bluuebunny/crossref_metadata_2025 huggingface dataset:
Successful treatment of acquired haemophilia with prednisolone therapy
Authors: Ali R. , Özçelik T. , Özkalemkaş F. , Özkocaman V. , Ozan Ü. , Yalçin M. , Saricaoğlu H. , Tunali A.
Published: November 2003

Summary.  Acquired hemophilia is a rare, life threatening coagulopathy in adults caused by the development of autoantibodies against to factor VIII. No general consensus exists on the best therapeutic approach. We report here a case that presented with extensive cutaneous and mucosal bleedings due to factor VIII inhibitors and treated successfully with steroid therapy alone but complicated with a life threatening thromboembolic attack during her follow up. In conclusion, corticosteroids are “cost effective therapy” associated with high inhibitor elimination rates and although recurrence of inhibitor in a patient with factor VIII inhibitor is an expected clinical situation thrombosis risk should also be considered.
Chemical sensitization and regulation of TRAIL‐induced apoptosis in a panel of B‐lymphocytic leukaemia cell lines
Authors: Kang Jian , Kisenge Rodrick R. , Toyoda Hidemi , Tanaka Shigeki , Bu Jun , Azuma Eiichi , Komada Yoshihiro
Published: November 2003

Summary.  Tumour necrosis factor‐related apoptosis‐inducing ligand (TRAIL) effectively kills tumour cells but not normal cells. We investigated TRAIL sensitivity and the TRAIL‐induced apoptosis signalling pathway in a panel of B‐lymphocytic leukaemia cell lines. Depending upon TRAIL sensitivity, leukaemia cells could be divided into three groups: highly sensitive, moderately sensitive and resistant. TRAIL receptor‐2 (DR5) plays an important role in transducing apoptosis signals. DR5 was internalized into the cytoplasm where it recruited FAS‐associated death domain protein (FADD) under TRAIL stimulation in both sensitive and resistant cells. However, the active form of caspase‐8 was recruited to FADD and only sensitive cells showed increased caspase‐8 activity upon TRAIL stimulation. The caspase‐8 specific inhibitor, Z‐IETD, impaired caspase‐8 activation and completely abrogated TRAIL‐induced apoptosis. These results suggest that TRAIL resistance in B‐lymphocytic leukaemia cells is due to negative regulation at the level of caspase‐8 activation and that caspase‐8 activation is an indispensable process in TRAIL‐induced apoptosis. However, FADD‐like interleukin‐1 β‐converting enzyme inhibitory protein (c‐FLIPL) was similarly expressed and down‐regulated after TRAIL stimulation in both sensitive and resistant cells. Interestingly, in some cell lines, TRAIL sensitivity and caspase‐8 activity was enhanced or restored with the treatment of cycloheximide (CHX). In addition, X‐linked inhibitor of apoptosis (XIAP) levels decreased significantly and rapidly following treatment with CHX. Down‐regulation of XIAP may be responsible for enhancement or restoration of TRAIL sensitivity after CHX treatment in B‐lymphocytic leukaemia cells.
Endothelial microparticles released in thrombotic thrombocytopenic purpura express von Willebrand factor and markers of endothelial activation
Authors: Jimenez Joaquin J. , Jy Wenche , Mauro Lucia M. , Horstman Lawrence L. , Soderland Carl , Ahn Yeon S.
Published: November 2003

Summary.  It has been suggested that endothelial apoptosis is a primary lesion in the pathogenesis of thrombotic thrombocytopenic purpura (TTP). We tested this hypothesis by examining the phenotypic signatures of endothelial microparticles (EMP) in TTP patients. In addition, the effect of TTP plasma on microvascular endothelial cells (MVEC) in culture was further delineated. EMP released by endothelial cells (EC) express markers of the parent EC; EMP released in activation carry predominantly CD54 and CD62E, while those in apoptosis CD31 and CD105. We investigated EMP release in vitro and in TTP patients. Following incubation of MVEC with TTP plasma, EMP and EC were analysed by flow cytometry for the expression of CD31, CD51, CD54, CD62E, CD105, CD106 and von Willebrand factor (VWF) antigen. EMP were also analysed in 12 TTP patients. In both EC and EMP, CD62E and CD54 expression were increased 3‐ to 10‐fold and 8‐ to 10‐fold respectively. However, CD31 and CD105 were reduced 40–60% in EC but increased twofold in EMP. VWF expression was found in 55 ± 15% of CD62E+ EMP. Markers of apoptosis were negative. In TTP patients, CD62E+ and CD31+/CD42b− EMP were markedly elevated, and preceded and correlated well with a rise in platelet counts and a fall in lactate dehydrogenase. CD62E+ EMP (60 ± 20%) co‐expressed VWF and CD62E. The ratio of CD31+/42b− to CD62E+ EMP exhibited a pattern consistent with activation. In conclusion, our studies indicate endothelial activation in TTP. EMP that co‐express VWF and CD62E could play a role in the pathogenesis of TTP.
Double jeopardy: the link between child abuse and maternal depression in child and family social work
Authors: Sheppard Michael
Published: November 2003

The link between child care and mental health problems in social work clients has begun to attract some attention. Despite some review articles, research is, as yet, at a very early stage of development. Maternal depression and child care problems in particular appear likely to be closely associated. This paper focuses on the link between maternal depression and the most severe of child care problems: child abuse. The paper shows a significant relationship between maternal depression and child abuse. It explores this relationship by distinguishing three groups: families where no abuse had occurred (non abuse families), families where abuse had occurred but where the mother was not depressed (non depressed‐abuse group) and families where both child abuse and maternal depression were present (depressed‐abuse group). The depressed‐abuse group are shown to be considerably worse off than both the other groups for a range of measures, including indices of deprivation and range and severity of social problems. The depressed‐abuse group were also more chronic users of services and consumed far more resources than the other two groups. Remarkably, there were few differences between the non abuse group and the non depressed abuse group in nature and severity of problems and intervention. Depression in mothers, then, provides the major distinction between families where abuse was an issue compared with families where abuse was not present. Such families are characterized not simply by maternal depression and child abuse, but frequently by abuse of the mother herself, who is often socially isolated. These findings are of major importance for child care practice, indicating that working with the mother’s depression and the social conditions that provide its backdrop, are a major aspect of social work practice.
Increased IGF‐I : IGFBP‐3 ratio in patients with hepatocellular carcinoma
Authors: Mattera Daniele , Capuano Gaetano , Colao Annamaria , Pivonello Rosario , Manguso Francesco , Puzziello Alessandro , D’Agostino Luciano
Published: November 2003

background  The development of hepatocellular carcinoma in liver cirrhosis is associated with altered synthesis and secretion of several growth factors.

aim  The aim of this prospective study was to investigate the potential implication of IGF‐I and its major binding protein (IGFBP‐3) in the development of hepatocellular carcinoma.

patients and methods  IGF‐I and IGFBP‐3 were measured in 150 healthy subjects, 40 patients with liver cirrhosis and 63 with liver cirrhosis and untreated hepatocellular carcinoma. The ratio between IGF‐I and IGFBP‐3 was also calculated.

results  Serum IGF‐I (70 ± 10 and 65 ± 7 vs. 185 ± 6·4 µg/l, P < 0·001) and IGFBP‐3 levels (1225 ± 113 and 984 ± 67 vs. 3017 ± 80 µg/l, P < 0·001) were lower in patients with liver cirrhosis, without or with hepatocellular carcinoma, than in controls. Age was negatively correlated with IGF‐I levels in patients with liver cirrhosis (r = −0·6; P = 0·0002) as well as in controls (r = −0·8, P < 0·0001), but not in patients with hepatocellular carcinoma (r = −0·2; P = 0·2). Additionally, in patients with liver cirrhosis (r = −0·54; P = 0·0003) and more weakly in those with hepatocellular carcinoma (r =−0·24; P = 0·04) IGF‐I levels were negatively correlated with liver failure measured according with Child class. Despite patients with class C hepatocellular carcinoma being older than those in the same functional class with cirrhosis (64 ± 2 vs. 57 ± 2 years, P < 0·01), they had a significantly increased IGF‐I : IGFBP‐3 ratio (0·18 ± 0·05 vs. 0·41 ± 0·09, P = 0·04), due mostly to increased IGF‐I levels (27·1 ± 5·6 vs. 42 ± 6·2 µg/l) as IGFBP‐3 levels were similar to patients with cirrhosis (734 ± 81 vs. 679 ± 83 µg/l).

conclusions  Hepatocellular carcinoma is associated with a higher IGF‐I : IGFBP‐3 ratio than that found in patients with liver cirrhosis and a similar degree of liver failure.
Vasoactive intestinal peptide (VIP): a new neuroendocrine marker of clinical progression in chronic heart failure?
Authors: Lucia Piernatale , Caiola Stefania , Coppola Alessandro , Manetti Luca L. , Maroccia Ettore , Buongiorno Angela M. , De Martinis Carlo
Published: November 2003

objective  Vasoactive intestinal peptide (VIP) is a powerful vasodilatory neuropeptide with positive inotropic and chronotropic properties. The aim of the study was to investigate the pathophysiological role of VIP in heart failure.

design and results  VIP was assayed in plasma within the first in‐hospital day in 52 patients with heart failure due to dilated cardiomyopathy. The concentration of VIP was: (i) higher in patients than in healthy subjects; (ii) higher in elderly but not in younger patients compared with healthy controls; (iii) inversely related to NYHA class: higher in NYHA 2 than in NYHA > 2 patients and in normal subjects, in both young and elderly groups; (iv) not correlated with echocardiographic parameters and (v) not influenced by the aetiology of dilated cardiomyopathy.

conclusions  The physiological properties of VIP suggest that the increased plasma concentrations in patients with heart failure contribute to restore the compromised haemodynamic balance either by improving myocardial performance or by counteracting the harmful effects related to simultaneous activation of other neuroendocrine systems, i.e. the sympathetic and renin‐angiotensin systems. Decreased VIP concentrations are related to progressive worsening of heart failure. The higher VIP concentrations in elderly patients compared with healthy controls suggest that the capacity to increase VIP production is preserved in older people.
The androgen receptor gene CAG polymorphism is associated with the severity of coronary artery disease in men
Authors: Alevizaki M. , Cimponeriu A. T. , Garofallaki M. , Sarika H.‐L. , Alevizaki C. C. , Papamichael C. , Philippou G. , Anastasiou E. A. , Lekakis J. P. , Mavrikakis M.
Published: November 2003

objective  The role of androgens in the pathogenesis of coronary artery disease (CAD) remains controversial. The length of the polyglutamine stretch of the transactivation domain (CAG repeat) of the androgen receptor (AR) inversely affects androgen activity. The aim of this study was to investigate the effect of this polymorphism of the AR gene in the extent of CAD in male patients.

design and patients  The relationship of the length of the AR gene CAG repeat on the severity of CAD was examined in 131 men (36–86 years old) undergoing coronary angiography.

measurements  The severity of CAD was assessed by the number (0–3) of coronary vessels with > 50% reduction in the luminal diameter. The interaction of the AR gene polymorphism with the intima media thickness (IMT) of peripheral arteries and serum levels of sex steroids, insulin and biochemical parameters were also studied.

results  The upper quartile of CAG length (range 9–30) was ≥ 23 repeats (longAR). The mean body mass index (BMI) of patients with shorter repeats (< 23; shortAR) was significantly lower than in men with longAR (26·1 vs. 27·6, respectively; P = 0·043 M‐W Rank test). There was no correlation between the AR gene repeat length and serum testosterone. Oestradiol levels were significantly higher in longAR (0·19 ± 0·08 nmol/l vs. 0·14 ± 0·07 in shortAR, P = 0·031). This difference was independent of BMI. Men with shortAR had significant CAD (i.e. one to three arteries with stenosis) more frequently (79·5%) than men with longAR (20·5%); of the subjects with stenosis in no arteries, 56·5% had shortAR and 43·5% longAR (χ2 = 4·3, P = 0·038). This association was independent of age and BMI. The IMT of peripheral arteries, lipid parameters, basal insulin resistance, blood pressure and family history for early CAD, did not differ according to AR length.

conclusions  The shorter CAG repeat of the AR gene is associated with more severe CAD, which suggests a role for the sensitivity to androgens in the increased frequency of CAD in males. In addition, a protective role of endogenous oestrogen, which is higher in the longAR subgroup, can contribute to the observed difference.
Prolonged psychological stress suppresses cortisol secretion
Authors: Žarković Miloš , Stefanova Elka , Ćirić Jasmina , Penezić Zorana , Kostić Vladimir , Šumarac‐Dumanović Mirjana , Macut Djuro , Ivović Miomira S. , Gligorović Predrag V.
Published: November 2003

objective  Response to acute psychological stress is characterized by activation of the hypothalamic–pituitary–adrenal (HPA) axis and the sympathetic nervous system. However, response to the prolonged psychological stress is less well known.

design  This study was designed as a prospective assessment of cortisol secretion during prolonged psychological stress induced by continuous air raids and after elimination of the stress‐inducing factor.

subjects  The study group consisted of five healthy subjects (34–39 years).

measurements  Psychological and endocrine (morning cortisol and 1 µg ACTH test) testing was done 2 months after the war had begun and 18 months after the end of it. Psychiatric assessment was done at the same periods, and 30 months after the start of the study.

results  After 2·5 years of follow‐up, there were no signs of endocrine or psychiatric disorders in any of the subjects. After the war, Beck Inventory of Depression and Hamilton Anxiety Rating Scale scores were significantly reduced. Suppression of the HPA axis was present during the war but not after.

conclusions  Prolonged psychological stress is associated with a transient suppression of the HPA axis, manifested by low morning cortisol and reduced cortisol response to ACTH. The reduction of cortisol response is sufficient to cause false diagnosis of HPA insufficiency.
Comparative analysis of mt LSU rRNA secondary structures of Odonates: structural variability and phylogenetic signal
Authors: Misof B. , Fleck G.
Published: November 2003

Secondary structures of the most conserved part of the mt 16S rRNA gene, domains IV and V, have been recently analysed in a comparative study. However, full secondary structures of the mt LSU rRNA molecule are published for only a few insect species. The present study presents full secondary structures of domains I, II, IV and V of Odonates and one representative of mayflies, Ephemera sp. The reconstructions are based on a comparative approach and minimal consensus structures derived from sequence alignments. The inferred structures exhibit remarkable similarities to the published Drosophila melanogaster model, which increases confidence in these structures. Structural variance within Odonates is homoplastic, and neighbour‐joining trees based on tree edit distances do not correspond to any of the phylogenetically expected patterns. However, despite homoplastic quantitative structural variation, many similarities between Odonates and Ephemera sp. suggest promising character sets for higher order insect systematics that merit further investigations.
In vitro expression and pharmacology of the 5‐HT7‐like receptor present in the mosquito Aedes aegypti tracheolar cells and hindgut‐associated nerves
Authors: Lee D.‐W. , Pietrantonio P. V.
Published: November 2003

We have previously reported the cloning of a 5‐hydroxytryptamine receptor (Aedes 5‐HT7‐like receptor) from adult Aedes aegypti. For functional expression of the Aedes 5‐HT7‐like receptor, CHO‐K1 cells were stably transfected with a receptor expression construct, pC5‐HT7. The Aedes 5‐HT7‐like receptor positively coupled to Gs protein, increasing intracellular cAMP in response to 5‐HT; adenylyl cyclase activity was induced in a concentration‐dependent, saturable manner. Only 5‐HT, and not octopamine, dopamine or tyramine, caused the induction of cAMP. At 10 nm 5‐HT a weak synergism was observed between octopamine and 5‐HT. Other known agonists of the mammalian 5‐HT7 receptor were tested. Their order of potency was: 5‐HT >> 5‐CT = 8‐OH‐DPAT >> pimozide. This is the first report on the functional expression of a mosquito neurohormone receptor.
Sexual dimorphic expression of putative antennal carrier protein genes in the malaria vector Anopheles gambiae
Authors: Justice R. W. , Dimitratos S. , Walter M. F. , Woods D. F. , Biessmann H.
Published: November 2003

To obtain a better understanding of the olfactory processes that allow mosquitoes to identify human hosts, a molecular study has been performed to identify and characterize molecules in the olfactory signalling pathway of the African malaria vector Anopheles gambiae. Using cDNA libraries from antennae of females and males, a collection of cDNAs encoding odorant binding proteins and other novel antennal proteins were isolated and characterized, which represent various families of putative carrier proteins with homologues in other insects. Using filter array hybridizations and quantitative RT PCR, regulation and gender specificity of expression of these genes was investigated. Significant differences in steady‐state levels of some of these putative carrier protein genes were detected between the sexes and after blood feeding in females.
Modulation of Na+ transport across isolated rumen epithelium by short‐chain fatty acids in hay‐ and concentrate‐fed sheep
Authors: Uppal S. K. , Wolf K. , Khahra S. S. , Martens H.
Published: November 2003

The effect of increasing concentrations of short‐chain fatty acids [SCFA; mixture of the Na+ salts of acetic acid (62.5%), propionic acid (25.0%) and of butyric acid (12.5%)] on Na+ transport of sheep rumen epithelium was studied in vitro. The conventional Ussing chamber method was used for measuring Na+ transport rates (22Na+), short‐circuit current (Isc) and tissue conductance (GT) of isolated rumen epithelium. SCFA in the buffer solution on the mucosal side caused a linear increase of Jnet Na+ from 1.14, to 1.22, 1.78 and 2.50 μeq/cm2/h in hay‐fed sheep at 0, 15, 40 and 80 mmol/l SCFA, respectively. In a second study, the effect of higher SCFA concentrations [0 (control), 80, 100 and 120 mmol/l] was investigated with epithelia from two groups of sheep. One group was subjected to hay ad libitum, whereas the other received concentrate feed (800 g/day in equal portions at 7.00 am and 3.00 pm) and hay ad libitum. Epithelia from concentrate‐fed sheep again showed a significant (p < 0.05) and linear increase in Jnet Na+ at 80, 100 and 120 mmol/l. However, in hay‐fed sheep, the difference in increase among 80, 100 and 120 mmol/l SCFA was not significant, indicating that, above 80 mmol/l SCFA Jms and Jnet exhibit saturation. Moreover, Na+ fluxes (Jms and Jnet) were generally higher in concentrate‐fed than in hay‐fed sheep at all SCFA concentrations and significant differences were observed at 100 and 120 mmol/l SCFA. The obtained results confirm the effect of SCFA on Na+ transport and are in agreement with studies regarding feeding regimes and electrolyte transport in the rumen. The important new observation is the increase of Na+ transport in concentrate‐fed sheep even at high concentrations of SCFA (100 and 120 mmol/l). The enhanced activity of the Na+/H+ exchanger at these SCFA concentrations supports the assumption that the capacity for regulating the intracellular pH by extrusion of protons is increased, suggesting an adaptation in concentrate‐fed sheep. This adaptation could prevent possible disturbances of epithelial functions (transport and barrier) under conditions of increased SCFA absorption.
Subacute Ruminal Acidosis (SARA): a Review
Authors: Kleen J. L. , Hooijer G. A. , Rehage J. , Noordhuizen J. P. T. M.
Published: November 2003

Subacute ruminal acidosis (SARA) is likely to arise when an easily palatable, high‐energy diet meets a ruminal environment not adapted to this type of substrate. Increase of short‐chained fatty acids (SCFA) will occur. Eventually, this may result in a transient nadir of ruminal pH below 5.5. Two situations are likely to represent the risk of SARA. First, fresh lactating cows are confronted with a diet considerably differing from that in the dry‐period. A diet change carried out too rapidly or without proper transition management will put the animals at risk. Secondly, further in lactation, inaccurate calculation of dry‐matter‐intake (DMI) leading to wrong roughage/concentrate ratio, an inadequate content of structure within the diet or mistakes in preparing of total mixed rations may produce SARA. The consequences of SARA are diverse and complex. Laminitis is regularly connected to SARA and the negative impact of organic acids on the ruminal wall may lead to parakeratosis enabling translocation of pathogens into the bloodstream provoking inflammation and abscessation throughout the ruminant body. Moreover, milk‐fat depression (MFD) can be related to SARA. In order to achieve a proper diagnosis, SARA has to be understood as a herd‐management problem. A screening of the herd for SARA by means of a rumenocentesis, performed on a sample‐group, preferably 12 individuals, may reveal the presence of SARA. The herd screening should include the risk group suspected, preferably. The prevention of SARA applies to the principles of ruminant feeding. Careful transition management from the dry to the lactation period and control of fibre‐content and ration quality should be more yielding than the use of buffers or antibiotic drugs.
Herpes simplex esophagitis from 1307 autopsy cases
Authors: ITOH TOHRU , TAKAHASHI TAKASHI , KUSAKA KAZUYA , KAWAURA KEN , NAKAGAWA YOSHIAKI , YAMAKAWA JUN’ICHI , KANDA TSUGIYASU
Published: November 2003

Background and Aims:  The aim of the present study was to clarify relationship between macroscopic and microscopic features of herpes simplex esophagitis (HSE), and localization of herpes simplex virus type 1 (HSV‐1)‐infected cells in esophageal lesions from autopsy cases of histopathologically proven HSE.

Methods:  The study comprised morphological, immunohistochemical, cultural and electron microscopic investigations for 24 HSE patients collected from 1307 serial autopsy cases in the past 10 years.

Results:  Macroscopic characteristics of HSE were divided into three types. Types I and II showed small punched‐out lesions with and without raised margins, respectively. Type III revealed that multiple ulcers became confluent like a map. Microscopic findings showed that the HSV infection process seemed to begin in squamous epithelium and to induce vertical cellular change into the intact epithelial layer. Intranuclear inclusion bodies were observed at the centers of lesions, and ballooning changes of squamous cells at the margins. Both localization of HSV‐1‐infected cells and presence of HSV‐1 in the esophageal lesions were confirmed with immunohistochemical staining, viral culture and electron microscopy.

Conclusion:  The present results suggest that the macroscopic and microscopic postmortem features of HSE may provide useful information for clinical diagnosis of HSE.
Geographical difference in antimicrobial resistance pattern of Helicobacter pylori clinical isolates from Indian patients: Multicentric study
Authors: THYAGARAJAN SP , RAY PALLAB , DAS BIMAL KUMAR , AYYAGARI ARCHANA , KHAN ALEEM AHMED , DHARMALINGAM S , RAO USHA ANAND , RAJASAMBANDAM P , RAMATHILAGAM B , BHASIN DEEPAK , SHARMA MP , NAIK SR , HABIBULLAH CM
Published: November 2003

Aim:  To assess the pattern of antimicrobial resistance of Helicobacter pylori isolates from peptic ulcer disease patients of Chandigarh, Delhi, Lucknow, Hyderabad and Chennai in India, and to recommend an updated anti‐H. pylori treatment regimen to be used in these areas.

Methods:  Two hundred and fifty‐nine H. pylori isolates from patients with peptic ulcer disease reporting for clinical management to the Post Graduate Institute of Medical Education and Research, Chandigarh; All India Institute of Medical Sciences, New Delhi; Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow; Deccan College of Medical Sciences and Allied Hospitals, Hyderabad; and hospitals in Chennai in collaboration with the Dr ALM Post Graduate Institute of Basic Medical Sciences were analyzed for their levels of antibiotic susceptibility to metronidazole, clarithromycin, amoxycillin, ciprofloxacin and tetracycline. The Epsilometer test (E‐test), a quantitative disc diffusion antibiotic susceptibility testing method, was adopted in all the centers. The pattern of single and multiple resistance at the respective centers and at the national level were analyzed.

Results:  Overall H. pylori resistance rate was 77.9% to metronidazole, 44.7% to clarithromycin and 32.8% to amoxycillin. Multiple resistance was seen in 112/259 isolates (43.2%) and these were two/three and four drug resistance pattern to metronidazole, clarithromycin, amoxycillin observed (13.2, 32 and 2.56%, respectively). Metronidazole resistance was high in Lucknow, Chennai and Hyderabad (68, 88.2 and 100%, respectively) and moderate in Delhi (37.5%) and Chandigarh (38.2%). Ciprofloxacin and tetracycline resistance was the least, ranging from 1.0 to 4%.

Conclusion:  In the Indian population, the prevalence of resistance of H. pylori is very high to metronidazole, moderate to clarithromycin and amoxycillin and low to ciprofloxacin and tetracycline. The rate of resistance was higher in southern India than in northern India. The E‐test emerges as a reliable quantitative antibiotic susceptibility test. A change in antibiotic policy to provide scope for rotation of antibiotics in the treatment of H. pylori in India is a public health emergency.
Valuing the past: The importance of an understanding of the history of psychiatry for healthcare professionals, service users and carers
Authors: Ion Robin M. , Beer M. Dominic
Published: November 2003

ABSTRACT:  Drawing primarily on examples from the UK, this paper argues that an under­standing of the history of psychiatry can be of practical use to clinicians, service users and carers. It can provide a window on the present and an explanation of some aspects of current practice. In addition, a study of the past can provide a vision of how things might be done differently in the present and in the future. Moreover, knowledge of the past can also serve to remind us of psychiatry's potential for misuse and the dangers inherent in a view of the world in which psychiatry is simply seen as a benevolent science destined to find an answer to mental illness.
Implementing research findings into mental health nursing practice: Exploring the clinical research fellowship approach
Authors: Happell Brenda , Johnston Linda , Hill Christine
Published: November 2003

ABSTRACT:  The lack of research utilization within nursing practice has been extensively discussed in the literature. The Clinical Research Fellowship (CRF) program was developed to assist nurses to change practice on the basis of high‐quality research evidence. This paper presents the results of a qualitative study examining the experiences of four CRF participants and three of their unit managers in completing the program and implementing changes within the clinical setting. The major themes to emerge from the data were: experience of the program, outcomes, implementation, assistance from the Centre for Psychiatric Nursing Research and Practice, Victoria, Australia, benefits and drawbacks to the program and whether it would be recommended to others. The findings indicate a positive view of the program itself although problems with the implementation stage were clearly evident. Further support following completion of the program is required to achieve maximum benefit from the program.
Microstructures and adiabatic shear bands formed by ballistic impact in steels and tungsten alloy
Authors: DUAN Z. Q. , LI S. X. , HUANG D. W.
Published: November 2003

Projectiles of sintered tungsten alloy were fired directly at two kinds of steel target plates. The microstructures near the perforation of a medium, 0.45% carbon steel target plate can be identified along the radial direction as: melted and rapidly solidified layer, recrystallized fine‐grained layer, deformed fine‐grained layer, deformed layer and normal matrix. The adiabatic shear bands cannot be found in this intermediate strength steel. The microstructures along the radial direction of perforation of 30CrMnMo steel target plate are different from that of the medium carbon steel. There was a melted and rapidly solidified layer on the surface of the perforation, underneath there was a diffusing layer, and then fine‐grained layer appeared as streamlines. Several kinds of adiabatic shear bands were found in this higher strength steel; they had different directions and widths, which were relative to the shock waves, as well as the complex deformation process of penetration. The deformation of the projectiles was rather different when they impacted on target plates of medium carbon steel and 30CrMnMo steel. The projectile that impacted on the medium carbon steel target plate was tamped and its energy dissipated slowly, while that which impacted on the 30CrMnMo steel target plate was sheared and the energy dissipated quickly.
An effective method of stress intensity factor calculation for cracks emanating from a triangular or square hole under biaxial loads
Authors: YAN X.
Published: November 2003

This paper is concerned with stress intensity factors for cracks emanating from a triangular or square hole under biaxial loads by means of a new boundary element method. The boundary element method consists of the constant displacement discontinuity element presented by Crouch and Starfied and the crack‐tip displacement discontinuity elements proposed by the author. In the boundary element implementation, the left or the right crack‐tip displacement discontinuity element is placed locally at the corresponding left or right crack tip on top of the constant displacement discontinuity elements that cover the entire crack surface and the other boundaries. The method is called a Hybrid Displacement Discontinuity Method (HDDM). Numerical examples are included to show that the method is very efficient and accurate for calculating stress intensity factors for plane elastic crack problems. In addition, the present numerical results can reveal the effect of the biaxial loads on stress intensity factors.
Eliciting whole‐family interaction with a standardized clinical interview
Authors: Kinston Warren , Loader Peter
Published: November 2003

This paper describes the origin and objectives of a method of research interviewing of the whole family, provides details of the protocol and the way it is administered, and evaluates its usefulness. The method aims to elicit family interaction in a standardized fashion using principles derived from clinical interviewing. The most difficult task is training of the interviewer; he requires both the sensitivity and skill of the expert clinician and the discipline and rigour of the careful researcher. Adherence to the principles of interviewing should be monitored appropriately during research projects. The implications of the basic approach underlying the method has led to further developments in training and research interviewing.
Women be Healthy: Evaluation of a Women's Health Curriculum for Women with Intellectual Disabilities
Authors: Lunsky Yona , Straiko Amy , Armstrong Sharon
Published: November 2003

Background  Insufficient attention has been paid towards treating the unique health needs of women with intellectual disabilities. This paper describes an 8‐week curriculum, ‘Women Be Healthy’, developed for women with intellectual disabilities to help them become more equal partners in their health care. The curriculum includes psycho‐education, coping skills training, exposure to the medical setting and assertiveness training.

Materials and methods  Twenty‐two women completed assessments of health knowledge, health behaviour beliefs and coping strategies, prior to and following participation in the 8‐week curriculum, which took place in a group setting at a clinic for people with intellectual disabilities.

Results  Women showed significant improvements in health knowledge, health behaviour beliefs and coping strategies following intervention, and maintained some of these treatment gains (health knowledge and health behaviour beliefs) at a 10‐week follow‐up.

Conclusions  ‘Women Be Healthy’ is an example of a group‐based intervention that helps women with intellectual disabilities become more knowledgeable and perhaps more comfortable with health‐care procedures.
Expression of Pax258 in the gastropod statocyst: insights into the antiquity of metazoan geosensory organs
Authors: O'brien Elizabeth K. , Degnan Bernard M.
Published: November 2003

Most animals have sensory systems that allow them to balance and orient relative to the pull of gravity. Structures responsible for these functions range from very simple statocysts found in many aquatic invertebrates to the complex inner ear of mammals. Previous studies suggest that the specialized mechanosensory structures responsible for balance in vertebrates and insects may be homologous based on the requirement and expression of group II Pax genes (i.e., Pax‐2/5/8 genes). Here we report the expression of a Pax‐258 gene in the statocysts and other chemosensory and mechanosensory cells during the development of the gastropod mollusk Haliotis asinina, a member of the Lophotrochozoa. Based on the phylogenetic distribution of geo‐sensory systems and the consistent expression of Pax‐258 in the cells that form these systems, we propose that Pax‐258, along with POU‐III and ‐IV genes, has an ancient and conserved role in the formation of structures responsible for balance and geotaxis in eumetazoans.
Diagnosis‐Related Group–Adjusted Hospital Costs Are Higher in Older Medical Patients with Lower Functional Status
Authors: Chuang Kenneth H. , Covinsky Kenneth E. , Sands Laura P. , Fortinsky Richard H. , Palmer Robert M. , Landefeld C. Seth
Published: November 2003

Objectives: To determine whether hospital costs are higher in patients with lower functional status at admission, defined as dependence in one or more activities of daily living (ADLs), after adjustment for Medicare Diagnosis‐Related Group (DRG) payments.

Design: Prospective study.

Setting: General medical service at a teaching hospital.

Participants: One thousand six hundred twelve patients aged 70 and older.

Measurements: The hospital cost of care for each patient was determined using a cost management information system, which allocates all hospital costs to individual patients.

Results: Hospital costs were higher in patients dependent in ADLs on admission than in patients independent in ADLs on admission ($5,300 vs $4,060, P<.01). Mean hospital costs remained higher in ADL‐dependent patients than in ADL‐independent patients in an analysis that adjusted for DRG weight ($5,240 vs $4,140, P<.01), and in multivariate analyses adjusting for age, race, sex, Charlson comorbidity score, acute physiology and chronic health evaluation score, and admission from a nursing home as well as for DRG weight ($5,200 vs $4,220, P<.01). This difference represents a 23% (95% confidence interval=15–32%) higher cost to take care of older dependent patients.

Conclusion: Hospital cost is higher in patients with worse ADL function, even after adjusting for DRG payments. If this finding is true in other hospitals, DRG‐based payments provide hospitals a financial incentive to avoid patients dependent in ADLs and disadvantage hospitals with more patients dependent in ADLs.
Age and Features of Movement Influence Motor Overflow
Authors: Bodwell Julie A. , Mahurin Roderick K. , Waddle Sally , Price Robert , Cramer Steven C.
Published: November 2003

Objectives: To measure the magnitude and prevalence of motor overflow to the arm at rest during attempted unilateral arm movements.

Design: Cross‐sectional assessment.

Setting: Motor physiology laboratory.

Participants: Healthy young (n=20) and elderly (n=20) adult subjects.

Measurements: Surface electromyography (EMG) was obtained from bilateral forearm muscles during performance of 12 different unilateral finger‐tapping tasks.

Results: For all subjects, faster movement rate (F=2.56–3.30, P<.05), cognitive distraction (F=4.09, P<.05), and fatigue (F=15.15, P<.001) were each associated with a significant increase in the magnitude of EMG in the arm intended to be at rest. In elderly subjects, tapping at maximum rate and fatigue were each associated with a further increase in motor overflow across the midline. In addition, better left hand dexterity correlated with greater motor overflow to the right hand during rapid left hand tapping (r=0.63, P<.005). Prevalence of motor overflow was also higher in older subjects for some tasks, for example during 1 Hz tapping by the right index finger (motor overflow present in 45%, vs 15% young subjects, P<.05).

Conclusion: Several behavioral variables increase motor overflow across the midline in young and elderly adults. Motor overflow was even greater in elderly subjects with the most demanding tasks and was greater in those with better motor status, suggesting that this form of motor system change is a compensatory event of normal aging rather than age‐related dysfunction. The results support the hypotheses that healthy aging is associated with an increase in the degree to which brain function is bilaterally organized.
Alternative Therapy Use by Elderly African Americans Attending a Community Clinic
Authors: Sternberg Shelley A. , Chandran Anjana , Sikka Monica
Published: November 2003

Objectives: To describe the use of orally ingested alternative therapies (OAT) by a community‐dwelling, primarily African‐American sample of elders.

Design: Face‐to‐face survey.

Setting: University‐affiliated geriatric medicine primary care clinic.

Participants: One hundred two elderly OAT users and 100 nonusers who had an appointment between June and August 2000.

Measurements: Demographic characteristics, OAT products used, reasons for use, and influencing factors leading to use.

Results: Two hundred ninety‐two subjects were screened: 102 (35%) OAT users, 100 (34%) nonusers, and 90 (31%) who refused to participate. The OAT users were 78% female and 67% African American, with a mean age±standard deviation of 79.7±6.2. They were a frail group, with an average of 5.2±2.3 medical conditions, 4.5±2.3 medications, and 52% with at least one impairment in activities of daily living. Nonusers had more documented medical conditions and medications and a lower median household income. The most popular OAT products were multivitamins (65%), vitamin E (42%), and calcium (31%). Ninety‐seven percent of users reported concurrent OAT and prescription medication use. The patients took OATs to supplement their diet (23%) and stay well (15%), as well as for various medical conditions. Influencing factors for OAT use were media advertisements (37%), physicians' advice (36%), and immediate family members (19%). Sixty percent of elders discussed their OAT use with their physicians

Conclusion: Community‐dwelling, primarily African‐American, elders are using OATs despite physical frailty and limited financial resources. OAT users are healthier and wealthier than nonusers. More subjects used concurrent OAT and prescription medications and discussed their use with their physicians than would be expected from the literature. A large national survey of OAT use by minority elders could explore these findings.
Template boundary definition in mammalian telomerase
Authors: Chen Jiunn-Liang , Greider Carol W.
Published: November 2003

Telomerase uses a short template sequence in its intrinsic RNA component to synthesize telomere repeats. Disruption of the helix P1b in human telomerase RNA or alteration of its distance from the template resulted in telomerase copyingresidues past the normal template boundary both in vivo and in vitro. Therefore, helix P1b is important for template boundary definition in human telomerase. Mouse telomerase RNA lacks helix P1b, and the boundary is established at 2 nt downstream of the 5′-end. The divergent structure of boundary definition elements in mammals, yeast, and ciliates suggests diverse mechanisms for template boundary definition in telomerase.
Regulation of Polycomb group complexes by the sequence-specific DNA binding proteins Zeste and GAGA
Authors: Mulholland Niveen M. , King Ian F.G. , Kingston Robert E.
Published: November 2003

Repression and activation of the expression of homeotic genes are maintained by proteins encoded by the Polycomb group (PcG) and trithorax group (trxG) genes. Complexes formed by these proteins are targeted by PcG or trxG response elements (PREs/TREs), which share binding sites for several of the same factors. GAGA factor and Zeste bind specifically to PREs/TREs and have been shown to act as both activators and repressors. We have used purified proteins and complexes reconstituted from recombinant subunits to characterize the effects of GAGA and Zeste proteins on PcG function using a defined in vitro system. Zeste directly associates withthe PRC1 core complex (PCC) and enhances the inhibitory activity of this complex on all templates, with a preference for templates withZeste binding sites. GAGA does not stably associate with PCC, but nucleosomal templates bound by GAGA are more efficiently bound and more efficiently inhibited by PCC. Thus Zeste and GAGA factor use distinct means to increase repression mediated by PRC1.
Greenhouse emission reduction and sustainable development
Authors: Sathiendrakumar R.
Published: November 2003

Society has to find ways and means to reduce the emission of greenhouse gases, mainly carbon dioxide, to prevent global warming when considering inter‐generational equity with respect to environmental quality. The aim of the carbon dioxide emission control is to keep the level of carbon dioxide below a certain threshold level. This paper deals with the various policy instruments that are available to control greenhouse gases such as carbon dioxide. The criteria that should be used in selecting the appropriate policy instruments in controlling carbon dioxide emissions are: efficiency, equity and flexibility. Based on these criteria, the author is of the view that in the short‐run it is important for all the countries to ratify the Kyoto Protocol. However, in the long‐run, it may be possible to use the Kyoto targets to achieve an international carbon dioxide emission tradable permit system.
Markets, Institutions and Technology: Missing Links in Livelihoods Analysis
Authors: Dorward Andrew , Poole Nigel , Morrison Jamie , Kydd Jonathan , Urey Ian
Published: November 2003

The benefits of livelihoods thinking and approaches are widely recognised. This article focuses on an important gap in much of the conceptualization and application of ‘livelihood approaches’— a lack of emphasis on markets and their roles in livelihood development and poverty reduction. The omission is important, as it can lead to failure to identify and act on a wider range of market, institutional and technological opportunities and constraints. An alternative conceptualisation is proposed, with markets as one particular set of institutional mechanisms for co‐ordination and exchange in an economy. It is argued that more explicit attention to interactions between institutions, technology and assets in livelihood analysis may be valuable in conceptualising and managing programmes for livelihood development and poverty reduction.
Quality Design: A Planning Methodology for the Integration of Refugee and Local Health Services, West Nile, Uganda
Authors: Burnham Gilbert M. , Rowley Elizabeth A. , Ovberedjo Martins O.
Published: November 2003

In an emergency, the international community responds to the immediate health needs of refugees through the establishment of action‐oriented, life‐saving services. Healthcare delivery is often managed with limited, if any, coordination with local health management structures. In situations where refugees remain in the host country for many years, sustainability issues inevitably arise. Refugee‐hosting governments may ultimately be called upon to assume the management and funding of refugee services. Planning for service integration, while protecting against declines in service quality, is a challenge in the typically resource‐poor host environments. This paper discusses these issues by presenting the experience of the West Nile districts in northern Uganda, and describes quality design as a relevant planning methodology. Quality design is a systematic planning approach that documents and directly incorporates the service users' self‐defined expectations and needs.
Humanitarian Information Systems and Emergencies in the Greater Horn of Africa: Logical Components and Logical Linkages
Authors: Maxwell Daniel , Watkins Ben
Published: November 2003

Natural and man‐made emergencies are regular occurrences in the Greater Horn of Africa region. The underlying impoverishment of whole populations is increasing, making it more difficult to distinguish between humanitarian crises triggered by shocks and those resulting from chronic poverty. Shocks and hazards can no longer be seen as one‐off events that trigger a one‐time response. In countries that are both poor and exposed to frequent episodes of debilitating drought or chronic conflict, information needs tend to be different from the straightforward early warning/commodity accounting models of information systems that have proven reliable in past emergencies. This paper describes the interdependent components of a humanitarian information system appropriate for this kind of complex environment, noting the analytical links between the components and operational links to programme and policy. By examining a series of case studies from the Greater Horn region, the paper demonstrates that systems lacking one or more of these components will fail to provide adequate information — and thus incur humanitarian costs. While information always comes with a cost, the price of poor information — or none — is higher. And in situations of chronic vulnerability, in which development interventions are likely to be interspersed with both safety nets and emergency interventions on a recurrent basis, investment in improved information is a good investment from both a humanitarian and a financial viewpoint.
Moving Mountains: Community and Resistance in the Isle of Harris, Scotland, and Cape Breton, Canada
Authors: Mackenzie A Fiona D , Dalby Simon
Published: November 2003

Drawing on poststructuralist political ecology, the narratives of two struggles about siting a superquarry are examined to elucidate the complex articulations of community, nature, resistance and identity in play in public debates. Focusing on the discursive formulations of the quarry in the expert language, as well as in the arguments of both local proponents and opponents of the quarries, shows the importance of ontological categories in “environmental” siting disputes. In Harris, these themes rearticulate the histories of dispossession, crofting and religion, as well as complex layers of geographical identity in the various claims to community. In Cape Breton, the rethinking of aboriginal Mi'kmaq identity was stimulated by revived interest in the religious traditions linked to the sacred site near the proposed quarry. In light of these findings, the complexity and active rearticulation of local “community” as political resistance are emphasised and the difficulties of thinking about sustainability highlighted.