bluuebunny/crossref_metadata_2025_split huggingface dataset:
U.S.A. Tobacco Control: Six Lessons in Public Policy for Medical and Science Professionals
Authors: Rudder Catherine E. , Fritschler A. Lee 
Published: November 2009

AbstractThe expertise of medical and science professionals is needed in public policy debates in the U.S. and around the world. As societies mature, questions in public policy become increasingly complex and should be informed by science. However, too often public agendas are advanced without the benefit of science and those trained in how to interpret it. Similarly, those trained in the sciences often do not have requisite knowledge, training or an interest in politics and policymaking. Yet, it is clear that optimal policy results in those cases when scientists and policy elites work together in meaningful partnerships. Because the worlds of science and politics—their cultures, assumptions, and methods—are largely separate and different, cooperation between these two cultures is difficult. The authors of this paper hope that their work interpreting one major issue of scientific importance as it has wound its way through public policy processes will be instructive to those in science who are enlisted to bring scientific discovery to public policy making (Fritschler and Rudder 2007). The 60‐year political struggle to move the issue of tobacco control from the agenda of a small group of medical researchers to the public agenda offers insights about public policymaking that are transferable to other issues which rest on science.
Current Global Trends in Medical Professionalism
Authors: Blackmer Jeff 
Published: November 2009

AbstractMedical professionalism is a complex topic which must include a consideration of both individual and collective physicians, societal and patient rights and obligations. While attempting to propose a definition which might capture the various aspects of this issue, this paper also examines current global trends in medical professionalism such as care during a pandemic, professionally‐led regulation, conflict of interest, and conscientious objection. All of these are issues that are often dealt with on a systemic level as a medical collective but they also have a real and lasting impact at the individual physician level. While much of the attention in medical professionalism is paid to the individual practitioner, there is also an important role to be played in policy development, and national and international advocacy efforts by physician organizations such as the World Medical Association and others.
Training and Supply of Japanese Physicians: An Impending Crisis?
Authors: Yajima Kazuyoshi 
Published: November 2009

AbstractRecent shortages of physicians are forcing many Japanese city hospitals to close. These shortages are also affecting university hospitals. Medical graduates migrate to major hospitals in larger cities, rather than working at their local university hospitals or in smaller towns. Even larger in‐hospital units such as internal medicine or surgery tend to have very few, if any, doctors on staff. These units at one time had at least 10 doctors on their staff. Many university hospitals that employed at least ten full time specialists on different wards are now faced with the sad prospect of closing specialty departments. It is important to address the underlying roots of the problem and remediate this crisis affecting the Japanese health sector.
Comparative Analysis of Health Insurance Systems in the United States and South Korea
Authors: Doh Soogwan , Cole Benjamin R. 
Published: November 2009

AbstractThis paper uses a case study design to compare the U.S. health insurance system with that of South Korea, analyzing the effects of the two countries' cultural value systems, political institutions, and stakeholders on the historical development and current status of national health insurance policy. The authors find that in the United States, a value system characterized by anti‐statism, anti‐elitism, individualism, liberalism, and a laissez‐faire philosophy has acted, in combination with a decentralized democratic political system and strong, well‐organized interest groups opposed to publicly‐funded healthcare, to significantly limit the possibility of national health insurance reform on anything but an incremental basis. In contrast, South Korea's value system has been characterized by statism, elitism, groupism, and a philosophy of nobles oblige, which has interacted with autocratic but health insurance reform‐minded regimes, in a weak civil society (with particularly weak organizations representing anti‐health reform interests) where formal lobbying activities were illegal, to produce a policy environment particularly favorable to comprehensive health insurance reform from the 1960s through the 1980s. The study demonstrates that each country has not only different political institutions and laws governing interest groups, but also significantly different cultures and medical traditions, which must be considered if policy reforms in either country, or indeed for any country considering health insurance reform, are to be implemented successfully. The paper concludes with a brief discussion of implications of these findings on health insurance reforms in both countries, with particular consideration of the reform plans of the Obama administration in the United States.
A Community Health System Response to the Pandemic of Novel H1N1
Authors: Cormier Scott , Septimus Edward J. , Moody Julia , Perlin Jonathan B. 
Published: November 2009

AbstractOn Tuesday, April 21, 2009, the Centers for Disease Control and Prevention (CDC) announced the first U.S. cases of novel H1N1 virus in the United States. Within the next few days, the number of cases would grow, and hospitals saw increasing flu cases as well as a number of “worried well.” This article reviews the immediate response of the Hospital Corporation of America (HCA) system to the novel H1N1 pandemic within the first month after CDC announced confirmation of the first case.
Professional Governance and the Practice of Medicine: A Matter of Civil Engagement and Social Responsibility
Authors: Kloiber Otmar 
Published: November 2009

AbstractFor more than 60 years the World Medical Association has continued to serve as a platform to develop global medical policy on ethical and socio‐medical issues. Many of the WMA policies have become landmarks in policy development reaching far beyond the community of physicians, as they have inspired or even become part of legal regulations and international action. Yet this work is not seen as a self‐serving privilege, but as a service to the patients, the profession and society in general. It provides the basis for regulation and self‐governance based on the aim to serve the individual person's and the populations' health and well‐being.
Commentary for the Inaugural Issue
Authors: Rich Paul J. 
Published: November 2009

AbstractDr. Paul Rich, President of the Policy Studies Organization, introduces the editors of World Medical & Health Policy, and underscores the much‐needed aim of this journal, “to help all of us be informed and participate in the forging of medical and health policies so we can make informed decisions.” Dr. Rich continues that “this is a journal for the leaders in world medicine and health affairs. There never was a time when health decisions needed more well‐founded information and well crafted scholarship. That is a large task. It is not flattery but simply the truth to say that seldom has a new journal gone out into the world with better captains or more promise, and with prospects we trust not for great fatigue but for great achievement.”
Personalized Medicine and Its Ethical Challenges
Authors: Wolpe Paul Root 
Published: November 2009

AbstractPersonalized medicine is an emerging term for a medical philosophy that uses a person's individual clinical, genetic, genomic, and environmental information to tailor a treatment plan that will maximize efficacy and safety for that individual. While the technology offers much promise, it also is also challenged by some ethical and social questions in both its clinical application and in its research enterprise. Questions about privacy, safety, phenotypical expression, drug interactions, and genetic vs. social group identities will challenge clinical pharmacogenetics. Research studies raise some similar issues, as well as fairness in subject selection. Finally, personalized medicine will change the economics of drug production and distribution. Issues such as these and other complications of the coming focus on personalized medicine are discussed.
In The News
Authors: Kloc Michelle , Nicogossian Arnauld , Jacobs William 
Published: November 2009

AbstractThe Editors of the Journal are bringing to the readership's attention the most recent medical news and issues deserving consideration for developing medical and health policies, standards or use, and knowledge in counseling patients in preventive care. The readers might wish to visit additional medical news websites which are readily accessible, some free of charge, such as MedScape, Stone Heart, American College of Physicians and the World Medical Association news websites.
Molecular and Metabolic Evidence for Mitochondrial Defects Associated With β-Cell Dysfunction in a Mouse Model of Type 2 Diabetes
Authors: Lu Hongfang , Koshkin Vasilij , Allister Emma M. , Gyulkhandanyan Armen V. , Wheeler Michael B. 
Published: November 2009

OBJECTIVE
The inability of pancreatic β-cells to appropriately respond to glucose and secrete insulin are primary defects associated with β-cell failure in type 2 diabetes. Mitochondrial dysfunction has been implicated as a key factor in the development of type 2 diabetes; however, a link between mitochondrial dysfunction and defective insulin secretion is unclear.

RESEARCH DESIGN AND METHODS
We investigated the changes in islet mitochondrial function and morphology during progression from insulin resistance (3 weeks old), immediately before hyperglycemia (5 weeks old), and after diabetes onset (10 weeks old) in transgenic MKR mice compared with controls. The molecular and protein changes at 10 weeks were determined using microarray and iTRAQ proteomic screens.

RESULTS
At 3 weeks, MKR mice were hyperinsulinemic but normoglycemic and β-cells showed negligible mitochondrial or morphological changes. At 5 weeks, MKR islets displayed abrogated hyperpolarization of mitochondrial membrane potential (ΔΨm), reduced mitochondrial Ca2+ uptake, slightly enlarged mitochondria, and reduced glucose-stimulated insulin secretion. By 10 weeks, MKR mice were hyperglycemic and hyperinsulinemic and β-cells contained swollen mitochondria with disordered cristae. β-Cells displayed impaired stimulus-secretion coupling including reduced hyperpolarization of ΔΨm, impaired Ca2+-signaling, and reduced glucose-stimulated ATP/ADP and insulin release. Furthermore, decreased cytochrome c oxidase–dependent oxygen consumption and signs of oxidative stress were observed in diabetic islets. Protein profiling of diabetic islets revealed that 36 mitochondrial proteins were differentially expressed, including inner membrane proteins of the electron transport chain.

CONCLUSIONS
We provide novel evidence for a critical role of defective mitochondrial oxidative phosphorylation and morphology in the pathology of insulin resistance–induced β-cell failure.
Invariant Natural Killer T-Cell Control of Type 1 Diabetes: A Dendritic Cell Genetic Decision of a Silver Bullet or Russian Roulette
Authors: Driver John P. , Scheuplein Felix , Chen Yi-Guang , Grier Alexandra E. , Wilson S. Brian , Serreze David V. 
Published: November 2009

OBJECTIVEIn part, activation of invariant natural killer T (iNKT)-cells with the superagonist α-galactosylceramide (α-GalCer) inhibits the development of T-cell–mediated autoimmune type 1 diabetes in NOD mice by inducing the downstream differentiation of antigen-presenting dendritic cells (DCs) to an immunotolerogenic state. However, in other systems iNKT-cell activation has an adjuvant-like effect that enhances rather than suppresses various immunological responses. Thus, we tested whether in some circumstances genetic variation would enable activated iNKT-cells to support rather than inhibit type 1 diabetes development.RESEARCH DESIGN AND METHODSWe tested whether iNKT-conditioned DCs in NOD mice and a major histocompatibility complex–matched C57BL/6 (B6) background congenic stock differed in capacity to inhibit type 1 diabetes induced by the adoptive transfer of pathogenic AI4 CD8 T-cells.RESULTSUnlike those of NOD origin, iNKT-conditioned DCs in the B6 background stock matured to a state that actually supported rather than inhibited AI4 T-cell–induced type 1 diabetes. The induction of a differing activity pattern of T-cell costimulatory molecules varying in capacity to override programmed death-ligand-1 inhibitory effects contributes to the respective ability of iNKT-conditioned DCs in NOD and B6 background mice to inhibit or support type 1 diabetes development. Genetic differences inherent to both iNKT-cells and DCs contribute to their varying interactions in NOD and B6.H2g7 mice.CONCLUSIONSThis great variability in the interactions between iNKT-cells and DCs in two inbred mouse strains should raise a cautionary note about considering manipulation of this axis as a potential type 1 diabetes prevention therapy in genetically heterogeneous humans.
Clinical Heterogeneity in Monogenic Diabetes Caused by Mutations in the Glucokinase Gene (GCK-MODY)
Authors: Cuesta-Muñoz Antonio L. , Tuomi Tiinamaija , Cobo-Vuilleumier Nadia , Koskela Hanna , Odili Stella , Stride Amanda , Buettger Carol , Otonkoski Timo , Froguel Philippe , Grimsby Joseph , Garcia-Gimeno Maria , Matschinsky Franz M. 
Published: November 2009

OBJECTIVE
To evaluate the heterogeneity in the clinical expression in a family with glucokinase mature-onset diabetes of the young (GCK-MODY).

RESEARCH DESIGN AND METHODS
Members (three generations) of the same family presented either with overt neonatal hyperglycemia, marked postprandial hyperglycemia, or glucosuria. Homeostasis model assessment of insulin resistance (HOMAIR) and insulinogenic and disposition indexes were calculated. Oral glucose tolerance test (OGTT) results in the GCK mutation carriers from this family were compared with those from other subjects with GCK mutations in the same codon (GCK261), with other missense and other types of GCK mutations in different codons from the European MODY Consortium database (GCKm).

RESULTS
Mutation G261R was found in the GCK gene. During the OGTT, glucose (P = 0.02) and insulin (P = 0.009) response at 2 h as well as at the 2-h glucose increment (GCK261 versus other missense GCK mutations, P = 0.003) were significantly higher in GCK261 than in GCKm carriers.

CONCLUSIONS
Differing from other GCKm carriers, the glucose and insulin response to oral glucose was significantly higher in GCK261 carriers, indicating clinical heterogeneity in GCK-MODY.
Familial Risks for Type 2 Diabetes in Sweden
Authors: Hemminki Kari , Li Xinjun , Sundquist Kristina , Sundquist Jan 
Published: November 2009

OBJECTIVE
Our aim was to characterize familial risks for type 2 diabetes by the type and number of affected family members, including half-siblings, adoptees, and spouses, to quantify risks and estimate the contribution of environmental effect.

RESEARCH DESIGN AND METHODS
Families were identified from the Multigeneration Register, and type 2 diabetic patients were obtained from the Hospital Discharge Register. Standardized incidence ratios were calculated for offspring with type 2 diabetes whose family members were hospitalized for type 2 diabetes at ages &gt;39 years compared with those lacking affected family members.

RESULTS
The number of hospitalized type 2 diabetic patients was 157,549. Among 27,895 offspring, 27.9% had a parent or sibling also hospitalized for type 2 diabetes. The familial relative risk (RR) ranged from 2.0 to &gt;30, depending on the number and type of probands. The highest RRs of type 2 diabetes were found in individuals who had at least two siblings affected by type 2 diabetes, irrespective of the parental disease. Adoptees showed no risk from adopted parents.

CONCLUSIONS
The study, the largest yet published, showed that familial RRs varied by the number and type of affected family member. However, much of the familial clustering remains yet to be genetically explained. The high risk should be recognized in clinical genetic counseling. The data from adoptees confirmed the genetic basis of the familial associations, but those from half siblings and spouses suggested that a smaller part of familial clustering may be accounted for by environmental factors.
Epidemiological Perspectives on Type 1 Diabetes in Childhood and Adolescence in Germany
Authors: Ehehalt Stefan , Dietz Klaus , Willasch Andre M. , Neu Andreas ,   for the Baden-Württemberg Diabetes Incidence Registry (DIARY) Group
Published: November 2009

OBJECTIVE
To predict the frequency of type 1 diabetes in childhood and adolescence (&lt;15 years of age) in Germany for the next 20 years.

RESEARCH DESIGN AND METHODS
Data on diabetes onset has been collected by means of a registry in the federal German state of Baden-Württemberg (documentation period, 1987–2006; n = 5,108; completeness of data 98.1%).

RESULTS
The current incidence rate (2000–2006) is 19.4 per 100,000 per year (95% CI 18.6–20.2). The annual incidence rate can be expressed as a square of a linear function of the calendar year X [y = (3.05 + 0.0778 × {X–1986})2; r2 = 0.90]. The highest increase per year was observed in the age-groups comprising 2- and 3-year-olds (12 and 13% per year, respectively). The incidence rate for the year 2026 is estimated to be 37.9 per 100,000 per year (95% CI 33.3–42.9).

CONCLUSIONS
The increase that we found in younger children is characteristic of a left shift toward an earlier age.
A1C Cut Points to Define Various Glucose Intolerance Groups in Asian Indians
Authors: Mohan Viswanathan , Vijayachandrika Venkataraman , Gokulakrishnan Kuppan , Anjana Ranjit Mohan , Ganesan Anbazhagan , Weber Mary Beth , Narayan K.M. Venkat 
Published: November 2009

OBJECTIVE
To determine A1C cut points for glucose intolerance in Asian Indians.

RESEARCH DESIGN AND METHODS
A total of 2,188 participants without known diabetes were randomly selected from the Chennai Urban Rural Epidemiology Study. All had fasting plasma glucose (FPG) and 2-h postload plasma glucose measurements after a 75-g load and were classified as having impaired fasting glucose (IFG) (American Diabetes Association [ADA] criteria, FPG ≥5.5 and &lt;7 mmol/l, and World Health Organization [WHO] criteria, FPG ≥6.1 and &lt;7 mmol/l), impaired glucose tolerance (IGT) (2-h postload plasma glucose ≥7.8 and &lt;11.1 mmol/l), or diabetes (FPG ≥7 mmol/l and/or 2-h postload plasma glucose ≥11.1 mmol/l). A1C was measured using the Bio-Rad Variant machine. Based on receiver operating characteristic curves, optimum sensitivity and specificity were derived for defining A1C cut points for diabetes, IGT, and IFG.

RESULTS
Mean ± SD values of A1C among subjects with normal glucose tolerance, IGT, and diabetes were 5.5 ± 0.4, 5.9 ± 0.6, and 8.3 ± 2.0%, respectively (Ptrend &lt; 0.001) with considerable overlap. To identify diabetes based on 2-h postload plasma glucose, the A1C cut point of 6.1% had an area under the curve (AUC) of 0.941 with 88.0% sensitivity and 87.9% specificity. When diabetes was defined as FPG ≥7.0 mmol/l, the A1C cut point was 6.4% (AUC = 0.966, sensitivity 93.3%, and specificity 92.3%). For IGT, AUC = 0.708; for IFG, AUC = 0.632 (WHO criteria) and 0.708 (ADA criteria), and the A1C cut point was 5.6%.

CONCLUSIONS
In Asian Indians, A1C cut points of 6.1 and 6.4% defined diabetes by 2-h postload plasma glucose or FPG criteria, respectively. A value of 5.6% optimally identified IGT or IFG but was &lt;70% accurate.
Spatial light modulator as a reconfigurable intracavity dispersive element for tunable lasers
Authors: Dong Lin , Popov Sergei , Sergeyev Sergey , Friberg Ari 
Published: November 2009

Abstract
An improved approach for narrow-band wavelength selection in tunable lasers is described. To provide the tunability, a reconfigurable diffractive optical element (DOE) based on a programmable spatial light modulator (PSLM) is applied. With a proper choice of the phase transfer function of the PSLM, the device can be used as a dispersive intra-cavity component for precise tuning within the lasing spectral band of a solid-state dye laser. The suggested design allows avoiding the mechanical movement of any cavity components. The tunability performance and simulation are demonstrated using the Fourier optics method.
Impact of pharmaceutical dosage form on stability and dissolution of roxithromycin
Authors: Ostrowski Michał , Wilkowska Ewa , Bączek Tomasz 
Published: November 2009

Abstract
The behavior of dispersible tablets containing enteric-coated pellets and oral suspension, both containing roxithromycin, was investigated using dissolution tests in different media. The dissolution test was performed under different pH conditions. For both dosage forms investigated, the test was conducted at pH 1.2, 4.5, and 6.8. Additionally, for dispersible tablets, the test involving increasing pH was performed at pH 1.2 (acid stage) and afterwards at pH 6.8 (buffer stage). The extent of dissolution was measured using high-performance liquid chromatography (HPLC). In all cases tested, roxithromycin underwent rapid degradation at pH 1.2. Dispersible tablets displayed the features of modified release preparations with a non-complete dissolution during the test times in all media. Conversely, the oral suspension behaved as an immediate release preparation, with degradation at pH 1.2. However, the dissolution of the oral suspension at pH 4.5 and 6.8 was rapid and complete. The role of enteric-coated pellets is to mask the bitter taste of the active substance upon administration. However, the coating showed lack of resistance to media at pH 1.2. Therefore, dispersible tablets containing enteric-coated pellets are not pharmaceutically equivalent to the immediate-release oral suspension.
A Raman spectroscopy study on differently deposited DLC layers in pulse arc system
Authors: Ižák Tibor , Marton Marián , Vojs Marián , Redhammer Robert , Varga Marián , Veselý Marián 
Published: November 2009

AbstractThis study is focused on Raman spectroscopy investigations of differently deposited diamond-like carbon (DLC) layers due to varying: (i) Ar and/or N2 flow rate, (ii) number of impulses, and (iii) bias voltage during the growth process. Samples were prepared by a physical vapor deposition method in a pulse arc system. It is shown that Ar and N2 flow rates as well as the bias voltage influence the morphology and chemical composition of the deposited DLC layers. By changing the number of impulses, the number of carbon atoms sputtered from target in the vacuum chamber changes, which is reflected in the thickness and morphology of the DLC layers. Visible light Raman spectroscopy of 632 nm excitation wavelength was used for deep analysis of the deposited layers.
First Detection of Vancomycin Resistant Enterococcus faecium in Latvia
Authors: Rudzīte Dace , Balode Arta , Dumpis Uga , Miklaševičs Edvīns 
Published: November 2009

First Detection of Vancomycin Resistant Enterococcus faecium in Latvia
Enterococci have become one of the most important nosocomial pathogens in advanced treatment facilities. Though they are not considered as very pathogenic bacteria, their high levels of antimicrobial resistance are the subject of major concern. Particularly epidemiologically important are vancomycin-resistant enterococci (VRE) due to high risk of transmission of vancomycin resistance genes to staphylococci. We describe the first outbreak of VRE in a Latvian multidisciplinary hospital.