bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pediatric Fellows: Perspectives on Training and Future Scope of Practice
Authors: Freed Gary L. , Dunham Kelly M. , Switalski Kara E. , Jones M. Douglas , McGuinness Gail A. ,   and the Research Advisory Committee of the American Board of Pediatrics
Published: December 2008

OBJECTIVE. Training for pediatric residents who intend to pursue fellowship differs little from training for residents who intend to practice general pediatrics. It is unknown how well residents who intend to pursue subspecialty training believe that residency prepares them for subspecialty fellowships or future careers. To characterize the strengths and weaknesses of residency training and the factors influencing subspecialty choice from the perspective of subspecialty fellows, we conducted a survey of current fellows on these issues.METHODS. A random sample of 1000 physicians who were entering their second or third year of fellowship in the United States in 2007 received a structured questionnaire by mail. The survey focused on decision-making in selection of residency and fellowship programs, strength of residency training in preparation for fellowship, and plans for future practice.RESULTS. The overall response rate was 81%. A majority of the fellows would not have shortened their general pediatrics residency before fellowship if given the option (64% [n = 482]). However, more than half (52% [n = 390]) of the fellows would have chosen a 2-year fellowship without research or scholarly activity over the current 3-year structure. Few current fellows believed they could have used any additional training in the areas of patient safety, coordination of care for children with complex illnesses, or patient communication.CONCLUSIONS. The finding that a large proportion of fellows would opt for shortened subspecialty training should prompt discussion and debate within the profession regarding the skills necessary for a pediatric subspecialist. Patient safety, physician-parent communication, and care coordination are emphasized primarily through informal training during residency. Although most clinicians believe themselves to be adequately prepared, research has identified gaps in clinician skills and understanding of these issues of great importance to patients and their families.
Influence of Pay-for-Performance Programs on Information Technology Use Among Child Health Providers: The Devil Is in the Details
Authors: Menachemi Nir , Struchen-Shellhorn Wendy , Brooks Robert G. , Simpson Lisa 
Published: December 2008

OBJECTIVE. Pay-for-performance programs are used to promote improved health care quality, often through increased use of health information technology. However, little is known about whether pay-for-performance programs influence the adoption of health information technology, especially among child health providers. This study explored how various pay-for-performance compensation methods are related to health information technology use.
METHODS. Survey data from 1014 child health providers practicing in Florida were analyzed by using univariate and multivariate techniques. Questions asked about the adoption of electronic health records and personal digital assistants, as well as types of activities that affected child health provider compensation or income.
RESULTS. The most common reported method to affect respondents' compensation was traditional productivity or billing (78%). Of the pay-for-performance-related methods of compensation, child health providers indicated that measures of clinical care (41%), patient surveys and experience (34%), the use of health information technology (29%), and quality bonuses or incentives (27%) were a major or minor factor in their compensation. In multivariate logistic regression analyses, only pay-for-performance programs that compensated directly for health information technology use were associated with an increased likelihood of electronic health record system adoption. Pay-for-performance programs linking measures of clinical quality to compensation were positively associated with personal digital assistant use among child health providers.
CONCLUSIONS. Pay-for-performance programs that do not directly emphasize health information technology use do not influence the adoption of electronic health records among Florida physicians treating children. Understanding how different pay-for-performance compensation methods incentivize health information technology adoption is important for improving quality.
B-Cell Depletion for Autoimmune Thrombocytopenia and Autoimmune Hemolytic Anemia in Pediatric Systemic Lupus Erythematosus
Authors: Kumar Sathish , Benseler Susanne M. , Kirby-Allen Melanie , Silverman Earl D. 
Published: December 2008

OBJECTIVES. Our goal was to determine long-term efficacy and safety of B-cell–depletion therapy for children with autoimmune thrombocytopenia and autoimmune hemolytic anemia in pediatric systemic lupus erythematosus.
PATIENTS AND METHODS. A retrospective, single-center cohort study was conducted including all patients with pediatric systemic lupus erythematosus who were diagnosed with autoimmune thrombocytopenia and/or autoimmune hemolytic anemia and treated with rituximab. Treatment efficacy and safety parameters were monitored and recorded.
RESULTS. Nine patients with pediatric systemic lupus erythematosus were included in the study: 5 had autoimmune thrombocytopenia, 3 had autoimmune hemolytic anemia, and 1 had both. There were 5 female and 4 male patients; median age at diagnosis of pediatric systemic lupus erythematosus was 14 years (range: 8–16 years); and median pediatric systemic lupus erythematosus disease duration to time of rituximab treatment was 6 months (range: 2–30 months). Complete response was achieved in all 6 children with autoimmune thrombocytopenia (median time to complete response: 2 weeks [range: 1–12 weeks]). Two patients' conditions flared at 48 and 68 weeks, respectively, and were re-treated. The remaining 4 patients continued to be in remission at 24, 32, 36, and 88 weeks, respectively. All 4 children with autoimmune hemolytic anemia achieved complete response at a median time of 4 weeks (range: 4–32 weeks). All patients remained in complete response at 24, 44, 84, and 100 weeks of follow-up. Complete B-cell depletion was seen in all children after rituximab treatment. No serious infections occurred, but 1 patient had an infusion reaction.
CONCLUSIONS. Preliminary evidence suggests that B-cell–depletion therapy with rituximab is an efficacious and safe treatment for autoimmune thrombocytopenia and autoimmune hemolytic anemia in pediatric systemic lupus erythematosus. Despite the prolonged effect on B-cell numbers and function, no serious infections were observed.
Temperature Rise Within the Pulp Chamber During Composite Resin Polymerisation Using Three Different Light Sources
Authors: Santini A , Watterson C , Miletic V 
Published: December 2008

The purpose of the study was to compare temperature rise during polymerisation of resin based composites
(RBCs) with two LED light curing units (LCUs) compared to a halogen control light.

Methods:
Forty-five extracted molars, patients aging 11-18 years were used. Thermocouples (TCs) were placed in contact with the roof of the pulp chamber using a ‘split-tooth’ method. Teeth were placed in a water bath with the temperature of the pulp chamber regulated at 37°±1°C.

Group 1 (control):
Prismatics® Lite II (Dentsply Detrey, Konstanz, Germany), a halogen LCU, light intensity 500 mW/cm2.

Group 2:
Bluephase® ( Ivoclar Vivadent, Schaan, Liechtenstein), light intensity 1100 mW/cm2. Group 3:Elipar Freelight2 (3M ESPE, Seefeld, Germany), light intensity 1000 mW/cm2. Temperature changes were continuously recorded with a data logger connected to a PC.

Results:
Significantly higher temperature rise was recorded during bond curing than RBC curing in all 3 groups. (Halogen; p =0.0003: Bluephase; p=0.0043: Elipar; p=0.0002.). Higher temperatures were recorded during polymerisation of both Bond and RBC with both LED sources than with the halogen control. There was no significant difference between the two LED,LCUs (Bond:p=0.0279: RBC p=0.0562: Mann-Whitney).

Conclusion:
The potential risk of pulpal injury during RBC polymerisation is increased when using light-curing units with high energy output compared to low energy output light sources. The rise is greatest when curing bonding agent alone and clinicians are advised to be aware of the potential hazard of thermal trauma to the pulp when using high intensity light sources. However the mean temperature rise with all three units was below the limits normally associated with permanent pulp damage.
C-Reactive Protein and 5-Year Survival in Type 2 Diabetes
Authors: Bruno Graziella , Fornengo Paolo , Novelli Giulia , Panero Francesco , Perotto Massimo , Segre Olivia , Zucco Chiara , Deambrogio PierCarlo , Bargero Giuseppe , Perin Paolo Cavallo 
Published: December 2008

OBJECTIVE
To determine to what extent plasma C-reactive protein (CRP) values influence 5-year all-cause and cardiovascular mortality in type 2 diabetic individuals, independently of albumin excretion rate (AER) and other cardiovascular risk factors, and its incremental usefulness for predicting individual risk of mortality.

RESEARCH DESIGN AND METHODS
Measurements of CRP were performed in 2,381 of 3,249 (73.3%) subjects as part of the population-based Casale Monferrato Study. Its association with 5-year all-cause and cardiovascular mortality was assessed with multivariate Cox proportional hazards modeling. The C statistic and measures of calibration and global fit were also assessed.

RESULTS
Results are based on 496 deaths in 11.717 person-years of observations (median follow-up 5.4 years). With respect to subjects with CRP ≤3 mg/l, those with higher values had an adjusted hazard ratio (HR) of 1.51 (95% CI 1.18–1.92) for all-cause mortality and 1.44 (0.99–2.08) for cardiovascular mortality. In normoalbuminuric subjects, respective HRs of CRP were 1.56 (1.13–2.15) and 1.65 (1.00–2.74), AER being neither a modifier nor a confounder of CRP association. In analysis limited to diabetic subjects without cardiovascular disease (CVD), adjusted HRs were 1.67 (1.24–2.24) for all-cause mortality and 1.36 (0.83–2.24) for cardiovascular mortality. The improvement in individual risk assessment was marginal when measured with various statistical measures of model discrimination, calibration, and global fit.

CONCLUSIONS
CRP measurement is independently associated with short-term mortality risk in type 2 diabetic individuals, even in normoalbuminuric subjects and in those without a previous diagnosis of CVD. Its clinical usefulness in individual assessment of 5-year risk of mortality, however, is limited.
Angiotensin II Reduces Mitochondrial Content in Skeletal Muscle and Affects Glycemic Control
Authors: Mitsuishi Masanori , Miyashita Kazutoshi , Muraki Ayako , Itoh Hiroshi 
Published: December 2008

OBJECTIVE—Blockade of angiotensin (Ang) II has been shown to prevent new-onset type 2 diabetes. We focused on the effects of AngII on muscle mitochondria, especially on their biogenesis, as an underlining mechanism of type 2 diabetes.
RESEARCH DESIGN AND METHODS—C2C12 cells and C57bl/6 mice were used to examine roles for AngII in the regulation of muscle mitochondria and to explore whether the effect was mediated by type 1 AngII receptor (AT1R) or type 2 receptor (AT2R).
RESULTS—C2C12 cells treated with 10−8–10−6 mol/l AngII reduced the mitochondrial content associated with downregulation of the genes involved in mitochondrial biogenesis. The action of AngII was diminished by blockade of AT2R but not AT1R, whereas overexpression of AT2R augmented the effect. AngII increased mitochondrial ROS and decreased mitochondrial membrane potential, and these effects of AngII were significantly suppressed by blockade of either AT1R or AT2R. Chronic AngII infusion in mice also reduced muscle mitochondrial content in association with increased intramuscular triglyceride and deteriorated glycemic control. The AngII-induced reduction in muscle mitochondria in mice was partially, but significantly, reversed by blockade of either AT1R or AT2R, associated with increased fat oxidation, decreased muscle triglyceride, and improved glucose tolerance. Genes involved in mitochondrial biogenesis were decreased via AT2R but not AT1R under these in vivo conditions.
CONCLUSIONS—Taken together, these findings imply the novel roles for AngII in the regulation of muscle mitochondria and lipid metabolism. AngII reduces mitochondrial content possibly through AT1R-dependent augmentation of their degradation and AT2R-dependent direct suppression of their biogenesis.
Expansion of Human Regulatory T-Cells From Patients With Type 1 Diabetes
Authors: Putnam Amy L. , Brusko Todd M. , Lee Michael R. , Liu Weihong , Szot Gregory L. , Ghosh Taumoha , Atkinson Mark A. , Bluestone Jeffrey A. 
Published: December 2008

OBJECTIVE—Regulatory T-cells (Tregs) have catalyzed the field of immune regulation. However, translating Treg-based therapies from animal models of autoimmunity to human clinical trials requires robust methods for the isolation and expansion of these cells—a need forming the basis for these studies.
RESEARCH DESIGN AND METHODS—Tregs from recent-onset type 1 diabetic patients and healthy control subjects were isolated by fluorescence-activated cell sorting and compared for their capacity to expand in vitro in response to anti-CD3–anti-CD28–coated microbeads and IL-2. Expanded cells were examined for suppressive function, lineage markers and FOXP3, and cytokine production.
RESULTS—Both CD4+CD127lo/− and CD4+CD127lo/−CD25+ T-cells could be expanded and used as Tregs. However, expansion of CD4+CD127lo/− cells required the addition of rapamycin to maintain lineage purity. In contrast, expansion of CD4+CD127lo/−CD25+ T-cells, especially the CD45RA+ subset, resulted in high yield, functional Tregs that maintained higher FOXP3 expression in the absence of rapamycin. Tregs from type 1 diabetic patients and control subjects expanded similarly and were equally capable of suppressing T-cell proliferation. Regulatory cytokines were produced by Tregs after culture; however, a portion of FOXP3+ cells were capable of producing interferon (IFN)-γ after reactivation. IFN-γ production was observed from both CD45RO+ and CD45RA+ Treg populations.
CONCLUSIONS—The results support the feasibility of isolating Tregs for in vitro expansion. Based on expansion capacity, FOXP3 stability, and functional properties, the CD4+CD127lo/−CD25+ T-cells represent a viable cell population for cellular therapy in this autoimmune disease.
Association of Variants in RETN With Plasma Resistin Levels and Diabetes-Related Traits in the Framingham Offspring Study
Authors: Hivert Marie-France , Manning Alisa K. , McAteer Jarred B. , Dupuis Josée , Fox Caroline S. , Cupples L. Adrienne , Meigs James B. , Florez Jose C. 
Published: December 2008

OBJECTIVE— The RETN gene encodes the adipokine resistin. Associations of RETN with plasma resistin levels, type 2 diabetes, and related metabolic traits have been inconsistent. Using comprehensive linkage disequilibrium mapping, we genotyped tag single nucleotide polymorphisms (SNPs) in RETN and tested associations with plasma resistin levels, risk of diabetes, and glycemic traits.
RESEARCH DESIGN AND METHODS— We examined 2,531 Framingham Offspring Study participants for resistin levels, glycemic phenotypes, and incident diabetes over 28 years of follow-up. We genotyped 21 tag SNPs that capture common (minor allele frequency &gt;0.05) or previously reported SNPs at r2 &gt; 0.8 across RETN and its flanking regions. We used sex- and age-adjusted linear mixed-effects models (with/without BMI adjustment) to test additive associations of SNPs with traits, adjusted Cox proportional hazards models accounting for relatedness for incident diabetes, and generated empirical P values (Pe) to control for type 1 error.
RESULTS— Four tag SNPs (rs1477341, rs4804765, rs1423096, and rs10401670) on the 3′ side of RETN were strongly associated with resistin levels (all minor alleles associated with higher levels, Pe&lt;0.05 after multiple testing correction). rs10401670 was also associated with fasting plasma glucose (Pe = 0.02, BMI adjusted) and mean glucose over follow-up (Pe = 0.01; BMI adjusted). No significant association was observed for adiposity traits. On meta-analysis, the previously reported association of SNP −420C/G (rs1862513) with resistin levels remained significant (P = 0.0009) but with high heterogeneity across studies (P &lt; 0.0001).
CONCLUSIONS— SNPs in the 3′ region of RETN are associated with resistin levels, and one of them is also associated with glucose levels, although replication is needed.
Physical Activity and the Metabolic Syndrome in Elderly German Men and Women
Authors: Hahn Valerie , Halle Martin , Schmidt-Trucksäss A. , Rathmann W. , Meisinger C. , Mielck A. 
Published: December 2008

OBJECTIVE—The purpose of this study is to determine the optimal duration and intensity of exercise for elderly people for the prevention of the metabolic syndrome.
RESEARCH DESIGN AND METHODS—The population-based Cooperative Research in the Region of Augsburg (KORA) S4 Survey with 1,653 participants aged 55–74 years was used to investigate the relationship between the metabolic syndrome and physical activity.
RESULTS—Fifty-seven percent of men and 48% of women showed clinical symptoms of the metabolic syndrome. Leisure activities were common (&gt;80% walked &gt;30 min/day). Sports activities performed regularly for ≤1 h per week reduced the odds of having the metabolic syndrome (odds ratio 0.70 [95% CI 0.49–1.02] for men and 0.74 [0.53–1.04] for women), and sports activities &gt;2 h per week were even more effective (0.62 [0.42–0.92] for men and 0.59 [0.39–0.89] for women). In contrast, activities such as walking and cycling did not have an additional influence.
CONCLUSIONS—Intense physical activity by the elderly should be promoted in addition to leisure physical activity for the prevention of the metabolic syndrome.
Abnormal LDIflare but Normal Quantitative Sensory Testing and Dermal Nerve Fiber Density in Patients with Painful Diabetic Neuropathy
Authors: Krishnan Singhan T.M. , Quattrini Cristian , Jeziorska Maria , Malik Rayaz A. , Rayman Gerry 
Published: December 2008

OBJECTIVE—Abnormal small nerve fiber function may be an early feature of diabetic neuropathy and may also underlie painful symptoms. Methods for assessing small-fiber damage include quantitative sensory testing (QST) and determining intraepidermal nerve fiber density. We recently described a reproducible physiological technique, the LDIflare, which assesses small-fiber function and thus may reflect early dysfunction before structural damage. The value of this technique in painful neuropathy was assessed by comparing it with QST and dermal nerve fiber density (NFD).
RESEARCH DESIGN AND METHODS—Fifteen healthy control subjects, 10 subjects with type 2 diabetes and painful neuropathy (PFN), and 12 subjects with type 2 diabetes and painless neuropathy (PLN) were studied. LDIflare and QST were performed on the dorsum of the foot, and dermal NFD was determined.
RESULTS—Results of both large- and small-fiber quantitative sensory tests were abnormal in patients with PLN but not those with PFN compared with control subjects. Dermal NFD was also significantly reduced in the PLN group compared with control subjects (205.8 ± 165.3 vs. 424.9 ± 176.3 [mean ± SD]; P = 0.003) but not in the PFN group (307.6 ± 164.5). In contrast, the LDIflare (square centimeters) was reduced in both PFN (1.59 ± 0.41) and PLN (1.51 ± 0.56) groups compared with control subjects (4.38 ± 1.4) (P &lt; 0.001 for both). NFD correlated significantly with the LDIflare (r = 0.57, P &lt; 0.0001).
CONCLUSIONS—The LDIflare demonstrated impaired small-fiber function in patients with PFN when other assessments revealed no abnormality. We believe that this method has potential diagnostic value, particularly because it is noninvasive, has excellent reproducibility, and correlates with NFD. Furthermore, it may have an important role in assessing preventative therapies in early neuropathy.
NMDA-induced stimulation of glycolysis in developing hippocampal cell cultures
Authors: Luengviriya Jiraporn , Helmeke Carina , Braun Katharina , Hauser Marcus , Mair Thomas 
Published: December 2008

AbstractDevelopmental changes in energy metabolism of primary hippocampal cell cultures from newborn rats were investigated during the first 3 weeks. These changes were measured by intensity of and number of cells exhibiting NAD(P)H fluorescence in response to NMDA-induced activation of neuronal activity. We observed gradual changes of stimulation-evoked NAD(P)H signaling over the first 3 weeks, such that at day 7 and 16, this stimulation is minimal, while at 5 and 12 days, it is maximal. These results describe a biphasic pattern that was similar to earlier findings from experiments investigating developmental changes in population spike amplitudes or glutamate release in young rats. Inhibition of mitochondrial respiration by KCN revealed that the NMDA-evoked stimulation of energy metabolism is mainly due to increased glycolytic activity.
Mapping the Domain of Medical Informatics
Authors: Talmon J. L. , Moorman P. W. , Kors J. A. , Schuemie M. J. 
Published: December 2008

Summary
Objectives: The domain of medical informatics (MI) is not well defined. It covers a wide range of research topics. Our objective is to characterize the field of MI by means of the scientific literature in this domain.
Methods: We used titles and abstracts from MEDLINE records of papers published between July 1993 and July 2008, and extracted uni-, bi- and trigrams as features. Starting with the ISI category of medical informatics, we applied a semi-automated procedure to identify the set of journals and proceedings pertaining to MI. A clustering algorithm was subsequently applied to the articles from this set of publications.
Results: MI literature can be divided into three subdomains: 1) the organization, application, and evaluation of health information systems, 2) medical knowledge representation, and 3) signal and data analysis. Over the last fifteen years, the field has remained relatively stable, although most journals have shifted their focus somewhat.
Conclusions: We identified the scientific literature pertaining to the field of MI, and the main areas of research. We were able to show trends in the field, and the positioning of different journals within this field.