bluuebunny/crossref_metadata_2025 huggingface dataset:
Central-local government relations in Scotland
Authors: McConnell Allan
Published: March 2006

For many years, advocates of a Scottish Parliament hoped that its eventual arrival would mark a new phase in local government: an increase in local autonomy and a redressing of the creeping centralization of the Conservative years. This article addresses the question: to what extent, if any, has there been a shift in the balance of power between centre and local government since the advent of a Scottish Parliament in 1999? It examines the pre- and post-1999 periods in this area of Scottish governance, focusing particularly on the legal/constitutional, financial and policy parameters set by the centre. It argues that continuity has been more important than change, and that reasons for the continued domination of the centre lie particularly with (a) the pervasive influence of the UK Union (b) a relative continuity in political actors and (c) the ongoing self-interest of the ‘centre’.
American hesitations to reduce greenhouse gas emissions: an institutional interpretation
Authors: Mercier Jean
Published: March 2006

In 2005, the objectives of the Kyoto Protocol appear somewhat out of reach, even if Russia gave life to the protocol by signing it in 2004. Even if implemented, the protocol entails huge operational problems. Will the United States prove to be the first country to realize the difficulties in implementing Kyoto, or did they refuse to ratify it for reasons that are very particular to their own institutions? This article is an attempt at supporting the latter proposition. In March 2001, the US government announced that it was withdrawing from the Kyoto Protocol on the reduction of greenhouse gases (GHG) and it has not replaced this participation with a credible program of greenhouse gas reduction. This decision could be analyzed through different angles. In this article, we would like to look at these hesitations through an institutional angle, through the American institutions themselves. Few elements from their institutional and historical past prepare the United States to initiate a vigorous program of GHG reduction, other than through technological innovation or voluntary actions. Even though the institutional concept of path dependency is identified as the concept most helpful in explaining, from an institutional point of view, these hesitations, other institutional explanations are called upon to explain and understand these decisions.
Management Reactions to Technological Change
Authors: Harley Bill , Wright Christopher , Hall Richard , Dery Kristine
Published: March 2006

This article explores how different types of managers respond to large-scale organizational change and what factors underpin differences in management attitudes and reactions. Through qualitative analysis of the introduction of enterprise resource planning (ERP) systems in two case study organizations, the authors argue that variations in managerial responses to organizational change relate to both the structural position of individual managers and their level of involvement in the implementation of change. Managers are also shown to exhibit agency in interpreting, influencing, and negotiating the impact of organizational change. The analysis emphasizes the need to incorporate more critical perspectives informed by labor process theory with existing insights from conventional organizational change literature.
ICT and Organizational Change
Authors: Barrett Michael , Grant David , Wailes Nick
Published: March 2006

In this introduction to the special issue, the authors explore a number of connections between recent thinking about change in the organization studies (OS) literature and debates about information and communication technology (ICT) and change in the information systems (IS) literature. The authors examine these debates and highlight their potential significance for understanding ICT and organizational change. They argue that what is needed are studies such as those in this special issue that draw on and combine the insights provided by both the OS and the IS literatures to advance the study and practice of ICT-related change.
Do Organizational Climate and Competitive Strategy Moderate the Relationship Between Human Resource Management and Productivity?
Authors: Neal Andrew , West Michael A. , Patterson Malcolm G.
Published: March 2006

This study examined whether the effectiveness of human resource management (HRM) practices is contingent on organizational climate and competitive strategy. The concepts of internal and external fit suggest that the positive relationship between HRM and subsequent productivity will be stronger for firms with a positive organizational climate and for firms using differentiation strategies. Resource allocation theories of motivation, on the other hand, predict that the relationship between HRM and productivity will be stronger for firms with a poor climate because employees working in these firms should have the greatest amount of spare capacity. The results supported the resource allocation argument.
Autonomy and Performance in Teams: The Multilevel Moderating Effect of Task Interdependence
Authors: Langfred Claus W.
Published: March 2006

The author predicts that the interaction between individual- and team-level autonomy influences team performance and that their combined effects are contingent on the level of task interdependence. Multiple regression analysis of data from 89 teams in a manufacturing setting confirm these expectations, demonstrating that team performance depends on the combination of individual and team autonomy. These findings suggest that the optimal combination of individual and team autonomy depends on the level of task interdependence in a team. Implications for future research, particularly in the areas of cross-level analyses and contingency theory, are discussed as well.
Anterior Cruciate Ligament Reconstruction Using Navigation
Authors: Plaweski Stephan , Cazal Julian , Rosell Philip , Merloz Philippe
Published: March 2006

Background

Poor outcome in anterior cruciate ligament reconstruction is often related to tunnel position.

Hypothesis

Improving accuracy of the tunnel position will lead to improved outcome.

Study Design

Randomized controlled trial; Level of evidence, 1.

Methods

Sixty patients were randomized to either standard instrumentation or computer-assisted guides to position the tibial and femoral tunnels. The results were evaluated on clinical outcome based on International Knee Documentation Committee form (laxity) and radiologic assessment: radiologic Lachman (Telos at 150 and 200 N) and analysis of the tunnel positions.

Results

International Knee Documentation Committee laxity was level A in 22 knees in the conventional group (mean, 1.5 mm at 200 N) compared with 26 navigated knees (mean laxity, 1.3 mm; P= .49). Laxity was less than 2 mm in 96.7% of the navigated group and 83% of the conventional group (P= .292). The variability of laxity in the navigated group was significantly less than in the conventional group, with the standard deviation of the navigated group being smaller than that in the conventional group (P= .0003 at 150 N and .0005 at 200 N Telos). A significant difference (P= .03) was found between the groups in the ATB value (distance between the projection of the Blumensaat line on the tibial plateau and the anterior edge of the tibial tunnel), characterizing the sagittal position of the tibial tunnel (negative ATB values imply graft impingement in extension). In the conventional group, mean ATB was –0.2 (–5 to + 4), whereas it was 0.4 (0 to 3) in the navigated patients. There were no negative ATB values in the navigated group.

Conclusion

This study confirms that the accuracy and consistency of tibial tunnel position can be improved by the use of computer-assisted navigation and that the clinical result in terms of laxity is more reliable.
Clinics, Communities, and Cost Recovery
Authors: Foster Kira E.
Published: March 2006

Upon coming to power in 1994, South Africa’s first postapartheid government launched its ambitious Reconstruction and Development Programme with several major primary health care initiatives. Two years later, it adopted a macroeconomic policy that put neoliberal reforms ahead of redistributive goals. Based on ethnographic research in one urban health district, this article examines the consequences of this discordant national policy configuration as manifested in the micropolitics of four community clinics. The article examines contrasting experiences of desegregation in two formerly ‘White’ facilities, and contrasting community responses to two newly built township clinics. The article finds that, in general, South Africa’s neoliberal shift undermined its health policy objectives. However, in exceptional cases where strong nurse leadership combined with relatively uncontentious local class relations, some community clinics did succeed in becoming sites for the local pursuit of health and development goals.
Genocide in the African Diaspora
Authors: Vargas João H. Costa
Published: March 2006

Inspired by the multidimensional concept of genocide suggested by Patterson and his collaborators in 1951, I advance an argument for the necessity of coming to terms with the deadly, often state- and society-sanctioned, yet seldom overt contemporary campaigns against peoples of African descent. Approached from various angles, genocide allows us to understand seemingly disparate phenomena as they relate to each other, contributing to the continued oppression and death of Black people in Africa and its diaspora. Building on critical analyses of and comparisons between the US and Brazil, I propose a heuristic framework around which we can not only recognize but also combat the multiple forms that anti-Black genocide has acquired in late capitalist polities.
The Turkish Review of Anthropology and the Racist Face of Turkish Nationalism
Authors: Maksudyan Nazan
Published: March 2006

As a new nation state founded in 1923 on the ashes of the Ottoman Empire, the Republic of Turkey faced the need to establish a new national identity and ideology. Recognizing the multiple faces of Turkish nationalism, this article explores how Kemalist conceptions of national identity were not limited to civic nationalist ideologies, but incorporated racist ascriptions of ethnic nationalism as well. Based on the research and publications of scholars associated with the Turkish Review of Anthropology from 1925 to 1939, this article analyzes a form of early Turkish nationalism that was shaped by a racist discourse supported by and purveyed through the disciplinary authority of anthropology. The author’s analysis reveals a dominating and exclusionary discourse of Turkish nationalism, in which the ‘Turkish race’ (posited as the dominant national group) had a sense of proprietary ownership of the nation and national identity.
Sonography of the Carotid Body Tumor
Authors: Bernhardt Steve
Published: March 2006

For the past century, medical professionals have debated about the management of the carotid body tumor and the risk of morbidity and mortality. Controversies still remain in deciding a treatment plan. Treatment options are related to patient age, tumor type (sporadic vs familial), size of tumor and malignancy potential. A carotid body tumor is a type of paraganglioma arising from specialized cells (the carotid body) at the carotid bifurcation. These tumors are typically slow growing and benign. Increasing size can lead to adjacent nerve damage and thus require resection. Although carotid body tumors are uncommon, sonographers that perform carotid artery evaluations over the course of many years may encounter this neck mass. This review is to familiarize the sonographer with the identifiable features of the carotid body tumor and how this information relates to the treatment decisions.
ARDMS OB/GYN Task Analysis Results
Authors: DuBose Terry , Weinberg Kerry E. , Calton Sharon , Diacon Lindley , Balderston Keith
Published: March 2006

The American Registry for Diagnostic Medical Sonographers (ARDMS) administers credentialing examinations for individuals in specialties in medical sonography and vascular technology. The ARDMS is a member of the National Commission of Certifying Agencies, which accredits certifying organizations, as well as being accredited by the American National Standards Institute (ANSI) and the International Standards Organization (ISO). Part of the requirement of the certifying agencies is that the examinations reflect current practices in each of the specialty areas. To fulfill this requirement, the ARDMS performs a task analysis of each specialty examination every five years. The survey covers each content area of the certifying examination and the content outline is revised to reflect any changes in the current practice of the specialty. The examination blueprint is the revised outline which ARDMS provides for their OB/GYN examination candidates. (See appendix at the end of this article.)
Percutaneous Balloon Mitral Valvuloplasty During Pregnancy
Authors: Peters Priscilla J. , Goldglantz Danielle , Sadler Marie , Schuck Jacqueline , Weiss Michele , Tarditi Daniel
Published: March 2006

Although on the decline in industrialized nations, rheumatic mitral stenosis is still the most commonly encountered valvular lesion in pregnancy. Treatment of pregnant women with mitral stenosis is complicated by the risk that traditional drug and interventional therapies pose to the fetus. The goal of medical therapy in these patients is to reduce heart rate and left atrial pressure, as the dramatic increase in cardiac output associated with pregnancy can more than double the transmitral gradient. In the setting of the symptomatic pregnant patient with severe mitral stenosis who is not responding to, or cannot tolerate, medical therapy, percutaneous balloon valvuloplasty may be indicated.
Diastolic Function
Authors: Taylor Dick
Published: March 2006

Information about left ventricular function was traditionally provided primarily with measures of systolic function. Including the assessment of diastolic function has become an integral part of the evaluation of left ventricular function. Echocardiographic parameters of structure and Doppler provide information on each portion of the diastolic phases. These diastolic phases indicate change as impairment in diastolic function becomes more severe. This review of diastolic function provides the background as well as the techniques for clinical assessment of diastolic function in adult transthoracic echocardiography.
Incidental Sonographic Finding of Bilateral Ureteroceles
Authors: Ayers Elizabeth
Published: March 2006

An ureterocele is a congenital saccular dilatation of the terminal aspect of the ureter, arising from abnormal embryogenesis and affecting the early development of the intravesicular ureter, the ipsilateral kidney, and its collecting system. This is one of the more challenging urologic abnormalities facing pediatric and adult urologists, posing a diagnostic and therapeutic dilemma because of the many variations of anatomic abnormalities and nonspecific clinical symptoms.
Recurrent Renal Cell Carcinoma Postnephrectomy With Intracardiac Extensions
Authors: Flores Kara , Digiacinto Dora
Published: March 2006

The purpose of this case study is to describe a patient who presented postnephrectomy with recurrent renal cell carcinoma extending through the inferior vena cava (IVC) into the heart. The metastases were found by transesophageal echocardiography after the patient began retaining fluid in both lower extremities. The IVC portion of the tumor was continuous with the muscular wall, eliminating surgery as an option. Because this tumor has the potential to spread from the renals through the IVC to the heart, it is important for all sonographers, regardless of specialty, to be familiar with it.
Ellis—van Creveld Syndrome
Authors: Gardner Susan K. , Almon Jaymie M. , Barton Lorraine E. , Ramsey Linda M.
Published: March 2006

Ellis—van Creveld syndrome is a rare, singlegene genetic congenital skeletal disorder. It is an autosomal recessive inherited disorder, which means that both parents must carry the gene for the child to be affected. It involves abnormalities of multiple body systems, including teeth, nails, hair, lungs, and liver, and approximately 50% of affected patients will have major heart defects. There is short-limbed dwarfism, with the extremities being disproportionate with the trunk, this being more apparent in the lower limbs. Postaxial polydactyly, or extra digits in the hands, is seen in virtually 100% of those individuals affected with Ellis—van Creveld. Despite the advances in sonography, the prenatal diagnosis of a specific skeletal dysplasia remains very difficult and often can only be made after birth or termination of the pregnancy.
Aortic Pseudothrombus
Authors: Toepfer Nicholas J. , Racadio John M. , Adams Janet M. , Babcock Diane S. , Holland Christy K.
Published: March 2006

Although sonographic artifacts are common in sonography, they can create diagnostic challenges and even lead to critical diagnostic errors. The authors report a case of an echogenic artifact resembling an abdominal aortic thrombus. An awareness of the existence of this pseudothrombus and techniques to differentiate this artifact from an actual fibrinous clot may help avoid unnecessary anxiety and costly testing.
Would people with Parkinson's disease benefit from palliative care?
Authors: Hudson Peter L , Toye Christine , Kristjanson Linda J
Published: March 2006

Parkinson's disease (PD) is a chronic, progressive, degenerative disorder of the nervous system, causing substantial morbidity and has the capacity to shorten life. People with PD and their families can find the disease devastating. Nevertheless, this population of patients is not usually considered a group to be supported by palliative care specialists. But the nature of the illness and the challenges of managing its many physical and psychological effects raises questions about the potential benefits of a palliative care approach. The purpose of this project was to describe the experience of PD and consider the relevance of palliative care for this population. Semi-structured interviews were conducted with eight people with PD, 21 family caregivers and six health professionals. Five themes were developed from the data analysis: (1) emotional impact of diagnosis; (2) staying connected; (3) enduring financial hardship; (4) managing physical challenges; and (5) finding help for advanced stages. These data revealed that people with PD and family caregivers are confronted with similar issues to people with typical palliative care diagnoses, such as advanced cancer, and that a palliative approach may be helpful in the care of people with PD and their families.
Atherogenesis in rheumatology
Authors: van Leuven S I , Kastelein J JP , D’Cruz D P , Hughes G R , Stroes E S
Published: March 2006

Atherosclerosis is a chronic inflammatory disorder characterized by immune cell activation, inflammation driven plaque formation and subsequent destabilization. In other disorders of an inflammatory nature, the chronic inflammatory state per se has been linked to acceleration of the atherosclerotic process which is underlined by an increased incidence of cardiovascular disease (CVD) in disorders such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and antiphopholipid (Hughes) syndrome (APS). In addition to systemic inflammation, additional mechanisms have been put forward that are more specific for the pathophysiology of the individual chronic inflammatory disorders.
Prediction and prevention of autoimmune diseases: additional aspects of the mosaic of autoimmunity
Authors: Shepshelovich D , Shoenfeld Y
Published: March 2006

Autoimmune connective tissue diseases are chronic, potentially life threatening complex multisystem disorders. Their etiology is unknown but genetic, hormonal and environmental factors are important. The clinical disease is preceded by a long period of time (sometimes many years) when the patients can be identified by characteristic antibodies in their serum. When such a patient is identified he is usually followed and treated if clinical disease manifests itself. However, other factors besides the existence of autoantibodies have a predictive value for those disorders; some of them hereditary or genetic, and can be used only to predict likelihood of future disease, and others, connected to lifestyle and environment, could be modified in order to try and prevent it. Several non-randomized small scale studies have suggested that autoimmune disease could be prevented if treated aggressively prior to manifestations of symptoms. However, if such is the case, criteria would have to be formalized for selection of patients for this preventive treatment. Only patients whose probability to develop clinical disease is higher then a certain threshold should be treated while asymptomatic. The aim of this article is to review the major risk factors for autoimmune disease, both hereditary and environmental, and so to help define those future criteria. Individuals who are at risk to develop an autoimmune disease should be advised to refrain from activities and lifestyle which endangers their health and quality of life.
Anticoagulation via anti-Factor Xa inhibition
Authors: Wiles N , Hunt B J
Published: March 2006

Hospital-acquired deep vein thrombosis (DVT) affects 10-25% of medical patients and up to 60% of surgical patients. While thromboprophylaxis is without a doubt under utilized in the hospital setting, there is also a need for more efficacious agents. Fondaparinux, the first of a new class of agents Factor Xa inhibitiors, has recently come into clinical use. It is a synthetic pentasaccharide and indirect Factor Xa inhibitor with a predictable antithrombotic action. Being a synthetic product, there are no concerns about supply, nor viral or prion protein contamination. Initial large international trials in orthopaedic patients demonstrated its superior efficacy to standard thromboprophylaxis. Further trials confirmed its superior efficacy in venous thromboembolism (VTE) prevention, both in medical and surgical patient groups, as well as treatment of pulmonary embolism and DVT. Its use has also recently been evaluated in acute coronary syndromes and angioplasty. Fondaparinux currently has licenses in the UK for thromboprophylaxis and treatment of VTE and a license for the management of acute coronary syndrome is likely to be forthcoming. It has a favourable side effect profile and if the price is acceptable, is likely to take over from low molecular weight heparins in these indications as the drug of choice on the grounds of efficacy and safety.
Antiphospholipid syndrome and tissue factor: a thrombotic couple
Authors: López-Pedrera Ch , Buendía P , Aguirre M A , Velasco F , Cuadrado M J
Published: March 2006

The antiphospholipid syndrome (APS) is characterized by thrombosis and/or pregnancy morbidity in the presence of antiphospholipid antibodies (aPL). Among the thrombogenic mechanisms proposed, it has been suggested that aPL can stimulate tissue factor (TF) expression by endothelial cells (ECs) and monocytes. Moreover, our in vivo studies have shown that APS patients (particularly those with thrombosis) have increased monocyte TF expression. Yet, the molecular mechanism(s) by which aPL induce TF expression has not been completely underscored. In a recent study, we have demonstrated that aPL induces TF expression in monocytes from APS patients by activating, simultaneously and independently, the phosphorylation of MEK-1/ERK proteins, and the p38 MAP kinase-depenent nuclear translocation and activation of NFκB/Rel proteins. Understanding the intracellular mechanism(s) of aPL-mediated monocyte activation may help to establish new therapeutic approaches, such as selective inhibition of MAP kinases, to reverse the prothrombotic state in APS. Furthermore, the contribution of TF to a protrombotic state in the APS provides a renewed focus on antithrombotic therapies in current use, including the oral anticoagulation and, more recently, the use of statins, which have been proven to be effective in the inhibition of EC and monocyte TF-expression.
Primary systemic vasculitis: treatment of difficult cases
Authors: Foster R , Rosenthal E , Marques S , Vounotrypidis P , Sangle S , D’Cruz D
Published: March 2006

The primary systemic necrotizing vasculitides are a severe group of diseases, which untreated have a high mortality. The majority respond to treatment with high dose steroids and cyclophosphamide, however a significant proportion of those treated suffer morbidity due to the side effects of these agents, and a number of patients are refractory to treatment. We review and discuss alternative and emerging treatment options for patients who fail or cannot tolerate conventional therapy. An interesting subgroup of patients with systemic vasculitis and antiphospholipid antibodies provides an additional diagnostic and therapeutic challenge. We review what is known about this subgroup, and suggest screening for antiphospholipid antibodies in all patients with systemic vasculitis.
The world of biologics
Authors: Symmons D PM , Silman A J
Published: March 2006

In March 2002 the National Institute for Health and Clinical Excellence (NICE) published guidelines for the use of anti-TNF therapy for patients with rheumatoid arthritis (RA). The guidelines recommended that all RA patients treated with these drugs should be enrolled on a national register which had been established by the British Society for Rheumatology (the BSRBR). A comparison cohort of RA patients treated with traditional disease modifying drugs (DMARDs) is also being recruited. The main role of the BSRBR is to study the long-term safety of biologic drugs. Up to the end of March 2005, 9508 patients with RA had been enrolled on the BSRBR. Four thousand, three-hundred and six had been treated with etanercept, 3561 with infliximab, 1500 with adalimumab and 141 with anakinra. With regards to anti-TNF drugs, 79% remained on their original drug at six months, 65% of whom could be classified as responders. Co-prescription with methotrexate was associated with a 70% response rate. Patients with a high baseline level of disability were less likely to respond. Overall the rates of serious infection were not increased in the anti-TNF versus the comparison cohort. However the rates of skin and soft tissue infection and of intracellular infections (eg, salmonella, listeria, legionella) were increased. There were 11 cases of tuberculosis (seven extra-pulmonary). There was concern about the high mortality rates among patients with baseline pulmonary fibrosis treated with anti-TNF therapy. It is unclear whether this is related to the drug or to the underlying disease. The rates of malignancy and mortality were not increased compared to the DMARD treated group in the short term. Further follow-up is needed to determine the long term safety of these drugs.
Pregnancy, lupus and antiphospholipid syndrome (Hughes syndrome)
Authors: Tincani A , Bompane D , Danieli E , Doria A
Published: March 2006

Autoimmune diseases (AD) occur frequently in women during their childbearing years and may influence pregnancy outcome and neonatal health. Patients with systemic lupus erythematosus (SLE) can experience a disease flare-up during pregnancy with potential negative effects on the product of conceptus, especially if the disease is active. Recurrent pregnancy loss is now considered as a treatable clinical condition associated with the presence of circulating antiphospholipid antibodies (aPL). The neonatal lupus syndromes (NLS), caused by the transplacental passage of maternal IgG anti-Ro/SS-A and anti-La/SS-B antibodies to the fetus, carry significant morbidity and mortality in case of cardiac manifestations. Immunosuppressive agents are often administered during pregnancy in order to control maternal disease and to ensure a better pregnancy outcome. Nowadays, owing to our increasing knowledge of the disease pathophysiological mechanisms and the development of combined medical-obstetric clinics, pregnancy outcome in patients with AD has notably improved.
Connective tissue associated pulmonary arterial hypertension
Authors: Coghlan J G , Handler C
Published: March 2006

The number of publications in the field of pulmonary hypertension has increased exponentially over the past 10 years. As a consequence our understanding of the condition has advanced enormously. Pulmonary hypertension is now recognised as an uncommon and treatable disease, rather than a rare lethal disease. Progress in the field of connective tissue disease associated pulmonary hypertension has been less consistent. This paper covers the most influential published data on connective tissue associated pulmonary hypertension, and adds some insights from data available on file with pharmaceutical companies and from our database at the Royal Free Hospital. The following conclusions may be drawn. First, the prevalence of pulmonary hypertension associated with connective tissue diseases is lower than generally accepted. Second, the natural history and prognosis, at least in the setting of systemic sclerosis, is worse than seen in patients with idiopathic pulmonary hypertension. Finally, widespread and timely availability of disease modifying therapies substantially improves the prognosis for patients with systemic sclerosis associated pulmonary hypertension, in the treatment population and consequentially in the population as a whole. Identifying patients with very early disease and analysing the drivers for disease progression, is the key to further progress. Early diagnosis is most readily achieved in patients with connective tissue disease associated pulmonary hypertension. This represents an opportunity for those with an interest in academic rheumatology.
Lupus nephritis and renal disease in pregnancy
Authors: Germain S , Nelson-Piercy C
Published: March 2006

Management of pregnant women with renal disease involves awareness of, and allowance for, physiological changes including decreased serum creatinine and increased proteinuria. For women with systemic lupus erythematosus (SLE), pregnancy increases likelihood of flare. These can occur at any stage, and are more difficult to diagnose, as symptoms overlap those of normal pregnancy. Renal involvement is no more common in pregnancy. Worsening proteinuria may be lupus flare but differential includes pre-eclampsia. In women with chronic renal disease, pregnancy may accelerate decline in renal function and worsen hypertension and proteinuria, with increased risk of maternal (eg, pre-eclampsia) and fetal (eg, IUGR, IUD) complications, strongly correlating with degree of renal impairment peri-conception. Pregnancy success rate varies from 20% to 95% depending on base-line creatinine. Best outcome is obtained if disease was quiescent for >6 months pre-conception. Women on dialysis or with renal transplants can achieve successful pregnancy but have higher maternal and fetal complication rates. Acute on chronic renal failure can develop secondary to complications such as HELLP and AFLP. Management needs to be by a multidisciplinary team involving physicians and obstetricians, ideally beginning with pre-pregnancy counselling. Treatment of flares includes corticosteroids, hydroxychloroquine, azothioprine, NSAIDs and MMF. Blood pressure is controlled with methyldopa, nifedipine or hydralazine.
Immunodeficiency in the lupus clinic
Authors: Karim M Y
Published: March 2006

Systemic lupus erythematous (SLE) and immunodeficiency are linked in various ways. For example, rare genetic complement deficiencies can pre-dispose to developing SLE, whilst some treatments for SLE can cause secondary immunodeficiencies. Various case reports describe SLE patients who have concomitant or later develop antibody deficiency, possibly related to immunosuppressive treatment, or possibly related to the lupus itself. Other components of the immune system, innate and adaptive may also be affected. Immunosuppressive treatment may also cause infections in the absence of defects on routine immunological testing. It is important for the clinician to be aware of the associations between SLE and immunodeficiency to ensure optimal investigation and management. This review focuses on aspects of humoral and cellular immunity, and their association with SLE.
Mixed connective tissue disease
Authors: Venables P JW
Published: March 2006

Mixed connective tissue disease (MCTD) was first described in 1972 as a disease syndrome with overlapping features of systemic sclerosis, systemic lupus erythematosus (SLE) and polymyositis associated with antibodies to RNAse sensitive extractable nuclear antigen. When the antigen was subsequently characterized as polypeptides on the U1 ribonuclear protein component of the splicesosome (U1RNP), MCTD became the first rheumatic disease syndrome to be defined by a serologic test. Clinical features include a high frequency of Raynaud’s syndrome, swollen hands, sclerodactyly, arthritis, polymyositis and interstitial lung disease. Over the last 30 years there has been a continuing debate as to whether MCTD constitutes a ‘distinct clinical entity’. Here, I will review the pathological, immunogenetic and clinical features of MCTD and conclude that the debate remains unresolved. The early misconception that it has a relatively good prognosis has not stood the test of time with long-term follow-up studies. These have identified a tendency for MCTD to evolve into SLE or systemic sclerosis and highlighted pulmonary hypertension and scleroderma renal crisis as important causes of death. Providing it is realized that our appreciation of the clinical features associated with anti-U1RNP have evolved over time, MCTD remains a useful concept in clinical practice. Whether it can be credited with the term ‘disease’ awaits the demonstration of common etiopathological events underlying the development of antibodies to U1 RNP and their associated clinical features.
Laboratory diagnosis and management challenges in the antiphospholipid syndrome
Authors: Bertolaccini M L , Khamashta M A
Published: March 2006

The antiphospholipid syndrome (APS) is characterized by recurrent arterial and/or venous thrombosis and pregnancy morbidity manifested by early or late losses. Laboratory diagnosis of APS relies on the demonstration of a positive test for antiphospholipid antibodies (aPL). In clinical practice, the gold standard tests are those that detect anticardiolipin antibodies (aCL) and/or the lupus anticoagulant (LA). Although other specificities for aPL have been described their clinical utility and standardization has still to be established. Persistence of aPL positive tests must be demonstrated, and other causes and underlying factors considered. Although it is universally recognized that the routine screening tests (aCL and/or LA) might miss some cases, careful differential diagnosis and repeat testing are mandatory before the diagnosis of ‘seronegative APS’ can be made. Correct identification of patients with APS is important, because prophylactic anticoagulant therapy can prevent thrombosis from recurring, and treatment of affected women during pregnancy can improve fetal and maternal outcome.
Mycophenylate mofetil: what role in the treatment of lupus?
Authors: Dooley M A
Published: March 2006

Improved patient survival following lupus nephritis with the institution of corticosteroids, immunosuppressants and renal replacement therapy allows greater emphasis on long-term management issues. In particular, the recent focus has been on therapies to treat nephritis with fewer adverse effects of cyclophosphamide-including immunosuppressive regimens. Mycophenolate mofetil (MMF) has been used in the field of transplantation for more than 10 years. Following initial anecdotal reports describing benefits of MMF in the treatment of lupus nephritis, randomized, controlled trials have established a role for MMF in the treatment of lupus nephritis. MMF use to treat other lupus manifestations has been evaluated only in anecdotal case reports or series with few well-designed trials. Issues complicating clinical trial design in lupus including appropriate use and interpretation of activity and damage indices, comparable remission and response criteria and stratification of high risk populations have been the subject of much discussion and emerging consensus. As long-term outcomes in lupus improve, the toxicity of therapy and risk of relapse become increasingly important determinants of choice of therapeutic agents.
Cancer Symptom Assessment Instruments: A Systematic Review
Authors: Kirkova Jordanka , Davis Mellar P. , Walsh Declan , Tiernan Eoin , O'Leary Norma , LeGrand Susan B. , Lagman Ruth L. , Russell K. Mitchell
Published: March 2006

Purpose

A variety of assessment instruments have been created to identify cancer symptoms. We reviewed systematically cancer symptom assessment instruments published in English.

Methods

A systematic search of the MEDLINE database, Cochrane Library, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and EMBASE was performed. Non–peer-reviewed articles were identified through BIOSIS. Articles were accessed through the related article links in PubMed and references were searched by hand. Studies were included if the instrument had symptom assessment as the primary outcome. Quality-of-life instruments were excluded.

Results

We identified 21 instruments; some had undergone modification or validation. An additional 28 studies examined symptom prevalence and interrelations; many involved symptom checklists. Studies varied in design, patient characteristics, symptoms, and outcome. Meta-analysis was not possible due to heterogeneity in design, study outcomes, and validation. Seventy-six articles and two conference abstracts (derived from MEDLINE, Cochrane, CINAHL, EMBASE, BIOSIS, related articles link in PubMed, and search by hand) met inclusion/exclusion criteria. The electronic search (without related links) yielded only 26% of those articles and conference abstracts that met inclusion criteria. Searches by hand of related articles identified 59% of studies.

Conclusion

Twenty-one instruments were identified as appropriate for clinical use. The instruments vary in symptom content and extent of psychometric validation. Both comprehensive and shorter instruments have been developed, and some instruments are intended for specific symptom assessment or symptoms related to treatment. There is no ideal instrument, and the wide variety of instruments reflects the different settings for symptom assessment. Additional research is necessary.
Antibiotic Treatment Is Not Effective in Patients Infected With Helicobacter pylori Suffering From Extragastric MALT Lymphoma
Authors: Grünberger Birgit , Wöhrer Stefan , Streubel Berthold , Formanek Michael , Petkov Ventzislav , Puespoek Andreas , Haefner Michael , Hejna Michael , Jaeger Ulrich , Chott Andreas , Raderer Markus
Published: March 2006

Purpose

Apart from anecdotal reports implicating Helicobacter pylori (HP) in the development of extragastric mucosa associated lymphoid tissue (MALT) lymphoma, no large scale prospective studies have been performed on this topic.

Patients and Methods

A total of 77 patients with extragastric MALT lymphoma were prospectively studied. The presence or absence of HP was tested by histology, urease breath test, and serology. Patients were also tested for hepatitis A, B, and C and autoimmune conditions along with assessment of MALT lymphoma-specific genetic changes.

Results

Evidence for infection with HP was present in 35 of 77 patients (45%), and three of 75 patients tested (4%) were positive for hepatitis C and one for hepatitis B. All patients with HP-infection underwent eradication, 16 before initiation of further therapy. Apart from one patient with lymphoma involving parotid and colon, who achieved regression of the colonic lesions, none of these 16 patients showed regression of the lymphoma after a median follow-up of 14 months (range, 8 to 48+ months) before initiation of definitive treatment. No correlation between HP-status, localization, stage, autoimmune diseases, and genetic findings was seen.

Conclusion

In our series, HP-eradication was ineffective for treatment of extragastric MALT lymphomas. This finding, along with an infection rate of 45%—as could also be expected in the general Austrian population—suggests that HP does not play a role in the development of these lymphomas. Antibiotic treatment targeting HP should, therefore, be discouraged in patients with extragastric MALT lymphomas.
Phase II Study of Donepezil in Irradiated Brain Tumor Patients: Effect on Cognitive Function, Mood, and Quality of Life
Authors: Shaw Edward G. , Rosdhal Robin , D'Agostino Ralph B. , Lovato James , Naughton Michelle J. , Robbins Michael E. , Rapp Stephen R.
Published: March 2006

Purpose

A prospective, open-label phase II study was conducted to determine whether donepezil, a US Food and Drug Administration–approved reversible acetylcholinesterase inhibitor used to treat mild to moderate Alzheimer’s type dementia, improved cognitive functioning, mood, and quality of life (QOL) in irradiated brain tumor patients.

Patients and Methods

Thirty-four patients received donepezil 5 mg/d for 6 weeks, then 10 mg/d for 18 weeks, followed by a washout period of 6 weeks off drug. Outcomes were assessed at baseline, 12, 24 (end of treatment), and 30 weeks (end of wash-out). All tests were administered by a trained research nurse.

Results

Of 35 patients who initiated the study, 24 patients (mean age, 45 years) remained on study for 24 weeks and completed all outcome assessments. All 24 patients had a primary brain tumor, mostly low-grade glioma. Scores significantly improved between baseline (pretreatment) and week 24 on measures of attention/concentration, verbal memory, and figural memory and a trend for verbal fluency (all P < .05). Confused mood also improved from baseline to 24 weeks (P = .004), with a trend for fatigue and anger (all P < .05). Health-related QOL improved significantly from baseline to 24 weeks, particularly, for brain specific concerns with a trend for improvement in emotional and social functioning (all P < .05).

Conclusion

Cognitive functioning, mood, and health-related QOL were significantly improved following a 24-week course of the acetylcholinesterase inhibitor donepezil. Toxicities were minimal. We are planning a double blinded, placebo-controlled, phase III trial of donepezil to confirm these favorable results.
Meta-Analysis of Survival in African American and White American Patients With Breast Cancer: Ethnicity Compared With Socioeconomic Status
Authors: Newman Lisa A. , Griffith Kent A. , Jatoi Ismail , Simon Michael S. , Crowe Joseph P. , Colditz Graham A.
Published: March 2006

Purpose

The extent to which socioeconomic disadvantages and inadequate health care access account for the disproportionately elevated mortality hazard observed in African American compared with white American patients with breast cancer is poorly defined.

Methods

We identified 20 studies reported between January 1980 and June 2005 that provided survival analyses in patients with breast cancer after adjusting for ethnicity and some measurement of socioeconomic status. These studies also adjusted for age and stage of disease at time of diagnosis.

Results

The pooled outcome data yielded estimates for the mortality hazard in 14,013 African American and 76,111 white American patients with breast cancer. Studies varied in their methods for assigning socioeconomic status, with most relying on area-wide measures such as census tract and census block data. The combined analysis (adjusted for age, stage, and socioeconomic status) revealed that African American ethnicity was associated with a statistically significant excess mortality risk in overall survival (mortality hazard, 1.27; 95% CI, 1.18 to 1.38) and in breast cancer-specific survival (mortality hazard, 1.19; 95% CI, 1.10 to 1.29).

Conclusion

Our pooled analysis demonstrated that African American ethnicity is a significant and independent predictor of poor outcome from breast cancer, even after accounting for socioeconomic status by conventional measures. These findings support the need for further investigation of the biologic, genetic, and sociocultural factors that may influence survival in African American patients with breast cancer.
Elevated Incidence of Lung Cancer Among HIV-Infected Individuals
Authors: Engels Eric A. , Brock Malcolm V. , Chen Jinbo , Hooker Craig M. , Gillison Maura , Moore Richard D.
Published: March 2006

Purpose

People with HIV infection in the United States frequently smoke tobacco. We sought to characterize lung cancer incidence among HIV-infected individuals, examine whether cancer risk was related to HIV-induced immunosuppression, and assess whether the high prevalence of smoking explained elevated risk.

Methods

We conducted a retrospective cohort study at an HIV specialty clinic in Baltimore, MD (1989-2003). Incident lung cancers were identified using hospital records. We used negative binomial regression to compare incidence across subgroups defined by demographics, use of highly active antiretroviral therapy (HAART), and HIV markers. Standardized incidence ratios (SIRs) compared incidence with an urban reference population (Detroit, MI). We adjusted SIRs for the effect of smoking, using smoking prevalences estimated from part of the cohort and the general population. 95% CIs and P values were two sided.

Results

Thirty-three lung cancers were observed among 5,238 HIV-infected patients (incidence: 170 per 100,000 person-years). Incidence increased with age (P < .0001), but did not differ by sex, race, or CD4 count. Incidence tended to increase with calendar year (P = .09) and HAART use (P = .10), and was inversely related to HIV viral load (P = .03), but these associations were attenuated with age adjustment. The SIR was 4.7 (95% CI, 3.2 to 6.5) versus the general population. Twenty-eight lung cancer patients (85%) and 69% of the cohort were smokers. After smoking adjustment, risk remained elevated (SIR, 2.5; 95% CI, 1.6 to 3.5).

Conclusion

Lung cancer risk was substantially elevated in HIV-infected individuals. Incidence was unrelated to HIV-induced immunosuppression. Notably, incidence remained high after adjustment for smoking, suggesting the involvement of additional factors.