bluuebunny/crossref_metadata_2025 huggingface dataset:
Phylogeny of the nematode genus Pristionchus and implications for biodiversity, biogeography and the evolution of hermaphroditism
Authors: Mayer Werner E , Herrmann Matthias , Sommer Ralf J
Published: July 2007

Background

The nematode Pristionchus pacificus has originally been developed as a satellite organism for comparison to Caenorhabditis elegans. A 10X coverage of the whole genome of P. pacificus is available, making P. pacificus the first non-Caenorhabditis nematode with a fully sequenced genome. The macroevolutionary comparison between P. pacificus and C. elegans has been complemented by microevolutionary studies of closely related strains and species within the genus Pristionchus. In addition, new understanding of the biology of Pristionchus from field studies, demonstrating a close association with various scarab beetles and the Colorado potato beetle, supports consideration of this nematode in studies of ecosystems. In the course of field studies on four continents more than 1,200 isolates were established from 15,000 beetle specimens representing 18 Pristionchus species. Two remarkable features of the Pristionchus – beetle association are the high species specificity of the interaction and the interception of the beetle's sex communication system for host recognition by the nematodes, as suggested by chemotaxis studies. Evolutionary interpretations of differences in developmental, behavioral and ecological patterns require a phylogenetic framework of the genus Pristionchus.

Results

Here, we provide a robust phylogeny of all 18 available Pristionchus species based on a set of 27 ribosomal protein genes encompassing a total of 10,971 bp. The phylogenetic tree provides evidence for North American and European clades, which are embedded in a deeper clade that includes Asian species. It also indicates putative invasion events. Of the 18 Pristionchus species, 13 are gonochoristic and five are hermaphroditic. The phylogeny indicates that all hermaphroditic species have arisen independently within the genus Pristionchus.

Conclusion

Combined ribosomal protein cDNA data can provide the basis for reconstruction of a robust phylogenetic framework for microevolutionary and biogeographic analyses. An additional major implication of our studies is the use of Pristionchus for nematode biodiversity assessments. While some species are represented by more than 100 isolates, others were found less than four times. Such patterns were observed on all continents and in all phylogenetic clades indicating that species asymmetry is a widespread phenomenon, which can now be further investigated by molecular tools.
The Hawthorne Effect: a randomised, controlled trial
Authors: McCarney Rob , Warner James , Iliffe Steve , van Haselen Robbert , Griffin Mark , Fisher Peter
Published: July 2007

Background

The 'Hawthorne Effect' may be an important factor affecting the generalisability of clinical research to routine practice, but has been little studied. Hawthorne Effects have been reported in previous clinical trials in dementia but to our knowledge, no attempt has been made to quantify them. Our aim was to compare minimal follow-up to intensive follow-up in participants in a placebo controlled trial of Ginkgo biloba for treating mild-moderate dementia.

Methods

Participants in a dementia trial were randomised to intensive follow-up (with comprehensive assessment visits at baseline and two, four and six months post randomisation) or minimal follow-up (with an abbreviated assessment at baseline and a full assessment at six months). Our primary outcomes were cognitive functioning (ADAS-Cog) and participant and carer-rated quality of life (QOL-AD).

Results

We recruited 176 participants, mainly through general practices. The main analysis was based on Intention to treat (ITT), with available data. In the ANCOVA model with baseline score as a co-variate, follow-up group had a significant effect on outcome at six months on the ADAS-Cog score (n = 140; mean difference = -2.018; 95%CI -3.914, -0.121; p = 0.037 favouring the intensive follow-up group), and on participant-rated quality of life score (n = 142; mean difference = -1.382; 95%CI -2.642, -0.122; p = 0.032 favouring minimal follow-up group). There was no significant difference on carer quality of life.

Conclusion

We found that more intensive follow-up of individuals in a placebo-controlled clinical trial of Ginkgo biloba for treating mild-moderate dementia resulted in a better outcome than minimal follow-up, as measured by their cognitive functioning.

Trial registration

Current controlled trials: ISRCTN45577048
Delays in the diagnosis and treatment of tuberculosis patients in Vietnam: a cross-sectional study
Authors: Huong Nguyen T , Vree Marleen , Duong Bui D , Khanh Vu T , Loan Vu T , Co Nguyen V , Borgdorff Martien W , Cobelens Frank G
Published: July 2007

Background

Treatment delay is an important indicator of access to tuberculosis diagnosis and treatment. Analyses of patient delay (i.e. time interval between onset of symptoms and first consultation of a health care provider) and health care delay (i.e. time interval between first consultation and start of treatment) can inform policies to improve access. This study assesses the patient, health care provider and total delay in diagnosis and treatment of new smear-positive pulmonary tuberculosis patients, and the risk factors for long delay, in Vietnam.

Methods

A cross-sectional survey of new patients treated by the National Tuberculosis Control Programme was conducted in 70 randomly selected districts in Vietnam. All consecutively registered patients in one quarter of 2002 were interviewed using a pre-coded structured questionnaire.

Results

Median (range) delay was 4 weeks (1–48) for total, 3 (1–48) weeks for patient and 1 (0–25) week for health care delay. Patients with long total delay (≥ 12 weeks, 15%) accounted for 49% of the cumulative number of delay-weeks. Independent risk factors (p < 0.05) for long total delay were female sex, middle age, remote setting, residence in the northern or central area, and initial visit to the private sector. For long patient delay (≥ 6 weeks) this was female sex, belonging to an ethnic minority, and living at > 5 km distance from a health facility or in the northern area. For long health care delay (≥ 6 weeks) this was urban setting, residence in the central area and initial visit to a communal health post, TB hospital or the private sector.

Conclusion

Analyses of patient and treatment delays can indicate target groups and areas for health education and strengthening of the referral system, in particular between the private sector and the NTP.
How does mental health care perform in respect to service users' expectations? Evaluating inpatient and outpatient care in Germany with the WHO responsivenessconcept
Authors: Bramesfeld Anke , Wedegärtner Felix , Elgeti Hermann , Bisson Susanne
Published: July 2007

Background

Health systems increasingly try to make their services more responsive to users' expectations. In the context of the World Health Report 2000, WHO developed the concept of health system responsiveness as a performance parameter. Responsiveness relates to the system's ability to respond to service users' legitimate expectations of non-medical aspects. We used this concept in an effort to evaluate the performance of mental health care in a catchment area in Germany.

Methods

In accordance with the method WHO used for its responsiveness survey, responsiveness for inpatient and outpatient mental health care was evaluated by a standardised questionnaire. Responsiveness was assessed in the following domains: attention, dignity, clear communication, autonomy, confidentiality, basic amenities, choice of health care provider, continuity, and access to social support. Users with complex mental health care needs (i.e., requiring social and medical services or inpatient care) were recruited consecutively within the mental health services provided in the catchment area of the Hanover Medical School.

Results

221 persons were recruited in outpatient care and 91 in inpatient care. Inpatient service users reported poor responsiveness (22%) more often than outpatients did (15%); however this was significant only for the domains dignity and communication. The best performing domains were confidentiality and dignity; the worst performing were choice, autonomy and basic amenities (only inpatient care). Autonomy was rated as the most important domain, followed by attention and communication. Responsiveness within outpatient care was rated worse by people who had less money and were less well educated. Inpatient responsiveness was rated better by those with a higher level of education and also by those who were not so well educated. 23% of participants reported having been discriminated against in mental health care during the past 6 months.

The results are similar to prior responsiveness surveys with regard to the overall better performance of outpatient care. Where results differ, this can best be explained by certain characteristics that are applicable to mental health care and also by the users with complex needs. The expectations of attention and autonomy, including participation in the treatment process, are not met satisfactorily in inpatient and outpatient care.

Conclusion

Responsiveness as a health system performance parameter provides a refined picture of inpatient and outpatient mental health care. Reforms to the services provided should be orientated around domains that are high in importance, but low in performance. Measuring responsiveness could provide well-grounded guidance for further development of mental health care systems towards becoming better patient-orientated and providing patients with more respect.
Electroporator with automatic change of electric field direction improves gene electrotransfer in-vitro
Authors: Reberšek Matej , Faurie Cécile , Kandušer Maša , Čorović Selma , Teissié Justin , Rols Marie-Pierre , Miklavčič Damijan
Published: July 2007

Background

Gene electrotransfer is a non-viral method used to transfer genes into living cells by means of high-voltage electric pulses. An exposure of a cell to an adequate amplitude and duration of electric pulses leads to a temporary increase of cell membrane permeability. This phenomenon, termed electroporation or electropermeabilization, allows various otherwise non-permeant molecules, including DNA, to cross the membrane and enter the cell. The aim of our research was to develop and test a new system and protocol that would improve gene electrotransfer by automatic change of electric field direction between electrical pulses.

Methods

For this aim we used electroporator (EP-GMS 7.1) and developed new electrodes. We used finite-elements method to calculate and evaluate the electric field homogeneity between these new electrodes. Quick practical test was performed on confluent cell culture, to confirm and demonstrate electric field distribution. Then we experimentally evaluated the effectiveness of the new system and protocols on CHO cells. Gene transfection and cell survival were evaluated for different electric field protocols.

Results

The results of in-vitro gene electrotransfer experiments show that the fraction of transfected cells increases by changing the electric field direction between electrical pulses. The fluorescence intensity of transfected cells and cell survival does not depend on electric field protocol. Moreover, a new effect a shading effect was observed during our research. Namely, shading effect is observed during gene electrotransfer when cells are in clusters, where only cells facing negative electro-potential in clusters become transfected and other ones which are hidden behind these cells do not become transfected.

Conclusion

On the basis of our results we can conclude that the new system can be used in in-vitro gene electrotransfer to improve cell transfection by changing electric field direction between electrical pulses, without affecting cell survival.
Small but versatile: the extraordinary functional and structural diversity of the β-grasp fold
Authors: Burroughs A Maxwell , Balaji S , Iyer Lakshminarayan M , Aravind L
Published: July 2007

Background

The β-grasp fold (β-GF), prototyped by ubiquitin (UB), has been recruited for a strikingly diverse range of biochemical functions. These functions include providing a scaffold for different enzymatic active sites (e.g. NUDIX phosphohydrolases) and iron-sulfur clusters, RNA-soluble-ligand and co-factor-binding, sulfur transfer, adaptor functions in signaling, assembly of macromolecular complexes and post-translational protein modification. To understand the basis for the functional versatility of this small fold we undertook a comprehensive sequence-structure analysis of the fold and developed a natural classification for its members.

Results

As a result we were able to define the core distinguishing features of the fold and numerous elaborations, including several previously unrecognized variants. Systematic analysis of all known interactions of the fold showed that its manifold functional abilities arise primarily from the prominent β-sheet, which provides an exposed surface for diverse interactions or additionally, by forming open barrel-like structures. We show that in the β-GF both enzymatic activities and the binding of diverse co-factors (e.g. molybdopterin) have independently evolved on at least three occasions each, and iron-sulfur-cluster-binding on at least two independent occasions. Our analysis identified multiple previously unknown large monophyletic assemblages within the β-GF, including one which unifies versions found in the fasciclin-1 superfamily, the ribosomal protein L25, the phosphoribosyl AMP cyclohydrolase (HisI) and glutamine synthetase. We also uncovered several new groups of β-GF domains including a domain found in bacterial flagellar and fimbrial assembly components, and 5 new UB-like domains in the eukaryotes.

Conclusion

Evolutionary reconstruction indicates that the β-GF had differentiated into at least 7 distinct lineages by the time of the last universal common ancestor of all extant organisms, encompassing much of the structural diversity observed in extant versions of the fold. The earliest β-GF members were probably involved in RNA metabolism and subsequently radiated into various functional niches. Most of the structural diversification occurred in the prokaryotes, whereas the eukaryotic phase was mainly marked by a specific expansion of the ubiquitin-like β-GF members. The eukaryotic UB superfamily diversified into at least 67 distinct families, of which at least 19–20 families were already present in the eukaryotic common ancestor, including several protein and one lipid conjugated forms. Another key aspect of the eukaryotic phase of evolution of the β-GF was the dramatic increase in domain architectural complexity of proteins related to the expansion of UB-like domains in numerous adaptor roles.

Reviewers

This article was reviewed by Igor Zhulin, Arcady Mushegian and Frank Eisenhaber.
Endothelial Microparticle Levels Are Similar in Acute Ischemic Stroke and Stroke Mimics Due to Activation and Not Apoptosis/Necrosis
Authors: Williams Justin B. , Jauch Edward C. , Lindsell Christopher J. , Campos Begoña
Published: July 2007

BackgroundEndothelial microparticles (EMPs) are <2‐μm membranous blebs from endothelial cell membranes that have been demonstrated to be elevated in vasculopathic conditions. One study has demonstrated elevated EMPs in acute ischemic stroke (AIS) versus age‐ and comorbidity‐matched controls.

ObjectivesTo determine the level of EMPs in stroke mimics and AIS and determine if EMPs are released as a result of activation or apoptosis/necrosis in AIS.

MethodsEMP levels in plasma of patients with AIS and stroke mimic patients were quantified by flow cytometry. Stroke status was verified in all patients by magnetic resonance imaging. Patients were matched for age and comorbidities. Markers for apoptosis/necrosis (platelet/endothelial cell adhesion molecule‐1 [PECAM‐1]/CD31 antigen) and activation (E‐selectin/CD62e antigen) were compared. A PECAM‐1/E‐selectin ratio of >4.0 was used to determine whether EMPs were generated via activation or apoptosis/necrosis. Data were compared between groups using the Mann‐Whitney U test.

ResultsEMP levels were similar in stroke mimic patients when compared with AIS; there was no difference between groups (PECAM‐1, p = 0.393; E‐selectin, p = 0.579). The PECAM‐1/E‐selectin ratio was also similar for AIS and stroke mimics, and all were >4.0.

ConclusionsEMP levels were similar in patients with AIS and stroke mimic patients. The PECAM‐1/E‐selectin ratio demonstrated that EMPs were generated via activation and not apoptosis/necrosis. This suggests that EMPs may not be a good marker for AIS, given the inability to discriminate between stroke mimics and AIS.
Phase II Clinical Trial of the Epothilone B Analog, Ixabepilone, in Patients With Non–Small-Cell Lung Cancer Whose Tumors Have Failed First-Line Platinum-Based Chemotherapy
Authors: Vansteenkiste Johan , Lara Primo N. , Le Chevalier Thierry , Breton Jean-Luc , Bonomi Philip , Sandler Alan B. , Socinski Mark A. , Delbaldo Catherine , McHenry Brent , Lebwohl David , Peck Ronald , Edelman Mark
Published: July 2007

Purpose

Ixabepilone is the first in a new class of antineoplastic agents, the epothilones and their analogs. This international, randomized, phase II trial assessed two administration schedules of ixabepilone as second-line therapy in patients with non–small-cell lung cancer (NSCLC).

Patients and Methods

Patients had experienced disease progression after one prior cisplatin- or carboplatin-based chemotherapy regimen. Ixabepilone was administered as a single 32 mg/m2 3-hour infusion (77 patients; arm A) or a 6 mg/m2 1-hour infusion daily for 5 consecutive days (69 patients; arm B) in a 3-week cycle.

Results

The intent-to-treat objective response rate was 14.3% in arm A and 11.6% in arm B. Median duration of response was 8.7 months (95% CI, 5.3 to 9.5 months) in arm A and 9.6 months (95% CI, 6.1 to 19.7 months) in arm B. Median time to progression was 2.1 months (95% CI, 1.4 to 2.8 months) for arm A and 1.5 months (95% CI, 1.4 to 2.8 months) for arm B. Median survival was 8.3 months (95% CI, 5.8 to 11.5 months) for arm A, and 7.3 months (95% CI, 5.7 to 11.7 months) for arm B; the 1-year survival rate (both cohorts) was 38%. Responses occurred in patients with taxane-pretreated and platinum-refractory tumors. Both regimens had an acceptable toxicity profile. Myelosuppression was manageable, manifesting primarily as neutropenia and leukopenia. Neuropathy was primarily sensory, generally mild to moderate in severity, and mostly reversible (both regimens).

Conclusion

Single-agent ixabepilone had clinically relevant activity and an acceptable safety profile in patients with advanced NSCLC whose tumors had failed one prior platinum-based chemotherapy regimen.
Phase II Trial of Ixabepilone, an Epothilone B Analog, in Patients With Metastatic Breast Cancer Previously Untreated With Taxanes
Authors: Denduluri Neelima , Low Jennifer A. , Lee James J. , Berman Arlene W. , Walshe Janice M. , Vatas Ujala , Chow Catherine K. , Steinberg Seth M. , Yang Sherry X. , Swain Sandra M.
Published: July 2007

Purpose

Ixabepilone is an epothilone B analog that binds to microtubules and results in microtubule stabilization and mitotic arrest. Ixabepilone was evaluated for efficacy and safety in a phase II clinical trial for women with metastatic breast cancer.

Patients and Methods

Patients were eligible if they had not previously received treatment with a taxane and had measurable metastatic breast cancer. Ixabepilone was administered at 6 mg/m2/d intravenously days 1 through 5 every 3 weeks until unacceptable toxicity or disease progression. Patients underwent pretreatment and post-treatment tumor biopsies, and tissues were analyzed for acetylated α-tubulin, tau-1, and p53 expression when possible.

Results

Twenty-three patients received 210 cycles with a median of eight cycles (range, two to 22 cycles) per patient. Thirteen patients (57%; exact 95% CI, 34.5% to 76.8%) had partial responses, six patients (26%) had stable disease, and four patients (17%) had progressive disease. Median time to progression and duration of response were 5.5 and 5.6 months, respectively. Four patients required dose reductions for neutropenia, neuropathy, or fatigue. Grade 3 or 4 toxicities included neutropenia (22%), fatigue (13%), anorexia (9%), and motor neuropathy (4%). Thirty-nine percent of patients experienced grade 1, 13% experienced grade 2, and none experienced grade 3/4 sensory neuropathy. The six patients with paired biopsies all had increases in tumor α-tubulin acetylation after treatment. Baseline or cycle 2 acetylated α-tubulin, tau-1, or p53 expression did not correlate with clinical response.

Conclusion

Women with metastatic breast cancer previously untreated with taxanes have a meaningful durable response to single-agent ixabepilone therapy. Minimal hematologic toxicity and no grade 3 sensory neuropathy were noted.
Distortion of metal strip during rolling with rough rolls
Authors: Crane F A A , Lampkin W
Published: July 2007

An experiment simulating the deformation that occurs in hot rolling, by rolling a small specimen of aluminium at room temperature with rough rolls, is described. A rectangular grid incorporated into the body of the specimen allows the determination of the mode of deformation that occurs under conditions of plane strain. The data are anlysed by a computerized method which presents the results in the form of a pattern of directions of maximum shear stress. The pattern obtained agrees substantially with a theoretical slip-line field of the type first proposed by Alexander.
High-strain low-endurance fatigue behaviour of AISI 1018 steel in reversed torsion
Authors: Nypan L J
Published: July 2007

Experiments in repersed torsion of AISI 1018 solid-steel specimens of circular cross-section are reported. Cyclic strain hardening and softening were observed. The relations between shear strain and fatigue life and between cyclic shear strees and strain are presented.
Calculation of the elastic deformation of textile beams during yarn winding
Authors: Vicentini V
Published: July 2007

The problem of winding yarn on beams is examined.

A theoretical calculation of the pressures on and the deformation of the beams is developed. In a first approximation the beam is assumed to be completely rigid and in a second approximation the elasticity of the barrel and flanges is taken into account.

The results, developed on several types of yarn and on beams of various shapes and forms, are compared with experimental data obtained during a series of tests by the I.D.I. of Turin, Italy, on beams during use.
Stresses at end-milled keyways in plain shafts subjected to tension, bending, and torsion
Authors: Fessler H , Rogers C C , Stanley P
Published: July 2007

The frozen-stress photoelastic technique has been used to determine the complete surface stress field in empty keyways of British Standard proportions for rectangular keys. A method is included for the photoelastic analysis of general surface stresses in doubly curved surfaces with one small radius. The ratio of measured stress to stress in the same fibre in a shaft without keyway is the same for bending and tension. Stress indices for combined bending and torsion have been calculated for one fillet-radius ratio. A simple method is presented for obtaining a close upper bound for the peak stress in any B.S. keyway for rectangular keys subjected to any combination of bending and torsion.
Large deformation of time-dependent materials in uniaxial tension
Authors: Soden P D W , Sowerby R
Published: July 2007

Unaxial tensile tests have been conducted on commercially pure lead and cellulose nitrate, both time-dependent materials. It is shown that it is possible to predict all the important features of a tensile stress-strain curve from creep-test data, including the dependence of the curve upon extension rate.

The behaviour of cellulose nitrate at the yield point is shown to be similar in nature to that of lead at the ultimate point. The stresses at these particular points were predicted with remarkable accuracy from the creep data over a range of extension rates from 1 per cent per minute up to 100 per cent per minute.
A photoelastic examination of the stresses in rolls during rolling
Authors: Khayyat F A , Lancaster P R
Published: July 2007

The paper describes some experiments to determine the stress distribution in rolls during the rolling of pure lead. The rolls were made from a hard transparent resin and the isochromatics and isoclinics were recorded whilst rolling was in progress. From these recordings the stress distributions were obtained. Particular reference was made to conditions of normal and shear stress at the contacting surfaces. The paper gives results for three roll diameters and for each of these four roll loads were applied. The experiments were carried out for both dry and lubricated conditions.

The results of this work show a variation of the shear stress at the surface of contact accompanied by a change of sign at the neutral point. The normal roll-pressure curves are in general agreement with those found by workers using other techniques. The results also indicate a significant variation in the ratio (shear stress/normal pressure) over the contact surface, although this was decreased by lubrication. For a given roll load and diameter lubricated rolling, as opposed to dry rolling, increases the reduction but appears to have no effect on lateral spread. For a given roll load a decrease in roll diameter results in an increase in reduction, lateral spread, mean roll pressure, and friction.
Transient stress concentration at an elliptical discontinuity
Authors: James W G , North W P T
Published: July 2007

In this investigation, the photoelastic technique with a modulated-ruby-laser light source was used to determine the maximum dynamic-stress concentration factors in a strut containing a symmetrically located elliptical discontinuity. The two parameters, time after impact and size of discontinuity, were considered. Some simplifying assumptions and the one- and two-dimensional theory of stress-wave propagation were used to develop a theoretical solution which agrees well with experimental results.
Stresses at keyway ends near shoulders
Authors: Fessler H , Rogers C C , Stanley P
Published: July 2007

The photoelastic stress analysis of a series of shouldered shafts with keyways in the shanks is described. Direct loading and torsion have been studied. The shoulder-fillet ratio (shoulder-fillet radius/shank diameter) and the distance between keyway end and shoulder have been varied but both the ratio of the shoulder diameter to the shank diameter and the ratio of the keyway-fillet radius to the shank diameter were held constant through the model series.

It is shown for both forms of loading that variations in the shoulder-fillet ratio have no significant effect on the greater principal stresses in the keyway fillet when the keyway end touches the shoulder-fillet toe; appreciable changes are caused in the stresses at the top of the keyway wall for torsional loading. Shoulder-fillet stresses are also presented. The dependence of the keyway stresses on the distance between shoulder fillet and keyway end has been studied; important stress reductions occur when the keyway end is continued through the shoulder fillet and into the shoulder proper. Maximum-stress indices for combined direct and torsional loads are derived for a particular geometry.
Apparatus for strain and load cycling at elevated temperature with high-accuracy control during hold periods
Authors: White D J , Horwood G P , Czajkowski Z
Published: July 2007

A description is given of apparatus which has been developed to determine accurately the cyclic stress-strain behaviour of materials subjected to combined high-strain fatigue and creep at temperatures up to 700°C. The servo-hydraulic testing machine has a load capacity of ±20 000 lbf in push-pull and can operate in either a strain-cycling or a load-cycling mode. The specimen has a diameter of 0.5 in and a parallel gauge length of 1.5 in terminating in conic-section ridges on which extensometers are mounted for the measurement and control of axial strain. Strain is held constant to better than ±1 × 10−5 during hold times of up to 12 h and temperature control is better than ±0.5 degC.
Chants et vies de femmes dans Les Silences du palais de Moufida Tlatli
Authors: Peysson-Zeiss Agns
Published: July 2007

In her film, Les Silences du palais Moufida Tlatli depicts a young woman, following her steps of a forgotten past. When the character Alia returns to the palace where she spent her childhood and adolescence, we discover, through her memories, the daily life of the domestic servants
in the service of the beys. The film-maker takes her viewers back to the pre-independence era, suggesting an unbroken legacy of women as their masters' slaves since time immemorial. This article explores the different types of violence and suffering that Tlatli evokes as she brings to light
this forgotten feminine past, and as she captures Alia's stolen past on camera. This study examines the way in which the eye of the camera displays a feminine history and creates a metalanguage to project onto the screen the silent suffering of these women. It is with the help of the songs
and the gaze, which take over the silence, a golden rule in the palace, that the camera unveils what it meant to be a domestic servant. It is this silence that becomes a mode of resistance that Tlatli captures, because between silence and resistance a bond is created allowing women to be reborn.
Continuous subcutaneous hydrocortisone infusion in Addison’s disease
Authors: Løvås Kristian , Husebye Eystein S
Published: July 2007

Objective: The conventional replacement therapy in Addison’s disease (AD) does not restore the normal diurnal cortisol rhythm. We explored the feasibility and safety of continuous s.c. hydrocortisone infusion (CSHI) as a novel mode of glucocorticoid replacement therapy.

Design and methods: Seven patients with AD were treated with CSHI in an open-labelled clinical study for up to three months. Adequacy of glucocorticoid replacement was assessed by 24 h blood and saliva sampling in one patient and by salivary cortisol day curves in six outpatients. Subjective health status was monitored by the Short Form-36 questionnaire.

Results: CSHI re-established the circadian variation and normal levels of cortisol in the patients, with minor day-to-day variation. Most of the patients could reduce their glucocorticoid dose considerably without adverse reactions. The treatment was well tolerated and positively evaluated by the patients.

Conclusions: CSHI is technically feasible and safe in patients with AD. A daily dose of ~10 mg/m2 body surface area/day restores the circadian variation and normal levels of salivary cortisol in most patients, which is close to the estimated daily requirement. We hypothesise that selected patients will benefit from restoration of the circadian cortisol rhythm.
Locoregional recurrence and death from medullary thyroid carcinoma in a contemporaneous series: 5-year results
Authors: Machens Andreas , Hofmann Christine , Hauptmann Steffen , Dralle Henning
Published: July 2007

Objective: Studies of outcome in patients with medullary thyroid carcinoma require long follow-ups to accrue enough cancer-specific events. Owing to time-dependent changes in diagnosis and therapy, long observation periods render studies susceptible to ‘time bias’ which can yield spurious results. This study was designed to investigate cancer-specific event rates after initial neck resection in contemporaneous patients recruited within less than a decade.

Design: Institutional cohort study of 128 consecutive patients who underwent compartment-oriented neck surgery between 1994 and 2002 at a tertiary surgical center for hitherto untreated medullary thyroid carcinoma.

Methods: The Kaplan–Meier method was used in conjunction with the log-rank test for analysis of time-dependent outcomes.

Results: Follow-up was available for 120 patients (94%) including 63 rearranged during transfection (RET) carriers. There were six locoregional recurrences in the 110 patients with clear surgical margins at initial neck resection, and 12 cancer-specific deaths in the 120 patients with available follow-up. On Kaplan–Meier analysis, most clinicopathological variables were significantly associated with recurrence-free survival and cancer-specific survival. Within the median observation period of 64.5 months, patients with node-negative tumors did not develop locoregional recurrence or die from their malignancies. The low event rates precluded multivariate analyses with all clinicopathological variables. With our extensive surgical approach, median recurrence-free survival and cancer-specific survival at 5 years were 95.2 and 89.3% respectively.

Discussion: Compared with literature data, our 5-year locoregional recurrence rate of 4.8% appeared very favorable, and our 5-year cancer-specific mortality rate of 10.7% was among the lowest ever reported. The growing proportion of localized medullary thyroid carcinomas among contemporaneous patients can be expected to ultimately lower the event rates, complicating future studies of outcome.
Association between glycosylated hemoglobin, left ventricular mass and aortic function in nondiabetic individuals with insulin resistance
Authors: Stakos Dimitrios A , Schuster Dara P , Sparks Elizabeth A , Meis Sophia Boudoulas , Wooley Charles F , Osei Kwame , Boudoulas Harisios
Published: July 2007

Objective: An association between glycosylated hemoglobin (GHb) and cardiovascular mortality in nondiabetic individuals has recently been reported. Prompt detection of nondiabetic individuals with high-normal GHb and early cardiovascular involvement may be of value for preventive strategies. In this investigation, a possible relationship between GHb, aortic function and left ventricular (LV) mass in nondiabetic individuals has been studied.

Methods: A total of 263 nondiabetic African–Americans, aged 22–63 (mean 42 ± 8) years were studied. All individuals were first degree relatives of diabetic patients, had normal oral glucose tolerance test (2-h OGTT) and decreased peripheral action of insulin. LV diameters and mass (echocardiography); ascending and abdominal aortic distensibility (echocardiography, arterial pressure); pulse wave velocity (PWV; electrocardiography, Doppler); fasting glucose; GHb; insulin sensitivity index (SI) and 2-h OGTT were measured. Multiple linear and logistic regression analyses were used to identify significant independent associations of fasting glucose; GHb; SI and 2-h OGTT with aortic function and LV mass.

Results: In fully adjusted multivariate logistic regression analysis, GHb predicted lower values of aortic distensibility (odds ratio (OR) 1.67 95% CI (1.04–2.75), P=0.04); higher PWV (OR 1.79 95% CI (1.09–2.93), P=0.022); and higher values of LV mass (OR 1.56 95% CI (1.08–2.88), P=0.029). Fasting glucose, SI, and 2 h OGTT were not associated with aortic function and LV mass.

Conclusion: Higher GHb concentrations, even within ‘normal’ range, are independently associated with stiffer aorta and increased LV mass and thus may detect nondiabetic individuals at increased cardiovascular risk.
Metformin administration improves leukocyte count in women with polycystic ovary syndrome: a 6-month prospective study
Authors: Orio Francesco , Manguso Francesco , Di Biase Sebastiano , Falbo Angela , Giallauria Francesco , Labella Donato , Tolino Achille , Lombardi Gaetano , Colao Annamaria , Palomba Stefano
Published: July 2007

Introduction: Polycystic ovary syndrome (PCOS) is a common disorder associated with a wide range of endocrine and metabolic abnormalities. Low-grade chronic inflammation is a related complication recently observed in PCOS. Increased white blood cell (WBC) count was previously reported in PCOS women.

Objective: To evaluate the effects of six months metformin administration on WBC count in PCOS women.

Patients and methods: Fifty normal-weight PCOS women without additional metabolic or cardiovascular diseases were enrolled and treated with metformin (850 mg twice daily) for 6 months in a prospective baseline-controlled clinical study. At baseline and after treatment, WBC count and C-reactive protein (CRP) were evaluated in each patient. The whole hormonal profile, serum insulin and glucose levels (at fasting and during a 75 g 2-h oral glucose tolerance test), serum lipid profile were also assessed.

Results: A significant difference was observed in WBC count (7050 ± 552 vs 6080 ± 577 cell/mm3 ± s.d., P<0.001) and CRP levels (1.8 ± 0.9 vs 1.1 ± 0.6 mg/l ± s.d., P<0.001) after metformin treatment in comparison with baseline values. SHBG levels and the free androgen index also changed significantly (P<0.001). Finally, high-density lipoproteins and the area under curve for glucose/area under curve for insulin ratio also significantly increased (P<0.001), whereas low-density lipoproteins and area under curve for insulin were significantly reduced (P<0.001). No other change was found in any of the biochemical parameters evaluated.

Conclusion: A six-month course of metformin reduces WBC count in PCOS women.
Surgical Outcomes for Velopharyngeal Insufficiency in Velocardiofacial Syndrome and Nonsyndromic Patients
Authors: Milczuk Henry A. , Smith Dana S. , Brockman Janet H.
Published: July 2007

Objective:

To compare speech outcomes after operative intervention for velopharyngeal insufficiency between velocardiofacial syndrome patients and nonsyndromic patients.

Design:

Retrospective cohort study.

Setting:

Tertiary academic center.

Patients:

Cohorts of 14 velocardiofacial syndrome and 15 nonsyndromic patients without overt cleft palate who underwent operative procedures to correct velopharyngeal insufficiency. All velocardiofacial syndrome patients were positive for 22q11.2 microdeletion by fluorescent in situ hybridization and possessed phenotypic features of velocardiofacial syndrome.

Interventions:

Operative procedures, including sphincter pharyngoplasty, Furlow palatoplasty, or both, were selected based on preoperative endoscopic assessments of velopharyngeal motion and residual gap size and shape, as well as velocardiofacial syndrome status. Five single and 9 combined procedures were performed in the velocardiofacial syndrome group, whereas 13 single and 2 combined procedures were performed in the nonsyndromic group.

Outcome Measures:

Pre- and post-op evaluation was conducted by a speech pathologist. Assessment parameters scored on a numerical scale included speech intelligibility, resonance, nasal air emissions, and overall severity of velopharyngeal insufficiency. Postoperative complications were recorded.

Results:

Most velocardiofacial syndrome patients and nonsyndromic patients demonstrated significant improvements in all parameters. Comparison of the two groups demonstrated similar improvements in both. Changes in speech resonance were significantly different between the two groups, whereas other speech parameters did not reach significance. There was no difference in airway complications between groups.

Conclusions:

Velocardiofacial syndrome patients may have comparable outcomes to nonsyndromic patients in selective surgical management of velopharyngeal insufficiency. In addition, the data demonstrate the efficacy of a single-stage combined procedure without increased morbidity.
Birth Prevalence of Oral Clefting in Northern Iran
Authors: Golalipour Mohammad Jafar , Mirfazeli Arezo , Behnampour Naser
Published: July 2007

Objective:

To explore the prevalence of oral clefting in northern Iran.

Setting:

In the Dezyani hospital 37,951 live births from 1998 through 2003 were screened for oral clefts. Clinical and demographic factors of diagnosed cases, including birth date, ethnicity, type of oral cleft, parental consanguinity, and coexisting anomalies, were recorded for analysis.

Results:

The overall prevalence of oral clefting was 0.97 per 1000 live births. The prevalence of cleft lip with or without cleft palate and isolated cleft palate was 0.60 and 0.37 per 1000, respectively. The prevalence of oral clefting was 1.08 per 1000 male births and 0.86 per 1000 female births. With respect to parental ethnicity, the prevalence of oral clefting was 0.86, 0.88, and 1.47 per 1000 in Fars, Turkman, and Sistani, respectively.

Conclusions:

The prevalence of oral cleft among live births in the Dezyani hospital is similar to that reported in the previous studies for Iran and whites.
Heightened Telescopic Copings in Cleft Palate Rehabilitation: A Case Report
Authors: Kurtulmus Huseyin , Saygi Tugrul , Cotert H. Serdar
Published: July 2007

Objective:

To increase retention of overdentures in cleft palate patients by means of heightened telescopic copings with a newly designed attachment. In this study, a “precision attachment” is described to develop the stability and retention of telescopic overdentures.

Case:

A cleft palate patient was treated with a newly designed overdenture. Intraoral examination revealed poor tooth structure and retention. Therefore, a new semiprecision attachment was designed in order to increase retention and stabilization.

Conclusion:

The patient's tolerance was increased with the new overdenture.
Distribution of Orofacial Clefts and Frequent Occurrence of an Unusual Cleft Variant in the Rift Valley of Kenya
Authors: Spritz Richard A. , Arnold Thomas D. , Buonocore Samuel , Carter David , Fingerlin Tasha , Odero Wilson W. , Wambani John O. , Tenge Robert K. , Weatherley-White R. Christopher
Published: July 2007

Objective:

To investigate the pattern and distribution of nonsyndromic orofacial clefts among patients in the Rift Valley region of northwestern Kenya.

Methods:

Subjects were categorized anatomically for occurrence of an atypical cleft lip variant (ACL), typical cleft lip (CL), cleft lip and palate (CLP), or cleft palate (CP), and family history of orofacial clefts. Tribal ethnicity data were obtained from both cleft and noncleft clinic attendees.

Results:

There were 194 patients with CL (52.7%), 153 with CLP (41.6%), and 21 with CP (5.7%). CL constitutes a greater fraction of orofacial clefts in the Rift Valley region than reported elsewhere in Africa, principally due to frequent occurrence of ACL (52.5% of all CL). Among noncleft clinic attendees there was a lower fraction of Bantu and larger fraction of Nilotic-Paranilotic tribal ethnicity than in Kenya overall. In contrast, among patients with orofacial clefts there was significant underrepresentation of Bantu and overrepresentation of Nilotic-Paranilotic tribes, particularly Kalenjin. Patients of Kalenjin origin had a much higher rate of positive family history of orofacial clefts than Bantu patients.

Conclusions:

There is an unusual anatomic distribution of orofacial clefts in the Kenya Rift Valley, with frequent occurrence of an atypical CL variant. Our findings indicate that Bantu tribes have lower risk of orofacial clefts than Nilotic-Paranilotic tribes, possibly due to inherited genetic differences, perhaps accounting for the relatively low prevalence of orofacial clefts through much of Africa.
Prologue
Authors: Ridley T. M.
Published: July 2007

I have been invited to write this prologue welcoming the first issue of Transport, the new specialist Proceedings dealing with transport matters. I write on behalf of myself and my colleagues on the Transport Board. I give Transport a very warm welcome and commend it to members and other readers
The application of lime and cement soil stabilization at BAA airports
Authors: Heath D. C.
Published: July 2007

The Paper covers the introduction and progressive development of soil stabilization of the natural soil conditions at Gatwick, Stansted, Heathrow and Glasgow airports in the period 1980–1990.

The main applications relate to the Weald Clay at Gatwick and the Boulder Clay at Stansted; reference is also made to work at Heathrow involving Gravel/Brickearth deposits and at Glasgow where soft clay deposits occur.

The dual use of both lime and cement to modify and strengthen the natural subgrades and earthwork formation are described together with summaries of the main control testing results. Reference is also made to a general description of the specification and construction plant methods in use.

The prime object of the Paper is to make available full practical details of large scale lime and cement soil stabilization work, bearing in mind the shortage of such information on construction site work undertaken in the UK.
The development of transport strategies for Edinburgh
Authors: May A. D. , Roberts M. , Mason P.
Published: July 2007

In 1990 a consortium of the Scottish Development Department, Lothian Regional Council and Edinburgh District Council commissioned The MVA Consultancy to conduct a study of potential transport strategies for Edinburgh for the year 2010. The study was completed in under a year. This timescale was achieved by developing a strategic sketch-planning model, which enabled the performance of alternative strategies to be tested against a range of objectives and in the context of different scenarios for future development. A range of novel evaluation measures was developed, including a procedure for combining the issues of cost-benefit analysis and financial feasibility

The study considered a wide range of transport policy measures, including road and light rail infrastructure, traffic and environmental management, parking supply, park-and-ride, public transport service levels, fares, parking charges and road user charging. It demonstrated the contribution of each of these to achievement of the transport policy objectives and the added benefits of combining infrastructure, management and pricing measures

The Paper presents the objectives and structure of the study. It describes the sketch planning model developed and the ways in which this was used to evaluate strategies against the range of policy objectives. It presents the results of the strategy tests and identifies those strategy elements which contribute most to the resolution of transport problems. It demonstrates that it is possible, as a result, to achieve improvements in today's levels of environmental conditions, safety and accessibility, despite significant growth in the demand for travel
Mancunian Way (A57M) and London Road (A6) junction reconstruction, Manchester
Authors: Robinson D. L. , Barnes G. F.
Published: July 2007

The Paper outlines the justification for the remodelling of an important intersection between the A6, a radial route into Manchester, and the Mancunian Way (A57/A57M), part of the city's Inner Relief Route. It also deals with basic design considerations and describes some of the more important features of the scheme.

The existing junction straddles the River Medlock which flows through the site in culvert and is surrounded by housing, commercial property and the UMIST campus. Its layout takes the form of a large four-sided roundabout incorporating a pedestrian subway system. Traffic signal control operates during peak periods.

The objectives of the scheme are those common to the overall policy of improvements to the Inner Relief Route. These are the relief of traffic congestion, the reduction of city centre traffic and the provision of improved facilities for pedestrians and cyclists.

The adopted solution is a grade separated junction incorporating an overpass on the Mancunian Way axis. It meets the desired objectives but only with the degree of compromise common to most major urban highway schemes.