bluuebunny/crossref_metadata_2025 huggingface dataset:
Reduction of Plasma Cold Agglutinin Titers by Means of Plasmapheresis to Prepare a Patient for Coronary Bypass Surgery
Authors: Zoppi M. , Oppliger R. , Althaus U. , Nydegger U.
Published: May 2009

A 53-year-old man with abnormally elevated cold agglutinins was treated successfully by plasma exchange so that he was able to sustain coronary artery surgery and extracorporeal circulation. Two plasma exchanges, consisting in the exchange of one plasma volume with a 5% albumin solution each, were performed in our intensive care unit with careful monitoring of vital parameters. The plasma exchanges resulted in a reduction of the titer of the cold agglutinins and of the thermal amplitude as well. With the exception of postoperative bleeding requiring re-intervention, the patient was successfully operated and could be dismissed on the 16th postoperative day in good condition.
Das Risiko einer Infektionsübertragung durch Blutkomponenten
Authors: Kubanek B. , Cardoso M. , Glück D. , Koerner K.
Published: May 2009

Ziel: Das aktuelle Risiko transfusionsassoziierter Infektionen, besonders mit dem Human Immunodeficiency Virus (HIV) und dem Hepatitis-C-Virus (HCV), für Mitteleuropa zu definieren. Quellen: Relevante neueste englische und deutsche Veröffentlichungen und eigene Daten. Auswahlkriterien: Keine spezielle Literaturrecherche über die Zeit. Ergebnisse: Durch verstärkte Spenderselektion, zusätzliches und verbessertes Labor-Screening und eine sich ändernde Epidemiologie ist das Risiko eine dynamische Gröβe, deren gegenwärtiger Stand immer wieder neu bestimmt werden muβ. Das Risiko einer HIV-Übertragung wird auf 1:1 Million per transfundierte Blutkomponente geschätzt. Durch die seit 1990 durchgeführte Testung aller Blutspenden auf Anti-HCV wurde die Posttransfusionshepatitis-C-(PTH-C-)Übertragung um 80% reduziert und nach eigenen Daten auf 1 per 5000 transfundierte Blutpräparate geschätzt. Eine zu erwartende Verbesserung des HCV-Screenings wird das Risiko, HCV durch Blut zu übertragen, weiter reduzieren. Das Risiko, Hepatitis B zu übertragen, liegt in der Gröβenordnung von 1 per 50000 transfundierte Blutkomponenten. Schluβfolgerung: Dieses in den letzten Jahren deutlich verminderte, aber häufig überschätzte Infektionsrisiko muβ bei einer Nutzen/Risiko-Abschätzung für alternative Methoden zur homologen Bluttransfusion für den einzelnen Patienten in Betracht gezogen werden.
Monoklonale Antikörper in der Blutgruppenserologie Teil 1: Technik der Herstellung, AB0- und Lewis-System
Authors: Sonneborn H.-H. , Dahr W. , Helmbold W. , Kasulke D.
Published: May 2009

Ziel: Die Einführung der monoklonalen Antikörper in die routinemäßige Blut-gruppenbestimmung hat unter anderem auch zu neuen Erkenntnissen geführt. Die Arbeit soil dem Anwender Änderungen aufzeigen und verständlich machen. Quellen: Eigene Erfahrung bei der Herstellung und Anwendung sowie die ein-schlägige Literatur wurden berücksichtigt. Ergebnisse: Die Erzeugung von tierischen wie auch humanen monoklonalen Antikörpern wird beschrieben, besonders auch in Hinsicht auf die umfangreiche Prüfung und Sicherung. Der aktuelle Stand der Verfügbarkeit und des Einsatzes von monoklonalen Antikörpern in den einzelnen Blutgruppensystemen wird dargestellt, wobei besonders auch die neuen Erkenntnisse wie Aι(B)- und B(A)-Phänomene behandelt werden. Schlußfolgerung: Der Einsatz von monoklonalen Antikörpern in der Blutgruppenserologie hat zu wesentlichen Verbesserungen geführt, vor allem hinsichtlich der Erfassung schwacher Varianten sowie der Verfügbarkeit von Reagenzien. Der wei-tere Ausbau dieser Technologie läßt den Einsatz von monoklonalen Antikörpern auch für andere Systeme erwarten.
Improved Cumulated Nitrogen Balance after Administration of Recombinant Human Growth Hormone in Patients Undergoing Gastrointestinal Surgery
Authors: Tacke J. , Bolder U. , Löhlein D.
Published: May 2009

Objective: To examine the effect of recombinant human growth hormone (rhGH) on the catabolic state following major gastrointestinal surgery. Design: The study was designed as a prospective controlled randomized clinical trial. Setting: Intensive care unit the surgical ward of the Department of Surgery Städtische Kliniken Dortmund FRG. Patients: 39 patients were studied postoperatively following gastrectomy or resection of the rectum. The patients were 40-75 years old. Intervention: 0.075 (n = ll) 0.15 (n = 9) or 0.30 IU rhGH/kg/day (n = 9) or placebo (n = 10) were given subcutaneously at 8:00 a.m. during 5 postoperative days. Resting energy expenditure (REE) on the 1st postoperative day was 2,042 ± 82 kcal/24 h (REE/BEE 1.44 + 0.04). Isocaloric isonitrogenous total parenteral nutrition provided the energy requirements (4 g carbohydrates/kg 0.9 g fat/kg 1.25 g amino acids/kg). Results: After 5 days of treatment cumulated nitrogen balance (CNB) was improved dose-relatedly. In controls net nitrogen losses (-20.47 ± 3.86 g) were significantly higher than after 0.15 (-12.14 ± 3.5 g) 0.30 IU rhGH/kg (-10.0 ± 2.61 g). 0.075 IU rhGH/kg showed no significant effect on CNB (-18.07 ± 5.73 g). The modulation of protein metabolism by GH may be mediated by insulin-like growth factor-I (IGF-I). Postoperatively serum (S)-IGF-I was decreased in all groups. rhGH caused a significant dose-related increase in S-IGF-I levels on day 6 whereas in controls it remained unchanged during the study period. Besides significant elevations in serum glucose in some cases of both larger dosage groups no side effects were detected. Conclusions: The protein-sparing effect of rhGH after major gastrointestinal surgery is dose related but not linear. A threshold value for a significant improvement in the CNB seems to be at least at 0.15 IU rhGH/kg/day.
Perioperative Glucose-Insulin-Potassium Infusion in Elective Coronary Surgery: Minor Benefit in Connection with Blood Cardioplegia?
Authors: Wistbacka J.-O.M. , Nuutinen L.S. , Lepojärvi M.V.K. , Nissinen J. , Karlqvist K.E.V. , Ruokonen A.
Published: May 2009

Objective: The goal of this study was to examine the metabolic and hemodynamic effects of a glucose-insulin-potassium infusion in elective coronary surgery, when blood cardioplegia was used for cardiac protection. Design and Patients: A prospective, randomized, open, clinical comparison was performed between 2 perioperative infusion regimens in 40 elective nondiabetic coronary artery bypass graft (CABG) surgery patients. Setting and Interventions: 20 patients (glucose-insulin-potassium – GIK – group) received glucose 0.2 g/kg/h, insulin 0.12 U/kg/h, potassium 0.15, magnesium 0.032 and phosphate 0.024 mmol/kg/h from anesthesia induction to the start of bypass, when infusion rate was reduced to 30%, and after bypass increased to 50% of the initial rate. The infusion was continued until the first postoperative morning. Another 20 patients (control – R – group) received glucose 0.05 g/kg/h, potassium 0.075, magnesium 0.016 and phosphate 0.008 mmol/kg/h from the end of bypass to the next morning. Pump prime was glucose-free and a blood cardioplegia technique was used for cardiac protection. Results: The GIK patients needed less dopamine support in the intensive care unit (ICU) (p < 0.05). No difference was found between the groups with regard to myocardial injury, the MB-fractions of serum creatine kinase (CK-MB) being elevated to a similar degree in both groups. Likewise there were no significant differences in hemodynamic changes or duration of ICU stay. Although the glucose infusion was continued during bypass in the GIK patients, there was a considerable risk of hypo-glycemia (due to insulin and hemodilution) after the onset of bypass: in 5 GIK patients (25%; 95% confidence interval 8.7 to 49.1%) blood glucose was less than 2 mmol/l. However, the hypoglycemia was of short duration and no detrimental effects were seen. Conclusions: Perioperative GIK infusion entailed a slight decrease in the postoperative need for dopamine support, but was connected with a considerable risk of hypoglycemia.
Biochemical and pharmacological effects of the direct thrombin inhibitor AR-H067637
Authors: Mattsson Christer , Inghardt Tord , Elg Margareta , Deinum Johanna
Published: May 2009

AZD0837 is in development as a new oral anticoagulant for use in thromboembolic disorders. In vivo, AZD0837 is converted to AR-H067637, a selective and reversible direct thrombin inhibitor. Established biochemical methods were used to assess and measure the biochemical and pharmacological properties of AR-H067637. Both direct Biacore binding studies of AR-H067637 with immobilised α-thrombin and inhibition studies using pre-steady state kinetics with thrombin in the fluid phase confirmed that AR-H067637 is a rapid-binding, reversible and potent (inhibition constant K
i = 2–4 nM), competitive inhibitor of thrombin, as well as of thrombin bound to fibrin (clot-bound thrombin) or to thrombomodulin. The total amount of free thrombin generated in platelet-poor clotting plasma was inhibited concentration-dependently by AR-H067637, with a concentration giving half maximal inhibition (IC50) of 0.6 μM. Moreover, AR-H067637 is, with the exception of trypsin, a se-lective inhibitor for thrombin without inhibiting other serine proteases involved in haemostasis. Furthermore, no anticoagulant effect of the prodrug was found. AR-H067637 prolonged the clotting time concentration-dependently in a range of plasma coagulation assays including activated partial thromboplastin time, prothrombin time, prothrombinase-induced clotting time, thrombin time and ecarin clotting time. The two latter assays were found to be most sensitive for assessing the anticoagulant effect of AR-H067637 (plasma IC50 93 and 220 nM, respectively). AR-H067637 also inhibited thrombin-induced platelet activation (by glycoprotein IIb/IIIa exposure, IC50 8.4 nM) and aggregation (IC50 0.9 nM). In conclusion, AR-H067637 is a selective, reversible, competitive inhibitor of α-thrombin, with a predictable anticoagulant effect demonstrated in plasma coagulation assays.
Monitoring thrombin generation: Is addition of corn trypsin inhibitor needed?
Authors: Dielis Arne , Panova-Noeva Marina , Oerle René van , Govers-Riemslag José , Hamulyák Karly , Falanga Anna , Cate Hugo Ten , Spronk Henri
Published: May 2009

Thrombin generation monitoring has the potential to be used as a clinical diagnostic tool in the near future. However, robust pre-analytical conditions may be required, and one factor that has been reported is in-vitro contact activation that might influence in-vitro measurements of thrombin generation and thereby act as an unpredictable pre-analytical variable. The aim of the current study was to investigate the influence of contact activation and the necessity of corn trypsin inhibitor (CTI) to abolish contact activation in thrombin generation measurements at low tissue factor (TF) concentrations. Thrombin generation was performed using the calibrated automated thrombinoscopy (CAT), thereby determining the endogenous thrombin potential (ETP), peak height, and the lag time, in plasma obtained from healthy volunteers. Addition of CTI after plasma preparation had no significant influence on thrombin generation triggered with 0.5 pM TF or higher, as demonstrated by unaltered ETP and lag time values between analyses with and without CTI. Addition of CTI before blood collection reduced thrombin generation triggered with 0.5 pM TF: both the ETP and peak height were significantly reduced compared to no CTI addition. In contrast, thrombin generation remained unaltered at a 1 pM TF trigger or above. This study demonstrates that addition of CTI after plasma separation is not necessary when triggering with TF concentrations of 0.5 pM and higher. Furthermore, it was demonstrated that it is not needed to pre-fill blood collecting tubes with CTI when measuring thrombin generation at TF concentrations of ≥1 pM.
Obstetric analgesia and anaesthesia in women with inherited bleeding disorders
Authors: Chi Claudia , Lee Christine , England Adrian , Hingorani Jaishree , Paintsil James , Kadir Rezan
Published: May 2009

A retrospective review was carried out on the methods of obstetric analgesia/anesthesia used in 80 pregnancies amongst 63 women with inherited bleeding disorders (19 factor XI deficiency, 16 carriers of haemophilia, 15 von Willebrand disease, seven platelet function disorders, four factor VII deficiency, one factor VII and XI deficiency and one factor X deficiency). In 72 pregnancies, the woman was seen antenatally in a multidisciplinary clinic to discuss and plan pain relief options. Regional block was performed for 41 pregnancies. The mothers were known to have a bleeding disorder in 35 of these pregnancies. Prophylactic cover was given in 10 pregnancies prior to the insertion of regional block but not required in the remaining 25 pregnancies because the coagulation defects had spontaneously normalised at term. There were six reported adverse effects from regional block similar to that found in the general population: inadequate anesthesia/analgesia (2), bloody tap (2), hypotension and a possible dural puncture which was treated conservatively. There were no reports of long-term complications. The findings show that it is possible to offer women with inherited bleeding disorders the option of regional block provided their coagulation defects have normalised, either spontaneously during pregnancy or following adequate haemostatic cover.
Anticoagulant mechanisms of covalent antithrombin-heparin investigated by thrombelastography
Authors: Atkinson Helen M. , Mewhort-Buist Tracy A. , Berry Leslie R. , Chan Anthony K. C.
Published: May 2009

We have developed an antithrombin-heparin covalent complex (ATH) which inhibits coagulation enzymes by two mechanisms: directly, or by catalytic activation of plasma antithrombin (AT). Anticoagulation by ATH was compared to unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) using a blood-based, tissue factor (TF)-activated thrombelastography (TEG) assay. Simplified TEG assays with plasma or purified plasma components were used to determine the contribution of the direct and catalytic mechanisms to ATH efficacy. Low anti-Xa concentrations of UFH inhibited clot formation significantly more than equivalent concentrations of ATH or LMWH in blood and plasma. ATH had reduced ability to catalyse AT-mediated thrombin (IIa) inhibition compared to UFH. However, at high anti-Xa concentrations, ATH had similar anticoagulant activity to UFH. ATH and non-covalent AT+UFH directly inhibited clotting to a similar degree in AT-deficient plasma. IIa-ATH complexes, which are limited to catalytic inhibition, displayed impaired anticoagulation compared to free ATH, and the magnitude of this effect increased significantly as anticoagulant concentration increased. Kinetic experiments indicated that the rate of reaction of AT with IIa is lower when catalysed by ATH versus UFH. In conclusion, at low anti-Xa doses catalytic inhibition is the primary mechanism of ATH anticoagulation, and the catalytic potential of ATH is reduced relative to UFH. However, the direct inhibitory activity of ATH is comparable to noncovalent AT+UFH, and at high anti-Xa doses the direct inhibitory activity of ATH may play a larger role in anticoagulation.
The potential for circular dichroism as an additional facile and sensitive method of monitoring low-molecular-weight heparins and heparinoids
Authors: Guimond Scott , Holman Joseph , Turnbull Jeremy , Lauder Robert , Fernig David , Rudd Timothy , Skidmore Mark , Yates Edwin
Published: May 2009

The ultraviolet circular dichroism (CD) spectra of commercial low-molecular-weight heparins, heparinoids and other anticoagulant preparations have been recorded between 180 and 260 nm. Principal component analysis of the spectra allowed their differentiation into a number of groups related to the means of their production reflecting the structural changes introduced by each process. The findings suggest that CD provides a complementary technique for the rapid analysis of heparin preparations.
The multi-functionality of CD40L and its receptor CD40 in atherosclerosis
Authors: Lievens Dirk , Eijgelaar Wouter , Biessen Erik , Daemen Mat , Lutgens Esther
Published: May 2009

Disrupting the CD40-CD40L co-stimulatory pathway reduces atherosclerosis and induces a stable atherosclerotic plaque phenotype that is low in inflammation and high in fibrosis. Therefore, inhibition of the CD40-CD40L pathway is an attractive therapeutic target to reduce clinical complications of atherosclerosis. The CD40-CD40L dyad is known to interact with other costimulatory molecules, to activate antigen-presenting cells (APC) and to contribute to T-cell priming and B-cell isotype switching. Besides their presence on T-cells and APCs, CD40 and CD40L are also present on macrophages, endothelial cells and vascular smooth muscle cells in the plaque, where they can exert pro-atherogenic functions. Moreover, recent progress indicates the involvement of neutrophil CD40, platelet CD40L and dendritic cell CD40 in atherogenesis. Since systemic CD40-CD40L modulation compromises host defense, more targeted interventions are needed to develop superior treatment strategies for atherosclerosis. We believe that by unravelling the cell-cell CD40-CD40L interactions, inhibition of cell-type specific (signalling components of) CD40(L) that do not compromise the patient’s immune system, will become possible. In this review, we highlight the cell-type specific multi-functionality of CD40-CD40L signalling in atherosclerosis.
Lack of extended venous thromboembolism prophylaxis in high-risk patients undergoing major orthopaedic or major cancer surgery
Authors: Siebenrock Klaus-Arno , Metzger Urs , Tuor Philipp , Sterzing Daniel , Oehy Kurt , Wondberg Daniela , Mouhsine El Yazid , Gautier Emanuel , Kalka Christoph , Spirk David , Kucher Nils
Published: May 2009

Extended pharmacological venous thromboembolism (VTE) prophylaxis beyond discharge is recommended for patients undergoing high-risk surgery. We prospectively investigated prophylaxis in 1,046 consecutive patients undergoing major orthopaedic (70%) or major cancer surgery (30%) in 14 Swiss hospitals. Appropriate in-hospital prophylaxis was used in 1,003 (96%) patients. At discharge, 638 (61%) patients received prescription for extended pharmacological prophylaxis: 564 (77%) after orthopaedic surgery, and 74 (23%) after cancer surgery (p <0.001). Patients with knee replacement (94%), hip replacement (81%), major trauma (80%), and curative arthroscopy (73%) had the highest prescription rates for extended VTE prophylaxis; the lowest rates were found in patients undergoing major surgery for thoracic (7%),gastrointestinal (19%),and hepatobiliary (33%) cancer. The median duration of prescribed extended prophylax is was longer in patients with orthopaedic surgery (32 days, interquartile range 14–40 days) than in patients with cancer surgery (23 days, interquartile range 11–30 days; p<0.001).Among the 278 patients with an extended prophylaxis order after hip replacement, knee replacement, or hip fracture surgery, 120 (43%) received a prescription for at least 35 days, and among the 74 patients with an extended prophylaxis order after major cancer surgery, 20 (27%) received a prescription for at least 28 days. In conclusion, approximately one quarter of the patients with major orthopaedic surgery and more than three quarters of the patients with major cancer surgery did not receive prescription for extended VTE prophylaxis. Future effort should focus on the improvement of extended VTE prophylaxis, particularly in patients undergoing major cancer surgery.
Tumor Necrosis Factor-α Mediates Hemolysis-Induced Vasoconstriction and the Cerebral Vasospasm Evoked by Subarachnoid Hemorrhage
Authors: Vecchione Carmine , Frati Alessandro , Di Pardo Alba , Cifelli Giuseppe , Carnevale Daniela , Gentile Maria Teresa , Carangi Rosa , Landolfi Alessandro , Carullo Pierluigi , Bettarini Umberto , Antenucci Giovanna , Mascio Giada , Busceti Carla Letizia , Notte Antonella , Maffei Angelo , Cantore Gian Paolo , Lembo Giuseppe
Published: May 2009

Hypertension can lead to subarachnoid hemorrhage and eventually to cerebral vasospasm. It has been suggested that the latter could be the result of oxidative stress and an inflammatory response evoked by subarachnoid hemorrhage. Because an unavoidable consequence of hemorrhage is lysis of red blood cells, we first tested the hypothesis on carotid arteries that the proinflammatory cytokine tumor necrosis factor-α contributes to vascular oxidative stress evoked by hemolysis. We observed that hemolysis induces a significant increase in tumor necrosis factor-α both in blood and in vascular tissues, where it provokes Rac-1/NADPH oxidase–mediated oxidative stress and vasoconstriction. Furthermore, we extended our observations to cerebral vessels, demonstrating that tumor necrosis factor-α triggered this mechanism on the basilar artery. Finally, in an in vivo model of subarachnoid hemorrhage obtained by the administration of hemolyzed blood in the cisterna magna, we demonstrated, by high-resolution ultrasound analysis, that tumor necrosis factor-α inhibition prevented and resolved acute cerebral vasoconstriction. Moreover, tumor necrosis factor-α inhibition rescued the hemolysis-induced brain injury, evaluated with the method of 2,3,5-triphenyltetrazolium chloride and by the histological analysis of pyknotic nuclei. In conclusion, our results demonstrate that tumor necrosis factor-α plays a crucial role in the onset of hemolysis-induced vascular injury and can be used as a novel target of the therapeutic strategy against cerebral vasospasm.
Triple Antihypertensive Therapy With Amlodipine, Valsartan, and Hydrochlorothiazide
Authors: Calhoun David A. , Lacourcière Yves , Chiang Yann Tong , Glazer Robert D.
Published: May 2009

Many patients with hypertension require ≥3 agents to achieve target blood pressure (BP). The efficacy/safety of the dual combinations of valsartan (Val)/hydrochlorothiazide (HCTZ) and amlodipine (Aml)/Val in hypertension are well established. This randomized, double-blind study evaluated the efficacy/safety of triple therapy with Aml/Val/HCTZ for moderate or severe hypertension (mean sitting systolic BP: ≥145 mm Hg; mean sitting diastolic BP: ≥100 mm Hg). The study included a single-blind, placebo run-in period, followed by double-blind treatment for 8 weeks; patients were randomly assigned to 1 of 4 groups titrated to Aml/Val/HCTZ 10/320/25 mg, Val/HCTZ 320/25 mg, Aml/Val 10/320 mg, or Aml/HCTZ 10/25 mg once daily. Dual-therapy recipients received half of the target doses of both agents for the first 2 weeks, titrating to target doses during week 3. Those on triple therapy received Val/HCTZ 160.0/12.5 mg during week 1, Aml/Val/HCTZ 5.0/160.0/12.5 mg during week 2, and target doses of all 3 of the agents during week 3. Of the 4285 patients enrolled, 2271 were randomly assigned to treatment, and 2060 completed the study. Triple therapy was significantly superior to all of the dual therapies in reducing mean sitting systolic BP and mean sitting diastolic BP from baseline to end point (all
P
<0.0001). Significantly more patients on triple therapy achieved overall BP control (<140/90 mm Hg;
P
<0.0001) and systolic and diastolic control (
P
≤0.0002) compared with each dual therapy. Aml/Val/HCTZ was well tolerated. The benefits of triple therapy over dual therapy were observed regardless of age, sex, race, ethnicity, or baseline mean sitting systolic BP. In conclusion, this study demonstrates the efficacy/safety of treating moderate and severe hypertension with Aml/Val/HCTZ 10/320/25 mg.
Low Cardiorespiratory Fitness Levels and Elevated Blood Pressure
Authors: Rhéaume Caroline , Arsenault Benoit J. , Bélanger Stéphane , Pérusse Louis , Tremblay Angelo , Bouchard Claude , Poirier Paul , Després Jean-Pierre
Published: May 2009

Individuals with poor cardiorespiratory fitness have higher blood pressure than fit individuals. Individuals with low fitness levels also tend to be characterized by higher visceral adiposity compared with physically fit individuals. We tested the hypothesis that the relationship between low fitness and elevated blood pressure could be related, at least in part, to the higher level of visceral adipose tissue often found among unfit individuals. This study included 407 asymptomatic, nondiabetic participants. Visceral adipose tissue was assessed by computed tomography, and fitness was measured by a progressive submaximal physical working capacity test. Participants in the highest visceral adipose tissue tertile showed the highest systolic and diastolic blood pressures, whereas participants in the highest fitness tertile had the lowest blood pressure values (
P
<0.001). When participants were classified into fitness tertiles and then subdivided on the basis of visceral adipose tissue (high versus low), participants with a high visceral adipose tissue had higher systolic and diastolic blood pressure values (
P
=0.01), independent of their fitness category. Linear regression analyses showed that age and visceral adipose tissue, but not fitness, predicted systolic blood pressure (
r
2
=0.11 [
P
<0.001], 0.12 [
P
<0.001], and 0.01 [
P
value nonsignificant], for age, visceral adipose tissue, and fitness, respectively) and diastolic blood pressure (
r
2
=0.17 [
P
<0.001], 0.14 [
P
<0.001], and 0.01 [
P
value nonsignificant], for age, visceral adipose tissue, and fitness, respectively). Individuals with high visceral adipose tissue levels have higher blood pressure, independent of their fitness. Visceral adipose tissue may represent an important clinical target in the management of elevated blood pressure.
Power Asymmetry and Negotiations in International River Basins
Authors: Dinar Shlomi
Published: May 2009

Realist thinkers traditionally argue that when the upstream state is the river basin's hegemon, cooperation is least likely to materialize. Conversely, when the downstream state is the basin's hegemon, cooperation is likely to ensue, yet the agreement is often imposed and shaped along the interests of the stronger party. Implied in both scenarios is that the otherwise weaker riparian, in aggregate power terms, is not in a position to achieve its aims and satisfy its needs in an optimal fashion. Its capabilities are inferior to those of its adversary. In effect, it has little alternative but to accept the desires of the stronger riparian. By considering a set of international water agreements and hydro-political contexts, this article challenges the realist conception of power in international river basins. Particularly, it demonstrates that otherwise weaker states may influence the hydro-political context and subsequent international agreements. Cooperation, in general, materializes when both states, but particularly the stronger state, realize that benefits can accrue from coordination and joint action. In other words, to harness the river in an efficient manner, cooperation must ensue and the downstream state's participation is important. Even when the benefits to cooperation are not clear, i.e. when the upstream riparian does not foresee immediate economic incentives to cooperation, coordination may still be attained through the manipulation of incentives (or strategic interaction).
Greek Immigration Policy at the Turn of the 21st Century. Lack of Political Will or Purposeful Mismanagement?
Authors: Triandafyllidou Anna
Published: May 2009

This article traces the development of Greek immigration policy during the last two decades with a view to explaining the role that parties, trade unions and other actors including the Church for instance have played in shaping this policy. The article outlines the reactive and piecemeal character of the policy, its important weakness in dealing effectively with immigration flows and the excessive red tape that characterises it. It is noted that nearly 20 years after the first migrants arrived in the country, Greek immigration policy remains short-sighted, dealing with immigration as a necessary evil and not as an opportunity. This lack of vision and the closed character of the policy has been supported directly or indirectly by both parties and trade unions. The two major parties have been until recently largely agreed in their exclusionary views towards immigrants. It is only since 2004 that the Socialist party has changed its plans but it remains uncertain whether and how it would implement its radical (by Greek standards) pro-immigrant policies if it came to power. Overall, Greek political elites lack the political will to adopt a proactive and realistic migration policy plan. This is partly because migration neither wins nor loses national elections. And partly because they fear that stating publicly that Greece should accept economic immigrants through legal channels and that immigrants should become part of Greek society on a basis of equality and plurality would cost them votes.
Immigration Policies in Portugal: Limits and Compromise in the Quest for Regulation
Authors: Sabino Catarina , Peixoto João , Abreu Alexandre
Published: May 2009

The main objective of this article is to describe the key elements of the making of immigration control policies in Portugal until 2007. First, the main policy initiatives and measures concerning the admission of foreigners are presented. Second, the mechanisms and difficulties surrounding the issue of immigration control are discussed, and a tension is identified between the structural demand for foreign labour and the measures taken for control. Third, the positions of the main political parties and of the most relevant stakeholders are highlighted. The evidence indicates that despite continued attempts to control immigration, the stated policy objectives are at odds with the outcome, characterised by endemic irregular migration. The factors hindering regulation are both internal and external, encompassing the economic, social, institutional and legal domains. Given the limits to control, policy-makers have sought to achieve a compromise by enacting frequent regularization programmes while seeking to improve admission and control. In this process, the main political parties have exhibited a significant degree of consensus, which may be partially accounted for by the convergence among the other stakeholders (employers, trade unions, Catholic organisations and immigrants' associations) and by the increasing, albeit contradictory, acceptance of immigration by public opinion.
Islamists in Jordan: Promoters of or Obstacles to Female Empowerment and Gender Equality?
Authors: Roald Anne Sofie
Published: May 2009

This study deals with the Muslim Brotherhood's reception of CEDAW (Convention on the Elimination of All Forms of Discriminations against Women) in Jordan. In view of the Arab Human Development Report (AHDR) and interviews with several political actors in Jordanian society it is possible to evaluate Islamist ideas on women's rights. The main aim is to investigate whether Jordanian Islamists are promoters of or obstacles to female empowerment and gender equality. By analyzing various political stands it became apparent that Islamists, on the one hand, reject CEDAW, gender empowerment, and gender equality, and on the other promote issues which in the long run may empower women in Jordanian society. There is thus an unintentional trend towards female empowerment in the organization of the Muslim Brotherhood despite its opposition to such female politics.
Variations in Ocean Surface Temperature due to Near-Surface Flow: Straining the Cool Skin Layer
Authors: Wells Andrew J. , Cenedese Claudia , Farrar J. Thomas , Zappa Christopher J.
Published: May 2009

The aqueous thermal boundary layer near to the ocean surface, or skin layer, has thickness O(1 mm) and plays an important role in controlling the exchange of heat between the atmosphere and the ocean. Theoretical arguments and experimental measurements are used to investigate the dynamics of the skin layer under the influence of an upwelling flow, which is imposed in addition to free convection below a cooled water surface. Previous theories of straining flow in the skin layer are considered and a simple extension of a surface straining model is posed to describe the combination of turbulence and an upwelling flow. An additional theory is also proposed, conceptually based on the buoyancy-driven instability of a laminar straining flow cooled from above. In all three theories considered two distinct regimes are observed for different values of the Péclet number, which characterizes the ratio of advection to diffusion within the skin layer. For large Péclet numbers, the upwelling flow dominates and increases the free surface temperature, or skin temperature, to follow the scaling expected for a laminar straining flow. For small Péclet numbers, it is shown that any flow that is steady or varies over long time scales produces only a small change in skin temperature by direct straining of the skin layer. Experimental measurements demonstrate that a strong upwelling flow increases the skin temperature and suggest that the mean change in skin temperature with Péclet number is consistent with the theoretical trends for large Péclet number flow. However, all of the models considered consistently underpredict the measured skin temperature, both with and without an upwelling flow, possibly a result of surfactant effects not included in the models.
Neutrality of the State and Regulation of Religious Symbols in Schools in Quebec and France
Authors: Koussens David
Published: May 2009

The difference in attitudes towards the wearing of religious symbols in schools in France and Canada is symptomatic of the respective legal and political definitions of the official neutrality of the school institution and thus of way in which laicism is used to regulate religious pluralism and the “socio-cultural” integration of immigrant populations. In what ways is state neutrality put into practice, in Quebec and in France, as regards the judicial and political treatment of the wearing of religious symbols in public schools? The author proposes to examine the implementation of the liberal principle of neutrality by the French law dated 15 March 2004 on the wearing of religious symbols in public schools and by the decision of the Supreme Court of Canada of 2 March 2006 to allow a young Sikh to wear his ritual kirpan at school.
The Nonformative Elements of Religious Life: Questioning the “Sociology of Spirituality” Paradigm
Authors: Wood Matthew
Published: May 2009

Sociological assertions of religious vitality in Euro-American societies have developed a paradigm of spirituality in which, following earlier studies of the New Age, a distinction is drawn between external authority and self-authority. Methodologically and theoretically problematic, this paradigm diverts attention from people's social practices and interactions, especially in relation to multiple religious authorities. Drawing upon ethnographic fieldwork with an English religious network, and building upon the work of Pierre Bourdieu, the author considers situations in which multiple authorities tend to relativize each other. Conceptualizing this in terms of “nonformativeness”—the lack of authorities' ability formatively to shape religious identity, habitus, and competition over religious capital—allows a new understanding of individual secularization to emerge that questions assertions of vitality.
American Presidential Rhetoric from Ronald Reagan to George W. Bush: Another Look at Civil Religion
Authors: Roof Wade Clark
Published: May 2009

The period since 1980 in the United States offers an opportunity to reexamine the “American civil religion” hypothesis as put forth by sociologist Robert N. Bellah. In a time of massive changes both domestically and globally, presidential rhetoric on God and country underwent important shifts in substance and style. The author examines several major myths by which Americans have affirmed their identity historically, and how these have informed the rhetoric of presidents Ronald Reagan, George H.W. Bush, William J. Clinton, and George W. Bush. It is argued that popular and highly contested “public faiths” in the United States blending religious and political ideals take diverse forms of expression and vary in the degree to which they approach a civil religion of the sort Bellah imagined. In this recent period, a shift toward religious nationalism is clearly evident.
What has meta-analysis ever done for me? A comment on the context and value of the research presented in: `Is custody an effective sentencing option for the UK? Evidence from a meta-analysis of existing studies'
Authors: McCarthy Kerry
Published: May 2009

This edition of the Probation Journal contains an article by Kevin Marsh, Chris Fox and Rashmi Sarmah on an evidence review and meta-analysis of the evidence on prison as an effective sentencing option. This comment piece provides some detail on the context of the research and a more general introduction to the methodology. The value of this type of research and some of the limitations are also discussed.
Spasticity, an impairment that is poorly defined and poorly measured
Authors: Malhotra S. , Pandyan AD , Day CR , Jones PW , Hermens H.
Published: May 2009

Objective: To explore, following a literature review, whether there is a consistent definition and a unified assessment framework for the term `spasticity'. The congruence between the definitions of spasticity and the corresponding methods of measurement were also explored.

Data sources: The search was performed on the electronic databases Web of Science, Science Direct and MEDLINE.

Review methods: A systematic literature search of publications written in English between the years 1980 and 2006 was performed with the following keywords: spasticity and tone. The search was limited to the following keywords: stroke, hemiplegia, upper, hand and arm.

Results: Two hundred and fifty references contributed to this review (190 clinical trials, 46 literature reviews, and 14 case reports). Seventy-eight used the Lance definition; 88 equated spasticity with increased muscle tone; 78 provided no definition; and six others used their own definitions for spasticity. Most papers used a single measure and some used more than one. Forty-seven papers used neurophysiological methods of testing, 228 used biomechanical methods of measurement or assessment, 25 used miscellaneous clinical measures (e.g. spasm frequency scales) and 19 did not explicitly describe a measure.

Conclusion: The term spasticity is inconsistently defined and this inconsistency will need to be resolved. Often, the measures used did not correspond to the clinical features of spasticity that were defined within a paper (i.e. internal validity was compromised). There is need to ensure that this lack of congruence is addressed in future research.
The addition of electrical stimulation to progressive resistance training does not enhance the wrist strength of people with tetraplegia: a randomized controlled trial
Authors: Glinsky Joanne , Harvey Lisa , van Es Pauline , Chee Shane , Gandevia Simon C
Published: May 2009

Objective: To determine whether the addition of electrical stimulation to progressive resistance training increases the voluntary strength of the wrist muscles in people with tetraplegia.

Design: Assessor-blind within-subject randomised controlled trial.

Setting: Two Australian spinal cord injury units and the community.

Participants: Sixty-four wrists of 32 people with tetraplegia and bilateral weakness of the wrist extensor or flexor muscles (grade 2 - 4 Medical Research Council grades).

Interventions: Participants' wrists were randomly allocated to one of two conditions. Wrist muscles of the experimental arm received electrical stimulation superimposed on progressive resistance training. The wrist muscles of the contralateral arm received sham electrical stimulation superimposed on progressive resistance training. Both arms received 6 sets of 10 contractions three times a week for eight weeks such that the only difference between arms was the application of electrical stimulation.

Main Measures: The primary outcome was maximal voluntary isometric strength. Secondary outcomes were a fatigue resistance ratio representing voluntary and electrically-stimulated endurance. Measurements were taken at the start and end of the eight-week treatment period.

Results: The mean treatment effect (95% Confidence Interval) of electrical stimulation for voluntary strength was 0.04 Nm (95% CI, -0.5 to 0.6; p =0.89). The mean treatment effect (95% CI) for fatigue ratio representing voluntary endurance and electrically-stimulated endurance was -0.01 (95% CI, -0.1 to 0.1; p =0.78) and -0.07 (95% CI, -0.3 to 0.1; p =0.47), respectively.

Conclusions: Voluntary strength of the wrist is not enhanced by the addition of electrical stimulation to progressive resistance training programs in people with tetraplegia.
Between Flexible Life and Flexible Labor
Authors: Song Jesook
Published: May 2009

■ This article contextualizes the historical emergence of liberal socialism (socialism with a strong stance against the state and social power over individual) in South Korea and its inadvertent convergence with neoliberalism. By observing experiences of three leftist single independent women who embodied liberal socialism through the democratization movement towards neoliberalization (1987—2007), this article situates ways in which South Korean leftist intellectuals enjoy a flexible lifestyle and at the same time criticize flexible labor. On the one hand, the article elucidates that liberal individualism was both means and product of socialist struggles against the late-developing authoritarian capitalist state in South Korea. However, it argues that socialist adaptation of liberal values is no longer effective in countering a neoliberal capitalism that requires flexible labor and autonomous individuals.
Arthroscopic Suture Material and Knot Type
Authors: Swan Kenneth G. , Baldini Todd , McCarty Eric C.
Published: May 2009

Background

Several new arthroscopic suture materials are available. It is important for surgeons to know which suture-knot combination provides the strongest construct.

Hypothesis

The newer, polyblend sutures have dissimilar load-to-failure characteristics.

Study Design

Controlled laboratory study.

Methods

The load to failure of 4 knots was evaluated (surgeon's, Duncan loop, Samsung Medical Center [SMC], and Roeder) using 5 No. 2 suture materials (Ethibond, Ticron, FiberWire, ForceFiber, MaxBraid). One surgeon tied all knots. Fifteen samples were tested for each suture-knot configuration. Knots were pretensioned to 10 N, then loaded to failure at a rate of 1.0 mm/s. Failure load recorded was the maximum load applied between 0 and 3 mm of displacement. Cyclic loading of suture-knot samples was performed on 3 knots (surgeon's, Duncan loop, and SMC) using 4 suture materials (Ethibond, FiberWire, ForceFiber, MaxBraid). Six samples were tested for each suture-knot configuration. Knots were cyclically loaded from 5 to 40 N at 0.5 Hz for 1000 cycles, then loaded to failure. Data were compared with analysis of variance and the Tukey multiple range test and considered significant at P <. 05.

Results

The surgeon's and SMC knots were strongest, particularly if tied using MaxBraid or ForceFiber. With single load-to-failure testing, MaxBraid was significantly stronger than Ethibond, Ticron, or FiberWire, regardless of knot type used. ForceFiber was stronger than Ethibond and Ticron with any knot type, and stronger than FiberWire when tied with a surgeon's knot or Roeder knot. The MaxBraid surgeon's knot (246 N) and MaxBraid SMC knot (239 N) were more than twice as strong as the Ethibond surgeon's knot (111 N) and Ethibond SMC (118 N). With cyclic loading, MaxBraid and ForceFiber were stronger than FiberWire and Ethibond, regardless of knot type tied. The SMC knot using MaxBraid withstood the highest load, and was stronger than the Duncan loop tied with MaxBraid. When stricter criteria (1-mm and 2-mm displacement) for failure were used, MaxBraid and ForceFiber remained superior to other sutures, including FiberWire, but knot type became less significant.

Conclusion

Nonabsorbable polyblend sutures are stronger than traditional sutures, but not all polyblend sutures are alike. MaxBraid and ForceFiber provide a stronger knot than FiberWire, Ethibond, and Ticron, particularly if tied using a surgeon's or SMC knot.

Clinical Relevance

The SMC knot using MaxBraid provides the strongest knot/suture combination of knots and sutures tested.
Older Adults’ Responses to Hurricane Katrina
Authors: Henderson Tammy L. , Roberto Karen A. , Kamo Yoshinori
Published: May 2009

Using the stress and coping model, this article explores how older adults prepared for and coped with the aftermath of Hurricane Katrina. Interviews with a sample of 122 displaced adults, 60 years of age or older, provided insights regarding the daily hassles they faced that included securing basic resources, facing communication difficulties, and finding transportation. Positive thinking, modified thinking, staying busy, and spirituality were categories that emerged from the qualitative analysis of 119 participants and explained coping by displaced older adults. Our findings reflect what and how older adults coped with a disaster and have implications for disaster preparedness.
Life-cycle assessment of the municipal solid waste management system in Hangzhou, China (EASEWASTE)
Authors: Yan Zhao  , Wang Hong-Tao , Lu Wen-Jing , Damgaard Anders , Christensen Thomas H.
Published: May 2009

With the purpose of assessing the environmental impacts and benefits of the current municipal solid waste management system and two modified systems, EASEWASTE, a life-cycle-based model, was used to evaluate the waste system of Hangzhou city in China. An integrated model was established, including waste generation, collection, transportation, treatment, disposal and accompanying external processes. The results showed that CH4 released from landfilling was the primary pollutant contributing to global warming, and HCl and NH3 from incineration contributed most to acidification. Material recycling and incineration with energy recovery were important because of the induced savings in material production based on virgin materials and in energy production based on coal combustion. A modified system in which waste is transported to the nearest incinerators would be relatively better than the current system, mainly due to the decrease of pollution from landfilled waste and the increase in energy production from waste avoiding energy production by traditional power plants. A ban on free plastic bags for shopping was shown to reduce most environmental impacts due to saved oil resources and other materials used in producing the plastic bags. Sensitivity analysis confirmed the robustness of the results. LCA methodology and a model like EASEWASTE are very suitable for evaluating the overall environmental consequences, and can be used for decision support and strategic planning in developing countries such as China where pollution control has become increasingly important with the rapid increase of waste generation as well as the increasing public awareness of environmental protection.
Developing a fuzzy decision support system to determine the location of a landfill site
Authors: Alves Maria C. M. , Lima Beatriz S. L. P. , Evsukoff Alexandre G. , Vieira Ian N.
Published: May 2009

This paper presents two case studies of municipal solid waste site location using a decision-support system based on fuzzy logic. This problem is very complex, as it requires the evaluation of different criteria, which involve environmental, social and economic data. Such data deal with a wide range of information that presents not only quantitative, but also qualitative knowledge. In order to deal with this characteristic, the developed system employs fuzzy rules due to its ability to treat linguistic variables and the human way of thinking. Conventional approaches tend to be less effective in dealing with the imprecise or vague nature of the linguistic assessment. A case study for selecting the location of a new municipal solid waste landfill for the city of Petropolis in Rio de Janeiro is presented. Testing of the proposed method was carried out using data from the municipal solid waste location for another municipality in Rio de Janeiro, Brazil.