bluuebunny/crossref_metadata_2025 huggingface dataset:
Coping with Time
Authors: Haandrikman Karen , Rajeswari N. V. , Hutter Inge , Ramesh B. M.
Published: September 2004

Reproductive health surveys often face difficulties in measuring age and durations. Heaping is the phenomenon that certain dates, ages or durations are over-or underrepresented. Following the calendar method used in several Demographic and Health Surveys, the current research proposes the use of a local timepath calendar, based on time perceptions of women in South India. The objective of the calendar is to reduce heaping in the durations of postpartum amenorrhoea, breastfeeding, postpartum abstinence, and contraceptive use. The interviewer takes the respondent back in time using the local calendar; the memory of respondents is triggered by relating events to Indian festivals and other landmarks in the lives of people, enabling them to reply in their own time perspective. The method was tested in 2000 in a survey in South India; the findings indicate significantly less duration heaping.
Damage Identification in Aging Aircraft Structures with Piezoelectric Wafer Active Sensors
Authors: Giurgiutiu Victor , Zagrai Andrei , Bao Jingjing
Published: September 2004

Piezoelectric wafer active sensors can be applied to aging aircraft structures to monitor the onset and progress of structural damage such as fatigue cracks and corrosion. Two main detection strategies are considered: (a) the wave propagation method for far-field damage detection; and (b) the electro-mechanical (E/M) impedance method for near-field damage detection. These methods are developed and verified on simple-geometry specimens, and then tested on realistic aging-aircraft panels with seeded cracks and corrosion. The specimens instrumentation with piezoelectric-wafer active sensors and ancillary apparatus is presented. The experimental methods, signal processing, and damage detection algorithms, tuned to the specific method used for structural interrogation, are discussed. In the wave propagation approach, the pulse-echo and acousto-ultrasonic methods were considered. Reflections from seeded cracks were successfully recorded. In addition, acoustic emission and low-velocity impact were also detected. In the E/M impedance method approach, the high-frequency spectrum is processed using overall-statistics damage metrics. The (1- R2)3 damage metric, where R is the correlation coefficient, was found to yield the best results. The simultaneous use of the E/M impedance method in the near field and of the wave propagation method in the far field opens the way for a comprehensive multifunctional damage detection system for aging aircraft structural health monitoring.
Active Vibration Control of a High Speed Rotor Using PZT Patches on the Shaft Surface
Authors: Horst H.-G. , Wölfel H. P.
Published: September 2004

This paper describes the development of a structural model of a high speed rotor for the examination of active vibration control in rotor dynamics. Suppression of lateral bending vibrations of the elastic shaft is realized by means of surface-bonded piezoceramic actuator patches on the shaft surface. Models for actuator implementation are derived. Simulations demonstrate the effectiveness of this approach. To validate the simulation, a rotor test-rig was built. The characteristics of the system model with implemented actuators are compared to experimental tests. Both results show good agreement.
Adaptive Neurocontrollers for Vibration Suppression of Nonlinear and Time Varying Structures
Authors: Jha Ratneshwar , He Chengli
Published: September 2004

Neural network based control systems with online adaptation are capable of coping with system uncertainty, nonlinearity, and variations with time. The current article presents a comparison of neurocontrollers with a standard LQR control system for vibration reduction. Controller performances are tested using an experimental setup employing a cantilevered plate with surface bonded PZT actuators. The large accelerations due to sinusoidal (first and second mode) disturbances cause geometric nonlinearity. Time variations of system dynamics (by adding mass or attaching modification plate) and external excitations are investigated. The results are presented in both time and frequency domains and the measurement uncertainties are identified. The results show that neural adaptive predictive controller is very promising in terms of control effectiveness and control effort in the vibration suppression of nonlinear, time varying smart structures.
Parallel Robots with Adaptronic Components
Authors: Rose M. , Keimer R. , Breitbach E. J. , Campanile L. F.
Published: September 2004

Performance in high-speed mechanisms can be increased by means of a lightweight design. But, quite often, the resulting structures have the drawback of being susceptible to vibrations. This can be overcome by applying a smart-structures technology.

In this work, an application to parallel mechanisms is presented, in which undesired vibrations are reduced by integrated piezoceramic (PZT) actuators and sensors, which are driven by a proper control system. As a basis for the development of suitable control laws, a proper simulation approach is to be used which is capable to model the mechanism’s dynamic behavior correctly, taking into account large motions. The multibody approach fulfills these requisites.

The paper deals with the development of a fast C++-coded S-function in MATLAB/SIMULINK for a “five revolute joint” mechanism chosen as a test platform. This routine incorporates a multibody model with changing states. The flexibility of the bodies is taken into account in a modal form. The corresponding parameters are read from data files which can be generated by suitable preprocessors of proprietary multibody software packages like SIMPACK. The created model is compared with an equivalent SIMPACK-model and an interpolation-based control strategy is discussed.
Analytical and Numerical Modelling of Laminated Composites with Piezoelectric Elements
Authors: Fernandes Amâncio , Pouget Joël
Published: September 2004

We propose an accurate and efficient approach to laminated piezoelectric plates based on a refinement of elastic displacement and electric potential through the plate thickness. More precisely, the model accounts for a shearing function and a layerwise approximation for the electric potential. The layerwise approach becomes a necessity in order to accommodate electric potential at the electrode interfaces. The equations of motion for the piezoelectric composite are deduced from a variational formulation incorporating the continuity conditions at the layer interfaces by using Lagrange multipliers. Different situations are investigated among them (i) bimorph and (ii) sandwich structures for two kinds of electro-mechanical loads applied (density of force and electric potential) and are compared to the finite element computations performed on the 3D model. The vibration problem is also presented and the frequencies for the axial and flexural modes are obtained. At last performance and effectiveness of the model are also discussed and applications to control of the structure shape and vibration are proposed.
Modeling and Analysis of Active Flap Using Coiled Bender Piezoelectric Actuators
Authors: Vasilescu Roxana , Dancila D. Stefan
Published: September 2004

The applicability and effectiveness of three novel piezoelectric coiled bender actuators to deflect a plain trailing edge flap on a straight wing in the presence of incompressible flow airloads is investigated in this paper through analytical modeling. This work builds upon previous research in which the three actuator configurations, the linear spiral type, the helicoidal type, and the hybrid type, have been proposed and analytically modeled, and the first two configurations have been experimentally validated. A simple analytical model for the piezoelectrically actuated flap is developed and used for this investigation. Results show that the use of coiled piezoelectric actuators for flap deflection is an effective approach. The variation of flap deflection angles with applied actuation voltage and wing angle of attack is also shown, together with performance envelopes.
Strategies Used by Low-Income Mexican Women to Deal with Miscarriage and “Spontaneous” Abortion
Authors: Erviti Joaquina , Castro Roberto , Collado Ana
Published: September 2004

This study focuses on lowest income Mexican women attended for abortion-related complications in a public hospital. The objective was to investigate the women’s experience of having a so-called “spontaneous” abortion and their related strategies to avoid stigmatization. Four strategies emerge from women’s testimonies: presenting themselves as women who “play by the rules,” pleading ignorance of the pregnancy, stating that they had already accepted their pregnancy, or presenting the abortion as the result of an accident. Women use these strategies to deflect any blame to which they might be subjected and as a means of dealing with the stigma attached to a behavior that transgresses social norms regarding reproduction. Far from being passive receptors of the social imperative, which makes motherhood compulsory, women oscillate strategically within the margins of a seemingly uniform normative discourse and thereby ensure their moral survival. The authors discuss results within the framework of praxis theory.
Struggling with Recovery: Participant Perspectives on Battling an Eating Disorder
Authors: D’Abundo Michelle , Chally Pamela
Published: September 2004

Recovery from an eating disorder encompasses a complex matrix of mental, physical, and social factors. Although methodological differences affect rates of reported recovery (from 24 to 76%), many women are not experiencing full recoveries from eating disorders. This trend is apparent in persons who discontinue severely destructive behaviors but continue to exhibit psychiatric problems and impairment in social and occupational roles. The purpose of this grounded theory study was to provide an explanatory schema about recovery. Data collection included 17 interviews, a focus group, and participant observation. Findings included repeating wavelike patterns of disease and recovery that seldom returned to a state of normal eating but, instead, remained at a level of atypical eating.
The Effects of Child Maltreatment on the Hypothalamic-Pituitary-Adrenal Axis
Authors: van voorhees Elizabeth , Scarpa Angela
Published: September 2004

Abnormal functioning of the hypothalamic-pituitary-adrenal (HPA) axis, a critical mammalian stress response system, has been associated with emotional responses such as anxiety and depression, as well as with behavioral and cognitive processes such as aggression, learning and memory deficits, and failure of response inhibition. This review examines the evidence for HPA axis dysregulation related to childhood maltreatment. It is concluded that child maltreatment may lead to disruptions in HPA axis functioning, and that factors such as age of maltreatment, parental responsiveness, subsequent exposure to stressors, type of maltreatment, and type of psychopathology or behavioral disturbance displayed may influence the degree and patterning of HPA disturbance.
Intimate Partner Violence and Sexual Assault in Native American Communities
Authors: Wahab Stéphanie , Olson Lenora
Published: September 2004

Previous studies indicate that Native American women experience the highest rate of violence of any ethnic or racial group in the United States. This article addresses the prevalence of intimate partner violence and sexual assault among Native Americans. We present significant substantive and methodological issues that inform research on violence in the lives of Native Americans, as well as existing interventions. Interventions discussed in this article fall within three major categories including those that are community based, those grounded in the public health and health care systems, and those grounded in federal and national organizations. We provide some examples of interventions from each of these three levels of direct service, including a brief discussion of barriers to service accessibility. We conclude with substantive and methodological recommendations for research and practice.
Transformative Education in a Poststructuralist Perspective
Authors: Steinnes Jenny
Published: September 2004

Inspired by the philosopher Jacques Derrida and Finnegans Wake by James Joyce, this article is an attempt to bring perspectives taken from the language critique of poststructuralism into the field of transformative education. This might make a serious and thorough treatment of the wordtransformative possible, trying to prevent ideologies to be more or less blindly reinscribed into the field, presenting a deconstructive attitude and an ability for political inventiveness at the very core of transformative education.
Dancing on the Threshold of Meaning
Authors: Berger Jennifer Garvey
Published: September 2004

This thinking paper uses theory and data to begin to map the terrain of transformation, particularly the threshold of transformation, the growing edge of peoples’ thinking and sense making. The author reanalyzed a set of interview data from several studies, paying attention to those places when participants reached the edges of their meaning making. She offers three examples of those places as well as an analysis of the different ways participants experienced their growing edge. She suggests that the work of a transformative teacher is first to help students find the edge of their understanding, second to be company at that edge, and finally help students construct a new, transformed place. Ultimately, she argues, this process will help students find the courage they need to transform.
Splenic lymphoma with villous lymphocytes, associated with type II cryoglobulinemia and HCV infection: a new entity?
Authors: Saadoun David , Suarez Felipe , Lefrere François , Valensi Françoise , Mariette Xavier , Aouba Achille , Besson Caroline , Varet Bruno , Troussard Xavier , Cacoub Patrice , Hermine Oliver
Published: September 2004

Hepatitis C virus (HCV) has been associated with the development of B-cell non-Hodgkin lymphomas. We recently reported the regression of splenic lymphoma with villous lymphocytes (SLVL) in patients with HCV after antiviral treatment, demonstrating a direct role of HCV in lymphomagenesis. This study expands our previous results in 18 patients with chronic HCV and SLVL. Mixed cryoglobulinemia (MC) was present in all cases and was symptomatic in 13 (72%). All patients were treated with interferon alone or in association with ribavirin. Hematologic and virologic responses were correlated. Fourteen (78%) patients achieved a sustained complete hematologic response after clearance of HCV RNA. Two patients had a virologic partial response and achieved a complete hematologic response. Two virologic nonresponders achieved partial hematologic response. Regardless of the response, monoclonal immunoglobulin gene rearrangement persisted after treatment. This study underscores the role of HCV in the lymphomagenesis and the benefit of antiviral treatment for patients presenting with HCV-driven lymphoproliferations.
Artificial neural network approach for selection of susceptible single nucleotide polymorphisms and construction of prediction model on childhood allergic asthma
Authors: Tomita Yasuyuki , Tomida Shuta , Hasegawa Yuko , Suzuki Yoichi , Shirakawa Taro , Kobayashi Takeshi , Honda Hiroyuki
Published: September 2004

Background

Screening of various gene markers such as single nucleotide polymorphism (SNP) and correlation between these markers and development of multifactorial disease have previously been studied. Here, we propose a susceptible marker-selectable artificial neural network (ANN) for predicting development of allergic disease.

Results

To predict development of childhood allergic asthma (CAA) and select susceptible SNPs, we used an ANN with a parameter decreasing method (PDM) to analyze 25 SNPs of 17 genes in 344 Japanese people, and select 10 susceptible SNPs of CAA. The accuracy of the ANN model with 10 SNPs was 97.7% for learning data and 74.4% for evaluation data. Important combinations were determined by effective combination value (ECV) defined in the present paper. Effective 2-SNP or 3-SNP combinations were found to be concentrated among the 10 selected SNPs.

Conclusion

ANN can reliably select SNP combinations that are associated with CAA. Thus, the ANN can be used to characterize development of complex diseases caused by multiple factors. This is the first report of automatic selection of SNPs related to development of multifactorial disease from SNP data of more than 300 patients.
Most of the extant mtDNA boundaries in South and Southwest Asia were likely shaped during the initial settlement of Eurasia by anatomically modern humans
Authors: Metspalu Mait , Kivisild Toomas , Metspalu Ene , Parik Jüri , Hudjashov Georgi , Kaldma Katrin , Serk Piia , Karmin Monika , Behar Doron M , Gilbert M Thomas P , Endicott Phillip , Mastana Sarabjit , Papiha Surinder S , Skorecki Karl , Torroni Antonio , Villems Richard
Published: September 2004

Background

Recent advances in the understanding of the maternal and paternal heritage of south and southwest Asian populations have highlighted their role in the colonization of Eurasia by anatomically modern humans. Further understanding requires a deeper insight into the topology of the branches of the Indian mtDNA phylogenetic tree, which should be contextualized within the phylogeography of the neighboring regional mtDNA variation. Accordingly, we have analyzed mtDNA control and coding region variation in 796 Indian (including both tribal and caste populations from different parts of India) and 436 Iranian mtDNAs. The results were integrated and analyzed together with published data from South, Southeast Asia and West Eurasia.

Results

Four new Indian-specific haplogroup M sub-clades were defined. These, in combination with two previously described haplogroups, encompass approximately one third of the haplogroup M mtDNAs in India. Their phylogeography and spread among different linguistic phyla and social strata was investigated in detail. Furthermore, the analysis of the Iranian mtDNA pool revealed patterns of limited reciprocal gene flow between Iran and the Indian sub-continent and allowed the identification of different assemblies of shared mtDNA sub-clades.

Conclusions

Since the initial peopling of South and West Asia by anatomically modern humans, when this region may well have provided the initial settlers who colonized much of the rest of Eurasia, the gene flow in and out of India of the maternally transmitted mtDNA has been surprisingly limited. Specifically, our analysis of the mtDNA haplogroups, which are shared between Indian and Iranian populations and exhibit coalescence ages corresponding to around the early Upper Paleolithic, indicates that they are present in India largely as Indian-specific sub-lineages. In contrast, other ancient Indian-specific variants of M and R are very rare outside the sub-continent.
Effects of age and leg length upon central loop of the Gastrocnemius-soleus H-reflex latency
Authors: Sadeghi Shahram , Ghavanini Mohammadrezaalavian , Ashraf Alireza , Jafari Peyman
Published: September 2004

Background

central loop of the gastrocnemius-soleus H-reflex latency (Tc) that looks promising in the diagnosis of S1 radiculopathy; has been investigated in a few studies and only two of them have focused on the constitutional factors affecting it. Although leg length has been shown to contribute to the Tc, the role of age is controversial. More confusing, none of the previously performed studies have used strict criteria to rule out subclinical neuropathy, so the results could be misleading. This study has been performed to determine the influence of leg length and age on Tc among a carefully selected group of healthy volunteers.

Methods

after screening forty six volunteers by taking history, physical examination and a brief electrophysiologic study; forty of them were selected to enroll into the study. Tc was obtained in all the study subjects and leg length and age were recorded for correlational analyses.

Results

this group was consisted of 26 males (65%) and 14 females (35%) with the age range of 19–65 years (Mean ± SD: 37 ± 10.7) and leg length range of 29.5–43 centimeters (36.4 ± 3.4).

Mean ± SD for Tc was 6.78 ± 0.3. We found a significant correlation between Tc and leg length (p value= 0.003, r = 0.49 and confidence interval 95% = 0.59–0.88), no significant correlation was found between age and Tc (p value= 0.48, r = 0.11), also we obtained the regression equation as: Tc = 0.04L + 5.28

Conclusions

in contrast to leg length, age was not correlated with Tc. Future studies are required to delineate other contributing factors to Tc.
Lactobacillus caseistrain GG in the treatment of infants with acute watery diarrhea: A randomized, double-blind, placebo controlled clinical trial [ISRCTN67363048]
Authors: Salazar-Lindo Eduardo , Miranda-Langschwager Percy , Campos-Sanchez Miguel , Chea-Woo Elsa , Sack R Bradley
Published: September 2004

Background

Adjuvant therapy to ORT with probiotic bacteria for infants with acute watery diarrhea has been under active investigation. Most studies have been done in the developed world showing benefit only for viral mild gastroenteritis. We evaluated the effect of a milk formula containing one billion (109) cfu/ml of Lactobacillus casei strain GG (LGG) upon duration and severity of diarrhea in infants in an environment with more severe acute diarrhea, where etiologic agents other than rotavirus are involved more frequently, and where mixed infections are more prevalent.

Methods

Male infants aged 3–36 months brought for treatment of acute watery diarrhea of less than 48 hours were eligible. After rehydration was completed with the WHO's oral rehydration solution, patients were randomly assigned to receive a milk formula either containing LGG or not. Stool volume was periodically measured using a devise suited to collect stools separate from urine. Duration of diarrhea was estimated based on stools physical characteristics.

Results

Eighty nine patients received the placebo milk formula and ninety received the LGG containing formula. Both groups were comparable in their baseline characteristics. Total stool output was significantly larger (p = 0.047) in the LGG group (247.8 ml/kg) than in the placebo group (195.0 ml/kg). No significant differences were found in duration of diarrhea (58.5 hours with LGG vs. 50.4 hours with placebo), rate of treatment failure (21.1% with LGG vs. 18.0% with placebo), and proportion of patients with unresolved diarrhea after 120 hours (12.2% with LGG vs. 12.5% with placebo). The rate of stools with reducing substances after 24 hours of treatment increased significantly in both groups (from 41.4% to 72.2% with LGG and from 45.9% to 68.0% with placebo).

Conclusion

This study did not show a positive effect of LGG on the clinical course of acute watery diarrhea. Positive beneficial effects of LGG, as had been reported elsewhere, could have been masked in our study by worsening diarrhea due to transient lactose malabsorption. Further studies with low-lactose or non-lactose conveyors of LGG are desirable.
Strategies for the recovery of active proteins through refolding of bacterial inclusion body proteins
Authors: Vallejo Luis Felipe , Rinas Ursula
Published: September 2004

Recent advances in generating active proteins through refolding of bacterial inclusion body proteins are summarized in conjunction with a short overview on inclusion body isolation and solubilization procedures. In particular, the pros and cons of well-established robust refolding techniques such as direct dilution as well as less common ones such as diafiltration or chromatographic processes including size exclusion chromatography, matrix- or affinity-based techniques and hydrophobic interaction chromatography are discussed. Moreover, the effect of physical variables (temperature and pressure) as well as the presence of buffer additives on the refolding process is elucidated. In particular, the impact of protein stabilizing or destabilizing low- and high-molecular weight additives as well as micellar and liposomal systems on protein refolding is illustrated. Also, techniques mimicking the principles encountered during in vivo folding such as processes based on natural and artificial chaperones and propeptide-assisted protein refolding are presented. Moreover, the special requirements for the generation of disulfide bonded proteins and the specific problems and solutions, which arise during process integration are discussed. Finally, the different strategies are examined regarding their applicability for large-scale production processes or high-throughput screening procedures.
Polyphosphoinositides suppress the adhesion of Haemophilus influenzae to pharyngeal cells
Authors: Liu Jim-Wen R , Anderson Steve N , Meulbroek Jonathan A , Hwang Shie-Ming , Mukerji Pradip , Huang Yung-Sheng
Published: September 2004

Background

One of the primary causes of otitis media (OM), an inflammation of the middle ear, is the bacterium Haemophilus influenzae (HI). OM often occurs to young children, and is mostly treated with antibiotics. Due to concerns over bacterial resistance toward antibiotics, reliable prophylactic treatments such as administrating anti-adhesion agents are now viewed as viable alternatives.

Results

The present study tested the feasibilty of using phosphoinositides as anti-adhesion agents against HI cells. Cells of non-typeable HI were radiolabeled with 111- indium-oxine, pre-incubated with various individual phosphoinositides for 15 minutes at 37°C, and incubated with a monolayer of human pharynx carcinoma (DT 562) cells for 20 minutes at 37°C. The result showed that at 0.1 mg/mL dipalmitoylphosphatidylinositol-3,4-diphosphate (PI-3,4-PP) had the highest anti-adhesion activity, followed by phosphatidylinositol-3-phosphate (PI-3-P) and phosphatidylinositol-4-phosphate (PI-4-P). The anti-adhesion activity of PI-3,4-PP was dose-dependent ranging from 0.006 to 0.1 mg/mL. In addition, results from an in vivo study demonstrated that pre-incubation of HI cells with PI-3,4-PP at 1 mg/mL suppressed the growth of HI in nasopharynx of neonatal rats.

Conclusions

These findings suggest that PI-3-P and PI-4-P and more so PI-3,4-PP may serve as prophylactic agents against HI adhesion and colonization.
Disability weights for the burden of oral disease in South Australia
Authors: Brennan David S , Spencer A John
Published: September 2004

Background

Australian burden of disease estimates appeared inconsistent with the reported repetitive and ubiquitous nature of dental problems. The aims of the study were to measure the nature, severity and duration of symptoms for specific oral conditions, and calculate disability weights from these measures.

Methods

Data were collected in 2001–02 from a random sample of South Australian dentists using mailed self-complete questionnaires. Dentists recorded the diagnosis of dental problems and provided patients with self-complete questionnaires to record the nature, severity and duration of symptoms using the EuroQol instrument. Data were available from 378 dentists (response rate = 60%).

Results

Disability weights were highest for pulpal infection (0.069), caries (0.044) and dentinal sensitivity (0.040), followed by denture problems (0.026), periodontal disease (0.023), failed restorations (0.019), tooth fractures (0.014) and tooth wear (0.011). Aesthetic problems had a low disability weight (0.002), and both recall/maintenance care and oral hygiene had adjusted weights of zero.

Conclusions

Disability weights for caries (0.044), periodontal disease (0.023) and denture problems (0.026) in this study were higher than comparable oral health conditions in the Australian Burden of Disease and Injury Study (0.005 for caries involving a filling and 0.014 for caries involving an extraction, 0.007 for periodontal disease, and 0.004 for edentulism). A range of common problems such as pulpal infection, failed restorations and tooth fracture that were not included in the Australian Burden of Disease and Injury Study had relatively high disability weights. The inclusion of a fuller range of oral health problems along with revised disability weights would result in oral health accounting for a larger amount of disability than originally estimated.
Dichotomous factor analysis of symptoms reported by UK and US veterans of the 1991 Gulf War
Authors: Nisenbaum Rosane , Ismail Khalida , Wessely Simon , Unwin Catherine , Hull Lisa , Reeves William C
Published: September 2004

Background

Factor analysis is one of the most used statistical techniques to analyze the inter-relationships among symptoms reported by Gulf War veterans. The objective of this study was to apply factor analyses to binary symptom data from the UK study of Gulf War illness and the US Air Force study of Gulf War veterans, and to compare the symptom domains derived from the distinct samples.

Methods

UK veterans of the 1991 Gulf War (n = 3,454), individuals deployed to Bosnia on U.N. peacekeeping operations (n = 1,979) and Gulf War-era servicemen (n = 2,577) who were not deployed to the Gulf were surveyed in 1997–1998, and US 1991 Gulf War veterans from four Air Force units (n = 1,163) were surveyed in 1995 to collect health characteristics including symptoms. Each sample was randomly split in half for exploratory and confirmatory dichotomous factor analyses with promax oblique rotation.

Results

Four correlated factors were identified in each of the samples. Three factors (Respiratory, Mood-Cognition, Peripheral Nervous) overlapped considerably across the UK cohorts. The Gastrointestinal/Urogenital factor in the UK Gulf cohort was noticeably different from the Gastrointestinal factor identified from the Bosnia and Era cohorts. Symptoms from Gulf War UK and U.S cohorts yielded similar Gastrointestinal, Respiratory and Mood-Cognition factors, despite differences in symptom inventories between the two surveys. A Musculoskeletal factor was only elicited from the US Gulf sample.

Conclusion

Findings of this report are consistent with those from other factor analysis studies that identified similar symptom dimensions between Gulf and non-Gulf War veterans, except that the Gastrointestinal factor in Gulf veterans included other symptom types. Correlations among factors raise the question as to whether there is a general illness, even if not unique to Gulf veterans, representing the common pathway underlying the identified factors. Hierarchical factor analysis models may be useful to address this issue.
Emergence of new SalmonellaEnteritidis phage types in Europe? Surveillance of infections in returning travellers
Authors: Nygård Karin , de Jong Birgitta , Guerin Philippe J , Andersson Yvonne , Olsson Agneta , Giesecke Johan
Published: September 2004

Background

Among human Salmonella Enteritidis infections, phage type 4 has been the dominant phage type in most countries in Western Europe during the last years. This is reflected in Salmonella infections among Swedish travellers returning from abroad. However, there are differences in phage type distribution between the countries, and this has also changed over time.

Methods

We used data from the Swedish infectious disease register and the national reference laboratory to describe phage type distribution of Salmonella Enteritidis infections in Swedish travellers from 1997 to 2002, and have compared this with national studies conducted in the countries visited.

Results

Infections among Swedish travellers correlate well with national studies conducted in the countries visited. In 2001 a change in phage type distribution in S. Enteritidis infections among Swedish travellers returning from some countries in southern Europe was observed, and a previously rare phage type (PT 14b) became one of the most commonly diagnosed that year, continuing into 2002 and 2003.

Conclusions

Surveillance of infections among returning travellers can be helpful in detecting emerging infections and outbreaks in tourist destinations. The information needs to be communicated rapidly to all affected countries in order to expedite the implementation of appropriate investigations and preventive measures.
Is HIV-1 RNA dimerization a prerequisite for packaging? Yes, no, probably?
Authors: Russell Rodney S , Liang Chen , Wainberg Mark A
Published: September 2004

During virus assembly, all retroviruses specifically encapsidate two copies of full-length viral genomic RNA in the form of a non-covalently linked RNA dimer. The absolute conservation of this unique genome structure within the Retroviridae family is strong evidence that a dimerized genome is of critical importance to the viral life cycle. An obvious hypothesis is that retroviruses have evolved to preferentially package two copies of genomic RNA, and that dimerization ensures the proper packaging specificity for such a genome. However, this implies that dimerization must be a prerequisite for genome encapsidation, a notion that has been debated for many years. In this article, we review retroviral RNA dimerization and packaging, highlighting the research that has attempted to dissect the intricate relationship between these two processes in the context of HIV-1, and discuss the therapeutic potential of these putative antiretroviral targets.
Emergency Medical Services Utilization during an Outbreak of Severe Acute Respiratory Syndrome (SARS) and the Incidence of SARS‐associated Coronavirus Infection among Emergency Medical Technicians
Authors: Chow‐In Ko Patrick , Chen Wen‐Jone , Huei‐Ming Ma Matthew , Chiang Wen‐Chu , Su Chan‐Ping , Huang Chien‐Hua , Lu Tsung‐Chien , Shih Fuh‐Yuan , Lin Fang‐Yue
Published: September 2004

Objectives: This was a study to evaluate the utilization of emergency medical services (EMS) systems during the outbreak of severe acute respiratory syndrome (SARS), and to assess the incidence of infection among emergency medical technicians (EMTs). Methods:This was a prospective, observational study conducted in the EMS system of Taipei, Taiwan. Probable/suspect cases of SARS were defined by World Health Organization criteria. SARS‐related transports were categorized into 1) requests from hospitals for probable/suspect cases of SARS, 2) quarantined individuals, and 3) febrile persons. City ambulances were organized into teams A, B, and C for transports of different perceived risks. Data on the EMS volume, the transport category, the final SARS status of patients, and the EMT responsible for the transports were collected. The EMS projected volume was computed by previous years' data and compared with that collected. The SARS incidence among EMTs was assessed by investigating probable SARS (P‐SARS) and by surveying the seroprevalence of SARS‐associated coronavirus (SARS‐CoV) antibody. Results: From March 18 to June 19, 2003, there were 7,961 EMS transports, similar to the volume projected from previous years (7,506) (95% CI = 6,688 to 8,324). Of these, 1,760 (22.1%) were SARS‐related. When SARS‐related transports were excluded, there was a 12.2% decrease (95% CI = 11.4% to 12.9%) in EMS activities. Requests from hospitals, quarantined individuals, and febrile citizens accounted for 23%, 18%, and 59% of SARS‐related transports. Among the 397 P‐SARS cases in the city of 2.65 million people (incidence 0.01%, 95% CI = 0.01% to 0.02%), 138 (35%) required EMS transports. Two EMTs working in team C, the team with the lowest risk, developed P‐SARS. One of them died soon thereafter. The incidence of P‐SARS was 0.6% (95% CI = 0.2% to 2.2%), or 0.1% (95% CI = 0.03% to 0.4%) per transport. SARS‐CoV serology was available in 74.1% of EMTs who were alive. In addition to the surviving P‐SARS EMT, one EMT from team A, the team with the highest risk, was seropositive. Combining P‐SARS and the seropositive case, three EMTs were infected (incidence 1.3%, 95% CI = 0.4% to 3.6%). No patient transported by the infected EMTs developed SARS. The hospitals serving EMS by the infected EMTs had been involved in a clustered outbreak prior to the EMTs' infections. Conclusions: During the outbreak of SARS, the overall EMS volume did not change significantly, but the non‐SARS EMS activities decreased. Compared with the general population, EMS providers are at higher risk of contracting the SARS virus regardless of different perceived levels of risk. Standard protections and procedures for infection control should be strictly followed during transport and within the hospital environment.
Prevalence of Elevated Troponin I in End‐stage Renal Disease Patients Receiving Hemodialysis
Authors: Donnino Michael W. , Karriem‐Norwood Varnada , Rivers Emanuel P. , Gupta Ajay , Nguyen H. Bryant , Jacobsen Gordon , McCord James , Tomlanovich Michael C.
Published: September 2004

Objectives: Patients with end‐stage renal disease (ESRD) who are receiving hemodialysis have an increased incidence of atherosclerotic heart disease. Currently, there is considerable controversy regarding the significance of elevated cardiac troponin I (cTnI) levels in patients with ESRD. The objective of this study was to examine the prevalence of elevated cTnI levels in asymptomatic patients with ESRD on hemodialysis. Methods:This was a prospective cohort study at an urban hospital outpatient dialysis center. Serum was collected pre‐ and postdialysis from patients on dialysis at this center over a two‐week period. Samples were batched and analyzed for cTnI using the Asxym fluorescent antibody test. An elevated cTnI level was defined as >0.8 ng/dL. Results: Predialysis cTnI levels ranged from <0.1 to 0.7 ng/dL, and postdialysis cTnI levels ranged from <0.1 to 0.6 ng/dL. None of the patients had a cTnI level >0.8 ng/dL. Conclusions: cTnI levels are not falsely elevated in patients with ESRD on hemodialysis. In a patient with ESRD, myocardial injury should be suspected if his or her cTnI level is >0.8 ng/dL.
Assessment of Resident Professionalism Using High‐fidelity Simulation of Ethical Dilemmas
Authors: Gisondi Michael A. , Smith‐Coggins Rebecca , Harter Phillip M. , Soltysik Robert C. , Yarnold Paul R.
Published: September 2004

Objectives: To examine the responses of emergency medicine residents (EMRs) to ethical dilemmas in high‐fidelity patient simulations as a means of assessing resident professionalism. Methods:This cross‐sectional observational study included all EMRs at a three‐year training program. Subjects were excluded if they were unable or unwilling to participate. Each resident subject participated in a simulated critical patient encounter during an Emergency Medicine Crisis Resource Management course. An ethical dilemma was introduced before the end of each simulated encounter. Resident responses to that dilemma were compared with a professional performance checklist evaluation. Multiresponse permutation procedure analysis was used to compare performance measures between resident classes, with the a priori hypothesis that mean performance should increase as experience increases. Results: Of the 30 potential subjects, 90% (27) participated. The remaining three residents were unavailable due to scheduling conflicts. It was observed that senior residents (second and third year) performed more checklist items than did first‐year residents (p < 0.028 for each senior class). Omnibus comparison of mean critical actions completed across all three years was not statistically significant (p < 0.13). Residents performed a critical action with 100% uniformity across training years in only one ethical scenario (“Practicing Procedures on the Recently Dead”). Residents performed the fewest critical actions and overall checklist items for the “Patient Confidentiality” case. Conclusions: Senior residents had better overall performance than incoming interns, suggesting that professional behaviors are learned through some facet of residency training. Although limited by small sample size, the application of this performance‐assessment tool showed the ability to discriminate between experienced and inexperienced EMRs with respect to a variety of aspects of professional competency. These findings suggest a need for improved resident education in areas of professionalism and ethics.
SAEM Abstracts to Articles: 1997 and 1999–2001
Authors: Li Siu Fai , Umemoto Tom , Crosley Pascal , Cassidy Christine
Published: September 2004

Objectives: The Society for Academic Emergency Medicine (SAEM) annual meeting is the primary research conference in emergency medicine. An abstract presented at the 2000 SAEM meeting found a trend of decreasing publication rates of articles based on SAEM abstracts from 47% in 1995 to 33% in 1997. The authors wished to determine whether the publication rates of articles based on SAEM abstracts continued to decline since 1997. Methods:A MEDLINE search of all SAEM abstracts from 1997 and 1999–2001 was conducted. The primary outcome was the publication rates of articles based on abstracts presented each year. Secondary outcomes included comparison of publication rates by oral versus poster presentation and category of research. Results: Thirty‐eight percent of 2,054 SAEM abstracts were published as articles by fall 2003, with 40% in 1997, 40% in 1999, 38% in 2000, and 35% in 2001. The publication rate was higher for oral presentations (50%) than poster presentations (34%). Publication rates ranged from 32% to 53% by category of research; the highest rates were in wound (53%) and cardiopulmonary resuscitation/resuscitation (51%), and the lowest rates were in administration (32%) and cardiovascular (33%). Twenty‐six percent of articles were published in emergency medicine journals. The times to publication were similar across the years: 4%–7% were published in the same year of the meeting, 15%–17% one year later, 10%–11% two years later, 5% three years later, and 3%–5% after three years. Conclusions: The publication rate of articles based on SAEM abstracts has held steady at 40% in recent years when the time delay to publication is taken into account.
A Randomized Clinical Trial to Assess the Efficacy of the Epley Maneuver in the Treatment of Acute Benign Positional Vertigo
Authors: Chang Andrew K. , Schoeman Gary , Hill MaryAnn
Published: September 2004

Objectives: To compare the efficacy of the Epley maneuver with that of a placebo maneuver in patients presenting to the emergency department (ED) with benign positional vertigo (BPV). Methods:This was a prospective, randomized, single‐blind placebo‐controlled trial. Consecutive adult ED patients presenting to a university teaching hospital with BPV were randomized to treatment with either the Epley or placebo maneuver. The severity of vertigo was evaluated on a 0 to 10‐point scale before and after the maneuvers. Results: Eleven patients were randomized to the Epley group and 11 to the placebo group before the trial was terminated, based on a planned interim analysis. The median decreases in vertigo severity were 6 (95% confidence interval [95% CI] = 4 to 9) for the Epley group and 1 (95% CI = 0 to 3) for the placebo group (p = 0.001). Conclusions: The Epley maneuver is a simple bedside maneuver that appears to be more efficacious than a placebo maneuver in the treatment of acute BPV among ED patients.
Ethics Seminars: The Ethical Debate on Practicing Procedures on the Newly Dead
Authors:   The SAEM Ethics Committee, Schmidt Terri A. , Abbott Jean T. , Geiderman Joel M. , Hughes Jason A. , Johnson Catherine X. , McClure Katie B. , McKay Mary P. , Razzak Junaid A. , Salo David , Schears Raquel M. , Solomon Robert C. ,   for the SAEM Board of Directors
Published: September 2004

Emergency medicine and its academic teaching programs face an ethical dilemma surrounding the question of practicing procedures on the newly dead. For many years, procedures have been practiced on the newly dead, but few institutions have had policies addressing the practice. This article considers the ethical arguments both for and against practicing procedures on the newly dead without consent, reviews the empirical studies on the subject, and presents the positions of other professional societies, before concluding with the position of the Society for Academic Emergency Medicine (SAEM). SAEM strongly encourages all emergency medicine training programs to develop a policy and make that policy available to the institution, educators, trainees, and the public. The practice should not occur behind closed doors or on an ad hoc basis without clearly articulated guidelines. With improvements in technology, including patient simulation and virtual reality, the need for the practice may decrease, but there is no current evidence that is compelling regarding the best methods of teaching procedural skills. Given the importance of protecting trust in the profession of medicine and the existing evidence that the public would expect that consent be obtained, SAEM recommends that families be asked for consent prior to practicing procedures on the newly dead.
Hormone Therapy Impairs Endothelial Function in Postmenopausal Women with Type 2 Diabetes Mellitus Treated with Rosiglitazone
Authors: Honisett Suzy Y. , Stojanovska Lily , Sudhir Krishnankutty , Kingwell Bronwyn A. , Dawood Tye , Komesaroff Paul A.
Published: September 2004

Diabetes and ovarian senescence are associated with impaired endothelial function and altered arterial mechanical properties. Alterations in normal vascular structure and functioning are the primary cause of mortality and morbidity with type 2 diabetes. Similarly, after menopause, women experience an increase in the rate of cardiovascular disease. Thiazolidinediones have exhibited a number of antiatherogenic actions in populations with type 2 diabetes. The effect of thiazolidinediones in combination with hormone therapy (HT) in postmenopausal women is, however, unknown. To assess whether HT (transdermal estradiol 50 μg and micronized progesterone (100 mg/d) affects vascular function, 21 women receiving rosiglitazone were randomly assigned to receive HT or placebo for 12 wk in a double-blind crossover design. Measures of glycemic control, lipids, blood pressure, flow-mediated dilation, and distensibility index were undertaken at baseline and after each treatment. As a result, flow-mediated dilation was significantly reduced (15.3 ± 3.8 to 6.6 ± 1.6%, P = 0.02) with HT, whereas lipids, blood pressure, and distensibility index were unchanged. Placebo had no significant affect on any variables. Thus, the addition of HT to rosiglitazone treatment attenuates endothelial function without altering other cardiovascular risk factors. Caution should, therefore, be exercised when considering combined treatment with thiazolidinedione and HT.
Reproductive Function during Summer and Winter in Norwegian Men Living North and South of the Arctic Circle
Authors: Malm Gunilla , Haugen Trine B. , Henrichsen Trine , Bjørsvik Cathrine , Grotmol Tom , Sæther Thomas , Malm Johan , Figenschau Yngve , Hagmar Lars , Rylander Lars , Levine Richard J. , Giwercman Aleksander
Published: September 2004

Seasonal, daylight-dependent variation in human spermatozoa counts, with lowest values during summer, has been suggested. To test this hypothesis, we performed a longitudinal study of semen quality and reproductive hormone levels in Norwegian men living north and south of the Arctic Circle. An ejaculate and a serum specimen were obtained both in summer and in winter from 92 volunteers in Tromsoe (69° north latitude) and 112 in Oslo (60° north latitude). Semen analyses were performed, and serum was assayed for FSH and inhibin B. The median spermatozoa concentration in Tromsoe after adjustment for abstinence period length was 49 × 106/ml in summer and 54 × 106/ml in winter. Corresponding values for Oslo were 59 × 106/ml and 54 × 106/ml. The seasonal differences in spermatozoa concentration were not statistically significant, nor were significant differences observed in median total spermatozoa count, semen volume, percentage progressive motile spermatozoa, or FSH. In Tromsoe, but not Oslo, inhibin B concentration was slightly, but significantly (P = 0.02) higher in winter than summer (229 ng/liter vs. 223 ng/liter).

The length of the daylight period may have a slight impact on hormonal markers of spermatogenesis but does not cause substantial changes in spermatozoa numbers and motility.