Showing papers by "University of Vermont published in 1997"

A framework for market-based organizational learning: Linking values, knowledge, and behavior

Abstract: The authors review the concept of organizational learning and present a broad conceptual framework for its modeling. Within this framework, one specific process for market-based organizational learning is postulated. An empirical test of this model leads the authors to conclude that a more positive learning orientation (a value-based construct) will directly result in increased market information generation and dissemination (knowledge-based constructs), which, in turn, directly affects the degree to which an organization makes changes in its marketing strategies (a behavioral construct). Managerial implications are discussed.

Secondary Sexual Characteristics and Menses in Young Girls Seen in Office Practice: A Study from the Pediatric Research in Office Settings Network

Abstract: Objective. To determine the current prevalence and mean ages of onset of pubertal characteristics in young girls seen in pediatric practices in the United States. Methods. A cross-sectional study was conducted by 225 clinicians in pediatric practices belonging to Pediatric Research in Office Settings, a practice-based research network. After standardized training in the assessment of pubertal maturation, practitioners rated the level of sexual maturation on girls 3 through 12 years who were undergoing complete physical examinations. Results. Data were analyzed for 17 077 girls, of whom 9.6% were African-American and 90.4% white. At age 3, 3% of African-American girls and 1% of white girls showed breast and/or pubic hair development, with proportions increasing to 27.2% and 6.7%, respectively, at 7 years of age. At age 8, 48.3% of African-American girls and 14.7% of white girls had begun development. At every age for each characteristic, African-American girls were more advanced than white girls. The mean ages of onset of breast development for African-American and white girls were 8.87 years (SD, 1.93) and 9.96 years (SD, 1.82), respectively; and for pubic hair development, 8.78 years (SD, 2.00) and 10.51 years (SD, 1.67), respectively. Menses occurred at 12.16 years (SD, 1.21) in African-American girls and 12.88 years (SD, 1.20) of age in white girls. Conclusions. These data suggest that girls seen in a sample of pediatric practices from across the United States are developing pubertal characteristics at younger ages than currently used norms. Practitioners may need to revise their criteria for referral of girls with precocious puberty, with attention to racial differences.

Absence of excitotoxicity-induced apoptosis in the hippocampus of mice lacking the Jnk3 gene

Abstract: Excitatory amino acids induce both acute membrane depolarization and latent cellular toxicity, which often leads to apoptosis in many neurological disorders. Recent studies indicate that glutamate toxicity may involve the c-Jun amino-terminal kinase (JNK) group of mitogen-activated protein (MAP) kinases. One member of the JNK family, Jnk3, may be required for stress-induced neuronal apoptosis, as it is selectively expressed in the nervous system. Here we report that disruption of the gene encoding Jnk3 in mice caused the mice to be resistant to the excitotoxic glutamate-receptor agonist kainic acid: they showed a reduction in seizure activity and hippocampal neuron apoptosis was prevented. Although application of kainic acid imposed the same level of noxious stress, the phosphorylation of c-Jun and the transcriptional activity of the AP-1 transcription factor complex were markedly reduced in the mutant mice. These data indicate that the observed neuroprotection is due to the extinction of a Jnk3-mediated signalling pathway, which is an important component in the pathogenesis of glutamate neurotoxicity.

A modification of the injury severity score that both improves accuracy and simplifies scoring

Abstract: Objectives : The Injury Severity Score (ISS) has served as the standard summary measure of anatomic injury for more than 20 years. Nevertheless, the ISS has an idiosyncrasy that both impairs its predictive power and complicates its calculation. We present here a simple modification of the ISS called the New Injury Severity Score (NISS), which significantly outperforms the venerable but dated ISS as a predictor of mortality. Design: Retrospective calculation of NISS and comparison of NISS with prospectively calculated ISS. Materials and Methods: The NISS is defined as the sum of the squares of the Abbreviated Injury Scale scores of each of a patient's three most severe Abbreviated Injury Scale injuries regardless of the body region in which they occur. NISS values were calculated for every patient in two large independent data sets: 3,136 patients treated during a 4-year period at the American College of Surgeons' Level I trauma center in Albuquerque, New Mexico, and 3,449 patients treated during a 4-year period at the American College of Surgeons' Level I trauma center at the Emanuel Hospital in Portland, Oregon. The power of NISS to predict mortality was then compared with previously calculated ISS values for the same patients in each of the two data sets. Measurements and Main Results: We find that NISS is not only simple to calculate but more predictive of survival as well (Albuquerque: receiver operating characteristic (ROC) ISS = 0.869, ROC NISS = 0.896, p < 0.001; Portland: ROC ISS = 0.896, ROC NISS = 0.907, p < 0.004). Moreover, NISS provides a better fit throughout its entire range of prediction (Hosmer Lemeshow statistic for Albuquerque ISS = 29.12, NISS = 8.88; Hosmer Lemeshow statistic for Portland ISS = 83.48, NISS = 19.86). Conclusion: NISS should replace ISS as the standard summary measure of human trauma.

Relationship of C-Reactive Protein to Risk of Cardiovascular Disease in the Elderly Results From the Cardiovascular Health Study and the Rural Health Promotion Project

Abstract: Markers of inflammation, such as C-reactive protein (CRP), are related to risk of cardiovascular disease (CVD) events in those with angina, but little is known about individuals without prevalent clinical CVD. We performed a prospective, nested case-control study in the Cardiovascular Health Study (CHS; 5201 healthy elderly men and women). Case subjects (n = 146 men and women with incident CVD events including angina, myocardial infarction, and death) and control subjects (n = 146) were matched on the basis of sex and the presence or absence of significant subclinical CVD at baseline (average follow-up, 2.4 years). In women but not men, the mean CRP level was higher for case subjects than for control subjects (P < or = .05). In general, CRP was higher in those with subclinical disease. Most of the association of CRP with female case subjects versus control subjects was in the subgroup with subclinical disease; 3.33 versus 1.90 mg/L, P < .05, adjusted for age and time of follow-up. Case-control differences were greatest when the time between baseline and the CVD event was shortest. The strongest associations were with myocardial infarction, and there was an overall odds ratio for incident myocardial infarction for men and women with subclinical disease (upper quartile versus lower three quartiles) of 2.67 (confidence interval [CI] = 1.04 to 6.81), with the relationship being stronger in women (4.50 [CI = 0.97 to 20.8]) than in men (1.75 [CI = 0.51 to 5.98]). We performed a similar study in the Rural Health Promotion Project, in which mean values of CRP were higher for female case subjects than for female control subjects, but no differences were apparent for men. Comparing the upper quintile with the lower four, the odds ratio for CVD case subjects was 2.7 (CI = 1.10 to 6.60). In conclusion, CRP was associated with incident events in the elderly, especially in those with subclinical disease at baseline.

Variability in the measurement of C-reactive protein in healthy subjects: implications for reference intervals and epidemiological applications

Abstract: We developed a reproducible ELISA for C-reactive protein (CRP), calibrated with WHO Reference Material, for which intra- and interassay CVs were 3.0% and 6.0%, respectively. Analytical recovery was 97.9%. The distribution of CRP in a healthy blood donor population (n = 143) was nongaussian, with 2.5th, 50th, and 97.5th percentile values of 0.08, 0.64, and 3.11 mg/L, respectively. There was no sex-related difference, and the association with age was weak. In a study of variability [by the method of Fraser and Harris (Crit Rev Clin Lab Sci 1989;27:409-37)], the analytical variability was 5.2%; the within-subject variability, CVI, was 42.2%; and the between-subject variability, CVG, was 92.5%. The critical difference for sequential values significant at P < or =0.05 (i.e., the smallest percentage change unlikely to be due to analytical variability or CVI) was calculated as 118%, and the index of individuality, CVI/CVG, was 0.46. This suggests that CRP, like many clinical chemistry analytes, has limited usefulness in detecting early disease-associated changes when used in conjunction with a healthy reference interval. From a molecular epidemiological standpoint, the usefulness of CRP in longitudinal studies is suggested by the small index of individuality and by observations that (a) short-term fluctuations were infrequent, (b) all data stayed within the reference interval, and (c) relative rankings of the subjects over 6 months only moderately deteriorated.

Effects of aging on in vivo synthesis of skeletal muscle myosin heavy-chain and sarcoplasmic protein in humans

Abstract: A decline in muscle mass and contractile function are prominent features of the sarcopenia of old age. Because myosin heavy chain is an important contractile protein, it was hypothesized that synth...

Troglitazone improves defects in insulin action, insulin secretion, ovarian steroidogenesis, and fibrinolysis in women with polycystic ovary syndrome.

Abstract: Women with polycystic ovary syndrome (PCOS) are characterized by defects in insulin action, insulin secretion, ovarian steroidogenesis, and fibrinolysis. We administered the insulin-sensitizing agent troglitazone to 13 obese women with PCOS and impaired glucose tolerance to determine whether attenuation of hyperinsulinemia ameliorates these defects. All subjects had oligomenorrhea, hirsutism, polycystic ovaries, and hyperandrogenemia. Before and after treatment with troglitazone (400 mg daily for 12 weeks), all had 1) a GnRH agonist (leuprolide) test, 2) a 75-g oral glucose tolerance test, 3) a frequently sampled iv glucose tolerance test to determine the insulin sensitivity index and the acute insulin response to glucose, 4) an oscillatory glucose infusion to assess the ability of the β-cell to entrain to glucose as quantitated by the normalized spectral power for the insulin secretion rate, and 5) measures of fibrinolytic capacity[ plasminogen activator inhibitor type 1 (PAI-1) and tissue plasminogen ac...

That Rare Feeling: Re-presenting Research Through Poetic Transcription:

Abstract: This article explores an experimental form of writing that I'm terming poetic transcription. Inspired by Laurel Richardson (1992, 1994a, 1994b), I define poetic transcription as the creation of poemlike compositions from the words of interviewees. In this article, I present six poetic transcriptions of Dona Juana, an elderly Puerto Rican researcher and educator; describe my poetic transcription process; and examine issues that experimental writing—specifically, poetic transcription—raises for research re-presentation.

Comparisons of problems reported by parents of children in 12 cultures: total problems, externalizing, and internalizing.

Abstract: Objective To compare parent-reported problems for children in 12 cultures. Method Child Behavior Checklists were analyzed for 13,697 children and adolescents, aged 6 through 17 years, from general population samples in Australia, Belgium, China, Germany, Greece, Israel, Jamaica, the Netherlands, Puerto Rico, Sweden, Thailand, and the United States. Results Comparisons of 12 cultures across ages 6 through 11 and 9 cultures across ages 6 through 17 yielded medium effect sizes for cross-cultural variations in Total Problem, Externalizing, and Internalizing scores. Puerto Rican scores were the highest, while Swedish scores were the lowest. With great cross-cultural consistency, Total and Externalizing scores declined with age, while Internalizing scores increased; boys obtained higher Total and Externalizing scores but lower Internalizing scores than girls. Cross-cultural correlations were high among the mean item scores. Conclusions Empirically based assessment provides a robust methodology for assessing and comparing problems reported for children from diverse cultures. Age and gender variations are cross-culturally consistent. Although clinical cutoff points should not necessarily be uniform across all cultures, empirically based assessment offers a cost-effective way to identify problems for which children from diverse cultural backgrounds may need help.

Breast Cancer Surveillance Consortium: a national mammography screening and outcomes database.

Abstract: M ammography is the primary method of detecting early stage breast cancer and has been shown in randomized clinical trials to reduce breast cancer mortality, especially among women 50 years old and older [1-5]. Authorities in cancer screening have bong recognized that the level of efficacy of screening demonstrated in randomized clinical trials may not pertain to community practice for several reasons [6]. These reasons include possible differences in the population groups receiving screening, lower accuracy of screening mammography in the community, and lower compliance with diagnostic follow-up and treatment in community practice, which may result in more adverse outcomes. Screening effectiveness in community practice today could exceed that estimated in trials because the technical and interpretative quality of mammography has improved since the trials were performed. Furthermore, clinical trial efficacy has been estimated on the basis of assignment to receive screening; to the extent that women assigned to screening were not screened or that women in the control groups were screened, efficacy in trials may have been underestimated. To optimally evaluate the performance of mammography in a community setting, the screening prevalence and patterns and the associated sensitivity, specificity, and predictive value of mammography in community screening programs should be determined by linkage with cancer outcomes [7, 8]. A program of monitoring should also provide data on specific populations, such as rural and minority subgroups, that are traditionally underserved by screening programs and that may have different breast cancer mortality rates [9]. Before the Mammography Quality Standards Act (MQSA) of 1992, most mammography facilities in the United States did not maintain records that could provide reliable and comprehensive data to evaluate the performance of screening mammography [10]. The concept of a medical audit of outcomes data had been proposed [ 1 1 ] but has not been routinely practiced in the community. The interim regulations of the MQSA mandated maintaining mammography data and performing a medical outcomes audit [12]. In practical terms, the medical audit requirement of the MQSA was limited to an analysis of patients with tests interpreted as “suspicious abnormality” or “highly suggestive for malignancy,” which permits evaluation of the positive predictive value of such interpretations. However, the MQSA does not require linkage to populationbased cancer registry data or another source of pathology data, without which it is impossible to accurately assess the outcomes of patients with mammograms interpreted as having normal findings. To understand the full effect of

Does improving a firm's environmental management system and environmental performance result in a higher stock price?

Abstract: We believe that sound environmental management leads to reduced risk to the firm, and that this risk reduction is valued by financial markets. Investments in environmental management lead to better short-term environmental performance as well as the prospect of further improvements in the future. These improvements confer a reduction in the firm’s risk, which is the key factor that investors consider when deciding upon the return that they will require for making a particular investment. Lower risks mean lower required returns, and therefore, lower costs for financing the activities of the firm. We have developed a conceptual model that links together the environmental activities and performance of the firm, the ways in which these are communicated to investors and others, the firm’s riskiness, and its cost of equity capital. This model provides a framework for understanding how corporate environmental activities ultimately are translated into changes in the market value of the firm.

Nuclear Accumulation of NFAT4 Opposed by the JNK Signal Transduction Pathway

Abstract: The nuclear factor of activated T cells (NFAT) group of transcription factors is retained in the cytoplasm of quiescent cells. NFAT activation is mediated in part by induced nuclear import. This process requires calcium-dependent dephosphorylation of NFAT caused by the phosphatase calcineurin. The c-Jun amino-terminal kinase (JNK) phosphorylates NFAT4 on two sites. Mutational removal of the JNK phosphorylation sites caused constitutive nuclear localization of NFAT4. In contrast, JNK activation in calcineurin-stimulated cells caused nuclear exclusion of NFAT4. These findings show that the nuclear accumulation of NFAT4 promoted by calcineurin is opposed by the JNK signal transduction pathway.

Helping or Hovering? Effects of Instructional Assistant Proximity on Students with Disabilities:

Abstract: This study presents data on the effects of the proximity of instructional assistants on students with multiple disabilities who are placed in general education classrooms. Based on extensive observations and interviews, analyses of the data highlighted eight major findings of educational significance, all related to proximity of instructional assistants. Categories of findings and discussion include (a) interference with ownership and responsibility by general educators, (b) separation from classmates, (c) dependence on adults, (d) impact on peer interactions, (e) limitations on receiving competent instruction, (f) loss of personal control, (g) loss of gender identity, and (h) interference with instruction of other students. The article concludes with implications for practice related to policy development, training, classroom practices, and research.

A unique point mutation in the fibroblast growth factor receptor 3 gene (FGFR3) defines a new craniosynostosis syndrome.

Abstract: The underlying basis of many forms of syndromic craniosynostosis has been defined on a molecular level However, many patients with familial or sporadic craniosynostosis do not have the classical findings of those craniosynostosis syndromes Here we present 61 individuals from 20 unrelated families where coronal synostosis is due to an amino acid substitution (Pro250Arg) that results from a single point mutation in the fibroblast growth factor receptor 3 gene on chromosome 4p In this instance, a new clinical syndrome is being defined on the basis of the molecular finding In addition to the skull findings, some patients had abnormalities on radiographs of hands and feet, including thimble-like middle phalanges, coned epiphyses, and carpal and tarsal fusions Brachydactyly was seen in some cases; none had clinically significant syndactyly or deviation of the great toe Sensorineural hearing loss was present in some, and developmental delay was seen in a minority While the radiological findings of hands and feet can be very helpful in diagnosing this syndrome, it is not in all cases clearly distinguishable on a clinical basis from other craniosynostosis syndromes Therefore, this mutation should be tested for in patients with coronal synostosis

Database of p53 gene somatic mutations in human tumors and cell lines: updated compilation and future prospects

Abstract: In recent years, there has been an exponential increase in the number of p53 mutations identified in human cancers. The p53 mutation database consists of a list of point mutations in thep53 gene of human tumors and cell lines, compiled from the published literature and made available through electronic media. The database is now maintained at the International Agency for Research on Cancer (IARC) and is updated twice a year. The current version contains records on 5091 published mutations and is expected to surpass the 6000 mark in the January 1997 release. The database is available in various formats through the European Bioinformatics Institute (EBI) ftp server at: ftp://ftp.ebi.ac.uk/pub/databases/p53/ or by request from IARC (p53database@iarc.fr) and will be searchable through the SRS system in the near future. This report provides a description of the criteria for inclusion of data and of the current formats, a summary of the relevance ofp53 mutation analysis to clinical and biological questions, and a brief discussion of the prospects for future developments.

Authenticity in Constructivist Inquiry: Methodological Considerations Without Prescription

Abstract: Principles concerning authenticity in constructivist inquiry are described in the context of the emergent paradigm. Suggestions are offered from which the researcher can choose to work toward, though never prescriptively guarantee, high-quality research findings.

Nicotinic system involvement in Alzheimer's and Parkinson's diseases. Implications for therapeutics.

Abstract: Advances in our understanding of the structure, function and distribution of nicotinic acetylcholine receptors in the CNS have provided the impetus for new studies examining the role(s) that these receptors and associated processes may play in CNS functions Further motivation has come from the realisation that such receptors must be involved in the maintenance of cigarette smoking, and from clues provided by studies of degenerative neurological diseases such as Alzheimer's disease and Parkinson's disease, in which the loss of nicotinic receptors has been described Ongoing investigations of the molecular substructure of central nicotinic receptors and their pharmacology have begun to open up new possibilities for novel CNS therapeutics with nicotinic agents Exploiting these possibilities will require understanding of the role(s) that these receptor systems play in human cognitive, behavioural, motor and sensory functioning Clues from careful studies of human cognition are beginning to emerge and will provide direction for studies of potentially therapeutic novel nicotinic agents Despite the promising results of acute studies, few long term studies with nicotine or nicotinic drugs have been performed in dementing disorders Thus there is uncertainty as to whether long term nicotinic treatment will provide sustained cognitive benefit It is even more uncertain whether such cognitive benefit will have a significant clinical impact on patients and their families To maximise the potential benefit of long term treatment with nicotinic agonists (or other cholinergic drugs), we suggest that drug treatment should be combined with cognitive rehabilitation strategies This will enable patients and/or their families to focus on the particular cognitive domains that may be improved

The Strain Behavior of the Anterior Cruciate Ligament During Squatting and Active Flexion-Extension A Comparison of an Open and a Closed Kinetic Chain Exercise

Abstract: The effects of weightbearing (closed kinetic chain) and nonweightbearing (open kinetic chain) exercises on the biomechanical behavior of an injured anterior cruciate ligament or a healing anterior cruciate ligament graft are unknown. To understand the effects of these exercises on the healing graft, we measured the strain behavior of the normal anterior cruciate ligament in human subjects while they performed squatting, a closed kinetic chain exercise, and active flexion-extension of the leg, an open kinetic chain exercise. The maximum anterior cruciate ligament strain values obtained during squatting did not differ from those obtained during active flexion-extension. Also, anterior cruciate ligament strain values obtained during squatting were unaffected by the application of elastic resistance intended to increase muscle activity. These findings indicate that squatting, which produces a substantial compressive joint force, does not necessarily protect the anterior cruciate ligament more than active flexion-extension of the leg, which is characterized primarily by contraction of the dominant quadriceps muscle. These findings also demonstrate that increasing resistance during the squat exercise does not produce a significant increase in anterior cruciate ligament strain values, unlike increased resistance during active flexion-extension exercise.

Pulmonary Vasoconstriction and Hypertension in Mice With Targeted Disruption of the Endothelial Nitric Oxide Synthase (NOS 3) Gene

Abstract: NO, synthesized in endothelial cells by endothelial NO synthase (NOS 3), is believed to be an important endogenous pulmonary vasodilator substance that contributes to the normal low pulmonary vascular resistance. To selectively investigate the role of NOS 3 in the pulmonary circulation, mice with targeted disruption of the NOS 3 gene were studied. Pulmonary hemodynamics were studied by measuring pulmonary artery pressure, left ventricular end-diastolic pressure, and lower thoracic aortic flow by using a novel open-chest technique. Transient partial occlusion of the inferior vena cava was used to assess the pulmonary artery pressure-flow relationship. Tension developed by isolated pulmonary artery segments after acetylcholine stimulation was measured in vitro. The histological appearance of NOS 3–deficient and wild-type murine lungs was compared. NOS 3–deficient mice (n=27), when compared with wild-type mice (n=32), had pulmonary hypertension (pulmonary artery pressure, 19.0±0.8 versus 16.4±0.6 mm...

Multicenter, randomized, prospective trial of early tracheostomy

Abstract: Objectives: Determine the effect of early (days 3-5) or late (days 10-14) tracheostomy on intensive care unit length of stay (ICU LOS), frequency of pneumonia, and mortality, and evidence of short-term or long-term pharyngeal, laryngeal, or tracheal injury in head trauma, non-head trauma, and critically ill nontrauma patients. Study Design: Randomized, prospective. Setting: Five Level I trauma centers. Methods: Data were obtained prospectively and included Acute Physiology and Chronic Health Evaluation III score (AIII), Glasgow Coma Scale score, Emergency Room Trauma Score, Injury Severity Score, Acute Injury Score, type of endotracheal tube or tracheostomy, level of positive end-expiratory pressure, and peak inspiratory pressure. Patients were to undergo laryngoscopy for detection of injury according to the Lindholm criteria at the time of endotracheal tube or tracheostomy removal and be reevaluated at 3 to 5 months after discharge. Results: One hundred fifty-seven patients were entered, 127 to early randomization (3-5 days) and 28 to late randomization (10-14 days); however, only 112 patients with early and 14 with late randomization had completed data forms for the primary study goals. An additional 22 patients from the early entry groups were rerandomized late. Early randomization data: the AIII score was higher (p < 0.05) in the head trauma tracheostomy (65 ± 4) than in the nontracheostomy group (51 ± 4) and in the nontrauma tracheostomy (92 ± 6) than in the nontracheostomy group (68 ± 7), but was equivalent in the non-head trauma group. Glasgow Coma Scale score, Emergency Room Trauma Score, Injury Severity Score, Acute Injury Score, positive end-expiratory pressure, and peak inspiratory pressure were not significantly different in any of the groups. There were no significant differences in ICU LOS, frequency of pneumonia, or death in any of the groups after either early or late tracheostomy compared with continued endotracheal intubation. Only 83 patients underwent postextubation laryngoscopy. There were no significant differences between the groups; however, there were trends to more vocal cord ulceration and subglottic inflammation in the continued intubation group. No patient was seen in this study with late vocal cord or laryngeal stenosis; there were no tracheal-innominate artery fistulae. Seven of the patients with abnormal findings at extubation had normal 3- to 5-month postextubation laryngoscopy. Conclusion: Physician bias limited patient entry into the study. Although there were higher AIII scores in the head trauma early tracheostomy patients, there were no differences in the primary end points of ICU LOS, pneumonia, or death in any of the groups studied. Long-term endoscopic follow-up was poor, but no known late tracheal stenosis was seen.

The epidemiology of quantitative ultrasound: A review of the relationships with bone mass, osteoporosis and fracture risk

Abstract: Quantitative ultrasound (QUS) is a simple, inexpensive and non-invasive measure of bone which has been used in research settings for the prediction of osteoporosis. This review summarizes the current status of the epidemiology of QUS analysis, including its relationship with bone mineral density (BMD), risk of osteoporotic fracture and risk factors for osteoporosis. Although only moderately correlated with BMD, QUS appears to be as strong a predictor of osteoporotic fracture as BMD and may predict fracture independent of BMD. Risk factors for low QUS, including age, menopause, body composition and physical inactivity, seem to parallel those of low BMD. More longitudinal research is needed to confirm the clinical utility of QUS and more experimental and population-based studies are needed to determine whether the etiology of low QUS values is different from that of low bone mass.

Civic culture and democracy from Europe to America

Abstract: In this study we explore the extent to which the civic cultures of European immigrants to the United States persist in their contemporary descendants. Analyses using data from the World Values Survey and the cumulative General Social Surveys indicate that the civic attitudes of contemporary Americans bear a strong resemblance to the civic attitudes of the contemporary citizens of the European nations with whom they share common ancestors. The Americans who descend from nations with highly civic populations tend to hold relatively civic attitudes, while those who descend from nations with less civic populations tend to hold relatively less civic attitudes. The significance of these findings for democracy is discussed.

TNK-Tissue Plasminogen Activator in Acute Myocardial Infarction Results of the Thrombolysis in Myocardial Infarction (TIMI) 10A Dose-Ranging Trial

Abstract: Background TNK-tissue plasminogen activator (TNK-TPA) is a genetically engineered variant of TPA, which in experimental models has a slower plasma clearance and greater fibrin specificity and is 80-fold more resistant to plasminogen activator inhibitor-1 than alteplase TPA Methods and Results The Thrombolysis in Myocardial Infarction (TIMI) 10A trial was a Phase 1, dose-ranging pilot trial designed to evaluate the pharmacokinetics, safety, and efficacy of TNK-TPA in patients with acute myocardial infarction One hundred thirteen patients with acute ST-segment elevation myocardial infarction presenting within 12 hours and without contraindications to thrombolysis were enrolled and treated with a single bolus of TNK-TPA over 5 to 10 seconds with doses ranging from 5 to 50 mg TNK-TPA demonstrated a plasma clearance of 151±55 mL/min and a half-life of 17±7 minutes Comparable values for wild-type TPA are 572±132 mL/min and 35±14 minutes, respectively Systemic fibrinogen and plasminogen levels fell by onl

Accelerated longitudinal comparisons of aggressive versus delinquent syndromes.

Abstract: Accelerated longitudinal analyses revealed both similarities and differences between the developmental trajectories of empirically based aggressive versus delinquent syndromes in childhood and adolescence. Syndromes were scored from standardized ratings obtained from parents five times at 2-year intervals for seven birth cohorts of Dutch children initially assessed at ages 4 to 10 years. Scores for both the aggressive and delinquent syndromes declined from ages 4 to 10. After about age 10 years, scores for the aggressive syndrome continued to decline, but scores for the delinquent syndrome increased until about age 17. The aggressive syndrome was significantly more stable than the delinquent syndrome. Long-term predictive correlations between matched subjects from different cohorts were as high as predictive correlations between scores obtained by the same subjects, thus supporting the validity of accelerated longitudinal analyses. The results highlight important developmental distinctions between aggressive versus delinquent conduct problems. Failure to distinguish between aggressive and delinquent conduct problems could generate misleading conclusions about their respective developmental courses and limit the generalizability of results. Language: en

Prophylactic natural surfactant extract for preventing morbidity and mortality in preterm infants.

Abstract: BACKGROUND This section is under preparation and will be included in the next issue. OBJECTIVES To assess the effect of prophylactic intratracheal administration of natural surfactant extract in preterm newborns at risk for developing respiratory distress syndrome (RDS). SEARCH STRATEGY Searches were made of the Oxford Database of Perinatal Trials, Medline (MeSH terms: pulmonary surfactant; limits: age groups; newborn infants), previous reviews including cross references, abstracts, conference and symposia proceedings, expert informants and journal hand searching in the English language. SELECTION CRITERIA Randomized controlled trials which compared the effect of prophylactic natural surfactant administration (surfactant obtained from human or bovine sources, either modified with additional phospholipids or not) administered to high risk preterm newborns at or shortly after birth in order to prevent respiratory distress syndrome, other complications of prematurity, and mortality. DATA COLLECTION AND ANALYSIS Data regarding clinical outcomes including incidence of pneumothorax, pulmonary interstitial emphysema, patent ductus arteriosus, necrotizing enterocolitis, intraventricular hemorrhage (any grade and severe intraventricular hemorrhage), bronchopulmonary dysplasia, mortality, bronchopulmonary dysplasia or death, and retinopathy of prematurity were excerpted from the reports of the clinical trials by the reviewer. Data analysis was done in accordance with the standards of the Cochrane Neonatal Review Group. MAIN RESULTS All of the included studies note an initial improvement in respiratory status and a decrease in the risk of respiratory distress syndrome in infants who receive prophylactic natural surfactant extract. The meta-analysis supports a decrease in the risk of pneumothorax (typical relative risk 0.35, 95% CI 0.26, 0.49; typical risk difference -0.15, 95% CI -0.20, -0.11), a decrease in the risk pulmonary interstitial emphysema (typical relative risk 0.46, 95% CI 0.35, 0.60; typical risk difference -0.19, 95% CI -0.25, -0.13), a decrease in the risk of neonatal mortality (typical relative risk 0. 60, 95% CI 0.44, 0.83; typical risk difference -0.07, 95% CI -0.12, -0.03), and a decrease in the risk of bronchopulmonary dysplasia or death (typical relative risk 0.84, 95% CI 0.75, 0.93; typical risk difference -0.10, 95% CI -0.16, -0.04. No differences are reported in the risk of intraventricular hemorrhage, patent ductus arteriosus, necrotizing enterocolitis or retinopathy of prematurity. Few data are available on long-term followup of treated infants. REVIEWER'S CONCLUSIONS Prophylactic intratracheal administration of natural surfactant extract to infants judged to be at risk of developing respiratory distress syndrome (intubated infants <30 weeks gestation) has been demonstrated to improve clinical outcome. Infants who receive prophylactic natural surfactant extract have a decreased risk of pneumothorax, a decreased risk of pulmonary interstitial emphysema, a decreased risk of mortality, and a decreased risk of bronchopulmonary dysplasia or death.