bluuebunny/crossref_metadata_2025 huggingface dataset:
Impossible Things Before Breakfast: Myths in Education Abroad
Authors: Woolf Michael
Published: August 2007

In recent years, there has been a considerable development of administrative skills in study-abroad management, but much less in the educational dimension of this endeavour. The field is burdened by myths and conceptions that exist unchallenged in the uncontested climate of study abroad. An exploration of three of these prevailing myths demonstrates the degree to which the field needs to reexamine some of its assumptions: the association of immersion and integration with quality, the growth of short-term programmes, and the call to significantly expand programmes in nontraditional locations. This essay critically examines the misconceptions that have accumulated around these topics.
Creating Universities for a Multiethnic and Multicultural World: A Utopia?
Authors: Cooper Michael
Published: August 2007

The main challenge facing internationalsation of higher education is retaining roots in a cultural setting while being open to new influences. Internationalsation affects every aspect of university life. An initial issue this raises is language. Universities must decide in which languages to teach and which languages will be offered, decisions that raise questions regarding graduation requirements. It would seem a logical step to require all students to study a foreign language. Introducing language requirements into the curriculum necessitates considerable and probably continual revision of study and degree programmes. However, to meet their challenges and realise their opportunities, universities will no longer be able to go it alone. Apart from staff and student mobility, distance education, and other forms of delivery, universities will need to work together. The next decade will therefore see much close cooperation in networks, both general and disciplinary. Further development of joint study and research programmes will also characterise the period.
An Evaluation of Community Health Center Adoption of Online Health Information
Authors: Martinez Meredith A. , Kind Terry , Pezo Eduardo , Pomerantz Karyn L.
Published: August 2007

Health care providers and patients in community health centers often lack access to online scientific and patient education resources. These resources can improve medical decision making and promote communication between provider and patient. In 2000, a community health information program, Partners for Health Information, provided 10 community health centers in Washington, D.C. with computers, training, and consumer health resources, supplemented with visits to coach patients and staff in their use. The purpose of this study is to assess the adoption of the use of online health information among staff in seven of these health centers. The methods of this evaluation were designed to measure frequency of patient referral by health center staff to online health information and to describe providers' perceptions of the barriers and enablers to using online resources. Recommendations made by respondents can be used to modify the Partners program and guide the development of other similar programs.
How Using a Logic Model Refined Our Program to Ensure Success
Authors: Page Melissa , Parker Sheila H. , Renger Ralph
Published: August 2007

When a program does not produce expected changes in the outcomes of interest, program staff must understand why before making programmatic decisions. One mechanism for doing so is the logic model. This article describes how using one such logic model (the ATM approach) was used to improve areas of program planning and implementation. The key components include interviewing stakeholders to identify antecedent conditions to the problem of interest that are placed in a summary map and then prioritizing those conditions to address with program activities. Although the logic modeling process was helpful in making programmatic improvements, there were also several unintended benefits of engaging in the process including: providing a framework for planning and evaluation, helping the program operate more effectively and efficiently, and providing a common language among program staff and the evaluators.
Improving Nutrition Education Newsletters for the Food Stamp Eligible Audience
Authors: Harmon Alison H. , Grim Brian J. , Gromis Judy C.
Published: August 2007

The purpose of this study was to identify the types of nutrition newsletter content that reading clientele perceive as relevant to them in making healthy food choices consistent with sound dietary advice, and to identify ways newsletter design and wording affect the usefulness of the content. The authors conducted five focus groups with readers of nutrition education newsletters in three different regions of Pennsylvania between January and April 2003. All participants were obtaining food from their community food pantry, where newsletters are distributed by the Pennsylvania Nutrition Education Program. Major nutrition and health concerns of participants included heart disease, diabetes, dietary fat, and sodium intake. Recipes are the most highly valued portion of the newsletters. To summarize, newsletter readers indicate that effectiveness in facilitating food and nutrition behavior change is a function of the relevance, design, and practicality of the content.
Changes in Activity After a Complete Spinal Cord Injury as Measured by the Spinal Cord Independence Measure II (SCIM II)
Authors: Wirth Brigitte , van Hedel Hubertus J.A. , Kometer Barbara , Dietz Volker , Curt Armin
Published: August 2007

Background. The assessment of rehabilitation efficacy in spinal cord injury (SCI) should be based on a combination of neurological and functional outcome measures. The Spinal Cord Independence Measure II (SCIM II) is an independence scale that was specifically developed for subjects with SCI. However, little is known about the changes in SCIM II scores during and after rehabilitation. Objective. The aims of this study were to evaluate changes in functional recovery during the first year after a complete SCI as measured by the SCIM II compared with neurological recovery (motor scores according to the American Spinal Injury Association [ASIA]). Methods. SCIM II data and ASIA motor scores at 1, 3, 6, and 12 months after injury (derived from the database of the European Multicenter Study of Human Spinal Cord Injury) of 64 patients with complete paraplegia and 36 patients with complete quadriplegia were analyzed. Results. In patients with complete paraplegia, the SCIM II total score improved significantly during the 1-year follow-up, even after discharge from rehabilitation. In contrast, the ASIA motor scores showed little recovery. In patients with quadriplegia, functional and motor recovery developed in parallel during rehabilitation and after discharge. Conclusions. The SCIM II is responsive to functional changes in patients with a persistent motor complete SCI. It is clinically useful for monitoring functional improvement during rehabilitation and after discharge. The SCIM II and the clinical examination based on the ASIA protocol are of complementary value and separately describe changes in independence and sensorimotor deficits in SCI patients.
CONDOR: a database resource of developmentally associated conserved non-coding elements
Authors: Woolfe Adam , Goode Debbie K , Cooke Julie , Callaway Heather , Smith Sarah , Snell Phil , McEwen Gayle K , Elgar Greg
Published: August 2007

Background

Comparative genomics is currently one of the most popular approaches to study the regulatory architecture of vertebrate genomes. Fish-mammal genomic comparisons have proved powerful in identifying conserved non-coding elements likely to be distal cis-regulatory modules such as enhancers, silencers or insulators that control the expression of genes involved in the regulation of early development. The scientific community is showing increasing interest in characterizing the function, evolution and language of these sequences. Despite this, there remains little in the way of user-friendly access to a large dataset of such elements in conjunction with the analysis and the visualization tools needed to study them.

Description

Here we present CONDOR (COnserved Non-coDing Orthologous Regions) available at: http://condor.fugu.biology.qmul.ac.uk. In an interactive and intuitive way the website displays data on > 6800 non-coding elements associated with over 120 early developmental genes and conserved across vertebrates. The database regularly incorporates results of ongoing in vivo zebrafish enhancer assays of the CNEs carried out in-house, which currently number ~100. Included and highlighted within this set are elements derived from duplication events both at the origin of vertebrates and more recently in the teleost lineage, thus providing valuable data for studying the divergence of regulatory roles between paralogs. CONDOR therefore provides a number of tools and facilities to allow scientists to progress in their own studies on the function and evolution of developmental cis-regulation.

Conclusion

By providing access to data with an approachable graphics interface, the CONDOR database presents a rich resource for further studies into the regulation and evolution of genes involved in early development.
Cytokine profiles of cord and adult blood leukocytes: differences in expression are due to differences in expression and activation of transcription factors
Authors: Nitsche Andreas , Zhang Meixia , Clauss Theresa , Siegert Wolfgang , Brune Kay , Pahl Andreas
Published: August 2007

Background

Stem cell transplantation as therapy for hematological disorders is often hampered by severe graft-versus-host-disease. This may be reduced by umbilical cord blood transplantation, an effect that has been attributed to qualitative differences between neonatal and adult T cells. We compared levels of secreted proteins and cytokine mRNA induced in cord blood leukocytes (CBL) and adult blood leukocytes (ABL) by various stimuli.

Results

While interleukin-2 (IL-2) levels were similar in CBL and ABL, there was less induction of the Th1 cytokine interferon-γ in CBL. Production of the Th2 cytokines IL-4, IL-5, and IL-13 and the hematopoietic cytokine IL-3 was much lower in CBL versus ABL after T-cell receptor-mediated stimulation, whereas production of GM-CSF was comparable in the 2 cell types. The lower levels of Th1 and Th2 cytokines were maintained in CBL during a 4-day time-course study, while after 12 hours IL-3 and GM-CSF reached in CBL levels similar to those in ABL. For all cytokines except IFNγ, the IC50values for inhibition by cyclosporin A were similar in ABL and CBL. In contrast, there was less expression and activation of transcription factors in CBL. Activation of NF-κB by TPA/ionomycin was detected in ABL but not CBL. Furthermore, there was less expression of the Th subset-specific transcription factors T-bet and c-maf in CBL versus ABL, whereas GATA-3 expression was similar. Expression of T-bet and c-maf correlated with expression of the Th1 and Th2 cytokines, respectively. Time course experiments revealed that T-bet expression was stimulated in both cell types, whereas c-maf and GATA-3 were induced only in ABL.

Conclusion

The diminished capability of CBL to synthesize cytokines is probably due to decreased activation of NF-κB, whereas differences in Th subsets are due to differences in regulation of Th lineage-specific transcriptions factors. We propose that the reduced incidence and severity of GvHD after allogeneic transplantation of umbilical CB cells is due to lesser activation of specific transcription factors and a subsequent reduction in production of certain cytokines.
The sensitivity and specificity of four questions (HARK) to identify intimate partner violence: a diagnostic accuracy study in general practice
Authors: Sohal Hardip , Eldridge Sandra , Feder Gene
Published: August 2007

Background

Intimate partner violence (IPV) including physical, sexual and emotional violence, causes short and long term ill-health. Brief questions that reliably identify women experiencing IPV who present in clinical settings are a pre-requisite for an appropriate response from health services to this substantial public health problem. We estimated the sensitivity and specificity of four questions (HARK) developed from the Abuse Assessment screen, compared to a 30-item abuse questionnaire, the Composite Abuse Scale (CAS).

Methods

We administered the four HARK questions and the CAS to women approached by two researchers in general practice waiting rooms in Newham, east London. Inclusions: women aged more than 17 years waiting to see a doctor or nurse, who had been in an intimate relationship in the last year. Exclusions: women who were accompanied by children over four years of age or another adult, too unwell to complete the questionnaires, unable to understand English or unable to give informed consent.

Results

Two hundred and thirty two women were recruited. The response rate was 54%. The prevalence of current intimate partner violence, within the last 12 months, using the CAS cut off score of ≥3, was 23% (95% C.I. 17% to 28%) with pre-test odds of 0.3 (95% C.I. 0.2 to 0.4). The receiver operator characteristic curve demonstrated that a HARK cut off score of ≥1 maximises the true positives whilst minimising the false positives. The sensitivity of the optimal HARK cut-off score of ≥1 was 81% (95% C.I. 69% to 90%), specificity 95% (95% C.I. 91% to 98%), positive predictive value 83% (95% C.I. 70% to 91%), negative predictive value 94% (95% C.I. 90% to 97%), likelihood ratio 16 (95% C.I. 8 to 31) and post-test odds 5.

Conclusion

The four HARK questions accurately identify women experiencing IPV in the past year and may help women disclose abuse in general practice. The HARK questions could be incorporated into the electronic medical record in primary care to prompt clinicians to ask about recent partner violence and to encourage disclosure by patients. Future research should test the effectiveness of HARK in clinical consultations.
Association analysis of chromosome 1 migraine candidate genes
Authors: Fernandez Francesca , Curtain Robert P , Colson Natalie J , Ovcaric Micky , MacMillan John , Griffiths Lyn R
Published: August 2007

Background

Migraine with aura (MA) is a subtype of typical migraine. Migraine with aura (MA) also encompasses a rare severe subtype Familial Hemiplegic Migraine (FHM) with several known genetic loci. The type 2 FHM (FHM-2) susceptibility locus maps to chromosome 1q23 and mutations in the ATP1A2 gene at this site have recently been implicated. We have previously provided evidence of linkage of typical migraine (predominantly MA) to microsatellite markers on chromosome 1, in the 1q31 and 1q23 regions. In this study, we have undertaken a large genomic investigation involving candidate genes that lie within the chromosome 1q23 and 1q31 regions using an association analysis approach.

Methods

We have genotyped a large population of case-controls (243 unrelated Caucasian migraineurs versus 243 controls) examining a set of 5 single nucleotide polymorphisms (SNPs) and the Fas Ligand dinucleotide repeat marker, located within the chromosome 1q23 and 1q31 regions.

Results

Several genes have been studied including membrane protein (ATP 1 subtype A4 and FasL), cytoplasmic glycoprotein (CASQ 1) genes and potassium (KCN J9 and KCN J10) and calcium (CACNA1E) channel genes in 243 migraineurs (including 85% MA and 15% of migraine without aura (MO)) and 243 matched controls. After correction for multiple testing, chi-square results showed non-significant P values (P > 0.008) across all SNPs (and a CA repeat) tested in these different genes, however results with the KCN J10 marker gave interesting results (P = 0.02) that may be worth exploring further in other populations.

Conclusion

These results do not show a significant role for the tested candidate gene variants and also do not support the hypothesis that a common chromosome 1 defective gene influences both FHM and the more common forms of migraine.
Preventable hospitalization and access to primary health care in an area of Southern Italy
Authors: Rizza Paolo , Bianco Aida , Pavia Maria , Angelillo Italo F
Published: August 2007

Background

Ambulatory care-sensitive conditions (ACSC), such as hypertension, diabetes, chronic heart failure, chronic obstructive pulmonary disease and asthma, are conditions that can be managed with timely and effective outpatient care reducing the need of hospitalization. Avoidable hospitalizations for ACSC have been used to assess access, quality and performance of the primary care delivery system. The aims of this study were to quantify the proportion of avoidable hospital admissions for ACSCs, to identify the related patient's socio-demographic profile and health conditions, to assess the relationship between the primary care access characteristics and preventable hospitalizations, and the usefulness of avoidable hospitalizations for ACSCs to monitor the effectiveness of primary health care.

Methods

A random sample of 520 medical records of patients admitted to medical wards (Cardiology, Internal Medicine, Pneumology, Geriatrics) of a non-teaching acute care 717-bed hospital located in Catanzaro (Italy) were reviewed.

Results

A total of 31.5% of the hospitalizations in the sample were judged to be preventable. Of these, 40% were for congestive heart failure, 23.2% for chronic obstructive pulmonary disease, 13.5% for angina without procedure, 8.4% for hypertension, and 7.1% for bacterial pneumonia. Preventable hospitalizations were significantly associated to age and sex since they were higher in older patients and in males. The proportion of patients who had a preventable hospitalization significantly increased with regard to the number of hospital admissions in the previous year and to the number of patients for each primary care physician (PCP), with lower number of PCP accesses and PCP medical visits in the previous year, with less satisfaction about PCP health services, and, finally, with worse self-reported health status and shorter length of hospital stay.

Conclusion

The findings from this study add to the evidence and the urgency of developing and implementing effective interventions to improve delivery of health care at the community level and provided support to the usefulness of avoidable hospitalizations for ACSCs to monitor this process.
Development of a complex intervention to test the effectiveness of peer support in type 2 diabetes
Authors: Paul Gillian , Smith Susan M , Whitford David , O'Kelly Fergus , O'Dowd Tom
Published: August 2007

Background

Diabetes is a chronic illness which requires the individual to assume responsibility for their own care with the aim of maintaining glucose and blood pressure levels as close to normal as possible. Traditionally self management training for diabetes has been delivered in a didactic setting. In recent times alternatives to the traditional delivery of diabetes care have been investigated, for example, the concept of peer support which emphasises patient rather than professional domination. The aim of this paper is to describe the development of a complex intervention of peer support in type 2 diabetes for a randomised control trial in a primary care setting.

Methods

The Medical Research Council (MRC) framework for the development and evaluation of complex interventions for randomised control trials (RCT) was used as a theoretical guide to designing the intervention.

The first three phases (Preclinical Phase, Phase 1, Phase 2) of this framework were examined in depth. The Preclinical Phase included a review of the literature relating to type 2 diabetes and peer support. In Phase 1 the theoretical background and qualitative data from 4 focus groups were combined to define the main components of the intervention. The preliminary intervention was conducted in Phase 2. This was a pilot study conducted in two general practices and amongst 24 patients and 4 peer supporters. Focus groups and semi structured interviews were conducted to collect additional qualitative data to inform the development of the intervention.

Results

The four components of the intervention were identified from the Preclinical Phase and Phase 1. They are: 1. Peer supporters; 2. Peer supporter training; 3. Retention and support for peer supporters; 4.Peer support meetings. The preliminary intervention was implemented in the Phase 2. Findings from this phase allowed further modeling of the intervention, to produce the definitive intervention.

Conclusion

The MRC framework was instrumental in the development of a robust intervention of peer support of type 2 diabetes in primary care.

Trial registration

Current Controlled Trials ISRCTN42541690
Actions of N-Arachidonyl-Glycine in a Rat Inflammatory Pain Model
Authors: Succar Rebecca , Mitchell Vanessa A , Vaughan Christopher W
Published: August 2007

Background:

While cannabinoid receptor agonists have analgesic activity in inflammatory pain states they produce a range of side effects. Recently, it has been demonstrated that the arachidonic acid-amino acid conjugate, N-arachidonyl-glycine (NA-glycine) is effective in acute pain models.

Results:

In the present study we examined the effect of NA-glycine in a rat model of inflammatory pain. Intrathecal administration of NA-glycine (70 – 700 nmol) and the pan-cannabinoid receptor agonist HU-210 (10 nmol) reduced the mechanical allodynia and thermal hyperalgesia induced by intraplantar injection of Freund's complete adjuvant (FCA). The actions of HU-210, but not NA-glycine were reduced by the cannabinoid CB1 receptor antagonist AM251. The cannabinoid CB2 receptor antagonist SR144528 also had no effect on the actions of NA-glycine. In contrast, N-arachidonyl-GABA (NA-GABA, 700 nmol) and N-arachidonyl-alanine (NA-alanine, 700 nmol) had no effect on allodynia and hyperalgesia. HU-210, but not NA-glycine produced a reduction in rotarod latency.

Conclusion:

These findings suggest that NA-glycine may provide a novel non-cannabinoid receptor mediated approach to alleviate inflammatory pain.
NADPH oxidase deficiency results in reduced alveolar macrophage 5-lipoxygenase expression and decreased leukotriene synthesis
Authors: Coffey Michael J , Serezani Carlos H , Phare Susan M , Flamand Nicolas , Peters-Golden Marc
Published: August 2007

Reactive oxygen intermediates (ROI) play an important role in cell signaling in addition to their role in microbial killing. We have shown previously that exogenous ROI regulate activity of the enzyme 5-lipoxygenase (5-LO) in alveolar macrophages (AM). Here, we examined the role of endogenous ROI, specifically generated by NADPH oxidase, in the regulation of leukotriene (LT) synthetic capacity in AM, which from NADPH oxidase knockout (KO) mice, was significantly less than that from wild-type (WT) AM. The decrease in LT synthesis could not be explained by reduced release of the substrate for 5-LO, arachidonic acid. However, the expression of 5-LO was reduced ∼50% in AM from NADPH oxidase KO mice compared with WT mice. Reduced 5-LO expression could be reproduced by treating WT AM with ROI scavengers and with selective pharmacologic inhibitors of NADPH oxidase. Furthermore, conditioned media from WT AM augmented 5-LO metabolism in AM from NADPH oxidase KO mice. This decrease in 5-LO expression in NADPH oxidase KO cells was associated with decreased expression of the transcription factors, specificity protein-1 and early growth response-1, both of which are known to regulate 5-LO mRNA expression. These data reveal a previously unrecognized influence of endogenous ROI generated by NADPH oxidase on expression of the key LT biosynthetic protein, 5-LO. In view of the antimicrobial actions of LT, a reduction in LT synthetic capacity by AM from NADPH oxidase KO mice may contribute to the susceptibility of these animals to infection.
Annual Meeting Selection Papers
Authors: Herman Gérard C.
Published: August 2007

Most authors of GEOPHYSICS papers are from universities or government research institutions. That does not mean no interesting research is being done by the oil or geophysical industry. In the current competitive age, it is apparently difficult for geophysicists from the industry to find time to write elaborate papers for GEOPHYSICS. Therefore, the GEOPHYSICS editors have decided to encourage authors from the oil and geophysical industry to submit high-quality papers. SEG Editor Gerard T. Schuster asked me to develop a shorter route for such papers that have at least one author from the industry.
Validity evidence in a university group oral test
Authors: Van Moere Alistair
Published: August 2007

This article investigates a group oral test as administered at a university in Japan to find if it is appropriate to use scores for higher stakes decision making. It is one component of an in-house English proficiency test used for placing students, evaluating their progress, and making informed decisions for the development of the English language curriculum. The implementation of a cut-score for students to advance through the university system has recently been proposed, bringing the group oral test component under increased scrutiny. On two successive occasion 113 participants sat the oral test in groups composed of different interlocutors each time. Rasch analysis shows rater fit within acceptable levels considering the length and nature of the test; however, at correlations of .74 inter-rater agreements are lower than has been reported in research on commercially available interview tests. Candidates’ scores on the two different test occasions correlate at .61. A generalizability study shows that the greatest systematic variation in test scores is contributed by the person-by-occasion interaction. Topic, or prompt, was not a significant factor. Candidates’ performances, or how raters perceive an individual candidates’ ability, could be affected to a large degree by the characteristics of interlocutors and interaction dynamics within the group.
MCMC model determination for discrete graphical models
Authors: Tarantola Claudia
Published: August 2007

In this paper we compare two alternative MCMC samplers for the Bayesian analysis of discrete graphical models; we present both a hierarchical and a nonhierarchical version of them. We first consider the MC3 algorithm by Madigan and York (1995) for which we propose an extension that allows for a hierarchical prior on the cell counts. We then describe a novel methodology based on a reversible jump sampler. As a prior distribution we assign, for each given graph, a hyper-Dirichlet distribution on the matrix of cell probabilities. Two applications to real data are presented.
Protective estimator for linear regression with nonignorably missing Gaussian outcomes
Authors: Lipsitz Stuart R , Molenberghs Geert , Fitzmaurice Garrett M , Ibrahim Joseph G
Published: August 2007

We propose a method for estimating the regression parameters in a linear regression model for Gaussian data when the outcome variable is missing for some subjects and missingness is thought to be nonignorable. Throughout, we assume that missingness is restricted to the outcome variable and that the covariates are fully observed. Although maximum likelihood estimation of the regression parameters is possible once joint models for the outcome variable and the nonignorable missing data mechanism have been specified, these models are fundamentally nonidentifiable unless unverifiable modeling assumptions are imposed. In this paper, rather than explicitly modeling the nonignorable missingness mechanism, we consider the use of a ‘protective’ estimator of the regression parameters (Brown, 1990). To implement the proposed method, it is necessary to assume that the outcome variable and one of the covariates have an approximate bivariate normal distribution, conditional on the remaining covariates. In addition, it is assumed that the missing data mechanism is conditionally independent of this covariate, given the outcome variable and the remaining covariates; the latter is referred to as the ‘protective’ assumption. A method of moments approach is used to obtain the protective estimator of the regression parameters; the jackknife (Quenouille, 1956) is used to estimate the variance. The method is illustrated using data on the persistence of maternal smoking from the Six Cities Study of the health effects of air pollution (Ware et al., 1984). The results of a simulation study are presented that examine the magnitude of any finite sample bias.
Why don't patients take their medicine? Reasons and solutions in psychiatry
Authors: Mitchell Alex J. , Selmes Thomas
Published: August 2007

Over the course of a year, about three-quarters of patients prescribed psychotropic medication will discontinue, often coming to the decision themselves and without informing a health professional. Costs associated with unplanned discontinuation may be substantial if left uncorrected. Partial non-adherence (much more common than full discontinuation) can also be detrimental, although some patients rationally adjust their medication regimen without ill-effect. This article reviews the literature on non-adherence, whether intentional or not, and discusses patients' reasons for failure to concord with medical advice, and predictors of and solutions to the problem of non-adherence.
DSPD or ‘Don't Stigmatise People in Distress’
Authors: Kingdon David
Published: August 2007

Working with people who have criminal convictions for endangering others is certainly challenging. The place of psychiatric or psychological intervention is still uncertain but for some people, for example those who have a background of physical or sexual abuse, it seems reasonable to provide them with access to interventions that seem to benefit those who do not have such convictions. The dangerous and severe personality disorder (DSPD) system provides an environment to do this. However, if it is ever to be successful in enabling future safe community placements, it has to address issues of stigmatisation.
How can clinicians help patients to take their psychotropic medication?
Authors: Chaplin Robert
Published: August 2007

Enhancing a patient's adherence to psychotropic medication regimens is one of the challenges facing all mental health professionals. Medication is part of an overall care package that often depends on patients' engagement with the clinician or service. The therapeutic alliance might be improved by more active listening to patients. A reduced capacity may limit a patient's ability to make a treatment choice. This can be improved by provision of more time and information. If these techniques are insufficient, closer monitoring may be achieved by working with relatives and carers, or more frequent visiting. Strategies to avoid covert non-adherence could include checking for picked up prescriptions and the use of depot preparations. Finally, the use of compulsory powers may be appropriate, with attention to preserving or rebuilding the therapeutic alliance.
Caudate volume in offspring of patients with schizophrenia
Authors: Rajarethinam Rajaprabhakaran , Upadhyaya Ameet , Tsou Pon , Upadhyaya Margie , Keshavan Matcheri S.
Published: August 2007

Caudate nuclei are smaller in drug-naive people with schizophrenia but larger in antipsychotic-treated patients. In this magnetic resonance imaging study we found volume reduction of right and left caudate by 8.9 and 8.1% respectively in 50 offspring without psychosis of patients with schizophrenia compared with 53 age- and gender-matched controls, providing new evidence that caudate volume reduction may be a trait-related abnormality in schizophrenia.
Evaluating the cost-effectiveness of reduced tardive dyskinesia with second-generation antipsychotics
Authors: Rosenheck Robert A.
Published: August 2007

Background

Second-generation antipsychotics may have few advantages over older, cheaper drugs, except for possibly reduced risk of tardive dyskinesia.

Aims

To evaluate the cost-effectiveness of second-generation antipsychotics with regard to reducing tardive dyskinesia.

Method

Literature was reviewed on risk of tardive dyskinesia with second-generation antipsychotics; on severity duration and impairment of tardive dyskinesia; and on the relationship of this disorder to quality of life and quality-adjusted life-years (QALYs). Diverse cost and benefit assumptions and of 1-year and 5-year planning horizons were examined in a deterministic sensitivity analysis.

Results

Estimating 0.143 QALYs lost per case of severe tardive dyskinesia, 1-year cost-effectiveness estimates for second-generation antipsychotics ranged from $185 000 ($370 000) to $850 000 ($1.7 million) per QALY, and 5-year cumulative estimates ranged from $74 000 ($ 149 000) to $342 000 ($683 000) per QALY, all above the conventional policy threshold of $25 000 ($50 000).

Conclusions

Reduction of tardive dyskinesia with second-generation antipsychotics appears unlikely to meet standards for cost-effectiveness.
Psychiatric morbidity and health service use among attendees at a winter shelter
Authors: Hayward Marianne
Published: August 2007

Aims and Method

Homelessness is associated with raised psychiatric morbidity. Case records for 597 consecutive attendees at a winter shelter medical service were retrospectively reviewed to assess routine recording of psychiatric morbidity and to examine associations between current psychiatric symptoms and health service use.

Results

Previous psychiatric morbidity was recorded in 36.0% of attendees, including 20.4% with comorbid substance misuse. Current psychiatric morbidity was recorded in 31.3% of attendees, and was associated with reduced total medication prescription, increased referral to other services and increased re-presentation to the shelter medical service.

Clinical Implications

Psychiatric morbidity was frequently recorded in this population. Current psychiatric symptoms were associated with increased health service use. Improved training of shelter staff should be instituted to increase engagement with mainstream mental health services.
On leaving
Authors: Fagin Leonard
Published: August 2007

Negotiating the process of leaving a post one has occupied in a senior position for many years can be stressful and emotionally draining. Considerable thought has to be given to the process to ensure that patients, colleagues and the organisation are not badly affected, but unfortunately the literature on the subject is practically non-existent. What follows is a personal account of the process I went through and the lessons I learnt after I made a major change in my professional life.
Antipsychotic prescribing patterns in care homes and relationship with dementia
Authors: Alldred David P. , Petty Duncan R. , Bowie Peter , Zermansky Arnold G. , Raynor David K.
Published: August 2007

Aims and Method

To determine the prescribing patterns for antipsychotics in care homes for the elderly, a cross-sectional study was carried out using data from the intervention group of a randomised controlled trial of medication review in care homes.

Results

Of 331 residents studied, 67 (20%) were prescribed an antipsychotic (70% atypical); 57 of these (85%) did not have a diagnosis of a psychotic disorder. The antipsychotic prescribing rate was 32% (46 out of 146) for those with dementia and 10% (17 out of 174) for those without dementia. A quarter (82 out of 331) had received a medication review by the general practitioner in the preceding 12 months.

Clinical Implications

One-fifth of residents were prescribed an antipsychotic with little evidence of review. Systems should ensure residents' treatment is reviewed regularly.
Attention-deficit hyperactivity and developmental coordination disorders: knowledge and practice among child and adolescent psychiatrists and paediatricians
Authors: Kirby Amanda , Salmon Gill , Edwards Lisa
Published: August 2007

Aims and Method

Despite extensive evidence that attention-deficit hyperactivity disorder (ADHD) and developmental coordination disorder commonly present as overlapping disorders, it is not clear whether clinicians routinely enquire about movement difficulties when assessing children with suspected ADHD. We describe a survey that examines knowledge and practice of child and adolescent psychiatrists (n=107) and paediatricians (n=51) in this area.

Results

Results show that 67.3% of child and adolescent psychiatrists compared with 15.7% of paediatricians claimed to have poor or very poor knowledge of developmental coordination disorder, and 28% compared with 5.9% respectively reported that they never or only occasionally ask about motor difficulties.

Clinical Implications

Child and adolescent psychiatrists should consider routine screening for developmental coordination disorder when assessing for ADHD. Further training in assessment of developmental coordination disorder is recommended to facilitate this.
Reliability of a Computerized Version of the Pediatric Canadian Triage and Acuity Scale
Authors: Gravel Jocelyn , Gouin Serge , Bailey Benoit , Roy Michel , Bergeron Sylvie , Amre Devendra
Published: August 2007

Background: The use of a standardized triage tool allows better comparison of the patients; a computerized version could theoretically improve its reliability.

Objectives: To compare the interrater agreement of the Pediatric Canadian Triage and Acuity Scale (PedCTAS) and a computerized version (Staturg).

Methods: A two‐phase experimental study was conducted to compare the interrater agreement between nurses assigning triage level to written case scenarios using either traditional PedCTAS or Staturg. Participants were nurses with at least one year of experience in pediatric emergency medicine and trained at triage. Each of the 54 scenarios was evaluated first by all nurses using either one of the strategies. Four weeks later, they evaluated the same scenarios using the other tool. The primary outcome was the interrater agreement measured using κ score.

Results: Eighteen of the 29 eligible nurses participated in the study. The computerized triage tool showed a better interrater agreement, with a Staturg κ score of 0.55 (95% confidence interval = 0.53 to 0.57) versus a PedCTAS κ score of 0.51 (95% confidence interval = 0.49 to 0.53). The computerized version was also associated with higher agreements for scenarios describing patients with the highest severity of triage (κ score of 0.72 vs. 0.55 for level 1; κ score of 0.70 vs. 0.51 for level 2).

Conclusions: A computerized version of the PedCTAS showed a statistically significant improvement in the interrater agreement for nurses evaluating the triage level of 54 clinical scenarios, but this difference has probably small clinical significance.
Evaluating the Effectiveness of Dispatch‐assisted Cardiopulmonary Resuscitation Instructions
Authors: Vaillancourt Christian , Verma Aikta , Trickett John , Crete Denis , Beaudoin Tammy , Nesbitt Lisa , Wells George A. , Stiell Ian G.
Published: August 2007

Objectives: To determine the frequency of agonal breathing during cardiac arrest (CA), its impact on the ability of 9‐1‐1 dispatchers to identify CA, and the impact of dispatch‐assisted cardiopulmonary resuscitation (CPR) instructions on bystander CPR rates.

Methods: A before‐after observational study enrolling out‐of‐hospital adult CA patients where resuscitation was attempted in a single city with basic life support with defibrillation/advanced life support tiered emergency medical services. Victim, caller, and system characteristics were measured during two successive nine‐month periods before (control group) and after (intervention group) the introduction of dispatch‐assisted CPR instructions.

Results: There were 529 CAs between July 1, 2003, and December 31, 2004. Victim characteristics were similar in the control (n= 295) and intervention (n= 234) period; mean age was 68.3 years; 66.7% were male; 50.1% of CAs were witnessed; call‐to‐vehicle stop was 6 minutes, 37 seconds; ventricular fibrillation/ventricular tachycardia occurred in 29.9%; and the survival rate was 4.0%. Dispatchers identified 56.3% (95% confidence interval [CI] = 48.9% to 63.0%) of CA cases; agonal breathing was present in 37.0% (95% CI = 30.1% to 43.9%) of all CA cases and accounted for 50.0% (95% CI = 39.1% to 60.9%) of missed diagnoses. Callers provided ventilations in 17.2% and chest compressions in 8.3% of cases as a result of the intervention. Long time intervals were observed between call to diagnosis (2 minutes, 38 seconds) and during ventilation instructions (2 minutes, 5 seconds). Bystander CPR rates increased from 16.7% in the control phase to 26.4% in the intervention phase (absolute rate, 9.7%; 95% CI = 8.5% to 11.3%; p = 0.006).

Conclusions: This trial demonstrates an increase in bystander CPR rate after the introduction of dispatch‐assisted CPR. Agonal breathing occurred frequently and had a negative impact on the recognition of CA. There were long time intervals between call initiation and diagnosis of CA and during mouth‐to‐mouth ventilation instructions.
Brain Structure and Function Differences in Monozygotic Twins: Possible Effects of Breast Cancer Chemotherapy
Authors: Ferguson Robert J. , McDonald Brenna C. , Saykin Andrew J. , Ahles Tim A.
Published: August 2007

Purpose

Adjuvant chemotherapy has been associated with mild cognitive decline among a subset of breast cancer survivors. Late cognitive effects after chemotherapy can have a deleterious impact on survivor quality of life and functional health; however, the etiology of chemotherapy-related cognitive dysfunction remains unknown.

Patients and Methods

We present a case of monozygotic twins who are discordant for breast cancer and chemotherapy exposure (ie, one twin contracted breast cancer and underwent chemotherapy, and the other had no breast cancer). As part of a larger study, each was evaluated with standardized, self-report measures of cognitive function, standard neuropsychological tests, and structural and functional magnetic resonance imaging (MRI).

Results

Results indicated small differences in neuropsychological test performance but striking contrasts in self-reported cognitive complaints and structural and functional MRI images. Specifically, the twin who underwent chemotherapy had substantially more subjective cognitive complaints, more white matter hyperintensities on MRI, and an expanded spatial extent of brain activation during working memory processing than her nonaffected twin.

Conclusion

This case illustrates possible physiologic mechanisms that could produce long-term cognitive complaints among chemotherapy recipients and help formulate hypotheses for further empirical study in the area of chemotherapy-associated cognitive dysfunction.
Clinical Implications of CYP2D6 Genotypes Predictive of Tamoxifen Pharmacokinetics in Metastatic Breast Cancer
Authors: Lim Hyeong-Seok , Ju Lee Han , Seok Lee Keun , Sook Lee Eun , Jang In-Jin , Ro Jungsil
Published: August 2007

Purpose

The CYP3A and CYP2D6 enzymes play a major role in converting tamoxifen to its active metabolites. CYP3A is a highly inducible enzyme, regulated mainly by pregnane X receptor (PXR). This study assessed the association between genetic polymorphisms of CYP2D6 and PXR, and tamoxifen pharmacokinetics (PK) and clinical outcomes in patients with breast cancer.

Patients and Methods

Plasma concentrations of tamoxifen and its metabolites were measured. Common alleles of CYP2D6 and PXR were identified in 202 patients treated with tamoxifen 20 mg daily for more than 8 weeks. Twelve of the 202 patients and an additional nine patients with metastatic breast cancer receiving tamoxifen were assessed for clinical outcome in correlation with genotypes.

Results

Patients carrying CYP2D6*10/*10 (n = 49) demonstrated significantly lower steady-state plasma concentrations of 4-hydroxy-N-desmethyltamoxifen and 4-hydroxytamoxifen than did those with other genotypes (n = 153; 4-hydroxy-N-desmethyltamoxifen: 7.9 v 18.9 ng/mL, P < .0001; 4-hydroxytamoxifen: 1.5 v 2.6 ng/mL, P < .0001), whereas no difference by PXR genotypes was found. CYP2D6*10/*10 was significantly more frequent among nonresponders with MBC (100% v 50%, P = .0186). In Cox proportional hazard analysis, CYP2D6 genotype and number of disease sites were significant factors affecting time to progression (TTP). The median TTP for patients receiving tamoxifen was shorter in those carrying CYP2D6*10/*10 than for others (5.0 v 21.8 months, P = .0032)

Conclusion

CYP2D6*10/*10 is associated with lower steady-state plasma concentrations of active tamoxifen metabolites, which could possibly influence the clinical outcome by tamoxifen in Asian breast cancer patients.
Phase III Double-Blind, Placebo-Controlled Study of Thalidomide in Extensive-Disease Small-Cell Lung Cancer After Response to Chemotherapy: An Intergroup Study FNCLCC cleo04–IFCT 00-01
Authors: Pujol Jean Louis , Breton Jean Luc , Gervais Radj , Tanguy Marie-Laure , Quoix Elisabeth , David Philippe , Janicot Henri , Westeel Virginie , Gameroff Sabine , Genève Jean , Maraninchi Dominique
Published: August 2007

Purpose

This randomized, double-blind, placebo-controlled phase III study aimed to determine whether thalidomide prolongs survival of patients with extensive-disease small-cell lung cancer (SCLC).

Patients and Methods

One hundred nineteen patients received two courses of etoposide, cisplatin, cyclophosphamide, and 4′-epidoxorubicin (PCDE). Responder patients who had recovered from chemotherapy toxicity were randomly assigned to receive four additional PCDE cycles plus thalidomide (400 mg daily) or placebo.

Results

After the first two PCDE cycles, objective response rate was 81.5%, and 92 patients were randomly assigned to placebo (n = 43) or thalidomide (n = 49). Median exposure duration to placebo was 4.5 months, and median exposure to thalidomide was 4.9 months. Patients treated with thalidomide had a longer survival compared with patients who received placebo, although the difference was not statistically significant (minimal follow-up, 3 years; median survival time, 11.7 v 8.7 months, respectively; log-rank test: hazard ratio [HR] = 0.74; 95% CI, 0.49 to 1.12; P = .16). Patients with a performance status (PS) of 1 or 2 who received thalidomide had a significantly longer survival (HR = 0.59; 95% CI, 0.37 to 0.92; P = .02). The disease also progressed slower in patients with PS of 1 or 2 receiving thalidomide (HR = 0.54; 95% CI, 0.36 to 0.87; P = .02), whereas the difference did not reach statistical significance for the whole population (HR = 0.74; 95% CI, 0.49 to 1.12; P = .15). Neuropathy occurred more frequently in the thalidomide group compared with the placebo group (33% v 12%, respectively).

Conclusion

Treatment with thalidomide was not associated with a significant improvement in survival of SCLC patients. There was pronounced heterogeneity in survival outcomes between groups of patients. Some benefit was observed among patients with a PS of 1 or 2 (exploratory analyses), deserving further studies targeting angiogenesis in this disease.