bluuebunny/crossref_metadata_2025 huggingface dataset:
Enteral Glutamine Supplementation in Critically Ill Patients with Burn Injuries: A Retrospective Case‐Control Evaluation
Authors: Juang Paul , Fish Douglas N. , Jung Rose , MacLaren Robert
Published: December 2006

Study Objectives. To evaluate the clinical application of enteral glutamine supplementation in critically ill patients and compare the frequency of nosocomial infections in these patients with a historical control group in a burn intensive care unit (BICU), and to assess lengths of stay in the hospital and BICU, mortality rates, and safety profile of glutamine.

Design. Retrospective case‐control descriptive study.

Setting. A university‐affiliated hospital BICU.

Patients. Seventeen patients receiving enteral glutamine supplementation and 15 historical control patients who were admitted to the BICU for thermal burn injuries from January 1, 2001‐September 30, 2004.

Measurements and Main Results. Data for patients receiving enteral glutamine supplementation were identified through the pharmacy database, and data for the control patients were identified through the BICU patient registry. No significant differences were noted in baseline characteristics or nutritional parameters and outcomes between the two groups. The mean daily dose and duration of glutamine were 0.52 g/kg and 21.6 days, respectively. The mean number of infections/patient between the glutamine and control groups was similar (2.47 and 2.73, respectively) as was the number of gram‐negative infections (1.29 and 1.20, respectively). Bloodstream infections occurred more frequently in the glutamine group (24 vs 8 patients, p=0.0006); however, cellulitis (4 vs 11, p=0.05) and pneumonia (9 vs 15, p=0.15) occurred less often. For the glutamine group versus control group, BICU length of stay (17.9 vs 15.3 days, p=NS), hospital length of stay (32.3 vs 26 days, p=NS), and mortality rates (0% vs 6.7%, p=NS) were similar between groups. No adverse events were attributed to glutamine supplementation.

Conclusion. Enteral glutamine supplementation was not associated with a change in the cumulative rate of infectious complications compared with the control group, but this was attributed to more cases of bloodstream infections and fewer cases of pneumonia and cellulitis in the glutamine group. Large, prospective, randomized trials designed to detect small but clinically relevant outcomes are needed to definitively determine the effect of enteral glutamine supplementation in the BICU population.
Clarifying the Role of Rasburicase in Tumor Lysis Syndrome
Authors: Sood Amy R. , Burry Lisa D. , Cheng Doret K. F.
Published: December 2006

Tumor lysis syndrome (TLS) is a complication of malignancies with high tumor cell proliferation, tumor burden, and chemosensitivity. It manifests with the release of intracellular components and results in hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia. These biochemical abnormalities may lead to serious complications such as renal failure, cardiac dysrhythmias, and death. Rasburicase, a recombinant urate oxidase enzyme, is a new agent indicated in the treatment or prophylaxis of hyperuricemia in pediatric patients with cancer who are at high risk for TLS. We reviewed the evidence for treatment with this agent compared with standard therapy with allopurinol. Rasburicase may be considered for use in patients with hyperuricemia at presentation and in patients at high risk for TLS that would otherwise result in a delay in chemotherapy. However, randomized controlled trials are required to establish the comparative efficacy of rasburicase in the adult population. Preliminary evidence suggests that single‐dose or reduced‐dose rasburicase may be effective in the prophylaxis and the treatment of hyperuricemia and TLS. However, to our knowledge, there is no evidence comparing clinically relevant outcomes such as acute renal failure or dialysis.
Clinical Importance of Carbapenem Hypersensitivity in Patients with Self‐Reported and Documented Penicillin Allergy
Authors: Prescott William A. , Kusmierski Kristen A.
Published: December 2006

The risk of carbapenem hypersensitivity in patients with self‐reported or documented penicillin allergy needs to be determined so that practitioners can make better‐informed decisions regarding antibiotic therapy for this patient population. The risk of cross‐reactivity between penicillin and carbapenem antibiotics initially was reported to approach 50%. Recent retrospective studies have suggested that the clinical risk of cross‐hypersensitivity between these two drug classes is 9.2–11%, which is significantly lower than initially reported. Patients whose history of penicillin allergy is self‐reported and is not type 1 may be at moderate risk for hypersensitivity when treated with a carbapenem antibiotic. The risk of hypersensitivity appears to be higher in patients whose penicillin allergy was documented by a health care provider, those with several antibiotic allergies, and those with a positive penicillin skin test result or a history of type 1 penicillin hypersensitivity.
Practical Application of Nonrandomized Research to Patient Care: A Case Study of Nesiritide
Authors: Winegardner Megan L. , Reaume Kristen T. , Dabaja Gladys S. , Kalus James S.
Published: December 2006

Prospective, randomized clinical trials are the gold standard for establishing cause‐and‐effect relationships between therapeutic interventions and specific outcomes. Unfortunately, these types of studies are not always available to evaluate important clinical end points such as mortality. Meta‐analyses and observational studies are often used in an attempt to fill the gap in the literature when no prospective, randomized trials exist to answer a research question. A rapid increase in the number of published meta‐analyses and observational studies has occurred in recent years. In the absence of prospective, randomized studies, it is essential for the clinician to understand the important issues involved in interpreting these other types of studies. When evaluating a meta‐analysis, the clinician should assess for several different forms of bias, clinical heterogeneity, and use of appropriate methodology. When evaluating an observational study, sources of bias and confounding should be identified. If the potential for confounding is present, the methods used to minimize the impact of confounders should be evaluated for appropriateness. Mortality associated with nesiritide in the treatment of acute decompensated heart failure is a contemporary example of the use of nonrandomized research to address a research question that is unanswered by prospective, randomized studies. We review the details of a recent metaanalysis and observational evaluation of mortality associated with nesiritide and discuss the issues that are important in critical evaluation of nonrandomized study designs.
Subdural Hematoma After a Fall in an Elderly Patient Taking High‐Dose Omega‐3 Fatty Acids with Warfarin and Aspirin: Case Report and Review of the Literature
Authors: McClaskey Elizabeth M. , Michalets Elizabeth Landrum
Published: December 2006

The elderly population is at an increased risk for major bleeding, possibly due to increased sensitivity to anticoagulation, multiple comorbidities, and polypharmacy. Elderly patients receiving antiplatelet and anticoagulant therapy have an additional risk for bleeding. Omega‐3 fatty acids, also known as fish oil, have been used for hyperlipidemia, coronary heart disease, hypertension, and other conditions. Some studies have demonstrated that consumption of fish oil concentrate, n‐3 polyunsaturated fatty acid (n‐3 PUFA), results in cardiovascular benefits that include reductions in mortality, sudden death, nonfatal myocardial infarction, and thrombotic stoke, as well as improvement in graft patency. The mechanism of action of n‐3 PUFA is not completely understood, but a dual antiplatelet and anticoagulant effect has been proposed. Few data exist on whether or not fish oil can be used safely with other antiplatelet or anticoagulant drugs. We report the case of a patient who after a minor fall developed a subdural hematoma requiring craniotomy that likely was precipitated by concomitant use of high‐dose omega‐3 fatty acids 6 g/day with both aspirin and warfarin. These findings are important because of the wide availability of omega‐3 fatty acids and the propensity for use of complementary and alternative medicine in patients with cardiovascular disease who are already taking antiplatelet and/or anticoagulant agents. Judicious use of these combinations is advised, and pharmacists can play an important role in educating patients and other health care providers about the bleeding risks associated with combination therapy.
Successful Treatment of Klebsiella rhinoscleromatis Bacteremia with Levofloxacin
Authors: Pound Melanie W. , Fulton Kathey B. , Chima Chukwuemeka O.
Published: December 2006

A 71‐year‐old Caucasian woman was admitted to the hospital with right‐sided weakness and slurred speech. Glioblastoma multiforme was diagnosed, and resection of the tumor was performed. During the patient's hospitalization, blood and urine cultures were obtained after her temperature rose to 103.3°F. Four blood cultures revealed Klebsiella rhinoscleromatis sensitive to trimethoprim‐sulfamethoxazole, levofloxacin, cefazolin, gentamicin, and tetracycline, but resistant to ampicillin. The patient had no recent history of foreign travel. After a 3‐week course with levofloxacin, the patient was afebrile, and repeat blood cultures were negative. To our knowledge, this was the first case of K. rhinoscleromatis bacteremia in the United States to be treated successfully with levofloxacin.
Possible Pentostatin‐Induced Symptomatic Hyponatremia
Authors: Bruno Jeffrey J. , Canada Todd W.
Published: December 2006

Pentostatin is an adenosine deaminase inhibitor used in the treatment of hairy cell leukemia and T‐cell lymphomas. A 27‐year‐old man with refractory cutaneous T‐cell lymphoma developed severe hyponatremia 3 days after completing his first cycle of pentostatin therapy. Shortly after hospital admission, he became disoriented and was admitted to the medical intensive care unit and treated with a combination of hypertonic saline, intravenous diuretics, and fluid restriction to reestablish normal sodium homeostasis. The mechanism by which pentostatin may have induced hyponatremia in this patient is unknown; clinical and laboratory findings represented both extrarenal sodium loss and syndrome of inappropriate antidiuretic hormone. Clinicians should be aware of the possible development of life‐threatening symptomatic hyponatremia in patients receiving pentostatin.
Effectiveness of Statins in Reducing the Rate of Severe Sepsis: A Retrospective Evaluation
Authors: Martin Christopher P. , Talbert Robert L. , Burgess David S. , Peters Jay I.
Published: December 2006

Study Objectives. To determine whether use of 3‐hydroxy‐3‐methylglutaryl coenzyme A reductase inhibitors (statins) is associated with a reduced rate of severe sepsis, and to further characterize the effect of statins on the frequency of organ dysfunction in patients with severe sepsis.

Design. Retrospective cohort study.

Setting. University‐associated teaching hospital.

Patients. Fifty‐three patients admitted with sepsis; 16 were receiving statins and 37 were not receiving statins (controls) before admission.

Measurements and Main Results. Patients were identified by theInternational Classification of Diseases, Ninth Revision, Clinical Modificationcodes. Patient demographics, vital signs, and laboratory values were collected from their electronic medical records. The primary end point was rate of severe sepsis, defined in accordance with guidelines from the American College of Chest Physicians and the Society of Critical Care Medicine. Secondary end points were in‐hospital mortality rate and rate of five categories of organ dysfunction (cardiovascular, renal, pulmonary, hematologic, and metabolic). Preadmission statin therapy, compared with no statin therapy, was associated with a 30% lower rate of severe sepsis (56% vs 86%, p<0.02). In‐hospital mortality was not significantly different between groups (38% vs 49%, p=0.33); however, the rate of cardiovascular dysfunction, defined as hypotension requiring vasopressor therapy, was significantly lower in the statin group (38% vs 73%, p<0.02). No significant differences in the other organ dysfunction categories were noted between groups.

Conclusion. Statins appear to prevent sepsis from becoming severe, most notably through prevention of sepsis‐induced hypotension. This potential role for statins in the prevention and treatment of severe sepsis should be further evaluated in a randomized controlled trial.
Risk of Diabetes Mellitus Associated with Atypical Antipsychotic Use Among Medicaid Patients with Bipolar Disorder: A Nested Case‐Control Study
Authors: Guo Jeff J. , Keck Paul E. , Corey‐Lisle Patricia K. , Li Hong , Jiang Dongming , Jang Raymond , L'Italien Gilbert J.
Published: December 2006

Study Objective. To quantify the risk of diabetes mellitus associated with atypical antipsychotics compared with conventional antipsychotics in managed care Medicaid patients with bipolar disorder.

Design. Retrospective nested case‐control study.

Data Source. Integrated seven‐state Medicaid managed care claims database from January 1, 1998–December 31, 2002.

Patients. Two hundred eighty‐three patients with diabetes (cases) and 1134 controls matched by age, sex, and the index date on which bipolar disorder was diagnosed.

Measurements and Main Results. Cases were defined as those having an International Classification of Diseases, Ninth Revision diagnosis of diabetes or those receiving treatment with antidiabetic drugs. Both case and control patients had at least a 3‐month exposure to either conventional or atypical antipsychotic agents or three filled prescriptions related to treatment for bipolar disorder. Of the 283 cases, 139 (49%) received atypical antipsychotics (olanzapine, risperidone, quetiapine, ziprasidone, and clozapine) and 133 (47%) were prescribed conventional antipsychotics. To compare the risk for new‐onset diabetes associated with atypical versus conventional antipsychotics, we conducted a Cox proportional hazard regression, in which we controlled for age; sex; duration of bipolar disorder follow‐up; use of lithium, anticonvulsants, antidepressants, and other drugs; and psychiatric and medical comorbidities. Compared with patients receiving conventional antipsychotics, the risk of diabetes was greatest among patients taking risperidone (hazard ratio [HR] 3.8, 95% confidence interval [CI] 2.7–5.3), olanzapine (3.7, 95% CI 2.5–5.3), and quetiapine (2.5, 95% CI 1.4–4.3). The risk for developing diabetes was also associated with weight gain (HR 2.5, 95% CI 1.9–3.4), hypertension (HR 1.6, 95% CI 1.2–2.2), and substance abuse (HR 1.5, 95% CI 1.0–2.2).

Conclusion. Olanzapine, risperidone, and quetiapine are all associated with development or exacerbation of diabetes mellitus in patients with bipolar disorder. When prescribing therapy for this patient population, metabolic complications such as diabetes, weight gain, and hypertension need to be considered.
Antimicrobial Susceptibility and Staphylococcal Chromosomal Cassette mec Type in Community‐ and Hospital‐Associated Methicillin‐Resistant Staphylococcus aureus
Authors: LaPlante Kerry L. , Rybak Michael J. , Amjad Muhammad , Kaatz Glenn W.
Published: December 2006

Study Objective. To differentiate the characteristics of community‐associated methicillin‐resistant Staphylococcus aureus (MRSA) and hospital‐associated MRSA isolates on the basis of their susceptibility profiles, induction of clindamycin resistance, and staphylococcal chromosomal cassette (SCC) mec types.

Design. In vitro molecular and susceptibility study of isolates obtained from December 2004–January2006 as part of a large, ongoing clinical study.

Setting. Level I trauma center in Detroit, Michigan.

Bacterial Strains. Three hundred eight MRSA isolates randomly collected from patients; 130 were classified as community‐associated, and 178 were classified hospital‐associated by using definitions from the Centers for Disease Control and Prevention (CDC).

Intervention. Minimum inhibitory concentrations were tested on the basis of current guidelines from the Clinical and Laboratory Standards Institute.

Measurements and Main Results. All tested MRSA isolates were susceptible to daptomycin, linezolid, and vancomycin. In addition, community‐associated MRSA isolates were significantly (all p≤0.05) more susceptible to trimethoprim‐sulfamethoxazole (99%), clindamycin (96%), and a fluoroquinolone (76%) than hospital‐associated MRSA isolates. Inducible resistance to clindamycin was demonstrated in 8.4% of community‐associated MRSA isolates versus 50% of hospital‐associated MRSA isolates (p≤0.001). Of interest, 35% of the MRSA isolates collected from hospitalized patients (> 48 hrs after admission and according to the CDC definition) possessed SCCmec type I V.

Conclusion. Overall, inducible clindamycin resistance occurred at significantly higher rates in the hospital‐associated MRSA isolates, susceptibility differed significantly between community‐ and hospital‐associated MRSA, and most of the hospital isolates contained SCCmec type I V.
Discrepancies in Identification of Bleeding Events After Percutaneous Coronary Intervention
Authors: McCollum Marianne , Stringer Kathleen A. , Wittkowsky Ann K. , Young Sallie , Spinler Sarah A.
Published: December 2006

Study Objective. To evaluate the level of agreement between two sets of criteria, the Thrombolysis in Myocardial Infarction (TIMI) criteria and investigator‐developed criteria, for identifying bleeding events in patients who had undergone a percutaneous coronary intervention (PCI) and to measure length of hospital stay (LOS) as a surrogate marker of bleeding severity.

Design. Retrospective chart review.

Setting. Two university‐affiliated medical centers.

Patients. Four hundred twenty‐two consecutive patients who had undergone PCI from December 1, 2001‐June 30, 2002.

Measurements and Main Results. Data were collected on the number of bleeding events that occurred within 1 week after PCI (limited to one event/patient) and on LOS. Bleeding was assessed by TIMI criteria and by investigator‐developed criteria. Bleeding according to TIMI criteria included intracranial hemorrhage, spontaneous hematuria or hematemesis, or decreases in hemoglobin level. Bleeding according to investigator‐developed criteria included intracranial, retroperitoneal, intraocular, or clinically overt bleeding without a specified decrease in hemoglobin level. Agreement between criteria was assessed by means of the κ statistic. Of the 422 patients, 23 (5%) experienced TIMI‐defined bleeding events and 229 (54%) investigator‐defined bleeding events. A κ value of 0.09 (95% confidence interval 0.06–0.13) indicated a poor level of agreement between the two sets of bleeding criteria. The effect of this discrepancy on LOS was 66 fewer days of care when TIMI criteria were applied versus investigator‐developed criteria in the 206 patients who experienced bleeding events that met investigator criteria (total LOS 645 days) but not TIMI criteria (total LOS 579 days).

Conclusion. Bleeding assessment with use of TIMI criteria versus investigator‐developed criteria yielded discrepant bleeding event rates and LOS, making it difficult to accurately compare bleeding rates and consequences across clinical trials and in practice. Consensus bleeding criteria are needed for applications in clinical evaluations of antithrombotic agents.
Pertussis Resurgence: Diagnosis, Treatment, Prevention, and Beyond
Authors: Raguckas Sarah E. , VandenBussche Heather L. , Jacobs Carrie , Klepser Michael E.
Published: December 2006

The introduction of routine vaccination against Bordetella pertussis more than a half century ago led to a drastic decline in the number of reported cases of pertussis. It was originally believed that lifelong immunity was afforded after vaccination. Unfortunately, this belief is flawed, as the highest number of pertussis cases since 1959 was reported in 2004. This significant increase has led to additional research on immunity, vaccination, and treatment of B. pertussis in all age groups. We performed a MEDLINE search of literature from 1966–2006 to evaluate and review the existing data on immunity to and prevention or treatment of B. pertussis infections. Additional articles were identified from the bibliographies of reviewed literature. Numerous articles pertaining to these topics have been published recently. The most significant changes in the management of this infectious disease surround the new recommendations by the Advisory Committee on Immunization Practices for adult and adolescent immunizations to assist in preventing outbreaks of B. pertussis. The Centers for Disease Control and Prevention recently published guidelines updating the recommended pharmacologic agents for treatment or prevention of B. pertussis. Despite decades of successful vaccination programs, pertussis continues to be a problematic disease. Fortunately, data and vaccines are now available that make development of a pertussis booster vaccination campaign reasonable. However, until widespread compliance with such programs is achieved, clinicians need to maintain vigilance against pertussis.
Micafungin: A New Echinocandin Antifungal
Authors: Joseph Jomy M. , Jain Rupali , Danziger Larry H.
Published: December 2006

The echinocandins represent the newest class of antifungals to combat infections caused by Candida sp. Micafungin is an echinocandin recently approved by the United States Food and Drug Administration. It is indicated in adults for esophageal candidiasis and prophylaxis against candidal infections in hematopoietic stem cell transplant recipients. Micafungin exhibits in vitro fungicidal activity against Candida sp, including fluconazole‐resistant isolates. Its in vivo efficacy is comparable to that of fluconazole in the treatment of esophageal candidiasis and superior to that of fluconazole for prophylaxis of invasive candidal infections. Because it is not significantly metabolized by the cytochrome P450 3A system, micafungin is associated with few drug interactions. Micafungin does not require adjustment in patients with renal and/or hepatic impairment, and it has been shown to be well tolerated in both adult and pediatric patients. Its efficacy against Candida sp, coupled with its overall safety and drug interaction profiles, makes it an attractive option in the treatment against esophageal candidiasis and prophylaxis against invasive candidal infections.
Historical Review of Carbamazepine for the Treatment of Bipolar Disorder
Authors: Stoner Steven C. , Nelson Leigh Anne , Lea Jessica W. , Marken Patricia A. , Sommi Roger W. , Dahmen Megan M.
Published: December 2006

The management of bipolar disorder has seen significant evolution in terms of the number of treatment options now approved for both the acutely manic phase and the maintenance stages of the illness. In addition, new formulations of traditional agents are available for clinicians to use in their treatment approach. One such example is carbamazepine, which has approval by the United States Food and Drug Administration for the treatment of acute and mixed mania in an extended‐release formulation that uses a three‐bead delivery system. Although the parent compound has been available for decades, its approval for bipolar disorder is recent despite numerous clinical trials that have supported its use in both the acute and maintenance phases of bipolar disorder. Advantages of the new formulation include less fluctuation in plasma concentration and, in general, improved tolerability. However, issues remain with regard to cytochrome P450 drug‐related interactions and the need for therapeutic drug monitoring (e.g., drug concentrations, epoxide metabolite concentrations, hematology, and liver function tests) as part of the treatment and monitoring process. We review the current body of literature describing the use of carbamazepine in bipolar disorder during both the acute and maintenance phases of the disorder, including trials of both monotherapy and combination therapy, as well as findings from trials that included patients with rapid cycling and mixed episodes.
Therapeutic Options for Sleep‐Maintenance and Sleep‐Onset Insomnia
Authors: Morin Anna K. , Jarvis Courtney I. , Lynch Ann M.
Published: December 2006

Insomnia, defined as difficulty falling asleep, staying asleep, and/or experiencing restorative sleep with associated impairment or significant distress, is a common condition resulting in significant clinical and economic consequences. Many options are available to treat insomnia, to assist with either falling asleep (sleep onset) or maintaining sleep. We searched MEDLINE for articles published between January 1996 and January 2006, evaluated abstracts from recent professional meetings, and contacted the manufacturer of the most recent addition to the pharmacologic armamentarium for insomnia treatment (ramelteon) to gather information. Nonpharmacologic options include stimulus control, sleep hygiene education, sleep restriction, paradoxical intention, relaxation therapy, biofeedback, and cognitive behavioral therapy. Prescription and over‐the‐counter drug therapies include benzodiazepine and nonbenzodiazepine sedative‐hypnotic agents; ramelteon, a melatonin receptor agonist; trazodone; and sedating antihistamines. Herbal and alternative preparations include melatonin and valerian. Before recommending any treatment, clinicians should consider patient‐specific criteria such as age, medical history, and other drug use, as well as the underlying cause of the sleep disturbance. All pharmacotherapy should be used with appropriate caution, at minimum effective doses, and for minimum duration of time.
Dynamics of Patient Targeting for Care Management in Medicaid: A Case Study of the Durham Community Health Network
Authors: Horvath Brian , Silberberg Mina , Landerman Lawrence R. , Johnson Frederick S. , Michener J. Lloyd
Published: December 2006

Targeting appropriate patients for care management is crucial to maximizing quality of care and cost-effectiveness in Medicaid care management programs. This study examined patient characteristics predicting selection for care management pre- and postmanagement changes at the Durham Community Health Network (DHCN), one of North Carolina’s Medicaid primary care management networks. From the beginning, care managers were directed to target asthmatics, diabetics, and high-volume utilizers of health care, using an array of markers to identify patients who needed management. In 2003, the state reinforced its focus on chronic disease and high utilizers, and new management at DCHN began emphasizing the use of protocols for patient targeting. This study examined the relative effects of patient demographics, diagnoses, PCP group, and health care utilization as predictors of patient selection before and after these changes.
Nursing Care Management of Older Adults With HIV/AIDS and Chronic Depression
Authors: Petrovic Kimberly
Published: December 2006

Older adults with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and chronic depression constitute a growing population of individuals in need of quality nursing care management. Although the small amounts of research currently available focus on both middle-aged and older adults living with these chronic conditions, this article offers specific suggestions for the nursing care of older adults who have been diagnosed with HIV, have experienced the progression of HIV to AIDS, and who have lived with chronic depression prior to the onset of HIV/AIDS. Given the increasingly significant role that nurses play in the lives of older adults with chronic health conditions, this article aims to provide nurses with a number of interventions associated with 10 nursing diagnoses pertinent to the care of older adults with HIV/AIDS and chronic depression.
The Fallacy of Late-Life Divorce in Japan
Authors: Kumagai Fumie
Published: December 2006

Late-life divorces in Japan, that is, divorces by couples with more than 20 years’ duration of marriage at the time of divorce, have become increasingly conspicuous since in the mid-1990s. However, an increase in the number of late-life divorces is not the same as an increase in the divorce rate. That is, the conspicuous phenomenon of late-life divorces may not reflect the true nature of the institution of divorce. It may be a fallacy of late-life divorce in Japan today. This is the starting point of the present study. Five major findings have emerged. First, late-life divorces did increase dramatically over the recent past. Second, late-life divorces will continue to increase after 2007, when the new old-age pension division scheme for couples who pursue divorce will be in effect. Third, the increment in late-life divorce cases is due primarily to the baby-boomers born between 1947 and 1949 who are pursuing such late-life divorces. Fourth, as the duration of marriage increases, Japanese married couples are less inclined to pursue divorce. Fifth, the reasons for late-life divorces differ from those expressed for divorces in general. It is hoped that these findings will provide valuable insights for Japanese couples married for many years who may wish to reconsider and to reconstruct their marital relationship for the better.
Dignity for All: Affordable Assisted Living
Authors: Janeski James F. , Pruchnicki Alec
Published: December 2006

In 2026, the first of the baby boomers, including Presidents Clinton and Bush, will reach the age of 80, the average age of residents currently in assisted living facilities. In her book The Denial of Aging: Perpetual Youth, Eternal Life, and Other Dangerous Fantasies, Muriel Gillick proposes that the baby boomers will seek assisted living as an alternative to nursing home care. But what about that portion of the population not able to afford the high cost of private assisted living? What option will be available to the low-asset/low-income population in lieu of nursing home care?
The Health Impact of Child Labor in Developing Countries: Evidence From Cross-Country Data
Authors: Roggero Paola , Mangiaterra Viviana , Bustreo Flavia , Rosati Furio
Published: December 2006

Objectives. Research on child labor and its effect on health has been limited. We sought to determine the impact of child labor on children’s health by correlating existing health indicators with the prevalence of child labor in selected developing countries.

Methods. We analyzed the relationship between child labor (defined as the percentage of children aged 10 to14 years who were workers) and selected health indicators in 83 countries using multiple regression to determine the nature and strength of the relation. The regression included control variables such as the percentage of the population below the poverty line and the adult mortality rate.

Results. Child labor was significantly and positively related to adolescent mortality, to a population’s nutrition level, and to the presence of infectious disease.

Conclusions. Longitudinal studies are required to understand the short- and long-term health effects of child labor on the individual child.
Prevalence Estimates of Overweight and Obesity in Cree Preschool Children in Northern Quebec According to International and US Reference Criteria
Authors: Willows Noreen D. , Johnson Melissa S. , Ball Geoff D.C.
Published: December 2006

Objectives. We estimated the prevalence of overweight and obesity in Cree Canadian children aged 5 years (n=1044) using international and US growth references and examined the longitudinal tracking of weight categories between ages 2 and 5 years (n=562).

Methods. Weight categories based on body mass index (calculated from measured heights and weights) were derived from the International Obesity Task Force (IOTF) and the Centers for Disease Control and Prevention (CDC) references.

Results. According to the IOTF reference, 52.9% of children were overweight (31.6%) or obese (21.3%) whereas with the CDC reference, 64.9% were overweight (27.5%) or obese (37.4%). The IOTF and CDC references provided dissimilar tracking of weight categories. Based on the IOTF reference, 4.9% of the children who were normal weight at age 2 years were obese at age 5 years. Based on the CDC reference, 14.9% of children categorized as normal weight at age 2 years were obese at age 5 years.

Conclusions. The IOTF reference provided more conservative estimates of obesity than the CDC reference, and longitudinal analyses showed dissimilar tracking of weight categories with the 2 references. Public health responses to obesity prevalence estimates should be made with awareness of methodological limitations.
Anemia and Iron Deficiency in School Children, Adolescents, and Adults: A Community-Based Study in Rural Amazonia
Authors: Ferreira Marcelo U. , da Silva-Nunes Mônica , Bertolino Carla N. , Malafronte Rosely S. , Muniz Pascoal T. , Cardoso Marly A.
Published: December 2006

We investigated the prevalence and risk factors of anemia and iron deficiency in 398 rural Amazonians aged 5–90 years in Acre, Brazil. Anemia and iron deficiency were diagnosed in 16% and 19% of the population, respectively. Anemia was likely to have multiple causes; although nearly half of anemic school children and women had altered iron status indicators, only 19.7% of overall anemia was attributable to iron deficiency. Geo-helminth infection and a recent malaria episode were additional factors affecting iron status indicators in this population.
Paternalism & Its Discontents: Motorcycle Helmet Laws, Libertarian Values, and Public Health
Authors: Jones Marian Moser , Bayer Ronald
Published: December 2006

The history of motorcycle helmet legislation in the United States reflects the extent to which concerns about individual liberties have shaped the public health debate. Despite overwhelming epidemiological evidence that motorcycle helmet laws reduce fatalities and serious injuries, only 20 states currently require all riders to wear helmets. During the past 3 decades, federal government efforts to push states toward enactment of universal helmet laws have faltered, and motorcyclists’ advocacy groups have been successful at repealing state helmet laws. This history raises questions about the possibilities for articulating an ethics of public health that would call upon government to protect citizens from their own choices that result in needless morbidity and suffering.
Sensory gating and alpha‐7 nicotinic receptor gene allelic variants in schizoaffective disorder, bipolar type
Authors: Martin Laura F. , Leonard Sherry , Hall Mei‐Hua , Tregellas Jason R. , Freedman Robert , Olincy Ann
Published: December 2006

Objectives: Single nucleotide allelic variants in the promoter region of the chromosome 15 alpha‐7 acetylcholine nicotinic receptor gene (CHRNA7) are associated with both schizophrenia and the P50 auditory evoked potential sensory gating deficit. The purpose of this study was to determine if CHRNA7 promoter allelic variants are also associated with abnormal P50 ratios in persons with schizoaffective disorder, bipolar type. Methods: P50 auditory evoked potentials were recorded in a paired stimulus paradigm in 17 subjects with schizoaffective disorder, bipolar type. The P50 test to conditioning ratio was used as the measure of sensory gating. Mutation screening of the CHRNA7 promoter region was performed on the subjects' DNA samples. Comparisons to previously obtained data from persons with schizophrenia and controls were made. Results: Subjects with schizophrenia, regardless of allele status, had an abnormal mean P50 ratio. Subjects with schizoaffective disorder, bipolar type and a variant allele had an abnormal mean P50 ratio, whereas those schizoaffective subjects with the common alleles had a normal mean P50 ratio. Normal control subjects had a normal mean ratio, but controls with variant alleles had higher P50 ratios. Conclusions: In persons with bipolar type schizoaffective disorder, CHRNA7 promoter region allelic variants are linked to the capacity to inhibit the P50 auditory evoked potential and thus are associated with a type of illness genetically and biologically more similar to schizophrenia. © 2006 Wiley‐Liss, Inc.
Correction of humoral derangements from mutant superoxide dismutase 1 spinal cord
Authors: Kim Yun‐Sook , Martinez Tara , Deshpande Deepa M. , Drummond Jennifer , Provost‐Javier Katie , Williams Ariel , McGurk Julie , Maragakis Nicholas , Song Hongjun , Ming Guo‐Li , Kerr Douglas A.
Published: December 2006

Objective

We sought to define molecular and cellular participants that mediate motor neuron injury in amyotrophic lateral sclerosis using a coculture system.

Methods

We cocultured embryonic stem cell–derived motor neurons with organotypic slice cultures from wild‐type or SOD1G93A (MT) mice. We examined axon lengths and cell survival of embryonic stem cell–derived motor neurons. We defined and quantified the humoral factors that differed between wild‐type and MT organotypic cultures, and then corrected these differences in cell culture.

Results

MT spinal cord organotypic slices were selectively toxic to motor neurons as defined by axonal lengths and cell survival. MT spinal cord organotypic slices secreted higher levels of nitric oxide, interleukin (IL)‐1β, IL‐6, and IL‐12p70 and lower levels of vascular endothelial growth factor. The toxicity of MT spinal cord organotypic cultures was reduced and axonal lengths were restored to near normal by coculturing in the presence of reactive oxygen species scavenger, vascular endothelial growth factor, and neutralizing antibodies to IL‐1β, IL‐6, and IL‐12.

Interpretation

MT spinal cord organotypic cultures overexpress certain factors and underexpress others, creating a nonpermissive environment for cocultured motor neurons. Correction of these abnormalities as a group, but not individually, restores axonal length to near normal. Such a “cocktail” approach to the treatment of amyotrophic lateral sclerosis should be investigated further. Ann Neurol 2006;60:716–728
Financial anatomy of neuroscience research
Authors: Dorsey E. Ray , Vitticore Philip , De Roulet Jason , Thompson Joel P. , Carrasco Melisa , Johnston S. Claiborne , Holloway Robert G. , Moses Hamilton
Published: December 2006

Objective

To estimate the level of funding for neuroscience research from federal and industry sources and to examine the therapeutic advances in the neurosciences over the past decade.

Methods

We examined financing for neuroscience research over the past decade from the following principal sponsors of biomedical research: the National Institutes of Health, the pharmaceutical industry, large biotechnology firms, and large medical device firms. We also examined US Food and Drug Administration approvals for new molecular entities and medical devices for indications within the neurosciences. Neuroscience was defined to include funding and approvals for neurological and psychiatric conditions.

Results

Total (nominal) industry and government funding for neuroscience research increased from $4.8 billion in 1995 to $14.1 billion in 2005 and doubled after adjusting for inflation. In 2005, the pharmaceutical industry and the largest biotechnology and medical device firms accounted for 58% of total funding. The US Food and Drug Administration approved 40 new molecular entities for indications within the neurosciences from 1995 to 2005, with the annual number of approvals remaining relatively stagnant during this period. From 1995 to 2005, the US Food and Drug Administration also approved 1,679 medical devices in the neurosciences for use.

Interpretation

Financing for neuroscience research has increased significantly over the past decade, but new approvals for drugs in the neurosciences have not kept pace with the rapid increase in funding. This lag may represent a natural delay in realizing the return in the investment in scientific research or a decline in the productivity of neuroscience research. Ann Neurol 2006;60:652‒659
Orally available compound prevents deficits in memory caused by the Alzheimer amyloid‐β oligomers
Authors: Townsend Matthew , Cleary James P. , Mehta Tapan , Hofmeister Jacki , Lesne Sylvain , O'Hare Eugene , Walsh Dominic M. , Selkoe Dennis J.
Published: December 2006

Objective

Despite progress in defining a pathogenic role for amyloid β protein (Aβ) in Alzheimer's disease, orally bioavailable compounds that prevent its effects on hippocampal synaptic plasticity and cognitive function have not yet emerged. A particularly attractive therapeutic strategy is to selectively neutralize small, soluble Aβ oligomers that have recently been shown to mediate synaptic dysfunction.

Methods

Using electrophysiological, biochemical, and behavioral assays, we studied how scyllo‐inositol (AZD‐103; molecular weight, 180) neutralizes the acutely toxic effects of Aβ on synaptic function and memory recall.

Results

Scyllo‐inositol, but not its stereoisomer, chiro‐inositol, dose‐dependently rescued long‐term potentiation in mouse hippocampus from the inhibitory effects of soluble oligomers of cell‐derived human Aβ. Cerebroventricular injection into rats of the soluble Aβ oligomers interfered with learned performance on a complex lever‐pressing task, but administration of scyllo‐inositol via the drinking water fully prevented oligomer‐induced errors.

Interpretation

A small, orally available natural product penetrates into the brain in vivo to rescue the memory impairment produced by soluble Aβ oligomers through a mechanism that restores hippocampal synaptic plasticity. Ann Neurol 2006;60:668–676
A status report on neuroscience research, without grade inflation
Authors: Johnston S. Claiborne , Hauser Stephen L.
Published: December 2006

The fact is that most of us (then) doing research on poliomyelitis were motivated mainly by curiosity, and for the challenges of the many unsolved problems concerning the interaction of virus and host, rather than by the hope of a practical solution in our lifetime. —David Bodian discussing the reaction of the academic community after an outline for conquest of polio set forth by Thomas Rivers in 1938 had failed to inspire scientists to work collaboratively on a practical, pragmatic approach to a pressing health problem.

From Oshinsky, DM. Polio: an American story. New York: Oxford University Press, 2005
Titelbild: Sekundärstruktur, Dynamik und Topologie eines Sieben‐Helix‐Rezeptors in nativer Membranumgebung, untersucht mit Festkörper‐NMR‐Spektroskopie (Angew. Chem. 3/2007)
Authors: Etzkorn Manuel , Martell Swetlana , Andronesi Ovidiu C. , Seidel Karsten , Engelhard Martin , Baldus Marc
Published: December 2006

Membranproteine können nun durch hochauflösende Festkörper‐NMR‐Spektroskopie in ihrer natürlichen Umgebung studiert werden. Die Detektion unbeweglicher, mobiler und wasserzugänglicher Proteinsegmente liefert Einblicke in die membranständige Struktur des sensorischen Rhodopsins II von Natromonas pharaonis. Die Sekundärstruktur, Dynamik und Membrantopologie dieses Sieben‐Helix‐Rezeptors werden von M. Engelhard, M. Baldus et al. in der Zuschrift auf S. 463 ff. diskutiert.
Synthesis of polyacrylonitrile via reverse ATRP initiated by 1,1,2,2‐tetraphenyl‐1,2‐ethanediol/CuCl2/2,2′‐bipyridine
Authors: Hou Chen , Liu Junshen , Guo Zhenliang , Qu Rongjun
Published: December 2006

The reverse atom‐transfer radical polymerization (RATRP) technique using CuCl2/2,2′‐bipyridine (bipy) complex as a catalyst was applied to the living‐radical polymerization of acrylonitrile (AN). 1,1,2,2‐Tetraphenyl‐1,2‐ethanediol (TPED) was first used as the initiator in this copper‐based RATRP initiation system. A CuCl2 to bipy ratio of 0.5 not only gives the best control of molecular weight and its distribution, but also provides rather rapid reaction rate. The rate of polymerization increases with increasing the polymerization temperature, and the apparent activation energy was calculated to be 53.2 kJ mol−1. Because the polymers obtained were end‐functionalized by chlorine atoms, they were used as macroinitiators to proceed the chain extension polymerization in the presence of CuCl/bipy catalyst system via a conventional ATRP process. © 2006 Wiley Periodicals, Inc. J Appl Polym Sci 103: 3529–3533, 2007
Monomer apparent reactivity ratios for acrylonitrile/ammonium itaconate radical copolymerization systems
Authors: Hou Chen , Ji Chunnuan , Ying Liang
Published: December 2006

Ammonium itaconate was first used to copolymerize with acrylonitrile. This was achieved by using azobisisobutyronitrile as the initiator and dimethyl sulfoxide as the solvent. Effects of copolymerization systems on monomer apparent reactivity ratios for acrylonitrile/ammonium itaconate copolymers were studied. The values of monomer apparent reactivity ratios were calculated by Kelen‐Tudos method. The apparent reactivity ratios in the aqueous suspension polymerization system are similar to those in the solution polymerization system at polymerization conversions of less than 18% [reactivity ratio of acrylonitrile (rAN) = 0.47 ± 0.01, reactivity ratio of ammonium itaconate (rAIA) = 3.08 ± 0.01]. At conversions of more than 50%, the changes of monomer apparent reactivity ratios become less prominent (rAN = 0.68 ± 0.01, rAIA = 2.47 ± 0.01). In water‐rich reaction medium [(H2O/dimethylsulfoxide (DMSO) > 80/20)], the monomer apparent reactivity ratios are approximately equivalent to those in the aqueous suspension polymerization system. In DMSO‐rich reaction medium (DMSO/H2O > 80/20), the apparent reactivity ratios are similar to those in the solution polymerization system. With an increase in the polarity of the solvent, the values of apparent reaction ratios both decrease. The values of apparent reaction ratios gradually tend to 1 with increasing the copolymerization temperature. © 2007 Wiley Periodicals, Inc. J Appl Polym Sci 103: 3920–3923, 2007
Thermotropic liquid crystalline polyphenylphosphates containing aryl ester mesogens
Authors: Senthil S. , Poomathi N. , Kannan P.
Published: December 2006

A series of main‐chain liquid crystalline polyphosphate esters with varying center core in a triad ester mesogen were prepared. The phosphorus is incorporated in the middle of the spacer unit. All the monomers and polymers were characterized by spectral and thermal techniques. Thermogravimetric analysis shows that these polymers were stable up to 295–340°C. The char yields of the polymer were in range of 11–31%. Differential scanning calorimetry (DSC) thermal analysis confirms the mesophase formation of the polymers. Some of the polymers exhibited micro‐grainy textures with low glass transition. The DSC and microscopic analysis reveal that the polymer containing central unit which increases the aspect ratio shows liquid crystalline properties, whereas the unit that decreases the aspect ratio failed to show the mesophase formation. Energy minimized structures for the mesogenic units reveal that the polymers containing phenyl, pyridazine, diphenyl ester, and biphenyl unit shows high aspect ratio compared to nonmesogenic phenolphthalein, bisphenol‐A, and bisphenol‐S units. It revealed that increasing the length of the mesogen and incorporating heteroatoms in the aromatic moiety increased the mesophase stability. © 2006 Wiley Periodicals, Inc. J Appl Polym Sci 103: 3924–3930, 2007
Comparative study of the physical aging of the epoxy systems BADGE n = 0/m‐XDA and BADGE n = 0/m‐XDA/PEI
Authors: Fraga F. , Payo P. , Rodríguez‐Núñez E. , Martínez‐Ageitos J. M. , Castro‐Díaz C.
Published: December 2006

The physical aging of the epoxy network consisting of a diglycidyl ether of bisphenol A, m‐xylylenediamine, and polyetherimide was studied by differential scanning calorimetry. The glass transition temperature and the variation of the specific heat capacities have been calculated using the method, based on the intersection of both enthalpy–temperature lines for glassy and liquid states. The apparent activation energy (EH) was calculated using a single method that involved separate temperature and excess enthalpy dependency. All calorimetric data were compared with those obtained for the epoxy network without thermoplastic. thermoplastic. © 2007 Wiley Periodicals, Inc. J Appl Polym Sci 103: 3931–3935, 2006