Showing papers by "Emory University published in 2002"
TL;DR: Cardiac resynchronization results in significant clinical improvement in patients who have moderate-to-severe heart failure and an intraventricular conduction delay.
Abstract: Background Previous studies have suggested that cardiac resynchronization achieved through atrial-synchronized biventricular pacing produces clinical benefits in patients with heart failure who have an intraventricular conduction delay. We conducted a double-blind trial to evaluate this therapeutic approach. Methods Four hundred fifty-three patients with moderate-to-severe symptoms of heart failure associated with an ejection fraction of 35 percent or less and a QRS interval of 130 msec or more were randomly assigned to a cardiac-resynchronization group (228 patients) or to a control group (225 patients) for six months, while conventional therapy for heart failure was maintained. The primary end points were the New York Heart Association functional class, quality of life, and the distance walked in six minutes. Results As compared with the control group, patients assigned to cardiac resynchronization experienced an improvement in the distance walked in six minutes (+39 vs. +10 m, P=0.005), functional clas...
4,329 citations
TL;DR: TSH and the prevalence of antithyroid antibodies are greater in females, increase with age, and are more in whites and Mexican Americans than in blacks, which needs more research to relate these findings to clinical status.
Abstract: NHANES III measured serum TSH, total serum T(4), antithyroperoxidase (TPOAb), and antithyroglobulin (TgAb) antibodies from a sample of 17,353 people aged > or =12 yr representing the geographic and ethnic distribution of the U.S. population. These data provide a reference for other studies of these analytes in the U.S. For the 16,533 people who did not report thyroid disease, goiter, or taking thyroid medications (disease-free population), we determined mean concentrations of TSH, T(4), TgAb, and TPOAb. A reference population of 13,344 people was selected from the disease-free population by excluding, in addition, those who were pregnant, taking androgens or estrogens, who had thyroid antibodies, or biochemical hypothyroidism or hyperthyroidism. The influence of demographics on TSH, T(4), and antibodies was examined. Hypothyroidism was found in 4.6% of the U.S. population (0.3% clinical and 4.3% subclinical) and hyperthyroidism in 1.3% (0.5% clinical and 0.7% subclinical). (Subclinical hypothyroidism is used in this paper to mean mild hypothyroidism, the term now preferred by the American Thyroid Association for the laboratory findings described.) For the disease-free population, mean serum TSH was 1.50 (95% confidence interval, 1.46-1.54) mIU/liter, was higher in females than males, and higher in white non-Hispanics (whites) [1.57 (1.52-1.62) mIU/liter] than black non-Hispanics (blacks) [1.18 (1.14-1.21) mIU/liter] (P < 0.001) or Mexican Americans [1.43 (1.40-1.46) mIU/liter] (P < 0.001). TgAb were positive in 10.4 +/- 0.5% and TPOAb, in 11.3 +/- 0.4%; positive antibodies were more prevalent in women than men, increased with age, and TPOAb were less prevalent in blacks (4.5 +/- 0.3%) than in whites (12.3 +/- 0.5%) (P < 0.001). TPOAb were significantly associated with hypo or hyperthyroidism, but TgAb were not. Using the reference population, geometric mean TSH was 1.40 +/- 0.02 mIU/liter and increased with age, and was significantly lower in blacks (1.18 +/- 0.02 mIU/liter) than whites (1.45 +/- 0.02 mIU/liter) (P < 0.001) and Mexican Americans (1.37 +/- 0.02 mIU/liter) (P < 0.001). Arithmetic mean total T(4) was 112.3 +/- 0.7 nmol/liter in the disease-free population and was consistently higher among Mexican Americans in all populations. In the reference population, mean total T(4) in Mexican Americans was (116.3 +/- 0.7 nmol/liter), significantly higher than whites (110.0 +/- 0.8 nmol/liter) or blacks (109.4 +/- 0.8 nmol/liter) (P < 0.0001). The difference persisted in all age groups. In summary, TSH and the prevalence of antithyroid antibodies are greater in females, increase with age, and are greater in whites and Mexican Americans than in blacks. TgAb alone in the absence of TPOAb is not significantly associated with thyroid disease. The lower prevalence of thyroid antibodies and lower TSH concentrations in blacks need more research to relate these findings to clinical status. A large proportion of the U.S. population unknowingly have laboratory evidence of thyroid disease, which supports the usefulness of screening for early detection.
3,471 citations
TL;DR: The descriptive epidemiology revealed that males, older adults, more educated individuals, and married adults were more likely to be mentally healthy and flourishing and moderate mental health were associated with superior profiles of psychosocial functioning.
Abstract: This paper introduces and applies an operationalization of mental health as a syndrome of symptoms of positive feelings and positive functioning in life. Dimensions and scales of subjective well-being are reviewed and conceived of as mental health symptoms. A diagnosis of the presence of mental health, described as flourishing, and the absence of mental health, characterized as languishing, is applied to data from the 1995 Midlife in the United States study of adults between the ages of 25 and 74 (n = 3,032). Findings revealed that 17.2 percent fit the criteria for flourishing, 56.6 percent were moderately mentally healthy, 12.1 percent of adults fit the criteria for languishing, and 14.1 percent fit the criteria for DSM-III-R major depressive episode (12-month), of which 9.4 percent were not languishing and 4.7 percent were also languishing. The risk of a major depressive episode was two times more likely among languishing than moderately mentally healthy adults, and nearly six times greater among languishing than flourishing adults. Multivariate analyses revealed that languishing and depression were associated with significant psychosocial impairment in terms of perceived emotional health, limitations of activities of daily living, and workdays lost or cutback. Flourishing and moderate mental health were associated with superior profiles of psychosocial functioning. The descriptive epidemiology revealed that males, older adults, more educated individuals, and married adults were more likely to be mentally healthy. Implications for the conception of mental health and the treatment and prevention of mental illness are discussed.
3,275 citations
TL;DR: The probability of optimal well-being (high SWB and PWB) increased as age, education, extraversion, and conscientiousness increased and as neuroticism decreased; adults with higher SWB than PWB were younger, had more education, and showed more openness to experience.
Abstract: Subjective well-being (SWB) is evaluation of life in terms of satisfaction and balance between positive and negative affect; psychological well-being (PWB) entails perception of engagement with existential challenges of life. The authors hypothesized that these research streams are conceptually related but empirically distinct and that combinations of them relate differentially to sociodemographics and personality. Data are from a national sample of 3,032 Americans aged 25–74. Factor analyses confirmed the related-but-distinct status of SWB and PWB. The probability of optimal well-being (high SWB and PWB) increased as age, education, extraversion, and conscientiousness increased and as neuroticism decreased. Compared with adults with higher SWB than PWB, adults with higher PWB than SWB were younger, had more education, and showed more openness to experience. Research on well-being has flourished in recent decades (Diener, Suh, Lucas, & Smith, 1999; Kahneman, Diener, & Schwarz, 1999), with increasing recognition of the different streams of inquiry guiding this broad domain. Ryan and Deci’s (2001) integrative review organized the field of well-being into two broad traditions: one dealing with happiness (hedonic well-being), and one dealing with human potential (eudaimonic well-being; Ryan & Deci, 2001; see also Waterman, 1993). In the present study, we draw and extend these distinctions, which we refer to as traditions of research on subjective well-being (SWB) and psychological well-being (PWB). We use these terms to underscore the fact that studies of SWB have repeatedly included not only affective indicators of happiness (hedonic well-being) but also cognitive assessments of life satisfaction. In addition, some aspects of PWB (e.g., personal growth, purpose in life) but not others (e.g., positive relations with others, self-acceptance) reflect the self-fulfillment meanings of eudaimonic well-being. As described below, SWB and PWB are also the overarching phrases most frequently used in studies that constitute these traditions, both of which are fundamentally concerned with subjective accounts of well-being. Our specific empirical aims are to examine whether indicators of SWB and PWB constitute taxonomically distinct reflections of well-being in a national sample of U.S. adults. Although both approaches assess well-being, they address different features of what it means to be well: SWB involves more global evaluations of affect and life quality, whereas PWB examines perceived thriving vis-a `-vis the existential challenges of life (e.g., pursuing meaningful goals, growing and developing as a person, establishing quality ties to others). We further test the hypothesis that these distinct varieties of well-being are contoured by the broad categories of sociodemographic and personality factors. Specifically, we investigate the role of location in the life course (i.e., age) and position in the socioeconomic hierarchy (e.g., educational status) as well as personality traits in accounting for different profiles of well-being. To put the inquiry in historical context, we provide a brief summary of each tradition.
2,628 citations
TL;DR: To improve the ability to predict epidemics in wild populations, it will be necessary to separate the independent and interactive effects of multiple climate drivers on disease impact.
Abstract: Infectious diseases can cause rapid population declines or species extinctions. Many pathogens of terrestrial and marine taxa are sensitive to temperature, rainfall, and humidity, creating synergisms that could affect biodiversity. Climate warming can increase pathogen development and survival rates, disease transmission, and host susceptibility. Although most host-parasite systems are predicted to experience more frequent or severe disease impacts with warming, a subset of pathogens might decline
2,462 citations
Emory University1, Research Triangle Park2, Case Western Reserve University3, National Institutes of Health4, University of Alabama at Birmingham5, Yale University6, Indiana University7, University of Cincinnati8, Boston Children's Hospital9, University of Texas Health Science Center at Houston10, Brown University11, University of Miami12, University of Tennessee Health Science Center13, Wayne State University14, University of Texas Southwestern Medical Center15, Stanford University16, University of New Mexico17
TL;DR: Infants who developed late-onset sepsis had a significantly prolonged hospital stay and were significantly more likely to die than those who were uninfected, especially if they were infected with Gram-negative organisms or fungi.
Abstract: Objective. Late-onset sepsis (occurring after 3 days of age) is an important problem in very low birth weight (VLBW) infants. To determine the current incidence of late-onset sepsis, risk factors for disease, and the impact of late-onset sepsis on subsequent hospital course, we evaluated a cohort of 6956 VLBW (401–1500 g) neonates admitted to the clinical centers of the National Institute of Child Health and Human Development Neonatal Research Network over a 2-year period (1998–2000). Methods. The National Institute of Child Health and Human Development Neonatal Research Network maintains a prospective registry of all VLBW neonates admitted to participating centers within 14 days of birth. Expanded infection surveillance was added in 1998. Results. Of 6215 infants who survived beyond 3 days, 1313 (21%) had 1 or more episodes of blood culture-proven late-onset sepsis. The vast majority of infections (70%) were caused by Gram-positive organisms, with coagulase-negative staphylococci accounting for 48% of infections. Rate of infection was inversely related to birth weight and gestational age. Complications of prematurity associated with an increased rate of late-onset sepsis included patent ductus arteriosus, prolonged ventilation, prolonged intravascular access, bronchopulmonary dysplasia, and necrotizing enterocolitis. Infants who developed late-onset sepsis had a significantly prolonged hospital stay (mean length of stay: 79 vs 60 days). They were significantly more likely to die than those who were uninfected (18% vs 7%), especially if they were infected with Gram-negative organisms (36%) or fungi (32%). Conclusions. Late-onset sepsis remains an important risk factor for death among VLBW preterm infants and for prolonged hospital stay among VLBW survivors. Strategies to reduce late-onset sepsis and its medical, social, and economic toll need to be addressed urgently.
2,102 citations
TL;DR: This work has shown how the emission wavelength of quantum-dot nanocrystals can be continuously tuned by changing the particle size, and a single light source can be used for simultaneous excitation of all different-sized dots.
2,066 citations
TL;DR: Experimental evidence acquired in vitro and in vivo suggests that the major drivers of vascular remodeling, hemodynamics, injury, inflammation, and oxidative stress, regulate MMP expression and activity, and nonspecific MMP inhibition seems to oppose remodeling.
Abstract: Vascular remodeling, defined as any enduring change in the size and/or composition of an adult blood vessel, allows adaptation and repair. On the other hand, inappropriate remodeling, including its absence, underlies the pathogenesis of major cardiovascular diseases, such as atherosclerosis and restenosis. Since degradation of the extracellular matrix scaffold enables reshaping of tissue, participation of specialized enzymes called matrix metalloproteinases (MMPs) has become the object of intense recent interest in relation to physiological ("good") and pathological ("bad") vascular remodeling. Experimental evidence acquired in vitro and in vivo suggests that the major drivers of vascular remodeling, hemodynamics, injury, inflammation, and oxidative stress, regulate MMP expression and activity. Alternatively, nonspecific MMP inhibition seems to oppose remodeling, as suggested by the inhibition of intimal thickening and outward arterial remodeling. An emerging concept is that MMP-related genetic variations may contribute to heterogeneity in the presentation and natural history of atherosclerosis. The hypothesis that MMPs contribute to weakening of atherosclerotic plaques is especially attractive for the potential development of therapeutic interventions aimed at preventing plaque disruption ("the ugly"), a major cause of acute cardiovascular events. However, the current lack of appropriate experimental tools, including availability of specific MMP inhibitors and pertinent animal models, still limits our understanding of the many actions and relative contributions of specific MMPs. Our future potential ability to control vascular remodeling via regulation of MMPs will also depend on reaching a consensus of what is indeed "good" or "bad" vascular remodeling, concepts that have continued to evolve and change.
1,838 citations
TL;DR: In this article, the authors determined the prevalence of in-hospital hyperglycemia and determined the survival and functional outcome of patients with and without a history of diabetes in patients admitted to the Georgia Baptist Medical Center.
Abstract: Admission hyperglycemia has been associated with increased hospital mortality in critically ill patients; however, it is not known whether hyperglycemia in patients admitted to general hospital wards is associated with poor outcome. The aim of this study was to determine the prevalence of in-hospital hyperglycemia and determine the survival and functional outcome of patients with hyperglycemia with and without a history of diabetes. We reviewed the medical records of 2030 consecutive adult patients admitted to Georgia Baptist Medical Center, a community teaching hospital in downtown Atlanta, GA, from July 1, 1998, to October 20, 1998. New hyperglycemia was defined as an admission or in-hospital fasting glucose level of 126 mg/dl (7 mmol/liter) or more or a random blood glucose level of 200 mg/dl (11.1 mmol/liter) or more on 2 or more determinations. Hyperglycemia was present in 38% of patients admitted to the hospital, of whom 26% had a known history of diabetes, and 12% had no history of diabetes before the admission. Newly discovered hyperglycemia was associated with higher in-hospital mortality rate (16%) compared with those patients with a prior history of diabetes (3%) and subjects with normoglycemia (1.7%; both P < 0.01). In addition, new hyperglycemic patients had a longer length of hospital stay, a higher admission rate to an intensive care unit, and were less likely to be discharged to home, frequently requiring transfer to a transitional care unit or nursing home facility. Our results indicate that in-hospital hyperglycemia is a common finding and represents an important marker of poor clinical outcome and mortality in patients with and without a history of diabetes. Patients with newly diagnosed hyperglycemia had a significantly higher mortality rate and a lower functional outcome than patients with a known history of diabetes or normoglycemia.
1,771 citations
Baylor College of Medicine1, Cleveland Clinic2, University of Utah3, University of Illinois at Chicago4, National Institutes of Health5, University of Alabama6, Emory University7, Washington University in St. Louis8, University of California, Davis9, Tufts University10, Yeshiva University11, Harvard University12, University of Rochester13, Wake Forest University14, Vanderbilt University15, Duke University16
TL;DR: Patients undergoing hemodialysis thrice weekly appear to have no major benefit from a higher dialysis dose than that recommended by current U.S. guidelines or from the use of a high-flux membrane.
Abstract: Background The effects of the dose of dialysis and the level of flux of the dialyzer membrane on mortality and morbidity among patients undergoing maintenance hemodialysis are uncertain. Methods We undertook a randomized clinical trial in 1846 patients undergoing thrice-weekly dialysis, using a two-by-two factorial design to assign patients randomly to a standard or high dose of dialysis and to a low-flux or high-flux dialyzer. Results In the standard-dose group, the mean (±SD) urea-reduction ratio was 66.3±2.5 percent, the single-pool Kt/V was 1.32±0.09, and the equilibrated Kt/V was 1.16±0.08; in the high-dose group, the values were 75.2±2.5 percent, 1.71±0.11, and 1.53±0.09, respectively. Flux, estimated on the basis of beta2-microglobulin clearance, was 3±7 ml per minute in the low-flux group and 34±11 ml per minute in the high-flux group. The primary outcome, death from any cause, was not significantly influenced by the dose or flux assignment: the relative risk of death in the high-dose group as com...
1,670 citations
TL;DR: The signals required for commitment to this programme of development and the factors that might influence its progression are discussed and models of the pathways of effector and memory T-cell differentiation are discussed.
Abstract: Recent work shows that after stimulation with antigen, CD4+ and CD8+ T cells embark on a programme of proliferation that is closely linked with the acquisition of effector functions and leads ultimately to memory-cell formation. Here, we discuss the signals required for commitment to this programme of development and the factors that might influence its progression. Models of the pathways of effector and memory T-cell differentiation are discussed, and we highlight the implications of this new understanding for the optimization of vaccine strategies.
TL;DR: This work is presented for the first time to the Ad Hoc Committee for Standardized Reporting Practices in Vascular Surgery of The Society for Vascular surgery/American Association forVascular Surgery.
TL;DR: An evolving approach to analyzing resilience in SESs, as a basis for managing resilience, with a framework with four steps, involving close involvement of SES stakeholders is proposed.
Abstract: Approaches to natural resource management are often based on a presumed ability to predict probabilistic responses to management and external drivers such as climate. They also tend to assume that the manager is outside the system being managed. However, where the objectives include long-term sustainability, linked social-ecological systems (SESs) behave as complex adaptive systems, with the managers as integral components of the system. Moreover, uncertainties are large and it may be difficult to reduce them as fast as the system changes. Sustainability involves maintaining the functionality of a system when it is perturbed, or maintaining the elements needed to renew or reorganize if a large perturbation radically alters structure and function. The ability to do this is termed "resilience." This paper presents an evolving approach to analyzing resilience in SESs, as a basis for managing resilience. We propose a framework with four steps, involving close involvement of SES stakeholders. It begins with a stakeholder-led development of a conceptual model of the system, including its historical profile (how it got to be what it is) and preliminary assessments of the drivers of the supply of key ecosystem goods and services. Step 2 deals with identifying the range of unpredictable and uncontrollable drivers, stakeholder visions for the future, and contrasting possible future policies, weaving these three factors into a limited set of future scenarios. Step 3 uses the outputs from steps 1 and 2 to explore the SES for resilience in an iterative way. It generally includes the development of simple models of the system's dynamics for exploring attributes that affect resilience. Step 4 is a stakeholder evaluation of the process and outcomes in terms of policy and management implications. This approach to resilience analysis is illustrated using two stylized examples.
TL;DR: In this article, the authors used fMRI to scan 36 women as they played an iterated Prisoner's Dilemma Game with another woman to investigate the neurobiological basis of cooperative social behavior.
TL;DR: It is shown that a form of protein synthesis-dependent synaptic plasticity, long-term depression triggered by activation of metabotropic glutamate receptors, is selectively enhanced in the hippocampus of mutant mice lacking FMRP.
Abstract: Fragile X syndrome, the most common inherited form of human mental retardation, is caused by mutations of the Fmr1 gene that encodes the fragile X mental retardation protein (FMRP). Biochemical evidence indicates that FMRP binds a subset of mRNAs and acts as a regulator of translation. However, the consequences of FMRP loss on neuronal function in mammals remain unknown. Here we show that a form of protein synthesis-dependent synaptic plasticity, long-term depression triggered by activation of metabotropic glutamate receptors, is selectively enhanced in the hippocampus of mutant mice lacking FMRP. This finding indicates that FMRP plays an important functional role in regulating activity-dependent synaptic plasticity in the brain and suggests new therapeutic approaches for fragile X syndrome.
TL;DR: This article surveys preconditioning techniques for the iterative solution of large linear systems, with a focus on algebraic methods suitable for general sparse matrices, including progress in incomplete factorization methods, sparse approximate inverses, reorderings, parallelization issues, and block and multilevel extensions.
01 Jan 2002
TL;DR: The purpose of self-efficacy changes with development and has elucidated variables that affect this change and is suggested to highlight ways that self- efficacy can be enhanced in learners across developmental levels.
Abstract: Publisher Summary This chapter describes the development of academic self-efficacy. This chapter focuses on the development of one type of motivational process: perceived self-efficacy. Self-efficacy refers to beliefs about one's capabilities to learn or perform behaviors at designated levels. It provides theoretical background information on self-efficacy to show its relation to other similar motivation constructs. According to this chapter, self-efficacy has been shown to play an important role in achievement contexts, and much research supports the idea that it can influence the instigation, direction, persistence, and outcomes of achievement-related actions. In this chapter it traced the purpose of self-efficacy changes with development and has elucidated variables that affect this change. It also suggests profitable areas of future research. This chapter encourages by the rapid increase in self-efficacy research. This chapter concludes that the future should provide greater clarification of the operation of self-efficacy in different domains and highlight ways that self-efficacy can be enhanced in learners across developmental levels.
TL;DR: The magnitude of familial influences was lower in parent-offspring adoption studies than in both twin studies and sibling adoption studies, and age were significant moderators of the magnitude of genetic and environmental influences on antisocial behavior.
Abstract: A meta-analysis of 51 twin and adoption studies was conducted to estimate the magnitude of genetic and environmental influences on antisocial behavior. The best fitting model included moderate proportions of variance due to additive genetic influences (.32), nonadditive genetic influences (.09), shared environmental influences (.16), and nonshared environmental influences (.43). The magnitude of familial influences (i.e., both genetic and shared environmental influences) was lower in parent-offspring adoption studies than in both twin studies and sibling adoption studies. Operationalization, assessment method, zygosity determination method, and age were significant moderators of the magnitude of genetic and environmental influences on antisocial behavior, but there were no significant differences in the magnitude of genetic and environmental influences for males and females.
TL;DR: This study illustrates the use of the Analytical Hierarchy Process (AHP) as a decision support model to help managers understand the trade-offs between environmental dimensions and examines how AHP can be incorporated into a comprehensive information system supporting Environmentally Conscious Purchasing (ECP).
TL;DR: It is shown that lymphoblast mitochondria from patients with HD have a lower membrane potential and depolarize at lower calcium loads than do mitochondriaFrom controls, and mitochondrial calcium abnormalities occur early in HD pathogenesis and may be a direct effect of mutant huntingtin on the organelle.
Abstract: Huntington's disease (HD) is caused by an expansion of exonic CAG triplet repeats in the gene encoding huntingtin protein (Htt), but the mechanisms by which this mutant protein causes neurodegeneration remain unknown. Here we show that lymphoblast mitochondria from patients with HD have a lower membrane potential and depolarize at lower calcium loads than do mitochondria from controls. We found a similar defect in brain mitochondria from transgenic mice expressing full-length mutant huntingtin, and this defect preceded the onset of pathological or behavioral abnormalities by months. By electron microscopy, we identified N-terminal mutant huntingtin on neuronal mitochondrial membranes, and by incubating normal mitochondria with a fusion protein containing an abnormally long polyglutamine repeat, we reproduced the mitochondrial calcium defect seen in human patients and transgenic animals. Thus, mitochondrial calcium abnormalities occur early in HD pathogenesis and may be a direct effect of mutant huntingtin on the organelle.
TL;DR: A time course of gene expression and functional changes in antigen-specific T cells during viral infection was evaluated and it was suggested that antigen- specific CD8 T cells progressively differentiate into memory cells following viral infection.
University of Rochester1, Cornell University2, University of California, San Diego3, Emory University4, Rush University Medical Center5, Washington University in St. Louis6, Johns Hopkins University7, University of Pennsylvania8, Albany Medical College9, University of Virginia10, University of Southern California11
TL;DR: Coenzyme Q10 appears to slow the progressive deterioration of function in PD, but these results need to be confirmed in a larger study.
Abstract: Background Parkinson disease (PD) is a degenerative neurological disorder for which no treatment has been shown to slow the progression. Objective To determine whether a range of dosages of coenzyme Q10is safe and well tolerated and could slow the functional decline in PD. Design Multicenter, randomized, parallel-group, placebo-controlled, double-blind, dosage-ranging trial. Setting Academic movement disorders clinics. Patients Eighty subjects with early PD who did not require treatment for their disability. Interventions Random assignment to placebo or coenzyme Q10at dosages of 300, 600, or 1200 mg/d. Main Outcome Measure The subjects underwent evaluation with the Unified Parkinson Disease Rating Scale (UPDRS) at the screening, baseline, and 1-, 4-, 8-, 12-, and 16-month visits. They were followed up for 16 months or until disability requiring treatment with levodopa had developed. The primary response variable was the change in the total score on the UPDRS from baseline to the last visit. Results The adjusted mean total UPDRS changes were +11.99 for the placebo group, +8.81 for the 300-mg/d group, +10.82 for the 600-mg/d group, and +6.69 for the 1200-mg/d group. ThePvalue for the primary analysis, a test for a linear trend between the dosage and the mean change in the total UPDRS score, was .09, which met our prespecified criteria for a positive trend for the trial. A prespecified, secondary analysis was the comparison of each treatment group with the placebo group, and the difference between the 1200-mg/d and placebo groups was significant (P= .04). Conclusions Coenzyme Q10was safe and well tolerated at dosages of up to 1200 mg/d. Less disability developed in subjects assigned to coenzyme Q10than in those assigned to placebo, and the benefit was greatest in subjects receiving the highest dosage. Coenzyme Q10appears to slow the progressive deterioration of function in PD, but these results need to be confirmed in a larger study.
TL;DR: The resulting computational model is shown to anticipate a class of single-unit neural responses in orbitofrontal and striatal neurons that support the conversion of disparate types of future rewards into a kind of internal currency, that is, a common scale used to compare the valuation of future behavioral acts or stimuli.
TL;DR: In conclusion, smoking has little or no independent effect on the risk of developing breast cancer; the effect of alcohol on breast cancer needs to be interpreted in the context of its beneficial effects, in moderation, on cardiovascular disease and its harmful effects on cirrhosis.
Abstract: Alcohol and tobacco consumption are closely correlated and published results on their association with breast cancer have not always allowed adequately for confounding between these exposures. Over 80% of the relevant information worldwide on alcohol and tobacco consumption and breast cancer were collated, checked and analysed centrally. Analyses included 58515 women with invasive breast cancer and 95067 controls from 53 studies. Relative risks of breast cancer were estimated, after stratifying by study, age, parity and, where appropriate, women's age when their first child was born and consumption of alcohol and tobacco. The average consumption of alcohol reported by controls from developed countries was 6.0 g per day, i.e. about half a unit/drink of alcohol per day, and was greater in ever-smokers than never-smokers, (8.4 g per day and 5.0 g per day, respectively). Compared with women who reported drinking no alcohol, the relative risk of breast cancer was 1.32 (1.19 - 1.45, P < 0.00001) for an intake of 35 - 44 g per day alcohol, and 1.46 (1.33 - 1.61, P < 0.00001) for greater than or equal to 45 g per day alcohol. The relative risk of breast cancer increased by 7.1% (95% CI 5.5-8.7%; P<0.00001) for each additional 10 g per day intake of alcohol, i.e. for each extra unit or drink of alcohol consumed on a daily basis. This increase was the same in ever-smokers and never-smokers (7.1 % per 10 g per day, P < 0.00001, in each group). By contrast, the relationship between smoking and breast cancer was substantially confounded by the effect of alcohol. When analyses were restricted to 22 255 women with breast cancer and 40 832 controls who reported drinking no alcohol, smoking was not associated with breast cancer (compared to never-smokers, relative risk for ever-smokers= 1.03, 95% CI 0.98 - 1.07, and for current smokers=0.99, 0.92 - 1.05). The results for alcohol and for tobacco did not vary substantially across studies, study designs, or according to 15 personal characteristics of the women; nor were the findings materially confounded by any of these factors. If the observed relationship for alcohol is causal, these results suggest that about 4% of the breast cancers in developed countries are attributable to alcohol. In developing countries, where alcohol consumption among controls averaged only 0.4 g per day, alcohol would have a negligible effect on the incidence of breast cancer. In conclusion, smoking has little or no independent effect on the risk of developing breast cancer; the effect of alcohol on breast cancer needs to be interpreted in the context of its beneficial effects, in moderation, on cardiovascular disease and its harmful effects on cirrhosis and cancers of the mouth, larynx, oesophagus and liver. (C) 2002 Cancer Research UK.
TL;DR: The relationship between sprawl and health is discussed based on eight considerations: air pollution, heat, physical activity patterns, motor vehicle crashes, pedestrian injuries and deaths, water quality and quantity, mental health, and social capital.
Abstract: This article discusses the relationship between sprawl and health based on eight considerations: air pollution, heat, physical activity patterns, motor vehicle crashes, pedestrian injuries and deaths, water quality and quantity, mental health, and social capital. The data show both health benefits and health cost. As is true for most public health hazards, the adverse impacts of sprawl do not fall equally across the population, and those who are most affected deserves special attention. We address sprawl on a variety of levels, from personal transportation decisions to local zoning ordinances, from regional mass transit and land-use decisions to federal regulations, it is essential to incorporate health considerations into policy-making. Because the health effects of sprawl are unevenly distributed across the population, it is essential to incorporate considerations of social justice and equity. KW: Hyperthermia in automobiles Language: en
Duke University1, Harvard University2, Emory University3, University of Western Ontario4, University of Missouri5, National Institutes of Health6, Baptist Health7, Oregon Health & Science University8, Virginia Commonwealth University9, Mount Sinai St. Luke's and Mount Sinai Roosevelt10, Tufts University11, Thomas Jefferson University12, University of California, San Francisco13
TL;DR: Overall, dual-chamber pacing offers significant improvement as compared with ventricular pacing, and reduces the risk of atrial fibrillation, reduces signs and symptoms of heart failure, and slightly improves the quality of life.
Abstract: Background Dual-chamber (atrioventricular) and single-chamber (ventricular) pacing are alternative treatment approaches for sinus-node dysfunction that causes clinically significant bradycardia. However, it is unknown which type of pacing results in the better outcome. Methods We randomly assigned a total of 2010 patients with sinus-node dysfunction to dual-chamber pacing (1014 patients) or ventricular pacing (996 patients) and followed them for a median of 33.1 months. The primary end point was death from any cause or nonfatal stroke. Secondary end points included the composite of death, stroke, or hospitalization for heart failure; atrial fibrillation; heart-failure score; the pacemaker syndrome; and the quality of life. Results The incidence of the primary end point did not differ significantly between the dual-chamber group (21.5 percent) and the ventricular-paced group (23.0 percent, P=0.48). In patients assigned to dual-chamber pacing, the risk of atrial fibrillation was lower (hazard ratio, 0.79; 9...
TL;DR: This review considers the behavioral, cellular, and molecular literatures on extinction and presents the most recent advances in understanding while identifying issues that require considerable further research.
TL;DR: In this paper, a meta-analysis examines the relative strength of the association between psychopathology in mothers versus fathers and the presence of internalizing and externalizing disorders in children, with all average effect sizes being small in magnitude.
Abstract: In light of the selective focus on maternal (vs. paternal) psychopathology as a risk factor for child development, this meta-analysis examines the relative strength of the association between psychopathology in mothers versus fathers and the presence of internalizing and externalizing disorders in children. Associations were stronger between maternal than paternal psychopathology and the presence of internalizing (but not externalizing) problems in children, with all average effect sizes being small in magnitude. Relations were moderated by variables that highlight theoretically relevant differences between psychopathology in mothers versus fathers (e.g., age of children studied, type of parental psychopathology) and by variables related to methodological differences across studies (e.g., method of assessing psychopathology in parents and children, type of sample recruited, familial composition).
TL;DR: The recent identification of homologs of one of the membrane components in nonphagocytic cells will expand understanding of the biological contexts in which this system may function.
TL;DR: Results indicate that treatments that promote NMDA receptor activity after either systemic or intra-amygdala administration promote the extinction of conditioned fear.
Abstract: NMDA receptor antagonists block conditioned fear extinction when injected systemically and also when infused directly into the amygdala. Here we evaluate the ability of D-cycloserine (DCS), a partial agonist at the strychnine-insensitive glycine-recognition site on the NMDA receptor complex, to facilitate conditioned fear extinction after systemic administration or intra-amygdala infusions. Rats received 10 pairings of a 3.7 sec light and a 0.4 mA footshock (fear conditioning). Fear-potentiated startle (increased startle in the presence vs the absence of the light) was subsequently measured before and after 30, 60, or 90 presentations of the light without shock (extinction training). Thirty non-reinforced light presentations produced modest extinction, and 60 or 90 presentations produced nearly complete extinction (experiment 1). DCS injections (3.25, 15, or 30 mg/kg) before 30 non-reinforced light exposures dose-dependently enhanced extinction (experiment 2) but did not influence fear-potentiated startle in rats that did not receive extinction training (experiment 3). These effects were blocked by HA-966, an antagonist at the glycine-recognition site (experiment 4). Neither DCS nor HA-966 altered fear-potentiated startle when injected before testing (experiment 5). The effect of systemic administration was mimicked by intra-amygdala DCS (10 microg/side) infusions (experiment 6). These results indicate that treatments that promote NMDA receptor activity after either systemic or intra-amygdala administration promote the extinction of conditioned fear.