bluuebunny/crossref_metadata_2025 huggingface dataset:
Particulate matter properties and health effects: consistency of epidemiological and toxicological studies
Authors: Schwarze P E , Øvrevik J , Låg M , Refsnes M , Nafstad P , Hetland R B , Dybing E
Published: November 2006

Identifying the ambient particulate matter (PM) fractions or constituents, critically involved in eliciting adverse health effects, is crucial to the implementation of more cost-efficient abatement strategies to improve air quality. This review focuses on the importance of different particle properties for PM-induced effects, and whether there is consistency in the results from epidemiological and experimental studies. An evident problem for such comparisons is that epidemiological and experimental data on the effects of specific components of ambient PM are limited. Despite this, some conclusions can be drawn. With respect to the importance of the PM size-fractions, experimental and epidemiological studies are somewhat conflicting, but there seems to be a certain consistency in that the coarse fraction (PM10-2.5) has an effect that should not be neglected. Better exposure characterization may improve the consistency between the results from experimental and epidemiological studies, in particular for ultrafine particles. Experimental data indicate that surface area is an important metric, but composition may play an even greater role in eliciting effects. The consistency between epidemiological and experimental findings for specific PM-components appears most convincing for metals, which seem to be important for the development of both pulmonary and cardiovascular disease. Metals may also be involved in PM-induced allergic sensitization, but the epidemiological evidence for this is scarce. Soluble organic compounds appear to be implicated in PM-induced allergy and cancer, but the data from epidemiological studies are insufficient for any conclusions. The present review suggests that there may be a need for improvements in research designs. In particular, there is a need for better exposure assessments in epidemiological investigations, whereas experimental data would benefit from an improved comparability of studies. Combined experimental and epidemiological investigations may also help answer some of the unresolved issues.
Headache, Raynaud’s syndrome and serotonin receptor agonists in systemic lupus erythematosus
Authors: Bernatsky S , Pineau C A , Lee J L , Clarke A E
Published: November 2006

There are potential concerns regarding serotonin receptor agonists in SLE patients with migraine, particularly patients with concomitant Raynaud’s syndrome. We estimated the prevalence of lupusrelated headache and Raynaud’s syndrome in the Montreal General Hospital SLE clinic cohort and evaluated the relationship between these two variables in multivariable logistic regression models, controlling for age, sex, race, SLE duration and the presence of lupus anticoagulant and antibodies to cardiolipin and beta2 glycoprotein I. We also assessed, through chart review in those individuals with both Raynaud’s syndrome and migraine, a history of serotonin receptor agonist use, and any associated worsening vasospasm. Based on Systemic Lupus Activity Measure (SLAM) scores, the cumulative incidence of lupus-related headache in our sample ( n 391) was 46.1%; the prevalence of Raynaud’s syndrome was 49.4%. The adjusted odds ratio (OR) for lupus-related headache and Raynaud’s syndrome was 1.7 (95% CI 1.1, 2.5). In addition, there was a strong independent relationship between headache and anti-beta2 glycoprotein I antibodies (adjusted OR 5.6 [95% CI 1.8, 17.0]). The data from our chart review suggest that careful use of serotonin receptor agonists in patients with both Raynaud’s syndrome and migraines may be undertaken, although caution would necessitate that these agents not be used in individuals with very severe Raynaud’s (eg, digital ulcerations, and so on).
Speaking Silence
Authors: Roy Mallarika Sinha
Published: November 2006

Women's history is not only an effort to restore women to history, but perhaps, more importantly, also to restore history to women. Writing women's history, therefore, calls for overcoming the isolationist celebration of individual women and to posit gender as an analytical category for studying history. Since ‘women’ do not constitute a composite, ahistorical, perennial ‘other’ with their distilled autonomous history, their histories are inextricably mapped in the grid of class and caste relations, community life and collective mobilisation, colonialism and capitalism. Capturing the continuous fluidity of domination and resistance in the lives of women belonging to various socio-political, cultural, economic locations demand an identification of the both subordination and expressions of defiance, imprinted in the micro-histories of biographies, oral traditions, legends and myths. This paper analyses the ideology of the Naxalbari movement, a radical Maoist movement in post-colonial Bengal, and its historiography from the point of view of gender. This is an endeavour to account for not only the conspicuous silence about women participants both in its ideology and academic historiography, but also to seek the multiple locations of victimhood and agency enmeshed in women's identity and to locate the negotiated spaces of individual participants in collective action; and the limitations of both social and political institutions like family, caste, class and party in motivating women to actively take part in the public sphere.
Women, English Literature and Identity Construction in Southern Punjab, Pakistan
Authors: Zubair Shirin
Published: November 2006

The present study attempts to understand young Pakistani women's identities in relation to their aspirations for higher degrees in English literature. The research reported here is part of a larger ongoing study aimed at exploring linkages between young women's literacy practices in various languages and their concepts of self and identity. The feminist techniques of unstructured in-depth interviews backed up with a self-participatory approach and participant observation were used to capture the richness and fluidity of women's public and private identities. The analysis and findings suggest that despite resistance shown by women to Western culture and ideologies, they do take on new subjectivities and positionalities as they tend to imbibe the norms and values associated with English. The wider exposure to English at an institution of higher education opens up windows to the world, to Western ideologies and world-view, coupled with access to the Internet, cable channels, literary texts, books and magazines. Often in expressing personal aspirations that are contrary to their more traditional roles there is also a certain resistance to this cultural invasion; the women seem to project distinct hybrid identities that are dichotomous and conflictual.
Bilateral Learning and Teaching in Chinese-Australian Arts and Architecture
Authors: Joubert Lindy , Whitford Steven
Published: November 2006

A collaborative design-based, cross-cultural exchange between the Chinese School of Architecture, Tsinghua University of Beijing, and the Faculty of Architecture, Building, and Planning at the University of Melbourne is the case study presented in this article. Two design studios were conducted: one in the Master of Urban Design program, and the other in the final year architecture program in China. Each studio focused on different aspects of the same project to make creative and innovative contributions to Melbourne’s Chinatown and a context for introducing international dimensions to pedagogical experiences. Issues raised in this article focus on the responses by both the students and the two universities, the design ideas, and the logistics of delivering a cross-cultural project in two different cities in relation to the educational design and the teaching and learning experiences. Conclusions are drawn from the experience and future possibilities for similar project-based studios are speculated on.
Photovoice: Use of a Participatory Action Research Method to Explore the Chronic Pain Experience in Older Adults
Authors: Baker Tamara A. , Wang Caroline C.
Published: November 2006

Photovoice is a participatory action research method in which individuals photograph their everyday health and work realities. The objective of this study is to determine the efficacy of photovoice as a unique and innovative method examining the pain experiences of clinic and nonclinic-based Black and White adults older than 50 years of age. Participants took photographs and composed written narratives based on their experiences with pain. Respondents also completed several open-ended questions focusing on their daily experiences with chronic pain. Some respondents identified their participation as a way of helping others cope with pain. Others felt it was a way of sharing their experiences with others. Photovoice might be used as an alternative method to enhance the understanding of the pain experience, thereby allowing researchers, health care providers, and policy makers to understand more fully and identify the dimensions of the pain experience not captured through quantitative measures.
Preparing Home Health Clients for Work Opportunities With Workplace Accommodation
Authors: Sabata Dory , Bruce Carrie , Sanford Jon
Published: November 2006

Few people with chronic health conditions actively engage in work activities. Yet workplace accommodations including assistive technologies and more accessible environments are creating the potential for more employment opportunities. Occupational therapists are trained to assist clients in maximizing participation in self-care, work activities, and leisure. Home health services often address self-care and leisure; however, little attention is given to home health discharge planning directed at transitions to work. This article explores some of the policies that affect work opportunities for people with disabilities, some workplace accommodations that can be used to increase access to the workplace and maximize capacities of persons with disabilities to complete job tasks, and implications for how home health occupational therapy practitioners can facilitate referrals and inform client decisions about workplace accommodations.
Quality of life in dementia in perspective
Authors: Dröes Rose-Marie , Boelens-Van Der Knoop Ellen C.C. , Bos Joke , Meihuizen Lucinda , Ettema Teake P. , Gerritsen Debbie L. , Hoogeveen Frans , De Lange Jacomine , SchöLzel-Dorenbos Carla J.M.
Published: November 2006

Many different definitions of the concept of quality of life (QOL) are found in the literature. This raises the question as to which domains are viewed as really important by people with dementia and which are possibly based on views of others, such as (in)formal carers, or theoretical models. An explorative study was carried out among people with dementia living in the community and in nursing homes. Their opinions were compared to those of professional carers and to the current theoretical models and instruments for QOL in dementia. Data were gathered by means of interviews, focus groups and literature study. Most QOL domains mentioned as important by the persons with dementia were also acknowledged by the carers and in the literature. A few, however, were not mentioned by the carers (i.e. ‘sense of aesthetics in living environment’,‘financial situation’ and ‘being of use/giving meaning to life’), and not selected in the measuring instruments (‘security and privacy’, and ‘self-determination and freedom’). This indicates differences in perspectives on quality of life between persons with dementia, their carers and theoretical models. Further research is recommended on this point.
A Single Injection of d-Amphetamine Facilitates Improvements in Motor Training Following a Focal Cortical Infarct in Squirrel Monkeys
Authors: Barbay Scott , Zoubina Elena V. , Dancause Numa , Frost Shawn B. , Eisner-Janowicz Ines , Stowe Ann M. , Plautz Erik J. , Nudo Randolph J.
Published: November 2006

Background. There is growing interest in the use of d-amphetamine (d-AMPH) as a pharmacological treatment to supplement rehabilitative therapy following stroke. Based on the success of earlier animal models, several clinical studies have demonstrated beneficial effects of applying physical rehabilitation while stroke patients are under the influence of d-AMPH. To begin to understand the neural mechanisms underlying this promising adjuvant therapy, the authors examined the effects of a single pairing of d-AMPH and rehabilitative training on motor performance after cortical infarct in squirrel monkeys.

Methods. Microelectrode stimulation techniques were used to delineate hand movement areas in the primary motor cortex prior to delivering a unilateral infarct to the complete hand representation. Postinfarct recovery was assessed for 3 groups of monkeys: d-AMPH + training, saline + training, and spontaneous recovery (SR). Postinfarct training groups received 14 consecutive days of motor skill training on a reach and retrieval task. A single injection of d-AMPH (0.25 mg/kg) or saline was given only on the 1st day of training (postinfarct day 10). Monkeys in the SR group had only minimal exposure to the training task once per week to monitor recovery.

Results. The results show that a single coupling of d-AMPH + training initiated 10 days after cortical infarct facilitated the rate of recovery and improved performance (68% improvement from 1st day of training) beyond the level achieved by the monkeys in the saline + training group (27% improved from 1st day of training).

Conclusions. D-AMPH is a potent modulator of behavioral recovery following an ischemic infarct in nonhuman primates.
Addition of sildenafil to bosentan monotherapy in pulmonary arterial hypertension
Authors: Mathai S. C. , Girgis R. E. , Fisher M. R. , Champion H. C. , Housten-Harris T. , Zaiman A. , Hassoun P. M.
Published: November 2006

Combination therapy has been recommended for the treatment of pulmonary arterial hypertension (PAH). However, there is scant information on combination therapy after failure of monotherapy, particularly in patients with scleroderma-associated PAH (PAH-SSD).

From a group of 82 consecutive patients with PAH who received initial bosentan monotherapy, a total of 13 idiopathic PAH (IPAH) and 12 PAH-SSD patients requiring additional therapy with sildenafil were studied. Sildenafil was added for clinical deterioration based upon symptoms, New York Heart Association (NYHA) classification or 6-min walk distance (6MWD). Clinical data and haemodynamics were collected at baseline. Assessments were made at 1–3-month intervals.

At baseline, there were no differences in demographics, NYHA classification, haemodynamics or 6MWD between the two groups. After initiation of bosentan, both groups experienced clinical improvement but ultimately deteriorated (median time to monotherapy failure 792versus458 days for IPAH and PAH-SSD patients, respectively). After addition of sildenafil, more IPAH patients tended to improve in NYHA class (five out of 13versustwo out of 12) and walked further (mean difference in 6MWD 47±77 mversus-7±40 m) compared with PAH-SSD patients.

In conclusion, addition of sildenafil after bosentan monotherapy failure improved New York Heart Association class and 6-min walk distance in idiopathic pulmonary arterial hypertension patients but failed to improve either parameter in scleroderma-associated pulmonary arterial hypertension patients. Additional studies are needed to assess the tolerability and efficacy of this combination in patients with scleroderma-associated pulmonary arterial hypertension.
Lung and blood mononuclear cell responses of tuberculosis patients to mycobacterial proteins
Authors: Sable S. B. , Goyal D. , Verma I. , Behera D. , Khuller G. K.
Published: November 2006

The differences in specificity of human lung and peripheral lymphocytes for mycobacterial antigens (Ag) need to be evaluated in order to identify vaccine candidates against pulmonary tuberculosis (TB).

Therefore, the present study examined the response to low molecular weight secretory proteins ofMycobacterium tuberculosisin bronchoalveolar lavage (BAL) and peripheral blood mononuclear cells (PBMCs) from minimal pulmonary TB and non-TB patients.

Ag85A, Ag85B, culture filtrate protein (CFP)-31, CFP-22.5, CFP-21,M. tuberculosisprotein-64 and an as yet uncharacterised 19 kDa protein were found to be predominantly recognised by BAL cells of TB patients on the basis of lymphocyte proliferation and significant interferon-γ release. However, recognition of CFP-8, 6-kDa early secreted antigenic target, CFP-10, CFP-14.5,M. tuberculosissecretory protein-17 and five other as yet uncharacterised low molecular weight polypeptides was found to be high on the basis of lymphocyte proliferation at the level of PBMCs. Furthermore, BAL macrophages, and not blood monocytes, were found to produce nitric oxide (NO) in response to mycobacterial Ags. Among polypeptides predominantly recognised by BAL lymphocytes, only Ag85A and Ag85B were found to induce both NO and interleukin-12 (p40) by alveolar macrophages.

In conclusion, the present results indicate heterogeneity in antigen recognition by bronchoalveolar lavage cells and peripheral mononuclear blood cells of minimal tuberculosis patients, and also suggest the utility of antigen 85 complex polypeptides for the development of a future mucosal antituberculous vaccine.
Predictors of outcome in idiopathic rapidly progressive glomerulonephritis (IRPGN)
Authors: Alexopoulos Efstathios , Gionanlis Lazaros , Papayianni Ekaterini , Kokolina Elizabeth , Leontsini Maria , Memmos Dimitrios
Published: November 2006

Background

Small vessel vasculitides are known to follow a devastating course towards end-stage renal disease, unless treated with immunosuppressive regiments. We investigated the value of clinical, histological and immunohistochemical parameters as predictors of outcome at diagnosis in patients with pauci immune necrotizing glomerulonephritis.

Methods

In 34 patients the percentage and evolution stage of crescents, the presence of glomerular necrosis, the degree or severity of arteriosclerosis, as well as the extent of tubulointerstitial infiltration, interstial fibrosis and tubular atrophy were assessed. Monoclonal antibodies were used to identify infiltrating macrophages, α-SMA(+) and PCNA(+) cells, the expression of integrins α3β1 and LFA-1β, the adhesion molecule ICAM-1, the growth factor TGF-β1 and the terminal complement component C5b-9.

Results

24 pts (70.6%) showed a complete or partial response to the treatment. The follow-up period was 20 ± 22 months. At multivariate analysis, serum CRP (p = 0.024), the intensity of tubular expression of C5b-9 (p < 0.0001) as well as the extent of glomerular and tubular expression of α3β1 integrin (p = 0.001 and 0.008 respectively) independently predicted the response to treatment. The response rate was better in ANCA(+) pts (p = 0.008). The extent of interstitial infiltrate (p < 0.0001), the severity of tubulointerstitial fibrosis (p < 0.0001) and the severity of tubular TGF-β1 expression (p < 0.0001) were independent predictors of long term outcome of renal function.

Conclusion

Patients with ANCA-associated renal vasculitis seem to respond better to the treatment. Acute phase reactants, such as CRP, implying a more intense parenchymal inflammatory reaction, as well as the intensity of the de novo expression of C5b-9 and the glomerular and tubular expression of α3β1 integrin predict the response to therapy. The severity of TIN lesions and of the tubulo-interstitial TGF-β1 and C5b-9 expression predict an unfavourable outcome.
A dynamic fate map of the forebrain shows how vertebrate eyes form and explains two causes of cyclopia
Authors: England Samantha J. , Blanchard Guy B. , Mahadevan L. , Adams Richard J.
Published: November 2006

Mechanisms for shaping and folding sheets of cells during development are poorly understood. An example is the complex reorganisation of the forebrain neural plate during neurulation, which must fold a sheet into a tube while evaginating two eyes from a single contiguous domain within the neural plate. We, for the first time, track these cell rearrangements to show that forebrain morphogenesis differs significantly from prior hypotheses. We postulate a new model for forebrain neurulation and demonstrate how mutations affecting two signalling pathways can generate cyclopic phenotypes by disrupting normal cell movements or introducing new erroneous behaviours.
Do carotenoid-based sexual traits signal the availability of non-pigmentary antioxidants?
Authors: Bertrand Sophie , Faivre Bruno , Sorci Gabriele
Published: November 2006

Carotenoid-based signals are thought to be indicators of male quality because they must be obtained from the diet and might thus indicate the ability of individuals to gather high-quality food. However, carotenoids are also known to have important physiological functions as immunoenhancers and antioxidants, and, as such, carotenoid-based sexual traits have also been suggested to reflect the health and antioxidant status of their bearers. This last idea is based on the hypothesis that carotenoids that are allocated to sexual signals are no longer available for the detoxification system. Recently, this hypothesis has been challenged on the grounds that the antioxidant activity is not the main biological role of carotenoids. Instead,carotenoid-based sexual traits might signal the availability of other non-pigmentary antioxidant molecules that might protect carotenoids from free radical attacks and make them available for sexual advertisements. We tested this hypothesis in the zebra finch, a passerine species with a carotenoid-based signal: the colour of the bill. We simultaneously manipulated the availability of carotenoids and of a non-pigmentary antioxidant(melatonin) in the drinking water. If the antioxidant properties of melatonin protect carotenoids from oxidation, we predict that birds supplemented with melatonin should have redder bills than birds not supplemented with melatonin,and that birds supplemented with carotenoids and melatonin should have redder bills than birds supplemented with carotenoids alone. Our findings are in agreement with these predictions since carotenoid and melatonin supplementation had an additive effect on bill colour. To our knowledge this is the first experimental evidence that a non-pigmentary antioxidant enhances the expression of a carotenoid-based sexual trait.
Active ammonia transport and excretory nitrogen metabolism in the climbing perch,Anabas testudineus, during 4 days of emersion or 10 minutes of forced exercise on land
Authors: Tay Yi L. , Loong Ai M. , Hiong Kum C. , Lee Shi J. , Tng Yvonne Y. M. , Wee Nicklaus L. J. , Lee Serene M. L. , Wong Wai P. , Chew Shit F. , Wilson Jonathan M. , Ip Yuen K.
Published: November 2006

The climbing perch, Anabas testudineus, inhabits large rivers,canals, stagnant water bodies, swamps and estuaries, where it can be confronted with aerial exposure during the dry season. This study aimed to examine nitrogen excretion and metabolism in this fish during 4 days of emersion. Contrary to previous reports, A. testudineus does not possess a functional hepatic ornithineurea cycle because no carbamoyl phosphate synthetase I or III activity was detected in its liver. It was ammonotelic in water, and did not detoxify ammonia through increased urea synthesis during the 4 days of emersion. Unlike many air-breathing fishes reported elsewhere, A. testudineus could uniquely excrete ammonia during emersion at a rate similar to or higher than that of the immersed control. In spite of the fact that emersion had no significant effect on the daily ammonia excretion rate, tissue ammonia content increased significantly in the experimental fish. Thus, it can be concluded that 4 days of emersion caused an increase in ammonia production in A. testudineus, and probably because of this, a transient increase in the glutamine content in the brain occurred. Because there was a significant increase in the total essential free amino acid in the experimental fish after 2 days of emersion,it can be deduced that increased ammonia production during emersion was a result of increased amino acid catabolism and protein degradation. Our results provide evidence for the first time that A. testudineus was able to continually excrete ammonia in water containing 12 mmol l-1NH4Cl. During emersion, active ammonia excretion apparently occurred across the branchial and cutaneous surfaces, and ammonia concentrations in water samples collected from these surfaces increased to 20 mmol l-1. It is probable that the capacities of airbreathing and active ammonia excretion facilitated the utilization of amino acids by A. testudineus as an energy source to support locomotor activity during emersion. As a result, it is capable of wandering long distance on land from one water body to another as reported in the literature.
Surgical and nonsurgical treatment of penetrating injuries to the cervical esophagus
Authors: Mandal Ashis K. , Bui Hum D. , Oparah Sonny S.
Published: November 2006

We presented two patients with gunshot wounds and one patient with a stab wound of the cervical esophagus, managed conservatively, which resulted in no deaths. Results of eight studies of cervical esophageal injuries are reviewed and presented in Table I. One must consider both the surgical and conservative methods of management in planning treatment for the given patient.
Nasal turbinate resection for relief of nasal obstruction.
Authors: Martinez Serge A. , Nissen Alan J. , Stock Curt R. , Tesmer Tim
Published: November 2006

Surgical correction of mechanical nasal airway obstruction is commonly attempted by means of septoplasty or submucous resection. In spite of these procedures, patients continue to present postoperatively with inadequate nasal airflow due to hypertrophied turbinates. Partial resection of turbinate mucosa, submucous turbinate resection, electrocautery and outfracture of turbinates provide additional improvement but are incomplete procedures.

Total inferior turbinectomies have been performed on 40 patients over the past 5 years; 29 of these patients have been followed from 2 to 60 months postoperatively by clinical examination and by formal questionnaire. Twenty‐five patients described a marked improvement of their nasal breathing, 3 had mild improvement, and 1 had no improvement at all. Only 1 patient, 1 year postoperatively, described excessive dryness, 2 described mild dryness, 3 described excessive secretions and none complained of foul smell or pain postoperatively. All patients had patent airways by clinical examination by at least 2 otolaryngologists.

The inferior turbinates play a role in humidification and temperature regulation of inspired air. The removal of them, however, does not seem to be fraught with the morbidity which has heretofore been attributed to this procedure.
Benign lipoblastoma in the neck causing respiratory insufficiency
Authors: Gammelgaard Niels , Jørgensen Karsten , Lund Claus
Published: November 2006

A benign lipoblnstoma in the neck, causing respiratory insufficiency and ipsilateral ptosis and miosis, in a 9‐month‐old girl is reported, followed by a short discussion about the nomenclature, genesis, differential diagnosis and behavior of this rare condition.
Congenital rubella syndrome: Function of equilibrium of 80 cases with deafness
Authors: Nishida Yukiaki , Ueda Kohji , Fung Kin‐Ching
Published: November 2006

The equilibrium function of 80 deaf children with congenital rubella syndrome, aged 12, was examined by the caloric and righting reflex tests. Of these 80 children, 24 (30%) had vestibular hypofunction, 6 (7.6%) were suspect, and the remaining 50 (62.5%) were normal. Of all 160 ears tested, vestibular hypofunction was proven in 21.3%, suspect in 5.6%, and normal in the rest. There was no correlation between the incidence of vestibular hypofunction and the degree of hearing loss. Of the 30 children with vestibular hypofunction, 14 (47%) showed a normal righting reflex, suggesting the working of a compensatory mechanism. Of the 50 children with normal caloric responses, 26% revealed an abnormal righting reflex. This discrepancy might be accounted for by an otolith organ injury or minimal brain dysfunction.
Safety and tolerability of the implantable recurrent laryngeal nerve stimulator
Authors: Wernicke J. F. , Friedman Michael , Caldarelli David D.
Published: November 2006

The recurrent laryngeal nerve (RLN) stimulator has been implanted on a limited basis since 1988 for control of spasmodic dysphonia. A similar vagus nerve stimulator has been implanted in a larger series of patients to control epilepsy. The safety and tolerability of these two stimulators were evaluated. In 113 patients implanted with the vagus nerve stimulator, the complication rate was 0.9%. All patients were monitored for vital signs, electrocardiographic changes, and adverse effects. The absence of changes in vital signs and electrocardiograms during vagal stimulation establishes the safety of this treatment. Since placement of the electrode around the vagus nerve is an easier surgical technique than placement deep to the RLN, it seems reasonable to change the technique to implant the stimulator on the vagus in patients with spasmodic dysphonia.
Neurosecretory endings and target cells in the synaptic cleft of the human vocal cord: An electron microscopic study
Authors: Basterra J. , Duly P. N. , Martorell M.
Published: November 2006

The action of neurotransmitters is of interest in the normal function of the vocal cord since they regulate mucous secretion and vessel caliber. The intersynaptic space between glandular and myoepithelial cells and the corresponding neuroendocrine endings is the area in which these substances are delivered. This area has not been previously studied in the human vocal cord.

Specimens from vocal cords have been studied by electron microscopy. In our study, it seems to be clear that there exists a very close contact between myoepithelial cells and secretory nerve endings. This close relationship is likewise observed between these cells and glandular cells.
Enhanced Performance with Brain Stimulation: Attentional Shift or Visual Cue?
Authors: Cavanaugh James , Alvarez Bryan D. , Wurtz Robert H.
Published: November 2006

The premotor theory of visual spatial attention proposes that the same brain activity that prepares for saccades to one part of the visual field also facilitates visual processing at that same region of the visual field. Strong support comes from improvements in performance by electrical stimulation of presaccadic areas, including the frontal eye field and superior colliculus (SC). Interpretations of these stimulation experiments are hampered by the possibility that stimulation might be producing an internal visual flash or phosphene that attracts attention as a real flash would. We tested this phosphene hypothesis in the SC by comparing the effect of interchanging real visual stimuli and electrical stimulation. We first presented a veridical visual cue at the time SC stimulation improved performance; if a phosphene improved performance at this time, a real cue should do so in the same manner, but it did not. We then changed the time of SC visual-motor stimulation to when we ordinarily presented the veridical visual cue, and failed to improve performance. Last, we shifted the site of SC stimulation from the visual-motor neurons of the SC intermediate layers to the visual neurons of the superficial layers to determine whether stimulating visual neurons produced a larger improvement in performance, but it did not. Our experiments provide evidence that a phosphene is not responsible for the shift of attention that follows SC stimulation. This added evidence of a direct shift of attention is consistent with a key role of the SC in the premotor theory of attention.
Corticotropin-Releasing Factor within the Central Nucleus of the Amygdala Mediates Enhanced Ethanol Self-Administration in Withdrawn, Ethanol-Dependent Rats
Authors: Funk Cindy K. , O'Dell Laura E. , Crawford Elena F. , Koob George F.
Published: November 2006

Alcohol dependence is characterized by excessive consumption, loss of control over intake, and the presence of a withdrawal syndrome, including both motivational and physical symptoms. The motivational symptoms, including anxiety, have been hypothesized to be important factors eliciting excessive drinking during abstinence. Previous work has shown that ethanol-dependent rats also display enhanced anxiety-like behaviors and enhanced ethanol self-administration during withdrawal, likely resulting from dysregulation of brain corticotropin-releasing factor (CRF) stress systems. The present study was designed to explore the brain sites within the extended amygdala [central nucleus of the amygdala (CeA), lateral bed nucleus of the stria terminalis (BNST), and nucleus accumbens shell (NAcSh)] that mediate the increased ethanol self-administration observed during withdrawal. Ethanol-dependent animals showed an increase in ethanol self-administration after acute withdrawal relative to nondependent controls. The CRF antagonistd-Phe-CRF12–41([d-Phe12,Nle21,38,Cα MeLeu37]-rCRF(12–41)) was administered into the CeA, lateral BNST, or NAcSh of acute-withdrawn dependent and nondependent rats. Administered into the CeA, the antagonist reduced ethanol self-administration in dependent animals, with no effect in nondependent animals. Administration ofd-Phe-CRF12–41into the lateral BNST and NAcSh was without effect on ethanol self-administration in dependent and nondependent animals. At the same time point of withdrawal, there was a decrease in CRF immunoreactivity within the CeA, suggesting an increased extracellular release of CRF during withdrawal. There was no change in CRF immunoreactivity in the BNST or NAcSh. These results indicate that CRF, specifically within the CeA, plays a role in mediating excessive ethanol consumption in ethanol-dependent animals.
Breastfeeding, Sensitivity, and Attachment
Authors: Britton John R. , Britton Helen L. , Gronwaldt Virginia
Published: November 2006

OBJECTIVE. Our goal was to test the hypothesis that breastfeeding is associated with enhanced infant-mother attachment and its antecedent maternal sensitivity.

METHODS. Breastfeeding intent and practice were assessed by questionnaires administered to 152 mothers between 32 weeks of gestation and 12 months postpartum. Early maternal sensitivity was measured by the Sensitivity to Cues subscale of the Nursing Child Assessment Satellite Training Feeding Scale at 3 months, and quality of the mother-infant interaction was measured by the Nursing Child Assessment Satellite Training Feeding Scale at 6 months. Security of attachment was evaluated by the Ainsworth Strange Situation at 12 months.

RESULTS. A direct relationship between attachment security and breastfeeding practice was not identified. The quality of the mother-infant interaction at 6 months, rather than the type of feeding, predicted security of attachment. However, mothers who chose to breastfeed displayed greater sensitivity in dyadic interactions with their infants 3 months postnatally than those who chose to bottle feed, and intended breastfeeding duration prenatally correlated with sensitivity 3 months postpartum. Although a path analysis failed to demonstrate contributions of early breastfeeding duration to either sensitivity or security, it did substantiate a significant path between prenatal breastfeeding intent and attachment security mediated by sensitivity. In addition, multivariate analyses revealed that early sensitivity among breastfeeding mothers was an independent predictor of the duration of any and exclusive breastfeeding during the first year.

CONCLUSIONS. Although the quality of the dyadic interaction in infancy, rather than feeding type, is predictive of attachment security, mothers who choose to breastfeed display enhanced sensitivity during early infancy that, in turn, may foster secure attachment. Among breastfeeding mothers, higher sensitivity is associated with longer duration of breastfeeding during the first postpartum year. These findings suggest a link between attachment security and breastfeeding.
Implementation and Case-Study Results of Potentially Better Practices to Improve the Discharge Process in the Neonatal Intensive Care Unit
Authors: Mills Marla M. , Sims Debra C. , Jacob Jack
Published: November 2006

Objective. The objective of this study was to implement potentially better practices for discharge planning in the NICU.

Methods. Each participating hospital completed a self-assessment tool on discharge planning and a staff satisfaction survey. Parent satisfaction data were obtained from an Internet-based survey. Many projects regarding discharge planning were completed at each participating center. A major emphasis was the development of transition points to span discharge planning over the entire hospitalization. Results of compliance with tasks or processes that were identified by the transition points and results of staff and parent satisfaction surveys were monitored over time.

Results. The implementation of the transition points at each center demonstrated an improvement in the completion of discharge tasks within the recommended time frame. Combined results of all centers demonstrated a moderate improvement in compliance with transition points from baseline to final measurement in the following areas: unit orientation (56%–81%), identification of a parent feeding plan (74%–92%), completion of cardiopulmonary resuscitation training (55%–72%), and car seat education (42%–63%). Staff survey results showed improvement from baseline to final measurement in the following areas: staff satisfaction with the discharge process (32%–50%), clear documentation of the discharge plan (26%–40%), and clarity of team members' roles in the discharge process (24%–44%). A resource kit on discharge planning was developed for staff and included a section with parent education material. An Internet-based parent satisfaction survey was implemented successfully.

Conclusions. All centers that participated in the collaborative made significant strides in the discharge planning process. Overall, parent satisfaction with discharge planning was high, and improvements were noted in staff satisfaction and availability of resource material.
Implementation and Case-Study Results of Potentially Better Practices for Staffing in Neonatal Intensive Care Units
Authors: Rikli Joan , Hegwood Pat , Atwater Amy , Bauman Barbara , Brown Betty Beverly , Carteaux Pat , Hartmann Elaine , Hilton Shadin , Michael Laura , Norton Lori , Secrest Joel , Sprague Pam , Plsek Paul
Published: November 2006

Objective. Five NICUs that participate in the Vermont Oxford Network Quality Improvement Collaborative have implemented several potentially better practices in an attempt to decrease nurse turnover by 50%. These potentially better practices focus on orientation, rewards and recognition, healthy work environment, nurse–physician collaboration, and nursing autonomy.

Methods. Each unit implemented some or all of the potentially better practices. An Excel spreadsheet tool for tracking turnover rates was developed and used to measure the impact of the potentially better practices on retention. Rates were measured quarterly.

Results. After implementation of the potentially better practices, turnover rates fell at all of the NICUs ranging from 13% to 64%.

Conclusions. Nurse retention is multifactorial. Implementation of the potentially better practices had a positive influence on nurse satisfaction but a varied impact on nurse retention. The impact of larger issues such as pay and staffing levels is significant and may not be influenced at the unit level.
Evaluation and Development of Potentially Better Practices for Perinatal and Neonatal Communication and Collaboration
Authors: Ohlinger Judy , Kantak Anand , Lavin Justin P. , Fofah Ona , Hagen Erik , Suresh Gautham , Halamek Louis P. , Schriefer Janice A.
Published: November 2006

Objective. The obstetric and neonatal exploratory focus group of the Vermont Oxford Network Neonatal Intensive Care Quality Improvement Collaborative 2002 set out to improve collaboration, communication, and coordination between maternal and neonatal caregivers in 3 areas: the pregnancy at 22 to 26 weeks, measurement of maternal outcomes that are linked with neonatal outcomes, and team performance during high-risk delivery. Antepartum and intrapartum maternal attributes and interventions also were considered important measurements to identify practice variations and their relationship to neonatal outcomes for ongoing obstetric and neonatal collaboration.

Methods. Potentially better practices were developed on the basis of evidence in the literature, expert opinion, and internal analysis at the participating perinatal centers. The potentially better practices include development of local guidelines at each center for the care and counseling of pregnant women who are at risk for delivering at the margin of viability; communication strategies for obstetric and neonatology providers relating to high-risk pregnancy treatment plans; team communication and performance at high-risk deliveries; design of organizational structures and processes that facilitate obstetric and neonatal collaboration; and development of perinatal data to evaluate effects of perinatal practices on maternal, fetal, and neonatal outcomes.

Results. As a result of the project, participating centers developed local guidelines for pregnancies between 22 and 26 weeks, created a cross-center maternal database that currently is being linked to neonatal outcomes, and completed a pilot study on video simulation of neonatal–perinatal team communication.

Conclusions. Increased understanding of practice variation in the management of care for infants who are at the margins of viability, locally developed guidelines, and a focus on improved team communication during delivery can be accomplished with a multicenter collaborative approach.
Attitudes of Obstetric and Pediatric Health Care Providers Toward Resuscitation of Infants Who Are Born at the Margins of Viability
Authors: Lavin Justin P. , Kantak Anand , Ohlinger Judy , Kaempf Joseph W. , Tomlinson Mark , Campbell Betty , Fofah Ona , Edwards William , Allbright Kathy , Hagen Erik , Suresh Gautham , Schriefer Janice
Published: November 2006

OBJECTIVES. The objective of this study was to determine the attitudes of a variety of health care providers toward the recommendations that should be made to parents regarding the resuscitation of infants who are born at the margins of viability.

METHODS. A written questionnaire was distributed to the medical and nursing staff at 4 tertiary perinatal centers. For each of 5 weekly gestational age intervals from 22 weeks to 26 weeks, 6 days, the health care providers were asked to describe on a scale from 1 to 5 whether they would strongly discourage through strongly encourage resuscitation. They also were queried regarding their comfort with counseling regarding these issues. The attitudes of various groups of providers were compared across weekly intervals.

RESULTS. A total of 204 physicians and 539 nurses completed the survey. The majority would strongly discourage, either discourage or strongly discourage, be neutral or recommend, recommend or strongly recommend, and strongly recommend resuscitation during the 23rd, 24th, 25th, 26th, and 27th weeks of gestation, respectively. Obstetric caregivers were slightly less likely than pediatric caregivers to strongly discourage resuscitation from 22 weeks to 22 weeks, 6 days and 23 weeks to 23 weeks, 6 days. There were no significant differences in the recommendations of obstetricians and pediatricians. Pediatric nurses were more likely to strongly recommend resuscitation from 26 weeks to 26 weeks, 6 days and more likely either to discourage or to strongly discourage resuscitation from 23 weeks to 23 weeks, 6 days and to strongly discourage resuscitation from the 22 weeks to 22 weeks, 6 days than their obstetric counterparts. Obstetric nurses were slightly less likely than obstetricians to strongly recommend resuscitation at 26 weeks to 26 weeks, 6 days and less likely to strongly discourage resuscitation from 22 weeks to 22 weeks, 6 days.

CONCLUSIONS. The caregivers' recommendations seem to be based logically on the current literature regarding survival and morbidity that is experienced by infants who are born at the threshold of viability. Although there are minor differences, there was a relatively consistent approach among professional groups.
Standardizing Nasal Cannula Oxygen Administration in the Neonatal Intensive Care Unit
Authors: Jackson Jodi K. , Ford Susannah P. , Meinert Kerri A. , Leick-Rude Mary Kay , Anderson Betsi , Sheehan Michael B. , Haney Barbara M. , Leeks Sherri R. , Simon Stephen D.
Published: November 2006

OBJECTIVE. A multicycle, quality improvement method was used to standardize nasal cannula O2 administration and weaning in the NICU.

METHODS. A 2-armed nasal cannula standardized order form (nasal cannula for stable O2 arm and nasal cannula for stable flow arm) was developed after review of the literature, surveying of the practice of NICU physicians and nurse practitioners, and development of consensus among these providers. Outcomes were measured by tracking the distribution of protocol arm chosen, days on O2, weeks on nasal cannula, and disposition of infants who were supported by nasal cannula. Data were collected in an SPSS statistical data set.

RESULTS. Of the 90 infants evaluated, 12 were supported on the stable O2 arm and 53 on the stable flow arm for their entire nasal cannula course. Twenty-five infants switched between arms of support. Patients who were on the stable flow arm of the standard order set for their entire nasal cannula course experienced fewer O2 days but more days on nasal cannula. A subpopulation of infants were supported on nasal cannula flow 0.5 to 1.0 L, with fraction of inspired O2 of 21%. When data from the first 10 weeks of observation were compared with that of the second 10 weeks, the rate of discharge on O2 had decreased from 13 (30%) of 44 to 3 (7%) of 39.

CONCLUSIONS. The multiple steps of literature review, practice surveys, and consensus-building resulted in enthusiastic reception of the nasal cannula standardized order form. The 2-armed nasal cannula protocol forced caregivers to consider which method of support was most beneficial for each infant who was on nasal cannula and allowed a subpopulation of NICU patients to be supported with a lower fraction of inspired O2 than previously used in the NICU.