bluuebunny/crossref_metadata_2025 huggingface dataset:
Testing for parameter constancy in general causal time‐series models
Authors: Kengne William Charky
Published: March 2012

We consider a processbelonging to a large class of causal models including AR(∞), ARCH(∞), TARCH(∞),… processes. We assume that the model depends on a parameterand consider the problem of testing for change in the parameter. Two statisticsandare constructed using quasi‐likelihood estimator of the parameter. Under the null hypothesis that there is no change, it is shown that each of these two statistics weakly converges to the supremum of the sum of the squares of independent Brownian bridges. Under the alternative of a change in the parameter, we show that the test statisticdiverges to infinity. Some simulation results for AR(1), ARCH(1), GARCH(1,1) and TARCH(1) models are reported to show the applicability and the performance of our procedure with comparisons to some other approaches.
Gendering the Organization of Home‐based Work in Turkey: Classical versus Familial Patriarchy
Authors: Sarıoğlu Esra
Published: March 2012

This article examines the link between industrial homework and family dynamics in Turkey by asking how and why varied patterns emerge in the organization of industrial homework. I develop a framework for the analysis of gendered organization of industrial homework by comparing labour practices in extended family and nuclear family households. In extended family households, subcontracts are made between industrial enterprises and male family members. Women carry out piece‐rated work at home under the supervision of male family members and have very little contact with people outside their family. In nuclear family households, subcontracts are made between women homeworkers and industrial enterprises or middle persons. Women work at residential streets and neighbourhood homework stores, as well as at home. They have control over their income as well as their working hours. To explain the divergent practices of industrial homework, I show that enterprises incorporate distinct patterns of patriarchy into the subcontracting arrangements through gendered organization of industrial homework.
Relative risk of cardiovascular disease among people living with HIV: a systematic review and meta‐analysis
Authors: Islam FM , Wu J , Jansson J , Wilson DP
Published: March 2012

Objectives

The aim of this study was to estimate the relative risk of cardiovascular disease (CVD) among people living with HIV (PLHIV) compared with the HIV‐uninfected population.

Methods

We conducted a systematic review and meta‐analysis of studies from the peer‐reviewed literature. We searched the Medline database for relevant journal articles published before August 2010. Eligible studies were observational and randomized controlled trials, reporting CVD, defined as myocardial infarction (MI), ischaemic heart disease, cardiovascular and cerebrovascular events or coronary heart disease among HIV‐positive adults. Pooled relative risks were calculated for various groupings, including different classes of antiretroviral therapy (ART).

Results

The relative risk of CVD was 1.61 [95% confidence interval (CI) 1.43–1.81] among PLHIV without ART compared with HIV‐uninfected people. The relative risk of CVD was 2.00 (95% CI 1.70–2.37) among PLHIV on ART compared with HIV‐uninfected people and 1.52 (95% CI 1.35–1.70) compared with treatment‐naïve PLHIV. We estimate the relative risk of CVD associated with protease inhibitor (PI)‐, nucleoside reverse transcriptase inhibitor‐ and nonnucleoside reverse transcriptase inhibitor‐based ART to be 1.11 (95% CI 1.05–1.17), 1.05 (95% CI 1.01–1.10) and 1.04 (95% CI 0.99–1.09) per year of exposure, respectively. Not all ART was associated with increased risk; specifically, lopinavir/ritonavir and abacavir were associated with the greater risk and the relative risk of MI for PI‐based versus non‐PI‐based ART was 1.41 (95% CI 1.20–1.65).

Conclusion

PLHIV are at increased risk of cardiovascular disease. Although effective in prolonging survival, ART (in particular PI‐based regimens) is related to further increased risk of CVD events among people at highest initial absolute risk of cardiovascular disease.
Long‐term beneficial effect of protease inhibitors on the intrinsic apoptosis of peripheral blood mononuclear cells in HIV‐infected patients
Authors: Jung N , Lehmann C , Knispel M , Meuer EK , Fischer J , Fätkenheuer G , Hartmann P , Taubert D
Published: March 2012

Background

Viral suppression by antiretroviral therapy (ART) inhibits HIV‐induced apoptosis and CD4 T‐cell loss. It has been suggested that protease inhibitors (PIs) have nonviral antiapoptotic effects by maintaining mitochondrial integrity. Long‐term clinical effects of PI‐based ART on mitochondrial toxicity and lymphocyte apoptosis beyond viral suppression have not been exploited to date.

Methods

We conducted a 7‐year study on HIV‐1‐infected patients from the Cologne HIV cohort with sufficient viral suppression under either a PI‐based or nonnucleoside reverse transcriptase inhibitor (NNRTI)‐based regimen. Eight patients on PI and eight on NNRTI were eligible for inclusion in the analysis. The primary outcome measure was defined as a change in the mitochondrial‐to‐nuclear DNA ratio in PBMCs. Further key molecules involved in extrinsic [tumour necrosis factor‐related apoptosis‐inducing ligand (TRAIL), Fas ligand (FasL) and caspase 8], intrinsic [B‐cell lymphoma 2 (Bcl‐2), Bcl‐2‐associated X protein (Bax), caspase 9 and lactate‐to‐pyruvate ratio] and overall apoptosis [Annexin+/7‐aminoactinomycin D (7‐AAD)– and caspase 3/7] and viral activity [negative regulatory factor (Nef), interferon‐α (IFN‐α) and myxovirus resistance protein A (MxA)] were measured.

Results

Demographic and baseline clinical parameters were similar in the two groups, except that patients in the PI group had a higher mean age. After 7 years of treatment, CD4 T‐cell count increased and the expression of genes encoding the proapoptotic viral protein Nef and HIV‐induced cytokine IFN‐α and its downstream effector MxA decreased in both groups. Focusing on the different pathways of apoptosis, only in the PI group intrinsic apoptosis decreased significant and in the inter‐group comparison the decrease was significantly higher than in the NNRTI group.

Conclusions

Our study provides evidence that long‐term therapy with a PI‐based regimen may be superior to that with a NNRTI‐based regimen with regard to its intrinsic antiapoptotic effect.
Nurse‐delivered universal point‐of‐care testing for HIV in an open‐access returning traveller clinic
Authors: Herbert R , Ashraf AN , Yates TA , Spriggs K , Malinnag M , Durward‐Brown E , Phillips D , Mewse E , Daniel A , Armstrong M , Kidd IM , Waite J , Wilks P , Burns F , Bailey R , Brown M
Published: March 2012

Background

Early diagnosis of HIV infection reduces morbidity and mortality associated with late presentation. Despite UK guidelines, the HIV testing rate has not increased. We have introduced universal HIV screening in an open‐access returning traveller clinic.

Methods

Data were prospectively recorded for all patients attending the open‐access returning traveller clinic between August 2008 and December 2010. HIV testing was offered to all patients from May 2009; initially testing with laboratory samples (phase 1) and subsequently a point‐of‐care test (POCT) (phase 2).

Results

A total of 4965 patients attended the clinic; 1342 in phase 0, 792 in phase 1 and 2831 in phase 2. Testing rates for HIV increased significantly from 2% (38 of 1342) in phase 0 to 23.1% (183 of 792) in phase 1 and further increased to 44.5% (1261 of 2831) during phase 2 (P < 0.0001). Two new diagnoses of HIV‐1 were identified in phase 1 (1.1% of tested); seven patients had a reactive POCT test in phase 2, of whom five (0.4% of those tested) were confirmed in a 4th generation assay. The patients with false reactive tests had a concurrent Plasmodium falciparum infection. Patients travelling to the Middle East and Europe were less likely to accept an HIV test with POCT.

Conclusions

A nurse‐delivered universal point‐of‐care HIV testing service has been successfully introduced and sustained in an acute medical clinic in a low‐prevalence country. Caution is required in communicating reactive results in low‐prevalence settings where there may be alternative diagnoses or a low population prevalence of HIV infection.
Simultaneous measurement of urinary albumin and total protein may facilitate decision‐making in HIV‐infected patients with proteinuria
Authors: Samarawickrama A , Cai M , Smith ER , Nambiar K , Sabin C , Fisher M , Gilleece Y , Holt SG
Published: March 2012

Objective

We recently showed that a urine albumin/total protein ratio (uAPR) < 0.4 identifies tubular pathology in proteinuric patients. In tubular disorders, proteinuria is usually of low molecular weight and contains relatively little albumin. We tested the hypothesis that uAPR is useful in identifying tubular pathology related to antiretroviral use in HIV‐infected patients.

Methods

We retrospectively identified urine protein/creatinine ratios (uPCRs) in HIV‐infected patients. A subset of samples had uPCR and urine albumin/creatinie ratio (uACR) measured simultaneously. We classified proteinuric patients (uPCR > 30 mg/mmol) into two groups: those with predominantly ‘tubular’ proteinuria (TP) (uAPR < 0.4) and those with predominantly ‘glomerular’ proteinuria (GP) (uAPR ≥ 0.4).

Results

A total of 618 of 5244 samples from 1378 patients had uPCR ≥ 30 mg/mmol. uAPRs were available in 144 patients: 46 patients (32%) had TP and 21 (15%) GP; the remainder had uPCR < 30 mg/mmol. The TP group had a higher fractional excretion of phosphate compared with the GP group (mean 27% vs. 16%, respectively; P < 0.01). Patients with TP were more likely to be on tenofovir and/or a boosted protease inhibitor compared with those with GP. In 18 patients with heavy proteinuria (uPCR > 100 mg/mmol), a renal assessment was made; eight had a kidney biopsy. In all cases, the uAPR results correlated with the nephrological diagnosis.

Conclusions

In HIV‐infected patients, measuring uAPR may help to identify patients in whom a renal biopsy is indicated, and those in whom tubular dysfunction might be an important cause of proteinuria and which may be related to antiretroviral toxicity. We suggest that this would be useful as a routine screening procedure in patients with proteinuria.
Modifying the Modifier: Body Modification as Social Incarnation
Authors: JOHNCOCK WILL
Published: March 2012

The notion that body modification occurs when one undertakes practices like tattooing, piercing or scarification, engenders discourses in which: (i) body modifiersendorsesuch practices as self‐constructive, distancing their practitioners from social regulation and a deterministic biology, whereas; (ii) criticscondemntheir seemingly violent, corporeal interference. However, in suspecting that such analysis should be attentive to the concurrent individual and social co‐constitution of behaviours, a sociological and post‐structural interrogation of this characterization of body modification as a “sovereign, denaturalizing” endeavour is demanded.

An engagement with theoriginary violenceof Derridian deconstruction will duly re‐conceive body modification practice as not something which introduces violence to corporeality. Rather, violence will present as a primordial differentiating process which bodies always already condition, and by which they are conditioned/produced/modified. The second issue at stake in this article will thus develop as a contestation to the characterization of “body modification” as an exclusive category of practice. Such practices do not arrive, pre‐existing, but rather manifest as the originary violence/differentiation of bodies‐as‐modifications‐which‐modify. This re‐defines modification from something that agentive subjects introduce to bodies, to something that subjects‐as‐bodies cannot help but be. Consequently, individual agency is not divorced from behaviour, but emerges as a corporeal, social production.
Morphological evidence that pentagastrin regulates secretion in the human parotid gland
Authors: Loy Francesco , Diana Martina , Isola Raffaella , Solinas Paola , Isola Michela , Conti Gabriele , Lantini Maria Serenella , Cossu Margherita , Riva Alessandro , Ekström Jörgen
Published: March 2012

Salivary secretion is principally regulated by autonomic nerves. However, recent evidence from in vivo animal experiments suggests that gastrointestinal peptide hormones can also influence saliva production. The aim of the present study was to define the secretagogue activity of the gastrin‐analogue pentagastrin in human salivary glands. For this purpose, parotid tissues were exposed to pentagastrin in vitro. Morphological techniques were used to evaluate modifications to serous acinar cells associated with secretion. Using a variant of the osmium maceration method, high resolution scanning electron microscopy allowed assessment of the morphology of the cytoplasmic aspect of the plasmalemma to demonstrate secretory activity. To quantify responses to pentagastrin, we recorded morphometric data on microvilli, microbuds, and protrusions. Dose‐dependent morphological changes were observed, whereas protein concentration increased in the incubate. The use of selective receptor antagonists showed pentagastrin to act principally via cholecystokinin‐A receptors. The morphological responses observed following exposure to pentagastrin differed from those elicited following exposure to the pan‐muscarinic agonist carbachol. This study provides the first demonstration of a direct secretory action of gastrointestinal peptides on salivary glands in humans.
Incremental evolution of the neural crest, neural crest cells and neural crest‐derived skeletal tissues
Authors: Hall Brian K. , Gillis J. Andrew
Published: March 2012

Urochordates (ascidians) have recently supplanted cephalochordates (amphioxus) as the extant sister taxon of vertebrates. Given that urochordates possess migratory cells that have been classified as ‘neural crest‐like’– and that cephalochordates lack such cells – this phylogenetic hypothesis may have significant implications with respect to the origin of the neural crest and neural crest‐derived skeletal tissues in vertebrates. We present an overview of the genes and gene regulatory network associated with specification of the neural crest in vertebrates. We then use these molecular data – alongside cell behaviour, cell fate and embryonic context – to assess putative antecedents (latent homologues) of the neural crest or neural crest cells in ascidians and cephalochordates. Ascidian migratory mesenchymal cells – non‐pigment‐forming trunk lateral line cells and pigment‐forming ‘neural crest‐like cells’ (NCLC) – are unlikely latent neural crest cell homologues. Rather,Snail‐expressing cells at the neural plate of border of urochordates and cephalochordates likely represent the extent of neural crest elaboration in non‐vertebrate chordates. We also review evidence for the evolutionary origin of two neural crest‐derived skeletal tissues – cartilage and dentine. Dentine is abona fidevertebrate novelty, and dentine‐secreting odontoblasts represent a cell type that is exclusively derived from the neural crest. Cartilage, on the other hand, likely has a much deeper origin within the Metazoa. The mesodermally derived cellular cartilages of some protostome invertebrates are much more similar to vertebrate cartilage than is the acellular ‘cartilage‐like’ tissue in cephalochordate pharyngeal arches. Cartilage, therefore, is not a vertebrate novelty, and a well‐developed chondrogenic program was most likely co‐opted from mesoderm to the neural crest along the vertebrate stem. We conclude that the neural crest is a vertebrate novelty, but that neural crest cells and their derivatives evolved and diversified in a step‐wise fashion – first by elaboration of neural plate border cells, then by the innovation or co‐option of new or ancient metazoan cell fates.
Non‐convulsive status epilepticus of frontal origin in mucopolysaccharidosis type II successfully treated with ethosuximide
Authors: BONANNI PAOLO , GUBERNALE MARCO , MARTINEZ FEDERICA , RANDAZZO GIOVANNA , MILANTONI LUCA , MARTINUZZI ANDREA , BONIVER CLEMENTINA , VECCHI MARILENA , SCARPA MAURIZIO
Published: March 2012

At 7 years of age, a female with mucopolysaccharidosis type II (MPS II) showed a sudden deterioration in neurological function, a sleep disorder, and progressive behavioural impairment. Electroencephalography was performed 1 year and 8 months after the onset of the neurological regression and revealed continuous ictal activity in the frontal regions. The female was diagnosed as having frontal non‐convulsive status epilepticus. After 5 weeks of therapy with ethosuximide, the ictal electroencephalographic activity disappeared. At the same time, her sleep and cognitive and behavioural functions were observed to improve. This is the first case of MPS type II reported in an individual with non‐convulsive status epilepticus. Two main forms of MPS II can be recognized: attenuated and severe. Severe MPS II is characterized by neurodegeneration. No study has explored the relationship between epilepsy and neurological deterioration in MPS II. Our observation shows that epilepsy may be a treatable cause of neurological regression in individuals with MPS II.
Active head lifting from supine in early infancy: an indicator for non‐optimal cognitive outcome in late infancy
Authors: VAN HAASTERT INGRID C , GROENENDAAL FLORIS , VAN DE WAARSENBURG MARIA K , EIJSERMANS MARIA J C , KOOPMAN‐ESSEBOOM CORINE , JONGMANS MARIAN J , HELDERS PAUL J M , DE VRIES LINDA S
Published: March 2012

Aim  To explore whether active head lifting from supine (AHLS) in early infancy is associated with cognitive outcome in the second year of life.

Method  The presence of AHLS was always recorded in the notes of infants admitted to our tertiary neonatal intensive care unit. Random sampling was used to pair infants with AHLS with two comparison infants without AHLS whose sex, gestational age, birth year (1993–2009), time of assessment, and developmental test (Griffiths Mental Development Scales, Mental Scale of the Bayley Scales of Infant Development‐II, or cognitive subtest of the Bayley Scales of Infant and Toddler Development‐III) were comparable. Brain injury identified from neonatal cranial ultrasound scans was classified as no – mild or moderate – severe. Z‐scores of cognitive test outcomes were calculated for multivariable analysis.

Results  Eighty‐seven preterm (34 males, 53 females) and 40 term (17 males, 23 females) infants with AHLS were identified. AHLS was documented at a mean (corrected) age of 7.0 (SD 1.7) and 8.1 (SD 2.2) months respectively. The cognitive assessments were performed at a mean corrected age of 15.7 (SD 1.7) and 23.9 (SD 1.6) months in preterm infants, and 19.1 (SD 2.3) months in term infants. The mean cognitive outcome of preterm and term infants with AHLS was lower than that of infants without AHLS (p=0.002 and p=0.004 respectively). This remained after excluding infants with cerebral palsy with matching comparison infants (p=0.001 in preterm and p=0.001 in term infants). The mean difference was highest (1.35SD) between term male infants and comparison infants (p=0.001).

Interpretation  AHLS is associated with a less favourable cognitive outcome in the second year of life in preterm as well as in term‐born infants than in comparison infants.
The effects of blood‐draw and injection stimuli on the vasovagal response
Authors: Gilchrist Philippe T. , Ditto Blaine
Published: March 2012

Vasovagal reactions (VVR) are common, complicating and deterring people from various medical procedures. A recent perspective (R. R. Diehl, ) suggests that VVR developed from the adaptive process of hemorrhagic fainting, perhaps as a means of preparing for anticipated blood loss. The primary goal of this study was to compare vasovagal symptoms during intravenous‐injection and blood‐draw videos. Sixty‐two young adults watched the videos. Vasovagal symptoms were assessed with self‐report, blood pressure, and heart rate variability. As predicted, participants reported more vasovagal symptoms and anxiety following the blood‐draw video. Sympathetic nervous system activity (low‐ to high‐frequency ratio) decreased during both videos but significantly more during the blood‐draw video, although this could be reversed by the Applied Tension technique. Results are discussed in terms of the relevance of specific stimuli and emotions in VVR.
Defensive coping, urbanization, and neuroendocrine function inBlackAfricans: TheTHUSAstudy
Authors: Malan Leoné , Hamer Mark , Reimann Manja , Huisman Hugo , Van Rooyen Johannes , Schutte Alta , Schutte Rudolph , Potgieter Johan , Wissing Marié , Steyn Faans , Seedat Yaackob , Malan Nico
Published: March 2012

Dissociation between β‐adrenergic behavioral and physiological defensive active coping (AC) responses was associated with cardiometabolic risk in urban but not ruralAfrican males. Whether this is partly driven by underlying neuroendocrine dysfunction is not certain. We aimed to assess the association between coping style, urbanization, and neuroendocrine function. Blood pressure (BP) and serum stress hormones were assessed across levels of urbanization (rural vs. urban) and coping style (active vs. passive) in 178BlackAfrican men. Urban men demonstrated increased hypertension prevalence, α‐adrenergic hemodynamic pattern, lower testosterone levels, and a larger cortisol:testosterone ratio (Cort:Test) compared to their rural counterparts. This was particularly evident in urbanACmen where cortisol andCort:Test explained 36–40% of the variance inBP. Dissociation between behavioral and physiological β‐adrenergic neuroendocrine responses in urbanACAfrican men was shown. A stressful urban environment might induce an apparent loss of physiological control, thereby facilitating disturbed neuroendocrineACresponses, which could increase cardiovascular disease risk.
The world according to iTunes: mapping urban networks of music production
Authors: WATSON ALLAN
Published: March 2012

In this article, I present a social network analysis that explores and maps relational urban networks of production within the global recorded music industry. Within the analysis, recorded music albums are viewed as temporary market‐based projects that bring together teams of skilled creative workers in recording studios across the globe. New tools and techniques for networking studios in geographically distant locations give mobile musically creative workers the ability to coordinate musical recordings on a global scale, resulting in new relational geographies of music production. An innovative approach is taken to the social network analysis to assess the connectedness of cities and determine the centrality and power of cities within networks of production for three major Anglophone digital music markets. The result is a mapping of the relational urban networks of music production as indicated through the interdependencies between projects, studios and local urban agglomerations.
The performance of adverse effects search filters in MEDLINE and EMBASE
Authors: Golder Su , Loke Yoon K.
Published: March 2012

Background:  Search filters can potentially improve the efficiency of searches involving electronic databases such as medline and embase. Although search filters have been developed for identifying records that contain adverse effects data, little is known about the sensitivity of such filters.

Objectives:  This study measured the sensitivity of using available adverse effects filters to retrieve papers with adverse effects data.

Methods:  A total of 233 included studies from 26 systematic reviews of adverse effects were used for analysis. Search filters from medline and embase were tested for their sensitivity in retrieving the records included in these reviews. In addition, the sensitivity of each individual search term used in at least one search filter was measured.

Results:  Subheadings proved the most useful search terms in both medline and embase. No indexing terms in medline achieved over 12% sensitivity. The sensitivity of published search filters varied in medline from 3% to 93% and in embase from 57% to 97%. Whether this level of sensitivity is acceptable will be dependent on the purpose of the search.

Conclusions:  Although no adverse effects search filter captured all the relevant records, high sensitivity could be achieved. Search filters may therefore be useful in retrieving adverse effects data.
The Effect of Phase 2 of the Premier Hospital Quality Incentive Demonstration on Incentive Payments to Hospitals Caring for Disadvantaged Patients
Authors: Ryan Andrew M. , Blustein Jan , Doran Tim , D. Michelow Marilyn , Casalino Lawrence P.
Published: March 2012

Objective

The Medicare and Premier Inc. Hospital Quality Incentive Demonstration (HQID), a hospital‐based pay‐for‐performance program, changed its incentive design from one rewarding only high performance (Phase 1) to another rewarding high performance, moderate performance, and improvement (Phase 2). We tested whether this design change reduced the gap in incentive payments among hospitals treating patients across the gradient of socioeconomic disadvantage.

Data

To estimate incentive payments in both phases, we used data from the Premier Inc. website and from Medicare Provider Analysis and Review files. We used data from the American Hospital Association Annual Survey and Centers for Medicare and Medicaid Services Impact File to identify hospital characteristics.

Study Design

Hospitals were divided into quartiles based on their Disproportionate Share Index (DSH), from lowest disadvantage (Quartile 1) to highest disadvantage (Quartile 4). In both phases of the HQID, we tested for differences across the DSH quartiles for three outcomes: (1) receipt of any incentive payments; (2) total incentive payments; and (3) incentive payments per discharge. For each of the study outcomes, we performed a hospital‐level difference‐in‐differences analysis to test whether the gap between Quartile 1 and the other quartiles decreased from Phase 1 to Phase 2.

Principal Findings

In Phase 1, there were significant gaps across the DSH quartiles for the receipt of any payment and for payment per discharge. In Phase 2, the gap was not significant for the receipt of any payment, but it remained significant for payment per discharge. For the receipt of any incentive payment, difference‐in‐difference estimates showed significant reductions in the gap between Quartile 1 and the other quartiles (Quartile 2, 17.5 percentage points [p < .05]; Quartile 3, 18.1 percentage points [p < .01]; Quartile 4, 28.3 percentage points [p < .01]). For payments per discharge, the gap was also significantly reduced between Quartile 1 and the other quartiles (Quartile 2, $14.92 per discharge [p < .10]; Quartile 3, $17.34 per discharge [p < .05]; Quartile 4, $21.31 per discharge [p < .01]). There were no significant reductions in the gap for total payments.

Conclusions

The design change in the HQID reduced the disparity in the receipt of any incentive payment and for incentive payments per discharge between hospitals caring for the most and least socioeconomically disadvantaged patient populations.
Racial/Ethnic Disparities in Health and Health Care among U.S. Adolescents
Authors: Lau May , Lin Hua , Flores Glenn
Published: March 2012

Objective

To examine racial/ethnic disparities in medical and oral health status, access to care, and use of services in U.S. adolescents.

Data Source

Secondary data analysis of the 2003 National Survey of Children's Health. The survey focus was children 0–17 years old.

Study Design

Bivariate and multivariable analyses were conducted for white, African American, Latino, Asian/Pacific Islander, American Indian/Alaskan Native, and multiracial adolescents 10–17 years old (n = 48,742) to identify disparities in 40 measures of health and health care.

Principal Findings

Certain disparities were especially marked for specific racial/ethnic groups and multiracial youth. These disparities included suboptimal health status and lack of a personal doctor or nurse for Latinos; suboptimal oral health and not receiving all needed medications in the past year for African Americans; no physician visit or mental health care in the past year for Asian/Pacific Islanders; overweight/obesity, uninsurance, problems getting specialty care, and no routine preventive visit in the past year for American Indian/Alaska Natives; and not receiving all needed dental care in multiracial youth.

Conclusions

U.S. adolescents experience many racial/ethnic disparities in health and health care. These findings indicate a need for ongoing identification and monitoring of and interventions for disparities for all five major racial/ethnic groups and multiracial adolescents.
Ghrelin: An emerging new anticonvulsant neuropeptide
Authors: Portelli Jeanelle , Michotte Yvette , Smolders Ilse
Published: March 2012

Neuropeptides appear to be of importance when the central nervous system (CNS) is challenged, such as during high‐frequency firing and pathologic conditions. Potential advantages of treatments that target neuropeptide systems in comparison to classical neurotransmitter systems and ion channels revolve around the subject of efficacy as well as the reduced likelihood of side effects, thus making them attractive candidates for the development of new clinical applications for various disorders. The number of neuropeptides linked to epilepsy is on the rise, reflecting the increased interest of researchers in this domain. Ghrelin has only very recently been introduced into the field of epilepsy, and has already led to contradictory clinical publications. There is a great paucity with regard to what mechanism of action is utilized by ghrelin to inhibit seizures. In this review we disclose how we can better understand the mechanism ghrelin uses to prevent seizures, which indirectly could give an insight to researchers who are studying ghrelin in other fields of research.
Onset of intractability and its course over time: The Dutch study of epilepsy in childhood
Authors: Geerts Ada , Brouwer Oebele , Stroink Hans , van Donselaar Cees , Peters Boudewijn , Peeters Els , Arts Willem F.
Published: March 2012

Purpose:  Intractability in epilepsy is difficult to define, and little is known about its onset, course, and duration. We investigated these aspects (as well as the occurrence of intractability) during long‐term follow‐up in patients with epilepsy, focusing on possible explanations for the variation in time of onset and duration of intractability.

Methods:  After diagnosis, 453 patients with childhood‐onset epilepsy had a 5‐year follow‐up with regular visits and data collection. Ten years later they received a questionnaire with items concerning epilepsy, which was completed by 413 patients resulting in a mean follow‐up of 15 years. Intractability during the first 5 years was compared with that in the last year of follow‐up. Intractability was defined as having no 3‐month remission during a 1‐year period despite adequate medical treatment.

Key Findings: At least 12.1% of the cohort had a period of intractability during the 15‐year follow‐up, and 8.5% were intractable in the final year. Of the patients with idiopathic etiology 4.3% had a period of intractability versus 17.0% for those with cryptogenic, and 22.6% for those with remote symptomatic etiology (p < 0.001). Other risk factors at baseline were younger age at first seizure, generalized cryptogenic/symptomatic or localization‐related symptomatic epilepsy, mental retardation, and febrile convulsions before enrollment. The cumulative risk of a period of intractability was 6.1% (95% confidence interval [CI] 3.7–8.5) at 2 years follow‐up and 8.2% (95% CI 5.4–11.0) at 5 years. The mean time to onset of intractability during the first 5 years of follow‐up was 1.6 (95% CI 1.3–2.0; median 1.0) years and the mean duration of intractability during these 5 years was 3.3 (95% CI 2.8–3.8; median 3.6) years. Fifteen patients were intractable only during the first 5 years of follow‐up (group A), and 19 subjects were intractable both during the first 5 years and the last year of follow‐up (group B). Compared with group A, group B had shorter remission and a longer time to intractability during the first 5 years and more were intractable in the fifth year of follow‐up. Sixteen other patients had a late onset of intractability after 5 years of follow‐up, sometimes after long periods of remission (group C). No significant differences in baseline characteristics were found among groups A, B, and C, but slightly more children in groups B and C became mentally retarded during the follow‐up. In all groups, antiepileptic drugs were of little use in preventing and ending intractability.

Significance:  There is a large unpredictable variation in time of onset, course, and duration of intractability, with a higher chance of final intractability after a poor course during the first 5 years of follow‐up. The natural course of epilepsy probably best explains the variable course of intractability. The effect of medication seems to be minor.
Pathogen safety of human C1 esterase inhibitor concentrate
Authors: Gröner Albrecht , Nowak Thomas , Schäfer Wolfram
Published: March 2012

BACKGROUND: Human plasma–derived products—such as C1 esterase inhibitor (C1‐INH) concentrate, used to treat hereditary angioedema—carry with them the risk of transmitting blood‐borne viruses and, theoretically, prion proteins. To minimize this risk, three complementary approaches are implemented: selection and testing of plasma donations for the absence of pathogenic blood‐borne viruses, similarly testing and releasing the plasma pool for fractionation, and ensuring that the manufacturing process includes validated steps for pathogen inactivation and removal.

STUDY DESIGN AND METHODS: This article describes the selection of plasma for the production of C1‐INH and the studies used to confirm the pathogen reduction capacity of the manufacturing process: three independent virus reduction steps—pasteurization, hydrophobic interaction chromatography (HIC), and virus filtration—and two prion reduction steps. Samples of product intermediates from the manufacturing steps were spiked with a panel of enveloped and nonenveloped viruses and two prion preparations and subjected to a valid scaled‐down version of the respective manufacturing steps resulting in the quantification of the pathogen reduction factors.

RESULTS: Validation studies demonstrated overall virus reduction factors for all viruses of more than 15 log, considerably exceeding the potential amount of virus present in a plasma pool for fractionation. Prion proteins were also efficiently removed by the manufacturing process, as currently determined in evaluating the prion removal capacity of the ammonium sulfate precipitation and HIC steps.

CONCLUSION: The pathogen reduction capacity demonstrated here indicates that the manufacturing process of the C1‐INH Berinert is highly effective for reducing enveloped and nonenveloped viruses and prion proteins.
Patient blood transfusion management: discharge hemoglobin level as a surrogate marker for red blood cell utilization appropriateness
Authors: Edwards Jason , Morrison Chris , Mohiuddin Maleeha , Tchatalbachev Vladislav , Patel Charmi , Schwickerath Vicki L. , Menitove Jay E. , Singh Gurmukh
Published: March 2012

BACKGROUND: Blood transfusion management strategies minimize transfusion‐associated risks, enhance outcomes, and reduce costs. We explored an association of discharge hemoglobin (Hb) with pretransfusion Hb, transfusion indications, and red blood cell (RBC) transfusions. We stipulate that patients with discharge Hb concentrations greater than 10.0 g/dL, or even 9.0 g/dL, received excessive RBC transfusions.

STUDY DESIGN AND METHODS: We examined aggregate data from five hospitals and for one of the hospitals, the focus hospital, we reviewed patient records for a period of 6 months. Data analyses included number of RBC units transfused and Hb values before transfusion, after transfusion, and at discharge.

RESULTS: In aggregate, 27% to 47% patients had discharge Hb levels greater than 10.0 g/dL. At the focus hospital, 27% had a discharge Hb level greater than 10 g/dL and 50.3% had a discharge Hb level greater than 9.0 g/dL. At the focus hospital, the mean Hb trigger for transfusion was a Hb level of 7.3 g/dL; the mean posttransfusion Hb level was 9.3 g/dL and mean discharge Hb level was 9.2 g/dL. Overall, 76% of the transfusions were of an even number of RBC units.

CONCLUSION: In aggregate, overutilization exceeded 20%. At the focus hospital, approximately one‐quarter of patients receiving transfusions had a Hb concentration greater than 10.0 g/dL at discharge. Transfused patients' discharge Hb concentration represents an effective indicator for retrospective monitoring of transfusion appropriateness. In light of the large number of patients receiving even number transfusions, reviewing Hb levels after transfusion of each RBC unit could reduce unnecessary transfusions. Retrospective review of discharge Hb data focuses providers on transfusion outcomes and affords an educational opportunity for blood utilization management.
Determination of neutrophil antigen HNA‐3a and HNA‐3b genotype frequencies in six racial groups by high‐throughput 5′ exonuclease assay
Authors: Bowens Krista L. , Sullivan Mia J. , Curtis Brian R.
Published: March 2012

BACKGROUND: People with the human neutrophil antigen (HNA)‐3b/3b type can make HNA‐3a antibodies, which have been reported to cause immune neutropenia disorders and are especially prone to cause severe cases of transfusion‐related acute lung injury. However, knowledge of HNA‐3 allele frequencies outside Caucasian populations is limited. We developed a high‐throughput genotyping assay and determined the HNA‐3a/3b genotype frequencies in six different racial and ethnic groups.

STUDY DESIGN AND METHODS: Genotyping utilized TaqMan 5′ exonuclease chemistry and real‐time polymerase chain reaction. A total of 742 DNA samples from six different racial and ethnic groups were genotyped for HNA‐3a and HNA‐3b.

RESULTS: The genotyping assay showed 100% sensitivity and specificity compared to sequencing and phenotyping and had high throughput. A significant percentage of Caucasians (6.5%), Han Chinese (16%), and Asian Indians (6%) typed HNA‐3b/3b, but only a small percentage of Hispanics (1%) and no African or Native Americans.

CONCLUSIONS: The HNA‐3 genotyping assay had high sensitivity, specificity, and sample throughput. HNA‐3b/b genotype results determined for 742 individuals representing six different racial and ethnic groups showed that there could be a significant risk of producing anti‐HNA‐3a in Chinese, as well as in Caucasian and Asian Indian blood donor populations, but a very low risk in Hispanic, African, or Native American populations.
European data on stem cell mobilization with plerixafor in patients with nonhematologic diseases: an analysis of the European consortium of stem cell mobilization
Authors: Worel Nina , Apperley Jane F. , Basak Grzegorz W. , Douglas Kenneth W. , Gabriel Ian H. , Geraldes Catarina , Hübel Kai , Jaksic Ozren , Koristek Zdenek , Lanza Francesco , Lemoli Roberto , Mikala Gabor , Selleslag Dominik , Duarte Rafael F. , Mohty Mohamad
Published: March 2012

BACKGROUND: Plerixafor with granulocyte–colony‐stimulating factor (G‐CSF) has been shown to enhance stem cell mobilization in patients with multiple myeloma and lymphoma with previous mobilization failure. In this European named patient program we report the experience in insufficiently mobilizing patients diagnosed with nonhematologic diseases.

STUDY DESIGN AND METHODS: Thirty‐three patients with germ cell tumor (n = 11), Ewing sarcoma (n = 6), Wiscott‐Aldrich disease (n = 5), neuroblastoma (n = 4), and other nonhematologic diseases (n = 7) were included in the study. Plerixafor was limited to patients with previous or current stem cell mobilization failure and given after 4 days of G‐CSF (n = 21) or after chemotherapy and G‐CSF (n = 12) in patients who mobilized poorly.

RESULTS: Overall, 28 (85%) patients succeeded in collecting at least 2 × 106/kg body weight (b.w.) CD34+ cells (median, 5.0 × 106/kg b.w. CD34+ cells; range, 2.0 × 106‐29.5 × 106/kg b.w. CD34+ cells), and five (15%) patients collected a median of 1.5 × 106/kg b.w. CD34+ cells (range, 0.9 × 106‐1.8 × 106/kg b.w. CD34+ cells). Nineteen patients proceeded to transplantation. The median dose of CD34+ cells infused was 3.3 × 106/kg b.w. (range, 2.3 × 106‐6.7 × 106/kg b.w. CD34+ cells). The median numbers of days to neutrophil and platelet engraftment were 11 (range, 9‐12) and 15 (range, 10‐25) days, respectively.

CONCLUSION: These data emphasize the role of plerixafor in combination with G‐CSF or chemotherapy and G‐CSF as an effective mobilization regimen with the potential of successful stem cell collection. Accordingly, plerixafor seems to be safe and effective in patients with nonhematologic diseases. Larger prospective studies are warranted to further assess its use in these patients.
High‐Speed Rail: Lessons for Policy Makers from Experiences Abroad
Authors: Albalate Daniel , Bel Germà
Published: March 2012

In April 2009, the U.S. government unveiled its blueprint for a national network of high‐speed passenger rail (HSR) lines, aimed at reducing traffic congestion, cutting national dependence on foreign oil, and improving rural and urban environments. In implementing such a project, it is essential to identify the factors that might influence decision making and the eventual success of the HSR project, as well as to foresee the obstacles that must be overcome. The authors review, summarize, and analyze the most important HSR projects carried out to date around the globe, focusing on the main concerns of HSR projects: their impact on mobility, the environment, the economy, and urban centers. The authors identify lessons for policy makers and managers who are implementing HSR projects.
Effects of modality change on health‐related quality of life
Authors: Painter Patricia , Krasnoff Joanne B. , Kuskowski Michael , Frassetto Lynda , Johansen Kirsten
Published: March 2012

Patients with end‐stage renal disease (ESRD) requiring renal replacement have impaired health‐related quality of life (HRQoL), and there is general consensus that HRQoL improves with successful transplant and evidence of improvement with frequent hemodialysis. This study reports changes in HRQoL associated with changes in treatment modality to daily hemodialysis (DHD) and transplant among patients requiring renal replacement. This cohort study had assessments at baseline and 6‐month following modality change. Subjects were nondiabetic individuals receiving conventional hemodialysis who (a) remained on conventional hemodialysis (n = 13), (b) changed to daily hemodialysis (DHD) (n = 10), or (c) received a living donor transplant (n = 20). Thirty‐four healthy controls were assessed once for comparison. HRQoL was measured using the Kidney Disease Quality of Life Instrument. The Physical Functioning and Physical Composite Scale scores were primary outcomes. Transplantation resulted in significant improvements in six of eight generic scales and the physical composite scale (PCS). Those changing to DHD had significant improvements in Physical Function and PCS scales. Those remaining on dialysis remained lower than controls on all scales except for Vitality; the transplant group remained lower than controls only on the Vitality and General Health scales. Transplant resulted in significant improvements in four of the seven disease‐specific scales (symptoms, effects, and burden of kidney disease, work). DHD resulted in improvements in the effects of kidney disease. Modality change to transplant results in significant improvement in HRQoL, achieving levels similar to controls. Change to daily hemodialysis improves only select HRQoL domains and remains low in disease‐specific domains.
Representations in Dynamical Embodied Agents: Re‐Analyzing a Minimally Cognitive Model Agent
Authors: Mirolli Marco
Published: March 2012

Understanding the role of ‘‘representations’’ in cognitive science is a fundamental problem facing the emerging framework of embodied, situated, dynamical cognition. To make progress, I follow the approach proposed by an influential representational skeptic, Randall Beer: building artificial agents capable of minimally cognitive behaviors and assessing whether their internal states can be considered to involve representations. Hence, I operationalize the concept of representing as ‘‘standing in,’’ and I look for representations in embodied agents involved in simple categorization tasks. In a first experiment, no representation can be found, but the relevance of the task is undermined by the fact that agents with no internal states can reach high performance. A simple modification makes the task more “representationally hungry,” and in this case, agents’ internal states are found to qualify as representations. I conclude by discussing the benefits of reconciling the embodied‐dynamical approach with the notion of representation.
Facing the Sunrise: Cultural Worldview Underlying Intrinsic‐Based Encoding of Absolute Frames of Reference in Aymara
Authors: Núñez Rafael E. , Cornejo Carlos
Published: March 2012

The Aymara of the Andes use absolute (cardinal) frames of reference for describing the relative position of ordinary objects. However, rather than encoding them in available absolute lexemes, they do it in lexemes that are intrinsic to the body: nayra (“front”) and qhipa (“back”), denoting east and west, respectively. Why? We use different but complementary ethnographic methods to investigate the nature of this encoding: (a) linguistic expressions and speech–gesture co‐production, (b) linguistic patterns in the distinct regional Spanish‐based variety Castellano Andino (CA), (c) metaphorical extensions of CA’s spatial patterns to temporal ones, and (d) layouts of traditional houses. Findings indicate that, following fundamental principles of Aymara cosmology, people, objects, and land—as a whole—are conceived as having an implicit canonical orientation facing east, a primary landmark determined by the sunrise. The above bodily based lexicalizations are thus linguistic manifestations of a broader macro‐cultural worldview and its psycho‐cognitive reality.
Healing with Plant Intelligence: A Report from Ayahuasca
Authors: Doyle Richard
Published: March 2012

Numerous and diverse reports indicate the efficacy of shamanic plant adjuncts (e.g., iboga, ayahuasca, psilocybin) for the care and treatment of addiction, post‐traumatic stress disorder, cancer, cluster headaches, and depression. This article reports on a first‐person healing of lifelong asthma and atopic dermatitis in the shamanic context of the contemporary Peruvian Amazon and the sometimes digital ontology of online communities. The article suggests that emerging language, concepts, and data drawn from the sciences of plant signaling and behavior regarding “plant intelligence” provide a useful heuristic framework for comprehending and actualizing the healing potentials of visionary plant “entheogens” (Wasson 1971) as represented both through first‐person experience and online reports. Together with the paradigms and practices of plant signaling, biosemiotics provides a robust and coherent map for contextualizing the often reported experience of plant communication with ayahuasca and other entheogenic plants. The archetype of the “plant teachers” (called Doctores in the upper Amazon) is explored as a means for organizing and interacting with this data within an epistemology of the “hallucination/perception continuum (Fischer 1975). “Ecodelic” is offered as a new linguistic interface alongside “entheogen” (Wasson 1971).