bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of MAPP as a Coupling Agent on the Performance of Jute–PP Composites
Authors: Mohanty S. , Nayak S. K. , Verma S. K. , Tripathy S. S.
Published: April 2004

Like other natural fibers jute, because of its hydrophilic nature, is incompatible with nonpolar plastics matrices. This has been the major handicap for preparing stable composites. In this paper we have used maleic anhydride grafted polypropylene, MAPP(G-3015) as the coupling agent for the surface modification of the fibers. Various parameters such as effect of fiber length, MAPP concentration, time period of MAPP treatment, percentage (wt./wt.) of fiber loading on mechanical properties such as tensile, flexural and impact strengths have been studied. It has been found that 30% fiber loading with 0.5% MAPP concentration in toluene and 5 min impregnation time with 6 mm average fiber lengths give the best results. Nearly 72.3% increase in flexural strength was observed in respect of treated composites. The fiber matrix interface was analyzed from the SEM micrographs. Water absorption of the composites has also been considerably reduced in the treated composites. Thermal behavior of the composites were also studied through DSC measurements. The MFI study also supports better fiber matrix adhesion.
Isothermal Pseudo-2D Analysis of Reactive Extrusion in Single-Screw Extruders
Authors: Roy Saswata , Lawal Adeniyi
Published: April 2004

Reactive extrusion involves the continuous synthesis and modification of polymers in a screw extruder. Over the years, it has received a lot of attention both in academic research and industrial applications. It remains a potential source for further development of new products and processes. The present analysis is focused on power-law fluids undergoing isothermal homogeneous and heterogeneous reactions simulating reactive extrusion in a single-screw extruder. The assumption of shallow screw geometry enables the flow to be modeled as that occurring between infinitely long parallel plates, the analytical solutions of which are available in the literature. For the concentration problem, the reaction is taken to be first order, and the equation of conservation of component species is transformed into an eigenvalue problem. The eigenvalues and eigenfunctions are determined using the Runge–Kutta method. Analytical solutions are developed for the concentration distribution in the extruder and expressions for the conversion of the reactant, and Sherwood number are presented. The accuracy of the solutions is established and the concentration profiles at different axial locations in the extruder are presented for various values of power-law index, flow rate, and the homogeneous and heterogeneous reaction rate parameters. The effects of these parameters on the Sherwood number, reactant conversion and, bulk and wall concentration are also investigated.
Ventricular Shunts
Authors: Chabrerie Alexandra , Black Peter M.
Published: April 2004

Ventricular shunts are mechanical devices used in the treatment of hydrocephalus, by means of which cerebrospinal fluid (CSF) is diverted from the ventricles to other low-pressure body cavities. Over the last 50 years, mechanical shunting has become the cornerstone for the treatment of hydrocephalus with shunt valves evolving from simple differential valves to complex programmable valves. The chief complications of ventricular shunting include obstruction, infections, and overdrainage causing subdural hematomas and slit-ventricle syndrome. As the number of commercially available valve designs continues to grow, each new generation aims at reducing the likelihood of complications, especially those resulting from overdrainage. Several studies aimed at establishing the superiority of any valve design have been conducted. All have highlighted the advantages and shortcomings of most models without conclusively providing evidence for choosing one over another. As a result, choices still rest on individual and institutional preferences.
Analytic Reviews: Management of Patients Exposed to Biological and Chemical Warfare Agents
Authors: Marik Paul E. , Bowles Stephen
Published: April 2004

Biological and chemical weapons have been used for waging war since the dawn of recorded history. Recently, these agents have been used on civilian populations by terrorist groups. Terrorist attacks using biological or chemical weapons have far-reaching implications, as they cause widespread fear, anxiety, and panic among the public. Biological agents have particular appeal for use in terrorist attacks because they are reasonably easy to acquire, are inexpensive to produce, and have the potential to affect large populations of people. Biological agents are selected based on their toxicity, ease of production and stability, and ability to be dispersed in respirable aerosols. The most common biological agents that have been weaponized include anthrax, plague, tularemia, botulism toxin, and smallpox. Chemical agents are more expensive and more difficult to manufacture and deploy and are therefore more likely to be used in conventional warfare. Mustard gas and nerve agents are the favored chemical agents of mass destruction.
Systemic Capillary Leak Syndrome, Leukotrienes, and Anaphylaxis
Authors: Lilly Craig M. , Silverman Eric S. , Sheffer Albert L.
Published: April 2004

The association of cysteinyl leukotrienes with plasma exudation allowed the authors to form the hypothesis that rates of leukotriene excretion would be increased in the acute phase of systemic capillary leak syndrome (SCLS) and that leukotriene-modifier therapy would reduce the frequency and severity of life-threatening episodes. The authors report the association of SCLS in 3 cases, 1 with seafood-induced anaphylaxis. Rates of urinary leukotriene excretion were greater during the evolution of an episode than after resolution. In a third case, the rate of urinary leukotriene excretion was significantly higher when symptoms were evolving than when they were absent (230 ± 17 vs 110 ± 6 pg/mg, P < 0.001). Treatment with a leukotriene receptor (cys-LT1) antagonist eliminated episodes in 1 patient. Treatment with the 5-lipoxygenase inhibitor zileuton was completely effective in another patient and prevented life-threatening episodes in the patient with SCLS after seafood exposure. The authors' finding that allergen exposure—associated episodes of SCLS were eliminated by allergen avoidance implies that anaphylaxis can present as SCLS. The acute phase of all 3 forms of SCLS (paraprotein associated, anaphylaxis associated, and idiopathic) is associated with increased excretion of cystinyl leukotrienes, and leukotriene-modifier treatment appears to control the disease.
Test-Ordering Strategy in the Intensive Care Unit
Authors: Krinsley James Stephen
Published: April 2004

The objective of this study was to assess the effect of an intervention designed to reduce utilization of portable chest x-rays (CXRs) in the intensive care unit (ICU). In this prospective observational study, patients representing 2734 consecutive admissions over a 35-month period were studied. Data collected from the comprehensive ICU database included patient days, ventilator days, number of admissions to the unit, number of CXRs ordered, costs for CXR, Acute Physiology and Chronic Health Evaluation II (Apache II) scores, ICU length of stay (LOS), length of mechanical ventilation, inadvertent extubations from mechanical ventilation, and reintubation within 48 hours of planned extubation. There was a 22.5% reduction in the rate CXR utilization during the study period, resulting in a $109,968 cost savings, and these savings were not associated with any adverse clinical outcomes.
Management of Infectious Complications in the Hematopoietic Stem Cell Transplant Recipient
Authors: Nichols W. Garrett
Published: April 2004

Despite impressive accomplishments in supportive care over the past decade, infections with a diverse group of microorganisms remain leading causes of morbidity and mortality after hematopoietic stem cell transplantation. The epidemiology of infectious complications has shifted substantially in the past decade with changes in antimicrobial prophylaxis, conditioning regimens, and graft manipulation, such that invasive mould infections and late viral infections are now the overriding concerns. Individual patient risk for infections is predicated on multiple disease-specific, patient-specific, and transplantrelated factors but often tracks with the cumulative level of immunosuppression (such as dose of corticosteroids used for the treatment of graft vs host disease [GVHD]). New antivirals and antifungals have entered clinical practice and hold considerable promise for improved outcomes.
Outcome Prediction for Critically Ill Cirrhotic Patients: A Comparison of APACHE II and Child-Pugh Scoring Systems
Authors: Ho Yu-Pin , Chen Yung-Chang , Yang Chun , Lien Jau-Min , Chu Yin-Yi , Fang Ji-Tseng , Chiu Cheng-Tang , Chen Pang-Chi , Tsai Ming-Hung
Published: April 2004

Cirrhotic patients admitted to the medical intensive care unit (ICU) are associated with high mortality rates. The prognosis of critically ill cirrhotic patients is determined by the extent of hepatic and extrahepatic organ dysfunction. This study was conducted to assess and compare the accuracy of the Child-Pugh classification and APACHE II scores, obtained on the first day of ICU admission, in predicting hospital mortality in critically ill cirrhotic patients. One hundred thirty-five patients diagnosed with liver cirrhosis were admitted to the medical ICU between January 2002 and March 2003. Information considered necessary to compute the Child-Pugh and APACHE II scores on the first day of ICU admission was prospectively collected. The overall hospital mortality rate was 66.6%. Liver disease was most commonly attributed to hepatitis B viral infection. The APACHE II scores demonstrate a good fit using the Hosmer and Lemeshow goodness-of-fit test. Furthermore, by using the areas under receiver operating characteristic (AUROC) curve, the APACHE II scores demonstrated a better discriminative power (AUROC 0.833 ± 0.039) than Child-Pugh scores (AUROC 0.75 ± 0.05) ( P= .024). This investigation confirms the grave prognosis for the cirrhotic patients admitted to the ICU. While both Child-Pugh and the APACHE II scores can satisfactorily predict the outcomes for critically ill cirrhotic patients, APACHE II is more powerful in discriminating the survivors from the nonsurvivors.
Influence of Different Sterilization Procedures and Partial Demineralization of Screws Made of Bone on their Mechanical Properties
Authors: Actis A. B. , Obwegeser J. A. , Rupérez C.
Published: April 2004

Since 1992, screws made of allogenic, autoclaved human cortical bone have been employed as osteosynthesis materials. Autoclaving at 134 C for 5 min makes them microbiologically safe, but on the other hand it reduces both their mechanical properties and osteoconductive capacity.

The aim of this in vitro study was to determine if the mechanical properties of these screws could be improved after receiving different autoclaving procedures and partial inner demineralization, the latter additionally tending to increase their osteoconductive potential.

132 screws made of bovine cortical bone were employed. Some of them were partially demineralized with 0.6 N HCl from an inner canal performed following their longitudinal axis. All the specimens were autoclaved at 134 C but under different vacuum conditions and sterilization time (A1–A2). They were then subjected to tension, shear and torque tests.

A difference between both sterilization procedures was observed. Samples sterilized at 134 C, 2–2.4 mbars for 5 min (A1) showed better mechanical properties than those autoclaved for longer time and higher vacuum conditions (A2). Demineralization also influenced their mechanical properties, being less resistant with increasing time.

Based on these results, a standard screw made of bone and autoclaved at 134 C, 2–2.4 mbars, 5 min seems to be the most appropriate, from a biomechanical point of view, to be used as osteosynthesis material.
Stress Distribution of Post–Core Applications in Maxillary Central Incisors
Authors: Yaman S[UNKNOWN]s Darendel[UNKNOWN]ler , Karacaer Özgül , Sahin Melin
Published: April 2004

The purpose of this study was to evaluate the stress distribution in a maxillary central incisor restored with various post–core applications.

The study used a three-dimensional finite element method. The tooth was assumed to be endodontically treated with a porcelain crown. Two different sizes of Flexi-post, Cera-post, and Composipost were compared for 200 N palatal and incisal loads.

It was determined that, purely from the point of view of strength considerations, core material was determined to be of greater importance than post material or size. Higher elastic moduli of the posts resulted in lower stresses throughout the tooth.
Influence of a Self-Etching Primer on Compound Nerve Action Potentials
Authors: Cüehrel[UNKNOWN] Zafer C. , Tasman Fugen , Onur Mehmet Al[UNKNOWN] , Gumrukcuoglu Ayse
Published: April 2004

The aim of this study was to evaluate the effect of self-etching primers on nerve conductance. A self-etching primer (One Up Bond F) which combines etching and bonding in one step, and a fifth-generation bonding agent (Prime&Bond NT) were tested. Isolated rat sciatic nerves were placed between two platinum electrodes in a bath containing Tyrode solution. The bonding agents were brought into contact with the nerves and the evoked compound action potentials (CAP) were recorded before and after contact with the materials. One Up Bond F caused total inhibition of the CAP within an average time of 7 min. All CAPs in this group were blocked irreversibly. As with Prime&Bond NT, the reduction in CAP was 45.9% after an application time of 15 min, after which readings were terminated. Recovery of the CAP in this group were maintained after rinsing with fresh tyrode solution. One Up Bond F elicited faster blocking of nerve conductance under the conditions of this model. In the context of dentin desensitization with bonding agents, the self-etching primer may be more effective, clinically.
Resistance to Tensile Stress of a Bioadhesive Utilized for Medical Purposes: Loctite 4011
Authors: Páez J. M. García , Herrero E.Jorge , Rocha A. , Maestro M. , Castillo-Olivares J. L. , Millán I. , Sanmartin A. Carrera , Cordon A.
Published: April 2004

Sutures are the materials presently employed to secure and give shape to the valve leaflets of cardiac bioprostheses. Their high resistance and low degree of elasticity in comparison with the calf pericardium of which the leaflets are made generates internal stresses that contribute to the failure of the bioprostheses.

Biological adhesives are bonding materials that have begun to be utilized in surgery, although there is a lack of experience in their use with inert tissues or bioprostheses.

We report our study of Loctite 4011, a biological glue composed of a cyano-acrylate that has been employed for medical purposes, in which samples of pericardium bonded with this adhesive were subjected to uniaxial tensile stress. The samples were glued in such a way as to leave an overlap of 1 cm2 between the surfaces of the tissue. The series included 83 samples: 12 tested 24 h after bonding, 17 after 45 days, 17 after 90 days, 19 after 106 days and 18 after 152 days. The samples subjected to deferred trials were preserved using three types of chemical substances: glutaraldehyde, glycerol or saline plus antibiotics. The mean resistance to rupture of the series tested 24 h after gluing was 0.15 MPa (1.47 machine kg). This resistance remained nearly unchanged, regardless of the preservation solution employed, for at least 152 days, the time at which the study ended. The stress strain curves demonstrated a high degree of elasticity throughout the 152 days, a finding that was not influenced by the preservation solution.

This adhesive showed a considerable resistance to tensile stress, although probably insufficient to replace sutures. However, it maintained a surprisingly high degree of elasticity in the samples. Perhaps the time has come to combine these two elements, sutures and adhesives, to improve the elasticity of the structure without a loss of resistance, and increase the durability of bioprostheses.
Writers and Society in Eastern Europe, 1989-2000: The End of the Golden Age
Authors: Wachtel Andrew
Published: April 2004

Although an enormous amount has been written about the political, social, and economic effects of post-communist transition, little concern has been paid to its equally traumatic effects on culture—particularly literary culture which was traditionally highly valued in Eastern Europe. Based on field research conducted in 10 countries, this article documents the changes in the environment for literary publishing and the extent to which writers in post-communist societies have suffered a loss of material wealth as well as prestige since 1989.
The Fist of the Working Class: The Social Movements of Jiu Valley Miners in Post-Socialist Romania
Authors: Vasi Ion Bogdan
Published: April 2004

This article analyzes one of the most virulent protests witnessed by post-socialist societies: the social movements of the Jiu Valley miners in Romania. I argue that the key to comprehending the Jiu Valley miners’ extraordinary mobilization can be found in the density of their social networks, which, under a particular political opportunity structure, became a crucial resource for social movement organizations. Dense social networks and a favorable political opportunity created organizational resources that were utilized by movement entrepreneurs to build a unique participant identity. Having abundant organizational resources, influential allies, and sharing a special collective identity rooted in a tradition of militancy, Jiu Valley miners could achieve a high degree of mobilization, use noninstitutionalized confrontational tactics, and be victorious.
“Do as I Say, Not as I Do”: The European Union, Eastern Europe and Minority Rights
Authors: Johns Michael
Published: April 2004

This article tests the assumption that the European Union has forced the potential new members from Eastern Europe to adhere to standards regarding the treatment of national minorities current member states do not meet. The article examines the treatment of the Russian minorities in Latvia and Estonia and the Roma population in Slovakia compared to the treatment of the Turks in Germany and the Roma in Italy. Using EU accession reports, Organization for Security and Co-operation in Europe (OSCE) recommendations, and the Minorities at Risk data set, a double standard becomes apparent. The newly democratized states of Eastern Europe are being forced to choose between the economic advantages of membership in the EU and legislation designed to protect the language and culture of the majority group. The article concludes with an examination of the histories of Estonia and Latvia to illustrate why being forced into altering laws concerning culture and citizenship is so difficult.
From Good Communists to Even Better Capitalists? Entrepreneurial Pathways in Post-Socialist Romania
Authors: Stoica Cătălin Augustin
Published: April 2004

This article tests four theses regarding the origins of Romanian post-socialist entrepreneurs: (1) “political capitalism,” (2) “post-socialist managerialism,” (3) “capitalism from below,” and (4) “refuge from poverty.” The results of the analyses show that the former cadres are at an advantage in being employers due to their organizational experience and network resources. Nevertheless, in line with arguments advanced by the second thesis mentioned above, education, as the most basic form of human capital, plays an important role in this story of entrepreneurship. Consistent with the predictions of the third thesis, the experience in the second economy under state socialism, as a form of cultural capital, represents an asset for being an employer and a small business operator in 2000. Private farming is an avenue taken by former socialist farmers and by some of those who have lost their jobs after 1990, especially the former peasant-workers of state socialism.
Civil Society Development and Democratic Values in Romania and Moldova
Authors: Bădescu Gabriel , Sum Paul , Uslaner Eric M.
Published: April 2004

Does civic engagement lead to democratic values such as trust and tolerance? This is the claim of the literature on social capital. Using surveys of the public and organizational activists the authors conducted in Romania and Moldova in 2001 with the support of the Starr Foundation, they investigate these linkages. In both countries, they find low levels of civic engagement, trust, and tolerance for the mass public. They also find little support for the argument that participation leads to greater trust and tolerance among the mass public. However, they find considerably higher levels of trust, tolerance, and engagement among organizational activists and suggest that this elite may help transfer democratic values to the larger population. It is disconcerting that such activists constitute minuscule proportions of the population in both countries.
Lyudmila Zhivkova and the Paradox of Ideology and Identity in Communist Bulgaria
Authors: Atanasova Ivanka Nedeva
Published: April 2004

This article argues that Lyudmila Zhivkova is the most controversial political figure in Communist Bulgaria. Zhivkova’s ideas and initiatives that have been overlooked so far are used as a background for exploring a significant conflict between ideology and national identity in modern Bulgarian history. After outlining briefly Zhivkova’s early and unexpected death, the author analyzes the Communist paradoxes of utopia, modernization, and return to feudalism that produced the idiosyncratic phenomenon of Zhivkova as “the uncrowned princess” of Communist Bulgaria. The author explains Zhivkova’s cultural politics as a rational approach worked out with the help of some of the most outstanding Bulgarian intellectuals at that time. Because of its heavy emphasis on national identity, Zhivkova’s cultural politics reveal clearly several sets of contradictory components of the Bulgarian national character and in some cases challenge the conventional wisdoms about Bulgarians. These sets are the quest for cultural achievements versus limited state resources; excessive national pride versus “shameful national identity”; Russophobes versus Russophiles; East versus West or how to escape the geopolitical trap; and mysticism versus atheism.
Home Forced Use in an Outpatient Rehabilitation Program for Adults with Hemiplegia: A Pilot Study
Authors: Pierce Samuel R. , Gallagher Kara G. , Schaumburg Susan W. , Gershkoff Arthur M. , Gaughan John P. , Shutter Lori
Published: April 2004

The objective of this study was to examine the effectiveness of a program of traditional outpatient neurological rehabilitation that included home forced use. In total, 17 patients with chronic stroke and 1 patient with subacute stroke (mean time poststroke = 27.6 months) completed an individualized program consisting of seven 2-hour treatment sessions composed of 1 hour of occupational therapy and 1 hour of physical therapy. Therapy sessions were completed over a 2- to 3-week period and included instruction on the use of a restraining mitt at home during functional activities. The Wolf Motor Function Test (WMFT) was used to assess upper extremity impairment and function at baseline, midway through treatment, and posttreatment. Patients demonstrated statistically significant improvements (P < 0.05 corrected for multiple comparisons) in mean time for completion in 12 of 17 WMFT subtasks when comparing baseline to posttreatment. The preliminary results suggest that the forced-use component of constraint-induced therapy may be effective when applied within a traditional outpatient rehabilitation program. However, additional investigation is required to examine the effectiveness of using forced use within typical outpatient rehabilitation under more experimentally controlled conditions.
Effects of Sudden, Passive Muscle Shortening According to Grimaldi’s Method on Patients Suffering from Multiple Sclerosis: A Randomized Controlled Trial
Authors: Crippa Alessandro , Cardini Roldano , Pellegatta Daniel , Manzoni Silvia , Cattaneo Davide , Marazzini Francesca
Published: April 2004

Purpose. The purpose of this study was to investigate the short-term effect of a therapeutical approach called “Grimaldi’s method.” The authors hypothesized that Grimaldi’s method would improve active muscle recruitment. The treatment was focused on hip abductors. The authors collected data of hip’s active range of motion against gravity (AROM), maximum isometric endurance (END), and maximum mechanical work (WORK). Participants and methods. Forty patients suffering from multiple sclerosis were randomized into 2 groups, 20 were allocated to the Grimaldi’s group and 20 to the control group. Results. After 3 sessions of Grimaldi’s treatment parameter, AROM increased from 21.4° to 37.2° in the experimental group; the improvement was statistically significant. Parameter END did not show any improvement, whereas mechanical work had a sharp increase: from 103.9 Nm to 149.6 Nm. Conclusion. The findings suggest that Grimaldi’s method could be useful in increasing muscular recruitment of hip abductors, improving active range of motion and mechanical work of the hip in patients suffering from multiple sclerosis.
Timing, Intensity, and Duration of Rehabilitation for Hip Fracture and Stroke: Report of a Workshop at the National Center for Medical Rehabilitation Research
Authors: Weinrich Michael , Good David C. , Reding Michael , Roth Elliot J. , Cifu David X. , Silver Kenneth H. , Craik Rebecca L. , Magaziner Jay , Terrin Michael , Schwartz Myrna , Gerber Lynn
Published: April 2004

This article summarizes the proceedings of an NIH workshop on timing, intensity, and duration of rehabilitation for acute stroke and hip fracture. Participants concentrated on methodological issues facing investigators and suggested priorities for future research in this area.
An Evaluation of the Extended Barthel Index with Acute Ischemic Stroke Patients
Authors: Janša Jelka , Pogačnik Tomaž , Gompertz Patrick
Published: April 2004

Objective. To evaluate the Extended Barthel Index with acute ischemic stroke patients. Methods. This prospective 1- to 6-week poststroke follow-up study was carried out using 33 newly diagnosed acute ischemic stroke patients who were admitted to the University Medical Centre Ljubljana, Department of Neurology. Measures used were Barthel Index (BI), Extended Barthel Index (EBI), Fugl Meyer Motor Impairment Scale, 1-5 Self-assessment scale, Rivermead Behavioural Memory Test. Results. The EBI is a reliable scale in terms of internal consistency. The cognitive part is less reliable than the physical part of the EBI. It is a 3-dimensional scale as calculated by factor analysis (factor 1 with eigenvalue 8.2, factor 2 with eigenvalue 2.7 and factor 3 with eigenvalue 0.9). Criterion validity to the BI and and the Fugl-Meyer Motor Impairment scale was supported (P = 0.1-0.001). External validity to the Self-Assessment scale was also supported (P < 0.001). It is more sensitive to the changes in functional status that occur in the 1st 6 weeks poststroke than the original BI, although the ceiling effect was not really explained in this follow-up period. Conclusion. The EBI is a valid, reliable, 2- to 3-dimensional outcome measure of disability/activity for stroke patients. To some extent, it also reveals the level of patients’ perception of their functional status.
Treatment of Delirium in Older Adults with Quetiapine
Authors: Kim Kye Y. , Bader Geoffrey M. , Kotlyar Victor , Gropper Debra
Published: April 2004

Delirium is a neuropsychiatric syndrome characterized by impairment of consciousness, changes in cognition, or perceptual disturbances. In addition, delirium is often accompanied by delusions, hallucinations, and agitation. In this study, 12 older patients with delirium were treated for neuropsychiatric symptoms with quetiapine. The mean duration for stabilization was 5.91 ± 2.22 days, and the mean dose was 93.75 ± 23.31 mg/day. None of the 12 patients developed extrapyramidal symptoms. There were significant improvements on all measures used in this study. Interestingly, the Delirium Rating Scale scores along with scores of the Mini-Mental State Examination and Clock Drawing Test continued to improve throughout the 3-month study period. In our study, we found that quetiapine was a safe and effective treatment in hospitalized older patients with delirium. ( J Geriatr Psychiatry Neurol 2003; 16:29-31)
Recorded Delirium in a National Sample of Elderly Inpatients: Potential Implications for Recognition
Authors: Kales Helen C. , Kamholz Barbara A. , Visnic Stephanie G. , Blow Frederic C.
Published: April 2004

This retrospective study examined delirium and related confusional diagnoses recorded in patients older than age 60 discharged from Veterans Affairs (VA) acute inpatient units nationally in 1996 (n = 267,947). Only 4% of patients had delirium or related confusional diagnoses recorded. Patients with recorded delirium had significantly higher mortality than did those without recorded delirium or those with other confusional diagnoses (“organic psychoses”); the most common delirium types were dementia with delirium and alcohol intoxication/withdrawal delirium. Organic psychoses patients had the longest lengths of stay and significantly more admissions to nonmedical/surgical units and discharges to nursing homes; almost 20% were African American. The recorded rate of delirium in the VA health system likely underestimates true prevalence and possibly reflects nonrecognition of delirium in many older veterans. Certain motoric and etiologic types of delirium may be more commonly diagnosed and recorded. Future research should prospectively examine recognition of motoric and etiologic delirium subtypes and racial differences in delirium diagnoses. ( J Geriatr Psychiatry Neurol 2003; 16:32-38)
Effects of Cognitive Challenge on Gait Variability in Patients with Parkinson’s Disease
Authors: Hausdorff Jeffrey M. , Balash Jackov , Giladi Nir
Published: April 2004

Attention plays an important role in the gait disturbances of patients with Parkinson’s disease (PD); however, the effects of “dual tasking” on fall risk and gait instability have not been well studied. The authors tested the hypothesis that gait variability increases when subjects with PD walk while performing a cognitively challenging task (CCT). Subjects with idiopathic PD walked under normal conditions and while performing a CCT. During normal walking, gait variability was significantly (.0001 < P < .05) correlated with fall risk, disease duration, disease severity, motor function, mentation, behavior and mood, and cognitive function. When walking while cognitively challenged, gait variability increased (from 47 ± 29 msec to 223 ± 281 msec, P < .002). During dual-task walking, only disease duration remained significantly associated with gait variability. These results highlight the profound effects of attention on gait and indicate that walking while cognitively challenged impairs the ability of patients with PD to maintain a stable walk. ( J Geriatr Psychiatry Neurol 2003; 16:53-58)
Familial Dementia with Lewy Bodies with an Atypical Clinical Presentation
Authors: Bonner Lauren T. , Tsuang Debby W. , Cherrier Monique M. , Eugenio Charisma J. , Du Jennifer Q. , Steinbart Ellen J. , Limprasert Pornprot , La Spada Albert R. , Seltzer Benjamin , Bird Thomas D. , Leverenz James B.
Published: April 2004

The authors report a case of a 64-year-old male with Alzheimer’s disease (AD) and dementia with Lewy bodies (DLB) pathology at autopsy who did not manifest the core symptoms of DLB until very late in his clinical course. His initial presentation of early executive and language dysfunction suggested a cortical dementia similar to frontotemporal lobar degeneration (FTLD). Core symptoms of DLB including dementia, hallucination, and parkinsonian symptoms were not apparent until late in the course of his illness. Autopsy revealed both brainstem and cortical Lewy bodies and AD pathology. Family history revealed 7 relatives with a history of dementia including 4 with possible or probable DLB. This case is unique because of the FTLD-like presentation, positive family history of dementia, and autopsy confirmation of DLB. ( J Geriatr Psychiatry Neurol 2003; 16:59-64)
•1-Acid Glycoprotein in Late-Life Depression: Relationship to Medical Burden and Genetics
Authors: Adeoye Opeolu M. , Ferrell Robert E. , Kirshner Margaret A. , Mulsant Benoit H. , Seligman Karen , Begley Amy E. , Reynolds Charles F. , Pollock Bruce G.
Published: April 2004

Serum •1-acid glycoprotein (AAG) concentrations were examined in relationship to age, medical burden, depression, and mental status in elderly control (n = 19, mean age = 72.1 ± 6.8 years) and depressed (n = 58, mean age = 71.9 ± 7.1 years) subjects. DNA was analyzed for allelic variants of the AGP1 (ORM1) gene in both groups. Depressed subjects’ AAG serum levels were measured at baseline and after 6 weeks of antidepressant treatment. Before treatment, depressed subjects had significantly higher serum AAG concentrations than nondepressed controls ( t49.2 = –3.48, P= .0011). Pretreatment AAG levels also correlated with degree of medical burden, measured by the Cumulative Illness Rating Scale–Geriatrics ( r= 0.28, P= .0303), but not with age, depression severity, or cognitive scores. There was no significant difference between responders and nonresponders on changes in AAG levels from baseline to week 6. Frequency differences in ORM1 allelic variants apparently did not influence increased AAG concentrations in depressed patients.
Neuroimaging Correlates of Dementia Rating Scale Performance at Baseline and 12-Month Follow-up among Patients with Vascular Dementia
Authors: Sweet Lawrence H. , Paul Robert H. , Cohen Ronald A. , Moser David , Ott Brian R. , Gordon Norman , Browndyke Jeff N. , Shah Pari , Garrett Kelly D.
Published: April 2004

The authors previously reported that subcortical hyperintensity (SH) and whole-brain volume (WBV) each covary with different subscale scores of the Mattis Dementia Rating Scale (MDRS) among vascular dementia (VaD) patients. The present longitudinal analysis examined these relationships for change. The authors found that SH volume increased and WBV decreased significantly over 12 months. At baseline, SH volume accounted for significant variance in MDRS total score and every subscale score, except Memory. WBV was unrelated to any MDRS measure. After 12 months, SH volume was related only to the Construction subscale score, whereas WBV accounted for the majority of variance in Attention and Memory subscale performance. These findings indicate that although SH volume increases with disease progression, the relative impact of SH volume on cognitive status decreases among patients with advanced VaD.
Psychosis in Elderly Patients: Classification and Pharmacotherapy
Authors: Mintzer Jacobo , Targum Steven D.
Published: April 2004

Psychosis in elderly patients is a growing clinical concern because psychotic symptoms most frequently occur as noncognitive manifestations of Alzheimer’s disease, as side effects of drug therapy for Parkinson’s disease, or as the primary abnormalities in schizophrenia, and the clinical characteristics of psychosis are distinct for each. In planning antipsychotic pharmacotherapy for elderly patients, age-related pharmacokinetic changes, polypharmacy for comorbid diseases, and concerns about the underlying conditions responsible for the psychotic symptoms must be considered. Traditional antipsychotic agents bind to dopamine receptors and effectively relieve positive schizophrenic symptoms but frequently cause tardive dyskinesia and other extrapyramidal symptoms, a problem for elderly patients, particularly for those with Parkinson’s disease. Atypical antipsychotics bind to dopamine and serotonin receptors, relieving both positive and negative symptoms, and are less likely to cause extrapyramidal symptoms. The authors review common diagnostics associated with psychosis in the elderly and clinical guidelines to selecting antipsychotic pharmacotherapy.
The Biology of Psychosis in Older People
Authors: Karim Salman , Burns Alistair
Published: April 2004

The nosology, classification, and biological basis of psychosis in the elderly have been much debated. Psychotic features are seen in schizophrenia, affective illness, and dementia in the elderly. This article reviews evidence for the biological basis of psychosis in older people. In schizophrenia, there is evidence of gender differences in brain volume loss and dopamine receptor numbers, possibly linked to estrogen loss in women. Neuroimaging evidence of ventricular brain changes and more dopamine receptors have also been documented. In Alzheimer’s disease, genetic factors such as PS1 and ApoE4 have been associated with psychotic symptoms, and histopathological studies have revealed differences in neuronal pathology. Radiological studies have shown right and left hemisphere differences in size, blood flow, and glucose metabolism between psychotic and nonpsychotic patients. In affective illnesses, there is evidence of structural brain changes in psychotic depression. Ample evidence suggests that biological substrates underlie many psychotic symptoms. More research will identify causal links between brain changes, symptom appearance, and the effects of psychosocial factors in their genesis.
Parkinsonism in a Nursing Home: Underrecognition
Authors: Friedman Joseph H. , Fernandez Hubert H. , Trieschmann Martha M.
Published: April 2004

Parkinsonism is a very common condition in the elderly, particularly the elderly demented. The authors’ experience in both the in-and outpatient settings suggested that parkinsonism was generally underdiagnosed in the elderly. They evaluated the residents at a local nursing home to assess for parkinsonian signs. They then compared the findings to those noted in the charts. Blinded assessment of all nursing home residents for signs of parkinsonism was performed. A standardized evaluation instrument was used, followed by a chart review to determine if patients were taking medications that might induce the parkinsonism and whether the parkinsonism had been recognized. The authors looked separately at those patients receiving antipsychotics because of their increased risk. Twenty-seven out of 100 residents had “probable” parkinsonism, 12 of whom were severe, and 33 had “possible” parkinsonism. Of 27 residents on antipsychotics, 23 showed parkinsonian features versus 43 of 73 not on such drugs ( P< .02). Only 1 patient with drug-induced parkinsonism and 3 residents with previously diagnosed Parkinson’s disease had chart notes indicating that parkinsonism had been recognized.
Is Your Source Ever Really Safe?
Authors: Crook Tim
Published: April 2004

Doctor David Kelly told the House of Commons Foreign Affairs Select Committee that one lesson he had learned was never to talk to journalists. But the political violence of the battle between the Government and the BBC forced Kelly to surrender the confidentiality he had hoped for when doing so. The actions and words of journalists, civil servants and politicians destroyed the self-esteem of one of the world's foremost experts on weapons of mass destruction.

A basic principle in law has been in the background to this affair, writes Crook. Scribbled in a Downing Street minute when politicians and civil servants scrambled to deal with the implications of Dr Kelly's death was the expression "duty of care". Had Government properly executed its duty of care to Dr Kelly? Had journalism fulfilled its duty of care to the scientist who had been prepared to speak out and whistle-blow on the misuse of intelligence? Again with the benefit of hindsight, could the practice of journalism have done more to protect Dr Kelly? Is confidentiality so absolute an obligation that journalists should not surrender that confidentiality to their editors and proprietors? And does confidentiality extend beyond the grave? Media academic Crooks on the ethical questions of the affair on which the Hutton Inquiry will soon report.
Public and be Damned
Authors: Cox David
Published: April 2004

Surveys show that we nowadays regard broadcasting as our primary provider of information, and in Britain broadcast journalism is a quite different proposition from its print equivalent. Its purpose is not to sell anything, even airtime. Britain's biggest journalistic operation, the BBC, pursues not profit but a tax-funded mission to advance the public weal. The belief that broadcast news is therefore to be trusted more than newspapers ensures that the nation turns to it automatically in times of crisis.

But it is not only Alastair Campbell who considers the BBC to have strayed from its proper path in its dealings with the late doctor. Some of the BBC's Governors have apparently been wondering whether the corporation "should stick to reporting news, instead of trying to make it". Yet broadcast news chiefs have thus become understandably determined to enhance the popular appeal of their output. Endless visual rejigs, an influx of nubile newsreaders and the prioritisation of celebrity gossip bear witness to this ambition. The kind of engagement and sensation which seem to work in print have seemed another obvious way to put bums on sofas. If this has had to mean sacrificing central features of the traditional order, that has been considered a price worth paying.
Pick Your Fights Carefully
Authors: Lindley Richard
Published: April 2004

When the row between Government and the Today programme erupted, Lindley felt again that moment of nervousness that was familiar to him and most of his contemporaries at Panorama, the BBC current affairs flagship that is celebrating its fiftieth anniversary. The fact that they were often paranoid did not always mean that somebody wasn't out to get them, he recalls - "We might have felt pleased and proud to have got a story on air but we knew there would be repercussions, and sometimes we could not tell how far our colleagues and our bosses in the BBC would support us. Occasionally, facing hostile reaction, we might wish we'd told the story just slightly differently."
Chill Wind in Zimbabwe
Authors: Nyaira Sandra
Published: April 2004

Zimbabwean journalists Nyaira tells how she faces an unexpected winter in the United Kingdom - because her Government has closed down the paper she work a for. The news editor of The Daily News - the only independent daily newspaper in the country - had been attending City University in London when she heard from home that the paper had been closed. A personal and vivid portrait of the atrocities being carried out and the suppression of the media under Robert Mugabe.
United We Fall
Authors: Collins Patrick
Published: April 2004

The chief sportswriter of the Mail on Sunday laments the changes in football writing demanded by a sport now totally dominated by money. The relationship between reporters and players are now conducted through staged press conferences and copy-controlled interviews, he says. Players can no longer confide their problems to sympathetic ears and writers are no longer privy to the stresses of the professional game. And so, concludes Collins, everybody loses.
Putting Ourselves Beyond Reproach
Authors: Brunson Michael
Published: April 2004

The former ITV political editor looks back on the Hutton report and comments: "When governments fight the political battle with the intensity shown in Britain since May 1997, peacetime complaints can be just as voluminous as those that arise during a time of conflict. Peacetime procedures for handling them need to be equally robust. As the Phillis inquiry concluded, a greater willingness to separate fact from comment and entertainment might do the media a power of good, but so might "a greater willingness to admit and to correct mistakes and inaccuracies. However, if [Andrew] Gilligan's mistake and the consequences that still may flow from it affect us all, it should only be in the sense that it provides us with a chance for a great strengthening of British journalism."
For the Sake of the Children
Authors: Frost Chris
Published: April 2004

The general view within the media seems to be that if we are unable to publish names and other identification of children, often as young as 10 or 11, who are brought before the courts accused of minor crimes, then the story is not worth running, claims Frost. But why should this be so? he asks. "When children are named in these circumstances, is it really a famous victory for press freedom - the reporting David versus the courtroom Goliath - that the press portrays, or simply an invasion into the privacy of vulnerable youngsters?"
Risky Business
Authors: Harrabin Roger
Published: April 2004

The BBC had been examining news accuracy and responsibility for the information it broadcasts since long before the Hutton bodyblow. As part of the continuous examination of standard and revision of work practices in the multi-media age, new guidance designed to avoid accusations of scaremongering - particularly in stories concerning health issues - have been introduced. The defence of a world-famous brand, the BBC claims, is an ongoing process. Roger Harrabin, an architect of the health document, explains how reporters can get it right all of the time.
Tabloids: Only the Beginning
Authors: Preston Peter
Published: April 2004

The former editor of The Guardian applauds the recent decisions by The Independent and The Times to produce tabloid editions and writes: "The quality tabloid revolution will roll on, giving a surge of adrenaline, showing what's possible when you produce newspapers, which, in shape or pace, fit readers' lives. It is a natural step beyond the tabloid feature second sections The Guardian began over a decade ago. It puts the wishes and habits of young, busy readers first... It may shake up the middle market mightily as the Mail and Express face challenges from above as well as below. It could see chunks of current redtop readership migrate to The Independent or The Guardian..."
Racist, or Just Animal Crackers?
Authors: Charles Alec
Published: April 2004

University lecturer Charles reports how the media is full of stories about invading squirrels. One such report told how a local councillor proposed increased security measures at the usual ports of entry - overhanging trees should be pruned, commenting: "When I was a lad you didn't see squirrels coming into town - now we're inundated with them.... One woman told me she got surrounded by six squirrels.... One's OK, but five or six is a bit of a problem." Was the man is merely parroting racist phrases? asks Charles, contrasting his comments with those of the BNP's David Guynan: "This town is turning completely into a foreign land.... It's like the grey squirrels taking over. I'm a red squirrel, that's what I am." Writes Charles: Is this analogy of immigrants and asylum-seekers as grey squirrels merely a modern retelling of the Nazi metaphor of Jews as rats? There's an old joke: "What are the two differences between a squirrel and a rat? A bushy tail and a good PR guy." And these days the greys aren't getting great PR.
‘Original Narcissism’ Or the Shadow of a Philosophy of History
Authors: Cotti Patricia
Published: April 2004

Upon reading again the third chapter of Totem and Taboo it becomes clear that it was the English eighteenth-century philosophers and their followers who inspired in Freud his conception of a universal history of man’s evolution. This paper analyses, in particular, the links between this Weltanschauung and notions such as narcissism, omnipotence of thoughts and the Freudian ‘history of the libido’s development’ ( Entwicklungsgeschichte der Libido ), the latter usually being considered as the results of clinical observations.