bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role of Individualism and the Five‐Factor Model in the Prediction of Performance in a Leaderless Group Discussion
Authors: Waldman David A. , Atwater Leanne E. , Davidson Ronald A.
Published: December 2003

Personality has seen a resurgence in the work performance literature. The Five‐Factor Model (FFM) represents a set of personality factors that has received the most attention in recent years. Despite its popularity, the FFM may not be sufficiently comprehensive to account for relevant variation across performance dimensions or tasks. Accordingly, the present study also considers how individualism may predict additional variance in performance beyond the FFM. The study involved 152 undergraduate students who experienced a leaderless group discussion (LGD) exercise. Results showed that while the FFM accounted for variance in students' LGD performance, individualism (independence) accounted for additional, unique variance. Furthermore, analyses of the group compositions revealed curvilinear relationships between the relative amount of extraversion, conscientiousness, and individualism in relation to group‐level performance.
Unmitigated Communion, Social Constraints, and Psychological Distress Among Women With Rheumatoid Arthritis
Authors: Danoff‐Burg Sharon , Revenson Tracey A. , Trudeau Kimberlee J. , Paget Stephen A.
Published: December 2003

AbstractThe personality trait of unmitigated communion, an extreme focus on relationships that has been associated with self‐neglect, has been linked to poorer outcomes for both men and women, but is more common among women. This longitudinal study is the first to examine the influence of unmitigated communion on adaptation to a chronic illness that affects a much greater proportion of women to men. Women with rheumatoid arthritis completed measures of unmitigated communion, social constraints, and psychological distress at study entry and repeated the distress measure one year later. As expected, unmitigated communion was associated with psychological distress. Cross‐sectional moderation analyses indicated that low social constraints buffered the negative effects of unmitigated communion.
The Emotional Costs of Parents' Conditional Regard: A Self‐Determination Theory Analysis
Authors: Assor Avi , Roth Guy , Deci Edward L.
Published: December 2003

Parents' use of conditional regard as a socializing practice was hypothesized to predict their children's introjected internalization (indexed by a sense of internal compulsion), resentment toward parents, and ill‐being. In Study 1, involving three generations, mothers' reports of their parents' having used conditional regard to promote academic achievement predicted (a) the mothers' poor well‐being and controlling parenting attitudes, and (b) their collge‐aged daughters' viewing them as having used conditional regard, thus showing both negative affective consequences from and intergenerational transmission of conditional regard. Study 2 expanded on the first by using four domains, including both genders, and examining mediating processes. College students' perceptions of their mothers' and fathers' having used conditional regard in four domains (emotion control, prosocial, academic, sport) were found to relate to introjected internalization, behavioral enactment, fluctuations in self‐esteem, perceived parental disapproval, and resentment of parents. Introjection mediated the link from conditional regard to behavioral enactment. The results suggest that use of conditional regard as a socializing practice can promote enactment of the desired behaviors but does so with significant affective costs.
Identity Configurations: A New Perspective on Identity Formation in Contemporary Society
Authors: Schachter Elli P.
Published: December 2003

AbstractThis paper deals with the theoretical construct of “identity configuration.” It portrays the different possible ways in which individuals configure the relationship among potentially conflicting identifications in the process of identity formation. In order to explicate these configurations, I analyzed narratives of identity development retold by individuals describing personal identity conflicts that arise within a larger context of sociocultural conflict. Thirty Jewish modern orthodox young adults were interviewed regarding a potentially conflictual identity issue (i.e. their religious and sexual development). Their deliberations, as described in the interviews, were examined, and four different configurations were identified: a configuration based on choice and suppression; an assimilative and synthesizing configuration; a confederacy of identifications; and a configuration based on the thrill of dissonance. The different configurations are illustrated through exemplars, and the possible implications of the concept of “configuration” for identity theory are discussed.
Die metaphorische Funktion literarischer Texte Ein methodengeschichtliches Problem und sein sprachphilosophischer Lösungsansatz
Authors: Schmidt Christopher M.
Published: December 2003

Der Artikel untersucht die Rolle der Eingrenzbarkeit und Unbegrenztheit literarischer Bedeutungen für die Funktionsweise literarischer Texte. Vor dem geschichtlichen Hintergrund verschiedener literaturtheoretischer Methoden‐Lehren wird gezeigt, auf welche Weise die Spannung zwischen Eingrenzbarkeit und Unbegrenztheit methodenbedingt durch Überbetonung des einen Extrems auf Kosten des anderen zu greifen versucht worden ist. Auf der Basis des sprachphilosophischen Verweis‐Konzepts Nelson Goodmans wird gezeigt, wie die alten literaturtheoretischen Fragen nach den Funktionen von Eingrenzbarkeit und Unbegrenztheit bei der literarischen Bedeutungsbildung in ausgeglichener Weise in Einklang gebracht werden können. Dies geschieht über die metaphorische Verweisfunktion des Themas, welches als Etikett (im Sinne Goodmans) unbegrenzt mögliche Rezeptionen generieren kann. Dabei handelt es sich jedoch nicht um ein ‘anything goes’, da das Etikett als enzyklopädisch bedingte Eingrenzbarkeit fungiert. Durch die jeweils individuell unterschiedlichen Ausfüllungen des Etiketts mit Bedeutung wird auch der literarische Text auf immer wieder neu zu motivierende Wirklichkeitsanschlüsse eines Rezipienten beziehbar. Dies löst den literarischen Text sowohl von einer einseitigen Verankerung im Eingrenzbarkeitsideal formalistischer, strukturalistischer und in gewissem Sinne auch einiger hermeneutischer Schulen. Des weiteren wird dadurch die Funktionsweise literarischer Texte auch vom einseitig geprägten Ideal der Unbegrenztheit der Dekonstruktion und der Version des Radikalen Konstruktivismus gelöst, was jedoch ein konstruktivistisches Verständnis als solches für die Funktionsweise literarischer Texte nicht ausschließt.
“Besuche in Briefen”1 Die epistolare Praxis der Anakreontiker und Gellerts Briefreform
Authors: Hentschel Uwe
Published: December 2003

Es gehört zum Standardwissen, daß mit Gellert eine Reform der Briefliteratur in Deutschland einsetzte. Dabei wurde kaum beachtet, daß zwischen den barocken Briefstellern des 17. Jahrhunderts und Gellerts Musterbriefsammlung aus dem Jahre 1751 unter zahlreichen Schriftstellern eine epistolare Praxis gepflegt wurde, die vorab schon die Forderungen einlöste, die Gellert erst später formulieren sollte. Unter Heranziehung dieser Autoren und anhand der noch zu wenig bekannten Freundschaftlichen Briefe aus dem Jahre 1746 wird der Nachweis erbracht, daß Gellert nicht der Begründer der Reform ist, sondern “nur” derjenige, der den unter den Autoren der Zeit praktizierten epistolaren Stil popularisierte.
The Narrator as Special Pleader: The death of a child in La Peste
Authors: McCann John
Published: December 2003

This article examines the role of the narrator. He presents himself as a reasonable man, who is stirred to revolt against evil by the suffering that he observes. His principle concern is to witness to the truth so that others may do likewise. However, his agenda means that he is not as objective as he would have us believe. The truth that he tells is his truth and the novel bears the traces of a battle for truth in which competing narrators are one by one eliminated. In fact it can be argued that the narrator's account is compromised by the ambiguous relationship between himself and the plague.
Die antihermeneutische Stellung Goethes in den Unterhaltungen deutscher Ausgewanderten*
Authors: Pirro Maurizio
Published: December 2003

Die erzählerische Struktur der Unterhaltungen deutscher Ausgewanderten beruht auf einem engen Zusammenspiel zwischen der im Rahmen beschriebenen Situation der kleinen Gemeinschaft, die sich um den klugen Geistlichen versammelt, und den in den verschiedenen Erzählungen dargestellten Ereignissen, deren intendierte Bedeutung von den Zuhörern meist mißverstanden wird. Unter anderem aufgrund der Gemeinsamkeiten, die den Erzähler der Unterhaltungen und Goethe miteinander verbinden, so, wie der Schriftsteller in Champagne in Frankreich sich selbst als frustrierten und nicht immer willkommenen Gast bei den nach Pempelfort geflohenen Adligen darstellt, gelangt man zu einer Interpretation der Beziehungen Goethes zur Französischen Revolution, deren Hauptpunkt darin besteht, daß die politischen Umwälzungen dem Schriftsteller den später nicht mehr widersprochenen Eindruck vermittelt hätten, das Verhältnis des Publikums zu den literarischen Werken sei durch die allgemeine Politisierung der Gesellschaft unwiederbringlich getrübt. Im Verhalten des Erzählers und der Zuhörer im Rahmen der Unterhaltungen spiegelt sich somit die Strategie des Erzählers Goethe wider, die dazu neigt, die vielfältigen, irreführenden Interpretationen, denen sich die politisierte Gesellschaft hingibt, dadurch ungültig zu machen, den »Geist der Erzählung«über jegliche moralische, zu praktischen Zwecken unmittelbar benutzbare Bedeutung der dargestellten Geschichten ungebändigt schweben zu lassen.
A New Reading of Werther as Goethe's Critique of Rousseau
Authors: Tantillo Astrida Orle
Published: December 2003

This article argues for a new ironic reading of Werther– a reading that highlights Goethe's early critique of Rousseau's political philosophy. The article first compares key passages in Werther to Rousseau's Discours sur l'Origine et les Fondements de l'Inégalitéparmi les hommes and Essai sur l'origine des langues to show how Goethe uses Rousseau's texts to create a critical distance between the reader and the sentimental narrative. The article then analyzes Goethe's farcical play, Der Triumph der Empfindsamkeit. While the play is generally read as a satiric criticism of the public's reaction to Werther, this article contends that the play is also a commentary on Rousseau's philosophy and Werther itself.
Lichenoid graft vs. host disease following liver transplantation
Authors: Walling Hobart W. , Voigt Michael D. , Stone Mary Seabury
Published: December 2003

Background: Graft vs. host disease (GVHD) is a common complication of bone marrow transplantation (BMT) but is rarely seen after solid organ transplantation.

Methods: We report a case of lichenoid GVDH arising in a 60‐year‐old man 10 weeks after orthotopic liver transplantation.

Results: Skin biopsies revealed changes suggestive of lichenoid GVHD, but histological features differed from those described in post bone marrow (stem cell) transplant GVHD, in that a dense lymphoid infiltrate was present. The brisk infiltrate contained eosinophils that initially led to concern for a lichenoid drug eruption. The patient developed multiorgan GVHD after reduction in immunosuppression. The diagnosis of chronic GVHD was confirmed by the demonstration of chimerism in the patient's peripheral blood. The generalized cutaneous eruption and systemic manifestations responded to salvage therapy including intravenous immunoglobulin infusion, increased immunosuppression with high‐dose steroids, mycophenolate mofetil, and systemic and topical tacrolimus.

Conclusions: In interpreting skin biopsies, it is important to recognize that brisk inflammation may be seen in GVHD in the setting of solid organ transplantation, in contrast to the more sparse inflammation typical of GVHD following BMT. The clinical and histologic differential diagnosis included the eruption of lymphocyte recovery, drug reaction, and viral exanthem. We provide a conceptual framework for evaluating generalized cutaneous changes that may occur post transplantation.
The diagnostic utility of p63, CK5/6, CK 7, and CK 20 in distinguishing primary cutaneous adnexal neoplasms from metastatic carcinomas
Authors: Qureshi Hina S. , Ormsby Adrian H. , Lee Min W. , Zarbo Richard J. , Ma Chan K.
Published: December 2003

Background:  Distinguishing primary cutaneous adnexal neoplasms (PCANs) from metastatic carcinomas (MCs) can be difficult. We study the utility of p63, CK 5/6, CK 7, and 20 expression in PCAN vs. MC.

Methods:  Twenty‐one PCAN with sweat gland differentiation (six benign, 15 malignant), one sebaceous carcinoma, and 15 MC (14 adenocarcinomas, one urothelial carcinoma) to skin were retrieved from the pathology files. Immunostains for p63, CK 5/6, CK 7, and CK 20 were performed and graded as follows: 1, <10; 2, 11–50; and 3 >50% of tumor cells stained.

Results:  Twenty of 22 PCAN expressed p63 and CK 5/6. Four of 15 and two of 15 MC were positive for CK 5/6 and p63, respectively. Thirteen of 22 PCAN and 13 of 15 MC were positive for CK 7, respectively. All PCAN were negative for CK 20, two of 15 MC were positive. The sensitivity and specificity for the diagnosis of PCAN were 91 and 73% for CK 5/6, 91 and 100% for p63, and 60 and 13% for CK 7, respectively.

Conclusions:  For distinguishing PCAN from MC: (1) positivity for p63 and CK 5/6 are relatively specific and sensitive for PCAN, (2) CK 7 and 20 are neither sensitive nor specific, and (3) CK 7 positivity in PCAN was focal with a specific pattern in contrast to the diffuse positivity for MC.
Cellular nodules in congenital pattern nevi
Authors: Xu Xiaowei , Bellucci Kirsten S. W. , Elenitsas Rosalie , Elder David E.
Published: December 2003

Background:  The diagnosis of ‘cellular dermal nodule in melanocytic nevi’ is challenging, as it can simulate invasive and tumorigenic melanoma. Because cellular nodules are presumed benign, it is essential to differentiate them from true malignant melanoma arising within a nevus, which portends a poor prognosis. Although presumed benign, to date, no published long‐term follow‐up studies have proved the benignity of this lesion.

Methods:  To better understand the clinical behavior and histological features of these lesions, we present a clinical pathological study of a cohort of 26 cases, for which we obtained clinical follow up by chart review and questionnaires.

Results:  Clinical follow up was obtained on 16 out of 26 patients (61.5%) and ranged from 12 to 132 months (average 62.3 months). The cellular nodules in congenital pattern nevi, reported here, had an invariably benign clinical course.

Conclusions:  Features useful in differentiating cellular nodule from melanoma include: (1) lack of high‐grade uniform cellular atypia; (2) lack of necrosis within the nodule; (3) rarity of mitoses; (4) evidence of maturation in the form of blending or transitional forms between the cells in the nodule and the adjacent nevus cells; (5) lack of pagetoid spread into the overlying epidermis; and (6) no destructive expansile growth. The difference between cellular nodule and melanoma arising from nevus can be very subtle, and it is important to emphasize that these lesions must be assessed on an individual case‐by‐case basis.
Melanocytic nevi of the breast: a histologic case‐control study
Authors: Rongioletti F. , Urso C. , Batolo D. , Chimenti S. , Fanti P. A. , Filotico R. , Gianotti R. , Innocenzi D. , Lentini M. , Tomasini C. , Pippione M. , Rebora A.
Published: December 2003

Background:  Melanocytic nevi in the genital, acral, and flexural sites often display clinical and histologic features that may simulate melanoma. We verified whether this is the case also for nevi of the breast.

Methods:  Eleven dermatopathologists, from nine Italian Institutions, collected the specimens of melanocytic lesions from the breast and other body sites, excluding the acral, genital, and flexural areas, as controls. Cases and controls were matched for sex and age. All nevi were observed ‘blindly’ and simultaneously by all participants. For each lesion, 10 histological parameters were analyzed: asymmetry, absence of lateral demarcation of melanocytes, lentiginous proliferation, nested and dyshesive pattern, intraepidermal melanocytes above the basal layer, involvement of the hair follicle, absence of maturation of dermal melanocytes, melanocytic atypia, fibroplasia of the papillary dermis, and lymphocytic dermal infiltrate. Each parameter was scored 2 when present and 1 when absent or not valuable. A total score was calculated for each lesion. Results were statistically analyzed by the chi‐square test and the Mann–Whitney U‐test.

Results:  One hundred and one nevi came from the breast area and 97 from elsewhere. Breast nevi exhibited significantly more atypical features than nevi from other sites. In particular, breast nevi with intraepidermal melanocytes, melanocytic atypia, and dermal fibroplasia were significantly more numerous. We did not find any sexual difference.

Conclusions:  To avoid undue concerns, dermatopathologists should be aware that melanocytic nevi of the breast may show a high degree of atypical features.
Benign ectopic thyroid tissue in a cutaneous location: a case report and review
Authors: Maino Kim , Skelton Henry , Yeager Josef , Smith Kathleen J.
Published: December 2003

Background:  For many years, lateral, aberrant thyroid tissue in adults was a term used almost exclusively for metastatic thyroid carcinoma. However, aberrant, benign ectopic thyroid tissue does occur, and it is most commonly found as a part of the evaluation of endocrine dysfunction. Rarely, aberrant, benign ectopic thyroid presents as a primary mass.

Case report:  We present a 35‐year‐old female who presented for removal of a lifelong posterior lateral neck nodule.

Results:  Histologic examination and immunohistochemical studies confirmed the presence of aberrant, benign ectopic thyroid tissue. The patient had no endocrine problems, and she had a normally located and functioning thyroid gland.

Conclusions:  This case illustrates that not all aberrant thyroid tissues in adults are malignant or associated with endocrine disorders. This case also illustrates the rare association of ectopic thyroid and a normally located and functioning thyroid gland. In this patient, a somatic mutation in a transcription factor important in thyroid migration could explain these findings.
Verrucous carcinoma of the axilla: case report and review
Authors: Assaf Chalid , Steinhoff Matthias , Petrov Ivailo , Geilen Christoph C. , De Villiers Ethel‐Michele , Schultz‐Ehrenburg Ulrich , Orfanos Constantin E.
Published: December 2003

Background:  Verrucous carcinoma, a variant of squamous cell carcinoma, is distinct from squamous cell carcinoma in morphology and behavior. It preferentially occurs on the oropharyngeal mucosa, the urogenital mucosa, and the soles. In contrast to its malignant clinical picture, the tumor grows locally invasive but is histologically benign and metastasizes rarely.

Methods:  We report the uncommon occurrence of a large verrucous carcinoma on apparently uninvolved skin in the right axilla in a 47‐year‐old male.

Results:  Histologic examination reveals a cauliflower‐like tumor consisting of deep invaginated epidermal proliferation with rabbit burrow‐like, keratin‐filled sinus formations; the basement membrane, however, remains intact. Immunohistology showed positivity for pancytokeratin (KL‐1) and cytokeratin (CK) 18 and negativity for CK7, and assessment of the proliferative activity of the tumor cells revealed low percentage of Ki‐67 expression. Furthermore, there were only scattered cells expressing p53 or bcl‐2. Polymerase chain reaction excluded the presence of human papillomavirus. After complete excision, no signs of recurrence occurred over a follow‐up period of three years.

Conclusion:  Verrucous carcinoma should be distinguished from typical squamous cell carcinoma. The clinicopathological features, differential diagnosis, and therapy are discussed here together with the molecular biologic aspects of the tumor.
Tumefactive lipedema with pseudoxanthoma elasticum‐like microscopic changes
Authors: Taylor Nancy E. , Foster William C. , Wick Mark R. , Patterson James W.
Published: December 2003

Background:  Lipedema is a condition characterized by diffuse, bilaterally symmetrical, painful swelling of the legs and buttocks. Microscopically, there are dermal and septal edema, adipocyte degeneration, and numerous mast cells, features held in common with lipedematous alopecia.

Case report:  We present the case of a 60‐year‐old woman with a long history of bilateral leg masses with microscopic features of lipedema. In addition, elastic‐fiber changes typical of pseudoxanthoma elasticum (PXE) were discovered within the subcutaneous septa in three separate specimens obtained from an affected extremity. The patient did not have other clinical findings of PXE, although there was a history of both hypertension and congestive heart failure.

Conclusion:  This tumefactive presentation of lipedema has not been previously described. Regarding the elastic‐tissue abnormalities, the patient could have either a subclinical form of PXE, perhaps predisposing to lipedema, or secondary elastic‐tissue changes resulting from the massive edema. If the latter is the case, then this could represent an unusual manifestation of localized acquired cutaneous PXE (calcific elastosis).
Black's Model of Interest Rates as Options, Eigenfunction Expansions and Japanese Interest Rates
Authors: Gorovoi Viatcheslav , Linetsky Vadim
Published: December 2003

Black's (1995) model of interest rates as options assumes that there is a shadow instantaneous interest rate that can become negative, while the nominal instantaneous interest rate is a positive part of the shadow rate due to the option to convert to currency. As a result of this currency option, all term rates are strictly positive. A similar model was independently discussed by Rogers (1995). When the shadow rate is modeled as a diffusion, we interpret the zero‐coupon bond as a Laplace transform of the area functional of the underlying shadow rate diffusion (evaluated at the unit value of the transform parameter). Using the method of eigenfunction expansions, we derive analytical solutions for zero‐coupon bonds and bond options under the Vasicek and shifted CIR processes for the shadow rate. This class of models can be used to model low interest rate regimes. As an illustration, we calibrate the model with the Vasicek shadow rate to the Japanese Government Bond data and show that the model provides an excellent fit to the Japanese term structure. The current implied value of the instantaneous shadow rate in Japan is negative.
MultiFactor Valuation of Floating Range Notes
Authors: Nunes João Pedro Vidal
Published: December 2003

Under a one‐factor Gaussian Heath‐Jarrow‐Morton model, Turnbull (1995) as well as Navatte and Quittard‐Pinon (1999) have provided explicit pricing solutions for range notes contracts. The present paper generalizes such closed‐form solutions for the context of a multifactor Gaussian HJM framework.
Nonparametric Estimation and Sensitivity Analysis of Expected Shortfall
Authors: Scaillet O.
Published: December 2003

We consider a nonparametric method to estimate the expected shortfall—that is, the expected loss on a portfolio of financial assets knowing that the loss is larger than a given quantile. We derive the asymptotic properties of the kernel estimators of the expected shortfall and its first‐order derivative with respect to portfolio allocation in the context of a stationary process satisfying strong mixing conditions. An empirical illustration is given for a portfolio of stocks. Another empirical illustration deals with data on fire insurance losses.
The spiny devil katydids, Panacanthus Walker (Orthoptera: Tettigoniidae): an evolutionary study of acoustic behaviour and morphological traits
Authors: Montealegre‐Z. Fernando , Morris Glenn K.
Published: December 2003

Abstract.  A cladistic analysis and systematic revision of the genus Panacanthus accompanies the description of three new species, with calling songs reported for four species. The evolutionary origin of spines is considered as a defensive mechanism in Panacanthus; both morphological and behavioural (i.e. acoustic) traits allow inferences about relationships. Phylogenetic analysis produced one most parsimonious cladogram eighty‐two steps long, with the ensemble consistency index = 0.84. Panacanthus cuspidatus and P. pallicornis (formerly Storniza Walker 1869, Martinezia Bolivar 1881) are properly incorporated in Panacanthus. On morphology, Panacanthus is more related to the Neotropical Copiphora and Lirometopum than to the Old World Lesina. Character analysis reveals that in Panacanthus the ancestral condition of calling song resonance (the production of musical sounds) has given rise to a more nonresonant (transient) stridulation. A correlation between the production of more complex sound waves and spinous protection of the body (especially the pronotum) is noted. Because early workers grouped Panacanthus with other spiny genera, based on pronotal morphology, we present a critique of the evolutionary and ecological implications of the development of defensive spines in this genus. This approach may be applied to other taxa using a similar protective mechanism. We advise against arrangement of the pronotal, cephalic and femoral armature as a homologous characteristic across subfamilies. Several pronotal processes and modifications evolved independently in other genera of Conocephalinae, Hetrodinae, Pseudophyllinae and Phaneropterinae. The pronotal structure of Panacanthus is unique and may be taken as a synapomorphic characteristic of all its species and as an autapomorphic feature of the genus.
First descriptions of Coelometopini pupae (Coleoptera: Tenebrionidae) from Australia, Southeast Asia and the Pacific region, with comments on phylogenetic relationships and antipredator adaptations
Authors: Bouchard Patrice , Steiner Warren E.
Published: December 2003

Abstract.  The pupal stage of ten Coelometopini species occurring in Australia, New Guinea, Southeast Asia and the Pacific region are described and a key for their identification is provided. The species are Chrysopeplus expolitus Broun, Derosphaerus hirtipes Kaszab, Hypaulax crenata (Boisduval), Leprocaulus borneensis Kaszab, Metisopus purpureipennis Bates, Promethis carteri Kaszab, P. nigra (Blessig), P. quadraticollis (Gebien), P. quadricollis Pascoe and P. sulcigera (Boisduval). The gin trap structures of D. hirtipes and P. quadraticollis are described in detail using scanning electron micrographs. A summary of antipredator structures of all known Coelometopini pupae is given. The phylogenetic value of pupal characters is assessed at intra‐ and intergeneric levels within the tribe.
Diagnostic, prognostic and pathogenic value of the direct immunofluorescence test in cutaneous leukocytoclastic vasculitis
Authors: Barnadas María A. , Pérez Eugenia , Gich Ignasi , Llobet José M. , Ballarín José , Calero Francesca , Facundo Carmen , Alomar Agustín
Published: December 2003

Background    No precise studies have been performed on cutaneous leukocytoclastic vasculitis (LV) to establish whether it is better to obtain a skin biopsy from lesional or from perilesional skin for direct immunofluorescence (DIF). There is no agreement on the immunoglobulins most frequently detected and the value of DIF for the classification of cutaneous vasculitis.

Methods    A prospective study of DIF in lesional and perilesional skin was performed in 50 leukocytoclastic vasculitis patients and 15 nonvasculitis patients.

Results   We detected a higher level of positivity in involved skin than in uninvolved skin for IgG, IgA, IgM, C3 and fibrinogen but not for C1q. In vasculitic patients, IgA was the immunoglobulin most frequently detected in lesional (82%) and perilesional skin (68%), followed by IgM (56 and 34%, respectively) and IgG (20 and 8%, respectively). Only IgA deposits were associated with the diagnosis of vasculitis, with a sensitivity of 82% in lesional and 68% in perilesional skin, and with a specificity of 73 and 66.7%, respectively. The presence of IgA in lesional skin was associated with renal involvement but there was no association with severity. The presence of IgG or IgM, or the absence of IgA in perilesional skin was related to the presence of cryoglobulins. The absence of IgA in lesional and perilesional skin was also related to hepatitis C virus infection.

Conclusions   DIF findings in involved skin are more closely related to the diagnosis of vasculitis and can give more information about overall renal involvement than findings in uninvolved skin. However, findings in uninvolved skin are more closely related to the pathogenic factors that trigger the development of vasculitis.
Acute hemorrhagic edema of infancy: a case report
Authors: Da Silva Manzoni Ana Paula Dornelles , Viecili Josiane Burmann , De Andrade Cristiane Benvenuto , Kruse Ricardo Lapa , Bakos Lucio , Cestari Tania Ferreira
Published: December 2003

Background  Acute hemorrhagic edema of infancy (AHEI), or Seidlmayer's disease, is a type of leukocytoclastic vasculitis proper of infants and children. It is characterized by a local increase in temperature, erythematous edema and purpuric lesions involving mainly the face and extremities. There usually is no visceral involvement. The disease is self‐limited, bearing a benign clinical course. Infection, drugs and immunization have been considered as precipitating factors. The main differential diagnosis is Henoch‐Schönlein purpura (HSP).

Methods  We describe a classic example of acute hemorrhagic edema of infancy, and comment on the clinical features, pathology, immunopathology and proposed therapy. We characterize the differences between AHEI and HSP.

Results  A course of corticosteroids was given to avoid quick progression of disease.

Conclusion  Acute hemorrhagic edema of infancy is a rare disease, and the most striking classic feature of the disease is the contrast between the acuteness of the cutaneous lesions and the good general condition of the patient. Considering its clinical features, pathology and immunopathology, AHEI can be justifiably characterized as a unique disorder, distinct from HSP.
Necrolytic migratory erythema: clinicopathologic study of 13 cases
Authors: Pujol Ramon M. , Wang Chin‐Yao Eric , El‐Azhary Rokea A. , Su W. P. Daniel , Gibson Lawrence E. , Schroeter Arnold L.
Published: December 2003

Background  The clinical mucocutaneous manifestations of glucagonoma syndrome are recognized easily when they occur in the classic pattern of acral or periorificial lesions evolving in recurrent crops, with an annular and migratory distribution, in a patient with diabetes mellitus who has had recent weight loss and anemia. Not infrequently, noncharacteristic clinical and histopathologic features are observed and, in these cases, the diagnosis of pancreatic neoplasm may be delayed.

Aim  To review the clinical and histopathologic features of cutaneous manifestations of glucagonoma syndrome.

Methods  The clinicopathologic features of 13 patients (eight women) with widespread or localized cutaneous eruption as a manifestation of islet cell pancreatic carcinoma with marked glucagon secretion (glucagonoma) were reviewed.

Results  The definitive diagnosis of the cutaneous eruption was established at the time of diagnosis of the pancreatic neoplasm (three patients) or afterwards (10 patients). In nine patients, the mucocutaneous manifestations preceded the diagnosis of the pancreatic neoplasm by 1 month to 3 years (mean, 12 months). In only eight biopsy specimens were the histopathologic features considered to be suggestive or characteristic of necrolytic migratory erythema. Diffuse parakeratosis, that occasionally arose abruptly from normal epidermis, was observed in 12 biopsy specimens. By the time necrolytic migratory erythema was diagnosed, the pancreatic carcinoma had metastasized to the liver, regional lymph nodes, or bone in 12 patients.

Conclusion  Increased awareness of the polymorphic mucocutaneous and nonspecific histopathologic features of glucagonoma syndrome is needed to avoid unnecessary delay in the diagnosis of this syndrome.
Erythema multiforme associated with phenytoin and cranial radiation therapy: A report of three patients and review of the literature
Authors: Ahmed Iftikhar , Reichenberg Jason , Lucas Allison , Shehan James M.
Published: December 2003

Background  Intracranial malignancies (primary and metastatic) are often complicated by seizure activity. Phenytoin (Dilantin) is typically employed as prophylactic anticonvulsant in this setting. Uncommonly, erythema multiforme (EM) can develop in such patients at the port site during or soon after cranial radiation and can rapidly progress to EM major. Herein, in addition to a comprehensive literature review of this entity, three additional patients are presented. The acronym ‘EMPACT’ is suggested (E: erythema; M: multiforme; associated with P: phenytoin; A: and; C: cranial, radiation; T: therapy) to best describe this disorder.

Methods  An extensive review of the English medical literature through the National Library of Medicine (PUBMED) was performed to identify patients who had received or continued to receive radiation therapy while on phenytoin. A total of 24 patients were identified and clinical information of varying detail was available in all cases. Clinical and histological information on three additional patients seen at two institutions (Rochester Methodist Hospital, Rochester, MN, and Fairview‐University Medical Center, Minneapolis, MN) by the authors were also compiled.

Results  The mean age was 44 years (range: 23–67) and no sexual predisposition was noted. All patients had taken phenytoin for variable time periods (range 16–80 days; mean: 40) and were on the medication when the skin lesions first appeared. These lesions developed within the port site during the radiation treatments (11 cases) or soon after (nine cases) its completion (mean: 16 days; range: 2–35). Subsequent disease evolution to EM major occurred in all cases (Stevens–Johnsons syndrome developed in 73% of patients). No relationship was identified between the extent and the severity of the skin lesions with the phenytoin and radiation dosages and with the histologic type and origin of the intracranial malignancy. None of the patients demonstrated the requisite features of the ‘Dilantin hypersensitivity syndrome’. Although, a systemic steroid taper was employed in 10 out of the 14 patients before the development of the skin lesions, the subsequent progression of the skin lesions was not influenced by the use of systemic steroid therapy. Complete recovery occurred in all but two patients typically within 1–8 weeks of discontinuation of phenytoin.

Conclusions  The need for prophylactic anticonvulsant therapy especially utilizing phenytoin in patients undergoing cranial radiation therapy should be assessed on a case by case basis. If anticonvulsants are employed, then they must be administered with caution, and all cutaneous reactions developing subsequently within the radiation site must be promptly evaluated with a high index of suspicion for erythema multiforme.
Suggestion for the treatment of steatocystoma multiplex located exclusively on the face
Authors: Düzova Aylin Noyan , Şentürk Gonca Boztepe
Published: December 2003

Background  Although there are numerous reports of different treatment methods, the long‐term management of steatocystoma multiplex remains difficult. In this article we describe a simple technique that we used to treat the cysts on the face of a patient.

Methods  A 31‐year‐old male with steatocystoma multiplex located on the forehead and both temples was treated by inserting the tip of a needle and extirpating the contents, without removing the cyst wall.

Results  The procedure was very well tolerated by the patient. There have been no complications during or following the procedure. There were no recurrences after 10 months of follow up.

Conclusions  We suggest that this very simple technique is worth trying as a treatment of choice, especially for the management of facial lesions, where scaring is unacceptable.
Itraconazole in the treatment of seborrheic dermatitis: a new treatment modality
Authors: Baysal Vahide , Yildirim Mehmet , Ozcanli Cagnur , Ceyhan A. Murat
Published: December 2003

Background  Due to the high rate of recurrence, seborrheic dermatitis (SD) represents a therapeutic problem.

Aim  To evaluate the role of oral itraconazole in the treatment of SD.

Patients and methods  Thirty‐two patients with SD were enrolled in the study. All topical and oral treatments were stopped. The patients applied 1% hydrocortisone cream twice daily for 1 month. In addition, they took itraconazole, 200 mg/day, during the first week of the first month and then hydrocortisone cream was stopped and itraconazole (200 mg/day) was given on the first 2 days of the following 11 months. The patients were followed for 2 months without medicine. The severity score was measured at the initial evaluation, and at the first, 12th, and 14th months.

Results  Twenty‐eight patients completed the study. There was a statistically significant decrease in the mean severity score at the first, 12th, and 14th months. On the final evaluation at the 12th month, 19 of the 28 patients showed a complete improvement, and three patients showed a slight improvement.

Conclusions  This study indicates that itraconazole plays an important role in the treatment of SD.
Group work in the mental health field: researching outcome
Authors: McDermott Fiona
Published: December 2003

This paper reviews outcome studies from groups facilitated for persons living with serious mental illness. Although the research base is limited (groups posing considerable methodological challenges), available studies show that, in general, group work is as effective as individual work, if not more so. This paper describes findings from studies of short‐term, long‐term and self‐help groups dealing with mood disorders, schizophrenia, eating disorders and borderline personality disorders over the last 10 years. The concept of ‘time‐effective’ group work is discussed as are the potentially harmful effects of group participation. The paper concludes by arguing that group work is an effective and less expensive treatment option that would benefit from further research to establish an evidence base, both for current practice and for the expansion of group work practice in the future.
Centrelink: how social workers make a difference for young persons. A model of intervention
Authors: Squires Jane , Kramaric‐Trojak Natasa
Published: December 2003

It is mandatory for social workers at Centrelink to interview and assess under 18‐year‐old youth who are applying for the ‘Unreasonable to Live at Home’ (UTLAH) rate of Youth Allowance. The aims of this research project were to identify and describe social work models of intervention when interviewing young persons who applied for UTLAH payments and to examine the way in which social workers developed a response to organisational and legislative changes. The qualitative research consisted of two components: field observations of social work interviews with claimants and an open‐ended questionnaire completed by social workers after the observed interaction. The research confirmed the hypothesis that parts of a number of social work interventions could be combined and used to effectively assess and assist clients within the prescribed short‐term approach. In addition, it supported the researchers' belief that social work models of intervention could be adapted to organisational and environmental changes. A potential challenge for social workers at Centrelink is to produce a brief social work model of intervention that is flexible enought to be used by professionals across sectors.
Breakdown of foster care placement: carer perspectives and system factors
Authors: Gilbertson Robyn , Barber James G
Published: December 2003

A crisis in foster care is suggested by many of the national and international published reports. One seemingly intractable problem is placement instability, particularly for adolescents with behavioural problems. A qualitative study of foster carers who had ended a placement because of the young person's disruptive behaviour (n = 19) was conducted to examine ways in which system shortcomings might be affecting placement outcomes. Data were collected on the process of placement deterioration, the incident(s) that precipitated the decision to end placement, formal carer support, and the carer's response to the breakdown. All placements fell into one of two categories: those that, with certain interventions, might have been sustained (n = 9); and those that, regardless of intervention, appear to have been unsustainable (n= 10). This study contributes to the alternative care literature by highlighting the potential of some faltering placements to be maintained and of some failed placements to be renegotiated.
Danger of strong causal reasoning in juvenile justice policy and practice
Authors: Borowski Allan
Published: December 2003

Policy responses to social problems are shaped, among other things, by understandings of their causes. Strong causal reasoning, however, poses the danger of unsuccessful program outcomes where ‘weak’ theories are uncritically adopted to inform program design. This article describes this danger in the field of juvenile crime and corrections where theory development remains wanting. It also focuses on the findings of meta‐analyses of juvenile correctional programs as providing scope for strengthening explanations for juvenile crime by inductive means of theory building.
A Placebo‐Controlled Trial of a Proprietary Extract of North American Ginseng (CVT‐E002) to Prevent Acute Respiratory Illness in Institutionalized Older Adults
Authors: Mcelhaney Janet E. , Gravenstein Stefan , Cole Sharon K. , Davidson Edward , O'neill Dennis , Petitjean Sharon , Rumble Barry , Shan Jacqueline J.
Published: December 2003

Objectives: To compare a proprietary extract of American ginseng, CVT‐E002, with placebo in preventing acute respiratory illness (ARI) in an institutional setting during the influenza season.

Design: Two randomized, double‐blind, placebo‐controlled trials conducted late in the 2000 (8 week) and 2000–2001 (12 week) influenza seasons.

Setting: Long‐term care setting that included nursing home and assisted living at three sites.

Participants: Eighty‐nine (2000) and 109 (2000–2001) enrolled subjects, average age 81 and 83.5, respectively; 74% women. Approximately 90% had received influenza vaccine in each of the 2 years.

Intervention: Oral twice‐daily administration of a proprietary ginseng extract, CVT‐E002, 200 mg or placebo.

Measurements: ARI was defined as two new respiratory symptoms or one with a constitutional symptom. Confirmation of viral ARI was by culture (influenza or respiratory syncytial virus (RSV)) or serology for influenza. Laboratory safety monitoring was done at 0, 4, and 8 or 12 weeks.

Results: An intent‐to‐treat analysis of pooled data corrected for drug exposure time showed that the incidence of laboratory‐confirmed influenza illness (LCII) was greater in placebo‐ (7 cases/101 subjects) than CVT‐E002‐treated (1/97) groups (odds ratio (OR)=7.73, P=.033). Combined data for LCII and RSV illness were also greater in placebo‐ (9/101) than CVT‐E002‐treated (1/97) groups (OR=10.50, P=.009), for an overall 89% relative risk reduction of ARI in the CVT‐E002 group.

Conclusion: CVT‐E002 was shown to be safe, well tolerated, and potentially effective for preventing ARI due to influenza and RSV.
Outcomes and Costs Among Seniors Requiring Hospitalization for Community‐Acquired Pneumonia in Alberta
Authors: Carriere Keumhee C. , Jin Yan , Marrie Thomas J. , Predy Gerry , Johnson David H.
Published: December 2003

Objectives: To determine the age‐specific rates of hospital discharge, cost per day, and overall in‐hospital 1‐ and 4‐year mortality for seniors who required hospitalization for the treatment of community‐acquired pneumonia (CAP).

Design: Retrospective analysis of two administrative health service databases.

Setting: Province of Alberta, Canada.

Participants: Residents of Alberta aged 18 and older.

Measurements: Hospital abstracts and vital statistics from April 1, 1994, to March 31, 1999, were analyzed, and mortality and cost outcomes statistically modeled by regression.

Results: There were 8,500 annual hospital discharges for CAP costing more than $40 million per year. The overall in‐hospital all‐cause mortality rate was 12%, and the 1‐year mortality rate was 26%. The mean age of pneumonia cases increased (P<.000) from 62.8 in 1994/1995 to 67.2 in 1998/1999. The proportion of hospital discharges in those aged 85 and older was 13% in 1994/1995, increasing to 18% in 1998/1999 (P<.000). The age‐specific hospital discharge rate and length of hospitalization increased with age. After adjustment for other factors using modeling, it was found that the relative risk (RR) of in‐hospital and 1‐year mortality increased with age, the RR of using special medical care and higher‐than‐average daily hospital cost decreased with age, and the RR of greater‐than‐average daily hospital cost was not associated with an increase in comorbidity. Total costs per hospital stay were similar in patients aged 85 and older to those in patients aged 65 to 74, despite a one‐third longer length of stay, which was consistent with reduced use of special medical care in those aged 85 and older.

Conclusion: The increased use of hospital resources for CAP in the setting of an aging population may have been partially avoided because of limitations in care provided for seniors aged 85 and older.
Antibiotic Treatment of Acute Respiratory Tract Infections in the Elderly: Effect of a Multidimensional Educational Intervention
Authors: Gonzales Ralph , Sauaia Angela , Corbett Kitty K. , Maselli Judith H. , Erbacher Kathleen , Leeman‐castillo Bonnie A. , Darr Carol A. , Houck Peter M.
Published: December 2003

Objectives: To measure and improve antibiotic use for acute respiratory tract infections (ARIs) in the elderly.

Design: Prospective, nonrandomized controlled trial.

Setting: Ambulatory office practices in Denver metropolitan area (n=4 intervention practices; n=51 control practices).

Participants: Consecutive patients enrolled in a Medicare managed care program who were diagnosed with ARIs during baseline (winter 2000/2001) and intervention (winter 2001/2002) periods. A total of 4,270 patient visits were analyzed (including 341 patient visits in intervention practices).

Intervention: Appropriate antibiotic use and antibiotic resistance educational materials were mailed to intervention practice households. Waiting and examination room posters were provided to intervention office practices.

Measurements: Antibiotic prescription rates, based on administrative office visit and pharmacy data, for total and condition‐specific ARIs.

Results: There was wide variation in antibiotic prescription rates for ARIs across unique practices, ranging from 21% to 88% (median=54%). Antibiotic prescription rates varied little by patient age, sex, and underlying chronic lung disease. Prescription rates varied by diagnosis: sinusitis (69%), bronchitis (59%), pharyngitis (50%), and nonspecific upper respiratory tract infection (26%). The educational intervention was not associated with greater reduction in antibiotic prescription rates for total or condition‐specific ARIs beyond a modest secular trend (P=.79).

Conclusion: Wide variation in antibiotic prescription rates suggests that quality improvement efforts are needed to optimize antibiotic use in the elderly. In the setting of an ongoing physician intervention, a patient education intervention had little effect. Factors other than patient expectations and demands may play a stronger role in antibiotic treatment decisions in elderly populations.