bluuebunny/crossref_metadata_2025_split huggingface dataset:
Recombinant Human Bone Morphogenetic Protein‐2 for Peri‐Implant Bone Regeneration: A Case Report
Authors: Rotenberg Shaun A. , Tatakis Dimitris N. 
Published: January 2011

Background: Currently, clinicians have a limited treatment arsenal in the repair of peri‐implant defects. The aim of the present report is to present the clinical results of treating a dental implant using recombinant human bone morphogenetic protein (rhBMP)‐2 in an elderly patient.Methods: A 75‐year‐old man presented for routine dental prophylaxis. Clinical and radiographic examination revealed significant loss of attachment and bone loss around an implant replacing the maxillary left first molar. The patient did not report any symptoms, and the implant showed no signs of mobility. Because of the severity of the defect, regenerative treatment using a combination of rhBMP‐2 and freeze‐dried bone allograft was used.Results: The patient was followed for 80 weeks postoperatively. By 28 weeks, significant probing depth reduction and radiographic bone fill was observed, and the original implant crown was replaced. From 28 weeks postoperatively to 80 weeks, no significant clinical or radiographic changes were observed.Conclusions: rhBMP‐2 represents a potential therapeutic modality for severe peri‐implant hard tissue loss. Future studies should examine parameters, such as surgical technique, to maximize the rhBMP‐2‐driven regenerative outcomes.
From Politics to Parity: Using a Health Disparities Index to Guide Legislative Efforts for Health Equity
Authors: Webb Bryant Cameron , Simpson Sean L. , Hairston Kristen G. 
Published: January 2011

Objectives. We created an index quantifying the longitudinal burden of racial health disparities by state and compared this index to variables to guide the construction of, and validate support for, legislative efforts aimed at eliminating health disparities. Methods. We evaluated 5 focus areas of greatest racial disparities in health from 1999 to 2005 and compiled state health disparities index (HDI) scores. We compared these scores with variables representing the purported social determinants of health. Results. Massachusetts (0.35), Oklahoma (0.35), and Washington (0.39) averaged the fewest disparities. Michigan (1.22), Wisconsin (1.32), and Illinois (1.50) averaged the greatest disparities. The statistical reference point for nationwide average racial disparities was 1.00. The longitudinal mixed model procedure yielded statistically significant correlations between HDI scores and Black state population percentage as well as with the racial gap in uninsured percentages. We noted a trend for HDI correlations with median household income ratios. Conclusions. On the basis of the HDI-established trends in the extent and distribution of racial health disparities, and their correlated social determinants of health, policymakers should consider incorporating this tool to advise future efforts in minority health legislation.
Education Associations With Smoking and Leisure-Time Physical Inactivity Among Hispanic and Asian Young Adults
Authors: Stoddard Pamela , Adler Nancy E. 
Published: January 2011

Objectives. We assessed whether associations between education and 2 health behaviors—smoking and leisure-time physical inactivity (LTPI)—depended on nativity and age at immigration among Hispanic and Asian young adults. Methods. Data came from the 2000–2008 National Health Interview Survey. The sample included 13 345 Hispanics and 2528 Asians aged 18 to 30 years. Variables for smoking and LTPI were based on self-reported data. We used logistic regression to examine education differentials in these behaviors by nativity and age at immigration. Results. The association of education with both smoking and LTPI was weaker for foreign-born Hispanics than for US-born Hispanics but did not vary by nativity for Asians. Education associations for smoking and LTPI among foreign-born Hispanics who had immigrated at an early age more closely resembled those of US-born Hispanics than did education associations among foreign-born Hispanics who had immigrated at an older age. A similar pattern for smoking was evident among Asians. Conclusions. Health-promotion efforts aimed at reducing disparities in key health behaviors among Hispanic and Asian young adults should take into account country of residence in childhood and adolescence as well as nativity.
Making the Case for Using Financial Indicators in Local Public Health Agencies
Authors: Suarez Virginia , Lesneski Cheryll , Denison Dwight 
Published: January 2011

The strength of the public health infrastructure determines the ability of local public health agencies to respond to emergencies and provide essential services. Organizational and systems capacity measures and assessments are important components of the public health infrastructure.Hospitals and governments have a long tradition of using financial indicators to assess fiscal and operational activities. We reviewed the literature on how hospitals use financial indicators to monitor financial risk, promote organizational sustainability, and improve organizational capacity.Given that financial indicators have not generally been employed by public health practitioners, we discuss how these measures can be applied to local public health agencies to improve their organizational capacity.
Barriers and Facilitators to Implementing Primary Stroke Center Policy in the United States: Results From 4 Case Study States
Authors: O'Toole Laurence J. , Slade Catherine P. , Brewer Gene A. , Gase Lauren N. 
Published: January 2011

Objectives. We identified barriers and facilitators to the state-level implementation of primary stroke center (PSC) policies, which encourage the certification or designation of specialized stroke treatment facilities and may address concerns such as transportation bypass, telemedicine, and treatment protocols. Methods. We studied the experiences of 4 states (Florida, Massachusetts, New Mexico, and New York) selected from the 18 states that had enacted PSC policies or were actively considering doing so. We conducted semistructured interviews during fieldwork in each case study state. Results. Our results showed that system fragmentation, gaps in human and financial resources, and complexity at the interorganizational and operational levels are common barriers and that policy champions, stakeholder support and communication, and operational adaptation are essential facilitators in the adoption and implementation of PSC policies. Conclusions. The identification of barriers and facilitators reveals the contextual elements that can help or hinder policy implementation and may be useful in informing policy formulation and implementation in other jurisdictions. Proactively identifying jurisdictional challenges and opportunities may help facilitate the policy process for PSC designation and allow jurisdictions to develop more effective stroke systems of care.
Water moss as a food item of the zoobenthos in the Yenisei River
Authors: Kalachova Galina , Gladyshev Michail , Sushchik Nadezhda , Makhutova Olesia 
Published: January 2011

Abstract
Bryophytes are abundant in streams and are a habitat for many invertebrates, but their contribution to the diet of fluvial zoobenthos is still debated. To estimate the amount of bryophyte-derived organic matter assimilated by benthic invertebrates, we used a combination of fatty acid and stable isotope analyses during a four-year monthly study of a littoral site in the Yenisei River (Siberia, Russia). Acetylenic acids, which are highly specific biomarkers of the water moss Fontinalis antipyretica, were found in lipids of all dominant benthic animals: gammarids, ephemeropterans, chironomids and trichopterans. The dominant zoobenthic species, Eulimnogammarus viridis, had maximum levels of the biomarkers in its biomass during winter, and minimum levels in summer. The zoobenthos in the studied site regularly consume and assimilate bryophyte-derived organic matter as a minor supplemental food. This consumption increases in winter, when the main food source of the zoobenthos, epilithic biofilms, are probably scarce.
Transcranial magnetic stimulation and extradural electrodes implanted on secondary auditory cortex for tinnitus suppression
Authors: De Ridder Dirk , Vanneste Sven , Kovacs Silvia , Sunaert Stefan , Menovsky Tomas , van de Heyning Paul , Moller Aage 
Published: January 2011

Object
Tinnitus is a prevalent symptom, with clinical, pathophysiological, and treatment features analogous to pain. Noninvasive transcranial magnetic stimulation (TMS) and intracranial auditory cortex stimulation (ACS) via implanted electrodes into the primary or overlying the secondary auditory cortex have been developed to treat severe cases of intractable tinnitus.

Methods
A series of 43 patients who benefited transiently from 2 separate placebo-controlled TMS sessions underwent implantation of auditory cortex electrodes. Targeting was based on blood oxygen level–dependent activation evoked by tinnitus-matched sound, using functional MR imaging–guided neuronavigation.

Results
Thirty-seven percent of the patients responded to ACS with tonic stimulation. Of the 63% who were nonresponders, half benefited from burst stimulation. In total, 33% remained unaffected by the ACS. The average tinnitus reduction was 53% for the entire group. Burst stimulation was capable of suppressing tinnitus in more patients and was better than tonic stimulation, especially for noise-like tinnitus. For pure tone tinnitus, there were no differences between the 2 stimulation designs. The average pure tone tinnitus improvement was 71% versus 37% for noise-like tinnitus and 29% for a combination of both pure tone and noise-like tinnitus. Transcranial magnetic stimulation did not predict response to ACS, but in ACS responders, a correlation (r = 0.38) between the amount of TMS and ACS existed. A patient's sex, age, or tinnitus duration did not influence treatment outcome.

Conclusions
Intracranial ACS might become a valuable treatment option for severe intractable tinnitus. Better understanding of the pathophysiological mechanisms of tinnitus, predictive functional imaging tests, new stimulation designs, and other stimulation targets are needed to improve ACS results.
Economic impact of comorbidities in spine surgery
Authors: Walid M. Sami , Robinson Joe Sam 
Published: January 2011

Object
Comorbidities in patients undergoing spine surgery may reasonably be factors that increase health care costs. To verify this hypothesis, the authors conducted the following study.

Methods
Major comorbidities and age-adjusted Charlson Comorbidity Index scores were retrospectively analyzed for 816 patients who underwent spine surgery at the authors' institutions between 2005 and 2008, and treatment costs (hospital charges) were assessed with the help of statistical software. The sample was collected by a nonmedical staff (hired at the beginning of 2006). Patients underwent one of the three most common types of spine surgery: lumbar microdiscectomy (20.5%), anterior cervical decompression and fusion (ACDF; 60.3%), or lumbar decompression and fusion (LDF; 19.2%). Patients were nearly equally divided by sex (53% were female and 47% male), and 78% were Caucasian versus 21% who were African American; the rest were of mixed or unidentified race. The average age was 54 years, with an SD of ± 14 years.

Results
There were significant differences in the prevalence of major comorbidities between male and female and between severely obese and nonseverely obese patients. The impact of comorbidities on the cost of spine surgery was more prominent in older patients, and an additive effect from some comorbidities was recorded in various types of spine surgery. For instance, in the ACDF group, female patients with both severe obesity and diabetes mellitus (DM) had significantly higher hospital charges than those with only one or neither of these conditions ($34,943 for both severe obesity and DM vs $25,633 for severe obesity only; $25,826 for DM only; and $25,153 for those with neither condition [p < 0.05]). In the LDF group, female patients with both DM and a history of depression had significantly higher hospital charges than those with only one or neither of these conditions ($65,782 for both DM and depression vs $53,504 for DM only; $55,990 for depression only; and $52,249 for those with neither condition [p < 0.05]). A significant difference was also found in hospital cost ($16,472 [p < 0.01]; 32% increase over baseline) in the LDF group between patients with the lowest and highest scores on the Charlson Index.

Conclusions
Comorbidities additively increase hospital costs for patients who undergo spine surgery, and should be considered in payment arrangements.
Impact of temozolomide chemotherapy on seizure frequency in patients with low-grade gliomas
Authors: Sherman Jonathan H. , Moldovan Krisztina , Yeoh H. Kwang , Starke Robert M. , Pouratian Nader , Shaffrey Mark E. , Schiff David 
Published: January 2011

Object
Seizures occur in approximately 80% of patients with low-grade gliomas (LGGs). The majority of patients are treated with anticonvulsant monotherapy; however, many patients require multidrug therapy, or their seizures are refractory to antiepileptic drugs altogether. The oral alkylating agent temozolomide has emerged as a potential initial treatment option for LGG. A few reports suggest an association between temozolomide and reduced seizure frequency in patients with intractable epilepsy.

Methods
Using their clinical database, the authors identified adult patients whose LGGs were treated using temozolomide as the initial antineoplastic therapy at the University of Virginia Health System. As a control group, the authors assessed patients whose LGGs were under observation. All patients had seizure disorders that were treated with anticonvulsants. Seizure frequency in patients with intractable epilepsy was analyzed before and after treatment with temozolomide. Age at diagnosis, sex, antiepileptic drugs, pathological subtype, surgical treatment, and follow-up until progression were also assessed. Interval seizure frequency was meticulously analyzed at each neurooncology clinic visit. A meaningful difference in seizures was defined as a reduction in seizure frequency of greater than 50% per month.

Results
Thirty-nine patients were identified in the temozolomide cohort and 30 patients in the control cohort. The median age at diagnosis was 46 years for the former cohort and 41.5 years for the latter. The median length of follow-up was 39 months for the temozolomide group and 37 months for the control group. There was a significant difference in reduced seizure frequency between patients receiving temozolomide (59%) and those who did not receive temozolomide (13%, p < 0.001). Seven patients (18%) in the temozolomide group displayed this improvement independent of antiepileptic drug adjustment compared with no patient in the control group (p < 0.001).

Conclusions
The authors' data suggest that a subset of patients with LGGs experience improvement in seizure frequency during treatment with temozolomide independent of antiepileptic drug adjustment. This decrease in seizure frequency appears independent of the natural history of seizures in patients whose tumors are under observation. Consequently, seizures in patients with LGGs may be better controlled with the combination of AEDs and temozolomide.
Cortical ependymoma: an unusual epileptogenic lesion
Authors: Van Gompel Jamie J. , Koeller Kelly K. , Meyer Fredric B. , Marsh W. Richard , Burger Peter C. , Roncaroli Federico , Worrell Gregory A. , Giannini Caterina 
Published: January 2011

Object
Supratentorial cortical ependymomas (CE) are rare, with 7 cases reported. The lesions, typically occurring in the superficial cortex in young adults and associated with a history of seizures, are not fully characterized. Furthermore, their relationship with the recently described angiocentric glioma (AG) is still being debated. This study was undertaken to summarize the authors' experience with CEs.

Methods
Between 1997 and 2009, 202 cases of ependymoma were surgically treated at the Mayo Clinic, 49 of which were supratentorial. Among these, 9 CE cases were retrospectively identified. Clinical, imaging, and pathological features of each case were reviewed.

Results
Tumors arose from the frontal (5 cases), parietal (3), and occipital (1) lobes. No tumor occurred in the temporal lobe, despite its reported association with seizures. The mean age at presentation was 27 ± 19 years (± SD) and age at resection was 36 ± 16 years. The mean size of the lesion was 16 ± 14 cm3. Seizures were the presenting symptom in 78%. Cross-sectional imaging in 8 cases was characterized by a heterogeneous mass with multiple cystlike areas and enhancement of the soft-tissue component. Gross-total resection was achieved in 8 of 9 tumors. Pathologically, 6 were low-grade (WHO Grade II) and 3 were anaplastic (WHO Grade III) ependymomas. All tumors exhibited the focal presence of perivascular pseudorosettes, but only 1 (11%) exhibited the focal presence of a true rosette. A bipolar spindle cell component resembling AG was present in 3 (33%) and “Schwannian-like” nodules in 2 (22%). Subpial aggregation and peripheral infiltration were present in 4 cases (44%). With a mean postsurgery follow-up of 62 ± 38 months, only 2 lesions recurred locally after imaging-confirmed gross-total resection, both being Grade III. In 5 (71%) of 7 patients presenting with seizures an Engel Class I outcome was achieved.

Conclusions
Cortical ependymomas represent a rare type of ependymoma occurring superficially in the cortex. Morphologically, these tumors are protean, varying from classic to epithelioid, clear cell, and tanycytic. Some also exhibited features typical of AG. Most tumors were low grade and cured with resection. Anaplastic tumors occur and may recur locally despite provision of radiation therapy. Cortical ependymomas frequently, but not always, present with seizures, but despite their high association with epilepsy, none occurred in the temporal lobe in any of the authors' 9 patients. Overall, CEs appear to have a relatively favorable prognosis compared with other supratentorial ependymomas.
Accident Precursors and Warning Systems Management: A Bayesian Approach to Mathematical Models
Authors: Paté‐Cornell Elisabeth 
Published: January 2011

AbstractObserving and recognizing precursors and near misses are essential parts of risk management. Many industries have implemented monitoring programs to that effect. The problem is to decide what to monitor, how to interpret the signal(s), and how to respond given the lead time. This article focuses on a Bayesian (probabilistic) approach to the design of warning systems, which permits addressing the trade‐off between the probabilities of false positives and false negatives. The results can then be used as input in a decision analysis to support system‐wide risk management. Probabilistic risk assessment (PRA) is used here as a fundamental tool that allows identifying and fixing the weakest parts of a system. It is shown how one can update the probability of failure of a system given signals that one of the components or subsystems has deteriorated, and how to use PRA to identify potential precursors. The example of a risk analysis for the tiles of the space shuttle is used to illustrate the identification of the failure modes and the weakest parts of a system, a warning that was ignored at the time of that study, years before the Columbia accident. In the dynamic case, it is shown how to optimize a warning threshold to minimize risks and losses. Finally, it is shown how human and organizational factors can be linked to the risk of system failure and the effectiveness of an organizational warning system.
An Introduction to Platelet Inventory and Ordering Problems
Authors: Blake John T. 
Published: January 2011

AbstractPlatelets are blood cells that initiate the hemostatic plug that causes blood clot formation. Patients receiving intense chemotherapy or suffering massive bleeding complications require platelet transfusions for the prevention of a potentially fatal hemorrhage. A stable, readily available inventory of platelets is required for the safe and effective delivery of health care.Since platelets must be kept warm to remain viable, they are subject to bacterial contamination, and thus have a shelf life of between five and seven days. Since platelets have a very limited shelf life and are expensive to collect and produce, outdates are an important practical concern for hospitals and blood system operators. Thus, the platelet inventory problem revolves around identifying policies for ordering and holding platelets such that unit availability is maximized, while ensuring that outdates are minimized.In this paper we define the platelet inventory problem, survey the existing literature, and provide a discussion of solution approaches.
Application of Operations Research In Amusement Park Industry
Authors: Yildirim Utku 
Published: January 2011

AbstractIn this article, a review of the application of operations research methods in the amusement park industry is provided. Although marketing and strategic management side of the theme park industry has been studied extensively, literature in the field of operations research is limited. Research focuses mainly on capacity management and revenue management; however, there are a few under‐researched but key areas that merit more attention. We identify those areas for future research.