bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multiculturalism in the Age of Terror: Confronting the Challenges
Authors: Mahajan Gurpreet 
Published: August 2007

Multiculturalism appears to be under siege in Western liberal democracies. The encounter with organised terrorism has placed a question mark against the multicultural wisdom of recognising and accommodating cultural differences in the public arena. As concerns of national security dominate the post-9/11 world, distinctions between ‘us’ and ‘them’ are surfacing in a way that has prompted some to say that the present war on terror is actually a war on Islam. Will the multicultural ethic survive in this environment? Will states be willing to accommodate cultural diversity and live with the presence of visible differences? The article explores these questions through the lens of India. India has been battling with terrorism for more than a decade now. While this has severely strained the capacity of the political community to nurture multiculturalism, it has successfully resisted the challenges posed by an assertive cultural/religious majoritarianism that surfaced in the shadow of terrorism. India has dealt with the schisms produced by terrorism by drawing upon the collective imaginary and past cultural legacies that ensued from its understanding of a ‘situated self’. This was supplemented by a functioning democracy in which significant minorities were able to shape the electoral fate of political parties and reduce the political clout of those who were insensitive to their concerns. The multicultural ethic is far from secure in India, yet it does not, and has not, faced the problems that confront multiculturalism in Western Europe today. The issues before European democracies may have been accentuated by terrorism but they are linked closely to the liberal notion of tolerance. Does a notion of the ‘situated self’ that informs tolerance in India offer a viable alternative? We cannot expect any political community to erase its historically defined identity, yet a reflection on other ways of thinking and living may assuage some of our anxieties and open us to the possibility of redefining our understanding of differences.
Cellular and molecular pathology of HTS: basis for treatment
Authors: Armour Alexis , Scott Paul G. , Tredget Edward E. 
Published: August 2007

ABSTRACTHypertrophic scar and keloids are fibroproliferative disorders of the skin which occur often unpredictably, following trauma and inflammation that compromise cosmesis and function and commonly recur following surgical attempts for improvement. Despite decades of research in these fibrotic conditions, current non‐surgical methods of treatment are slow, inconvenient and often only partially effective. Fibroblasts from these conditions are activated to produce extracellular matrix proteins such as collagen I and III, proteoglycans such as versican and biglycan and growth factors, including transforming growth factor‐β and insulin like growth factor I. However, more consistently these cells produce less remodeling enzymes including collagenase and other matrix metalloproteinases, as well as the small proteoglycan decorin which is important for normal collagen fibrillogenesis. Recently, the systemic response to injury appears to influence the local healing process whereby increases in Th2 and possibly Th3 cytokines such as IL‐2, IL‐4 and IL‐10 and TGF‐β are present in the circulating lymphocytes in these fibrotic conditions. Finally, unique bone marrow derived cells including mesenchymal and endothelial stem cells as well as fibrocytes appear to traffic into healing wounds and influence the healing tissue. On this background, clinicians are faced with patients who require treatment and the pathophysiologic basis as currently understood is reviewed for a number of emerging modalities.
Consequences of excessive scar formation: dealing with the problem and aiming for the future
Authors: Greenhalgh David G. 
Published: August 2007

ABSTRACTScarring is the major hindrance to the healing of all tissues. Unfortunately, our knowledge about the factors that regulate scarring is quite limited. Even worse is the fact that there have been few gains in the treatment of pathologic scarring. This review sets the stage for the supplement on scar formation that provides the latest knowledge on the pathophysiology and treatment of scar formation.
Bone marrow‐derived stem cells in wound healing: a review
Authors: Wu Yaojiong , Wang JianFei , Scott Paul G. , Tredget Edward E. 
Published: August 2007

ABSTRACTOptimum healing of a cutaneous wound requires a well‐orchestrated integration of the complex biological and molecular events of cell migration and proliferation, and of extracellular matrix deposition and remodeling. Several studies in recent years suggest that bone marrow derived stem cells such as mesenchymal stem cells, progenitor cells such as endothelial progenitor cells and fibrocytes may be involved in these processes, contributing to skin cells or releasing regulatory cytokines. Stem/progenitor cells may be mobilized to leave the bone marrow, home to injured tissues and participate in the repair and regeneration. Direct injection of bone marrow derived mesenchymal stem cells or endothelial progenitor cells into injured tissues shows improved repair through mechanisms of differentiation and/or release of paracrine factors. Enhanced understanding of these cells may help develop novel therapies for difficult cutaneous conditions such as non‐healing chronic wounds and hypertrophic scarring as well as engineering cutaneous substitutes.
TGF‐β–induced fibrosis and SMAD signaling: oligo decoys as natural therapeutics for inhibition of tissue fibrosis and scarring
Authors: Cutroneo Kenneth R. 
Published: August 2007

ABSTRACTTransforming‐growth factor‐β (TGF‐β) is a pleiotrophic growth factor that is synthesized by many cells in the body. This growth factor is chemotactic for fibroblasts, stimulates fibroblast proliferation, and increases the synthesis of a number of extracellular matrix proteins including collagens. The TGF‐β activator protein is a transacting factor, which binds to the TGF‐β element in the distal promoter of the COL1A1 collagen gene and induces transcription of this gene. Although transient TGF‐β1 activity participates in repair and regeneration of tissues, persistent TGF‐β1 function affects excessive fibrosis and ultimately scarring of both skin and internal organs. Scarring of internal organ (e.g., liver and lung) results in a loss of function and ultimately death may occur. The central issue of this review is that phosphorothioate double‐stranded decoys or other decoys decrease procollagen gene expression, procollagen synthesis, and collagen during fibrogenesis. The rationale is that the decoys containing the TGF‐β element or other gene transcription regulatory CIS‐elements bind the transacting proteins preventing the latter from binding to the CIS‐element in the 5′‐flanking region of the natural gene resulting in transcription inhibition. We will, in part, focus on aspects involved in TGF‐β1–induced fibrosis that occur during fibrogenesis and the use of the dsTGF‐β element containing oligodeoxynucleotide decoys to control excessive collagen synthesis, and deposition resulting from persistent TGF‐β. In our model of regulation of collagen synthesis, these double‐stranded oligo decoys act as promoter competitors, binding to the activator protein either in the cytoplasm or in the nucleus. The significance of the proposed studies is that these novel natural antifibrotics will mimic the effect of glucocorticoids on collagen synthesis during fibrogenesis without the unwanted side effects of these steroids. Based on our previous studies on the molecular mechanisms by which glucocorticoids selectively decrease collagen synthesis, designed phosphorothioate oligodeoxynucleotides resistant to nuclease action will mimic the effects of glucocorticoids at the molecular, cellular, and in vivo levels of collagen synthesis. However, the glucocorticoids significantly inhibit noncollagen protein synthesis. Both the single‐stranded and double‐stranded oligodeoxynucleotide specifically decrease collagen synthesis without an inhibitory effect on noncollagen protein synthesis. In this review, we will specifically ask if TGF‐β–induced collagen synthesis is inhibited in cell culture and in vivo by using the double‐stranded oligodeoxynucleotide decoys, will this inhibit fibrogenesis and ultimately scarring?
Empirical Assessment of a Research Advance Directive for Persons with Dementia and Their Proxies
Authors: Stocking Carol B. , Hougham Gavin W. , Danner Deborah D. , Patterson Marian B. , Whitehouse Peter J. , Sachs Greg A. 
Published: August 2007

OBJECTIVES: To evaluate a research advance directive for persons with established dementia diagnoses and their family caregivers or proxies.DESIGN: Prospective randomized, controlled trial.SETTING: Three clinics, one each in Ohio, Kentucky, and Illinois.PARTICIPANTS: At the end of separate interviews about enrollment choices in five types of hypothetical research projects, 149 persons with established dementia diagnoses and their family proxies were randomized to jointly complete the Planning Ahead Together (PAT) document, a research advance directive (n=69) or to remain in the control group (n=80).INTERVENTION: The directive was assessed at two points: immediately after sample members received naturally occurring invitations to participate in other studies and again 2 years after initial enrollment.MEASUREMENTS: Personal enrollment rates, reported ease of enrollment decision for patients and proxies, and proxy comfort were compared between the experimental and control groups.RESULTS: Forty‐one dyads were reinterviewed immediately after consent discussions for other trials. Forty‐seven patients and 106 proxies were interviewed at 2‐year follow‐up. There was no evidence immediately after a trial enrollment opportunity or in the follow‐up interview that the research advance directive (PAT) assisted patients or proxies. Enrollment rates, decision ease, and proxy comfort and certainty were similar in the PAT and control groups.CONCLUSION: Patient and proxy experience making hypothetical decisions in the interview may have affected enrollment decisions by the PAT and control groups. Although the low number of recruitment attempts and the natural attrition of the geriatric population limit conclusions about effectiveness that may be drawn from this unique data set, the feasibility of a research advance directive is clearly demonstrated.
High‐Intensity Environmental Light in Dementia: Effect on Sleep and Activity
Authors: Sloane Philip D. , Williams Christianna S. , Mitchell C. Madeline , Preisser John S. , Wood Wendy , Barrick Ann Louise , Hickman Susan E. , Gill Karminder S. , Connell Bettye Rose , Edinger Jack , Zimmerman Sheryl 
Published: August 2007

OBJECTIVES: To determine whether high‐intensity ambient light in public areas of long‐term care facilities will improve sleeping patterns and circadian rhythms of persons with dementia.DESIGN: A cluster‐unit crossover intervention trial involving four conditions: morning bright light, evening bright light, all‐day bright light, and minimum standard light.SETTING: The common areas of two geriatric units in a psychiatric hospital and a dementia‐specific residential care facility.PARTICIPANTS: Sixty‐six older adults with dementia.INTERVENTION: Ambient bright light of approximately 2,500 lux, delivered through a low‐glare lighting system installed in the dining and activity areas. Participant exposure averaged 2.5 to 3.0 hours for the morning and evening interventions and 8.4 hours for the all‐day intervention.MEASUREMENTS: Nighttime sleep using wrist actigraphy and daytime activity using nonobtrusive daytime observations.RESULTS: Night‐time sleep increased significantly in participants exposed to morning and all‐day light, with the increase most prominent in participants with severe or very severe dementia (mean increase 16 minutes (P=.008) for morning, and 14 minutes (P=.01) for all‐day). Morning light produced a mean phase advance of 29 minutes (P=.02) and evening light a mean phase delay of 15 minutes (P=.06). Effects on daytime sleepiness were inconsistent, and the number of sleep bouts, mesor, amplitude, intradaily variability, and interdaily stability were not significantly different, indicating that the overall strength of day and night activity rhythms did not change significantly under any treatment condition.CONCLUSION: Bright light appears to have a modest but measurable effect on sleep in this population, and ambient light may be preferable to stationary devices such as light boxes.
Psychiatric Comorbidity and Greater Hospitalization Risk, Longer Length of Stay, and Higher Hospitalization Costs in Older Adults with Heart Failure
Authors: Sayers Steven L. , Hanrahan Nancy , Kutney Ann , Clarke Sean P. , Reis Brendali F. , Riegel Barbara 
Published: August 2007

OBJECTIVES: To explore associations between psychiatric comorbidity and rehospitalization risk, length of hospitalization, and costs.DESIGN: Cross‐sectional study of 1‐year hospital administrative data.SETTING: Claims‐based study of older adults hospitalized in the United States.PARTICIPANTS: Twenty‐one thousand four hundred twenty‐nine patients from a 5% national random sample of U.S. Medicare beneficiaries aged 65 and older, with at least one acute care hospitalization in 1999 with a Diagnostic‐Related Group of congestive heart failure.MEASUREMENTS: The number of hospitalizations, mean length of hospital stay, and total hospitalization costs in calendar year 1999.RESULTS: Overall, 15.8% of patients hospitalized for heart failure (HF) had a coded psychiatric comorbidity; the most commonly coded comorbid psychiatric disorder was depression (8.5% of the sample). Most forms of psychiatric comorbidity were associated with greater inpatient utilization, including risk of additional hospitalizations, days of stay, and hospitalization charges. Additional hospitalization costs associated with psychiatric comorbidity ranged up to $7,763, and additional days length of stay ranged up to 1.4 days.CONCLUSION: Psychiatric comorbidity appears in a significant minority of patients hospitalized for HF and may affect their clinical and economic outcomes. The associations between psychiatric comorbidity and use of inpatient care are likely to be an underestimate, because psychiatric illness is known to be underdetected in older adults and in hospitalized medical patients.
Collaborative Clinical Quality Improvement for Pressure Ulcers in Nursing Homes
Authors: Lynn Joanne , West Jeff , Hausmann Susan , Gifford David , Nelson Rachel , McGann Paul , Bergstrom Nancy , Ryan Judith A. 
Published: August 2007

The National Nursing Home Improvement Collaborative aimed to reduce pressure ulcer (PU) incidence and prevalence. Guided by subject matter and process experts, 29 quality improvement organizations and six multistate long‐term care corporations recruited 52 nursing homes in 39 states to implement recommended practices using quality improvement methods. Facilities monitored monthly PU incidence and prevalence, healing, and adoption of key care processes.In residents at 35 regularly reporting facilities, the total number of new nosocomial Stage III to IV PUs declined 69%. The facility median incidence of Stage III to IV lesions declined from 0.3 per 100 occupied beds per month to 0.0 (P<.001) and the incidence of Stage II to IV lesions declined from 3.2 to 2.3 per 100 occupied beds per month (P=.03). Prevalence of Stage III to IV lesions trended down (from 1.3 to 1.1 residents affected per 100 occupied beds (P=.12). The incidence and prevalence of Stage II lesions and the healing time of Stage II to IV lesions remained unchanged. Improvement teams reported that Stage II lesions usually healed quickly and that new PUs corresponded with hospital transfer, admission, scars, obesity, and immobility and with noncompliant, younger, or newly declining residents. The publicly reported quality measure, prevalence of Stage I to IV lesions, did not improve. Participants documented disseminating methods and tools to more than 5,359 contacts in other facilities.Results suggest that facilities can reduce incidence of Stage III to IV lesions, that the incidence of Stage II lesions may not correlate with the incidence of Stage III to IV lesions, and that the publicly reported quality measure is insensitive to substantial improvement. The project demonstrated multiple opportunities in collaborative quality improvement, including improving the measurement of quality and identifying research priorities, as well as improving care.
Profound thrombocytopenia and survival of hematopoietic stem cell transplant patients without clinically significant bleeding, using prophylactic platelet transfusion triggers of 10 × 109or 20 × 109per L
Authors: Nevo Shoshan , Fuller Alice K. , Zahurak Marianna L. , Hartley Eric , Borinsky Mark E. , Vogelsang Georgia B. 
Published: August 2007

BACKGROUND:A trigger of 10 × 109per L for prophylactic platelet (PLT) transfusions is generally recommended for stable thrombocytopenic patients who receive chemotherapy, based on studies showing similar incidence, severity, and fatality of bleeding compared with the 20 × 109per L trigger. The outcome of thrombocytopenic nonbleeding patients has not been well described. This retrospective analysis evaluates thrombocytopenia and survival of 381 hematopoietic stem cell transplant (HSCT) patients without clinically significant bleeding, with 10 × 109and 20 × 109per L prophylactic triggers.STUDY DESIGN AND METHODS:A total of 170 patients who received prophylactic PLT transfusions at 20 × 109per L (1997‐1998, SP1) and 211 patients who had prophylaxis at 10 × 109per L (1999‐2001, SP2) were identified as nonbleeding patients. PLT counts and clinical complications were assessed within 100 days from HSCT.RESULTS:PLT counts less than or equal to 10 × 109per L were found in 69.2 percent of patients in SP2 and 38.3 percent in SP1 (p < 0.001). Profound thrombocytopenia (4+ PLT counts ≤10 × 109/L) was found in 19.0 percent of patients in SP2 and 7.0 percent in SP1 (p = 0.001). Patients with profound thrombocytopenia had significantly increased early mortality (odds ratio [OR], 3.18; 95% confidence interval [CI], 1.25‐8.07) and significantly reduced overall survival (hazard ratio [HR], 1.95; 95% CI, 1.28‐2.97) compared to patients with 0 to 3 PLT counts less than or equal to 10 × 109per L. The association of profound thrombocytopenia with early mortality was more notable in SP2.CONCLUSION:The 10 × 109per L transfusion trigger is associated with significantly greater exposure to low PLT counts. Nonbleeding patients with profound thrombocytopenia were at significantly greater risk of dying compared with nonthrombocytopenic patients. These results suggest that safety of the 10 × 109per L trigger should be more thoroughly evaluated.
AABB survey of transfusion‐related acute lung injury policies and practices in the United States
Authors: Kopko Patricia , Silva Marianne , Shulman Ira , Kleinman Steven 
Published: August 2007

BACKGROUND: Policies and practices with regard to transfusion‐related acute lung injury (TRALI) diagnosis, laboratory investigation of TRALI cases, and donor deferral and donor management are not standardized.STUDY DESIGN AND METHODS: A Web‐based survey was designed and administered to participating AABB member institutions in July 2006.RESULTS: The survey response rate was highest for donor centers, followed by larger hospital blood banks and transfusion services. Laboratory case workups regularly included HLA Class I and II antibody testing of donors followed less frequently by HNA antibody testing; recipient specimens for leukocyte antigen typing were usually not obtained, even if indicated as part of the planned workup. Several different criteria (i.e., all donors, female donors only, case by case determination) were used to select which donors should be tested. There was agreement that donors should be deferred if implicated in a TRALI case (i.e., antibody‐cognate antigen match); however, donor management policies varied in other scenarios. The final diagnosis of TRALI was often (45%‐66% depending on institutional type) based on a combination of clinical and serologic findings rather than on adherence to the clinical definition recommended by the Canadian Consensus Conference. Many TRALI policies appeared to be decided on a case‐by‐case basis at the discretion of the institution's medical director.CONCLUSIONS: There is wide variability in procedures and policies related to the diagnosis of and donor investigation and/or management of TRALI cases. Lack of a consensus approach may partly reflect limitations in understanding of TRALI pathogenesis. The survey suggests that increased education of transfusion medicine practitioners is needed.
Peripheral blood progenitor uncontrolled‐rate freezing: a single pediatric center experience
Authors: Iannalfi Alberto , Bambi Franco , Tintori Veronica , Lacitignola Laura , Bernini Gabriella , Mariani Maria Pia , Sanvito Maria Chiara , Pagliai Francesca , Brandigi Francesco , Muscarella Elisa , Tapinassi Francesca , Faulkner Lawrence 
Published: August 2007

BACKGROUND: Controlled‐rate freezing (CRF) followed by storage in liquid nitrogen is employed by most centers as the standard procedure for peripheral blood progenitor cell (PBPC) cryopreservation. Uncontrolled‐rate freezing (URF) at −80°C is more simple, time‐saving, less expensive, and, possibly, as effective as CRF. The aim of this retrospective analysis was to compare CRF and URF in childhood transplantation.STUDY DESIGN AND METHODS: A total of 54 PBPC transplants performed in 39 children aged 3 to 16 years (median, 9.5 years) were analyzed: 23 transplants in 16 children with CRF versus 31 transplants performed in 23 children with −80°C URF. All grafts contained at least 2 × 106 per kg unselected CD34+ cells, enumerated before freezing. Nucleated cells infused ranged from 1.32 × 108 to 4.3 × 108 per mL with a median of 3.1 × 108 per mL. Cryoprotectant solution consisted of a final dimethyl sulfoxide (DMSO) concentration of 10 percent DMSO with autologous plasma.RESULTS: The two study groups did not differ in terms of timing of neutrophil and platelet recovery or transfusion requirements. Adverse events related to graft infusion, severe complications, and transplant‐related mortality were not significantly different between CRF and URF groups. In both groups only mild adverse events were observed during graft administration. URF procedures, however, were simpler and less expensive. At a median follow‐up of 72 months, no secondary myelodysplasia was observed in either group.CONCLUSION: Our analysis suggests that URF is safe and effective in the pediatric population.