bluuebunny/crossref_metadata_2025_split huggingface dataset:
Community‐acquired pneumonia in older patients: Does age influence systemic cytokine levels in community‐acquired pneumonia?
Authors: KELLY Emer , MacREDMOND Ruth E. , CULLEN Garret , GREENE Catherine M. , McELVANEY Noel G. , O'NEILL Shane J. 
Published: November 2008

ABSTRACTBackground and objective:  Community‐acquired pneumonia (CAP) is a major cause of death in the elderly. The age‐related increase in comorbid illnesses plays a part but the effect of aging on the immune response may be equally important. We aimed to evaluate patients with CAP for evidence of a muted response to infection in elderly patients admitted to hospital compared with a younger patient group.Methods:  Patients with CAP admitted through the Emergency Department were recruited for this prospective observational study. Clinical data were collected at presentation. Severity of pneumonia was assessed using the British Thoracic Society confusion, urea nitrogen, respiratory rate, blood pressure (CURB) score, the Pneumonia Severity Index (PSI) and the systemic inflammatory response syndrome (SIRS) definition. IL‐6 and IL‐10 levels were measured within 24 h of admission.Results:  Eighty patients were included in the study, of whom 38 (48%) were female. The median age was 74 years (range 18–95). Patients greater than 65 years of age had a lower incidence of chest pain and a higher incidence of altered mental status on presentation. CURB score and PSI were higher in the older patients. SIRS showed similar frequencies in both groups. IL‐6 and IL‐10 levels were similar in young (< 65 years), older (> 65 years) and very elderly (> 80 years) patients. This finding was not altered by severity of pneumonia.Conclusions:  Age does not diminish the severity of illness scores in patients with CAP. There was no blunting of the systemic cytokine response with advanced age in this study.
Stroke discharges from a rehabilitation unit: 1‐year and 5‐year domicile outcomes. Function is important
Authors: Hanger H. C. , Wilkinson T. J. , Mears A. 
Published: November 2008

AbstractBackground: Stroke units save lives, reduce disability and increase the chances of the person returning to their own home. Following the introduction of a stroke rehabilitation unit, we assessed the durability of stroke discharges over a 1‐year period and predictors of early ‘failed’ home discharges. Stability of discharge domicile and survival over 5 years was also reviewed.Methods: A 6‐month cohort of all discharges was followed for 5 years. Changes in domicile, including entry into institutional care, were recorded out to 5 years or until death. Predictors of early (3 months) and later (1 year) discharge stability were assessed.Results: There were 142 discharges. Fifty‐eight (76%) of those who returned home were still at home 12 months later. In contrast, there was a high mortality of dependent patients who were discharged to high dependency care (9 (29%) and 13 (42%) at 3 and 12 months, respectively). The chance of an early failed discharge was associated with lower functional ability on discharge (P= 0.012). Lower function on discharge was also independently associated with death in the next 12 months (P < 0.0001). At 5 years the mortality for the whole sample was 55% (78 of 141) and 38 (61%) of the survivors still lived in the community whereas 24 (39%) resided in institutional care.Conclusion: Functional ability on discharge is a key predictor of ability to remain at home as well as survival and therefore every effort should be made to maximize function.
Effects of long‐term transdermal hormone replacement therapy on the renin–angiotensin– aldosterone system, plasma bradykinin levels and blood pressure in normotensive postmenopausal women
Authors: Ichikawa Akiko , Sumino Hiroyuki , Ogawa Tetsuya , Ichikawa Shuichi , Nitta Kosaku 
Published: November 2008

Aim:  This study was designed to investigate the effects of 24‐month long‐term transdermal hormone replacement therapy (HRT) on the circulating levels of components of the renin–angiotensin–aldosterone system (RAAS) and bradykinin, blood pressure (BP) and lipid profile in normotensive postmenopausal women (PMW).Methods:  Twenty‐two normotensive PMW were randomized to receive transdermal HRT (continuous 17‐β estradiol patch at 36 µg/day plus cyclic oral medroxyprogesterone acetate 2.5 mg/day for 12 days/month) (n = 12) or control (n = 10). The plasma renin activity (PRA), serum angiotensin‐converting enzyme (ACE) activity, plasma angiotensin (Ang) I, Ang II, aldosterone, bradykinin, and BP were measured before, and 12 and 24 months after, the start of the HRT.Results:  In the HRT group, the diastolic BP and mean BP were significantly decreased at 12 and 24 months (both P < 0.05) after the start of therapy, however, no significant change of the systolic BP was noted during the study period. No changes in the RAAS components or lipid profile were noted in either group. The plasma bradykinin levels were significantly reduced at 12 (P < 0.05) and 24 months (P < 0.01), while no changes were observed in the control group.Conclusion:  More than 12 months of long‐term transdermal HRT kept diastolic BP, mean BP and plasma bradykinin levels decreased in normotensive PMW, without influencing any of the components of the RAAS. This therapy may allow optimal blood pressure control and prevent elevation of the cardiovascular risk.
Incidence of vertebral fractures in Thai women and men: A prospective population‐based study
Authors: Jitapunkul Sutthichai , Thamarpirat Jittima , Chaiwanichsiri Dootchai , Boonhong Jariya 
Published: November 2008

Background:  Vertebral fracture is the most common but the least well‐investigated osteoporotic fracture. A population‐based prospective study was conducted to determine incidence of vertebral fracture in Thai older adults.Methods:  Lateral thoracic and lumbar spine radiographs obtained in 1997 and 2002 of 322 participants were evaluated morphometrically. Incidence of fracture was considered if the vertebra was determined as normal at baseline and any of the anterior, central, posterior vertebral heights on the follow‐up film showed a decrease of at least 20% or 4 mm compared with baseline height.Results:  Incidences of vertebral fracture in women and men were 32.1/1000 and 54.5/1000 person‐year, respectively. Incident rates in men were higher than those in women in all age groups. Incidence increased with age, ranging from 27.4/1000 person‐year at ages 50–59 years to 46.1/1000 person‐year at ages of 70 years or more for women, and 42.3/1000 person‐year at ages 50–59 years to 66.7/1000 person‐year at ages of 70 years or more in men. The incidence was markedly high compared with other studies conducted in white older adults. Thai older adults with incidental vertebral fractures had a much higher proportion of having multiple‐level fractures compared with white older adults.Conclusions:  This study showed a remarkably high incidence of vertebral fractures in a Thai population, particularly in men. The main contributing factor for incidental vertebral fracture was likely to be trauma or micro‐trauma associated with strenuous physical activity or work rather than osteoporosis, particularly among the younger age group and men.
Predictors of length of stay between the young and aged in hospitalized community‐acquired pneumonia patients
Authors: Kaysar Mamun , Augustine Tee , Jim Lim , Benjamin Castasus 
Published: November 2008

Aim:  To determine the factors that may prolong the length of stay (LOS) for older patients hospitalized for community‐acquired pneumonia (CAP) and also to see if they are applicable to the younger patients.Methods:  A retrospective case record review was conducted of all adult patients who were discharged from the general medical service or the geriatric medicine service of an acute care hospital over 6 months.Results:  During the study period, 393 patients were discharged with the diagnosis of pneumonia. Based on the study criteria, 200 patients were included in the study. Of the elderly patients, 39% had severe pneumonia compared to 9.3% in the younger group (P < 0.001), resulting in a higher mortality rate. All patients with severe pneumonia had serum albumin levels of less than 3.7 g/dL. The median LOS was significantly shorter in the younger patients (4 days) compared to the elderly patients (9 days, P < 0.001). Severe pneumonia, dysphagia, chronic renal disease, hypoalbuminemia and older age group were found to be significantly associated with longer LOS.Conclusion:  Compared to younger patients, older subjects aged 65 years and above hospitalized with CAP were more likely to have severe pneumonia and longer LOS. Presence of severe pneumonia, dysphagia, chronic renal disease, hypoalbuminaemia and age of more than 65 years were significantly associated with longer LOS for all patients. However, in the younger group, only hypoalbuminaemia remained a significant factor. In the elderly patients, severe pneumonia, dysphagia and type of residence were important factors predicting longer LOS.
Stress‐induced blood pressure elevation in subjects with mild cognitive impairment: Effects of the dual‐type calcium channel blocker, cilnidipine
Authors: Kawashima Yumiko , Akishita Masahiro , Hasegawa Hiroshi , Kozaki Koichi , Toba Kenji 
Published: November 2008

Aim: We investigated whether mental stress‐induced blood pressure elevation was related to cognitive function in the elderly, and further examined the effects of the dual‐type calcium channel blocker, cilnidipine, on stress induced hypertension in subjects with mild cognitive impairment.Methods: In study I, 39 consecutive outpatients (mean age ± standard deviation, 77 ± 8 years), who were referred to our memory clinic and were not taking any medications, were studied. They were divided into three groups according to cognitive function on the Hasegawa Dementia Scale‐Revised (HDSR): group 1 (n = 8), 28 points or more; group 2 (n = 18), 21–27 points; and group 3 (n = 13), 20 points or less. In study II, 14 outpatients with hypertension and mild cognitive impairment (aged 79 ± 8 years; HDSR score, 24 ± 4) were assigned to receive cilnidipine (10–20 mg/day). The control group (n = 10) matched for age, HDSR and blood pressure was followed without cilnidipine.Results: In study I, although age and basal blood pressure were similar among the three groups, the blood pressure response to a mental arithmetic test was twice as large in group 2 (26 ± 12 mmHg in systolic pressure and 11 ± 8 mmHg in diastolic pressure) as those in groups 1 and 3. In study II, after 4 weeks, cilnidipine treatment significantly decreased the blood pressure responses to the mental arithmetic test compared to the baseline as well as to those of the control group.Conclusions: Stress‐induced blood pressure elevations are exaggerated in subjects with mild cognitive impairment. Cilnidipine may have inhibitory effects on stress‐induced hypertension.
Isolation of novel bacteria within the Chloroflexi capable of reductive dechlorination of 1,2,3‐trichloropropane
Authors: Yan J. , Rash B. A. , Rainey F. A. , Moe W. M. 
Published: November 2008

SummaryTwo strictly anaerobic bacterial strains were isolated from contaminated groundwater at a Superfund site located near Baton Rouge, LA, USA. These strains represent the first isolates reported to reductively dehalogenate 1,2,3‐trichloropropane. Allyl chloride (3‐chloro‐1‐propene), which is chemically unstable, was produced from 1,2,3‐trichloropropane, and it was hydrolysed abiotically to allyl alcohol and also reacted with the sulfide‐ and cysteine‐reducing agents in the medium to form various allyl sulfides. Both isolates also dehalogenated a variety of other vicinally chlorinated alkanes (1,2‐dichloropropane, 1,2‐dichloroethane, 1,1,2‐trichloroethane, 1,1,2,2‐tetrachloroethane) via dichloroelimination reactions. A quantitative real‐time PCR (qPCR) approach targeting 16S rRNA genes indicated that both strains couple reductive dechlorination to cell growth. Growth was not observed in the absence of hydrogen (H2) as an electron donor and a polychlorinated alkane as an electron acceptor. Alkanes containing only a single chlorine substituent (1‐chloropropane, 2‐chloropropane), chlorinated alkenes (tetrachlorothene, trichlorothene, cis‐dichloroethene, trans‐dichloroethene, vinyl chloride) and chlorinated benzenes (1‐chlorobenzene and 1,2‐dichlorobenzene) were not dechlorinated. Phylogenetic analysis based on 16S rRNA gene sequence data showed these isolates to represent a new lineage within the Chloroflexi. Their closest previously cultured relatives are ‘Dehalococcoides’ strains, with 16S rRNA gene sequence similarities of only 90%.
Phylogenetic analysis of actinobacterial populations associated with Antarctic Dry Valley mineral soils
Authors: Babalola Olubukola O. , Kirby Bronwyn M. , Le Roes‐Hill Marilize , Cook Andrew E. , Cary S. Craig , Burton Stephanie G. , Cowan Don A. 
Published: November 2008

SummaryDespite the apparent severity of the environmental conditions in the McMurdo Dry Valleys, Eastern Antarctica, recent phylogenetic studies conducted on mineral soil samples have revealed the presence of a wide diversity of microorganisms, with actinobacteria representing one of the largest phylotypic groups. Previous metagenomic studies have shown that the majority of Antarctic actinobacterial populations are classified as ‘uncultured’. In this study, we assessed the diversity of actinobacteria in Antarctic cold desert soils by complementing traditional culture‐based techniques with a metagenomic study. Phylogenetic analysis of clones generated with actinobacterium‐ and streptomycete‐specific PCR primers revealed that the majority of the phylotypes were most closely related to uncultured Pseudonocardia and Nocardioides species. Phylotypes most closely related to a number of rarer actinobacteria genera, including Geodermatophilus, Modestobacter and Sporichthya, were also identified. While complementary culture‐dependent studies isolated a number of Nocardia and Pseudonocardia species, the majority of the cultured isolates (> 80%) were Streptomyces species – although phylotypes affiliated to the genus Streptomyces were detected at a low frequency in the metagenomic study. This study confirms that Antarctic Dry Valley desert soil harbours highly diverse actinobacterial communities and suggests that many of the phylotypes identified may represent novel, uncultured species.
Childbearing beliefs among Low‐German‐speaking Mennonite women
Authors: Kulig Judith C. , Wall Margaret , Hill Shirley , Babcock Ruth 
Published: November 2008

Background: Low‐German‐speaking (LGS) Mennonites are a conservative religious group that has migrated from Eastern Europe to Canada and then to countries such as Mexico. They are now returning to Canada in large numbers. They adhere to religious principles based upon a literal interpretation of the Bible. This conservative religious group provides opportunities for nurses and midwives to implement culturally competent care.Aim: The purpose of this article is to discuss LGS Mennonite women's childbearing knowledge and beliefs to develop and implement care that considers and includes their conservative religious beliefs.Methods: An exploratory, descriptive study was conducted to generate information through open‐ended interviews with 38 LGS Mennonite women about their knowledge, beliefs and practices related to childbearing. Data collection and analysis occurred simultaneously; emerging themes were discussed by the research team to ensure a contextual understanding of the data.Findings: The participants engage in proscribed practices (‘turning the baby’) and adhere to specific dietary measures (increasing dairy products) during pregnancy to ensure a healthy birth outcome. During the post‐partum, extensive support is provided by other Mennonite women to assist the mother and newborn during this important transition.Conclusion: Building trust and working in a respectful manner with religious groups such as the LGS Mennonites are a cornerstone of culturally competent nursing practice.
Persons' experience of HIV/AIDS in Japan: application of Margaret Newman's theory
Authors: Awa M. , Yamashita M. 
Published: November 2008

Purpose:  To describe human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) persons' experience in Japan applying Margaret Newman's theory of health as expanding consciousness.Method:  Five men who had sex with other men and who were afflicted with HIV/AIDS were interviewed to describe their experience.Findings:  Their narratives revealed an evolving pattern of the whole of five stages; self‐conscious of own sexual orientation, chaos, stagnation, turning point and regaining a new identity. After viewing their pattern, their expanding consciousness was evident from their becoming compassionate for those who were underserved and underprivileged, and having deeper levels of connectedness with their family and friends. The a priori nature of theory in this praxis research was evident when the researcher embodied the theory of expanding consciousness.Recommendations:  The findings of the study demonstrated the relevance and importance of understanding how the condition intersects with race, gender and ethnicity in constructing the unique experience of living with HIV/AIDS. Community health workers, community mental health nurses in particular, should be cognizant of the illness trajectory of those who are afflicted with the condition. Programmes such as outreach should be carried out on an ongoing basis in order to identify and render support to those who might need help from various stages of illness. Community health workers should identify clients' specific needs to refer to appropriate services because there are physical, mental and socio‐economic implications throughout illness trajectory in HIV/AIDS.
Menopause: a qualitative study of Jordanian women's perceptions
Authors: Mahadeen A.I. , Halabi J.O. , Callister L.C. 
Published: November 2008

Purpose:  The purpose of this descriptive qualitative study was to describe the perceptions of Jordanian midlife women about making the menopausal transition.Methods:  Audio taped interviews were conducted with 25 peri‐menopausal Jordanian women. Interviews were analysed as appropriate for descriptive qualitative inquiry.Results:  The major theme generated was ‘A Life Transition’, which included: a time of no more reproductive obligations, changing from the burdens and obligations of reproductive roles and responsibilities to freedom, relief and rest; a time for managing peri‐menopausal symptoms; and a time for growing into a wise woman and accepting aging as a part of life.Nursing implications:  These data can assist healthcare providers to provide culturally competent health care to midlife Jordanian women. Support groups may be helpful to facilitate connections between midlife women, increase self‐awareness, assist women to come to value their menopausal experiences, to manage their symptoms appropriately through self‐care measures and healthcare interventions and to more fully embrace being ‘wise women’.
The Strategic Use of Formal Argumentation in Legal Decisions
Authors: KLOOSTERHUIS HARM 
Published: November 2008

AbstractIn legal decisions standpoints can be supported by formal and also by substantive interpretative arguments. Formal arguments consist of reasons the weight or force of which is essentially dependent on the authoritativeness that the reasons may also have: In this connection one may think of linguistic and systemic arguments. On the other hand, substantive arguments are not backed up by authority, but consist of a direct invocation of moral, political, economic, or other social considerations. Formal arguments can be analyzed as exclusionary reasons: The authoritative character excludes—in principle—substantial counterarguments. Formal arguments are sometimes used to conceal value judgements based on substantial arguments. This paper deals with reconstructing problems regarding this strategic use of formal arguments in legal decisions, with a focus on linguistic argumentation.
THE IDEA OF DEFENSE IN HISTORICAL AND CONTEMPORARY THINKING ABOUT JUST WAR
Authors: Johnson James Turner 
Published: November 2008

ABSTRACTWhat is, or should be, the role of defense in thinking about the justification of use of armed force? Contemporary just war thinking prioritizes defense as the principal, and perhaps the only, just cause for resorting to armed force. By contrast, classic just war tradition, while recognizing defense as justification for use of force by private persons, did not reason from self‐defense to the justification of the use of force on behalf of the political community, but instead rendered the idea of just cause for resort to force in terms of the sovereign's responsibility to maintain justice, vindicating those who had suffered from injustice and punishing evildoers. This paper moves through three major stages in the historical development of just war thinking, first examining a critical phase in the formation of the classical idea of just cause as the responsibility to maintain justice, then discussing the shift, characteristic of the modern period, to an idea of sovereignty as connected to the state and the prioritization of defense of the state as just cause for use of force, and lastly showing how this conception of the priority of defense became part of the recovery of just war thinking in the latter part of the twentieth century. The paper concludes by noting recent changes in thought on international law that tend to emphasize justice at the expense of the right of self‐defense, suggesting that the roots of just war thinking imply the need for a similar rethinking of contemporary just war discourse.
THE SECULAR FAITH OF GILLIAN ROSE
Authors: Lloyd Vincent 
Published: November 2008

ABSTRACTGillian Rose was a philosopher, social theorist, memoirist, and Jewish convert to Christianity who died an untimely death in 1995. She offers a novel account of faith, which grows out of her Hegelian philosophical background inflected by her reading of Kierkegaard and her rediscovered Jewish heritage. For Rose, faith is a mode of social practice. Rose's conception of faith is here reconstructed by translating her obscure jurisprudential idiom into the language of social practices and norms. The conception of secular faith developed by Rose is shown to have implications for contemporary discussions of ethics and politics. The contemporary relevance of Rose's work is made clear through comparison with recent work by Robert Brandom, Robert Adams, and Patrick Deneen.