bluuebunny/crossref_metadata_2025 huggingface dataset:
Recovery from Adolescent Anorexia Nervosa and Associations with Diurnal Patterns of Salivary Stress Hormones: A Case Report
Authors: Oskis Andrea , Loveday Catherine , Hucklebridge Frank , Wood David , Clow Angela
Published: December 2012

In the neurodevelopment of adolescent anorexia nervosa (AN), dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis is proposed to be a central component. Furthermore, a therapeutic milieu focusing on affect regulation can contribute much to treatment, given the emotional processing difficulties associated with this disorder. Studies of HPA axis function following such specialist treatments for adolescent AN, however, are rare. This study describes the diurnal pattern of HPA axis activation, including the cortisol awakening response (CAR), in a 16-year-old female diagnosed with AN both during illness and at clinical recovery following milieu therapy with a focus on affect regulation. Specialised single-case study statistics were used to assess whether the patient's data were significantly different from the healthy “norm” at illness and recovery. During illness, her measure of affective problems was outside of the normal range and cortisol and DHEA secretory profiles were significantly elevated across the diurnal period. However, at recovery both her affective state and HPA axis function became comparable to healthy controls. This case study suggests that salivary markers of HPA axis function can be feasibly incorporated into the clinical regime within a specialist adolescent AN residential service and could be used by clinicians to monitor prognosis and interventions.
Arthroscopic Excision of Intra-Articular Hip Osteoid Osteoma: A Report of 2 Cases
Authors: Nehme Alexandre H. , Bou Ghannam Alaa G. , Imad Joseph P. , Jabbour Fouad C. , Moucharafieh Ramzi , Wehbe Joseph
Published: December 2012

Intra-articular osteoid osteoma is uncommon accounting for approximately 12% of all osteoid osteomas. It presents diagnostic and therapeutic challenges since several traumatic or degenerative pathologies of the joint can be simulated with delay in the diagnosis. We report the clinical, radiographic, and histopathological findings in 2 cases of intra-articular osteoid osteoma of the femoral neck and of the acetabulum. Technical aspects of arthroscopic excision and results of surgery are discussed. Arthroscopy allowed complete excision of the osteoid osteomas, with a short postoperative rehabilitation and excellent functional results.
Submental Intubation Including Extubation: Airway Complications of Maxillomandibular Fixation
Authors: Yadav Santosh Kumar , Deo Gopendra
Published: December 2012

Hernandez first described the submental route for endotracheal intubation in 1986 as an alternative airway maneuver for maxillofacial procedures. Since that time, several case studies have been performed demonstrating the efficacy of the submental approach. This method was recently implemented in the case of a patient with altered nasal anatomy who sustained a mandibular fracture necessitating maxillomandibular fixation. Unlike most of the cases described in the literature, this patient’s operative course was confounded by the need to extubate through the submental tunnel. The patient tolerated the procedure well and was able to avoid other forms of surgical airway.
Positive Periodic Solutions of Nicholson‐Type Delay Systems with Nonlinear Density‐Dependent Mortality Terms
Authors: Chen Wei , Wang Lijuan
Published: December 2012

This paper is concerned with the periodic solutions for a class of Nicholson‐type delay systems with nonlinear density‐dependent mortality terms. By using coincidence degree theory, some criteria are obtained to guarantee the existence of positive periodic solutions of the model. Moreover, an example and a numerical simulation are given to illustrate our main results.
Numerical Model on Frost Height of Round Plate Fin Used for Outdoor Heat Exchanger of Mobile Electric Heat Pumps
Authors: Lee Moo-Yeon
Published: December 2012

The objective of this study is to provide the numerical model for prediction of the frost growth of the round plate fin for the purpose of using it as a round plate fin-tube heat exchanger (evaporator) under frosting conditions. In this study, numerical model was considering the frost density change with time, and it showed better agreement with experimental data of Sahin (1994) than that of the Kim model (2004) and the Jonse and Parker model (1975). This is because the prediction on the frost height with time was improved by using the frost thermal conductivity reflecting the void fraction and density of ice crystal with frost growth. Therefore, the developed numerical model could be used for frosting performance prediction of the round plate fin-tube heat exchanger.
A Kantorovich Type of Szasz Operators Including Brenke‐Type Polynomials
Authors: Taşdelen Fatma , Aktaş Rabia , Altın Abdullah
Published: December 2012

We give a Kantorovich variant of a generalization of Szasz operators defined by means of the Brenke‐type polynomials and obtain convergence properties of these operators by using Korovkin′s theorem. We also present the order of convergence with the help of a classical approach, the second modulus of continuity, and Peetre′s K‐functional. Furthermore, an example of Kantorovich type of the operators including Gould‐Hopper polynomials is presented and Voronovskaya‐type result is given for these operators including Gould‐Hopper polynomials.
Natural Immunity to HIV: A Delicate Balance between Strength and Control
Authors: Poudrier Johanne , Thibodeau Valérie , Roger Michel
Published: December 2012

Understanding how the mucosal immune system in the human female reproductive tract might prevent or facilitate HIV infection has important implications for the design of effective interventions. We and others have established cohorts of highly-exposed, HIV-seronegative individuals, such as HIV-uninfected commercial sex workers, who have remained HIV-negative after more than 5 years of active prostitution. Observations obtained in studies of such individuals, who represent a model of natural immunity to HIV, indicate that HIV resistance may be associated with the host’s capacity to preserve systemic integrity by constraining immune activity and controlling inflammatory conditions at the mucosal point of entry. This likely necessitates the orchestration of balanced, first-line and adaptive immune responses.
The Antibiotic Resistance Profiles of Bacterial Strains Isolated from Patients with Hospital-Acquired Bloodstream and Urinary Tract Infections
Authors: Ghadiri Hamed , Vaez Hamid , Khosravi Samira , Soleymani Ebrahim
Published: December 2012

Treatment of nosocomial infections is becoming difficult due to the increasing trend of antibiotics resistance. Current knowledge on antibiotic resistance pattern is essential for appropriate therapy. We aimed to evaluate antibiotic resistance profiles in nosocomial bloodstream and urinary tract pathogens. A total of 129 blood stream and 300 urinary tract positive samples were obtained from patients referring to Besat hospital over a two-year period (2009 and 2010). Antibiotic sensitivity was ascertained using the Kirby-Bauer disk diffusion technique according to CLSI guidelines. Patient's data such as gender and age were recorded. The ratio of gram-negative to gram-positive bacteria in BSIs was 1.6 : 1. The most prevalent BSI pathogen was Coagulase-NegativeStaphylococci(CoNS). The highest resistance rate of CoNS was against penicillin (91.1%) followed by ampicillin (75.6%), and the lowest rate was against vancomycin (4.4%).Escherichia coliwas the most prevalent pathogen isolated from urinary tract infections (UTIs). Ratio of gram-negative to gram-positive bacteria was 3.2 : 1. The highest resistance rate ofE. coliisolates was against nalidixic acid (57.7%). The present study showed that CoNS andE. coliare the most common causative agents of nosocomial BSIs and UTIs, and control of infection needs to be addressed in both antibiotic prescription and general hygiene.
Characterization of a “Smart” Hybrid Varnish Electrospun Nylon Benzotriazole Copper Corrosion Protection Coating
Authors: Menchaca C. , Castañeda I. , Soto-Quintero A. , Guardián R. , Cruz R. , García-Sánchez M. A. , Uruchurtu J.
Published: December 2012

This work presents the electrochemical evaluation of a proposed copper corrosion protection hybrid coating acting as asmartcorrosion protection system. This consists of an alkyd varnish, painted over electrospun nylon fibers acting as a secondary diffusion barrier and also as a benzotriazole (BTAH) inhibitor nanocontainer. Submicron diameter electrospun nylon 6-6 fiber nanocontainers were prepared from a polymeric solution containing BTAH at different concentrations, and Cu samples were coated with the electrospun fibers and painted over with an alkyd varnish by the drop method. Functional groups in fibers were determined through FTIR spectroscopy. Optical and SEM microscopies were used to characterize the nanocontainer fibers. Samples were evaluated using electrochemical impedance and noise, during six weeks of immersion, in a chloride-ammonium sulfate solution. Excellent response was obtained for thesmartinhibitor coating system. For long periods of immersion good corrosion protection performance was observed. The results presented demonstrate the good barrier properties of the hybrid coating, obstructing the diffusion of aggressive species, through the electrospun structure. Furthermore the nanocontainer functionality to store and liberate the corrosion inhibitor, only when it is needed, was also proved.
Modification of Multiwalled Carbon Nanotubes by Dipyridile Amine for Potentiometric Determination of Lead(II) Ions in Environmental Samples
Authors: Lotfi Zadeh Zhad Hamid Reza , Aboufazeli Forouzan , Amani Vahid , Najafi Ezzatollah , Sadeghi Omid
Published: December 2012

A carbon paste electrode was modified by dipyridile amine functionalized multiwalled carbon nanotubes for determination of trace amounts of lead(II) ions. The electrode composition was graphite powder 70%, paraffin 23%, and dipyridile amine modified MWCNTs 7% (W/W). The linear range for lead(II) was 9.5 × 10−8 to 2.5 × 10−3 mol L−1, and the limit of detection was obtained 7.0 × 10−8 mol L−1. The lifetime of the electrode was ten weeks, and a fast response time was observed. The electrode was used for determination of trace amounts of Pb(II) ions in real samples and standard reference materials of water, soil, and plant.
MDA-9/Syntenin and IGFBP-2 Promote Angiogenesis in Human Melanoma
Authors: Das Swadesh K. , Bhutia Sujit K. , Azab Belal , Kegelman Timothy P. , Peachy Leyla , Santhekadur Prasanna K. , Dasgupta Santanu , Dash Rupesh , Dent Paul , Grant Steven , Emdad Luni , Pellecchia Maurizio , Sarkar Devanand , Fisher Paul B.
Published: December 2012

Melanoma differentiation–associated gene-9 (mda-9/syntenin) encodes an adapter scaffold protein whose expression correlates with and mediates melanoma progression and metastasis. Tumor angiogenesis represents an integral component of cancer metastasis prompting us to investigate a possible role of mda-9/syntenin in inducing angiogenesis. Genetic (gain-of-function and loss-of-function) and pharmacologic approaches were used to modify mda-9/syntenin expression in normal immortal melanocytes, early radial growth phase melanoma, and metastatic melanoma cells. The consequence of modifying mda-9/syntenin expression on angiogenesis was evaluated using both in vitro and in vivo assays, including tube formation assays using human vascular endothelial cells, chorioallantoic membrane (CAM) assays and xenograft tumor animal models. Gain-of-function and loss-of-function experiments confirm that MDA-9/syntenin induces angiogenesis by augmenting expression of several proangiogenic factors/genes. Experimental evidence is provided for a model of angiogenesis induction by MDA-9/syntenin in which MDA-9/syntenin interacts with the extracellular matrix (ECM), activating Src and FAK resulting in activation by phosphorylation of Akt, which induces hypoxia inducible factor 1-α (HIF-1α). The HIF-1α activates transcription of insulin growth factor–binding protein-2 (IGFBP-2), which is secreted thereby promoting angiogenesis and further induces endothelial cells to produce and secrete VEGF-A augmenting tumor angiogenesis. Our studies delineate an unanticipated cell nonautonomous function of MDA-9/syntenin in the context of angiogenesis, which may directly contribute to its metastasis-promoting properties. As a result, targeting MDA-9/syntenin or its downstream-regulated molecules may provide a means of simultaneously impeding metastasis by both directly inhibiting tumor cell transformed properties (autonomous) and indirectly by blocking angiogenesis (nonautonomous). Cancer Res; 73(2); 844–54. ©2012 AACR.
Sorafenib Inhibits Cell Migration and Stroma-Mediated Bortezomib Resistance by Interfering B-cell Receptor Signaling and Protein Translation in Mantle Cell Lymphoma
Authors: Xargay-Torrent Sílvia , López-Guerra Mónica , Montraveta Arnau , Saborit-Villarroya Ifigènia , Rosich Laia , Navarro Alba , Pérez-Galán Patricia , Roué Gaël , Campo Elias , Colomer Dolors
Published: December 2012

Purpose: We evaluated the antitumoral properties of the multikinase inhibitor sorafenib in mantle cell lymphoma (MCL), an aggressive B lymphoma for which current therapies have shown limited efficacy.

Experimental Design: Sensitivity to sorafenib was analyzed in MCL cell lines and primary samples in the context of BCR and microenvironment simulation. Sorafenib signaling was characterized by quantitative PCR, Western blotting, immunofluorescence, and protein immunoprecipitation. Migration analysis included flow cytometric counting, actin polymerization assays, and siRNA-mediated knockdown of focal adhesion kinase (FAK). In vivo antitumor effect of sorafenib and bortezomib was analyzed in an MCL xenograft mouse model.

Results: Sorafenib rapidly dephosphorylates the BCR-associated kinases, Syk and Lyn, as well as FAK, an Src target involved in focal adhesion. In this line, sorafenib displays strong synergy with the Syk inhibitor, R406. Sorafenib also blocks Mcl-1 and cyclin D1 translation, which promotes an imbalance between pro- and antiapoptotic proteins and facilitates Bax release from cyclin D1, leading to the induction of mitochondrial apoptosis and caspase-dependent and -independent mechanisms. Moreover, sorafenib inhibits MCL cell migration and CXCL12-induced actin polymerization. FAK knockdown partially prevents this inhibitory effect, indicating that FAK is a relevant target of sorafenib. Furthermore, sorafenib enhances the antitumoral activity of bortezomib in an MCL xenograft mouse model as well as overcomes stroma-mediated bortezomib resistance in MCL cells.

Conclusion: We show for the first time that sorafenib interferes with BCR signaling, protein translation and modulates the microenvironment prosurvival signals in MCL, suggesting that sorafenib, alone or in combination with bortezomib, may represent a promising approach to treat patients with MCL. Clin Cancer Res; 19(3); 586–97. ©2012 AACR.
Prolonged Biologically Active Colonic Tissue Levels of Curcumin Achieved After Oral Administration—A Clinical Pilot Study Including Assessment of Patient Acceptability
Authors: Irving Glen R.B. , Howells Lynne M. , Sale Stewart , Kralj-Hans Ines , Atkin Wendy S. , Clark Susan K. , Britton Robert G. , Jones Donald J.L. , Scott Edwina N. , Berry David P. , Hemingway David , Miller Andrew S. , Brown Karen , Gescher Andreas J. , Steward William P.
Published: December 2012

Curcumin, the main constituent of turmeric, is suspected to possess cancer chemopreventive properties. Pharmacokinetic and pharmacodynamic parameters have been reported, but few data exist describing whether methodologies are suitably robust for curcuminoid detection in colonic biopsy specimens. Information on the acceptability of prolonged administration of daily curcumin is not available. This is of vital importance to implement chemoprevention strategies. This study aimed to quantify levels of curcuminoids in colorectal mucosa of patients undergoing colorectal endoscopy or surgical resection and to obtain information on the acceptability and compliance with daily curcumin. Curcumin C3 complex (2.35 g) was administered to patients once daily for 14 days before endoscopic biopsy or colonic resection. Safety and tolerance were monitored. Analysis of curcuminoids in plasma, urine, and colonic mucosa was conducted by ultraperformance liquid chromatography (UPLC)-UV with characterization by liquid chromatography/tandem mass spectrometry (LC/MS-MS). Twenty-four of 26 patients commencing curcumin completed the course. Six patients reported mild gastrointestinal adverse events. Curcuminoids were detectable in nine of 24 plasma samples, 24 of 24 urine samples, and in the colonic mucosa of all 23 biopsied participants. Mean tissue levels were 48.4 μg/g (127.8 nmol/g) of parent curcuminoids. The major conjugate, curcumin glucuronide, was detectable in 29 of 35 biopsies. High levels of topical curcumin persisted in the mucosa for up to 40 hours postadministration. Sixteen participants (67%) stated that they would take curcumin long-term should it be of proven benefit. In summary, pharmacologically active levels of curcumin were recovered from colonic mucosa. The regimen used here seems safe, and patients support its use in long-term trials. Cancer Prev Res; 6(2); 119–28. ©2012 AACR.
Continuous Surveillance to Reduce Extended-Spectrum β-Lactamase Klebsiella pneumoniae Colonization in the Neonatal Intensive Care Unit
Authors: Benenson Shmuel , Levin Phillip D. , Block Colin , Adler Amos , Ergaz Zivanit , Peleg Ofra , Minster Naomi , Gross Ilana , Schaffer Keren , Moses Allon E. , Cohen Matan J.
Published: December 2012

Background: Clinical illness caused by resistant bacteria usually represents a wider problem of asymptomatic colonization. Active surveillance with appropriate institution of isolation precautions represents a potential mechanism to control colonization and reduce infection. The neonatal intensive care unit (NICU) is an environment particularly appropriate for such interventions. Neonates are rarely colonized by resistant bacteria on admission and staff enthusiasm for infection control is high. Objective: To reduce extended-spectrum β-lactamase-producing Klebsiella pneumoniae (ESBL-KP) acquisition amongst neonates through a continuous active surveillance intervention. Methods: Fecal ESBL-KP cultures were performed weekly on all neonates over 4 years. Neonates with positive cultures were managed with contact precautions by dedicated nurses separately from other neonates. ESBL-KP acquisition amongst neonates staying >7 days was compared for the consecutive years. A subset of ESBL-KP isolates was typed with pulsed-field gel electrophoresis (PFGE). Results: Surveillance cultures were obtained from 1,482/1,763 (84%) neonates over 4 years. ESBL-KP acquisition decreased continuously from 94/397 (24%) neonates in 2006 to 33/304 (11%) in 2009 (p < 0.001, hazard ratio 0.75, 95% confidence interval 0.66–0.85, p < 0.001 for comparison of years). Hospital-wide ESBL-KP acquisition did not decrease outside the NICU. PFGE identified identical ESBL-KP strains from multiple neonates on six occasions and different strains from single neonates on seven occasions. Conclusions: ESBL-KP is probably both imported into and spread within the NICU. Continuous long-term surveillance with cohorting was associated with a decrease in ESBL-KP acquisition within the NICU. This low-risk intervention should be considered as a means to decrease neonatal acquisition of resistant bacteria.
Neonatal Morbidity after Exchange Transfusion for Red Cell Alloimmune Hemolytic Disease
Authors: Smits-Wintjens Vivianne E.H.J. , Rath Mirjam E.A. , van Zwet Erik W. , Oepkes Dick , Brand Anneke , Walther Frans J. , Lopriore Enrico
Published: December 2012

Background: Exchange transfusion (ET) is a high-risk procedure. The type and rate of complications in neonatal red cell alloimmune hemolytic disease exclusively are not clear. Objectives: Our aim was to study the type and rate of complications associated with ET in a large series of neonates with hemolytic disease of the fetus and newborn (HDFN) due to red cell alloimmunization. Methods: All neonates with HDFN due to red cell alloimmunization admitted to our center between January 2001 and June 2011 were eligible for this study. We recorded the number and rate of complications during admission in the group of neonates treated with ET (ET group) and not treated with ET (no-ET group). Multivariate logistic regression analysis was performed to measure the independent risk of complications of ET treatment. Results: A total of 347 infants with red cell alloimmune hemolytic disease were included; 39% (134/347) were treated with at least one ET (ET group), and 61% (213/347) did not require ET (no-ET group). Comparison between the ET group and no-ET group showed that ET treatment was independently associated with proven sepsis [8 vs. 1%, respectively; odds ratio (OR) 8.3, 95% confidence interval (CI) 1.7–40.3; p = 0.009], leukocytopenia (88 vs. 23%, respectively; OR 36.0, 95% CI 17.5–73.8; p < 0.001), severe thrombocytopenia (platelet count <50 × 109/l; 63 vs. 8%, respectively; OR 31.4, 95% CI 14.0–70.4; p < 0.001), hypocalcemia (22 vs. 1%, respectively; OR 27.4, 95% CI 5.9–126.8; p < 0.001) and hypernatremia (8 vs. 0%, respectively; p < 0.001). There were no neonatal deaths in the ET group. Conclusion: ET in neonates with HDFN is associated with an increased risk of sepsis, leukocytopenia, thrombocytopenia, hypocalcemia and hypernatremia.
Admixture Mapping of Coronary Artery Calcified Plaque in African Americans With Type 2 Diabetes Mellitus
Authors: Divers Jasmin , Palmer Nicholette D. , Lu Lingyi , Register Thomas C. , Carr J. Jeffrey , Hicks Pamela J. , Hightower R. Caresse , Smith S. Carrie , Xu Jianzhao , Cox Amanda J. , Hruska Keith A. , Bowden Donald W. , Lewis Cora E. , Heiss Gerardo , Province Michael A. , Borecki Ingrid B. , Kerr Kathleen F. , Chen Y.-D. Ida , Palmas Walter , Rotter Jerome I. , Wassel Christina L. , Bertoni Alain G. , Herrington David M. , Wagenknecht Lynne E. , Langefeld Carl D. , Freedman Barry I.
Published: December 2012

Background—

The presence and severity of coronary artery calcified plaque (CAC) differs markedly between individuals of African and European descent, suggesting that admixture mapping may be informative for identifying genetic variants associated with subclinical cardiovascular disease.

Methods and Results—

Admixture mapping of CAC was performed in 1040 unrelated African Americans with type 2 diabetes mellitus from the African American-Diabetes Heart Study, Multi-Ethnic Study of Atherosclerosis and Family Heart Study using the Illumina custom ancestry informative marker panel. All cohorts obtained computed tomography scanning of the coronary arteries using identical protocols. For each ancestry informative marker, the probability of inheriting 0, 1, and 2 copies of a European-derived allele was determined. Linkage analysis was performed by testing for association between each ancestry informative marker using these probabilities and CAC, accounting for global ancestry, age, sex, and study. Markers on 1p32.3 in the
GLIS1
gene (rs6663966, logarithm of odds [LOD]=3.7), 1q32.1 near CHIT1 (rs7530895, LOD=3.1), 4q21.2 near PRKG2 (rs1212373, LOD=3.0), and 11q25 in the
OPCML
gene (rs6590705, LOD=3.4) had statistically significant LOD scores, whereas markers on 8q22.2 (rs6994682, LOD=2.7), 9p21.2 (rs439314, LOD=2.7), and 13p32.1 (rs7492028, LOD=2.8) manifested suggestive evidence of linkage. These regions were uniformly characterized by higher levels of European ancestry associating with higher levels or odds of CAC. Findings were replicated in 1350 African Americans without diabetes mellitus and 2497 diabetic European Americans from Multi-Ethnic Study of Atherosclerosis and the Diabetes Heart Study.

Conclusions—

Fine mapping these regions will likely identify novel genetic variants that contribute to CAC and clarify racial differences in susceptibility to subclinical cardiovascular disease.
Low Numeracy Is Associated With Increased Odds of 30-Day Emergency Department or Hospital Recidivism for Patients With Acute Heart Failure
Authors: McNaughton Candace D. , Collins Sean P. , Kripalani Sunil , Rothman Russell , Self Wesley H. , Jenkins Cathy , Miller Karen , Arbogast Patrick , Naftilan Allen , Dittus Robert S. , Storrow Alan B.
Published: December 2012

Background—

More than 25% of Medicare patients hospitalized for heart failure are readmitted within 30 days. The contributions of numeracy and health literacy to recidivism for patients with acute heart failure (AHF) are not known.

Methods and Results—

A cohort of patients with acute heart failure who presented to 4 emergency departments between January 2008 and September 2011. Research assistants administered subjective measures of numeracy and health literacy; 30-day follow-up was performed by phone interview. Recidivism was defined as any unplanned return to the emergency department or hospital within 30 days of the index emergency department visit for AHF. Multivariable logistic regression adjusting for patient age, sex, race, insurance status, hospital site, days eligible for recidivism, chronic kidney disease, abnormal hemoglobin, and low ejection fraction evaluated the relation between numeracy and health literacy with 30-day recidivism. Of the 709 patients included in the analysis, 390 (55%) had low numeracy skills and 258 (37%) had low literacy skills. Low numeracy was associated with increased odds of recidivism within 30 days (adjusted odds ratio, 1.41; 95% confidence interval, 1.00–1.98;
P
=0.048). For low health literacy, adjusted odds ratio of recidivism was 1.17 (95% confidence interval, 0.83–1.65;
P
=0.37).

Conclusions—

Low numeracy was associated with greater odds of 30-day recidivism. Further investigation is warranted to determine whether addressing numeracy and health literacy may reduce 30-day recidivism for patients with acute heart failure.
Assessing Appropriateness of Lipid Management Among Patients With Diabetes Mellitus
Authors: Beard Ashley J. , Hofer Timothy P. , Downs John R. , Lucatorto Michelle , Klamerus Mandi L. , Holleman Rob , Kerr Eve A. ,   for the Diabetes Clinical Action Measures Workgroup
Published: December 2012

Background—

Performance measures that emphasize only a treat-to-target approach may motivate overtreatment with high-dose statins, potentially leading to adverse events and unnecessary costs. We developed a clinical action performance measure for lipid management in patients with diabetes mellitus that is designed to encourage appropriate treatment with moderate-dose statins while minimizing overtreatment.

Methods and Results—

We examined data from July 2010 to June 2011 for 964 818 active Veterans Affairs primary care patients ≥18 years of age with diabetes mellitus. We defined 3 conditions as successfully meeting the clinical action measure for patients 50 to 75 years old: (1) having a low-density lipoprotein (LDL) <100 mg/dL, (2) taking a moderate-dose statin regardless of LDL level or measurement, or (3) receiving appropriate clinical action (starting, switching, or intensifying statin therapy) if LDL is ≥100 mg/dL. We examined possible overtreatment for patients ≥18 years of age by examining the proportion of patients without ischemic heart disease who were on a high-dose statin. We then examined variability in measure attainment across 881 facilities using 2-level hierarchical multivariable logistic models. Of 668 209 patients with diabetes mellitus who were 50 to 75 years of age, 84.6% passed the clinical action measure: 67.2% with LDL <100 mg/dL, 13.0% with LDL ≥100 mg/dL and either on a moderate-dose statin (7.5%) or with appropriate clinical action (5.5%), and 4.4% with no index LDL on at least a moderate-dose statin. Of the entire cohort ≥18 years of age, 13.7% were potentially overtreated. Facilities with higher rates of meeting the current threshold measure (LDL <100 mg/dL) had higher rates of potential overtreatment (
P
<0.001).

Conclusions—

Use of a performance measure that credits appropriate clinical action indicates that almost 85% of diabetic veterans 50 to 75 years of age are receiving appropriate dyslipidemia management. However, many patients are potentially overtreated with high-dose statins.
Finescale Vertical Structure of the Upwelling System off Southern Peru as Observed from Glider Data
Authors: Pietri Alice , Testor Pierre , Echevin Vincent , Chaigneau Alexis , Mortier Laurent , Eldin Gerard , Grados Carmen
Published: December 2012

The upwelling system off southern Peru has been observed using an autonomous underwater vehicle (a Slocum glider) during October–November 2008. Nine cross-front sections have been carried out across an intense upwelling cell near 14°S. During almost two months, profiles of temperature, salinity, and fluorescence were collected at less than 1-km resolution, between the surface and 200-m depth. Estimates of alongshore absolute geostrophic velocities were inferred from the density field and the glider drift between two surfacings. In the frontal region, salinity and biogeochemical fields displayed cross-shore submesoscale filamentary structures throughout the mission. Those features presented a width of 10–20 km, a vertical extent of ~150 m, and appeared to propagate toward the shore. They were steeper than isopycnals and kept an aspect ratio close to f/N, the inverse of the Prandtl ratio. These filamentary structures may be interpreted mainly as a manifestation of submesoscale turbulence through stirring of the salinity gradients by the mesoscale eddy field. However, meandering of the front or cross-frontal wind-driven instabilities could also play a role in inducing vertical velocities.
A Comparison of Skill between Two Versions of the NCEP Climate Forecast System (CFS) and CPC’s Operational Short-Lead Seasonal Outlooks
Authors: Peng Peitao , Barnston Anthony G. , Kumar Arun
Published: December 2012

Analyses of the relative prediction skills of NOAA’s Climate Forecast System versions 1 and 2 (CFSv1 and CFSv2, respectively), and the NOAA/Climate Prediction Center’s (CPC) operational seasonal outlook, are conducted over the 15-yr common period of 1995–2009. The analyses are applied to predictions of seasonal mean surface temperature and total precipitation over the conterminous United States for the shortest and most commonly used lead time of 0.5 months. The assessments include both categorical and probabilistic verification diagnostics—their seasonalities, spatial distributions, and probabilistic reliability. Attribution of skill to specific physical sources is attempted when possible. Motivations for the analyses are to document improvements in skill between two generations of NOAA’s dynamical seasonal prediction system and to inform the forecast producers, but more importantly the user community, of the skill of the CFS model now in use (CFSv2) to help guide the users’ decision-making processes. The CFSv2 model is found to deliver generally higher mean predictive skill than CFSv1. This result is strongest for surface temperature predictions, and may be related to the use of time-evolving CO2 concentration in CFSv2, in contrast to a fixed (and now outdated) concentration used in CFSv1. CFSv2, and especially CFSv1, exhibit more forecast “overconfidence” than the official seasonal outlooks, despite that the CFSv2 hindcasts have outperformed the outlooks more than half of the time. Results justify the greater weight given to CFSv2 in developing the final outlooks than given to previous dynamical input tools (e.g., CFSv1) and indicate that CFSv2 should be of greater interest to users.
Firm Exit and Armed Conflict in Colombia
Authors: Camacho Adriana , Rodriguez Catherine
Published: December 2012

This article uses two unique panel data sets to study the causal effect that armed conflict has over firm exit in Colombia. Using a fixed-effect estimation methodology at the plant level and controlling for the possible endogeneity of armed conflict through the use of instrumental variables, we find that a one-standard deviation ( SD) increase in the number of guerrilla and paramilitary attacks in a municipality increases the probability of plant exit in 5.5 percentage points or .28 SD. This effect is stronger for younger manufacturing plants, with a smaller number of workers and low levels of capital.
What’s with the attitude?
Authors: Mandracchia Jon T. , Shaw Lucas B. , Morgan Robert D.
Published: December 2012

Public policies related to the criminal justice system in the United States ultimately reflect the attitudes of its citizens. It is surprising, therefore, how few studies have investigated influences on attitudes about criminal justice issues and how narrow the scope of such investigations has been. In this study, we examined the effects of education on attitudes toward several criminal justice issues in college students enrolled in a senior-level forensic psychology course compared to a nonpsycholegal psychology course. Results indicated that education about public policy issues influenced students’ attitudes toward the death penalty, prison reform, and the insanity defense. In addition, we examined preexisting differences in these attitudes based on demographic and other status variables (i.e., race, gender, academic class standing) and found that these variables were associated with differences in attitudes about criminal justice issues in a much more complex way than previously considered in the extant literature.
Age-Friendly Environments and Self-Rated Health:
Authors: Lehning Amanda J. , Smith Richard J. , Dunkle Ruth E.
Published: December 2012

While a number of organizations and government entities have encouraged the development of more “age-friendly” environments, to date there has been limited research linking these environment features to elder outcomes. Using a representative sample of older adults living in Detroit, this study examined the association between age-friendly environment factors and self-rated health. Results indicated that access to health care, social support, and community engagement were each associated with better self-rated health, while neighborhood problems were associated with poorer self-rated health. Moreover, individual-level income and education no longer predicted self-rated health once age-friendly environment factors were taken into account. These findings highlight the need for more research documenting the effects of age-friendly environments, particularly across diverse contexts and populations.
Loss in Rural Incomes, Children’s Education, and Child Labor
Authors: Homi Katrak
Published: December 2012

This essay focuses on how marked losses in incomes amongst poor households may lead parents to make significant cutbacks in their expenditures on their children’s education, and perhaps also put their children to work. It is based on simulation exercises using data on farming households in Punjab state, India. This research generated three main results. First, even small–moderate losses in incomes, ranging from 6 to 10 percent, can cause parents to cutback all their education expenditures, as well as other expenditures. Second, free education can help avoid cutbacks in these and other expenditures if the income losses are approximately 10 percent. Third, free education can significantly reduce parents’ need for income from child labor, and the decrease could be in the range of 67–76 percent.
Acoustic and fluid-dynamic optimization of an automotive muffler
Authors: Siano Daniela , Bozza Fabio , Auriemma Fabio
Published: December 2012

In this work, the acoustic and fluid-dynamic performances of a commercial three-chamber perforated muffler were simulated with a three-dimensional boundary element method and also a one-dimensional approach. The inner insulating material (wool) was taken into account in the performed analyses, together with the presence of a mean flow across the muffler in order to predict both the transmission loss and the pressure drop Δ p. Three-dimensional analyses were experimentally validated in a wide frequency range and in the absence of mean flow and were utilized to build a more precise one-dimensional representation of the device. In this way, better agreement between the one-dimensional results and the experimental data was realized, at least in the frequency range characterized by planar wave propagation (below 800 Hz). Once validated, the one-dimensional model was coupled to an external optimizer to perform acoustic and fluid-dynamic optimizations of the considered muffler. Initially, a genetic algorithm was employed to modify the internal muffler geometry and to improve the transmission loss, in the absence of mean flow, in the 100–800 Hz frequency range. A second optimization was also performed to identify the trade-off between the acoustic performance and the fluid-dynamic performance, in terms of the transmission loss and Δ p, in the 100–400 Hz frequency range.
Antibody response to common viruses and human leukocyte antigen-DRB1 in pediatric multiple sclerosis
Authors: Waubant Emmanuelle , Mowry Ellen M , Krupp Lauren , Chitnis Tanuja , Yeh E Ann , Kuntz Nancy , Ness Jayne , Belman Anita , Milazzo Maria , Gorman Mark , Weinstock-Guttman Bianca , Rodriguez Moses , James Judith A
Published: December 2012

Background:

As remote infections with common herpes viruses are associated with modulation of the risk of multiple sclerosis (MS), we hypothesized that antibody concentrations against these viruses may further modify risk. As many common viruses are first encountered during childhood, pediatric MS offer a unique opportunity to investigate more closely their influence on susceptibility. Our aim was to determine if MS patients who were positive for these viruses had higher levels of antibodies to these viruses. We also assessed whether human leukocyte antigen (HLA)-DRB1*1501 genotype influenced viral antibody levels.

Methods:

Antibody response levels toward Epstein Barr virus (EBV), cytomegalovirus (CMV), and herpes simplex virus (HSV)-1, and HLA-DRB1*1501 status were determined in pediatric MS patients ( n=189) and controls ( n=38). Multivariate analyses were used, adjusted for age, gender, race, ethnicity and use of disease-modifying therapies.

Results:

The antibody concentrations against EBV (Epstein-Barr nuclear antigen 1 (EBNA-1), viral capsid antigen (VCA) and early antigen (EA)), CMV and HSV-1 were similar between pediatric MS patients and controls positive for seroconversion against the virus of interest. EBNA-1 humoral responses were higher in HLA-DRB1 positive individuals ( p=0.005) whereas other viral humoral responses were similar in HLA-DRB1 positive and negative individuals.

Conclusion:

Among those positive for EBNA-1, MS patients did not have higher levels of antibody response to EBNA-1: however, titers for EBNA-1 were higher in those who were HLA-DRB1 positive. This suggests that genotype might influence the humoral response to EBV. Whether other genotypes influence antibody response to other viruses remains to be determined.
Fanon’s postcolonial cosmopolitanism
Authors: Go Julian
Published: December 2012

While early theory and research on cosmopolitanism have been criticized for their European focus, a number of works have incorporated non-Eurocentric perspectives. This article contributes to this literature by examining the colonial production of cosmopolitan orientations as evidenced in the writings of Frantz Fanon. Colonialism has been treated as a deviation in the historical sociology of cosmopolitanism, but Fanon helps disclose how colonialism has also contributed to a particular form of cosmopolitanism that has been overlooked in existing theory and research: postcolonial cosmopolitanism. This form of cosmopolitanism, forged from the spaces of colonialism’s contradictions, emphasizes global citizenship and humanism but strives to remember rather than repress the history of modern empire. It seeks to negate colonialism’s contradictions and thus realize the ideals which Europe had initially pronounced but which it failed to institute.
Promoting Medication Adherence and Regimen Responsibility in Two Adolescents on Hemodialysis for End-Stage Renal Disease
Authors: Payne Mary E. , Eaton Cyd K. , Mee Laura L. , Blount Ronald L.
Published: December 2012

Medication adherence and regimen responsibility (RR) have important implications for adolescents with hemodialysis-dependent end-stage renal disease (ESRD). This case study assesses the preliminary efficacy of a cognitive-behavioral intervention to promote medication adherence and RR in two African American adolescents. Two patients and their mothers participated. Intervention modules addressed adherence barriers. Using a case-series design, weekly parent–adolescent reports of medication adherence and RR were collected. The female participant’s selective nonadherence improved during treatment. Mother and daughter were high in RR throughout the study. The male participant’s adherence initially decreased following his mother’s reduced involvement in treatment. His adherence improved by the end of treatment, and coincided with his mother’s reassumption of RR. Improvements were maintained through follow-up for both patients. This case study provides preliminary support for using a cognitive-behavioral protocol to improve medication adherence in adolescents with hemodialysis-dependent ESRD.
Caring for prisoners: towards mindful practice
Authors: Walsh Elizabeth , Freshwater Dawn , Fisher Pamela
Published: December 2012

Those caring for prisoners are subject to the influences of the dominant custodial discourses of security and risk management that prevail in a prison environment. The conflicting caring and custodial roles adopted by nurses working in prisons and by prison officers constitute the foundation for further exploration of prisoner care in the wider healthcare literature. In this discussion paper, we argue that the identities and practices of those working in prison care are significantly shaped by organisational and societal discourses and that these generate rigidities and defensive mechanisms that limit the development of practice. We argue that a greater emphasis on mindfulness in professional development and clinical supervision may be helpful in enabling prison workers involved in caring roles to enter a professional dialogue characterised by openness, inclusion and engagement. This, we argue, would facilitate the development of newer and richer understandings of practice and to a revitalisation of professional engagement.
An imprecision importance measure for uncertainty representations interpreted as lower and upper probabilities, with special emphasis on possibility theory
Authors: Flage Roger , Aven Terje , Baraldi Piero , Zio Enrico
Published: December 2012

Uncertainty importance measures typically reflect the degree to which uncertainty about risk and reliability parameters at the component level influences uncertainty about parameters at the system level. The definition of these measures is typically founded on a Bayesian perspective where subjective probabilities are used to express epistemic uncertainty; hence, they do not reflect the effect of imprecision in probability assignments, as captured by alternative uncertainty representation frameworks such as imprecise probability, possibility theory and evidence theory. In the present article, we define an imprecision importance measure to evaluate the effect of removing imprecision to the extent that a probabilistic representation of uncertainty remains, as well as to the extent that no epistemic uncertainty remains. Possibility theory is highlighted throughout the article as an example of an uncertainty representation reflecting imprecision, and used in particular in two numerical examples that are included for illustration.
The Impact of an Online Social Network With Wireless Monitoring Devices on Physical Activity and Weight Loss
Authors: Greene Jessica , Sacks Rebecca , Piniewski Brigitte , Kil David , Hahn Jin S.
Published: December 2012

Background: Online social networks (OSNs) are a new, promising approach for catalyzing health-related behavior change. To date, the empirical evidence on their impact has been limited. Purpose: Using a randomized trial, we assessed the impact of a health-oriented OSN with accelerometer and scales on participant’s physical activity, weight, and clinical indicators. Methods: A sample of 349 PeaceHealth Oregon employees and family members were randomized to the iWell OSN or a control group and followed for 6 months in 2010-2011. The iWell OSN enabled participants to connect with “friends,” make public postings, view contacts’ postings, set goals, download the number of their steps from an accelerometer and their weight from a scale, view trends in physical activity and weight, and compete against others in physical activity. Both control and intervention participants received traditional education material on diet and physical activity. Laboratory data on weight and clinical indicators (triglycerides, high-density lipoprotein, or low-density lipoprotein), and self-reported data on physical activity, were collected at baseline, 3 months, and 6 months. Results: At 6 months, the intervention group increased leisure walking minutes by 164% compared with 47% in the control group. The intervention group also lost more weight than the controls (5.2 pounds compared with 1.5 pounds). There were no observed significant differences in vigorous exercise or clinical indicators between the 2 groups. Among intervention participants, greater OSN use, as measured by number of private messages sent, was associated with a greater increase in leisure walking and greater weight reduction over the study period. Conclusions: The study provides evidence that interventions using OSNs can successfully promote increases in physical activity and weight loss.
Comparisons Between Hispanic and Non-Hispanic White Informal Caregivers
Authors: Karlin Nancy J. , Weil Joyce , Gould James
Published: December 2012

This study focuses on understanding similarities and differences between non-Hispanic White and Hispanic informal caregivers of those with Alzheimer’s disease. Comparisons take place between caregivers reporting high levels of burden as indicated by the Zarit Burden Inventory. Data suggest similarities and differences between Hispanic ( n = 17) and non-Hispanic White ( n = 17) caregivers in this study in several areas. Hispanic caregivers indicated fewer sources of income, had less investment money for family member’s treatment, reported caregiving as a greater interference with life’s accomplishments, and indicated a lesser percentage of the total care cost provided by the family member. Non-Hispanic White caregivers reported having completed a higher level of formal education and that organized religion’s importance prior to becoming a caregiver was not quite as important as compared with the Hispanic care provider. With current trends, of demographic and cultural changes, it is crucial to fully understand the changing role and needs of both Hispanic and non-Hispanic White caregivers.
Tolerance induction with gene-modified stem cells and immune-preserving conditioning in primed mice: restricting antigen to differentiated antigen-presenting cells permits efficacy
Authors: Coleman Miranda A. , Bridge Jennifer A. , Lane Steven W. , Dixon Chantelle M. , Hill Geoffrey R. , Wells James W. , Thomas Ranjeny , Steptoe Raymond J.
Published: December 2012

Key Points

Restricting transgenic antigen expression to differentiated antigen-presenting cells protects hematopoietic progenitors from immune attack. Restricting transgenic antigen expression to differentiated antigen-presenting cells promotes tolerogenic outcomes.
Visualization of the dynamics of fibrin clot growth 1 molecule at a time by total internal reflection fluorescence microscopy
Authors: Hategan Alina , Gersh Kathryn C. , Safer Daniel , Weisel John W.
Published: December 2012

Key Points

Fibrin polymerization was observed for the first time at the single-molecule level by total internal reflection fluorescence microscopy. Live observation of fibrin polymerization with a single-molecule fluorescence intensity calibration revealed the real-time growth kinetics.