bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ascertaining the views of people with profound and multiple learning disabilities
Authors: Ware Jean 
Published: November 2004

SummaryThere has been a welcome recent shift towards taking account of the views of those who have traditionally been seen as lacking competence, including those with learning disabilities. Innovative methods have been devised to help people express their views and research demonstrates that people with learning disabilities can be taught this skill. However, none of this work has involved people with profound and multiple learning disabilities and serious doubts have been raised about the extent to which it is possible to ascertain the views of this group. Those operating at a preintentional level may not express, or have, views in the usually understood sense. Methods which attempt to ascertain the views of this group are highly inferential and it is often only possible to infer immediate preferences. It is important that the limitations of such methods are acknowledged. A case study is used to demonstrate that, in relation to major life decisions, taking account of a wide range of assessment information may give a clearer picture of the preferences of someone with profound and multiple learning disabilities than subjective interpretations of their behaviour or proxies. This should be combined with a focus on teaching the person so that they acquire as much control over their own lives as possible.
Putting words into their mouths? Interviewing people with learning disabilities and little/no speech
Authors: Brewster Stephanie J. 
Published: November 2004

SummaryPeople with learning disabilities who are unable to speak are often excluded from research. Techniques to support interviewing, such as Talking Mats, can help to improve the quality of research in which such people could not otherwise participate. Talking Mats, in common with many techniques which augment communication, relies on someone else selecting the vocabulary to be made available. This paper outlines the Talking Mats framework, and discusses various methods of vocabulary selection. In particular it reports on empirical work with two effective communication aid users, who were invited to advise on vocabulary. It is proposed that many of the difficulties of research involving people with limited communication, can be ameliorated by viewing the process of accessing their views not as a one off event, but as an ongoing process.
The association of socio‐economic position across the life course and age at menopause: the British Women's Heart and Health Study
Authors: Lawlor Debbie A. , Ebrahim Shah , Smith George Davey 
Published: November 2004

ObjectiveTo assess the association of indicators of adverse socio‐economic position from across the life course with age at menopause.DesignCross sectional study as part of the British Women's Heart and Health Study.Setting23 British towns.PopulationThree thousand and five hundred and thirteen women aged 60–79 years from a total cohort of 4286. Women who underwent a hysterectomy or oophorectomy prior to their ‘natural’ menopause or who were taking hormone replacement therapy around the perimenopausal period and for whom a biological age at menopause could not be calculated were excluded from this study.Main outcome measureAge at menopause.ResultsMost of the 10 indicators of adverse socio‐economic position from childhood through to adulthood were linearly associated with a younger age at menopause. In age adjusted analyses, women from manual social classes in childhood began their menopause on average 0.68 years (95% confidence interval [CI] 0.11, 1.3) earlier than those from non‐manual social classes. Those who lived in a house as a child without a bathroom began their menopause 0.47 years (95% CI 0.12, 0.82) earlier than those with a bathroom. Those who shared a bedroom began 0.36 years (95% CI 0.03, 0.70) earlier than those who had their own bedroom and finally those who lived in a household with no access to a car as a child began their menopause 0.47 years (95% CI 0.02, 0.95) earlier than those with access to a car. Adult indicators of adverse socio‐economic position were similarly associated with earlier age at menopause. Age at completing full time education was not substantively associated with age at menopause. The inverse associations between each of the indicators of both childhood and adult socio‐economic position and age at menopause were not importantly affected by adjustment for other reproductive factors but they attenuated by between 6% and 21% with adjustment for adult smoking and body mass index. The inverse associations between each of the childhood indicators of socio‐economic position only and age at menopause attenuated markedly (between 12% and 70%) with adjustment for adult leg length. There was a cumulative effect of disadvantage across the life course demonstrated by a strong linear trend between a composite score of the 10 socio‐economic indicators and young age at menopause. The age at onset of menopause for women who had 9 or 10 adverse socio‐economic indicators was on average 1.70 years (95% CI 0.36, 3.0) younger than that of women with none or only one indicator.ConclusionsAdverse socio‐economic circumstances in childhood, as well as in adulthood, are associated with an earlier age at menopause. The association between childhood deprivation and early menopause may at least in part be mediated via exposures, such as childhood diet, which affect both linear growth and age at menopause.
Randomised controlled study comparing oral and vaginal misoprostol for cervical priming prior to surgical termination of pregnancy
Authors: Ashok Premila W. , Hamoda Haitham , Nathani Fatima , Flett Gillian M.M. , Templeton Allan 
Published: November 2004

Objective
To compare the effectiveness of oral misoprostol with vaginal misoprostol as a cervical priming agent prior to first trimester vacuum aspiration.Design
Randomised study.Setting
Scottish teaching hospital.Population
Primigravid women at gestations up to 91 days requesting surgical abortion under the 1967 Abortion Act.Methods
Sixty‐four women were randomised to receive misoprostol 400 μg orally at home or vaginally in hospital 2–4 hours pre‐operatively for cervical priming.Main outcome measures
The main outcome measures were cumulative force required to dilate the cervix to 9 mm, baseline cervical dilatation, intra‐operative blood loss and patient and staff acceptability.Results
There was no significant difference in baseline cervical dilatation, peak force required to dilate the cervix at 8 and 9 mm and cumulative force required between the two groups. Operating time and intra‐operative blood loss were not significantly different between the two groups. The priming to abortion interval was significantly longer with oral misoprostol when compared with the vaginal group (P < 0.0001). Women receiving oral misoprostol were significantly more likely to experience nausea (OR: 3.9, 95% CI: 1.3 to 11.2), while women receiving vaginal misoprostol were more likely to complain of tiredness (OR: 0.2, 95% CI: 0.1 to 0.7) with no significant differences in other side effects between the two groups. There was no significant difference in patient acceptability in relation to the priming agent between the two groups (P= 0.96). However, majority of the nursing staff (83%) admitting women preferred the oral route of administration.Conclusion
Cervical priming with oral misoprostol at home is effective with high patient and staff acceptability.
Modulation of cerebral vascular tone by activated glia: involvement of nitric oxide
Authors: Chisari M. , Salomone S. , Laureanti F. , Copani A. , Sortino M. A. 
Published: November 2004

AbstractThe ability of activated glia to affect cerebral vascular tone has been evaluated using an in vitro experimental system in which basilar arteries were incubated with glial cultures activated by treatment with lipopolysaccharide (LPS). Vascular tone was measured with an isometric myograph. Contraction in response to high KCl and serotonin was reduced in arteries co‐incubated for 24 h with LPS‐activated glia, whereas the response to acetylcholine was not modified. The reduced contraction was prevented when the nitric oxide synthase (NOS) inhibitor l‐N‐nitro‐arginine (L‐NNA) was added throughout the whole incubation time (activation of glial cells with LPS + co‐incubation of glial cells with cerebral arteries). Under these conditions, nitrite levels were drastically reduced. A reduced contraction to KCl was also observed after treatment of the cerebral vessel with sodium nitroprusside. In contrast, L‐NNA added to the vessel did not modify the response to contracting stimuli and the expression of endothelial NOS was not modified in cerebral arteries pre‐incubated with activated glia. These results suggest that activated glia, which finds an in vivo correlate in several neuropathological conditions, can contribute to changes of vascular tone by modifying the levels of nitric oxide (NO) to which the vessel is exposed.
Differential regulation of GLAST immunoreactivity and activity by protein kinase C: evidence for modification of amino and carboxyl termini
Authors: Susarla Bala T. S. , Seal Rebecca P. , Zelenaia Olga , Watson Deborah J. , Wolfe John H. , Amara Susan G. , Robinson Michael B. 
Published: November 2004

AbstractMany neurotransmitter transporters, including the GLT‐1 and EAAC1 subtypes of the glutamate transporter, are regulated by protein kinase C (PKC) and these effects are associated with changes in cell surface expression. In the present study, the effects of PKC activation on the glutamate aspartate transporter (GLAST) subtype of glutamate transporter were examined in primary astrocyte cultures. Acute (30 min) exposure to the phorbol 12‐myristate 13‐acetate (PMA) increased (approximately 20%) transport activity but had the opposite effect on both total and cell surface immunoreactivity. Chronic treatment (6 or 24 h) with PMA had no effect on transport activity but caused an even larger decrease in total and cell surface immunoreactivity. This loss of immunoreactivity was observed using antibodies directed against three different cytoplasmic epitopes, and was blocked by the PKC antagonist, bisindolylmaleimide II. We provide biochemical and pharmacological evidence that the activity observed after treatment with PMA is mediated by GLAST. Two different flag‐tagged variants of the human homolog of GLAST were introduced into astrocytes using lentiviral vectors. Although treatment with PMA caused a loss of transporter immunoreactivity, flag immunoreactivity did not change in amount or size. Together, these studies suggest that activation of PKC acutely up‐regulates GLAST activity, but also results in modification of several different intracellular epitopes so that they are no longer recognized by anti‐GLAST antibodies. We found that exposure of primary cultures of neurons/astrocytes to transient hypoxia/glucose deprivation also caused a loss of GLAST immunoreactivity that was attenuated by the PKC antagonist, bisindolylmaleimide II, suggesting that some acute insults previously thought to cause a loss of GLAST protein may mimic the phenomenon observed in the present study.
Invited review: the evolution of antidepressant mechanisms
Authors: Slattery D.A. , Hudson A.L. , Nutt D.J. 
Published: November 2004

AbstractPresent antidepressants are all descendents of the serendipitous findings in the 1950s that the monoamine oxidase inhibitor iproniazid and the tricyclic antidepressant imipramine were effective antidepressants. The identification of their mechanism of action, and those of reserpine and amphetamine, in the 1960s, led to the monoamine theories of depression being postulated; first, with noradrenaline then 5‐hydroxytryptamine being considered the more important amine. These monoamine theories of depression predominated both industrial and academic research for four decades. Recently, in attempts to design new drugs with faster onsets of action and more universal therapeutic action, downstream alterations common to current antidepressants are being examined as potential antidepressants. Additionally, the use of animal models has identified a number of novel targets some of which have been subjected to clinical trials in humans. However, monoamine antidepressants remain the best current medications and it may be some time before they are dislodged as the market leaders.
Effective HIV Treatment and the Employment of HIV+ Adults
Authors: Goldman Dana P. , Bao Yuhua 
Published: November 2004

Objective. To examine whether highly active antiretroviral therapy (HAART) helps HIV‐infected patients return to work, remain employed, and maintain hours of work.Data Source. Longitudinal data from a national probability sample of HIV+ patients older than 18 years old who made at least one visit in the contiguous United States in early 1996.Study Design. We consider the effect of HAART on three employment outcomes: (1) returning to work within six months of treatment, conditional on not working pretreatment; (2) remaining employed within six months of treatment, conditional on working pretreatment; (3) hours of work conditional on working at the second follow‐up survey. We use a bivariate probit model to jointly model employment and treatment with HAART for the first two outcomes and the two‐stage least squares method for hours of work. State policies regarding prescription drug coverage are used as instrumental variables for HAART to account for a key source of potential bias—the more severely ill tend to have the most difficulty working, but are also the most likely to be on HAART.Principal Findings. Our results indicate that HAART increases the probability of remaining employed by HIV patients and hours of work for those working within six months of treatment. In the case of remaining employed, the employment effect (an increase from 58 percent to 94 percent in the probability of remaining employed) is statistically significant and the related incremental income is sizable compared to the incremental costs of HAART. Sensitivity analyses demonstrate that the results are robust to different specifications for insurance coverage.Conclusions. Patients who are working are more likely to remain employed because of treatment with HAART. HAART prescribed to patients in less advanced stages of the infection may lead to the greatest gain in employment.
Identifying and Accommodating Statistical Outliers When Setting Prospective Payment Rates for Inpatient Rehabilitation Facilities
Authors: Paddock Susan M. , Wynn Barbara O. , Carter Grace M. , Buntin Melinda Beeuwkes 
Published: November 2004

Objective. To demonstrate how a Bayesian outlier accommodation model identifies and accommodates statistical outlier hospitals when developing facility payment adjustments for Medicare's prospective payment system for inpatient rehabilitation care.Data Sources/Study Setting. Administrative data on costs and facility characteristics of inpatient rehabilitation facilities (IRFs) for calendar years 1998 and 1999.Study Design. Compare standard linear regression and the Bayesian outlier accommodation model for developing facility payment adjustors for a prospective payment system.Data Collection. Variables describing facility average cost per case and facility characteristics were derived from several administrative data sources.Principal Findings. Evidence was found of non‐normality of regression errors in the data used to develop facility payment adjustments for the inpatient rehabilitation facilities prospective payment system (IRF PPS). The Bayesian outlier accommodation model is shown to be appropriate for these data, but the model is largely consistent with the standard linear regression used in the development of the IRF PPS payment adjustors.Conclusions. The Bayesian outlier accommodation model is more robust to statistical outlier IRFs than standard linear regression for developing facility payment adjustments. It also allows for easy interpretation of model parameters, making it a viable policy alternative to standard regression in setting payment rates.
Cost Convergence between Public and For‐Profit Hospitals under Prospective Payment and High Competition in Taiwan
Authors: Xirasagar Sudha , Lin Herng‐Ching 
Published: November 2004

Objective.To test the hypotheses that: (1) average adjusted costs per discharge are higher in high‐competition relative to low‐competition markets, and (2) increased competition is associated with cost convergence between public and for‐profit (FP) hospitals for case payment diagnoses, but not for cost‐plus reimbursed diagnoses.Data Sources.Taiwan's National Health Insurance database; 325,851 inpatient claims for cesarean section, vaginal delivery, prostatectomy, and thyroidectomy (all case payment), and bronchial asthma and cholelithiasis (both cost‐based payment).Study Design.Retrospective population‐based, cross‐sectional study.Data Analysis.Diagnosis‐wise regression analyses were done to explore associations between cost per discharge and hospital ownership under high and low competition, adjusted for clinical severity and institutional characteristics.Principal Findings.Adjusted costs per discharge are higher for all diagnoses in high‐competition markets. For case payment diagnoses, the magnitudes of adjusted cost differences between public and FP hospitals are lower under high competition relative to low competition. This is not so for the cost‐based diagnoses.Conclusions.We find that the empirical evidence supports both our hypotheses.
Chemokine Levels in the Jugular Venous Blood of Migraine Without Aura Patients During Attacks
Authors: Sarchielli Paola , Alberti Andrea , Vaianella Luana , Pierguidi Laura , Floridi Alessandro , Mazzotta Giovanni , Floridi Ardesio , Gallai Virgilio 
Published: November 2004

Objective.—To investigate changes in the levels of calcitonin gene‐related peptide and its intracellular messenger cyclic adenosine monophosphate in serial samples of internal jugular blood taken from migraine patients without aura assessed during attacks, and to assess their relationship with the levels of IL‐8, MCP‐1, and RANTES in the same samples.Background.—Calcitonin gene‐related peptide, the marker of trigeminovascular activation, is released in both the internal and external jugular venous blood of migraine patients during attacks. Experimental evidence demonstrated that when released from C‐type sensory neurons in inflammatory pain models, it differentially induced expression of neutrophil chemotactic chemokine IL‐8, but not monocyte chemotactic chemokine MCP‐1 or lymphocyte chemotactic chemokine RANTES. These chemokines were never investigated in migraine.Design/Methods.—Eight migraine without aura patients were admitted to the hospital during the attacks. Internal jugular venous blood samples were taken immediately after catheter insertion, at the 1st, 2nd, and 4th hours after attack onset, and within 2 hours from its cessation. The levels of the sensory neuropeptide calcitonin gene‐related peptide and the messenger cyclic adenosine monophosphate were measured by RIA method, and those of IL‐8, MCP‐1, and RANTES were measured by ELISA method.Results.—Higher calcitonin gene‐related peptide levels were found in the internal jugular venous blood of migraine without aura patients compared with the time of catheter insertion (ANOVA: P < .0001) with a peak at the first hour (52.6 ± 9.2 ng/mL). A transient increase in IL‐8 was observed at the 2nd and 4th hours (P < .01 and P < .002, respectively), whereas no changes in the levels of MCP‐1 and RANTES were found at any time of the study. The increase in IL‐8 was accompanied by a parallel increase in cyclic adenosine monophosphate.Conclusions.—The present study confirms previous findings of an increase in calcitonin gene‐related peptide in internal jugular venous blood of migraine without aura patients during attacks. The transient increase in the levels of IL‐8 concurs with the results of recent experimental research showing a calcitonin gene‐related peptide‐induced activation of IL‐8 gene expression, but not RANTES and MCP‐1, via the transcriptional factor AP‐2, which mediates transduction in response to cyclic adenosine monophosphate. Although IL‐8 is transiently increased during migraine attacks, an accumulation of leukocytes secondary to neurogenic inflammation is unlikely, as it is for other inflammatory events, because they are self limiting. Other events, including nitric oxide production, may contribute to counteract meningeal transvascular leukocyte migration during migraine attacks, as suggested by the model of sterile inflammation.
Individualizing Treatment With Verapamil for Cluster Headache Patients
Authors: Blau Joseph N. , Engel Hans O. 
Published: November 2004

Background.—Verapamil is currently the best available prophylactic drug for patients experiencing cluster headaches (CHs). Published papers usually state 240 to 480 mg taken in three divided doses give good results, ranging from 50% to 80%; others mention higher doses—720, even 1200 mg per day. In clinical practice we found we needed to adapt dosage to individual's time of attacks, in particular giving higher doses before going to bed to suppress severe nocturnal episodes. A few only required 120 mg daily. We therefore evolved a scheme for steady and progressive drug increase until satisfactory control had been achieved.Objective.—To find the minimum dose of verapamil required to prevent episodic and chronic cluster headaches by supervising each individual and adjusting the dosage accordingly.Methods.—Consecutive patients with episodic or chronic CH (satisfying International Headache Society (IHS) criteria) were started on verapamil 40 mg in the morning, 80 mg early afternoon, and 80 mg before going to bed. Patients kept a diary of all attacks, recording times of onset, duration, and severity. They were advised, verbally and in writing, to add 40 mg verapamil on alternate days, depending on their attack timing: with nocturnal episodes the first increase was the evening dose and next the afternoon one; when attacks occurred on or soon after waking, we advised setting an alarm clock 2 hours before the usual waking time and then taking the medication.Patients were followed‐up at weekly intervals until attacks were controlled. They were also reviewed when a cluster period had ended, and advised to continue on the same dose for a further 2 weeks before starting systematic reduction.Chronic cluster patients were reviewed as often as necessary.Results.—Seventy consecutive patients, 52 with episodic CH during cluster periods and 18 with chronic CH, were all treated with verapamil as above. Complete relief from headaches was obtained in 49 (94%) of 52 with episodic, and 10 (55%) of 18 with chronic CH; the majority needed 200 to 480 mg, but 9 in the episodic, and 3 in the chronic group, needed 520 to 960 mg for control. Ten, 2 in the episodic and 8 in the chronic group, with incomplete relief, required additional therapy—lithium, sumatriptan, or sodium valproate. One patient withdrew because verapamil made her too tired, another developed Stevens‐Johnson syndrome, and the drug was withdrawn.Conclusions.—Providing the dosage for each individual is adequate, preventing CH with verapamil is highly effective, taken three (occasionally with higher doses, four) times a day. In the majority (94%) with episodic CH steady dose increase under supervision, totally suppressed attacks. However in the chronic variety only 55% were completely relieved, 69% men, but only 20% women. In both groups, for those with partial attack suppression, additional prophylactic drugs or acute treatment was necessary.