bluuebunny/crossref_metadata_2025 huggingface dataset:
Health and social needs of older Australians from culturally and linguistically diverse backgrounds: issues and implications
Authors: Rao D Visala , Warburton Jeni , Bartlett Helen
Published: October 2006

Australia has one of the most diverse migrant populations in the world. This pattern of cultural diversity is also reflected in the older population, with increasing numbers of older people from culturally and linguistically diverse (CALD) backgrounds. The aim of the present review is to examine the evidence base related to the health and social needs and existing support systems for older Australians from CALD backgrounds. It is difficult to generalise the issues and challenges associated with these groups because of their heterogeneity, both between and within groups. However, their health and social needs may be particularly acute as a result of cultural and language barriers; their geographical location and the circumstances of migration, which impact on their financial circumstances as well as psycho‐social health. Whilst there is a range of community and government stakeholders involved in addressing these issues, the evidence base for policy and practice is not well understood.
Promoting evidence‐based best practices for hip fracture prevention in residential aged care
Authors: Scherer Samuel C , Jennings Catherine , Rule Jeanette , Smeaton Mindy , Farrell Michael J , Garratt Sally A , Flicker Leon , Davis Ivor , Wark John D
Published: October 2006

Objectives:  To evaluate the effect of advice about hip fracture prevention on clinical practice in residential aged care facilities (RACFs) and to survey consumer knowledge.

Methods:  Cluster randomised trial using modified two‐by‐two factorial design. Clinicians received written advice in three RACFs; online advice in three RACFs; both in three RACFs and three RACFs were controls. Free hip protectors were offered in one RACF from each intervention group. Consumer awareness and attitudes to hip fractures were surveyed.

Results:  Baseline rate of calcium plus vitamin D prescription was 3.5%. Information provision failed to produce a significant effect on clinical practice during 12‐week follow up. Offering free hip protectors was effective (P < 0.0001), but was associated with lower compliance (P < 0.05). Consumer awareness was low.

Conclusions:  Low rates of preventative interventions among residents at high risk of hip fracture were not increased by provision of advice to health professionals.
Spectroscopic characterization of a higher plant heme oxygenase isoform‐1 from Glycine max (soybean) −coordination structure of the heme complex and catabolism of heme
Authors: Gohya Tomohiko , Zhang Xuhong , Yoshida Tadashi , Migita Catharina T.
Published: October 2006

Heme oxygenase converts heme into biliverdin, CO, and free iron. In plants, as well as in cyanobacteria, heme oxygenase plays a particular role in the biosynthesis of photoreceptive pigments, such as phytochromobilins and phycobilins, supplying biliverdin IXα as a direct synthetic resource. In this study, a higher plant heme oxygenase, GmHO‐1, of Glycine max (soybean), was prepared to evaluate the molecular features of its heme complex, the enzymatic activity, and the mechanism of heme conversion. The similarity in the amino acid sequence between GmHO‐1 and heme oxygenases from other biological species is low, and GmHO‐1 binds heme with 1 : 1 stoichiometry at His30; this position does not correspond to the proximal histidine of other heme oxygenases in their sequence alignments. The heme bound to GmHO‐1, in the ferric high‐spin state, exhibits an acid–base transition and is converted to biliverdin IXα in the presence of NADPH/ferredoxin reductase/ferredoxin, or ascorbate. During the heme conversion, an intermediate with an absorption maximum different from that of typical verdoheme–heme oxygenase or CO–verdoheme–heme oxygenase complexes was observed and was extracted as a bis‐imidazole complex; it was identified as verdoheme. A myoglobin mutant, H64L, with high CO affinity trapped CO produced during the heme degradation. Thus, the mechanism of heme degradation by GmHO‐1 appears to be similar to that of known heme oxygenases, despite the low sequence homology. The heme conversion by GmHO‐1 is as fast as that by SynHO‐1 in the presence of NADPH/ferredoxin reductase/ferredoxin, thereby suggesting that the latter is the physiologic electron‐donating system.
Low Doses of Tumour Necrosis Factor α and Interleukin 1β Diminish Hepatic Gluconeogenesis from Alanine in vivo
Authors: Kelmer‐Bracht Ana Maria , Broetto‐Biazon Ana Carla , De Sá‐Nakanishi Anacharis Babeto , Ishii‐Iwamoto Emy Luiza , Bracht Adelar
Published: October 2006

Abstract: Previous reports have attributed a stimulating action on hepatic gluconeogenesis to tumour necrosis factor α (TNFα) administered to rats at high doses (250 μg/kg). However, in adjuvant‐induced arthritic rats, which present TNFα and other interleukins in the circulation, hepatic gluconeogenesis is diminished. The same occurs in some types of experimental cancer models as, for example, rats bearing the Walker‐256 tumour. The present work represents an attempt of reproducing in rats gluconeogenesis inhibition by interleukins using low instead of high doses of both TNFα and interleukin 1β (IL1β). TNFα and IL1β at doses of up to 10 μg/kg were given endovenously to rats and, after six hours, gluconeogenesis from alanine and several related parameters were evaluated in the isolated haemoglobin‐free perfused rat liver. Livers from rats injected with TNFα and IL1β, either alone or in combination, presented diminished gluconeogenesis. The degrees of inhibition caused by TNFα+IL1β, TNFα and IL1β were, respectively, 48.5, 38.8 and 30.4%. TNFα also diminished oxygen uptake. No action on urea and ammonia production was found. Possibly, both TNFα and IL1β contribute to the decreased rates of hepatic gluconeogenesis that were found in rats with arthritis, sepsis and some kinds of cancer, but not to the decreased rates of ureagenesis.
Effects of Diesel Exhaust on Lung Inflammation Related to Bacterial Endotoxin in Mice
Authors: Inoue Ken‐ichiro , Takano Hirohisa , Yanagisawa Rie , Sakurai Miho , Ueki Naoko , Yoshikawa Toshikazu
Published: October 2006

Abstract: We have previously shown that intratracheal instillation of diesel exhaust particles enhances lung inflammation and lung expression of proinflammatory cytokines and chemokines related to bacterial endotoxin (lipopolysaccharide) in mice. The present study was designed to elucidate the effects of inhalation of diesel exhaust on lung inflammation related to lipopolysaccharide. ICR mice were exposed for 12 hr to clean air or diesel exhaust at a soot concentration of 0.3, 1.0, or 3.0 mg/m3 after intratracheal challenge with 125 μg/kg of lipopolysaccharide. Lung inflammation and lung expression of proinflammatory chemokines such as macrophage chemoattractant protein‐1 and keratinocyte chemoattractant were evaluated 24 hr after intratracheal administration. Diesel exhaust inhalation decreased lipopolysaccharide‐elicited inflammatory cell recruitment into the bronchoalveolar lavage fluid as compared with clean air inhalation. Histological study demonstrated that exposure to diesel exhaust did not affect lipopolysaccharide‐enhanced neutrophil recruitment into the lung parenchyma. Lipopolysaccharide instillation elevated lung expression of macrophage chemoattractant protein‐1 and keratinocyte chemoattractant under clean air or diesel exhaust inhalation. However, diesel exhaust exposure did not influence but rather did suppress these levels in the presence of lipopolysaccharide. These results suggest that short‐term exposure to diesel exhaust did not exacerbate lung inflammation related to bacterial endotoxin.
Tetrahydrocurcumin: Effect on Chloroquine‐Mediated Oxidative Damage in Rat Kidney
Authors: Pari Leelavinothan , Murugan Pidaran
Published: October 2006

Abstract: Tetrahydrocurcumin is an antioxidative substance, which is derived from curcumin, the component of turmeric. In the present investigation, the effect of tetrahydrocurcumin and curcumin against chloroquine‐induced nephrotoxicity were studied in female wistar rats. Oral administration of tetrahydrocurcumin significantly prevented the occurrence of chloroquine (970 mg/kg body weight)‐induced renal damage. Upon administration of tetrahydrocurcumin to chloroquine‐treated rats, the level of lipid peroxidation was significantly decreased while the levels of non‐enzymic and enzymic antioxidants were significantly increased in kidney. Oral administration (80 mg/kg body weight) attenuated the chloroquine‐induced nephrotoxicity by significantly decreased levels of serum urea and creatinine with significant normalization of creatinine clearance. On administration of tetrahydrocurcumin, the depleted renal antioxidant defense system (enzymatic and non‐enzymatic antioxidants) was significantly increased in rats treated with chloroquine. These biochemical observations were supplemented by histopathological examination of kidney section. These results suggest that administration of chloroquine imposes an oxidative stress to renal tissue and that tetrahydrocurcumin protects the oxidative damage associated with chloroquine.
Alternative Therapies for Osteoporosis
Authors: Yao F. A. , Dobs A. S. , Brown T. T.
Published: October 2006

A variety of common complementary and alternative medicine therapies are now being examined for effectiveness in the management of osteoporosis. Short-term studies in postmenopausal women show beneficial effects of soy isoflavone supplementation on bone density, but its long-term effects require clarification. Prospective controlled trials have shown that physical training can increase bone density to varying degrees. Other therapies that have been examined include herbal formulae, essential fatty acids and vitamins A, C, and K, but few data regarding their effectiveness, mechanisms and safety have been published. Further randomized controlled trials are needed.
Anti-hyperalgesic and Anti-inflammatory Effects of the Modified Chinese Herbal Formula Huo Luo Xiao Ling Dan (HLXL) in Rats
Authors: Lao Lixing , Fan Arthur Yin , Zhang Rui-Xin , Zhou Annan , Ma Zhong-Ze , Lee David Yue-Wei , Ren Ke , Berman Brian
Published: October 2006

Chinese herbal medicine has been used for thousands of years in China and other Asian countries to treat a variety of inflammatory diseases. The classic Chinese herbal formula, Huo Luo Xiao Ling Dan (活络效灵丹, HLXL) is commonly used in traditional Chinese herbal medicine for the treatment of joint pain and other symptoms of arthritis. The present study is an investigation of the effects of a modified HLXL extract on persistent hyperalgesia and edema in rats with peripheral inflammation. Inflammation was induced by injecting complete Freund's adjuvant (CFA) into one hind paw. Four dosages of the extract were compared to a vehicle control. Each was administered intragastrally (i.g.) daily for seven days beginning one day before CFA. Hyperalgesia was assessed using a paw withdrawal latency (PWL) test and edema was determined by measuring paw thickness at pre-CFA and 2 hours, 24 hours, and 5 days post-CFA. Immunohistochemistry was performed 2 hours post-CFA to determine spinal Fos protein expression. Adverse effects of the extract were monitored by observing the animals closely for unusual behavioral changes. Compared to the control, HLXL at the two lower dosages (0.575 g/kg and 1.15 g/kg) were effective in the later stage (day 5) of inflammatory hyperalgesia and edema, while the two higher dosages (2.3 g/kg and 4.6 g/kg) alleviated early stage hind paw inflammation and hyperalgesia and facilitated recovery from paw edema and hyperalgesia during the late stage. HLXL at 2.30 g/kg significantly suppressed Fos expression in laminae I–II, III–IV and V–VI ipsilaterally and in III-IV contralaterally. No significant signs of toxicity or adverse effects were observed. The data suggest that HLXL dosage-dependently attenuates CFA-induced inflammation and hyperalgesia, at least in part by inhibiting noxious transmission at the dorsal horn of the spinal cord.
Activation of Nitric Oxide Signaling Pathway Mediates Hypotensive Effect ofMuntingia calaburaL. (Tiliaceae) Leaf Extract
Authors: Shih Cheng-Dean , Chen Jih-Jung , Lee Hsinn-Hsing
Published: October 2006

The cardiovascular effect of the crude methanol extract from the leaf of Muntingia calabura L. (Tiliaceae) was investigated in the anesthetized rats. The crude methanol extract was sequentially fractionated to obtain the water-soluble extract (WSE). Intravenous administration of the WSE (10, 25, 50, 75 or 100 mg/kg) produced an initial followed by a delayed decrease in systemic arterial pressure (SAP) in a dose-dependent manner. The M. calabura-induced initial hypotension lasted for 10 min and the delayed depressor effect commenced after 90 min and lasted for at least 180 min post-injection. The same treatment, on the other hand, had no appreciable effect on heart rate (HR) or the blood gas/electrolytes concentrations. Both the initial and delayed hypotensive effects of WSE (50 mg/kg, i.v.) were significantly blocked by pre-treatment with a nonselective nitric oxide (NO) synthase (NOS) inhibitor, NG-nitro-L-arginine methyl ester (L-NAME, 0.325 mg/kg/min for 5 min) or a soluble guanylate cyclase (sGC) inhibitor, 1H-[1,2,4]oxadiazole[4,3-α]quinoxalin-1-one (ODQ, 0.2 mg/kg/min for 5 min). Moreover, whereas the initial depressor effect of WSE was inhibited by pre-treatment with a selective endothelial NOS (eNOS) inhibitor, N5-(1-Iminoethyl)-L-ornithine (L-NIO, 1 mg/kg/min for 5 min), the delayed hypotension was attenuated by a selective inducible NOS (iNOS) inhibitor, S-methylisothiourea (SMT, 0.5 mg/kg/min for 5 min). Administration of WSE also produced an elevation in plasma nitrate/nitrite concentration, as well as an increase in the expression of iNOS protein in the heart and thoracic aorta. These results indicate that WSE from the leaf of M. calabura elicited both a transient and delayed hypotensive effect via the production of NO. Furthermore, activation of NO/sGC/cGMP signaling pathway may mediate the M. calabura-induced hypotension.
The Effects of Five Alkaloids from Bulbus Fritillariae on the Concentration of cAMP in HEK Cells Transfected with Muscarinic M2 Receptor Plasmid
Authors: Zhou Ying , Ji Hui , Lin Bao-Qin , Jiang Yan , Li Ping
Published: October 2006

The aim of this study was to investigate the effects of five alkaloids, namely verticine, verticinone, imperialine, imperialine-3β-D-glucoside, and puqietinone, purified from Bulbus Fritillariae and used as an antitussive drug in traditional Chinese medicine, on their antimuscarinic M2 function and the cAMP level of HEK cells transfected with muscarinic M2 receptor plasmid. By transfecting the HEK cells with the method of calcium phosphate co-precipitation and screening with G418, the cells stably expressing M2 receptor were identified. The expression of M2 receptor in HEK cells was confirmed by both RT-PCR and western blot. The cAMP level in the treated cells was analyzed with RIA method (125I-cAMP KIT). And the results suggested that the five alkaloids could significantly elevate the cAMP concentration in the HEK cells transfected with muscarinic M2 receptor plasmid ( p < 0.01).
Effect of Epigallocatechingallate on Ultraviolet B-Induced Photo-Damage in Keratinocyte Cell Line
Authors: Luo Dan , Min Wei , Lin Xiang-Fei , Wu Di , Xu Yang , Miao Xu
Published: October 2006

One type of traditional Chinese medicines, epigallocatechingallate (EGCG) has been commonly used as a clinical and skin health protective ingredient. It has been known to have photo-protective, anti-inflammatory, and anti-oxidant effects. However, little is known about the mechanisms of EGCG on UV-induced photo-aging and photo-carcinogenesis. In the present study, we investigated the photo-protective mechanisms of EGCG on UVB-induced skin damage, including the potency of EGCG to inhibit the UVB-induced cytotoxicity, secretion of cytokine (IL-6 and TNF-α), cellular apoptosis, expression of apoptosis-regulatory genes (p53–p21) and c-fos gene in cultured immortalized human keratinocyte HaCaT cells. EGCG treatment decreased UVB- induced cell cytotoxicity and apoptosis. It also inhibited the mRNA expressions of apoptosis-regulatory gene (p53 and p21) and c-fos gene. These results suggest that EGCG may have an inhibitory effect on UVB-induced photo-damage and apoptosis by blocking the cytokine secretion and the mRNA expressions of p53, p21 and c-fos genes.
AN ANOMALOUS MUSCLE MIMICKING A DORSO-RADIAL GANGLION AS A CAUSE OF RADIAL WRIST PAIN
Authors: Imran D. , Avarmidis M. , Attar K. H.
Published: October 2006

We report an abnormal muscle on the radial aspect of the wrist, which presented clinically as a ganglion and radial wrist pain. Existence of muscles in the first compartment has been accounted earlier, however its atypical presentation advocates its inclusion in the differential diagnosis of a dorso-radial ganglion and wrist pain.
THE EFFECTIVENESS OF RA WRIST FUSION USING BETA-TCP WITHOUT AUTOGENOUS ILIAC BONE GRAFTING: A REPORT OF FOUR CASES
Authors: Nakagawa Natsuko , Saegusa Yasuhiro , Abe Shuji , Miura Yasushi , Yoshiya Shinchi
Published: October 2006

Wrist arthrodesis is indicated for the rheumatoid hand especially in cases with severe destruction of the carpal bones. In the arthrodesis procedure for the rheumatoid wrist, autogenous iliac bone grafting is required in most cases. However, autogenous iliac bone graft necessitates the additional surgical intervention, and can be associated with the problem of inadequate bony quality or quantity. It is thought that use of the artificial bone substitute in the procedure can lessen the surgical morbidity while supplying the consistent material without shortage of graft quantity. We have performed arthrodesis of the rheumatoid wrist using beta-TCP for four patients. Clinical results of these patients were satisfactory both in pain relief and functional improvement with complete bony healing. Therefore, this procedure seems to be an effective option for the rheumatoid wrist with severe destructive changes.
NECROTISING FASCIITIS CAUSING COMPARTMENT SYNDROME OF THE FOREARM AND SEPTIC SHOCK DUE TOVIBRIO VULNIFICUS: A CASE REPORT
Authors: Leechavengvongs Somsak , Jidpugdeebodin Suwanee , Milindankura Samaniya
Published: October 2006

Compartment syndrome caused by necrotising fasciitis has rarely been described. We report a case of systemic Vibrio vulnificus necrotising fasciitis presented with compartmental syndrome of the forearm and septic shock. The patient was treated with systemic antibiotic treatment and urgent surgical decompression followed by multiple necrotic tissue debridements. The patient recovered with some limited motion of the hand function. Prompt recognition and immediate treatment with antibiotics and surgical intervention are essential.
Crucial Role of NO and Endothelium-Derived Hyperpolarizing Factor in Human Sustained Conduit Artery Flow-Mediated Dilatation
Authors: Bellien Jeremy , Iacob Michele , Gutierrez Laurence , Isabelle Marc , Lahary Agnes , Thuillez Christian , Joannides Robinson
Published: October 2006

Whether NO is involved or not in sustained conduit artery flow-mediated dilatation in humans remains unclear. Moreover, the role of endothelium-derived hyperpolarizing factor (EDHF), synthesized by cytochrome epoxygenases and acting through calcium-activated potassium channels, and its relationship with NO during flow-mediated dilatation have never been investigated previously. In 12 healthy subjects we measured radial artery diameter (echotracking) and blood flow (Doppler) during flow-mediated dilatation induced by gradual distal hand skin heating (34 to 44°C), during the local infusion of saline and inhibitors of NO synthase (
N
G
-monomethyl-
l
-arginine [
l
-NMMA]: 8 to 20 μmol/min per liter), calcium-activated potassium channels (tetraethylammonium chloride: 9 μmol/min per liter), and cytochrome epoxygenases (fluconazole: 0.4 to 1.6 μmol/min per liter), alone and in combination. Mean wall shear stress, the flow-mediated dilatation stimulus, was calculated at each level of flow, and the diameter–wall shear stress relationship was constructed. During heating, compared with saline, the diameter–shear stress relationship was shifted downward by
l
-NMMA, tetraethylammonium, fluconazole, and, in a more pronounced manner, by the combinations of
l
-NMMA with tetraethylammonium or with fluconazole. Therefore, maximal radial artery flow-mediated dilatation, compared with saline (0.62±0.03 mm), was decreased under our experimental conditions by
l
-NMMA (−39±4%), tetraethylammonium chloride (−14±4%), fluconazole (−18±6%), and to a greater extent, by the combinations of
l
-NMMA with tetraethylammonium (−64±4%) or with fluconazole (−71±3%). This study demonstrates that NO and a cytochrome-related EDHF are involved in peripheral conduit artery flow-mediated dilatation in humans during sustained flow conditions. Moreover, the synergistic effects of the inhibitors strongly suggest a functional interaction between NO and EDHF pathways.
Polymorphic Variation in the 11β-Hydroxylase Gene Associates With Reduced 11-Hydroxylase Efficiency
Authors: Barr Marianne , MacKenzie Scott M. , Friel Elaine C. , Holloway Christine D. , Wilkinson Donna M. , Brain Nick J.R. , Ingram Mary C. , Fraser Robert , Brown Morris , Samani Nilesh J. , Caulfield Mark , Munroe Patricia B. , Farrall Martin , Webster John , Clayton David , Dominiczak Anna F. , Connell John M.C. , Davies Eleanor
Published: October 2006

The −344 C/T and intron 2 conversion variants in the CYP11B2 gene, encoding aldosterone synthase, have been associated with markers of impaired 11β-hydroxylase activity. We hypothesize that this association is because of variations in the adjacent 11β-hydroxylase gene (CYP11B1) and arises through linkage disequilibrium between CYP11B1 and CYP11B2. The pattern of variation across the entire CYP11B locus was determined by sequencing 26 normotensive subjects stratified by and homozygous for the −344 and intron conversion variants. Eighty-three variants associated with −344 and intron conversion were identified. Haplotype analysis revealed 4 common haplotypes, accounting for 68% of chromosomes, confirming strong linkage disequilibrium across the region. Two novel CYP11B1 polymorphisms upstream of the coding region (−1889 G/T and −1859 A/G) were identified as contributing to the common haplotypes. Given the potential for such mutations to affect transcriptional regulation of CYP11B1, these were analyzed further. A total of 512 hypertensive subjects from the British Genetics of Hypertension Study population were genotyped for these polymorphisms. A significant association was identified between the −1889 polymorphism and urinary tetrahydrodeoxycortisol/total cortisol metabolite ratio, indicating reduced 11β-hydroxylase efficiency. A similar pattern was observed for the −1859 polymorphism, but this did not achieve statistical significance. Functional studies in vitro using luciferase reporter gene constructs show that these polymorphisms significantly alter the transcriptional response of CYP11B1 to stimulation by adrenocorticotropic hormone or forskolin. This study strongly suggests that the impaired 11β-hydroxylase efficiency associated previously with the CYP11B2 −344 and intron conversion variants is because of linkage with these newly identified polymorphisms in CYP11B1.
Effectiveness of Blood Pressure Control Outside the Medical Setting
Authors: Banegas José R. , Segura Julián , Sobrino Javier , Rodríguez-Artalejo Fernando , de la Sierra Alejandro , de la Cruz Juan J. , Gorostidi Manuel , Sarría Antonio , Ruilope Luis M.
Published: October 2006

We studied the effectiveness of blood pressure (BP) control outside the clinic by using ambulatory BP monitoring (ABPM) among a large number of hypertensive subjects treated in primary care centers across Spain. The sample consisted of 12 897 treated hypertensive subjects who had indications for ABPM. Office-based BP was calculated as the average of 2 readings. Twenty-four–hour ABPM was then performed using a SpaceLabs 90207 monitor under standardized conditions. A total of 3047 patients (23.6%) had their office BP controlled, and 6657 (51.6%) were controlled according to daytime ABPM. The proportion of office resistance or underestimation of patients’ BP control by physicians in the office (office BP ≥140/90 mm Hg and average daytime ambulatory BP <135/85 mm Hg) was 33.4%, and the proportion of isolated office control or overestimation of control (office BP <140/90 mm Hg and average daytime ambulatory BP ≥135/85 mm Hg) was 5.4%. BP control was more frequently underestimated in patients who were older, female, obese, or with morning BP determination than in their counterparts. BP control was more frequently overestimated in those who were younger, male, nonobese, smokers, or with evening BP determination. Ambulatory-based hypertension control was far better than office-based hypertension control. This conveys an encouraging message to clinicians, namely that they are actually doing better than is evidenced by office-based data. However, the burden of underestimation and overestimation of BP control at the office is still remarkable. Physicians should be aware that the likelihood of misestimating BP control is higher in some hypertensive subjects.
Coronary Multidetector Computed Tomography in the Assessment of Patients With Acute Chest Pain
Authors: Hoffmann Udo , Nagurney John T. , Moselewski Fabian , Pena Antonio , Ferencik Maros , Chae Claudia U. , Cury Ricardo C. , Butler Javed , Abbara Suhny , Brown David F. , Manini Alex , Nichols John H. , Achenbach Stephan , Brady Thomas J.
Published: October 2006

Background—

Noninvasive assessment of coronary atherosclerotic plaque and significant stenosis by coronary multidetector computed tomography (MDCT) may improve early and accurate triage of patients presenting with acute chest pain to the emergency department.

Methods and Results—

We conducted a blinded, prospective study in patients presenting with acute chest pain to the emergency department between May and July 2005 who were admitted to the hospital to rule out acute coronary syndrome (ACS) with no ischemic ECG changes and negative initial biomarkers. Contrast-enhanced 64-slice MDCT coronary angiography was performed immediately before admission, and data sets were evaluated for the presence of coronary atherosclerotic plaque and significant coronary artery stenosis. All providers were blinded to MDCT results. An expert panel, blinded to the MDCT data, determined the presence or absence of ACS on the basis of all data accrued during the index hospitalization and 5-month follow-up. Among 103 consecutive patients (40% female; mean age, 54±12 years), 14 patients had ACS. Both the absence of significant coronary artery stenosis (73 of 103 patients) and nonsignificant coronary atherosclerotic plaque (41 of 103 patients) accurately predicted the absence of ACS (negative predictive values, 100%). Multivariate logistic regression analyses demonstrated that adding the extent of plaque significantly improved the initial models containing only traditional risk factors or clinical estimates of the probability of ACS (c statistic, 0.73 to 0.89 and 0.61 to 0.86, respectively).

Conclusions—

Noninvasive assessment of coronary artery disease by MDCT has good performance characteristics for ruling out ACS in subjects presenting with possible myocardial ischemia to the emergency department and may be useful for improving early triage.
Compassion at the counter: Service providers and bereaved consumers
Authors: O’Donohoe Stephanie , Turley Darach
Published: October 2006

Although the emotional labour required of service providers has received considerable research attention, few studies have examined service workers’ experiences of emotionally charged service encounters. In this article we review literature on emotion management and compassion in the workplace. We then describe a qualitative study which examined the service encounter occurring when bereaved Irish consumers contacted their local newspaper to place In Memoriam notices on the anniversary of a close family member’s death. We suggest that these newspaper employees engaged in philanthropic emotion management when dealing with bereaved customers, and we locate this within the broader context of compassion as interpersonal work and as organizational accomplishment. We also suggest that compassion in organizations is not amenable to managerial systematization and control.
A Global Eddy-Resolving Coupled Physical-Biological Model: Physical Influences on a Marine Ecosystem in the North Pacific
Authors: Sasai Yoshikazu , Ishida Akio , Sasaki Hideharu , Kawahara Shintaro , Uehara Hitoshi , Yamanaka Yasuhiro
Published: October 2006

Physical influences on a marine ecosystem in the open ocean are investigated using a simplified four-component ecosystem model embedded in an eddy-resolving ocean general-circulation model (OGCM). The annual cycle of temperature, nitrate, and phytoplankton in the upper ocean is well reproduced with the climatological monthly mean forcing.A comparison with satellite ocean color data shows that the model is capable of a realistic description of the annual mean and regional patterns of surface chlorophyll.Simulated chlorophyll distribution at the surface shows a pattern influenced by the western boundary current (Kuroshio) and meso-scale eddies.Nitrate distribution in the upper ocean in the northwestern Pacific is mainly controlled by physical processes, especially meso-scale variability, including many anticyclonic and cyclonic eddies, fine-scale fronts, and filaments.The warm-core eddy entrains high-nitrate water from the surrounding filaments, creating conditions for the high production in spring.
Management as a (Self) Confidence Trick: Management Ideas, Education and Identity Work
Authors: Sturdy Andrew , Brocklehurst Michael , Winstanley Diana , Littlejohns Margaret
Published: October 2006

Debates on the impact of management ideas tend to assume a mechanistic view of knowledge with its value or threat conceived of in terms of the extent to which it is directly applied in practice. This is echoed in policies and practices of management education in terms of an emphasis on practical relevance. Such debates typically neglect processual views of knowledge and, in particular, the existential and associated emotional aspects of ‘acquiring’ knowledge—learning as becoming. This article explores managers’ reflections on the consequences of studying a range of explicit management ideas within the context of the MBA. Some direct translation, combination and application of ideas is evident, along with the more indirect discursive construction of an identity as ‘strategic’ or managerial in content. However, the reverse is more evident, where opportunities for application to organizational practices are seen as inappropriate or impeded within the organization. Instead the principal outcome of ideas acquisition and the process of ‘acquiring’ them is an (albeit necessarily precarious) sense of ‘self-confidence’, which is reinforced through discourse. The MBA thus becomes a means for acquiring appropriate language fluency in management and the self-confidence to gain legitimacy and social privilege in senior management. The article points to the analytical value of exploring the translation of knowledge beyond that of the transformation of ideas and of the discursive content of identity towards the existential-emotional transitions associated with ‘identity work’. It also has significant implications for our understanding of management, management education and the centrality and boundaries of knowledge as an organizing concept.
Negotiating the indistinct: reflections of a Korean Adopted American working with Korean Born, Korean Americans
Authors: Palmer John D.
Published: October 2006

The article addresses the ambiguities around my researcher role and racial/ethnic identity as a Korean Adopted American qualitative researcher working with Korean Born, Korean American high school students. These ambiguities stem from my attempts to be recognized and accepted by the participants as an insider researcher. However, the participants delineated and established my researcher role and racial/ethnic identity as an outsider, which ultimately had a profound influence on our relationship and the overall research project. Accordingly in this article, I reflect on my racial/ethnic identity development and research role by discussing: 1) how my racial/ethnic identity led me to believe that I held insider status with the participants, 2) how my racial/ethnic identity was challenged by the participants, and 3) how my researcher role and racial/ethnic identity were ultimately modified through interactions with the participants.
Abduction as the type of inference that characterizes the development of a grounded theory
Authors: Richardson Rudy , Kramer Eric Hans
Published: October 2006

In this article, abduction is introduced in relation to theorizing in grounded theory. Theoretical insights are inevitable cornerstones of the development of a grounded theory and abduction is worked out as a type of inference that characterizes this development. How abduction could be used in grounded theorizing is shown in a grounded theory research on ‘organizing doubt’, i.e. the way Dutch army units are formed with self-organizing capabilities that can be deployed during crisis operations. The authors show that two concepts from organizational theory that are central in this grounded theory’s analytical framework - i.e. ‘dynamic complexity’ and ‘self-organization’ - are developed and embedded in a substantive theory on ‘organizing doubt’ by abductive reasoning.
Heideggerian Law Beyond Law? Technique, Recht, and Phusis
Authors: Norris Andrew
Published: October 2006

In this essay I situate Philippe Nonet's reading of the Antigone within his larger Heideggerian Destruktion of the tradition of Western legal philosophy. I argue that the sweeping terms of Nonet's condemnation of that tradition as a mode of nihilism place significant strains upon his reading of the tragedy, and, more importantly, leave little reason to hope that an appreciation of the law Nonet sees embodied in the Gestalt of Antigone's person will help us understand or address, even indirectly, the problems with which Recht and Gesetz are concerned.
Le Droit du Plus Fort: Lawas Metaphor and Morality in Milton's Samson Agonistes
Authors: Yovel Jonathan
Published: October 2006

This study explores the emergence of legal language as the salient language for social relations in early modernity, through its prominence in the last, most personal and most passionate work of John Milton, the dramatic poem Samson Agonistes (1671). In this extraordinary work, law functions as a secularized order of obligations on different levels of metaphor. In each of the poem's major parts some legal construction is introduced metaphorically in such a way as to render coherence, meaning and unity to its central argument. The source of normative obligation is transformed from divine command (or grace) to a secularized paradigm of legality. Through their distinctive and developing voices, the characters reveal their relations as framed by mutual expectations grounded in reciprocal rights and duties, conveniently arranged in the several forms of legal relations. Likewise, claims of transgressions are arranged and presented in recognizable social-normative forms, i.e. along legal lines of English family law, property law, and the law of trusts and bonds.

With Hobbes, political theory became grounded in a normative framework independent of religion, and the legal metaphor of “social contract” became the prevalent metaphor in political theory. This study - dealing not so much in law and literature as in the history of legal language - traces how Milton, the generation's foremost humanist, cast law both as an internal grammar for social relations and as an interpretative principle of action. Albeit a religious author, Milton's last work's extensive use of legal language anticipates one of modernity's most recognizable structures, namely the emergence of law as the salient normative field.
RiboSubstrates: a web application addressing the cleavage specificities of ribozymes in designated genomes
Authors: Lucier Jean-François , Bergeron Lucien Junior , Brière Francis P , Ouellette Rodney , Elela Sherif Abou , Perreault Jean-Pierre
Published: October 2006

Background

RNA-dependent gene silencing is becoming a routine tool used in laboratories worldwide. One of the important remaining hurdles in the selection of the target sequence, if not the most important one, is the designing of tools that have minimal off-target effects (i.e. cleaves only the desired sequence). Increasingly, in the current dawn of the post-genomic era, there is a heavy reliance on tools that are suitable for high-throughput functional genomics, consequently more and more bioinformatic software is becoming available. However, to date none have been designed to satisfy the ever-increasing need for the accurate selection of targets for a specific silencing reagent.

Results

In order to overcome this hurdle we have developed RiboSubstrates http://www.riboclub.org/ribosubstrates. This integrated bioinformatic software permits the searching of a cDNA database for all potential substrates for a given ribozyme. This includes the mRNAs that perfectly match the specific requirements of a given ribozyme, as well those including Wobble base pairs and mismatches. The results generated allow rapid selection of sequences suitable as targets for RNA degradation. The current web-based RiboSubstrates version permits the identification of potential gene targets for both SOFA-HDV ribozymes and for hammerhead ribozymes. Moreover, a minimal template for the search of siRNAs is also available. This flexible and reliable tool is easily adaptable for use with any RNA tool (i.e. other ribozymes, deoxyribozymes and antisense), and may use the information present in any cDNA bank.

Conclusion

RiboSubstrates should become an essential step for all, even including "non-RNA biologists", who endeavor to develop a gene-inactivation system.
The machine as psychotherapist: impersonal communication with a machine
Authors: Tantam Digby
Published: October 2006

Machines will replace therapists and counsellors. This was the confident prediction made a decade ago. In this article, I discuss the inherent limitations of machines as conversationalists that have prevented the prediction from coming true. Machines can, however, be exploited to assist therapy and I consider the following digital tools: test administration; managing procedural, symptom-relieving cognitive–behavioural therapies; providing virtual environments for immersive behavioural therapies and for e-learning; and assisting training through automated discourse analysis and the use of cognitive maps.
The machine as intermediary: personal communication via a machine
Authors: Tantam Digby
Published: October 2006

The physical co-presence of psychotherapist or counsellor and client has been considered essential to the development of the therapeutic relationship. Psychotherapists have often, therefore, been resolutely opposed to anything other than face-to-face therapy. The richness and ubiquity of internet communication is likely to change that. I consider here the circumstances in which internet psychotherapy is indicated, some of the new problems it poses, including boundary-keeping and ethics, along with some solutions to these problems. The potential of the internet has already been exploited by many clients themselves and I conclude with a consideration of the growth of internet-based peer support groups.
Survey of clozapine use by consultant old age psychiatrists
Authors: Paranthaman Raghupathy , Baldwin Robert C.
Published: October 2006

Aims and Method

The aim of the survey was to assess the attitudes of specialists in old age psychiatry towards the use of clozapine in elderly patients. A postal questionnaire was sent to a random sample of 155 consultant old age psychiatrists in England.

Results

The response rate was 87%. A majority of respondents felt that clozapine had a useful place in the treatment of elderly patients, although they expressed concerns about the lack of published data and about safety and practical difficulties in monitoring. Prescribers of clozapine (n=45) were significantly more positive about its role in treating older patients than those who had not used it.

Clinical Implications

The findings suggest that familiarity with and confidence in clozapine and practical difficulties in monitoring are important determinants of its use in older patients.
Palifermin Reduces the Incidence of Oral Mucositis in Patients With Metastatic Colorectal Cancer Treated With Fluorouracil-Based Chemotherapy
Authors: Rosen Lee S. , Abdi Ehtesham , Davis Ian D. , Gutheil John , Schnell Frederick M. , Zalcberg John , Cesano Alessandra , Gayko Urte , Chen Mon-Gy , Clarke Stephen
Published: October 2006

Purpose

To characterize the efficacy and safety of palifermin in reducing the incidence of oral mucositis (OM) and diarrhea when administered to patients with metastatic colorectal cancer (CRC) receiving fluorouracil/leucovorin (FU/LV) chemotherapy.

Patients and Methods

Patients (N = 64) were randomly assigned to receive either placebo or palifermin (40 μg/kg for 3 consecutive days) before each of two consecutive cycles of chemotherapy with FU/LV. The incidence of OM and diarrhea, safety, disease progression, and survival were evaluated.

Results

Thirty-six patients received placebo and 28 patients received palifermin. The incidence of WHO grade 2 or higher OM was lower in patients who received palifermin compared with placebo (29% v 61% in cycle 1; 11% v 47% in cycle 2). FU dose reductions in the second chemotherapy cycle were more frequent in the placebo group (31%) than in the palifermin group (14%). Investigators reported lower mucositis scores and patients reported less severe symptoms with palifermin. There were no statistically significant differences in the incidence or severity of diarrhea or in overall survival between the groups. Overall, palifermin was safe and well tolerated.

Conclusion

Palifermin administered at the indicated dosing regimen (40 μg/kg for 3 consecutive days) before chemotherapy was well tolerated and resulted in a statistically significant and clinically meaningful reduction in the incidence of WHO grade 2 or higher OM in patients with metastatic CRC.
Measuring and Mitigating the Costs of Stockouts
Authors: Anderson Eric T. , Fitzsimons Gavan J. , Simester Duncan
Published: October 2006

There is now an extensive theoretical literature investigating optimal inventory policies for retailers. Yet several recent reviews have recognized that these models are rarely applied in practice. One explanation for the paucity of practical applications is the difficulty of measuring how stockouts affect both current and future demand. In this paper, we report the findings of a large-scale field test that measures the short- and long-run opportunity cost of a stockout. The findings confirm that the adverse impact of a stockout extends to both other items in the current order as well as future orders.

We show how the findings can be used to provide input to inventory planning models and illustrate how failing to account for the long-run effects of a stockout will lead to suboptimal inventory decisions. We also demonstrate how the findings can be used in a customer lifetime value model. Finally, the study investigates the effectiveness of different responses that firms can offer to mitigate the cost of stockouts. There is considerable variation in the effectiveness of these responses. Offering discounts to encourage customers to backorder rather than cancel their orders is widely used in practice, but that was the least profitable of the responses that we evaluated. The findings have important implications for retailers considering the use of discounts as a response to stockouts.
Surgical management of nasopharyngeal angiofibroma with intracranial extension
Authors: Krekorian Edmund A. , Kato Ronald H.
Published: October 2006

Intracranial extension of nasopharyngeal angiofibroma is a condition difficult to diagnose and even more difficult to treat. Often the diagnosis is not suspected until autopsy. The management of intracranial extension has included incomplete removal via the extracranial approach, radiation therapy, hormonal therapy and cryosurgery. The results of these therapeutic efforts have been characterized by persistent tumor, severe hemorrhage, intracranial complications and death.

The combined intra‐extracranial approach shows some promise of total tumor removal in the patient with intracranial extension with minimal morbidity. The general criteria of patient selection, risks, surgical technique and case histories of two patients are presented.
Management of carcinoma of the lip
Authors: Bailey Bykon J.
Published: October 2006

Carcinoma of the lip is a very common variety of head and neck malignancy, usually seen in elderly white male patients. Surgical management is recommended for most patients because of the advantages which it offers in the areas of tumor tissue evaluation, cosmetic results, cure rate, long‐teim scar tolerance, the avoidance of radiotherapy complications, time requirements, and rapid rehabilitation. Radiotherapy should be considered for the eldei'ly patient with a small, localized lesion and for the patient who is not an acceptable surgical candidate. Specific surgical techniques are discussed in detail.

It is the purpose of this paper to provide the reader with a greater awareness of the behavior and clinical management of lip carcinoma, and to review information which will be helpful to the reader in his future management of these problems.
Toward the total rehabilitation of the alaryngeal patient
Authors: Johnson Jonas T. , Casper Janina , Lesswing N. Jacob
Published: October 2006

Rehabilitative efforts directed toward the total laryngectomee are receiving increasing interest. Fifteen to 50% of laryngectomees fail to develop speech, and 50% do not return to full employment. Many make poor psychological adjustment.

A study was designed wherein laryngectomees and their families were individually interviewed. These people suggested that their rehabilitation could have been facilitated had they been better informed preoperatively. Many expressed a desire for exposure to a speech pathologist and a successfully rehabilitated laryngectomee preoperatively.

A total of 1,276 otolaryngologists were surveyed regarding the substance and amount of information they believed patients should receive prior to laryngectomy.

Otolaryngologists, in the main, feel that they do fully and adequately inform their patients. Speech pathologists and rehabilitated laryngectomy patients are often called to see patients preoperatively. Nevertheless, we deduce that improvements need to be made to insure that the preoperative patient does in fact receive the information and counselling intended.
Bone conduction changes following successful tympanoplasty type I
Authors: Ostfeld Ervin , Bar‐On Chaim , Bergman Moe
Published: October 2006

Pre and one year postoperative bone conduction (b.c.) thresholds were compared for 50 ears of 48 patients, ranging in age from 14 to 42 years, in whom successful tympanic grafts resulted in at least an average improvement of 10 db for 500 to 4000 Hz. While pre and postoperative data are included for all ears and test frequencies, significant BC improvement is seen only at those frequencies, in each case, where the pre‐op BC thresholds were worse than 10 db. Normal pre‐op BC thresholds cannot show substantial improvement because of audiometric limitations. The amount of BC shift at each frequency for those with pre‐op BC thresholds that were subnormal averaged 6 db at 500 Hz, 13.3 db at 1000 Hz, 13.8 db at 2000 Hz and 9 db at 4000 Hz, all highly significant statistically. There were no significant postoperative BC shifts related either to duration of the disease process, length of postoperative period before final test (all were more than one year) or whether the surgical procedure was tympanoplasty type I or myringoplasty.