bluuebunny/crossref_metadata_2025 huggingface dataset:
On a nonlinear elastic shell system in liquid crystal theory: generalized Willmore surfaces and Dupin cyclides
Authors: Schief W.K , Kléman M , Rogers C
Published: July 2005

An elastic membrane model of smectic A liquid crystal deformation is derivedab initiovia a variational approach. The well-determined nature of the resulting nonlinear model equations reveals that the deformed states of the liquid crystal lamellae can only adopt privileged geometries. These are shown to generalize classical and novel ‘integrable’ geometries associated with Willmore, linear Weingarten and ‘membrane’ O surfaces. The main result establishes that, remarkably, the membrane model admits layered parallel Dupin cyclide structures of the kind originally observed by Friedel and Grandjean in their pioneering experiments of 1910 and subsequently elaborated upon by Friedel in 1922 and later by Bragg.
The metrology of time
Authors: Arias Elisa Felicitas
Published: July 2005

Measuring time is a continuous activity, an international and restless enterprise hidden in time laboratories spread all over the planet. The Bureau International des Poids et Mesures is charged with coordinating activities for international timekeeping and it makes use of the world's capacity to produce a remarkably stable and accurate reference time-scale. Commercial atomic clocks beating the second in national laboratories can reach a stability of one part in 10
14
over a 5 day averaging time, compelling us to research the most highly performing methods of remote clock comparison. The unit of the international time-scale is the second of the International System of Units, realized with an uncertainty of the order 10
−15
by caesium fountains. Physicists in a few time laboratories are making efforts to gain one order of magnitude in the uncertainty of the realization of the second, and more refined techniques of time and frequency transfer are in development to accompany this progress. Femtosecond comb technology will most probably contribute in the near future to enhance the definition of the second with the incorporation of optical clocks. We will explain the evolution of the measuring of time, current state-of-the-art measures and future challenges.
The quantum electrical triangle
Authors: Gallop John
Published: July 2005

The past 35 years have seen the development of an unexpected plethora of quantum electrical standards based on just two fundamental constants,
e
and
h
. First came a voltage standard based on the Josephson a.c. effect, in terms of which most maintained primary standards of voltage are defined. This was followed a decade later by the quantized Hall effect, based on the von Klitzing constant which allows the ohm to be maintained very precisely. It became clear 20 years ago that there is also a possible quantum current standard. This third standard has yet to play a full part in practical electrical metrology. However, recent developments suggest that there are many different possible manifestations in which such a current standard might be realized.

The three quantum standards, taken together, define the quantum electrical triangle of standards which would allow the units to be realized in terms of different combinations of
e
and
h
. We summarize the very different physics behind the three standards, reviewing the present state of development in all three. Implications for the future are also considered, especially relating to ultra-low temperature, nanoscale and truly quantum mechanical versions of the standards.
Viewpoint: Towards a solution to the puzzles in exchange rate economics: where do we stand?
Authors: Sarno Lucio
Published: July 2005

Abstract. This paper provides a selective overview of puzzles in exchange rate economics. We begin with the forward bias puzzle: high interest rate currencies appreciate when one might guess that investors would demand higher interest rates on currencies expected to fall in value. We then analyse the purchasing power parity puzzle: the real exchange rate displays no (strong) reversion to a stable long‐run equilibrium level. Finally, we cover the exchange rate disconnect puzzle: the lack of a link between the nominal exchange rate and economic fundamentals. For each puzzle, we critically review the literature and speculate on potential solutions. JEL classification: F31
Peer effects and selection effects on smoking among Canadian youth
Authors: Krauth Brian V.
Published: July 2005

Abstract.  A number of studies have indicated that peer smoking is a highly influential factor in a young person's decision to smoke. However, this finding is suspect, because the studies often fail to account for selection and simultaneity bias. This paper develops an econometric model of youth smoking that incorporates both peer effects and selection effects. Identification is achieved by using the degree of selection on observables as a proxy for the degree of selection on unobservables. The results indicate that peers have some influence on a young person's decision to smoke, but that influence is much weaker than is suggested by reduced form models. JEL classification: C35, I12
Trade and direct investment in producer services and the domestic market for expertise
Authors: Markusen James , Rutherford Thomas F. , Tarr David
Published: July 2005

Abstract.  Foreign producer services can provide substantial benefits for domestic firms. We build on earlier monopolistic‐competition models of intermediate producer services in this paper. Results show that: (1) while foreign services are partial‐equilibrium substitutes for domestic skilled labour, they may be general‐equilibrium complements, (2) service trade can provide crucial missing inputs that reverse comparative advantage in final goods, (3) the ‘optimal’ tax on imported services may be a subsidy, and (4) in our dynamic formulation, there may be earnings losses for immobile workers along a transition path that suggest potentially important equity consequences of reform. JEL classification: F12, F16, F23
Export orientation and domestic merger policy: theory and some empirical evidence
Authors: Clougherty Joseph A. , Zhang Anming
Published: July 2005

Abstract.  Recent ‘open‐economy industrial organization’ literature finds export orientation enhances the weight of post‐merger international competitive gains, favouring lenient domestic merger policy. However, mergers seldom generate the ‘significant synergies’ supportive of international competitive gains. Since a joint‐economies‐of‐production effect suggests domestic mergers tend to generate international competitive losses (not gains), export orientation favours strict (not lenient) domestic merger policy. We show how non‐synergistic domestic mergers in the presence of international sales might reduce national welfare and incur stringent merger reviews. A panel data set of U.S. merger policy by manufacturing sector, 1990–2001, empirically supports export orientation, leading to strict merger policy. JEL classification: L40, F10
Interconnected communications networks and home market effects
Authors: Kikuchi Toru
Published: July 2005

Abstract.  This study develops a model of trade that highlights the effects of the interconnection of country‐specific communications networks as a driving force behind trade in high‐tech products with positive transport costs. By constructing a two‐country model of monopolistic competition with two production factors, it is shown that the locational decisions of firms may magnify the influence of interconnected networks. In a reversal of the standard home market effects, the abundance of unskilled labour in the developing countries can attract high‐tech firms from the developed countries. JEL classification: D43, F12, L13
A note on trade liberalization and common pool resources
Authors: Bulte Erwin H. , Damania Richard
Published: July 2005

Abstract.  When countries share access to a common resource stock, optimal management is based on strategic considerations. We develop a general equilibrium model and show that regulatory policies are strategic substitutes under autarky. Trade liberalization not only changes relative prices, but may change the qualitative nature of the game between jurisdictions. In the small country case with exogenous prices, regulatory policies become strategic complements. In the context of a two‐country model, policies remain strategic substitutes but the factors that drive policy changes differ from those under autarky and the small country case. The implications for conservation and resource management are discussed.
A theory of mutual migration of polluting firms
Authors: Zhao Laixun , Yu Zhihao , Onuma Yoshiko
Published: July 2005

Abstract.  Suppose that governments care about their tax revenue and local firms have some say in environmental regulations. Then, the level of employment and environmental compliance may be negotiated. We find that firms located in different countries can improve their threat‐point payoffs by mutual migration. This in turn affects the negotiated output/employment and environmental regulations, which causes profits to increase if the firm's threat‐point payoff is higher than that of the local government. The model predicts that pollution‐intensive firms or firms with highly inelastic demands are more likely to move out. Increases in the government's valuation of the environment, or in the degree of globalization also cause mutual migration of dirty firms. The effect of a government caring about consumer surplus leads to a lower pollution tax, reducing firms’ incentives to move out. JEL classification: F2, Q0
Poverty and inequality under income and price dispersions
Authors: Muller Christophe
Published: July 2005

Abstract.  We introduce an analytical framework for welfare analysis that accounts for changes in the joint distribution of prices and incomes by using parametric formulae of poverty and inequality measures. We propose statistical indicators for the levels, variabilities and a statistical link of price indices and nominal living standards, which are consistent with a bivariate lognormal model. Our analysis provides intuitive insight about the social welfare impact of economic shocks affecting levels, variabilities, and correlation of prices and incomes. The roles of price and income variabilities for poverty and inequality are exhibited, with the possibility of several variation regimes. JEL classification: I32, O15, D31
A computer software price index using scanner data
Authors: Prud’homme Marc , Sanga Dimitri , Yu Kam
Published: July 2005

Abstract.  In the last 20 years, the expenditure share of prepackaged software in the national output has grown. The large number of characteristics in computer software make hedonic regression techniques impractical for purposes of controlling for quality changes. In this study, matched model price indices are constructed using monthly scanner data on prices and unit values for various prepackaged computer software titles and categories sold in Canada from January 1996 to June 2000. Quality differences are controlled for by applying the maximum overlap method. Results show that prices declined during the period studied at an average annual rate of 5.9%. JEL classification: C43, L86
Measuring volatility persistence in the presence of sudden changes in the variance of Canadian stock returns
Authors: Malik Farooq , Ewing Bradley T. , Payne James E.
Published: July 2005

Abstract.  It is well known that volatility persistence is overestimated if regime shifts are not accounted for in the standard GARCH model. This research detects time periods of sudden changes in variance using the iterated cumulated sums of squares (ICSS) algorithm. Using weekly data for the Canadian stock market indicates that after accounting for endogenously determined volatility shifts in the GARCH model, the estimated persistence in volatility is significantly reduced. This casts some doubt on previous findings that volatility in financial markets is highly persistent. The findings have important implications for investors and financial market participants. JEL classification: G1
Life‐cycle asset accumulation and allocation in Canada
Authors: Milligan Kevin
Published: July 2005

Abstract.  This paper documents the life‐cycle patterns of household portfolios in Canada, and investigates several hypotheses about asset accumulation and allocation. Inferences are drawn from the 1999 Survey of Financial Security, with some comparisons to earlier wealth surveys from 1977 and 1984. I find cross‐sectional evidence for asset decumulation at older ages when annuitized assets like pension wealth are included in the analysis. I also find that the portfolio share of financial assets increases sharply with age, while indicators of risk tolerance appear to decrease. This is consistent with families’ desiring more liquid and less risky assets as they age. JEL classification: D31, E21, G11
Development of intestinal M cells
Authors: Mach Julie , Hshieh Tammy , Hsieh Dennis , Grubbs Nathaniel , Chervonsky Alexander
Published: July 2005

Summary:  Intestinal epithelium contains several specialized cell types including M cells, which can be found in the follicle‐associated epithelium (FAE) or occasionally on the villi. M cells are critical for sampling of intestinal flora and for transferring pathogens across the epithelial barrier for recognition by the immune system. Development of M cells on the villi (Mv) is independent of the presence of lymphocytes, while development of the FAE and M cells within the FAE (Mf) is dependent on B lymphocytes. Here, the concept is discussed that B cells are not required for induction of Mf differentiation but are required for transition to and maintenance of the mature Mf phenotype. Signaling pathways possibly involved in the B‐cell‐independent stages of M‐cell development are also discussed.
Mucosal B cells: phenotypic characteristics, transcriptional regulation, and homing properties
Authors: Brandtzaeg Per , Johansen Finn‐Eirik
Published: July 2005

Summary:  Mucosal antibody defense depends on a complex cooperation between local B cells and secretory epithelia. Mucosa‐associated lymphoid tissue gives rise to B cells with striking J‐chain expression that are seeded to secretory effector sites. Such preferential homing constitutes the biological basis for local production of polymeric immunoglobulin A (pIgA) and pentameric IgM with high affinity to the epithelial pIg receptor that readily can export these antibodies to the mucosal surface. This ultimate functional goal of mucosal B‐cell differentiation appears to explain why the J chain is also expressed by IgG‐ and IgD‐producing plasma cells (PCs) occurring at secretory tissue sites; these immunocytes may be considered as ‘spin‐offs’ from early effector clones that through class switch are on their way to pIgA production. Abundant evidence supports the notion that intestinal PCs are largely derived from B cells initially activated in gut‐associated lymphoid tissue (GALT). Nevertheless, insufficient knowledge exists concerning the relative importance of M cells, major histocompatibility complex class II‐expressing epithelial cells, and professional antigen‐presenting cells for the uptake, processing, and presentation of luminal antigens in GALT to accomplish the extensive and sustained priming and expansion of mucosal B cells. Likewise, it is unclear how the germinal center reaction in GALT so strikingly can promote class switch to IgA and expression of J chain. Although B‐cell migration from GALT to the intestinal lamina propria is guided by rather well‐defined adhesion molecules and chemokines/chemokine receptors, the cues directing preferential homing to different segments of the gut require better definition. This is even more so for the molecules involved in homing of mucosal B cells to secretory effector sites beyond the gut, and in this respect, the role of Waldever's ring (including the palatine tonsils and adenoids) as a regional inductive tissue needs further characterization. Data suggest a remarkable compartmentalization of the mucosal immune system that must be taken into account in the development of effective local vaccines to protect specifically the airways, eyes, oral cavity, small and large intestines, and urogenital tract.
Lymphocyte homing to the gut: attraction, adhesion, and commitment
Authors: Salmi Marko , Jalkanen Sirpa
Published: July 2005

Summary:  Lymphocytes continuously migrate from the blood into the intestine. Naive lymphocytes leave the blood through high endothelial venules in Peyer's patches. During the multistep extravasation cascade, they sequentially roll on, firmly adhere to, and transmigrate through the endothelial layer using multiple adhesion molecules and chemotactic signals. In the organized lymphoid tissues of the gut, lymphocytes can become activated, if they meet their cognate antigens transported to Peyer's patches through the gut epithelium. During activation and proliferation, the lymphocytes become imprinted by the local dendritic cells, so that after returning to systemic circulation via the efferent lymphatic vasculature, they preferentially home to lamina propria of the gut to execute their effector functions. In inflammation, the recirculation routes of lymphocytes are altered, and these may explain the pathogenesis of certain extra‐intestinal manifestations of gut infections and inflammatory bowel diseases. The increased knowledge on the mechanisms that regulate lymphocyte homing and imprinting has clear applicability in designing more effective vaccination regimens. A detailed understanding of the mucosal homing has recently led to the development of the first successful anti‐adhesive therapeutics in human.
Involvement of intestinal dendritic cells in oral tolerance, immunity to pathogens, and inflammatory bowel disease
Authors: Kelsall Brian L. , Leon Francisco
Published: July 2005

Summary:  Dendritic cells (DCs) are composed of a family of cells, now recognized to be essential for innate and acquired immunity. DCs at mucosal surfaces have a particular capacity to induce the differentiation of regulatory T cells producing interleukin‐10 (IL‐10) and transforming growth factor‐β (TGF‐β) in the steady state (non‐infected, non‐immunized), yet they retain the capacity to induce effector T cells in response to invasive pathogens. This decision between the induction of active immunity and tolerance will depend on the subpopulation of DC involved and the surface receptors engaged during DC activation and T‐cell priming. The local microenvironment will likely play an important role both in defining the DC phenotype and in providing direct signals to responding T cells. Furthermore, DCs in organized mucosal lymphoid tissues preferentially induce the expression of CCR9 and α4β7 on T cells, which results in T‐cell homing to the intestinal lamina propria. Finally, DCs may play an important role in the maintenance of abnormal intestinal inflammation either by driving pathogenic T‐cell responses in mesenteric lymph nodes or by acting to expand or maintain pathogenic T cells locally at sites of inflammation. In this review, a brief discussion of general issues of DC biology that are pertinent to mucosal immunity is followed by a more in‐depth discussion of the phenotype and function of DC populations in the intestine.
Bronchus‐ and nasal‐associated lymphoid tissues
Authors: Bienenstock John , McDermott Mark R.
Published: July 2005

Summary:  The bronchus‐associated lymphoid tissue (BALT) and the nasal‐associated lymphoid tissue (NALT) constitute organized lymphoid aggregates that are capable of T‐ and B‐cell responses to inhaled antigens. BALT, located mostly at bifurcations of the bronchus in animals and humans, is present in the fetus and develops rapidly following birth, especially in the presence of antigens. Humoral immune responses elicited by BALT are primarily immunoglobulin A secretion both locally and by BALT‐derived B cells that have trafficked to distant mucosal sites. Similarly located T‐cell responses have been noted. On the basis of these findings, the BALT can be thought of as functionally analogous to mucosal lymphoid aggregates in the intestine and is deemed a member of the common mucosal immunologic system. NALT has been described principally in the rodent nasal passage as two separate lymphoid aggregates. It develops after birth, likely in response to antigen, and B‐ and T‐cell responses parallel those that occur in BALT. It is not known whether NALT cells traffic to distant mucosal sites, although mucosal responses have been detected after nasal immunization. NALT appears from many studies to be a functionally distinct lymphoid aggregate when compared with BALT and Peyer's patches. It may exist, however, in humans as a diffuse collection of isolated lymphoid follicles.
Drug combinations and impaired renal function – the ‘triple whammy’
Authors: Loboz Katarzyna K. , Shenfield Gillian M.
Published: July 2005

Background

Recent studies have identified the ‘triple whammy’ in which combinations of diuretics, nonsteroidal anti‐inflammatory drugs (NSAIDs), ACE inhibitors (ACEI) and/or angiotensin receptor antagonists (ARA) may impair renal function.

Methods

We performed a cross‐sectional study of patients admitted to a general medical ward of a teaching hospital. Age, sex, disease status and prior consumption of the ‘target’ drugs, diuretics, NSAIDs (including aspirin), ACEI and ARA were correlated with creatinine and creatinine clearance on admission.

Results

Three hundred and one patients (48% male) were included, 135 were on no prior target drugs, 87 on one, 60 on two and 19 on three such drugs. There was a significant (P < 0.01) correlation between both creatinine and creatinine clearance with male sex, age and number of target drugs. Multivariate analysis confirmed these associations but did not support associations between renal function and heart failure or total number of diagnoses. Increasing doses of diuretics, possibly because in many cases this included two drugs, but not the other drugs, were significantly (P < 0.001) associated with impaired renal function. For the other three drug groups patients on doses of any drug at lower than the defined daily dose (DDD) did not have significantly different creatinine or creatinine clearance from those on doses at or above the DDD.

Conclusion

Taking two or more of the identified drugs was associated with significant renal impairment but did not correlate with heart failure or other diseases for which the drugs might have been prescribed. Care is necessary to balance the demonstrated advantages of these medications against the risk of inducing renal failure.
Drugs with anticholinergic properties and cognitive performance in the elderly: results from the PAQUID Study
Authors: Lechevallier‐Michel Nathalie , Molimard Mathieu , Dartigues Jean‐François , Fabrigoule Colette , Fourrier‐Réglat Annie
Published: July 2005

Objectives

To measure the association between the use of drugs with anticholinergic properties and cognitive performance in an elderly population, the PAQUID cohort.

Methods

The sample studied was composed of 1780 subjects aged 70 and older, living at home in South western France. Data on socio‐demographic characteristics, medical history and drug use were collected using a standardized questionnaire. Cognitive performance was assessed using the following neuropsychological tests: the Mini‐Mental State Examination (MMSE) which evaluates global cognitive functioning, the Benton Visual Retention Test (BVRT) which assesses immediate visual memory, and the Isaacs’ Set Test (IST) which assesses verbal fluency. For each test, scores were dichotomized between low performance and normal to high performance using the score at the 10th percentile of the study sample as the cut‐off point, according to age, gender and educational level. The association between the use of drugs with anticholinergic properties and cognitive performance was examined using logistic regression models, adjusting for several potential confounding factors.

Results

About 13.7% of the subjects used at least one drug with anticholinergic properties. In multivariate analyses, the use of these drugs was significantly associated with low performance in the BVRT [odds ratio (OR) = 1.6; 95% confidence interval (CI) 1.1, 2.3] and in the IST (OR = 1.9; 95% CI 1.3, 2.8). The association found with low performance in the MMSE (OR = 1.4; 95% CI 1.0, 2.1) was barely statistically significant.

Conclusion

These findings suggest that the use of drugs with anticholinergic properties is associated with low cognitive performance among community‐dwelling elderly people.
The effects of hepatic impairment on the pharmacokinetics of fosfluconazole and fluconazole following a single intravenous bolus injection of fosfluconazole
Authors: Sobue Satoshi , Tan Keith , Haug‐Pihale Gertraud
Published: July 2005

Aims

Fosfluconazole is a phosphate pro‐drug of fluconazole (FLCZ). This study was conducted to determine the pharmacokinetics of fosfluconazole and FLCZ following a single intravenous injection of fosfluconazole in subjects with hepatic impairment and to compare them with healthy subjects.

Methods

Twenty‐four subjects (12 with normal hepatic function and 12 with chronic stable mild to moderate impaired hepatic function) received a single 1000‐mg bolus intravenous injection of fosfluconazole. Concentrations of fosfluconazole and FLCZ were determined in plasma and urine samples taken up to 192 h and 48 h postdose, respectively.

Results

The total clearance of fosfluconazole was higher and the t1/2,Z and mean residence time were shorter in hepatically impaired subjects than in normal subjects. This may reflect more rapid conversion to FLCZ. The degree of protein binding of fosfluconazole (> 90%) and the amount of fosfluconazole excreted in the urine were similar in both groups. Slightly higher mean plasma concentrations of FLCZ were observed in the impaired group than in the normal group; however, hepatic impairment had no statistically significant effect on the FLCZ pharmacokinetic parameters apart from tmax. The tmax values were 4.8 h and 3.1 h in the normal and impaired subjects, respectively. The shorter tmax for FLCZ is also consistent with the more rapid conversion in the impaired subjects. The ratios (95% confidence intervals) for Cmax and AUC of FLCZ (impaired/normal) were 106.0% (92.8, 121.2) and 115.6% (86.4, 154.7), respectively. There were no serious adverse events, and no discontinuations due to adverse events or laboratory test abnormalities. The adverse events reported were mostly mild in severity and no trend could be discerned between the groups.

Conclusions

Fosfluconazole was more rapidly converted to FLCZ in the hepatically impaired subjects but the FLCZ pharmacokinetic parameters (except tmax) were not statistically significantly affected by hepatic impairment. Fosfluconazole was well tolerated by both groups. These results suggest that there is no requirement to adjust the dose of fosfluconazole when administered to subjects with mild to moderate hepatic impairment.
Efficacy and safety of three ophthalmic inserts for topical anaesthesia of the cornea. An exploratory comparative dose‐ranging, double‐blind, randomized trial in healthy volunteers
Authors: Mahé Isabelle , Mouly Stéphane , Jarrin Irène , Otéro Jacqueline , Tavera Catherine , Simoneau Guy , Tillet Yves , Conti Robert , El Meski Saïd , Gaudric Alain , Bergmann Jean‐François
Published: July 2005

Background

Cataract surgery requires prolonged anaesthesia, concomitant with permanent hydration and lubrication of the cornea, in order to provide a clear view of the operation area.

Aims

The primary objective of the study was to assess several formulae of a soluble ophthalmic insert: TOPICSERT [bupivacaine (Bupi) + hyaluronic acid (HA) or sodium hyaluronate] in terms of complete and long‐lasting anaesthesia of the cornea. The hydration properties of HA were not assessed in this study.

Methods

In a prospective double‐blind, cross‐over, randomized study, with latin‐square allocation of treatments, 16 healthy volunteers received a single dose of each formula (A, 1 mg Bupi and 0.1 mg HA; B, 0.5 mg Bupi and 0.1 mg HA; C, 1 mg Bupi and 0 mg HA, and D acting as a placebo) via the ocular route with 1 week of wash‐out between each period. Corneal anaesthesia was measured using a Cochet‐Bonnet esthesiometer.

Results

There was a statistically significant difference between treatments with regard to the main criterion (complete anaesthesia lasting at least 20 min) when general association statistics were used (Mantel–Haenzel test, P < 0.0001): 68.75% (n = 11) of subjects receiving treatment A, 37.5% (n = 6) receiving treatment B, and 87.5% (n = 14) on treatment C reached complete and satisfactory anaesthesia, while this was not achieved in any of the subjects receiving placebo. Ninety‐five percent confidence intervals of the difference between treatments were as follows: treatment A vs.  B  (−0.03,  0.66),  treatment  A vs.  C  (−0.47,  0.10),  treatment  B vs.  C  (−0.84, − 0.16). Only the difference between B and C was statistically significant (adjusted probability by the method of Bonferroni, P < 0.001). When complete anaesthesia was reached, mean (±SD) duration of anaesthesia was as follows: 20.7 (±6.5), 15.3 (±11.4) and 24.7 (±7.6) min for treatments A, B, C, respectively.

Conclusions

Bupivacaine 1 mg seems to be the efficient and safe dose. The value of hyaluronic acid as a corneal hydration agent and used in association with bupivacaine will be the subject of further studies.
The influence of guidelines on the use of statins: analysis of prescribing trends 1998–2002
Authors: Teeling M. , Bennett K. , Feely J.
Published: July 2005

Aims:

To monitor statin prescribing trends over time in order to determine whether prescribers were influenced by study results and/or clinical guidelines in terms of type and dosage of statin prescribed.

Methods:

The GMS (General Medical Services) prescription database in Ireland was used to identify a cohort of patients, prescribed statins, in order to investigate prescribing trends from January 1998–December 2002. Statin prescribing rates for patients with ischaemic heart disease and diabetes were compared with rates in the general GMS population. Logistic regression analysis was used in patients with ischaemic heart disease and diabetes and adjusted odds ratios and 95% confidence intervals presented.

Results:

Increased statin prescribing over time was noted (test for linear trend P < 0.0001). Pravastatin was the most frequently prescribed, followed by atorvastatin; simvastatin and fluvastatin showed lower rates of prescribing. Atorvastatin showed the greatest increased rate over time. An increase in the overall dose prescribed (test for trend P < 0.01) was chiefly due to increases in pravastatin dose, but doses were still below those recommended from clinical trials. Statins were prescribed more frequently in patients with ischaemic heart disease and diabetes, 44% (95% CI 43–45%) compared with the total GMS population, 7.7% (95% CI 7.6–7.8%), by December 2002. However, statins were only prescribed to 52% (95% CI 51–53%) of ischaemic heart disease patients and 40% (95% CI 39–41%) of patients with diabetes by December 2002. Patients aged 45–64 years were more likely to receive statins, compared with those aged 65 years and older.

Conclusion:

These findings suggest that the beneficial effects of statins shown in clinical studies may not be achieved in practice.
Weight related differences in the pharmacokinetics of abacavir in HIV‐infected patients
Authors: Jullien V. , Tréluyer J.‐M. , Chappuy H. , Dimet J. , Rey E. , Dupin N. , Salmon D. , Pons G. , Urien S.
Published: July 2005

Aim

To study the possible influence of patient characteristics on abacavir pharmacokinetics.

Methods

A population pharmacokinetic model for abacavir was developed using data from 188 adult patients by the use of a nonlinear mixed effects modelling method performed with NONMEM.

Results

Abacavir pharmacokinetics was well described by a two‐compartment open model with linear absorption and elimination. Typical population estimates for the absorption rate constant (Ka), the apparent central distribution volume (Vc/F), the apparent peripheral distribution volume (Vp/F), the apparent intercompartmental clearance (Q/F) and the apparent plasma clearance (CL/F) were 1.8 h−1, 75 l, 23.6 l, 10 l h−1 and 47.5 l h−1, respectively. Apparent plasma clearance was positively related to bodyweight. Individual Bayesian estimates of CL/F were used to calculate abacavir AUC. The latter decreased from 10.7 ± 5.0 to 5.7 ± 1.6 mgh l−1 when bodyweight increased from 36 to 102 kg. This drop in abacavir exposure could lead to suboptimal treatment for the heaviest patients, as antiviral efficacy of abacavir is known to be related to its AUC. A 400 mg abacavir dose would be necessary to achieve adequate exposure to abacavir in patients weighing more than 60 kg.

Conclusions

The apparent plasma clearance of abacavir was positively related to bodyweight. The efficacy of the current recommended abacavir dosage for patients with high bodyweight should be evaluated in further studies.
Health professionals rarely record history of complementary and alternative medicines
Authors: Cockayne Nicole L. , Duguid Margaret , Shenfield Gillian M.
Published: July 2005

Aims

To identify the completeness of documentation of Complementary And Alternative Medicine (CAM) use in hospital medical records of patients before and after an education programme.

Methods

Documentation of CAM in all parts of the medical records was compared to patients’ self‐reported use. Data were collected for one month before and one month after an education programme for hospital staff.

Results

At baseline: 59 (58%) of 101 patients used 129 CAM in the month prior to admission; only 36 (28%) of the CAM were documented in the medical record. After education: 51 (54%) of 94 patients used 91 CAM in the month prior to admission; 40 (44%) of the CAM were documented in the medical record. After education, recording rates increased by 16% (95% CI: 3% to 29%) due to improvements by pharmacists (18%, 95% CI: 5% to 31%). 32 (54%) of CAM users at baseline and 29 (57%) of CAM users after education informed a health professional. The recording rates were only 23 (39%) and 28 (55%) respectively for patients in these two sub‐groups, being an improvement of 16% (95% CI: −2% to 34%).

Conclusions

Prevalence of CAM use among patients admitted to hospital is high, but documentation of usage is low. Strategies need to be designed to improve health professionals’ knowledge about the need to record history of CAM use.
Child or family assessed measures of activity performance and participation for children with cerebral palsy: a structured review
Authors: Morris C. , Kurinczuk J. J. , Fitzpatrick R.
Published: July 2005

Background There is a need to measure children's ‘activity performance and participation’ as defined in the World Health Organization's International Classification of Functioning, Disability and Health for Children and Youth (WHO ICF). The aim of this review is to identify instruments that are suitable for use in postal surveys with families of children with cerebral palsy.

Methods We conducted a structured review of instruments that use child or family self‐assessment of ‘activity performance and participation’. The review involved a systematic search for instruments using multiple published sources. Appraisal of the instruments used the predefined criteria of appropriateness, validity, reliability, responsiveness, precision, interpretability, acceptability and feasibility.

Results There are relatively few child or family assessed instruments appropriate for measuring children's activities and participation. Seven instruments were identified that could potentially be administered by mail. The Assessment of Life Habits for Children (LIFE‐H) was the most appropriate instrument as assessed by its content but the reliability of child or family self‐assessment is not known. If the LIFE‐H were shown to be a reliable self‐report measure then the LIFE‐H would be the recommended choice. Currently, the Activities Scale for Kids and the condition‐specific Lifestyle Assessment Questionnaire for cerebral palsy (LAQ‐CP) provide the broadest description of what and how frequently children with cerebral palsy perform a range of activities and thereby indicate participation. The LAQ‐CP also provides additional contextual information on the impact of any disability on the participation of the family unit.

Conclusion There remains much scope for developing valid and reliable self‐assessed measures corresponding to the WHO ICF dimensions of activities and participation.
Getting the run around: accessing services for children with developmental co‐ordination disorder
Authors: Rodger S. , Mandich A.
Published: July 2005

Background  Accessing services for children with developmental co‐ordination disorder (DCD) is frequently difficult for parents who have to navigate both health and education systems to find a diagnosis and appropriate interventions.

Method  A qualitative study design incorporating a phenomenological perspective was utilized to understand the nature of the experiences of these parents in attempting to access support for their children with DCD. Twelve parents, whose children attended the Kids Skills Clinic at the University of Western Ontario and were identified as having DCD, were interviewed by the second author. Interviews were transcribed verbatim and analysed using constant comparative method. Member checking, peer checking and code‐recoding were carried out to enhance rigour in data analysis.

Results  A number of themes emerged focusing on the common problems experienced leading to occupational therapy referral. Parents’ journeys to seek and access services for their children with DCD were characterized by a sense of maternal knowing, experience of frustration, trivialization of the problem, a sense of ‘going it alone’, and ‘getting the run around’.

Conclusions  Implications for health and educational professionals working with children, in terms of recognition of DCD and referral for services, are described.
Clinical, socio‐demographic, neurophysiological and neuropsychiatric evaluation of children with volatile substance addiction
Authors: Uzun N. , Kendirli Y.
Published: July 2005

Background  Abuse of organic volatile substances in children has become a social health problem that is increasing in the recent years. Among these substances, toluene is highly preferred by abusers because of its euphoric effect, cheapness and easy availability. There is no published research on the clinical and neurophysiological evaluation of children with short‐term volatile substance addiction.

Methods  In this study, socio‐demographic characteristics were questioned in 12 children with a mean age of 15 years and a duration of toluene abuse for a mean of 2.3 years, and the clinical characteristics of central and peripheral nervous system damage caused by volatile substances, particularly by toluene were analysed, and probable neurological disorders were investigated by means of neurophysiological and neuropsychological tests. All tests were compared with a control group.

Results  Fifty‐eight percent of the children included in the study had pathological findings in the neurological examination. There was pyramidal involvement in 25% and peripheral nerve involvement in 33.3% of the cases. Evaluation of the cognitive functions revealed 33.3% pathology in the ‘Short Test of Mental Status’ which assesses functions of orientation, attention, learning, arithmetic calculation, abstraction, information, construction and recall. Sensorial polyneuropathy was found in 33.3% of the cases in nerve conduction studies. Somatosensory‐evoked potentials revealed pathology in 16.7% of the cases and brainstem‐evoked potentials in 50% of the cases. No pathology was observed in electroencephalography and visual‐evoked potentials.

Conclusion  In our study, neurophysiological and neuropsychiatric tests revealed that toluene causes slow progressive, clinical and subclinical central and peripheral nerve damage. In Turkey, because of cheapness, easy availability and legal use of volatile substances, the clinical extent of systemic and neurological toxicity of volatile substance abuse is increasing. Abuse of volatile substances, a currently increasing social issue, may create important physical problems which can be permanent.
Associations of lifestyle factors with quality of life (QOL) in Japanese children: a 3‐year follow‐up of the Toyama Birth Cohort Study
Authors: Chen X. , Sekine M. , Hamanishi S. , Yamagami T. , Kagamimori S.
Published: July 2005

Purpose  To examine the associations between lifestyle factors and quality of life (QOL) among Japanese children.

Methods  Participants were 7794 children (3869 boys and 3925 girls) aged 9–10. They completed a questionnaire regarding lifestyles at baseline survey and were followed up for 3 years. In the follow‐up survey, QOL was evaluated using a Japanese version of the COOP charts. Children rated their QOL as one of five response categories. Subjects rated as ‘very well’ or ‘pretty good’ were considered to have good QOL, and the remainder was assumed to have poor QOL. Logistic regression analysis was performed to evaluate the relationship between lifestyles or changes in lifestyles and QOL. In the multivariate analysis model, age, sex, body mass index (BMI), and lifestyle factors were simultaneously entered.

Results  During the follow‐up period, children became more sedentary. Compared to children participating in physical activity ‘very often’ at baseline, those who exercised ‘almost never’ were more likely to have poor QOL [OR (95% CI): 1.92 (1.26–2.93)]. Children who developed or maintained undesirable lifestyles had high OR for poor QOL. Compared to children taking breakfast ‘often’ during the follow‐up period, those changing from ‘often’ to ‘seldom’ or those taking breakfast ‘seldom’ were more likely to have poor QOL [1.61 (1.24–2.07), 2.05 (1.03–4.09), respectively]. When compared with children maintaining their participation in physical activity ‘often’, those who changed from ‘often’ to ‘seldom’ and those who kept ‘seldom’ were more likely to have poor QOL [2.10 (1.84–2.39), 2.21 (1.88–2.59), respectively].

Conclusions  This study shows that unfavourable lifestyles in childhood are associated with poor QOL in early adolescence. Early intervention could be worth considering to keeping desirable lifestyles during childhood.
Practice nurses and older people: a case management approach to care
Authors: Evans Catherine , Drennan Vari , Roberts Julia
Published: July 2005

Aim. This paper reports on aspects of a study designed to answer the research questions: (i) To what extent do practice nurses use the five cyclical elements of a case management approach when caring for people aged over 75 years? (ii) What determines or deters practice nurses’ use of the cyclical elements of a case management approach in caring for older people?

Background. Case management is an approach that uses a cyclical process of assessment, planning, implementation, monitoring and evaluation to provide systematic proactive care to people with complex health and social care needs. In England, specialist practice nurse case managers for older people have been piloted in ten primary care trusts and the posts are to be implemented nationally by 2008. No baseline work has, however, considered the applicability of developing the existing generalist practice nurse workforce.

Method. A 26‐item structured postal questionnaire was used to explore both practice nurses’ use of a case management approach when working with older people, and what factors influenced the care provided. A random sample of 500 practice nurses was selected from the Royal College of Nursing Practice Nurse Association member database.

Results. A 45% response rate was achieved. Practice nurses assessed, planned and implemented care, but reviewing medication opportunistically and evaluating the care were uncommon. A case management approach was significantly (P = 0·005) more likely to be used in on‐going management activities than in one‐off treatment room care. Practice nurses with postregistration education in district nursing were significantly (P = 0·016) more likely to refer patients to social care services. Lack of time and the central role of the general practitioner were the main reasons for not incorporating case management into practice.

Conclusions. The extent to which practice nurses used elements of a case management approach was highly variable and influenced by individual professional expertise, the nature of the consultation and the practice nurse's position in the general practice.
Stress in women with postpartum depression: a phenomenological study
Authors: Leung Sharron , Arthur David G. , Martinson Ian
Published: July 2005

Aim. The aim of this paper is to report a study of the lived experience of postpartum stress among depressed Hong Kong Chinese mothers.

Background. Research consistently relates postpartum stress to the mood and well‐being of mothers during the postpartum period. While several studies have used questionnaires to assess the stress levels of mothers or have identified stressors by asking them to list stressful events, the existing literature lacks in‐depth information on the lived experience of postpartum stress from the perspective of the depressed mother.

Methods. The study adopted a phenomenological approach with a purposive sample of 11 depressed Hong Kong Chinese mothers at around the sixth postpartum month. In‐depth interviews were conducted in Cantonese and focused on the stress the mothers experienced during the postpartum period up to the time of the interview. The data were collected in 2000.

Results. Living in a metropolitan city under the mixed and sometimes conflicting influences of cultures from the East and the West, Hong Kong Chinese mothers face a unique set of challenges which, if not properly managed, may cause stress and/or depression in the postpartum period. We identified five major postpartum stress themes amongst this group of women: parenting competence, the expectation–experience gap, baby‐minder arrangements, childcare demands, and conflict with culture and tradition.

Conclusions. Health care staff should give anticipatory guidance to mothers and their spouses about the culturally prescribed set of rules that proved stressful. Antenatal education classes need to enhanced, and support is needed to help this population of women manage and overcome the challenges in the postpartum period.
Nursing and cancer support groups
Authors: Zabalegui Adelaida , Sanchez Susanav , Sanchez Pablo D. , Juando Clara
Published: July 2005

Aim.  The aim of this paper is to review the evidence on the effectiveness of support groups by reporting a meta‐analysis of randomized controlled trials evaluating support groups for patients with cancer.

Background.  One of the most important nursing aims is to give patients with cancer emotional support and strengthen their adaptation to the disease. According to the literature, support groups for these patients are beneficial.

Methods.  Original studies from 14 databases published during the past 20 years in peer review journals were selected. Twenty studies with a randomized clinical trial design constituted the final meta‐analysis sample. Methodological quality of the selected articles was checked using the Jadad Scale and the Checklist of Consort Statement. Demographic data were analysed using the SPSS program, and the heterogeneity calculation and effect size were analysed using the Rev‐Man 4‐.1‐Metaview program.

Findings.  The results indicate that participation in a support group is associated with significant improvements in a patient's emotional state (depression and anxiety), illness adaptation, quality of life, and marital relationships.

Conclusion.  Support group participation for patients with cancer has a positive impact in various areas. Nurses should promote participation as a crucial part of their care.