bluuebunny/crossref_metadata_2025 huggingface dataset:
Adrenomedullin and Leptin Levels in Diabetic Retinopathy and Retinal Diseases
Authors: Er Hamdi , Doğanay Selim , Özerol Elif , Yürekli Muhittin
Published: April 2005

Purpose: Proliferative and vascular retinal diseases are important cause of irreversible blindness. Consistent features of these diseases are endothelial dysfunction and angiogenesis. Adrenomedullin (ADM) is a multifunctional vasorelaxant peptide. Leptin is a recently discovered metabolic peptide that regulates energy metabolism in human. In the present study, we aimed to investigate the possible roles of adrenomedullin and leptin in the pathophysiology of diabetic and proliferative diseases. Methods: Ten patients with proliferative diabetic retinopathy (57.1 years, 5 female and 5 male) and 8 patients (51 years, 5 female and 3 male) with other retinal diseases including macular hole and epiretinal membrane were included in this study. All the patients had undergone pars plana vitrectomy for complications of the diseases. Vitreous samples were collected by vitreous tap during the vitrectomy. Adrenomedullin analysis was made by using reverse-phase high-performance liquid chromatography (HPLC). Leptin was measured by enzyme-linked immunosorbent assay (ELISA). Body mass index (BMI) [weight (kg)/height (m2)] was calculated for each group. The Mann-Whitney U test was used for statistics. Results: The age, gender ratio and BMI were not substantially different between the two groups. The mean vitreous adrenomedullin levels (63.9 ± 7.1 pmol/l) were significantly higher (p < 0.05) in group I than in group II (34.25 ± 3.0 pmol/l). Leptin levels in vitreous (4.54 ±1.6 ng/ml) were also significantly higher (p < 0.05) in patients with diabetic retinopathy than in those without diabetes (1.83 ± 0.5 ng/ml). Conclusion: Increased adrenomedullin and leptin levels in vitreous humor might be a possible newly associated factor in the course of vascular and proliferative retinal diseases.
Antiplatelet Antibodies and Their Correlation with Clinical Findings in Childhood Immune Thrombocytopenic Purpura
Authors: Yildirmak Yildiz , Yanikkaya-Demirel Gulderen , Palanduz Ayse , Kayaalp Nimet
Published: April 2005

The demonstration of antiplatelet antibodies (PAIgG, PAIgM) and decreased detection of platelet surface antigens (CD41, CD61, CD42b) in children with immune thrombocytopenic purpura (ITP) have a diagnostic role. This study was conducted to determine whether these parameters differed in acute and chronic ITP. Chronic ITP was defined as thrombocytopenia persisting for more than 6 months from the onset of illness. A total of 80 subjects were divided into three groups: group 1 included 39 patients with acute ITP; group 2 included 31 patients with chronic ITP, and group 3 included 10 healthy children. At diagnosis, blood samples were obtained for platelet count, mean platelet volume, plateletcrit and platelet distribution width along with platelet surface antigens and antiplatelet immunoglobulins. We found that platelet surface antigens were significantly decreased in both acute and chronic ITP when compared to the control group (p = 0.001). In contrast, PAIgG was increased in acute and chronic ITP patients compared to the control group. PAIgM was significantly higher in acute ITP. We conclude that decreased platelet surface antigens and increased antiplatelet antibodies are observed in both acute and chronic ITP. In patients with chronic progress, a relatively lower level of PAIgM can be identified.
Macrophage Activation Syndrome in Children with Systemic-Onset Juvenile Chronic Arthritis
Authors: Kounami Shinji , Yoshiyama Megumi , Nakayama Keiko , Okuda Masumi , Okuda Shuji , Aoyagi Noriyuki , Yoshikawa Norishige
Published: April 2005

Macrophage activation syndrome (MAS) is a life-threatening complication in children with rheumatic diseases, particularly systemic-onset juvenile chronic arthritis (SOJCA). Because of the potential fatality of this condition, prompt recognition and immediate therapeutic intervention are important. This study assessed the clinical features of nine MAS events in five children with SOJCA. Nonremitting fever and decreased platelet and white blood cell counts led to a diagnosis of MAS. The urinary β2-microglobulin (β2MG) level was a sensitive indicator of MAS. Serum levels of β2MG and soluble interleukin-2 receptor were also elevated. These biologic markers reflecting hyperactivated cellular immunity are useful indicators of MAS. Four children treated with cyclosporin A (CSP) achieved rapid and complete recovery, but one patient without CSP died due to rapidly progressive respiratory failure. All children treated with CSP responded quickly, and fever abated within 36 h of initiation of treatment. CSP should be added to first-line therapy of MAS.
Novel Endoscopic Imaging Techniques toward in vivo Observation of Living Cancer Cells in the Gastrointestinal Tract
Authors: Inoue Haruhiro , Kudo Shin-ei , Shiokawa Akira
Published: April 2005

Recent advances in endoscopic imaging technology have enabled the visualization of cellular-level microstructures of early-stage cancer and its precursors. Chromoendoscopy, magnifying endoscopy, endoscopic optical coherent tomography (EOCT) spectroscopy, and various combinations of these technologies, are all important for the recognition of small and unclear lesions. In order to observe cancer cells in vivo two types of ultra-high magnifying endoscope – ‘laser-scanning confocal laser-scanning endoscopy series’ and ‘contact endoscopy series’ – that have a maximum of >1,000 times magnifying power have been developed. The use of these endoscopes has allowed the generation of high quality images of both living cancer cells and normal cells in the gastrointestinal tract. In particular, clear images of cells and their nuclei, equivalent to the high quality that is possible with conventional cytology, have been produced. These novel imaging technologies may make in vivo histological diagnosis by virtual histology possible.
Update on Surgery of Gastric Cancer: New Procedures versus Standard Technique
Authors: Katai Hitoshi , Sano Takeshi , Sasako Mitsuru , Fukagawa Takeo , Saka Makoto
Published: April 2005

D2 lymphadenectomy has been the mainstay of treatment for every stage of gastric cancer including early gastric cancer in Japan. However, the use of conventional D2 nodal dissection is being challenged. There was a recent improvement in techniques for preoperative diagnosis and perioperative diagnosis. Less extensive surgeries to maintain patients’ quality of life have been introduced as standard treatment for some forms of early gastric cancer in the Gastric Cancer Treatment Guidelines 2001 (The Japanese Gastric Cancer Association). Superextended dissection (more than D2) for non-early gastric cancer is set at investigational treatment. Japanese surgeons are now aiming at wide variations of surgical treatment according to the stage of disease based on new procedures. Further evaluations are proceeding to prove superior to standard techniques.
(Neo)adjuvant Strategies of Advanced Gastric Carcinoma: Time for a Change?
Authors: Moehler Markus , Schimanski Carl C. , Gockel Ines , Junginger Theodor , Galle Peter R.
Published: April 2005

Despite surgical R0 resections, patients with gastric cancer stage UICC II–III have a high risk of recurrence and metachronic metastases. Preliminary evidence exists that adjuvant chemotherapy or neoadjuvant chemo(radio)therapy protocols may improve the prognosis of these patients undergoing surgery of gastric cancer with curative intention. As for palliative regimens, 5-fluorouracil and cisplatin are integral components of such (neo)adjuvant strategies. Upcoming cytostatic agents, i.e. irinotecan, docetaxel, oxaliplatin, and oral fluoropyridines are currently under investigation in new multimodality treatment regimens and may further increase R0 resection rates and may prolong disease-free and overall survival in the treatment of advanced localized gastric cancer.
Recent Advances in Molecular Diagnosis and Therapy of Gastric Cancer
Authors: Chen Jie , Röcken Christoph , Malfertheiner Peter , Ebert Matthias P.A.
Published: April 2005

Gastric cancer is the fourth most common malignancy and the second most frequent cause of cancer-related death in the world. It is often diagnosed in advanced stages when treatment options are limited, leading to a poor prognosis. During the past 15 years, much has been learnt about the molecular mechanisms of gastric carcinogenesis and the development of metastases. This coincided with the development of new techniques for functional genomics, including both transcriptomics and proteomics, which significantly improve the ability to explore new molecular alterations involved in carcinogenesis and tumor progression. An improved understanding of the molecular pathology and pathogenesis of gastric cancer may lead to a more rapid development of molecular diagnostic and patient tailored therapeutic targets.
Helicobacter pylori Seropositivity and Atherosclerosis Risk Factors
Authors: Köksal Aydın , Ekmekçi Yakup , Karadeniz Yasemin , Köklü Seyfettin , Apan Teoman , Yilmaz Murat , Sezikli Mesut , İnal Birsen , Demirel Tolga , Yildiz Akın
Published: April 2005

Certain viral and bacterial infections may contribute to the initiation and progression of atherosclerosis. The aim of this study is to determine whether Helicobacter pylori (HP) seropositivity contributes to conventional atherosclerosis risk factors in the development of an early sign of atherosclerosis: intima-media thickness (IMT) of the carotid artery. Eighty-four patients who had at least two conventional atherosclerosis risk factors and a control group of 50 patients having no risk factors for atherosclerosis were enrolled in the study. None of the patients had ever received HP eradication treatment. HP IgG antibodies were determined by enzyme-linked immunosorbent assay. Carotid artery IMT was measured 1 cm before the carotid bifurcation. Seventy-five percent of the study group was HP seropositive. HP seropositive (n = 64) and seronegative (n = 21) groups were identical in terms of sex distribution, smoking pattern, mean age, hemoglobin, leukocyte, platelet, C-reactive protein, erythrocyte sedimentation rate, glucose, cholesterol, triglyceride, low-density lipoprotein, high-density lipoprotein, systolic blood pressure and diastolic blood pressure levels. There was no significant difference between the mean carotid IMT of HP seropositive (0.8 ± 0.3 mm) and negative (0.8 ± 0.3 mm) patients in the study group. Similar to the study group, there was no statistically significant difference between mean carotid IMT of HP seropositive (0.56 ± 0.19 mm) and negative patients (0.67 ± 0.13 mm) in the control group (p = 0.2). Future studies concerning virulent strains are needed to determine the probable role of HP in atherosclerosis.
The K Variant of the Butyrylcholinesterase Gene Is Associated with Reduced Phosphorylation of Tau in Dementia Patients
Authors: Ballard Clive , Morris Christopher , Kalaria Rajesh , McKeith Ian , Perry Robert , Perry Elaine
Published: April 2005

Accumulating evidence suggests that butyrylcholinesterase (BuChE) plays an important role in the progression of cognitive deficits and Alzheimer-type pathology in dementia patients. We examined the relationship between the K variant of BuChE and the severity of deposits of amyloid (Aβ1–42) and phosphorylated tau in the temporal cortex (BA36) of 30 prospectively studied autopsy-diagnosed dementia (Alzheimer’s disease and dementia with Lewy bodies) patients. There was 42% less phosphorylated tau in BA36 in cases with ≧1 K compared with those with wild-type BuChE alleles (t = 2.2, p = 0.039), but no difference in the extent of Aβ1–42 deposition. BuChE may play this role in the phosphorylation of tau, relevant to therapeutic inhibition of the enzyme.
Follow-Up Investigations of Tau Protein and S-100B Levels in Cerebrospinal Fluid of Patients with Creutzfeldt-Jakob Disease
Authors: Cepek Lukas , Steinacker Petra , Mollenhauer Brit , Wiese Birgitt , Ciesielczyk Barbara , Bibl Mirko , Wiltfang Jens , Zerr Inga , Schulz-Schaeffer Walter , Kretzschmar Hans A. , Poser Sigrid , Otto Markus
Published: April 2005

Background: S-100B and tau protein have a high differential diagnostic potential for the diagnosis of Creutzfeldt-Jakob disease (CJD). So far there has been only limited information available about the dynamics of these parameters in the cerebrospinal fluid (CSF). However, there is a special interest in finding biochemical markers to monitor disease progression for differential diagnosis and treatment. Patients and Methods: We analyzed CSF of 45 patients with CJD and of 45 patients with other neurological diseases for tau protein and S-100B in a follow-up setting. All diagnoses of CJD were later neuropathologically verified. A ratio between tau protein differences and the time between lumbar puncture was calculated. The same was done for S-100B. Results: Tau protein levels of 34 cases were above the cut-off level for CJD (>1,300 pg/ml) in the first CSF sample. In 7 of 11 patients with lower tau levels in the first CSF sample, tau levels rose. The above-mentioned ratio was significantly higher in the CJD group than in the group with other neurological diseases. Similar results were obtained for S-100B. Conclusion: We conclude that follow-up investigations and calculation of ratios is a useful tool in the differential diagnosis of CJD. Variations in this pattern were observed in single cases.
On Averaging Power for Genetic Association and Linkage Studies
Authors: Zheng Gang , Joo Jungnam , Ganesh Santhi K. , Nabel Elizabeth G. , Geller Nancy L.
Published: April 2005

A power calculation is crucial in planning genetic studies. In genetic association studies, the power is often calculated using the expected number of individuals with each genotype calculated from an assumed allele frequency under Hardy-Weinberg equilibrium. Since the allele frequency is often unknown, the number of individuals with each genotype is random and so a power calculation assuming a known allele frequency may be incorrect. Ambrosius et al. [1] recently showed that the power ignoring this randomness may lead to studies with insufficient power and proposed averaging the power due to the randomness. We extend the method of averaging power in two directions. First, for testing association in case-control studies, we use the Cochran-Armitage trend test and find that the time needed for calculating the averaged power is much reduced compared to the chi-square test with two degrees of freedom studied by Ambrosius et al. [1]. A real study is used for illustration of the method. Second, we extend the method to linkage analysis, where the number of identical-by-descent alleles shared by siblings is random. The distribution of identical-by-descent numbers depends on the underlying genetic model rather than the allele frequency. The robust test for linkage analysis is also examined using the averaged powers. We also recommend a sensitivity analysis when the true allele frequency or the number of identical-by-descent alleles is unknown.
Maximum Likelihood Haplotyping for General Pedigrees
Authors: Fishelson Ma’ayan , Dovgolevsky Nickolay , Geiger Dan
Published: April 2005

Haplotype data is valuable in mapping disease-susceptibility genes in the study of Mendelian and complex diseases. We present algorithms for inferring a most likely haplotype configuration for general pedigrees, implemented in the newest version of the genetic linkage analysis system SUPERLINK. In SUPERLINK, genetic linkage analysis problems are represented internally using Bayesian networks. The use of Bayesian networks enables efficient maximum likelihood haplotyping for more complex pedigrees than was previously possible. Furthermore, to support efficient haplotyping for larger pedigrees, we have also incorporated a novel algorithm for determining a better elimination order for the variables of the Bayesian network. The presented optimization algorithm also improves likelihood computations. We present experimental results for the new algorithms on a variety of real and semiartificial data sets, and use our software to evaluate MCMC approximations for haplotyping.
Interdependency of β-Adrenergic Receptors and CFTR in Regulation of Alveolar Active Na
+
Transport
Authors: Mutlu Gökhan M. , Adir Yochai , Jameel Mohammed , Akhmedov Alexander T. , Welch Lynn , Dumasius Vidas , Meng Fan Jing , Zabner Joseph , Koenig Craig , Lewis Erin Rachel , Balagani Rajesh , Traver Geri , Sznajder Jacob I. , Factor Phillip
Published: April 2005

β-Adrenergic receptors (βAR) regulate active Na
+
transport in the alveolar epithelium and accelerate clearance of excess airspace fluid. Accumulating data indicates that the cystic fibrosis transmembrane conductance regulator (CFTR) is important for upregulation of the active ion transport that is needed to maintain alveolar fluid homeostasis during pulmonary edema. We hypothesized that βAR regulation of alveolar active transport may be mediated via a CFTR dependent pathway. To test this hypothesis we used a recombinant adenovirus that expresses a human CFTR cDNA (adCFTR) to increase CFTR function in the alveolar epithelium of normal rats and mice. Alveolar fluid clearance (AFC), an index of alveolar active Na
+
transport, was 92% greater in CFTR overexpressing lungs than controls. Addition of the Cl
−
channel blockers NPPB, glibenclamide, or bumetanide and experiments using Cl
−
free alveolar instillate solutions indicate that the accelerated AFC in this model is due to increased Cl
−
channel function. Conversely, CFTR overexpression in mice with no β
1
- or β
2
-adrenergic receptors had no effect on AFC. Overexpression of a human β
2
AR in the alveolar epithelium significantly increased AFC in normal mice but had no effect in mice with a non-functional human CFTR gene (Δφ508 mutation). These studies indicate that upregulation of alveolar CFTR function speeds clearance of excess fluid from the airspace and that CFTRs effect on active Na
+
transport requires the βAR. These studies reveal a previously undetected interdependency between CFTR and βAR that is essential for upregulation of active Na
+
transport and fluid clearance in the alveolus.
The Impact of Cultural Biases on African American Students’ Education
Authors: Baker Paula Booker
Published: April 2005

Education, at all levels, opens routes to achieve higher incomes, status advancement, and upward social mobility. The goal for most families is to present an opportunity for their children to receive a jump on acquiring knowledge to afford this achievement. Schools within our education system declare they offer a quality education for African American students. This concept will be examined along with the research that maintains schooling for African American students is deliberately sabotaged. To ensure success for all students, awareness and sensitivity to diversity issues should reflect the importance of presenting different cultural perspectives in education.
Family Income, Home Environment, Parenting, and Mathematics Achievement of Children in China and the United States
Authors: Tsui Ming
Published: April 2005

Using standardized tests and surveys of eighth graders in China and the United States, this study explores the relationships among family income, parenting, home environment, and mathematics achievement. Focusing on Chinese only children and American children with no more than one sibling, the study found that the mathematics achievement of Chinese eighth graders is higher than American students. Chinese parents had higher expectations for their children and talked more frequently with them about school. Furthermore, the relationship between parental expectations and mathematics scores is stronger for Chinese students than for American students. China’s national curriculum, well-trained elementary and secondary school mathematics teachers, high parental expectations, a universal concern for children’s education engendered by the one child rule, and children’s willingness to work hard on mathematics are discussed as possible causes for the higher mathematics achievement of Chinese children.
Relationships Among Involvement, Attachment, and Behavioral Problems in Adolescence: Examining Father’s Influence
Authors: Williams Susan K. , Kelly F. Donald
Published: April 2005

This study explores the nature of the parent-child relationship during early adolescence. Differences between the mother-adolescent and father-adolescent relationships and possible behavioral correlates of parental involvement and attachment are examined. A multimodal data collection procedure was used to gather information from adolescents (N = 116), their parents, and their teachers. Findings indicate that consistent with previous reports, fathers are less involved in parenting their adolescent children than are mothers, and teenagers report being more securely attached to their mothers. Nonresidential fathers were found to be significantly less involved in parenting than fathers who live at home. In addition, adolescents not living with their fathers reported feeling less secure paternal attachment than adolescents who lived with their fathers. Finally, father-adolescent involvement and attachment were found to explain a unique proportion of the variance seen in adolescents’ teacher-reported externalizing and total behavioral problems at school. Implications of these findings are discussed.
Participation and Involvement of Senior Staff in the Reform of the British Civil Service
Authors: Horton Sylvia
Published: April 2005

Developments in human resource management in the U.K. public services have, in recent years, seen significant increases in ways of involving staff in decisions about policy and implementation. This article examines the direct and indirect communication and consultation methods used in developing and implementing 2 major personnel policy changes in the British senior civil service.
Criteria for Evaluation of Theory
Authors: Fawcett Jacqueline
Published: April 2005

This column presents criteria for evaluation of nursing theories specified by Jacqueline Fawcett and Rosemarie Rizzo Parse. Fawcett’s criteria are significance, internal consistency, parsimony, testability, empirical adequacy, and pragmatic adequacy. Some of those criteria are differentiated for grand theories and middle-range theories but are not differentiated by type of data—qualitative or quantitative—used to develop the theory. Parse’s criteria are structure and process. Structure encompasses historical evolution, foundational elements, and relational statements. Process encompasses correspondence, coherence, and pragmatics. Parse’s criteria are appropriate for the critical appraisal of all frameworks and theories, regardless of level of abstraction. Parse also presents a comparison of her own and Fawcett’s criteria.
A Discussion of the Concept of Spirituality
Authors: Delgado Cheryl
Published: April 2005

The purpose of this article is to discuss the concept of spirituality. There is a recognized connection between spirituality and health, and nurse leaders have acknowledged the importance of the spiritual as well as the physical in providing optimal nursing care. Spirituality goes beyond religious or cultural boundaries. Spirituality is characterized by faith, a search for meaning and purpose in life, a sense of connection with others, and a transcendence of self, resulting in a sense of inner peace and well-being. A strong spiritual connection may improve one’s sense of satisfaction with life or enable accommodation to disability.
Exposure to Diethylstilbestrol: Design of a Multilevel Community Intervention
Authors: Duke Suzanne S. , McGraw Sarah A. , Avis Nancy E.
Published: April 2005

The planning of community health education interventions aimed at multiple levels is complex and challenging. This challenge is increased when a primary audience is difficult to reach. Individuals who were exposed to diethylstilbestrol (DES) decades ago represent a difficult-to-reach audience because they are not always aware of their exposure or the health risks of their exposure. However, DES-exposed individuals need specific screening and health care. An intervention was developed to increase awareness about DES in Nassau County, New York to address this concern. The Precede-Proceed Model was used to develop distinct intervention strategies to reach the general public, which includes individuals who may not be aware that they were exposed; those who are aware of their exposure but may not be following recommended health care practices; and community physicians. Behavioral targets, determining factors, and intervention goals were identified for each group. Specific intervention strategies were planned and implemented for each target audience. Addressing three target audiences simultaneously may produce a synergistic effect, enhancing program impact.
Promoting Sustainability of Community Health Initiatives: An Empirical Case Study
Authors: Paine-Andrews Adrienne , Fisher Jacqueline L. , Campuzano Mary K. , Fawcett Stephen B. , Berkley-Patton Jannette
Published: April 2005

Community health initiatives are a prominent strategy for health promotion and disease prevention. This article describes an empirical study of strategies used to promote sustainability of six community health initiatives that began in 1993 and received funding for 4 years. The study, conducted 1 year after funding ceased, examined how each initiative approached sustainability. First, the context for the work is described. Second, we describe the methodology used to gather information about sustainability. Third, we describe the current status of sustainability for each initiative. Fourth, we discuss the strategies for sustainability we observed, the context for sustaining the efforts, and the factors that may have affected sustainability. We end with recommendations for practice.
Increasing Research and Evaluation Productivity: Tips for Successful Writing Retreats
Authors: Rosser B. R. Simon , Rugg Deborah L. , Ross Michael W.
Published: April 2005

Part of the responsibilities of researchers, evaluators, and program planners is ensuring that the results of their studies are disseminated promptly and efficiently. Yet, many, if not most, projects, particularly those involving senior staff, suffer from time constraints and competing demands placed on investigators. In this article, writing retreats are discussed as an innovative strategy for prioritizing research and evaluation, planning publications, and ensuring prompt analysis of data and efficient writing of results. Ten tips are offered for a successful and productive writing retreat: (a) get the buy-in of all investigators, (b) be goal oriented, (c) set tasks to be completed before the retreat, (d) select an environment conducive to writing, (e) prioritize writing, (f) create opportunities for midcourse correction and the mentoring of junior researchers and evaluators, (g) protect the principal investigator’s time for writing, (h) ensure adequate and compatible technology, (i) ensure the writers’ comfort, and (j) focus on success.
From Theory to Practice: A Determinants Approach to Workplace Health Promotion in Small Businesses
Authors: Eakin Joan M. , Cava Maureen , Smith Trevor F.
Published: April 2005

A determinants approach to workplace health promotion focuses on the sources of health and ill health in the workplace itself. Key practice requirements of such an approach include the capacity to shift focus beyond the individual to the work environment, to cross disciplinary and jurisdictional boundaries in identifying problems and solutions, to foster health promotion self-sufficiency within the workplace, to enable worker participation in the process, and to adapt practice strategies to a business setting. This article identifies the challenges of such practice by reference to the experiences of health promoters in a Canadian public health department who attempted a determinants-centered stress reduction program for small-sized businesses. Findings under-score the significance for workplace health promotion of the broader structural context in which the workplace and the intervention are located, of differing perspectives between health professionals and workplace parties, and of conflicting professional accountabilities. Possibilities for addressing these challenges are considered.
An Interview with Dr. Laura Leviton, Leader in the Field of Evaluating Community Health Promotion Initiatives
Authors: Francisco Vincent T. , Butterfoss Frances D. , Capwell Ellen M.
Published: April 2005

This article summarizes a recent interview with Dr. Laura Leviton, Senior Program Officer in Re-search and Evaluation for the Robert Wood Johnson Foundation. Dr. Leviton is also the immediate past president of the American Evaluation Association. With a wealth of experience in working with community health promotion initiatives, Dr. Leviton provides important insights, recommendations, and dreams for the future of the field. The authors’ questions are in italics, followed by Dr. Leviton’s responses.
Linking Research and Practice: Two Academic–Public Health Collaborations That Are Working
Authors: Doll Lynda , Dino Geri , Deutsch Charles , Holmes Alan , Mills Dora , Horn Kimberly
Published: April 2005

In this commentary, two examples of successful collaboration between academic research centers and public health agencies at a statewide level are described. One program sought to reduce tobacco use, whereas the other has the goal of improving physical activity and nutrition among children and youth and reducing child and adolescent obesity and subsequent health risks. The features of the collaboration contributing to their success are outlined, as is the federal role in fostering these partnerships.
Even if You Were Successful, How Would You Know?
Authors: Berkanovic Emil , Jones Candace J. , Batmale Jeannine , Jimenez Armando , Roberson Angel , Ivie Sylvia Drew
Published: April 2005

There is considerable interest within the public health community in the evaluation of programs intended to reduce health disparities. This commentary discusses an attempt to evaluate a prenatal clinic in a community-based organization serving disadvantaged African American women. The staff members of the clinic were convinced that the birth outcomes of their patients were better than might be expected from national data. The available data, however, were insufficient to permit a clear conclusion regarding the effectiveness of this clinical service. Nonetheless, data from focus groups conducted among staff members and current clients of the clinic suggested some reasons why birth outcomes might be better in this clinic. These reasons were supported both by the stress and coping literature and by empirical research into the determinants of birth outcomes. The article concludes with a discussion of some of the issues that need to be addressed by evaluators working in community-based organizations.
Building Community Trust: Lessons from an STD/HIV Peer Educator Program with African American Barbers and Beauticians
Authors: Lewis Yalonda R. , Shain Lara , Quinn Sandra Crouse , Turner Katherine , Moore Timothy
Published: April 2005

Sexually transmitted diseases (STDs), HIV, and AIDS disproportionately affect the African American community. In 1999, the rates of gonorrhea and primary and secondary syphilis among African Americans in the United States were approximately 30 times greater than those rates in Whites. Although African Americans represent only 12% of the population nationwide, they constitute 37% of the cumulative AIDS cases. In North Carolina’s Durham County, African Americans accounted for 88% (553) of the HIV cases reported as of December 2000. There remains a demand for prevention efforts that are culturally relevant, incorporating the social norms and values of the African American community. Through the Barber and Beautician STD/HIV Peer Educator Program of the Durham County Health Department’s Project StraighTalk (PS), local barbers and beauticians provide condoms, educational materials, and education to their clients about STDs/HIV. In collaboration with PS, Lewis and Shain performed a needs assessment of the program, including interviews with stylists and clients, to inform program enhancement and materials development. This article describes the needs assessment process, with a specific focus on the challenges of working closely with a community and the lessons learned.
The Praise! Project:
Authors: Ammerman Alice , Washington Chanetta , Jackson Bethany , Weathers Benita , Campbell Marci , Davis Gwen , Garson-Angert Dan , Paige Reverend Joseph , Parks-Bani Carol , Joyner Margo , Keyserling Thomas , Switzer Boyd
Published: April 2005

Cancer prevention research has inadequately reached the African American community despite a higher risk for cancer and many other chronic diseases. Reasons for this failure include historical mistrust of research and medical institutions; lack of culturally relevant interventions; and a failure to design and implement interventions that “give back” to the community. The Partnership to Reach African Americans to Increase Smart Eating (PRAISE!) project is a National Cancer Institute-funded study that developed and tested a nutrition intervention program in partnership with African American churches. Sixty churches and over 1300 individuals participated in this 5 year randomized controlled trial. In this article, the authors describe the design and implementation of the PRAISE! intervention, building on the strengths of the African American church to create a community-university partnership to enhance cultural relevance of the intervention and foster the potential for long term sustainability and diffusion in the African American community.
Increasing the Efficacy of School-Based Directly Observed Therapy: From Needs Assessment to Program Implementation
Authors: Bhavaraju Rajita R. , Pirog Lillian T.
Published: April 2005

In 1995, 43 Essex County, New Jersey, children received school nurse directly observed therapy (DOT) for tuberculosis. School-year adherence was 78.5% compared to summer adherence at 93.5%. The only nurse-involved adherence enhancement was individualized education. In early 1996, nurses completed a questionnaire determining DOT challenges. A cross-sectional study later emphasized nurse characteristics and DOT problems and successes. Problems were categorized as student, student’s family, school administration, and school environment. The assessment elicited problem resolutions as education, skills training, and resources; 26% of nurses indicated eliminating school DOT. There were statistically insignificant relationships between nurses’ personal characteristics or reported barriers and student adherence. Resulting interventions included needs-appropriate individual and group education, pediatric nurse case management, and dosing procedure changes. As a result, the 1996 school-based DOT adherence rate increased to 91.1% and continued to be above 90% for 3 consecutive years.
Achieving Success in Poor Urban Minority Community-Based Research: Strategies for Implementing Community-Based Research within an Urban Minority Population
Authors: Richards Leslie , Kennedy Patricia H. , Krulewitch Cara J. , Wingrove Barbara , Katz Kathy , Wesley Barbara , Feinson Clare , Herman Allen
Published: April 2005

Various models of community research have been employed to assess community health needs and address community health problems. Infant mortality remains a problem in urban minority communities throughout the United States. This article compares various community research models with a three-tiered community involvement model used in Washington, D.C., an urban, predominantly African American community with one of the worst rates of infant mortality in the nation. The research design incorporated community input throughout the research design process, resulting in a better understanding of issues and problems associated with infant mortality within the community setting. The use of the model improved community participation in the research process, facilitating improved health initiatives.
SDX-101, the R-enantiomer of etodolac, induces cytotoxicity, overcomes drug resistance, and enhances the activity of dexamethasone in multiple myeloma
Authors: Yasui Hiroshi , Hideshima Teru , Hamasaki Makoto , Roccaro Aldo M. , Shiraishi Norihiko , Kumar Shaji , Tassone Pierfrancesco , Ishitsuka Kenji , Raje Noopur , Tai Yu-Tzu , Podar Klaus , Chauhan Dharminder , Leoni Lorenzo M. , Kanekal Sarath , Elliott Gary , Munshi Nikhil C. , Anderson Kenneth C.
Published: April 2005

In this study we report that R-etodolac (SDX-101), at clinically relevant concentrations, induces potent cytotoxicity in drug-sensitive multiple myeloma (MM) cell lines, as well as in dexamethasone (MM.1R)-, doxorubicin (Dox40/RPMI8226)-, and bortezomib (DHL4)-resistant cell lines. Immunoblot analysis demonstrates that R-etodolac induces apoptosis characterized by caspase-8, -9, and -3 and PARP (poly-ADP [adenosine diphosphate]-ribose polymerase) cleavage and down-regulation of cyclin D1 expression. Subcytotoxic doses of R-etodolac up-regulate myeloid cell leukemia-1 proapoptotic variant (Mcl-1S), while enhancing dexamethasone (Dex)-induced caspase activation and apoptosis. The combination of R-etodolac with Dex results in a highly synergistic cytotoxic effect. R-etodolac also induces apoptosis against primary cells isolated from patients with MM refractory to chemotherapy. Although interleukin 6 (IL-6) and insulin-like growth factor-1 (IGF-1) abrogate Dex-induced MM cell cytotoxicity, neither IL-6 nor IGF-1 protects against R-etodolac-induced cytotoxicity in MM cells. R-etodolac also inhibits viability of MM cells adherent to bone marrow stromal cells (BMSCs), thereby overcoming a mechanism of drug resistance commonly observed with other conventional chemotherapeutic agents. Our data, therefore, indicate that R-etodolac circumvents drug resistance in MM cells at clinically relevant concentrations, targets Mcl-1, and can be synergistically combined with Dex. (Blood. 2005;106:706-712)
The optimal starting time of postoperative intraperitoneal mitomycin-C therapy with preserved intestinal wound healing
Authors: Uzunkoy Ali , Bolukbas Cengiz , Horoz Mehmet , Bolukbas Fusun F , Kocyigit Abdurrahim
Published: April 2005

Background

There is controversy about the effect of the timing of intraperitoneal administration of chemotherapeutic agents on the healing of intestinal anastomosis. We have investigated the effect on intestinal wound healing of mitomycin-C administered at different times post-operatively.

Methods

Eighty-four Wistar-Albino female rats underwent ileal resection and end-to-end anastomosis. The rats were randomly selected for intraperitoneal administration of mitomycin-C or saline as follows: mitomycin-C group (n = 65), 2 mg/kg mitomycin-C; control group (n = 13), 10 ml saline. The former was sub-divided into 5 equal groups (A 1–5) and mitomycin-C was administered postoperatively as follows: day 0 (A1), day 3 (A2), day 5 (A3), day 7 (A4) and day 10 (A5). All the rats were sacrificed on the 14th postoperative day and anastomotic bursting pressures and tissue hydroxyproline levels were determined.

Results

Five of the animals died postoperatively: 2 (15.4%) in group A1, 2 (15.4%) in group A2 and 1(7.7%) in group A3. Non-lethal anastomotic leakage was observed in a further five animals: 1 in group A1, 2 in group A2, 1 in group A5 and 1 in the control group. Groups A1 and A2 had significantly lower anastomotic bursting pressures than the other groups (P was <0.05 for each comparison). The anastomotic bursting pressures of group A3, A4 and A5 were comparable with those of the controls (P was >0.05 for each comparison). Tissue hydroxyproline levels in group A1 and A2 were significantly lower than in the controls (P values were <0.05 for each comparison) or the other mitomycin-C sub-groups (P was <0.05 for each comparison).

Conclusions

Intraperitoneal chemotherapy impairs intestinal wound healing when applied before the 5th postoperative day. Additional therapeutic approaches are needed to prevent this potentially lethal side effect of early intraperitoneal mitomycin-C administration.
The asthma epidemic and our artificial habitats
Authors: Maziak Wasim
Published: April 2005

Background

The recent increase in childhood asthma has been a puzzling one. Recent views focus on the role of infection in the education of the immune system of young children. However, this so called hygiene hypothesis fails to answer some important questions about the current trends in asthma or to account for environmental influences that bear little relation to infection.

Discussion

The multi-factorial nature of asthma, reflecting the different ways we tend to interact with our environment, mandates that we look at the asthma epidemic from a broader perspective. Seemingly modern affluent lifestyles are placing us increasingly in static, artificial, microenvironments very different from the conditions prevailed for most part of our evolution and shaped our organisms. Changes that occurred during the second half of the 20th century in industrialized nations with the spread of central heating/conditioning, building insulation, hygiene, TV/PC/games, manufactured food, indoor entertainment, cars, medical care, and sedentary lifestyles all seem to be depriving our children from the essential inputs needed to develop normal airway function (resistance). Asthma according to this view is a manifestation of our respiratory maladaptation to modern lifestyles, or in other words to our increasingly artificial habitats. The basis of the artificial habitat notion may lie in reduced exposure of innate immunity to a variety of environmental stimuli, infectious and non-infectious, leading to reduced formulation of regulatory cells/cytokines as well as inscribed regulatory pathways. This could contribute to a faulty checking mechanism of non-functional Th2 (and likely Th1) responses, resulting in asthma and other immuno-dysregulation disorders.

In this piece I discuss the artificial habitat concept, its correspondence with epidemiological data of asthma and allergy, and provide possible immunological underpinning for it from an evolutionary perspective of health and disease.
Scale and shape issues in focused cluster power for count data
Authors: Puett Robin C , Lawson Andrew B , Clark Allan B , Aldrich Tim E , Porter Dwayne E , Feigley Charles E , Hebert James R
Published: April 2005

Background

Interest in the development of statistical methods for disease cluster detection has experienced rapid growth in recent years. Evaluations of statistical power provide important information for the selection of an appropriate statistical method in environmentally-related disease cluster investigations. Published power evaluations have not yet addressed the use of models for focused cluster detection and have not fully investigated the issues of disease cluster scale and shape. As meteorological and other factors can impact the dispersion of environmental toxicants, it follows that environmental exposures and associated diseases can be dispersed in a variety of spatial patterns. This study simulates disease clusters in a variety of shapes and scales around a centrally located single pollution source. We evaluate the power of a range of focused cluster tests and generalized linear models to detect these various cluster shapes and scales for count data.

Results

In general, the power of hypothesis tests and models to detect focused clusters improved when the test or model included parameters specific to the shape of cluster being examined (i.e. inclusion of a function for direction improved power of models to detect clustering with an angular effect). However, power to detect clusters where the risk peaked and then declined was limited.

Conclusion

Findings from this investigation show sizeable changes in power according to the scale and shape of the cluster and the test or model applied. These findings demonstrate the importance of selecting a test or model with functions appropriate to detect the spatial pattern of the disease cluster.
Use of intranasal mupirocin to prevent methicillin-resistant Staphylococcus aureus infection in intensive care units
Authors: Muller Arno , Talon Daniel , Potier Alexandre , Belle Evelyne , Cappelier Gilles , Bertrand Xavier
Published: April 2005

Introduction

Methicillin-resistant Staphylococcus aureus (MRSA) causes severe morbidity and mortality in intensive care units (ICUs) worldwide. The purpose of this study was to determine whether intranasal mupirocin prophylaxis is useful to prevent ICU-acquired infections with MRSA.

Materials and methods

We conducted a 4-year observational retrospective study in a 15-bed adult medical ICU. During the first 2-year period mupirocin ointment was included in the MRSA control programme; during the second, mupirocin was not used. The main endpoint was the number of endogenous ICU-acquired infections with MRSA.

Results

The number of endogenous acquired infections was significantly higher during the second period than during the first (11 versus 1; P = 0.02), although there was no significant difference in the total number of patients infected with MRSA between the two periods. We also observed that nasal MRSA decolonisation was significantly higher in the mupirocin period than in mupirocin-free period (P = 0.002).

Conclusion

Our findings suggest that intranasal mupirocin can prevent endogenous acquired MRSA infection in an ICU. Further double-blind, randomised, placebo-controlled studies are needed to demonstrate its cost-effectiveness and its impact on resistance.
Additional Resources for Medical Student Educators: An Annotated Review
Authors: Howard Tamara
Published: April 2005

There are numerous resources available to help educators of medical students improve their methods of instruction. For example, several Internet sites exist that describe specific ways to teach and reinforce concepts basic to emergency medicine. Some of these sites also allow users to share their own experiences and teaching techniques. There are professional associations and organizations that specifically cater to the needs of those involved in the education and training of medical students and resident physicians. Educators may wish to take advantage of distance learning programs that offer instruction in areas such as adult learning, curriculum and teaching methods, and medical education evaluation and research. Finally, educators may wish to participate in professional development opportunities such as fellowships and online modules that have been designed to offer instruction on teaching skills, provide an arena for exchange of effective techniques, and acclimate faculty to academic medicine.
Evaluation of Student Performance: Clinical and Professional Performance
Authors: Farrell Susan E.
Published: April 2005

In 1999, the Accreditation Council for Graduate Medical Education (ACGME) endorsed six general competencies for residents as part of an ongoing attempt to emphasize educational outcomes as part of residency program assessment and accreditation. Although the focus of these reforms has been on postgraduate training, the competencies are applicable to medical students who aspire to become excellent clinicians and can help guide the development of assessment tools to measure clinical and professional performance of students in the emergency department. This article reviews the definitions of clinical competence and briefly addresses the issues of evaluation tool validity, reliability, and feasibility as they relate to the assessment of medical students. Several assessment tools are outlined, with an eye to the ACGME competencies and the ACGME Toolbox of Assessment Methods. The pros and cons of global rating scales, direct observation, simulations, and oral examinations are reviewed. Multiple assessment tools are often necessary to provide a true evaluation of a student's clinical and professional skills. Their application in the setting of an emergency medicine rotation is described and discussed.