Combinatorial treatment of acute spinal cord injury with ghrelin, ibuprofen, C16, and ketogenic diet does not result in improved histologic or functional outcome

Because of the complex, multifaceted nature of spinal cord injury (SCI), it is widely believed that a combination of approaches will be superior to individual treatments. Therefore, we employed a rat model of cervical SCI to evaluate the combination of four noninvasive treatments that individually have been reported to be effective for acute SCI during clinically relevant therapeutic time windows. These treatments included ghrelin, ibuprofen, C16, and ketogenic diet (KD). These were selected not only because of their previously reported efficacy in SCI models but also for their potentially different mechanisms of action. The administration of ghrelin, ibuprofen, C16, and KD several hours to days postinjury was based on previous observations by others that each treatment had profound effects on the pathophysiology and functional outcome following SCI. Here we showed that, with the exception of a modest improvement in performance on the Montoya staircase test at 8-10 weeks postinjury, the combinatorial treatment with ghrelin, ibuprofen, C16, and KD did not result in any significant improvements in the rearing test, grooming test, or horizontal ladder. Histologic analysis of the spinal cords did not reveal any significant differences in tissue sparing between treatment and control groups. Although single approaches of ghrelin, ibuprofen, C16, and KD have been reported to be beneficial after SCI, our results show that the combination of the four interventions did not confer significant functional or histological improvements in a cervical model of SCI. Possible interactions among the treatments may have negated their beneficial effects, emphasizing the challenges that have to be addressed when considering combinatorial drug therapies for SCI.

Bound phytophenols from ready-to-eat cereals: comparison with other plant-based foods

Whole-grain diets are linked to reduced risk of several chronic diseases (heart disease, cancer, diabetes, metabolic syndrome) and all-cause mortality. There is increasing evidence that these benefits are associated with the gut microbiota and that release of fibre-related phenolic metabolites in the gut is a contributing factor. Additional sources of these metabolites include fruits and vegetables, but the evidence for their protective effects is less well established. With respect to the availability of bound phytophenols, ready-to-eat cereals are compared with soft fruits (considered rich in antioxidants) and other commonly consumed fruits and vegetables. The results demonstrated that when compared with an equivalent serving of fruits or vegetables, a recommended portion of whole-grain cereals deliver substantially higher amounts of bound phytophenols, which are available for metabolism in the colon. The increased amount of these phenolic metabolites may, in part, explain the evidence for the protective effects of whole-grain cereals.

Sibling, peer, neighbor, and schoolmate correlations as indicators of the importance of context for adolescent development

We use nationally representative data to calculate correlations in achievement and delinquency between genetically differentiated siblings within a family, between peers as defined by adolescents' "best friend" nominations, between schoolmates living in the same neighborhood, and between grademates within a school. We find the largest correlations between siblings, especially identical twins. Grademate and neighbor correlations are small. Peer-based correlations are considerably larger than grademate and neighbor correlations but not larger than most sibling correlations. The data suggest that family-based factors are several times more powerful than neighborhood and school contexts in affecting adolescents' achievement and behavior.

Work-based antipoverty programs for parents can enhance the school performance and social behavior of children

We assess the impact of the New Hope Project, an antipoverty program tested in a random assignment experimental design, on family functioning and developmental outcomes for preschool- and school-aged children (N = 913). New Hope offered wage supplements sufficient to raise family income above the poverty threshold and subsidies for child care and health insurance to adults who worked full-time. New Hope had strong positive effects on boys' academic achievement, classroom behavior skills, positive social behavior, and problem behaviors, as reported by teachers, and on boys' own expectations for advanced education and occupational aspirations. There were not corresponding program effects for girls. The child outcomes may have resulted from a combination of the following: Children in New Hope families spent more time in formal child care programs and other structured activities away from home than did children in control families. New Hope parents were employed more, had more material resources, reported more social support, and expressed less stress and more optimism about achieving their goals than did parents in the control sample. The results suggest that an anti-poverty program that provides support for combining work and family responsibilities can have beneficial effects on the development of school-age children.

Family poverty, welfare reform, and child development

Our review of research suggests that family poverty has selective effects on child development. Most important for policy are indications that deep or persistent poverty early in childhood affects adversely the ability and achievement of children. Although the 1996 welfare reforms have spurred many welfare-to-work transitions, their time limits and, especially, sanctions are likely to deepen poverty among some families. We suggest ways policies might be aimed at preventing either economic deprivation itself or its effects.

Rat metallothionein-2 contains N(alpha)-acetylated and unacetylated isoforms

Mammalian metallothioneins (MT), are characteristically N(alpha)-acetylated and the presence of an unblocked N-terminus has not previously been reported. On-line capillary electrophoresis-electrospray mass spectrometry of hepatic MT-2 from rats injected with zinc revealed two isoforms differing by a mass equivalent to that of a single acetyl group. The lower mass component constituted > 20% of total MT-2 protein and both MT-2 isoforms were separated by reversed-phase high-performance liquid chromatography. The identity of each fraction was confirmed by matrix-assisted laser desorption ionisation mass spectrometry, and amino acid analysis and N-terminal sequencing revealed that the lower mass isoform was unblocked at the N-terminus and had an amino acid composition and sequence which is characteristic of rat MT-2. Thus the complementary techniques of mass spectrometry and N-terminal sequencing demonstrated conclusively that purified MT-2 from zinc-treated rats contains an unacetylated isoform. We propose that the cotranslational acetylation of rat MT-2 may under some circumstances be inefficient compared to that in other nonrodent species, where we have detected only trace levels of unacetylated MT isoforms.

Gender and the socioeconomic gradient in mortality

Despite considerable evidence documenting a strong and persistent relationship between socioeconomic position and mortality, recent research suggests that this association may be weaker among women. In our examination of gender differences in the socioeconomic gradient in mortality, we argue that this inconsistency arises from the failure to consider the ways in which gender is a fundamental constituent of socioeconomic position. The data used are from the Panel Study of Income Dynamics. Respondents, including all household heads and their partners, aged 29 years and older in 1972 (N = 5,665; 56% female), were followed until 1991, death, or attrition. Discrete time event history analysis was used to examine the predictors of death between 1972 and 1991. Of the key socioeconomic predictors, years of education was measured at baseline, while earned income was a time-varying covariate. We find no gender differences in the effect of respondents' own socioeconomic positions on their mortality risk. However, increasing spousal income raises men's odds of dying, while the opposite is true for women. Our results raise questions about the prevailing view that the socioeconomic gradient in mortality is weaker among women. Moreover, gender differences in the effects of spousal earnings on mortality risk suggest that their labor market rewards have fundamentally different meanings for women and men.

Macro-to-micro links in the relation between income inequality and mortality

A growing literature points to links between income inequality and mortality. Any examination of the link should distinguish, both theoretically and empirically, between shifts in inequality that result from changes in the bottom and top of the income distribution. When state-level data from the U.S. censuses of 1980 and 1990 were used to measure differences in mortality, the results indicated that inequality measures reflecting depth of poverty show stronger correlations with mortality than do inequality measures reflecting heights of affluence. In addition, longitudinal data from the Panel Study of Income Dynamics were used to related state-level inequality measures to individual-level data on mortality. This comparison revealed significant associations between degree of income inequality in state of residence and individual risk of death only for nonelderly individuals with middle-class incomes in 1990.

Kienbock's disease: treatment by implantation of vascular pedicle and bone grafting

Eleven patients with stage II and IIIA Kienbock's disease treated with vascular pedicle implantation and bone grafting were reviewed to determine the long term efficacy of the procedure. Eight wrists had a negative ulnar variance and three wrists had a neutral ulnar variance. The procedure involved implanting the second dorsal metacarpal artery and its venae commitantes into a hole made in the lunate through a dorsal approach. Cancellous bone graft from the dorsal aspect of the distal radius was loosely packed in the hole to secure the pedicle. Follow-up was from 37 to 140 months with an average of six years. Nine patients had significant long term pain relief, improved function, and required no additional procedures. In two patients, continued pain necessitated proximal row carpectomy at two and 4.5 years postoperatively. Ten of the eleven patients had no worsening of their radiographic staging, but in no patient was the architecture of the lunate restored. There were no complications. The results are promising enough to recommend consideration of this procedure in the early stages of Kienbock's disease in patients with a neutral or negative ulnar variance.

Income dynamics and adult mortality in the United States, 1972 through 1989

OBJECTIVES

The aim of this study was to examine relationships between income and mortality, focusing on the predictive utility of single-year and multiyear measures of income, the shape of the income gradient in mortality, trends in this gradient over time, the impact of income change on mortality, and the joint effects of income and age, race, and sex on mortality risk.

METHODS

Data were taken from the Panel Study of Income Dynamics for the years 1968 through 1989. Fourteen 10-year panels were constructed in which predictors were measured over the first 5 years and vital status over the subsequent 5 years. The panels were pooled and logistic regression was used in the analysis.

RESULTS

Income level was a strong predictor of mortality, especially for persons under the age of 65 years. Persistent low income was particularly consequential for mortality. Income instability was also important among middle-income individuals. Single-year and multiyear income measures had comparable predictive power. All effects persisted after adjustment for education and initial health status.

CONCLUSIONS

The issues of low income and income instability should be addressed in population health policy.

The effects of poverty on children

Although hundreds of studies have documented the association between family poverty and children's health, achievement, and behavior, few measure the effects of the timing, depth, and duration of poverty on children, and many fail to adjust for other family characteristics (for example, female headship, mother's age, and schooling) that may account for much of the observed correlation between poverty and child outcomes. This article focuses on a recent set of studies that explore the relationship between poverty and child outcomes in depth. By and large, this research supports the conclusion that family income has selective but, in some instances, quite substantial effects on child and adolescent well-being. Family income appears to be more strongly related to children's ability and achievement than to their emotional outcomes. Children who live in extreme poverty or who live below the poverty line for multiple years appear, all other things being equal, to suffer the worst outcomes. The timing of poverty also seems to be important for certain child outcomes. Children who experience poverty during their preschool and early school years have lower rates of school completion than children and adolescents who experience poverty only in later years. Although more research is needed on the significance of the timing of poverty on child outcomes, findings to date suggest that interventions during early childhood may be most important in reducing poverty's impact on children.

Economic mobility of young workers in the 1970s and 1980s

This paper uses longitudinal data to estimate cohort changes in the earnings trajectories of young adult males. Levels of earnings are uniformly lower for male workers turning 21 between 1980 and 1991 than in 1970-1979, although rates of earnings growth are roughly comparable. Among males turning 21 before 1980, six in 10 (60%) of all men and seven in 10 (71%) college-educated men attained earnings levels by age 30 that were at least twice the poverty level. Corresponding fractions for workers turning 21 between 1980 and 1991 were considerably lower (42% and 56%). Recent cohorts from all demographic subgroups appeared to have more difficulty than older cohorts in attaining middle-class earnings.

Income dynamics and health

The focus of this article is the economic dimension of socioeconomic status as it relates to health. In contrast to the assumptions of many life cycle models, the author finds household income to be quite volatile for many families, even during periods of macroeconomic growth. Income inequality has increased dramatically in the last 20 years. Studies relating various measures of health (e.g., low birth weight; cognitive development, stunting, wasting in early childhood; mortality in later adult years) to longitudinal measures of family income often find quite powerful effects of income, even after controlling for correlated aspects of socioeconomic status and baseline health status. The author discusses strategies for modeling income effects.

Ethnic differences in children's intelligence test scores: role of economic deprivation, home environment, and maternal characteristics

We examine differences in intelligence test scores of black and white 5-year-olds. The Infant Health and Development Program data set includes 483 low birthweight premature children who were assessed with the Wechsler Preschool and Primary Scale of Intelligence. These children had been followed from birth, with data on neighborhood and family poverty, family structure, family resources, maternal characteristics, and home environment collected over the first 5 years of life. Black children's IQ scores were 1 SD lower than those of white children. Adjustments for ethnic differences in poverty reduced the ethnic differential by 52%. Adjustments for maternal education and whether the head of household was female did not reduce the ethnic difference further. However, differences in home environment reduced the ethnic differential by an additional 28%. Adjustments for economic and social differences in the lives of black and white children all but eliminate differences in the IQ scores between these two groups.

Entrapment of the palmar cutaneous branch of the median nerve by a normal palmaris longus tendon

An anomalous course of the palmar cutaneous branch of the median nerve was noted in a patient with symptoms of compression of the median nerve and its palmar cutaneous branch at the wrist level. The palmar cutaneous branch of the nerve pierced the tendon of a normal palmaris longus muscle near its insertion. Decompression of the median nerve and its palmar cutaneous branch was performed, with complete relief of symptoms.

One hundred years of automobile-induced orthopedic injuries

As the automobile has evolved over its first 100 years, many changes have improved its safety and have resulted in lower fatality rates. To a great extent, physicians have provided the thrust for these improvements. Now, as more people survive automobile accidents, injuries to the musculoskeletal system take on importance as causes of individual disability and social cost. The patterns of automobile-induced orthopedic injuries continue to change. This article reviews the first 100 years of these injury patterns and relates their occurrence to specific automobile design features and oversights. Because any one automobile accident is likely to injury only a few people at most, trends and patterns are much more difficult to ascertain than for mass transit vehicular accidents. For this reason, physician awareness of contemporary injury patterns is the first step toward safer automobile design.

Sharing prosperity across the age distribution: a comparison of the United States and Germany in the 1980s

Using six waves of data from the Panel Study of Income Dynamics and the German Socio-Economic Panel we compare the relative economic well-being of Americans and Germans in the 1980s. Economic growth during the 1980s substantially improved the economic well-being of the average person in the both the United States and Germany. But the rewards were disproportionately distributed across age and gender. In both countries, the family incomes of the very old, the very young and women were lower and grew more slowly than did the income of other families. Social security policy in Germany was more successful than American policy in providing income security in old age. But, despite massive social security programs in both countries, older women were still the most vulnerable members of society, in part because of a substantial drop in the level of social insurance they received following the death of their spouse.

Economic deprivation and early childhood development

We consider 3 questions regarding the effects of economic deprivation on child development. First, how are developmental outcomes in childhood affected by poverty and such poverty correlates as single parenthood, ethnicity, and maternal education? Second, what are the developmental consequences of the duration and timing of family economic deprivation? And, third, what is the comparative influence of economic deprivation at the family and neighborhood level? We investigate these issues with longitudinal data from the Infant Health and Development Program. We find that family income and poverty status are powerful correlates of the cognitive development and behavior of children, even after accounting for other differences--in particular family structure and maternal schooling--between low- and high-income families. While the duration of poverty matters, its timing in early childhood does not. Age-5 IQs are found to be higher in neighborhoods with greater concentrations of affluent neighbors, while the prevalence of low-income neighbors appears to increase the incidence of externalizing behavior problems.

Validation in sheep of the doubly labeled water method for estimating CO2 production

Carbon dioxide production (rCO2) was estimated in four sheep over a period of 10 days using doubly labeled water (2H and 18O) and was compared with simultaneous respiration chamber measurements of CO2. The excess 2H and 18O measurements were corrected for the empirically determined effects of isotope rebreathing within the confines of the chambers. A weighted monoexponential curve was then fitted to the data from which isotope flux rates and ultimately rCO2 and water turnover (rH2O) estimates were made. The curve fits were weighted assuming a Poisson model. Selection of this weighting policy did not bias the results, and curvature in the data also appeared to have little effect on the rCO2 estimates. Fractionated evaporative water loss expressed as a fraction of rH2O (X) was estimated from water balance and breath water production estimates; the mean X was 0.145 and ranged from 0.108 to 0.183. Corrections for 2H loss in fecal solids reduced the mean rH2O (4,746 g/day) by 35.5 g/day and increased the mean rCO2 (332.3 l/day) by 21.2 l/day. Further corrections to account for 2H loss in methane (mean production rate 27.2 l/day) reduced rH2O by 33.8 g/day and increased rCO2 by 20.3 l/day. The final isotopic estimates of rH2O were 14.6 +/- 6.59% (n = 4) lower than direct measurements and the mean rCO2 was 3.5 +/- 14.48% (n = 4) lower than the chamber measured rCO2. However, in one of the animals studied the rCO2 deviated markedly from the chamber-derived value, and this discrepancy has yet to be explained. When this animal was excluded from the comparisons, the standard deviation was greatly reduced (+/- 3.6, n = 3) and the mean overall error on rCO2 was +3.6%.

Magnetic resonance imaging to visualize the internal anatomy in the Baller-Gerold syndrome

The Baller-Gerold syndrome is identified by radial aplasia with craniosynostosis. Only 12 cases have been reported previously in the literature; none of the reports describe surgical treatment for the radial aplasia. We report the case of a 10-month-old female infant with this syndrome, including severe bilateral radial clubhands. A radial anlage, which was tethering growth of the ulna, was suspected on physical examination and confirmed with magnetic resonance imaging. Resection of the anlage resulted in dramatic improvement in elbow extension, but additional follow-up will be necessary to determine the complete functional effect of the procedure.

Remarriage patterns among recent widows and widowers

Remarriage is one of the most important determinants of physical and economic well-being among the widowed. The goal of this study is to estimate how hazard rates for remarriage vary among widows and widowers on the basis of both observable and unobservable characteristics. The remarriage estimates rely on nationally representative samples of widows and widowers from the Panel Study of Income Dynamics. Continuous-time hazard rate regressions indicate strong age and duration dependence effects for middle-aged widows and widowers and for older widowers. Among middle-aged widows, blacks and those with dependent children in the home have lower rates of remarriage. For middle-aged widowers, living in urbanized areas limits the prospects of remarriage. For older widowers, education and, to some extent, economic status appear to have positive effects on the remarriage rates. Overall, age and time since widowhood have the strongest and most consistent effects on remarriage rates for different widowed groups.

Wife or Frau, women do worse: a comparison of men and women in the United States and Germany after marital dissolution

Longitudinal data from the Panel Study of Income Dynamics and the German Socio-Economic Panel show that in the Federal Republic of Germany, women experience even sharper drops in economic status immediately after a marital split than in the United States, while German and American men fare about the same. German social policy does little to reduce the disparities.

Poverty dynamics in widowhood

Data from a national sample of widows of all ages were used to examine links between poverty and widowhood. We found that widowhood drops living standards by 18 percent, on average, and pushes 10 percent of women whose incomes were above the poverty line prior to widowhood into poverty after it. Not surprisingly, economic status prior to widowhood is the strongest predictor of status during widowhood. Striking in the data is the instability of family income during widowhood, producing substantial numbers of exits from poverty.

Renal function predicts colchicine toxicity: guidelines for the prophylactic use of colchicine in gout

In order to establish the degree of renal malfunction necessary for colchicine toxicity in patients receiving it daily for the prevention of recurrent acute gout, we obtained serum creatinine levels and measured or estimated creatinine clearances in a consecutive series of 17 patients with demonstrated colchicine myotoxicity. An estimate of creatinine clearance, based on ideal body weight and age, was nearly always 50 ml/min or less, and was the most practical predictor of the risk of toxicity. By comparison, patients with gout from the same clinical data base, but without myotoxicity, had normal renal function. The data yield clear guidelines for safe use of colchicine chronically.

United States public policy and the elderly: the disproportionate risk to the well-being of women

"Cross-sectional comparisons show that poverty among the aged in the United States has dropped dramatically over the last two decades. We use longitudinal data to identify economic events associated with unfavorable economic outcomes and to trace the influence of these events on women and men at different ages. We find that while social insurance programs appear to prevent severe financial hardship from the most frequent work-related events, they are far less effective in cushioning the economic impact of widowhood and divorce, especially for women. We suggest a number of policy changes that would provide some measure of social insurance against adverse family-related events."

Echinococcus infestation of the biceps brachii. A case report

Echinococcus is a genus of tapeworm endemic in certain parts of the world but found only rarely in the United States. An extremely unusual case of an intramuscular infestation involving an extremity occurred in a 41-year-old man. Since the infestation closely resembled a soft-tissue tumor on clinical and roentgenographic examination, the patient was treated with an incisional biopsy of the mass, which consisted of a cystic cavity filled with clear fluid. The diagnosis of an Echinococcus cyst was made only after permanent section analysis revealed numerous scoleces within the cyst lining. The patient was asymptomatic six months after cyst excision but still remains at risk for recurrence of the infestation. The present report serves to alert the reader to this rare but potentially fatal condition. Preoperative diagnosis is imperative to avoid inadvertant rupture of a hydatid cyst, which releases viable scoleces into the systemic circulation and may precipitate an anaphylactic reaction.

Welfare benefits, economic opportunities, and out-of-wedlock births among black teenage girls

This article presents a model of teenage out-of-wedlock births that incorporates the effects of both welfare and nonwelfare economic opportunities. We construct measures of the likely "medium-run" income available to a teenage girl in the event of an out-of-wedlock birth and in the absence of a birth and then estimate a logit model to determine their importance in influencing fertility behavior. The model is estimated with data from the Panel Study of Income Dynamics on nearly 900 black teenagers. We find weak and statistically insignificant positive effects of Aid to Families With Dependent Children (AFDC) benefit levels and stronger and significant negative effects of economic opportunities on the probability of AFDC-related out-of-wedlock teen births.

Teenage welfare receipt and subsequent dependence among black adolescent mothers

Black teenage mothers who receive benefits through Aid to Families with Dependent Children (AFDC) around the time they give birth are more likely to be receiving AFDC at age 26 than are other black teenage mothers or women who do not have a teenage birth, even after adjustments are made for differences in parental background and the economic accomplishments of siblings. Moreover, they are also more likely to have a lower earned family income and a lower total family income (when transfer income such as AFDC is taken into account). The results of this analysis suggest that AFDC receipt around the time of a nonmarital teenage birth itself may be an independent cause of future economic problems for these young mothers, although they do not elucidate the causal mechanism by which such an association might operate.

What are the economic consequences of divorce?

Our analysis suggests that Weitzman's finding concerning the precipitous decline in the economic status of women following divorce is likely to be incorrect. Her findings not only imply improbably large changes in income but are also inconsistent with the information she reports on changes in income and in income per capita. Corrected estimates suggest a decline in economic status of about one-third, rather than the widely cited 73 percent figure. It remains the case that the economic status of men and women diverge substantially in the years after divorce. That difference, however, is not nearly as dramatic as suggested by Weitzman's findings.

Multinomial and conditional logit discrete-choice models in demography

Although discrete-choice statistical techniques have been used with increasing regularity in demographic analyses, McFadden's conditional logit model is less well known and seldom used. Conditional logit models are appropriate when the choice among alternatives is modeled as a function of the characteristics of the alternatives, rather than (or in addition to) the characteristics of the individual making the choice. We argue that this feature of conditional logit makes it more appropriate for estimating behavioral models. In this article, the conditional logit model is presented and compared with the more familiar multinomial logit model. The difference between the two techniques is illustrated with an analysis of the choice of marital and welfare status by divorced or separated women.

Welfare dependence within and across generations

A central question in the debate about the effects of welfare programs is whether their intended positive results--providing needed resources to recipients and their children--outweigh any unintended negative results--for example, the breaking up of families, reduction in work effort, or the fostering of a welfare "culture" that is passed on from parent to child. Recent research shows that although work effort is affected adversely by the generosity of welfare programs, effects on family structure appear quite weak, most welfare experiences are relatively short, and the majority of women who grew up in homes heavily dependent on welfare do not rely on those programs when they are young adults.

A reconsideration of the economic consequences of marital dissolution

A close look at the income flows in the years following a divorce or separation reveals marked differences in the distribution of effects. The economic consequences of divorce are especially adverse for women. In most cases, children remain with the mother, who usually has considerably lower potential labor market earnings than her former husband, partly because her responsibilities for the children are likely to reduce her labor supply and may have limited her past human capital investments. Alimony and child support are the principal mechanisms for transfers from the ex-husband to the ex-wife, but payments are rarely frequent or sizeable enough to make up for an appreciable amount of the labor income lost through the departure of the ex-husband. Human capital investments on the part of the mother have a modest effect on her economic situation in the years following the divorce. Most men who divorce or separate are immediately better off because they retain most of their labor incomes, typically do not pay large amounts of alimony and child support to their ex-wives, and no longer have to provide for the level of needs associated with their former families. Much more important than growth in the ex-wife's own labor income is the role of a new husband's labor income upon her remarriage. More than half of the white women remarry within five years following a divorce or separation; the comparable fraction for black women is less than half. An interesting question is whether the currently unmarried would enjoy the same kind of economic benefits, were they to remarry, as women who have remarried. Estimates from a model of the new husband's labor income, adjusted for selection bias inherent in the process of remarriage, indicate that the currently unmarried would probably not gain equal benefits if they were to remarry. The expected labor income of potential husbands of black women averages only about $5000--a modest amount when compared with the alternatives available to these women.