bluuebunny/crossref_metadata_2025 huggingface dataset:
Reproducibility of saline contrast sonohysterography for the detection of intracavitary abnormalities in women with abnormal uterine bleeding
Authors: Beemsterboer S. N. , Thurkow A. L. , Verstraeten R. , Brölmann H. A. M.
Published: March 2008

Objectives

Saline contrast sonohysterography (SCSH) is a diagnostic test for the examination of intracavitary abnormalities. The objective of this study was to calculate interobserver and intraobserver agreement for the interpretation of video recordings of SCSH procedures according to different levels of experience.

Methods

SCSH examinations were carried out by an operator experienced at performing SCSH and were recorded on video. To assess interobserver and intraobserver agreement, video material was scored by observers allocated to different groups according to their level of experience. Observers who had performed 25 or more SCSH procedures were defined as experienced (Group A), those who had carried out 1–24 as less experienced (Group B), and those with no experience of performing SCSH as inexperienced (Group C). All observers were blinded to the case histories of the patients.

Results

There was a significant difference in kappa values for interobserver agreement between the most experienced group and the less experienced observers. Group A, with the highest level of experience, had a mean kappa value of 0.62 (95% CI, 0.56–0.67), compared with 0.38 (95% CI, 0.33–0.43) in Group B and 0.47 (95% CI, 0.43–0.52) in Group C. The interobserver agreement in Group A was significantly higher than that in Groups B and C (P < 0.001 and P = 0.023, respectively), and Group C performed better than Group B (P = 0.024). Intraobserver agreement (n = 7) was good, with a mean kappa value of 0.66 (Group A, 0.63; Group C, 0.71).

Conclusions

Interobserver agreement in interpretation of video recordings of SCSH by inexperienced sonographers is poor, whereas the intraobserver agreement is good. We consider the poor interobserver agreement to be due to non‐uniform diagnostic criteria. Uniform diagnostic criteria for SCSH should be incorporated into the training of residents and other physicians performing these examinations. Copyright © 2008 ISUOG. Published by John Wiley & Sons, Ltd.
Selective use of sonographic cervical length measurement for predicting imminent preterm delivery in women with preterm labor and intact membranes
Authors: Schmitz T. , Kayem G. , Maillard F. , Lebret M.‐T. , Cabrol D. , Goffinet F.
Published: March 2008

Objectives

To determine, in a population of women with preterm labor and intact membranes, whether ultrasound cervical length measurement performed only in patients selected according to the Bishop score predicts imminent preterm delivery better than does systematic cervical length measurement in the entire population.

Methods

The Bishop score and sonographic cervical length were recorded prospectively in women with preterm labor between 24 and 34 completed weeks' gestation. Outcome measures were preterm delivery within 48 h and within 7 days. Predictive values were calculated for each marker separately and then in combination.

Results

Of the study population of 395 women, 17 (4.3%) and 32 (8.1%) delivered within 48 h and within 7 days, respectively, following inclusion. For delivery within 7 days, areas under the Bishop score (0.848) and sonographic cervical length (0.813) receiver–operating characteristics curves did not differ significantly. For the selective use of sonographic cervical length measurement in patients selected according to the Bishop score, the test was considered positive if the Bishop score was ≥ 8, or 4–7 with cervical length ≤ 30 mm. This test was as sensitive (94%) but more specific (60% vs. 42%, P < 0.001) for predicting preterm birth within 7 days than was sonographic cervical length with a 30‐mm cut‐off value in the entire population. Results were similar for delivery within 48 h.

Conclusion

For predicting imminent preterm delivery in women with preterm labor, measuring sonographic cervical length only in patients with a Bishop score between 4 and 7, compared with a strategy of systematic measurement in the entire population, reduces by 30% the number of false positives and might thus decrease unnecessary therapeutic intervention. Copyright © 2008 ISUOG. Published by John Wiley & Sons, Ltd.
A mixture model of nuchal translucency thickness in screening for chromosomal defects
Authors: Wright D. , Kagan K. O. , Molina F. S. , Gazzoni A. , Nicolaides K. H.
Published: March 2008

Objective

Fetal nuchal translucency (NT) thickness increases with crown–rump length (CRL). In screening for chromosomal defects patient‐specific risks are derived by multiplying the a priori maternal age‐related risk by a likelihood ratio, determined from the deviation of the measured NT from the expected median. To quantify this deviation the measured NT is either subtracted (delta NT) or divided by the expected median (multiple of the median method, MoM). This study examines the validity of these methods.

Methods

NT was prospectively measured at 11 + 0 to 13 + 6 weeks in screening for chromosomal defects. The distribution of NT in euploid and chromosomally abnormal fetuses was examined.

Results

There were 37 078 normal pregnancies and 264 with trisomy 21, 81 with trisomy 18, 38 with trisomy 13 and 27 with Turner syndrome. We found that firstly, contrary to the assumption underlying the delta NT method, the distribution of delta NT changes with CRL and secondly, contrary to the assumption underlying the MoM method the distribution of NT was not Gaussian. Fetal NT followed two distributions, one that was dependent on CRL and one that was independent of CRL. The distribution in which NT increases with CRL was observed in about 95% of euploid fetuses, 5% with trisomy 21, 30% with trisomy 18, 15% with trisomy 13 and 10% with Turner syndrome. The median CRL‐independent NT was 2.0 mm for the euploid group and 3.4, 5.5, 4.0 and 7.8 mm for trisomies 21, 18, 13 and Turner syndrome, respectively.

Conclusions

The NT thickness in chromosomally normal and abnormal fetuses follows a mixture of a gestation‐dependent and gestation‐independent distribution. Copyright © 2008 ISUOG. Published by John Wiley & Sons, Ltd.
Optimal frequency assignment for IEEE 802.11 wireless networks
Authors: El‐Hajj Wassim , Alazemi Hamed
Published: March 2008

The performance of wireless local area networks (WLANs) is based on the performance of the corresponding access points (APs). Nowadays, network engineers tend to manually assign data channels (frequencies) for each AP. They only use channels 1, 6, and 11 because no interference exists between these channels. But it will be far more efficient if all 11 channels are used. Therefore, the channel allocation problem becomes a major challenge when deploying WLANs. In this paper, we assume that the location of each AP is known. Our objective is to optimally assign a frequency for each AP such that the throughput is maximized and the interference between the various APs is minimized. We also consider a realistic scenario where the APs are not in line of sight of each other, but on the other hand there are different barriers that separate them. We formulate the problem using integer linear programming (ILP) in order to obtain the optimal frequency assignment (OFA). Then, we propose two efficient heuristic algorithms to achieve the same results. Finally, we evaluate the performance of all techniques and make a comparison between them. Copyright © 2008 John Wiley & Sons, Ltd.
A routing layer based approach for energy efficient service discovery in mobile ad hoc networks
Authors: Ververidis Christopher N. , Polyzos George C.
Published: March 2008

Service discovery can be greatly enhanced in terms of efficiency, both regarding service discoverability and energy consumption, by piggybacking service information into routing messages. Thus, service discovery does not generate additional messages and a node requesting a service, in addition to discovering that service, it is simultaneously informed of the route to the service provider. We extended the Zone Routing Protocol in order to encapsulate service information in its routing messages. Our extended protocol, E‐ZRP, may be seen as a representative of routing layer protocols providing service discovery functionality. Simulations demonstrate the superiority of this routing layer‐based service discovery scheme over that of a similar, but application layer based service discovery scheme. In order to have a thorough evaluation of our approach we introduced a new metric, called Service Availability Duration (SAD), which characterizes the ‘quality’ of discovered services and experimentally examines the implications of network density and node mobility on the availability of services discovered with E‐ZRP, as a typical representative of routing layer based service discovery protocols. Copyright © 2008 John Wiley & Sons, Ltd.
Early Experience with the Bioabsorbable Anal Fistula Plug
Authors: Lawes D. A. , Efron J. E. , Abbas M. , Heppell J. , Young‐Fadok T. M.
Published: March 2008

Purpose

Management of anal fistula represents a balance between curing the condition and maintaining anal continence. Recent reports of the results of the porcine anal fistula plug have demonstrated excellent fistula healing rates without reporting significant complications.

Methods

The outcome of patients who underwent treatment for anal fistula with the Surgisis® anal plug was retrospectively reviewed.

Results

Twenty patients were treated; three underwent concomitant anal advancement flap at the time of plug placement. Seventeen patients had a trans‐sphincteric fistula, and three had an anoperineal fistula. Ten patients had previously undergone failed surgical therapy to cure their fistula, including anal advancement flap in four, muscle interposition flap in two, fistulotomy in two, and cutting seton placement in two. Mean follow‐up was 7.4 months. Only 4 of 17 (24%) patients treated with the plug alone had closure of their fistula. Acute postoperative sepsis was seen in 5 of 17 (29%) patients treated with the plug alone. Four developed perianal abscesses that required incision and drainage, and one intersphincteric abscess was treated with antibiotics. Two of the patients who underwent concomitant anal advancement flaps and plug placement healed successfully.

Conclusions

Contrary to other published series, the use of the Surgisis® anal plug was associated with a low rate of fistula healing and a high incidence of perianal sepsis. The addition of a transanal advancement flap to the procedure may improve success rates.
Model Evaluation and Multiple Strategies in Cognitive Diagnosis: An Analysis of Fraction Subtraction Data
Authors: de la Torre Jimmy , Douglas Jeffrey A.
Published: March 2008

This paper studies three models for cognitive diagnosis, each illustrated with an application to fraction subtraction data. The objective of each of these models is to classify examinees according to their mastery of skills assumed to be required for fraction subtraction. We consider the DINA model, the NIDA model, and a new model that extends the DINA model to allow for multiple strategies of problem solving. For each of these models the joint distribution of the indicators of skill mastery is modeled using a single continuous higher-order latent trait, to explain the dependence in the mastery of distinct skills. This approach stems from viewing the skills as the specific states of knowledge required for exam performance, and viewing these skills as arising from a broadly defined latent trait resembling the θ of item response models. We discuss several techniques for comparing models and assessing goodness of fit. We then implement these methods using the fraction subtraction data with the aim of selecting the best of the three models for this application. We employ Markov chain Monte Carlo algorithms to fit the models, and we present simulation results to examine the performance of these algorithms.
Cultured stellate cells in human vocal fold mucosa
Authors: Sato K , Miyajima Y , Izumaru S , Nakashima T
Published: April 2008

Objectives:

Stellate cells in the maculae flavae, located at both ends of the human vocal fold mucosa, have been considered an independent category of cells. We aimed to isolate and subculture these stellate cells, and to observe their morphological characteristics.

Methods:

Stellate cells from the maculae flavae and fibroblasts from Reinke's space were cultured in three normal, adult human vocal fold mucosa preparations.

Results:

The subcultured cells from Reinke's space were conventional fibroblasts. The subcultured cells from the maculae flavae were stellate in shape and had cytoplasmic processes. They were larger than conventional fibroblasts, and lipid droplets in the cytoplasm disappeared in the second culture. These stellate cells proliferated by attaching their cytoplasmic processes to each other. During the seven to 10 month subculture period, each cell type continued to exhibit its own morphological characteristics.

Conclusion:

This study demonstrated that such stellate cells form an independent cell category, which should be considered as a new category of cells within the human vocal fold.
Laryngeal reconstruction following shrapnel injury in a British soldier: case report
Authors: Sharma N , De M , Martin T , Pracy P
Published: April 2008

Introduction:

Laryngeal injuries are uncommon but result in high mortality and morbidity rates when they do occur. We report a case of laryngeal fracture due to penetrating shrapnel injury, repaired with miniplates.

Case report:

A 26-year-old soldier was involved in an explosion and sustained a shrapnel wound to his right neck. After immediate airway management at the field hospital he was transferred to the UK, where he underwent a neck exploration, laryngofissure and repair of the thyroid cartilage using miniplates. An endolaryngeal stent was placed, which was removed at a second operation seven days later. Post-operatively, the patient recovered well and his voice improved rapidly. Six months post-operatively, he returned to work.

Discussion:

The cause and nature of laryngeal injury differs between wartime and peacetime. The methods of diagnosis and management strategies are reviewed. The early recognition of injury and protection of the airway are of paramount importance when dealing with laryngeal injury. Delayed laryngeal reconstruction using miniplates can give a good functional result.
Expansion of source equation of elastic line
Authors: Filipovic Mirjana , Vukobratovic Miomir
Published: April 2008

The paper is concerned with the relationship between the equation of elastic line motion, the “Euler-Bernoulli approach” (EBA), and equation of motion at the point of elastic line tip, the “Lumped-mass approach” (LMA). The Euler–Bernoulli equations (which have for a long time been used in the literature) should be expanded according to the requirements of the motion complexity of elastic robotic systems. The Euler–Bernoulli equation (based on the known laws of dynamics) should be supplemented with all the forces that are participating in the formation of the bending moment of the considered mode. This yields the difference in the structure of Euler–Bernoulli equations for each mode. The stiffness matrix is a full matrix. Mathematical model of the actuators also comprises coupling between elasticity forces. Particular integral of Daniel Bernoulli should be supplemented with the stationary character of elastic deformation of any point of the considered mode, caused by the present forces. General form of the elastic line is a direct outcome of the system motion dynamics, and can not be described by one scalar equation but by three equations for position and three equations for orientation of every point on that elastic line. Simulation results are shown for a selected robotic example involving the simultaneous presence of elasticity of the joint and of the link (two modes), as well the environment force dynamics.
Making Good Land from Bad: The Drainage of West Lancashire, c. 1650–1850
Authors: GRITT ANDREW
Published: March 2008

This article investigates the changing administrative context of drainage in south-west Lancashire from the mid-seventeenth to the mid-nineteenth centuries. Successive schemes managed by Commissions of Sewers, piecemeal reclamation and private agreement were characterised by primitive technology, under-investment and poor management. Consequently, their achievements were limited. Large scale drainage schemes under the control of single individuals or powerful syndicates enjoyed greater success, but to coordinate drainage across an ecosystem that went beyond estate boundaries required state intervention in the form of an Act of Parliament of 1779. After some initial success the drainage commissioners found themselves immersed in legal wranglings with landowners and maintenance of the drainage system largely fell into abeyance. It was not until the landlords provided the administrative and financial resources to invest in technological solutions in the 1840s that the land achieved its full potential. It is argued that drainage of this land, resulting in its transformation from some of the worst land in the country to some of the best, was a major contributor not only to the agricultural success of the region, but also to Lancashire's industrial success.
‘Cut down by some cowardly miscreants’: Plant Maiming, or the Malicious Cutting of Flora, as an Act of Protest in Eighteenth- and Nineteenth-Century Rural England
Authors: GRIFFIN CARL J.
Published: March 2008

Since the publication of Hobsbawm and Rudé'sCaptain Swingour understanding of the role(s) of covert protests in Hanoverian rural England has advanced considerably. Whilst we now know much about the dramatic practices of incendiarism and animal maiming and the voices of resistance in seemingly straightforward acquisitive acts, one major gap remains. Despite the fact that almost thirty years have passed since E. P. Thompson brought to our attention that under the notorious ‘Black Act’ the malicious cutting of trees was a capital offence, no subsequent research has been published. This paper seeks to address this major lacuna by systematically analysing the practices and patterns of malicious attacks on plants (‘plant maiming’) in the context of late eighteenth- and early nineteenth-century southern England. It is shown that not only did plant maiming take many different forms, attacking every conceivable type of flora, but also that it was universally understood and practised. In some communities plant maiming was the protestors' weapon of choice. As a social practice it therefore embodied wider community beliefs regarding the defence of plebeian livelihoods and identities.
Listening to the learner voice: The ever changing landscape of technology use for language students
Authors: Conole Gráinne
Published: March 2008

What does learning in today's technology-enhanced environment mean? Is learning as an activity fundamentally changing as a result of the opportunities offered by new technologies and tools? How are the new communicative channels and increased social dimensions possible through Web 2.0 technologies impacting on the way students work and learn? And what does this mean for the role of teachers and institutions in terms of how they support students? This paper considers these questions and reports on findings from current research evaluating how students are actually using technologies and what this research tells us about the ways in which patterns of learning might be changing. It will consider the implications for individual teachers (in terms of designing and supporting learning activities for students) and institutions in terms of the impact on policy and the associated infrastructure needed to provide an appropriate environment that maximises the potential offered by new technologies.
Virtual interaction through video-web communication: A step towards enriching and internationalizing language learning programs
Authors: Jauregi Kristi , Bañados Emerita
Published: March 2008

This paper describes an intercontinental project with the use of interactive tools, both synchronous and asynchronous, which was set up to internationalize academic learning of Spanish language and culture. The objective of this case study was to investigate whether video-web communication tools can contribute to enriching the quality of foreign language curricula, by facilitating a motivating virtual communication environment for purposeful interaction between non native and native speakers of Spanish to accomplish learning tasks. The project was carried out between a class of twenty Spanish as foreign language students from the University of Utrecht, The Netherlands, and a class of twenty Chilean trainee Spanish teachers from the University of Concepción, Chile. Students interacted weekly, over two months, in dyads and small groups making use of a video-web communication tool, Adobe Connect. The video-web communication tool enabled synchronous interactions, during which participants could see each other while talking and sharing audiovisual documents on-line. A blog was also used to promote collaboration, reflection and exchange of ideas about issues raised during the synchronous sessions. Qualitative data was collected through a questionnaire, analysis of recordings of learners' interaction sessions and the project blog. Results show a positive impact on motivation and on learning outcomes, particularly regarding understanding of the use of language in given contexts, and of cultural issues.
The Evolving Norms of Conference Papers: Editor's
Introduction
Authors: Dometrius Nelson C.
Published: March 2008

Organizations of any duration develop norms of behavior. A few are
codified in organizational rules but many remain informal,
transmitted to new members through socialization mechanisms. All
norms, informal norms in particular, are resilient but not
permanent. They change if socialization instruments are no longer
effective or if members are aware of established norms but opt to no
longer follow them.
Duplicate Presentations in a Dual World: A Perspective
from a Public Administration Political Scientist
Authors: Bowling Cynthia J.
Published: March 2008

When I first was asked to write this piece about “double
conferencing,” I immediately went to my vita. Looking at the
evidence Nelson Dometrius presented introducing this symposium and
placing myself on the degree year list, I found I was in the center
of the controversy, having received my degree in 1998. Had I
committed the crime of presenting the same paper at two conferences?
I skimmed my CV, and yes, there it was: an identically titled paper
at both a national and a section conference. Granted, this was the
only one I could find on my CV, there was only a month between the
two conferences, and we had made some changes based on feedback.
However, there was more than enough overlap to place me among the
group of violators.
Latinos, Immigration, and the 2006 Midterm
Elections
Authors: Leal David L. , Nuño Stephen A. , Lee Jongho , de la Garza Rodolfo O.
Published: March 2008

The 2006 election will best be remembered for returning Democrats to
power in both the U.S. Senate and the House of Representatives. By
almost any metric, November 7 was a bad day for the Republicans.
After 12 years of Republican majorities, the Democrats picked up 31
seats in the House and six in the Senate. While significant GOP
losses were expected, the results on Election Day were essentially
the best case scenario for the Democrats.
The People's Perspective on the Size of the People's
House
Authors: Frederick Brian
Published: March 2008

The quality of representation the citizenry receives from its
political leaders is central to evaluating the character of any
democratic institution. Moreover, the number of elected members that
comprise an institution can be vital in determining whether citizens
have access to and can influence the decisions of their
representatives (Dahl and Tufte 1973). The
United States House of Representatives has been frozen at 435
members for almost a century. This durability of this alignment is
astonishing; in its first century of existence, the U.S. House
experienced a virtually uninterrupted string of decennial increases
in its membership. Despite the magnitude of the effects of this
stasis on representation, political scientists have not extensively
examined this subject (Squire and Hamm 2005). While the House has remained constant in size for
nearly 100 years, the nation's population has grown by more than
200% over this duration. Members of the House on average represent
more than 600,000 citizens; a figure that increases with population
growth as long as the size of the body remains constant. This
development has sparked a debate among some observers about whether
it is time to increase the size of the House of Representatives.
Spouses as Campaign Surrogates: Strategic Appearances by
Presidential and Vice Presidential Candidates' Wives in the 2004
Election
Authors: MacManus Susan A. , Quecan Andrew F.
Published: March 2008

It is clear from the presidential primary campaign that 2008 can
legitimately be labeled “the year of the spouse as surrogate.” The
sheer number of candidates on both sides of the aisle and the
heavily front-loaded campaign season have made using the wives—and
husband—of the candidates a “must.” Never before has media attention
been so heavily focused on the spouses. In fact, they have often
been an equal, or in some cases, bigger story than the candidates
themselves. The same pattern will characterize the spouses of the
vice presidential candidates. The bottom line is that use of
presidential and vice presidential spouses has
become an integral part of presidential campaigns. In this article,
we detail how the Bush and Kerry camps strategically scheduled
spouses in the final days of the campaign—from Labor Day until
Election Day. We conclude with some thoughts about what to expect in
2008.
Experiential Learning in an Arms Control
Simulation
Authors: Kelle Alexander
Published: March 2008

This paper discusses an arms control simulation that formed a central
part of the course, Controlling Chemical and Biological Weapons.
Based on the experiential learning approach this simulation sought
to (a) provide an active learning context for students to acquire an
in-depth understanding of central aspects of biological arms
control, and (b) gain an appreciation for the complexities of
multilateral diplomacy in general and arms control negotiations in
particular. I taught this course in spring 2006 to a group of 16
final-year undergraduate students. The arms control simulation
complemented the weekly one-hour lectures and replaced the standard
one-hour student-led seminar sessions. At the beginning of the
simulation I supplied students with a set of confidential country
instructions to approach the simulation, which was subdivided into
two negotiating rounds of three sessions each and a drafting
exercise towards the end of the semester.
Transborder Service Learning: New Fronteras in Civic
Engagement
Authors: Cabrera Luis , Anastasi Jeffrey
Published: March 2008

Hour after hour, box by box, and bag by bag, the team of students
transferred the thousands of food items warehoused in a second-floor
conference room at the Fletcher Library on Arizona State
University's West campus. Employing techniques they had developed
over the six weeks of a campus-wide food drive, they formed a chain,
tossing food back from the conference room to a waiting cart, then
down an elevator, to a 16-foot rental truck waiting at the library
loading dock. There, another student team, most sweating profusely
in the 95 degrees of a spring day in Phoenix, rolled the items into
the truck and stacked them. Ultimately, the truck would sag under
the weight of tens of thousands of food items beginning the first
leg of a journey to a community center that serves hot lunches to
children in some of the poorest shantytown neighborhoods of Nogales,
Mexico. The authors would like to
thank for their support and guidance in the project Barbara
Tinsley, Ila Abernathy, Esther Torres, Francisco Trujillo, Jessi
Pederson, Lisa Steenson, Emily Taylor, and Esmeralda Gonzalez;
and for their helpful comments the anonymous referees for this
journal.
Norwegian Political Science at 60
Authors: Moses Jonathon W.
Published: March 2008

On the February 28, 1947, by way of royal decree, the University of
Oslo (UiO) was allowed to grant a degree in political science;
Norway's first department of political science was established at
the same university in 1957. Today, 60 years later, political
science departments can be found on each of Norway's largest
university campuses; their graduates are active and evident locally,
nationally, and internationally—with jobs in both the public and
private sectors. While it is difficult to provide an accurate survey
of the breadth and depth of contemporary Norwegian political
science, this short article aims to supply a brief historical and
institutional map for American political scientists interested in
working in Norway or with Norwegian political scientists. I would like to thank Nils Petter
Gleditsch, Torbjørn Knutsen, Ola Listhaug, Willy Martinusen, and
Knut Erik Solem for their helpful advice and comments. Any
errors and omissions are obviously the sole responsibility of
the author.
Professor Emeritus of Political Science at Yale and APSA
Congressional Fellow in Inaugural 1953–54 Class H. Bradford
Westerfield Dies at 79
Authors: Biggs Jeffrey
Published: March 2008

On January 19, 2008, long-time APSA member and Damon Wells Professor
Emeritus of political science at Yale University H. (Holt) Bradford
Westerfield died from complications of Parkinson's disease in Watch
Hill, Rhode Island. He was 79. Douglas Martin's obituary in the
January 27 issue of The New York Times provided a full account of
his illustrious career, the details of which do not need to be
repeated here. The APSA archives would not, however, have included
the fact that over four decades of teaching at Yale, from 1957 when
he joined the faculty as an assistant professor of international
relations until his retirement in 2001, Professor Westerfield's
largely undergraduate classes attracted some 10,000 students. Those
classes included President Bush, Vice President Dick Cheney,
Senators John Kerry and Joseph I. Lieberman, and other public
officials who “… cited his influence in framing their approach to
public policy. Mr. Cheney repeatedly said Dr. Westerfield helped
shape his hard-line approach to foreign policy. But an article in
The Nation in 2004,” noted Martin, “reported that Dr. Westerfield
came to regret the hard-nosed lessons Mr. Cheney said he had
learned. Dr. Westerfield explained that his own politics had become
much more dovish since.”
Bildgebung in der Mammadiagnostik – Früherkennung, Screening und Problemlösung
Authors: Wruk Daniela
Published: March 2008

Brustkrebs stellt die häufigste Krebserkrankung und Krebstodesursache der Frau in den industrialisierten Ländern dar. Allein in der Schweiz gibt es pro Jahr etwa 5000 Neuerkrankungen. Sinnvoll eingesetzt, stehen uns mit Mammographie, Sonographie und Kontrastmittel-MRT drei potente bildgebende Untersuchungsverfahren im Dienste der Früherkennung, des Screening und der Problemlösung bei unklaren Befunden an der Brust zur Verfügung.
Adjuvante Chemotherapie – Entscheidungshilfe aus dem Internet: Adjuvant!Online
Authors: Hess Viviane
Published: March 2008

Die adjuvante Chemotherapie hat die Prognose von Brustkrebspatientinnen entscheidend verbessert. Internationale Studien mit Tausenden von Patientinnen haben zur Einführung von neuen Medikamenten geführt, aber auch zu einer immer individuelleren Abstimmung der Therapien aufgrund von zahlreichen Risikofaktoren und den damit verbundenen, differenzierten Prognoseabschätzungen. Die Integration dieser Fülle an Informationen aus zahlreichen relevanten klinischen Studien in einen Therapieentscheid ist eine Herausforderung. Adjuvant! Online ist ein öffentlich zugängliches Computerprogramm (www.adjuvantonline.com), welches innert Sekunden die Prognose einer Patientin – basierend auf den wichtigsten Risikofaktoren – berechnet. Wie Adjuvant!Online am besten in den Alltag integriert wird und wo Vorsicht geboten ist, wird in diesem Artikel aufgezeigt.
Neue Behandlungsansätze beim Mammakarzinom
Authors: Spirig Christian , Thürlimann Beat , Huober Jens
Published: March 2008

Durch die gezielte Beeinflussung tumorspezifischer Merkmale, wie z.B. des HER2- Rezeptors, konnten sowohl in der metastasierten wie auch in der adjuvanten Behandlung des Her2-positiven Mammakarzinoms erhebliche Fortschritte verzeichnet werden. Mit dem oral verfügbaren Tyrosinkinaseinhibitor Lapatinib steht seit einigen Monaten eine Behandlungsoption für unter Trastuzumab progrediente Tumoren zur Verfügung. Eine weitere neue Behandlungsstrategie besteht in der Angiogenesehemmung, z.B. mit dem VEGF- Antikörper Bevacizumab, welcher in der Erstlinienbehandlung des metastasierten Brustkrebses in Kombination mit Paclitaxel zu einer signifikanten Verlängerung des progressionsfreien Überlebens im Vergleich zu einer alleinigen Paclitaxeltherapie geführt hat. Erste Studien zur Überprüfung dieses Therapieprinzipes in der adjuvanten und neoadjuvanten Situation haben begonnen. Weitere adjuvante Studien überprüfen den prädiktiven und prognostischen Nutzen von Genanalysen am Tumormaterial, um das Risikoprofil und die Chemosensitivität eines Tumors besser einschätzen zu können.
Die adjuvante Bestrahlung beim Mammakarzinom
Authors: Naehrig Diana
Published: March 2008

Im Laufe der letzten Jahrzehnte hat sich die Behandlung von Brustkrebs und vor allem auch die Indikation und Technik der Bestrahlung wesentlich verändert. Radikale Operationstechniken wurden vermehrt zugunsten der Brusterhaltung verlassen. Zugleich gewann die Bestrahlung zusehends an Bedeutung. Ein Umdenken bezüglich des Erkrankungsmodells fand aufgrund von Erkenntnissen aus klinischen Studien und pathologischen Untersuchungen statt. Die heute gültigen Indikationen und Richtlinien für Bestrahlungen beim Mammakarzinom werden dargelegt und Implikationen für Patientin und Arzt kurz dargestellt. Aktuell zeigt sich zunehmend ein gewisser Trend hin zu so genannten Teilbrustbestrahlungen. Diese Techniken, wie und wann sie angewendet werden, werden ebenfalls erläutert.
Welche Faktoren sind mit subjektiver Belastung und Depressivität bei Pflegepersonen kognitiv beeinträch tigter älterer Menschen assoziiert?
Authors: Schäufele Martina , Köhler Leonore , Lode Sandra , Weyerer Siegfried
Published: March 2008

Ziele: Ziel der vorliegenden Studie war es, erstmals für Deutschland repräsentative Daten zur Situation von privaten Pflegepersonen kognitiv beeinträchtigter älterer Menschen bereit zu stellen. Dabei sollten (modifizierbare) Faktoren ermittelt werden, die mit der subjektiven Belastung und Depressivität der Pflegenden assoziiert sind. Methode: Ausgehend von einer Zufallsstichprobe der deutschen Bevölkerung (N = 52,916) wurden alle über 60-jährigen Personen mit mindestens einer (I)ADL-Beeinträchtigung und kognitiven Auffälligkeiten kontaktiert. Die teilnehmenden Personen und ihre Hauptpflegepersonen (HPP) wurden mittels eines standardisierten Instrumentariums, das u. a. die Häusliche Pflegeskala (subjektive Belastung) und die Allgemeine Depressionsskala (Depressivität) enthielt, befragt. Ergebnisse: Die HPP der gepflegten Personen waren zumeist nahe Familienangehörige (N = 262; mittleres Alter = 61 Jahre; 73 % Frauen). Multivariate Regressionsanalysen erbrachten folgende Faktoren, die signifikant mit erhöhten Belastungs- und erhöhten Depressivitätswerten bei den HPP assoziiert waren: schwerere nicht kognitive Symptomatik (z. B. Apathie, Depression, Agitiertheit/Aggression) bei der gepflegten Person und weibliches Geschlecht der HPP. Verminderte Belastungs- und Depressionswerte resultierten, wenn die HPP die Wahrnehmung hatte, von ihrem privaten Umfeld gut unterstützt zu werden. Schlussfolgerungen: Maßnahmen zur Prävention und Linderung nicht kognitiver Symptome bei den gepflegten Personen sowie kognitive und andere psychosoziale Interventionen bei den Pflegenden könnten die HPP entlasten und die häusliche Pflege kognitiv beeinträchtigter älterer Menschen insgesamt fördern.
«In guten wie in schlechten Zeiten ...»
Authors: Kofahl Christopher , Arlt Sönke , Mnich Eva
Published: March 2008

Die Pflege von älteren betreuungsbedürftigen Menschen wird mehrheitlich von Angehörigen wie Lebenspartner und Kinder oder von anderen nahestehenden Personen übernommen. Nur wenige Studien vergleichen die aus der Pflege resultierende Belastung von Lebenspartnern mit der von anderen, meist jüngeren pflegenden Angehörigen. Die vorliegende Untersuchung basiert auf der deutschen Stichprobe des EU-geförderten Projektes EUROFAMCARE. In diese wurden 1003 betreuende Angehörige eingeschlossen, von denen 908 den Bedingungen der ambulanten Versorgung unterlagen. Diese wurden zu ihrer Beziehung zur betreuungsbedürftigen Person, zu ihren Motiven, der empfundenen Belastung (COPE-Index) und Lebensqualität (SF-36, WHO-5) untersucht. Hierbei wurde insbesondere auf die Situation pflegender Lebenspartner im Vergleich zu Pflegepersonen anderer Verwandtschaftsgrade fokussiert. Insgesamt wird die Mehrzahl der zu pflegenden Personen von weiblichen Angehörigen (76 %) versorgt, 19 % der Pflegepersonen waren Ehepartner oder Lebensgefährten. Hauptbetreuungsmotive waren eine enge Bindung oder das Gefühl der moralischen Verpflichtung. Lebenspartner zeigten eine höhere Belastung durch die Pflege und eine schlechtere Lebensqualität als andere Betreuungsgruppen. Faktoren, die mit einer erhöhten Pflegebelastung einhergehen, waren unter anderem Verhaltensauffälligkeiten der zu pflegenden Person, fehlende soziale Unterstützung und eigene gesundheitliche Probleme. Die Ergebnisse der Untersuchung legen nahe, dass insbesondere pflegende Lebenspartner sowie emotional stark beteiligte Familienmitglieder des engeren Familienkreises unter der Pflegebelastung zu leiden haben. Aufgrund ihrer starken Betroffenheit sollte ihre Rolle in der Beurteilung des Pflegebedarfs z. B. im Rahmen der SGB XI-Pflegebedürftigkeitsbegutachtung oder in der ärztlichen wie pflegerischen Sozialanamnese der betreuungsbedürftigen Personen eine stärkere Berücksichtigung erfahren und entsprechende psychosoziale Beratungsangebote vermittelt werden.
Belastungsfaktoren pflegender Angehöriger von Patienten nach Schlaganfall
Authors: Hasemann Wolfgang , Kesselring Annemarie , Stöcklin Markus , Gräßel Elmar
Published: March 2008

Hintergrund: Die häusliche Pflege eines Menschen, der einen Schlaganfall erlitten hatte, durch Angehörige beinhaltet emotionale, soziale und körperliche Betreuung. Diese kann von den Angehörigen als belastend empfunden werden. Forschungsresultate beinhalten widersprüchliche Aussagen über Risikofaktoren (Prädiktoren), die eine mehr oder weniger starke subjektive Belastung pflegender Angehöriger erwarten lassen. Ziel dieser Studie war, in einer Gruppe pflegender Angehöriger Prädiktoren für deren subjektive Belastung zu identifizieren. Methode: Es wurden die Daten einer Teilstichprobe pflegender Angehöriger von Schlaganfallbetroffenen (N = 466) aus einer größeren deutschen Querschnittsstudie analysiert. Merkmale des Patienten, der Pflegeperson und der Pflegesituation dienten als potenzielle Prädiktorvariablen in einem Strukturgleichungsmodell, in dem die subjektive Belastung der pflegenden Angehörigen, gemessen mit der «Häusliche-Pflege-Skala» (HPS), die Ergebnisvariable darstellt. Ergebnisse: Das Risiko, sich subjektiv belastet zu fühlen, stieg für pflegende Angehörige, wenn sie jünger bzw. gesundheitlich eingeschränkt waren, eine hohe Arbeitsbelastung empfanden, oder wenn der Patient Veränderungen im Verhalten zeigte. Der stärkste Prädiktor für subjektive Belastung war eine negative Bewertung der Pflegesituation durch die pflegenden Angehörigen, welche mit Gefühlen, wie sich zur Betreuung gezwungen fühlen oder fürchten, die eigene Identität zu verlieren, korrelierte. Die prädiktive Beziehung zwischen nächtlichem Arbeitsaufwand und Belastung war inkonsistent. Der kognitive Zustand, der Antrieb und das Alter des pflegebedürftigen Menschen beeinflussten die subjektive Belastung der Pflegeperson nicht signifikant. Diskussion: Die subjektive Belastung pflegender Angehöriger von Schlaganfallbetroffenen wird von mehreren Faktoren beeinflusst. Ein zentraler Punkt für ein erweitertes Assessment subjektiver Belastung ist die Bewertung der Pflegesituation durch die Pflegeperson. Professionelle, an praktischen Pflegeaufgaben orientierte Unterstützung reduziert zwar den Arbeitsaufwand betreuender Angehöriger, lindert jedoch kaum deren subjektive Belastung. Dafür wären psycho-soziale Interventionen notwendig.
Who is Gelotophobic? Assessment Criteria for the Fear of Being Laughed at
Authors: Ruch Willibald , Proyer René T.
Published: March 2008

Ruch and Proyer (2008) provided preliminary evidence for the validity of gelotophobia (the fear of being laughed at) by showing that a group of individuals diagnosed as gelotophobic could be discriminated from groups of shame-based neurotics, non shame-based neurotics, and normal controls by means of a self-report measure. The present study reanalyzes data aimed at identifying the set of items best suited for measuring gelotophobia and estimates the prevalence of gelotophobia in the four groups (N = 863). The application of several criteria led to a final list of 15 statements. Cut-off points for a slight, pronounced, and extreme expression of gelotophobia were defined. In the group of those clinically assessed as having gelotophobia, the cut-off points were exceeded by approximately 31%, 39%, and 22%, respectively. Only 7.1% did not exceed the cut-off point, suggesting that the self-report measure validly determines the presence of and measures the intensity of gelotophobia. Close to 12% of the normal controls exceeded the cut-off points, suggesting that gelotophobia can be studied as an individual differences variable among normal individuals.
Risk-Specific Search for Risk-Defusing Operators
Authors: Wilke Martina , Haug Heike , Funke Joachim
Published: March 2008

Active risk-defusing behavior is that performed by decision makers in risky situations when they look for additional actions that decrease the risk and allow them to favor a riskier alternative. Our study demonstrates that risk-defusing behavior depends on the type of risk (normal, medium, catastrophic, or global) as well as on the domain (health, economy, or ecology). In total, 12 scenarios (four types of risk from three risk domains each) were constructed. Using the interview techniques of active information search and thinking aloud, we conducted 120 interviews about decision-making processes with these scenarios. The results showed that active search for different risk-defusing operators depends on the type of risk, but even more on the domain of the scenario. Results suggest a need for further research about a typology of risk situations in which, besides formal classification criteria, content issues are also explored.
Hostile and Hardened? An Experimental Study on (De-)Sensitization to Violence and Suffering Through Playing Video Games
Authors: Staude-Müller Frithjof , Bliesener Thomas , Luthman Stefanie
Published: March 2008

This study tests whether playing violent video games leads to desensitization and increased cardiovascular responding. In a laboratory experiment, 42 men spent 20 min playing either a high- or low-violence version of a “first-person shooter” game. Arousal (heart rate, respiration rate) was measured continuously. After playing the game, emotional responses to aversive and aggressive stimuli - pictures from Lang, Bradley, and Cuthbert’s (1999) International Affective Picture System - were assessed with self-ratings and physiological measurement (skin conductance). Results showed no differences in the judgments of emotional responses to the stimuli. However, different effects of game violence emerged in the physiological reactions to the different types of stimulus material. Participants in the high-violence condition showed significantly weaker reactions (desensitization) to aversive stimuli and reacted significantly more strongly (sensitization) to aggressive cues. No support was found for the arousal hypothesis. Post-hoc analyses are used to discuss possible moderating influences of gaming experience and player’s trait aggressiveness in terms of the General Aggression Model ( Anderson & Bushman, 2001 ) and the Downward Spiral Model ( Slater, Henry, Swaim, & Anderson, 2003 ).
Attitudes Toward Older Workers and Human Resource Practices
Authors: Kluge Annette , Krings Franciska
Published: March 2008

This study investigated attitudes towards older employees, perceived age discrimination, and HR practices (personnel development and reward) in 240 employees. Attitudes toward older employees were largely positive, thus supporting the notion that attitudes toward older employees are becoming increasingly positive. Older employees’ attitudes towards older employees were more positive, but younger employees’ attitudes were still favorable. Moreover, older and younger employees reported benefiting from HR measures, such as training, to a similar extent. Also, older employees did not feel more discriminated against than younger employees did, indicating that employees’ attitudes were in line with HR practices. Nevertheless, some results suggested that HR practices preferred younger to older employees, indicating that in some domains of personnel development and reward, positive attitudes toward older employees do not necessarily parallel organizational practices.
Die Behandlung von Aufmerksamkeitsdefizit-/Hyperaktivitätsstörungen mit mehrfach ungesättigten Fettsäuren - eine wirksame Behandlungsoption?
Authors: Frölich Jan , Döpfner Manfred
Published: March 2008

Zusammenfassung: Fragestellung: Essentielle Fettsäuren stellen einen integralen Bestandteil neuronaler Zellmembranen dar. Insbesondere sogenannte Omega-3-Fettsäuren tragen zu einer Verbesserung der interzellulären Signaltransduktion bei. Darüber hinaus sind sie in den Dopaminmetabolismus des fronto-cortico-striatalen Systems involviert, wodurch sich eine pathogenetische Verbindung zu Aufmerksamkeitsdefizit-/ Hyperaktivitätsstörungen (ADHS) ergeben könnte. Der vorliegende Beitrag untersucht diese möglichen Zusammenhänge sowie v.a. die klinisch-therapeutische Bedeutung einer Nahrungsergänzung mit mehrfach ungesättigten Fettsäuren für den Symptomverlauf der ADHS. Methodik: Methodenkritisch werden die wenigen vorliegenden kontrollierten Studien vorgestellt und hieraus Schlussfolgerungen für zukünftige Untersuchungen gezogen. Ergebnisse: Möglicherweise liegt bei einem Teil der von einer ADHS-Betroffenen eine normabweichende Verstoffwechselung von Omega-Fettsäuren vor, sei es durch verminderte Nahrungszufuhr, aus einer ineffizienten Umwandlung von Vorläufersubstanzen in langkettige, mehrfach ungesättigte Fettsäuren oder durch eine veränderte Metabolismusrate. Therapeutisch kann folglich möglicherweise bei einer Subgruppe von Kindern und Jugendlichen mit einer ADHS eine mehrwöchige Nahrungssupplementierung aus einer Mischung von Omega-3- und Omega-6-Fettsäuren zu einer klinisch signifikanten Verminderung von Symptomen einer ADHS führen. Schlussfolgerungen: Die vorliegenden Studienergebnisse sind noch als sehr vorläufig einzuschätzen. Möglicherweise könnte allerdings eine Nahrungsergänzung mit essentiellen Fettsäuren bei subklinischer oder moderater Symptomausprägung der ADHS einen signifikanten therapeutischen Nutzen erbringen.