bluuebunny/crossref_metadata_2025 huggingface dataset:
Defective Mismatch Repair As a Predictive Marker for Lack of Efficacy of Fluorouracil-Based Adjuvant Therapy in Colon Cancer
Authors: Sargent Daniel J. , Marsoni Silvia , Monges Genevieve , Thibodeau Stephen N. , Labianca Roberto , Hamilton Stanley R. , French Amy J. , Kabat Brian , Foster Nathan R. , Torri Valter , Ribic Christine , Grothey Axel , Moore Malcolm , Zaniboni Alberto , Seitz Jean-Francois , Sinicrope Frank , Gallinger Steven
Published: May 2010

Purpose

Prior reports have indicated that patients with colon cancer who demonstrate high-level microsatellite instability (MSI-H) or defective DNA mismatch repair (dMMR) have improved survival and receive no benefit from fluorouracil (FU) -based adjuvant therapy compared with patients who have microsatellite-stable or proficient mismatch repair (pMMR) tumors. We examined MMR status as a predictor of adjuvant therapy benefit in patients with stages II and III colon cancer.

Methods

MSI assay or immunohistochemistry for MMR proteins were performed on 457 patients who were previously randomly assigned to FU-based therapy (either FU + levamisole or FU + leucovorin; n = 229) versus no postsurgical treatment (n = 228). Data were subsequently pooled with data from a previous analysis. The primary end point was disease-free survival (DFS).

Results

Overall, 70 (15%) of 457 patients exhibited dMMR. Adjuvant therapy significantly improved DFS (hazard ratio [HR], 0.67; 95% CI, 0.48 to 0.93; P = .02) in patients with pMMR tumors. Patients with dMMR tumors receiving FU had no improvement in DFS (HR, 1.10; 95% CI, 0.42 to 2.91; P = .85) compared with those randomly assigned to surgery alone. In the pooled data set of 1,027 patients (n = 165 with dMMR), these findings were maintained; in patients with stage II disease and with dMMR tumors, treatment was associated with reduced overall survival (HR, 2.95; 95% CI, 1.02 to 8.54; P = .04).

Conclusion

Patient stratification by MMR status may provide a more tailored approach to colon cancer adjuvant therapy. These data support MMR status assessment for patients being considered for FU therapy alone and consideration of MMR status in treatment decision making.
Embodying Art: The Spectator and the Inner Body
Authors: Esrock Ellen J.
Published: May 2010

Embodied approaches to art history concerned with empathic projection can be reinforced by introducing empirical research that corroborates experiential observations about a spectator's bodily responses and by a more nuanced repertoire of bodily focused viewing. To reinforce existing scholarship, I examine a study exemplary in its analysis of embodied experience, Michael Fried's Menzel's Realism: Art and Embodiment in Nineteenth-Century Berlin (2002), proposing that the author's reported empathic experiences of Adolph Menzel's painting Rear Courtyard and House can be understood through concepts of sensorimotor imaging, hypnosis, and interoception. To expand the range and nuance of embodied responses, I first counterpoint Fried's two interpretations of the painting Balcony Window, offering a gendered reading and a taxonomy of three sensory modes of looking at art. Second, I shift to a micro level to explore how the spectator's breathing interacts with this painting and how these respiratory interactions create a mnemonic overlay that operates over time. Although these analyses focus on a nineteenth-century realist painting, the concepts and practices can be applied to diverse genres and media.
Ehyeh Asher Ehyeh(Exodus 3:14): God's “Narrative Identity” Among Suspense, Curiosity, and Surprise
Authors: Sonnet Jean-Pierre
Published: May 2010

God's enigmatic answer to Moses' question about his name—Ehyeh asher ehyeh, usually translated “I am who I am” (Exod. 3:14)—has provoked philological analysis for centuries, often coupled with high philosophical and theological reflection; yet little attention has been paid to the narrative relevance of God's self-designation in the context of the book of Exodus. The article investigates the narrative potential of God's revealed name along the threefold movement of suspense, curiosity, and surprise. The attention to the syntactic, semantic, rhetorical, and narrative aspects of God's name in itself and within its immediate context is interrelated with the tracking of suspense, curiosity, and surprise dynamics triggered by God's name in the book of Exodus as a whole. The fine and multiplied dynamism of God's self-naming phrase, it is shown, turns the Exodus narrative into the embodiment of God's name and into the crucible of God's narrative identity.
Drosophila Tey represses transcription of the repulsive cue Toll and generates neuromuscular target specificity
Authors: Inaki Mikiko , Shinza-Kameda Makiko , Ismat Afshan , Frasch Manfred , Nose Akinao
Published: May 2010

Little is known about the genetic program that generates synaptic specificity. Here we show that a putative transcription factor, Teyrha-Meyhra (Tey), controls target specificity, in part by repressing the expression of a repulsive cue, Toll. We focused on two neighboring muscles, M12 and M13, which are innervated by distinct motoneurons in Drosophila. We found that Toll, which encodes a transmembrane protein with leucine-rich repeats, was preferentially expressed in M13. In Toll mutants, motoneurons that normally innervate M12 (MN12s) formed smaller synapses on M12 and instead appeared to form ectopic nerve endings on M13. Conversely, ectopic expression of Toll in M12 inhibited synapse formation by MN12s. These results suggest that Toll functions in M13 to prevent synapse formation by MN12s. We identified Tey as a negative regulator of Toll expression in M12. In tey mutants, Toll was strongly upregulated in M12. Accordingly, synapse formation on M12 was inhibited. Conversely, ectopic expression of tey in M13 decreased the amount of Toll expression in M13 and changed the pattern of motor innervation to the one seen in Toll mutants. These results suggest that Tey determines target specificity by repressing the expression of Toll. These results reveal a mechanism for generating synaptic specificity that relies on the negative regulation of a repulsive target cue.
Value of wound biopsy in chronic venous ulceration
Authors: Miller D R , Enoch S , Williams D T , Price P E , Harding K G
Published: May 2010

Objectives: Malignant transformation in chronic venous ulcers (CVU) is a limb threatening complication, which has an insidious onset. Clinical experience in our practice suggests a lack of suspicious macroscopic features making diagnosis difficult. The aim of this study is to evaluate the role of routine wound biopsy in the outpatient clinic for CVU without suspicious appearances but with no signs of healing despite appropriate treatment.

Methods: A three-year (2000-2003) retrospective review of records for all patients who underwent biopsy of a CVU in the outpatient clinic in a specialist wound healing clinic set in a university hospital.

Results: In our series ( n =76), three indications for biopsy were identified: CVU that had developed features suspicious of carcinoma ( n =17), CVU that had no suspicious features but were non-healing ( n =24) and CVU that had developed features of inflammatory ulceration ( n =35). A positive finding of carcinoma (squamous or basal cell carcinoma) or intraepidermal carcinoma (Bowen's disease) was made in four (24%), nine (37.5%) and 0 cases respectively.

Conclusions: Malignancy may arise in CVU without showing suspicious features and wound biopsy should be advocated for any ulcer that fails to respond to appropriate treatment.
A comparison of physical methods for prophylaxis of deep vein thrombosis on augmentation of venous flow velocity and reduction of calf volume
Authors: Hirai M , Iwata H
Published: May 2010

Objective: This study was designed to determine the optimal physical methods for promoting venous return of the leg.

Methods: Ten healthy volunteers were investigated in the supine position on a couch, and their peak femoral venous velocity and calf muscle volume were determined using duplex ultrasound and strain gauge plethysmography,respectively,before and during deep respiration, limb elevation, calf squeezing and various types of leg exercises.

Results: Deep respiration showed the smallest effect on both percentage increase of peak flow velocity and expelled volume. Elevation of the leg showed the same effect on the expelled volume as calf muscle squeezing and ankle movement, while the former showed significantly less effect than the latter on the percentage increase of peak flow velocity. In both dorsal flexion of the ankle and squeezing at the calf, the stronger of each procedure caused more effective changes in haemodynamics. Ankle exercise was more effective in promoting venous return in the calf muscle than wiggling the toes, making circling movements with the feet or alternately flexing and spreading the toes.

Conclusions: Ankle exercise or calf muscle squeezing, performed maximally,may be the first recommendation for reducing venous stasis at the calf muscle and prophylaxis of deep vein thrombosis..
Leiomyosarcoma of the inferior vena cava presenting as a left-sided variocele
Authors: Masannat Y , Al-Koteesh J , Sharaf U , Evans H
Published: May 2010

Leiomyosarcomas of the great vessels are rare, but the most common site for them is the inferior vena cava. Due to non-specific clinical signs, diagnosis is usually late. At present, surgery is the treatment of choice. This is a case report of a 44-year-old man who presented with left groin discomfort and a left varicocele which were secondary to leiomyosarcoma of the inferior vena cava.
Neoplastic spread after trauma: natural death or manslaughter?
Authors: Ausania Francesco , De-Giorgio Fabio , Valerio Luca , Capelli Arnaldo , Arena Vincenzo
Published: May 2010

We report an unusual death of a seemingly healthy 26-year-old man due to diffuse metastasization of adrenal paraganglioma caused by rupture of the primitive tumour with subsequent massive haemorrhage after a relatively minor trauma. Our report describes the results of forensic investigation and discusses the possible mechanisms of metastasization.
Attitudes toward autopsy in unexpected death: a nationwide survey of physicians and risk managers in Japanese teaching hospitals
Authors: Kamishiraki Etsuko , Maeda Shoichi , Starkey Jay , Ikeda Noriaki
Published: May 2010

Context

Autopsy is a useful tool for understanding the manner and cause of death in unexpected patient death. The information about the opinions of physicians and risk managers in Japan regarding autopsy is limited.

Objective

To describe and evaluate the opinions of physicians and risk managers at Japanese teaching hospitals regarding forensic autopsy.

Design, setting and participants

Cross-sectional study of all residency programme directors and risk managers completing a survey in January 2009. Specific clinical scenarios where autopsy would be essential to determine whether medical error occurred and whether medical care contributed to the death of the patient were presented. Respondents gave their opinion regarding the necessity of autopsy and their beliefs about if they would actually recommend it.

Results

Of 1113 eligible physicians and 1113 eligible chief risk management officers, 466 physicians (41.9%) and 599 risk managers (53.8%) responded. The majority of physicians and risk managers reported they would recommend an autopsy in cases of unclear medical error or unclear cause and effect relationship of medical care and patient death; however, 10% or more of physicians and 25% or more of risk managers (depending on the situation) reported that they would not recommend an autopsy. Risk managers were less likely than physicians to recommend and believe that autopsy was necessary.

Conclusions

The majority of physicians and risk managers in Japan would recommend autopsy and believe in its necessity in cases of unexpected patient death.
Native mRNA antisense-accessible sites library for the selection of antisense oligonucleotides, PNAs, and siRNAs
Authors: Fang Huafeng , Shen Yuefei , Taylor John-Stephen
Published: May 2010

A procedure for rapidly generating a library of antisense-accessible sites on native mRNAs (mRNA antisense-accessible sites library [MASL]) is described that involves reverse transcription of whole cell mRNA extracts with a random oligodeoxynucleotide primer followed by mRNA-specific polymerase chain reaction (PCR). Antisense phosphorothioate oligodeoxynucleotides (ODNs), peptide nucleic acids (PNAs), and small interfering RNAs (siRNAs) can then be identified by screening against the antisense-accessible sites. The utility of this methodology is demonstrated for the identification of more effective inhibitors of inducible nitric oxide synthase (iNOS) induction than have previously been reported. This method may also be useful for constraining folding calculations of native mRNAs and for designing mRNA imaging probes.
BarMap: RNA folding on dynamic energy landscapes
Authors: Hofacker Ivo L. , Flamm Christoph , Heine Christian , Wolfinger Michael T. , Scheuermann Gerik , Stadler Peter F.
Published: May 2010

Dynamical changes of RNA secondary structures play an important role in the function of many regulatory RNAs. Such kinetic effects, especially in time-variable and externally triggered systems, are usually investigated by means of extensive and expensive simulations of large sets of individual folding trajectories. Here we describe the theoretical foundations of a generic approach that not only allows the direct computation of approximate population densities but also reduces the efforts required to analyze the folding energy landscapes to a one-time preprocessing step. The basic idea is to consider the kinetics on individual landscapes and to model external triggers and environmental changes as small but discrete changes in the landscapes. A “barmap” links macrostates of temporally adjacent landscapes and defines the transfer of population densities from one “snapshot” to the next. Implemented in the BarMap software, this approach makes it feasible to study folding processes at the level of basins, saddle points, and barriers for many nonstationary scenarios, including temperature changes, cotranscriptional folding, refolding in consequence to degradation, and mechanically constrained kinetics, as in the case of the translocation of a polymer through a pore.
How Riskily Do I Invest? The Role of Risk Attitudes, Risk Perceptions, and Overconfidence
Authors: Nosić Alen , Weber Martin
Published: May 2010

Our study analyzes the determinants of investors' risk-taking behavior. We find that investors' risk-taking behavior is affected by their subjective risk attitude in the financial domain and by the risk and return of an investment alternative. Our results also suggest that, consistent with previous findings in the literature, the objective, or historical, return and volatility of a stock are worse predictors of risk-taking behavior than subjective risk and return measures. Moreover, we illustrate that overconfidence, or more precisely, miscalibration, has an impact on risk behavior as predicted by theoretical models. However, our results regarding the effect of various determinants on risk-taking behavior heavily depend on the content domain in which the respective determinant is elicited. We interpret this as an indication for an extended content domain specificity. In particular, with regard to the Markets of Financial Instruments Directive, we believe practitioners could improve on their investment advising process by incorporating some of the determinants that, by our argument, influence investment behavior.
The Analytics Movement: Implications for Operations Research
Authors: Liberatore Matthew J. , Luo Wenhong
Published: May 2010

The movement toward the increased use of analytics in organizations has generated much discussion by academics and professionals about the impacts and opportunities that analytics offers. Although operations research (OR) has been a driving force in applying quantitative and analytical models for organizational decision making, it is less clear how we as OR practitioners can take advantage of the surging interest in analytics to promote the OR profession and expand its reach. In this paper, we discuss the drivers of the analytics movement, an example of an analytics project, and the opportunities and implications for OR, i.e., the problem scope, models and methods, implementation issues, organizational role, professional skills, and education.
Linking research and policy in Dutch healthcare: infrastructure, innovations and impacts
Authors: Bekker Marleen , Egmond Stans van , Wehrens Rik , Putters Kim , Bal Roland
Published: May 2010

The call for ‘evidence-based health policy’ in the Netherlands has to date been accommodated by the consensual policy tradition in this country and by the institutionalised arrangements for research funding, researcher career development and research accountability systems. The aim of this paper is to describe and explain from a sociological perspective how these arrangements for two-way research–policy interactions enable the co-production of ‘useable knowledge’ for ‘doable problems’ in health policy making. We conclude that many arrangements function as boundary objects that allow for mediation between research and policy. This mediation occurs via both frontstage and backstage processes. The backstage processes are an essential precondition for the co-production of acceptable evidence, policy advice and policy in the frontstage. However, as a result of the increasing emphasis on evidence-based policy, and an accompanying instrumentalisation of research use in the policy process, some of the characteristic, and until now productive, elements of the Dutch system are threatened.
An exploration of evidence-based policy in Ireland: health and social inclusion
Authors: Kennedy Patricia , Brún Tomas de , Brún Mary O’Reilly-de , MacFarlane Anne
Published: May 2010

Ireland is a small country with a history of a social partnership approach to policy making. This paper considers how the ambition of government to utilise an evidence-based approach to policy making plays out against this partnership agenda. Drawing on the authors’ experiences and personal reflections, the paper considers how these issues operate within a number of health and social inclusion policy areas, and it explores the role of stakeholders’ expectations and involvement in generating evidence for policy.
Predicting beauty: Fractal dimension and visual complexity in art
Authors: Forsythe A. , Nadal M. , Sheehy N. , Cela‐Conde C. J. , Sawey M.
Published: May 2010

Visual complexity has been known to be a significant predictor of preference for artistic works for some time. The first study reported here examines the extent to which perceived visual complexity in art can be successfully predicted using automated measures of complexity. Contrary to previous findings the most successful predictor of visual complexity was Gif compression. The second study examined the extent to which fractal dimension could account for judgments of perceived beauty. The fractal dimension measure accounts for more of the variance in judgments of perceived beauty in visual art than measures of visual complexity alone, particularly for abstract and natural images. Results also suggest that when colour is removed from an artistic image observers are unable to make meaningful judgments as to its beauty.
Determining the performance of collaborative design systems based on AHP sensitivity analysis
Authors: Chang Che-Wei , Wu Cheng-Ru , Chen Chiu-Chin
Published: May 2010

Internet information technological advances have transformed customer and supplier collaborative design systems into a major trend. Studies have shown that product data can be effectively exchanged and shared in collaborative design, which can enhance enterprise competitiveness. This study used analytical hierarchy process, sensitivity analysis, and benefits, opportunities, costs, and risks decision-support tools to analyze the collaborative design information system, which can effectively integrate supplier and customer resources in differs industries. Collaborative design information systems employed by the control information system of the Taiwan Freeway Bureau to analyze case studies. Finally, the proposed model can provide decision-makers with a more realistic and accurate description of the risks and challenges involved in controlling collaborative design information systems.
Nuclear Revival in Post-Suharto Indonesia
Authors: Amir Sulfikar
Published: May 2010

Indonesia is planning to build a nuclear power plant to meet soaring demand for energy. Opposing this policy, an anti-nuclear alliance is emerging from grassroots groups driven by distrust of the government's ability to handle high-risk technology. This article explores the contemporary politics of Indonesia's nuclear power program.
Climate Change and Regime Perpetuation in North Korea
Authors: Habib Benjamin
Published: May 2010

Climate change is a new variable that may weaken the Kim Jong-il regime by disrupting North Korea's agricultural sector, leading to greater food insecurity and erosion of the state's institutions. North Korea has limited capacity to adapt to climate hazards, which could exacerbate existing stresses and push the regime into terminal decay.
Upgrading the Local: Belgian Cuisine in Global Waves
Authors: scholliers peter , geyzen anneke
Published: May 2010

This essay touches upon questions about the use of food as an identity marker, the nature of local food, and the influence of foreign food. Since 1830, Belgium witnessed two international food waves that alternated with two local food waves, both opposing as well as using each other's characteristics. In this process, local food was continuously redefined. Belgium reveals a relationship between local and foreign food both in the sense of incorporation and exclusion. Foreign food always influenced local cooking and eating. The opposition between the ““self”” and the ““other”” is at times strongly upheld: local food is labeled as ““our,”” ““authentic,”” ““national,”” or ““regional”” (the ““self””) to make the difference with ““their,”” ““artificial,”” or ““international”” (the ““other””). This classification of foodways as national/regional is used to forge sentiments of belonging, especially in Belgium where strong separatist political feelings lead to intense regional reactions.
Food Masquerade
Authors: bermingham ann
Published: May 2010

Radishes cut to look like roses, watermelons carved into fruit baskets, apples made into swans, cakes frosted to look like dolls——when did this game of food masquerade start and how? This essay speculates about food's on-going history of disguise, of pretending to be what it's not. From the Renaissance courtier's delight in confections disguised as beasts, birds, and other fancies to our present day fascination with Japanese bento lunch boxes, food masquerade would seem to be a fanciful part of the history of food.

Food masquerade injects some levity into our growing seriousness about food, our suspicion that most supermarket food is riddled with toxins and bad karma. It proposes that eating food should be fun. Food masquerade also gets to the very heart of artistic visual representation: the magical transformation of paint, clay or wood into an image of something else. It is a synecdoche for art itself.
Modeling Common-Practice Rhythm
Authors: Temperley David
Published: May 2010

THIS STUDY EXPLORES WAYS OF MODELING the compositional processes involved in common-practice rhythm (as represented by European classical music and folk music). Six probabilistic models of rhythm were evaluated using the method of cross-entropy: according to this method, the best model is the one that assigns the highest probability to the data. Two corpora were used: a corpus of European folk songs (the Essen Folksong Collection) and a corpus of Mozart and Haydn string quartets. The model achieving lowest cross-entropy was the First-Order Metrical Duration Model, which chooses a metrical position for each note conditional on the position of the previous note. Second best was the Hierarchical Position Model, which decides at each beat whether or not to generate a note there, conditional on the note status of neighboring strong beats (i.e., whether or not they contain notes).When complexity (number of parameters) is also considered, it is argued that the Hierarchical Position Model is preferable overall.
High or Low Oxygen Saturation and Severe Retinopathy of Prematurity: A Meta-analysis
Authors: Chen Minghua L. , Guo Lei , Smith Lois E. H. , Dammann Christiane E. L. , Dammann Olaf
Published: May 2010

CONTEXT:

Low oxygen saturation appears to decrease the risk of severe retinopathy of prematurity (ROP) in preterm newborns when administered during the first few weeks after birth. High oxygen saturation seems to reduce the risk at later postmenstrual ages (PMAs). However, previous clinical studies are not conclusive individually.

OBJECTIVE:

To perform a systematic review and meta-analysis to report the association between severe ROP incidence of premature infants with high or low target oxygen saturation measured by pulse oximetry.

METHODS:

Studies were identified through PubMed and Embase literature searches through May 2009 by using the terms “retinopathy of prematurity and oxygen” or “retinopathy of prematurity and oxygen therapy.” We selected 10 publications addressing the association between severe ROP and target oxygen saturation measured by pulse oximetry. Using a random-effects model we calculated the summary-effect estimate. We visually inspected funnel plots to examine possible publication bias.

RESULTS:

Low oxygen saturation (70%–96%) in the first several postnatal weeks was associated with a reduced risk of severe ROP (risk ratio [RR]: 0.48 [95% confidence interval (CI): 0.31–0.75]). High oxygen saturation (94%–99%) at ≥32 weeks’ PMA was associated with a decreased risk for progression to severe ROP (RR: 0.54 [95% CI: 0.35–0.82]).

CONCLUSIONS:

Among preterm infants with a gestational age of ≤32 weeks, early low and late high oxygen saturation were associated with a reduced risk for severe ROP. We feel that a large randomized clinical trial with long-term developmental follow-up is warranted to confirm this meta-analytic result.
On-time Vaccine Receipt in the First Year Does Not Adversely Affect Neuropsychological Outcomes
Authors: Smith Michael J. , Woods Charles R.
Published: May 2010

OBJECTIVES:

To determine whether children who received recommended vaccines on time during the first year of life had different neuropsychological outcomes at 7 to 10 years of age as compared with children with delayed receipt or nonreceipt of these vaccines.

METHODS:

Publicly available data, including age at vaccination, from a previous VaccineSafety Datalink study of thimerosal exposure and 42 neuropsychological outcomes were analyzed. Vaccine receipt was defined as timely when each vaccine was received within 30 days of the recommended age. Associations between timeliness and each outcome were tested in univariate analyses. Multivariable regression models were constructed for further assessment of the impact of timeliness on neuropsychological outcomes after adjustment for potential confounders. Secondary analyses were performed on a subset of children with the highest and lowest vaccine exposures during the first 7 months of life.

RESULTS:

Timely vaccination was associated with better performance on 12 outcomes in univariate testing and remained associated with better performance for 2 outcomes in multivariable analyses. No statistically significant differences favored delayed receipt. In secondary analyses, children with the greatest vaccine exposure during the first 7 months of life performed better than children with the least vaccine exposure on 15 outcomes in univariate testing; these differences did not persist in multivariable analyses. No statistically significant differences favored the less vaccinated children.

CONCLUSIONS:

Timely vaccination during infancy has no adverse effect on neuropsychological outcomes 7 to 10 years later. These data may reassure parents who are concerned that children receive too many vaccines too soon.
Variation in Pediatric and Adolescent Firearm Mortality Rates in Rural and Urban US Counties
Authors: Nance Michael L. , Carr Brendan G. , Kallan Michael J. , Branas Charles C. , Wiebe Douglas J.
Published: May 2010

OBJECTIVE:

We examined whether firearm mortality rates among children varied across US counties along a rural-urban continuum.

METHODS:

US vital statistics data were accessed for all pediatric (age: 0–19 years) firearm deaths from 1999 through 2006. Deaths were analyzed according to a modified rural-urban continuum code (based on population size and proximity to metropolitan areas) assigned to each county (3141 counties).

RESULTS:

In the 8-year study period, there were 23649 pediatric firearm deaths (15190 homicides, 7082 suicides, and 1377 unintentional deaths). Pediatric nonfirearm mortality rates were significantly higher in the most-rural counties (adjusted rate ratio: 1.36 [95% confidence interval [CI]: 1.13–1.64]), compared with the most-urban counties. The most-rural counties demonstrated virtually identical pediatric firearm mortality rates (adjusted rate ratio: 0.91 [95% CI: 0.63–1.32]), compared with the most-urban counties. The most-rural counties had higher rates of pediatric firearm suicide (adjusted rate ratio: 2.01 [95% CI: 1.43–2.83]) and unintentional firearm death (adjusted rate ratio: 2.19 [95% CI: 1.27–3.77]), compared with the most-urban counties. Pediatric firearm homicides rates were significantly higher in the most-urban counties (adjusted rate ratio: 3.69 [95% CI: 2.00–6.80]), compared with the most-rural counties.

CONCLUSIONS:

Children in the most-rural US counties had firearm mortality rates that were statistically indistinguishable from those for children in the most-urban counties. This finding reflects a greater homicide rate in urban counties counterbalanced by greater suicide and unintentional firearm death rates in rural counties. Nonfirearm mortality rates were significantly greater outside the most-urban US counties.
Pediatric Mobility Aid–Related Injuries Treated in US Emergency Departments From 1991 to 2008
Authors: Barnard Alison M. , Nelson Nicolas G. , Xiang Huiyun , McKenzie Lara B.
Published: May 2010

OBJECTIVES:

Although mobility aids such as crutches, walkers, and wheelchairs are typically beneficial, they can be associated with injury. The objective of this study was to describe the incidence, patterns, and trends of pediatric mobility aid–related injuries to children and adolescents who were aged ≤19 years and treated in US emergency departments between 1991 and 2008.

METHODS:

A retrospective analysis was conducted by using data from the National Electronic Injury Surveillance System database for children and adolescents who were aged ≤19 years. Sample weights were used to calculate national estimates of mobility aid–related injuries on the basis of 2301 actual cases.

RESULTS:

An estimated 63 309 cases of children and adolescents who were aged ≤19 years were treated in US emergency departments for mobility aid–related injuries. Approximately 70% of mobility aid– related injuries occurred while patients were using wheelchairs. Children who were aged 2 to 10 years were more likely to sustain injuries while using walkers and wheelchairs, injure their heads, and sustain traumatic brain injuries. Children who were aged 11 to 19 years were more likely to sustain injuries while using crutches, injure their lower extremities, and sustain sprains and strains. Injuries involving wheelchairs were more likely to be traumatic brain injuries and result in hospitalization. Injuries involving crutches were more likely to involve misuse and be triggered by stairs or curbs.

CONCLUSIONS:

Injuries related to crutches, walkers, and wheelchairs have distinct injury patterns, mechanisms of injury, and trigger factors. Injury patterns between younger and older children were different. Additional research is needed to identify effective injury prevention strategies for the pediatric population.
Validade científica de conhecimento epidemiológico gerado com base no estudo Saúde Bucal Brasil 2003
Authors: Narvai Paulo Capel , Antunes José Leopoldo Ferreira , Moysés Samuel Jorge , Frazão Paulo , Peres Marco Aurélio , Peres Karen Glazer , Sousa Maria da Luz Rosário de , Roncalli Angelo Giuseppe
Published: May 2010

Problematiza-se a afirmação de que não são válidas as estimativas sobre as condições de saúde bucal da população brasileira geradas pelo SB Brasil 2003. Criticam-se os elementos que pretendem sustentar esse ponto de vista com base apenas em conceitos estatísticos, sem prova empírica. Identificam-se reduções decorrentes da abordagem epistemocêntrica que recusa peremptoriamente outras formas de conhecimento e não reconhece o caráter multidisciplinar da epidemiologia. Reconstituem-se informações sobre a realização do levantamento e seu impacto na produção de conhecimento. Faz-se uma analogia entre ciência e arte, argumentando-se que, nas imagens obtidas por ambas, os saberes gerados a partir do objeto cognoscível assumem feições variadas e, portanto, o reconhecimento de sua validade requer amplo domínio do objeto e operações com adequados critérios de valor. Conclui-se pela cientificidade, validade e relevância da produção acadêmica desenvolvida a partir da base de dados do levantamento SB Brasil 2003.
Integração entre vigilância sanitária e assistência à saúde da mulher: um estudo sobre a integralidade no SUS
Authors: Maia Christiane , Guilhem Dirce , Lucchese Geraldo
Published: May 2010

A integralidade é um princípio do SUS, com várias perspectivas, entre as quais a da articulação de seus serviços. O debate sobre esse princípio está presente na assistência à saúde, com destaque para a área de Saúde da Mulher, e nas diretrizes da Vigilância Sanitária. Como as duas áreas buscam a qualidade dos serviços de saúde, o objetivo é analisar a integração entre Vigilância Sanitária e assistência à saúde da mulher. Trata-se de estudo de caso, qualitativo, com entrevistas de profissionais de Vigilância Sanitária de serviços de saúde e coordenadores de Saúde da Mulher (CSM). Os achados apontam para isolamento da Vigilância Sanitária nas secretarias de saúde. A importância da integração é citada por CSM, porém não é fácil de ser aplicada. As relações, se ocorrem, são por situações emergenciais. Os trabalhadores de Vigilância Sanitária acham que não há articulação por não haver problemas na Saúde da Mulher que demandem sua participação e que, com inspeções e palestras, estão colaborando com a área. Mostram-se dificuldades à concretização da integralidade, com o desafio de articular ações em saúde, sobretudo para a Vigilância Sanitária.
A política de atenção primária à saúde no Brasil: notas sobre a regulação e o financiamento federal
Authors: Castro Ana Luisa Barros de , Machado Cristiani Vieira
Published: May 2010

O artigo analisa a condução federal da política de atenção primária à saúde no Brasil de 2003 a 2008, considerando as funções de Estado na saúde de planejamento, regulação, financiamento e execução direta de serviços. A pesquisa compreendeu revisão bibliográfica, realização de entrevistas semi-estruturadas com atores-chave da política, análise documental, orçamentária e de bases de dados secundários. Observou-se redução na execução federal direta das ações e fragilidades no que diz respeito ao planejamento. A atuação federal se caracterizou principalmente pela regulação, baseada na emissão de portarias atreladas a mecanismos financeiros. No que concerne ao financiamento, houve discreto aumento da participação da atenção básica no orçamento federal, reajustes e criação de novos incentivos, alguns visando à eqüidade. Embora tenham ocorrido avanços no período, permanece o desafio de reconuração do modelo regulatório federal e a garantia de um aporte maior de recursos para este nível de atenção, a fim de que ocorra o efetivo fortalecimento da atenção primária no país.
Priorities in health: what do they mean to Brazilian adults?
Authors: Reichert Felipe Fossati , Domingues Marlos Rodrigues , Hallal Pedro C. , Azevedo Mario Renato , Siqueira Fernando Vinholes , Barros Aluísio J.D.
Published: May 2010

We aimed to evaluate how Brazilian adults rank seven well-known health-related factors in terms of importance for health. A population-based study was undertaken in Pelotas, Rio Grande do Sul State, Brazil (N = 3,100; response rate: 96.5%). Individuals ranked three out of seven factors that, in their opinion, were the most important for health. The factors investigated were: "controlling stress", "practicing physical activity regularly", "avoiding drinking in excess", "avoiding smoking", "visiting a doctor regularly", "keeping the ideal weight", and "having a healthy diet". Healthy diet (73.9%), physical activity (59.9%), and visiting a doctor regularly (45.7%) were the most frequently reported factors. Younger subjects and those with higher socioeconomic status were more likely to report physical activity and stress as important factors for health than their counterparts. The importance attributed to health-related factors changes markedly among population subgroups.
Disparidades nas filas para transplantes de órgãos nos estados brasileiros
Authors: Marinho Alexandre , Cardoso Simone de Souza , Almeida Vivian Vicente de
Published: May 2010

Avaliamos alguns aspectos dos transplantes de órgãos nas Unidades da Federação brasileira, nos anos de 2004, 2005 e 2006. Estimamos, com base em um modelo de teoria das filas, os tempos de espera para transplantes de coração, córnea, fígado, pulmão, rim, pâncreas, e transplante simultâneo de rim e pâncreas. Os resultados indicam redução na espera por alguns órgãos (córnea, e pâncreas); elevação em outros (fígado, coração, rim/pâncreas); e ligeiras flutuações, sem tendência muito definida, nos transplantes de rim e nos transplantes de pulmão ao longo do período estudado. Os estados das regiões Sul e Sudeste (com a exceção do Rio de Janeiro) e Centro-oeste têm os menores tempos de espera e as maiores taxas de atendimento do país.
Efetividade dos centros de atenção psicossocial no cuidado a portadores de sofrimento psíquico em cidade de porte médio do Sul do Brasil: uma análise estratificada
Authors: Tomasi Elaine , Facchini Luiz Augusto , Piccini Roberto Xavier , Thumé Elaine , Silva Ricardo Azevedo da , Gonçalves Helen , Silva Suele Manjourany
Published: May 2010

Objetivo foi analisar a efetividade dos Centros de Atenção Psicossocial (CAPS) no cuidado de portadores sofrimento psíquico em Pelotas, Rio Grande do Sul, Brasil. Coorte prospectiva, com usuários de todos os CAPS do município em duas visitas domiciliares. Três variáveis de exposição terapêutica e duas da situação de saúde foram comparadas e estratificadas pela modalidade de atendimento e pelo tempo de freqüência ao serviço. Foram entrevistados 1.013 usuários na visita 1 e 875 na visita 2. Os transtornos mais freqüentes foram os de humor (39%), esquizofrenia (24%) e neuroses (13%). Mais de 50% recebiam atendimento intensivo ou semi-intensivo e quase 60% freqüentavam o serviço há três anos ou mais. Houve uma redução significativa na ocorrência de crises (p = 0,000), e o número de internações psiquiátricas foi menor entre aqueles em atendimento intensivo (p = 0,002) e com maior tempo de CAPS (p = 0,003). Entre os não-intensivos, diminuiu o uso de medicamentos (p = 0,032) e aumentou a participação em grupos (p = 0,000). Os CAPS podem ser considerados efetivos na assistência aos portadores de sofrimento psíquico.
Likely transmission of hepatitis C virus through sharing of cutting and perforating instruments in blood donors in the State of Pará, Northern Brazil
Authors: Oliveira-Filho Aldemir Branco de , Pimenta Adriana do Socorro Coelho , Rojas Márcia de Fátima Maciel , Chagas Márcia Cristina Munhoz , Crespo Deborah Maia , Crescente José Ângelo Barletta , Lemos José Alexandre Rodrigues de
Published: May 2010

We determined the risk factors for HCV infection in blood donors in the State of Pará, Northern Brazil. We examined 256 blood donors seen at the Blood Bank of Pará State between 2004 and 2006. They were divided into two groups, depending on whether they were infected with HCV or not; 116 donors were infected with HCV, while the other 140 were free of infection. The HCV-RNA was detected by real-time PCR. All of the participants filled out a questionnaire about possible risk factors. The data were evaluated using simple and multiple logistic regressions. The main risk factors for HCV were found to be use of needles and syringes sterilized at home (OR = 4.55), invasive dental treatment (OR = 3.08), shared use of razors at home (OR = 1.99), sharing of disposable razors in barbershops, beauty salons, etc. (OR = 2.34), and sharing manicure and pedicure material (OR = 3.45). Local and regional health authorities should educate the public about sharing perforating and cutting materials at home, in barber/beauty shops, and in dental clinics as risk factors for HCV infection.
Formulary Decisions: Then and Now
Authors: Boucher Bradley A.
Published: May 2010

An institution's formulary is a constantly evolving entity with a myriad of considerations that must be taken into account when any agent or chemical entity is being evaluated for formulary inclusion or is under review to continue as a therapeutic option. Originally a simple list of available agents, the formulary has developed into a required part of the hospital's administrative structure and an authoritative source for cost‐effective management of drug use within the institution. In recent years, closer evaluations of internal processes surrounding drugs with black‐box warnings, safety protocols, and the development of programs such as the risk evaluation and mitigation strategies (REMS) have added to the costs of using some therapeutic agents. Whether it is regulatory agencies levying fines for inappropriate use of a drug, the cost of compliance with various therapeutic protocols within an institution, or the costs of adhering to the requirements of REMS, formulary choices have a much greater impact on an institution's budget now than they did in the recent past. In the future, one may also see reduced or denied payments under increasingly recognized “never events,” should they be applied specifically to a given drug or class of drugs. Forward‐looking pharmacists must accept the challenge of making thoughtful formulary decisions within this complex milieu that extends well beyond assessment of cost‐effectiveness focused on therapeutic efficacy and acquisition costs.
The Formulary Process from a Risk Management Perspective
Authors: Raber Jack H.
Published: May 2010

During their evolution over the past 6 decades, hospital formularies have become more than a list of drugs that an institution keeps in stock. Today, an agent under formulary consideration must be examined not only in light of its relative efficacy, safety, and acquisition cost, but consideration must also be given to the potential indirect costs that accompany its use. Federal regulations have, for some drugs, added layers of administrative actions that must be followed to ensure their appropriate use. Examples of this are risk evaluation and mitigation strategies (REMS) and duties that may be implied or expressly addressed in the black‐box warnings associated with some classes of agents and, in isolated instances, specific drugs within a given class. Regulatory interpretation of these programs and warnings has often led to the expectation that the institution providing the agent will implement effective protocols and procedures to minimize the risk of adverse events to a patient in addition to or in accordance with required programs such as REMS. The consequences for failing to meet this expectation can lead to regulatory sanctions; the potential also exists for liability exposure. Risk management principles apply to all levels of the decision‐making process for evaluating a new agent for formulary inclusion or when reevaluating an agent's formulary status. Pharmacists play an important role in mitigating these risks by carefully evaluating every agent from a broader perspective.
Isolation and Characterization of the Betaine Aldehyde Dehydrogenase Gene in
Authors: Liu Jun , Zeng Huiming , Li Xue , Xu Lixin , Wang Yingbo , Tang Wei , Han Liebao
Published: May 2010

Betaine aldehyde dehydrogenase (BADH) catalyzes the last step in the synthesis of the glycine betaine from
choline. The BADH gene from turfgrass Ophiopogon japonicus has not been reported. In this study, we first isolated the
full length cDNA of betaine aldehyde dehydrogenase gene (OjBADH) from O. japonicus using Reverse Transcriptase-
Polymerase Chain Reaction (RT-PCR) and Rapid Amplification of cDNA Ends (RACE) techniques. The OjBADH gene
(GenBank accession number: DQ645888) has 1785 nucleotides with the 5’ untranscribed region (UTR) of 63 nucleotides,
3’ UTR of 219 nucleotides, and an open reading frame of 1503 nucleotides. This gene encodes a polypeptide of 500
amino acids. It shares a high homology with BADH genes of other Chenopodiaceae species. The putative protein includes
a conservative region of phosphofructokinase, aldehyde dehydrogenase, and glutamy phosphoric acid reductase. Overexpression
of OjBADH in transgenic tobacco plants demonstrated 2-2.5 folds increase of glycine betaine content and 60-
85% increase of survival rate under salt tolerance. These results suggested that the O. japonicus BADH gene may be used
to engineer plants for salt stress tolerance.
Increased Fluorodeoxyglucose Uptake Following Endovascular Abdominal Aortic Aneurysm Repair: A Predictor of Endoleak?
Authors: Paraskevas Kosmas I , Tzovaras Alexandros A , Stathopoulos Vassilios , Gentimi Fotini , Mikhailidis Dimitri P
Published: May 2010

The main criterion for abdominal aortic aneurysm (AAA) repair is an AAA diameter ≥5.5 cm. However, some AAAs rupture when they are smaller. Size alone may therefore not be a sufficient criterion to determine rupture risk. Fluorodeoxyglucose (FDG) uptake is increased in the presence of inflammation and it was suggested that this may be a better predictor of rupture risk than AAA size. Furthermore, increased FDG uptake following endovascular AAA repair may be an indirect predictor of continuous AAA sac enlargement due to the presence of an endoleak (even if this is not detected by imaging modalities) and/or increased AAA rupture risk. The role of FDG uptake needs to be explored further in the management of AAAs.
Measuring the Quality of Data Collection in a Large Observational Cohort of HIV and AIDS
Authors: Hillebregt Mariska , de Lange-de Klerk Elly , Knol Dirk , de Wolf Frank , Smit Colette
Published: May 2010

The aim of this study was to examine the quality of data collection by studying the validity of collected data. Data were extracted from the clinic charts of two anonymous outpatients by 38 data collectors. A standard for the data to be collected was determined (168 items). The validity was measured by comparing the collected items with the standard; in this way, the percentages of the collected items that were ‘correct’ could be calculated. The percentage ‘correct’ was higher for clinic chart 1 (mean: 83% correct, SD 7%) than for clinic chart 2 (mean: 78% correct, SD 8%). All categories contained incorrectly collected data. These data were divided into missing data, incorrect start-stop dates, and surplus collected data. Almost all start-stop dates would change into ‘correct’ if ‘monthyear’ was considered correct (instead of the standard ‘daymonthyear’). Not all data collectors used specific protocols, and sources other than the written comments were not always checked. This study shows that a high proportion of data was correctly collected. However, the collection of start-stop dates was not optimal, and the collected data included surplus and missing data. Data collectors should be more knowledgeable about HIV disease and trained in the use of difficult protocols, so that they can better recognize what data to collect and how it should be collected. Among physicians, there should be more agreement about what information to record in the charts, to facilitate data extraction for data collectors.