bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating climate model simulations of precipitation: methods, problems and performance
Authors: Airey Martin , Hulme Mike
Published: November 2007

Climate system modelling has been used extensively to investigate the role of human activities in causing global change. Model evaluation assesses the ability of the models used to simulate current climate. This article reviews the methodology of model evaluation with examples from recent studies involving precipitation. This crucial element of climate is difficult to model since the majority of precipitation occurs at scales less than that of the gridboxes of the highest resolution models. Detailed and reliable evaluation requires investigation of interannual variability as well as of climatological means on a variety of spatial scales. This sort of detailed analysis requires time-series of observed global precipitation at monthly time-steps or less. No single currently available global dataset of precipitation fulfils all the requirements for model evaluation, making the comparison of modelled global precipitation fields with 'reality' difficult. A number of recent precipitation evaluation projects are reviewed and a hierarchy of evaluation methods is provided based on spatial and temporal scale and whether or not tests for statistical significance are applied. Most studies to date have not tested for statistical significance, although when models improve with higher resolution and better physical parameterizations, statistical significance testing of differences will become increasingly more essential. The problems of evaluating modelled precipitation are being tackled by international projects such as the Global Precipitation Climatology Project, the WetNet Precipitation Intercomparison Projects and the Atmospheric Model Intercomparison Project. The results of evaluation studies to date emphasize that model simulations of future changes to the magnitude, timing and spatial pattern of global precipitation be viewed as scenarios and not as predictions.
Cyanobacterial (blue-green algal) blooms in the UK: a review of the current situation and potential management options
Authors: Howard A. , McDonald A.T. , Kneale P.E. , Whitehead P.G.
Published: November 2007

Nuisance cyanobacterial blooms are an important environmental problem. Toxins released by cyanobacteria can kill animals and cause illness in humans. The sustainable manage ment of toxic cyanobacteria would increase the conservation and amenity value of affected water bodies, and decrease on-site water treatment costs. Methods are available to kill or to prevent blooms but often the expense is prohibitive or the agent used is detrimental to desirable lake organisms. Different management strategies are therefore considered within the context of the current state of the UK water industry. Particular reference is made to the potential impact of the 1994 Ofwat-determined water-price increase limits on environmental policy and prioritization.
Recent developments in luminescence dating of Quaternary sediments
Authors: Duller G.A.T.
Published: November 2007

Luminescence dating is an important technique for providing chronological control for Quaternary sedimentary sequences. In this article recent developments in luminescence dating are described, together with the implications of these developments for the application of the various types of luminescence dating techniques now available. In particular, the development of optically stimulated luminescence (OSL) techniques has had a profound effect upon the field, enabling younger materials to be dated, increasing the diversity of depositional environments that can be dated, and allowing the development of novel methods of age determination. The most exciting developments are the ability to obtain luminescence ages for samples in the age range from 100 to 1000 years, and the ability to date individual sand grains from a sample.
Impacts of global climate change in a hydrologically vulnerable region: challenges to South African hydrologists
Authors: Schulze R.E.
Published: November 2007

South Africa is already hydrologically vulnerable and this is likely to be exacerbated by both nonpermanent ENSO-related as well as more permanently greenhouse-gas forced climate changes. Climate change effects are explained by way of the hydrological equation. This serves as a backdrop to a brief review, in a hydrological context, of projected perturbations to temperature, rainfall and potential evaporation, over southern Africa. Methodologies for simulating hydro logical responses to climate change are assessed. These include more direct GCM-derived output, with some emphasis on recent advances in climatic downscaling, and the application of appro priate hydrological models for use in impact studies. Scale problems of importance to hydrologists are highlighted. Directions to which climate change-related hydrological research efforts should be expended in South Africa are summarized, before two case study simulations, one a general sensitivity study of hydrological responses to changes in rainfall over southern Africa, the other a more specific hydrological response study to the El Niño of the 1982-83 season, are presented. The article concludes with a discussion on whether or not water resources practitioners in South Africa should respond to climate change.
Landscape and plant community boundaries in biogeography
Authors: Kent Martin , Gill Wendy J. , Weaver Ruth E. , Armitage Richard P.
Published: November 2007

The increasing relevance and importance of the subject of landscape ecology to bio geography are introduced. Research into landscape and plant community boundaries, never theless, remains comparatively neglected. In particular, the nature of those boundaries in terms of the patterns of floristic change and related ecosystem properties constitutes a potentially signifi cant new area of research for biogeographers. The term 'ecotone' has traditionally been used to describe boundaries between plant communities and ecosystems at a range of scales. Various definitions are presented and the often confusing terminology surrounding the word 'ecotone' is reviewed. Boundary types range from sharp, clearly defined boundaries (ecotones) between more highly modified plant communities and anthropogenically created land-use types at one extreme, to more gradual and diffuse boundaries (ecoclines) between natural and semi-natural plant communities at the other. It is proposed that the term 'transitional area' is used to describe all types of vegetation boundary when working at the local/community scale.

There is little literature of direct significance to the subject of transitional areas. The concept can only be meaningfully discussed in the context of recent developments in the conceptualization of the plant community and these are summarized. The importance of mosaics within plant communities is described and the need to understand and recognize mosaics when studying transitional areas between plant communities is emphasized.

The range of research methods available to describe and analyse variations in patterns of floristics and associated environmental variables across transitional areas is then critically reviewed. The potential relevance of remote sensing and geographical information systems, net work analysis and fractals is demonstrated. Ideas on possible adaptations of sampling strategies for the description of floristics and environmental/biotic factors to cater for boundary/transitional area situations are presented and the concept of a rectangular sampling area as an alternative to the more normal linear transect is introduced. The traditional approach to the description of vegetation change across boundaries using transects and similarity coefficients has now been superseded by new developments, notably moving-window analysis, the Mantel test, pattern analysis, semi-variograms, spectral analysis and analysis for spatial autocorrelation, and the scope of these methods is summarized.

Finally, the dynamics of plant communities and their boundaries are considered and the implications of research into transitional areas for vegetation management and biological conserv ation are assessed. The importance of this whole subject as a possible new focus for biogeography and spatial ecology is then reiterated.
Pronival (protalus) ramparts: a review of forms, processes, diagnostic criteria and p alaeoenvi ronmental implications
Authors: Shakesby R.A.
Published: November 2007

Most of the literature on pronival (protalus) ramparts deals with supposed fossil examples with very few studies devoted to active features and/or observed processes. Not surprisingly, this has led to circular reasoning and assumptions about typical rampart form, constituent material and genesis that have been shown to be inadequate or spurious from the few detailed investigations of actively forming ramparts so far carried out. Nevertheless, reliance continues to be placed on the characteristics of fossil features in the search for previously unidentified fossil examples. This article provides a critical review of rampart terminology, morphology and sedimentology, mechanisms, 'diagnostic' criteria, position in a continuum of talus-derived landforms and palaeoclimatic significance. It is suggested that the descriptor pronival is preferable to the widely used protalus, as the latter is misleadingly restrictive in terms of the known range of possible locations. Greater variability in terms of form and mechanisms of formation than most workers assume is indicated by recent studies of active features, with multiple as well as single ridges, fines and edge-worn as well as coarse angular clasts being found, and a variety of supranival and also subnival processes regarded as possibly contributing to rampart formation. It is concluded that only when further investigations of actively forming ramparts have been carried out, will it be possible to compile a reliable list of criteria for dist inguishing ramparts from moraines, protalus rock glaciers and other bedrock cliff-foot deposi tional forms. Correct identification of fossil ramparts may then lead to a better understanding of 1) their place in a continuum of talus-derived landforms; and 2) their potential as palaeoclimatic indicators.
Interleukin-1 and Interleukin-6 Activities are Increased in the Cerebrospinal Fluid of Patients with CNS Lupus Erythematosus and Correlate with Local Late T-Cell Activation Markers
Authors: Alcocer-Varela Jorge , Aleman-Hoey Deborah , Alarcon-Segovia Donato
Published: November 2007

We examined cerebrospinal fluid (CSF) samples from 12 patients with SLE and active central nervous system (CNS) involvement for their levels of the following cytokines: interleukin- 1 (IL-1) by means of two different assays-the IL-1 responsive murine cell line LBRM 33-1a5 and an ELISA for IL-1 alpha; IL-2 by means of the CTLL cell line responsive to it; and interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF) both determined by a specific ELISA. We found that SLE CSF had significantly higher levels of IL-1 and IL-6 than did those obtained at surgery from eight controls without inflammatory neurologic disease. IL-2 and TNF were not detectable in any of the CSF samples. We also studied the status of activation in CSF T cells using monoclonal antibodies against early (anti-IL-2R (CD25) and antitransferrin (CD71)), late (anti-T10) and very late (anti-VLA-1) activation antigens, and found increased percentages of T10-bearing (18 ± 2 vs 3 ± 0.7%) and VLA-1-bearing T cells (12 ± 2 vs 0.7 ± 0.2%) in SLE patients as compared to controls (both P < 0.01). Levels of IL-1 and IL-6 correlated with T10 and those of IL-1 correlated also with VLA-1. Markers of early T-cell activation did not differ in SLE and control CSF. Because of these findings we analysed the effect of recombinant IL,-I, IL-6 or normal CSF on normal T cells and found that they did not induce the expression of activation markers. However, incubation in SLE CSF caused CD25, T10 and VLA-1 activation markers to become significantly expressed on cultured normal T cells. This expression of T10 and VLA-1 was partially inhibited by pre-incubation in anti-human IL-1 alpha polyvalent antibody.

Our findings suggest increased in situ production of IL- and IL-6 and perhaps other factors in CNS lupus that might condition T-cell activation in the CNS compartment. These findings could have pathogenetic significance.
Antiphosphatidylethanolamine Antibodies in Systemic Lupus Erythematosus
Authors: Karmochkine M. , Berard M. , Piette J.C. , Cacoub P. , Aillaud M.F. , Harlet J.R. , Godeau P. , Boffa M.C.
Published: November 2007

Antiphosphatidylethanolamine antibodies (aPEA) were investigated in a population of 78 systemic lupus erythematosus (SLE) patients, by means of an enzyme-linked immunosorbent assay method. These antibodies are specifically directed against phosphatidylethanolamine, one of the zwitterionic phospholipids present in cell membranes. Antiphosphatidylethanolamine antibodies were found in 13 patients (16.6%). They were generally associated with lupus anticoagulant (two patients), antiphospholipid antibodies directed against anionic phospholipids (six patients), or both (four patients). In only one case, aPEA were the sole detectable antiphospholipid antibodies. Thrombosis, recurrent fetal loss, valvular disease or neurological involvement was present in most (11 of 13) of the patients with aPEA. It seems valuable to carry on further searches for these antibodies in SLE, since patients with aPEA are at higher risk of thrombosis and/or recurrent fetal losses than are patients with antiphospholipid antibodies (anticardiolipin, anti-anionic phospholipid and/or lupus anticoagulant) other than aPEA. Moreover, since aPEA can be the sole detectable antiphospholipid antibodies, they should be investigated in SLE with thrombosis when neither lupus anticoagulant nor anticardiolipin antibodies can be demonstrated.
Clinical Renal Involvement in Afro-Caribbean Lupus Patients
Authors: Nossent J.C.
Published: November 2007

This study reports the severity of clinical lupus nephritis (LN), defined as the sustained presence of proteinuria and/or cellular casts, in a group of 68 newly diagnosed patients with systemic lupus erythematosus (SLE) in Curaçao. Fifty-four patients (78%) developed clinical signs of LN, of whom 31 (34%) had clinical LN at the time of SLE diagnosis. The probability of developing clinical LN reached 80% in the first 3 years after SLE diagnosis and hardly increased later.

No clinical or serological differences existed at the time of SLE diagnosis or at onset of LN between patients with early-or late-onset LN. Survival in patients without LN was 100% at 5 years, while for patients with clinical LN these rates at 1 and 5 years were 91% and 59%, respectively (P = 0.0001); male LN patients had a worse prognosis than females (P = 0.012), while time of LN onset did not influence survival. Six patients (11 %) developed end-stage renal failure; all were female, five had early LN and one had late-onset LN (P = 0.17). Renal survival was 97% and 80% at 1 and 5 years, with decreased rates for patients with nephroticrange proteinuria (P = 0.02). Hypertension was present in 13% of LN patients, but had no influence on patient or renal survival. Thus, clinical LN was a frequent complication, which carried a poor prognosis in these Afro-Caribbean lupus patients.
Relationship of IL-2, IL-2R (CD25+), Soluble IL-2R and IL-4 with Disease Activity in SLE Patients
Authors: Cuadrado Maria J. , Marubayashi Miriam , Ortega Consuelo , Fernandez-Arcas Nieves , Garcia-Cozar Francisco , Pena Jose , Sanchez-Guijo Pedro , Santamaria Manuel
Published: November 2007

The plasma levels of interleukin-4 (IL-4), interleukin-2 (IL-2), soluble receptor of IL-2 (IL-2R) and T cell expression of IL-2 receptor chain (CD25+) were determined in an attempt to relate these parameters with disease activity in systemic lupus erythematosus (SLE). IL-4, IL-2 and sIL-2R plasma levels of SLE patients were significantly higher than those of the control group (P<0.05) while CD25+ expression was similar in both groups. Only sIL-2R levels were significantly higher (P<0.05) in active than in inactive patients.
Systemic Lupus Erythematosus in Greece. Clinical Features, Evolution and Outcome: a Descriptive Analysis of 292 Patients
Authors: Vlachoyiannopoulos Panayiotts G. , Karassa Fotini B. , Karakostas Kostas X. , Drosos Alexandros A. , Moutsopoulos Haralampos M.
Published: November 2007

The purpose of this study was the descriptive analysis of patients with systemic lupus erythematosus (SLE) with a particular focus on initial clinical features, evolution and outcome of disease, prevalence of clinical and serological manifestations and identification of clinicoserological associations indicative of renal and CNS involvement. The methodology applied was the following: retrospective analysis of the clinical charts of 292 unselected patients (246 female (84.2%) and 46 male (15.7%)) with SLE examined between 1982 and 1992. Multivariate analysis and hierarchical log linear models were used to examine for clinicoserological associations. Descriptive analysis was based on the prevalence of main clinicoserological features and disease outcome. The outcome was examined on the basis of the number of flares, the presence of chronic renal failure, the presence of central nervous system (CNS) involvement with subsequent disability and deaths. Flares were considered the severe alterations in disease status, requiring additional therapy to be controlled. The disease begins most frequently in the second and third decade of life with cutaneous and joint manifestations, while renal and CNS involvement developed later. The prevalence of serious renal, pulmonary and CNS involvement as well as the prevalence of RF, anti-Sm and anti-nRNP antibodies remain low. Multivariate analysis revealed the associations of renal involvement with leukopenia and serositis, of anti-Sm with leukopenia, of secondary Sjogren's syndrome with RF and of thromboembohc events with anticardiolipin antibodies. Patients with childhood onset SLE have a higher tendency for developing renal involvement than adult onset SLE patients. In addition, anti-Ro(SSA) antibodies were associated with anti-La(SSB) and RF, while anti-Sm antibodies were associated with anti-nRNP and RF. Flares occurred with a frequency of 0.07 per patient per year. Only 63.6% of flares were accompanied by positive anti-dsDNA reactivities. Reported deaths were 0.0047 per patient per year. Hierarchical log linear models indicated that the main variables of the disease were sufficient to describe our disease model and that the arder of the interaction between the variables was insignificant. We conclude that the prevalence of various clinical features associated with SLE is similar, although the prevalence of CNS and pulmonary involvement as well as anti-Sm and anti-nRNP antibodies are less prominent in Greek SLE patients than that reported in the literature. The various clinicaseralogical associations detected do not appear to be of major significance as they are not powerful enough to subgroup the disease.
Lupus Anticoagulant and Cardiac Manifestations in Systemic Lupus Erythematosus
Authors: Jouhikainen Taneli , Pohjola-Sintonen Sinikka , Stephansson Eua
Published: November 2007

The occurrence of cardiac manifestations and their relationship with the lupus anticoagulant (LA) in SLE was studied in 74 patients who were followed up for 22 years (median), of which 16 years were after the initial LA testing. Pericarditis was the most common cardiac event occurring in 16 (22%) patients but it did not correlate with LA. Valvular heart disease, coronary artery disease, left ventricular failure and/or cor pulmonale were observed in 16 (22%) patients. Taken together, their occurrence was associated with a history of leg ulcers (odds 3.8, P = 0.028) but not with LA or other common clinical manifestations of the antiphospholipid syndrome. Valvular heart disease in five patients was significantly associated with LA (P = 0.05). Cor pulmonale due to chronic pulmonary embolism was present in two patients with LA. Myocardial infarctions in five patients occurred late in the course of disease but in relatively young patients (mean 43 years). Fatal myocardial infarction in the absence of atherosclerosis in two LA-positive patients supports a pathogenetic role for LA in these cases.

In conclusion, of the various cardiac complications in SLE, valvular heart disease and cor pulmonale appear to be connected with the antiphospholipid syndrome. Both conditions should be actively sought in patients with LA to decrease possible adverse events (arterial emboli and right ventricular failure) affecting the patients' prognosis.
Liver transplantation in patients with systemic lupus erythematosus
Authors: Barthel Hans Richard , Wallace Daniel J , Klinenberg James R
Published: November 2007

Liver transplantation has never been reported in patients with systemic lupus erythematosus (SLE). At our medical center, three patients with SLE underwent transplantation and it was successful in two of them. Management considerations germane to SLE are reviewed.
In Utero identification and therapy of congenital heart block
Authors: Buyon JP , Waltuck J. , Kleinman C. , Copel J.
Published: November 2007

To determine the feasibility and effectiveness of prenatal therapy of congenital heart block (CHB), information was sought regarding the timing of identification of CHB in 72 pregnancies and the outcome of those pregnancies in which the mothers were administered corticosteroids. Mailed questionnaires with telephone follow-up, data from primary physicians and chart review were utilized. In 38 (53%) of affected pregnancies CHB was identified between 16 and 24 weeks of gestation, in 17 (24%) between 25 and 30 weeks of gestation, in 8 (11%) between 31 and 37 weeks, and in 5 (7%) between 38 and 40 weeks. In four pregnancies the timing was unknown. Five women were taking prednisone for disease activity prior to the discovery of CHB and in six other women prednisone therapy was initiated at or about the time CHB was identified. In 19 pregnancies, women were given fluorinated steroids (available to the fetus in an active form) as attempted therapy after the discovery of CHB. Of these, one fetus with second degree block reverted to sinus rhythm and two with third degree block exhibited an improvement in the degree of block. In eight fetuses pleural and/or pericardial effusions resolved. In conclusion, the gestational period of heightened fetal vulnerability for the development of heart block is in the mid second to early third trimester. Although there is no evidence that maternal prednisone should be used prophylactially, fluorinated steroids may be efficacious after the identification of heart block, particularly with regard to an associated myocarditis.
Demonstration of antiphospholipid antibody heterogeneity by phospholipid column chromatography and salt gradient elution techniques
Authors: Walton S.P. , Pierangeli S.S. , Campbell A. , Klein E. , Burchitt B. , Harris E.N.
Published: November 2007

Antiphospholipid (aPL) antibodies are associated with thrombosis, recurrent abortions and thrombocytopenia. Studies to determine the mechanisms of action of these antibodies have been hindered by their heterogeneity and limited availability of techniques to isolate and characterize subgroups of the antibodies. We report a new phospholipid affinity chromatography method which enables separation of antiphospholipid positive sera into more than one antibody subpopulation. Sera from five patients with complications of the antiphospholipid syndrome (APS) were studied. Each serum was applied to chromatography columns prepared by coating polystyrene beads (diameter 100 Å) with phosphatidylserine (PS) or cardiolipin (CL). A linear salt gradient (0.03-1.0 M NaCl) was used for elution. Eluates were analyzed for phospholipid binding and for inhibition of the prothrombin-thrombin conversion reaction. Each sample yielded two to three peaks for CL and PS affinity columns. Molarities at which peaks were eluted differed between samples. For individual samples, molarities at which peaks were eluted differed between CL and PS columns. These data suggest that aPL antibodies are heterogenous, with differences existing between patients and even within single serum samples. Subpopulations differed in their avidities for CL and PS but generally all had prothrombinase inhibitory activity.
Synovial fluid cells in systemic lupus erythematosus: light and electron microscopic studies
Authors: Schumacher HR , Howe HS
Published: November 2007

Joint fluid findings in systemic lupus erythematosus (SLE) have been described in only a few series and systematic electron microscopic study of the synovial fluid (SF) cells has not been reported. We describe the evaluation of 17 SF in patients with SLE with routine analysis and electron microscopy. Joint effusions had a wider range of leukocyte counts than often appreciated, with counts varying from 875 to 39 250 cells per mm3. LE inclusions were seen in eight fluids and have been shown to contain chromatin-like filaments by electron microscopy. There was little associated electron dense immunoglobulin-like material. Tubuloreticular structures (TRS) found in seven SF were mostly in mononuclear cells including some LE cells. The known association of TRS with alpha interferon and viral infections may have important implications for pathogenesis.
Clinical evaluation of various selected ELISA kits for the detection of anti-DNA antibodies
Authors: Aviña-Zubieta JA , Galindo-Rodriguez G. , Kwan-Yeung L. , Davis P. , Russell AS
Published: November 2007

Fifty four coded sera, 38 from eight patients with systemic lupus erythematosus (SLE), four from one patient with systemic vasculitis, one from one patient with polyarthritis and 11 normal controls were tested for anti-dsDNA antibodies using seven commercial enzyme linked immunosorbent assays (ELISA) and the radioimmunoassay method (RIA) routinely used in our unit. Sensitivity, specificity and predictive values were tested for both SLE diagnosis and disease activity. Using anti- dsDNA antibodies as a diagnostic test for SLE there were differences in sensitivity (from 66% to 95%), specificity (from 75% to 100%), predictive positive values (from 89% to 100%) and predictive negative values (from 50% to 87%) among ELISA kits. The RIA method was either more specific or equal to ELISA kits. Using 'equivocal' values as positive values an increase in sensitivity was observed but at the expense of specificity. Similar differences and trends were observed when the results were used as a measure for disease activity. This suggests that there are differences in sensitivity, specificity and predictive values among ELISA kits both in the diagnosis of SLE as well as in the determination of disease activity.
Review : Antibodies to fibrin-bound tissue-type plasminogen activator in systemic lupus erythematosus are associated with Raynaud's phenomenon and thrombosis
Authors: Salazar-Paramo Mario , Garcia de la Torre Ignacio , Fritzler Marvin J , Loyau Stéphane , Anglés-Cano Eduardo
Published: November 2007

Fibrinolysis triggered by t-PA bound to fibrin is one of the main antithrombotic mecha nisms. Defects in the fibrinolytic system - decreased tissue-type plasminogen activator (t- PA) activity and elevated levels of plasminogen activator inhibitor (PAI-1), in patients with SLE have been associated with an increased tendency to thrombosis. In the present study, 43 patients with SLE fulfilling the ACR criteria for the disease, were studied for the presence of autoantibodies to fibrin-bound t-PA, i.e. the physiological active form of this plasmin ogen activator. A solution of 200IU/ml of t-PA was incubated with solid-phase fibrin pre pared as previously described ( Anal Biochem 1986; 153: 201-210). Sera diluted 1 : 50 were incubated with fibrin-bound t-PA, the plates were then washed, and bound immuno globulins were detected using a polyvalent peroxidase-labeled goat anti-human Ig. Plates coated with fibrin alone were used as controls. Sera were considered positive when A490/ 630 obtained with normal human sera in two independent test was greater than the mean plus 2 SD. Eleven of 43 (26%) SLE sera demonstrated antibody reactivity against fibrin- bound t-PA. Within the anti-t-PA positive group there was a higher proportion of SLE patients with severe Raynaud's phenomenon and thrombotic events when compared to the anti-t-PA negative group: 36% vs 6% and 18% vs 6%, respectively. These results suggest that autoantibodies to fibrin-bound t-PA could play a role in the pathogenesis of vascular disease in some SLE patients.
Acinetobacter pericarditis with tamponade in a patient with systemic lupus erythematosus
Authors: Lam S-M. , Huang T-Y.
Published: November 2007

We describe a case of active systemic lupus erythematosus (SLE) complicated with a large amount of pericardial effusion with diastolic collapse of right ventricle suggestive of tamponade. Isolates from surgical drainage of pericardial fluid showed Acinetobacter baumannii exhibiting multiple antibiotics resistance. Despite the high frequency of both pericardial involvement and of infection complications in SLE, septic pericarditis and tamponade is considered rare. Most of the reported cases of septic pericarditis in SLE were due to Staphylococcal aureus, and Acinetobacter baumannii has never been reported before.
Review : Obstetric outcome in antiphospholipid syndrome
Authors: Granger KA , Farquharson RG
Published: November 2007

The presence of lupus anticoagulant (LA) and anticardiolipin antibodies (ACA) are associated with recurring pregnancy loss. Of 387 consecutive patients investigated at a Recurring Miscarriage Clinic over a three year period, 63 (16%) were positive for LA and ACA or both. Fifty-nine patients by definition were classified as having antiphospholipid syndrome and four also had systemic lupus erythematosus (SLE). Fifty-three subsequent pregnancies occurred in 63 patients and of these 37 ended in a live birth giving an overall livebirth rate of 70%

Treatment included low dose aspirin alone in 37 pregnancies and low dose aspirin and low molecular weight heparin (L11WH) in 16 pregnancies. The decision for treatment was made empirically on past obstetric history and level of LA and ACA, and past history of venous thromboembolic disease. Obstetric outcome was worst in the group who were positive for both LA and ACA, with a success rate of 53%, compared to 72 or 81% in the single parameter groups. Complications in the 37 successful pregnancies included eight Caesarean sections, four cases of intra-uterine growth restriction, one case of pregnancy induced proteinuric hypertension, one deep vein thrombosis and one pulmonary embolism. Patients with antiphospholipid syndrome are at high risk of pregnancy loss as well as maternal morbidity, especially thrombo-embolic disease. A randomised prospective controlled trial is necessary to determine the optimum therapy for pregnancy conservation and thrombprophylaxis.
Cerebral microemboli in patients with antiphospholipid syndrome
Authors: Specker Ch , Rademacher J. , Söhngen D. , Sitzer M. , Janda I. , Siebler M. , Steinmetz H. , Schneider M.
Published: November 2007

CNS involvement is one of the hallmarks underlying poor prognosis in SLE and for therapeutic strategies it is difficult to assess which patients are at risk. As detectability of cerebral microembolic signals (MES) using long-term transcranial Doppler ultrasonography (TCD) proved to be predictive of past and future thromboembolic events in patients with carotid artery stenosis, we investigated whether MES might be similarly useful in patients with antiphospholipid syndrome (APS).

Our study population consisted of 46 SLE patients and five with primary APS (pAPS). Twelve of the 46 patients with SLE, 10 of them with secondary APS (sAPS), and four of five patients with pAPS had a history of cerebrovascular ischaemia (CVI). MES in the middle cerebral artery were detected in 14 of 16 patients with and in one of 35 without CVI ( P < 0.001). Antiphospholipid antibodies (aPL) were positive in 12 of 15 patients with and 18 of 36 without MES, and the rate of MES correlated to the titre of aPL. MES from APS patients resembled in their energy distribution those from patients with symptomatic carotid disease and were significantly different from those associated with artificial heart valves.

In conclusion, cerebral MES are detectable in APS patients and correlate with a history of CVI. Whether this innovative method may provide individual risk assessment in APS patients has to be addressed in prospective studies.
Atherosclerosis in LDL-receptor knockout mice is accelerated by immunization with anticardiolipin antibodies
Authors: George J. , Afek A. , Gilburd B. , Levy Y. , Blank M. , Kopolovic J. , Harats D. , Shoenfeld Y.
Published: November 2007

Atherosclerosis is a process initiated by accumulation of macrophages in distinct areas of endothelial cell damage and uptake of large amounts of lipids. Recently, it has been shown that the immune system plays an active part in the progression of the atherosclerotic plaque although its precise role has not yet been elucidated.

Anticardiolipin antibodies (aCL) are generally found in the sera of patients with the antiphospholipid syndrome (APS) and are associated with a prothrombotic state. Several authors have demonstrated that aCL can activate platelets and endothelial cells as well as increase oxidized low density lipoprotein (LDL) uptake by macrophages. In the present study we sought to assess the effect of immunization with aCL (Ab1, leading to the production of mouse aCL-Ab3) on the progression of atherosclerosis. Two groups of 8-weeks old female LDL-receptor knockout mice (n = 13 per group) were immunized with IgG purified from the serum of an APS patient or with normal human IgG, respectively. The aCL immunized mice developed high titres of 'self' aCL (detected using the standard aCL ELISA) as compared with the normal human IgG immunized mice, whereas no differences were noted between both study groups with respect to the serum lipid levels. The extent of fatty streak formation was significantly higher in the aCL immunized mice in comparison with the human IgG injected mice (mean aortic lesion size of 5308 ± 471 μm2 vs 1027 ± 184 μm2, respectively, P < 0.01). The immunohistochemical analysis of the atherosclerotic plaques from both mouse groups did not display differences in cellular composition.

The results of the study show that mouse aCL induced by immunization with human aCL from an APS patient enhance atherogenesis in LDL-RKO mice and imply that these antibodies may play a role in atherosclerosis development in patients with the APS.
Ethical Reasoning Concerning the Feeding of Severely Demented Patients: an International Perspective
Authors: Norberg A. , Hirschfeld M. , Davidson B. , Davis A. , Lauri S. , Lin J.Y. , Phillips L. , Pittman E. , Vander Laan R. , Ziv L.
Published: November 2007

Structured interviews were held with 149 registered nurses in seven countries in America, Asia, Australia and Europe concerning the feeding of severely demented patients who do not accept food. The most common reasons for nurses being willing to change their decision to feed or not to feed were an order from the medical head, a request from the patient's husband and/or the staff meeting. There was a connection between the willingness to feed and the ranking of ethical principles. Nurses who were most prone to feed the patient most often gave a high rank to the ethical principle of sanctity of life, while those who primarily chose not to feed the patient gave a high rank to the ethical principle of autonomy. All nurses stressed the ethical principle of beneficence.

Des interviews structurés ont eu lieu avec 149 infirmiers/ères dans sept pays en Amérique, Asie, Australie et Europe concernant l'alimentation des malades gravement dément qui refusent de manger. La raison la plus générale pour des infirmiers/ères d'être prêt à changer leures décisions de donner à manger ou non sont: un ordre du médecin, la demande du mari de la malade ou de la réunion du personnel. Il y avait un lien entre la volonté de nourir et le rang des principes éthiques. Les infirmiers/ères les plus enclins de nourir la malade le plus souvent donnaient un rang supérieur au principe éthique de la sainteté de vie, pendant que ceux et celles qui choisissaient de ne pas nourrir la malade donnaient un rang supérieur au principe éthique de l'autonomie. Tous insistaient sur l'importance du principe éthique de la bienfaisance.

Konstruktive Interviews wurden mit 149 ausgebildeten Krankenschwestern und Pfleger in sieben Ländern in Amerika, Asien, Australien und Europa gehalten über die Ernährung von schwer von Dementia praecox leidenden Patienten, die das Essen verweigern. Die gewöhnlichsten Gründe des Pflegepersonals für die Bereitwilligkeit, ihre Entscheidung, zu ernähren oder nicht, zu ändern, waren Anordnungen vom medizinischen Chef, Anfragen vom Ehemann der Patientin und/oder einer Personalsitzung. Es bestand ein Zusammenhang zwischen der Bereitwilligkeit zur Ernährung und dem Rang der ethischen Prinzipien. Die Pflegenden, die sich am meisten neigten, die Patientin zu ernähren, gaben dem ethischen Prinzip der Heiligkeit des Lebens einen hohen Rang, während die, die meistens vorzogen, die Patientin nicht zu ernähren, gaben dem ethischen Prinzip der Autonomie einen hohen Rang. Alle Pflegenden legten grossen Wert auf das ethische Prinzip der Wohltätigkeit.
Ethics and Research in Nursing
Authors: Rogero-Anaya P. , Carpintero-Avellaneda J.L. , Vila-Blasco B.
Published: November 2007

Considering the importance of research in the development of nursing, we examine the ethical principles governing nurses' investigative activity, as well as the different codes regulating biomedical investigation with human beings, amongst which are the Nuremberg Code, the Declaration of Human Rights, and the Declaration of Helsinki.

From the perspective of the central points of the article reference is made to different codes proposed by international nursing associations, as well as reviewing the Deontological Code of Spanish Nursing.

The ethical principles a nurse has to bear in mind in research are analysed, with respect to patients, society and the profession. Finally, we refer to certain ethical aspects to be considered in the elaboration and development of a research project, as well as publication of the results.
Ethical Decision-Making by Staff Nurses
Authors: Smith Katharine Vogel
Published: November 2007

Ethical decision-making is inherent in nursing practice. Although a definite portion of the nursing literature is devoted to ethics and ethical decision-making, the profession is just beginning to ground its ethics research in the actual experience of nurses. Therefore, the purpose of this phenomenological study was to examine the experience of staff nurses as they engage in ethical decision-making. Interview data were collected from 19 staff nurses in a large, midwestern American metropolitan hospital. Interviews were subse quently transcribed and Giorgi's method of data analysis applied. The emerging descrip tion revealed four common aspects of ethical decision-making among staff nurses: context, trigger, ethical decision-making process (i.e. deliberation and integration), and outcomes. This description provides a foundation for future research regarding a descrip tive theory of ethical decision-making in nursing.
Provider Choice: Essential To Autonomy or Advertising Gimmick?
Authors: Olsen Douglas P.
Published: November 2007

Free choice of provider is heralded as a right of autonomy, but the goals of autonomy are better served in today's health care environment when there is informed choice of the care delivery system. The principle of liberty is distinguished from respect for auton omy. Free choice of provider would be demanded only by liberty, except that allocation of health care resources does not meet criteria for the application of liberty.

Patients attempting to choose the best practitioner do not have data to support the decision. If data were available, access to these superior practitioners would become an allocation problem. A mythology of the wise practitioner fosters the concept of provider choice as a personal judgement about clinical knowledge.

The emerging trends of collaborative care, standardization of practice guidelines and diversity of delivery systems among reimbursers create a situation where a patient's autonomy to choose goals for treatment is respected through the choice of delivery sys tem.
Ethical Dilemmas Faced By the Nursing Disciplinary Committee
Authors: Wagner Nurit , Tabak Nili
Published: November 2007

This article presents the complicated ethical dilemmas that arise in the procedures and proceedings of the Nursing Disciplinary Committee, which deals with matters of life and death (e.g. patients' rights to quality. and safe care, professional integrity and account ability, and the nurse's future). The article also describes the composition and function of the Committee, the type of case it deliberates, its limitations, and the dilemmas its members may encounter.
Exploring Ethical Dilemmas in Perioperative Nursing Practice Through Critical Incidents
Authors: von Post Iréne
Published: November 2007

This article describes the nature of ethical dilemmas in perioperative nursing practice. Using the Critical Incident Technique, common ethical dilemmas experienced by periop erative nurses are explored.

The aim of the study was to elicit the ethical dilemmas that arise in perioperative nurses' practice. The study has a descriptive design and the data are critical incidents described by 48 anaesthetic nurses and 76 operating theatre nurses. An analysis of the critical incidents gave four domains of ethical dilemmas: those arising as value conflicts in the intraoperative phase of surgery; those emanating from the patient's right of self- determination ; those arising in caring for patients; and those resulting from the alloca tion of scarce resources and the demands of increased effectiveness.
Portents, Disaster, and Adaptation in Sixteenth Century Germany
Authors: Sodrgel Philip M.
Published: November 2007

Historians have long noted an upswell in early-modern Germany in portents, signs worked in nature that pointed to future ills, and have interpreted this increase as an indicator of rising anxiety and fears, fears that were the result, either of a new ‘guilt culture’, or which were conditioned by the generally dismal relationship that sixteenth- and seventeenth-century people had to their environment. This article argues for a new interpretation. It relies on recent studies in the psychology of well-being which have shown that natural disasters and a dismal environment do not condition human beings to long-term fear and anxiety. Instead, the mind's ability to adapt to such trials is evidence of an evolutionary process of ‘hedonic adaptation’. The subsequent investigation draws upon the works of Martin Luther, one sixteenth-century moralist generally judged to be among the bleakest critics of the time, to show that his attitude towards the environment was complex and multifaceted, and was not characterised by an unrelieved pessimism towards nature. The conclusions thus call upon scholars of natural disaster to distinguish carefully between long-standing theological commonplaces concerning sin and its effects upon nature and the genuine reactions of human beings to historical disasters.
‘...prima ci fu la cagione de la mala provedenza de’ Fiorentini...’ Disaster and ‘Life World'—Reactions in the Commune of Florence to the Flood of November 1333
Authors: Schenk Gerrit Jasper
Published: November 2007

Early in November 1333 flood waters gushed into the city of Florence. Giovanni Villani, eyewitness and chronicler of this disaster, wrote extensively on contemporary discourses about its origins. In recent research Villani's explanatory models have been viewed as characteristic of the oscillatory perceptions of his contemporaries, alternating between factors of natural history and notions of theological guilt. However, even Villani cited the lack of preparedness on the part of the inhabitants of Florence as the foremost cause of this particular tragedy that overtook his city. This explanation, which constitutes one more contemporary reaction to the disaster, has been largely overlooked by research on the subject of the 1333 floods. The records of the city administration open up fresh insights into hitherto little known reactions and measures resorted to by the Commune of Florence. This allows us a glimpse into the ‘life-world’ of contemporaries. The emerging account of pragmatic responses and concrete measures is useful in giving us access to collective attitudes which can legitimately take their place alongside of earlier, well-known interpretive models seeking to uncover ‘theories of practice’ in dealing with natural disasters.
Narrative Conscience and the Autoethnographic Adventure
Authors: Poulos Christopher N.
Published: November 2007

This article explores the common practice in families of keeping secrets close, allowing them to develop a life of their own. The problem with this practice is that the secrets often won't stay put, emerging into everyday life as (sometimes unwelcome) interruptions in the flow of healthy living. Indeed, secrets and memories—if they remain untold stories—may, at times, be crippling. In this article, the author discusses the process of storying family secrets as a way to engage personal and family healing. In the writing of autoethnographic research, the relationship between the researcher and his or her significant others becomes a primary locus of ethical action. Relational research ethics, informed by narrative conscience, calls the researcher to embrace new layers of complexity in the search for the right story, written with care, while offering narrative and dialogic methodologies for dealing with the dilemmas that come with the territory.
Significance and impact of bisphosphonate-induced acute phase responses
Authors: Olson Karin , Van Poznak Catherine
Published: November 2007

Background: Bisphosphonates are synthetic analogs of inorganic pyrophosphates with high avidity for bone, where they bind to hydroxyapatite crystals. Bisphosphonates are effective in decreasing bone resorption, the incidence of skeletal-related events, and pain from bone metastases. These agents have recently become incorporated into the treatment regimen of patients with osteolytic and osteoblastic metastatic bone disease. Although relatively well tolerated, the initial dose(s) of intravenous aminobisphosphonates can be associated with an acute phase response, a nonspecific physiologic reaction associated with increased levels of inflammatory cytokines, fever, and flu like symptoms including fatigue, nausea, and myalgia.

Objective: The purpose of this article is to provide an updated review of the literature in this field.

Data Sources: A search of PubMed was performed using the key terms bisphosphonate, acute phase response, and cancer, and limited to publications in English. The published literature on acute phase response with bisphosphonate therapy was reviewed.

Results and Conclusions: Approximately 40% of patients receiving aminobisphosphonates experience an acute phase response, which generally occurs only on first exposure to the drug and typically last <72 h. Not all bisphosphonates induce acute phase responses to the same extent. This article reviews acute phase response in patients with metastatic bone disease treated with aminobisphosphonates. J Oncol Pharm Practice (2007) 13: 223—229.