bluuebunny/crossref_metadata_2025 huggingface dataset:
Cost-effectiveness of a participatory return-to-work intervention for temporary agency workers and unemployed workers sick-listed due to musculoskeletal disorders: design of a randomised controlled trial
Authors: Vermeulen Sylvia J , Anema Johannes R , Schellart Antonius JM , van Mechelen Willem , van der Beek Allard J
Published: March 2010

Background

Within the working population there is a vulnerable group: workers without an employment contract and workers with a flexible labour market arrangement, e.g. temporary agency workers. In most cases, when sick-listed, these workers have no workplace/employer to return to. Also, for these workers access to occupational health care is limited or even absent in many countries. For this vulnerable working population there is a need for tailor-made occupational health care, including the presence of an actual return-to-work perspective. Therefore, a participatory return-to-work program has been developed based on a successful return-to-work intervention for workers, sick-listed due to low back pain.

The objective of this paper is to describe the design of a randomised controlled trial to study the (cost-)effectiveness of this newly developed participatory return-to-work program adapted for temporary agency workers and unemployed workers, sick-listed due to musculoskeletal disorders, compared to usual care.

Methods/Design

The design of this study is a randomised controlled trial with one year of follow-up. The study population consists of temporary agency workers and unemployed workers sick-listed between 2 and 8 weeks due to musculoskeletal disorders. The new return-to-work program is a stepwise program aimed at making a consensus-based return-to-work implementation plan with the possibility of a (therapeutic) workplace to return-to-work. Outcomes are measured at baseline, 3, 6, 9 and 12 months. The primary outcome measure is duration of the sickness benefit period after the first day of reporting sick. Secondary outcome measures are: time until first return-to-work, total number of days of sickness benefit during follow-up; functional status; intensity of musculoskeletal pain; pain coping; and attitude, social influence and self-efficacy determinants. Cost-benefit is evaluated from an insurer's perspective. A process evaluation is part of this study.

Discussion

For sick-listed workers without an employment contract there can be gained a lot by improving occupational health care, including return-to-work guidance, and by minimising the 'labour market handicap' by creating a return-to-work perspective. In addition, reduction of sickness absence and work disability, i.e. a reduction of disability claims, may result in substantial benefits for the Dutch Social Security System.

Trial registration

Trial registration number: NTR1047.
Escherichia coli MW005: lambda Red-mediated recombineering and copy-number induction of oriV-equipped constructs in a single host
Authors: Westenberg Marcel , Bamps Sophie , Soedling Helen , Hope Ian A , Dolphin Colin T
Published: March 2010

Background

Escherichia coli strain EL350 contains chromosomally integrated phage lambda Red recombinase genes enabling this strain to be used for modifying the sequence of resident clones via recombineering. BAC and fosmid clones are highly suitable for modification by recombineering but, because they are present at low (1-2) copies per cell, the DNA is difficult to isolate in high yield and purity. To overcome this limitation vectors, e.g. pCC1FOS, have been constructed that contain the additional replication origin, oriV, which permits copy-number to be induced transiently when propagated in a suitable host strain, e.g. EPI300, that supplies the cognate trans-replication protein TrfA. Previously, we used EL350 and EPI300 sequentially to recombineer oriV-equipped fosmid genomic clones and, subsequently, to induce copy-number of the resulting recombinant clone. To eliminate these intervening DNA isolation and transformation steps we retrofitted EL350 with a P
BAD-driven trfA gene generating strain MW005 that supports, independently, both recombineering and copy-number induction.

Results

The P
BAD-driven copy of cre in EL350 was replaced seamlessly with a copy of trfA, PCR-amplified from EPI300 chromosomal DNA, to generate MW005. This new strain has been used to both generate, via recombineering, a number of reporter gene fusions directly from pCC1FOS-based Caenorhabditis elegans genomic clones and to transiently induce copy-number of fosmid and BAC clones prior to DNA preparation.

Conclusions

By retrofitting EL350, an established 'recombineering' E. coli strain, with a tightly regulated copy of trfA we have produced a new strain, MW005, which combines recombineering capacity with the useful ability to transiently induce copy-number of oriV-equipped clones. By coupling these two steps in a single strain, use of MW005 will enable the more rapid recombineering-mediated production of recombinant clones in the yield and quality necessary for many downstream purposes.
Multifactorial control and treatment intensity of type-2 diabetes in primary care settings in Catalonia
Authors: Mengual Lucas , Roura Pilar , Serra Marta , Montasell Montserrat , Prieto Gemma , Bonet Sandra
Published: March 2010

Background

Many studies on diabetes have demonstrated that an intensive control of glycaemia and the main associated risk factors (hypertension, dislipidaemia, obesity and smoking) reduce cardiovascular morbi-mortality. Different scientific societies have proposed a multifactorial approach to type 2 diabetes.

The objective of this study was to identify the degree of control of glycosylated haemoglobin (HbA1c) and of cardiovascular risk factors in type 2 diabetic patients, using the GedapS 2004 guidelines, and to analyse the type and intensity of drug treatment.

Methods

This cross-sectional, multicentre, epidemiological study was conducted in a primary care setting in Vallès Occidental South, Catalonia. Data were collected of 393 patients aged 18 and above who were diagnosed with diabetes mellitus type 2. Biodemographic and clinical data, cardiovascular risk factors, associated cardiovascular disease, and treatment were assessed. Descriptive and multivariable analysis with logistic regression was realized.

Results

A total of 392 patients with a mean age of 66.8 years (SD = 10.6) (45.4% male patients) were analyzed. The duration of diabetes was 8.4 years (SD = 7.6). The degree of multifactorial control of risk factors was only 2.6%, although in more than 50% individual cardiovascular risk factor was controlled, except for LDL cholesterol (40.6%) and systolic blood pressure (29.6%). Furthermore, only 13.0% of subjects had an optimal BMI, 27.5% an optimal waist circumference. Treatment for diabetes was prescribed in 82.7% of patients, for hypertension 70.7%, for dyslipidaemia 47.2% and 40.1% were taking antiplatelets.

Conclusion

Over 50% of type 2 diabetic patients presented optimal control of the majority of individual cardiovascular risk factors, although the degree of multifactorial control of diabetes was insufficient (2.6%) and should be improved. Drug treatment can be intensified using a larger number of combinations, particularly in patients with target organ damage and associated clinical cardiovascular disease.
Developmental and oncogenic effects of Insulin-like Growth Factor-I in Ptc1+/- mouse cerebellum
Authors: Tanori Mirella , Santone Melissa , Mancuso Mariateresa , Pasquali Emanuela , Leonardi Simona , Di Majo Vincenzo , Rebessi Simonetta , Saran Anna , Pazzaglia Simonetta
Published: March 2010

Background

Medulloblastoma is amongst the most common malignant brain tumors in childhood, arising from neoplastic transformation of granule neuron precursors (GNPs) of the cerebellum via deregulation of pathways involved in cerebellar development. Deregulation of the Sonic hedgehog/Patched1 (Shh/Ptc1) signaling pathway predisposes humans and mice to medulloblastoma. In the brain, insulin-like growth factor (IGF-I) plays a critical role during development as a neurotrophic and neuroprotective factor, and in tumorigenesis, as IGF-I receptor is often activated in medulloblastomas.

Results

To investigate the mechanisms of genetic interactions between Shh and IGF signaling in the cerebellum, we crossed nestin/IGF-I transgenic (IGF-I Tg) mice, in which transgene expression occurs in neuron precursors, with Ptc1

+/-
knockout mice, a model of medulloblastoma in which cancer develops in a multistage process. The IGF-I transgene produced a marked brain overgrowth, and significantly accelerated tumor development, increasing the frequency of pre-neoplastic lesions as well as full medulloblastomas in Ptc1

+/-
/IGF-I Tg mice. Mechanistically, tumor promotion by IGF-I mainly affected preneoplastic stages through de novo formation of lesions, while not influencing progression rate to full tumors. We also identified a marked increase in survival and proliferation, and a strong suppression of differentiation in neural precursors.

Conclusions

As a whole, our findings indicate that IGF-I overexpression in neural precursors leads to brain overgrowth and fosters external granular layer (EGL) proliferative lesions through a mechanism favoring proliferation over terminal differentiation, acting as a landscape for tumor growth. Understanding the molecular events responsible for cerebellum development and their alterations in tumorigenesis is critical for the identification of potential therapeutic targets.
Proteome analysis of soybean leaves, hypocotyls and roots under salt stress
Authors: Sobhanian Hamid , Razavizadeh Roya , Nanjo Yohei , Ehsanpour Ali Akbar , Jazii Ferdous Rastgar , Motamed Nasrin , Komatsu Setsuko
Published: March 2010

Background

Salinity is one of the most widespread agricultural problems in arid and semi-arid regions that makes fields unproductive, and soil salinization is a serious problem in the entire world. To determine the effects of salt stress on soybean seedlings, a proteomic technique was used.

Results

Soybean plants were exposed to 0, 20, 40, or 80 mM NaCl for one week. The effect of treatment at 20 mM NaCl on plant growth was not severe, at 80 mM NaCl was lethal, and at 40 mM NaCl was significant but not lethal. Based on these results, proteins were extracted from the leaves, hypocotyls and roots of soybean treated with 40 mM NaCl. Nineteen, 22 and 14 proteins out of 340, 330 and 235 proteins in the leaves, hypocotyls and roots, respectively, were up- and down-regulated by NaCl treatment. In leaves, hypocotyls and roots, metabolism related proteins were mainly down-regulated with NaCl treatment. Glyceraldehyde-3-phosphate dehydrogenase was down-regulated in the leaf/hypocotyls, and fructokinase 2 was down-regulated in the hypocotyls/root with NaCl treatment. Stem 31 kDa glycoprotein precursor was up-regulated in all three organs with NaCl treatment. Glyceraldehyde-3-phosphate dehydrogenase was specifically down-regulated at the RNA and protein levels by salt stress.

Conclusion

These results suggest that metabolism related proteins play a role in each organ in the adaptation to saline conditions.
A framework for evaluating the impact of the United Nations fellowship programmes
Authors: Rotem Arie , Zinovieff Michael A , Goubarev Alexandre
Published: March 2010

The United Nations (UN) System's agencies have been criticized for not adequately assessing the impact of their training and fellowship programmes. Critics point out that beyond documentation of the number of fellows that underwent training, and their immediate reaction to the experience, it is necessary to ascertain that fellows are using what they have learned, and most importantly that their institution and country are benefiting from the significant investments made in the fellowship programmes.

This paper presents an evaluation framework that was adopted by the 17th Meeting of the UN System Senior Fellowship Officers convened in London in 2008 in response to this challenge. It is arranged in three sections. First, the assumptions and constraints concerning impact evaluation of training are presented. Second, a framework for evaluating the impact of training in the context of UN System programmes is proposed. Third, necessary conditions and supportive measures to enable implementation of the impact evaluation framework are identified.

The critical message emerging from this review is the importance of constructing a 'performance story' based on key milestones associated with the design and implementation of fellowship programmes as a way of assessing the contribution of different components of the fellowship programmes to institutional outcomes.
Neighbourhood physical activity environments and adiposity in children and mothers: a three-year longitudinal study
Authors: Timperio Anna , Jeffery Robert W , Crawford David , Roberts Rebecca , Giles-Corti Billie , Ball Kylie
Published: March 2010

Background

Although neighbourhood environments are often blamed for contributing to rising levels of obesity, current evidence is based predominantly on cross-sectional samples. This study examined associations between objectively-measured environmental characteristics of neighbourhoods and adiposity cross-sectionally and longitudinally over three years in children and their female carers.

Methods

Longitudinal study of 140 5-6 year-old and 269 10-12 year-old children and their female carers (n = 369). At baseline (2001) and follow-up (2004), height and weight were measured among children and self-reported among female carers, and were used to compute BMI z-scores and BMI, respectively. A Geographic Information System determined access to destinations (public open spaces, sports options, walking/cycling tracks), road connectivity (density of cul-de-sacs and intersections, proportion of 4-way intersections, length of 'access' paths (overpasses, access lanes, throughways between buildings)) and traffic exposure (length of 'busy' and 'local' roads) within 800 m and 2 km of home. Univariate and multivariable linear regression analyses examined associations between environmental characteristics and BMI/BMI z-scores at baseline and change in BMI/BMI z-scores over the three years.

Results

Cross-sectionally, BMI z-score was inversely associated with length (km) of access paths within 800 m (b = -0.50) and 2 km (b = -0.16) among younger and number of sport/recreation public open spaces (b = -0.14) and length (km) of 'access' paths (b = -0.94) within 800 m and length of local roads within 2 km (b = -0.01) among older children. Among female carers, BMI was associated with length (km) of walking/cycling tracks (b = 0.17) and busy roads (b = -0.34) within 800 m. Longitudinally, the proportion of intersections that were 4-way (b = -0.01) within 800 m of home was negatively associated with change in BMI z-score among younger children, while length (km) of access paths (b = 0.18) within 800 m was significant among older children. Among female carers, options for aerobics/fitness and swimming within 2 km were associated with change in BMI (B = -0.42).

Conclusion

A small number of neighbourhood environment features were associated with adiposity outcomes. These differed by age group and neighbourhood scale (800 m and 2 km) and were inconsistent between cross-sectional and longitudinal findings. However, the results suggest that improvements to road connectivity and slowing traffic and provision of facilities for leisure activities popular among women may support obesity prevention efforts.
Tax gene expression and cell cycling but not cell death are selected during HTLV-1 infection in vivo
Authors: Zane Linda , Sibon David , Jeannin Lionel , Zandecki Marc , Delfau-Larue Marie-Hélène , Gessain Antoine , Gout Olivier , Pinatel Christiane , Lançon Agnès , Mortreux Franck , Wattel Eric
Published: March 2010

Background

Adult T cell leukemia results from the malignant transformation of a CD4+ lymphoid clone carrying an integrated HTLV-1 provirus that has undergone several oncogenic events over a 30-60 year period of persistent clonal expansion. Both CD4+ and CD8+ lymphocytes are infected in vivo; their expansion relies on CD4+ cell cycling and on the prevention of CD8+ cell death. Cloned infected CD4+ but not CD8+ T cells from patients without malignancy also add up nuclear and mitotic defects typical of genetic instability related to theexpression of the virus-encoded oncogene tax. HTLV-1 expression is cancer-prone in vitro, but in vivo numerous selection forces act to maintain T cell homeostasis and are possibly involved in clonal selection.

Results

Here we demonstrate that the HTLV-1 associated CD4+ preleukemic phenotype and the specific patterns of CD4+ and CD8+ clonal expansion are in vivo selected processes. By comparing the effects of recent (1 month) experimental infections performed in vitro and those observed in cloned T cells from patients infected for >6-26 years, we found that in chronically HTLV-1 infected individuals, HTLV-1 positive clones are selected for tax expression. In vivo, infected CD4+ cells are positively selected for cell cycling whereas infected CD8+ cells and uninfected CD4+ cells are negatively selected for the same processes. In contrast, the known HTLV-1-dependent prevention of CD8+ T cell death pertains to both in vivo and in vitro infected cells.

Conclusions

Therefore, virus-cell interactions alone are not sufficient to initiate early leukemogenesis in vivo.
GPG-NH2acts via the metabolite αHGA to target HIV-1 Env to the ER-associated protein degradation pathway
Authors: Jejcic Alenka , Höglund Stefan , Vahlne Anders
Published: March 2010

Background

The synthetic peptide glycyl-prolyl-glycine amide (GPG-NH2) was previously shown to abolish the ability of HIV-1 particles to fuse with the target cells, by reducing the content of the viral envelope glycoprotein (Env) in progeny HIV-1 particles. The loss of Env was found to result from GPG-NH2targeting the Env precursor protein gp160 to the ER-associated protein degradation (ERAD) pathway during its maturation. However, the anti-viral effect of GPG-NH2has been shown to be mediated by its metabolite α-hydroxy-glycineamide (αHGA), which is produced in the presence of fetal bovine serum, but not human serum. In accordance, we wanted to investigate whether the targeting of gp160 to the ERAD pathway by GPG-NH2was attributed to its metabolite αHGA.

Results

In the presence of fetal bovine serum, GPG-NH2, its intermediary metabolite glycine amide (G-NH2), and final metabolite αHGA all induced the degradation of gp160 through the ERAD pathway. However, when fetal bovine serum was replaced with human serum only αHGA showed an effect on gp160, and this activity was further shown to be completely independent of serum. This indicated that GPG-NH2acts as a pro-drug, which was supported by the observation that it had to be added earlier to the cell cultures than αHGA to induce the degradation of gp160. Furthermore, the substantial reduction of Env incorporation into HIV-1 particles that occurs during GPG-NH2treatment was also achieved by treating HIV-1 infected cells with αHGA.

Conclusions

The previously observed specificity of GPG-NH2towards gp160 in HIV-1 infected cells, resulting in the production of Env (gp120/gp41) deficient fusion incompetent HIV-1 particles, was most probably due to the action of the GPG-NH2metabolite αHGA.
Antibodies to actin in autoimmune haemolytic anaemia
Authors: Felder Kathrin M , Hoelzle Katharina , Heinritzi Karl , Ritzmann Mathias , Hoelzle Ludwig E
Published: March 2010

Background

In autoimmune haemolytic anaemia (AIHA), autoreactive antibodies directed against red blood cells are up-regulated, leading to erythrocyte death.Mycoplasma suisinfections in pigs induce AIHA of both the warm and cold types. The aim of this study was to identify the target autoantigens of warm autoreactive IgG antibodies. Sera from experimentallyM. suis-infected pigs were screened for autoreactivity.

Results

Actin-reactive antibodies were found in the sera of 95% of all animals tested. The reactivity was species-specific, i.e. reactivity with porcine actin was significantly higher than with rabbit actin. Sera of animals previously immunised with theM. suisadhesion protein MSG1 showed reactivity with actin prior to infection withM. suisindicating that molecular mimicry is involved in the specific autoreactive mechanism. A potentially cross-reactive epitope was detected.

Conclusions

This is the first report of autoreactive anti-actin antibodies involved in the pathogenesis of autoimmune haemolytic anaemia.
Perioperative infusion of low- dose of vasopressin for prevention and management of vasodilatory vasoplegic syndrome in patients undergoing coronary artery bypass grafting-A double-blind randomized study
Authors: Papadopoulos Georgios , Sintou Eleni , Siminelakis Stavros , Koletsis Efstratios , Baikoussis Nikolaos G , Apostolakis Efstratios
Published: March 2010

Preoperative medication by inhibitors of angiotensin-converting enzyme (ACE) in coronary artery patients predisposes to vasoplegic shock early after coronary artery bypass grafting. Although in the majority of the cases this shock is mild, in some of them it appears as a situation, "intractable" to high-catecholamine dose medication. In this study we examined the possible role of prophylactic infusion of low-dose vasopressin, during and for the four hours post-bypass after cardiopulmonary bypass, in an effort to prevent this syndrome. In addition, we studied the influence of infused vasopressin on the hemodynamics of the patients, as well as on the postoperative urine-output and blood-loss. In our study 50 patients undergoing coronary artery bypass grafting were included in a blind-randomized basis. Two main criteria were used for the eligibility of patients for coronary artery bypass grafting: ejection fraction between 30-40%, and patients receiving ACE inhibitors, at least for four weeks preoperatively. The patients were randomly divided in two groups, the group A who were infused with 0.03 IU/min vasopressin and the group B who were infused with normal saline intraoperativelly and for the 4 postoperative hours. Measurements of mean artery pressure (MAP), central venous pressure (CVP), systemic vascular resistance (SVR), ejection fracture (EF), heart rate (HR), mean pulmonary artery pressure (MPAP), cardiac index (CI) and pulmonary vascular resistance (PVR) were performed before, during, and after the operation. The requirements of catecholamine support, the urine-output, the blood-loss, and the requirements in blood, plasma and platelets for the first 24 hours were included in the data collected. The incidence of vasodilatory shock was significantly lower (8% vs 20%) in group A and B respectively (p = 0,042). Generally, the mortality was 12%, exclusively deriving from group B. Postoperatively, significant higher values of MAP, CVP, SVR and EF were recorded in the patients of group A, compared to those of group B. In group A norepinephrine was necessary in fewer patients (p = 0.002) and with a lower mean dose (p = 0.0001), additive infusion of epinephrine was needed in fewer patients (p = 0.001), while both were infused for a significant shorter infusion-period (p = 0.0001). Vasopressin administration (for group A) was associated with a higher 24 hour diuresis) (0.0001).

In conclusion, low-dose of infused vasopressin during cardiopulmonary bypass and for the next 4 hours is beneficial for its postoperative hemodynamic profile, reduces the doses of requirements of catecholamines and contributes to prevention of the postcardiotomy vasoplegic shock in the patient with low ejection fraction who is receiving ACE preoperatively.
The detection, treatment, and biology of epithelial ovarian cancer
Authors: Gubbels Jennifer AA , Claussen Nick , Kapur Arvinder K , Connor Joseph P , Patankar Manish S
Published: March 2010

Ovarian cancer is particularly insidious in nature. Its ability to go undetected until late stages coupled with its non-descript signs and symptoms make it the seventh leading cause of cancer related deaths in women. Additionally, the lack of sensitive diagnostic tools and resistance to widely accepted chemotherapy regimens make ovarian cancer devastating to patients and families and frustrating to medical practitioners and researchers. Here, we provide an in-depth review of the theories describing the origin of ovarian cancer, molecular factors that influence its growth and development, and standard methods for detection and treatment. Special emphasis is focused on interactions between ovarian tumors and the innate and adaptive immune system and attempts that are currently underway to devise novel immunotherapeutic approaches for the treatment of ovarian tumors.
A novel Aβ isoform pattern in CSF reflects γ-secretase inhibition in Alzheimer disease
Authors: Portelius Erik , Dean Robert A , Gustavsson Mikael K , Andreasson Ulf , Zetterberg Henrik , Siemers Eric , Blennow Kaj
Published: March 2010

Introduction

LY450139 (semagacestat) inhibits γ-secretase, a key enzyme for generation of amyloid β (Aβ), the peptide deposited in plaques in Alzheimer disease (AD). Previous data have shown that LY450139 lowers plasma Aβ, but has no clear effect on Aβ1-40 or Aβ1-42 levels in cerebrospinal fluid (CSF). By using targeted proteomics techniques, we recently identified several shorter Aβ isoforms, such as Aβ1-16, that in experimental settings increase during γ-secretase inhibitor treatment, and thus may serve as sensitive biochemical indices of the treatment effect. Here, we test the hypothesis that these shorter Aβ isoforms may be biomarkers of γ-secretase inhibitor treatment in clinical trials.

Methods

In a phase II clinical trial, 35 individuals with mild to moderate AD were randomized to placebo (n = 10) or LY450139 (100 mg (n = 15) or 140 mg (n = 10)) and underwent lumbar puncture at baseline and after 14 weeks of treatment. The CSF Aβ isoform pattern was analyzed with immunoprecipitation combined with MALDI-TOF mass spectrometry.

Results

The CSF levels of Aβ1-14, Aβ1-15, and Aβ1-16 showed a dose-dependent increase by 57% and 74%, 21% and 35%, and 30% and 67%, respectively in the 100-mg and 140-mg treatment groups. Aβ1-40 and Aβ1-42 were unaffected by treatment.

Conclusions

CSF Aβ1-14, Aβ1-15, and Aβ1-16 increase during γ-secretase inhibitor treatment in AD, even at doses that do not affect Aβ1-42 or Aβ1-40, probably because of increased substrate availability of the C99 APP stub (APP β-CTF) induced by γ-secretase inhibition. These Aβ isoforms may be novel sensitive biomarkers to monitor the biochemical effect in clinical trials.

Trial registration

Clinical Trials.gov NCT00244322
Influence of Factor V Leiden on susceptibility to and outcome from critical illness: a genetic association study
Authors: Benfield Thomas , Ejrnæs Karen , Juul Klaus , Østergaard Christian , Helweg-Larsen Jannik , Weis Nina , Munthe-Fog Lea , Kronborg Gitte , Andersen Marianne Ring , Tybjærg-Hansen Anne , Nordestgaard Børge G , Garred Peter
Published: March 2010

Introduction

Disturbance of the pro-coagulatant and anti-coagulant balance is associated with a poor outcome from critical illness. The objective of this study is to determine whether the Factor V Leiden (FVL) mutation is associated with susceptibility to or death from critical illness.

Methods

A genetic association study involving four case cohorts comprising two Gram negative sepsis, one invasive pneumococcal disease and one intensive care unit cohort with a total of 1,249 patients. Controls were derived from a population-based cohort study (N = 8,147). DNA from patients and controls was genotyped for the FVL mutation.

Results

When all patients were investigated together no significant difference in the frequency of FVL mutation was observed compared with controls (odds ratio (OR), 1.03; 95% confidence interval (CI), 0.83 to 1.29). However, when stratified among patients admitted to intensive care (N = 237), susceptibility and the likelihood of long-term death was influenced by the FVL mutation. In adjusted logistic regression analysis, FVL carriers had an increased risk of ICU admission compared to non-carriers (OR 1.62; 95% CI, 1.08 to 2.42). In adjusted Cox regression analysis, FVL carriers were at increased risk of long-term death compared to non-carriers (relative risk 1.78; 95% CI, 1.13 to 2.81). FVL carrier status did not predict either susceptibility to or outcome from Gram negative, Escherichia coli or Streptococcus pneumoniae sepsis.

Conclusions

Overall, the FVL mutation did not appear to increase the risk of admission due to severe invasive infections. Nevertheless, in the subgroup of patients admitted to intensive care an increased risk and a poorer long-term outcome for individuals with critical illness were observed for FVL mutation carriers.
Prognostic value of cell-free plasma DNA in patients with cardiac arrest outside the hospital: an observational cohort study
Authors: Arnalich Francisco , Menéndez Marta , Lagos Verónica , Ciria Enrique , Quesada Angustias , Codoceo Rosa , Vazquez Juan José , López-Collazo Eduardo , Montiel Carmen
Published: March 2010

Introduction

Many approaches have been examined to try to predict patient outcome after cardiopulmonary resuscitation. It has been shown that plasma DNA could predict mortality in critically ill patients but no data are available regarding its clinical value in patients after out-of-hospital cardiac arrest. In this study we investigated whether plasma DNA on arrival at the emergency room may be useful in predicting the outcome of these patients.

Methods

We performed a prospective study of out-of-hospital patients with cardiac arrest who achieved return of spontaneous circulation after successful resuscitation. Cardiovascular co-morbidities and resuscitation history were recorded according to the Utstein Style. The outcome measures were 24 h and overall in-hospital mortality. Cell-free plasma DNA was measured by real-time quantitative PCR assay for the β-globin gene in blood samples drawn within two hours after the arrest. Descriptive statistics, multiple logistic regression analysis, and receiver operator characteristic (ROC) curves were calculated.

Results

Eighty-five consecutive patients were analyzed with a median time to return of spontaneous circulation of 27 minutes (interquartile range (IQR) 18 to 35). Thirty patients died within 24 h and 58 died during the hospital course. Plasma DNA concentrations at admission were higher in non-survivors at 24 h than in survivors (median 5,520 genome equivalents (GE)/ml, vs 2810 GE/ml, P < 0.01), and were also higher in patients who died in the hospital than in survivors to discharge (median 4,150 GE/ml vs 2,460 GE/ml, P < 0.01). Lactate clearance at six hours was significantly higher in 24 h survivors (P < 0.05). The area under the ROC curves for plasma DNA to predict 24-hour mortality and in-hospital mortality were 0.796 (95% confidence interval (CI) 0.701 to 0.890) and 0.652 (95% CI 0.533 to 0.770). The best cut-off value of plasma DNA for 24-h mortality was 4,340 GE/ml (sensitivity 76%, specificity 83%), and for in-hospital mortality was 3,485 GE/ml (sensitivity 63%, specificity 69%). Multiple logistic regression analysis showed that the risk of 24-h and of in-hospital mortality increased 1.75-fold and 1.36-fold respectively, for every 500 GE/ml increase in plasma DNA.

Conclusions

Plasma DNA levels may be a useful biomarker in predicting outcome after out-of hospital cardiac arrest.
Elderly patients undergoing mechanical ventilation in and out of intensive care units: a comparative, prospective study of 579 ventilations
Authors: Lieberman David , Nachshon Liat , Miloslavsky Oleg , Dvorkin Valery , Shimoni Avi , Zelinger Julian , Friger Michael , Lieberman Devora
Published: March 2010

Introduction

Many mechanically ventilated elderly patients in Israel are treated outside of intensive care units (ICUs). The decision as to whether these patients should be treated in ICUs is reached without clear guidelines. We therefore conducted a study with the aim of identifying triage criteria and factors associated with in-hospital mortality in this population.

Methods

All mechanically invasive ventilated elderly (65+) medical patients in the hospital were included in a prospective, non-interventional, observational study.

Results

Of the 579 ventilations, 283 (48.9%) were done in ICUs compared with 296 (51.1%) in non-ICU wards. The percentage of ICU ventilations in the 65 to 74, 75 to 84, and 85+ age groups was 62%, 45%, and 23%, respectively. The decision to ventilate in ICUs was significantly and independently influenced by age (Odds Ratio (OR) = 0.945, P < 0.001), and pre-hospitalization functional status by functional independence measure (FIM) scale (OR = 1.054, P < 0.001). In-hospital mortality was 53.0% in ICUs compared with 68.2% in non-ICU wards (P < 0.001), but the rate was not independently and significantly affected by hospitalization in ICUs.

Conclusions

In Israel, most elderly patients are ventilated outside ICUs and the percentage of ICU ventilations decreases as age increases. In our study groups, the lower mortality among elderly patients ventilated in ICUs is related to patient characteristics and not to their treatment in ICUs per se. Although the milieu in which this study was conducted is uncommon today in the western world, its findings point to possible means of managing future situations in which the demand for mechanical ventilation of elderly patients exceeds the supply of intensive care beds. Moreover, the findings of this study can contribute to the search for ways to reduce costs without having a negative effect on outcome in ventilated elderly patients.
Depopulation, Fascism, and Eugenics in 1930s Argentina
Authors: Reggiani Andrés H.
Published: March 2010

The article explores the reception of eugenics in Argentina in the 1930s. It aims, first, to place eugenics as a topic of expert and public concern against the background of the “demographic fears” associated with the decline of the birthrate among the white population and the closing of European immigration that followed the world depression. Second, it underscores the role played by Italian and German cultural and scientific transnational networks in the reception and dissemination of medical ideas of race improvement. Based upon previously overlooked sources of the Prussian state archives, the essay seeks to revise conventional “neo-Lamarckian” explanations about Latin America’s (and Argentina’s) alleged immunity to negative eugenics. By examining the activities of the Asociación de Biotipología, the debates of the Second Pan-American Conference on Eugenics, and the academic exchanges fostered by the Deutsche-Iberoamerikanische Ärzteakademie, the article argues that Argentine medical practitioners were much more receptive to eugenic sterilization than previously claimed. As they made great efforts to separate it from other “unscientific” forms of racism, they lent credibility to practices which, as recent research has shown, many of them had adopted on allegedly therapeutic grounds.
“Women's Time” in Theory
Authors: Apter Emily
Published: March 2010

Taking Julia Kristeva's “Women's Time” as its point of departure, this article considers contemporary feminist theory and its contributions to recent theoretical paradigms of temporality. From Kristeva's understanding of women's subjectivity in relation to “linear time as the time of project and history,” this essay engages the various ways that feminism has thought the temporal, arriving at a notion of the démodé. The démodé, in its multivalent capacity as an aesthetic function of women's time, is explored in the photographs of Moyra Davey, whose work, this article argues, enables us to see the démodé as a mechanism that makes possible the radical dispossession of time.
Unbelonging: In Motion
Authors: Khanna Ranjana
Published: March 2010

This essay considers the clash of different notions of difference as they exist philosophically (through the work of poststructuralism) and sociologically (through diverse placement in the world). It highlights an idea of movement and oceanic archive as a way of resisting notions of belonging tied to dwelling articulated in the work of Martin Heidegger. It also strives to understand how the postcolonial emerges in ways quite distinct from any notion of identity, with its often unexamined claim to a politics of injury. The author considers the importance of theory as moving across the queer aesthetic of Isaac Julien. Understanding Julien's use of citation and technology allows for an aesthetic elaboration of difference that highlights the persistence of modernism in postcolonial installations. It reinvests the idea of hope in modernism through a postcolonial lens that both laments and looks to a different future. In so doing, the essay considers how archival reference emerges through altered vision and different technologies.
Here Are the Dogs: Poverty in Theory
Authors: Salamon Gayle
Published: March 2010

This essay considers the difficulties of representing poverty, its conditions and phenomenology, in narrative and asks after the relation between language and poverty. Are there unique pressures on narrative when it is asked to describe deprivation? What are the conditions of its speakability? And what investments and theoretical suppositions attend the assertion of poverty as a position of narrative impossibility, or of asserting the impossibility, for the poor, of inhabiting a speaking subject position? Through a reading of William Vollmann's Poor People and George Orwell's Down and Out in Paris and London, the author asks whether there is a paucity of theory about poverty in contemporary discourses of identity and why that might be so. Orwell and Vollmann each offer a moralist anti-aesthetic and suspicion of rhetorical complexity commonly found in literary representations of poverty, and they represent the poor as subjects dislocated from both voice and temporality, asserting the experience of poverty as that which cannot be given voice and offering the narrator as a figure redeemed from poverty precisely through his narration. If poverty is the end of the future, as Orwell suggests, what temporality does that offer for either the subject or the narrator of poverty?
Complexity and Whole-System Change Programmes
Authors: Dattée Brice , Barlow James
Published: March 2010

Objective

There has been growing interest in applying complexity theory to health care systems, both in policy and academic research discourses. However, its application often lacks rigour - authors discuss the properties of complex systems, state that they apply to health care and draw conclusions anchored around the idea of ‘whole system change’. This paper explores the use of whole systems change in a programme to improve the delivery of unscheduled health care in Scotland.

Methods

Qualitative case-studies of five health boards in Scotland reflecting different demographics, initial performance data and progress towards meeting programme targets.

Results

The programme's collaborative approach was successful in moving to a culture of mutual understanding and greater awareness of the interdependencies between different functions within the hospitals. There was whole system working at the acute hospital level, leading to improved patient flows. But despite recognizing the need for whole system change overall, it proved hard to address relationships with stakeholders influencing wider out-of-hospital patient flows. This was exacerbated by the structure of the programme, which was designed much more around acute patient flows.

Conclusions

The programme worked well to improve performance by focusing on interdependencies within a large part of the acute care subsystem but did not have the same impact at the overall health care system level. This has important implications for the design of policy and associated programmes which seek to effect whole system reform, or at least are realistic about the magnitude of change they can achieve.
Sex Redefined: The Reclassification Of Oral‐Genital Contact
Authors: Hans Jason D. , Gillen Martie , Akande Katrina
Published: March 2010

CONTEXT: Although partially anecdotal, some evidence suggests that oral‐genital contact is increasingly excluded from young people's notions of what behaviors constitute sex. Such a shift may have implications for STD prevention.

METHODS: In 2007, a convenience sample of 477 university students participated in a survey that included the question “Would you say you ‘had sex’ with someone if the most intimate behavior you engaged in was” each of 11 behaviors. Chi‐square tests and independent samples t tests were used to assess gender differences, and chi‐square analyses were used to compare the data with similar data collected in 1991. Predictors of beliefs concerning the classification of oral‐genital contact were assessed using logistic regression analysis.

RESULTS: The majority of respondents indicated that penile‐vaginal intercourse and penile‐anal intercourse constitute sex (98% and 78%, respectively), but only about 20% believed the same was true of oral‐genital contact. The proportion classifying oral‐genital contact as sex in 2007 was about half that in 1991. This difference was consistent for both sexes and for both giving and receiving oral‐genital stimulation. Responses did not vary by respondents’ sexual experience or demographic characteristics.

CONCLUSIONS: Sociocultural conceptualizations of oral‐genital contact have shifted in a way that may leave people who engage in this activity unmindful of its potential health risks. Sex education programs, which generally focus on penile‐vaginal contact, could help STD prevention efforts by explaining the risks associated with oral‐genital stimulation and the measures that can be taken to minimize those risks.
Medicaid Funding for Abortion: Providers’ Experiences with Cases Involving Rape, Incest and Life Endangerment
Authors: Kacanek Deborah , Dennis Amanda , Miller Kate , Blanchard Kelly
Published: March 2010

CONTEXT: The Hyde Amendment bans federal Medicaid funding for abortion in the United States except if a pregnancy resulted from rape or incest or endangers the life of the woman. Some evidence suggests that providers do not always receive Medicaid reimbursement for abortions that should qualify for funding.

METHODS: From October 2007 to February 2008, semistructured in‐depth interviews about experiences with Medicaid reimbursement for qualifying abortions were conducted with 25 respondents representing abortion providers in six states. A thematic analysis approach was used to explore respondents’ knowledge of and experiences seeking Medicaid reimbursement for qualifying abortions, as well as individual, clinical and structural influences on reimbursement. The numbers of qualifying cases that were and were not reimbursed were assessed.

RESULTS: More than half of Medicaid‐eligible cases reported by respondents in the past year were not reimbursed. Respondents reported that filing for reimbursement takes excessive staff time and is hampered by bureaucratic claims procedures and ill‐informed Medicaid staff, and that reimbursements are small. Many had stopped seeking Medicaid reimbursement and relied on nonprofit abortion funds to cover procedure costs. Respondents reporting receiving reimbursement said that streamlined forms, a statewide education intervention and a legal intervention to ensure that Medicaid reimbursed claims facilitated the process.

CONCLUSIONS: The policy governing federal funding of abortion is inconsistently implemented. Eliminating administrative burdens, educating providers about women’s rights to obtain Medicaid reimbursement for abortion in certain circumstances and holding Medicaid accountable for reimbursing qualifying cases are among the steps that may facilitate Medicaid reimbursement for qualifying abortions.
Spanish articles in Correntinean Guaraní: a comparison with Paraguayan Guaraní
Authors: Cerno Leonardo
Published: March 2010

This contribution offers a comparison between the usage of borrowed Spanish articles into two dialects of the Guaraní language spoken by mestizos in South America: Paraguayan Guaraní, spoken in Paraguay, and Correntinean Guaraní, spoken in the Argentinean province of Corrientes. With respect to the Paraguayan dialect, the presence of the definite feminine Spanish la and definite plural lo (> Sp. los ) has been attested early on by scholars (Gregores & Suárez 1967, Morínigo 1990, Thun 2006). On the other hand, borrowed articles in Correntinean Guaraní shape a more complex repertoire, including both definite masculine el, feminine la, and definite plural lo, as well as indefinites un and una. This article makes a comparative analysis of the usage of borrowed articles in both varieties. It also provides an overview of the historical and sociolinguistic background of both the Correntinean and Paraguayan varieties.
Lexical evidence for a redefinition of Paraguayan “Jopara”
Authors: Dietrich Wolf
Published: March 2010

Paraguay is characterized by a specific kind of bilingualism. More than 90% of the population does not use, in colloquial situations, only one of the official languages of the country, Spanish or Guaraní, but both of them in the same discourse. Continuous code switching is the main characteristic of this phenomenon, called “Jopara”. The article discusses the problem of the nature of this phenomenon and, moreover, gives lexical examples of the partial convergence of the two languages in contact. Speakers of Jopara distinguish the two linguistic systems, but are not always aware of the origin of some specific lexical items.
Searching for Recursive Causal Structures in Multivariate Quantitative Genetics Mixed Models
Authors: Valente Bruno D , Rosa Guilherme J M , de los Campos Gustavo , Gianola Daniel , Silva Martinho A
Published: March 2010

Biology is characterized by complex interactions between phenotypes, such as recursive and simultaneous relationships between substrates and enzymes in biochemical systems. Structural equation models (SEMs) can be used to study such relationships in multivariate analyses, e.g., with multiple traits in a quantitative genetics context. Nonetheless, the number of different recursive causal structures that can be used for fitting a SEM to multivariate data can be huge, even when only a few traits are considered. In recent applications of SEMs in mixed-model quantitative genetics settings, causal structures were preselected on the basis of prior biological knowledge alone. Therefore, the wide range of possible causal structures has not been properly explored. Alternatively, causal structure spaces can be explored using algorithms that, using data-driven evidence, can search for structures that are compatible with the joint distribution of the variables under study. However, the search cannot be performed directly on the joint distribution of the phenotypes as it is possibly confounded by genetic covariance among traits. In this article we propose to search for recursive causal structures among phenotypes using the inductive causation (IC) algorithm after adjusting the data for genetic effects. A standard multiple-trait model is fitted using Bayesian methods to obtain a posterior covariance matrix of phenotypes conditional to unobservable additive genetic effects, which is then used as input for the IC algorithm. As an illustrative example, the proposed methodology was applied to simulated data related to multiple traits measured on a set of inbred lines.