bluuebunny/crossref_metadata_2025 huggingface dataset:
The SKP2 E3 ligase regulates basal homeostasis and stress-induced regeneration of HSCs
Authors: Rodriguez Sonia , Wang Lin , Mumaw Christen , Srour Edward F. , Lo Celso Cristina , Nakayama Kei-ichi , Carlesso Nadia
Published: April 2011

Exit from quiescence and reentry into cell cycle is essential for HSC self-renewal and regeneration. Skp2 is the F-box unit of the SCF E3-ligase that targets the CDK inhibitors (CKIs) p21Cip1, p27Kip1, p57Kip2, and p130 for degradation. These CKIs inhibit the G1 to S-phase transition of the cell cycle, and their deletion results in increased cell proliferation and decreased stem cell self-renewal. Skp2 deletion leads to CKIs stabilization inducing cell-cycle delay or arrest, and conversely, increased Skp2 expression is often found in cancers. Here, we show that SKP2 expression is increased in HSC and progenitors in response to hematopoietic stress from myelosuppression or after transplantation. At steady state, SKP2 deletion decreased the mitotic activity of HSC and progenitors resulting in enhanced HSC quiescence, increased HSC pool size, and maintenance. However, the inability to rapidly enter cell cycle greatly impaired the short-term repopulating potential of SKP2 null HSC and their ability to regenerate after myeloablative stress. Mechanistically, deletion of SKP2 in HSC and progenitors stabilized CKIs in vivo, particularly p27Kip1, p57Kip2, and p130. Our results demonstrate a previously unrecognized role for SKP2 in regulating HSC and progenitor expansion and hematopoietic regeneration after stress.
Idiopathic CD4+ T lymphopenia without autoimmunity or granulomatous disease in the slipstream of RAG mutations
Authors: Kuijpers Taco W. , IJspeert Hanna , van Leeuwen Ester M. M. , Jansen Machiel H. , Hazenberg Mette D. , Weijer Kees C. , van Lier Rene A. W. , van der Burg Mirjam
Published: April 2011

A girl presented during childhood with a single course of extensive chickenpox and moderate albeit recurrent pneumonia in the presence of idiopathic CD4+ T lymphocytopenia (ICL). Her clinical condition remained stable over the past 10 years without infections, any granulomatous disease, or autoimmunity. Immunophenotyping demonstrated strongly reduced naive T and B cells with intact proliferative capacity. Antibody reactivity on in vivo immunizations was normal. T-cell receptor-Vβ repertoire was polyclonal with a very low content of T-cell receptor excision circles (TRECs). Kappa-deleting recombination excision circles (KRECs) were also abnormal in the B cells. Both reflect extensive in vivo proliferation. Patient-derived CD34+ hematopoietic stem cells could not repopulate RAG2−/−IL2Rγc−/− mice, indicating the lymphoid origin of the defect. We identified 2 novel missense mutations in RAG1 (p.Arg474Cys and p.Leu506Phe) resulting in reduced RAG activity. This report gives the first genetic clue for ICL and extends the clinical spectrum of RAG mutations from severe immune defects to an almost normal condition.
Randomized Phase II Study of Bevacizumab in Combination With Chemotherapy in Previously Untreated Extensive-Stage Small-Cell Lung Cancer: Results From the SALUTE Trial
Authors: Spigel David R. , Townley Peter M. , Waterhouse David M. , Fang Liang , Adiguzel Ibrahim , Huang Jane E. , Karlin David A. , Faoro Leonardo , Scappaticci Frank A. , Socinski Mark A.
Published: April 2011

Purpose

Because of promising efficacy signals in single-arm studies, a placebo-controlled, double-blind, randomized phase II trial was designed to assess the efficacy and safety of adding bevacizumab to first-line standard chemotherapy for treatment of extensive-stage small-cell lung cancer (SCLC).

Patients and Methods

Patients with SCLC were randomly assigned to receive bevacizumab or placebo, with cisplatin or carboplatin plus etoposide, for four cycles followed by single-agent bevacizumab or placebo until progression or unacceptable toxicity. The primary end point was progression-free survival (PFS).

Results

Fifty-two patients were randomly assigned to the bevacizumab group and 50 to the placebo group; 69% versus 66%, respectively, completed four cycles of therapy. Median PFS was higher in the bevacizumab group (5.5 months) than in the placebo group (4.4 months; hazard ratio [HR], 0.53; 95% CI, 0.32 to 0.86). Median overall survival (OS) was similar for both groups (9.4 v 10.9 months for bevacizumab and placebo groups, respectively), with an HR of 1.16 (95% CI, 0.66 to 2.04). Overall response rates were 58% (95% CI, 43% to 71%) for the bevacizumab group and 48% (95% CI, 34% to 62%) for the placebo group. Median duration of response was 4.7 months for the bevacizumab group and 3.2 months for the placebo group. In the bevacizumab and placebo groups, 75% versus 60% of patients, respectively, experienced one or more grade 3 or higher adverse events. No new or unexpected safety signals for bevacizumab were observed.

Conclusion

The addition of bevacizumab to cisplatin or carboplatin plus etoposide for treatment of extensive-stage SCLC improved PFS, with an acceptable toxicity profile. However, no improvement in OS was observed.
International Phase III Trial Assessing Neoadjuvant Cisplatin, Methotrexate, and Vinblastine Chemotherapy for Muscle-Invasive Bladder Cancer: Long-Term Results of the BA06 30894 Trial
Authors:   International Collaboration of Trialists on behalf of the Medical Research Council Advanced Bladder Cancer Working Party (now the National Cancer Research Institute Bladder Cancer Clinical Studies Group), the European Organisation for Research and Treatment of Cancer Genito-Urinary Tract Cancer Group, the Australian Bladder Cancer Study Group, the National Cancer Institute of Canada Clinical Trials Group, Finnbladder, Norwegian Bladder Cancer Study Group, and Club Urologico Espanol de Tratamiento Oncologic
Published: April 2011

Purpose

This article presents the long-term results of the international multicenter randomized trial that investigated the use of neoadjuvant cisplatin, methotrexate, and vinblastine (CMV) chemotherapy in patients with muscle-invasive urothelial cancer of the bladder treated by cystectomy and/or radiotherapy. Nine hundred seventy-six patients were recruited between 1989 and 1995, and median follow-up is now 8.0 years.

Patients and Methods

This was a randomized phase III trial of either no neoadjuvant chemotherapy or three cycles of CMV.

Results

The previously reported possible survival advantage of CMV is now statistically significant at the 5% level. Results show a statistically significant 16% reduction in the risk of death (hazard ratio, 0.84; 95% CI, 0.72 to 0.99; P = .037, corresponding to an increase in 10-year survival from 30% to 36%) after CMV.

Conclusion

We conclude that CMV chemotherapy improves outcome as first-line adjunctive treatment for invasive bladder cancer. Two large randomized trials (by the Medical Research Council/European Organisation for Research and Treatment of Cancer and Southwest Oncology Group) have confirmed a statistically significant and clinically relevant survival benefit, and neoadjuvant chemotherapy followed by definitive local therapy should be viewed as state of the art, as compared with cystectomy or radiotherapy alone, for deeply invasive bladder cancer.
Bankruptcy, Finance Constraints, and the Value of the Firm
Authors: Gale Douglas , Gottardi Piero
Published: April 2011

We study a competitive model in which market incompleteness implies that debt-financed firms may default in some states of nature, and default may lead to the sale of the firms' assets at fire sale prices when a finance constraint is binding. The anticipation of such “losses” alone may distort firms' investment decisions. We characterize the conditions under which fire sales occur in equilibrium, and their consequences on firms' investment decisions. We also show that endogenous financial crises may arise in this environment, with asset prices collapsing as a result of pure self-fulfilling beliefs. Finally, we examine alternative interventions to restore the efficiency of equilibria. (JEL D83, G31, G32, G33)
Concordance between thyroglobulin antibody assays
Authors: Taylor Kevin P , Parkington Damon , Bradbury Sonia , Simpson Helen L , Jefferies Sarah J , Halsall David J
Published: April 2011

Background

Antithyroglobulin antibodies are a prevalent cause of interference in serum thyroglobulin immunoassays. Current guidelines recommend that antithyroglobulin antibodies should be measured concurrently with thyroglobulin when monitoring thyroid cancer patients post‐thyroidectomy. However, the concordance between different antithyroglobulin assays has been questioned despite the availability of an international thyroglobulin antibody Reference Preparation.

Methods

Four antithyroglobulin assays currently in use in UK laboratories (Siemens Immulite®, Brahms GmbH, PerkinElmer AutoDELFIA and Siemens ADVIA Centaur®) were compared in a cohort of 145 thyroid cancer patients.

Results

Using reference data provided by the kit manufacturer, concordance between the assays was 74%. Adjusting the cut-offs to maximize agreement increased concordance to 90%. Recovery of exogenous thyroglobulin using the Brahms Tg-plus immunoradiometric assay was neither a specific nor a sensitive test for the presence of a positive antibody result by any assay.

Conclusions

Despite the availability of an international reference preparation, current antithyroglobulin assays show unacceptable variance.
Studies on electrooxidation of lignin and lignin model compounds. Part 1: Direct electrooxidation of non-phenolic lignin model compounds
Authors: Shiraishi Takumi , Takano Toshiyuki , Kamitakahara Hiroshi , Nakatsubo Fumiaki
Published: April 2011

The direct anodic oxidation of non-phenolic lignin model compounds was investigated to understand their basic behaviors. The results of cyclic voltammetry (CV) studies of monomeric model, such as 1-(4-ethoxy-3-methoxyphenyl)ethanol, are interpreted as the oxidation for Cα-carbonylation did not proceed in the reaction without a catalyst, but a base promotes this reaction. Indeed, the bulk electrolyses of the monomeric lignin model compounds with 2,6-lutidine afforded the corresponding Cα-carbonyl compounds in high yields (60–80%). It is suggested that deprotonation at Cα-H in the ECEC mechanism (E=electron transfer and C=chemical step) is important for Cα-carbonylation. In the uncatalyzed bulk electrolysis of a β-O-4 model dimeric compound, 4-ethoxy-3-methoxyphenylglycerol-β-guaiacyl ether, the corresponding Cα-carbonyl compound was not detected but as a result of Cα-Cβcleavage 4-O-ethylvanillin was found in 40% yield. In the electrolysis reaction in the presence of 2,6-lutidine (as a sterically hindered light base), the reaction stopped for a short time unexpectedly. These results indicate the different electrochemical behavior of simple monomeric model compounds and dimeric β-O-4 models. The conclusion is that direct electrooxidation is unsuitable for Cα-carbonylation of lignin.
Modeling of Dispersion and Settling of Micron-Sized Dust Particles in Pressure Regulator Used in Oxygen-Enriched Environment
Authors: Oza Aditi , Ghosh Sudipto , Chowdhury Kanchan
Published: April 2011

It is essential to maintain cleanliness in an oxygen system as many accidents occurring in oxygen-enriched environment indicate contamination as a major source of ignition. Computational fluid dynamics (CFD) analyses show that valve seats, T-joints, elbows and spots with complex geometries are possible locations for accumulation of the dust particles. It is important to understand the mechanisms of contaminant accumulation, the initiation of fire and its propagation in valves and regulators in order to suggest ways for their prevention. As contaminant dust particles flow with oxygen through valves and piping systems, the solid dust particles impact or rub with the pipe wall or with each other. This results in the building up of static electric charges in them. These charged dust particles may eventually accumulate and lead to electrostatic discharge, thus creating a potential cause of initiation of fire. The aim of the present work is to develop a mathematical model based on CFD, of the dispersion and settling of micron-sized charged dust particles in the pressure regulator, commonly used in oxygen application. A two-dimensional numerical model of flow, dust particle dispersion and particle settling, utilizing finite volume approach, has been developed on FLUENT 6.3.26 platform. The results show that there is a possibility of electrical discharge due to the settlement of charged dust particles if a regulator is attempted to be reopened within a short time of it being closed. Since it is practically impossible to make all oxygen systems free of contaminants at all times, it may be worthwhile to analyze ways about how to avoid ignition even in presence of large concentration of dust particles. The present study may give an insight into the possibility of ignition and offer suggestions to avoid it through appropriate system configuration and operation timings.
Outcome in surgically treated Rathke's cleft cysts: long-term monitoring needed
Authors: Trifanescu R , Stavrinides V , Plaha P , Cudlip S , Byrne J V , Ansorge O , Wass J A H , Karavitaki N
Published: April 2011

Objective

To clarify the outcome of all cases of Rathke's cleft cysts (RCC) treated surgically and followed up in Oxford during a long-term period.

Subjects and methods

The records of all patients with RCC seen in the Department of Endocrinology between January 1978 and June 2009 were reviewed.

Results

A total of 33 patients (20 females, median age 43 years) were identified. At presentation, major visual field defects were detected in 58% of patients and gonadotrophin, ACTH and TSH deficiency in 60, 36 and 36% of patients respectively. Desmopressin treatment was required in 18% of patients. Treatment consisted of cyst evacuation combined with or without biopsy/removal of the wall. Post-operatively, visual fields improved in 83% of patients with impairment, whereas there was no reversal of ACTH or TSH deficiency or of diabetes insipidus. All but one subject had imaging follow-up during a mean period of 48 months (range 2–267). Cyst relapse was detected in 22% of patients at a mean interval of 29 months (range 3–48 months); in 57% of them, the recurrence was symptomatic. Relapse-free rates were 88% at 24-months and 52% at 48-months follow-up. At last assessment, at least quadrantanopia was reported in 19% of patients, gonadotrophin, ACTH and TSH deficiency in 50, 42 and 47% of patients respectively. Desmopressin treatment was required in 39% of patients.

Conclusions

In this study of patients with RCC and long-term follow-up, we showed a considerable relapse rate necessitating long-term monitoring. Surgical intervention is of major importance for the restoration of visual field defects, but it does not improve endocrine morbidity, which in the long-term affects a substantial number of patients.
Hypothalamic involvement and insufficient sex steroid supplementation are associated with low bone mineral density in women with childhood onset craniopharyngioma
Authors: Holmer Helene , Popovic Vera , Ekman Bertil , Follin Cecilia , Siversson Ann Britt , Erfurth Eva Marie
Published: April 2011

Context

Data on bone mineral density (BMD) are lacking in adults with childhood onset (CO)–craniopharyngioma (CP) with hypothalamic damage from the tumor. In patients with CO GH deficiency, BMD increases during GH treatment.

Objective

The aims were to evaluate BMD in adults with CO–CPs on complete hormone replacement, including long-term GH and to evaluate the impact of hypothalamic damage on these measures.

Design and participants

BMD (dual-energy X-ray absorptiometry), markers of bone turn over, physical activity and calcium intake were assessed in 39 CO–CP adults (20 women), with a median age of 28 (17–57) years, in comparison with matched population controls.

Results

Late puberty induction was recorded in both genders, but reduced androgen levels in females only. Only CP women had lower BMD (P=0.03) at L2–L4, and reduced Z-scores at femoral neck (P=0.004) and L2–L4 (P=0.004). Both genders had increased serum leptin levels (P=0.001), which significantly correlated negatively with BMD at L2–L4 (P=0.003; r=−0.5) and 45% of CP women had Z-score levels ≤−2.0 s.d. Furthermore, 75% of those with a Z-score ≤−2.0 s.d. had hypothalamic involvement by the tumor. Calcium intake (P=0.008) and physical activity (P=0.007) levels were reduced in CP men only. Levels of ostecalcin and crossLaps were increased in CP men only.

Conclusions

Despite continuous GH therapy, low BMD was recorded in CO–CP females. Insufficient estrogen and androgen supplementation during adolescence was the main cause, but hypothalamic involvement with consequent leptin resistance was also strongly associated with low BMD in both genders.
A critical evaluation of the role of aromatase inhibitors as adjuvant therapy for postmenopausal women with breast cancer
Authors: Petit Thierry , Dufour Patrick , Tannock Ian
Published: April 2011

The introduction of aromatase inhibitors (AI) has provided more options for adjuvant treatment of postmenopausal women; they are associated with improved disease-free survival, but less commonly with improvements in overall survival. Current evidence suggests that women at high risk of recurrence, especially those with node-positive disease, should receive an AI for 2 years as part of their treatment, but routine prescription of AIs to postmenopausal patients with low-risk disease is not appropriate. Not only the expected benefits but also the specific toxicity of the prescribed hormone therapy, and its cost, should be considered when selecting treatment.
Anaplastic lymphoma kinase in human cancer
Authors: Barreca Antonella , Lasorsa Elena , Riera Ludovica , Machiorlatti Rodolfo , Piva Roberto , Ponzoni Maurilio , Kwee Ivo , Bertoni Francesco , Piccaluga Pier Paolo , Pileri Stefano A , Inghirami Giorgio , _ _
Published: April 2011

The receptor tyrosine kinases (RTKs) play a critical role, controlling cell proliferation, survival, and differentiation of normal cells. Their pivotal function has been firmly established in the pathogenesis of many cancers as well. The anaplastic lymphoma kinase (ALK), a transmembrane RTK, originally identified in the nucleophosmin (NPM)–ALK chimera of anaplastic large cell lymphoma, has emerged as a novel tumorigenic player in several human cancers. In this review, we describe the expression of the ALK–RTK, its related fusion proteins, and their molecular mechanisms of activation. Novel tailored strategies are briefly illustrated for the treatment of ALK-positive neoplasms.
In vitro growth and steroidogenesis of dog follicles are influenced by the physical and hormonal microenvironment
Authors: Songsasen N , Woodruff T K , Wildt D E
Published: April 2011

The present study examined the influences of the physical and hormonal microenvironment on in vitro growth and steroidogenesis of dog follicles. Follicles were enzymatically isolated and individually encapsulated in 0.5% (w/v; n=17) or 1.5% (n=10) alginate and cultured with 0.5 IU/ml equine chorionic gonadotropin for 192 h. In a separate experiment, follicles were encapsulated in 0.5% alginate and cultured with 0 (n=22), 1 (n=23), 10 (n=20) or 100 (n=21) μg/ml FSH for 240 h. Follicle diameter and steroid production were assessed every 48 h in both studies. Follicles encapsulated in the 0.5% alginate grew faster (P<0.05) than those cultured in the 1.5% concentration. Oestradiol (E2) and progesterone (P4) increased consistently (P<0.05) over time, and follicles in the 1.5% alginate produced more (P<0.05) P4 than those in the 0.5% solution. Follicles cultured in the highest FSH concentration (100 μg/ml) increased 100% in size after 240 h compared with 50 to 70% in lower dosages. E2 concentration remained unchanged over time (P>0.05) across FSH dosages. However, P4 increased (P<0.05) as culture progressed and with increasing FSH concentration. Results demonstrate that dog follicles cultured in alginate retain structural integrity, grow in size and are hormonally active. Lower alginate and increasing FSH concentrations promote in vitro follicle growth. However, the absence of an E2 rise in follicles cultured in FSH alone suggests the need for LH supplementation to support theca cell differentiation and granulosa cell function.
Intrapartum-Related Stillbirths and Neonatal Deaths in Rural Bangladesh: A Prospective, Community-Based Cohort Study
Authors: Ellis Matthew , Azad Kishwar , Banerjee Biplob , Shaha Sanjit Kumer , Prost Audrey , Rego Arati Roselyn , Barua Shampa , Costello Anthony , Barnett Sarah
Published: April 2011

OBJECTIVE:

Using a low-cost community surveillance system, we aimed to estimate intrapartum stillbirth and intrapartum-related neonatal death rates for a low-income community setting.

PATIENTS AND METHODS:

From 2005 to 2008, information on all deliveries in 18 unions of 3 districts of Bangladesh was ascertained by using traditional birth attendants as key informants. Outcomes were measured using a structured interview with families 6 weeks after delivery.

RESULTS:

We ascertained information on 31 967 deliveries, of which 26 173 (82%) occurred at home. For home deliveries, the mean cluster-adjusted stillbirth rate was 26 (95% confidence interval [CI[: 24–28) per 1000 births, and the perinatal mortality rate was 51 per 1000 births (95% CI: 47–55). The NMR was 33 per 1000 live births (95% CI: 30–37). There were 3186 (12.5%) home-born infants who did not breathe immediately. Of these, 53% underwent some form of resuscitation. Of 1435 infants who were in poor condition at 5 minutes (5% of all deliveries), 286 (20%) died; 35% of all causes of neonatal mortality. Of 201 fresh stillbirths, 40 (14%) of the infants had major congenital abnormalities. Our estimate of the intrapartum-related crude mortality rate among home-born infants is 17 in 1000 (95% CI: 16–19), 6 in 1000 stillborn and 11 in 1000 neonatal deaths after difficulties at birth.

CONCLUSIONS:

Difficulty initiating respiration among infants born at home in rural Bangladesh is common, and resuscitation is frequently attempted. Newborns who remain in poor condition at 5 minutes have a 20% mortality rate. Evaluation of resuscitation methods, early intervention trials including antibiotic regimes, and follow-up studies of survivors of community-based resuscitation are needed.
Validating Office-Based Screening for Psychosocial Strengths and Difficulties Among Youths in Foster Care
Authors: Jee Sandra H. , Szilagyi Moira , Conn Anne-Marie , Nilsen Wendy , Toth Sheree , Baldwin Constance D. , Szilagyi Peter G.
Published: April 2011

OBJECTIVES:

To assess the effectiveness of social-emotional screening in the primary care setting for youths in foster care.

METHODS:

The setting was a primary care practice for all youth in home-based foster care in 1 county. Subjects were youths, aged 11 to 17 years, and their foster parents; both completed a Strengths and Difficulties Questionnaire at well-child visits. The Strengths and Difficulties Questionnaire is a previously validated 25-item tool that has 5 domains: emotional symptoms; conduct problems; hyperactivity/inattention; peer problems; and prosocial behaviors and an overall total difficulties score. We first compared youth versus parent Strengths and Difficulties Questionnaire scores and then assessed the accuracy of these Strengths and Difficulties Questionnaire scores by comparing them in a subsample of youths (n = 50) with results of home-based structured clinical interviews using the Children's Interview for Psychiatric Syndromes.

RESULTS:

Of 138 subjects with both youth and parent reports, 78% had prosocial behaviors (strengths), and 70% had 1 or more social-emotional problems. Parents reported significantly more conduct problems (38% vs 16%; P < .0001) and total difficulties (30% vs 16%; P = .002) than did youth. The Strengths and Difficulties Questionnaire had better agreement with the Children's Interview for Psychiatric Syndromes (n = 50) for any Strengths and Difficulties Questionnaire–identified problem for combined youth and foster-parent reports (93%), compared with youth report alone (54%) or parent report alone (71%).

CONCLUSIONS:

Although most youths in foster care have social-emotional problems, most have strengths as well. Youth and foster-parent perspectives on these problems differ. Systematic social-emotional screening in primary care that includes both youth and parent reports can identify youths who may benefit from services.
A Parent's Decision on Immunization: Making the Right Choice
Authors: Walther Suzanne
Published: April 2011

A loving parent faces peer pressure to reject routine vaccination of her children. She begins researching immunizations to make a well-informed health care decision in the best interests of her children. Misleading and frightening information is readily accessible. She simply cannot find answers to her questions and concerns about vaccines. Her poor choice made in ignorance and fear results in her 1-year-old daughter contracting spinal meningitis. Once her daughter is in a pediatric intensive care isolation room suffering from this deadly disease, the mom gains access to accurate information regarding immunizations. All her questions regarding vaccine production, testing, safety, and ethics are answered. She wants accurate information readily available to all parents.
Acceptance of Pandemic 2009 Influenza A (H1N1) Vaccine in a Minority Population: Determinants and Potential Points of Intervention
Authors: Frew Paula M. , Hixson Brooke , del Rio Carlos , Esteves-Jaramillo Alejandra , Omer Saad B.
Published: April 2011

OBJECTIVE:

We sought to understand pandemic 2009 influenza A (H1N1) vaccine acceptance in a minority community including correlates of vaccine hesitancy and refusal. We identified intervention points to increase H1N1 vaccine coverage.

PATIENTS AND METHODS:

Minority parents and caregivers of children ≤18 years participated in a cross-sectional survey. Statistical analyses included bivariate correlations, exploratory factor analyses, internal-consistency assessment, and logistic regressions.

RESULTS:

The sample (N = 223) included mostly lower-income (71% [n = 159]) and black (66% [n = 147]) participants. Potential and actual receipt of pediatric H1N1 vaccination was low (36% [n = 80]). Pediatric H1N1 vaccine acceptance was associated with lack of insurance (odds ratio [OR]: 3.04 [95% confidence interval (CI): 1.26–7.37]), perceived H1NI pediatric susceptibility (OR: 1.66 [95% Cl: 1.41–1.95]), child vaccination prioritization in family (OR: 3.34 [95% CI: 1.33–8.38]), believing that H1N1 is a greater community concern than other diseases (OR: 1.77 [95% CI: 1.01–3.09]), believing that other methods of containment (eg, hand-washing, masks) are not as effective as the H1N1 vaccine (OR: 1.73 [95% CI: 1.06–2.83]), and a desire to promote influenza vaccination in the community (OR: 2.35 [95% CI: 1.53–3.61]).

CONCLUSIONS:

We found low acceptance of the H1N1 vaccine in our study population. Perceived influenza susceptibility, concern about H1N1 disease, and confidence in vaccinations as preventive methods were associated with vaccine acceptance. Physician support for HIN1 vaccination will aid in increasing immunization coverage for this population, and health departments are perceived as ideal community locations for vaccine administration.
Attitudes and Beliefs of Parents Concerned About Vaccines: Impact of Timing of Immunization Information
Authors: Vannice Kirsten S. , Salmon Daniel A. , Shui Irene , Omer Saad B. , Kissner Jennifer , Edwards Kathryn M. , Sparks Robert , Dekker Cornelia L. , Klein Nicola P. , Gust Deborah A.
Published: April 2011

OBJECTIVES:

To determine if giving vaccine-information materials before the 2-month vaccination visit to mothers with concerns about vaccine safety positively changed their attitudes and beliefs about vaccine safety.

METHODS:

Mothers who indicated concerns about infant vaccinations were recruited from 2 separate sites in Tennessee and California and were given vaccine information at 1 of 3 times: during a prenatal visit; a 1-week postpartum well-child visit; or a 2-month vaccination visit. A separate group of concerned mothers was assigned to be followed longitudinally at all 3 time points and was analyzed separately. The mothers reviewed a new vaccine-information pamphlet and Vaccine Information Statements (VIS) from the Centers for Disease Control and Prevention. Attitudes and beliefs about immunization were assessed both before and after the review of materials with written surveys.

RESULTS:

A total of 272 mothers with immunization concerns participated in the study. After review of the materials, mothers in all groups were significantly more likely to respond positively to questions and statements supporting the safety and importance of vaccines. Mothers who received this information at earlier visits were not significantly more likely to respond positively than mothers who received the information at the child's 2-month vaccination visit; however, participating mothers did indicate a preference for receiving vaccine information before the first vaccination visit.

CONCLUSIONS:

Distribution of the vaccine-information pamphlet and Vaccine Information Statements significantly improved attitudes about vaccination regardless of at what visit they were provided. Allowing adequate time to review vaccine information, even if done at the vaccination visit, may benefit concerned mothers.
How to Communicate With Vaccine-Hesitant Parents
Authors: Healy C. Mary , Pickering Larry K.
Published: April 2011

Development of safe and effective vaccines is one the greatest medical triumphs. However, despite high immunization rates in the United States, 85% of health care providers (HCPs) will have a parent refuse a vaccine for his or her child each year. HCPs have the greatest influence on a parent's decision to vaccinate his or her child. To effectively communicate with vaccine-hesitant parents, HCPs must first understand the concerns of parents regarding immunization and understand influences that can lead to misinformation about the safety and effectiveness of vaccines. HCPs should establish an open, nonconfrontational dialogue with vaccine-hesitant parents at an early stage and provide unambiguous, easily comprehensible answers about known vaccine adverse events and provide accurate information about vaccination. Personal stories and visual images of patients and parents affected by vaccine-preventable diseases and reports of disease outbreaks serve as useful reminders of the need to maintain high immunization rates. Ongoing dialogue including provider recommendations may successfully reassure vaccine-hesitant parents that immunization is the best and safest option for their child.
Cost-effectiveness of Essential Newborn Care Training in Urban First-Level Facilities
Authors: Manasyan Albert , Chomba Elwyn , McClure Elizabeth M. , Wright Linda L. , Krzywanski Sara , Carlo Waldemar A. ,   the Eunice Kennedy Shriver National Institute of Child Health and Human Development Global Network for Women's and Children's Health Research
Published: April 2011

OBJECTIVE:

To determine the cost-effectiveness of the World Health Organization (WHO) Essential Newborn Care (ENC) training of health care providers in first-level facilities in the 2 largest cities in Zambia.

METHODS:

Data were extracted from a study in which the effectiveness of the ENC training was evaluated (including universal precautions and cleanliness, routine neonatal care, resuscitation, thermoregulation, breastfeeding, skin-to-skin care, care of the small infant, danger signs, and common illnesses). The costs to train an ENC instructor for each first-level delivery facility and the costs of salary/benefits for 2 coordinators responsible for maintenance of the program were recorded in 2005 US dollars. The incremental costs per life gained and per disability-adjusted life-year averted were calculated.

SETTING:

A 5-day ENC training-of-trainers was conducted in Lusaka, Zambia, to certify 18 college-trained midwives as ENC instructors. The instructors trained all clinic midwives working in their first-level facilities as part of a before-and-after study of the effect of ENC training on early neonatal mortality conducted from Oct 2004 to Nov 2006.

RESULTS:

All-cause 7-day (early) neonatal mortality decreased from 11.5 per 1000 to 6.8 per 1000 live births after ENC training of the clinic midwives (relative risk: 0.59; 95% confidence interval: 0.48–0.77; P < .001; 40 615 births). The intervention costs were $208 per life saved and $5.24 per disability-adjusted life-year averted.

CONCLUSIONS:

ENC training of clinic midwives who provide care in low-risk facilities is a low-cost intervention that can reduce early neonatal mortality in these settings.
A Cluster-Randomized Evaluation of a Responsive Stimulation and Feeding Intervention in Bangladesh
Authors: Aboud Frances E. , Akhter Sadika
Published: April 2011

OBJECTIVES:

The goal of this study was to determine if a responsive stimulation and feeding intervention improved developmental and nutritional outcomes compared with a regular information-based parenting program. The hypothesis was that mothers in the intervention would exhibit better parenting skills and children would exhibit better developmental and nutritional outcomes than controls.

METHODS:

A cluster-randomized field trial was conducted with 302 children aged 8 to 20 months and their mothers in rural Bangladesh who were randomly assigned according to village to 1 of 3 groups. The control mothers received 12 informational sessions on health and nutrition. The intervention groups received an additional 6 sessions delivered by peer educators who included modeling and coached practice in self-feeding and verbal responsiveness with the child during play. A second intervention group received, along with the sessions, 6 months of a food powder fortified with minerals and vitamins. Developmental outcomes included the Home Observation for Measurement of the Environment (HOME) Inventory, mother-child responsive talk, and language development. Nutritional outcomes included weight, height, self-feeding, and mouthfuls eaten. We used analysis of covariance to compare the 3 groups at the posttest and at follow-up, covarying the pretest levels and confounders.

RESULTS:

At follow-up, responsive stimulation-feeding groups had better HOME inventory scores, responsive talking, language, mouthfuls eaten, and hand-washing. Micronutrient fortification resulted in more weight gain.

CONCLUSIONS:

A brief behavior-change program that focused on modeling and practice in stimulation and feeding was found to benefit children's nutrition and language development. Micronutrients benefited children's weight but not length.
Birth Weight, Postnatal Weight Change, and Risk for High Blood Pressure Among Chinese Children
Authors: Bowers Katherine , Liu Gongshu , Wang Ping , Ye Tao , Tian Zhen , Liu Enqing , Yu Zhijie , Yang Xilin , Klebanoff Mark , Yeung Edwina , Hu Gang , Zhang Cuilin
Published: April 2011

BACKGROUND:

It is hypothesized that a physiological predisposition toward hypertension results from a combination of intrauterine growth restriction or overgrowth and excessive postnatal weight gain. Previous studies were conducted largely in Western countries however the hypothesis may also be relevant in developing countries where metabolic disorders are increasing.

OBJECTIVE:

We investigated the association of birth weight and postnatal weight gain with hypertension among Chinese children.

METHODS:

A population based study was conducted among 15 600 children aged 3 to 6 years from Tianjin, China. Weight was expressed as z scores. Postnatal weight gain was defined as changes in z scores from birth to 3 to younger than 4 years, 4 to younger than 5 years, and 5 to 6 years. Hypertension was defined as greater than the 90th percentile of either systolic or diastolic blood pressure. Logistic regression-derived odds ratios and 95% confidence intervals were generated to estimate the association between birth weight and postnatal weight gain with hypertension risk in childhood.

RESULTS:

Birth weight was positively associated with childhood hypertension in boys and girls (odds ratios [95% confidence interval] comparing extreme quartiles [high versus low] were 5.67 [3.83–8.39] and 2.58 [3.83–8.39], respectively). Postnatal weight gain was positively associated with hypertension and the association did not significantly vary by birth size for gestational age.

CONCLUSIONS:

Greater birth weight or postnatal weight gain was associated with increased childhood hypertension risk, suggesting that intrauterine growth and postnatal weight gain may have implications on health during childhood.
Racial/Ethnic Disparities in Risk of Early Childhood Mortality Among Children With Congenital Heart Defects
Authors: Nembhard Wendy N. , Salemi Jason L. , Ethen Mary K. , Fixler David E. , DiMaggio Angela , Canfield Mark A.
Published: April 2011

BACKGROUND:

Infants with congenital heart defects (CHDs) have increased risk of childhood morbidity and mortality. However, little is known about racial/ethnic differences in early childhood mortality.

PATIENTS AND METHODS:

We conducted a retrospective cohort study with data from the Texas Birth Defect Registry on 19 530 singleton, live-born infants with a CHD and born January 1, 1996, to December 31, 2003, to non-Hispanic (NH) white, NH black, and Hispanic women. Texas Birth Defect Registry data were linked to Texas death records and the National Death Index to ascertain deaths between January 1, 1996, and December 31, 2005. Kaplan-Meier survival estimates were computed, and hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated from multivariable Cox-proportional hazard regression models to determine the effect of maternal race/ethnicity on mortality for selected CHD phenotypes.

RESULTS:

After adjusting for covariates, compared with NH white children, NH black children had increased early childhood mortality risk for transposition of the great arteries (HR: 2.04 [95% CI: 1.40–2.97]), tetralogy of Fallot (HR: 1.85 [95% CI: 1.09–3.12]), pulmonary valve atresia without ventricular septal defect (VSD) (HR: 2.60 [95% CI: 1.32–5.12]), VSD (HR: 1.56 [95% CI: 1.19–2.03]), and atrial septal defect (HR: 1.34 [95% CI: 1.08–1.66]). Hispanic children had higher mortality risk for pulmonary valve atresia without VSD (HR: 1.76 [95% CI: 1.06–2.91]) and hypoplastic left heart syndrome (HR: 1.51 [95% CI: 1.13–2.02]).

CONCLUSIONS:

We provide evidence that supports racial/ethnic disparities in early childhood mortality among infants with CHDs. Identifying infants with the greatest risk of early childhood mortality will facilitate development of interventions and policies to mitigate these risks.
The Social Environment and Suicide Attempts in Lesbian, Gay, and Bisexual Youth
Authors: Hatzenbuehler Mark L.
Published: April 2011

OBJECTIVE:

To determine whether the social environment surrounding lesbian, gay, and bisexual youth may contribute to their higher rates of suicide attempts, controlling for individual-level risk factors.

METHODS:

A total of 31 852 11th grade students (1413 [4.4%] lesbian, gay, and bisexual individuals) in Oregon completed the Oregon Healthy Teens survey in 2006–2008. We created a composite index of the social environment in 34 counties, including (1) the proportion of same-sex couples, (2) the proportion of registered Democrats, (3) the presence of gay-straight alliances in schools, and (4) school policies (nondiscrimination and antibullying) that specifically protected lesbian, gay, and bisexual students.

RESULTS:

Lesbian, gay, and bisexual youth were significantly more likely to attempt suicide in the previous 12 months, compared with heterosexuals (21.5% vs 4.2%). Among lesbian, gay, and bisexual youth, the risk of attempting suicide was 20% greater in unsupportive environments compared to supportive environments. A more supportive social environment was significantly associated with fewer suicide attempts, controlling for sociodemographic variables and multiple risk factors for suicide attempts, including depressive symptoms, binge drinking, peer victimization, and physical abuse by an adult (odds ratio: 0.97 [95% confidence interval: 0.96–0.99]).

CONCLUSIONS:

This study documents an association between an objective measure of the social environment and suicide attempts among lesbian, gay, and bisexual youth. The social environment appears to confer risk for suicide attempts over and above individual-level risk factors. These results have important implications for the development of policies and interventions to reduce sexual orientation–related disparities in suicide attempts.
Advancing a Social Policy Agenda through Economic Policy: Obama's Stimulus and Education Reform
Authors: Weatherford M. Stephen , McDonnell Lorraine M.
Published: April 2011

In using parts of the American Recovery and Reinvestment Act as a down payment on an ambitious education reform agenda, Barack Obama has accomplished what few others presidents have. The strategy has given his administration three distinct advantages: a large discretionary funding source with little Congressional scrutiny; flexibility in pursuing education reform goals without crowding out other policies on the presidents agenda; and the ability to shape the national reform discussion for more than a year on the administrations terms, without being constrained by negotiations over a specific piece of legislation. Now the question is whether the Obama administrations political dexterity can be matched by skill in fashioning institutional arrangements that ensure the long-term sustainability of these reforms.
Where Are We in History? 2010 in the Longest Run
Authors: Engle Pär Jason , Shafer Byron
Published: April 2011

One classic way to get perspective on the most recent election is to drop it into the full sweep of congressional elections across all of American history. A focus on partisan control of the House, on partisan control of national government, and on the difference in these between mid-term and presidential years provides a way to isolate elements of distinction for the mid-term of 2010. While this hardly provides a means of foretelling the future, it does suggest some key structural elements that help distinguish the most recent elections from even their immediate predecessors.
The Inter-Personal Presidency of Chief Executive George W. Bush: Review of Decision Points
Authors: Jones Charles O.
Published: April 2011

At the very least, presidential memoirs can serve as cautionary tales. Many of the same political and policy challenges facing President Bush are likely to prevail in the near future. Additionally, the Twenty-Second Amendment is unlikely to be repealed, thus continuing to set a termination date for second-term presidents. Therefore, Decision Points is relevant text for whoever is inaugurated in 2013 and beyond.
Challenges to Mainstream Journalism in Baseball and Politics
Authors: Marx Greg
Published: April 2011

The increasing acceptance of sabermetric perspectives by sports media outlets provides a useful framework to think about the relationship between political science and political journalism. In many ways, the experience in the sports world, in which the conventional journalistic narrative proved flexible enough to accommodate quantitative methods and new analytical frameworks, represents an optimistic model for those who hope to see political reporting become more informed by scholarly research. On the other hand, there are important differences between the two cases. For example, political science poses a much larger challenge to the prevailing approach among journalists to everyday reporting than sabermetrics did. For this reason, it have the field may have less influence on practicing journalists than its supporters hope.
Polarized Populism: Masses, Elites, and Partisan Conflict
Authors: Quirk Paul J
Published: April 2011

Scholars offer differing accounts of the roles played by political elites, on the one hand, and ordinary citizens, on the other, in the highly polarized partisan conflict of contemporary American politics. Some take polarized elite conflict to indicate, in itself, that elected policymakers have escaped the constraints of democratic control and act essentially independently. In sharp contrast to this view, I outline a case for the importance of what I call polarized populisma condition of politics in which elected officials accord very substantial deference to ordinary citizens, especially those who hold relatively extreme ideological views. I clarify the differences between elite centered and populist accounts of polarized policymaking, and then develop the argument for polarized populism, presenting theoretical considerations in support and assessing several kinds of relevant evidence. I also reply to some claims by Lawrence Jacobs and Robert Shapiro, proponents of the elite-centered view, in an earlier exchange in the Forum. In concluding, I comment briefly about some directions for research to assess the case for polarized populism and discuss some broader implications of this pattern of policymaking.
Genome-Phenome Linkages in Human Population Surveys, with Special Emphasis on the Health and Retirement Survey
Authors: Singer Burton
Published: April 2011

We review a diversity of genome-wide association studies (GWAS) with particular emphasis on precision in specifying phenotypes. This implies that examination of any specific phenotype involves considering the likely genetic contributions to it from the entire genome. We consider a variety of phenotypes specifiable with data from the Health and Retirement Survey (HRS). However, evidence from other large population studies is also incorporated as part of the process of developing and refining pathway representations from the genome thru a hierarchy of intermediate endpoints to behavioral, cognitive, and economic phenotypes. Any causal modeling focused on genome-phenotype connections must, of necessity, include consideration of intermediate endpoints (endophenotypes) as mediators of such associations. We also discuss metabolic and gene expression consequences of gene-environment interactions as a next research step beyond GWAS, not only for HRS but also for an integrated set of human population surveys that can provide much more statistical power than any one of them used alone. A variety of concrete examples based on physiological, psychological, sociological, and economic outcomes are carried along throughout our discussion.
Medical Expenditure Measures in the Health and Retirement Study
Authors: Goldman Dana P , Zissimopoulos Julie , Lu Yang
Published: April 2011

This paper reviews out-of-pocket (OOP) medical expenditure measures collected in the Health and Retirement Study (HRS). Medical expenditures are an important cost of poor health. Medical expenditure measures are important for understanding retirement decisions, financial preparation for retirement, and predicting the consequences of health care reform, particularly Medicare reform. Despite the comprehensiveness of the HRS, there are always limitations to what can be learned from population interviews. To assess the quality of current HRS measures of OOP spending, we compare various measures of OOP spending across survey waves to the Medical Expenditure Panel Survey (MEPS) and Medicare Current Beneficiary Survey (MCBS), two surveys that expend considerable resources on measuring both OOP spending and total medical expenditures. Such comparisons make it possible to identify potential bias in the HRS data and to improve HRS measures of OOP. We find that the HRS produces good quality and useful data on OOP spending.