bluuebunny/crossref_metadata_2025 huggingface dataset:
Evidence on measures for the prevention of ventilator-associated pneumonia
Authors: Lorente L. , Blot S. , Rello J.
Published: November 2007

Ventilator-associated pneumonia (VAP) continues to be an important cause of morbidity and mortality in ventilated patients.

Evidence-based guidelines have been issued since 2001 by the European Task Force on ventilator-associated pneumonia, the Centers for Disease Control and Prevention, the Canadian Critical Care Society, and also by the American Thoracic Society and Infectious Diseases Society of America, which have produced a joint set of recommendations.

The present review article is based on a comparison of these guidelines, together with an update of further publications in the literature. The 100,000 Lives campaign, endorsed by leading US agencies and societies, states that all ventilated patients should receive a ventilator bundle to reduce the incidence of VAP.

The present review article is useful for identifying evidence-based processes that can be modified to improve patients' safety.
Aqua jogging-induced pulmonary oedema
Authors: Wenger M. , Russi E. W.
Published: November 2007

The present study reports the case of a 43-yr-old very sporty male, who developed shortness of breath and expectorated bloody froth during aqua jogging. Pulmonary oedema was diagnosed clinically and by computed tomography of the chest. The patient made a full recovery and his echocardiography was entirely normal.

Pulmonary oedema occurring in healthy scuba-divers and swimmers has been reported previously. However, this is the first case where pulmonary oedema was observed during aqua jogging.
Double knockdown of α1,6-fucosyltransferase (FUT8) and GDP-mannose 4,6-dehydratase (GMD) in antibody-producing cells: a new strategy for generating fully non-fucosylated therapeutic antibodies with enhanced ADCC
Authors: Imai-Nishiya Harue , Mori Katsuhiro , Inoue Miho , Wakitani Masako , Iida Shigeru , Shitara Kenya , Satoh Mitsuo
Published: November 2007

Background

Antibody-dependent cellular cytotoxicity (ADCC) is greatly enhanced by the absence of the core fucose of oligosaccharides attached to the Fc, and is closely related to the clinical efficacy of anticancer activity in humans in vivo. Unfortunately, all licensed therapeutic antibodies and almost all currently-developed therapeutic antibodies are heavily fucosylated and fail to optimize ADCC, which leads to a large dose requirement at a very high cost for the administration of antibody therapy to cancer patients. In this study, we explored the possibility of converting already-established antibody-producing cells to cells that produce antibodies fully lacking core fucosylation in order to facilitate the rapid development of next-generation therapeutic antibodies.

Results

Firstly, loss-of-function analyses using small interfering RNAs (siRNAs) against the three key genes involved in oligosaccharide fucose modification, i.e. α1,6-fucosyltransferase (FUT8), GDP-mannose 4,6-dehydratase (GMD), and GDP-fucose transporter (GFT), revealed that single-gene knockdown of each target was insufficient to completely defucosylate the products in antibody-producing cells, even though the most effective siRNA (>90% depression of the target mRNA) was employed. Interestingly, beyond our expectations, synergistic effects of FUT8 and GMD siRNAs on the reduction in fucosylation were observed, but not when these were used in combination with GFT siRNA. Secondly, we successfully developed an effective short hairpin siRNA tandem expression vector that facilitated the double knockdown of FUT8 and GMD, and we converted antibody-producing Chinese hamster ovary (CHO) cells to fully non-fucosylated antibody producers within two months, and with high converting frequency. Finally, the stable manufacture of fully non-fucosylated antibodies with enhanced ADCC was confirmed using the converted cells in serum-free fed-batch culture.

Conclusion

Our results suggest that FUT8 and GMD collaborate synergistically in the process of intracellular oligosaccharide fucosylation. We also demonstrated that double knockdown of FUT8 and GMD in antibody-producing cells could serve as a new strategy for producing next-generation therapeutic antibodies fully lacking core fucosylation and with enhanced ADCC. This approach offers tremendous cost- and time-sparing advantages for the development of next-generation therapeutic antibodies.
Cognitive dysfunction in first-episode psychosis: the processing
speed hypothesis
Authors: Rodríguez-Sánchez José Manuel , Crespo-Facorro Benedicto , González-Blanch Cesar , Pérez-Iglesias Rocío , Vázquez-Barquero José Luis ,   PAFIP Group Study
Published: November 2007

Background

Speed of processing is a cognitive process underlying cognitive
dysfunction in people with chronic schizophrenia

Aims

To investigate the contribution of speed of processing to the cognitive
deficits observed in a representative large sample with first-episode
schizophrenia

Method

People with a diagnosis of first-episode schizophrenia-spectrum disorders
(n=26) and healthy controls (n=28)
were compared on several cognitive measures before and after controlling
for speed of processing

Results

Before controlling for speed of processing, patients and controls
differed significantly on all cognitive measures. All significant
differences in cognitive functioning disappeared when the result of the
Digital Symbol Substitution Test was included as an additional
covariate

Conclusions

Speed of information processing may be considered a core cognitive
deficit in schizophrenia and might be mediating a broader diversity of
cognitive disturbances
One-year effect of changing duration of untreated psychosis in a
single catchment area
Authors: Larsen Tor K. , Melle Ingrid , Friss Svein , Joa Inge , Johannessen Jan Olav , Opjordsmoen Stein , Simonsen Erik , Vaglum Per , McGlashan Thomas H.
Published: November 2007

Background

There is highly replicated positive correlation between longer duration
of untreated psychosis and poorer outcome

Aims

To study the effect of early intervention in first psychosis on one-year
outcome using an historical quasi-experimental design

Method

We compare the outcome of two samples of first-episode psychosis from the
same healthcare district at different time periods. The historical
control sample was assessed during 19931994, before the establishment of
a system for early detection of psychosis. The experimental sample is the
early detection sample in the Early Treatment and Intervention in
Psychosis study assessed during 1997–2000

Results

At 1-year follow-up, the early detection group was younger, had a smaller
fraction of individuals with schizophrenia, had less severe negative and
general symptoms and had more friends in the past year than the
historical control group. No differences were found in clinical course
(remission, relapse, continuously psychotic) or positive symptoms, but
more patients in the early detection sample were treated as outpatients
without hospitalisation

Conclusions

Early detection of schizophrenia in one healthcare sector is associated
with less severe deterioration at 1 year
The Lambeth Early Onset Crisis Assessment Team Study: general
practitioner education and access to an early detection team in
first-episode psychosis
Authors: Power Paddy , Iacoponi Eduardo , Reynolds Nicola , Fisher Helen , Russell Morris , Garety Philippa A. , McGuire Phillip K. , Craig Tom
Published: November 2007

Background

There are few evaluations of strategies to improve rates of early
detection and treatment of patients with first-episode psychosis

Aims

To evaluate the effectiveness of a general practitioner (GP) education
programme and an early detection assessment team (the Lambeth Early Onset
Crisis Assessment Team; LEO CAT) in reducing delays in accessing
treatment for first-episode psychosis patients.

Method

46 clusters of GP practices randomised to GP education in early detection
with direct access to LEO CATv. care as usual. Primary
outcome measures were GP referral rates, duration of untreated psychosis
(DUP) and delays in receiving treatment. Results 150
patients with first-episode psychosis were recruited; 113 were registered
with the study GPs, who referred 54 (47.7%) directly to mental health
services. Significantly more intervention group GPs (86.1%
v. 65.7%) referred their patients directly to mental
health services and fewer patients experienced long delays in receiving
treatment. However, their overall DUP was unaffected

Conclusions

Educating GPs improves detection and referral rates of first-episode
psychosis patients. An early detection team reduces the long delays in
initial assessment and treatment. However, these only impact on the later
phases of the DUP. Broader measures, such as public health education, are
needed to reduce the earlier delays in DUP.
Impairment of self-monitoring: part of the endophenotypic risk
for psychosis
Authors: Versmissen Dagmar , Myin-Germeys Inez , Janssen Ilse , Franck Nicolas , Georgieff Nicolas , Campo Joosta , Mengelers Ron , Van Os Jim , Krabbendam Lydia
Published: November 2007

Background

A disorder of self-monitoring may underlie the positive symptoms of
psychosis. The cognitive mechanisms associated with these symptoms may
also be detectable in individuals at risk of psychosis

Aims

To investigate (a) whether patients with psychosis show impaired
self-monitoring, (b) to what degree this is associated with positive
symptoms, and (c) whether this is associated with liability to psychotic
symptoms

Method

The sample included: individuals with a lifetime history of non-affective
psychosis (n=37), a genetically defined risk group
(n=41), a psychometrically defined risk group
(n=40), and control group (n=49).
All participants carried out an action-recognition task

Results

Number of action – recognition errors was associated with psychosis risk
(OR linear trend over 3 levels: 1.12, 95% CI 1.04–1.20) and differential
error rate was associated with the degree of delusional ideation in a
dose–response fashion (OR linear trend over 3 levels: 1.13, 95% CI
1.00–1.26)

Conclusions

Alterations in self-monitoring are associated with psychosis with
evidence of specificity for delusional ideation. In the risk state, this
is expressed more as failure to recognise self-generated actions, whereas
in illness failure to recognise alien sources come to the fore
Virtual reality and paranoid ideations in people with an ‘at-risk mental state’ for psychosis
Authors: Valmaggia Lucia R. , Freeman Daniel , Green Catherine , Garety Philippa , Swapp David , Antley Angus , Prescott Corinne , Fowler David , Kuipers Elizabeth , Bebbington Paul , Slater Mel , Broome Matthew , McGuire Philip K.
Published: November 2007

Background

Virtual reality provides a means of studying paranoid thinking in controlled laboratory conditions. However, this method has not been used with a clinical group

Aims

To establish the feasibility and safety of using virtual reality methodology in people with an at-risk mental state and to investigate the applicability of a cognitive model of paranoia to this group

Method

Twenty-one participants with an at-risk mental state were assessed before and after entering a virtual reality environment depicting the inside of an underground train

Results

Virtual reality did not raise levels of distress at the time of testing or cause adverse experiences over the subsequent week. Individuals attributed mental states to virtual reality characters including hostile intent. Persecutory ideation in virtual reality was predicted by higher levels of trait paranoia, anxiety, stress, immersion in virtual reality, perseveration and interpersonal sensitivity

Conclusions

Virtual reality is an acceptable experimental technique for use with individuals with at-risk mental states. Paranoia in virtual reality was understandable in terms of the cognitive model of persecutory delusions
Structural brain abnormalities in individuals with an at-risk
mental state who later develop psychosis
Authors: Borgwardt Stefan J. , McGuire Philip K. , Aston Jacqueline , Berger Gregor , Dazzan Paola , Gschwandtner Ute , Pflüger Marlon , D'Souza Marcus , Radue Ernst-Wilhelm , Riecher-Rössler Anita
Published: November 2007

Background

Neuroanatomical abnormalities are a well-established feature of
schizophrenia. However, the timing of their emergence and the extent to
which they are related to vulnerability to the disorder as opposed to
psychotic illness itself is unclear

Aims

To assess regional grey matter volume in the at-risk individuals who
subsequently developed psychosis

Method

Magnetic resonance imaging data from at-risk individuals who developed
psychosis (n = 12) within the following 25 months were
compared with data from healthy volunteers (n=22) and
people with first-episode psychosis (n=25)

Results

Compared with healthy volunteers, individuals who subsequently developed
psychosis had smaller grey matter volume in the posterior cingulate
gyrus, precuneus, and paracentral lobule bilaterally and in the left
superior parietal lobule, and greater grey matter volume in a left
parietal/posterior temporal region. Compared with first-episode patients,
they had relatively greater grey matter volume in the temporal gyrus
bilaterally and smaller grey matter volume in the right lentiform
nucleus

Conclusions

Some of the structural brain abnormalities in individuals with an at-risk
mental state may be related to an increased vulnerability to psychosis,
while others are associated with the development of a psychotic
illness
Cognitive and neural processes in non-clinical auditory
hallucinations
Authors: Barkus Emma , Stirling John , Hopkins Richard , McKie Shane , Lewis Shôn
Published: November 2007

Background

The nosological status of auditory hallucinations in non-clinical samples
is unclear

Aims

To investigate the functional neural basis of non-clinical
hallucinations

Method

After selection from 1206 people, 68 participants of high, medium and low
hallucination proneness completed a task designed to elicit verbal
hallucinatory phenomena under conditions of stimulus degradation. Eight
subjects who reported hearing a voice when none was present repeated the
task during functional imaging

Results

During the signal detection task, the high hallucination-prone
participants reported a voice to be present when it was not (false
alarms) significantly more often than the average or low participants
(P<0.03, d.f. =2). On functional magnetic
resonance imaging, patterns of activation during these false alarms
showed activation in the superior and middle temporal cortex
(P<0.001)

Conclusions

Auditory hallucinatory experiences reported in non-clinical samples
appear to be mediated by similar patterns of cerebral activation as found
during hallucinations in schizophrenia
Inflammatory Status Influences Aromatase and Steroid Receptor Expression in Endometriosis
Authors: Bukulmez Orhan , Hardy Daniel B. , Carr Bruce R. , Word R. Ann , Mendelson Carole R.
Published: November 2007

Aberrant up-regulation of aromatase in eutopic endometrium and implants from women with endometriosis has been reported. Aromatase induction may be mediated by increased cyclooxygenase-2 (COX-2). Recently, we demonstrated that progesterone receptor (PR)-A and PR-B serve an antiinflammatory role in the uterus by antagonizing nuclear factor κB activation and COX-2 expression. PR-C, which antagonizes PR-B, is up-regulated by inflammation. Although estrogen receptor α (ERα) is implicated in endometriosis, an antiinflammatory role of ERβ has been suggested. We examined stage-specific expression of aromatase, COX-2, ER, and PR isoform expression in eutopic endometrium, implants, peritoneum, and endometrioma samples from endometriosis patients. Endometrial and peritoneal biopsies were obtained from unaffected women and those with fibroids. Aromatase expression in eutopic endometrium from endometriosis patients was significantly increased compared with controls. Aromatase expression in endometriosis implants was markedly increased compared with eutopic endometrium. Aromatase mRNA levels were increased significantly in red implants relative to black implants and endometrioma cyst capsule. Moreover, COX-2 expression was increased in implants and in eutopic endometrium of women with endometriosis as compared with control endometrium. As observed for aromatase mRNA, the highest levels of COX-2 mRNA were found in red implants. The ratio of ERβ/ERα mRNA was significantly elevated in endometriomas compared with endometriosis implants and eutopic endometrium. Expression of PR-C mRNA relative to PR-A and PR-B mRNA was significantly increased in endometriomas compared with eutopic and control endometrium. PR-A protein was barely detectable in endometriomas. Thus, whereas PR-C may enhance disease progression, up-regulation of ERβ may play an antiinflammatory and opposing role.
Hypothalamic Phosphatidylinositol 3-Kinase Pathway of Leptin Signaling Is Impaired during the Development of Diet-Induced Obesity in FVB/N Mice
Authors: Metlakunta Anantha S. , Sahu Maitrayee , Sahu Abhiram
Published: November 2007

Phosphatidylinositol 3-kinase (PI3K) pathway of leptin signaling plays an important role in transducing leptin action in the hypothalamus. Obesity is usually associated with resistance to the effect of leptin on food intake and energy homeostasis. Although central leptin resistance is thought to be involved in the development of diet-induced obesity (DIO), the mechanism behind this phenomenon is not clearly understood. To determine whether DIO impairs the effect of leptin on hypothalamic PI3K signaling, we fed 4-wk-old FVB/N mice a high-fat diet (HFD) or low-fat diet (LFD) for 19 wk. HFD-fed mice developed DIO in association with hyperleptinemia, hyperinsulinemia, and impaired glucose and insulin tolerance. Leptin (ip) significantly increased hypothalamic PI3K activity and phosphorylated signal transducer and activator of transcription 3 (p-STAT3) levels in LFD-fed mice but not in DIO mice. Immunocytochemical study confirmed impaired p-STAT3 activation in various hypothalamic areas, including the arcuate nucleus. We next tested whether both PI3K and STAT3 pathways of leptin signaling were impaired during the early period of DIO. Leptin failed to increase PI3K activity in DIO mice that were on a HFD for 4 wk. However, leptin-induced p-STAT3 activation in the hypothalamus measured by Western blotting and immunocytochemistry remained comparable between LFD- and HFD-fed mice. These results suggest that the PI3K pathway but not the STAT3 pathway of leptin signaling is impaired during the development of DIO in FVB/N mice. Thus, a defective PI3K pathway of leptin signaling in the hypothalamus may be one of the mechanisms of central leptin resistance and DIO.
Placenta Defects and Embryonic Lethality Resulting from Disruption of Mouse Hydroxysteroid (17-β) Dehydrogenase 2 Gene
Authors: Rantakari Pia , Strauss Leena , Kiviranta Riku , Lagerbohm Heidi , Paviala Jenni , Holopainen Irma , Vainio Seppo , Pakarinen Pirjo , Poutanen Matti
Published: November 2007

Hydroxysteroid (17-β) dehydrogenase 2 (HSD17B2) is a member of aldo-keto reductase superfamily, known to catalyze the inactivation of 17β-hydroxysteroids to less active 17-keto forms and catalyze the conversion of 20α-hydroxyprogesterone to progesterone in vitro. To examine the role of HSD17B2 in vivo, we generated mice deficient in Hsd17b2 [HSD17B2 knockout (KO)] by a targeted gene disruption in embryonic stem cells. From the homozygous mice carrying the disrupted Hsd17b2, 70% showed embryonic lethality appearing at the age of embryonic d 11.5 onward. The embryonic lethality was associated with reduced placental size measured at embryonic d 17.5. The HSD17B2KO mice placentas presented with structural abnormalities in all three major layers: the decidua, spongiotrophoblast, and labyrinth. Most notable was the disruption of the spongiotrophoblast and labyrinthine layers, together with liquid-filled cysts in the junctional region and the basal layer. Treatments with an antiestrogen or progesterone did not rescue the embryonic lethality or the placenta defect in the homozygous mice. In hybrid background used, 24% of HSD17B2KO mice survived through the fetal period but were born growth retarded and displayed a phenotype in the brain with enlargement of ventricles, abnormal laminar organization, and increased cellular density in the cortex. Furthermore, the HSD17B2KO mice had unilateral renal degeneration, the affected kidney frequently appearing as a fluid-filled sac. Our results provide evidence for a role for HSD17B2 enzyme in the cellular organization of the mouse placenta.
Mechanical properties of the rigid and hydrostatic skeletons of molting blue crabs, Callinectes sapidus Rathbun
Authors: Taylor Jennifer R. A. , Hebrank Jack , Kier William M.
Published: November 2007

Molting in crustaceans involves significant changes in the structure and function of the exoskeleton as the old cuticle is shed and a new one is secreted. The flimsy new cuticle takes several days to harden and during this time crabs rely on a hydrostatic skeletal support system for support and movement. This change from a rigid to a hydrostatic skeletal support mechanism implies correlated changes in the function, and thus mechanical properties, of the cuticle. In particular, it must change from primarily resisting compression, bending and torsional forces to resisting tension. This study was designed to explore the changes in the mechanical properties of the crustacean cuticle as the animals switch between two distinct skeletal support mechanisms. Samples of cuticle were removed from blue crabs, Callinectes sapidus, at 1 h (soft-shell stage), 12 h (paper-shell stage), and 7 days(hard-shell stage) following molting. We measured and compared the flexural stiffness, Young's modulus of elasticity (in tension), and tensile strength for each postmolt stage. We found that the hard-shell cuticle has a flexural stiffness fully four orders of magnitude greater than the soft-shell and paper-shell cuticle. Although the soft-shell cuticle has a Young's modulus significantly lower than that of the paper-shell and hard-shell cuticle, it has the same tensile strength. Thus, the soft-shell and paper-shell cuticles are unable to resist the significant bending forces associated with a rigid skeletal support system, but can resist the tensile forces that characterize hydrostatic support systems. The mechanical properties of the cuticle thus change dramatically during molting in association with the change in function of the cuticle. These results emphasize the significant role that mechanics plays in the evolution of the molting process in arthropods, and possibly other ecdysozoans.
Control of neuronal firing by dynamic parallel fiber feedback:implications for electrosensory reafference suppression
Authors: Lewis John E. , Lindner Benjamin , Laliberté Benoit , Groothuis Sally
Published: November 2007

The cancellation of self-generated components of sensory inputs is a key function of sensory feedback pathways. In many systems, cerebellar parallel fiber feedback mediates this cancellation through anti-Hebbian plasticity,resulting in the generation of a negative image of the reafferent inputs. Parallel fiber feedback involves direct excitation and disynaptic inhibition as well as synaptic plasticity on multiple time scales. How the dynamics of these processes interact with anti-Hebbian plasticity to shape synaptic inputs and provide a cancellation mechanism remains unclear. In the present study, we investigated the influence of parallel fiber feedback onto pyramidal neurons of the electrosensory lateral line lobe (ELL) in weakly electric fish under open loop conditions. We mimicked naturalistic parallel fiber inputs in an ELL brain slice by implementing an experimentally based model of this synaptic pathway using dynamic clamp. We showed that as parallel fiber activity increases, the effective input to ELL pyramidal neurons changes from net excitation to net inhibition, resulting in a non-monotonic firing response. Using a model neuron, we found that this robust non-monotonic response is due to a shift from balanced excitation and inhibition at low parallel fiber input rates, to dominant inhibition at high input rates. We then showed that this non-monotonic response provides a simple basis for negative image generation. Through changes in the mean activation rate of parallel fibers, the feedback can switch roles between enhancement and suppression of sensory inputs in a manner that is directly determined by the slope of the non-monotonic response curve.
Use of Intravenous Lipids in Very Low-birthweight Infants
Authors: Adamkin David H.
Published: November 2007

Lipids are essential components of parenteral nutrition for preterm infants to provide essential fatty acids and to meet high energy needs. However, there is concern about increased risks of sepsis, displacement of bilirubin from albumin, and pulmonary complications when parenteral lipids are provided to sick preterm infants early in postnatal life. Slow administration of intravenous lipid emulsions, with stepwise increases, appears to be well-tolerated in most preterm infants. High doses probably should be avoided in infants who have severe acute respiratory failure with or without pulmonary hypertension.
Influence of Institutionalization on Time to HIV Disease Progression in a Cohort of Romanian Children and Teens
Authors: Ferris Margaret , Burau Keith , Constantin Ana Maria , Mihale Stefania , Murray Nancy , Preda Alina , Ross Michael , Kline Mark W.
Published: November 2007

OBJECTIVES.The purpose of this work was to investigate the effect of institutionalization on death and CD4 decline in a cohort of 325 HIV-infected Romanian children.

METHODS. A retrospective database analysis was conducted. Data from a nearly 3-year period were examined with Kaplan-Meier survival analysis and Cox regression analysis models. Subjects all received primary and HIV specialty care and treatment at the Romanian American Children's Center in Constanta, Romania. Children in one group resided with their biological families and the other children resided in “family home”–style institutions.

RESULTS. There was no difference between groups for death during the follow-up period, although there was a trend for survival advantage for children in institutional care. There was no statistically significant difference between the study groups in terms of CD4 decline, although there was a trend toward greater decline among children who resided with their biological families. Children with their biological families were more likely to experience disease progression through either death or CD4 decline than were children in institutions.

CONCLUSIONS. The family home–style institution may prove to be a replicable model for the safe and appropriate care of HIV-infected orphaned and abandoned children and teens.
Successful Use of a Primary Care Practice–Specialty Collaboration in the Care of an Adolescent With Chronic Fatigue Syndrome
Authors: Kuo Dennis Z. , Cheng Tina L. , Rowe Peter C.
Published: November 2007

We report on the successful collaborative care of an adolescent with chronic fatigue syndrome between a primary care pediatrician and an academic chronic fatigue syndrome specialist located in different cities. Regular telephone and e-mail communication and clearly defined patient-care roles allowed for timely management of symptoms and marked clinical improvement. We discuss ways to improve the collaboration of primary care and subspecialty physicians for patients with chronic fatigue syndrome and children with special health care needs.
Effects of Two Different Doses of Amino Acid Supplementation on Growth and Blood Amino Acid Levels in Premature Neonates Admitted to the Neonatal Intensive Care Unit: A Randomized, Controlled Trial
Authors: Clark Reese H. , Chace Donald H. , Spitzer Alan R. ,   for the Pediatrix Amino Acid Study Group
Published: November 2007

OBJECTIVES. The goal was to measure the effects of 2 distinct strategies for parenteral nutrition on neonatal growth and blood amino acid profiles.

METHODS. In a multicenter trial (n = 11 sites), we randomly allocated premature (23–29 weeks and 6 days of gestation) neonates to 1 of 2 approaches to intravenous amino acid administration. In one group, amino acid supplementation was started at 1.0 g/kg per day and advanced by 0.5 g/kg per day to a maximum of 2.5 g/kg per day (2.5 g/kg per day group). The other group received amino acids starting at 1.5 g/kg per day and advancing by 1.0 g/kg per day to a maximum of 3.5 g/kg per day (3.5 g/kg per day group). Filter paper blood spots were obtained from each infant on the day of random assignment and on days 7 and 28 of age, to monitor blood amino acid levels.

RESULTS. We enrolled 122 neonates (64 in the 3.5 g/kg per day group and 58 in the 2.5 g/kg per day group). There were no differences in demographic or baseline characteristics between the 2 treatment groups. There was no significant difference in growth by day 28 after birth (median weight gain: 12.9 and 11.4 g/kg per day for the 3.5 and 2.5 g/kg per day groups, respectively), and the incidences of secondary morbidities were similar in the 2 groups. On day 7, blood levels of several amino acids and the serum urea nitrogen level were higher in the 3.5 g/kg per day group, compared with the 2.5 g/kg per day group; none of the amino acid levels were lower.

CONCLUSIONS. Higher doses of amino acid supplementation did not improve neonatal growth and were associated with increased blood amino acid and urea nitrogen levels.
Recognizing and Responding to Medical Neglect
Authors: Jenny Carole ,   and the Committee on Child Abuse and Neglect
Published: November 2007

This Clinical Report was retired March 2022.

A caregiver may fail to recognize or respond to a child's medical needs for a variety of reasons. An effective response by a health care professional to medical neglect requires a comprehensive assessment of the child's needs, the parents' resources, the parents' efforts to provide for the needs of the child, and options for ensuring optimal health for the child. Such an assessment requires clear, 2-way communication between the family and the health care professional. Physicians should consider the least intrusive options for managing cases of medical neglect that ensure the health and safety of the child.
Ethical Challenges in Cancer Research in Children
Authors: Berg Stacey L.
Published: November 2007

Learning Objectives

After completing this course, the reader will be able to: Discuss the ethical challenges in cancer clinical trials that are particularly important when children are research subjects.Describe the process of obtaining assent and consent for a child to participate in a cancer clinical trial.Identify the different ethical challenges that arise in different phases of oncology studies.

Access and take the CME test online and receive 1 AMA PRA Category 1 Credit™ at CME.TheOncologist.com
Stalking Victimization in the Context of Intimate Partner Violence
Authors: Logan TK , Shannon Lisa , Cole Jennifer
Published: November 2007

This article is one of the first to extensively compare characteristics of women who do and do not report stalking by a violent partner or ex-partner using a large sample of women with civil protective orders. Specifically, the purpose of this study was to examine similarities and differences in relationship and victimization history characteristics, mental health symptoms, help-seeking, and protective order violations for women who report being stalked in the past year (n = 345) by the partner they received a protective order against compared to women who received a protective order against a violent partner but who report no stalking by that partner ever in the relationship (n = 412). Results indicate that women who report partner stalking have more severe partner violence victimization, histories, increased distress, greater fear, and more protective order violations, suggesting that partner stalking victimization warrants more research and practice attention.
Morphometric Study of the Interproximal Unit in the Esthetic Region to Correlate Anatomic Variables Affecting the Aspect of Soft Tissue Embrasure Space
Authors: Martegani P. , Silvestri M. , Mascarello F. , Scipioni T. , Ghezzi C. , Rota C. , Cattaneo V.
Published: November 2007

Background: The presence of a normal papilla is crucial to avoid the unpleasant esthetic defects that are of major concern to periodontists, restorative dentists, and patients. During the course of progressive periodontitis and following periodontal treatment, it is not uncommon to have a partial loss of the interdental papilla. This loss can lead to an unesthetic gingival appearance. This study evaluated different anatomic variables in an effort to determine their role in the papillary appearance of maxillary incisors.

Methods: A total of 178 interdental embrasures in 58 patients were selected randomly for examination. For each patient, a digital photograph and a modified periapical radiograph of the interdental embrasure of the four maxillary incisors were taken by using a special metric device fixed to a centrator as a reference marker. Clinical and radiographic data were obtained for the distance from the contact point to the alveolar crest and for the interradicular distance. We used a classification system with regard to peri‐implant soft tissue based on esthetic assessments related to the space between reference lines through the highest gingival curvature of the crown–tooth margin and the contact point.

Results: In the group of interdental sites with an interradicular distance of less than ∼2.4 mm, an increase in the distance between the contact point and the bone crest corresponded to a marked increase in the interdental black triangle's dimensions and, therefore, a less esthetic smile. In particular, when the interradicular distance was >2.4 mm, we statistically estimated that the other anatomic variable considered, the distance from the contact point to the alveolar crest, lost its influence on whether the interdental papilla would be present or absent.

Conclusion: The interradicular distance and the distance between the contact point and the alveolar crest have independent and combined effects on the presence or absence of the interdental papilla.
The Interleukin‐1 and Fcγ Receptor Gene Polymorphisms in Japanese Patients With Rheumatoid Arthritis and Periodontitis
Authors: Kobayashi Tetsuo , Ito Satoshi , Kuroda Takeshi , Yamamoto Kouji , Sugita Noriko , Narita Ichiei , Sumida Takayuki , Gejyo Fumitake , Yoshie Hiromasa
Published: November 2007

Background: The pathobiology of rheumatoid arthritis (RA) is similar to that of periodontitis in that proinflammatory cytokines and immunoglobulin G Fc receptor (FcγR) play an important role. Functional polymorphisms of interleukin (IL)‐1 and FcγR were shown to be associated with susceptibility to both diseases. Therefore, we evaluated whether the IL‐1 and FcγR gene polymorphisms represent a common risk factor for RA and periodontitis.

Methods: The study population consisted of Japanese adults with RA (RA group; N = 100), periodontitis only (P group; N = 100), and healthy individuals with no systemic or oral disease (H group; N = 100). Clinical periodontal condition was defined by measurements of probing depth, clinical attachment level, and bleeding on probing. Genomic DNA was isolated from peripheral blood and analyzed for determination of IL‐1 genotypes (IL‐1A+4845, IL‐1B+3954, and IL‐1RN+2028) and FcγR genotypes (FcγRIIA, FcγRIIIA, and FcγRIIIB) by allele‐specific polymerase chain reactions.

Results: Among 100 patients with RA, 86% showed periodontal tissue destruction. However, the RA group exhibited milder levels of periodontal tissue destruction than the P group (P <0.01). There was a significant difference in the distribution of IL‐1B+3954 C/T genotypes between the RA and P groups and between the RA and H groups (P = 0.03 for both comparisons), with enrichment of the T allele in the RA group (P = 0.04; odds ratio, 2.9 for both comparisons). The combination of IL‐1A+4845 T and IL‐1+3954 T alleles yielded a strong association with RA and periodontitis (RA versus P group: P = 0.00001; RA versus H group: P = 0.00001).

Conclusions: These results failed to show that IL‐1 and FcγR gene polymorphisms constitute a common risk factor for RA and periodontitis. However, it was suggested that the distributions of IL‐1B+3954 genotypes and IL‐1A+4845 and IL‐1B+3954 haplotypes were unique to the patients with RA and periodontitis.
Use of a Population-Based Survey to Describe the Health of Boston Public Housing Residents
Authors: Digenis-Bury Eleni C. , Brooks Daniel R. , Chen Leslie , Ostrem Mary , Horsburgh C. Robert
Published: November 2007

Objectives. We compared the health of public housing residents with other Boston residents through a random-digit-dial survey.

Methods. We used data from the Boston Behavioral Risk Factor Surveillance System collected in 2001 and 2003 to make crude and demographically adjusted comparisons between public housing residents and other city residents on measures of health status, access and utilization, and health behaviors.

Results. Public housing residents were more likely to report fair or poor overall health status, ever-diagnosed hypertension, current asthma, ever-diagnosed diabetes, obesity, disability, loss of 6 or more teeth, and feelings of depression for 15 days or more in the past month. Public housing residents were slightly more likely than others to be without health insurance or report financial barriers to medical care. Public housing residents reported more smoking and physical inactivity, less past-month binge drinking and past-year marijuana use, and similar levels of lifetime drug use.

Conclusions. Public housing residents reported substantially poorer health than did other city residents across a variety of conditions but similar levels of access to and utilization of health care. Public health departments may be able to use established surveys to measure health among public housing residents.
Trends and Disparities Among Diabetes-Complicated Births in Minnesota, 1993–2003
Authors: Devlin Heather M. , Desai Jay , Holzman Gregory S. , Gilbertson David T.
Published: November 2007

We used Minnesota birth certificate data from 1993–2003 to test 2 hypotheses: rates of diabetes-complicated pregnancy are increasing, and disparities between more and less socially advantaged groups are widening. Significant increases occurred in rates (per 1000 live births) of prepregnancy and gestational diabetes mellitus (from 2.6 to 4.9 and 25.6 to 34.8, respectively). Increases were significant in all demographic groups except gestational diabetes among American Indian mothers, and disparities worsened among all groups. Targeted interventions and surveillance improvements are needed.
Long-Term Health Correlates of Timing of Sexual Debut: Results From a National US Study
Authors: Sandfort Theo G.M. , Orr Mark , Hirsch Jennifer S. , Santelli John
Published: November 2007

Objectives. We explored long-term health consequences of age at sexual initiation and of abstinence until marriage to evaluate empirical support for the claim that postponing sexual initiation has beneficial health effects.

Methods. We analyzed data from the 1996 National Sexual Health Survey, a cross-sectional study of the US adult population. We compared sexual health outcomes among individuals who had initiated sexual activity at an early or late age versus a normative age. We also compared individuals whose first sexual intercourse had occurred before versus after marriage.

Results. Early initiation of sexual intercourse was associated with various sexual risk factors, including increased numbers of sexual partners and recent sexual intercourse under the influence of alcohol, whereas late initiation was associated with fewer risk factors. However, both early and late initiation were associated with sexual problems such as problems with arousal and orgasm, primarily among men. Relationship solidity and sexual relationship satisfaction were not associated with early or late initiation.

Conclusions. Early sexual debut is associated with certain long-term negative sexual health outcomes, including increased sexual risk behaviors and problems in sexual functioning. Late initiation was also associated with sexual problems, especially among men. Further research is needed to understand how sexual initiation patterns affect later health outcomes.
The Healthy Migrant Effect: New Findings From the Mexican Family Life Survey
Authors: Rubalcava Luis N. , Teruel Graciela M. , Thomas Duncan , Goldman Noreen
Published: November 2007

Objectives. We used nationally representative longitudinal data from the Mexican Family Life Survey to determine whether recent migrants from Mexico to the United States are healthier than other Mexicans. Previous research has provided little scientific evidence that tests the “healthy migrant” hypothesis.

Methods. Estimates were derived from logistic regressions of whether respondents moved to the United States between surveys in 2002 and 2005, by gender and urban versus rural residence. Covariates included physical health measurements, self-reported health, and education measured in 2002. Our primary sample comprised 6446 respondents aged 15 to 29 years.

Results. Health significantly predicted subsequent migration among females and rural males. However, the associations were weak, few health indicators were statistically significant, and there was substantial variation in the estimates between males and females and between urban and rural dwellers.

Conclusions. On the basis of recent data for Mexico, the largest source of migrants to the United States, we found generally weak support for the healthy migrant hypothesis.
Results of the 2004 National Worksite Health Promotion Survey
Authors: Linnan Laura , Bowling Mike , Childress Jennifer , Lindsay Garry , Blakey Carter , Pronk Stephanie , Wieker Sharon , Royall Penelope
Published: November 2007

Objectives. We examined worksite health promotion programs, policies, and services to monitor the achievement of the Healthy People 2010 worksite-related goal of 75% of worksites offering a comprehensive worksite health promotion program.

Methods. We conducted a nationally representative, cross-sectional telephone survey of worksite health promotion programs stratified by worksite size and industry type. Techniques appropriate for analyzing complex surveys were used to compute point estimates, confidence intervals, and multivariate statistics.

Results. Worksites with more than 750 employees consistently offered more programs, policies, and services than did smaller worksites. Only 6.9% of responding worksites offered a comprehensive worksite health promotion program. Sites with a staff person dedicated to and responsible for health promotion were significantly more likely to offer a comprehensive program, and sites in the agriculture and mining or financial services sector were significantly less likely than those in other industry sectors to offer such a program.

Conclusions. Increasing the number, quality, and types of health promotion programs at worksites, especially smaller worksites, remains an important public health goal.
Community Health Workers: Social Justice and Policy Advocates for Community Health and Well-Being
Authors: Pérez Leda M. , Martinez Jacqueline
Published: November 2007

Community health workers are resources to their communities and to the advocacy and policy world on several levels.

Community health workers can connect people to health care and collect information relevant to policy. They are natural researchers who, as a result of direct interaction with the populations they serve, can recount the realities of exclusion and propose remedies for it. As natural researchers, they contribute to best practices while informing public policy with the information they can share.

In this light, community health workers may also be advocates for social justice.
HIV-Associated Orphanhood and Children’s Psychosocial Distress: Theoretical Framework Tested With Data From Zimbabwe
Authors: Nyamukapa Constance A. , Gregson Simon , Lopman Ben , Saito Suzue , Watts Helen J. , Monasch Roeland , Jukes Matthew C.H.
Published: November 2007

Objectives. We measured the psychosocial effect of orphanhood in a sub-Saharan African population and evaluated a new framework for understanding the causes and consequences of psychosocial distress among orphans and other vulnerable children.

Methods. The framework was evaluated using data from 5321 children aged 12 to 17 years who were interviewed in a 2004 national survey in Zimbabwe. We constructed a measure of psychosocial distress using principle components analysis. We used regression analyses to obtain standardized parameter estimates of psychosocial distress and odds ratios of early sexual activity.

Results. Orphans had more psychosocial distress than did nonorphans. For both genders, paternal, maternal, and double orphans exhibited more-severe distress than did nonorphaned, nonvulnerable children. Orphanhood remained associated with psychosocial distress after we controlled for differences in more-proximate determinants. Maternal and paternal orphans were significantly more likely than were nonorphaned, nonvulnerable children to have engaged in sexual activity. These differences were reduced after we controlled for psychosocial distress.

Conclusions. Orphaned adolescents in Zimbabwe suffer greater psychosocial distress than do nonorphaned, nonvulnerable children, which may lead to increased likelihood of early onset of sexual intercourse and HIV infection. The effect of strategies to provide psychosocial support should be evaluated scientifically.
Application of enzymes in anaerobic digestion
Authors: Bochmann G. , Herfellner T. , Susanto F. , Kreuter F. , Pesta G.
Published: November 2007

Owing to the very low economic value of brewer's spent grains, its utilisation for biogas production is very promising. The hydrolysis of ligno-cellulose is the rate limiting step in anaerobic digestion. Enzymatic pre-treatment promotes the hydrolysis of ligno-cellulose, breaking it down to lower molecular weight substances which are ready to be utilised by the bacteria. A cheap raw multi-enzyme produced by a solid state fermentation (SSF) process is a good substitute for expensive conventional enzyme. The SSF enzyme application to spent grain has been investigated by carrying out enzymatic solubility tests, hydrolytic experiments and two-step anaerobic fermentation of spent grain. Gas chromatograph analysis was conducted to quantify fatty acids concentrations, while CH4, CO2, O2, H2 and H2S were measured to determine biogas quality by means of a gas analyser. DS, oDS, pH were also measured to analyse the anaerobic digestion. The result shows that enzyme application promotes the hydrolysis of ligno-cellulose, indicated by higher enzymatic solubility and fatty acid concentration in a hydrolytic bioreactor. Moreover, biogas production is also increased. The quality of the gases produced is also enhanced. Since the anaerobic digestion can be operated in a stable performance, it can also be concluded that SSF enzyme is compatible with anaerobic digestion.
Small wastewater treatment plants in mountain areas: combination of septic tank and biological filter
Authors: Maunoir S. , Philip H. , Rambaud A.
Published: November 2007

Research work has been carried out for more than 20 years by Eparco and the University of Montpellier (France) on the application of biological wastewater treatment processes for small communities. This research has led to a new process which is particularly suitable for remote populations, taking into account several specificities such as as the seasonal fluctuations in the population, the accessibility of the site, the absence of a power supply on site, the reduced area of land available and the low maintenance. Thus, the process, which combines a septic tank operating under anaerobic conditions and a biological aerobic filter, is a solution for wastewater treatment in mountain areas. This paper presents the process and three full-scale applications in the region of the Alps.