Diagnosis, management, and future developments of fibromuscular dysplasia

Fibromuscular dysplasia (FMD) is a nonatherosclerotic noninflammatory vascular disease that primarily affects women from age 20 to 60, but may also occur in infants and children, men, and the elderly. It most commonly affects the renal and carotid arteries but has been observed in almost every artery in the body. FMD has been considered rare and thus is often underdiagnosed and poorly understood by many health care providers. There are, however, data to suggest that FMD is much more common than previously thought, perhaps affecting as many as 4% of adult women. When it affects the renal arteries, the most common presentation is hypertension. When it affects the carotid or vertebral arteries, the patient may present with transient ischemic attack or stroke, or dissection. An increasing number of patients are asymptomatic and are only discovered incidentally when imaging is performed for some other reason or by the detection of an asymptomatic bruit. FMD should be considered in the differential diagnosis of a young person with a cervical bruit; a “swishing” sound in the ear(s); transient ischemic attack, stroke, or dissection of an artery; or in individuals aged ≤35 years with onset hypertension. Treatment consists of antiplatelet therapy for asymptomatic individuals and percutaneous balloon angioplasty for patients with indications for intervention. Patients with aneurysms should be treated with a covered stent or open surgical repair. Little new information has been published about FMD in the last 40 years. The recently instituted International Registry for Fibromuscular Dysplasia will remedy that situation and provide observational data on a large numbers of patients with FMD

The Public and the Profession’s Perception of Social Work

The social work profession has long been concerned about its mission and perception. The two interests go hand in hand, because to have an effect on how we as social workers are viewed, we must be self-aware about who we are and what we do. This paper will address how social work periodically reflects upon and re-assesses its purpose because of internal considerations, such as the profession’s ethics, and external forces, including the job market and public perception. Some of the research conducted over the years into public perception of social work as well as that of our clients will be presented and compared. In addition, I review how the media have portrayed the field, and how we as professionals have marketed ourselves. Finally, some suggestions will be offered, which can be applied at various levels, including direct practice, program development and evaluation, administration, and branding of the profession as a whole

Toward Guidelines for Harvest Intensities and Regeneration Targets with Minimal Impact Upon Retained Genetic Diversity in Central Hardwood Tree Species

There is an urgent need for a coordinated and systematic approach to the in situ conservation of the genetic resources of commercially important forest tree species in the Central Hardwoods. Effective in situ management of genetic resources would benefit from clear guidelines for how many adult trees can be harvested with minimal impact on allelic diversity. We are constructing a computer model for this purpose, and present preliminary results based upon replicate harvests of a virtual forest stand consisting of 200 adult trees. Our model explores how much regeneration is needed so that there is no more than a 10 percent risk of retaining less than 90 percent of the original allelic diversity. In the absence of regeneration, up to 55 percent of the adult trees can be harvested without exceeding the 10 percent risk level. At higher harvest intensities, locally-derived regeneration is needed to replace the alleles removed from the adult population. When all 200 adult trees are harvested, the 10 percent risk level is not exceeded if there are at least 116 regenerants, provided that these are derived from pre-harvest random mating among the adults. In the presence of substantial pollen flow from a genetically differentiated outside pollen source (e.g., 10-20 percent pollen flow), the minimum amount of regeneration needed is reduced. This indicates that outside pollen can be more efficient, relative to pollen from within the stand, at replacing alleles lost from the adult population

Class Is Not Dead! It Has Been Buried Alive

By means of a reanalysis of the most relevant data source—the International Social Mobility and Politics File—this article criticizes the newly grown consensus in political sociology that class voting has declined since World War II. An increase in crosscutting cultural voting, rooted in educational differences rather than a decline in class voting, proves responsible for the decline of traditional class-party alignments. Moreover, income differences have not become less but more consequential for voting behavior during this period. It is concluded that the new consensus has been built on quicksand. Class is not dead—it has been buried alive under the increasing weight of cultural voting, systematically misinterpreted as a decline in class voting because of the widespread application of the so-called Alford index

Different histories but similar genetic diversity and structure for black walnut in Indiana and Missouri

—Missouri and Indiana have markedly different histories of glaciation and recolonization by forest trees. These states also differ in land use patterns and degree of anthropogenic landscape change such as forest fragmentation. To determine the overall effects of these and other demographic differences on the levels of genetic diversity and structure in black walnut (Juglans nigra L.) more than 550 total black walnut trees from nine populations in Indiana and 10 in Missouri were sampled and analyzed using 12 nuclear microsatellite loci. Although genetic diversity parameters such as allelic richness and expected heterozygosity were high overall, they varied little among populations and their mean values for the two states were not significantly different. Pairwise genetic distance values between all population pairs ranged from 0.012-0.159, but no significant pattern of isolation by distance was detected. The estimate of the degree of genetic differentiation between states (FPT = 0.0009) was very small and not significant, indicating that differences between states explained an inconsequential portion of the total variance. The observed low levels of local and regional genetic structure indicate that high levels of pollen flow have buffered black walnut from the genetic consequences of founder effects and genetic drift in both geologic and recent time scales

Elevated osteoprotegerin is associated with abnormal ankle brachial indices in patients infected with HIV: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Patients infected with HIV have an increased risk for accelerated atherosclerosis. Elevated levels of osteoprotegerin, an inflammatory cytokine receptor, have been associated with a high incidence of cardiovascular disease (including peripheral arterial disease, or PAD), acute coronary syndrome, and cardiovascular mortality. The objective of this study was to determine whether PAD is prevalent in an HIV-infected population, and to identify an association with HIV-specific and traditional cardiovascular risk factors, as well as levels of osteoprotegerin.</p> <p>Methods</p> <p>One hundred and two patients infected with HIV were recruited in a cross-sectional study. To identify the prevalence of PAD, ankle-brachial indices (ABIs) were measured. Four standard ABI categories were utilized: ≤ 0.90 (definite PAD); 0.91-0.99 (borderline); 1.00-1.30 (normal); and >1.30 (high). Medical history and laboratory measurements were obtained to determine possible risk factors associated with PAD in HIV-infected patients.</p> <p>Results</p> <p>The prevalence of PAD (ABI ≤ 0.90) in a young HIV-infected population (mean age: 48 years) was 11%. Traditional cardiovascular risk factors, including advanced age and previous cardiovascular history, as well as elevated C-reactive protein levels, were associated with PAD. Compared with patients with normal ABIs, patients with high ABIs had significantly elevated levels of osteoprotegerin [1428.9 (713.1) pg/ml vs. 3088.6 (3565.9) pg/ml, respectively, p = 0.03].</p> <p>Conclusions</p> <p>There is a high prevalence of PAD in young HIV-infected patients. A number of traditional cardiovascular risk factors and increased osteoprotegerin concentrations are associated with abnormal ABIs. Thus, early screening and aggressive medical management for PAD may be warranted in HIV-infected patients.</p

Problem formulation in the environmental risk assessment for genetically modified plants

Problem formulation is the first step in environmental risk assessment (ERA) where policy goals, scope, assessment endpoints, and methodology are distilled to an explicitly stated problem and approach for analysis. The consistency and utility of ERAs for genetically modified (GM) plants can be improved through rigorous problem formulation (PF), producing an analysis plan that describes relevant exposure scenarios and the potential consequences of these scenarios. A properly executed PF assures the relevance of ERA outcomes for decision-making. Adopting a harmonized approach to problem formulation should bring about greater uniformity in the ERA process for GM plants among regulatory regimes globally. This paper is the product of an international expert group convened by the International Life Sciences Institute (ILSI) Research Foundation