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Ki-67 antibody labeling index in colorectal carcinoma.

Ki-67 labeling index of 58 colorectal carcinomas and 10 normal colonic mucosa samples was determined by the use of an immunohistochemical staining technique. The Ki-67 labeling index in colorectal carcinomas ranged from 15.7 to 63.6% (mean +/- SD of 38.5 +/- 10.5) and was significantly higher than the index for normal colon mucosa (mean +/- SD of 14.1 +/- 2.8). The mean Ki-67 labeling index was significantly higher in Dukes' B and Dukes' C tumors than in Dukes' A tumors, but the index did not correlate with the size of the tumor. There was no correlation between the Ki-67 labeling index of the tumor and lymph node involvement. The present study disclosed that the Ki-67 labeling index correlated with local invasion of colorectal carcinoma, but not with metastasis of the tumor.

Aged↗

Evaluation of an index of peripheral vascular resistance in human subjects.

Based on evidence in animal studies, an index of resistance in man has been evaluated. In 10 human subjects, ranging in age from 31 to 60 years, direct brachial arterial pressure was measured, and a computer program using linear regression calculated the index of resistance from the slope of the logarithm of the pressure versus time during the second half of diastole. Resistance was independently calculated from 20-s averages of pressure and cardiac output obtained by thermodilution. Resistance was varied by infusion of phenylephrine and nitroprusside. The values of the index of resistance were compared with independently calculated resistance by linear regression and correlation. The index of resistance was variably correlated with independently calculated resistance. However, when the comparison was limited to points with a model correlation coefficient greater than or equal to 0.98 (i.e. a good fit of a straight line to the logarithm of pressure versus time), the correlation of the index of resistance with calculated resistance approached or exceeded 0.9 in eight of 10 subjects. In the two subjects showing poor correlation of the index with calculated resistance, estimated compliance from the same model was much lower than in the other subjects. In the same two subjects pressure dependence of estimated compliance was much higher than in the other subjects, suggesting the presence of significant atherosclerosis. We concluded that the diastolic decay of pressure may be used to calculate a useful index of resistance, provided that a single exponential decay fits the observed diastolic waveform well, and arterial compliance is not significantly reduced by atherosclerosis.

Adult↗

Describing the size of lumbar disc herniations using computed tomography. A comparison of different size index calculations and their relation to sciatica.

STUDY DESIGN: The study compared different methods to measure the absolute and relative size of lumbar disc herniations on computed tomography scans and their relation to sciatica. METHODS: Computed tomography (CT) examinations were done before and at 3 and 24 months after nonoperative treatment in 30 patients with lumbar disc herniations. The size of the herniation was described by different indexes and related to the degree of sciatica. One index was formed by the area of the herniation in relation to the spinal canal (A-index), whereas two indexes were formed by linear measurements of the herniation in relation to the spinal canal in either two (ST-index) or one direction (S-index). RESULTS: Each index was correlated significantly to the degree of sciatica. The area of the herniations decreased markedly over time. CONCLUSIONS: Linear measurements of the herniation in two perpendicular directions provide a practical and accurate way of describing the size of lumbar disc herniations.

Adult↗

The sagittal pelvic tilt index as a criterion in the evaluation of spondylolisthesis. Preliminary observations.

STUDY DESIGN: Radiographic analysis of a pediatric population with spondylolisthesis was performed to examine sagittal plane pelvic rotation and degree of slip over time. OBJECTIVES: To determine whether the degree of standing sagittal offset of L5 with respect to the acetabulum correlated with slip progression and symptoms. SUMMARY OF BACKGROUND DATA: The natural history of isthmic spondylolisthesis remains unclear. Attempts to predict slip progression in the clinical setting, and thus the possible need for eventual surgical intervention, remain imprecise. Predicting slip progression based on sagittal alignment of the L5 vertebra with respect to the acetabulum has been proposed by some investigators. METHODS: Fifty-two children and adolescents were followed clinically and radiographically for an average of 5.6 years. Serial lateral standing radiographs that included the hips and lumbar spine were measured to compute a sagittal pelvic tilt index. The latter value is a ratio of relative distances from the center of S2 to the projection of L5 and the center of the femoral heads on the horizontal. RESULTS: Of the 52 patients studied, 38 have remained asymptomatic without significant slip progression or change in sagittal pelvic tilt index ratio. Of the original group, 13 patients had significant symptoms and revealed a decrease in the sagittal pelvic tilt index over time. Eight of the 13 stabilized at the end of adolescence, whereas 5 had continued decrease in the sagittal pelvic tilt index ratio. These five required operative treatment for pain and progressive slip. CONCLUSIONS: The sagittal pelvic tilt index gives the examiner an objective measure of the stability of the lumbosacral junction by quantifying the relationship between S2, the center of the hip, and L5. A decreasing sagittal pelvic tilt index ratio in this preliminary series correlated with slip progression and risk of conservative treatment failure, whereas those patients with a stable sagittal pelvic tilt index did not progress and remained clinically asymptomatic.

Adolescent↗

A toxicity index of skin and wound cleansers used on in vitro fibroblasts and keratinocytes.

OBJECTIVE: To determine toxicity indexes of commercially available skin, wound, and skin/wound cleansers on in vitro fibroblasts and keratinocytes. DESIGN: Seventeen cleansers and 3 liquid bath soaps were evaluated for cytotoxic effect on human infant dermal fibroblasts and epidermal keratinocytes. Both skin cell types were exposed to serial 10-fold dilutions of each cleanser until treated cell viability was comparable to untreated controls. RESULTS: The experimental design allowed calculation of relative toxicity indexes ranging from 0 to 100,000. Shur-Clens, SAF-Clens, and saline were found to be the least toxic to fibroblasts (toxicity index 0); Dial Antibacterial Soap and Ivory Liqui-Gel were the most toxic (toxicity index 100,000). Biolex, Shur-Clens, and Techni-Care were the least toxic to keratinocytes (toxicity index 0); hydrogen peroxide, modified Dakin's solution, and povidone (10%) were found to be the most toxic (toxicity index 100,000). CONCLUSIONS: Successful cutaneous tissue repair depends on the viability of the principal cell types involved (fibroblasts and keratinocytes). Toxicity indexes provide helpful guidelines for subsequent in vivo evaluations and clinical applications. The study findings also suggest that judicious use of these supposedly innocuous agents should be considered in a clinical setting.

Acetic Acid↗

Sedation monitoring of children by the Bispectral Index in the pediatric intensive care unit.

OBJECTIVE: To compare the Bispectral Index with clinical sedation assessment using the Ramsay score in normal sedated and paralyzed critically ill children. DESIGN: Prospective observational study. SETTING: Multidisciplinary 18-bed pediatric intensive care unit at a university-affiliated children's hospital. PATIENTS: A total of 48 pediatric intensive care unit patients requiring mechanical ventilation and sedation. Of these, 24 patients were not paralyzed. MEASUREMENTS AND MAIN RESULTS: Twenty-four pediatric intensive care unit children with normal mentation who were sedated and being ventilated in the intensive care unit were included in the study. The Ramsay score as assessed by the nurses was compared with the blinded Bispectral Index score. The regression coefficient between the Bispectral Index score and Ramsay score was 0.77 (p < 0.0001). The second group of patients included normal children similar to the previous group but paralyzed. The Ramsay score, as expected, was a poor tool for sedation assessment in a paralyzed patient. The nurse assessment only detected 8% of those patients at risk for awareness and recall (Bispectral Index score, > or = 80). Nurse assessment for oversedation (Bispectral Index score, < 40) was better with a sensitivity of 89.7% but a poor specificity of 38.6%. CONCLUSIONS: The Bispectral Index correlates well with the Ramsay score in the normal sedated child. The Ramsay score and bedside nurse assessment are inadequate for monitoring the depth of sedation in paralyzed children. The Bispectral Index is a useful adjunct in assessing sedation in a paralyzed patient.

Adolescent↗

Estimation of excess risk of readmission to hospital after an index inpatient separation.

OBJECTIVES: To develop methods to measure excess risk of readmission following an index admission using linked administrative health data. RESEARCH DESIGN: The cumulative risk of readmission following an index admission was calculated for index and reference subjects using linked hospital morbidity, death, and electoral roll data in cohort, cohort-crossover, and cohort-comparison-crossover designs. SUBJECTS: Index subjects were defined as any man age 20 years or older who separated from an acute hospital in Western Australia in 1990 to 1995 following any form of prostatectomy for a principal diagnosis of benign prostatic hypertrophy. Reference subjects were selected from the general population and the electoral roll (cohort designs). Cases were also used as their own historical controls (cohort-crossover) with and without adjustment for background time difference (cohort-comparison-crossover). MEASURES: The excess risk of readmission following an index admission was estimated by calculating the cumulative risk of readmission in index subjects and subtracting the background risk of admission. The background risk calculation varied according to the study design. RESULTS: The risk of readmission at 30 days increased by 241 to 328% following the procedure. After 1 year of follow-up, the risk of readmission was still increased by 58 to 108%. In general, the absolute differences between index and reference subjects decrease or remain the same with increasing rigor of the methods. CONCLUSIONS: In this example, there was little difference between the cohort-crossover and the cohort-comparison-crossover designs, suggesting that the cohort-crossover method is a justifiable method in the absence of electoral roll controls.

Adult↗

Heterosexual transmission of hepatitis C virus and the possible role of coexistent human immunodeficiency virus infection in the index case. A multicentre study of 423 pairings.

OBJECTIVES: To define the role that sexual transmission plays in the spread of hepatitis C virus (HCV) infection, and to examine the influence of coexistent human immunodeficiency virus (HIV) infection on this mode of transmission. DESIGN: A multicentre, seroprevalence study of anti-HCV performed in the stable heterosexual partners (SHP) of index cases reactive for anti-HCV. SETTING: Department of Internal Medicine and Section of Gastroenterology of three University Hospitals, Spain. SUBJECTS: A total of 423 stable heterosexual partners of index cases reactive for anti-HCV. This included a group of 142 intravenous drug users (IVDU), 120 of whom were coinfected with HIV. Additionally, 2886 first-time voluntary blood donors selected at random were included to compare the prevalence of anti-HCV. MAIN OUTCOME MEASURES: Serum samples were screened for anti-HCV by a commercially available, second-generation enzyme-linked immunoassay. Tests repeatedly reactive for anti-HCV were analysed by a four-antigen, recombinant immunoblot assay. Anti-HIV was tested by enzyme immunoassay and Western blot was used for confirmation of positive cases. RESULTS: The prevalence of anti-HCV, was 7.1% in SHP and 1.2% in random donors (P < 0.001). This prevalence was higher in SHP of index cases coinfected with HIV in comparison with that shown in the SHP of index cases only reactive for the anti-HCV (9.1 vs. 6.3%; P = 0.2), particularly when a younger and more homogeneous group such as the SHP of IVDU index cases was considered alone (9.2 vs. 0%; P = 0.1). However, the SHP of IVDU index cases coinfected with HIV were almost three times more likely to be infected with HIV than HCV (24.2 vs. 9.2%). CONCLUSIONS: These data suggest that HCV infection may be sexually transmitted but with low efficiency, and this could be increased in the presence of coexistent HIV infection in the index case.

Adolescent↗

Higher cut-off index value of immunoglobulin M antibody to hepatitis B core antigen in Taiwanese patients with hepatitis B.

BACKGROUND: The cut-off index value of immunoglobulin M (IgM) antibody to hepatitis B core antigen (anti-HBc; AxSYM CORE-M, Abbott) for diagnosing acute hepatitis B is 1.2. A high false-positive rate of IgM anti-HBc was observed in acute flare-ups of chronic hepatitis B in Taiwanese patients. Thus the purpose of the present paper was to study the optimal index value of IgM anti-HBc in Taiwanese subjects. METHODS: The peak index values of 42 IgM anti-HBc-positive patients were collected. There were 20 acute hepatitis B patients and 22 patients with chronic hepatitis B with acute flare. The biochemical, virological, and serological data were obtained. RESULTS: There were significant differences in mean age (36 vs 47 years, P = 0.01), serum alanine aminotransferase level (2042 U/L vs 1193 U/L, P = 0.02) and peak index value of IgM anti-HBc (2.9 vs 1.5, P < 0.01) between patients with acute hepatitis B and those with acute flare of chronic hepatitis B. Eleven (50%) of 22 patients with chronic hepatitis B with acute flare had index value of >1.2. The optimal cut-off index value to differentiate acute hepatitis B from chronic hepatitis B with acute flare was 2.4-2.5, with a sensitivity of 90% and specificity of 90%. CONCLUSIONS: The cut-off index value of IgM anti-HBc to differentiate acute hepatitis B from chronic hepatitis B with acute flare among Taiwanese patients should be set at 2.4-2.5 instead of 0.8-1.2.

Adult↗

Validation of a prognostic index in breast cancer.

The validation of a prognostic index for patients with primary breast cancer is described. The actual survival data in a group of 383 patients was compared with expected survival predicted by an index based on axillary lymph node status, oestrogen receptor, progesterone receptor and age. There was no significant difference between actual and predicted deaths for five ranges of index value at 2 years and for the three highest ranges of index value at 5 years. However, in the two lowest ranges, the index significantly underpredicted deaths at 5 years. The Cox proportional hazards model was used to determine if there was any significantly better combination of coefficients and covariates to predict survival in the test group. The original index--1 = N + E + P + A, where N = 0 if no nodes are involved, 13 if one to three nodes are involved, and 31 if more than three nodes are involved; E = 15 if oestrogen receptor value is less than 10 fmol/mg cytosol protein and 0 otherwise; P = 12.5 if progesterone receptor value is less than 10 fmol/mg cytosol protein and 0 otherwise; and A = number of years over age 65--was as good as any competing model in ranking survival prospects in the test group. However, it was a less sensitive predictor in this group than in the original set of patients. A second index based on tumour size, hormone receptor status and age, for use when lymph node status was unavailable, was tested by the same method and validated.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗

The value of the lipid-laden macrophage index in the assessment of aspiration pneumonia.

BACKGROUND: A semi-quantitative index of lipid-laden macrophages on broncho-alveolar lavage (BAL) has been reported to be highly sensitive but only moderately specific for aspiration in adults. There has been little published literature evaluating this technique since the original report. AIMS: To assess the value of a lipid-laden macrophage index (LLMI) of greater than 100 to confirm the clinical diagnosis of aspiration in patients with abnormal radiological investigations. METHODS: Prospective evaluation of 80 adult patients with abnormal radiology was undertaken using BAL and the LLMI. A diagnosis of aspiration was made prior to bronchoscopy if the patient had one or more of: clinically witnessed aspiration, positive barium swallow or speech pathology assessment; or an upper gastrointestinal endoscopy showed severe reflux oesophagitis and the patient had a history consistent with aspiration. RESULTS: Eighteen patients were diagnosed with aspiration. Of these, 17 had an index > 100, and one had an index of 94 (mean 157, 99% CI 127-187, range 94-238). Of the other 62 subjects, seven had an index > 100 (mean 46, 99% CI 22-70, range 0-303). There was a significant difference between index scores for the two groups (p = 0.002). For aspiration, an index > 100 had a sensitivity of 94% and a negative predictive value of 98%. The specificity was 89%, with a positive predictive value of 71%. CONCLUSIONS: The LLMI is a sensitive indicator for aspiration causing radiological lung disease in adults. Its lack of specificity means it cannot be the sole means of diagnosis, but it can allow better targeting of other investigations in those patients in whom bronchoscopy is undertaken to investigate radiological abnormalities.

Adult↗

The use of low glycaemic index foods improves metabolic control of diabetic patients over five weeks.

The aim of the present study was to determine whether any benefit might occur from lowering the glycaemic index of diet in the medium term in diabetic patients. Eighteen well-controlled diabetic patients (12 Type 1 and 6 Type 2 non-insulin-treated), were assigned to either a high mean glycaemic index or low mean glycaemic index diet for 5 weeks each in a random order using a cross-over design. The two diets were equivalent in terms of nutrient content and total and soluble fibre content. The glycaemic indices were 64 +/- 2 (mean +/- SD) % and 38 +/- 5% for the two diets. The high glycaemic index diet was enriched in bread and potato and the low glycaemic index diet in pasta, rice, and legumes. At the end of the study periods, the following variables were improved on the low compared to the high glycaemic index diet: fructosamine (3.9 +/- 0.9 vs 3.4 +/- 0.4 mmol l-1, p less than 0.05); fasting blood glucose (10.8 +/- 2.8 vs 9.6 +/- 2.7 mmol l-1, p less than 0.02); 2-h postprandial blood glucose (11.6 +/- 2.9 vs 10.3 +/- 2.5 mmol l-1, p less than 0.02); mean daily blood glucose (12.0 +/- 2.5 vs 10.4 +/- 2.7 mmol l-1, p less than 0.02); serum triglycerides (1.5 +/- 0.9 vs 1.2 +/- 0.6 mmol l-1, p less than 0.05). No significant differences were found in body weight, HbA1C, insulin binding to erythrocytes, insulin and drug requirements, and other circulating lipids (cholesterol, HDL-cholesterol, phospholipids, Apolipoprotein A1, Apolipoprotein B). Thus the inclusion of low glycaemic index foods in the diet of diabetic patients may be an additional measure which slightly but favourably influences carbohydrate and lipid metabolism, requires only small changes in nutritional habits and has no known deleterious effects.

Adult↗

Effectiveness of ultrasound determination of fetal abdominal circumference and fetal ponderal index in the diagnosis of asymmetrical growth retardation.

A total of 310 unselected women attending an antenatal clinic was screened for growth retardation by ultrasound between 34 and 36 weeks gestation, by measuring the fetal abdominal circumference (AC) and femoral length (FL), from which the 'fetal ponderal index' (AC/FL) was calculated. Asymmetrical growth retardation in the newborn was assessed by Rohrer's ponderal index and the mid-arm/occipito-frontal circumference (MAC/OFC) ratio within 72 h of birth, a neonatal ponderal index or MAC/OFC ratio below the 10th centile being considered abnormal. The sensitivities of an AC below the 25th centile in identifying a birthweight, neonatal ponderal index or MAC/OFC ratio below the 10th centile were 86, 62 and 67% respectively, the specificities being 80, 78 and 76%. The sensitivities of a fetal ponderal index below the 25th centile in identifying a neonatal ponderal index or MAC/OFC ratio below the 10th centile were 52 and 47% respectively, the specificities being 77 and 77%. A possible reason for the poor performance of the fetal ponderal index is discussed.

Abdomen↗

The need for standardizing the index of hemolysis.

Hemolysis is one of the most important performance parameters of blood pumps. However, comparative in vitro evaluation of the reported hemolysis effect is difficult owing to the lack of uniformity in the test methods used. Currently, three types of formulas are generally accepted and widely used for the index of hemolysis: the traditionally used index of hemolysis (defined as grams of plasma free hemoglobin released per 100 L of blood pumped); the normalized index of hemolysis (normalized by hematocrit); and the modified index of hemolysis (taking into account not only hematocrit but also hemoglobin). In addition, the tested blood conditions are often not indicated in the reports. To address this confusing situation, all three indices of hemolysis were routinely derived in our laboratory. To avoid further confusion, the tested blood conditions and test loop were defined in each study in our laboratory. If we limit the acceptable range of hemoglobin in human blood, the normalized index of hemolysis is sufficient. Furthermore, using milligrams as the unit of expression would be easier and reasonable for comparing the less hemolytic blood pumps, such as the centrifugal pumps that are currently available clinically. We would like to propose this value of a normalized index of hemolysis in milligrams as the most useful formula for the index of hemolysis in the assessment of various types of rotary blood pumps.

Assisted Circulation↗

A comparison of the mid-arm circumference/head circumference ratio and ponderal index for the evaluation of newborn infants after abnormal intrauterine growth.

We studied the accuracy of the ponderal index and the mid-arm circumference/head circumference ratio for detecting newborn infants who were likely to be symptomatic because of aberrant intrauterine growth. Sixty infants were evaluated because of suspected intrauterine growth retardation; both the mean ponderal index and mid-arm circumference/head circumference ratio were significantly lower in the group of 30 symptomatic infants than in the group of 30 asymptomatic infants (p less than 0.05). However, the mid-arm circumference/head circumference ratio identified a significantly higher percentage of the symptomatic infants than the ponderal index (80% vs. 47%; p = 0.007). An additional 60 infants were evaluated because of suspected abnormal intrauterine growth acceleration. The mean mid-arm circumference/head circumference ratio, but not the ponderal index, was significantly higher in the group of 30 symptomatic infants than in the group of 30 asymptomatic infants (p less than 0.005). Again, the mid-arm circumference/head circumference ratio identified a significantly higher percentage of the symptomatic infants than the ponderal index (79% vs. 33%; p less than 0.001). The mid-arm circumference/head circumference ratio is more accurate than the ponderal index for the evaluation of potentially symptomatic newborn infants who suffered abnormal fetal growth. The ponderal index is not useful for the detection of symptomatic large-for-dates infants.

Arm↗

Correlation of a scanning laser derived oedema index and visual function following grid laser treatment for diabetic macular oedema.

AIM: To correlate change of an oedema index derived by scanning laser tomography with change of visual function in patients undergoing grid laser photocoagulation for clinically significant diabetic macular oedema (DMO). METHODS: The sample comprised 24 diabetic patients with retinal thickening within 500 micro m of the fovea. Inclusion criteria included a logMAR visual acuity of 0.25, or better. Patients were assessed twice before a single session of grid laser treatment and within 1 week of, and at 1, 2, 4, and 12 weeks after, treatment. At each visit, patients underwent logMAR visual acuity, conventional and short wavelength automated perimetry (SWAP), and scanning laser tomography. Each visual function parameter was correlated with the mean oedema index. The mean oedema index represented the z-profile signal width divided by the maximum reflectance intensity (arbitrary units). A Pearson correlation coefficient (Bonferroni corrected) was undertaken on the data set of each patient. RESULTS: 13 patients exhibited significant correlation of the mean oedema index and at least one measure of visual function for the 10 degrees x 10 degrees scan field while 10 patients correlated for the 20 degrees x 20 degrees scan field. Seven patients demonstrated correlation for both scan fields. Laser photocoagulation typically resulted in an immediate loss of perimetric sensitivity whereas the oedema index changed over a period of weeks. Localised oedema did not impact upon visual acuity or letter contrast sensitivity when situated extrafoveally. CONCLUSIONS: Correlation of change of the oedema index and of visual function following grid laser photocoagulation was not found in all patients. An absence of correlation can be explained by the localised distribution of DMO in this sample of patients, as well as by differences in the time course of change of the oedema index and visual function. The study has objectively documented change in the magnitude and distribution of DMO following grid laser treatment and has established the relation of this change to the change in visual function.

Aged↗

Unemployment rates: an alternative to the Jarman index?

OBJECTIVE: To compare the Jarman index with alternative deprivation measures with regard to its usefulness to district health authorities as an indicator of need at small area level. DESIGN: The Jarman index (UPA (8)), Townsend's index of material deprivation, the Scottish Development Department's index, the Department of the Environment's basic index, and unemployment rates were compared in respect of their correlation with measures of morbidity by electoral ward in a typical English district health authority. Measures of morbidity comprised standardised mortality ratios, admission rates (standardised and non-standardised), and permanent sickness rates. Spearman rank correlation coefficients were calculated for each combination of measures and were then ranked for each of the deprivation indices. SETTING: The 59 electoral wards of the Central Nottinghamshire Health Authority. RESULTS: The Jarman index consistently ranked lower in respect of its correlation with measures of morbidity than did the other deprivation measures. Current unemployment rates correlated well with morbidity measures, in particular with hospital admission rates, with correlations ranging from 0.669 to 0.830 for average and standardised all age admission rates. CONCLUSIONS: The Jarman index seems to be the least appropriate of these indices for health authority use. Unemployment rate merits further consideration as a simple, up to date marker for deprivation and consequent need for health service provision.

Adolescent↗

Representation of authors and editors from countries with different human development indexes in the leading literature on tropical medicine: survey of current evidence.

OBJECTIVE: To assess the current international representation of members of editorial and advisory boards and authors in the leading peer reviewed literature on tropical medicine. DESIGN: Systematic review. MAIN OUTCOME MEASURES: Country affiliations, as classified by the human development index, of editorial and advisory board members of all tropical medicine journals referenced by the Institute of Scientific Information (ISI) as of late 2003 and of all contributing authors of full articles published in the six leading journals on tropical medicine in 2000-2. RESULTS: Sixteen (5.1%) of the 315 editorial and advisory board members from the 12 ISI referenced journals on tropical medicine are affiliated to countries with a low human development index and 223 (70.8%) to countries with a high index. Examination of the 2384 full articles published in 2000-2 in the six highest ranking tropical medicine journals showed that 48.1% of contributing authors are affiliated to countries with a high human development index, whereas the percentage of authors from countries with a low index was 13.7%. Articles written exclusively by authors from low ranked countries accounted for 5.0%. Our data indicate that research collaborations between a country with a high human development index and one that has either a medium or a low index are common and account for 26.5% and 16.1% of all full articles, respectively. CONCLUSION: Current collaborations should be transformed into research partnerships, with the goals of mutual learning and institutional capacity strengthening in the developing world.

Advisory Committees↗