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PubMed2004

Frequency of bed sharing and its relationship to breastfeeding.

Bed sharing has been promoted as facilitating breastfeeding but also may increase risks for sudden, unexpected infant deaths. This prospective cohort study was performed to determine the prevalence of adult and infant bed sharing and its association with maternal and infant characteristics. Demographic data were collected from 10,355 infant-mother pairs at birth hospitals in Eastern Massachusetts and Northwest Ohio, and follow-up data were collected at 1, 3, and 6 months by questionnaire. Associations with bed sharing were estimated using odds ratios and 95% confidence intervals from multiple logistic regression models while adjusting for confounding variables. At 1, 3, and 6 months, 22%, 14%, and 13% of infant-mother pairs shared a bed, respectively. On multivariate analysis, race/ethnicity and breastfeeding seemed to have the strongest association with bed sharing. These factors need to be considered in any comprehensive risk to benefit analysis of bed sharing.

Adolescent↗

PubMed2003

Prediction of treatment outcome from relationship variables in child and adolescent therapy: a meta-analytic review.

Results from 23 studies examining associations between therapeutic relationship variables and treatment outcomes in child and adolescent therapy were reviewed with meta-analytic procedures. Results indicated that the overall strength of the relationship-outcome associations was modest and quite similar to results obtained with adults. This modest association was moderated by 1 substantive factor, type of patient problem, and 5 methodological factors, timing and source of relationship measurement, type and source of outcome, and shared versus cross-source measurement of relationship and outcome variables. Type, mode, structure, and context of treatment did not moderate associations between relationship variables and outcomes. Findings indicated that the association between the therapeutic relationship and treatment outcome was consistent across developmental levels and across diverse types and contexts of child and adolescent therapy. Recommendations for future process research on the therapeutic relationship in child psychotherapy are offered.

Adolescent↗

PubMed1998

Outcome of liver transplantation in critically ill patients with alcoholic cirrhosis: survival according to medical variables and sobriety.

BACKGROUND: At our center from August 1989 to December 1992, 834 adults underwent orthotopic liver transplantation (OLT) using tacrolimus as the primary immunosuppressive agent. A total of 183 adults (22%) had alcohol-related liver disease. Patients with alcoholic cirrhosis had a better though not statistically significant 5-year survival rate compared with all other patients. We were interested in specific predictors of survival, particularly for alcoholic cirrhotics who were gravely ill at the point of transplantation. METHODS: For the 78 patients with alcohol-related liver disease who were United Network for Organ Sharing status IIA (critically ill) at the point of transplantation, variables of length of sobriety, alcohol rehabilitation, and medical variables (ventilator support, dialysis, vasopressor support, degree of encephalopathy, and infection) were assessed for contribution to survival. RESULTS: Although there was a trend toward poorer survival in patients with the shortest length of sobriety (< or =1 month), pre-OLT length of sobriety or alcohol rehabilitation did not predict survival. However, these patients tended to be in multiorgan failure and encephalopathic. Nevertheless, pre-OLT dialysis requirement was the only variable that predicted poorer survival (P < 0.002). This study was not designed to evaluate recidivism. However, we know that 24% of these patients have used alcohol at some point after OLT. CONCLUSIONS: Short pre-OLT length of sobriety may not predict which patients are likely to resume alcohol consumption after OLT, but it may identify patients in whom there will exist a variety of poor outcome variables. In our study, in these patients, post-OLT survival was associated with medical rather than alcohol history variables.

Adult↗

PubMed1990

Do diagnostic patterns exist in the sleep behaviors of normal children?

We investigated the factor structure of the Children's Sleep Behavior Scale in an unselected sample of children (N = 838), ages 6 to 12.5 years, drawn from an elementary school population. Although no factor emerged that corresponded exactly to the parasomnias, as described by the Association of Sleep Disorders Centers (1979), all of the variables that loaded on Factor 1 were behaviors characteristic of the parasomnias, with the exception of recalled nightmares. Variables that were expected to load on this factor, but did not, were sleeptalking, teeth grinding, and enuresis. Enuresis was not related to any of the sleep behaviors assessed, and teeth grinding shared less than 9% of the variance with any of the other variables. Many of the variables loaded on more than one factor. The second factor, which was labeled bedtime resistance, was the only clearly unambiguous factor. Of the five factors that emerged, the third reflected positive affect, the fourth was a motor factor, and the fifth was an anxiety factor. Nightmares loaded on the anxiety factor as well as the first factor. The results of the study offered no support for the category of Disorders of Initiating and Maintaining sleep (DIMS), which has a childhood onset.

Arousal↗

PubMed1986

A multivariate investigation of postpartum mood disturbance.

The interrelationships of 'blues' and later postpartum depression with a number of biochemical, medical, and psychosocial variables have been examined in 52 subjects. The two syndromes shared only an impressive association with a prior history of gynaecological problems. Puerperal 'blues' was characterised in addition by associations with primiparity, tearfulness during pregnancy, and reduced plasma total tryptophan in the early puerperium. Depressive symptomatology up to nine months postpartum was related to an excess of male births and to an altered pattern of decline of non-esterified fatty acids immediately postpartum. In each case, the 'risk' variables were statistically independent and combined linearly. Stepwise discriminant analysis successfully discriminated 'blues' and depression from their respective non-cases. 'Blues and postpartum depression were only weakly related and, apart from gynaecological history, each was associated with separate and independent causative factors.

Adolescent↗

PubMed1990

DNA homologies shared among E. corrodens isolates and other corroding bacilli from the oral cavity.

In a previous microbiological study of Eikenella corrodens, we noted the presence of E. corrodens strains with variability in colony morphology, as well as other corroding bacilli phenotypically similar to E. corrodens but which were unidentifiable on the basis of biochemical reactions. This raised questions as to whether E. corrodens constitutes a genetically heterogeneous group of organisms, and whether the unidentified corroding bacilli represent atypical E. corrodens or genetically unrelated organisms. In the present study, the genetic relationship among 14 E. corrodens isolates and 6 unidentified corroding bacilli was examined. DNA base compositions were determined from the melting temperatures of DNA samples. DNA homologies among E. corrodens and corroding bacilli were determined by DNA hybridization in solution using S1 nuclease. The % G + C content of E. corrodens strains varied from 56 to 58%, and from 56 to 60% for unidentified corroding bacilli. The DNA homologies among 12 E. corrodens isolates and 2 reference strains varied from 57 to 97%. Although these E. corrodens isolates exhibited variabilities in colony morphology and biochemical profile, no subspecies was identified. The unidentified corroding bacilli shared less than 33% homology with either of the E. corrodens reference strains. These corroding bacilli were further divided into 3 species on the basis of DNA hybridization studies using radiolabeled DNA from 2 representative corroding bacilli. One of the unidentified corroding bacilli appears to be a component of the normal flora in the human oral cavity. Our results indicate that E. corrodens is a genetically homogeneous species containing no recognizable subspecies.(ABSTRACT TRUNCATED AT 250 WORDS)

Bacteria↗

PubMed1997

Long-term survival after retransplantation of the liver.

OBJECTIVE: The authors determined the long-term outcome of patients undergoing hepatic retransplantation at their institution. Donor, operative, and recipient factors impacting on outcome as well as parameters of patient resource utilization were examined. SUMMARY BACKGROUND DATA: Hepatic retransplantation provides the only available option for liver transplant recipients in whom an existing graft has failed. However, such patients are known to exhibit patient and graft survival after retransplantation that is inferior to that expected using the same organs in naiive recipients. The critical shortage of donor organs and resultant prolonged patient waiting periods before transplantation prompted the authors to evaluate the results of a liberal policy of retransplantation and to examine the factors contributing to the inferior outcome observed in retransplanted patients. METHODS: A total of 2053 liver transplants were performed at the UCLA Medical Center during a 13-year period from February 1, 1984, to October 1, 1996. A total of 356 retransplants were performed in 299 patients (retransplant rate = 17%). Multivariate regression analysis was performed to identify variables associated with survival. Additionally, a case-control comparison was performed between the last 150 retransplanted patients and 150 primarily transplanted patients who were matched for age and United Network of Organ Sharing (UNOS) status. Differences between these groups in donor, operative, and recipient variables were studied for their correlation with patient survival. Days of hospital and intensive care unit stay, and hospital charges incurred during the transplant admissions were compared for retransplanted patients and control patients. RESULTS: Survival of retransplanted patients at 1, 5, and 10 years was 62%, 47%, and 45%, respectively. This survival is significantly less than that seen in patients undergoing primary hepatic transplantation at the authors' center during the same period (83%, 74%, and 68%). A number of variables proved to have a significant impact on outcome including recipient age group, interval to retransplantation, total number of grafts, and recipient UNOS status. Recipient primary diagnosis, cause for retransplantation, and whether the patient was retransplanted before or after June 1, 1992, did not reach statistical significance as factors influencing survival. In the case-control comparison, the authors found that of the more than 25 variables studied, only preoperative ventilator status showed both a significant difference between control patients and retransplanted patients and also was a factor predictive of survival in retransplanted patients. Retransplant patients had significantly longer hospital and intensive care unit stays and accumulated total hospitalization charges more than 170% of those by control patients. CONCLUSIONS: Hepatic retransplantation, although life-saving in almost 50% of patients with a failing liver allograft, is costly and uses scarce donor organs inefficiently. The data presented define patient characteristics and preoperative variables that impact patient outcome and should assist in the rational application of retransplantation.

Adolescent↗

PubMed1982

Somatic mutation in genes for the variable portion of the immunoglobulin heavy chain.

The size of the gene pool potentially encoding antibodies to p-azophenyl arsonate has been examined. A heavy chain-specific full-length complementary DNA clone has been constructed with the use of messenger RNA from a hybridoma that produces antibodies to the arsonate hapten and bears nearly a full complement of the determinants comprising the cross-reactive idiotype (CRI). The sequences of both the complementary DNA clone and the corresponding immunoglobulin heavy chain have been independently determined. A probe for the variable region gene was prepared from the original heavy chain complementary DNA clone and used to analyze, by Southern filter hybridization, genomic DNA from both A/J (CRI positive) and BALB/c (CRI negative) mice. Approximately 20 to 25 restriction fragments containing "germline" variable region gene segments were detected in both strains, and many are shared by both, Since 35 CRI-positive heavy chains have been partially sequenced thus far and 31 are different, the results of the hybridization analysis suggest that somatic mutation events involving the variable region gene segments of the heavy chain play a role in the origin of the amino acid sequence diversity seen in this system.

Amino Acid Sequence↗

PubMed2005

Effect of increased cost-sharing on oral hypoglycemic use in five managed care organizations: how much is too much?

BACKGROUND: For patients with a chronic disease, increased cost-sharing for medications may lead to unintended consequences, including reduced use of medications essential for control of their disease. OBJECTIVE: The objective of this study was to estimate the effects of small ($1-6 per 30-day supply), moderate ($7-10), and large (>$10) increases in medication cost-sharing on 12-month trends in oral hypoglycemic (OH) use among adults with type 2 diabetes. METHODS: We conducted a quasiexperimental study using a time series with comparison group design. Data were obtained from computerized membership, benefit, and pharmacy dispensing data of 5 managed care organizations (MCOs). A total of 13,110 12-month episodes of OH use and a medication cost-sharing increase ("intervention") were matched with 13,110 that had no increase. The dependent variable was OH average daily dose (ADD) standardized to each episode's mean OH ADD in the 6-month preintervention period. The principal independent variable was change in cost per 30-day OH supply between the 6-month pre- and postintervention periods. Effects of changes in cost-sharing on OH ADD were estimated using segmented time series regression. RESULTS: Episodes with >$10 increase in cost-sharing had significantly (alpha=0.05) decreased OH ADD in the postintervention period. At 6 months after this increase, OH ADD had decreased by 18.5% from that predicted from the preintervention trend. Episodes with a $1 to $10 increase in cost-sharing and those with no increase in cost-sharing had significant linear increases in OH use over the 12-month period. CONCLUSIONS: Large increases in medication cost-sharing were associated with immediate and persistent reductions in OH use. Small and moderate increases had little effect on OH use in the 6-month period after the increase.

Adolescent↗

PubMed2006

Multiple alternative splicing in gonads of chicken DMRT1.

Many basic cellular processes are shared across vast phylogenetic distances, whereas sex-determining mechanisms are highly variable between phyla, although the existence of two sexes is nearly universal in the animal kingdom. However, the evolutionarily conserved DMRT1/dsx/mab3 with a common zinc finger-like DNA-binding motif, DM domain, share both similar structure and function between phyla. Here we report that six transcripts of the chicken DMRT1 were generated in gonads by multiple alternative splicing. By cDNA cloning and genomic structure analysis, we found that there were nine exons of DMRT1, which were involved in alternatively splicing to generate the DMRT1 transcripts. Northern blotting and reverse transcription (RT) PCR analysis revealed that the expression of chicken DMRT1 was testis-specific in adults. Whole-mount in situ hybridizations and RT-PCR indicated that DMRT1 b was specially expressed in embryo gonads and higher in male than female gonads at stage 31. The female gonad had stronger DMRT1 c expression than the male one, whereas DMRT1 f was detectable only in the male gonad at stage 31 of the key time of sex gonadal differentiation. The differential expression of these transcripts during gonadal differentiation provides new insight into roles of alternative splicing of DMRT1 in governing sex differentiation of the chicken.

Alternative Splicing↗

PubMed2004

Distribution, genetic diversity, and variable expression of the gene encoding hyaluronate lyase within the Streptococcus suis population.

Although Streptococcus suis is an economically important pathogen of pigs and an occasional cause of zoonotic infections of humans knowledge of crucial virulence factors, and as a consequence targets for therapeutic or prophylactic intervention, remains limited. Here we describe a detailed study of the distribution, diversity, and in vitro expression of hyaluronate lyase, a protein implicated as a virulence factor of many mucosal pathogens. The gene encoding hyaluronate lyase, hyl, was present in all 309 bona fide S. suis isolates examined representing diverse serotypes, geographic sources, and clinical backgrounds. Examination of the genetic diversity of hyl by RFLP and sequence analysis indicated a pattern of diversity shared by many gram-positive surface proteins with a variable 5' region encoding the most distal cell surface-exposed regions of the protein and a much more conserved 3' region encoding domains more closely associated with the bacterial cell. Variation occurs by several mechanisms, including the accumulation of point mutations and deletion and insertion events, and there is clear evidence that genetic recombination has contributed to molecular variation in this gene. Despite the ubiquitous presence of hyl, the corresponding enzyme activity was detected in fewer than 30% of the 309 isolates. In several cases this lack of activity correlates with the presence of mutations (either sequence duplications or point mutations) within hyl that result in a truncated polypeptide. There is a striking absence of hyaluronate lyase activity in a large majority of isolates from classic S. suis invasive disease, indicating that this protein is probably not a crucial virulence factor, although activity is present in significantly higher numbers of isolates associated with pneumonia.

Animals↗

PubMed2004

Load-sharing at the wrist following radial head replacement with a metal implant. A cadaveric study.

BACKGROUND: Surgical excision of the radial head is frequently required after a comminuted fracture of the radial head. The outcome of this procedure is often unpredictable, with some patients experiencing ulna-sided pain in the wrist secondary to proximal migration of the radius. Insertion of a radial head prosthesis could prevent proximal radial migration and restore normal load-sharing at the wrist. The thickness of the radial head implant is an important variable in restoring anatomical radial length; however, the effects of varying the length of implants that were used to reconstruct the radius on load-sharing at the wrist have not been studied biomechanically, to our knowledge. METHODS: A miniature load cell was attached to fifteen fresh-frozen cadaveric forearms to record force in the distal part of the ulna as the wrist was axially loaded to 134 N of compression force. Proximal displacement of the radius relative to the capitellum was also recorded. Loading tests on intact forearms were performed with the elbow in valgus and varus alignment and with three positions of wrist rotation (neutral, 45 degrees of pronation, and 45 degrees of supination). Loading tests were then repeated, with the same positions of varus and valgus elbow alignment and wrist rotation as had been used in the tests of the intact forearm, after radial head excision and subsequent insertion of metal radial head implants that restored anatomical length, implants that produced a radial length that was longer than the anatomical length, and implants that produced a radial length that was shorter than the anatomical length. Testing of these different implant thicknesses was repeated after sectioning of the interosseous membrane. RESULTS: The mean distal ulnar forces and mean proximal radial displacements following insertion of an implant that restored anatomical length were not significantly different from the corresponding values for the intact forearm. At neutral wrist rotation, replacing that implant with an implant that increased the radial length by 4 mm (after sectioning of the interosseous membrane) decreased the mean distal ulnar force from 13.4% to 3.3% of the applied wrist force with the elbow in valgus alignment and from 29.1% to 8.6% with the elbow in varus alignment. Replacing the implant that restored anatomical length with one that decreased the length by 4 mm (after sectioning of the interosseous membrane) significantly increased the mean distal ulnar force from 13.4% of the applied wrist load to 33.3% with the elbow in valgus alignment and from 29.1% to 51.6% with it in varus alignment. The mean distal ulnar forces were not significantly affected by the position of wrist rotation when the elbow was in valgus alignment. However, when the elbow was in varus alignment, the mean distal ulnar forces associated with all reconstructed radial lengths were significantly higher when the wrist was placed in 45 degrees of supination. CONCLUSIONS: In this cadaveric model, insertion of a metal implant maintained distal ulnar forces at normal levels, at all three positions of wrist rotation, when the radius had been restored to its original anatomical length. Distal ulnar forces and proximal radial displacements were significantly affected by the reconstructed length of the radius. CLINICAL RELEVANCE: Radial head implants are utilized to prevent proximal migration of the radius as the wrist is loaded; this is especially important when the interosseous membrane has been ruptured and thus cannot help to limit radial displacement. At the time of surgery, comminution and displacement of a radial head fracture may make estimation of the original radial length difficult. Our results demonstrate that, in terms of distal ulnar loading, it is preferable to insert an implant that is too thick rather than too thin.

Aged↗

PubMed1996

Heterogeneity of mitochondrial DNA haplotypes in Pre-Columbian Natives of the Amazon region.

We report the first study of mitochondrial DNA (mtDNA) sequencing from ancestral Amerindian populations of the South American continent. Sequencing of the D-loop region of mtDNA was carried out for bone fragments from 18 skeletons of Pre-Columbian Amerinidians. The skeletons were excavated in different archeological sites of the Brazilian Amazon region, with dating estimated at 500-4,000 years before the present. The sequencing of at least 354 bases permitted the identification of 13 haplotypes defined by variation of 26 nucleotide positions. Two haplotypes were shared by more than one sample, while 11 haplotypes were observed for a single sample. Seven haplotypes observed in 11 individuals (61% of the sample) belong to the four haplogroups described by Horai et al. (1993). Three samples that shared the transition C-->T in positions 16,223 and 16,278 formed a fifth haplogroup, which has been previously described in present-day Indian populations. Finally, four samples formed a heterogeneous group but each haplotype had at least one mutation typically detected in Asian or Mongoloid populations. Thus, although only haplotypes shared by Asian populations were detected, a wide haplotype variability was observed. If our sample is representative of Pre-Columbian South America, the percentage of haplotypes (39%) not belonging to the four haplogroups described by Horai is much greater than in contemporary indigenous populations. This permits us to suggest that, in addition to the postulated bottleneck effect during the migration from Asia to the Americas, the depopulation effect started by European colonization in the 16th century contributed to the reduction in genetic variability of Amerindians.

Base Sequence↗

PubMed1999

Addressing the inequity of capitation by variable soft contracts.

In the search for greater efficiency and cost-containment, many health systems have introduced the practice of medical care providers operating under a fixed budget, often referred to as the capitation or fundholding contract. Although the capitation contract seems equitable at first glance, the sequential decision-making practice of providers-shaped by their rate of present-preference and their attitude toward the risk of running out of budget-may result in serious violations of basic equity principles. We propose a variable soft (or mixed) payment contract (VSC), where the share of the retrospective payment increases over time, as a way to make the contracts more equitable. We also discuss how the parameters of the capitation contract (length of the budget period, soft or hard contracts, solo vs. consortium practice etc.), which are usually set by efficiency criteria, may have serious implications with regard to the equity of the system.

Budgets↗

PubMed2002

How do features of sensory representations develop?

Sensory representations in the brainstem and cortex have a number of features that support the idea that neural activity patterns are important in their development. Many of these features vary across species in ways that could result from perturbances in the balance of the effects of activity patterns and position-dependent gene expression. (1) Most notably, disruptions or septa in sensory maps often reflect actual discontinuities in the receptor sheet, and the discontinuities may be reflected in a series of interconnected maps. Species with different disruption patterns in sensory sheets have different matching disruption patterns in the sensory maps and variant individuals and strains of the same species have matching variations in the receptor disruption patterns and their sensory maps. (2) In addition, mutations that misdirect some of the retinal afferents from one side of the brain to the other create new sensory maps that preserve continuities in the altered pattern of input, while creating new structural discontinuities. (3) Furthermore, functionally different classes of afferents that are mixed in the receptor sheet often segregate to activate separate populations of target cells. (4) Finally, early developing portions of receptor sheets may gain more than their share of territory in sensory maps. These and other variable features of sensory maps are most readily accommodated by theories that involve roles for instruction by evoked and spontaneous neural activity patterns.

Animals↗

PubMed2002

Characterization of the genomic and transcriptional structure of the CRX gene: substantial differences between human and mouse.

We have previously shown that there is a temporal difference in human CRX: gene expression compared with that of mouse Crx. We have now characterized these genes at the genomic and transcriptional levels and here we expand on this earlier report. Human CRX: spans 25 kb and has six exons, and mouse CRX: spans 15 kb and has four exons. We isolated seven human and two mouse mRNAs generated by alternative splicing of a variable 5' untranslated region. The human and mouse genes share an evolutionarily conserved promoter, which contains OTX/CRX type and SP1/AP2 binding sites and drives expression of two conserved transcripts in both species. Additionally, the human gene has a second human-specific promoter, which has OTX/CRX type binding sites and drives expression of five other transcripts. Band shift assays have shown that six of the seven candidate OTX/CRX elements bind CRX in vitro, possibly implying that the gene can regulate its own expression. These data may account for the differences in temporal expression IN VIVO: we have previously reported between these two species.

3' Untranslated Regions↗

PubMed1995

Identification and characterization of T-cell antigen receptor-related genes in phylogenetically diverse vertebrate species.

Characterization of the structure, multiplicity, organization, and cell lineage-specific expression of T-cell receptor (TCR) genes of nonmammalian vertebrate species is central to the understanding of the evolutionary origins of rearranging genes of the vertebrate immune system. We recently described a polymerase chain reaction (PCR) strategy that relies on short sequence similarities shared by nearly all vertebrate TCR and immunoglobulin (Ig) variable (V) regions and have used this approach to isolate a TCR beta (TCRB) homolog from a cartilaginous fish. Using these short PCR products as probes in spleen cDNA and genomic libraries, we were able to isolate a variety of unique TCR and TCR-like genes. Here we report the identification and characterization of a chicken TCR gamma (TCRG) homolog, apparent Xenopus and pufferfish TCR alpha (TCRA) homologs, and two horned shark TCR delta (TCRD)-like genes. In addition, we have identified what could be a novel representative of the Ig gene superfamily in the pufferfish. This method of using short, minimally degenerate PCR primers should speed progress in the phylogenetic investigations of the TCR and related genes and lend important insights into both the origins and functions of these unique gene systems.

Amino Acid Sequence↗

PubMed2001

The accelerator hypothesis: weight gain as the missing link between Type I and Type II diabetes.

Blood glucose concentrations are controlled by a loop incorporating two components, the beta cells which secrete insulin and the insulin-sensitive tissues (liver, muscle, adipose) which respond to it. Loss of blood glucose control might result from failure of the beta cells to secrete insulin, resistance of the tissues to its action, or a combination of both. The distinctions between Type I (insulin-dependent) and Type II (non-insulin-dependent) diabetes mellitus are becoming increasingly blurred both clinically and aetiologically, where beta-cell insufficiency is the shared characteristic. The 'Accelerator Hypothesis' identifies three processes which variably accelerate the loss of beta cells through apoptosis: constitution, insulin resistance and autoimmunity. None of the accelerators leads to diabetes without excess weight gain, a trend which the 'Accelerator Hypothesis' deems central to the rising incidence of both types of diabetes in the industrially developed world. Weight gain causes an increase in insulin resistance, which results in the weakening of glucose control. The rising blood glucose (glucotoxicity) accelerates beta-cell apoptosis directly in all and, by inducing beta-cell immunogens, further accelerates it in a subset genetically predisposed to autoimmunity. Rather than overlap between two types of diabetes, the 'Accelerator Hypothesis' envisages overlay. Body mass is central to the development and rising incidence of all diabetes. Only tempo distinguishes the 'types'. The control of weight gain, and with it insulin resistance, could be the means of minimising both.

Apoptosis↗