bluuebunny/crossref_metadata_2025_split huggingface dataset:
Identification of a Subset of Human Immunodeficiency Virus Type 1 (HIV-1), HIV-2, and Simian Immunodeficiency Virus Strains Able To Exploit an Alternative Coreceptor on Untransformed Human Brain and Lymphoid Cells
Authors: Willey Samantha J. , Reeves Jacqueline D. , Hudson Richard , Miyake Koichi , Dejucq Nathalie , Schols Dominique , Clercq Erik De , Bell Jeanne , McKnight Áine , Clapham Paul R. 
Published: May 2003

ABSTRACTThe chemokine receptors CCR5 and CXCR4 are the major coreceptors for human immunodeficiency virus (HIV) and simian immunodeficiency virus (SIV). At least 12 other chemokine receptors or close relatives support infection by particular HIV and SIV strains on CD4+transformed indicator cell lines in vitro.However, the role of these alternative coreceptors in vivo is presently thought to be insignificant. Infection of cell lines expressing high levels of recombinant CD4 and coreceptors thus does not provide a true indication of coreceptor use in vivo. We therefore tested primary untransformed cell cultures that lack CCR5 and CXCR4, including astrocytes and brain microvascular endothelial cells (BMVECs), for naturally expressed alternative coreceptors functional for HIV and SIV infection. An adenovirus vector (Ad-CD4) was used to express CD4 in CD4−astrocytes and thus confer efficient infection if a functional coreceptor is present. Using a large panel of viruses with well-defined coreceptor usage, we identified a subset of HIV and SIV strains able to infect two astrocyte cultures derived from adult brain tissue. Astrocyte infection was partially inhibited by several chemokines, indicating a role for the chemokine receptor family in the observed infection. BMVECs were weakly positive for CD4 but negative for CCR5 and CXCR4 and were susceptible to infection by the same subset of isolates that infected astrocytes. BMVEC infection was efficiently inhibited by the chemokine vMIP-I, implicating one of its receptors as an alternative coreceptor for HIV and SIV infection. Furthermore, we tested whether the HIV type 1 and type 2 strains identified were able to infect peripheral blood mononuclear cells (PBMCs) via an alternative coreceptor. Several strains replicated in Δ32/Δ32 CCR5 PBMCs with CXCR4 blocked by AMD3100. This AMD3100-resistant replication was also sensitive to vMIP-I inhibition. The nature and potential role of this alternative coreceptor(s) in HIV infection in vivo is discussed.
Multiple Epstein-Barr Virus Infections in Healthy Individuals
Authors: Walling Dennis M. , Brown Abigail L. , Etienne Wiguins , Keitel Wendy A. , Ling Paul D. 
Published: May 2003

ABSTRACT
We employed a newly developed genotyping technique with direct representational detection of LMP-1 gene sequences to study the molecular epidemiology of Epstein-Barr virus (EBV) infection in healthy individuals. Infections with up to five different EBV genotypes were found in two of nine individuals studied. These results support the hypothesis that multiple EBV infections of healthy individuals are common. The implications for the development of an EBV vaccine are discussed.
History of the development of geriatric medicine in the UK
Authors: Barton A , Mulley G 
Published: May 2003

Abstract
In this review the development of the specialty of geriatric medicine in the UK is traced from its humble beginnings. Elderly medicine is now thriving and represents the largest group of physician members of the Royal Colleges of Physicians. Geriatric medicine is essentially about optimising the care and wellbeing of older people. A key component of this is teamwork. A successful service for old people depends on the skills of many people, including nurses, therapists, social workers, and others. The contributions made by nurses and other professionals have been immense, but space does not permit a historical review of their important role.
EURIPIDES, MEDEA 131-213
Authors:   Willink
Published: May 2003

AbstractThe Parodos of Medea, with the following musical exchanges between Chorus, Medea (offstage) and Nurse, has some unsatisfactory features in the manuscripts and in editions, for which some new remedies are proposed. Already in the Entry-verses (131-8) the detail of the text has long been controversial, on grounds partly linguistic, partly metrical. Later, at 160 Medea is heard invoking "Themis and Artemis", in words directly referred to by the Nurse at 168-9 as addressed to "Themis and Zeus", and less directly at 208-9 by the Chorus as addressed to "Themis (wife) of Zeus". The apparently irrelevant '′Αρτεμι in 160 has been variously emended by Weil and others. A number of other points of interest (especially of metre) are discussed in passing. But the most important single proposal is a transposition putting lines 160-72 after 173-203; thus on the one hand making the antistrophe 173-83 directly sequential to the strophe 148-59, and on the other hand making the concluding choral epode (204-13: "I heard . . .") directly responsive to the Nurse's question at 168-70 ("Do you hear . . .?"). The Nurse's sinister forecast at 171-2 becomes her parting words, as she goes into the house (we shall not see her again) to fetch her mistress.
DIVINE TYRANNY AND PUBLIC HUMILIATION: A SUGGESTION FOR THE INTERPRETATION OF THE LYDIAN AND PHRYGIAN CONFESSION INSCRIPTIONS
Authors: Schnabel Eckhard 
Published: May 2003

AbstractThe Lydian and Phrygian confession inscriptions dating mostly to the 2nd and 3rd centuries C.E. have provoked less discussion than one would expect. This paper focuses on what was probably the main reason for the pressure to confess sins publicly. A major cause for public confession seems to have been the perceived necessity to reinforce the control of the local god over his or her devotees. The impetus may have been the spreading of the Christian faith in Lydia and Phrygia. It is suggested that the local religious functionaries may have responded by heightening the people's awe concerning the power of the gods, requiring public confessions of specific sins that highlight the frightful power of the gods over all aspects of life, and by requiring the erection of steles in the hope of establishing the permanent loyalty of the people for the god who ruled over the village.
Nonallergic respiratory morbidity improved along with a decline of traditional air pollution levels: a review
Authors: Heinrich J. 
Published: May 2003

The tremendous decline of combustion-derived emissions of traditional air pollutants such as sulphur dioxide (SO2) and total suspended particles (TSP) in Eastern Germany shortly after German reunification in 1990 provided the unique opportunity to study trends of prevalence of respiratory illness along with the improvement of air quality.The present review focused on the results of two repeated surveys of nonallergic respiratory illness in children living in East Germany. The crude prevalence of respiratory illness such as lifetime bronchitis, otitis media, tonsillitis, frequent colds, and frequent cough decreased during the 1990s in East German children. For two surveys the effect estimates showed consistently statistically significant association of TSP with bronchitis. For SO2statistically significant associations with frequent colds were also consistently found, whereas at least one survey reported higher statistically significant effect estimates for tonsillitis, otitis media, frequent cough and reduced forced vital capacity.The present study concludes that the prevalence of nonallergic respiratory illness in East German children is associated with sulphur dioxide and total suspended particles and that the improvement of air quality has beneficial effects on respiratory health.
Short-term effects of ambient particles on mortality in the elderly: results from 28 cities in the APHEA2 project
Authors: Aga E. , Samoli E. , Touloumi G. , Anderson H.R. , Cadum E. , Forsberg B. , Goodman P. , Goren A. , Kotesovec F. , Kriz B. , Macarol-Hiti M. , Medina S. , Paldy A. , Schindler C. , Sunyer J. , Tittanen P. , Wojtyniak B. , Zmirou D. , Schwartz J. , Katsouyanni K. 
Published: May 2003

Within the framework of the APHEA2 (Air Pollution on Health: a European Approach) project, the effects of ambient particles on mortality among persons ≥65 yrs were investigated.Daily measurements for particles with a 50% cut-off aerodynamic diameter of 10 µm (PM10) and black smoke (BS), as well as the daily number of deaths among persons ≥65 yrs of age, from 29 European cities, have been collected. Data on other pollutants and meteorological variables, to adjust for confounding effects and data on city characteristics, to investigate potential effect modification, were also recorded. For individual city analysis, generalised additive models extending Poisson regression, using a locally weighted regression (LOESS) smoother to control for seasonal effects, were applied. To combine individual city results and explore effect modification, second stage regression models were applied.The per cent increase (95% confidence intervals), associated with a 10 µg·m−3increase in PM10, in the elderly daily number of deaths was 0.8% (0.7–0.9%) and the corresponding number for BS was 0.6% (0.5–0.8%). The effect size was modified by the long-term average levels of nitrogen dioxide (higher levels were associated with larger effects), temperature (larger effects were observed in warmer countries), and by the proportion of the elderly in each city (a larger proportion was associated with higher effects).These results indicate that ambient particles have effects on mortality among the elderly, with relative risks comparable or slightly higher than those observed for total mortality and similar effect modification patterns. The effects among the older persons are of particular importance, since the attributable number of events will be much larger, compared to the number of deaths among the younger population.
Genetic aspects of susceptibility to air pollution: Table 1
Authors: Kleeberger S.R. 
Published: May 2003

Inter-individual variation in human responses to air pollutants suggests that some subpopulations are at increased risk, and it is increasingly clear that genetic background is an important susceptibility factor.Genetically standardised animal models provide useful investigative tools. Linkage analyses using inbred mice identified chromosomal segments (quantitative trait loci (QTL)), with genes controlling susceptibility to the lung inflammatory (chromosome 17), injury (chromosome 11), and hyperpermeability (chromosome 4) responses to ozone (O3) exposure. An immune dysfunction response induced by exposure to sulphate-associated particles is linked to the identical chromosome 17 and 11 QTLs described for O3susceptibility, thus similar genetic mechanisms may be controlling pulmonary responses to these pollutants. Candidate genes within the QTLs on chromosomes 4 and 17 include the toll-like receptor 4 and the pro-inflammatory cytokine, tumour necrosis factor‐α, respectively. Functional analyses strongly support a role for these candidate genes in determining susceptibility to O3and particulates. Because striking linkage homology exists between the human and mouse genomes, candidate susceptibility genes identified in the mouse are likely to aid research aimed at understanding human genetic factors that contribute to differential susceptibility.To date, no studies have examined the interaction between age and genetic background in the development of air pollution-induced lung disease. However, investigations have suggested an influence of age on genetic susceptibility to lung cancer and other diseases, which indicate that an interaction between age and genetic background may be important in air pollution disease pathogenesis.
Indoor air pollution and respiratory health in the elderly
Authors: Simoni M. , Jaakkola M.S. , Carrozzi L. , Baldacci S. , Di Pede F. , Viegi G. 
Published: May 2003

People spend about ≥80–90% of their daily time indoors, elderly people especially at home. Thus, it is important to investigate possible health effects of indoor air pollutants and to consider their contributions to the total human exposure.This report summarises current knowledge on health effects of three common indoor air pollutants, respirable suspended particles, nitrogen dioxide and environmental tobacco smoke, with focus on the adults and the elderly. Preliminary findings on exposure distributions and health effects of these pollutants in older subjects of two panel studies carried out in Italian general populations will also be reported.The two indoor pollution studies were performed in the Po Delta area in North Italy (428 subjects and 140 houses investigated) and in Pisa in Central Italy (761 subjects and 282 houses investigated). Individuals aged ≥65 yrs spent a significantly larger number of hours at home than the other age groups both in winter and in summer. A trend of higher occurrence of acute respiratory symptoms in the presence of environmental tobacco smoke was shown in comparison to the unexposed elderly both in winter (31versus29%) and summer (33versus16%). The occurrence of acute respiratory symptoms was consistently higher in relation to the high respirable suspended particles-index exposure compared to low exposure (33versus27% in winter, 27versus21% in summer). Both the presence of environmental tobacco smoke at home and exposure to the high respirable suspended particles-index were associated with a decrease in the mean daily peak expiratory flow.
Comparison of bedside measurement of cardiac output with the thermodilution method and the Fick method in mechanically ventilated patients
Authors: Gonzalez Jésus , Delafosse Christian , Fartoukh Muriel , Capderou André , Straus Christian , Zelter Marc , Derenne Jean-Philippe , Similowski Thomas 
Published: May 2003

Abstract
Introduction
Bedside cardiac output determination is a common preoccupation in the critically ill. All available methods have drawbacks. We wished to re-examine the agreement between cardiac output determined using the thermodilution method (QTTHERM) and cardiac output determined using the metabolic (Fick) method (QTFICK) in patients with extremely severe states, all the more so in the context of changing practices in the management of patients. Indeed, the interchangeability of the methods is a clinically relevant question; for instance, in view of the debate about the risk–benefit balance of right heart catheterization.

Patients and methods
Eighteen mechanically ventilated passive patients with a right heart catheter in place were studied (six women, 12 men; age, 39–84 years; simplified acute physiology scoreII, 39–111). QTTHERM was obtained using a standard procedure. QTFICK was measured from oxygen consumption, carbon dioxide production, and arterial and mixed venous oxygen contents. Forty-nine steady-state pairs of measurements were performed. The data were normalized for repeated measurements, and were tested for correlation and agreement.

Results
The QTFICK value was 5.2 ± 2.0 l/min whereas that of QTTHERM was 5.8 ± 1.9 l/min (R = 0.840, P < 0.0001; mean difference, -0.7 l/min; lower limit of agreement, -2.8 l/min; upper limit of agreement, 1.5 l/min). The agreement was excellent between the two techniques at QTTHERM values <5 l/min but became too loose for clinical interchangeability above this value. Tricuspid regurgitation did not influence the results.

Discussion and conclusions
No gold standard is established to measure cardiac output in critically ill patients. The thermodilution method has known limitations that can lead to inaccuracies. The metabolic method also has potential pitfalls in this context, particularly if there is increased oxygen consumption within the lungs. The concordance between the two methods for low cardiac output values suggests that they can both be relied upon for clinical decision making in this context. Conversely, a high cardiac output value is more difficult to rely on in absolute terms.
Protein-losing enteropathy in patients with Fontan circulation: is it triggered by infection?
Authors: Lenz Dominik , Hambsch Jörg , Schneider Peter , Häusler Hans-Jürgen , Sauer Ursula , Hess John , Tárnok Attila 
Published: May 2003

Abstract
Introduction
Protein-losing enteropathy (PLE) is a recognised complication of the Fontan circulation. Its pathogenesis is not fully understood, however, and it is unclear why its onset occurs months or even years after Fontan surgery.

Patients
We report a 4.5-year-old girl with Fontan circulation who developed PLE almost 1 year after surgery. At the time of onset the patient had rotavirus enteritis and streptococcal tonsillitis. We have reviewed the records of seven other patients with longstanding PLE. In six of these patients we identified infections at the onset of symptoms. None of our patients had evidence of opportunistic infection.

Discussion and conclusion
The immune system of patients with PLE is compromised, but reports on recurrent opportunistic infections are rare. The present observations suggest that infection and inflammation may be associated with the onset of PLE. The mechanism of how infection may trigger PLE warrants further investigation.
Severe sepsis: variation in resource and therapeutic modality use among academic centers
Authors: Yu D Tony , Black Edgar , Sands Kenneth E , Schwartz J Sanford , Hibberd Patricia L , Graman Paul S , Lanken Paul N , Kahn Katherine L , Snydman David R , Parsonnet Jeffrey , Moore Richard , Platt Richard , Bates David W ,   for the Academic Medical Center Consortium Sepsis Project Working Group
Published: May 2003

Abstract
Background
Treatment of severe sepsis is expensive, often encompassing a number of discretionary modalities. The objective of the present study was to assess intercenter variation in resource and therapeutic modality use in patients with severe sepsis.

Methods
We conducted a prospective cohort study of 1028 adult admissions with severe sepsis from a stratified random sample of patients admitted to eight academic tertiary care centers. The main outcome measures were length of stay (LOS; total LOS and LOS after onset of severe sepsis) and total hospital charges.

Results
The adjusted mean total hospital charges varied from $69 429 to US$237 898 across centers, whereas the adjusted LOS after onset varied from 15.9 days to 24.2 days per admission. Treatments used frequently after the first onset of sepsis among patients with severe sepsis were pulmonary artery catheters (19.4%), ventilator support (21.8%), pressor support (45.8%) and albumin infusion (14.4%). Pulmonary artery catheter use, ventilator support and albumin infusion had moderate variation profiles, varying 3.2-fold to 4.9-fold, whereas the rate of pressor support varied only 1.92-fold across centers. Even after adjusting for age, sex, Charlson comorbidity score, discharge diagnosis-relative group weight, organ dysfunction and service at onset, the odds for using these therapeutic modalities still varied significantly across centers. Failure to start antibiotics within 24 hours was strongly correlated with a higher probability of 28-day mortality (r2 = 0.72).

Conclusion
These data demonstrate moderate but significant variation in resource use and use of technologies in treatment of severe sepsis among academic centers. Delay in antibiotic therapy was associated with worse outcome at the center level.
Gastric intramucosal pH is stable during titration of positive end-expiratory pressure to improve oxygenation in acute respiratory distress syndrome
Authors: Akinci Ibrahim Ozkan , Çakar Nahit , Mutlu Gökhan Mehmet , Tugrul Simru , Ergin Ozcan Perihan , Gitmez Musa , Esen Figen , Telci Lutfi 
Published: May 2003

Abstract
Background
Optimal positive end-expiratory pressure (PEEP) is an important component of adequate mechanical ventilation in acute lung injury and acute respiratory distress syndrome (ARDS). In the present study we tested the effect on gastric intramucosal pH of incremental increases in PEEP level (i.e. PEEP titration) to improve oxygenation in ARDS. Seventeen consecutive patients with ARDS, as defined by consensus criteria, were included in this clinical, prospective study. All patients were haemodynamically stable, and were not receiving vasopressors. From an initial level of 5 cmH2O, PEEP was titrated at 2 cmH2O increments until the partial arterial oxygen tension was 300 mmHg or greater, peak airway pressure was 45 cmH2O or greater, or mean arterial blood pressure decreased by 20% or more of the baseline value. Optimal PEEP was defined as the level of PEEP that achieved the best oxygenation. The maximum PEEP was the highest PEEP level reached during titration in each patient.

Results
Gastric mucosal pH was measured using gastric tonometry at all levels of PEEP. The thermodilution technique was used for measurement of cardiac index. Gastric mucosal pH was similar at baseline and at optimal PEEP levels, but it was slightly reduced at maximum PEEP. Cardiac index and oxygen delivery remained stable at all PEEP levels.

Conclusion
Incremental titration of PEEP based on improvement in oxygenation does not decrease gastric intramucosal perfusion when cardiac output is preserved in patients with ARDS.
Erythropoietin mimics the acute phase response in critical illness
Authors: Elliot John Michael , Virankabutra Tanit , Jones Stephen , Tanudsintum Surasak , Lipkin Graham , Todd Susan , Bion Julian 
Published: May 2003

Abstract
Background
In a prospective observational study, we examined the temporal relationships between serum erythropoietin (EPO) levels, haemoglobin concentration and the inflammatory response in critically ill patients with and without acute renal failure (ARF).

Patients and method
Twnety-five critically ill patients, from general and cardiac intensive care units (ICUs) in a university hospital, were studied. Eight had ARF and 17 had normal or mildly impaired renal function. The comparator group included 82 nonhospitalized patients with normal renal function and varying haemoglobin concentrations. In the patients, levels of haemoglobin, serum EPO, C-reactive protein, IL-1β, IL-6, serum iron, ferritin, vitamin B12 and folate were measured, and Coombs test was performed from ICU admission until discharge or death. Concurrent EPO and haemoglobin levels were measured in the comparator group.

Results
EPO levels were initially high in patients with ARF, falling to normal or low levels by day 3. Thereafter, almost all ICU patients demonstrated normal or low EPO levels despite progressive anaemia. IL-6 exhibited a similar initial pattern, but levels remained elevated during the chronic phase of critical illness. IL-1β was undetectable. Critically ill patients could not be distinguished from nonhospitalized anaemic patients on the basis of EPO levels.

Conclusion
EPO levels are markedly elevated in the initial phase of critical illness with ARF. In the chronic phase of critical illness, EPO levels are the same for patients with and those without ARF, and cannot be distinguished from noncritically ill patients with varying haemoglobin concentrations. Exogenous EPO therapy is unlikely to be effective in the first few days of critical illness.
Ethical Issues Regarding Human Cloning: a nursing perspective
Authors: Dinç Leyla 
Published: May 2003

Advances in cloning technology and successful cloning experiments in animals have raised concerns about the possibility of human cloning in recent years. Despite many objections, this is not only a possibility but also a reality. Human cloning is a scientific revolution. However, it also introduces the potential for physical and psychosocial harm to human beings. From this point of view, it raises profound ethical, social and health related concerns. Human cloning would have an impact on the practice of nursing because it could result in the creation of new physiological and psychosocial conditions that would require nursing care. The nursing profession must therefore evaluate the ethics of human cloning, in particular the potential role of nurses. This article reviews the ethical considerations of reproductive human cloning, discusses the main reasons for concern, and reflects a nursing perspective regarding this issue.