Volumetric and anatomical MRI for hypoxic-ischemic encephalopathy: relationship to hypothermia therapy and neurosensory impairments.

OBJECTIVE: To relate volumetric magnetic resonance imaging (MRI) findings to hypothermia therapy and neurosensory impairments. STUDY DESIGN: Newborns > or =36 weeks' gestation with hypoxic-ischemic encephalopathy who participated in the National Institute of Child Health and Human Development hypothermia randomized trial at our center were eligible. We determined the relationship between hypothermia treatment and usual care (control) to absolute and relative cerebral tissue volumes. Furthermore, we correlated brain volumes with death or neurosensory impairments at 18 to 22 months. RESULT: Both treatment groups were comparable before randomization. Total brain tissue volumes did not differ in relation to treatment assignment. However, relative volumes of subcortical white matter were significantly larger in hypothermia-treated than control infants. Furthermore, relative total brain volumes correlated significantly with death or neurosensory impairments. Relative volumes of the cortical gray and subcortical white matter also correlated significantly with Bayley Scales psychomotor development index. CONCLUSION: Selected volumetric MRI findings correlated with hypothermia therapy and neurosensory impairments. Larger studies using MRI brain volumes as a secondary outcome measure are needed.

Intensive care for extreme prematurity--moving beyond gestational age.

BACKGROUND: Decisions regarding whether to administer intensive care to extremely premature infants are often based on gestational age alone. However, other factors also affect the prognosis for these patients. METHODS: We prospectively studied a cohort of 4446 infants born at 22 to 25 weeks' gestation (determined on the basis of the best obstetrical estimate) in the Neonatal Research Network of the National Institute of Child Health and Human Development to relate risk factors assessable at or before birth to the likelihood of survival, survival without profound neurodevelopmental impairment, and survival without neurodevelopmental impairment at a corrected age of 18 to 22 months. RESULTS: Among study infants, 3702 (83%) received intensive care in the form of mechanical ventilation. Among the 4192 study infants (94%) for whom outcomes were determined at 18 to 22 months, 49% died, 61% died or had profound impairment, and 73% died or had impairment. In multivariable analyses of infants who received intensive care, exposure to antenatal corticosteroids, female sex, singleton birth, and higher birth weight (per each 100-g increment) were each associated with reductions in the risk of death and the risk of death or profound or any neurodevelopmental impairment; these reductions were similar to those associated with a 1-week increase in gestational age. At the same estimated likelihood of a favorable outcome, girls were less likely than boys to receive intensive care. The outcomes for infants who underwent ventilation were better predicted with the use of the above factors than with use of gestational age alone. CONCLUSIONS: The likelihood of a favorable outcome with intensive care can be better estimated by consideration of four factors in addition to gestational age: sex, exposure or nonexposure to antenatal corticosteroids, whether single or multiple birth, and birth weight. (ClinicalTrials.gov numbers, NCT00063063 [ClinicalTrials.gov] and NCT00009633 [ClinicalTrials.gov].).

"A Room of One's Own": Reale und mentale Innenräume weiblicher Selbstbestimmung im spätmittelalterlichen England

Frauen werden im englischen Spätmittelalter auf den Innenraum von Haus und Kirche verwiesen. Wie sie diese Räume nutzten und kreativ (um-)gestalteten und auf welche Weise es ihnen gelang, reale Räume mental zu transgredieren und durch mentale Innenräume auszuwechseln, zeigt diese Arbeit. Dabei wird Raum - in Anlehnung an Giddens’ Theory of Structuration und den poststrukturalistischen Ansatz der Archäologie - als sowohl wirkmächtig als auch verschieden interpretierbar und transformierbar verstanden. Der Rückzug in den mentalen Innenraum führte im Extremfall dazu, daß neben der realen eine zweite Existenz aufgebaut wurde. Beide Existenzweisen konnten, wie insbesondere an den Biographien von Margaret Beaufort sowie Cicely und Margaret von York ablesbar ist, problemlos nebeneinander bestehen oder - wie am Beispiel von Margery Kempe gezeigt wird - so unvereinbar miteinander sein, daß gesellschaftliche Sanktionen die Folge waren.

Prevalence and determinants of hepatitis B co-infection among a United States Veterans Administration cohort with hepatitis C

Background and aim. Hepatitis B virus (HBV) and hepatitis C virus (HCV) co-infection is associated with increased risk of cirrhosis, decompensation, hepatocellular carcinoma, and death. Yet, there is sparse epidemiologic data on co-infection in the United States. Therefore, the aim of this study was to determine the prevalence and determinants of HBV co-infection in a large United States population of HCV patients. ^ Methods. The National Veterans Affairs HCV Clinical Case Registry was used to identify patients tested for HCV during 1997–2005. HCV exposure was defined as two positive HCV tests (antibody, RNA or genotype) or one positive test combined with an ICD-9 code for HCV. HCV infection was defined as only a positive HCV RNA or genotype. HBV exposure was defined as a positive test for hepatitis B core antibodies, hepatitis B surface antigen, HBV DNA, hepatitis Be antigen, or hepatitis Be antibody. HBV infection was defined as only a positive test for hepatitis B surface antigen, HBV DNA, or hepatitis Be antigen within one year before or after the HCV index date. The prevalence of exposure to HBV in patients with HCV exposure and the prevalence of HBV infection in patients with HCV infection were determined. Multivariable logistic regression was used to identify demographic and clinical determinants of co-infection. ^ Results. Among 168,239 patients with HCV exposure, 58,415 patients had HBV exposure for a prevalence of 34.7% (95% CI 34.5–35.0). Among 102,971 patients with HCV infection, 1,431 patients had HBV co-infection for a prevalence of 1.4% (95% CI 1.3–1.5). The independent determinants for an increased risk of HBV co-infection were male sex, positive HIV status, a history of hemophilia, sickle cell anemia or thalassemia, history of blood transfusion, cocaine and other drug use. Age >50 years and Hispanic ethnicity were associated with a decreased risk of HBV co-infection. ^ Conclusions. This is the largest cohort study in the United States on the prevalence of HBV co-infection. Among veterans with HCV, exposure to HBV is common (∼35%), but HBV co-infection is relatively low (1.4%). There is an increased risk of co-infection with younger age, male sex, HIV, and drug use, with decreased risk in Hispanics.^

The response of Texas public health agencies and workers to the emergency preparedness initiatives after 9/11

The purpose of this research was to better understand the impact of the terrorist attacks in 2001 on public health, particularly for Texas public health. This study employed mixed methods to examine changes to public health culture within Texas local public health agencies, important attitudes of public health workers toward responding to a disaster, and the funding policies that might ensure our investment in public health emergency preparedness is protected. ^ A qualitative analysis of interviews conducted with a large sample of public health officials in Texas found that all the constituent parts of a peculiar culture for public health preparedness existed that spanned the state's local health departments regardless of size, or funding level. The new preparedness culture in Texas had the hallmarks necessary for a robust public health preparedness and emergency response system. ^ The willingness of public health workers, necessary to make these kinds of changes and mount a disaster response was examined in one of Texas' most experienced disaster response teams—the public health workers for the City of Houston. A hypothesized latent variable model showed that willingness mediated all other factors in the model (self-efficacy, knowledge, barriers, and risk perception) for self-reported likelihood of reporting to work for a disaster. The RMSEA for the final model was 0.042 with a confidence interval of 0.036—0.049 and the chi-squared difference test was P=0.08, indicating a well-fitted model that suggests willingness is an important factor for consideration by preparedness planners and researchers alike. ^ Finally, with disasters on the rise and federal funding for preparedness dwindling, a review of states' policies for the distribution of these funds and their advantages and disadvantages were examined through a review of current literature and public documents, and a survey of state-level public health officials, emergency management professionals and researchers. Although the base plus per-capita method is the most common, it is not necessarily perceived to be the most effective. No clear "optimal" method emerged from the study, but recommendations for a strategic combination of three methods were made that has the potential to maximize the benefits of each method, while minimizing the weaknesses.^

La 'pija de oro' en Las aventuras del señor Maíz de Washington Cucurto : Algunas notas

El presente trabajo consiste en notas de una investigación en curso. Las mismas dan cuenta del dispositivo de escritura de Washington Cucurto en relación con la pija de oro del negro que se implanta el narrador/personaje Tyson Grande/ Washington Cucurto/Norberto Vega en Las aventuras del Señor Maíz (2005). Nos interesa pensar que esa prótesis quirúrgica y corporal exhibe fuerzas (en un sentido deleuziano) que rigen toda la producción de Cucurto/Vega: la social, la económica, la sexual y la cultural latinoamericana. La pija de oro es, entonces, una condensación poética que exhibe la máquina de escritura como una bestia melancólica en cuyo cuerpo se desequilibran fuerzas en disputa por la literatura

La 'pija de oro' en Las aventuras del señor Maíz de Washington Cucurto : Algunas notas

El presente trabajo consiste en notas de una investigación en curso. Las mismas dan cuenta del dispositivo de escritura de Washington Cucurto en relación con la pija de oro del negro que se implanta el narrador/personaje Tyson Grande/ Washington Cucurto/Norberto Vega en Las aventuras del Señor Maíz (2005). Nos interesa pensar que esa prótesis quirúrgica y corporal exhibe fuerzas (en un sentido deleuziano) que rigen toda la producción de Cucurto/Vega: la social, la económica, la sexual y la cultural latinoamericana. La pija de oro es, entonces, una condensación poética que exhibe la máquina de escritura como una bestia melancólica en cuyo cuerpo se desequilibran fuerzas en disputa por la literatura

La 'pija de oro' en Las aventuras del señor Maíz de Washington Cucurto : Algunas notas

El presente trabajo consiste en notas de una investigación en curso. Las mismas dan cuenta del dispositivo de escritura de Washington Cucurto en relación con la pija de oro del negro que se implanta el narrador/personaje Tyson Grande/ Washington Cucurto/Norberto Vega en Las aventuras del Señor Maíz (2005). Nos interesa pensar que esa prótesis quirúrgica y corporal exhibe fuerzas (en un sentido deleuziano) que rigen toda la producción de Cucurto/Vega: la social, la económica, la sexual y la cultural latinoamericana. La pija de oro es, entonces, una condensación poética que exhibe la máquina de escritura como una bestia melancólica en cuyo cuerpo se desequilibran fuerzas en disputa por la literatura

Jurassic sedimentation history at DSDP Hole 76-534A

Site 534 reflects a complex interplay of global, basinal, and local influences on sedimentation during the Callovian and Late Jurassic. Rifting and rapid subsidence of the continental margins of the North Atlantic-Tethys seaway occurred during the late Early Jurassic (Sinemurian-Pliensbachian), but rapid spreading between the North American margin (Blake Spur Ridge and magnetic lineation) and the northwest African margin did not commence until the Bathonian or earliest Callovian. Site 534, drilled on marine magnetic anomaly "M-28" of Bryan et al. (1980), was initially about 150 km from either continental margin. The ?middle Callovian basal sediments are dusky red silty marl. Callovian transgression led to active carbonate platforms on the margin, recorded at Site 534 as a rise in the CCD (carbonate compensation depth), then arrival of lime-rich turbidites from the Blake Plateau platform across the Blake Spur Ridge. The host pelagic sediment is greenish black, organic-rich, radiolarian-rich, silty claystone. Hydrothermal activity on the nearby spreading ridge enriched this lower unit in metals. In the Oxfordian, the input of terrestrial silt rapidly diminished; radiolarians or other bioclasts were not preserved. The dark variegated claystone has fine-grained marl and reddish claystone turbidite beds. The late Callovian-Oxfordian Western Tethys has radiolarian chert deposition, marine hiatuses, or organic-rich sediments. The Kimmeridgian and Tithonian had a stable or receding sea level. Near the end of the Jurassic many of the carbonate platforms of the margins were buried beneath prograding fan or alluvial deposits. Carbonate deposition shifted to the deep sea. Site 534 records the deepening of the CCD and ACD (aragonite compensation depth) during the Kimmeridgian and early Tithonian, then a rise of the ACD in the middle Tithonian. Similar trends occurred throughout the Western Tethys-Atlantic. High nannofossil productivity of the seaway led to deposition of very widespread white micritic limestone in the late Tithonian-Berriasian. The underlying sediment had a slower deposition rate of carbonate, therefore its higher clay and associated Fe content produced a red marl. A short sea-level incursion occurred on the Atlantic margins during the Kimmeridgian and is reflected in the Site 534 greenish gray marl unit by numerous turbidite beds of shallow-water carbonates.

Palynofacies investigation of Callovian sediments of DSDP Hole 79-534A

During the extension of Deep Sea Drilling Project (DSDP) Leg 76 a new and previously unpenetrated lithological unit composed mainly of claystones was cored above basalt basement at Site 534 in the Blake-Bahama Basin. The Callovian part of the new unit contains interbedded 'black shales' which were hitherto unexpected in this part of the section. This Paper presents a brief palynological examination of lithofacies-kerogen relationships in these sediments and shows that their organic content is almost entirely a function of the re-deposition of terrestial and marine organic matter versus the ambient redox conditions of the depositional environment. Allochthonous organic matter inputs are highest in the interbedded turbidites and decline progressively toward the pelagic black shales in which marine organic matter is comparatively well preserved. The significance of various kerogen and palynomorph indices are discussed. The study emphasizes the absolute necessity for sedimentologically-aware sampling in all palynological and geochemical work on lithologically heterogeneous sequences.