bluuebunny/crossref_metadata_2025 huggingface dataset:
Is it possible to identify early predictors of the future cost of chronic arthritis? The VErA project
Authors: Flipon E. , Brazier M. , Clavel G. , Boumier P. , Gayet A. , Le Loët X. , Fardellone P. ,   on behalf of the VErA group
Published: February 2009

This study was conducted to identify early predictors of the total cost of inflammatory arthritis (IA). One hundred and eighty patients affected by undifferentiated arthritis (UA) or rheumatoid arthritis (RA) were included in the French Very Early rheumatoid Arthritis (VErA) cohort between 1998 and 2001. Health economic data for 2003 were collected using a patient self‐questionnaire. Results were analysed in terms of direct, indirect and total costs in 2003 euros (2003€) for the population as a whole and in diagnostic subgroups. A payor perspective (the French National Health Insurance, in this case) was adopted. Multiple linear regression models were used to identify predictors of total cost from among the criteria assessed on recruitment. Results of the study showed that for the study population as a whole, the mean total cost was €4700 per patient. The costs attributable to the RA and UA sub‐groups were €5928 and €2424 per patient, respectively. In a univariate analysis, certain parameters were significantly correlated with a higher cost of illness. In the multivariate analysis, some of these parameters were further identified as being predictive of higher cost. Two strong significant, early predictors of total cost were identified: higher pain (P = 0.002) and the presence of rheumatoid factor (P = 0.004). In the RA sub‐group, lower grip strength of the dominant hand (P = 0.039) was another predictor of the illness’s subsequent economic impact. In conclusion, our data show that simple clinical and laboratory parameters can be used early in the course of IA to predict the condition’s impact on healthcare budgets.
Different dietary restriction regimens extend lifespan by both independent and overlapping genetic pathways in C. elegans
Authors: Greer Eric L. , Brunet Anne
Published: February 2009

Dietary restriction (DR) has the remarkable ability to extend lifespan and healthspan. A variety of DR regimens have been described in species ranging from yeast to mammals. However, whether different DR regimens extend lifespan via universal, distinct, or overlapping pathways is still an open question. Here we examine the genetic pathways that mediate longevity by different DR regimens in Caenorhabditis elegans. We have previously shown that the low‐energy sensing AMP‐activated protein kinase AMPK/aak‐2 and the Forkhead transcription factor FoxO/daf‐16 are necessary for longevity induced by a DR regimen that we developed (sDR). Here we find that AMPK and FoxO are necessary for longevity induced by another DR regimen, but are dispensable for the lifespan extension induced by two different DR methods. Intriguingly, AMPK is also necessary for the lifespan extension elicited by resveratrol, a natural polyphenol that mimics some aspects of DR. Conversely, we test if genes previously reported to mediate longevity by a variety of DR methods are necessary for sDR‐induced longevity. Although clk‐1, a gene involved in ubiquinone biosynthesis, is also required for sDR‐induced lifespan extension, we find that four other genes (sir‐2.1, FoxA/pha‐4, skn‐1, and hsf‐1) are all dispensable for longevity induced by sDR. Consistent with the observation that different DR methods extend lifespan by mostly independent genetic mechanisms, we find that the effects on lifespan of two different DR regimens are additive. Understanding the genetic network by which different DR regimens extend lifespan has important implications for harnessing the full benefits of DR on lifespan and healthspan.
NQR1 controls lifespan by regulating the promotion of respiratory metabolism in yeast
Authors: Jiménez‐Hidalgo María , Santos‐Ocaña Carlos , Padilla Sergio , Villalba José M. , López‐Lluch Guillermo , Martín‐Montalvo Alejandro , Minor Robin K. , Sinclair David A. , De Cabo Rafael , Navas Plácido
Published: February 2009

The activity and expression of plasma membrane NADH coenzyme Q reductase is increased by calorie restriction (CR) in rodents. Although this effect is well‐established and is necessary for CR's ability to delay aging, the mechanism is unknown. Here we show that the Saccharomyces cerevisiae homolog, NADH‐Coenzyme Q reductase 1 (NQR1), resides at the plasma membrane and when overexpressed extends both replicative and chronological lifespan. We show that NQR1 extends replicative lifespan in a SIR2‐dependent manner by shifting cells towards respiratory metabolism. Chronological lifespan extension, in contrast, occurs via an SIR2‐independent decrease in ethanol production. We conclude that NQR1 is a key mediator of lifespan extension by CR through its effects on yeast metabolism and discuss how these findings could suggest a function for this protein in lifespan extension in mammals.
Diet and Mental Health in Children
Authors: Tomlinson Diane , Wilkinson Heather , Wilkinson Paul
Published: February 2009

The role played by diet in mental health is of increasing interest to patients, parents, health professionals and public policy makers. This review examines the literature assessing the role of diet in childhood cognitive development, school performance and behaviour. The effects of inadequate dietary intake and of nutrient supplements are considered. Studies of diet and specific psychiatric diagnoses such as depression and psychosis are discussed, with a focus on the evidence for the child and adolescent population.
Obesity: The Role of Child Mental Health Services
Authors: Walker Lucy , Hill Andrew J.
Published: February 2009

Increasing levels of child obesity are placing pressure on all children’s services, including CAMHS. The need for input by mental health professionals is justified by the increased risk of depression, low self‐esteem, binge eating, and impaired quality of life seen in obese children and adolescents. Two routes for CAMHS involvement with obese youngsters are described. Balance It!, a service operating in the NE England, is an example of a long‐term approach involving Tiers 1‐3 of CAMHS. Research testifies to the psychological value of weight loss. However, a series of questions remain regarding best practice, perceived need, and funding of CAMHS in child obesity.
Developing the Primary Mental Health Worker Role in England
Authors: Hickey Nicole , Kramer Tami , Garralda Elena
Published: February 2009

Background:  The Primary Mental Health Worker (PMHW) interface role was introduced in England 13 years ago. This study evaluated the development of the role.

Method:  415 English PMHWs (64% of workforce) completed a survey about the services they provide, management organisation, training and development, and job satisfaction.

Results:  PMHWs perceive their role to involve successful collaboration with primary care staff, offering improved access to mental health services, and being supported by a generally good infrastructure; although training opportunities remain an area of need.

Conclusions:  The workforce development policy appears, from the PMHWs’ perspective, to be successful although training opportunities need consideration.
Data construction method for the analysis of the spatial distribution of disastrous earthquakes in Taiwan
Authors: Wang Hsiao‐Fan , Huang Chun‐Jung
Published: February 2009

Considering a disastrous earthquake as a rare event, the aim of this study is to apply the proposed data construction method (DCM) to determine the possible distribution pattern of disastrous earthquakes in Taiwan. Owing to the availability of only a limited amount of data and based on the multiset division of DCM, virtual samples have been generated. The procedure is illustrated by a numerical experiment that consists of data from 12 disastrous earthquakes in Taiwan from 1990 to 1999. The results show that the pattern constructed by DCM is geologically consistent with the actual phenomenon, which was caused by the collision of the Philippine Sea Plate and the Eurasian Continental Plate. A case study of disastrous earthquakes in East Taiwan is then conducted by studying three near‐source regions. Based on the Kolmogorov–Smirnov test, the constructed spatial distribution has shown its validity and capability in providing useful information for the risk assessment of disastrous earthquakes as rare events.
Simulating Coxian phase‐type distributions for patient survival
Authors: Marshall Adele H. , Zenga Mariangela
Published: February 2009

Coxian phase‐type distributions are a special type of Markov model that can be used to represent survival times in terms of phases through which an individual may progress until they eventually leave the system completely. Previous research has considered the Coxian phase‐type distribution to be ideal in representing patient survival in hospital. However, problems exist in fitting the distributions. This paper investigates the problems that arise with the fitting process by simulating various Coxian phase‐type models for the representation of patient survival and examining the estimated parameter values and eigenvalues obtained. The results indicate that numerical methods previously used for fitting the model parameters do not always converge. An alternative technique is therefore considered. All methods are influenced by the choice of initial parameter values. The investigation uses a data set of 1439 elderly patients and models their survival time, the length of time they spend in a UK hospital.
Integrated bus transit scheduling for the Beijing bus group based on a unified mode of operation
Authors: Shen Yindong , Xia Jiahong
Published: February 2009

This paper presents an applied study of scheduling buses and drivers for the Beijing Bus Group (BJBUS), the largest bus company in China. This is pioneering research in China for bus transit scheduling using computers based on a unified mode of operation. It is anticipated that the research fruits and experiences obtained would be of benefit to other bus operators in China. The bus transit scheduling problem in BJBUS is first presented in the paper. The particular characteristics are pointed out, which are different from those in developed countries, while many are common in China. After a brief review and analysis of the appropriateness of some currently successful approaches, the paper focuses on reporting the solution ideas and methods for BJBUS, especially those developed to solve the specific problems of BJBUS, such as scheduling buses with built‐in meal periods, multi‐type bus scheduling, restricting drivers to one or two particular buses, etc. Finally, the implementation and computational results are reported before the concluding remarks.
Planning without state space explosion: Petri net to Markov decision process
Authors: Naguleswaran Sanjeev , White Langford B.
Published: February 2009

This paper explores the construction of a Markov decision process (MDP) from a predicate transition net representation of a planning problem, which can be optimised using dynamic programming methods. The construction methodology alleviates the problem of state space explosion.
Prostaglandin E2induces contraction of liver myofibroblasts by activating EP3and FP prostanoid receptors
Authors: Ayabe S , Murata T , Maruyama T , Hori M , Ozaki H
Published: February 2009

Background and purpose: Increased portal pressure in liver injury results from hypercontraction of perivascular non‐parenchymal cells including liver myofibroblasts (MFs). Prostaglandin E2(PGE2) is the major eicosanoid which is released around the venous system during liver injury, but little is known about their contractile effect on MFs.

Experimental approach: Contraction of primary rat liver MFs was measured by a collagen gel contraction assay. Expression of E prostanoid (EP) receptor subtypes was assessed by reverse transcription‐polymerase chain reaction. Fura‐2 fluorescence was used to determine intracellular Ca2+concentration ([Ca2+]i). Phosphorylation of protein kinase C (PKC) was detected by Western blot analysis.

Key results: Liver MFs expressed mRNAs for all four EP receptors. PGE2induced contraction in a dose‐ and time‐dependent manner, and slightly increased [Ca2+]ionly at high concentrations (10 µmol·L−1). An agonist selective for EP3receptors, ONO‐AE‐248, dose‐dependently induced MF contraction but did not increase [Ca2+]i. Pretreatment with rottlerin (a specific novel PKC inhibitor) and Ro 31‐8425 (a general PKC inhibitor) significantly reduced 1 µmol·L−1PGE2‐ or ONO‐AE‐248‐induced contractions. Furthermore, 1 µmol·L−1PGE2stimulated phosphorylation of PKC isoforms PKCδ and PKCε. The F prostanoid (FP) receptor antagonist AL8810 abolished the [Ca2+]ielevation and the rapid contraction induced by 10 µmol·L−1PGE2.

Conclusions and implications: Lower concentrations up to 1 µmol·L−1of PGE2induce liver MF contraction via a [Ca2+]i‐independent PKC‐mediated pathway through the EP3receptor, while higher concentrations have an additional pathway leading to Ca2+‐dependent contraction through activating the FP receptor.
The integrin α2β1agonist, aggretin, promotes proliferation and migration of VSMC through NF‐kB translocation and PDGF production
Authors: Chung Ching‐Hu , Lin Kuan‐Ting , Chang Chien‐Hsin , Peng Hui‐Chin , Huang Tur‐Fu
Published: February 2009

Background and purpose: During the development of atherosclerotic plaques, vascular smooth muscle cells (VSMCs) migrate from the media to the intima through the basement membrane and interstitial collagenous matrix, and proliferate to form neointima. Here, we investigate the mechanism of VSMC migration and proliferation caused by aggretin, a snake venom integrin α2β1 agonist.

Experimental approach: Cultures of rat and human VSMCs were treated with aggretin and the signal transduction pathways induced by this agonist were examined by Western blotting, immunoprecipitation and electrophoretic mobility shift assay techniques.

Key results: Aggretin‐induced VSMC proliferation was blocked by a monoclonal antibody (mAb) against integrin α2 (AII2E10) or against the platelet‐derived growth factor receptor (PDGFR)‐β. Proliferation was also blocked by inhibition of the tyrosine kinase Src with PP2, phospholipase C (PLC) with U73122, extracellular signal‐regulated kinase (ERK) with PD98059 or nuclear factor‐kappa B (NF‐kB) activation with pyrrolidine dithiocarbamate (PDTC). VSMC migration towards immobilized aggretin was increased in a modified Boyden chamber and this effect was blocked by α2β1‐Src‐PLC‐MAPK axis inhibitors, but not by PDTC, PDGFR‐β mAb, or a phosphoinositide‐3 kinase inhibitor, LY294002. Aggretin stimulated the phosphorylation of PDGFR‐β, Src and ERK in a time‐dependent manner. NF‐kB translocation and platelet‐derived growth factor (PDGF)‐BB production were also observed. The ERK activation, NF‐kB translocation and PDGF‐BB production were blocked by PP2, U73122 and PD98059.

Conclusions and implications: Aggretin induces VSMC proliferation and migration mainly through binding to integrin α2β1, and subsequently activates Src, PLC and ERK pathways, inducing NF‐kB activation and PDGF production.
Exploring the quality of dying of patients with chronic obstructive pulmonary disease in the intensive care unit: a mixed methods study
Authors: Goodridge Donna , Duggleby Wendy , Gjevre John , Rennie Donna
Published: February 2009

Rationale for the study:  Improving the quality of end‐of‐life (EOL) care in critical care settings is a high priority. Patients with advanced chronic obstructive pulmonary disease (COPD) are frequently admitted to and die in critical care units. To date, there has been little research examining the quality of EOL care for this unique subpopulation of critical care patients.

Aims:  The aims of this study were (a) to examine critical care clinician perspectives on the quality of dying of patients with COPD and (b) to compare nurse ratings of the quality of dying and death between patients with COPD with those who died from other illnesses in critical care settings.

Design and sample:  A sequential mixed method design was used. Three focus groups provided data describing the EOL care provided to patients with COPD dying in the intensive care unit (ICU). Nurses caring for patients who died in the ICU completed a previously validated, cross‐sectional survey (Quality of Dying and Death) rating the quality of dying for 103 patients.

Data analysis:  Thematic analysis was used to analyse the focus group data. Total and item scores for 34 patients who had died in the ICU with COPD were compared with those for 69 patients who died from other causes.

Results:  Three primary themes emerged from the qualitative data are as follows: managing difficult symptoms, questioning the appropriateness of care and establishing care priorities. Ratings for the quality of dying were significantly lower for patients with COPD than for those who died from other causes on several survey items, including dyspnoea, anxiety and the belief that the patient had been kept alive too long. The qualitative data allowed for in‐depth explication of the survey results.

Conclusions:  Attention to the management of dyspnoea, anxiety and treatment decision‐making are priority concerns when providing EOL care in the ICU to patients with COPD.
Matching service need with staff development: a project management experience
Authors: Wadams Beverley
Published: February 2009

Aim:  This paper will investigate the development of enhanced clinical practice of the senior nurses’ role (band 6 and above) within one cardiac intensive care unit. The enhanced role was primarily patient focused and supported local need. Role development was perceived to run parallel with national trend rather than follow it directly.

Method:  The process and strategies used to facilitate such clinical development will be explored in depth.

Conclusions:  The aim of the developed senior role was to expedite respiratory care for critical care patients, specifically, requesting chest X ray and supplying and administrating limited respiratory drugs for the deteriorating patient. To enable this, an education framework was required to support new policy formulation. Wider organization issues confronted during this policy construction are additionally explored.
Factors leading to self‐extubation of endotracheal tubes in the intensive care unit
Authors: Huang Yuan‐Ting
Published: February 2009

Aim and objective:  To discuss the factors leading to self‐extubation of endotracheal tubes (ETTs) and explore the differences between the groups of patients who did and did not self‐remove their ETTs.

Background:  Self‐extubation of ETTs has been reported to occur in 4·2% of severely ill patients and is associated with adverse medical effects.

Design:  A case‐control study.

Methods:  One hundred and thirty‐nine subjects were recruited from a teaching hospital in southern Taiwan based on purposive sampling. The rate of self‐extubation of ETTs was 6·4%. Analysis of the two groups demonstrated that significant variables were identified and fell into three categories: (1) the department to which the patient was admitted (p < 0·001), (2) whether the patient met the criteria for extubation (p < 0·001) and (3) the patient age (p < 0·05). Based on multiple logistic regression analysis, whether the patient met the criteria for extubation was a main variable that was associated with self‐extubation of the ETT. Among the 44 patients who had self‐extubation of their ETT, 28 met the criteria to be extubated, 70% and 81·8% of whom were not sedated, and self‐extubation of their ETT was conscious of the act. Of the patients who attempted to self‐remove their ETT, 80% were successful and 93·2% did not incur any adverse medical effects.

Conclusion:  The medical doctor and nurse should fully evaluate a patient’s oxygenation status, decrease the length of the extubation training session for patients and extubate patients promptly when extubation criteria are met.

Relevance to clinical practice:  Adopting a proactive approach to patient extubation will improve the overall quality of care.
Ventilatory weaning: a case study of protracted weaning
Authors: Pattison Natalie , Watson Jennifer
Published: February 2009

Background:  Dysfunctional ventilatory weaning response (DVWR) is characterized by interrupted and prolonged weaning. This reflective analysis presents how using nursing diagnoses in critical care can raise awareness of, and provide strategies for, managing problems related to ventilatory weaning.

Aim:  To examine and reflect upon why one patient took so long to wean from the ventilator using the structured approach of instrumental case study and nursing diagnosis to explain aspects of the weaning process.

Analysis:  This case study examines one patient’s experiences around ventilatory weaning using selected nursing diagnoses, exploring the implications that physiological, social, emotional and psychological factors have on both weaning and healing processes in critical care. By using dialogue, an explicit texture is presented of how one patient felt, with particular resonance to the relationships she had and the impact they made. Various nursing diagnoses proved useful in determining why this patient had an extended weaning trajectory and included DVWR, ineffective breathing pattern, impaired spontaneous ventilation, anxiety and impaired verbal communication. There were specific points of interest, in particular her anxiety, which proved a major factor, and her significantly improved functional status after the critical care episode. A DVWR may be minimized by nursing presence, reassurance and respect for patient autonomy. Complex anatomy and physiology contributes to protracted weaning and a DVWR and is compounded by anxiety. Furthermore, there is a significant element of nursing care, timely reassurance and presence, which can have a positive impact on patient well‐being.

Conclusions:  This reflective analysis highlights the benefits and importance of the nurse‐patient relationship during what was a very protracted ventilatory wean. This shared trajectory enabled significant patient empowerment, and this case study gives the patient the voice she temporarily lost.
Interlobate ice‐sheet dynamics during the Last Glacial Maximum at Whitburn Bay, County Durham, England
Authors: DAVIES BETHAN J. , ROBERTS DAVID H. , Ó COFAIGH COLM , BRIDGLAND DAVID R. , RIDING JAMES B. , PHILLIPS EMRYS R. , TEASDALE DEREK A.
Published: February 2009

This research reconstructs ice‐sheet processes operating during the Late Devensian in northeast England. The article assesses the lithostratigraphy of the Devensian glacial tills of Whitburn Bay, eastern County Durham, and presents the first detailed analysis of petrological, geochemical and biostratigraphical data to reconstruct lithostratigraphy, provenance and iceflow pathways. Two Devensian tractions tills (the Blackhall and Horden tills) are separated by a boulder pavement, pointing to a switch in ice‐bed conditions and the production of a melt‐out lag prior to deposition of the upper traction till, the Horden Till. The Blackhall Till contains Magnesian Limestone, Carboniferous Limestone, Whin Sill dolerite and Old Red Sandstone, suggesting a northwesterly source, probably from the Midland Valley and the Southern Uplands. The Horden Till contains erratics and heavy minerals derived from crystalline bedrock sources in the Cheviot Hills and northeast Scotland. Within the Horden Till are numerous sand, clay and gravel‐filled canals incised downwards into the diamicton which are attributed to a low‐energy, distributed, subglacial canal drainage system. Coupled with hydro‐fractures and the boulder pavement, this suggests that a partially decoupled, fast‐flowing ice stream deposited the Horden Till. The uphill, landward direction of ice movement indicates that the ice stream was confined in the North Sea Basin, possibly by the presence of Scandinavian Ice.
The origin and migration of the earliest‐developing sensory neurons in the peripheral nervous system of amphioxus
Authors: Kaltenbach Stacy L. , Yu Jr‐Kai , Holland Nicholas D.
Published: February 2009

SUMMARY
In amphioxus embryos, the early development of the type 1 sensory neurons was followed by Tlx gene expression and scanning electron microscopy. At the early neurula stage, AmphiTlx transcription is first detectable in a ventral zone of epidermis. In later embryos, expression is also seen in differentiating type 1 receptor cells of the peripheral nervous system, in a few cells in the central nervous system (CNS), and in anterior notochord cells. The type 1 receptors originate from the ventral epidermis by delaminating individually into the subepidermal space, where they can conveniently be visualized because of their strong expression of AmphiTlx. Within the subepidermal space, the apex of each delaminated receptor loses its cilium and microvilli whereas the base of the cell extends lamellate pseudopodia on the surface of the deeper tissues. The pseudopodia become oriented toward the dorsal side of the embryo, the direction of cell migration. After reaching the flanks of the embryo, the receptor cell stops migrating, loses its pseudopodia, and produces an axon that extends to the CNS. As the receptor finishes differentiating, it downregulates Tlx expression and evidently re‐inserts its perikaryon into the epidermis. The discussion considers the possible homology of the type 1 receptor neurons of amphioxus with migrating lateral line primordia and hair cells of vertebrates.
Sensory structures of Archaeostraca (Phyllocaridida, Crustacea)
Authors: Crasquin Sylvie , Racheboeuf Patrick R. , Bergström Jan
Published: February 2009

SUMMARY
The carapace of some Archaeostraca exhibits two kinds of structures that are best interpreted as corresponding to sensory organs. Dorsal ones are located either along the dorsal margin of the valves of the carapace, or on the median dorsal plate. Anterolateral ones are located in the anterior region of both valves. Both structures are respectively homologous of the anterior and posterior sensory organs known from extant Leptostraca and other Crustacea. These structures are described in adult Archaeostraca from the Ordovician to the Carboniferous. It is expected that they could have baroreceptor, mechanoreceptor, and/or chemoreceptor functions in some cases, and a function in osmotic regulation in others.
Responses, Actions and Health‐Promoting Behavior Among Rural Taiwanese Women With Abnormal Papanicolaou Test
Authors: Liou Huoy‐In , Ling Xue‐Min , Feng Man‐Xuan , Guo Yue‐Ling , Chen Mei‐Yen
Published: February 2009

ABSTRACT
Objectives: The incidence and mortality rate of cervical cancer in Taiwan are higher than in other developed countries. This study aimed to explore women's responses and actions after receiving their test reports and their practice of health‐promoting behaviors.

Design: This study employed a cross‐sectional descriptive design.

Sample: A convenient sample of 101 women living in a rural area.

Measurements: Demographic characteristics, semistructured questions and Chinese Adult Health Promotion scale were used in this study.

Results: The mode of the duration of their marriages was 20 years. Nearly 14% were diagnosed as precancerous and underwent further treatment. 24 percent of the women took no action during the 3 months after receiving the results. As many as 96% of the participants were not aware of the 90% 5‐year survival rate for localized cervical cancer. From semistructured interviews, 4 behavioral responses and 5 actions were identified. Notably, many women in this study practiced health‐promoting behaviors for health responsibility, regular exercise and stress management with low frequency.

Conclusions: These analytical results may prove useful in developing intervention strategies to assist women with positive Papanicolaou test results to choose treatment modalities and adopt healthy behaviors.
The Effect of a Nutrition Education Program on the Nutritional Knowledge, Hemoglobin Levels, and Nutritional Status of Nicaraguan Adolescent Girls
Authors: Moore Jean Burley , Pawloski Lisa , Rodriguez Claudia , Lumbi Laura , Ailinger Rita
Published: February 2009

ABSTRACT
Objectives: The purpose of this study was to examine the effect of a community‐based nutrition education program on the nutritional knowledge, hemoglobin levels, and nutritional status of Nicaraguan adolescent girls and the nutritional knowledge of their mothers.

Theory: Self‐care deficit nursing theory was used in this study.

Design: This longitudinal study used a mixed quantitative/qualitative design to study the effect of the nutrition education program.

Sample: The nonprobability sample consisted of 182 adolescent girls and 67 of their mothers. The setting for the study was a community (barrio) in Managua, Nicaragua.

Intervention/Measurement: A team of nurse and nutrition researchers created the nutrition education program designed to improve girls' and mother's nutrition‐related self‐care operations. Data collection was carried out for 4 years for girls and 2 years for mothers in Managua, Nicaragua, using questionnaires, a HemoCue, and anthropometric measures.

Results and Conclusion: The findings of this study were that girls' and mothers' nutritional knowledge scores significantly improved in most cases after participation in the nutrition intervention program. Girls' hemoglobin levels did not significantly improve and their nutritional status findings were mixed. Girls and mothers described what dietary changes girls made and why.
Vaccination Competence
Authors: Nikula Anne , Hupli Maija , Rapola Satu , Leino‐Kilpi Helena
Published: February 2009

ABSTRACT
Objective: Vaccinating is one of the most significant methods of health promotion in the world. The purpose of this study was to describe vaccination competence from the perspective of professionals, clients, and students.

Design: A cross‐sectional interview study.

Sample: Participants (n=40) were public health nurses, physicians, nursing teachers and graduating public health nursing students, and vaccinated clients of various ages or vaccinated children's parents in Finland.

Measurements: Interview data were collected using semistructured interviews in focus groups and individual interviews, and were analyzed by content analysis.

Results: The participants pointed out that the competent vaccinator (CV) displays distinctive personal qualities, possesses the necessary attributes required in the vaccinator‐client relationship, and is authorized to administer vaccinations. The competent vaccinator is a health care professional who is committed to vaccinating and who fosters social awareness of vaccinations. The competent implementation of the vaccination procedure consists of the vaccinator's actions before, during, and after the vaccination. The outcomes of a competent implementation are divided into immediate and long‐term outcomes.

Conclusions: Vaccination competence is a broad entity. These results may be utilized for improving the practical implementation of vaccinations, administration, education, and research of vaccination procedures.
Friday at Frontier Nursing Service
Authors: January Anna May
Published: February 2009

ABSTRACT
The Frontier Nursing Service (FNS) was founded in 1925 in eastern Kentucky by Mary Breckinridge, a nurse whose interest in improving rural health and midwifery changed the course of rural public health nursing and improved health outcomes for some of the most isolated and poorest people in 20th century America. The visual image of Breckinridge on horseback visiting her scattered rural patients is imprinted on the minds of most public health nurses in the United States and has, perhaps, been the wellspring of many nursing career aspirations. The daily life of FNS nurses was one of hardship, uncertainty and variey, as is evidenced in this tale of one day; nonetheless, the experiment of a rural nursing service combining midwifery and generalized nursing was ultimately a tremendous success. The following historical reprint recounts a singular day in the life of Anna January, a nurse midwife at the FNS in Confluence, Kentucky. She captures the dialect and earthiness of the region and the period in her story, but the events she relates also illustrate how interconnected life events can be in rural communities. The original article appeared in the December 1948 issue of Public Health Nursing [Volume 40 (12), 601–602].
Prospects in Lyophilization of Bovine Pericardium
Authors: Leirner Adolfo A. , Tattini Virgílio , Pitombo Ronaldo N.M.
Published: February 2009

Almost 30 years after the introduction of heart valve prostheses patients worldwide are benefiting from the implant of these devices. Among the various types of heart valves, the ones made of treated bovine pericardium have become a frequently used replacement of the heart's native valve. Lyophilization, also known as freeze‐drying, is an extremely useful technique for tissue storage for surgical applications. This article gives a brief overview on the current bovine pericardium lyophilization development, including the chemical modification to improve physical–chemical characteristics and the advanced technologies used to guarantee a high‐quality product. It was shown that lyophilization process can be successfully applied as a method of bovine pericardium preservation and also as a technological tool to prepare new materials obtained by chemical modification of native tissues.
Development and Validation of Small‐diameter Vascular Tissue From a Decellularized Scaffold Coated With Heparin and Vascular Endothelial Growth Factor
Authors: Zhou Min , Liu Zhao , Wei Zhiqing , Liu Changjian , Qiao Tong , Ran Feng , Bai Yan , Jiang Xuefeng , Ding Ying
Published: February 2009

To overcome shortcomings of current small‐diameter vascular prostheses, we developed a novel allogenic vascular graft from a decellularized scaffold modified through heparin immobilization and vascular endothelial growth factor (VEGF) coating. The VEGF coating and release profiles were assayed by enzyme‐linked immunosorbent assay, the biological activity of modified surface was validated by human umbilical vein endothelial cells seeding and proliferation for 10 days in vitro. In vivo, we implanted either a modified or a nonmodified scaffold as bilateral carotid allogenic graft in canines (n = 15). The morphological examination of decellularized scaffolds showed complete removal of cellular components while the extracellular matrix structure remained intact. After modification, the scaffolds possessed local sustained release of VEGF up to 20 days, on which the cells cultured showed significantly higher proliferation rate throughout the time after incubation compared with the cells cultured on nonmodified scaffolds (P < 0.0001). After 6 months of implantation, the luminal surfaces of modified scaffolds exhibited complete endothelium regeneration, however, only a few disorderly cells and thrombosis overlay the luminal surfaces of nonmodified scaffolds. Specifically, the modified scaffolds exhibited significantly smaller hyperplastic neointima area compared with the nonmodified, not only at midportion (0.56 ± 0.07 vs. 2.04 ± 0.12 mm2, P < 0.0001), but also at anastomotic sites (1.76 ± 0.12 vs. 3.67 ± 0.20 mm2, P < 0.0001). Moreover, modified scaffolds had a significantly higher patency rate than the nonmodified after 6 months of implantation (14/15 vs. 7/15, P = 0.005). Overall, this modified decellularized scaffold provides a promising direction for fabrication of small‐diameter vascular grafts.
Reversal Blood Flow Component as Determinant of the Arterial Functional Capability: Theoretical Implications in Physiological and Therapeutic Conditions
Authors: Bia Daniel , Zócalo Yanina , Armentano Ricardo L. , De Forteza Eduardo , Cabrera‐Fischer Edmundo
Published: February 2009

In several physiological, pathological, and therapeutic circumstances, the arterial blood flow is acutely modified, increasing, in some vascular segments the reversal (SSR) and oscillatory (SSO) components of the shear stress. Recently, in an in vivo model we found a relationship between acute changes in SSR and SSO, and variations in the arterial viscoelasticity. As the arterial viscoelasticity and diameter are the main determinants of the arterial buffering (BF) and conduit (CF) functions, changes in those functions could be expected associated with variations in SSR and SSO. The aim was to analyze the association between acute increases in SSR and SSO, and changes in the aortic CF and BF. Aortic flow, pressure, and diameter were measured in 16 sheep under basal and high reversal and oscillatory flow conditions (high SSR and SSO). Aortic BF and CF were quantified, and their potential association with the SSR and SSO components were analyzed. During high reversal flow rate conditions, a smooth muscle contraction‐pattern was evidenced, with an increase in BF and a decrease in CF. Changes in BF and CF were associated with the changes in SSR and SSO. The acute effects on the arterial wall biomechanics of variations in SSR and SSO could contribute to comprehend their chronic effects, and the meaning of the acute vascular effects of changes in SSR and SSO would depend on the situation. Increases in SSR and SSO could be associated with smooth muscle tone increase‐dependent changes in arterial BF and CF.
Adjunctive levetiracetam in infants and young children with refractory partial‐onset seizures
Authors: Piña‐Garza Jesus Eric , Nordli Jr Douglas R. , Rating Dietz , Yang Haichen , Schiemann‐Delgado Jimmy , Duncan Benjamin ,   on behalf of the Levetiracetam N01009 Study Group
Published: February 2009

Purpose:  To evaluate the efficacy and tolerability of adjunctive levetiracetam in very young children (aged 1 month to <4 years) with partial‐onset seizures inadequately controlled with one or two antiepileptic drugs.

Methods:  This multicenter, double‐blind, randomized, placebo‐controlled study consisted of a 48‐h inpatient baseline video‐EEG (electroencephalography) and a 5‐day inpatient treatment period (1‐day up‐titration; 48‐h evaluation video‐EEG in the last 2 days). Children who experienced at least two partial‐onset seizures during the 48‐h baseline video‐EEG were randomized to either levetiracetam [40 mg/kg/day (age 1 to <6 months); 50 mg/kg/day (age ≥6 months to <4 years] or placebo.

Results:  Of 175 patients screened, 116 patients were randomized [60 levetiracetam; 56 placebo; intent‐to‐treat (ITT) population], and 111 completed the study. The responder rate in average daily partial‐onset seizures frequency (48‐h video‐EEG monitoring; primary efficacy variable) was 43.1% for levetiracetam [modified ITT (mITT) = 58] versus 19.6% for placebo (mITT = 51; p=0.013), with odds ratio for response 3.11 [95% confidence interval (CI), 1.22–8.26]. The median percent reduction from baseline in average daily partial‐onset seizure frequency was 43.6% for levetiracetam and 7.1% for placebo with a median difference between treatment groups of 39.2% (95% CI, 17.5–62.2; p < 0.001). In general, levetiracetam was well tolerated. Treatment‐emergent adverse events were reported by 55.0% levetiracetam‐ and 44.6% placebo‐treated patients (ITT population). The most frequently reported adverse events were somnolence (13.3% levetiracetam, 1.8% placebo) and irritability (11.7% levetiracetam, 0% placebo).

Discussion:  Adjunctive levetiracetam is an efficacious and well‐tolerated treatment for partial‐onset seizures in infants and young children.
Long‐term seizure outcome of surgery versus no surgery for drug‐resistant partial epilepsy: A review of controlled studies
Authors: Schmidt Dieter , Stavem Knut
Published: February 2009

A majority of patients with formerly drug‐resistant temporal lobe epilepsy become seizure‐free after surgery. However, apart from one 12‐month randomized trial, it is unclear how many become seizure‐free because of surgery. To determine the net benefit of surgery, we performed a systematic review and meta‐analysis of the published evidence of how many patients in similar studies become seizure‐free without surgery. Of 155 potentially eligible articles reviewed in full text, 29 (19%) fulfilled eligibility criteria. After excluding 9 publications, 20 studies form the base of evidence. Overall, 719 of 1,621 (44%) of patients with mostly temporal lobe surgery were seizure‐free compared to 139 of 1113 (12%) of nonoperated controls [pooled random effects relative risk (RR) 4.26, 95% confidence interval (CI) 3.03–5.98]. The pooled risk difference in favor of surgery was 42% (95% CI 32–51%). We found no comparative outcome data in patients with extratemporal lobe epilepsy only. The available evidence from mostly nonrandomized observational studies indicates that in appropriately selected patients with drug‐resistant temporal lobe epilepsy, the combination of surgery with medical treatment is 4 times as likely as medical treatment alone to achieve freedom from seizures.
Atypical language lateralization in epilepsy patients
Authors: Möddel Gabriel , Lineweaver Tara , Schuele Stephan U. , Reinholz Julia , Loddenkemper Tobias
Published: February 2009

Purpose:  To investigate whether atypical language dominance in epilepsy patients is related to localization and type of lesions.

Methods:  Four hundred and forty‐five epilepsy patients received bilateral Wada testing. Language was classified as left (L), right (R), bilateral‐dependent (BD, speech arrest after left and right injections), or bilateral‐independent (BI, no speech arrest after either injection). Groups were compared regarding handedness and magnetic resonance imaging (MRI) lesions. Lesions were classified as “early” (congenital), “late” neocortical (acquired after birth), and hippocampal sclerosis (HS).

Results:  Of all patients, 78% were L, 6% R, 7% BD, and 9% BI. Right‐handers with left lesions did not differ from those without lesions. Left‐handers with normal MRI did not differ from right‐handers. Left‐handers with early left lesions were most likely R (46%). Left‐handers with late neocortical left lesions were most likely BD (37%); those with left HS were most likely BD (33%) or L (33%). In both latter groups, R language was rare (13% and 11%, respectively).

Discussion:  The data support the notion that R dominance may indicate development of functional language areas in the right hemisphere following an early insult. BD language may signal defective maintenance of right hemispheric language caused by a late left hemispheric insult at a time when left dominance has already started to develop. In contrast, BI language may represent a variant with functional language representation in both hemispheres.
EEG features of absence seizures in idiopathic generalized epilepsy: Impact of syndrome, age, and state
Authors: Sadleir Lynette Grant , Scheffer Ingrid E. , Smith Sherry , Carstensen Bendix , Farrell Kevin , Connolly Mary B.
Published: February 2009

Purpose:  Factors influencing the electroencephalography (EEG) features of absence seizures in newly presenting children with idiopathic generalized epilepsy (IGE) have not been rigorously studied. We examined how specific factors such as state, provocation, age, and epilepsy syndrome affect the EEG features of absence seizures.

Methods:  Children with untreated absence seizures were studied using video‐EEG recording. The influence of state of arousal, provocation (hyperventilation, photic stimulation), age, and epilepsy syndrome on specific EEG features was analyzed.

Results:  Five hundred nine seizures were evaluated in 70 children with the following syndromes: childhood absence epilepsy (CAE) 37, CAE+ photoparoxysmal response (PPR) 10, juvenile absence epilepsy (JAE) 8, juvenile myoclonic epilepsy (JME) 6, and unclassified 9. Polyspikes occurred in all syndromes but were more common in JME. They were brought out by drowsiness and sleep in fragments of generalized spike and wave (GSW). Polyspikes were more likely to occur during photic stimulation, but were not influenced by age independently. GSW was more likely to be disorganized in JME than JAE, and in JAE than CAE. Increasing age and levels of arousal were more likely to result in organized GSW. Factors specific to each child independently influenced EEG features; the nature of these factors has not been identified.

Discussion:  The EEG features of absence seizures are influenced by a complex interaction of age, epilepsy syndrome, level of arousal, provoking factors, and other intrinsic factors. Epilepsy syndrome alone cannot predict specific features of GSW; however, JME is more frequently associated with polyspikes and disorganization of the paroxysm.
Electrocardiogram‐Based Algorithm to Predict the Left Ventricular Lead Position in Recipients of Cardiac Resynchronization Systems
Authors: PLOUX SYLVAIN , BORDACHAR PIERRE , DEPLAGNE ANTOINE , MOKRANI BILEL , REUTER SYLVAIN , LABORDERIE JULIEN , GARRIGUE STEPHANE , DELARCHE NICOLAS , JAIS PIERRE , HAISSAGUERRE MICHEL , CLEMENTY JACQUES
Published: February 2009

Introduction: Biventricular pacing is associated with various electrocardiographic patterns depending on the position of the left ventricular (LV) lead. We aimed to develop an electrocardiogram‐based algorithm to predict the position of the LV lead.

Methods: The algorithm was developed in 100 consecutive recipients of cardiac resynchronization therapy (CRT) systems. QRS axis, morphology, and polarity were analyzed with a view to define the specific electrocardiographic characteristics associated with the various LV lead positions
. The algorithm was prospectively validated in 50 consecutive CRT device recipients.

Results: The first analysis of the algorithm was the QRS morphology in V1. A positive R wave in V1 suggested LV lateral or posterior wall stimulation. A QS pattern was specific of anterior LV leads. In the presence of an R wave in V1, V6 was analyzed to distinguish between an inferior and anterior LV lead. Inferior leads were never associated with a positive V6. To differentiate between lateral and posterior positions, we analyzed the pattern in V2. Lateral leads were associated with an R morphology in V1 and a negative V2. Posterior leads were associated with an R morphology in V1 and V2. The algorithm allowed a reliable distinction between an inferior or anterior and a lateral or posterior lead position in 90% of patients. Inferior, anterior, lateral, and posterior positions were reliably distinguished in 80% of patients.

Conclusion: This algorithm predicted the position of the LV lead with a high sensitivity and predictive value.