bluuebunny/crossref_metadata_2025 huggingface dataset:
Disability pension, employment and obesity status: a systematic review
Authors: Neovius K. , Johansson K. , Rössner S. , Neovius M.
Published: June 2008

Disability pensions incur huge societal costs in many countries. In Sweden, the three greatest drivers of such productivity losses are musculo‐skeletal, circulatory and psychiatric disorders, all closely associated with weight status. We identified 16 studies investigating the body mass index (BMI)–disability pension relation. In cross‐sectional studies, a significantly greater proportion of obese compared with normal weight subjects were disability pensioners. In longitudinal studies, a J‐shaped relation with BMI was generally found in both men and women of various ages. Different definitions of obesity status complicated interpretation, as several studies mixed the underweight and normal weight, which appear to have different disability pension risks. In middle‐aged men, relative risks were elevated for circulatory causes only for the overweight and obese, while associations for mental disorders were similar in the underweight and overweight but much higher in the obese. In both sexes, monotonic increases and decreases were seen for circulatory and respiratory causes respectively. In intervention studies, reduced disability pension incidence and increased gainful employment were reported after surgery. In summary, BMI was significantly associated with disability pension, but the direction of causality may vary with underlying cause. Interventions had positive productivity effects in the morbidly obese, but whether this holds for the overweight remains to be proven.
FIRM AND GOVERNMENT AS ACTORS IN PENROSE'S PROCESS THEORY OF INTERNATIONAL GROWTH: IMPLICATIONS FOR THE RESOURCE‐BASED VIEW AND OWNERSHIP–LOCATION– INTERNATIONALISATION PARADIGM
Authors: Connell Carol M.
Published: June 2008

Edith Penrose's The Theory of the Growth of the Firm proposed a process theory of growth based on the pursuit of knowledge by the firm and unconstrained by government. In her subsequent studies of foreign direct investment by large firms in developing countries, Penrose considers the firm and government as actors in the same growth process. This paper explores the development of Penrose's expanded process theory of growth from 1955 to 1973 in which she assumes that neither dual actors nor foreign expansion requires a new or special theory. This finding has implications for the resource‐based view and the eclectic ownership–location–internationalisation paradigm interpretations of international business.
INTEREST RATE RULES AND WELFARE IN OPEN ECONOMIES
Authors: Senay Ozge
Published: June 2008

This paper analyses the welfare performance of a set of five alternative interest rate rules in an open economy stochastic dynamic general equilibrium model with nominal rigidities. A rule with a lagged interest rate term, high feedback on inflation and low feedback on output is found to yield the highest welfare for a small open economy. This result is robust across different degrees of openness, different sources of home and foreign shocks, alternative foreign monetary rules and different specifications for price‐setting behaviour. The same rule emerges as both the Nash and cooperative equilibria in a two‐country version of the model.
BIASED TECHNOLOGICAL SHOCKS, RELATIVE WAGE RIGIDITIES AND LOW‐SKILLED UNEMPLOYMENT
Authors: Pierrard Olivier , Sneessens Henri R.
Published: June 2008

The contrast between the evolution over the last decades of the European Union (EU) and the US unemployment rates, especially for the low‐skilled, is well known. A consensus view is that these different outcomes can be explained by the interactions between common shocks and specific institutional setups. In this paper, we emphasize the interactions between technological changes and wages rigidities. We construct a fully calibrated general equilibrium model with two types of jobs and two types of workers, and with search unemployment. Our simulations show that with wage rigidities, technological changes suffice to generate a continuous rise in the low‐skilled unemployment rate and an almost unchanged high‐skilled unemployment rate. Without wage rigidities, the unemployment rates remain unchanged but the wage dispersion widens.
OVERINVESTMENT IN TEAM SPORTS LEAGUES: A CONTEST THEORY MODEL
Authors: Dietl Helmut M. , Franck Egon , Lang Markus
Published: June 2008

This paper applies contest theory to provide an integrated framework of a team sports league and analyzes the competitive interaction between clubs. We show that dissipation of the league revenue arises from ‘overinvestment’ in playing talent as a direct consequence of the ruinous competitive interaction between clubs. This overinvestment problem increases if the discriminatory power of the contest function increases, revenue‐sharing decreases, and the size of an additional exogenous prize increases. We further show that clubs invest more when they play in an open league compared with a closed league. Moreover, the overinvestment problem within open leagues increases with the revenue differential between leagues.
Connecting with Parents: Mothers' Depressive Symptoms and Responsive Behaviors in the Regulation of Social Contact by One‐ and Young Two‐year‐olds
Authors: Dix Theodore , Cheng Nina , Day William H.
Published: June 2008

When children act to involve mothers in positive interaction, they influence the amount, timing, and content of parent–child exchanges. By assessing children's smiling and positive initiation, we examined child behaviors that function to create positive interaction. In a non‐clinical North American sample of 103 mothers and their 14‐ to 27‐month‐olds, we observed that children attempted to connect positively with mothers (1) more with age, (2) more frequently and quickly immediately after mothers were responsive, (3) more with mothers who were generally supportive, and (4) more with mothers low in depressive symptoms. When mothers were high in depressive symptoms, age‐related increases in smiling and positive initiation were absent. Findings demonstrate the importance of maternal depression and responsiveness to child behaviors that involve mothers in ongoing activity. They suggest that both immediate cues and children's stored knowledge related to how mothers will respond may regulate children's positive connecting behaviors.
A Plan for Action: Key Perspectives from the Racial/Ethnic Disparities Strategy Forum
Authors: KING RODERICK K. , GREEN ALEXANDER R. , TAN‐McGRORY ASWITA , DONAHUE ELIZABETH J. , KIMBROUGH‐SUGICK JESSIE , BETANCOURT JOSEPH R.
Published: June 2008

Context: Racial and ethnic disparities in health care in the United States have been well documented, with research largely focusing on describing the problem rather than identifying the best practices or proven strategies to address it.

Methods: In 2006, the Disparities Solutions Center convened a one‐and‐a‐half‐day Strategy Forum composed of twenty experts from the fields of racial/ethnic disparities in health care, quality improvement, implementation research, and organizational excellence, with the goal of deciding on innovative action items and adoption strategies to address disparities. The forum used the Results Based Facilitation model, and several key recommendations emerged.

Findings: The forum's participants concluded that to identify and effectively address racial/ethnic disparities in health care, health care organizations should: (1) collect race and ethnicity data on patients or enrollees in a routine and standardized fashion; (2) implement tools to measure and monitor for disparities in care; (3) develop quality improvement strategies to address disparities; (4) secure the support of leadership; (5) use incentives to address disparities; and (6) create a messaging and communication strategy for these efforts. This article also discusses these recommendations in the context of both current efforts to address racial and ethnic disparities in health care and barriers to progress.

Conclusions: The Strategy Forum's participants concluded that health care organizations needed a multifaceted plan of action to address racial and ethnic disparities in health care. Although the ideas offered are not necessarily new, the discussion of their practical development and implementation should make them more useful.
Population Causes and Consequences of Leading Chronic Diseases: A Comparative Analysis of Prevailing Explanations
Authors: STUCKLER DAVID
Published: June 2008

Context: The mortality numbers and rates of chronic disease are rising faster in developing than in developed countries. This article compares prevailing explanations of population chronic disease trends with theoretical and empirical models of population chronic disease epidemiology and assesses some economic consequences of the growth of chronic diseases in developing countries based on the experiences of developed countries.

Methods: Four decades of male mortality rates of cardiovascular and chronic noncommunicable diseases were regressed on changes in and levels of country income per capita, market integration, foreign direct investment, urbanization rates, and population aging in fifty‐six countries for which comparative data were available. Neoclassical economic growth models were used to estimate the effect of the mortality rates of chronic noncommunicable diseases on economic growth in high‐income OECD countries.

Findings: Processes of economic growth, market integration, foreign direct investment, and urbanization were significant determinants of long‐term changes in mortality rates of heart disease and chronic noncommunicable disease, and the observed relationships with these social and economic factors were roughly three times stronger than the relationships with the population's aging. In low‐income countries, higher levels of country income per capita, population urbanization, foreign direct investment, and market integration were associated with greater mortality rates of heart disease and chronic noncommunicable disease, less increased or sometimes reduced rates in middle‐income countries, and decreased rates in high‐income countries. Each 10 percent increase in the working‐age mortality rates of chronic noncommunicable disease decreased economic growth rates by close to a half percent.

Conclusions: Macrosocial and macroeconomic forces are major determinants of population rises in chronic disease mortality, and some prevailing demographic explanations, such as population aging, are incomplete on methodological, empirical, and policy grounds. Rising chronic disease mortality rates will significantly reduce economic growth in developing countries and further widen the health and economic gap between the developed and developing world.
Universal ureteral stent placement at hysterectomy to identify ureteral injury: a decision analysis
Authors: Schimpf MO , Gottenger EE , Wagner JR
Published: June 2008

Objective  Iatrogenic ureteral injury during gynaecological surgery is associated with increased morbidity when not diagnosed during the initial surgery. Preoperative insertion of ureteral catheters may enhance intraoperative recognition of injury and repair, but it is controversial. We sought to analyse the costs of this approach.

Design/setting/population  A decision‐tree analysis of clinical scenarios of using universal ureteral catheterisation compared with no catheterisation was conducted for benign abdominal hysterectomy and radical hysterectomy.

Methods  Diagnostic‐Related Groups and Current Procedural Terminology coding and reimbursement information were used as calculated for Medicare patients in the USA.

Main outcome measures  Differences in projections of total hospital‐related costs related to clinical scenarios of perioperative care for women undergoing hysterectomy with or without ureteral catheterisation.

Results  Universal ureteral catheterisation is cost saving when the rate of ureteral injury during benign abdominal hysterectomy or radical hysterectomy is greater than 3.2%.

Conclusions  The cost savings of universal ureteral catheterisation at hysterectomy depend on the injury rate but are minimal at common levels of injury.
Reducing multiple pregnancy in assisted reproduction technology: towards a policy of single blastocyst transfer in younger women
Authors: Kalu E , Thum M‐Y , Abdalla H
Published: June 2008

Objectives  To investigate the effects of single blastocyst transfer (SBT) on live birth and multiple pregnancy in women undergoing in vitro fertilisation (IVF).

Design  Descriptive cohort study.

Setting  A London private IVF/postgraduate training unit.

Sample  A total of 700 fresh and 102 frozen blastocyst cycles performed between January 2005 and December 2006.

Methods  Young women aged 25–37 years and those aged 38–43 years were further divided into those who had SBT and those who received two blastocysts (double blastocyst transfer [DBT]). Live birth and multiple pregnancy rates were compared between groups. Cumulative live birth was compared between women who had DBT and those who received a SBT followed by a frozen blastocyst if the fresh cycle was unsuccessful.

Main outcome measures  Live birth rate, cumulative live birth rate, multiple pregnancy rate, uptake of SBT.

Results  Among women aged 25–37 years, live birth rate following SBT was 59.0 versus 60.7% following DBT. The twin pregnancy rate in this group was 2.3 and 47.6% respectively. For women aged 38–43 years, live birth following SBT was 29.4% and multiple pregnancy rate was 33.3%. DBT in older women gave a higher live birth rate (44.3%) and a multiple pregnancy rate of 36.4%. Cumulative live birth following SBT in women aged 25–37 years was 72.8% versus 60.5% following DBT. Among the women aged 38–43 years, cumulative live birth was higher (63.3%) following DBT versus 28.6% following SBT.

Conclusion  Single blastocyst transfer followed by transfer of a frozen blastocyst if the preceding fresh cycle was unsuccessful resulted in a better cumulative live birth and lower twin pregnancy in young women. In older women, two fresh blastocysts gave better results than one fresh followed by a frozen cycle. Older women should have the option of replacing two fresh blastocysts as this optimises their chances of taking home a baby.
Maternal temperature during labour
Authors: Schouten FD , Wolf H , Smit BJ , Bekedam DJ , De Vos R , Wahlen I
Published: June 2008

Objective  The aim of this study was to describe the variation of normal maternal temperature during labour.

Design  A prospective cohort study.

Setting  Two hospitals in Amsterdam, the Netherlands.

Population  All women with a live singleton pregnancy and a gestational age of 36 weeks or more admitted to the delivery ward from June 2000 to January 2002.

Methods  Maternal temperature was measured rectally every 2–3 hours from admission until the beginning of second stage, and 1‐hour postpartum. Normal labour (n = 843) was defined as gestational age ≥37 weeks, spontaneous onset of labour, rupture of membranes <18 hours before birth, normal progress of labour without the need for augmentation or epidural analgesia and spontaneous vaginal delivery of a healthy infant. The remaining group was classified as abnormal (n = 2209).

Main outcome measures  Rectal measured temperature in degrees Celsius.

Results  The mean temperature during labour in the complete study population increased from 37.1°C at the beginning of labour to 37.4°C after 22 hours. Temperature in the abnormal labour group was equal to the normal labour group during the first 3 hours of labour (P > 0.05) but increased thereafter.

Conclusions  At the beginning of labour, temperature was 37.1°C. Temperature increased slowly during labour and was 37.4°C (2SD 1.2) after 22 hours. The upper 2SD limit for normal temperature did not follow a circadian pattern and time of day is not relevant for the classification of normal versus elevated temperature.
The use of JJ stent in the management of deep endometriosis lesion, affecting or potentially affecting the ureter: a review of our practice
Authors: Weingertner AS , Rodriguez B , Ziane A , Gibon E , Thoma V , Osario F , Haddad C , Wattiez A
Published: June 2008

Objective  With the increasing number of operative laparoscopies performed for the treatment of deep pelvic endometriosis, technical difficulties and risk of complications inevitably increase. We report our experience using JJ stents, in women treated for deep pelvic endometriosis, with regard to prevention and management of ureteral lesions.

Design  Descriptive retrospective analysis between March 2004 and March 2007.

Setting  Department of Obstetrics and Gynaecology, University Hospital, Strasbourg, France.

Population and methods  Cases of women who underwent laparoscopic surgery for severe endometriosis and who needed a JJ stent in their management were recorded. Laparoscopic surgery was performed at the Department of Obstetrics and Gynaecology at CMCO‐SIHCUS and Hautepierre Hospitals, Strasbourg, which are referral centres in the treatment of deep endometriosis.

Main outcome measures  To evaluate the contribution of JJ stent in the prevention and management of ureteral lesions from endometriotic origin and/or iatrogenic origin in women treated for deep pelvic endometriosis.

Results  A total of 145 women had surgery for deep pelvic endometriosis. Seventeen (11.7%) women had a JJ ureteral stent inserted. In 82.4% of women, the stent was inserted pre‐ or peroperatively. We noted three ureteral complications, of which only one needed management by laparotomy.

Conclusions  Except in extreme cases, management of ureteral endometriosis should be performed laparoscopically. Ureteral lesions whether iatrogenic, or secondary to endometriotic disease, can be treated by cystoscopy, JJ stent and laparoscopy. The combination of these three elements is the optimal management and is unlikely to cause subsequent complications. Laparotomy and its associated morbidity should be avoided.
Insulin blocks cytochrome c release in the reperfused brain through PI3‐K signaling and by promoting Bax/Bcl‐XL binding
Authors: Sanderson Thomas H. , Kumar Rita , Sullivan Jonathon M. , Krause Gary S.
Published: June 2008

The critical event of the intrinsic pathway of apoptosis following transient global brain ischemia is the release of cytochrome c from the mitochondria. In vitro studies have shown that insulin can signal specifically via phosphatidylinositol‐3‐OH‐kinase (PI3‐K) and Akt to prevent cytochrome c release. Therefore, insulin may exert its neuroprotective effects during brain reperfusion by blocking cytochrome c release. We hypothesized that insulin acts through PI3‐K, Akt, and Bcl‐2 family proteins to inhibit cytochrome c release following transient global brain ischemia. We found that a single bolus of insulin given immediately upon reperfusion inhibited cytochrome c release for at least 24 h, and produced a fivefold improvement in neuronal survival at 14 days. Moreover, insulin’s ability to inhibit cytochrome c release was completely dependent on PI3‐K signaling and insulin induces phosphorylation of Akt through PI3‐K. In untreated animals, there was an increase in mitochondrial Bax at 6 h of reperfusion, and Bax binding to Bcl‐XL was disrupted at the mitochondria. Insulin prevented both these events in a PI3‐K‐dependent manner. In summary, insulin regulates cytochrome c release through PI3‐K likely by activating Akt, promoting the binding between Bax and Bcl‐XL, and by preventing Bax translocation to the mitochondria.
Volume‐dependent osmolyte efflux from neural tissues: regulation by G‐protein‐coupled receptors
Authors: Fisher Stephen K. , Cheema Tooba A. , Foster Daniel J. , Heacock Anne M.
Published: June 2008

The CNS is particularly vulnerable to reductions in plasma osmolarity, such as occur during hyponatremia, the most commonly encountered electrolyte disorder in clinical practice. In response to a lowered plasma osmolarity, neural cells initially swell but then are able to restore their original volume through the release of osmolytes, both inorganic and organic, and the exit of osmotically obligated water. Given the importance of the maintenance of cell volume within the CNS, mechanisms underlying the release of osmolytes assume major significance. In this context, we review recent evidence obtained from our laboratory and others that indicates that the activation of specific G‐protein‐coupled receptors can markedly enhance the volume‐dependent release of osmolytes from neural cells. Of particular significance is the observation that receptor activation significantly lowers the osmotic threshold at which osmolyte release occurs, thereby facilitating the ability of the cells to respond to small, more physiologically relevant, reductions in osmolarity. The mechanisms underlying G‐protein‐coupled receptor‐mediated osmolyte release and the possibility that this efflux can result in both physiologically beneficial and potentially harmful pathophysiological consequences are discussed.
Exercise in Migraine Therapy—Is There Any Evidence for Efficacy? A Critical Review
Authors: Busch Volker , Gaul Charly
Published: June 2008

Background.—Some migraine patients find that regular exercise helps in reducing the frequency of headache attacks. In addition, exercise in migraine is recommended from many headache experts. However, most of these recommendations refer to some anecdotal reports or observational studies in literature stating that regular exercise can reduce the frequency and severity of migraine.

Objective.—The purpose of this review is to investigate whether recommendations for exercise in migraine are based on sufficient data to cope with requirements of an evidence‐based modern migraine therapy. The review summarizes and discusses all available trials on this topic.

Results.—Eight studies und 4 case reports investigated the therapeutic role of aerobic exercise on migraine headache. Some results are controversial regarding the efficacy of sports intervention in migraine. The majority of studies did not find a significant reduction of headache attacks or headache duration and only indicate a reduction of pain intensities in migraine patients due to regular exercise. The grade of recommendation of exercise in migraine based on evidence based medicine (EBM)‐criteria is presently B‐C. But due to methodological limitations, the available data are insufficient for a final statement on this topic.

Conclusions.—To further recommend exercise in migraine based on EBM‐criteria, more studies are imperative. Future studies should adhere to the rules for randomized clinical trials in pharmacological migraines prophylaxis. Implications for further studies are given.
Pearls From an Inpatient Headache Unit
Authors: Saper Joel R.
Published: June 2008

Much can be learned from treating over 15,000 headache hospitalized patients over the course of 30 years. By the very need to be admitted, these individuals are complicated, both physiologically and often psychologically. Founded in 1978, the Michigan Head Pain and Neurological Institute and its hospital unit developed a set of criteria for admission and a growing staff of professionals to serve this complex population of patients. Experience has taught us many lessons; several are considered in this review. Among the important topics discussed are: admission criteria to the hospital unit; treatment protocols and other hospital‐based strategies; integration of behavioral therapy and therapists into the treatment system; diagnostic testing of patients with intractable headache; identifying the “problem patient” and “medication misuse” early in the course of therapy; approaching the headache patient with cluster B personality disorder; and the use of interventional and anesthesiological treatment for intractable headache. Outcome data and a review of recent publications are presented.
Refractory Headache: Classification and Nomenclature
Authors: Levin Morris
Published: June 2008

There are a number of reasons to attempt to define and classify refractory headache disorders. Particularly important are the potential benefits in the areas of research, treatment, and medical cost reimbursement. There are challenges in attempting to classify refractory forms of headaches, including the lack of biological or other objective markers and a lack of consensus among practitioners as to what qualifies as refractoriness, or even if a separate category for refractory migraine and other refractory headaches needs to be established. A definition of refractory migraine has been proposed by Schulman et al in this issue (“Defining Refractory Migraine [RM] and Refractory Chronic Migraine [RCM]: Proposed Criteria for the Refractory Headache Special Interests Section of the American Headache Society”), which should be tested for validity and usefulness. It seems reasonable to consider adding this defined syndrome to the International Classification of Headache Disorders, second edition (ICHD‐II). In this article, options for adding refractory headache syndromes to the ICHD are discussed with pros and cons for each. Two “best” options for adding the disorder “refractory migraine” to the ICHD are presented along with an illustrative case example.
Continuous Opioid Therapy (COT) is Rarely Advisable for Refractory Chronic Daily Headache: Limited Efficacy, Risks, and Proposed Guidelines
Authors: Saper Joel R. , Lake III Alvin E.
Published: June 2008

Intractable pain, headache or otherwise, is a devastating and life‐controlling experience. The need to effectively and aggressively control pain is a fundamental tenet of clinical care. In the past several years, increasing advocacy for continuous opioid therapy has become an important, if not controversial, theme in the development of treatment guidelines and teaching programs. Ironically, the increasing willingness of physicians to prescribe scheduled opioids for their headache and pain patients has occurred in the absence of compelling data demonstrating efficacy or long‐term safety. To the contrary, two meta‐analyses on chronic noncancer pain (CNCP) and one long‐term uncontrolled study on headache patients demonstrate a relatively small number of patients benefiting from the treatment. Recent neuroscience data on the effects of opioids on the brain raise serious concern for long‐term safety and also provide the basis for the mechanism by which chronic opioid use might induce progression of headache frequency and severity. Significant adverse effects, including influence on sexual hormonal balances, physical and psychological dependence, the development of opioid‐induced hyperalgesia, and cardiac arrhythmia and sudden death that can be seen with standard dosages of methadone, make a strong argument against widespread use of continuous opioid therapy (COT) in otherwise healthy young and middle‐aged headache patients.

We believe that COT should be used in rare circumstances for chronic headache patients, and propose initial guidelines for selecting patients and monitoring treatment. The physician should be well versed in the details of opioid prescribing, administration, and monitoring, and should be prepared to discontinue opioids when clinical justification, patient behavior, or failure to achieve therapeutic goals make discontinuance necessary.
Examining the Utility of In‐Clinic “Rescue” Therapy for Acute Migraine
Authors: Morey Veronica , Rothrock John F.
Published: June 2008

Background.— Management options currently are limited for patients with acute migraine whose symptoms prove refractory to self‐administered therapy.

Objective.— To evaluate the clinical utility and cost‐effectiveness of a management program offering in‐clinic “rescue” treatment for patients with acute migraine.

Methods.— Two hundred consecutive migraine patients presenting to a university‐based headache clinic were randomized to receive either optimal self‐administered medical therapy for acute migraine (“standard therapy”) or similar therapy plus the option of in‐clinic parenteral drug administration should self‐administered therapy prove ineffective (“rescue therapy”). Patients randomized to the latter group were restricted to a maximum of 2 “rescue visits” per month, and all patients were followed for one year. Patients “rescued” in clinic were contacted by telephone 24 hours following treatment to evaluate their treatment response. The primary analysis involved a comparison of the number of emergency department (ED) visits for headache recorded within each group over the one‐year period of study. For all ED visits in the rescue group and for a randomly selected and equal number of ED visits within the standard group, the direct costs associated with those visits were assessed, and the direct costs of all in‐clinic rescue visits also were recorded and analyzed.

Results.— The 2 groups studied were similar in terms of age, gender ratio, migraine subtype, migraine‐related disability status at baseline and type/extent of medical insurance coverage. Over the one‐year study period, the rescue group recorded 423 in‐clinic rescue visits and reported 27 ED visits for headache treatment. The standard therapy group reported 73 ED visits (27 vs 73 visits; P < .01). The total direct costs associated with ED visits were $45,330 for the rescue group (mean $1690 per ED visit) and (by extrapolation from the sample selected) $147,971 for the standard therapy group (mean $2027 per ED visit). The total direct cost of the 423 “rescue visits” was $33,647 (mean $80 per visit). In 79% of the 423 rescue encounters, the patients involved reported no residual functional disability 24 hours following treatment. Of those in the rescue group who sought in‐clinic rescue, 89% reported themselves “very satisfied” with such management.

Conclusion.— Providing the alternative of in‐clinic “rescue” for acute migraine refractory to self‐administered therapy offers an attractive alternative for patients and appears to substantially lower use of an ED for headache treatment and the cost associated with that use.
Standard of Care
Authors: Blumenthal Harvey J. , Woodard III John R.
Published: June 2008

“Standard of care” sounds like a medical term, but actually it is a universal legal concept. It is codified differently by individual state statutes and is written into each state's uniform jury instructions. The phrase increasingly appears in scientific articles discussing the management of patients with headache. But, the term usually is not defined nor is evidence presented to justify the notion that the so‐called standard has any scientific basis. In a courtroom, jury instructions using this phrase can be a legal sword aimed at a defendant doctor, rather than a shield. At risk is a physician's basic right to care for a patient according to that individual's particular needs.
Integration of adult generated neurons during epileptogenesis
Authors: Zhao Chuan‐Sheng , Overstreet‐Wadiche Linda
Published: June 2008

Summary

Adult generated neurons in the dentate gyrus become functionally integrated into the existing hippocampal circuit by forming synapses with mature neurons. It is now well established that seizure activity increases neural proliferation, but only recently has the fate of seizure‐induced newborn neurons been examined. An emerging consensus proposes that newborn neurons are highly sensitive to their environment, such that synaptic integration is profoundly altered following insults such as seizures. Whether these changes contribute to or counteract epileptogenesis is a subject of great interest because neurogenesis provides a potential target for therapeutic intervention. In this review, we summarize the current understanding of the functional integration of adult generated granule cells in the normal rodent hippocampus, and describe how this process can be altered during epileptogenesis.
Structural changes for adult‐born dentate granule cells after status epilepticus
Authors: Shapiro Lee A. , Ribak Charles E. , Jessberger Sebastian
Published: June 2008

Summary

Status epilepticus (SE) not only results in an increased number of newly generated neurons in the dentate gyrus but also leads to structural alterations of many of these newborn granule cells. One of the structural changes involving newly generated dentate granule cells is the formation of hilar basal dendrites that persist on mature granule cells and integrate into synaptic circuitry. SE also causes other newborn granule cells to migrate ectopically into the hilus, and these cells also integrate into synaptic circuitry. This article will describe these structural alterations of granule cells found in the dentate gyrus after SE and will also discuss the time course of these events and possible underlying causes.
Comparative assessment of normal and methoxypolyethylene glycol–modified murine red cells on swimming endurance and hippocampal injury in hypoxic mice
Authors: Tan YingXia , Ji ShouPing , Li SuBo , Wang JieXi , Jin XiaoPan , Zhang YangPei
Published: June 2008

BACKGROUND: Membrane grafting of methoxypolyethylene glycol (mPEG) provides a unique strategy in preventing the immunologic recognition in blood transfusion. mPEG‐modified red blood cells (mPEG‐RBCs) have acceptable in vitro properties and provide a useful solution to problems with clinical blood matching. The aim of this study was to demonstrate the physiologic normality of mPEG‐RBCs in mice.

STUDY DESIGN AND METHODS: Mouse RBCs were withdrawn via cardiac bleed and modified with 1.0 mmol per L mPEG with succinimidyl propionate linker. The fluorescein‐labeled mPEG‐RBCs were then transfused into recipient mice for in vivo survival analysis. At the same time, the exsanguine mouse model was produced, and mice were transfused with mPEG‐RBCs. The effects of mPEG‐RBC transfusion on the hemoglobin (Hb) level, swimming endurance capacity, and hypoxic‐ischemic injury in hippocampal pyramidal cells of exsanguine mice were investigated.

RESULTS: mPEG‐RBCs showed the same in vivo survival curve and t½ as those of untreated RBCs. Transfusion of mPEG‐RBCs could elevate Hb level of exsanguine mice and improve their swimming endurance capacity, and histologic studies showed that mPEG‐RBCs could also restore the hypoxic‐ischemic injury of hippocampal pyramidal cells in exsanguine mice, which were similar with control RBCs. That is, mPEG‐RBCs functioned in a similar fashion to untreated RBCs in exsanguine mice. Therefore, these results revealed that mPEG‐RBCs had normal oxygen‐carrying capacity.

CONCLUSION: In conclusion, the results confirmed that mPEG‐RBCs could perform their in vivo function of carrying O2 and improve some physiologic indexes of exsanguine mice, and the physiologic normality of mPEG‐RBCs provides new findings for clinical use.
Fatal hemolytic disease of the fetus and newborn associated with anti‐Jra
Authors: Peyrard Thierry , Pham Bach‐Nga , Arnaud Lionel , Fleutiaux Sophie , Brossard Yves , Guerin Bénédicte , Desmoulins Isabelle , Rouger Philippe , Le Pennec Pierre‐Yves
Published: June 2008

BACKGROUND: Jra is a high‐prevalence red cell (RBC) antigen. The clinical significance of anti‐Jra is controversial. When hemolytic disease of the fetus and newborn (HDFN) occurred, most reported cases were clinically mild. We report the first case of fatal HDFN due to anti‐Jra.

CASE REPORT: A 28‐year‐old Caucasian woman with transfusion history was monitored at the 29th week of pregnancy (G4P1). An ultrasound scan showed fetal cardiomegaly and hepatomegaly. An antibody directed against a high‐prevalence antigen was detected, but without conclusive identification. An emergency cesarean section was performed at the 36th week. The newborn was hydropic and showed severe anemia. Death occurred 30 hours after birth.

MATERIALS AND METHODS: Serologic methods were performed to investigate the mother's RBCs and serum. An in vitro functional cellular assay and semiquantitative measurement of anti‐Jra were used to determine the clinical significance of the antibody.

RESULTS: Anti‐Jra was identified in the serum and Jr(a−) phenotype was confirmed. The anti‐Jra titer was 1024, with predominant immunoglobulin (Ig)G1 and minor IgG4 subclasses. The functional cellular assay was consistent with an antibody unlikely to cause HDFN. Semiquantitative measurement of anti‐Jra showed a reactivity equivalent to a 25 IU per mL (5 µg/mL) concentration of anti‐D, a value associated with a significant risk of HDFN.

CONCLUSION: This is the first documented case of fatal HDFN due to anti‐Jra. Therefore, we recommend close monitoring of pregnant women with a high‐titer anti‐Jra, especially those with an incompatible transfusion history and/or multiple pregnancies. This case report provides new arguments about the clinical significance of anti‐Jra in the transfusion setting.
Seroprevalence of Trypanosoma cruzi infection in at‐risk blood donors in Catalonia (Spain)
Authors: Piron Maria , Vergés Mireia , Muñoz José , Casamitjana Natàlia , Sanz Sergi , Maymó Rosa María , Hernández José Manuel , Puig Lluís , Portús Montserrat , Gascón Joaquim , Sauleda Sílvia
Published: June 2008

BACKGROUND: The increasing arrival of Latin Americans to Europe and, particularly, to Spain has led to the appearance of new pathologies, such as Chagas disease, a zoonotic infection endemic to rural areas of Central and South America. In the absence of the triatomid vector, one of the main modes of transmission of Chagas disease in nonendemic regions is through blood transfusion.

STUDY DESIGN AND METHODS: The Catalonian Blood Bank has implemented a screening program for Chagas disease in at‐risk blood donors and has performed a study to determine the seroprevalence of Trypanosoma cruzi infection in the donor population. The two commercial tests used in all samples were the ID‐PaGIA Chagas antibody test (DiaMed) and the bioelisa Chagas assay (Biokit).

RESULTS: Overall seroprevalence was 0.62 percent, with 11 donors confirmed positive among the 1770 at‐risk donors studied; the highest rate (10.2%) was in Bolivian donors. Interestingly, 1 of the 11 positive donors was a Spaniard who had resided various years in a Chagas disease endemic area. Furthermore, 1 of the positive donors presented detectable parasitemia.

CONCLUSION: The results of this study emphasize the need for T. cruzi screening in at‐risk blood donors in nonendemic countries. An important finding is the relevance of including in the at‐risk category persons who have resided in, but were not necessarily born in, an endemic region. If T. cruzi screening is not routinely performed in all donations, it remains highly dependent on proper identification of at‐risk donors during the predonation interview.
Transfusion‐related immunomodulation by platelets is dependent on their expression of MHC Class I molecules and is independent of white cells
Authors: Aslam Rukhsana , Speck Edwin R. , Kim Michael , Freedman John , Semple John W.
Published: June 2008

BACKGROUND: Transfusion‐related immunomodulation (TRIM) has been correlated with the presence of white cells (WBCs) in blood transfusions, but the role of components such as platelets (PLTs) in mediating TRIM has not been extensively examined. We designed a murine PLT transfusion model to study whether leukoreduced PLTs mediate TRIM effects.

STUDY DESIGN AND METHODS: CBA recipient mice were administered four weekly transfusions of either fresh (4 hr) or aged (24 and 72 hr) donor leukoreduced PLTs from allogeneic BALB/c mice and then transplanted with skin grafts from donor‐matched mice. TRIM was measured by comparing the times to graft rejection and these were correlated with immunoglobulin G (IgG) antibody development measured by flow cytometry.

RESULTS: Compared with nontransfused control recipients, four transfusions of fresh, extremely leukoreduced (<0.05 WBCs/mL), allogeneic PLTs significantly (p < 0.002) reduced the recipient's ability to reject donor‐matched skin grafts (survival >49 days compared with <14 days in nontransfused controls) despite the presence of high‐titered serum IgG donor antibodies. In contrast, however, aged PLTs or fresh PLTs devoid of MHC Class I molecules were unable to affect skin graft survival nor stimulate antibody production. The PLT age‐related inability to induce TRIM was shown to be due to loss of PLT‐associated MHC Class I molecules; soluble supernatant MHC molecules that were transfused were unable to induce TRIM.

CONCLUSION: These results suggest that fresh PLTs can induce TRIM independently of WBCs due to their MHC antigen expression whereas aging results in loss of MHC and ability to mediate TRIM. The findings support the concept that either active MHC removal from fresh PLTs or passive removal by, for example, storage, may reduce any deleterious effects of TRIM in transfusion recipients.
Two MER2‐negative individuals with the same novel CD151 mutation and evidence for clinical significance of anti‐MER2
Authors: Karamatic Crew Vanja , Poole Joyce , Long Shannon , Warke Nicole , Colavecchia Connie , Burton Nicholas , Moulds Marilyn , Schlanser Gloria , Wilson Laura , Noumsi Ghislain , Moulds Joann M. , Moulds John J. , Daniels Geoff
Published: June 2008

BACKGROUND: MER2 (RAPH1), the only antigen of the RAPH blood group system, is located on the tetraspanin CD151. Only four examples of alloanti‐MER2 are known. We report here two new examples of alloanti‐MER2, in women of Pakistani and Turkish origin, one of whom showed signs of a hemolytic transfusion reaction (HTR) after transfusion of 3 units of red cells (RBCs).

STUDY DESIGN AND METHODS: Standard serologic methods were used. A monocyte monolayer assay (MMA) was used to assess the potential clinical significance of one of the antibodies. All exons and flanking intronic sequences of CD151 were amplified and sequenced. A homology model for CD151 second extracellular loop (EC2) was constructed based on the crystal structure of CD81.

RESULTS: RBCs of both patients did not react with alloanti‐MER2, and neither of their antibodies reacted with MER2‐negative RBCs. The MMA results suggested that the antibody that appeared to have caused an HTR had the potential to be clinically significant. Both patients were homozygous for a 511C>T mutation in CD151 encoding an Arg171Cys change. This change did not result in any significant structural rearrangement in the protein model.

CONCLUSIONS: Two MER2‐negative patients with anti‐MER2 are homozygous for the same novel mutation encoding an amino acid substitution in the EC2 of CD151. One of the antibodies may have been responsible for an HTR, and crossmatch‐compatible RBCs should be recommended for transfusion to patients with anti‐MER2.
BaxSr1−xTiO3 Thin Film Ferroelectric‐Coupled Microstripline Phase Shifters with Reduced Device Hysteresis
Authors: Miranda Félix A. , Mueller Carl H. , Van Keuls Frederick W. , Romanofsky Robert R.
Published: June 2008

In this work, we present experimental results on the performance of coupled microstripline phase shifters (CMPS) fabricated using BaxSr1−xTiO3 (BST) ferroelectric thin films. The CMPS were fabricated using commercially available pulsed laser deposition BST films with Ba:Sr ratios of 30:70 and 20:80. Microwave characterization of these CMPS was performed at upper Ku‐band frequencies, particularly at frequencies near 16 and 18 GHz. The quality of performance of the CMPS was studied based on their relative phase shift (Δϕ=ϕnV−ϕ0V, where n=0–400 V DC) and insertion loss within the DC bias range of 0–400 V (i.e., E‐field ranges within 0–53 V/μm). The performance of the CMPS was tested as a function of temperature to investigate their operation in the paraelectric as well as in the ferroelectric state (i.e., above and below the Curie temperature, respectively). It was observed that for the CMPS fabricated with the BST films, with Ba:Sr ratio of 30:70, the performance was very good with Δϕ up to 400° and nominal insertion losses of ∼3 dB. In addition, these devices were hysteresis‐free in the paraelectric state and only showed Δϕ hysteresis while performing in the ferroelectric state. In contrast, while the CMPS made with Ba:Sr ratios of 20:80 exhibited very good values of Δϕ, they exhibited a mild hysteresis both in the paraelectric and ferroelectric states. X‐ray diffraction studies indicate that the 30:70 films exhibit almost a 1:1 ratio between the in‐plane and out‐of‐plane lattice parameters, suggesting that their cubic structure creates strain‐free films conducive to CMPS devices with reduced hysteresis in the paraelectric state. Elimination of Δϕ hysteresis is essential because many practical microwave applications such as voltage‐controlled oscillators and beam steerable devices, particularly electronically steerable phased array antennas, rely on accurate phase shift versus tuning voltage profiles required for reliable device operation. Accordingly, the optimization of the interplay between film microstructure, Ba content, and dielectric constant is critical for reliable CMPS devices.
Physical Modeling and Electrodynamic Characterization of Dielectric Slurries by Impedance Spectroscopy (Part II)
Authors: Petrovsky Vladimir , Petrovsky Tatiana , Kamlapurkar Swetha , Dogan Fatih
Published: June 2008

Electrical characterization of dielectric slurries, as 0–3 composite systems, can provide valuable information on the dielectric properties of suspended particles. A new approach developed in our laboratory is based on impedance spectroscopy measurements of the slurries containing dispersed dielectric powders. Dielectric constants of the particles are determined through analysis of the low‐frequency section of the impedance spectra. It was shown previously that this approach allows accurate and reliable measurement of dielectric constant of particles (ɛ: ∼100–2000) using host liquids (ɛ: ∼10–65). This study addresses the validation of this new method with physical model experiments using millimeter‐sized sintered BaTiO3 model samples suspended in the liquid. Impedance spectra of barium titanate powder slurries were compared with the spectra of the model samples containing macroscopic cubes prepared by sintering of the same starting powder. This comparison shows a good agreement between the impedance spectra of powder and bulk BaTiO3 and validates the reliability of the new method to determine the dielectric constant of particulate materials.
Demographic correlates of psychotic‐like experiences in young Australian adults
Authors: Scott J. , Welham J. , Martin G. , Bor W. , Najman J. , O'Callaghan M. , Williams G. , Aird R. , McGrath J.
Published: June 2008

Objective:  Psychotic‐like experiences (PLE) in the general community are common. The aims of this study were to examine the prevalence and demographic correlates of PLE in young adults.

Method:  The sample consisted of 2441 subjects aged 18–23 years. Subjects completed the Composite International Diagnostic Interview (CIDI) and the 21‐item Peters Delusional Inventory (PDI). Associations between age, gender, hallucinations and delusions were examined using logistic regression.

Results:  Both CIDI hallucinations and delusions predicted high scores on the PDI. Younger age was significantly associated with endorsement of CIDI delusions [odds ratio (OR) = 0.66, 95% confidence interval (CI) 0.48–0.92) and with PDI total scores (OR = 0.68, 95% CI 0.55–0.83). Women were significantly more likely to endorse items related to hallucinations (OR = 1.49, 95% CI 1.14–1.95) but not delusions.

Conclusion:  PLE are common in young adults. The mechanisms underpinning the age and gender gradients in PLE may provide clues to the pathogenesis of psychotic disorders.