bluuebunny/crossref_metadata_2025 huggingface dataset:
Diagnosis of sexually transmitted infections and bacterial vaginosis among HIV-1-infected pregnant women in Nairobi
Authors: Marx G , John-Stewart G , Bosire R , Wamalwa D , Otieno P , Farquhar C
Published: October 2010

HIV-infected women with sexually transmitted infections (STIs) or bacterial vaginosis (BV) during pregnancy are at increased risk for poor obstetric outcomes. In resource-limited settings, diagnostic testing for STIs and BV is often not available and most pregnant women are managed using syndromic algorithms. As part of a Nairobi perinatal cohort, HIV-1-infected pregnant women were interviewed and samples were collected for STIs and BV testing. Diagnostic accuracy of STIs and BV by syndromic algorithms was evaluated with comparison to the reference standard. Among 441 women, prevalence of BV was 37%, trichomoniasis 16%, chlamydia 4%, syphilis 3% and gonorrhoea 2%. Significantly more women with STIs were aged 21-years-old, had not attended secondary school and had a history of STIs. Syndromic diagnosis of STIs and BV demonstrated a sensitivity of 45% and 57%, and positive predictive value of 30% and 42%, respectively. Among these HIV-infected, pregnant women, STIs and vaginal infections were common and syndromic diagnosis was insensitive, resulting in missed opportunities to intervene and improve infant and maternal health.
Knowledge of human papillomavirus among high school students can be increased by an educational intervention
Authors: Gottvall M , Tydén T , Höglund A T , Larsson M
Published: October 2010

The aim of this study was to evaluate the effect of an educational intervention concerning human papillomavirus (HPV) directed at Swedish first year high school students. The intervention consisted of a class room lesson, a website and a folder. Outcome variables were knowledge of HPV and attitudes to preventive methods such as HPV vaccination, condom use and Pap smear testing. An intervention group ( n = 92) was matched with two comparison groups ( n = 184). At baseline, the median score for HPV knowledge was one out of 10 in both groups. At follow-up, the median knowledge score had increased to six in the intervention group, but was still one in the comparison group ( P < 0.001). Attitudes to HPV vaccination, condom use and Pap smear testing remained the same ( P > 0.05). In conclusion, a short school-based intervention can greatly increase the students' knowledge about HPV, but attitudes and behaviours are less easy to influence.
Patients' attitudes towards increasing the offer of HIV testing in primary and secondary care
Authors: Drayton R , Keane F , Prentice E
Published: October 2010

The UK National Guidelines on HIV testing (2008) recommend routinely offering an HIV test to patients in certain clinical settings. We wished to investigate the acceptability of implementing these guidelines in a population with a low HIV prevalence. Patients accessing primary and secondary care were asked to circle one of the five responses to a series of statements regarding HIV testing. Of the 616 respondents, 579 (94%) stated they would be willing to be tested if presenting with a condition known to be associated with HIV. Four hundred and forty out of 616 (71%) stated they would be willing to be tested as part of their routine care, while 445/616 (72%) stated they would be willing to have the result in their main medical notes. Although the patients' responses were largely receptive to increased testing, we encountered notable negative attitudes to the project from professional and administrative staff. Resistance to increased HIV testing may be related to health-care workers rather than patients.
Daniel Turner (1667–1741): syphillis and the condum
Authors: Waugh M
Published: October 2010

Daniel Turner 1667–1741 was the first English medical author to use the term syphillis incidentally, also mentioning early usage of the condom (condum). This paper shows that venereologists in 18th century London wrote on the use of condoms by some men, but who were sceptical about its usage. This paper also describes some of the contemporary spellings of condum and syphillis.
Management of pregnancy in an HIV elite controller
Authors: Rutland E , Mani R
Published: October 2010

Elite control of HIV infection has been defined as spontaneous and sustained maintenance of HIV RNA to <50 copies/mL in the absence of therapy. It is estimated to occur in approximately one in 300 HIV-infected individuals. We present the case of a Zimbabwean woman who tested positive for HIV-1 infection on routine antenatal bloods at 15 weeks gestation. Her CD4 count was 500 cells/mm3; however, HIV-1 RNA viral load measured below the level of detection on several assays. A Cavidi ExaVir reverse transcriptase assay was below the level of detection. Pro-viral DNA was positive using long terminal repeat primers and sequencing demonstrated subtype C virus. Zidovudine monotherapy (250 mg twice daily) was commenced at 24 weeks for the prevention of mother to child transmission. She was keen for a standard vaginal delivery, having had one previously, and she delivered a healthy baby without complications at 39 weeks gestation. The neonate received four weeks of Zidovudine and tested negative for HIV infection. We discuss some challenges involved in the management of a pregnant ‘elite controller’.
Acceptability of neonatal circumcision by Hispanics in southern Florida
Authors: Castro J G , Jones D L , López M R , Deeb K , Barradas I , Weiss S M
Published: October 2010

This study attempted to determine the acceptability of neonatal circumcision in Hispanic expectant and new parents and to explore potential associations with lower acceptability. Overall, we found surprisingly high rates of acceptability in this community that contrasts with the actual low rates of circumcision in Hispanics in the USA. This gap is important since newborn circumcision has been suggested as an additional long-range tool in reducing longstanding ethnic disparities in HIV incidence in the USA. A larger study will be needed to determine what factors are associated with low acceptability and how one might effectively address these concerns in this population.
Status and Trends in the Direct Support Workforce in Self-Directed Supports
Authors: Bogenschutz Matthew , Hewitt Amy , Hall-Lande Jennifer , LaLiberte Traci
Published: October 2010

Self-directed programs that allow individuals with intellectual and developmental disabilities to exercise greater control over their finances have become increasingly common in recent years. At the same time, challenges in the recruitment, retention, and training of direct support workers in the field have grown more acute. In this article, the authors investigate the status of the direct support workforce for people using self-directed supports in 1 Midwestern state, based on the results of a statewide survey of service users. Although additional research is needed, the results of this study suggest that people who use self-directed funding options are satisfied with their ability to direct staffing, though challenges remain. Among these challenges, the presence of higher than expected wages but lower than expected benefits provision compared with traditional services may have serious policy and staff retention ramifications that affect the long-term viability of self-directed funding options. In addition, staff training remains a challenge, with service users in this sample reporting low rates of training beyond a general skill set. Implications of these findings are discussed.
On the Pulse of Change: The New Beat of Special Education in Higher Education
Authors: Keeffe Mary , De George-Walker Linda
Published: October 2010

The roles and responsibilities of special educators in both special and regular school settings are changing rapidly. More than two decades ago the move towards more inclusive practices disrupted the traditional, niche separatism of special educators to the extent that they are now an integral part of the regular school teaching staff. Today the broad agenda to facilitate access and participation for all students in education, not just students with disabilities, influences the roles and responsibilities of special educators. This article briefly identifies some of the generic pulses that are moving the special education profession from a focus on low incidence disabilities towards a more comprehensive approach to inclusion, school responsiveness and individualised learning pathways. From the foundation of inclusive practice, this article will describe how a qualitative study was used to understand the changing roles and responsibilities of special educators. A case-study analysis of 17 schools formed the basis of the investigation. Principals, lead teachers in special education and special education teachers were asked to identify trends and priorities in special education and also to identify rewards and challenges in their jobs. Further cross-referencing with teacher and special educator standards, a focus group, a stakeholder group and research in the field increased the opportunity for academics and special educators to critically reflect on the emerging demands placed on special educators and the attributes that are needed to be professionally effective.
Framing an integrated framework of design curriculum in higher education: understandings, meanings and interpretations
Authors: Szeto Elson
Published: October 2010

This article aims to explore an alternative framework of design curriculum among the diverse and fragmented interpretations of design education, contributing to rethinking future design education in higher education. Data were collected from thirteen individual and group interviews
with fifteen informants, and a series of investigations into the academic performance of a Hong Kong university's design department. The qualitative study of the data identified embedded understandings and interpretations of design education expressed by the design experts, faculty members
and local designers. Grounded theory analysis unveiled the experts' recommendations to the university senior management that design was not art in its own right but supported industrial transformation. Paradoxically, the designers aimed for art to be the foundation of design practices for
economic development, while the faculty members faced a tension between art-based and industry-based design practices at all levels that reflect the nature of design. These diverse interpretations were subject to several cycles of comparison and abstraction. The findings shape the alternative
vision of design education in the interplay between design artefacts and the human-made world, which integrates design-making, design planning and design thinking in a coherent framework of study. The implications are that the fragmented interpretations are neither mutually exclusive nor antagonistic
in the further development of design education.
Can Corrective Ad Statements Based on U.S. v. Philip Morris USA Inc. Affect Consumer Beliefs About Smoking?
Authors: Tangari Andrea Heintz , Kees Jeremy , Andrews J. Craig , Burton Scot
Published: October 2010

To comply with the court's ruling in U.S. v. Philip Morris USA Inc., tobacco companies must fund a large advertising campaign to “correct” smoking beliefs about which consumers may have been misled as a result of past deceptive practices of tobacco companies. The authors use an ad copy experiment to examine (1) the effects of different versions of corrective ad statements that plaintiff intervenors submitted to the court on multi-item belief measures and (2) the impact of the ad versions and beliefs on general attitudes toward smoking across current adult smokers and nonsmokers. The tested ad versions include a copy-only control condition, a copy-with-graphic-visual condition, and a version with a potentially distracting visual. The results indicate that the corrective statements in advertisements can have a positive effect on antismoking beliefs of focal interest in the case and that the test advertisements affect some beliefs more strongly than others. The authors discuss potential policy implications and limitations and provide suggestions for further research.
The Unintended Consequences of Using “Posers” in Nonprofit Public Service Announcements and Proposed Self-Regulatory Disclosure Solutions
Authors: Shanahan Kevin J. , Hopkins Christopher D. , Carlson Les
Published: October 2010

Although public service announcements (PSAs) employing undisclosed actor portrayals (posers) in the message are in technical violation of Federal Trade Commission regulations on deception, sponsors of such PSA formats are unlikely to be pursued for such violations. However, when nonprofits use actors in lieu of real victims in their PSA messages, real financial and reputational loss to the nonprofit may occur. In this study, the authors develop and test a model of the antecedents to perceived social responsibility of and people's subsequent intent to donate to nonprofits that employ PSAs. They also investigate the efficacy of using actor portrayal labels when composites of real victims rather than actual victims are portrayed in the PSAs. The results confirm that viewers experience a stronger emotional connection when the PSA uses real victims, along with greater perceptions of the nonprofit's social responsibility and greater subsequent intent to donate to the nonprofit. The authors propose that self-regulation may help mitigate negative reactions to PSA messages that employ actors rather than real victims in the PSAs.
The Impact of Parenting Strategies on Child Smoking Behavior: The Role of Child Self-Esteem Trajectory
Authors: Yang Zhiyong , Schaninger Charles M.
Published: October 2010

Multidisciplinary research has documented that parenting strategies influence children's cigarette use. Extending the extant literature, this article develops an integrative model that examines the effect of parenting strategies on children's smoking progression, in which children's self-esteem plays the role of mediator. The authors validate this model using longitudinal panel data from parents and children ages 10–17. The primary findings are that parenting strategies influence children's smoking development and that the impact of these strategies is mediated by the child's self-esteem trajectory, particularly for the rate of increase in smoking. Parental responsiveness decreases children's smoking development by enhancing the child's initial self-esteem and reducing the natural rate of deterioration in self-esteem, while psychological control increases smoking development both directly and indirectly by reducing initial self-esteem. Targeting parents through multimedia ad campaigns to bring about changes in parenting strategies to reduce or avoid teen smoking offers a fruitful complementary tool to targeting teens themselves. Such campaigns should also emphasize avoiding parental psychological control as a strategy and begin reaching parents well before their children approach late grade school.
Global Digital Divide: A Dynamic Analysis Based on the Bass Model
Authors: Huang Chun-Yao , Chen Hua-Ning
Published: October 2010

Heterogeneity in Internet diffusion across countries is the core issue of the global digital divide—a phenomenon that has attracted wide academic discussions and various international initiatives. However, prior studies on the global digital divide have addressed the issue mainly from a cross-sectional perspective. This article attempts to examine the topic from a longitudinal perspective by using the Bass new product diffusion model, which has been successfully applied in diffusion studies over the past four decades. Summarizing information from an empirical study on 48 countries, the modeling framework finds three types of divide dynamics; assesses the severity of the global digital divide at various Internet diffusion stages; and identifies cultural, economic, and educational factors as the major causes of the global digital divide at different stages. The article concludes with a discussion on marketing and policy-making implications.
Synchronous Artefact Reduction in Industrial Computed Tomography
Authors: Franz Matthias , Kasperl Stefan , Stamminger Marc
Published: October 2010

Computed tomography (CT) can be used for dimensional measurement. Reliable results require an effective artefact correction. In two earlier papers a Synchronous Artefact Correction (German: Einsatzsynchrone Artefakt-Reduktion EAR) was introduced. In this paper some further developments of EAR are given though the key concept isn´t altered. It is still two-staged with a separation in fine and coarse registration, the latter is subdivided into translation and rotation. For the coarse rotation the idea of the Overall Cachment Area is applied. In-depth tests favoured “Normalized Mutual Information” that was only second-best in the prime research. Another topic is the analysis of the accuracy of the registration result concerning the applied similarity measure. In this test “Normalized Mutual Information” was figured out to be the measure with the highest accuracy.
Aufgabenspezifische Messunsicherheit von Koordinatenmessungen
Authors: Hernla Michael , Wendt Klaus , Franke Matthias
Published: October 2010

Der Beitrag beschreibt drei Verfahren zur Ermittlung der aufgabenspezifischen Messunsicherheit von Koordinatenmessungen nach dem international anerkannten “Leitfaden zur Angabe der Unsicherheit beim Messen” (GUM): Numerische Simulation, Messung von kalibrierten Werkstücken sowie Messunsicherheitsbudget. Er stellt drei Ansätze zur praktischen Umsetzung dieser Verfahren an Werkstücken mit Regelgeometrien gegenüber und diskutiert ihre Einsatzmöglichkeiten.
Incorporating Recognition and Management of Perinatal and Postpartum Depression Into Pediatric Practice
Authors: Earls Marian F. ,   The Committee on Psychosocial Aspects of Child and Family Health
Published: October 2010

Every year, more than 400 000 infants are born to mothers who are depressed, which makes perinatal depression the most underdiagnosed obstetric complication in America. Postpartum depression leads to increased costs of medical care, inappropriate medical care, child abuse and neglect, discontinuation of breastfeeding, and family dysfunction and adversely affects early brain development. Pediatric practices, as medical homes, can establish a system to implement postpartum depression screening and to identify and use community resources for the treatment and referral of the depressed mother and support for the mother-child (dyad) relationship. This system would have a positive effect on the health and well-being of the infant and family. State chapters of the American Academy of Pediatrics, working with state Early Periodic Screening, Diagnosis, and Treatment (EPSDT) and maternal and child health programs, can increase awareness of the need for perinatal depression screening in the obstetric and pediatric periodicity of care schedules and ensure payment. Pediatricians must advocate for workforce development for professionals who care for very young children and for promotion of evidence-based interventions focused on healthy attachment and parent-child relationships.
Phosphate fertilization and phosphorus forms in an Oxisol under no-till
Authors: Olibone Dácio , Rosolem Ciro Antonio
Published: October 2010

Under no-till phosphorus (P) accumulates in a few centimeters of the topsoil layer. Plant residues left on the soil surface release P and organic acids, which may improve P availability and fertilizer efficiency, including both soluble (such as triple super phosphate) and less soluble sources (such as reactive natural phosphates). In this study, soybean response to P fertilizer and P forms in the top 40 cm of an Oxisol were evaluated after surface application of different phosphates in a 5-year-old no-till system. Treatments consisted of 0 or 80 kg ha-1 of total P2O5 applied on the soil surface, both as natural reactive phosphate (NRP) or triple super phosphate (TSP). In addition, 80 kg ha-1 of P2O5 were applied to subplots, in furrows below and beside the soybean (Glycine max L.) seeds, in different combinations of NRP and TSP. Soil samples were taken before and after the soybean growth, down to 0.40 m and soil phosphorus was chemically fractionated. The responses to NRP were similar to TSP, with an increase in P reserves at greater depths, even in non-available forms, such as P-occluded. After the soybean harvest, P-occluded levels were lower at the surface layer, but an increase was observed in the soluble, organic and total P down to 40 cm. An improved P distribution in soil depth, especially regarding the soluble and organic forms, resulted in higher soybean yields, even when the phosphates were applied to the soil surface.
Prevalência de fatores de risco e proteção de doenças crônicas não transmissíveis em adolescentes: resultados da Pesquisa Nacional de Saúde do Escolar (PeNSE), Brasil, 2009
Authors: Malta Deborah Carvalho , Sardinha Luciana Monteiro Vasconcelos , Mendes Isabel , Barreto Sandhi Maria , Giatti Luana , Castro Inês Rugani Ribeiro de , Moura Lenildo de , Dias Antonio José Ribeiro , Crespo Claudio
Published: October 2010

A adolescência é marcada por transformações e exposição a diversas situações e riscos para a saúde. O estudo atual estima a prevalência dos principais fatores de risco e proteção à saúde dos adolescentes entrevistados em 2009 na Pesquisa Nacional de Saúde do Escolar (PeNSE). A PeNSE, parceria do Instituto Brasileiro de Geografia e Estatística (IBGE) com o Ministério da Saúde, usou questionário autoaplicável em palmtop coletando informação de 60.973 estudantes em 1.453 escolas públicas privadas nas 27 capitais. RESULTADOS: consumo de alimentos em cinco dias ou mais na semana: 62,6% comem feijão, apenas 31,5% consomem frutas, 58,3% comem guloseimas e 37% tomam refrigerantes; 43,1% dos alunos são suficientemente ativos fisicamente e 79,5% gastam mais de duas horas diárias em frente à TV. Em relação a tabaco e drogas: 6,3% são fumantes atuais, 71,4% dos alunos disseram já ter experimentado alguma bebida alcoólica. O consumo atual de bebida alcoólica foi de 27% e as drogas ilícitas foram usadas alguma vez na vida em 8,7%. Esses dados geram evidências para orientar a implementação de políticas públicas e realizar ações para minimizar a exposição de fatores de risco dos adolescentes brasileiros.
Prática de atividade física em adolescentes brasileiros
Authors: Hallal Pedro Curi , Knuth Alan Goularte , Cruz Danielle Keylla Alencar , Mendes Maria Isabel , Malta Deborah Carvalho
Published: October 2010

O objetivo deste estudo é descrever a prática de atividade física em adolescentes, utilizando dados da Pesquisa Nacional de Saúde do Escolar (PeNSE), coletados em todas as capitais do Brasil e no Distrito Federal em 2009. A amostra incluiu escolares do 9º ano do ensino fundamental (n=60.973). Foram investigadas a prática de atividade física nos últimos sete dias, incluindo modo de deslocamento para a escola, prática de atividade física dentro e fora da escola e participação nas aulas de educação física. Consideraram-se ativos os jovens que acumularam > 300 min/sem de atividade física. A proporção de ativos foi de 43,1%, sendo maior nos meninos (56,2%) em comparação às meninas (31,3%). Metade dos adolescentes (49,2%) relatou ter tido duas ou mais aulas de educação física na semana anterior à entrevista; 79,2% relataram assistir a duas horas diárias de televisão ou mais. Os dados do PeNSE indicam baixa prevalência de jovens ativos e com duas ou mais aulas de educação física por semana, além de elevada prevalência de comportamento sedentário. Tais dados podem ser utilizados como linha de base para o monitoramento de atividade física em escolares brasileiros, mas desde já sugerem a necessidade de intervenções para a promoção de atividade física em adolescentes brasileiros.
Consumo e comportamento alimentar entre adolescentes brasileiros: Pesquisa Nacional de Saúde do Escolar (PeNSE), 2009
Authors: Levy Renata Bertazzi , Castro Inês Rugani Ribeiro de , Cardoso Letícia de Oliveira , Tavares Letícia Ferreira , Sardinha Luciana Monteiro Vasconcelos , Gomes Fabio da Silva , Costa André Wallace Nery da
Published: October 2010

O objetivo deste artigo é descrever características de consumo e comportamento alimentar de adolescentes brasileiros e sua associação com fatores sociodemográficos. Estudou-se, em 2009, amostra representativa de alunos do 9º ano do ensino fundamental de escolas públicas e privadas das 26 capitais brasileiras e do Distrito Federal. Utilizou-se questionário autoaplicável sobre atributos sociodemográficos, consumo e comportamento alimentar, entre outros. Estimativas dos indicadores construídos foram apresentadas para o total da população e por sexo. A associação de cada um dos indicadores com variáveis sociodemográficas foi examinada por meio de regressão logística. A maioria dos adolescentes consumia regularmente feijão (62,6%), leite (53,6%) e guloseimas (50,9%), realizava pelo menos o almoço ou o jantar com a mãe ou responsável (62,6%) e comia assistindo televisão ou estudando (50,9%). Em geral, as meninas estavam mais expostas a práticas alimentares não desejáveis, e o melhor nível socioeconômico associou-se a maiores prevalências dos indicadores estudados. Os resultados revelaram consumo regular dos marcadores de alimentação não saudável e consumo inferior ao recomendado dos de alimentação saudável, apontando a necessidade de ações de promoção de saúde dirigidas a jovens.
Prevalência de alterações da mucosa bucal em adolescentes brasileiros institucionalizados em dois centros de reeducação
Authors: Hipólito Ramon Aluâne , Martins Carlos Roberto
Published: October 2010

O propósito do presente estudo foi verificar a prevalência de lesões fundamentais e alterações da normalidade na mucosa bucal de adolescentes brasileiros institucionalizados. Foram examinados 231 adolescentes, todos do gênero masculino. Os critérios clínicos de diagnóstico das lesões foram os propostos pelo SB (Brasil) 2000-Prevalência de fatores de riscos. A prevalência total de lesões da mucosa bucal foi de 27,70% (64 lesões), com 24,24% dos adolescentes as apresentando. A mais frequente foi a placa. Encontraram-se 293 alterações de normalidade, com 78,35% dos examinados apresentando pelo menos uma delas. A pigmentação melânica fisiológica foi a mais encontrada. Os dados coletados foram analisados estatisticamente através do teste não paramétrico de Kruskall-Wallis e as associações pelo teste Qui-quadrado, considerando-se nível de significância de 5%. Diferença estatisticamente significante foi identificada quando se avaliou a presença de lesão fundamental e/ou alteração da normalidade versus cor da pele (p=0,002), entre a cor da pele e o número médio de alterações de normalidade (p=0,000), entre a presença de pigmentação melânica fisiológica e leucoedema versus cor da pele do examinado com p=0,000 e p=0,002. Sobre o número médio de lesões da mucosa versus cor da pele, não houve diferença estatisticamente significante, com p=0,618.
Avaliação da incidência de cárie em pacientes com síndrome de Down após sua inserção em um programa preventivo
Authors: Castilho Aline Rogéria Freire de , Marta Sara Nader
Published: October 2010

O objetivo deste trabalho foi verificar a incidência de cárie dentária por meio dos índices CPO-D, CPO-S, ceo-d e ceo-s em indivíduos com síndrome de Down regularmente matriculados em um programa preventivo. Foram examinados 24 indivíduos com síndrome de Down de ambos os sexos, com idade entre um e 48 anos. A prevalência (situação experimental inicial) e a incidência (situação experimental final) de cárie dentária foram verificadas utilizando-se os índices CPO-D, CPO-S, ceo-d e ceo-s iniciais e finais dos participantes. Dos 24 indivíduos examinados, dez (42,0%) eram livres de cárie. A prevalência de cárie dentária mostrou valores de CPO-D= 2,33; CPO-S= 3,60; ceo-d= 1,75 e ceo-s= 2,80; enquanto a incidência de cárie apresentou valores de 2,33; 3,80; 1,10 e 1,90, respectivamente. Os indivíduos com síndrome de Down avaliados neste estudo apresentaram baixos índices de cárie e pequena incidência de novas lesões, enfatizando a importância da manutenção desses pacientes em programas preventivos.
Pharmacogenetic Impact of UDP‐Glucuronosyltransferase Metabolic Pathway and Multidrug Resistance—Associated Protein 2 Transport Pathway on Mycophenolic Acid in Thoracic Transplant Recipients: An Exploratory Study
Authors: Ting Lillian S. L. , Benoit‐Biancamano Marie‐Odile , Bernard Olivier , Riggs K. Wayne , Guillemette Chantal , Ensom Mary H. H.
Published: October 2010

Study Objective. To assess the contribution of polymorphisms in the uridine diphosphate glucuronosyltransferase gene (UGT) and the multidrug resistance‐associated protein 2 gene (ABCC2) to mycophenolic acid (MPA) pharmacokinetics and clinical outcomes in thoracic transplant recipients.

Design. Open‐label, cross‐sectional study.

Setting. Transplant clinic in Vancouver, British Columbia, Canada.

Patients. Sixty‐eight thoracic (36 lung, 32 heart) transplant recipients who were receiving steady‐state oral mycophenolate mofetil.

Measurements and Main Results. Eleven blood samples were obtained from each patient over a 12–hour dosing period. Plasma concentrations of MPA (active metabolite of mycophenolate mofetil), the MPA metabolites 7–O‐mycophenolic acid glucuronide (MPAG) and acyl glucuronide (AcMPAG), and free MPA were measured, and dose‐normalized conventional pharmacokinetic parameters were determined by noncompartmental methods. Genetic polymorphisms in UGT and ABCC2 were determined by sequencing, and their contributions to pharmacokinetic variability were investigated by using multivariate analysis. For both the lung and heart transplant groups, the UGT2B7 variant 802T (Tyr268 or UGT2B7*2, rs7439366) and the UGT2B7 variant −138A modified AcMPAG exposure (2.5–3.7–fold and 9.3–12.3–fold higher AcMPAG area under the concentration‐time curve [AUC] and AcMPAG:MPA ratio, respectively). In an exploratory analysis, occurrences of rejection, infection, anemia, and leukopenia were associated with an AcMPAG AUC greater than 50 μg•hour/ml and an AcMPAG:MPA ratio greater than 2.

Conclusion. UGT2B7 is a promising gene candidate that may influence MPA pharmacokinetics clinically; however, larger clinical pharmacogenetic studies in thoracic transplant subpopulations are warranted to corroborate the role of AcMPAG and UGT2B7 variants in optimizing mycophenolate mofetil therapy.
Suboptimal Use of Inhaled Corticosteroids in Children with Persistent Asthma: Inadequate Prescription, Poor Drug Adherence, or Both?
Authors: Pando Silvia , Lemière Catherine , Beauchesne Marie‐France , Perreault Sylvie , Forget Amélie , Blais Lucie
Published: October 2010

Study Objective. To assess the use of inhaled corticosteroids in children with persistent asthma, including patients' adherence to these drugs and physicians' prescribing patterns, by using a novel drug adherence measure, the Proportion of Prescribed Days Covered (PPDC).

Design. Retrospective analysis.

Data Source. Two administrative claims databases in Quebec, Canada.

Patients. Two thousand three hundred fifty‐five children aged 5–15 years with persistent asthma who used more than 3 doses/week on average of a short‐acting β‐agonist during a 12–month period before beginning treatment with inhaled corticosteroids between 1997 and 2005.

Measurements and Main Results. The PPDC measure was defined as the total days' supply dispensed divided by the total days' supply prescribed. During the 12–month follow‐up period, 20% of the children received only one prescription for inhaled corticosteroids with no prescribed renewals. The mean number of prescriptions (including prescribed renewals) was 5.0, corresponding to only 152 days' supply prescribed. Mean PPDC (drug adherence) was 62.4%. Only 25% of the patients had controlled asthma, based on the use of 3 or fewer doses/week of short‐acting β2‐agonists and absence of moderate‐to‐severe exacerbations.

Conclusion. A large percentage of children with persistent asthma were prescribed intermittent rather than daily inhaled corticosteroids, and patient adherence to these drugs was suboptimal even though children had free access to their drugs. Many of these patients continued to experience poor asthma control. The PPDC adherence measure developed for this study allowed a better understanding of the gap between treatment goals and asthma control.
Bivalirudin versus Unfractionated Heparin for Prevention of Hemofilter Occlusion During Continuous Renal Replacement Therapy
Authors: Kiser Tyree H. , MacLaren Robert , Fish Douglas N. , Hassell Kathryn L. , Teitelbaum Isaac
Published: October 2010

Study Objective. To evaluate the safety and efficacy of bivalirudin compared with heparin for preventing hemofilter occlusion during continuous venovenous hemofiltration (CVVH).

Design. Prospective, randomized, double‐blind study.

Setting. University‐affiliated hospital.

Patients. Ten critically ill adults (median age 58 yrs, 70% male) with acute renal failure who, without anticoagulation, experienced hemofilter survival time of 24 hours or less during CVVH.

Intervention. Patients were randomized to receive bivalirudin 2 mg/hour (five patients) or heparin 400 units/hour (five patients) administered prefilter into the extracorporeal circuit.

Measurements and Main Results. Patients had a median Acute Physiology and Chronic Health Evaluation (APACHE) II score of 24, Sequential Organ Failure Assessment (SOFA) score of 11, and reduced antithrombin activity (75.5 units/dl). Baseline characteristics were not significantly different between groups. Study drug was administered in 40 hemofilters (18 from bivalirudin‐treated patients, 22 from heparin‐treated patients). The primary efficacy outcome was hemofilter survival time, defined as the interval of time between commencement of CVVH with a new extracorporeal circuit (hemofilter) and hemofilter failure. Compared with no anticoagulation, the addition of bivalirudin or heparin significantly improved hemofilter survival time (mean ± SD 10 ± 5 hrs with no anticoagulation vs 22 ± 18 hrs with anticoagulation, p=0.0005). Hemofilter survival time was significantly increased in patients receiving bivalirudin versus those receiving heparin (29.6 ± 20.7 vs 16.5 ± 13.6 hrs, p=0.045). Independent predictors of hemofilter survival were use of bivalirudin therapy and increased antithrombin III activity. No patients randomized to bivalirudin experienced any bleeding or thrombosis events; one patient who received heparin developed alveolar hemorrhage, and one developed a lower extremity deep vein thrombosis.

Conclusion. Compared with heparin, bivalirudin was more efficacious in prolonging hemofilter survival time and was well tolerated. Additional studies of bivalirudin for prevention of hemofilter occlusion during continuous renal replacement therapy are warranted.
Reduced Health Care Expenditures After Enrollment in a Collaborative Cardiac Care Service
Authors: Delate Thomas , Olson Kari L. , Rasmussen Jon , Hutka Kara , Sandhoff Brian , Hornak Roseanne , Merenich John ,   Clinical Pharmacy Cardiac Risk Service Study Group
Published: October 2010

Study Objective. To assess the impact of a collaborative cardiovascular risk reduction service (Collaborative Cardiac Care Service [CCCS]) on total health care expenditures after an incident acute coronary event.

Design. Matched, retrospective cohort study.

Data Source. Kaiser Permanente Colorado (KPCO) databases.

Patients. Patients who had an incident coronary event between January 1999 and June 2004 and were either enrolled (CCCS group) or never enrolled in the CCCS (No CCCS group). Patients in the CCCS group (628 patients) were matched in a 1:1 ratio to patients in the No CCCS group (628 patients) by Chronic Disease Score (CDS) and total health care expenditures in the 180 days before the index coronary event (baseline).

Measurements and Main Results. Drug purchases and medical utilization encounters were extracted from the KPCO administrative and claims databases after the incident coronary event until death, KPCO plan termination, 3 years later, or December 31, 2005, whichever came first (follow‐up). Expenditure estimates from the plan's decision support system (in 2007 U.S. dollars) were applied to each utilization encounter. A$1/follow‐up day cost was applied to all patients in the CCCS group. Expenditures/follow‐up day were modeled with adjustment for matching variables, patient characteristics, baseline expenditures, and intracorrelations of matched patients. Patients in the No CCCS group were slightly older and were more likely to be female and have had a myocardial infarction as their incident event compared with those in the CCCS group. During follow‐up, there were 12 and 98 cardiac‐related deaths and 16 and 188 all‐cause deaths for the CCCS and No CCCS groups, respectively; mean and median total health care expenditures/day were $39 and $20, respectively, for the CCCS group, and $108 and $45, respectively, for the No CCCS group (all p<0.001). After adjustment, total health care expenditures for patients in the CCCS group were approximately $60/day ($21,900/yr) lower than those for patients in the No CCCS group (p<0.001; adjusted R2=0.29 with log‐transformed expenditures).

Conclusion. The comprehensive and aggressive implementation of secondary cardiac prevention strategies and close monitoring and follow‐up of patients with coronary artery disease provided by the CCCS were associated with reduced health care expenditures.
Vancomycin‐Resistant Enterococcal Urinary Tract Infections
Authors: Heintz Brett H. , Halilovic Jenana , Christensen Cinda L.
Published: October 2010

Enterococci are a common cause of urinary tract infections (UTIs) among hospitalized patients. The rising prevalence of vancomycin‐resistant enterococci (VRE) is of particular concern within many institutions because of its association with increased mortality and health care costs, as well as limited treatment options. Clinicians need to differentiate between VRE‐associated urinary colonization, asymptomatic bacteriuria, and UTIs in order to determine the need for treatment, optimal therapeutic options, and length of therapy. Unnecessary use of antibiotics in patients simply colonized and not infected with VRE in the urine has become a large problem in both hospitals and long‐term care facilities. A PubMed‐MEDLINE search was conducted to identify all English‐language literature published between January 1975 and March 2010 in order to summarize diagnostic criteria and treatment options for VRE UTIs. Several antimicrobials are discussed, with the specific focus on those with the potential to treat VRE UTIs and susceptibility patterns of VRE from urinary sources: ampicillin, amoxicillin, daptomycin, doxycycline, fosfomycin, imipenem‐cilastatin, linezolid, nitrofurantoin, penicillin, piperacillin, quinupristin‐dalfopristin, tetracycline, and tigecycline. Recommendations for empiric treatment of enterococcal UTIs and definitive treatment of VRE UTIs, including an evidence‐based treatment algorithm, are proposed. Ampicillin generally is considered the drug of choice for ampicillin‐susceptible enterococcal UTIs, including VRE. Nitrofurantoin, fosfomycin, and doxycycline have intrinsic activity against enterococci, including VRE, and are possible oral options for VRE cystitis. Linezolid and daptomycin should be reserved for confirmed or suspected upper and/or bacteremic VRE UTIs among ampicillin‐resistant strains. Use of other antimicrobials, such as quinupristin‐dalfopristin and tigecycline, should be evaluated on a case‐by‐case basis due to concerns of toxicity, resistance, and insufficient supportive data. Additional clinical data are needed to determine the optimal management and duration of therapy for VRE UTIs.
Optimal Medication Therapy Prescribing and Management: Meeting Patients' Needs in an Evolving Health Care System
Authors: Zarowitz Barbara J. , Miller William A. , Helling Dennis K. , Nappi Jean , Wells Barbara G. , Nahata Milap C.
Published: October 2010

Evolving health care environments present opportunities and challenges for clinical pharmacists to become increasingly more pivotally integrated as critical members of interprofessional care teams. Optimal medication therapy prescribing and management is best characterized as a process that results in safe, effective, efficient, and culturally sensitive medication ordering, order fulfillment, administration, and monitoring, which achieves desired clinical outcomes for a specific patient. Bringing together the knowledge, skills, and perspectives of an interprofessional team of physicians, nurses, physician assistants, nurse practitioners, pharmacists, and others where appropriate provides the expertise and synergy to optimize medication therapy decisions, educate patients, implement and monitor medication therapy, enhance adherence, and achieve and measure quality clinical outcomes. Although there are well‐defined barriers to overcome, we, the members of the 2009 American College of Clinical Pharmacy Presidential Task Force, envision optimal medication therapy prescribing and management functions ideally to occur in health care settings with adequate resources to deliver high‐quality care. In the presence of financial pressure, safeguards should be developed between practice activities and economic and accounting procedures to mitigate conflicts of interest that could otherwise occur in drug selection and overuse. In the future, clinical pharmacists will participate prospectively as essential full‐time members of interprofessional care teams. Although it is anticipated that pharmacists will be embraced in these roles in all managed care and government‐based systems, virtual or remote participation in medication therapy management may remedy access to pharmacists in settings and locales where they cannot be physically present or where economic models necessitate virtual care delivery.
Global Social Interactions with Sequential Binary Decisions: The Case of Marriage, Divorce, and Stigma
Authors: Christensen Finn , Jung Juergen
Published: October 2010

This paper studies global social interactions in a stylized model of marriage and divorce with complementarities across agents. The key point of departure from traditional models of social interactions is that actions are interrelated and sequential. We establish existence and uniqueness results akin to those in traditional models. In contrast to these models, however, we show that the presence of strategic complementarities is no longer sufficient to generate a social multiplier that exceeds one in this environment. Self-fulfilling conformity, whereby a greater desire to conform at the individual level leads to greater homogeneity of choices in the aggregate, is not retained either. Some empirical implications are also discussed.
Content of fluorine in soils in the vicinity of aluminium plant in Podgorica
Authors: Blagojevic Srdjan , Jakovljevic Miodrag , Radulovic Mirjana
Published: October 2010

The purpose of this paper was to determine whether soils, located in the vicinity of the aluminium plant in Podgorica, are polluted with fluorine. For this purpose 60 soil samples (26 of brown and 34 of alluvial soil) were collected from two depths (0 to 20 and 20 to 40 cm). Total and available fluorine were determined by potentiometric method, after necessary preparations of soil samples for the analysis. It was found that in almost all soil samples the content of total fluorine was above 300 mg/kg - maximum permissible value for the content of this element in agricultural soils. Highest values were found on locations southwards of the aluminium plant. However, the content of available fluorine (soluble in water) in the soil samples is very low (average value is 0.70 mg/kg) indicating that major part of deposited fluorine had transformed itself into insoluble compounds like CaF2.
The influence of meteorological conditions on major quantitative and qualitative traits of buckwheat (Fagopyrum esculentum Moench)
Authors: Maletic Radojka , Jevdjovic Radosav
Published: October 2010

The results of two-year investigations of buckwheat raised in agroecological conditions of South Banat (Pancevo) and West Serbia (Gorobilje) are presented in the paper. Based on the obtained investigation data, we confirm the hypothesis that buckwheat is a plant suited to more humid regions, since we have determined higher yield of the plant on locations with higher precipitation amount. During 1999, the yield of buckwheat was higher at the location in Pancevo and the next year at the location in Gorobilje. Also, in the year 2000, values of average plant height, number of seeds per plant and seed mass per plant were higher at the location in Gorobilje, whereas in the year 1999 (first year of investigation), which from the aspect of climatic conditions could be considered as optimal, plant yield and all other investigated parameters were better in case of buckwheat originating from the location in Pancevo. In the year 2000, in regard to the seed proportionally medium fractions were more present, which is, among other things, the result of the influence of higher precipitation amount. In regard to the exploitation value of the seed, better germination was registered for seed produced in 2000 (at both locations), although it had lower mass compared to the seed produced in 1999. Blossoming (blooming) in the first study year at both locations started 5 to 7 days earlier compared to the second year of investigations and lasted 5 to 8 days longer. On the other hand, in the second year of investigations at both locations harvesting started 10 to 12 days earlier compared to the previous year.
The influence of zeolite on the quality of fresh beet pulp silages
Authors: Koljajic Viliman , Djordjevic Nenad , Grubic Goran , Adamovic Milan
Published: October 2010

The influence of different doses of natural zeolite addition on chemical composition and quality of beet pulp silages was investigated. Beet pulp was ensiled in the sugar factory in Pozarevac immediately after they were obtained, or after 9 or 17 days. The two-factorial trial was conducted where the first factor (A) was the time of ensiling expressed in days after the pulp was obtained (a1= O; a2 = 9; a3 = 17), while the second factor (B) was the amount of zeolite added (b1= 0; b2 = 0.05; b3 = 0.25 and b4 = 1.25% in dry matter or 0; 50; 250 and 1250 g zeolite per 100 kg of raw beet pulp). Sample collection for standard chemical composition and quality estimation was taken 60 days after the beginning of the ensiling. The results from the literature show that adding technologically processed natural zeolite (Min-a-Zel, produced by ITNMS, Belgrade) while ensiling beet pulp has significant influence on the increase of lactic acid production, decrease in bonded acetic acid content and lower pH value. The influence of explained doses of zeolite on standard chemical composition is smaller and mostly of relative value. The only real changes in chemical composition are the increase in dry matter and mineral content. In the ensiling of the beet pulp stored in the longer period of time, the more intensive fermentation processes were achieved and the production of organic acids was larger which has better conserving effects on silage.
Analyzing of coffee quality with different methods
Authors: Rajkovic Milos , Vukovic Gorica , Peric Lidija , Demin Mirjana , Lalicic Jovanka , Kovacevic Divna
Published: October 2010

The results obtained by the analysis of the samples of coffee mostly consumed on our market showed that the coffee quality corresponds to the values as given in the Law of Health Food. It was not found that any of the parameters which determine food quality exceeded permitted values. Content of heavy metals and aflatoxines is below permitted values. The least content of caffeine was determined in a coffee sample roasted in the private roaster?s shop, and only in it the presence of coffee surrogates/substitutes was not proved. The obtained results of the coffee analysis showed that the coffees of most popular producers are very equal, and results of caffeine analysis are even more equal. This indicates the most probable fact that coffee is of the same origin, and that later, on during production, a different mixture was made, which affects the final product and gives aroma and taste to the liquid.