Racial Disparities in Access to and Outcomes of Kidney Transplantation in Children, Adolescents, and Young Adults: Results From the ESPN/ERA-EDTA (European Society of Pediatric Nephrology/European Renal Association-European Dialysis and Transplant Association) Registry.

BACKGROUND Racial disparities in kidney transplantation in children have been found in the United States, but have not been studied before in Europe. STUDY DESIGN Cohort study. SETTING & PARTICIPANTS Data were derived from the ESPN/ERA-EDTA Registry, an international pediatric renal registry collecting data from 36 European countries. This analysis included 1,134 young patients (aged ≤19 years) from 8 medium- to high-income countries who initiated renal replacement therapy (RRT) in 2006 to 2012. FACTOR Racial background. OUTCOMES & MEASUREMENTS Differences between racial groups in access to kidney transplantation, transplant survival, and overall survival on RRT were examined using Cox regression analysis while adjusting for age at RRT initiation, sex, and country of residence. RESULTS 868 (76.5%) patients were white; 59 (5.2%), black; 116 (10.2%), Asian; and 91 (8.0%), from other racial groups. After a median follow-up of 2.8 (range, 0.1-3.0) years, we found that black (HR, 0.49; 95% CI, 0.34-0.72) and Asian (HR, 0.54; 95% CI, 0.41-0.71) patients were less likely to receive a kidney transplant than white patients. These disparities persisted after adjustment for primary renal disease. Transplant survival rates were similar across racial groups. Asian patients had higher overall mortality risk on RRT compared with white patients (HR, 2.50; 95% CI, 1.14-5.49). Adjustment for primary kidney disease reduced the effect of Asian background, suggesting that part of the association may be explained by differences in the underlying kidney disease between racial groups. LIMITATIONS No data for socioeconomic status, blood group, and HLA profile. CONCLUSIONS We believe this is the first study examining racial differences in access to and outcomes of kidney transplantation in a large European population. We found important differences with less favorable outcomes for black and Asian patients. Further research is required to address the barriers to optimal treatment among racial minority groups.

Determination of the Myogenic Potential of Human Embryonic Stem Cell-Derived Mesenchymal Stem Cells

Human embryonic stem cells (hESCs) have the potential to differentiate to all adult somatic cells. This property makes hESCs a very promising area of research for the treatment of disorders in which specific cell populations need to be restored. Despite this potential, research that focuses on producing mesodermally derived cell populations from hESCs is decidedly limited, notwithstanding the prevalence of disorders involving mesodermal tissues for which treatment options are limited. Skeletal muscle myoblasts are derivatives of mesodermal cells and are characterized by the expression of the MyoD gene. These cells are difficult to obtain from hESCs in a reproducible and efficient manner. Recent developments in the field have showed some success in obtaining myogenic cells from hESCs through a mesenchymal stem cell (MSC)-like intermediate population. MSCs, which are an adult stem cell population typically derived from the bone marrow, are capable of generating multiple cell types including skeletal muscle. The aim of this study was to develop an efficient method that derives myoblasts from an MSC-like intermediate. To accomplish this goal, we first set out to isolate and expand the MSC-like intermediate from hESCs differentiated in vitro. Difficulties in reproducing published cell-differentiation methodologies, which represent a significant and familiar challenge in hESC research, are highlighted in this report.

Surplus Labor in Indian Manufacturing: Evidence from the Annual Survey of Industries

In this paper we analyze state level data for total manufacturing constructed from the Annual Survey of Industries for the period 1986-2000 using the nonparametric method of Data Envelopment Analysis (DEA). We assess the extent of surplus labor in the manufacturing sector in the individual states in India. The study also investigates whether the same states show the maximum incidence of surplus labor every year in the sample period and if there any evidence that the extent of surplus labor in manufacturing has been reduced or eliminated in the post-reform era. Our study shows the presence of considerable measure of surplus labor in all of the years in a majority of the states. Things have worsened rather than improved after the reform. Also, the regional distribution of surplus labor has remain fairly unchanged with the same states performing inefficiently both before and after the reform.

A cross-sectional analysis of physical activity and obesity in inner city Houston Texas Mexican American youth

Obesity prevalence among children and adolescents is rising. It is one of the most attributable causes of hospitalization and death. Overweight and obese children are more likely to suffer from associated conditions such as hypertension, dyslipidemia, chronic inflammation, increased blood clotting tendency, endothelial dysfunction, hyperinsulinemia, and asthma. These children and adolescents are also more likely to be overweight and obese in adulthood. Interestingly, rates of obesity and overweight are not evenly distributed across racial and ethnic groups. Mexican American youth have higher rates of obesity and are at higher risk of becoming obese than non-Hispanic black and non-Hispanic white children. ^ Methods. This cross-sectional study describes the association between rates of obesity and physical activity in a sample of 1313 inner-city Mexican American children and adolescents (5-19 years of age) in Houston, Texas. This study is important because it will contribute to our understanding of childhood and adolescent obesity in this at-risk population. ^ Data from the Mexican American Feasibility Cohort using the Mano a Mano questionnaire are used to describe this population's status of obesity and physical activity. An initial sample taken from 5000 households in inner city Houston Texas was used as the baseline for this prospective cohort. The questionnaire was given in person to the participants to complete (or to parents for younger children) at a home visit by two specially trained bilingual interviewers. Analysis comprised prevalence estimates of obesity represented as percentile rank (<85%= normal weight, >85%= at risk, >95%= obese) by age and gender. The association between light, moderate, strenuous activity, and obesity was also examined using linear regression. ^ Results. Overall, 46% of this Mexican American Feasibility cohort is overweight or obese. The prevalence for children in the 6-11 age range (53.2%) was significantly greater than that reported from NHANES, 1999–2002 data (39.4%). Although the percentage of overweight and obese among the 12-19 year olds was greater than that reported in NHANES (38.5% versus 38.6%) this difference was not statistically significant. ^ A significant association between BMI and sit time and moderate physical activity (both p < 0.05) found in this sample. For males, this association was significant for moderate physical activity (p < 0.01). For the females, this association was significant for BMI and sit time (p < 0.05). These results need to be interpreted in the light of design and measurement limitations. ^ Conclusion. This study supports observations that the inner city Houston Texas Mexican American child and adolescent population is more overweight and obese than nationally reported figures, and that there are positive relationships between BMI, activity levels, and sit time in this population. This study supports the need for public health initiatives within the Houston Hispanic community. ^

BIOLOGICAL MECHANISMS AND CLINICAL IMPLICATIONS OF BCR-ABL-INDUCED MITOCHONDRIAL OXIDATIVE STRESS AND CELL SURVIVAL IN CHRONIC MYELOID LEUKEMIA

Chronic myeloid leukemia (CML), a myeloproliferative disorder, represents approximately 15-20% of all adult leukemia. The development of CML is clearly linked to the constitutively active protein-tyrosine kinase BCR-ABL, which is encoded by BCR-ABL fusion gene as the result of chromosome 9/22 translocation (Philadelphia chromosome). Previous studies have demonstrated that oxidative stress-associated genetic, metabolic and biological alterations contribute to CML cell survival and drug refractory. Mitochondria and NAD(P)H oxidase (NOX) are the major sources of BCR-ABL-induced cellular reactive oxygen species (ROS) production. However, it is still unknown how CML cells maintain the altered redox status, while escaping from the persistent oxidative stress-induced cell death. Therefore, elucidation of the mechanisms by which CML cells cope with oxidative stress will provide new insights into CML leukemogenesis. The major goal of this study is to identify the survival factors protecting CML cells against oxidative stress and develop novel therapeutic strategies to overcome drug resistance. Several experimental models were used to test CML cell redox status and cellular sensitivity to oxidative stress, including BCR-ABL inducible cell lines, BCR-ABL stably transformed cell lines and BCR-ABL-expressing CML blast crisis cells with differential BCL-XL/BCL-2 expressions. Additionally, an artificial CML cell model with heterogenic BCL-XL/BCL-2 expression was established to assess the correlation between differential survival factor expression patterns and cell sensitivity to Imatinib and oxidative stress. In this study, BCL-XL and GSH have been identified as the major survival factors responsive to BCR-ABL-promoted cellular oxidative stress and play a dominant role in regulating the threshold of oxidative stress-induced apoptosis. Cell survival factors BCL-XL and BCL-2 differentially protect mitochondria under oxidative stress. BCL-XL is an essential survival factor in preventing excessive ROS-induced cell death while BCL-2 seems to play a relatively minor role. Furthermore, the redox modulating reagent β-phenethyl isothiocyanate (PEITC) has been found to efficiently deplete GSH and induce potent cell killing effects in drug-resistant CML cells. Combination of PEITC with BCL-XL/BCL2 inhibitor ABT737 or suppression of BCL-XL by BCR-ABL inhibitor Gleevec dramatically sensitizes CML cells to apoptosis. These results have suggested that elevation of BCL-XL and cellular GSH are important for the development of CML, and that redox-directed therapy is worthy of further clinical investigations in CML.

An examination of the cross-cultural reliability and construct validity of a measure of loneliness

Loneliness is a pervasive, rather common experience in American culture, particularly notable among adolescents. However, the phenomenon is not well documented in the cross-cultural psychiatric literature. For psychiatric epidemiology to encompass a wide array of psychopathologic phenomena, it is important to develop useful measures to characterize and classify both non-clinical and clinical dysfunction in diverse subgroups and cultures.^ The goal of this research was to examine the cross-cultural reliability and construct validity of a scale designed to measure loneliness. The Roberts Loneliness Scale (RLS-8) was administered to 4,060 adolescents ages 10-19 years enrolled in high schools along either side of the Texas-Tamaulipas border region between the U.S. and Mexico. Data collected in 1988 from a study focusing on substance use and psychological distress among adolescents in these regions were used to examine the operating characteristics of the RLS-8. A sample stratified by nationality and language, age, gender, and grade was used for analysis.^ Results indicated that in general the RLS-8 has moderate reliability in the U.S. sample, but not in the Mexican sample. Validity analyses demonstrated that there was evidence for convergent validity of the RLS-8 in the U.S. sample, but none in the Mexican sample. Discriminant validity of the measures in neither sample could be established. Based on the factor structure of the RLS-8, two subscales were created and analyzed for construct validity. Evidence for convergent validity was established for both subscales in both national samples. However, the discriminant validity of the measure remains unsubstantiated in both national samples. Also, the dimensionality of the scale is unresolved.^ One primary goal for future cross-cultural research would be to develop and test better defined culture-specific models of loneliness within the two cultures. From such scientific endeavor, measures of loneliness can be developed or reconstructed to classify the phenomenon in the same manner across cultures. Since estimates of prevalence and incidence are contingent upon reliable and valid screening or diagnostic measures, this objective would serve as an important foundation for future psychiatric epidemiologic inquiry into loneliness. ^

(Table 1) Cortisol concentration in hair of East Greenland polar bears (Ursus maritimus)

To demonstrate the ability to assess long-term hypothalamic-pituitary-adrenocortical (HPA) axis activity in polar bears (Ursus maritimus), a pilot study was conducted in which cortisol concentration was analyzed in hair from 7 female (3-19 years) and 10 male (6-19 years) East Greenland polar bears sampled in 1994-2006. The hair was chosen as matrix as it is non-invasive, seasonally harmonized, and has been validated as an index of long-term changes in cortisol levels. The samples were categorized according to contamination: eight were clean (2 females, 6 males), 5 had been contaminated with bear blood (2 F, 3 M), and 4 with bear fat (3 F, 1 M). There was no significant difference in cortisol concentration between the three categories after external contamination was removed. However, contaminated hair samples should be cleaned before cortisol determination. Average hair cortisol concentration was 8.90 pg/mg (range: 5.5 to 16.4 pg/mg). There was no significant correlation between cortisol concentration and age (p = 0.81) or sampling year (p = 0.11). However, females had higher mean cortisol concentration than males (females mean: 11.0 pg/mg, males: 7.3 pg/mg; p = 0.01). The study showed that polar bear hair contains measurable amounts of cortisol and that cortisol in hair may be used in studies of long-term stress in polar bears.

A silviculture-oriented spatio-temporal model for germination in Pinus pinea L. in the Spanish Northern Plateau based on a direct seeding experiment

Natural regeneration in Pinus pinea stands commonly fails throughout the Spanish Northern Plateau under current intensive regeneration treatments. As a result, extensive direct seeding is commonly conducted to guarantee regeneration occurrence. In a period of rationalization of the resources devoted to forest management, this kind of techniques may become unaffordable. Given that the climatic and stand factors driving germination remain unknown, tools are required to understand the process and temper the use of direct seeding. In this study, the spatio-temporal pattern of germination of P. pinea was modelled with those purposes. The resulting findings will allow us to (1) determine the main ecological variables involved in germination in the species and (2) infer adequate silvicultural alternatives. The modelling approach focuses on covariates which are readily available to forest managers. A two-step nonlinear mixed model was fitted to predict germination occurrence and abundance in P. pinea under varying climatic, environmental and stand conditions, based on a germination data set covering a 5-year period. The results obtained reveal that the process is primarily driven by climate variables. Favourable conditions for germination commonly occur in fall although the optimum window is often narrow and may not occur at all in some years. At spatial level, it would appear that germination is facilitated by high stand densities, suggesting that current felling intensity should be reduced. In accordance with other studies on P. pinea dispersal, it seems that denser stands during the regeneration period will reduce the present dependence on direct seeding.

An Evening with Lisa Nicole Bell, Award-Winning Media Entrepreneur, Writer, Producer, and On Camera Talent

Lisa Bell is the founder and CEO of Inspired Life Media Group, a Los Angeles-based international content development and production company that works with a diverse cross-section of venture-backed startups, high profile individuals, and fortune 500 brands. Lisa, past content and business ventures are critically-acclaimed, diverse, and plentiful. She created, directed, and produced The American Dream Revised, a digital docuseries that follows a diverse group of young entrepreneurs. Lisa’s past business ventures include startups in technology, personal development, and original content.After launching her first company at 19 years old, she later started a for-profit social enterprise that reached more than 400,000 girls around the world with active programs in Liberia, England, Brazil, and the US.

Situações de risco e proteção à saúde de adolescentes da Comunidade São Remo

No mundo, um em cada cinco pessoas estão na faixa etária de 10 a 19 anos, sendo que 85% habitam países em desenvolvimento (WHO, 2006). Brasil, 21% do total da população está nesta faixa etária (IBGE, 2002). A adolescência é considerada um dos períodos mais saudáveis da vida humana, porém é reconhecido o aumento dos índices de mortalidade em acidentes, suicídios, violência, complicações na gestação e outras doenças que podem ser prevenidas ou tratadas. O objetivo deste estudo é investigar as situações de risco e de proteção à saúde e à vida, vivenciadas por um grupo de adolescentes de baixa renda. É um estudo descritivo qualitativo, realizado na Comunidade São Remo, município de São Paulo, caracterizada pela pobreza e violência. O método utilizado para a coleta de dados foi o grupo focal. Participaram 20 adolescentes, divididos em dois grupos, um de 12 a 14 anos e outro de 15 a 18 anos, foram realizadas três reuniões com cada grupo. As reuniões foram gravadas, posteriormente transcritas e os conteúdos foram analisado, segundo os propostos de Bardin (1977). Os resultados da pesquisa demonstraram que situações de riscos à saúde estão presentes na fragilidade do suporte familiar, violência física causada por terceiros (com ênfase na violência policial), violência psicológica, situações de exclusão social vivenciadas na escola, uso de drogas e condutas transgressoras. Os fatores de proteção detectados foram: família com ênfase na mãe, religiosidade, professor como referência e projetos futuros. Os resultados demonstram que as situações de risco à saúde são mais evidentes do que de proteção para este grupo de adolescentes de baixa renda.

Situações de risco e proteção à saúde de adolescentes da Comunidade São Remo

No mundo, um em cada cinco pessoas estão na faixa etária de 10 a 19 anos, sendo que 85% habitam países em desenvolvimento (WHO, 2006). Brasil, 21% do total da população está nesta faixa etária (IBGE, 2002). A adolescência é considerada um dos períodos mais saudáveis da vida humana, porém é reconhecido o aumento dos índices de mortalidade em acidentes, suicídios, violência, complicações na gestação e outras doenças que podem ser prevenidas ou tratadas. O objetivo deste estudo é investigar as situações de risco e de proteção à saúde e à vida, vivenciadas por um grupo de adolescentes de baixa renda. É um estudo descritivo qualitativo, realizado na Comunidade São Remo, município de São Paulo, caracterizada pela pobreza e violência. O método utilizado para a coleta de dados foi o grupo focal. Participaram 20 adolescentes, divididos em dois grupos, um de 12 a 14 anos e outro de 15 a 18 anos, foram realizadas três reuniões com cada grupo. As reuniões foram gravadas, posteriormente transcritas e os conteúdos foram analisado, segundo os propostos de Bardin (1977). Os resultados da pesquisa demonstraram que situações de riscos à saúde estão presentes na fragilidade do suporte familiar, violência física causada por terceiros (com ênfase na violência policial), violência psicológica, situações de exclusão social vivenciadas na escola, uso de drogas e condutas transgressoras. Os fatores de proteção detectados foram: família com ênfase na mãe, religiosidade, professor como referência e projetos futuros. Os resultados demonstram que as situações de risco à saúde são mais evidentes do que de proteção para este grupo de adolescentes de baixa renda.

D-AKAP2, a novel protein kinase A anchoring protein with a putative RGS domain

Subcellular localization directed by specific A kinase anchoring proteins (AKAPs) is a mechanism for compartmentalization of cAMP-dependent protein kinase (PKA). Using a two-hybrid screen, a novel AKAP was isolated. Because it interacts with both the type I and type II regulatory subunits, it was defined as a dual specific AKAP or D-AKAP1. Here we report the cloning and characterization of another novel cDNA isolated from that screen. This new member of the D-AKAP family, D-AKAP2, also binds both types of regulatory subunits. A message of 5 kb pairs was detected for D-AKAP2 in all embryonic stages and in all adult tissues tested. In brain, skeletal muscle, kidney, and testis, a 10-kb mRNA was identified. In testis, several small mRNAs were observed. Therefore, D-AKAP2 represents a novel family of proteins. cDNA cloning from a mouse testis library identified the full length D-AKAP2. It is composed of 372 amino acids which includes the R binding fragment, residues 333–372, at its C-terminus. Based on coprecipitation assays, the R binding domain interacts with the N-terminal dimerization domain of RIα and RIIα. A putative RGS domain was identified near the N-terminal region of D-AKAP2. The presence of this domain raises the intriguing possibility that D-AKAP2 may interact with a Gα protein thus providing a link between the signaling machinery at the plasma membrane and the downstream kinase.

A novel member of the RING finger family, KRIP-1, associates with the KRAB-A transcriptional repressor domain of zinc finger proteins

The Krüppel-associated box A (KRAB-A) domain is an evolutionarily conserved transcriptional repressor domain present in approximately one-third of zinc finger proteins of the Cys2-His2 type. Using the yeast two-hybrid system, we report the isolation of a cDNA encoding a novel murine protein, KRAB-A interacting protein 1 (KRIP-1) that physically interacts with the KRAB-A region. KRIP-1 is a member of the RBCC subfamily of the RING finger, or Cys3HisCys4, family of zinc binding proteins whose other members are known to play important roles in differentiation, oncogenesis, and signal transduction. The KRIP-1 protein has high homology to TIF1, a putative modulator of ligand-dependent activation function of nuclear receptors. A 3.5-kb mRNA for KRIP-1 is ubiquitously expressed among all adult mouse tissues studied. When a GAL4–KRIP-1 fusion protein is expressed in COS cells with a chloramphenicol acetyltransferase reporter construct with five GAL4 binding sites, there is dose-dependent repression of transcription. Thus, KRIP-1 interacts with the KRAB-A region of C2H2 zinc finger proteins and may mediate or modulate KRAB-A transcriptional repressor activity.

Urokinase-type plasminogen activator is effective in fibrin clearance in the absence of its receptor or tissue-type plasminogen activator.

The availability of gene-targeted mice deficient in the urokinase-type plasminogen activator (uPA), urokinase receptor (uPAR), tissue-type plasminogen activator (tPA), and plasminogen permits a critical, genetic-based analysis of the physiological and pathological roles of the two mammalian plasminogen activators. We report a comparative study of animals with individual and combined deficits in uPAR and tPA and show that these proteins are complementary fibrinolytic factors in mice. Sinusoidal fibrin deposits are found within the livers of nearly all adult mice examined with a dual deficiency in uPAR and tPA, whereas fibrin deposits are never found in livers collected from animals lacking uPAR and rarely detected in animals lacking tPA alone. This is the first demonstration that uPAR has a physiological role in fibrinolysis. However, uPAR-/-/tPA-/- mice do not develop the pervasive, multi-organ fibrin deposits, severe tissue damage, reduced fertility, and high morbidity and mortality observed in mice with a combined deficiency in tPA and the uPAR ligand, uPA. Furthermore, uPAR-/-/tPA-/- mice do not exhibit the profound impairment in wound repair seen in uPA-/-/tPA-/- mice when they are challenged with a full-thickness skin incision. These results indicate that plasminogen activation focused at the cell surface by uPAR is important in fibrin surveillance in the liver, but that uPA supplies sufficient fibrinolytic potential to clear fibrin deposits from most tissues and support wound healing without the benefit of either uPAR or tPA.

A conserved family of elav-like genes in vertebrates.

A large family of genes encodes proteins with RNA recognition motifs that are presumed to bind RNA and to function in posttranscriptional regulation. Neural-specific members of this family include elav, a gene required for correct differentiation and maintenance of neurons in Drosophila melanogaster, and a related gene, HuD, which is expressed in human neuronal cells. I have identified genes related to elav and HuD in Xenopus laevis, zebrafish, and mouse that define a family of four closely related vertebrate elav-like genes (elrA, elrB, elrC, and elrD) in fish, frogs, and mammals. In addition to protein sequence conservation, a segment of the 3'-untranslated sequence of elrD is also conserved, implying a functional role in elrD expression. In adult frogs, elrC and elrD are exclusively expressed in the brain, whereas elrB is expressed in brain, testis, and ovary. During Xenopus development, elrC and elrD RNAs are detected by late gastrula and late neurula stages, respectively, whereas a nervous system-specific elrB RNA species is expressed by early tadpole stage. Additional elrB transcripts are detected in the ovary and early embryo, demonstrating a maternal supply of mRNA and possibly of protein. These expression patterns suggest a role for different elav-like genes in early development and neuronal differentiation. Surprisingly, elrA is expressed in all adult tissues tested and at all times during development. Thus, the widely expressed elrA is expected to have a related function in all cells.