Unanticipated Finding Research Articles

The Complexities of the Religious Response to Domestic Violence

Drawing on data from a study conducted in Wyoming about the community response to domestic violence, this article focuses on an unanticipated finding: how religion is paradoxically both a source of assistance and a barrier to women surviving domestic violence. The results indicate that although religious institutions are a resource for emotional comfort and provide practical assistance, they may also perpetuate silence. The article concludes that many religious communities are not adequately equipped to respond to the problem of domestic violence in a way that is safe for women. Implications for social work, particularly for recent faith-based initiatives, are discussed.

Physical Disabilities and Food Access Among Limited Resource Households

Food is a basic need of all people. The degree to which people have access to food influences food choice, quality of life, health, and illness. We examined how physically impaired and disabled food shoppers from low-income households managed food provision for their families and the impact health and physical disabilities had on family food choice among those with limited resources. This qualitative study examined food access among 28 low-income rural, village, and inner city families in upstate New York selected by purposive and theoretical sampling. An unanticipated finding emerged that nearly one-half of participants, all primary grocery shoppers for their families, had a variety of health conditions and disabilities that limited food access and, in turn, healthy, affordable food. These findings suggest that physical abilities, agency, and context interact in food access.

Impact of Experimentally Induced Positive and Anxious Mood on Alcohol Expectancy Strength in Internally Motivated Drinkers

The effects of musically‐induced positive and anxious mood on explicit alcohol‐related cognitions (alcohol expectancy strength) in 47 undergraduate students who consume alcohol either to enhance positive mood states (for enhancement motives) or to cope with anxiety (for anxiety‐related coping motives) were investigated. Pre‐ and post‐mood induction, participants completed the emotional reward and emotional relief subscales of the Alcohol Craving Questionnaire – Now. The hypothesis that anxiety‐related coping motivated drinkers in the anxious mood condition (but not those in the positive mood condition) would exhibit increases in strength of explicit emotional relief alcohol expectancies after the mood induction was supported. An additional, unanticipated finding was that enhancement‐motivated drinkers in the anxious condition also showed significant increases in strength of explicit emotional relief (but not emotional reward) alcohol expectancies. The hypothesis that enhancement‐motivated (but not anxiety‐related coping motivated) participants would exhibit increases in explicit emotional reward expectancies following exposure to the positive mood induction procedure was not supported. Taken together with past research findings, the current results highlight the importance of distinguishing between subtypes of negative affect (i.e., anxious and depressed affect) in exploring the affective antecedents of explicit alcohol outcome expectancies.

Pioneering advantage and product-country image: evidence from an exploratory study in China

Food distribution channel members in the Peoples' Republic of China have been interviewed to determine the factors that they regard as most relevant when selecting imported food products. In the Chinese market, country of origin itself appears to play little role in product evaluation by channel members. However, an unanticipated finding in this exploratory study is that pioneer (or first mover) status appears to play a major role in regard to beliefs concerning the country of origin of food products. Products considered to have been first into the market are often perceived as having better quality or being the 'genuine' one, with followers having a lesser status. This seems likely to be due to the long-term orientation of Chinese culture, and the value that is placed on hierarchy, tradition and history. It could also be due in part to the prevalence of counterfeit products, including food products, in the Chinese market, leading to widespread mistrust of 'non-genuine' products.

Association between indices of prosthesis internal orifice size and operative mortality after isolated aortic valve replacement

The appropriate index of prosthesis internal orifice size and its effect on operative mortality after aortic valve replacement are controversial. We examined the association between several relevant indices and patient size on operative mortality. Indices examined included projected in vivo effective orifice area and geometric orifice area, with patient size defined as body surface area. A review of the Society of Thoracic Surgeons National Cardiac Database (2000-2004) yielded 48,722 patients who had isolated aortic valve replacement. This analysis is based on the cohort of 42,310 patients with the 8 most prevalent valve types with manufacturer's labeled sizes 19 mm through 29 mm. Multivariable logistic regression models were employed to determine the effects of body surface area, effective orifice area, geometric orifice area, and selected derived indices (eg, effective orifice area/body surface area) on risk-adjusted operative mortality. In separate multivariable models, effective orifice area and geometric orifice area were both inversely correlated with operative mortality. However, an unanticipated finding was that with either effective orifice area or geometric orifice area held constant, body surface area was significantly and inversely correlated with operative mortality. When patients were stratified by effective orifice area, geometric orifice area, or manufacturer's labeled valve size and type, elevations in body surface area were associated with a decrease rather than an increase in operative mortality. Prostheses with small geometric orifice area or small effective orifice area are associated with increased operative mortality after isolated aortic valve replacement. Even for valves with small effective orifice area, however, mortality decreases as body surface area increases. With respect to operative mortality, therefore, our results do not support using arbitrary cutoff values of effective orifice area/body surface area to determine the valve to utilize in a given patient.

Elementary, Middle, and High School Students Vary in Frequency and Purpose When Using Online Digital References

Elementary, Middle, and High School Students Vary in Frequency and Purpose When Using Online Digital References

The Use of Intravenous Compared with Oral Busulfan in High-Dose Chemotherapy and Autologous Stem Cell Transplantation (ASCT) for Lymphoma Is Associated with Improved Relapse-Free Survival.

The efficacy of high-dose chemotherapy and ASCT for lymphomas is generally believed to be independent of the preparative regimen used, although toxicities may vary. Delayed toxicities after ASCT led us to investigate IV busulfan in older patients as a substitute for oral busulfan in a preparative regimen of busulfan/cyclophosphamide/etoposide (BuCyVP), based on data suggesting lower treatment-related mortality after ASCT with the IV formulation. We then queried whether other outcomes of ASCT for lymphomas were improved by substituting IV busulfan for oral busulfan. We retrospectively analyzed the outcomes of 308 patients over age 50 years who underwent ASCT for NHL (93%) or HL (7%) at the Cleveland Clinic from 1996 through 2/2006. Oral BuCyVP (“PO Bu”) was used in 261 patients and IV BuCyVP (“IV Bu”, 0.8 mg/kg IV x 14 doses given without monitoring or adjustment for serum Bu levels) in 47 patients. Differences in baseline characteristics were that the IV Bu group was more heterogeneous in the number of prior chemotherapy regimens (P=0.013), more often received chemotherapy for stem cell mobilization (P=0.026), had fewer NHL patients with a high-intermediate or high IPI score (P<0.001), and had fewer patients with stage III or IV disease (P=0.046). Follow up from ASCT was significantly longer in the PO Bu group (median 45.7 vs. 8.8 months). CD34+ cell doses and hematopoietic recovery were similar between groups.Median overall survival was 43.6 months after ASCT with PO Bu but was not reached for the IV Bu group. Kaplan-Meier analysis demonstrated the unanticipated finding that IV Bu was associated with a lower rate of relapse (P=0.013), superior relapse-free survival (P=0.008), and a marginal improvement in overall survival (P=0.06). [Display omitted] Univariate Cox models identified the route of busulfan administration and disease status at ASCT as significant predictors of relapse. Age at transplant, the number of prior regimens, and LDH at transplant were significant predictors of mortality. Only the route of busulfan administration significantly predicted RFS in univariate analysis. In a multivariable model, the route of busulfan administration was the strongest predictor of RFS (P=0.043). Age was also predictive of RFS (P=0.047). These preliminary results suggest that replacing PO Bu with IV Bu is associated with a reduced relapse rate and improved RFS following ASCT for lymphoma. In contrast to other reports, we observed these improvements without targeting Bu dosage according to serum levels. Further study is necessary to confirm these findings and to ascertain whether IV Bu will favorably influence overall survival in this setting.

Recent Trials in Hypertension

95% CI, 0.44-0.76), and total mortality (RR, 0.90; 95% CI, 0.81-0.99). Compared with placebo, -blockers— primarily atenolol, which had been used in many of the trials—wereassociatedwithreducedrisksofstroke(RR,0.71; 95%CI,0.59-0.86)andheartfailure(RR,0.58;95%CI,0.400.84) but not of coronary heart disease (RR, 0.93; 95% CI, 0.80-1.09) or total mortality (RR, 0.95; 95% CI, 0.841.07). 4 The results of recent meta-analyses by Carlberg et al 5 andLindholmetal 6 haveconfirmedthese-blockerfindings, although heart failure was omitted as an outcome of interest. 6 The importance of -blocker therapy in patients with heart failure was also clearly defined in the 1990s. 7 For -blocker therapy, an unanticipated finding was the disparity between its clear mortality benefit in the treatment of patients with coronary heart disease regardless of hypertension status 8 and its apparent inability to prevent coronaryheartdiseaseinthetreatmentofpatientswithhigh blood pressure. In the meta-analyses of placebo-controlled trials in hypertension, 4-6 the reductions in coronary heart disease risk associated with -blockers have been modest, with 95% CIs that include 1.0. Severalexplanationsarepossible.Inlow-riskasymptomatic populations receiving -blockers for hypertension, a withdrawal syndrome precipitating coronary syndromes in

Identification of a Dynamic Atmosphere at Enceladus with the Cassini Magnetometer

The Cassini magnetometer has detected the interaction of the magnetospheric plasma of Saturn with an atmospheric plume at the icy moon Enceladus. This unanticipated finding, made on a distant flyby, was subsequently confirmed during two follow-on flybys, one very close to Enceladus. The magnetometer data are consistent with local outgassing activity via a plume from the surface of the moon near its south pole, as confirmed by other Cassini instruments.

Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System

In response to the landmark 1999 report by the Institute of Medicine and safety initiatives promoted by the Leapfrog Group, our institution implemented a commercially sold computerized physician order entry (CPOE) system in an effort to reduce medical errors and mortality. We sought to test the hypothesis that CPOE implementation results in reduced mortality among children who are transported for specialized care. Demographic, clinical, and mortality data were collected of all children who were admitted via interfacility transport to our regional, academic, tertiary-care level children's hospital during an 18-month period. A commercially sold CPOE program that operated within the framework of a general, medical-surgical clinical application platform was rapidly implemented hospital-wide over 6 days during this period. Retrospective analyses of pre-CPOE and post-CPOE implementation time periods (13 months before and 5 months after CPOE implementation) were subsequently performed. Among 1942 children who were referred and admitted for specialized care during the study period, 75 died, accounting for an overall mortality rate of 3.86%. Univariate analysis revealed that mortality rate significantly increased from 2.80% (39 of 1394) before CPOE implementation to 6.57% (36 of 548) after CPOE implementation. Multivariate analysis revealed that CPOE remained independently associated with increased odds of mortality (odds ratio: 3.28; 95% confidence interval: 1.94-5.55) after adjustment for other mortality covariables. We have observed an unexpected increase in mortality coincident with CPOE implementation. Although CPOE technology holds great promise as a tool to reduce human error during health care delivery, our unanticipated finding suggests that when implementing CPOE systems, institutions should continue to evaluate mortality effects, in addition to medication error rates, for children who are dependent on time-sensitive therapies.

Unexpected Findings during Thyroid Surgery in a Regional Community Hospital: A 5-Year Experience of 738 Consecutive Cases

Unexpected findings during thyroid surgery in a nonuniversity setting have rarely been reported in large series. Our goal was to describe the unexpected findings during thyroid surgery in a busy regional community hospital. All thyroid operations conducted by the teaching staff at Greenville Memorial Hospital, a 735-bed nonuniversity regional hospital, from December 1998 through December 2003 were reviewed. Pre- and post-operative diagnoses, surgical procedure, and specimen histopathology were examined. Unexpected findings were defined as either thyroid pathology not anticipated based on preoperative diagnosis or as unsuspected nonthyroidal disease found during cervicotomy. During the 5-year study period, 738 patients presented with thyroid disease requiring surgery. Incidental thyroid cancer was discovered in 28 cases (3.8%), the predominance being papillary microcarcinoma. Synchronous benign thyroid disease, separate from the indication from surgery, was observed in 56 patients (7.6%). Forty patients had unexpected nodular goiter and 16 had lymphocytic thyroiditis. Primary hyperparathyroidism was observed in 33 patients (4.5%). Both solitary adenomas (22 cases) and multigland parathyroid disease (11 cases) were seen. Unexpected nonendocrine findings were less common, including solitary cases of large cell carcinoma, metastatic endometrial carcinoma, and tracheal duplication (bronchogenic cyst). In conclusion, unexpected findings during thyroid surgery at a busy community hospital are fairly common. Indeed, an unanticipated finding is encountered in one out of seven operations on the thyroid gland. Although most are of unclear clinical significance, there is a surprisingly high incidence of hyperparathyroidism. This underscores the need for preoperative screening, as the "thyroid patient" may also be the "parathyroid patient."

Harmonic Scalpel versus Conventional Tonsillectomy: A Double-Blind Clinical Trial

We conducted a prospective, double-blind clinical trial to evaluate the differences in operating time, intraoperative blood loss, postoperative pain at 3 hours and 1 week, and delayed (>24 hr) bleeding associated with ultrasonic harmonic scalpel tonsillectomy and conventional tonsillectomy. The study was carried out on 28 patients with recurrent tonsillitis and/or adenotonsillar hypertrophy who underwent harmonic scalpel tonsillectomy on one side and cold dissection tonsillectomy with suction electrocautery hemostasis on the other. The harmonic scalpel was associated with significantly less intraoperative blood loss (mean: 6.2 vs. 58.8 ml; p < 0.0001) and less early (3 hr) postoperative pain as determined by scores on a 10-point visual analog scale (mean: 3.5 vs. 4.4; p = 0.0042); although the difference in early pain scores is statistically significant, it is probably not clinically significant. Pain scores at 1 week were nearly identical (mean: 2.7 vs. 2.6; p = 0.9246). The length of operating time was similar (mean: 10.9 vs. 7.7 min; p = 0.0022). An unanticipated finding was the fact that delayed bleeding, which occurred in 3 patients (10.7%), occurred only on the harmonic scalpel side. We conclude that the only clearly demonstrable advantage that the harmonic scalpel had over cold dissection was that it caused less intraoperative blood loss.

Defective processing of unusually large von Willebrand factor multimers and thrombotic thrombocytopenic purpura

Defective processing of unusually large von Willebrand factor multimers and thrombotic thrombocytopenic purpura

Crystal structure of the actin binding domain of the cyclase-associated protein.

Cyclase-associated protein (CAP or Srv2p) is a modular actin monomer binding protein that directly regulates filament dynamics and has been implicated in a number of complex developmental and morphological processes, including mRNA localization and the establishment of cell polarity. The crystal structure of the C-terminal dimerization and actin monomer binding domain (C-CAP) reveals a highly unusual dimer, composed of monomers possessing six coils of right-handed beta-helix flanked by antiparallel beta-strands. Domain swapping, involving the last two strands of each monomer, results in the formation of an extended dimer with an extensive interface. This structural and biochemical characterization provides new insights into the organization and potential mechanistic properties of the multiprotein assemblies that integrate dynamic actin processes into the overall physiology of the cell. An unanticipated finding is that the unique tertiary structure of the C-CAP monomer provides a structural model for a wide range of molecules, including RP2 and cofactor C, proteins involved in X-linked retinitis pigmentosa and tubulin maturation, respectively, as well as several uncharacterized proteins that exhibit very diverse domain organizations. Thus, the unusual right-handed beta-helical fold present in C-CAP appears to support a wide range of biological functions.

Hepatitis C virus replication kinetics in chimpanzees with self-limited and chronic infections.

The availability of molecular beacon-based, real time polymerase chain reaction (PCR) and a semi-automated sample extraction procedure have made it possible for us to retrospectively examine HCV replication kinetics in HCV naive chimpanzees infected during the past 20 years. We compared these in 17 animals that developed chronic infection, and in 21 that developed self-limited infection. No differences were found in infecting dose, or replication kinetics in the acute phase between these two types of infection. An unanticipated finding was the fact that 10 of 17 animals developing chronic infection partially controlled virus replication for 48 +/- 48 weeks after typical acute phase viraemia, and prior to development of chronic infection. Twenty-nine out of 30 (29/30) sera, which were negative by quantitative PCR during the downregulated period, were, however, positive by the more sensitive Genprobe isothermal transcription-mediated amplification (TMA) assay. Thus, downregulation was not complete. Ten animals showing self-limited infection showed complete resolution of viraemia by TMA assay. Quasispecies analysis revealed that in all, except one case, the virus reappearing after downregulation was essentially identical to that of the originally infecting virus.

The geography of Irish voter turnout: A case study of the 2002 general election

Abstract ‘Turnout’ is a key measure of participation in the democratic process. Specifically, it measures the proportion of eligible voters that turns out to vote on election day. Low (or declining) turnout rates are a cause of concern and are often taken as a measure of disaffection with the political decision‐making process. In Ireland, turnout in the 2002 general election confirmed a downward trend in voter participation and represented the lowest turnout since the foundation of the State. However, turnout rates vary markedly across the State. Until recently, it was not possible to examine turnout at a sufficiently detailed geographical scale to allow systematic analysis of the potential causes of such variations. This paper reports on a joint project, involving the Geary Institute, UCD and the National Institute for Regional and Spatial Analysis (NIRSA), NUI Maynooth, that is undertaking a comprehensive analysis of turnout in the 2002 general election at the lowest possible level of aggregation. Here, a cartographic description and introductory analysis is presented that includes the first ever electoral‐district‐level map of turnout. The resulting geographical patterns are generally coherent and explicable and provide important pointers for future research. In an unanticipated finding, this map shows that the phenomenon of low turnout in urban areas occurs beyond the main cities and their suburbanised hinterlands and shows up as a characteristic of most provincial towns.

Intracellular formation of "undisruptable" dimers of inducible nitric oxide synthase.

Overproduction of nitric oxide (NO) by inducible NO synthase (iNOS) has been implicated in the pathogenesis of many diseases. iNOS is active only as a homodimer. Dimerization of iNOS represents a potentially critical target for therapeutic intervention. In this study, we show that intracellular iNOS forms dimers that are "undisruptable" by boiling, denaturants, or reducing agents. Undisruptable (UD) dimers are clearly distinguishable from the easily dissociated dimers formed by iNOS in vitro. UD dimers do not form in Escherichia coli-expressed iNOS and could not be assembled in vitro, which suggests that an in vivo cellular process is required for their formation. iNOS UD dimers are not affected by intracellular depletion of H4B. However, the mutation of Cys-115 (critical for zinc binding) greatly affects the formation of UD dimers. This study reveals insight into the mechanisms of in vivo iNOS dimer formation. UD dimers represent a class of iNOS dimers that had not been suspected. This unanticipated finding revises our understanding of the mechanisms of iNOS dimerization and lays the groundwork for future studies aimed at modulating iNOS activity in vivo.

The prevalence and significance of clinically unsuspected neoplasms in cervical lymph nodes

Histopathologic scrutiny of surgical pathology specimens can uncover unexpected but important pathologic processes that might not (yet) be clinically apparent. We suspect that cervical lymph nodes removed from patients with known cancers of the head and neck might occasionally harbor clinically unsuspected neoplasms. We reviewed the pathology reports of all patients who had undergone cervical lymph node dissections at our institution between 1984 and 2001 to determine the prevalence of occult metastatic thyroid cancer and other clinically unsuspected tumors. The medical records were reviewed to obtain follow-up information when histologic examination disclosed some significant finding that was unsuspected on clinical grounds. Of the 1337 patients who underwent cervical lymphadenectomy during the 17-year period, 27 (2.0%) had at least one lymph node harboring an unanticipated finding that raised the concern of a clinically unsuspected neoplasm. Sixteen (1.2%) of these patients had conclusive histologic evidence of an unexpected neoplasm, including 6 patients (0.4%) with malignant lymphomas (low-grade B cell, n = 5; high-grade B cell, n = 1) and 10 patients (0.7%) with metastatic papillary thyroid carcinomas. An additional 11 patients (0.8%) had lymph nodes harboring "benign" thyroid inclusions or psammoma bodies. Four of these 11 patients underwent thyroidectomy, but thyroid cancer was not detected in the ipsilateral thyroid. Only one patient died as a consequence of the incidentally discovered neoplasm. To the degree that our study population is reflective of the adult population at large, at least 1% of adults harbor malignant neoplasms in their cervical lymph nodes. Although this statistic seems alarmingly high, most of these neoplasms are indolent and do not undergo unrelenting progression to clinically overt malignancies.

Paving Professional Futures Ethnic Minority Accountants In the United Kingdom

There are some signs that ethnic minority entrepreneurs, particularly in the UK, are gradually diversifying into potentially more rewarding economic activities in the 'professions'. Yet, the experiences of these professional ethnic minority entrepreneurs have rarely been documented. This article explores the case of ethnic minority accountants operating as entrepreneurs in the United Kingdom. The results highlight the importance of the small ethnic minority accountancy practice as a stepping-stone for ethnic minorities seeking to establish themselves in the profession. An unanticipated finding is the potential importance of the ethnic minority accountants as a business resource for their ethnic minority clients. Finally, although ethnic minority accountants appear to be operating successfully, continued reliance on such firms may prove problematic.

A possible link between stigmatization of sexual-erotic identities and sexual violence

It is suggested that stigmatization of sexual-erotic identities causes shame that leads to emotions of anger and rage that, in turn, create a fertile basis for violent behavior related to the source of stigmatization. This model is tested comparatively in the U.S. and Germany. A curvilinear regression of evaluation of identities on sexual-eroticism ratings indicates stigmatization of sexualerotic identities in the U.S. but not in Germany. It also leads to the unanticipated finding that Germans tend to stigmatize people with identities that appear extremely non-sexual-erotic. Matching their affective meaning with that of explicit sexual-erotic identities, typical sexual-erotic emotions are empirically identified. In the U.S., emotions of anger are typically associated with sexual-eroticism, compared to emotions of excitement in Germany. The stated consequence of these emotions, the different prevalence of violent sexual behavior, is tested comparing statistics of reported sexual-violent crime in both nations.