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Rationale
Kinds of Rationale Selected AbstractsI. THEORETICAL, EMPIRICAL, AND PRACTICAL RATIONALEMONOGRAPHS OF THE SOCIETY FOR RESEARCH IN CHILD DEVELOPMENT, Issue 3 2008Article first published online: 24 NOV 200 First page of article [source] PRODIGALITY AND MYOPIA,TWO RATIONALES FOR SOCIAL SECURITY*THE MANCHESTER SCHOOL, Issue 6 2008PIERRE PESTIEAU Among the rationales for social security, there is the fact that some people have to be forced to save. To explain undersaving, rational prodigality and hyperbolic preferences are often cited but treated separably. In this paper we study those two particular behaviors that lead to forced saving within an optimal income tax second-best setting. [source] Emergence of Electronic Home Monitoring in Chronic Heart Failure: Rationale, Feasibility, and Early Results With the HomMed SentryÔ-ObserverÔ SystemCONGESTIVE HEART FAILURE, Issue 3 2000Mandeep R. Mehra MD Electronic home monitoring for chronic heart failure is emerging as an available option to add to our armamentarium as a vital part of the multidisciplinary care process. This investigation describes the early clinical results of a multicenter study which suggests that important trends in medical resource utilization may be attained by the use of this modality. [source] Debating the Ecosystem Service Rationale for Conservation: Response to Kremen et al.CONSERVATION BIOLOGY, Issue 3 2008JABOURY GHAZOUL No abstract is available for this article. [source] Rationale for esthetic tissue preservation of a fresh extraction socket by an implant treatment concept simulating a tooth replantationDENTAL TRAUMATOLOGY, Issue 1 2010Georgia Trimpou A soft-tissue recession must be avoided, whether it is due to a compression of the peri-implant soft-tissue caused by an over-dimensioned restoration in the cervical collar of the provisional crown or to a too small dimensioned sulcus former. A simulation of the exact dimension of the lost tooth , especially on the cervical part of the new provisional restoration , is expected to preserve all relevant information and allows the design of a naturally looking emergence profile. Based on theoretical considerations and a case report, the authors intend to demonstrate that a near-naturally dimensioned sealing of the dento-gingival soft-tissue collar may initiate a tissue-maintaining healing process, similar to a tooth replantation. The natural dental crown, connected to an implant instead of the root, is applied for a tight sealing of the wound. If due to traumatic impact the tooth is no longer available, a naturally dimensioned crown restoration will serve as an alternative wound sealant. [source] Gender, Caste and Matchmaking in Kerala: A Rationale for DowryDEVELOPMENT AND CHANGE, Issue 2 2008Praveena Kodoth ABSTRACT The matrilineal castes of northern Kerala consider dowry demeaning and resort to it only in ,exceptional' circumstances. In local discourse, dowry is transacted when women are considered ,old' by the standards of the marriage market, where over-age is a condition reached usually on account of what is considered a deficit of a normative conception of femininity. Dowry is practised openly only by poor and socially vulnerable households, as the relatively affluent could mask dowry with hidden compensations. This article explores the ways in which gender mediates matchmaking and generates a residual category of women for whom dowry is openly negotiated. Open negotiation on the margins of the marriage market expose the terms of exchange in ,respectable' society, where matchmaking strategies reveal the emphasis placed on conjugality and on caste in the social construction of women's interests and identity. Up to the mid-twentieth century, matrilineal women derived their identity from their natal families. The political economy of marriage in Kerala brought a new emphasis to bear on conjugality and on caste, which generated new restrictions on women and produced a rationale for dowry. [source] Private-Sector Investment in Infrastructure: Rationale and Causality for Pro-poor ImpactsDEVELOPMENT POLICY REVIEW, Issue 4 2009Rebecca Shah This article reviews the arguments for promoting private investment in infrastructure as a basis for poverty reduction in developing countries. It describes the experience leading to the development of international ,facilities' intended to address impediments to private investment. It then explores three ,levels' of literature: that of the facilities themselves, of donor organisations, and of academic authors. At each, it investigates the rationale and causal pathways leading from support for private investment to pro-poor outcomes. It finds there is a possible but not necessary association between private investment, economic growth and poverty reduction, but the causal chain is poorly understood. It proposes the development of such a causal framework. [source] The Economic Partnership Agreements: Rationale, Misperceptions and Non-trade AspectsDEVELOPMENT POLICY REVIEW, Issue 5 2008Louise Curran The European Union and the African, Caribbean and Pacific (ACP) countries entered a new era in 2008. The Cotonou trade regime and the WTO waiver legitimising it have expired, and the long anticipated, and much debated, move to Economic Partnership Agreements (EPAs) has begun. This article explains the background and analyses the ,alternatives' to EPAs, in order to tackle common misperceptions. Moving on from what has been the focus of debates, namely, the reciprocal liberalisation required under WTO rules, it sheds some light on the non-goods trade aspects of EPAs which, while integral to economic policy, are inherently hard to quantify and often skimmed over in existing studies or addressed in ideological terms. [source] Locating Responsibility: The Sphere Humanitarian Charter and Its RationaleDISASTERS, Issue 2 2004James Darcy Criticised by some as a technical initiative that neglects core principles, Sphere was seen by its originators precisely as an articulation of principle. The Humanitarian Charter was the main vehicle through which this was expressed, but its relationship to the Minimum Standards has remained a matter of uncertainty. Specifically, it was unclear in the original (1999) edition of Sphere how the concept of rights informed the Minimum Standards. The revised (2004) edition goes some way to clarifying this in the way the standards are framed, yet the link between the standards and the charter remains unclear. The concern with the quality and accountability of humanitarian assistance, which motivated the attempt to establish system-wide standards through the Sphere Project, was accompanied by a desire to establish such actions in a wider framework of legal and political responsibility. In part, this reflects the conditional nature of the undertaking that agencies make when they adopt Sphere. This aspect of the charter has been neglected, but it is fundamental to an understanding of the standards and their application. This paper considers the rationale of the Sphere Humanitarian Charter and the conceptual model that underpins it. It discusses the relationship between the charter and the Minimum Standards, and the sense in which the latter are properly called ,rights-based' (explored further in a related paper herein by Young and Taylor). The author was closely involved in the conception and drafting of the charter, and this paper attempts to convey some of the thinking that lay behind it. [source] Assessment of the Tilting Properties of the Human Mitral Valve during Three Main Phases of the Heart Cycle: An Echocardiographic StudyECHOCARDIOGRAPHY, Issue 4 2006Daniel Vanhercke B.N., N.F.E.S.C., R.D.C.S. Rationale and Objectives: In experimental models of the left heart, the mitral valve (MV) is commonly implanted perpendicular to a central axis of the apex/MV. To adapt this to a more correct anatomical model, as well as for further studies of the left ventricle, we created a database of implantation angles of the MV and annulus during three main phases of the heart cycle, based on standard cardiac ultrasound measurements. Materials and Methods: Twenty-eight patients were studied with the standard cardiac ultrasound equipment. From the apical echo window, an anteroposterior (AP) plane and a perpendicular commisure-commisure (CC) plane were generated during three critical moments in the heart cycle: systole (S); diastole early filling (E); and diastole late filling (A). In both planes, the angles between the annular plane and each mitral leaflet, as well as the angle between a theoretical longitudinal axis through the apex and center of the MV orifice and the mitral annulus plane, were measured with a custom-made application of Matlab R14. Results: We observed an inclination of the angle mitral annulus/central left ventricle axis, with its lowest point in the direction of the aortic valve (AP plane) of 85°± 7° in systole (S), 88°± 8° in early diastole (E), and 88°± 7° in late diastole (A). In the CC plane, we observed an almost horizontal implantation of 91°± 5° in systole (S), 91°± 8° in early diastole (E), and 91°± 7° in late diastole (A). [source] Asymmetric Cyclopropanation of Optically Active (1-Diethoxyphosphoryl)vinyl p -Tolyl Sulfoxide with Sulfur Ylides: A Rationale for DiastereoselectivityEUROPEAN JOURNAL OF ORGANIC CHEMISTRY, Issue 4 2005Wanda H. Midura Abstract The title sulfoxide (S)-(+)- 1a was found to react with sulfur ylides affording the corresponding cyclopropanes in high yields. With fully deuterated dimethyl(oxo)sulfonium methylide, (CD3)2S(O)CD2, the cyclopropanation reaction occurred in a highly diastereoselective manner producing the cyclopropane 4a - d2 as a major diastereomer in which the newly formed quaternary ,-carbon atom is chiral due to isotopic substitution (CH2 vs. CD2). The diastereomer 4b - d2, having the opposite configuration at the ,-carbon atom, was obtained starting form the 2,2-dideuterio substituted vinyl sulfoxide, (S)-(+)- 1a - d2, and the nondeuterated ylide. The diastereomeric ratio in both reactions was found to be ca. 10:1. The reaction of (S)-(+)- 1a with diphenylsulfonium isopropylide yielded the cyclopropane (+)- 7 as a single diastereomer. X-ray structural studies of the crystalline 1-phosphorylvinyl sulfoxide 9 as well as density functional calculations (B3LYP/6-31G*) on (1-phosphoryl)vinyl sulfoxides revealed the origin of the experimentally observed diastereoselectivities and allowed us to propose a transition state model for the cyclopropanation reaction of chiral 1-phosphorylvinyl sulfoxides. (© Wiley-VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2005) [source] A Mechanistic Rationale for the Mode Selectivity in the Intramolecular Cyclization of Ethylene-Tethered Iminoketenimines: [2+2] versus [4+2] Stepwise CycloadditionsEUROPEAN JOURNAL OF ORGANIC CHEMISTRY, Issue 12 2004Mateo Alajarín Abstract A stepwise mechanism, via a zwitterionic intermediate, has been established by ab initio and DFT calculations for the intramolecular cyclization of N -(3-azabut-3-enyl)ketenimine into its corresponding [2+2] cycloadduct. The control of the mode selectivity ([2+2] versus [4+2] cycloaddition) in the intramolecular cyclization of C -vinyl- N -(iminoethylene)ketenimines, which favors the [4+2] cycloadducts, also has been rationalized by comparing the energies calculated for both reaction pathways; the results have been confirmed by a quantitative kinetic analysis. (© Wiley-VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2004) [source] Rationale, design and methods of the OSCAR study: observational study on cognitive function and systolic blood pressure reduction in hypertensive patientsFUNDAMENTAL & CLINICAL PHARMACOLOGY, Issue 2 2007Atul Pathak Abstract Data from several recent clinical trials have suggested a beneficial effect of antihypertensive medications on preservation of cognitive function. Eprosartan, an angiotensin type-1 receptor antagonist (ARA) with dual action on both pre- and postsynaptic angiotensin type 1 receptors, may be effective in the control of SBP and the prevention of cognitive decline. The OSCAR (Observational Study on Cognitive function And SBP Reduction) study is an international longitudinal observational study with a duration of 6 months intended to examine the impact of the ARA eprosartan on cognitive function (assessed using the Mini-Mental State Examination [MMSE]) and control of systolic blood pressure (SBP) in a large international population of hypertensive patients managed in a standard primary care setting. A total of 100 000 hypertensive patients, aged ,50 years and with SBP of >140 mmHg will be recruited by more than 20 000 primary care physicians in 27 countries. These patients will receive eprosartan 600 mg once a day for 6 months. The MMSE, a globally validated cognitive screening test, will be performed at baseline, and after 6 months of treatment. After the first month of monotherapy, eprosartan treatment may, at the absolute discretion of individual investigators, be supplemented with other antihypertensive medications for the remainder of the study. The primary outcome indices are the mean relative change in MMSE score and the absolute change from baseline in SBP in the study population as a whole and in subsets of patients according to various factors among them: ethnicity, comorbidities (i.e. target organ damage, diabetes), baseline cognitive level and baseline blood pressure level. The secondary objectives are to identify factors influencing SBP and MMSE changes. The OSCAR trial is the first international observational study focusing on MMSE in a wide international cohort of hypertensive patients. The results are expected in 2007. [source] Radiation therapy for esthesioneuroblastoma: Rationale for elective neck irradiation,HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 7 2003Alan T. Monroe MD Abstract Purpose. Esthesioneuroblastoma is an uncommon malignancy of neural crest origin arising in the upper nasal cavity. We describe the University of Florida experience using radiation therapy (RT) in the treatment of this neoplasm, particularly the use of elective nodal irradiation. Materials and Methods. Between May 1972 and August 1998, 22 patients received RT for esthesioneuroblastoma. Two additional patients were treated with palliative intent and were excluded from analysis. Equal numbers of male and female patients were treated, with a median age of 54 years (range, 3,82). The modified Kadish stage was A in 1 patient, B in 4 patients, C in 15 patients, and D in 2 patients. Treatment modalities included primary RT in 6 patients, preoperative RT in 1 patient, postoperative RT after craniofacial resection in 12 patients, and salvage RT in 3 patients treated for recurrence after surgery. Elective neck RT was performed in 11 of 20 patients; 2 patients had cervical metastases at presentation for RT. Results. Rates of local control, cause-specific survival, and absolute survival at 5 years were 59%, 54%, and 48%, respectively. The cause-specific survival rate at 5 years was lower after primary RT (17%) than after craniofacial resection and postoperative RT (56%). Cervical metastases occurred in 6 of 22 patients (27%). No neck recurrences occurred in 11 patients treated with elective neck RT compared with 4 neck recurrences in 9 patients (44%) not receiving elective neck RT (p = .02). Conclusions. Combined modality therapy is preferred over RT alone in advanced-stage esthesioneuroblastoma. Our data and review of the current literature suggest a higher cervical failure rate than previously recognized. Elective neck RT seems to correlate with improved nodal control and should be considered in the treatment of esthesioneuroblastoma. © 2003 Wiley Periodicals, Inc. Head Neck 25: 529,534, 2003 [source] The International Quotidian Hemodialysis Registry: Rationale and challengesHEMODIALYSIS INTERNATIONAL, Issue 2008Robert M. LINDSAY Abstract Outcomes from conventional thrice-weekly hemodialysis (CHD) are disappointing for a life-saving therapy. The results of the HEMO Study show that the recommended minimum dose (Kt/V) for adequacy is also the optimum attainable with CHD. Interest is therefore turning to alternative therapies exploring the effects of increased frequency and time of hemodialysis (HD) treatment. The National Institutes of Health have sponsored 2 randomized prospective trials comparing short hours daily in-center HD and long hours slow nightly home HD with CHD. An International Registry has also been created to capture observational data on patients receiving short hours daily in-center HD, long hours slow nightly home HD, and other alternative therapies. Participation by individual centers, other registries and the major dialysis chains is growing and currently data from nearly 3000 patients have been collected. Pitfalls in data collection have been identified and are being corrected. A matched cohort (patients in other registries) study is planned to obtain information regarding hard outcomes expected from these therapies. The Registry may become the most important source of information required by governments, providers, and the nephrological community in assessing the utility of such therapies. [source] The International Quotidian Hemodialysis Registry: Rationale and methodsHEMODIALYSIS INTERNATIONAL, Issue 4 2004Gihad E Nesrallah Abstract The HEMO study has provided evidence that a higher dialysis dose per session does not improve survival in conventional three times a week hemodialysis (HD). Attention has therefore shifted to HD schedules that vary in frequency and/or duration of dialysis. Although observational data favoring the use of frequent dialysis are steadily accumulating, compelling evidence supporting its superiority is still lacking. Several advances have recently been made with a view to put this form of therapy on much more solid footing. Upcoming research initiatives including clinical trials of frequent HD and the quotidian HD registry will provide a wealth of analytic and descriptive data that will help define the role for frequent HD regimens as a therapy for end-stage renal disease. [source] High prevalence of abnormal alanine and aspartate aminotransferases in a "worried-well" population in the United Kingdom: Rationale for a liver screening program?,HEPATOLOGY, Issue 5 2008Diana García-Romero No abstract is available for this article. [source] Neuropsychological functioning in buprenorphine maintained patients versus abstinent heroin abusers on naltrexone hydrochloride therapyHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 7 2009Lambros Messinis Abstract Rationale Methadone and buprenorphine are among the most widely employed pharmacological treatments currently available for opioid addiction. Cognitive effects of buprenorphine in abstinent heroin abusers are nevertheless far from being understood. Methods Neuropsychological performance of 18 buprenorphine-maintained patients (BMP) was evaluated relative to that of 32 currently abstinent heroin abusers on naltrexone hydrochloride therapy (FHAN), and 34 non-drug dependent controls. The three groups were demographically balanced. Clinical groups reported histories of similar patterns of drug use and had increased periods of abstinence from any illicit substance use including heroin. Results The BMP group performed poorer than controls on the RAVLT (encoding and delayed recall of verbal information), CTT (conceptual flexibility, executive functions) and the RBANS figure copy (visual perception) and delayed recall of visual information. There were no significant differences in any of the cognitive measures between the BMP and FHAN groups or between the FHAN group and controls. Furthermore, the non-differing percentage of abnormal cases between the two patient groups led us to infer that treatment with either BPM or FHAN is not accompanied by qualitative differences in the cognitive profiles of these patients. Conclusion Overall, results suggest that treatment with naltrexone in abstinent heroin abusers may result in less impairment of cognitive functions compared to treatment with buprenorphine. These findings are relevant for improved prognosis and treatment strategies in opioid dependence. Copyright © 2009 John Wiley & Sons, Ltd. [source] Caffeine, cognitive failures and health in a non-working community sampleHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 1 2009Andrew P Smith Abstract Rationale Most studies of the effects of caffeine on performance have been conducted in the laboratory and further information is required on the real-life effects of caffeine consumption on cognition. In addition, possible effects of caffeine consumption on a range of health outcomes should also be assessed in these studies to enable cost-benefit analyses to be conducted. Objectives Secondary analyses of a large epidemiological database (N,=,3223 non-working participants, 57% female, with a mean age of 49.6 years, range 17,92 years) were conducted to examine associations between caffeine consumption (mean caffeine consumption was 140,mg/day, range 0,1800,mg) and cognitive failures (errors of memory, attention and action) in a non-working sample. Associations between caffeine consumption and physical and mental health problems were also examined. Methods The study involved secondary analyses of a database formed by combining the Bristol Stress and Health at Work and Cardiff Health and Safety at Work studies. Associations between caffeine consumption and frequency of cognitive failures and health outcomes were examined in a sample of non-workers. Results After controlling for possible confounding factors significant associations between caffeine consumption and fewer cognitive failures were observed. Initial analyses suggested that many health variables were associated with regular level of caffeine consumption. However, most of the significant effects of caffeine disappeared when demographic and lifestyle factors were controlled for. Consumption of caffeine was, however, associated with a reduced risk of depression. These effects were also observed in separate analyses examining the source of the caffeine (coffee and tea). Conclusions Overall, the results show that caffeine consumption may benefit cognitive functioning in a non-working population. This confirms earlier findings from working samples. This beneficial effect of caffeine was not associated with negative health consequences. Indeed, consumption of caffeine was found to be associated with a reduced risk of depression. Copyright © 2008 John Wiley & Sons, Ltd. [source] Effects of dietary caffeine on EEG, performance and mood when rested and sleep restricted,HUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 8 2008Michael A. Keane Abstract Rationale: Until recently, little account had been taken of the confounding effects of caffeine withdrawal and withdrawal reversal when examining the net effects of dietary caffeine. Objectives: By including a manipulation involving sleep restriction, the present study aimed to extend recent findings from research in which caffeine withdrawal and withdrawal reversal were controlled. The main aims of the study were to examine the net effects of caffeine, as well as its potential restorative effects following sleep restriction, on EEG, performance and mood. Method: A randomised cross-over design was used in which 15 participants alternated weekly between ingesting placebo and caffeine (1.75,mg/kg) three times daily for four consecutive weeks following either usual sleep or sleep restriction. EEG activity was measured at 32 sites during eyes closed, eyes open and performance of a vigilance task. Results: Modest effects of caffeine were found in the delta and beta bandwidths, but no main effects of caffeine were observed in the theta or alpha bandwidths. Overall, the effects of caffeine on EEG activity were relatively few, weak and inconsistent, and no evidence was found of net restorative effects of caffeine for any outcome variables. Conclusions: The findings do not support the use of caffeine as a means for enhancing human function or as an antidote to the negative effects of sleep loss. Copyright © 2008 John Wiley & Sons, Ltd. [source] Relationship between the cardiac response to acute intoxication and alcohol-induced subjective effects throughout the blood alcohol concentration curveHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 7 2007Caroline Brunelle Abstract Rationale There is evidence to suggest that individual differences in the subjective response to alcohol exist and exaggerated cardiac response to alcohol has been suggested to be a marker of increased sensitivity to the stimulant properties of alcohol. Objectives The present investigation examines the relationship between cardiac reactivity to alcohol measured on the ascending limb of the Blood Alcohol Concentration (BAC) curve and the subjective stimulant and sedative effects of alcohol throughout the BAC curve. Methods The stimulant and sedative effects of alcohol anticipatory to alcohol and during the ascending and descending limbs of the BAC curve were evaluated using the Biphasic Alcohol Effects Scale in 39 male social drinkers. Results Cardiac response to ethanol measured on the ascending limb of the BAC curve was positively correlated with intoxicated stimulant effects at numerous time points during the ascending and descending limbs of the BAC curve (ps,<,0.01). No associations were found between cardiac change following alcohol and alcohol-related sedative effects at any time point. Conclusions Objective and subjective reports of stimulation post-alcohol ingestion may increase risk for problematic drinking. Copyright © 2007 John Wiley & Sons, Ltd. [source] Relationship of prolactin response to meta-chlorophenylpiperazine with severity of drug use in cocaine dependenceHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 6 2006Ashwin A. Patkar Abstract Rationale Serotonergic (5-HT) mechanisms appear to mediate central effects of cocaine. Therefore 5-HT disturbances could be associated with drug severity. Objectives We investigated whether prolactin (PRL) response to meta-chlorophenylpiperazine (m-CPP), a mixed 5-HT agonist/antagonist were associated with severity of cocaine use. Methods Thirty-six cocaine-dependent subjects and 33 controls underwent a challenge with 0.5,mg/kg of oral m-CPP. Severity of drug use was assessed using the Addiction Severity Index (ASI). Results The PRL response to m-CPP was significantly blunted in cocaine patients compared to controls (F,=,21.86, p,<,0.001). ,PRL (peak PRL,baseline PRL) was negatively correlated with ASI-drug (r,=,,0.45, p,<,0.01), ASI-alcohol (r,=,,0.32, p,<,0.05), and ASI-psychological (r,=,,0.41, p,<,0.01) composite scores, and with the quantity, frequency and duration of drug use (r ranged from ,,0.41 to ,,0.32, p ranged from <,0.01 to 0.05). Hierarchical regressions showed that ASI-drug composite scores significantly predicted the variance in ,PRL after controlling for behavioral and demographic variables (F,=,4.27, p,<,0.05). Conclusions The results indicate that disturbances in 5-HT function as reflected by a blunted response to m-CPP seem to be primarily associated with severity of drug use and to a lesser, although significant extent with behavioral traits in cocaine-dependent patients. Copyright © 2006 John Wiley & Sons, Ltd. [source] The effects of transdermal nicotine on inspection timeHUMAN PSYCHOPHARMACOLOGY: CLINICAL AND EXPERIMENTAL, Issue 3 2002J. C. Thompson Abstract Rationale The acute administration of nicotine via a cigarette has been demonstrated to enhance inspection time (IT), a measure of rapid visual information processing, while the nicotinic antagonist mecamylamine impairs IT. However, as transdermal nicotine patches provide a slow delivery of nicotine, it is unclear if they produce similar effects to nicotine administered by more rapid methods. Objectives To examine the effects of transdermal nicotine on inspection time. Methods Ten moderate smokers were administered nicotine (21,mg/day) or placebo via a transdermal patch in a randomized, double-blind, repeated measures design. Subjects were administered the IT task at baseline, then 1, 3, and 6,h subsequent to patch application. Results The change in IT from baseline was significantly different in the nicotine condition, relative to placebo, at 3,h but not 1 or 6,h. Conclusions The findings suggest that nicotine administered via transdermal patches improves IT, but this improvement may be subject to tolerance. Data from previous studies on tolerance to the cognitive effects of nicotine have been inconclusive. However, the slow delivery of nicotine from patches may be more likely to produce such effects. Copyright © 2002 John Wiley & Sons, Ltd. [source] Maternal Depression and the Ability to Facilitate Joint Attention With 18-Month-OldsINFANCY, Issue 1 2003Erin N. Henderson Maternal depression has been associated with the mother-child dyad's ability to engage in joint attention. This study of 69 depressed and 63 control mothers and their 18-month-olds addresses how aspects of maternal psychopathology are related to joint attention during a snack interaction. Although nondepressed-mother dyads appeared better at joint attention than depressed-mother dyads, this difference was not statistically significant. Among the depressed-mother dyads, joint attention was related to presence of a comorbid Axis I diagnosis (usually an anxiety disorder) versus a diagnosis of major depressive disorder (MDD) only. Surprisingly, dyads with mothers who met criteria for a comorbid diagnosis were better at joint attention than those with MDD only, despite the fact that those mothers were likely to have longer and more severe depressive histories. The relationship between comorbid status and joint attention was mediated by the mother's affect. Rationale for the paradoxical finding that the "more pathological" mothers had greater success in engaging in joint attention is discussed. [source] Quetiapine indication shift in the elderly: diagnosis and dosage in 208 psychogeriatric patients from 2000 to 2006INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 5 2007Lorenz Hilwerling Abstract Rationale Quetiapine was approved in Germany as an atypical antipsychotic for treatment of schizophrenia in 2000, followed by the approval as an antipsychotic for treatment of bipolar mania in 2003. The approval of quetiapine for treatment of bipolar depression is expected. We hypothesized that the psychogeriatric prescription pattern for quetiapine shifts from the psychotic to the affective spectrum. Methods Retrospectively we screened discharge reports of all geriatric inpatients of the psychiatric department of the Ruhr-University of Bochum in the period from January 2001 until March 2006 and identified 208 individual patients aged over 60 years, who had received quetiapine as final medication. Age, gender, daily drug dose, year of treatment and diagnosis (according to ICD-10) were recorded and analyzed. Results Over the six-year time span, the proportion of affective disorders (F3) as indication for quetiapine in the elderly increased, whereas the proportion of dementia (F0) as indication for quetiapine decreased significantly. The proportion of schizophrenic disorders (F2) treated with quetiapine did not change significantly. Discussion Since the decision of the German Federal Court in 2002 ,off label' use goes to the expenses of the prescriber. So the decrease of quetiapine in dementia is probably due to its ,off label' status in dementia. The psychogeriatric indication shift for quetiapine towards affective disorders could be the consequence of good clinical experiences with the drug and growing evidence for its antidepressant effect. Conclusion In addition to controlled pharmacological trials prospective clinical research is needed to evaluate the prescription attitudes of clinicians. Copyright © 2006 John Wiley & Sons, Ltd. [source] A Coherent Mechanistic Rationale for Additive Effects and Autoinductive Behaviour in Proline-Mediated ReactionsADVANCED SYNTHESIS & CATALYSIS (PREVIOUSLY: JOURNAL FUER PRAKTISCHE CHEMIE), Issue 17 2009Natalia Zotova Abstract Differences in the kinetic behaviour of aldol reactions compared to aminoxylation and amination reactions are rationalized by consideration of the rate-determining step in each case. Both autoinductive behaviour and the rate-enhancing effect of additives are attributed to an effect on the enamine formation step. [source] The STRokE DOC trial technique: ,video clip, drip, and/or ship'INTERNATIONAL JOURNAL OF STROKE, Issue 4 2007B. C. Meyer Rationale To describe the clinical trial methods of a site-independent telemedicine system used in stroke. Aims A lack of readily available stroke expertise may partly explain the low rate of rt-PA use in acute stroke. Although telemedicine systems can reliably augment expertise available to rural settings, and may increase rt-PA use, point-to-point systems do require fixed base stations. Site-independent systems may minimize delay. The STRokE DOC trial assesses whether site-independent telemedicine effectively and efficiently brings rt-PA to a remote population. Design STRokE DOC is a 5-year, 400-participant, noninvasive trial, comparing two consultative techniques at four remote sites. Participants are randomized to acute ,STRokE DOC telemedicine' or ,telephone' consultations. Treatment decision accuracy is adjudicated at two time points, using three levels of data availability and an independent auditor. Study outcomes The primary outcome measure is whether there was a ,correct decision to treat or not to treat using rt-PA' at each of three adjudication levels (primarily at Level #2). Secondary outcomes include the number of thrombolytic recommendations, intracerebral hemorrhage, and 90-day outcomes. Using the STRokE DOC system (or telephone evaluation), medical history, neurologic scales, CT interpretations, and recommendations have been completed on over 200 participants to date. Of the initial 11, nonrandomized, ,run-in' patients, six (65%) were evaluated wirelessly, and five (45%) were evaluated with a site-independent LAN or cable modem. Three (27%) received rt-PA. The adjudication methodology was able to show both agreements and disagreements in these 11 cases. It is feasible to perform site-independent stroke consultations, and adjudicate those cases, using the STRokE DOC system and trial design. Telemedicine efficacy remains to be proven. [source] Idiopathic Left Ventricular Arrhythmias Originating Adjacent to the Left Aortic Sinus of Valsalva: Electrophysiological Rationale for the Surface ElectrocardiogramJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 2 2010TAKUMI YAMADA M.D. IVT Arising Adjacent to the Left Sinus of Valsalva.Background: Idiopathic ventricular arrhythmias (VAs) may be amenable to catheter ablation within or adjacent to the left sinus of Valsalva (LSOV). However, features that discriminate these sites have not been defined. The purpose of this study was to determine the electrocardiographic and electrophysiological features of VAs originating within or adjacent to the LSOV. Methods and Results: We studied 48 consecutive patients undergoing successful catheter ablation of idiopathic VAs originating from the left coronary cusp (LCC, n = 29), aortomitral continuity (AMC, n = 10) and great cardiac vein or anterior interventricular cardiac vein (Epi, n = 9). A small r wave, or rarely an R wave, was typically observed in lead I during the VAs and pacing in these regions. An S wave in lead V5 or V6 occurred significantly more often during both the VAs and pacing from the AMC than during that from the LCC and Epi (p < 0.05 to 0.0001). For discriminating whether VA origins can be ablated endocardially or epicardially, the maximum deflection index (MDI = the shortest time to the maximum deflection in any precordial lead/QRS duration) was reliable for VAs arising from the AMC (100%), but was less reliable for LCC (73%) and Epi (67%) VAs. In 3 (33%) of the Epi VAs, the site of an excellent pace map was located transmurally opposite to the successful ablation site (LCC = 1 and AMC = 2). Conclusions: The MDI has limited value for discriminating endocardial from epicardial VA origins in sites adjacent to the LSOV probably due to preferential conduction, intramural VA origins or myocardium in contact with the LCC. (J Cardiovasc Electrophysiol, Vol. 21, pp. 170-176, February 2010) [source] Rationale and Design of ATHENA: A Placebo-Controlled, Double-Blind, Parallel Arm Trial to Assess the Efficacy of Dronedarone 400 mg Bid for the Prevention of Cardiovascular Hospitalization or Death from Any Cause in PatiENts with Atrial Fibrillation/Atrial FlutterJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 1 2008STEFAN H. HOHNLOSER M.D. Background: Atrial fibrillation (AF) is the most commonly encountered clinical arrhythmia, predominantly affecting elderly patients. There is a continued need for new antiarrhythmic drugs to treat the ever-increasing number of patients with this arrhythmia. Dronedarone is a new antiarrhythmic compound currently being developed for treatment of AF. Methods: The ATHENA trial (A placebo-controlled, double-blind, parallel arm Trial to assess the efficacy of dronedarone 400 mg bid for the prevention of cardiovascular Hospitalization or death from any cause in patiENts with Atrial fibrillation/atrial flutter) is the largest single antiarrhythmic drug trial ever conducted. More than 4,600 patients with a history of AF or atrial flutter (AFL) have been randomized to receive dronedarone 400 mg bid or matching placebo. The primary study endpoint is time to first cardiovascular hospitalization or death from any cause. The study has completed patient enrollment in December 2006 and is expected to end follow-up 1 year later. Conclusion: ATHENA will be the largest efficacy and safety trial of dronedarone, a multichannel blocker compound with properties from class I, II, III, and IV antiarrhythmic drugs developed to treat patients with AF. [source] Biventricular Versus Right Ventricular Pacing in Patients with AV Block (BLOCK HF): Clinical Study Design and RationaleJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 9 2007ANNE B. CURTIS M.D. Background: Right ventricular (RV) pacing restores ventricular systole in patients with atrioventricular (AV) block, yet recent studies have suggested that in patients with AV block and left ventricular (LV) dysfunction, RV pacing may exacerbate the progression to heart failure (HF). BLOCK HF is a prospective, multi-center, randomized, double-blind, controlled trial designed to determine whether patients with AV block, LV dysfunction (EF , 50%), and mild to moderate HF (NYHA I-III) who require pacing benefit from biventricular (BiV) pacing, compared with RV pacing alone. Objective: The primary objective of this trial is to determine whether the time to first event (all-cause mortality, heart failure-related urgent care, or a , 15% increase in left ventricular end systolic volume index [LVESVI]) for patients with BiV pacing is superior to that of patients with RV pacing. Methods: Patients with AV block and LV dysfunction who require permanent pacing and undergo successful implantation of a commercial Medtronic CRT device, with or without an ICD, will be randomized to BiV or RV pacing. Patients are followed at least every 6 months until study closure. Up to 1,636 patients may be enrolled in 150 centers worldwide. Conclusion: BLOCK HF is a large, randomized, clinical study in pacing-indicated patients with AV block, mild to moderate HF symptoms, and LV dysfunction to determine whether BiV pacing is superior to RV pacing in slowing the progression of HF. [source] | ||||||||||||||||||||||||||||||||||||||||||||||||||||