bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Responsibility to Protect and International Law
Authors: Reike Ruben , Bellamy Alex 
Published: July 2010

AbstractThe article evaluates the relationship between the Responsibility to Protect (RtoP) principle and international law. We argue that although the principle is best understood as a political commitment to implement already existing legal commitments, the RtoP is not devoid of legal content as some of its critics claim. The principle contains two sets of legal responsibilities. The first – responsibilities owed by a state towards its own population – are well-established customary principles in international law. The second – responsibilities owed by states to populations in other states – are much less well established. We argue that although RtoP does not in itself create new legal duties, states already have international legal responsibilities that relate directly to the principle's second pillar. Moreover, we identify the emergence of nascent legal thinking which suggests that a wider set of legal duties might emerge in the future.
On Gareth Evans, The Responsibility to Protect: Ending Mass Atrocity Crimes Once and For All
Authors: Barnett Michael 
Published: July 2010

AbstractThis article is part of a forum on Gareth Evans' book, The Responsibility to Protect: Ending Mass Atrocity Crimes Once and For All (Washington, D.C.: Brookings Institution, 2008). The forum features contributions from Michael Barnett, Chris Brown and Robert Jackson, and it concludes with a response from Gareth Evans.
Return to Play after Anterior Cruciate Ligament Reconstruction in National Football League Athletes
Authors: Shah Vishal M. , Andrews James R. , Fleisig Glenn S. , McMichael Christopher S. , Lemak Lawrence J. 
Published: July 2010

Background Rupture of the anterior cruciate ligament (ACL) is a common and potentially career-threatening injury in the National Football League (NFL). The return to play (RTP) percentage and the factors affecting RTP after ACL reconstruction in NFL players are not well defined. Purpose To determine the actual rate of return to professional football play in the NFL after ACL reconstruction surgery and to determine what factors can predict ability to RTP. We hypothesize that the RTP percentage in this unique patient population will differ from previously reported populations. Study Design Case series; Level of evidence, 4. Methods Forty-nine NFL athletes who had undergone primary ACL reconstruction at our institution were followed to determine their RTP percentages and factors predicting RTP. Results Sixty-three percent (31 of 49) of NFL athletes returned to NFL game play at an average of 10.8 months after surgery. Age at time of surgery, position, and the type and number of procedures were not significantly different between those who did and did not return to play. The average number of games before surgery was 51 for those who did return to play and 28 for those who did not (P = .039). The odds ratio favoring RTP was 5.5 (P = .016) for those players who had more than 4 years of NFL experience before surgery. The average NFL draft round was 3.4 for the group who returned to play and 6.4 for those who did not (P < .001). The odds ratio favoring RTP was 12.2 (P < .001) for those players drafted in the first 4 rounds of the NFL draft compared with those drafted after the fourth round. Conclusions The RTP rates after ACL reconstruction in NFL football players are lower than previously perceived. More experienced and established athletes are more likely to return to competition at the same level after this procedure than those with less professional experience. Being selected in the first 4 rounds of the NFL draft was highly predictive of RTP.
Birthing Practices of Traditional Birth Attendants in South Asia in the Context of Training Programmes
Authors: Saravanan Sheela , Turrell Gavin , Johnson Helen , Fraser Jennifer 
Published: July 2010

Traditional Birth Attendants (TBA) training has been an important component of public health policy interventions to improve maternal and child health in developing countries since the 1970s. More recently, since the 1990s, the TBA training strategy has been increasingly seen as irrelevant, ineffective or, on the whole, a failure due to evidence that the maternal mortality rate (MMR) in developing countries had not reduced. Although, worldwide data show that, by choice or out of necessity, 47 percent of births in the developing world are assisted by TBAs and/or family members, funding for TBA training has been reduced and moved to providing skilled birth attendants for all births. Any shift in policy needs to be supported by appropriate evidence on TBA roles in providing maternal and infant health care service and effectiveness of the training programmes. This article reviews literature on the characteristics and role of TBAs in South Asia with an emphasis on India. The aim was to assess the contribution of TBAs in providing maternal and infant health care service at different stages of pregnancy and after-delivery and birthing practices adopted in home births. The review of role revealed that apart from TBAs, there are various other people in the community also involved in making decisions about the welfare and health of the birthing mother and new born baby. However, TBAs have changing, localised but nonetheless significant roles in delivery, postnatal and infant care in India. Certain traditional birthing practices such as bathing babies immediately after birth, not weighing babies after birth and not feeding with colostrum are adopted in home births as well as health institutions in India. There is therefore a thin precarious balance between the application of biomedical and traditional knowledge. Customary rituals and perceptions essentially affect practices in home and institutional births and hence training of TBAs need to be implemented in conjunction with community awareness programmes.
Pregnancy-induced fluctuations in functional T-cell subsets in multiple sclerosis patients
Authors: Neuteboom Rinze F , Verbraak Evert , Wierenga-Wolf Annet F , van Meurs Marjan , Steegers Eric AP , de Groot Christianne JM , Laman Jon D , Hintzen Rogier Q 
Published: July 2010

Background: During pregnancy, especially during the third trimester, multiple sclerosis (MS) disease activity is reduced. It is not known which factors mediate this disease amelioration. Objective: To study whether the frequency of two important T-cell subsets, T-helper 17 (Th17) and regulatory T-cells (Treg), is altered in relation to pregnancy-induced MS disease amelioration. Methods: Each individual was tested longitudinally, after sampling of blood at timepoints before pregnancy, during the first and third trimester, and in the early post-partum period. Frequencies of Th17 cells were assessed after short (4 hours) re-stimulation of peripheral blood lymphocytes with PMA and ionomycin, followed by flow cytometry using CD4, CD45RO and IL-17A antibodies. To assess peripheral blood Treg frequencies, we used six-colour flow cytometry with antibodies against CD3, CD4, CD25, CD127, FoxP3 and HLA-DR, to specifically identify Treg. Results: Both MS patients ( n = 9) and controls ( n = 8) displayed unaltered Th17 frequencies during pregnancy. In contrast, circulating Treg frequency significantly decreased in MS patients ( n = 15) during the first and third ( p < 0.001) trimesters compared with the period before pregnancy. In the post-partum period, the frequency of circulating Treg again resurged back to near pre-pregnancy levels. In controls ( n = 15) comparable frequency kinetics were observed in that post-partum a significant increase in circulating Treg frequency was detected compared with the first ( p < 0.001) and third ( p = 0.012) trimester. Conclusions: Third trimester amelioration is not related to the fluctuation of circulating Th17 cells. Furthermore, a paradoxical decrease of immunosuppressive circulating Tregs can be observed during this phase, both in MS patients and controls.
Cognitive function in radiologically isolated syndrome
Authors: Lebrun Christine , Blanc Frederic , Brassat David , Zephir Hélène , de Seze Jerome ,   behalf of CFSEP
Published: July 2010

Background: Radiologically isolated syndrome (RIS) is characterized by patients with asymptomatic T2 hypersignals detected by brain MRI fulfilling dissemination in space criteria and is suggestive of subclinical multiple sclerosis (MS). In previous studies, it was demonstrated that visual evoked potential and cerebrospinal fluid help to identify pejorative markers in converting to MS. Objective: To date the cognitive function has never been investigated in a cohort of RIS. The objective of this study was to investigate cognitive function in a cohort of 26 RIS patients. Methods: We prospectively assessed the BCcogSEP (a French adaptation of the Brief Repeatable Battery (BRB) including eight cognitive tests) of 26 patients with RIS, compared with 26 MS patients and 26 healthy subjects matched for age, sex and level of education. Results: When comparing the three groups, the cognitive performance was significantly lower in the RIS and MS groups compared with healthy subjects for the Paced Auditory Serial Addition Test (PASAT) 3 seconds ( p = 0.002), phonemic fluencies ( p = 0.02), the code of the WAIS ( p = 0.05), the direct ( p = 0.002) or indirect ( p = 0.007) digit span test, the cross-taping test ( p = 0.019) and Go—No-Go ( p = 0.001). When we compared RIS and MS, the cognitive performance was significantly lower in MS patients for the direct span number ( p = 0.003) and cross-tapping test ( p = 0.05). We did not find significant differences between the three groups for the other tests. We did not find a correlation between clinical, biological and MRI results and cognitive dysfunctions. Conclusions: This study confirms the recently developed concept of RIS patients who present similar features to MS patients. Further studies are necessary to confirm these initial results and to correlate cognitive disorders with MRI surrogate markers.
High adherence and concordance within a clinical trial of antihypertensives
Authors: Horne Robert , Clatworthy Jane , Hankins Matthew ,   On behalf of the ASCOT Investigators
Published: July 2010

Objectives: To explore hypertensive patients’ beliefs about their condition and its treatment and their adherence within the context of a clinical trial. To assess the degree of concordance between patients’ beliefs about hypertension and the medical model of the condition. Methods: This was a questionnaire-based study, involving 230 patients participating in the Anglo-Scandinavian Cardiac Outcomes Trial (ASCOT), a randomized controlled trial comparing two pharmaceutical approaches to the management of hypertension. A comparison group of 106 hypertensive patients who were screened for ASCOT but did not meet the entry criteria was also recruited. Outcome measures were beliefs about hypertension and antihypertensive medication, and adherence to medication (self-report and tablet count). Results: Adherence to medication was higher than anticipated, with 45% participants reporting complete adherence over the 18-month study and a further 40% only rare non-adherence. Patients’ beliefs about their condition and treatment were generally concordant with the medical model of hypertension. High concordance was associated with high medication adherence (p<0.001). Discussion: Clinical trial volunteers may have beliefs that are unusually concordant with the medical model of hypertension and may demonstrate atypically high adherence. This has implications for the transferability of trial findings to the general hypertensive population.
Biodistribution and retargeting of FX-binding ablated adenovirus serotype 5 vectors
Authors: Alba Raul , Bradshaw Angela C. , Coughlan Lynda , Denby Laura , McDonald Robert A. , Waddington Simon N. , Buckley Suzanne M. K. , Greig Jenny A. , Parker Alan L. , Miller Ashley M. , Wang Hongjie , Lieber Andre , van Rooijen Nico , McVey John H. , Nicklin Stuart A. , Baker Andrew H. 
Published: July 2010

AbstractA major limitation for adenoviral transduction in vivo is the profound liver tropism of adenovirus type 5 (Ad5). Recently, we demonstrated that coagulation factor X (FX) binds to Ad5-hexon protein at high affinity to mediate hepatocyte transduction after intravascular delivery. We developed novel genetically FX-binding ablated Ad5 vectors with lower liver transduction. Here, we demonstrate that FX-binding ablated Ad5 predominantly localize to the liver and spleen 1 hour after injection; however, they had highly reduced liver transduction in both control and macrophage-depleted mice compared with Ad5. At high doses in macrophage-depleted mice, FX-binding ablated vectors transduced the spleen more efficiently than Ad5. Immunohistochemical studies demonstrated transgene colocalization with CD11c+, ER-TR7+, and MAdCAM-1+ cells in the splenic marginal zone. Systemic inflammatory profiles were broadly similar between FX-binding ablated Ad5 and Ad5 at low and intermediate doses, although higher levels of several inflammatory proteins were observed at the highest dose of FX-binding ablated Ad5. Subsequently, we generated a FX-binding ablated virus containing a high affinity Ad35 fiber that mediated a significant improvement in lung/liver ratio in macrophage-depleted CD46+ mice compared with controls. Therefore, this study documents the biodistribution and reports the retargeting capacity of FX binding-ablated Ad5 vectors in vitro and in vivo.
Reduced susceptibility to selected synthetic pyrethroids in urban malaria vector Anopheles stephensi: a case study in Mangalore city, South India
Authors: Tiwari Satyanarayan , Ghosh Susanta K , Ojha Vijay P , Dash Aditya P , Raghavendra Kamaraju 
Published: July 2010

Abstract

Background
Synthetic pyrethroids are potent insecticides most commonly used in the vector control programme. These are applied for indoor residual sprays, space sprays and in impregnated bed nets. Resistance reduces the efficacy of insecticides. Thus, the susceptibility status of the target vector(s) is monitored routinely to select the effective ones. A study was undertaken in a malaria endemic coastal city Mangalore, Karnataka, South India, against the known malaria vector Anopheles stephensi.

Methods
The susceptibility status was assessed at diagnostic doses of DDT (4%), malathion (5%), deltamethrin (0.05%), cyfluthrin (0.15%), alphacypermethrin (0.10%), lambdacyhalothrin (0.05%) and permethrin (0.75%) using the standard WHO tube test method during October/November 2006.

Results

Anopheles stephensi was resistant to malathion by 54.9%, but tolerant to deltamethrin by 86.1%, cyfluthrin 95.5% and alphacypermethrin 90.6%, whereas it was susceptible to DDT by 98.1%, lambdacyhalothrin 98.6% and permethrin 100.0%, respectively. The KDT50 and KDT95 values for these insecticides also showed the similar responses.

Conclusion
Susceptibility of An. stephensi to DDT is an important finding as this has never been used in Mangalore city, whereas its rural counterpart Anopheles culicifacies is widely resistant to this insecticide. The study explores the selection and rotation of the appropriate insecticide molecule even within the same group for effective vector management.
Joubert Syndrome and related disorders
Authors: Brancati Francesco , Dallapiccola Bruno , Valente Enza Maria 
Published: July 2010

Abstract
Joubert syndrome (JS) and related disorders (JSRD) are a group of developmental delay/multiple congenital anomalies syndromes in which the obligatory hallmark is the molar tooth sign (MTS), a complex midbrain-hindbrain malformation visible on brain imaging, first recognized in JS. Estimates of the incidence of JSRD range between 1/80,000 and 1/100,000 live births, although these figures may represent an underestimate. The neurological features of JSRD include hypotonia, ataxia, developmental delay, intellectual disability, abnormal eye movements, and neonatal breathing dysregulation. These may be associated with multiorgan involvement, mainly retinal dystrophy, nephronophthisis, hepatic fibrosis and polydactyly, with both inter- and intra-familial variability. JSRD are classified in six phenotypic subgroups: Pure JS; JS with ocular defect; JS with renal defect; JS with oculorenal defects; JS with hepatic defect; JS with orofaciodigital defects. With the exception of rare X-linked recessive cases, JSRD follow autosomal recessive inheritance and are genetically heterogeneous. Ten causative genes have been identified to date, all encoding for proteins of the primary cilium or the centrosome, making JSRD part of an expanding group of diseases called "ciliopathies". Mutational analysis of causative genes is available in few laboratories worldwide on a diagnostic or research basis. Differential diagnosis must consider in particular the other ciliopathies (such as nephronophthisis and Senior-Loken syndrome), distinct cerebellar and brainstem congenital defects and disorders with cerebro-oculo-renal manifestations. Recurrence risk is 25% in most families, although X-linked inheritance should also be considered. The identification of the molecular defect in couples at risk allows early prenatal genetic testing, whereas fetal brain neuroimaging may remain uninformative until the end of the second trimester of pregnancy. Detection of the MTS should be followed by a diagnostic protocol to assess multiorgan involvement. Optimal management requires a multidisciplinary approach, with particular attention to respiratory and feeding problems in neonates and infants. Cognitive and behavioral assessments are also recommended to provide young patients with adequate neuropsychological support and rehabilitation. After the first months of life, global prognosis varies considerably among JSRD subgroups, depending on the extent and severity of organ involvement.
The rheumatoid foot: a systematic literature review of patient‐reported outcome measures
Authors: Walmsley Steven , Williams Anita E , Ravey Mike , Graham Andrea 
Published: July 2010

AbstractBackgroundThe foot is often the first area of the body to be systematically affected by rheumatoid arthritis. The multidimensional consequences of foot problems for patients can be subjectively evaluated using patient‐reported outcome measures (PROMs). However, there is currently no systematic review which has focused specifically upon the PROMs available for the foot with rheumatoid arthritis. The aim of this systematic review was to appraise the foot‐specific PROMs available for the assessment and/or evaluation of the foot affected with rheumatoid arthritis.MethodsA systematic search of databases was conducted according to pre‐defined inclusion/exclusion criteria. PROMs identified were reviewed in terms of: conceptual bases, quality of construction, measurement aims and evidence to support their measurement properties.ResultsA total of 11 PROMs were identified and 5 papers that provided evidence for the measurement properties of some of the PROMs. Only one of the PROMs was found to be RA disease‐specific. The quality of construction, pretesting and presence of evidence for their measurement properties was found to be highly variable. Conceptual bases of many of the PROMs was either restricted or based on reductionist biomedical models. All of the PROMs were found to consist of fixed scales.ConclusionsThere is a need to develop an RA‐disease and foot‐specific PROM with a greater emphasis on a biopsychosocial conceptual basis, cognitive pre‐testing methods, patient preference‐based qualities and evidence to support the full complement of measurement properties.
Emergent factors in Eating Disorders in childhood and preadolescence
Authors: Sacrato Leonardo , Pellicciari Alessandro , Franzoni Emilio 
Published: July 2010

Abstract
We have reviewed the literature related to the current advances in comprehension of Eating Disorders (ED) in childhood and preadolescence. The state of art regarding the psychodynamic models concerning the onset of ED are explained. DSM-IV and ICD-10 criteria are discussed, pointing out their little value in the characterization of early eating difficulties. Historic and new diagnostic classifications are displayed in detail. We provided a clearer description of subclinical patterns. Finally we focus on the key role of the paediatrician in detecting and managing parental concerns regarding feeding.
The PGE2 EP2 receptor and its selective activation are beneficial against ischemic stroke
Authors: Ahmad Muzamil , Saleem Sofiyan , Shah Zahoor , Maruyama Takayuki , Narumiya Shuh , Doré Sylvain 
Published: July 2010

Abstract

Background
The prostaglandin E2 EP2 receptor has been shown to be important in dictating outcomes in various neuroinflammatory disorders. Here, we investigated the importance of the EP2 receptor in short- and long-term ischemic outcomes by subjecting wildtype (WT) and EP2 knockout (EP2-/-) mice to two distinct and complementary stroke models [transient and permanent middle cerebral artery occlusion (tMCAO and pMCAO)] and by using the EP2 receptor agonist ONO-AE1-259-01.

Methods
First, WT and EP2-/- mice were subjected to 90-min tMCAO with a monofilament followed by 4-day reperfusion. Second, WT mice were infused intracerebroventricularly with vehicle or ONO-AE1-259-01 45-50 min before being subjected to tMCAO. Finally, WT and EP2-/- mice were subjected to pMCAO and allowed to survive for an extended period of 7 days.

Results
Infarct volumes in EP2-/- mice were 55.0 ± 9.1% larger after tMCAO and 33.3 ± 8.6% larger after pMCAO than those in WT mice. Neurobehavioral deficits also were significantly greater in the EP2-/- mice. These results suggest that EP2 is beneficial and that activation is sustained for days after the stroke. We also found that pharmacologic activation of EP2 with 1.0- and 2.0-nmol doses of ONO-AE1-259-01 was sufficient to significantly reduce the infarct volume in WT mice compared with that in vehicle-treated controls (20.1 ± 3.9% vs. 37.1 ± 4.6%). This reduction correlated with improved neurologic scores. No significant effect on physiologic parameters was observed.

Conclusion
Together, our results reveal that pharmacologic stimulation of the EP2 receptor has an important beneficial role in cerebral ischemia and might be considered as an adjunct therapy for ischemic stroke.
Implications of late complications from adhesions for preoperative informed consent
Authors: Rajab Taufiek Konrad , Ahmad Umar Naeem , Kelly Edward 
Published: July 2010

Summary The process of informed consent is a critical aspect of the doctor–patient relationship. Doctors have a professional duty to provide patients with sufficient information if a treatment is associated with a significant risk. NHS guidelines advise doctors to mention risks that occur more frequently than 1–2% or risks that are serious even if the likelihood is very small. In the case of abdominal and pelvic surgery, risks can broadly be divided into early and late complications. Early complications, such as bleeding and infection, have a close temporal relationship with the operation. Such complications are routinely mentioned during the consent process. In contrast, postoperative adhesions cause changes in the normal anatomy that can adversely affect function many years and even decades after the original operation, leaving patients at lifelong risk for late complications. These late adhesive complications, namely bowel obstruction, mechanical female infertility and chronic pain, are often neglected during the consent process. However, the risks to patients from late adhesive complications are serious and well in excess of the accepted threshold where it could be considered a breach in the duty of care not to inform patients. This is reflected by a number of claims against the NHS based on consent issues regarding late adhesive complications of surgery. Therefore, late complications of surgery from adhesions should be included in the pre-operative consent process. This would decrease litigation costs but more importantly also underpins the doctor–patient relationship.