bluuebunny/crossref_metadata_2025 huggingface dataset:
The Persistence of Thought
Authors: Levinson Daniel B. , Smallwood Jonathan , Davidson Richard J.
Published: March 2012

Tasks that tax working memory (WM) have consistently been found to decrease mind wandering. These findings may indicate that maintenance of mind wandering requires WM resources, such that mind wandering cannot persist when WM resources are being consumed by a task. An alternative explanation for these findings, however, is that mind wandering persists without the support of WM but is nonetheless decreased during any demanding task because good task performance requires that attention be restricted from task-unrelated thought (TUT). The present study tested these two competing theories by investigating whether individuals with greater WM resources mind-wander more during an undemanding task, as would be predicted only by the theory that WM supports TUT. We found that individuals with higher WM capacity reported more TUT in undemanding tasks, which suggests that WM enables the maintenance of mind wandering.
Perspectives of Adolescent Siblings of Children With Down Syndrome Who Have Multiple Health Problems
Authors: Graff Carol , Mandleco Barbara , Dyches Tina Taylor , Coverston Catherine R. , Roper Susanne Olsen , Freeborn Donna
Published: March 2012

Authors of this qualitative descriptive study interviewed 21 adolescent siblings of children with Down syndrome (DS) who also had additional health problems rated as requiring extensive care by parents. Analysis revealed positive/negative aspects of the experience; however, participants emphasized the positive rather than negative experiences and focused more on the fact that the child had DS rather than health problems requiring additional care. Most said they would not change anything about their experience and did not believe the child with DS would ever live independently. They did, however, acknowledge their family was affected by the caregiving needs of the child which often required extra vigilance or specific care depending on the health problem. Information gained can help improve understanding of adolescent sibling perceptions about living with a child with DS who also requires additional care because of ongoing health problems so more appropriate and individualized nursing interventions can be provided.
Prediction of ADHD to Anxiety Disorders
Authors: Tai Yueh-Ming , Gau Churn-Shiouh , Gau Susan Shur-Fen , Chiu Hung-Wen
Published: March 2012

Objective: To prospectively investigate prediction of ADHD to anxiety disorders (ANXs) in a national sample of Taiwan. Method: From the Taiwan National Health Insurance Dataset (1997-2007), we collected 2,385 cases of new diagnoses of ADHD from 1999 to 2003 and 9,540 sex-, age- and index dates of the first diagnosis of ADHD-matched cohort controls without ADHD. The outcome is age of the first diagnosis of ANXs until December 31, 2007. Results: More cases of ADHD (17.7%) developed ANXs than did matched controls (1.9%) with a younger age onset (12.7 years vs. 17.9 years) and a shorter “survival time” (1.4 years vs. 5.0 years). Cox models revealed a significant prediction of ADHD to ANXs controlling for other psychiatric comorbidities [Hazard ratio (HR) = 15.83]. The magnitude of such association was greater in males and decreased with older age of first ADHD diagnosis. Conclusion: The findings imply that early detection and treatment for ADHD may offset later development of ANXs.
Clinical and radiological characteristics of tumefactive demyelinating lesions: follow-up study
Authors: Altintas A , Petek B , Isik N , Terzi M , Bolukbasi F , Tavsanli M , Saip S , Boz C , Aydin T , Arici-Duz O , Ozer F , Siva A
Published: March 2012

Background: Demyelinating lesions over 20 mm in size, referred to as tumefactive demyelinating lesions, can be misdiagnosed as being either a tumor or an abscess. Although some radiological characteristics can help make a differential diagnosis easier, a cerebral biopsy may still be necessary.

Objective: Our objective was to assess the clinical characteristics of tumefactive lesions, with or without a diagnosis of multiple sclerosis (MS), and present follow-up data for 54 patients with tumefactive lesions.

Methods: Demographic, clinical, radiological and laboratory data were gathered and treatment responses were evaluated in a total of 54 patients from five medical centers.

Result: Twenty-nine patients were diagnosed with tumefactive lesions at the onset, whereas 25 patients were diagnosed with tumefactive lesions after a diagnosis of MS. Median follow-up was 38.12 months. At final examination, 19 of the patients with a tumefactive lesion diagnosis at the onset eventually developed relapsing–remitting MS, while 10 remained with the condition as a clinically isolated syndrome. The tumefactive lesions studied were mostly focal, with closed-ring enhancement. We found that oligoclonal band positivity was less frequent in the patients with tumefactive onset.

Conclusion: Although our demographic data were similar to formerly collected Turkish MS data, we found that the distribution of the patients’ clinical course differed if there was an absence of primary progressive MS and that there was a lower frequency of secondary progressive MS cases in our group of patients. We believe that less frequent oligoclonal band positivity and the difference we witnessed in the clinical course of disease in our study groups suggest that there is a need for further studies to compare all the biological and immunological differences between MS and tumefactive lesion cases, in order to reveal whether there are different pathogenetic mechanisms involved.
Inflammation inhibits GABA transmission in multiple sclerosis
Authors: Rossi Silvia , Studer Valeria , Motta Caterina , De Chiara Valentina , Barbieri Francesca , Bernardi Giorgio , Centonze Diego
Published: March 2012

Abnormal glutamate-dependent synaptic excitation contributes to neuronal damage in multiple sclerosis (MS). Little is known about the involvement of the GABA system in this disorder. Here we found that cerebrospinal fluid (CSF) from MS patients with enhanced brain lesions on magnetic resonance imaging inhibited GABA transmission in mouse brain slices. Enhanced IL-1β neuronal action was responsible for this effect, because IL-1β receptor antagonist blocked, and exogenous IL-1β mimicked the synaptic effect of inflamed CSF. Our results provide evidence that focal inflammation in MS perturbs the cytokine milieu within the circulating CSF, resulting in diffuse GABAergic alteration in neurons.
Enrollment and participation in a pilot walking programme: The role of self-efficacy
Authors: Jerome Gerald J , McAuley Edward
Published: March 2012

This pilot study investigated the association of self-efficacy with enrollment in and compliance with an 8-week exercise trial. We compared self-efficacy levels of adults who were eligible but did not enroll ( N=221) to those who enrolled ( N=115) and enrollees who were compliant at the end of the study ( N=66). Those in the top three self-efficacy quintiles had higher odds of enrollment (adjusted odds ratios (AOR)=2.61–2.82) and being compliant at the end of the trial (AOR=4.31–4.38) compared to those in the lowest efficacy quintile. These results demonstrated the theoretical association between self-efficacy and one’s choice of behavior.
Combining Cognitive-Behavioral Therapy and Interpersonal Therapy for Geriatric Depression With Complicated Grief
Authors: Wyman-Chick Kathryn A.
Published: March 2012

The focus of this article is to discuss the application of cognitive-behavioral therapy and interpersonal therapy with a 65-year-old woman experiencing depressive symptoms and complicated grief associated with a brain injury and an acquired disability. Findings indicate the intervention, which consisted of 20 sessions, produced significant clinical improvement in depressive symptoms as measured by the Geriatric Depression Scale as calculated by the Reliable Change Index. Cognitive-behavioral techniques, such as cognitive restructuring and behavioral activation, were modified according to the client’s cognitive functioning and physical abilities. Interpersonal therapy techniques were used to examine current relationships and grief related to the acquired brain injury.
Racial/Ethnic Differences in Treatment Discussed, Preferred, and Received for Prostate Cancer in a Tri-Ethnic Population
Authors: Hosain G. M. Monawar , Sanderson Maureen , Du Xianglin L. , Chan Wenyaw , Strom Sara S.
Published: March 2012

This study was conducted to explore whether racial/ethnic differences exist in treatment discussed, preferred, and ultimately received for localized prostate cancer (PCa) as epidemiological data are scant on this issue. The authors recruited 640 localized PCa patients from the Texas Medical Center, Houston, Texas, between 1996 and 2004. The authors used a structured questionnaire to collect data through personal interviews. Three main treatment modalities for localized PCa, consisting of surgery, radiation therapy, and watchful waiting, were considered for this study. It was found that health professionals were less likely to discuss surgery (odds ratio [OR] = 0.35, 95% confidence interval [CI] = 0.18-0.68) and watchful waiting (OR = 0.53, 95% CI = 0.34-0.83) with Hispanics than Whites. However, African Americans were less likely to receive watchful waiting (OR = 0.22, 95% CI = 0.05-0.93). They were more likely to prefer (OR = 1.23, 95% CI = 0.78-1.94) and receive (OR = 1.27, 95% CI = 0.87-1.86) radiation therapy, although they did not achieve statistical significance ( p < .05). Higher age was associated with lower likelihood of discussing, preferring, and receiving surgical treatment. Higher Gleason sum was associated with lower likelihood of discussing treatment. A comparison of concordances between treatment preferred by patients and what was actually received, in general, showed a higher agreement for surgery and radiation therapy. More exploration needs to be done in other settings to confirm these findings.
Minireview: Human Ovarian Cancer: Biology, Current Management, and Paths to Personalizing Therapy
Authors: Romero Ignacio , Bast Robert C.
Published: March 2012

More than 90% of ovarian cancers have been thought to arise from epithelial cells that cover the ovarian surface or, more frequently, line subserosal cysts. Recent studies suggest that histologically similar cancers can arise from the fimbriae of Fallopian tubes and from deposits of endometriosis. Different histotypes are observed that resemble epithelial cells from the normal Fallopian tube (serous), endometrium (endometrioid), cervical glands (mucinous), and vaginal rests (clear cell) and that share expression of relevant HOX genes which drive normal gynecological differentiation. Two groups of epithelial ovarian cancers have been distinguished: type I low-grade cancers that present in early stage, grow slowly, and resist conventional chemotherapy but may respond to hormonal manipulation; and type II high-grade cancers that are generally diagnosed in advanced stage and grow aggressively but respond to chemotherapy. Type I cancers have wild-type p53 and BRCA1/2, but have frequent mutations of Ras and Raf as well as expression of IGFR and activation of the phosphatidylinositol-3-kinase (PI3K) pathway. Virtually all type II cancers have mutations of p53, and almost half have mutation or dysfunction of BRCA1/2, but other mutations are rare, and oncogenesis appears to be driven by amplification of several growth-regulatory genes that activate the Ras/MAPK and PI3K pathways. Cytoreductive surgery and combination chemotherapy with platinum compounds and taxanes have improved 5-yr survival, but less than 40% of all stages can be cured. Novel therapies are being developed that target high-grade serous cancer cells with PI3Kness or BRCAness as well as the tumor vasculature. Both in silico and animal models are needed that more closely resemble type I and type II cancers to facilitate the identification of novel targets and to predict response to combinations of new agents.
The Cakewalk of Capital in Charles Chesnutt's The Marrow of Tradition
Authors: Kilgore John Mac
Published: March 2012

Engaging in a long-standing debate about how to understand post-Reconstruction era “spectacle lynching,” Kilgore's essay revisits Charles Chesnutt's 1901 novel The Marrow of Tradition in light of current theories of racial violence read through the logics of corporate capitalism. It contends that Marrow highlights the deep affinities between two nineteenth-century national institutions of US popular culture—minstrelsy and lynching. Chesnutt's novel does not support the traditional view that late nineteenth-century popular industries functioned as a mask of progressive modernity in order to conceal the regressive barbarisms of racist violence, a violence understood as the resilient legacy of convulsive, psychoaffective white supremacy; as a conspiratorial compromise between a reunited North and South; or as a response to the rise of an African American middle-class in the wake of a depressed Southern economy. Instead, Chesnutt gives the reader a subtle and underappreciated look into the constitutive, imperial, and “modern” economic forces behind racial violence, represented, like cakewalk performances, as banal popular entertainment, part and parcel of the extension of US capital both intranationally and internationally. Thus, in an analysis of the violent marrow of US racism, Chesnutt offers a surprising diagnosis: the cakewalk of capital.
Introduction: For Dignity; Tunisia and the Poetry of Emergent Democratic Humanism
Authors: Judy R. A.
Published: March 2012

When Mohamed-Salah Omri and I met in Cairo during the first week of December 2010, we discussed in some detail whether Tunisia would blow up–the suspected spark being the TuniLeaks depiction of Sakhr Materi’s opulence, another sign of the thorough corruption of the Ben Ali/Trabelsi crowd–and we thought it was time to critically engage in print what we took to be the emergent revolutionary intelligence we’d both been tracking for nearly a decade. Events overtook us, and when the January 2011 insurrection in Kasserine had clearly transformed into a national revolutionary movement, I proposed that what we must do immediately is gather up a selection of reflections from Tunisians engaged in the activities about the long-term significance of these events. The aim was for these accounts to be thoughtful considerations about what have been and are the immanent material conditions that have articulated the revolution, as well as a sense of the arch of those trends. What appears in this dossier are the fruits of that effort. Each of the pieces here is informed by an intense contest currently going on in the immediate post-insurrection phase between the traditional old-guard bourgeois elites and the emergent revolutionary elites over the meaning of the forces of social change and the modalities through which they are to be sustained or institutionalized. That contestation is fundamentally over the legitimacy of divergent, although related, intellectual formations or structures of knowledge.
A History of Tunisia, January 14, 2011: The End of a Dictator and the Beginning of Democratic Construction
Authors: Jdey Ahmed
Published: March 2012

History has its own laws and its own tricks. Dictators, who are inherently antihistorical, do not realize it; yet humanity, in its rich and exciting trajectory, continues to instruct the great dictators and despots of the world about the force of history, in Africa as well as Asia, in America as well as Europe. All the elements are in place for writing the histories of dictatorships, with their attendant bloodiness and social exclusion. Tunisia’s is one such history. Friday, January 14, 2011, became a new date and a special chapter in the periodization of the history of Tunisia since independence, just like March 20, 1956 (Independence Day), or April 9, 1938. This key date will go down not only in the collective Tunisian memory, but also in the memory of the world as a turning point in modern history. Looking at what is happening in Tunisia now, one cannot help but ask how revolutions, or revolts, uprisings, and insurrections, are being born, not only in the contemporary Arab and Muslim world but also anywhere else in the world today. The answer is not to be found in the geography of Tunisia. The roots must be sought in the history, the culture, and the deep psychology of individuals as well as groups, and in the collective national memory as well. In order to have a clear view of the significance of this extraordinary early twenty-first-century Tunisian event, the historian must dig deep, before January 14, 2011.
Efficacy and safety of ceftriaxone for uncomplicated gonorrhoea: a meta-analysis of randomized controlled trials
Authors: Bai Z-G , Bao X-J , Cheng W-D , Yang K-H , Li Y-P
Published: March 2012

We conducted a systematic review and meta-analysis of ceftriaxone for treatment of uncomplicated gonorrhoea compared with four other antibiotics. Thirteen randomized controlled trials (RCTs) totalling treatment of 2557 patients with uncomplicated gonorrhoea were included. Statistically significant differences were observed in side-effects, which were increased after ceftriaxone 250 mg versus cefotaxime 500 mg (odds ratio [OR] 1.87; 95% confidence interval [CI] 1.14–3.08). Cure rates of ceftriaxone 250 mg were significantly better than cefixime 400 mg (OR 1.77; 95% CI 1.11–2.80) as was ceftriaxone 125 mg versus spectinomycin 2 g (OR 3.44; 95% CI 1.08–10.90). There was no statistically significant difference between ceftriaxone 250 mg and cefixime 800 mg in cure rates (OR 1.39; 95% CI 0.92–2.10) or adverse effects (OR 1.29, 95% CI 0.58–2.84) for treating uncomplicated gonorrhoea. The cure rate after ceftriaxone 250 mg was not significantly different from that after spectinomycin 2 g (OR 1.96; 95% CI 1.00–3.87). In conclusion, this meta-analysis revealed that 250 mg ceftriaxone had a higher efficacy than 400 mg cefixime for uncomplicated gonorrhoea. Also, ceftriaxone 125 mg is a better choice than spectinomycin 2 g for patients with uncomplicated gonorrhoea, but ceftriaxone had higher side-effect rates than cefotaxime. In the current era further randomized controlled clinical trials of ceftriaxone for uncomplicated gonorrhoea are warranted.
Use of the Internet for home testing for Chlamydia trachomatis in Sweden: who are the users?
Authors: Novak D , Novak M
Published: March 2012

Sweden was the first country to introduce online Chlamydia trachomatis testing for both men and women and this article provides information about the user characteristics and which risk groups are reached with this method. During the years 2005–2007 a questionnaire was administered with a response rate of 86% ( n = 6025) (62.5% women, 37.5% men). Over 60% of respondents were aged below 26 years and single. The average years of education for men and women was 14 (range 9.0–26.0). The mean Internet usage time was 22.4 hours/week among men and 15.5 hours/week among women. Only 22% men and 34% women had tested themselves for C. trachomatis at clinics previously. Respondents reported a higher frequency of previous sexually transmitted infections (STIs) compared with other Internet users (i.e. C. trachomatis: men 19%, women 24%). Eighty percent of online test users had engaged in sex with ≥2 partners without a condom during the previous year. Online C. trachomatis test users are mostly young people with high sexual risk behaviour.
Longitudinal assessment of cardiac diastolic function in HIV-infected patients
Authors: Blaylock J M , Byers D K , Gibbs B T , Nayak G , Ferguson M , Tribble D R , Porter C , Decker C F
Published: March 2012

Asymptomatic isolated diastolic dysfunction (DD), with normal left ventricular systolic function, may be the first indication of underlying cardiac disease in HIV-negative populations. We previously reported a high prevalence (37%) of DD among asymptomatic HIV-infected patients at low risk for AIDS and cardiovascular disease (CVD). We performed a longitudinal assessment of interval echocardiographic changes in this cohort over a four-year period. Repeat transthoracic echocardiograms (TTEs) utilized standard techniques. Sixty (of the original 91) HIV-infected patients, predominately men, underwent repeat TTE (median follow-up 3.7 years, interquartile range [IQR] 3.5, 4.0). Cohort characteristics (median; IQR) include age 42.0 (36.5, 46.0) years, HIV duration 16.4 years (8.1, 18.9), current CD4 count 572.0 cells/mm3 (436.5, 839.0), antiretroviral therapy (ART) duration 8.1 years (4.8, 13.4) and Framingham risk score 1.0 (0.0, 2.0). DD was observed in 28/60 patients on re-evaluation (47%, 95% confidence interval [CI] 34%, 60%); 31% (11/36) of patients had new onset DD for an overall incidence of 8.2/100 person-years. On follow-up, subjects with DD were older, had a trend towards higher body mass index, hypertension and longer duration of HIV infection compared with subjects without DD. We confirmed a high prevalence of DD (47%) in asymptomatic HIV-infected patients at low risk for AIDS and CVD.
Incidence of major clinical outcomes in a cohort of Ugandan and Zimbabwean women with HIV-1 infection followed from seroconversion
Authors: Beversluis D , Musoke R , Mandima P , Nyamapfeni P , Chipato T , Mukasa J B , Byamugisha J , Mugerwa R , Morrison C , Salata R A
Published: March 2012

We conducted a prospective cohort study of 306 HIV-1-infected women, followed from seroconversion for median 6.4 years in Uganda (UG) and Zimbabwe (ZM) to describe the incidence of major clinical outcomes (MCOs), defined as World Health Organization stage 4 conditions and any tuberculosis (TB). In Uganda, 19 MCOs occurred in 13 participants at median 4.6 years and a median CD4 count of 213 cells/mm3. In Zimbabwe, 29 MCOs occurred in 27 participants at median 4.0 years ( P < 0.001 versus UG) and median CD4 count of 219 cells/mm3 ( P = 0.83 versus UG). MCO incidence was not statistically different (UG: 2.82 cases/100 person-years versus ZM: 2.45; P = 0.64) except for TB (UG: 0.59 versus ZM: 2.02 cases/100 person-years; P = 0.02). This significant difference in TB incidence is primarily due to a TB screening and isoniazid prevention therapy programme that was implemented in Uganda, but not in Zimbabwe, highlighting the importance of integrated TB screening and treatment within HIV programmes.
Early invasive squamous cell carcinoma of the penis presenting in a 39-year-old man
Authors: Bhaduri S , Eaton J
Published: March 2012

Penile cancer, albeit an uncommon malignancy, commonly affects men aged between 50 and 70 years, often with a history of predisposing factors such as Bowen's disease or leukoplakia. We describe a case of early invasive squamous cell carcinoma of the penis in a 39-year-old man with no history of predisposing factors, treated by a partial glansectomy.
Brachial plexus neuritis in the context of acute HIV seroconversion illness: a case report
Authors: Finney K A , David L
Published: March 2012

We report an unusual case of bilateral brachial plexus neuritis occurring during the seroconversion stage of an HIV infection in a 45-year-old man. Brachial plexus neuritis is thought to be an immune mediated inflammatory reaction resulting in acute onset of shoulder pain followed by muscle weakness and wasting. There is often a history of viral illness, diagnosis is clinical, and treatment is supportive. Many sufferers are left with residual defects. Clinicians should consider the possibility of HIV infection when managing a patient with brachial plexus neuritis.
Reflexiones sobre la estrategia de rehabilitación basada en la comunidad (RBC): la experiencia de un programa de RBC en Bolivia
Authors: Díaz-Aristizabal Urko , Sanz-Victoria Silvia , Sahonero-Daza Milton , Ledesma-Ocampo Sandra , Cachimuel-Vinueza Mesías , Torrico Marisabel
Published: March 2012

La Rehabilitación Basada en la Comunidad (RBC) es una estrategia de desarrollo comunitario avalada por la Organización Mundial de la Salud (OMS), la Organización Internacional del Trabajo (OIT) y la Organización de las Naciones Unidas para la Educación, la Ciencia y la Cultura (UNESCO), que persigue la rehabilitación, la igualdad de oportunidades y la integración social de las Personas con Discapacidad (PD) en sus entornos. Con este objetivo promueve la colaboración entre las PD, sus familias y los diferentes actores de la comunidad involucrados, así como el liderazgo comunitario y la participación de las PD mediante el impulso de la colaboración multisectorial. Este artículo expone los antecedentes históricos y las características fundamentales de la estrategia de RBC a partir de un programa llevado a cabo por una fundación del departamento de Cochabamba (Bolivia), para después incidir en algunos aspectos referentes al contexto sociocultural, que especialmente en situaciones de interculturalidad, pueden determinar que un programa de RBC tenga éxito o esté abocado al fracaso.
A saúde no licenciamento ambiental: uma proposta metodológica para a avaliação dos impactos da indústria de petróleo e gás
Authors: Barbosa Eduardo Macedo , Barata Matha Macedo de Lima , Hacon Sandra de Souza
Published: March 2012

Considerando a importância dos impactos da indústria do petróleo sobre a saúde humana, este artigo apresenta uma proposta metodológica para a análise desses aspectos nos estudos de avaliação de impacto ambiental, a partir dos parâmetros legais estabelecidos e da adaptação de uma matriz validada para o setor hidrelétrico. A análise dos relatórios ambientais de 21 empreendimentos nacionais de produção de petróleo, licenciados no período de 1º de janeiro de 2004 a 31 de outubro de 2009, constatou a inexistência de evidências da incorporação de aspectos de saúde na maioria dos seus respectivos estudos de avaliação de impacto ambiental. A matriz mostrou-se um instrumento metodológico adequado para analisar a inserção da saúde no licenciamento ambiental e orientar a tomada de decisão e intervenções para a gestão socioambiental.
Estimativa de valores corrigidos e o efeito da correção pelo erro de medida em dados dietéticos obtidos por Questionário de Frequência Alimentar para Adolescentes (QFAA)
Authors: Voci Silvia Maria , Enes Carla Cristina , Romero Alexandre , Slater Betzabeth
Published: March 2012

O objetivo do estudo foi estimar valores corrigidos para os dados dietéticos obtidos por QFAA na amostra principal de uma coorte de adolescentes e ilustrar o efeito desta abordagem nas informações de consumo alimentar. Os adolescentes foram avaliados em dois momentos, com intervalo médio de 12 meses. Em 2004, participaram 393 escolares, sendo reavaliado, em 2005, um total de 289 adolescentes. Dados dietéticos obtidos por Questionário de Frequência Alimentar para Adolescentes (QFAA) foram corrigidos utilizando-se os coeficientes de regressão estimados a partir da média de dois Recordatórios de 24 horas (R24h) da subamostra. Os valores corrigidos se aproximaram dos obtidos por R24h na subamostra. Em 2004 e 2005 observou-se diferença significativa entre as médias de consumo do QFAA antes e após a calibração para todos os nutrientes. Com o uso dos dados corrigidos aumentou a proporção de escolares que apresentaram consumo de fibras abaixo do recomendado. Portanto, conclui-se que dados calibrados podem ser utilizados para a obtenção de associações corrigidas devido ao deslocamento dos indivíduos dentro de categorias pré-determinadas.
Avaliação da qualidade de comprimidos de propranolol e enalapril distribuídos no sistema público de saúde em uma cidade do sul do Brasil
Authors: Bianchin Mariana Domingues , Blatt Carine Raquel , Soares Alessandra de Sá , Külkamp-Guerreiro Irene Clemes
Published: March 2012

A aquisição de medicamentos no serviço público de saúde brasileiro através de licitação com critério de menor preço gera preocupação com a qualidade dos produtos distribuídos à população. O objetivo deste trabalho foi avaliar a qualidade dos comprimidos de Enalapril 10 mg e Propranolol 40 mg adquiridos através de processo licitatório e distribuídos na rede pública de saúde de um município catarinense durante o período de um ano. Foram analisados: o aspecto visual, o peso médio, a friabilidade, o teor de fármaco e o tempo de dissolução. De um total de sete lotes, cinco apresentaram desvio da qualidade. Encontraram-se irregularidades no aspecto visual, peso médio, friabilidade e teor de princípio ativo. A avaliação dos medicamentos além de assegurar que os medicamentos dispensados na rede pública possuem qualidade e que podem ser utilizados com segurança pelos pacientes é também uma ferramenta para a qualificação de fornecedores e um subsídio para o aprimoramento do processo licitatório. Sugere-se a implantação de um sistema de gestão da qualidade que inclua a qualificação de fornecedores, o aperfeiçoamento do processo de licitação, incluindo especificações claras sobre a qualidade dos medicamentos adquiridos, bem como o monitoramento da qualidade integrado a ações de farmacovigilância.
Three-Dimensional Digital Models for Rating Dental Arch Relationships in Unilateral Cleft Lip and Palate
Authors: Chawla O. , Atack N.E. , Deacon S.A. , Leary S.D. , Ireland A.J. , Sandy J.R.
Published: March 2012

Objective

To determine the reliability and reproducibility of using three-dimensional digital models as an alternative to plaster models for rating dental arch relationships in patients born with unilateral cleft lip and palate.

Design

Reliability and reproducibility study.

Methods

Study models of 45 patients born with unilateral cleft lip and palate were made available in plaster and three-dimensional digital models. Records were scored a week apart by three examiners using the 5-year-olds’ index reference models in the same two formats as the patient models. To assess reproducibility the study was repeated 4 weeks later under similar conditions to minimize the influence of memory bias on the results. The reliability of using the three-dimensional digital models was determined by comparing the scores for each examiner with the plaster model scores.

Results

Weighted kappa statistics indicated repeatability for the plaster models was very good (.83 to .87). For the three-dimensional digital models it was good to very good (.74 to .83). Overall, the use of the three-dimensional digital models showed good agreement with the plaster model scores on both occasions.

Conclusion

Three-dimensional digital models appear to be a good alternative to plaster models for assessing dental arch relationships using the 5-year-olds’ index.
Explaining Racial/Ethnic Disparities in Children’s Dental Health: A Decomposition Analysis
Authors: Guarnizo-Herreño Carol Cristina , Wehby George L.
Published: March 2012

Objectives. We measured racial/ethnic inequalities in US children’s dental health and quantified the contribution of conceptually relevant factors.

Methods. Using data from the 2007 National Survey of Children’s Health, we investigated racial/ethnic disparities in selected child dental health and preventive care outcomes. We employed a decomposition model to quantify demographic, socioeconomic, maternal health, health insurance, neighborhood, and geographic effects.

Results. Hispanic children had the poorest dental health and lowest preventive dental care utilization, followed by Black then White children. The model explanatory variables accounted for 58% to 77% of the disparities in dental health and 89% to 100% of the disparities in preventive dental care. Socioeconomic status accounted for 71% of the gap in preventive dental care between Black children and White children and 55% of that between Hispanic children and White children. Maternal health, age, and marital status; neighborhood safety and social capital; and state of residence were relevant factors.

Conclusions. Reducing US children’s racial/ethnic dental health disparities—which are mostly socioeconomically driven—requires policies that recognize the multilevel pathways underlying them and the need for household- and neighborhood-level interventions.
An Experimental Investigation of Possible Memory Biases Affecting Support for Racial Health Care Policy
Authors: Mazzocco Philip J. , Brunner Ryan P.
Published: March 2012

Objectives. We aimed to test the theory that estimates of racial disparities may be based on small recalled samples of specific individuals (Black vs White), a strategy likely to lead to underestimates of true racial disparities and a corresponding opposition to race-focused health care policies.

Methods. We asked a sample of White adults to list the first 5 Black and White individuals who came to mind, and then measured support for various race-focused health care policies.

Results. Analyses indicated that the Black individuals recalled by participants tended to be more famous and wealthy than their White counterparts. Furthermore, the tendency to list wealthier Black individuals predicted opposition to progressive racial health care programs. A follow-up study demonstrated that support for certain race-focused health care policies could be increased by informing Whites of potential memory biases.

Conclusions. The survival and success of minority health care policies depend partially on public acceptance. Education regarding continuing racial disparities may help to increase support for race-focused health care policies.
The New York Policy on Smoking in Addiction Treatment: Findings After 1 Year
Authors: Guydish Joseph , Tajima Barbara , Kulaga Agatha , Zavala Roberto , Brown Lawrence S. , Bostrom Alan , Ziedonis Douglas , Chan Mable
Published: March 2012

Objectives. We assessed changes in smoking prevalence and other measures associated with the July 2008 New York Office of Alcoholism and Substance Abuse Services tobacco policy, which required that all publicly funded addiction treatment programs implement smoke-free grounds, have “no evidence” of smoking among staff, and make tobacco dependence treatment available for all clients.

Methods. In a random sample of 10 programs, staff and clients were surveyed before the policy and 1 year later. Measures included tobacco-related knowledge, attitudes, and practices used by counselors and received by clients.

Results. Client smoking decreased from 69.4% to 62.8% (P = .044). However, response to the policy differed by program type. Outpatient programs showed no significant changes on any of the staff and client survey measures. In methadone programs, staff use of tobacco-related practices increased (P < .01), client attitudes toward tobacco treatment grew more positive (P < .05), and clients received more tobacco-related services (P < .05). Residential clients were more likely to report having quit smoking after policy implementation (odds ratio = 4.7; 95% confidence interval = 1.53, 14.19), but they reported less favorable attitudes toward tobacco treatment (P < .001) and received fewer tobacco-related services from their program (P < .001) or their counselor (P < .001).

Conclusions. If supported by additional research, the New York policy may offer a model that addiction treatment systems can use to address smoking in a population where it has been prevalent and intractable. Additional intervention or policy supports may be needed in residential programs, which face greater challenges to implementing tobacco-free grounds.
Regulation of the Extracellular Matrix Interactome by Trypanosoma cruzi
Authors: C. Cardenas Tatiana , A. Johnson Candice , Pratap Siddharth , N. Nde Pius , Furtak Vyacheslav , Y. Kleshchenko Yuliya , F. Lima Maria , Villalta Fernando
Published: March 2012

It has been shown that the invasive trypomastigote forms of Trypanosoma cruzi use and modulate components
of the extracellular matrix (ECM) during the initial process of infection. Infective trypomastigotes up-regulate the expression
of laminin γ-1 (LAMC1) and thrombospondin (THBS1) to facilitate the recruitment of trypomastigotes to enhance
cellular infection. Silencing the expression of LAMC1 and THBS1 by stable RNAi dramatically reduces trypanosome infection.
T. cruzi gp83, a ligand that mediates the attachment of trypanosomes to cells to initiate infection, up-regulates
LAMC1 expression to enhance cellular infection. Infective trypomastigotes interact with LAMC1 through galectin-3
(LGALS3), a human lectin, to enhance cellular infection. Silencing the expression of LGALS3 also reduces cellular infection.
Some trypanosome surface molecules also interact with the ECM to facilitate infection. Despite the role of the ECM
in T. cruzi infection, almost nothing is known about the ECM interactome networks operating in the process of T. cruzi infection.
In this mini review, we critically analyze and discuss the regulation of the ECM by T. cruzi and its gp83 ligand,
and present the first elucidation of the human ECM interactome network, regulated by T. cruzi and its gp83 ligand, to facilitate
cellular infection. The elucidation of the human ECM interactome regulated by T. cruzi is critically important to
the understanding of the molecular pathogenesis of T. cruzi infection and developing novel approaches of intervention in
Chagas’ disease.
Endocytosis in Trypanosoma cruzi
Authors: Leal Cunha-e-Silva Narcisa , Sant’Anna Celso , G. Pereira Miria , de Souza Wanderley
Published: March 2012

Endocytic activity is particularly intense in Trypanosoma cruzi epimastigotes, while in amastigotes and trypomastigotes
it is untraceable. Cargo molecules enters through the cytostome or flagellar pocket at the parasite anterior region,
goes along a branched early endosomal network of tubules and vesicles spread from nuclear periphery to the posterior
pole, until delivery to reservosomes, the final compartment. Reservosomes are acid compartments that store protein
and lipid cargo and also accumulate lysosomal hydrolases, modulating digestive activity. Although T. cruzi infective
forms are unable to uptake molecules, its lysosome related organelles represent a potential targets for anti-parasitic
chemotherapy.
The trans-Sialidase from Trypanosoma cruzi a Putative Target for Trypanocidal Agents
Authors: Mendonça-Previato Lucia , Regina Todeschini Adriane , Freire de Lima Leonardo , Osvaldo Previato Jose
Published: March 2012

Trypanosomatid protozoa are parasites of considerable medical and economical importance because they are
the causative agents of chronic human and livestock diseases endemic in developing countries. Trypanosoma cruzi is the
causative agent of Chagas´ disease, present in most of Latin America. The biology of this parasite presents some unusual
features, one of which is the mechanism employed for the addition of sialic acid units to its own glycoproteins, the mucinlike
molecules, or to exogenous glycoconjugates. This is mediated by a transglycosylase for sialic acid known as transsialidase
and located on the external surface of the parasite, rather than by an intracellular CMP-sialic acid-dependent sialyltransferase.
The Trypanosoma cruzi trans-sialidase is thought to play an important role in the pathogenesis of Chagas’
disease, and it represents a potential therapeutic target.
Endosymbiosis in Trypanosomatids as a Model to Study Cell Evolution
Authors: M. Motta Maria Cristina
Published: March 2012

Some trypanosomatids harbor a symbiotic bacterium, which maintains a close association with the host, constituting
an excellent model to study organelle origin and cellular evolution. Molecular data show that all endosymbiontharboring
trypanosomatids are grouped together in a single phylogenetic branch. According to rRNA sequences, symbionts
of different species are similar, being classified in the ß division of Proteobacteria, thus suggesting that a single evolutionary
event gave rise to the symbiosis in the Trypanosomatidae family. The bacterium is enclosed by two unit membranes
and presents a reduced peptidoglycan layer, which is essential for cell division and morphological maintenance.
Regarding the protein composition, the number of intramembrane particles in the endosymbiont envelope is similar to that
described for Gram-negative bacteria. Lipid analyses of purified endosymbionts show absence of sterols and indicate
phosphatidylcholine as a major component of the envelope, as described in other intracellular bacteria. The presence of
the endosymbiont is associated with distinct ultrastructural and physico-chemical alterations in the trypanosomatid and influences
the protozoan interaction with the insect host and mammalian cells. Symbiont-containing trypanosomatids are
able to infect and to replicate inside fibroblasts and macrophages, whose microbicidal activity was deactivated by HIV-1
infection. The symbiosis in trypanosomatids is characterized by intensive metabolic exchanges; the bacterium expresses
enzymes and metabolic precursors that complete essential biosynthetic pathways of the protozoan. Conversely, the symbiont
is capable of obtaining part of the required energetic molecules from the host glycosomes. Taken together data suggest
that endosymbiosis in trypanosomatids represents an interesting model to study cell evolution.
Cell Signaling During Trypanosoma cruzi Development in Triatominae
Authors: A.C. Silva-Neto Mário , Fampa Patrícia , Donato Caiaffa-Neto Carlo , B. Carneiro Alan , C. Atella Georgia
Published: March 2012

The year 2009 is the centennial anniversary of the original description of Chagas disease by Carlos Chagas.
During the last 100 years, several advances have occurred regarding our knowledge of the development of Trypanosoma
cruzi and its travel along the gut of Triatominae vectors. We have also witnessed the completion of both the human and
parasite genome projects; the genome of one of Chagas disease vectors, Rhodnius prolixus, is currently being sequenced.
The development of T. cruzi in triatomine gut relies on several biochemical and molecular processes. The biochemistry of
blood digestion and the molecular and biological aspects of parasite development are well known. However, several signaling
molecules are generated during blood digestion, and their effects on parasite biology are only beginning to be understood.
Here, we will summarize our current knowledge in this area with an emphasis on heme and bioactive lipids. In
addition, we will highlight some recently described members of the parasite signaling machinery, which were identified
through high-throughput studies, but whose ligands are unknown thus far. Finally, we will discuss some potential aspects
for future investigation in this area that may strengthen our view of such a concomitant biological process in the next
years.
Comparative effectiveness research in chronic obstructive pulmonary disease
Authors: Mularski Richard A , McBurnie Mary Ann , Lindenauer Peter K , Lee Todd A , Vollmer William M , Au David H , Carson Shannon S , Krishnan Jerry A
Published: March 2012

Chronic obstructive pulmonary disease affects millions worldwide. It is America’s third leading cause of death, and results in significant morbidity and cost. Although many therapies exist and are being developed to alleviate symptoms and decrease morbidity and mortality in chronic obstructive pulmonary disease, most have only been studied in placebo-controlled efficacy studies in highly selected populations. Comparative effectiveness and translational research in chronic obstructive pulmonary disease will require the development of infrastructures to support collaboration between researchers and the stakeholders who generate, disseminate and use new knowledge. Methodologies need to evolve to both prioritize research questions and to conduct collaborative comparative effectiveness research studies. Given the impracticality of testing every clinical intervention in comparative pragmatic trials for comparative effectiveness research in chronic obstructive pulmonary disease, we advocate expanding methodology that includes the use of observational databases with serially performed effectiveness analyses and quasi-experimental designs that include following healthcare changes longitudinally over time to assess benefit, harm, subgroups and cost.
Comparative effectiveness research in obstructive sleep apnea: bridging gaps between efficacy studies and clinical practice
Authors: Weinstock Tanya G , Redline Susan
Published: March 2012

Comparative effectiveness research encompasses research that compares two interventions to each other, and takes place in real-world settings without strict inclusion and exclusion criteria, according to the established standard of care. There is a need for comparative evaluations of the treatments for obstructive sleep apnea, a disease associated with increased cardiovascular risk, stroke and metabolic derangement. This article reviews the recent, representative literature that addresses obstructive sleep apnea intervention and treatment, paradigms for diagnosis and randomized control trials addressing the efficacy of interventions, in an effort to demonstrate examples of both traditional observational and randomized control trials, as well as to illustrate the considerable overlap between some traditional studies and comparative effectiveness research. Despite methodological challenges, the potentially large clinical and public health impact of obstructive sleep apnea, accompanied by considerable cost, mandates that randomized controlled trials and comparative effectiveness research be systematically applied to identify both the efficacy and effectiveness of alternative diagnosis and treatment strategies.
The AGE-Breaker ALT-711 Restores High Blood Flow–Dependent Remodeling in Mesenteric Resistance Arteries in a Rat Model of Type 2 Diabetes
Authors: Freidja Mohamed L. , Tarhouni Kahena , Toutain Bertrand , Fassot Céline , Loufrani Laurent , Henrion Daniel
Published: March 2012

Flow-mediated remodeling of resistance arteries is essential for revascularization in ischemic diseases, but this is impaired in diabetes. We hypothesized that breaking advanced glycation end product (AGE) cross-links could improve remodeling in mesenteric resistance arteries in Zucker diabetic fatty (ZDF) rats compared with lean Zucker (LZ) rats. Arteries, exposed to high (HF) or normal (NF) blood flow after alternate arterial ligation in vivo, were collected after 2 weeks. In LZ rats, HF artery diameter was larger than for NF vessels, but this was not the case in ZDF rats. Endothelium-mediated dilation in ZDF rats, which was lower than in LZ rats, was further decreased in HF arteries. Treatment of rats with the AGE-breaker 4,5-dimethyl-3-phenacylthiazolium chloride (ALT-711) (3 mg/kg/day; 3 weeks) reversed diabetes-induced impairment of HF-dependent remodeling. ALT-711 also improved endothelium nitric oxide–dependent relaxation in mesenteric resistance arteries. Reactive oxygen species reduction restored relaxation in ZDF rats but not in LZ or ALT-711–treated rats. AGEs were reduced in ALT-711–treated ZDF rats compared with ZDF rats. Metalloproteinase activity, necessary for HF-dependent remodeling, was reduced in ZDF rats compared with LZ rats and restored by ALT-711. Thus, targeting AGE cross-links may provide a therapeutic potential for overcoming microvascular complications in ischemic disorders occurring in diabetes.
Adipose and Myxoid Tumors of Childhood and Adolescence
Authors: Coffin Cheryl M. , Alaggio Rita
Published: March 2012

Adipose and myxoid tumors in children are an unusual and challenging group of neoplasms that have some unique aspects in contrast to these tumors in adults. Less than 10% of soft tissue neoplasms in the 1st 2 decades of life have an adipose phenotype and most are benign. The most common are various types of lipoma and lipoblastoma. Liposarcoma in young patients is rare and has a distinctive distribution of histologic subtypes, including classic myxoid liposarcoma, and unusual variants, such as pleomorphic-myxoid liposarcoma. Pathologic examination enhanced by adjunct techniques, such as immunohistochemistry and cytogenetic or molecular genetic studies, is useful for classification of difficult cases. Myxoid tumors can overlap with adipose tumors and are included in this review because of the morphologic similarities and importance of diagnostic accuracy. This article reviews the clinicopathologic features of adipose and myxoid tumors with an emphasis on the unique aspects of these neoplasms in children and adolescents and the differential diagnosis.