bluuebunny/crossref_metadata_2025 huggingface dataset:
Absorption of sugars in the Egyptian fruit bat (Rousettus aegyptiacus): a paradox explained
Authors: Tracy Christopher R. , McWhorter Todd J. , Korine Carmi , Wojciechowski Michal S. , Pinshow Berry , Karasov William H.
Published: May 2007

Two decades ago D. J. Keegan reported results on Egyptian fruit bats(Rousettus aegyptiacus, Megachiroptera) that were strangely at odds with the prevailing understanding of how glucose is absorbed in the mammalian intestine. Keegan's in vitro tests for glucose transport against a concentration gradient and with phloridzin inhibition in fruit bat intestine were all negative, although he used several different tissue preparations and had positive control results with laboratory rats. Because glucose absorption by fruit bats is nonetheless efficient, Keegan postulated that the rapid glucose absorption from the fruit bat intestine is not through the enterocytes, but must occur via spaces between the cells. Thus, we hypothesized that absorption of water-soluble compounds that are not actively transported would be extensive in these bats, and would decline with increasing molecular mass in accord with sieve-like paracellular absorption. We did not presume from Keegan's studies that there is no Na+-coupled, mediated sugar transport in these bats, and our study was not designed to rule it out, but rather to quantify the level of possible non-mediated absorption. Using a standard pharmacokinetic technique, we fed,or injected intraperitonealy, the metabolically inert carbohydrates l-rhamnose (molecular mass=164 Da) and cellobiose (molecular mass=342 Da), which are absorbed by paracellular uptake, and 3-O-methyl-d-glucose (3OMd-glucose), a d-glucose analog that is absorbed via both mediated(active) and paracellular uptake. As predicted, the bioavailability of paracellular probes declined with increasing molecular mass (rhamnose,62±4%; cellobiose, 22±4%) and was significantly higher in bats than has been reported for rats and other mammals. In addition, fractional absorption of 3OMd-glucose was high (91±2%). We estimated that Egyptian fruit bats rely on passive, paracellular absorption for the majority of their glucose absorption (at least 55% of 3OMd-glucose absorption), much more than in non-flying mammals.
A Mobile Medical Care Approach Targeting Underserved Populations in post-Hurricane Katrina Mississippi
Authors: Krol David M , Redlener Michael , Shapiro Alan , Wajnberg Ania
Published: May 2007

On August 29, 2005, Hurricane Katrina devastated the Gulf Coast Mississippi region, damaging health care infrastructure and adversely affecting the health of populations left behind. Operation Assist, a project of the Children's Health Fund and the Columbia University Mailman School of Public Health, operated mobile medical units to provide health services to underserved populations in the affected areas. Data collected from all patient encounters from September 5–20, 2005 demonstrate that in addition to common respiratory illnesses, skin conditions, and minor injuries, a high proportion of visits were for vaccine administration and chronic medical problems including hypertension, diabetes, and asthma. Mobile medical units staffed by primary care clinicians experienced in dealing with the clinical and social needs of the underserved and comfortable working in a resource-poor environment can make a positive contribution to post-disaster care.
Mitigating the Health Effects of Disasters for Medically Underserved Populations: Electronic Health Records, Telemedicine, Research, Screening, and Surveillance
Authors: Mack Dominic , Brantley Katrina M , Bell Kimberly G
Published: May 2007

The Regional Coordinating Center for Hurricane Response (RCC) collaborated with the EXPORT Centers (Centers of Excellence in Partnerships for Community Outreach, Research on Health Disparities and Training) to rebuild, revitalize, and improve the health care infrastructure in the Gulf Coast states damaged by Hurricanes Katrina and Rita. This initiative aims to enhance the provision of health care by installing Electronic Health Records and Telepsychiatry systems throughout the Gulf Coast. Through the EXPORT Centers, the RCC plans to perform screening and surveillance projects within the communities and develop research projects focused on eliminating health disparities affecting underserved populations in the region. Another goal is to establish partnerships with EXPORT Centers, Community Health Centers, and other essential primary care practices in hurricane-ravaged communities. Through these partnerships, the overarching goal is to create a balanced health care system model that academic institutions can integrate into preventive care for emergency planning and research.
Another Russia? After the Leviathan
Authors: Aron Leon
Published: May 2007

Abstract: In the last three years, Russia has at least been inoculated against faith in false shortcuts, the most pernicious of which are order without law and democracy without liberty. It is impossible to say exactly when this realization might translate into renewed tolerance for conflicts and stalemates. The experience of other nations, however, suggests that this will happen when the deficiencies of the current political system begin to reverberate in increasingly more obvious and damaging ways throughout Russia’s economy and society.
The Pushback Against Democracy
Authors: Puddington Arch
Published: May 2007

Freedom appeared in a state of stagnation during 2006, according to Freedom House's annual Freedom in the World survey. The most significant development was the decline in freedom in Asia and continued poor performance in Russia and the former Soviet Union. Globally, many countries showed evidence of problems with press freedom, rule of law, and corruption. Freedom House also pointed to a growing "pushback" against democracy in such countries as Russia, Venezuela, Iran, China, Belarus, and Zimbabwe. Regimes used legalistic methods to smother independent media and marginalize nongovernmental organizations in a broad effort to eliminate sources of potential democratic ferment.
India’s Unlikely Democracy: Economic Growth and Political Accommodation
Authors: Sinha Aseema
Published: May 2007

Abstract: There is no doubt that India’s democracy has become stable, yet economic change could create distributional conflicts and stresses on its democratic institutions. Economic change and liberalization have served to reinforce and further stabilize democracy rather than undermining it. This has happened partly because of the nature of economic and social transition, which has allowed the rich many options in the private, urban, and global economy. Simultaneously, the poor are divided and seek redress through electoral and democratic channels. Weak coalition governments in the 1990s have responded to claims from the poor contributing to the continuing stability of Indian democracy.
Runx3/AML2/Cbfa3 Regulates Early and Late Chondrocyte Differentiation
Authors: Soung Do Y , Dong Yufeng , Wang Yong Jun , Zuscik Michael J , Schwarz Edward M , O'Keefe Regis J , Drissi Hicham
Published: May 2007

We studied the expression and function of Runx3 during chondrogenesis and chondrocyte maturation. We found that Runx3 is essential for mediating the early stage of endochondral ossification through cooperation with other Runx family members.

Introduction: Runx proteins are spatially and temporally co-expressed during skeletal formation. A cooperative and/or redundant function between these factors was postulated, yet the mechanisms underlying these cooperative effects are unknown.

Materials and Methods: Expression patterns of Runx3 transcripts were assessed during mouse embryonic developments and limb bud—derived mesenchymal cell differentiation into mature chondrocytes by real-time RT-PCR. Runx3 protein distribution was also determined by immunohistochemistry in mouse embryos. Runx3 gain and loss of function was performed through overexpression and siRNA knockdown of Runx3 into the limb bud—derived cell line MLB13MYC clone17, respectively. Co-transfection experiments were performed in clone 17 cells using the Runx1 promoter and Runx3 cDNA. Promoter activity was measured by luciferase reporter assay.

Results: Both Runx3 isoforms are significantly upregulated at the onset of cartilage mineralization and bone formation in E15.5 mice. This upregulation follows that of Sox9 and is concomitant with that of alkaline phosphatase. Furthermore, Runx3 expression remains high during later stages of embryonic development when the levels of osteocalcin are maximal. We determined the expression patterns of Runx3 during chondrogenesis and chondrocyte maturation using mouse limb bud—derived micromass cultures between days 3 and 21. Whereas Runx3 mRNAs are progressively upregulated between days 3 and 14, it is dramatically downregulated at day 21. Markers of chondrocyte maturation alkaline phosphatase and type X collagen are upregulated and maintained throughout the 21 days of culture. Runx3 role in mediating chondrocyte terminal differentiation through gain and loss of function in MLB13MYC clone17 shows that Runx3 regulates both early and late markers of chondrocyte maturation. Finally, Runx3 transcriptionally inhibits Runx1 expression in chondrocytes.

Conclusions: We show a role for Runx3 in mediating stage-specific chondrocyte maturation. Our study clearly suggests that, whereas Runx3 may cooperate with Runx2 to induce chondrocyte terminal differentiation, it inhibits Runx1 expression during late maturation.
Effect of Fracture on Bone Turnover Markers: A Longitudinal Study Comparing Marker Levels Before and After Injury in 113 Elderly Women
Authors: Ivaska Kaisa K , Gerdhem Paul , Åkesson Kristina , Garnero Patrick , Obrant Karl J
Published: May 2007

In this longitudinal, prospective, and population-based study (n = 1044), seven BTMs were assessed before and after trauma in 113 elderly women (85 with fractures). Markers were not altered in the immediate postfracture period but were clearly elevated during fracture repair. Recent fracture should thus be taken into account when markers are used in clinical practice.

Introduction: Fracture may influence the levels of bone turnover markers (BTM) and have implications for their use in clinical practice. In this longitudinal, prospective, and population-based study, we assessed prefracture levels of BTMs and compared them with postfracture levels of the same individuals immediately after fracture and during fracture repair. This is the first study in which the effect of fracture on bone markers has been evaluated with prefracture samples available.

Materials and Methods: Serum and urine were collected at the emergency unit from 85 women (77.9 ± 1.8 yr) who sustained a fracture after low-energy trauma and 28 controls (77.8 ± 2.0 yr) with similar trauma but no fracture. All were participants of the Malmö OPRA study (n = 1044), and pretrauma samples were collected 1.05 ± 0.85 yr before. Bone turnover was assessed by seven different BTMs reflecting different stages of bone metabolism {C-terminal cross-linked telopeptides of type I collagen [S-CTX], S-TRACP5b, N-terminal propeptides of type I collagen [S-PINP], serum osteocalcin (S-OC[1–49] and S-TotalOC), urinary deoxypyridinoline [U-DPD], and urinary osteocalcin [U-OC]}.

Results: BTMs sampled within a few hours after fracture were not altered from preinjury levels. Both bone formation and bone resorption markers were, however, significantly increased 4 mo after fracture. The elevation was most pronounced after hip fracture. Bone turnover remained elevated up to 12 mo after fracture.

Conclusions: We believe this study extends our knowledge on the skeletal postfracture metabolic processes. In addition, it may provide a basis for future means to monitor pharmacological intervention promoting fracture healing.
Maternal Age And Birth Weight Characteristics of Twins Born to Nulliparous Mothers: A Population Study
Authors: Blickstein Isaac , Goldman Ran D. , Mazkereth Ram
Published: May 2007

In order to examine birth weight characteristics of twins delivered to nulliparous mothers in relation to maternal age, we used a population-based cohort of Israeli twins delivered between 1993–98 to select all 4793 (37.6%) nulliparas who delivered twins. Maternal age was subdivided as less than 20 years, 20–24, 25–29, 30–34, 35–39, and 40 years or more. We counted the frequencies of each total twin birth weight (twin A+twin B) in each of three categories (less than 3000, 3000–4999, and more than 5000 g) and the frequency of very low birth weight (VLBW, less than 1500 g) neonates in each of the six maternal age categories. There were significantly more nulliparas in the twin population at age groups less 30 years and significantly less at ages 30 years or more. We found a highly significant inverse correlation between the proportion of nulliparas and maternal age group, decreasing from 71.8% at less than 20 years to 18.6% at age 35–39 years (% nulliparas = 85 − 13.7 × age group, Pearson R2 = 0.98). However, this trend changed abruptly to the observed figure of 25.9% nulliparas aged 40 years or more instead of the expected 2.8%. We failed to reveal any significant difference in birth weight characteristics between the maternal age groups (all p > 0.05, all confidence intervals included 1.0). The more than tenfold deviation of the observed from the predicted frequency of nulliparas aged 40 years or more suggests that a different relationship between parity and age occurs at this age group. Maternal age of nulliparas is not associated with different birth weight characteristics of their twins.
Genetics of Cognition: Outline of a Collaborative Twin Study
Authors: Wright Margie , De Geus Eco , Ando Juko , Luciano Michelle , Posthuma Danielle , Ono Yutaka , Hansell Narelle , Van Baal Caroline , Hiraishi Kai , Hasegawa Toshikazu , Smith Glen , Geffen Gina , Geffen Laurie , Kanba Shigenobu , Miyake Akira , Martin Nick , Boomsma Dorret
Published: May 2007

Amultidisciplinary collaborative study examining cognition in a large sample of twins is outlined. A common experimental protocol and design is used in The Netherlands, Australia and Japan to measure cognitive ability using traditional IQ measures (i.e., psychometric IQ), processing speed (e.g., reaction time [RT] and inspection time [IT]), and working memory (e.g., spatial span, delayed response [DR] performance). The main aim is to investigate the genetic covariation among these cognitive phenotypes in order to use the correlated biological markers in future linkage and association analyses to detect quantitativetrait loci (QTLs). We outline the study and methodology, and report results from our preliminary analyses that examines the heritability of processing speed and working memory indices, and their phenotypic correlation with IQ. Heritability of Full Scale IQ was 87% in the Netherlands, 83% in Australia, and 71% in Japan. Heritability estimates for processing speed and working memory indices ranged from 33–64%. Associations of IQ with RT and IT (−0.28 to −0.36) replicated previous findings with those of higher cognitive ability showing faster speed of processing. Similarly, significant correlations were indicated between IQ and the spatial span working memory task (storage [0.31], executive processing [0.37]) and the DR working memory task (0.25), with those of higher cognitive ability showing better memory performance. These analyses establish the heritability of the processing speed and working memory measures to be used in our collaborative twin study of cognition, and support the findings that individual differences in processing speed and working memory may underlie individual differences in psychometric IQ.
Epidemiological trends in multiple births in the United States, 1971–1998
Authors: Kiely John L. , Kiely Michele
Published: May 2007

The astounding rise in multiple births in the United States continues. We analyzed live birth files from the U.S. National Center for Health Statistics. Twin, triplet, quadruplet, and quintuplet+ rates were calculated for the period 1971–1977 and for each year between 1990 and 1998. Triplet rates were also computed within categories of mother's education and age. The twin rate increased from 1.8% in 1971–77 to 2.8% in 1998. The rate of triplets increased 5.9-fold, quadruplets 11.9-fold, and quintuplets+ 5.3-fold between 1971–77 and 1998. Increases in triplet rates were much more marked among births to university-educated women and women 30 years and older. Among women 45 years and older, the triplet rate was approximately fifty times higher in 1998 than in 1971–77. This group of older women (≥ 45 years) had the highest multiple birth rate in 1998.
The Ten Commandments in Multiple Pregnancies
Authors: Di Renzo G.C. , Luzietti R. , Gerli S. , Clerici G.
Published: May 2007

Multiple pregnancy represents a challenge for obstetrics and also poses significant psychological, social and economic problems. The chances of a successful outcome may be improved by appropriate preventive, diagnostic and management strategies, by the availability of specific skills and experience and by a multidisciplinary approach. In this paper are indicated and discussed, on the basis of current evidences, what can be considered the ten “commandments” in terms of providing optimal care in multiple pregnancies. In particular in this review we focus on the following topics: psychological support and clinical counseling; diagnosis and characterization of chorionicity; management at referral centers; individualization of care; avoidance of most frequent complications; consideration of specific pathologies; evaluation of fetal anatomy; monitoring of fetuses; planning of time and mode of delivery; monitoring of the mother during postpartum.
Controversial Issues in the Management of Multiple Pregnancies
Authors: Blickstein Isaac
Published: May 2007

The management of multiple pregnancies represents a true challenge for all sub-specialties concerned with perinatal medicine. Many issues were neglected over the years merely because they were rare and therefore considered not sufficiently important to merit clinical trials. This paper discusses a personal selection of controversial issues, such as multifetal pregnancy reduction of triplets and twins, special cases in multifetal preganncy reduction, need for invasive genetic studies, management of twin-twin transfusion, discordant fetal conditions, the definition of “term” in multiples, and the controversy about the mode of delivery.
Early Plasma Creatinine Values in Discordant Twins
Authors: Arad Ilan , Bar-Oz Benjamin , Peleg Ofra
Published: May 2007

It has been suggested that impairment of placental perfusion prior to delivery may manifest in early postnatal increase of creatinine values. We hypothesized that the smaller of a discordant set of twins would have a higher initial plasma creatinine value and decided to measure early plasma creatinine levels in discordant twins in order to evaluate whether this value may serve as an index of impaired placental perfusion. Plasma creatinine, urea nitrogen and blood hematocrit values were simultaneously measured in 35 sets of twins during the first day of life. The sets of twins were divided into 2 groups according to birth weight difference. Thus, 18 sets of discordant twins with birth weight difference greater than 15% comprised the GT group and 17 sets of twins with birth weight difference less than or equal to 15% comprised the LE group. The differences between the values obtained within each group were analyzed using the Wilcoxon Signed Rank test. In the GT group the mean plasma creatinine level of the smaller twins was significantly higher than the level of the larger ones (p = 0.03), but there was no statistically significant difference between values obtained in twins of the LE group. The mean plasma urea level was higher in the larger twins of both groups, however only the difference in the GT group was statistically significant (p = 0.01). The mean hematocrit of the smaller twins was higher in both groups, but only the difference in the LE group was statistically significant (p = 0.02). Generally, there was a negative correlation between gestational age and early creatinine values. These results apparently support the notion that prenatal exposure to impaired placental perfusion may compromise the creatinine clearance of the fetus and result in higher early creatinine values. Since the creatinine values in our growth-retarded twins were within the normal range, no distinguishing line for evidence of a uterine-placental compromise could be drawn. Whether a certain early plasma creatinine value is suggestive or indicative of an intra-uterine hypoxic-ischemic insult, should be determined by documented instances of severe fetal compromise prior to delivery.
Ultrasound Determination of Chorionicity in Twin Pregnancy: Accuracy and Operator Experience
Authors: Devlieger Roland G.L. , Demeyere Thomas , Deprest Jan A. , Schoubroeck Dominique Van , Witters Ingrid , Timmerman Dirk , Hanssens Myriam
Published: May 2007

To evaluate the accuracy of ultrasound in early detection of chorionicity and amnionicity in twin pregnancies and evaluate the role of operator-experience, a prospective follow up of 87 consecutive twin pregnancies was performed. Chorionicity and amnionicity were determined by 17 different observers, divided in 2 groups on the basis of their experience, using a composite of US markers at the first US examination confirming a viable intrauterine twin pregnancy. Accuracy of prediction was determined for both groups by comparison with postnatal pathology. From the 87 pregnancies examined at 10.1 (minimum 5.5 weeks, maximum 26.0) weeks of gestation, pathology was available in 82 cases and a correct prediction of chorionicity was made in all but two cases, both being diagnosed as monochorionic while dichorionic by observers belonging the more experienced group. No monochorionic pregnancy was missed and amnionicity was correctly diagnosed in all cases, including two monoamniotic twins. We conclude that use of a composite of ultrasound markers for early detection of chorionicity and amnionicity is reliable in a clinical setting where physicians with a variable degree of experience perform ultrasound examination.
Estimated Number of Multiplets Under 16 Years Using Two Sets of Census Data in Japan: 1990 and 1995
Authors: Imaizumi Yoko
Published: May 2007

Data for sets of multiples under 16 years of age were obtained from the population censuses of Japan in 1990 and 1995. These numbered 147,188 twin pairs, 1410 sets of triplets, 59 sets of quadruplets, and 3 sets of quintuplets in 1990, with the corresponding numbers in 1995 being 141,354, 2,211, 136 and 12, respectively. The total number of sets of multiples was 148,660 in 1990 and 143,713 in 1995. Twinning, triplet, quadruplet and quintuplet rates were estimated for each age. Rates of monozygotic twins and triplets remained constant age by age up to 15 years, while the dizygotic twinning rate, and rates of di- and tri-zygotic triplets decreased over the same period. Quadruplet and quintuplet rates also decreased. The accuracy of estimating number of multiples from census data is discussed using data on vital statistics.
Twinning Rates in Ghana
Authors: Mosuro A.A. , Agyapong A.N. , Opoku-Fofie M. , Deen S.
Published: May 2007

The incidence of twin births in Accra and Kumasi, the two major cities in Ghana, was investigated. In Accra, data were collected from the Korle-Bu Teaching Hospital while data were collected and analyzed from the Komfo Anokye Teaching Hospital in Kumasi. Both hospitals are the leading teaching hospitals in Ghana. The data consisted mainly of single and twin births recorded in the hospitals over a period of 12 years in Accra (1988–1999) and 15 years in Kumasi (1985–1999). The study revealed an incidence of 33.4 twin births per thousand live births for Accra and 26.6 twin births per thousand live births for Kumasi. Though these values are not as high as those reported among the Yoruba tribe of southwest Nigeria, who are reported to have the highest twin birth rates in the world, the present values still rank among the highest recorded twin birth rates.
The Influence of Genetic and Environmental Factors in Estimations of Current Body Size, Desired Body Size, and Body Dissatisfaction
Authors: Wade Tracey D. , Bulik Cynthia M. , Heath Andrew C. , Martin Nicholas G. , Eaves Lindon J.
Published: May 2007

The objective was to investigate the genetic epidemiology of figural stimuli. Standard figural stimuli were available from 5,325 complete twin pairs: 1,751 (32.9%) were monozygotic females, 1,068 (20.1%) were dizygotic females, 752 (14.1%) were monozygotic males, 495 (9.3%) were dizygotic males, and 1,259 (23.6%) were dizygotic male-female pairs. Univariate twin analyses were used to examine the influences on the individual variation in current body size and ideal body size. These data were analysed separately for men and women in each of five age groups. A factorial analysis of variance, with polychoric correlations between twin pairs as the dependent variable, and age, sex, zygosity, and the three interaction terms (age x sex, age x zygosity, sex x zygosity) as independent variables, was used to examine trends across the whole data set. Results showed genetic influences had the largest impact on the individual variation in current body size measures, whereas non-shared environmental influences were associated with the majority of individual variation in ideal body size. There was a significant main effect of zygosity (heritability) in predicting polychoric correlations for current body size and body dissatisfaction. There was a significant main effect of gender and zygosity in predicting ideal body size, with a gender x zygosity interaction. In common with BMI, heritability is important in influencing the estimation of current body size. Selection of desired body size for both men and women is more strongly influenced by environmental factors.
The Effect of Treatment of Twin-Twin Transfusion Syndrome on the Diagnosis-to-Delivery Interval
Authors: Skupski Daniel W. , Gurushanthaiah Keerti , Chasen Stephen
Published: May 2007

No randomised controlled trials of treatment of twin-to-twin transfusion syndrome (TTTS) exist. Since severely preterm neonatal survival has increased over time, survival as an outcome measure is confounded by improvements in neonatal care. The diagnosis-to-delivery interval is a measure of success of treatment independent of improvements in neonatal care. We wished to evaluate whether treatment of TTTS is associated with a lengthening of the diagnosis-to-delivery interval. MEDLINE search was performed supplemented by careful reference review. All TTTS series were included where the following information on each patient was available: survival, fetal demise, gestational age at diagnosis and diagnosis-to-delivery interval in days. Inclusion criteria: gestational age at diagnosis < 29 weeks and diagnosis by ultrasound in the absence of maternal symptoms. Cases undergoing multiple types of treatment were excluded. Eight publications met inclusion criteria and included the following cases: controls (n = 16), amnioreduction (n = 61), septostomy (n = 12), and fetoscopic laser occlusion of chorioangiopagus vessels (n = 51). There was no difference in the diagnosis-to-delivery interval, overall survival, at least one survivor, or number of fetal deaths between the four groups. Logistic regression using at least one survivor as the dependent variable revealed a positive association with gestational age at diagnosis and with diagno-sis-to-delivery interval, a negative correlation with fetal death, and no correlation with treatment group. We conclude that there is no difference in diagnosis-to-delivery interval or survival for any treatment for TTTS compared to expectant management. The lack of significance appears to be due to small sample sizes.
Twinning and Birth Weight in the Israeli Jewish Versus Muslim Maternities
Authors: Goldman Ran D. , Mazkereth Ram , Blickstein Isaac
Published: May 2007

Ethnicity differences account for genetic, environmental, lifestyle, and reproductive variables, influencing the rate of twinning (Nylander, 1981). Frequently, ethnic differences correlate with variable perinatal care leading to differences in outcome. Free access to antenatal care, and to facilities for delivery and neonatal care is available for the entire population in Israel, and therefor differences attributed to levels of medical care are practically negligible. We previously evaluated the overall relationship between ethnicity and outcome in a popula-tion-based cohort of mothers of twins (Goldman et al., 2001). However, the overall comparison may have masked some differences that could be present. The purpose of this study was to evaluate whether ethnicity is associated with differences in perinatal outcome in randomly selected, matched-controlled Israeli Jewish and Muslim mothers of twins.
Yoruba Customs and Beliefs Pertaining to Twins
Authors: Leroy Fernand , Olaleye-Oruene Taiwo , Koeppen-Schomerus Gesina , Bryan Elizabeth
Published: May 2007

The Yoruba are an important ethnic group mainly occupying Southwestern Nigeria. Mainly for genetic reasons, this very large tribe happens to present the highest dizygotic twinning rate in the world (4.4 % of all maternities). The high perinatal mortality rate associated with such pregnancies has contributed to the integration of a special twin belief system within the African traditional religion of this tribe. The latter is based on the concept of a supreme deity called Olodumare or Olorun, assisted by a series of secondary gods (Orisha) while Yoruba religion also involves immortality and reincarnation of the soul based on the animistic cult of ancestors. Twins are therefore given special names and believed to detain special preternatural powers. In keeping with their refined artistic tradition, the Yoruba have produced numerous wooden statuettes called Ibejis that represent the souls of deceased newborn twins and are involved in elaborate rituals. Among Yoruba traditional beliefs and lore some twin-related themes are represented which are also found in other parts of the world. Basic features of the original Yoruba beliefs have found their way into the religious traditions of descendants of African slaves imported in the West Indies and in South America.
Routine Cervical Cerclage in Higher Order Multiple Gestation — Does It Prolong the Pregnancy?
Authors: Strauss Alexander , Heer Ivo M. , Janßen Udo , Dannecker Christian , Hillemanns Peter , Müller-Egloff Susanne
Published: May 2007

Preterm birth following cervical dilatation is the greatest threat to infants of a multiple pregnancy. Lacking reliable data concerning the effect of prophylactic cerclage, we compared a study group to controls for maternal and perinatal outcome. Sixteen of 94 triplet-, 9 of 18 quadruplet/quintuplet-pregnancies, treated with prophylactic cerclage, were retrospectively compared to those without cervical cerclage respectively. Kruskal-Wallis test and Mann-Whitney-U test were performed as non-parametric one way analysis of variance. For the analysis of frequencies Chi Square test or Fisher’s exact test were performed. Odds ratio with 95% confidence interval was used to compare the need for intravenous tocolysis as well as perinatal morbidity and mortality. Gestational age at delivery was not different from the controls in all studied groups. Birth weight revealed a 200g dominance for the “no cerclage-triplets”, while this significant difference was inverted for quadruplets/quintuplets (1245g vs. 1069g). With respect to gestational age at birth, need for hospitalisation or medical intervention no benefit was achieved. Moreover, perinatal outcome analysed by arterial pH, APGAR-Score and perinatal mortality was not altered by a prophylactic cerclage. Perinatal morbidity for quadruplets and quintuplets was even higher in cerclage pregnancies. Therefore, these retrospective results disclaim a positive impact of cervical cerclage on pregnancy management or perinatal outcome in multifetal pregnancies.
Vaginal Sonography of the Cervix for the Prediction of “Time to Delivery” in ART Twins Gestations
Authors: Shulman Adrian , Jauniaux Eric , Holmes Anna , Maschiach Shlomo , Maymon Ron
Published: May 2007

The present study aimed to determine a reliable tool to estimate the interval time to delivery in assisted conception twin pregnancies. Mid-gestation cervical length was prospectively measured using transvaginal sonography (TVS) during routine antenatal care. Fifty-seven of 101 suitable women were longitudinally followed and two TVS measurements of their cervical length were obtained, first at approximately 24 weeks gestation and then at approximately 27 weeks gestation. The mean cervical length decreased from 37 ± 12mm at first measurement to 34 ± 11mm at the second one. A linear regression model was found between the time interval of the first (R = 0.656, p < 0.001) and the second (R = 0.435, p < 0.001) assessments and the week of delivery. The current data confirm that the length of the preserved segment of the cervix is an important indicator of its competence. A simple equation using the cervical length (mm) divided by 3 can predict mid gestation scan-to-delivery interval in twin gestation.
Twin and Singleton Births in Ghana — A Case-control Study
Authors: Nkyekyer Kobinah
Published: May 2007

Aretrospective study involving 623 twin and 1246 singleton births was conducted to compare the two groups with regard to selected maternal, fetal and labor and delivery characteristics and outcomes. Maternal age and parity were significantly higher for twins. The risks of preterm delivery, arrival in the labor ward in second stage of labor, cesarean births and postpartum haemorrhage were significantly higher in twin than in singleton births. In vaginal deliveries twin mothers were significantly less likely to have had episiotomies or perineal lacerations. There was no difference in the duration of the third stage of labor or in the incidence of retained placentae. Antepartum haemorrhage was a less likely indication for cesarean delivery among twins, while there was no significant difference in the likelihood of severe pre-eclampsia/eclampsia being an indication. Singleton babies were significantly heavier than twins. The incidences of malpresentation, low birth weight, stillbirths and of admission of live births to the neonatal intensive care unit were significantly higher in twins. There was no difference in the rate of instrumental vaginal delivery, or in the route of delivery of fetuses presenting by the breech. There is the need for detailed study of the incidences of antepartum haemorrhage and hypertensive diseases in twin and singleton pregnancies and of the factors determining the mode of delivery when such complications arise. Labor and delivery should also be examined to determine any differences between the two groups, especially in the first and second stages.
Errors in Birth Registrations and Coding of Twins and Higher Order Multiples
Authors: Pharoah Peter O.D.
Published: May 2007

Dizygotic compared with monozygotic conceptions are at decreased risk of fetal and infant death and serious morbidity in surviving infants. Different sex twin maternities must be dizygotic but miscoding and incorrect registration of sex and number of fetuses may lead to an incorrect assignment of zygosity. The aim of the study was to validate the coding and registration of number and sex of births in multiple pregnancies. Fetal and infant death registrations from all multiple maternities in England and Wales 1993–1998 were examined. There were 51,792 twin, 1627 triplet and 51 higher order multiple maternities that were registered. Among these there were 1926 fetal deaths, 58 of which were registered as being of indeterminate sex but were coded as male in 56 and female in 2 cases. A fetus papyraceous was registered as male in 19 and as female in 19 cases. Other fetal deaths weighing ≤100g, with no mention of papyraceous on the death certificate, nevertheless, likely to be of indeterminate sex, were registered as male in 26 and as female in 23 cases. In 13 maternities, the number of infants registered at birth was less than the number mentioned on the registration certificate. It cannot be assumed that multiple births of different registered sex are dizygotic. As surviving infants from a monozygotic multiple birth are at much greater risk of infant death and serious morbidity than dizygotic multiple births, incorrect assignment of sex has important implications for parental counselling and may have medicolegal relevance when attributing negligence as the cause of morbidity in a survivor from a multiple pregnancy.
The Korean Twin Registry — Methods, Current Stage, and Interim Results
Authors: Sung Joohon , Cho Soo-Hun , Cho Sung-Il , Duffy David L. , Kim Jin-Hee , Kim Ho , Park Kyung Sook , Park Sue Kyung
Published: May 2007

The Korean Twin Registry is the first nationwide twin study in Korea. We compiled 154,783 twin pairs from existing nationwide data sources, mainly from address and national health insurance data. The coverage of this registry was almost complete for the twins born since 1970, but less complete as age increased, so that there were only 990 pairs who were born before 1930. The twins' health examination (N = 54,390 persons) and questionnaire (N = 44,546 persons) results were incorporated into the registry, yielding 12,894 and 9074 concordantly informative pairs. Morbidity and mortality outcomes have been followed up since 1990, for most diseases. For preliminary analysis of complex diseases, we selected ventricular septal defects (VSD) in young twins, stomach and colorectal cancers in adult twins. We identified 353 VSDs, 284 stomach cancers, and 116 colorectal cancers among twins. The prevalence rates of cancers, but not that of VSD, were lower in twins than those in population. The difference in the cancer prevalence was marked for twins born before 1926, implying some degree of selection. Like-sex (LS) twins showed familial recurrence risks (λLS) of 41.2 for VSD and 22.4 for colorectal cancers, and 1.74 for stomach cancers. For opposite-sex (OS) twins, we could estimate λOS of 19.8 for VSD only. These results were compatible with previous studies for VSD and colorectal cancers, but not for stomach cancers. Despite the strength in size, availability of health outcomes, and some lifestyle and basic laboratory data, we need accurate zygosity information to improve the validity of the results.
Guest Editorial — Developmental Studies of Twins from Birth on: Heredity, Environment, Biomedical Variables, and Co-twin Relations
Authors: Riese Marilyn L.
Published: May 2007

The reports in this section demonstrate several ways in which longitudinal research with twins is informative for the study of development. All of these twins have been followed for long time periods. These results are the latest stage of study for each. By virtue of their long-term nature, together these studies provide information on patterns and changes in several developmental areas from infancy to adulthood. They also document when specific variables no longer exert any influence on development. The first report, by Alin Akerman and Suurvee (“The Cognitive and Identity Development of Twins at 16 Years of Age: A Follow-up Study of 32 Twin Pairs”) is a study of twins followed from birth to 16 years of age. The second report, by Ebeling, Porkka, Penninkilampi-Kerola, Berg, Jarvi, and Moilanen (“Inter-twin Relationships and Mental Health”), is a study of twins followed from pregnancy to 22–30 years of age. The third report, by Lange (“Coping Ability at Midlife in Relation to Genetic and Environmental Influences at Adolescence”), is a study of twins and singletons followed from 10 to 16 years of age to 35 years of age. The section attests to the perseverance of these authors as researchers, and to the strength of the personal relationships of these authors with the individuals in their projects.
Serum Osmolal Gap in Patients With Idiopathic Nephrotic Syndrome and Severe Edema
Authors: Kapur Gaurav , Valentini Rudolph P. , Imam Abubakr A. , Jain Amrish , Mattoo Tej K.
Published: May 2007

Pseudohyponatremia in idiopathic nephrotic syndrome with severe edema is attributed to hyperlipidemia that results in displacement of a portion of water phase of plasma. Current methods of measurement of serum electrolytes are unaffected by hyperlipidemia. In this report we demonstrate that patients with idiopathic nephrotic syndrome with severe edema and true hyponatremia may have an increased rather than normal osmolal gap. We believe that this could be secondary to non-Na+ and non-K+ osmoles in response to plasma-volume contraction secondary to hypoalbuminemia. This observation has implications for management of severe edema in such patients, because fluid restriction could increase their risk for pre–renal failure.
Propofol Compared With the Morphine, Atropine, and Suxamethonium Regimen as Induction Agents for Neonatal Endotracheal Intubation: A Randomized, Controlled Trial
Authors: Ghanta Satish , Abdel-Latif Mohamed E. , Lui Kei , Ravindranathan Hari , Awad John , Oei Julee
Published: May 2007

OBJECTIVES. The purpose of this work was to compare the efficacy of propofol, a hypnotic agent, to the regimen of morphine, atropine, and suxamethonium as an induction agent for nonemergency neonatal endotracheal intubation. We hypothesized that propofol aids intubation by allowing the continuation of spontaneous breathing.

PATIENTS AND METHODS. We conducted a randomized, open-label, controlled trial of infants who required nonemergency endotracheal intubation. Primary outcome was successful intubation confirmed by chest auscultation and clinical examination of the infant.

RESULTS. Infants randomly assigned to propofol (n = 33) and the morphine, atropine, and suxamethonium regimen (n = 30) were comparable in median gestational age (27 vs 28 weeks), birth weight (1020 vs 1095 g), weight at intubation (1068 vs 1275 g), and age at intubation (4 vs 3 days). Sleep or muscle relaxation were achieved within 60 seconds in both groups, but time to achieve successful intubation was more than twice as fast with propofol (120 vs 260 seconds). Blood pressure and heart rates were not different, but intraprocedural oxygen saturations were significantly lower in infants on the morphine, atropine, and suxamethonium regimen (trough arterial oxygen saturation: 60% vs 80%). Nasal/oral trauma was less common, and recovery time was shorter (780 vs 1425 seconds) in the propofol group. No significant adverse effects were seen in either group.

CONCLUSIONS. Propofol is more effective than the morphine, atropine, and suxamethonium regimen as an induction agent to facilitate neonatal nasal endotracheal intubation. Importantly, hypoxemia was less severe, probably because of the maintenance of spontaneous breathing. A controlled environment may have promoted the ease of intubation, resulting in less trauma. The shorter duration of action would be advantageous in a compromised infant.
Reading in Kazakhstan and Oceania
Authors: Topping Keith , Golopyatova Nina , Goodwin Maureen , Peirce Robin
Published: May 2007

This column focuses on the innovative strategies some teachers from Kazakhstan and Oceania are using to overcome the challenges they face.

In Kazakhstan, schools organize reading days to encourage and inspire children to read. In the predominantly oral culture of the Cook Islands, Niue Island, and Rarotonga, teachers and administrators model reading for their students. They also create newsletters to communicate with remote schools and make their own books when resources allow.

Despite the challenges faced by all of these teachers, they are finding success through determination and creative ideas.
Raising Urban Students' Literacy Achievement by Engaging in Authentic, Challenging Work
Authors: Teale William H. , Gambrell Linda B.
Published: May 2007

An innovative, technology‐enabled elementary school literacy program was implemented in a large urban school district. The program revolved around having student–adult pen pals read the same books and correspond about them. Statistical comparisons showed that program classrooms outperformed students in comparison classrooms on the SAT‐9 standardized test of reading achievement. Analyses of interviews, survey results, and classroom observations were conducted to discern factors associated with program success. It was found that the effects of the program could best be understood in terms of three features: practices, principles, and persistence. The specifics of each of these factors are discussed in detail.
Choice of Action: Using Data to Make Instructional Decisions in Kindergarten
Authors: Reilly Mary Ann
Published: May 2007

This article focuses on the different—and at times uncertain—choices a kindergarten teacher makes when selecting and interpreting assessment data and designing instruction intended to help students develop the skills and dispositions for later reading. By examining assessment data and engaging in reflective practice, the teacher is able to anticipate students' literacy needs and design instruction that builds upon their strengths.

A close‐up look at a shared writing lesson is used to illustrate the connections the teacher makes between her interpretation of data and the instruction she delivers. The article concludes with a brief examination of the complexities inherent in data analysis.
Traffic Light Reading: Fostering the Independent Usage of Comprehension Strategies With Informational Text
Authors: Marcell Barclay
Published: May 2007

Does fluency need to be an instructional precursor to comprehension? The perceived causal relationship between the two may in fact translate into the creation of word‐calling students who can read with adequate speed and expression, but cannot retell story events or make inferences.

A discussion of fluency's relationship to comprehension provides the framework for a practical teaching tool that can be used to foster independent use of before‐, during‐, and after‐reading strategies. “Traffic Light Reading” is designed to motivate word‐calling students to become thinking readers. Sample lessons are described, in which the reasons for reading are clarified and the during‐reading strategies are accentuated.

With modeling and ongoing practice, the use of Traffic Light Reading can help teachers engage formerly unengaged students by teaching them to monitor and repair comprehension of informational text routinely and independently.