bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tritonus der Hoffnung. Ein fiktives Intervall in Thomas Manns Doktor Faustus
Authors: Börnchen Stefan 
Published: December 2003

Meinen Eltern gewidmetDie musiktheoretischen Ausführungen in Thomas Manns Roman Doktor Faustus gehen auf Adornos (geschichts‐) philosophische Schriften zur Musik zurück. Dennoch greift eine Deutung zu kurz, die den Roman – mit den philologischen Mitteln des Quellenaufspürens – auf Adornos Thesen zu reduzieren versucht. Vielmehr läßt sich zeigen, daß der Faustus‐Roman und Adornos Schriften als Texte gelesen werden können, die gegenseitig Licht aufeinander werfen. Das ist möglich mit Blick auf zwei Textstellen im Doktor Faustus, die sich als durch ein fiktives Intervall verbunden interpretieren lassen. Am Beispiel dieses ‘Tritonus der Hoffnung’, eines der fast zahllosen intra‐ und intertextuellen Bezüge des Buches, lassen sich einige zentrale Motive des Faustus‐Romans umreißen.
A reappraisal of the histologic findings of pigmented pretibial patches of diabetes mellitus
Authors: Houck Gregory M. , Morgan Michael B. 
Published: December 2003

Background:  Pigmented pretibial patches (PPPs) are the most common cutaneous alterations in diabetes mellitus, found in up to 50% of diabetic patients. They classically present as flat‐topped, dull‐red papules on the pretibial areas, later becoming hyperpigmented and atrophic. Little is known regarding the pathogenesis of these lesions, and the histopathologic findings have been regarded as non‐specific.Methods:  We investigated the clinical and pathologic attributes of a series of 12 diabetic patients with PPP in an effort to discern any specific histologic attributes compared to normal skin removed from diabetic patients with cutaneous carcinoma.Results:  All cases of PPP showed hyaline microangiopathy, all patients showed extravasated erythrocytes and/or hemosiderin deposits, and 10 patients showed an appreciable number of perivascular plasma cells. The average number of plasma cells per vascular plexus was 2.2. Control specimens removed from five diabetic patients showed hyaline microangiopathy, and three showed extravasated erythrocytes and hemosiderin. One patient showed a single vascular plexus with two plasma cells, p = 0.01.Conclusion:  The presence of increased dermal perivascular plasma cells in the appropriate clinical context might be an important and under‐recognized clue for PPP. The pathogenic significance of this finding is unknown.
The histologic spectrum of cutaneous sarcoidosis: a study of twenty‐eight cases
Authors: Ball Nigel J. , Kho Grace T. , Martinka Magdalena 
Published: December 2003

Background:  Naked sarcoidal granulomas (NSGs) are the characteristic histologic finding in sarcoidosis. This descriptive study was designed to identify the frequency of other histologic changes in cutaneous sarcoidosis.Methods:  The slides from 28 sequential biopsies previously diagnosed as sarcoidosis in patients with known systemic sarcoidosis were reviewed.Results:  Classic NSGs were identified in 25 biopsies (89%). Four biopsies contained tuberculoid granulomas, two with neutrophils suggesting infection (cultures negative). Five biopsies contained interstitial granulomas that resembled granuloma annulare and necrobiosis lipoidica in one case each. Additional histologic findings included birefringent foreign material in 14 biopsies (50%), focal necrosis (43%), elastophagocytosis (39%), linear peri‐neural granulomas resembling leprosy (25%), increased dermal mucin (18%) and lichenoid inflammation (14%) [two with plasma cells resembling syphilis (7%)]. In all but three cases, the clinical morphology of the lesions suggested sarcoidosis. Special stains for mycobacteria and fungi were negative.Conclusions:  The histologic changes in cutaneous sarcoidosis are more diverse than previously recognized. In sarcoidosis, foreign material may be a frequent nidus for cutaneous granuloma formation. Histologic examination without the clinical history could lead to a misdiagnosis of leprosy, syphilis, other infectious granulomas, rosacea, granuloma annulare, necrobiosis lipoidica, and foreign body reaction in selected cases from this series.
Seasonal variation of dermatologic disease in the USA: a study of office visits from 1990 to 1998
Authors: Hancox John G. , Sheridan Scott C. , Feldman Steven R. , Fleischer Alan B. 
Published: December 2003

AbstractBackground  Seasonal variation has been demonstrated in many diseases, including certain skin diseases.Objective  To determine whether there is seasonal variation in dermatologic office visits in the USA.Methods  Data on dermatologic office visits were obtained from representative visits to outpatient physicians in the USA from the National Ambulatory Medical Care Survey from 1990 to 1998. Office visit seasonality was examined for all skin conditions, and individually for the 15 most commonly diagnosed conditions.Results  Office visits for skin conditions were seasonal (P = 0.002). The magnitude of variation can be roughly expressed by the following scheme: actinic keratosis (P = 0.0001) > acne (P = 0.0001) > folliculitis (P = 0.002) > dyschromia (P = 0.01) > seborrheic keratosis (P = 0.04) > psoriasis (P = 0.07) > seborrheic dermatitis (P = 0.09). Visits for skin cancer, not otherwise specified (skin cancer NOS), atopic dermatitis, cysts, common wart, wart, not otherwise specified (wart NOS), rosacea, contact dermatitis, and benign tumors showed no significant seasonal variations or trends.Conclusions  Dermatologic office visits are seasonal, with visits for individual diseases varying in their magnitude of seasonality. This seasonal variation may be a result of biological and nonbiological variables.
Contribution of sexually transmitted diseases and socioeconomic factors to perinatal mortality in rural Ghana
Authors: Bouwhuis Saskia A. , Davis Mark D. P. 
Published: December 2003

AbstractBackground  The infant mortality rate is higher in sub‐Saharan Africa than in other developing regions. The purpose of this study was to evaluate the association of sexually transmitted diseases (STDs) and socioeconomic and obstetric factors with perinatal mortality in rural Ghana.Methods  Perinatal mortality data were collected from 154 patient records of the outpatient and inpatient gynecology department of a rural Ghanaian setting in 1997. All women attended the antenatal care unit of the hospital at least once before delivery, where they were screened for common STDs, including syphilis, gonorrhea, and trichomoniasis. Patients’ socioeconomic characteristics and previous obstetric complications were recorded.Results  The rate of perinatal mortality at the Holy Family Hospital in the Berekum district of Ghana was 13.7% in 1997 (154 of 1123 documented births). Characteristics of mothers whose infants died in the perinatal period and who had attended antenatal care at least once were as follows: prior obstetric complications, 108 patients (70.1%); average age, 25 years (range: 16–42 years); average number of previous sexual partners, three; prevalence of STDs, including gonorrhea, trichomoniasis, or syphilis, 83 patients (53.8%); history of other chronic diseases, 13 patients (8.5%); and illiteracy, 66 patients (42.8%). The number of previous sexual partners and illiteracy were higher in the STD‐positive women.Conclusions  Sexually transmitted diseases and previous obstetric complications seemed to contribute considerably to perinatal mortality in rural Ghana.
Prevalence of skin diseases in Ibadan, Nigeria
Authors: Ogunbiyi Adebola O. , Daramola Olaniyi O. M. , Alese Olatunji O. 
Published: December 2003

AbstractAim   To study the pattern of skin diseases in patients attending the skin clinic of the University College Hospital, Ibadan, Nigeria, and to compare our findings with studies performed earlier in the same clinic.Patients and methods  The study involved 1091 new patients who had attended the skin clinic of the University College Hospital, Ibadan, Nigeria, between January 1994 and December 1998. The patients were examined by the authors, and laboratory investigations were ordered when necessary to make a diagnosis.Results  An increased prevalence of eczema, idiopathic pruritus, urticaria, connective tissue diseases, and fixed drug eruptions was observed. Infections, such as scabies, candidiasis, and tinea versicolor, had also increased. Pyoderma, leprosy, onchocerciasis, and dermatophytoses showed a decline. Psoriasis was uncommon, although there was a slight increase in prevalence. Vitiligo and alopecia were stable. Cutaneous tuberculosis, such as lupus vulgaris, was rare.Conclusions  Allergic conditions have increased; connective tissue disorders, such as systemic lupus erythematosus, scleroderma, and discoid lupus erythematosus, have also increased. Cutaneous disorders associated with human immunodeficiency virus infection, such as seborrheic dermatitis, have increased. Health workers need to be educated on the management and treatment of these conditions, and should be advised to refer patients to appropriate health facilities when necessary.
Research and theory building functions of heuristic case practice
Authors: Poulter Jim 
Published: December 2003

Existing concepts of reflexive and reflective practice are used in this paper to examine the interventive and modelling research functions embedded in case practice. The sequential steps involved in these embedded research functions are compared to those identified in qualitative research methodology and the two models developed by Norma Lang. This paper integrates the research steps involved in both reflexive and reflective practice into a single model of two loops, one truncated and one extended. The six sequential research steps involved in the truncated cycle of reflexive practice are defined as observing, describing, abstracting, generalising, assimilating and acting. The 10 sequential steps involved in the full reflective cycle are defined as observing, describing, abstracting, generalising, categorising, ordering, contextualising, modelling, accommodating and acting. The practical expression of these steps in the field within the processes of critical incident learning and critical mass learning is then discussed.
Nutritional Formula Enhanced Immune Function and Reduced Days of Symptoms of Upper Respiratory Tract Infection in Seniors
Authors: Langkamp‐henken Bobbi , Bender Bradley S. , Gardner Elizabeth M. , Herrlinger‐garcia Kelli A. , Kelley Michael J. , Murasko Donna M. , Schaller Joseph P. , Stechmiller Joyce K. , Thomas Debra J. , Wood Steven M. 
Published: December 2003

Objectives: To assess whether an experimental nutritional formula, given as a supplement, would reduce days of symptoms of upper respiratory tract infection (URTI) and affect antibody and lymphocyte proliferative responses to influenza vaccine.Design:A prospective, randomized, double‐blind, controlled trial was conducted between October 1999 and April 2000.Setting: Assisted‐ and independent‐living facilities in North Central Florida.Participants: Sixty‐six individuals, aged 65 and older.Intervention: Subjects received 8 oz/d of an experimental formula containing antioxidants, zinc, selenium, fermentable oligosaccharides, and structured triacylglycerol or an isoenergetic, isonitrogenous control formula for 183 days.Measurements: Subjects recorded daily symptoms of URTI. Antibody titers and lymphocyte proliferation to three influenza vaccine components were measured on Days 57 and 183.Results: Eighteen subjects in the control group and 16 subjects in the experimental group consumed an average of 7 ounces of formula daily and completed the 183‐day study. Median days of symptoms of URTI were 3 (range 0–69, total days=156) and 0 (range 0–49, total days=78) for the control and experimental groups, respectively (P= .049). On Day 57, seven of 17 (41%) subjects in the control group and 13 of 15 (87%) subjects in the experimental group achieved a fourfold or greater increase in serum antibody titer to A/Beijing (P=.012). Lymphocyte proliferation to influenza vaccine components was greater in the experimental (median=1,365 cpm, range=0–14,955 cpm) than the control group (median=136 cpm, range=0–4,270 cpm) (P=.013).Conclusion: Subjects consuming an experimental nutritional formula experienced enhanced immune function and fewer days of URTI symptoms.
Can a Short Period of Micronutrient Supplementation in Older Institutionalized People Improve Response to Influenza Vaccine? A Randomized, Controlled Trial
Authors: Allsup Stephen J. , Shenkin Alan , Gosney Margot A. , Taylor Stephen , Taylor William , Hammond Margaret , Zambon Maria C. 
Published: December 2003

Objectives: To test the hypothesis that a micronutrient supplement can improve seroconversion after influenza immunization in older institutionalized people.Design: Randomized, double‐blind, placebo‐controlled study.Setting: Nursing and residential homes in Liverpool, United Kingdom.Participants: One hundred sixty‐four residents aged 60 and older from 31 homes were initially randomized; of these, 119 (72.6%) completed the study.Intervention: Participants were randomized to receive a micronutrient supplement providing the reference nutrient intake for all vitamins and trace elements or identical placebo. Tablets were taken over an 8‐week period during September and October 2000; influenza vaccine was administered 4 weeks after their commencement.Measurements: The hemagglutination‐inhibiting antibody response as defined by a fourfold or greater titer rise over 4 weeks and assessed separately for each of the three antigens contained in the 2000/2001 influenza vaccine (A/New Caledonia/20/99 (H1N1), A/Moscow/10/99 (H3N2), B/Beijing/184/93 (B)).Results: Despite a significant increase in serum concentrations of vitamins A, C, D3, E, folate, and selenium in the supplemented group, there was no significant difference between groups (supplemented vs placebo, respectively) in the proportion of participants seroconverting to H1N1 (41% vs 49%, P=.374), H3N2 (49% vs 58%, P=.343), or B (41% vs 40%, P=.944).Conclusion: A micronutrient supplement providing the reference nutrient intake administered over 8 weeks had no beneficial effect on antibody response to influenza vaccine in older people living in long‐term care.
Barriers to Pneumococcal and Influenza Vaccination in Older Community‐Dwelling Adults (2000–2001)
Authors: Nowalk Mary Patricia , Zimmerman Richard K. , Shen Shunhua , Jewell Ilene K. , Raymund Mahlon 
Published: December 2003

Objectives: To identify facilitators of and barriers to vaccination in patients from a range of socioeconomic levels.Design: A survey was conducted in 2001 using computer‐assisted telephone interviewing.Setting: Patients from inner‐city health centers and suburban practices were interviewed.Participants: Inclusion criteria were aged 66 and older and an office visit after September 30, 1998.Measurements: Self‐reported influenza and pneumococcal vaccination status and facilitating conditions, attitudes, social influences, and perceived consequences from the Triandis model were assessed.Results: Overall, 557 interviews were completed with 775 eligible patients (72%). Patients who reported having received pneumococcal vaccine more frequently believed that their physicians recommended the vaccine than did the unvaccinated (97% vs 49%; P=.001). This was also true for influenza vaccine (99% vs 80%; P<.001). More unvaccinated patients than vaccinated patients felt that obtaining either vaccine was more trouble than it is worth (pneumococcal 19% vs 1%; P=.04, influenza 20% vs 1%; P=.004). The vaccinated were more likely to be willing to obtain the influenza and pneumococcal vaccines at the same time (pneumococcal 91% vs 59%; P=.002, influenza 91% vs 55%; P=.014).Conclusion: Physicians should take every opportunity to recommend vaccination to their eligible adult patients. Offering influenza and pneumococcal vaccines at the same visit is an acceptable means to ensure that adults are fully vaccinated.
The Effect of Equipment Usage and Residual Task Difficulty on Use of Personal Assistance, Days in Bed, and Nursing Home Placement
Authors: Taylor Donald H. , Hoenig Helen 
Published: December 2003

Objectives: To determine whether residual difficulty in functioning in spite of equipment use is linked with increased use of personal assistance.Design: Longitudinal. Two waves of the Asset and Health Dynamics Among the Oldest Old (AHEAD) database were used to test the effect of residual difficulty on hours of personal assistance and bed days at Wave 1 on hours of personal assistance, bed days, and nursing home placement at Waves 1 and 2.Setting: A nationally representative setting of community‐dwelling persons aged 70 and older and their spouses, regardless of age at Wave 1 AHEAD. There was movement of some respondents into nursing homes by the Wave 2 interview.Participants: Respondents to the AHEAD survey, N=8,222 at Wave 1.Measurements: The dependent variables were hours of personal assistance in the month before the AHEAD survey (Waves 1 and 2), number of days in month before the survey in which the person did not get out of bed (Waves 1 and 2), and residence in a nursing home at Wave 2. The key explanatory variable was a mutually exclusive (four category) variable that specified whether there was residual difficulty (yes/no) in indoor mobility in spite of using equipment to aid specifically with indoor mobility. The four‐category variable was defined by the four categories created by a cross‐tabulation of equipment use (yes/no) and difficulty with indoor mobility (yes/no). A similar four‐category variable was also defined for transferring in the home.Results: In cross section, equipment users with residual difficulty reported more hours of personal assistance in the case of indoor mobility impairment and were more likely to have some hours of personal assistance than those without residual difficulty with indoor mobility and transferring. Longitudinally, those with residual difficulty at Wave 1 were more likely to need some personal assistance hours at Wave 2 (odds ratio=1.67, 95% confidence interval= 1.23–2.26 for indoor mobility). For transferring, those with residual difficulty had 43 more hours of personal assistance per month (P=.001) than those for whom equipment resolved their disability. Residual disability was linked to more bed days for users of indoor mobility and transferring equipment, but it was not predictive of nursing home placement by Wave 2.Conclusion: Equipment for indoor mobility or transfers apparently resolves difficulty for some users of the equipment but not for others. Residual task difficulty in spite of equipment for indoor mobility and transferring is linked with worse outcomes, including increased dependency on personal assistance and more days in bed. This shows that more attention is needed to determine whether equipment prescribed is appropriate for a patient's difficulty and that follow‐up assessment is crucial after equipment is prescribed.
Efficacy, Safety, and Tolerability of Sertraline in Patients with Late‐Life Depression and Comorbid Medical Illness
Authors: Sheikh Javaid I. , Cassidy Erin L. , Doraiswamy P. Murali , Salomon Ronald M. , Hornig Mady , Holland Peter J. , Mandel Francine S. , Clary Cathryn M. , Burt Tal 
Published: December 2003

Objectives: To report on the efficacy, safety, and tolerability of sertraline in the treatment of elderly depres‐sed patients with and without comorbid medical illness.Setting: Multicenter.Design: Randomized, double‐blind, placebo‐controlled study.Participants: A total of 752 patients aged 60 and older with diagnosis of major depressive disorder according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis.Measurements: Outcome measures included the 17‐item Hamilton Depression Scale (HAMD); the Clinical Global Depression—Severity/Improvement (CGI‐S/CGI‐I); efficacy and safety/adverse event assessments; Quality of Life, Enjoyment, and Satisfaction Questionnaire; and the Medical Outcomes Study 36‐Item Short‐Form Health Status Survey.Results: In the overall sample, sertraline was superior to placebo on all three primary outcome measures, HAMD, and overall clinical severity and change (CGI‐S/CGI‐I). Furthermore, therapeutic response to sertraline was comparable in those with or without medical comorbidity, and there were no treatment‐by–comorbidity group interactions. Sertraline was also associated with a faster time to response than placebo in the comorbid group (P<.006). Sertraline‐treated patients in the comorbid group had similar adverse events and discontinuations when compared to those in the noncomorbid group.Conclusion: Sertraline was efficacious in reducing depressive symptomatology, regardless of the presence of comorbid medical illness. Sertraline was safe and well tolerated by patients with or without medical illness.
The Short‐Term Effect of Interdisciplinary Medication Review on Function and Cost in Ambulatory Elderly People
Authors: Williams Mark E. , Pulliam Charles C. , Hunter Rebecca , Johnson Ted M. , Owens Justine E. , Kincaid Jean , Porter Carol , Koch Gary 
Published: December 2003

Objectives: To determine whether a medication review by a specialized team would promote regimen changes in elders taking multiple medications and to measure the effect of regimen changes on monthly cost and functioning.Design: A randomized‐controlled trial.Setting: Health center ambulatory clinic.Participants: Community‐dwelling older adults taking five or more medications were assessed at baseline and 6 weeks. A medication‐change intervention group of 57 elders was compared with a control group of 76 elder adults.Intervention: The primary intervention was a comprehensive review and recommended modification of a patient's medication regimen. Changes were endorsed by each patient's primary physician and discussed with each patient.Measurements: Measures were the Timed Manual Performance Test, Physical Performance Test, Functional Reach Assessment, subtests from the Wechsler Adult Intelligence Scale, a modified Randt Memory Test, the Center for Epidemiological Studies—Depression Scale, the Self‐Rating Anxiety Scale, and the Rand 36‐item Health Survey 1.0. Comorbidity was determined using the International Classification of Diseases, Ninth Revision, Clinical Modification. Medication usage was determined using brown bag review.Results: Intervention subjects decreased their medications by an average of 1.5 drugs. No differences in functioning were observed between groups. Intervention subjects saved an average $26.92 per month in wholesale medication costs; control subjects saved $6.75 per month (P<.006).Conclusion: Although the intervention significantly reduced the medications taken and monthly cost, most patients were resistant to reducing medications to the recommended level. Further study is needed to understand patient resistance to reducing adverse polypharmacy and to devise better strategies for addressing this important problem in geriatric health. Greater focus on prescriber behavior is recommended.