bluuebunny/crossref_metadata_2025 huggingface dataset:
A Theory of Outsourcing and Wage Decline
Authors: Holmes Thomas J , Snider Julia Thornton
Published: April 2011

This paper develops a theory of outsourcing in which the circumstances under which factors of production can grab rents play the leading role. One factor has monopoly power (call this labor) while a second factor does not (call this capital). There are two kinds of production tasks: labor-intensive and capital-intensive. We show that if frictions limiting outsourcing are not too large, in equilibrium labor-intensive tasks are separated from capital-intensive tasks into distinct firms. When a capital-intensive country is opened to free trade, outsourcing increases and labor rents decline. A decrease in outsourcing frictions lowers labor rents. (JEL J31, L22, L24)
The Principal-Agent Approach to Testing Experts
Authors: Olszewski Wojciech , Pęski Marcin
Published: April 2011

Recent literature on testing experts shows that it is often impossible to determine whether an expert knows the stochastic process that generates data. Despite this negative result, we show that there often exist contracts that allow a decision maker to attain the first-best payoff without learning the expert's type. This kind of full-surplus extraction is always possible in infinite-horizon models in which future payoffs are not discounted. If future payoffs are discounted (but the discount factor tends to 1), the possibility of full-surplus extraction depends on a constraint involving the forecasting technology. (JEL D82)
Leptin/adiponectin ratio in patients with coronary heart disease: comparing subjects with and without metabolic syndrome
Authors: Hall J I , Vora N , Langworthy R , Stock S , Momin A , Sherwood R A , le Roux C W , Alaghband-Zadeh J
Published: April 2011

Background

Adiponectin and leptin are adipose tissue-derived hormones, shown to have opposing associations with the metabolic syndrome and coronary heart disease (CHD). This study evaluated the association between the leptin/adiponectin ratio and the components of the metabolic syndrome in a cohort with CHD.

Methods and results

This cross-sectional study included data from 105 subjects (men = 91), undergoing first-time elective coronary artery bypass grafting (CABG). Leptin and adiponectin concentrations were determined by enzyme-linked immunosorbent assay (ELISA). Association was found between the leptin/adiponectin ratio and homeostatic model assessment (HOMA) ( rs = 0.34, P = 0.0006), fasting insulin concentrations ( rs = 0.37, P = 0.0001), fasting glucose concentrations ( rs = 0.24, P = 0.01), systolic blood pressure ( rs = 0.20, P = 0.05), diastolic blood pressure ( rs = 0.24, P = 0.02), waist circumference ( rs = 0.55, P < 0.0001), body mass index (BMI) ( rs = 0.55, P < 0.0001) and waist/hip ratio ( rs = 0.38, P = 0.0001). A significant difference was found in ratios between those with and without insulin resistance (HOMA > 3 and HOMA ≤ 3) ( P = 0.029) and those with and without metabolic syndrome, defined by the International Diabetes Federation, ( P < 0.001). However, using receiver operating characteristic (ROC) analysis and assessment of area under curve (AUC), the leptin/adiponectin ratio did not perform significantly better than its components.

Conclusion

In patients with severe CHD, the leptin/adiponectin ratio was not found to be a robust tool to distinguish patients with and without insulin resistance and those with and without the metabolic syndrome.
Contribution of IKCa channels to the control of coronary blood flow
Authors: Kurian Michelle M , Berwick Zachary C , Tune Johnathan D
Published: April 2011

The purpose of this investigation was to elucidate the contribution of intermediate conductance calcium-activated potassium channels (IKCa) to the regulation of coronary blood flow in vivo. We hypothesized that IKCa channels modulate coronary arteriolar resistance at rest and contribute to vasomotor responses to changes in coronary perfusion pressure and/or in response to cardiac ischemia. Experiments were conducted in open-chest anesthetized dogs in the absence and presence of IKCa channel inhibitor, TRAM-34 (1 μg/min, intracoronary), and the nitric oxide (NO) synthase inhibitor, NG-nitro-l-arginine-methyl ester (l-NAME) (150 μg/min, intracoronary). We found that administration of the potent SKCa and IKCa channel agonist NS309 dose-dependently increased coronary blood flow and that inhibition of IKCa channels with TRAM-34 attenuated this response by ∼90%. The increase in coronary blood flow to NS309 was also decreased ∼100% by the inhibition of NO production with l-NAME. Multiple linear regression analysis demonstrated that TRAM-34 diminished the autoregulatory capability of the coronary circulation at coronary pressures ranging from 60 to 120 mmHg. However, inhibition of IKCa channels did not affect coronary vasodilation in response to a transient 15 s coronary artery occlusion (i.e. reactive hyperemia). Our data reveal that IKCa channels are functionally expressed in the coronary circulation and that activation of these channels produces marked coronary vasodilation in vivo, primarily via increases in endothelial NO production. In addition, IKCa channels modestly contribute to changes in coronary vascular resistance in response to alterations in coronary perfusion pressure but do not contribute to the reactive hyperemic response following a brief coronary artery occlusion.
Asymptotic Moments of the Bottleneck Assignment Problem
Authors: Spivey Michael Z.
Published: April 2011

One of the most important variants of the standard linear assignment problem is the bottleneck assignment problem. In this paper we give a method by which one can find all of the asymptotic moments of a random bottleneck assignment problem in which costs (independent and identically distributed) are chosen from a wide variety of continuous distributions. Our method is obtained by determining the asymptotic moments of the time to first complete matching in a random bipartite graph process and then transforming those, via a Maclaurin series expansion for the inverse cumulative distribution function, into the desired moments for the bottleneck assignment problem. Our results improve on the previous best-known expression for the expected value of a random bottleneck assignment problem, yield the first results on moments other than the expected value, and produce the first results on the moments for the time to first complete matching in a random bipartite graph process.
Hemodynamic instability during resection of pheochromocytoma in MEN versus non-MEN patients
Authors: Scholten Anouk , Vriens Menno R , Cromheecke Geert Jan E , Borel Rinkes Inne H M , Valk Gerlof D
Published: April 2011

Objective

Hemodynamic (HD) instability still underlies difficulties during pheochromocytoma resection. Little is known about HD instability in patients with multiple endocrine neoplasia (MEN) type 2-related pheochromocytoma. Our aim was to assess differences in HD during pheochromocytoma resection between MEN2 and non-MEN patients. In addition, we sought to identify risk factors for intraoperative HD instability.

Design

Retrospective cohort study.

Methods

A total of 22 MEN2 and 34 non-MEN patients underwent 61 pheochromocytoma resections at the University Medical Center Utrecht between 2000 and 2010. All MEN2-related pheochromocytomas were diagnosed by annual screening. HD instability was assessed by measuring the frequency of hypotensive (mean arterial blood pressure (MABP) <60 mmHg) and/or hypertensive (systolic arterial blood pressure (SABP) >200 mmHg) episodes.

Results

Compared with non-MEN patients, MEN2 patients were younger at diagnosis, had less symptoms, lower hormone levels, and smaller tumors. Intraoperatively, MEN2 patients had a similar frequency of hypertensive episodes (1.3 vs 1.9, P=0.162, 95% confidence interval (CI): −6.7 to 35.4) and a similar maximum SABP (200 vs 220 mmHg, P=0.180, 95% CI: −9.7 to 50.5). However, MEN2 patients experienced less frequent (1.04 vs 2.6, P=0.003, 95% CI: 0.57 to 2.6) and less severe hypotensive episodes after tumor resection (lowest MABP: 52.5 vs 45.6 mmHg, P=0.015, 95% CI: −12.6 to 1.16). Tumor size was an independent risk factor for HD instability for the total group after multivariate analysis.

Conclusion

MEN2 patients with pheochromocytoma, despite their smaller tumors, do not distinguish themselves from non-MEN patients in terms of hypertensive episodes during pheochromocytoma resection. Therefore, pretreatment with α- and β-blockade remains the standard of care in MEN2-related as well as in non-MEN-related pheochromocytomas.
A mouse model of spontaneous preterm birth based on the genetic ablation of biglycan and decorin
Authors: Calmus Megan L , Macksoud Elyse E , Tucker Richard , Iozzo Renato V , Lechner Beatrice E
Published: April 2011

Preterm premature rupture of membranes is responsible for one-third of preterm births. Ehlers–Danlos syndrome (EDS) is associated with preterm premature rupture of membranes in humans. In particular, an EDS variant is caused by a genetic mutation resulting in abnormal secretion of biglycan and decorin, two small leucine-rich proteoglycans highly expressed in reproductive tissues. Because biglycan/decorin null mutant (Bgn−/−Dcn−/−) mice demonstrate phenotypic changes similar to EDS, we used this model to test whether either biglycan or decorin or both play a role in the attainment of successful term gestation. Wild-type biglycan null mutant, decorin null mutant, and biglycan/decorin null mutant pregnancies were assessed for the length of gestation, pup and placenta weight, and litter size. Quantitative real-time PCR was performed to measure biglycan and decorin gene expression, and immunohistochemistry was performed to assess protein expression in placenta and fetal membranes at embryonic days E12, E15, and E18.Bgn−/−Dcn−/−dams displayed preterm birth, whereas the possession of at least two biglycan or decorin wild-type alleles was protective of preterm birth. The number ofBgn−/−Dcn−/−pups was decreased at postnatal day P1 but not at E18. Biglycan and decorin were upregulated in the placenta in the absence of each other and were developmentally regulated in fetal membranes, suggesting that these two proteoglycans demonstrate genetic complementation and contribute to gestational success in a dose-dependent manner. Thus, the biglycan/decorin null mutant mouse is a model of genetically induced preterm birth and perinatal loss. This model presents novel targets for preventive or therapeutic manipulation of preterm birth.
Adolescent Chronic Fatigue Syndrome: Prevalence, Incidence, and Morbidity
Authors: Nijhof Sanne L. , Maijer Kimberley , Bleijenberg Gijs , Uiterwaal Cuno S. P. M. , Kimpen Jan L. L. , van de Putte Elise M.
Published: April 2011

OBJECTIVE:

To determine nationwide general practitioner (GP)-diagnosed prevalence and pediatrician–diagnosed incidence rates of adolescent chronic fatigue syndrome (CFS), and to assess CFS morbidity.

DESIGN AND SETTING:

We collected data from a cross-sectional national sample among GPs and prospective registration of new patients with CFS in all pediatric hospital departments in the Netherlands.

PATIENTS AND METHODS:

Study participants were adolescents aged 10 to 18 years. A representative sample of GPs completed questionnaires on the prevalence of CFS in their adolescent patients. Pediatric hospital departments prospectively reported new cases of CFS in adolescent patients. For every new reported case, a questionnaire was sent to the reporting pediatrician and the reported patient to assess CFS morbidity. Prevalence was estimated through the data from GP questionnaires and incidence was estimated on the basis of cases newly reported by pediatricians from January to December 2008.

RESULTS:

Prevalence was calculated as 111 per 100 000 adolescents and incidence as 12 per 100 000 adolescents per year. Of newly reported patients with CFS, 91% scored at or above cutoff points for severe fatigue and 93% at or above the cutoff points for physical impairment. Forty-five percent of patients with CFS reported >50% school absence during the previous 6 months.

CONCLUSIONS:

Clinically diagnosed incidence and prevalence rates show that adolescent CFS is uncommon compared with chronic fatigue. The primary adverse impact of CFS is extreme disability associated with considerable school absence.
Outcomes of Laparoscopic Versus Open Fundoplication in Children's Hospitals: 2005–2008
Authors: Fox David , Morrato Elaine , Campagna Elizabeth J. , Rees Daniel I. , Dickinson L. Miriam , Partrick David A. , Kempe Allison
Published: April 2011

BACKGROUND:

Fundoplication is a common pediatric surgery, but little data comparing the laparoscopic approach with the open approach have been published.

OBJECTIVE:

To compare infection rates, complication rates, length of stay, and cost for laparoscopic fundoplication versus open fundoplication among pediatric patients and to examine trends in utilization of laparoscopic fundoplication.

METHODS:

We used the Pediatric Health Information System database to conduct a retrospective study of children (aged <19 years) admitted for a fundoplication between 2005 and 2008. Descriptive characteristics for those undergoing a laparoscopic and open fundoplication were compared. Multivariate regression with random effects specified at the hospital level was used to model the association between laparoscopic fundoplication and the outcomes.

RESULTS:

Fifty-six percent of 7083 fundoplication admissions had laparoscopic fundoplication. Median length of stay was 4 days for laparoscopic and 10 days for open fundoplication. The median cost of laparoscopic fundoplication was $13 003 versus $22 487 for open fundoplication. Laparoscopic fundoplication was associated with a 24% and 51% reduction in the adjusted odds of infection and surgical complications, respectively. The proportion of fundoplications performed laparoscopically increased from 51% in 2005 to 63% in 2008 (P < .001), but there was no increase in the overall fundoplication rate.

CONCLUSIONS:

In a large study of children's hospitals, laparoscopic fundoplication was associated with improved outcomes compared with the open procedure, even after adjustment for patient severity. Laparoscopic fundoplication has become the most common form of antireflux surgery in children over 1 year of age, but this has not been associated with an increase in the overall utilization of the fundoplication procedure. These data have important implications for clinical practice and surgical training.
Preterm Birth and Attention-Deficit/Hyperactivity Disorder in Schoolchildren
Authors: Lindström Karolina , Lindblad Frank , Hjern Anders
Published: April 2011

OBJECTIVE:

Previous studies have demonstrated an increased risk for attention-deficit/hyperactivity disorder (ADHD) in follow-up studies of preterm survivors from NICUs. In this study we analyzed the effect of moderate as well as extreme preterm birth on the risk for ADHD in school age, taking into account genetic, perinatal, and socioeconomic confounders.

METHODS:

Register study in a Swedish national cohort of 1 180 616 children born between 1987 and 2000, followed up for ADHD medication in 2006 at the age of 6 to 19 years. Logistic regression was used to test hypotheses. A within-mother-between-pregnancy design was used to estimate the importance of genetic confounding in a subpopulation of offspring (N = 34 334) of mothers who had given birth to preterm (≤34 weeks) as well as term infants.

RESULTS:

There was a stepwise increase in odds ratios for ADHD medication with increasing degree of immaturity at birth; from 2.1 (1.4–2.7) for 23 to 28 weeks' gestation, to 1.6 (1.4–1.7) for 29 to 32 weeks', 1.4 (1.2–1.7) for 33 to 34 weeks', 1.3 (1.1–1.4) for 35 to 36 weeks', and 1.1 (1.1–1.2) for 37 to 38 weeks' gestation compared with infants born at 39 to 41 weeks' gestation in the fully adjusted model. The odds ratios for the within-mother-between-pregnancy analysis were very similar. Low maternal education increased the effect of moderate, but not extreme, preterm birth on the risk for ADHD.

CONCLUSION:

Preterm and early term birth increases the risk of ADHD by degree of immaturity. This main effect is not explained by genetic, perinatal, or socioeconomic confounding, but socioeconomic context modifies the risk of ADHD in moderately preterm births.
Food and Drug Administration Regulation and Evaluation of Vaccines
Authors: Marshall Valerie , Baylor Norman W.
Published: April 2011

The vaccine-approval process in the United States is regulated by the Center for Biologics Evaluation and Research of the US Food and Drug Administration. Throughout the life cycle of development, from preclinical studies to after licensure, vaccines are subject to rigorous testing and oversight. Manufacturers must adhere to good manufacturing practices and control procedures to ensure the quality of vaccines. As mandated by Title 21 of the Code of Regulations, licensed vaccines must meet stringent criteria for safety, efficacy, and potency.
The Vaccine Safety Datalink: A Model for Monitoring Immunization Safety
Authors: Baggs James , Gee Julianne , Lewis Edwin , Fowler Gabrielle , Benson Patti , Lieu Tracy , Naleway Allison , Klein Nicola P. , Baxter Roger , Belongia Edward , Glanz Jason , Hambidge Simon J. , Jacobsen Steven J. , Jackson Lisa , Nordin Jim , Weintraub Eric
Published: April 2011

The Vaccine Safety Datalink (VSD) project is a collaborative project between the Centers for Disease Control and Prevention and 8 managed care organizations (MCOs) in the United States. Established in 1990 to conduct postmarketing evaluations of vaccine safety, the project has created an infrastructure that allows for high-quality research and surveillance. The 8 participating MCOs comprise a large population of 8.8 million members annually (3% of the US population), which enables researchers to conduct studies that assess adverse events after immunization. Each MCO prepares computerized data files by using a standardized data dictionary containing demographic and medical information on its members, such as age and gender, health plan enrollment, vaccinations, hospitalizations, outpatient clinic visits, emergency department visits, urgent care visits, and mortality data, as well as additional birth information (eg, birth weight) when available. Other information sources, such as medical chart review, member surveys, and pharmacy, laboratory, and radiology data, are often used in VSD studies to validate outcomes and vaccination data. Since 2000, the VSD has undergone significant changes including an increase in the number of participating MCOs and enrolled population, changes in data-collection procedures, the creation of near real-time data files, and the development of near real-time postmarketing surveillance for newly licensed vaccines or changes in vaccine recommendations. Recognized as an important resource in vaccine safety, the VSD is working toward increasing transparency through data-sharing and external input. With its recent enhancements, the VSD provides scientific expertise, continues to develop innovative approaches for vaccine-safety research, and may serve as a model for other patient safety collaborative research projects.
Active Surveillance for Adverse Events: The Experience of the Vaccine Safety Datalink Project
Authors: Yih W. Katherine , Kulldorff Martin , Fireman Bruce H. , Shui Irene M. , Lewis Edwin M. , Klein Nicola P. , Baggs James , Weintraub Eric S. , Belongia Edward A. , Naleway Allison , Gee Julianne , Platt Richard , Lieu Tracy A.
Published: April 2011

OBJECTIVE:

To describe the Vaccine Safety Datalink (VSD) project's experience with population-based, active surveillance for vaccine safety and draw lessons that may be useful for similar efforts.

PATIENTS AND METHODS:

The VSD comprises a population of 9.2 million people annually in 8 geographically diverse US health care organizations. Data on vaccinations and diagnoses are updated and extracted weekly. The safety of 5 vaccines was monitored, each with 5 to 7 prespecified outcomes. With sequential analytic methods, the number of cases of each outcome was compared with the number of cases observed in a comparison group or the number expected on the basis of background rates. If the test statistic exceeded a threshold, it was a signal of a possible vaccine-safety problem. Signals were investigated by using temporal scan statistics and analyses such as logistic regression.

RESULTS:

Ten signals appeared over 3 years of surveillance: 1 signal was reported to external stakeholders and ultimately led to a change in national vaccination policy, and 9 signals were found to be spurious after rigorous internal investigation. Causes of spurious signals included imprecision in estimated background rates, changes in true incidence or coding over time, other confounding, inappropriate comparison groups, miscoding of outcomes in electronic medical records, and chance. In the absence of signals, estimates of adverse-event rates, relative risks, and attributable risks from up-to-date VSD data have provided rapid assessment of vaccine safety to policy-makers when concerns about a specific vaccine have arisen elsewhere.

CONCLUSIONS:

Care with data quality, outcome definitions, comparison groups, and length of surveillance are required to enable detection of true safety problems while minimizing false signals. Some causes of false signals in the VSD system were preventable and have been corrected, whereas others will be unavoidable in any active surveillance system. Temporal scan statistics, analyses to control for confounding, and chart review are indispensable tools in signal investigation. The VSD's experience may inform new systems for active safety surveillance.
Understanding the Role of Human Variation in Vaccine Adverse Events: The Clinical Immunization Safety Assessment Network
Authors: LaRussa Philip S. , Edwards Kathryn M. , Dekker Cornelia L. , Klein Nicola P. , Halsey Neal A. , Marchant Colin , Baxter Roger , Engler Renata J. M. , Kissner Jennifer , Slade Barbara A.
Published: April 2011

The Clinical Immunization Safety Assessment (CISA) Network is a collaboration between the Centers for Disease Control and Prevention (CDC) and 6 academic medical centers to provide support for immunization safety assessment and research. The CISA Network was established by the CDC in 2001 with 4 primary goals: (1) develop research protocols for clinical evaluation, diagnosis, and management of adverse events following immunization (AEFI); (2) improve the understanding of AEFI at the individual level, including determining possible genetic and other risk factors for predisposed people and subpopulations at high risk; (3) develop evidence-based algorithms for vaccination of people at risk of serious AEFI; and (4) serve as subject-matter experts for clinical vaccine-safety inquiries. CISA Network investigators bring in-depth clinical, pathophysiologic, and epidemiologic expertise to assessing causal relationships between vaccines and adverse events and to understanding the pathogenesis of AEFI. CISA Network researchers conduct expert reviews of clinically significant adverse events and determine the validity of the recorded diagnoses on the basis of clinical and laboratory criteria. They also conduct special studies to investigate the possible pathogenesis of adverse events, assess relationships between vaccines and adverse events, and maintain a centralized repository for clinical specimens. The CISA Network provides specific clinical guidance to both health care providers who administer vaccines and those who evaluate and treat patients with possible AEFI. The CISA Network plays an important role in providing critical immunization-safety data and expertise to inform vaccine policy-makers. The CISA Network serves as a unique resource for vaccine-safety monitoring efforts conducted at the CDC.
The National Vaccine Injury Compensation Program
Authors: Cook Katherine M. , Evans Geoffrey
Published: April 2011

The National Childhood Vaccine Injury Act of 1986 established the National Vaccine Injury Compensation Program to compensate people thought to be injured by certain vaccines. The act's goals are to ensure an adequate supply of vaccines, to stabilize vaccine costs, and to establish and maintain an accessible and efficient setting for providing compensation to people found to have been injured by certain childhood vaccines. In addition, the legislation called for the reporting of adverse events after vaccination, the creation of vaccine-information materials that detail vaccine benefits and risks, and Institute of Medicine studies of possible vaccine-related injuries and encouraged research and development of new and safer vaccines. Over its 22-year history, the National Vaccine Injury Compensation Program has been a key component in stabilizing the US vaccine market through liability protection to both vaccine companies and health care providers and by providing a forum for people, no matter what age, to seek compensation.
Immunization-Safety Monitoring Systems for the 2009 H1N1 Monovalent Influenza Vaccination Program
Authors: Salmon Daniel A. , Akhtar Aysha , Mergler Michelle J. , Vannice Kirsten S. , Izurieta Hector , Ball Robert , Lee Grace M. , Vellozzi Claudia , Garman Patrick , Cunningham Francesca , Gellin Bruce , Koh Howard , Lurie Nicole ,   the H1N1 Working Group of the Federal Immunization Safety Task Force
Published: April 2011

The effort to vaccinate the US population against the 2009 H1N1 influenza virus hinged, in part, on public confidence in vaccine safety. Early in the vaccine program, >20% of parents reported that they would not vaccinate their children. Concerns about the safety of the vaccines were reported by many parents as a factor that contributed to their intention to forgo vaccination (see www.hsph.harvard.edu/news/press-releases/2009-releases/survey-40-adults-absolutely-certain-h1n1-vaccine.html and www.med.umich.edu/mott/npch/reports/h1n1.htm). The safety profiles of 2009 H1N1 monovalent influenza vaccines were anticipated to be (and have been) similar to those of seasonal influenza vaccines, for which an excellent safety profile has been demonstrated. Here we describe steps taken by the US government to (1) assess the key federal systems in place before 2009 for monitoring the safety of vaccines and (2) integrate and upgrade those systems for optimal vaccine-safety monitoring during the 2009 H1N1 monovalent influenza vaccination program. These efforts improved monitoring of 2009 H1N1 vaccine safety, hold promise for enhancing future national monitoring of vaccine safety, and may ultimately help improve public confidence in vaccines.
Tracking Vaccine-Safety Inquiries to Detect Signals and Monitor Public Concerns
Authors: Miller Elaine , Batten Brigid , Hampton Lee , Campbell Scott R. , Gao Jinrong , Iskander John
Published: April 2011

BACKGROUND:

The Centers for Disease Control and Prevention frequently receives inquiries from health care providers, public health officials, and the general public seeking data or guidance on vaccine-safety issues. Past inquiries to public health authorities identified potential problems including viscerotropic illness rarely associated with yellow fever vaccination.

OBJECTIVE:

To systematically describe vaccine-safety inquiries received at the Centers for Disease Control and Prevention.

METHODS:

External and internal inquiries were recorded in a database from May 1, 2002 to May 31, 2009. Key variables analyzed included the source of the question, the type of information being sought, and the vaccine type(s) associated with the inquiry.

RESULTS:

A total of 983 vaccine-safety inquiries were answered and analyzed. Health care workers were the source of 43% of the questions, and the general public accounted for 19% of the questions. Nearly half of the requests (49%) concerned information about the Vaccine Adverse Event Reporting System, and nearly one-fourth (21%) were requests from providers for clinical guidance. The most frequent specific topics of inquiry and vaccines involved were neurologic adverse events (AEs) temporally associated with vaccination (17%) and safety of all vaccines or childhood vaccines (20%), respectively.

CONCLUSIONS:

Questions about rare but potentially serious AEs and general concerns about vaccine safety were encountered relatively frequently. The substantial number of clinically focused inquires may indicate a need for more provider support tools and resources. Tracking of inquiries can supplement information received through vaccine AE reporting and contribute to an enhanced scientific and communications response to vaccine-safety concerns.
Vaccine Attitudes, Concerns, and Information Sources Reported by Parents of Young Children: Results From the 2009 HealthStyles Survey
Authors: Kennedy Allison , Basket Michelle , Sheedy Kristine
Published: April 2011

OBJECTIVE:

To describe the vaccine-related attitudes, concerns, and information sources of US parents of young children.

METHODS:

We calculated weighted proportions and 95% confidence intervals for vaccine-related attitudes, concerns, and information sources of parents with at least 1 child aged 6 years or younger who participated in the 2009 HealthStyles survey.

RESULTS:

The overall response rate for the survey was 65% (4556 of 7004); 475 respondents were parents or guardians (“parents”) of at least 1 child aged 6 years or younger. Among those respondents, nearly all (93.4%) reported that their youngest child had or would receive all recommended vaccines. The majority of parents reported believing that vaccines were important to children's health (79.8%) and that they were either confident or very confident in vaccine safety (79.0%). The vaccine-related concern listed most often by parents was a child's pain from the shots given in 1 visit (44.2%), followed by a child getting too many vaccines at 1 doctor's visit (34.2%). When asked to list their most important sources of information on vaccines, the most common response was a child's doctor or nurse (81.7%).

CONCLUSIONS:

To maintain and improve on the success of childhood vaccines in preventing disease, a holistic approach is needed to address parents' concerns in an ongoing manner. Listening and responding in ways and with resources that address specific questions and concerns could help parents make more informed vaccination decisions.
Finding Reliable Information About Vaccines
Authors: Pineda Diego , Myers Martin G.
Published: April 2011

Misinformation about vaccines confuses parents who may delay or refuse vaccines for their children, which places them and others at risk of vaccine-preventable diseases. Many parents do not understand the risks and severity of these diseases but also are unaware that they are uninformed. There are a number of favorable factors available for educating parents about these diseases, their prevention, and how to counter misinformation: most parents are seeking a trusting health care relationship; they want more information; they appreciate guidance; and they are looking for means to validate the information that they find. These factors represent opportunities to enhance confidence in immunization programs by providing parents with the tools that they need.
Racial and Ethnic Differences in Use of Intubation for Periviable Neonates
Authors: Tucker Edmonds Brownsyne , Fager Corinne , Srinivas Sindhu , Lorch Scott
Published: April 2011

OBJECTIVE:

Racial/ethnic minorities report preferences for resuscitative care at the end of life. The main objective of this study was to determine if there are racial/ethnic differences in use of intubation for periviable neonates. We hypothesized that infants born to black and Hispanic women are more likely to be resuscitated compared with infants born to white women.

METHODS:

We conducted a retrospective cohort study of state-level maternal and infant hospital discharge data of women who delivered between 23.0 and 24.6 weeks' gestation linked to birth and death certificate data for California, Missouri, and Pennsylvania from 1995 to 2005 (N = 9632).

RESULTS:

Overall, 78.9% of the population was aged 18 to 35 years, and almost half were nulliparous; 19.4% of the women were black, 36.6% were Hispanic, and 33.4% were white. Approximately 30% had less than a high school education, and 49.2% were federally insured. Overall, 44.7% of periviable neonates were intubated. In multivariable analyses adjusting for sociodemographic characteristics, black and Hispanic race/ethnicity was significantly associated with neonatal intubation (odds ratios [ORs]: 1.14 [95% confidence interval (CI): 1.01–1.29] and 1.22 [95% CI: 1.10–1.36], respectively). In models controlling for clustering at the level of the delivery hospital, black race remained a predictor of neonatal intubation (OR: 1.25 [95% CI: 1.07–1.46]), but differences among Hispanics dissipated (OR: 1.12 [95% CI: 0.98–1.27]).

CONCLUSIONS:

Racial/ethnic differences exist in patterns of periviable resuscitation, which may reflect underlying differences in patient preference. Alternatively, institutional practices or resources may account for these differences. These findings have important implications for patient care and institutional practice. Our results lay the foundation for additional work to investigate how social, cultural, and institutional factors influence patient–provider decision-making regarding periviable care.
Beyond budgeting: inovação ou resgate de antigos conceitos do orçamento empresarial?
Authors: Frezatti Fábio
Published: April 2011

O estudo tem por objetivo analisar a abordagem conhecida pela expressão "beyond budgeting", que faz o questionamento do que é denominado abordagem "tradicional" do orçamento empresarial, e avaliar se ela constitui uma inovação. A estratégia do desenvolvimento do trabalho é orientada por uma pesquisa bibliográfica, a partir da qual a análise se desenvolve. Esta trata as questões levantadas por críticos e confronta os clássicos do tema no sentido de tentar identificar possíveis inovações e novos problemas que possam derivar da nova abordagem. Em termos gerais, sugere-se que se trata de um novo ciclo que tenta recuperar os aspectos qualitativos clássicos do orçamento, que, uma vez cumpridos, não precisariam de um novo rótulo para serem administrativamente efetivos. Adicionalmente, afirma-se que a abordagem, além de não resolver alguns problemas que a ausência do orçamento pode acarretar, cria outros que não existiriam sem a referida proposta.
Análise da difusão tecnológica usando algoritmos genéticos
Authors: Kimura Herbert , Moori Roberto Giro , Asakura Oscar Kenjiro Norimassu
Published: April 2011

Este artigo avalia os diferentes impactos de variáveis relevantes na descoberta e na difusão de tecnologias, em mercados de alta competitividade. O objetivo foi identificar possibilidades de convívio de diferentes grupos estratégicos, associados ao uso ou à produção de tecnologias convencionais ou inovadoras. Foi utilizado um método matemático de busca e otimização, inspirado nos mecanismos da genética e na evolução de população de seres vivos. Os resultados obtidos sugerem que a interação entre empresas inovadoras pode, simultaneamente, permitir um aprimoramento da tecnologia e criar obstáculos para a entrada de novos competidores. Apesar de ser uma simplificação que não permite incorporar toda a complexidade do mercado, o modelo possibilita uma investigação dos comportamentos corporativos e de evolução de estratégias tecnológicas, principalmente em situações em que é difícil levantar dados empíricos ou em que casos específicos não permitem generalizações de evidências.
Dinâmica da estratégia logística em empresas brasileiras
Authors: Wanke Peter Fernandes
Published: April 2011

O objetivo do artigo é analisar a estratégia logística das empresas brasileiras a partir da mensuração do impacto de diferentes características do negócio sobre as principais decisões de produção e distribuição física de produtos acabados. Foi conduzida uma pesquisa de campo em empresas listadas no Ranking Exame para confrontar as quatro políticas propostas por Pagh e Cooper (1998), derivadas das combinações entre centralizar/descentralizar os estoques e produzir para estoque/produzir contra-pedido, com diversas características do produto, da operação e da demanda. Técnicas de análise multivariada, como as análises de regressão logística simples e multinomial, foram empregadas, permitindo o desenvolvimento de diversos modelos quantitativos. Seus resultados apontam para avanços acadêmicos e gerenciais, como a quantificação e hierarquização de relações empíricas descritas na literatura e o direcionamento da atenção gerencial para as variáveis relevantes à decisão. Os modelos também permitem avaliar a adequação dessas políticas para diferentes valores do tempo de entrega, da variabilidade das vendas e do grau de obsolescência dos produtos.
Estratégia de marketing: contribuições para a teoria em marketing
Authors: Maria Machado Toaldo Ana , Bins Luce Fernando
Published: April 2011

O artigo aborda o tema estratégia de marketing, enfocando sua formulação e implementação. Apresenta o desenvolvimento de um modelo teórico de formação da estratégia de marketing e suas contribuições para a teoria em Marketing. Para tanto, analisou-se a literatura sobre estratégia e estudaram-se dois modelos de formação da estratégia de marketing. Além desses modelos, agregou-se uma pesquisa exploratória realizada em algumas empresas, a qual permitiu que fosse elaborada uma estrutura inicial de um modelo evolutivo, validada por um grupo de executivos das empresas pesquisadas a partir dos resultados da modelagem de equações estruturais. A análise dos resultados da pesquisa sugere as variáveis significativas, bem como as suas relações para a formação da estratégia de marketing. Esse modelo contribui para o estudo da estratégia de marketing por apresentar reﬂexões sobre formulação e implementação de estratégias, elaborando um construto a partir das várias visões de estratégia.
A institucionalização do governo eletrônico no Brasil
Authors: Henrique Ramos Medeiros Paulo , de Aquino Guimarães Tomás
Published: April 2011

O artigo tem como objetivo identiﬁcar o estágio de institucionalização do governo eletrônico no Brasil e os possíveis reﬂexos dessa política na inclusão digital. A pesquisa realizada, de natureza qualitativa, baseou-se na opinião de informantes-chaves dos principais setores institucionais que compõem o e-gov no país: setor público, iniciativa privada, terceiro setor e academia. A análise de conteúdo foi o método utilizado para se extrair a percepção dos entrevistados sobre a política de e-gov, tendo sido utilizado o software Atlas.ti para auxiliar na ordenação conceitual dos dados coletados. Concluiu-se que o único aspecto que poderia ser considerado institucionalizado no governo eletrônico seria a relação do Estado com o terceiro setor na política de inclusão digital, encontrando-se os demais aspectos investigados, em sua maioria, em estágios de semi-institucionalização.
Dinâmica de mercado e trajetória de produtores em face do sistema de classificação de vinhos
Authors: Garcia-Parpet Marie-France
Published: April 2011

O objetivo deste artigo é reﬂetir sobre a relação entre os agentes econômicos e as instituições de mercado. Em específico, o artigo analisa como os produtores de vinhos na França reagem às rígidas classifi cações existentes no mercado de vinhos desse país. Partindo de um estudo de caso de dois produtores vinícolas franceses, o artigo discorre sobre dois conjuntos distintos de estratégias por eles adotados para maximizar seus lucros em um contexto de forte enquadramento institucional, que prima pela marca e qualidade do vinho atreladas à região a que pertencem. Como conclusão, o artigo destaca a importância da sociologia do agente para se compreender a dinâmica do mercado.
Avaliação de políticas públicas: uma revisão teórica de um campo em construção
Authors: Trevisan Andrei Pittol , Van Bellen Hans Michael
Published: April 2011

Este artigo realiza um resgate teórico da literatura sobre a área de políticas públicas em geral, e de avaliação de políticas públicas especificamente. O conhecimento teórico-histórico de um dado campo do conhecimento é essencial para sua práxis, para uma melhor compreensão dos seus desdobramentos, sua trajetória e perspectivas. O artigo começa com uma explanação sobre políticas públicas, sua origem e dimensões conceituais. Continua com uma discussão a respeito dessa temática no Brasil, principalmente nos últimos anos. A avaliação de políticas públicas é observada com maior profundidade, atravessando diversas definições conferidas pela literatura. Destaca-se a identificação de três fases da avaliação desde a década de 1960 até os dias atuais. Posteriormente, apresentam-se metodologias de avaliação de políticas públicas, suas diversas classificações, timing, posição do avaliador, critérios e estruturação. Por fim, a possibilidade de aplicação de metaavaliações, assim como o surgimento de novas issues que se impõem ao contexto democrático-participativo brasileiro.
Imunofluorescência indireta no pênfigo foliáceo endêmico. contribuição para sua padronização
Authors: Friedman Horácio , Campbell Iphis T. , Alvarez Rosicler Rocha , Diaz Luis A. , Castro Raymundo Martins De , Roitman Isaac , Parreiras Rosa M. , Raick Alberto N.
Published: April 2011

O propósito da presente investigação foi padronizar a reação de imunofluorescência indireta para Pênfigo Foliáceo Endêmico (Fogo Selvagem). Verificamos que a pele humana normal é o substrato ideal e que pode proceder de prepúcio, cabeça, pescoço ou da parede abdominal anterior. A lavagem prévia da pele precedendo a incubação com o soro deve ser evitada pois a antigenicidade pode ser diminuída. O TAS-cálcio preserva as propriedades antigênicas da pele e deve ser preferido como diluente para os soros. Lâminas cobertas com albumina são úteis porque aumentam a aderência dos cortes de pele. A diluição apropriada do conjugado é convenientemente determinada pelo teste de imunodifusão radial (método de Ouch-terlony). Com referência à correlação entre título de anticorpos e atividade clínica, concluímos que um título igual ou maior do que 160 era de mau prognóstico pois estava associado à forma generalizada da doença ou à casos de forma localizada refratários à terapêutica usual. Contudo, esta obervação requer confirmação através de estudos que envolvam uma abordagem clínica apropriada.
Susceptibilidad "in vitro" de cepas de Cryptococcus a 5 drogas antifungicas
Authors: Bava A. J. , Negroni R.
Published: April 2011

Se estudió la susceptibilidad "in vitro" de 24 cepas de 3 especies del género Cryptococcus a 5 drogas antifúngicas (anfotericina B, 5 fluorocitosina, ketoconazol, itraconazol y miconazol). Las mismas se agruparon según su especie, variedad y origen de aislamiento. Para determinar la concentración inhibitoria mínima (C.I.M.) de cada droga se empleó el método de dilución en agar con el medio básico nitrogenado para levaduras, adicionado de glucosa. Se obtuvo además la media geométrica de estos valores para cada grupo y se comparó cada uno de ellos. Los resultados obtenidos fueron homogéneos con la sola excepción de las cepas de Cryptococcus sp (no neoformans), en las cuales se detectaron elevados valores de C.I.M. para la 5 fluorocitosina.
Long-term outcome of neuroparacoccidioidomycosis treatment
Authors: Francesconi Fabio , Silva Marcus Tulius Teixeira da , Costa Regina Lana Braga , Francesconi Valeska Albuquerque , Carregal Eleonora , Talhari Sinésio , Valle Antonio Carlos Francesconi do
Published: April 2011

INTRODUCTION: Neuroparacoccidioidomycosis (NPCM) is a term used to describe the invasion of the central nervous system by the pathogenic fungus Paracoccidioides brasiliensis. NPCM has been described sporadically in some case reports and small case series, with little or no focus on treatment outcome and long-term follow-up. METHODS: All patients with NPCM from January 1991 to December 2006 were analyzed and were followed until December 2009. RESULTS: Fourteen (3.8%) cases of NPCM were identified out of 367 patients with paracoccidioidomycosis (PCM). A combination of oral fluconazole and sulfamethoxazole/trimethoprim (SMZ/TMP) was the regimen of choice, with no documented death due to Paracoccidioides brasiliensis infection. Residual neurological deficits were observed in 8 patients. Residual calcification was a common finding in neuroimaging follow-up. CONCLUSIONS: All the patients in this study responded positively to the association of oral fluconazole and sulfamethoxazole/trimethoprim, a regimen that should be considered a treatment option in cases of NPCM. Neurological sequela was a relatively common finding. For proper management of these patients, anticonvulsant treatment and physical therapy support were also needed.
Fatores de risco associados a alterações renais em pacientes infectados por HIV-1
Authors: Pinto Neto Lauro Ferreira Silva , Braga Andressa Costa , Rocha Juliana Alvarenga , Vieira Nilo Fernando Rezende , Miranda Angélica Espinosa
Published: April 2011

INTRODUÇÃO: A doença renal é uma das principais comorbidades envolvendo pacientes infectados com o HIV, em razão da melhora da sobrevida proporcionada pela terapêutica antirretroviral. O objetivo deste estudo foi detectar fatores de risco, possivelmente correlacionados com função renal alterada, em pacientes infectados pelo HIV. MÉTODOS: Estudo transversal foi realizado em 254 pacientes infectados pelo HIV, atendidos em ambulatório na Santa Casa de Vitória. Eles foram entrevistados e submetidos a coletas de amostras de sangue para contagem de células CD4, quantificação de carga viral do HIV-1, dosagens de glicose, lipídeos e creatinina. A proteinúria foi avaliada em amostra de primeira urina da manhã. A filtração glomerular foi estimada com as fórmulas de modified diet in renal disease (MDRD) simplificada e Cockcroft-Gault. RESULTADOS: Cento e três (40,6%) pacientes tinham alguma anormalidade no exame de urina, sendo proteinúria o achado mais comum (46; 18,1% pacientes). Vinte e cinco (9,8%) pacientes tinham filtração glomerular estimada inferior a 60ml/min/1.73m² de acordo com MDRD. A análise de regressão logística multivariada mostrou que baixa filtração glomerular foi positivamente correlacionada com raça negra [OR 9,6 (IC95% 1,28-23,80)], hipertensão arterial sistêmica [OR 3,3 (IC95% 1,28-23,81)], idade acima de 51 anos [OR 3,3 (IC95%1,11-9,90)], proteinúria [OR 5,2 {IC95% 1,67-16,25}]; hematúria [OR 3,2 (1,12-9,29)] e negativamente com pacientes em uso de zidovudina [OR 0,2 (0,04-0,78)]. CONCLUSÕES: Os fatores de risco tradicionais para doença renal como raça negra, hipertensão arterial e idade avançada foram correlacionados com menor filtração glomerular estimada em nossos pacientes.