bluuebunny/crossref_metadata_2025_split huggingface dataset:
Undifferentiated connective tissue disease and its cutaneous manifestations
Authors: Pestelli E , Volpi W , Giomi B , Caproni M , Fabbri P 
Published: October 2003

ABSTRACTUndifferentiated connective tissue disease (UCTD, also named UCT syndrome, latent lupus or incomplete lupus) is regarded as an autoimmune disorder in which signs and symptoms are widely variable and evocative for connectivitis but not sufficiently evolved to fulfil any of the accepted classification criteria for the defined connective tissue diseases. In this paper we describe the case of a 47‐year‐old woman affected by UCTD according to the preliminary classification criteria supplied by Mosca et al. in 1999.
A new surgical approach for the treatment of severe epithelial skin sun‐induced damage
Authors: Pianigiani E , Cherubini Di Simplicio F , Ierardi F , Taddeucci P , Andreassi A , Fimiani M 
Published: October 2003

ABSTRACTBackground  Cutaneous photoageing is a complex biological process affecting all layers of the skin. Skin damage resulting from intrinsic ageing and extrinsic photoageing may trigger skin cancer. In patients with advanced photoageing and/or diffuse actinic damage, local therapy is often inadequate and the possibility of combined therapy needs to be assessed.Subjects  Here we report three cases of patients over 75 years of age with advanced diffuse epithelial skin damage of photoexposed areas consisting of several superficial actinic keratoses, ipermelanotic lesions and multiple skin cancers.Methods  Neoplastic lesions and damaged skin were removed by superficial erbium laser ablation and the epidermis reconstructed with autologous epidermal sheets expanded in vitro from healthy cells obtained from unexposed areas of the body.Results  Our initial studies show that this procedure is very effective in the short term for treating and preventing the UV‐induced skin cancer and precancerous lesions, and also suggest good long‐term control of the disease with very interesting aesthetic results.
Langerhans’ cell histiocytosis and haemophagocytic lymphohistiocytosis in an elderly patient
Authors: Ioannidou D , Krasagakis K , Panayiotidis J , Stefanidou M , Alexandrakis M , Tosca A 
Published: October 2003

ABSTRACTWe present a case of a 78‐year‐old man suffering from a chronic psoriasiform eruption, with rapid deterioration over the previous 8 weeks. Langerhans’ cell histiocytosis with skin and bone involvement was diagnosed, and there was evidence of liver and lung dysfunction. The patient was treated with prednisolone and etoposide, and initially experienced a partial improvement. Three weeks later, haemophagocytic lymphohistiocytosis and subsequently a large pulmonary abscess with sepsis attributed to opportunistic gram‐negative enterobacteriaceae Serratia marcescens developed, and the patient died. The present case of Langerhans’ cell histiocytosis is of particular interest because of the previously unreported development of haemophagocytic lymphohistiocytosis in the elderly population.
Comparative population dynamics of Eucalyptus cladocalyx in its native habitat and as an invasive species in an urban bushland in south‐western Australia
Authors: Ruthrof Katinka X. , Loneragan William A. , Yates Colin J. 
Published: October 2003

Abstract.  Eucalyptus cladocalyx F. Muell., is a tree with a restricted distribution in the Southern Flinders Ranges, South Australia. It was originally introduced into the urban bushland of Kings Park, Perth, Western Australia in 1932 as an ornamental. Since its planting, E. cladocalyx has become invasive, spreading into the bushland up to 70 m away from planting sites. Anecdotal evidence suggests that the E. cladocalyx population is increasing at a greater rate than the two principal native tree species, E. gomphocephala DC. and E. marginata Donn ex Smith, but little is known about the factors influencing its invasion, or its biology. This study describes the population structure of E. cladocalyx, E. gomphocephala and E. marginata in Kings Park and the role of fire in the recruitment process. The study indicated that the three species have characteristics common to temperate Eucalyptus species that mass recruit seedlings following fire, with high numbers of seedlings found in recently burnt areas and low numbers in unburnt areas. Seedling survival in E. cladocalyx was higher than either of the native species. Furthermore, E. cladocalyx adults showed higher rates of canopy recovery following fires. It is argued that although fire in Kings Park is providing opportunities for E. cladocalyx, E. gomphocephala and E. marginata recruitment, the E. cladocalyx population is more resilient in an environment frequently disturbed by fire compared with the native populations.
Age, Vascular Risk, and Cognitive Decline in an Older, British, African‐Caribbean Population
Authors: Stewart Robert , Prince Martin , Mann Anthony 
Published: October 2003

Objectives: To investigate associations between baseline factors and subsequent cognitive decline in an older African‐Caribbean population.Design: Three‐year follow‐up of a community sample.Setting: Registration lists for seven primary care services in south London, United Kingdom.Participants: Of 290 Caribbean‐born people aged 55 to 75 recruited at baseline, 216 (75%) were reinterviewed after a 3‐year period. Sufficient data for analysis were present for 207.Measurements: Tests of verbal memory (immediate and delayed), orientation, and attention were administered at baseline and at 3 years. A composite measure of cognitive change was derived through factor analysis. Participants in the lowest quintile were defined as having cognitive decline and were compared with the rest of the sample with respect to baseline characteristics.Results: Cognitive decline was strongly associated with increased age, but not with sex, education, or occupation. It was also not directly associated with hypertension, diabetes mellitus, or exercise, but the age‐decline association was significantly stronger in people with diabetes mellitus and was lower in those reporting vigorous physical exercise at baseline. When cognitive decline was investigated separately for individual tests, both these patterns of association were particularly strong for decline in delayed verbal recall.Conclusion: The association between increased age and cognitive decline, particularly decline in verbal recall, was stronger in people with diabetes mellitus (but not hypertension) and weaker in people who were more physically active.
Treatment of Elderly and Other Adult Patients for Depression in Primary Care
Authors: Fischer Lucy Rose , Wei Feifei , Solberg Leif I. , Rush William A. , Heinrich Richard L. 
Published: October 2003

Objectives:To determine whether depression is treated differently in older and younger patients in primary care clinics.Design:Administrative data were used to identify patients with a depression diagnosis code. The sources of data were baseline and 3‐month follow‐up surveys, the health plan electronic database, and chart audits.Setting:Nine primary care clinics owned by a health maintenance organization in the Midwest.Participants:The study sample (N=1,023) consisted of adult patients, aged 19 to 93, and was divided into six age groups, from young adult, under age 35, to old old, 75 or older.Measurements:Independent variables were a series of dummy variables: age groups, baseline depression severity, sex, and incident depression. Outcomes were defined as care processes (assessment, resources) and improvement in depression symptoms (Center for Epidemiologic Studies—Depression scale short form). Univariate and multivariate logistic regression analyses were used to analyze patient characteristics, depression symptoms, and care process variables. Significance level was reported based on the chi‐square test of probability,P≤.05.Results:The adjusted response rates to the baseline and follow‐up surveys were 69% and 82%. Elderly depressed patients were more likely than younger depressed patients to be widowed, have low levels of education, have fair or poor health, and have three or more comorbid health problems. There were no differences, by age, in number of depressive symptoms, antidepressant treatment, or recommendation for a follow‐up appointment. Younger patients were more likely than older patients to have a new diagnosis of depression and to report being depressed most of the past year. Providers were only 6% as likely to ask old‐old depressed patients about suicide risk, about one‐fourth as likely to referral them to a mental health therapist, about one‐fifth as likely to ask if they felt depressed, and one‐twentieth as likely to ask about a problem with alcohol as they were with young‐adult depressed patients. The old‐old were about one‐third as likely to report improvement in depression symptoms after 3 months as the young‐adult patients.Conclusion:This study suggests a possible pattern of underattention to the oldest depressed patients. Failure to ask about suicide risk is especially of concern because of the high suicide rate of depressed geriatric patients. The finding that physicians are less likely to focus on depression with old‐old patients may be explained, in part, by the concept of invisibility of the ordinary.
Influence of Executive Function on Locomotor Function: Divided Attention Increases Gait Variability in Alzheimer's Disease
Authors: Sheridan Pamela L. , Solomont Judi , Kowall Neil , Hausdorff Jeffrey M. 
Published: October 2003

Objectives: To evaluate how cognitive function and divided attention affect gait in Alzheimer's disease (AD).Design: Cross‐sectional intervention study with subjects serving as their own controls.Setting: Inpatient unit and outpatient clinic for patients with dementia located at a Veterans Affairs Medical Center.Participants: Twenty‐eight patients diagnosed with probable AD.Intervention: Performance of a cognitive task (repeating random digits) while walking.Measurements: Neuropsychological measures includ‐ing clock drawing, verbal fluency, and digit span were obtained along with the Clinical Dementia Rating and Mini‐Mental State Examination, the measures of dementia severity. Gait speed and stride‐to‐stride variability of gait rhythm were measured, once during normal walking and once during dual‐task walking.Results: During usual walking, subjects walked slowly and with greater gait variability than older adults without AD. Gait speed was significantly reduced (P<.012) and gait variability increased with dual‐task walking (P<.007). The effect on gait variability was larger than the effect on gait speed (P<.015). Executive and neuropsychological function were significantly (P<.02) associated with the increased gait variability that occurred when walking with divided attention but not with gait speed or usual, single‐task walking measures of gait.Conclusion: Divided attention markedly impairs the ability of patients with AD to regulate the stride‐to‐stride variations in gait timing. This susceptibility to distraction and its effect on stride time variability, a measure of gait unsteadiness, could partially explain the predilection to falling observed in patients with dementia. The results also support the concept that persons with AD have significant impairments in the cognitive domain of attention and that locomotor function relies upon cognitive, especially executive, function.
Differing Risk Factors for Falls in Nursing Home and Intermediate‐Care Residents Who Can and Cannot Stand Unaided
Authors: Lord Stephen R. , March Lynn M. , Cameron Ian D. , Cumming Robert G. , Schwarz Jennifer , Zochling Jane , Chen Jian Sheng (Charles) , Makaroff Jan , Sitoh Yih Yiow , Lau Tang Ching , Brnabic Alan , Sambrook Philip N. 
Published: October 2003

Objectives: To determine fall risk factors in nursing home and intermediate‐care residents who can and cannot stand unaided.Design: Prospective cohort study.Setting: Residential elderly care facilities in Sydney, Australia.Participants: One thousand people aged 65 to 103 (mean age ± standard deviation: 85.0 ± 7.4).Measurements: Accidental falls.Results: Fall rates were highest in those with fair standing balance, intermediate in those with the best standing balance, and lowest in those with the worst standing balance. This nonlinear pattern was even more striking when subjects were categorized according to their standing balance and ability to rise from a chair. Using this dual classification, fall rates were highest in those who could rise from a chair but could not stand unaided (81%) and lowest in those who could neither rise from a chair nor stand unaided (48%). In residents who could stand unaided, risk factors included increased age, male sex, higher care classifications, incontinence, psychoactive medication use, previous falls, and slow reaction times. In contrast, quite different risk factors were evident in residents who could not stand unaided, with a number of known fall risk factors (previous stroke, reduced ability to rise from a chair, slow reaction times) being associated with fewer falls. In this group, risk factors were intermediate versus nursing home care, poor health status, psychoactive medication use, Parkinson's disease, previous falls, and being able to get out of a chair.Conclusion: The findings indicate that there are different risk factors for falls for people living in residential aged care facilities who can and cannot stand unaided. These findings provide important information for developing fall‐prevention strategies and suggest that those who can stand unaided but have multiple falls risk factors constitute the highest priority group for such interventions.
Behavioral and infectious disease risks in young blood donors: implications for recruitment
Authors: Damesyn Mark A. , Glynn Simone A. , Schreiber George B. , Ownby Helen E. , Bethel James , Fridey Joy , McMullen Quentin , Garratty George , Busch Michael P. 
Published: October 2003

BACKGROUND:  Recruitment of young donors is critical to expand the donor base and sustain the blood supply. Nevertheless, there is concern that younger blood donors may have a higher risk profile than their older counterparts.STUDY DESIGN AND METHODS:  The prevalence of behavioral risks associated with transfusion‐transmissible viral infections and the incidence of viral markers were compared between younger and older donors. Behavioral risks included unreported deferrable risks (UDRs) and HIV test seeking estimated from anonymous donor surveys administered in 1993 and 1998. The incidence of HIV, HCV, or HBV was estimated from donors giving at five US blood centers between 1996 and 2000.RESULTS:  Donors younger than 25 years of age were significantly more likely to report a UDR or HIV test seeking than those 25 years or older. ORs comparing donors 18 to 19 and 20 to 24 years of age to those 25 years or older were 2.0 (95% CI, 1.5‐2.6) and 1.5 (95% CI, 1.2‐1.9) for UDR and 4.5 (95% CI, 3.0‐6.9) and 5.5 (95% CI, 4.2‐7.1) for test seeking, respectively. Although incidence estimates did not significantly differ between age groups, HIV incidence appeared to be highest in 18‐ to 19‐year‐old donors, whereas HBV incidence was highest in 20‐ to 24‐year‐old donors.CONCLUSIONS:  Donors younger than 25 years of age appeared to have a higher behavioral risk profile than older donors. The message not to donate when a behavioral risk is present or for obtaining HIV tests needs to be reinforced in younger donors.
Laser‐assisted optical rotational cell analyzer measurements reveal early changes in human RBC deformability induced by photodynamic treatment
Authors: Hardeman Max R. , Besselink Geert A.J. , Ebbing Iwan , De Korte Dirk , Ince Can , Verhoeven Arthur J. 
Published: October 2003

BACKGROUND:  The ability to deform is important for circulating RBCs in vivo, and earlier studies showed that this property can objectively be measured in vitro by the LORCA. In this study it was investigated whether photodynamic treatment of human RBCs (meant to inactivate contaminating pathogens) affects deformability.STUDY DESIGN AND METHODS:  WBC‐reduced RBC suspensions (30% Hct) were treated with 1,9‐dimethylmethylene blue (DMMB) and red light. Changes in deformability were analyzed by LORCA measurements, in which elongation of the cells is measured at increasing shear stress. The effect of DMMB concentration and light dose was determined as well as the interfering effect of two scavengers of reactive oxygen species, that is, dipyridamole and Trolox.RESULTS:  Photodynamic treatment with DMMB resulted in clear changes in RBC deformability. Deformability changes occurred before onset of hemolysis. Under relatively mild treatment conditions, especially deformability at low shear stress was decreased, whereas deformability changes at high shear stress only occurred under harsher treatment conditions. Inclusion of dipyridamole and/or Trolox primarily prevented deformability changes at high shear stress.CONCLUSION:  LORCA measurements can effectively be used to detect changes in deformability that are induced by photodynamic treatment of human RBCs. A change in deformability represents an early marker of RBC damage under these conditions.
Bioethics, Theology, and Social Change
Authors: Cahill Lisa Sowle 
Published: October 2003

ABSTRACTRecent years have witnessed a concern among theological bioethicists that secular debate has grown increasingly “thin,” and that “thick” religious traditions and their spokespersons have been correspondingly excluded. This essay disputes that analysis. First, religious and theological voices compete for public attention and effectiveness with the equally “thick” cultural traditions of modern science and market capitalism. The distinctive contribution of religion should be to emphasize social justice in access to the benefits of health care, challenging the for‐profit global marketing of research and biotechnology to wealthy consumers. Second, religion and theology have been and are still socially effective in sponsoring activism for practical change, both locally and globally. This claim will be supported with specific examples; with familiar concepts like subsidiarity and “middle axioms”; and with recent analyses of “participatory democracy” and of emerging, decentralized forms of global governance.
Can it Ever Be Better Never to Have Existed At All? Person‐Based Consequentialism and a New Repugnant Conclusion
Authors: Roberts Melinda A. 
Published: October 2003

ABSTRACT Broome and others have argued that it makes no sense, or at least that it cannot be true, to say that it is better for a given person that he or she exist than not. That argument can be understood to suggest that, likewise, it makes no sense, or at least that it cannot be true, to say that it is worse for a given person that he or she exist than that he or she never have existed at all.This argument is of critical importance to the question of whether consequentialist theory should take a traditional, aggregative form or a less conventional, person‐affecting, or person‐based, form. I believe that, potentially, the argument represents a far more serious threat to the person‐based approach than does, for example, Parfit's two medical programmes example. Parfit's example nicely illustrates the distinction between aggregative and person‐based approaches and raises important questions. But the example — though not, I think, by Parfit — is sometimes pressed into service as a full‐fledged counterexample against the person‐based approach. As such, I argue, the example is not persuasive. In contrast, the Broomeian argument, if correct, is definitive. For that argument relies on certain metaphysical assumptions and various uncontroversial normative claims — and hence nicely avoids putting into play the controversial normative claims that lie at the very heart of the debate.The purpose of the present paper, then, is to evaluate the Broomeian argument. I argue that this potentially definitive challenge to a person‐based approach does not in fact succeed.
Scheduling the production of rolling ingots: industrial context, model, and solution method
Authors: Schwindt C. , Trautmann N. 
Published: October 2003

AbstractWe study a real‐world scheduling problem arising in the context of a rolling ingots production. First we review the production process and discuss peculiarities that have to be observed when scheduling a given set of production orders on the production facilities. We then show how to model this scheduling problem using prescribed time lags between operations, different kinds of resources, and sequence‐dependent changeovers. A branch‐and‐bound solution procedure is presented in the second part. The basic principle is to relax the resource constraints by assuming infinite resource availability. Resulting resource conflicts are then stepwise resolved by introducing precedence relationships among operations competing for the same resources. The algorithm has been implemented as a beam search heuristic enumerating alternative sets of precedence relationships.
A genetic algorithm and the Monte Carlo method for stochastic job‐shop scheduling
Authors: Yoshitomi Y. , Yamaguchi R. 
Published: October 2003

AbstractThis paper proposes a method for solving stochastic job‐shop scheduling problems using a hybrid of a genetic algorithm in uncertain environments and the Monte Carlo method. First, the genetic algorithm in uncertain environments is applied to stochastic job‐shop scheduling problems where the processing times are treated as stochastic variables. The Roulette strategy is adopted for selecting the optimum solution having the minimum expected value for makespan. Applying crossover based on Giffler and Thompson's algorithm results in two offspring inheriting the ancestor's characteristics as the operation completion times averaged up to the parent's generation. Individuals having very high frequency through all generations are selected as the good solutions. Second, the Monte Carlo method is effectively used for finding out the approximately optimum solution among these good solutions.
In Vitro-In Vivo Model for Evaluating the Antiviral Activity of Amprenavir in Combination with Ritonavir Administered at 600 and 100 Milligrams, Respectively, Every 12 Hours
Authors: Preston Sandra L. , Piliero Peter J. , Bilello John A. , Stein Daniel S. , Symonds William T. , Drusano George L. 
Published: October 2003

ABSTRACTThe study objective was to evaluate the pharmacodynamics of amprenavir in an in vitro system, develop an exposure target for maximal viral suppression, and determine the likelihood of target attainment based on the pharmacokinetics of amprenavir and ritonavir in human immunodeficiency virus (HIV)-infected patients. Population pharmacokinetic data were obtained from 13 HIV-infected patients receiving amprenavir and ritonavir in doses of 600 and 100 mg, respectively, every 12 h. A 2,500-subject Monte Carlo simulation was performed. Target attainment was also estimated for a target derived from clinical data. Maximal viral suppression (in vitro) was achieved when amprenavir free-drug concentrations remained greater than four times the 50% effective concentration (EC50) for 80% of the dosing interval. At an amprenavir EC50of 0.03 μM, the likelihood of target attainment is 97.4%. For reduced-susceptibility isolates for which the EC50s are 0.05 and 0.08 μM, target attainment is 91.0 and 75.8%, respectively. For the clinical target of a trough concentration/EC50ratio of 5, the target attainment rates were similar. Treatment with amprenavir and ritonavir at doses of 600 and 100 mg, respectively, twice a day provides excellent suppression of wild-type isolates and reduced-susceptibility isolates up to an EC50of 0.05 μM. Even at 0.12 μM, target attainment likelihood exceeds 50%, making this an option for patients with extensive exposure to protease inhibitors when this treatment is used with additional active antiretroviral agents.