bluuebunny/crossref_metadata_2025 huggingface dataset:
Long‐term course of post‐transplant mesangial IgA deposition: clinicopathologic study of nine cases
Authors: Hara Shigeo , Yamaguchi Yutaka , Hara Shigeko , Tanimoto Akihide , Seki Kunihiko , Matsushita Hiroshi , Tomikawa Shinji , Kuzuhara Keihachiro
Published: June 2005

Abstract:  We conducted the present study to elucidate the fate of post‐transplant mesangial IgA deposit under the long‐term observation. Out of a total of 45 cases with post‐transplant mesangial IgA deposition, nine cases with more than 4 yr of follow‐up term were enrolled in this study, and clinicopathologic characteristics were described. The study included three men and six women with a mean age of 34.2 yr. The average observation time from the detection of mesangial IgA deposition was 6.1 yr. Three cases were categorized as recurrent IgA nephropathy, while six cases were classified into latent mesangial IgA deposition. One case with hypertension developed end‐stage renal disease. The significant improvement in microscopic hematuria was observed in one recurrent IgA nephropathy case. Microscopic findings included mild mesangial stalk thickening in all but one case. IgA deposition demonstrated a significant decrease in three latent mesangial IgA deposition cases. No apparent reduction in dense deposit quantity was observed on electron microscopy. There was no association between clinicopathologic findings and the regimen of anti‐immunosuppressive agents. This study showed the improvement of the disease activity did occur in both recurrent IgA nephropathy and latent mesangial IgA deposition. Further investigation of latent mesangial IgA deposition may present the important clue to the pathogenesis of IgA nephropathy.
Does repetition of post‐tetanic count every 3 min during profound relaxation affect accelerographic recovery of atracurium blockade?
Authors: Motamed C. , Kirov K. , Combes X. , Duvaldestin P.
Published: June 2005

Background:  Post‐tetanic count is a valuable method to assess profound neuromuscular blockade. However, subsequent responses to repetitive stimulation might be altered due to post tetanic facilitation (PTF). To avoid PTF, it has been advocated to limit the interval of stimulation from 6 to 10 min. The impact of PTF on 90% recovery of the TOF ratio has not been evaluated. Therefore, we assessed the effect of repetitive PTC stimulation on atracurium blockade with the primary outcome being the time to reach 90% TOF recovery in comparison to classical TOF stimulation.

Methods:  After informed consent 20 patients ASA I–II, scheduled for peripheral surgery under general anaesthesia and requiring tracheal intubation were enrolled into the study. Anaesthesia was induced with fentanyl, propofol, and atracurium, 0.5 mg kg−1. Neuromuscular characteristics were assessed at the adductor pollicis by a TOF Watch® accelerometer (Organon, Teknika, Holland) on each arm. After onset of maximum neuromuscular blockade, repetitive PTC every 3 min on one arm and repetitive TOF stimulation every 15 s on the opposite arm was performed. The following parameters were recorded: onset of maximum blockade, mean time of PTC stimulation, the maximum number of responses to PTC, time of the first and second TOF responses, and recovery profile until 90% TOF ratio.

Results:  Time to reach 90% TOF recovery was similar on both arms (48 ± 9 min), with a difference of 16 ± 38 s between the arms (P = 0.64). The first and second responses of the TOF on the PTC‐stimulated arm appeared at 29 ± 8 min and 33 ± 7 min, respectively. On the other arm the responses appeared at 30 ± 8 min and 35 ± 8 min, respectively (P < 0.05).

Conclusion:  Repetitive PTC stimulation every 3 min hastened the first and second responses of the TOF stimulation but we could not detect a significant difference in the 90% recovery of TOF ratio during atracurium blockade.
Randomized, double‐blind study comparing postoperative effects of treatment timing with histamine H2‐receptor antagonist cimetidine
Authors: Chia Y‐Y. , Chiang H‐L. , Liu K. , Ko N‐H.
Published: June 2005

Background:  The purpose of this study was to evaluate the effect of timing of preoperative, postoperative, and placebo administration of the H2‐antagonist cimetidine on postoperative pain management and the incidence of side‐effects.

Methods:  One hundred and twenty ASA I to II patients, undergoing major gynaecological abdominal surgery, were randomly divided into three groups, and received a standardized general anaesthesia. The patients in the preoperative (‘Pre’) group received an intravenous infusion of cimetidine 4 mg kg−1 prior to anaesthesia induction; the postoperative (‘Post’) group received the same volume of normal saline. Postoperatively, the patients in the Post group received an intravenous infusion of cimetidine 4 mg kg−1; the patients in the Pre group received the same volume of normal saline. The Control group received the same volume of normal saline prior to anaesthesia induction and after the end of operation. Postoperatively, all patients were treated with a patient‐controlled intravenous analgesia system, which was programmed to deliver 1 mg of morphine on demand for three consecutive days.

Results:  Pain intensity, morphine consumption, sedation score, and side‐effects were recorded and evaluated. We found no difference among the three groups with respect to pain intensities, morphine usage, sedation scores, and the incidence of nausea, vomiting, pruritus, or dizziness.

Conclusions:  Our results suggested that neither preoperative nor postoperative administration of cimetidine 4 mg kg−1 provided a pre‐emptive or preventive analgesic advantage for postoperative pain or morphine consumption, and that the use of cimetidine failed to reduce the incidence of nausea or vomiting.
Home haemodialysis: ‘home, home, sweet, sweet home!’ (Review Article)
Authors: BLAGG CHRISTOPHER R
Published: June 2005

SUMMARY:  Home haemodialysis was first developed 40 years ago as a means of treating more patients with the limited funds then available. It soon became obvious that the treatment worked well and subsequent studies and experience have confirmed that it improves both mortality and morbidity and provides the best quality of life and other benefits for dialysis patients. The present review describes the history of the development of home haemodialysis in Seattle and elsewhere and the lessons learned about its benefits in the early days, which are just as relevant today. The advantages and disadvantages are discussed, as are the issues of which patients are candidates for this treatment and what is required of a home haemodialysis training and support programme. The decline in use of home haemodialysis in the USA and elsewhere is described and the actions that may already be beginning to reverse this trend. The role of home haemodialysis in giving the opportunity for longer hours of dialysis three times a week or on alternate nights is important. There is discussion of the relationship of home haemodialysis and peritoneal dialysis and its important future role as the means to enable treatment with more frequent short daily and long nightly haemodialysis.
Postischemic exercise attenuates whereas enriched environment has certain enhancing effects on lesion‐induced subventricular zone activation in the adult rat
Authors: Komitova Mila , Zhao Li Ru , Gidö Gunilla , Johansson Barbro B. , Eriksson Peter
Published: June 2005

Experimental stroke increases cell proliferation and neurogenesis in the subventricular zone (SVZ) and in the dentate gyrus subgranular zone (SGZ) in the adult mammalian brain. This study examined the effects of postischemic voluntary exercise (running wheel) and environmental enrichment on the SVZ and SGZ 1 week after focal cortical ischemia in adult spontaneously hypertensive rats. Immunohistochemical labeling was performed for incorporation of specific cell markers such as Ki67 and 5‐bromodeoxyuridine (proliferating and newborn cells), terminal deoxynucleotidyl transferase‐mediated dUTP in situ nick‐end labeling (apoptotic cells), Sox‐2 and glial fibrillary acidic protein (neural stem and progenitor cells), polysialylated neural cell adhesion molecule and doublecortin (neuroblasts). Postischemic exercise and environmental enrichment differentially modulated SVZ cell genesis but lacked effects on the SGZ. Lesion‐induced proliferation of neural stem/progenitor cells and neuronal precursors was attenuated in stroke runners without any effects on apoptosis or neuronal migration in the forebrain. Running activity did not affect the SVZ in intact rats. In contrast to postischemic wheel running, postischemic environmental enrichment did not have attenuating effects on the ipsilateral SVZ and increased proliferating putative neural stem cells and neuronal precursors contralaterally. A significant functional improvement, assessed using a rotating pole, was observed only in the postischemically enriched group and was likely due to other types of plasticity than neuronal replacement at this early time point. It may be concluded that in contrast to enriched environment, exercise during the first postischemic week might be detrimental for regenerative processes initiated in the SVZ after stroke.
Estrogen increases sensory nociceptor neuritogenesis in vitro by a direct, nerve growth factor‐independent mechanism
Authors: Blacklock A. D. , Johnson M. S. , Krizsan‐Agbas D. , Smith P. G.
Published: June 2005

Estrogen affects many aspects of the nervous system, including pain sensitivity and neural regulation of vascular function. We have shown that estrogen elevation increases sensory nociceptor innervation of arterioles in Sprague–Dawley rat mammary gland, external ear and mesentery, suggesting widespread effects on sensory vasodilatory innervation. However, it is unclear whether estrogen elicits nociceptor hyperinnervation by promoting target release of neurotrophic factors, or by direct effects on sensory neurons. To determine if estrogen may promote axon sprouting by increasing release of target‐derived diffusible factors, dorsal root ganglia explants were co‐cultured with mesenteric arterioles for 36 h in the absence or presence of 17β‐estradiol (E2). Mesenteric arteriolar target substantially increased neurite outgrowth from explanted ganglia, but estrogen had no effect on outgrowth, suggesting that estrogen does not increase the availability of trophic proteins responsible for target‐induced neurite outgrowth. To assess the direct effects of estrogen, dissociated neonatal dorsal root ganglion neurons were cultured for 3 days in the absence or presence of E2 and nerve growth factor (NGF; 1–10 ng/mL), and immunostained for the nociceptor markers peripherin or calcitonin gene‐related peptide. NGF increased neuron size, survival and numbers of neurons with neurites, but did not affect neurite area per neuron. Estrogen did not affect neuron survival, size or numbers of neurons with neurites, but did increase neurite area per neuron. The effects of these agents were not synergistic. We conclude that estrogen exerts direct effects on nociceptor neurons to promote axon outgrowth, and this occurs through an NGF‐independent mechanism.
Mice lacking dopamine D1 receptors express normal lithium chloride‐induced conditioned taste aversion for salt but not sucrose
Authors: Cannon Claire Matson , Scannell Christopher A. , Palmiter Richard D.
Published: June 2005

Conditioned taste aversion (CTA), is a form of Pavlovian learning wherein a novel flavour is powerfully associated with subsequent feelings of illness, and is afterwards avoided. In rats, pharmacological blockade of dopamine D1 receptors has been reported to prevent the expression of a CTA to the sweet taste of sucrose or saccharine. We used genetically modified mice to determine whether dopamine D1 receptors are necessary for the expression of a CTA. Food‐deprived mice lacking the dopamine D1 receptor (D1r–/–) did not express a LiCl‐induced (125 or 254 mg/kg) CTA to the sweet taste of 0.5 m sucrose, in agreement with previous pharmacological studies. However, water‐deprived D1r–/– mice did express normal LiCl‐induced (40, 150 and 254 mg/kg) CTA to a salty taste (0.2 m NaCl). Our results suggest that activation of D1 receptors might contribute to the strength of an aversive gustatory association, but might not be required for the formation of a CTA in general.
Comparative evaluation of midazolam and ketamine with midazolam alone as oral premedication
Authors: GHAI BABITA , GRANDHE RADHIKA PRASAD , KUMAR ARUN , CHARI PRAMILA
Published: June 2005

Background : Oral premedication with midazolam and ketamine is widely used in pediatric anesthesia to reduce emotional trauma and ensure smooth induction. However, various dosing regimens when used alone or in combination have variable efficacy and side effect profile. The aim of our study was to investigate and compare the efficacy of oral midazolam alone with a low‐dose combination of oral midazolam and ketamine.

Methods : We performed a prospective randomized double‐blind study in 100 children who were randomly allocated into two groups. Group M received 0.5 mg·kg−1 oral midazolam and group MK received 0.25 mg·kg−1 oral midazolam with 2.5 mg·kg−1 oral ketamine. The preoperative sedation score, ease of parental separation and ease of mask acceptance were evaluated on a 4‐point scale. The time to recovery from anesthesia and to achieve satisfactory Aldrete score was also noted.

Results : Uniform and acceptable sedation scores were seen in both the groups (group M 95.9%; group MK 97.96%), without any serious side effects. However, the combination offered significantly more children in an awake, calm and quiet state, who were easily separated from their parents (73.46% in MK vs 41% in group M). The induction scores were comparable between the groups. The recovery room characteristics and time to achieve satisfactory Aldrete score were also comparable between the two groups.

Conclusions : Oral midazolam alone and a combination of midazolam with ketamine provide equally effective anxiolysis and separation characteristics. However, the combination provided more children in an awake, calm and quiet state who could be separated easily from parents.
Perioperative management of a child with severe hypertension from a catecholamine secreting neuroblastoma
Authors: SEEFELDER CHRISTIAN , SPARKS J. WILLIAM , CHIRNOMAS DEBORAH , DILLER LISA , SHAMBERGER ROBERT C.
Published: June 2005

Increased catecholamine secretion from neuroblastomas can occasionally be demonstrated, but severe hypertension is uncommon. We report the perioperative management of a 5 year old child with stage III adrenal neuroblastoma who presented with malignant hypertension and high norepinephrine and dopamine levels. Hypertensive crises occurred during anesthesia for surgical biopsy and during chemotherapy. After blood pressure control using phenoxybenzamine and enalapril, doxazosin was used successfully as the preoperative α‐adrenergic receptor antagonist for surgical tumor resection.
A unified treatment of top‐down and bottom‐up control of reproduction in populations
Authors: Munch Stephan B. , Snover Melissa L. , Watters George M. , Mangel Marc
Published: June 2005

Generalizations describing how top‐down and bottom‐up processes jointly influence the production of offspring (recruitment) and the number of reproducing adults are lacking. This is a deficiency because (1) it is widely recognized that both top‐down and bottom‐up processes are common in ecosystems; and (2) the relationship between the number of individuals recruiting and number of reproductively active individuals present in that population is of fundamental importance in all branches of ecology. Here we derive a model to consider the joint effects of top‐down and bottom‐up forcing in any ecosystem. In general, during the lifetime of a cohort, bottom‐up effects are likely to limit recruitment over longer periods of time than top‐down effects. Top‐down effects are likely to be most important early in the life history when potential recruits are small in size, and such effects will be more recognizable in small cohorts comprised of slowly growing individuals.
The enemy release and EICA hypothesis revisited: incorporating the fundamental difference between specialist and generalist herbivores
Authors: Joshi J. , Vrieling K.
Published: June 2005

The success of invasive plants has been attributed to their escape from natural enemies and subsequent evolutionary change in allocation from defence to growth and reproduction. In common garden experiments with Senecio jacobaea, a noxious invasive weed almost worldwide, the invasive populations from North America, Australia, and New Zealand did indeed allocate more resources to vegetative and reproductive biomass. However, invasive plants did not show a complete change in allocation from defence to growth and reproduction. Protection against generalist herbivores increased in invasive populations and pyrrolizidine alkaloids, their main anti‐herbivore compounds, did not decline in invasive populations but were higher overall compared with native populations. In contrast, invasive plants lost additional protection against specialist herbivores adapted to pyrrolizidine alkaloids. Hence, the absence of specialist herbivores in invasive populations resulted in the evolution of lower protection against specialists and increased growth and reproduction, but also allowed a shift towards higher protection against generalist herbivores.
Studying invasion: have we missed the boat?
Authors: Puth Linda M. , Post David M.
Published: June 2005

Invasive species, and the ensuing homogenization of the world's biota, form a global problem with consequences ranging from the decline and extirpation of native species to threats to human health. The magnitude of this issue demands a thorough understanding of the invasion process, which consists of three main stages: initial dispersal, establishment of self‐sustaining populations, and spread. To assess the relative distribution of research effort among these stages, we conducted a literature review using 873 articles published in 23 major journals over the past 10 years. Of the 873 papers, only 96 (11.0%) studied initial dispersal, and only half of these (6.2% of the total) were empirical. As the first stage in a contingent process, we argue that initial dispersal is the best stage during which to direct management efforts. In addition, initial dispersal has direct relevance for fundamental ecological questions regarding community assembly and metacommunity dynamics. In so far that answering these questions and preventing invasion are goals of ecologists, the disparity in research effort noted here suggests that ecologists need to expand their efforts to include more research on initial dispersal.
Sources of Openness/Intellect: Cognitive and Neuropsychological Correlates of the Fifth Factor of Personality
Authors: DeYoung Colin G. , Peterson Jordan B. , Higgins Daniel M.
Published: June 2005

AbstractWe characterize Openness/Intellect as motivated cognitive flexibility, or cognitive exploration, and develop a neuropsychological model relating it to dopaminergic function and to the functions of the prefrontal cortex (PFC). Evidence is reviewed for sources of Openness/Intellect shared with Extraversion and sources unique to Openness/Intellect. The hypothesis that the cognitive functions of the dorsolateral PFC are among the latter was tested using standard measures of cognitive ability and a battery of tasks associated with dorsolateral PFC function (N=175). Dorsolateral PFC function, as well as both fluid and crystallized cognitive ability, was positively related to Openness/Intellect but no other personality trait. Additionally, facet level analysis supported the characterization of Openness/Intellect as a primarily cognitive trait.
Processing of Facial Expressions of Negative Emotion in Alexithymia: The Influence of Temporal Constraint
Authors: Parker Philippa D. , Prkachin Kenneth M. , Prkachin Glenda C.
Published: June 2005

Abstract
Alexithymia, a characteristic involving a limited affective vocabulary appears to involve three components: difficulty identifying feelings, difficulty describing feelings, and externally oriented thinking. There is evidence that alexithymic characteristics are associated with differences in emotion information‐processing. We examined the role of temporal factors in alexithymic emotion‐processing deficits, taking into account the confound between alexithymic characteristics and positive and negative affectivity. One hundred forty‐six participants completed the 20‐item Toronto Alexithymia Scale and the Positive and Negative Affect Schedule. In a signal‐detection paradigm, participants judged facial expressions depicting neutral or negative emotions under slow and rapid presentation conditions. The alexithymia component of difficulty in describing feelings was inversely related to the ability to detect expressions of negative emotion in the speeded condition. This relationship was independent of positive and negative affectivity. Alexithymic components positive and negative affectivity were unrelated to response bias. The results emphasize the influence of difficulty describing feelings within the alexithymia construct and its difference from positive and negative affectivity. They suggest that an alexithymic deficit in describing feelings is associated with a deficit in processing negative emotions that is most apparent when processing capacity is challenged. Theoretical and methodological implications are discussed.
A Complete History of Early Christianity: Taking the “Heretics” Seriously1
Authors: FRANZMANN MAJELLA
Published: June 2005

The heterodox have been treated unfairly within the histories of mainstream Christian tradition, whether by their ecclesiastical opponents or by recent and current scholarship. This article outlines the place of Christian Gnostic belief and practices in the processes of self‐definition and institutionalization that took place within the early history of Christianity and makes a plea to reinstate the “heretics” to their rightful place in any academic discussion of the history and beliefs of Christianity.
Serum uric acid, dehydroepiandrosterone sulphate, and apolipoprotein E genotype in benign vs. progressive multiple sclerosis
Authors: Ramsaransing G. S. M. , Heersema D. J. , De Keyser J.
Published: June 2005

The majority of patients with multiple sclerosis (MS) experience gradual progression of disability, either as secondary progressive MS (SPMS) or primary progressive MS (PPMS). A subgroup with relapsing–remitting MS shows a benign course with little or no disease progression and minimal disability decades after the first manifestations, so called benign MS (BMS). In our search to identify factors that are associated with progression of MS, we investigated serum levels of uric acid and dehydroepiandrostenedione sulphate (DHEAS), and apolipoprotein (apo)E genotype in 28 patients with BMS, 33 with SPMS, 21 with PPMS, and 29 healthy individuals. We found no significant changes in uric acid levels and apoE genotype between the four groups. Mean DHEAS levels were lower in MS patients compared with healthy controls (P = 0.049), but there were no significant differences between the clinical subgroups of MS. In patients with SPMS and PPMS there was no correlation between progression rate and serum levels of either uric acid or DHEAS. Our results suggest that serum levels of uric acid and DHEAS, and apoE genotype do not differ between patients with a benign and progressive course of MS.
Ocular complications of neurological therapy
Authors: Hadjikoutis S. , Morgan J. E. , Wild J. M. , Smith P. E. M.
Published: June 2005

Treatments used for several neurological conditions may adversely affect the eye. Vigabatrin‐related retinal toxicity leads to a visual field defect. Optic neuropathy may result from ethambutol and isoniazid, and from radiation therapy. Posterior subcapsular cataract is associated with systemic corticosteroids. Transient refractive error changes may follow treatment with acetazolamide or topiramate, and corneal deposits and keratitis with amandatine. Intraocular pressure can be elevated in susceptible individuals by anticholinergic drugs, including oxybutynin, tolterodine, benzhexol, propantheline, atropine and amitriptyline, and also by systemic corticosteroids and by topiramate. Nystagmus, diplopia and extraocular muscle palsies can occur with antiepileptic drugs, particularly phenytoin and carbamazepine. Ocular neuromyotonia can follow parasellar radiation. Congenital ocular malformations can result from in utero exposure to maternally prescribed sodium valproate, phenytoin and carbamazepine. Neurologists must be aware of potential ocular toxicity of these drugs, and appropriately monitor for potential adverse events.
Platelet Activation and Platelet-Leucocyte Interaction in Patients with Migraine. Subtype Differences and Influence of Triptans
Authors: Zeller JA , Lindner V , Frahm K , Baron R , Deuschl G
Published: June 2005

As migraine is the result of an inflammatory mechanism with serotonergic signalling, leucocyte function, platelet function and intercellular communication between those cells is likely to be connected to the final pathway of the disease. We examined P-selectin expression on platelets (platelet activation) and leucocyte-platelet aggregate formation in 72 migraine patients during their attack-free interval and controls using a flow cytometric assay. Patients suffering from migraine without aura had a significantly increased platelet activation and leucocyte-platelet aggregation compared with the control group, unlike the migraine patients with aura. Patients who had taken a triptan within 3 days prior to the investigation showed platelet activation values similar to the control group. The variations in platelet activation patterns of migraine subgroups could indicate different pathomechanisms. Even outside an attack, migraine patients, particularly those without aura, show an increased level of platelet activation which seems to be down-regulated by triptans. This mechanism may account for the triptan-induced increases in headache frequency. The involvement of proinflammatory platelet-leucocyte cross-talk suggests a possible therapeutic strategy using anti-inflammatory drugs.
The impact of intrapartum analgesia on infant feeding
Authors: Jordan Sue , Emery Simon , Bradshaw Ceri , Watkins Alan , Friswell Wendy
Published: June 2005

Objective  To investigate the impact of intrapartum analgesia on infant feeding at hospital discharge.

Design  Retrospective cohort.

Setting  Maternity unit of a UK district general hospital.

Population  A random sample of 425 healthy primiparae delivering healthy singleton babies at term in 2000.

Methods  A random sample of primiparae delivering term neonates was identified from the birth register. We retrieved and analysed the corresponding joint midwifery/obstetric case notes.

Main outcome measure  Infant feeding method at discharge from hospital.

Results  Women [190/424 (45%)] were exclusively bottle feeding their babies at discharge from hospital. No one commenced breastfeeding after hospital discharge. Regression analysis revealed that the main determinants of bottle feeding were as follows: maternal age [odds ratio (OR) 0.90, 95% confidence interval [CI] 0.85–0.95 per year]; occupation (OR 0.63, 95% CI 0.40–0.99 for each category, unemployed, manual, non‐manual); antenatal feeding intentions (OR 0.12, 95% CI 0.080–0.19 for each category, bottle feeding, undecided, breastfeeding); caesarean section (OR 0.25, 95% CI 0.13–0.47, caesarean or vaginal delivery); and dose of fentanyl administered intrapartum (OR 1.004, 95% CI 1.000–1.008, 90% CI 1.001–1.007 for each microgram administered, range 8–500 μg).

Conclusions  A dose–response relationship between fentanyl and artificial feeding has not been reported elsewhere. When well‐established determinants of infant feeding are accounted for, intrapartum fentanyl may impede establishment of breastfeeding, particularly at higher doses.
Cohort study of maternal and neonatal morbidity in relation to use of episiotomy at instrumental vaginal delivery
Authors: Youssef Refaat , Ramalingam Uma , Macleod Maureen , Murphy Deirdre J.
Published: June 2005

Objective  The aim of this study was to investigate the maternal and neonatal morbidity related to use of episiotomy for vacuum and forceps deliveries.

Design  Retrospective population‐based cohort study.

Setting  Dundee, Scotland.

Population  Two thousand one hundred and fifty three women who experienced an instrumental vaginal delivery between January 1998 and December 2002.

Methods  Univariate and multivariate logistic regression analyses were performed comparing deliveries with and without the use of episiotomy.

Main outcome measures  Extensive perineal tears (third and fourth degree) and shoulder dystocia.

Results  Two hundred and forty‐one (11%) of the 2153 women who underwent instrumental vaginal deliveries did not receive an episiotomy. Vacuum delivery was associated with less use of episiotomy compared with forceps (odds ratio 0.10, 95% CI 0.07–0.14). Extensive perineal tears were more likely with use of episiotomy (7.5%vs 2.5%, adjusted OR 2.92, 95% CI 1.27–6.72) as was neonatal trauma (6.0%vs 1.7%, adjusted OR 2.62, 95% CI 1.05–6.54). Use of episiotomy did not reduce the risk of shoulder dystocia (6.9%vs 4.6%, adjusted OR 1.43, 95% CI 0.74–2.76). The findings were similar for delivery by vacuum and forceps.

Conclusion  The use of episiotomy increased the risk of extensive perineal tears without a reduction in the risk of shoulder dystocia.
Outcomes of severe pre‐eclampsia/eclampsia in Yorkshire 1999/2003
Authors: Tuffnell D.J. , Jankowicz D. , Lindow S.W. , Lyons G. , Mason G.C. , Russell I.F. , Walker J.J. ,   On behalf of the Yorkshire Obstetric Critical Care Group
Published: June 2005

Objective  To establish the risk of serious complications from severe pre‐eclampsia and eclampsia in a region using a common guideline for the management of these conditions.

Design  A five‐year prospective study.

Setting  Sixteen maternity units in Yorkshire.

Population  All women managed with severe pre‐eclampsia and eclampsia.

Methods  A common guideline was developed for the management of women with these conditions. A network of midwives prospectively collected outcome data.

Main outcome measure  Incidence of the conditions and serious complication rates.

Results  A total of 210,631 women delivered in the 16 units between 1 January 1999 and 31 December 2003. One thousand eighty‐seven women were diagnosed with severe pre‐eclampsia or eclampsia (5.2/1000). One hundred and fifty‐one women had serious complications including 82 women (39/10,000) having eclamptic seizures and 49 women (23/10,000) requiring ICU admission. There were no maternal deaths but 54 out of 1145 babies died before discharge, giving a mortality rate of 47.2/1000. Of the 82 cases of eclampsia, 45 occurred antenatally (55%), 18 before admission to the maternity unit. Eleven cases occurred in labour (13%), including 1 during a caesarean section, and 26 cases occurred following delivery (32%). Twenty‐five women developed pulmonary oedema (2.3% of cases) and six women required renal dialysis (0.55% of cases). One hundred and sixty‐five (15%) required no antihypertensive therapy and 489 (53%) of the remainder required only oral therapy. Two hundred and one (18.5%) required more than one drug.

Conclusion  A regional guideline for severe pre‐eclampsia and eclampsia can be developed and implemented. Its use may contribute to a low rate of serious complications.
Neonatal death after hypoxic ischaemic encephalopathy: does a postmortem add to the final diagnoses?
Authors: Elder Dawn E. , Zuccollo Jane M. , Stanley Thorsten V.
Published: June 2005

Background  Case review after fatal perinatal asphyxia may have medicolegal implications. Accurate diagnosis of cause of death is therefore essential.

Objective  To determine consent rate and utility of autopsy after fatal grade III hypoxic ischaemic encephalopathy (HIE) presumed to be secondary to birth asphyxia.

Design  A retrospective clinical review from January 1995 to December 2002.

Setting  Regional tertiary referral neonatal unit, Wellington, New Zealand.

Population  Inclusion criteria were gestation ≥37 weeks, resuscitation after delivery and clinical course of grade III HIE. Exclusions were a recognised major lethal malformation.

Methods  Review of clinical records including the autopsy report.

Main outcome measures  Consent for autopsy, change in diagnosis after autopsy.

Results  Twenty‐three infants died during the time period with a major diagnosis of grade III HIE. Three did not meet inclusion criteria. Of the remaining 20, 11 were female. Median gestation at birth was 40 weeks (range 38–42 weeks) and median birth weight was 3568 g (range 2140–4475 g). In 8/17 of the infants for whom length and head measurements were available, the Ponderal Index suggested intrauterine growth retardation. The 16/20 infants had an autopsy. Four of these were Coroner's cases giving an autopsy rate of 80% with a rate by consent of 60%. In 10 (62.5%) infants, significant new information was added to the clinical diagnoses.

Conclusions  Neonatal HIE is a symptom rather than a final clinical diagnosis. A full autopsy is required to fully explore the reasons for fatal neonatal HIE and may provide information that is important medicolegally.
Postjunctional α1‐adrenoceptors in the vasculature of the pithed mouse are of the α1A‐subtype
Authors: López‐Guerrero J. J. , Ibarra M. , Villalobos‐Molina R.
Published: June 2005

1 The pressor action of noradrenaline and its blockade by selective α1‐adrenoceptor antagonists in the pithed mouse were evaluated.

2 Chloroethylclonidine (α1B/D‐adrenoceptor alkylating agent) or BMY 7378 (α1D‐adrenoceptor antagonist), both at 1 mg kg−1, did not block the increase in blood pressure induced by noradrenaline.

3 5‐Methylurapidil (α1A‐adrenoceptor antagonist), at 0.1 mg kg−1, displaced the dose–response curve approximately six‐fold to the right.

4 The results support the idea that the pithed mouse vasculature express α1A‐adrenoceptors and suggest that it is a good model to study the roles of α1‐adrenoceptors in gene knockout or overexpression.
Toward a Dynamic Learning Perspective of Entrepreneurship
Authors: Cope Jason
Published: June 2005

This conceptual article introduces a dynamic learning perspective of entrepreneurship that builds upon existing “dominant” theoretical approaches to understanding entrepreneurial activity. As many aspects of entrepreneurial learning remain poorly understood, this article maps out and extends current boundaries of thinking regarding how entrepreneurs learn. It presents key conclusions from emergent empirical and conceptual work on the subject and synthesizes a broad range of contributory adult, management, and individual learning literature to develop a robust and integrated thematic conceptualization of entrepreneurial learning. Three distinctive, interrelated elements of entrepreneurial learning are proposed—dynamic temporal phases, interrelated processes, and overarching characteristics. The article concludes by demonstrating how a “learning lens” can be applied to create further avenues for research in entrepreneurship from a learning perspective.
Experiential Learning within the Process of Opportunity Identification and Exploitation
Authors: Corbett Andrew C.
Published: June 2005

The article uses experiential learning theory to magnify the importance of learning within the process of entrepreneurship. Previous research details the contributions of prior knowledge, creativity, and cognitive mechanisms to the process of opportunity identification and exploitation; however, the literature is devoid of work that directly addresses learning. The extant research assumes learning is occurring but does not directly address the importance of learning to the process. To fully understand the nature of the entrepreneurial process, researchers must take into account how individuals learn and how different modes of learning influence opportunity identification and exploitation. This article makes connections between knowledge, cognition, and creativity to develop the concept of learning asymmetries and illustrates how a greater appreciation for the differences in individual learning will fortify entrepreneurship research.
An index for assigning distances between odor‐baited spheres on perimeter trees of orchards for control of apple maggot flies
Authors: Prokopy Ronald J. , Jácome Isabel , Bigurra Everardo
Published: June 2005

Previously, the distances between odor‐baited spheres deployed on perimeter trees of apple orchards for behavioral control of apple maggot flies, Rhagoletis pomonella (Walsh) (Diptera: Tephritidae), have been assigned largely arbitrarily. Here, we report a new approach for assigning distances that employs an index incorporating the state of four environmental variables: the size of orchard trees, quality of pruning, cultivar composition, and nature of bordering habitat. The deployment of odor‐baited spheres on the perimeters of 12 plots of apple trees (each ∼0.4 ha) in commercial orchards in 2003 resulted in an apple maggot control which was no different from that achieved by insecticide sprays in adjacent plots in 2003, and no different from that achieved by an arbitrary assignment of distances between odor‐baited spheres on perimeter trees in these same plots in 2001 and 2002. However, only 61–67% of spheres were used under the new index approach compared with the previous arbitrary approach, thereby substantially reducing the cost of behavioral control. Our findings are discussed in relation to use of the index for blocks of trees which are large in size and pruned poorly vs. small in size and pruned well, and in relation to the cost‐competitiveness of odor‐baited perimeter spheres vs. insecticidal sprays for the control of apple maggots.
Resistance to the rice leaf bug, Trigonotylus caelestialium, is conferred by Neotyphodium endophyte infection of perennial ryegrass, Lolium perenne
Authors: Shiba Takuya , Sugawara Koya
Published: June 2005

Neotyphodium fungal endophytes form mutualistic symbiotic associations with many grasses of the subfamily Pooideae, including important forage and turfgrass species. This relationship provides a competitive advantage to the host plant by increasing abiotic/biotic stress tolerance, such as its resistance to drought, diseases, and insect pests. The insect deterrent effects of endophytes are now receiving attention in Japan, as insect pests growing in meadows are causing problems in adjacent rice paddies. One of the most serious problems is the kernel spotting of rice grains caused by the rice leaf bug, Trigonotylus caelestialium Kirkaldy (Heteroptera: Miridae), which reproduces on Lolium species grown as forage. To determine the potential of Neotyphodium endophytes to reduce the invasion of rice crops by T. caelestialium from adjacent Lolium crops, we carried out choice and no‐choice feeding tests using endophyte‐infected and endophyte‐free clonal perennial ryegrass (Lolium perenne L.) (Poaceae). Our experiments revealed that the presence of the Neotyphodium endophyte strongly deterred the feeding of both first‐instar larvae and adults of T. caelestialium. These results show the potential of Neotyphodium endophytes to reduce the number of T. caelestialium in forage fields and grasslands, and thus to reduce the damage to rice grains caused by this insect pest.
Measuring and causes of inequality in farm sizes in the United States
Authors: Miljkovic Dragan
Published: June 2005

This article examines the notion of farm size inequality expressed as sales inequality in the United States. The farm size index (FSI) is developed as a measure of farm size inequality. FSIs are calculated for the farming sector in all 50 states and large variation in farm size across the states and over time is determined. The largest FSIs are calculated for a number of Southern, Southwestern, and Pacific states. Increasing FSIs over time are observed in all states as well. The spatial and temporal (between 1987 and 1997) differences in FSIs are explained by running a pooled, cross‐sectional time‐series model. The most influential variables accounting for the differences have to do with the ownership structure, where a larger presence of individual and family farms relative to corporate farms and cooperatives leads to a lower degree of farm size inequality. Also, states and regions having relatively larger number of farms owned by minorities have higher FSIs. Shrinking opportunities in the agricultural sector relative to the rest of the economy, primarily services, are reflected in a declining share of agricultural sector state income in total gross state product (GSP). This in turn leads to an increase in the farming sector's FSI suggesting that only larger, more profitable operations are the likely candidates to pursue farming activities. Finally, grains farming regions have all lower degree of farm size inequality than livestock or fruits and vegetables regions. Profitable grains farming requires relatively large farm size and equipment investments, which leads to a relatively homogeneous structure of grains farms. A larger variation in the size of profitable farm operations is possible in fruits and vegetables and livestock. This leads to the existence of a large number of very small but still sustainable farms, and a relatively small number of large farms that capture most of market sales share.
How much do farmers value their independence?
Authors: Key Nigel
Published: June 2005

A farmer's decision to contract or produce independently depends on the distribution of income and the nonpecuniary attributes associated with both business arrangements. The benefits to growers from contracting (such as risk reduction) may be overestimated if the nonpecuniary benefits enjoyed by independent producers (such as the right to make management decisions and own the commodity produced) are not accounted for. This study uses data from a U.S. national survey of hog producers to estimate (1) the difference in expected net returns between contracting and independent production, (2) the premium a representative farmer would pay for the risk reduction provided by a contract, and (3) the premium a farmer would pay for the nonpecuniary benefits associated with independent production. Results indicate that growers have a strong preference for autonomy—with moderately risk‐averse growers being willing to pay more for the attributes of independent production than they would for the risk‐reducing benefits of a contract.
Premorbid adjustment in first episode schizophrenia and schizoaffective disorders: a comparison of social and academic domains
Authors: Norman R. M. G. , Malla A. K. , Manchanda R. , Townsend L.
Published: June 2005

Objective: Recent evidence suggests that premorbid adjustment in schizophrenia and related disorders can be separated into social and academic domains. In this paper, we examine the correlates of and prognostic significance of social and academic premorbid adjustment in a sample of 113 patients.

Method: Premorbid adjustment, symptoms and cognitive functioning were assessed at presentation for treatment and symptoms were re‐assessed after a year of treatment.

Results: Females and those with a diagnosis of schizoaffective disorder were found to have better premorbid adjustment in the academic domain, but not in the social domain. Neurocognitive functioning was more consistently related to academic than social adjustment. Better social and academic premorbid adjustment was correlated with lower negative symptoms after 1 year of treatment, but neither was a significant predictor of positive symptoms.

Conclusion: Social and academic premorbid adjustments show different relations to gender, specific diagnosis and neurocognitive functioning in schizophrenia and related disorders.
UV‐induzierte regulatorische T‐Zellen
Authors: Schwarz Thomas
Published: June 2005

Regulatorische T‐Zellen stellen eine Untergruppe von T‐Zellen dar, die Immunreaktionen in Antigen‐spezifischer Weise unterdrücken. Sie spielen eine wichtige Rolle bei der Kontrolle der Entstehung von Autoimmunerkrankungen. Ultraviolette (UV) Strahlung unterdrückt das Immunsystem in Antigen‐spezifischer Weise. Dies wird über UV‐induzierte regulatorische T‐Zellen vermittelt. Diese exprimieren CD4 und CD25 und setzen nach Aktivierung das immunsuppressive Zytokin Interleukin‐10 frei. Nach intravenöser Injektion migrieren UV‐induzierte regulatorische T‐Zellen primär in die Lymphknoten, was erklärt, daß sie primär eine Sensibilisierung verhindern. Kürzlich konnte in einem experimentellen Modell gezeigt werden, daß Photopherese ebenfalls regulatorische T‐Zellen induzieren dürfte. Die genauere Charakterisierung dieser Zellen wird entscheiden, ob es in Zukunft möglich sein wird, diese Zellen therapeutisch einzusetzen, mit dem Ziel eine spezifische Immunsuppression zu induzieren.
Design profession and ageing in place
Authors: Spanbroek Nancy
Published: June 2005

Design associations and the media have a responsibility to the community to promote good aesthetic and innovative universal housing design solutions. This could be encouraged through awards and publications that focus on excellence in universal design. Housing designers have a responsibility to both the present and future users, and need to be encouraged to integrate universal design features into the design of the home.
Improving the efficacy of nutritional supplementation in the hospitalised elderly
Authors: Jukkola Katja , MacLennan Penny
Published: June 2005

Background:  Protein‐energy malnutrition delays wound healing, extends length of stay, and increases complication rates. Identification of patients at risk of malnutrition, together with early intervention, may prevent further deterioration of nutritional status.

Objectives:  Through the use of nutrition screening and assessment, prioritise nutrition intervention to those at greatest nutritional risk. To improve the consumption rate of nutritional supplements, using a ‘nutrition as medication’ program.

Methods:  We assessed 200 acute aged care patients for malnutrition risk using the Mini Nutritional Assessment (MNA) tool (Nestle SA, Vevey, Switzerland) within 72 h of hospital admission. Patients ‘at risk’ or malnourished, received either mid meal supplements (control group) or 60 mL of a 2 kcal per ml supplement, given four times daily (trial group). Outcome measures included comparison of supplement consumption changes in MNA scores on fortnightly reassessment or discharge.

Results:  Thirty per cent of patients were malnourished on admission, with a further 42%‘at risk’. Patient compliance with the ‘nutrition as medication’ program was excellent (95%) compared with current practice (48%). On reassessment patients in the trial group showed a trend towards a greater improvement in score for appetite (P = 0.065), number of meals consumed (P = 0.01) and protein intake (P = 0.007). Improvement in score for weight was significant in the trial group (P = 0.027). Length of stay was shorter in the trial group (P = 0.044).

Conclusion:  Routine use of a validated assessment tool is essential for early identification of malnutrition risk. A ‘nutrition as medication’ program is effective in attenuating deterioration in nutritional status.