bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk of developing schizophrenia among Japanese high‐risk offspring of affected parent: outcome of a twenty‐four‐year follow up
Authors: Nishida Atsushi , Sasaki Tsukasa , Harada Seiichi , Fukuda Masato , Masui Kanji , Nishimura Yukika , Ikebuchi Emi , Okazaki Yuji
Published: December 2008

Aims:  Prospective follow‐up studies of high‐risk children may help clarify the etiological factors in schizophrenia. While studies from North America, Europe and Israel have estimated the risk of schizophrenia at 7–16% in the offspring of an affected parent, no data have been reported for Asian populations.

Method:  We started a follow up of the offspring of Japanese schizophrenia patients in 1978. We investigated the estimated risk of schizophrenia in 51 high‐risk offspring at the 24‐year follow up. The effects of the parents' status, including history of psychiatric hospitalization and social functioning, on the risk in the offspring were also investigated.

Results:  The cumulative incidence of schizophrenia was 13.7 % and the lifetime prevalence was estimated to be 13.5 ± 4.8%. The association between the psychiatric hospitalization in the probands and the risk of schizophrenia in the offspring was not significant, and the Global Assessment of Functioning score was significantly lower in the probands with a history of psychiatric hospitalization than in those without such a history.

Conclusions:  The risk of developing schizophrenia in Japanese high‐risk offspring might be comparable with the Western results. The present study suggests that the severity of the disease or the level of social functioning may not significantly affect the risk in Japanese offspring.
Four cases of venous thromboembolism associated with olanzapine
Authors: Maly Radovan , Masopust Jiri , Hosak Ladislav , Urban Ales
Published: December 2008

Aims:  Psychiatric disorders and treatment with conventional antipsychotic medications have been associated with venous thromboembolism, but only a few data on recent antipsychotics such as olanzapine are available.

Methods:  We describe four subjects treated with olanzapine who developed venous thromboembolism, and were hospitalized at the University Hospital in Hradec Kralove during the period 2004–2006.

Results:  We found a combination of several clinical and laboratory risk factors in our patients.

Conclusions:  A cohort study or case–control studies are needed to better elucidate the possible role of olanzapine in etiopathogenesis of venous thromboembolism.
D2 receptor‐mediated inhibition of dopamine release in the rat striatum in vitro is modulated by CB1 receptors: studies using fast cyclic voltammetry
Authors: O’Neill Carmel , Evers‐Donnelly Alex , Nicholson David , O’Boyle Kathy M. , O’Connor John J.
Published: December 2008

Cannabinoid CB1 receptors are highly expressed in the striatum where they are known to be co‐localized with dopamine D2 receptors. There is now strong evidence that cannabinoids modulate dopamine release in the brain. Using fast cyclic voltammetry, single pulse stimulation (0.1 ms; 10 V) was applied every 5 min and peak dopamine release was measured with a carbon fibre microelectrode. Application of the D2 receptor agonist, quinpirole, inhibited single pulse dopamine overflow in a concentration‐dependent manner (IC50: 3.25 × 10−8 M). The CB1 receptor agonist WIN55212‐2 (WIN; 1 μM) had no effect on single pulse dopamine release (93.9 ± 6.6% at 60 min, n = 5) but attenuated the inhibitory effect of quinpirole (30 nM; quinpirole 39.0 ± 4.2% vs. quinpirole + WIN, 48.2 ± 3.7%, n = 5, p < 0.05). This affect was antagonized by the CB1 receptor anatgonist [N‐(Piperidin‐1‐yl)‐5‐(4‐iodophenyl)‐1‐(2,4‐dichlorophenyl)‐4‐methyl‐1H‐pyrazole‐3‐carboxamide] (AM‐251, 1 μM). Dopamine release evoked by four pulses delivered at 1 Hz (4P1Hz) and 10 pulses delivered at 5 Hz (10P5Hz) was significantly inhibited by WIN [72.3 ± 7.9% control (peak 4 to 1 ratio measurement) and 66.9 ± 3.8% control (area under the curve measurement), respectively, p < 0.05; n = 6 for both]. Prior perfusion of WIN significantly attenuated the effects of quinpirole on multiple pulse‐evoked dopamine release (4P1Hz: quinpirole, 28.4 ± 4.8% vs. WIN + quinpirole, 52.3 ± 1.2%; 10P5Hz: quinpirole, 29.5 ± 1.3% vs. WIN + quinpirole, 59.4 ±7.1%; p < 0.05 for both; n = 6). These effects were also antagonized by AM‐251 (1 μM). This is the first report demonstrating a functional, antagonistic interaction between CB1 receptors and D2 autoreceptors in regulating rat striatal dopamine release.
Leptin reverses long‐term potentiation at hippocampal CA1 synapses
Authors: Moult Peter R. , Milojkovic Bogdan , Harvey Jenni
Published: December 2008

The hormone leptin crosses the blood brain barrier and regulates numerous neuronal functions, including hippocampal synaptic plasticity. Here we show that application of leptin resulted in the reversal of long‐term potentiation (LTP) at hippocampal CA1 synapses. The ability of leptin to depotentiate CA1 synapses was concentration‐dependent and it displayed a distinct temporal profile. Leptin‐induced depotentiation was not associated with any change in the paired pulse facilitation ratio or the coefficient of variance, indicating a post‐synaptic locus of expression. Moreover, the synaptic activation of NMDA receptors was required for leptin‐induced depotentiation as the effects of leptin were blocked by the competitive NMDA receptor antagonist, D‐aminophosphovaleric acid (D‐AP5). The signaling mechanisms underlying leptin‐induced depotentiation involved activation of the calcium/calmodulin‐dependent protein phosphatase, calcineurin, but were independent of c‐jun NH2 terminal kinase. Furthermore, leptin‐induced depotentiation was accompanied by a reduction in α‐amino‐3‐hydroxy‐5‐methylisoxazole‐4‐propionate (AMPA) receptor rectification indicating that loss of glutamate receptor 2 (GluR2)‐lacking AMPA receptors underlies this process. These data indicate that leptin reverses hippocampal LTP via a process involving calcineurin‐dependent internalization of GluR2‐lacking AMPA receptors which further highlights the key role for this hormone in regulating hippocampal synaptic plasticity and neuronal development.
Falls in somatic and dementia wards at Community Care Units
Authors: Fonad Edit , Emami Azita , Wahlin Tarja‐Brita Robins , Winblad Bengt , Sandmark Helene
Published: December 2008

Introduction:  Falls and fall injuries are common problems for patients at nursing homes in Sweden. Impaired cognitive function, a poor sense of orientation and a high intake of medicine, can lead to an increase in falls among older people.

Aim:  The objective of this study was to investigate the associations between falls and: fall risks, fractures, the use of physical restraints and the use of certain medications in somatic and dementia wards, respectively.

Method:  The study design is ecological, and aggregated data regarding falls, fall risk assessments, fractures, the use of physical restraints and medication were collected between 2000 and 2003. The Pearson correlation analysis and regression analyses were used to investigate associations between fall risks, medication, fractures, wheelchair‐bound situations, bed rails and falls.

Results:  The total number of reported fall incidents was 2651; of these, 737 incidents were registered in dementia wards and 1914 in somatic wards. Dementia wards and somatic wards differed regarding falls and fractures, as it was only in dementia wards that falls were associated with fractures. There was also a significant correlation between falls and assessed risk of falling, the use of certain medication, and physical restraints such as wheelchairs and bed rails in dementia wards. Falls at somatic wards were associated with the use of sleeping pills with benzodiazepines.

Conclusion:  For dementia wards there were associations between falls and fractures, physical restraints and the use of certain medications. Fractures were associated with the use of neuroleptics, sleeping pills and sleeping pills with benzodiazepines. At somatic wards, falls correlated with the use of sleeping pills with benzodiazepines, and with the use of wheelchairs and bed rails.
ANTIMONATE OPAQUE GLAZE COLOURS FROM THE FAIENCE MANUFACTURE OF LE BOIS D’ÉPENSE (19TH CENTURY, NORTHEASTERN FRANCE)*
Authors: MAGGETTI M. , NEURURER CH. , ROSEN J.
Published: December 2008

Three types of antimony‐based, opaque ceramic colours were used in the faience workshop of Le Bois d’Épense during the first decades of the 19th century; that is, yellow, tawny and green. Yellow is generated by lead antimonate crystals (Naples Yellow), which are incorporated into an uncoloured glass matrix. According to SEM–EDS measurements, these pigments contain iron. The tawny colour is the optical result of the combined presence of similar yellow, iron‐bearing lead antimonate particles in a Fe‐rich, brownish glass matrix. The green opaque colour is produced by the combination of a blue cobalt glass and yellow Pb–Sn–Fe‐antimonate crystals. Cores of zoned pigments lighten the recipes, according to which the pigments were produced. First, they were synthesized by calcination, ground and then mixed with a colourless, brown or blue glass powder. The resulting powder mixture was added to a liquid agent and used as high‐temperature ceramic colour.
Social agency and networked spatial relations in sustainable agriculture
Authors: Trauger A
Published: December 2008

Agriculture in the USA is in social and economic crisis, but sustainable agriculture is gaining unprecedented popularity among producers and consumers. This article examines the agency articulated by farmers and activists in the sustainable agriculture community in Pennsylvania to exploit ruptures in the conventional food system and develop new forms of food provisioning in local economies. Actor‐network theory offers roads out of structure/agency dialectics and proposes new possibilities for understanding structure as a network, and agency as the outcome of networking. The research shows agency to be an outcome of collectivities, but is also contingent on leadership, partially distributed throughout the network and not necessarily emancipatory for all enrolled actors.
Outcomes of Percutaneous Mechanical Thrombectomy of Arteriovenous Fistulas in Hemodialysis Patients
Authors: Jain Gaurav , Maya Ivan D. , Allon Michael
Published: December 2008

Thrombosis of arteriovenous fistulas is usually superimposed on underlying stenosis in the arterial anastomosis, draining vein, or central vein. Restoring the patency of thrombosed fistulas requires mechanical thrombectomy, in conjunction with angioplasty of the underlying lesion. We evaluated the success rate of percutaneous thrombectomy of fistulas at our medical center. We retrospectively queried a prospective, computerized vascular access database to identify 41 patients with thrombosed fistulas treated percutaneously. Technical success was defined as the ability to use the fistula for at least one dialysis session. Primary patency was defined as time to the next intervention, and secondary failure as the time to permanent fistula failure. Of the 41 thrombosed fistulas, 21 were in the forearm and 20 in the upper arm. Percutaneous thrombectomy was technically successful in 31 of 41 patients (76%). The technical success rate was similar for upper arm and forearm fistulas (85% vs. 66%, p = 0.43). An underlying stenotic lesion was present at the arterial anastomosis in 13 patients (31%), in the draining vein in 37 (90%), and in the central vein in 3 patients (7%). Twelve patients (29%) had concurrent stenoses at two locations. At 6 months, the primary patency was 20%, and the secondary patency was 54%. In conclusion, percutaneous treatment of thrombosed fistulas can restore fistula patency about three‐fourths of patients. However, the primary fistula patency is fairly short‐lived, and the fistulas require repeated interventions to achieve long‐term survival.
Seizure Disorders: The Changes With Age
Authors: Hauser W. Allen
Published: December 2008

Summary: Age has a profound influence on our approach to the convulsive disorders. Age is a variable which is an important determinant for risk factors for epilepsy. Age, as a surrogate of brain maturation, is a determinant of the specific characteristics of the seizure disorder in those with epilepsy, and age‐related changes in these manifestations can be identified. Age is a determinant for the occurrence of acute symptomatic seizures in several types of metabolic or central nervous system insults. Age is a determinant for prognosis, whether one considers remission, medication withdrawal in those entering remission, relapse following prolonged remission, or mortality. Last, age per se seems to be a risk factor for epilepsy independent of other factors. This seems particularly true for partial seizures.
Status Epilepticus in Children, Adults, and the Elderly
Authors: DeLorenzo Robert J. , Towne Alan R. , Pellock John M. , Ko Daijin
Published: December 2008

Summary: Status epilepticus (SE) is a major neurological and medical emergency associated with a high morbidity and mortality. Retrospective and prospective studies from the Medical College of Virginia Epilepsy Research Center have been utilized to investigate several clinical and epidemiological factors associated with SE. Univariate and multivariate logistic regression analysis of predictive indicators in patients with SE indicated that seizure duration, certain specific etiologies, and age were predictors of mortality. Sex, race, and certain other etiologies were not found to be factors that significantly affect mortality. These findings demonstrate that specific indicators are important in predicting mortality in SE. Preliminary prospective epidemiological data from Richmond, Virginia suggested that more than 250,000 cases of SE may occur annually in the United States with a mortality greater than 55,000 individuals. Studies comparing community and university hospitals in Richmond indicate that the mortality and clinical variables associated with SE in these two hospital populations are essentially identical. Further investigations employing prospective population‐based studies are essential in evaluating the epidemiology and mortality of SE.
Pregnancy and the Risk of Teratogenicity
Authors: Lindhout Dick , Omtzigt J. G. C.
Published: December 2008

Summary:One in every 250 newborns is exposed to antiepileptic drugs (AEDs) in utero. Various studies have attributed a teratogenic effect to these AEDs, mainly consisting of major malformations, minor anomalies, intrauterine or postnatal growth failure, and psychomotor retardation. Prospective studies confirm the increased risk of major malformations. The absolute risk of 7–10% is about 3–5% higher than that in the general population. Barbiturates and phe‐nytoin (PHT) are particularly associated with congenital heart malformations, facial clefts, and some other malformations. Valproate (VPA) and carbamazepine (CBZ) are associated predominantly with spina bifida aperta (1–2 and 0.5–1.0% risk, respectively) and hypospadias. Bilateral radial aplasia is a rare but specific effect of VPA. Several studies identified additional risk factors, i.e., high daily AED dosage, high maternal serum AED concentrations, low folate levels, or po‐lytherapy [phenobarbital (PB) plus primidone (PRM) plus PHT or CBZ plus VPA plus PB with or without PHT]. The few prospective studies controlled for socioeconomic factors or that considered parental findings indicate that risk of specific cognitive defects rather than risk of overall mental retardation may be increased, that early growth retardation is followed by a catch‐up growth to normal, and that ocular hypertelorism and nail hypoplasia are the only minor anomalies causally related to PHT exposure. However, no final conclusions can be made. Genetic predisposition to the teratogenic side effects of AEDs plays a role, codetermining the recurrence risk if the woman has previously given birth to a child with a major malformation. The molecular genetic basis of this predisposition is unclear. No tests are yet available for identifying parents or fetuses at particularly high risk. Prevention of teratogenic AED side effects is possible by critical evaluation, before pregnancy, of the woman's need for AED therapy. If AED therapy cannot be avoided, it should be monotherapy with the lowest possible dosage. High peak levels should be avoided by dividing the daily dosage into at least two or three doses. The efficacy of folate supplementation alone in reducing teratogenic risks is unclear. In cases of obvious folate deficiency, treatment is required, but concomitant vitamin B12deficiency should first be excluded or treated. Prenatal diagnosis should be offered. It may consist of fetal ultrasound examination during Week 18–20, and of afetoprotein analysis of amniotic fluid obtained during Week 16 if the mother is receiving VPA or CBZ. This should be discussed with the parents before the pregnancy. The choice of medication is made not only by balancing the therapeutic advantages and teratogenic risks of each AED or AED combination but also by considering the parental attitudes toward prenatal diagnosis and termination of pregnancy.
Ethanol Exposure Impairs LPS‐Induced Pulmonary LIX Expression: Alveolar Epithelial Cell Dysfunction as a Consequence of Acute Intoxication
Authors: Walker Jr James E. , Odden Anthony R. , Jeyaseelan Samithamby , Zhang Ping , Bagby Gregory J. , Nelson Steve , Happel Kyle I.
Published: December 2008

Background:  Alcohol intoxication impairs innate immune responses to bacterial pneumonia, including neutrophil influx. Lipopolysaccharide (LPS)‐induced chemokine (LIX or CXCL5) is a recently described chemokine produced by type‐II alveolar epithelial (AE2) cells which facilitates neutrophil recruitment. The effect of acute alcohol intoxication on AE2 cell expression of LIX is unknown.

Methods:  C57BL/6 mice were given an intraperitoneal (i.p.) injection of ethanol (4 g/kg) or saline 30 minutes prior to intratracheal (i.t.) injection with 10 μg Escherichia coli LPS. In vitro stimulation of primary AE2 cells or murine AE2 cell line MLE‐12 was performed with LPS and tumor necrosis factor‐alpha (TNF‐α).

Results:  LIX protein is readily detectable in the lung but not in plasma following LPS administration, demonstrating “compartmentalization” of this chemokine during pulmonary challenge. In contrast to the CXC chemokines keratinocyte‐derived chemokine and macrophage inflammatory protein‐2, which are abundantly expressed in both lung tissue and alveolar macrophages, LIX expression is largely confined to the lung parenchyma. Compared to controls, intoxicated animals show a decrease in LIX and neutrophil number in bronchoalveolar lavage fluid following LPS challenge. Ethanol inhibits LIX at the transcriptional level. In vitro studies show that LPS and TNF‐α are synergistic in inducing LIX by either primary AE2 or MLE‐12 cells. Acute ethanol exposure potently and dose‐dependently inhibits LIX expression by AE2 cells. Activation of nuclear factor‐κB is critical to LIX expression in MLE‐12 cells, and acute ethanol treatment interferes with early activation of this pathway as evidenced by impairing phosphorylation of p65 (RelA). Inhibition of p38 mitogen‐activated protein kinase signaling, but not ERK1/2 activity, in MLE‐12 cells by acute alcohol is likely an important cause of decreased LIX expression during challenge.

Conclusions:  These data demonstrate direct suppression of AE2 cell innate immune function by ethanol and add to our understanding of the mechanisms by which acute intoxication impairs the lung’s response to microbial challenge.
OPRM1 Asn40Asp Predicts Response to Naltrexone Treatment: A Haplotype‐Based Approach
Authors: Oroszi Gabor , Anton Raymond F. , O’Malley Stephanie , Swift Robert , Pettinati Helen , Couper David , Yuan Qiaoping , Goldman David
Published: December 2008

Background:  Individualized pharmacotherapy requires identification of genetic variants predictive of treatment response. In OPRM1, Asn40Asp has been reported to be predictive of response to naltrexone treatment. Nevertheless, the in vitro function of the polymorphism remains elusive and over 300 OPRM1 sequence variants have been identified to date. Therefore we used a haplotype‐based approach to capture information of other genetic variants that might predict treatment response to naltrexone in the COMBINE Study.

Methods:  5′ nuclease genotyping assays (TaqMan®) were applied for 10 SNPs. Five‐locus haplotypes in 2 OPRM1 haplotype blocks were assigned to Caucasian participants. The relationship of the haplotypes to medication reflected by “good clinical outcome” was analyzed in 306 Caucasians treated without Combined Behavioral Intervention and with either naltrexone or placebo.

Results:  A significant haplotype by medication interaction (p = 0.03) was found in OPRM1 block 1. Naltrexone‐treated alcoholics with haplotype AGCCC, the single haplotype carrying the Asp40 allele had the highest percent of good clinical outcome. When interaction of genotypes at each of the 5 loci comprising block 1 with medication was examined, only the Asn40/Asp40 and Asp40/Asp40 genotypes were found to significantly interact with naltrexone treatment. No haplotype by medication interaction was documented in OPRM1 block 2.

Conclusions:  Our haplotype‐based approach confirms that the single OPRM1 locus predictive of response to naltrexone treatment is Asn40Asp in exon 1. A substantial contribution of any other OPRM1 genetic variant to interindividual variations in response to naltrexone treatment (at least in terms of good clinical outcome) is not supported by our findings.
Low Bone Mineral Density and Impaired Bone Metabolism in Young Alcoholic Patients Without Liver Cirrhosis: A Cross‐Sectional Study
Authors: Malik Peter , Gasser Rudolf W , Kemmler Georg , Moncayo Roy , Finkenstedt Gerd , Kurz Martin , Fleischhacker W. Wolfgang
Published: December 2008

Background:  Osteoporosis is regularly mentioned as a consequence of alcoholism. Ethanol′s direct effect on bone‐modeling cells as well as alcoholism‐related “life‐style factors” such as malnutrition, lack of exercise, hormonal changes, and liver cirrhosis are discussed as potential causative factors.

Methods:  In a cross‐sectional study, we have examined 57 noncirrhotic alcoholic patients (37 male, 20 female) aged 27 to 50 years. Patients suffering from comorbid somatic diseases and with co‐medication known to have an influence on bone mineral density (e.g., glucocorticoids, heparin, anticonvulsant agents, oral contraceptives) were excluded. We determined bone mineral density (BMD) by dual x‐ray absorptiometry (DXA) in the lumbar spine (L1–L4) and the proximal right femur (femoral neck, total hip) as well as parameters of bone metabolism.

Results:  In males but not females, BMD was significantly reduced in the lumbar region, as well as in the proximal femur (femoral neck, total hip). Nine male patients (24.3% of men) and 1 female patient (5% of women) had low BMD (defined as Z‐score ≤ −2.0). As expected, there was a positive correlation between body mass index (BMI) and BMD. Alcohol‐related factors (e.g., duration of abuse, consumed amount of alcohol per day) as well as smoking were not associated with a significant effect on BMD. All of the 20 women examined showed elevated estradiol levels, which may have served as a protective factor. In this study, 75.7% of the men and 90% of the women had vitamin D insufficiency or deficiency (plasma levels of 25‐hydroxy‐vitamin D < 30 ng/ml).

Conclusions:  Our study indicates that younger alcoholic patients without other diseases may suffer from an increased risk to develop low BMD and a disturbance of vitamin D metabolism. Nutritional factors or less exposure to sunlight may play an important role in bone loss in young alcoholic patients. BMD measurement and assessment of bone metabolism should be considered in all patients with chronic alcoholism.
Central and Peripheral Timing Variability in Children With Heavy Prenatal Alcohol Exposure
Authors: Simmons Roger W. , Levy Susan S. , Riley Edward P. , Madra Naju M. , Mattson Sarah N.
Published: December 2008

Background:  The study examined whether prenatal alcohol exposure is associated with increased motor timing variability when the timing response is partitioned into central clock variability, which indexes information processing at the central nervous system (CNS) level and motor delay variability, which reflects timing processes at the level of the peripheral nervous system.

Methods:  Eighteen children with histories of prenatal alcohol exposure and 22 control children were assigned to young (7 to 11 years) or older (12 to 17 years) groups. Children tapped a single response key with the index finger in synchrony with a series of externally generated tones (the paced phase). At the conclusion of these tones, children continued tapping (the continuation phase) while attempting to maintain the same rate of tapping imposed by the paced phase. Two blocks of tapping were completed with inter‐tone‐intervals set at either 400 or 900 milliseconds. Inter‐response interval, central clock variability, and motor delay variability produced during the continuation phase were the dependent variables.

Results:  Mean inter‐response interval for the 4 groups did not differ for either time interval. Central clock variability produced by the young alcohol‐exposed group was significantly greater than the two older groups for the 400 millisecond interval and all other groups for the 900 millisecond interval. Motor delay variability produced by the young alcohol‐exposed group was significantly greater than the other three groups for both time intervals. Central and motor delay variability in children with and without alcohol exposure was directly related to the duration of the interval to be reproduced.

Conclusions:  Central and peripheral timing variability was significantly greater for the young alcohol‐exposed children. This atypical timing may be related to the teratogenic effects of alcohol, although the negative effects are limited to younger alcohol‐exposed children since there were no differences in central and peripheral timing variability between the older alcohol‐exposed children and controls.
Area‐Level Poverty Is Associated with Greater Risk of Ambulatory–Care–Sensitive Hospitalizations in Older Breast Cancer Survivors
Authors: Schootman Mario , Jeffe Donna B. , Lian Min , Deshpande Anjali D. , Gillanders William E. , Aft Rebecca , Sumner Walton
Published: December 2008

OBJECTIVES: To estimate the frequency of ambulatory care–sensitive hospitalizations (ACSHs) and to compare the risk of ACSH in breast cancer survivors living in high‐poverty with that of those in low‐poverty areas.

DESIGN: Prospective, multilevel study.

SETTING: National, population‐based 1991 to 1999 National Cancer Institute Surveillance, Epidemiology, and End Results Program data linked with Medicare claims data throughout the United States.

PARTICIPANTS: Breast cancer survivors aged 66 and older.

MEASUREMENTS: ACSH was classified according to diagnosis at hospitalization. The percentage of the population living below the U.S. federal poverty line was calculated at the census‐tract level. Potential confounders included demographic characteristics, comorbidity, tumor and treatment factors, and availability of medical care.

RESULTS: Of 47,643 women, 13.3% had at least one ACSH. Women who lived in high‐poverty census tracts (≥30% poverty rate) were 1.5 times (95% confidence interval (CI)=1.34–1.72) as likely to have at least one ACSH after diagnosis as women who lived in low‐poverty census tracts (<10% poverty rate). After adjusting for most confounders, results remained unchanged. After adjustment for comorbidity, the hazard ratio (HR) was reduced to 1.34 (95% CI=1.18–1.52), but adjusting for all variables did not further reduce the risk of ACSH associated with poverty rate beyond adjustment for comorbidity (HR=1.37, 95% CI=1.19–1.58).

CONCLUSION: Elderly breast cancer survivors who lived in high‐poverty census tracts may be at increased risk of reduced posttreatment follow‐up care, preventive care, or symptom management as a result of not having adequate, timely, and high‐quality ambulatory primary care as suggested by ACSH.
Effect of Computerized Provider Order Entry with Clinical Decision Support on Adverse Drug Events in the Long‐Term Care Setting
Authors: Gurwitz Jerry H. , Field Terry S. , Rochon Paula , Judge James , Harrold Leslie R. , Bell Chaim M. , Lee Monica , White Kathleen , LaPrino Jane , Erramuspe‐Mainard Janet , DeFlorio Martin , Gavendo Linda , Baril Joann L. , Reed George , Bates David W.
Published: December 2008

OBJECTIVES: To evaluate the efficacy of computerized provider order entry with clinical decision support for preventing adverse drug events in long‐term care.

DESIGN: Cluster‐randomized controlled trial.

SETTING: Two large long‐term care facilities.

PATIENTS: One thousand one hundred eighteen long‐term care residents of 29 resident care units.

INTERVENTION: The 29 resident care units, each with computerized provider order entry, were randomized to having a clinical decision support system (intervention units) or not (control units).

MEASUREMENTS: The number of adverse drug events, severity of events, and whether the events were preventable.

RESULTS: Within intervention units, 411 adverse drug events occurred over 3,803 resident‐months of observation time; 152 (37.0%) were deemed preventable. Within control units, there were 340 adverse drug events over 3,257 resident‐months of observation time; 126 (37.1%) were characterized as preventable. There were 10.8 adverse drug events per 100 resident‐months and 4.0 preventable events per 100 resident‐months on intervention units. There were 10.4 adverse drug events per 100 resident‐months and 3.9 preventable events per 100 resident‐months on control units. Comparing intervention and control units, the adjusted rate ratios were 1.06 (95% confidence interval (CI)=0.92–1.23) for all adverse drug events and 1.02 (95% CI=0.81–1.30) for preventable adverse drug events.

CONCLUSION: Computerized provider order entry with decision support did not reduce the adverse drug event rate or preventable adverse drug event rate in the long‐term care setting. Alert burden, limited scope of the alerts, and a need to more fully integrate clinical and laboratory information may have affected efficacy.
Recruitment and Retention of Older Adults in Aging Research
Authors: Mody Lona , Miller Douglas K. , McGloin Joanne M. , Freeman Marcie , Marcantonio Edward R. , Magaziner Jay , Studenski Stephanie
Published: December 2008

Older adults continue to be underrepresented in clinical research despite their burgeoning population in the United States and worldwide. Physicians often propose treatment plans for older adults based on data from studies involving primarily younger, more‐functional, healthier participants. Major barriers to recruitment of older adults in aging research relate to their substantial health problems, social and cultural barriers, and potentially impaired capacity to provide informed consent. Institutionalized older adults offer another layer of complexity that requires cooperation from the institutions to participate in research activities. This paper provides study recruitment and retention techniques and strategies to address concerns and overcome barriers to older adult participation in clinical research. Key approaches include early in‐depth planning; minimizing exclusion criteria; securing cooperation from all interested parties; using advisory boards, timely screening, identification, and approach of eligible patients; carefully reviewing the benefit:risk ratio to be sure it is appropriate; and employing strategies to ensure successful retention across the continuum of care. Targeting specific strategies to the condition, site, and population of interest and anticipating potential problems and promptly employing predeveloped contingency plans are keys to effective recruitment and retention.
The Effect of Transitioning to Medicare Part D Drug Coverage in Seniors Dually Eligible for Medicare and Medicaid
Authors: Shrank William H. , Patrick Amanda R. , Pedan Alex , Polinski Jennifer M. , Varasteh Laleh , Levin Raisa , Liu Nan , Schneeweiss Sebastian
Published: December 2008

OBJECTIVES: To evaluate medication use, out‐of‐pocket spending, and medication switching during the transition period for patients dually eligible for Medicaid and Medicare (dual eligibles).

DESIGN: Time‐trend analysis, using segmented linear regression.

SETTING: Patient‐level pharmacy dispensing data from January 2005 to December 2006 from a large pharmacy chain with stores in 34 states.

PARTICIPANTS: Dual eligibles aged 65 and older.

MEASUREMENTS: Changes in utilization, patient copayments, and medication switching were analyzed using interrupted time trend analyses. Utilization and spending were evaluated for five study drugs: clopidogrel, proton pump inhibitors (PPIs), warfarin, and statins (essential drugs covered by Part D plans) and benzodiazepines (not covered through Part D but potentially covered through Medicaid).

RESULTS: Drug use for 13,032 dual eligibles was evaluated. There was no significant effect of the transition to Medicare Part D on use of all study drugs, including the uncovered benzodiazepines. Cumulative reductions were seen in copayments for all covered drugs after implementation of Part D, ranging from 25% annually for PPIs to 53% for warfarin, but there was a larger increase in copayments, 91% annually, for benzodiazepines after the transition. The rate of switching medications was 3.0 times as great for the PPIs after implementation of Part D than before implementation, but there was no significant change in the other study drug classes.

CONCLUSION: These findings in a single, large pharmacy chain indicate that the transition plan for dual eligibles led to less medication discontinuation and switching than many had expected. The substantially greater cost sharing for benzodiazepines highlights the importance of implementing a thoughtful transition plan when executing such a national policy.
Setting the Stage for a New Strategic Plan for Geriatrics and Extended Care in the Veterans Health Administration: Summary of the 2008 VA State of the Art Conference, “The Changing Faces of Geriatrics and Extended Care: Meeting the Needs of Veterans in the Next Decade”
Authors: Shay Kenneth , Burris James F. ,   for the State of the Art Planning Committee
Published: December 2008

The Department of Veterans Affairs (VA) assumed an early leadership role in focusing on care of elderly adults. In 1998, the Federal Advisory Committee on the Future of VA Long‐Term Care, appointed by the VA Undersecretary for Health, recommended redirection of VA's extended care programs toward noninstitutional forms. A decade later, VA's Office of Geriatrics and Extended Care (GEC) initiated a strategic planning process by convening experts in geriatrics and health care, policy, and finance in Virginia on March 25 to 27, 2008, to present to VA clinicians and clinical managers the “State of the Art” of VA GEC.

Recurring clinical themes included rising numbers and complexity of aging veterans, recent addition of younger veterans to VA's extended care mix, challenges that dementia and mental illness exert throughout GEC, and need for seamlessness in delivery of care across multiple venues. Ongoing research efforts quantifying demand and resources and validating models of care will remain indispensible for meeting clinical challenges.

Serious undersupply of clinicians of all disciplines with general or specialty geriatrics knowledge persists. Much of VA's healthcare workforce and leadership are approaching retirement age, driving the need for new educational approaches, recruitment and retention strategies, and innovative delivery systems. Growing dependence on informal caregivers highlights the need for supporting these partners.

VA's healthcare budget allocation illustrates how national policy dictates systemic, regional, and local clinical decisions. Rehabilitation of the newest veterans is resulting in systemwide efficiencies. Educating and empowering patients and families results in optimized utilization of health resources.
Pulmonary Hypertension Affects Left Ventricular Basal Twist: A Novel Use for Speckle‐Tracking Imaging
Authors: Ramani Gautam V. , Bazaz Raveen , Edelman Kathy , López‐Candales Angel
Published: December 2008

Background: Chronic pulmonary hypertension (PH) results in right ventricular (RV) mechanical dyssynchrony. However, its effects on left ventricular (LV) mechanics have not been examined. Objective: Since speckle‐tracking echocardiography (STE) is a novel approach to quantify LV dyssynchrony; we decided to use STE to assess the effect of PH on LV mechanics. Methods: Our echocardiography database was queried for patients with PH who had undergone STE analysis and compared to similarly collected data from a group of healthy volunteers. Results: Group I (15 patients, age of 53 ± 17 years, pulmonary artery pressure of 62 ± 20 mmHg, eccentricity index of 0.78 ± 0.06, and LV ejection fraction of 64 ± 11%) and Group II (8 healthy volunteers, age 41 ± 9 years, pulmonary artery pressure 14.6 ± 4.2 mmHg, eccentricity index of 1.02 ± 0.05, and LV ejection fraction of 66 ± 6 mmHg). There was no difference in QRS duration between the two groups. Although PH significantly altered basal LV twist (Group I: M =−5.76° versus Group II: M =−1.82°, P < 0.05), it had no effect on LV apical twist (5.29° versus 4.50°; P = NS, respectively). More notably, significant LV radial basal LV dyssynchrony, measured as the time to peak LV basal twist, was seen as a result of PH. Conclusions: STE identifies the presence of LV dyssynchrony in PH despite normal LV ejection fraction and no difference in QRS duration. Additional studies are now required to further characterize these results and determine their prognostic significance.
Acquired AortoVentricular Tunnel: A Rare Complication of Infective Endocarditis
Authors: Moaref Alireza , Shahrzad Shahab , Aslani Amir
Published: December 2008

A 26‐year‐old man presented to emergency department with fever associated with night sweating and weight loss since 2 months prior to admission. He was an intravenous heroin user admitted for infective endocarditis of aortic valve 1 year ago. Transthoracic echocardiography followed by the transesophageal study showed bileaflet aortic prosthesis with normal transvalvular gradient and severe paravalvular aortic insufficiency. A pseudoaneurysm of intervalvular fibrosa connecting left ventricular outflow tract (LVOT) to noncoronary sinus of valsalva was detected.
Assessment of Regional Myocardial Function in Patients with Dilated Cardiomyopathy by Velocity Vector Imaging
Authors: Zeng Shi , Zhou Qi‐chang , Peng Qing‐hai , Cao Dan‐min , Tian Lei‐qi , Ao Kun , Liang Xia
Published: December 2008

Objective: To assess the left ventricular (LV) longitudinal systolic and diastolic function in patients with dilated cardiomyopathy (DCM) by syngo Velocity Vector Imaging (VVI). Methods: Digital dynamic images of 30 DCM patients and 30 healthy subjects were collected; then the longitudinal velocity, strain, and strain rate were measured in systolic early and late diastolic periods, and the time to peak systolic velocity, strain, and strain rate were measured and recorded. The parameters of the two groups were compared. Results: All of the parameters of the DCM were significantly lower than those of the normal group (P < 0.05–0.01), except that the parameter of late diastolic strain was not different between the two groups (P > 0.05). Conclusions: VVI is a novel noninvasive tool to assess quantitatively and objectively LV regional systolic and diastolic function in patients with DCM; it provides another useful modality for evaluating cardiac function.
An Unusual Presentation of an Anomalous Left Coronary Artery Arising from the Pulmonary Artery (ALCAPA) in an Adult: Anterior Papillary Muscle Rupture Causing Severe Mitral Regurgitation
Authors: Hofmeyr Louis , Moolman Johannes , Brice Edmund , Weich Helmuth
Published: December 2008

We describe a 29‐year‐old male, previously in good health, with no history of angina pectoris and no risk factors for ischemic heart disease presenting with biventricular failure and severe mitral valve regurgitation. There were no signs or serological test results to suggest infective endocarditis. Transthoracic echocardiography (TTE) revealed severe anterior mitral valve prolapse secondary to papillary muscle rupture, severe mitral valve regurgitation, as well as an anterior myocardial wall hypokinesis. Parasternal short‐axis view showed an anomalous left coronary artery arising from the pulmonary artery (ALCAPA), which was confirmed on coronary angiography. This is an unusual presentation of ALCAPA in an adult.
Identification of a Retained Intravascular Wire by Three‐Dimensional Transesophageal Echocardiography
Authors: Tokarz Stephen R. , Aktas Mehmet K. , Kroening Daniel , Sawyer Thomas J. , Daubert James P. , Huang David T. , Schwarz Karl Q.
Published: December 2008

A 78‐year‐old man with an implantable cardioverter‐defibrillator (ICD) for ischemic cardiomyopathy and prior ventricular tachycardia (VT) ablation presented with abdominal pain and was found to have a small bowel obstruction requiring immediate surgery. His postoperative course was complicated by incessant VT leading to multiple ICD shocks. He was referred to our hospital for repeat VT ablation. TEE revealed a wire coiled in the right pulmonary artery. This is the first reported identification of an embolized wire by transesophageal three‐dimensional echocardiography.
Techniques for Acute Stroke Intervention
Authors: PATEL RAJAN A.G. , COLLINS TYRONE J.
Published: December 2008

Stroke or cerebrovascular accident is the second most common cause of death in Western countries. Although stroke is a treatable disease, the majority of patients do not receive intravenous thrombolysis or catheter‐based therapy. The lack of treatment is multifactorial. Several treatments have been studied. Research and development in the area of acute stroke treatment are ongoing.
Social Opacity and the Dynamics of Empathic In‐Sight among the Tzotzil Maya of Chiapas, Mexico
Authors: Groark Kevin P.
Published: December 2008

Abstract
In this article, I explore local constructions of empathic access and social knowing among the highland Maya of San Juan Chamula. I argue that a pervasive sense of social opacity—a presumed inability to accurately know the motivations, potencies, and identities of social others—gives rise to a moral‐interpretive dilemma centering on the degree of concordance between the publicly presented self and the subjective or “private” self. I introduce the phrase “empathic in‐sight” to refer to those processes—both real and fantasy based—intended to produce an understanding of the inner states of others (in terms of underlying emotions, feelings, motivations, thoughts, and desires), thereby restoring a degree of transparency to everyday social interactions. The phrase is meant to suggest a dynamic and active process of “seeing within,” through which one attempts to gain access to, and understanding of, otherwise occluded conative and cognitive states—particularly those dimensions of the self that are actively hidden from view. [Chiapas, Tzotzil Maya, empathy, emotion, ethnopsychology]
Daughter and Pawn: One Ethnographer's Routes to Understanding Children
Authors: Briggs Jean L.
Published: December 2008

Abstract
In this article, I describe my experiences of being a “child” in different ways in two Canadian Inuit camps. I analyze how I came to have those experiences and how they helped me to understand Inuit children. [empathy, emotions, Inuit, children]
Visual Field Notes: Drawing Insights in the Yucatan
Authors: HENDRICKSON CAROL
Published: December 2008

This article considers the creation of visual field notes as part of the process of conducting fieldwork. By means of drawing and related activities, anthropologists immerse themselves in a field‐based, generative process that engages them, simultaneously, in the acts of thinking, seeing, and doing. Insight and understanding emerge in the course of producing marks on a page that have iconic and indexical dimensions. The indexical potential of drawing(s), in particular, is noteworthy as visual signs stimulate connections between the world “out there” and issues in anthropology and other disciplines via culturally recognized signifiers. This path to understanding by visual means is never entirely predictable but nonetheless vital and creative. With theoretical inspiration drawn from the fields of anthropology, art, and education, this article is based on the experience of producing a set of visual and verbal field notes as part of a college field study trip to the Yucatan.
Distracción: Notes on Cultural Citizenship, Visual Ethnography, and Mexican Migration to Pennsylvania
Authors: DIAZ‐BARRIGA MIGUEL
Published: December 2008

As part of his effort to organize Mexican workers in the mushroom industry of southeastern Pennsylvania, Luis Tlaseca has made and shown videos on a variety of topics, including Mexican migrants' participation in the annual Mushroom Festival. In this article, I describe Tlaseca's understandings of this video project as well as the video's reception by a group of migrant workers. I argue that at both levels, production and reception, the video has been interpreted both as a reflection on class and race relations as well as cultural citizenship. In doing so, I contextualize understandings of cultural citizenship in terms of what I call “structures of belonging.”
Soccer and the (Tri‐) Color of the Ecuadorian Nation: Visual and Ideological (Dis‐) Continuities of Black Otherness from MonoculturalMestizajeto Multiculturalism
Authors: RAHIER JEAN MUTEBA
Published: December 2008

As evidenced by the series of commentaries that followed the good performance of the Ecuadorian soccer team at the 2006 Mundial, which I discuss in the last section of this essay, the place of blackness within/outside Ecuadorian national identity continues to be ambiguous despite the multicultural turn formally officialized with the adoption of the 1998 Constitution. Through the analysis of visual representations of Afro‐Ecuadorian men, I sketch the long history of black exclusion from the dominant Ecuadorian understanding of the nation during monocultural mestizaje, and the metamorphosis of this exclusion into multiculturalism. This provides a genealogy for today's spontaneous representations of Ecuadorian black athletes found on the internet and on the daily press. As indicated by the essay's title, I conclude that even though notable changes have occurred since the “multicultural turn,” there are also profound ideological continuities. I argue that in fact with multiculturalism, mestizaje—as an ideological technology of the state and as a project of the Ecuadorian elites—has not disappeared from the political landscape but instead continues to do its work both within and around multiculturalism. Thus, for Afro‐Ecuadorians, the passage of the official or national stance from “monocultural mestizaje” to “multiculturalism” has not been accompanied by the transformations that the change of vocabulary might suggest. Instead, it has reinscribed the prevalent racial order in a “new” narration of the nation.
Effect of Thickness of the Intergranular Film on Fracture in Si3N4
Authors: Zhang Shenghong , Garofalini Stephen H.
Published: December 2008

Molecular dynamics computer simulations were used to study the fracture behavior of silica intergranular films (IGFs) between silicon nitride crystals as a function of film thickness. Results showed a significant increase in fracture stress with decreasing IGF thickness. IGFs that are 2 nm thick fracture similarly to bulk silica glass, while the 1 nm IGF fractured at a much higher value. The simulations show bond rupture and rearrangement of siloxane rings that coalescence to form larger rings, or “voids.” The delineating difference in the systems is the significantly larger concentration of six‐membered rings in the 1 nm IGF in comparison to the 2 nm IGF or bulk silica glass. The Si–O bond is more stable in six‐membered rings than other ring sizes. Rupture is more catastrophic in the 1 nm IGF than the other systems where stress decays more slowly with strain.