bluuebunny/crossref_metadata_2025 huggingface dataset:
A Philosophy of Teaching . . . and More
Authors: Chonko Lawrence B.
Published: July 2007

This article presents one educator's philosophic answer to the question “Why am I teaching?” During the course of this article, principles of servant teachership are presented. In addition, some teaching approaches used by the author are presented.
Designing Discussion Activities to Achieve Desired Learning Outcomes: Choices Using Mode of Delivery and Structure
Authors: Sautter Pookie
Published: July 2007

The article provides insights on how the design of discussion activities can be used to facilitate alternative learning objectives in the marketing curriculum. A review of the literature provides insight for making choices with regards to two aspects of discussion design: (a) the choice between face-to-face and online (i.e., threaded bulletin boards) delivery modes and (b) the choice between structured and unstructured discussion. Exploratory research is explicated that lends support to recommendations made relevant to matching desired learning outcomes and discussion activity design.
Structured Case Analysis: Developing Critical Thinking Skills in a Marketing Case Course
Authors: Klebba Joanne M. , Hamilton Janet G.
Published: July 2007

Structured case analysis is a hybrid pedagogy that flexibly combines diverse instructional methods with comprehensive case analysis as a mechanism to develop critical thinking skills. An incremental learning framework is proposed that allows instructors to develop and monitor content-specific theory and the corresponding critical thinking skills. Structured exercises are used initially to examine theory and augment critical thinking skills. The degree of structure decreases progressively as students develop these skills and master theory. The process culminates in traditional (unstructured) case analysis. This discussion explores the characteristics and benefits of structured case analysis and describes how the method can be implemented in a marketing case course. The incremental learning framework fosters metacognition and task generalization. Structured case analysis can be adapted to courses that seek to develop critical thinking and marketing decision making.
Does Marketing Attract Less Ethical Students? An Assessment of the Moral Reasoning Ability of Undergraduate Marketing Students
Authors: Herington Carmel , Weaven Scott
Published: July 2007

This article assesses the level of moral reasoning ability (MRA) of undergraduate marketing students and compares the results with the MRA of students in a range of other business disciplines. The aim was to determine if marketing attracts individuals who have a greater predisposition to unethical behaviors given that marketing is often reported as the most unethical of all business activities. The Defining Issues Test (DIT) was used to measure MRA. Although frequently used to measure the MRA of undergraduate students, the DIT has not been used within the marketing domain. The findings indicate that marketing students do not exhibit a lower level of MRA than other business disciplines. Marketing students are no less ethical in their thinking than those pursuing other business careers. The perception of unethical behavior is more likely to be a product of the visible nature of marketing activities to consumers.
A Replicable, Zero-Based Model for Marketing Curriculum Innovation
Authors: Borin Norm , Metcalf Lynn E. , Tietje Brian C.
Published: July 2007

As university curriculums inevitably change, their evolution typically occurs through a series of minor incremental adjustments to individual courses that cause the curriculum to lose strategic consistency and focus. This article demonstrates a zero-based approach to marketing curriculum innovation. The authors describe forces of change that led them to completely redesign their marketing curriculum, and they chronicle a replicable process that can be used to develop and launch an extensive transformation of an existing program that is focused yet adaptive. The process includes faculty commitment, consensus, collaboration, and compromise; stake-holder input; points of distinction; unifying themes; intended learning outcomes; instructional design; approval; a transition plan; launch; and evaluation and continuous improvement. The authors believe that departments of any size can implement a similar redesign process to develop a curriculum that is strategically consistent with the department's core competencies and focused on learning outcomes that are fundamental to any marketing career.
MTR 2756 A > G polymorphism is associated with the risk of systemic lupus erythematosus in the Polish population
Authors: Burzynski M. , Duriagin S. , Mostowska M. , Wudarski M. , Chwalińska-Sadowska H. , Jagodziński P.P.
Published: July 2007

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by overexpression of cytokines and T cell accessory molecules, which is due to a reduction of DNA regulatory region methylation in T cells. It has been shown that polymorphic variants of genes encoding key enzymes of folate and methionine metabolism may have an effect on DNA methylation. Therefore, in patients with SLE ( n = 106) and controls ( n = 141) we examined the distribution of polymorphisms of genes encoding methionine synthase (MTR); 5,10-methylenetetrahydrofolate dehydrogenase, 5,10-methenyltetrahydrofolate cyclohydrolase and 10-formyltetrahydrofolate synthetase (MTHFD1); and methylenetetrahydrofolate reductase (MTHFR). We found that MTR 2756AG (919DG) or GG (919GG) genotype exhibited 2.005-fold increased risk of SLE (95% CI = 1.177—3.416, P = 0.0146). However, MTHFR 677C > T (A222V) and MTHFD1 1958G > A (R653Q) allele and genotype frequencies did not exhibit statistical differences between SLE patients and controls. Since MTR is located on 1q43, our findings confirm the significance of the role of 1q region and the methyl cycle in etiopathogenesis of SLE. Lupus (2007) 16, 450—454.
Autoantibodies in lupus nephritis patients requiring renal transplantation
Authors: Stinton L.M. , Barr S.G. , Tibbles L.A. , Yilmaz S. , Sar A. , Benedikttson H. , Fritzler M.J.
Published: July 2007

The goal of this nested case-control study was to compare autoantibody profiles in systemic lupus erythematosus (SLE) patients with lupus nephritis (LN), lupus nephritis patients requiring renal transplantation (LNTP) and a SLE control group without nephritis (CON). Sera were assayed for a variety of autoantibodies by addressable laser bead immunoassay (ALBIA) and enzyme-linked immunoassay (ELISA) and to dsDNA by Crithidia luciliae assay. The frequency of nucleosome autoantibodies was significantly greater in the LNTP group (79%) compared to the LN (18%) and CON (9%) groups ( P < 0.0005). The frequency of other autoantibodies, including anti-dsDNA, did not differ significantly between groups. Among patients with LN, the odds of progressing to renal transplantation was 16-fold higher (OR 16.5 [95% CI 2.5, 125.7], P = 0.0005) in patients testing positive for anti-nucleosome antibodies compared to those who tested negative. Furthermore, the level of anti-nucleosome antibodies was significantly ( P < 0.00005) higher in the LNTP group (3.69 ± 2.79) than the LN (0.51 ± 0.51) and CON (0.34 ± 0.44) groups. Review of 48 renal biopsies from 29 patients indicated that there was no difference in renal histological classification among patients with anti-nucleosome antibodies compared to those who tested negative. Our observations suggest that nucleosome autoantibodies are a biomarker for more severe SLE renal disease requiring transplantation. Lupus (2007) 16, 394—400.
Hydroxychloroquine sulfate treatment is associated with later onset of systemic lupus erythematosus
Authors: James JA , Kim-Howard XR , Bruner BF , Jonsson MK , McClain MT , Arbuckle MR , Walker C. , Dennis GJ , Merrill JT , Harley JB
Published: July 2007

Systemic lupus erythematosus (SLE) is a clinically diverse, complex autoimmune disease which may present with coincident onset of many criteria or slow, gradual symptom accrual. Early intervention has been postulated to delay or prevent the development of more serious sequelae. One option for treatment in this setting is hydroxychloroquine. Using 130 US military personnel who later met ACR SLE criteria, a retrospective study of onset, development and progression of SLE with and without pre-classification hydroxychloroquine ( n = 26) use was performed. Patients treated with hydroxychloroquine prior to diagnosis had a longer (Wilcoxon signed rank test, P = 0.018) time between the onset of the first clinical symptom and SLE classification (median: 1.08 versus 0.29 years). Patients treated with prednisone before diagnosis also more slowly satisfied the classification criteria (Wilcoxon signed rank test, P = 0.011). The difference in median times between patients who received NSAIDs before diagnosis, as opposed to those who did not, was not different ( P = 0.19). Patients treated with hydroxychloroquine also had a lower rate of autoantibody accumulation and a decreased number of autoantibody specificities at and after diagnosis. These findings are consistent with early hydroxychloroquine use being associated with delayed SLE onset. A prospective, blinded trial testing the capacity of hydroxychloroquine to delay or prevent SLE in high risk populations is warranted. Lupus (2007) 16, 401—409.
Posterior reversible encephalopathy syndrome: another manifestation of CNS SLE?
Authors: Ishimori M.L. , Pressman B.D. , Wallace D.J. , Weisman M.H.
Published: July 2007

A variety of neuropsychiatric findings may complicate systemic lupus erythematosus (SLE) and pose diagnostic and therapeutic dilemmas. We describe the clinical and radiographic features of posterior reversible encephalopathy syndrome (PRES) and distinguish PRES from other conditions seen in SLE. Patient charts and magnetic resonance imaging (MRI) findings of four patients with SLE on immunosuppressive therapy with acute or subacute neurologic changes initially suggesting cerebritis or stroke were reviewed. The English language literature was reviewed using the Medline databases from 1996—2006 for other reports of PRES with SLE. Literature review yielded 26 other SLE cases reported with PRES. SLE patients with PRES were more commonly on immunosuppressive drugs, had episodes of relative hypertension, and had renal involvement. Characteristic findings are seen on MRI, which differentiate PRES from other CNS complications of SLE. Clinical and radiographic resolution of abnormalities within 1—4 weeks is typically seen. PRES has been increasingly recognized. Reversible changes are found on brain MRI accompanied by sometimes dramatic signs and symptoms. The therapeutic implications for separating PRES from stroke or cerebritis are important. We propose that PRES should be considered in the differential diagnosis in SLE patients with new-onset neurologic signs and symptoms. Lupus (2007) 16, 436—443.
Systemic lupus erythematosus in a multiethnic US Cohort LUMINA XLVIII: factors predictive of pulmonary damage
Authors: Bertoli A.M. , Vila L.M. , Apte M. , Fessler B.J. , Bastian H.M. , Reveille J.D. , Alarcon G.S.
Published: July 2007

The objective of this study was to determine the factors predictive of time to the occurrence of pulmonary damage in systemic lupus erythematosus (SLE). Six-hundred and twenty-six SLE patients from a multiethnic (Hispanics, African Americans and Caucasians) longitudinal study of outcome were studied. Pulmonary damage was defined as per the Systemic Lupus International Collaborating Clinics Damage Index. Socioeconomic-demographic, clinical, genetic, serological features, pharmacologic treatments, behavioural, psychological and disease activity [as per the Systemic Lupus Activity Measure-Revised (SLAM-R)] were examined. Factors associated with time to the occurrence of pulmonary damage were examined by Cox proportional hazards regressions. A Kaplan—Meier survival curve was also examined. Forty-six (7.3%) patients had pulmonary damage after a mean (SD) total disease duration of 5.3 (3.6) years. Among those patients, 25 had pulmonary fibrosis, 12 pulmonary hypertension, eight pleural fibrosis, four pulmonary infarction and four shrinking lung syndrome. Seven patients had more than one type of lung damage. Cumulative rates of pulmonary damage at five and 10 years were 7.6% and 11.6%, respectively. In the multivariable analyses, age (HR = 1.033, 95% CI 1.006—1.060; P = 0.0170), pneumonitis (HR = 2.307, 95% CI 1.123—4.739; P = 0.0229) and anti-RNP antibodies (HR = 2.344, 95% CI 1.190—4.618; P = 0.0138) were associated with a shorter time to the occurrence of pulmonary damage while photosensitivity (HR = 0.388, 95% CI 0.184—0.818; P = 0.0128) and oral ulcers (HR = 0.466, 95% CI 0.230—0.942; P = 0.0335) with a longer time. Pulmonary damage is relatively common in SLE. Age, pneumonitis and anti-RNP antibodies were associated with a shorter time to the development of permanent lung disease. Lupus (2007) 16, 410—417.
Monoclonal gammopathy in systemic lupus erythematosus
Authors: Ali Y.M. , Urowitz M.B. , Ibanez D. , Gladman D.D.
Published: July 2007

We studied the prevalence, type and associated features of monoclonal gammopathy in patients with systemic lupus erythematosus (SLE). Patients included in the University of Toronto Lupus Database with an abnormal band on serum electropheresis were identified. Monoclonal gammopathy patients were matched with two controls each from the same database by age at SLE diagnosis, sex and disease duration. Of 1083 patients followed at the Lupus Clinic 59 (5.4%) were identified with monoclonal gammopathy. The gammopathies included 32 with IgG, 14 IgM and 12 IgA, one undefined. Nine (15.3%) malignancies were detected in monoclonal gammopathy and 12 (10.1%) in the controls during the entire course of their disease ( P = 0.13). None had multiple myeloma. There was no difference between patients with monoclonal gammopathy and their controls with respect to disease activity, damage, or dose of steroids. The mean ESR and gammaglobulin levels in the monoclonal gammopathy patients were higher than the controls at last visit. We conclude that monoclonal gammopathy is more frequent in SLE patients than in the general population and has a benign course in patients with SLE. There were no differences in disease manifestations, treatment approaches, or malignancies between SLE patients with and those without monoclonal gammopathy. Lupus (2007) 16, 426—429.
Inflammatory cervicovaginal cytology is associated with disease activity in juvenile systemic lupus erythematosus
Authors: Febronio M.V. , Pereira R.M.R. , Bonfa E. , Takiuti A.D. , Pereyra E.A.G. , Silva C.A.A.
Published: July 2007

To evaluate cervicovaginal cytology in adolescents with juvenile systemic lupus erythematosus (JSLE) and to compare them to controls. Fifty-two female adolescents with JSLE (ACR criteria) were compared to 52 age-matched healthy controls. All Pap smears were evaluated by the same cytopathologist blinded to gynecology examination (Bethesda 2001). The mean age of JSLE patients and controls were similar (16.17 ± 1.94 versus 16.13 ± 2.16 years, P = 0.92). The cervicovaginal cytology was found to be similar in both groups, although sexual intercourses in the last month were less frequent in JSLE than controls (23% versus 59.6%, P = 0.0003). Only one patient (2%) with JSLE versus two controls (4%) had cervical dysplasia (LGSIL) and human papilomavirus ( P = 1.0). Candida spp vaginitis was observed in seven JSLE (14%) versus none in controls ( P = 0.012) and was associated with immunosuppressive drugs ( P = 0.01) and high dose of prednisone ( P = 0.002). Of interest, inflammatory cervicovaginal cytology was observed in 21 (60%) of patients with SLEDAI ≥ 4 and only four (23%) of those with SLEDAI < 4 ( P = 0.001). Likewise, a higher frequency of inflammatory changes was also observed in virgin JSLE (57% versus 8%, P = 0.005). Our findings supports the notion that female genital tract may be a potential target organ in SLE since cervical inflammation is associated to disease activity independently of sexual activity. Lupus (2007) 16, 430—435.
High dose methylprednisolone therapy for the treatment of severe systemic lupus erythematosus
Authors: Parker BJ , Bruce IN
Published: July 2007

The pharmacological armamentarium for the treatment of SLE is expanding and a number of novel therapies are currently under investigation. In spite of this, steroid therapy remains the cornerstone of treatment and intravenous methylprednisolone (IVMP) is still widely used in clinical practice. There is however surprisingly little evidence on which to define its precise role. The objective of this review was to consider the published evidence relating to the use of IVMP in SLE patients and also to identify open questions that still need to be answered with regard to its use.

In acute flares, IVMP induces rapid suppression of acute inflammation. There is not however a strong evidence base to support the use of high doses compared to low IVMP doses or oral prednisolone. In maintenance regimes, secondary analyses suggest that IVMP may confer additional long-term renal survival over oral steroids as part of a cyclophosphamide regime. Therefore, in addition to the evaluation of novel therapies for SLE, better evidence to define the precise role of IVMP in SLE is still required. ( Lupus (2007) 16, 387—393)
The provision of policing and the problem of pluralism
Authors: Vaughan Barry
Published: July 2007

The problem of policing is often portrayed as providing sufficient personnel to sate demand. Pluralism, however, complicates the issue since the public disagree among themselves over which activities or individuals should be policed. In turn, police priorities may differ from these demands, inciting public discontent. In these circumstances, how can public policing sustain its legitimacy? Lessons can be learnt from how political theories have grappled with pluralism and legitimacy. This article analyses how three major political theorists, John Rawls, Michael Walzer and Friedrich Hayek, dealt with these issues. It mines their insights to nominate the principle of non-domination, defined as freedom from interference on an arbitrary basis, as best suited to justify policing in an era of pluralism.
Rules in policing
Authors: Ericson Richard V.
Published: July 2007

This article examines five perspectives on how rules relate to police power and discretion. Each perspective is appreciated for its heuristic value, depending upon the types of rules in question and the pragmatic circumstances faced in police decisions. At the same time, it is argued that policing is undergoing rapid transformation involving a new division of labor with regulatory agencies and private police, an attendant reconfiguration of the principles, standards and procedures of criminal law and the rise of surveillance-based control without the law. This `counter-law' environment of policing networks, legal exceptions and surveillance technologies is increasingly relied upon to ensure that the police are watched as well as watchers and the bearers of their own control.
Crime, film and criminology
Authors: Rafter Nicole
Published: July 2007

This article aims at giving crime-film research a stronger sense of purpose by asking: How do crime films relate to criminology? Using the example of recent films about sex crimes, I argue that crime films should be conceptualized as an aspect of popular criminology, and popular criminology as an aspect of criminology itself. If we define criminology as the study of crime and criminals, it becomes clear that film is one of the primary sources through which people get their ideas about the nature of crime. Some of those ideas echo academic criminology, while others bring to bear ethical, philosophical and psychological perspectives beyond the scope of academic research. By recognizing that popular criminology is integral to criminology, we can invigorate the study of crime films—and criminology itself.
Questioning the `Evidence' of Risk that Underpins Evidence-led Youth Justice Interventions
Authors: Case Stephen
Published: July 2007

In this article, I evaluate the Risk Factor Prevention Paradigm (RFPP) as employed in risk-focused research and risk assessment in the Youth Justice System in England and Wales and elsewhere. This paradigm has been criticized as theoretically and methodologically flawed, static, limited in scope and subject to political manipulation. Criticisms are explicated and evaluated, then counter-balanced with discussions of the methodological robustness and empirical successes of the paradigm. I conclude by recommending that quantitative risk-focused research is supplemented with routine qualitative consultation of neglected stakeholders (youth justice practitioners, young people) and that evidence of risk is interpreted, utilized and disseminated in a more valid, realistic manner.
Classification in Youth Justice and Child Welfare: In Search of `the Child'
Authors: McGhee Janice , Waterhouse Lorraine
Published: July 2007

This article draws on interdisciplinary social science to explore the socio-legal classification of children as `offenders' and `non-offenders'. It applies classification theories interpretively using two case studies from the USA and Scotland. It is argued that such classifications oversimplify complex issues and, in reality, children move between categories over time. Classifications contribute to the ascendancy of certain aspects of children's functioning over others. Their use risks that we stop seeing the individual child. The `borderline' or `hard cases' (persistent and/or serious offenders) highlight the variability of judgement. These cases illustrate the moral dimension of classification whereby some children come to be treated as adults in justice systems.
How adult are our learners?
Authors: Norrie Peter , Dalby David
Published: July 2007

Knowles proposed a model to describe the characteristics of adult learners. This may be summarised by a move away from highly structured teaching methods (pedagogic teaching) to more explorative and less formal ones (andragogic teaching). This paper explores whether this progression occurs across an undergraduate nursing programme. Twelve questions based upon Knowles' model were incorporated into a Likert scale questionnaire. The sample was inclusive across three cohorts of an undergraduate nursing programme ( n = 555).

No significant differences were found within the sample with reference to gender or branch. Some significant differences were present with reference to age and year of study, but these suggest that students regress from the characteristics of the adult learners within these parameters.

Some significant differences were present with reference to ethnicity, suggesting that some ethnic-minority students were more willing to add to learning with independent study.

The research findings do not conform to predictions based upon Knowles' model. There is no evidence that students gain more of the characteristics of andragogy as they progress through their studies. Instead, there is some evidence that students become less willing to take responsibility for their learning. This should be of concern to those involved in health education.
`No worries!'
Authors: Ingram Jenny , Salmon Debra
Published: July 2007

`No Worries!' is a nurse-led drop-in sexual health service for young people in one Primary Care Trust in South West England. The service aims to provide sexual health promotion, contraception, STI testing and a range of health promotion advice. The service was evaluated from the young people's perspectives using quantitative and qualitative methodologies. Attendance data, questionnaires and interviews explored patterns of use, effectiveness and acceptability of three clinics, two in areas of social deprivation and a third with increasing teenage conception rates.

Questionnaire data were collected from 153 young people (232 clinic attendances) and 18 were interviewed (aged 14—18 years). The pattern of service use varied across the clinics, with those from the lowest socio-economic community using fewer condoms, having more pregnancy tests and STI swabs. Average age of first intercourse was 15 years, and most visited the clinic after having sex rather than before. Young people found the service accessible and they highlighted close proximity to home and school, the drop-in nature, and confidentiality, professionalism and friendliness of staff. After using the service, respondents reported that they would be more likely to practise safer sex and change their behaviour.

The clinics appeared to match up to young people's expectations of the service, but did not manage to attract many boys. Young people said the service made them feel more confident, more informed about sex, aware of sexually transmitted diseases and take fewer risks.
`Introducing yourself to strangers'
Authors: Lambert Susan , Thomas Valerie , Gardner Lyn
Published: July 2007

The aims of this study were to explore the practicability of two instruments developed to assess older people with complex care needs and to assess compliance with criteria for assessment tools that require tools to be person-centred and to support rather than replace professional judgement. Nurse assessors undertook assessments of older people living in a care-home setting or awaiting discharge from hospital, using EASY-Care and Minimum Data Set Resident Assessment Instrument (MDS-RAI). The results suggest that both tools are practicable and useful in enabling older people to identify their needs. EASY-Care was preferred to identify both health and social-care needs. It was considered to be more person-centred in that open-ended questions allowed people to describe their circumstances in their own words. Its style made it easier to develop rapport with older people and encouraged them to talk and to disclose information beyond the immediate scope of the tool itself. Nevertheless some questions provoked anxiety and assessors needed to use their professional judgement in order to achieve a person-centred, appropriate assessment. MDS-RAI appeared to be more useful in identifying nursing or medical issues. But it did not always reveal a complete picture of the person's care needs and situation. Some nurses suggested that MDS-RAI was useful in circumstances where, in their professional judgement, older people were not being realistic in discussing their needs and their expectations for future care. The findings identify how nurses can use tools to support their assessment skills.
Development of a questionnaire to determine professionals' attitudes to type 2 diabetes
Authors: McDowell Joan , Lindsay Grace , McPhail Kathryn
Published: July 2007

This study aimed to develop a valid and reliable questionnaire to measure primary health care professionals' (PHCP) views and perceptions of type 2 diabetes care. Management of type 2 diabetes within the UK is moving from secondary to primary led care. A need was identified to develop a tool to measure PHCP' views and perceptions of diabetes as studies have shown that these can have an impact on patient outcomes. There were four main stages in the development of the questionnaire that has used rare methodology. The first was an in-depth literature review of research databases, nationally recognized standards and professional literature. From this, criteria for the questionnaire were developed.The second stage involved a consultation with a national panel of diabetes experts. This utilized the nominal group technique consensus approach to determine ranked criteria. A sample of PHCP was interviewed on a one-to-one basis using the `talk through' technique for the third stage and was invited to make in-depth comments on each of the questions. The questionnaire was finally piloted with different professional groups working in community care. The developed questionnaire was used in a study evaluating the impact of the Glasgow Diabetes Project.
Exploring the effectiveness of action research as a tool for organizational change in health care
Authors: Bridges Jackie , Meyer Julienne
Published: July 2007

This paper acknowledges the similarities between action research and successful strategies for planned organizational change, and uses an action research case study to explore the extent to which democratic and participatory approaches to organizational change, such as action research, can flourish in a context of externally imposed targets, as is characteristic of the UK National Health Service. Using case study findings, the authors claim that some practice changes are possible, but that locally devised targets may not be achievable if managers' attention is distracted by other priorities or if targets are in conflict with externally set targets. The authors emphasise the value of engaging managers as well as practitioners in action research, and identify that an action research approach not only has the potential for positive organizational change, but can also provide a unique data set on how central policy translates into practice and patient outcomes. Whether or not planned change occurs, with action research there is always potential for new understandings to emerge.
Student nurses in dialogues with hypothetical patients regarding paintings
Authors: Wikström Britt-Maj , Svidén Gunilla
Published: July 2007

As early as the work by Lichtwark (1902) arts were used as a pedagogical tool. His aim was to teach children to `see' through careful observations of works of art. The pedagogy employed in health care education must continually be questioned and expanded. Student nurses must be prepared for nursing practice that continually changes, meaning that alternative concepts in nurse education must be considered. Thus, visual art dialogues in student nurses' education could be a valuable teaching/learning complement to theoretical knowledge. The aim of this study is to investigate the ways in which student nurses intended to conduct a dialogue with a patient using a painting as a starting point. The study was conducted in the students' second year at a university college of health sciences in Sweden. In all, 50 students (47 female and three male) participated. The students had previously received a short introduction to art perception of some of the museums' paintings by the curator. This included observation and reflection on specific works of art. When they had studied several works of art at the museum they were asked to select one work of art from a series of 12 paintings that they thought might be used as a conversation tool with patients. The selection of these paintings was performed on basis of methods in psychological and art scientific research into aesthetic reactions to and perception of art tendencies. Analysis of the students' comments on how the dialogue with the patient would develop revealed comments of five qualitatively different types: activating memories, presenting knowledge, existential aspects/meaning of life, emotional reactions and concrete aspects.
The developmental program of human dendritic cells is operated independently of conventional myeloid and lymphoid pathways
Authors: Ishikawa Fumihiko , Niiro Hiroaki , Iino Tadafumi , Yoshida Shuro , Saito Noriyuki , Onohara Shinya , Miyamoto Toshihiro , Minagawa Hiroko , Fujii Shin-ichiro , Shultz Leonard D. , Harada Mine , Akashi Koichi
Published: July 2007

Two distinct dendritic cell (DC) subsets, conventional DCs (cDCs) and plasmacytoid DCs (pDCs), have been shown to develop via either the myeloid or the lymphoid pathway in murine hematopoiesis. Lineage-specific phenotypes or functions of “myeloid” and “lymphoid” DCs, however, still remain elusive. Furthermore, such analysis has been particularly difficult in humans, due to lack of an assay system appropriate for the analysis of human stem and progenitor cell differentiation. Here, using a highly efficient xenotransplantation model, we extensively analyze the origin and the molecular signature of human DCs. Purified human common myeloid progenitors (CMPs) and common lymphoid progenitors (CLPs) were intravenously transplanted into nonobese diabetic–severe combined immunodeficiency (NOD-scid)/IL2rγnull newborn mice. CMPs and CLPs displayed significant expansion in the xenogeneic host, and human cDC and pDC progeny were isolatable. Strikingly, each human DC subset possessed indistinguishable expression patterns of surface phenotype and gene transcripts regardless of their CMP or CLP origin, even at the genome-wide level. Thus, cDC and pDC normally develop after cells have committed to the myeloid or the lymphoid lineage in human hematopoiesis, while their transcriptional signatures are well preserved irrespective of their lineage origin. We propose that human DCs use unique and flexible developmental programs that cannot be categorized into the conventional myeloid or lymphoid pathway.
Combination Therapy With Gefitinib and Rofecoxib in Patients With Platinum-Pretreated Relapsed Non–Small-Cell Lung Cancer
Authors: O'Byrne Kenneth J. , Danson Sarah , Dunlop David , Botwood Nick , Taguchi Fumiko , Carbone David , Ranson Malcolm
Published: July 2007

Purpose

In non–small-cell lung cancer (NSCLC), the epidermal growth factor receptor (EGFR) and cyclooxygenase-2 (COX-2) play major roles in tumorigenesis. This phase I/II study evaluated combined therapy with the EGFR tyrosine kinase inhibitor (TKI) gefitinib and the COX-2 inhibitor rofecoxib in platinum-pretreated, relapsed, metastatic NSCLC (n = 45).

Patients and Methods

Gefitinib 250 mg/d was combined with rofecoxib (dose escalated from 12.5 to 25 to 50 mg/d through three cohorts, each n = 6). Because the rofecoxib maximum-tolerated dose was not reached, the 50 mg/d cohort was expanded for efficacy evaluation (n = 33).

Results

Among the 42 assessable patients, there was one complete response (CR) and two partial responses (PRs) and 12 patients with stable disease (SD); disease control rate was 35.7% (95% CI, 21.6% to 52.0%). Median time to tumor progression was 55 days (95% CI, 47 to 70 days), and median survival was 144 days (95% CI, 103 to 190 days). In a pilot study, matrix-assisted laser desorption/ionization (MALDI) proteomics analysis of baseline serum samples could distinguish patients with an objective response from those with SD or progressive disease (PD), and those with disease control (CR, PR, and SD) from those with PD. The regimen was generally well tolerated, with predictable toxicities including skin rash and diarrhea.

Conclusion

Gefitinib combined with rofecoxib provided disease control equivalent to that expected with single-agent gefitinib and was generally well tolerated. Baseline serum proteomics may help identify those patients most likely to benefit from EGFR TKIs.
Magnetic Resonance Imaging of the Axial Skeleton for Detecting Bone Metastases in Patients With High-Risk Prostate Cancer: Diagnostic and Cost-Effectiveness and Comparison With Current Detection Strategies
Authors: Lecouvet Frédéric E. , Geukens Daphné , Stainier Annabelle , Jamar François , Jamart Jacques , d'Othée Bertrand Janne , Therasse Patrick , Berg Bruno Vande , Tombal Bertrand
Published: July 2007

Purpose

To evaluate the diagnostic performance, costs, and impact on therapy of one-step magnetic resonance imaging (MRI) of the axial skeleton (MRIas) for detecting bone metastases in patients with high-risk prostate cancer (PCa).

Patients and Methods

Sixty-six consecutive patients with high-risk PCa prospectively underwent MRIas in addition to the standard sequential work-up (SW) of bone metastases (technetium-99m bone scintigraphy [BS] completed with targeted x-rays [TXR] in patients with equivocal BS findings and with MRI obtained on request [MRIor] in patients with inconclusive BS/TXR findings). Panel review of initial and 6-month follow-up MRI findings, BS/TXR, and all available baseline and follow-up clinical and biologic data were used as the best valuable comparator to define metastatic status. Diagnostic effectiveness of MRIas alone was compared with each step of the SW. Impact of MRIas screening on patient management and costs was evaluated.

Results

On the basis of the best valuable comparator, 41 patients (62%) had bone metastases. Sensitivities were 46% for BS alone, 63% for BS/TXR, 83% for BS/TXR/MRIor, and 100% for MRIas; the corresponding specificities were 32%, 64%, 100%, and 88%, respectively. MRIas was significantly more sensitive than any other approach (P < .05, McNemar). MRIas identified metastases in seven (30%) of 23 patients considered negative and eight (47%) of 17 patients considered equivocal by other strategies, which altered the initially planned therapy. Economic impact was variable among countries, depending on reimbursement rates.

Conclusion

MRIas is more sensitive than the current SW of radiographically identified bone metastases in high-risk PCa patients, which impacts the clinical management of a significant proportion of patients.
Parental Grief After Losing a Child to Cancer: Impact of Professional and Social Support on Long-Term Outcomes
Authors: Kreicbergs Ulrika C. , Lannen Patrizia , Onelov Erik , Wolfe Joanne
Published: July 2007

Purpose

It is still uncertain whether or not parents can ever come to terms with the loss of a child and whether professional or social support facilitate the long-term grief process.

Methods

A Swedish population-based study, which sent an anonymous, mail-in questionnaire to parents who had lost a child to a malignancy 4 to 9 years earlier, gained the participation of 449 (80%) of 561 parents. Parents were asked whether, and to what extent, they had worked through their grief. Questions were also asked regarding those who provided parents with support. We examined candidate factors to determine their associations with greater likelihood of working through parental grief.

Results

Overall, most parents (74%) stated that they had worked through their grief “a lot” or “completely” at the time of the follow-up. Parents who had shared their problems with others during the child's illness (fathers: relative risk [RR], 3.0; 95% CI, 1.8 to 5.0; mothers: RR 1.9; 95% CI, 1.2 to 2.8) and who had access to psychological support during the last month of their child's life (fathers: RR 1.4; 95% CI, 1.0 to 1.8; mothers: RR 1.3; 95% CI, 1.1 to 1.6) were more likely to have worked through their grief. In cases where health care staff offered parents counseling during the child's last month, the parents were more likely to have worked through their grief (fathers: RR 1.5; 95% CI, 1.2 to 1.8; mothers; RR 1.2; 95% CI, 1.1 to 1.4).

Conclusion

Most parents eventually work through the grief associated with losing a child to cancer. In the long term, sharing the emotional burden with others facilitates the grieving process.
Bone Marrow Transplantation Generates Immature Oocytes and Rescues Long-Term Fertility in a Preclinical Mouse Model of Chemotherapy-Induced Premature Ovarian Failure
Authors: Lee Ho-Joon , Selesniemi Kaisa , Niikura Yuichi , Niikura Teruko , Klein Rachael , Dombkowski David M. , Tilly Jonathan L.
Published: July 2007

Purpose

Although early menopause frequently occurs in female cancer patients after chemotherapy (CTx), bone marrow (BM) transplantation (BMT) has been linked to an unexplained return of ovarian function and fertility in some survivors. Studies modeling this in mice have shown that BMT generates donor-derived oocytes in CTx-treated recipients. However, a subsequent report claimed that ovulated eggs are not derived from BM and that BM-derived oocytes reported previously are misidentified immune cells. This study was conducted to further clarify the impact of BMT on female reproductive function after CTx using a preclinical mouse model.

Methods

Female mice were administered CTx followed by BMT using coat color-mismatched female donors. After housing with males, the number of pregnancies and offspring genotype were recorded. For cell tracking, BM from germline-specific green fluorescent protein-transgenic mice was transplanted into CTx-treated wild-type recipients. Immune cells were sorted from blood and analyzed for germline markers.

Results

BMT rescued long-term fertility in CTx-treated females, but all offspring were derived from the recipient germline. Cell tracking showed that donor-derived oocytes were generated in ovaries of recipients after BMT, and two lines of evidence dispelled the claim that these oocytes are misidentified immune cells.

Conclusion

These data from a preclinical mouse model validate a testable clinical strategy for preserving or resurrecting ovarian function and fertility in female cancer patients after CTx, thus aligning with recommendations of the 2005 National Cancer Institute Breast Cancer Progress Review Group and President's Cancer Panel to prioritize research efforts aimed at improving the quality of life in cancer survivors.
Clinical Benefit With Docetaxel Plus Fluorouracil and Cisplatin Compared With Cisplatin and Fluorouracil in a Phase III Trial of Advanced Gastric or Gastroesophageal Adenocarcinoma: The V-325 Study Group
Authors: Ajani Jaffer A. , Moiseyenko Vladimir M. , Tjulandin Sergei , Majlis Alejandro , Constenla Manuel , Boni Corrado , Rodrigues Adriano , Fodor Miguel , Chao Yee , Voznyi Edouard , Marabotti Cindy , Van Cutsem Eric
Published: July 2007

Purpose

For patients with advanced gastric or gastroesophageal cancer (AGGEC) providing clinical benefit with improved palliation is highly desirable. However, a prospective evaluation of clinical benefit in AGGEC patients has never before been reported in a phase III setting.

Patients and Methods

In a multinational trial (V325), 445 patients were randomly assigned and treated with either docetaxel plus cisplatin and fluorouracil (DCF) or cisplatin and fluorouracil (CF). Clinical benefit was prospectively evaluated in this trial as a secondary end point. The primary measure for clinical benefit analysis was time to definitive worsening by one or more categories of Karnofsky performance status (KPS). Secondary clinical benefit end points included time to 5% definitive weight loss, time to definitive worsening of appetite by one grade, pain-free survival (defined as time to first appearance of pain), and time to first cancer pain-related opioid intake. Clinical benefit assessments were recorded at each clinic visit.

Results

Clinical benefit assessments were performed in more than 75% of patients throughout V325. DCF significantly prolonged time to definitive worsening of KPS compared with CF (median, 6.1 v 4.8 months; hazard ratio, 1.38; 95% CI, 1.08 to 1.76; log-rank P = .009). Although time to definitive weight loss and time to definitive worsening of appetite favored DCF, the results were not statistically significant. Pain-free survival and time to first cancer pain-related opioid intake were comparable.

Conclusion

To our knowledge, V325 is the first phase III trial to report clinical benefit in AGGEC patients. Clinical benefit was assessed beyond protocol-specific chemotherapy. The addition of D to CF not only significantly improved clinical benefit but also improved quality of life, time to progression, and overall survival compared with CF.
Expression of Epiregulin and Amphiregulin and K-ras Mutation Status Predict Disease Control in Metastatic Colorectal Cancer Patients Treated With Cetuximab
Authors: Khambata-Ford Shirin , Garrett Christopher R. , Meropol Neal J. , Basik Mark , Harbison Christopher T. , Wu Shujian , Wong Tai W. , Huang Xin , Takimoto Chris H. , Godwin Andrew K. , Tan Benjamin R. , Krishnamurthi Smitha S. , Burris Howard A. , Poplin Elizabeth A. , Hidalgo Manuel , Baselga Jose , Clark Edwin A. , Mauro David J.
Published: July 2007

Purpose

The antiepidermal growth factor receptor (EGFR) antibody cetuximab shows activity in multiple epithelial tumor types; however, responses are seen in only a subset of patients. This study was conducted to identify markers that are associated with disease control in patients treated with cetuximab.

Patients and Methods

One hundred ten patients with metastatic colorectal cancer were enrolled onto a cetuximab monotherapy trial. Transcriptional profiling was conducted on RNA from mandatory pretreatment metastatic biopsies to identify genes whose expression correlates with best clinical responses. EGFR and K-ras mutation analyses and EGFR gene copy number analyses were performed on DNA from pretreatment biopsies.

Results

Gene expression profiles showed that patients with tumors that express high levels of the EGFR ligands epiregulin and amphiregulin are more likely to have disease control with cetuximab (EREG, P = .000015; AREG, P = .000025). Additionally, patients whose tumors do not have K-ras mutations have a significantly higher disease control rate than patients with K-ras mutations (P = .0003). Furthermore, patients with tumors that have high expression of EREG or AREG also have significantly longer progression-free survival (PFS) than patients with low expression (EREG: P = .0002, hazard ratio [HR] = 0.47, and median PFS, 103.5 v 57 days, respectively; AREG: P < .0001, HR = 0.44, and median PFS, 115.5 v 57 days, respectively).

Conclusion

Patients with tumors that have high gene expression levels of epiregulin and amphiregulin and patients with wild-type K-ras are more likely to have disease control on cetuximab treatment. The identified markers could be developed further to select patients for cetuximab therapy.
Prospective Study of Rituximab in Chemotherapy-Dependent Human Immunodeficiency Virus–Associated Multicentric Castleman's Disease: ANRS 117 CastlemaB Trial
Authors: Gérard Laurence , Bérezné Alice , Galicier Lionel , Meignin Véronique , Obadia Martine , De Castro Nathalie , Jacomet Christine , Verdon Renaud , Madelaine-Chambrin Isabelle , Boulanger Emmanuelle , Chevret Sylvie , Agbalika Felix , Oksenhendler Eric
Published: July 2007

Purpose

Single-agent chemotherapy is usually effective in HIV-associated multicentric Castleman's disease (MCD). However, in most patients, chemotherapy cannot be discontinued.

Patients and Methods

To evaluate the efficacy of four weekly rituximab infusions (375 mg/m2) after discontinuation of chemotherapy in HIV-associated MCD, 24 patients were enrolled onto a prospective open-label trial.

Results

At study entry, the median time from MCD diagnosis was 21 months. All patients had stable disease on chemotherapy and were dependent on chemotherapy for a median time of 13 months. The median CD4 cell count was 270 × 106/L, and the plasma HIV RNA was less than 50 copies/mL in 18 patients. One patient died with progressive disease at day 15, and 23 patients completed the four cycles of rituximab. Sustained remission (SR) off treatment at day 60 (primary end point) was achieved in 22 patients (92%). From day 60 to day 365, one patient died with acute respiratory failure of undetermined origin, and four patients experienced relapse. Seventeen patients (71%) were alive in SR at day 365 without specific treatment, and the overall survival rate was 92% (95% CI, 71% to 98%). Rituximab was well tolerated, and the majority of adverse events were mild to moderate infections. Mild exacerbation of Kaposi's sarcoma (KS) lesions was observed in eight of 12 patients with previous KS.

Conclusion

Rituximab was both effective and safe in HIV-infected patients with chemotherapy-dependent MCD.