bluuebunny/crossref_metadata_2025_split huggingface dataset:
Secondary gain as hidden motive for getting psychiatric treatment
Authors: Van Egmond Jacques , Kummeling Ischa , Balkom Ton aan 
Published: March 2005

AbstractBackgroundA high proportion (42.4%) of outpatients attending a psychiatric hospital appears to harbor expectations of secondary gain and hide this from their psychiatrists. This study investigated whether the prevalence of expectations of secondary gain could be replicated in a different sample, namely, a general hospital outpatient clinic attended by patients with less severe mental disorders, and whether patients hid these expectations from the psychiatrists they consulted.MethodsThe study was performed at a Dutch psychiatric outpatient department of a general hospital. In a prospective cohort, expectation of secondary gain was assessed by directly asking the patients via questionnaires whether they expected gaining specific ‘benefits’ from being in therapy.ResultsOf 99 patients, 41 (41.4%) expected secondary gain while being in therapy. In contrast, only nine patients (9.5%) told their diagnosing psychiatrist of these expectations.DiscussionThe present finding of a large proportion of patients expecting secondary gain is consistent with the results of an earlier study. Again, in most cases the diagnosing psychiatrists were unaware of their patients’ expectations. Thus many patients have hidden expectations of what therapy will do for them, in terms of material or non-material benefits other than getting better. Earlier empirical studies have shown that harboring expectations of benefits other than therapeutic benefits may be detrimental to therapeutic success.
Effects of acupuncture therapy on insomnia
Authors: Sok Sohyune R. , Erlen Judith A. , Kim Kwuy Bun 
Published: March 2005

Background.  Acupuncture therapy, commonly used in clinical practice in oriental cultures, has the potential to produce a positive effect with patients experiencing insomnia.Aim.  The purposes of this systematic review were: (1) to assess the trends across intervention studies using acupuncture for insomnia from 1975 to 2002, (2) to examine dependent variables, and (3) to evaluate the effects of acupuncture therapy on insomnia in older people.Method.  Data were collected from November 2001 to January 2003. A wide range of electronic databases was searched using the keywords ‘insomnia’, ‘acupuncture’ and ‘experimental design’. Papers were included if they were published in the English language between 1975 and 2002 and described an experimental study using acupuncture therapy to treat insomnia. Eleven reports met these criteria.Findings.  Most of the studies had been conducted since 1990. The findings showed that the first author was usually a Chinese medical doctor (n = 9) employed in a traditional department of medicine. Most of the papers were published in two journals: International Journal of Clinical Acupuncture and Journal of Traditional Chinese Medicine. Data were limited because of the small number of studies available. Half the studies had small samples (50 subjects or fewer), which were composed mainly of older women who had a variable duration of insomnia from 3 days to 34 years. The main method used to assess outcomes was questionnaire. All the studies reported statistically significant positive results.Conclusion.  The results of this review suggest that acupuncture may be an effective intervention for the relief of insomnia. Further research, using a randomized clinical trial design, are necessary to determine the effectiveness of acupuncture. More work is also needed to promote the long‐term therapeutic effects of acupuncture and to compare it with other therapies for insomnia.
Bear any burden? John F. Kennedy and Nuclear Weapons
Authors: Nash Philip 
Published: March 2005

Abstract
Kennedy's reliance on non‐nuclear assets and flexible response overshadowed his reliance on nuclear weapons, just as his nuclear restraint eclipsed recklessness. This is not surprising in view of the national security strategy Kennedy chose and the concerns about nuclear weapons he had. It is surprising, however, in light of the profound alarm with which Kennedy and most Americans viewed the Soviet threat; the frequency and intensity of the international crises Kennedy faced; and the widely acknowledged superiority of the US nuclear arsenal. Against this backdrop of threat, crisis, and strategic superiority, it is striking how small an active role nuclear weapons played in Kennedy's foreign policy.
Before the Bomb and After: Winston Churchill and the Use of Force
Authors: Rosenberg Jonathan 
Published: March 2005

Abstract
Between 1945 and 1955, Churchill's attitude towards the use of force had undergone a dramatic transformation. In the period of the American nuclear monopoly, Churchill's views were largely consistent with those he held for many years: It was possible to maintain peace through strength, and, more specifically, the bomb could preserve European democracy against the threat of Soviet expansionism. Moreover, in keeping with his lifetime vigour as a soldier and a statesman, Churchill spoke privately about attacking the Soviet Union and forcing a showdown before the Soviets acquired the bomb. With the disappearance of that monopoly, Churchill came to realize that the new bomb could decrease the likelihood of war and perhaps some day eliminate great‐power conflict altogether. Accordingly, the idea of ’peaceful coexistence’ became an integral part of Churchill's approach to international politics.
COMPREHENSIVE EDUCATIONS AND THE LIBERAL UNDERSTANDING OF AUTONOMY
Authors: Burtt Shelley 
Published: March 2005

Abstract
This is the first of the four essays in Part II of the book on liberalism and traditionalist education; all four are by authors who would like to find ways for the liberal state to honour the self-definitions of traditional cultures and to find ways of avoiding a confrontation with differences. For example, Shelley Burtt argues that the liberal state has good reason to be far more accommodating of traditional groups than liberals commonly recognize. She contends that liberal autonomy, properly understood, is not threatened in any special way by traditional religious or cultural groups, and that traditional cultures are as capable of fostering autonomy as their more cosmopolitan counterparts. Most strikingly, she maintains that it is a good thing, from the perspective of liberal autonomy, to be encumbered by unchosen attachments and loyalties such as those that we might expect to be most fully developed within religious communities. The essay is in two main parts: Part One takes up the challenge of the notion that liberal theorists have missed the chance to describe in detail the possibilities for autonomous thought from within a comprehensive education to a particular way of life or understanding of the good, offering several reasons why the central demand of autonomy – to think and know for oneself – is well within the reach of individuals who receive this sort of ‘grounded’ education; Part Two looks more closely at liberal theories of autonomy, particularly aspects of those accounts that encourage the idea that comprehensive educations are at odds with the development of autonomy, arguing that such characterizations overstate the difficulties that exist, and concluding by reaffirming the possibility of combining an education for autonomy with education toward a comprehensive vision of the good life.
Chapter 7 INTERPRETING THE UNRELIABLE
Authors: Currie Gregory 
Published: March 2005

Abstract
Argues for a rethinking of the standard account of narrative unreliability. Works can be unreliable in many ways, and unreliable works do not, the author claims, always have unreliable narrators. Narrative theory needs to focus more on unreliable works, less on unreliable narrators. As an example of this, the author uses Ford's The Searchers.
Maternal hemodynamics during cesarean delivery assessed by whole‐body impedance cardiography
Authors: Tihtonen Kati , Kööbi Tiit , Yli‐Hankala Arvi , Uotila Jukka 
Published: March 2005

Background.  This descriptive study was designed to evaluate maternal hemodynamics and cardiovascular responses to delivery during cesarean section (CS) under spinal anesthesia. We also assessed the feasibility of a noninvasive and continuous method of measuring cardiac output, namely whole‐body impedance cardiography (ICGWB), during elective CS. Because of the techniques used in previous studies, only fractionated data on maternal hemodynamics during CS are available to date.Methods.  We studied 10 healthy women with normal pregnancies and two pregnant women with heart disease undergoing elective CS. Mean arterial pressure (MAP), heart rate (HR), stroke index (SI), cardiac index (CI) and systemic vascular resistance index (SVRI) were recorded continuously during CS, during the period of dissipation of anesthesia and on the second to fifth postpartum day. Analysis of variance for repeated measurements (anova) and the paired sample t‐test were used in statistical analysis.Results.  The hemodynamic parameters could be registered continuously during the whole procedure. At the point of delivery, a 47% increase in CI and a 39% decrease in SVRI were recorded, while MAP remained stable. These changes occurred within 2 min of delivery of the newborn and persisted on average for 10 min.Conclusion.  Sudden and significant hemodynamic changes take place at the moment of delivery. Intact physiological cardiovascular compensation mechanisms are needed to adapt to these challenges. Whole‐body impedance cardiography may offer a useful noninvasive tool to monitor hemodynamics during cesarean section.
Prospective randomized comparison of single‐dose versus 1‐day cefazolin for prophylaxis in gynecologic surgery
Authors: Su Her‐Young , Ding Dah‐Ching , Chen Da‐Chung , Lu Mei‐Fen , Liu Jah‐Yao , Chang Feng‐Yee 
Published: March 2005

Background.  The purpose of this prospective, randomized study was to compare the efficacy of single‐dose versus 1‐day cefazolin prophylaxis for the prevention of postoperative gynecologic infections.Methods.  From June 2001 to January 2003, 548 patients were randomized to receive either single‐dose (1 g of cefazolin intravenously before surgery, 273 patients) or 1‐day cefazolin (1 g intravenously before surgery and three more doses every 6 hr after surgery, 275 patients) prophylaxis.Results.  A total of 531 (267 patients in the single‐dose group and 264 in the 1‐day group) completed the study. Only one of 267 (0.37%) patients in the single‐dose group developed a trocar wound infection and one of 264 (0.37%) patients in the 1‐day group developed a vaginal cuff infection. Had a single dose of prophylactic antibiotics been administered to all patients, the antibiotic cost would have been reduced by 75–80%.Conclusions.  The use of single‐dose preoperative cefazolin prophylaxis was as effective as four doses of cefazolin for preventing serious infectious morbidity among our patients. Shortening the duration of antibiotics prophylaxis also reduced medical costs and microorganism resistance.
The importance of parental support when caring for the acutely ill child
Authors: Wheeler Hilary J 
Published: March 2005

AbstractLevel 2 or above paediatric care may need to be instigated in an adult, critical care environment prior to retrieval to a specialist centre. To facilitate safe, effective and appropriate care of the child, it is essential that staff are aware of the precise needs of paediatric patients and the importance of parental involvement. The importance of parental support for the critically ill child is examined . Staff perceptions of parental need in comparison to actual need are explored to facilitate support for parents that will then aid paediatric recovery. Recommendations on how such information can be disseminated to staff are discussed.
Alpha-fodrin as a putative autoantigen in Graves’ ophthalmopathy
Authors: Kahaly G J , Bang H , Berg W , Dittmar M 
Published: March 2005

Summary
Alpha-fodrin, an intracellular organ-specific cytoskeleton protein is a recently identified autoantigen associated with Sicca- and Sjögren's syndrome (SS). SS frequently affects patients with Graves’ ophthalmopathy (GO). We have therefore cloned and expressed the human recombinant 120-kDa fodrin-fragment. A sequential purification procedure was applied to isolate the recombinant protein. Using sera from patients with SS, the antigenicity of the purified fodrin fragment was demonstrated by immunoblotting. Sera from 144 patients with GO and 1200 blood donors were screened for the presence of anti-α-fodrin IgA and IgG antibodies by a newly developed ELISA using the human α-fodrin fragment as an autoantigen. In contrast to controls (&lt;1% IgA only, P &lt; 0·001) and to subjects with various autoimmune diseases (P &lt; 0·001), α-fodrin antibodies were detected in 22% of patients with GO (n = 32). IgA and IgG antibodies were present in 21 (15%) and 14 (10%) GO subjects, respectively. A total of 45 patients with GO (31%) had at least one fodrin- or SS-antibody. GO patients with SS showed SS- and high titres of α-fodrin-antibodies. In GO patients, fodrin antibodies correlated with TPO- (P &lt; 0·05) and SS-A (P = 0·002) antibodies. Thus, for the first time, antibodies reactive with fodrin are reported in patients with GO.
Evaluating a nurse‐led model for providing neonatal care
Authors:   The Ashington Audit Group
Published: March 2005

Aims.  The paper presents an overview of a multi‐dimensional, prospective, comparative 5‐year audit of the quality of the neonatal care provided by a maternity unit in the UK delivering 2000 babies a year, where all neonatal care after 1995 was provided by advanced neonatal nurse practitioners, in relation to that provided by a range of other medically staffed comparator units.Methods.  The audit includes 11 separate comparative studies supervised by a panel of independent external advisors. Data on intrapartum and neonatal mortality is reported. A review of resuscitation at birth, and a two‐tier confidential inquiry into sentinel events in six units were carried out. The reliability of the routine predischarge neonatal examination was studied and, in particular, the recognition of congenital heart disease. A review of the quality of postdischarge letters was undertaken alongside an interview survey to elicit parental views on care provision. An audit of all hospital readmissions within 28 days of birth is reported. Other areas of study include management of staff stress, perceived adequacy of the training of nurse practitioners coming into post, and an assessment of unit costs.Results.  Intrapartum and neonatal death among women with a singleton pregnancy originally booked for delivery in Ashington fell 39% between 1991–1995 and 1996–2000 (5·12 vs. 3·11 deaths per 1000 births); the decline for the whole region was 27% (4·10 vs. 2·99). By all other indicators the quality of care in the nurse‐managed unit was as good as, or better than, that in the medically staffed comparator units.Conclusion.  An appropriately trained, stable team with a store of experience can deliver cot‐side care of a higher quality than staff rostered to this task for a few months to gain experience, and this is probably more important than their medical or nursing background. Factors limiting the on‐site availability of medical staff with paediatric expertise do not need to dictate the future disposition of maternity services.
Dynamic EBV gene loads in renal, hepatic, and cardiothoracic transplant recipients as determined by real‐time PCR light cycler
Authors: Leung E. , Shenton B.K. , Green K. , Jackson G. , Gould F.K. , Yap C. , Talbot D. 
Published: March 2005

Abstract: Background: Epstein–Barr virus (EBV) is recognised as one of the causative agents for most cases of post‐transplant lymphoproliferative disease (PTLD). Elevated levels of EBV DNA are known to be associated with the onset of PTLD, but little information is available regarding how EBV loads change with time in asymptomatic transplant recipients following transplantation. Our aims were to study the trend of EBV loads in renal (RTx), hepatic, and cardiothoracic transplant recipients and to compare their EBV loads with other healthy and patient controls.Methods: A prospective study was performed using a real‐time TaqMan polymerase chain reaction technique to measure EBV DNA loads from three types of organ transplant recipients and haemodialysis patients (HD). Their results were then compared with those from the healthy controls (HC); monospot test negative (MN−) and infectious mononucleosis positive (IM+) patients; patients who were previously treated for PTLD (pPTLD); those who were currently diagnosed to have PTLD (PTLD+); and patients who had a stable renal, hepatic, or cardiothoracic graft for more than a year.Results: Post‐transplant EBV loads were significantly higher than the pre‐transplant levels. Asymptomatic transplant recipients were differentiated from the PTLD+group at 600 genome copies of EBV/μg DNA, and from IM+group at 100 genome copies. Both HC and MN− groups had significantly lower EBV loads than the three transplant groups. The dynamic change of EBV loads in RTx was greater in the first post‐transplant month when compared with the HD group. All transplant recipients had transient rises of EBV loads whereas EBV load continued to rise in one suspected PTLD patient.Conclusions: Asymptomatic transplant recipients had higher baseline post‐transplant EBV levels than the non‐transplant and MN− groups. The rising post‐transplant EBV load in these transplant recipients did not seem to be sustained for longer than 2 weeks. However, in a PTLD+patient the rising EBV load continued over a period of 4 weeks. Hence, the dynamic pattern of EBV loads is more important than absolute EBV DNA measurements alone in identifying those who might go on to develop PTLD.
Quality of life for patients with bipolar disorder: relationship with clinical and demographic variables
Authors: Sierra Pilar , Livianos Lorenzo , Rojo Luis 
Published: March 2005

Objectives:  The aim of this study was to assess the quality of life in bipolar disorder patients, and to analyze a set of clinical variables and sociodemographic data that could act as quality‐of‐life predictors.Methods:  The study sample included 50 euthymic outpatients attending a specific bipolar patient unit. Patients were assessed with the Clinician‐Administered Rating Scale for Mania, and the Hamilton Scale for Depression. To evaluate quality of life, all patients received the Spanish version of the SF‐36 Health Survey. At the same time, sociodemographic and clinical data were obtained. The scores were compared with those of a control group representative of the general population.Results:  The group of bipolar patients obtained statistically significantly lower scores on all the subscales when compared with the control population. No statistically significant differences appeared when comparing the SF‐36 scores with the demographic variables.Conclusions:  Bipolar patients experience lower functioning and well‐being even in the stable phase of the disorder. Due to the great impact of bipolar disorder on many areas, it would be of interest to know the clinical predictors related to patient quality of life, as this would contribute to the design of different clinical interventions.
Actigraphic assessment of circadian activity and sleep patterns in bipolar disorder
Authors: Jones Steven Huntley , Hare Dougal Julian , Evershed Kate 
Published: March 2005

Objectives:  Theoretical accounts and psychological interventions for bipolar disorder indicate that disruption of circadian rhythms is important, both in affective episodes and as a vulnerability factor in subsyndromal periods. This study aims at assessing both circadian activity and sleep patterns using actigraphy within a bipolar sample experiencing low levels of subsyndromal symptoms. It is hypothesized that such participants will display circadian activity disruption in spite of low levels of symptoms.Methods:  This study employed a mixed design with cross‐sectional assessment of mood and week‐long (7‐day) recording of actigraphy data. All clinical participants were psychiatric outpatients within a UK NHS Hospital. Nineteen bipolar patients and 19 age‐ and gender‐matched controls wore an actigraph for 7 days to obtain sleep and circadian activity data. SCID was used to confirm DSM‐IV diagnostic status. Self‐report measures of mood were obtained from both groups.Results:  Bipolar patients were found to have less stable and more variable circadian activity patterns than controls. Regression analysis indicated that variability alone was a significant independent predictor of diagnostic group. There was evidence from raw activity data that bipolar patients were also less active than controls. These differences were not associated with levels of subsyndromal symptoms. Bipolar patients did not differ from controls on any of the sleep indices used.Conclusions:  Circadian activity disruption is apparent in bipolar patients even when not acutely ill. This finding is not associated with the presence of sleep disturbance. Should such patterns be replicated interventions to address both circadian instability and individual attributions for the effects of such instability are likely to be relevant to successful psychological interventions.
PSYCHOSOCIAL FACTORS IN PATIENTS WITH CHRONIC KIDNEY DISEASE: Depression in End‐Stage Renal Disease Patients Treated With Hemodialysis: Tools, Correlates, Outcomes, and Needs
Authors: Kimmel Paul L. , Peterson Rolf A. 
Published: March 2005

ABSTRACTDepression has been thought to be the most common psychiatric abnormality in hemodialysis (HD) patients. There are few data using psychiatric diagnostic criteria and a lack of large, well‐designed epidemiologic research studies in patients with end‐stage renal disease (ESRD) that can render definitive results on this topic. The prevalence of major depression or a defined psychiatric illness in ESRD patients is unknown, but is probably between 5% and 10%. The prevalence of increased levels of depressive affect is greater. Estimates of the prevalence will vary according to the screening techniques used. Depression could affect medical outcomes in ESRD patients through several mechanisms. Correlational analyses suggest stressors and protective factors play roles in mediating the level of depressive affect and associated outcomes. Although early studies suggested a deleterious effect of depression on survival in ESRD patients, more recent studies had failed to confirm such findings. The use of longitudinal analyses and larger samples has confirmed an association of depressive affect and morbidity and mortality in more contemporary ESRD populations. The importance of depressive affect compared with the presence of a defined psychiatric syndrome in mediating clinically important outcomes in patients with chronic kidney disease has not been determined. Studies of interventions designed to reduce levels of depressive affect in ESRD patients are urgently needed.
Effects of Counter Cations in Selective Monohydrolyses of Symmetric Diesters
Authors: Niwayama Satomi , Rimkus Audrius 
Published: March 2005

Abstract
Monohydrolyses of symmetric diesters were carried out using several aqueous inorganic bases, LiOH, NaOH, KOH, and CsOH. The more reactive bases showed higher selectivities in the monohydrolyses of acyclic symmetric diesters.