bluuebunny/crossref_metadata_2025 huggingface dataset:
Trends in prevalence of hepatitis B virus infection among Iranian blood donors, 1998–2007
Authors: Kafi‐Abad S. Amini , Rezvan H. , Abolghasemi H.
Published: August 2009

summary.

Assessment of the quality of donor selection and safety of the blood supply can be estimated by monitoring the prevalence of the serologic markers of infectious disease in screening tests. In the present study, changes in rates of hepatitis B virus (HBV) infection are studied in the period 1998–2007 in Iranian Blood Transfusion Organization (IBTO). Prevalence of serological marker of HBV infection [hepatitis B surface antigen (HBsAg)] was evaluated in blood donations in Iran as well as for Fars province representing a low prevalence, and Sistan‐Baluchestan (S&B) province as a high prevalence region throughout 1998–2007. For assessing frequency of infection, the prevalence of HBsAg per 100 000 donations and 95% confidential intervals (95% CIs) is calculated.Pvalue is estimated by χ2test. A total of 14 599 783 donations were collected during 10 years. The overall HBsAg prevalence rates declined from a 1.79% (1789/100 000 donations) in 1998 to 0.41% (409/100 000 donations) in 2007 in Iran. In Fars province, HBsAg prevalence decreased from 0.89% in 92 999 donations in 1998 to 0.34% in 148 014 donations in 2007 and in S&B province, the rate of HBsAg has gone down from 3.74% in 44 036 donations in 1998 to 1.15% in 56 057 donations in 2007. The frequency of HBV infection entering the blood supply has decreased over this period as a result of improvement in donor recruitment and selection, usage of software in transfusion services and possibly decreasing HBV infection prevalence in general population.
Recently introduced Aedes albopictus in Corsica is competent to Chikungunya virus and in a lesser extent to dengue virus
Authors: Moutailler Sara , Barré Hélène , Vazeille Marie , Failloux Anna‐Bella
Published: August 2009

Aedes albopictus has been established in Europe for some decades rendering temperate countries vulnerable to tropical diseases. The Italian chikungunya (CHIK) outbreak in the summer of 2007 demonstrated that indigenous transmission of CHIK was possible in Europe. To estimate the risk of a CHIK outbreak in Corsica, we assessed the vector competence of A. albopictus established in the island since 2006 towards a CHIK variant (E1‐A226V). A dengue serotype 2 virus was also tested. Experimental infections showed that A. albopictus was highly competent to CHIK virus (disseminated infection rates ranging from 75% to 100%) and to a lesser extent, to dengue virus (12.5–68.8%). Moreover, A. albopictus ensured a high level of viral replication and was able to transmit the virus as early as 2 days after ingestion of infected blood with around 1 000 viral RNA available in salivary glands. The risk for a local transmission of CHIK is thus likely in Corsica, if other parameters determining the vector capacity of A. albopictus are suitable.
Germination behavior, biochemical features and sequence analysis of the RACK1/arcA homolog from Phaseolus vulgaris
Authors: Islas‐Flores Tania , Guillén Gabriel , Islas‐Flores Ignacio , San Román‐Roque Carolina , Sánchez Federico , Loza‐Tavera Herminia , Bearer Elaine L. , Villanueva Marco A.
Published: August 2009

Partial peptide sequence of a 36 kDa protein from common bean embryo axes showed 100% identity with a reported β‐subunit of a heterotrimeric G protein from soybean. Analysis of the full sequence showed 96.6% identity with the reported soybean Gβ‐subunit, 86% with RACK1B and C from Arabidopsis and 66% with human and mouse RACK1, at the amino acid level. In addition, it showed 85.5, 85 and 83% identities with arcA from Solanum lycopersicum, Arabidopsis (RACK1A) and Nicotiana tabacum, respectively. The amino acid sequence displayed seven WD40 domains and two sites for activated protein kinase C binding. The protein showed a constant expression level but the mRNA had a maximum at 32 h post‐imbibition. Western immunoblotting showed the protein in vegetative plant tissues, and in both microsomal and soluble fractions from embryo axes. Synthetic auxin treatment during germination delayed the peak of RACK1 mRNA expression to 48 h but did not affect the protein expression level while the polar auxin transport inhibitor, naphtylphtalamic acid had no effect on either mRNA or protein expression levels. Southern blot and genomic DNA amplification revealed a small gene family with at least one member without introns in the genome. Thus, the RACK1/arcA homolog from common bean has the following features: (1) it is highly conserved; (2) it is both soluble and insoluble within the embryo axis; (3) it is encoded by a small gene family; (4) its mRNA has a peak of expression at the time point of germination stop and (5) its expression is only slightly affected by auxin but unaffected by an auxin transport blocker.
Pragmatist and Neo‐Classical Policy Paradigms in Public Services: Which is the Better Template for Program Design?
Authors: Marsh Ian , Spies‐Butcher Ben
Published: August 2009

Principal‐agent theory alerts principals to their problematic relationship with agents. The former are encouraged to take deliberate action to counter asymmetries in knowledge, moral hazard etc. To avoid this, principals should determine outcomes and contracts and incentives should be designed to achieve them. This approach has influenced the form of purchaser‐provider arrangements, including the Job Network. This article reviews impacts, which include incentives for gaming and increased transaction costs. Another survey highlighted the extent to which innovation in the disability employment sector had depended on collaboration, which competition would end. The article then sketches an alternative pragmatic or experimental approach, which assumes that the centre can never establish outcomes that are other than provisional and corrigible. Program design needs to be built around this fundamental fact. Learning not ‘carrots and sticks’ is the appropriate form of relationship. The article explores the feasibility of this approach in a Job Network context.
How Should Governments Make Risky Policy Decisions?
Authors: Hardaker J. Brian , Fleming Euan , Lien Gudbrand
Published: August 2009

Public policy‐making does not follow the long‐established and well‐recognised principles of rational decision analysis under risk. Public views of risk are often inconsistent and seemingly irrational, and a gulf exists between risk perceptions and attitudes of the public and those of ‘experts’. On the other hand, experts often claim unjustifiably high levels of confidence in their predictions of policy choice outcomes, creating a lack of public faith in their recommendations. While risky policy choices deserve more systematic decision analysis, many challenges remain to effective implementation of such analyses. Among the suggestions for improvement that we offer is the need for more effective interaction between policy‐makers, decision analysts and the public.
Australia's Indicator‐Based Sustainability Assessments and Public Policy
Authors: Hezri Adnan A. , Dovers Stephen R.
Published: August 2009

Operationalising sustainability has proven difficult because the concept is ambiguous and fraught with contradictions. In response, sustainability indicator systems to characterise and measure sustainable development have been developed globally. The focus of this article is on how indicators function as an instrument of policy to enhance achievement of environmental and sustainability policy in Australia at national scale. In theory, by integrating information from the environmental, social and economic domains and then feeding knowledge to a wide range of policy sectors, sustainability indicator systems may facilitate cross‐agency and ‐portfolio connectivity. Key characteristics of the various sustainability indicator systems developed to inform policy at the national level are described, noting the diverse approaches to indicator development in Australia. The structural relevance of indicator systems to the mechanisms of policy and institutions in Australia is discussed, and corresponding issues of institutional fit are analysed.
Bread and Wine: Bourdieu's Photography of Colonial Algeria
Authors: Haddour Azzedine
Published: August 2009

The photography of Bourdieu, whilst documenting aspects of his sociological work in Algeria, problematizes the relationship between its photographic referents and their history. To grasp this relationship, I will decode the historical signification of three photographs taken by Bourdieu in the mid-1950s when Tillion published L'Algérie en 1957 and Sartre ‘Le colonialisme est un système’ situating Bourdieu's photographic and sociological work in relation to both Tillion and Sartre. Although the influence of Tillion on Bourdieu is discernable, especially in Sociologie de l'Algérie, their political positions are at variance. Bourdieu's snapshots provide us with a perspective on how to interpret the causes of the vagrancy and famine in colonial times. Despite his avowed hostility to Sartre, Bourdieu concurs with the latter's critique of colonialism. His three photographs together project a political affinity with both Sartre and Barthes. The impoverishment of native Algerian society was not due to the fact that it failed to catch the train of progress, as Tillion intimates; rather it resulted from its systematic despoilment by colonial France.
DO STOCK RETURNS VARY WITH CAMPAIGN CONTRIBUTIONS? BUSH VS. GORE: THE FLORIDA RECOUNT
Authors: SHON JOHN J.
Published: August 2009

I examine the relation between campaign contributions and stock returns during the Florida recount period of the 2000 presidential elections. Using the full population of publicly traded firms, I find an economically significant positive (negative) relation between pre‐election campaign contributions to Bush (Gore) and stock returns during the 37‐day election recount period. This relation exists for both the level and partisanship of contributions, and exists incrementally at both the firm and industry levels. These relations are robust to several different specifications, including alternative event windows that exclude the potentially confounding House/Senate races. The firm‐level analysis is consistent with contributions being influence‐motivated.
Worker Pay Protection: Implications for Labor’s Political Spending and Voice
Authors: MASTERS MARICK F. , GIBNEY RAYMOND , ZAGENCZYK THOMAS J.
Published: August 2009

Labor’s participation in politics requires money. Within legal restrictions, unions use compulsory dues to pay for much of their involvement. Such usage has continually raised controversy, leading to a host of U.S. Supreme Court decisions to give nonmember dues‐payers the right to object to union political spending. We examine the current legal framework and are the first to report comprehensive data on union political spending financed from dues. We estimate the potential impact of a national “worker paycheck protection” law on labor’s political spending. With the potential to reduce money available to finance union involvement in politics, such a law may lessen the ability of labor to have its voice heard by lawmakers, especially in the face of shrinking density in the workforce. The importance of this is demonstrated by the large role unions played in the 2008 congressional and presidential elections. Despite Democratic victories in that historic year, “paycheck protection” is likely to loom large, fueled by efforts to enact the Employee Free Choice Act.
Unpaid Work at Home
Authors: SONG YOUNGHWAN
Published: August 2009

A substantial number of people take work home without a formal payment arrangement. Using the Work Schedules and Work at Home Supplement to the May 2001 Current Population Survey, this paper investigates the determinants of unpaid work at home. Education, lack of overtime rates, being a team leader, efficiency wages, and larger earnings inequality in an occupation are positively related to the prevalence of unpaid work at home. Unpaid work at home appears to be a form of investment made in expectation of a return in the long run.
“Reconsidering the Study of International Migration: A Way Forward for Macrostructural Migration Research”
Authors: Sanderson Matthew R.
Published: August 2009

The “globalization of migration” has raised new and important questions about the macrostructural or global determinants of international population movements (Castles and Miller, 2003). Yet there remains a dearth of cross‐national, empirical research in this area (Portes, 1997). In one of the earliest attempts to empirically identify macrostructural determinants of migration, Amankwaa makes an important contribution to the literature (1995). There are, however, some conceptual, analytical, and methodological shortcomings in Amankwaa’s analysis of migration. These deficiencies merit comment because Amankwaa’s paper could become an increasingly important source of information for public policies and analytical research efforts, particularly as international migration continues to garner increased attention from public policy practitioners and academic researchers. I address key deficiencies in Amankwaa’s study and describe a more robust analytical framework and more rigorous methodological techniques for future research inquiries into the relationship between globalization and international migration.
Shape and mechanics in thalattosuchian (Crocodylomorpha) skulls: implications for feeding behaviour and niche partitioning
Authors: Pierce S. E. , Angielczyk K. D. , Rayfield E. J.
Published: August 2009

Variation in modern crocodilian and extinct thalattosuchian crocodylomorph skull morphology is only weakly correlated with phylogeny, implying that factors other than evolutionary proximity play important roles in determining crocodile skull shape. To further explore factors potentially influencing morphological differentiation within the Thalattosuchia, we examine teleosaurid and metriorhynchid skull shape variation within a mechanical and dietary context using a combination of finite element modelling and multivariate statistics. Patterns of stress distribution through the skull were found to be very similar in teleosaurid and metriorhynchid species, with stress peaking at the posterior constriction of the snout and around the enlarged supratemporal fenestrae. However, the magnitudes of stresses differ, with metriorhynchids having generally stronger skulls. As with modern crocodilians, a strong linear relationship between skull length and skull strength exists, with short‐snouted morphotypes experiencing less stress through the skull than long‐snouted morphotypes under equivalent loads. Selection on snout shape related to dietary preference was found to work in orthogonal directions in the two families: diet is associated with snout length in teleosaurids and with snout width in metriorhynchids, suggesting that teleosaurid skulls were adapted for speed of attack and metriorhynchid skulls for force production. Evidence also indicates that morphological and functional differentiation of the skull occurred as a result of dietary preference, allowing closely related sympatric species to exploit a limited environment. Comparisons of the mechanical performance of the thalattosuchian skull with extant crocodilians show that teleosaurids and long‐snouted metriorhynchids exhibit stress magnitudes similar to or greater than those of long‐snouted modern forms, whereas short‐snouted metriorhynchids display stress magnitudes converging on those found in short‐snouted modern species. As a result, teleosaurids and long‐snouted metriorhynchids were probably restricted to lateral attacks of the head and neck, but short‐snouted metriorhynchids may have been able to employ the grasp and shake and/or ‘death roll’ feeding and foraging behaviours.
The origin, molecular regulation and therapeutic potential of myogenic stem cell populations
Authors: Otto A. , Collins‐Hooper H. , Patel K.
Published: August 2009

Satellite cells, originating in the embryonic dermamyotome, reside beneath the myofibre of mature adult skeletal muscle and constitute the tissue‐specific stem cell population. Recent advances following the identification of markers for these cells (including Pax7, Myf5, c‐Met and CD34) (CD, cluster of differentiation; c‐Met, mesenchymal epithelial transition factor) have led to a greater understanding of the role played by satellite cells in the regeneration of new skeletal muscle during growth and following injury. In response to muscle damage, satellite cells harbour the ability both to form myogenic precursors and to self‐renew to repopulate the stem cell niche following myofibre damage. More recently, other stem cell populations including bone marrow stem cells, skeletal muscle side population cells and mesoangioblasts have also been shown to have myogenic potential in culture, and to be able to form skeletal muscle myofibres in vivo and engraft into the satellite cell niche. These cell types, along with satellite cells, have shown potential when used as a therapy for skeletal muscle wasting disorders where the intrinsic stem cell population is genetically unable to repair non‐functioning muscle tissue. Accurate understanding of the mechanisms controlling satellite cell lineage progression and self‐renewal as well as the recruitment of other stem cell types towards the myogenic lineage is crucial if we are to exploit the power of these cells in combating myopathic conditions. Here we highlight the origin, molecular regulation and therapeutic potential of all the major cell types capable of undergoing myogenic differentiation and discuss their potential therapeutic application.
Travelling theory in China: contextualization, compromise and combination
Authors: LIU MENG , HU YANHONG , LIAO MINLI
Published: August 2009

In this article we explore the dissemination of human rights ideas in China through an ethnographic study of three women's organizations: the government's ‘letters and complaints’ department, the governmental NGO affiliated with it, and a legal aid centre; all are located in Beijing. We argue that there are two paths in China for the transmission of international human rights ideas – a government one and a non‐government one. The government path, featured as contextual and compromising, is rooted in socialist and collective values, and the governmental organizations we studied function squarely within the domestic legal framework and the concept of ‘women's rights and interests’. The non‐governmental path, by contrast, characterized by vernacularization, namely a combination of international ideas with local practice to promote legal reform in China, is the result of economic development and interactions with the international community. Both paths interact within their different spheres to further the development of women's rights.
Adaptive designs for Phase I dose‐finding studies
Authors: Zhou Yinghui
Published: August 2009

Improving methodology for Phase I dose‐finding studies is currently of great interest in pharmaceutical and medical research. This article discusses the current atmosphere and attitude towards adaptive designs and focuses on the influence of Bayesian approaches.
Involvement of protein kinase C and Src tyrosine kinase in acute tolerance to ethanol inhibition of spinal NMDA‐induced pressor responses in rats
Authors: Hsieh W‐K , Lin H‐H , Lai C‐C
Published: August 2009

Background and purpose:  The present study was carried out to examine the role of protein kinases in the development of acute tolerance to the effects of ethanol on spinal N‐methyl‐D‐aspartate (NMDA) receptor‐mediated pressor responses during prolonged ethanol exposure.

Experimental approach:  Blood pressure responses induced by intrathecal injection of NMDA were recorded. The levels of several phosphorylated residues on NMDA receptor NR1 (GluN1) (NR1) and NMDA receptor NR2B (GluN2B) (NR2B) subunits were determined by immunohistochemistry and Western blot analysis.

Key results:  Ethanol inhibited spinal NMDA‐induced pressor responses at 10 min, but the inhibition was significantly reduced at 40 min following continuous infusion. This effect was dose‐dependently blocked by chelerythrine [a protein kinase C (PKC) inhibitor, 1–1000 pmol] or PP2 (a Src family tyrosine kinase inhibitor, 1–100 pmol) administered intrathecally 10 min following ethanol infusion. A significant increase in the immunoreactivity of phosphoserine 896 of NR1 subunits (pNR1‐Ser896) and phosphotyrosine 1336 of NR2B subunits (pNR2B‐Tyr1336) was found in neurons of intermediolateral cell column during the development of tolerance. Levels of pNR1‐Ser896 and pNR2B‐Tyr1336 were also significantly increased in lateral horn regions of the spinal cord slices incubated with ethanol for 40 min in vitro. The increases in pNR1‐Ser896 and pNR2B‐Tyr1336 levels were inhibited by post‐treatment with chelerythrine and PP2, respectively, both in the in vivo and in vitro studies.

Conclusions and implications:  The results suggest that activation of PKC and Src tyrosine kinase during prolonged ethanol exposure leading to increases in the levels of pNR1‐Ser896 and pNR2B‐Tyr1336 may contribute to acute tolerance to inhibition by ethanol of NMDA receptor function.
Arginase: a key enzyme in the pathophysiology of allergic asthma opening novel therapeutic perspectives
Authors: Maarsingh Harm , Zaagsma Johan , Meurs Herman
Published: August 2009

Allergic asthma is a chronic inflammatory airways' disease, characterized by allergen‐induced early and late bronchial obstructive reactions, airway hyperresponsiveness (AHR), airway inflammation and airway remodelling. Recent ex vivo and in vivo studies in animal models and asthmatic patients have indicated that arginase may play a central role in all these features. Thus, increased arginase activity in the airways induces reduced bioavailability of L‐arginine to constitutive (cNOS) and inducible (iNOS) nitric oxide synthases, causing a deficiency of bronchodilating and anti‐inflammatory NO, as well as increased formation of peroxynitrite, which may be involved in allergen‐induced airways obstruction, AHR and inflammation. In addition, both via reduced NO production and enhanced synthesis of L‐ornithine, increased arginase activity may be involved in airway remodelling by promoting cell proliferation and collagen deposition in the airway wall. Therefore, arginase inhibitors may have therapeutic potential in the treatment of acute and chronic asthma. This review focuses on the pathophysiological role of arginase in allergic asthma and the emerging effectiveness of arginase inhibitors in the treatment of this disease.
A nurse‐led intensive care after‐care programme – development, experiences and preliminary evaluation
Authors: Samuelson Karin AM , Corrigan Ingrid
Published: August 2009

Background: The benefits of critical care follow‐up services include increased understanding of the long‐term consequences of intensive care and entail helping patients and their next of kin to come to terms with their problems and distress following critical illness and intensive care treatment.

Aims: To establish an intensive care after‐care programme and to conduct a preliminary evaluation of the follow‐up service from the patients' and relatives' perspectives in a general intensive care unit (ICU) in Sweden.

Design: A descriptive and evaluative design was used, and data from the first year of the after‐care programme were collected. The final programme was nurse led and included five main points; a patient diary with colour photographs, ward visits, a patient information pamphlet, a follow‐up consultation 2–3 months after intensive care discharge and feedback to the ICU staff. An evaluation questionnaire was handed out to patients and next of kin attending the follow‐up clinic, e.g. asking the respondents to rate their satisfaction of the consultation on a visual analogue scale (VAS).

Results: The first year of after‐care statistics showed that 170 survivors with a stay of 48 h or more were discharged from the ICU, resulting in 190 ward visits and 79 follow‐up consultations. The preliminary evaluation revealed that the 2‐month follow‐up consultation achieved a median VAS rating of 9·8 (ranging from 1 to 10, poor to excellent) from both patients and next of kin.

Conclusion: The development and preliminary evaluation of this nurse‐led intensive care programme resulted in a feasible programme, requiring modest resources, with a high level of patient and relative satisfaction.

Relevance to clinical practice: This paper attempts to share with professional colleagues important steps during the developmental process of establishing an intensive care follow‐up service and presents the content and preliminary evaluation of a nurse‐led intensive care after‐care programme focusing on the patients' and relatives' perspectives.
Characteristics of deaths in paediatric intensive care: a 10‐year study
Authors: Sands Rebecca , Manning Joseph C , Vyas Harish , Rashid Asrar
Published: August 2009

Objective: To describe the patient mortality over a 10‐year period in a paediatric intensive care unit (PICU) including patient demographics, length of stay, cause and mode of death and to compare these findings with pre‐existing literature from the western world.

Design: A retrospective chart review.

Setting: A UK tertiary PICU.

Patients: All children who died in the PICU over a 10‐year period between 1 November 1997 and 31 October 2007 (n = 204).

Interventions: None.

Measurements and main results: Data recorded for each patient included patient demographics, length of stay and cause of death according to the International Classification of Disease‐10 classification, and mode of death. Mode of death was assigned for each patient by placement in one of four categories: (i) brain death (BD), (ii) managed withdrawal of life‐sustaining medical therapy (MWLSMT), (iii) failed cardiopulmonary resuscitation (CPR) and (iv) limitation of treatment (LT). Over the study period, findings showed a median length of stay of 2 days (IQR 0–5 days), with a mortality rate of 5%. The most common mode of death was MWLSMT (n = 112, 54.9%) and this was consistent across the 10‐year period. Linear regression analysis demonstrated no significant change in trend over the 10 years in each of the modes of death; BD (p = 0.84), MWLSMT (p = 0.88), CPR (p = 0.35) and LT (p = 0.67).

Conclusion: End‐of‐life care is an important facet of paediatric intensive nursing/medicine. Ten years on from the Royal College of Paediatrics and Child Health publication ‘Withholding or withdrawing life sustaining treatment in children: A framework for practice’, this study found managed withdrawal of MWLSMT to be the most commonly practised mode of death in a tertiary PICU, and this was consistent over the study period.
Postoperative hyperglycaemia of diabetic patients undergoing cardiac surgery – a clinical audit
Authors: Lehwaldt Daniela , Kingston Mary , O'Connor Sheila
Published: August 2009

Background: Previous studies have shown that hyperglycaemia is associated with postoperative complications in cardiac surgical patients. Conversely, well‐controlled glucose levels are said to reduce major infectious complications in diabetic patients.

Aim/Objectives: The purpose of this clinical audit was to evaluate the blood glucose levels of diabetic patients undergoing cardiac surgery and to determine the effectiveness of postoperative glycaemic control.

Methods: A group of 150 patients from a large Irish cardiac surgery centre was selected by convenience sampling. An audit tool was designed to capture the patients' blood glucose levels, treatment regimes and postoperative complications.

Findings: The findings showed major variations between ‘high’, ‘good’ and ‘borderline’ blood glucose levels in the pre‐ and postoperative phase. Although blood glucose testing practices seemed inconsistent, mean levels measured ‘borderline’. Furthermore, the treatment regimes varied greatly and suggest a lack of consensus regarding the management of postoperative hyperglycaemia. A total of 52% (n = 78) patients developed 114 complications with a level of 21·4% (n = 32) postoperative wound infections.

Conclusion: The findings from this audit highlight the importance of regular blood glucose testing to enable early detection of hyperglycaemia and timely initiation of appropriate treatments regimes for diabetic patients undergoing cardiac surgery. Findings also show that hyperglycaemia derangement may make a difference in the recovery phase. While patients will benefit from lesser wound infections, hospitals might save costs involved with treating postoperative complications.

Relevance to practice: More consistent blood glucose testing might be achieved through the use of evidence‐based protocols. However, the education of staff is as important as it develops knowledge on the complex metabolic interactions of diabetic patients undergoing cardiac surgery. While this means investing in staff education and policy development, costs for daily care and expensive treatments for complications will be saved as patient recovery will be speedier and less eventful.
PROGRESS IN UREMIC TOXIN RESEARCH: Asymmetric Dimethylarginine and Symmetric Dimethylarginine: Axis of Evil or Useful Alliance?
Authors: Kielstein Jan T. , Fliser Danilo , Veldink Hendrik
Published: August 2009

Almost 40 years ago, in 1970, Kakimoto and Akazawa were the first to isolate and describe N‐N, N‐G‐ and N‐G,N′‐G‐dimethyl‐arginine from human urine. Today, these substances are known as asymmetric dimethylarginine (ADMA) and symmetric dimethylarginine (SDMA). In their detailed and meticulous publication, Kakimoto and Akazawa speculated about these two compounds: “They may have functional importance in proteins in which they are formed. If they are excreted into the urine as metabolites of body proteins, amounts of these substances in human urine may reflect methylation rate of body proteins and their turnover rates and determination of these substances might be important for the study of various pathological states.” The following decades proved them to be right. ADMA, the most potent endogenous nitric oxide synthase (NOS) inhibitor was first found to be elevated in hemodialysis patients. It has been shown to correlate with traditional and nontraditional cardiovascular risk factors. ADMA is also a strong predictor of cardiovascular events and death in both patients with chronic kidney disease (CKD, stage 2–5) and in the general population. Moreover, ADMA predicts the progression of CKD. SDMA, the structural isomer of ADMA, has been shown to be an excellent marker of renal function in human and animal studies. There is emerging evidence that SDMA might also be involved in inflammation and atherosclerosis although it is only thought to be a (weak) indirect inhibitor of NOS. There is burgeoning evidence that these two substances may indeed damage normal physiological functions, or interfere with physiological defense mechanisms in CKD, play a role in the progression of renal disease, induce uremic symptoms, and may even contribute to dialysis‐related complications. Hence these compounds are considered uremic toxins. This review summarizes our current concept how these two compounds might play a crucial part in the pathophysiology of uremia, either alone or in their combination. We also allude to the potential physiological role these substances might have.
PROGRESS IN UREMIC TOXIN RESEARCH: Free Immunoglobulin Light Chains as a Risk Factor in Renal and Extrarenal Complications
Authors: Cohen Gerald , Hörl Walter H.
Published: August 2009

Immunoglobulin light chains (IgLCs) are part of intact immunoglobulins and contribute to antigen recognition. However, IgLCs are synthesized by B cells slightly in excess of Ig heavy chains and are found in the plasma of healthy people at low concentrations. IgLCs are metabolized primarily by the kidney. In B‐cell lymphoproliferative disorders, e.g., multiple myeloma, the serum concentration of monoclonal IgLCs markedly increases and the reabsorptive capacity of the proximal tubuli is exceeded. As a consequence, monoclonal IgLCs appear as Bence Jones proteins (BJPs) in the urine and can give rise to IgLC deposits in the kidney that may result in renal insufficiency. In patients with chronic kidney disease (CKD) of various origins, reduced excretion leads to increased serum levels of polyclonal IgLCs. Free IgLCs interfere with essential functions of neutrophils, cells of the first‐line nonspecific immune defense, and therefore contribute to the disturbed immune function in CKD patients. IgLCs attenuate the coordinated apoptotic cell death of neutrophils and therefore may interfere with the normal resolution of inflammation and contribute to the chronic inflammatory state found in CKD patients. Recently it was shown that IgLCs may confer mast cell‐dependent hypersensitivity and thereby play an important role in the development of contact sensitivity.
PROGRESS IN UREMIC TOXIN RESEARCH: Beta2‐Microglobulin
Authors: Drüeke Tilman B. , Massy Ziad A.
Published: August 2009

Among the uremic toxins in the “middle molecule” range, beta2‐microglobulin (β2‐M) is certainly one of the most frequently studied compounds. Its serum level increases with the progression of chronic kidney disease, to reach very high concentrations in patients with end‐stage kidney disease. It is the major protein component of dialysis‐related amyloidosis, a dramatic complication which results from high extracellular concentration and posttranslational modification of β2‐M and a number of other promoters of amyloid fibril formation and deposition in osteo‐articular tissues. Effective removal of β2‐M can be achieved with highly effective hemodialysis and hemodiafiltration techniques but predialysis session serum levels cannot be normalized. The prevalence and severity of β2‐M amyloidosis appear to have decreased in the last 20 years, although its occurrence may simply be delayed.
PROGRESS IN UREMIC TOXIN RESEARCH: Cytokines, Atherogenesis, and Hypercatabolism in Chronic Kidney Disease: A Dreadful Triad
Authors: Carrero Juan Jesus , Park Sun‐Hee , Axelsson Jonas , Lindholm Bengt , Stenvinkel Peter
Published: August 2009

The term cytokine clusters denotes a copious family of molecules and correspondent receptors implicated in numerous processes mediating health and disease. In the context of chronic kidney disease (CKD), generation and metabolism of most of these cytokines are disturbed. Available evidence suggests that cytokine imbalances contribute to the progression of common CKD complications, such as atherosclerosis, mineral‐bone disease, and protein‐energy wasting via pleiotropic effects. The belief that cytokine CKD research is solely represented by interleukins (IL) and tumor‐necrosis factors (TNF) (mainly IL‐6 and TNF‐α) is a common misconception among nephrologists. We here explore recent findings concerning the pathophysiological role of various cytokines in uremic complications, and discuss how cytokines could be used as novel potential therapeutic targets in CKD. At the same time, we provide a brief overview of current discoveries in the main transforming growth factors and chemokines.
PROGRESS IN UREMIC TAXIN RESEARCH: Leptin and Uremic Protein‐Energy Wasting—The Axis of Eating
Authors: Yamamoto Tae , Carrero Juan Jesús , Lindholm Bengt , Stenvinkel Peter , Axelsson Jonas
Published: August 2009

Leptin, a regulator of eating behavior, is secreted by adipocytes and affects energy homeostasis in health and disease. Specifically, leptin is implicated in modulating multiple pathways controlling energy intake, energy expenditure and the allocation of precious nutrients between conversion, storage, and consumption. Whereas leptin has been shown to be a major determinant of anorexia in uremic animals, human data are so far unclear. Regardless, multiple studies have demonstrated that patients with chronic kidney function impairment have elevated leptin levels, although these levels still correlate strongly with body fat mass. In the present publication, we will review the current evidence for the pathophysiological role of leptin, focusing on chronic kidney disease (CKD) patients.
PROGRESS IN UREMIC TOXIN RESEARCH: Endothelium and Vascular Smooth Muscle Cells in the Context of Uremia
Authors: Günthner Thomas , Jankowski Vera , Kretschmer Axel , Nierhaus Marc , Van Der Giet Markus , Zidek Walter , Jankowski Joachim
Published: August 2009

It is obvious that retention of uremic toxins leads to endothelial dysfunction, which in turn initiates proliferation of vascular smooth muscle cells. Yet, the entity of the cascade of pathomechanisms has not sufficiently been elucidated. Endothelial dysfunction inevitably and irreversibly leads to progressive cardiovascular dysfunction and thereby represents the beginning of a life‐limiting cascade. This review highlights important findings in this field.
Progress in Uremic Toxin Research: Effects of Uremic Toxins on Vascular and Bone Remodeling
Authors: Barreto Fellype C. , Barreto Daniela V. , Liabeuf Sophie , Drüeke Tilman B. , Massy Ziad A.
Published: August 2009

Chronic kidney disease (CKD) is associated with both extensive vascular calcification and abnormal bone remodeling, namely renal osteodystrophy. Moreover, there is increasing evidence for a close relationship between bone and vessel function. Pathological vascular calcification has been recently recognized as an active, cell‐mediated process with similarities to physiological skeletal mineralization. Accordingly, we described the concept of vascular remodeling, in analogy to bone remodeling. In this review, we discuss the role of uremic toxins in the cross‐talk between bone and vessel, and emphasize their potential contribution to the development of both vascular and bone remodeling disorders in patients with CKD.
PROGRESS IN UREMIC TOXIN RESEARCH: C‐Reactive Protein and Uremia
Authors: Wanner Christoph , Drechsler Christiane , Krane Vera
Published: August 2009

Since the first report of elevated serum levels of C‐reactive protein (CRP) predicting all cause and cardiovascular mortality more than 10 years ago, many other studies have recognized that the uremic milieu is associated with a state of chronic inflammation. The causes for inflammation are multiple and have been well studied in the past 10 years. Nondialysis, uremia related and endogenous factors as well as the dialysis procedure itself may be responsible for the high prevalence of inflammation in dialysis patients. Today, CRP serves to improve overall vascular risk stratification and, in the individual, to detect sources of specific infections. Because multiple factors contribute to the milieu of inflammation, the predictive value of CRP is rather nonspecific in dissecting a cause, with respect to the subcomponents of cardiac, vascular, and even noncardiovascular causes of mortality. So far, no specific pharmacologic treatment, including atorvastatin, has been identified that can substantially reduce CRP and accompanying inflammation.
PROGRESS IN UREMIC TOXIN RESEARCH: Uremic Toxins in Acute Kidney Injury
Authors: Herget‐Rosenthal Stefan , Glorieux Griet , Jankowski Joachim , Jankowski Vera
Published: August 2009

Acute kidney injury (AKI) is a serious and frequent condition which may fully resolve but is associated with markedly increased mortality. Mortality in AKI is caused by nonrenal, distant organ failure. Renal recovery from AKI is often not achieved on account of new injuries in the repair phase. Uremic toxins may be the missing link between AKI and nonrenal organ failure, tubular and endothelial injury. Compared with chronic kidney disease (CKD), research of uremic toxins in AKI is in its infancy. This review presents the current knowledge on uremic toxins in AKI which is predominately derived from experimental studies. Most uremic toxins investigated have previously been identified in CKD. The review focuses on those uremic toxins with biologic effect on the respective nonrenal organs failing in AKI and on the renal tubule and the endothelium. These uremic toxins may insofar be specific mediators of pathophysiological processes in AKI.
Community/Public Health Nursing Practice Leaders' Views of the Doctorate of Nursing Practice
Authors: Swider Susan M. , Levin Pamela , Cowell Julia , Breakwell Susan , Holland Pearl , Wallinder Janet
Published: August 2009

ABSTRACT
Objectives: This paper presents thoughts of practice leaders in the community/public health nursing (C/PHN) specialty on advanced nursing practice (ANP) and the necessary educational preparation for such practice.

Design and Sample: Practice leaders were engaged in conversations specifically focused on the Doctor of Nursing Practice (DNP) as preparation for ANP in their specialties, and asked to consider the benefits of, and challenges to, this educational program.

Measures and Results: The resulting remarks were then assessed for themes by the interviewers and these are presented along with thoughts on the future of education for ANP.

Conclusion: Overall, there was much agreement among the practice leaders interviewed about the importance of a broad skill set for ANP in the specialty. However, the practice leaders interviewed here also identified the practical challenges involved in educating nurses at the DNP level in the C/PHN specialty, as well as some concerns about the definitions of ANP for the future.
Perceptions of Public Health Nursing Practice by Municipal Health Officials in Norway
Authors: Clancy Anne , Svensson Tommy
Published: August 2009

ABSTRACT
Objectives: The objective of this study was to describe and analyze municipal decision‐maker's views on public health nursing and to reflect upon and discuss the relevance of those views to the future of public health nursing in Norway.

Design: This explorative qualitative study using face‐to‐face interviews is part of a larger project, comprising 5 studies, that explores perceptions of public health nursing.

Sample: A purposeful sample of 11 municipal decision‐makers was selected for interview during 2006–2007 to reflect variation in community size and perspective.

Results: Thematic content analysis of the transcribed interviews revealed 4 content categories: contribution, collaboration, challenges, and visibility. The decision‐makers expressed satisfaction with the public health nursing services, showed concern about lack of visibility and clear boundaries, and some expressed irritation over lacking collaboration. The interviewees elaborated on their past experiences as the public health nurses coworkers, leaders, collaborators, and service users.

Conclusions: The respondents recognized public health nursing's contribution to public health but they lack sufficient knowledge of its content and tend to take services at local health clinics for granted. Dialogue between nurses and decision‐makers is necessary in order to ensure updated evaluation and continued development of public health nursing services.
Observed Use of Standard Precautions in Chilean Community Clinics
Authors: Ferrer Lilian Marcela , Cianelli Rosina , Norr Kathleen F. , Cabieses Baltica , Araya Alejandra , Irarrázabal Lisette , Bernales Margarita
Published: August 2009

ABSTRACT
Objectives: In Chile, little information about the use of standard precautions (SP) among health care workers (HCWs) exists. As part of a larger study to tailor and test an HIV prevention intervention for community HCWs, this study describes the observed frequency with which appropriate SP were used by HCWs in low‐income community clinics of Santiago. Also, the availability of supplies is described.

Sample: A total of 52 structured observations with potential contamination with body fluids were done.

Results: HCWs used SP inconsistently, especially neglecting hand washing, surface cleaning, and cleaning of shared materials. Lack of materials contributed in some instances of failure to use SPs, especially wiping surfaces and safe disposal of sharp instruments, as shown by a positive correlation between use of SP and availability of materials. Essential materials were usually available. Although more education should relate to a better understanding of the importance of SP, no difference was found between professionals and paraprofessionals in the use of SP.

Conclusions: It is clear that the initial training, continuing education, and ongoing support for practicing SP are not adequate. Training should be offered to HCWs involved in caring for clients at community clinics to stop the spread of HIV or other infectious diseases in health care settings.
Is Charter School Competition in California Improving the Performance of Traditional Public Schools?
Authors: Zimmer Ron , Buddin Richard
Published: August 2009

A premise of charter school initiatives has been that these schools have direct benefits for the students attending them and indirect benefits for other students by creating competition for traditional public schools to improve their performance. This study uses a two‐pronged approach to assess whether California charter schools are having indirect effects on students in traditional public schools. First, we examine how traditional public school principals react to the introduction of charter schools. Second, we assess whether competition from nearby charters is affecting student achievement outcomes for students that remain in traditional public schools. The survey results show that traditional public school principals felt little competitive pressure from charters. Similarly, the student achievement analysis shows that charter competition was not improving the performance of traditional public schools. These results suggest that California charter schools are having little effect on the climate of traditional public schools.
Reassessing Privatization Strategies 25 Years Later: Revisiting Perry and Babitsky's Comparative Performance Study of Urban Bus Transit Services
Authors: Leland Suzanne , Smirnova Olga
Published: August 2009

Privatization appeals to citizen and politician desires for more cost‐effective methods of service delivery. For this reason, it is important for public administrators to know when gains can be made by contracting out or privatizing services and when it is better to keep service provision in house. This article assesses the viability of contracting out and privatization of transit services. Following up on the 1986 work of James Perry and Timlynn Babitsky, which used data from the early 1980s, the authors revisit whether certain service delivery arrangements are more efficient and effective than others in the provision of transit services. Twenty‐five years later, they find results similar to those of Perry and Babitsky's original study. Neither the type of government nor whether an agency contracts out has much impact on the efficiency and performance of urban bus services. The main difference between the two studies is that private transit agencies are no longer more efficient or effective than public providers.
Race, Region, and Representative Bureaucracy
Authors: Grissom Jason A. , Nicholson‐Crotty Jill , Nicholson‐Crotty Sean
Published: August 2009

Scholars of representative bureaucracy have long been interested in the linkage between passive representation in public agencies and the pursuit of specific policies designed to benefit minority groups. Research in this area suggests that the structural characteristics of those organizations, the external political environment, and the perceptions of individual bureaucrats each help to facilitate that relationship. Work to date has not, however, sufficiently investigated the impact of region on representation behavior, which is surprising given the emphasis that it receives in the broader literature on race and politics. Drawing on that literature, this study argues that, for black bureaucrats, region of residence is an important moderator of active representation because it helps to determine the salience of race as an issue and the degree of identification with racial group interests. It tests hypotheses related to that general argument in a nationally representative sample of more than 3,000 public schools. The results suggest that black teachers produce greater benefits for black students in the South, relative to other regions. A supplementary analysis also confirms the theoretical supposition that race is a more salient issue for Southern black bureaucrats, when compared with their non‐Southern counterparts.