bluuebunny/crossref_metadata_2025 huggingface dataset:
How can occupational therapy improve the daily performance and communication of an older patient with dementia and his primary caregiver?
Authors: Graff Maud J.L. , Vernooij-Dassen Myrra J.M. , Zajec Jana , Olde-Rikkert Marcel G.M. , Hoefnagels Willibrord H.L. , Dekker Joost
Published: November 2006

Objective: To enhance insight into the process of occupational therapy (OT) and the changes after OT, in an older patient with mild dementia and his primary caregiver.

Design and setting: Case study: content analysis of an OT patient record.

Intervention: System-based OT at home using a guideline focusing on both patient's performance in daily activities and caregiver's cognition on patient behaviour and caregiver role and focusing on adaptation of the physical environment.

Measures: Triangulation of results of qualitative content analysis and quantitative description using the following measures: Brief Cognitive Rating Scale (BCRS), Assessment of Motor and Process Skills (AMPS), Interview of Deterioration in Daily Activities in Dementia (IDDD), Canadian Occupational Performance Measurement (COPM), Dementia Quality of Life Instrument (DQOL), Sense of Competence Scale (SCQ) and the Mastery Scale.

Results: The global categories derived from content analysis were: daily performance and communication. The specific categories were the patient with dementia, his or her caregiver and the occupational therapist. Important themes derived from content analysis were: patient's capacity for pleasure, autonomy and appreciation in performing daily activities and caregiver's competence. Patient's changes reported after OT: more initiative, autonomy and pleasure in performing daily activities, increase of quality of life; caregiver's changes reported after OT: improved communication and supervision skills, changed cognition on patient behaviour and caregiver role, improved sense of competence. The quantitative results showed an improved daily performance (e.g. initiative, motor and process skills, need for assistance) and quality of life of the patient and improved sense of competence, quality of life and mastery of the situation of the caregiver after OT intervention. Thus the results of the qualitative content analysis were supported by the quantitative results. Additionally, based on the results of the content analysis an exploratory and system-based model has been developed connecting OT diagnosis and OT treatment at home for patients with dementia and their primary caregivers.

Conclusion: This case study provides information on how occupational therapy can improve the daily performance, communication, sense of competence and quality of life of an older patient with dementia and his or her primary caregiver. A combination of education, setting feasible goals, using adaptations in physical environment, training compensatory skills, training supervision skills, and changing dysfunctional cognitions on patient behaviour and caregiver role seemed to be successful. A randomized controlled trial must provide information on the effects of OT at home for older patients with dementia and their primary caregivers.
Motor Learning and Parkinson Disease: Refinement of Movement Velocity and Endpoint Excursion in a Limits of Stability Balance Task
Authors: Jessop Reuben T. , Horowicz Christopher , Dibble Leland E.
Published: November 2006

Objective. To investigate the effects of practice on performance and retention of a balance task in persons with Parkinson disease (PD).

Methods. Ten persons with PD and 10 age and gender-matched healthy control subjects were tested on an anticipatory, static base of support, limits of stability (LOS) balance task on a force plate. The motor learning paradigm utilized for all subjects included an acquisition phase and retention tests at 24 h and 1 week after acquisition. A force plate was used for testing and to collect outcome measures including movement velocity (MVL), endpoint excursion (EPE), and directional control. Data were analyzed for differences between groups and change over time.

Results.Persons with PD demonstrated performance deficits relative to controls for MVL at all testing periods ( P < 0.05), and initially for EPE ( P < 0.05), but were able to maintain significant improvements through retention testing relative to baseline ( P < 0.05).

Conclusions. Persons with PD demonstrated unimpaired capacity for motor learning in a LOS balance task for MVL and EPE, although performance deficits remained for MVL. The results concur with previous motor learning research of upper extremity tasks by suggesting that individuals with mild to moderate PD exhibit a preserved ability to benefit from practice as a means of improving balance task performance.
Evolution of Subjective Visual Vertical Perturbation After Stroke
Authors: Bonan I. V. , Leman M. C. , Legargasson J. F. , Guichard J. P. , Yelnik A. P.
Published: November 2006

Objective. The perception of visual verticality is often perturbed after stroke and might be an underlying component of imbalance. The aim of this study was to describe the evolution of visual vertical (VV) perturbation and to investigate the factors affecting it.

Methods. Thirty patients with hemiplegia after a single hemispheric stroke (17 left lesioned [LL] and 13 right lesioned [RL]) were studied. Visual verticality was tested within 45 days of stroke, and then at 3 and 6 months. Subjects sat in a dark room and adjusted a luminous rod to the vertical position. The differences between patients’ adjustments and vertical were calculated. The effects on VV evolution of the side, size, type, and location of the lesion were tested.

Results. Sixty percent of the recent stroke patients had an initial inaccurate perception of verticality, and 39% of these patients recovered during the 1st 3 months after stroke. The evolution of VV tilt depended on the side of the lesion ( P = 0.01), with better recovery in LL patients. None of the other factors studied affected VV normalization.

Conclusions. The poorer recovery of vertical perception after right-side stroke might be due to the predominant role of the right hemisphere in spatial cognition, and might be involved in the poorer recovery of balance after stroke in RL patients.
Recovery of Grasp versus Reach in People with Hemiparesis Poststroke
Authors: Lang Catherine E. , Wagner Joanne M. , Edwards Dorothy F. , Sahrmann Shirley A. , Dromerick Alexander W.
Published: November 2006

Background and Objective. The authors recently found that grasping was not relatively more disrupted than reaching in people with acute hemiparesis. They now extend this work to the recovery of reach versus grasp.

Methods. Hemiparetic subjects were tested acutely, after 90 days, and then after 1 year poststroke, and a control group was evaluated once. Using kinematic techniques, subjects were studied performing reach and reach-to-grasp movements. The authors quantified 3 characteristics of performance for each movement: speed, accuracy, and efficiency, where an efficient movement was defined as a movement directly to the target without extraneous or abnormally circuitous movements. To evaluate the relative deficits and recovery in reach versus grasp, performance measures were converted to z scores using control group means and standard deviations.

Results. The authors’ results showed that, starting with small deficits in speed acutely, both reach speed and grasp speed improved over time. Deficits in accuracy were greater in the reach than the grasp acutely, and these deficits lessened such that by the 90-day time point, the relative accuracy of the 2 movements was the same. In contrast, deficits in efficiency were greater in the grasp than the reach acutely, and grasp efficiency did not recover. The majority of recovery in reaching and grasping occurred by the 90-day time point, with little change occurring between the 90-day and 1-year time points.

Conclusions. The authors hypothesize that, in chronic hemiparesis, purposeful movements requiring distal control may be more impaired than purposeful movements requiring proximal control, not because of the initial lesion, but because, over the course of recovery, spared components of the descending motor systems may be able to compensate for the accuracy deficits in reaching (proximal control) but not the efficiency deficits in grasping (distal muscular control).
Gene-expression profiling of systemic anaplastic large-cell lymphoma reveals differences based on ALK status and two distinct morphologic ALK+ subtypes
Authors: Lamant Laurence , Reyniès Aurélien de , Duplantier Marie-Michèle , Rickman David S. , Sabourdy Frédérique , Giuriato Sylvie , Brugières Laurence , Gaulard Philippe , Espinos Estelle , Delsol Georges
Published: November 2006

With the use of microarray gene-expression profiling, we analyzed a homogeneous series of 32 patients with systemic anaplastic large-cell lymphoma (ALCL) and 5 ALCL cell lines. Unsupervised analysis classified ALCL in 2 clusters, corresponding essentially to morphologic subgroups (ie, common type vs small cell and “mixed” variants) and clinical variables. Patients with a morphologic variant of ALCL had advanced-stage disease. This group included a significant number of patients who experienced early relapse. Supervised analysis showed that ALK+ALCL and ALK− ALCL have different gene-expression profiles, further confirming that they are different entities. Among the most significantly differentially expressed genes between ALK+ and ALK− samples, we found BCL6, PTPN12, CEBPB, and SERPINA1 genes to be overexpressed in ALK+ ALCL. This result was confirmed at the protein level for BCL-6, C/EBPβ and serpinA1 through tissue microarrays. The molecular signature of ALK− ALCL included overexpression of CCR7, CNTFR, IL22, and IL21 genes but did not provide any obvious clues to the molecular mechanism underlying this tumor subtype. Once confirmed on a larger number of patients, the results of the present study could be used for clinical and therapeutic management of patients at the time of diagnosis.
Impact of blood transfusions on outcome after pneumonectomy for thoracic malignancies
Authors: Thomas P. , Michelet P. , Barlesi F. , Thirion X. , Doddoli C. , Giudicelli R. , Fuentes P.
Published: November 2006

The aim of the present study was to determine the risk factors and impact on outcome of blood transfusions following pneumonectomy for thoracic malignancies.

A retrospective analysis of 432 consecutive patients was carried out, of whom 183 (42.4%) were transfused post-operatively. The associations between blood transfusions and 20 variables were assessed by univariate and multivariate analysis. Survival analysis included log-rank test and Cox regression model.

Patient age, neoadjuvant treatment, completion pneumonectomy and extended procedures were independent predictors of transfusion. It was found that 30-day mortality increased significantly from 2.4% (no transfusion) to 10.9 and 21.9% (≤2 and >2 red blood cell packs, respectively). Blood transfusion was the strongest predictor of 30-day mortality (odds ratio (OR) 10; 95% confidence interval (CI): 3.7–27), respiratory failure (OR 19.2; 95% CI 7.4–49.4) and infectious complications (OR 3; 95% CI 1.5–6.2). In the 367 lung cancer patients, a significantly lower 5-yr survival was observed in univariate analysis of transfused patients (27.8±5.4%versus39.4±4.5%). In a Cox regression analysis, blood transfusion was no longer found to be significant.

A dose-related correlation is suggested between blood transfusion and early mortality through an increase of infectious and respiratory complications. In contrast, blood transfusion had no independent adverse impact on long-term survival.
Ultrasound-assisted transthoracic biopsy: fine-needle aspiration or cutting-needle biopsy?
Authors: Diacon A. H. , Theron J. , Schubert P. , Brundyn K. , Louw M. , Wright C. A. , Bolliger C. T.
Published: November 2006

The present study compared the diagnostic yield of ultrasound-assisted cutting-needle biopsy (CNB) and fine-needle aspiration biopsy (FNAB) in chest lesions.

A physician performed ultrasound and FNAB with a 22-G spinal needle in all patients, directly followed by a 14-G CNB in patients without contraindication.

A total of 155 consecutive lesions arising from the lung (74%), pleura (12%), mediastinum (11%) or chest wall (3%) in patients with a final diagnosis of lung carcinoma (74%), other malignant tumours (12%), non-neoplastic disease (9%) or unknown (5%) were prospectively included. The overall diagnostic yield was 87%. Combined specimens were obtained in 123 lesions (79%). In these, yields of FNAB, CNB and both methods combined were 82, 76 and 89%, respectively. FNAB was significantly better than CNB in lung carcinoma (95versus81%) but CNB was superior in noncarcinomatous tumours and in benign lesions. On-site cytology was 90% sensitive and 100% specific for predicting a positive FNAB. One patient required drainage for pneumothorax (0.6%).

Ultrasound-assisted fine-needle aspiration biopsy performed by chest physicians is an accurate and safe initial diagnostic procedure in patients with a high clinical probability of lung carcinoma. All other patients should undergo concurrent fine-needle aspiration biopsy and cutting-needle biopsy.
Exhaled breath condensate pH standardised for CO2partial pressure
Authors: Kullmann T. , Barta I. , Lázár Z. , Szili B. , Barát E. , Valyon M. , Kollai M. , Horváth I.
Published: November 2006

Exhaled breath condensate (EBC) pH is considered to reflect the acid-base balance of the airways. Current pH measurements do not take into account the effect of CO2. The aim of the present study was to determine the effect of condensate CO2partial pressure on pH and to provide a more precise mode of EBC pH determination.

Condensate pH and CO2partial pressure were measured in parallel from 12 healthy volunteers and 12 asthmatics using a blood gas analyser in neat, argon de-aerated and CO2-loaded samples. The regression analysis was used to test the relationship between pH and CO2, and to calculate the pH at a CO2level of 5.33 kPa (physiological alveolar CO2partial pressure). Reproducibility of different pH readings was compared using the Bland–Altman test.

Condensate CO2concentration was variable both in neat and argon de-aerated samples. There was a close negative logarithmic relationship between CO2and pH. Calculation of pH at a CO2level of 5.33 kPa provided reproducibility approximately six times as good as that of the currently used measurements.

Condensate CO2partial pressure influences pH measurements. Determination of pH at a standard CO2level provides the most reproducible condensate pH values to date.
Vitamin A supplementation in Tanzania: the impact of a change in programmatic delivery strategy on coverage
Authors: Masanja Honorati , Schellenberg Joanna Armstrong , Mshinda Hassan M , Shekar Meera , Mugyabuso Joseph KL , Ndossi Godwin D , de Savigny Don
Published: November 2006

Background

Efficient delivery strategies for health interventions are essential for high and sustainable coverage. We report impact of a change in programmatic delivery strategy from routine delivery through the Expanded Programme on Immunization (EPI+) approach to twice-yearly mass distribution campaigns on coverage of vitamin A supplementation in Tanzania

Methods

We investigated disparities in age, sex, socio-economic status, nutritional status and maternal education within vitamin A coverage in children between 1 and 2 years of age from two independent household level child health surveys conducted (1) during a continuous universal targeting scheme based on routine EPI contacts for children aged 9, 15 and 21 months (1999); and (2) three years later after the introduction of twice-yearly vitamin A supplementation campaigns for children aged 6 months to 5 years, a 6-monthly universal targeting scheme (2002). A representative cluster sample of approximately 2,400 rural households was obtained from Rufiji, Morogoro Rural, Kilombero and Ulanga districts. A modular questionnaire about the health of all children under the age of five was administered to consenting heads of households and caretakers of children. Information on the use of child health interventions including vitamin A was asked.

Results

Coverage of vitamin A supplementation among 1–2 year old children increased from 13% [95% CI 10–18%] in 1999 to 76% [95%CI 72–81%] in 2002. In 2002 knowledge of two or more child health danger signs was negatively associated with vitamin A supplementation coverage (80% versus 70%) (p = 0.04). Nevertheless, we did not find any disparities in coverage of vitamin A by district, gender, socio-economic status and DPT vaccinations.

Conclusion

Change in programmatic delivery of vitamin A supplementation was associated with a major improvement in coverage in Tanzania that was been sustained by repeated campaigns for at least three years. There is a need to monitor the effect of such campaigns on the routine health system and on equity of coverage. Documentation of vitamin A supplementation campaign contacts on routine maternal and child health cards would be a simple step to facilitate this monitoring.
Reproducibility of target volumes generated using uncoached 4-dimensional CT scans for peripheral lung cancer
Authors: van der Geld Ylanga G , Lagerwaard Frank J , van Sörnsen de Koste John R , Cuijpers Johan P , Slotman Ben J , Senan Suresh
Published: November 2006

Background

4-dimensional CT (4DCT) scans are increasingly used to account for mobility during radiotherapy planning. As variations in respiratory patterns can alter observed motion, with consequent changes in the generated target volumes, we evaluated the reproducibility of 4D target volumes generated during repeat uncoached quiet respiration.

Methods

A retrospective analysis was performed on two successive scans (4DCT1 and 4DCT2) generated at the same scanning session for 26 patients with peripheral lung cancer treated with stereotactic radiotherapy (SRT). The volume and position of planning target volumes (PTV4DCT1 and PTV4DCT2) contoured on both scans were compared, and a dosimetric analysis performed. A SRT plan optimized for each PTV was sequentially applied to the other PTV, and coverage by the 80% isodose was evaluated. Color intensity projections (CIP) were used to evaluate regions of underdosage.

Results

No significant volumetric differences were observed between the two PTVs (t-Test p = 0.60). The average displacement of the center of mass between corresponding PTVs was 1.4 ± 1.0 mm, but differences in position were 2.0 mm or greater in 5 cases (19%). Coverage of both PTVs by the 80% prescription isodose exceeded 90% for all but one patient. For the latter, the prescription isodose covered only 82.5% of PTV4DCT1. CIP analysis revealed that the region of underdosage was an end-inspiratory position occupied by the tumor for only 10–20% of the respiratory cycle.

Conclusion

In nearly all patients with stage I lung cancer, the PTV derived from a single uncoached 4DCT achieves dosimetric coverage that is similar to that achieved using two such consecutive scans.
Thimerosal induces TH2 responses via influencing cytokine secretion by human dendritic cells
Authors: Agrawal Anshu , Kaushal Poonam , Agrawal Sudhanshu , Gollapudi Sastry , Gupta Sudhir
Published: November 2006

Thimerosal is an organic mercury compound that is used as a preservative in vaccines and pharmaceutical products. Recent studies have shown a TH2-skewing effect of mercury, although the underlying mechanisms have not been identified. In this study, we investigated whether thimerosal can exercise a TH2-promoting effect through modulation of functions of dendritic cells (DC). Thimerosal, in a concentration-dependent manner, inhibited the secretion of LPS-induced proinflammatory cytokines TNF-α, IL-6, and IL-12p70 from human monocyte-derived DC. However, the secretion of IL-10 from DC was not affected. These thimerosal-exposed DC induced increased TH2 (IL-5 and IL-13) and decreased TH1 (IFN-γ) cytokine secretion from the T cells in the absence of additional thimerosal added to the coculture. Thimerosal exposure of DC led to the depletion of intracellular glutathione (GSH), and addition of exogenous GSH to DC abolished the TH2-promoting effect of thimerosal-treated DC, restoring secretion of TNF-α, IL-6, and IL-12p70 by DC and IFN-γ secretion by T cells. These data suggest that modulation of TH2 responses by mercury and thimerosal, in particular, is through depletion of GSH in DC.
Integrating the Core Competencies: Proceedings from the 2005 Academic Assembly Consortium
Authors: Stahmer Sarah A. , Ellison Stefanie R. , Jubanyik Karen K. , Felten Scott , Doty Christopher , Binder Louis , Jouriles Nicholas J.
Published: November 2006

The Accreditation Council for Graduate Medical Education mandated the integration of the core competencies into residency training in 2001. To this end, educators in emergency medicine (EM) have been proactive in their approach, using collaborative efforts to develop methods that teach and assess the competencies. The first steps toward a collaborative approach occurred during the proceedings of the Council of Emergency Medicine Residency Directors (CORD‐EM) academic assembly in 2002. Three years later, the competencies were revisited by working groups of EM program directors and educators at the 2005 Academic Assembly. This report provides a summary discussion of the status of integration of the competencies into EM training programs in 2005.
Arabidopsis HAP2(GCS1) is a sperm-specific gene required for pollen tube guidance and fertilization
Authors: von Besser Kiera , Frank Aubrey C. , Johnson Mark A. , Preuss Daphne
Published: November 2006

In flowering plants, sperm cells develop in the pollen cytoplasm and are transported through floral tissues to an ovule by a pollen tube, a highly polarized cellular extension. After targeting an ovule, the pollen tube bursts, releasing two sperm that fertilize an egg and a central cell. Here, we identified the gene encoding Arabidopsis HAP2, demonstrating that it is allelic to GCS1. HAP2 is expressed only in the haploid sperm and is required for efficient pollen tube guidance to ovules. We identified an insertion (hap2-1) that disrupts the C-terminal portion of the protein and tags mutant pollen grains with the β-glucuronidase reporter. By monitoring reporter expression, we showed that hap2-1 does not diminish pollen tube length in vitro or in the pistil, but it reduces ovule targeting by twofold. In addition, we show that the hap2 sperm that are delivered to ovules fail to initiate fertilization. HAP2 is predicted to encode a protein with an N-terminal secretion signal, a single transmembrane domain and a C-terminal histidine-rich domain. These results point to a dual role for HAP2, functioning in both pollen tube guidance and in fertilization. Moreover, our findings suggest that sperm, long considered to be passive cargo, are involved in directing the pollen tube to its target.
Seasonal adjustment of energy budget in a large wild mammal, the Przewalski horse (Equus ferus przewalskii) I. Energy intake
Authors: Kuntz Regina , Kubalek Christina , Ruf Thomas , Tataruch Frieda , Arnold Walter
Published: November 2006

Large ruminants respond to changing plant phenology during winter by decreasing voluntary food intake, increasing gut passage time and utilizing body fat reserves. It is uncertain, however, how other large mammals with a non-ruminant digestive physiology cope with winter forage conditions. Therefore, we investigated seasonality of energy intake in a large herbivorous wild mammal, the Przewalski horse (Equus ferus przewalskii). Throughout all seasons we used the n-alkane method to measure daily dry matter intake (DMI), diet composition and digestion, and determined an index of gut passage time in horses living under close to natural conditions.

DMI correlated positively with its content of crude protein and nitrogen-free extract. Independent of these effects, DMI further varied seasonally with a peak in autumn and a nadir in late winter. Fluctuations of DMI corresponded to the annual change in body condition, which decreased during winter while energy reserves were depleted, and increased during the fattening period. Gut passage time varied in the course of the year and was longer during winter when the diet was high in crude fibre. Nevertheless,changes in gut passage time occurred rather independently of changes in forage composition and DMI, suggesting endogenous control for timely adaption of the digestive strategy to meet predictable changes in forage quality.
Excitatory actions of GABA mediate severe-hypoxia-induced depression of neuronal activity in the pond snail (Lymnaea stagnalis)
Authors: Cheung Una , Moghaddasi Mehrnoush , Hall Hannah L. , Smith J. J. B. , Buck Leslie T. , Woodin Melanie A.
Published: November 2006

To characterize the effect of severe hypoxia on neuronal activity,long-term intracellular recordings were made from neurones in the isolated central ring ganglia of Lymnaea stagnalis. When a neurone at rest in normoxia was subjected to severe hypoxia, action potential firing frequency decreased by 38% (from 2.4-1.5 spikes s-1), and the resting membrane potential hyperpolarized from -70.3 to -75.1 mV. Blocking GABAA receptor-mediated synaptic transmission with the antagonist bicuculline methiodide (100 μmol l-1) decreased neuronal activity by 36%, and prevented any further changes in response to severe hypoxia, indicating that GABAergic neurotransmission mediates the severe hypoxia-induced decrease in neuronal activity. Puffing 100 μmol l-1 GABA onto the cell body produced an excitatory response characterized by a transient increase in action potential (AP) firing, which was significantly decreased in severe hypoxia. Perturbing intracellular chloride concentrations with the Na+/K+/Cl-(NKCC1) cotransporter antagonist bumetanide (100 μmol l-1)decreased AP firing by 40%, consistent with GABA being an excitatory neurotransmitter in the adult Lymnaea CNS. Taken together, these studies indicate that severe hypoxia reduces the activity of NKCC1, leading to a reduction in excitatory GABAergic transmission, which results in a hyperpolarization of the resting membrane potential (Vm)and as a result decreased AP frequency.
Epiglottic reconstruction and subtotal laryngectomy
Authors: Schbchter Gary L.
Published: November 2006

Vertical hemilaryngectomy has been expanded aggressively in recent years so that, in some cases, the term subtotal laryngectomy would be more appropriate. Reconstruction after these extended resections is a problem. Intraluminal stenting has not been successful in cases where resection has been aggressive. The resulting lumen is inadequate. As a means of overcoming this problem, the epiglottic reconstruction procedure has been promoted.

This paper presents experiences with 12 patients who underwent epiglottic reconstruction after subtotal laryngectomy. Indications, anatomic details, and overall results using this reconstructive technique are outlined. It is the conclusion of the author that epiglottic reconstruction is an effective procedure for preservation of function after subtotal laryngectomy.
Warthin's tumor: A review indicating no male predominance.
Authors: Kennedy Thomas L.
Published: November 2006

There is probably no other head and neck group of tumors as those found in the parotid gland that constitute such a diversity of growths, both benign and malignant. Warthin's or papillary cystadenoma lymphomatosum is the second most common benign tumor of the parotid gland. One universally held clinical characteristic of this tumor is its high male ratio. Because of a high frequency of female Warthin's tumor seen at Geisinger Medical Center, a review of all primary parotid gland tumors from 1971 to 1981 was carried out. Sixty‐two cases out of 204 primary neoplasms were classified as Warthin's. There was no significant difference in the number of male and female cases with 32 males and 30 females. The clinical characteristics of Warthin's tumor and this unusually high female occurrence are discussed.
Vestibular function testing: Where are we in 1983?
Authors: Rubin Wallace
Published: November 2006

Conceptual, technological, electronic and computer revolutions have transformed the methodology for evaluating the patient with dysequilibrium. What has been said and written for the past 25 years is not currently applicable.

Present day, cost effective, clinical evaluation format is presented, including changes and deletions in the conventional ENG test battery. It also includes the addition of computer technology in the rotation and ocular tracking tests. These deletions and additions in technique provide the clinician with more useful practical data for diagnosis. There is also capability for patient follow‐up and monitoring. These concepts are presented from the clinical vantage point and are supported with patient evaluation examples.
Complications of pectoralis myocutaneous flaps.
Authors: Maisel Robert H. , Liston Stephen L. , Adams George L.
Published: November 2006

The myocutaneous pectoralis major flap has recently caught the attention of head and neck surgeons. Over the last 12 months, our service has used this flap in 14 patients. Reconstruction in the oral cavity and larynx as well as closure of large areas of skin necrosis of the neck have been the indications. Our complications occurred in 4 of the 14 patients and included neck abscess and fistula, flap necrosis, and chest wall hematoma or abscess. The flap is an eminently useful and successful flap when designed and performed as indicated in the body of the paper.
Angioleiomyoma of the larynx. Report of a case and review of the literature
Authors: Nuutinen Juhani , Syrjänen Kari
Published: November 2006

A rare case of angioleiomyoma in a 76‐year‐old man is presented. The main symptoms were hoarseness and dyspnea. The tumor originated in the subglottic surface of the right vocal cord and there was only 3 mm of the laryngeal inlet free of the tumor. Histopathologically it was well circumscribed and composed of proliferating smooth muscle fibers and dilated blood vessels. The tumor was partially removed endoscopically, and subsequent cryotherapy was instituted. After two courses of cryotherapy the tumor had completely disappeared. Laryngeal function was restored to normal, and no signs of recurrence were observed after follow‐up of 8 months.
New Approaches in Investigation of Removal Mechanisms during Copper Chemical-Mechanical Polishing
Authors: Kulkarni M , Greisen D , Ng D , Liang H
Published: November 2006

This paper discusses new techniques for elucidating removal mechanisms of copper during chemical-mechanical polishing. Two new approaches were used in this research. One is the linkage between electrochemical, passivation, and wear for removal mechanisms. The other is to use an atomic force microscope to analyze polished copper surfaces at a nanometer length scale. Effects of pH, concentration of oxidizer, cathodic current, and amount of abrasive particles on surface materials removal were studied. Our investigation indicates that a balance between passivation and removal is needed to achieve a good localized planarization.
Increased T Cell Recruitment to the CNS after Amyloid β1–42Immunization in Alzheimer's Mice Overproducing Transforming Growth Factor-β1
Authors: Buckwalter Marion S. , Coleman Bronwen S. , Buttini Manuel , Barbour Robin , Schenk Dale , Games Dora , Seubert Peter , Wyss-Coray Tony
Published: November 2006

Immunotherapy targeting the amyloid β (Aβ) peptide is a novel therapy under investigation for the treatment of Alzheimer's disease (AD). A clinical trial using Aβ1–42(AN1792) as the immunogen was halted as a result of development of meningoencephalitis in a small number of patients. The cytokine TGF-β1 is a key modulator of immune responses that is increased in the brain in AD. We show here that local overexpression of TGF-β1 in the brain increases both meningeal and parenchymal T lymphocyte number. Furthermore, TGF-β1 overexpression in a mouse model for AD [amyloid precursor protein (APP) mice] leads to development of additional T cell infiltrates when mice were immunized at a young but not old age with AN1792. Notably, only mice overproducing both Aβ (APP mice) and TGF-β1 experienced a rise in T lymphocyte number after immunization. One-third of infiltrating T cells were CD4 positive. We did not observe significant differences in B lymphocyte numbers in any of the genotypes or treatment groups. These results demonstrate that TGF-β1 overproduction in the brain can promote T cell infiltration, in particular after Aβ1–42immunization. Likewise, levels of TGF-β1 or other immune factors in brains of AD patients may influence the response to Aβ1–42immunization.
Non-NMDA-Type Glutamate Receptors Are Essential for Maturation But Not for Initial Assembly of Synapses atDrosophilaNeuromuscular Junctions
Authors: Schmid Andreas , Qin Gang , Wichmann Carolin , Kittel Robert J. , Mertel Sara , Fouquet Wernher , Schmidt Manuela , Heckmann Manfred , Sigrist Stephan J.
Published: November 2006

The assembly of glutamatergic postsynaptic densities (PSDs) seems to involve the gradual recruitment of molecular components from diffuse cellular pools. Whether the glutamate receptors themselves are needed to instruct the structural and molecular assembly of the PSD has hardly been addressed. Here, we engineeredDrosophilaneuromuscular junctions (NMJs) to express none or only drastically reduced amounts of their postsynaptic non-NMDA-type glutamate receptors. At such NMJs, principal synapse formation proceeded and presynaptic active zones showed normal composition and ultrastructure as well as proper glutamate release. At the postsynaptic site, initial steps of molecular and structural assembly took place as well. However, growth of the nascent PSDs to mature size was inhibited, and proteins normally excluded from PSD membranes remained at these apparently immature sites. Intriguingly, synaptic transmission as well as glutamate binding to glutamate receptors appeared dispensable for synapse maturation. Thus, our data suggest that incorporation of non-NMDA-type glutamate receptors and likely their protein–protein interactions with additional PSD components triggers a conversion from an initial to a mature stage of PSD assembly.
The Association of Child and Household Food Insecurity With Childhood Overweight Status
Authors: Casey Patrick H. , Simpson Pippa M. , Gossett Jeffrey M. , Bogle Margaret L. , Champagne Catherine M. , Connell Carol , Harsha David , McCabe-Sellers Beverly , Robbins James M. , Stuff Janice E. , Weber Judith
Published: November 2006

CONTEXT. The prevalence of childhood overweight status is increasing. Some have suggested that childhood overweight is associated with food insecurity, defined as limited or uncertain access to enough nutritious food.

OBJECTIVES. The purpose of this work was to assess the association of household and child food insecurity with childhood overweight status.

METHODS. The National Health and Nutrition Examination Survey 1999–2002 uses a stratified multistaged probability sample and collects a broad array of data from a nationally representative sample of US citizens. All children 3 to 17 years old in this sample are included in these analyses. We measured BMI categorized as at risk for overweight or greater (≥85%) or overweight (≥95%) and household and child food security/insecurity using the US Food Security Scale.

RESULTS. When compared with children from food-secure households, children from food-insecure households were more likely to demonstrate significant associations with being at risk for overweight or greater in the following demographic categories: 12 to 17 years, girls, white, and in households with income <100% and >4 times the federal poverty level. Household food insecurity is associated with child overweight status in children aged 12 to 17, girls, and children who live in households with incomes >4 times the federal poverty level. Child food insecurity demonstrated the same associations with being at risk for overweight or greater, as did household food insecurity, but associations were also seen in 3- to 5-year-old children, boys, and Mexican American children. Child food insecurity is significantly associated with child overweight status for children aged 12 to 17, girls, white children, and children in families with income ≤100% poverty level. Controlling for ethnicity, gender, age, and family poverty index level, childhood food insecurity is associated with a child being at risk for overweight status or greater, but not overweight status.

CONCLUSIONS. Household and child food insecurity are associated with being at risk for overweight and overweight status among many demographic categories of children. Child food insecurity is independently associated with being at risk for overweight status or greater while controlling for important demographic variables. Future longitudinal research is required to determine whether food insecurity is causally related to child overweight status.
Sleep Environment, Positional, Lifestyle, and Demographic Characteristics Associated With Bed Sharing in Sudden Infant Death Syndrome Cases: A Population-Based Study
Authors: Ostfeld Barbara M. , Perl Harold , Esposito Linda , Hempstead Katherine , Hinnen Robert , Sandler Alissa , Pearson Paula Goldblatt , Hegyi Thomas
Published: November 2006

BACKGROUND. In 2005, the American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome recommended that infants not bed share during sleep.

OBJECTIVE. Our goal was to characterize the profile of risk factors associated with bed sharing in sudden infant death syndrome cases.

DESIGN/METHODS. We conducted a population-based retrospective review of sudden infant death syndrome cases in New Jersey (1996–2000) dichotomized by bed-sharing status and compared demographic, lifestyle, bedding-environment, and sleep-position status.

RESULTS. Bed-sharing status was reported in 239 of 251 cases, with sharing in 39%. Bed-sharing cases had a higher percentage of bedding risks (44.1% vs 24.7%), exposure to bedding risks in infants discovered prone (57.1% vs 28.2%), and lateral sleep placement (28.9% vs 17.8%). The prone position was more common for bed-sharing and non–bed-sharing cases at placement (45.8% and 51.1%, respectively) and discovery (59.0% and 64.4%, respectively). In multivariable logistic-regression analyses, black race, mother <19 years, gravida >2, and maternal smoking were associated with bed sharing. There was a trend toward less breastfeeding in bed-sharing cases (22% vs 35%). In bed-sharing cases, those breastfed were younger than those who were not and somewhat more exposed to bedding risks (64.7% vs 45.1%) but less likely to be placed prone (11.8% vs 52.9%) or have maternal smoking (33% vs 66%).

CONCLUSIONS. Bed-sharing cases were more likely to have had bedding-environment and sleep-position risks and higher ratios of demographic and lifestyle risk factors. Bed-sharing subjects who breastfed had a risk profile distinct from those who were not breastfed cases. Risk and situational profiles can be used to identify families in greater need of early guidance and to prepare educational content to promote safe sleep.
Comparison of the Immunogenicity and Reactogenicity of a Prophylactic Quadrivalent Human Papillomavirus (Types 6, 11, 16, and 18) L1 Virus-Like Particle Vaccine in Male and Female Adolescents and Young Adult Women
Authors: Block Stan L. , Nolan Terry , Sattler Carlos , Barr Eliav , Giacoletti Katherine E.D. , Marchant Colin D. , Castellsagué Xavier , Rusche Steven A. , Lukac Suzanne , Bryan Janine T. , Cavanaugh Paul F. , Reisinger Keith S. ,   for the Protocol 016 Study Group
Published: November 2006

OBJECTIVE. Prophylactic vaccination of 16- to 23-year-old females with a quadrivalent human papillomavirus (types 6, 11, 16, 18) L1 virus-like particle vaccine has been shown to prevent type-specific human papillomavirus infection and associated clinical disease. We conducted a noninferiority immunogenicity study to bridge the efficacy findings in young women to preadolescent and adolescent girls and boys, who represent a primary target for human papillomavirus vaccination.

METHODS. We enrolled 506 girls and 510 boys (10–15 years of age) and 513 females (16–23 years of age). Participants were vaccinated on day 1, at month 2, and at month 6, and serology testing was performed on day 1 and at months 3 and 7 on blinded samples. Neutralizing antibody concentrations were determined using type-specific immunoassays and summarized as geometric mean titers and seroconversion rates. Vaccine tolerability also was assessed.

RESULTS. By month 7, seroconversion rates were ≥99% for all 4 human papillomavirus types in each group. By month 7, compared with women, anti–human papilloma virus geometric mean titers in girls or boys were noninferior and were 1.7- to 2.7-fold higher. Most (>97%) injection-site adverse events were mild to moderate in intensity. Significantly more boys (13.8%) and girls (12.8%) than women (7.3%) reported fevers ≥37.8°C within 5 days of vaccination. Most (96.4%) fevers were mild (<39°C).

CONCLUSIONS. Noninferior immunogenic responses to all 4 human papillomavirus types in the quadrivalent vaccine permit the bridging of efficacy data that were generated in young women to girls. The results in boys lend support for the implementation of gender-neutral human papillomavirus vaccination programs. This vaccine generally was well tolerated.
Variations in Low Birth Weight and Preterm Delivery Among Blacks in Relation to Ancestry and Nativity: New York City, 1998–2002
Authors: Howard David L. , Marshall Susan S. , Kaufman Jay S. , Savitz David A.
Published: November 2006

OBJECTIVES. Black women in the United States are more likely to give birth to preterm and low birth-weight infants than their white counterparts, but little is known about variation in birth outcomes within the black population. This study aimed to test the hypothesis that the risk of low birth weight and preterm birth within the black population varies by maternal ancestry and nativity.

POPULATION AND METHODS. We conducted a retrospective cohort study using New York City birth records. All of the recorded live births to black women occurring in New York City between January 1, 1998, and December 31, 2002 (N = 168039), were divided into the following self-reported ancestry groups: African, American, Asian, Cuban, European, Puerto Rican, South and Central American (excluding Brazilian), and West Indian and Brazilian. To estimate adjusted risk ratios for low birth weight (weight at birth <2500 g) and preterm birth (gestational age at delivery <37 weeks, based on clinical estimate), we ran 3 models for each outcome, using negative binomial regression and Poisson regression with robust SE estimation. All of the models used blacks reporting American ancestry as the reference group. The first model included ancestry as the primary exposure variable along with covariates that included maternal age, parity, smoking, and education, as well as paternal education and race. Nativity (US- or foreign-born) was included in the second model, and terms representing interaction effects between ancestry and nativity were included in the third model.

RESULTS. There was substantial variation in risks of preterm birth and low birth weight among the black subgroups, with all of the groups having lower risks than the American black reference group, even after adjusting for maternal risk factors and other covariates. Risk ratios for low birth weight ranged from 0.55 among South/Central Americans to 0.91 among Cubans; risk ratios for preterm birth showed a similar pattern. Nativity was also associated with low birth weight and preterm birth; births to foreign-born women were less likely to be preterm or low birth weight than births to US-born women. Furthermore, nativity effects varied by ancestry group, with foreign-born status inversely associated with poor birth outcomes among South/Central Americans but not among West Indians/Brazilians.

CONCLUSIONS. Important health differences may be masked in studies that treat black women in America as a homogeneous group and do not take ethnic variation and nativity into account.
Illness and Injury Among Children Attending Summer Camp in the United States, 2005
Authors: Yard Ellen E. , Scanlin Margery M. , Erceg Linda Ebner , Powell Gwynn M. , Wilkins John R. , Knox Christy L. , Comstock R. Dawn
Published: November 2006

OBJECTIVES. The purpose of this work was to describe illnesses and injuries sustained by campers at summer camps, calculate illness and injury rates, and identify risk factors for camp-related illness and injury.

METHODS. A convenience sample of camps selected from the US summer camp population participated in this pilot illness and injury surveillance study. Camps completed weekly reports detailing the number of campers on site and the number of adverse events sustained and provided specific information about each adverse event.

RESULTS. A total of 177 camper illnesses and injuries occurred during 122379 camper-days, with a median rate of 1.15 adverse events per 1000 camper-days. The majority of reported events were illnesses (68.0%), 11.8% of which were communicable and seen in multiple individuals at camp. Of the injury events (32.0%), cut/scratch/scrape were the most common diagnoses (33.3%), followed by fracture (14.6%) and sprain/strain (10.4%); horseback riding and capture the flag were identified as injury-producing activities.

CONCLUSIONS. Internet- and telephone-based surveillance systems can be successfully used to conduct illness and injury surveillance among children attending summer camp. Data collected via such systems can be used to calculate illness and injury rates, to describe patterns of illness and injury, and to identify risk factors for camper-related illness and injury. Given the millions of children attending summer camp yearly, a surveillance system such as this can provide the data needed to develop evidence-based prevention interventions to decrease the number of youth whose camp experiences are negatively affected by illness and injury.