bluuebunny/crossref_metadata_2025 huggingface dataset:
Safety and Effectiveness of Endovascular Therapy After 8 Hours of Acute Ischemic Stroke Onset and Wake-Up Strokes
Authors: Natarajan Sabareesh K. , Snyder Kenneth V. , Siddiqui Adnan H. , Ionita Catalina C. , Hopkins L. Nelson , Levy Elad I.
Published: July 2009

Background and Purpose—

This is a retrospective review of patients who underwent endovascular recanalization ≥8 hours after acute ischemic stroke symptom onset, including wake-up strokes, between June 2005 and June 2008.

Methods—

Thirty patients with a premorbid modified Rankin score ≤1 and NIHSS between 5 and 22 were included. All had admission CT, CTA, and CT perfusion scans to evaluate for salvageable brain tissue. Recanalization effectiveness was assessed by angiograms obtained within 30 hours after intervention. Patient, treatment characteristics, and immediate and 3-month outcomes were analyzed.

Results—

Mean NIHSS at presentation was 13 (median=12). Mean interval between time last-seen well and angiogram was 12.75 hours (median=10). Twenty-six patients (86.7%) presented with complete-to-near-complete vessel occlusion (thrombolysis in myocardial infarction [TIMI] 0/1); 4 had partial vessel occlusion (TIMI 2). Interventions included intra-arterial pharmacological thrombolysis (n=10), mechanical thrombectomy(n=21; Merci, 16; intracranial stent, 9; extracranial stent, 3), angioplasty (n=14; intracranial, 11; extracranial, 3). Nine patients received GPIIb/IIIa inhibitors (eptifibatide); all received heparin. Partial-to-complete recanalization (TIMI 2/3) was achieved in 20 patients (66.7%). Procedure-related complications included vascular perforations (n=3) and femoral access site complication (n=1). One patient had an embolic anterior cerebral artery infarct during intervention; another had progression of brain stem infarct. Symptomatic intracerebral hemorrhage occurred in 3 patients (10%), with 2 being primarily subarachnoid in location. Total in-hospital mortality including procedural mortality, disease progression, or other comorbidities was 23.3% (n=7). Mean discharge NIHSS was 9.5, representing an overall NIHSS 3.5-point improvement. Overall, mean modified Rankin score at death or last follow-up (mean=10.6 months) was 4.2. At 3 months, total mortality was 33.3% (n=10), 20% had modified Rankin score ≤2, and 33% had modified Rankin score ≤3. Among survivors, mean modified Rankin score at 3-month follow-up was 3.

Conclusion—

Our data show that delayed endovascular revascularization of carefully selected patients is safe, effective, and improves clinical outcome.
Minocycline and Tissue-Type Plasminogen Activator for Stroke
Authors: Machado Livia S. , Sazonova Irina Y. , Kozak Anna , Wiley Daniel C. , El-Remessy Azza B. , Ergul Adviye , Hess David C. , Waller Jennifer L. , Fagan Susan C.
Published: July 2009

Background and Purpose—

New treatment strategies for acute ischemic stroke must be evaluated in the context of effective reperfusion. Minocycline is a neuroprotective agent that inhibits proteolytic enzymes and therefore could potentially both inactivate the clot lysis effect and decrease the damaging effects of tissue-type plasminogen activator (t-PA). This study aimed to determine the effect of minocycline on t-PA clot lysis and t-PA–induced hemorrhage formation after ischemia.

Methods—

Fibrinolytic and amidolytic activities of t-PA were investigated in vitro over a range of clinically relevant minocycline concentrations. A suture occlusion model of 3-hour temporary cerebral ischemia in rats treated with t-PA and 2 different minocycline regimens was used. Blood–brain barrier basal lamina components, matrix metalloproteinases (MMPs), hemorrhage formation, infarct size, edema, and behavior outcome were assessed.

Results—

Minocycline did not affect t-PA fibrinolysis. However, minocycline treatment at 3 mg/kg IV decreased total protein expression of both MMP-2 (
P
=0.0034) and MMP-9 (
P
=0.001 for 92 kDa and
P
=0.0084 for 87 kDa). It also decreased the incidence of hemorrhage (
P
=0.019), improved neurologic outcome (
P
=0.0001 for Bederson score and
P
=0.0391 for paw grasp test), and appeared to decrease mortality. MMP inhibition was associated with decreased degradation in collagen IV and laminin-α1 (
P
=0.0001).

Conclusions—

Combination treatment with minocycline is beneficial in t-PA–treated animals and does not compromise clot lysis. These results also suggest that neurovascular protection by minocycline after stroke may involve direct protection of the blood–brain barrier during thrombolysis with t-PA.
Medial Medullary Infarction
Authors: Kim Jong S. , Han Young S.
Published: July 2009

Background and Purpose—

Clinical-imaging correlation and long-term clinical outcomes remain to be investigated in medial medullary infarction (MMI).

Methods—

We studied clinical, MRI, and angiographic data of 86 consecutive MMI patients. The lesions were correlated with clinical findings, and long-term outcomes, divided into mild and severe (modified Rankin scale >3), were assessed by telephone interview. Central poststroke pain (CPSP) was defined as persistent pain with visual numeric scale ≥4.

Results—

The lesions were located mostly in the rostral medulla (rostral 76%, rostral+middle 16%), while ventro-dorsal lesion patterns include ventral (V, 20%), ventral+middle (VM, 33%), and ventral+middle+dorsal (VMD, 41%). Clinical manifestations included motor dysfunction in 78 patients (91%), sensory dysfunction in 59 (73%), and vertigo/dizziness in 51 (59%), each closely related to involvement of ventral, middle, and dorsal portions, respectively (
P
<0.001, each). Vertebral artery (VA) atherosclerotic disease relevant to the infarction occurred in 53 (62%) patients, mostly producing atheromatous branch occlusion (ABO). Small vessel disease (SVD) occurred in 24 (28%) patients. ABO was more closely related to VMD (versus V+VM) than was SVD (
P
=0.035). During follow-up (mean 71 months), 11 patients died, and recurrent strokes occurred in 11. Old age (
P
=0.001) and severe motor dysfunction at admission (
P
=0.001) were factors predicting poor prognosis. CPSP, occurring in 21 patients, was closely (
P
=0.013) related to poor clinical outcome.

Conclusion—

MMI usually presents with a rostral medullary lesion, with a good clinical ventro-dorsal imaging correlation, caused most frequently by ABO followed by SVD. A significant proportion of patients remain dependent or have CPSP.
Untangling the Roots of Tolerance
Authors: Côté Rochelle R. , Erickson Bonnie H.
Published: July 2009

Past research suggests that tolerance flows from personal characteristics, diversified networks, and participation in voluntary associations. Earlier studies have never included all of these, so researchers have not explored alternative theoretical accounts of how possible causes of tolerance connect to each other and to tolerance. For example, do association members have more tolerance because association activities meet the conditions of the contact hypothesis,because members are well educated, or because association activity widens one's networks? Furthermore, both associations and social networks vary in the extent to which they provide the experiences theoretically linked to tolerance, so types of associations and types of networks should also have different effects on tolerance. Exploring these and other variations provides an enriched test of theoretical conjectures. Findings from analyses of the 2000 Canadian federal election study show that tolerance is complex, stemming from a combination of social networks, voluntary association activities, and individual attributes.
The Question of Drive VS. Motive in Psychoanalysis: a Modest Proposal
Authors: Meissner W.W.
Published: July 2009

This essay explores the possibility of an alternative hypothesis to the prevailing psychoanalytic instinctual drive theory whose theoretical and clinical validity has been variously critiqued and challenged. Arguments are suggested in support of the concept of motive as a viable alternative theory to the drive theory and as a replacement for the traditional instinctual drive model. Issues discussed include the understanding of the mind—body relation, the meaning of psychic determinism and overdetermination, the opposition of drive vs. motive (and the related distinction of cause vs. motive), the meaning of psychic energy, and the difference between the concept of drives as the source of all mental energy and the concept of personal agency. The discussion concludes with some observations on the clinical implications of these concepts.
Unethical Prescriptions: Alternative Therapies for Children With Cerebral Palsy
Authors: Weisleder Pedro
Published: July 2009

The US National Center for Complementary and Alternative Medicine (CAM) defines CAM as “a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional medicine.” The problem with said therapies is that, for the most part, their effectiveness is questionable and their side effect profile is essentially unknown. Furthermore, as stated by Rosenbaum, many CAM treatments are based on “at best, anecdotal evidence and at times rather unusual ideas about the biology of the conditions to which they are being applied.” In spite of the data shortage,Americans are forecasted to spend more than $42 billion on CAM during 2009. Using a patient for illustration purposes, the author presents 3 CAM treatments that have been advocated for children with cerebral palsy. The current scientific literature on these remedies and their purported benefit is reviewed. The article ends with a discussion on the reasons why prescribing said therapies is contrary to the concept of evidence-based medicine and the tenets of medical ethics.
Isolated Low HDL Cholesterol Emerges as the Most Common Lipid Abnormality Among Obese Adolescents
Authors: Harel Zeev , Riggs Suzanne , Vaz Rosalind , Flanagan Patricia , Harel Dalia
Published: July 2009

A 12-hour fasting lipid profile was obtained from 88 otherwise healthy obese (BMI ≥ 95%) adolescents (age 16 ± 1 years, BMI 36 ± 1 kg/m2, 55 males, 33 females, 57% Hispanic, 23% African American, 19% Caucasian, 1% Asian American). About 56% of the obese adolescents exhibited lipid abnormalities based on cutoff points established by American Heart Association (AHA) guidelines, and about 57% exhibited lipid abnormalities based on percentile values established by the Lipid Research Clinic Pediatric Prevalence Study. Isolated low high-density lipoprotein—cholesterol (HDL-C) was the most common abnormality (43% based on AHA, 36% based on the Lipid Research Clinic Pediatric Prevalence Study) among the obese adolescents with lipid disorders. While there was no significant statistical difference (SSD) between genders in the levels of total cholesterol and low-density lipoprotein—cholesterol (LDL-C), triglyceride (TG) levels were significantly higher ( P = .003) in males (120 ± 11 mg/dL) than in females (81 ± 7 mg/dL), and levels of HDL-C were significantly higher ( P = .006) in females (42 ± 2 mg/dL) than in males (35 ± 1 mg/dL). There was no SSD between races in total cholesterol and LDL-C levels. TG levels were significantly lower in African-American participants (81 ± 9 mg/ dL) compared with levels in Caucasian participants (117 ± 15 mg/dL, P ≤ .05) and with levels in Hispanic participants (112 ± 11 mg/dL, P = .03). HDL-C levels were significantly higher in African-American participants (43 ± 3 mg/dL) compared with levels in Hispanic participants (36 ± 1 mg/dL, P = .03), but there was no SSD when compared with HDL-C levels in Caucasian participants (37 ± 2 mg/dL).
Perceptions of User Involvement: a User-Led Study
Authors: Rose Diana , Fleischmann Pete , Schofield Peter
Published: July 2009

Background: User involvement in health services has been a priority for government since 1990. In mental health, concern has been expressed that involved service users (activists) are not representative of ‘ordinary’ patients.

Aims: (i) To investigate service users’ perceptions of the outcomes of user involvement in two London boroughs. (ii) To determine whether the perceptions of outcomes differ between activists and non-activists.

Method: The study was user-led. The user-researchers compiled a semi-structured interview schedule which they then administered to a sample of 40 people; 20 were defined as activists and 20 as non-activists. There were also 20 participants in each borough.

Results: Activists were aware of more user groups and forms of user involvement than non-activists. However, in terms of perceptions of the outcomes of user involvement, there was little difference between the activists and non-activists.

Discussion: There is very little extant work on the outcomes of user involvement in mental health services. This study examined this and, contrary to reservations often expressed, there was little difference between activists and non-activists.

Conclusion: This is a pilot study. Further work should examine perceptions of the outcomes of user involvement by other stakeholders, for example, front-line workers, managers, carers and commissioners.
Continuous Glucose Monitoring Technology for Personal Use
Authors: Evert Alison , Trence Dace , Catton Sarah , Huynh Peter
Published: July 2009

Purpose

The purpose of this article is to describe the development and implementation of an educational program for the initiation of real-time continuous glucose monitoring (CGM) technology for personal use, not 3-day CGMS™ diagnostic studies. The education program was designed to meet the needs of patients managing their diabetes with either diabetes medications or insulin pump therapy in an outpatient diabetes education center using a team-based approach.

Methods

Observational research, complemented by literature review, was used to develop an educational program model and teaching strategies. Diabetes educators, endocrinologists, CGM manufacturer clinical specialists, and patients with diabetes were also interviewed for their clinical observations and experience.

Results

The program follows a progressive educational model. First, patients learn in-depth about real-time CGM technology by attending a group presensor class that provides detailed information about CGM. This presensor class facilitates self-selection among patients concerning their readiness to use real-time CGM. If the patient decides to proceed with real-time CGM use, CGM initiation is scheduled, using a clinic-centered protocol for both start-up and follow-up.

Conclusions

Successful use of real-time CGM involves more than just patient enthusiasm or interest in a new technology. Channeling patient interest into a structured educational setting that includes the benefits and limitations of real-time CGM helps to manage patient expectations.
Grounding the Regime of Precarious Employment
Authors: Williams Damian T.
Published: July 2009

This ethnography of day laboring contends that to better understand how the labor process situated within the industry is regulated at the micro-level, it is necessary to move beyond studies that limit their analyses of homeless day laborers—an important subset of workers who mediate and respond to this low-road industry's bottom line imperatives—to worker grievances or the strategies they use to combat anonymity. This article shows that the reasons homeless workers see day labor as a “sensible” income-generating strategy and the ways in which they comprehend and negotiate the job queue—the central, supply-side regulatory mechanism with which they contend each day—illuminate both the ways in which they coproduce the regime of workplace discipline that regulates the temporary-labor process and contribute to the reproduction of the industry's micro-foundations. By extending the concept of “reliable contingency” to include these supply-side processes, this analysis reveals that agency loyalty is produced by a divide-and-rule dynamic that emerges from and acts back on these interpretive and interactional dynamics, creating an informal regulatory structure embedded in the hiring hall.
The Linguistic Representation of Rhetorical Function
Authors: Dahl Trine
Published: July 2009

This article deals with how economists present their new knowledge claim in the genre of the research article. In the discipline of economics today, the claim is typically included not only in the obvious results/discussion section(s) but also in three other locations of the article: the abstract, the introduction, and the conclusion. The present study considers whether the rhetorical function of each of these three text parts has an impact on the linguistic realization of the claim. The corpus consists of 25 articles from two international journals, European Economic Review and Journal of International Economics. The investigation shows that economist authors commonly draw their readers’ attention to the claim by means of signaling expressions such as Our main finding is that . . . , not only in the introduction but also in the conclusion. The simple present seems to be the preferred tense in the claim sentence, even in the conclusion ( We find . . . / We argue . . .). The discussion of these findings includes the views of discipline insiders, providing clear indications of the strategic nature of the research communication process.
Special Education Teaching as a Profession
Authors: Connelly Vincent J. , Rosenberg Michael S.
Published: July 2009

In this article, issues surrounding the status of special education teaching as a profession are investigated. First, the authors consider what makes an occupation a profession and examine the range of views of professions in American society. Second, the authors describe the evolution and developmental history of three established professions: medicine, law, and engineering. The authors then consider the developmental status of special education in relation to the histories of these three established professions. Using this information, the authors consider issues that professions typically face as they develop, including personnel supply and demand; public perception and status; and the role of the profession in personnel preparation. The authors conclude this article with a discussion of actions that will be necessary if special education teaching is to achieve the status of a profession.
A Qualitative Analysis of Teachers' and Counselors' Perceptions of the Overrepresentation of African Americans in Special Education
Authors: Shippen Margaret E. , Curtis Rebecca , Miller Alan
Published: July 2009

In this study, the authors investigate the perceptions of general educators, special educators, and school counselors on the topic of overrepresentation of minorities (specifically, African American) in special education programs. The study took place in a rural school district in south central Alabama, where overrepresentation of African American students in the category of mental retardation had been identified as a chronic problem by the Alabama State Department of Education. Participants took part in focus groups that were held separately for each identified group (e.g., general educators: n = 5; special educators: n = 4; and school counselors: n = 4). Qualitative data collected from the focus groups were examined using content analysis, resulting in the identification of multiple overlapping themes related to overrepresentation. These themes included a lack of family involvement, misinterpretation of assessment results, a lack of understanding of overrepresentation, and unclear ideas about disability characteristics. Findings from the data include a discussion of variables related to systematic bias and susceptibility to disability labeling. Implications for professional development and educator training are presented.
Accountability Online: Understanding the Web-Based Accountability Practices of Nonprofit Organizations
Authors: Saxton Gregory D. , Guo Chao
Published: July 2009

Nonprofit organizations are increasingly using Internet-based technologies to address accountability. This article presents a set of conceptual, theoretical, and empirical innovations to help understand this phenomenon. First, this article presents a conceptual framework that delineates two key dimensions of Web-based accountability practices: disclosure and dialogue. It then posits a four-factor explanatory model of online accountability incorporating organizational strategy, capacity, governance, and environment. Last, it tests the model through a content analysis of 117 U.S. community foundation Web sites combined with survey and financial data. The descriptive statistics show that the Web site has been more effectively used to provide financial and performance disclosures than to provide dialogic mechanisms for stakeholder input and interactive engagement. Our multivariate analyses, in turn, highlight capacity- and governance-related variables, especially asset size and board performance, as the most significant factors associated with the adoption of Web-based accountability practices.
Toward a Network Society
Authors: Ring Peter Smith , De Leo Francesco
Published: July 2009

Part I of the article offers “traditional” academic comment on what Raab and Kenis (2009) do say in their article about the topics they address. Then, in ways that radically depart from the normal academic discourse in such cases, Part II discusses some things that they do not “say” but which need to start to become an integral part of “regular” academic discourse on these kinds of topics by focusing on the “dark” sides of a society of networks—dark, figuratively, and dark, literally.
Heading Toward a Society of Networks
Authors: Raab Jörg , Kenis Patrick
Published: July 2009

In the essay, it is first argued that Western societies are moving towards a society of networks, i.e. a society, in which the formal, vertically integrated organization that has dominated the 20th century is replaced or at least complemented by consciously created and goal directed networks of three and more organizations (whole networks). To substantiate this proposition we describe and analyze the development of organizational forms and the subsequent scientific efforts to grasp these developments theoretically and methodologically in the last 200-300 years. Second, the current state of network theory is briefly evaluated with regard to whole networks. In a third part, future research avenues concerning the development of theories that explain the coming into being, functioning, structure, governance and dissolution of whole networks (network theories) are discussed.
Nurse Working Conditions and Nursing Unit Costs
Authors: Mark Barbara A. , Lindley Lisa , Jones Cheryl B.
Published: July 2009

The authors examined the relationship between nurse working conditions and nursing unit costs in 210 general medical, general surgical, and general medical surgical units in 112 randomly selected U.S. hospitals. Data were collected from registered nurses ( N = 3,747 and 2,878), patients ( N = 2,100), study coordinators, and secondary data sources. After controlling for relevant hospital, nursing unit, and patient characteristics, the authors found that good working conditions did not increase nursing unit costs. Teaching status was associated with higher costs, whereas larger unit size was associated with lower costs. Higher proportions of registered nurses and licensed practical nurse staffing were also associated with higher costs. Patient variables were not significantly related to costs. We suggest a variety of strategies that managers may use to improve working conditions.
Bilateral Asymmetric Popliteal Entrapment Syndrome Treated With Successful Surgical Decompression and Adjunctive Thrombolysis
Authors: Shen James , Abu-Hamad Ghassan , Makaroun Michel S. , Chaer Rabih A.
Published: July 2009

Popliteal artery entrapment syndrome (PAES) is the most common cause of lower leg claudication in patients younger than 50 years. The different types of PAES can result in different rates of arterial damage, leading to aneurysmal degeneration or occlusion. We report a rare case of a young patient presenting with asymmetrical bilateral popliteal artery entrapment. Type III PAES on the right resulted in severe limb ischemia and was treated by division of the accessory tendon and replacement of damaged artery with vein graft. On the left, the medial head of gastrocnemius was resected to release a type I PAES.
Saphenous Laser Ablation at 1470 nm Targets the Vein Wall, Not Blood
Authors: Almeida Jose , Mackay Edward , Javier Julian , Mauriello John , Raines Jeffrey
Published: July 2009

The 2 primary objectives of this study were to investigate whether the 1470-nm wavelength can close a saphenous vein painlessly and determine safety, efficacy, and side effects of the 1470-nm laser. In all, 26 limbs were treated in the Dominican Republic, with a radially-emitting fiber at low energy ranging from 20 J/cm to 30 J/cm. Perivenous anesthesia was used selectively. Then 41 veins were treated with the 1470-nm laser at 30 J/cm at 5 watts, using standard perivenous tumescent anesthesia in Miami and compared to a historical control (980 nm, 80 J/cm, and 12 watts). We demonstrated that the 1470-nm wavelength endovenous laser system could not close saphenous veins without use of anesthesia. Closure with a dramatic reduction in energy when compared to a 980-nm wavelength control demonstrated a marked reduction in postoperative pain and ecchymosis; this implies that vein-wall perforations are minimized with this system.
Control of Inferior Vena Cava Injury Using Percutaneous Balloon Catheter Occlusion
Authors: Bui Trung D. , Mills Joseph L.
Published: July 2009

Traumatic inferior vena cava (IVC) injuries are highly lethal and require prompt surgical intervention. Traditional methods of vascular control include manual compression, gentle clamping or balloon occlusion catheters. These open methods require direct dissection into the hematoma for visualization, which can lead to massive hemorrhage. We present a case of percutaneously delivered balloon catheter occlusion for vascular control prior to repair of an infrarenal IVC injury as a potential alternative. This approach achieves complete occlusion of the injury site and allow easier repair of the IVC, thereby reducing operative time and blood loss.
CT Angiography of Renal Arteriovenous Fistulae: A Report of Two Cases
Authors: Abdel-Gawad Ehab A. , Housseini Ahmed M. , Cherry Kenneth J. , Bonatti Hugo , Maged Ismaeel M. , Norton Patrick T. , Hagspiel Klaus D.
Published: July 2009

Renal arteriovenous fistulas (AVFs) are rare abnormal communications between the arterial and venous circulations that can be congenital or acquired. We describe the multidetector computed tomography angiography (MDCTA) appearance of 2 cases of renal AVF, one with the cirsoid and one with the aneurysmal subtype, and the impact of these findings on therapeutic decision making and treatment follow-up.
Partial Tendon Release for Treatment of a Symptomatic Snapping Biceps Femoris Tendon: A Case Report
Authors: Crow Scott A. , Quach Tony , McAllister David R.
Published: July 2009

Snapping of the biceps femoris tendon over the fibular head is an uncommon condition. Reported causes include an anomalous insertion of the tendon, trauma at the insertion site of the tendon, and an abnormality of the fibular head. This article reports a case of a painful snapping biceps femoris tendon in a patient without an anomalous tendon insertion or an abnormality of the fibular head. Partial release of the superior aspect of the tendon resulted in resolution of symptoms.
Annexin A2 is involved in antiphospholipid antibody-mediated pathogenic effects in vitro and in vivo
Authors: Romay-Penabad Zurina , Montiel-Manzano Maria Guadalupe , Shilagard Tuya , Papalardo Elizabeth , Vargas Gracie , Deora Arun B. , Wang Michael , Jacovina Andrew T. , Garcia-Latorre Ethel , Reyes-Maldonado Elba , Hajjar Katherine A. , Pierangeli Silvia S.
Published: July 2009

Antiphospholipid (aPL) antibodies recognize receptor-bound β2 glycoprotein I (β2GPI) on target cells, and induce an intracellular signaling and a procoagulant/proinflammatory phenotype that leads to thrombosis. Evidence indicates that annexin A2 (A2), a receptor for tissue plasminogen activator and plasminogen, binds β2GPI on target cells. However, whether A2 mediates pathogenic effects of aPL antibodies in vivo is unknown. In this work, we studied the effects of human aPL antibodies in A2-deficient (A2−/−) mice. A2−/− and A2+/+ mice were injected with immunoglobulin G (IgG) isolated from either a patient with antiphospholipid syndrome (IgG-APS), a healthy control subject (IgG-normal human serum), a monoclonal anti-β2GPI antibody (4C5), an anti-A2 monoclonal antibody, or monoclonal antibody of irrelevant specificity as control. We found that, after IgG-APS or 4C5 injections and vascular injury, mean thrombus size was significantly smaller and tissue factor activity was significantly less in A2−/− mice compared with A2+/+ mice. The expression of vascular cell adhesion molecule-1 induced by IgG-APS or 4C5 in explanted A2−/− aorta was also significantly reduced compared with A2+/+ mice. Interestingly, anti-A2 monoclonal antibody significantly decreased aPL-induced expression of intercellular cell adhesion molecule-1, E-selectin, and tissue factor activity on cultured endothelial cells. Together, these data indicate for the first time that A2 mediates the pathogenic effects of aPL antibodies in vivo and in vitro APS.
Epigenetic regulation of killer immunoglobulin–like receptor expression in T cells
Authors: Li Guangjin , Yu Mingcan , Weyand Cornelia M. , Goronzy Jörg J.
Published: July 2009

With increasing age, T cells gain expression of killer immunoglobulin–like receptors (KIRs) that transmit negative signals and dampen the immune response. KIR expression is induced in CD4 and CD8 T cells by CpG DNA demethylation suggesting epigenetic control. To define the mechanisms that underlie the age-associated preferential KIR expression in CD8 T cells, we examined KIR2DL3 promoter methylation patterns. With age, CD8 T cells developed a patchy and stochastic promoter demethylation even in cells that did not express the KIR2DL3-encoded CD158b protein; complete demethylation of the minimal KIR2DL3 promoter was characteristic for CD158b-expressing cells. In contrast, the promoter in CD4 T cells was fully methylated irrespective of age. The selectivity for CD8 T cells correlated with lower DNMT1 recruitment to the KIR2DL3 promoter which further diminished with age. In contrast, binding of the polycomb protein EZH2 known to be involved in DNMT1 recruitment was not different. Our data suggest that CD8 T cells endure increasing displacement of DNMT1 from the KIR promoter with age, possibly because of an active histone signature. The ensuing partial demethylation lowers the threshold for transcriptional activation and renders CD8 T cells more susceptible to express KIR, thereby contributing to the immune defect in the elderly.
Novel quantitative trait locus is mapped to chromosome 12p11 for left ventricular mass in Dominican families: the Family Study of Stroke Risk and Carotid Atherosclerosis
Authors: Wang Liyong , Beecham Ashley , Di Tullio Marco R , Slifer Susan , Blanton Susan H , Rundek Tatjana , Sacco Ralph L
Published: July 2009

Background

Left ventricular mass (LVM) is an important risk factor for stroke and vascular disease. The genetic basis of LVM is unclear although a high heritability has been suggested. We sought to map quantitative trait loci (QTL) for LVM using large Dominican families.

Methods

Probands were selected from Dominican subjects of the population-based Northern Manhattan Study (NOMAS). LVM was measured by transthoracic echocardiography. A set of 405 microsatellite markers was used to screen the whole genome among 1360 subjects from 100 Dominican families who had complete phenotype data and DNA available. A polygenic covariate screening was run to identify the significant covariates. Variance components analysis was used to estimate heritability and to detect evidence for linkage, after adjusting for significant risk factors. Ordered-subset Analysis (OSA) was conducted to identify a more homogeneous subset for stratification analysis.

Results

LVM had a heritability of 0.58 in the studied population (p < 0.0001). The most significant evidence for linkage was found at chromosome 12p11 (MLOD = 3.11, empirical p = 0.0003) with peak marker at D12S1042. This linkage was significantly increased in a subset of families with the high average waist circumference (MLOD = 4.45, p = 0.0045 for increase in evidence for linkage).

Conclusion

We mapped a novel QTL near D12S1042 for LVM in Dominicans. Enhanced linkage evidence in families with larger waist circumference suggests that gene(s) residing within the QTL interact(s) with abdominal obesity to contribute to phenotypic variation of LVM. Suggestive evidence for linkage (LOD = 1.99) has been reported at the same peak marker for left ventricular geometry in a White population from the HyperGEN study, underscoring the importance of this QTL for left ventricular phenotype. Further fine mapping and validation studies are warranted to identify the underpinning genes.
Contributions of myofascial pain in diagnosis and treatment of shoulder pain. A randomized control trial
Authors: Perez-Palomares Sara , Oliván-Blázquez Bárbara , Arnal-Burró Ana Mª , Mayoral-Del Moral Orlando , Gaspar-Calvo Elena , de-la-Torre-Beldarraín Mª Luisa , López-Lapeña Elena , Pérez-Benito Marina , Ara-Loriente Victoria , Romo-Calvo Laura
Published: July 2009

Background

Rotator cuff tendinopathy and subacromial impingement syndrome present complex patomechanical situations, frequent difficulties in clinical diagnosis and lack of effectiveness in treatment. Based on clinical experience, we have therefore considered the existence of another pathological entity as the possible origin of pain and dysfunction. The hypothesis of this study is to relate subacromial impingement syndrome (SIS) with myofascial pain syndrome (MPS), since myofascial trigger points (MTrPs) cause pain, functional limitation, lack of coordination and alterations in quality of movement, even prior to a tendinopathy. MTrPs can coexist with any degenerative subacromial condition. If they are not taken into consideration, they could perpetuate and aggravate the problem, hindering diagnosis and making the applied treatments ineffective.

The aims and methods of this study are related with providing evidence of the relationship that may exist between this condition and MPS in the diagnosis and treatment of rotator cuff tendonitis and/or SIS.

Method/design

A descriptive transversal study will be made to find the correlation between the diagnosis of SIS and rotator cuff tendonitis, positive provocation test responses, the existence of active MTrPs and the results obtained with ultrasonography (US) and Magnetic Renonance Imaging (MRI). A randomized double blinded clinical trial will be carried out in experimental conditions: A Protocolized treatment based on active and passive joint repositioning, stabilization exercises, stretching of the periarticular shoulder muscles and postural reeducation. B. The previously described protocolized treatment, with the addition of dry needling applied to active MTrPs with the purpose of isolating the efficacy of dry needling in treatment.

Discussion

This study aims to provide a new vision of shoulder pain, from the perspective of MPS. This syndrome can, by itself, account for shoulder pain and dysfunction, although it can coexist with real conditions involving the tendons.

Trail Registration

ISRCTN Number: 30907460
Critical illness-related corticosteroid insufficiency in patients with severe acute biliary pancreatitis: a prospective cohort study
Authors: Peng Yun-Shing , Wu Cheng-Shyong , Chen Yung-Chang , Lien Jau-Min , Tian Ya-Chung , Fang Ji-Tseng , Yang Chun , Chu Yun-Yi , Hung Chien-Fu , Yang Chih-Wei , Chen Pang-Chi , Tsai Ming-Hung
Published: July 2009

Introduction

Gallstones are the most common cause of acute pancreatitis worldwide. Patients with severe acute biliary pancreatitis (SABP) constitute a subgroup of severe acute pancreatitis (SAP) patients in whom systemic inflammation may be triggered and perpetuated by different mechanisms. The aim of this prospective investigation was to examine the adrenal response to corticotropin and the relationship between adrenal function and outcome in patients with SABP.

Methods

Thirty-two patients with SABP were enrolled in this study. A short corticotropin (250 μg) stimulation test (SST) was performed within the first 24 hours of admission to the ICU. Critical illness related corticosteroid insufficiency (CIRCI) was defined as follows: baseline value less than 10 μg/dL, or cortisol response less than 9 μg/dL.

Results

CIRCI occurred in 34.4% of patients. The patients with CIRCI were more severely ill as evidenced by higher APACHE II and SOFA scores and numbers of organ system dysfunction on the day of SST. The in-hospital mortality for the entire group was 21.9%. The CIRCI group had a higher hospital mortality rate compared to those with normal adrenal function (45.5% vs. 9.5%, P = 0.032). The hospital survivors had a higher cortisol response to corticotropin (17.4 (8.3–27.1) vs. 7.2 (1.7–12) μg/dL, P = 0.019). The cortisol response to corticotropin inversely correlated with SOFA score and the number of organ dysfunction on the day of SST. The rates of pancreatic necrosis and bacteremia were significantly higher in the CIRCI group (100% vs 42.9%, P = 0.002; 81.8% vs 23.8%, P = 0.003, respectively).

Conclusions

CIRCI is common in patients with SABP. It is associated with bacteremia, multiple organ dysfunction and increased mortality.
Reviving Witiko (Windigo): An Ethnohistory of “Cannibal Monsters” In the Athabasca District of Northern Alberta, 1878–1910
Authors: Carlson Nathan D.
Published: July 2009

An ethnohistorical examination of the Algonquian witiko (windigo) phenomenon, utilizing both previously unexamined documentary sources and oral traditions of Athabasca Cree and Métis elders, reveals that a witiko “condition” is historically verifiable, that the celebrated cannibalistic “windigo psychosis” of Algonquianists eludes proper definition as a bona fide culture-bound pathology, and finally, that no single hypothesis, as of yet, consistently accounts for this phenomenon within an internally coherent non-indigenous theory. The witiko phenomenon should be analyzed from within northern Algonquian cosmologies rather than Western perspectives if it is to be adequately accounted for in future discussions.
The “Identified Full-Bloods” In Mississippi: Race and Choctaw Identity, 1898–1918
Authors: Osburn Katherine M. B.
Published: July 2009

Federal Indian policy during the allotment era intersected with the segregated society of the Jim Crow South to create a market for Indian identity; the discourse of Indian blood was the currency of this realm. For the Mississippi Choctaws, heirs to the failed promises of allotments for Choctaws remaining in Mississippi granted by the 1830 Treaty of Dancing Rabbit Creek, a policy known as the “full-blood rule of evidence” legitimized their enrollment with the Choctaw Nation of Indian Territory following the Dawes Act. This paper analyzes how the Mississippi Choctaws negotiated ideologies of “Indian blood” during their campaign for inclusion on the Choctaw Nation rolls. Appropriating the racial language of “full-blood” as defined by the Dawes Commission, they claimed citizenship in the Choctaw Nation by virtue of their “unadulterated” ancestry, their ethnicity, their historic role as military allies of the United States, and their treaty rights. Moreover, as thousands of people clamored for enrollment, the Mississippi Choctaws asserted their status as full-bloods to distinguish themselves from those claimants whom they viewed as pretenders. The Choctaws' use of racial language thus reflected multifaceted meanings that obscured the boundaries between racial and cultural delineations of ethnic identity. It was strategic to the political moment and did not reflect significant changes in the Choctaws' cultural practices; moreover, it did not become the basis for future political divisions based on “blood.” Rather, Choctaws' racial identity as full-blood Indians was a form of political capital in their drive for tribal resurgence in the early twentieth century.
“Obvious Indian”—missionaries, Anthropologists, and the “Wild Indians” Of Cuba: Representations of the Amerindian Presence in Cuba
Authors: Yaremko Jason M.
Published: July 2009

This article examines Amerindian identity and the trope of extinction through the prism of anthropological and other representations of indigenous peoples, with a particular focus on observations of peoples labeled as “Indian” or “aboriginal” in Cuba during the nineteenth and twentieth centuries. By the nineteenth century, indigenous peoples assumed a privileged position as subjects of scientific study, but as peoples undergoing or having undergone biological and cultural decline, if not disappearance, especially in Cuba, where indigenous Taíno were (are) considered long extinct. This diminution was facilitated by anthropological paradigms, historiography, and the ideology of race. Though indigenous studies have recently advanced toward a richer, more complex and nuanced understanding of these issues, necessarily facilitated by indigenous participants, holdovers from the old theories of blood quantum and cultural essentialism endure. Paradoxically, however, representations of indigenous peoples based in these persistent paradigms, however obsolete, provide important evidence for the persistence of indigenous peoples and communities in places like Cuba.
Maravall's Post-Hegelian Roots
Authors: Gilbert-Santamaría Donald
Published: July 2009

Culture of the Baroque offers José Antonio Maravall's most comprehensive vision of the baroque in Spain as a historical phenomenon that encompasses virtually all aspects of seventeenth-century social and cultural life. Maravall's study reappraises the conventional view of the baroque as the privileged locus of Spanish literary and historical production by appealing to the secularized post-Hegelianism of Jacob Burckhardt and Heinrich Wölfflin. In particular, Maravall's analysis draws on two related elements in the post-Hegelian approach to early modern historiography that contemporary work tends to ignore or even contradict: a nominalist view of the baroque that rejects the transcendent claims of Hegelian historiography and an explicit embrace of subjectivism as the necessary condition of historical scholarship. Maravall's adherence to these foundational principles of post-Hegelian historiography illuminates the original stakes of early modern periodization and their radical deformation over time. In the process, his work not only facilitates a reassessment of many of the conventional claims made for the Spanish baroque but, more important, establishes a theoretical perspective from which to evaluate contemporary scholarship on the baroque as a historical and aesthetic concept.
Complex leadership competency in health care: towards framing a theory of practice
Authors: Ford Randal
Published: July 2009

Many analysts characterize the health-care industry and health-care systems as complex adaptive organizations. New hybrid organizational forms are emerging that exhibit diverse relational-structural alliances between physicians, hospitals and/or insurers, over which administrators have limited control and restricted ability to predict or direct. Meeting the challenges in leading and managing health-care systems as complex adaptive organizations calls for additional competency in what theorists determine as ‘complex leadership’. This research study presents findings on complex leadership principles that augment those competencies that health-care administration education scholars recognize and recommend as necessary for future leaders in health care to master. The findings from this study make two contributions: first, they ground complex leader theory, derived from complexity science, in empirical data; and second, the findings add to a growing body of literature investigating the underlying logics of the complex adaptive organization and the innovative ways complex leaders are developing practices and principles in leading and managing these new, emerging organizations.
Strategic information technology alliances for effective health-care supply chain management
Authors: Shih Stephen C , Rivers Patrick A , Hsu H Y Sonya
Published: July 2009

To gain and sustain competitive advantage, health-care providers have to continuously review and renovate their operational and information technology (IT) strategies through collaborative and cooperative endeavour with their supply chain channel members. This paper explores new ways of enhancing a health-care organization's responsiveness to changes and increasing its competitiveness through implementing strategic information technology alliances among channel members in a health-care supply chain network. An overview of issues and problems (e.g. bullwhip effect, negative externalities and free-riding phenomenon in multichannel supply chains) presented in the health-care supply chains is first delineated. This paper further goes over the issues of health-care supply chain coordination and integration for strategic IT alliances, followed by the discussion of the spillover effect of IT investments.

A number of viable IT practices (such as information sharing and Internet-enabled supply chain portal) for effective health-care supply chain collaboration and coordination are then examined in this research. Finally, the paper discusses how strategic IT alliances can help improve the effectiveness of health-care supply chain management.
Retailers' Multichannel and Price Advertising Strategies
Authors: Zhang Xubing
Published: July 2009

Online retailing boasts two major advantages: convenience of home shopping and easy access to information. In this paper, I argue that these two features have important implications for retailers' channel and advertising decisions. Two major questions are addressed: When should a conventional bricks-and-mortar retailer adopt a multichannel strategy? When should a multichannel retailer use its website to advertise offline prices? Analysis shows that the answers hinge on the nature of the product, the retailer's costs, and the competitors' strategies as well as the competitiveness of the market. Multichannel retailing is not necessarily the best strategy for all retailers; no adoption, asymmetric adoption, and symmetric adoption of the strategy are all possible equilibria. Advertising the in-store prices online is not always optimal. Price advertising in multichannel retailing has a different effect when compared with conventional single-channel retailing. It helps coordinate the channels by shifting the sales from online to offline, which is particularly useful when margins online are relatively low. The finding that multichannel retailers can benefit from drawing consumers back to physical stores highlights the risk of boosting online sales without considering the adverse effect on the offline channel and indicates a shifting role of the Web in retailers' businesses.