bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of the Enabling Rural Innovation (ERI) approach: Case studies from Malawi and Uganda
Authors: Kaaria Susan , Njuki Jemimah , Abenakyo Annet , Delve Robert , Sanginga Pascal
Published: April 2008

This paper presents lessons from applying an innovative action research approach for linking smallholder farmers to markets, in eastern and southern Africa. The Enabling Rural Innovation (ERI) approach aims to strengthen social organization and entrepreneurial capacity in rural communities. It focuses on fostering community‐based capacity for the inclusion of rural women and the poor in analyzing and accessing market opportunities. Using case studies from Malawi and Uganda the paper assesses the outcomes of ERI on rural communities with a focus on human capital, gender issues and investment in natural resource management. Results show that households are benefiting significantly from linkages to markets in terms of increasing household incomes, and accumulating assets. Skills in analyzing markets and in negotiating with traders have increased among smallholder farmers. The integration of gender in the approach has led to changes in gender decision making patterns at household and community level towards a more shared decision‐making process. The results however show a difference in skills between men and women, with women showing lower levels of skills acquisition. Farmer participatory research has increased investments in improved technologies such as fertilizer applications for soil fertility management.
Antiepileptic drugs—best practice guidelines for therapeutic drug monitoring: A position paper by the subcommission on therapeutic drug monitoring, ILAE Commission on Therapeutic Strategies
Authors: Patsalos Philip N. , Berry David J. , Bourgeois Blaise F. D. , Cloyd James C. , Glauser Tracy A. , Johannessen Svein I. , Leppik Ilo E. , Tomson Torbjörn , Perucca Emilio
Published: April 2008

Summary

Although no randomized studies have demonstrated a positive impact of therapeutic drug monitoring (TDM) on clinical outcome in epilepsy, evidence from nonrandomized studies and everyday clinical experience does indicate that measuring serum concentrations of old and new generation antiepileptic drugs (AEDs) can have a valuable role in guiding patient management provided that concentrations are measured with a clear indication and are interpreted critically, taking into account the whole clinical context. Situations in which AED measurements are most likely to be of benefit include (1) when a person has attained the desired clinical outcome, to establish an individual therapeutic concentration which can be used at subsequent times to assess potential causes for a change in drug response; (2) as an aid in the diagnosis of clinical toxicity; (3) to assess compliance, particularly in patients with uncontrolled seizures or breakthrough seizures; (4) to guide dosage adjustment in situations associated with increased pharmacokinetic variability (e.g., children, the elderly, patients with associated diseases, drug formulation changes); (5) when a potentially important pharmacokinetic change is anticipated (e.g., in pregnancy, or when an interacting drug is added or removed); (6) to guide dose adjustments for AEDs with dose‐dependent pharmacokinetics, particularly phenytoin.
Wind turbines, flicker, and photosensitive epilepsy: Characterizing the flashing that may precipitate seizures and optimizing guidelines to prevent them
Authors: Harding Graham , Harding Pamela , Wilkins Arnold
Published: April 2008

Summary

Wind turbines are known to produce shadow flicker by interruption of sunlight by the turbine blades. Known parameters of the seizure provoking effect of flicker, i.e., contrast, frequency, mark‐space ratio, retinal area stimulated and percentage of visual cortex involved were applied to wind turbine features. The proportion of patients affected by viewing wind turbines expressed as distance in multiples of the hub height of the turbine showed that seizure risk does not decrease significantly until the distance exceeds 100 times the hub height.

Since risk does not diminish with viewing distance, flash frequency is therefore the critical factor and should be kept to a maximum of three per second, i.e., sixty revolutions per minute for a three‐bladed turbine. On wind farms the shadows cast by one turbine on another should not be viewable by the public if the cumulative flash rate exceeds three per second. Turbine blades should not be reflective.
Abnormalities in diffusion tensor imaging of the uncinate fasciculus relate to reduced memory in temporal lobe epilepsy
Authors: Diehl Beate , Busch Robyn M. , Duncan John S. , Piao Zhe , Tkach Jean , Lüders Hans O.
Published: April 2008

Summary

Aims: To use Diffusion Tensor Imaging (DTI) to explore structural integrity and connectivity of the uncinate fasciculus (UF) in patients with temporal lobe epilepsy (TLE) and its relationship to memory performance.

Methods: DTI and UF reconstruction were performed in 28 patients with TLE (18 left, 10 right) and 10 normal controls. Differences between left and right UF fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values and correlations between DTI measures and memory scores in the TLE groups were computed.

Results: In controls, FA was higher in the left than right UF (p < 0.01). In left TLE, FA values were lower and ADC values higher than controls in the left UF and ADC values were higher in the right UF (all p < 0.05). In right TLE, ADCs were higher in the left and right UF compared to controls, and FA was reduced in the left UF (all p < 0.05). In left TLE, ADCs in the left UF were negatively correlated with Auditory Immediate (p < 0.05) and Delayed Memory (p < 0.01). Visual Delayed Memory was positively correlated with reduced FA in the ROI of the right UF and increased radial diffusivities (p < 0.05). No significant correlations were found in right TLE. Thus, DTI values correlated with memory scores in the expected direction in patients with left TLE.

Conclusions: Abnormal diffusion measures in the UF ipsilateral to the epileptogenic zone suggest that integrity of the UF is related to memory performance in patients with left TLE. Larger sample sizes are needed to evaluate structure‐function correlations further.
Pork‐Barrel Politics in Postwar Italy, 1953–94
Authors: Golden Miriam A. , Picci Lucio
Published: April 2008

This article analyzes the political determinants of the distribution of infrastructure expenditures by the Italian government to the country's 92 provinces between 1953 and 1994. Extending implications of theories of legislative behavior to the context of open‐list proportional representation, we examine whether individually powerful legislators and ruling parties direct spending to core or marginal electoral districts and whether opposition parties share resources via a norm of universalism. We show that when districts elect politically more powerful deputies from the governing parties, they receive more investments. We interpret this as indicating that legislators with political resources reward their core voters by investing in public works in their districts. The governing parties, by contrast, are not able to discipline their own members of parliament sufficiently to target the parties' areas of core electoral strength. Finally, we find no evidence that a norm of universalism operates to steer resources to areas when the main opposition party gains more votes.
Candidate and Party Strategies in Two‐Stage Elections Beginning with a Primary
Authors: Adams James , Merrill Samuel
Published: April 2008

In the United States and Latin America, candidates for national and state‐level office frequently must win primary elections in order to advance to the general election. We model policy and valence issues for office‐seeking candidates facing such two‐stage elections. We determine a Nash equilibrium for the candidates' optimal strategies, and we find that holding a primary is likely to increase a party's chances of winning the general election, particularly in situations where valence issues that involve the candidates' campaigning skills and that are not known prior to the campaign are more salient than policy issues. Furthermore, we find that primary elections are especially likely to benefit parties that expect to be underdogs in the general election. Our conclusions are directly relevant to U.S. politics and by extension to the strategic decisions that many Latin American parties currently confront, about whether it is strategically desirable to hold primaries.
The Check Is in the Mail: Interdistrict Funding Flows in Congressional Elections
Authors: Gimpel James G. , Lee Frances E. , Pearson‐Merkowitz Shanna
Published: April 2008

This article analyzes the financial ties between congressional candidates and individual donors residing outside those candidates' districts. Congressional campaigns today rely more heavily on nonresidents than in the past, with contests in the typical district drawing more than two‐thirds of individual donations from nonresidents. Empirical results reveal that nonresident contributions are primarily partisan and strategic in nature, rather than access‐oriented or expressive/identity‐based. Funds are efficiently redistributed from a small number of highly educated, wealthy congressional districts to competitive districts anywhere in the country. Big donors direct funds where they can make a difference for party control of seats, even if those investments are hundreds, or even thousands, of miles away.
An Exploration of Correct Voting in Recent U.S. Presidential Elections
Authors: Lau Richard R. , Andersen David J. , Redlawsk David P.
Published: April 2008

Lau and Redlawsk (1997)

proposed that the quality of voter decision making can be evaluated by measuring what they called correct voting—the extent to which people vote in accordance with their own values and priorities—but in so doing provided little guidance about what actually determines whether voters can make such high‐quality decisions. This article develops a framework for analyzing the vote decision that views the quality of decision making as a joint function of individual characteristics and various higher‐level campaign factors. We hypothesize that differences in cognitive capacity, political motivation, the availability of political heuristics, and macrolevel factors that affect the difficulty of the choice confronting citizens, including the nature of the political information environment, should all affect the probability of a correct vote. We find significant support for seven proposed hypotheses across three levels of analysis, which places responsibility for incorrect votes on both the individual and our electoral system.
Opinion Taking within Friendship Networks
Authors: Parker Suzanne L. , Parker Glenn R. , McCann James A.
Published: April 2008

Communication within friendship networks can provide gains in efficiency that help individuals enrich their understanding of politics. Through two panel survey experiments, we demonstrate that the dissemination of an individual's opinion about the hazards posed by public policies can have both durable and significant effects on the policy judgments of friends. These effects are conditioned by both the content of the communication and the recipient's level of political awareness. Opinions emphasizing potential risks carry more weight than those that attempt to alleviate concerns about potential risks. Moreover, opinion transmission is more effective for subjects who are less politically aware when policy issues are salient; but when the political issue is more esoteric, friends who are more politically aware evidence greater opinion change.
Prescribing and monitoring hemodialysis in a 3‐4 ×/week setting
Authors: DAUGIRDAS John T.
Published: April 2008

The basics of targeting, writing, adjusting, and monitoring a hemodialysis prescription are reviewed for patients being dialyzed 3 or 4 times a week. K/DOQI 2006 adequacy guidelines and practice recommendations are reviewed, and a practical method using a variety of nomograms is suggested to monitor and adjust the desired level of Kt/V.
A king‐size dialysis bed: A couple on hemodialysis for more than 30 years
Authors: ATERINI Stefano , AMATO Marcello
Published: April 2008

Dialysis patients exhibit a higher morbidity and mortality rate than those in the general population of comparable age. Survival on dialysis has become significantly longer and is mainly related to comorbid factors. Patients are usually the main research subjects, but caregivers play a pivotal role in patients' well‐being. Here we describe the remarkable case of wife and husband both on hemodialysis for 32 years.
Determinants of C‐reactive protein in chronic hemodialysis patients: Relevance of dialysis catheter utilization
Authors: HUNG Adriana , PUPIM Lara , YU Chang , SHINTANI Ayumi , SIEW Edward , AYUS Carlos , HAKIM Raymond M. , IKIZLER Talat Alp
Published: April 2008

Biomarkers of inflammation, especially C‐reactive protein (CRP), have been consistently shown to predict poor outcomes in chronic hemodialysis (CHD) patients. However, the determinants of CRP and the value of its monitoring in CHD patients have not been well defined. We conducted a retrospective cohort study to evaluate possible determinants of the inflammatory response in CHD patients with a focus on dialysis catheter utilization. Monthly CRP were measured in 128 prevalent CHD patients (mean age 56.6 years [range 19–90], 68% African Americans, 39% diabetics [DM]) over a mean follow‐up of 12 months (range 2–26 months). There were a total of 2405 CRP measurements (median 5.7 mg/L; interquartile range [IQR] 2.4–16.6 mg/L). The presence of a dialysis catheter (p<0.002), cardiovascular disease (p=0.01), male gender (p=0.005), higher white blood cell count (p<0.0001), elevated phosphorus (p=0.03), and lower cholesterol (p=0.02) and albumin (p<0.0001) concentrations were independent predictors of elevated CRP in the multivariate analysis. Additionally, CRP levels were significantly associated with the presence of a catheter, when comparing the levels before and after catheter insertion (p=0.002) as well as before and after catheter removal (p=0.009). Our results indicate that the presence of a hemodialysis catheter is an independent determinant of an exaggerated inflammatory response in CHD patients representing a potentially modifiable risk factor.
A new safety device for hemodialysis
Authors: AHLMÉN Jarl , GYDELL Karl‐Henrik , HADIMERI Henrik , HERNANDEZ Isabel , ROGLAND Björn , STRÖMBOM Ulf
Published: April 2008

Accidental venous needle dislodgement during hemodialysis may cause serious bleeding including a sometimes fatal outcome. The venous pressure gauge of the dialysis monitor does not react when dislodgement occurs. A sensor patch put as an adhesive over the venous needle puncture site connected to an alarm unit by an optic fiber has been clinically tested in 5 dialysis departments. A small amount of blood on the sensor activates a light and sound alarm. A simple questionnaire was filled out by the nurses at each dialysis concerning their feeling of safety when the new device was used. Forty‐one patients, mean age 65 years, have tested the new safety device. Two hundred test dialyses were studied, after exclusion of 13 tests. One hundred seventy‐nine tests reacted positively on blood. In another 6 dialyses, a warning light appeared on the alarm unit indicating a failure in the sensor patch. Thus, the alarm functioned in 92.5% of all tests. After a small modification of the sensor patches there were only 2 dialyses (2/71) without an activated alarm on blood, i.e., 97.2% positive alarm reactions. The answers of the nurses indicated that they had an increased feeling of safety when using the new safety device, with a mean value of 3.4 points on a visual scale from 0 to 5 where 5 meant very much increased safety. In a situation when the dialysis monitors today do not react on bleedings from venous needle dislodgements, the new alarm safety device fulfils a known shortage in routine dialysis safety. In situations where supervision during a dialysis session may be insufficient as, for example, in home hemodialysis and self‐care dialysis or in other situations when the patient is sleeping, the device may be life saving.
Clinical correlates and treatment of bone/joint pain and difficulty with sexual arousal in patients on maintenance hemodialysis
Authors: CARREON Myra , FRIED Linda F. , PALEVSKY Paul M. , KIMMEL Paul L. , ARNOLD Robert M. , WEISBORD Steven D.
Published: April 2008

Bone/joint pain and difficulty with sexual arousal are prevalent, frequently severe, and potentially treatable in patients on maintenance hemodialysis. However, the mediators and adequacy of treatment for these symptoms have been less well studied. We sought to assess the clinical correlates and treatment of these symptoms in patients receiving chronic hemodialysis. Using the Dialysis Symptom Index, we assessed the presence and severity of bone/joint pain and difficulty with sexual arousal in 75 patients on chronic hemodialysis. Associations of demographic and clinical variables with these 2 symptoms were assessed. We also recorded the use of analgesics for bone/joint pain and, among men, phosphodiesterase‐5 inhibitors for difficulty with sexual arousal. Twenty‐eight patients (37%) reported bone/joint pain, of whom 20 (71%) described it as moderate to severe. Nineteen of 50 male patients (38%) reported difficulty with sexual arousal, which was described as moderate to severe by 15 (79%). Patients' demographic and clinical characteristics were not correlated with bone/joint pain. Among men, there were no correlations between patients' demographic and clinical characteristics and difficulty with sexual arousal. Only 48% of patients with bone/joint pain were receiving analgesics, while 21% of men who described difficulty with sexual arousal were receiving phosphodiesterase‐5 inhibitors. Demographic, clinical, and dialysis‐related variables are poorly correlated with bone/joint pain and difficulty with sexual arousal. However, these symptoms are prevalent and under‐treated, which should spur efforts to assess the impact of improving provider assessment and treatment of these symptoms on patient outcomes, including health‐related quality of life.
Genotyping of respiratory syncytial virus (RSV) group A in Stockholm, Sweden, using PCR and two‐dimensional melting curve analysis
Authors: RAFIEFARD FARIDEH , ÖRVELL CLAES , BONDESON KÅRE
Published: April 2008

Genotyping of respiratory syncytial (RS) virus group A, by means of a novel method based on PCR, FRET (fluorescence resonance energy transmission) detection and two‐dimensional melting curve analysis, was carried out on 80 RS virus samples of group A collected in Stockholm from 1976 to 2005. The Tm values were assessed for three different genotypes (GA2, GA5 and GA7) circulating in Sweden. Two pairs of probes were used and results of subsequent data analysis were plotted in a two‐dimensional system. The results obtained were compared to genotyping using conventional nucleotide sequencing and phylogenetic tree analysis. It was found that the new assay was able to correctly identify genotype in about 89% of the isolates; it identified the remaining 11% as untypeable and as candidates for conventional nucleotide sequencing. The new method constitutes a complement to nucleotide sequencing and could be useful in studies of large numbers of samples in epidemiological studies.
Disturbed expression of E‐cadherin, beta‐catenin and tight junction proteins in colon carcinoma is unrelated to growth pattern and genetic polymorphisms
Authors: HAHN‐STRÖMBERG VICTORIA , EDVARDSSON HENRIK , BODIN LENNART , FRANZÉN LENNART
Published: April 2008

Adhesion proteins are responsible for the structural integrity of epithelial tissue and in tumors this integrity is often lost, resulting in a disorganization of the tissue. In the present study the complexity of the invasive front of colon carcinomas was correlated with cell adhesion protein expression and with polymorphisms in their genes. A complexity index was constructed from 32 colon carcinomas using computer‐assisted morphometry estimating fractal dimension and tumor cell clusters followed by tree analysis. Immunohistochemical staining of beta‐catenin, E‐cadherin, occludin and claudin 2 was used for assessment of protein expression. Genetic screening of tissue from the tumor invasion front with laser microdissection was performed using SSCP and DNA sequencing. Adhesion protein distribution was significantly disturbed in most carcinomas. A single mutation in the gene of beta‐catenin was found but there was no correlation between protein expression and genetic polymorphism. Nor was there any correlation between the complexity of the invasive border and protein distribution or genetic alterations. The results indicate that the complexity of colon carcinoma invasion is not dependent on genetic derangements in the genes of adhesion proteins or the protein distribution. Rather, aberrations in the function of other proteins related to the adhesive proteins could be responsible.
Immunoexpression and prognostic role of hTERT and cyclin D1 in urothelial carcinoma
Authors: YANG CHING‐HSIU , HUNG WEN‐CHUN , WANG SHENG‐LAN , KANG WAN‐YI , CHEN WAN‐TZU , HUANG YA‐CHUN , SU YUE‐CHIU , CHAI CHEE‐YIN
Published: April 2008

The aim was to investigate the expression of human telomerase reverse transcriptase (hTERT) and cyclin D1 in correlation with clinicopathologic features of urothelial carcinoma (UC). Tissue microarrays (TMA) were constructed from paraffin‐embedded specimens of 94 UC patients and immunohistochemical staining was used. High hTERT expression was found in 50 (53%) of the 94 tumors and was significantly associated with tumor invasiveness and tumor grade (P=0.008 and 0.0190, respectively). High cyclin D1 expression was found in 69 (73%) of the 94 tumors and was significantly associated with non‐invasiveness and smaller tumor size, but there was no correlation with tumor grade. Kaplan–Meier analysis indicated that patients with low hTERT and high cyclin D1 levels had longer local recurrence‐free survival (P=0.0482 and 0.0123, respectively). In addition, patients with high cyclin D1 levels had longer disease‐free survival (P=0.0195). In conclusion, this study demonstrated that hTERT and cyclin D1 may be of recurrence predictive value for UC, thus providing clinicians with ancillary information when deciding on suitable therapeutic strategies in UC.
Is Blastocystis hominis a new etiologic factor or a coincidence in iron deficiency anemia?
Authors: Yavasoglu Irfan , Kadikoylu Gurhan , Uysal Hilal , Ertug Sema , Bolaman Zahit
Published: April 2008

Iron deficiency anemia (IDA) is a frequent health problem. Gut parasites such as N. americanus and A. duodenale are known to cause blood loss, but the role of Blastocystis hominis is uncertain. In this study, 212 patients (193 female, 19 male, mean age 41 SD 15 yrs) with IDA were enrolled and 90 persons without IDA (78 female, 12 male, mean age 45 SD 17 yrs). Microscopic examination of stools for B. hominis using the native lugol method was done three times on each subject. If any specimen contained five or more cysts per ×400 field, the person was considered positive. B. hominis was found in 48 out of 212 subjects with IDA (22.6%) and in five of 90 (5.6%) subjects without IDA. This difference is highly statistically significant (P < 0.001). Few subjects had other gut parasites and there was no statistical difference in the ir frequencies between IDA and non‐IDA subjects. Blastocystis hominis may play a role in the development of IDA either on its own or in conjunction with some other agent.
Excellent prognosis and prevalence of HCV infection of primary hepatic and splenic non‐Hodgkin’s lymphoma
Authors: De Renzo Amalia , Perna Fabiana , Persico Marcello , Notaro Rosario , Mainolfi Ciro , De Sio Ilario , Ciancia Giuseppe , Picardi Marco , Del Vecchio Luigi , Pane Fabrizio , Rotoli Bruno
Published: April 2008

Background:  Primary Hepatic (PHL) and Primary Splenic (PSL) non‐Hodgkin’s Lymphoma are rare entities. Small series of PHL and PSL have been reported, suggesting a non‐fortuitous association with Hepatitis C Virus (HCV) infection. The prognosis is believed to be dismal, with early recurrence and short survival.

Patients:  We retrospectively reviewed all PHL and PSL patients diagnosed at our institution between 1990 and 2005.

Results:  Twenty‐five adult patients were identified, six with PHL and 19 with PSL. Twenty‐four patients had a B‐cell lymphoma, defined as Diffuse Large B‐cell lymphoma in 18. The prevalence of HCV infection was 68% among PSL and 66% among PHL. Combination chemotherapy was the mainstay of treatment for PHL and PSL; all but one patient with PSL underwent splenectomy before chemotherapy. Complete remission was achieved in all the cases after frontline therapy; only four patients relapsed but responded to additional chemotherapy courses. Most patients presented with aggressive histological subtypes; 92% were alive at a median follow up of 79 months. HCV infection did not appear to influence the results of therapy.

Conclusion:  Our study confirms the rarity of PHL and PSL, shows a high prevalence of HCV infection, and demonstrates that the outcome of patients with PHL and PSL may be favourable.
Screening of glucose/insulin metabolic alterations in men with multiple skin tags on the neck
Authors: Sudy Emilio , Urbina Francisco , Maliqueo Manuel , Sir Teresa
Published: April 2008

Multiple skin tags appear associated with abnormalities in glucose/insulin metabolism. Clinical and metabolic glucose/insulin characteristics of men with multiple (8 or more) skin tags on the neck were compared with a control group with few or none. Both groups were divided in two subgroups according to normal or abnormal laboratory findings. In the study subgroup with normal laboratory findings the number of skin tags varied from 8–33, whereas in those with abnormal laboratory findings the range was 9–65. Eight or more skin tags were related with statistically significant laboratory glucose/insulin abnormalities: basal hyperinsulinemia (p<0.002), postprandial hyperinsulinemia (p<0.003), and postprandial hyperglycemia (p<0.01). In the multiple skin tag group 77 % had diverse laboratory abnormalities, including insulin resistance, basal hyperinsulinemia, postprandial hyperinsulinemia, glucose intolerance or type 2 diabetes, in contrast with the control group, where only 33 % showed laboratory abnormalities. One‐third of the study group had acanthosis nigricans. Only 15 % of patients with metabolic abnormalities did not show any cutaneous expression of glucose/insulin alterations (9 or more skin tags on the neck, acanthosis nigricans, or waist circumference greater than 95 cm). Multiple skin tags were more sensitive than acanthosis nigricans in identifying those with alterations in the glucose/insulin metabolism (77 vs. 32 % respectively), although less specific (68 vs.100%). Multiple skin tags should raise suspicion of insulin resistance or hyperinsulinemia.
Structure–activity relationships of wheat flavone O‐methyltransferase – a homodimer of convenience
Authors: Kornblatt Jack A. , Zhou Jian‐Min , Ibrahim Ragai K.
Published: April 2008

Wheat flavone O‐methyltransferase catalyzes three sequential methylations of the flavone tricetin. Like other flavonoid O‐methyltransferases, the protein is a homodimer. We demonstrate, using analytical ultracentrifugation, that perchlorate dissociates the dimer into monomers. The resulting monomers retain all their catalytic capacity, including the ability to catalyze the three successive methylations. We show, using isothermal titration calorimetry, that the binding constant for S‐adenosyl‐l‐methionine does not change significantly as the protein dissociates. The second substrate, tricetin, binds to the dimers but could not be tested with the monomers. CD, UV and fluorescence spectroscopy show that there are substantial changes in the structure of the protein as it dissociates. The fact that there are differences between the monomers and dimers even as the monomers maintain activity may be the result of the very low catalytic capacity of this enzyme. Maximal turnover numbers for the dimers and monomers are only about 6–7 per minute. Even though the binding pockets for S‐adenosyl‐l‐methionine, tricetin, selgin and tricin are intact, selection of a catalytically competent structure may be a very slow step during catalysis.
The crystal structure of human WD40 repeat‐containing peptidylprolyl isomerase (PPWD1)
Authors: Davis Tara L. , Walker John R. , Ouyang Hui , MacKenzie Farrell , Butler‐Cole Christine , Newman Elena M. , Eisenmesser Elan Z. , Dhe‐Paganon Sirano
Published: April 2008

Cyclophilins comprise one of the three classes of peptidylprolyl isomerases found in all eukaryotic and prokaryotic organisms, as well as viruses. Many of the 17 annotated human cyclophilins contain the catalytic domain in tandem with other domains, and many of the specific functions of a particular cyclophilin or its associated domains remain unknown. The structure of the isomerase domain from a spliceosome‐associated cyclophilin, PPWD1 (peptidylprolyl isomerase containing WD40 repeat), has been solved to 1.65 Å. In the crystal, the N‐terminus of one isomerase domain is bound in the active site of a neighboring isomerase molecule in a manner analogous to substrate. NMR solution studies show that this sequence binds to the active site of the cyclophilin, but cannot be turned over by the enzyme. A pseudo‐substrate immediately N‐terminal to the cyclophilin domain in PPWD1 could have wider implications for the function of this cyclophilin in the spliceosome, where it is located in human cells.
Spectroscopic characterization of the oxyferrous complex of prostacyclin synthase in solution and in trapped sol–gel matrix
Authors: Yeh Hui‐Chun , Hsu Pei‐Yung , Tsai Ah‐Lim , Wang Lee‐Ho
Published: April 2008

Prostacyclin synthase (PGIS) is a member of the cytochrome P450 family in which the oxyferrous complexes are generally labile in the absence of substrate. At 4 °C, the on‐rate constants and off‐rate constants of oxygen binding to PGIS in solution are 5.9 × 105 m−1·s−1 and 29 s−1, respectively. The oxyferrous complex decays to a ferric form at a rate of 12 s−1. We report, for the first time, a stable oxyferrous complex of PGIS in a transparent sol–gel monolith. The encapsulated ferric PGIS retained the same spectroscopic features as in solution. The binding capabilities of the encapsulated PGIS were demonstrated by spectral changes upon the addition of O‐based, N‐based and C‐based ligands. The peroxidase activity of PGIS in sol–gel was three orders of magnitude slower than that in solution owing to the restricted diffusion of the substrate in sol–gel. The oxyferrous complex in sol–gel was observable for 24 h at room temperature and displayed a much red‐shifted Soret peak. Stabilization of the ferrous–carbon monoxide complex in sol–gel was observed as an enrichment of the 450‐nm species over the 420‐nm species. This result suggests that the sol–gel method may be applied to other P450s to generate a stable intermediate in the di‐oxygen activation.
Investigation of the interaction between the atypical agonist c[YpwFG] and MOR
Authors: Gentilucci Luca , Squassabia Federico , Demarco Rossella , Artali Roberto , Cardillo Giuliana , Tolomelli Alessandra , Spampinato Santi , Bedini Andrea
Published: April 2008

Endogenous and exogenous opiates are currently considered the drugs of choice for treating different kinds of pain. However, their prolonged use produces several adverse symptoms, and in addition, many forms of pain are resistant to any kind of therapy. Therefore, the discovery of compounds active towards μ‐opioid receptors (MORs) by alternative pharmacological mechanisms could be of value for developing novel classes of analgesics. There is evidence that some unusual molecules can bind opioid receptors, albeit lacking some of the typical opioid pharmacophoric features. In particular, the recent discovery of a few compounds that showed agonist behavior even in the absence of the primary pharmacophore, namely a protonable amine, led to a rediscussion of the importance of ionic interactions in stabilizing the ligand–receptor complex and in activating signal transduction. Very recently, we synthesized a library of cyclic analogs of the endogenous, MOR‐selective agonist endomorphin‐1 (YPWF‐NH2), containing a Gly5 bridge between Tyr1 and Phe4. The cyclopeptide c[YpwFG] showed good affinity and agonist behavior. This atypical MOR agonist does not have the protonable Tyr amine. In order to gain more information about plausible mechanisms of interaction between c[YpwFG] and the opioid receptor, we synthesized a selected set of derivatives containing different bridges between Tyr1 and Phe4, and tested their affinities towards μ‐opioid receptors. We performed conformational analysis of the cyclopeptides by NMR spectroscopy and molecular dynamics, and investigated plausible, unprecedented modes of interaction with the MOR by molecular docking. The successive quantum mechanics/molecular mechanics investigation of the complexes obtained by the molecular docking procedure furnished a more detailed description of the binding mode and the electronic properties of the ligands. The comparison with the binding mode of the potent agonist JOM‐6 seems to indicate that the cyclic endomorphin‐1 analogs interact with the receptor by way of an alternative mechanism, still maintaining the ability to activate the receptor.
Health Care Information Technology in Rural America: Electronic Medical Record Adoption Status in Meeting the National Agenda
Authors: Bahensky James A. , Jaana Mirou , Ward Marcia M.
Published: April 2008

ABSTRACT:  Continuing is a national political drive for investments in health care information technology (HIT) that will allow the transformation of health care for quality improvement and cost reduction. Despite several initiatives by the federal government to spur this development, HIT implementation has been limited, particularly in the rural market. The status of technology use in the transformation effort is reviewed by examining electronic medical records (EMRs), analyzing the existing rural environment, identifying barriers and factors affecting their development and implementation, and recommending needed steps to make this transformation occur, particularly in rural communities. A review of the literature for HIT in rural settings indicates that very little progress has been made in the adoption and use of HIT in rural America. Financial barriers and a large number of HIT vendors offering different solutions present significant risks to rural health care providers wanting to invest in HIT. Although evidence in the literature has demonstrated benefits of adopting HIT such as EMRs, important technical, policy, organizational, and financial barriers still exist that prevent the implementation of these systems in rural settings. To expedite the spread of HIT in rural America, federal and state governments along with private payers, who are important beneficiaries of HIT, must make difficult decisions as to who pays for the investment in this technology, along with driving standards, simplifying approaches for reductions in risk, and creating a workable operational plan.
The Importance of Location for Tobacco Cessation: Rural–Urban Disparities in Quit Success in Underserved West Virginia Counties
Authors: Northridge Mary E. , Vallone Donna , Xiao Haijun , Green Molly , Blackwood Julia Weikle , Kemper Suzanne E. , Duke Jennifer , Watson Kimberly A. , Burrus Barri , Treadwell Henrie M.
Published: April 2008

ABSTRACT: 
Context:

Adults who live in rural areas of the United States have among the highest smoking rates in the country. Rural populations, including Appalachian adults, have been historically underserved by tobacco control programs and policies and little is known about their effectiveness. Purpose: To examine the end‐of‐class quit success of participants in A Tobacco Cessation Project for Disadvantaged West Virginia Communities by place of residence (rural West Virginia and the urban area of Greater Charleston). Methods: This collaborative program was implemented in 5 underserved rural counties in West Virginia and consisted of 4 intervention approaches: (1) a medical examination; (2) an 8‐session educational and behavioral modification program; (3) an 8‐week supply of pharmacotherapy; and (4) follow‐up support group meetings. Findings: Of the 725 program participants, 385 (53.1%) had successfully quit using tobacco at the last group cessation class they attended. Participants who lived in rural West Virginia counties had a lower end‐of‐class quit success rate than those who lived in the urban area of Greater Charleston (unadjusted odds ratio [OR]= 0.69, 95% confidence interval [CI]= 0.48, 0.99), even after taking into account other characteristics known to influence quit success (adjusted OR = 0.58, 95% CI = 0.35, 0.94). Conclusions: Tobacco control programs in rural West Virginia would do well to build upon the positive aspects of rural life while addressing the infrastructure and economic needs of the region. End‐of‐class quit success may usefully be viewed as a stage on the continuum of change toward long‐term quit success.
Vital Signs Screening for Alcohol Misuse in a Rural Primary Care Clinic: A Feasibility Study
Authors: Seale J. Paul , Guyinn Monique R. , Matthews Michael , Okosun Ike , Dent M. Marie
Published: April 2008

ABSTRACT: 
Context: Alcohol misuse is more common in rural areas, and rural problem drinkers are less likely to seek alcohol treatment services. Rural clinics face unique challenges to implementing routine alcohol screening and intervention. Purpose: To assess the feasibility of using the single alcohol screening question (SASQ) during routine nursing vital signs in a rural clinic, and to determine its effect on alcohol screening and intervention rates. Methods: Patient exit interviews were used to identify alcohol misuse and to measure changes in screening and intervention rates. Chi‐square tests were used to compare rates of screening across study phases, while odds ratios from logistic regression analyses were used to quantify association between nurse screening and clinician intervention. Findings: Exit interviews were completed by 126 current drinkers (41 before vital signs screening implementation and 85 afterward). Screening rates for alcohol misuse rose from 14.6% at baseline to 20.0% (P = .027) after screening implementation. Clinician intervention rates among alcohol misusers rose from 6.3% to 11.8% (P = .039). Nurse screening increased the odds of clinician intervention (OR 1.47; 95% CI 1.10‐1.95). Conclusions: Vital signs screening proved to be feasible in this rural clinic and produced modest but significant increases in alcohol screening by nurses and brief interventions by clinicians. Additional studies are needed to define effective strategies for further increasing these rates.
Alcohol Consumption and Injury Among Canadian Adolescents: Variations by Urban–Rural Geographic Status
Authors: Jiang Xuran , Li Dongguang , Boyce William , Pickett William
Published: April 2008

ABSTRACT: 
Context:

The impact of alcohol consumption on risks for injury among rural adolescents is an important and understudied public health issue. Little is known about whether relationships between alcohol consumption and injury vary between rural and urban adolescents. Purpose: To examine associations between alcohol and medically attended injuries by urban–rural geographic status using a representative national sample of Canadian adolescents. Methods: The study involved a secondary analysis of a national sample of Canadian adolescents aged 11‐15 years (n = 7,031) from the 2001‐2002 Health Behavior in School‐Aged Children Survey. Respondents were classified into 5 geographic categories of rural‐urban status. Multiple logistic regression was used to examine the magnitude and homogeneity of associations between drinking patterns and adolescent injuries across these 5 geographic groupings. Findings: Higher rates of alcohol consumption and adolescent injuries were observed in more rural areas. Alcohol consumption was significantly associated with higher risks for injury occurrence with evidence of a dose‐related pattern of risk. Associations between alcohol consumption and injury were consistent by urban–rural geographic status. Conclusions: Misuse of alcohol is an important potential cause of injury. Adolescents whose lifestyle includes alcohol consumption experience higher risks for injury, and this association is observed consistently by urban–rural geographic status. Findings of this study emphasize a need to intervene with high‐risk adolescents as a tertiary prevention strategy, irrespective of geographic background.
Mental Health Professional Shortage Areas in Rural Appalachia
Authors: Hendryx Michael
Published: April 2008

ABSTRACT: 
Context: Research on health disparities in Appalachia has rarely compared Appalachia to other geographic areas in such a way as to isolate possible Appalachian effects. Purpose: This study tests hypotheses that nonmetropolitan Appalachia will have higher levels of mental health professional shortage areas than other nonmetropolitan areas of the same states, but that these disparities will dissipate when accounting for social and economic differences. Methods: The study analyzed secondary data for nonmetropolitan counties (N = 618) in the 13 Appalachian states. Appalachian counties were identified from the Appalachian Regional Commission designations. Mental health professional shortages were identified from Health Resources and Services Administration data. Area Resource File data were used to measure county‐level income, education, uninsurance, unemployment, race/ethnicity percentages, and urban influence codes. Logistic regression models tested whether Appalachia was significantly associated with shortage areas, and whether the Appalachian effect persisted after accounting for social and economic covariates. Findings: Seventy percent of Appalachian nonmetropolitan counties were mental health professional shortage areas, significantly higher than non‐Appalachian, nonmetropolitan counties in the same states. The Appalachian effect did not persist after controlling for the full set of other variables; education and race/ethnicity emerged as significant predictors. Conclusions: Appalachia location is associated with mental health professional shortages, but this effect is driven by underlying social differences, in particular by lower education. This method of identifying Appalachia for comparative purposes may be applied to many other health services research questions and to other defined geographic regions.
Rural Residence and Prescription Medication Use by Community‐Dwelling Older Adults: A Review of the Literature
Authors: Grymonpre Ruby E. , Hawranik Pamela G.
Published: April 2008

ABSTRACT: Context: Due to various barriers to health care access in the rural setting, there is concern that rural older adults might have lower access to prescribed medications than their urban counterparts.Purpose:To review published research reports to determine prevalence and mean medication use in rural, noninstitutionalized older adults and assess whether rural–urban differences exist.Methods:PubMed, Ageline, Cinahl, PsycInfo, International Pharmaceutical Abstracts, Agricola, and Institute for Scientific Information Web of Science – Social Science Index were searched.English‐language articles through May 2005 involving a sample of rural, noninstitutionalized older adults and analyses of overall medication prevalence and/or intensity were included. Review articles, conference abstracts, dissertations, books, and articles targeting nonprescription or specific therapeutic categories were excluded. A total of 206 citations were identified and 26 met the inclusion criteria.Findings:Reported prevalence of prescription medication use by rural older adults varied between 62% and 96%, with 2‐6 prescriptions per person. Multivariate analyses results were equally inconsistent. Controlling for insurance, most US studies suggest there is no rural–urban difference in access to prescribed medications. However, this finding may not be generalizable across all regions in the United States or other countries.Conclusions:Geographic location may not be as important a variable for medication usage as for other health services utilization.
Determinants of Rural Women's Health: A Qualitative Study in Southwest Ontario
Authors: Leipert Beverly D. , George Julie A.
Published: April 2008

ABSTRACT: 
Context:

The influences of gender and geography are increasingly being acknowledged as central to a comprehensive understanding of health. Since little research on rural women's health has been conducted, an in‐depth qualitative approach is necessary to gain a better initial understanding of this population. Purpose: To explore the determinants of health and their influence on rural women's health. Methods: From November 2004 to September 2005, 9 focus groups and 3 individual interviews were conducted in 7 rural southwestern Ontario communities. Sixty‐five rural residents aged 26 years and older participated in the study. Semi‐structured interview questions were used to elicit participants' perceptions regarding determinants of rural women's health. Findings: Four Health Canada determinants (employment, gender, health services, and social environments) and 3 new determinants (rural change, rural culture, and rural pride) emerged as key to rural women's health. Conclusions: Although health determinants affect both urban and rural people, this qualitative study revealed that rural women experience health determinants in unique ways and that rural residents may indeed have determinants of their health that are particular to them. More research is needed to explore the nature and effects of determinants of health for rural residents in general, and rural women in particular.
Reason for Visit: Is Migrant Health Care That Different?
Authors: Henning George F. , Graybill Marie , George John
Published: April 2008

ABSTRACT: 
Purpose:

The purpose of this pilot study was to determine the reasons for which migrant agricultural workers in Pennsylvania seek health care.

Methods:

Participants were individuals 14 years of age and over, actively involved in agricultural labor and presenting for medical care at 6 migrant health care centers. Bilingual health care providers randomly selected and interviewed the participants.

Findings:

The most commonly reported reason for visiting the health care provider was for physical examination. The most frequent acute problems were related to the musculoskeletal and integumentary systems. Frequently cited problems in the medical history were hypertension, musculoskeletal/back pain, and gastrointestinal conditions. Most medications being taken were for cardiovascular or pain‐related problems.

Conclusions:

These results suggest that migrant workers present with medical problems that are similar to those of the general primary care population. Many problems were recurrent and represented common chronic medical conditions.