bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of inulin on the textural and sensory properties of mortadella, a Spanish cooked meat product
Authors: Luisa García Maria , Cáceres Ester , Dolores Selgas Maria
Published: October 2006

Inulin is a fructooligosaccharide with demonstrable beneficial effects on health. Its effect on the textural and sensory properties of mortadella, a Spanish cooked meat product, was studied. Conventional (23% fat) and reduced‐fat sausages (10% fat) were prepared. Fat reduction yields an energy value reduction close to 33%. In both cases, inulin was incorporated, in powder and as gel form, in sufficient amounts to constitute the 2.5%, 5% and 7.5% of the final product. To evaluate the effect of inulin, instrumental measures of texture and sensory analysis (hedonic test) were performed. Textural analysis indicated that powdered inulin increases hardness and this fact was more evident in reduced‐fat sausages which showed that this changes even at concentrations of 2.5%. However, when inulin was incorporated as a gel, textural parameter changed only when the high levels were assayed (7.5%) showing softer sausages independent of the fat content. Sensory analysis was highly favourable and the overall acceptability was good in all batches in spite of the changes observed in texture. It can be established that this product can be enriched with inulin to a maximum level of 7.5% and preferably as gel with a good sensory quality.
Effect of malt pretreatment on phytate and tannin level of two sorghum (Sorghum bicolor) cultivars
Authors: Idris Wisal H. , AbdelRahaman Samia M. , ElMaki Hagir B. , Babiker Elfadil E. , El Tinay Abdullahi H.
Published: October 2006

The seeds of two cultivars of Sudanese sorghum (Sorghum bicolor), namely Wad Ahmed and Tabat, were germinated for 4 days to obtain 1‐, 2‐ and 4‐day‐old malts. Sorghum malt (5% and 10%) was added to sorghum flour. The mixtures were incubated at 30 °C with shaking for 30, 60, 90 and 120 min. Malting loss was very slight for both cultivars and for all incubation periods. Phytic acid and tannin contents were assayed for all treatments. The results revealed that phytate and tannin contents were significantly (P ≤ 0.05) reduced when sorghum flour was pretreated with malt. When a mixture containing 10%, 4‐day‐old malt and sorghum flour was incubated for 120 min, it significantly (P ≤ 0.05) reduced phytate and tannin contents by 92% and 98%, respectively, for Wad Ahmed cultivar, while for Tabat they were reduced by 93% and 96%, respectively. The rate of reduction of phytate and tannin content increased with incubation time and malt age and concentration.
Durum wheat quality I: some physical and chemical characteristics of Syrian durum wheat genotypes
Authors: El‐Khayat Ghassan H. , Samaan Jihad , Manthey Frank A. , Fuller Mick P. , Brennan Charles S.
Published: October 2006

Some physical and chemical characteristics of nine Syrian durum wheat genotypes were determined in order to investigate the relationships among individual kernel components and kernel quality. All genotypes were grown on fully irrigated plots in Syria. Test weight, 1000‐kernel weight, kernel size distribution, hardness and semolina extraction rates were determined along with the chemical characteristics of the kernel (ash, moisture, protein, wet gluten, starch content and falling number). All tested genotypes had high test weight (83.1–85.9 kg hl−1) and 1000‐kernel weight (42.5–55.5 g) indicating high milling yield potential. Additionally, all the wheat genotypes demonstrated high falling numbers (433–597 s). Correlation coefficients among the quality properties showed that moisture content did not demonstrate any strong correlations with the studied quality parameters. Protein content exhibited a positive correlation with vitreousness (r = 0.78), and a negative correlation with ash content (r = −0.57). Test weight exhibited a negative correlation with 1000‐kernel weight (r = −0.66), and a positive correlation was observed between test weight and starch content of the kernel (r = 0.78). The results illustrate the commonality between Syrian durum wheat genotypes and US and Canadian durum wheat genotypes reported by researchers previously.
Clinical prediction rules for bacteremia and in‐hospital death based on clinical data at the time of blood withdrawal for culture: an evaluation of their development and use
Authors: Nakamura Tsukasa , Takahashi Osamu , Matsui Kunihiko , Shimizu Shiro , Setoyama Motoichi , Nakagawa Masahisa , Fukui Tsuguya , Morimoto Takeshi
Published: October 2006

Rationale, aims and objectives  To develop clinical prediction rules for true bacteremia, blood culture positive for gram‐negative rods, and in‐hospital death using the data at the time of blood withdrawal for culture.

Methods  Data on all hospitalized adults who underwent blood cultures at a tertiary care hospital in Japan were collected from an integrated medical computing system. Logistic regression was used for developing prediction rules followed by the jackknife cross validation.

Results  Among 739 patients, 144 (19.5%) developed true bacteremia, 66 (8.9) were positive for gram‐negative rods, and 203 (27.5%) died during hospitalization. Prediction rule based on the data at the time of blood withdrawal for culture stratified them into five groups with probabilities of true bacteremia 6.5, 9.6, 21.9, 30.1, and 59.6%. For blood culture positive for gram‐negative rods, the probabilities were 0.6, 4.7, 8.6, and 31.7%, and for in‐hospital death, those were 6.7, 15.5, 26.0, 35.5, and 56.1%. The area of receiver operating characteristic for true bacteremia, blood culture positive for gram‐negative rods, and in‐hospital death were 0.73, 0.64, and 0.64, respectively, in original cohort and 0.72, 0.64, and 0.64 in validation respectively.

Conclusions  The clinical prediction rules are helpful for improved clinical decision making for bacteremia patients.
Follow‐up of children with rhinitis and cough associated with milk allergy
Authors: Huang Shih‐Wen
Published: October 2006

Young children sensitized with foods may develop early respiratory symptoms including nasal symptoms and cough, but not clinical manifestations in the skin or gastrointestinal tract. The long‐term outcome of these patients is largely unknown. We studied 36 children sensitized with cow's milk and three different age‐matched control groups. The patients were followed from 12 to 18 months of age for at least 5 yr with repeat skin testing and oral food challenge. After 2½ yr, 63.9% (n = 23) of those in the mild allergy group lost sensitivity to foods; after 5 yr, the number was 86.1% (n = 31). However, during the study period of 5 yr, 69.4% (n = 25) simultaneously developed a sensitivity to common indoor airborne allergens. A similar trend was found only in the egg allergy control group. A positive family history and a history of parental smoking significantly increased the relative risk (RR) of sustaining nasal allergy symptoms (RR = 3.33 and 1.79, respectively). We concluded that allergy march from food sensitivity to sensitivity to airborne allergens may occur in a subset of children before 4 yr of age. Genetics and environmental factors might independently contribute to the continuation of these respiratory symptoms.
A matched patient‐sibling study on the usage of paracetamol and the subsequent development of allergy and asthma
Authors: Riece Koniman , Yiong Huak Chan , Teng Nging Tan , Van Bever Hugo P.
Published: October 2006

A number of studies have suggested that intake of paracetamol during pregnancy and during the first months of life is associated with an increased risk of childhood asthma. We aimed to determine the association between paracetamol usage during pregnancy and the first 6 months of life, and childhood allergy (i.e. positive skin prick tests), allergic asthma, and asthma, using a matched patient‐sibling study comparing patients with allergic asthma with their healthy siblings without any symptoms of allergic diseases. Allergy in patients and their siblings was determined by skin prick tests. Children having at least one positive skin prick test were considered to be allergic. Intake of paracetamol was assessed by standardized, interviewer‐administered, questionnaire. Nineteen pairs of allergic asthma patients vs. non‐allergic siblings were compared to determine the risk factors for allergic asthma, while 15 pairs of allergic asthma patients vs. allergic siblings were compared to determine the risk factors for asthma. Moreover, 33 pairs of allergic asthma patients vs. non‐asthmatic siblings (with and without allergy) were compared to determine the risk factors for asthma. In addition, 17 allergic siblings (without asthma) were compared with 19 non‐allergic siblings (without asthma) to determine the risk factors for allergy. Usage of paracetamol during pregnancy was associated with allergic asthma (p = 0.03). Furthermore, usage of paracetamol between birth and 6 months of age, and between 4 and 6 months of age, was also found to be associated with non‐allergic asthma (p = 0.008 and p = 0.03 respectively). Usage of paracetamol during pregnancy and during the early months of life may play a role in the development of allergic and non‐allergic asthma in children. However, due to obvious ethical reasons, direct evidence for this association (i.e. a double‐blind, prospective study) is not available.
House cleaning with chlorine bleach and the risks of allergic and respiratory diseases in children
Authors: Nickmilder Marc , Carbonnelle Sylviane , Bernard Alfred
Published: October 2006

Chlorine bleach or sodium hypochlorite can inactivate common indoor allergens. In this cross‐sectional study we evaluated to what extent regular house cleaning with bleach can influence the risks of respiratory and allergic diseases in children. We studied a group of 234 schoolchildren aged 10–13 yr among whom 78 children were living in a house cleaned with bleach at least once per week. Children examination included a questionnaire, an exercise‐induced bronchoconstriction test and the measurement of exhaled nitric oxide (NO) and of serum total and aeroallergen‐specific immunoglobulin (Ig)E, Clara cell protein (CC16) and surfactant‐associated protein D (SP‐D). Children living in a house regularly cleaned with bleach were less likely to have asthma (OR, 0.10; CI, 0.02–0.51), eczema (OR, 0.22; CI, 0.06–0.79) and of being sensitized to indoor aeroallergens (OR, 0.53; CI, 0.27–1.02), especially house dust mite (OR, 0.43; CI, 0.19–0.99). These protective effects were independent of gender, ethnicity, previous respiratory infections, total serum IgE level and of family history of allergic diseases. They were however abolished by parental smoking, which also interacted with the use of bleach to increase the risk of recurrent bronchitis (OR, 2.03; CI, 1.12–3.66). House cleaning with bleach had effect neither on the sensitization to pollen allergens, nor on the levels of exhaled NO and of serum CC16 and SP‐D. House cleaning with chlorine bleach appears to protect children from the risks of asthma and of sensitization to indoor allergens while increasing the risk of recurrent bronchitis through apparently an interaction with parental smoking. As chlorine bleach is one of the most effective cleaning agent to be found, these observations argue against the idea conveyed by the hygiene hypothesis that cleanliness per se increases the risk of asthma and allergy.
Consequences of hydrochory in Hibiscus
Authors: KUDOH HIROSHI , SHIMAMURA RYOUJI , TAKAYAMA KOJI , WHIGHAM DENNIS F.
Published: October 2006

Seed dispersal provides a template upon which the demographic processes of plant life cycles operate and, most importantly, seed dispersal determines the spatial distribution of genetic variation. Here, we review recent studies on seed dispersal by water (hydrochory) in species of Hibiscus to elucidate the potential ecological and evolutionary consequences of hydrochory at different spatiotemporal scales. We consider seed dispersal related processes that determine the distribution and dynamics of genetic variation, that is, the spatial shuffling effect of the seed bank that modifies genetic make‐up within a population, the formation of a genetic reservoir within a metapopulation, and lineage dispersions and speciation that may produce patterns in plant phylogeography. Seed movement patterns within ecological time and space are likely to leave non‐random patterns in long‐term plant evolution and phylogeny.
Differences in the allocation patterns between liana and shrubHydrangeaspecies
Authors: KANEKO YOHEI , HOMMA KOSUKE
Published: October 2006

Allometric analysis of fourHydrangeaspecies (Hydrangea petiolaris,Hydrangea paniculata,Hydrangea macrophyllavar.megacarpaandHydrangea hirta) was conducted to test the hypothesis that the liana species (H. petiolaris) invests more in leaves and reproductive organs than the shrub species. We calculated the allocation ratios of leaves, supporting tissues (trunks and roots) and reproductive organs.Hydrangea petiolarisdiffered markedly from the three shrubs in terms of trunk and root allocations, while leaf allocation was not statistically different. The C/F ratios (the ratios of the dry weights of non‐photosynthetic organs to photosynthetic ones) of the four species ranged from 9 to 12, and were not statistically different. These results did not support the hypothesis. The biomass ofH. petiolariswas up to 100‐fold greater than the biomass of the three shrubs. The growth form ofH. petiolariswould minimize allocation to supporting tissue and produce a large biomass. The biomass of reproductive organs ofH. petiolariswas up to 700‐fold greater than the biomass of the three shrubs. This advantage might, therefore, serve as a driving force for the evolution of lianas.
Population biology of Pogonia japonica in Russia and Japan
Authors: TATARENKO IRINA V. , KONDO KATSUHIKO
Published: October 2006

Pogonia japonica (Orchidaceae) is a clonal plant forming numerous adventitious shoots on long perennial roots. Seeds remained dormant for 3 years or more and rarely germinated. Populations consisted of ramets of different ages. Each ramet was a partial shoot growing vertically and monopodially before changing to sympodial growth after the first flowering. Annual growth consisted of two internodes making it easy to determine the shoot age. Three to 12 ramets were connected by a common root system. This might provide rapid development of ramets. In favorable habitats, vigorous ramets started flowering in the second or third year, and flowering lasted for another 3–4 years. In unfavorable habitats, preflowering shoot development took 3–5 years, or it died before or just after the first flowering. Ramets remained alive but senescent for 1–2 years after the last flowering. Disconnection of 2–4‐year‐old shoots was a normal process of vegetative reproduction. Some isolated mature shoots stayed dormant for 1–2 years. Young shoots disconnected within the first year usually died. Vegetative mature shoots predominated in the Russian populations, whereas young ramets were more numerous in the Japanese populations. The proportion of flowering to vegetative shoots averaged 15%, but reached as high as 55% in one Japanese population. Fruiting was high (80%) in Russian populations, but in some Japanese populations it dropped to zero after all fruits were damaged by insects. Differences in plant size and population structure reflected differences in ecological conditions more than geographic difference.
Andromonoecious sex expression of flowers and pollinia delivery by insects in a Japanese milkweed Metaplexis japonica (Asclepiadaceae), with special reference to its floral morphology
Authors: TANAKA HAJIME , HATANO TAKEO , KANEKO NORIKO , KAWACHINO SUGATAKO , KITAMURA OSAMU , SUZUKI YURIKO , TADA TAEKO , YAOI YOSHIHITO
Published: October 2006

Pollination ecological studies of Metaplexis japonica Makino were carried out in central Japan. We found that the flowers were andromonoecious; the proportion of hermaphrodite flowers was 61%. Unlike other Asclepiadaceae flowers, M. japonica has a unique and outstanding long protrusion on the pistil end, which looks like a stigma. However, we confirmed that the true stigma is present on the lateral surface of the style, as it is in other Asclepiadaceae flowers. Various insects visited the flowers for nectar and the most effective pollinators were scoliid wasps. The pollen/ovule ratio was 21 and the fruit set of the hermaphrodite flowers was 11%.
7: Cardiocrinum cordatum (Thunb.) Makino (Liliaceae)
Authors: OHARA MASASHI , NARUMI TADASHI , YOSHIZANE TOMOKO , OKAYASU TAROU , MASUDA JUNZO , KAWANO SHOICHI
Published: October 2006

The life‐history characteristics of Cardiocrinum cordatum (Thunb.) Makino (Liliaceae) are described here. This is a unique monocarpic perennial herb of temperate broad‐leaved deciduous forests in the Japanese Islands and adjacent Far East regions. New aerial shoots appear above ground in mid April to early May. Cardiocrinum cordatum comprises distinct growth stages, single‐leaf and multiple‐leaved rosette stages, and then a flowering stage with a large multiflowered inflorescence at the top of the stem. The flowering plants attain 0.7–2.0 m in height and bear several large cordate cauline leaves, and 2–15 laterally blooming, greenish white flowers, 12–18 cm in size, are borne at the top of the straight inflorescence. Cardiocrinum cordatum depends on two reproductive modes, sexual reproduction via seeds and vegetative reproduction forming a few to several bulblets at the base of mother bulbs. The flowers are furnished with large nectar glands at the base of corolla, and the amount of nectar secreted is very high; thus, many bumblebee species are attracted to the flowers. Each flower has 600–670 ovules and produces 393–531 seeds (average 410). The average seed‐setting rate per flower is high at 65–79%. An exceedingly large number of seeds with 4–5 mm thin filmy wings are produced, attaining several thousand (800–6000) in number per plant. Individuals asexually formed have large one‐leaf or multiple‐leaves, and can bypass crucial small juvenile stages with high mortality. In addition, because mature plants die after sexually reproducing once, ramets asexually reproduced can use the large spaces that the mother plants occupied.
Serious untoward incidents and their aftermath in acute inpatient psychiatry: The Tompkins Acute Ward Study
Authors: Bowers Len , Simpson Alan , Eyres Sophie , Nijman Henk , Hall Cerdic , Grange Angela , Phillips Louise
Published: October 2006

ABSTRACT:  Serious untoward incidents, or sentinel events (suicide, homicide, suicide attempt, serious assault, and absconding of high‐risk patients) occur from time to time in association with acute psychiatric inpatient wards. The aim of this study was to discover the impact of serious untoward incidents on inpatient wards. Doctors, nurses, and occupational therapists at three hospitals were interviewed about these events and their impact on their wards. Staff reported feelings of shock, depression, demoralization, upset, loss, and grief, followed by ruminations, guilt, and anxiety. Levels of containment increased, as did the focus on risk assessment. Processing of the emotional impact was hindered by the pace of ward life, a lack of external support, and management investigations. Patient responses were largely ignored. A few staff responded negatively, hindering service improvements. Much more attention needs to be given to the needs of the patient group following incidents. Substantial planning, organization, and investment are required to properly prepare for such events and manage their outcome. Without this planning and action, acute inpatient work has the capacity to be damaging to staff.
The health‐care environment on a locked psychiatric ward: An ethnographic study
Authors: Johansson Inger M. , Skärsäter Ingela , Danielson Ella
Published: October 2006

ABSTRACT:  Recent changes in psychiatric hospital care involving a reduction in the number of beds and time spent in hospital motivated the study of conditions of inpatient care on such wards. An ethnographic study of a locked, acute psychiatric ward in a department of psychiatry was performed with the aim of describing the health‐care environment in such a ward. The ward admitted patients on both a voluntarily and involuntarily basis. Data were collected by means of 3.5 months of participant observations. The results showed a health‐care environment that was overshadowed by control. Staff were in control but they also lacked control; they attempted to master the situation in line with organizational demands and they sometimes failed. At the same time, the staff tried to share the responsibility of caring for patients and next of kin. Patients were controlled by staff; they were the underdogs and dependent on staff for their care and the freedom to leave the ward. Patients tried to make themselves heard and reacted to the control by developing counter‐strategies. What this study adds to earlier research is patients’ pressure on staff and sometimes quite an open struggle for more control, which may be an expression for an unacceptable imbalance in power between patients and staff.
A nurse–physician co‐leadership model in psychiatric hospitals: Results of a survey among leading staff members in three sites
Authors: Steinert Tilman , Goebel Rita , Rieger Wolfgang
Published: October 2006

ABSTRACT:  In three psychiatric hospitals in Baden‐Wuerttemberg, Germany, a physician–nurse shared leadership model was implemented in 1997 by the hospital management. The whole hospital, departments, and single wards are led each by a leadership team consisting of a physician, psychologist or social worker and a nurse, being responsible for organization, staff, and budgets. The consequences for staff opinion in leadership positions were evaluated. All 165 leading staff members of all professional groups were anonymously interviewed with a questionnaire containing 45 items regarding their satisfaction with this new leadership model. The response rate was 79.4%. Overall, the leading staff members were satisfied with the shared leadership model both in their own clinical practice and in general. Non‐medical staff members were significantly more in favour of several aspects of shared leadership than physicians, but even the latter reported to be generally satisfied. However, both professional groups estimated leading positions to be only modestly attractive. The results yield some evidence that the change from traditional leadership models to the physician–nurse shared leadership model may have advantages in the management of psychiatric hospitals.
Hypermedia authoring with writing process guidance
Authors: Chang Kuo‐En , Sung Yao‐Ting , Zheng Jie‐Wen
Published: October 2006

A writing process of five stages, setting the topic and goals, planning the outline, organising the structure, building the content, and reviewing, is proposed to guide hypermedia authoring. To explore the effects of the system designed with writing‐process guidance, this study enrolled 108 seventh graders at a junior high school as experimental subjects. Results of the experiment show that writing‐process guidance does indeed help in the presentation of students’ web page creations. This experiment also explored the differences in web page creations between different genders. Results show that creations of male students are better than those of female students.
The effect of problem‐based video instruction on learner satisfaction, comprehension and retention in college courses
Authors: Choi Hee Jun , Johnson Scott D.
Published: October 2006

The main purpose of this study was to identify the effects of two major components (ie, video and group discussion) of problem‐based video instruction (PBVI) on college students’ learning. To achieve this purpose, this study examined whether or not PBVI can improve learner satisfaction, comprehension and retention by comparing the results from three dependent variables in PBVI with two other kinds of instruction: (1) problem‐based text instruction (PBTI) and (2) PBVI without group discussion.

According to the findings, there were significant differences in learner satisfaction, comprehension, and delayed retention between PBVI and PBTI groups, whereas there were no significant differences in learners’ satisfaction, comprehension, and delayed retention between PBVI and PBVI without group discussion. This study implies that PBVI in college courses have the potential to enhance student satisfaction, comprehension and delayed retention.
Early modern stereotypes and the rise of English: Jonson, Dryden, Arnold, Eliot
Authors: McDOWELL NICHOLAS
Published: October 2006

Stereotyping is a mode of stigmatisation and polarisation, and so we tend to think of the stereotype as a deadening force which closes down conversation. But we need to appreciate further the extent to which the transmission of stereotypes can facilitate and shape creative cultural response, even if that response is designed to simplify and satirise in the service of an ideological imperative. The stereotype of the Puritan as ignoramus in Ben Jonson's seventeenth‐century comedies reappears in, and helps to structure, aesthetic discussions over three centuries, beginning with Dryden's post‐Restoration literary criticism. These discussions were central to the generation of a dominant narrative of English literary history, to the development of notions of literary refinement and politeness and to the construction of a literary canon. Incorporated by Matthew Arnold and T. S. Eliot into their versions of literary history ‐ versions which were themselves a response to what Arnold and Eliot perceived as the cultural crises of their own time ‐ early modern dramatic stereotypes became naturalised in university courses and school textbooks. Ultimately, this essay suggests, the transmission of the early modern stereotype of the Puritan was bound up with the rise of English as an academic discipline.
Unruly bodies: death, discourse and the limits of representation
Authors: SMITH KATHY
Published: October 2006

There are some silences within our culture that defy even description, and some thresholds of which we do not ‐ or feel we cannot ‐ speak. The intensity of human experience can be beyond words and, often, we do not have the tools to reveal the nature or content of these moments. How can we speak of those human experiences which are not 'contained' by discourse? How can we comprehend and make sense of the eruption of the Real? Intimacy, death, pain, maternity: these are all areas of experience and of 'otherness' which evade discourse and are obscured by silence. How can we speak these silences? Samuel Beckett's Footfalls, a bleak representation resonating the processes of mourning and melancholia, might be read as an attempt to physically represent states of 'otherness' and to physicalise absence. Japanese Story, an Australian film directed by Sue Brooks, would seem to be an attempt to explore 'otherness' on a number of levels, to a point where the most intense moments of 'otherness' defy discourse altogether. Central to the discussion of silences, bodily experience, emotional experience and states of 'otherness' are questions of representation, of the nature and placing of these experiences in relation to discourse, and of the tools available to us. What is the relationship between lived experience and the Symbolic? What happens when the Symbolic is no longer adequate? These are the questions, in the light of the representations examined, that this paper finally considers.
Film: Cannes 2006
Authors: MacCABE COLIN
Published: October 2006

No one could begrudge Ken Loach the Palme d'Or that he won at this year's Cannes. One of the great directors of post‐war European cinema, Loach is perhaps the most important heir of that realist tradition which finds its aesthetic roots in Rossellini and its justification in the representation of hitherto unrecognised elements of social reality. From Cathy Come Home in the mid‐sixties to The Navigators nearly forty years later, Loach has been at his best when using his camera to bring to the screen stories that display the unacceptable faces of late capitalism...
Collective complexes—total perspectives
Authors: Alho Päivi Marjaana
Published: October 2006

Abstract:  A much greater part of our identity than we generally believe is collectively determined. Awareness of the causal link between identity, its connected values and the influence exerted by these values on perception is therefore crucial. In the implicit personality model of Peabody and Goldberg (1989), the apparent wide variety of human characteristics is broken down into three broad dimensions: general evaluation, impulse control and assertiveness. My hypothesis is that the regulation of impulses can be equated with the Jungian concept of the mother and father complexes, and assertiveness with the relation between individualism and collectivism. I have utilized Montgomery's perspective theory and Jung's concepts of the union of opposites, the complex and the shadow in order to provide an alternative interpretation of the implicit personality model. According to my interpretation, the traditional values of any culture can be read against these three dimensions. These values can be seen as the greatest treasure of a culture but, at the same time, they can also be devastating if they become complex‐like.
The death of a mind: a study of Shakespeare's Richard III
Authors: Anderson Maxine K.
Published: October 2006

Abstract:  Some of the most difficult aspects of our work involve our encounters with states of mind which are steeped in and spread violence. In these circumstances, we experience our best efforts to offer empathic presence and thought to avoid being assaulted and obliterated. In these instances, a figure from literature depicting the details in question may come to our aid.

In the play popularly known as Richard III,William Shakespeare depicts how the state of mind which is etched by grievance and committed to revenge may impose the ‘winter of (its) discontent’ upon the sunny dispositions of others' healthy, integrated functioning. Shakespeare masterfully depicts Richard's cunning and malice, but he also illustrates how this vengeful state uses guile and ‘changes of shape’ to seduce its way past protective boundaries, utilizing the human qualities of trust, open‐heartedness and longing as pathways for invasion, betrayal and emotional devastation.

This paper will view excerpts of the play's text from a psychoanalytic perspective which suggests that several clear lessons about this obliterative state of mind may be gleaned: that grievance can only operate to spread grievance and destruction; that our open‐hearted and trusting qualities do make us vulnerable to such invasion and betrayal, but that our humanity is also the only avenue for rescue from this plight. In addition a clear lesson is offered about the value of protected ‘sanctuary’, that is, mental space where our most potent tool in these circumstances, our discerning minds, might find residence.
Lower urinary tract injuries after transobturator tape insertion by different routes: a large retrospective study
Authors: Abdel‐Fattah M , Ramsay I , Pringle S
Published: October 2006

Objectives  To identify the rate of, and risk factors for, lower urinary tract (LUT) injuries associated with the transobturator tension‐free vaginal tape (TOT) procedure.

Design  Retrospective cohort study.

Setting  Tertiary referral urogynaecology centre.

Population  390 women who underwent transobturator suburethral tapes for management of urodynamic stress incontinence between July 2002 and January 2006.

Methods  Early cases were identified from theatre records and a case note review performed. From May 2005 (n= 94), data from an ongoing prospective audit were reviewed. Data for LUT injuries with TOT procedures were examined and routes of insertion were compared using Fischer’s exact test.

Main outcome measures  Rate of LUT injuries associated with the TOT procedures. Assessment of factors increasing risk of LUT injury, and comparison of the ‘outside‐in’ and ‘inside–out’ techniques.

Results  241 women underwent TOT outside–in technique and 148 of them underwent inside–out technique. Four LUT injuries occurred (1%): two urethral injuries (0.5%) and two bladder injuries (0.5%). All LUT injuries occurred in the outside–in group, although this difference did not reach significance (P= 0.146). Bladder injuries occurred in women who underwent concomitant vaginal surgery, while urethral injuries occurred in women undergoing secondary procedures.

Conclusion  LUT injury is an uncommon complication of the TOT procedures, and in our hands only occurred with the outside–in technique. Intraoperative cystoscopy should be considered only in selected cases.
Sublingual compared with vaginal misoprostol for labour induction at term: a randomised controlled trial
Authors: Bartusevicius A , Barcaite E , Krikstolaitis R , Gintautas V , Nadisauskiene R
Published: October 2006

Objective  To compare the efficacy and safety of 50 μg of sublingual misoprostol with 25 μg of vaginal misoprostol administered for labour induction at term.

Design  Double‐blinded, randomised controlled trial.

Setting  University Hospital, Kaunas, Lithuania.

Sample  A total of 140 women at term with indications for labour induction.

Methods  Women were randomised to receive either 50 μg of sublingual misoprostol with vaginal placebo (n= 70) or sublingual placebo with 25 μg of vaginal misoprostol (n= 70) every 4 hours (maximum six doses).

Main outcome measures  The number of women delivering vaginally within 24 hours of labour induction.

Results  Fifty‐eight women (83%) in the sublingual misoprostol group and 53 (76%) in the vaginal misoprostol group delivered vaginally within 24 hours [relative risk (RR) 1.1, 95% confidential interval (CI) 0.9–1.3]. However, the induction to vaginal delivery time was significantly shorter in the sublingual group (15.0 ± 3.7 hours) compared with the vaginal group (16.7 ± 4.1 hours, P= 0.03). The incidence of tachysystole was more than three‐fold higher in the sublingual than in the vaginal group (14 versus 4.3%; RR 3.3, 95% CI 0.9–11.6), but this was not statistically significant. There were no significant differences in the incidence of hypertonus or hyperstimulation syndrome, mode of delivery, interventions for fetal distress or neonatal outcomes between the two groups.

Conclusion  A 50 μg of sublingual misoprostol 4 hourly for labour induction at term seems to have similar efficacy as 25 μg of vaginal misoprostol. Further studies on safety with larger numbers of women need to be conducted before routine sublingual misoprostol use in this setting.
BENEFITS TO RESEARCH SUBJECTS IN INTERNATIONAL TRIALS: DO THEY REDUCE EXPLOITATION OR INCREASE UNDUE INDUCEMENT?
Authors: BALLANTYNE ANGELA
Published: October 2006

There is an alleged tension between undue inducement and exploitation in research trials. This paper considers claims that increasing the benefits to research subjects enrolled in international, externally‐sponsored clinical trials should be avoided on the grounds that it may result in the undue inducement of research subjects. It proceeds from the premise that there are good grounds for thinking that, at least some, international research sponsors exploit trial participants because they do not provide the research population with a fair share of the benefits of research. This provides a prima facie argument for increasing the benefits for research participants. Concern over undue inducement is a legitimate moral concern; however, if this concern is to prevent research populations from receiving their fair share of benefits from research there must be sufficient evidence that these benefits will unduly influence patients’ decision‐making regarding trial participation. This article contributes to the debate about exploitation versus undue inducement by introducing an analysis of the available empirical research into research participants’ motivations and the influence of payments on research subjects’ behaviour and risk assessment. Admittedly, the available research in this field is limited, but the research that has been conducted suggests that financial rewards do not distort research subjects’ behaviour or blind them to the risks involved with research. Therefore, I conclude that research sponsors should prioritise the prevention of exploitation in international research by providing greater benefits to research participants.
Predicting Memory Decline Following Epilepsy Surgery: A Multivariate Approach
Authors: Baxendale Sallie , Thompson Pamela , Harkness William , Duncan John
Published: October 2006

Summary:  Background: While some patients experience a decline in memory function following an anterior temporal lobe resection, there is considerable individual variation in the extent, nature, and direction of postoperative memory change. Patients with surgically remediable temporal lobe epilepsy differ in etiology, the extent and type of underlying pathology, and on demographic and epilepsy‐related variables, all of which may have an impact on their pre‐ and postoperative neuropsychological functioning. This study examined the relationship between these variables and postoperative memory decline.

Methods: Logistic regression was used to examine the effects of age, laterality of surgery, age of onset of epilepsy, underlying pathology and preoperative level of memory function on postoperative verbal learning in 288 patients who had undergone an anterior temporal lobe resection. One hundred twenty‐five patients underwent a right temporal lobe resection (RTL), 163 patients underwent a left temporal lobe resection (LTL).

Results: In the group as a whole, 25% of the patients demonstrated a significant postoperative deterioration in verbal learning. Postoperative deterioration in verbal learning was significantly associated with higher levels of preoperative function in both the RTL and LTL groups. Older age at the time of the operation and a lower verbal IQ were additional significant predictors for the RTL group. The presence of cortical dysgenesis was a significant predictor of postoperative decline in the LTL group. The logistic regression models accurately identified 3/4 of those who experienced a postoperative decline in memory, using a cutoff of 0.25 or above to identify high risk.

Conclusions: Our analyses suggest that the majority of patients with a high risk of significant postoperative memory decline can be reliably identified preoperatively. These models are valuable tools helping patients make an informed decision regarding surgery.
Memory, Emotional and Vocational Impairments before and after Anterior Temporal Lobectomy for Complex Partial Seizures
Authors: Dulay Mario F. , York Michele K. , Soety Elizabeth M. , Hamilton Winifred J. , Mizrahi Eli M. , Goldsmith Ian L. , Verma Amit , Grossman Robert G. , Yoshor Daniel , Armstrong Dawna D. , Levin Harvey S.
Published: October 2006

Summary:  Purpose: To assess the pre‐ and postsurgical frequency of memory, emotional, and vocational impairments in patients who underwent anterior temporal lobectomy (ATL), and to assess the relationship between emotional disturbance and memory abilities after ATL.

Methods: Retrospective analysis of data was performed on 90 patients with medically intractable complex partial seizures who underwent ATL between 1981 and 2003. Patients were evaluated an average of 5 months before surgery and 11.3 months after surgery.

Results: A moderate to high frequency of memory impairment (44.4%; verbal or nonverbal), emotional disturbance (38.9%) and unemployment (27.8%) existed in the same individuals both before and after surgery. There were small to moderate rates of new onset memory (18.9%), emotional (11.1%), and vocational (7.8%) difficulties after surgery often regardless of seizure control outcome. Patients who underwent left‐ATL and had emotional disturbance after surgery had the lowest verbal memory test scores.

Conclusions: Results highlight the importance of taking into account emotional status when assessing memory abilities after ATL. Results replicate the finding of moderate to high frequencies of memory impairment, emotional disturbance, and unemployment both before and after ATL. Results provide support for the rationale that cognitive, psychiatric and vocational interventions are indicated to mitigate the problems that exist before and persist after ATL.
Pharmacokinetics of the New Antiepileptic and CNS Drug RWJ‐333369 Following Single and Multiple Dosing to Humans
Authors: Yao Caiping , Doose Dennis R. , Novak Gerald , Bialer Meir
Published: October 2006

Summary:  Purpose: To characterize the pharmacokinetics of the new antiepileptic and CNS drug RWJ‐333369 following single and multiple oral doses to healthy subjects, including the effect of food on bioavailability.

Method: Two studies were conducted. The first study had a randomized, double‐blind, placebo‐controlled, sequential, ascending‐dose crossover design. Subjects were divided into four dose groups (100, 250, 500, and 750 mg) of 10 to 11 subjects each. RWJ‐333369 or placebo was administered for two 7‐day periods, separated by a 14‐day washout. In the second study RWJ‐333369 (750 mg) was administered to 12 healthy subjects under fasted and fed conditions. Plasma and urine samples were analyzed for RWJ‐333369 by liquid chromatography‐mass spectroscopy. Safety was assessed throughout the studies.

Results: Mean (range) pharmacokinetic parameters in the above studies were: oral clearance (CL/F) 3.4–4.2 L/h, half‐life (t1/2) 10.6–12.8 h, and renal clearance (CLr) 0.042–0.094 L/h, indicating that RWJ‐333369 is eliminated primarily by metabolism. These parameters were not significantly different (p > 0.05) for the four dose groups and for single and multiple dosing. Cmax and AUC increased proportionally with dose and decreased with food by 11% and 5%, respectively.

Conclusions: Following single and repetitive (q12h) doses of 100–750 mg, RWJ‐333369 had linear pharmacokinetics; food did not alter pharmacokinetics to a clinically relevant extent. RWJ‐333369 is extensively metabolized and has a low CL/F that equals < 5% of the liver blood flow. Thus, orally administered RWJ‐333369 has no hepatic first‐pass effect. The 12‐h half‐life will enable bid dosing with an immediate‐release oral formulation.
Effects of the Novel Antiepileptic Drug Lacosamide on the Development of Amygdala Kindling in Rats
Authors: Brandt Claudia , Heile Anna , Potschka Heidrun , Stoehr Thomas , Löscher Wolfgang
Published: October 2006

Summary: Purpose:The current treatment of epilepsy focuses exclusively on the prophylaxis or suppression of seizures and thus provides merely a symptomatic treatment, without clear influence on the course of the disease. There is a need for new drugs that act at different molecular targets than currently available antiepileptic drugs (AEDs) and for new therapies designed to block the process of epileptogenesis. In recent years, different research lines have examined the epileptogenic process in order to understand the different stages in this process, and with the hope that early recognition and intervention could prevent the development or progression of epilepsy. In animals, acquired epilepsy is studied most commonly with the kindling model and status epilepticus models. In the present study, we used the kindling model to evaluate whether the novel AED lacosamide affects kindling‐induced epileptogenesis. This drug does not seem to act by any of the mechanisms of currently available AEDs, but the exact molecular mechanisms of action of lacosamide have not yet been clarified.

Methods:Groups of 9–10 rats were treated with either vehicle or different doses of lacosamide (3, 10, or 30 mg/kg/day) over 22–23 days during amygdala kindling.

Results:Daily administration of lacosamide during kindling acquisition produced a dose‐dependent effect on kindling development. While the drug was inactive at 3 mg/kg/day, significant retardation of kindling was observed at 10 mg/kg/day, by which the average number of stimulations to reach kindling criterion was increased by >90%. A significant inhibitory effect on kindling acquisition was also observed with 30 mg/kg/day, but this dose of lacosamide was associated with adverse effects.

Conclusions:The present data demonstrate that lacosamide, in addition to exerting anticonvulsant activity, has the potential to retard kindling‐induced epileptogenesis. Whether this indicates that lacosamide possesses antiepileptogenic or disease‐modifying potential needs to be further evaluated, including studies in other models of acquired epilepsy.
In Situ Metabolism of Levetiracetam in Blood of Patients with Epilepsy
Authors: Patsalos Philip N. , Ghattaura Sandirup , Ratnaraj Neville , Sander Josemir W.
Published: October 2006

Summary: Purpose:Although levetiracetam undergoes minimum metabolism, B‐esterases have been identified in whole blood that are capable of metabolising levetiracetam. The present study was designed to ascertain any variability in levetiracetam blood concentrations that could be attributed to in situ metabolism and which could impact on the utility of such concentration measurements in guiding therapeutic management.

Methods:Blood samples were collected from 40 patients that were prescribed levetiracetam. Sera (Groups 1 and 2) or whole blood (Groups 3 and 4) were compared. Paraoxan, an inhibitor of B‐esterase activity, was added to samples assigned to Groups 2 and 4. Samples within each group were assigned to Time 0 (frozen within 30 min of sample collection), Time 2 days and Time 7 days (samples kept at ambient temperature for 2 and 7 days).

Results:For serum samples, mean levetiracetam concentrations at Time 2 days and Time 7 days were indistinguishable from Time 0, regardless of whether B‐esterase activity was inhibited on not. In contrast, for whole blood, in the absence of B‐esterase inhibition, mean levetiracetam concentrations declined over time (11% and 29%; 2 and 7 days) compared to baseline values. In the presence of B‐esterase inhibitor, mean levetiracetam concentrations at 2 days were indistinguishable from baseline values, although at 7 days values declined by 4%.

Conclusions:If therapeutic monitoring of levetiracetam is to be undertaken, serum should be the matrix of choice and that whole blood should be separated as soon as possible after patient sampling so as to minimize in situ levetiracetam metabolism which could result in spuriously low concentrations and substantial intrapatient variability.
Toothbrush‐Thinking Seizures
Authors: Navarro Vincent , Adam Claude , Petitmengin Claire , Baulac Michel
Published: October 2006

Summary:  Seizures associated with toothbrushing have been reported in patients with precentral or postcentral partial epilepsy. Seizures precipitated by thinking have been described in patients with idiopathic generalized epilepsy. We report a patient with intractable partial epilepsy in which seizures were induced both by toothbrushing, and by seeing or thinking about toothbrush and toothpaste. Video‐EEG analysis revealed a left temporal lobe origin for these reflex seizures. We discuss how complex multimodal stimuli may trigger these reflex seizures.
How to Replace Lamotrigine with Valproate
Authors: Steinhoff Bernhard J.
Published: October 2006

Summary:  If lamotrigine (LTG) has to be replaced with valproate (VPA), this exchange may be complicated by adverse events that result from the complex interaction of both drugs. We report on two cases in which such problems occurred in spite of a cautious switch considering the VPA induced LTG serum increase. The satisfying outcome after a sudden and complete withdrawal of LTG in both cases encouraged us to perform the switch from LTG to VPA systematically by discontinuing LTG abruptly and building up the VPA maintenance dosage very rapidly in the following five consecutive patients who required this exchange. We recommend our abrupt dosage change‐over strategy as an easy, safe and cost‐effective option.