bluuebunny/crossref_metadata_2025 huggingface dataset:
Rapamycin Generates Graft-Homing Murine Suppressor CD8+T Cells That Confer Donor-Specific Graft Protection
Authors: Essawy Basset El , Putheti Prabhakar , Gao Wenda , Strom Terry B.
Published: December 2011

It has been reported that rapamycin (RPM) can induce de novo conversion of the conventional CD4+Foxp3-T cells into CD4+Foxp3+regulatory T cells (iTregs) in transplantation setting. It is not clear whether RPM can similarly generate suppressor CD8+T cells to facilitate graft acceptance. In this study, we investigated the ability of short-term RPM treatment in promoting long-term acceptance (LTA) of MHC-mismatched skin allografts by generating a CD8+suppressor T-cell population. We found that CD4 knockout (KO) mice (in C57BL/6 background, H-2b) can promptly reject DBA/2 (H-2d) skin allografts with mean survival time (MST) being 13 days ( p < 0.01). However, a short course RPM treatment in these animals induced LTA with graft MST longer than 100 days. Adoptive transfer of CD8+T cells from LTA group into recombination-activating gene 1 (Rag-1)-deficient mice provided donor-specific protection of DBA/2 skin grafts against cotransferred conventional CD8+T cells. Functionally active immunoregulatory CD8+T cells also resided in donor skin allografts. Eighteen percent of CD8+suppressor T cells expressed CD28 as measured by flow cytometry, and produced reduced levels of IFN-γ, IL-2, and IL-10 in comparison to CD8+effector T cells as measured by ELISA. It is unlikely that CD8+suppressor T cells mediated graft protection via IL-10, as IL-10/Fc fusion protein impaired RPM-induced LTA in CD4 KO mice. Our data supported the notion that RPM-induced suppressor CD8+T cells home to the allograft and exert donor-specific graft protection.
Asking Questions and Appreciating Inquiry: A Winning Strategy for the Nurse Educator and Professional Nurse Learner
Authors: Nickitas Donna M.
Published: December 2011

This article explores “asking questions” as an effective teaching-learning strategy and endorses a culture that facilitates asking questions to promote ethical and clinical reasoning to keep patients safe and improve care. Nurse educators who appreciate the use of empowering, thoughtful questions in provocative ways can encourage learners to become astute thinkers and innovative problem solvers. Asking questions teaches learners to argue their thoughts, ideas, and decisions persuasively and ultimately to realize that is it not the right answer that counts as much as asking the right question.
Ocular Motor Dysfunction in Parry–Romberg Syndrome: Four Cases
Authors: Prescott Christina R. , Hasbani M. Joshua , Levada Andrew J. , Silbert Jonathan E. , Winterkorn Jacqueline M. S. , Lesser Robert L.
Published: December 2011

The authors describe four patients with Parry–Romberg syndrome (PRS) who had abnormal eye movements, ptosis, and facial hemiatrophy. There were delays in diagnosis in all cases, often requiring multiple imaging studies, prior to diagnosis of PRS. These cases demonstrate the variable ophthalmic manifestations of PRS, which can lead to difficulty in diagnosis. Case 1 was a 23-year-old woman with lateral rectus paresis who presented with horizontal diplopia and developed ptosis and facial hemiatrophy. Case 2 was a 28-year-old woman with medial rectus weakness adjusted to diplopia by head turn and gaze preference. Case 3 was a 68-year-old woman who presented with dry eye symptoms and was noted to prefer right gaze and have left hemifacial atrophy. Case 4 was a 68-year-old woman who presented with ptosis, enophthalmos, and restriction of up gaze. The ocular motor defect in all of these cases is best explained by muscle fibrosis rather than nerve paresis.
Progressive Growth of Bilateral Choroidal Osteomas in a Child
Authors: Voluck Matthew R. , Say Emil Anthony T. , Shields Carol L.
Published: December 2011

A 7-year-old girl was referred for retinal dystrophy. On examination, visual acuity was 20/20 in the right eye and 20/30 in the left eye. Fundus examination revealed bilateral orange-colored subfoveal choroidal tumors. Ultrasonography showed calcification, confirming the diagnosis of choroidal osteoma. Because vision was preserved without subretinal fluid or choroidal neovascularization, observation with calcium supplementation was recommended. Three years later, there was minimal tumor growth and visual acuity was maintained. Choroidal osteomas are rare, benign tumors that may decrease vision through decalcification, particularly when subfoveal. In these cases, cautious observation and possibly calcium supplementation may help protect vision.
Corneal Haze Following Disruption of Epithelial Basement Membrane on Ultra-high-resolution OCT Following Femtosecond LASIK
Authors: Vaddavalli Pravin K. , Hurmeric Volkan , Wang Jianhua , Yoo Sonia H.
Published: December 2011

PURPOSE:

To analyze in vivo structural properties of a case with interface haze that developed after femtosecond laser–assisted LASIK.

METHODS:

Case report.

RESULTS:

A 42-year-old man underwent uncomplicated LASIK. Four months after the surgery he developed regression of his refractive error and interface haze in both eyes. Flap thickness was calculated as 73 μm and 81 μm in the right and left eyes, respectively. A novel ultra-high-resolution spectral domain optical coherence tomography (OCT) system was used to demonstrate in vivo morphology of the cornea. On ultra-high-resolution OCT, haze was demonstrated as increased bright white reflectivity of the flap interface. Areas of focal disruption of the basement membrane and Bowman layer corresponded with the most significant areas of interface haze.

CONCLUSIONS:

Our results support the hypothesis that haze after femtosecond LASIK may be a result of damage to the basement membrane and Bowman layer of the cornea.
Limbal Lacuna: A Novel Limbal Structure Detected by In Vivo Laser Scanning Confocal Microscopy
Authors: Zarei-Ghanavati Siamak , Ramirez-Miranda Arturo , Deng Sophie X.
Published: December 2011

Limbal lacuna is a novel limbal structure detected by in vivo laser scanning confocal microscopy in normal subjects and the unaffected limbus in sectoral limbal stem cell deficiency. This unique structure harbors normal limbal epithelial cells deep inside the limbal stroma and the palisades of the Vogt are absent in these subjects. This well-protected location could better shield limbal stem/progenitor cells from damage and might serve as an alternative niche for limbal stem/progenitor cells.
Long QT Syndrome: From Genetic Basis to Treatment
Authors: Crotti Lia , Dagradi Federica , Schwartz Peter J.
Published: December 2011

The congenital long QT syndrome (LQTS) is a monogenic disorder, not as rare as it was originally estimated to be, mainly caused by mutations in genes encoding for ion channels. Molecular screening in this disease is part of the diagnostic process and this has already been recognized by current guidelines since 2006. However, very recently, two consensus documents have been published, with the recommendations for the use of genetic testing in the clinical evaluation of genetically transmitted arrhythmogenic diseases. Therefore, we devoted a specific section of the present review to the discussion of these two documents in relation to LQTS. The clinical presentation of the disease is typically characterized by a prolongation of the QT interval on the electrocardiogram (ECG) and by the occurrence of syncope or cardiac arrest, mainly precipitated by sympathetic activation. While the diagnosis of typical cases it is quite easy, borderline cases can be quite challenging and therefore the availability of diagnostic criteria is very useful to support the diagnostic process. Very recently, the LQTS diagnostic criteria have been updated and they are presented in the current review. Finally, the clinical management of LQTS patients is presented together with a schematic flow-chart and recent data coming from the LQTS-ICD European registry are illustrated. The last part of the review is dedicated at future perspectives and latest results on modifier genes and stem cells are presented.
Chronic lymphoedema caused by recurrent infections in a patient with allergic hand eczema
Authors: Dyring-Andersen Beatrice , Skov Lone , Jensen Peter
Published: December 2011

Allergic contact dermatitis is very common and may be complicated by secondary infections. Chronic lymphoedema is a potentially debilitating condition, which may occur due to secondary infections or the dermatitis itself. The problem of chronic lymphoedema following allergic contact dermatitis has been infrequently reported. We report a case of a 47-year-old woman with severe allergic contact dermatitis complicated by chronic, intractable lymphoedema of the hands and forearms. This case report reminds us that allergic hand dermatitis may be complicated by a chronic and debilitating state of lymphoedema. Also, it underlines the importance of fast and adequate treatment of both the dermatitis and the secondary infections.
Primary bilateral malignant melanoma of the lower limbs
Authors: Lembo Serena , Megna Matteo , Maddalena Paolo , Monfrecola Ambra , Balato Anna , Baldo Antonello
Published: December 2011

Malignant melanoma is the eighth most common cancer in European women. Its incidence is increasing rapidly and it has been demonstrated that this is related to sun exposure. Although few cases of bilateral uveal or choroidal melanoma are described in literature, there are no cases reporting bilateral cutaneous malignant melanoma. We report a singular case of a 43-year-old woman with two primary bilateral melanomas localized on the flexural surface of both legs.
Flagellate dermatitis following consumption of shiitake mushroom
Authors: Loo Hui Voon , Oon Hazel H.
Published: December 2011

Japanese dermatologists were the first to describe the very characteristic flagellate dermatitis following consumption of under-cooked or raw shiitake mushroom (Lentinus edodes). These similar eruptions were also reported in patients treated with bleomycin, in dermatomyositis and adult onset Still’s disease. We report a case where a 40 year old chinese female developed flagellate dermatitis following ingestion of a bun containing shiitake mushroom.
Lichen sclerosus et atrophicans, scleroderma en coup de sabre and Lyme borreliosis
Authors: Bonin Serena , Gubertini Nicoletta , Trevisan Giusto
Published: December 2011

Lichen sclerosus et atrophicans (LSA) is a chronic, inflammatory skin disease of unknown etiology, characterized by atrophy. We report a case of LSA with frontoparietal distribution, mimicking scleroderma en coup de sabre, causing scarring alopecia. The case was associated with Borrelia infection. The lesion improved with 2 cycles of antibiotic therapy with ceftriaxone 2 gr /day i.v for 21 days associated with UVA-1 therapy and local and systemic vitamin E supply (400 mg 2x/day per os for 3 months). This case stresses the importance of identifying clinical manifestations associated with Lyme disease and the use of tissue PCR to detect borrelial DNA in patients with these lesions, but characterized by negative serology for Borrelia.
Tegafur-induced acral hyperpigmentation
Authors: Teixeira Vera , Vieira Ricardo , Figueiredo Américo
Published: December 2011

Tegafur is a prodrug of 5-fluorouracil (5-FU) with a similar spectrum of antitumor activity. It is used in the treatment of advanced gastrointestinal neoplasms. Over 5-FU, tegafur has the advantage of oral administration and less hematologic toxicity. Gastrointestinal toxicity is its main dose-limiting factor. The cutaneous adverse effects of tegafur include mucositis, photosensitivity, diffuse or nail-restricted hyperpigmentation, palmoplantar erythrodysesthesia syndrome, palmoplantar keratoderma, sclerodactyly and Raynaud phenomenon. We report here the case of a patient who developed acral hyperpigmentation during treatment with tegafur.
Infliximab-induced intertriginous psoriasis in patient with Crohn's desease
Authors: Mola Federica , Motolese Alberico
Published: December 2011

Tumor necrosis factor-α (TNFα) inhibition is an effective treatment of moderate-to-severe psoriasis and other diseases (rheumatoid arthritis, ankylosing spondylitis, psoriasis or Crohn’s disease). We report a case of a 32- years-old patient affected by Crohn’s disease since the age of 25 who started infliximab infusion after four years of treatment with prednisone and azathioprine per os without improvement. After the fifth infusion of infliximab, he developed a form of intertriginous psoriasis which was approached with topical steroid cream. The patient never presented psoriasis in the past. New onset of psoriasis in patients without history for skin diseases (as in our case) is a quite uncommon complication of TNFα inhibitor therapy. The increased production of IFNα during TNFα inhibitor therapy is a possible pathophysiologic explanation for this paradoxical effect of the anti-TNFα.
Hyperimmunoglobulin E syndrome in two siblings
Authors: Hawilo Abdulmohti , Zaraa Ines , Trojjet Sondes , Zribi Hella , Rouhou Rym Cheikh , El Euch Dalenda , Mokni Mourad , Ben Osman Amel
Published: December 2011

Hyperimmunoglobulin E recurrent infection syndrome (HIES) is characterized by recurrent skin and lung infections, eczema, elevated serum immunoglobulin E (IgE) levels (>2000 IU/mL), various connective tissue, skeletal, and vascular abnormalities.1 We describe herein two brothers with HIES and documented the complications and management of such involvement.
Churg-Strauss syndrome and hemorragic vasculitis
Authors: Moreira Marques Rui , Cabral Ana Rita , Monteiro Antonio , Henriques Pedro
Published: December 2011

Churg-Strauss syndrome (CSS) is a rare syndrome characterized by sinusitis, asthma and peripheral eosinophilia. This vasculitic syndrome affects medium and small-sized vessels, the lung being the most commonly affected organ, followed by the skin. The authors report a case of a 59-year-old male with a past history of asthma and allergic rhinitis. He presented necrohemorragic lesions in the distal phalanx of the 2nd, 3rd and 4th fingers of the lefthand and petechial lesions in the plant of both feet, accompanied by asthenia, anorexia and weight loss. The analytical study revealed leukocytosis with eosinophilia, elevated inflammatory parameters and p-ANCA positive antibodies. The diagnosis of CSS was established based on clinical and histopathological data. Cutaneous manifestations of hemorragic vasculitis are rare in CSS syndrome but can be the first manifestation of the disease. The recognition of this presentation is important for the early diagnosis and treatment of this syndrome.
Cutaneous lesions as presentation form of mantle cell lymphoma
Authors: Merino de Paz Nayra , Rodriguez-Martin Marina , Contreras Ferrer Patricia , Garcia-Hernandez Sonia , Hernandez de Leon Nieves , Martin-Herrera Antonio , Noda-Cabrera Antonio
Published: December 2011

Mantle cell lymphoma is a type of no-Hodgkin lymphoma that affects extranodal areas, especially, bone narrow, digestive tract and Waldeyer ring. Here we report a case of mantle cell lymphoma IV Ann Arbor stage with cutaneous lesions on nasal dorsum and gland as the first manifestations. Skin involvement is a very rare manifestation and less than 20 cases have been reported in the literature. The importance of stablishing multidisciplinary relationships for a global approach has been shown by this clinical case.
Long-term safety, tolerability, and efficacy of vismodegib in two patients with metastatic basal cell carcinoma and basal cell nevus syndrome
Authors: Weiss Glen J. , Tibes Raoul , Blaydorn Lisa , Jameson Gayle , Downhour Molly , White Erica , Caro Ivor , Von Hoff Daniel D.
Published: December 2011

Tumor responses in advanced basal cell carcinoma (BCC) have been observed in clinical trials with vismodegib, a SMO antagonist. The result of SMO antagonism is inhibition Hedgehog Signaling Pathway (HHSP) downstream target genes. HHSP inhibition has been shown to affect stem cells responsible for blood, mammary, and neural development. We report on our experience of treating two patients with advanced BCC participating. These two patients have had no new BCCs develop for at least 2.25 years. Both patients have been receiving ongoing daily treatment with vismodegib for greater than 2.75 years without experiencing any significant side effects. After prolonged continuous daily dosing with a SMO antagonist, we have not observed a significant alteration in hematologic parameters or physical abnormalities of the pectoral regions of two patients with advanced BCC.
Successful surgical management of an extrahepatic biliary cystadenocarcinoma
Authors: Pais-Costa Sergio Renato , Martins Sandro J. , Araújo Sergio L. M. , Lima Olímpia A. T. , Paes Marcio A. , Guimarães Marcio L.
Published: December 2011

Extrahepatic bile duct cancer is an uncommon disease, and few cases are curable by surgery. We report a case of extrahepatic biliary cystadenocarcinoma (BCAC) associated with atrophy of the left hepatic lobe. A 54-year old male was admitted with painless obstructive jaundice and a hepatic palpable mass noticed one month before presentation. Liver functions tests were consistent with cholestatic damage and serum carbohydrate antigen 19.9 (CA 19-9) was increased before treatment. Magnetic resonance imaging (MRI) disclosed dilatation of the left hepatic bile duct with irregular wall thickening close to the hepatic confluence, and atrophy of left hepatic lobe. The patient was submitted to en bloc extended left hepatectomy with resection of caudate lobe, hilar lymphadenectomy, and suprapancreatic biliary tree resection. All surgical margins were grossly negative, and postoperative course was uneventful, except for a minor bile leak. The patient was discharged on the 15th postoperative day; he is alive without tumor recurrence one year after primary therapy. Although technically challenging, extended en bloc resection is feasible in adults with extrahepatic BCAC and can improve survival with acceptable and manageable morbidity.
Fetal axillary cystic hygroma: a case report and review
Authors: Temizkan Osman , Abike Faruk , Ayvaci Habibe , Demirag Ersan , Görücü Yasin , Isik Ecmel
Published: December 2011

Cystic hygroma (CH) is a lymphatic malformation occurring different parts of fetal body, typically in the region of the fetal neck and axillary, abdominal wall, mediastinal, inguinal and retroperitoneal areas. CH has been associated with fetal aneuploidy, hydrops fetalis, structural malformations and intrauterine fetal death.

A 24-year-old gravida 1, para 1 was admitted to our hospital at 28 weeks of gestation. Ultrasonographic examination determined 28 weeks of gestation, singleton, alive fetus who had a mass derived from the right axillary region which was extending to the anterior and posterior thoracic wall with fluid-filled cavities about 12 cm in size. There was no evidence of intrathorasic or intraabdominal extension of mass. Cordocentesis was performed and karyotype examination was normal 46 XY. The fetal demise was found after the first visit. The patient was delivered vaginally after labor induction with oxytocin infusion. The fetal autopsy confirmed the diagnosis of CH.

The fetal CH carries high risk of aneuploidy and fetal malformations. Patients that have been diagnosed with CH in antenatal follow-ups should be assessed in terms of other anomalies. Fetal karyotyping should be done and the patient should be monitored for fetal hydrops. The birth should be planned in a multidisciplinary hospital and as neonatal resuscitation could be needed, pediatricians should be consulted.
A giant ectopic hidradenoma papilliferum in a Niger delta region of Nigeria
Authors: Abudu Emmanuel K. , Umanah Ivy N. , Ekpo Memphin D. , Etuk Emmanuel B. , Onwuezobe Ifeanyi A. , Obi-Ihesie Agility
Published: December 2011

Hidradenoma papilliferum is a known example of adnexal skin tumours with apocrine differentiation. It is a rare benign tumour which tends to arise from areas with rich concentration of aporine glands such as anogenital region, vulval, perineal, axillae, and periumbilical areas. In this report, the tumour was found in the upper outer quadrant of left breast, being one of the ectopic sites for this tumour. Contrary to most reports where male preponderance was popular for ectopic hidradenoma papilliferum, the patient in this report is a 71-year-old female. Considering the location of this tumour in this report, the likely histopathological differential diagnoses such as tubular apocrine adenoma, clear cell (apocrine) adenoma, lipoma, intraductal papilloma and papillary carcinoma of the breast should be considered for exclusion. This is the first reported case of a giant ectopic hidradenoma papilliferum of the breast in a Niger Delta region of Nigeria which also highlights the role of fine needle aspiration and cytology in the diagnosis of breast lesions.
Intrathoracic lipoblastoma in a 15-month-old infant
Authors: Geramizadeh Bita , Javadi Farshid , Foroutan Hamid-Reza
Published: December 2011

Lipoblastoma is a rare tumor of infancy. It originates from the white fetal fat in soft tissue. The most common location of this rare tumor is extremity and to best of our knowledge less than 10 cases of intrathoracic and mediastinal lipoblastoma has been reported in the English literature. Herein we present our experience with a 15-month-old boy infant who presented with severe dyspnea. Imaging studies showed a mass in the thoracic cavity and mediastinum which was diagnosed as lipoblastoma after pathologic examination of the resected mass. Lipoblastoma has been considered as a tumor of soft tissue, but it should also be considered as a rare cause of intrathoracic masses of young children.
Pineocytoma with diffuse dissemination to the leptomeninges
Authors: Gomez Caitlin , Wu Jeffrey , Pope Whitney , Vinters Harry , DeSalles Antonio , Selch Michael
Published: December 2011

Pineal parenchymal tumors are rare. Of the three types of pineal parenchymal tumors, pineocytomas are the least aggressive and are not known to diffusely disseminate. In this paper, we report the successful treatment of a case of pineocytoma with diffuse leptomeningeal relapse following initial stereotactic radiotherapy. A 39-year-old female presented with headaches, balance impairment, urinary incontinence, and blunted affect. A pineal mass was discovered on magnetic resonance imaging (MRI). A diagnosis of pineocytoma was established with an endoscopic pineal gland biopsy, and the patient received stereotactic radiotherapy. Ten years later, she developed diffuse leptomeningeal dissemination. The patient was then successfully treated with craniospinal radiation therapy. Leptomeningeal spread may develop as late as 10 years after initial presentation of pineocytoma. Our case demonstrates the importance of long-term follow-up of patients with pineal parenchymal tumors following radiation therapy, and the efficacy of craniospinal radiation in the treatment of leptomeningeal dissemination.
Eletroestimulação e mobilização articular em crianças com paralisia cerebral e pés equinos
Authors: Zuardi Marina Campos , Do Amaral Valéria Alves , Borges Heloise Cazangi , Chamlian Therezinha Rosane , Monteiro Vanessa Costa , Do Prado Gilmar Fernandes
Published: December 2011

Introdução. A paralisia cerebral (PC) gera alterações motoras e compensações que resultam em deformidades no paciente, entre elas, o pé equino. Um dos recursos terapêuticos amplamente utilizado em pacientes com PC é a eletroestimulação, cujos benefícios já são bastante conhecidos. Outra técnica, também muito utilizada na prática clínica e com efeitos ortopédicos comprovados, é a mobilização articular. Objetivo. Verificar os efeitos terapêuticos da associação entre a eletroestimulação em dorsiflexores e a mobilização articular de tornozelo em pacientes com paralisia cerebral diparética espástica com pés equinos. Método. Participaram do estudo três crianças com PC do tipo diparesia espástica, com idade entre 3 e 9 anos e que apresentavam deformidade redutível do pé em equino. Estas foram avaliadas quanto à função motora grossa, marcha, gasto energético, amplitude de movimento (ADM) e espasticidade. O protocolo de tratamento foi de 16 sessões, sendo duas vezes por semana, durante 30 minutos cada. Resultados. Todos os participantes apresentaram melhora na função motora grossa, na qualidade da marcha e na ADM ao término do tratamento. Conclusão. Associação dessas duas técnicas terapêuticas foi benéfica para promover a melhora da função motora grossa, da marcha e da ADM, para esta amostra restrita de pacientes.
Creating a Smoke-Free Hospital: Attitudes and Smoking Behaviors of Nurses and Physicians
Authors: Stillman Frances A. , Hantula Donald A. , Swank Robert
Published: December 2011

Purpose.

To assess smoking prevalence and attitudes of physicians and nurses before a smoking ban. The relationship between pre-ban attitudes and post-ban smoking behavior was also studied.

Design.

This is a prospective descriptive study of a cohort of nurses and physicians who were surveyed six months before and six months after a ban on smoking was implemented.

Setting.

A large, 1,000-bed teaching hospital in the Northeast of the United States.

Subjects.

All full-time members of the medical (n=1,496) and nursing staff (n=1,500) were surveyed. The overall response rate for the cohort was 41 % for physicians and 39% for nurses.

Measures.

Surveys included standardized questions on current smoking behavior, and sociodemographic variables. Attitudes toward quitting and the smoking policy and attitudes about implementation and enforcement of the smoking ban were included.

Results.

Both physicians and nurses were supportive of a smoke-free policy, but the two groups differed significantly on attitudes related to implementation and enforcement, with nurses being more accommodating toward smoking and less likely to enforce a ban on smoking. Physicians were more likely than nurses to quit smoking after implementation of the ban. Pre-ban attitudes were not predictive of post-ban changes in smoking behavior.

Conclusions.

Physicians and nurses agreed with establishing a smoke-free environment but disagreed over the efforts needed to maintain the smoke-free environment. Quitting behavior was not influenced by pre-ban attitudes.
Relationship between Cumulative Exposure to Health Messages and Awareness and Behavior-Related Drinking during Pregnancy
Authors: Kaskutas Lee Ann , Graves Karen
Published: December 2011

Purpose.

This paper describes the relationship between exposure to multiple sources of health messages about the risk of drinking during pregnancy and respondents' awareness and behavior related to this risk.

Design.

Observational study using telephone interview data.

Setting.

Exposure to this message occurs via a government warning on alcoholic beverage containers, warning posters in restaurants and bars, and media advertisements.

Subjects.

Representative nationwide samples of adults were interviewed in 1990 (n=2,000) and 1991 (n=2,017), with response rates of 64% and 62%, respectively.

Measures.

Outcomes assessed are knowledge of the alcohol-related risk of birth defects, conversations about drinking during pregnancy, and self-reported reduction of alcohol consumption due to health concerns.

Results.

Multivariate logistic regression models were used. In the total sample, respondents exposed to one, two, and three different message sources were more likely to converse about drinking during pregnancy than those exposed to no messages (odds ratio=2.6, 3.8, and 4.1, respectively), while reduced alcohol consumption due to health concerns associated with exposure to two and three different sources (odds ratio=1.6 and 2.0, respectively). Among women aged 18 to 40, a similar relationship is found for conversations, but it was only among those seeing all three message types that a reduction in consumption was observed (odds ratio=2.8). Interpretation of these findings are limited because of respondent bias in alcohol consumption, message source exposure, and the cross-sectional nature of the data employed.

Conclusions.

These findings support the public health approach of implementing multi-faceted strategies to maximize risk reduction interventions.
Simulated Lifetime Costs of Three Types of Employer-Based, Periodic, Breast Cancer Screening Programs for Working-Age Women
Authors: Griffiths Robert I. , Griffiths Claudia B. , Powe Neil R.
Published: December 2011

Purpose.

To estimate the lifetime cost of three types of employer-sponsored breast cancer screening programs and to identify factors influencing cost.

Design.

A computerized decision analysis model was constructed to compare lifetime costs of providing breast cancer screening in each of three screening programs: on-site within an employer, mobile unit visiting the employer, and off-site.

Subjects.

Three hypothetical cohorts of 10,000 female employees 38 years of age at time of first screening.

Intervention.

A cohort was enrolled in each screening program and received screening from age 38 through age 64. Employees continued to receive benefits related to breast cancer until age 100 or death.

Measures.

Costs in the model included those for screening, workup for a suspicious mammogram, treatment for breast cancer, short-term losses in employee productivity, and disability due to breast cancer.

Approach.

The model was used to estimate the mean lifetime cost per employee, to the employer, of the On-Site program. This cost was compared to the cost of the other programs.

Results.

Mean lifetime cost per employee was $5,485 for the On-Site screening program. This cost was significantly (P<.0001) lower than in the Off-Site program (by $311) or the Mobile program (by $212). The baseline results for the On-Site program were quite sensitive to the cost of screening, the sensitivity and specificity of screening, age at initiation of screening, and the underlying incidence of breast cancer in the population.

Conclusion.

Employers and other entities should consider these factors such as location and content in selecting the most efficient and effective breast cancer screening program.
Diffusion of Innovations in Schools: A Study of Adoption and Implementation of School-Based Tobacco Prevention Curricula
Authors: McCormick Laura K. , Steckler Allan B. , McLeroy Kenneth R.
Published: December 2011

Purpose.

The purpose of this study was to determine the extent of implementation of school health education curricula, to identify factors which enhanced or impeded implementation, and to examine the link between the adoption and implementation phases of the diffusion process.

Design.

The study used an experimental design; 22 school districts were randomly assigned to intervention and control conditions.

Setting.

The study was conducted in North Carolina.

Subjects.

All teachers in the study districts identified by their schools as “eligible to teach health” were included in the sample.

Intervention.

An in-depth training was conducted on the use of the middle school tobacco prevention curriculum that had been adopted.

Measures.

Three measures were used to assess implementation of the curricula. Independent variables of interest included organizational size and climate, teacher training, how long it took to make the adoption decision, and attitudes toward tobacco use prevention curricula. Response rates for these measures ranged from 44% to 78%.

Results.

Nonparametric correlations and regression modeling indicated that larger organizational size and teacher training were the strongest predictors of curricula implementation. A favorable organizational climate within school districts also improved implementation.

Conclusions.

While interventions to increase adoption of school health education curricula should focus on larger school districts, the majority of efforts to improve implementation should focus on smaller districts.
Psychometric Testing of the Reduced Laffrey Health Conception Scale
Authors: Lusk Sally L. , Kerr Madeleine J. , Baer Leslie Martel
Published: December 2011

Purpose.

Laffrey's Health Conception Scale (LHCS), an instrument designed to measure personal definitions of health, was reduced with the intent of creating a useful yet less cumbersome version of the LHCS.

Design.

The original form of the LHCS was tested in a preliminary study, and results were used as a basis for the reduction of the instrument. The original clinical and new overall wellness subscales were subsequently tested with a larger population of manufacturing plant workers.

Setting.

One chemical plant and three Midwestern manufacturing plants.

Subjects.

The sample for the preliminary study comprised 94 chemical plant workers. For the larger study, the sample comprised 892 subjects; because this instrument was part of a larger questionnaire to identify predictors of workers' use of hearing protection, only those workers who spent some part of their work time in areas of the plant which required hearing protection use were eligible to participate.

Measures.

The original LHCS was used in the preliminary study. The reduced LHCS was used in the larger study and psychometrically evaluated.

Results.

The reduced LHCS accounted for 51 % of the variance in definition of health; all but one item had loaded on one of the two factors with a loading of .41 or greater. The revised LHCS demonstrated excellent internal consistency. Two distinct factors, the clinical subscale and the overall wellness subscale, were isolated.

Conclusions.

The researchers recommend the reduced LHCS be used for assessing subjects' definition of health; the reduced instrument requires fewer items, and therefore less time, to measure individuals' definitions of health with excellent reliability.
Prevention of Alcohol Misuse: A Review of Health Promotion Efforts among American Indians
Authors: May Philip A. , Moran James R.
Published: December 2011

Purpose.

The purpose of this review is to provide an overview of a wide range of potentially useful strategies to address the prevention of alcohol misuse among American Indians. This broad approach to the review is useful because the extreme heterogeneity of the American Indian population requires that health promotion professionals explore many options and tailor their activities to specific communities.

Search Method.

A literature search was initiated through MEDLINE using the following key words: prevention, alcohol, substance abuse, American Indian, and Native American. The search yielded 29 articles from the years 1982 through 1994. These articles, along with 45 previously identified in three overview articles, form the basis of the review and discussion in this paper.

Summary of findings.

As a group, American Indians experience many health problems that are related to alcohol misuse. Comparison of Indians to non-Indians shows that the age of first involvement with alcohol is younger, the frequency and amount of drinking is greater, and negative consequences are more common. Health promotion programs that address these issues must take into account American Indian heterogeneity and should use a comprehensive approach that addresses both heavy drinking and the sequelae of problems related to alcohol misuse.

Major Conclusions.

Important concepts for providing health promotion services to this population are: cultural relevance must be carefully planned and monitored; individuals in the local community must be involved; the drunken Indian stereotype must be addressed; and community empowerment should be an important goal.
Fruit and Vegetable Intake in the United States: The Baseline Survey of the Five a Day for Better Health Program
Authors: Subar Amy F. , Heimendinger Jerianne , Patterson Blossom H. , Krebs-Smith Susan M. , Pivonka Elizabeth , Kessler Ronald
Published: December 2011

Purpose.

The purpose of the Five A Day Baseline Survey was to assess fruit and vegetable intake and associated factors among US adults.

Design.

Questionnaires querying frequency of intake of 33 fruits and vegetables, as well as demographics, attitudes, and knowledge related to fruits and vegetables were administered by telephone.

Setting.

The study was a nationally representative random digit dial survey conducted by telephone in the summer of 1991; response rate was 42.8%.

Subjects.

Respondents were 2811 US adults (including an oversample of African-Americans and Hispanics).

Measures.

Mean and median self-reported intakes of fruits and vegetables were calculated. Estimated servings per week were adjusted on the basis of responses to summary questions regarding overall fruit and vegetable intakes.

Results.

Median intake of fruits and vegetables was 3.4 servings per day. Linear regressions (accounting for no more than 10% of the variation) showed that education, income, and smoking status were predictors of fruit and vegetable intake and that intake increased with education, income, and nonsmoking status. Women had higher intakes than men at all ages; these differences between men and women increased with age. Fruit and vegetable intakes increased with age for whites and Hispanics, but not for African-Americans.

Conclusions.

Fruit and vegetable intake among adults in the United States is lower than the recommended minimum of five daily servings. These data will be useful in targeting campaign efforts and in assessing progress of the Five A Day for Better Health Program.
Evaluation of the Heart to Heart Project: Lessons from a Community-Based Chronic Disease Prevention Project
Authors: Goodman Robert M. , Wheeler Fran C. , Lee Peter R.
Published: December 2011

Purpose.

To present an evaluation of a 5-year, community-based, chronic disease prevention project managed by a state health department to determine whether the department could replicate similar previous projects that had received more funding and other resources.

Design.

The evaluation used a matched comparison design and a review of archive and interview data.

Setting.

Florence, South Carolina (population: 56,240).

Subjects.

A random sample of 1642 persons in Florence (and 1551 in the comparison) who responded to a risk factor questionnaire and underwent a physical assessment; 70. 7% of baseline subjects participated in the postintervention. Forty key persons were interviewed concerning project effectiveness.

Interventions by Project.

Walk-a-thons, a speakers' bureau, media messages, restaurant food labeling, and cooking seminars. More than 31,000 participants were involved in 585 activities.

Measures.

Questionnaires focused on hypertension, obesity, high cholesterol, smoking, and exercise. Physical assessments determined lipid, lipoprotein, apolipoprotein, and blood pressure levels. Analysis of covariance was used for baseline and postintervention comparisons. Content analysis was used on archive and interview data.

Results.

The project had a slightly favorable intervention effect on cholesterol and smoking, but failed to have an effect on other risk factors for cardiovascular disease. The project influenced community awareness, enlisted influential community members, and fostered linkages among local health services.

Conclusions.

Health departments can be instrumental in community risk reduction programming; however, they may not replicate projects having greater resources.
A method for evaluating bias in global measurements of CO2 total columns from space
Authors: Wunch D. , Wennberg P. O. , Toon G. C. , Connor B. J. , Fisher B. , Osterman G. B. , Frankenberg C. , Mandrake L. , O'Dell C. , Ahonen P. , Biraud S. C. , Castano R. , Cressie N. , Crisp D. , Deutscher N. M. , Eldering A. , Fisher M. L. , Griffith D. W. T. , Gunson M. , Heikkinen P. , Keppel-Aleks G. , Kyrö E. , Lindenmaier R. , Macatangay R. , Mendonca J. , Messerschmidt J. , Miller C. E. , Morino I. , Notholt J. , Oyafuso F. A. , Rettinger M. , Robinson J. , Roehl C. M. , Salawitch R. J. , Sherlock V. , Strong K. , Sussmann R. , Tanaka T. , Thompson D. R. , Uchino O. , Warneke T. , Wofsy S. C.
Published: December 2011

Abstract. We describe a method of evaluating systematic errors in measurements of total column dry-air mole fractions of CO2 (XCO2) from space, and we illustrate the method by applying it to the v2.8 Atmospheric CO2 Observations from Space retrievals of the Greenhouse Gases Observing Satellite (ACOS-GOSAT) measurements over land. The approach exploits the lack of large gradients in XCO2 south of 25° S to identify large-scale offsets and other biases in the ACOS-GOSAT data with several retrieval parameters and errors in instrument calibration. We demonstrate the effectiveness of the method by comparing the ACOS-GOSAT data in the Northern Hemisphere with ground truth provided by the Total Carbon Column Observing Network (TCCON). We use the observed correlation between free-tropospheric potential temperature and XCO2 in the Northern Hemisphere to define a dynamically informed coincidence criterion between the ground-based TCCON measurements and the ACOS-GOSAT measurements. We illustrate that this approach provides larger sample sizes, hence giving a more robust comparison than one that simply uses time, latitude and longitude criteria. Our results show that the agreement with the TCCON data improves after accounting for the systematic errors, but that extrapolation to conditions found outside the region south of 25° S may be problematic (e.g., high airmasses, large surface pressure biases, M-gain, measurements made over ocean). A preliminary evaluation of the improved v2.9 ACOS-GOSAT data is also discussed.
Aerosol hygroscopicity and CCN activation kinetics in a boreal forest environment during the 2007 EUCAARI campaign
Authors: Cerully K. M. , Raatikainen T. , Lance S. , Tkacik D. , Tiitta P. , Petäjä T. , Ehn M. , Kulmala M. , Worsnop D. R. , Laaksonen A. , Smith J. N. , Nenes A.
Published: December 2011

Abstract. Measurements of size-resolved cloud condensation nuclei (CCN) concentrations, subsaturated hygroscopic growth, size distribution, and chemical composition were collected from March through May, 2007, in the remote Boreal forests of Hyytiälä, Finland, as part of the European Integrated project on Aerosol Cloud Climate and Air Quality Interactions (EUCAARI) campaign. Hygroscopicity parameter, κ, distributions were derived independently from Continuous Flow-Streamwise Thermal Gradient CCN Chamber (CFSTGC) and Hygroscopicity Tandem Differential Mobility Analyzer (HTDMA) measurements. CFSTGC-derived κ values for 40, 60, and 80 nm particles range mostly between 0.10 and 0.40 with an average characteristic of highly oxidized organics of 0.20 ± 0.10, indicating that organics play a dominant role for this environment. HTDMA-derived κ were generally 30% lower. Diurnal trends of κ show a minimum at sunrise and a maximum in the late afternoon; this trend covaries with inorganic mass fraction and the m/z 44 organic mass fraction given by a quadrupole aerosol mass spectrometer, further illustrating the importance of organics in aerosol hygroscopicity. The chemical dispersion inferred from the observed κ distributions indicates that while 60 and 80 nm dispersion increases around midday, 40 nm dispersion remains constant. Additionally, 80 nm particles show a markedly higher level of chemical dispersion than both 40 and 60 nm particles. An analysis of droplet activation kinetics for the sizes considered indicates that most of the CCN activate as rapidly as (NH4)2SO4 calibration aerosol.
Modelling the effects of (short-term) solar variability on stratospheric chemistry
Authors: Muncaster R. , Bourqui M. S. , Chabrillat S. , Viscardy S. , Melo S. , Charbonneau P.
Published: December 2011

Abstract. The photochemical response of the stratosphere to short-term solar variability is investigated using a photochemistry column model with interactive photolysis calculation. The solar variability is here simply represented using the Lean (1997) solar minimum and maximum spectra. In order to isolate the photochemistry effect, simulations are devoid of diffusion or any other external forcing and the temperature is held constant. The solar mininum/maximum response is estimated for all chemical families and partitioning ratios, and the underlying photochemical mechanisms are described in detail. The ozone response peaks at 0.18 ppmv (approximatively 3%) at 37 km altitude. In an attempt to find the simplest statistical model able to represent the effect of solar variability in the stratosphere, the diurnal-average response of ozone from an ensemble of 200 simulations is regressed linearly following two auto-regressive models. In the simplest case, an adjusted coefficient of determination R2 larger than 0.97 is found throughout the stratosphere using two predictors, namely the previous day's ozone perturbation and the current day's solar irradiance perturbation. A better accuracy (R2 larger than 0.9992) is achieved with an additional predictor, the previous day's solar irradiance perturbation. The skills of the two auto-regressive models at representing the effect of solar variability are then evaluated independently when coupled either on-line or off-line with the comprehensive photochemistry column model driven by the solar average spectrum. In all cases, the magnitude of the bias and the RMS error are found smaller than 5% and 20% of the ozone response, respectively. When used on-line, the 3-predictor model captures the ozone response to solar variability throughout the stratosphere with bias and RMS error lower than 1% and 15% of the ozone response, respectively. The results are found to be insensitive to an increase in the magnitude of the solar variability by a factor three, when this increase is applied uniformly throughout the solar spectrum. These statistical models offer accurate, computationally inexpensive parameterisations of the effect of solar variability in the stratosphere for climate-chemistry models with simplified chemistry that can be driven by any solar variability index. Finally, the statistical approach introduced here, based on ensemble photochemical simulations, provides an effective gauge to measure the effects of using more realistic solar variability spectra on the ozone response.
Coupling a new turbulence parametrization to RegCM adds realistic stratocumulus clouds
Authors: O'Brien T. A. , Chuang P. Y. , Sloan L. C. , Faloona I. C. , Rossiter D. L.
Published: December 2011

Abstract. To model stratocumulus clouds in the regional climate model, RegCM4.1, the University of Washington (UW) turbulence parametrization has been coupled to RegCM. We describe improvements in RegCM's coastal and near-coastal climatology, including improvements in the representation of stratiform clouds. By comparing output from a 27-yr (1982–2009) simulation of the climate of Western North America to a wide variety of observational data (station data, satellite data, and aircraft in situ data), we show the following: (1) RegCM-UW is appropriate for use in general regional climate studies, and (2) the UW model distinctly improves the representation of the marine boundary layer in RegCM. These model-data comparisons also show that RegCM-UW has slight cold bias, a (wet) precipitation bias, a systematic low bias in the vertically-integrated liquid water content near the coast, and a high bias in the fractional cloud coverage. The model represents well the diurnal, monthly, and interannual variability in low clouds. These results show RegCM-UW as a nascent mesoscale stratocumulus model that is appropriate for stratocumulus investigations at scales ranging from hourly to decadal. The source code for RegCM-UW is publicly available, under the GNU license, through the International Centre for Theoretical Physics.