bluuebunny/crossref_metadata_2025 huggingface dataset:
Prediction of Coronary Heart Disease in a Population With High Prevalence of Diabetes and Albuminuria
Authors: Lee Elisa T. , Howard Barbara V. , Wang Wenyu , Welty Thomas K. , Galloway James M. , Best Lyle G. , Fabsitz Richard R. , Zhang Ying , Yeh Jeunliang , Devereux Richard B.
Published: June 2006

Background—

The present article presents equations for the prediction of coronary heart disease (CHD) in a population with high rates of diabetes and albuminuria, derived from data collected in the Strong Heart Study, a longitudinal study of cardiovascular disease in 13 American Indian tribes and communities in Arizona, North and South Dakota, and Oklahoma.

Methods and Results—

Participants of the Strong Heart Study were examined initially in 1989–1991 and were monitored with additional examinations and mortality and morbidity surveillance. CHD outcome data through December 2001 showed that age, gender, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein cholesterol, smoking, diabetes, hypertension, and albuminuria were significant CHD risk factors. Hazard ratios for ages 65 to 75 years, hypertension, LDL cholesterol ≥160 mg/dL, diabetes, and macroalbuminuria were 2.58, 2.01, 2.44, 1.66, and 2.11 in men and 2.03, 1.69, 2.17, 2.26, and 2.69 in women, compared with ages 45 to 54 years, normal blood pressure, LDL cholesterol <100 mg/dL, no diabetes, and no albuminuria. Prediction equations for CHD and a risk calculator were derived by gender with the use of Cox proportional hazards model and the significant risk factors. The equations provided good discrimination ability, as indicated by a
c
statistic of 0.70 for men and 0.73 for women. Results from bootstrapping methods indicated good internal validation and calibration.

Conclusions—

A “risk calculator” has been developed and placed on the Strong Heart Study Web site, which provides predicted risk of CHD in 10 years with input of these risk factors. This may be valuable for diverse populations with high rates of diabetes and albuminuria.
Abnormal Ventilatory Response to Exercise in Adults With Congenital Heart Disease Relates to Cyanosis and Predicts Survival
Authors: Dimopoulos Konstantinos , Okonko Darlington O. , Diller Gerhard-Paul , Broberg Craig S. , Salukhe Tushar V. , Babu-Narayan Sonya V. , Li Wei , Uebing Anselm , Bayne Stephanie , Wensel Roland , Piepoli Massimo F. , Poole-Wilson Philip A. , Francis Darrel P. , Gatzoulis Michael A.
Published: June 2006

Background—

Limited data exist with which to stratify risk in adult congenital heart disease (ACHD). An increased ventilatory response to exercise, expressed as ventilation per unit of carbon dioxide production (V̇
e
/V̇
co
2
slope), is an established predictor of impaired survival in acquired heart disease. We sought to establish the distribution, relation to cyanosis, and prognostic value of the V̇
e
/V̇
co
2
slope across a wide spectrum of ACHD patients.

Methods and Results—

Five hundred sixty ACHD patients of varying diagnoses and 50 healthy controls underwent cardiopulmonary exercise testing at a single laboratory between 2001 and 2004. Patient age was 33.2±12.9 years (mean±SD). Peak oxygen consumption was 23.5±9.0 mL · kg
−1
· min
−1
. V̇
e
/V̇
co
2
slope for all patients was 36.3±15.3. The slope was raised in all ACHD groups compared with controls and was 73% higher in cyanotic patients. Cyanosis, with or without pulmonary arterial hypertension, was the strongest predictor of abnormal V̇
e
/V̇
co
2
slope. The V̇
e
/V̇
co
2
slope was the most powerful univariate predictor of mortality in the noncyanotic group and the only independent predictor of mortality among exercise parameters on multivariate analysis. In cyanotic patients, no parameter was predictive of death.

Conclusions—

Ventilatory response to exercise is abnormal across the spectrum of ACHD. Cyanosis is a powerful stimulus for such exaggerated ventilatory patterns irrespective of the presence of pulmonary arterial hypertension. Increased V̇
e
/V̇
co
2
slope is the strongest exercise predictor of death in noncyanotic ACHD patients.
Bone Morphogenic Protein-4 Induces Hypertension in Mice
Authors: Miriyala Sumitra , Gongora Nieto Maria C. , Mingone Christopher , Smith Debra , Dikalov Sergey , Harrison David G. , Jo Hanjoong
Published: June 2006

Background—

Recent in vitro studies have shown that disturbed flow and oxidative conditions induce the expression of bone morphogenic proteins (BMPs 2 and 4) in cultured endothelial cells. BMPs can stimulate superoxide production and inflammatory responses in endothelial cells, raising the possibility that BMPs may play a role in vascular diseases such as hypertension and atherosclerosis. In this study, we examined the hypothesis that BMP4 would induce hypertension in intact animals by increasing superoxide production from vascular nicotinamide adenine dinucleotide phosphate (NADPH) oxidases and an impairment of vasodilation responses.

Methods and Results—

BMP4 infusion by osmotic pumps increased systolic blood pressure in a time- and dose-dependent manner in both C57BL/6 mice (from 101 to 125 mm Hg) and apolipoprotein E–null mice (from 107 to 146 mm Hg) after 4 weeks. Cotreatment with the BMP antagonist noggin or the NADPH oxidase inhibitor apocynin completely blocked the BMP4 effect. In addition, BMP4 infusion stimulated aortic NADPH oxidase activity and impaired vasorelaxation, both of which were prevented either by coinfusing noggin or by treating the isolated aortas with apocynin. BMP4, however, did not cause significant changes in maximum relaxation induced by the endothelium-independent vasodilator nitroglycerin. Remarkably, BMP4 infusion failed to stimulate aortic NADPH oxidases, increase blood pressure, and impair vasodilation responses in p47phox-deficient mice.

Conclusions—

These results suggest that BMP4 infusion induces hypertension in mice in a vascular NADPH oxidase–dependent manner and the subsequent endothelial dysfunction. We suggest that BMP4 is a novel mediator of endothelial dysfunction and hypertension and that noggin and its analogs could be used as therapeutic agents for treating vascular diseases.
Matrix Metalloproteinase-7 Affects Connexin-43 Levels, Electrical Conduction, and Survival After Myocardial Infarction
Authors: Lindsey Merry L. , Escobar G. Patricia , Mukherjee Rupak , Goshorn Danielle K. , Sheats Nina J. , Bruce James A. , Mains I. Matthew , Hendrick Jennifer K. , Hewett Kenneth W. , Gourdie Robert G. , Matrisian Lynn M. , Spinale Francis G.
Published: June 2006

Background—

Matrix metalloproteinases (MMPs) contribute to left ventricular remodeling after myocardial infarction (MI). Specific causative roles of particular MMPs, however, remain unclear. MMP-7 is abundant in cardiomyocytes and macrophages, but MMP-7 function after MI has not been defined.

Methods and Results—

Wild-type (WT; n=55) and MMP-7–null (MMP-7
−/−
; n=32) mice underwent permanent coronary artery ligation for 7 days. MI sizes were similar, but survival was greatly improved in MMP-7
−/−
mice. The survival difference could not be attributed to differences in left ventricular dilation because end-diastolic volumes increased similarly. ECG analysis revealed a prolonged PR interval in WT but not in MMP-7
−/−
post-MI mice. Post-MI conduction velocity, determined by optically mapping electrical wavefront propagation, decreased to 78±6% of control for WT and was normalized in MMP-7
−/−
mice. In WT mice, slower conduction velocity correlated with a 53% reduction in the gap junction protein connexin-43. Direct binding of MMP-7 to connexin-43, determined by surface plasmon resonance technology, occurred in a dose-dependent manner. Connexin-43 processing by MMP-7 was confirmed by in silico and in vitro substrate analyses and MMP-7 infusion induced arrhythmias in vivo.

Conclusions—

MMP-7 deletion results in improved survival and myocardial conduction patterns after MI. This is the first report to implicate MMP-7 in post-MI remodeling and to demonstrate that connexin-43 is a novel MMP-7 substrate.
Prevalence, Predictors, and Outcomes of Premature Discontinuation of Thienopyridine Therapy After Drug-Eluting Stent Placement
Authors: Spertus John A. , Kettelkamp Richard , Vance Clifton , Decker Carole , Jones Philip G. , Rumsfeld John S. , Messenger John C. , Khanal Sanjaya , Peterson Eric D. , Bach Richard G. , Krumholz Harlan M. , Cohen David J.
Published: June 2006

Background—

Although drug-eluting stents (DES) significantly reduce restenosis, they require 3 to 6 months of thienopyridine therapy to prevent stent thrombosis. The rate and consequences of prematurely discontinuing thienopyridine therapy after DES placement for acute myocardial infarction (MI) are unknown.

Methods and Results—

We used prospectively collected data from a 19-center study of MI patients to examine the prevalence and predictors of thienopyridine discontinuation 30 days after DES treatment. We then compared the mortality and cardiac hospitalization rates for the next 11 months between those who stopped and those who continued thienopyridine therapy. Among 500 DES-treated MI patients who were discharged on thienopyridine therapy, 68 (13.6%) stopped therapy within 30 days. Those who stopped were older, less likely to have completed high school or be married, more likely to avoid health care because of cost, and more likely to have had preexisting cardiovascular disease or anemia at presentation. They were also less likely to have received discharge instructions about their medications or a cardiac rehabilitation referral. Patients who stopped thienopyridine therapy by 30 days were more likely to die during the next 11 months (7.5% versus 0.7%,
P
<0.0001; adjusted hazard ratio=9.0; 95% confidence interval=1.3 to 60.6) and to be rehospitalized (23% versus 14%,
P
=0.08; adjusted hazard ratio=1.5; 95% confidence interval=0.78 to 3.0).

Conclusions—

Almost 1 in 7 MI patients who received a DES were no longer taking thienopyridines by 30 days. Prematurely stopping thienopyridine therapy was strongly associated with subsequent mortality. Strategies to improve the use of thienopyridines are needed to optimize the outcomes of MI patients treated with DES.
Reduced Connexin43 Expression Limits Neointima Formation After Balloon Distension Injury in Hypercholesterolemic Mice
Authors: Chadjichristos Christos E. , Matter Christian M. , Roth Isabelle , Sutter Esther , Pelli Graziano , Lüscher Thomas F. , Chanson Marc , Kwak Brenda R.
Published: June 2006

Background—

Reducing the expression of the gap junction protein connexin43 (Cx43) inhibits the progression of atherosclerosis, a chronic inflammatory disease. Furthermore, acute vascular injury induced by percutaneous coronary interventions is associated with increased Cx43 expression in neointimal smooth muscle cells (SMCs). However, the relevance of Cx43 after acute vascular injury remains unclear.

Methods and Results—

To investigate whether reducing Cx43 expression would affect neointima formation in vivo, we subjected hypercholesterolemic Cx43
+/−
LDL receptor–deficient (LDLR
−/−
) mice and Cx43
+/+
LDLR
−/−
control littermates to carotid balloon distension injury, which induced marked endothelial denudation and activation of medial SMCs. We observed decreased macrophage infiltration in Cx43
+/−
LDLR
−/−
mice 7 days after injury. Similarly, peritoneal macrophages isolated from Cx43
+/−
LDLR
−/−
mice showed reduced migration in vitro compared with Cx43
+/+
LDLR
−/−
macrophages. Interestingly, Cx43
+/−
LDLR
−/−
macrophages also displayed decreased chemotactic activity for SMCs. In addition, we observed less SMC infiltration and proliferation in Cx43
+/−
LDLR
−/−
mice 7 and 14 days after balloon angioplasty. Likewise, Cx43
+/−
LDLR
−/−
SMCs showed decreased proliferation and migration in vitro compared with Cx43
+/+
LDLR
−/−
cells. All these events resulted in a reduction of neointimal thickening after vascular injury in Cx43
+/−
LDLR
−/−
mice.

Conclusions—

The present study shows for the first time that reducing Cx43 limits neointima formation after acute vascular injury by decreasing the inflammatory response and reducing SMC migration and proliferation. Thus, decreasing Cx43 expression may offer a novel therapeutic strategy for reducing restenosis after percutaneous coronary intervention.
Dynamic Gain Changes During Attentional Modulation
Authors: Sripati Arun P. , Johnson Kenneth O.
Published: June 2006

Attention causes a multiplicative effect on firing rates of cortical neurons without affecting their selectivity (Motter, 1993; McAdams & Maunsell, 1999a) or the relationship between the spike count mean and variance (McAdams & Maunsell, 1999b). We analyzed attentional modulation of the firing rates of 144 neurons in the secondary somatosensory cortex (SII) of two monkeys trained to switch their attention between a tactile pattern recognition task and a visual task. We found that neurons in SII cortex also undergo a predominantly multiplicative modulation in firing rates without affecting the ratio of variance to mean firing rate (i.e., the Fano factor). Furthermore, both additive and multiplicative components of attentional modulation varied dynamically during the stimulus presentation.

We then used a standard conductance-based integrate-and-fire model neuron to ascertain which mechanisms might account for a multiplicative increase in firing rate without affecting the Fano factor. Six mechanisms were identified as biophysically plausible ways that attention could modify the firing rate: spike threshold, firing rate adaptation, excitatory input synchrony, synchrony between all inputs, membrane leak resistance, and reset potential. Of these, only a change in spike threshold or in firing rate adaptation affected model firing rates in a manner compatible with the observed neural data. The results indicate that only a limited number of biophysical mechanisms can account for observed attentional modulation.
On the Analysis and Interpretation of Inhomogeneous Quadratic Forms as Receptive Fields
Authors: Berkes Pietro , Wiskott Laurenz
Published: June 2006

In this letter, we introduce some mathematical and numerical tools to analyze and interpret inhomogeneous quadratic forms. The resulting characterization is in some aspects similar to that given by experimental studies of cortical cells, making it particularly suitable for application to second-order approximations and theoretical models of physiological receptive fields. We first discuss two ways of analyzing a quadratic form by visualizing the coefficients of its quadratic and linear term directly and by considering the eigenvectors of its quadratic term. We then present an algorithm to compute the optimal excitatory and inhibitory stimuli—those that maximize and minimize the considered quadratic form, respectively, given a fixed energy constraint. The analysis of the optimal stimuli is completed by considering their invariances, which are the transformations to which the quadratic form is most insensitive, and by introducing a test to determine which of these are statistically significant. Next we propose a way to measure the relative contribution of the quadratic and linear term to the total output of the quadratic form. Furthermore, we derive simpler versions of the above techniques in the special case of a quadratic form without linear term. In the final part of the letter, we show that for each quadratic form, it is possible to build an equivalent two-layer neural network, which is compatible with (but more general than) related networks used in some recent articles and with the energy model of complex cells. We show that the neural network is unique only up to an arbitrary orthogonal transformation of the excitatory and inhibitory subunits in the first layer.
Comment on “Characterization of Subthreshold Voltage Fluctuations in Neuronal Membranes,” by M. Rudolph and A. Destexhe
Authors: Lindner Benjamin , Longtin André
Published: June 2006

In two recent articles, Rudolph and Destexhe (2003, 2005) studied a leaky integrator model (an RC-circuit) driven by correlated (“colored”) gaussian conductance noise and Gaussian current noise. In the first article, they derived an expression for the stationary probability density of the membrane voltage; in the second, they modified this expression to cover a larger parameter regime. Here we show by standard analysis of solvable limit cases (white noise limit of additive and multiplicative noise sources; only slow multiplicative noise; only additive noise) and by numerical simulations that their first result does not hold for the general colored-noise case and uncover the errors made in the derivation of a Fokker-Planck equation for the probability density. Furthermore, we demonstrate analytically (including an exact integral expression for the time-dependent mean value of the voltage) and by comparison to simulation results that the extended expression for the probability density works much better but still does not exactly solve the full colored-noise problem. We also show that at stronger synaptic input, the stationary mean value of the linear voltage model may diverge and give an exact condition relating the system parameters for which this takes place.
Implications of Neuronal Diversity on Population Coding
Authors: Shamir Maoz , Sompolinsky Haim
Published: June 2006

In many cortical and subcortical areas, neurons are known to modulate their average firing rate in response to certain external stimulus features. It is widely believed that information about the stimulus features is coded by a weighted average of the neural responses. Recent theoretical studies have shown that the information capacity of such a coding scheme is very limited in the presence of the experimentally observed pairwise correlations. However, central to the analysis of these studies was the assumption of a homogeneous population of neurons. Experimental findings show a considerable measure of heterogeneity in the response properties of different neurons.

In this study, we investigate the effect of neuronal heterogeneity on the information capacity of a correlated population of neurons. We show that information capacity of a heterogeneous network is not limited by the correlated noise, but scales linearly with the number of cells in the population. This information cannot be extracted by the population vector readout, whose accuracy is greatly suppressed by the correlated noise. On the other hand, we show that an optimal linear readout that takes into account the neuronal heterogeneity can extract most of this information. We study analytically the nature of the dependence of the optimal linear readout weights on the neuronal diversity. We show that simple online learning can generate readout weights with the appropriate dependence on the neuronal diversity, thereby yielding efficient readout.
Web-Based Historical City Walks: Advances and Bottlenecks
Authors: Zara Jiri
Published: June 2006

This paper deals with a set of useful methods for presenting large-scale models of real cities in a web environment. While acquisition issues are outlined only briefly, this study focuses on the optimal organization of city models and efficient rendering techniques. We also address data optimization for real-time delivery. The methods under discussion are illustrated by examples taken from several existing web presentations developed by our students, especially from the Virtual Old Prague project. Although the principles are general, specific attention is paid to the use of standards developed by the Web3D Consortium.
The Augurscope: Refining its Design
Authors: Schnädelbach Holger , Koleva Boriana , Paxton Mark , Twidale Mike , Benford Steve , Anastasi Rob
Published: June 2006

In this paper we explore the iterative design of the Augurscope, a mobile mixed reality device for open-air museum experiences. It allows a 3D virtual environment to be viewed as if overlaid on an outdoor physical environment. While exploring a heritage site, groups of visitors can experience simulated scenes from the past from a dynamic user-controlled viewpoint by moving, rotating, and tilting the device. The development focused on creating an interface to a visualization of a medieval castle as it used to appear in relation to its current, quite different site. We describe the development and application of the Augurscope through two iterative design stages. We discuss the issues revealed through public trials with the first prototype and how they informed the design of the Augurscope 2. The deployment of this second prototype then enables us to offer insights into what makes such a novel presentation device successful in an outdoor museum environment.
Physically Realistic Virtual Surgery Using the Point-Associated Finite Field (PAFF) Approach
Authors: De Suvranu , Lim Yi-Je , Manivannan Muniyandi , Srinivasan Mandayam A
Published: June 2006

The generation of multimodal virtual environments for surgical training is complicated by the necessity to develop heterogeneous simulation scenarios such as surgical incision, cauterization, bleeding, and smoke generation involving the interaction of surgical tools with soft biological tissues in real time. While several techniques ranging from rapid but nonphysical geometry-based procedures to complex but computationally inefficient finite element analysis schemes have been proposed, none is uniquely suited to solve the digital surgery problem. In this paper we discuss the challenges facing the field of realistic surgery simulation and present a novel point-associated finite field (PAFF) approach, developed specifically to cope with these challenges. Based upon the equations of motion dictated by physics, this technique is independent of the state of matter, geometry and material properties and permits different levels of detail. We propose several specializations of this scheme for various operational complexities. The accuracy and efficiency of this technique is compared with solutions using traditional finite element methods and simulation results are reported on segmented models obtained from the Visible Human Project.
Key Issues for AR-Based Digital Reconstruction of Yuanmingyuan Garden
Authors: Liu Yue , Wang Yongtian , Li Yu , Lei Jinchao , Lin Liang
Published: June 2006

Yuanmingyuan was called “Garden of All Gardens” before it was looted and burnt down by the Anglo-French allied forces in 1860. Nowadays there are only stone ruins that used to be parts of ancient buildings. The Digital Yuanmingyuan project is designed to provide visitors with the visualization of virtual reconstructions superimposed upon the natural field of the ruins using a personal AR (Augmented Reality) system. It can not only preserve the current appearance of the ruins, but also exhibit the original exquisite architecture of Yuanmingyuan. The technical difficulties of the system are analyzed, and the design of the system hardware and the tracking algorithm are discussed. A prototype of the proposed system is developed and the initial result of restoring one typical scene in Yuanmingyuan is presented.
A Study of Certified Diabetes Educators
Authors: Funnell Martha M. , Anderson Robert M. , Nwankwo Robin , Gillard Mary Lou , Butler Patricia M. , Fitzgerald James T. , Feathers Jackie Two
Published: June 2006

Purpose

There were 2 related goals for this study. The first purpose was to describe the structure (type, staffing, and number of educational sessions provided), process (preferred learning approaches), and outcome measures commonly used to provide patient education. The second purpose was to identify the influences, resources, and constraints that affect and alter the attitudes and practices of diabetes educators.

Methods

A 30-item questionnaire that addressed 4 areas— demographics, practice characteristics, education program structure, and educational processes—was mailed to a sample of American Association of Diabetes Educators members. Three hundred sixty-one registered nurse and registered dietician certified diabetes educators completed the questionnaire and were included in the final analysis.

Results

This survey indicated that this group of certified diabetes educators has incorporated new research findings and innovative teaching methods into their practices. They experience few barriers and tend to make changes in their attitudes and practices based on scientific and experiential evidence. The 3 most highly rated influences on these changes were related to patient responses to their teaching, followed by continuing education conferences and new research findings.

Conclusions

Based on these findings, providing continuing education that first and foremost incorporates experience-based examples of effective strategies supported by research published in professional journals appears to have the most influence on the practice of educators.
Exercise for Low-Income Patients With Diabetes
Authors: Boyd Steven T. , Scott David M. , Augustine Sam C.
Published: June 2006

Purpose

The specific aim of this project was to form a partnership between a community health center (CHC) to improve access to exercise for low-income patients with type 2 diabetes.

Methods

Eligible participants were members of the Siouxland Community Health Center (SCHC), 19 years of age or older, with a diagnosis of type 2 diabetes. Patients were medically waived and received an invitation to exercise at the Siouxland YMCA. An exercise coach (pharmacist, registered nurse, or medical assistant) met with each patient and scheduled and conducted exercise visits for participating patients 2 times each week. Patients’ baseline clinical variables were taken and assessed quarterly over a 12-month period.

Results

This collaboration established an ongoing exercise program with a total of 1297 exercise encounters in a 12-month period. Forty-eight of 130 eligible patients (36.9%) visited theYMCA on at least 1 occasion. Patients were categorized as experimental (56.3%), involved (25%), and regular (18.8%) exercisers. Nine (18.8%) of the 48 patients attended supplementary YMCA exercise encounters. Five (11%) of the 48 patients renewed and purchased a membership at the YMCA and adopted a self-management approach to regular exercise.

Conclusion

The creation of a partnership between a community health center and an exercise organization permitted disadvantaged patients with diabetes an affordable exercise program and contributed to improved clinical measurements. The exercise program can be used as a model for other community health centers and health professionals who desire to improve the implementation of an exercise program for patients with diabetes.
Improving Hyperglycemia Management in the Intensive Care Unit
Authors: Osburne Robert C. , Cook Curtiss B. , Stockton Lawrence , Baird Marianne , Harmon Valerie , Keddo Annie , Pounds Teresa , Lowey Linda , Reid Joyce , McGowan Kathryn A. , Davidson Paul C.
Published: June 2006

Purpose

The purpose of this study was to assess the feasibility of a nurse-driven effort to improve hyperglycemia management in the intensive care unit (ICU) setting.

Methods

The setting was the ICU of a large urban hospital. The program was composed of 3 components: nurses as leaders, a clinical pathway to identify patients in need of hyperglycemia therapy, and implementation of a redesigned insulin infusion algorithm (the Columnar Insulin Dosing Chart). Time to reach a target glucose range of 80 to 110 mg/dL (4.4-6.1 mmol/L) was evaluated.

Results

One hundred sixteen ICU nurses were trained in the project. The Columnar Insulin Dosing Chart was applied to 20 patients. The average time required to reach the target blood glucose range was 12.8 hours. Below-target blood glucose levels were 6.9% of all blood glucose levels recorded, but only 0.9% were below 60 mg/dL (3.3 mmol/L). There was no sustained hypoglycemia, and no persistent clinical findings attributable to hypoglycemia were noted. Barriers to implementing the project included an increased nursing workload, the need for more finger-stick blood glucose monitors, and the need to acquire new finger-lancing devices that allowed for shallower skin puncture and increased patient comfort.

Conclusions

Tighter glycemic control goals can be attained in a busy ICU by a nurse-led team using a pathway for identifying and treating hyperglycemia, clear decision support tools, and adequate nurse education. The novel chart based insulin infusion algorithm chosen as the standard for this pilot was an effective tool for reducing the blood glucose to target range with no clinically significant hypoglycemia.
Physiologic Insulin Replacement in Type 2 Diabetes
Authors: Robertson Carolyn
Published: June 2006

Purpose

The purpose of this article is to review physiologic insulin replacement using a basal-prandial approach and focus on the role of postprandial glucose control. In addition, therapeutic options for optimizing glycemic control are described, including diabetes education, currently available agents, treatment regimens, and strategies.

Methods

This article reviews the benefits of treating with a basal-prandial insulin approach and focuses on post prandial glucose-targeted therapies, including rapid- acting insulin analogs.

Results

Data from landmark clinical trials in type 2 diabetes suggest that intensive glycemic control can reduce the frequency and severity of diabetes complications. A basal-prandial insulin regimen combines a long-acting insulin analog with a rapid-acting insulin to mimic normal physiologic insulin secretion, providing a flexible tool to enhance patient self-management.

Conclusions

Strategies that include patient education, improved health care provider/patient communication, and basal-prandial insulin treatment can help patients achieve good glycemic control. The optimal setting for successful diabetes treatment is a team approach with the health care provider, nurse/certified diabetes educator, and patient as essential members.
Youth WAVE Screener
Authors: Isasi Carmen R. , Soroudi Nafisseh , Wylie-Rosett Judith
Published: June 2006

Purpose

This study evaluated the feasibility of using the youth Weight, Activity, Variety, and Excess (WAVE) screener in a classroom setting for assessing student weight control intentions and the extent to which they used the WAVE strategies to control their weight.

Methods

The Youth WAVE Screener was administered to fifth-grade students in an inner-city school located in the Bronx, New York. The study was conducted in part to increase student awareness of snack foods and sugary beverages in relation to weight.

Results

Of the 169 students who completed the survey, 45.5% (n = 77) were trying to lose weight. Students who were trying to lose weight were more likely to have low-fat dairy products, less likely to have sugary beverages, and less likely to eat junk foods than those who were not trying to lose weight. Students who reported exercising 3 times weekly were more likely to report healthier dietary patterns and less sedentary behaviors than were students who exercise less often. Feedback and dialogue with fifth graders addressed the relationship between TV viewing and eating behavior, advertisement, availability, and preferences of fruits and vegetables.

Conclusions

The Youth WAVE Screener can be used to quickly identify children who are concerned about their weight as well as those with dietary and physical activity patterns that may increase the risk of obesity. Diabetes educators can use this screener to start a dialogue with children about their weight-related behaviors.
Fostering Organizational Change Through a Community-Based Initiative
Authors: Kaplan Sue A. , Calman Neil S. , Golub Maxine , Ruddock Charmaine , Billings John
Published: June 2006

Program funders and managers are increasingly interested in fostering changes in the policies, practices, and procedures of organizations participating in community-based initiatives. But little is known about what factors contribute to the institutionalization of change. In this study, the authors assess whether the organizational members of the Bronx Health REACH Coalition have begun to change their functioning and role with regard to their clients and their staff and in the broader community, apart from their implementation of the funded programs for which they are responsible. The study identifies factors that seemed to contribute to or hinder such institutional change and suggests several strategies for coalitions and funders that are seeking to promote and sustain organizational change.
Community-Based Strategies to Reduce Childhood Immunization Disparities
Authors: Findley Sally E. , Irigoyen Matilde , Sanchez Martha , Guzman Letty , Mejia Miriam , Sajous Michelle , Levine Deborah A. , Chen Shaofu , Chimkin Frank
Published: June 2006

This study demonstrates how community-based immunization promotion reduced immunization disparities. In 2002 to 2004, the coalition enrolled 3,748 children younger than 5, with 1,502 aged 19 to 35 months in April 2004. Disparity reduction was assessed by comparing coalition immunization coverage rates (4:3:1:3:3) to the National Immunization Survey 2003 rates. Logistic regression was used to assess factors contributing to up-to-date immunizations. Coverage increased from 46.0% at enrollment to 80.5%, matching nationwide rates for all (t = 0.87) or White (t = 1.99) children. The 78% for African Americans was higher than 73% for U.S. African American children (t = 2.90); 84% for Latinos was higher than 77% for U.S. Latinos (t = 2.32). Being current with age-appropriate immunizations at enrollment (OR = 9.8), being Latino (OR = 1.6), and participating through child health insurance enrollment (OR = 4.9), Women, Infants, and Children (OR = 3.1), or child care or parenting (OR = 1.9) programs increased immunization coverage. Embedding immunization promotion into existing community programs was successful in eliminating immunization disparities. Most effective programs were those with direct linkages to health care systems or that targeted young children.
Teaching Cultural Competence to Reduce Health Disparities
Authors: Selig Suzanne , Tropiano Elizabeth , Greene-Moton Ella
Published: June 2006

As part of the Genesee County, Michigan, REACH 2010 initiative, a new course, Cultural Competence in Health Care, was developed at the University of Michigan-Flint. The objective of this course is to improve the cultural competence of future health and human service providers and to reduce persistent racial and ethnic health disparities. This article describes the course and the important role that REACH 2010 partners played in its development and implementation. Course materials, methods, and student feedback are summarized, along with lessons learned.
Chronic Disease – Related Behaviors and Health Among African Americans and Hispanics in the REACH Detroit 2010 Communities, Michigan, and the United States
Authors: Kieffer Edith C. , Sinco Brandy R. , Rafferty Ann , Spencer Michael S. , Palmisano Gloria , Watt Earl E. , Heisler Michele
Published: June 2006

Objectives: To compare chronic disease risk factors and their correlates for African American and Hispanic residents of REACH Detroit, Michigan, and the United States. Method: Behavioral Risk Factor Survey data from 2001-2003 were used for comparisons and regression models. Results: Several chronic disease risk factors were more prevalent among REACH Detroit residents than their Michigan and U.S. counterparts. In REACH Detroit, greater fruit and vegetable consumption was associated with more than high school education and older age among Hispanics, and meeting exercise guidelines and older age among African Americans. Less than high school education, smoking, and male gender were associated with lower consumption among African Americans. Greater physical activity was associated with younger age, male gender, and more fruit and vegetable consumption among African Americans, and unemployment among Hispanics. Conclusions: Surveillance of health behaviors in high-risk communities contributes to planning interventions and policies for reducing racial and ethnic disparities.
Using Community-Based Participatory Research to Address Health Disparities
Authors: Wallerstein Nina B. , Duran Bonnie
Published: June 2006

Community-based participatory research (CBPR) has emerged in the past decades as an alternative research paradigm, which integrates education and social action to improve health and reduce health disparities. More than a set of research methods, CBPR is an orientation to research that focuses on relationships between academic and community partners, with principles of colearning, mutual benefit, and long-term commitment and incorporates community theories, participation, and practices into the research efforts. As CBPR matures, tensions have become recognized that challenge the mutuality of the research relationship, including issues of power, privilege, participation, community consent, racial and/or ethnic discrimination, and the role of research in social change. This article focuses on these challenges as a dynamic and ever-changing context of the researcher-community relationship, provides examples of these paradoxes from work in tribal communities, discusses the evidence that CBPR reduces disparities, and recommends transforming the culture of academia to strengthen collaborative research relationships.
Obvious and Not-So-Obvious Strategies to Disseminate Research
Authors: Fullilove Mindy Thompson , Green Lesley L. , Hernández-Cordero Lourdes J. , Fullilove Robert E.
Published: June 2006

The findings of health disparities research will have to be disseminated to a broad public in order to influence health outcomes. Some strategies for dissemination are obvious, and these generally work for ideas that are within the mainstream of current paradigms. However, ideas that challenge existing theories and assumptions may require different, and not-so-obvious, strategies. This article discusses the use of movies and site visits as two novel strategies for research dissemination.
A Transdisciplinary Approach to Improve Health Literacy and Reduce Disparities
Authors: Lloyd Linda L. Johnston , Ammary Neyal J. , Epstein Leonard G. , Johnson Rae , Rhee Kyu
Published: June 2006

A challenge to public health professionals, health care providers, and consumers is to come together to improve the quality of health care and to eliminate disparities. Improving health literacy skills along with a transdisciplinary approach to care contributes to effective patient-provider communication. This article addresses a team approach to health care, a community health center experience, self-management skills, patient education, and cultural competency training. In addition, the authors provide concepts that can be incorporated in health care settings to eliminate health disparities and improve health literacy.
Historical and Current Policy Efforts to Eliminate Racial and Ethnic Health Disparities in the United States: Future Opportunities for Public Health Education Research
Authors: Thomas Stephen B. , Benjamin Georges C. , Almario Donna , Lathan Monica J.
Published: June 2006

In the summer of 2005, the Society for Public Health Education convened a meeting, Health Disparities and Social Inequities, with the task of setting the minority health disparities research agenda for public health educators. The article provides a history of minority health efforts beginning with the Negro Health Improvement Week in 1915 and an overview of National Institutes of Health’s (NIH) current 5-year strategic research plan to eliminate health disparities. The plan’s goals represent a significant investment in minority health research and the emergence of NIH as the leading federal agency funding health disparity research. Understanding the history of minority health efforts and current health disparity research offers a perspective that will help guide public health educators in reaching the Healthy People 2010 goal of eliminating racial and ethnic health disparities.
The Inaugural SOPHE Summit on Eliminating Racial and Ethnic Health Disparities
Authors: Airhihenbuwa Collins O.
Published: June 2006

As we break the 20-year mark for the release of the 1985 Secretary’s Task Force Report on Black and Minority Health by the Department of Health and Human Services, the disparity gap measured by excess death has widened. Although we continue to recognize the importance of setting disparity goals based on excess death reduction, we believe there is a greater need to focus on the social contexts that create vulnerability to disease from which minorities die in disproportionate numbers. This theme issue focuses on articles written mostly by scholars who were invited to participate at the Society for Public Health Education (SOPHE) inaugural summit to develop a transdisciplinary research agenda on eliminating racial and ethnic health disparities.
Mentoring: A Framework for Developing Health Disparities Researchers
Authors: Green B. Lee , Rivers Brian M. , Arekere Dhananjaya M.
Published: June 2006

Health disparities have been conceptualized as being the result of a confluence of factors: environmental, social, biological, economic, and cultural to name a few. Given the increasingly deleterious impact of health disparities on the lives of all Americans, new research methodological research approaches are needed to adequately understand and address the component parts of health disparities. To effectively address health disparities, an increased focus is needed on implementing transdisciplinary approaches to health disparities research. One approach is to focus on mentoring young investigators and students. This article discusses the centrality of mentoring in developing young health disparities researchers. An overview of health disparities research and researchers, and a summary of the different aspects of mentoring are provided. In addition, a case study of the implementation of a transdisciplinary mentoring framework at a higher education institution is presented.
What Will It Take to Close the Racial and Ethnic Health Disparities Gap? A Conversation With Michael E. Bird, Reed Tuckson, and Marilyn Aguirre-Molina
Authors: Head Carmen J. , Lathan Monica J.
Published: June 2006

In the United States, the health of a community is often times determined by poverty and race. As the nation becomes more racially and ethnically diverse, new directives and approaches must be taken to improve health outcomes of minority and underserved communities. Three leading experts in racial and ethnic health share their perspectives regarding where we are and where we need to be in addressing health disparities. Michael E. Bird, MSW, MPH, Reed Tuckson, MPH, and Marilyn Aguirre-Molina, EdD, offer transdisciplinary-focused recommendations that encompass disease prevention, health care, and community mobilization.
Therapeutic bronchoscopy with immediate effect: laser, electrocautery, argon plasma coagulation and stents
Authors: Bolliger C. T. , Sutedja T. G. , Strausz J. , Freitag L.
Published: June 2006

Minimally invasive diagnostic and therapeutic approaches in medicine have been applied for a more selective and tailored approach to reduce patients' morbidity and mortality. The efficacy of interventional pulmonology for palliation of patients with central airways obstruction has been established and its curative potential for intralesional treatment of early cancer has raised great interest in current screening programmes.

This is due to the fact that surgical resection and systemic nodal dissection as the gold standard is relatively morbid and risky, especially when dealing with individuals with limited functional reserves due to smoking-related comorbidities, such as chronic obstructive pulmonary disease. Furthermore, such comorbidities have been proven to harbour early stage lesions of several millimetres in size without involvement of nodal disease that may be amenable to local bronchoscopic treatment.

Therefore, the success of minimally invasive strategies for palliation and treatment with curative intent strongly depends on the diligent identification of the various factors in lung cancer management, including full comprehension of the limits and potential of each particular technique. Maximal preservation of quality of life is a prerequisite in successfully dealing with individuals at risk of harbouring asymptomatic early lung cancer, to prevent aggressive surgical diagnostic and therapeutic strategies since overdiagnosis remains an issue that is heavily debated.

In the palliative setting of alleviating central airway obstruction, laser resection, electrocautery, argon plasma coagulation and stenting are techniques that can provide immediate relief, in contrast to cryotherapy, brachytherapy and photodynamic therapy with delayed effects. With curative intent, intraluminal techniques that easily coagulate early stage cancer lesions will increase the implementation of interventional pulmonology for benign and relatively benign diseases, as well as early cancer lesions and its precursors at their earliest stage of disease.
Adult pulmonary Langerhans’ cell histiocytosis
Authors: Tazi A.
Published: June 2006

Adult pulmonary Langerhans’ cell histiocytosis is a rare disorder of unknown aetiology that occurs predominantly in young smokers, with an incidence peak at 20–40 yrs of age. In adults, pulmonary involvement with Langerhans’ cell histiocytosis usually occurs as a single-system disease and is characterised by focal Langerhans’ cell granulomas infiltrating and destroying distal bronchioles.

High-resolution computed tomography (HRCT) of the chest is essential to the diagnosis, typically showing a combination of nodules, cavitated nodules, and thick- and thin-walled cysts. A high macrophage count in bronchoalveolar lavage (BAL) fluid is a common but nonspecific finding that merely reflects exposure to tobacco smoke. BAL is useful for eliminating infections and the other infiltrating lung disorders that can be seen in young adults. Langerhans’ cells can be identified in BAL fluid, but, in contrast to what was initially hoped, this test shows a very low sensitivity and is rarely useful in the diagnosis of the disease.

The definite diagnosis of pulmonary Langerhans’ cell histiocytosis requires identification of Langerhans’ cell granulomas, which is usually achieved by surgical lung biopsy at a site selected by chest HRCT. In practice, however, lung biopsy is performed on a case-by-case basis.

No effective treatment is available to date, and improved understanding of the mechanisms involved in the pathogenesis of pulmonary Langerhans’ cell histiocytosis is urgently needed, and should help in the development of specific therapeutic strategies for patients with this orphan disease.
Endothelial, inducible and neuronal nitric oxide synthase in congenital pulmonary lymphangiectasis
Authors: Hoehn T. , William M. , McPhaden A. R. , Stannigel H. , Mayatepek E. , Wadsworth R. M.
Published: June 2006

Abnormal growth and development of lymphatic pulmonary structures leads to severe hypoxia in congenital pulmonary lymphangiectasis (CPL).

This case study aims to determine the cellular source and topographical distribution of the nitric oxide synthases in CPL. It studies thepost mortemtissue of a term newborn with the clinical course and histological findings of CPL and three controls without pulmonary pathology.

It was found that endothelial cells of pulmonary arteries and lymphatic structures stained significantly more for endothelial nitric oxide synthase protein in the CPL patient compared to the controls.

The authors conclude that synthesis of endothelial nitric oxide synthase is upregulated in vascular and lymphatic endothelial cells in congenital pulmonary lymphangiectasis.