bluuebunny/crossref_metadata_2025 huggingface dataset:
The Funding Dilemma for Rural Water Infrastructure on Tribal Nations
Authors: Jones Sharon A. , Moerschbacher Jenny , Petrova Milena
Published: April 2007

Safe drinking water is the most capital intensive of all utility services. Paying for water infrastructure improvements is a particular problem for small, rural communities, such as those on Native American reservations. These communities often rely on federal grant programs for capital improvements; however, granting agencies face difficulties deciding who to fund. By evaluating water infrastructure projects for 10 Native American communities, the authors show advantages and limitations of three methods for awarding grants—traditional benefit—cost analysis, social benefit—cost analysis, and funding criteria used for the Tribal Set-Aside grants program. Results suggest that the choice of prioritization method leads to very different results. As an example, fire protection benefits can change the viability of a water system project, but the Environmental Protection Agency does not directly consider these benefits for statutory reasons. From a life cycle perspective, mission agencies may want to reevaluate their decision-making methods to more holistically consider risk when allocating infrastructure funding.
The Case for Truck-Only Toll Lanes
Authors: Poole Robert W.
Published: April 2007

Truck traffic will grow faster than other traffic during the next 20 years, raising the need for added highway capacity. Current fuel taxes provide barely enough funding to maintain existing highways. Thus, there is growing interest in using toll finance to develop truck-only toll (TOT) lanes, generally added to existing limited-access roadways that are key trucking routes. Urban TOT lanes would provide congestion relief and better access to and from key ports and airports, whereas long-distance TOT lanes would permit longer combination vehicles that are not allowed on most interstate highways. Increased speed, reliability, and payload are reasons for trucking firms and shippers to pay tolls for superior performance. Tolls may do a better job than increased diesel fuel taxes of targeting investment to new capacity for goods movement. There are signs that the trucking industry is interested in TOT lanes, and federal and state policy is becoming more favorable.
Food-Away-From-Home Expenditure of Senior Households in the United States: A Double-Hurdle Approach
Authors: Jang SooCheong (Shawn) , Ham Sunny , Hong Gong-Soog
Published: April 2007

This study investigated the association of demographic and socioeconomic variables with food-away-from-home (FAFH) expenditures in senior households in the United States. Using the Consumer Expenditure Survey, the two-step decision process for FAFH consumption was examined using Heckman's double-hurdle approach. The first step was a probit regression to estimate the probability of FAFH participation. The second step was to predict FAFH expenditure using a truncated regression with the inverse Mills ratio for correcting sample selection bias. The results indicated that sociodemographic characteristics were more useful in understanding the participation decision of senior households about FAFH, whereas access to and availability of restaurants as well as financial resources are better predictors of FAFH expenditures. This approach provided in-depth information on the unique role of each variable in the decision-making process for eating out and for how much to spend. This information will be valuable in understanding senior consumers in the restaurant industry.
Does Combining Health Care Hospitality Services Increase Efficiency?
Authors: Reynolds Dennis , Leeman Darin
Published: April 2007

Throughout the health care industry, managers of hospitality services are exploring potential efficiencies gained by merging departments in an attempt to leverage operational similarities with the goal of minimizing labor costs while maintaining or increasing customer satisfaction. Although the notion of optimizing operations by focusing on the service customer is central to general-system theorists, no extant studies assess whether such a practice applied to health care hospitality services enhances labor efficiency. Moreover, there is no apparent consensus in the industry whether such an approach is warranted or, if it is, what combinations are optimal. This exploratory study's findings, which included 105 acute-care hospitals in the United States, suggest that combining one hospitality service (such as foodservice) with another (such as housekeeping or maintenance) is more labor efficient but that no one combination is better than another.
Conceptualization and Operationalization of Destination Image
Authors: Tasci Asli D. A. , Gartner William C. , Tamer Cavusgil S.
Published: April 2007

The destination image has received much attention for about three decades. Studies of various aspects of destination images increased in volume during the 1990s. Echtner and Ritchie's (1991) review of destination image literature resulted in several suggestions in terms of both the conceptualization and operationalization of destination image. This study looks at the evolutionary nature of tourism destination image studies from both theoretical and operational perspectives. Necessary adjustments in the methodological rigor and the focus of inquiry for destination image research are offered using Echtner and Ritchie's review as a guide. A review of literature about destination image and other pertinent concepts indicated that several of Echtner and Ritchie's recommendations have been followed, whereas others have not. Also, several other important conceptualization- and methodology-related issues identified in the destination image literature are addressed.
Hepatic Gene Expression Changes in Hypothyroid Juvenile Mice: Characterization of a Novel Negative Thyroid-Responsive Element
Authors: Dong Hongyan , Yauk Carole L. , Williams Andrew , Lee Alice , Douglas George R. , Wade Michael G.
Published: April 2007

The molecular mechanisms involved in the response of developing mice to disruptions in maternal thyroid hormone (TH) homeostasis are poorly characterized. We used DNA microarrays to examine a broad spectrum of genes from the livers of mice rendered hypothyroid by treating pregnant mice from gestational d 13 to postnatal d 15 with 6-propyl-2-thiouracil in drinking water. Twenty-four individuals (one male and one female pup from six litters of control or 6-propyl-2-thiouracil treatment groups, respectively) were profiled using Agilent oligonucleotide microarrays. MAANOVA identified 96 differentially expressed genes (false discovery rate adjusted P < 0.1 and fold change > 2 in at least one gender). Of these, 72 genes encode proteins of known function, 15 of which had previously been identified as regulated by TH. Pathway analysis revealed these genes are involved in metabolism, development, cell proliferation, apoptosis, and signal transduction. An immediate-early response gene, Nr4a1 (nuclear receptor subfamily 4, group A, member 1), was up-regulated by 3-fold in hypothyroid juvenile mouse liver; treatment of HepG2 cells with T3 resulted in down-regulation of Nr4a1. A potential thyroid response element −1218 to −1188 bp upstream of the promoter region of Nr4a1 was identified and demonstrated to bind TH receptor (TR)-α and TRβ. Point mutation or deletion of the sequence containing the potential Nr4a1-thyroid response element in transient gene expression studies resulted in both higher basal expression and loss of T3 regulatory capacity, suggesting that this site is responsible for the negative regulation of gene expression by TR and TH.
Self-assembled Silver Dendritic Nanostructure on the Surface of AAO Template
Authors: Wang Zhijun , Tao Feng , Chen Dongbo , Yao Lianzeng , Cai Weili , Li Xiaoguang
Published: April 2007

Silver dendritic hierarchical structures have been prepared using a simple, surfactant-free method by carrying out the silver mirror reaction on the surface of a porous anodic aluminium oxide (AAO) template. The surface of the AAO template has a guiding effect in the formation process of silver dendritic hierarchical structures.
A Polydiacetylene Supramolecular System that Displays Reversible Thermochromism
Authors: Lee Cheol Hee , Kim Jong Seung , Park Sun Young , Ahn Dong June , Kim Jong-Man
Published: April 2007

A reversible blue-to-red color transition of polydiacetylene supramolecules derived from an oligoethylene glycol-bridged bisdiacetylene was observed upon thermal stress.
Analytical Validation of the Oncotype DX Genomic Diagnostic Test for Recurrence Prognosis and Therapeutic Response Prediction in Node-Negative, Estrogen Receptor–Positive Breast Cancer
Authors: Cronin Maureen , Sangli Chithra , Liu Mei-Lan , Pho Mylan , Dutta Debjani , Nguyen Anhthu , Jeong Jennie , Wu Jenny , Langone Kim Clark , Watson Drew
Published: April 2007

Background: Oncotype DX™ is a clinically validated, high-complexity, multianalyte reverse transcription–PCR genomic test that predicts the likelihood of breast cancer recurrence in early-stage, node-negative, estrogen receptor–positive breast cancer. The Recurrence Score™ (RS) provides a more accurate, reproducible measure of breast cancer aggressiveness and therapeutic responsiveness than standard measures. Individualized patient management requires strict performance criteria for clinical laboratory tests. We therefore investigated the analytical performance of the assay.

Methods: Assays used a pooled RNA sample from fixed paraffin-embedded tissues to evaluate the analytical performance of a 21-gene panel with respect to amplification efficiency, precision, linearity, and dynamic range, as well as limits of detection and quantification. Performance variables were estimated from assays carried out with sample dilutions. In addition, individual patient samples were used to test the optimized assay for reproducibility and sources of imprecision.

Results: Assay results defined acceptable operational performance ranges, including an estimated maximum deviation from linearity of <1 cycle threshold (CT) units over a ≥2000-fold range of RNA concentrations, with a mean quantification bias of 0.3% and CVs of 3.2%–5.7%. An analysis of study design showed that assay imprecision contributed by instrument, operator, reagent, and day-to-day baseline variation was low, with SDs of <0.5 CT.

Conclusion: The analytical and operational performance specifications defined for the Oncotype DX assay allow the reporting of quantitative RS values for individual patients with an SD within 2 RS units on a 100-unit scale.
Real-Time PCR Determination of IMPDH1 and IMPDH2 Expression in Blood Cells
Authors: Bremer Sara , Rootwelt Helge , Bergan Stein
Published: April 2007

Background: Inosine monophosphate dehydrogenase (IMPDH) catalyzes the rate-limiting step in de novo guanine nucleotide synthesis and is implicated in cell cycle control. Inhibition of this enzyme is associated with immunosuppressive, antiviral, and antitumor activity. IMPDH basal activity increases after initiation of immunosuppressive therapy.

Methods: A real-time reverse-transcription PCR assay was developed and validated for mRNA quantification of the 2 human IMPDH isoforms. Target gene expressions were normalized to the geometric mean of 3 housekeeping genes. Assay utility was tested by analyzing patient samples and cultured cells exposed to immunosuppressive drugs such as the IMPDH inhibitor mycophenolic acid.

Results: The assay was linear over 6 logs of cDNA input and demonstrated specific quantification of IMPDH1 and IMPDH2 expression in cultured cells and patient samples. Limits of detection and quantification were 10 and 103 copies of cDNA per reaction, respectively. Within-run and total between-day CVs were <15% for normalized expression. Changes in IMPDH1 and 2 expression were observed in patient samples after initiation of an immunosuppressive regimen that included calcineurin inhibitors, mycophenolate mofetil, and steroids.

Conclusions: This assay can be used to study the regulation of IMPDH expression and the involvement of the enzymes in immunological and malignant proliferative conditions. This may contribute to the processes of drug development and to the establishment of monitoring strategies for treatment effect and disease activity.
Limitations of Functional Analysis: The Case for Including Valued Outcomes Analysis in the Investigation of Difficult Behaviour
Authors: Bitsika Vicki
Published: April 2007

Effective behaviour change is based on understanding the reasons for difficult behaviour. However, current functional analytic technology is often limited in its effectiveness in the clinical setting because the focus is on labelling and classifying behavioural outcomes rather than conducting a detailed analysis of the manner in which these outcomes assist the client to operate in the environment. The effectiveness of existing functional analytic techniques might be enhanced by moving the focus of the investigation from identifying the consequent variables that impact on behaviour to systematically exploring client–environment interactions as well as the manner in which the client experiences the consequences of his/her actions. One potential method (Valued Outcomes Analysis) that provides a framework for the systematic investigation of the effects of ‘inner skin’ factors on the incidence of behavioural difficulties is described here.
An analysis of the biochemical diagnosis of 66 pheochromocytomas
Authors: d’Herbomez Michèle , Forzy Gérard , Bauters Catherine , Tierny Catherine , Pigny Pascal , Carnaille Bruno , Pattou François , Wémeau Jean-Louis , Rouaix Nathalie
Published: April 2007

Objectives: The aims of this study were to determine the performance of each variable, to define the optimal diagnostic thresholds and to determine the relative value of assaying chromogranin A (CgA).

Design: Prospective study.

Methods: Two groups of patients were studied: a control group of 71 patients and a group of 63 patients with a histologically-proven pheochromocytoma (52 pheochromocytomas and 14 paragangliomas). Fourteen of the patients had a family history of the disease. Eleven variables were assayed in each patient, i.e. the plasma and urinary concentrations of amines and their derivatives, and the CgA serum concentration.

Results: The study of the control group showed that all the serum assays gave false positive results (from 6 to 23%), as did four of the six urinary assays (from 2.9 to 12.3%). The areas under the receiver operating characteristic curves varied from 0.689 to 0.992. The variables relating to the epinephrine pathway were significantly less expressed in the hereditary diseases than in the sporadic cases. The diagnostic thresholds of the three most efficient variables have been raised.

Conclusions: Plasma determinations of metanephrines are now an easy and convenient tool for the diagnosis of pheochromocytoma. However, in our study the best specificity was obtained with the urinary tests rather than with the plasma assays while the highest sensitivities were for the normetanephrine assays. The assay of CgA was highly efficient in diagnosing pheochromocytomas in the absence of renal insufficiency. By combining it with fractionated metanephrine assays, the sensitivities of the latter were increased.
Metabolic follow-up after long-term pancreas graft survival
Authors: Dieterle Christoph D , Arbogast Helmut , Illner Wolf-Dieter , Schmauss Susanne , Landgraf Rüdiger
Published: April 2007

Design: Successful pancreas transplantation results in insulin independence and normoglycemia. This prospective study was performed to investigate long-term metabolic changes after pancreas transplantation.

Methods: Thirty-eight type 1 diabetic patients after simultaneous pancreas/kidney transplantation (SPK) with a pancreas graft survivalfor at least10years were studied in a prospective manner. HbA1c and glucose levels before and during an oral glucose tolerance test (OGTT) were analyzed from 3 months to 10 years after SPK. In addition, insulin secretion and glucagon response were measured.

Results: Fasting glucose increased slightly and continuously from 3 months to 10 years (from 78 ± 3 to 91 ± 2 mg/dl). Even HbA1c levels showed a mild but significant increase from 3 months to 10 years after SPK. Glucose tolerance deteriorated markedly 10 years after SPK. Insulin secretion during OGTT remained stable for 10 years. Parameters of insulin resistance and sensitivity did not change significantly but glucagon secretion increased significantly during the course after SPK. Late after SPK, glucagon levels were higher in patients with an impaired or diabetic glucose tolerance.

Conclusions: Pancreas transplantation is able to restore endogenous insulin secretion for 10 years or more. Especially, late after SPK, a deterioration of glycemic control was detected, even if glucose values were within the normal range. During prospective long-term follow-up, an increase of glucagon secretion but no decrease of insulin secretion was detected.
In men older than 70 years, total testosterone remains stable while free testosterone declines with age. The Health in Men Study
Authors: Yeap Bu B , Almeida Osvaldo P , Hyde Zoë , Norman Paul E , Chubb S A Paul , Jamrozik Konrad , Flicker Leon
Published: April 2007

Objective: An age-related decline in serum total and free testosterone concentration may contribute to ill health in men, but limited data are available for men > 70 years of age. We sought to determine the distribution and associations of reduced testosterone concentrations in older men.

Design: The Health in Men Study is a community-representative prospective cohort investigation of 4263 men aged ≥ 70 years. Cross-sectional hormone data from 3645 men were analysed.

Methods: Early morning sera were assayed for total testosterone, sex hormone binding globulin (SHBG) and LH. Free testosterone was calculated using the Vermeulen method.

Results: Mean (± s.d.) serum total testosterone was 15.4 ± 5.6 nmol/l (444 ± 162 ng/dl), SHBG 42.4 ± 16.7 nmol/l and free testosterone 278 ± 96 pmol/l (8.01 ± 2.78 ng/dl). Total testosterone correlated with SHBG (Spearman’s r = 0.6, P < 0.0001). LH and SHBG increased with age (r = 0.2, P < 0.0001 for both). Instead of declining, total testosterone increased marginally (r = 0.04, P = 0.007) whilst free testosterone declined with age (r = −0.1, P < 0.0001). Free testosterone was inversely correlated with LH (r = −0.1, P < 0.0001). In multivariate analyses, increasing age, body mass index (BMI) and LH were associated with lower free testosterone.

Conclusions: In men aged 70–89 years, modulation of androgen action may occur via an age-related increase in SHBG and reduction in free testosterone without a decline in total testosterone concentration. Increasing age, BMI and LH are independently associated with lower free testosterone. Further investigation would be required to assess the clinical consequences of low serum free testosterone, particularly in older men in whom total testosterone may be preserved.
The sex-specific association of serum osteoprotegerin and receptor activator of nuclear factor κB legend with bone mineral density in older adults: the Rancho Bernardo Study
Authors: Stern Anna , Laughlin Gail A , Bergstrom Jaclyn , Barrett-Connor Elizabeth
Published: April 2007

Objective: The role of osteoprotegerin (OPG) and its receptor activator of nuclear factor κB legend (RANKL) in the regulation of bone in humans remain unclear. We examined the sex-specific associations of serum OPG, RANKL, and their ratio with bone mineral density (BMD) in older adults.

Design: Participants were 681 community-dwelling adults, ages 45–90 years, who had serum OPG and RANKL measured and bone density scans in 1988–1991, with follow-up scans 5 and/or 10 years later.

Methods: Analyses were sex-specific; women using and not using estrogen were evaluated separately. Cross-sectional analyses used multivariable regression models; longitudinal analyses used repeated measures mixed effects models.

Results: In cross-sectional analyses, age- and weight-adjusted serum OPG levels were significantly positively associated with BMD at the lumbar spine in men, and at the femoral neck, total hip, and lumbar spine in women using estrogen, but not in non-users of estrogen. RANKL concentrations were significantly and inversely associated with BMD in men only, and at the total hip. Neither OPG nor RANKL was significantly associated with bone loss. Results for the RANKL/OPG ratio were the same as those for RANKL alone.

Conclusions: These results suggest a modulatory effect of both endogenous and exogenous sex hormones on the biologic interaction of OPG, RANKL, and bone.
Changes in Prevalence of HIV Infection and Sexual Risk Behavior in Men Who Have Sex With Men in San Francisco: 1997–2002
Authors: Osmond Dennis H. , Pollack Lance M. , Paul Jay P. , Catania Joseph A.
Published: April 2007

Objectives. We assessed differences in HIV prevalence and sexual risk behavior among men who have sex with men (MSM) between 1997 and 2002 in San Francisco.

Methods. We used 2 population-based random-digit-dial telephone surveys of MSM households in San Francisco in 1997 (n=915) and 2002 (n=879).

Results. Estimated HIV prevalence increased from 19.6% in 1997 to 26.8% in 2002. Measures of sexual risk also increased. Unprotected anal intercourse with a partner of different or unknown HIV serostatus increased from 9.3% to 14.6%. Mean number of male partners increased from 10.7 to 13.8. The largest reported increase was 18.9% to 26.8% for “serosorting,” or choosing unprotected anal intercourse partners believed to have the same HIV serostatus as oneself. Men aged 30 to 50 reported the largest increase in unprotected anal intercourse, whereas men aged 18 to 29 reported the largest increase in serosorting. Changes in the age distribution did not explain the increase in risky behavior.

Conclusions. Both HIV prevalence and sexual risk increased substantially among MSM in San Francisco between 1997 and 2002. Serosorting is being adopted more frequently than condom use by young MSM, but its effectiveness as a harm reduction strategy is not known.
Managing Medicare’s HIV Caseload in the Era of Suppressive Therapy
Authors: Gilden David E. , Kubisiak Joanna M. , Gilden Daniel M.
Published: April 2007

Objectives. The 1996 introduction of antiretroviral medications changed Medicare’s role in providing HIV care. We analyzed Medicare’s patient database in an effort to document the new HIV therapies’ effects on expenditures and outcomes.

Methods. We examined the medical billing records of a 5% national Medicare sample from 1997 through 2003. The cohort was stratified by year and categorized by age, race/ethnicity, gender, and Medicare status. Population summaries were categorized according to presence of major chronic diseases and HIV-related conditions.

Results. The number of Medicare beneficiaries with HIV increased from 42520 in 1997 to 76500 in 2003, whereas mortality among this group fell by 35%. HIV-associated infections declined by as much as 43% (mycoses). Heart and liver disease and diabetes increased by more than 50%. Adjusted annual per person Medicare expenditures fell 28%; expenditures were 49% higher for Blacks than for Whites.

Conclusions. Improved HIV medical management has led to fewer deaths and has shifted treatment toward chronic care. However, successful management is complicated by conditions that have not been historically linked to HIV and whose effects vary according to race/ethnicity.
History of Childhood Sexual Abuse and HIV Risk Behaviors in Homosexual and Bisexual Men
Authors: Brennan David J. , Hellerstedt Wendy L. , Ross Michael W. , Welles Seth L.
Published: April 2007

Objectives. We examined the prevalence and frequency of childhood sexual abuse and their association with sexual risk among a sample of gay and bisexual men.

Methods. Cross-sectional data were collected by survey from randomly selected gay and bisexual men who attended the 1997 and 1998 Minneapolis/St. Paul Gay, Lesbian, Bisexual, and Transgender Pride Festivals. Data included demographics, sexual activity, history of childhood sexual abuse, HIV status, history of sexually transmitted infection, use of sex-related drugs (such as crack, cocaine, Ecstasy, amyl nitrate, crystal methamphetamine, and Special K), and history of exchanging sex for payment.

Results. childhood sexual abuse was reported by 15.5% of the survey respondents (n = 134). Those who reported experiencing abuse regularly were more likely to (1) be HIV positive, (2) have exchanged sex for payment, and (3) be a current user of sex-related drugs. Neither unsafe sex nor sexually transmitted infections were associated with childhood sexual abuse.

Conclusions. These findings show that more than 1 in 7 gay and bisexual men in a non-clinical, festival-based setting were victims of childhood sexual abuse and that childhood sexual abuse was associated with alarmingly high rates of men who were HIV infected and antecedent risk behaviors.
Reproductive Health of Adolescent Girls Perinatally Infected With HIV
Authors: Brogly Susan B. , Watts D. Heather , Ylitalo Nathalie , Franco Eduardo L. , Seage George R. , Oleske James , Eagle Michelle , Van Dyke Russell
Published: April 2007

Objectives. We sought to describe the reproductive health of adolescent girls perinatally infected with HIV.

Methods. We estimated the incidence of first pregnancy, genital infections, and abnormal cervical cytology for 638 girls aged 13 years and older in the Pediatric AIDS Clinical Trials Group protocol 219C.

Results. Thirty-eight girls became pregnant, for a first pregnancy rate of 18.8/ 1000 person-years; 7 of these girls had additional pregnancies (95% confidence interval [CI]=13.3, 25.7). Thirty-two pregnancies resulted in live births. All girls received antiretroviral therapy during pregnancy. One infant was HIV infected, 29 were uninfected, and 2 had unknown infection status, for a rate of mother-to-child transmission of HIV in infants with known infection status of 3.3% (95% CI=0.1, 18.6). Condylomata and trichomoniasis were the most frequent genital infections. Forty-eight (47.5%) of 101 girls with Papanicolaou test examinations had abnormal cervical cytology, including atypical cells of undetermined significance (n=18), low-grade squamous intraepithelial lesions (SIL; n=27), and high-grade SIL (n=3). Many abnormalities persisted despite intervention.

Conclusions. Pregnancy rates were lower and cervical abnormalities were higher than among non–HIV-infected adolescents. These findings underscore the importance of Papanicolaou tests and promotion of safer sexual practices in this population.
Prevalence of HIV Infection and Predictors of High-Transmission Sexual Risk Behaviors Among Men Who Have Sex With Men
Authors: Schwarcz Sandra , Scheer Susan , McFarland Willi , Katz Mitchell , Valleroy Linda , Chen Sanny , Catania Joseph
Published: April 2007

Objectives. We sought to determine the prevalence of HIV and novel cofactors of high-transmission-risk behavior in a probability sample of men who have sex with men (MSM).

Methods. We performed a cross-sectional telephone survey of 1976 adult MSM in San Francisco.

Results. We found an HIV prevalence of 25.2%. Predictors of unprotected insertive anal intercourse with a serodiscordant (not having the same HIV/AIDS serostatus) partner among HIV-infected men included use of Viagra and a greater number of partners in the past 12 months. Unprotected receptive anal intercourse with a serodiscordant partner among men not known to be HIV infected was independently associated with having lived in San Francisco for less than 1 year, use of crystal methamphetamine and amyl nitrites, a greater number of partners, and agreement with the statement, “You are less careful about being safe with sex or drugs than you were several years ago because there are better treatments for HIV now.”

Conclusions. Strategies to prevent HIV for urban MSM should focus on new predictors of HIV transmission.
Ethics in Public Health Research
Authors: Graham Wendy J. , Hussein Julia
Published: April 2007

Maternal and perinatal mortality reduction has remained a priority on the international health agenda for nearly 2 decades. During this time, strategies for achieving these goals have shifted in emphasis from prevention of pregnancies to provision of care. Robust evidence is limited, particularly regarding what works best in delivering care in specific health system settings and at the population level.

We describe the limited evidence base using a framework that highlights the consequences of the major gaps in measurement, evidence, and action, and we discuss existing opportunities for bridging these gaps at the policy level. Capitalizing on current global policy interests and generating demand-driven evidence is a priority for enabling documentation of progress toward reaching the United Nations Millennium Development Goals for 2015.
Growth Trajectories of Sexual Risk Behavior in Adolescence and Young Adulthood
Authors: Fergus Stevenson , Zimmerman Marc A. , Caldwell Cleopatra H.
Published: April 2007

Objectives. Adolescence and young adulthood (ages 18–25 years) are periods of development and change, which include experimentation with and adoption of new roles and behaviors. We investigated longitudinal trajectories of sexual risk behaviors across these time periods and how these trajectories may be different for varying demographic groups.

Methods. We developed multilevel growth models of sexual risk behavior for a predominantly African American sample (n=847) that was followed for 8 years, from adolescence to young adulthood. We investigated differences in growth parameters by race/ethnicity and gender and their interactions.

Results. The final model included linear and quadratic terms for both adolescence and young adulthood, indicating acceleration of sexual risk behaviors during adolescence and a peak and deceleration during young adulthood. African American males exhibited the highest rate of sexual risk behavior in ninth grade, yet had the slowest rate of growth. Compared with their White peers, African American males and females exhibited less sexual risk behavior during young adulthood.

Conclusions. Our results suggest that youths of different races/ethnicities and genders exhibit varying sexual risk behavior trajectories.
Directly Observed Highly Active Antiretroviral Therapy for HIV-Infected Children in Cambodia
Authors: Myung Patricia , Pugatch David , Brady Mark F. , Many Phok , Harwell Joseph I. , Lurie Mark , Tucker John
Published: April 2007

Antiretroviral medications are becoming available for HIV-infected children in resource-limited settings. Maryknoll, an international Catholic charity, provided directly observed antiretroviral therapy to HIV-infected children in Phnom Penh, Cambodia. Child care workers administered generic antiretroviral drugs twice daily to children, ensuring adherence.

Treatment began with 117 late-stage HIV-infected children; 22 died of AIDS during the first 6 months. The rest were treated for at least 6 months and showed CD4 count increases comparable to those achieved in US and European children. Staffing cost for this program was approximately US $5 per child per month, or 15% more than the price of the medications. Drug toxicities were uncommon and easily managed.

Directly observed antiretroviral therapy appears to be a promising, low-cost strategy for ensuring adherent treatment for HIV-infected children in a resource-limited setting.
Research, Curricula, and Resources Related to Lesbian, Gay, Bisexual, and Transgender Health in US Schools of Public Health
Authors: Corliss Heather L. , Shankle Michael D. , Moyer Matthew B.
Published: April 2007

To assess the extent to which public health schools conduct research, offer planned curricula, and provide resources related to lesbian, gay, bisexual, and transgender health, we mailed a self-administered questionnaire to individual department chairpersons at each school. Survey results suggested that departmental lesbian, gay, bisexual, and transgender research and curricular activities extending beyond HIV and AIDS were uncommon in most public health school programs. Expanding lesbian, gay, bisexual, and transgender health research and curricula may help health professionals improve their response to lesbian, gay, bisexual, and transgender health disparities.
Male-to-Female Transgender and Transsexual Clients of HIV Service Programs in Los Angeles County, California
Authors: Edwards Jordan W. , Fisher Dennis G. , Reynolds Grace L.
Published: April 2007

Data on HIV risk were collected with the Countywide Risk Assessment Survey from 2126 participants; 92 were male-to-female transgender persons (i.e., cross-dressers, and those who identify with the opposite sex), and 9 were male-to-female transsexual individuals (i.e., those who have undergone gender-reassignment surgery or other procedures). Transgender-identified individuals were more likely than the rest of the sample to have received hormone injections, offensive comments, and HIV testing; injected hormones with a used needle; been Asian or American Indian; been paid for sexual intercourse; and lived in unstable housing but less likely to have used heroin. Transgender-identified individuals are at high risk for HIV infection because of reuse of needles and being paid for sexual intercourse.
Cytoskeleton Vimentin Disruption of Mouse Sertoli Cells Injured by Nitrogen Mustard In Vitro
Authors: He Dawei , Zhang Deying , Wei Guanghui , Lin Tao , Li Xuliang
Published: April 2007

ABSTRACT: Reproductive toxicity is one of the potential side effects of anticancer alkylating agents, with potential effects on vimentin intermediate filaments, one of the main components of the Sertoli cytoskeleton. Research suggests (Aumuller et al, 1988; Aumuller et al, 1992) that the highly organized and active Sertoli cytoskeleton is important in spermatogenesis. The aim of the current study was to investigate the effects of alkylating agents on vimentin filament expression in vitro. Sertoli cells, isolated from 20‐day‐old mice testes, were cultured for 5 days and then incubated with 0, 50, 100, and 200 μmol/L nitrogen mustard (HN2). Morphologic changes in Sertoli cells were observed per 30‐minute interval at 12‐hour exposure time points to 100 μmol/L HN2. Vimentin expression was investigated by immunocytochemistry at 6 hours and 24 hours posttreatment and reverse transcriptase polymerase chain reaction and Western blot at 12 hours posttreatment with 50, 100, and 200 μmol/L HN2. Exposure to HN2 resulted in a comparatively small Sertoli cell body with diminished cytoplasm. Sertoli cells were shrunk or detached. Cytoskeletal disruption increased with increasing HN2 concentration. The optical density values of vimentin antibody and expression of vimentin mRNA and protein were significantly decreased with increasing concentration of HN2. Significant treatment dose‐dependent and time‐dependent differences of vimentin mRNA and protein expression levels were also noted. Our data suggest that the change in the biochemical properties of vimentin may indicate that one of the mechanisms of reproductive toxicity resulting from HN2 is disruption of Sertoli cell vimentin filament structure, accompanied by a down‐regulation of vimentin expression.
Acrosome Reaction Induced by Recombinant Human Zona Pellucida 3 Peptides rhuZP3a22∼176 and rhuZP3b177∼348 and Their Mechanism
Authors: Ni Ya , Li Kun , Xu Wanxiang , Song Liwen , Yao Kangshou , Zhang Xinzong , Huang Hefeng , Zhang Yanling , Shi Qi‐Xian
Published: April 2007

ABSTRACT: To explore the biological characteristics of the recombinant zona pellucida 3 (ZP3) peptides of rhuZP3a22∼176 and rhuZP3b177∼348, we examined whether rhuZP3a22∼176 or rhuZP3b177∼348 trigger the acrosome reaction (AR) of human spermatozoa and we investigated the underlying mechanism. The assessment of AR was performed using chlortetracycline staining. The intracellular free calcium concentration ([Ca2+]i) in Fura‐2/AM‐loaded human sperm was monitored with a spectrofluorophotometer. We found that rhuZP3a22∼176 and rhuZP3b177∼348 were capable of eliciting AR at different concentrations. With the addition of either peptide, the [Ca2+]i level was raised to a peak with or without a plateau. The AR could be inhibited by pertussis toxin (PTX), EGTA, and pimozide (a T‐type calcium channel blocker), whereas verapamil was less effective in this regard. The results of the present study suggest that peptides rhuZP3a22∼176 and rhuZP3b177∼348 have a role similar to human ZP3, and that the mechanism of the response to the peptides involves influx of calcium, the G protein pathway, and a T‐type calcium channel.
Relationships Between Serum Hormone Levels and Semen Quality Among Men From an Infertility Clinic
Authors: Meeker John D. , Godfrey‐Bailey Linda , Hauser Russ
Published: April 2007

ABSTRACT: Participation rates in epidemiologic studies on semen quality are generally very low, raising concerns as to the potential for selection bias. Since hormones both initiate and maintain spermatogenesis, they may serve as surrogates of semen quality in epidemiologic studies. For this reason, in the present study, we explored the influence and predictive ability of reproductive and thyroid hormones on semen quality among men who were partners in an infertile couple. Between 1999 and 2003, 388 men were recruited from Massachusetts General Hospital Andrology Laboratory for clinical evaluation of fertility status. Fresh semen samples were assessed for quality (concentration, motility and morphology) and the serum levels of hormones, including follicle‐stimulating hormone (FSH), luteinizing hormone (LH), inhibin B, sex hormone‐binding globulin (SHBG), testosterone, free androgen index, free T4, total T3, and thyroid‐stimulating hormone (TSH), were measured. Multiple logistic regression revealed increased odds for below‐reference sperm concentration and morphology in men with increased FSH, and decreased odds for below‐reference sperm concentration and motility in men with increased inhibin B. When FSH and inhibin B were divided into quintiles, the relationships with sperm concentration showed evidence of a threshold value. However, the ability of specific FSH (10 IU/L) and/or inhibin B (80 pg/mL) cutoff values to predict semen quality was lower than in previous reports. In multiple linear regression analysis, FSH and LH were inversely associated with sperm concentration, motility, and morphology. Inhibin B and free T4 were positively associated with sperm concentration, while there was a suggestive positive association between testosterone and sperm motility. In conclusion, we have found that FSH, LH, inhibin B, testosterone and free T4 levels are associated with human semen parameters. Additional consideration should be given to the utility of serum hormone levels as a surrogate for semen quality in epidemiologic studies in which the collection of semen is difficult due to logistical and/or volunteer rate constraints.
Regional Variations in Semen Quality of Community‐Dwelling Young Men From Flanders Are Not Paralleled by Hormonal Indices of Testicular Function
Authors: Dhooge Willem , van Larebeke Nicolas , Comhaire Frank , Kaufman Jean‐Marc
Published: April 2007

ABSTRACT: Epidemiological studies of sperm quality are hampered by problems such as low participation rates and poor comparability of results due to methodological differences in semen analysis. More objective sperm quality‐related serum markers would facilitate worldwide comparisons of male reproductive status. Our objectives were to investigate to what extent a set of hormonal indices of testicular function, previously established in a clinical setting, could predict regional variations in seminal parameters in men from the general population. We recruited 101 men aged 20–40 years from two regions in Flanders, and assessed their sperm parameters and levels of serum reproductive hormones. In one region compared to another, the participants had lower sperm counts (by 34%; P = .06), lower total sperm counts (by 41%; P = .02) and poorer sperm morphology (by 32%; P < .001), which were paralleled by significantly lower levels of free testosterone (by 11%; P = .03), while for total testosterone (T) and follicle‐stimulating hormone (FSH), the differences were not significant (both P = .09) at 10% and 17%, respectively. There were no differences in inhibin B and the T to luteinizing hormone (LH) ratio, which are markers of testicular function. Receiver operating characteristic curve analysis revealed that T:LH, inhibin B, and the inhibin B/FSH ratio had significant discriminatory power between men with sperm concentrations below or above 13.5 × 106/mL. Regional variations in the semen quality of community‐dwelling individuals are not necessarily reflected in altered hormonal indices of testicular function and thus, these markers, validated in clinical settings, are not valid substitutes for the traditional semen quality assessment used in epidemiological population studies.
Role of Gemcitabine in the Treatment of Ovarian Cancer
Authors: AbuShahin Fadi , Rose Peter G
Published: April 2007

The US FDA has recently approved the combination of carboplatin and gemcitabine as a second-line therapy for recurrent platinum-sensitive ovarian cancer. This article briefly reviews the pharmacokinetics and mechanism of action of gemcitabine and its synergistic effect with platinum. An overview of the literature on the role of gemcitabine in the treatment of epithelial ovarian cancer is also presented.
Nonsurgical Transurethral Radiofrequency Treatment of Stress Urinary Incontinence in Women
Authors: Juma Saad , Appell Rodney A
Published: April 2007

A transurethral radiofrequency collagen denaturation system was recently approved by the US FDA for nonsurgical, outpatient treatment of women with stress urinary incontinence associated with urethral hypermobility. Controlled radiofrequency energy applied through a transurethral probe heats submucosal tissue to produce collagen denaturation, resulting in reduced tissue compliance without necrosis, thus distinguishing this procedure from transvaginal radiofrequency tissue ablation. Treatment can be administered in 30 min under local anesthesia, without incisions, use of cystoscopy or other visualization of the treatment site. Safety and efficacy have been demonstrated in several studies, including a 12-month, multicenter, sham-procedure-controlled clinical trial in 173 women with mild-to-moderate stress urinary incontinence. In patients receiving active treatment, two of the four groups experienced significant quality-of-life changes (p = 0.004; p = 0.02), and all women exhibited significant increases in Valsalva leak point pressure (p = 0.02 vs sham group).
Obstetricians and the Rights of Pregnant Women
Authors: Minkoff Howard , Paltrow Lynn M
Published: April 2007

At times, obstetricians are called upon to assist pregnant women in making clinical choices between options that may selectively disadvantage either the mother or the fetus. If a mother chooses a therapeutic course that disadvantages the fetus the physician may feel distressed. In this paper we argue that the choices made by mothers are almost always in the interests of the fetus, and supported by physicians. When there is disagreement it is often due to poor communication. While acknowledging that the rare circumstances in which the physician and patient wish to pursue different clinical paths can be stressful for the provider, we explain why obstetricians should accept the judgment of their patient in all instances. Finally, we will maintain that positing a choice between maternal and fetal interests is, in fact, creating a false choice, in as much as options are presented as being exclusive, when in fact that is not the case.
Advances in the Adjuvant and Neoadjuvant Treatment of Breast Cancer
Authors: Briest Susanne , Stearns Vered
Published: April 2007

Several advances in the adjuvant systemic therapy of primary breast cancer have occurred in the last decade and contributed to a decline in disease-related mortality. These include the introduction of aromatase inhibitors, new chemotherapy agents, and the novel antibody trastuzumab. New supportive treatments, such as growth factors, have contributed to the optimization of chemotherapy dose and schedule, and have improved the efficacy and safety of the treatment. In this review we will outline some of the recent advances in the adjuvant and neoadjuvant treatment of breast cancer. We will also discuss ongoing and proposed clinical trials.
Pro12Ala Polymorphism of the PPARγ2 Locus Modulates the Relationship Between Energy Intake and Body Weight in Type 2 Diabetic Patients
Authors: Vaccaro Olga , Lapice Emanuela , Monticelli Antonella , Giacchetti Manuela , Castaldo Imma , Galasso Rocco , Pinelli Michele , Donnarumma Giovanna , Rivellese Angela A. , Cocozza Sergio , Riccardi Gabriele
Published: April 2007

OBJECTIVE—We explore the relationship among BMI, habitual diet, and the Pro12Ala polymorphism in the peroxisome proliferator–activated receptor (PPAR)γ2.

RESEARCH DESIGN AND METHODS—The Pro12Ala variant was characterized in 343 unrelated type 2 diabetic patients who were consecutively seen at the outpatient clinic of a health district of the province of Naples. Anthropometric and laboratory parameters were measured; habitual diet was assessed by a validated semiquantitative food frequency questionnaire.

RESULTS—The overall frequency of Ala12 was 12% (n = 42). BMI was significantly higher in Ala carriers than non-Ala carriers, whereas total daily energy intake or macronutrient composition of the diet were similar in the two groups. For further analysis, participants were stratified according to genotype and sex-specific quartiles of energy intake. BMI increased in both genotype groups with increasing energy intake (P < 0.03). BMI was similar in Ala carriers and non-Ala carriers (30.0 vs. 30.1 kg/m2, P > 0.10) in the lower quartile of energy intake but significantly higher in Ala carriers in the upper quartile (36.0 vs. 32.1 kg/m2, P < 0.001). Average daily energy intake and diet composition were comparable within each quartile for carriers or noncarriers of the Ala allele. Relative to the noncarriers, Ala carriers had a significantly lower energy intake per kilogram body weight, thus suggesting that the Ala allele is associated with a higher food efficiency. The confounding role of medications, glucose control, and physical exercise was ruled out.

CONCLUSIONS—This study provides evidence of a differential susceptibility to fat accumulation, and, hence, weight gain, in response to habitual high energy intake for Ala carriers compared with Pro/Pro homozygotes.