with all other racial/ethnic groups included in the total). The gastroschisis case definition was based on the British Pediatric Association Classification of Diseases code (756.71) or the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for gastroschisis (756.73, or before 10/1/2009, 756.79, with verification to confirm cases of gastroschisis, because the previous code was shared with omphalocele). Gastroschisis cases included live births, fetal deaths, † and elective terminations. § Data were pooled at CDC, and gastroschisis prevalence was calculated for each year, maternal age group, and race/ethnicity. Prevalence was calculated as number of gastroschisis cases among all birth outcomes divided by the total number of live births. The denominators of total number of live births in the same catchment area as the birth defects surveillance program were reported by states or obtained from public use data files. Poisson exact methods were used to calculate 95% CIs for each prevalence estimate. Prevalence ratios were calculated by dividing the prevalence during 2006-2012 by the prevalence during 1995-2005, and CIs for the prevalence ratios were calculated using Poisson regression.Because the comparison of prevalence between the two study periods involved an artificial breakpoint during the 18-year data span and only examined pooled prevalence within those periods, joinpoint regression analysis was used to identify statistically significant changes in the annual prevalence of gastroschisis over the course of the entire study period (1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012). Joinpoint regression initially models annual trend data by fitting a straight line (i.e., zero joinpoints). Then, joinpoints are added, one at a time, and a Monte Carlo permutation test is used to determine the optimal number of joinpoints. Each joinpoint in the final model corresponds to a significant change in the trend, and an AAPC and its 95% CI are calculated to describe how the rate changes within each time interval (3). The estimated overall percent change was calculated by first converting the AAPC to the projected single year change in prevalence and then exponentiating to the number of years studied minus one to estimate the total increase throughout the 18 years. This gives the magnitude of the increase, which

Damage to the intestinal mucosa results in the translocation of microbes from the intestinal lumen into the circulation. Microbial translocation has been proposed to trigger immune activation, inflammation, and coagulopathy, all of which are key factors that drive HIV disease progression and non-HIV comorbidities; however, direct proof of a causal link is still lacking. Here, we have demonstrated that treatment of acutely SIV-infected pigtailed macaques with the drug sevelamer, which binds microbial lipopolysaccharide in the gut, dramatically reduces immune activation and inflammation and slightly reduces viral replication. Furthermore, sevelamer administration reduced coagulation biomarkers, confirming the contribution of microbial translocation in the development of cardiovascular comorbidities in SIV-infected nonhuman primates. Together, our data suggest that early control of microbial translocation may improve the outcome of HIV infection and limit noninfectious comorbidities associated with AIDS.

Intrinsic versus extrinsic goal contents in self-determination theory: Another look at the quality of academic motivation.

In several reviews, exercise was reported to be effective in reducing the risk for cognitive decline and dementia [1,2]. However, not all reviews concluded this. One recent review [3] stated that there was still insufficient evidence, as most studies were too small and had insufficient methodological information (intensity, duration) to enable appropriate evaluation. Here we discuss potential confounds or mediators that may explain these discrepancies.We found that most observational studies showed at least some positive associations of exercise, but not always on the same cognitive tests [1]. Variance in studies was induced by inconsistent use of cognitive assessments (e.g. fluid intelligence compound scores vs Symbol Digit Modalities Test (SDMT) scores by itself); different assessments of fitness (objective vs. self reported hours of exercise engaged in); and different cut-offs for high/low exercise across studies. These limitations were echoed by others and recent reviews also illuminated potential confounds associated with both exercise and cognitive improvement, such as lifting of depression, as well as social and cognitive stimulation [4], and an increase in self efficacy (Stock, in press), which have usually not been taken along in analyses or adequately controlled for. Observational studies are limited in their ability to establish causality and many people could have stopped exercise because of other confounding morbidity, which may also affect cognitive function (e.g. vascular disease, see below). Randomised controlled trials (RCT) are better at establishing causality, but can also be affected by choice of measurements and population, suffer from baseline differences, regression to the mean and design of the control conditions (e.g. without social or cognitive stimulating aspects), as well as the above mentioned limitations of potential non-assessed confounds or mediators, such as mood.In our earlier review of 26 RCT studies in community dwelling elderly without known dementia or cognitive impairment, which had been carried out up to 2009 [1], only 6 studies showed overall cognitive improvement, 13 some improvement and 7 none at all. The most consistent cognitive tests to be affected by exercise interventions in this group were simple tests, such as those of concentration and those using simple reaction times. Several earlier reviews suggested that more complex cognitive tests were most affected by exercise. However, our review finding was substantiated by those of the Cochrane meta analyses [5], which is a gold standard medical review system. About half of RCT studies we had included in our review [1], which had used a simple test of concentration and working memory (Digit Span) found that it displayed significant positive results of exercise, but the other half of studies using this test (n=5) had not found any improvement. Of the complex information processing tests previously thought to be most sensitive to exercise, 21 tests (including the Stroop 4x, Symbol Digit Modalities test (SDMT) 4x, CRT 3x,...

Increased chronic immune activation and inflammation are hallmarks of HIV/SIV infection and are highly correlated with progression to AIDS and development of non-AIDS comorbidities, such as hypercoagulability and cardiovascular disease. Intestinal dysfunction resulting in microbial translocation has been proposed as a lead cause of systemic immune activation and hypercoagulability in HIV/SIV infection. Our goal was to assess the biological and clinical impact of a therapeutic strategy designed to reduce microbial translocation through reduction of the microbial content of the intestine (Rifaximin-RFX) and of gut inflammation (Sulfasalazine-SFZ). RFX is an intraluminal antibiotic that was successfully used in patients with hepatic encephalopathy. SFZ is an antiinflammatory drug successfully used in patients with mild to moderate inflammatory bowel disease. Both these clinical conditions are associated with increased microbial translocation, similar to HIV-infected patients. Treatment was administered for 90 days to five acutely SIV-infected pigtailed macaques (PTMs) starting at the time of infection; seven untreated SIVsab-infected PTMs were used as controls. RFX+SFZ were also administered for 90 days to three chronically SIVsab-infected PTMs. RFX+SFZ administration during acute SIVsab infection of PTMs resulted in: significantly lower microbial translocation, lower systemic immune activation, lower viral replication, better preservation of mucosal CD4+ T cells and significantly lower levels of hypercoagulation biomarkers. This effect was clear during the first 40 days of treatment and was lost during the last stages of treatment. Administration of RFX+SFZ to chronically SIVsab–infected PTMs had no discernible effect on infection. Our data thus indicate that early RFX+SFZ administration transiently improves the natural history of acute and postacute SIV infection, but has no effect during chronic infection.