bluuebunny/crossref_metadata_2025 huggingface dataset:
Stable or Dynamic Value Importance?
Authors: Howes Yuko , Gifford Robert
Published: August 2008

In proposing that value endorsement level is dynamic rather than static, this study investigated how value importance judgments would vary with situation. Questionnaires were mailed to community residents ( N = 276), using a scenario that described a realistic value conflict in an environmental issue. The results demonstrated that value importance judgments varied with situation, but the degree to which the situation influenced the judgment was moderated by the preexisting value endorsement level. Moreover, the study suggests that when 2 values are in conflict, the degree of difference in preexisting level of endorsement of the 2 values may be a better predictor of the judgments than the endorsement level of a single value.
Bullying and Special Education as Predictors of Serious Delinquency
Authors: White Norman A. , Loeber Rolf
Published: August 2008

Bullying can create a climate of fear and discomfort in schools and communities. This study examined the longitudinal associations between children's bullying, special education placements in elementary school, and serious delinquent behavior during secondary school. Using data from the youngest sample of the Pittsburgh Youth Study, the authors examined these associations while controlling for prior poor academic achievement and aggression. They found that contrary to prior research, neither special education placements nor poor academic achievement predicted bullying or serious delinquency. They found substantial continuity between early aggression and special education placements, bullying, and serious delinquency. They discuss the implications of our finding for future research and policy development.
Resocializing Suffering
Authors: Benson Peter , Fischer Edward F. , Thomas Kedron
Published: August 2008

An ethnographic account of the putative shift away from state-sponsored violence and the emergence of new patterns of violence in postwar Guatemala challenges liberal political and moral models that narrowly interpret violence in terms of individual suffering and/or culpability. Such models converge with a resurgence of right-wing political activity. The origins and outcomes of violence are more usefully and accurately conceived in terms of structural and societal conditions. Guatemala's new violence (e.g., crime, gang activity, and vigilantism) is not the chaos of media accounts but a manifestation of enduring legacies of state violence and the social and economic insecurities brought on by structural adjustment policies.
The Myths of Violence
Authors: Hume Mo
Published: August 2008

Empirical data gathered in El Salvador indicate that knowledge about violence there is built upon an exclusionary and highly masculinist logic. Violence has come to be perceived as normal through a political project that has actively employed terror to pursue its ends. This process has been made possible by a legitimization of violence as a key element of male gender identity. Political circumstances in El Salvador, principally the war, have both nourished and reinforced a sense of gender identity based on polarization, exclusion, and hegemony.
Lynchings and Political Conflict in the Andes
Authors: Vilas Carlos M.
Published: August 2008

In 2004 the mayors of two municipalities in the Aymará region of the Andes were lynched—the apparent culmination of bitter conflicts within their communities and between those communities and the central government. These two cases illustrate the recent transformation of the organization and internal dynamics of Andean communities and the conflictive articulation of local politics with wider processes and institutions. They point to the importance of recent political-institutional processes, as opposed to traditional cultural factors of alleged indigenous nationalism, for understanding the cultural and political transformation of communities and the ways in which they process their internal conflicts as well as those with the wider state.
The Malvinas Executions
Authors: Guber Rosana
Published: August 2008

In a 1991 book translated into Spanish in 1992, the British paratrooper Vincent Bramley denounced various crimes perpetrated by the Royal Task Force against Argentine prisoners during the Malvinas War of 1982. However, his account became an (im)plausible path toward Argentines' historicization of this international conflict. The democratic government of Carlos S. Menem and the Argentine military command (including members who had participated in the campaign) rejected these charges while war veterans and victims of British crimes added to them or kept silent. There is a striking resemblance between these reactions and Argentine responses to the crimes against humanity committed during the last military dictatorship (1976—1983) variously labeled as the “antisubversive war,” the “Dirty War,” and “state terrorism.”
Workers' Mobilization and Political Violence
Authors: Santella Agustín
Published: August 2008

The labor and political conflicts that took place in the city of Villa Constitución between 1970 and 1975 show in detail crucial aspects of the national social and political contention in Argentina that ended in the coup d'état of 1976. Both working-class struggles and civil war intensified during this period and conditioned each other in complex ways.
Neuroticism and Interpersonal Negativity: The Independent Contributions of Perceptions and Behaviors
Authors: McNulty James K.
Published: August 2008

Why are neurotic intimates likely to have troubled relationships? Do they create greater negativity through their own negative behavior, or do they perceive greater negativity through processes of perceptual construal? The current research addressed this question through a study of newlyweds. Spouses reported their neuroticism and their expectancies for two upcoming problem-solving discussions with their partners, then participated in those discussions, and finally reported their perceptions of how their partners behaved during the discussions. Objective observations revealed that the partners of more neurotic spouses behaved more negatively than the partners of less neurotic spouses. For wives, their own behavior mediated these effects. In addition, once the objective quality of partners' behavior was controlled, more neurotic spouses also reported more negative perceptions of those partners' behavior. For husbands, their own expectancies mediated these effects. That personality uniquely affects relationships through behavioral and perceptual processes suggests that those processes should be studied independently.
Immigrants and Problem-Solving Courts
Authors: Das Alina
Published: August 2008

Problem-solving courts are increasingly imposing requirements that adversely affect immigrant defendants seeking to participate in alternative sentencing and diversion programs. Upfront guilty pleas, admissions of guilt, and jail sanctions may leave immigrants at risk of deportation and other negative immigration consequences—even if they successfully complete court-ordered programming and the court ultimately dismisses the charges against them. These consequences in turn affect defendants' families and communities and complicate the work of key players in the criminal justice system. This article explains why immigrant defendants are at risk and how problem-solving courts may adopt programs and policies that address these concerns for immigrant communities.
Graduated Density Zoning
Authors: Shoup Donald
Published: August 2008

The difficulty of assembling sites large enough to redevelop at higher density can impede regeneration in city centers and accelerate suburban sprawl onto large sites already in single ownership. One promising new planning strategy to encourage voluntary land assembly is graduated density zoning, which allows higher density on larger sites. This strategy can increase the incentive for owners to cooperate in a land assembly that creates higher land values. Graduated density zoning will not eliminate the incentive to hold out, but it can create a new fear of being left out. Holdouts who are left with sites that cannot be combined with enough contiguous properties to trigger higher density lose a valuable economic opportunity. This article examines the difficulty of assembling land for infill development, and explains graduated density zoning as a way to encourage voluntary land assembly. Finally, it presents the results of graduated density zoning in practice.
Methicillin-Resistant Staphylococcus aureus Infection With Intermediate Sensitivity to Vancomycin: A Case Report and Literature Review
Authors: Schairer Jason , Sankri-Tarbichi Abdul Ghani , Fairfax Marilynn R. , Salimnia Hossein , Guzman Jorge A.
Published: August 2008

Staphylococcus aureus is a major cause of bacteremia and endocarditis in adults. Vancomycin is the standard therapy for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Although clinical failure associated with the development of reduced susceptibility to vancomycin during the course of treatment for MRSA bacteremia has been reported infrequently, such an occurrence is very serious. We report a case of 43-year-old woman with of MRSA bacteremia, who relapsed after initial, apparently successful vancomycin treatment and developed left-sided endocarditis and vertebral osteomyelitis. Two weeks into her second admission, the vancomycin minimal inhibitory concentration rose from ≤ 2 µg/mL (susceptible) to 4 µg/mL (intermediate). The antibiotic was changed to daptomycin. Subsequent blood cultures were negative and sepsis resolved.
Argatroban Anticoagulation in Intensive Care Patients: Effects of Heart Failure and Multiple Organ System Failure
Authors: Begelman Susan M. , Baghdasarian Sarkis B. , Singh Inder M. , Militello Michael A. , Hursting Marcie J. , Bartholomew John R.
Published: August 2008

We retrospectively evaluated argatroban dosing patterns, clinical outcomes, and the effects of heart failure and multiple organ system failure on dosing requirements in 65 adult, intensive care patients administered argatroban anticoagulation for clinically suspected heparin-induced thrombocytopenia (n = 56) or history of heparin-induced thrombocytopenia (n = 9). Argatroban was initiated then titrated to achieve target activated partial thromboplastin times 1.5 to 3 times normal control (ie, 42-84 seconds). Overall, argatroban was initiated at 1.14 ± 0.62 µg/kg/min (mean ± SD) and administered for 11.4 ± 9.5 days, with comparable dosing patterns between patients with suspected, versus previous, heparin-induced thrombocytopenia. Sixty-four (98.5%) patients achieved target activated partial thromboplastin times, typically following no or one dose adjustment. Therapeutic doses were lower in patients with, versus without, heart failure (0.58 ± 0.28 vs 0.97 ± 0.6 µg/kg/min, P = .042) and decreased as the number of failed organ systems increased from 1 to 2 to =3 (1.10 ± 0.67 vs 0.87 ± 0.47 vs 0.58 ± 0.47 µg/kg/min, P = .008). From argatroban initiation until patient discharge or death, 11 (16.9%) patients (3 off argatroban) developed thromboembolic complications; 14 (21.5%) died (11 off argatroban, 7 from multiple organ system failure); and 1 (1.5%) required amputation. Nine patients (13.8%) experienced bleeding, none fatal. This experience suggests that argatroban administered at approximately 1 µg/kg/min provides adequate levels of anticoagulation in many intensive care unit patients with suspected or previous heparin-induced thrombocytopenia. Reduced doses are needed when heart failure or multiple organ system failure is present.
Use of Sildenafil to Facilitate Weaning From Inhaled Nitric Oxide in Children With Pulmonary Hypertension Following Surgery for Congenital Heart Disease
Authors: Lee Jaclyn E. , Hillier Simon C. , Knoderer Chad A.
Published: August 2008

Pulmonary hypertension frequently complicates the postoperative management of patients after congenital cardiac surgery. Inhaled nitric oxide is an effective treatment option, but rebound pulmonary hypertension can occur upon its withdrawal. Sildenafil may facilitate its withdrawal by restoring cyclic guanosine monophosphate availability via phosphodiesterase-5 inhibition. The purpose of this study was to evaluate the use of sildenafil in facilitating weaning from inhaled nitric oxide after congenital cardiac surgery in patients who had previously failed weaning, and to compare the effects of sildenafil on pulmonary and systemic hemodynamics. Children who received sildenafil after cardiovascular surgery during a 23-month period at Riley Hospital for Children were identified. Medical records were retrospectively reviewed to determine sildenafil and nitric oxide dosing, pulmonary and systemic blood pressures, and adverse effects. Oral sildenafil was administered to 7 children who had failed attempts at inhaled nitric oxide weaning. Inhaled nitric oxide was weaned from 29.8 ± 5.9 ppm prior to sildenafil initiation to 12.2 ± 3.4 ppm (mean ± SE; P = .024) in the 24 hours after sildenafil. Mean pulmonary artery and systemic arterial pressure were unchanged from baseline when measured 1 hour after sildenafil dosing (mean pulmonary artery pressure, 29 ± 1 to 27 ± 0.7 mm Hg, P = .066; mean systemic arterial pressure, 56 ± 1.2 to 54 ± 1.2 mm Hg, P = .202). Sildenafil may facilitate withdrawal of inhaled nitric oxide and prevent rebound pulmonary hypertension in patients previously failing inhaled nitric oxide weaning attempts.
Intimate Homicide Between Asians and Non-Asians
Authors: Wu Bohsiu
Published: August 2008

This study tests two competing hypotheses regarding the social structural dynamics of intimate homicide: backlash versus collective efficacy. This study also examines the role of race in how social factors specified in each hypothesis affect intimate homicide. Data are from the California Vital Statistics and Homicide Data, 1990-1999. Results from a negative binomial regression partially support both hypotheses. In terms of magnitude, social deprivation is more important than both the backlash and collective efficacy factors. Asian intimate homicide is susceptible to the ability of communities to resolve commonly identified problems, whereas non-Asian intimate homicide is vulnerable to the depletion of socioeconomic resources. Implications of these findings are discussed in this article.
Exploring Taboos
Authors: Peter Tracey
Published: August 2008

The objective of this article is to compare male- and female-perpetrated sexual abuse in terms of victim and abuser characteristics, type of abuse, family structure, and worker information. Bivariate tests of significance were performed on the 1998 Canadian Incidence Study of Reported Child Abuse and Neglect, which included 308 male and 37 female abusers. Results show a prevalence rate of 10.7% for female-perpetrated sexual abuse. Girls were more likely to be victimized for both male- and female-perpetrated sexual violence and females tended to abuse younger children. The majority of children came from families with lower socioeconomic status although one in five victims of female-perpetrated sexual abuse came from middle-class homes. Referrals to child welfare agencies were more likely to be made by nonprofessionals when females abused.
Predictors of Sexually Coercive Behavior in a Nationally Representative Sample of Adolescent Males
Authors: Casey Erin A. , Beadnell Blair , Lindhorst Taryn P.
Published: August 2008

Data from male participants in the National Longitudinal Study of Adolescent Health are used to examine childhood predictors of late adolescent and early adulthood sexually coercive behavior and adolescent mediators of these relationships. A path analysis shows that experiencing sexual abuse as a child has a direct effect on perpetrating subsequent coercion that is partially mediated by early sexual initiation. Involvement in delinquent activities in adolescence was the only additional significant predictor of sexually coercive behavior and completely mediated the relationship between physical abuse in childhood and later sexual coercion. Of note, more than half of men reporting sexually aggressive acts had no history of childhood victimization, so pathways to sexually coercive behavior for this group remain unidentified. In addition to the universal prevention approaches currently in use in the field, these findings suggest that targeted prevention programs need to be formulated for youth with histories of childhood sexual or physical abuse.
Multi-Mode Control of Structures by Using Neural Networks with Marquardt Algorithms
Authors: Jeng C. A. , Yang S. M. , Lin J. N.
Published: August 2008

This paper presents an integrated approach of identification, estimation and vibration control of smart structures by using neural networks with Marquardt adaptation algorithm. An identification neural network is first constructed to model the system dynamics of a composite laminate structure embedded with piezoelectric sensor and actuator. Based on the identification network, a neural controller is then developed to meet the vibration suppression performance specified by a reference model. In addition, an estimation neural network is also developed that enables the measurement of a single piezoelectric sensor to represent the state variables of displacement and velocity of the structure. The neural controller can then minimize the structure vibration by using a pair of piezoelectric sensors and actuators. Experimental verification shows that the vibration amplitude of the smart structure under two-mode harmonic excitation and random excitation can be reduced by 80% and 60%, respectively.
Spatially Convolving Wave Sensors for Structural Control-Part II: Experimental Verification Using PVDF Sensors
Authors: Pines Darryll J. , von Flotow Andreas H.
Published: August 2008

This paper attempts to confirm experimentally, an approach for sensing actual disturbance information which can propagate along one-dimensional structural waveguides. In this work, a polyvinylidene fluoride-PVDF distributed wave sensing scheme is reported which exploits the characterization of 1-dimensional structural motion in terms of traveling waves. Design and manufacture of a spatially convolving wave sensor is discussed. This spatially convolving wave sensor is then used on an experimental test beam to control structural vibration using a feedforward control law. Experimental results indicate that the sensor is capable of sensing directional wave propagation dynamics. In addition, active vibration suppression can be achieved over several modes of the structure using a feedforward control law.
Parametric Analysis of the Vibration Control of Sandwich Beams Through Shear-Based Piezoelectric Actuation
Authors: Trindade M. A. , Benjeddou A. , Ohayon R.
Published: August 2008

This paper presents a comparative numerical analysis of shear and extension actuation mechanisms for the bending vibrations control of sandwich beams. The extension actuation mechanism denotes the use of through-thickness poled piezoelectric actuators bonded on the surfaces of the structure such that, when submitted to a through-thickness applied electric potential, these actuators produce axial stresses or strains. The shear actuation mechanism, in the contrary, is obtained through an embedded longitudinally poled piezoelectric actuator that, subjected to the same electric potential, produces shear stresses or strains. Theoretical and finite element models of a sandwich beam, capable of dealing with both mechanisms, are presented. The models are based on Bernoulli-Euler assumptions for the surface layers and Timoshenko ones for the core. An optimal state feedback control law is used to maximize the damping of the first four natural modes of the sandwich beam. The influence of important parameters variation, such as actuator thickness and structure/actuator modulus ratio, on the performance of the control system is analyzed under limited input voltage and induced beam tip transverse deflection. Results suggest that shear actuators can be more effective than extension ones for the control of bending vibrations.
Experimental Study on Performance of Tuned Liquid Column Damper in Suppressing Pitching Vibration of Structures
Authors: Xue S. D. , Ko J. M. , Xu Y. L.
Published: August 2008

Tuned liquid column damper (TLCD) was developed mainly for suppressing horizontal motion of building structures. No relevant research has been found on the suppression of structural pitching vibration by using TLCD. This paper thus presents a detailed experimental investigation on the possibility and effectiveness of applying TLCD to reduce pitching vibration of structures. A theoretical model of TLCD-structure interaction under pitching vibration is first presented to guide the experiments. Then, a large scale experimental model simulating TLCD-structure interaction is designed and a series of free and forced vibration experiments are conducted using different TLCD configurations and parameters. The free vibration experiments indicate that the system damping can be significantly increased by installing the TLCD. The forced vibration experiments show that the peak value of the structural pitching vibration can be effectively mitigated. From the experiments, the influences of various TLCD parameters on control effectiveness and performance are determined and the optimum control parameters are also obtained. It is finally concluded that TLCD can effectively reduce structural pitching vibration if its parameters are properly selected.
Thermally Driven Polysilicon Actuators for Lateral Displacement
Authors: Wu Ming-Fa , Lin Cheng-Hsuan , Hsu Wensyang
Published: August 2008

A novel one-mask polysilicon actuator driven by thermal expansion is developed, modeled and tested. The structures are heated by electric current due to resistive dissipation. Thermal strain is magnified by two mechanical mechanisms-lever and parallelogram. The device is tested in air and has a lateral 8 jim-displacement by applying a low voltage (below 3.5 V). The critical current to reach melting point is about 67 mA with the input voltage less than 5 V. The simulation results by analytical and FEM schemes are compared with experimental data. The maximum output forces is measured with a built-in cantilever beam and is calculated to be about 3.3 μN.
New Trends in Pertussis: What School Nurses Need to Know
Authors: Marley Susan E.
Published: August 2008

Throughout the year, I see many children with upper respiratory symptoms and coughs. One child stands out in my mind: a 10 year old boy who was afebrile and came to me for cough drops several days in a row. Within a week his cough was more forceful and frequent. He stated his mother was giving him cough syrup. He looked exhausted. While assessing him I witnessed an episode of paroxysmal coughing followed by a long inspiratory phase sounding like a high-pitched whoop. His teacher was very concerned because she thought he was going to vomit. On inquiry, I learned others in his family were coughing. He had not seen a doctor. I was suspicions of pertussis, although I knew his vaccinations were up-to-date.
Pulmonary Sequestration With CCAM Type II Appearing as Adrenal Tumor Protruding Through a Bochdalek Hernia
Authors: Kuechle Joseph B. , Pasha Seema , Sadat Kamel , Tran Jay , Hatipoglu Betul , Bui James T. , Chejfec Gregorio , Oberholzer Jose
Published: August 2008

A case of a pulmonary sequestration, which almost exclusively consisted of a congenital cystic adenomatoid malformation type II located subdiaphragmatically in the left retroperitoneal area, is reported. This case, in a 24-year-old male patient, is unique in that it appeared as an adrenal incidentaloma and extended through a Bochdalek hernia into the pleural space. It was discovered upon routine ultrasound screening for hepatocellular carcinoma in a patient with a carrier state for hepatitis B. Diagnosis was established only upon histological analysis of the surgically removed tumor after staining with hematoxylin and eosin as well as surfactant A and B. The location of the tumor may indicate that it was formed by an entrapment of a lung bud by the developing diaphragm. This appearance may give us insight into the formation of such tumors. It also highlights the difficulty of diagnosing subdiaphragmatic retroperitoneal tumors without histological examination.
Cytomegalovirus Prostatitis: A Series of 4 Cases
Authors: Yoon Ghil-Suk , Nagar Michael S. , Tavora Fabio , Epstein Jonathan I.
Published: August 2008

Cytomegalovirus (CMV) prostatitis is very rare with only 1 report of biopsy-proven CMV prostatitis in the literature. The authors report 4 cases, 3 detected on needle biopsy and 1 detected on transurethral resection. Patients were 36, 41, 48, and 71 years old. All patients were immunosuppressed, including 1 with AIDS and 3 undergoing immunosuppressive therapy following organ transplantation. CMV inclusions were seen in secretory cells of the prostatic glands, endothelial cells of small vessels, and prostatic stromal cells associated with a dense lymphoid inflammation. Only very rarely is CMV prostatitis detected on clinical specimens, typically in immunosuppressed hosts undergoing immunosuppressive therapy following organ transplantation. Patients with CMV prostatitis may harbor multiple infections or have other serious medical conditions adversely affecting their prognosis.
A Comparison of Intimate Partner Homicide to Intimate Partner Homicide–Suicide
Authors: Banks Laura , Crandall Cameron , Sklar David , Bauer Michael
Published: August 2008

The authors compare cases of female intimate partner homicide–suicide to female intimate partner homicide alone to describe risk factors and suggest prevention strategies, including strategies in the medical setting. Differences are found between the types of cases in marital relationship, age, blood alcohol, and the use of firearms. Physicians and other health care providers who treat victims of intimate partner violence and patients at risk for suicide should be aware of the interwoven risk factors within these populations. Interventions aimed at suicide prevention as well as targeted removal of firearms should be investigated as tools in the prevention of intimate partner homicide.
Gender Attitudes and Sexual Behaviors
Authors: Gage Elizabeth Ann
Published: August 2008

This research examines the impact of participating in different sports on male athletes' gender attitudes, hegemonic masculinity, sexual behavior, and sexual aggression. Expanding on past research that compares athletes with nonathletes, this research finds differences between collegiate athletes and men who do not participate in collegiate sports, as well as between men who play different collegiate sports. Athletes in center sports (such as football) scored significantly higher on hyper-masculinity scales, had lower attitudes toward women, and displayed more sexual aggression and more sexual activity than men who competed in marginal sports (e.g., track and field) or not at all.
Early relapses after the first dose of natalizumab in active multiple sclerosis patients
Authors: Centonze D , Furlan R , Gasperini C , Salvetti M , Battistini L
Published: August 2008

Background

Natalizumab is prescribed in Italy in patients who experienced at least two clinical relapses during a 12-month therapy with other approved immunomodulatory agents.

Results

In 7 of 35 patients selected on the basis of these recommendations, we have observed clinical relapses occurring within 24 h after the first dose of natalizumab.

Conclusion

The mechanism by which a first injection of natalizumab may precipitate a clinical relapse in patients with MS is unknown. We speculate that natalizumab can promote the release of inflammatory mediators from lymphocytes present in the central nervous system at the time of the first infusion, thus favoring the clinical manifestation of a pre-existing active lesion.
Human endogenous retrovirus-K18 Env as a risk factor in multiple sclerosis
Authors: Tai AK , O’Reilly EJ , Alroy KA , Simon KC , Munger KL , Huber BT , Ascherio A
Published: August 2008

Background

The human endogenous retrovirus (HERV)-K18 Env is an Epstein-Barr virus (EBV)-associated superantigen. Given the evidence for a role of EBV in the etiology of multiple sclerosis (MS), HERV-K18 Env is a plausible candidate for association with MS.

Objective

To assess whether variation in HERV-K18 Env is a risk factor for MS.

Methods

We developed a single nucleotide polymorphism-based genotyping method to determine the distribution of the three alleles of HERV-K18 env. We then conducted a nested case-control study including 207 MS cases and 403 matched controls. Analyses were replicated in an independent series of 909 MS cases and 339 controls.

Results

Overall, there was a significant association between HERV-K18 env genotype and MS risk (χ2 P = 0.03). As compared with K18.2/K18.2 individuals, risk of MS was three fold higher among K18.3/K18.3 individuals ( P = 0.03). An increase in MS risk among carriers of the K18.3 allele was also observed in the replication study, but did not reach statistical significance. In pooled analyses, K18.3/K18.3 individuals had a significantly increased risk of MS (relative risks [RR] comparing K18.3/K18.3 vs K18.2/K18.2 = 2.7; 95% confidence interval: 1.1–6.4).

Conclusion

Variation in EBV-associated superantigen HERV-K18 Env could influence the genetic susceptibility to MS.
Frequency and risk factors of mitoxantrone-induced amenorrhea in multiple sclerosis: the FEMIMS study
Authors: Cocco E , Sardu C , Gallo P , Capra R , Amato MP , Trojano M , Uccelli A , Marrosu MG ,   the FEMIMS group*
Published: August 2008

Background

Improved prognosis in women with multiple sclerosis (MS) undergoing immunosuppressive treatment with mitoxantrone (MITO) has led to an increased interest in the effect of such treatments on fertility. FErtility and Mitoxantrone In MS (FEMIMS) is a collaborative retrospective study aimed at evaluating the impact of MITO treatment on fertility in women with MS.

Methods

Occurrence of chemotherapy-induced amenorrhea (CIA) was evaluated in 189 women with MS treated with MITO before the age of 45. An “ad hoc” questionnaire, paying particular attention to onset of CIA either during or post-MITO treatment, was administered to each patient. The probability of CIA was calculated using a multivariate logistic regression analysis taking into account age at exposure, cumulative dose, and use of estroprogestinic (EP) drugs during treatment.

Results

Forty-eight (26%) patients presented CIA following MITO. The probability of CIA was increased by 2%/mg/m2 of cumulative dose and by 18% for each year of age, whereas it was reduced by administration of EP during treatment.

Conclusions

MITO treatment may affect reproductive capacity in women with MS. Patients of childbearing age should be properly counseled before MITO treatment and EP therapy should be administered to reduce the risk of CIA.
Cognitive impairments in relapsing-remitting multiple sclerosis: a meta-analysis
Authors: Prakash RS , Snook EM , Lewis JM , Motl RW , Kramer AF
Published: August 2008

There is debate in the literature regarding the magnitude, nature, and influence of cognitive impairment in individuals with relapsing-remitting multiple sclerosis (RRMS). Therefore, we conducted a meta-analysis that quantified the overall magnitude of cognitive impairment in individuals with RRMS and identified the domains of cognition and clinical/demographic variables that were moderators of the overall effect. We included 57 studies with 3891 participants that yielded a total of 755 effect sizes. Overall, there was a moderate decline in cognitive functioning in individuals with RRMS compared with healthy controls. Larger effects were observed in cognitive domains of motor functioning, mood status and memory and learning. Regarding demographic and clinical variables, age and gender were moderators of cognitive impairment in all cognitive domains, whereas neurological disability and disease duration primarily moderated performance on tasks assessing memory and learning.
Use of health services in people with multiple sclerosis with and without fatigue
Authors: Johansson S , Ytterberg C , Gottberg K , Widén Holmqvist L , von Koch L
Published: August 2008

Objective

To explore and compare the use of health services in people with multiple sclerosis (MS) with and without fatigue.

Methods

Over a period of 30 months, the use of health services in 48 MS outpatients with persistent fatigue and 36 without fatigue was studied. Data were collected from a computerized register and by interviews, and analyzed with regard to disease severity categorized as mild or moderate/severe MS.

Results

Fatigued people with mild MS used more hospital outpatient care and primary care including rehabilitation, and a higher proportion had transportation service, compared with non-fatigued people with mild MS. In moderate/severe MS, the differences were that non-fatigued people used more occupational therapy in primary care and a higher proportion had salaried service. Regardless of MS severity, informal care was more common among fatigued people.

Conclusions

Overall, fatigued people with mild MS have more contacts with outpatient health care compared with non-fatigued people. There are few such differences in people with moderate/severe MS. The reasons for the differences in use between fatigued and non-fatigued people are not understood and need further exploration. Fatigued people more often receive informal care, thus support to caregivers are of particular importance if fatigue is present.
Higher levels of 25-hydroxyvitamin D are associated with a lower incidence of multiple sclerosis only in women
Authors: Kragt JJ , van Amerongen BM , Killestein J , Dijkstra CD , Uitdehaag BMJ , Polman CH , Lips P
Published: August 2008

Introduction

Multiple sclerosis (MS) is a chronic inflammatory disease with an as yet not fully understood etiological background. The geographical distribution of MS is striking with a prevalence that increases with latitude. For this reason, vitamin D deficiency is considered a possible pathogenic co-factor in MS.

Materials and methods

To study the role of the vitamin D metabolism in MS, blood samples were taken twice (summer and winter) from 103 patients with MS and 110 healthy controls. Serum concentrations of 25-hydroxyvitamin D (25(OH) D) and 1,25-dihydroxyvitamin D (1,25(OH)2D) were measured, and detailed information on disease characteristics and environmental factors that might influence the vitamin D metabolite levels was collected.

Results

Mean serum 25(OH)D and 1,25(OH)2D concentrations were significantly higher in summer compared to winter in both patients and controls. Using logistic regression methods, we found that in women for every 10 nmol/L increase of serum 25(OH)D level the odds of MS was reduced by 19% (odds ratio 0.81; 95% confidence interval: 0.69–0.95), suggesting a “protective” effect of higher 25(OH)D serum levels. In addition, also restricted to women, a negative correlation was found between Expanded Disability Status Scale and 25(OH)D levels ( r = −0.29, P = 0.020).

Conclusions

Our data suggest that higher circulating levels of 25(OH)D are associated with a lower incidence of MS and MS-related disability in women. This may imply clues to the pathogenesis of the sex difference in risk and to the nature of the environmental factors involved in MS.
Review: Thiazolidinediones today
Authors: Bailey Clifford J , Day Caroline
Published: August 2008

The thiazolidinediones (TZDs) rosiglitazone and pioglitazone are new oral antidiabetic agents with `insulin sensitising' activity for the treatment of type 2 diabetes. Rosiglitazone and pioglitazone produce a slowly generated antihyperglycaemic effect which is often accompanied by decreases in circulating insulin and free fatty acids. Circulating triglycerides may also decline, while low-density and high-density lipoprotein cholesterol concentrations are either unchanged or slightly increased, with little alteration to their ratio. The blood glucose-lowering efficacy of TZDs is typically additive or possibly more than additive to the effects of other classes of antidiabetic agents. In Europe rosiglitazone and pioglitazone can be used in combination with metformin or a sulphonylurea, whilst in the USA these TZDs can also be prescribed as monotherapy and pioglitazone in combination with insulin. Because TZDs tend to cause fluid retention they are excluded for patients with cardiac insufficiency. TZDs act via the nuclear peroxisome proliferator-activated receptor-gamma (PPARγ), which mediates the transcription of certain genes that are also responsive to insulin, enabling these agents to improve insulin action.
Review: Optimal dosing strategies for maximising the clinical response to metformin in type 2 diabetes
Authors: Scarpello John Hb
Published: August 2008

Recently revised consensus targets for glycaemic management in patients with type 2 diabetes are challenging and require optimisation of dosing strategies for oral antidiabetic therapies. The demonstration of significant cardiovascular outcome benefits in metformin-treated type 2 diabetic patients enrolled in the United Kingdom Prospective Diabetes Study has established this agent as the first line oral therapy after diet failure in newly presenting overweight people with type 2 diabetes mellitus. The antihyperglycaemic efficacy of metformin increases with increasing daily doses between 500 mg and the upper limits of the recommended daily dosage ( ≥ 2000 mg/day). Although metformin is associated with gastrointestinal side-effects in up to 20% of patients, this is not generally dose related. Transient dose reduction, slower titration and taking the dose with meals may ameliorate the problem. Risk of lactic acidosis due to metformin is negligible when this agent is prescribed correctly, and is unrelated to the plasma metformin concentration. Intensification of metformin therapy within the dose range represents a rational and practical therapeutic strategy for optimising glycaemic control in patients who are suitable for, and tolerant of, metformin treatment. The recently introduced 1000 mg metformin tablet should facilitate the use of higher doses and may help treatment compliance.
Translating wish lists to blueprints
Authors: Ken Harry
Published: August 2008

The diabetes community awaits, with a mixture of suspended expectation and cautious enthusiasm, the report, recommendations and, most crucially, the implementation of the Department of Health's National Service Framework for Diabetes. With the full report due to appear this summer, implementation in England and Wales is scheduled to start in April 2002. Scotland and Northern Ireland have their own Diabetes Frameworks in preparation, in the former case drawing heavily on the results of the substantial and very productive Scottish investment in the St Vincent Declaration initiative of the last decade.
The Diabetes Prevention Program: headline results
Authors: Bailey Clifford J
Published: August 2008

The Diabetes Prevention Program (DPP) was a trial of over 3,000 people with impaired glucose tolerance (IGT) to assess the effect of different interventions on their progression to type 2 diabetes. During an average follow-up period of three years, intensive lifestyle intervention with regular exercise and weight loss reduced the risk of progression to type 2 diabetes by 58%. Treatment with the antihyperglycaemic agent metformin reduced progression to type 2 diabetes by 31%. The DPP has therefore confirmed that rigorous lifestyle management can reduce the risk of type 2 diabetes and also shown that metformin therapy can reduce diabetes risk.
Review: Implications of obesity for diabetes and coronary heart disease in clinical practice
Authors: Pinkney Jonathan
Published: August 2008

Obesity is a powerful risk factor for both type 2 diabetes and for coronary heart disease (CHD). The prevalence of obesity has risen rapidly in most populations across the world, in both developing and developed countries, and as a result the prevalence of type 2 diabetes and CHD is rising. In patients with established type 2 diabetes or CHD, obesity is also a clinical problem. Weight loss has been shown clearly to improve glycaemic control in overweight patients with type 2 diabetes, yet the present approach to management pays little attention to this. Similarly, weight loss in overweight patients with established CHD improves risk factors, and reduces symptoms of angina and fatigue. At the public health level, an active approach to obesity prevention would reap substantial rewards in terms of reducing future prevalence of diabetes and CHD. Recent investigations have shown that sustained weight loss of just 3—4 kg in overweight individuals with impaired glucose tolerance resulted in 58% risk reduction for diabetes at four years. Prevention and management should therefore play a far greater role in treating overweight and obese individuals, preferably before diabetes or CHD are manifest.
Review: Adipose tissue: passive sump or active pump?
Authors: Perry Colin , Sattar Naveed , Petrie John
Published: August 2008

Recent discoveries suggest that adipose tissue can synthesise and secrete mediators that contribute to the pathogenesis of type 2 diabetes mellitus and cardiovascular disease, leading to the concept of `adipose tissue as an endocrine organ'. These mediators include tumour necrosis factor-α, interleukin-6, adiponectin, resistin, plasminogen activator inhibitor type 1 and angiotensin II. They modify the activity of regulatory enzymes in adipocyte metabolism, alter the release of non-esterified fatty acids and affect glucose uptake. They may also have direct actions on the vascular endothelium. The diverse effects of these mediators support the notion that inflammation plays a role in metabolic and vascular disease, at least in part via adipocyte-derived cytokines.
The Alphabet Strategy
Authors: Patel Vinod , Morrissey John
Published: August 2008

We have no cure for diabetes but as the recently published National Service Framework for Diabetes: Standards notes `with the support of high quality healthcare, people with diabetes have the potential to live long lives free of the devastating complications suffered by previous generations`.1 An earlier NSF, that for Coronary Heart Disease, observes that `excellence requires that important, simple things are done right all the time`.2 Exactly the same maxim can be applied to diabetes care. Vinod Patel and John Morrissey outline their Alphabet Strategy — a condensed but simple mnemonic to help them get seven important, simple things right:
`PROGRESS' in prevention of stroke
Authors: Gupta Abhaya
Published: August 2008

PROGRESS (Perindopril pROtection aGainst REcurrent Stroke Study) was an international multicentre trial designed primarily to determine the effects of lowering blood pressure on the risk of recurrent strokes, using perindopril alone or with indapamide, in hypertensive and normotensive patients with and without diabetes. Treatment with perindopril ± indapamide for four years reduced the risk of a further stroke by 28% and cerebral haemorrhage by 50%.
Review: Renovascular disease in diabetic patients
Authors: Hay Cathy J , Kalra Philip A
Published: August 2008

Atherosclerotic renovascular disease (ARVD) is a common condition which presents with acute or chronic renal failure, hypertension or cardiac failure. Its prevalence is high in the elderly and in those with evidence of generalised vascular disease. It is therefore common in diabetic patients, who are prone to development of generalised atherosclerotic vascular disease. The majority of diabetic patients have clinical indications that merit angiotensin-converting enzyme (ACE) inhibitor or angiotensin II receptor antagonist (AIIA) therapy, but even if ARVD is present, acute renal dysfunction will be the exception rather than the rule. Certain clinical clues should instigate a high index of suspicion for the presence of ARVD in the diabetic patient, but it does not follow that detection of anatomically significant stenoses within the renal arteries should automatically be treated by renal revascularisation. The results of Angioplasty and Stent for Renal Artery Lesions (ASTRAL), a UK multi-centre study, should hopefully guide appropriate practice in this area in the future.
What is diabetic renal disease?
Authors: Gallagher Hugh , Andrews Peter A
Published: August 2008

Diabetic nephropathy is the most common indication for long-term renal replacement therapy. In type 1 diabetes, it is rare after less than 10 or more than 35 years of disease, while the incidence in type 2 diabetes is related to the duration of diabetes. It is characterised histologically by mesangial expansion, glomerular basement membrane thickening, and glomerulosclerosis. Glomerular hyperfiltration is usual in the early stages of disease, and is thought to be an important mediator of the observed histological features. Hyperglycaemia-induced biochemical abnormalities, notably the formation of advanced glycation end products, overactivity of the polyol pathway, and protein kinase C activation, play a role in the pathogenesis; genetic factors are also implicated. Glycaemic control is of proven benefit in the early, often clinically silent stages of disease. When significant proteinuria and renal impairment have supervened, blood pressure control and reduction of proteinuria by means of angiotensin-converting enzyme inhibitors and angiotensin II receptor antagonists are the most effective therapies to delay progression.
Angiotensin II receptor blockade and type 2 diabetic nephropathy
Authors: Bilous Rudy W
Published: August 2008

ACE inhibitors have been shown to reduce albuminuria and slow the progression of nephropathy in type 1 diabetes. There are fewer data in type 2 patients.

Three large studies: IRbesartan in patients with type 2 diabetes and MicroAlbuminuria Study (IRMA2), Irbesartan Diabetic Nephropathy Trial (IDNT) and Reduction in End points in NIDDM with the Angiotensin II Antagonist Losartan (RENAAL), of the angiotensin II receptor blockers (ARBs) irbesartan and losartan in microalbuminuric (IRMA2) and nephropathic (IDNT and RENAAL) patients have recently been published. They compared ARBs to conventional treatment, and one used amlodipine as a comparator (IDNT).

IRMA2 showed that irbesartan reduced albuminuria in a dose-dependent fashion, achieving a magnitude of response similar to that seen in type 1 diabetic patients. The adjusted hazard ratio for progressing to nephropathy was 0.32 for patients treated with irbesartan 300 mg.

IDNT and RENAAL showed that irbesartan 300 mg or losartan 100 mg reduced by 16—19% the numbers of patients reaching a combined end point of doubling of baseline serum creatinine, end-stage renal failure, or all-cause mortality. This effect was not seen in amlodipine treated patients, implying a specific benefit of ARBs.

ARBs should be considered as first line therapy in both early and established type 2 diabetic nephropathy.