Probing the high momentum component of the deuteron at high Q2

The (2)H(e,e'p)n cross section at a momentum transfer of 3.5 (GeV/c)(2) was measured over a kinematical range that made it possible to study this reaction for a set of fixed missing momenta as a function of the neutron recoil angle θ(nq) and to extract missing momentum distributions for fixed values of θ(nq) up to 0.55  GeV/c. In the region of 35°≤θ(nq)≤45° recent calculations, which predict that final-state interactions are small, agree reasonably well with the experimental data. Therefore, these experimental reduced cross sections provide direct access to the high momentum component of the deuteron momentum distribution in exclusive deuteron electrodisintegration.

Statin treatment use in diabetic patients with breast cancer: A potential C-reactive protein mediated benefit

173

Background: Statin treatment has not yet been evaluated in relation to breast cancer (BC) prognosis in diabetes mellitus (DM) patients. Reported decreased survival following BC in women with metabolic syndrome, led us to investigate whether specific statin therapy may lead to improved BC survival. Reported associations between elevated C-reactive protein (CRP) levels at the time of diagnosis with worse cancer prognosis, and CRP-lowering properties of statin treatment in non-cancer patients, led us to investigate whether statin use is associated with lower CRP levels at the time of BC diagnosis and with improved BC outcomes.

Methods: All DM patients newly diagnosed with BC between 2003 and 2007 (Roswell Park Cancer Institute) were retrospectively reviewed (n = 225). BC pathology, outcomes, existing comorbidities and drug therapy were documented. Follow up began at BC diagnosis and ended with first confirmed recurrence and/or death, or last date of follow-up. Hazard ratios (HR) and 95% confidence intervals (CI)s representing the association between statins, BC and a defined event were computed with Cox proportional hazards model. CRP plasma levels were determined by enzyme-linked immunosorbent assay in specimens donated at the time of BC diagnosis. A total of 98 study patients, DM+BC, and their matched controls, BC only (n = 196) were analyzed.

Results: After a median follow up of 30 months, patients receiving statins for cholesterol management were found to have better disease-free survival (HR 0.27, 95% CI: 0.10, 0.71, X2 = 7.31, p = 0.06), and lower overall mortality (HR 0.23, 95% CI: 0.08, 0.66, X2 = 7.80, p = 0.05) compared to patients not receiving any cholesterol management medication. CRP levels have ranged between 0.2 and 21 mg/L and clinically relevant levels ( > 3mg/L) were noted in the study group.

Conclusions: This study explored for the first time the association between statin therapy and BC prognosis in DM. We observed improved outcomes in statin-treated patients. While we currently analyze statin therapy in relationship with baseline CRP levels and BC prognosis, our existing findings suggest that statins have the potential to improve BC outcomes potentially through lowering overall inflammation.

Fibroblast growth factor 23 in patients undergoing peritoneal dialysis

BACKGROUND AND OBJECTIVES

Fibroblast growth factor 23 (FGF23) is an independent risk factor for mortality in patients with ESRD. Before FGF23 testing can be integrated into clinical practice of ESRD, further understanding of its determinants is needed.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

In a study of 67 adults undergoing peritoneal dialysis, we tested the hypothesis that longer dialysis vintage and lower residual renal function and renal phosphate clearance are associated with higher FGF23. We also compared the monthly variability of FGF23 versus parathyroid hormone (PTH) and serum phosphate.

RESULTS

In unadjusted analyses, FGF23 correlated with serum phosphate (r = 0.66, P < 0.001), residual renal function (r = -0.37, P = 0.002), dialysis vintage (r = 0.31, P = 0.01), and renal phosphate clearance (r = -0.38, P = 0.008). In adjusted analyses, absence of residual renal function and greater dialysis vintage associated with higher FGF23, independent of demographics, laboratory values, peritoneal dialysis modality and adequacy, and treatment with vitamin D analogs and phosphate binders. Urinary and dialysate FGF23 clearances were minimal. In three serial monthly measurements, within-subject variability accounted for only 10% of total FGF23 variability compared with 50% for PTH and 60% for serum phosphate.

CONCLUSIONS

Increased serum phosphate, loss of residual renal function, longer dialysis vintage, and lower renal phosphate clearance are associated with elevated FGF23 levels in ESRD patients undergoing peritoneal dialysis. FGF23 may be a more stable marker of phosphate metabolism in ESRD than PTH or serum phosphate.

Temporal and spectral cues for musical timbre perception in electric hearing

PURPOSE

The purpose of this study was to investigate musical timbre perception in cochlear-implant (CI) listeners using a multidimensional scaling technique to derive a timbre space. Methods Sixteen stimuli that synthesized western musical instruments were used (McAdams, Winsberg, Donnadieu, De Soete, & Krimphoff, 1995). Eight CI listeners and 15 normal-hearing (NH) listeners participated. Each listener made judgments of dissimilarity between stimulus pairs. Acoustical analyses that characterized the temporal and spectral characteristics of each stimulus were performed to examine the psychophysical nature of each perceptual dimension.

RESULTS

For NH listeners, the timbre space was best represented in three dimensions, one correlated with the temporal envelope (log-attack time) of the stimuli, one correlated with the spectral envelope (spectral centroid), and one correlated with the spectral fine structure (spectral irregularity) of the stimuli. The timbre space from CI listeners, however, was best represented by two dimensions, one correlated with temporal envelope features and the other weakly correlated with spectral envelope features of the stimuli.

CONCLUSIONS

Temporal envelope was a dominant cue for timbre perception in CI listeners. Compared to NH listeners, CI listeners showed reduced reliance on both spectral envelope and spectral fine structure cues for timbre perception.

If I were a rich man could I sell a pancreas? A study in the locus of oppression

Dan Brock argues that since the unexploitable rich could sell their kidneys too, exploitation could not be an essential feature of organ vending. This paper takes his claim as the point of departure for a discussion on the locus of organ vending-associated oppression. While it accepts Brock's conclusion, it explores the possibility that such oppression is invariably found rather outside the sphere of exchange. It then analyses the implications of this possibility for the discourse surrounding the ethics of organ vending.

Listening habits of iPod users

PURPOSE

To estimate real-environment iPod listening levels for listeners in 4 environments to gain insight into whether average listeners receive dosages exceeding occupational noise exposure guidelines as a result of their listening habits.

METHOD

The earbud outputs of iPods were connected directly into the inputs of a digital recorder to make recordings of listening levels. These recordings were used to estimate listening levels using reference recordings made in a real ear. Recordings were made in 4 environments with a wide range of background noises: (a) a library, (b) a student center, (c) busy streets, and (d) the subway.

RESULTS

None of the 64 listeners were estimated to exceed allowable occupational dosages, with a maximum dose of 7.57% based on Occupational Safety and Health Administration (OSHA; 1998) methods and 10.83% based on National Institute for Occupational Safety and Health (NIOSH; 1998) methods.

CONCLUSIONS

All of the listeners surveyed were exposed to dosages well below OSHA and NIOSH occupational regulations. Although this does not guarantee individual safety, the results do not support the widespread concern regarding the safety of common iPod usage. However, measurements made in this study agree with the finding that iPod output can exceed safe levels and further support recommendations to monitor and limit listening volume and listening duration.

Creating and Sustaining Effective Partnerships to Advance Research on Youth With Serious Emotional and Behavioral Disorders

A key barrier to conducting research involving children and families is the difficulty of creating partnerships among researchers, treatment agencies, and schools. This article describes several key factors that were essential to establishing an effective research collaboration between practitioners and university-based researchers, including a mutual respect for the unique needs of research and practice; a strategy for joint decision making; a partnership model of incremental growth; a plan for mentoring junior faculty and students; a format for regular contact between the partners; and a plan for long-term sustainability. This collaboration has conducted over a dozen evaluation studies, as well as examined best practice issues surrounding the needs of children and families with serious emotional and behavioral needs. Even more important has been the lines of research that have been developed from this partnership which keeps the collaboration focused. The lessons learned from this research partnership should inform other collaborations.

Pilot study of dietary phosphorus restriction and phosphorus binders to target fibroblast growth factor 23 in patients with chronic kidney disease

BACKGROUND

High levels of fibroblast growth factor 23 (FGF23) are associated with mortality and progression of chronic kidney disease (CKD). Reducing dietary phosphorus intake lowers FGF23 secretion in healthly individuals, but there is little data on its effects in patients with pre-dialysis CKD.

METHODS

Using a 2×2 factorial design, we randomly assigned 16 normophosphataemic CKD stage 3-4 patients to receive a 2-week treatment with either lanthanum carbonate 1000 mg three times daily or placebo, and to ingest a tightly controlled diet containing 750 or 1500 mg of dietary phosphorus daily. We analysed serial measurements of FGF23, parathyroid hormone, serum phosphate and calcium, and 24-h urinary phosphate and calcium excretion using repeated-measures analyses.

RESULTS

Compared with the 1500-mg phosphorus diet, patients assigned to the 750-mg diet had greater reduction in 24-h urinary phosphate excretion (66% vs. 29%; P<0.0001). Lanthanum-treated patients experienced a significant reduction in 24-h urinary phosphate excretion compared with baseline (64%; P<0.0001), but the difference compared with placebo did not reach significance (64% vs. 31%). Despite the significant reductions in 24-h urinary phosphate excretion, no group demonstrated a significant reduction in FGF23 levels; FGF23 levels actually increased significantly in the 1500-mg diet plus placebo group, suggesting dietary phosphorus loading.

CONCLUSIONS

Although dietary phosphorus restriction and lanthanum lowered urinary phosphate excretion consistent with a rapid decrease in phosphorus absorption, inducing a reduction in FGF23 levels in CKD patients may require interventions with a longer duration than in healthy volunteers.

Racial differences in postprandial mineral ion handling in health and in chronic kidney disease

BACKGROUND

Increased serum phosphate is associated with cardiovascular disease. Compared with whites, blacks have significantly higher serum phosphate and increased risk of hyperphosphataemia in health and chronic kidney disease (CKD). While population-based studies suggest that diminished urinary phosphorus excretion in blacks may explain these differences, few physiological studies explored the potential mechanisms. The aim of this study was to examine racial differences in postprandial urinary mineral ion excretion in health and in CKD.

METHODS

Twenty-eight healthy (18 white and 10 black) and 19 CKD (9 white and 10 black) subjects consumed a standardized meal; after which, blood and urine samples were collected for 4 h for measurement of phosphate, calcium, parathyroid hormone (PTH) and fibroblast growth factor 23 (FGF23).

RESULTS

Although serum phosphate did not differ by race, blacks had ∼30% lower postprandial fractional excretion of phosphate than whites in health (P < 0.001) and CKD (P = 0.02). Similarly, blacks had ∼35% lower fractional excretion of calcium in health (P = 0.02) and CKD (P = 0.3). Moreover, the postprandial response in serum calcium among CKD subjects differed by race (P = 0.03), with serum calcium significantly decreasing in whites but not blacks.

CONCLUSIONS

Blacks had lower fractional excretion of phosphate than whites despite similar levels of PTH and FGF23 in health and in CKD, suggesting racial variability in renal sensitivity to phosphaturic hormones. Furthermore, blacks defend postprandial serum calcium more effectively than whites in CKD. Further studies are needed to define the mechanisms underlying these observations and evaluate whether racial differences in mineral ion handling may contribute to disparities in CKD outcomes.

Estimating loudness growth from tone-burst evoked responses

Several studies have investigated the relationship between click-evoked auditory brainstem responses (ABRs) and loudness growth in human listeners. While some of these studies have reported promising results, showing a correlative relationship between click ABR and loudness growth as a function of level, additional studies are necessary to determine if similar results can be obtained with frequency-specific stimuli and more specific details of the loudness function can be derived from ABR recordings. The aims of this study, therefore, were to (1) develop a fully objective procedure that segments specific features of evoked, tone-burst ABR recordings, (2) investigate the feasibility of using information derived from these recordings for estimating frequency-specific loudness-growth functions, and (3) determine to what extent the loudness-growth estimation performance through ABR can be improved by controlling for residual noise levels and parametric fitting. Results from eight normal-hearing listeners using 1- and 4-kHz stimuli show that the average mean-square error of the loudness-growth estimation obtained through the procedure is comparable to that of standard psychoacoustical procedures used to estimate loudness growth. The data set has been made publicly available at www.physionet.org.

Circulating fibroblast growth factor 23 in patients with end-stage renal disease treated by peritoneal dialysis is intact and biologically active

CONTEXT

Fibroblast growth factor 23 (FGF23) regulates phosphorus homeostasis and vitamin D metabolism. Circulating FGF23 levels are elevated in inherited and acquired hypophosphatemic disorders that can cause rickets or osteomalacia. Particularly increased concentrations of FGF23 are observed in patients with chronic kidney disease (CKD), in which increased FGF23 is associated with more rapid disease progression, improved bone mineralization, the development of left ventricular hypertrophy, and increased mortality.

OBJECTIVE

Our objective was to determine whether the markedly elevated levels of immunoreactive FGF23 in CKD represent accumulation of intact, biologically active hormone, C-terminal cleavage fragments, or both.

DESIGN

Biologically active FGF23 in plasma from CKD patients treated by peritoneal dialysis was quantified using a cell-based Egr-1 reporter assay; bioactive FGF23 levels were compared with those measured with immunometric FGF23 assays detecting either intact hormone alone or intact hormone and C-terminal fragments.

SETTING AND PATIENTS

Adult and pediatric patients with end-stage renal disease treated with peritoneal dialysis participated in the study at a tertiary referral center.

RESULTS

Serially diluted patient samples revealed levels of bioactive FGF23 that ran in parallel to CHO cell-derived recombinant human FGF23. FGF23 bioactivity was inhibited by an anti-FGF23 antibody. Levels of bioactive and immunoreactive FGF23 were tightly correlated, and Western blot analysis of FGF23 immunoprecipitated with anti-FGF23 antibodies from plasma of dialysis patients revealed only a single prominent protein band, which was indistinguishable from recombinant intact FGF23, without clear evidence for FGF23 fragments.

CONCLUSIONS

Our results provide strong evidence for the conclusion that virtually all circulating FGF23 in dialysis patients is intact and biologically active.

Molecular identification of the light brown apple moth (Lepidoptera: Tortricidae) in California using a polymerase chain reaction assay of the internal transcribed spacer 2 locus

A molecular protocol using a hemi-nested polymerase chain reaction (PCR) of the internal transcribed spacer region 2 (ITS2) is reported for the diagnosis of light brown apple moth, Epiphyas postvittana (Walker) (Lepidoptera: Tortricidae), in California. This protocol distinguishes the light brown apple moth from other moths in California based on size differences of PCR amplicons that are visualized on agarose gels. The molecular diagnostic tool generated no false negatives based on analysis of 337 light brown apple moths collected from California, Hawaii, England, New Zealand, and Australia. Analysis of a data set including 424 moths representing other tortricid species generated correct identification for >95% of the samples and only two false positives. Of the 761 moths tested only fourteen produced no PCR amplicons and five generated inconclusive data.

Analysis of parameters for the estimation of loudness from tone-burst otoacoustic emissions

There is evidence that tone-burst otoacoustic emissions (TBOAEs) might be useful for estimating loudness. However, within-listener comparisons between loudness and TBOAE measurements are an essential prerequisite to determine appropriate analysis parameters for loudness estimation from TBOAE measurements. The purpose of the present work was to collect TBOAE measurements and loudness estimates across a wide range of levels in the same listeners. Therefore, TBOAEs were recorded for 1- and 4-kHz stimuli and then analyzed using a wide range of parameters to determine which parameter set yielded the lowest mean-square-error estimation of loudness with respect to a psychoacoustical, cross-modality-matching procedure and the inflected exponential (INEX) loudness model. The present results show strong agreement between 1-kHz loudness estimates derived from TBOAEs and loudness estimated using cross-modality matching (CMM), with TBOAE estimation accounting for almost 90% of the CMM variance. Additionally, the results indicate that analysis parameters may vary within a reasonable range without compromising the results (i.e., the estimates exhibit some parametric robustness). The lack of adequate parametric optimization for TBOAEs at 4 kHz suggests that measurements at this frequency are strongly contaminated by ear-canal resonances, meaning that deriving loudness estimates from TBOAEs at this frequency is significantly more challenging than at 1 kHz.

Heterozygous mutations of the voltage-gated sodium channel SCN8A are associated with spike-wave discharges and absence epilepsy in mice

In a chemical mutagenesis screen, we identified the novel Scn8a^8J allele of the gene encoding the neuronal voltage-gated sodium channel Na_v1.6. The missense mutation V929F in this allele alters an evolutionarily conserved residue in the pore loop of domain 2 of Na_v1.6. Electroencephalography (EEG) revealed well-defined spike-wave discharges (SWD), the hallmark of absence epilepsy, in Scn8a^8J heterozygotes and in heterozygotes for two classical Scn8a alleles, Scn8a^med (null) and Scn8a^med-jo (missense). Mouse strain background had a significant effect on SWD, with mutants on the C3HeB/FeJ strain showing a higher incidence than on C57BL/6J. The abnormal EEG patterns in heterozygous mutant mice and the influence of genetic background on SWD make SCN8A an attractive candidate gene for common human absence epilepsy, a genetically complex disorder.

Argonaute2 is essential for mammalian gastrulation and proper mesoderm formation

Mammalian Argonaute proteins (EIF2C1-4) play an essential role in RNA-induced silencing. Here, we show that the loss of eIF2C2 (Argonaute2 or Ago2) results in gastrulation arrest, ectopic expression of Brachyury (T), and mesoderm expansion. We identify a genetic interaction between Ago2 and T, as Ago2 haploinsufficiency partially rescues the classic T/+ short-tail phenotype. Finally, we demonstrate that the ectopic T expression and concomitant mesoderm expansion result from disrupted fibroblast growth factor signaling, likely due to aberrant expression of Eomesodermin. Together, these data indicate that a factor best known as a key component of the RNA-induced silencing complex is required for proper fibroblast growth factor signaling during gastrulation, suggesting a possible micro-RNA function in the formation of a mammalian germ layer.

An introduction to induced loudness reduction

Induced loudness reduction (ILR) is a phenomenon by which a preceding higher-level tone (an inducer tone) reduces the loudness of a lower-level tone (a test tone). The strength of this effect depends on a number of parameters, reviewed here. Some of the implications of ILR on loudness data are presented via the analysis of several studies in which ILR likely resulted in otherwise unexplained biases in data sets. These results serve as examples of the pervasiveness of ILR in loudness measurements and indicate that it is necessary to consider ILR when designing any psychoacoustical experiment in which level varies.

Total flammable mass and volume within a vapor cloud produced by a continuous fuel-gas or volatile liquid-fuel release

The top-hat jet/plume model has recently been employed to obtain simple closed-form expressions for the mass of fuel in the flammable region of a vapor "cloud" produced by an axisymmetric (round) continuous-turbulent jet having positive or negative buoyancy [1]. The fuel release may be a gas or a volatile liquid. In this paper, the top-hat analysis is extended to obtain closed-form approximate expressions for the total mass (fuel+entrained air) and volume of the flammable region of a release cloud produced by either a round or a plane (two-dimensional) buoyant jet. These expressions lead to predicted average fuel concentrations in the flammable regions of the release clouds which, when compared with the stoichiometric concentration, serve as indicators of the potential severity of release cloud explosions. For a fixed release mass, the combustion overpressure following ignition of a hydrogen/air cloud is anticipated to be significantly lower than that due to ignition of a hydrocarbon/air cloud. The predicted average hydrogen concentration within the flammable region of the release cloud is below the lower detonability limit. The facility with which the expressions can be used for predictions of combustion overpressures is illustrated for propane releases and deflagrations in a closed compartment.

Reforming the acute phase of the inpatient journey

The medical admissions unit (MAU) of the Royal Free Hospital, London, should receive all acute accident and emergency (A&E) medical admissions. The unit aims to discharge 60% of patients and to transfer the remainder to a base ward within 48 hours of admission. This study tracked the patient journey from admission to A&E through the MAU during two parallel weeks, one year apart. Key bottlenecks were identified in the first audit and reforms implemented prior to the second. These reforms included improved transfer to base wards, improved weekend work patterns and improved access to investigation, specialist teams and pharmacy. The reforms served to facilitate the patient journey. A greater proportion of acute medical admissions were managed on the MAU and the number of patients exceeding a 48-hour stay fell from 55% to 10%. Both study periods demonstrated a peak in transfer activity from A&E in the 20 minutes before the four-hour target.