bluuebunny/crossref_metadata_2025 huggingface dataset:
Rhythmic Instruction From Square One
Authors: Miller Beth Ann
Published: February 2012

Adhering to a constructivist approach, this teacher focused on problem solving and group discussion as she initiated a study of traditional notation. She began with the metronome to make the steady beat less abstract for those students who still learn best through concrete operations. The students were challenged to match magnets of various proportional lengths to the number of metronome beats in each word of a familiar song. The completed colored template provided a visual and tactile illustration of the relative length of each sound. With the music map as a guide, the students replaced the colored lengths with traditional notation and added the time signature. Using the aural, visual, and tactile base provided by the metronome beat and the iconic graphic that looked the way the music sounded seemed to help the students understand symbolic notation on a deeper level than previous lecture modes of instruction.
Validation of the Employment Hope Scale
Authors: Hong Philip Young P. , Polanin Joshua R. , Pigott Therese D.
Published: February 2012

Objectives: The Employment Hope scale (EHS) was designed to measure the empowerment-based self-sufficiency (SS) outcome among low-income job-seeking clients. This measure captures the psychological SS dimension as opposed to the more commonly used economic SS in workforce development and employment support practice. The study validates the EHS and reports its psychometric properties. Method: An exploratory factor analysis (EFA) was conducted using an agency data from the Cara Program in Chicago, United States. The principal axis factor extraction process was employed to identify the factor structure. Results: EFA resulted in a 13-item two-factor structure with Factor 1 representing “Psychological Empowerment” and Factor 2 representing “Goal-Oriented Pathways.” Both factors had high internal consistency reliability and construct validity. Conclusions: While findings may be preliminary, this study found the EHS to be a reliable and valid measure, demonstrating its utility in assessing psychological SS as an empowerment outcome among low-income jobseekers.
A Pilot Study of Palliative Medicine Fellows’ Hospice Home Visits
Authors: Shoemaker Laura K. , Aktas Aynur , Walsh Declan , Hullihen Barbara , Khan Mohammed I. Ahmed , Russell Kraig M. , Davis Mellar P. , Lagman Ruth , LeGrand Susan
Published: February 2012

This was a prospective descriptive study of hospice physician home visits (HVs) conducted by Hospice and Palliative Medicine Fellows. Our objectives were 1) to improve our knowledge of hospice care at home by describing physician HVs 2) to identify the indications for physician HVs and the problems addressed during the HV. Data was collected on 58 consecutive patients using a standardized form completed before and after the home visit. More than half of the persons were women. Most were Caucasian. Median age was 75 years; 57% had cancer; 77% were do-not-resuscitate. 76% HV occurred in the home. The median visit duration was 60 minutes; median travel distance and time 25 miles and 42 minutes, respectively. A hospice nurse case manager was present in 95%. The most common issues addressed during HVs were: health education, symptom management, and psychosocial support. Medication review was prominent. Physicians identified previously unreported issues. Symptom control was usually pain, although 27 symptoms were identified. Medications were important; all home visits included drug review and two thirds drug change. Physicians had unique responsibilities and identified important issues in the HV. Physicians provided both education and symptom management. Physician HVs are an important intervention. HVs were important in continuity of care, however, time-consuming, and incurred considerable travel, and professional time and costs.
A Review of the Use of Antiepileptic Drugs in High-Grade Central Nervous System Tumors
Authors: Wallace Elaine M. , O'Reilly Maeve , Twomey Marie
Published: February 2012

Background:

Seizures are a common complication in patients with central nervous system (CNS) tumors. Optimal management is unclear with no defined guidelines and pharmacological management poses many controversies. Due to a hypothesized lack of consistency, we aimed to retrospectively review seizure management in patients with high-grade CNS tumors in our institution.

Methods:

The medical records of patients with high-grade CNS tumors referred to the specialist palliative medicine service in our institution from January-June 2008 were retrospectively reviewed. Seizure incidence, antiepileptic drug (AED) choice, neurology input, medication interactions, and appropriate drug level monitoring were assessed.

Results:

Twenty-seven patients were included for analysis. Fifteen (56%) were female. The mean age was 58.8 years (range 31-82 years). Three (11%) patients presented with seizures and 8 (30%) developed seizures subsequently. Eight (73% of those with seizures) were on monotherapy AED. Six different agents were used as first-line agents. Phenytoin was the most common AED used (n = 4). Three (27%) patients were on combination AEDs. Five (45.5%) patients had been seen by neurology and 6 (54.5%) had appropriate drug level monitoring performed. Six (55%) patients had potential AED-non-AED interactions. None of the patients had instructions documented in the clinical notes against driving.

Conclusion:

Seizure management in patients with CNS tumors is not consistent and remains very much a neglected area. Appropriate choice of AED is crucial. Physicians should be aware of potential drug interactions. Ownership and regular follow-up of this group is required to ensure optimum patient management.
A Protocol for the Acute Control of Agitation in Palliative Care
Authors: Gonçalves Ferraz , Almeida Ana , Teixeira Sara , Pereira Sara , Edra Natércia
Published: February 2012

Agitation is one of the most frequent causes for palliative sedation. It often requires urgent control to avoid negative consequences and even endangerment of all involved, including the patients themselves. A protocol for the control of episodes of agitation was developed, based on a previous experience. The protocol includes a combination of haloperidol and midazolam. The protocol was used 86 times in 27 patients. Each patient was sedated from 1 to 12 times, median 2 times. The median time from the beginning of sedation to the control of agitation was 15 minutes with a range from 1 minute (2 cases) to 3 hours and 5 minutes (only 1 case). In 71 cases (83%), only the first dose was needed. There were no significant complications.
Multisystem Atrophy Made Worse by Lithium Treatment in a Hospice Patient
Authors: Babinsky Ellen , Levene Richard S.
Published: February 2012

Multisystem atrophy is a neurologic condition defined as an adult-onset, progressive, neurodegenerative disease of unknown etiology. It carries a multisystem clinical course, including autonomic, urogenital, cerebellar, and parkinsonian features. Lithium toxicity, classically manifesting as increased thirst, polyuria, gastric distress, weight gain, tremor, fatigue, and mild cognitive impairment, can present in a similar manner. 1 We would like to present a patient diagnosed with progressive neurologic features typical of multisystem atrophy that also had bipolar disorder and had been taking lithium for many years. Despite normal lithium levels, it appeared as though a subclinical lithium toxicity was manifesting in the patient, and once lithium was discontinued, the patient was discharged from hospice with significant improvement in his presenting symptoms.
The 70th Anniversary of the Death of Lou Gehrig
Authors: Brennan Frank
Published: February 2012

The year 2011 marked the 70th anniversary of the death of Lou Gehrig. This article reviews his history, illness, relationship with his physicians, and what the modern physician can learn from his story. Lou Gehrig’s disease continues to be the popular eponym for amyotrophic lateral sclerosis.
Concept Analysis of Good Death in Terminally Ill Patients
Authors: Granda-Cameron Clara , Houldin Arlene
Published: February 2012

The purpose of this concept analysis of good death was to examine the attributes of a good death and explore the changes of the concept over time and its impact on terminally ill patients. The method used for this analysis was the Rodgers’ evolutionary method. A literature search was completed using Medline Ovid and Journal Storage (JSTOR).The findings describe the evolution of the good death concept over time from the prehistoric era followed by premodern, modern, and postmodern times. In addition, information is presented about surrogate terms, attributes, antecedents, and consequences associated with good death followed by analysis and discussion of the findings. General attributes of a good death include pain and symptom management, awareness of death, patient’s dignity, family presence, family support, and communication among patient, family, and health care providers.
Most Advance Directives Written by Patients With Advanced Cancer or Their Proxies Request Only Minimally Invasive Treatments During End-of-Life Care
Authors: Kwon Soo Hoon , Im Sang Hyuk , Cho Ki Won , Cho Eunha , Yoon Su-Jin , Oh So Yeon
Published: February 2012

Although it is assumed that most patients with terminal cancer are reluctant to receive life-sustaining treatment, there is a paucity of evidence supporting this assumption. We retrospectively analyzed the advance directives of terminal cancer patients to determine the preferences of patients. Patients with cancer who had life expectancy of less than 6 months were admitted to a palliative care unit in Seoul Medical Center from March 2008 to February 2010. Among a total of 247 patients, advance directives were present in the medical records of 168 patients (68.0%). Most of the advance directives were written by the patients’ families (95.2%) and they stated that they did not want most of the invasive procedures. Patients with advanced cancer mostly requested that only minimally invasive treatments that eased suffering be performed.
Close Relatives Find Meaning to Cope With Cancer Diagnosis and Treatment of Family Members
Authors: Feyh Janelle M. , Levine Ellen G. , Clay Karine
Published: February 2012

Pediatric palliative care has recently become a priority in the health care field and is implemented at the time of diagnosis rather than days or weeks before the child’s death. Social constructivism theory in which humans generate meaning from their experiences was utilized as a general framework to determine the impact of pediatric palliative care on close relatives. The purpose of this grounded theory study was to generate a substantive theory that explains how close relatives such as grandparents, aunts, and uncles of a child with cancer experience palliative care. The participants of the study included close relatives of children in palliative care. Semistructured interviews and journaling were used to collect data. Initial, focused, and axial coding procedures were used to manage the data and a content analysis of the textual data was performed. Findings from the data suggested a process of finding meaning which helps close relatives to let go of what they cannot control while holding on to what they can control. Social change implications of this study may include improving health care programming for close relatives utilizing supportive–expressive measures. This programming may promote mental health of the close relatives who will learn to deal with their adjustment difficulties and improve their coping skills.
Outcomes of Critically Ill Gynecological Cancer Patients Admitted to Intensive Care Unit
Authors: Ñamendys-Silva Silvio A. , González-Herrera María O. , Texcocano-Becerra Julia , Herrera-Gómez Angel
Published: February 2012

Purpose:

To assess the characteristics of critically ill patients with gynecological cancer, and to evaluate their prognosis.

Methods:

Fifty-two critically ill patients with gynecological cancer admitted to intensive care unit (ICU) were included. Univariate and multivariate logistic regressions were used to identify factors associated with hospital mortality.

Results:

Thirty-five patients (67.3%) had carcinoma of the cervix uteri and 11 (21.2%) had ovarian cancer. The mortality rate in the ICU was 17.3% (9 of 52) and hospital mortality rate were 23%(12 of 52). In the multivariate analysis, independent prognostic factors for hospital mortality were vasopressor use (odds ratio [OR] = 8.60, 95% confidence interval [CI] 2.05-36; P = .03) and the Acute Physiology and Chronic Health Evaluation (APACHE) II score (OR = 1.43, 95% CI 1.01-2.09; P = .048).

Conclusions:

The independent prognostic factors for hospital mortality were the need for vasopressors and the APACHE II score.
On the effects of non-homogeneous materials on the vibrations and static stability of tapered shafts
Authors: Mazzei Arnaldo J , Scott Richard A
Published: February 2012

Shafts loaded by axial compressive forces constitute an area of considerable technical importance. The static stability and transverse vibrations of such shafts are the subjects of this work. Occasionally the shafts are tapered and of interest is the effect of employing functionally graded materials (FGMs), with properties varying in the axial direction, on the buckling load and lowest bending natural frequency. Here the shaft cross section is taken to be circular and three types of taper are treated: linear, sinusoidal and exponential. The shafts are assumed to have the same volume and length and to be subjected to a constant axial force. Euler–Bernoulli theory is used with the axial force handled by a buckling type approach. The problems that arise are computationally challenging but an efficient numerical strategy employing MAPLE®’s two-point boundary value solver has been developed. Typical results for a linear tapered pin–pin shaft where one end radius is twice the other, and the FGM model varies in a power law fashion with material properties increasing in the direction of increasing area, include doubling of the buckling load and first bending frequency increase of approximately 43%, when compared with a homogeneous tapered shaft.
Efficacy of Atomoxetine for the Treatment of ADHD Symptoms in Patients With Pervasive Developmental Disorders
Authors: Fernández-Jaén Alberto , Fernández-Mayoralas Daniel Martín , Calleja-Pérez Beatriz , Muñoz-Jareño Nuria , Campos Díaz María del Rosario , López-Arribas Sonia
Published: February 2012

Objective: Atomoxetine’s tolerance and efficacy were studied in 24 patients with pervasive developmental disorder and symptoms of ADHD. Method: Prospective, open-label, 16-week study was performed, using the variables of the Clinical Global Impression Scale and the Conners’ Scale, among others. Results: A significant difference was found between pre- and posttreatment scores as well as a significant reduction was found on the scales used. Only five patients presented adverse events. Conclusion: Atomoxetine therefore appears to be a useful drug, pointing to the need for larger, randomized, controlled, double-blind studies to confirm its efficacy versus placebo and in comparison with other treatment options.
Preservice teachers’ use of production and reproduction teaching styles within multi-activity and sport education units
Authors: Parker Mitchum , Curtner-Smith Mathew
Published: February 2012

The purpose of this study was to examine the influence of one component of physical education teacher education on preservice teachers’ (PTs) use of Mosston’s (1981) spectrum of teaching styles within an early field experience (EFE). Participants were two PTs who were trained to use the spectrum within a methods course and team/turn-taught multi-activity (MA) and sport education (SE) units during the EFE. Units were filmed and coded with the Instrument for Identifying Teaching Styles. Lesson-by-lesson profiles of teaching style use within each unit were plotted. Descriptive statistics were computed across lessons for both units. Comparisons of total teaching style use during the two units were made by employing independent t-tests. The pattern of teaching style use employed by the PTs during both units was virtually identical. This pattern was largely congruent with the requirements of the MA model but did not match the requirements of the SE model.
Prevalence of sedentary behaviour in young people in Romania and Slovakia
Authors: Soos Istvan , Biddle Stuart , Boros-Balint Iuliana , Sandor Iosif , Szabo Peter , Hamar Pal , Simonek Jaromir
Published: February 2012

Sedentary behaviour is becoming a popular area of health research, but most studies report data on samples from Australia, the UK and USA, and on a narrow range of behaviours. The present study reports on the prevalence of multiple sedentary behaviours in a sample of secondary school students ( n = 635; mean age 16.0 years) from Romania and Slovakia. Ecological Momentary Assessment diaries were used to record multiple behaviours across weekdays and weekend days. Results showed high levels of many sedentary behaviours, particularly for screen time at weekends. Other behaviours included homework, sedentary socializing and motorized transport. Gender, age and country differences were evident for some behaviours. Interventions may need to account for socio-demographic moderators, and studies need to assess multiple sedentary behaviours.
Disordered eating behavior and body weight and shape relatives’ criticism in overweight and obese 15- to 19-year-old females
Authors: Unikel Santoncini Claudia , Martín Martín Verónica , Juárez García Francisco , González-Forteza Catalina , Nuño Gutiérrez Bertha
Published: February 2012

This study evaluated the link between relatives’ criticism of overweight or obese teenage girls’ figure and body weight and their relationship with their mothers, fathers and siblings, affection, self-esteem, the internalization of the aesthetic body thin ideal, depressive symptoms and disordered eating behaviors (DEB). The sample comprised 2174 senior high school students aged 15 to 19. Teenagers criticized by their relatives showed higher DEB, without interaction between Body Mass Index (BMI) and DEB. The structural equations model showed DEB was primarily explained by the internalization of the body aesthetic thin ideal, family’s criticism, BMI and depressive symptoms.
Using genograms to understand pediatric practices’ readiness for change to prevent abuse and neglect
Authors: Abatemarco Diane J , Kairys Steven , Gubernick Ruth S , Hurley Tammy
Published: February 2012

A novel use of genograms in primary care practice is to identify processes and relationships among physicians and staff prior to implementing practice change. The authors hypothesized that the genogram would inform researchers and practice staff, participating in a child maltreatment prevention study, how practice members function in a practice. They describe the use of genograms and show how the genogram results are associated with intervention uptake. Researchers constructed genograms, collected baseline surveys, and conducted postintervention interviews with physicians. Data were analyzed to determine processes associated with intervention uptake. While survey results supported the relationships and conflicts observed in the genograms, the genogram provided more multilevel information that reflected practices’ abilities to implement change. By providing a snapshot of the relationship and organizational dynamics within a practice, genograms can assess culture for practice change. Genograms describe organizational dynamics and are useful tools to use prior to initiating new programs.
How children’s rights are constructed in family-centred care
Authors: Kelly Margaret , Jones Susan , Wilson Val , Lewis Peter
Published: February 2012

It appears that the acceptance of children’s rights within the acute care setting is treated as a given but such a given requires a more systematic analysis. This has been undertaken here in the form of a review of the literature. The purpose of the review is to explore how children’s rights, defined by the United Nations Convention on the Rights of the Child (UNCRC) are recognized in family-centred care in the acute care paediatric setting as reported in the literature. Reports that were available from 1989 to 2010 were reviewed. Children’s rights are not mentioned frequently in the literature of interest to children’s nurses. What is revealed are the ethical tensions in the challenge to act at all times in children’s best interests (in the spirit of Article 3) while giving due weight to their views (in the spirit of Article 12) ( OHCHR, 1989 ). The continuing failure to address these tensions undermines the spirit and practice of family-centred care.
Building a new media platform for local storytelling and civic engagement in ethnically diverse neighborhoods
Authors: Chen Nien-Tsu N. , Dong Fan , Ball-Rokeach Sandra J. , Parks Michael , Huang Jin
Published: February 2012

This article describes a research-driven initiative to develop a hyper-local news website to promote civic engagement in an ethnically diverse neighborhood in Los Angeles County, California, United States. Utilizing Communication Infrastructure Theory’s elucidation of the contribution of an integrated local storytelling network to civic engagement, multi-method research was conducted to identify gaps and opportunities in the extant storytelling network – comprising residents, local media and community organizations – that shape the study area’s current engagement patterns. Empirical findings point to a web-based local storytelling platform as a promising mechanism for facilitating engagement and inter-group interaction. The implications of these findings for developing research-driven communication interventions to enhance civic engagement in other diverse neighborhoods are discussed.
Early urinary aldosterone excretion in very low birth weight infants
Authors: Costa Simonetta , Cota Francesco , Romagnoli Costantino , Latella Caterina , Maggio Luca , Tesfagabir Mikael Ghennet , Gallini Francesca
Published: February 2012

Hypothesis/Introduction: In the neonatal period, many factors may interfere with aldosterone production but data currently available are few and controversial. In this study we aim to assess the early urinary aldosterone excretion (UAE) in very low birth weight (VLBW) infants and to identify some possible clinical and biochemical variables that may influence this excretion.

Materials and methods: We conducted a prospective study in 30 VLBW infants. Aldosterone was measured in the first 72 hours of life in the urine and plasma and urinary electrolytes were determined. Demographic and clinical data were also recorded.

Results: The exploratory analysis showed that a significant positive correlation exists between UAE and gestational age and birth weight and that infants with respiratory distress syndrome have higher urinary aldosterone levels than infants without respiratory distress, but only plasma sodium resulted a significant independent factor that negatively influenced UAE at linear regression analysis (coefficient −0.02, 95% confidence interval [−0.03; −0.004]; adjusted R2 0.33).

Conclusions: The renin–angiotensin–aldosterone system of VLBW infants seems to be able, even immediately after birth, to respond to variations of plasma sodium concentrations; measurement of UAE constitutes an interesting method to determine aldosterone production, avoiding blood sampling in neonates so small and frail as VLBW infants.
An evaluation of a therapeutic garden's influence on the quality of life of aged care residents with dementia
Authors: Edwards Christine Anne , McDonnell Colin , Merl Helga
Published: February 2012

To evaluate whether a therapeutic garden can improve the quality of life of aged care residents with dementia and their carers, objective instruments as well as interviews with residents, staff, and family members were employed.

Residents' mean quality of life scores increased by just over 10%, mean depression scores decreased similarly and mean agitation scores decreased by almost half. Resident, staff and family member interviews elicited positive feedback including observations that it had improved the quality of life for residents and decreased staff and family stress levels. In sum, qualitative and quantitative pre and post findings indicate that an environmental change such as a therapeutic garden can improve the lives of aged care residents with dementia, and their formal and informal carers.
Analyses and statistical modeling of crimp extension stage of single and multiple yarn ends pull-out in textured polyester woven fabric
Authors: Bilisik Kadir , Demiryurek Oguz , Yolacan Gaye
Published: February 2012

The aim of this study was to understand the crimp extension stage of yarn, being pulled out of fabric. Polyester woven fabrics were used to conduct the pull-out tests. Yarn pull-out crimp extension depends on sample dimensions, fabric density, fabric weave, crimp ratio and the number of pulled ends in the fabric. Results showed that multiple and single yarn pull-out crimp extensions of long samples were higher than those of short samples, and the multiple yarn pull-out crimp extension was higher than that of the single-yarn pull-out force, and the crimp extensions in fabrics were proportional to their crimp ratios. Satin fabric weave showed high weft directional single and multiple pull-out crimp extension compared to plain and ribs fabric weaves. The developed regression model may be helpful for the design of multifunctional fabrics in technical textile applications.
HIV Treatment Adherence, Patient Health Literacy, and Health Care Provider–Patient Communication
Authors: Nachega Jean B. , Morroni Chelsea , Zuniga José M. , Schechter Mauro , Rockstroh Jürgen , Solomon Suniti , Sherer Renslow
Published: February 2012

Background: Little is known about patients' health literacy regarding antiretroviral therapy (ART) adherence and drug resistance and patient–provider communication about these topics. Design and Methods: The AIDS Treatment for Life International Survey was a multicountry cross-sectional study (January-March 2010) including 2035 HIV-infected adults. A 40-minute interview was conducted using a standardized self-report adherence questionnaire. Results: Overall, 57% of patients reported a 30-day recall of 100% adherence (Latin America: 89%; Africa: 73% vs North America: 45% and Asia Pacific: 47%; P < .01). Overall, 18% identified HIV drug resistance as a “good thing” in North America (35%) and Africa (24%). Only 71% said their health care providers had offered practical recommendations about adherence, 62% of the patients in North America and 80% in Latin America and Africa. Conclusions: Optimal ART adherence remains a challenge globally. There is a critical need to improve patient–provider communication about the importance of ART adherence and its benefits for patient’s health.
“I Can’t Prescribe Something Just Because Someone Asks for It . . .”
Authors: Flick Uwe , Garms-Homolová Vjenka , Herrmann Wolfram J. , Kuck Joachim , Röhnsch Gundula
Published: February 2012

This article demonstrates how a systematic triangulation of research perspectives can provide a methodological framework for the practice of mixed methods research. The authors illustrate the application of a “systematic approach” by focusing on an in-depth case study concerning the management of sleeping problems in nursing homes. Two sources of quantitative data (assessment of the status of residents and medication prescribed by physicians) and several contextualized qualitative approaches—one that focuses on physicians’ interpretive patterns concerning their prescription practices, and another that looks at nursing staff and nursing home residents’ attitudes toward sleep medication—are triangulated. The authors discuss the levels on which these perspectives can be linked, as well as the implications of their case study analysis for the methodological development of a mixed methods approach that is tied to the concept of triangulation.
Dynamic properties of nanoconfined water films
Authors: Guo Weichuan , Zhao Gutian , Chen Yunfei
Published: February 2012

A surface force apparatus has been used to investigate the fluidity of water confined between two mica surfaces. The observed normal surfaces forces F(D), where D is separation, were fitted to the expression of Derjaguin Landau Verwey Overbeek theory. The abrupt jump-in from separation Dj=3–5 nm to flat adhesive contact was recorded and examined; this is due to an instability expected whenever F/ D≥ K, where K is the constant of the normal spring. A speed decrease in the range 0–1.5 nm during the jump-in was observed, and indicated orders of magnitude increase of the viscosity with respect to bulk water.
Pathophysiologic mechanisms of calcific aortic stenosis
Authors: Alexopoulos Alexandros , Kaoukis Andreas , Papadaki Helen , Pyrgakis Vlassios
Published: February 2012

Calcific aortic stenosis (CAS) comprises the leading indication for valve replacement in the Western world. Until recently, progressive calcification was considered to be a passive process. Emerging evidence, however, suggests that degenerative aortic stenosis constitutes an active process involving stimulation of several pathophysiologic pathways such as inflammation and osteogenesis. In addition, CAS and atherosclerosis share common features regarding histopathology of lesions. These novel data raise a new perspective on the prevention and treatment of disease. The current article reviews the most important pathophysiologic mechanisms of senile aortic stenosis.
Safety of statins: an update
Authors: Hu Miao , Cheung Bernard M.Y. , Tomlinson Brian
Published: February 2012

Statins are widely used and have been proven to be effective in the prevention of atherosclerotic vascular disease events, primarily by reducing plasma low-density lipoprotein cholesterol concentrations. Although statins are generally well tolerated and present an excellent safety profile, adverse effects from muscle toxicity and liver enzyme abnormalities may occur in some patients. Myopathy and rhabdomyolysis are rare with statin monotherapy at the approved dose ranges, but the risk increases with use of higher doses, interacting drugs and genetic predisposition. Asymptomatic increases in liver transaminases with statin treatment do not seem to be associated with an increased risk of liver disease. Therefore, statin treatment can be safely used in patients with mild to moderately abnormal liver tests that are potentially attributable to nonalcoholic fatty liver disease and can improve liver tests and reduce cardiovascular morbidity in this group of patients. The risks of other unfavorable effects such as the slightly increased risk of new-onset diabetes and potentially increased risk of haemorrhagic stroke are much smaller than the cardiovascular benefits with the use of statins.
Spirometry and Response to Bronchodilator Studies
Authors: Pruitt Bill
Published: February 2012

Spirometry is a valuable tool for diagnosing asthma, establishing the severity, and assessing the control of asthma over time in those patients who can perform the procedure. Response to bronchodilator also helps in diagnosing the disease and assessing control. Guidelines and standards are available to help perform and interpret spirometry and response to bronchodilator tests. These guidelines come from the American Thoracic Society, the European Respiratory Society, the National Asthma Education and Prevention Program—Expert Panel Report-3, and the American Association for Respiratory Care Clinical Practice Guidelines. The objective measurements, especially in the forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and the FEV1/FVC, enable proper management and provide continuing assessment to check the effectiveness of therapy and to follow the disease over time.
Race and Ethnicity Missingness in the Traffic Stop Data Reported by 308 Massachusetts Police Agencies
Authors: Lundman Richard J.
Published: February 2012

Data reported by police agencies were at the core of most analyses of Driving While Black in the 1990s and 2000s. There is, however, no previous macro-level research directed exclusively at the accuracy of the Driving While Black traffic stop data reported by police agencies. This article remedies that omission by reaching back across a little more than 10 years to examine data reported by 308 Massachusetts police agencies during April and May of 2001, a time when collection of driver race and ethnicity data was still relatively new. The baseline data show that race and ethnicity missingness is nonrandom on several important dimensions. The article concludes that the Driving While Black data reported by most of the 308 Massachusetts police agencies during April and May of 2001 appear to underestimate the frequency with which police stopped Black and African American drivers for traffic law violations.
24-h duration of the novel LABA vilanterol trifenatate in asthma patients treated with inhaled corticosteroids
Authors: Lötvall Jan , Bateman Eric D. , Bleecker Eugene R. , Busse William W. , Woodcock Ashley , Follows Richard , Lim Jessica , Stone Sally , Jacques Loretta , Haumann Brett
Published: February 2012

Current guidelines recommend adding a long-acting inhaled β2-agonist (LABA) to inhaled corticosteroids (ICS) in patients with uncontrolled asthma. This study evaluated the novel, once-daily LABA vilanterol trifenatate (VI) in asthma patients who remained symptomatic despite existing ICS therapy.

The study involved a randomised, double-blind, placebo-controlled trial of VI (3, 6.25, 12.5, 25 and 50 μg), administered once daily in the evening by dry powder inhaler for 28 days, in asthma patients aged ≥12 yrs symptomatic on current ICS therapy. The primary end-point was trough (24 h post-dose) forced expiratory volume in 1 s (FEV1); secondary end-points were weighted mean FEV1, peak expiratory flow (PEF), symptom-/rescue-free 24-h periods, and safety.

A significant relationship was observed between VI dose and improvements in trough FEV1(p=0.037). Statistically significant increases in mean trough FEV1, relative to placebo, were documented for VI 12.5–50 μg (121–162 mL; p≤0.016). Dose-related effects of VI were observed on weighted mean (0–24 h) FEV1, morning/evening PEF, and symptom-/rescue-free 24-h periods. All doses of VI were well tolerated with low incidences of recognised LABA-related adverse events (tremor 0–2%; palpitations 0–2%; glucose effects 0–1%; potassium effects 0–<1%).

Once-daily VI 12.5–50 μg resulted in prolonged bronchodilation of at least 24 h with good tolerability in asthma patients receiving ICS. Based on the overall efficacy and adverse event profile from this study, the optimum dose of VI appears to be 25 μg.
Occlusion pressure analysis role in partitioning of pulmonary vascular resistance in CTEPH
Authors: Toshner Mark , Suntharalingam Jay , Fesler Pierre , Soon Elaine , Sheares Karen K. , Jenkins David , White Paul , Morrell Nicholas W. , Naeije Robert , Pepke-Zaba Joanna
Published: February 2012

Flow-directed pulmonary artery occlusion is posited to enable partitioning of vascular resistance into small and large vessels. As such it may have a role in assessment for pulmonary endarterectomy.

To test if the occlusion technique distinguished small from large vessel disease we studied 59 subjects with chronic thromboembolic pulmonary hypertension (CTEPH), idiopathic pulmonary arterial hypertension (IPAH), and connective tissue disease (CTD)-associated PAH. At right heart catheterisation, occlusion pressures were recorded. With fitting of the pressure decay curve, pulmonary vascular resistance was partitioned into downstream (small vessels) and upstream (large vessels, Rup).

47 patients completed the study; 14 operable CTEPH, 15 inoperable CTEPH, 13 idiopathic or CTD-PAH and five post-operative CTEPH. There was a significant difference in mean Rupin the proximal operable CTEPH group 87.3 (95% CI 84.1–90.5); inoperable CTEPH mean 75.8 (95% CI 66.76–84.73), p=0.048; and IPAH/CTD, mean 77.1 (95% CI 71.86–82.33), p=0.003. Receiver operating characteristic curves to distinguish operable from inoperable CTEPH demonstrated an area under the curve of 0.75, p=0.0001. A cut-off of 79.3 gave 100% sensitivity (95% CI 73.5–100%) but 57.1% specificity (95% CI 28.9–82.3%). In a subgroup analysis of multiple lobar sampling there was demonstrable heterogeneity.

Rupis significantly increased in operable proximal CTEPH compared with non-operable distal CTEPH and IPAH/CTD-PAH. Rupvariability in patients with CTEPH and PAH is suggestive of pathophysiological heterogeneity.
Leptin and regulatory T-lymphocytes in idiopathic pulmonary arterial hypertension
Authors: Huertas Alice , Tu Ly , Gambaryan Natalia , Girerd Barbara , Perros Frédéric , Montani David , Fabre Dominique , Fadel Elie , Eddahibi Saadia , Cohen-Kaminsky Sylvia , Guignabert Christophe , Humbert Marc
Published: February 2012

Immune mechanisms and autoimmunity seem to play a significant role in idiopathic pulmonary arterial hypertension (IPAH) pathogenesis and/or progression, but the pathophysiology is still unclear. Recent evidence has demonstrated a detrimental involvement of leptin in promoting various autoimmune diseases by controlling regulatory T-lymphocytes. Despite this knowledge, the role of leptin in IPAH is currently unknown. We hypothesised that leptin, synthesised by dysfunctional pulmonary endothelium, might play a role in the immunopathogenesis of IPAH by regulating circulating regulatory T-lymphocytes function.

First, we collected serum and regulatory T-lymphocytes from controls, and IPAH and scleroderma-associated pulmonary arterial hypertension (SSc-PAH) patients; secondly, we recovered tissue samples and cultured endothelial cells after either surgery or transplantation in controls and IPAH patients, respectively.

Our findings indicate that serum leptin was higher in IPAH and SSc-PAH patients than controls. Circulating regulatory T-lymphocyte numbers were comparable in all groups, and the percentage of those expressing leptin receptor was higher in IPAH and SSc-PAH compared with controls, whereas their function was reduced in IPAH and SSc-PAH patients compared with controls, in a leptin-dependent manner. Furthermore, endothelial cells from IPAH patients synthesised more leptin than controls.

Our data suggest that endothelial-derived leptin may play a role in the immunopathogenesis of IPAH.
Indoor air pollution and the lung in low- and medium-income countries
Authors: Kurmi Om P. , Lam Kin Bong Hubert , Ayres Jon G.
Published: February 2012

Over half the world’s population, mostly from developing countries, use solid fuel for domestic purposes and are exposed to very high concentrations of harmful air pollutants with potential health effects such as respiratory problems, cardiovascular problems, infant mortality and ocular problems. The evidence also suggests that, although the total percentage of people using solid fuel is decreasing, the absolute number is currently increasing. Exposure to smoke from solid fuel burning increases the risk of chronic obstructive pulmonary disease (COPD) and lung cancer in adults, and acute lower respiratory tract infection/pneumonia in children. Despite the heterogeneity among studies, the association between COPD and exposure to smoke produced by burning different types of solid fuel is consistent. However, there is strong evidence that while coal burning is a risk factor for lung cancer, exposure to other biomass fuel smoke is less so. There is some evidence that reduction of smoke exposure using improved cooking stoves reduces the risk of COPD and, possibly, acute lower respiratory infection in children, so approaches to reduce biomass smoke exposure are likely to result in reductions in the global burden of respiratory disease.
High inhaled corticosteroids adherence in childhood asthma: the role of medication beliefs
Authors: Klok Ted , Kaptein Adrian A. , Duiverman Eric J. , Brand Paul L.
Published: February 2012

Our aim was to study determinants of adherence in young asthmatic children over a 3-month period, including the role of parental illness and medication perceptions as determinants of adherence.

Consecutive 2–6-yr-old children with asthma, using inhaled corticosteroids (ICS), followed-up at our paediatric asthma clinic (where patients are being extensively trained in self-management, and are followed-up closely) were enrolled. Adherence was measured electronically using a Smartinhaler® and calculated as a percentage of the prescribed dose. We examined the association of adherence to a range of putative determinants, including clinical characteristics and parental perceptions about illness and medication.

Median (interquartile range) adherence, measured over 3 months in 93 children, was 92 (76–97)%, and most children had well controlled asthma. 94% of parents expressed the view that giving ICS to their child would protect him/her from becoming worse. Adherence was significantly associated with asthma control and with parental perceptions about medication.

The high adherence rate observed in our study was associated with parental perceptions about ICS need. The high perceived need of ICS may probably be ascribed to the organisation of asthma care (with repeated tailored education and close follow-up).
Diagnostic accuracy of a urine lipoarabinomannan strip-test for TB detection in HIV-infected hospitalised patients
Authors: Peter Jonathan G. , Theron Grant , van Zyl-Smit Richard , Haripersad Asheen , Mottay Lynelle , Kraus Sarah , Binder Anke , Meldau Richard , Hardy Anneli , Dheda Keertan
Published: February 2012

Lack of point-of-care tests for tuberculosis (TB) result in diagnostic delay, and increased mortality and healthcare-related costs.

The urine DetermineTMTB-LAM point-of-care strip-test was evaluated in 335 prospectively-recruited hospitalised patients with suspected TB-HIV co-infection (group 1) and from 88 HIV-infected hospitalised patients with non-TB diagnoses (group 2). Cut-off point-specific analyses were performed using: 1) a microbiological reference standard (culture positiveversusnegative); and 2) a composite reference standard (exclusion of patients with clinical-TB from the culture-negative group).

Using the microbiological reference and the manufacturer-recommended grade-1 cut-off point, LAM sensitivity and specificity was 66% (95% CI 57–74%). By contrast, using the composite reference sensitivity was 60% (95% CI 53–67%) and specificity improved to 96% (95% CI 89–100%) (p=0.001). The same pattern was seen when the grade-2 cut-off point was used (specificity 75%versus96%; p=0.01). In group two patients specificity was poor using the grade-1 cut-off point, but improved significantly when the grade-2 cut-off point was used (90%versus99%; p=0.009). The grade-2 cut-off point also offered superior inter-reader reliability (p=0.002). Sensitivity was highest in those with a CD4 <200 cells per mL. LAM combined with smear-microscopy was able to rule-in TB in 71% ofMycobacterium tuberculosisculture-positive patients.

This preliminary study indicates that the LAM strip-test may be a potentially useful rapid rule-in test for TB in hospitalised patients with advanced immunosuppression. The grade 2, but not the manufacturer-recommended grade 1 cut-off point, offered superior rule-in utility and inter-reader reliability. Larger studies to evaluate cut-off points and diagnostic accuracy are urgently required.
Paediatrics in Amsterdam
Authors: Eber Ernst , Aurora Paul , Lødrup Carlsen Karin C. , Lindblad Anders , Dankert-Roelse Jeannette E. , Ross-Russell Robert I. , Turner Steve W. , Midulla Fabio , Hedlin Gunilla
Published: February 2012

The aim of this update is to describe the paediatric highlights from the 2011 European Respiratory Society (ERS) Annual Congress in Amsterdam, the Netherlands. Abstracts from all seven groups of the ERS Paediatric Assembly (Paediatric Respiratory Physiology, Paediatric Asthma and Allergy, Cystic Fibrosis, Paediatric Respiratory Infection and Immunology, Neonatology and Paediatric Intensive Care, Paediatric Respiratory Epidemiology, and Paediatric Bronchology) are presented in the context of current literature.
Boundedness of (k + 1)-linear fractional integral with a multiple variable kernel
Authors: Zhang Huihui , Ruan Jianmiao , Yu Xiao
Published: February 2012

In this article, we discuss the boundedness of (k + 1)-linear fractional integrals with variable kernels on product L

p
spaces. Our results improved some known results.

2000 Mathematics Subject Classification: 42B20; 42B25.
REGγ is associated with multiple oncogenic pathways in human cancers
Authors: He Jing , Cui Long , Zeng Yu , Wang Guangqiang , Zhou Ping , Yang Yuanyuan , Ji Lei , Zhao Yanyan , Chen Jiwu , Wang Zhuo , Shi Tieliu , Zhang Pei , Chen Rui , Li Xiaotao
Published: February 2012

Background

Recent studies suggest a role of the proteasome activator, REGγ, in cancer progression. Since there are limited numbers of known REGγ targets, it is not known which cancers and pathways are associated with REGγ.

Methods

REGγ protein expressions in four different cancers were investigated by immunohistochemistry (IHC) analysis. Following NCBI Gene Expression Omnibus (GEO) database search, microarray platform validation, differential expressions of REGγ in corresponding cancers were statistically analyzed. Genes highly correlated with REGγ were defined based on Pearson's correlation coefficient. Functional links were estimated by Ingenuity Core analysis. Finally, validation was performed by RT-PCR analysis in established cancer cell lines and IHC in human colon cancer tissues

Results

Here, we demonstrate overexpression of REGγ in four different cancer types by micro-tissue array analysis. Using meta-analysis of publicly available microarray databases and biological studies, we verified elevated REGγ gene expression in the four types of cancers and identified genes significantly correlated with REGγ expression, including genes in p53, Myc pathways, and multiple other cancer-related pathways. The predicted correlations were largely consistent with quantitative RT-PCR analysis.

Conclusions

This study provides us novel insights in REGγ gene expression profiles and its link to multiple cancer-related pathways in cancers. Our results indicate potentially important pathogenic roles of REGγ in multiple cancer types and implicate REGγ as a putative cancer marker.
Traffic models impact on OFDMA scheduling design
Authors: Ameigeiras Pablo , Wang Yuanye , Navarro-Ortiz Jorge , Mogensen Preben E , Lopez-Soler Juan M
Published: February 2012

This article studies the impact on the design of scheduling algorithms forOrthogonal Frequency Division Multiple Access(OFDMA) systems of two traffic models described in the evaluation methodology proposals from standardization bodies: the full buffer and the finite buffer traffic models. The analysis concentrates on utility-based scheduling with an α-fair utility function forNon-Real Time(NRT) services. The results show that a gradient scheduling algorithm is able to maximize the aggregate utility over all the users when the less realistic full buffer model is adopted; but not when the finite buffer model is applied. The results also show that with the full buffer model a gradient scheduler exhibits a trade-off between average user throughput and the user throughput at 5% outage, but it does not when the more realistic finite buffer is used. Therefore, it is concluded that designs of scheduling algorithms for NRT services for OFDMA systems carried out under the full buffer model assumption may fail to provide the desired performance benefits in realistic scenarios. Based on the results presented, a recommendation on scheduling design is provided.