bluuebunny/crossref_metadata_2025_split huggingface dataset:
Reflection on practice: an intubated patient suffering panic attacks
Authors: Davies Debbie 
Published: June 2007

AbstractPanic attacks and respiratory disease have been shown to have probable links; which one is the precursor to the other is unknown. However, what is known is that there is a correlation between high serum carbon dioxide and lactate levels, which are suffocation indicators, and panic attacks. Females are at a higher risk of suffering panic attacks than men, as they have been shown to have a lower tolerance of suffocation indicators. The aim of this paper is to review the relevance of panic attacks within the intensive care unit setting, where a significant number of patients with respiratory disease have an oral endotracheal tube, which limits communication and may add to the feeling of panic. Using a reflective model, I revisited the actual scenario and consider the series of events as I reflect in action, and at the conclusion of the situation, I reflect on action. The results show that suffering from panic attacks did not inhibit the patient with weaning from the ventilator. Effective communication between the patient and myself led to recognition of the problem, for the correct treatment to be being given, and enabling subsequent extubation. In conclusion, once the link is made of the likelihood of a patient with respiratory disease being prone to panic attacks, the nurse can communicate with the patient or family to establish whether the patient has a panic disorder. The treatment of a regular benzodiazepine, such as diazepam, and constant reassurance from the nurse can then be given to the patient to minimize the symptoms. Reducing the effects of panic attacks can decrease the distress experienced by the patient and improve the clinical picture to facilitate extubation.
Ethical Issues in Dialysis Aaron Spital, Series Editor: Responding to Requests for Dialysis for Severely Demented and Brain Injured Patients
Authors: Spike Jeffrey P. 
Published: June 2007

AbstractNephrologists, like all physicians, need to offer their patients all reasonable treatment options, but only the reasonable options. When dialysis is (or is not) a reasonable option is an important ethical issue. The justification for dialysis, like any life‐sustaining treatment, is that it prolongs life for a patient who either wishes to live or, if cognitively impaired, would (in the opinion of others) likely benefit from extending their life. This article focuses on patients with advanced dementia or severe and irreversible brain injury who are no longer capable of enjoying life, and hence gain no benefit from dialysis. I present guidelines for withholding and withdrawing dialysis and offer suggestions designed to help nephrologists avoid causing harm when the patient’s family demands that dialysis be performed.
Application of Isoelectric Focusing in Immobilized pH Gradients to the Study of Acetaldehyde‐Modified Hemoglobin
Authors: Gordis Enoch , Herschkopf Sybil 
Published: June 2007

We applied the technique of isoelectric focusing (IEF) on immobilized pH gradients (LKB) to determine whether acetaldehyde‐modified hemoglobins (Hb) prepared in vitro with unphysiotogical acetalde‐hyde concentrations have clinical relevance. This technique separates proteins with pi < 0.01 and provides detail about hemoglobins not otherwise separable. We performed two kinds of studies. In one kind of study, we incubated red cells from control subjects with acetaldehyde. Products of these incubations were applied to IEF gels either directly or after reduction with sodium cyanoborohydride. Incubation of red cells with acetaldehyde in 1–150 mm concentration without cyanoborohydride reduction yielded hemoglobin bands of decreasing pi the appearance of which coincided with the disappearance of Hb A and Hb A14. When the products of incubation were reduced with cyanoborohydride before IEF, an additional acidic Hb band appeared which we call the “anodal CNBH band.”In a second kind of study, we compared IEF patterns of hemoly‐sates from control subjects and alcoholism detoxification patients, without adding acetaldehyde. Again, samples were applied to IEF gels either directly or after reduction with cyanoborohydride. When samples were run on IEF without reduction, no differences were seen between patients and controls. When samples were reduced before IEF, an anodal CNBH band appeared having the same mobility as the band seen after in vitro incubations with acetaldehyde. These bands were often stronger in samples from patients, but not consistently so.Several experiments, including the use of glycolysis inhibitors, indicated that the anodal CNBH band is an adduct of fructose 1,6‐diphosphate with hemoglobin. We suggest that in millimolar concentrations, acetaldehyde may function as an inhibitor of glycolysis at or below the aldolase step.
Alcoholism Diagnoses for Convicted Drinking Drivers Referred for Alcoholism Evaluation
Authors: Miller Brenda A. , Whitney Robert , Washousky Richard 
Published: June 2007

The types and extent of alcohol‐related problems were determined for a sample of 461 convicted drinking drivers who were referred to an alcoholism treatment facility for evaluation and possible treatment Using responses to questionnaire and structured interview questions on alcohol‐related problems, DSM III diagnoses are constructed; approximately three‐quarters of the sample are diagnosed with sufficient severity for a DSM III diagnosis of abuse or dependence.Self‐reported consumption levels and drinking/driving incidents increase as the level of the alcohol problem increases; persons in the Alcohol Abuse category are heavier consumers and drive more frequentfy after drinking than are persons who are not diagnosed by the DSM III as having an alcohol problem. Persons in the Alcohol Dependence category are heavier consumers than either the Alcohol Abuse or Undiagnosed Problem categories and report more drinking/ driving incidents.The DSM III provides useful subcategories of convicted drinking drivers referred for alcoholism evaluation and distinguishes groups differing in quantity, frequency, and self‐reported DWI measures, independent of basic demographics. These analyses suggest that drinking/driving countermeasures should include intervention efforts to address alcohol‐related problems. Serious alcohol problems exist among some drinking drivers, and drinking/driving incidents are more frequent among these individuals.
Acute Interactions Between Cytokines and Alcohol on ACTH and Corticosterone Secretion in the Rat
Authors: Rivier Catherine 
Published: June 2007

Possible interactions between alcohol (EtOH) and interleukins (ILs) were studied in intact and adrenalectomized (ADX) rats. In intact animals, administration of 0.3 or 0.65 g EtOH/kg 30 min to 4 hr earlier did not cause measurable changes in plasma adrenocorticotropic hormone (ACTH) levels measured immediately before acute intravenous injection of IL‐1β or endotoxin [lipopolysaccharide (LPS)], and did not interfere with the ability of either treatments to increase ACTH secretion. Administration of 1.5 g EtOH/kg, on the other hand, resulted in elevated plasma ACTH and corticosterone 30 min later, and significantly decreased the magnitude of the ACTH response to IL‐1β in both intact and ADX rats. When administered 4 hr before the cytokine, however, 1.5 g EtOH/kg did not alter the responsiveness of the hypothalamic‐pituitary‐adrenal (HPA) axis to IL‐1/3. Studies of the reverse paradigm were conducted in rats injected with LPS, a means of increasing endogenous IL‐1 levels. Intraperitoneal administration of alcohol 4 hr later resulted in measurably blunted ACTH release by intact rats, but not ADX animals.We conclude that when prior alcohol administration does not result in elevated ACTH levels at the time of IL‐1 injection, no alteration in the HPA axis' response to the cytokine is observed. As we have shown in other experiments that circulating levels of corticosterone were temporarily increased by all doses of alcohol used in the present study, these results suggest that steroid feedback did not play a major role in modulating the ability of IL‐1β to activate the HPA axis. In contrast, prior exposure to endotoxin 4 hr earlier blunted the subsequent effect of an acute injection of alcohol. This effect was probably mediated through corticosteroid feedback, because it was absent in ADX rats. Thus the order in which alcohol and cytokines are administered, and/or the time frame that separates the two treatments, appears to be important in determining whether these stimuli can influence each other's ability to activate the HPA axis.
Diminution of Biological Reactivity of Ethanol by Changing the Solution Structure by Weak Ultrasonication
Authors: Haseba Takeshi , Matsushita Kazuhiro , Asakura Toshihiro , Kameyama Kouji , Tamaki Takeshi , Okouchi Shoichi , Watanabe Tokinori , Uedaira Hisashi 
Published: June 2007

The weak ultrasonication (40 kHz, 12 mW, 1 week) of ethanol solutions was found to reduce stimulation of the senses of smell and taste by the ethanol on the basis of blind tests with an aqueous ethanol solution (33.0% w/v) and an immature distilled spirit (25.0% v/v). Experiments on mice also demonstrated that a treated aqueous ethanol solution had a weaker depressant effect on the central nervous system, as evaluated by the relative frequency with which mice regained the righting reflex at a dose of either 4.0 or 4.5 g/kg (p < 0.05 or p < 0.01, respectively) and by the reduction in rectal temperature at a dose of 5.0 g/kg (p < 0.05) soon after ethanol administration.Analyses of both the ethanol concentration by head‐space gas chromatography and the free radicals by electron spin resonance spectrometer failed to reveal any chemical changes in aqueous ethanol solutions subjected to weak ultrasonication. However, measurement of the spin‐lattice relaxation time (7'i) of the 2H of water molecules by 2H‐NMR showed that the treatment slightly accelerated the thermal motion of water molecules in the solutions. Treated solutions were also found to have a slightly higher density than untreated ones. These physical data demonstrate that weak ultrasonication induces a structural change, such as a more compact and homogeneous structure by changing the microdynamic behavior of the solution. These biological and physical studies suggest that only a slight structural change in an ethanol solution induces a marked change in the biological reactivity of ethanol without any chemical modification of the solution itself.
Effect of Exposure to an Alcohol Diet for 10 Days on the Ability of Interleukin‐1β to Release ACTH and Corticosterone in the Adult Ovariectomized Female Rat
Authors: Lee Soon , Rivier Catherine 
Published: June 2007

Adult ovariectomized female rats were fed an alcohol diet for 10 days. Animals fed ad libitum, or fed an isocaloric diet (pair‐fed), were also included in all experiments. The intravenous injection of interleukin‐β caused dose‐related increases in plasma adrenocorticotropic hormone (ACTH) levels in all three groups of rats. However, alcohol‐fed animals showed a significant blunting of their ACTH, but not corticosterone response, in comparison with rats fed ad libitum or pair‐fed. In contrast, corticotropin‐releasing factor (CRF) injection caused overall statistically comparable ACTH secretory rates in all animals, although small differences were observed in some cases. Exposure to mild electroshocks for 30 min significantly increased ACTH values in all animals, but alcohol‐fed rats again showed blunted release. In this paradigm, pair‐fed animals exhibited a response that was intermediate between that of the ad libitum and alcohol‐fed groups.We conclude that chronic alcohol consumption decreases the response of the hypothalamic‐pituitary axis to cytokines and mild footshocks. This suggests that the activity of both CRF nerve terminals in the median eminence, and of CRF perikarya in the hypothalamus, is inhibited by this treatment, although pituitary responsiveness to CRF appears unchanged.
Temperature, temperature extremes, and mortality: a study of acclimatisation and effect modification in 50 US cities
Authors: Medina-Ramón M , Schwartz J 
Published: June 2007

Objectives:The authors examined the increase in mortality associated with hot and cold temperature in different locations, the determinants of the variability in effect estimates, and its implications for adaptation.Methods:The authors conducted a case-crossover study in 50 US cities. They used daily mortality and weather data for 6 513 330 deaths occurring during 1989–2000. Exposure was assessed using two approaches. First, the authors determined exposure to extreme temperatures using city-specific indicator variables based on the local temperature distribution. Secondly, they used piecewise linear variables to assess exposure to temperature on a continuous scale above/below a threshold. Effects of hot and cold temperature were examined in season-specific models. In a meta-analysis of the city-specific results, the authors examined several city characteristics as effect modifiers.Results:Mortality increases associated with both extreme cold (2-day cumulative increase 1.59% (95% CI 0.56 to 2.63)) and extreme heat (5.74% (95% CI 3.38 to 8.15)) were found, the former being especially marked for myocardial infarction and cardiac arrest deaths. The increase in mortality was less marked at less extreme temperatures. The effect of extreme cold (defined as a percentile) was homogeneous across cities with different climates, suggesting that only the unusualness of the cold temperature (and not its absolute value) had a substantial impact on mortality (that is, acclimatisation to cold). Conversely, heat effects were quite heterogeneous, with the largest effects observed in cities with milder summers, less air conditioning and higher population density. Adjustment for ozone led to similar results, but some residual confounding could be present due to other uncontrolled pollutants.Conclusions:The authors confirmed in a large sample of cities that both cold and hot temperatures increase mortality risk. These findings suggest that increases in heat-related mortality due to global warming are unlikely to be compensated for by decreases in cold-related mortality and that population acclimatisation to heat is still incomplete.
Seasonal-to-Interannual Forecasting of Tropical Indian Ocean Sea Surface Temperature Anomalies: Potential Predictability and Barriers
Authors: Wajsowicz Roxana C. 
Published: June 2007

Abstract
Whether seasonally phased-locked persistence and predictability barriers, similar to the boreal spring barriers found for El Niño–Southern Oscillation (ENSO), exist for the tropical Indian Ocean sector climate is investigated using observations and hindcasts from two coupled ocean–atmosphere dynamical ensemble forecast systems: the National Centers for Environmental Prediction (NCEP) Coupled Forecast System (CFS) for 1990–2003, and the NASA Seasonal-to-Interannual Prediction Project (NSIPP) system for 1993–2002. The potential predictability of the climate is also assessed under the “perfect model/ensemble” assumption.
Lagged correlations of the indices calculated over the east and west poles of the Indian Ocean dipole mode (IDM) index show weak sea surface temperature anomaly (SSTA) persistence barriers in boreal spring at both poles, but the major decline in correlation at the east pole occurs in boreal midwinter for all start months with an almost immediate recovery, albeit negative correlations, until summer approaches. Processes responsible for the change in sign of SSTAs associated with a major IDM event effect a similar change on much weaker SSTAs. At the west pole, a major decline occurs at the end of boreal summer for fall and winter starts when the thermocline deepens with the seasonal cycle and coupling between the ocean and atmosphere is weak.
A decline in skillful prediction of SSTA at the east pole over boreal winter is also found in the hindcasts, but the relatively large thermocline depth anomalies are skillfully predicted through this time and skill in SSTA prediction returns. A predictability barrier at the onset of the boreal summer monsoon is found at both IDM poles with some return of skill in late fall. Potential predictability calculations suggest that this barrier may be overcome at the west pole with improvements to the forecast systems, but not at the east pole for forecasts initiated in boreal winter unless the ocean is initialized with a memory of fall conditions.
A Model-Based Assessment and Design of a Tropical Indian Ocean Mooring Array
Authors: Oke Peter R. , Schiller Andreas 
Published: June 2007

AbstractA series of observing system simulation experiments (OSSEs) are performed for the tropical Indian Ocean (±15° from the equator) using a simple analysis system. The analysis system projects an array of observations onto the dominant empirical orthogonal functions (EOFs) derived from an intermediate-resolution (2° × 0.5°) ocean circulation model. This system produces maps of the depth of the 20°C isotherm (D20), representing interannual variability, and the high-pass-filtered mixed layer depth (MLD), representing intraseasonal variability. The OSSEs are designed to assess the suitability of the proposed Indian Ocean surface mooring array for resolving intraseasonal to interannual variability. While the proposed array does a reasonable job of resolving the interannual time scales, it may not adequately resolve the intraseasonal time scales. A procedure is developed to rank the importance of observation locations by determining the observation array that best projects onto the EOFs used in the analysis system. OSSEs using an optimal array clearly outperform the OSSEs using the proposed array. The configuration of the optimal array is sensitive to the number of EOFs considered. The optimal array is also different for D20 and MLD, and depends on whether fixed observations are included that represent an idealized Argo array. Therefore, a relative frequency map of observation locations identified in 24 different OSSEs is compiled and a single, albeit less optimal, array that is referred to as a consolidated array is objectively determined. The consolidated array reflects the general features of the individual optimal arrays derived from all OSSEs. It is found that, in general, observations south of 8°S and off of the Indonesian coast are most important for resolving the interannual variability, while observations a few degrees south of the equator, and west of 75°E, and a few degrees north of the equator, and east of 75°E, are important for resolving the intraseasonal variability. In a series of OSSEs, the consolidated array is shown to outperform the proposed array for all configurations of the analysis system for both D20 and MLD.
End-of-life decision-making in respiratory intermediate care units: a European survey
Authors: Nava S. , Sturani C. , Hartl S. , Magni G. , Ciontu M. , Corrado A. , Simonds A. 
Published: June 2007

A survey was performed on behalf of the European Respiratory Society to assess end-of-life practices in patients admitted to European respiratory intermediate care units and high dependency units over a 6-month period.A 33-item questionnaire was sent by e-mail to physicians throughout Europe and the response rate was 28 (29.5%) out of 95. A total of 6,008 patients were admitted and an end-of-life decision was taken in 1,292 (21.5%). The mortality rate in these patients was 68% (884 out of 1,292).The patients received similar proportions of withholding of treatment (298 (23%) out of 1292), do-not-resuscitate or do-not-intubate orders (442 (34%) out of 1,292) and noninvasive mechanical ventilation as the ceiling of ventilatory care (402 (31%) out of 1,292). Withdrawal of therapy was employed in 149 (11%) out of 1,292 patients and euthanasia in one. Do-not-intubate/do-not-resuscitate orders were more frequently used in North compared with South Europe. All of the 473 competent patients directly participated in the decision, whereas, in 722 (56%) out of 1,292 cases, decision-making was reported to be shared with the nurses.In European respiratory intermediate care units and high dependency units, an end-of-life decision is taken for 21.5% of patients admitted. Withholding of treatment, do-not-intubate/do-not-resuscitate orders and noninvasive mechanical ventilation as the ventilatory care ceiling are the most common procedures. Competent patients are often involved, together with nurses.
CD8+ T-cell alveolitis in familial pulmonary alveolar microlithiasis
Authors: de Laurentiis G. , Vitiello L. , Racioppi L. , Perna F. , Galgani M. , Merola G. , Carratù P. , Maniscalco M. , Marsico S. , Sofia M. 
Published: June 2007

Pulmonary alveolar microlithiasis (PAM) is a rare diffuse lung disease characterised by the accumulation of calcium phosphate microliths within the alveoli.The causative mechanism of PAM has only recently been discovered, and involves a gene mutation of sodium phosphate co-transporter, which is expressed by alveolar epithelial cells. This mutation may have variable consequences on the clinical phenotype. However, pulmonary cell immune phenotyping in familial PAM has not previously been assessed.In the present article, the analysis of bronchoalveolar lavage fluid of two siblings with PAM diagnosis revealed a pattern of lymphocytic alveolitis with accumulation of CD8+ T-cells. The clonal complexity of this lymphocyte’s population was assayed by spectratyping, which showed an oligoclonal accumulation of T-cells with a restricted variable beta T-cell receptor (TCR) gene usage. TCR analysis in peripheral blood lymphocytes revealed no abnormal patterns of T-lymphocytes.In the pulmonary alveolar microlithiasis familial cases reported, CD8-mediated maladaptive immune response may have taken place in the bronchoalveolar compartment. The relationship between this immune dysregulation and genetic background in pulmonary alveolar microlithiasis warrants further investigation.
Gene expression of lung squamous cell carcinoma reflects mode of lymph node involvement
Authors: Larsen J. E. , Pavey S. J. , Bowman R. , Yang I. A. , Clarke B. E. , Colosimo M. L. , Hayward N. K. , Fong K. M. 
Published: June 2007

Tumour, node, metastasis staging is essential for lung cancer management. However, similarly staged cancers may have markedly different prognoses, indicating that stage cannot completely explain tumour behaviour. While ipsilateral hilar node involvement is designated N1, the current authors hypothesised that primary tumours involving nodes by direct extension are biologically distinct from those involving nodes through lymphatic metastasis.Microarrays were used to investigate the gene expression profiles of 59 primary lung squamous cell carcinomas, comparing N0 tumours (n = 35), N1 tumours by direct extension (N1d; n = 8), and N1/N2 tumours by lymphatic metastasis (N1/N2m; n = 16).Hierarchical clustering using 125 genes differentially expressed between N0 and N1/N2mtumours found N1dtumours clustered with N0 tumours. Class prediction modelling found the expression profiles of all eight N1dtumours were more similar to N0 than to N1/N2mtumours.The present study demonstrates for the first time that N1 tumours directly invading hilar nodes are genomically different to those that metastasisevialymphatics. Independent reports suggest that tumours with direct, rather than metastatic node involvement have better outcomes. Consequently, the data suggest that there is a need to re-evaluate the N1 staging definition in lung cancer. This is relevant for prognosis prediction and also for clinical management, particularly in selecting those patients most likely to benefit from adjuvant chemotherapy.