bluuebunny/crossref_metadata_2025 huggingface dataset:
A Novel Registration Method for Computer-Assisted Total Knee Arthroplasty Using a Patient-Specific Registration Guide
Authors: Jang Taeho , Lee Kunwoo
Published: October 2013

Total knee arthroplasty (TKA) is a surgical method for replacing a degenerated or diseased knee joint that can no longer perform daily functions with an artificial knee implant. In TKA, the artificial knee implant should be inserted such that it aligns well with the mechanical axis of the leg. Thus, precise bone cutting is essential. To improve TKA outcomes, a registration process is performed to locate the predetermined bone cutting area by calculating the position and posture of the femur and tibia. In this article, we propose a patient-specific registration guide that is able to significantly reduce registration time and effort without loss of accuracy. Furthermore, the patient-specific registration guide can be implemented with real-time registration, allowing continuous surgical information to be provided without the insertion of any tracking devices. The precision and accuracy of the proposed registration guide were confirmed through animal tests with a digitizer, stereo camera, and linear motion generator. The error of our registration method, including measurement and guide attachment errors, reached a maximum of 0.321 mm for one pair of cow legs.
Emergency Preparedness in the School Setting for the Child Assisted by Medical Technology
Authors: Porter Stephanie M. , Page Dorothy R. , Somppi Carrie
Published: October 2013

Children with special health care needs are those who have a health condition that requires health or related health services over and above what is expected to be required for the majority of children who are typically developing. Children with special health care needs have a range of conditions that may require medical technology. For the purposes of this article, emergency preparedness for children with special health care needs who require oxygen, tracheostomy care, and ventilator care will be discussed.
Clonal diversity of Acinetobacter baumannii clinical isolates revealed by a snapshot study
Authors: Wang Xiaohui , Qiao Fu , Yu Rujia , Gao Yanyu , Zong Zhiyong
Published: October 2013

Background

Acinetobacter baumannii is a notorious opportunistic pathogen mainly associated with hospital-acquired infections. Studies on the clonal relatedness of isolates could lay the foundation for effective infection control. A snapshot study was performed to investigate the clonal relatedness of A. baumannii clinical isolates in our local settings.

Results

Among 82 non-repetitive Acinetobacter spp. clinical isolates that were recovered during a period of four days in 13 hospitals in Sichuan, Southwest China, 67 isolates were identified as A. baumannii. Half of the 67 A. baumannii isolates were non-susceptible to carbapenems. bla
OXA-23 was the only acquired carbapenemase gene detected, present in 40 isolates including five carbapenem-susceptible ones. The isolates belonged to 62 pulsotypes determined by PFGE and 31 sequence types (ST) by multi-locus sequence typing. Forty-three isolates belonged to the globally-disseminated clonal complex 92, among which ST75, ST92 and ST208 were the most common sequence types.

Conclusions

Clinical isolates of A. baumannii were diverse in clonality in this snapshot study. However, most of the isolates belonged to the globally-distributed clonal complex CC92. ST75, ST92 and ST208 were the most common types in our region. In particular, ST208 might be an emerging lineage carrying bla
OXA-23.
Proteins of novel lactic acid bacteria from Apis mellifera mellifera: an insight into the production of known extra-cellular proteins during microbial stress
Authors: Butler Èile , Alsterfjord Magnus , Olofsson Tobias C , Karlsson Christofer , Malmström Johan , Vásquez Alejandra
Published: October 2013

Background

Lactic acid bacteria (LAB) has been considered a beneficial bacterial group, found as part of the microbiota of diverse hosts, including humans and various animals. However, the mechanisms of how hosts and LAB interact are still poorly understood. Previous work demonstrates that 13 species of Lactobacillus and Bifidobacterium from the honey crop in bees function symbiotically with the honeybee. They protect each other, their hosts, and the surrounding environment against severe bee pathogens, bacteria, and yeasts. Therefore, we hypothesized that these LAB under stress, i.e. in their natural niche in the honey crop, are likely to produce bioactive substances with antimicrobial activity.

Results

The genomic analysis of the LAB demonstrated varying genome sizes ranging from 1.5 to 2.2 mega-base pairs (Mbps) which points out a clear difference within the protein gene content, as well as specialized functions in the honeybee microbiota and their adaptation to their host. We demonstrate a clear variation between the secreted proteins of the symbiotic LAB when subjected to microbial stressors. We have identified that 10 of the 13 LAB produced extra-cellular proteins of known or unknown function in which some are arranged in interesting putative operons that may be involved in antimicrobial action, host interaction, or biofilm formation. The most common known extra-cellular proteins secreted were enzymes, DNA chaperones, S-layer proteins, bacteriocins, and lysozymes. A new bacteriocin may have been identified in one of the LAB symbionts while many proteins with unknown functions were produced which must be investigated further.

Conclusions

The 13 LAB symbionts likely play different roles in their natural environment defending their niche and their host and participating in the honeybee’s food production. These roles are partly played through producing extracellular proteins on exposure to microbial stressors widely found in natural occurring flowers. Many of these secreted proteins may have a putative antimicrobial function. In the future, understanding these processes in this complicated environment may lead to novel applications of honey crop LAB proteins.
The study of the Oxytropis kansuensis-induced apoptotic pathway in the cerebrum of SD rats
Authors: Lu Hao , Zhang Liang , Wang Shan-shan , Wang Wen-long , Zhao Bao-yu
Published: October 2013

Background

Locoweeds cause significant livestock poisoning and economic loss all over the world. Animals can develop locoism, a chronic neurological disease, after grazing on locoweeds. Oxytropis kansuensis is a variety of locoweed that contains swainsonine as its main toxic ingredient. The purpose of this study was to investigate the apoptotic pathway induced in the cerebrum by swainsonine.

Results

Twenty-four Sprague-Dawley rats were randomly divided into four groups (experimental groups I, II, III and a control group) and 6 SD rats of each group were feed in 3 cages separately. Rats were penned as groups and fed with feeds containing 15% (SW content 0.03‰), 30% (SW content 0.06‰), or 45% (SW content 0.09‰) O. kansuensis for experimental groups I, II, and III, respectively, or complete feed in the case of the control group. One hundred and nineteen days after poisoning, and all rats showed neurological disorders at different degrees, which were considered to be successful established a chronic poisoning model of O. kansuensis. rats were sacrificed and the expression of Fas, FasL, Bcl-2, Bax as well as cleaved caspase-3, -8 and -9 proteins in brain tissues were detected by Western blot. The results showed that SW treatment up-regulated Fas and Fas ligand (FasL) (P < 0.05), and that there was an increase in Bax and a decrease in Bcl-2 protein (P < 0.01). Moreover, SW treatment significantly increases the activation of caspase-3, 8 and -9, the key effectors in apoptosis pathway (P < 0.01).

Conclusion

Our data suggest that SW induces apoptosis in cells of the brain through death receptor and mitochondria-mediated, caspase-dependent apoptotic pathways in the brain tissue of SD rats.
Gleaning evolutionary insights from the genome sequence of a probiotic yeast Saccharomyces boulardii
Authors: Khatri Indu , Akhtar Akil , Kaur Kamaldeep , Tomar Rajul , Prasad Gandham Satyanarayana , Ramya Thirumalai Nallan Chakravarthy , Subramanian Srikrishna
Published: October 2013

Background

The yeast Saccharomyces boulardii is used worldwide as a probiotic to alleviate the effects of several gastrointestinal diseases and control antibiotics-associated diarrhea. While many studies report the probiotic effects of S. boulardii, no genome information for this yeast is currently available in the public domain.

Results

We report the 11.4 Mbp draft genome of this probiotic yeast. The draft genome was obtained by assembling Roche 454 FLX + shotgun data into 194 contigs with an N50 of 251 Kbp. We compare our draft genome with all other Saccharomyces cerevisiae genomes.

Conclusions

Our analysis confirms the close similarity of S. boulardii to S. cerevisiae strains and provides a framework to understand the probiotic effects of this yeast, which exhibits unique physiological and metabolic properties.
PointBreak: A Randomized Phase III Study of Pemetrexed Plus Carboplatin and Bevacizumab Followed by Maintenance Pemetrexed and Bevacizumab Versus Paclitaxel Plus Carboplatin and Bevacizumab Followed by Maintenance Bevacizumab in Patients With Stage IIIB or IV Nonsquamous Non–Small-Cell Lung Cancer
Authors: Patel Jyoti D. , Socinski Mark A. , Garon Edward B. , Reynolds Craig H. , Spigel David R. , Olsen Mark R. , Hermann Robert C. , Jotte Robert M. , Beck Thaddeus , Richards Donald A. , Guba Susan C. , Liu Jingyi , Frimodt-Moller Bente , John William J. , Obasaju Coleman K. , Pennella Eduardo J. , Bonomi Philip , Govindan Ramaswamy
Published: October 2013

Purpose

PointBreak (A Study of Pemetrexed, Carboplatin and Bevacizumab in Patients With Nonsquamous Non-Small Cell Lung Cancer) compared the efficacy and safety of pemetrexed (Pem) plus carboplatin (C) plus bevacizumab (Bev) followed by pemetrexed plus bevacizumab (PemCBev) with paclitaxel (Pac) plus carboplatin (C) plus bevacizumab (Bev) followed by bevacizumab (PacCBev) in patients with advanced nonsquamous non–small-cell lung cancer (NSCLC).

Patients and Methods

Patients with previously untreated stage IIIB or IV nonsquamous NSCLC and Eastern Cooperative Oncology Group performance status of 0 to 1 were randomly assigned to receive pemetrexed 500 mg/m2 or paclitaxel 200 mg/m2 combined with carboplatin area under the curve 6 and bevacizumab 15 mg/kg every 3 weeks for up to four cycles. Eligible patients received maintenance until disease progression: pemetrexed plus bevacizumab (for the PemCBev group) or bevacizumab (for the PacCBev group). The primary end point of this superiority study was overall survival (OS).

Results

Patients were randomly assigned to PemCBev (n = 472) or PacCBev (n = 467). For PemCBev versus PacCBev, OS hazard ratio (HR) was 1.00 (median OS, 12.6 v 13.4 months; P = .949); progression-free survival (PFS) HR was 0.83 (median PFS, 6.0 v 5.6 months; P = .012); overall response rate was 34.1% versus 33.0%; and disease control rate was 65.9% versus 69.8%. Significantly more study drug–related grade 3 or 4 anemia (14.5% v 2.7%), thrombocytopenia (23.3% v 5.6%), and fatigue (10.9% v 5.0%) occurred with PemCBev; significantly more grade 3 or 4 neutropenia (40.6% v 25.8%), febrile neutropenia (4.1% v 1.4%), sensory neuropathy (4.1% v 0%), and alopecia (grade 1 or 2; 36.8% v 6.6%) occurred with PacCBev.

Conclusion

OS did not improve with the PemCBev regimen compared with the PacCBev regimen, although PFS was significantly improved with PemCBev. Toxicity profiles differed; both regimens demonstrated tolerability.
Plant leaf senescence and death – regulation by multiple layers of control and implications for aging in general
Authors: Woo Hye Ryun , Kim Hyo Jung , Nam Hong Gil , Lim Pyung Ok
Published: October 2013

How do organisms, organs, tissues and cells change their fate when they age towards senescence and death? Plant leaves provide a unique window to explore this question because they show reproducible life history and are readily accessible for experimental assays. Throughout their lifespan, leaves undergo a series of developmental, physiological and metabolic transitions that culminate in senescence and death. Leaf senescence is an ‘altruistic death’ that allows for the degradation of the nutrients that are produced during the growth phase of the leaf and their redistribution to developing seeds or other parts of the plant, and thus is a strategy that has evolved to maximize the fitness of the plant. During the past decade, there has been significant progress towards understanding the key molecular principles of leaf senescence using genetic and molecular studies, as well as ‘omics’ analyses. It is now apparent that leaf senescence is a highly complex genetic program that is tightly controlled by multiple layers of regulation, including at the level of chromatin and transcription, as well as by post-transcriptional, translational and post-translational regulation. This Commentary discusses the latest understandings and insights into the underlying molecular mechanisms, and presents the perspectives necessary to enable our system-level understanding of leaf senescence, together with their possible implications for aging in general.
Interaction of 4.1G and cGMP-gated channels in rod photoreceptor outer segments
Authors: Cheng Christiana L. , Molday Robert S.
Published: October 2013

In photoreceptors, the assembly of signaling molecules into macromolecular complexes is important for phototransduction and maintaining the structural integrity of rod outer segments (ROS). However, the molecular composition and formation of these complexes are poorly understood. Using immunoprecipitation and mass spectrometry, 4.1G was identified as a new interacting partner for the cyclic-nucleotide gated (CNG) channels in ROS. 4.1G is a widely expressed multifunctional protein that plays a role in the assembly and stability of membrane protein complexes. Multiple splice variants of 4.1G were cloned from bovine retina. A smaller splice variant of 4.1G selectively interacted with CNG channels not associated with peripherin-2-CNG channel complex. A combination of truncation studies and domain binding assays demonstrated that CNG channels selectively interacted with 4.1G through its FERM and CTD domains. By immunofluorescence, punctate labeling of 4.1G partially co-localized with CNG channels in the ROS. Our studies indicate that 4.1G interact with a subset of CNG channels in ROS and implicate this protein-protein interaction in organizing the spatial arrangement of CNG channels in the plasma membrane of outer segments.
LigandRNA: computational predictor of RNA–ligand interactions
Authors: Philips Anna , Milanowska Kaja , Łach Grzegorz , Bujnicki Janusz M.
Published: October 2013

RNA molecules have recently become attractive as potential drug targets due to the increased awareness of their importance in key biological processes. The increase of the number of experimentally determined RNA 3D structures enabled structure-based searches for small molecules that can specifically bind to defined sites in RNA molecules, thereby blocking or otherwise modulating their function. However, as of yet, computational methods for structure-based docking of small molecule ligands to RNA molecules are not as well established as analogous methods for protein-ligand docking. This motivated us to create LigandRNA, a scoring function for the prediction of RNA–small molecule interactions. Our method employs a grid-based algorithm and a knowledge-based potential derived from ligand-binding sites in the experimentally solved RNA–ligand complexes. As an input, LigandRNA takes an RNA receptor file and a file with ligand poses. As an output, it returns a ranking of the poses according to their score. The predictive power of LigandRNA favorably compares to five other publicly available methods. We found that the combination of LigandRNA and Dock6 into a “meta-predictor” leads to further improvement in the identification of near-native ligand poses. The LigandRNA program is available free of charge as a web server at http://ligandrna.genesilico.pl.
Effects of commonly used medications on bone tissue mineralisation in SaOS-2 human bone cell line
Authors: Salai M. , Somjen D. , Gigi R. , Yakobson O. , Katzburg S. , Dolkart O.
Published: October 2013

We analysed the effects of commonly used medications on human osteoblastic cell activity in vitro, specifically proliferation and tissue mineralisation. A list of medications was retrieved from the records of patients aged > 65 years filed in the database of the largest health maintenance organisation in our country (> two million members). Proliferation and mineralisation assays were performed on the following drugs: rosuvastatin (statin), metformin (antidiabetic), metoprolol (β-blocker), citalopram (selective serotonin reuptake inhibitor [SSRI]), and omeprazole (proton pump inhibitor (PPI)). All tested drugs significantly stimulated DNA synthesis to varying degrees, with rosuvastatin 5 µg/ml being the most effective among them (mean 225% (sd 20)), compared with metformin 10 µg/ml (185% (sd 10)), metoprolol 0.25 µg/ml (190% (sd 20)), citalopram 0.05 µg/ml (150% (sd 10)) and omeprazole 0.001 µg/ml (145% (sd 5)). Metformin and metoprolol (to a small extent) and rosuvastatin (to a much higher extent) inhibited cell mineralisation (85% (sd 5)). Our results indicate the need to evaluate the medications prescribed to patients in terms of their potential action on osteoblasts. Appropriate evaluation and prophylactic treatment (when necessary) might lower the incidence and costs associated with potential medication-induced osteoporosis.

Cite this article: Bone Joint J 2013;95-B:1575–80.
Metal-on-metal hip resurfacing compared with 28-mm diameter metal-on-metal total hip replacement
Authors: Vendittoli P-A. , Rivière C. , Roy A. G. , Barry J. , Lusignan D. , Lavigne M.
Published: October 2013

A total of 219 hips in 192 patients aged between 18 and 65 years were randomised to 28-mm metal-on-metal uncemented total hip replacements (THRs, 107 hips) or hybrid hip resurfacing (HR, 112 hips). At a mean follow-up of eight years (6.6 to 9.3) there was no significant difference between the THR and HR groups regarding rate of revision (4.0% (4 of 99) vs 5.8% (6 of 104), p = 0.569) or re-operation rates without revision (5.1% (5 of 99) vs 2.9% (3 of 104), p = 0.428). In the THR group one recurrent dislocation, two late deep infections and one peri-prosthetic fracture required revision, whereas in the HR group five patients underwent revision for femoral head loosening and one for adverse reaction to metal debris. The mean University of California, Los Angeles activity scores were significantly higher in HR (7.5 (sd 1.7) vs 6.9 (sd 1.7), p = 0.035), but similar mean Western Ontario and McMaster Universities Osteoarthritis Index scores were obtained (5.8 (sd 9.5) in HR vs 5.1 (sd 8.9) in THR, p = 0.615) at the last follow-up. Osteolysis was found in 30 of 81 THR patients (37.4%), mostly in the proximal femur, compared with two of 83 HR patients (2.4%) (p < 0.001). At five years the mean metal ion levels were < 2.5 μg/l for cobalt and chromium in both groups; only titanium was significantly higher in the HR group (p = 0.001). Although revision rates and functional scores were similar in both groups at mid-term, long-term survival analysis is necessary to determine whether one procedure is more advantageous than the other.

Cite this article: Bone Joint J 2013;95-B:1464–73.
Current concepts of the management of anterior cruciate ligament injuries in children
Authors: Al-Hadithy N. , Dodds A. L. , Akhtar K. S. N. , Gupte C. M.
Published: October 2013

Recent reports have suggested an increase in the number of anterior cruciate ligament (ACL) injuries in children, although their true incidence is unknown.

The prognosis of the ACL-deficient knee in young active individuals is poor because of secondary meniscal tears, persistent instability and early-onset osteoarthritis. The aim of surgical reconstruction is to provide stability while avoiding physeal injury. Techniques of reconstruction include transphyseal, extraphyseal or partial physeal sparing procedures.

In this paper we review the management of ACL tears in skeletally immature patients.

Cite this article: Bone Joint J 2013;95-B:1562–9.
Are Students Dropping Out or Simply Dragging Out the College Experience? Persistence at the Six-Year Mark
Authors: Stratton Leslie S. , Wetzel James N.
Published: October 2013

Standard analyses of college outcomes look at six-year graduation rates, treating all non-graduates alike as “failures”. However, we find that 36% of non-graduates are still enrolled. Using micro-level data with rich information on demographic and academic background, we employ a multinomial logit model to distinguish among graduates, persisters, and dropouts six years following matriculation. We find that there are significant differences across these populations. Separate evidence indicates that as many as half of those persisting at the six-year mark will graduate within a few years. Thus, six-year graduation rates understate “success,” but future success is not the same for all groups. Holding academic background constant, reported graduation rates are lower for Hispanics because they are taking longer to graduate and lower for first-generation college students because they are dropping out. The most important factor is academic background, suggesting that increased financial aid is unlikely to substantially increase graduation rates.
Lipid-lowering effect of molluscan (Katelysia opima) glycosaminoglycan (GAG) in hypercholesterolemic induced rats
Authors: Pandian Vijayabaskar , Aravindan Natarajan , Subramanian Sethupathy , Somasundaran Somasundaram T.
Published: October 2013

Identifying pharmacologically safe lipid-lowering ‘deliverables’ could potentiate therapeutic outcome for diet-induced atherogenesis. Accordingly, we investigated the potential of molluscan (Katelysia opima) glycosaminoglycan (GAG) in modulating the early lipid changes in atherogenesis. Wistar rats were fed a diet with (n=24) or without (n=6) hypercholesterolemic atherogenic CCT (rat chow supplemented with 4% cholesterol, 1% cholic acid, and 0.5% thiouracil) for 17 days. CCT-fed rates were (i) treated with isolated molluscan GAG (40 mg/kg/day, s.c.) for 10 days after the introduction of CCT diet, (ii) cotreated with GAG (40 mg/kg/day, s.c.) for 17 days, or (iii) treated with heparin (200 units/kg/day, s.c.) for 10 days after the introduction of CCT. The increases induced by CCT diet in the plasma levels of cholesterol, triglycerides, high-density lipoprotein, very-low-density lipoprotein, and low-density lipoprotein were completely attenuated with GAG treatment. Consistently, alterations induced by CCT diet in the levels of plasma lecithin cholesterol acyltransferase and lipoprotein lipase activities were restored to baseline levels with GAG treatment. Coherently, histology revealed a decrease associated with GAG treatment in the CCT-diet-induced foam cells (in aorta), tubular damages (kidney), and lipid accumulations (liver). Together, these results suggest that GAG may exert antiatherogenesis potential by significantly attenuating lipid modulations derived by a high-fat diet. Further, the data imply that the GAG extracts may comprehensively prevent hypercholesterolemia-associated tissue damage and could thus serve as a therapeutic deliverable for hypercholesterolemia.
Psychotropic Medication Use and Polypharmacy in Children With Autism Spectrum Disorders
Authors: Spencer Donna , Marshall Jaclyn , Post Brady , Kulakodlu Mahesh , Newschaffer Craig , Dennen Taylor , Azocar Francisca , Jain Anjali
Published: October 2013

OBJECTIVE:

The objectives of this study were to examine rates and predictors of psychotropic use and multiclass polypharmacy among commercially insured children with autism spectrum disorders (ASD).

METHODS:

This retrospective observational study used administrative medical and pharmacy claims data linked with health plan enrollment and sociodemographic information from 2001 to 2009. Children with ASD were identified by using a validated ASD case algorithm. Psychotropic polypharmacy was defined as concurrent medication fills across ≥2 classes for at least 30 days. Multinomial logistic regression was used to model 5 categories of psychotropic use and multiclass polypharmacy.

RESULTS:

Among 33 565 children with ASD, 64% had a filled prescription for at least 1 psychotropic medication, 35% had evidence of psychotropic polypharmacy (≥2 classes), and 15% used medications from ≥3 classes concurrently. Among children with polypharmacy, the median length of polypharmacy was 346 days. Older children, those who had a psychiatrist visit, and those with evidence of co-occurring conditions (seizures, attention-deficit disorders, anxiety, bipolar disorder, or depression) had higher odds of psychotropic use and/or polypharmacy.

CONCLUSIONS:

Despite minimal evidence of the effectiveness or appropriateness of multidrug treatment of ASD, psychotropic medications are commonly used, singly and in combination, for ASD and its co-occurring conditions. Our results indicate the need to develop standards of care around the prescription of psychotropic medications to children with ASD.
Using Registries to Identify Adverse Events in Rheumatic Diseases
Authors: Lionetti Geraldina , Kimura Yukiko , Schanberg Laura E. , Beukelman Timothy , Wallace Carol A. , Ilowite Norman T. , Winsor Jane , Fox Kathleen , Natter Marc , Sundy John S. , Brodsky Eric , Curtis Jeffrey R. , Del Gaizo Vincent , Iyasu Solomon , Jahreis Angelika , Meeker-O’Connell Ann , Mittleman Barbara B. , Murphy Bernard M. , Peterson Eric D. , Raymond Sandra C. , Setoguchi Soko , Siegel Jeffrey N. , Sobel Rachel E. , Solomon Daniel , Southwood Taunton R. , Vesely Richard , White Patience H. , Wulffraat Nico M. , Sandborg Christy I.
Published: October 2013

The proven effectiveness of biologics and other immunomodulatory products in inflammatory rheumatic diseases has resulted in their widespread use as well as reports of potential short- and long-term complications such as infection and malignancy. These complications are especially worrisome in children who often have serial exposures to multiple immunomodulatory products. Post-marketing surveillance of immunomodulatory products in juvenile idiopathic arthritis (JIA) and pediatric systemic lupus erythematosus is currently based on product-specific registries and passive surveillance, which may not accurately reflect the safety risks for children owing to low numbers, poor long-term retention, and inadequate comparators. In collaboration with the US Food and Drug Administration (FDA), patient and family advocacy groups, biopharmaceutical industry representatives and other stakeholders, the Childhood Arthritis and Rheumatology Research Alliance (CARRA) and the Duke Clinical Research Institute (DCRI) have developed a novel pharmacosurveillance model (CARRA Consolidated Safety Registry [CoRe]) based on a multicenter longitudinal pediatric rheumatic diseases registry with over 8000 participants. The existing CARRA infrastructure provides access to much larger numbers of subjects than is feasible in single-product registries. Enrollment regardless of medication exposure allows more accurate detection and evaluation of safety signals. Flexibility built into the model allows the addition of specific data elements and safety outcomes, and designation of appropriate disease comparator groups relevant to each product, fulfilling post-marketing requirements and commitments. The proposed model can be applied to other pediatric and adult diseases, potentially transforming the paradigm of pharmacosurveillance in response to the growing public mandate for rigorous post-marketing safety monitoring.
Association of Constipation and Fecal Incontinence With Attention-Deficit/Hyperactivity Disorder
Authors: McKeown Connor , Hisle-Gorman Elizabeth , Eide Matilda , Gorman Gregory H. , Nylund Cade M.
Published: October 2013

OBJECTIVE:

Functional constipation and fecal incontinence are common childhood gastrointestinal conditions. Both conditions may be associated with behavioral problems. Attention-deficit/hyperactivity disorder (ADHD) is the most common behavioral disorder of childhood, characterized by shortened attention span and hyperactivity. We hypothesize that a diagnosis of ADHD increases the risk for functional constipation and fecal incontinence.

METHODS:

A retrospective cohort study of children was performed by using the military health system database. Children of active-duty military personnel, aged 4 to 12 years, from October 2005 to September 2007, were included. ADHD, constipation, and fecal incontinence were identified by International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic codes. Relative risks and adjusted incidence rate ratios (IRRs) were calculated. A subgroup analysis of subjects receiving medical therapy was performed.

RESULTS:

There were 742 939 children identified in the study, 32 773 (4.4%) of whom had ADHD. Children with ADHD had an increased prevalence of constipation (4.1% of children with ADHD vs 1.5% children without ADHD; P < .001) and fecal incontinence (0.9% of children with ADHD vs 0.15% of children without ADHD; P < .0001). Children with ADHD had more visits than those without ADHD for both constipation (IRR 3.39; 95% confidence interval 2.59–4.43) and fecal incontinence (IRR 7.74; 95% confidence interval 5.01–11.98). Children with ADHD receiving medicinal therapy did not differ significantly from children with ADHD not receiving medicinal therapy on rates of constipation visits (P = .57) or fecal incontinence visits (P = .32).

CONCLUSIONS:

Children with ADHD are significantly more likely to have constipation and fecal incontinence. Medical therapy for ADHD does not impact visit rates for defecation disorders.
A PACAP-38 citoprotektív és antiinflammatórikus hatásának vizsgálata vékonybél-autotranszplantációs modellben
Authors: Nedvig Klára , Szabó Györgyi , Csukás Domokos , Sándor József , Németh József , Kovács Krisztina , Reglődi Dóra , Kemény Ágnes , Wéber György , Ferencz Andrea
Published: October 2013

Absztrakt

Bevezetés: A vékonybél ischaemia-reperfusióval szembeni fokozott érzékenysége a szerv transzplantációjakor is jelen lévő probléma. Ismert a hypophysis adenilát-cikláz aktiváló polipeptid (PACAP) sejtvédő hatása. Munkánkban azt vizsgáltuk, hogy PACAP-38-at tartalmazó University of Wisconsin (UW) oldatban történő konzerválás hogyan befolyásolja a szöveti PACAP- és citokinszinteket. Anyag és módszer: Wistar-patkányokon (n = 56) vékonybél-autotranszplantációt végeztünk. A graftokat 4 °C-os UW oldatban tároltuk 1 (I. csoport), 3 (II.) és 6 órán (III.), illetve 100 μg PACAP-38-at tartalmazó UW oldatban 1 (IV.), 3 (V.) és 6 órán (VI.) át. A reperfusio 3 óra volt. Bélmintákból a PACAP-38- és PACAP-27-szinteket radioimmunassayjel határoztuk meg, míg a citokinexpressiót kemilumineszcens módszerrel és Luminex Multiplex Immunoassayjel mértük. Eredmények: A szöveti PACAP-38-szint a kontrollhoz (57,32 ± 3,5 fmol/mg) képest a konzerválás idejével csökkent, és 6 óra után szignifikáns volt (III.: 32,6 ± 3,9 fmol/mg, p < 0,05), míg a IV–VI. csoportoknál szignifikánsan nőtt. A PACAP-27 szöveti értéke is hasonló tendenciával változott. Az sICAM-1, L-selectin és a metalloproteáz-1 szöveti inhibitorának emelkedett expressióját mértük a III. csoportban, és jelentős csökkenés volt a VI. csoportban. Következtetés: UW oldathoz adott PACAP-38 növelte a szöveti PACAP-38- és PACAP-27-szinteket, és csökkentette a citokinexpressiót. Mindez a PACAP-38 citoprotektív és anti-inflammatórikus hatását jelzi bél-autotranszplantációs modellben. Támogatta: OTKA (PD77474, 104984, CNK78480), MTA Bolyai-ösztöndíj és Lendület program.
Estrutura de ocupações e distribuição de rendimentos: uma análise da experiência brasileira nos anos 2000
Authors: Maia Alexandre Gori
Published: October 2013

Em um contexto de profundas transformações na economia e no mercado de trabalho, o objetivo deste trabalho é analisar as relações entre a dinâmica da estrutura de ocupações e da distribuição de rendimentos no Brasil nos anos 2000. Primeiramente, verifica-se em que medida a prevalência de ocupações pouco qualificadas e de baixa remuneração contribui para o elevado estágio de exclusão e desigualdade do país. Verifica-se ainda como as mudanças na composição e nos rendimentos dos principais grupos ocupacionais contribuíram para o crescimento da renda e a redução da desigualdade no Brasil. Os resultados destacam a importância da estrutura ocupacional para compreensão das extremas diferenças socioeconômicas existentes no país.
Efeitos do comércio internacional e de fatores de oferta na escolaridade dos trabalhadores brasileiros
Authors: Pauli Rafael Camargo de , Nakabashi Luciano , Sampaio Armando Vaz
Published: October 2013

Neste artigo, analisamos as fontes das oscilações na demanda por trabalhadores, de acordo com seus respectivos níveis de escolaridade, com especial ênfase à indústria de transformação brasileira, entre 1994 e 2008. Consideramos duas teorias para explicar essas fontes: o teorema de Heckscher-Ohlin (H-O)e a hipótese do viés de habilidade. Na análise empírica utilizamos pioneiramente para o Brasil a análise de decomposição ao nível setorial e da firma para verificar qual das teorias refletiria melhor à realidade. Os resultados dão algum suporte à hipótese do viés de habilidade para os trabalhadores com ensino superior completo. Adicionalmente, os resultados apontam que as forças do comércio internacional destacadas pelo teorema de H-O têm relevância no caso da economia brasileira. Contudo, verificou-se que o aumento da oferta de trabalhadores com qualificação intermediária foi a principal causa do aumento da escolaridade da força de trabalho da indústria de transformação.
Programmatic Impact of 5 Years of Mortality Surveillance of New York City Homeless Populations
Authors: Gambatese Melissa , Marder Dova , Begier Elizabeth , Gutkovich Alexander , Mos Robert , Griffin Angela , Zimmerman Regina , Madsen Ann
Published: October 2013

A homeless mortality surveillance system identifies emerging trends in the health of the homeless population and provides this information to key stakeholders in a timely and ongoing manner to effect evidence-based, programmatic change.

We describe the first 5 years of the New York City homeless mortality surveillance system and, for the first time in peer-reviewed literature, illustrate the impact of key elements of sustained surveillance (i.e., timely dissemination of aggregate mortality data and real-time sharing of information on individual homeless decedents) on the programs of New York City’s Department of Homeless Services.

These key elements had a positive impact on the department’s programs that target sleep-related infant deaths and hypothermia, drug overdose, and alcohol-related deaths among homeless persons.
Substance-Use Disorders and Poverty as Prospective Predictors of First-Time Homelessness in the United States
Authors: Thompson Ronald G. , Wall Melanie M. , Greenstein Eliana , Grant Bridget F. , Hasin Deborah S.
Published: October 2013

Objectives. We examined whether substance-use disorders and poverty predicted first-time homelessness over 3 years.

Methods. We analyzed longitudinal data from waves 1 (2001–2002) and 2 (2004–2005) of the National Epidemiologic Survey on Alcohol and Related Conditions to determine the main and interactive effects of wave 1 substance use disorders and poverty on first-time homelessness by wave 2, among those who were never homeless at wave 1 (n = 30 558). First-time homelessness was defined as having no regular place to live or having to live with others for 1 month or more as a result of having no place of one’s own since wave 1.

Results. Alcohol-use disorders (adjusted odds ratio [AOR] = 1.34), drug-use disorders (AOR = 2.51), and poverty (AOR = 1.34) independently increased prospective risk for first-time homelessness, after adjustment for ecological variables. Substance-use disorders and poverty interacted to differentially influence risk for first-time homelessness (P < .05), before, but not after, adjustment for controls.

Conclusions. This study reinforces the importance of both substance-use disorders and poverty in the risk for first-time homelessness, and can serve as a benchmark for future studies. Substance abuse treatment should address financial status and risk of future homelessness.
When Health Insurance Is Not a Factor: National Comparison of Homeless and Nonhomeless US Veterans Who Use Veterans Affairs Emergency Departments
Authors: Tsai Jack , Doran Kelly M. , Rosenheck Robert A.
Published: October 2013

Objectives. We examined the proportion of homeless veterans among users of Veterans Affairs (VA) emergency departments (EDs) and compared sociodemographic and clinical characteristics of homeless and nonhomeless VA emergency department users nationally.

Methods. We used national VA administrative data from fiscal year 2010 for a cross-sectional study comparing homeless (n = 64 091) and nonhomeless (n = 866 621) ED users on sociodemographics, medical and psychiatric diagnoses, and other clinical characteristics.

Results. Homeless veterans had 4 times the odds of using EDs than nonhomeless veterans. Multivariate analyses found few differences between homeless and nonhomeless ED users on the medical conditions examined, but homeless ED users were more likely to have been diagnosed with a drug use disorder (odds ratio [OR] = 4.12; 95% confidence interval [CI] = 3.97, 4.27), alcohol use disorder (OR = 3.67; 95% CI = 3.55, 3.79), or schizophrenia (OR = 3.44; 95% CI = 3.25, 3.64) in the past year.

Conclusions. In a national integrated health care system with no specific requirements for health insurance, the major differences found between homeless and nonhomeless ED users were high rates of psychiatric and substance abuse diagnoses. EDs may be an important location for specialized homeless outreach (or “in” reach) services to address mental health and addictive disorders.
Comparing Homeless Smokers to Economically Disadvantaged Domiciled Smokers
Authors: Businelle Michael S. , Cuate Erica L. , Kesh Anshula , Poonawalla Insiya B. , Kendzor Darla E.
Published: October 2013

We compared characteristics of homeless smokers and economically disadvantaged domiciled smokers (Dallas, TX; August 2011–November 2012). Although findings indicated similar smoking characteristics across samples, homeless smokers (n = 57) were exposed to more smokers and reported lower motivation to quit, lower self-efficacy for quitting, more days with mental health problems, and greater exposure to numerous stressors than domiciled smokers (n = 110). The sample groups reported similar scores on measures of affect, perceived stress, and interpersonal resources. Results may inform novel cessation interventions for homeless smokers.
Admission Decisions and Outcomes of Community-Acquired Pneumonia in the Homeless Population: A Review of 172 Patients in an Urban Setting
Authors: Jones Barbara , Gundlapalli Adi V. , Jones Jason P. , Brown Samuel M. , Dean Nathan C.
Published: October 2013

Objectives. We compared admission rates, outcomes, and performance of the CURB-65 mortality prediction score of homeless patients and nonhomeless patients with community-acquired pneumonia (CAP).

Methods. We compared homeless (n = 172) and nonhomeless (n = 1897) patients presenting to a Salt Lake City, Utah, emergency department with CAP from 1996 to 2006. In the homeless cohort, we measured referral from and follow-up with the local homeless health care clinic and arrangement of medical housing.

Results. Homeless patients were younger (44 vs 59 years; P < .001) and had lower CURB-65 scores and higher hospitalization risk (severity-adjusted odds ratio = 1.89; 95% confidence interval = 1.33, 2.69) than did nonhomeless patients, with a similar length of stay, median inpatient cost, and median outpatient cost, even after severity adjustment. Of homeless patients, 22% were referred from the homeless health care clinic to the emergency department; 54% of outpatients and 51% of hospital patients were referred back to the clinic, and medical housing was arranged for 23%.

Conclusions. A large cohort of homeless patients with CAP demonstrated higher hospitalization risk than but similar length of stay and costs as nonhomeless patients. The strong relationship between the hospital and homeless health care clinic may have contributed to this finding.
A Comprehensive Assessment of Health Care Utilization Among Homeless Adults Under a System of Universal Health Insurance
Authors: Hwang Stephen W. , Chambers Catharine , Chiu Shirley , Katic Marko , Kiss Alex , Redelmeier Donald A. , Levinson Wendy
Published: October 2013

Objectives. We comprehensively assessed health care utilization in a population-based sample of homeless adults and matched controls under a universal health insurance system.

Methods. We assessed health care utilization by 1165 homeless single men and women and adults in families and their age- and gender-matched low-income controls in Toronto, Ontario, from 2005 to 2009, using repeated-measures general linear models to calculate risk ratios and 95% confidence intervals (CIs).

Results. Homeless participants had mean rates of 9.1 ambulatory care encounters (maximum = 141.1), 2.0 emergency department (ED) encounters (maximum = 104.9), 0.2 medical–surgical hospitalizations (maximum = 14.9), and 0.1 psychiatric hospitalizations per person-year (maximum = 4.8). Rate ratios for homeless participants compared with matched controls were 1.76 (95% CI = 1.58, 1.96) for ambulatory care encounters, 8.48 (95% CI = 6.72, 10.70) for ED encounters, 4.22 (95% CI = 2.99, 5.94) for medical–surgical hospitalizations, and 9.27 (95% CI = 4.42, 19.43) for psychiatric hospitalizations.

Conclusions. In a universal health insurance system, homeless people had substantially higher rates of ED and hospital use than general population controls; these rates were largely driven by a subset of homeless persons with extremely high-intensity usage of health services.
Universal Screening for Homelessness and Risk for Homelessness in the Veterans Health Administration
Authors: Montgomery Ann Elizabeth , Fargo Jamison D. , Byrne Thomas H. , Kane Vincent R. , Culhane Dennis P.
Published: October 2013

We examined data for all veterans who completed the Veterans Health Administration’s national homelessness screening instrument between October 1, 2012, and January 10, 2013. Among veterans who were not engaged with the US Department of Veterans Affairs homeless system and presented for primary care services, the prevalence of recent housing instability or homelessness was 0.9% and homelessness risk was 1.2%. Future research will refine outreach strategies, targeting of prevention resources, and development of novel interventions.
Housing First Improves Residential Stability in Homeless Adults With Concurrent Substance Dependence and Mental Disorders
Authors: Palepu Anita , Patterson Michelle L. , Moniruzzaman Akm , Frankish C. James , Somers Julian
Published: October 2013

Objectives. We examined the relationship between substance dependence and residential stability in homeless adults with current mental disorders 12 months after randomization to Housing First programs or treatment as usual (no housing or support through the study).

Methods. The Vancouver At Home study in Canada included 2 randomized controlled trials of Housing First interventions. Eligible participants met the criteria for homelessness or precarious housing, as well as a current mental disorder. Residential stability was defined as the number of days in stable residences 12 months after randomization. We used negative binomial regression modeling to examine the independent association between residential stability and substance dependence.

Results. We recruited 497 participants, and 58% (n = 288) met the criteria for substance dependence. We found no significant association between substance dependence and residential stability (adjusted incidence rate ratio = 0.97; 95% confidence interval = 0.69, 1.35) after adjusting for housing intervention, employment, sociodemographics, chronic health conditions, mental disorder severity, psychiatric symptoms, and lifetime duration of homelessness.

Conclusions. People with mental disorders might achieve similar levels of housing stability from Housing First regardless of whether they experience concurrent substance dependence.
New to Care: Demands on a Health System When Homeless Veterans Are Enrolled in a Medical Home Model
Authors: O’Toole Thomas P. , Bourgault Claire , Johnson Erin E. , Redihan Stephen G. , Borgia Matthew , Aiello Riccardo , Kane Vincent
Published: October 2013

Objectives. We compared service use among homeless and nonhomeless veterans newly enrolled in a medical home model and identified patterns of use among homeless veterans associated with reductions in emergency department (ED) use.

Methods. We used case–control matching with a nested cohort analysis to measure 6-month health services use, new diagnoses, and care use patterns in veterans at the Providence, Rhode Island, Veterans Affairs Medical Center from 2008 to 2011.

Results. We followed 127 homeless and 106 nonhomeless veterans. Both groups had similar rates of chronic medical and mental health diagnoses; 25.4% of the homeless and 18.1% of the nonhomeless group reported active substance abuse. Homeless veterans used significantly more primary, mental health, substance abuse, and ED care during the first 6 months. Homeless veterans who accessed primary care at higher rates (relative risk ratio [RRR] = 1.46; 95% confidence interval [CI] = 1.11, 1.92) or who used specialty and primary care (RRR = 10.95; 95% CI = 1.58, 75.78) had reduced ED usage. Homeless veterans in transitional housing or doubled-up at baseline (RRR = 3.41; 95% CI = 1.24, 9.42) had similar reductions in ED usage.

Conclusions. Homeless adults had substantial health needs when presenting for care. High-intensity primary care and access to specialty care services could reduce ED use.
An Integrated Approach at Real-Time Surveillance Gets You Ahead of the Game
Authors: Linggu Azmi , Bellegem Bas Van , Shishebarov Sergey , Briers Jan , Chin YeeMen
Published: October 2013

In Sakhalin Energy the oil and gas production from all the wells is monitored in real-time by data-driven models. These models are based on single-rate well test data, test-by-difference data and/or ‘synthetic’ data generated by physical models. The system is technically easy to maintain, fast to simulate and reconcile with the fiscal meters. SEIC has two new facilities with good instrumentation that allowed for a successful deployment of FieldWare Production Universe for real-time production surveillance and allocation. This paper also highlights the key lessons learnt from the roll-out exercise and the key issues and risks involved during the implementation and execution process.