bluuebunny/crossref_metadata_2025 huggingface dataset:
To What Extent Do Geriatricians Document the Most Bothersome Symptoms of Patients with Advanced Dementia?
Authors: Garrett Stephanie L. , Cox‐Hayley Déon , Hougham Gavin W. , Sachs Greg A.
Published: September 2006

OBJECTIVES: To assess whether geriatricians documented the bothersome symptoms of patients with advanced dementia, proxy reports of the most‐bothersome symptoms affecting those patients (as elicited in research interviews) were compared with what geriatricians who had seen those patients in a proximate clinic visit documented in the medical record.

DESIGN: Retrospective chart review.

SETTING: Outpatient geriatrics clinic at the University of Chicago.

PARTICPANTS: Fifty‐seven pairs of patients with dementia (Functional Assessment Staging Tool stage 6 or 7) and their proxies.

MEASUREMENTS: Clinic notes were reviewed for documentation of patients' bothersome symptoms that proxies reported during research interviews. Proxy reports had been recorded in the previously established Palliative Excellence in Alzheimer Care Efforts database.

RESULTS: The most‐bothersome symptom was documented at least once in 84.2% (48/57) of clinic notes. The second‐most‐bothersome symptom was documented in 70.3% (26/37) of clinic notes. Most symptoms were documented in the Assessment and Plan section of the note.

CONCLUSION: Geriatricians identified and documented the vast majority of bothersome symptoms, as reported by proxies, of patients with moderate to severe dementia.
Preoperative Risk Assessment for Delirium After Noncardiac Surgery: A Systematic Review
Authors: Dasgupta Monidipa , Dumbrell Andrea C.
Published: September 2006

Delirium is a common postoperative complication in older adults associated with adverse events including functional decline, longer lengths of stay, and risk of institutionalization. The purpose of this article is to systematically review preoperative risk factors associated with delirium following noncardiac surgery.

A medical literature search was conducted using several bibliographic databases (PubMed, CINAHL, Cochrane, PsychInfo), supplemented by a manual search of the references of retrieved articles. Studies were retained for review after meeting strict inclusion criteria that included only operative patients with incident postoperative delirium diagnosed prospectively using criteria derived from the Diagnostic and Statistical Manual of Mental DisordersThird or Fourth Edition. Quantitative analyses included significance testing, homogeneity testing, and effect‐size pooling.

Twenty‐five articles were included for review. The incidence of delirium ranged from 5.1% to 52.2%, with greater rates after hip fracture and aortic surgeries. This review found two scales, a clinical prediction rule, and a delirium risk classification system that were validated in other operative settings.

Individual risk factor analysis suggested that cognitive impairment, older age, functional impairment, sensory impairment, depression, preoperative psychotropic drug use, psychopathological symptoms, institutional residence, and greater comorbidity were associated with postoperative delirium. Of the risk factors examined, evidence was most robust for an association between delirium and cognitive impairment or psychotropic drug use, with moderate effect sizes for both. Missing data and measurement differences did not allow for inferences to be made about other risk factors.

Effect‐size pooling supports the concept that delirium is a heterogeneous disorder with multiple risk factors. More research is needed to better identify patients at risk for postoperative delirium and to develop preventive strategies.
Traumatic Brain Injury in Older Adults: Epidemiology, Outcomes, and Future Implications
Authors: Thompson Hilaire J. , McCormick Wayne C. , Kagan Sarah H.
Published: September 2006

Traumatic brain injury (TBI) is a significant problem in older adults. In persons aged 65 and older, TBI is responsible for more than 80,000 emergency department visits each year; three‐quarters of these visits result in hospitalization as a result of the injury. Adults aged 75 and older have the highest rates of TBI‐related hospitalization and death. Falls are the leading cause of TBI for older adults (51%), and motor vehicle traffic crashes are second (9%). Older age is known to negatively influence outcome after TBI. Although geriatric and neurotrauma investigators have identified the prognostic significance of preadmission functional ability, comorbidities, sex, and other factors such as cerebral perfusion pressure on recovery after illness or injury, these variables remain understudied in older adults with TBI. In the absence of good clinical data, predicting outcomes and providing care in the older adult population with TBI remains problematic. To address this significant public health issue, a refocusing of research efforts on this population is justified to prevent TBI in the older adult and to discern unique care requirements to facilitate best patient outcomes.
Influence of Drive Cycle Length on Initiation of Ventricular Fibrillation During Implantable Cardioverter Defibrillator Threshold Testing
Authors: SANGHVI NEIL K. , LELORIER PAUL , GURURAJ ARJUN V. , MONAHAN KEVIN M.
Published: September 2006

Background: Programmed electrical stimulation of the heart as a method to induce tachyarrhythmias has been described since the 1960s. To date, no study has examined optimal drive cycle length in the induction of ventricular fibrillation (VF) during defibrillation threshold testing after implantable cardioverter‐defibrillator placement. We hypothesized that longer drive cycle length, by means of the longer action potential duration, would promote intramyocardial phase 2 reentry and facilitate induction of VF.

Methods: Fifty consecutive implants were randomized in a prospective crossover format for this study. The group consisted of 40 men and 10 women, with each patient receiving either a 400 or 600 ms initial drive train prior to 1.2 J internal shock on the T wave with a goal to induce ventricular fibrillation. The timing of the T wave shock was determined by measuring the interval from the beginning of the QRS to the apex of the T wave in lead II. Successful inductions were defibrillated via the cardioverter defibrillator. Patients were then crossed over and the protocol repeated.

Results: Twenty of 23 (87%) patients were successfully induced into VF in the initial 400 ms drive train arm whereas 22 of 27 (81%) were successfully induced in the 600 ms arm. Thus, a total of 44 (88%) patients were successfully induced at 400 ms, 41 (82%) patients were successfully induced at 600 ms, and 2 (4%) patients were not inducible at either cycle length, but were inducible with 50 Hz ventricular stimulation. However, no significant difference was noted between the two groups.

Conclusion: No investigation to date has questioned whether a relationship exists between drive cycle length and initiation of ventricular fibrillation. Our study addresses this question, though negative for difference between 400 and 600 ms drive trains. Further research into optimal strategies for inducing ventricular fibrillation will minimize patient sedation time and discomfort while undergoing defibrillator threshold testing.
Anodal Capture in Cardiac Resynchronization Therapy Implications for Device Programming
Authors: TAMBORERO DAVID , MONT LLUIS , ALANIS ROBERTO , BERRUEZO ANTONIO , TOLOSANA JOSE MARIA , SITGES MARTA , VIDAL BARBARA , BRUGADA JOSEP
Published: September 2006

Introduction: Right ventricular (RV) anodal capture (AC) has been reported in cardiac resynchronization therapy (CRT), when left ventricular (LV) pacing uses pseudobipolar (LV tip to RV proximal electrode) configuration. The aim of the study was to analyze the prevalence of AC and its implications for device programming.

Methods and Results: When AC occurred, the resulting QRS morphology was evaluated with the following pacing modes: (1) LV tip pacing plus RV AC, (2) Biventricular (BiV) pacing (i.e., both LV and RV tip pacing), and (3) BiV pacing plus RV AC. Several interventricular pacing (VV) intervals from 50 ms of LV preactivation to 30 ms of RV preactivation were tested in modes 2 and 3. From 38 consecutive patients, AC was achieved in 14 (in 74% of the pacemakers and in none of the defibrillators). LV tip pacing plus RV AC obtained narrower QRS than BiV pacing at all VV intervals in seven of the patients with AC (50%). When BiV pacing is combined with RV AC, it produced a ventricular depolarization through two wave fronts (one from the LV tip and the second from either the ring or the tip of the RV lead depending on the VV interval programmed).

Conclusions: AC obtained the narrowest QRS of all tested pacing modes in a significant proportion of patients undergoing CRT. Though the stimulus was delivered from three sites (BiV pacing plus RV AC mode), only two wave fronts of ventricular activation were seen by ECG.
Long‐Term Follow‐Up of Patients Supplied with Single‐Chamber or Dual‐Chamber Cardioverter Defibrillators
Authors: KOLB CHRISTOF , DEISENHOFER ISABEL , SCHMIEDER SEBASTIAN , BARTHEL PETRA , ZRENNER BERNHARD , KARCH MARTIN R. , SCHMITT CLAUS
Published: September 2006

Introduction: In patients who have an indication for an implantable cardioverter defibrillator (ICD) a dual‐chamber device is indicated in the case of concomitant significant sinus node disease or atrioventricular block. It is a matter of debate whether dual‐chamber ICD may be beneficial for patients with preserved sinus and atrioventricular nodal function as data from prospective randomized trials are limited. Mid‐ or long‐term follow‐up data are unavailable.

Methods and Results: One hundred patients (age 60 ± 12 years, 11 women) with the indication for the implantation of an ICD and without antibradycardia pacing indication were randomly assigned to either receive a dual‐chamber ICD (n = 52) or a single‐chamber ICD (n = 48). Patients were followed‐up for a mean of 52 ± 14 months. Mortality and arrhythmogenic morbidity were assessed.

All‐cause mortality was 21% for single‐chamber and 31% for dual‐chamber ICD recipients, respectively (P = 0.26). Cardiovascular mortality was 13% for single‐chamber ICD recipients versus 21% in the dual‐chamber group (P = 0.25). Subgroup analysis using 35% of ventricular paced beats as cutoff value in the dual‐chamber ICD group revealed a 42% mortality rate for the patients with frequent ventricular pacing compared to 10% of patients with a low rate of ventricular pacing (P = 0.05, relative risk 4.21, 95% confidence interval: 0.9–19.8). As for arrhythmogenic morbidity, the difference in the ventricular tachyarrhythmia load was not different in both groups (single chamber: 23 ± 74 VT episodes, dual chamber: 54 ± 134 VT episodes, P = 0.17).

Conclusion: In ICD recipients without conventional indication for dual‐chamber pacing, dual chamber compared to single‐chamber ICD has no advantage concerning mortality and arrhythmogenic morbidity in a long‐term follow‐up. In these patients the implantation of a single‐chamber device is sufficient.
Effect of Right Ventricular Apex Pacing on the Tei Index and Brain Natriuretic Peptide in Patients with a Dual‐Chamber Pacemaker
Authors: ICHIKI HITOSHI , OKETANI NAOYA , HAMASAKI SHUICHI , ISHIDA SANEMASA , KATAOKA TETSURO , OGAWA MASAKAZU , SAIHARA KEISHI , OKUI HIDEKI , FUKUDOME TSUYOSHI , SHINASATO TAKURO , KUBOZONO TAKURO , NINOMIYA YUICHI , MATSUSHITA TAKEHIKO , OTSUJI YUTAKA , TEI CHUWA
Published: September 2006

Background: Asynchronous electrical activation induced by right ventricular apex (RVA) pacing can cause various abnormalities in left ventricular (LV) function, particularly in the context of severe LV dysfunction or structural heart disease. However, the effect of RVA pacing in patients with normal LV and right ventricular (RV) function has not been fully elucidated. The aim of this study was to characterize the effects of RVA pacing on LV and RV function by assessing isovolumic contraction time and isovolumic relaxation time divided by ejection time (Tei index) and by assessing changes in plasma brain natriuretic peptide (BNP).

Methods: Doppler echocardiographic study and BNP measurements were performed at follow‐up (mean intervals from pacemaker implantation, 44 ± 75 months) in 76 patients with dual chamber pacemakers (sick sinus syndrome, n = 30; atrioventricular block, n = 46) without structural heart disease. Patients were classified based on frequency of RVA pacing, as determined by 24‐hour ambulatory electrocardiogram (ECG) that was recorded just before echocardiographic study: pacing group, n = 46 patients with RVA pacing ≥50% of the time, percentage of ventricular paced 100 ± 2%; sensing group, n = 30, patients with RVA pacing <50% of the time, percentage of ventricular paced 3 ± 6%.

Results: There was no significant difference in mean heart rate derived from 24‐hour ambulatory ECG recordings when comparing the two groups (66 ± 11 bpm vs 69 ± 8 bpm). LV Tei index was significantly higher in pacing group than in sensing group (0.67 ± 0.17 vs 0.45 ± 0.09, P < 0.0001), and the RV Tei index was significantly higher in pacing group than in sensing group (0.34 ± 0.19 vs 0.25 ± 0.09, P = 0.011). Furthermore, BNP levels were significantly higher in pacing group than in sensing group (40 ± 47 pg/mL vs 18 ± 11 pg/mL, P = 0.017). With the exception of LV diastolic dimension (49 ± 5 mm vs 45 ± 5 mm, P = 0.012), there were no significant differences in other echocardiographic parameters, including left atrium (LA) diameter (35 ± 8 mm vs 34 ±5 mm), LA volume (51 ± 27 cm3 vs 40 ± 21 cm3), LV systolic dimension (30 ± 6 mm vs 29 ± 7 mm), or ejection fraction (66 ± 9% vs 63 ± 11%), when comparing the two groups.

Conclusions: These findings suggest that the increase of LV and RV Tei index, LVDd, and BNP are highly correlated with the frequency of the RVA pacing in patients with dual chamber pacemakers.
Detection of Impaired Coronary Flow Reserve in Coronary Artery Disease Using Transthoracic Echocardiographic Assessment of Coronary Sinus Blood Flow
Authors: Tabel Ghasan M. , Vlachonassios Konstantinos , Tabel Mohammed , Vaghafi Houman , Abdelmessih Niveen , Chandraratna P. Anthony
Published: September 2006

In order to establish whether coronary flow reserve (CFR) can be measured by transthroracic echocardiography (TTE) with pulse wave Doppler echocardiography, 14 patients with coronary artery disease (CAD) and 12 normal subjects were studied. Coronary sinus blood flow was measured at rest and 2 minutes after intravenous injection of 0.56 mg/kg dipyridamole (DP). CFR was calculated as the DP to rest flow ratio. Patients with CAD were found to have significantly decreased CFR when compared to normal subjects. These findings suggest that TTE may be useful in diagnosing CAD.
Right Coronary Artery Hepatic Vein Fistula: A Case Report
Authors: Gorgulu Sevket , Nurkalem Zekeriya , Eren Mehmet
Published: September 2006

There is a slight predominance for coronary artery fistulas that involve the right coronary artery, while multiple fistulas have also been reported. The usual site of termination is one or more of the low‐pressure structures in the heart or the great vessels such as the right or left atria, right ventricle, coronary sinus, pulmonary artery, or superior vena cava. However, a coronary fistula that drains into a hepatic vein has not been reported in the literature. Therefore, this is the first case report indicating a right coronary artery fistula that drains into the middle hepatic vein.
A Quadricuspid Aortic Valve with Atrial Septal Defect
Authors: Vohra Rakesh Kumar , Singh Harshinder , Siu Benjamin L. , Failinger Conard Frederick
Published: September 2006

A quadricuspid aortic valve (QAV) is a rare congenital heart defect, previously described as an incidental finding at the time of surgery or postmortem, which is now being increasingly detected by 2D transthoracic or transesophageal echocardiogram. With advances in echocardiography, secondary cardiac anomalies are also being described in association with QAV. Herein we describe a patient with QAV with a secundum atrial septal defect.
The Promise and Pitfalls of Consensus Decision Making in School Management
Authors: Erbes Kristen
Published: September 2006

School/Community‐Based Management (SCBM) advocates insisted that changing the bureaucratic structure of governance, moving from top‐down decision making to a shared decision making at the local level, would revolutionize schools and result in higher student achievement. Many schools have struggled with shared decision‐making processes. This article examines one high school's attempt to implement a dress code using consensus‐based decision‐making. Organizations that strive to make decisions by consensus should be aware of the pitfalls that may occur and work to address them if they arise.
Survival and Institutionalization of an Idea: The Rapid Rise of Intelligent Vehicle‐Highway Systems
Authors: Lindquist Eric
Published: September 2006

Changes in existing institutions and/or the creation of new institutions often follow changes in political agendas and the acceptance of new ideas as viable policy solutions. This article describes the rise of a new policy solution in the early 1990s, an integrated set of transportation technologies—initially referred to as “intelligent vehicle‐highway systems” (IVHS)—and its subsequent survival and institutionalization. As a theoretical contribution, this article expands on the agenda‐setting framework of Kingdon (1995) and the subsequent work of Baumgartner and Jones (1993) on the nexus between agenda access and institutions. Tracing changes in existing institutions within the transportation policy domain, as well as the creation of a new institution devoted to the advocacy of this technology, this study illustrates the significance of ideas and institutions in the public policy process.
Direct Democracy Paradox: State Fiscal Policies in the United States and the Threat of Direct Initiatives
Authors: Saeki Manabu
Published: September 2006

Many studies have argued that the initiative process in U.S. state governments strengthened the proximity between the citizens' preferences and policy output. In contrast, this study hypothesizes that the direct initiative process weakens, rather than strengthens, the link between citizen preferences and state fiscal policy. Governments respond to the threat of initiatives but only those of conservative agendas. The results show that while the level and the progressivity of tax rates in the states without direct initiatives are influenced by citizen preferences, those in states with direct initiatives are more conservative than those without direct initiatives and the former are insulated from the influence of the citizen preferences.
Quantum Change in the Fragmented Metropolis: Political Environment and Homeless Policy in New York City
Authors: Main Thomas J.
Published: September 2006

The dominant paradigm for understanding urban policy change has long been that of “incrementalism.” The incrementalist argument is that institutional fragmentation reduces coordination, and thus discourages what might be called “nonincremental” or “quantum” change. This article seeks to test the incrementalist understanding of urban political change. Is it possible that under certain circumstances fragmentation can encourage quantum change? We will test this possibility with an analysis of homeless policy in New York City. Briefly put, over the last 25 years homeless policy in New York City has developed in a series of quantum jumps with dramatic, short‐term changes in funding, administration, and policy “philosophy.” Policy change followed this trajectory even though New York City's political environment is notoriously fragmented. This pattern contradicts what incrementalism would predict, and therefore suggests that that paradigm must be modified. Urban politics, this study suggests, can sometimes display the nonincremental, entrepreneurial, and “ideational” characteristics that have been identified as typical of the national “new politics of public policy.”
The treatment of negative symptoms and deficit states of chronic schizophrenia: olanzapine compared to amisulpride and placebo in a 6‐month double‐blind controlled clinical trial
Authors: Lecrubier Y. , Quintin P. , Bouhassira M. , Perrin E. , Lancrenon S.
Published: September 2006

Objective:  The aim of the study was to evaluate the efficacy of olanzapine (5 and 20 mg/day) over a 6‐month period in chronic schizophrenic patients experiencing predominantly negative symptoms.

Method:  Two hundred and forty‐four patients participated in a 6‐month multicenter double‐blind trial of placebo (n = 34), olanzapine 5 mg/day (n = 70), olanzapine 20 mg/day (n = 70), or amisulpride 150 mg/day (n = 70). Primary measure was the scale for the assessment of negative symptoms.

Results:  Olanzapine 5 mg/day showed significantly greater improvement than placebo in negative symptoms and in the Positive and Negative Syndrome Scale total score. Baseline positive symptoms were low at baseline and changed minimally. The neurological tolerance of olanzapine, amisulpride and placebo were comparable.

Conclusion:  Olanzapine 5 mg/day was effective in treating negative symptoms in a group of schizophrenic with predominantly negative symptoms during the stabilization phase. Improvement in positive symptoms or extrapyramidal symptoms (EPS) was unlikely to explain this result while improvement in depression may have partially contributed.
Full‐mouth ultrasonic debridement and risk of disease recurrence: a 1‐year follow‐up
Authors: Tomasi Cristiano , Bertelle Alberto , Dellasega Ester , Wennström Jan L.
Published: September 2006

Aim: To evaluate the incidence of disease recurrence following a full‐mouth pocket/root debridement approach with ultrasonic instrumentation versus that following a traditional approach of quadrant‐wise scaling and root planing (Q‐SRP) performed with hand instrumentation.

Methods: Thirty‐seven patients were re‐examined 1 year after the completion of a 6‐month clinical trial comparing two different treatment protocols: a 1‐h session of full‐mouth ultrasonic debridement (UD – 19 patients) or four sessions of Q‐SRP with hand instruments (Q‐SRP – 18 patients). At 3 months, re‐instrumentation was performed of pockets showing a remaining probing pocket depth (PPD) of 5 mm using the same type of instruments as used during the initial treatment phase. The clinical examinations comprised assessments of plaque, bleeding on probing (BoP) and PPD. The primary outcome variable was the incidence of recurrent diseased sites (i.e., sites showing PPD5 mm and BoP+) between the post‐treatment and 1‐year follow‐up examinations. All sites that were healed (PPD4 mm and BoP−) at the post‐treatment examination were included in the study sample, with a mean number of sites per patient of 23.5.

Results: In the UD group, 29 (7%) out of 430 initially healed sites showed disease recurrence at the 1‐year follow‐up examination compared with 47 (11%) of 440 sites in the Q‐SRP group (p>0.05). Twelve patients (63%) in the UD group presented recurrent diseased pockets, compared with 14 patients (78%) in the Q‐SRP group. Two or more recurrent, diseased pockets were observed in nine patients in the UD group versus 11 in the Q‐SRP group. All but one of the smokers belonged to the group of patients presenting recurrences. A tendency towards a higher mean plaque score was observed for the patients with recurrent sites.

Conclusion: The study revealed no significant difference in the incidence of recurrence of diseased periodontal pockets between the full‐mouth UD approach and the traditional approach of Q‐SRP.
Prognostic factors in the treatment of generalized aggressive periodontitis: II. Effects of smoking on initial outcome
Authors: Hughes Francis J. , Syed Mahnaz , Koshy Bindhu , Bostanci Nagihan , McKay Ian J. , Curtis Michael A. , Marcenes Wagner , Croucher Raymond E.
Published: September 2006

Aims: The aim of this study was to investigate the effects of smoking on the response to non‐surgical treatment for aggressive periodontitis.

Methods: Seventy‐nine patients with generalized aggressive periodontitis were included in the study; 20 were smokers. All patients received a course of non‐surgical periodontal therapy and outcomes assessed 10 weeks post‐operatively. Non‐responding patients were designated if they had 30% or more non‐responding deep sites.

Results: At baseline, bleeding scores were lower in smokers. There was no difference in baseline plaque, pocket depth (PD), recession or clinical attachment levels (CALs); when sites were selected by equal levels of CAL, increased recession was seen in smokers. Outcomes were poorer in smokers (mean PD change 1.75±0.56 versus 2.23±0.87 mm). The odds ratio for 30% of sites not responding in smokers was 2.9; for 40% non‐responding it was 5.9. Smoking altered the distribution of site‐specific responses to increase specifically the number of non‐responding sites. There was no significant difference in responses between ex‐smokers and never‐smokers.

Conclusions: The results demonstrate that smoking is a major risk factor for poor response to initial treatment and emphasize the importance of smoking cessation in periodontal therapy.
Prognostic factors in the treatment of generalized aggressive periodontitis: I. Clinical features and initial outcome
Authors: Hughes Francis J. , Syed Mahnaz , Koshy Bindhu , Marinho Valeria , Bostanci Nagihan , McKay Ian J. , Curtis Michael A. , Croucher Raymond E. , Marcenes Wagner
Published: September 2006

Aims: The aims of this study were to investigate prognostic factors for initial response to non‐surgical periodontal treatment for generalized aggressive periodontitis.

Methods: Seventy‐nine patients with generalized aggressive periodontitis were included in this prospective follow‐up intervention study. Patients' clinical and demographic parameters were collected at baseline and 10 weeks following a standard course of treatment (four visits of non‐surgical root surface debridement together with OHI as required). The relationship between clinical variables and treatment outcome were analysed at site‐specific level by χ2 analysis and for patient‐specific variables by logistic regression.

Results: In general, there was a good response to the treatment provided. In deep sites the mean pocket depth reduction was 2.11±2.01 mm. Site‐specific analysis showed that the presence of plaque had a small but significant predictive effect on outcome (odds ratio 1.4). Sites on teeth with grade II/III mobility showed a significantly reduced response to treatment.

Twenty‐five patients were classified as “non‐responders”. Current smoking was strongly associated with non‐responding patients (odds ratio 3.8) in a logistic regression model; plaque, baseline bleeding and initial pocket depth were not significantly associated with treatment outcomes.

Conclusions: Overall, the results emphasize the importance of smoking as a negative prognostic factor, and suggest that treatment outcomes may be determined by a wide range of different determinants requiring further study.
Protein contact dermatitis in slaughterhouse workers
Authors: Hansen Klaus Stagis , Petersen Hans Overgard
Published: September 2006

Protein contact dermatitis, described is “gut eczema” or “fat eczema” by slaughterhouse workers. was first described it decade ago and presents as an itching, vesicular eczema on the hands and fingers, a few hours after contact with animal material, especially gut material. In a cross‐sectional study of 144 slaughterhouse workers, a cumulative prevalence of current and anamnestic case of protein contact dermatitis of 22% was found, with (lie highest prevalence in workers eviscerating and cleansing gut. The scratch patch lest was the only skin lest showing positive results in workers with protein contact dermatitis, positive reactions being found, however, in less than half the cases.
Allergic contact dermatitis from croconazole hydrochloride
Authors: Shono Mamiko , Hayashi Ken , Sugimoto Rie
Published: September 2006

We report 6 cases of contact sensitivity to croconazole hydrochloride, a new imidazole antimycotic drug introduced to the Japanese market in 1986. and available as 1% gel and cream, 6 sensitized patients reacted on patch testing in cruconazole hydrochloride down to 0.5 to 0.1% pet, and 3 appeared to be cross‐sensitized to sulconazole nitrate. In Japan, allergic contact dermatitis to this drug has now been detected in 12 cases, including our own 6. Prescribes should be aware of contact sensitivity lo this drug.
Contact allergy to Manilla resin Nomenclature and physico‐chemistry of Manilla, kauri, dammar and copal resins
Authors: Jost T. , Sell Y. , Foussereau J.
Published: September 2006

16 cases of allergic, eczema from a resin used in a surgical adhesive (Alphacopal®) arc described. Because of the extreme confusion regarding the nomenclature and origin of the resins failed copals and damars, this report attempts to give a terminological, botanical, physico‐chemical and allergological restatement of this problem. Copals and damars are produced by trees belonging to the Araucariaceae. Caesalpiniaceae. Dipterocarpaceae and Bursernccae families. We suggest that the word “copal” be reserved for the resins of the Caesalpniaecae and that of “damar” for the resins of the Dipterocarpaceae. The resins of the Araucariaceae are special products that may be called Manilla resin and kauri resin, which are relatively different from each other. As far as the soft resins of the Burseraccae are concerned, it would be appropriate to use the word “elemi”. The component resin of (he surgical adhesive implicated (Alphacopal®) is a Manilla resin, produced by a variety of Agathis dammara (Lamb.) Rich., native to the Philippines. We suggest 3 allergen screening series. Finally 2 pseudo‐cross‐sensitivities are mentioned.
Patch testing in actinic prurigo
Authors: Lane Peter R. , Harms Vernon L. , Hogan Daniel J.
Published: September 2006

42 out of 93 Saskatchewan Indians (32 female (F) and 10 male (M)) with actinic prurigo were patch tested to standard series allergens between 1983 and 1987. Positive, reactions were most frequently seen with nickel (3F:2M) and colophony. All 3 positive patch tests to colophony were in males. The same patients were also patch tested to extracts of 21 Saskatchewan plants and 3 Hollister‐Stier plant extracts. Only 1 male and 2 females had positive patch tests. None of these 3 had rashes on the eyelids, behind the ears or under the chin. We conclude that plant contact dermatitis is unlikely to be mistaken for actinic prurigo in Saskatchewan.
Percutaneous absorption of 3 organic solvents in the guinea pig
Authors: Boman Anders , Mellström Gunh
Published: September 2006

The efficacy of 3 protective glove materials against percutaneous absorption of organic solvents was investigated in the guinea pig. All 3 materials gave a reduction in blood concentration of the solvents, particularly in the early phase of exposure. Of the tested materials, butyl rubber showed the best protective effect, followed by PVC and natural rubber. Gloves of polymeric material can be considered as offering sufficient protection against percutaneous absorption of organic solvents only if their selection is based on results obtained in a controlled and adequately performed test.
A historical perspective on immunological privilege
Authors: Simpson Elizabeth
Published: September 2006

Summary:  Intimations of immunological privilege in sites of the body such as the eye and the brain go back in the literature more than a century, to reports of experiments using outbred animals and tumor transplants. The starting points of this review, however, are publications stemming from the transplantation of normal tissues and, as far as possible, the use of inbred animals, exploring the way in which interplay between genetic differences of different degree, from single minor histocompatibility antigens to full‐house major histocompatibility complex mismatches, has been reported to affect the ‘take’ of grafts in putatively privileged sites. While these sites traditionally included the brain, the eye, the pregnancy, and the endocrine tissues such as thyroid, parathyroid, adrenal, and islets of Langerhans, from readings of the literature, it is clear that the eye and the pregnancy have claims to being in the strongest positions of privilege. Even then, the position is precarious, with stirrings of the adaptive immune system poised to attack. Various regulatory mechanisms have now moved center stage and will undoubtedly form a significant part in subsequent chapters in this volume. Perhaps surprisingly, as investigations on these mechanisms have advanced, there is evidence for the convergence of those mechanisms controlling both induced tolerance and immunological privilege.
Stranger in a strange land
Authors: Hunt Joan S.
Published: September 2006

Summary:  Mammalian mothers and their embryos/fetuses are almost invariably genetically different, which raises the question of how the mother’s immune system is diverted so as to permit cohabitation with the ‘foreign’ body. Several decades of research have shown that multiple cooperative systems sanction uteroplacental immune privilege. These systems include production of several varieties of soluble immunosuppressive molecules in the uterus and the placenta and strict regulation of the molecules expressed on or by placental trophoblast cells. Trophoblast, a unique lineage without counterpart in adult tissues, is in direct contact with maternal blood and tissue. The major graft rejection‐promoting molecules, human leukocyte antigens (HLAs), are tightly regulated in these cells, with none of HLA‐A, HLA‐B, or HLA class II antigens expressed. The HLA class Ib antigens, HLA‐E, HLA‐F, and HLA‐G, are detectable on some subpopulations. Our studies have focused on the expression, regulation, and functions of the soluble isoforms of HLA‐G, which circulate in maternal blood and are present at high levels in the pregnant uterus. These isoforms are derived from the single HLA‐G gene by alternative splicing and are now known to have immunosuppressive properties. Ours and other studies indicate that soluble HLA‐G proteins may comprise a unique tolerogenic system for establishing local immune privilege during pregnancy.
TGF‐β: a mobile purveyor of immune privilege
Authors: Wahl Sharon M. , Wen Jie , Moutsopoulos Niki
Published: September 2006

Summary:  Functionally barricaded immune responses or sites of immune privilege are no longer considered dependent on specific anatomical considerations, but rather, they can develop in any location where immunoregulatory cells congregate and express or release products capable of deviating the host response to foreign antigens. Among the pivotal molecules involved in orchestrating these ectopic sites of immune suppression is transforming growth factor‐β (TGF‐β), a secreted and cell‐associated polypeptide with a multiplicity of actions in innate and adaptive immunity. While beneficial in initiating and controlling immune responses and maintaining immune homeostasis, immunosuppressive pathways mediated by TGF‐β may obscure immune surveillance mechanisms, resulting in failure to recognize or respond adequately to self, foreign, or tumor‐associated antigens. CD4+CD25+Foxp3+ regulatory T cells represent a dominant purveyor of TGF‐β‐mediated suppression and are found in infiltrating tumors and other sites of immune privilege, where they influence CD8+ T cells; CD4+ T‐helper (Th)1, Th2, and Th17 cells; natural killer cells; and cells of myeloid lineage to choreograph and/or muck up host defense. Defining the cellular sources, mechanisms of action, and networking that distinguish the dynamic establishment of localized immune privilege is vital for developing strategic approaches to diminish or to embellish these tolerogenic events for therapeutic benefit.
Immune privilege and HIV‐1 persistence in the CNS
Authors: Persidsky Yuri , Poluektova Larisa
Published: September 2006

Summary:  Human immunodeficiency virus‐1 (HIV‐1) neuroinvasion occurs early (during period of initial viremia), leading to infection of a limited amount of susceptible cells with low CD4 expression. Protective cellular and humoral immunity eliminate and suppress viral replication relatively quickly due to peripheral immune responses and the low level of initial central nervous system (CNS) infection. Upregulation of the brain protective mechanisms against lymphocyte entry and survival (related to immune privilege) helps reduce viral load in the brain. The local immune compartment dictates local viral evolution as well as selection of cytotoxic lymphocytes and immunoglobulin G specificity. Such status can be sustained until peripheral immune anti‐viral responses fail. Activation of microglia and astrocytes, due to local or peripheral triggers, increases chemokine production, enhances traffic of infected cells into the CNS, upregulates viral replication in resident brain macrophages, and significantly augments the spread of viral species. The combination of these factors leads to the development of HIV‐1 encephalitis‐associated neurocognitive decline and patient death. Understanding the immune‐privileged state created by virus, the brain microenvironment, and the ability to enhance anti‐viral immunity offer new therapeutic strategies for treatment of HIV‐1 CNS infection.
BURDEN OF PROOF BEGONE
Authors: Chill Paul
Published: September 2006

This article examines the tendency of emergency child removal decisions—by social workers, police officers, and judges—to become self‐reinforcing and self‐perpetuating in subsequent child protective proceedings. This “snow‐ball effect,” as one court has referred to it, is widely acknowledged by lawyers who practice in juvenile court yet is largely unknown beyond those circles. The article explores the causes and consequences of this phenomenon in the age of ASFA (the 1997 federal Adoption and Safe Families Act), which converts every day that a child spends in foster care into one more tick of the clock in a countdown toward termination of parental rights. This article provides some background on the law and practice of emergency child removal in the United States today, analyzes the factors that make initial removals outcome determinative in many child protection cases, considers the implications of this phenomenon in light of ASFA, and identifies possible solutions.
LESSONS LEARNED FROM A CHILD PROTECTION MEDIATION PROGRAM: If At First You Succeed and Then You Don't…
Authors: Olson Kelly Browe
Published: September 2006

This article discusses the U.A.L.R. child protection mediation program as well as several other child protection mediation programs in order to examine what makes a program a continuing success. Child protection mediation programs have gone through a period of tremendous progress and growth over the past 20 years in the United States and Canada. Numerous studies have shown that child protection mediation helps families and courts by lowering the amount of time that children spend in foster care and the amount of costs for courts and agencies. Child protection mediation is an essential tool for juvenile courts and the families that have cases there. This article addresses the development of child protection mediation programs, their importance to juvenile courts, and some reasons that these programs succeed or fail. Although many of these programs have early accomplishments, they have not always been able to maintain their growth or to continue to exist. The U.A.L.R. Mediation Project has not sustained its early levels of cases or referrals from court for numerous reasons. Using the techniques of other thriving programs, we will attempt to restart and re‐energize the program. It has been established that the people who have a role in the establishment of a program, the funding sources and especially the commitment of the parties to the program all have a significant long‐term impact. This article points out how programs should begin and proceed if they are to be a long‐term success.
THE CORPORAL PUNISHMENT DEBATE IN CANADA
Authors: Bailey Martha
Published: September 2006

The controversial issue of corporal punishment of children is now before the Supreme Court of Canada. Whether or not Canada's highest court rules that the “reasonable chastisement” defense to charges of assault on children by parents and teachers is unconstitutional, it is likely that Parliament will move forward with reforms. Social science evidence on the negative effects of corporal punishment has been accepted by the federal government, and it seems likely that Canada will soon join the list of countries that prohibit the practice.
REFUSING TO BLAME THE VICTIM FOR THE AFTERMATH OF DOMESTIC VIOLENCE
Authors: White Heidi A.
Published: September 2006

This note addresses the decision of Nicholson v. Williams and the significant impact it will have on the rights of domestic violence victims. Victims are faced with unique challenges with regards to protecting their children from witnessing domestic violence. The Nicholson decision recognizes that the dynamics of domestic violence require special consideration in “failure to protect” cases and that removal from the home is not necessarily the best alternative for the well‐being of the children. This note attempts to explain that the abuser, not the victim, is responsible for the effects that domestic violence has on the children who witness it and that it is important to keep the victim and children united to cope with the effects of domestic violence.
Tudor Religious Cultures in Practice: The Piety and Politics of Grace Mildmay and Her Circle
Authors: Warren Nancy Bradley
Published: September 2006

This essay explores the diversities, complexities, and ambiguities of English religious cultures during the period of religious and political turmoil that constituted the Tudor era. An examination of the religious practices and writings of Grace Sharington Mildmay, members of her natal and conjugal families, and her Northamptonshire neighbors provides a snapshot of the diverse, complex range of Catholicisms and Protestantisms in existence from the beginning of the reign of the first Tudor monarch Henry VII through the end of the Elizabethan regime. The essay emphasizes continuity as well as change, providing an overview of competing versions of the historiography of Tudor religion and underlining the need to reconsider overly simplified understandings of such terms as “Calvinist,”“Puritan,”“recusant,” and “church papist.” It also highlights, through a comparative reading of texts written by Grace Mildmay and the medieval mystic and anchoress Julian of Norwich, the need to rethink the binaries of “medieval” and “early modern” as well as “Catholic” and “Protestant.”
Isoprenoid biosynthesis in plants – 2C‐methyl‐d‐erythritol‐4‐phosphate synthase (IspC protein) of Arabidopsis thaliana
Authors: Rohdich Felix , Lauw Susan , Kaiser Johannes , Feicht Richard , Köhler Peter , Bacher Adelbert , Eisenreich Wolfgang
Published: September 2006

The ispC gene of Arabidopsis thaliana was expressed in pseudomature form without the putative plastid‐targeting sequence in a recombinant Escherichia coli strain. The recombinant protein was purified by affinity chromatography and was shown to catalyze the formation of 2C‐methyl‐d‐erythritol 4‐phosphate from 1‐deoxy‐d‐xylulose 5‐phosphate at a rate of 5.6 µmol·min−1·mg−1 (kcat 4.4 s−1). The Michaelis constants for 1‐deoxy‐d‐xylulose 5‐phosphate and the cosubstrate NADPH are 132 and 30 µm, respectively. The enzyme has an absolute requirement for divalent metal ions, preferably Mn2+ and Mg2+, and is inhibited by fosmidomycin with a Ki of 85 nm. The pH optimum is 8.0. NADH can substitute for NADPH, albeit at a low rate (14% as compared to NADPH). The enzyme catalyzes the reverse reaction at a rate of 2.1 µmol·min‐1·mg‐1.
The Emery–Dreifuss muscular dystrophy associated‐protein emerin is phosphorylated on serine 49 by protein kinase A
Authors: Roberts Rhys C. , Sutherland‐Smith Andrew J. , Wheeler Matthew A. , Norregaard Jensen Ole , Emerson Lindsay J. , Spiliotis Ioannis I. , Tate Christopher G. , Kendrick‐Jones John , Ellis Juliet A.
Published: September 2006

Emerin is a ubiquitously expressed inner nuclear membrane protein of unknown function. Mutations in its gene give rise to X‐linked Emery–Dreifuss muscular dystrophy (X‐EDMD), a neuromuscular condition with an associated life‐threatening cardiomyopathy. We have previously reported that emerin is phosphorylated in a cell cycle‐dependent manner in human lymphoblastoid cell lines [Ellis et al. (1998) Aberrant intracellular targeting and cell cycle‐dependent phosphorylation of emerin contribute to the EDMD phenotype. J. Cell Sci. 111, 781–792]. Recently, five residues in human emerin were identified as undergoing cell cycle‐dependent phosphorylation using a Xenopus egg mitotic cytosol model system (Hirano et al. (2005) Dissociation of emerin from BAF is regulated through mitotic phosphorylation of emerin in a Xenopus egg cell‐free system. J. Biol. Chem.280, 39 925–39 933). In the present paper, recombinant human emerin was purified from a baculovirus‐Sf9 heterogeneous expression system, analyzed by protein mass spectrometry and shown to exist in at least four different phosphorylated species, each of which could be dephosphorylated by treatment with alkaline phosphatase. Further analysis identified three phosphopeptides with m/z values of 2191.9 and 2271.7 corresponding to the singly and doubly phosphorylated peptide 158‐DSAYQSITHYRPVSASRSS‐176, and a m/z of 2396.9 corresponding to the phosphopeptide 47‐RLSPPSSSAASSYSFSDLNSTR‐68. Sequence analysis confirmed that residue S49 was phosphorylated and also demonstrated that this residue was phosphorylated in interphase. Using an in vitro protein kinase A assay, we observed two phospho‐emerin species, one of which was phosphorylated at residue S49. Protein kinase A is thus the first kinase that has been identified to specifically phosphorylate emerin. These results improve our understanding of the molecular mechanisms underlying X‐EDMD and point towards possible signalling pathways involved in regulating emerin's functions.
The Effects of Residual Oxygen on the Storage Life of Retail‐Ready Fresh Beef Steaks Masterpackaged Under a CO2 Atmosphere
Authors: Venturini A.C. , Contreras C.J.C. , Sarantópoulos C.I.G.L. , Villanueva N.D.M.
Published: September 2006

ABSTRACT:  Retail‐packed rump (Gluteus medius, GM) and striploins (Longissiumus dorsi, LD) steaks were masterpackaged under carbon dioxide (CO2) and stored at 1 °C ± 1 °C for 14, 28, 35, and 42 d. A commercial oxygen (O2) scavenger (ATCO HV1000®, Standa Industrie, Caen, France) was used in the masterpacks to achieve an O2‐free atmosphere. Similar packages without the O2 scavengers were also prepared. At each storage time, 2 masterpacks of each treatment were opened and the retail trays were placed in a display case at 4 °C ± 2 °C for 1 and 48 h for microbiological and sensorial evaluations. The low growth rate of aerobic psychrotrophic flora on the stored beefsteaks demonstrated the bacteriostatic effect of CO2 during storage. The maximum level of psychrotrophic aerobic bacteria reached during storage was approximately 106 CFU/g. The steaks stored in masterpacks with scavengers bloomed to the desirable red color associated with freshly cut meat in the display case for all of the storage periods, except in the case of GM steaks, which showed a cycle of transient discoloration. GM and LD steaks were well accepted (65% and 82%, respectively) after 42 d under CO2 at 1 °C ± 1 °C. The GM and LD steaks stored without the O2 scavenger showed variable fractions of discoloration that significantly detracted from the appearance of the samples.