bluuebunny/crossref_metadata_2025 huggingface dataset:
Black male athlete activism and the link to Michael Jordan: A transformational leadership and social cognitive theory analysis
Authors: Agyemang Kwame JA
Published: March 2011

Have you ever thought about the potentialities coming about if Michael Jordan chose to emulate previous figures such as Muhammad Ali, John Carlos, and Tommie Smith regarding social activism? Michael Jordan has often been criticized for his failure to speak on social matters. Like Jordan, contemporary Black male athletes’ engagement in social activism has been minimal, unmatched to that of their predecessors of decades ago. The article employs transformational leadership principles and social cognitive theory (SCT) to analyze the link between Michael Jordan and the lack of Black male athlete activism in the current era. Implications for current and future generations of Black male athletes are discussed. Future research directions are also presented for scholars interested in Jordan’s impact on Black male athlete activism.
Expanding the Notion of Researcher Distress: The Cumulative Effects of Coding
Authors: Woodby Lesa L. , Williams Beverly Rosa , Wittich Angelina R. , Burgio Kathryn L.
Published: March 2011

Qualitative researchers who explore the individual’s experience of health, illness, death, and dying often experience emotional stress in their work. In this article, we describe the emotional stress we experienced while coding semistructured, after-death interviews conducted with 38 next of kin of deceased veterans. Coding sensitive topic data required an unexpected level of emotional labor, the impact of which has not been addressed in the literature. In writing this discussion article, we stepped back from our roles as interviewers/coders and reflected on how our work affected us individually and as a team, and how a sequence of exposures could exert a cumulative effect for researchers in such a dual role. Through this article, we hope to generate an expanded discourse on how qualitative inquiry impacts the emotional well-being of researchers.
Hypoglycemia Education Needs
Authors: Sutton Leslie , Chapman-Novakofski Karen
Published: March 2011

Because more than half of those participating in a community-based diabetes session expressed experience with hypoglycemia, we sought additional information by conducting focus groups before developing programs or materials for educational support. The objectives of these focus groups were to determine how and to what extent hypoglycemia affected people, and what, if any, methods were used to prevent or treat the condition, to better target education in the future. Four focus groups were held using a tiered discussion script with a moderator and comoderator. Discussions were audiotaped, transcribed, and analyzed by content by independent researchers. Five themes emerged from the discussions: friends, family, and neighbors need hypoglycemia education as well as individuals themselves; leaving home is a concern if you experience hypoglycemia; overeating occurs when treating hypoglycemia; routine is important; and hypoglycemia is a limitation. We found that hypoglycemia had a significant impact on the participants’ quality of life.
Connecting With Frequent Adolescent Visitors to the School Nurse Through the Use of Intentional Interviewing
Authors: Pavletic Adria C.
Published: March 2011

Nurses as accessible, helping adults within schools have daily opportunities to reach adolescents with unmet mental health needs. Understanding the relationship between frequent clinic visits or somatic complaints as a sign of underlying problems, which may be organic or psychoemotional in origin, requires the unique skill set of the school nurse. The welcoming school nurse, who cares for students with acceptance and emotional availability, nurtures the development of trust and meaningful personal connection. It is through this relationship that effective care and case finding occurs. Attachment to the school nurse as a responsive adult fosters a sense of school connectedness, which is associated with academic success. Intentional Interviewing is a person-centered, evidence-based approach that can be used by school nurses in this important work.
Psychometric Properties of the Miranda Rights Comprehension Instruments With a Juvenile Justice Sample
Authors: Goldstein Naomi E. Sevin , Romaine Christina L. Riggs , Zelle Heather , Kalbeitzer Rachel , Mesiarik Constance , Wolbransky Melinda
Published: March 2011

This article describes the psychometric properties of the Miranda Rights Comprehension Instruments, the revised version of Grisso’s Miranda instruments. The original instruments demonstrated good reliability and validity in a normative sample. The revised instruments updated the content of the original instruments and were administered to a sample of 183 youth in pre- and postadjudication facilities. Analyses were conducted to establish the psychometric properties of the revised instruments and included similar analyses to those conducted by Grisso, as well as additional calculations (e.g., standard errors of measurement, intraclass correlation coefficients, Kappa coefficients). Results revealed sound psychometric properties, similar to those observed for the original instruments.
Health Care Reform: Long-Range Implications for Your Workforce
Authors: Gilliland John C.
Published: March 2011

Although many of health care reform’s previsions are not effective until 2014, agencies should begin now to analyze its long-term implications on operations and workforce. Three provisions with significant impact in this regard are the Small Employer Health Insurance Tax Credit, Free Choice Vouchers, and the Employer Mandate. Oddly, how these work may argue for an agency to maximize the number of its part-time employees and to consider not offering health insurance to anyone.
The Politics of Unsustainability: COP15, Post-Ecologism, and the Ecological Paradox
Authors: Blühdorn Ingolfur
Published: March 2011

More spectacularly than ever before, the United Nations Framework Convention on Climate Change Fifteenth Session of the Conference of the Parties (UNFCCC COP15) summit in Copenhagen in December 2009 exposed the limitations of established approaches to, and institutional arrangements for, international climate and environmental politics. It illustrated the paradoxical simultaneity of, on one hand, the wide acceptance that to mitigate climate change and achieve sustainability rich consumer societies, in particular, need to radically change their established values, lifestyles, and social practices, and on the other, a profound inability and unwillingness to implement such change. Conceptualising the form of ecopolitics on display (not only) in Copenhagen as the “politics of unsustainability,” this article looks for explanations for the apparent impasse in contemporary ecopolitics and explores the practices that help advanced modern consumer societies to cope with the paradox of wanting to sustain the unsustainable. Adopting a social—theoretical approach rooted in the European tradition, the article focuses on one particular explanatory factor that in the prevalent context of environmental depoliticisation is receiving too little attention: the sociocultural norms underpinning all ecopolitics.
The Impact of a Community-Based Chronic Disease Prevention Initiative: Evaluation Findings From Steps to Health King County
Authors: Cheadle Allen , Bourcier Emily , Krieger James , Beery William , Smyser Michael , Vinh Diana V. , Lessler Dan , Alfonsi Lorrie
Published: March 2011

Steps to Health King County ( Steps KC; Seattle, Washington) was one of 40 community-level initiatives funded in 2003 as part of the Steps to a HealthierUS initiative. Steps KC goals included reducing the impact of chronic diseases through a comprehensive, coordinated approach and reducing health disparities due to chronic illness. Steps KC intervention activities took place on two levels: the overall Steps KC collaborative and individual funded programs. Collaborative-level activities included policy and systems change initiatives and efforts to better integrate the funded-program organizations. The funded programs ranged from group health promotion programs to intensive case management. Steps KC was successful in creating a large, diverse community collaborative and funding 14 separate programs that reached approximately 8,000 community residents with medium- and high-intensity programs of demonstrated effectiveness. Systems change initiatives within school districts and government agencies led to a greater institutional emphasis on health promotion and on partnership with communities to address health inequities.
An Initial Attempt at Operationalizing and Testing the Community Coalition Action Theory
Authors: Kegler Michelle C. , Swan Deanne W.
Published: March 2011

The Community Coalition Action Theory (CCAT) blends practice wisdom with empirical data to explain how community coalitions achieve community change and community capacity outcomes. The current study uses data from an evaluation of 20 California Healthy Cities and Communities coalitions to test relationships between coalition factors and outcomes as predicted by CCAT in two stages of coalition development. Data are from two rounds of coalition member surveys, interviews with local coalition coordinators, and semiannual progress reports. Consistent with CCAT predictions and prior research, shared decision making and leadership were correlated with participation; staff competence, task focus, and cohesion were correlated with member satisfaction. Coalition size was associated with participation and dollars leveraged. Also, consistent with CCAT, diversity of funding sources was associated with new leadership opportunities and program expansion; dollars leveraged was correlated with new leadership opportunities and new partners. Findings provide preliminary support for many, but not all, of the relationships predicted by CCAT.
Children’s Perceived Cost for Exercise: Application of an Expectancy-Value Paradigm
Authors: Chiang Evelyn S. , Byrd Sandra P. , Molin Ashley J.
Published: March 2011

Expectancy-value models of motivation have been applied to understanding children’s choices in areas such as academics and sports. Here, an expectancy-value paradigm is applied to exercising (defined as engaging in physical activity). The notion of perceived cost is highlighted in particular. Two hundred twenty children in third, fourth, and fifth grades were surveyed on their competence beliefs, perceived importance, interest, and perceived cost of being physically active. Results indicated that perceived cost is empirically distinct from competence beliefs and other types of value, that perceived cost is marginally related to children’s self-reported level of physical activity, and children’s beliefs and other values are related to their self-reported level of physical activity. Children’s perceptions of cost vary depending on grade and gender. Interventions based on these findings are proposed.
Outcomes of an HIV Prevention Peer Group Intervention for Rural Adults in Malawi
Authors: Kaponda Chrissie P. N. , Norr Kathleen F. , Crittenden Kathleen S. , Norr James L. , McCreary Linda L. , Kachingwe Sitingawawo I. , Mbeba Mary M. , Jere Diana L. N. , Dancy Barbara L.
Published: March 2011

This study used a quasi-experimental design to evaluate a six-session peer group intervention for HIV prevention among rural adults in Malawi. Two rural districts were randomly assigned to intervention and control conditions. Independent random samples of community adults compared the districts at baseline and at 6 and 18 months postintervention. Using multiple regressions controlling for six demographic factors, intervention district adults had significantly more favorable outcomes at 6- and 18-month evaluations for condom attitudes, self-efficacy for community prevention, self-efficacy for practicing safer sex, partner communication, using condoms ever in the past 2 months, and community prevention activities. Knowledge and hope for controlling the epidemic were significantly higher in the intervention district only at the 6-month evaluation; having a recent HIV test was significantly higher only at 18 months. Levels of stigma and the number of risky sex practices did not decrease when demographic factors were controlled. Expanding peer group intervention for HIV prevention would benefit rural adults.
A CBPR Partnership Increases HIV Testing Among Men Who Have Sex With Men (MSM): Outcome Findings From a Pilot Test of the CyBER/testing Internet Intervention
Authors: Rhodes Scott D. , Vissman Aaron T. , Stowers Jason , Miller Cindy , McCoy Thomas P. , Hergenrather Kenneth C. , Wilkin Aimee M. , Reece Michael , Bachmann Laura H. , Ore Addison , Ross Michael W. , Hendrix Ellen , Eng Eugenia
Published: March 2011

The Internet has emerged as an important tool for the delivery of health promotion and disease prevention interventions. Our community-based participatory research (CBPR) partnership developed and piloted CyBER/testing, a culturally congruent intervention designed to promote HIV testing among men who have sex with men (MSM) within existing Internet chat rooms. Using a quasi-experimental, single-group study design, cross-sectional data were collected from chat room participants, known as “chatters,” at pretest ( n = 346) and posttest ( n = 315). Extant profile data also were collected to describe the demographics of the online population. The intervention significantly increased self-reported HIV testing among chatters overall, increasing rates from 44.5% at pretest to nearly 60% at posttest ( p < .001). Furthermore, chatters who reported having both male and female sexual partners had nearly 6 times the odds of reporting HIV testing at posttest. Findings suggest that chat room—based HIV testing intervention may increase testing among MSM who may be difficult to reach in traditional physical spaces.
Politics and Evaluation: More Than Methodology
Authors: Datta Lois-ellin
Published: March 2011

In the 1960s, evaluation thrived in the sunshine of political support for our work. We also experienced the dark side of the force of politics: efforts to introduce partisan biases favorable to special interests. In response to politics as contamination, at least two families of stances developed: populist and public interest. The populist stances embraced the politics of extensive stakeholder involvement, democratic deliberation, collaboration, social justice, and empowering the disenfranchised. The public-interest-stances continued to explore strategies for carrying out evaluations of high-stakes, controversial, large-scale national policy issues, being wary of political bias in any form and from any source. How have these stances developed and played out over the past 25 years? Whether the originating theory is populist or public interest, we may have more in common in practice than we may think. These communalities could form a necessary political toolkit to join our methodological knowledge.
Testing Conceptual Frameworks of Nonexperimental Program Evaluation Designs Using Structural Equation Modeling
Authors: Adedokun Omolola A. , Childress Amy L. , Burgess Wilella D.
Published: March 2011

A theory-driven approach to evaluation (TDE) emphasizes the development and empirical testing of conceptual models to understand the processes and mechanisms through which programs achieve their intended goals. However, most reported applications of TDE are limited to large-scale experimental/quasi-experimental program evaluation designs. Very few (limited) examples of the relevance of TDE to nonexperimental program evaluation designs exist in literature. Using the method of structural equation modeling to analyze data from the Interns for Indiana (IfI) program, this study demonstrates how evaluation practitioners can test logical and sequential relationships among tiers of outcomes of nonexperimental programs, especially programs with limited datasets. The study also describes how the empirical feedback can be used to understand program dynamics and improve program implementation and evaluation.
Microvascular function is impaired in children with morbid obesity
Authors: Schlager Oliver , Willfort-Ehringer Andrea , Hammer Alexandra , Steiner Sabine , Fritsch Maria , Giurgea Aura , Margeta Christian , Lilaj Ilda , Zehetmayer Sonja , Widhalm Kurt , Koppensteiner Renate , Gschwandtner Michael E
Published: March 2011

Children’s obesity is a growing problem in Western societies. We hypothesized that morbid obesity (body mass index [BMI] > 99.5th percentile) might affect microvascular function at an early stage. Therefore, we assessed the microvascular function of 41 obese children (13.2 ± 2.8 years, BMI 32.9 ± 6.6) in comparison to 91 healthy controls (12.7 ± 2.1 years, BMI 18.2 ± 2.5) by post-occlusive reactive hyperemia measured by a laser Doppler: baseline perfusion, biological zero (defined as ‘no-flow’ laser Doppler signal during suprasystolic occlusion), peak perfusion (following occlusion), time to peak perfusion and recovery time (time until resuming baseline perfusion) were recorded and compared between both groups. Peak perfusion was higher in children with morbid obesity than in controls (1.67 ± 0.76 AU [arbitrary units] vs 1.26 ± 0.5 AU, p < 0.001). Consecutively, recovery time was longer in children with morbid obesity (118.21 ± 34.64 seconds) than in healthy children (83.18 ± 35.08 seconds, p < 0.001). In conclusion, higher peak perfusion and prolonged recovery time in children with morbid obesity seem to reflect microvascular dysfunction due to an impaired vasoconstrictive ability of precapillary sphincters.
Offspring sex determines the impact of the maternal ACE I/D polymorphism on maternal glycaemic control during the last weeks of pregnancy
Authors: Hocher Berthold , Schlemm Ludwig , Haumann Hannah , Jian Li  , Rahnenführer Jan , Guthmann Florian , Bamberg Christian , Kalk Philipp , Pfab Thiemo , Chen You-Peng
Published: March 2011

Hypothesis/Introduction: We recently demonstrated that fetal sex may affect maternal glycaemic control in genetically prone mothers. We tested the hypothesis that fetal sex/fetal Y/X chromosomes might affect maternal glycaemic control during pregnancy depending on the maternal angiotensin converting enzyme (ACE) I/D polymorphism.

Material and methods: One thousand, three hundred and thirty-two Caucasian women without pre-existing diabetes and pre-existing hypertension with singleton pregnancies delivering consecutively at the Charité obstetrics department were genotyped. Glycaemic control was analysed by measuring total glycated haemoglobin at birth. Correction for confounding factors and multiple testing was done.

Results: Maternal ACE I/D polymorphism showed significant interaction with fetal sex concerning maternal total glycated haemoglobin. Total glycated haemoglobin in DD mothers delivering boys was 6.42 ± 0.70% vs. 6.21 ± 0.66% in DD mother delivering girls ( p < 0.005), whereas the II carrying mothers showed the opposite effect. II mothers delivering a girl had a higher ( p = 0.044) total glycated haemoglobin at birth (6.40 ± 0.80%) compared to II mothers delivering boys (6.21 ± 0.81%). There was no interaction of the ACE I/D polymorphism and fetal sex with respect to new onset proteinuria, new onset edema and pregnancy-induced hypertension.

Conclusions: Maternal glycaemic control during the last weeks of pregnancy seems to be influenced by an interaction of the ACE I/D genotyp and fetal sex.
Losartan protects mesenteric arteries from ROS-associated decrease in myogenic constriction following 5/6 nephrectomy
Authors: Vavrinec Peter , van Dokkum Richard PE , Goris Maaike , Buikema Hendrik , Henning Robert H
Published: March 2011

Background: Chronic renal failure (CRF) is associated with hypertension, proteinuria, loss of myogenic constriction (MC) of mesenteric arteries and increased production of reactive oxygen species (ROS) under experimental conditions. Previous results showed that ACE (angiotensin-converting enzyme activity) inhibitor therapy is effective in slowing down the progression of disease. Therefore, we wanted to study whether the inverse AT1 (angiotensin II type 1) receptor agonist, losartan (LOS) was effective in preventing loss of MC in a rat model of CRF and whether acute ROS scavengers could improve MC.

Methods: Rats underwent 5/6 nephrectomy (5/6 Nx) and were treated with vehicle or LOS (20 mg/kg/day; 5/6 Nx + LOS) for 12 weeks. Thereafter, the MC of the mesenteric arteries were measured in the presence and/or absence of tempol and catalase. Systolic blood pressure and proteinuria were measured weekly.

Results: Systolic blood pressure and proteinuria in the 5/6 Nx + LOS group were significantly lower than in the 5/6 Nx group. Moreover, the MC of 5/6 Nx + LOS arteries was significantly increased compared with the untreated 5/6 Nx group (maximum MC, 32.3 ± 6.9 vs 8.9 ± 3.8% (p < 0.01)). Tempol + catalase significantly increased the MC in the 5/6 Nx group, but not in the 5/6 Nx + LOS group (increase in MC, 59.7 ± 13.0 (p < 0.05) vs. 17.0 ± 15.1%).

Conclusion: These results support the roles of the RAAS (renin—angiotensin—aldosterone system) and ROS in the vascular dysfunction of systemic vessels in CRF.
Verification and evaluation of aldosteronism demographics in the Taiwan Primary Aldosteronism Investigation Group (TAIPAI Group)
Authors: Kuo Chin-Chi , Wu Vin-Cent , Huang Kuo-How , Wang So-Mong , Chang Chin-Chen , Lu Ching-Chu , Yang Wei-Shun , Tsai Ching-Wei , Lai Chun-Fu , Lee Tzong-Yann , Lin Wei-Chou , Wu Ming-Shou , Lin Yen-Hung , Chu Tzong-Shinn , Lin Chien-Yu , Chang Hung-Wei , Wang Wei-Jei , Kao Tze-Wah , Chueh Shih-Chieh , Wu Kwan-Dun , TAIPAI Study Group
Published: March 2011

Objective: Current data on primary aldosteronism (PA) from Asian populations are scarce. This cohort study clarifies the attributes of patients with PA in a typical Chinese population.

Design: An observational cohort study.

Methods: The records of patients referred to the Hypertension Clinic from a multi-centre registration in Taiwan from January 1995 to December 2007 were reviewed. All patients with PA were classified into two subtypes: aldosterone-producing adenomas (APA) and idiopathic hyperaldosteronism (IHA); their characteristics were compared.

Results: Our cohort consisted of 346 patients with PA, 255 with APA and 91 with IHA. The initial hypokalaemia (59% in APA vs. 27.5% in IHA, p < 0.0001) and transtubular potassium gradient (TTKG) (6.30 ± 2.41 in APA vs. 4.91 ± 2.03 in IHA, p = 0.01) were higher in the APA group. Baseline plasma aldosterone concentration (PAC) was also significantly different between the two subgroups (49.96 ± 38.15 ng/dl in APA vs. 34.24 ± 21.47 in IHA, p < 0.0001).

Conclusions: In typical Chinese PA patients, the APA subgroup had a higher proportion of hypokalaemia with elevated TTKG and higher PAC as compared with the IHA subgroup. This largest Asian database also demonstrated major differences between the Caucasian and Chinese populations including female predilection, frequent hypokalaemia, and common paralytic myopathy.
Highly purified human peripheral blood monocytes produce IL-6 but not TNFα in response to angiotensin II
Authors: Gelinas Laura , Falkenham Alec , Oxner Adam , Sopel Mryanda , Légaré Jean-Francois
Published: March 2011

Hypothesis: Monocytes produce pro-inflammatory cytokines in response to Angiotensin II (AngII).

Introduction: AngII has been suggested by many to be pro-inflammatory and likely to contribute to the migration of leukocytes in patients with cardiovascular conditions.

Materials and methods: Monocytes were purified from peripheral blood mononuclear cells (PBMCs) by negative selection using antibodies conjugated to magnetic beads. Detection of CD14+ and AT1R expression was achieved by double-labeling flow cytometry. Highly purified monocytes were then stimulated with AngII (6 and 24 h) to assess IL-6 and TNF-α transcript levels by qRT-PCR and protein secretion by ELISA.

Results: Monocytes comprised 9.7 ± 2.0% of the PBMCs. Monocyte isolation by negative selection yielded a purity of up to 99.8%. We demonstrated AT1R expression on 9.5 ± 0.3% of highly purifed CD14+/CD16- monocytes. Stimulation of highly purified monocytes with AngII resulted in increased transcript levels of IL-6 at 6 h but not at 24 h, and increased secretion of IL-6 in a dose-dependent manner compared with controls ( p <0.01). Conversely, there was no increase in TNF-α mRNA transcripts or protein secretion.

Conclusions: We provide evidence that a CD14+/CD16- subset of highly purified human monocytes express AT1R and respond to AngII exposure in vitro by producing IL-6 but not TNF-α.
Characterization of a stable, hypertensive rat model suitable for the consecutive evaluation of human renin inhibitors
Authors: St-Jacques René , Toulmond Sylvie , Auger Anick , Binkert Christoph , Cromlish Wanda , Fischli Walter , Harris Jennifer , Hess Patrick , Jie Lan  , Liu Susana , Riendeau Denis , Steiner Beat , Percival M David
Published: March 2011

Introduction: The hypertensive double-transgenic (dTG) rat strain, expressing human renin and angiotensinogen, develops severe hypertension and organ damage and 50% of individuals die by 7 weeks of age. Here, we characterise a variation of this model in which animals present stable hypertension.

Materials and methods: The effect of renin—angiotensin system blockers on blood pressure was determined with adult dTG rats treated with enalapril from 3 to 12 weeks of age. Tissue expression levels of renin and angiotensinogen were determined in dTG rats and rhesus monkeys by quantitative PCR.

Results: Upon withdrawal from enalapril, mean arterial pressure (MAP) rose to 160—180 mmHg, with 95% of the female dTG rats surviving for 6 to 12 months, In Sprague-Dawley (SD) rats and rhesus monkeys, renin mRNA was absent or weakly expressed in most tissues, except for the kidneys and adrenals. In dTG rats, human renin expression was high in many additional tissues. The expression of human angiotensinogen in dTG rats followed a similar tissue pattern to SD and rhesus monkey angiotensinogen. Oral dosing of aliskiren, enalapril or losartan provided a similar maximal reduction in MAP and duration of efficacy in telemetrised dTG rats.

Conclusions: Enalapril-pretreated dTG rats are suitable for long-term MAP monitoring and sequential evaluation of human renin inhibitors.
Chronic angiotensin II infusion modulates angiotensin II type I receptor expression in the subfornical organ and the rostral ventrolateral medulla in hypertensive rats
Authors: Nunes Fabíola C , Braga Valdir A
Published: March 2011

Blood-borne angiotensin II (Ang II) has profound effects on the central nervous system, including regulation of vasopressin secretion and modulation of sympathetic outflow. However, the mechanism by which circulating Ang II affects the central nervous system remains largely unknown. We tested the hypothesis that increased circulating levels of Ang II activate angiotensin type I (AT1) receptors in the subfornical organ (SFO), increasing the Ang II signalling in the rostral ventrolateral medulla (RVLM). Male Wistar rats were subcutaneously implanted with two 14-day osmotic minipumps filled with Ang II (150ng/kg/minute), Losartan (10mg/kg/day), or saline. In addition, AT1 receptor mRNA levels in the SFO and RVLM were detected by reverse transcription polymerase chain reaction (RT-PCR). Infusion of Ang II-induced hypertension (134 ± 10 mmHg vs 98 ± 9 mmHg, n = 9, p < 0.05), which was blunted by concomitant infusion of Losartan (105 ± 8 vs 134 ± 10 mmHg, n = 9, p < 0.05). In addition, hexamethonium produced a greater decrease in blood pressure in Ang II-infused rats. Real time PCR revealed that chronic Ang II infusion induced an increase in AT1 receptor mRNA levels in the RVLM and a decrease in the SFO. Taken together, using combined in vivo and molecular biology approaches, our data suggest that Ang II-induced hypertension is mediated by an increase in sympathetic nerve activity, which seems to involve up-regulation of AT1 receptors in the RVLM and down-regulation of AT1 receptors in the SFO.
A new negative pressure dressing (PrevenaTM) to prevent wound complications following lower limb distal arterial bypass
Authors: Haghshenasskashani Alireza , Varcoe Ramon L
Published: March 2011

Wound complications in patients undergoing distal arterial bypass grafting are common and can lead to loss of limb and life. Vacuum-assisted closure (VAC) has been in use for some time and has proven to expedite the process of wound healing when used in those with open sterile or infected wounds. Recent modifications to the VAC system to make it a topical closed incision dressing have been successful and led to the development of the new PrevenaTM dressing. We present the first application of this purpose-built closed incision site vacuum dressing in a patient with multiple potential risk factors undergoing popliteal-tibial bypass grafting.
Fibrates: old drugs with a new role in type 2 diabetes prevention?
Authors: Elkeles Robert
Published: March 2011

The incidence of type 2 diabetes is increasing throughout the world resulting in a huge growth in demands on health services. Despite advances in treatment, complications still occur. Prevention of type 2 diabetes or delaying its onset is therefore a desirable goal. In trials, lifestyle measures have been partially successful but continuing adherence is difficult. A number of drugs have been tried with varying success. Those people who develop type 2 diabetes have been found to have a more atherogenic lipid profile and to be more insulin resistant, than those who do not, and at increased cardiovascular risk. Fibrates, which are safe and cheap, could help to correct these abnormalities at an early stage and reduce cardiovascular risk. They would seem a suitable option for prevention of type 2 diabetes. Evidence is presented to suggest that the fibrates, in particular bezafibrate, could have a role in prevention of type 2 diabetes in those at high risk and that a randomised trial would seem justified.
Therapy with oral antidiabetic drugs: applied pharmacogenetics
Authors: Holstein Andreas , Seeringer Angela , Kovacs Peter
Published: March 2011

Pharmacogenetics focuses on the relationship between individual gene variants and variable drug effects. The present brief review addresses the importance of pharmacogenetic factors for the efficacy and adverse effects of oral antidiabetic drugs in the therapy of type 2 diabetes mellitus. In particular, genetic polymorphisms of cytochrome P450 drug metabolizing enzymes, peroxisome proliferator-activated receptor- γ gene, TCF7L2 gene regulating insulin resistance and secretion and organic cation transporters or organic anion transporting polypeptides modify the individual response to drugs such as metformin, thiazolidinediones, sulphonylureas, meglitinides, and DPP4 inhibitors. However, apart from a complex variety of individual factors, genetic heterogeneity makes assessing the role of genetic factors in diabetes therapy for a single individual highly challenging. Continuing advances in pharmacogenetics will uncover further genetic variants that modify responses to diabetes medications and may offer targeted pharmacotherapy to the patient.
The DUBASCO SCORE: A scoring system for selecting patients for consideration of bariatric surgery
Authors: Labib Mourad , Haddon Angela L , Head Alison , Nightingale Peter
Published: March 2011

The National Institute for Health and Clinical Excellence guidance states that bariatric surgery should be available as a treatment option for people with a body mass index (BMI) of > 40.0 kg/m2 and those with a BMI 35.0—40.0 kg/m 2 and other significant disease that may be improved with weight loss. Despite this, funding criteria are different between primary care trusts (PCTs) in England and some use a cut-off BMI of > 50.0 kg/m2. However, BMI may not be the best parameter to decide on who would benefit most from bariatric surgery. We have developed a scoring system, which takes into account the number and severity of four comorbidities in addition to BMI and age. Using this scoring system, 24% of patients with BMI > 50.0 kg/m2 did not score high enough, whereas 63% of patients with BMI 35.0—50.0 kg/m 2 had significant comorbidities and would have potentially benefited more from undergoing bariatric surgery. The advantage of using a scoring system, is that the cut-off level for referral for surgery can be adjusted up or down depending on the level of resources available, but will always identify those patients who would benefit most from surgery.
Changes in lipid parameters in patients with type 2 diabetes following a switch from rosiglitazone to pioglitazone in primary and secondary care: a prospective, descriptive study
Authors: Triay Jessica , Raghavan Rajeev , Day Andrew , Singhal Parag , Osborne Giles
Published: March 2011

Mounting evidence for increased cardiovascular risk being associated with rosiglitazone had led to Weston Health Trust to begin switching patients to the alternative thiazolidenedione, pioglitazone, at the end of 2007. The opportunity was taken to audit the lipidaemic and glycaemic results of these patients pre- and post-switch. In this predominantly elderly population (median ages: male 66 years; female 72), all markers of lipidaemia and glycaemia significantly improved over 12 weeks. Median changes from baseline to post-switch were: Total cholesterol from 4.0 mmol/L to 3.9 mmol/L; LDL-C from 2.3 mmol/L to 2.1 mmol/L; triglycerides from 1.5 mmol/L to 1.2 mmol/L; HDL-C rose 9% from 1.1 mmol/L to 1.2 mmol/L; non-HDL cholesterol fell 3.0 mmol/L to 2.7 mmol/L and ApoB fell from 0.73g/L to 0.62g/L. Glycaemic parameters also improved, with glycated haemoglobin A1c dropping from 7.2% to 6.2% and fasting plasma glucose reducing from 7.7 mmol/L to 6.4 mmol/L. These results increased the percentage of patients achieving current guideline targets for all measured lipidaemic and glycaemic parameters.
Treatment With Pantethine
Authors: Horváth Zoltán , Vécsei László
Published: March 2011

The current increase in cardiovascular and cerebrovascular morbidity is a growing burden for society. Consideration must therefore be given to compounds capable of slowing down these pathological processes without significant adverse effects. The natural vitamins pantetheine/pantothenic acid are major precursors of coenzyme A and acyl carrier protein, which are essential for fatty acid oxidation and participate in the metabolism of cholesterol and carbohydrates and in at least 70 other enzymatic processes. Following a number of theoretical considerations and clinical observations, various clinical studies have revealed that they possess significant beneficial effects. In particular, they demonstrate useful moderating effects on vascular pathological processes, lowering lipid levels, and inhibiting platelet functions and lipid peroxidation. Although they are natural, well-tolerated therapeutic agents, few controlled clinical trials have been conducted. The available data suggest the need for larger clinical trials and possible use of pantetheine/pantothenic acid as adjuvant therapy.
Biological Effects of Pharmacological Concentrations of Biotin
Authors: Fernandez-Mejia Cristina , Lazo-de-la-Vega-Monroy Maria-Luisa
Published: March 2011

Understanding the molecular mechanisms of vitamins has opened new perspectives regarding the relationship between nutritional signals and biological functions, which, in turn, has led to the development of new therapeutic agents. Although little is known about water-soluble vitamins as genetic modulators, evidence about their effects on gene expression has grown. In the case of biotin, besides its role as a carboxylase prosthetic group, it also affects gene expression and has a wide repertoire of effects on biological functions. Only recently, the role of pharmacological concentrations of biotin on systemic functions has attracted attention, and it is now being reconsidered with the help of new technologies. This novel approach could lead to new perspectives in its use as a therapeutic agent. The present review is focused on the effects of pharmacological concentrations of biotin on several biological functions and on the biotin signaling pathways that participate in gene expression.
Emerging Issues in Vitamin K Research
Authors: Truong Jennifer T. , Booth Sarah L.
Published: March 2011

Vitamin K is traditionally recognized for its role in blood clotting. More recently, new roles for vitamin K have emerged. The current evidence for the role of vitamin K in bone, cardiovascular, and reproductive health will be discussed. There will be a particular focus on populations who could be at risk for vitamin K deficiency.
Diastolic dysfunction and abnormal exercise ventilation predict adverse outcome in elderly patients with chronic systolic heart failure
Authors: Malfatto Gabriella , Branzi Giovanna , Giglio Alessia , Ciambellotti Francesca , Villani Alessandra , Parati Gianfranco , Facchini Mario
Published: March 2011

Background: Heart failure is increasing in the elderly and represents a socioeconomic burden requiring the correct management for which risk stratification is mandatory. Among younger patients, echocardiogram and cardiopulmonary exercise test are useful in prognostic stratification. Few studies have analyzed the utility of these tests in elderly patients.

Methods: We report on 90 patients over 70 years old, on whom cardiopulmonary tests and echocardiograms were performed between 1998 and 2006 (67 M, 23 F; 75 ± 3 years; ejection fraction (EF) 30 ± 6%; NYHA 2.1 ± 0.8; 60% ischemic; therapy according to international guidelines). Echocardiographic variables were (1) left ventricular ejection fraction (EF); (2) severity of diastolic dysfunction on multiparametric examination of Doppler and TDI parameters; (3) severity of functional mitral regurgitation. Cardiopulmonary variables were (1) peak VO2; (2) peak O2 pulse; (3) peak respiratory quotient (RQ); (4) VE/VCO2 slope. Endpoint considered was mortality of any cause at three-years follow-up.

Results: Mortality was 21%. At univariate analysis, survivors ( n = 71) and deceased ( n = 19) were similar for age, NYHA class, peakVO2 and RQ; they differed for EF, severity of mitral regurgitation, severity of diastolic dysfunction, O2 pulse and VE/VCO2 slope. At multivariate analysis, only VE/VCO2 slope and severe diastolic dysfunction (restrictive filling pattern) discriminated between the two groups. In particular, the association of restrictive filling pattern and VE/VCO2 slope ≥ 45 predicted 3-year mortality with sensitivity of 84% and specificity of 88%.

Conclusions: Echocardiographic and cardiopulmonary data can identify high-risk elderly patients with systolic heart failure, who may need aggressive clinical management.
The role of monoclonal antibodies in the treatment of severe asthma
Authors: Tourangeau Louanne M. , Kavanaugh Arthur , Wasserman Stephen I.
Published: March 2011

A number of therapeutic agents are available for the treatment of asthma, including inhaled corticosteroids, long- and short-acting beta-agonists, leukotriene-modifying agents, long- and short-acting anticholinergic agents, chromones, theophylline, allergen immunotherapy, and oral corticosteroid therapy. All available therapies, despite their proven efficacy, are purely symptomatic including the topical steroids. This issue has led to the development of several biologic agents to aid in asthma management and to potentially alter the course of the disease by interfering with specific aspects of inflammation which may modify remodeling in the airways. Monoclonal antibodies have offered a class of therapeutic agents that enhance treatment options for patients with moderate-to-severe persistent asthma. As such, this article provides an overview of present and future monoclonal antibody therapies for the treatment of patients with severe asthma.
Ultrasonographic Appearance of Lung Sliding in a Patient With a Bronchopleural Fistula on a High-Frequency Oscillator Ventilator
Authors: Wallace David John , Sappington Penny , Tisherman Samuel , Stone Michael
Published: March 2011

The patient with a bronchopleural fistula and acute respiratory distress syndrome can present a therapeutic challenge for the treating clinician. In this case, the authors describe the use of bedside thoracic sonography to show real-time improvement in a pneumothorax after initiation of high-frequency oscillatory ventilation. Sonography may have a role in the evaluation of ventilator strategies in the future, although validation of this application is still needed.
Echocardiographic Evaluation of Diastolic Function
Authors: Bierig S. Michelle , Hill Jeffrey
Published: March 2011

Left ventricular diastolic dysfunction is common in patients with heart failure. Echocardiographic evaluation of diastolic function provides the clinician with important information about ventricular relaxation and estimation of filling pressures. Optimal evaluation includes the integration of multiple echocardiographic parameters such as Doppler, M-mode, and volumes. This article aims to review the components of diastolic filling and ventricular performance, as well as discuss the techniques used for the assessment of left ventricular diastolic function.
Inhibition of bone morphogenetic protein signaling attenuates anemia associated with inflammation
Authors: Steinbicker Andrea U. , Sachidanandan Chetana , Vonner Ashley J. , Yusuf Rushdia Z. , Deng Donna Y. , Lai Carol S. , Rauwerdink Kristen M. , Winn Julia C. , Saez Borja , Cook Colleen M. , Szekely Brian A. , Roy Cindy N. , Seehra Jasbir S. , Cuny Gregory D. , Scadden David T. , Peterson Randall T. , Bloch Kenneth D. , Yu Paul B.
Published: March 2011

Anemia of inflammation develops in settings of chronic inflammatory, infectious, or neoplastic disease. In this highly prevalent form of anemia, inflammatory cytokines, including IL-6, stimulate hepatic expression of hepcidin, which negatively regulates iron bioavailability by inactivating ferroportin. Hepcidin is transcriptionally regulated by IL-6 and bone morphogenetic protein (BMP) signaling. We hypothesized that inhibiting BMP signaling can reduce hepcidin expression and ameliorate hypoferremia and anemia associated with inflammation. In human hepatoma cells, IL-6–induced hepcidin expression, an effect that was inhibited by treatment with a BMP type I receptor inhibitor, LDN-193189, or BMP ligand antagonists noggin and ALK3-Fc. In zebrafish, the induction of hepcidin expression by transgenic expression of IL-6 was also reduced by LDN-193189. In mice, treatment with IL-6 or turpentine increased hepcidin expression and reduced serum iron, effects that were inhibited by LDN-193189 or ALK3-Fc. Chronic turpentine treatment led to microcytic anemia, which was prevented by concurrent administration of LDN-193189 or attenuated when LDN-193189 was administered after anemia was established. Our studies support the concept that BMP and IL-6 act together to regulate iron homeostasis and suggest that inhibition of BMP signaling may be an effective strategy for the treatment of anemia of inflammation.
Hematopoietic stem/progenitor cells, generation of induced pluripotent stem cells, and isolation of endothelial progenitors from 21- to 23.5-year cryopreserved cord blood
Authors: Broxmeyer Hal E. , Lee Man-Ryul , Hangoc Giao , Cooper Scott , Prasain Nutan , Kim Young-June , Mallett Coleen , Ye Zhaohui , Witting Scott , Cornetta Kenneth , Cheng Linzhao , Yoder Mervin C.
Published: March 2011

Cryopreservation of hematopoietic stem cells (HSCs) and hematopoietic progenitor cells (HPCs) is crucial for cord blood (CB) banking and transplantation. We evaluated recovery of functional HPC cryopreserved as mononuclear or unseparated cells for up to 23.5 years compared with prefreeze values of the same CB units. Highly efficient recovery (80%-100%) was apparent for granulocyte-macrophage and multipotential hematopoietic progenitors, although some collections had reproducible low recovery. Proliferative potential, response to multiple cytokines, and replating of HPC colonies was extensive. CD34+ cells isolated from CB cryopreserved for up to 21 years had long-term (≥ 6 month) engrafting capability in primary and secondary immunodeficient mice reflecting recovery of long-term repopulating, self-renewing HSCs. We recovered functionally responsive CD4+ and CD8+ T lymphocytes, generated induced pluripotent stem (iPS) cells with differentiation representing all 3 germ cell lineages in vitro and in vivo, and detected high proliferative endothelial colony forming cells, results of relevance to CB biology and banking.
Tim-3 expression on peripheral T cell subsets correlates with disease progression in hepatitis B infection
Authors: Wu Wei , Shi Yu , Li Jie , Chen Feng , Chen Zhi , Zheng Min
Published: March 2011

Background and objective

T-cell immunoglobulin domain and mucin domain-containing molecule-3 (Tim-3) represents a novel mechanism of T-cell dysfunction in chronic viral diseases. However, the role of Tim-3 in the pathogenesis of chronic hepatitis B (CHB) is not well understood. We investigated Tim-3 expression on peripheral T cell subsets and analyzed the relationship between Tim-3 expression and disease progression in HBV infection.

Methods

peripheral blood samples were obtained from CHB patients (n = 40), including 23 patients with moderate CHB [MCHB] and 17 with severe CHB [SCHB]. Control samples were obtained from nine acute hepatitis B patients (AHB) and 26 age-matched healthy subjects. The expression of Tim-3 on T cells was determined by flow cytometry.

Results

Tim-3 expression was elevated on peripheral CD4+ and CD8+ T cells from AHB and CHB patients compared to those from healthy controls. The percentage of Tim-3+ T cells was further increased in SCHB patients relative to MCHB patients and showed a positive correlation with conventional markers for liver injury (alanine aminotransferase (ALT), aspartate transaminase (AST), total bilirubin (TB) and international normalized ratio (INR) level). The frequency of Tim-3-expressing T cells was negatively correlated with T-bet mRNA expression and plasma interferon-gamma (INF-gamma) levels. Further, Tim-3 expression on CD4+ or CD8+ T cells was reduced in CHB patients with disease remission after antiviral treatment and in AHB patients during the convalescence phase.

Conclusions

Our results suggest that over-expression of Tim-3 is involved in disease progression of CHB and that Tim-3 may participate in skewing of Th1/Tc1 response, which contributes to persistency of HBV infection.