bluuebunny/crossref_metadata_2025 huggingface dataset:
Exploring Nurses’ Experiences of Providing High Dependency Care in Children’s Wards
Authors: Doman Maggie , Prowse Morag , Webb Christine
Published: September 2004

The care of critically ill children has received much attention in the past decade, and many of the recommendations from reports relating to the provision of paediatric intensive care have been addressed. In comparison, high dependency care has received less attention. This level of care is often provided on ‘general’ children’s wards, yet its impact on nursing staff and care delivery have received little attention. This article presents a study which explores nurses’ experiences of providing high dependency care on children’s wards using focus groups. Following analysis, six categories emerged: definitions and perceptions of high dependency care; having a high dependency unit; problems in district general hospitals; the skills needed for high dependency care; team working; and staffing for high dependency care. These findings have implications for current clinical, managerial and educational practice and for future developments in the field of high dependency care for children.
Manual Handling the Deceased Child in a Children’s Hospice
Authors: Pike Anne M.
Published: September 2004

The introduction of the Manual Handling Operation Regulations 1992 has forced organizations to review all manual handling carried out in the work-place. Safe manual handling is now a legislative requirement to enable the workforce to carry out their jobs in a safe and structured environment. This project looked in detail at the manual handling that was being carried out when caring for a child after they have died. It was undertaken at CHASE Children’s Hospice in the period up until December 2002, with a telephone survey investigating practice at six other children’s hospices. It aimed to identify incorrect procedures and, by applying the theory of ergonomics, identify changes that needed to occur in practice, making recommendations for environmental changes. The study led to the production of a policy for handling the children, devising child-specific handling guidelines, reducing the number of times the children are moved after they have died and providing appropriate equipment.
Evaluating Student Paediatric Advanced Nurse Practitioners’ Experiences of a Paediatric Pharmacology Module: In the Context of Reflective Learning
Authors: Watt Sigrid , Carter Bernie
Published: September 2004

An evaluation of the first paediatric pharmacology module at Master’s level was undertaken. The broad aims were: to ascertain whether the participants had achieved the modular learning outcomes; how their pharmacological knowledge base had altered as a result of the module; and whether their professional practice had been influenced subsequent to undertaking the module. The findings of the 12 participants who registered on the module are reported. Three tools were utilized to generate the data for this broadly qualitative study. The findings indicated that reflective thinking at the evaluative level enabled the participants to monitor their professional and personal performance and that their critical thinking skills and confidence had increased. The questionnaire survey had some limitations, but was seen as the only feasible method of achieving a representation as to whether the module had subsequently influenced the professional practice of the participants. The data presented convincing evidence of the relevance of study of a paediatric pharmacology module at Master’s level for the professional and personal development of practitioners.
Introduction: The Potential of Peer Talk
Authors: Blum-Kulka Shoshana , Snow Catherine E.
Published: September 2004

Research on children interacting with each other encompasses a wide variety of specific research interest, including but not limited to a focus on language. In this introduction to an issue of Discourse Studies devoted to the contribution of peer talk to pragmatic development, we define ‘peer talk’ as an interdisciplinary field of inquiry and we critically review literature on the role of peer talk in children’s pragmatic development. We suggest that ‘peer talk’ as a field of inquiry properly encompasses studies of the development of language through peer interaction as well as the ways in which peer talk functions in children’s co-construction of their social and cultural worlds. Research reviewed here suggests that peer talk may be a crucial site for pragmatic development, offering children a wide range of opportunities for mutual learning of interactive as well as linguistic skills. The evidence we review, which comes from the fields of language socialization, second language learning, and child-discourse, highlights two major contextual features of peer talk: (1) its collaborative, multi-party, symmetrical participation structure; and (2) its role in the co-constructed worlds of childhood culture. Finally, we call for research and theorizing that would bridge the gap between developmental and ethnographically-informed approaches to the study of child discourse, in order to ensure that children’s peer talk receives the attention due it as a major site for both the development of discourse skills and the creation of childhood culture.
Building Peer Relationships in Talk: Toddlers’ Peer Conversations in Childcare
Authors: Katz Jane R.
Published: September 2004

How do very young children use talk to create relationship? Are there associations between the quality of children’s relationships and their language use? Do children’s pragmatic abilities relate to other language competencies? This qualitative study addresses these questions using naturalistic data from a daycare setting by looking at the spontaneous peer talk in two overlapping dyads of toddler girls. This analysis indicates that young children have considerable pragmatic skill in using talk to create and maintain relationship. Children’s relational style and language use seem closely connected: the different talk styles of the two dyads instantiate and support their distinct relational styles. Further, different styles of relational talk appear to tap different language abilities. Considered with other studies looking at young children’s language and particularly pragmatic skills, this analysis suggests that young children’s language capabilities in the context of specific relationships merit further attention.
‘When Your Powers Combine, I am Captain Planet’: The Developmental Significance of Individual- and Group-Authored Stories by Preschoolers
Authors: Nicolopoulou A Geliki , Richner Elizabeth S.
Published: September 2004

This study analyzed 328 single- and group-authored stories composed by nine 4-year-olds in a mixed-age preschool class participating in a peer-oriented storytelling and story-acting practice. Group-authored stories (33 percent) were overwhelmingly told by same-gender groups. The frequencies, developmental trajectories, and functions of group-authored stories were different for girls and boys. Girls told mostly group-authored stories in the fall and single-authored stories in the spring. Group-authoring provided ‘brain-storming sessions’ for narrative experimentation; these stories were longer, with more dramatic problems and more sophisticated character portrayals. By the spring, girls’ single-authored stories also included these features, suggesting internalized narrative gains. Boys consistently preferred single-authored stories, though in the spring the frequency and quality of their group-authored stories increased. These were longer, with more sophisticated character portrayals, than single-authored stories. Group-authored stories made a distinctive contribution to narrative development, partly by helping boys and girls overcome limitations of their preferred narrative genres.
Repetition and Joking in Children’s Second Language Conversations: Playful Recyclings in an Immersion Classroom
Authors: Cekaite Asta , Aronsson Karin
Published: September 2004

Repetition is often associated with traditional teaching drills. However, it has been documented how repetitions are exploited by learners themselves (Duff, 2000). In a study of immersion classroom conversations, it was found that playful recyclings were recurrent features of young learners’ second language repertoires. Such joking events were identified on the basis of the participants’ displayed amusement, and they often involved activity-based jokes (Lampert, 1996) and meta pragmatic play, that is, joking about how or by whom something is said. Two types of recyclings: intertextual play and role appropriations were both important features in informal classroom entertainment and in the formation of a community of learners (cf. Rogoff, 1990). In a broad sense, both types of joking contained subversive elements in that they created play zones or ‘time-out’ (cf. Goffman, 1959; Jefferson, 1996) within classroom activities. Moreover, role appropriations were subversive in that they inverted classroom hierarchies.
Explanatory Discourse in Young Second Language Learners’ Peer Play
Authors: Aukrust Vibeke Grøver
Published: September 2004

This article investigates young second language learners’ participation in explanatory discourse during peer play in preschools. Twenty-seven 5-year-old Turkish-speaking children in Norwegian preschools were studied in peer play. Characteristics of conversational moves and of various explanatory types (Immediate-activity Explanations, Principle-based, Frame-based and Extended Explanations), as well as how such types were related to children’s academic language skills (receptive vocabulary and word definition skills) in Turkish and Norwegian were examined. Children, both native and non-native speakers of Norwegian, mostly produced explanations spontaneously, while requests for explanations occurred only occasionally. Second language learners who attended play groups with much explanatory peer talk had higher academic language skills. In particular, we discuss whether second language learners with more Principle-based Explanations had higher academic language skills in Norwegian. The contribution of peer play explanatory talk to second language learners’ academically mediated language skills is discussed.
Ideology and Learning in Policy Diffusion
Authors: Grossback Lawrence J. , Nicholson-Crotty Sean , Peterson David A. M.
Published: September 2004

Scholarly research on the diffusion of policies across state governments focuses predominantly on the pathways of information between the states. Absent from this research is a thorough discussion of the content of the information state governments use when deciding whether or not to adopt an innovative policy. Given the importance of information in decision making, we develop a model that focuses attention on one type of information, namely, the ideological position of previous adopters. Although not the only piece of relevant information, we believe that states look to the previous adopters in an effort to minimize the uncertainty about how issues fit in the liberalconservative policy space. We test this theory in three different policy areas, finding consistent evidence that ideological cues help states learn about policy innovations while replicating important findings from previous research.
Revisiting the Link Between Electoral Competition and Policy Extremism in the U.S. Congress
Authors: Gulati Girish J.
Published: September 2004

Prominent theories of American political parties imply that higher levels of competition cause lawmakers to be more responsive to the center of public opinion, but there is little empirical evidence to support this assertion. Furthermore, many studies have found that competition causes lawmakers to be less responsive to public opinion as a whole and more responsive to their own partisans. Parties and candidates pursue a “mobilization” rather than “moderation” strategy supposedly because competitive constituencies are inherently heterogeneous, which then creates a context for more ideological campaigns and a more partisan policymaking environment. An analysis of U.S. Senate roll call votes between 1989 and 2000 reveals that legislators from more marginal states are less responsive to the ideological center than legislators from safe states. Furthermore, there is no evidence of a relationship between constituency diversity and electoral competition or that greater partisanship is the result of greater diversity.
“Successful” Treatment of Persistent Nocturnal Enuresis in an Adolescent with Graduated Night Waking
Authors: Freeman Kurt A.
Published: September 2004

“Craig,” a 13-year-old biracial male, presented for treatment with primary nocturnal enuresis. Historical information indicated a history of treatment failure with various psychological interventions. In the current case analysis, a “successful” intervention for the client’s presenting complaint is documented and discussed. On the basis of the client’s expressed wishes, graduated night waking was utilized as an intervention, despite the fact that he was informed of other treatments that were more likely to be successful (i.e., the urine alarm). This case highlights the importance of collaborative treatment planning, particularly with an adolescent with a history of conflicts with authority figures. Also, the case is discussed in terms of identifying markers of success that are “client-centered.”
Retinoids and myelomonocytic growth factors cooperatively activate RARΑ and induce human myeloid leukemia cell differentiation via MAP kinase pathways
Authors: Glasow Annegret , Prodromou Natalia , Xu Ke , von Lindern Marieke , Zelent Arthur
Published: September 2004

Use of all-trans-retinoic acid (ATRA) in combinatorial differentiation therapy of acute promyelocytic leukemia (APL) results in exceptional cure rates. However, potent cell differentiation effects of ATRA are so far largely restricted to this disease and long-term survival rates in non-APL acute myelogeneous leukemia (AML) remain unacceptably poor, requiring development of novel therapeutic strategies. We demonstrate here that myelomonocytic growth factors (granulocyte colony-stimulating factor [G-CSF] and/or granulocyte macrophage colony-stimulating factor [GM-CSF]) potentiate differentiation effects of ATRA in different AML cell lines and primary cells from patients with myeloid leukemia. The ligand-dependent activities of endogenous and transiently expressed retinoic acid receptor alpha (RARα) isoforms can be potentiated by G/GM-CSF in U-937 cells and correlate with increased expression of ATRA-inducible RARα2 isoform. Specific inhibitors of mitogen mitogen-activated protein kinase (MAPK) (MEK)-1/-2 or p38 extracellular signal-related kinase (ERK) kinase diminish the ATRA as well as ATRA and G/GM-CSF-induced activation of the RARα proteins and decreased the differentiation-induced decline in cell numbers. Our data demonstrate that acting, at least in part, via the MAP kinase pathways, myelomonocytic growth factors enhance ATRA-dependent activation of the RARα isoforms and maturation of myeloid leukemia cells. These results suggest that combinatorial use of these agents may be effective in differentiation therapy of AML. (Blood. 2005;105:341-349)
Combined effects of As4S4 and imatinib on chronic myeloid leukemia cells and BCR-ABL oncoprotein
Authors: Yin Tong , Wu Ying-Li , Sun Hui-Ping , Sun Guan-Lin , Du Yan-Zhi , Wang Kan-Kan , Zhang Ji , Chen Guo-Qiang , Chen Sai-Juan , Chen Zhu
Published: September 2004

Imatinib (STI571, Gleevec) is a tailored drug for chronic myelogenous leukemia (CML), whereas arsenic compounds were used as ancient remedies for CML with certain efficacy. The aim of this study was to investigate the potential benefit of combination therapy with imatinib and arsenic sulfide (As4S4). Analysis of cell proliferation and clonogenic ability showed that As4S4 and imatinib exerted synergistic effects on both K562 cells and fresh CML cells. The effective concentrations on fresh CML cells were pharmacokinetically available in vivo but had much less inhibitory effect on CD34+ cells from the nonleukemic donors. Examination of cell cycles showed that As4S4 induced G2/M arrest whereas imatinib induced G1 arrest. Using a number of parameters such as morphology, annexin V/propidium iodide (PI), mitochondrial transmembrane potential, caspase-3 activity, and Fas/Fas-L, the synergistic effects were revealed on induction of cell apoptosis, largely through the mitochondrial pathway. The 2 drugs also exhibited a synergistic effect in targeting BCR-ABL protein. While As4S4 triggered its degradation and imatinib inhibited its tyrosine kinase activity, combined use of the 2 led to lower protein/enzymatic activity levels of BCR-ABL. Our in vitro data thus strongly suggest a potential clinical application of imatinib and As4S4 combination on CML.
Rod mutations associated with MYH9-related disorders disrupt nonmuscle myosin-IIA assembly
Authors: Franke Josef D. , Dong Fan , Rickoll Wayne L. , Kelley Michael J. , Kiehart Daniel P.
Published: September 2004

MYH9-related disorders are autosomal dominant syndromes, variably affecting platelet formation, hearing, and kidney function, and result from mutations in the human nonmuscle myosin-IIA heavy chain gene. To understand the mechanisms by which mutations in the rod region disrupt nonmuscle myosin-IIA function, we examined the in vitro behavior of 4 common mutant forms of the rod (R1165C, D1424N, E1841K, and R1933Stop) compared with wild type. We used negative-stain electron microscopy to analyze paracrystal morphology, a model system for the assembly of individual myosin-II molecules into bipolar filaments. Wild-type tail fragments formed ordered paracrystal arrays, whereas mutants formed aberrant aggregates. In mixing experiments, the mutants act dominantly to interfere with the proper assembly of wild type. Using circular dichroism, we find that 2 mutants affect the α-helical coiled-coil structure of individual molecules, and 2 mutants disrupt the lateral associations among individual molecules necessary to form higher-order assemblies, helping explain the dominant effects of these mutants. These results demonstrate that the most common mutations in MYH9, lesions in the rod, cause defects in nonmuscle myosin-IIA assembly. Further, the application of these methods to biochemically characterize rod mutations could be extended to other myosins responsible for disease.
Macrovascular thrombosis is driven by tissue factor derived primarily from the blood vessel wall
Authors: Day Sharlene M. , Reeve Jennifer L. , Pedersen Brian , Farris Diana M , Myers Daniel D. , Im Michael , Wakefield Thomas W. , Mackman Nigel , Fay William P.
Published: September 2004

Leukocytes and leukocyte-derived microparticles contain low levels of tissue factor (TF) and incorporate into forming thrombi. Although this circulating pool of TF has been proposed to play a key role in thrombosis, its functional significance relative to that of vascular wall TF is poorly defined. We tested the hypothesis that leukocyte-derived TF contributes to thrombus formation in vivo. Compared to wild-type mice, mice with severe TF deficiency (ie, TF–/–, hTF-Tg+, or “low-TF”) demonstrated markedly impaired thrombus formation after carotid artery injury or inferior vena cava ligation. A bone marrow transplantation strategy was used to modulate levels of leukocyte-derived TF. Transplantation of low-TF marrow into wild-type mice did not suppress arterial or venous thrombus formation. Similarly, transplantation of wild-type marrow into low-TF mice did not accelerate thrombosis. In vitro analyses revealed that TF activity in the blood was very low and was markedly exceeded by that present in the vessel wall. Therefore, our results suggest that thrombus formation in the arterial and venous macrovasculature is driven primarily by TF derived from the blood vessel wall as opposed to leukocytes.
Pulmonary function and exercise capacity in survivors of severe acute respiratory syndrome
Authors: Ong K-C. , Ng A.W-K. , Lee L.S-U. , Kaw G. , Kwek S-K. , Leow M.K-S. , Earnest A.
Published: September 2004

The aim of this study was to investigate pulmonary function and exercise capacity in a group of survivors of the severe acute respiratory syndrome (SARS).

At 3 months after hospital discharge, 46 survivors of SARS underwent the following evaluation: spirometry, static lung volumes and carbon monoxide transfer factor (TL,CO). In total, 44 of these patients underwent cardiopulmonary exercise testing.

No abnormalities were detected in the pulmonary function tests in 23 (50%) of the patients. Abnormalities of forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC andTL,COwere detected in seven (15%), 12 (26%), one (2%) and 18 (39%) patients, respectively. All of these abnormalities were mild except in one case. In 18 patients (41%), the maximum aerobic capacity was below the lower limit of the normal range. Breathing reserve was low in four patients and significant oxygen desaturation was detected in a further four patients. Comparison of the measured exercise capacity with resting pulmonary function tests showed many cases of discordance in impairment.

In conclusion, pulmonary function defects were detected in half of the recovered severe acute respiratory syndrome patients 3 months after hospital discharge, but the impairment was mild in almost all cases. Many patients had reduced exercise capacity that cannot be accounted for by impairment of pulmonary function.
Side-effects of fluticasone in asthmatic children: no effects after dose reduction
Authors: Visser M.J. , van der Veer E. , Postma D.S. , Arends L.R. , de Vries T.W. , Brand P.L.P. , Duiverman E.J.
Published: September 2004

To assess long-term effects and side-effects of fluticasone propionate (FP), a 2-yr study was performed, comparing a step-down dose approach (1,000 µg·day−1, with reductions every 2 months to 500, 200 and 100 µg·day−1for the remainder of the study)versusa constant dose (200 µg·day−1).

In 55 children with chronic persistent asthma, aged 6–10 yrs, airways hyperresponsiveness (AHR) and systemic side-effects (height, bone parameters and adrenal cortical function) were assessed at predetermined intervals in a double-blind prospective 2-yr study.

AHR improved after 4 months treatment with 1,000 µg·day−1FP followed by 500 µg·day−1, without significant differences during long-term treatment between the two approaches. Dose-dependent reduction of growth velocity, adrenal cortical function and biochemical bone turnover was found during therapy with 1,000 and 500 µg·day−1FP when compared with 200 µg·day−1.

In conclusion, doses of 1,000 and 500 µg·day−1fluticasone propionate are associated with marked reductions of growth velocity, bone turnover and adrenal cortical function. However, conventional doses (≤200 µg·day−1fluticasone propionate) appear to be safe in the long-term management of childhood asthma. From a safety point of view, high doses of fluticasone propionate should only be prescribed in exceptions,e.g.in persistent severe asthma.
Cystic fibrosis patients and families support cross-infection measures
Authors: Griffiths A.L. , Armstrong D. , Carzino R. , Robinson P.
Published: September 2004

A clonal strain ofPseudomonas aeruginosa(PA) was isolated in 1999 at the Royal Children's Hospital, Melbourne, Australia, after five unrelated children with cystic fibrosis (CF) died from severe lung disease aged <5 yrs. Subsequently, more than half of the patients in the clinic with PA were found to harbour this strain, and segregation measures were instituted at the hospital to prevent further spread.

The aim of this study was to assess CF parent and patient responses to the segregation measures to determine overall support. A questionnaire was sent out to the families of 291 CF children treated at the centre.

A 65% response rate was obtained. The majority of parents (85%) and patients ≥12 yrs old (63%) were positive about the segregation measures instituted. A total of 11% of parents and 25% of patients were unsure, and 4% of parents and 12% of children gave negative responses. Those who were not happy listed reasons such as concerns about the emotional impact of not socialising with other CF children, inconclusive evidence about person–person spread of infection and feelings of alienation created in the clinic by the separation.

In conclusion, the majority of responding cystic fibrosis patients and their families understand and are supportive of infection control measures instituted at the Royal Children's Hospital, Melbourne, Australia.
Surfactant proteins in pulmonary alveolar proteinosis in adults
Authors: Brasch F. , Birzele J. , Ochs M. , Guttentag S.H. , Schoch O.D. , Boehler A. , Beers M.F. , Müller K.M. , Hawgood S. , Johnen G.
Published: September 2004

Pulmonary alveolar proteinosis (PAP) is a rare disorder characterised histologically by an intra-alveolar accumulation of fine granular eosinophilic and periodic acid-Schiff positive material.

In a retrospective study, the composition of the intra-alveolarly accumulated material of adult patients with PAP was analysed by means of immunohistochemistry and Western blotting.

In patients with PAP, the current authors found an intra-alveolar accumulation of surfactant protein (SP)-A, precursors of SP-B, SP-B, variable amounts of mono-, di-, and oligomeric SP-C forms, as well as SP-D. Only in one patient was a precursor of SP-C detected. By means of immuno-electron microscopy, the current authors identified not only transport vesicles labelled for precursors of SP-B and SP-C, but also transport vesicles containing either precursors of SP-B or SP-C in type-II pneumocytes in normal human lungs.

It is concluded that pulmonary alveolar proteinosis in adults is characterised by an intra-alveolar accumulation of surfactant protein A, precursors of surfactant protein B, and surfactant proteins B, C and D. The current data provide evidence that not only an impairment of surfactant clearance by alveolar macrophages, but also an abnormal secretion of transport vesicles containing precursors of surfactant protein B (but not surfactant protein C) and an insufficient palmitoylation of surfactant protein C, which may lead to the formation of di- and oligomeric surfactant protein C forms, play a role in the pathogenesis of pulmonary alveolar proteinosis.
Can psychological factors help us to determine adherence to CPAP? A prospective study
Authors: Wild M.R. , Engleman H.M. , Douglas N.J. , Espie C.A.
Published: September 2004

The present study objective was to establish whether pretreatment social cognitive variables may contribute to the explanation of variance in adherence to continuous positive airway pressure (CPAP) treatment for patients with obstructive sleep apnoea/hypopnoea syndrome (OSAHS).

A total of 119 of 180 consecutive OSAHS patients were recruited to the study prior to initial CPAP titration. Patients completed psychological measures of health value, health locus of control (incorporating internality, chance, powerful others) and self-efficacy prior to CPAP titration. Objective adherence data were measured by CPAP unit time clocks and collected at 3-month follow-up. Average nightly use was calculated over this period.

Logistic regression of prospective predictors of adherence produced a model comprising psychological (health value, internality, powerful others), as well as clinical variables (Epworth score, body mass index, apnoea/hypopnoea index, CPAP pressure). This model explained 24% of the variance in CPAP use, and correctly identified 75% of adherers and 53% of nonadherers.

Although the psychological variables explained only a small amount of the overall variance in adherence behaviour, this result provides further support for the hypothesis that psychological variables contribute, in part, to continuous positive airway pressure adherence. Future research should focus on highlighting discrete variables, which may helpfully inform psychologically based interventions aimed at improving the use of continuous positive airway pressure by patients with obstructive sleep apnoea/hypopnoea syndrome at risk of discontinuance.
Dynamic hyperinflation and tolerance to interval exercise in patients with advanced COPD
Authors: Vogiatzis I. , Nanas S. , Kastanakis E. , Georgiadou O. , Papazahou O. , Roussos Ch.
Published: September 2004

Dynamic hyperinflation (DH) contributes importantly to the limitation of constant-load exercise (CLE) in patients with chronic obstructive pulmonary disease (COPD). However, its role in the limitation of interval exercise (IE) remains to be explored.

The change (Δ) in inspiratory capacity (IC) was measured to reflect changes in DH in 27 COPD patients (forced expiratory volume in one second mean±sem% predicted: 40±3) at the end of a symptom-limited CLE test at 80% of peak work capacity (WRmax) and an IE test at 100% WRmax(30 s of work, alternated with 30 s of unloaded pedalling).

At the limit of tolerance in both IE and CLE, patients exhibited similar DH (ΔIC: 0.39±0.05 L and 0.45±0.05 L, respectively). However, exercise endurance time (tend) for IE (32.7±3.0 min) was significantly greater than for CLE (10.3±1.6 min). The IEtendcorrelated with resting IC, expressed as % pred normal. At 30 and 90% of total IEtend, ΔIC (0.43±0.06 and 0.39±0.05 L, respectively) and minute ventilation (31.1±1.6 and 32.7±2.2 L·min−1, respectively) were not significantly different.

Resting hyperinflation helps to explain the limitation of interval exercise. Implementation of interval exercise for rehabilitation should provide important clinical benefits because it prolongs exercise endurance time and allows sustaining higher stable ventilation.
Home respiratory polygraphy for diagnosis of sleep-disordered breathing in heart failure
Authors: Quintana-Gallego E. , Villa-Gil M. , Carmona-Bernal C. , Botebol-Benhamou G. , Martínez-Martínez Á. , Sánchez-Armengol Á. , Polo-Padillo J. , Capote F.
Published: September 2004

The present study assessed the usefulness of home cardiorespiratory polygraphy as an alternative to overnight polysomnography for the diagnosis of sleep-disordered breathing in heart failure.

A total of 75 patients with chronic stable heart failure due to systolic dysfunction (left ventricular ejection fraction ≤45%) underwent polysomnography at the Virgen del Rocio Hospital and cardiorespiratory polygraphy at home. The two studies were performed in random order and within 30 days. The accuracy of polygraphical findings was determined by sensitivity and specificity obtained by area under the receiver operating characteristics (ROC) curves for apnoea-hypopnoea index (AHI) thresholds of ≥5, ≥10 and ≥15 in the polysomnography.

The area under the ROC curve for AHI ≥5, ≥10 and ≥15 was 0.896, 0.907 and 0.862, respectively. The diagnostic accuracy of polygraphy compared with polysomnography ranged 78.6–84%, with sensitivities of 68.4–82.5%, and specificities of 88.6–97.8% for the different AHI thresholds. Altogether, 29 patients had an AHI ≥10 (central pattern 24, obstructive pattern 5). Sensitivity and specificity of home polygraphy for identifying the sleep-disordered breathing pattern was 100%.

These data show that home cardiorespiratory polygraphy has a high sensitivity and specificity for the diagnosis of sleep-disordered breathing associated with heart failure.
XHM: A system for detection of potential cross hybridizations in DNA microarrays
Authors: Flikka Kristian , Yadetie Fekadu , Laegreid Astrid , Jonassen Inge
Published: September 2004

Background

Microarrays have emerged as the preferred platform for high throughput gene expression analysis. Cross-hybridization among genes with high sequence similarities can be a source of error reducing the reliability of DNA microarray results.

Results

We have developed a tool called XHM (cross hybridization on microarrays) for assessment of the reliability of hybridization signals by detecting potential cross-hybridizations on DNA microarrays. This is done by comparing the sequences of the probes against an extensive database representing the transcriptome of the organism in question. XHM is available online at http://www.bioinfo.no/tools/xhm/.

Conclusions

Using XHM with its user-adjustable parameters will enable scientists to check their lists of differentially expressed genes from microarray experiments for potential cross-hybridizations. This provides information that may be useful in the validation of the microarray results.
Combined analysis of expression data and transcription factor binding sites in the yeast genome
Authors: Nagaraj Vijayalakshmi H , O'Flanagan Ruadhan A , Bruning Adrian R , Mathias Jonathan R , Vershon Andrew K , Sengupta Anirvan M
Published: September 2004

Background

The analysis of gene expression using DNA microarrays provides genome wide profiles of the genes controlled by the presence or absence of a specific transcription factor. However, the question arises of whether a change in the level of transcription of a specific gene is caused by the transcription factor acting directly at the promoter of the gene or through regulation of other transcription factors working at the promoter.

Results

To address this problem we have devised a computational method that combines microarray expression and site preference data. We have tested this approach by identifying functional targets of the a 1-α 2 complex, which represses haploid-specific genes in the yeast Saccharomyces cerevisiae. Our analysis identified many known or suspected haploid-specific genes that are direct targets of the a 1-α 2 complex, as well as a number of previously uncharacterized targets. We were also able to identify a number of haploid-specific genes which do not appear to be direct targets of the a 1-α 2 complex, as well as a 1-α 2 target sites that do not repress transcription of nearby genes. Our method has a much lower false positive rate when compared to some of the conventional bioinformatic approaches.

Conclusions

These findings show advantages of combining these two forms of data to investigate the mechanism of co-regulation of specific sets of genes.
POSA: Perl Objects for DNA Sequencing Data Analysis
Authors: Aerts Jan A , Jungerius Bart J , Groenen Martien AM
Published: September 2004

Background

Capillary DNA sequencing machines allow the generation of vast amounts of data with little hands-on time. With this expansion of data generation, there is a growing need for automated data processing. Most available software solutions, however, still require user intervention or provide modules that need advanced informatics skills to allow implementation in pipelines.

Results

Here we present POSA, a pair of new perl objects that describe DNA sequence traces and Phrap contig assemblies in detail. Methods included in POSA include basecalling with quality scores (by Phred), contig assembly (by Phrap), generation of primer3 input and automated SNP annotation (by PolyPhred). Although easily implemented by users with only limited programming experience, these objects considerabily reduce hands-on analysis time compared to using the Staden package for extracting sequence information from raw sequencing files and for SNP discovery.

Conclusions

The POSA objects allow a flexible and easy design, implementation and usage of perl-based pipelines to handle and analyze DNA sequencing data, while requiring only minor programming skills.
Spontaneous activity of rat pretectal nuclear complex neurons in vitro
Authors: Prochnow Nora , Schmidt Matthias
Published: September 2004

Background

Neurons in the mammalian pretectum are involved in the control of various visual and oculomotor tasks. Because functionally independent pretectal cell populations show a wide variation of response types to visual stimulation in vivo, they may also differ in their intrinsic properties when recorded in vitro. We therefore performed whole-cell patch clamp recordings from neurons in the caudal third of the pretectal nuclear complex in frontal brain slices obtained from 3 to 6 week old hooded rats and tried to classify pretectal neurons electrophysiologically.

Results

Pretectal neurons showed various response types to intracellular depolarizations, including bursting and regular firing behavior. One population of pretectal nuclear complex neurons could be particularly distinguished from others because they displayed spontaneous activity in vitro. These cells had more positive resting potentials and higher input resistances than cells that were not spontaneously active. The maintained firing of spontaneously active pretectal cells was characterized by only small variances in interspike intervals and thus showed a regular temporal patterning. The firing rate was directly correlated to the membrane potential. Removing excitatory inputs by blockade of AMPA and/or NMDA receptors did not change the spontaneous activity. Simultaneous blockade of excitatory and inhibitory synaptic input by a substitution of extracellular calcium with cobalt neither changed the firing rate nor its temporal patterning. Each action potential was preceeded by a depolarizing inward current which was insensitive to calcium removal but which disappeared in the presence of tetrodotoxin.

Conclusions

Our results indicate that a specific subpopulation of pretectal neurons is capable of generating maintained activity in the absence of any external synaptic input. This maintained activity depends on a sodium conductance and is independent from calcium currents.
Malaria and anemia prevention in pregnant women of rural Burkina Faso
Authors: Miaffo Caroline , Some Florent , Kouyate Bocar , Jahn Albrecht , Mueller Olaf
Published: September 2004

Background

Pregnant women are a major risk group for malaria in endemic areas. Only little information exists on the compliance of pregnant women with malaria and anaemia preventive drug regimens in the rural areas of sub-Saharan Africa (SSA). In this study, we collected information on malaria and anaemia prevention behaviour in pregnant women of rural Burkina Faso.

Methods

Cross-sectional qualitative and quantitative survey among 225 women of eight villages in rural northwestern Burkina Faso. Four of the villages had a health centre offering antenatal care (ANC) services while the other four were more than five kilometers away from a health centre.

Results

Overall ANC coverage (at least one visit) was 71% (95% in health centre villages vs 50% in remote villages). Malaria and anaemia were considered as the biggest problems during pregnancy in this community. ANC using women were quite satisfied with the quality of services, and compliance with malaria and anaemia prevention regimens (chloroquine and iron/folic acid) was high in this population. Knowledge on the benefit of bed nets and good nutrition was less prominent. Distance, lack of money and ignorance were the main reasons for women to not attend ANC services.

Conclusions

There is an urgent need to improve access of rural SSA women to ANC services, either through increasing the number of rural health centres or establishing functioning outreach services. Moreover, alternative malaria and anaemia prevention programmes such as intermittent preventive treatment with effective antimalarials and the distribution of insecticide-treated bed nets need to become implemented on a large scale.
Valgus and varus deformity after wide-local excision, brachytherapy and external beam irradiation in two children with lower extremity synovial cell sarcoma: case report
Authors: Fletcher Daniel T , Warner William C , Neel Michael D , Merchant Thomas E
Published: September 2004

Background

Limb-salvage is a primary objective in the management of extremity soft-tissue sarcoma in adults and children. Wide-local excision combined with radiation therapy is effective in achieving local tumor control with acceptable morbidity and good functional outcomes for most patients.

Case Presentation

Two cases of deformity after wide-local excision, brachytherapy and external beam irradiation for lower-extremity synovial cell sarcoma are presented and discussed to highlight contributing factors, time course of radiation effects and orthopedic management. In an effort to spare normal tissues from the long-term effects of radiation therapy, more focal irradiation techniques have been applied to patients with musculoskeletal tumors including brachytherapy and conformal radiation therapy. As illustrated in this report, the use of these techniques results in the asymmetric irradiation of growth plates and contributes to the development of valgus or varus deformity and leg-length discrepancies.

Conclusions

Despite good functional outcomes, progressive deformity in both patients required epiphysiodesis more than 3 years after initial management. There is a dearth of information related to the effects of radiation therapy on the musculoskeletal system in children. Because limb-sparing approaches are to be highlighted in the next generation of cooperative group protocols for children with musculoskeletal tumors, documentation of the effects of surgery and radiation therapy will lead to improved decision making in the selection of the best treatment approach and in the follow-up of these patients.
Logistics of community smallpox control through contact tracing and ring vaccination: a stochastic network model
Authors: Porco Travis C , Holbrook Karen A , Fernyak Susan E , Portnoy Diane L , Reiter Randy , Aragón Tomás J
Published: September 2004

Background

Previous smallpox ring vaccination models based on contact tracing over a network suggest that ring vaccination would be effective, but have not explicitly included response logistics and limited numbers of vaccinators.

Methods

We developed a continuous-time stochastic simulation of smallpox transmission, including network structure, post-exposure vaccination, vaccination of contacts of contacts, limited response capacity, heterogeneity in symptoms and infectiousness, vaccination prior to the discontinuation of routine vaccination, more rapid diagnosis due to public awareness, surveillance of asymptomatic contacts, and isolation of cases.

Results

We found that even in cases of very rapidly spreading smallpox, ring vaccination (when coupled with surveillance) is sufficient in most cases to eliminate smallpox quickly, assuming that 95% of household contacts are traced, 80% of workplace or social contacts are traced, and no casual contacts are traced, and that in most cases the ability to trace 1–5 individuals per day per index case is sufficient. If smallpox is assumed to be transmitted very quickly to contacts, it may at times escape containment by ring vaccination, but could be controlled in these circumstances by mass vaccination.

Conclusions

Small introductions of smallpox are likely to be easily contained by ring vaccination, provided contact tracing is feasible. Uncertainties in the nature of bioterrorist smallpox (infectiousness, vaccine efficacy) support continued planning for ring vaccination as well as mass vaccination. If initiated, ring vaccination should be conducted without delays in vaccination, should include contacts of contacts (whenever there is sufficient capacity) and should be accompanied by increased public awareness and surveillance.
Osteoporosis-related life habits and knowledge about osteoporosis among women in El Salvador: A cross-sectional study
Authors: Hernandez-Rauda Roberto , Martinez-Garcia Sandra
Published: September 2004

Background

Osteoporosis is a systemic skeletal disorder, characterized by reduced bone mass, deterioration of bone structure, increased bone fragility, and increased fracture risk. It is more frequent to find among women than men at a 4:1 ratio. Evidence suggests that to adopt changes on some life habits can prevent or delay development of osteoporosis. Several osteoporosis-risk factors have been confirmed in the US and western Europe, but in El Salvador there are neither reliable epidemiological statistics about this skeletal disorder nor studies addressing osteoporosis-risk factors in women. The aim of this study was to determinate the extent of osteoporosis knowledge, the levels of both daily calcium intake and weight-bearing physical activity, and the influence of several osteoporosis-risk factors on these variables in three age groups of Salvadorean women.

Methods

In this exploratory cross-sectional study, an osteoporosis knowledge assessment questionnaire incluiding a food frequency and a physical activity record section were used to collect data and it was delivered through a face-to-face interview. A convenience sample (n = 197) comprised of three groups of women aged 25–35 years, 36–49 years, and over 49 years was taken. Among-group comparisons of means were analyzed by two-way ANOVA. To determinate the overall influence of osteoporosis-risk factors, the multivariate analysis was used.

Results

Study results indicated that better educated women had more knowledge about osteoporosis than women with a low education level, regardless of age, even though this knowledge was rather fair. Older women got more weight-bearing physical activity at home and less at place of employment than reported by the younger women; however, neither group performed sufficient high-intensity WBPA to improve bone mass. Regardless of age, the most women consumed 60% or less than the Dietary Reference Intake of calcium and depend on household income, lactose intolerance and coffee rather than milk consumption.

Conclusion

In summary, the majority of women in this study have modest knowledge on osteoporosis. The knowledge base is not linked to preventive health habits, including sufficient calcium intake and performance of weight-bearing physical activities. They are thus at increased risk for low bone mass.
Encouraging physician appropriate prescribing of non-steroidal anti-inflammatory therapies: protocol of a randomized controlled trial [ISRCTN43532635]
Authors: Doupe Malcolm , Katz Alan , Kvern Brent , Manness Lori-Jean , Metge Colleen , Thomson Glen TD , Morrison Laura , Rother Kat
Published: September 2004

Background

Traditional non-steroidal anti-inflammatory drugs (NSAIDs) are a widely used class of therapy in the treatment of chronic pain and inflammation. The drugs are effective and can be relatively inexpensive thanks to available generic versions. Unfortunately the traditional NSAIDs are associated with gastrointestinal complications in a small proportion of patients, requiring costly co-therapy with gastro-protective agents. Recently, a new class of non-steroidal anti-inflammatory agents known as coxibs has become available, fashioned to be safer than the traditional NSAIDs but priced considerably higher than the traditional generics. To help physicians choose appropriately and cost-effectively from the expanded number of anti-inflammatory therapies, scientific bodies have issued clinical practice guidelines and third party payers have published restricted reimbursement policies. The objective of this study is to determine whether an educational intervention can prompt physicians to adjust their prescribing in accordance with these expert recommendations.

Methods

This is an ongoing, randomized controlled trial. All primary care physicians in Manitoba, Canada have been randomly assigned to a control group or an intervention study group. The educational intervention being evaluated consists of an audit and feedback mechanism combined with optional participation in a Continuing Medical Education interactive workshop. The primary outcome of the study is the change, from pre-to post-intervention, in physicians' appropriate prescribing of non-steroidal anti-inflammatory therapies for patients requiring chronic treatment. Three classes of non-steroidal anti-inflammatory therapies have been identified: coxib therapy, traditional NSAID monotherapy, and traditional NSAID therapy combined with gastro-protective agents. Appropriate prescribing is defined based on international clinical practice guidelines and the provincial drug reimbursement policy in Manitoba.