bluuebunny/crossref_metadata_2025 huggingface dataset:
NSF: WHAT WE KNOW AND WHAT WE NEED TO KNOW: Treatment of Nephrogenic Systemic Fibrosis: Limited Options but Hope for the Future
Authors: Linfert Douglas R. , Schell Jane O. , Fine Derek M.
Published: March 2008

Nephrogenic systemic fibrosis has now been linked to gadolinium‐based contrast exposure in those with compromised kidney function. When present, symptoms can be quite devastating for the patient including severe pain and immobility. Unfortunately there is a lack of a universally effective therapy at this time and the literature, reviewed in this article, is comprised of primarily case reports and small case series allowing few conclusions to be drawn. It is widely recognized that supportive management with physical therapy and aggressive pain management is essential. Resolution of renal function in acute kidney injury appears to attenuate disease in most cases and transplantation has been associated with variable success. Therapies with anecdotal benefit include extracorporeal photopheresis and intravenous sodium thiosulfate. Other interventions have shown limited success. As the mechanism becomes more readily understood, it is hoped that targeted therapy might prove more effective than currently available remedies. In all likelihood prevention will prove to be most effective in avoiding this devastating complication.
NSF: WHAT WE KNOW AND WHAT WE NEED TO KNOW: Nephrogenic Systemic Fibrosis Risk: Is There a Difference between Gadolinium‐Based Contrast Agents?
Authors: Penfield Jeffrey G. , Reilly Robert F.
Published: March 2008

Nephrogenic systemic fibrosis (NSF) is a disabling and potentially fatal disease that has been associated with gadolinium‐based contrast (GBC) agents. There are five GBC agents approved for use in the United States and another four approved in Europe. The proposed cause of NSF is release of free Gd3+ into tissues in patients with decreased renal function. The number of associated cases and the potential to release free gadolinium is not equal between these agents. Gadodiamide has the largest number of reported cases of NSF followed by gadopentetate dimeglumine and gadoversetamide. The market share of these agents may contribute to the number of reported cases. The pharmokinetics of gadodiamide and gadoversetamide indicate that these two agents are more likely to release free Gd3+ than other GBC agents. Gadoteridol and gadoterate meglumine have a cyclic structure, making them less likely to release free Gd3+, and there is only a single reported case of NSF associated with gadoteridol use alone. Further research into individual agents is needed.
Guidelines for Venous Access in Patients with Chronic Kidney Disease
Authors: Hoggard Jeffrey , Saad Theodore , Schon Don , Vesely Thomas M. , Royer Tim
Published: March 2008

At the time of hemodialysis vascular access evaluation, many chronic kidney disease patients already have iatrogenic injury to their veins which impedes the surgical construction of an arteriovenous fistula (AVF). Achieving the important goal of a greater prevalence of arteriovenous fistulae in the US hemodialysis population will require identification of those patients prior to reaching end‐stage renal disease and an educational and procedural system for preserving their veins.
From Anemia Trials to Clinical Practice: Understanding the Risks and Benefits When Setting Goals for Therapy
Authors: Coyne Daniel W.
Published: March 2008

Management of anemia in chronic kidney disease (CKD) and dialysis patients with erythropoiesis stimulating agents continues to be an area of debate. Recent US Food and Drug Administration documents indicate that Normal Hematocrit Study (NHS) completed in 1996 had more patients (1265 vs. 1233) and showed significantly increased deaths or myocardial infarctions (p = 0.01; risk ratio: 1.28; 95% CI: 1.06–1.56) rather than the indeterminate evidence of harm (risk ratio: 1.30; 95% CI: 0.9–1.9) reported in the 1998 publication. This review places the NHS study results in context with the other three major anemia trials, which, together, contain ∼70% of all patients reported in trials using active therapy in both arms and examining a hemoglobin target >12 g/dl in CKD and dialysis. The potential impact of the ongoing TREAT trial, with its unique design characteristics, is also reviewed. This review outlines the known risks and benefits of various anemia targets based on these completed trials to better inform physicians about the realistic goals from anemia treatment.
Peritoneal Membrane Structural and Functional Changes during Peritoneal Dialysis
Authors: Goffin Eric
Published: March 2008

Peritoneal dialysis is now utilized as a renal replacement therapy modality in a substantial percentage of patients with end‐stage renal disease, with excellent short‐term patient and technique survival rates. However, the potential complications associated with longer‐term therapy, such as ultrafiltration failure or encapsulating peritoneal sclerosis, have led to raise some concern about peritoneal dialysis as an adequate mode of treatment of end‐stage renal disease in the long term. In the last decade, a substantial amount of information has been gathered on the characteristics of the peritoneal membrane at the onset of peritoneal dialysis, and on the anatomical and pathophysiologic changes that occur with long‐term peritoneal dialysis. I will review this subject with a special focus on the various strategies that can help protect the peritoneal membrane during peritoneal dialysis so as to allow peritoneal dialysis to succeed as a long‐term dialysis modality.
Editorials: Niacin and Related Compounds for Treating Hyperphosphatemia in Dialysis Patients
Authors: Berns Jeffrey S.
Published: March 2008

Recent experimental and clinical studies suggest the possible utility of niacin (nicotinic acid, vitamin B3) and its metabolite nicotinamide as a means of lowering phosphate levels in dialysis patients via direct inhibition of the Na‐Pi‐2b sodium‐dependent phosphate co‐transporter in the GI tract. While the possibility of taking just one or two pills a day, which do not have to be taken with meals, is very attractive, caution is warranted before moving forward with niacin and related compounds for lowering phosphate levels in dialysis patients until it is certain that they are effective, well tolerated, and safe for treatment of chronic hyperphosphatemia.
Sympathetic Blocks: The Evidence
Authors: Day Miles
Published: March 2008

▪ Abstract:  The sympathetic nervous system has been implicated in numerous pain syndromes ranging from neuropathic pain to vascular pain to visceral pain. In light of this, sympathetic ganglia have been the target of local anesthetic blockade to determine the sympathetic role in the transmission of pain. If analgesia is afforded with local anesthetic blockade, chemical or thermal neurolysis have been utilized to attempt to provide long‐term relief. Despite frequent use of minimally invasive sympathetic blocks and neurolysis by pain practitioners, their efficacy for providing analgesia has been sparsely reported in the literature. Many case reports and case series have been published, but few placebo‐controlled, blinded studies exist. This manuscript will review the literature on sympathetic blocks and summarize existing studies for each of the sympathetic blocks. The goal is to provide past, current, and future pain physicians with evidence that they can use to provide appropriate care for their patients. ▪
Thoracic Spinal Cord Stimulation for Post‐Ablation Cardiac Pain in a Patient with Permanent Pacemaker
Authors: Hoelzer Bryan C. , Burgher Abram H. , Huntoon Marc A.
Published: March 2008

▪ Abstract

Background:  Spinal cord stimulation (SCS) is increasingly utilized for inoperable, intractable chest pain because of ischemia. Because patients with ischemic heart disease commonly have permanent cardiac pacemakers (PPM) or automated implantable cardio‐defibrillators (AICD), concurrent use of SCS and PPM or AICD may grow. Interference between SCS and PPM or AICD devices is potentially dangerous and has been previously reported.

Case report:  A 51‐year‐old woman who underwent multiple catheter‐based cardiac ablations for a variety of tachy‐atrial arrhythmias. These procedures included atrioventricular node destruction, which left her PPM‐dependent (third degree heart block with an intrinsic heart rate in the 30s). During the course of her cardiac treatment, she developed chest pain which was not amenable to cardiac intervention and was refractory to medical management. The patient was evaluated for consideration of SCS and ultimately underwent implantation. Procedures evaluating SCS–PPM compatibility were followed and are described. Immediately after SCS implantation and at 6 months follow‐up, the patient experienced improved pain relief.

Discussion:  Others have reported SCS implantation in patients with PPM. This is the first report to describe safe and effective use of an Advanced Bionics® SCS in a patient with a Guidant® PPM. In addition, we speculate that this patient's cardiac pain may have been other than ischemic in origin. As such, this case may represent a unique clinical scenario. Despite many cases series and case reports demonstrating safety of concurrent SCS and PPM or AICD, the complexity of these technologies requires continued demonstration of device compatibility in novel contexts. ▪
Fibromyalgia: Harmonizing Science with Clinical Practice Considerations
Authors: Perrot Serge , Dickenson Anthony H. , Bennett Robert M.
Published: March 2008

▪ Abstract

This review summarizes the present and emerging knowledge base on the pathophysiology, diagnosis, and management of fibromyalgia.

Epidemiology:  Fibromyalgia is the most common chronic pain syndrome encountered in general medicine and rheumatology. Historically, contemporary concepts of fibromyalgia have evolved in terms of its clinical description and parallel advances in the understanding of its pathophysiology.

Pathophysiology:  A generally accepted paradigm postulates that fibromyalgia is the clinical expression of a rheumatologic disorder in which the associated pain is driven primarily by central sensitization and possibly through changes in several neuronal systems but not necessarily reliant on peripheral processes.

Management:  Several agents, including serotonin‐norepinephrine reuptake inhibitors (ie, duloxetine and milnacipran), opioids (ie, tramadol), and the α2‐δ ligand pregabalin, which recently received U.S. regulatory approval for the treatment of fibromyalgia, have been evaluated in clinical trials, demonstrating benefit in terms of pain reduction and improvement in core symptoms (ie, fatigue and sleep disturbance). The European League Against Rheumatism has developed updated guidelines for the management of fibromyalgia. ▪
Performance evaluation of the new fully automated human immunodeficiency virus antigen‐antibody combination assay designed for blood screening
Authors: Sickinger Eva , Jonas Gesa , Yem Alex W. , Goller Andreas , Stieler Myriam , Brennan Catherine , Hausmann Michael , Schochetman Gerald , Devare Sushil G. , Hunt Jeffery C. , Kapprell Hans‐Peter , Bryant Jane D.
Published: March 2008

BACKGROUND: Before the introduction of human immunodeficiency virus (HIV) combination assays, serologic diagnosis of HIV infection was performed with assays that detected either antibodies or p24 antigen. Owing to the capability to detect the early appearance of p24 antigen, combination assays that are designed for simultaneous detection of antibodies and antigen can significantly reduce the diagnostic window.

STUDY DESIGN AND METHODS: Specificity and sensitivity of a commercially available HIV antigen‐antibody combination assay (Abbott PRISM; assay is not licensed by the FDA for use in the United States) were evaluated in a multicenter study by testing volunteer blood donors, hospitalized patients, seroconversion panels, and p24 antigen and HIV antibody subtype panels. Performance data were compared to a commercially available HIV combination assay and the PRISM HIV O Plus assay.

RESULTS: Apparent specificity of 99.95 percent was observed in the donor population for the PRISM HIV antigen‐antibody combination assay, and better seroconversion sensitivity was demonstrated compared with another combination assay and the PRISM HIV O Plus assay. Analytical HIV antigen detection sensitivity averaged 33 pg per mL on the Agence Française de Sécurité Sanitaire des Produits de Santé (AFSSAPS) panel. Furthermore, comparable antigen sensitivity was demonstrated for 32 HIV‐1 group M subtype and group O panels. The PRISM HIV combination assay detected all HIV‐1 group M and O and HIV‐2 antibody–positive specimens evaluated.

CONCLUSIONS: The PRISM HIV antigen‐antibody combination assay demonstrated a significant reduction of the window period for diagnosis of HIV infection. The assay demonstrated enhanced specificity and sensitivity along with broad subtype detection. The assay performance represents the “state‐of‐the art” technology for serologic blood screening of HIV infection.
Mannose‐binding lectin is involved in multiple organ dysfunction syndrome after cardiac surgery: effects of blood transfusions
Authors: Bilgin Yavuz M. , Brand Anneke , Berger Stefan P. , Daha Mohamed R. , Roos Anja
Published: March 2008

BACKGROUND: Serum levels of mannose‐binding lectin (MBL), a recognition molecule of the lectin pathway of complement, are highly variable, based on genetic variation. After cardiac surgery, extracorporeal circulation and ischemia‐reperfusion injury initiate a systemic inflammatory response, which can evolve to multiple organ dysfunction syndrome (MODS). Preoperative transfusions of allogeneic white blood cells (WBCs) contribute to infectious and inflammatory complications. This study investigates the role of MBL in relation to blood transfusions and complications after cardiac surgery.

STUDY DESIGN AND METHODS: In cardiac surgery patients who participated in a randomized trial comparing leukoreduced with buffy coat–depleted red blood cell (RBC) transfusions, circulating MBL was measured pre‐ and postoperatively by enzyme‐linked immunosorbent assay (ELISA). Data were related to the incidence of complications and to the transfusions the patients received.

RESULTS: Patients with high preoperative serum MBL levels (>400 ng/mL) show a significant (52 ± 12%) decrease of serum MBL postoperatively, whereas patients with low serum MBL levels (≤400 ng/mL) show a significant increase of serum MBL levels after surgery (140 ± 106%), which was further enhanced by fresh‐frozen plasma (FFP) transfusions. MBL levels were not associated with infections, sepsis, or death. Patients with MBL deficiency (MBL ≤ 80 ng/mL) were protected against development of MODS (p = 0.016), whereas FFP transfusion abolished this protection (p = 0.048).

CONCLUSION: Cardiac surgery is associated with MBL consumption, independent of the transfusion of allogeneic WBCs. Patients with MBL deficiency develop no MODS, unless they have been transfused with FFP, which is associated with MBL reconstitution. Therefore, sustained MBL deficiency may be a favorable status for patients undergoing cardiac surgery.
Development of a novel assay to evaluate the functional potential of umbilical cord blood progenitors
Authors: Reems Jo‐Anna , Hall Karen M. , Gebru Luladay H. , Taber Greta , Rich Ivan N.
Published: March 2008

BACKGROUND: Although the colony‐forming cell (CFC) assay provides the most relevant information regarding the functional potential of progenitors in a unit of umbilical cord blood (UCB), technical challenges associated with this assay have made it difficult to standardize the assay among testing laboratories. The purpose of this study was to assess the reproducibility of a newly developed functional assay (HALO SPC‐QC [HALO], HemoGenix, Inc.). This test is based on the principle that cellular proliferation responses to cytokine stimuli are proportional to intracellular ATP levels from progeny cells generated in culture from progenitors.

STUDY DESIGN AND METHODS: Results of the HALO assay were evaluated at two geographically distinct sites with matched aliquots from 12 different UCB units.

RESULTS: A significant correlation between the two sites for total nucleated cell counts was observed (r = 0.98, p < 0.001). Similarly, a strong correlation between HALO results from both sites was observed (r = 0.94, p < 0.001). Also, despite using different methods at each site for the CFC assay, results from the two sites correlated (r = 0.79, p = 0.002). A good correlation between the CFC and HALO assays (r = 0.73, p < 0.005), however, was only observed at the site with the same cytokine cocktail for both the CFC and the HALO assays.

CONCLUSION: These results support the notion that the HALO assay is a reasonable approach for measuring the functional potential of hematopoietic progenitors in UCB. Moreover, because the final readout for the HALO assay is instrument based, unlike the CFC assay, which requires a subjective enumeration of colonies, the HALO assay may be more amenable to standardization.
Prospective randomized comparative observation of single‐ versus split‐dose lenograstim to enhance engraftment after autologous stem cell transplantation in patients with multiple myeloma or non‐Hodgkin's lymphoma
Authors: Jang Geundoo , Ko Ock Bae , Kim Shin , Lee Dae Ho , Huh Jooryung , Suh Cheolwon
Published: March 2008

BACKGROUND: Granulocyte–colony‐stimulating factor (G‐CSF) is used to enhance hematopoietic recovery after autologous stem cell transplantation (ASCT). Recommendations for administration of G‐CSF during the engraftment phase of ASCT have recently changed. This study sought to compare the early engraftment profile between groups receiving single‐dose versus split‐dose lenograstim to enhance engraftment after ASCT.

STUDY DESIGN AND METHODS: A prospective, randomized study was performed with 40 patients (14 with non‐Hodgkin's lymphoma, 26 with multiple myeloma) undergoing ASCT. Patients were randomly assigned to receive 5 μg per kg lenograstim once daily (single dose) or 2.5 μg per kg lenograstim twice daily (split dose) starting 1 day after transplantation (Day +1). A minimum of 3 × 106 per kg CD34+ cells per kg was required for the autograft.

RESULTS: The median time to neutrophil engraftment was 10 days for both groups. Platelet (PLT) engraftment was achieved in 11 days for the single‐dose group and 14 days for the split‐dose group. Episodes of clinically documented infection were low and similar in both groups (18 during 392 patient‐days in the single‐dose group and 22 during 556 patient‐days in the split‐dose group). There were no significant differences in requirements for red blood cell or PLT transfusion between the two groups. The duration of hospitalization after stem cell infusion was 18 days for the single‐dose group and 22 days for the split‐dose group.

CONCLUSION: Administration of split doses of lenograstim is not associated with superior clinical efficacy compared with conventional daily single‐dose administration for immediate hematopoietic recovery after ASCT.
A randomized clinical trial comparing immediate versus delayed clamping of the umbilical cord in preterm infants: short‐term clinical and laboratory endpoints
Authors: Strauss Ronald G. , Mock Donald M. , Johnson Karen J. , Cress Gretchen A. , Burmeister Leon F. , Zimmerman M. Bridget , Bell Edward F. , Rijhsinghani Asha
Published: March 2008

BACKGROUND: Most neonates less than 1.0 kg birth weight need red blood cell (RBC) transfusions. Delayed clamping of the umbilical cord 1 minute after delivery transfuses the neonate with autologous placental blood to expand blood volume and provide 60 percent more RBCs than after immediate clamping. This study compared hematologic and clinical effects of delayed versus immediate cord clamping.

STUDY DESIGN AND METHODS: After parental consent, neonates not more than 36 weeks' gestation were randomly assigned to cord clamping immediately or at 1 minute after delivery. The primary endpoint was an increase in RBC volume/mass, per biotin labeling, after delayed clamping. Secondary endpoints were multiple clinical and laboratory comparisons over the first 28 days including Score for Neonatal Acute Physiology (SNAP).

RESULTS: Problems with delayed clamping techniques prevented study of neonates of less than 30 weeks' gestation, and 105 neonates 30 to 36 weeks are reported. Circulating RBC volume/mass increased (p = 0.04) and weekly hematocrit (Hct) values were higher (p < 0.005) after delayed clamping. Higher Hct values did not lead to fewer RBC transfusions (p ≥ 0.70). Apgar scores after birth and daily SNAP scores were not significantly different (p ≥ 0.22). Requirements for mechanical ventilation with oxygen were similar. More (p = 0.03) neonates needed phototherapy after delayed clamping, but initial bilirubin levels and extent of phototherapy did not differ.

CONCLUSIONS: Although a 1‐minute delay in cord clamping significantly increased RBC volume/mass and Hct, clinical benefits were modest. Clinically significant adverse effects were not detected. Consider a 1‐minute delay in cord clamping to increase RBC volume/mass and RBC iron, for neonates 30 to 36 weeks' gestation, who do not need immediate resuscitation.
The influence of baseline hemoglobin concentration on tolerance of anemia in cardiac surgery
Authors: Karkouti Keyvan , Wijeysundera Duminda N. , Yau Terrence M. , McCluskey Stuart A. , Van Rensburg Adriaan , Beattie W. Scott
Published: March 2008

BACKGROUND: Current red blood cell (RBC) transfusion guidelines assume that most acutely anemic patients can tolerate hemoglobin (Hb) concentrations as low as 6.0 to 7.0 g per dL and recommend that range as the transfusion threshold in patients who have no overt signs of organ dysfunction. Nonetheless, “normal” Hb concentrations vary widely in the population, and this variability may influence patients' tolerance of acute anemia. This retrospective cohort study was carried out to test this hypothesis.

STUDY DESIGN AND METHODS: Data were analyzed on 10,179 consecutive patients who had normal Hb concentrations (12.0‐16.0 g/dL in women and 13.0‐18.0 g/dL in men) and underwent on‐pump cardiac surgery from 1999 to 2006 at an academic hospital. The relationships of lowest intraoperative Hb concentration and maximum decrease in Hb concentration (from baseline) with the composite outcome of in‐hospital death, stroke, or kidney failure were determined in various patient subgroups.

RESULTS: The relationship between lowest Hb concentration and adverse outcomes was not independently associated with increased risk. In contrast, the relationship between maximum decrease in Hb concentration and adverse outcomes was independently associated with increased risk, with a 50 percent decrease being the threshold beyond which risk was increased (adjusted odds ratio, 1.53; 95% confidence interval, 1.12‐2.08; p = 0.007).

CONCLUSION: The degree of acute anemia that patients can safely tolerate during cardiac surgery is inversely related to their baseline Hb concentration. Current transfusion guidelines do not account for this relationship.
Photochemical treatment of plasma with amotosalen and UVA light: process validation in three European blood centers
Authors: Schlenke Peter , Hervig Tor , Isola Hervé , Wiesel Marie‐Louise , Kientz Daniel , Pinkoski Linda , Singh Yasmin , Lin Lily , Corash Laurence , Cazenave Jean‐Pierre
Published: March 2008

BACKGROUND: A photochemical treatment (PCT) process has been developed to inactivate pathogens and white blood cells (WBCs) in therapeutic plasma. Process validation studies were performed in three European blood centers under routine operating conditions.

STUDY DESIGN AND METHODS: Each center prepared 30 apheresis and 30 to 36 whole blood–derived plasma units for PCT. Each whole blood–derived plasma unit contained a mixture of two to three matched donations. After removal of pretreatment control samples (control fresh‐frozen plasma [C‐FFP]), 546 to 635 mL of plasma was treated with 15 mL of 6 mmol per L amotosalen, 3 J per cm2 UVA treatment, and removal of residual amotosalen with a compound adsorption device. After processing, plasma samples (PCT‐FFP) were withdrawn, frozen at −60°C within 8 hours of collection, and assayed for coagulation factors and residual amotosalen.

RESULTS: A total of 186 units of plasma were processed. The mean prothrombin time (12.2 ± 0.6 sec) and activated partial thromboplastin time (32.1 ± 3.2 sec) of PCT‐FFP were slightly prolonged compared to C‐FFP. Fibrinogen and Factor (F)VIII were most sensitive to PCT (26% mean reduction). PCT‐FFP, however, retained sufficient levels of fibrinogen (217 ± 43 mg/dL) and FVIII (97 ± 29 IU/dL) for therapeutic plasma. Mean levels of FII, FV, FVII, F IX, FX, FXI, and FXIII in PCT‐FFP were comparable to C‐FFP (81%‐97% retention of activity). Antithrombotic proteins were not significantly affected by PCT with retention ranging between 83 and 97 percent. Mean residual amotosalen levels were 0.6 ± 0.1 μmol per L.

CONCLUSION: Process validation studies in three European centers demonstrated retention of coagulation factors in PCT‐FFP within the required European and respective national standards for therapeutic plasma.
Assessment of a travel question to identify donors with risk of Trypanosoma cruzi: operational validity and field testing
Authors: O'Brien Sheila F. , Chiavetta Jo Anne , Fan Wenli , Xi Guoliang , Yi Qi‐Long , Goldman Mindy , Scalia Vito , Fearon Margaret A.
Published: March 2008

BACKGROUND: Because Trypanosoma cruzi (T. cruzi) infection in Canada and the United States is largely contracted in endemic countries, targeted testing of blood donors with risk travel may improve safety. The operational validity of a travel question suitable for donor screening was tested, and it was field‐tested.

STUDY DESIGN AND METHODS: After 1331 donors completed a short travel question, operational validity was assessed by detailed travel histories in face‐to‐face interviews. Two nationwide donor surveys were carried out assessing donor responses to similar travel questions in 2001 (13,623 donors) and in 2006 (20,037 donors). All donors in Toronto, Ontario, answered a travel question in 1997 and those born in or who spent 6 months or more in Mexico, Central America, or South America were tested for antibody to T. cruzi.

RESULTS: There was 97.3 percent agreement between the travel question and detailed interviews, with 15 donors (1.1%) failing to acknowledge risk travel (false‐negative questioning responses). Of these, 6 donors were born there and 7 others had less than 1 year of cumulative travel. In 2001 and 2006, there were 2.1 and 2.0 percent of donors with risk travel, respectively, but 16.5 and 11.2 percent of these donors were identified only because they were born there (travel not acknowledge). There were 1337 (1.6%) donors in Toronto in 1997 with risk travel and none were positive for the presence of T. cruzi antibody.

CONCLUSION: Donors can answer a short question about cumulative time in Latin America with similar accuracy to detailed questioning, but screening questions should also include country of birth.
Career activities of physicians taking the subspecialty board examination in blood banking/transfusion medicine
Authors: McCullough Jeffrey , Benson Kaaron , Roseff Susan , Simon Toby , Strauss Ronald , Stubbs James , Triulzi Darrell
Published: March 2008

BACKGROUND: Changes in blood banking and transfusion medicine (BB/TM) in the past 15 years may have made BB/TM a less attractive career choice than previously for physicians.

STUDY DESIGN AND METHODS: To evaluate this, we developed a survey of professional activities and sent it to all physicians who took the BB/TM specialty examination offered by the American Board of Pathology (ABP) between 1995 and 2004.

RESULTS: The examination was taken by 390 physicians (range, 25‐68/year). Responses to the survey were received by 151 (39%). The number of candidates did not appear to be declining during the 10 years. All physicians who responded had practiced BB/TM and 94 percent were still doing so. Forty‐three percent were engaged in BB/TM full‐time and another 10 percent for at least 75 percent of the time. Most of the remaining time was devoted to pathology. Forty‐three percent practiced in a university hospital, 22 percent in a community hospital, and 21 percent in a blood center. Examples of practice activities included transfusion service (85%), therapeutic apheresis (63%), stem cell collection (46%), stem cell laboratory (32%), and coagulation laboratory (29%). Sixty‐six percent are involved in research.

DISCUSSION: Interest in BB/TM careers is not decreasing as evidenced by the number of physicians taking the ABP specialty examination. Most currently practice BB/TM, many in an academic environment. Their activities are diverse. Many are involved in research and have presented abstracts at professional meetings. Approximately 60 percent combine the practice of BB/TM with pathology, but only a few (6%) practice hematology.
Basic science focus on blood substitutes: a summary of the NHLBI Division of Blood Diseases and Resources Working Group Workshop, March 1, 2006
Authors: Estep Timothy , Bucci Enrico , Farmer Martha , Greenburg Gerson , Harrington John , Kim Hae Won , Klein Harvey , Mitchell Phyllis , Nemo George , Olsen Ken , Palmer Andre , Valeri C. Robert , Winslow Robert
Published: March 2008

In March 2006, a workshop sponsored by the National Heart, Lung, and Blood Institute was convened to identify the role of basic science research in clarifying issues that are impeding progress in the development of hemoglobin‐based oxygen carrying (HBOC) solutions. These discussions resulted in a consensus that, although HBOCs have shown clinical promise, various side effects have inhibited further development and regulatory approval, with cardiovascular events being of particular concern. As a consequence, workshop participants focused on formulating research recommendations to better understand and mitigate these side effects. In addition, several important corollary issues were identified, including better understanding of the impact of HBOC infusion on human physiology; the need for rapid, noninvasive methods for the measurement of tissue oxygenation in human patients to better inform transfusion decisions; further investigation of routes and consequences of hemoglobin metabolism; optimization of clinical protocols for HBOC use; and assessment of the impact of HBOC formulation excipients. Also discussed was the possibility and desirability of developing new HBOCs with improved characteristics, such as prolonged functional intravascular persistence, greater stability, and a decreased propensity to generate reactive oxygen species. One practical limitation in this area is the consistent availability of pure, well‐characterized HBOC solutions for the research community. This communication summarizes the opinion of workshop participants on these issues and concludes with a list of specific recommended areas of research that could positively impact the development of blood substitutes.
A Semiparametric Transition Model with Latent Traits for Longitudinal Multistate Data
Authors: Lin Haiqun , Guo Zhenchao , Peduzzi Peter N. , Gill Thomas M. , Allore Heather G.
Published: March 2008

Summary We propose a general multistate transition model. The model is developed for the analysis of repeated episodes of multiple states representing different health status. Transitions among multiple states are modeled jointly using multivariate latent traits with factor loadings. Different types of state transition are described by flexible transition‐specific nonparametric baseline intensities. A state‐specific latent trait is used to capture individual tendency of the sojourn in the state that cannot be explained by covariates and to account for correlation among repeated sojourns in the same state within an individual. Correlation among sojourns across different states within an individual is accounted for by the correlation between the different latent traits. The factor loadings for a latent trait accommodate the dependence of the transitions to different competing states from a same state. We obtain the semiparametric maximum likelihood estimates through an expectation‐maximization (EM) algorithm. The method is illustrated by studying repeated transitions between independence and disability states of activities of daily living (ADL) with death as an absorbing state in a longitudinal aging study. The performance of the estimation procedure is assessed by simulation studies.
Testing and Estimation of Time‐Varying Cause‐Specific Hazard Ratios with Covariate Adjustment
Authors: Sun Yanqing , Hyun Seunggeun , Gilbert Peter
Published: March 2008

Summary In the evaluation of efficacy of a vaccine to protect against disease caused by a genetically diverse infectious pathogen, it is often important to assess whether vaccine protection depends on variations of the exposing pathogen. This problem can be viewed within the framework of a K‐competing risks model where the endpoint event is pathogen‐specific infection and the cause of failure is the strain type determined after the infection is diagnosed. The Cox model with time‐dependent coefficients is used to relate the cause‐specific outcomes to explanatory variables to allow for time‐varying treatment effects. The strain‐specific vaccine efficacy can be defined in terms of one minus the cause‐specific hazard ratios. We develop inferential methods for testing whether the vaccine affords some protection against at least one pathogen strain, and for testing equal vaccine protection against the strains, adjusting for covariate effects. We also consider estimation of covariate‐adjusted time‐varying strain‐specific vaccine efficacy. The methods are applied to a dataset from an oral cholera vaccine trial and the performances of the proposed tests are studied through simulations. These techniques apply more generally for testing and estimation of time‐varying cause‐specific hazard ratios.
Bayesian Estimation of Inverse Dose Response
Authors: Hu Bo , Ji Yuan , Tsui Kam‐Wah
Published: March 2008

Summary Inverse dose–response estimation refers to the inference of an effective dose of some agent that gives a desired probability of response, say 0.5. We consider inverse dose response for two agents, an application that has not received much attention in the literature. Through the posterior profiling technique (Hsu, 1995, The Canadian Journal of Statistics 23, 399–410), we propose a Bayesian method in which we approximate the marginal posterior distribution of an effective dose using a profile posterior distribution, and obtain the maximum a posteriori (MAP) estimate for the effective dose. We then employ an adaptive direction sampling algorithm to obtain the highest posterior density (HPD) credible region for the effective dose. Using the MAP and HPD estimates, investigators will be able to simultaneously calibrate the levels of two agents in dose–response studies. We illustrate our proposed Bayesian method through a simulation study and two practical examples.
Application of an Artificial Neural Network for Simulating Robust Plasma‐Sprayed Zirconia Coatings
Authors: Jean Ming‐Der , Lin Bor‐Tsuen , Chou Jyh‐Horng
Published: March 2008

This article presents the application of the artificial neural network (ANN) of a statistically designed experiment for developing a robust wear‐resistant zirconia coating. In this research, experimental design with orthogonal arrays efficiently provides enough information with the least number of experiments, reducing the cost and time. A radial basis function (RBF) network for the wear behavior is adopted. The friction and tribological properties of zirconia coatings were investigated. The microstructural feature of the coatings is also addressed in this study. It is found that the worn volumes of plasma‐sprayed zirconia coatings after wear tests are greatly improved by the optimal parameters. The relationships between the microstructure of the worn surface and their properties are examined, and the results reveal a higher wear resistance and a lower worn surface roughness with a large amount of plastic deformations. These wear resistant structures formed as a result of a dense lamellar formation during sprayed zirconia coatings. The RBF network can be established efficiently. A comparison of the predicted results with that of the RBF network and the Taguchi method predictor shows average errors of 2.735% and 9.191% for the RBF network and the Taguchi method, respectively. It is experimentally confirmed that the RBF network predictions are in agreement with the experiments, and it can be reliably used for the prediction of wear for plasma sprayings. The experimental results demonstrate that the RBF network used for a statistically designed experiment is an effective, efficient, and intelligent approach for developing a robust, high efficiency, and high‐quality zirconia coating process.
Formation and Properties of GeSe2–Ga2Se3–PbI2 Novel Chalcohalide Glasses
Authors: Tang Gao , Yang Zhiyong , Luo Lan , Chen Wei
Published: March 2008

The glass‐forming region of the GeSe2–Ga2Se3–PbI2 system was determined and homogeneous glasses were prepared. The maximum dissolvable PbI2 can be up to 50 mol%. The structures of glasses were characterized by Raman spectroscopy. The thermal, optical, and some basic physical properties of the glasses were investigated. The results show that GeSe2–Ga2Se3–PbI2 glasses have a wide region of transmission window (0.7–16 μm) and high refractive index (∼2.5) with the addition of PbI2. The glasses have good glass‐forming ability and high glass transition temperatures. Consequently, these novel glasses may be promising candidate materials for infrared optics and nonlinear optical field.
Densification of Nanocrystalline Yttria by Low Temperature Spark Plasma Sintering
Authors: Yoshida Hidehiro , Morita Koji , Kim Byung‐Nam , Hiraga Keijiro , Kodo Masayasu , Soga Kohei , Yamamoto Takahisa
Published: March 2008

We investigated the densification of undoped, nanocrystalline yttria (Y2O3) powder by spark plasma sintering (SPS) at sintering temperatures between 650°C and 1050°C at a heating rate of 10°C/min and an applied stress of 83 MPa. In spite of the low sinterability of the undoped Y2O3, a remarkable densification of the powder started at about 600°C, and a theoretical density of more than 97% was achieved at a sintering temperature of 850°C with a grain size of about 500 nm. The low temperature SPS is effective for fabricating dense Y2O3 polycrystals.
Managers’ and Subordinates’ Evaluations of Feedback Strategies: The Critical Contribution of Voice1
Authors: Lizzio Alf , Wilson Keithia , MacKay Lori
Published: March 2008

This study investigated 87 managers’ and 91 subordinates’ evaluations of a range of strategies for delivering performance feedback in the workplace. The managers and subordinates rated 8 written vignettes describing different feedback strategies on a number of variables (perceived effectiveness, perceived risk, level of enactment demand, and congruence of strategy for managers). Feedback strategies that used an invitation for the subordinate to reply to the negative feedback were evaluated as more effective and managerially congruent, and less risky than were the other strategies. However, strategies requiring bidirectional communication (e.g., invitations to reply), as opposed to unidirectional communication (e.g., praise), were generally perceived as more demanding to enact.
Relations Among Ethnicity, Gender, Beliefs, Attitudes, and Intention to Pursue a Career in Information Technology
Authors: Johnson Richard D. , Stone Dianna L. , Phillips T. Nichole
Published: March 2008

Using data from 159 African Americans and 98 Anglo Americans, we examined relations among ethnicity, gender, information technology (IT) self‐efficacy, occupational stereotypes, attitudes toward IT, and IT career intentions. Results revealed that IT self‐efficacy and occupational stereotypes were related to attitudes toward IT jobs, and these attitudes were positively related to career intentions. In addition, there were ethnic and gender differences in IT self‐efficacy and occupational stereotypes. In particular, African American men reported higher levels of IT self‐efficacy, whereas Anglo American women reported lower levels of IT self‐efficacy than did members of all other groups. Furthermore, Anglo Americans had more negative stereotypes of IT professionals than did African Americans. Implications for research and practice are discussed.
Consumer Racial Discrimination in Tipping: A Replication and Extension
Authors: Lynn Michael , Sturman Michael , Ganley Christie , Adams Elizabeth , Douglas Mathew , McNeil Jessica
Published: March 2008

This study examined the effects of server race, customer race, and their interaction on restaurant tips while statistically controlling for customers' perceptions of service quality and other variables. The findings indicate that consumers of both races discriminated against Black service providers by tipping them less than White service providers. Furthermore, this server race effect on tipping was moderated by perceived service quality and dining party size. The theoretical and practical implications of these findings are discussed. Particularly noteworthy is the possibility that the server race effect on tipping represents an adverse impact against Black servers that makes the use of tipping to compensate employees a violation of employment discrimination law in the United States.
Self‐Evaluation Bias of Social Comparisons in Ethical Decision Making: The Impact of Accountability
Authors: Novicevic Milorad M. , Buckley M. Ronald , Harvey Michael G. , Fung Helen
Published: March 2008

The purpose of this paper is to examine how accountability and judgment biases that occur in social comparisons may be related to ethical decision making. Using Jones' (1991) model as the theoretical framework to investigate this phenomenon, we found that self‐enhancing individuals (i.e., those who thought they were more ethical in comparison to their peers) demonstrated higher responsiveness to increases in accountability than did self‐effacing individuals (i.e., those who thought they were less ethical in comparison to their peers). We discuss these findings and outline the implications for future ethics research. Further, we provide practical guidance to those who administer ethics compliance programs on effective ways of facilitating ethical behavior in organizations.
Biomarkers for early diagnosis of Alzheimer disease: ‘ALZheimer ASsociated gene’– a new blood biomarker?
Authors: Jellinger Kurt A. , Janetzky Bernd , Attems Johannes , Kienzl Elisabeth
Published: March 2008

Introduction

Pathogenesis of AD

Alzheimer pathology and diagnosis

Biomarkers of AD

ALZheimer ASsociated protein (ALZAS)

Conclusions

Simple, non‐invasive tests for an early detection of degenerative dementia by use of biomarkers are urgently required. However, up to the present, no validated extracerebral diagnostic markers (plasma/serum, platelets, urine, connective tissue) for the early diagnosis of Alzheimer disease (AD) are available. In disease stages with evident cognitive disturbances, the clinical diagnosis of probable AD is made with around 90% accuracy using modern clinical, neuropsychological and imaging methods. Diagnostic sensitivity and specificity even in early disease stages are improved by CSF markers, in particular combined tau and amyloid β peptides (Aβ) and plasma markers(e.g.Aβ‐42/Aβ‐40 ratio). Recently, a novel gene/protein – ALZAS (ALZheimer ASsociated protein) – with a 79 amino acid sequence, containing the amyloid β‐42 fragment (Aβ‐42), the amyloid precursor protein (APP) transmembrane signal and a 12 amino acid C‐terminal, not present in any other known APP alleles, has been discovered on chromosome 21 within the APP region. Reverse transcriptase‐PCR revealed the expression of the transcript of this protein in the cortex and hippocampal regions as well as in lymphocytes of human AD patients. The expression of ALZAS is mirrored by a specific autoimmune response in AD patients, directed against the ct‐12 end of the ALZAS‐peptide but not against the Aβ‐sequence. ELISA studies of plasma dectected highest titres of ALZAS in patients with mild cognitive impairment (presymptomatic AD), but only moderately increased titres in autopsy‐confirmed AD, whereas low or undetectable ct‐12 titres were found in cognitively intact age‐matched subjects and young controls. The antigen, ALZAS protein, was detected in plasma in later clinical stages of AD. It is suggested that ALZAS represents an indicator in a dynamic equilibrium between both peripheral and brain degenerative changes in AD and may become a useful ‘non‐invasive’ diagnostic markerviaa simple blood test.
Significant exposures to isoeugenol derivatives in perfumes
Authors: Rastogi Suresh Chandra , Johansen Jeanne Duus
Published: March 2008

Background:  Isoeugenol, an important fragrance allergen in consumers, has been restricted to 200 p.p.m. since 1998 according to guidelines issued by the fragrance industry. However, no decline in contact allergy to isoeugnol has been detected. It has been speculated that isoeugenol derivatives, especially isoeugenyl acetate, are used instead. Isoeugenyl acetate is probably metabolized in the skin to isoeugenol and gives positive patch test reactions in 1/3 of isoeugenol‐sensitized individuals.

Objectives:  To investigate the content of isoeugenol, isoeugenyl acetate, and two isoeugenol ethers in perfumes/aftershaves.

Materials and methods:  29 international brand perfumes/aftershaves were analysed for the target fragrance ingredient by gas chromatography–mass spectrometery. All samples were analysed in duplicate at detection levels of 1–5 p.p.m.

Results:  16 products (55%) contained isoeugenol. The maximum concentration was 202 p.p.m. 10 products (34%) contained isoeugenyl acetate, which in 9 cases occurred together with isoeugenol. The concentrations of isoeugenyl acetate ranged from 20 to 4689 p.p.m. 13 products (44%) contained 64.9–1755.0 p.p.m. isoeugenyl methyl ether. Isoeugenyl benzyl ether was not detected in any of the investigated products.

Conclusions:  Isoeugenyl acetate is present in perfumes/aftershaves, in some products in significant amounts. This may lead to elicitation of contact allergy in isoeugenol‐sensitized individuals and may contribute to unchanged levels of isoeugenol sensitization.
Sensitive scalp: does this condition exist? An epidemiological study
Authors: Misery Laurent , Sibaud Vincent , Ambronati Marc , Macy Guy , Boussetta Sami , Taieb Charles
Published: March 2008

Background:  The concept of the ‘sensitive scalp’ is vague. However, the ‘sensitive skin syndrome’ is probably not limited to the face.

Objectives:  To evaluate and analyse sensitive scalp conditions.

Patients and method:  1011 individuals, representative of the French population, were investigated.

Results:  44.2 % declared suffering from a ‘sensitive scalp’ (47.4% of women versus 40.8% of men). Of these subjects, 11.5% reported having an associated scalp disease versus 1.1% of non‐sensitive subjects. Hair loss was significantly associated with scalp sensitivity. The scalp was dry for 24%, normal for 58%, greasy for 16% and mixed for 1%. 13% complained of prickling, 25% of itching and 2% of burning or pain. These symptoms were more frequent among those with a ‘sensitive scalp’. The main triggering factors were considered to be pollution, heat, emotions and shampoos. No other area of skin sensitivity was specifically associated with scalp sensitivity.

Conclusion:  ‘Scalp sensitivity’ exists and occurs frequently. Triggering factors are numerous. Symptoms appear different from those of facial skin sensitivity. Further studies to define and assess sensitive scalp conditions are needed.