bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prediction of Mortality in Community‐Living Frail Elderly People with Long‐Term Care Needs
Authors: Carey Elise C. , Covinsky Kenneth E. , Lui Li‐Yung , Eng Catherine , Sands Laura P. , Walter Louise C. 
Published: November 2007

OBJECTIVES: To develop and validate a prognostic index for mortality in community‐living, frail elderly people.DESIGN: Cohort study of Program of All‐Inclusive Care for the Elderly (PACE) participants enrolled between 1988 and 1996.SETTING: Eleven PACE sites, a community‐based long‐term care program that cares for frail, chronically ill elderly people who meet criteria for nursing home placement.PARTICIPANTS: Three thousand eight hundred ninety‐nine PACE enrollees. The index was developed in 2,232 participants and validated in 1,667.MEASUREMENTS: Time to death was predicted using risk factors obtained from a geriatric assessment performed by the PACE interdisciplinary team at the time of enrollment. Risk factors included demographic characteristics, comorbid conditions, and functional status.RESULTS: The development cohort had a mean age of 79 (68% female, 40% white). The validation cohort had a mean age of 79 (76% female, 65% white). In the development cohort, eight independent risk factors of mortality were identified and weighted, using Cox regression, to create a risk score: male sex, 2 points; age (75–79, 2 points; 80–84, 2 points; ≥85, 3 points); dependence in toileting, 1 point; dependence in dressing (partial dependence, 1 point; full dependence, 3 points); malignant neoplasm, 2 points; congestive heart failure, 3 points; chronic obstructive pulmonary disease, 1 point; and renal insufficiency, 3 points. In the development cohort, respective 1‐ and 3‐year mortality rates were 6% and 21% in the lowest‐risk group (0–3 points), 12% and 36% in the middle‐risk group (4–5 points), and 21% and 54% in the highest‐risk group (>5 points). In the validation cohort, respective 1‐ and 3‐year mortality rates were 7% and 18% in the lowest‐risk group, 11% and 36% in the middle‐risk group, and 22% and 55% in the highest‐risk group. The area under the receiver operating characteristic curve for the point score was 0.66 and 0.69 in the development and validation cohorts, respectively.CONCLUSION: A multidimensional prognostic index was developed and validated using age, sex, functional status, and comorbidities that effectively stratifies frail, community‐living elderly people into groups at varying risk of mortality.
Weight, Mortality, Years of Healthy Life, and Active Life Expectancy in Older Adults
Authors: Diehr Paula , O'Meara Ellen S. , Fitzpatrick Annette , Newman Anne B. , Kuller Lewis , Burke Gregory 
Published: November 2007

OBJECTIVES:To determine whether weight categories predict subsequent mortality and morbidity in older adults.DESIGN:Multistate life tables, using data from the Cardiovascular Health Study, a longitudinal population‐based cohort of older adults.SETTING:Data were provided by community‐dwelling seniors in four U.S. counties: Forsyth County, North Carolina; Sacramento County, California; Washington County, Maryland; and Allegheny County, Pennsylvania.PARTICIPANTS:Five thousand eight hundred eighty‐eight adults aged 65 and older at baseline.MEASUREMENTS:The age‐ and sex‐specific probabilities of transition from one health state to another and from one weight category to another were estimated. From these probabilities, future life expectancy, years of healthy life, active life expectancy, and the number of years spent in each weight and health category after age 65 were estimated.RESULTS:Women who are healthy and of normal weight at age 65 have a life expectancy of 22.1 years. Of that, they spend, on average, 9.6 years as overweight or obese and 5.3 years in fair or poor health. For both men and women, being underweight at age 65 was associated with worse outcomes than being normal weight, whereas being overweight or obese was rarely associated with worse outcomes than being normal weight and was sometimes associated with significantly better outcomes.CONCLUSION:Similar to middle‐aged populations, older adults are likely to be or to become overweight or obese, but higher weight is not associated with worse health in this age group. Thus, the number of older adults at a “healthy” weight may be much higher than currently believed.
Interventions for Preventing Falls in Acute‐ and Chronic‐Care Hospitals: A Systematic Review and Meta‐Analysis
Authors: Coussement Joke , De Paepe Leen , Schwendimann René , Denhaerynck Kris , Dejaeger Eddy , Milisen Koen 
Published: November 2007

OBJECTIVES: To determine the characteristics and the effectiveness of hospital fall prevention programs.DESIGN: Systematic literature search of multiple databases (Medline, Cinahl, Precinahl, Invert, the Cochrane Library) and of the reference list of each identified publication.SETTING: Inclusion of prospective controlled‐design studies reporting the effectiveness of fall prevention programs in hospitals.PARTICIPANTS: Two reviewers.MEASUREMENTS: The methodological qualities of the studies were assessed based on 10 criteria. For the meta‐analysis, the relative risk of a fall per occupied bed day (RRfall) and the relative risk of being a faller (RRfaller) were calculated.RESULTS: Eight studies met the inclusion criteria, of which four studies tested multifactorial interventions. Although these studies took place in hospitals, most were conducted on long‐stay (mean length of stay (LOS) >1.5 years) and rehabilitation units (mean LOS 36.9 days). For analysis of the number of falls, one unifactorial and two multifactorial studies showed a significant reduction of 30% to 49% in the intervention group, with the greatest effect obtained in the unifactorial study that assessed a pharmacological intervention. The pooled RRfall for the four multifactorial studies became nonsignificant after adjustment for clustering (RRfall=0.82, 95% confidence interval (CI)=0.65–1.03). No studies reported a significant reduction, either single or pooled, in the number of fallers in the intervention group (pooled RRfaller‐0.87, 95% CI=0.70–1.08).CONCLUSION: This meta‐analysis found no conclusive evidence that hospital fall prevention programs can reduce the number of falls or fallers, although more studies are needed to confirm the tendency observed in the analysis of individual studies that targeting a patient's most important risk factors for falls actively helps in reducing the number of falls. These interventions seem to be useful only on long‐stay care units.
Long‐Term Effects of Childhood Abuse on the Quality of Life and Health of Older People: Results from the Depression and Early Prevention of Suicide in General Practice Project
Authors: Draper Brian , Pfaff Jon J. , Pirkis Jane , Snowdon John , Lautenschlager Nicola T. , Wilson Ian , Almeida Osvaldo P. ,   for the Depression and Early Prevention of Suicide in General Practice Study Group
Published: November 2007

OBJECTIVES: To determine whether childhood physical and sexual abuse are associated with poor mental and physical health outcomes in older age.DESIGN: Cross‐sectional, postal questionnaire survey.SETTING: Medical clinics of 383 general practitioners (GPs) in Australia.PARTICIPANTS: More than 21,000 older adults (aged ≥60) currently under the care of GPs participating in the Depression and Early Prevention of Suicide in General Practice (DEPS‐GP) Study. Participants were divided into two groups according to whether they acknowledged experiencing childhood physical or sexual abuse.MEASUREMENTS: Main outcome measures targeted participants' current physical health (Medical Outcomes Study 12‐item Short Form Survey, Version 2 and Common Medical Morbidities Inventory) and mental health (Patient Health Questionnaire‐9 and Hospital Anxiety and Depression Scale).RESULTS: One thousand four hundred fifty‐eight (6.7%) and 1,429 participants (6.5%) reported childhood physical and sexual abuse, respectively. Multivariate models of the associations with childhood abuse indicated that participants who had experienced either childhood sexual or physical abuse had a greater risk of poor physical (odds ratio (OR)=1.35, 95% confidence interval (CI)=1.21–1.50) and mental (OR=1.89, 95% CI=1.63–2.19) health, after adjustments. Older adults who reported both childhood sexual and physical abuse also had a higher risk of poor physical (OR=1.60, 95% CI=1.33–1.92) and mental (OR=2.40, 95% CI=1.97–2.94) health.CONCLUSION: The effects of childhood abuse appear to last a lifetime. Further research is required to improve understanding of the pathways that lead to such deleterious outcomes and ways to minimize its late‐life effects.
Minimum infectious dose of hepatitis B virus in chimpanzees and difference in the dynamics of viremia between genotype A and genotype C
Authors: Komiya Yutaka , Katayama Keiko , Yugi Hisao , Mizui Masaaki , Matsukura Harumichi , Tomoguri Tetsushi , Miyakawa Yuzo , Tabuchi Ayako , Tanaka Junko , Yoshizawa Hiroshi 
Published: November 2007

BACKGROUND: In planning optimal hepatitis B virus (HBV) blood screening strategies, the minimum infectious dose and early dynamics of HBV need to be determined for defining the window period for HBV DNA as well as for hepatitis B surface antigen (HBsAg).STUDY DESIGN AND METHODS: Pairs of chimpanzees were inoculated with preacute‐phase inocula containing HBV of genotype A or genotype C to determine the minimum infectious dose, and two pairs of chimps infected with the lowest infectious dose of genotypes A and C were followed for HBV markers.RESULTS: The minimum 50 percent chimpanzee infectious dose (CID50) was estimated to be approximately 10 copies for genotype A and for genotype C. In the two chimps inoculated with the lowest infectious dose, the HBV DNA window was 55 to 76 days for genotype  A and 35 to 50 days for genotype C, respectively. The HBsAg window was 69 to 97 days for genotype A and 50 to 64 days for genotype C, respectively. The doubling times of HBV DNA were 3.4 days (95% confidence interval [CI], 2.6‐4.9 days) for genotype A and 1.9 days (95% CI, 1.6‐2.3 days) for genotype C. When comparing the replication velocity of HBV DNA between the two genotypes, the doubling time of genotype C was significantly shorter than that of HBV genotype A (p < 0.01).CONCLUSION: Although the CID50 of approximately 10 copies was similar for the two HBV genotypes, the doubling time and pre‐HBV nucleic acid amplification technology (<100 copies/mL) window period in chimps infected with the lowest infectious dose seemed to be shorter for genotype C than for genotype A.
Potential and limitation of UVC irradiation for the inactivation of pathogens in platelet concentrates
Authors: Terpstra Fokke G. , Van 't Wout Angélique B. , Schuitemaker Hanneke , Van Engelenburg Frank A.C. , Dekkers David W.C. , Verhaar Robin , De Korte Dirk , Verhoeven Arthur J. 
Published: November 2007

BACKGROUND: Pathogen contamination, causing transfusion‐transmitted diseases, is an ongoing concern in transfusion of cellular blood products. In this explorative study, the pathogen‐inactivating capacity of UVC irradiation in platelet (PLT) concentrates was investigated. The dose dependencies of inactivation of several viruses and bacteria were compared with the effect on PLT quality.STUDY DESIGN AND METHODS: The potential of UVC irradiation was studied with a range of lipid‐enveloped (LE) and non–lipid‐enveloped viruses (NLE) and bacteria. LE viruses were bovine viral diarrhea virus (BVDV), human immunodeficiency virus (HIV), pseudorabies virus (PRV), transmissible gastroenteritis virus (TGEV), and vesicular stomatitis virus (VSV). NLE viruses were canine parvovirus (CPV) and simian virus 40 (SV40). Bacteria were Staphylococcus epidermidis, Staphylococcus aureus, Escherichia coli, and Bacillus cereus. After spiking and irradiation, samples were tested for residual infectivity and reduction factors (RFs) were calculated. Furthermore, the effect of UVC irradiation on PLT quality was determined by measuring in vitro quality variables.RESULTS: A UVC dose of 500 J per m2 resulted in acceptable PLT quality (as measured by pH, lactate production, CD62P expression, and exposure of phosphatidylserine) and high RFs (>4 log) for CPV, TGEV, VSV, S. epidermidis, S. aureus, and E. coli. Intermediate RFs (approx. 3 log) were observed for BVDV, PRV, and B. cereus. Low RFs (approx. 1 log) were found for HIV and SV40. No differences in virus reduction were observed between cell‐free and cell‐associated virus.CONCLUSION: UVC irradiation is a promising pathogen‐reducing technique in PLT concentrates, inactivating bacteria, and a broad range of viruses (with the exception of HIV) under conditions that have limited effects on PLT quality. Further optimization of the UVC procedure, however, is necessary to deal with blood‐borne viruses like HIV.
Establishing a cord blood banking and transplantation program in Mexico: a single institution experience
Authors: Novelo‐Garza Barbara , Limon‐Flores Alejandro , Guerra‐Marquez Angel , Luna‐Bautista Fernando , Juan‐Shum Luis , Montero Ines , Sanchez‐Valle Elizabeth , Vélez‐Ruelas Maria Antonieta , Mayani Hector 
Published: November 2007

BACKGROUND: Over the past decade, umbilical cord blood (UCB) banking and transplantation have increased significantly worldwide. The experience in developing countries, however, is still limited. In January 2005 the Mexican Institute of Social Security (IMSS) initiated its UCB banking and transplantation program. This study reports on the experience generated at this institution during the first 2 years of activities.STUDY DESIGN AND METHODS: A public UCB bank was established at La Raza Medical Center, IMSS, in Mexico City. Good manufacturing practices and standard operating procedures were used to address donor selection, as well as UCB collection, processing, and cryopreservation. Based mainly on human leukocyte antigen (HLA) and total nucleated cell (TNC) content, specific UCB units were thawed, processed, and released for transplantation.RESULTS: Based on stringent selection criteria, 360 UCB units were collected from January 2005 to December 2006. A total of 201 (56%) units (minimum volume, 50 mL without anticoagulant) were processed and stored. Median values for specific parameters were as follows: volume, 89.9 mL; viability, 94.8%; TNCs, 0.91 × 109; CD34+ cells, 3.13 × 106; and colony‐forming cells, 1.20 × 106. During this period, 10 units had been released for transplantation to seven patients (six children and one adult). Engraftment was observed in five patients; four of them were still in remission (114‐293 days after transplant). In spite of showing sustained engraftment, one patient died on Day +88. Two patients showed no engraftment and died 29 to 30 days after transplant.CONCLUSION: The results obtained during this initial period are encouraging and indicate that the UCB banking and transplantation program at IMSS will help to improve already existing hematopoietic cell transplant programs in Mexico. The experience generated at IMSS may be helpful to other institutions, particularly those in developing countries.
Neonatal alloimmune thrombocytopenia associated with maternal‐fetal incompatibility for blood group B
Authors: Curtis Brian R. , Fick Andrea , Lochowicz Andrew J. , McFarland Janice G. , Ball Robert H. , Peterson Julie , Aster Richard H. 
Published: November 2007

BACKGROUND: Blood group A and B antigens are expressed only weakly on platelets (PLTs) of most individuals but are very strongly expressed on PLTs from approximately 1 percent of normal subjects (Type II high expressers). The implications of this trait for transfusion medicine are undefined.STUDY DESIGN AND METHODS: A family was studied in which two Group B infants were born with neonatal thrombocytopenia, whereas a third infant whose blood group was A2 had a normal PLT count at birth.RESULTS: Serologic studies demonstrated a maternal antibody that reacted strongly with PLTs from the father and the two group B children in flow cytometry and with GPIIb/IIIa from their PLTs in solid‐phase assays. No PLT‐specific antibodies were detected in maternal serum sample, but it contained a high‐titer immunoglobulin G antibody specific for blood group B. All PLT‐reactive antibody in the mother's serum was removed by absorption with pooled, washed group A and B red cells (RBCs). Studies with monoclonal anti‐B and measurement of serum B‐glycosyltransferase activity showed that the father and both group B children were Type II high expressers of blood group B.CONCLUSIONS: The findings indicate that high‐titer blood group antibodies acquired from the mother can cause thrombocytopenia in infants possessing the Type II high‐expresser phenotype despite competition for antibody binding by blood group antigens expressed on RBCs and other tissues.
Clinical cardiac involvement in thrombotic thrombocytopenic purpura: a systematic review
Authors: Hawkins Beau M. , Abu‐Fadel Mazen , Vesely Sara K. , George James N. 
Published: November 2007

BACKGROUND: Autopsy studies consistently demonstrate cardiac involvement in thrombotic thrombocytopenic purpura (TTP), but clinical evidence for cardiac abnormalities is rarely reported.STUDY DESIGN AND METHODS: This systematic review addresses the apparent discrepancy between autopsy and clinical data. English language articles were identified by keywords for both TTP and for cardiac symptoms, testing, or events. Patients were analyzed if they were more than 10 years old with idiopathic TTP.RESULTS: Thirty articles were identified that described 111 eligible patients: 20 case reports described 27 patients, 9 retrospective cohort studies described 74 patients, and 1 prospective cohort study described 10 patients. Cardiac events included infarction (26 patients), congestive failure (17), arrhythmias (10), cardiogenic shock (6), and sudden cardiac death (8). Mortality was assessed in 101 patients: 55 died, and 48 autopsies were described. All demonstrated cardiac microvascular thrombi, hemorrhage, and/or necrosis. Follow‐up information was reported in only 6 of the 16 patients who survived a cardiac event (follow‐up duration, 10 days‐2 years; median, 7 weeks).CONCLUSIONS: The frequency and sequelae of clinical cardiac abnormalities in TTP cannot be accurately assessed because most patients were described in reports of few selected patients; many patients were reported before the availability of effective treatment for TTP and sensitive tests for cardiac involvement. Continuing case reports and cohort studies, however, suggest that cardiac abnormalities may be important and often unrecognized causes of mortality and morbidity in patients with TTP. Prospective studies are needed to determine if cardiac therapy can improve survival and long‐term outcomes of patients with TTP.
“There Was No Plan”: An Interview with Rajiv Chandrasekaran
Authors: Kosar Kevin 
Published: November 2007

The George W. Bush administration’s doctrines of preemption and democratization through military action have been much debated. Discussants have included former members of the military, students of international relations and diplomacy, philosophers, and legal theorists, to name a few. Not surprisingly, the focus of these expostulations has been on the utility of hard and soft power, the international ripple effects of military action and state toppling, and the legal and moral propriety of preemption. For the most part, public administrators have little participated in these debates. This is regrettable, for the central question nestled within any debate over public policy is the question of plausibility. Can this policy be executed successfully? The governance challenges in postconflict states are profound. Who should rule? How should the state be reconstructed? What administrative structures should be erected? Who should staff government offices and bureaucracies, and what principles should guide them? If preemption and democratization are to succeed, then these questions must be answered. Rajiv Chandrasekaran is an assistant managing editor of the Washington Post. His book Imperial Life in the Emerald City: Inside Iraq’s Green Zone (Alfred A. Knopf, 2006) is an examination of the Coalition Provisional Authority that governed Iraq from April 2003 through June 2004. Mr. Chandrasekaran has served as the journalist in residence for the International Reporting Project at the Johns Hopkins School for Advanced International Studies and as a public policy scholar at the Woodrow Wilson International Center in Washington, D.C. In March 2007, Mr. Chandrasekaran was interviewed by Kevin Kosar on behalf of the Public Administration Review.
Cardiac Arrest and Left Ventricular Fibrosis in a Finnish Family with the Lamin A/C Mutation
Authors: HOOKANA EEVA , JUNTTILA M. JUHANI , SÄRKIOJA TERTTU , SORMUNEN RAIJA , NIEMELÄ MATTI , RAATIKAINEN M.J. PEKKA , UUSIMAA PAAVO , LIZOTTE ERIC , PEUHKURINEN KEIJO , BRUGADA RAMON , HUIKURI HEIKKI V. 
Published: November 2007

Introduction: We screened the candidate genes from a Finnish family in which the mother was resuscitated from ventricular fibrillation and the daughter died suddenly without any prior cardiac symptoms. Methods and Results: In addition to screening of potential structural gene mutations, phenotyping of the proband and medico‐legal autopsy of the victim of the sudden death, including histopathological examinations, were performed. Genetic screening revealed an R541C mutation in the lamin A/C gene both in the proband and her daughter. None of the 16 first‐ or second‐degree relatives, or 96 unrelated healthy subjects, carried the same mutation. In the proband, the size and the global function of the left ventricle (LV) were normal, but a local hypokinesia and thinning of inferoposterior area of the LV were seen in 2D echocardiography and magnetic resonance imaging. Coronary angiogram and the results of the electrophysiological study were normal. Autopsy of the victim of sudden death showed localized thinning and fibrosis in the inferoposterior area of the LV, with only minimal fibrosis in the right ventricle and no abnormalities in the interventricular septum. Conclusion: These observations indicate that a fatal or near‐fatal cardiac arrhythmia can be the first clinical manifestation of a “de novo” mutation R541C of the lamin A/C gene. Replacement of cardiac myocytes by fibrosis seems to be the predominant pathologic‐anatomic finding.