significant differences between the DARE and control conditions on alcohol and marijuana use measures. Many of these differences occurred at cutoff points on the assessment scales for which post hoc meaningful labels were created. Our results are compared to those from evaluations of programs that appear on evidence-based drug prevention lists.
Biofuel Food Disasters and Cellulosic Ethanol Problems
Authors: Pimentel David
Published: April 2009

As shortages of fossil energy, especially oil and natural gas, become evident, the United States has moved to convert corn grain into ethanol with the goal to make the nation oil independent. Using more than 20% of all U.S. corn on 15 million acres in 2007 was providing the nation with less than 1% of U.S. oil consumption. Because the corn ethanol project has been a disaster, there is growing interest to develop cellulosic ethanol. Wood, grasses, and crop residues are being proposed as sources for ethanol fuel. Though it may seem beneficial to use renewable plant materials for biofuel, the use of crop residues and other biomass for biofuels raises major concerns about energy balance, food security, and environmental problems.
People's Initiative to Counteract Misinformation and Marketing Practices: The Pembo, Philippines, Breastfeeding Experience, 2006
Authors: Salud M. A. Lourdes B. , Gallardo Josephine I. , Dineros Juliana A. , Gammad Alma F. , Basilio Juanita , Borja Vicenta , Iellamo Alessandro , Worobec Lana , Sobel Howard , Olivé Jean-Marc
Published: April 2009

The Philippines is among 42 countries accounting for 90% of under 5-year-old deaths. Only 16% of 4 to 5 month old Filipinos exclusively breastfeed. In 2006, almost $100 million was spent advertising formula in the Philippines. To counter widespread misinformation and improve breastfeeding a peer counseling intervention was developed to target mothers with infants less than 2 months of age who were not exclusively breastfeeding or had difficulty breastfeeding. Participants received 3 peer counseling visits. At baseline and 3 weeks later, 24-hour food recalls for infants were collected. The number of exclusively formula-fed infants decreased seven-fold ( P < .001). Mixed-fed infants decreased 37% ( P < .001). Overall, of the 148 nonexclusively breastfeeding infants, 69.5% had changed feeding methods after 3 home visits, 76% of whom to exclusive breastfeeding. Community-based peer counseling was associated with a drastic improvement of exclusive breastfeeding practices. This intervention evolved and became sustainable by engaging political figures, cities, and communities throughout the process. In 2 years, the Department of Health, World Health Organization (WHO) program has scaled up to improve health service delivery for 161 612 persons in depressed urban communities in the Philippines. J Hum Lact. 25(3):341-349.
Volume of Foremilk, Hindmilk, and Total Milk Produced by Mothers of Very Preterm Infants Born at Less Than 28 Weeks of Gestation
Authors: Bishara Rosine , Dunn Michael S. , Merko Susan E. , Darling Pauline
Published: April 2009

The purpose of this study is to describe foremilk volume (milk produced in the first 3 minutes of pumping), hindmilk volume (remainder of milk produced), and total milk volume produced by mothers of very preterm infants at 3 weeks postpartum and associated factors. Mothers (n = 24) mechanically pump their breasts a median (minimum, maximum) of 7 times (5, 9 times) per 24 hours for a total of 15 minutes (9.4, 23.9 minutes) each time. Foremilk, hindmilk, and total milk volumes are 183 mL per 24 hours (80, 810), 318 mL per 24 hours (98, 1007), and 545 mL per 24 hours (224, 1817), respectively. Milk volumes are not associated with mother's age, race or ethnic background, education, parity, reported prepregnancy body mass index, previous breastfeeding experience, frequency of milk pumping, longest time between pumps, infant birth weight, or multiple births. The degree of pre-maturity (<26 weeks vs 260/7-276/7 weeks) is significantly related to the relative proportion of foremilk/hindmilk volumes (45:55 vs 36:65, respectively). J Hum Lact. 25(3):272-279.
Aligning Career Expectations With the Practice of Medicine
Authors: Gibson Denise D. , Borges Nicole J.
Published: April 2009

This study examined physicians' level of satisfaction with their job and the match between expectations and actual practice of specialty. Quantitative results suggested that physicians (N = 211) had a moderately high level of overall job satisfaction with no significant differences found between men and women physicians. Among those in primary care, medical specialties, surgical specialties, or supporting specialties, overall job satisfaction was found to be higher for surgical specialists compared to primary care physicians. Qualitative comments from two open-ended questions identified 20 themes regarding how closely the participants' expectations matched with the realities of the practice of medicine. Six themes are described in detail. Approximately 85% of physicians felt their expectations for their specialty matched their actual experience in the field. Helping students to understand how their expectations align with the actual practice of medicine and specific specialties is important to their development as a physician and to job satisfaction, and has implications for career counseling and advising in undergraduate and graduate medical education.
Did the Faith-Based Initiative Change Congregations?
Authors: Chaves Mark , Wineburg Bob
Published: April 2009

We use national surveys of congregations conducted in 1998 and 2006-2007 to assess whether or not the faith-based initiative increased congregations’ social service involvement, government funding, or collaborations with government or nonprofit organizations. More congregations indicated interest in social services and government funding in 2006-2007 than in 1998, but congregational involvement in social services, government funding, or collaborations has not increased since 1998. An in-depth local study of partnerships between congregations and nonprofit social service agencies leads to the same conclusion. The faith-based initiative did not change congregations’ behavior or expand their role in our social welfare system because it overlooked congregations’ longstanding role in community systems, and it was built on false assumptions about congregations’ latent capacity to expand that role and the extent to which they constitute a meaningful alternative to existing organizational networks of social support.
Gender-Specific Perceptions of Four Dimensions of the Work/Family Interaction
Authors: Tone Innstrand Siw , Melbye Langballe Ellen , Falkum Erik , Espnes Geir Arild , Aasland Olaf Gjerløw
Published: April 2009

The aim of this study was twofold. The first intention was to examine the factorial validity of a work/family interaction in terms of the direction of influence (work-to-family vs. family-to-work) and type of effect (conflict vs. facilitation). Second, gender differences along these four dimensions of work/family interaction were explored. Data were obtained from eight different occupational groups in Norway: lawyers, physicians, nurses, teachers, church ministers, bus drivers, and people working in advertising and information technology (IT; N = 3,313). Multigroup analysis indicated that the hypothesized four-factor model clearly has a better fit than the alternative one-factor and two-factor models. Latent mean comparisons revealed significant gender differences along all the dimensions. Women reported more conflict and facilitation in both directions compared to men. Although there were some occupational differences, this was indicative of a more fluid boundary between work and family among women. The findings are discussed in an identity perspective.
Getting Off and Getting Intimate
Authors: Ray Rashawn , Rosow Jason A.
Published: April 2009

Social scientists implicate high-status men as sexually objectifying women. Yet, few have investigated these men’s perceptions and accounts of their own experiences. Racial variation in gender relations in college has also received little scholarly attention. Analyzing 30 in-depth, individual interviews and surveys and two focus group interviews from Black and White men at a large university, we find racial differences in approaches toward women. More specifically, Black men exhibit more romantic approaches, whereas White men exhibit more sexual approaches. However, these differences are not solely related to race. Instead, ‘‘normative institutional arrangements’’ (e.g., community size and living arrangements) structure these approaches. We discuss the broader theoretical mechanisms regarding masculine performances, gender attitudes and behaviors, and race. In doing so, this study highlights the importance of ‘‘normative institutional arrangements’’ for understanding how the performances of masculinities are legitimized across racial- and status-group categories of men.
Past environmental sun exposure and risk of multiple sclerosis: a role for the Cdx-2 Vitamin D receptor variant in this interaction
Authors: Dickinson JL , Perera DI , van der Mei AF , Ponsonby A-L , Polanowski AM , Thomson RJ , Taylor BV , McKay JD , Stankovich J , Dwyer T
Published: April 2009

Multiple studies have provided evidence for an association between reduced sun exposure and increased risk of multiple sclerosis (MS), an association likely to be mediated, at least in part, by the vitamin D hormonal pathway. Herein, we examine whether the vitamin D receptor ( VDR), an integral component of this pathway, influences MS risk in a population-based sample where winter sun exposure in early childhood has been found to be an important determinant of MS risk. Three polymorphisms within the VDR gene were genotyped in 136 MS cases and 235 controls, and associations with MS and past sun exposure were examined by logistic regression. No significant univariate associations between the polymorphisms, rs11574010 ( Cdx-2A > G), rs10735810 ( Fok1T >  C), or rs731236 ( Taq1C > T) and MS risk were observed. However, a significant interaction was observed between winter sun exposure during childhood, genotype at rs11574010, and MS risk ( P = 0.012), with the ‘G’ allele conferring an increased risk of MS in the low sun exposure group (≤2 h/day). No significant interactions were observed for either rs10735810 or rs731236, after stratification by sun exposure. These data provide support for the involvement of the VDR gene in determining MS risk, an interaction likely to be dependent on past sun exposure.
The search for responsive clinical endpoints in primary progressive multiple sclerosis
Authors: Bosma LVAE , Kragt JJ , Brieva L , Khaleeli Z , Montalban X , Polman CH , Thompson AJ , Tintoré M , Uitdehaag BMJ
Published: April 2009

Objective

To determine whether in primary progressive multiple sclerosis (PPMS) combining scores of Expanded Disability Status Scale (EDSS) with data from Timed 25-Foot Walk (T25FW) and 9-Hole Peg Test (9HPT) would produce a clinical endpoint that has a higher event rate than EDSS alone.

Methods

In a group of 161 PPMS patients, EDSS, T25FW, and 9HPT were performed at three time points over 2 years. We calculated how many patients showed clinically meaningful deterioration (or improvement) on individual and combined scales. We defined improvements on one scale with deterioration on the other as “opposing changes.” We investigated the possible effect of baseline disability on the definition of our endpoint by dividing the population into two subsets of patients determined by baseline EDSS level.

Results

On individual scales, event rates were highest on T25FW: 34% and 46% 1 year and 2 years after baseline. On a combination of two scales, at 1 year the event rate was highest on T25FW/9HPT (46%; with a high rate of opposing changes) and at 2 years on T25FW/EDSS (57%; with a lower rate of opposing changes). In both subsets, event rates were highest on T25FW and (at 2 years) on the combination of T25FW/EDSS.

Conclusions

T25FW has the highest event rate as a single scale, independent of baseline disability level. A term of 2 years turned out to be more meaningful to observe than 1 year. “Worsening on either T25FW or EDSS” is the most appropriate composite endpoint in this patient group.
Regulation of matrix metalloproteinases and their inhibitors by interferon-β: a longitudinal study in multiple sclerosis patients
Authors: Bernal F , Elias B , Hartung HP , Kieseier BC
Published: April 2009

Background

Matrix metalloproteinases (MMPs) represent a large family of proteolytic enzymes, with some members being implicated in the immunopathogenesis of multiple sclerosis (MS). Interferon (IFN)-β is one of the current mainstays in MS therapy and known to downregulate the expression of MMP-9. However, only sparse information is available on the effects of IFN-β on the other 20 members of the MMP family.

Methods

This is a longitudinal analysis on the RNA expression pattern of all known MMPs and their endogenous inhibitors before and after 1 and 6 months of IFN-β therapy. RNA expression levels were assessed in peripheral venous blood cells from 14 MS patients and 8 matched controls by real time-PCR.

Results

RNA expression levels before treatment differed in part in MS patients compared to healthy controls (MMP-9, MMP-14, MMP-19, TIMP-1, TIMP-2). Some of the MMPs responded to therapy specifically (MMP-8, MMP-9, MMP-19), whereas others remained unchanged over time.

Conclusions

These data suggest that MMPs may differ in their expression levels in MS patients and that this group of enzymes is differentially regulated during the treatment with IFN-β in MS for at least 6 months.
The evaluation of spiritual care in a dementia care setting
Authors: Goodall Margaret A.
Published: April 2009

Spiritual care has become an integral part of the care package offered to older people who move to residential care. However, spirituality is a word that can mean everything or nothing and as such becomes difficult to define. Assessment of `spiritual care' becomes a real challenge, because it raises important questions. These are as follows: the nature of spiritual care; how it is offered; and who takes responsibility for it. This is especially true in dementia care homes where residents cannot normally take part in evaluation. This paper offers a model of evaluation of spiritual care by using reflection, relationship and restoration, and through observing the virtues described in the Biblical concept of `fruit of the spirit'.
Guiding design of dementia friendly environments in residential care settings: Considering the living experiences
Authors: Davis Sandra , Byers Suzanne , Nay Rhonda , Koch Susan
Published: April 2009

In the past twenty years, the importance of the physical and social environments in supporting the person with dementia has gained a much higher profile in dementia care. Despite efforts to move aged care away from the medical model to a more balanced social model of care, we still struggle with the dominance of an institutional context which impedes individuality and choice. This article argues that the experience of the person with dementia should frame the perspective brought to built design and the philosophy of care — in essence, `looking out from the inside'. Shifting the emphasis from condition to experience encourages the culture change needed to create environments that allow the person with dementia to be an active participant in everyday life rather than a passive recipient of care. Based on the development of a resource for residential and respite facilities in Australia, seven living experiences are identified: the presentation of self-experience, eating experience, personal enjoyment experience, bedroom experience, family and community connections experience, end-of-life experience and the staff experience. Each is discussed to show how consideration of the living experiences provides a way to focus thinking for design of the built environment to practically support the person with dementia, thereby addressing the wider spectrum of issues in creating a dementia friendly physical and social environment from the perspective of the person with dementia.
Where does risk feature in community care practice with older people with dementia who live alone?
Authors: Waugh Fran
Published: April 2009

Aiming to provide insight into a growing area of aged care services this article reports on five practitioners' perspectives of what were the key elements of their practice in community care for older persons with dementia who live alone. It draws on the findings from the first of two research projects undertaken collaboratively with Mercy Community Care (MCC), a non-profit community care agency, in Sydney, Australia and the University of Sydney in 2003 and 2006. The first project was a pilot qualitative research study focusing on practices of staff who were involved in the Dementia Monitoring Program (DMP), a specialist service for older persons living alone with dementia. Reducing risk is a major consideration driving policy development in community care of people with dementia in Australia. Using this preliminary research as a case study, this article explores the complexity and multi-dimensional nature of community care practices of these workers with older people who lived alone with dementia. The notion that `risk' is the all consuming focus of workers' intervention is challenged in this paper. While reducing risk and increasing the safety of their service users were important elements of these workers' intervention, addressing service users' needs and upholding their human rights remained paramount in workers' intervention with their service users.