bluuebunny/crossref_metadata_2025 huggingface dataset:
Is Epilepsy a Disease of Synaptic Transmission?
Authors: Kapur Jaideep
Published: September 2008

Masking Epilepsy by Combining Two Epilepsy Genes. Glasscock E, Qian J, Yoo JW, Noebels JL. Nat Neurosci 2007;10(12):1554–1558. Inherited errors in ion channel genes comprise the largest subset of monogenic causes of idiopathic epilepsy, and pathogenic variants contribute to genetic risk in the complex inheritance of this common disorder. We generated a digenic mouse model of human idiopathic epilepsy by combining two epilepsy-associated ion channel mutations with mutually opposing excitability defects and overlapping subcellular localization. We found that increasing membrane excitability by removing Shaker-like K+ channels, which are encoded by the Kcna1 gene, masked the absence epilepsy caused by a P/Q-type Ca2+ channelopathy due to a missense mutation in the Cacna1a gene. Conversely, decreasing network excitability by impairing Cacna1a Ca2+-channel function attenuated limbic seizures and sudden death in Kcna1-null mice. We also identified intermediate excitability phenotypes at the network and axonal levels. Protective interactions between pathogenic ion channel variants may markedly alter the clinical expression of epilepsy, highlighting the need for comprehensive profiling of this candidate gene set to improve the accuracy of genetic risk assessment of this complex disease.
Intrinsic Severity as a Determinant of Antiepileptic Drug Refractoriness
Authors: Rogawski Michael A. , Johnson Michael R.
Published: September 2008

For the most part, resistance to medications in epilepsy is independent of the choice of antiepileptic drug. This simple clinical observation constrains the possible biological mechanisms for drug refractory epilepsy by imposing a requirement to explain resistance for a diverse set of chemical structures that act on an even more varied group of molecular targets. To date, research on antiepileptic drug refractoriness has been guided by the “drug transporter overexpression” and the “reduced drug-target sensitivity” hypotheses. These concepts posit that drug refractoriness is a condition separate from the underlying epilepsy. Inadequacies in both hypotheses mandate a fresh approach to the problem. In this article, we propose a novel approach that considers epilepsy pharmacoresistance in terms of intrinsic disease severity. We suggest that neurobiological factors that confer increased disease severity lead to drug intractability. The occurrence of frequent seizures at disease onset is an important factor that signals increased severity.
Cross‐linked Polyvinyl Alcohol as a Binder for Gelcasting and Green Machining
Authors: Chabert France , Dunstan David E. , Franks George V.
Published: September 2008

Submicrometer alumina suspensions, dispersed in aqueous acidic solutions of polyvinyl alcohol (PVA) and 2,5‐dimethoxy‐2,5‐dihydrofuran, have been evaluated for suitability as a cross‐linkable binder system for casting complex‐shaped ceramic components. Suspensions of up to 50 vol% solids have rheological behavior, which is suitable for pouring and filling molds. Complex‐shaped green bodies are then formed by heating the suspension in the mold for a period of time (typically 15–60 min) at moderate temperature (60°–80°C) to gel the suspension. High green densities (58%–62% of full density) can be obtained. The dried green bodies have strength in excess of 1 MPa and may be readily machined. No more than 1–3 wt% PVA per weight of alumina is necessary, ensuring burnout that minimizes generation of flaws. The ceramic components can be fired to >96% of full density when fired for 2 h at 1400°–1450°C. Cross‐linkable PVA may receive more widespread acceptance in ceramic processing than previous gelcasting formulations because PVA is already a common processing additive.
CaTiO3‐Modified (K0.50Na0.50)(Nb0.96Sb0.04)O3Lead‐Free Piezoelectric Ceramics
Authors: Wu Jiagang , Xiao Dingquan , Wang Yuanyu , Wu Wenjuan , Zhang Bin , Zhu Jianguo
Published: September 2008

(1−x)(Na0.5K0.5)(Nb0.96Sb0.04)O3–xCaTiO3lead‐free piezoelectric ceramics were prepared by normal sintering. The effects of the CaTiO3on the phase structure and piezoelectric properties of the ceramics were systematically studied. These results show that the CaTiO3‐modified (K0.50Na0.50)(Nb0.96Sb0.04)O3lead‐free piezoelectric ceramics form stable solution with orthorhombic structure, and the Curie temperature and the polymorphic phase transition of the ceramics decreased with increasingx. Moreover, the effect of the polarization temperature (Tp) on the piezoelectric properties of the ceramics was also discussed. The result shows that the piezoelectric properties of the ceramics strongly depend on theTp. The ceramics withx=0.01 poled atTp=35°C possess optimum properties (d33=168 pC/N,kp=45%,Tc=314°C,To−t=120°C, ɛr∼1041, and tan δ∼2.5%). These results indicate that the ceramic is a promising candidate material for lead‐free piezoelectric ceramics.
Recent Advances in Dynamic Indentation Fracture, Impact Damage and Fragmentation of Ceramics
Authors: Subhash Ghatu , Maiti Spandan , Geubelle Philippe H. , Ghosh Dipankar
Published: September 2008

In this feature article, dynamic indentation‐induced deformation and fracture phenomena in brittle solids are related to the deformation behavior and fracture patterns evolved during dynamic impact on structural ceramics. Examples of indentation‐induced localized amorphization in boron carbide (B4C) and differences in fracture characteristics due to static and dynamic indentations on B4C and zirconium diboride–silicon carbide (ZrB2–SiC) ceramic composite are presented. These features are compared with the fracture patterns evolved during the high‐velocity ball impact on SiC. The influences of processing‐induced (inherent) flaws and deformation‐induced flaws on fracture initiation in a brittle material are discussed. Recent developments in analytical modeling of indentation‐ and impact‐induced damage in ceramics and computational efforts on fracture and fragmentation response of ceramics are thoroughly reviewed. Finally, some future research directions are identified.
Improving Flexural Strength of Dental Restorative Ceramics Using Laser Interference Direct Structuring
Authors: Daniel Claus , Drummond James , Giordano Russell A.
Published: September 2008

Zirconia and alumina ceramics restorative materials were treated with laser interference direct structuring using the third harmonic of a short pulse Nd:YAG and tested in a three‐point bending test to measure the flexural strength. The surface was restructured in a periodic line‐like pattern with controlled surface porosity and a surface composite pattern. As shown in earlier work [J. Am. Ceram. Soc. 91 [7] 2138‐42 (2008), the composite consists of two different defect states rather than different phase compositions. The resulting mechanical properties are a function of the number of laser pulses, laser energy, and angle in between the laser beams defining the periodic feature distance [Adv. Eng. Mater., 9 [7] 823–26 (2005)]. The material's fracture strength could be controlled through the three mentioned laser parameters and in an initial study significantly improved by up to 50% from initial 422 to 630 MPa for alumina and 833 to 1250 MPa for zirconia.
Transport of TMV Movement Protein Particles Associated with the Targeting of RNA to Plasmodesmata
Authors: Sambade Adrian , Brandner Katrin , Hofmann Christina , Seemanpillai Mark , Mutterer Jerome , Heinlein Manfred
Published: September 2008

The cell‐to‐cell movement of Tobacco mosaic virus through plasmodesmata (PD) requires virus‐encoded movement protein (MP). The MP targets PD through the endoplasmic reticulum (ER)/actin network, whereas the intercellular movement of the viral RNA genome has been correlated with the association of the MP with mobile, microtubule‐proximal particles in cells at the leading front of infection as well as the accumulation of the protein on the microtubule network during later infection stages. To understand how the associations of MP with ER and microtubules are functionally connected, we applied multiple marker three‐dimensional confocal and time‐lapse video microscopies to Nicotiana benthamiana cells expressing fluorescent MP, fluorescent RNA and fluorescent cellular markers. We report the reconstitution of MP‐dependent RNA transport to PD in a transient assay. We show that transiently expressed MP occurs in association with small particles as observed during infection. The same MP accumulates in PD and mediates the transport of its messenger RNA transcript to the pore. In the cellular cortex, the particles occur at microtubule‐proximal sites and can undergo ER‐associated and latrunculin‐sensitive movements between such sites. These and other observations suggest that the microtubule network performs anchorage and release functions for controlling the assembly and intracellular movement of MP‐containing RNA transport particles in association with the ER.
Nuclear Export Signal Consensus Sequences Defined Using a Localization‐Based Yeast Selection System
Authors: Kosugi Shunichi , Hasebe Masako , Tomita Masaru , Yanagawa Hiroshi
Published: September 2008

Proteins bearing nuclear export signals (NESs) are translocated to the cytoplasm from the nucleus mainly through the CRM1‐dependent pathway. However, the NES consensus sequence remains poorly defined, and there are currently no high‐throughput methods for identifying NESs. In this study, we report the development of an efficient yeast selection system for detecting nuclear export activity as well as several reliable NES consensus sequences identified using this method. Our selection system is based on the nuclear export‐dependent rescue of Tys1p, an essential cytoplasmic protein that has been artificially localized to the nucleus in a haploid Δtys1 knockout strain. A screen of a random peptide library revealed 101 distinct CRM1‐dependent NESs, which were classified into six patterns according to the conserved hydrophobic spacing. By combining mutational analyses, we have defined new NES consensus sequences with more specific and redundant residues than the traditional consensus sequence, which are consistent with most experimentally confirmed NESs. These NES consensus sequences should help identify functional NESs, and our selection system can be used to identify other targeting signals or proteins imported to specific subcellular compartments.
Effects of oyster extract on the reproductive function of zinc‐deficient mice: Bioavailability of zinc contained in oyster extract
Authors: Matsuda Yoshikazu , Walanabe Toshiaki
Published: September 2008

ABSTRACT Zinc is a vital nutrient in the normal reproductive function and embryonic development of mammals, and it is well known that oyster extract contains significant amounts of zinc. The effects of oyster extract on reproductive function, such as embryonic development, serum levels of zinc and sperm maturation were examined in zinc‐deficient mice. Zinc deficiency in dams during pregnancy induced a decrease in the successful pregnancy rate, maternal weight gain, the number of live fetuses and fetal body weight. Zinc deficiency for 12 weeks in male mice induced a decrease in body weight, testis weight and sperm count in the epididymis. However, reproductive failure, embryonic defects and decreased sperm motility in zinc‐deficient mice were improved by supplementation with oyster extract. Some nutrients contained in oyster extract, such as taurine and glycogen, may be related to the recovery of reproductive function. There were significantly lower serum concentrations of zinc in dams fed a zinc‐deficient diet However, the serum zinc concentration was normal in the oyster extract‐supplemented group. No difference in the concentration of serum zinc was observed between the oyster extract‐ and zinc carbonate‐supplemented groups. From these findings, it is suggested that oyster extract is a useful supplement that can prevent reproductive defects from zinc deficiency, and the bioavailability of zinc may be identical to zinc carbonate.
Trend of congenital anomalies over 20 years ascertained by population‐based monitoring in Ishikawa Prefecture, Japan
Authors: Seto Toshio , Nakagawa Hideaki , Morikawa Yuko , Nishijo Muneko , Miura Katsuyuki , Kadoshima Yoko
Published: September 2008

ABSTRACT Monitoring in Ishikawa Prefecture (mean population; 1,150,000), during the 20‐year period from 1981 to 2000, involved monitoring the prevalence of congenital anomalies starting at gestational week 22. The main objectives of the present study were (1) to investigate the trend over the past 20 years in the prevalence of congenital anomalies, and (2) to investigate whether there is area accumulation in congenital anomalies or not In addition, the prevalence of well‐known risk factors such as smoking, drinking and family history among cases with congenital anomalies was analyzed to obtain clues to the background of such anomalies. During the 20 years, more than 200,000 births have been observed. Thirty‐three selected congenital anomalies, consisting mainly of external anomalies, were analyzed in this study. The percentage of children born with congenital anomalies did not change markedly between the first and second halves of the monitoring period, remaining at approximately 4.5/ 1,000 births. There was also no significant change in annual trends in either Ishikawa Prefecture as a whole or in the three regions within Ishikawa. The prevalence of congenital anomalies by type showed a significant decrease in anencephaly and spina bifida. In contrast, Down syndrome and microcephaly increased significantly. The mean maternal age for Down syndrome increased significantly from the first‐half period to the second‐half period. The percentage of children with Polydactyly whose mother smoked were relatively higher than that for the other congenital anomalies.
Defective balancing ability and hyperactivity in the CLX (circling behavior linked to the X‐chromosome) mutant rat
Authors: Fuji Jun‐ichiro , Tanabe Hiroyuki , Fukuda Ryo , Ooshima Yojiro
Published: September 2008

ABSTRACT We have reported that the recently described circling behavior rat (CLX) is a hereditary mutant controlled by a single sex‐linked recessive gene (gene symbol: clx). This mutant shows intermittent circle walking and/or running and head tossing with the neck twisted. The abnormal behavior begins to appear around weaning and continues throughout life. In the present study, behavioral tests were performed during the suckling and post‐weaning periods and when the rats reached maturity, and the following peculiar abnormalities were revealed: (1) in the righting reflex test, the CLX young show a tendency to take a longer time to revert to normal posture; (2) in the negative geotaxis test, they had difficulty moving upward at 12 days of age; (3) in the air righting reflex test, they frequently fell on their backs or shoulders even after weaning; (4) almost none of the CLX rats showed nystagmus, which is invariably observed in normal rats after rotating stimulation, at 20 weeks of age; and (5) they showed hyperactivity in the open field test at the age of 5 or 6 weeks and a higher degree of locomotor activity in the home cage at the age of 7 and 15 weeks. These results suggest that CLX mutant rats may have some defect in vestibular function (balance sense) or abnormalities in an area of the central nervous system responsible for posture control, e.g., in the dopaminergic or GABAergic neurons.
Incorporating fairness in generalized games of matching pennies
Authors: Boylan Richard T. , Grant Simon
Published: September 2008

We examine individual behavior in generalized games of matching pennies. We have three main findings. First, individuals cooperate in these games; that is, they systematically select strategies that lead both players to obtain higher expected payoffs than in a Nash equilibrium. Second, existing models that assume altruistic preferences do not explain the cooperative behavior in these games. Third, among the main models in the extant literature, the only one that predicts the observed behavior is the quantal response equilibrium.
Exploring Youth Development With Diverse Children: Correlates of Risk, Health, and Thriving Behaviors
Authors: Smith Laureen H. , Barker Elizabeth
Published: September 2008

PURPOSE.  This study explored the relationships between internal and external assets, risk behaviors, health behaviors, and thriving behaviors in diverse children.

DESIGN AND METHODS.  The strength of relationships existing between measures, differences between group means based on gender, grades earned, and school, and confidence interval (p ≤ .05) were tested in a sample of 61 urban sixth graders.

RESULTS.  Few assets were related to substance use. Assets were related to delinquency acts, health behaviors, and thriving indicators. Group differences between schools and gender and the total number of assets were noted.

PRACTICE IMPLICATIONS.  Supporting assets are important to consider when nurses perform assessments and design interventions to support youths in their maturation processes.
Low-frequency radio spectrum and spectral turnover of LS 5039
Authors: Godambe Sagar , Bhattacharyya Subir , Bhatt Nilay , Choudhury Manojendu
Published: September 2008

LS 5039, a possible black hole X-ray binary, was recently observed with Giant Metrewave Radio Telescope. The observed spectrum presented here shows that the spectrum is inverted at low frequency. When combined with the archival data with orbital phase similar to the present observations, it shows a clear indication of a spectral turnover. The combined data are fitted with a broken power-law and the break frequency signifies a possible spectral turnover of the spectrum around 964 MHz. Truly simultaneous observations in radio wavelength covering a wide range of frequencies are required to fix the spectrum and the spectral turnover which will play a crucial role in developing a deeper understanding of the radio-emitting jet in LS 5039.
The trigger of the asymptotic giant branch superwind: the importance of carbon
Authors: Lagadec Eric , Zijlstra Albert A.
Published: September 2008

The driving mechanism of the asymptotic giant branch (AGB) superwind has become controversial in recent years. The efficacy of dust-driven mass loss has been queried. Spitzer observation of AGB stars in local group galaxies shows the surprising result that at low metallicity, AGB mass loss occurs at low luminosity, possibly lower than in the Galaxy, but only for carbon-rich stars. Oxygen-rich stars in the Galaxy and in lower metallicity galaxies have similar mass-loss rates only at high luminosities. To explain this dichotomy, we propose that the superwind has a dual trigger. The superwind starts either when sufficient excess carbon builds up for efficient formation of carbonaceous dust [which we propose occurs when XCO = (C − O)/O⊙ = 0.1], or when the luminosity reaches a value sufficient for a silicate dust-driven wind (proposed at L = 104Z−4/3 L⊙). We show that this dual trigger fits the current observational constraints: the luminosity at which the superwind begins, and the predominance of carbon superwind star at low metallicity. We use stellar evolution models to check the consistency of our explanations and present detailed predictions of the luminosities at which the superwind is triggered for different metallicities and initial stellar masses.
The apparent overdensity of open clusters in the Canis Major overdensity
Authors: Piatti Andrés E. , Clariá Juan J.
Published: September 2008

The exciting debate on the existence and nature of the relatively recent discovery of the so-called Canis Major (CMa) overdensity is re-examined here based on the positions, reddenings, ages and metallicities of Galactic open clusters (OCs). The data used to carry out the current study were taken from the recently updated version of the Dias et al.'s 1776 OC catalogue. We found that only Tombaugh 2 is physically located within the main body of CMa. Even if we take into account the whole sample of catalogued OCs with unknown distances, it is statistically expected that only one additional OC could be found within the CMa region. Since the CMa overdensity appears to be quite transparent to dust, only a few OCs in that zone could have been missed. Both metallicity and age distributions of OCs located in the Galactic outer disc, including Tombaugh 2 and those projected on to CMa, are in good agreement with the paradigm of a main dispersion of age and metallicity values. There are only marginal indications for a radial abundance variation. We conclude that CMa does not contain a significant population of OCs which share its properties. This result does not favour the dwarf galaxy scenario.
Differentiating chronic obstructive pulmonary disease from asthma
Authors: Kuebler Kim K. , Buchsel Patricia C. , Balkstra Cynthia R.
Published: September 2008

Purpose: Chronic obstructive pulmonary disease (COPD) and asthma are chronic diseases that are increasing worldwide in incidence, prevalence, and burden. The purpose of this article is to provide nurse practitioners (NPs) with the information necessary to make a differential diagnosis and to understand the different treatment approaches to these two diseases.

Data sources: Peer‐reviewed journal articles, book chapters, and evidence‐based Internet sources.

Conclusions: NPs who are familiar with the pathophysiology that differentiates COPD from asthma can make an appropriate diagnosis and initiate effective pharmacologic and nonpharmacologic interventions, which may lead to a reduced incidence of exacerbations.

Implications for practice: A misdiagnosis of COPD or asthma leads to inadequate management of patients and to escalating healthcare costs. An early and accurate diagnosis can help to ensure optimal and cost‐effective management of patient care.
Informational needs and the experiences of women with abnormal Papanicolaou smears
Authors: Bertram Cathy Cramer , Magnussen Lois
Published: September 2008

Purpose: To describe the experience of women with abnormal Papanicolaou (Pap) smears with a particular focus on their informational needs.

Data source: The small purposive sample consisted of 10 demographically diverse women with a history of at least one abnormal Pap smear, who attended one Women’s Health outpatient clinic that typically serves a multiethnic, low‐income population. Individual 30‐ to 60‐min tape‐recorded interviews were conducted, transcribed verbatim, and analyzed according to Colaizzi’s eidetic method of phenomenological analysis. A manual categorizing strategy and a computer software (Qualrus, version 2.0) strategy were used for data management and coding.

Conclusions: Six major themes emerged from the data: initial response to the diagnosis; dealing with stigma; seeking information and support; enduring diagnostic and treatment procedures; formulating a concept of disease; and normalizing. The essential structure of the experience of having an abnormal Pap smear in terms of informational needs involved initial anxiety at disclosure, followed by an urgent need for information. Stigma associated with a sexually transmitted disease (STD) and a dearth of information available for male partners were problematic and influenced decisions about disclosure of human papillomavirus (HPV) infection to current or future partners. Misinformation or misunderstanding of available information was common. Information obtained from the Internet was experienced as private and allowed adequate time, but Web sites that grouped HPV with general STD information were confusing and further stigmatizing. Information obtained from healthcare providers was experienced as supportive if facts were accompanied by reassurance and familiar analogies were used. Information from providers was experienced as nonsupportive if too much medical jargon was used, if not enough time was spent to explain the information, if facts were not accompanied by interpersonal concern, or if a patient–provider relationship was not established.

Implications for practice: Patient education regarding abnormal Pap smears and HPV should address the concerns of those affected and should use message framing that informs but decreases stigmatization. Women should be offered the option of individualized informative and supportive counseling resources after initial disclosure of an abnormal Pap smear to adequately address concerns such as information for partners, the nature of HPV, an appropriate concept of cancer risk, and reassurance regarding potential effects on sexuality and fertility. Public information forums should address issues specific to high‐risk HPV rather than generalization as an STD.
Measuring mobbing experiences of academic nurses: Development of a mobbing scale
Authors: Ozturk Havva , Sokmen Serap , Yılmaz Fatma , Cilingir Dilek
Published: September 2008

Purpose: The aims of this study were to develop a mobbing scale for academic nurses and to determine their mobbing experiences.

Data sources: Data were collected between January and June 2006 with a 60‐item mobbing scale and a questionnaire composed of 6 questions concerning demographics and 10 questions regarding nurses’ opinions about mobbing.

Conclusions: For the Mobbing Scale for Academic Nurses, the content validity index was 88%, item‐to‐total correlations ranged from .41 to .73, Cronbach αwas .97, and Kaiser–Meyer–Olkin measure of sampling adequacy was .72. Barlett’s test yielded quite significant results (χ2= 7905.47, p = .000). The scale was composed of eight subscales. One fifth of the academic nurses experienced mobbing, and there was evidence of mobbing at university nursing schools.

Implications for practice: The mobbing scale for academic nurses can be used to collect reliable and accurate data about mobbing experienced by academic nurses. If there is mobbing in nursing faculties and schools, appropriate precautions should be taken to protect people against mobbing, and a safe and comfortable atmosphere must be created in nursing faculties and schools.
Body mass index and nutritional intake in patients with HIV and chronic diarrhea: A secondary analysis
Authors: Capili Bernadette , Anastasi Joyce K.
Published: September 2008

Purpose: The purpose of this study was to examine the differences in nutritional intake and body mass index (BMI) in HIV patients with chronic diarrhea via secondary analysis of patients’ nutritional diaries. A secondary purpose was to evaluate the quality of diets against national dietary guidelines.

Data sources: Seventy‐five ambulatory patients with HIV were included in this study. Patients were categorized using baseline BMI as normal weight (BMI 18.5–24.9 kg/m2), overweight (BMI 25.0‐29.9 kg/m2), and obese (BMI ≥30.0 kg/m2). Seven‐day nutritional diaries were used to estimate diet in terms of dietary fats, cholesterol, fiber, protein, and sugar. A one‐way analysis of variance was conducted to evaluate the relationship between BMI and mean nutritional intake from fat, saturated fat, polyunsaturated fat, monounsaturated fat, cholesterol, fiber, and sugar.

Conclusions: 39.7% and 13.3% of participants were overweight and obese, respectively. The mean intake of fat, saturated fat, and cholesterol was higher than the recommended levels by the National Cholesterol Education Program (NCEP), while the mean intake of monounsaturated fat, polyunsaturated fat, and fiber was below the NCEP guideline. Although the results were not statistically different between groups, grams of fiber intake were lowest for individuals with BMI ≥30.0 kg/m2.

Implications for practice: Advanced practice nurses should encourage increased physical activity and healthy diets at each visit for individuals living with HIV. The continued use of nutritional supplements to boost weight should also be reviewed at each visit to prevent the consumption of unnecessary calories.
A challenge in academia: Meeting the healthcare needs of the growing number of older adults
Authors: Scherer Yvonne K. , Bruce Susan A. , Montgomery Carolyn A. , Ball Lisa S.
Published: September 2008

Purpose: The purposes of this study were to survey nurse practitioners (NPs) to determine their comfort level with knowledge about caring for individuals aged 65 years and older and to obtain their input on enhancing geriatric content in the educational preparation of advanced practice nurses who provide care to older adults but are not specialists in gerontology.

Data sources: The sample consisted of 500 randomly selected NPs who were certified to practice in New York State. The Geriatric Curriculum Survey designed by the researchers was based on the 47 “Older Adult Care” competencies developed by the American Association of Colleges of Nursing. The survey was mailed to the subjects along with a stamped self‐addressed envelope to facilitate its return. Two hundred and twenty–two surveys (44%) were returned.

Conclusions: A majority of the respondents were comfortable with their assessment skill knowledge of individuals aged 65 years and older in all areas except those related to cultural/ethnic items. Over half of the respondents were only “somewhat comfortable” with knowledge of management of Alzheimer’s disease, delirium, dementia, neurological problems, polypharmacy, and sleep issues. Finally, respondents were asked to rate their knowledge comfort level on topics relevant to physical and psychosocial issues of individuals aged 65 years and older. The majority of respondents only felt “somewhat comfortable” with their knowledge on all but one of the nine items in this category. Health promotion and disease prevention was the only item that over 50% of the respondents felt “very knowledgeable” about. Ninety‐five percent indicated they would be better prepared to care for individuals aged 65 years and older if a didactic course in geriatrics was required in their program of study. Seventy percent indicated they would consider taking an online course in geriatrics.

Implications for practice: Based on the results of this study, an online, four‐credit geriatric‐focused course “Issues in Geriatric Management” was developed. The course is required in the acute care and adult NP programs. Eventually, this course will be offered as continuing education credit for practicing NPs. The offering of a course focused on geriatrics will help to better prepare NPs to care for the growing number of elderly in this country.
BSAVA Manual of Canine and Feline Musculoskeletal Imaging
Authors: McLean C. Louise
Published: September 2008

BSAVA Manual of Canine and Feline Musculoskeletal Imaging
 Edited by Frances J. Barr and Robert M. Kirberger Published by the BSAVA, 2006, paperback, 220 pages, Price £70.00, ISBN‐10: 0905214862, ISBN‐13: 978‐0905214863
General population‐based cohorts for studies of lung health in adults in Sweden
Authors: Lundbäck B. , Rönmark E.
Published: September 2008

Epidemiological population‐based studies about lung health in Sweden have mostly been focused on obstructive airway diseases. From the 1960s to the 1980s, the epidemiological studies were cross‐sectional, aiming at the study of the prevalence of asthma, chronic bronchitis and respiratory symptoms and their associations with mainly demographic data. With the exception of highly stratified samples, for instance the men born on 1913 in Gothenburg and cohorts of occupational groups or work places, general population‐based cohorts for studies of lung health in adults are still not very common. Two large‐scale studies of lung health have been in progress in Sweden for more than 20 years; the Obstructive Lung Disease in Northern Sweden (OLIN) Studies, which started in 1985, and the Swedish part of European Community Respiratory Health Survey (ECRHS) since 1989 with the follow‐up survey labelled Respiratory Health in Northern Europe (RHINE). During the 1990s the comparative studies between Finland, Estonia and Sweden (The FinEsS Studies) started. These and other studies will be reviewed in the following exemplifying change of aims and study designs over time as well as change of focus of risk factors under study.

Please cite this paper as: Lundbäck B and Rönmark E. General population‐based cohorts for studies of lung health in adults in Sweden. The Clinical Respiratory Journal 2008; 2: 2–9.
The Obstructive Lung Disease in Northern Sweden (OLIN) longitudinal paediatric study I – the first 10 years
Authors: Rönmark E. , Bjerg A. , Hedman L. , Perzanowski M. , Sundberg S. , Lundbäck B.
Published: September 2008

Background:  Prospective studies of asthma and allergic conditions based on the general population are scare.

Aim:  To summarize the methods and main results from a prospective study among school children.

Methods:  In 1996, a cohort of 3525 children aged 7/8 years in Northern Sweden were invited to a questionnaire survey using an expanded ISAAC protocol, and 97% participated. The cohort has been followed up yearly with high participation rate. Skin prick tests were conducted 1996, 2000 and 2006/2007. Allergens in dust from homes and schools have been analyzed. Sub samples have participated in interviews, lung function tests, bronchial hyper reactivity test, and analyses of IgE and IgG antibodies in serum.

Results:  The prevalence of asthma was 6% at age 7–8 years and increased by age. The incidence of physician‐diagnosed asthma after the age of 7–8 years was around 1/100/year. The prevalence of positive skin prick test increased from 21% at age 7–8 to 30% at age 11–12 years. Remission of allergic sensitization was rare, while asthma remission was 5% yearly. The main risk factor for asthma and allergic sensitization increased in importance with increasing age. Allergic and non‐allergic asthma had different risk factor pattern. Environmental risk factors decreased in impact after the age of 7. Avoidance of pets at home did not protect from asthma or allergic sensitization.

Conclusion:  The study includes important sources of data for further longitudinal analyses that will contribute to the understanding of the development and the nature of asthma and allergic sensitization.

Please cite this paper as: Rönmark E, Bjerg A, Hedman L, Perzanowski M, Sundberg S and Lundbäck B. The Obstructive Lung Disease in Northern Sweden (OLIN) longitudinal paediatric study I – the first 10 years. The Clinical Respiratory Journal 2008; 22: 26–33.
What can we learn about asthma and allergy from the follow‐up of the RHINE and the ECRHS studies?
Authors: Omenaas E. , Svanes C. , Janson C. , Toren K. , Jogi R. , Gislason T. , Franklin K. A. , Gulsvik A.
Published: September 2008

Object:  The international population‐based studies RHINE and ECRHS have provided new insight in the epidemiology and management of asthma, allergy and rhinitis in young adults. The aim of the present review is to focus on longitudinal results with regard incidence and net change of asthma and asthma‐like symptoms, risk factors and management of asthma, with special reference to the Nordic‐Baltic countries.

Results:  Asthma and rhinitis are common conditions that are important in a public health perspective. There are gender differences in incidence and remission. A socio‐economic gradient that non‐atopic asthma is more strongly related to poverty seems to have developed in the last decade. These findings will challenge our welfare states in the future.

In addition, occupational, as well as indoor and outdoor environmental exposures, influenced the onset of asthma. The population‐attributable risk for adult asthma because of occupational exposures is equivalent to an incidence of new‐onset asthma of 250–300 cases per million per year. Genetic factors, allergic sensitisation, gastro‐oesophageal reflux, habitual snoring, diet and other factors may also contribute to the onset of asthma and rhinitis. Even though management of asthma has improved, there are still great variations throughout Europe. These findings highlight the key role doctors and nurses play in educating and reviewing management of patients.

Please cite this paper as: Omenaas E, Svanes C, Janson C, Toren K, Jogi R, Gislason T, Franklin KA and Gulsvik A. What can we learn about asthma and allergy from the follow‐up of the RHINE and the ECRHS studies? The Clinical Respiratory Journal 2008; 2: 45–52.
Association between respiratory symptom score and 30‐year cause‐specific mortality and lung cancer incidence
Authors: Frostad A.
Published: September 2008

Introduction: Respiratory symptoms are among the main reasons why patients make contact with healthcare professionals and they are associated with several diseases.

Objective: The aim of this study was to investigate the relationship between respiratory symptoms reported at one time and 30 years cause‐specific mortality and incidence of lung cancer in an urban Norwegian population.

Materials and Methods: A total of 19 998 men and women, aged 15–70 years, were in 1972 selected from the general population of Oslo. They received a postal respiratory questionnaire (response rate 89%). All were followed for 30 years for end‐point mortality and for lung cancer. The association between respiratory symptoms, given as a symptom load, and end point of interest were investigated separately for men and women by multivariable analyses, with adjustment for age, occupational exposure to air pollution and smoking habits.

Results: A total of 6710 individuals died during follow‐up. Obstructive lung diseases (OLDs) and pneumonia accounted for 250 and 293 of the total deaths, respectively. Ischaemic heart disease (IHD) accounted for 1572; stroke accounted for 653 of all deaths. Lung cancer developed in 352 persons during follow‐up. The adjusted hazard ratio for mortality from OLD and pneumonia, IHD and stroke increased in a dose–response manner with symptom score, more strongly for OLD and IHD than for pneumonia and stroke.

Conclusions: Respiratory symptoms were positively associated with mortality from OLD, pneumonia, IHD and stroke, and incidence of lung cancer. This association was significant for mortality from OLD and IHD.

Please cite this paper as: Frostad A. Association between respiratory symptom score and 30‐year cause‐specific mortality and lung cancer incidence.The Clinical Respiratory Journal2008; 2: 53–58.
COPD and co‐morbidities, with special emphasis on cardiovascular conditions
Authors: Löfdahl Claes‐Göran
Published: September 2008

The concept of COPD as a systemic disease has been widely accepted in the past several years. In parallel, it has been emphasised that COPD morbidity and mortality is strongly related to co‐morbid conditions.

This review summarises some recent studies showing that in patients with COPD, the prevalence of cardiac failure is manifested in 10%–46% of the patients, and that up to 40% of patients with cardiac failure show evidence of COPD, about half of them not earlier diagnosed. Recent data also show an increased risk for arteriosclerotic manifestations in COPD patients, and cardiac complications are common causes of death in COPD patients. Other manifestations of the metabolic syndrome, as diabetes, are also over‐represented in patients. It is also a well‐established fact that a low FEV1 is a risk factor for cardiovascular diseases and events.

Mechanistically, a systemic inflammation in COPD could be a link to cardiovascular events. COPD raises inflammatory parameters and local anti‐inflammatory treatment seems to have a potential to decrease the systemic inflammation and also to decrease cardiovascular events.

Please cite this paper as: Löfdahl C‐G. COPD and co‐morbidities, with special emphasis on cardiovascular conditions. The Clinical Respiratory Journal 2008; 2: 59–63.
The Obstructive Lung Disease in Northern Sweden Chronic Obstructive Pulmonary Disease Study: design, the first year participation and mortality
Authors: Lindberg A. , Lundbäck B.
Published: September 2008

Background:  Most epidemiological data on chronic obstructive pulmonary disease (COPD) are cross‐sectional, and the longitudinal course of disease on population bases is incompletely described.

Aim:  To describe an epidemiological study designed to follow the longitudinal course of disease in chronic obstructive lung disease, COPD, including co‐morbidity and mortality and further, to evaluate the impact of COPD on quality of life and health economics.

Materials and Methods:  From the Obstructive Lung Disease in Northern Sweden studies database cohorts I–IV, all subjects with COPD according to the Global Initiative for Chronic Obstructive Lung Disease spirometric criteria, FEV1/FVC < 0.70 (n = 993), were identified together with a similar size age‐ and gender‐matched control group. The study population was invited to a yearly examination starting in year 2005. The examinations included structured interview, spirometry with reversibility testing, oxygen saturation and health‐related quality of life questionnaires.

Results:  On the first year, 83% of the population was examined, and the subjects unable to attend the examination were interviewed by telephone. Altogether, 91% of the original study population participated (95% of all subjects were alive at the end of the first year). Mortality was significantly higher among subjects with COPD, 5.1%, compared with controls, 3.0% (P = 0.018).

Conclusion:  The study design including cases of COPD representative of COPD by disease severity in the general population and a similar sized control group, together with a high participation rate in the first study year, creates excellent conditions for evaluating the impact of COPD on population bases, and to follow the longitudinal course of disease in COPD.

Please cite this paper as: Lindberg A and Lundbäck B. The Obstructive Lung Disease in Northern Sweden Chronic Obstructive Pulmonary Disease Study: design, the first year participation and mortality. The Clinical Respiratory Journal 2008; 2: 64–71.
Designing studies for diagnostic tests
Authors: Bakke Per S.
Published: September 2008

Background and Aims:  Requirements for diagnostic tests include high validity and good repeatability.

Methods and Results:  The validity of a test refers to what extent the test measures what it is supposed to measure and is often expressed in terms of sensitivity and specificity. A graph may be constructed to incorporate both the sensitivity and specificity of a given test, the receiver operator characteristic (ROC) curve. The ROC curve actually compares the true positive fraction (sensitivity) vs the false positive fraction for a series of cut‐off points for a given test. Use of the curve requires that the diagnostic test and the gold standard must be independent of each other. Repeatability is the ability of a test to give the same results in repeated measurements.

Conclusion:  When designing a study to examine a diagnostic test, the following principles should be followed. First, the order of performance of the diagnostic test and the gold standard in repeated measurements should be randomised. Second, in repeated measurements, the test situations should be equal. Third, the technicians performing the tests should be blinded to the data obtained in the other test or to the result of the gold standard. A pilot study is recommended before conducting the study to examine the diagnostic test.

Please cite this paper as: Bakke PS. Designing studies for diagnostic tests. The Clinical Respiratory Journal 2008; 2: 72–75.
Is CT a new research tool for COPD?
Authors: Dirksen A.
Published: September 2008

Introduction:  Chronic obstructive pulmonary disease (COPD) is composed of two diseases: chronic bronchitis and emphysema.

Methods and results for emphysema:  The essence of emphysema is loss of alveolar walls. Computed tomography (CT), which is based on the attenuation of x‐rays, provides precise anatomical information on the density of tissues. Therefore, CT, especially HRCT, is the in vivo method of choice for detection and quantification of emphysema. Reduction of radiation dose has little influence on lung density measurements. This opens up opportunities for CT as a screen for emphysema. Furthermore, repeat scans can be used to follow the progress of emphysema. The depth of inspiration is an important source of variation of lung density measurements, but inspiratory level has no influence on the total weight of the lung derived from CT scans, making it easy to adjust lung densities to a standardised volume such as predicted Total Lung Capacity (TLC) by the following formula: adjusted lung density = observed lung density × observed TLC/predicted TLC.

Methods and results for chronic bronchitis:  Chronic bronchitis represents the airway component of COPD. During recent years, improved resolution of HRCT with faster scans, smaller detectors and multi‐detector‐row technology has made it possible to visualise airways down to a range of 2 mm diameter (6th generation), which represents the upper‐size limit of the pathophysiologically important ‘small airways’.

Conclusion:  In the future, CT may replace pulmonary function measurements (FEV1) as the gold standard for assessing the response to treatment in clinical trials of COPD, provided that the lung community does the same painstaking work of standardising and validating CT that it did for spirometry.

Please cite this paper as: Dirksen A. Is CT a new research tool for COPD? The Clinical Respiratory Journal 2008; 2: 76–83.
Inflammatory markers in COPD
Authors: Larsson K.
Published: September 2008

Chronic obstructive pulmonary disease (COPD) is identified as an inflammatory disorder characterised by airway and lung inflammation and destruction with systemic involvement of multiple organ systems. The inflammatory reaction could be monitored not only in the airways by the use of bronchoalveolar lavage (BAL), sputum, exhaled air, and exhaled breath condensate but also in blood and urine as well as in tissue obtained at surgery or autopsy. There is a large number of cytokines, chemoattractants and other mediators that are of importance for the interplay of inflammatory mechanisms in COPD. Neutrophilic granulocytes are key players in the inflammatory reaction and the most important chemoattractants for these cells seem to be IL‐8 (CXCL8) and leukotriene B4 (LTB4). Also, the macrophages and chemoattractants for mononuclear cells (CCL2, CCL3) are of importance as are T‐lymphocytes, predominantly of the cytotoxic subtype (CD8+). Analyses in exhaled breath condensates and exhaled air have not been tremendously encouraging but there is a clear space for further development in this field within the near future. Blood markers, such as IL‐6, CRP, and fibrinogen, have attracted interest during recent years, and further studies in this area will probably increase the understanding of systemic manifestations in COPD, in particular, regarding co‐morbidity with cardiovascular disease.

Please cite this paper as: Larsson K. Inflammatory markers in COPD. The Clinical Respiratory Journal 2008; 2: 84–87.
Attributable fractions for partitioning risk and evaluating disease prevention: a practical guide
Authors: Eide Geir E.
Published: September 2008

Introduction: The attributable fraction (AF) is used for quantifying the fraction of diseased ascribable to one or more exposures. The methodology and software for its estimation has undergone a considerable development during the last decades.

Objectives: To introduce methods for: (i) apportioning excess risk to multiple exposures, groups of exposures and subpopulations; (ii) graphical description; and (iii) survival data.

Results: Adjusted, sequential and average AFs are reasonable measures obtainable with standard software. The latter two both sum up to the combined AF for a set of exposures. The average AFs are independent of the exposures' ordering. For an ordered, preventive strategy, scaled sample space cubes illustrate the effects on the risk of disease from stepwise exposure removal. Pie charts illustrate the portions of the total risk ascribed to different exposures or risk‐profiles. Attributable hazard fraction, AF before time t, and AF within study incorporate time to disease and interventions.

Conclusions: The practice of crude calculations of AFs in epidemiology should be abandoned. Further development of methods for AFs with survival data and possibly linking it to causal modelling is of interest.

Please cite this paper as: Eide GE. Attributable fractions for partitioning risk and evaluating disease prevention: a practical guide.The Clinical Respiratory Journal2008; 2: 92–103.