bluuebunny/crossref_metadata_2025 huggingface dataset:
Cardiopulmonary bypass management and acute renal failure: risk factors and prognosis
Authors: Sirvinskas E , Andrejaitiene J , Raliene L , Nasvytis L , Karbonskiene A , Pilvinis V , Sakalauskas J
Published: May 2009

The aim of the study was to investigate if acute renal failure (ARF) following cardiac surgery is influenced by CPB perfusion pressure and to determine risk factors of ARF. Our research consisted of two studies. In the first study, 179 adult patients with normal preoperative renal function who had been subjected to cardiac surgery on CPB were randomized into three groups. The mean perfusion pressure (PP) during CPB in Group 65 (68 patients) was 60–69.9 mmHg, in Group 55 (59 patients) – lower than 60 mmHg and in Group 75 (52 patients) – 70 mmHg and higher. We have analyzed postoperative variables: central venous pressure, the need for diuretics, urine output, fluid balance, acidosis, potassium level in blood serum, the need for hemotransfusions, nephrological, cardiovascular and respiratory complications, duration of artificial lung ventilation, duration of stay in ICU and in hospital, and mortality. In the second study, to identify the risk factors for the development of ARF following CPB, we retrospectively analysed data of all 179 patients, divided into two groups: patients who developed ARF after surgery (group with ARF, n = 19) and patients without ARF (group without ARF, n = 160). We found that urine output during surgery was statistically significantly lower in Group 55 than in Groups 65 and 75. The incidence of ARF in the early postoperative period did not differ among the groups: it developed in 6% of all patients in Group 65, 4% in Group 55 and 6% in Group 75. There were no differences in the rate of other complications (cardiovascular, respiratory, neurological disorders, bleeding, etc) among the groups. There were 19 cases of ARF (10.6%), but none of these patients needed dialysis. We found that age (70.0 ± 7.51 vs. 63.5 ± 10.54 [standard deviation, SD], P = 0.016), valve replacement and/or reconstruction surgery (57.9% vs. 27.2%, P = 0,011), combined valve and CABG surgery (15.8% vs. 1.4%, P = 0.004), duration of CPB (134.74 ± 62.02 vs. 100.59 ± 43.99 min., P = 0.003) and duration of aortic cross-clamp (75.11 ± 35.78 vs. 53.45 ± 24.19 min., P = 0.001) were the most important independent risk factors for ARF. Cardiopulmonary bypass perfusion pressure did not cause postoperative renal failure. The age of patient, valve surgery procedures, duration of cardiopulmonary bypass and duration of aorta cross-clamp are potential causative factors for acute renal failure after cardiac surgery.
Outcome after coronary artery bypass surgery with miniaturized versus conventional cardiopulmonary bypass
Authors: Rimpiläinen R , Biancari F , Wistbacka JO , Loponen P , Koivisto SP , Rimpiläinen J , Teittinen K , Nissinen J
Published: May 2009

We have reviewed the results of our experience with the use of miniaturized (Mini-CPB) versus conventional (C-CPB) cardiopulmonary bypass in coronary artery bypass surgery (CABG). This study included 365 patients who underwent CABG with C-CPB and 101 patients with Mini-CPB. In-hospital mortality was lower in the C-CPB group (1.4% vs. 3.0%, P = 0.38). A better, but not statistically significant, immediate outcome was observed in the C-CPB group as indicated by a shorter length of stay in the intensive care unit as well as a lower incidence of combined adverse end-point. However, this was probably due to significantly higher operative risk in the Mini-CPB group (logistic EuroSCORE: 8.5 ± 10.0 vs. 4.6 ± 7.1, P < 0.0001). Seventy-seven propensity score-matched pairs had similar immediate postoperative results after Mini-CPB and C-CPB (30-day mortality: 1.3% vs. 1.3%; stroke: 0% vs. 0%; intensive care unit stay ≥5 days: 6.5% vs. 9.1%; combined adverse events: 14.3% vs. 11.7%). Mini-CPB achieves similar results to C-CPB in patients undergoing isolated CABG. The potential efficacy of Mini-CPB is expected to be more evident in high-risk patients or in complex cardiac surgery requiring much longer cardiopulmonary perfusion.
Does an allergy to fish pre-empt an adverse protamine reaction? A case report and a literature review
Authors: Collins C , O’Donnell A
Published: May 2009

The operating theatre exposes patients to myriad potential agents which could result in a life-threatening anaphylactic reaction. Anaesthetic drugs, blood products, and latex are only some of the possible allergens. Reactions are deemed to be anaphylactic when immediate sensitivity is combined with cardiovascular collapse. A patient who had a known allergy to shellfish presented for first time cardiopulmonary bypass. The perfusion team were concerned that there was a realistic possibility that an adverse reaction to protamine could occur. Anaphylactic reactions to protamine in patients allergic to fish have been reported. The anaesthetic team were informed and the necessary precautions taken. We report on the outcome for our patient and also discuss other risk factors and the types of reactions that can result when an adverse reaction to protamine occurs.
Future options in landscape ecology: development and research
Authors: Xiuzhen Li  , Mander Ülo
Published: May 2009

The aim of this brief overview is to highlight some new and promising research fields in landscape ecology, which is essentially an interdisciplinary field of study. We also analyse the development of some classical branches of landscape ecology regarding pattern and process relationships at broad spatial and temporal scales, such as landscape metrics, the influence of anthropogenic factors and global climate change on landscape development, the fragmentation of ecosystems and disturbances of populations, and material and energy cycling in and between ecosystems.
Globalization: a Physical Geography perspective
Authors: Clifford Nicholas J.
Published: May 2009

Although globalization is a term usually restricted to economics and the social sciences, there are aspects of the phenomenon that are intimately linked to the practice and purpose of the physical and environmental sciences and exemplified through Physical Geography. At a fundamental level, Physical Geography has always sought to describe and understand the multiple subsystems of the environment and their connections with human activity: it is global and globalizing at its very roots. Globalization may be seen historically in the global export of western science, including Physical Geography, that underpinned colonial resource exploitation, and which subsequently laid the foundations for the worldwide conservation movement, and for critiques of environment-development relations, such as Political Ecology. Globalization is evident today in the burgeoning productivity and increasing organization of science as well as in the growing accessibility of scientific information. It is also at work in setting contemporary scientific agendas that are focused on larger-scale issues of environment and development and environmental change, particularly in an emergent Earth System Science, and also in Sustainability Science. These global agendas are not simply shared with but also co-produced by the public, politicians and commercial interests, providing both opportunities and challenges for traditional disciplines and traditional disciplinary practices such as Physical Geography.
Coastal geomorphology: trends and challenges
Authors: French J.R. , Burningham H.
Published: May 2009

This review highlights recent work in coastal geomorphology that challenges existing wisdom, breaks new ground or contributes in some way to wider principles. Sediment transport by currents and by waves remains a major focus of coastal process geomorphology, and the contribution of this work to our appreciation of landform dynamics is particularly evident at the beach scale. Reconstructive studies over Holocene to historical timescales are yielding new insights into the adjustment of coastal sedimentary systems to progressive environmental forcing, high-magnitude events and human activities. Coastal geomorphology is currently buoyed by opportunities afforded by the implied threats of climate change and sea-level rise, and by the conceptual and technical challenges of predicting morphodynamic behaviour at the all-important `engineering' scales. Of some concern is the lack of dialogue with other major strands of geomorphology. One of the main challenges, to create models capable of revealing emergent aspects of spatially distributed interactions between form and process, is common to all geomorphologists engaged with the meso-scale. Yet coastal specialists seem reluctant both to draw inspiration from and also to contribute ideas to what might be seen as a single, extremely broad, research front. More generally, there is little exchange of ideas or contribution to a shared intellectual endeavour. Coastal geomorphology is at the forefront of the discipline when it comes to the exploitation of new environmental instrumentation and remote sensing technologies. It can only be hoped that the plethora of high-resolution multitemporal data sets will contribute to the advance of geomorphological thinking rather than merely being used to constrain sediment budgets as a basis for the management of localized erosion problems.
Leaving the Sphere of Exchange with David Houston, Karl Marx, and Even Adam Smith: Insights into the Debate about Sweatshops
Authors: Miller John A.
Published: May 2009

Today most economists are critical of the antisweatshop movement. But that was not always the case. At times even the leaders of the economics establishment condemned sweatshop labor or its equivalent and lent their support to social movements intended to eradicate it. My paper traces the change in consciousness about sweatshops and antisweatshop movements among economists by examining what Smith, Marx, and earlier neoclassical economists actually wrote about sweatshop-like conditions and antisweatshop movements.
The Design and Modeling of Multi-axis Knee Artificial Leg
Authors: Xie Hualong , Guo Lixin , Liu Yongxian , Li Fei
Published: May 2009

To provide an ideal test-base for the development of an intelligent bionic leg, a new pattern humanoid robot – biped robot with heterogeneous legs (BRHL) was designed. To simulate a normal human gait, a multi-axis knee mechanism was included into the artificial leg design that was different from the artificial leg of a common biped robot. The conception and research purposed for the BRHL was developed. Based on human bioscience, the bionic design of multi-axis knee artificial leg was analyzed and a virtual prototype was made. The kinematics model and dynamics model were deduced in detail. Based on human normal gait data, a simulation of dynamics model was carried. An optimized mechanical design of multi-axis knee artificial leg is discussed and a simulation was done. The optimal mechanism parameters for the multi-axis knee artificial leg and a BRHL prototype were given. This research indicated that a multi-axis knee artificial leg can simulate a human leg.
Intervertebral Spinal Fusion Using a RP-based PLGA/TCP/bBMP Biomimetic Grafting Material
Authors: Ma Xing , Wu Xiaoming , Hu Yunyu , Xiong Zhuo , Lv Rong , Wang Jun , Li Dan , Yan Yongnian
Published: May 2009

Three-dimensional highly porous poly(DL-lactic-co-glycolic acid)/tricalcium phosphate (PLGA/TCP) scaffolds were synthesized via a rapid prototyping (RP) technique. Bovine bone morphogenetic protein (bBMP) was loaded into the biopolymer scaffolds (PLGA/TCP/bBMP). Both the PLGA/TCP scaffolds and the PLGA/TCP/bBMP composites were evaluated by scanning electron microscopy. Lumbar intervertebral body fusion at L2~3 and L4~5 levels were performed on 15 goats using one of the following graft materials: RP synthesized PLGA/TCP scaffolds (group A), PLGA/TCP/bBMP composites (group B), and autogenous iliac bone graft (group C). All animals were sacrificed 24 weeks after surgery and the spine fusions evaluated by manual palpation tests, histological analyses, and radiography. In group A, the histological analyses showed that the PLGA/TCP scaffolds were biocompatible and biodegradable; however, no new bone was found. In group B, highly cellular bone marrow between the new trabecular bone was present in the fusion mass. In group C, there was a lesser amount of new bone. Twenty-four weeks after surgery, the fusion rate of lumbar intervertebral body fusion in group A, B, and C was 10% (1/10), 80% (8/10), and 50% (5/10), respectively. The fusion rate was significantly higher in group B compared with groups of A and C (p<0.01). Based on these results, extracted bBMP can be loaded in vitro into RP-based highly porous structural PLGA/TCP scaffolds to fabricate new graft composites that appear to be more effective for intervertebral spinal fusions. This biomimetic artificial grafting material holds promise as a tool for spine surgery.
Preparation of Bioactive Hydroxyapatite on Pure Titanium
Authors: Tianshi Wang , Renji Zhang , Yongnian Yan
Published: May 2009

In this study, a hydroxyapatite (HA) was coated on a pure titanium surface by means of a complex oxidation and hydrothermal treatment. First an anodic oxidation was done on the titanium plates, followed by micro-arc oxidation. The HA-coated specimens and pure titanium specimens were immersed in SLB for 1, 5, and 10 days, respectively, to study their electrochemical behavior. The corrosion currents of HA-coated specimens were less than pure titanium specimens. This indicated that HA coating prevented surface metal ions of the implant from dissolving, thereby, reducing the tissue toxicity. The cytotoxic effect on fibroblasts L929 cells was measured by cell counting after being seeded for 2, 4, 8, 12, and 24 h. The number of surface cell attachments on the HA-coated specimens was much greater than on pure titanium specimens. The morphology of the cells on the HA coating had normal shapes and spread well with some cells climbing onto surface pores while cells on the pure titanium were oval shaped. The results confirm that the cell compatibility on HA-coated ion titanium surfaces is much better than pure titanium.
Three-dimensional Reconstruction of Functional Fascicular Groups inside a Segment of Common Peroneal Nerve
Authors: Zhang Yi , Qi Jian , Liu Xiaolin , Xiong Zuo , Li Shengjie , Zhou Jiaming , Liang Yingjie
Published: May 2009

The virtual human plan has been the hot point of recent research. The objective of this study is to explore the possibility of three-dimensional (3D) reconstruction of functional fascicular groups inside short segmental peripheral nerve. A 5 cm length of common peroneal nerve was horizontally sliced at 0.25 mm intervals, and each section was stained with acetycholinesterase histochemical staining. The 2D panorama images were acquired by high-resolution digital camera under 100 x microscope and mosaic software; different functional fascicular groups were distinguished and marked. The topographic database was then matched using image processing software, through the 3D reconstruction achieved using 3D reconstruction software (Amira 3.1). The reconstructed 3D images could be rotated or zoomed in any direction and the intercross and recombination processes of nerve bundles could be observed. Based on the serial histological sections and computer technology, the 3D microstructure of short segmental peripheral nerve functional fascicular groups was reconstructed. These results provide the possibility of 3D reconstruction of long segmental peripheral nerve functional fascicular groups.
Feasibility and Tailoring of Bioactive Glass-ceramic Scaffolds with Gradient of Porosity for Bone Grafting
Authors: Vitale-Brovarone Chiara , Baino Francesco , Verné Enrica
Published: May 2009

The aim of this research study is the preparation and characterization of graded glass—ceramic scaffolds that are able to mimic the structure of the natural bone tissue, formed by cortical and cancellous bone. The material chosen for the scaffolds preparation is a glass belonging to the system SiO 2—P2O5—CaO—MgO—Na 2O—K2O (CEL2). The glass was synthesized by a conventional melting—quenching route, ground, and sieved to obtain powders of specific size. The scaffolds were fabricated using different methods: polyethylene burn-off, sponge replication, a glazing-like technique, and combinations of these methods. The scaffolds were characterized through morphological observations, density measurements, volumetric shrinkage, mechanical tests, and in vitro bioactivity tests. The features of the scaffolds prepared using the different methods were compared in terms of morphological structure, pores content, and mechanical strength. The proposed scaffolds effectively mimic the cancellous/cortical bone system in terms of structure, porosity, and mechanical strength, and they exhibit a highly bioactive behavior. Therefore, these graded grafts have a great potential for biomedical applications and can be successfully proposed for the substitution of load-bearing bone portions.
A Rolling Regression Analysis of International Transmission of Inflation in Malaysia
Authors: Ibrahim Mansor H.
Published: May 2009

The paper assesses the transmission of foreign inflationary disturbances for Malaysia. Using quarterly data from 1971 to 2003, we form a four–variable vector error correction model (VECM) consisting of domestic prices, US prices, Ringgit exchange rate and relative interest rate. Apart from the full–sample analysis, recursive and rolling regressions are adopted to examine potential changes in inflation transmission from the US to Malaysia. As a basis for inferences, we rely on the speed of adjustments estimates as well as the sig–nificance of lagged first–differenced terms of the VECM. The results unequivocally suggest significant spillover of US inflationary disturbances to Malaysia in the short run regardless of the estimation periods. However, the speed of adjustment estimates for domestic prices tend to decline or turn insignificant when recent observations are added. Our findings demonstrate that inflation transmission across nations ought not to be cast in the light of exchange rate regimes alone. Indeed, the degree of capital mobility may have played a more dominant role.
Challenges of a Sustainable Housing Finance System in India
Authors: Mahadeva M.
Published: May 2009

The Indian housing finance market (HFM) has failed to promote housing development across the country. In its desire to stabilise itself mainly in the major urban areas, the HFM has largely neglected issues of the housing sector in rural and less–developed regions. Further, the financial housing needs of a large segment of the population are not being addressed. They continue to rely on informal sources for housing finance. This paper describes and analyses the major issues confronting India's HFM. It offers policy options to make the HFM more effective in addressing the hitherto neglected segment, the rural and less–developed region.
Fabrication of Repairing Skull Bone Defects Based on the Rapid Prototyping
Authors: Wu Wenzheng , Zhang Yang , Li Hu , Wang Wanshan
Published: May 2009

The Rapid Prototyping (RP) manufacture technology, computer tomography (CT) image processing, and mechanical analyses were adopted to repair a skull defect injury. After the patient was inspected by spiral CT the data was exported to Digital Imaging and Communications in Medicine (DICOM) format. The data was processed with Mimics software to eliminate noise and gray-level registration. The processing filtered out the parenchyma data and preserved the bone data. The STL files were analyzed and processed by the Magics and put into the RP equipment. The RP equipment is one type of Stereo Lithography Apparatus (SLA) with laser light spot diameter that is <0. 2mm The 3D models were analyzed to comply with the patients’ requirements. The stereo lithography model emulated the mechanical properties and shape with the patient's bone. The titanium-alloy plate matched the anatomy well. The 3D reconstructed freeform model was accurate to within 0.2 mm.
Micromechanics on the Rate-dependent Fracture of Discontinuous Fiber-reinforced Plastics
Authors: Okabe T. , Nishikawa M. , Takeda N.
Published: May 2009

Numerical simulation by finite element analysis was used to investigate the relationship between the strength of glass fiber reinforced plastic (GFRP) and fiber length. Load speed dependability was also investigated, since thermoplastic resin used for GFRP exhibits much nonlinear stress—strain behavior and strong dependency on load speed. For this purpose, we conducted a periodic-cell simulation to address the effect of composite microstructure, matrix viscoplasticity, and microscopic damage (fiber break and matrix crack). When the fiber length was varied, the damage pattern was divided into two patterns: fiber-avoiding propagation and fiber-breaking modes of the matrix crack from fiber ends. When the matrix crack easily propagated in a fiber-avoiding way for shorter fiber lengths, the rate-dependent effect of the matrix was significant. Moreover, we considered the length at which the fracture mode changed based on this analysis, and compared it with the conventional critical length given by Kelly. Since the conventional critical length does not ensure improved composite strength, the consideration of the damage mode transition is essential for selecting the appropriate fiber length for strength improvement.
Coupled Analysis of Induction Hardening Considering Induction Heating, Thermal Elasto-viscoplastic Damage, and Phase Transformation
Authors: Takagaki Masakazu , Toi Yutaka
Published: May 2009

The coupled computational procedure of the induction heating, the thermal conduction, the thermal elasto-viscoplastic damage, and the phase transformation analysis has been developed for the induction hardening analysis of steel machine parts. The validity of the proposed computational procedure has been illustrated by conducting the induction hardening analysis of a circular bar and a notched circular bar.
Partner Violence and Sexual Jealousy in China
Authors: Wang Tianfu , Parish William L. , Laumann Edward O. , Luo Ye
Published: May 2009

Using data from a nationally representative survey in China, this article examines the prevalence and risk factors for partner violence with a special focus on the important role of sexual jealousy. Among women aged 20 to 49, 7.2% reported that they were hit by their partners in the past year. Comparison shows that the Chinese prevalence is modestly below the overall median for other societies. Net of other factors, jealousy exacerbates hitting for both men and women in a reactive pattern, with the jealous partner getting hit. This suggests a rethinking of the role of sexual jealousy in spousal violence in some social settings.
It Depends
Authors: Voorhees Clay M. , Baker Julie , Bourdeau Brian L. , Brocato E. Deanne , Cronin J. Joseph
Published: May 2009

When consumers have to wait, the service delivery process is frequently compromised. The literature suggests that reducing waiting time is beneficial, but for service firms faced with scarce resources this is not always an option. As an alternative strategy, this study identifies and tests the mitigating effects of three factors that moderate the waiting time—anger and waiting time—regret relationships. Results show that in four service industries, affective commitment, perceived justice, and physical environment quality affect negative evaluations of a service experience and attenuate the effects of waiting time on both anger and regret. The authors discuss implications for researchers and service marketers in light of the results.
The social and economic determinants of smoking in Moscow, Russia
Authors: Stickley Andrew , Carlson Per
Published: May 2009

Background: Despite a high prevalence of smoking for decades, recent research has documented an increase in the rates of both male and female smoking in post-Soviet Russia. As yet, however, little research has taken place on smoking at the subnational level. The current study addresses this deficit by examining smoking in Moscow — the city that has been at the forefront of the entry into the Russian market of transnational tobacco corporations (TTCs) in the transition period. Methods: Data were obtained from the Moscow Health Survey 2004 — a stratified random sample of 1190 people representative of Moscow’s larger population. Information was obtained about subjects’ smoking habits and age of smoking initiation. Results: The prevalence of smoking was high among both men (55.5%) and women (26.9%), with significantly higher rates in the younger age groups. There was also a high prevalence of smoking initiation before age 15 years, especially in the youngest women (18—30 years). Logistic regression analysis showed that respondents’ age, binge drinking, locus of control and economic situation were important determinants of smoking. Conclusions: Although lifestyle factors seem to underpin the generally high levels of smoking, other things, such as its high prevalence in the younger generations and the factors associated with smoking (locus of control), nevertheless suggest that the TTCs may have played an important role in the spread of smoking in transitional Russia’s changing social environment.
Parental attitudes and behaviour concerning adolescent alcohol consumption: do sociodemographic factors matter?
Authors: Pettersson Camilla , Linden-Boström Margareta , Eriksson Charli
Published: May 2009

Aims: Parental attitudes and behaviour with regard to young people and alcohol are associated with teenagers' drinking behaviour. This study examined the association between sociodemographic factors among parents and parental attitudes and behaviour with regard to alcohol and adolescents. Methods: Postal questionnaires were sent to parents of children aged 12—16 years in six Swedish municipalities. Seven hundred and ninety-five parents were included in the study. Seven sociodemographic factors and four questions identifying parental attitudes and behaviour were examined. Logistic regression was used to compute odds ratios and confidence intervals. Results: The study showed that fathers were more likely than mothers to report that children had been drinking or tasting alcohol at home. Parents who answered the questionnaire together also stated that their children had been served alcohol at home to a larger extent than mothers. Fathers, single parents and parents with older children were more likely to have non-restrictive attitudes towards adolescents and alcohol than mothers, parents living in a household with more than one adult, and parents with younger children. Factors such as age of the parents, employment status and numbers of children in the household were not associated with either parental attitudes or behaviour. Conclusions: The sex of the responding parent was the only sociodemographic factor that was associated with both parental attitudes and behaviour. Fathers were more likely than mothers to have a non-restrictive attitude. The fathers also reported to a greater extent than mothers that children had been drinking or tasting alcohol at home.
Sternal fractures
Authors: Raghunathan Rangan , Porter Keith
Published: May 2009

Sternal fractures are relatively common and range from simple unicortical cracks to displaced fractures associated with life threatening injuries. This paper describes the relevant anatomy, biomechanics, mechanism of injury, clinical presentation, investigation, treatment and complications and also includes associated and concomitant injuries. A management flow chart including criteria for discharge from the emergency department is presented.
Clavicle fractures
Authors: Moonot Pradeep , Ashwood Neil
Published: May 2009

Clavicular fractures represent 2.6—5% of all fractures, with middle third fractures being the commonest. The shape of the clavicle bone is such that it has a flat medial and lateral expanses, linked by a thin, tubular middle. This central transitional area represents a weak link in clavicular structure, which is not protected by or reinforced with muscle or ligamentous attachments, therefore rendering it prone to fracture. Due to the subcutaneous position of the clavicle, there is an inherent susceptibility to direct injury. These fractures are easy to diagnose due to the presence of swelling and bruising present. Radiographical examination should include an anteroposterior and a 45°caudal tilt view. Optimal treatment in undisplaced or minimally displaced fractures is with a sling. In displaced or comminuted fractures the risk of non-union and poor functional outcome may be markedly higher and may be best treated with surgical fixation.
Steps to a Healthier Arizona
Authors: Drummond Rebecca L. , Staten Lisa K. , Sanford Mary Reyes , Davidson Christopher L. , Magda Ciocazan Maria , Khor Kai-Ning , Kaplan Frances
Published: May 2009

Through Steps to a Healthier Arizona, a unique partnership was developed to reach the culturally diverse, rural communities of Southern Arizona. This partnership included local, regional, and state agencies and coalitions focused on reducing the burden of chronic disease and health disparities. This article describes the success of a program aimed at preventing childhood obesity and diabetes. Partners in Yuma County worked with child care providers to implement organizational best practices which promote positive nutrition and physical activity behaviors in young children. As a result of this project, the number of child care centers in Yuma County implementing best practices increased. Additionally a ripple effect has reached beyond the individual child care setting, into broader local and state early childhood development systems. Taking place against the backdrop of state-wide initiatives in early childhood development and health, the Steps to a Healthier Arizona's NAP SACC program positioned stakeholders to integrate with these advances.
Steps to a Healthier Anishinaabe, Michigan
Authors: Edgerly Catherine Carmel , Laing Shannon S. , Day Anya-Victoria G. , Blackinton Paulina M. , Pingatore Noel L. , Haverkate Richard T. , Heany Julia F.
Published: May 2009

American Indians experience significant health disparities compared to the general U.S. population. The Steps to a Healthier Anishinaabe program adopted a unique framework to implement health promotion intervention activities in multiple American Indian communities in Michigan. By enabling each community to tailor interventions to their specific culture and health priorities, the program is characterized by a culturally competent and community-driven approach to decrease the impact of chronic diseases on the health of Michigan's American Indians. This article describes the community-based framework and argues that multisite, community-tailored health promotion programs are a promising approach to reducing health disparities in minority populations.
Steps to a Healthier New York
Authors: Johnston Yvonne , Denniston Ray , Morgan Molly , Bordeau Mark
Published: May 2009

The rising rate of overweight poses a significant threat to the health of children. Because roughly one third of a child's dietary intake occurs during school hours and because both health and academic outcomes have been linked to children's nutrition, school nutrition policies and programs have been identified as a key area for intervention. This article describes the components, processes, and initial successes of a grassroots effort and innovative project to improve the nutritional quality of the School Lunch Program through a sustainable systems intervention and policy change across a regional area of upstate New York. The Rock on Cafe intervention was partially funded by the Steps to a Healthier New York program and promises to be a model for creating a school environment that supports healthy dietary behaviors among children.
Steps to a Healthier Washington
Authors: Dilley Julia A. , Reuer Jennifer R. , Colman Victor , Norman Robbi Kay
Published: May 2009

Steps to a Healthier Washington , in collaboration with other programs in the Washington State Department of Health and external partners, has implemented training to improve public health practice and create greater organizational and staff capacity for promoting effective policy and systems changes, including reducing disparities. The training is grounded in behavior change and adult learning theories. A comprehensive post training evaluation found long-term improvements in self-efficacy, reported changes in work, and attribution of those changes to the training. Organizations working to refocus public health work on policy and systems change should consider providing skills-based policy training to their staff. This study suggests that an integrated training, using adult learning theory, has led to long-term improvements in capacity among public health staff and partners.
Retinal changes and cardiac remodelling in systemic hypertension
Authors: Cuspidi Cesare , Negri Francesca , Giudici Valentina , Sala Carla
Published: May 2009

The clinical value of left ventricular hypertrophy (LVH), a cardinal manifestation of hypertensive organ damage, in predicting cardiovascular (CV) events, independently of blood pressure (BP) and other accompanying risk factors, has been widely documented and its role in CV stratification indisputability recognized. Although the examination of the fundus oculi provides a unique opportunity to evaluate retinal microvascular abnormalities, which may mirror systemic arteriolar damage due to high BP, no consistent evidence exists, on the prognostic value of mild degrees of retinopathy, encompassing the vast majority of uncomplicated hypertensive subjects. Personal and literature data indicate that: (1) there is a tight association between advanced retinopathy and LVH suggesting the existence of a parallel involvement of retinal tree and cardiac damage in severe untreated or poorly controlled hypertension; (2) in contrast, a firm conclusion about the relationship between early or nonspecific retinal changes (narrowing or arteriovenous crossing) and cardiac damage is not allowed by the majority of the studies; (3) future investigations, based on computer-assisted methods, are further required to document the relation between initial retinal changes with organ damage and more importantly to test their predictive value for clinical outcomes.
CCL21 mediates CD4+ T-cell costimulation via a DOCK2/Rac-dependent pathway
Authors: Gollmer Kathrin , Asperti-Boursin François , Tanaka Yoshihiko , Okkenhaug Klaus , Vanhaesebroeck Bart , Peterson Jeffrey R. , Fukui Yoshinori , Donnadieu Emmanuel , Stein Jens V.
Published: May 2009

CD4+ T cells use the chemokine receptor CCR7 to home to and migrate within lymphoid tissue, where T-cell activation takes place. Using primary T-cell receptor (TCR)–transgenic (tg) CD4+ T cells, we explored the effect of CCR7 ligands, in particular CCL21, on T-cell activation. We found that the presence of CCL21 during early time points strongly increased in vitro T-cell proliferation after TCR stimulation, correlating with increased expression of early activation markers. CCL21 costimulation resulted in increased Ras- and Rac-GTP formation and enhanced phosphorylation of Akt, MEK, and ERK but not p38 or JNK. Kinase-dead PI3KδD910A/D910A or PI3Kγ-deficient TCR-tg CD4+ T cells showed similar responsiveness to CCL21 costimulation as control CD4+ T cells. Conversely, deficiency in the Rac guanine exchange factor DOCK2 significantly impaired CCL21-mediated costimulation in TCR-tg CD4+ T cells, concomitant with impaired Rac- but not Ras-GTP formation. Using lymph node slices for live monitoring of T-cell behavior and activation, we found that G protein-coupled receptor signaling was required for early CD69 expression but not for Ca2+ signaling. Our data suggest that the presence of CCL21 during early TCR signaling lowers the activation threshold through Ras- and Rac-dependent pathways leading to increased ERK phosphorylation.
Activation of cAMP signaling inhibits DNA damage–induced apoptosis in BCP-ALL cells through abrogation of p53 accumulation
Authors: Naderi Elin Hallan , Findley Harry W. , Ruud Ellen , Blomhoff Heidi Kiil , Naderi Soheil
Published: May 2009

In lymphocytes, the second messenger cyclic adenosine monophosphate (cAMP) plays a well-established antiproliferative role through inhibition of G1/S transition and S-phase progression. We have previously demonstrated that, during S-phase arrest, cAMP inhibits the action of S phase–specific cytotoxic compounds, leading to reduction in their apoptotic response. In this report, we provide evidence that cAMP can also inhibit the action of DNA-damaging agents independently of its effect on S phase. Elevation of cAMP in B-cell precursor acute lymphoblastic leukemia cells is shown to profoundly inhibit the apoptotic response to ionizing radiation, anthracyclins, alkylating agents, and platinum compounds. We further demonstrate that this effect depends on the ability of elevated cAMP levels to quench DNA damage–induced p53 accumulation by increasing the p53 turnover, resulting in attenuated Puma and Bax induction, mitochondrial outer membrane depolarization, caspase activation, and poly(ADP-ribose) polymerase cleavage. On the basis of our findings, we suggest that cAMP levels may influence p53 function in malignant cells that retain wild-type p53, potentially affecting p53 both as a tumor suppressor during cancer initiation and maintenance, and as an effector of the apoptotic response to DNA-damaging agents during anticancer treatment.
Global optimal eBURST analysis of multilocus typing data using a graphic matroid approach
Authors: Francisco Alexandre P , Bugalho Miguel , Ramirez Mário , Carriço João A
Published: May 2009

Background

Multilocus Sequence Typing (MLST) is a frequently used typing method for the analysis of the clonal relationships among strains of several clinically relevant microbial species. MLST is based on the sequence of housekeeping genes that result in each strain having a distinct numerical allelic profile, which is abbreviated to a unique identifier: the sequence type (ST). The relatedness between two strains can then be inferred by the differences between allelic profiles. For a more comprehensive analysis of the possible patterns of evolutionary descent, a set of rules were proposed and implemented in the eBURST algorithm. These rules allow the division of a data set into several clusters of related strains, dubbed clonal complexes, by implementing a simple model of clonal expansion and diversification. Within each clonal complex, the rules identify which links between STs correspond to the most probable pattern of descent. However, the eBURST algorithm is not globally optimized, which can result in links, within the clonal complexes, that violate the rules proposed.

Results

Here, we present a globally optimized implementation of the eBURST algorithm – goeBURST. The search for a global optimal solution led to the formalization of the problem as a graphic matroid, for which greedy algorithms that provide an optimal solution exist. Several public data sets of MLST data were tested and differences between the two implementations were found and are discussed for five bacterial species: Enterococcus faecium, Streptococcus pneumoniae, Burkholderia pseudomallei, Campylobacter jejuni and Neisseria spp.. A novel feature implemented in goeBURST is the representation of the level of tiebreak rule reached before deciding if a link should be drawn, which can used to visually evaluate the reliability of the represented hypothetical pattern of descent.

Conclusion

goeBURST is a globally optimized implementation of the eBURST algorithm, that identifies alternative patterns of descent for several bacterial species. Furthermore, the algorithm can be applied to any multilocus typing data based on the number of differences between numeric profiles. A software implementation is available at http://goeBURST.phyloviz.net.
Erratum to: The extracellular Leucine-Rich Repeat superfamily; a comparative survey and analysis of evolutionary relationships and expression patterns
Authors: Dolan Jackie , Walshe Karen , Alsbury Samantha , Hokamp Karsten , O'Keeffe Sean , Okafuji Tatsuya , Miller Suzanne FC , Tear Guy , Mitchell Kevin J
Published: May 2009

Correction to Dolan J, Walshe K, Alsbury S, Hokamp K, O'Keeffe S, Okafuji T, Miller SF, Tear G, Mitchell KJ: The extracellular leucine-rich repeat superfamily; a comparative survey and analysis of evolutionary relationships and expression patterns. BMC Genomics 2007, 8:320.
A postal survey of data in general practice on the prevalence of Acquired Brain Injury (ABI) in patients aged 18–65 in one county in the west of Ireland
Authors: Finnerty Fionnuala , Glynn Liam , Dineen Brendan , Colfer Finbarr , MacFarlane Anne
Published: May 2009

Background

Very little is known about the prevalence of acquired brain injury (ABI) in Ireland. ABI prevalence has previously been obtained from Belgian general practitioners using a postal survey. We attempted to ascertain the prevalence of ABI in County Mayo through a postal survey of all general practitioners in the county.

The specific objectives of this project were to:

1. identify whether general practitioners are

a. aware of patients with ABI aged 18–65 in their practices

b. able to provide prevalence data on ABI in patients aged 18–65

c. able to provide data on age, gender and patient diagnosis

2. analyse prevalence of ABI from any available data from general practitioners.

Methods

A pilot postal survey was performed initially in order to assess the feasibility of the study. It was established that general practitioners did have the necessary information required to complete the questionnaire. A main postal survey was then undertaken. A postal questionnaire was administered to all general practices in County Mayo in the west of Ireland (n = 59). The response rate was 32.2% (n = 19).

Results

General practitioners who replied on behalf of their practice could provide data on patient age, gender and diagnosis. In the nineteen practices, there were 57 patients with ABI. The age-specific prevalence of ABI in the area surveyed was estimated at 183.7 per 100,000. The mean patient population per practice was 2,833 (SD = 950). There were found to be significantly more patients with ABI in rural areas than urban areas (p = 0.006). There were also significant differences in the ages of patients in the different ABI categories. Patients whose ABI was of traumatic origin were significantly younger than those patients with ABI of haemorrhagic origin (p = 0.002).

Conclusion

Although this is a small-scale study, we have ascertained that general practitioners do have data on patients with ABI. Also, some prevalence data now exist where none was available before. These can be used to form the basis of a more substantial programme of university/community partnership research which could provide medical and psychosocial benefits for people with ABI and their families.
Macroscopic extent of gastric mucosal atrophy: increased risk factor for esophageal squamous cell carcinoma in Japan
Authors: Akiyama Tomoyuki , Inamori Masahiko , Iida Hiroshi , Endo Hiroki , Hosono Kunihiro , Yoneda Kyoko , Fujita Koji , Yoneda Masato , Takahashi Hirokazu , Goto Ayumu , Abe Yasunobu , Kirikoshi Hiroyuki , Kobayashi Noritoshi , Kubota Kensuke , Saito Satoru , Rino Yasushi , Nakajima Atsushi
Published: May 2009

Background

We aimed to estimate whether the macroscopic extent of gastric mucosal atrophy is associated with a risk for esophageal squamous cell carcinoma using a case-control study in Japanese subjects, a population known to have a high prevalence of CagA-positive H. pylori infection.

Methods

Two hundred and fifty-three patients who were diagnosed as having esophageal squamous cell carcinoma, and 253 sex- and age-matched controls were enrolled in the present study. The macroscopic extent of gastric mucosal atrophy was evaluated based on the Kimura and Takemoto Classification. A conditional logistic regression model with adjustment for potential confounding factors was used to assess the associations.

Results

Body gastritis, defined endoscopically, was independently associated with an increased risk for esophageal squamous cell carcinoma.

Conclusion

Our findings suggest that macroscopic body gastritis may be a risk factor for esophageal squamous cell carcinoma in Japan. Further studies are needed to confirm these findings.
Quality assessment of an interferon-gamma release assay for tuberculosis infection in a resource-limited setting
Authors: Hang Nguyen TL , Ishizuka Naoki , Keicho Naoto , Hong Le T , Tam Do B , Thu Vu TX , Matsushita Ikumi , Harada Nobuyuki , Higuchi Kazue , Sakurada Shinsaku , Lien Luu T
Published: May 2009

Background

When a test for diagnosis of infectious diseases is introduced in a resource-limited setting, monitoring quality is a major concern. An optimized design of experiment and statistical models are required for this assessment.

Methods

Interferon-gamma release assay to detect tuberculosis (TB) infection from whole blood was tested in Hanoi, Viet Nam. Balanced incomplete block design (BIBD) was planned and fixed-effect models with heterogeneous error variance were used for analysis. In the first trial, the whole blood from 12 donors was incubated with nil, TB-specific antigens or mitogen. In 72 measurements, two laboratory members exchanged their roles in harvesting plasma and testing for interferon-gamma release using enzyme linked immunosorbent assay (ELISA) technique. After intervention including checkup of all steps and standard operation procedures, the second trial was implemented in a similar manner.

Results

The lack of precision in the first trial was clearly demonstrated. Large within-individual error was significantly affected by both harvester and ELISA operator, indicating that both of the steps had problems. After the intervention, overall within-individual error was significantly reduced (P < 0.0001) and error variance was no longer affected by laboratory personnel in charge, indicating that a marked improvement could be objectively observed.

Conclusion

BIBD and analysis of fixed-effect models with heterogeneous variance are suitable and useful for objective and individualized assessment of proficiency in a multistep diagnostic test for infectious diseases in a resource-constrained laboratory. The action plan based on our findings would be worth considering when monitoring for internal quality control is difficult on site.
Feasibility, design and conduct of a pragmatic randomized controlled trial to reduce overweight and obesity in children: The electronic games to aid motivation to exercise (eGAME) study
Authors: Maddison Ralph , Foley Louise , Ni Mhurchu Cliona , Jull Andrew , Jiang Yannan , Prapavessis Harry , Rodgers Anthony , Vander Hoorn Stephen , Hohepa Maea , Schaaf David
Published: May 2009

Background

Childhood obesity has reached epidemic proportions in developed countries. Sedentary screen-based activities such as video gaming are thought to displace active behaviors and are independently associated with obesity. Active video games, where players physically interact with images onscreen, may have utility as a novel intervention to increase physical activity and improve body composition in children. The aim of the Electronic Games to Aid Motivation to Exercise (eGAME) study is to determine the effects of an active video game intervention over 6 months on: body mass index (BMI), percent body fat, waist circumference, cardio-respiratory fitness, and physical activity levels in overweight children.

Methods/Design

Three hundred and thirty participants aged 10–14 years will be randomized to receive either an active video game upgrade package or to a control group (no intervention).

Discussion

An overview of the eGAME study is presented, providing an example of a large, pragmatic randomized controlled trial in a community setting. Reflection is offered on key issues encountered during the course of the study. In particular, investigation into the feasibility of the proposed intervention, as well as robust testing of proposed study procedures is a critical step prior to implementation of a large-scale trial.

Trial registration

Australian New Zealand Clinical Trials Registry ACTRN12607000632493