bluuebunny/crossref_metadata_2025 huggingface dataset:
Diverse Effects of Increasing Lisinopril Doses on Lipid Abnormalities in Chronic Nephropathies
Authors: Ruggenenti Piero , Mise Naobumi , Pisoni Roberto , Arnoldi Federica , Pezzotta Anna , Perna Annalisa , Cattaneo Dario , Remuzzi Giuseppe
Published: February 2003

Background—

Dyslipidemia frequently complicates chronic nephropathies and increases the risk of renal and cardiovascular events. This might be ameliorated by drugs, such as angiotensin-converting enzyme inhibitors, which effectively reduce proteinuria.

Methods and Results—

In this longitudinal study, we evaluated the extent to which uptitration of the ACE inhibitor lisinopril to maximum tolerated doses (median [range]: 30 [10 to 40] mg/d) ameliorated proteinuria and dyslipidemia in 28 patients with nondiabetic chronic nephropathies. Maximum lisinopril doses significantly and safely reduced proteinuria, serum total, LDL cholesterol, and triglycerides without substantially affecting serum HDL and renal hemodynamics. Proteinuria already decreased at 10 mg/d. Serum lipids progressively and dose-dependently decreased during uptitration to maximum doses. Reduction in total and LDL cholesterol correlated with increases in serum albumin/total protein concentration and oncotic pressure, peaked at lisinopril maximum doses, and persisted after treatment withdrawal. Despite less proteinuria reduction, hypercholesterolemia decreased more (and reflected the increase in serum albumin) in hypoalbuminemic than in normoalbuminemic patients who, despite more proteinuria reduction, had less decrease in cholesterol and no changes in serum albumin. Changes in serum triglycerides were independent of changes in serum proteins, were strongly correlated with lisinopril doses (
r
=−0.89,
P
=0.003) and recovered promptly after treatment withdrawal. Lisinopril was well tolerated, did not affect renal hemodynamics, and caused symptomatic, reversible hypotension in only two patients.

Conclusions—

In chronic nephropathies, angiotensin converting enzyme inhibitor uptitration to maximum tolerated doses safely ameliorated hypertriglyceridemia by a direct, dose-dependent effect, and hypercholesterolemia through amelioration of the nephrotic syndrome, particularly in patients with more severe hypoalbuminemia.
Detecting Acute Coronary Syndrome in the Emergency Department With Cardiac Magnetic Resonance Imaging
Authors: Kwong Raymond Y. , Schussheim Adam E. , Rekhraj Suresh , Aletras Anthony H. , Geller Nancy , Davis Janice , Christian Timothy F. , Balaban Robert S. , Arai Andrew E.
Published: February 2003

Background—

Managing chest pain in the emergency department remains a challenge with current diagnostic strategies. We hypothesized that cardiac MRI could accurately identify patients with possible or probable acute coronary syndrome.

Methods and Results—

The diagnostic performance of MRI was evaluated in a prospective study of 161 consecutive patients. Enrollment required 30 minutes of chest pain compatible with myocardial ischemia but an ECG not diagnostic of acute myocardial infarction. MRI was performed at rest within 12 hours of presentation and included perfusion, left ventricular function, and gadolinium-enhanced myocardial infarction detection. MRI was interpreted qualitatively but also analyzed quantitatively. The sensitivity and specificity, respectively, for detecting acute coronary syndrome were 84% and 85% by MRI, 80% and 61% by an abnormal ECG, 16% and 95% for strict ECG criteria for ischemia (ST depression or T-wave inversion), 40% and 97% for peak troponin-I, and 48% and 85% for a TIMI risk score ≥3. The MRI was more sensitive than strict ECG criteria for ischemia (
P
<0.001), peak troponin-I (
P
<0.001), and the TIMI risk score (
P
=0.004), and MRI was more specific than an abnormal ECG (
P
<0.001). Multivariate logistic regression analysis showed MRI was the strongest predictor of acute coronary syndrome and added diagnostic value over clinical parameters (
P
<0.001).

Conclusions—

Resting cardiac MRI exhibited diagnostic operating characteristics suitable for triage of patients with chest pain in the emergency department. Performed urgently to evaluate chest pain, MRI accurately detected a high fraction of patients with acute coronary syndrome, including patients with enzyme-negative unstable angina.
Prognostic Significance of Angiogenic Growth Factor Serum Levels in Patients With Acute Coronary Syndromes
Authors: Heeschen Christopher , Dimmeler Stefanie , Hamm Christian W. , Boersma Eric , Zeiher Andreas M. , Simoons Maarten L.
Published: February 2003

Background—

In patients with acute coronary syndromes, compensatory processes are initiated, including angiogenesis and endothelial regeneration of ruptured or eroded plaques. Angiogenic growth factors like vascular endothelial growth factor (VEGF), hepatocyte growth factor (HGF), and basic fibroblast growth factor (bFGF) are upregulated during ischemia. However, it is unknown whether their serum levels are related to clinical outcome.

Methods and Results—

We measured VEGF, HGF, and bFGF levels in 1090 patients with acute coronary syndromes. Angiographic evaluation was performed at baseline as well as death, and nonfatal myocardial infarctions were recorded during 6-month follow-up. HGF and VEGF, but not bFGF, were significantly and independently associated with the patients’ outcome. Patients with elevated VEGF serum levels suffered from adverse outcome (adjusted hazard ratio, 2.50 [1.52 to 4.82];
P
=0.002). VEGF elevation was associated with evidence of ischemia and was a significant predictor of the effect of glycoprotein IIb/IIIa inhibition. In contrast, patients with high HGF levels had a significantly lower event rate compared with patients with low HGF levels (adjusted hazard ratio, 0.33 [0.21 to 0.51];
P
<0.001). HGF levels did not correlate with evidence of ischemia and did not predict the effect of abciximab. Intriguingly, however, HGF levels significantly correlated with angiographically visible collateralization of the target vessel (22.4% versus 10.5%;
P
<0.001).

Conclusions—

The angiogenic growth factors VEGF and HGF are independent predictors of the patients’ prognosis in acute coronary syndromes. Whereas VEGF elevation correlated with the evidence of myocardial ischemia and indicated an adverse outcome, HGF elevation was independent of ischemia and associated with improved collateralization as well as a favorable prognosis.
TAXUS III Trial
Authors: Tanabe Kengo , Serruys Patrick W. , Grube Eberhard , Smits Pieter C. , Selbach Guido , van der Giessen Willem J. , Staberock Manfred , de Feyter Pim , Müller Ralf , Regar Evelyn , Degertekin Muzaffer , Ligthart Jurgen M.R. , Disco Clemens , Backx Bianca , Russell Mary E.
Published: February 2003

Background—The first clinical study of paclitaxel-eluting stent for de novo lesions showed promising results. We performed the TAXUS III trial to evaluate the feasibility and safety of paclitaxel-eluting stent for the treatment of in-stent restenosis (ISR).

Methods and Results—The TAXUS III trial was a single-arm, 2-center study that enrolled 28 patients with ISR meeting the criteria of lesion length ≤30 mm, 50% to 99% diameter stenosis, and vessel diameter 3.0 to 3.5 mm. They were treated with one or more TAXUS NIRx paclitaxel-eluting stents. Twenty-five patients completed the angiographic follow-up at 6 months, and 17 of these underwent intravascular ultrasound (IVUS) examination. No subacute stent thrombosis occurred up to 12 months, but there was one late chronic total occlusion, and additional 3 patients showed angiographic restenosis. The mean late loss was 0.54 mm, with neointimal hyperplasia volume of 20.3 mm3. The major adverse cardiac event rate was 29% (8 patients; 1 non-Q-wave myocardial infarction, 1 coronary artery bypass grafting, and 6 target lesion revascularization [TLR]). Of the patients with TLR, 1 had restenosis in a bare stent implanted for edge dissection and 2 had restenosis in a gap between 2 paclitaxel-eluting stents. Two patients without angiographic restenosis underwent TLR as a result of the IVUS assessment at follow-up (1 incomplete apposition and 1 insufficient expansion of the stent).

Conclusions—Paclitaxel-eluting stent implantation is considered safe and potentially efficacious in the treatment of ISR. IVUS guidance to ensure good stent deployment with complete coverage of target lesion may reduce reintervention.
Burgeoning Dilemmas in the Management of Diabetes and Cardiovascular Disease
Authors: Sobel Burton E. , Frye Robert , Detre Katherine M.
Published: February 2003

A paradoxical increase in mortality attributable to diabetes has occurred, particularly during the last decade, despite the overall decrease in mortality attributable to coronary artery disease in patients without diabetes. Insulin resistance with or without frank type 2 diabetes has emerged as a major determinant of accelerated coronary artery disease and its sequelae. The advent of insulin sensitizers enables clinicians to target treatment of insulin resistance, as well as hyperglycemia and dyslipidemia. The prevalence of diabetes in the United States is enormous and is increasing rapidly. Patients with diabetes respond less favorably to percutaneous coronary interventions and surgery compared with nondiabetic patients. These considerations led to the initiation of the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial. It is designed to determine whether treatment targeted to attenuate insulin resistance can arrest or retard progression of coronary artery disease compared with treatment targeted to the same level of glycemic control with an insulin-providing approach. It is designed also to determine whether early revascularization reduces mortality and morbidity in patients with type 2 diabetes whose cardiac symptoms are mild and stable. Despite challenges in study design and enrollment, intensive follow-up, and the long duration of follow-up planned, the questions being addressed are compelling and seem to merit the effort.
Paclitaxel Coating Reduces In-Stent Intimal Hyperplasia in Human Coronary Arteries
Authors: Hong Myeong-Ki , Mintz Gary S. , Lee Cheol Whan , Song Jong-Min , Han Ki-Hoon , Kang Duk-Hyun , Song Jae-Kwan , Kim Jae-Joong , Weissman Neil J. , Fearnot Neal E. , Park Seong-Wook , Park Seung-Jung
Published: February 2003

Background—

The aim of this study was to use serial volumetric intravascular ultrasound (IVUS) to evaluate the effect of a paclitaxel coating on in-stent intimal hyperplasia (IH).

Methods and Results—

Patients were randomized to placebo (bare metal stents) or 1 of 2 doses of paclitaxel (low dose: 1.28 μg/mm
2
; high dose: 3.10 μg/mm
2
). Complete post-stent implantation and follow-up IVUS were available in 81 patients, including 25 control patients and in 28 receiving a low-dose and 28 receiving a high dose. Volumetric analysis of the stented segment and of both reference segments was performed. Baseline stent measurements and both reference measurements were similar among the groups. With increasing doses, there was a stepwise reduction in IH accumulation within the stented segment (31±22 mm
3
in control, 18±15 mm
3
in low dose, and 13±14 mm
3
in high dose,
P
<0.001). Post hoc analysis showed less IH accumulation when low- and high-dose patients were compared with control (
P
=0.009 and
P
<0.001, respectively), but not when low-dose patients were compared with high-dose patients (
P
=0.2). Focal late malapposition was seen in 1 high-dose patient. With increasing doses, there was no significant change in the reference segments.

Conclusions—

Paclitaxel-coated stents are effective in reducing in-stent neointimal tissue proliferation in humans. They are not associated with edge restenosis or significant late malapposition.
Vitamin E Reduces Progression of Atherosclerosis in Low-Density Lipoprotein Receptor-Deficient Mice With Established Vascular Lesions
Authors: Cyrus Tillmann , Yao Yuemang , Rokach Joshua , Tang Lina X. , Praticò Domenico
Published: February 2003

Background—

A growing body of evidence from animal studies supports the hypothesis that oxidative stress-mediated mechanisms play a central role in early atherogenesis. In contrast, clinical trials with antioxidant vitamins have not produced consistent results in humans with established atherosclerosis.

Methods and Results—

Low-density lipoprotein receptor-deficient mice (LDLR KO) were fed a high-fat diet for 3 months to induce atheroma. At this time, 1 group of mice was euthanized for examination of atherosclerosis, and 2 other groups were randomized to receive high-fat diet either alone or supplemented with vitamin E for 3 additional months. At the end of the study, LDLR KO on a vitamin E-supplemented fat diet had decreased 8,12-
iso
-isoprostane (iP)F
2α
-VI and monocyte chemoattractant protein-1 levels, but increased nitric oxide levels compared with mice on placebo. No difference in lipid levels was observed between the 2 groups. Compared with baseline, placebo group had progression of atherosclerosis. In contrast, vitamin E-treated animals showed a significant reduction in progression of atherosclerosis.

Conclusions—

These results demonstrate that in LDLR KO, vitamin E supplementation reduces progression of established atherosclerosis by suppressing oxidative and inflammatory reactions and increasing nitric oxide levels.
LE POUVOIR MORAL ET SPIRITUEL DES FEMMES DANS LE VODOU HAÏTIEN: LA VOIX DE MAMA LOLA ET DE KAREN MCCARTHY BROWN
Authors: Michel Claudine
Published: February 2003

The article attempts to interpret morality in Haitian Vodou by illustrating its ethical framework in the day-to-day realities of its followers. In so doing, I demonstrate how Vodou as a living system of belief and practice has historically served as the informal infrastructure for morality in Haiti. To this end, I draw upon the work of Karen McCarthy Brown whose work on Mama Lola, a Haitian priestess living in Brooklyn, is an insightful venture into the heart of this widely misunderstood religious and social system. Furthermore, this essay offers the perspective of a very distinctive single voice which emerges from the long and complex dialogue between the multiple voices of the researcher/observer/participant and the manyfaceted voices of the priestess/informant. Their diverse perspectives and individual utterances fuse successfully in a powerful articulation of feminist intervention and cultural understanding. Their lives and their work clearly establish how the Haitian religion empowers women and how the manbo subtly manifests Haitian female power.
THE SATANIC RITUAL ABUSE PANIC AS RELIGIOUS-STUDIES DATA
Authors: Frankfurter David
Published: February 2003

Rumors and alleged memories of Satanic cult activity swept through the U.S. and U.K. during the 1980s and 1990s, confounding scholars of religion, as well as jurists and psychologists, with their combination of tantalizing ritual scenes and dubious forensic evidence. This essay discusses the work done on these Satanic cult claims since the early 1990s in a variety of academic fields; and it critiques some of the scholarly responses from the field of Religious Studies in particular.
INDIVIDUAL VARIATION IN THE ACOUSTIC BEHAVIOUR OF THE ADULT MALE LEOPARD SEAL, HYDRURGA LEPTONYX
Authors: Rogers Tracey , Cato Douglas
Published: February 2003

Vocalisations and vocalising bouts of adult male leopard seals recorded from the Prydz Bay region, East Antarctica, were compared to determine whether they showed individual variability. There were distinct individual patterns in the sequence of vocalisations within vocalising bouts. A sequence could be reliably ascribed to a particular individual with a high degree (83%) of certainty. Such sequences may carry information about the identity of the caller. Acoustic characteristics of the two most commonly used vocalisations, the high and low double trills, showed weak within individual variation. Although differences were observed among individuals in the high double trill few were observed in the low double trill consequently the low double trills of some individuals could not be reliably ascribed to any particular seal. For many species, individual variation occurs in acoustic characteristics of specific vocalisations rather than in the sequence in which the vocalisations are produced. The acoustic displays of solitary species such as the leopard seal, are constrained by the difficulties of detecting and recognising the signal at a distance. Vocalisation sequences may be less adversely affected by signal degradation and so could be effective for communicating information over distance. It has been suggested that individual acoustic variation is found primarily in gregarious species however findings from the current study suggest that solitary animals using long-range underwater acoustic displays may convey individual variability in their vocalising sequence patterns.
FOUR LETTERS OF SAYH HASAN AL-'ATTĀR TO SAYH TĀHIR AL-HUSAYNĪ OF JERUSALEM
Authors: Abu-Manneh Butrus
Published: February 2003

Sayh Hasan al-'Attār, a young 'ālim of al-Azhar, left Egypt for the Ottoman-Turkish lands in 1803. He stayed there for seven years before moving to Damascus in 1810 where he stayed for the next three and a half years. In late 1813 he joined the Hağğ caravan to Mecca. On his way back he went to Jerusalem where he enjoyed the hospitality of its hanafī muftī Sayh Tāhir al-Husainī whom he apparently befriended while the latter was studying at al-Azhar. From Jerusalem he returned to Egypt in the spring of 1814. The four letters sent by 'Attār to Sayh Tāhir shed a light on his movements and mood of thought at that time, and on the relations between 'ulamā' of al-Azhar and those of Jerusalem and the cultural interests of the latter. Two of the letters are of special importance because they give us a first hand account of his way back to Cairo and of the personal hardships which he encountered after his resettlement there. Moreover, he referred in them to the books which he started to teach and to the great interest they aroused among the Azharite students. In short those rare letters show a side of 'Attār's life unknown to scholars and help us to understand the condition of the 'ulamā' under Muhammad Alī.
DREAMS, DOCUMENTS AND 'FETISHES': AFRICAN CHRISTIAN INTERPRETATIONS OF THE PILGRIM'S PROGRESS
Authors: Hofmeyr Isabel
Published: February 2003

John Bunyan's The Pilgrim's Progress, a key text of the evangelical Protestant missionary movement, was translated into eighty African languages and consequently influenced African Christian intellectual traditions. This article examines one aspect of this influence, namely the ways in which Bunyan's portrayal of literacy in The Pilgrim's Progress became a site around which African reworkings of the text cohered. For Bunyan, a first-generation literate, literacy is a source of spiritual authority but also a source of powerlessness as documents are used to persecute the poor. African Christians likewise experienced literacy as a source of power and powerlessness. This contradiction often produced the phenomenon of 'miraculous literacy' in which believers magically gain the ability to read through spiritual gifts rather than via mission or colonially controlled institutions. Documents also gain talismanic or 'fetish-like' properties, a view not far removed from evangelical theories of text that likewise invest documents with extraordinary capacities.
Intranodal injection of semimature monocyte-derived dendritic cells induces T helper type 1 responses to protein neoantigen
Authors: Gilliet Michel , Kleinhans Martin , Lantelme Erica , Schadendorf Dirk , Burg Günter , Nestle Frank O.
Published: January 2003

Dendritic cells (DCs) represent the most potent antigen-presenting cells of the immune system capable of initiating primary immune responses to neoantigens. Here we characterize the primary CD4 T-cell immune response to protein keyhole limpet hemocyanin (KLH) in 5 metastatic melanoma patients undergoing a tumor peptide–based dendritic cell vaccination trial. Monocyte-derived dendritic cells displaying a semimature phenotype, as defined by surface markers, were loaded ex vivo with antigen and injected intranodally at weekly intervals for 4 weeks. All patients developed a strong and long-lasting delayed-type hypersensitivity reactivity to KLH, which correlated with the induction of KLH-dependent proliferation of CD4 T cells in vitro. Secondary in vitro stimulation with KLH showed significant increase in interferon-γ and interleukin-2 (IL-2) but not IL-4, IL-5, nor IL-10 secretion by bulk T cells. On the single-cell level, most TH1 cells among in vitro–generated KLH-specific T-cell lines confirmed the preferential induction of a KLH-specific type 1 T helper immune response. Furthermore, the induction of KLH-specific antibodies of the IgG2 subtype may reflect the induction of a type 1 cytokine profile in vivo after vaccination. Our results indicate that intranodal vaccination with semimature DCs can prime strong, long-lasting CD4 T-cell responses with a TH1-type cytokine profile in cancer patients. (Blood. 2003;102:36-42)
Genetic evidence for convergence of c-Kit– and α4 integrin–mediated signals on class IA PI-3kinase and the Rac pathway in regulating integrin-directed migration in mast cells
Authors: Tan Bai Lin , Yazicioglu Mustafa N. , Ingram David , McCarthy Jennifer , Borneo Jovencio , Williams David A. , Kapur Reuben
Published: January 2003

Mast cells play a critical role in host defense against a number of pathogens. Increased mast cell infiltration has been described in allergic asthma, in rheumatoid arthritis, and during helminthes infection. Despite the importance of mast cells in allergic disease and defense against infection, little is known about the mechanisms by which mast cells migrate to various tissues under steady state conditions or during infection or inflammation. Here, we show that activation of c-Kit by its ligand, stem cell factor (SCF), cooperates with α4 integrin in inducing directed migration of mast cells on fibronectin. A reduction in migration and activation of a small G protein, Rac, was observed in mast cells derived from class IA phosphoinositide-3 kinase (PI-3kinase)–deficient mice in response to SCF stimulation and in mast cells expressing the dominant-negative Rac (RacN17), as well as in mast cells deficient in the hematopoietic-specific small G protein, Rac2. In addition, a PI-3kinase inhibitor inhibited α4- as well as SCF-induced migration in a dose-dependent fashion. In contrast, a mitogen-activated protein kinase (MAPK) inhibitor had little effect. Consistent with the pharmacologic results, abrogating the binding of the p85α subunit of class IA PI-3kinase to c-Kit also resulted in inhibition of SCF-induced migration on fibronectin. These genetic and biochemical data demonstrate that both c-Kit and α4 integrin signaling are linked to class IA PI-3kinase and Rac pathways and regulate integrin-directed (haptotactic) migration in mast cells.
A unique atrial primary cardiac lymphoma mimicking myxoma presenting with embolic stroke: a case report
Authors: Quigley Michael M. , Schwartzman Eric , Boswell Pamela D. , Christensen Rebecca L. , Gleason Lisa A. , Sharpe Robert W. , d'Amato Thomas A.
Published: January 2003

An immunocompetent 29-year-old male presented with an embolic stroke from an unusual primary cardiac lymphoma. The cardiac lesion consisted of a polypoid, left atrial, mural fibrin thrombus with anaplastic tumor cells lining the surface of the clot. Histologic, immunophenotypic, and molecular characterizations were consistent with a diagnosis of CD30+ large B-cell lymphoma with anaplastic cytology. While tumor emboli from invasive primary cardiac lymphomas have been reported, this noninvasive fibrin thrombus–associated lymphoma appears to be unique and previously unreported.
The status of functional categories in child second language acquisition: evidence from the acquisition of CP
Authors: Haznedar Belma
Published: February 2003

This study examines the status of the functional categories in child second language (L2) acquisition of English. Results from longitudinally collected data are reported, presenting counterevidence for recent hypotheses on early L2 acquisition that assume (1) a structure-building approach according to which the acquisition of functional categories follows an implicational sequence of development of VP-IP-CP (Vainikka and Young-Scholten, 1994; 1996a; 1996b; 1998); and (2) a direct relationship between the acquisition of inflectional morphology and the development of functional categories (Eubank, 1993/94; 1996; Vainikka and Young-Scholten, 1994; 1996a; 1996b; 1998). The child L2 data analysed in this article show that the development of CP is not implicationally contingent on the prior acquisition of IP. The data also suggest that the lack of morphological forms in interlanguage grammars reflects a problem with the realization of surface morphology, rather than an impairment in the domain of functional projections.
Reconsidering ‘regional’ political ecologies: toward a political ecology of the rural American West
Authors: Walker Peter A.
Published: February 2003

Political ecology has recently seen a long-overdue movement toward studies of environmental conflicts in advanced capitalist societies, far from the rural African, Latin American, and Asian societies that constitute the great majority of studies in the field. This shift has raised questions about the commonalities and differences between ‘first-world’ and ‘third-world’ political ecologies - questions that present broader challenges and opportunities for the field. The question of commonalities and difference in ‘first-world’ and ‘third-world’ political ecologies is hemispheric, recent research in political ecology consists primarily of local-scale studies, leaving the field poorly positioned to address such broad-scale comparative questions. Appropriately, local political ecology studies challenge the stability of the ‘first world’ and ‘third world’ as meaningful geographic frames posed in these questions; but in dismantling these frames without suggesting alternatives for broader-scale analysis there is danger of moving political ecology toward even greater emphasis on specificity and difference and pushing consideration of broader-scale processes farther into the background. This is a serious challenge in a field already criticized for sprawling incoherence. This article argues that one response to these challenges is to reconsider the concept of ‘regional’ political ecologies. Regional approaches can retain the greatest strengths of recent political ecology in revealing the importance of local-scale social dynamics while situating these dynamics within broader scales of regional (and global) processes - providing greater coherence while avoiding such problematic frames as the ‘first’ and ‘third’ world. To illustrate, a brief case study and discussion are presented that consider a regional political ecology of the rural American West.
The place of locational analysis: a selective and interpretive history
Authors: Barnes Trevor J.
Published: February 2003

The paper has two purposes. The first is to provide a selective review of the history of locational analysis as it bears on economic geography. Three periods are examined: the German location school of von Thunen, Weber and L6sch that begins in the first part of the nineteenth century and ends in the middle of the twentieth century; American spatial science that starts in the mid-1950s and is in decline by the late 1970s; and the new economic geography associated with the economist Paul Krugman, and inaugurated by his 1991 book, Geography and trade. The second is to make a methodological argument. Locational analysis is most frequently justified in terms of the purity of its logical and mathematical reasoning, permitting some commentators to trace an unbroken line of progress over its 175-year history. I argue that such a claim is based upon acceptance of a broader philosophical position, rationalism - the belief that the foundation of knowledge is reason - which takes its most perfect form in logic and mathematics. Rationalism has been criticized in various ways ever since it first emerged in the Enlightenment, however, and the same critical sensibility informs this paper. Specifically, I criticize the rationalist interpretation of locational analysis by drawing upon a recent interdisciplinary body of literature arguing for the importance of local knowledge, the idea that knowledge, even abstract theoretical knowledge of the kind found in locational analysis, is shaped not by the universal but by the peculiar historical and geographical context of its production. This antirationalist argument in favour of local knowledge is exemplified by discussion of the three periods of locational analysis that form the paper's core.
Does workplace counselling work?
Authors: McLeod John , Henderson Max
Published: February 2003

There has been a rapid increase in compensation claims for work-related stress in recent years (Dyer, 2002). A Court of Appeal ruling last year (Sutherland v. Hatton, 2002) made it clear that employees who feel under stress at work should inform their employers and give them a chance to do something about it. Any employer who offers a confidential counselling service with access to treatment may have some protection from prosecution. In the face of a possible explosion in the provision of such services we need to ask – do they actually work? In 2001 the British Association for Counselling and Psychotherapy commissioned and published a report, Counselling in the Workplace: The Facts (McLeod, 2001), which described itself as ‘the most comprehensive possible review of all English language studies of counselling in the workplace’. The results appeared clear and unequivocal. After counselling, work-related symptoms returned to normal in more than half of all clients and sickness absence was reduced by over 25%. The report has received much publicity in the general medical press (Mayor, 2001). But just how reliable is the evidence? We asked Professor John McLeod, the author of the report, and Dr Max Henderson, Clinical Research Fellow in Occupational Psychiatry, to debate the issue: ‘Does workplace counselling work?’ The arguments will inform other debates into interventions that seem intrinsically to be a ‘good thing’ but that have not yet been subjected to rigorous investigation.
Ethnic variations in pathways to and use of specialist mental health services in the UK
Authors: Bhui Kamaldeep , Stansfeld Stephen , Hull Sally , Priebe Stefan , Mole Funke , Feder Gene
Published: February 2003

Background

Inequalities of service use across ethnic groups are important to policy makers, service providers and service users.

Aims

To identify ethnic variations in pathways to specialist mental health care, continuity of contact, voluntary and compulsory psychiatric in-patient admissions; to assess the methodological strength of the findings.

Method

A systematic review of all quantitative studies comparing use of mental health services by more than one ethnic group in the UK. Narrative analysis supplemented by meta-analysis, where appropriate.

Results

Most studies compared Black and White patients, finding higher rates of in-patient admission among Black patients. The pooled odds ratio for compulsory admission, Black patients compared with White patients, was 4.31 (95% CI 3.33–5.58). Black patients had more complex pathways to specialist care, with some evidence of ethnic variations in primary care assessments.

Conclusions

There is strong evidence of variation between ethnic groups for voluntary and compulsory admissions, and some evidence of variation in pathways to specialist care.
Migration as a risk factor for schizophrenia: A Danish population-based cohort study
Authors: Cantor-Graae Elizabeth , Pedersen Carsten Bøcker , Mcneil Thomas F. , Mortensen Preben Bo
Published: February 2003

Background

A growing body of evidence suggests that migration is a risk factor for the development of schizophrenia, although the putative mechanism remains obscure.

Aims

To examine immigrant background and history of foreign residence as risk factors for schizophrenia.

Method

Using data from the Danish Civil Registration System, we established a population-based cohort of 2.14 million persons resident in Denmark by their fifteenth birthday. Schizophrenia in cohort members and parental psychiatric disorder were identified by cross-linkage with the Danish Psychiatric Case Register.

Results

The relative risk of developing schizophrenia was 2.45 (95% CI 2.25–2.67) and 1.92 (95% CI 1.74–2.12) among first- and second-generation immigrants respectively, and 1.60 (95% CI 1.25–2.05) among Danes with a history of foreign residence.

Conclusions

Migration confers an increased risk for schizophrenia that is not solely attributable to selection factors and may also be independent of foreign birth.
Predicting engagement with services for psychosis: insight, symptoms and recovery style
Authors: Tait Lynda , Birchwood Max , Trower Peter
Published: February 2003

Background

Treatment non-adherence and service disengagement are commonly attributed to impaired insight. There is evidence that recovery style (i.e. psychological adjustment) may underlie service engagement.

Aims

We examined whether insight, psychotic symptoms or individuals' recovery style (‘integration’ v. ‘sealing-over’) predicts service engagement.

Method

Fifty patients with schizophrenia were assessed during acute psychosis and at 3-month and 6-month follow-ups. Measures included recovery style, psychosis symptoms, insight and service engagement.

Results

Sealing-over at 3 months following onset of an episode of psychosis predicted low service engagement at 6 months. Neither insight nor symptoms predicted engagement. The clear shift from integration to sealing-over within the first 3 months was independent of changes in symptoms or insight. Sealing-over between 3 and 6 months was associated with improvement in psychosis symptoms.

Conclusions

Recovery style contributed more to engagement than did insight, appears to be dynamic in the short term and is orthogonal to insight. Overall, this study demonstrated the importance of addressing psychological adjustment to psychosis as well as illness status when investigating treatment engagement in people with psychosis.
Impact of comorbid personality disorder on violence in psychosis
Authors: Moran Paul , Walsh Elizabeth , Tyrer Peter , Burns Tom , Creed Francis , Fahy Tom
Published: February 2003

Background

The impact of comorbid personality disorder on the occurrence of violence in psychosis has not been fully explored.

Aims

To examine the association between comorbid personality disorder and violence in community-dwelling patients with psychosis.

Method

A total of 670 patients with established psychotic illness were screened for comorbid personality disorder. Physical assault was measured from multiple data sources over the subsequent 2 years. Logistic regression was used to assess whether the presence of comorbid personality disorder predicted violence in the sample.

Results

A total of 186 patients (28%) were rated as having a comorbid personality disorder. Patients with comorbid personality disorder were significantly more likely to behave violently over the 2-year period of the trial (adjusted odds ratio = 1.71, 95% CI 1.05–2.79).

Conclusions

Comorbid personality disorder is independently associated with an increased risk of violent behaviour in psychosis.
Dialectical behaviour therapy for women with borderline personality disorder
Authors: Verheul Roel , Van Den Bosch Louise M. C. , Koeter Maarten W. J. , De Ridder Maria A. J. , Stijnen Theo , Van Den Brink Wim
Published: February 2003

Background

Dialectical behaviour therapy (DBT) is widely considered to be a promising treatment for borderline personality disorder (BPD). However, the evidence for its efficacy published thus far should be regarded as preliminary.

Aims

To compare the effectiveness of DBT with treatment as usual for patients with BPD and to examine the impact of baseline severity on effectiveness.

Method

Fifty-eight women with BPD were randomly assigned to either 12 months of DBT or usual treatment in a randomised controlled study. Participants were recruited through clinical referrals from both addiction treatment and psychiatric services. Outcome measures included treatment retention and the course of suicidal, self-mutilating and self-damaging impulsive behaviours.

Results

Dialectical behaviour therapy resulted in better retention rates and greater reductions of self-mutilating and self-damaging impulsive behaviours compared with usual treatment, especially among those with a history of frequent self-mutilation.

Conclusions

Dialectical behaviour therapy is superior to usual treatment in reducing high-risk behaviours in patients with BPD.
Mood stabilisers plus risperidone or placebo in the treatment of acute mania
Authors: Yatham Laksami N. , Grossman Fred , Augustyns Ilse , Vieta Eduard , Ravindran Arun
Published: February 2003

Background

Few double-blind trials have examined the efficacy of a combination of a mood stabiliser and an atypical antipsychotic in acute mania.

Aims

To determine the efficacy of risperidone in combination with a mood stabiliser in acute mania.

Method

Patients taking a mood stabiliser were randomised to 3 weeks' treatment with risperidone (n=75) or placebo (n=76).

Results

Young Mania Rating Scale (YMRS) scores improved rapidly with significantly greater reductions at week 1 in the risperidone group compared with the placebo group. At end-point YMRS scores decreased by 14.5 and 10.3 points in the risperidone and placebo groups, respectively. Significant improvements v. placebo (P < 0.05) were noted in the risperidone group on several other clinically meaningful measures. Additionally, a post hoc analysis excluding carbamazepine-treated patients (plasma concentrations of risperidone active moiety were 40% lower in this group) revealed significantly greater reductions (P=0.047) in YMRS scores in the risperidone group than in the placebo group. Incidence of adverse events was similar in both groups.

Conclusions

Risperidone is superior to placebo when used in combination with lithium or divalproex in acute mania.
Status of bipolar disorder research
Authors: Clement Sarah , Singh Swaran P. , Burns Tom
Published: February 2003

Background

Bibliometric research has used publication or funding databases to compare the amount of research activity on different illnesses. Only one study has examined bipolar disorder and schizophrenia in this way, and it was restricted to one database.

Aims

The primary aim is to compare levels of research activity in bipolar disorder and schizophrenia. Secondary aims are to examine how research activity on the disorders varies over time and across scientific fields.

Method

The numbers of publications, projects, journals and funding awards on bipolar disorder and schizophrenia were extracted from nine computer databases to compare research activity on the two conditions.

Results

Ratios (bipolar disorder: schizophrenia) ranged from 1:1.3 for the number of research funding awards to 1:7.6 for the number of clinical trials.

Conclusions

There is a relative dearth of research activity on bipolar disorder compared with schizophrenia.
Hospital doctors' management of psychological problems – Mayou & Smith revisited
Authors: Morgan John F. , Killoughery Maura
Published: February 2003

Background

In 1986 the British Journal of Psychiatry published a study of physicians' and surgeons' management of psychological problems, later cited as evidence of barriers limiting liaison psychiatry.

Aims

To repeat the study after 16 years of liaison psychiatry.

Method

Anonymous, confidential questionnaires were distributed to doctors at St George's Hospital, London, replicating the original study.

Results

Most of the 225 respondents believed that psychological factors could influence physical prognosis and should be routinely assessed, with greater sense of responsibility for overdoses and dying patients. Most respondents found emotional assessment impractical. Although 78% wanted more psychiatric input, referrals were avoided because of ‘stigmatisation’. Men were more likely than women to hold pejorative views, but outcomes no longer varied with seniority or speciality.

Conclusions

Compared with 1986, hospital doctors appear more aware of the psychological needs of patients.
Flashbacks and post-traumatic stress disorder: the genesis of a 20th-century diagnosis
Authors: Jones Edgar , Vermaas Robert Hodgins , Mccartney Helen , Beech Charlotte , Palmer Ian , Hyams Kenneth , Wessely Simon
Published: February 2003

Background

It has been argued that post-traumatic stress disorder (PTSD) is a timeless condition, which existed before it was codified in modern diagnostic classifications but was described by different names such as ‘railway spine’ and ‘shellshock’. Others have suggested that PTSD is a novel presentation that has resulted from a modern interaction between trauma and culture.

Aims

To test whether one core symptom of PTSD, the flashback, has altered in prevalence over time in soldiers subjected to the intense stress of combat.

Method

Random selections were made of UK servicemen who had fought in wars from 1854 onwards and who had been awarded war pensions for post-combat disorders. These were studied to evaluate the incidence of flashbacks in defined, at-risk populations.

Results

The incidence of flash backs was significantly greater in the most recent cohort, veterans of the 1991 Persian Gulf War; flashbacks were conspicuous by their absence in ex-servicemen from the Boer War and the First and Second World Wars.

Conclusions

Although this study raises questions about changing interpretations of post-traumatic illness, it supports the hypothesis that some of the characteristics of PTSD are culture-bound. Earlier conflicts showed a greater emphasis on somatic symptoms.
Influence of cohort effects on patterns of suicide in England and Wales, 1950–1999
Authors: Gunnell David , Middleton Nicos , Whitley Elise , Dorling Daniel , Frankel Stephen
Published: February 2003

Background

Age- and gender-specific suicide rates in England and Wales have changed considerably since 1950.

Aims

To assess whether cohort effects underlie some of these changes.

Method

Graphical displays to assess age–period–cohort effects on suicide for the period 1950–1999.

Results

Successive male birth cohorts born after 1940 carried with them, as they aged, a greater risk of suicide than their predecessors although this effect diminished for the 1975 and 1980 birth cohorts. There was less clear evidence of any increased risk of suicide in post-war female birth cohorts.

Conclusions

Succeeding generations of males born in the post-war years have experienced increasing rates of suicide at all ages, an observation in keeping with patterns seen in other countries. If these trends continue into middle- and old-age they will lead to a great increase in overall male suicide rates.
Crisis resolution/home treatment and in-patient care
Authors: Smyth Marcellino G.
Published: February 2003

With the development of crisis resolution/home treatment (CR/HT) teams according to the National Health Service (NHS) Plan and Policy Implementation Guidance (Department of Health, 2000), it is important to anticipate the issues involved in their collaboration with acute in-patient units. What are the implications for in-patient care (IC) of CR/HT availability? How can we realise the opportunities that full integration can offer towards an improved acute service?
The consultant psychiatrist – a remembrance of things past?
Authors: Timms Philip
Published: February 2003

The gilt seems to have rubbed off the gingerbread for the three members of our local community consultant group. We have senior lecturer contracts, have worked as consultants in inner London for 10 years and might be expected to be secure and content with our respective lots. Yet, we find ourselves increasingly uncomfortable with our place in the scheme of things.
In relative danger? The outcome of patients discharged by their nearest relative from sections 2 and 3 of the Mental Health Act
Authors: Shaw Philip , Hotopf Matthew , Davies Anthony
Published: February 2003

Aims and Method

Among the proposed changes in the current review of mental health legislation in England and Wales is the abolition of the right of the nearest relative to discharge patients from assessment and treatment orders (Sections 2 and 3 of the Mental Health Act 1983). We aimed to determine the clinical outcome of patients whose nearest relative applies for discharge. A retrospective case–control cohort study in a south London NHS Trust of 51 patients successfully discharged by their nearest relative and 33 patients whose nearest-relative applications were blocked by the treating psychiatrist on the grounds of ‘dangerousness'.

Results

Patients discharged from section by their nearest relative did not differ significantly from controls in all the measures of clinical outcome examined.

Clinical Implications

This study suggests that discharges by the nearest relative against psychiatric advice are not associated with a poor clinical outcome.
Workload implications of the proposed new Mental Health Act – an audit
Authors: Whyte Sean , Meux Clive
Published: February 2003

Aims and Method

To estimate specific time and resource implications for professionals, if proposed changes to the Mental Health Act 1983 (England & Wales) in the Government's white paper were to be implemented unchanged. An audit of time spent on current procedures was extrapolated.

Results

The amount of time required to comply with the Act will rise substantially (by 27% overall). Social workers and independent doctors will spend 30% and 207% more time respectively, complying with the Act, but psychiatrists providing clinical care to forensic patients should be largely unaffected.

Clinical Implications

If the Government presses ahead with its plans for mental health law reform as currently proposed, extra resources will be required to provide additional social work and independent medical time – or other services for patients will suffer.
Comparison of the assessment by doctors and nurses of deliberate self-harm
Authors: Weston Sian Nerys
Published: February 2003

Aims and Method

To compare the assessment by community psychiatric nurses and junior psychiatric doctors of individuals following deliberate self-harm (DSH) and, in particular, to elicit differences in referral practices and perceptions of mental illness. The health professionals involved completed questionnaires after carrying out DSH assessment.

Results

There was a significant difference in referral patterns between doctors and nurses after DSH assessment. Doctors were significantly more likely to refer individuals for psychiatric follow-up which involved direct contact with other doctors (51 of 72 (71%) compared with 60 of 175 (34%)). Doctors were also significantly more likely than nurses to perceive individuals as having a mental illness (57 of 72 (79%) compared with 86 of 175 (49%)).

Clinical Implications

Further research is warranted to establish the precise reasons for these differences, and to determine whether the widespread introduction of nurse-led services is an effective and efficient use of resources.