bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment with Intravenous Immunoglobulins in Critical Care of Neuromuscular Disorders
Authors: Stangel M. , Gold R.
Published: June 2009

Objective: Intravenous immunoglobulin (IVIg) has been widely used in neurological diseases during the last decade. The current indications for IVIg in the acute management of neuromuscular disorders, often similar to the indications for plasma exchange, are reviewed and discussed on the basis of the available clinical and experimental data. Data Sources and Selection Criteria: Original papers and reviews on IVIg, covered by repeated MEDLINE searches from 1981 to 1996 and some significant papers from other sources. Results: Compared to plasma exchange, that has been used for some of the indications treated with IVIg, the latter is more widely available and has only few side effects with a small risk of transmission of infectious agents. Good clinical evidence for the efficacy of IVIg is available for Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, and multifocal motor neuropathy. In conditions like myasthenia gravis and myositis, favorable effects were reported, but future studies have to be awaited. Conclusions: IVIg is a promising therapy, that has been shown to be effective in some neuromuscular disorders. Routine use in the acute management of these diseases should be restricted to conditions for which a positive effect has been proven in controlled trials.
Lagerstabilitätsprüfung von gefrorenem Frischplasma: Ergebnisse der Lagerung für 6 Monate bei -20 °C und -25 °C
Authors: Kotitschke R. , Morfeld F. , Kirchmaier C.M. , Stampe D. , Wieding J.U.
Published: June 2009

Hintergrund: Von der Sektion «Plasmatische Blutbestandteile» der DGTI wurde im Oktober 1995 ein Ringversuch mit drei Arten gefrorenen Frisch-plasmas (GFP) zur Ermittlung ihrer Lagerstabilität bei vier Temperaturen (-20 °C; -25 °C; -30 °C; -40 °C) begonnen, da die Monographie «Human Plasma for Fractionation» der Europäischen Pharmacopoeia (EP) keine Angaben über die Dauer der GFP-Verwendbarkeit enthält. Ziel der Ringstudie der DGTI-Sektion war die Prüfung der Lagerstabilität von gefrorenen Frischplasmen bei vier Lagertemperaturen durch Charakterisierung einzelner Proteine. Material und Methodik: Die GFPs wurden von drei verschiedenen Blutspendediensten in Deutschland produziert. Zwei GFPs wurden aus Vollblutspenden hergestellt, die innerhalb von maximal 6 h, bzw. 24 h nach der Blutspende gepoolt, aliquotiert in Beutel abgefüllt und eingefroren wurden. Der dritte GFP-Pool wurde aus Plasmapherese-plasmen hergestellt und aliquotiert in Beuteln innerhalb von 4 h nach der Plasmapherese eingefroren. Der Einfluβ der Lagerung auf die Plasmen wurde mit Hilfe der Bestimmung der Aktivität der Gerinnungsfaktoren FVIII, FIX, FV, Fibrinogen, der Aktivierungsprodukte TAT (Thrombin/ Antithrombin-Komplex) und Prothrombin-Fragment Fl und F2, der Inhibi-toren Antithrombin und Cl-Esterase-Inhibitor, des IgG-Gehaltes und des Anti-HBs-Titers untersucht. An dem Ringversuch nehmen 13 europäische Labors teil. Die Bestimmung der Proteine der GFP erfolgte mit kommer-ziellen Reagenzien. Ergebnisse: Die Stabilität der GFPs während 6mona-tiger Lagerung bei Temperaturen von -20 °C und -25 °C wurde anhand der Bestimmung charakteristischer Proteine der GFPs beurteilt. Der Ver-gleich der zu Beginn der Lagerung der GFPs ermittelten Werte für die verschiedenen überprüften Proteine mit den Werten nach 6 Monaten weist auf keine signifikanten Veränderungen dieser Proteine hin, mit einer Ausnahme, der Aktivität des Gerinnungsfaktors FVIII des GFPs, das aus Vollblut hergestellt und innerhalb von 4 h nach der Blutspende eingefroren wurde. Nach 6 Monaten nahm der FVIII-Gehalt dieses Plasmas bei der Lagerung bei -20 °C um 9% gegenüber dem Ausgangswert ab. Schluβfolgerung: Die Lagerstabilitätsprüfung von GFPs wird innerhalb der Ringstudie der Sektion Nr. 2 der DGTI über insgesamt 3 Jahre durch-geführt. Nach dieser Zeit sollte eine Aussage über den Einfluβ der Lager-temperatur auf die Eigenschaften der Proteine der GFPs möglich sein.
Associations of Physical Activity With Inflammatory Factors, Adipocytokines, and Metabolic Syndrome in Middle-Aged and Older Chinese People
Authors: Yu Zhijie , Ye Xingwang , Wang Jing , Qi Qibin , Franco Oscar H. , Rennie Kirsten L. , Pan An , Li Huaixing , Liu Yong , Hu Frank B. , Lin Xu
Published: June 2009

Background—

Inflammatory factors, adipocytokines, and the metabolic syndrome are important determinants of cardiometabolic disease. It remains unclear how physical activity is related to these risk factors. Our objective was to investigate single and joint associations of physical activity with inflammatory factors, adipocytokines, and the metabolic syndrome among middle-aged and older Chinese people.

Methods and Results—

A total of 3289 individuals (1458 men, 1831 women) 50 to 70 years of age participated in a population-based cross-sectional survey in Beijing and Shanghai, China. Levels of total physical activity were assessed with the International Physical Activity Questionnaire. High-sensitivity C-reactive protein, interleukin-6, tumor necrosis factor-α receptor 2, adiponectin, and retinol-binding protein 4 were measured. The metabolic syndrome was defined using the updated National Cholesterol Education Program/Adult Treatment Panel III criteria for Asian Americans. Plasma concentrations of high-sensitivity C-reactive protein were 1.58, 1.74, and 1.27 mg/L (
P
=0.0138) and of adiponectin were 16.12, 16.20, and 17.21 mg/L (
P
=0.0078) among individuals with low, medium, and high levels of total physical activity, respectively, with adjustment for potential confounders. In the multivariable-adjusted logistic regression analyses, participants with higher levels of total physical activity had a lower risk of having the metabolic syndrome (odds ratio, 0.68; 95% confidence interval, 0.54 to 0.85;
P
for trend=0.001) compared with those with lower levels.

Conclusions—

Being physically active is associated with a better profile of inflammatory factors and adipocytokines and a reduced risk of having the metabolic syndrome among Chinese people.
Will Hypertension Performance Measures Used for Pay-for-Performance Programs Penalize Those Who Care for Medically Complex Patients?
Authors: Petersen Laura A. , Woodard LeChauncy D. , Henderson Louise M. , Urech Tracy H. , Pietz Kenneth
Published: June 2009

Background—

There is concern that performance measures, patient ratings of their care, and pay-for-performance programs may penalize healthcare providers of patients with multiple chronic coexisting conditions. We examined the impact of coexisting conditions on the quality of care for hypertension and patient perception of overall quality of their health care.

Methods and Results—

We classified 141 609 veterans with hypertension into 4 condition groups: those with hypertension-concordant (diabetes mellitus, ischemic heart disease, dyslipidemia) and/or -discordant (arthritis, depression, chronic obstructive pulmonary disease) conditions or neither. We measured blood pressure control at the index visit, overall good quality of care for hypertension, including a follow-up interval, and patient ratings of satisfaction with their care. Associations between condition type and number of coexisting conditions on receipt of overall good quality of care were assessed with logistic regression. The relationship between patient assessment and objective measures of quality was assessed. Of the cohort, 49.5% had concordant-only comorbidities, 8.7% had discordant-only comorbidities, 25.9% had both, and 16.0% had none. Odds of receiving overall good quality after adjustment for age were higher for those with concordant comorbidities (odds ratio, 1.78; 95% confidence interval, 1.70 to 1.87), discordant comorbidities (odds ratio, 1.32; 95% confidence interval, 1.23 to 1.41), or both (odds ratio, 2.25; 95% confidence interval, 2.13 to 2.38) compared with neither. Findings did not change after adjustment for illness severity and/or number of primary care and specialty care visits. Patient assessment of quality did not vary by the presence of coexisting conditions and was not related to objective ratings of quality of care.

Conclusions—

Contrary to expectations, patients with greater complexity had higher odds of receiving high-quality care for hypertension. Subjective ratings of care did not vary with the presence or absence of comorbid conditions. Our findings should be reassuring to those who care for the most medically complex patients and are concerned that they will be penalized by performance measures or patient ratings of their care.
Transcatheter Aortic Valve Implantation
Authors: Webb John G. , Altwegg Lukas , Boone Robert H. , Cheung Anson , Ye Jian , Lichtenstein Samuel , Lee May , Masson Jean Bernard , Thompson Christopher , Moss Robert , Carere Ron , Munt Brad , Nietlispach Fabian , Humphries Karin
Published: June 2009

Background—

Transcatheter aortic valve implantation is an alternative to open heart surgery in patients with aortic stenosis. However, long-term data on a programmatic approach to aortic valve implantation remain sparse.

Methods and Results—

Transcatheter aortic valve implantation was performed in 168 patients (median age, 84 years) in the setting of severe aortic stenosis and high surgical risk. Access was transarterial (n=113) or, in the presence of small iliofemoral artery diameter, transapical (n=55). The overall success rate was 94.1% in this early experience. Intraprocedural mortality was 1.2%. Operative (30-day) mortality was 11.3%, lower in the transarterial group than the transapical group (8.0% versus 18.2%;
P
=0.07). Overall mortality fell from 14.3% in the initial half to 8.3% in the second half of the experience, from 12.3% to 3.6% (
P
=0.16) in transarterial patients and from 25% to 11.1% (
P
=0.30) in transapical patients. Functional class improved over the 1-year postprocedure period (
P
<0.001). Survival at 1 year was 74%. The bulk of late readmission and mortality was not procedure or valve related but rather was due to comorbidities. Paravalvular regurgitation was common but generally mild and remained stable at late follow-up. At a maximum of >3 years and a median of 221 days, structural valve failure was not observed.

Conclusions—

Transcatheter aortic valve implantation can result in early and sustained functional improvement in high-risk aortic stenosis patients. Late outcome is determined primarily by comorbidities unrelated to aortic valve disease.
Paclitaxel-Coated Balloon Catheter Versus Paclitaxel-Coated Stent for the Treatment of Coronary In-Stent Restenosis
Authors: Unverdorben Martin , Vallbracht Christian , Cremers Bodo , Heuer Hubertus , Hengstenberg Christian , Maikowski Christian , Werner Gerald S. , Antoni Diethmar , Kleber Franz X. , Bocksch Wolfgang , Leschke Matthias , Ackermann Hanns , Boxberger Michael , Speck Ulrich , Degenhardt Ralf , Scheller Bruno
Published: June 2009

Background—

Treatment of in-stent restenosis with paclitaxel-coated balloon catheter as compared with plain balloon angioplasty has shown surprisingly low late lumen loss at 6 months and fewer major adverse cardiac events up to 2 years. We compared the efficacy and safety of a paclitaxel-coated balloon with a paclitaxel-eluting stent as the current standard of care.

Methods and Results—

One hundred thirty-one patients with coronary in-stent restenosis were randomly assigned to treatment by a paclitaxel-coated balloon (3 μg/mm
2
) or a paclitaxel-eluting stent. The main inclusion criteria encompassed diameter stenosis of ≥70% and ≤22 mm in length, with a vessel diameter of 2.5 to 3.5 mm. The primary end point was angiographic in-segment late lumen loss. Quantitative coronary angiography revealed no differences in baseline parameters. At 6 months follow-up, in-segment late lumen loss was 0.38±0.61 mm in the drug-eluting stent group versus 0.17±0.42 mm (
P
=0.03) in the drug-coated balloon group, resulting in a binary restenosis rate of 12 of 59 (20%) versus 4 of 57 (7%;
P
=0.06). At 12 months, the rate of major adverse cardiac events were 22% and 9%, respectively (
P
=0.08). This difference was primarily due to the need for target lesion revascularization in 4 patients (6%) in the coated-balloon group, compared with 10 patients (15%) in the stent group (
P
=0.15).

Conclusions—

Treatment of coronary in-stent restenosis with the paclitaxel-coated balloon was at least as efficacious and as well tolerated as the paclitaxel-eluting stent. For the treatment of in-stent restenosis, inhibition of re-restenosis does not require a second stent implantation.
G Protein–Coupled Receptor Kinase 2 Expression and Activity Are Associated With Blood Pressure in Black Americans
Authors: Cohn Heather I. , Xi Yihuan , Pesant Stephanie , Harris David M. , Hyslop Terry , Falkner Bonita , Eckhart Andrea D.
Published: June 2009

Hypertension occurs with higher prevalence and morbidity in black Americans compared with other groups. Alterations in the signal transduction pathways of 7-transmembrane spanning receptors are found in hypertensive patients. G protein–coupled receptor kinases (GRKs) play an important role in regulating this receptor signaling. The 2 most abundantly expressed GRKs in the cardiovascular system are GRK2 and GRK5, and each has unique substrates. Understanding changes in expression may give us insight into activated receptors in the pathophysiological progression of hypertension. In heart failure and white hypertensives, increased GRK2 expression arises because of neurohormonal stimulation of particular receptors. GRK2 subsequently desensitizes specific receptors, including β-adrenergic receptors. In blood pressure control, β-adrenergic receptor desensitization could lead to increased blood pressure. GRK2 and GRK5 mRNA were evaluated in lymphocytes of black Americans via quantitative real-time PCR. GRK2 mRNA expression directly correlated with systolic blood pressure and norepinephrine levels. GRK2 was elevated >30% among those with systolic blood pressure ≥130 mm Hg. No significant correlation between GRK5 mRNA expression and blood pressure or catecholamines was observed. Diabetic status, age, sex, and body mass index were also compared with GRK2 expression using univariate and multivariate analyses. GRK2 protein expression was elevated 2-fold in subjects with higher blood pressure, and GRK activity was increased >40%. Our data suggest that GRK2, but not GRK5, is correlated with increasing blood pressure in black Americans. Understanding the receptors stimulated by increased neurohormonal activation may give insight into the pathophysiology of hypertension in this at-risk population.
Enhanced Distal Nephron Sodium Reabsorption in Chronic Angiotensin II–Infused Mice
Authors: Zhao Di , Seth Dale M. , Navar L. Gabriel
Published: June 2009

Chronic angiotensin II (Ang II) infusions enhance urinary excretion of angiotensinogen, suggesting augmentation of distal nephron sodium reabsorption. To assess whether chronic Ang II infusions (15 ng/min for 2 weeks) enhance distal nephron sodium reabsorption, we compared sodium excretion before and after blockade of the 2 main distal nephron sodium transporters by IV amiloride (5 mg/kg of body weight) plus bendroflumethiazide (12 mg/kg of body weight) in male C57/BL6 anesthetized control mice (n=10) and in chronic Ang II–infused mice (n=8). Chronic Ang II infusions increased systolic blood pressure to 141±6 mm Hg compared with 106±4 mm Hg in control mice. After anesthesia, mean arterial pressure averaged 97±4 mm Hg in chronic Ang II–infused mice compared with 94±3 mm Hg in control mice, allowing comparison of renal function at similar arterial pressures. Ang II–infused mice had lower urinary sodium excretion (0.16±0.04 versus 0.30±0.05 μEq/min;
P
<0.05), higher distal sodium reabsorption (1.74±0.18 versus 1.12±0.18 μEq/min;
P
<0.05), and higher fractional reabsorption of distal sodium delivery (91.1±1.8% versus 77.9±4.3%;
P
<0.05) than control mice. Urinary Ang II concentrations, measured during distal blockade, were greater in Ang II–infused mice (1235.0±277.2 versus 468.9±146.9 fmol/mL;
P
<0.05). In chronic Ang II–infused mice treated with spironolactone (n=5), fractional reabsorption of distal sodium delivery was similarly augmented as in chronic Ang II–infused mice (94.6±1.7%;
P
<0.01). These data provide in vivo evidence that there is enhanced distal sodium reabsorption dependent on sodium channel and Na
+
-Cl
−
cotransporter activity and increased urinary Ang II concentrations in mice infused chronically with Ang II.
Convectively Induced Transverse Band Signatures in Satellite Imagery
Authors: Lenz A. , Bedka K. M. , Feltz W. F. , Ackerman S. A.
Published: June 2009

Transverse cirrus bands have commonly been observed in the outflow of thunderstorms, though little literature exists on the subject. The primary objective of this paper is to characterize the transverse band signature in satellite imagery with references to storm location, movement, and life cycle. The transverse band signature was observed in nearly half of all convective systems analyzed between May and August 2006, commonly in the mature and decay stages of the system. Storm size and propagation did not appear to influence transverse bands, though the bands did appear to be associated with negative 300-hPa relative vorticity and positive divergence. Transverse bands lasted an average duration of 9 h and generally occurred during the nighttime hours. The satellite analysis was combined with eddy dissipation rate (EDR) atmospheric turbulence observations collected by commercial aircraft. At least one observation of light (moderate) turbulence was found within transverse bands for 93% (44%) of events, indicating that the presence of transverse bands in satellite imagery is a strong indicator for aviation turbulence.
Obesity in Children Is Associated With Increased Health Care Use
Authors: Hering Elie , Pritsker Irena , Gonchar Ludmila , Pillar Giora
Published: June 2009

Background: The prevalence of obesity in children has steadily risen during recent years in developed countries. There is increasing data associating this rise in obesity with a rise in morbidity. In adults, data show clear association between obesity and health care use. This study examined the effects of obesity on health care use in children of several age groups. Methods: The population consisted of children from Tirat HaCarmel, Israel, who are patients at the town’s Clalit Health Care, Child Care Center (CCC). All obese children (body mass index [BMI] > 95%) participated and were matched by age and gender with nonobese children (BMI < 85%) who served as a control group. Children were further divided into 3 age groups: ages 4 to 7 years, 8 to 11 years, and 12 to 18 years. Health care use was measured by 4 criteria over a 2-year time period: clinic visits, emergency department visits, hospitalizations, and medication use. Results: Of more than 4000 children treated in the CCC, 363 obese children were matched to 382 control children. Obese children had significantly more clinic visits (4942 vs 4058, P < .001), had more hospitalizations (67 vs 34, P < .001), were hospitalized for longer periods (207 vs 79 days, P < .001), and used significantly more medications (5945 vs 4638, P < .001) than did the control group. Conclusion: This study provides objective clinical evidence that obesity in children is associated with increased health care use. This information has clear implications for both the public health and health insurance sectors and supports the need to invest in efforts to reduce childhood obesity.
Obesity and the Built Environment Among Massachusetts Children
Authors: Oreskovic Nicolas M. , Winickoff Jonathan P. , Kuhlthau Karen A. , Romm Diane , Perrin James M.
Published: June 2009

Background: The built environment may influence weight status. Method: Using cross-sectional data for children aged 2 to 18 years, the authors linked clinical and spatial data using geographic information systems and analyzed for associations between body mass index (BMI) and density of and distance to nearest built environment variable (schools, sidewalks, subway stations, bicycle trails, open space, and fast-food restaurants) using bivariate and multilevel analyses. Results: The study sampled 21 008 children; 54% were white, 26% Hispanic, 37% overweight, and 20% obese. In bivariate analysis, distance to nearest fast-food restaurant was inversely associated with BMI, whereas density of fast-food restaurants was positively associated with BMI. Distance to school and subway station, amount of open space, and density of subway stations were inversely associated with BMI. Controlling for sociodemographic factors, only living near a greater density of subway stations was inversely associated with overweight (odds ratio, 0.87; 95% confidence interval, 0.81-0.94) and obesity (odds ratio, 0.90; 95% confidence interval, 0.82-0.99). Conclusion: Distance to nearest subway station is associated with BMI among Massachusetts children.
A Girl With Bilateral Temporomandibular Joint Pain, Generalized Arthralgias, and Inability to Walk
Authors: Sklirou Evgenia , Mavrikou Mersini , Voudris Konstantinos A. , Stamoyannou Lela
Published: June 2009

The authors present the case of a 6.5-year-old girl with bilateral temporomandibular joint (TMJ) pain, generalized arthralgias, inability to walk, and absence of deep tendon reflexes in the context of Guillain—Barrè syndrome. TMJ pain was the sole manifestation for 3 days, before other typical symptoms appeared, an issue that initially led to an improper diagnosis. A thorough clinical examination along with laboratory and radiographic evaluation excluded other possible causes of TMJ pain. To the best of the authors’ knowledge, this is the first case of Guillain—Barrè syndrome in the pediatric population initially presenting with bilateral TMJ pain. Guillain—Barrè syndrome may be quite atypical in its expression, especially in young children, with pain being a common presenting symptom, and pediatricians should be alert to avoid misdiagnosis.
Tinea Capitis: Predictive Value of Symptoms and Time to Cure With Griseofulvin Treatment
Authors: Lorch Dauk Kelly C. , Comrov Elana , Blumer Jeffrey L. , O'Riordan Mary Ann , Furman Lydia M.
Published: June 2009

Objectives. To describe ( a) the predictive value of symptoms for diagnosis of tinea capitis and ( b) the rate and timing of cure with high-dose griseofulvin treatment. Methods. This prospective open-label study enrolled children aged 1 to 12 years with clinical tinea capitis. Participants with a positive dermatophyte culture received oral griseofulvin (20-25 mg/kg/day) and topical selenium sulfide shampoo for 6 weeks. Main outcome measures. The rate of symptoms of tinea capitis, and rates of mycologic and clinical cure. Results. The positive predictive values of any 1, 2, 3, or 4 symptoms for a positive culture were 88%, 82%, 78%, and 77%, respectively. The observed rates of mycologic, clinical, and complete cure were 89%, 66%, and 49%, respectively. Conclusion. In a high-risk population it is reasonable to diagnose tinea capitis using one or more cardinal symptoms. Oral griseofulvin at 20 to 25 mg/ kg/day with adjunctive shampooing for 6 weeks is moderately successful as treatment.
Crowding and Cognitive Development
Authors: Evans Gary W. , Ricciuti Henry N. , Hope Steven , Schoon Ingrid , Bradley Robert H. , Corwyn Robert F. , Hazan Cindy
Published: June 2009

Residential crowding in both U.S. and U.K. samples of 36-month-old children is related concurrently to the Bracken scale, a standard index of early cognitive development skills including letter and color identification, shape recognition, and elementary numeric comprehension. In the U.S. sample, these effects also replicate prospectively. Statistical controls for income, child gender, maternal age, and maternal education are incorporated throughout. In both samples the association between crowding and cognitive development are mediated by maternal responsiveness. Mothers in more crowded homes are less responsive to their children.
Constructing Spatial Meaning
Authors: Wineman Jean D. , Peponis John
Published: June 2009

Informal education in museums is structured through movement in space. This article summarizes a range of research that examines the role of spatial layout in shaping the ways in which visitors explore, engage, and understand museums and museum exhibitions. It is demonstrated that behavior patterns are systematically linked to spatial characteristics of access and visibility. Furthermore, it is suggested that these patterns of access and visibility construct a spatial discourse that flows in its own right, although not entirely separate from the curatorial message.
Applying Hofstede’s National Culture Measures in Tourism Research: Illuminating Issues of Divergence and Convergence
Authors: Reisinger Yvette , Crotts John C.
Published: June 2009

Given the emerging evidence that national culture influences visitor behavior and that Hofstede’s concept (1980, 2001) has become the most accepted means to quantify dominant national cultural values, the focus of this study was to test the underlying assumptions of how these measures are applied in research. Drawing from a sample of tourists from eight countries who completed Hofstede’s original instruments, the results reveal little differences between Hofstede’s 2001 national cultural measures with the current study’s data. This finding provides strong support for Hofstede’s dimensions as a measure of central tendencies of visitors from different nations. Second, graphically contrasting respondents’ values along the five cultural dimensions reveals that the between-nation differences are relatively small when compared to the within-nation variability, indicating that subcultures do exist. This analysis also identifies international regions that cluster closely together, demonstrating that national cultural differences do not end at national borders.
How They See Us: Perceived Effects of Tourist Gaze on the Old Order Amish
Authors: Chhabra Deepak
Published: June 2009

Although abundant literature focuses on tourism impact perspectives, folk communities’ perceptions of tourist gaze and its effects on the cultural fabric of host communities as a subject of inquiry has received scant attention. To shed new light on this discourse, this study investigates perceived impacts of tourist gazing within the framework of resistance theory. The Old Order Amish (OOA) are positioned on a resistance scale, with an open-resistance stance at one end and a full-cooperation stance at the opposite end of the spectrum. This study gathers data from 42 OOA families residing in the state of Iowa, United States. The results show mixed reactions by the OOA and indicate a middle approach of resistance, termed as “negotiated reciprocity” on the resistance continuum.
Prospective Evaluation of the Bayesian Method for Individualizing Tacrolimus Dose Early After Living‐Donor Liver Transplantation
Authors: Fukudo Masahide , Yano Ikuko , Shinsako Keiko , Katsura Toshiya , Takada Yasutsugu , Uemoto Shinji , Inui Ken‐ichi
Published: June 2009

Tacrolimus is widely used to prevent acute rejection after transplantation, but achieving therapeutic blood concentrations of tacrolimus is often difficult because of large pharmacokinetic variability. In this study, the applicability of the Bayesian method to individualize tacrolimus dose was prospectively examined. Twenty adult recipients (Bayesian group) and another 20 adult patients (control group), all of whom underwent living‐donor liver transplantation, were enrolled in this study. In the Bayesian group, the dose of tacrolimus during the first 3 and 4 weeks after surgery was adjusted with the Bayesian method using a population pharmacokinetic model, targeting a trough level of 5 to 12 ng/mL. The interindividual variability in tacrolimus concentrations was significantly reduced in the Bayesian group compared with the control group (average percentage coefficient of variation for all occasions, 32% vs 44% and 31% vs 39% in the first 3 and 4 weeks, respectively). In addition, more patients achieved the target concentrations in the Bayesian group than in the control group (average for all occasions, 85% vs 59% and 83% vs 70% in the first 3 and 4 weeks, respectively). These findings suggest that the Bayesian method can be used to calculate maintenance doses of tacrolimus in adult patients early after living‐donor liver transplantation.
Diesel consumption in waste collection and transport and its environmental significance
Authors: Larsen Anna W. , Vrgoc Marko , Christensen Thomas H. , Lieberknecht Poul
Published: June 2009

Use of diesel in collection trucks is presumably the most important environmental burden from waste collection because of the emission of exhaust gases from the combustion process. The environmental impact depends not only on the amount of diesel used, but also the on the cleanness of the exhaust gas that is regulated by emission standards. We measured the diesel consumption for 14 different collection schemes in two municipalities in Denmark, yielding a total of 254 measurements. Collection was defined as driving and loading of waste from the first to the final stop on the collection route. All other distances covered were defined as transport of waste, which was modelled in generic transport simulation models. The diesel consumption per tonne of waste in the specified collection schemes turned out to be related to the type of housing and to the amount of waste collected per stop. The observations showed a considerable variation between different collection schemes, ranging from 1.4— 10.1 L diesel tonne— 1 of waste. Assessment of the potential environmental impact by a life-cycle-assessment method showed a substantial decrease over the last decade because of implementation of European emissions standard for diesel trucks. The paper also discusses the importance of energy used for collection and transport in relation to the potential energy savings from waste treatment. In many cases, the net savings exceed significantly the use of diesel.
Potential environmental impacts of using refuse derived material for landfill capping
Authors: van Praagh Martin , Persson Kenneth M. , Karlsson Patrik
Published: June 2009

In this study, the potential impacts on leachate emissions of applying a pretreated refuse-derived material as a capping layer on top of a municipal solid waste landfill were researched. Leachate emissions and stability against degradation were investigated with reference to the untreated material. Results from percolation leaching tests were analysed by multivariate data analysis and chemical speciation modelling. During 6 month aerobic pretreatment in composting windrows with forced aeration, the waste was stabilized against aerobic degradation measured as respiration activity down to 15% of the original value. Initial percolation leachate concentrations were reduced by 40% for As, by 50% for Co, by 60% for Ni, Pb, and total sulfur, by 40% for sulfate-sulfur, by 96% for ammonium nitrate, and by 62% for dissolved organic carbon. An increase was observed by a factor of 4 for Cd, by a factor of 150 for Cu, by a factor of 3 for Zn. Principle Component Analysis revealed that the leaching characteristics of the pretreated material developed towards those of a top soil used as reference material. Increasing the flow rate in column percolation experiments led to lower leachate concentrations at liquid to solid ratios of 10. Constructing a capping layer from the pretreated material is likely to have impacts on the leachate treatment system.
Small-scale home composting of biodegradable household waste: overview of key results from a 3-year research programme in West London
Authors: Smith Stephen R. , Jasim Sharon
Published: June 2009

Home composting (HC) is recognized by both local and national Governments for its contribution to reducing household waste disposal in landfill. However, the quantitative impact of HC on the diversion of household waste from landfill is uncertain. An overview of key results is presented from a 3-year research programme on HC in the West London area of Runnymede Borough Council (RBC), Surrey, UK. The amount of biodegradable household waste diverted from landfill disposal by HC was measured in a 2-year monitoring study involving 64 homeowners. The total average annual waste input to a standard 290 L HC bin was approximately 370 kg per household. The average relative mass inputs of kitchen, paper and garden waste were 29, 2 and 69%, respectively. A survey of the study area indicated that approximately 20% of households were engaged in HC and, based on inputs to HC bins, this corresponded to an overall recycling/diversion rate equivalent to 20% of household biodegradable waste. Temperature and gas composition measurements indicated organic matter decomposition by HC was aerobic and only traces of CH4 were occasionally detected. A field trial examined the end-use of composted products for the growth of Petunia grandiflora. Flower production increased with home-produced composts in comparison with peat-amended or untreated control soil. Compost chemical composition, bioaerosol emissions and vector attraction were also investigated.
Hospital medical waste management in Shandong Province, China
Authors: Ruoyan Gai  , Kuroiwa Chushi , Lingzhong Xu  , Xingzhou Wang  , Yufei Zhang  , Huijuan Li  , Chengchao Zhou  , Jiangjian He  , Wei Tang  , Kuroiwa Chushi , Wei Tang
Published: June 2009

Medical waste refers to those hazardous waste materials generated by healthcare activities, including a broad range of materials, and remains as an issue on both public health and environment. In China, there was inadequate information on the implementation of management systems in hospitals based on the national regulatory framework. The objectives of this study were to assess the current situation of medical waste management and to identify factors determining the implementation of a management system based on the national regulatory framework in hospitals. We investigated 23 general hospitals in both urban and rural areas of Shandong Province, China, by both quantitative and qualitative approaches. The medical waste generation rate was 0.744, 0.558 and 1.534 kg bed— 1 day—1 in tertiary hospitals, urban secondary hospitals and county hospitals, respectively. There is a wide disparity between implementation in tertiary, secondary and county hospitals. With increasing financial, technological, and materials investment, a management system has been established in tertiary and secondary hospitals. Financial support and administrative monitoring by the government is urgently needed to build a sound management system in hospitals located at remote and less-developed areas. In those areas issues in the financial, administrative and technical aspects should be further examined.
Altered Fronto-Striato-Thalamic Connectivity in Children with Tourette Syndrome Assessed with Diffusion Tensor MRI and Probabilistic Fiber Tracking
Authors: Makki Malek I. , Munian Govindan Rajkumar , Wilson Benjamin J. , Behen Michael E. , Chugani Harry T.
Published: June 2009

The aim of the study was to determine whether abnormal connectivity of the fronto-striato-thalamic circuit underlies the morphological changes in subcortical structures of patients with Tourette syndrome and to correlate these changes with neurobehavioral measures. A total of 18 children with Tourette syndrome and 12 age-matched healthy controls underwent diffusion tensor magnetic resonance imaging. Tractography of the fronto-striato-thalamic circuit was achieved using probability distribution function of individual voxels. The Tourette syndrome group had significantly lower probability of connection between caudate nucleus and anterior-dorsolateral-frontal cortex on the left (P = .038). Obsessive-compulsive behavior was negatively associated with connectivity score of the left caudate and anterior dorsolateral frontal cortex (P = .01) and was positively associated with connectivity score for the subcallosal gyrus (P = .009) and for the lentiform nucleus (P = .008). The abnormal connectivity among components of the fronto-striato-thalamic circuit bilaterally (ie, seeds on the caudate and thalamus) in patients with Tourette syndrome provides direct evidence for the involvement of these circuits in the pathophysiology.
Biotin-Responsive Basal Ganglia Disease: A Treatable and Reversible Neurological Disorder of Childhood
Authors: Bindu P.S. , Noone M.L. , Nalini A. , Muthane Uday B. , Kovoor Jerry M. E.
Published: June 2009

Biotin-responsive basal ganglia disease is a rare childhood neurological disorder of uncertain etiology that is treatable if suspected and diagnosed. Only few cases have been reported earlier in literature. We report a case of biotin-responsive basal ganglia disease suspected clinically, corroborated by neuroimaging and a dramatic response to biotin therapy.
Cogan's Syndrome: A Rare Cause of Meningoencephalitis
Authors: Pysden Karen S. , Long Vernon , Ferrie Colin D. , Leeds Teaching Hospitals NHS Trust
Published: June 2009

We report a 14-year-old boy who presented with meningoencephalitis. Other features particularly auditory, vestibular, and ocular lead to the diagnosis of Cogan's syndrome. Treatment with prednisolone resulted in a rapid improvement and recovery of his hearing. Cogan's syndrome is a rare primary vasculitis, characterized by ocular, auditory, and vestibular symptoms, which can have significant morbidity and mortality. Presentation with a meningoencephailitic picture is unusual. Increased awareness of its clinical features among pediatricians and pediatric neurologists should lead to earlier diagnosis and increased recognition of the serious systemic manifestations. Early use of prednisolone can prevent hearing loss and can also be useful in treating the other vasculitic manifestations.
Attention-Deficit Disorders and Epilepsy in Childhood: Incidence, Causative Relations and Treatment Possibilities
Authors: Kaufmann Rami , Goldberg-Stern Hadassa , Shuper Avinoam
Published: June 2009

At least 20% of children with epilepsy have clinical attention-deficit hyperactivity disorder (ADHD) compared to 3% to 7% of the general pediatric population. Several mechanisms may account for the high prevalence, such as a common genetic propensity, noradrenergic system dysregulation, subclinical epileptiform discharges, or even seizures, antiepileptic drug effects, and psychosocial factors. At the same time, children with attention-deficit hyperactivity disorder have a higher than normal rate of electroencephalography abnormalities (5.6-30.1% vs. 3.5%). Methylphenidate treatment is equally efficient in children with isolated attention-deficit hyperactivity disorder and in children with attention-deficit hyperactivity disorder and epilepsy (70%-77%). Electroencephalography screening in patients with attention-deficit hyperactivity disorder in the absence of other clinical indications or before starting methylphenidate treatment is not currently indicated. Methylphenidate is considered safe for use in children who are seizure-free. However, the few reports of seizure aggravation in methylphenidate-treated children with uncontrolled epilepsy have raised concern.
Does Powerlessness Explain the Relationship Between Intimate Partner Violence and Depression?
Authors: Filson Jennifer , Ulloa Emilio , Runfola Cristin , Hokoda Audrey
Published: June 2009

The current study aimed to test whether relationship power could act as a mediator of the relationship between intimate partner violence and depression. The proposed mediation model was based on the theory of gender and power and on previous research of intimate partner violence and depression. Survey results from a sample of 327 single undergraduate women lent support to the hypothesis stating that relationship power accounts for some of the association between intimate partner violence and depression. Results revealed that women who felt powerless had higher rates of intimate violence victimization and higher levels of depression; a mediation analysis revealed that sexual relationship power mediated the relationship between intimate partner violence and depression. Future interventions targeting the prevention of intimate partner violence among young women may want to utilize an empowerment approach to decrease their likelihood of experiencing dating violence victimization and their subsequent risk for depression.
Employee Benefits: The Age of Accountability
Authors: McKeeby Charles , Nunley Randall
Published: June 2009

Market conditions and new FAS 157 requirements underscore the importance of reviewing the sponsor’s fiduciary responsibilities.
Familiarity Breeds Contempt
Authors: Lust Aleksander
Published: June 2009

In referenda held in 2003, over 90% of Lithuanians supported joining the European Union (EU), while only two-thirds of Estonians did. Why? This article shows that Lithuanians and Estonians had different economic expectations about the EU. Most Lithuanians hoped that EU membership would help Lithuania overcome its economic backwardness and isolation. By contrast, many Estonians worried that the accession would reinforce Estonia's underdevelopment and dependency on the West. I argue that these expectations reflected the two countries' strategies of economic reform. Lithuania sold state-owned enterprises (SOEs) to their managers and continued to trade heavily with Russia, which slowed down the modernization of its economy. Estonia sold SOEs to foreigners and reoriented its trade rapidly from Russia to the West, which hurt its traditional sectors (particularly agriculture) and infrastructure.
Screening Depression Among Institutionalized Older Chinese Men by Minimum Data Set
Authors: Liang Chih-Kuang , Chen Liang-Kung , Tsai Chia-Fen , Su Tung-Ping , Lo Yuk-Keung , Lan Chung-Fu , Hwang Shinn-Jang
Published: June 2009

Objective: To compare the effectiveness of the Minimum Data Set-based Depression Rating Scale (MDS-DRS) and Geriatric Depression Scale (GDS) in screening depression among older institutionalized Chinese men living in Taiwan. Method: MDS Nursing Home 2.1 Chinese version, Mini-Mental State Examination (MMSE), and short form Geriatric Depression Scale (GDS-15) were used among elderly residents in Banciao Veterans Home. Screening results of MDS-DRS and GDS-15, and relationship between 16 MDS Mood and Anxiety symptoms and depression were evaluated. Results: The prevalence of depression defined by MDS-DRS and GDS were 0.2% and 8.7%, respectively. Multiple logistic regression disclosed that E1a (OR: 12.9, 95% CI: 2.8-58.8, p = 0.001), E1k (OR: 15.6, 95% CI: 5.6-43.5, p < 0.001), and E1l (OR: 22.2, 95% CI: 6.1-83.3, p < 0.001) were all independent associative factors for GDS-defined depression but only explained 51.9% of all depressive subjects. Conclusions: The effectiveness of MDS-DRS is limited, and a new MDS-based depression screening instrument is needed.
Vascular Risk Factors and Cognitive Functions in Nondemented Elderly Individuals
Authors: Wiederkehr Sandra , Laurin Danielle , Simard Martine , Verreault René , Lindsay Joan
Published: June 2009

Background: The brain-at-risk stage is the earliest phase of the vascular cognitive impairment continuum and includes individuals with vascular risk factors (VRF). However, there is still no clear definition of this concept. The aim of the study is to characterize the neuropsychological profile of elderly individuals by 3 levels of VRF. Methods: This is a cross-sectional analysis of the Canadian Study of Health and Aging baseline data; 577 nondemented elderly individuals ≥65 years old were divided into 3 groups: reference group (0 VRF; n = 82); intermediate brain-at-risk group (1-2 VRF; n = 360); high brain-at-risk group (≥3 VRF; n = 135). A principal component analysis (PCA) and univariate/multivariate analyses of variance were performed to examine the relationships between the groups and various cognitive measures. Main findings: The PCA produced a 2-component solution (1) executive/psychomotor functions including measures of abstraction and (2) verbal memory. The high brain-at-risk group performed significantly worse than the reference group on the first component. Conclusions: Elderly individuals presenting with ≥3 VRF are more impaired on measures of executive functions/ processing speed than participants without any VRF.
Antibacterial Nanofibers of Self-quaternized Block Copolymers of 4-Vinyl Pyridine and Pentachlorophenyl Acrylate
Authors: Xu Li Qun  , Yao Fang  , Yin Shan  , Fu Guo-Dong , Shen Liang  , Nie Shengzhe  , Zhu Meifang
Published: June 2009

Well-defined antibacterial block copolymers of 4-vinyl pyridine (4VP) and pentachlorophenyl acrylate (PCPA) (P(4VP- b-PCPA)) were prepared via reversible addition—fragmentation chain transfer (RAFT) polymerization. Electrospinning of the P(4VP- b-PCPA) from a solution in mixed tetrahydrofuran and dimethylformamide gave rise to fibers with diameters in the range of 0.5—4.0 µm. The quaternary ammonium salts (QASs) were generated by N-alkylation of pyridine groups of P4VP block and chloro-aromatic compounds of PPCPA block (or self-quaternization of P(4VP- b-PCPA)). The self-quaternization of P(4VP- b-PCPA) nanofibers was studied by X-ray photoelectron spectroscopy. Attributable to the hydrophobicity of the PPCPA blocks and the electrostatic interaction of QASs generated from the self-quaternization of P(4VP- b-PCPA), the resulting nanofibers exhibit a high antibacterial efficiency. The antibacterial effect of the P(4VP- b-PCPA) nanofibers was assayed using Escherichia coli and Staphylococcus aureus cultures. It was found that 99.6% of E. coli and 99.1% S. aureus were killed after being in contact with 50 mg nanofibers in 10 min. The permanence of antibacterial activity of the self-quaternized P(4VP- b-PCPA) nanofibers was also demonstrated in repeat application.
Finding a Home Abroad With “Eveline”: Using Narrative Inquiry to Establish a Sense of Place for a Western Teacher in a Foreign and Multicultural Context
Authors: Ferguson Matthew Robert
Published: June 2009

This is the exposition of a Western teacher working abroad in Thailand and his coming to terms with what it means to find a home and a sense of belonging while learning to teach in an unfamiliar land and culture. A foreign teacher finds himself isolated between feelings of perceived power (as an educated Westerner) and his all too real feelings of apprehension (as a cultural outsider in a Thai classroom) without feeling grounded in a unified place to call home. The author combines narrative inquiry along with theoretical formulations using the instrument of story to create a dynamic and sensuous space while at the same time proposing a more sophisticated multicultural approach to International Education.
Preparing Social Work Practitioners to Use Evidence-Based Practice
Authors: Manuel Jennifer I. , Mullen Edward J. , Lin Fang  , Bellamy Jennifer L. , Bledsoe Sarah E.
Published: June 2009

The implementation of evidence-based practice (EBP) as a professional model of practice for social work has been suggested as one approach to support informed clinical decision making. However, different barriers and processes have been identified that impact the use of EBP at individual, organizational, and systemic levels. This article describes results from a project that sought to enhance practitioner use of EBP by using a supportive strategy including training and technical assistance through a partnership between university-based researchers and three social work agencies. Results compare similarities and differences across each of the three agencies in terms of barriers and promoters at the team, organizational, and system levels. Results suggest that comprehensive multilevel interventions are needed to support the use of EBP in social work organizations and that further research is needed to test explicit partnership components. Findings suggest that a multilevel approach has the greatest potential to support implementation of EBP in social agencies.