bluuebunny/crossref_metadata_2025 huggingface dataset:
Interest of external photoprotection by means of clothing and sunscreen products in young children
Authors: Ghazi S. , Couteau C. , Paparis E. , Coiffard L.J.M.
Published: June 2011

Background  Protecting young children is a major public health issue.

Objective  We tested children’s clothing and sunscreen products that are specially designed for children.

Methods  The effectiveness of the different types of clothing and sunscreen products was determined using spectrophotometer equipped with an integrating sphere A measure of transmittance carried out, respectively, between 290 and 400 nm and between 320 and 400 nm, allowed us to assess the photoprotective properties in the UVB and UVA range respectively.

Results  Although the photoprotective effect varies according to the type of clothing (UV‐protection factor [UPF] of approximately 10 for a cotton T‐shirt and 500 for a pair of jeans), the effect is constant for any one type of clothing. Placing fabrics in layers is essential and this enables the protective effect to be greatly increased. Moreover, the authors wished to answer the question, ‘what makes a good sun cream?’ by analysing the formula of each product tested. It turns out that only creams containing both organic filters and inorganic filters have an sun protection factor (SPF) that is the same as the one stated on the product.

Conclusion  Concerning townwear, the jeans, tracksuits, sweatshirts, pullovers and tights turned out to be very photoprotective. They enable, in effect, to reach a UPF higher than 500. The mere presence of titanium dioxide and/or zinc dioxide does not mean that the product will have a high SPF. Products containing alcohol can be eliminated from the possible choices by carefully reading the label.
Management of dermatofibrosarcoma protuberans with fibrosarcomatous transformation: an evidence‐based review of the literature
Authors: Voth H. , Landsberg J. , Hinz T. , Wenzel J. , Bieber T. , Reinhard G. , Höller T. , Wendtner C.‐M. , Schmid‐Wendtner M.‐H.
Published: June 2011

Fibrosarcomatous transformation represents a rare event in dermatofibrosarcoma protuberans (DFSP) with unpredictable biological behaviour. No guidelines for the adequate treatment of patients with this rare neoplasm have been published. Herein, we present a comprehensive review of the literature comprising 157 patients with transformed DFSP focussing on surgical and adjuvant treatment modalities for this tumour. In the cohort examined, local recurrence occurred in 36% of cases and was significantly lower in patients treated by wide excision with margins ≥2 cm when compared with those treated with local excision without defined margins (P = 0.01). Consistently, negative margin status was associated with a lower recurrence rate when compared with positive or unknown margin status (P = 0.01). Distant metastases were detected in 13% of patients, which is significantly higher when compared with ordinary dermatofibrosarcoma protuberans. Systemic dissemination was preceded by local recurrence in 81% of cases, and is therefore strongly associated with tumour recurrence (P ≤ 0.001). The present data confirm that wide excision with margins ≥2 cm represent the gold standard in the treatment of transformed dermatofibrosarcoma protuberans, and prevents recurrence as well as metastasis. When R0‐resection is not feasible, adjuvant radiation should be considered for cases with incomplete resection or unknown surgical margins. Irresectable or metastatic transformed DFSP harbouring the COL1A1‐PDGFB fusion gene should be treated with imatinib in the palliative setting or as an adjunctive treatment before surgery, although responses may be short‐lasting.
A small‐scale investigation of hospital experiences among people with a learning disability on Merseyside: speaking with patients and their carers
Authors: Dinsmore Adam Peter
Published: June 2011

Accessible summary

 We did twelve interviews all about the times people with learning disabilities had been to hospital since March 2007. Some of them were with people with learning disabilities and some of them were with the carers of people with learning disabilities.

 This article talks about what people told us in the interviews and makes some recommendations to hospital staff which we think would help improve hospital experiences for people with learning disabilities in the future.

 This research should be important to people with learning disabilities because people with learning disabilities often have more need to attend hospital than other people, and so it is important that the care they receive is of a good enough standard when they are there.

People with a learning disability face a number of challenges when seeking access to hospital care which are often distinct from those faced by the general population. Numerous statistics indicative of these challenges are represented in the academic literature. Previous research has suggested several reasons for the continued existence of these challenges, including a lack of expertise in the provision of health care to people with learning disabilities and negative attitudes towards this population held by healthcare professionals. As a means of elucidating the hospital experiences of people with learning disabilities on Merseyside, the researcher conducted 13 semi‐structured interviews – an analysis of 12 of which are included in this article. Of these 12 interviews, two were conducted with an unaccompanied person with a learning disability, three were conducted with a person with a learning disability alongside their carer, and seven were conducted with the carer or carers of a person with a learning disability. The topics discussed in these semi‐structured interviews were determined by the findings of a literature search and pilot interview. Emergent themes within the interview transcripts are discussed and recommendations made for healthcare professionals engaged in the hospital care of people with learning disabilities. It is concluded that people with learning disabilities on Merseyside continue to contest with the same difficulties during hospital experiences as have been identified previously by numerous national and international investigations.
Dopamine release mediated by the dopamine transporter, facts and consequences
Authors: Leviel Vincent
Published: June 2011

J. Neurochem. (2011) 118, 475–489.

Spontaneous and/or stimulated neural activity of the nigrostriatal dopamine (DA) pathway makes amines run out from the neurons. This DA dynamic follows a rather complex path, running in or out the terminals, and flushing or diffusing into the extracellular space. The location of this leakage is not limited to the axon terminals; it also occurs from the cell bodies and dendrites. This molecular release mechanism was, for a long time, considered as being produced, in part, by the exocytosis of previously stored vesicles. The DA carrier protein (DAT, DA transporter) embedded in the DA cell membrane is known to clear previously released amines through an inward DA influx. The DAT also appears to be an active vector of amine release. Particular local conditions and the presence of numerous psychostimulant substances are able to trigger an outward efflux of DA through the DAT. This process, delivering slowly large amounts of amine could play a major regulatory role in extracellular DA homeostasis.
Endogenous presynaptic nitric oxide supports an anterograde signaling in the central nervous system
Authors: Fernández‐Alvarez Adriana , Gómez‐Sena Leonel , Fabbiani María Gabriela , Budelli Ruben , Abudara Verónica
Published: June 2011

J. Neurochem. (2011) 118, 546–557.

The source size and density determine the extent of nitric oxide (NO) diffusion which critically influences NO signaling. In the brain, NO released from postsynaptic somas following NMDA‐mediated activation of neuronal nitric oxide synthase (nNOS) retrogradely affects smaller presynaptic targets. By contrast, in guinea pig trigeminal motor nucleus (TMN), NO is produced presynaptically by tiny and disperse nNOS‐containing terminals that innervate large nNOS‐negative motoneurons expressing the soluble guanylyl‐cyclase (sGC); consequently, it is uncertain whether endogenous NO supports an anterograde signaling between pre‐motor terminals and postsynaptic trigeminal motoneurons. In retrogradely labeled motoneurons, we indirectly monitored NO using triazolofluorescein (DAF‐2T) fluorescence, and evaluated sGC activity by confocal cGMP immunofluorescence. Multiple fibers stimulation enhanced NO content and cGMP immunofluorescence into numerous nNOS‐negative motoneurons; NOS inhibitors prevented depolarization‐induced effects, whereas NO donors mimicked them. Enhance of cGMP immunofluorescence required extracellular Ca2+, a nNOS‐physiological activator, and was prevented by inhibiting sGC, silencing neuronal activity or impeding NO diffusion. In conclusion, NO released presynaptically from multiple cooperative tiny fibers attains concentrations sufficient to activate sGC in many motoneurons despite of the low source/target size ratio and source dispersion; thus, endogenous NO is an effective anterograde neuromodulator. By adjusting nNOS activation, presynaptic Ca2+ might modulate the NO diffusion field in the TMN.
Delayed response of human melanopsin retinal ganglion cells on the pupillary light reflex
Authors: Tsujimura Sei‐ichi , Tokuda Yuta
Published: June 2011

Citation information: Tsujimura S & Tokuda Y. Delayed response of human melanopsin retinal ganglion cells on the pupillary light reflex. Ophthalmic Physiol Opt 2011, 31, 469–479. doi: 10.1111/j.1475‐1313.2011.00846.x

Purpose:  A recent study has shown that retinal ganglion cells containing the photopigment melanopsin, which are intrinsically photosensitive in primates, project to the pupillary control centre in the pretectum. The aim of this study was to investigate how melanopsin retinal ganglion cells (mRGCs) contribute to the pupillary pathway.

Methods:  We designed and built a novel multi‐primary stimulation system to control stimulation of the three cone types and mRGCs independently in the human eye. We measured the latency and amplitude of transient pupillary responses to three types of test stimuli modulating excitations of mRGCs and cones (mRGC, luminance and the light flux stimuli).

Results:  It was found that the transient pupillary response to mRGC stimuli has a longer latency than that to luminance and the light flux stimuli when an onset of sinusoidal stimulus was used.

Conclusions:  The results indicate that we successfully demonstrated the pupillary response to mRGCs under conditions where mRGCs are isolated in humans. Furthermore, the data confirm that the delayed response disappeared when the stimulus is presented as a square‐wave pulse and not weighted by a sinusoid. The similarity of time courses for the earlier phase of pupillary responses to all stimuli suggested that these transient pupillary responses were driven by a single mechanism, which is perhaps associated with cone‐mediated signals.
Managing trade‐offs in ‘ecotopia’: becoming green at the Centre for Alternative Technology
Authors: Anderson Jon
Published: June 2011

The individual has been cast as both the source of and solution to many contemporary environmental problems. Although some individuals may display concern for the environment, actions are undertaken within a societal context that is often ambivalent to environmental issues. To ‘become green’, therefore, individuals have to negotiate a range of trade‐offs between their environmental aspirations and the realities of life in a developed, consumer‐based society. This paper draws on extensive field work at one site at which individuals have explicitly sought to manage these trade‐offs – the Centre for Alternative Technology, Wales, UK. It argues that two distinct strategies are adopted to manage the tensions involved in becoming green: a ‘strategy of segregation’– where professional practices are separated from personal actions to establish balance, if not consistency, in everyday life; and a ‘strategy of alignment’– where (unsuccessful) attempts are made to unify personal and professional practices in line with environmental ideals. This paper outlines how the inability of these strategies to fully reconcile the tensions involved in becoming green has led to a ‘politics of pragmatism’ within environmental practice. It argues that this politics offers a way forward for contemporary environmentalism, both within ‘ecotopian’ spaces such as the Centre for Alternative Technology, but also in more mainstream spaces where the majority live their lives.
Health Expenditure Dynamics and Years of U.S. Residence: Analyzing Spending Disparities among Latinos by Citizenship/Nativity Status
Authors: Vargas Bustamante Arturo , Chen Jie
Published: June 2011

Objective. We investigate health expenditure disparities between Latinos and non‐Latino whites by years of United States residence and citizenship/nativity status.

Data Sources. We link the Medical Expenditure Panel Survey and the National Health Interview Survey from 2000 to 2007. The sample consists of 31,514 Latinos and 76,021 white adults (18–64 years).

Study Design. The likelihood of any health spending, total health expenditure, and the out‐of‐pocket (OOP) share of health expenditure are our main dependent variables. We use two‐part multivariate models to adjust for confounding factors. A stratified analysis by insurance status checks for the results' robustness. The decomposition technique is implemented to estimate the share of disparities that can be explained by observed and unobserved variables.

Principal Findings. Latinos are much less likely to have any health spending (68 percent), total health expenditure (57 percent), and more likely to pay OOP (6 percent) compared with the white population. Overall, disparities narrow or disappear for naturalized Latinos the longer they stay in the country. Among noncitizen Latinos, disparities remain constant or decline slightly, but they remain large over time.

Conclusions. Low‐health spending by foreign‐born Latinos contributes to health expenditure disparities between Latinos and whites. Our findings provide preliminary evidence on health‐spending convergence over time between foreign‐born Latinos and that of whites.
Tree modelling from mobile laser scanning data‐sets
Authors: Rutzinger Martin , Pratihast Arun Kumar , Oude Elberink Sander J. , Vosselman George
Published: June 2011

In recent times mobile laser scanning (MLS) has been used to acquire massive 3D point clouds in urban areas and along road corridors for the collection of detailed data for 3D city modelling, building façade reconstruction and capture of vegetation and road features for inventories. The objectives of this paper are the extraction of tree features from such data‐sets and the modelling of trees for the purpose of visualisation in 3D city models. After the detection of high vegetation the point cloud is reduced using a 3D alpha shape approach. Then the required model parameters such as crown and stem height, crown and stem diameter, and crown shape are derived and the trees are modelled individually in a realistic manner. The tree model so generated correctly represents the overall appearance of the tree. However, the inner structure such as the branching of the tree crown is parameterised. The workflow reduces the point cloud by means of a step‐by‐step process, which eases the handling of the massive MLS data‐sets. The thinning using 3D alpha shapes reduces the amount of data to be processed by about 95%. It is shown that the model parameters are not influenced by the thinning procedure employed. This proves the robustness of the data reduction method and the tree modelling approach.
Quantitation of coated platelet potential during collection, storage, and transfusion of apheresis platelets
Authors: Charania Roseleen , Smith James , Vesely Sara K. , Dale George L. , Holter Jennifer
Published: June 2011

BACKGROUND: Coated platelets (PLTs), a subpopulation of PLTs observed upon dual agonist stimulation with collagen and thrombin, are known to retain several procoagulant α‐granule proteins on their surface. By formation of a highly active membrane‐bound prothrombinase complex, these PLTs represent an important step in the coagulation cascade as a consequence of their ability to generate thrombin at the site of vascular injury. Various clinical observations suggest that higher levels of coated PLTs are associated with thrombosis while a deficiency of coated PLTs results in a bleeding diathesis. Current quality control guidelines for in vitro PLT storage measure PLT viability but no routine evaluation of the hemostatic function of stored PLTs and particularly no estimation of coated PLT potential is performed. Our primary objective was to evaluate if the process of apheresis and storage of PLT units alters the levels of coated PLTs. In addition, we sought to determine how transfusion of stored PLTs into patients with thrombocytopenia affects the patient's coated PLT levels.

STUDY DESIGN AND METHODS: Coated PLT levels were analyzed in 13 voluntary PLT donors before donation, in the fresh apheresis product (Trima, CaridianBCT) and in the stored apheresis product just before transfusion. In addition, 10 patients with thrombocytopenia were analyzed for coated PLTs before and after transfusion of a stored PLT product.

RESULTS: Coated PLT levels were significantly decreased after the process of apheresis (17% relative decline; p < 0.01) and with prolonged storage (1 to 5 days; 53% relative decline; p < 0.001). Transfusion of stored PLT units did not result in significant increment of coated PLT levels in patients with thrombocytopenia as expected considering the low level of coated PLTs in stored PLT units. Furthermore, there was no suggestion of regeneration of coated PLT potential upon reinfusion.

CONCLUSIONS: Isolation and storage of apheresis PLTs by standard blood bank procedures results in a significant decline in coated PLT potential. Reinfusion of stored apheresis PLTs into patients with thrombocytopenia resulted in a predictable change in coated PLT potential with no suggestion of regeneration of lost coated PLT potential.
Transfusion of fresh murine red blood cells reverses adverse effects of older stored red blood cells
Authors: Hendrickson Jeanne E. , Hod Eldad A. , Hudson Krystalyn E. , Spitalnik Steven L. , Zimring James C.
Published: June 2011

BACKGROUND: Although a subset of recent studies have suggested that red blood cell (RBC) storage length is associated with adverse patient outcomes, others have shown no such relationship. Adults may be transfused with RBC units of different storage lengths, and existing studies do not take into consideration that fresh RBCs may alter responses to concurrently transfused stored RBCs. To test this possibility, we utilized a murine model and investigated transfusion outcomes of fresh, stored, or fresh‐plus‐stored RBCs.

STUDY DESIGN AND METHODS: Fresh, 14‐day‐stored or fresh plus 14‐day‐stored leukoreduced RBCs from HOD‐transgenic donors (with RBC‐specific expression of hen egg lysozyme, ovalbumin, and human Duffyb) were transfused into naïve C57BL/6 recipients. Serum cytokines and anti‐HOD alloimmunization were evaluated after transfusion.

RESULTS: In six of six experiments (n = 90 mice total), a proinflammatory serum cytokine storm of interleukin‐6, keratinocyte‐derived chemokine/CXCL1, and monocyte chemoattractant protein‐1 was observed in transfusion recipients of stored but not fresh RBCs, along with high degrees of anti‐HOD alloimmunization. However, concurrent transfusion of fresh HOD RBCs along with stored HOD RBCs significantly decreased these adverse outcomes (p < 0.05).

CONCLUSIONS: These results are consistent with fresh murine HOD RBCs losing protective properties during storage, and introduce a previously unrecognized variable in RBC storage studies. If translatable to humans, uniform “old blood” groups may be needed in future clinical studies to more accurately investigate the biologic effects of older RBC units.
Estimation of variant Creutzfeldt‐Jakob disease infectivity titers in human blood
Authors: Gregori Luisa , Yang Hong , Anderson Steven
Published: June 2011

BACKGROUND: Blood of individuals with variant Creutzfeldt‐Jakob disease (vCJD) is infectious but the titer is unknown. Current estimates of possible vCJD infectivity titers in blood have largely relied on an assumption that the titers of vCJD agent in human blood are likely to be similar to those in blood of rodents infected with model transmissible spongiform encephalopathy agents, assayed by intracerebral inoculations of rodents of the same species.

STUDY DESIGN AND METHODS: We analyzed published descriptions of experimental transfusion‐transmitted (TT) bovine spongiform encephalopathy and scrapie in sheep and reports of TTvCJD in humans, applying statistical approaches to estimate the probable number of intravenous infectious doses (IDiv) per unit of transfused blood (IDiv/unit). For humans, IDiv/unit of nonleukoreduced red blood cells (NLR‐RBCs) were estimated by two statistical models.

RESULTS: Sheep blood collected at or near onset of clinical illness contained a mean of 0.80 IDiv/unit. Estimates of infectivity in NLR‐RBCs from donors incubating vCJD indicated a probable mean infectivity of 0.29 IDiv/unit (Model 1) and 0.75 IDiv/unit (Model 2). The analysis predicted a mean of 21 vCJD‐infected recipients expected in a cohort transfused with vCJD‐implicated NLR‐RBCs in the United Kingdom.

CONCLUSION: Our analysis suggested that, while less than one IDiv is likely to be present in a given unit of NLR‐RBCs collected from a donor incubating vCJD, there is a high probability of TT infection among recipients of vCJD‐implicated blood components. The analysis supports continuing measures currently recommended to reduce the risk of TTvCJD.
Postoperative complications associated with transfusion of platelets and plasma in cardiac surgery
Authors: Bilgin Yavuz M. , van de Watering Leo M.G. , Versteegh Michel I.M. , van Oers Marinus H.J. , Vamvakas Eleftherios C. , Brand Anneke
Published: June 2011

BACKGROUND: Studies in cardiac surgery have reported increased postoperative morbidity and mortality after allogeneic red blood cell (RBC) transfusions. Whether platelet (PLT) and/or plasma transfusions are a marker for more concomitant RBC transfusions or are independently associated with complications after cardiac surgery is unknown.

STUDY DESIGN AND METHODS: Data from two randomized controlled studies were combined to analyze the effects of PLT and/or plasma transfusions on postoperative infections, length of stay in the intensive care unit (ICU), all‐cause mortality, and mortality in the presence or absence of infections in the postoperative period.

RESULTS: After adjusting for confounding factors, plasma units and not RBC transfusions were associated with all‐cause mortality. White blood cell (WBC)‐containing RBC transfusions and PLT transfusions were associated with mortality occurring in the presence of or after infections. The number of (WBC‐containing) RBC transfusions was also significantly associated with postoperative infections and with ICU stay for 4 or more days.

CONCLUSION: Although it is difficult to separate the effects of blood components, we found that in cardiac surgery, perioperative plasma transfusions are independently associated with all‐cause mortality. WBC‐containing RBC transfusions and PLT transfusions are independently associated with mortality in the presence of infections in the postoperative period. Future transfusion studies in cardiac surgery should concomitantly consider the possible adverse effects of all the various transfused blood components.
Physiologic strategies to prevent fainting responses during or after whole blood donation
Authors: Wieling Wouter , France Christopher R. , van Dijk Nynke , Kamel Hany , Thijs Roland D. , Tomasulo Peter
Published: June 2011

Vasovagal syncope (VVS) is a consistent, but infrequent (0.1%‐0.3%) complication of volunteer, whole blood donation. Given the large number of blood donations, a significant number of donors is involved. Syncope occasionally leads to injury. Recent rigorous data collection and analysis have led to the association of a small number of donor and donation factors with the risk of syncope. An analysis of the time course of syncope reactions among approximately 500,000 whole blood donors suggests that there are three distinct periods of risk for vasovagal reactions before, during, and after phlebotomy. This review examines the physiologic mechanisms that contribute to these periods of increased risk including the direct effects of removal of approximately 500 mL of whole blood, the psychological stress of instrumentation and giving blood (i.e., fear of needles, pain, and the sight of blood), and the orthostatic effects superimposed on a hypovolemic state after the donation. Specifically, we describe interventions that have been useful in controlling VVS in patients with fainting syndromes and we examine the potential of these interventions in the blood donation context, based on the physiologic principles involved. Finally, we propose an intervention (dietary replacement of salt lost with blood donation) that has not been applied in transfusion medicine previously but which has the potential to reduce risk.
Transmission of cytomegalovirus (CMV) infection by leukoreduced blood products not tested for CMV antibodies: a single‐center prospective study in high‐risk patients undergoing allogeneic hematopoietic stem cell transplantation (CME)
Authors: Thiele Thomas , Krüger William , Zimmermann Kathrin , Ittermann Till , Wessel Antje , Steinmetz Ivo , Dölken Gottfried , Greinacher Andreas
Published: June 2011

BACKGROUND: Measures to prevent transfusion‐transmitted cytomegalovirus (TT‐CMV) infection after hematopoietic stem cell transplantation (HSCT) include transfusion of CMV antibody–negative blood units and/or transfusion of leukoreduced cellular blood products. We assessed the incidence of TT‐CMV in CMV‐seronegative patients receiving CMV‐seronegative HSC transplants, who were transfused with leukoreduced cellular blood products not tested for anti‐CMV.

STUDY DESIGN AND METHODS: In a prospective observational study between 1999 and 2009, all HSCT patients received leukoreduced cellular blood products not tested for anti‐CMV. Patients were screened for CMV serostatus and CMV‐negative recipients of CMV‐negative transplants were systematically monitored for TT‐CMV clinically and by CMV nucleic acid testing. Anti‐CMV antibodies (immunoglobulin [Ig]G and IgM) were assessed after three time intervals (Interval 1, study inclusion to Day +30 after HSCT; Interval 2, Day +30‐Day +100; Interval 3, after Day +100).

RESULTS: Among 142 patients treated with allogeneic HSCT, 23 CMV‐negative donor‐patient pairs were identified. These 23 patients received 1847 blood products from 3180 donors. All patients remained negative for CMV DNA and none developed CMV‐associated clinical complications. This results in a risk for TT‐CMV per donor exposure of 0% (95% confidence interval, 0.0%‐0.12%). However, 17 of 23 patients seroconverted for anti‐CMV IgG, but none for anti‐CMV IgM. CMV IgG seroconverters received significantly more transfusions per week than nonconverters.

CONCLUSION: The risk of TT‐CMV is low in high‐risk CMVneg/neg HSCT patients transfused with leukoreduced blood products not tested for anti‐CMV. The cause of anti‐CMV IgG seroconversion is most likely passive antibody transmission by blood products.
Defined Benefit or Defined Contribution? A Study of Pension Choices
Authors: Cocco João F. , Lopes Paula
Published: June 2011

Abstract

We solve an empirically parameterized life‐cycle model of consumption and pension choices to show how expected earnings growth and risk affect the benefits of final‐salary defined benefit (DB) pension plans, relative to pension plans that are defined contribution (DC) in nature. We use micro data on the pension choices of individuals to provide evidence consistent with the model predictions: (1) individuals who expect a higher growth rate of earnings are more likely to choose DB final‐salary schemes, and (2) individuals who face a higher variance of persistent income shocks are less likely to choose DB final‐salary schemes. We control for cohort and age fixed effects in the empirical analysis.
Commitment and Lapse Behavior in Long‐Term Insurance: A Case Study
Authors: Pinquet Jean , Guillén Montserrat , Ayuso Mercedes
Published: June 2011

Abstract

This article presents a case study of a portfolio of individual long‐term insurance contracts sold by a Spanish mutual company. We describe the risk levels, the rating structure, and the implied cross‐subsidies on a portfolio of policies providing health, life, and long‐term care insurance. We show evidence of reclassification risk through the history of disability spells. We also analyze the lapse behavior and seek to provide a rationale for the portfolio’s dynamics. We discuss the lack of commitment from the policyholders (lapses) and from the mutual company (which took a run‐off decision). Finally, we draw conclusions regarding the design of such contracts.
Do Small‐Group Health Insurance Regulations Influence Small Business Size?
Authors: Kapur Kanika , Karaca‐Mandic Pinar , Gates Susan M. , Fulton Brent
Published: June 2011

Abstract

State small‐group health insurance reforms, implemented in the 1990s, aimed at controlling the variability of health insurance premiums and to improve access to health insurance. These reforms only affected firms within a specific size range, and as a result, they may have affected the size of small firms around the legislative threshold and may also have affected the propensity of small firms to offer health insurance. We examine the relationship between small‐group reform and firm size and find evidence that small firms just below the regulatory threshold that were offering health insurance grew in order to bypass reforms.
New Ceramic Seal for Na/NiCl2 Cells
Authors: Mali Amin , Petric Anthony
Published: June 2011

A ceramic seal based on a eutectic mixture of Na2O and Al2O3 for use in Na/NiCl2 (ZEBRA) cells was developed. The seal was tested in galvanic cells. The reproducibility of the emf data shows that the seal is fully impervious and can sustain high alkali pressure up to 1000°C without cracking or degradation. The cross‐sectional microstructure revealed liquid phase formation during sealing and reaction bonding with the ceramic components of the cell.
Oxygen Potentials of Pyrochlore‐Type Am2Zr2O7+y
Authors: Otobe Haruyoshi , Takano Masahide , Hayashi Hirokazu , Arai Yasuo
Published: June 2011

The relations between the oxygen potentials and the excess oxygen‐nonstoichiometry (y) of the pyrochlore‐type Am2Zr2O7+y at 1333 K were measured by the electrochemical method using a zirconia solid electrolyte and the change of mass by oxidation and reduction. The oxygen potentials at 1333 K smoothly increased from −516.5 to 0.00 kJ/mol with increasing y from 0.00 to 0.56. It was found that the oxygen potentials of Am2Zr2O7+y were higher than those of AmO2−x and Am0.5Np0.5O2−x measured in our previous studies at 1333 K. The results were discussed with the valence state and ionic radius of cations as well as the phase relations.
Relaxor Characteristics of Morphotropic Phase Boundary (Bi1/2Na1/2)TiO3–(Bi1/2K1/2)TiO3 Modified with Bi(Zn1/2Ti1/2)O3
Authors: Dittmer Robert , Jo Wook , Daniels John , Schaab Silke , Rödel Jürgen
Published: June 2011

Morphotropic phase boundary (Bi1/2Na1/2)TiO3–(Bi1/2K1/2)TiO3 (BNT–BKT), was modified with increasing additions of Bi(Zn1/2Ti1/2)O3 (BZT). Microstructure, electric‐field‐induced strain and polarization, dielectric permittivity, and temperature‐dependent piezoelectric coefficient were investigated and compared with crystal structure measured in situ as a function of applied electric field. Furthermore, permittivity and piezoelectric coefficient were characterized as a function of electric field. For small additions of BZT, an applied electric field leads to an irreversible phase transition into a ferroelectric phase with remanent polarization and a reduced relative permittivity. Increasing the content of BZT increased the threshold field for the transition. For additions of more than 2 mol% BZT, the piezoelectric coefficient dropped, permittivity remained almost constant, and a high normalized strain of up to 500 pm/V was observed. However, no field‐dependent structural change was evidenced by the in situ X‐ray experiment.
Granules of Brushite and Octacalcium Phosphate from Marble
Authors: Tas A. Cuneyt
Published: June 2011

Brushite (DCPD, dicalcium phosphate dihydrate, CaHPO4·2H2O) and octacalcium phosphate (OCP, Ca8(HPO4)2(PO4)4·5H2O) granules with millimeter sizes were prepared by using marble (calcium carbonate) granules as the starting material. The method of this study simply comprised of soaking the marble granules in aqueous solutions containing phosphate and/or calcium ions at temperatures between 20° and 37°C. This process did not cause any size change between the initial marble and final brushite or octacalcium phosphate granules. Such DCPD and OCP granules could be useful in maxillofacial, dental, and orthopedic void/bone defect filling and grafting applications. Samples were characterized by X‐ray diffraction, inductively coupled plasma atomic emission spectroscopy, and scanning electron microscopy.
Cervical nitric oxide release in Chlamydia trachomatis and high‐risk human papillomavirus infection
Authors: RAHKOLA PÄIVI , VÄISÄNEN‐TOMMISKA MERVI , HILTUNEN‐BACK EIJA , AUVINEN EEVA , YLIKORKALA OLAVI , MIKKOLA TOMI S.
Published: June 2011

Objective. To compare cervical fluid nitric oxide release in women with and without Chlamydia trachomatis and high‐risk human papillomavirus infection (hrHPV). Design. An open clinical study. Setting. University Hospital of Helsinki. Population. Thirty‐nine women with (n=21) and without C. trachomatis (n=18). Methods. Chlamydia trachomatis and/or hrHPV were studied by using specific RNA‐ and DNA‐based tests. Levels of cervical fluid nitric oxide metabolite (NOx) were assessed by the Griess reaction. Main Outcome Measures. The difference in cervical fluid NOx between women with and without C. trachomatis and hrHPV. Results. Fourteen (67%) C. trachomatis‐infected women and three (17%) noninfected women had concomitant hrHPV. The level of cervical fluid NOx in women with C. trachomatis (median 37.5μmol/l, 95% confidence interval 26.1–50.9) was higher (p=0.02) than that in C. trachomatis‐noninfected women (median 19.7μmol/L, 95% confidence interval 5.6–30.0). The presence of hrHPV did not associate with any difference in NOx levels between C. trachomatis‐infected or ‐noninfected women. Conclusions. Chlamydia trachomatis was associated with increased release of nitric oxide metabolites in the uterine cervix. This stimulus was stronger than that of hrHPV, because no additional rise in NOx was seen in women with concomitant C. trachomatis and hrHPV infection.
Expression of matrix metalloproteinases and their inhibitors at the feto‐maternal interface in unruptured ectopic tubal pregnancy
Authors: QIU XIAOYAN , XIE YI , CHEN LINGLING , GEMZELL‐DANIELSSON KRISTINA
Published: June 2011

Objective. To investigate expression of matrix metalloproteinases (MMPs) and the tissue inhibitors of MMPs (TIMPs) at the feto‐maternal interface and non‐implantation sites in unruptured tubal pregnancies. Design. Prospective study. Setting. University teaching hospital. Population. Eighteen patients with unruptured tubal pregnancy undergoing salpingectomy. Methods. Immunohistochemistry was used to detect MMP‐2, ‐9 and ‐14, and TIMP‐1, ‐2 and ‐3 at the feto‐maternal interface and non‐implantation regions of the Fallopian tube. Serum levels of human chorionic gonadotropin (β‐hCG) were determined, and trophoblastic invasion was histologiclly classified as stage I when limited to the tubal mucosa and stage II when extending to the muscular layer. Main Outcome Measures. The relation between serum β‐hCG concentration with the depth of trophoblastic invasion into the tubal wall and differential expression of MMPs and TIMPs. Results. A significant difference in the β‐hCG concentrations was seen between stage I and II invasion. Immunoreactivity for MMP‐2, ‐9 and ‐14, and TIMP‐1, ‐2 and ‐3 was primarily localized to cytotrophoblasts. At the implantation sites, the intensity of MMPs increased along the invasive pathway towards the maternal interstitium. The expression of MMP‐2, MMP‐14 and TIMP‐3 was localized to the epithelium and smooth muscle cells of the Fallopian tube, while expression of MMP‐9, TIMP‐1 and TIMP‐2 was weak or absent. Conclusions. Human chorionic gonadotropin correlated positively with invasion stage of trophoblasts. At ectopic implantation sites, the expression of MMPs gradually increased with increasing invasion depth of trophoblasts. TIMP‐1 and TIMP‐2 were only weakly expressed. The imbalance between expression of MMPs and TIMPs at the ectopic implantation sites may lead to the extensive destructive degradation of the extracellular matrix.
Pregnancy following robot‐assisted laparoscopic myomectomy in women with deep intramural myomas
Authors: LÖNNERFORS CELINE , PERSSON JAN
Published: June 2011

Objective. To describe fecundity after robot‐assisted laparoscopic myomectomy for deep intramural myomas. Design. Prospective observational study. Setting. University hospital. Population. Women undergoing robot‐assisted laparoscopic myomectomy. Methods. Expanding on a previous prospective feasibility study, 31 consecutive women in whom a robot‐assisted laparoscopic myomectomy was performed between April 2006 and July 2010 were included. The women, of whom 14 had known infertility, were selected for having symptomatic, deep intramural myomas with a possible impact on fertility. Using a prospective protocol, relevant peri‐operative and follow‐up data were retrieved. Main Outcome Measures. Fertility and pregnancy outcome. Results. The 31 women included had a median age of 35years (range 28–42years) and median body mass index of 22.0kg/m2 (range 20.1–24.7kg/m2). Fifteen (68%) of the 22 women with an active wish of conceiving had become pregnant at a median time of 10months after surgery. A total of 18 pregnancies occurred, resulting in three miscarriages, two terminated pregnancies, 10 successful term deliveries and three ongoing pregnancies. The subgroup of 14 women with a known but otherwise unexplained infertility had a similar pregnancy rate (69%) and of those, 55% conceived naturally. The women who conceived naturally were on average eight years younger than the women becoming pregnant after in vitro fertilization, and all miscarriages occurred in an in vitro fertilization pregnancy. Conclusions. In women with symptomatic, deep intramural myomas and either otherwise unexplained infertility or myomas with a possible effect on conception, the pregnancy rate following robot‐assisted laparoscopic myomectomy was 68%.
Exosome Secretion: Molecular Mechanisms and Roles in Immune Responses
Authors: Bobrie Angélique , Colombo Marina , Raposo Graça , Théry Clotilde
Published: June 2011

Exosomes are small membrane vesicles, secreted by most cell types from multivesicular endosomes, and thought to play important roles in intercellular communications. Initially described in 1983, as specifically secreted by reticulocytes, exosomes became of interest for immunologists in 1996, when they were proposed to play a role in antigen presentation. More recently, the finding that exosomes carry genetic materials, mRNA and miRNA, has been a major breakthrough in the field, unveiling their capacity to vehicle genetic messages. It is now clear that not only immune cells but probably all cell types are able to secrete exosomes: their range of possible functions expands well beyond immunology to neurobiology, stem cell and tumor biology, and their use in clinical applications as biomarkers or as therapeutic tools is an extensive area of research. Despite intensive efforts to understand their functions, two issues remain to be solved in the future: (i) what are the physiological function(s) of exosomes in vivo and (ii) what are the relative contributions of exosomes and of other secreted membrane vesicles in these proposed functions? Here, we will focus on the current ideas on exosomes and immune responses, but also on their mechanisms of secretion and the use of this knowledge to elucidate the latter issue.
Determinants of irritability in Huntington's disease
Authors: Nimmagadda Seshagiri Rao , Agrawal Niruj , Worrall-Davies Anne , Markova Ivana , Rickards Hugh
Published: June 2011

Nimmagadda SR, Agrawal N, Worrall-Davies A, Markova I, Rickards H. Determinants of irritability in Huntington's disease.

Objectives: Irritability is a common and disabling problem associated with Huntington's disease (HD). However, the underlying causes of such irritability remain unclear. This study investigates the association of irritability in HD with possible aetiological factors including dysexecutive syndrome, depression, anxiety (state and trait) and movement disorder.

Methods: Thirty patients with genetically confirmed HD and their carers were recruited from a regional HD neuropsychiatry service. Patients completed two self-reported questionnaires (Irritability, Anxiety and Depression Scale and State Trait Anxiety Inventory). Their carers filled in the Burns Irritability Scale. Patients were also administered the Behavioural Assessment of Dysexecutive Syndrome (BADS), Montgomery and Asberg Depression Rating Scale (MADRS) and the Motor component of the Unified Huntington's Disease Rating Scale (UHDRS).

Results: Both self-rated and carer-rated irritability scales showed significant positive correlation with trait anxiety. The self-rated irritability scales also showed significant positive correlation with state anxiety and depression. No association was observed between irritability and dysexecutive syndrome or motor impairment.

Conclusions: Trait anxiety might serve as a predictor for irritability in HD. Irritability is unrelated to motor or cognitive features of HD indicating that it is an independent neuropsychiatric manifestation of HD.
Warming preterm infants in the delivery room: polyethylene bags, exothermic mattresses or both?
Authors: McCarthy Lisa K , O’Donnell Colm PF
Published: June 2011

Aims:  To compare the admission temperature of infants treated with polyethylene bags alone to infants treated with exothermic mattresses in addition to bags in the delivery room.

Methods:  We prospectively studied infants born at <31 weeks’ gestation who were placed in bags at birth. Some infants were also placed on mattresses. Admission axillary temperatures were measured in all infants on admission to the neonatal intensive care. We compared the temperatures of infants treated with bags alone to those treated with mattresses and bags.

Results:  We studied 43 infants: 15 were treated with bags while 28 were treated with a bag and mattress. Mean admission temperature was similar between the groups. Hypothermia and hyperthermia occurred more frequently in infants treated with a bag and mattress, and more infants treated with a bag had admission temperatures 36.5–37.5°C.

Conclusion:  The use of exothermic mattresses in addition to polyethylene bags, particularly in younger, smaller newborns, may result in more hypothermia and hyperthermia on admission. A randomised controlled trial is necessary to determine which strategy results in more infants having admission temperatures in the normal range.
Sense of coherence and health behaviour in adolescence
Authors: Mattila M‐L , Rautava P , Honkinen P‐L , Ojanlatva A , Jaakkola S , Aromaa M , Suominen S , Helenius H , Sillanpää M
Published: June 2011

Aim:  To explore associations of Sense of coherence (SOC) with health behaviour and social competence among 15‐year‐old adolescents.

Methods:  Study population is a prospective cohort of a randomized cluster sample of families and their first‐born children from south‐western Finland in 1986–1987. In this study, cross‐sectional data of the 15‐year‐olds were used. The present data were based on mailed, pretested questionnaires. The outcome variable, SOC, was based on the 13‐item scale of Antonovsky’s Orientation to Life Questionnaire (OLQ). The principal explanatory variables were health behaviour, including experienced oral health, and social competence. The statistical analysis was performed using linear regression modelling.

Results:  Strong SOC of adolescents associated significantly with lighter use of alcohol, being a non‐smoker, better care of oral health and better social competence compared with the others.

Conclusion:  Sense of coherence is a useful tool for identifying adolescents in need of extra support and motivation for their health behaviour.
First two decades of paediatric heart transplantation in Sweden – outcome of listing and post‐transplant results
Authors: Gilljam Thomas , Higgins Thomas , Bennhagen Rolf , Wåhlander Håkan
Published: June 2011

Aims:  To evaluate outcome in the first generation of children with end‐stage heart disease to whom heart transplantation was available.

Methods:  Retrospective review of all 135 Swedish children <18 years old listed for heart transplantation 1989–2009, followed to December 31, 2009, including 74 (55%) with cardiomyopathy and 61 (45%) with congenital heart disease; 34 (25%) were infants (<1 year). Cumulative risk of requiring heart transplantation was 1:17 300 (11 patients who improved were omitted from outcome analysis).

Results:  Waiting‐list mortality was 31% (44% in infants). Median waiting time in 82 transplanted patients was 57 days (0–585 days). Post‐transplant follow‐up time was median 5.9 years (0.03–20.1 years), and actuarial survival was 92% at 1 year, 82% at 5 years, 76% at 10 years and 58% at 15 years. Survival after listing was 64% at 1 year, 58% at 5 years, 52% at 10 years and 40% at 15 years. Post‐transplant complications included rejections (34%), malignancies (12%), renal failure (8%), coronary artery vasculopathy (6%) and re‐transplantation (5%). Among 64 survivors, 84% were free of complications affecting prognosis.

Conclusion:  High waiting‐list mortality and post‐transplant attrition precluded 60% of this pioneer population from reaching adulthood. Functional status in survivors is generally good.
Novel therapeutics based on recombinant botulinum neurotoxins to normalize the release of transmitters and pain mediators
Authors: Dolly J. Oliver , Wang Jiafu , Zurawski Tomas H. , Meng Jianghui
Published: June 2011

A major unmet clinical need exists for long‐acting neurotherapeutics to alleviate chronic pain in patients unresponsive to available nonaddictive analgesics. Herein, a new strategy is described for the development of potent and specific inhibitors of the neuronal exocytosis of transmitters and pain mediators that exhibit unique antinociceptive activity. This entailed recombinant production in Escherichia coli of two serotypes of botulinum neurotoxin (BoNT) (BoNTA and BoNTE), which are proteins that are known to block the release of transmitters by targeting and entering nerve endings, where their proteases cleave and inactivate a protein, synaptosomal protein of Mr 25 000 (SNAP‐25), that is essential for Ca2+‐regulated exocytosis. Site‐directed mutagenesis of Leu428 and Leu429 in BoNTA revealed that the remarkable longevity of its neuroparalytic action is attributable to a dileucine‐containing motif. BoNTE acts transiently, because it lacks these residues, but is a superior inhibitor of transient receptor potential vanilloid type 1‐mediated release of pain peptides from sensory nerves. The advantageous features of each serotype were harnessed by attaching the BoNTE protease moiety to an enzymically inactive mutant of BoNTA. The resultant purified composite protein could target motoneurons by binding to the BoNTA ectoacceptor and persistently produce BoNTE‐truncated SNAP‐25. As this enzyme lasted for more than 1 month (as compared with 5 days for BoNTE alone), such a dramatic extension in the lifetime of this BoNTE protease is attributable to a stabilizing influence of the BoNTA mutant. Most importantly, injecting this novel biotherapeutic into the foot pads of rats resulted in extended amelioration of inflammatory pain. Thus, a new generation of biotherapeutics has been created with the potential to give long‐term relief of pain.