bluuebunny/crossref_metadata_2025 huggingface dataset:
The Recommendations Made by the International Court of Justice
Authors: Aspremont Jean D'
Published: January 2007

Any observer of the practice of the International Court of Justice (hereafter the ICJ or the Court) may have noticed the growing tendency of the United Nations judicial body to formulate recommendations to the parties that have appeared before it. Indeed, the Court is more and more inclined to recommend that the parties allay their dispute and alleviate all ensuing human sufferings. This leaning is particularly observable when the Court simultaneously dismisses a request for the indication of provisional measures. For instance, in the recent order rendered by the Court in the case concerning theArmed Activities on the Territory of Congo (Democratic Republic of the Congo v Rwanda), the Court made the following declaration:
Risk Factors for Invasive Cervical Cancer in Kenyan Women
Authors: WILLIAMS MICHELLE A , KENYA PATRICK R , MATI J K G , THOMAS DAVID B
Published: January 2007

Background

Few epidemiological investigations of invasive cervical cancer have been conducted in Sub-Saharan African populations.

Methods

Using information collected as part of the hospital-based World Health Organization (WHO) Collaborative Study of Neoplasia and Steroid Contraceptives, we examined potential risk factors for invasive cervical cancer among Kenyan women. In all 112 women with histologically confirmed invasive cervical cancer diagnosed at the Kenyatta National Hospital, Nairobi, Kenya, between June 1981 and September 1988 and 749 control subjects were included in the present analyses. All women were interviewed regarding their medical and reproductive history, methods of birth control, and history of sexual relationships and sexually transmitted infections. Multiple logistic regression procedures were used to derive maximum likelihood estimates of adjusted odds ratios (OR) and 95% confidence intervals (CI).

Results

After adjusting for age, several factors were found to be associated with invasive cervical cancer. These include multiple sexual partners, early age at first sexual intercourse (OR = 1.9 and 2.6 for women reporting first intercourse at age 16–17 years and <15 years, respectively, compared to women with first intercourse > 18 years), history of abnormal vaginal discharge (OR = 13.8, 95% CI: 8.3–23.0), and history of gonorrhoeal infection (OR = 3.2, 95% CI: 1.6–6.2). Low educational attainment and multiparity were also associated with the risk of invasive cervical cancer. Although the Papanicolaou smear has been extensively used as a screening method for cervical cancer in many countries, only three cases and four controls reported ever having a Papanicolaou smear (2.6% cases and 0.5% of controls).

Conclusions

As has been observed in other parts of the world, cervical neoplasia in Kenya appears to be a late consequence of venereally transmitted carcinogenic agents.
Lifestyle and the Risk of Acute Myocardial Infarction in a Gulf Arab Population
Authors: AL-ROOMI KHALDOON A , MUSAIGER ABDULRAHMAN O , AL-AWADI ABDUL-HAI
Published: January 2007

Background

Recent statistics indicate that acute myocardial infarction (AMI) is becoming very common in the State of Bahrain. A population-based case-control study was carried out to explore the importance of lifestyle in the occurrence of AMI in Bahrain among those aged 30–79 years.

Methods

Seventy consecutive cases with a first episode of AMI were identified from a register, which included all hospital admissions, during the period 1 February 1992 to 31 July 1992, and compared with 516 subjects obtained from a random sample of the same community. Multiple logistic regression was used to control for demographic variables as well as for the mutual confounding effects of the investigated risk factors.

Results

Of the patients with first-time AMI, 64% did not walk regularly for exercise compared with 34% of community controls (adjusted odds ratio [OR] = 3.06, 95% confidence interval [CI] :1.24–5.15). In all, 12% of community controls has a history of hypertension and 9% had diabetes. The comparative figures for AMI patients were 44% for hypertension (adjusted OR = 5.04, 95% CI: 2.82–9.00) and 22% for diabetes (adjusted OR = 3.28, CI: 1.73–6.20). Cigarette smoking and infrequent consumption of fruits and vegetables also appeared to be associated with an increased risk of AMI.

Conclusions

There is scope for lifestyle change in reducing AMI risk, by changes in physical activity, smoking and dietary habits. In addition, measures to control hypertension and diabetes should be given a high priority in any national health policy to prevent AMI.
A rapid alkaline extraction procedure for screening recombinant plasmid DNA
Authors: Birnboim H.C. , Doly J.
Published: January 2007

A procedure for extracting plasmid DNA from bacterial cells 1s described. The method 1s simple enough to permit the analysis by gel electrophoresis of 100 or more clones per day yet yields plasmid DNA which is pure enough to be digestible by restriction enzymes. The principle of the method is selective alkaline denaturation of high molecular weight chromosomal DNA while covalently closed circular DNA remains double-stranded. Adequate pH control is accomplished without using a pH meter. Upon neutralization, chromosomal DNA renatures to form an insoluble clot, leaving plasmid DNA in the supernatant. Large and small plasmid DNAs have been extracted by this method.
Changes in Treatment of Advanced Oropharyngeal Cancer, 1985–2001
Authors: Chen Amy Y. , Schrag Nicole , Hao Yongping , Stewart Andrew , Ward Elizabeth
Published: January 2007

Objective: The aim of this study is to describe patterns of care of advanced oropharyngeal cancer during 1985 to 2001.

Methods: We extracted oropharyngeal squamous cell cancer cases from the National Cancer Database. Type of initial treatment, type of facility, stage of tumor, payer status, and demographic variables were collected. Fisher exact test was used to compare the patient demographic and clinical characteristics across facility types. Weighted least squares regression analysis was used to analyze treatment trends over time and t‐tests were done to test for significance in trends.

Results: A total of 54,801 cases were available for analysis. Teaching/research facilities treated a disproportionately higher number of advanced‐stage cancers (81%, P < .01). In addition, these facilities treat a higher percentage of uninsured (7%, P < .01) and nonwhite patients (27%, P < .01). The use of organ preservation protocols (chemoradiation) increased from 15% in 1985 to 29% in 2001 (β1 = 0.0080, P < .05), whereas the use of radiation alone decreased from 42% in 1985 to 27% in 2001 (β1 = −0.0118, P < .05). The use of cancer‐directed surgery remained stable. There was no difference in rates of chemoradiation for advanced oropharyngeal cancer across facility types.

Conclusions: Our results suggest that chemoradiation is increasingly becoming more prevalent at all facility types. The use of radiation alone as primary treatment significantly declined during the study period. In view of the complexity and multidisciplinary nature of treatment for oropharyngeal cancer, it is recommended that care of such patients be discussed at institutional tumor boards and that the recommendations be systematically recorded and documented in hospital cancer registries.
Risk Factors for Wound Infection After Surgery in Primary Oral Cavity Cancer Patients
Authors: Liu Shih‐An , Wong Yong‐Kie , Poon Chiu‐Kwan , Wang Chen‐Chi , Wang Ching‐Ping , Tung Kwong‐Chung
Published: January 2007

Objectives: Few studies have discussed the predictive factors of surgical wound infection (WI) in primary oral cavity cancer patients. Therefore, we aimed to determine the relevant factors associated with postoperative WI in a large group of patients with oral cavity cancers.

Study Design: Retrospective chart review.

Methods: We retrospectively reviewed 1,693 chart records of oral cavity cancer patients. Twenty variables were obtained from chart review. Statistical methods included descriptive statistics, bivariate analyses, and a multiple logistic regression model for investigating the predictive factors for WI.

Results: Postoperative WI rate was 19.8%. Diabetes mellitus (odds ratio [OR]: 2.511, 95% confidence interval [CI]: 1.409–4.475), perioperative blood transfusion (OR: 4.293, 95% CI: 2.448–7.529), reconstruction with free flap or pectoris major myocutaneous flap (OR: 3.682, 95% CI: 1.909–7.102), and postoperative serum albumin level less than 2.8 g/dL (OR: 2.853, 95% CI: 1.928–4.221) were all independent factors associated with postoperative WI.

Conclusions: Recognition of relevant factors can help surgeons to identify those at high risk of WI after surgery for primary oral cavity cancer and can enable better management of such cases.
Arachidonic Acid Content in Adipose Tissue Is Associated With Insulin Resistance in Healthy Children
Authors: Aldámiz‐Echevarría Luis , Prieto José A , Andrade Fernando , Elorz Javier , Sanjurjo Pablo , Soriano Juan Rodríguez
Published: January 2007

Background:

The fatty acid composition of membrane structural lipids, which is partly dependent on dietary intake, is associated with insulin action.

Aim:

To examine the association between fatty acid composition of adipose tissue and skeletal muscle phospholipids with insulin resistance markers in a healthy pediatric population.

Methods:

Using a cross‐sectional design, we studied 83 healthy children divided into 3 groups, ages 2 to 5, 6 to 10 and more than 10 years.

Measurements:

Fatty acid composition of adipose tissue triacylglycerols and skeletal muscle phospholipids, plasma lipid profile and fasting plasma levels of glucose and insulin were measured.

Results:

There was a linear increase of insulinemia, glycemia and homeostasis adipose tissue model assessment (HOMA) index throughout the pediatric age range. Linoleic acid proportion in skeletal muscle and arachidonic acid proportion in adipose tissue also increased significantly with age. An age‐independent positive correlation between insulinemia or HOMA index and arachidonic acid content in adipose tissue triacylglycerols (r = 0.47, P < 0.001) was found. An age‐dependent negative correlation was present between insulinemia or HOMA index and oleic acid content in skeletal muscle phospholipids (r = −0.30, P = 0.03 and r = −0.28, P < 0.04, respectively). Trans fatty acids content did not correlate with any marker of insulin resistance.

Conclusion:

Healthy children present a prepubertal increase of insulin resistance, which is significantly correlated with arachidonic acid content in adipose tissue.
Reconsolidation of episodic memories: A subtle reminder triggers integration of new information
Authors: Hupbach Almut , Gomez Rebecca , Hardt Oliver , Nadel Lynn
Published: January 2007

Recent demonstrations of “reconsolidation” suggest that memories can be modified when they are reactivated. Reconsolidation has been observed in human procedural memory and in implicit memory in infants. This study asks whether episodic memory undergoes reconsolidation. College students learned a list of objects on Day 1. On Day 2, they received a reminder or not, and then learned a second list. Memory for List 1 was tested immediately on Day 2 (Experiment 2) or on Day 3 (Experiment 1). Although the reminder did not moderate the number of items recalled from List 1 on either day, subjects who received a reminder incorrectly intermixed items from the second list when recalling List 1 on Day 3. Experiment 2 showed that this effect does not occur immediately and thus is time-dependent. The reminder did not affect memory for List 2 on Day 3 (Experiment 3), demonstrating that modification occurred only for the original memory (List 1). The study demonstrates the crucial role of reminders for the modification of episodic memory, that reconsolidation of episodic memory is time-dependent, and, in contrast to previous reconsolidation findings, that reconsolidation is also a constructive process, one that supports the incorporation of new information in memory.
Orphanin FQ/nociceptin interacts with the basolateral amygdala noradrenergic system in memory consolidation
Authors: Roozendaal Benno , Lengvilas Ray , McGaugh James L. , Civelli Olivier , Reinscheid Rainer K.
Published: January 2007

Extensive evidence indicates that the basolateral complex of the amygdala (BLA) mediates hormonal and neurotransmitter effects on the consolidation of emotionally influenced memory and that such modulatory influences involve noradrenergic activation of the BLA. As the BLA also expresses a high density of receptors for orphanin FQ/nociceptin (OFQ/N), an opioid-like peptide with anxiolytic and amnestic properties, the present experiments investigated whether the BLA is involved in mediating OFQ/N effects on memory consolidation and whether such effects require noradrenergic activity. OFQ/N (0.01–100 pmol in 0.2 μL) administered bilaterally into the BLA of male Sprague-Dawley rats immediately after aversively motivated inhibitory avoidance training induced dose-dependent impairment on a 48-h retention trial. The β1-adrenoceptor antagonist atenolol (2.0 nmol) administered concurrently into the BLA potentiated the dose-response effects of OFQ/N. In contrast, immediate post-training infusions of the peptidergic OFQ/N receptor antagonist [Nphe1]nociceptin(1-13)NH2(1–100 pmol in 0.2 μL) into the BLA enhanced 48-h retention of inhibitory avoidance training, an effect that was blocked by coadministration of atenolol. Delayed infusions of OFQ/N or [Nphe1]nociceptin(1-13)NH2into the BLA administered either 6 or 3 h after training, respectively, or immediate post-training infusions of OFQ/N into the adjacent central amygdala did not significantly alter retention performance. These findings indicate that endogenously released OFQ/N interacts with noradrenergic activity within the BLA in modulating memory consolidation.
Impact of atorvastatin treatment on platelet‐activating factor acetylhydrolase and 15‐F2trans‐isoprostane in hypercholesterolaemic patients
Authors: Kom Ghainsom D. , Schwedhelm Edzard , Maas Renke , Schneider Lydia , Benndorf Ralf , Böger Rainer H.
Published: January 2007

What is already known about this subject

• Isoprostanes are the product of free radical oxidation of arachidonic acid bound to phospholipids.

• Their hydrolysis from phospholipids is presumably catalysed by phospholipases A2.

• Atorvastatin reduces protein concentrations of secretory PLA2s and concentrations of LDL, with which PAF‐AH (group VII phospholipase) is associated.

What this study adds

• Atorvastatin affects PAF‐AH activity and this effect is strongly associated with its lipid‐lowering effect, but it has no effect on groups IIA and V PLA2s' activity.

• Thus, PAF‐AH is no independent risk factor of cardiovascular diseases.

• Moreover, a role of PAF‐AH in the liberation of 15‐F2t‐isoP from phospholipids is excluded.

Aims

Isoprostanes are the product of free radical oxidation of arachidonic acid, whose hydrolysis from phospholipids is presumably catalysed by phospholipases A2 (PLA2s) such as group IIA or V PLA2s, or group VII PLA2[platelet‐activating factor acetylhydrolase (PAF‐AH), lipoprotein‐associated phospholipase]. Atorvastatin reduces concentrations of low‐density lipoprotein (LDL), with which PAF‐AH is associated, and PLA2s' protein concentrations. We investigated the effect of atorvastatin on PLA2s and PAF‐AH activity and the urinary excretion of 15‐F2trans‐isoprostane (15‐F2t‐IsoP, 8‐iso‐PGF2α, iPF2α‐III).

Methods

Twenty‐four hypercholesterolaemic individuals naive to lipid‐lowering therapy were randomized to atorvastatin 40 mg or placebo for 6 weeks. The 15‐F2t‐isoP urinary excretion (gas chromatography/mass spectrometry), PAF‐AH and group IIA and V PLA2 activities (photometry) were assessed at baseline and end‐point.

Results

At end‐point, 15‐F2t‐isoP urinary excretion concentrations as well as PLA2s' activity were unchanged under atorvastatin (mean change 0.21 ± 1.79 ng h−1, 95% confidence interval −0.92, 1.35 and 0.33 ± 0.94 nmol min−1 ml−1, −0.27, 0.93) and under placebo (mean change 0.69 ± 1.69 ng h−1, −0.52, 1.90 and 1.29 ± 2.16 nmol min−1 ml−1, −0.25, 2.84). Atorvastatin treatment decreased total (P < 0.001) and LDL‐cholesterol (P < 0.001) but had no effect on high‐density lipoprotein. PAF‐AH activity was lowered in the atorvastatin group (mean change − 5.27± 1.96 nmol min−1 ml−1, −6.51, −4.03, P < 0.001) but not in the placebo group (mean change 1.02 ± 1.64 nmol min−1 ml−1, 0.15, 2.20), and the change in PAF‐AH activity was correlated with that in total (P = 0.03) and LDL‐cholesterol (P = 0.03).

Conclusion

Our results show a lowering effect of atorvastatin on PAF‐AH activity associated with its lipid‐lowering effect and exclude a key role of PAF‐AH in the liberation of 15‐F2t‐isoP from phospholipids.
Modern management of non‐Hodgkin lymphoma in HIV‐infected patients
Authors: Mounier Nicolas , Spina Michele , Gisselbrecht Christian
Published: January 2007

Patients infected with human immunodeficiency virus (HIV) are at greater risk of developing non‐Hodgkin lymphoma than the general population and aggressive B‐cell lymphoma has become one of the most common of the initial acquired immunodeficiency syndrome (AIDS)‐defining illnesses. This review considers the prognostic factors and new approaches to the treatment of patients with AIDS‐related lymphoma (ARL). As highly active antiretroviral therapy (HAART) became available, the survival of many ARL patients has become comparable to that of HIV‐negative patients. This is partly due to the decrease in the incidence of opportunistic infections and improved prognosis. Both developments can also be attributed to new treatment strategies for ARL, such as the use of effective infusional regimens, Rituximab combinations and high‐dose therapy with autologous stem‐cell transplantation for relapsed disease. However, unresolved issues persist, such as the optimal therapy for patients with Burkitt ARL or central nervous system involvement.
Shigella chromosomal IpaH proteins are secreted via the type III secretion system and act as effectors
Authors: Ashida Hiroshi , Toyotome Takahito , Nagai Takeshi , Sasakawa Chihiro
Published: January 2007

Shigella possess 220 kb plasmid, and the major virulence determinants, called effectors, and the type III secretion system (TTSS) are exclusively encoded by the plasmid. The genome sequences of S. flexneri strains indicate that several ipaH family genes are located on both the plasmid and the chromosome, but whether their chromosomal IpaH cognates can be secreted from Shigella remains unknown. Here we report that S. flexneri strain, YSH6000 encodes seven ipaH cognate genes on the chromosome and that the IpaH proteins are secreted via the TTSS. The secretion kinetics of IpaH proteins by bacteria, however, showed delay compared with those of IpaB, IpaC and IpaD. Expression of the each mRNA of ipaH in Shigella was increased after bacterial entry into epithelial cells, and the IpaH proteins were secreted by intracellular bacteria. Although individual chromosomal ipaH deletion mutants showed no appreciable changes in the pathogenesis in a mouse pulmonary infection model, the ΔipaH‐null mutant, whose chromosome lacks all ipaH genes, was attenuated to mice lethality. Indeed, the histological examination for mouse lungs infected with the ΔipaH‐null showed a greater inflammatory response than induced by wild‐type Shigella, suggesting that the chromosomal IpaH proteins act synergistically as effectors to modulate the host inflammatory responses.
Peripheral and central mechanisms of visceral sensitization in man
Authors: Anand P. , Aziz Q. , Willert R. , Van Oudenhove L.
Published: January 2007

Abstract Visceral hypersensitivity (perception of gastrointestinal sensory events at a lower‐than‐normal threshold) is considered to be an important pathophysiological mechanism in the development of functional gastrointestinal disorders (FGIDs), such as irritable bowel syndrome, non‐cardiac chest pain and functional dyspepsia. These disorders are associated with significant health care and socioeconomic costs due to factors such as repeated visits to consultants, hospitalizations and work absenteeism. Despite the presence of extensive evidence linking visceral hypersensitivity and FGIDs, the mechanism(s) underlying visceral hypersensitivity has not been fully elucidated. Suggested hypotheses include sensitization of afferent neurones, both at the level of the enteric and the (afferent) autonomic nervous system (peripheral sensitization), sensitization of spinal cord dorsal horn neurones (central sensitization) and psychosocial factors/psychiatric comorbidity influencing the processing of afferent signals at the level of the brain. Importantly, these hypotheses may be complementary rather than mutually exclusive. However, the degree to which each of these mechanisms contributes to the overall perception of visceral pain, and therefore the generation of symptoms, still remains unclear. This article discusses the mechanisms that may underlie visceral hypersensitivity, with reference to FGIDs. Understanding these mechanisms is essential in order to improve the diagnosis and treatment of patients with these disorders.
COMPETITION AND RESOURCE EFFECTIVENESS IN EDUCATION*
Authors: MAYSTON DAVID
Published: January 2007

This paper examines the impact of competition in the markets for teachers and for housing on the long‐standing issue of the influence of school resourcing on educational attainment. The existence of such competition is found to imply not only downward bias in many earlier empirical estimates of the role of resources in the educational production function, but also powerful general equilibrium effects, especially for the impact of relative levels of school resources on the distribution of relative levels of educational attainment across individual schools, that highlight the importance of how resources are distributed across individual schools.
The Fate of Public International Law: Between Technique and Politics
Authors: Koskenniemi Martti
Published: January 2007

Public international law hovers between cosmopolitan ethos and technical specialization. Recently, it has differentiated into functional regimes such as ‘trade law’, ‘human rights law’, ‘environmental law’ and so on that seek to ‘manage’ global problems efficiently and empower new interests and forms of expertise. Neither of the principal legal responses to regime‐formation – constitutionalism and pluralism – is adequate, however. The emergence of regimes resembles the rise of nation States in the late nineteenth century. But if nations are ‘imagined communities’, so are regimes. Reducing international law to a mechanism to advance functional objectives is vulnerable to the criticisms raised against thinking about it as an instrument for state policy: neither regimes nor states have a fixed nature or self‐evident objectives. They are the stories we tell about them. The task for international lawyers is not to learn new managerial vocabularies but to use the language of international law to articulate the politics of critical universalism.
Trends in Intergenerational Mobility across Offspring's Earnings Distribution in Norway
Authors: BRATBERG ESPEN , NILSEN ØIVIND ANTI , VAAGE KJELL
Published: January 2007

Using register data for Norwegian cohorts born in 1950, 1955, and 1960, we found intergenerational earnings mobility to be high, and lower at the lower end of offspring's earnings distribution than at the upper end. The findings also indicate that mobility has increased over time and that the increase is somewhat higher for lower earnings. The increase in earnings mobility over time is larger for women than for men.
Luteinizing hormone receptor mediates neuronal pregnenolone production via up‐regulation of steroidogenic acute regulatory protein expression
Authors: Liu Tianbing , Wimalasena Jay , Bowen Richard L. , Atwood Craig S.
Published: January 2007

The functional consequences of luteinizing hormone/human chorionic gonadotropin signaling via neuronal luteinizing hormone/human chorionic gonadotropin receptors expressed throughout the brain remain unclear. A primary function of luteinizing hormone (LH) in the gonads is the stimulation of sex steroid production. As LH can cross the blood–brain barrier, present in cerebrospinal fluid and is expressed by neuronal cells, we tested whether LH might also modulate steroid synthesis in the brain. Treatment of differentiated rat primary hippocampal neurons and human M17 neuroblastoma cells with LH (100 mIU/mL) resulted in a twofold increase in pregnenolone secretion in both cell types, suggesting an increase in P450scc‐mediated cleavage of cholesterol to pregnenolone and its secretion from neurons. To explore how LH might regulate the synthesis of pregnenolone, the precursor for steroid synthesis, we treated rat primary hippocampal neurons with LH (0, 10 and 100 mIU/mL) and measured changes in the expression of LH receptor and steroidogenic acute regulatory protein (StAR). LH induced a rapid (within 30 min) increase in the expression of StAR, but induced a dose‐dependent decrease in LH receptor expression. Consistent with these results, the suppression of serum LH in young rats treated with leuprolide acetate for 4 months down‐regulated StAR expression, but increased LH receptor expression in the brain. Taken together, these results indicate that LH induces neuronal pregnenolone production by modulating the expression of the LH receptor, increasing mitochondrial cholesterol transport and increasing P450scc‐mediated cleavage of cholesterol for pregnenolone synthesis and secretion.
How Caregivers and Workers Fared in Cash and Counseling
Authors: Foster Leslie , Dale Stacy B. , Brown Randall
Published: January 2007

Objectives. To assess the effects of Cash and Counseling on Medicaid beneficiaries' primary informal caregivers and describe the experiences of their directly hired workers.

Study Setting. Beneficiaries in Arkansas, Florida, and New Jersey voluntarily enrolled in the demonstration and were randomly assigned to direct their own Medicaid supportive services as Cash and Counseling consumers (the treatment group) or to rely on Medicaid services as usual (the control group). Beneficiaries identified their primary informal caregiver during a baseline interview and their primary paid worker during a 9‐month follow‐up interview.

Data Sources. Data were collected through telephone interviews with caregivers and workers. These interviews were conducted about 10 months after beneficiaries' random assignment, between February 2000 and May 2003, depending on the state.

Data Analysis Methods. We estimated program effects with regression and logit models and compared the mean characteristics of directly hired workers and agency workers, by state.

Principal Findings. Compared with caregivers in the control group, those in the treatment group had modestly to substantially better outcomes for measures of satisfaction with care, worry, and physical and financial strain. For hours of care and emotional strain, outcomes in the treatment group were similar to or somewhat better than those in the control group. Directly hired workers reported greater satisfaction with wages, similar satisfaction with working conditions, and similar rates of injuries as agency workers. Workers who were related to the beneficiary reported more emotional strain than agency workers.

Conclusions. Cash and Counseling can lessen some of the burden associated with caring for a child or adult with disabilities. The experiences of hired workers suggest consumer direction is a sustainable option, but support networks for workers might be a welcome program improvement.
The Public/Private Partnership behind the Cash and Counseling Demonstration and Evaluation: Its Origins, Challenges, and Unresolved Issues
Authors: Knickman James R. , Stone Robyn I.
Published: January 2007

Objective. To discuss why and how the Cash and Counseling Demonstration came to be designed, implemented, and evaluated through a partnership between the U.S. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation (ASPE) and the Robert Wood Johnson Foundation (RWJF).

Principal Findings. This public/private partnership was created by two colleagues who were motivated by the need for funding to conduct a large‐scale demonstration and evaluation, the prestige that both organizations brought to the project, the ability to draw on both organizations' experience and expertise, and the potential to maximize flexibility in the design and implementation of the demonstration. The partnership, which has lasted over a decade and has supported two generations of Cash and Counseling programs, overcame several challenges including getting approval for the project through their respective bureaucracies, managing the decision making process and the ongoing program across the two organizations, dealing with leadership and staff turnover, and reaching consensus on how to apportion credit for the success of the program. Several unresolved issues remain, including how the program gets operationalized within each state, how case management is addressed within the context of a consumer‐directed model like Cash and Counseling, how quality is assured in this type of program, and how the Internal Revenue Service views and treats Cash and Counseling and other consumer‐directed programs.

Conclusion. This public/private partnership is an illustration of how public dollars can be leveraged effectively to examine a pressing policy issue and to produce information that can be translated into better policy and practice. The ASPE/RWJF collaboration made it possible to develop, test, and expand a policy‐oriented demonstration project that has become a pivotal strategy in most states' efforts to build their home and community‐based service systems.
Consumer Enrollment and Experiences in the Cash and Counseling Program
Authors: Schore Jennifer , Foster Leslie , Phillips Barbara
Published: January 2007

Study Context. Consumer direction of Medicaid supportive services raises concerns about who should be permitted to self‐direct, whether consumers should be allowed to pay family members, whether a self‐directed option increases demand for services, and how to ensure quality. The Cash and Counseling programs contained features designed to address these concerns.

Demonstration Enrollment. Many consumers used representatives to manage the allowance on their behalf and others chose to disenroll, suggesting that beneficiaries were capable of deciding for themselves whether the programs were suitable for them. Participation among eligible beneficiaries during the demonstration was modest, suggesting that consumer direction did not itself substantially increase the demand for services.

Consumer Experiences. Most consumers were able to assume the role of employer without difficulty, many hiring relatives or acquaintances as workers. In each state, more than 85 percent reported they would recommend the program to others seeking more control over their care, and more than half said the program had “improved their lives a great deal.”
A Comparative Pharmacokinetic Study in Healthy Volunteers of the Effect of Carbamazepine and Oxcarbazepine on Cyp3a4
Authors: Andreasen Astrid‐Helene , Brøsen Kim , Damkier Per
Published: January 2007

Summary: Purpose:Carbamazepine (CBZ) and oxcarbazepine (OXCZ) are well‐known inducers of drug metabolism via CYP3A4. Indirect interaction studies and clinical experience suggest that CBZ has a stronger potential in this regard than OXCZ. However this has never been subject to a direct comparative study. We performed a study in healthy volunteers to investigate the relative inductive effect of CBZ and OXCZ on CYP3A4 activity using the metabolism of quinidine as a biomarker reaction.

Methods:Ten healthy, male volunteers participated in an open, randomized crossover study consisting of two periods separated by a 4‐week wash‐out period. The subjects received 1200 mg oral OXCZ daily for 17 days and 800 mg oral CBZ for 17 days. A single 200 mg oral dose of quinidine was administered at baseline and following administration of CBZ and OXCZ. Outcome parameters were the formation clearance of 3‐hydroxyquinidine dose and the ratio of the AUCs of 3‐hydroxyquinidine to quinidine.

Results:Formation clearance of 3‐hydroxyquinidine was increased by means of 89% (CI: 36–164; p = 0.0022) and 181% (CI: 120–260, p < 0.0001) after treatment with OXCZ and CBZ, respectively, compared to baseline. The relative inductive effect of CBZ was 46% higher than for OXCZ. AUC ratio increased by means of 161% (CI: 139–187, p < 0.0001) (OXCZ) and 222% (CI: 192–257, p < 0.0001) (CBZ). Quinidine Cmax decreased by means of 29% (CI: 16–40, p = 0.0018) (OXCZ) and 33% (CI: 18–45, p = 0.0020) (CBZ). T½decreased by means of 12% (CI: 6–17, p < 0.0014) (OXCZ) and 32% (CI: 25–38, p < 0.0001) (CBZ). tmaxwas not changed in either period.

Conclusion:We confirm a clinically significant inductive effect of both OXCZ and CBZ. The inductive effect of CBZ was about 46% higher than that of OXCZ, a difference that may be of clinical relevance.
Effects of honeydew sugar composition on the longevity of Aphidius ervi
Authors: Hogervorst Petra A. M. , Wäckers Felix L. , Romeis Jörg
Published: January 2007

Feeding on sugar‐rich foods such as nectar and honeydew is important for survival of many adult parasitoids. Especially in agricultural systems, honeydew is often the most prevalent carbohydrate source. However, relative to plant nectar, honeydew may be relatively unsuitable, as a result of an unfavourable sugar composition or the presence of secondary plant compounds. We studied survival of the aphid parasitoid Aphidius ervi Haliday (Hymenoptera: Braconidae) on honeydew collected from various aphid species feeding on potato (Solanum tuberosum L., cv. Desiree) (Solanaceae), wheat (Triticum aestivum L., cv. Bobwhite) (Poaceae), or artificial diet, as well as the sugar composition of the different honeydews. Honeydews from the tested aphid species on potato, wheat, or artificial diet were found to be relatively suitable food sources for adult A. ervi, although not always as suitable as a 2 M sucrose solution. There were differences in honeydew sugar composition among the different aphid species on the various host plants. Multivariate statistics showed that the factor ‘aphid species’ had a significant influence on the sugar composition of the honeydew, explaining 27% of the variation in the potato system and 89% in the wheat system. When exploring the relationship between carbohydrate composition of the honeydews from aphids on potato and wheat plants, and their nutritional value for A. ervi, data revealed that differences in parasitoid longevity can to some extent be explained by carbohydrate composition. Furthermore, our results confirm that sucrose and its hexose components glucose and fructose are very suitable carbohydrate sources for hymenopteran parasitoids and show that parasitoid survival on an equimolar solution of the two monosaccharides glucose and fructose does not exceed performance on the disaccharide sucrose.
Detection of down‐regulated acetaldehyde dehydrogenase 1 in atopic dermatitis patients by two‐dimensional electrophoresis
Authors: Park Yong‐Doo , Lyou You‐Jeong , Yang Jun‐Mo
Published: January 2007

Abstract:  We conducted the proteomic studies to detect the dysregulated proteins in the atopic dermatitis (AD) proteome obtained from the patient‐derived primary cultured fibroblasts. Acetaldehyde dehydrogenase 1 (ALDH1) was detected as being significantly down‐regulated at the pH ranges of 6–9 and 4–7. The transcriptional levels of ALDH1, as detected by RT‐PCR and real‐time PCR, further confirmed the down‐regulated phenomena for all the AD‐fibroblasts (n = 20). The expression levels of ALDH1 in the whole skin tissue samples were further supported by the results of the primary cultured samples. These findings clearly demonstrate that ALDH1 can be a dermal biomarker for AD disease.
Thermography as a Physiological Measure of Sexual Arousal in Both Men and Women
Authors: Kukkonen Tuuli M. , Binik Yitzchak M. , Amsel Rhonda , Carrier Serge
Published: January 2007

Introduction

Current physiological measures of sexual arousal are intrusive, hard to compare between genders, and quantitatively problematic.

Aim

To investigate thermal imaging technology as a means of solving these problems.

Methods

Twenty-eight healthy men and 30 healthy women viewed a neutral film clip, after which they were randomly assigned to view one of three other video conditions: (i) neutral (N=19); (ii) humor (N=19); and (iii) sexually explicit (N=20).

Main Outcome Measures

Genital and thigh temperatures were continuously recorded using a TSA ImagIR camera. Subjective measures of sexual arousal, humor, and relaxation were assessed using Likert-style questions prior to showing the baseline video and following each film.

Results

Statistical (Tukey HSD) post-hoc comparisons (P <0.05) demonstrated that both men and women viewing the sexually arousing video had significantly greater genital temperature (mean=33.89°C, SD=1.00) than those in the humor (mean=32.09°C, SD=0.93) or neutral (mean=32.13°C, SD=1.24) conditions. Men and women in the erotic condition did not differ from each other in time to peak genital temperature (men mean=664.6 seconds, SD=164.99; women mean=743 seconds, SD=137.87). Furthermore, genital temperature was significantly and highly correlated with subjective ratings of sexual arousal (range r =0.51–0.68, P <0.001). There were no significant differences in thigh temperature between groups.

Conclusion

Thermal imaging is a promising technology for the assessment of physiological sexual arousal in both men and women.
Sexual Dysfunctions: Classifications and Definitions
Authors: Hatzimouratidis Konstantinos , Hatzichristou Dimitrios
Published: January 2007

Sexual classification systems are based on precise and understandable definitions of sexual dysfunctions and are needed for investigative research, determination of diagnostic standards, and delineation of treatment strategies. The four major categories of sexual dysfunctions include disorders of sexual desire/interest, arousal, orgasm, and sexual pain. The purpose of this article is to review the major features, differences, and similarities of the six classification systems widely used in sexual medicine, including the International Classification of Diseases, the Diagnostic and Statistical Manual of Mental Disorders, the National Institute of Health Consensus Conference on Impotence, the American Foundation for Urologic Diseases, International Consensus Conference on Women’s Sexual Dysfunction, and the First and Second International Consultations on Sexual Dysfunctions.
Comparison between a built‐in “dual side” chest imaging device and a standard “single side” CR
Authors: Riccardi Lucia , Cauzzo Maria Cristina , Fabbris Roberto , Tonini Eugenia , Righetto Roberto
Published: January 2007

An integrated readout computed radiography system (Fuji XU‐D1) incorporating dual‐side imaging plates (ST‐55BD) was analyzed in terms of modulation transfer function (MTF), noise power spectrum (NPS), and detective quantum efficiency (DQE) for standard beam qualities RQA 9 and RQA 5. NPS and DQE were assessed using a detector entrance air kerma consistent with clinical practice for chest radiography. Similar investigation was performed on a standard reader (Fuji FCR 5000) using single‐side imaging plates (ST‐VI). Negligible differences were found between the MTFs of the two imaging systems for RQA 9, whereas for RQA 5 the single‐side system exhibited slightly superior MTF. Regarding noise response, the dual‐side system turned out to be better performing for both beam qualities over a wide range of frequencies. For RQA 9, at , the DQE of the dual‐side system was moderately higher over the whole frequency range, whereas for RQA 5, at , significant improvement was found at low‐ and midrange frequencies. As an example, at , the following improvements in the DQE of the dual‐side system were observed: (RQA 9, at ), (RQA 9, at ), and (RQA 5, at ).
Optimization of dual‐energy imaging systems using generalized NEQ and imaging task
Authors: Richard S. , Siewerdsen J. H.
Published: January 2007

Dual‐energy (DE) imaging is a promising advanced application of flat‐panel detectors (FPDs) with a potential host of applications ranging from thoracic and cardiac imaging to interventional procedures. The performance of FPD‐based DE imaging systems is investigated in this work by incorporating the noise‐power spectrum associated with overlying anatomical structures (“anatomical noise” modeled according to acharacteristic) into descriptions of noise‐equivalent quanta (NEQ) to yield the generalized NEQ (GNEQ). Signal and noise propagation in the DE imaging chain is modeled by cascaded systems analysis. A Fourier‐based description of the imaging task is integrated with the GNEQ to yield a detectability index used as an objective function for optimizing DE image reconstruction, allocation of dose between low‐ and high‐energy images, and selection of low‐ and high‐kVp. Optimal reconstruction and acquisition parameters were found to depend on dose; for example, optimal kVp varied fromat typical radiographic dose levels (entrance surface dose, ESD) but increased toat high dose. At very low dose, detectability index indicates an optimal low‐energy technique ofbut was largely insensitive to the choice of high‐kVp in the range. Similarly, optimal dose allocation, defined as the ratio of low‐energy ESD and the total ESD, varied from 0.2 to 0.4 over the range. Furthermore, two applications of the theoretical framework were explored: (i) the increase in detectability for DE imaging compared to conventional radiography; and (ii) the performance of single‐shot vs double‐shot DE imaging, wherein the latter is found to have a DQE approximately twice that of the former. Experimental and theoretical analysis of GNEQ and task‐based detectability index provides a fundamental understanding of the factors governing DE imaging performance and offers a framework for system design and optimization.
How extensive of a 4D dataset is needed to estimate cumulative dose distribution plan evaluation metrics in conformal lung therapy?a)
Authors: Rosu Mihaela , Balter James M. , Chetty Indrin J. , Kessler Marc L. , McShan Daniel L. , Balter Peter , Ten Haken Randall K.
Published: January 2007

The purpose of this study was to investigate the number of intermediate states required to adequately approximate the clinically relevant cumulative dose to deforming/moving thoracic anatomy in four‐dimensional (4D) conformal radiotherapy that uses photons to target tumors. Four patients were involved in this study. For the first three patients, computed tomography images acquired at exhale and inhale were available; they were registered using B‐spline deformation model and the computed transformation was further used to simulate intermediate states between exhale and inhale. For the fourth patient, 4D‐acquired, phase‐sorted datasets were available and each dataset was registered with the exhale dataset. The exhale‐inhale transformation was also used to simulate intermediate states in order to compare the cumulative doses computed using the actual and the simulated datasets. Doses to each state were calculated using the Dose Planning Method (DPM) Monte Carlo code and dose was accumulated for scoring on the exhale anatomy via the transformation matrices for each state and time weighting factors. Cumulative doses were estimated using increasing numbers of intermediate states and compared to simpler scenarios such as a “2‐state” model which used only the exhale and inhale datasets or the dose received during the average phase of the breathing cycle. Dose distributions for each modeled state as well as the cumulative doses were assessed using dose volume histograms and several treatment evaluation metrics such as mean lung dose, normal tissue complication probability, and generalized uniform dose. Although significant “point dose” differences can exist between each breathing state, the differences decrease when cumulative doses are considered, and can become less significant yet in terms of evaluation metrics depending upon the clinical end point. This study suggests that for certain “clinical” end points of importance for lung cancer, satisfactory predictions of accumulated total dose to be received by the distorting anatomy can be achieved by calculating the dose to but a few (or even simply the average) phases of the breathing cycle.
Evaluation of the spatial resolution characteristics of a cone‐beam breast CT scanner
Authors: Kwan Alexander L. C. , Boone John M. , Yang Kai , Huang Shih‐Ying
Published: January 2007

The purpose of this study was to examine the spatial resolution of a prototype pendant‐geometry cone‐beam breast computed tomography (CT) system. Modulation transfer functions (MTFs) of the reconstructed image in the coronal ( and ) plane were computed as a function of the cone angle, the radial distance from the axis of rotation, the size of the reconstruction matrix, the back‐projection filter used, and the number of projections acquired for the reconstruction. The results show that the cone angle and size of the reconstruction matrix have minimal impact on the MTF, while the MTF degraded radially from the axis of rotation (from 0.76 at from axis of rotation down to 0.37 at from axis of rotation at ). The Ramp reconstruction filter increases the MTF near the axis of rotation relative to the Shepp‐Logan filter, while an increase in the number of projections from 500 to 1000 increased the MTF near the periphery of the reconstructed image. The MTF in the direction (anterior‐posterior direction) was also evaluated. The ‐direction MTF values tend to be higher when compared to the coronal MTF (0.85 at ), and tend to be very constant throughout the coronal plane direction. The results suggest that an increase in the MTF for the prototype breast CT system is possible by optimizing various scanning and reconstruction parameters.
Cluster Analysis of Hourly Wind Measurements to Reveal Synoptic Regimes Affecting Air Quality
Authors: Beaver Scott , Palazoglu Ahmet
Published: January 2007

A clustering algorithm is developed to study hourly, ground-level wind measurements obtained from a network of monitoring stations positioned throughout the San Francisco Bay Area of California. A statistical model based on principal components analysis (or empirical orthogonal functions) is used to cluster these autocorrelated and cross-correlated observations. Patterns at the synoptic time scale are isolated by using windowing and scaling operations to treat the data. Four dominant wind patterns that affect air quality are identified for the study region, and summer days from 8 yr of historical data are assigned to these modes. One cluster captures a high pressure system over the western United States, the anticyclonic winds of which block the typical marine flow through the study region. Differential heating convects a polluted air mass to a nearby valley in which severe episodes of higher-than-average ozone composition occur. A second pattern represents a seasonal, offshore ridge of high pressure that reduces marine flow and produces a shallow boundary layer. These two clusters capture distinct meteorological regimes that are favorable to ozone buildup and account for nearly all “exceedances” of ozone air-quality standards. Two other clusters have strong marine flow that inhibits ozone buildup.