bluuebunny/crossref_metadata_2025 huggingface dataset:
The Diversity of Nutritional Status in Cancer: New Insights
Authors: Ramos Chaves Mariana , Boléo-Tomé Carolina , Monteiro-Grillo Isabel , Camilo Maria , Ravasco Paula
Published: April 2010

Learning Objectives

After completing this course, the reader will be able to: Explain how malnutrition (deficit or excess) is used as a decisive factor in treatment of cancer patients.Describe the interactions and influences of overweight/obesity on tumor metabolism and of individualized tumor metabolism on tumor burden and undernutrition.Use the association of sarcopenic obesity to predict and manage poorer performance status and decreased survival in cancer patients.

CME This article is available for continuing medical education credit at CME.TheOncologist.com

Objective.

Nutritional status in cancer has been mostly biased toward undernutrition, an issue now in dispute. We aimed to characterize nutrition status, to analyze associations between nutritional and clinical/cancer-related variables, and to quantify the relative weights of nutritional and cancer-related features.

Methods.

The cross-sectional study included 450 nonselected cancer patients (ages 18–95 years) at referral for radiotherapy. Nutritional status assessment included recent weight changes, body mass index (BMI) categorized by World Health Organization's age/sex criteria, and Patient-Generated Subjective Global Assessment (PG-SGA; validated/specific for oncology).

Results.

BMI identified 63% as ≥25 kg/m2 (43% overweight, 20% obese) and 4% as undernourished. PG-SGA identified 29% as undernourished and 71% as well nourished. Crossing both methods, among the 319 (71%) well-nourished patients according to PG-SGA, 75% were overweight/obese and only 25% were well nourished according to BMI. Concordance between BMI and PG-SGA was evaluated and consistency was confirmed. More aggressive/advanced stage cancers were more prevalent in deficient and excessive nutritional status: in 83% (n = 235/282) of overweight/obese patients by BMI and in 85% (n = 111/131) of undernourished patients by PG-SGA. Results required adjustment for diagnoses: greater histological aggressiveness was found in overweight/obese prostate and breast cancer; undernutrition was associated with aggressive lung, colorectal, head-neck, stomach, and esophageal cancers (p < .005). Estimates of effect size revealed that overweight/obesity was associated with advanced stage (24%), aggressive breast (10%), and prostate (9%) cancers, whereas undernutrition was associated with more aggressive lung (6%), colorectal (6%), and head-neck (6%) cancers; in both instances, age and longer disease duration were of significance.

Conclusion.

Undernutrition and overweight/obesity have distinct implications and bear a negative prognosis in cancer. This study provides novel data on the prevalence of overweight/obesity and undernutrition in cancer patients and their potential role in cancer histological behavior.
Complex interactions between regional dispersal of native taxa and an invasive species
Authors: Strecker Angela L. , Arnott Shelley E.
Published: April 2010

In the event of an environmental disturbance, dispersal of native taxa may provide species and genetic diversity to ecosystems, increasing the likelihood that there will be species and genotypes present that are less vulnerable to the disturbance. This may allow communities to maintain functioning during a disturbance and may be particularly important when the perturbation is novel to the system, such as the establishment of an invasive species. We examined how dispersal of native species may influence crustacean zooplankton communities in freshwater lakes invaded by the invertebrate predator, Bythotrephes longimanus. Using large enclosures, we experimentally tested the effect of dispersal on zooplankton community abundance, richness, and composition in (1) a community invaded by Bythotrephes, (2) the same community with the invader removed, and (3) a community that was never invaded. Dispersal increased zooplankton community abundance and richness; however, these effects were usually only significant in the invader‐removed treatment. Dispersal tended to make the invader‐removed communities more similar to never‐invaded communities in abundance, richness, and composition. Dispersal had little effect on zooplankton abundance in the invaded community; however, richness significantly increased, and the community composition changed to resemble a never‐invaded community by the end of the experiment. Our results have implications for understanding the role of dispersal during transitory states in communities. Dispersal of native taxa may be particularly important during the period between the arrival and broad‐scale establishment of Bythotrephes, as dispersal through space or time (i.e., from resting eggs) may rapidly increase zooplankton abundance when the invader is absent or in low abundances. Overall, our results suggest that communities with strong local predatory and competitive interactions may be closed to immigration from colonists, but that invasive species may alter the conditions under which species can establish. These results have implications for the interaction of native and invasive species across broad spatial scales, as regional dispersal of native taxa may forestall the local extirpation of native species. In particular, transient phases that result from variable persistence of invaders within habitats or across a region may permit native colonists to successfully establish, and thus increase local and regional resistance to future disturbance.
Topographic influences on vegetation mosaics and tree diversity in the Chihuahuan Desert Borderlands
Authors: Poulos Helen M. , Camp Ann E.
Published: April 2010

The abundance and distribution of species reflect how the niche requirements of species and the dynamics of populations interact with spatial and temporal variation in the environment. This study investigated the influence of geographical variation in environmental site conditions on tree dominance and diversity patterns in three topographically dissected mountain ranges in west Texas, USA, and northern Mexico. We measured tree abundance and basal area using a systematic sampling design across the forested areas of three mountain ranges and related these data to a suite of environmental parameters derived from field and digital elevation model data. We employed cluster analysis, classification and regression trees (CART), and rarefaction to identify (1) the dominant forest cover types across the three study sites and (2) environmental influences on tree distribution and diversity patterns. Elevation, topographic position, and incident solar radiation were the major influences on tree dominance and diversity. Mesic valley bottoms hosted high‐diversity vegetation types, while hotter and drier mid‐slopes and ridgetops supported lower tree diversity. Valley bottoms and other topographic positions shared few species, indicating high species turnover at the landscape scale. Mountain ranges with high topographic complexity also had higher species richness, suggesting that geographical variability in environmental conditions was a major influence on tree diversity. This study stressed the importance of landscape‐ and regional‐scale topographic variability as a key factor controlling vegetation pattern and diversity in southwestern North America.
Life history and matrix heterogeneity interact to shape metapopulation connectivity in spatially structured environments
Authors: Shima Jeffrey S. , Noonburg Erik G. , Phillips Nicole E.
Published: April 2010

Metapopulation models have historically treated a landscape as a collection of habitat patches separated by a matrix of uniformly unsuitable habitat. This perspective is still apparent in many studies of marine metapopulations, in which recruitment variation is generally assumed to be primarily the result of variability in ocean currents and interactions with disperser behavior, with little consideration of spatial structure that can affect disperser viability. We use a simple model of dispersal of marine larvae to demonstrate how heterogeneity in dispersal habitat (i.e., the matrix) can generate substantial spatial variation in recruitment. Furthermore, we show how this heterogeneity can interact with larval life‐history variation to create alternative patterns of source–sink dynamics. Finally, we place our results in the context of spatially structured matrix population models, and we propose the damping ratio of the connectivity matrix as a general and novel measure of landscape connectivity that may provide conceptual unification to the fields of metapopulation biology and landscape ecology.
A nutritionally mediated risk effect of wolves on elk
Authors: Christianson David , Creel Scott
Published: April 2010

Though it is widely argued that antipredator responses carry nutritional costs, or risk effects, these costs are rarely measured in wild populations. To quantify risk effects in elk, a species that strongly responds to the presence of wolves, we noninvasively monitored diet selection and nutrient balance in wintering elk in the Upper Gallatin, Montana, USA, over three winters while quantifying the local presence of wolves at a fine spatiotemporal scale. Standard nutritional indices based on the botanical and chemical composition of 786 fecal samples, 606 snow urine samples, and 224 forage samples showed that elk were generally malnourished throughout winter. Increased selection for dietary nitrogen within forage types (e.g., grasses) led to ∼8% higher fecal nitrogen in the presence of wolves. However, urinary allantoin : creatinine and potassium : creatinine ratios decreased in the presence of wolves, suggesting large declines in energy intake, equal to 27% of maintenance requirements. Urinary nitrogen : creatinine ratios confirmed that deficiencies in nitrogen and/or energy were exacerbated in the presence of wolves, leading to increased endogenous protein catabolism. Overall, the nutritional effects of wolf presence may be of sufficient magnitude to reduce survival and reproduction in wintering elk. Nutritionally mediated risk effects may be important for understanding predator–prey dynamics in wild populations, but such effects could be masked as bottom‐up forces if antipredator responses are not considered.
Specialization of trophic position and habitat use by sticklebacks in an adaptive radiation
Authors: Matthews Blake , Marchinko Kerry B. , Bolnick Daniel I. , Mazumder Asit
Published: April 2010

Divergence in habitat use among closely related species is a common characteristic of adaptive radiations. Large differences in the size structure of prey between habitats could strengthen disruptive selection on generalist predators and lead to a divergence in trophic position among species in an adaptive radiation. Using threespine stickleback (Gasterosteus aculeatus) in freshwater lakes as a model system, we examined whether divergence in habitat use coincides with shifts in trophic position. We examined the habitat use and trophic position of individual sticklebacks from divergent lake environments that have only one stickleback species (allopatric lakes) and from lakes that have a pair of benthic and limnetic stickleback species (sympatric lakes). In two sympatric lakes, the limnetic species had a higher trophic position than the benthic species, and in both allopatric and sympatric lakes, sticklebacks specializing on pelagic prey had a higher trophic position for a given size than sticklebacks specializing on benthic prey. Furthermore, the trophic position of pelagic specialists was correlated with individual variation in their gill raker length. Our results indicate that gill raker length is an important trait that underlies differentiation in both habitat use and trophic position among stickleback species, populations, and individuals.
Correspondence analysis of raw data
Authors: Greenacre Michael
Published: April 2010

Correspondence analysis has found extensive use in ecology, archaeology, linguistics, and the social sciences as a method for visualizing the patterns of association in a table of frequencies or nonnegative ratio‐scale data. Inherent to the method is the expression of the data in each row or each column relative to their respective totals, and it is these sets of relative values (called profiles) that are visualized. This “relativization” of the data makes perfect sense when the margins of the table represent samples from subpopulations of inherently different sizes. But in some ecological applications sampling is performed on equal areas or equal volumes so that the absolute levels of the observed occurrences may be of relevance, in which case relativization may not be required. In this paper, I define the correspondence analysis of the raw “unrelativized” data and discuss its properties, comparing this new method to regular correspondence analysis and to a related variant of nonsymmetric correspondence analysis.
Herbivory of tropical rain forest tree seedlings correlates with future mortality
Authors: Eichhorn Markus P. , Nilus Reuben , Compton Stephen G. , Hartley Sue E. , Burslem David F. R. P.
Published: April 2010

Tree seedlings in tropical rain forests are subject to both damage from natural enemies and intense interspecific competition. This leads to a trade‐off in investment between defense and growth, and it is likely that tree species specialized to particular habitats tailor this balance to correspond with local resource availability. It has also been suggested that differential herbivore impacts among tree species may drive habitat segregation, favoring species adapted to particular resource conditions. In order to test these predictions, a reciprocal transplant experiment in Sabah, Malaysia, was established with seedlings of five species of Dipterocarpaceae. These were specialized to either alluvial (Hopea nervosa, Parashorea tomentella) or sandstone soils (Shorea multiflora, H. beccariana), or were locally absent (S. fallax). A total of 3000 seedlings were planted in paired gap and understory plots in five sites on alluvial and sandstone soils. Half of all seedlings were fertilized. Seedling growth and mortality were recorded in regular samples over 3.5 years, and rates of insect herbivore damage were estimated from censuses of foliar tissue loss on marked mature leaves and available young leaves. Greater herbivory rates on mature leaves had no measurable effects on seedling growth but were associated with a significantly increased likelihood of mortality during the following year. In contrast, new‐leaf herbivory rates correlated with neither growth nor mortality. There were no indications of differential impacts of herbivory among the five species, nor between experimental treatments. Herbivory was not shown to influence segregation of species between soil types, although it may contribute toward differential survival among light habitats. Natural rates of damage were substantially lower than have been shown to influence tree seedling growth and mortality in previous manipulative studies.
Mycorrhizal fungi reduce nutrient loss from model grassland ecosystems
Authors: van der Heijden Marcel G. A.
Published: April 2010

Nutrient loss from ecosystems is among the top environmental threats to ecosystems worldwide, leading to reduced plant productivity in nutrient‐poor ecosystems and eutrophication of surface water near nutrient‐rich ecosystems. Hence, it is of pivotal importance to understand which factors influence nutrient loss. Here it is demonstrated that arbuscular mycorrhizal (AM) fungi, widespread soil fungi that form mutualistic relationships with the majority of land plants, reduce nutrient loss from grassland microcosms during rain‐induced leaching events.

Grassland microcosms with AM fungi lost 60% less phosphorus and 7.5% less ammonium compared to control microcosms without AM fungi. Similar results were obtained for microcosms planted with each of three different grass species. In contrast, nitrate leaching was not affected by AM fungi but depended on the amount of nutrients supplied to the microcosms. Moreover, fertilization of the microcosms reduced the abundance of AM fungi and their ability to reduce phosphorus leaching losses. Extrapolation of these results suggests that the disruption of the mycorrhizal symbiosis is one of the reasons for enhanced phosphorus loss from fertilized ecosystems.

The microcosms contained a sandy soil, a soil type vulnerable to leaching losses. The reduction of phosphorus leaching by AM fungi may, therefore, represent an upper limit. Advantages and limitations of the experimental setup for assessing the impact of AM fungi on nutrient cycling are discussed.

The results indicate that AM fungi contribute to ecosystem sustainability by promoting a closed phosphorus cycle and reducing phosphorus leaching losses.
Plant species richness in montane grasslands affects the fitness of a generalist grasshopper species
Authors: Unsicker Sybille B. , Franzke Alexandra , Specht Juliane , Köhler Günter , Linz Jeanine , Renker Carsten , Stein Claudia , Weisser Wolfgang W.
Published: April 2010

Theory predicts negative effects of increasing plant diversity on the abundance of specialist insect herbivores, but little is known about how plant diversity affects the performance and abundance of generalist insect herbivores. We studied oviposition rates and offspring numbers in females of the generalist grasshopperChorthippus parallelusthat were collected in 15 montane grasslands in 2005 and 2007 along a gradient of plant species richness in central Germany. In addition to plant species richness, we determined evenness and plant community composition in the grasslands and measured aboveground plant biomass and other habitat variables such as leaf area index, vegetation height, and solar radiation. There was substantial variation among sites in grasshopper fecundity and the number of nymphs that hatched from the egg pods. Both fitness measures were positively influenced by plant species richness at the sites, while female fitness did not correlate with any of the other habitat parameters. Abundance ofC. parallelusin the grasslands was positively correlated with plant species richness, plant community composition, and incident solar radiation of the sites. There were no phenological differences between grasshoppers from the different study sites. Our results suggest that decreasing biodiversity threatens the persistence not only of specialist, but also of generalist insect herbivores via a variety of mechanisms including a decrease in diversity of the generalists‘ food plants.
Effects of climate change and variability on population dynamics in a long‐lived shorebird
Authors: van de Pol Martijn , Vindenes Yngvild , Sæther Bernt-Erik , Engen Steinar , Ens Bruno J. , Oosterbeek Kees , Tinbergen Joost M.
Published: April 2010

Climate change affects both the mean and variability of climatic variables, but their relative impact on the dynamics of populations is still largely unexplored. Based on a long‐term study of the demography of a declining Eurasian Oystercatcher (Haematopus ostralegus) population, we quantify the effect of changes in mean and variance of winter temperature on different vital rates across the life cycle. Subsequently, we quantify, using stochastic stage‐structured models, how changes in the mean and variance of this environmental variable affect important characteristics of the future population dynamics, such as the time to extinction. Local mean winter temperature is predicted to strongly increase, and we show that this is likely to increase the population's persistence time via its positive effects on adult survival that outweigh the negative effects that higher temperatures have on fecundity. Interannual variation in winter temperature is predicted to decrease, which is also likely to increase persistence time via its positive effects on adult survival that outweigh the negative effects that lower temperature variability has on fecundity. Overall, a 0.1°C change in mean temperature is predicted to alter median time to extinction by 1.5 times as many years as would a 0.1°C change in the standard deviation in temperature, suggesting that the dynamics of oystercatchers are more sensitive to changes in the mean than in the interannual variability of this climatic variable. Moreover, as climate models predict larger changes in the mean than in the standard deviation of local winter temperature, the effects of future climatic variability on this population's time to extinction are expected to be overwhelmed by the effects of changes in climatic means. We discuss the mechanisms by which climatic variability can either increase or decrease population viability and how this might depend both on species' life histories and on the vital rates affected. This study illustrates that, for making reliable inferences about population consequences in species in which life history changes with age or stage, it is crucial to investigate the impact of climate change on vital rates across the entire life cycle. Disturbingly, such data are unavailable for most species of conservation concern.
Herbivores affect natural selection for floral‐sex ratio in a field population of horsenettle, Solanum carolinense
Authors: Wise Michael J. , Hébert Julie B.
Published: April 2010

Although aspects of a plant's breeding system are generally believed to have evolved in response to selection for effective pollination, herbivores may also play a selective role. Here we report on a field experiment involving 960 transplanted ramets of the andromonoecious herb Solanum carolinense in which the pattern of natural selection for an important breeding‐system trait was influenced by naturally occurring herbivores. As the level of flower and fruit herbivory increased, the pattern of selection on floral‐sex ratio went from stabilizing (with an optimum of 29% male flowers), to directional toward a lower proportion of males, with the optimum bottoming at 0% male. This pattern of selection likely helped generate the broad‐sense genetic correlation (r = 0.42) between floral‐sex ratio and resistance to herbivory. These results contribute to the growing awareness that herbivores can be important influences not only on plant resistance traits, but also on the evolution of their hosts' breeding system.
The Greek Nurses’ Job Satisfaction Scale: Development and Psychometric Assessment
Authors: Moumtzoglou Anastasius
Published: April 2010

The growing literature relating to job satisfaction among nurses concludes that more research is required to understand the organizational, professional, and personal variables that improve nurse satisfaction and retention. This study developed and psychometrically tested a nurse satisfaction questionnaire, suitable for the nurses’ working conditions in Greece. A cross-sectional survey, in Greek, was conducted in three public hospitals. Two-hundred and twenty-five Greek nurses evaluated the psychometric properties of the Greek Nurses’ Job Satisfaction Scale (GNJSS). The 18-item questionnaire showed a high degree of internal consistency (Cronbach’s alpha = 0.907) and revealed four factors that are consistent with the predetermined subscales and the conceptual base of the GNJSS. The factors, which explain 62.420% of variance, are associated with interaction and recognition, leadership style and organizational policies, self-growth and responsibility, and remuneration and work itself. Although it would be useful to carry out further analyses to assess time-based properties of reliability, the GNJSS questionnaire is a reliable and valid instrument to assess nurses’ job satisfaction.
Returning Home
Authors: Haozous Emily A.
Published: April 2010

In 1886, the U.S. government took the last of the free Chiricahua Apaches captive, closing the chapter on the Indian Wars in the United States. Emily Haozous, a descendent of those original captives, describes her circuitous path back to New Mexico as part of her own journey through academic nursing 110 year later.
The Seventh U.S.–Russian Nursing Conference Cruise: One Participant's Perspective
Authors: LaRocco Susan A.
Published: April 2010

Participating in the seventh U.S.- Russian Nursing Conference Cruise was a unique opportunity for American nurses to interact with nurses from Russia, South Africa, and Australia. In addition to the conference sessions, visiting a hospital and a hospice provided insight into health care in Russia.
The Power of Music
Authors: Zust Barbara
Published: April 2010

A group of students with a passion for global health issues experience the power of music to bridge differences in language and culture.
Gingival Enlargement in Children Administered Cyclosporine After Liver Transplantation
Authors: Lin Yng‐Tzer , Yang Fang‐Tai
Published: April 2010

Background: Cyclosporine, a potent immunosuppressant agent, has significantly reduced the morbidity and mortality rates associated with solid‐organ transplantations. The major side effect of this drug in the oral cavity is gingival enlargement. Cyclosporine‐induced gingival enlargement was reported by different transplant centers as varying from 7% to 80%. Many factors related to cyclosporine‐induced gingival overgrowth have been investigated. However, controversies still exist. This study investigates the effects of cyclosporine on the gingival tissues of liver‐transplant pediatric patients, determines the prevalence and severity of gingival overgrowth, and analyzes the relationship between gingival enlargement and possible risk factors.

Methods: Twenty‐five children aged <4 years old (15 males and 10 females) with end‐stage liver disease, and awaiting liver transplantation were selected for this study. During the pretransplant period, baseline data were collected including serum level of cyclosporine and gingival enlargement, plaque, and gingival bleeding indices. After liver transplantation, all subjects received <5 mg/kg cyclosporine as an immunosuppressant agent. The children had the same data collected immediately and 3, 6, and 12 months after liver transplantation.

Results: The results show that the cyclosporine‐induced gingival enlargement of these children is not statistically associated with their age, gender, gingival inflammation, or serum level of cyclosporine (P >0.05). The gingival enlargement was found to be significantly related to the plaque index at each time period until 12 months after liver transplantation (P <0.05). An increased tendency of gingival enlargement was found in the immediate post‐transplant examination and at 3 months after liver transplantation.

Conclusions: Children administered cyclosporine after liver transplantation show that gingival enlargement is statistically more related to the plaque index than other factors such as age, gender, gingival inflammation, or the serum level of cyclosporine, which suggests that plaque control plays an important role in eliminating gingival enlargement in children who have undergone liver transplantation.
The “Contaminating Agent” UNRRA, Displaced Persons, and Venereal Disease in Germany, 1945–1947
Authors: Haushofer Lisa
Published: April 2010

World War II created a large group of persecuted, homeless or stateless people who came to be united under the term “displaced persons” (DPs). The United Nations Relief and Rehabilitation Administration (UNRRA) was charged with the care of these individuals in various camps in Germany, although the military governments of the respective zones of occupation had ultimate authority over them. Among the various public health efforts directed toward DPs was a campaign against venereal disease during which compulsory examinations were particularly stressed by the military governments. The controversy resulting from this campaign opens a new window on the complex context of an international organization working under the roof of a national authority to achieve common—or differing—public health goals.
Estimating Adolescent Risk for Hearing Loss Based on Data From a Large School-Based Survey
Authors: Vogel Ineke , Verschuure Hans , van der Ploeg Catharina P. B. , Brug Johannes , Raat Hein
Published: April 2010

Objectives. We estimated whether and to what extent a group of adolescents were at risk of developing permanent hearing loss as a result of voluntary exposure to high-volume music, and we assessed whether such exposure was associated with hearing-related symptoms.

Methods. In 2007, 1512 adolescents (aged 12–19 years) in Dutch secondary schools completed questionnaires about their music-listening behavior and whether they experienced hearing-related symptoms after listening to high-volume music. We used their self-reported data in conjunction with published average sound levels of music players, discotheques, and pop concerts to estimate their noise exposure, and we compared that exposure to our own “loosened” (i.e., less strict) version of current European safety standards for occupational noise exposure.

Results. About half of the adolescents exceeded safety standards for occupational noise exposure. About one third of the respondents exceeded safety standards solely as a result of listening to MP3 players. Hearing symptoms that occurred after using an MP3 player or going to a discotheque were associated with exposure to high-volume music.

Conclusions. Adolescents often exceeded current occupational safety standards for noise exposure, highlighting the need for specific safety standards for leisure-time noise exposure.
Heat–Health Warning Systems: A Comparison of the Predictive Capacity of Different Approaches to Identifying Dangerously Hot Days
Authors: Hajat Shakoor , Sheridan Scott C. , Allen Michael J. , Pascal Mathilde , Laaidi Karine , Yagouti Abderrahmane , Bickis Ugis , Tobias Aurelio , Bourque Denis , Armstrong Ben G. , Kosatsky Tom
Published: April 2010

Objectives. We compared the ability of several heat–health warning systems to predict days of heat-associated mortality using common data sets.

Methods. Heat–health warning systems initiate emergency public health interventions once forecasts have identified weather conditions to breach predetermined trigger levels. We examined 4 commonly used trigger-setting approaches: (1) synoptic classification, (2) epidemiologic assessment of the temperature–mortality relationship, (3) temperature–humidity index, and (4) physiologic classification. We applied each approach in Chicago, Illinois; London, United Kingdom; Madrid, Spain; and Montreal, Canada, to identify days expected to be associated with the highest heat-related mortality.

Results. We found little agreement across the approaches in which days were identified as most dangerous. In general, days identified by temperature–mortality assessment were associated with the highest excess mortality.

Conclusions. Triggering of alert days and ultimately the initiation of emergency responses by a heat–health warning system varies significantly across approaches adopted to establish triggers.
Individual and Network Interventions With Injection Drug Users in 5 Ukraine Cities
Authors: Booth Robert E. , Lehman Wayne E. K. , Latkin Carl A. , Dvoryak Sergey , Brewster John T. , Royer Mark S. , Sinitsyna Larisa
Published: April 2010

Objectives. We evaluated the effects of an individual intervention versus a network intervention on HIV-related injection and sexual risk behaviors among street-recruited opiate injection drug users in 5 Ukraine cities.

Methods. Between 2004 and 2006, 722 opiate injection drug users were recruited to participate in interventions that were either individually based or based on a social network model in which peer educators intervened with their network members. Audio computer-assisted self-interview techniques were used to interview participants at baseline and follow-up.

Results. Multiple logistic analyses controlling for baseline injection and sexual risks revealed that both peer educators and network members in the network intervention reduced injection-related risk behaviors significantly more than did those in the individually based intervention and that peer educators increased condom use significantly more than did those in the individual intervention. Individual intervention participants, however, showed significantly greater improvements than did network members with respect to reductions in sexual risk behaviors.

Conclusions. Social network interventions may be more effective than individually based interventions in changing injection risk behaviors among both peer educators and network members. The effectiveness of network interventions in changing sexual risk behaviors is less clear, probably owing to network composition and inhibitions regarding discussing sexual risk behaviors.
The First Condom Machine in a US Jail: The Challenge of Harm Reduction in a Law and Order Environment
Authors: Sylla Mary , Harawa Nina , Grinstead Reznick Olga
Published: April 2010

Most US jails and prisons do not provide condoms to prisoners because of concerns about possible negative consequences. Since 1989, the jail system of San Francisco, California, has provided condoms to male prisoners through 1-on-1 counseling sessions. Given the limitations of this approach, we installed, stocked, and monitored a free condom-dispensing machine in a jail to examine the feasibility of this method of providing condoms to jail prisoners. After the machine was installed, we observed increases in prisoners' awareness of programmatic access to condoms and in their likelihood of having obtained condoms. Particularly large increases in condom uptake were reported among those in high-risk groups. Sexual activity did not increase, custody operations were not impeded, and staff acceptance of condom access for prisoners increased.
Percentage of Gestational Diabetes Mellitus Attributable to Overweight and Obesity
Authors: Kim Shin Y. , England Lucinda , Wilson Hoyt G. , Bish Connie , Satten Glen A. , Dietz Patricia
Published: April 2010

Objectives. We calculated the percentage of gestational diabetes mellitus (GDM) attributable to overweight and obesity.

Methods. We analyzed 2004 through 2006 data from 7 states using the Pregnancy Risk Assessment Monitoring System linked to revised 2003 birth certificate information. We used logistic regression to estimate the magnitude of the association between prepregnancy body mass index (BMI) and GDM and calculated the percentage of GDM attributable to overweight and obesity.

Results. GDM prevalence rates by BMI category were as follows: underweight (13–18.4 kg/m2), 0.7%; normal weight (18.5–24.9 kg/m2), 2.3%; overweight (25–29.9 kg/m2), 4.8%; obese (30–34.9 kg/m2), 5.5%; and extremely obese (35–64.9 kg/m2), 11.5%. Percentages of GDM attributable to overweight, obesity, and extreme obesity were 15.4% (95% confidence interval [CI] = 8.6, 22.2), 9.7% (95% CI = 5.2, 14.3), and 21.1% (CI = 15.2, 26.9), respectively. The overall population-attributable fraction was 46.2% (95% CI = 36.1, 56.3).

Conclusions. If all overweight and obese women (BMI of 25 kg/m2 or above) had a GDM risk equal to that of normal-weight women, nearly half of GDM cases could be prevented. Public health efforts to reduce prepregnancy BMI by promoting physical activity and healthy eating among women of reproductive age should be intensified.
Socioeconomic Gradients in Sexually Transmitted Diseases: A Geographic Information System–Based Analysis of Poverty, Race/Ethnicity, and Gonorrhea Rates in California, 2004–2006
Authors: Springer Yuri P. , Samuel Michael C. , Bolan Gail
Published: April 2010

Objectives. We quantified the relationship between gonorrheal infection rates in California and a measure of poverty status and investigated how this relationship and the spatial dispersion of cases varied among the 4 dominant racial/ethnic groups in the state.

Methods. We geocoded gonorrhea cases reported in California between 2004 and 2006, and estimated the poverty status of each case by using the percentage of residents living below poverty in the census tract of residence. We calculated infection rates for African American, Asian, Hispanic, and White cases in each of 4 poverty strata. We mapped cases to visualize the patterns of spatial dispersion associated with each race/ethnicity–poverty combination.

Results. There was a strong positive relationship between poverty and infection, but racial/ethnic disparities in infection, driven by a disproportionate level of gonorrhea among African Americans, eclipsed this differential. The degree of spatial aggregation varied substantially among groups and was especially pronounced for African Americans with gonorrhea in the highest poverty category.

Conclusions. Prevention efforts should target low-income neighborhood “hot spots” to reach the largest numbers of cases, particularly among African Americans.
Testing for Racial/Ethnic Differences in the Association Between Childhood Socioeconomic Position and Adult Adiposity
Authors: Trotter LaTonya J. , Bowen Deborah J. , Beresford Shirley A. A.
Published: April 2010

Objectives. We tested the association between 2 measures of childhood socioeconomic position (SEP) and adult body mass index (BMI), stratified by race and ethnicity.

Methods. We used regression analyses to examine associations between adult BMI and 2 measures of childhood SEP (maternal education and whether the head of the child's household was working class), adjusted for a robust set of adult SEP measures, in a sample of 2068 adults from Los Angeles County, California.

Results. Maternal educational attainment was associated with a lower median adult BMI among Whites (8% decrease for high school diploma and 9% decrease for a college degree, compared with no high school diploma). A maternal high school diploma was associated with a 6% decrease in median adult BMI among Hispanics and an 11% decrease among Blacks. Our measure of childhood working-class status was not correlated with adult BMI.

Conclusions. Our results suggest that childhood SEP is independently associated with adult BMI. However, our results also suggest that the effect may depend on which measures of SEP are used and that some aspects of childhood SEP may matter more for adult BMI than others.
Life and Health Insurance Industry Investments in Fast Food
Authors: Mohan Arun V. , McCormick Danny , Woolhandler Steffie , Himmelstein David U. , Boyd J. Wesley
Published: April 2010

Previous research on health and life insurers' financial investments has highlighted the tension between profit maximization and the public good. We ascertained health and life insurance firms' holdings in the fast food industry, an industry that is increasingly understood to negatively impact public health. Insurers own $1.88 billion of stock in the 5 leading fast food companies. We argue that insurers ought to be held to a higher standard of corporate responsibility, and we offer potential solutions.
Clinic Versus Over-the-Counter Access to Oral Contraception: Choices Women Make Along the US–Mexico Border
Authors: Potter Joseph E. , White Kari , Hopkins Kristine , Amastae Jon , Grossman Daniel
Published: April 2010

Objectives. As part of the Border Contraceptive Access Study, we interviewed oral contraceptive (OC) users living in El Paso, Texas, to assess motivations for patronizing a US clinic or a Mexican pharmacy with over-the-counter (OTC) pills and to determine which women were likely to use the OTC option.

Methods. We surveyed 532 clinic users and 514 pharmacy users about background characteristics, motivations for choosing their OC source, and satisfaction with this source.

Results. Older women and women born and educated in Mexico were more likely to patronize pharmacies. Cost of pills was the main motivation for choosing their source for 40% of pharmacy users and 23% of clinic users. The main advantage cited by 49% of clinic users was availability of other health services. Bypassing the requirement to obtain a doctor's prescription was most important for 27% of pharmacy users. Both groups were very satisfied with their pill source.

Conclusions. Women of different ages, parities, and educational levels would likely take advantage of an OTC option were OCs available at low cost. Improving clinic provision of OCs should be considered.
Water, livelihoods and climate change adaptation in the Tonle Sap Lake area, Cambodia: learning from the past to understand the future
Authors: Nuorteva Paula , Keskinen Marko , Varis Olli
Published: April 2010

The changing environment is expected to intensify the challenges that people in developing countries are facing, particularly among the groups whose livelihoods depend on natural resources. The adaptive capacity of livelihoods largely defines the extent to which people can cope with future environmental changes, whether caused by climate change or other factors such as land use changes and water resources development. This article analyses the resilience and adaptive capacity of rural livelihoods around Cambodia's Tonle Sap Lake, an exceptional lake-floodplain system dominated by flood pulse. The research findings demonstrate that despite the people's tradition of adapting to the remarkable seasonal variation of water and related resources, their capacity to adapt to unusual environmental changes is weak, with the poorest being clearly the most vulnerable group. Reasons for the weak resilience include villages' relatively homogenous livelihood structures, unjust governance practices, increasing inequality and the lack of opportunities for livelihood diversification. It is concluded that while climate change is likely to pose a remarkable challenge to people's livelihoods in the longer term, climate change adaptation activities should also take into account other environmental changes. Equally critical is the understanding of the broader socio-political context and its dynamics in increasing—and decreasing—livelihood resilience.
Future challenges to asset investment in the UK water industry: the wastewater asset investment risk mitigation offered by minimising principal operating cost risks
Authors: Palmer S. J.
Published: April 2010

This paper defines challenges currently facing the water industry globally that will affect water industry asset investment and development now and in the near future. Those challenges include energy price volatility, climate change regulation, asset capital costs and strategic resource considerations. This paper presents potential answers to these challenges in the context of the UK water industry and described a methodology developed to assess them and provide accurate cost-benefit analysis. A best practice approach which allows sustainable investment to offer water utilities operational efficiency benefits, including cost benefits, is described and the critical elements of the best practice developed by the author identified.
Production of energy by co-fermentation with contents from fat separators
Authors: Wriege-Bechtold A. , Barjenbruch M. , Sieker C. , Peter-Fröhlich A. , Heinzmann B. , Lengemann B.
Published: April 2010

It is possible to use co-fermentation to increase biogas production considerably in digesters with free capacity. Also, the energy production increases by increasing biogas production. Many co-substrates such as energy crops, biodegradable waste from the food industry, restaurants and public parks, etc. are on the market. Water consumption is decreasing because of population movement and a decreasing population size because of a drop in the birth rate. Therefore, capacities in digesters will increase and new uses for this capacity are needed. Co-fermentation could be one solution. Useful co-substrates should be identified by material characteristics. It is important to assess suitability of materials for fermentation in small-scale tests, and to gain experience particularly with regard to the handling, the compatibility of the biocoenosis in the digester and the effects of returning effluent to the activated sludge process. A test period with fat separator contents has started at the wastewater treatment plant, Waßmannsdorf, Germany. Biogas production and methane content increased compared to the reference cascade without co-substrate input.
Improving Wind and Rain Simulations for Tropical Cyclones with the Assimilation of Doppler Radar Data
Authors: Cheung T. C. , Chan P. W.
Published: April 2010

More accurate prediction of the strong winds and heavy rain associated with tropical cyclones using numerical weather prediction (NWP) models would be helpful in the provision of weather services for the public. In this paper, the impact of assimilating radar data in the simulation of Typhoon Neoguri and Severe Tropical Storm Kammuri in 2008 is studied using Weather Research and Forecasting (WRF) version 2.2 and WRF VAR version 2.1. Only the data from the radar at Tate's Cairn in Hong Kong are considered. Four experiments are conducted, namely, (a) simulation without radar data, (b) simulation with radar data assimilated at the initial time, (c) cycling simulation with the assimilation of radar data (Doppler velocity and reflectivity) directly assimilated, and (d) cycling simulation with the assimilation of 2D wind field retrieved from the Doppler velocity data from the radar. By comparing with actual observations of the surface wind distribution in Hong Kong and the actual radar reflectivity data, it turns out that both (c) and (d) outperform (a) and (b), and (c) and (d) show comparable skills. As a result, cycling simulation with the assimilation of weather radar data (even for a single radar) could improve the prediction of winds and rain bands associated with tropical cyclones.
Anamneses-Based Internet Information Supply: Can a Combination of an Expert System and Meta-Search Engine Help Consumers find the Health Information they Require?
Authors: Honekamp Wilfried , Ostermann Herwig
Published: April 2010

An increasing number of people search for health information online. During the last 10 years various researchers have determined the requirements for an ideal consumer health information system. The aim of this study was to figure out, whether medical laymen can find a more accurate diagnosis for a given anamnesisviathe developed prototype health information system thanviaordinary internet search.

In a randomized controlled trial, the prototype information system was evaluated by the assessment of two sample cases. Participants had to determine the diagnosis of a patient with a headacheviainformation found searching the web. A patient’s history sheet and a computer with internet access were provided to the participants and they were guided through the study by an especially designed study website. The intervention group used the prototype information system; the control group used common search engines and portals. The numbers of correct diagnoses in each group were compared.

A total of 140 (60/80) participants took part in two study sections. In the first case, which determined a common diagnosis, both groups did equally well. In the second section, which determined a less common and more complex case, the intervention group did significantly better (P=0.031) due to the tailored information supply.

Using medical expert systems in combination with a portal searching meta-search engine represents a feasible strategy to provide reliable patient-tailored information and can ultimately contribute to patient safety with respect to information foundviathe internet.