bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of propofol on emergence behavior in children after sevoflurane general anesthesia
Authors: ABU‐SHAHWAN IBRAHIM
Published: November 2007

Background:  Emergence agitation (EA) is a postoperative behavior that may occur in children undergoing general anesthesia with inhaled agents.

Objectives:  The aim of the present study was to assess the effect of propofol administered at the end of sevoflurane anesthesia on the incidence and severity of EA in children undergoing magnetic resonance imaging (MRI).

Methods:  Eighty‐four children, 2–7 years old, undergoing MRI were enrolled in this randomized double‐blind study. No sedative premedication was administered prior to anesthesia induction. Anesthesia was induced and maintained with sevoflurane in N2O/O2. Group P received propofol 1 mg·kg−1 and group S received saline. Pediatric Anesthesia Emergence Delirium scale (PAEDs) was used to evaluate recovery characteristics upon awakening and during the first 30 min after emergence from anesthesia. Children with PAEDs >16 were considered agitated. EA was analyzed using the Mann–Whitney U‐test. Demographic data and other side effects were analyzed using the Student’s t‐test.

Results:  Eighty‐three children completed the study. There were 42 children in group P. EA was diagnosed in two children in the propofol group (4.8%) and in 11 children in the placebo group (26.8%, P < 0.05). Time to achieving postanesthesia care unit discharge criteria was not different between the two groups.

Conclusions:  The addition of propofol 1 mg·kg−1 can significantly decrease the incidence of EA after sevoflurane general anesthesia in children undergoing nonpainful procedures.
Do not mask the mask: use it as a premedicant
Authors: AYDIN TAYFUN , SAHIN LEVENT , ALGIN CEM , KABAY SAHIN , YUCEL MEHMET , HACIOGLU ALPER , YAYLAK FAIK , KILICOGLU ALEV
Published: November 2007

Background:  Preoperative anxiety frequently causes resistance to mask application and prolongs induction. Anesthesia masks resembling popular heroes or toys was used to deal with this problem. An anesthesia mask given on a preoperative visit to play with at home, may aid to establish a familiarity with the mask and alleviate mask fear, possibly making a gaseous induction more acceptable.

Methods:  After approval of the ethical committee, 50 children were randomly assigned into two groups. Both groups received conventional verbal information about the anesthetists, materials and equipment to be used for the procedure, description of gaseous induction via mask and transportation to the operating room. Additionally transparent anesthesia masks were given to children in the mask group after conventional verbal information. Both groups were premedicated with 0.3 mg·kg−1 midazolam. Anxiety was assessed during separation from parents and induction of anesthesia by a modified Yale Preoperative Anxiety Scale. Mask acceptance quality and total mask time (TMT; time between the introduction of mask anesthesia and the loss of lid reflex) were also determined.

Results:  Anxiety levels in the informed group were statistically higher than in the mask group during induction of anesthesia (26 ± 1.8 vs 30 ± 2.9, P < 0.05). Mask acceptance quality was better in the mask group than in the informed group (IG). TMTs were 5.1 ± 1.3 and 7 ± 0.9 min in the mask group and in the IG, respectively.

Conclusions:  Playing with an anesthesia mask given during a preanesthesia visit relieved anxiety, improved mask acceptance quality and shortened the induction period. We believe that this type of premedication would be feasible in gaseous induction of anesthesia in children.
Heterologous expression of the TsVP gene improves the drought resistance of maize
Authors: Li Bei , Wei Aiying , Song Chunxia , Li Ning , Zhang Juren
Published: November 2007

In this study, it was shown that the TsVP gene [vacuolar H+‐pyrophosphatase (V‐H+‐PPase) gene from a dicotyledonous halophyte Thellungiella halophila] could be transferred into the monocotyledonous crop maize (Zea mays L.), and that the heterologous expression of the transgene improved the drought resistance of transgenic plants. Polymerase chain reaction amplification and Southern blotting confirmed the existence of the foreign gene in transformed plants and their progeny. Expression differences of the TsVP gene in different transgenic lines were monitored by reverse transcriptase‐polymerase chain reaction. The measurement of isolated vacuolar membrane vesicles from the TsVP transgenic and wild‐type (WT) plants demonstrated that the transgenic plants had higher V‐H+‐PPase activity, and the performance of maize‐expressed TsVP in response to osmotic/drought stress was better in lines with higher V‐H+‐PPase activity. Transgenic plants showed a higher percentage of seed germination, better developed root systems and greater biomass, greater solute accumulation and less cell membrane damage relative to WT plants under osmotic stress. After drought stress treatment, transgenic plants showed less growth retardation and shorter anthesis–silking interval, and produced much larger grain yields, than WT plants. It was concluded that the high V‐H+‐PPase activity of transgenic maize improved the drought resistance of plants. This report provides a feasible approach to increase monocotyledonous crop yields under conditions of soil water deficit by the heterologous expression of TsVP.
Homologous recombination: a basis for targeted genome optimization in crop species such as maize
Authors: D’Halluin Kathleen , Vanderstraeten Chantal , Stals Ellen , Cornelissen Marc , Ruiter Rene
Published: November 2007

In an attempt to understand the feasibility of future targeted genome optimization in agronomic crops, we tested the efficiency of homologous recombination‐mediated sequence insertion upon induction of a targeted DNA double‐strand break at the desired integration site in maize. By the development of an efficient tissue culture protocol, and with the use of an I‐SceI gene optimized for expression in maize, large numbers of precisely engineered maize events were produced in which DNA integration occurred very accurately. In a subset of events examined in detail, no additional deletions and/or insertions of short filler DNA at the integration site were observed. In 30%–40% of the recovered events, no traces of random insertions were observed. This was true for DNA delivery by both Agrobacterium and particle bombardment. These data suggest that targeted double‐strand break‐induced homologous recombination is a superior method to generate specific desired changes in the maize genome, and suggest targeted genome optimization of agronomic crops to be feasible.
Marshall Calling
Authors: Dearlove Des
Published: November 2007

Marshall Goldsmith is the co‐founder of the California‐based firm Marshall Goldsmith Partners, an executive coaching firm delivering “measurable change in the behaviour of leaders at all levels of the organization”. He talked to Des Dearlove about achieving personal goals.
The return of the chairman
Authors: Kakabadse Andrew , Kakabadse Nada
Published: November 2007

After the corporate scandals of the last few years and tightened corporate governance, the role of the chairman is set to become ever more important. Andrew and Nada Kakabadse chart the return of the chairman.
Foreign Direct Investment and Economic Growth in EP and IS Countries: The Role of Corruption
Authors: Khamfula Yohane
Published: November 2007

Corruption is understood as an act in which the power of public office is used for personal gain in a manner that contravenes the rules established by the governing structures of a society. This study attempts to offer an extension to the empirical model employed by Balasubramanyam et al. (1996) by analysing how FDI determines economic growth within the new growth theory framework when the degree of corruption is considered. Thus, the study seeks to examine the way in which corruption can have an impact on the economic growth of developing countries whose trade strategies differ (either IS and EP). It suggests that further insight can be gained by considering how corruption might interact with the trade policy in affecting economic growth. This is examined using a fixed‐effects, simultaneous equation model for 17 countries over the period 1994–2004. The results show that the level of corruption strongly and negatively influences foreign direct investment in both IS and EP countries. However, when the corruption index is interacted with domestic investment, the influence on foreign direct investment is positive and significant for IS countries only. The most interesting outcome of the study is the effect of the interaction term between foreign direct investment and the corruption perception index on economic growth, which is found to be greater in magnitude for the EP countries than for the IS countries.
The possibilities and limits of telework in a bureaucratic environment: lessons from the public sector
Authors: Taskin Laurent , Edwards Paul
Published: November 2007

By modifying the spatial and temporal framework of work, telework involves a reorganisation of the conduct of work that affects the employment relationship in different ways. In this paper, we focus on control issues. Based on the empirical study of two experiences led in the public sector, we illustrate the necessity to redefine the rules of control and to recast managerial practices and role.
The co‐evolution of functional and numerical flexibility: do technology and networking matter?
Authors: Voudouris Irini
Published: November 2007

This study explores the relationship between functional and numerical flexibility and the moderating effects of information and communication technology use and networking by investigating the relative predictive power of two approaches: contingency and configuration. The direction of the relationship between the two modes of flexibility depends on the type of flexible staffing arrangement used. Contractors and temporaries are shown to serve different aims and to have different opportunities for evolution.
The construction of control: the physical environment and the development of resistance and accommodation within call centres
Authors: Barnes Alison
Published: November 2007

The paper explores the impact of the physical environment on employee resistance and accommodation. The findings suggest that the physical nature of call centres, whether purpose built or not, can be a focus of employee dissatisfaction and reflect broader, less concrete conflicts. It notes that the advantage of the physical environment as an arena for resistance lies in its tangibility.
Factors influencing absenteeism and intention to leave in a call centre
Authors: Schalk René , Van Rijckevorsel Adriënne
Published: November 2007

Personal, job, as well as contract characteristics and workplace attitudes were related to frequency of absenteeism and intention to leave of call centre employees. Frequency of absenteeism and intention to leave were found to be mainly influenced by contract characteristics and workplace attitudes, while job characteristics and personal characteristics were less important.
The relationship between employer endorsement of continuing education and training and work and study performance: a Hong Kong case study
Authors: Hung Humphry , Wong Yiu Hing
Published: November 2007

Based on psychological contract theory and expectancy disconfirmation theory, we posit that if employers support their staff by endorsing their continuing education and training, these employees will in turn be more satisfied and will perform better not only in their studies but also in their jobs. We also propose that such an endorsement will have a positive disconfirmation effect on employees' job satisfaction and performance when their perceived organizational support is relatively low. Using 434 part‐time postgraduate students in Hong Kong, China, as our survey sample, we found support for our propositions.
The Barcelona Process and the Political Economy of Euro‐Mediterranean Trade Integration*
Authors: MONTANARI MARCO
Published: November 2007

The Barcelona Process aims to create a free trade area between the EU and its Mediterranean neighbours by 2010. This article uses two‐level game theory to analyse the negotiations leading to the signature of the Euro‐Mediterranean Association Agreements. It argues that conflicts of interests between the actors involved in the bargaining process are responsible for the restrictive nature of the agreements, characterized by agricultural protectionism, long transition periods and small amounts of financial support allocated by the EU to its partners. These provisions have prevented the Barcelona Process from significantly boosting Euro‐Mediterranean bilateral trade in the last few years.
Trait‐Based Filtering of the Regional Species Pool to Guide Understory Plant Reintroductions in Midwestern Oak Savannas, U.S.A.
Authors: Brudvig Lars A. , Mabry Catherine M.
Published: November 2007

A common first step during ecological restoration is reestablishing the local species pool through active reintroduction of individual plant species. Unfortunately, the regional species pool is often far too large to be of practical use during restoration. Methods are needed to produce manageable lists of key species for directed reintroduction. We used life history traits to target species from the regional species pool (n= 900) for reintroduction to degraded Midwestern oak savanna remnants (n= 8) in central Iowa, U.S.A. Beginning with the full regional species pool, we first used a priori filters to remove exotic species, species that live in permanently wet habitats, and species already present at the degraded remnant savannas. Next, we created a set of filters to target species with high priority for reintroduction, based on comparisons between the degraded and regional species pools. By this process, we identified perennial forbs and grasses that may be dispersal limited (ant, passive, or heavy wind‐dispersed seeds) and are conservative in habitat requirement or have affinities for high‐light environments. By applying these filters, we were able to winnow down the regional species pool to a manageable number of species (n= 111) that we recommend for initial reintroduction efforts to the degraded savanna remnants. Furthermore, we specifically targeted members of the regional species pool that could fill under‐represented ecological niches at the degraded savanna remnants and discuss potential benefits of adding these species for restoring ecosystem function.
Langerhans cells in squamous cell carcinoma vs. pseudoepitheliomatous hyperplasia of the skin
Authors: Galan Anjela , Ko Christine J.
Published: November 2007

Background:  In clinical and histopathological practice, it is sometimes difficult to distinguish pseudoepitheliomatous hyperplasia (PEH) from squamous cell carcinoma (SCC) of the skin. Several studies have shown a low density of Langerhans cells in SCC of the skin, and recent research on cervical SCCs has suggested that the decreased density of dendritic cells is secondary to low E‐cadherin expression. SCCs of the head and neck similarly have decreased E‐cadherin expression, but E‐cadherin expression is preserved in PEH. We hypothesized that PEH of the skin would have an increased number of Langerhans cells compared with SCC.

Methods:  We studied immunohistochemical expression of CD1a on paraffin‐embedded tissue in 12 cases of SCC and 11 cases of PEH of the skin.

Results:  The number of Langerhans cells in SCCs vs. PEH was similar; in both types of lesions, the Langerhans cells were decreased in density compared with the normal flanking epidermis.

Conclusions:  PEH has a decreased number of Langerhans cells compared with the normal epidermis. As SCCs also have decreased numbers of CD1a‐positive cells, this stain is not useful in differentiating these two entities.
Metastatic ductal eccrine adenocarcinoma masquerading as an invasive ductal carcinoma of the male breast
Authors: McLean Sean R. , Shousha Sami , Francis Nick , Lim Adrian , Eccles Simon , Nathan Myooran , Brock Cathryn S. , Palmieri Carlo
Published: November 2007

We report the case of a 38‐year‐old man with metastatic ductal eccrine adenocarcinoma (DEA) of the left breast responding to 5‐flourouracil, epirubicin and cyclophosphamide (FEC) chemotherapy. He initially presented with a 2‐week history of difficulty walking because of bilateral hip and lower back pain. Examination showed an ulcerating cutaneous mass over the left anterior chest wall, left axillary lymphadenopathy and tenderness over the spine. A punch biopsy of the breast lesion resulted in a diagnosis of metastatic invasive ductal carcinoma (IDC) of the breast. He received palliative radiotherapy to the spine and also received six cycles of FEC chemotherapy and was subsequently commenced on tamoxifen and ibandronate. There was a symptomatic and radiological response to the FEC chemotherapy. Referral was subsequently made to our institution where the original punch biopsy was reviewed. This showed tumor cells that were polygonal with darkly stained pleomorphic nuclei and abundant eosinophilic cytoplasm and were also localized to areas of fibrotic stroma containing eccrine glands and ducts but did not appear to involve mammary tissue. Immunohistochemical studies showed the tumors to be cytokeratin 7 and gross cystic disease fluid protein‐15/prolactin inducible protein negative and estrogen receptor alpha positive. Both the morphological and the immunohistochemical characteristics of the tumor were consistent with a revised diagnosis of DEA rather than IDC. When last reviewed, the patient remains pain free and his disease stable 17 months after his original presentation. This case emphasizes the challenge in discriminating histopathologically between two rare tumors of the male breast, namely DEA and IDC. In addition, clinical response to FEC by metastatic DEA has not been previously documented, and this therapeutic regimen warrants further investigation.
Melatonin, endocrine pancreas and diabetes
Authors: Peschke Elmar
Published: November 2007

Abstract:  Melatonin influences insulin secretion both in vivo and in vitro. (i) The effects are MT1‐and MT2‐receptor‐mediated. (ii) They are specific, high‐affinity, pertussis‐toxin‐sensitive, Gi‐protein‐coupled, leading to inhibition of the cAMP‐pathway and increase of insulin release. Furthermore, melatonin inhibits the cGMP‐pathway, possibly mediated by MT2 receptors. In this way, melatonin likely inhibits insulin release. A third system, the IP3‐pathway, is mediated by Gq‐proteins, phospholipase C and IP3, which mobilize Ca2+ from intracellular stores, with a resultant increase in insulin. (iii) Insulin secretion in vivo, as well as from isolated islets, exhibits a circadian rhythm. This rhythm, which is apparently generated within the islets, is influenced by melatonin, which induces a phase shift in insulin secretion. (iv) Observation of the circadian expression of clock genes in the pancreas could possibly be an indication of the generation of circadian rhythms in the pancreatic islets themselves. (v) Melatonin influences diabetes and associated metabolic disturbances. The diabetogens, alloxan and streptozotocin, lead to selective destruction of β‐cells through their accumulation in these cells, where they induce the generation of ROS. β‐cells are very susceptible to oxidative stress because they possess only low‐antioxidative capacity. Results suggest that melatonin in pharmacological doses provides protection against ROS. (vi) Finally, melatonin levels in plasma, as well as the arylalkylamine‐N‐acetyltransferase (AANAT) activity, are lower in diabetic than in nondiabetic rats and humans. In contrast, in the pineal gland, the AANAT mRNA is increased and the insulin receptor mRNA is decreased, which indicates a close interrelationship between insulin and melatonin.
Management of a complicated crown‐root fracture in a young permanent incisor using intentional replantation
Authors: Wang Zhengyan , Heffernan Michelle , Vann William F
Published: November 2007

Abstract –  The purpose of this case presentation is to review the rationale for and illustrate the clinical procedures involved in intentional replantation of a maxillary central incisor following a complicated crown‐root fracture. The treatment of complicated crown‐root fractures in children often is compromised by a fracture below the gingival margin and/or bone. This makes isolation difficult and comprises the hermetic seal that is critical for a successful endodontic treatment. Orthodontic or surgical extrusion with gingivectomy has been suggested; however, these approaches can be expensive, time‐consuming, esthetically compromising, and unsatisfactory when the fracture line is deep below the gingiva. Our presentation will discuss the treatment options for such cases and introduce the concept of intentional replantation as an option to manage complicated crown‐root fractures in young permanent anterior teeth.
Clinical Decision Rules in the Diagnostic Work‐Up of Patients with Clinically Suspected Pulmonary Embolism
Authors: Douma R. A. , Kamphuisen P. W. , Büller H. R.
Published: November 2007

Pulmonary embolism (PE) is challenging to diagnose because of the low sensitivity and specificity of individual clinical signs and symptoms. Increasing emphasis is put on excluding the diagnosis in a safe, efficient and non‐invasive manner by determining the pre‐test probability of PE. Clinical variables of patients with suspected PE can be combined, either by implicit judgement or by explicit, more standardized clinical decision rules. An ‘unlikely’ probability according to the Wells rule or a ‘low’ clinical probability according to the Geneva rule, in combination with a normal d‐dimer test, results in a substantial reduction of the necessity for further diagnostic testing in patients with suspected PE. Interobserver variability is similar for the different clinical decision rules, but is higher for implicit judgement. Comparative studies of the different methods show similar accuracy in the determination of pre‐test probability. Using a standardized clinical decision score has advantages over implicit judgement, as even less experienced physicians can adequately assess clinical probability. Modified scores have recently been introduced with clear advantages over the more customary score, but these need further validation.
The Role of D‐Dimer in the Diagnosis of Deep Venous Thrombosis and Pulmonary Embolism
Authors: Haas F. J. L. M. , Kamphuisen P. W.
Published: November 2007

The use of the D‐dimer concentration for the exclusion of venous thromboembolism (VTE) has been evaluated circumstantially in many clinical studies and meta‐analyses with different kinds of assays and tests. The sensitivity and specificity depend upon the prevalence of the VTE in the patient population and this explains the variety of results of the different studies. With a combination of studies in meta‐analyses, more reliable results and conclusions can be obtained. The quantitative assays have a higher sensitivity, but a lower specificity than the qualitative tests, but no assay or test is sensitive enough for a safe exclusion of VTE.
Postpartum mood disorders and maternal perceptions of infant patterns in well‐child follow‐up visits
Authors: Orhon Filiz Simsek , Ulukol Betul , Soykan Atilla
Published: November 2007

Aims: The aims of this study were to evaluate the associations between postpartum depressive symptoms and maternal perceptions of infant patterns with 1‐year follow‐up examinations, and to assess the impacts of treatment on these perceptions.

Methods: One hundred three mother‐infant pairs were evaluated. Data on maternal reports of infant feeding, sleeping and temperament patterns were collected at each well‐child visit. The Edinburgh Postpartum Depression Scale was used to assess depressive symptoms. A psychiatrist interviewed the mothers with depressive symptoms, and psychiatric treatments were administered accordingly. The associations between depressive symptoms and maternal perceptions at each visit were analyzed by taking into account the entire follow‐up period.

Results: Thirty‐five mothers (34%) scored within the clinical range of the EPDS during the follow‐up period. Mothers with elevated depressive symptoms were more inclined to report infant cry‐fuss, sleeping and temperamental problems through the follow‐up. Such complains on infant cry‐fuss and temperament problems and maternal sleeping problems improved after treatment in compliant mothers. The dropout rate was high (58.3%) in noncompliant mothers.

Conclusion: Postpartum depressive symptoms may lead to negative maternal perceptions of infant patterns. Earlier management of these disorders and maternal compliance to psychiatric suggestions may provide a better care for the mother‐infant pairs.
Circulating apelin concentrations in mother/infant pairs at term
Authors: Malamitsi‐Puchner Ariadne , Gourgiotis Dimitrios , Boutsikou Maria , Baka Stavroula , Hassiakos Dimitrios , Briana Despina D.
Published: November 2007

Aim: To prospectively investigate circulating concentrations of the adipokine and angiogenic factor apelin in mother/infant pairs and correlate them with respective insulin concentrations.

Methods: Plasma apelin concentrations were determined in 40 mothers and their singleton full‐term foetuses and neonates on day 1 (N1) and 4 (N4) of life.

Results: Maternal apelin concentrations were lower compared to foetal, N1 and N4 ones (p < 0.001 in all cases). N1 apelin concentrations were lower compared to foetal and N4 ones (p = 0.002 and p = 0.005, respectively). Maternal apelin concentrations positively correlated with foetal, N1 and N4 concentrations (r= 0.663, p < 0.001, r= 0.486, p = 0.003, r= 0.484, p = 0.003, respectively). Foetal apelin concentrations positively correlated with N1 and N4 ones (r= 0.337, p = 0.044 and r= 0.574, p < 0.001, respectively). N1 apelin concentrations positively correlated with N4 ones (r= 0.513, p = 0.001). No association was found between apelin concentrations and birthweight, gender, parity or mode of delivery. No significant correlations were observed between apelin and insulin concentrations.

Conclusions: Concentrations of apelin are high in the foetus, possibly suggesting its potential role in intrauterine development. Apelin expression in placental tissue could account for its higher foetal concentrations and for its down‐regulation soon after birth. The postnatal increase of apelin concentrations could presumably point to a gradual initiation of ex utero angiogenesis.
Missed opportunities—adolescents with a chronic condition (insulin‐dependent diabetes mellitus) describe their cigarette‐smoking trajectories and consider health risks
Authors: Regber Susann , Kelly Kristina Berg
Published: November 2007

Aim: To enhance our knowledge on why adolescents with a chronic condition (insulin‐dependent diabetes mellitus, IDDM) choose to smoke despite possible awareness of health risks.

Methods: Twelve patients aged 15–20 with IDDM who smoked cigarettes volunteered to participate in qualitative interviews. The results were analyzed with content analysis according to Miles and Huberman 1994.

Results: One set confirmed what is earlier known on cigarette smoking among adolescents, such as plain exploring, needs to conform with group norms, identity needs and denial of risks. Other themes gave new insights. One was the emotional attitudes—or lack of emotions—expressed by important others, which exerted strong influences on the smoking trajectories. These emotions affected both initiation and motivation for quitting cigarette smoking and seemed crucial as means of meaningful communications concerning smoking. One theme was a flow path of cigarette smoking, which demonstrated opportunities for secondary prevention. Finally, developmental reasons for smoking and motivation for quitting could be described.

Conclusions: There are several windows of opportunities to lower the risk of adolescents with IDDM and other chronic conditions from becoming and remaining smokers, as reported by young people themselves.
Community‐Based Day Services for Adults With Intellectual Disabilities in the United Kingdom: A Review and Discussion
Authors: Simpson Murray K.
Published: November 2007

Abstract  Recent policy statements about services for adults with intellectual disabilities in the UK have pushed for a reoriented day services model. However, there is comparatively little research into new models of day service provision. Drawing on the findings of an evaluation of a “dispersed” or “center‐less” service, the author discusses the potential contribution such services might play. These findings showed that services based on accessing mainstream community amenities and facilities, rather than scheduled attendance at special day services centers, are popular with service users, staff, and parents. However, such conclusions can mask longer‐term and deeper tensions and problems. One notable feature is a failure to articulate clearly specific objectives for individuals and for the service. This elasticity and multiplicity of aims is what allows different constituent parties to appear to concur in their evaluations when in fact they have altogether different registers of success. These and a number of other questions are raised and need to be addressed before any further expansion of dispersed services is considered, such as their contribution to social inclusion and potential longer‐term implications—running out of new activities, boredom, and so forth. More significant is the question of the symbolic role day services centers played as a physical and fiscal commitment to public service provision. There are reasons to suspect that an increased shift toward dispersed services may lead to a declining commitment by local authorities to provide for others than those persons with severe or complex disabilities.
Continuity of Care to Prevent Emergency Room Use Among Persons With Intellectual and Developmental Disabilities
Authors: Wood David , Hall Allyson , Hou Tao , Wludyka Peter , Zhang Jianyi
Published: November 2007

Abstract The study explored the relationship between the level of primary and specialty care continuity and the likelihood of subsequent emergency room use for persons with intellectual and/or developmental disabilities (I/DD). Administrative files from the state's Agency for Persons with Disabilities from 1999 to 2003, containing demographic and clinical information, were used to identify persons with I/DD living in Florida and then were merged with the Florida Medicaid Claims database for outpatient and emergency room services from 1999 to 2003. For individuals with at least two primary or specialty care visits in 2000 and 2001, the Modified, Modified Continuity Index (M,MCI) was calculated and the M,MCI scores were used in multivariable models to predict emergency room utilization in 2002. Primary and specialty care continuity varied by sex, ethnicity, age, and IQ. Multivariate analyses controlling for socio‐demographic and clinical characteristics showed that high continuity for both primary and specialty care was associated with a 28% reduction in the likelihood of an emergency room visit. Continuity in both primary and specialty care is important for adults with I/DD in order to adequately manage their complex health problems and prevent health problems from deteriorating to the point of needing emergency care.
Comparing the efficacy of mandibular implant‐retained overdentures and conventional dentures among elderly edentulous patients: satisfaction and quality of life
Authors: Assunção Wirley Gonçalves , Zardo Gláucia Glowacki , Delben Juliana Aparecida , Barão Valentim Adelino Ricardo
Published: November 2007

Objectives:  The aim of this study was to compare the satisfaction and the quality of life in an elderly population using either mandibular conventional dentures or implant‐retained overdentures.

Materials and methods:  A total of 34 patients were divided into two groups: group I – complete dentures users; group II – users of upper complete dentures opposed by implant‐retained overdentures. The subjects were submitted to a questionnaire based on Oral Health Impact Profile and oral health related quality of life to evaluate their satisfaction levels and quality of life with their prostheses. Data were evaluated using a non‐parametric statistical analysis (Fischer test) with significant difference at α = 0.05.

Results:  There were no significant differences between the groups in relation to comfort, aesthetics, chewing ability, overall satisfaction, pain, functional, phonetic, social, and psychological limitations (p > 0.05). Comparing the stability of mandibular dentures, group II presented the better results (p < 0.05).

Conclusion:  Although the stability of the mandibular implant‐retained overdenture was enhanced compared to a conventional denture, the quality of life and satisfaction levels were similar for both the groups.
Fast track: Has it changed patient care in the emergency department?
Authors: Kwa Paul , Blake Denise
Published: November 2007

Objective:  To determine whether the introduction of a designated fast‐track area altered the time to care and patient flow in an Australian mixed adult and paediatric ED.

Methods:  Retrospective cohort study of all patients presenting to the ED between 08.00 and 22.00 hours, during a 6 month period before and after the opening of a fast‐track area. Data were stratified according to Australasian Triage Scale (ATS) category, and comparisons were made for performance indicators, waiting time, length of stay and did‐not‐waits.

Results:  During its operational hours, fast track managed 14.9% of all patients presenting to the ED. There was a significant increase in the proportion of all ATS 4 patients seen within their target times (77.8% to 79.9%, P < 0.001). There was a trend towards improved performance in ATS categories 2, 3 and 5. Median patient waiting times were significantly decreased in ATS 4 (24 to 22 min, P < 0.001) and ATS 5 (27 to 25 min, P < 0.05), but increased in ATS 2 (3 to 4 min, P < 0.05). No deterioration in performance or waiting time for ATS 1 was shown. There was a decreasing trend in the proportion of patients who did not wait to be assessed by a doctor in ATS categories 4 and 5. These improvements occurred despite a 12% increase in patient attendances and no change in medical staffing levels.

Conclusions:  Fast track in an Australian mixed ED can help meet the demand of increasing patient attendances, allowing lower‐acuity patients to be seen quickly without a negative impact on high‐acuity patients.
THE BRAZILIAN WORKERS' PARTY: FROM LOCAL PRACTICES TO NATIONAL POWER
Authors: Baiocchi Gianpaolo , Checa Sofia
Published: November 2007

Brazil's Partido dos Trabalhadores (PT), well into its second term in national office, is today heavily criticized for its conservative economic policies when only a few years ago it was celebrated for re‐invigorating the country's democracy and giving voice to its poor majority. In this essay, we discuss the role of participation in the party's politics since its inception, with a focus on the national administration. We argue that what is distinctive about the national administration is not so much the real or perceived transition of the PT to the ideological center or its economic policies per se, but the abandonment of one of the hallmarks of the PT in power: its creative forms of empowered popular participation. Even if these practices were translated to global forums, they were not translated to the national governance and this has locked the party into increasing conflict with, and isolation from, its base of support among social movements.
OUT OF AFRICA: THE EXODUS OF ELITE AFRICAN FOOTBALL TALENT TO EUROPE
Authors: Darby Paul
Published: November 2007

The squad rosters of the participating teams at recent editions of the biennial African Cup of Nations reveals that the majority of Africa's elite football players ply their trade in Europe and that this is a trend that is increasing year by year. For example, at the 2000 tournament cohosted by Ghana and Nigeria, just over 50 percent of the players were signed to a European club. For the 2002 competition in Mali, this figure had increased to 66 percent and for the 2004 edition in Tunisia it stood at 67 percent. Although the exodus of Africa's football talent to Europe has accelerated significantly since the early 1990s, it is important to recognize that this process has long historical roots. This article examines the changing patterns in the transit of African footballers to Europe and demonstrates the ways in which these patterns have been underpinned by broader developments within the political economy of world football.
MONETARY POLICY IN A SMALL OPEN ECONOMY: THE CASE OF MALAYSIA
Authors: UMEZAKI So
Published: November 2007

This paper provides a case study to characterize the monetary policy regime in Malaysia, from a medium‐ and long‐term perspective. Specifically, we ask how the Central Bank of Malaysia, Bank Negara Malaysia (BNM), has structured its monetary policy regime, and how it has conducted monetary and exchange rate policy under the regime. By conducting three empirical analyses, we characterize the monetary and exchange rate policy regime in Malaysia by three intermediate solutions on three vectors: the degree of autonomy in monetary policy, the degree of variability of the exchange rate, and the degree of capital mobility.
Research Letter: Retroinverso Mimetics of S Peptide
Authors: Rai Jagdish
Published: November 2007

The S peptide from ribonuclease S was used as a model system to explore the relationship between the native peptide and its retroinverso (RI) analog. As probed by circular dichroism, the conformations of S peptide and retroinverso S peptide (RIS peptide) are each right‐handed helical conformation. The helical propensity of retro S peptide is greater than S peptide, in trifluoroethanol (TFE). In 70% TFE, the S peptide possesses greater helicity at pH 4 than at pH 7, whereas RIS peptide possesses greater helicity at pH 7 than at pH 4. The RIS peptide does not mimic the S peptide in binding to S protein. Specifically, the RIS peptide does not mimic the S peptide to effect RNase activity with S protein and it also does not inhibit the RNase activity of S peptide with S protein. The biological mimicry between the S peptide and its RIS analog depends on the conformation and relatedness of both the side chain and backbone substructures. The backbones in the S peptide and its RIS analog are reverted with respect to each other; however, the side chain patterns are predicted to be similar. Importantly, if the molecular interactions of backbone atoms of the S peptide and its binding to S protein, then the RIS analog would be unlikely to mimic this parent peptide.
Medicine pipeline: Structure‐Based Drug Design and the Discovery of Aliskiren (Tekturna®): Perseverance and Creativity to Overcome a R&D Pipeline Challenge‡
Authors: Claude Cohen Nissim
Published: November 2007

At Ciba‐Geigy (now Novartis), the clinical development of the CGP38560 renin inhibitor was halted due to insufficient pharmacokinetics. This indicated that the peptidomimetic approach to the development of antihypertensive agents was improper. Real non‐peptide drug candidates were then expected to provide the necessary framework for obtaining the desired properties. For this purpose a homology model of the enzyme was used to characterize the binding mode of CGP38560 in complex with the renin model and served as a basis for the four chemistry laboratories that were assigned to this project. The renin team worked in a full structure‐based perspective with this model, and four chemically‐unrelated non‐peptide series were discovered acting as renin inhibitors at the 1‐3 nanomolar level. One of these leads was selected for further development and led to Aliskiren, which has been just approved by the FDA. Here is presented the successful structure‐based strategy that enabled the discovery of several non‐peptide inhibitors and the recent launch of a new drug that will be commercialized in the United States under the name Tekturna (for the treatment of high blood pressure as monotherapy or in combination with other high blood pressure medications).
Theoretical Analysis on the Autothermal Reforming Process of Ethanol as Fuel for a Proton Exchange Membrane Fuel Cell System
Authors: Perna Alessandra
Published: November 2007

The purpose of this work is to investigate, by a thermodynamic analysis, the effects of the process variables on the performance of an autothermal reforming (ATR)-based fuel processor, operating on ethanol as fuel, integrated into an overall proton exchange membrane (PEM) fuel cell system. This analysis has been carried out finding the better operating conditions to maximize hydrogen yield and to minimize CO carbon monoxide production. In order to evaluate the overall efficiency of the system, PEM fuel cell operations have been analyzed by an available parametric model.
Leucine Aminopeptidase Is an Immunodominant Antigen of
Fasciola hepatica
Excretory and Secretory Products in Human Infections
Authors: Marcilla A. , De la Rubia J. E. , Sotillo J. , Bernal D. , Carmona C. , Villavicencio Z. , Acosta D. , Tort J. , Bornay F. J. , Esteban J. G. , Toledo R.
Published: November 2007

The liver fluke
Fasciola hepatica
parasitizes humans and ruminant livestock worldwide, and it is now being considered a reemerging zoonotic disease, especially in areas in which it is endemic, such as South America. This study investigates the immune response to excretory and secretory products produced by
F. hepatica
in a group of patients from the Peruvian Altiplano, where the disease is highly endemic. Using a proteomic approach and immunoblotting techniques, we have identified the enzymes leucine aminopeptidase (LAP) and phosphoenolpyruvate carboxykinase as immunodominant antigens recognized by sera from fasciolosis patients. An indirect enzyme-linked immunosorbent assay using recombinant LAP as the antigen was developed to check sera from individuals of this region. Our results demonstrate that LAP produces a specific and strong reaction, suggesting its potential use in the serologic diagnosis of
F. hepatica
infections in humans.
Acute Renal Failure Due to Acute Tubular Necrosis Caused by Direct Invasion of
Orientia tsutsugamushi
Authors: Kim Dong-Min , Kang Dae Woong , Kim Jong O. , Chung Jong Hoon , Kim Hyun Lee , Park Chi Young , Lim Sung-Chul
Published: November 2007

We describe a scrub typhus patient with acute renal failure for whom a diagnosis was made based on serology as well as immunohistochemical (IHC) staining and an electron microscopic examination (EM) of a renal biopsy specimen. For our case, we demonstrated by IHC staining and EM that renal failure was caused by acute tubular necrosis due to a direct invasion of
Orientia tsutsugamushi
.
Improvement of PCR for Detection of
Opisthorchis viverrini
DNA in Human Stool Samples
Authors: Duenngai Kunyarat , Sithithaworn Paiboon , Rudrappa Umesha Kanasinakatte , Iddya Karunasagar , Laha Thewarach , Stensvold Christen Rune , Strandgaard Hanne , Johansen Maria Vang
Published: November 2007

Opisthorchis viverrini
is an important food-borne trematode in Southeast Asia. The infection causes significant morbidity in terms of hepatobiliary diseases and cholangiocarcinoma. The aim of this study was to improve the sensitivity of the PCR-based diagnosis of
O. viverrini
infection. A new fecal DNA extraction protocol for the detection of
O. viverrini
DNA using cetyltrimethyl-ammoniumbromide to remove PCR inhibitor was used and compared with the commercial stool kit method. The sensitivity of the new test was 79.3%, compared with the 44.8% of the previous method (
P
< 0.01). PCR-positive tests identified several cases judged parasite negative by the parasitological method (28.6%), indicating the new test's advantage in the diagnosis of individuals with light infections.
High Rates of Transmission of and Colonization by
Streptococcus pneumoniae
and
Haemophilus influenzae
within a Day Care Center Revealed in a Longitudinal Study
Authors: Sá-Leão Raquel , Nunes Sónia , Brito-Avô António , Alves Carla R. , Carriço João A. , Saldanha Joana , Almeida Jonas S. , Santos-Sanches Ilda , de Lencastre Hermíniade
Published: November 2007

Day care centers (DCCs) are unique settings where young children are at increased risk for colonization by pneumococci and
Haemophilus influenzae
. Although point prevalence studies in DCCs are frequent, only a few longitudinal studies on the dynamics of colonization have been published. We conducted a 1-year longitudinal study with 11 sampling periods on nasopharyngeal carriage of pneumococci and
H. influenzae
among 47 children who attended a single DCC. All isolates were antibiotyped and genotyped by pulsed-field gel electrophoresis. Pneumococci were also serotyped. Of the 414 samples obtained, 61.4% contained pneumococci, and 87% contained
H. influenzae
. Only 8.3% of the samples were negative for both species. Twenty-one pneumococcal clones and 47
H. influenzae
clones were identified. Introduction of clones occurred during all year. Ninety-eight percent and 96% of all pneumococcal and
H. influenzae
isolates, respectively, belonged to clones shared by more than one child. Children were sequentially colonized with up to six pneumococcal clones (mean, 3.6) and five serotypes and nine
H. influenzae
clones (mean, 7.1). Clones with increased capacity for transmission and/or prolonged colonization were identified in both species. These two fitness properties appeared to be independent. In conclusion, among DCC attendees, a high rate of acquisition and turnover of strains was observed, and all children were overwhelmingly colonized by clones shared with others. DCCs are units where permanent introduction of new clones occurs, and attendees, as a whole, provide a pool of hosts where the fittest clones find privileged opportunities to persist and expand.
Clostridium perfringen
s Type A Strains Carrying a Plasmid-Borne Enterotoxin Gene (Genotype IS
1151
-
cpe
or IS
1470
-like-
cpe
) as a Common Cause of Food Poisoning
Authors: Lahti Päivi , Heikinheimo Annamari , Johansson Tuula , Korkeala Hannu
Published: November 2007

The prevalences of various genotypes of enterotoxin gene-carrying (
cpe
-positive)
Clostridium perfringens
type A in 24 different food poisoning outbreaks were 75% (chromosomal IS
1470
-
cpe
), 21% (plasmid-borne IS
1470
-like-
cpe
), and 4% (plasmid-borne IS
1151
-
cpe
). These results show that
C. perfringens
type A carrying the plasmid-borne
cpe
is a common cause of food poisoning.
Transcriptome Analysis of NF-κB- and Phosphatidylinositol 3-Kinase-Regulated Genes in Human Cytomegalovirus-Infected Monocytes
Authors: Chan Gary , Bivins-Smith Elizabeth R. , Smith M. Shane , Yurochko Andrew D.
Published: November 2007

Human cytomegalovirus induces a proinflammatory monocyte following infection, and we have evidence that NF-κB and phosphatidylinositol 3-kinase [PI(3)K] are key mediators in this early activation. To begin to address how these signaling pathways are responsible for the rapid activation of infected monocytes, we examined the role that these pathways played in the transcriptome of infected monocytes. Global transcriptional profiling using cDNA microarrays revealed that a significant number of genes, including inflammatory genes, were regulated in an NF-κB- and/or PI(3)K-dependent manner, identifying the NF-κB and PI(3)K pathways as key cellular control points in the conversion of monocytes to an activated proinflammatory state following HCMV infection.