bluuebunny/crossref_metadata_2025 huggingface dataset:
Tibial Fixation in Anterior Cruciate Ligament Reconstruction
Authors: De Wall Mathew , Scholes Corey J. , Patel Sandeep , Coolican Myles R.J. , Parker David A.
Published: May 2011

Background: The use of hamstring tendons for anterior cruciate ligament reconstruction has increased in popularity over recent years. However, concerns with the stability of graft fixation on the tibial side remain. Centrally placed interference screw/sheath implants have demonstrated promising results in biomechanical studies.

Hypothesis: Centrally placed, polyethylene screw and sheath implants will provide clinically equivalent fixation to the standard metal interference screw and supplemental staple fixation.

Study Design: Randomized controlled trial; Level of evidence, 1.

Methods: A total of 113 consecutive patients undergoing isolated, unilateral, primary anterior cruciate ligament reconstruction with hamstring autografts were randomized to tibial fixation with metal interference screw and staples (RCI) or with a centrally placed polyethylene screw and sheath implant (INTRAFIX). Prospective assessment of subjective outcomes was performed using Lysholm, Mohtadi, and International Knee Documentation Committee (IKDC) scores.

Results: At minimum 2-year follow-up, there were no significant differences between the 2 groups in terms of instrumented stability testing (KT-1000 arthrometer) or subjective assessment of knee outcomes (IKDC, Lysholm, Mohtadi). Both fixation methods demonstrated a significant, but not different, increase in outcomes scores from preoperative to postoperative evaluation. There were 7 failures (5 INTRAFIX, 2 RCI) caused by reinjury, but no statistically significant differences were observed between the 2 fixation methods.

Conclusion: The centrally placed polyethylene screw and sheath provided equivalent clinical outcomes at minimum 2-year follow-up to standard tibial fixation with metal interference screw and staples.
Dynamic Ankle Control in Athletes With Ankle Instability During Sports Maneuvers
Authors: Lin Cheng-Feng , Chen Chin-Yang , Lin Chia-Wei
Published: May 2011

Background: Ankle sprain is a common sports injury. While the effects of static constraints in stabilizing the ankle joint are relatively well understood, those of dynamic constraints are less clear and require further investigation.

Purpose: This study was undertaken to evaluate the dynamic stability of the ankle joint during the landing phase of running and stop-jump maneuvers in athletes with and without chronic ankle instability (CAI).

Study Design: Controlled laboratory study.

Methods: Fifteen athletes with CAI and 15 age-matched athletes without CAI performed running and stop-jump landing tasks. The dynamic ankle joint stiffness, tibialis anterior (TA)/peroneus longus (PL) and TA/gastrocnemius lateralis (GL) co-contraction indices, ankle joint angle, and root-mean-square (RMS) of the TA, PL, and GL electromyographic signals were measured during each task.

Results: During running, the CAI group exhibited a greater ankle inversion angle than the control group in the pre-landing phase ( P = .012-.042) and a lower dynamic ankle joint stiffness in the post-landing phase (CAI: 0.109 ± 0.039 N·m/deg; control: 0.150 ± 0.068 N·m/deg; P = .048). In the stop-jump landing task, athletes with CAI had a significantly lower TA/PL co-contraction index during the pre-landing phase (CAI: 49.1 ± 19; control: 64.8 ± 16; P = .009). In addition, the CAI group exhibited a greater ankle inversion ( P = .049), a lower peak eversion ( P = .04), and a smaller RMS of the PL electromyographic signal in the post-landing phase (CAI: 0.73 ± 0.32; control: 0.51 ± 0.22; P = .04).

Conclusion: Athletes with CAI had a relatively inverted ankle, reduced muscle co-contraction, and a lower dynamic stiffness in the ankle joint during the landing phase of sports maneuvers and this may jeopardize the stability of the ankle.

Clinical Relevance: Sports training or rehabilitation programs should differentiate between the pre-landing and post-landing phases of sports maneuvers, and should educate athletes to land with an appropriate ankle position and muscle recruitment.
In vivo distribution of lead in male and female rats after intraperitoneal and oral administration
Authors: Nwokocha CR , Ufearo CS , Owu DU , Idemudo NC , Ojukwu LC
Published: May 2011

The resultant effects of lead exposure are seen in almost all the systems of the body and results in toxicity to many organs. Since toxicity depends on its degree of uptake, distribution and metabolism, the authors investigated the differential uptake, accumulation and distribution of lead in organs of males and female Wistar rats following various routes of administration. Group 1 served as control male and control female; group 2 males and females received 5 mg/kg body weight of lead intraperitoneally for 8 days while group 3 males and female rats were administered drinking water containing 100 ppm of lead acetate for 18 days. Tissues were collected for analysis of the lead content using atomic absorption spectroscopy. The relative retention of lead by the tissues was greater in rats exposed to lead by the i.p. route varying in the order of accumulation / uptake in males as lungs > spleen > stomach > kidney > blood > heart and in females as spleen > stomach > heart > kidney > blood > lungs (i.p. route) and (oral route) as for males kidney > lungs > stomach > blood > heart > spleen, and females as kidney > lungs > stomach > blood > heart > spleen. Male Wistar rats showed more accumulation with oral exposure in lungs, spleen and blood with values for kidney and stomach being significantly ( p < 0.05) higher when compared with females. Female Wistar rats showed more accumulation with i.p. exposure for spleen and stomach tissues while values for the heart was significantly ( p < 0.05) higher than the males. Our findings suggest that lead retention and the organ distribution varied depending upon the sex and route of lead administration.
RNA Expression Profiles From Blood for the Diagnosis of Stroke and Its Causes
Authors: Sharp Frank R. , Jickling Glen C. , Stamova Boryana , Tian Yingfang , Zhan Xinhua , Ander Bradley P. , Cox Christopher , Kuczynski Beth , Liu DaZhi
Published: June 2011

A blood test to detect stroke and its causes would be particularly useful in babies, young children, and patients in intensive care units and for emergencies when imaging is difficult to obtain or is unavailable. Whole genome microarrays were used to show specific gene expression profiles in rats 24 hours after ischemic and hemorrhagic stroke, hypoxia, and hypoglycemia. These proof-of-principle studies revealed that groups of genes (called gene profiles) can distinguish ischemic stroke patients from controls within 3 to 24 hours after the strokes. In addition, gene expression profiles have been developed that distinguish stroke due to large-vessel atherosclerosis from cardioembolic stroke. These profiles will be useful for predicting the causes of cryptogenic stroke. The results in adults suggest that similar diagnostic tools could be developed for children.
“Night Guard”: Holocaust Mechanisms in the Polish Rural Areas, 1942-1945
Authors: Żbikowski Andrzej
Published: May 2011

This article concerns some characteristics of the so-called third stage of the annihilation of Polish Jewry during World War II, after sending most of them to the killing centers. That phase consisted of individual—not mass—murder that took place “among Poles” and before their eyes, frequently with their participation, when Jewish refugees attempted to hide from persecutors or blended into the anonymous crowds of the larger cities (on the so-called Aryan side) or hid in hardly accessible rural areas poorly controlled by the German police. Most hiding Jews were hunted down and murdered by special Kommandos of the German gendarmerie in the first weeks following deportations in a given area. Unprepared for hiding for an extended period, they found hide-outs and trusted their financial means to Polish friends. In my opinion, in 80 to 90 percent of the cases, Poles rescued Jews for money or other material gain, and when the funds (or other valuables) were exhausted, the attitude to those rescued changed radically. The purpose of this article is to present an outline of how a certain structure functioned—the “Night Guard” (peasant or rural, part of the occupation-era administrative and coercive apparatus), which can be found in wartime historical sources and in the immediate postwar investigation and trial files based on the August Decree of 1944 (on account-settling with the past regarding collaboration with the German occupier) as well as in testimonies of Jewish survivors. The guards were obliged to hunt hidden Jews, and the score of their activity was very high.
Teacher Preparation for Inclusive and Critical (Special) Education
Authors: Oyler Celia
Published: June 2011

The author’s preservice program prepares both single and dual certification master’s students to teach in inclusive classrooms. This article provides an overview of the context in which, and for which, the program was designed, a description of the program, including what the author means by inclusive education and critical special education, explanations of key pedagogical and assessment practices that she leans on to meet her goals, and concludes with an account of how the program came to be developed.
Two-dimensional simulation of circulation control turbine cascade
Authors: Song Y , Li Y , Chen H , Chen F
Published: June 2011

The application of Coanda effect to turbine was first studied in this article through two-dimensional numerical simulation of circulation control turbine cascades. The influence of the aerodynamic and geometric parameters, such as the supply pressure of jet, the slot height, the shape, and curvature of the Coanda surface, on the performance of the circulation control turbine cascade was investigated in detail. The results show that the circulation control turbine cascade can achieve and exceed the performance level of the original turbine cascade (the baseline) at the cost of an acceptable jet supply pressure. The aerodynamic performance of circulation control turbine cascades is largely determined by two critical factors: the velocity of jet and the curvature of the Coanda surface. Low magnitude of jet velocity and large curvature of Coanda surface near the jet exit would lead to a serious jet detachment that is generally responsible for less flow turning and high energy loss. The jet attachment to the Coanda surface with a large curvature can be obtained only when the jet speed is high enough. Also, at this time, circulation control turbine cascade can bring a large flow turning but also a high energy loss based on a modified definition of the energy loss coefficient.
Integrated contour detection and pose estimation for fluoroscopic analysis of knee implants
Authors: Prins A H , Kaptein B L , Stoel B C , Nelissen R G H H , Reiber J H C , Valstar E R
Published: June 2011

With fluoroscopic analysis of knee implant kinematics the implant contour must be detected in each image frame, followed by estimation of the implant pose. With a large number of possibly low-quality images, the contour detection is a time-consuming bottleneck. The present paper proposes an automated contour detection method, which is integrated in the pose estimation.

In a phantom experiment the automated method was compared with a standard method, which uses manual selection of correct contour parts. Both methods demonstrated comparable precision, with a minor difference in the Y-position (0.08 mm versus 0.06 mm). The precision of each method was so small (below 0.2 mm and 0.3°) that both are sufficiently accurate for clinical research purposes.

The efficiency of both methods was assessed on six clinical datasets. With the automated method the observer spent 1.5 min per image, significantly less than 3.9 min with the standard method. A Bland–Altman analysis between the methods demonstrated no discernible trends in the relative femoral poses.

The threefold increase in efficiency demonstrates that a pose estimation approach with integrated contour detection is more intuitive than a standard method. It eliminates most of the manual work in fluoroscopic analysis, with sufficient precision for clinical research purposes.
Modeling the Influence of Initial Geometry on the Equilibrium Responses of Glucose-Sensitive Hydrogel
Authors: Hua Li  , Rongmo Luo
Published: June 2011

A model entitled the MECglu model is employed to investigate the effect of the initial geometric size on the equilibrium responses of glucose-sensitive hydrogel. With consideration of the chemo-electro-mechanical coupling effect, the model simulates the finite stimulus responsive deformation, which is associated with the electric potential and the fixed charge density in the hydrogel and the surrounding solvent, as the response to the change in the glucose concentration of the external solution. Influence of various material properties and environmental conditions on the performance of the smart material is analyzed by the model, especially focusing on the effect of the initial thickness of the hydrogel strip. The parameters studied include the ionic species, electric potential, fixed charge density, displacement, and swelling ratio of hydrogel. The parameter studies demonstrate that the response of the hydrogel can be optimized by varying the thickness of the hydrogel strip. In other words, while immersed in a glucose buffer solution, the glucose sensitivity of the thin membrane is higher than that of the thick one.
Development of the HD-Teen Inventory
Authors: Driessnack Martha , Williams Janet K. , Barnette J. Jackson , Sparbel Kathleen J. , Paulsen Jane S.
Published: June 2011

Adolescents, who have a parent with Huntington Disease (HD), not only are at genetic risk for HD but also are witness to its onset and devastating clinical progression as their parent declines. To date, no mechanism has been developed to direct health care providers to the atypical adolescent experiences of these teens. The purpose of this report is to describe the process of developing the HD-Teen Inventory clinical assessment tool. Forty-eight teens and young adults from 19 U.S. states participated in the evaluation of the HD-Teen Inventory tool. Following item analysis, the number of items was reduced and item frequency and reaction scales were combined, based on the strong correlation ( r = .94). The resultant tool contains 15 inventory and 2 open-ended response items. The HD-Teen Inventory emerged as a more compact and efficient tool for identifying the most salient concerns of at-risk teens in HD families in research and/or clinical practice.
The Effective Behavior of Elastic Bodies Containing Microcracks or Microholes Localized on a Surface
Authors: Marigo Jean-Jacques , Pideri Catherine
Published: June 2011

We propose a two-scale method to find the effective behavior of a three-dimensional linear elastic medium containing a series of microcracks or microholes located on a surface. The obtained effective behavior is that of a homogeneous body with, in place of the actual microdefects, a surface across which the displacements and the stresses suffer jump discontinuities. The transmission conditions are in general of Ventcel's type. The coefficients entering in these jump conditions are obtained by solving six elastic problems posed on an infinite representative cell. The theoretical analysis is illustrated by a few examples.
Revision of the Career Maturity Inventory
Authors: Savickas Mark L. , Porfeli Erik J.
Published: May 2011

Initially administered in 1961, the Career Maturity Inventory (CMI) was the first paper-and-pencil measure of vocational development. The present research revised the CMI to reestablish its usefulness as a succinct, reliable, and valid measure of career choice readiness, with a few theoretically relevant and practically useful content scales for diagnostic work with school populations up to and including Grade 12. The new Form C was produced by combining rational organization of item content with confirmatory factor analysis (CFA). In the end, CMI Form C provides a total score for career choice readiness, three scale scores reflecting career adaptability dimensions of concern, curiosity, and confidence, and a score reflecting relational style in forming occupational choices. Initial evidence supports the face, construct, and concurrent validity of the CMI scores as indicators of career choice readiness.
A Psychometric Evaluation of the Career Decision Self-Efficacy Scale–Short Form Among French University Students
Authors: Gaudron Jean-Philippe
Published: May 2011

The purpose of the present study was to examine the reliability and the factor structure of the Career Decision Self-Efficacy Scale–Short Form (CDSES-SF) among French university students. Based on a sample of 650 respondents, the alpha coefficients indicated high reliability for total scores but not for the subscale scores with values of .70 and below. The test–retest reliability of the total scores was .81. The original and theoretical five-factor model demonstrated inadequate model fit. A four-factor model, which fixed 18 items to load only on latent factors labelled Goal Selection, Problem Solving, Information Gathering, and Goal Pursuit Management, provided an acceptable fit to the data. The results are discussed in the light of previous studies; suggestions for future research are proposed.
The Jackson Career Explorer in Relation to the Career Directions Inventory
Authors: Schermer Julie Aitken , MacDougall Robyn
Published: May 2011

The Jackson Career Explorer (JCE) is a short form and continuous version of the Jackson Vocational Interest Survey (JVIS). The 34 scales of the JCE were investigated in relation to the Career Directions Inventory (CDI). Participants ( N = 282) aged 14–57 years were volunteers from local high schools and colleges and completed both measures. The reliability values for the JCE scales were moderate to high. In terms of convergent validity, corresponding scales from both measures were found to correlate highly, supporting the use of the JCE and adding information about the CDI.
The Effect of Distressing Imagery on Attention to and Persuasiveness of an Antialcohol Message
Authors: Brown Stephen L. , Richardson Miles
Published: June 2011

Background. Distressing imagery may inhibit health communications by inducing audiences to reduce distress by avoiding attention to persuasive messages. Method. This study used eye-tracking methods to compare gaze time allocated to a persuasive textual message, accompanied by either distressing high-resolution color images or less distressing two-color images with degraded outline and detail. Results. Participants in the distressing images condition showed lower intentions to reduce drinking in the following 3 months, which may have been mediated by lower gaze time to textual elements of the message. The effect was stronger in participants who both scored lower on dispositional mental disengagement and were more vulnerable to alcohol-related problems. Conclusions. These findings suggest that distressing imagery may inhibit persuasion by reducing audience attention to message components. Implications for message design are discussed.
An Examination of G-Theory Methods for Modeling Multitrait–Multimethod Data
Authors: Woehr David J. , Putka Dan J. , Bowler Mark C.
Published: May 2011

For nearly three decades, the predominant approach to modeling the latent structure of multitrait–multimethod (MTMM) data in organizational research has involved confirmatory factor analysis (CFA). Despite the frequency with which CFA is used to model MTMM data, commonly used CFA models may produce ambiguous or even erroneous results. This article examines the potential of generalizability theory (G-theory) methods for modeling MTMM data and makes such methods more accessible to organizational researchers. Although G-theory methods have existed for more than half a century, the research literature has yet to provide a clear description and integration of latent models implied by univariate and multivariate G-theory with MTMM data, notions of construct validity, and CFA. To help fill this void, the authors first provide a jargon-free overview of the univariate and multivariate G-theory models and analytically demonstrate linkages between their parameters (variance and covariance components), elements of the MTMM matrices, indices of convergent and discriminant validity, and CFA. The authors conclude with a discussion and empirical illustration of a G-theory-based modeling process that helps clarify the use of G-theory methods for modeling MTMM data.
Chinese translation and validation of the Walking Impairment Questionnaire in patients with peripheral artery disease
Authors: Yan Bryan P , Lau James Y , Yu Check-Man , Au Kim , Chan Ka-Wai , Yu Doris S , Ma Ronald C , Lam Yat-Yin , Hiatt William R
Published: June 2011

The Walking Impairment Questionnaire (WIQ) is a frequently used questionnaire to evaluate patients with intermittent claudication on four subscales: pain severity, walking distance, walking speed and the ability to climb stairs. The aim of this study is to translate and validate the WIQ in Chinese. After translation and cultural adaptation of the WIQ, 134 patients with intermittent claudication completed the Chinese WIQ and European Quality of Life 5 Dimension (EQ-5D). Walking distances were determined by the 6-minute walk test (6MWT). Correlations between the WIQ, quality of life questionnaire and walking distances were calculated to determine validity. Reliability and internal consistency were determined using the intra-class correlation coefficient (ICC) and Cronbach’s alpha (α), respectively. Significant correlations were found between the WIQ score, initial claudication distance (ICD), absolute claudication distance (ACD) and all domains of the EQ-5D (all p ≤ 0.01). Test—retest reliability (ICC = 0.74) and the overall internal consistency determined (α = 0.90) showed good agreement. A lower WIQ score corresponded to shorter walking distances. In conclusion, this study showed that the Chinese version of the WIQ is a valid, reliable and clinically relevant instrument for assessing walking impairment in patients with intermittent claudication.
Effect of darbepoetin alfa on endothelial progenitor cells and vascular reactivity in chronic kidney disease
Authors: Mohler Emile R , Lifeng Zhang  , Medenilla Elizabeth , Rogers Wade , French Benjamin , Bantly Andrew , Moore Jonni S , Yonghong Huan  , Murashima Miho , Berns Jeffrey S
Published: June 2011

Endothelial progenitor cells (EPCs) are thought to be important for maintaining normal vascular function. We conducted a prospective study evaluating the effect of the erythropoiesis-stimulating agent darbepoetin alfa on EPCs and vascular function in patients with chronic kidney disease (CKD), with or without diabetes. Thirty subjects with CKD (20 subjects with type II diabetes mellitus and 10 without diabetes mellitus) received weekly subcutaneous administration of darbepoetin alfa for 4 weeks. EPCs were measured at baseline and 2 and 4 weeks after drug administration. Vascular function was measured with brachial ultrasound and cell activity was measured with a cell proliferation assay. Cells expressing CD133, CD34, CD146 and CD146/31 were significantly elevated (all p < 0.05), flow-mediated vasodilatation increased 2.1%, 95% CI: (0.4%, 3.8%) and colony-forming units increased twofold, 95% CI: (1.7, 2.3) after 4 weeks of treatment with darbepoetin alfa. Subjects with diabetes exhibited an increase in a subset of EPCs (CD133 + and 34+, p < 0.01 and p = 0.06, respectively), vasodilatation and proliferation. In conclusion, the administration of darbepoetin alfa for 4 weeks increased a subset of EPCs, improved endothelial function and increased cell proliferation, including those with diabetes, which is consistent with a favorable improvement in vascular health.
Abstinence-orientated residential rehabilitation of opioid users in Denmark: Do changes in national treatment policies affect treatment outcome?
Authors: Pedersen Mads Uffe , Hesse Morten , Bloomfield Kim
Published: May 2011

Aims: Significant changes in the Danish drug-abuse treatment system occurred from 1998 to 2008, allowing the opportunity to study their impact on outcomes for opiate dependent patients. This paper examines whether such changes are related to possible changes in abstinence rates of two cohorts of drug users. Methods: We compared survival curves and the month-by-month probability of abstinence between cohorts of drug abusers who were followed for one year after treatment for opioid dependence in 1998 (n = 305) and in 2008 (n = 204). Of the 1998 cohort, 192 were interviewed face-to-face and 61 were found through national drug-abuse treatment registers. Of the 2008 cohort 112 were interviewed face-to-face and 42 were found through national drug-abuse treatment registers. Results: Survival curves did not differ between the two cohorts. After controlling for age and gender, people from the 2008 cohort had a higher frequency of month-to-month rates of abstinence. A higher proportion of clients received new treatment after their index treatment in 2008. Clients from the 1998 cohort who did not receive new treatment used drugs more often than clients who did not receive treatment in 2008. At the same time, the proportion of clients who received residential rehabilitation treatment for opiate dependence increased substantially by 2008. Conclusions: Total abstinence rates are highly consistent over time and seem to change little with changes in systems of care. However, changes in care that improve access to treatment may reduce the overall burden of opioid addiction to both individuals and society.
Socioeconomic position and effectiveness of lifestyle intervention in prevention of type 2 diabetes: One-year follow-up of the FIN-D2D project
Authors: Rautio Nina , Jokelainen Jari , Oksa Heikki , Saaristo Timo , Peltonen Markku , Niskanen Leo , Puolijoki Hannu , Vanhala Mauno , Uusitupa Matti , Keinänen-Kiukaanniemi Sirkka ,   FIN-D2D Study Group
Published: May 2011

Aims: Lifestyle intervention is effective in prevention of type 2 diabetes (T2D) in high-risk individuals. However, health behaviour and health outcomes are modified by socioeconomic position through various mechanisms. It is therefore possible that success in lifestyle intervention may be determined by factors such as level of education or occupation. In this study we assessed the impact of the level of education and occupation on the baseline anthropometric and clinical characteristics and their changes during a one-year follow-up in a cohort of Finnish men and women at high risk for T2D aged 20—64 years. Methods: As part of a Finnish national diabetes prevention programme 2003—2007 (FIN-D2D), high-risk individuals were identified using opportunistic screening for lifestyle intervention in primary health care. 1,067 men and 2,122 women had one-year follow-up data. Education and occupation were used as factors of socioeconomic position. Measures of anthropometric and clinical characteristics included weight, body mass index (BMI), waist circumference, systolic and diastolic blood pressure, total, HDL and LDL cholesterol, triglycerides, FINDRISC scores and glucose tolerance status. Results: The effect of intervention was similar in all socioeconomic groups, but the level of education was related to glucose tolerance status in both genders. In addition, socioeconomic differences existed in blood pressure, weight, BMI, waist circumference and HDL cholesterol. Conclusions: Socioeconomic position did not seem to have any impact on the effectiveness of lifestyle intervention in individuals at high risk for T2D, which is encouraging from the point of view of reducing health inequalities.
Love to Hate
Authors: Imre Anikó
Published: May 2011

This essay examines the love–hate relationship—overt hatred and secret love—that surrounds reality shows about Roma and other racialized celebrities in postsocialist New European nations. Taking the case study of the wildly popular yet universally despised Hungarian Gyõzike show and its national reception, it argues that the aversion to the cultural quality represented by reality TV and the aversion to the ethnoracial quality represented by the Roma and other minorities are thoroughly intertwined. Reality television has disclosed the unspoken role assigned to racial minorities to mark the whiteness of East European nations, a crucial but hardly discussed aspect of belonging to Europe. This study also demonstrates that understanding the role played by reality TV under the particular conditions of postsocialist nationalisms and media globalization requires expanding the focus of reality TV scholarship on post-welfare neoliberalism.
Theory and simulation of micropolar fluid dynamics
Authors: Chen J , Liang C , Lee J D
Published: June 2011

This paper reviews the fundamentals of micropolar fluid dynamics (MFD), and proposes a numerical scheme integrating Chorin’s projection method and time-centred split method (TCSM) for solving unsteady forms of MFD equations. It has been known that Navier–Stokes equations are incapable of explaining the phenomena at micro and nano scales. On the contrary, MFD can naturally pick up the physical phenomena at micro and nano scales owingto its additional degrees of freedom for gyration. In this study, the analytical and exact solutions of Couette and Hagen–Poiseuille flow are provided. Though this study is limited to the steady flow cases, the unsteady term in the MFD has been taken into account. This present work initiates the development of a general-purpose code of computational micropolar fluid dynamics (CMFD). The discretization scheme in space is demonstrated with nearly second-order accuracy on multiple meshes.
Provision of Psychosocial Care for Cancer Patients
Authors: Abrahamson Kathleen , Durham Morgan , Norton Kelli , Doebbeling Bradley N. , Doebbeling Caroline Carney , Anderson James G.
Published: May 2011

Although common, psychosocial distress is frequently under diagnosed and untreated in the US health care system. Previous research shows that cancer patients have unmet psychosocial needs, and provision of psychosocial care frequently falls to primary care providers who may lack the resources to adequately deal with complex psychosocial issues. We conducted 25 in-depth key informant interviews with health care professionals working within medical facilities that provide care to cancer patients. Cancer care centers included in the sample were located within both rural and urban communities in a midwestern state, and included providers of both inpatient and outpatient services. Interview questions addressed the assessment of psychosocial needs, availability of psychosocial care, perceptions of the effectiveness of psychosocial services, and perceptions of organizational processes to manage psychosocial needs among their patients. Respondents were also queried regarding recommendations for improving psychosocial care for patients with cancer. Assessment of psychosocial need in most settings was often subjective, not performed, or completed without access to an accepted standardized assessment tool, and clinical pathways to direct psychosocial care were often lacking. Because of the lack of systematic assessment, access to psychosocial care was frequently dependent on the subjective judgment of busy clinicians. This study shows the clear need for organizational and practice redesign initiatives in both rural and urban settings to improve the delivery of psychosocial services to cancer patients. A number of possible system improvements were identified, including the use of allied health providers, standardized screening, and information technology to increase the ease and efficiency of psychosocial assessment.
Variation in Excessive Fetal Growth across Levels of Prenatal Care among Women with Gestational Diabetes
Authors: Hale Nathan L. , Probst Janice C. , Liu Jihong , Bennett Kevin J. , Martin Amy Brock , Glover Saundra
Published: May 2011

Objective: Examine the association between prenatal care and excessive fetal growth outcomes among mothers with gestational diabetes mellitus (GDM). Methods: We conducted a retrospective analysis of 2004-2007 singleton live births to South Carolina women, limited to those for whom both birth certificate and hospital discharge data were available (N = 179 957). Gestational diabetes mellitus was identified from birth certificate and/or hospital discharge claims. Measures of excessive fetal growth were large for gestational age (90th and 95th percentiles) and macrosomia (birth weight > 4500 g). The Adequacy of Prenatal Care Utilization index was used to measure prenatal care. Results: Gestational diabetes mellitus was recorded for 6.9% of women in the study population. Women with GDM were more likely than other women to have an infant with excessive fetal growth, regardless of the level of prenatal care; however, there was a significant interaction between GDM status and levels of prenatal care. All women with GDM had increased odds for large infant outcomes. However, those receiving inadequate prenatal care were markedly more likely to experience excessive fetal growth outcomes (odds ratio = 1.38, confidence interval = 1.15-1.66) than women also with GDM and intermediate/adequate prenatal care. Similar patterns were noted for large for gestational age (95th) and macrosomia (total birth weight ≥ 4500 g). Conclusions: Observed associations suggest a link between inadequate prenatal care and a higher risk for excessive fetal growth among women with GDM. Further research is needed to clarify the nature of the association and suggest ways to get high-risk women into care sooner.
Enhancing Quality of Primary Care Using an Ambulatory ICU to Achieve a Patient- Centered Medical Home
Authors: Lewis Joy , Hoyt Alex , Kakoza Rose M.
Published: May 2011

Research Objective: The Patient-Centered Medical Home (PCMH) has been advocated as a model to address the lack of coordination and continuity in the health system. However, implementation in practice has been slow and incompletely described. Study Design: Patients referred into the program received intensive nurse follow-up focused on medication adherence, care coordination, and education. Patients graduate from the program when treatment goals are met. Population Studied: The first 100 patients enrolled into the PCMH focused program of a primary care clinic in an urban, academic medical center. The main outcome measures are goal adherence and emergency room use. Principal Findings: Ninety percent of enrollees met the health goals set for them at enrollment. During their enrollment, 31.6% of patients with diabetes reduced and maintained their blood glucose readings; 24.6% of patients with hypertension reduced and maintained their blood pressure readings. Emergency department use in the time period following enrollment dropped 46.7%. Conclusions: The ambulatory intensive care unit program showed an improvement in health outcomes and health care use.This program also helps to move the practice toward PCMH by centralizing care through a primary care provider, enhancing access to care, and by focusing on the patient holistically through rapport with a nurse. Implications for Policy, Delivery, or Practice: This care delivery method drives the clinic closer to the PCMH and toward the Accountable Care Organization (ACO) model.
Loss of p19Arf in a Rag1−/− B-cell precursor population initiates acute B-lymphoblastic leukemia
Authors: Hauer Julia , Mullighan Charles , Morillon Estelle , Wang Gary , Bruneau Julie , Brousse Nicole , Lelorc'h Marc , Romana Serge , Boudil Amine , Tiedau Daniela , Kracker Sven , Bushmann Frederic D. , Borkhardt Arndt , Fischer Alain , Hacein-Bey-Abina Salima , Cavazzana-Calvo Marina
Published: May 2011

In human B-acute lymphoblastic leukemia (B-ALL), RAG1-induced genomic alterations are important for disease progression. However, given that biallelic loss of the RAG1 locus is observed in a subset of cases, RAG1's role in the development of B-ALL remains unclear. We chose a p19Arf−/−Rag1−/− mouse model to confirm the previously published results concerning the contribution of CDKN2A (p19ARF /INK4a) and RAG1 copy number alterations in precursor B cells to the initiation and/or progression to B-acute lymphoblastic leukemia (B-ALL). In this murine model, we identified a new, Rag1-independent leukemia-initiating mechanism originating from a Sca1+CD19+ precursor cell population and showed that Notch1 expression accelerates the cells' self-renewal capacity in vitro. In human RAG1-deficient BM, a similar CD34+CD19+ population expressed p19ARF. These findings suggest that combined loss of p19Arf and Rag1 results in B-cell precursor leukemia in mice and may contribute to the progression of precursor B-ALL in humans.
New mechanism of X-linked anhidrotic ectodermal dysplasia with immunodeficiency: impairment of ubiquitin binding despite normal folding of NEMO protein
Authors: Hubeau Marjorie , Ngadjeua Flora , Puel Anne , Israel Laura , Feinberg Jacqueline , Chrabieh Maya , Belani Kiran , Bodemer Christine , Fabre Isabelle , Plebani Alessandro , Boisson-Dupuis Stéphanie , Picard Capucine , Fischer Alain , Israel Alain , Abel Laurent , Veron Michel , Casanova Jean-Laurent , Agou Fabrice , Bustamante Jacinta
Published: May 2011

Nuclear factor-κB essential modulator (NEMO), the regulatory subunit of the IκB kinase complex, is a critical component of the NF-κB pathway. Hypomorphic mutations in the X-linked human NEMO gene cause various forms of anhidrotic ectodermal dysplasia with immunodeficiency (EDA-ID). All known X-linked EDA-ID–causing mutations impair NEMO protein expression, folding, or both. We describe here 2 EDA-ID–causing missense mutations that affect the same residue in the CC2-LZ domain (D311N and D311G) that do not impair NEMO production or folding. Structural studies based on pull-down experiments showed a defect in noncovalent interaction with K63-linked and linear polyubiquitin chains for these mutant proteins. Functional studies on the patients' cells showed an impairment of the classic NF-κB signaling pathways after activation of 2 NEMO ubiquitin-binding–dependent receptors, the TNF and IL-1β receptors, and in the CD40-dependent NF-κB pathway. We report the first human NEMO mutations responsible for X-linked EDA-ID found to affect the polyubiquitin binding of NEMO rather than its expression and folding. These experiments demonstrate that the binding of human NEMO to polyubiquitin is essential for NF-κB activation. They also demonstrate that the normal expression and folding of NEMO do not exclude a pathogenic role for NEMO mutations in patients with EDA-ID.
Stromal cell–derived factor-1 and hematopoietic cell homing in an adult zebrafish model of hematopoietic cell transplantation
Authors: Glass Tiffany J. , Lund Troy C. , Patrinostro Xiaobai , Tolar Jakub , Bowman Teresa V. , Zon Leonard I. , Blazar Bruce R.
Published: May 2011

In mammals, stromal cell–derived factor-1 (SDF-1) promotes hematopoietic cell mobilization and migration. Although the zebrafish, Danio rerio, is an emerging model for studying hematopoietic cell transplantation (HCT), the role of SDF-1 in the adult zebrafish has yet to be determined. We sought to characterize sdf-1 expression and function in the adult zebrafish in the context of HCT. In situ hybridization of adult zebrafish organs shows sdf-1 expression in kidney tubules, gills, and skin. Radiation up-regulates sdf-1 expression in kidney to nearly 4-fold after 40 Gy. Assays indicate that zebrafish hematopoietic cells migrate toward sdf-1, with a migration ratio approaching 1.5 in vitro. A sdf-1a:DsRed2 transgenic zebrafish allows in vivo detection of sdf-1a expression in the adult zebrafish. Matings with transgenic reporters localized sdf-1a expression to the putative hematopoietic cell niche in proximal and distal renal tubules and collecting ducts. Importantly, transplant of hematopoietic cells into myelosuppressed recipients indicated migration of hematopoietic cells to sdf-1a–expressing sites in the kidney and skin. We conclude that sdf-1 expression and function in the adult zebrafish have important similarities to mammals, and this sdf-1 transgenic vertebrate will be useful in characterizing the hematopoietic cell niche and its interactions with hematopoietic cells.
Quantitative immunofluorescence mapping reveals little functional coclustering of proteins within platelet α-granules
Authors: Kamykowski Jeffrey , Carlton Peter , Sehgal Siddharth , Storrie Brian
Published: May 2011

Platelets are small anucleate blood cells that aggregate to seal leaks at sites of vascular injury and are important in the pathology of atherosclerosis, acute coronary syndromes, rheumatoid arthritis, cancer, and the regulation of angiogenesis. In all cases, platelet aggregation requires release of stored proteins from α-granules. However, how proteins with potentially antagonistic functions are packaged within α-granules is controversial. One possibility is the packaging of functional agonists and antagonists into different α-granule populations. By quantitative immunofluorescence colocalization, we found that pair-wise comparisons of 15 angiogenic-relevant α-granule proteins displayed little, if any, pattern of functional coclustering. Rather, the data suggested a Gaussian distribution indicative of stochastic protein delivery to individual granules. The apparent physiologic paradox raised by these data may be explained through alternate mechanisms, such as differential content release through incomplete granule fusion or dampened and balanced regulatory networks brought about by the corelease of antagonistic factors.
Adulthood residential ultraviolet radiation, sun sensitivity, dietary vitamin D, and risk of lymphoid malignancies in the California Teachers Study
Authors: Chang Ellen T. , Canchola Alison J. , Cockburn Myles , Lu Yani , Wang Sophia S. , Bernstein Leslie , Clarke Christina A. , Horn-Ross Pamela L.
Published: May 2011

To lend clarity to inconsistent prior findings of an inverse association between ultraviolet radiation (UVR) exposure and risk of lymphoid malignancies, we examined the association of prospectively ascertained residential ambient UVR exposure with risk of non-Hodgkin lymphomas (NHLs), multiple myeloma (MM), and classical Hodgkin lymphoma in the California Teachers Study cohort. Among 121 216 eligible women, 629 were diagnosed with NHL, 119 with MM, and 38 with Hodgkin lymphoma between 1995-1996 and 2007. Cox proportional hazards regression was used to estimate incidence rate ratios (RRs) with 95% confidence intervals (CIs). Residential UVR levels within a 20-km radius were associated with reduced risk of overall NHL (RR for highest vs lowest statewide quartile of minimum UVR [≥ 5100 vs < 4915 W-h/m2], 0.58; 95% CI, 0.42-0.80), especially diffuse large B-cell lymphoma (RR, 0.36; 95% CI, 0.17-0.78) and chronic lymphocytic leukemia/small lymphocytic lymphoma (RR, 0.46; 95% CI, 0.21-1.01), and MM (RR for maximum UVR, 0.57; 95% CI, 0.36-0.90). These associations were not modified by skin sensitivity to sunlight, race/ethnicity, body mass index, or neighborhood socioeconomic status. Dietary vitamin D also was not associated with risk of lymphoid malignancies. These results support a protective effect of routine residential UVR exposure against lymphomagenesis through mechanisms possibly independent of vitamin D.
Differentiation of human peripheral blood Vδ1+ T cells expressing the natural cytotoxicity receptor NKp30 for recognition of lymphoid leukemia cells
Authors: Correia Daniel V. , Fogli Manuela , Hudspeth Kelly , da Silva Maria Gomes , Mavilio Domenico , Silva-Santos Bruno
Published: June 2011

The success of cancer immunotherapy depends on productive tumor cell recognition by killer lymphocytes. γδ T cells are a population of innate-like lymphocytes endowed with strong, MHC-unrestricted cytotoxicity against tumor cells. This notwithstanding, we recently showed that a large proportion of human hematologic tumors is resistant to γδ peripheral blood lymphocytes (PBLs) activated with specific agonists to the highly prevalent Vγ9Vδ2 TCR. Although this probably constitutes an important limitation to current γδ T cell–mediated immunotherapy strategies, we describe here the differentiation of a novel subset of Vδ2− Vδ1+ PBLs expressing natural cytotoxicity receptors (NCRs) that directly mediate killing of leukemia cell lines and chronic lymphocytic leukemia patient neoplastic cells. We show that Vδ1+ T cells can be selectively induced to express NKp30, NKp44 and NKp46, through a process that requires functional phosphatidylinositol 3-kinase (PI-3K)/AKT signaling on stimulation with γc cytokines and TCR agonists. The stable expression of NCRs is associated with high levels of granzyme B and enhanced cytotoxicity against lymphoid leukemia cells. Specific gain-of-function and loss-of-function experiments demonstrated that NKp30 makes the most important contribution to TCR-independent leukemia cell recognition. Thus, NKp30+ Vδ1+ T cells constitute a novel, inducible and specialized killer lymphocyte population with high potential for immunotherapy of human cancer.
How I treat mucormycosis
Authors: Kontoyiannis Dimitrios P. , Lewis Russell E.
Published: May 2011

Unlike invasive aspergillosis, the prognosis and outcome of hematologic malignancy patients who develop invasive mucormycosis have not significantly improved over the past decade as a majority of patients who develop the infection still die 12 weeks after diagnosis. However, early recognition and treatment of invasive mucormycosis syndromes, as well as individualized approaches to treatment and secondary prophylaxis, could improve the odds of survival, even in the most persistently immunosuppressed patient receiving chemotherapy and/or of stem cell transplantation. Herein, we describe the subtle clinical and radiographic clues that should alert the hematologist to the possibility of mucormycosis, and aggressive and timely treatment approaches that may limit the spread of infection before it becomes fatal. Hematology patients with this opportunistic infection require integrated care across several disciplines and frequently highly individualized and complex sequence of decision-making. We also offer perspectives for the use of 2 antifungals, amphotericin B products and posaconazole, with activity against Mucorales. The availability of posaconazole in an oral formulation that can be administered safely for prolonged periods makes it an attractive agent for long-term primary and secondary prophylaxis. However, serum drug concentration monitoring may be required to minimize breakthrough infection or relapsing mucormycosis associated with inadequate blood concentrations.
Transcription factor networks in erythroid cell and megakaryocyte development
Authors: Doré Louis C. , Crispino John D.
Published: May 2011

Erythroid cells and megakaryocytes are derived from a common precursor, the megakaryocyte-erythroid progenitor. Although these 2 closely related hematopoietic cell types share many transcription factors, there are several key differences in their regulatory networks that lead to differential gene expression downstream of the megakaryocyte-erythroid progenitor. With the advent of next-generation sequencing and our ability to precisely define transcription factor chromatin occupancy in vivo on a global scale, we are much closer to understanding how these 2 lineages are specified and in general how transcription factor complexes govern hematopoiesis.