bluuebunny/crossref_metadata_2025 huggingface dataset:
Tailored Therapy: Matching the Method to the Patient
Authors: Macedo Etienne , Mehta Ravindra L.
Published: October 2012

Clinicians frequently have to decide when dialysis should be initiated and which modality should be used to support kidney function in critically ill patients with acute kidney injury. In most instances, these decisions are made based on the consideration of a variety of factors including patient condition, available resources and prevailing local practice experience. There is a wide variation worldwide in how these factors influence the timing of initiation and the utilization of various modalities. In this article, we review the therapeutic goals of renal support and the relative advantages and shortcomings of different dialysis techniques. We describe strategies for matching the timing of initiation to the choice of modality to individualize renal support in intensive care unit patients.
Utility of Capture-Recapture Methodology to Assess Completeness of Amyotrophic Lateral Sclerosis Case Ascertainment
Authors: Wittie Michael , Nelson Lorene M. , Usher Sharon , Ward Kevin , Benatar Michael
Published: October 2012

Background: With the establishment of a national amyotrophic lateral sclerosis (ALS) registry in the United States, methods are needed to ascertain the completeness of case ascertainment, especially in view of the proposal to rely largely on existing data sources. Methods: Data about ALS patients residing in the 5-county metropolitan Atlanta area (within the State of Georgia) from 2001 to 2005 were categorized according to their source – ALS Association, clinical (Emory Healthcare, community neurologist, Veterans Health Administration, Veterans Benefits Administration), Medicare and death certificates. ALS diagnoses were verified using chart review. Capture-recapture analyses were carried out using log-linear modeling, stratified by age and race. Results: The final model (based on 798 cases), which included the 4 main sources and 3 two-way interaction terms, yielded an estimated total population of 880 (95% CI 816–965), indicating that the combination of case-finding methods identified about 90.7% of cases. The estimated 5-year period prevalence is 38.5/100,000 (95% CI 35.66–42.19). Conclusion: This study highlights gaps in data based on existing data sources and illustrates a method for combining data from multiple sources to help facilitate the successful establishment of a US national ALS registry.
A Historic Cohort Study on Accelerated Advancement of Enteral Feeding Volumes in Very Premature Infants
Authors: Maas C. , Mitt S. , Full A. , Arand J. , Bernhard W. , Poets C.F. , Franz A.R.
Published: October 2012

Background: The optimal rate of enteral feeding (EF) advancement in very low birth weight infants is under debate. Objectives: To evaluate the effects of accelerated EF advancement on the time to full enteral feeds, on early postnatal growth as well as on the frequency of necrotizing enterocolitis (NEC) and focal intestinal perforation (FIP) in very premature infants. Methods: In a retrospective single-center historic cohort study, infants with a gestational age <32 weeks at birth and birth weight <1,500 g, born between January 1, 2006, and December 31, 2007 (n = 136), were compared with infants born between January 1, 2010, and December 31, 2010 (n = 88). In 2006/2007, enteral feeds were initiated on day 1 with 10–15 ml/kg/day and advanced by 15–20 ml/kg/day. In 2010, enteral feeds were initiated with 20 ml/kg/day on day 1 and advanced by 25–30 ml/kg/day. Full enteral feeds were defined as ≥140 ml/kg/day. Data are presented as median (P25–P75). Results: The time to establish full enteral feeds was shorter in 2010: 8 (7–11) days in 2006/2007 versus 6 (5–9) days in 2010. The incidences of NEC and FIP were 2.7 and 4.1% in 2006/2007 and 3.3 and 2.2% in 2010, respectively. Weight gain was not affected by the rate of EF advancement. Higher parenteral protein intake during week 1 in 2006/2007 was associated with better head circumference growth. Conclusions: The new approach was associated with a significantly shorter period to establish full enteral feeds. No difference in the incidence of FIP or NEC was observed; however, the study was underpowered to detect small but possibly important differences.
Role of TRPC1 and TRPC3 Channels in Contraction and Relaxation of Mouse Thoracic Aorta
Authors: Kochukov M.Y. , Balasubramanian A. , Noel R.C. , Marrelli S.P.
Published: October 2012

Background/Aims: Canonical transient receptor potential (TRPC) channels modulate membrane potential and intracellular Ca2+. We examined the role of TRPC1 and TRPC3 channels in vasocontraction and relaxation in mouse aorta. Methods: Vasocontraction and relaxation of aorta from wild-type (WT), TRPC1 KO and TRPC3 knockout (KO) mice were measured for phenylephrine (Phe) and carbachol (CCh). Intracellular Ca2+ was measured in primary aorta endothelial cells (EC) and whole cell K+ current in freshly isolated smooth muscle cells (SMC). Results and Conclusion: TRPC1 KO aorta showed increased vasocontraction to Phe compared to WT and TRPC3 KO aorta due to diminished role of BKCa channels. BKCa mRNA (aorta) and whole cell current (SMC) were reduced versus WT. Contraction in WT aorta was increased to TRPC1 KO level by BKCa channel inhibition. Relaxation to CCh was reduced in TRPC1 KO and TRPC3 KO aortas with concomitant reduction in EC Ca2+ response. Pyr3 (TRPC3 blocker) reduced the Ca2+ response to CCh in EC from WT, but not TRPC3 KO mice. In summary, TRPC1 attenuates receptor-mediated contraction through activation and/or expression of SMC BKCa channels while TRPC3 does not contribute to receptor-mediated constriction. Both TRPC1 and TRPC3 participate in EC Ca2+ influx and vasorelaxation of aorta.
Oxidative Stress in Obesity and Metabolic Syndrome in Children and Adolescents
Authors: Faienza Maria Felicia , Francavilla Ruggiero , Goffredo Rocco , Ventura Annamaria , Marzano Flaviana , Panzarino Gianvito , Marinelli Grazia , Cavallo Luciano , Di Bitonto Giovanna
Published: October 2012

Background/Aims: The aim of this study was to investigate the alterations in the oxidant/antioxidant status in obese children with and without metabolic syndrome (MetS). Methods: We recruited 25 Caucasian obese children with MetS, 30 Caucasian children with simple obesity and a control group of 30 Caucasian children. We performed diacron-reactive oxygen metabolites (d-ROMs) test and biological antioxidant potential (BAP) test in order to evaluate the oxidant-antioxidant status in recruited patients. Results: d-ROM level was significantly higher in obese children with and without MetS (p = 0.005). The total antioxidant capacity (BAP level) was reduced in MetS and noMetS children compared to controls (p = 0.009). The subjects without MetS had higher d-ROMs test and lower BAP/d-ROMs ratio than subjects with MetS (although not significant). The ratio BAP/d-ROMs was higher in controls than noMetS and MetS children (p < 0.0001). d-ROM level was higher in prepubertal subjects with MetS than pubertal ones (p = 0.03). A direct correlation was found between d-ROM levels and BMI SDS (p = 0.0005), while an inverse correlation was found between BAP and BMI SDS (p = 0.004) and BAP/d-ROMs and BMI SDS (p = 0.0001). Conclusions: This result confirms that fat accumulation plays a key role in the pathogenesis of systemic oxidative stress already during pediatric age.
Stroke and Transient Ischemic Attack Incidence Rate in Spain: The IBERICTUS Study
Authors: Díaz-Guzmán Jaime , Egido Jose-A. , Gabriel-Sánchez Rafael , Barberá-Comes Gloria , Fuentes-Gimeno Blanca , Fernández-Pérez Cristina ,   on behalf of the IBERICTUS Study Investigators of the Stroke Project of the Spanish Cerebrovascular Diseases Study Group
Published: October 2012

Background: In Spain, stroke is a major public health concern, but large population-based studies are scarce and date from the 1990s. We estimated the incidence and in-hospital mortality of stroke through a multicentered population-based stroke register in 5 geographical areas of Spain, i.e. Lugo, Almería, Segovia, Talavera de la Reina and Mallorca, representing north, south, central (×2) and Mediterranean areas of Spain, respectively, the aim and novelty being that all methodologies were standardized, and diagnoses were verified by a neurologist using neuroimaging techniques. Methods: The register identified subjects >17 years of age who suffered a first-ever stroke or transient ischemic attack (TIA) between 1 January and 31 December 2006. Stroke and TIA were defined according to the WHO criteria. The Lausanne Stroke Registry definitions were used to classify ischemic stroke subtypes, as follows: (1) large-artery atherosclerosis (LAA); (2) cardioembolism (CE); (3) lacunar stroke or small-artery occlusion (SAO); (4) stroke of other infrequent cause (SIC), and (5) stroke of undetermined cause (UND). We used several complementary data sources such as hospital discharge registers, emergency room registers and primary care surveillance systems. Results: In the 1-year study period, we identified 2,700 first-ever cerebrovascular episodes (53% men; 2,257 strokes + 443 TIA episodes). Brain CT in the acute stage was performed in 99% of cases. Of a total of 2,257 stroke patients, 1,817 (81%) had cerebral infarction, 350 (16%) had intracerebral hemorrhage, 59 (3%) had subarachnoid hemorrhage (SAH) and 31 (1%) had unclassifiable stroke. The overall unadjusted annual incidence for all cerebrovascular events was 187 per 100,000 [95% confidence interval (CI) 180–194; incidence for men: 202, 95% CI 189–210; incidence for women: 187, 95% CI 180–194]. The subtype of ischemic stroke could be determined in 1,779 patients and was classified as LAA in 624 (35%), CE in 352 (20%), SAO in 316 (18%), SIC in 56 (3%) and UND in 431 (24%). The incidence rates per 100,000 (95% CI) standardized to the 2006 European population were as follows: all cerebrovascular events, 176 (169–182); all stroke (non-TIA), 147 (140–153); TIA, 29 (26–32); ischemic stroke, 118 (112–123); intracerebral hemorrhage, 23 (21–26), and SAH, 4.2 (3.1–5.2). Incidence rates clearly increased with age in both genders, with a peak at or above 85 years of age. The in-hospital mortality was 14%. Conclusions: Our results show that the incidence of stroke and TIA in Spain is moderate compared to other Western and European countries. However, it is expected that these figures will change due to progressively aging populations.
Estradiol Modulates Tumor Necrosis Factor-Induced Endothelial Inflammation: Role of Tumor Necrosis Factor Receptor 2
Authors: Chakrabarti Subhadeep , Davidge Sandra T.
Published: October 2012

The sex hormone estradiol (E2) appears to mediate both anti-atherogenic and pro-inflammatory effects in premenopausal women, suggesting a complex immunomodulatory role. Tumor necrosis factor (TNF) is a key pro-inflammatory cytokine involved in the pathogenesis of atherosclerosis and other inflammatory diseases. Alterations at the TNF receptors (TNFRs) and their downstream signaling/transcriptional pathways can affect inflammatory responses. Given this background, we hypothesized that chronic E2 exposure would alter endothelial inflammatory response involving modulation at the levels of TNFRs and signaling pathways. HUVECs were used as the model system. Pre-treatment with E2 did not significantly alter TNF-induced upregulation of pro-inflammatory molecules ICAM-1 (3–6 times) and VCAM-1 (5–7 times). However, pharmacological inhibition of transcriptional pathways suggested a partial shift from NF-ĸB (from 97 to 64%) towards the JNK/AP-1 pathway in ICAM-1 upregulation on E2 treatment. In contrast, VCAM-1 expression remained NF-ĸB dependent in both control (∼96%) and E2 treated (∼85%) cells. The pro-inflammatory TNF effects were mediated by TNFR1. Interestingly, E2 pre-treatment increased TNFR2 levels in these cells. Concomitant TNFR2 activation (but not TNFR1 activation alone) led to the shift towards JNK/AP-1-mediated ICAM-1 upregulation in E2-treated cells, suggesting the effects of chronic E2 to be dependent on TNFR2 signaling.
Antiphospholipid Antibodies, Brain Infarcts, and Cognitive and Motor Decline in Aging (ABICMA): Design of a Community-Based, Longitudinal, Clinical-Pathological Study
Authors: Arvanitakis Zoe , Brey Robin L. , Rand Jacob H. , Schneider Julie A. , Leurgans Sue E. , Yu Lei , Buchman Aron S. , Arfanakis Konstantinos , Fleischman Debra A. , Boyle Patricia A. , Bennett David A. , Levine Steven R.
Published: October 2012

The overall goal of the Antiphospholipid Antibodies, Brain Infarcts, and Cognitive and Motor Decline in Aging study is to test the hypothesis that antiphospholipid antibodies (aPL) are associated with an increased risk of pathologically proven brain infarcts and are related to cognitive and motor decline in aging. Putative biologic mechanisms underlying the association of aPL with infarcts and the relation of aPL with clinical outcomes of cognitive and motor impairment, including vascular and other processes, will be examined. The design of this longitudinal, clinical-pathologic study involves quantifying four aPL assays, and relating these to brain infarcts, and to cognitive and motor decline. Vascular mechanisms assessed using antemortem magnetic resonance neuroimaging and postmortem neuropathology, as well as nonvascular mechanisms of inflammation and blood-brain barrier permeability alterations will be examined as plausible mediators of the relation of aPL to cognitive and motor impairment. We will take advantage of antemortem biological specimens (longitudinally collected sera and plasma from which aPL, annexins, C-reactive protein, and matrix metalloproteinases will be quantified), and clinical, neuroimaging, and postmortem neuropathologic data from about 800 elderly, community-dwelling women and men who have agreed to brain autopsy at the time of death, participating in one of two ongoing studies of aging: the Religious Orders Study and the Memory and Aging Project.
Two Cases of Psoriasis Responding to Erlotinib: Time to Revisiting Inhibition of Epidermal Growth Factor Receptor in Psoriasis Therapy?
Authors: Overbeck Tobias R. , Griesinger Frank
Published: October 2012

Erlotinib inhibits the tyrosine kinase of epidermal growth factor receptor (EGFR) and is successfully used in lung cancer treatment. EGFR is essential in skin development and function and may have a role in the pathogenesis of psoriasis. Cutaneous side effects are very common in patients treated with erlotinib, and therapeutic use of erlotinib in dermatological disorders has therefore not been considered. We report two cases of patients with lung cancer and concomitant psoriasis treated with erlotinib with complete resolution of the skin problems. We present a review of the current literature on the topic.
Phylloid Pattern of Hypomelanosis Closely Related to Chromosomal Abnormalities in the 13q Detected by SNP Array Analysis
Authors: Faletra F. , Berti I. , Tommasini A. , Pecile V. , Cleva L. , Alberini E. , Bruno I. , Gasparini P.
Published: October 2012

Phylloid hypomelanosis is a distinct type of pigmentary mosaicism characterized by congenital hypochromic macules resembling a floral ornament with various elements such as round or oval patches, asymmetrical macules similar to begonia leaves, or oblong lesions. It has been found to be predominantly associated with abnormalities in chromosome 13 and sometimes as-sociated with different extracutaneous abnormalities. Here, we report 2 new cases of phylloid hypomelanosis due to mosaicism involving chromosome 13. The first one is a mosaicism for a supernumerary marker belonging to chromosome 13 and the second one is the first report of phylloid hypomelanosis associated with a mosaic deletion of 13q. Because of the extremely low level of mosaicism in these 2 cases, SNP array analysis on skin fibroblasts was carried out, showing a 13q21.33-q34 duplication (71,024,411-115,103,529) and a 13q13.3-q34 (38,368,012-115,103,529) deletion. Both cases underline on the one hand the strict connection between phylloid hypomelanosis and anomalies of chromosome 13, and on the other hand the relevance of the SNP array analysis on skin fibroblasts in the detection of low-level mosaicism.
Effects of Core Instability Strength Training on Trunk Muscle Strength, Spinal Mobility, Dynamic Balance and Functional Mobility in Older Adults
Authors: Granacher Urs , Lacroix Andre , Muehlbauer Thomas , Roettger Katrin , Gollhofer Albert
Published: October 2012

Background: Age-related postural misalignment, balance deficits and strength/power losses are associated with impaired functional mobility and an increased risk of falling in seniors. Core instability strength training (CIT) involves exercises that are challenging for both trunk muscles and postural control and may thus have the potential to induce benefits in trunk muscle strength, spinal mobility and balance performance. Objective: The objective was to investigate the effects of CIT on measures of trunk muscle strength, spinal mobility, dynamic balance and functional mobility in seniors. Methods: Thirty-two older adults were randomly assigned to an intervention group (INT; n = 16, aged 70.8 ± 4.1 years) that conducted a 9-week progressive CIT or to a control group (n = 16, aged 70.2 ± 4.5 years). Maximal isometric strength of the trunk flexors/extensors/lateral flexors (right, left)/rotators (right, left) as well as of spinal mobility in the sagittal and the coronal plane was measured before and after the intervention program. Dynamic balance (i.e. walking 10 m on an optoelectric walkway, the Functional Reach test) and functional mobility (Timed Up and Go test) were additionally tested. Results: Program compliance was excellent with participants of the INT group completing 92% of the training sessions. Significant group × test interactions were found for the maximal isometric strength of the trunk flexors (34%, p < 0.001), extensors (21%, p < 0.001), lateral flexors (right: 48%, p < 0.001; left: 53%, p < 0.001) and left rotators (42%, p < 0.001) in favor of the INT group. Further, training-related improvements were found for spinal mobility in the sagittal (11%, p < 0.001) and coronal plane (11%, p = 0.06) directions, for stride velocity (9%, p < 0.05), the coefficient of variation in stride velocity (31%, p < 0.05), the Functional Reach test (20%, p < 0.05) and the Timed Up and Go test (4%, p < 0.05) in favor of the INT group. Conclusion: CIT proved to be a feasible exercise program for seniors with a high adherence rate. Age-related deficits in measures of trunk muscle strength, spinal mobility, dynamic balance and functional mobility can be mitigated by CIT. This training regimen could be used as an adjunct or even alternative to traditional balance and/or resistance training.
Mitral Annular Calcification Is Associated with Pulse Wave Velocity but Not with Augmentation Index
Authors: Durmus Ismet , Karaman Kayıhan , Öztürk Serkan , Kutlu Merih
Published: October 2012

Objective: To investigate the possible relationship between mitral annular calcification (MAC) and arterial stiffness. Subjects and Methods: Forty-two patients (mean age 68 ± 6 years) with MAC and an age-matched control group of 41 individuals (mean age 66 ± 6 years) were studied. Arterial stiffness and wave reflections of the study population were evaluated by using applanation tonometry (SphygmoCor). Aortic pulse wave velocity (PWV) was measured as an index of aortic stiffness. The heart rate-corrected augmentation index (AIx@75) was estimated as a composite marker of wave reflections and arterial stiffness. Results: Aortic PWV was significantly higher in patients with MAC (12.2 ± 2.3 m/s) than in controls (10.1 ± 1.3 m/s, p = 0.0001). However, AIx@75 was similar between the groups (28 ± 10 vs. 29 ± 10%, p = 0.59). Multivariate analysis involving the whole population revealed that brachial diastolic blood pressure (β = 1.87, p = 0.04) and MAC (β = 0.41, p = 0.0001) were independent determinants of aortic PWV. Conclusion: The data showed that MAC was significantly associated with increased arterial stiffness and that it was an independent determinant of aortic PWV.
The Utility of Administrative Data for Surveillance of Comorbidity in Multiple Sclerosis: A Validation Study
Authors: Marrie Ruth Ann , Yu Bo Nancy , Leung Stella , Elliott Lawrence , Caetano Patricia , Warren Sharon , Wolfson Christina , Patten Scott B. , Svenson Lawrence W. , Tremlett Helen , Fisk John , Blanchard James F. ,   for the CIHR Team in the Epidemiology and Impact of Comorbidity on Multiple Sclerosis
Published: October 2012

Background: Although comorbidity is important in multiple sclerosis (MS), few validated methods for its assessment exist. We validated and applied administrative case definitions for several comorbidities in MS. Methods: Using provincial administrative data we identified persons with MS and a matched general population cohort. Case definitions for chronic lung disease (CLD), epilepsy, inflammatory bowel disease (IBD), irritable bowel syndrome (IBS) and migraine were developed using administrative data, and validated against medical records. We applied these definitions to estimate the age-standardized prevalence of these comorbidities in the MS and matched cohorts. Results: Versus medical records, administrative case definitions showed moderate agreement for CLD (ĸ = 0.41), migraine (ĸ = 0.51), and epilepsy (ĸ = 0.44), fair agreement for IBS (ĸ = 0.36) and could not be calculated for IBD (small sample size). The 2005 prevalence of CLD was similar in the MS (15.6%) and general populations (14.4%). The prevalence of the remaining comorbidities was higher in the MS than the general populations: epilepsy (4.12 vs. 1.12%), IBD (0.78 vs. 0.65%), IBS (12.2 vs. 6.80%) and migraine (23.0 vs. 16.5%). Conclusions: Administrative data are valid for tracking CLD, epilepsy, and migraine in MS. The prevalence of epilepsy, IBD, IBS and migraine is increased in MS versus the general population.
Partial and Total Lower Lid Reconstruction: Our Experience with 41 Cases
Authors: Fogagnolo Paolo , Colletti Giacomo , Valassina Davide , Allevi Fabiana , Rossetti Luca
Published: October 2012

Purpose: To report our experience on lid reconstruction in patients with epitheliomas. Methods: A total of 41 consecutive patients affected by basal cell (n = 32) or squamous cell carcinoma (n = 9) underwent partial (n = 35) or total (n = 6) surgical demolition of the lower lid. Surgical defects <25% (n = 10) received direct closure. If the defect involved 30–60% of the eyelid (n = 21), a Tenzel semicircular flap or lateral advancement flap with a free mucosal graft was used. If the entire lid or a major part of the outer lamella had to be reconstructed (n = 10), a cheek advancement flap was used, with a free mucosal graft if the posterior lamella was involved. The success rates and the cosmetic and functional results were evaluated. Results: All 21 flaps used for partial reconstruction remained viable, whereas 1 of the 10 cheek flaps developed partial distal necrosis. Of the 27 mucosal grafts, 2 had to be removed for total necrosis, and 2 developed partial necrosis. In all cases, normal lid function and acceptable cosmetic results were obtained. Complications occurring in 4 cases (1 ectropion and 3 epiphora) were successfully managed with appropriate surgical procedures. Conclusions: Local flaps are the gold standard for lower lid reconstruction as they are highly reliable and guarantee optimal results. The technical details described in this study can help in achieving such results.
Association between Inflammatory and Obesity Markers in a Swiss Population-Based Sample (CoLaus Study)
Authors: Marques-Vidal Pedro , Bochud Murielle , Bastardot François , Lüscher Thomas , Ferrero François , Gaspoz Jean-Michel , Paccaud Fred , Urwyler Adrian , von Känel Roland , Hock Christoph , Waeber Gérard , Preisig Martin , Vollenweider Peter
Published: October 2012

Objective: To assess the associations between obesity markers (BMI, waist circumference and %body fat) and inflammatory markers (interleukin-1β (IL-1β); interleukin-6 (IL-6); tumor necrosis factor-α (TNF-α) and high-sensitivity C-reactive protein (hs-CRP)). Methods: Population sample of 2,884 men and 3,201 women aged 35–75 years. Associations were assessed using ridge regression adjusting for age, leisure-time physical activity, and smoking. Results: No differences were found in IL-1β levels between participants with increased obesity markers and healthy counterparts; multivariate regression showed %body fat to be negatively associated with IL-1β. Participants with high %body fat or abdominal obesity had higher IL-6 levels, but no independent association between IL-6 levels and obesity markers was found on multivariate regression. Participants with abdominal obesity had higher TNF-α levels, and positive associations were found between TNF-α levels and waist circumference in men and between TNF-α levels and BMI in women. Obese participants had higher hs-CRP levels, and these differences persisted after multivariate adjustment; similarly, positive associations were found between hs-CRP levels and all obesity markers studied. Conclusion: Obesity markers are differentially associated with cytokine levels. %Body fat is negatively associated with IL-1β; BMI (in women) and waist circumference (in men) are associated with TNF-α; all obesity markers are positively associated with hs-CRP.
Weight Change and Workplace Absenteeism in the HealthWorks Study
Authors: VanWormer Jeffrey J. , Linde Jennifer A. , Harnack Lisa J. , Stovitz Steven D. , Jeffery Robert W.
Published: October 2012

Objective: Little is known about the relationship between weight change and workplace absenteeism. The purpose of this study was to examine the degree to which weight change predicted 2-year absenteeism. Methods: A longitudinal analysis of 1,228 employees enrolled in a worksite-randomized controlled trial was performed. Participants were all working adults in the Minneapolis, MN, area (USA). Results: The final model indicated a significant interaction between weight change and baseline BMI. The difference in absenteeism ranged from (mean ± SE) 3.2 ± 1.2 days among healthy weight employees who maintained their weight to 6.6 ± 1.1 days among obese employees who gained weight (and slightly higher among healthy weight employees who lost weight). The adjusted model also indicated that participants who were male, not depressed, nonsmokers, and had lower baseline absenteeism had significantly less workplace absenteeism relative to participants who were female, depressed, smokers, and had higher baseline absenteeism. Conclusion: Absenteeism was generally low in this sample, but healthy weight employees who maintained their body weight over 2 years had the fewest number of sick days. More research is needed in this area, but future workforce attendance interventions may be improved by focusing on the primary prevention of weight gain in healthy weight employees.
Medical Director Responsibilities for Outpatient Cardiac Rehabilitation/Secondary Prevention Programs: 2012 Update
Authors: King Marjorie , Bittner Vera , Josephson Richard , Lui Karen , Thomas Randal J. , Williams Mark A.
Published: October 2012

Medical directors of cardiac rehabilitation/secondary prevention (CR/SP) programs are responsible for the safe and effective delivery of high-quality CR/SP services to eligible patients. Yet, the training and resources for CR/SP medical directors are limited. As a result, there appears to be considerable variability throughout CR/SP programs in the United States in the roles, responsibilities, and engagement of CR/SP medical directors. Since the publication of the 2005 scientific statement from the American Heart Association and American Association of Cardiovascular and Pulmonary Rehabilitation regarding medical director responsibilities for outpatient CR/SP programs, significant changes have occurred. This statement updates the responsibilities of CR/SP medical directors, in view of changes in federal legislation and regulations and changes in health care delivery and clinical practice that impact the roles and responsibilities of CR/SP medical directors.
Repeat Revascularization After Contemporary Percutaneous Coronary Intervention
Authors: Stolker Joshua M. , Cohen David J. , Kennedy Kevin F. , Pencina Michael J. , Lindsey Jason B. , Mauri Laura , Cutlip Donald E. , Kleiman Neal S.
Published: October 2012

Background—

Although drug-eluting stents and intensive secondary prevention have contributed to improved outcomes after percutaneous coronary intervention (PCI), repeat revascularization remains relatively common in contemporary practice. We used data from the multicenter Evaluation of Drug-Eluting Stents and Ischemic Events registry to evaluate the relative frequency and timing of staged revascularization, target lesion revascularization (TLR), and other nontarget revascularization during the first year after contemporary PCI.

Methods and Results—

Patients with staged revascularization, TLR, and other unplanned procedures (elsewhere in the target vessel or in other coronary arteries) were evaluated in time-dependent models using Kaplan-Meier life-table estimation. Predictors of TLR and unplanned revascularization at nontarget sites were identified using logistic regression. Between July 2004 to June 2007, 10 144 patients undergoing PCI were enrolled at 55 US hospitals, of whom 86% were treated with at least 1 drug-eluting stent. Twelve percent required repeat revascularization within the first year (3% staged; 9% unplanned). More than 75% of staged revascularizations were performed <30 days after index PCI, although there was significant variation in this practice across hospitals (range, 0%–54%). TLR occurred in 4.5% of patients, with higher hazard rates between 2 to 9 months after PCI, whereas the risk of unplanned non-TLR (4.4% cumulative incidence) was constant over time.

Conclusions—

Among unselected patients undergoing PCI in the drug-eluting stent era, the incidence of repeat revascularization at 1 year is ≈12%. Among unplanned procedures, only half are performed for TLR. To achieve further improvements in PCI outcomes, future efforts should concentrate as much on identifying ischemia-producing lesions and intensifying secondary prevention therapies as on the prevention of restenosis.
A Nutrient-Wide Association Study on Blood Pressure
Authors: Tzoulaki Ioanna , Patel Chirag J. , Okamura Tomonori , Chan Queenie , Brown Ian J. , Miura Katsuyuki , Ueshima Hirotsugu , Zhao Liancheng , Van Horn Linda , Daviglus Martha L. , Stamler Jeremiah , Butte Atul J. , Ioannidis John P.A. , Elliott Paul
Published: October 2012

Background—

A nutrient-wide approach may be useful to comprehensively test and validate associations between nutrients (derived from foods and supplements) and blood pressure (BP) in an unbiased manner.

Methods and Results—

Data from 4680 participants aged 40 to 59 years in the cross-sectional International Study of Macro/Micronutrients and Blood Pressure (INTERMAP) were stratified randomly into training and testing sets. US National Health and Nutrition Examination Survey (NHANES) four cross-sectional cohorts (1999–2000, 2001–2002, 2003–2004, 2005–2006) were used for external validation. We performed multiple linear regression analyses associating each of 82 nutrients and 3 urine electrolytes with systolic and diastolic BP in the INTERMAP training set. Significant findings were validated in the INTERMAP testing set and further in the NHANES cohorts (false discovery rate <5% in training,
P
<0.05 for internal and external validation). Among the validated nutrients, alcohol and urinary sodium-to-potassium ratio were directly associated with systolic BP, and dietary phosphorus, magnesium, iron, thiamin, folacin, and riboflavin were inversely associated with systolic BP. In addition, dietary folacin and riboflavin were inversely associated with diastolic BP. The absolute effect sizes in the validation data (NHANES) ranged from 0.97 mm Hg lower systolic BP (phosphorus) to 0.39 mm Hg lower systolic BP (thiamin) per 1-SD difference in nutrient variable. Inclusion of nutrient intake from supplements in addition to foods gave similar results for some nutrients, though it attenuated the associations of folacin, thiamin, and riboflavin intake with BP.

Conclusions—

We identified significant inverse associations between B vitamins and BP, relationships hitherto poorly investigated. Our analyses represent a systematic unbiased approach to the evaluation and validation of nutrient-BP associations.
Reperfusion Therapy in Unclear-Onset Stroke Based on MRI Evaluation (RESTORE)
Authors: Kang Dong-Wha , Sohn Sung-Il , Hong Keun-Sik , Yu Kyung-Ho , Hwang Yang-Ha , Han Moon-Ku , Lee Jun , Park Jong-Moo , Cho A-Hyun , Kim Hye-Jin , Kim Dong-Eog , Cho Yong-Jin , Koo Jaseong , Yun Sung-Cheol , Kwon Sun U. , Bae Hee-Joon , Kim Jong S.
Published: October 2012

Background and Purpose—

Unclear-onset strokes are generally excluded from time-based thrombolytic therapy. We examined the safety and feasibility of magnetic resonance imaging-based reperfusion therapy in unclear-onset stroke.

Methods—

This prospective, multicenter, single-arm study screened consecutive unclear-onset stroke patients within 6 hours of symptom detection. Patients with perfusion-diffusion mismatch >20% and negative or subtle fluid-attenuated inversion recovery changes were treated with intravenous tissue plasminogen activator, intra-arterial therapy, or a combination. The safety outcome was symptomatic intracranial hemorrhage within 48 hours after treatment. The primary efficacy outcome was a 3-month modified Rankin Scale score of 0 to 2. Controls were untreated unclear-onset stroke patients prospectively captured in stroke registries.

Results—

Of 430 unclear-onset stroke patients, 83 (19.3%) received reperfusion therapy (mean age, 67.5 ± 10.4 years; males, 66.3%; median baseline National Institutes of Health Stroke Scale, 14). Symptomatic intracranial hemorrhage with any neurological decline developed in 5 patients (6.0%). Symptomatic intracranial hemorrhage with National Institutes of Health Stroke Scale worsening ≥4 developed in 3 patients (3.6%). Thirty-seven patients (44.6%) achieved modified Rankin Scale score of 0 to 2, and 24 (28.9%) had modified Rankin Scale score of 0 to 1. Female, baseline National Institutes of Health Stroke Scale score, no immediate or early recanalization, and more white blood cells were independent predictors of poor outcome. Compared with untreated controls, the treated group was significantly associated with good outcomes of modified Rankin Scale score of 0 to 2 after adjusting for age, sex, and baseline National Institutes of Health Stroke Scale in logistic regression analysis (odds ratio, 2.25; 95% CI, 1.14–4.49).

Conclusions—

In unclear-onset stroke patients, magnetic resonance imaging-based reperfusion therapy was feasible and safe. Randomized controlled trials are warranted to confirm the benefit of reperfusion therapy for unclear-onset stroke.
Improvement of TMI Rain Retrievals in Mountainous Areas
Authors: Shige Shoichi , Kida Satoshi , Ashiwake Hiroki , Kubota Takuji , Aonashi Kazumasa
Published: October 2012

Heavy rainfall associated with shallow orographic rainfall systems has been underestimated by passive microwave radiometer algorithms owing to weak ice scattering signatures. The authors improve the performance of estimates made using a passive microwave radiometer algorithm, the Global Satellite Mapping of Precipitation (GSMaP) algorithm, from data obtained by the Tropical Rainfall Measuring Mission (TRMM) Microwave Imager (TMI) for orographic heavy rainfall. An orographic/nonorographic rainfall classification scheme is developed on the basis of orographically forced upward vertical motion and the convergence of surface moisture flux estimated from ancillary data. Lookup tables derived from orographic precipitation profiles are used to estimate rainfall for an orographic rainfall pixel, whereas those derived from original precipitation profiles are used to estimate rainfall for a nonorographic rainfall pixel. Rainfall estimates made using the revised GSMaP algorithm are in better agreement with estimates from data obtained by the radar on the TRMM satellite and by gauge-calibrated ground radars than are estimates made using the original GSMaP algorithm.
Global Warming Shifts the Monsoon Circulation, Drying South Asia
Authors: Annamalai H. , Hafner Jan , Sooraj K. P. , Pillai P.
Published: October 2012

Monsoon rainfall over South Asia has decreased during the last 5 to 6 decades according to several sets of observations. Although sea surface temperature (SST) has risen across the Indo-Pacific warm pool during this period, the expected accompanying increased rainfall has occurred only in the tropical western Pacific.

The above changes noted in observations are also seen in a coupled climate model, but only when the model includes the recent increase in greenhouse gas concentration. The hypothesis that the robust rise in SST over the warm pool, perhaps anchored by an increase in greenhouse gas concentrations, is instrumental in the east–west shift in monsoon rainfall (enhanced rainfall over tropical western Pacific and decreased rainfall over South Asia) is proposed. A suite of controlled experiments with an atmospheric general circulation model has been performed to isolate the impact of regional SST warming trends on the dryness over South Asia. Model experiments support the hypothesis that the rising SST trend over the tropical western Pacific has changed the atmospheric circulation: over the Bay of Bengal more dry and cool air is advected from the northeast than previously. Moist static energy budget diagnostics on the model solutions identify the sources for this east–west shift.

SST warming over the warm pool has accelerated in recent decades. Therefore, a close monitoring of that warming is important for long-term variations of monsoon rainfall. The inconsistency in the amplitude of drying over South Asia among the various land-based rainfall observations and lack of sustained rainfall observations over the open oceans, however, poses constraints in the results.
Removing Spurious Low-Frequency Variability in Drifter Velocities
Authors: Lumpkin Rick , Grodsky Semyon A. , Centurioni Luca , Rio Marie-Helene , Carton James A. , Lee Dongkyu
Published: October 2012

Satellite-tracked drifting buoys of the Global Drifter Program have drogues, centered at 15-m depth, to minimize direct wind forcing and Stokes drift. Drogue presence has historically been determined from submergence or tether strain records. However, recent studies have revealed that a significant fraction of drifters believed to be drogued have actually lost their drogues, a problem that peaked in the mid-2000s before the majority of drifters in the global array switched from submergence to tether strain sensors. In this study, a methodology is applied to the data to automatically reanalyze drogue presence based on anomalous downwind ageostrophic motion. Results indicate that the downwind slip of undrogued drifters is approximately 50% higher than previously believed. The reanalyzed results no longer exhibit the dramatic and spurious interannual variations seen in the original data. These results, along with information from submergence/tether strain and transmission frequency variations, are now being used to conduct a systematic manual reevaluation of drogue presence for each drifter in the post-1992 dataset.
Who Fits the Left-Right Divide? Partisan Polarization in the American Electorate
Authors: Carmines Edward G. , Ensley Michael J. , Wagner Michael W.
Published: October 2012

How has the American public responded to elite partisan polarization? Using panel data from both the Cooperative Campaign Analysis Project and the American National Election Studies, we explore the partisan consequences of the discrepancy between the one-dimensional structure of elite policy preferences and the two-dimensional structure of citizens’ policy preferences. We find that those citizens with preferences that are consistently liberal or consistently conservative across both economic and social issues have responded to elite polarization with mass polarization. However, we also find that the sizable number of citizens who hold preferences on economic and social issues that do not perfectly match the menu of options provided by elite Republicans and Democrats have not responded to elite polarization; indeed, these citizens are more likely to shift their partisan allegiance in the short-term and less likely to strengthen their party identification in the long term.
The nocebo effect: A clinicians guide
Authors: Data-Franco João , Berk Michael
Published: October 2012

Objective:

This paper aims to provide an overview on the nocebo effect, focusing on recognition — its phenomenology, at-risk demographic profiles, clinical situations and personality factors, as well as discriminating somatic symptoms in the general population from treatment-related adverse effects. Lastly, the paper addresses available evidence-based strategies for management and minimisation of the nocebo effect.

Method:

Data for this paper were identified by searching PubMed using the search terms "nocebo" and “nocebo effect”, augmented by a manual search of the references of the key papers and the related literature.

Results:

The nocebo effect refers to non-pharmacodynamic, harmful or undesirable effects occurring after inactive treatment, a phenomenon that also occurs in the context of active therapy. Known drivers include classical conditioning and negative expectations concerning treatment. Recent meta-analyses have reported a considerable prevalence, ranging from 18% in the symptomatic treatment of migraine, to more than 74% in multiple sclerosis. Recognition of the nocebo-driven adverse effects presents a challenge, especially because of its non-specific nature and the similarity to the active medication’s expected profile. Traits such as neuroticism, pessimism and type A personalities may predispose individuals to this phenomenon. Clinical management of the nocebo effect includes awareness and recognition, changing the manner of disclosure of potential drug-related adverse effects, shaping patients’ expectations and enhancing the treatment alliance.

Conclusion:

The nocebo effect is a common, clinically significant, yet covert driver of clinical outcomes. Increased awareness of its features, as well as knowledge of strategies on how to manage it, are fundamental so that clinicians can mitigate its impact on clinical practice.
Therapeutic effects of vitamin D as adjunctive therapy to fluoxetine in patients with major depressive disorder
Authors: Khoraminya Nayereh , Tehrani-Doost Mehdi , Jazayeri Shima , Hosseini Aghafateme , Djazayery Abolghassem
Published: October 2012

Objective:

To compare the therapeutic effects of vitamin D3 plus fluoxetine and fluoxetine alone in patients with major depressive disorder.

Methods:

In the present double-blind, randomized, placebo-controlled trial, 42 patients with a diagnosis of major depressive disorder based on DSM-IV criteria were randomly assigned into two groups to receive daily either 1500 IU vitamin D3 plus 20 mg fluoxetine or fluoxetine alone for 8 weeks. Depression severity was assessed at 2-week intervals using the 24-item Hamilton Depression Rating Scale (HDRS) as a primary outcome measure and the 21-item Beck Depression Inventory (BDI) as a secondary outcome measure. Serum 25(OH) vitamin D was measured at baseline and after intervention.

Results:

Forty patients completed the trial. A two-way repeated-measures analysis of variance showed that depression severity based on HDRS and BDI decreased significantly after intervention, with a significant difference between the two groups. The vitamin D + fluoxetine combination was significantly better than fluoxetine alone from the fourth week of treatment.

Conclusions:

In the present 8-week trial, the vitamin D + fluoxetine combination was superior to fluoxetine alone in controlling depressive symptoms.
Does a nutrition education programme change the knowledge and practice of healthy diets among high school adolescents in Chennai, India?
Authors: Rani M Anitha , Shriraam Vanishree , Zachariah Rony , Harries Anthony D , Satyanarayana Srinath , Tetali Shailaja , Anchala Raghupathy , Muthukumar Diviya , Sathiyasekaran BWC
Published: October 2012

Background:

Nutrition education is used as a way of promoting lifelong healthy eating practices among school adolescents. There is limited published information on the impact of nutrition education programmes in India.

Objectives:

To assess the knowledge and practices of high school students with respect to healthy diets before and after a nutrition education programme.

Design:

Pre- and post-intervention questionnaire survey.

Setting:

Two private schools in Chennai city.

Method:

This study was conducted among adolescents studying in standard VIII and IX in two private schools in Chennai city. Nutrition education as lectures and interactive discussions were given to students one hour every week for a period of 10 weeks. Information on knowledge and attitude on healthy eating and dietary practices was collected before and after the nutrition education intervention using a questionnaire. Differences in knowledge, attitude and practice of students on healthy diet were measured using the X2 test with the level of significance p<0.05.

Results:

A total of 181 students were involved in the study (response rate 92%). Following the nutrition education programme, satisfactory dietary knowledge significantly improved from 37% to 67% ( p<0.001). Similarly, students showing a positive attitude towards healthy diet increased from 18% to 40% ( p<0.001). The proportion of students taking soft drinks reduced from 20% to 10% ( p<0.01) and ingestion of fast food items through fast food restaurants reduced significantly.

Conclusions:

This short-term nutrition education programme brought significant improvements in dietary knowledge and reductions in soft drinks and fast foods consumption.
Can a brief educational intervention improve parents’ knowledge of healthy children’s sleep? A pilot-test
Authors: Jones Caroline HD , Owens Judith A , Pham Brian
Published: October 2012

Objective:

Insufficient and poor quality sleep is prevalent in children, and is a significant public health concern due to the negative consequences for health. Certain sleep-related behaviours are associated with improved sleep, and sleep behaviours are amenable to efforts targeted towards behaviour change. Parental educational interventions have been successful at improving parents’ knowledge and children’s health outcomes in some areas of health, but no population-based educational interventions have been designed to improve parents’ knowledge of healthy children’s sleep. This study aimed to design and test an educational tool to increase caregivers’ knowledge of healthy children’s sleep in a primary care setting.

Setting:

A hospital-based pediatric primary care clinic where children attend for well-child and sick visits.

Method:

Parents of 95 children aged three months to 12 years completed two surveys, one prior to and one after receiving the intervention. The surveys assessed children’s sleep habits (pre-intervention) and parental sleep beliefs and sleep knowledge (pre- and post-intervention). The intervention was a short, informational brochure.

Results:

Following the intervention there was a significant increase in parents’ knowledge regarding children’s healthy sleep, and in the number of parents who planned to make positive behaviour changes regarding their child’s sleep practices.

Conclusion:

Simple written educational interventions may be effective tools with which to increase parents’ knowledge and promote healthy sleep behaviours in children.