bluuebunny/crossref_metadata_2025 huggingface dataset:
The Post-1965 Reductions in United States Infant Mortality: A National or International Phenomenon?
Authors: Woodward Robert S. , Poertner Grace C.
Published: January 2017

The extent to which post-1965 declines in infant mortality could be attributed to (1) US medical and antipoverty programs and/or (2) internationally available medical advances was examined using data on infant, neonatal, and postneonatal mortality rates (IMRs, NMRs, PNMRs) in four western countries. The results showed that while post-1965 improvements occurred internationally, the US IMR improvements doubled that occurring elsewhere. Much of this advantage was attributable to post-1965 US PNMR improvements, which more than offset a slowing in the reduction of international PNMRs. In contrast, international effects contributed more to US declines in NMRs than did uniquely-United States factors.
Application of the Mantel—Haenszel Odds Ratio in Validation of Hospital Episode Statistics Data
Authors: Gilthorpe M. S.
Published: January 2017

The National Health Service reforms have led to a growing need to determine the efficiency and cost effectiveness of health care provision. Resource utilization and the factors that influence it form a vital part of the information procured by commissioners of health care. Currently, the most comprehensive source of routinely collected data is the Hospital Episode Statistics database. This database provides the most complete coverage of all areas of hospital inpatient services; these services account for up to 70% of the health care budget. Several studies have investigated the integrity of these data, but they have been concerned only with a subset of the data or with particular hospitals. This paper derives a method of data validation that can be applied either regionally or nationally to two key fields within the database: in this instance, consultant specialty and principal diagnosis. The process uses the Mantel—Haenszel odds ratio estimate to reveal large anomalies within either specialty or diagnostic coding. Within the West Midlands, it was generally observed that diagnosis codes are coded more consistently than consultant codes. However, problems occur due to incomplete or incorrect diagnostic entries and these anomalies are irregular across provider units. In contrast, anomalies within Korner specialty codes are associated predominantly with maternity, obstetrics, geriatric and general medicine. A large number of these anomalies are well understood within the context of local practice variation. Nevertheless, many anomalies remain within a wide range of other specialties where further investigation is warranted. Where systematic error is found, provider units should be notified in order to improve data consistency and enhance quality for future data users and health care planners.
Matching Services to Needs in the Health Care of Elderly People
Authors: Spicker P. , Hanslip J.
Published: January 2017

This paper is based on the results of a postal enquiry to health care professionals working in the care of elderly people in a Scottish Health Board. Responses fall into three main categories. The first refers to issues of process, where lack of information or delays in response create problems. Second, there are problems of scarcity, with both lack of provision and pressures on existing provision. Third, the responses relate to the impact of constrained choices, which are the consequences of that scarcity: either people are sent to existing services because of a lack of alternatives, or people cannot be referred on appropriately because of the lack of alternatives. The process of referral is, then, affected directly by the options that are available. In the process, compromises have to be made, and this produces mismatches between needs and services.
Conducting Qualitative Research in the Health Sector: Researcher Issues and Dilemmas
Authors: Hill S. , Beattie R. S. , McDougall M.
Published: January 2017

This article contributes to bridging the gap between research activity and the practical implementation of management decision making in the health sector by reflecting upon some of the issues and dilemmas for researchers, whether academics or managers, in conducting qualitative research in this sector.

The article presents the methodological issues addressed by a team of researchers engaged on a project about manager learning and development in an NHS Trust, and highlights concerns about ethical issues that emerged from the research process. The study had involved a series of interviews with senior managers and clinical staff, doctors, nurses and therapists, and it addressed issues surrounding change within the organization, the impact on individuals' jobs, and the resultant learning and development required and undertaken. The article emphasizes that engaging in reflection on the research process is valuable and suggests that it should become a mainstream part of such research. It concludes that there is an important role of qualitative management research in the health sector and that for it to be acceptable and valued, it must be operationally sensitive, ethically robust and methodologically rigorous.
Computational fluid dynamics and experimental analysis of the influence of the energy recovery unit on the proportional relief valve
Authors: Lin Tianliang , Chen Qiang , Ren Haoling , Lv Ruoxi , Miao Chen , Chen Qihuai
Published: January 2017

The overflow energy loss in relief valve, which is one of the main reasons leading to the low efficiency of the hydraulic system, had been considered to be impossible to solve. The principle of the overflow energy loss of the relief valve is analyzed and a novel method to reduce the overflow loss using an energy recovery unit, which can improve the return line pressure of the pilot proportional relief valve, is proposed. The influence of the energy recovery unit on the pressure control characteristics and steady-state flow force of the pilot proportional relief valve are discussed. The effects of the return line pressure on the distribution of the flow field and the pressure control characteristics are analyzed through computational fluid dynamics simulation and experiment. The results show that with the increase of the return line pressure, the displacement of the main valve spool increases and the reset spring force increases accordingly. While the steady-state flow force decreases dramatically with the increase of the return line pressure, which results in a smaller pressure differential the pressure differential can be reduced from 15% to 2.5%. It is also observed that the flow rate of the pilot proportional relief valve can be maintained at a certain value with a small oscillation and that the pilot proportional relief valve can release the redundant flow of hydraulic system. This verifies that the pilot proportional relief valve with the outlet connecting to the energy recovery unit to recovery the overflow energy loss cannot reduce the pressure control characteristics, but can achieve a better pressure control accuracy of the pilot proportional relief valve.
The generation principle, mathematical models of variable involute, and its application
Authors: Sun Qiang , Sun Yuehai
Published: January 2017

A novel generation method of tooth profile curve is presented in this paper. It introduces the concept of a variable involute whose curve is generated by the generating line rolling and slipping on the base circle simultaneously. The generation principle of variable involute is described and the equation of variable involute is deduced. Then, equations are established to synthesize a conjugate profile for the gear teeth, which include some restrictions to keep the involute meshing properties. With a selectable and arbitrary relative slippage which is defined as a slipping function, the variable involute has desirable properties of controllability and flexibility. By constructing different slipping functions, involute, cycloid and circular-arc gears can be expressed into one unified form. The freedom and unified form of variable involute suggests the possibility of optimal conjugation design. An application example of gear pair with a few teeth is presented, aiming at overcoming the shortcomings of involute gear pair in load-carrying capacity and meshing performance, and its simulation analysis is conducted. Through comparative analysis with the involute gear, the results demonstrate that the variable involute gear pair with a few teeth has larger contact ratio as well as load-carrying capacity, and engagement performance has been effectively improved.
Comparative investigation of auxiliary processes for increasing the strength of clinched joints
Authors: Chen Chao , Zhao Shengdun , Cui Minchao , Han Xiaolan , Fan Shuqin , Zhao Xuzhe
Published: January 2017

Mechanical clinching has been widely used in the field of automotive industry in recent years. However, the clinched joint has a lower static strength than spot welding. In order to increase the static strength, a comparative investigation of two auxiliary processes for increasing the strength of clinched joints was carried out. One auxiliary process needs a rivet, while another auxiliary process needs a bumped die. Tension-shearing strength tests and cross-tensile strength tests were conducted to assess the static strengths of the joints after different auxiliary processes. Failure mode of all the joints was neck fracture in the tension-shearing strength tests and cross-tensile strength tests. Geometrical parameters of the joint profile were also investigated by comparing the two auxiliary processes. The values of energy absorption of different joints were obtained by measuring the areas between the force–displacement curve and x-coordinate. The two auxiliary processes were proved to be effective. The auxiliary process with a rivet has a better performance than the auxiliary process with a bumped die.
HIV-associated sub-acute sclerosing panencephalitis – an emerging threat?
Authors: Manesh Abi , Moorthy Mahesh , Bandopadhyay Rini , Rupali Priscilla
Published: January 2017

Earlier age of measles virus infection predisposes to development of sub-acute sclerosing panencephalitis (SSPE) and this risk is heightened in HIV-infected children. We describe a HIV-infected young adult on antiretroviral therapy, presenting with a non-classical, fulminant form of SSPE to highlight the unpredictable nature of measles presentation. The recent spate of measles outbreaks due to virus introduction in populations with sub-optimal vaccine coverage or waning immunity and co-existing paediatric HIV cohorts is a cause for concern.
Ocular-Systemic Interrelationships in Acquired Immunodeficiency Syndrome
Authors: Mansour A M , Uchida T , Rodenko G , Dutt R
Published: January 2017

We analysed the correlation between ophthalmic and systemic findings in 125 subjects with AIDS and 50 subjects with AIDS-related complex (ARC). Positive eye findings were defined as the presence of cotton-wool spots (CWS) or cytomegalovirus (CMV) retinitis. The presence of positive eye findings was significantly more frequent in AIDS than in ARC ( P=0.0001). Both lowest haematocrit and lowest T-helper cell count were significantly lower in AIDS than in ARC, and also lower in subjects with positive eye findings than in those with negative eye findings. No association was found between ocular findings and the following: risk factors for human immunodeficiency virus (HIV) transmission; positive titres for CMV, herpes simplex, Epstein-Barr virus (EBV), and toxoplasmosis; systemic infections; and intake of azidothymidine (AZT). Patients with AIDS and CWS were similar to patients with AIDS and CMV retinitis in viral serology, haematocrit, T-helper count, and survival. Positive eye findings, low haematocrit, and low T-helper count are poor prognostic signs for survival in AIDS.
Ten Year Follow-Up Study of Women Presenting to a Genitourinary Medicine Clinic with Anogenital Warts
Authors: Handley J , Lawther H , Horner T , Maw R , Dinsmore W
Published: January 2017

One hundred heterosexual women presenting at our clinic in 1979 with anogenital warts, were reviewed 10 years later. Median duration of warts following initial clinic attendance was 2 months (range 0–120 months). In 1979 cervical PAP smear results were available for 76 patients; cervical intraepithelial neoplasia (CIN) was seen in 15/76 (19.7%) women; 3 (4%) women had low grade CIN, 12 (15.7%) women had high grade CIN. Nineteen women had had treatment for CIN between 1979 and 1989, 7 laser ablation, 9 cone biopsy, 2 laser ablation and cone biopsy, and one woman laser ablation, cauterization and cone biopsy. At 10-year follow-up in 1989 4/100 women had anogenital warts, 12/100 women had cytological evidence of CIN (7 low grade, 5 high grade), and 37/100 women had CIN detected on colposcopic biopsy (31 low grade, 6 high grade). No women developed invasive cervical carcinoma during the study period. CIN lesions, detected in 1979, regressed without any treatment in 2 women. Colposcopic biopsy was 3.1 times more sensitive than single cervical PAP smear at detecting CIN (4.4 times as sensitive in detecting low grade CIN; 1.2 times as sensitive in detecting high grade CIN). In 1989 CIN was detected in 7/19 (36.8%) of women who had undergone cervical treatment between 1979 and 1989, and in 35/81 (43.2%) of women having no cervical treatment within this period (chi squared P > 0.5). These findings suggest that cervical laser ablative therapy and cone biopsy do not in the long term influence the natural history of cervical human papilloma virus-associated disease (CIN) in women with anogenital warts. Fifty-three per cent of women had CIN (34% low grade, 19% high grade) at some time during the study period. When considered individually, age at first coitus, number of sexual partners, cigarette smoking habits, oral contraceptive usage, initial duration of warts after first clinic attendance and parity, did not significantly affect the risk of developing CIN.
Beyond rice farming: Evidence from central Korea reveals wide resource utilization in the Songgukri culture during the late-Holocene
Authors: Kwak Seungki , Kim Gyeongtaek , Lee Gyoung-Ah
Published: January 2017

This study investigates prehistoric subsistence of the middle Bronze (Mumun) period in the central part of the Korean Peninsula during the late-Holocene. Rice farming has often been regarded as a harbinger of complex society with an economic foundation based on rice yields. We test this common hypothesis on intensive rice farming as a primary means of subsistence and political economy through an integrative approach with archaeobotanical and isotopic data. We focus on the sites from the Songgukri culture (2900–2400 cal. BP) which are scattered along the middle and lower reaches of the Geum River. Our study indicates settlers along the Geum River utilized a wide range of crops and wild animals, a picture far removed from the popular view of a rice-dominated diet in the Songgukri culture.
Impact of Prenatal Screening and Diagnosis on the Epidemiology of Structural Congenital Anomalies
Authors: Le-Ha Chi , Stone David H , Gilmour W Harper
Published: January 2017

Objective —

To assess the impact of prenatal screening on the birth prevalence of three categories of structural congenital anomaly: abdominal wall defects (omphalocele and gastroschisis), renal agenesis/dysgenesis, and limb reduction defects.

Setting —

Glasgow, Scotland, United Kingdom.

Methods —

Data on the selected defects were obtained retrospectively from the population based Glasgow Register of Congenital Anomalies for the period 1980–91 inclusive. The register records all clinical or laboratory diagnoses of congenital anomaly in live births, stillbirths, and induced abortions occurring in women resident within the boundaries of the Greater Glasgow Health Board. The secular trends in the proportions of the defects diagnosed prenatally and terminated after screening, and in their prevalence at birth and during pregnancy, were examined. A total of 154845 births were surveyed: 309 cases were identified in the selected anomaly categories.

Results —

83 cases of omphalocele/gastroschisis (5·4/10000 births), 92 cases of renal agenesis/dysgenesis (5·9/10000 births), and 134 cases of limb reduction defects (8·7/10000 births) were found. Marked increases occurred over the study period in the proportions of cases diagnosed prenatally but not in the proportions terminated. The greatest difference between the prevalence at birth and during pregnancy was found for omphalocele. There were no significant secular trends in the prevalence of the selected defects.

Conclusions —

Prenatal screening has made a limited epidemiological impact on the prevalence of these defects. It has been moderately (but inconsistently) effective in the avoidance of births of infants with omphalocele/gastroschisis and renal agenesis/dysgenesis but not of limb reduction defects. Future efforts should be directed towards improving the technical aspects of the ultrasonographic detection of fetal abnormalities and exploring in detail, locally, the reasons for the varying pattern of decision making about termination of pregnancy among prospective parents.
Screening for Breast Cancer in Women Aged under 50: Mode of Detection, Incidence, Fatality, and Histology
Authors: Tabar Laszlo , Fagerberg Gunnar , Chen H H , Duffy S W , Gad A
Published: January 2017

Objective —

To assess the effect of screening for breast cancer in women aged 40–49 in the Swedish two county trial, in terms of mortality reduction, advanced cancer reduction, mode of detection, and the histology of tumours detected.

Setting —

The Swedish two county trial of screening for breast cancer, in which 77080 women aged 40–74 (19 844 aged 40–49) were randomly allocated to receive regular invitation to mammographic screening for breast cancer, and 55985 women aged 40–74 (15 604 aged 40–49) were allocated to an unscreened control group.

Methods —

The screening interval in the younger age group was two years and in the older age group about three years. Statistical analysis of mortality and incidence rates was performed by Poisson regression. Relative survival was estimated using proportional hazards regression.

Results —

The relative mortality for the group invited to screening compared with the control group was 0·87 (95% confidence interval 0·54 to 1·41) in the 40–49 age group, in close agreement with the relative incidence of advanced cancers. For Kopparberg county the relative mortality was 0·73 (95% CI 0·37 to 1·41) and for Ostergotland 1·02 (95% CI 0·52 to 1·99). The lesser effect in the 40–49 group as a whole was largely due to a higher rate of interval cancers in this age group, and the occurrence in Ostergotland of a higher number of cancers after randomisation, but before screening started, and in women who refused screening. The higher interval cancer rate was consistent with the higher proportion of ductal grade 3 and medullary cancers in women aged 40–49 at diagnosis.

Conclusions —

A major difficulty in screening women aged 40–49 is the rapid progression of a subset of tumours arising in this age group. Shortening the screening interval from two years would be necessary to achieve a higher mortality reduction.
Characteristics of Colorectal Cancer with False Negative Result on Immunochemical Faecal Occult Blood Test
Authors: Nakama Hidenori , Kamijo Noboru , Fujimori Kazuya , Horiuchi Akira , Fattah A S M Abdul , Zhang Bing
Published: January 2017

Objectives

–A comparative study was carried out to clarify the clinicopathological features of colorectal cancer diagnosed after a false negative result on the immunochemical faecal occult blood test.

Methods

–236 patients with colorectal cancer were studied: 48 patients with negative results and 188 patients with positive results with the faecal occult blood test. The two groups were compared according to their age and sex and by the site, size, macroscopic type, Dukes's classification, and histological type of their cancer lesions. Additionally, the above factors were investigated prospectively and compared in 40 cases of colorectal cancer cases diagnosed as false negative and in matched cases diagnosed as true positive in cancer screening by the immunochemical faecal occult blood test.

Results

–In both the hospital based case-control study and the screening programme based nested case—control study the prevalence of rectal cancers was higher in the false negative group than in the true positive group (P = 0.02, P = 0.03), but there were no differences between the two groups for any other factors.

Conclusion

–These results suggest that the immunochemical faecal occult blood test is unsuitable for the diagnosis of rectal cancer.
Regional and Country Policy Issues in Africa
Authors: Ahlers Theodore
Published: January 2017

Africa is growing and many of its socioeconomic indicators continue to improve. It is, however, no longer converging—catching up with the rest of the world. This failure to converge presents an urgent challenge to African governments and development partners. This article identifies key regional and country-specific issues requiring urgent attention to put Africa back on a convergence track. Africa is diverging in two important senses: slower growth than the rest of the world and increasing divergence among countries in Africa. Growth has slowed around the world over the last 3 years, but it has slowed more in Africa than elsewhere. For the first time in more than a decade, GDP growth in Africa in 2016 is projected to be below global GDP growth. Divergence is also increasing among countries in Africa. Convergence is still possible in Africa, but it depends on actions taken by individual countries. If African best-practice policies were generalized, the continent would be transformed. If they are not, Africa will continue to diverge from the rest of the world.
The Undeliverable Vision: Problems and Prospects of Motorisation in Asia
Authors: Dimitriou Harry T. , Ernst John P.
Published: January 2017

In the emerging economies of Asia, urban areas face a seemingly insurmountable challenge: the accommodation of rapid population growth while providing sufficient infrastructure to serve as hubs for the national economy competing in an increasingly global market. Transport infrastructure in such cities has typically been unable to keep up with freight and passenger traffic growth, as both national and local politicians have increasingly become enmeshed in a globalised vision of motorisation provided by the motor vehicle industry. Caught in this vision, despite its increasing unaffordability and some minimal opposition, cities in Asia have too often pursued road-building projects to service their development needs and relieve traffic congestion. This has resulted in a transport system catering to the needs of an affluent minority while reducing the public space available to the poorer majority. Aggravating the situation, past currency devaluation in the region has led to many governments providing fuel at subsidised costs with much of this subsidy being enjoyed by the transportation industry and middle/higher income groups. Within these developments has emerged a new conflict as the paradigm of sustainable development is increasingly promoted world-wide by international development agencies and national and city governments as a basis for future urban development. This paradigm focuses on environmental enhancement, poverty alleviation, equity improvement and good governance, providing a critical counter-voice to the vision of motorisation proponents. As a result of these parallel developments, we are now witnessing in Asia (and elsewhere), a collision of two globalised visions: motorisation and sustainable development. There is, consequently, an urgent need for the development of a new vision by (and for) the motor vehicle industry that assigns motorisation to a more constructive role in an integrated future for transport use and sustainable urban development, jointly arrived at by key stakeholders of development. It is the belief of the authors that this new vision can and will provide exciting new technological and commercial opportunities for the global transportation industry and urban inhabitants alike.
The future of economics: The case for an evolutionary approach
Authors: Neild Robert
Published: January 2017

Much theoretical and empirical work by economists and psychologists has shown that the neo-classical approach is defective, and economists are now looking for an alternative. Evolutionary economics is the answer. It starts from the realistic premise that society and the economy are shaped by competition, but unlike neo-classical economics, it proceeds empirically by observing and analysing what has been happening to the economy and society. It does so on the premise that a process of social selection is taking place, analogous but not identical to that of biological selection. This dynamic approach requires a revival of economic history. By reporting on, and inviting debate over, what is happening and its implications, the adoption of an evolutionary approach should help restore the moral content of economics and the surrounding social sciences. Such a change in approach would be a paradigm shift, and will take time. That it will happen is likely: in the end facts kick.
Comparison of three different primer sets for sexing birds
Authors: Çakmak Emel , Akın Pekşen Çiğdem , Bilgin C. Can
Published: January 2017

Because many bird species are monomorphic or only sexually dimorphic in adult stages, it is difficult to determine their sexes, which may cause significant problems in population and conservation studies. DNA-based sexing relies on the chromodomain helicase DNA binding ( CHD) gene located on the W chromosome and its homolog on the Z chromosome, giving distinct banding patterns on agarose gel as a result of length differences in intronic regions within this gene. We used 3 specific primer sets, CHD1F/CHD1R, 2550F/2718R, and P2/P8, for sex determination of 230 samples from 77 avian species. We report here the records for 70 of those species analyzed using the CHD1F/CHD1R primer set, and 49 species using 2550F/2718R, and 46 species using P2/P8. CHD1F/CHD1R PCR products on agarose gel generally showed an apparent single band in males and 2 bands in females, but the products of 2550F/2718R (61%) and P2/P8 (42%) showed distinct banding patterns for separate bird orders. However, when PCR products of these last 2 primer pairs labeled with fluorescent dye were run in a capillary gel and detected using a DNA analyzer, P2/P8 gave 2 distinguishable peaks in females, whereas 2550F/2718R results remained the same. DNA sexing with any of those 3 primer sets can be used for all sexually monomorphic avian taxa although the primer sets should be compared before choosing the most efficient one for molecular sexing of the studied species.
Leadership and Creativity in Public Services: An Interview With Lord Michael Bichard, Chair of the National Audit Office
Authors: Bolden Richard , O’Regan Nicholas
Published: January 2017

This interview with Lord Michael Bichard, one of the most distinguished public sector leaders in the United Kingdom, explores his ideas around the relationship between leadership, creativity, and innovation. A champion of place-based approaches to public services, where citizens are actively involved in service design, delivery, and appraisal, Bichard advocates the need for inclusive and supportive leadership that enables the emergence of the kinds of creativity required to respond to the financial challenges facing the public sector. Bichard’s ideas resonate with recent research on creative leadership and provide a practical illustration of place-based and systems leadership in the public sector and beyond.
Use of Granulocyte Colony-Stimulating Factor in the Treatment of Pancytopenia Secondary to Colchicine Overdose
Authors: Katz Roya , Chuang Linda C. , Sutton Jacqueline D.
Published: January 2017

OBJECTIVE:

To report a case of pancytopenia following colchicine overdose and to discuss the use of granulocyte colony-stimulating factor (G-CSF) for treating this severe complication.

CASE SUMMARY:

A 19-year-old man developed pancytopenia four days after ingestion of approximately 50–60 0.6-mg colchicine tablets in a suicide attempt. His pancytopenia resolved after subcutaneous administration of one 300-μg dose of G-CSF. The patient recovered from his other multiorgan disturbances during his hospitalization and was discharged from the hospital with elevated liver enzyme concentrations.

CONCLUSIONS:

Colchicine overdose is rare, but can be fatal. The use of G-CSF appears to be beneficial in alleviating bone marrow depression in colchicine overdose situations.
Antibiotic Prescribing Patterns in Italian Hospital Inpatients with Pneumonia, Chronic Obstructive Pulmonary Disease, and Urinary Tract Infections
Authors: Guglielmo Luigi , Leone Roberto , Moretti Ugo , Conforti Anita , Spolaor Alvise , Velo Giampaolo
Published: January 2017

OBJECTIVE:

The primary objective of this study was to describe the antibiotic prescribing patterns in hospital inpatients with pneumonia (PN), exacerbations of chronic obstructive pulmonary disease (COPD), and urinary tract infections (UTIs). A second objective was to verify if some selected variables (i.e., risk factors, patient age, size of hospitals) were affecting the therapeutic choice.

DESIGN:

Survey was performed on 1609 patients. The data were collected by physicians using a special form, covering a six-month period.

SETTING:

Twenty-six medical wards and 8 geriatric wards in 24 acute-care hospitals in the Veneto Region in Northern Italy.

PATIENTS:

A consecutive sample of PN, COPD, and UTI patients treated with antibiotics.

MAIN OUTCOME MEASURES:

The following information was collected: patient and hospital demographics, risk factors, diagnoses, and antibiotic regimens.

RESULTS:

Sixty-three antimicrobial agents used, with 2115 administrations, 1227 of which were single-drug therapy. The most frequently used drugs were third-generation cephalosporins (24.6 percent), fluoroquinolones (15.4 percent), aminopenicillins (15.0 percent), and ureidopenicillins (9.7 percent). There is great variability of therapeutic regimens in the various hospitals for the same disease. However, this variability is not explained by the different types of hospitals or by the patients' characteristics (e.g., age, risk factors).

CONCLUSIONS:

Our results show that the use of broad-spectrum antibiotics probably is excessive. Moreover, the treatment seems to be based more on the opinion of the treating physician and the local habits rather than objective criteria. These factors may have negative repercussions not only in economic terms, but also in terms of alteration of the bacterial ecology.
Calcium-Channel Antagonists for Prevention of Atherosclerosis
Authors: Borcherding Shawn M. , Meeves Suzanne G. , Klutman Neil E. , Howard Patricia A.
Published: January 2017

OBJECTIVE:

To critically evaluate the current literature regarding the role of calcium-channel antagonists in preventing atherosclerosis.

DATA SOURCES:

English language clinical studies, abstracts, conference proceedings, and review articles pertaining to calcium-channel antagonists and atherosclerosis.

STUDY SELECTION:

Relevant animal and human studies examining the role of calcium-channel antagonists in atherosclerosis prevention and treatment.

DATA EXTRACTION:

Potential mechanisms for the development of atherosclerosis and the use of calcium antagonists for preventing and treating coronary artery disease are discussed. Animal studies are summarized; next, significant data from human clinical studies are presented.

DATA SYNTHESIS:

Available studies are described and discussed.

CONCLUSIONS:

Results from animal and clinical trials in humans suggest that calcium antagonists may retard the development and progression of atherosclerosis. However, most clinical trials to date have been conducted in patients with proven atherosclerotic plaques. Further studies examining the role of calcium-channel antagonists in preventing and treating atherosclerosis are needed, but may be difficult to conduct because of the large numbers of patients required, long trial duration, and associated costs.
Assessing the Quality of Pharmaceutical Care I. One Perspective of Quality
Authors: Farris Karen B. , Kirking Duane M.
Published: January 2017

OBJECTIVE:

To evaluate the concept of pharmaceutical care (PC) as a standard of quality care for ambulatory pharmacy practice.

DATA SOURCES:

Donabedian's article on the seven pillars or characteristics of quality provides a framework for a discussion of the merits of PC as a definition of quality. A MEDLINE search augmented by a manual review of International Pharmacy Abstracts was also used to identify pertinent English-language pharmacy literature; indexing terms included quality, community pharmacy services, ambulatory, pharmacy services, and pharmacist(s).

STUDY SELECTION:

Representative articles and studies promoting PC were considered.

DATA EXTRACTION:

The literature was independently reviewed by the primary author.

DATA SYNTHESIS:

An interpretation of the principles of Donabedian's article was applied to PC. PC appears to be consistent with the quality characteristics of efficacy and acceptability. The effectiveness, cost-effectiveness, and efficiency of PC should be firmly established by its practitioners as barriers are eliminated and/or overcome. The pillars of optimality, equity, and legitimacy seem to be overlooked under the current definition of PC. This article contends that PC assumes an individualist definition of quality, by definition, because of its covenantal relationship with the patient.

CONCLUSIONS:

Quality is defined in terms of the values of individuals and society. For now, PC appears to be the appropriate standard for defining quality in pharmacy because of the importance of individual maximal benefits within our society.
Impact of Pharmacist Interventions on Medication Management by the Elderly: A Review of the Literature
Authors: Tett Susan E. , Higgins Gwen M. , Armour Carol L.
Published: January 2017

OBJECTIVE:

To review the impact of pharmacist interventions designed to assist older people in managing their medication regimens.

DATA SOURCES:

A computer search of literature published between 1975 and 1990 was conducted using MEDLINE. References were also identified from the bibliographies of pertinent articles.

STUDY SELECTION:

Studies included in the review were those evaluating pharmacist interventions that were designed to assist in medication management by people over 65 years of age. Only nine studies were identified by these criteria. Interventions that have not been evaluated are discussed briefly. The studies included were chosen by consensus of the authors.

DATA EXTRACTION:

A data extraction form was used to summarize the information in each study.

RESULTS:

This was a qualitative review. Some studies evaluating the effects of short verbal medication counseling episodes showed positive benefits; others showed no benefit. Written medication information, some memory devices, and audiovisual techniques have also been found to be of limited use. Self-medication programs for hospitalized elderly people need to be evaluated.

CONCLUSIONS:

This review identified the lack of published evaluations of pharmacist interventions in medication management by elderly people. Well-designed studies need to be performed to determine the effects of individualized advice and counseling. The cost-effectiveness of such interventions should be assessed, with consideration of long-term outcomes, such as readmission rates to the hospital and cost savings accruing from increased duration of independent living.
Hydrazine Production in Children Receiving Isoniazid for the Treatment of Tuberculous Meningitis
Authors: Donald Peter R. , Seifart Heiner I. , Parkin Donald P. , van Jaarsveld Pieter P.
Published: January 2017

OBJECTIVE:

To study the generation of the hepatotoxin hydrazine in 32 malnourished children receiving isoniazid for the treatment of tuberculous meningitis.

DESIGN AND SETTING:

This observational study was undertaken in the pediatric ward of a teaching hospital admitting children with advanced forms of tuberculous meningitis for treatment and management of complications.

METHODS:

Thirty-two children (mean age 2.28 years) receiving isoniazid 20 mg/kg/d were studied. Plasma isoniazid, acetylisoniazid, and hydrazine concentrations were determined by an HPLC method. Fourteen children were studied at weekly intervals for the first month of treatment and again after six months of therapy; 18 additional children were studied on one or more occasions during the first month of treatment only.

RESULTS:

The area under the curve for hydrazine two to five hours after the isoniazid dose correlated with the isoniazid elimination rate and with acetylisoniazid generation. Hydrazine production increased significantly during the first month of treatment, but decreased to approximate initial values at six months. No correlation was found between any clinical or biochemical indicator of liver dysfunction and hydrazine production.

CONCLUSIONS:

Hydrazine is formed in significant concentrations during the metabolism of isoniazid in young children. However, additional factors such as preexisting liver damage (e.g., from viral hepatitis) may be necessary for it to reach its toxic potential.
Acute Pulmonary Edema Associated with Ocular Metipranolol Use
Authors: Johns Melanie D , Ponte Charles D
Published: January 2017

Objective:

To report a case of pulmonary edema associated with the use of ocular metipranolol, a nonselective beta-blocker.

Case Summary:

A 72-year-old woman with no history of pulmonary or cardiac disease presented to the emergency room with signs and symptoms consistent with cardiogenic pulmonary edema. The patient had used metipranolol eyedrops approximately 1 hour before becoming symptomatic. When rechallenged inadvertently while hospitalized, the patient again became symptomatic. The patient's metipranolol eyedrops then were substituted with betaxolol eyedrops. She continued to be free of symptoms of pulmonary edema at subsequent clinic visits 1,4, and 6 weeks following discharge.

Discussion:

This is the first reported case of pulmonary edema associated with metipranolol. There was a reasonable temporal association between use of the eyedrops and the onset of symptoms. Beta-blockers may cause cardiogenic pulmonary edema secondary to their negative inotropic and negative chronotropic effects. The drug's lipid solubility or a deficiency in the enzyme responsible for its metabolism may have allowed the drug to accumulate to a critical concentration over the 6-week period of use.

Conclusions:

Ocular beta-blockers must be used with caution in patients with relative contraindications to beta-blockade. This case illustrates that these agents must be used prudently even in patients with no history of symptomatic congestive heart failure.
Bone and Tissue Changes following Prostaglandin Therapy in Neonates
Authors: Kaufman Michele B , El-Chaar Gladys M
Published: January 2017

OBJECTIVE:

To review case reports describing prostaglandin-induced bone changes and tissue swelling in neonates.

DATA SOURCES:

An Index Medicus and bibliographic search of the English-language literature pertaining to prostaglandin-induced bone changes and tissue swelling in neonates.

DATA SYNTHESIS:

Short- and long-term prostaglandin infusion in neonates is associated with cortical proliferation throughout the skeletal system. Total resolution of these changes has occurred in seven patients described to date; other reports did not note either the time or the regression of these changes. Skeletal changes may occur within 9 days of initiation of prostaglandin therapy and include widened fontanelles, pretibial and soft-tissue swelling, and swelling of the upper and lower extremities. These reactions may last up to 38 weeks following discontinuation of therapy. Alkaline phosphatase (AP) concentrations have been shown to be increased in four cases, as well as in one retrospective analysis. Although these were not prospective studies, evaluation of AP may provide a means to monitor neonates receiving prostaglandin therapy.

CONCLUSIONS:

Pharmacists need to be aware of the potentially serious skeletal changes, encourage dosage titration as soon as possible, and limit the duration of time neonates are exposed to prostaglandin therapy. Monitoring of AP concentrations during therapy with prostaglandins may be beneficial in predicting or preventing further complications.
A Method to Produce Sedation in Critically Ill Patients
Authors: Watling Sharon M , Johnson Melissa , Yanos John
Published: January 2017

OBJECTIVE:

To evaluate a protocol based on continuous infusion of a benzodiazepine and morphine to produce apnea/decreased respiratory effort as an adjunct to complex mechanical ventilation in patients with respiratory failure.

DESIGN:

Observational report of consecutive patients.

SETTING:

University medical intensive care unit.

PATIENTS:

Seventeen consecutive patients with acute respiratory failure requiring high levels of sedation and/or paralysis to facilitate mechanical ventilation were studied.

INTERVENTIONS:

Patients were started on a continuous infusion of a benzodiazepine and morphine soon after mechanical ventilation was instituted. The dosages of the benzodiazepine and morphine were increased to the end point of diminished respiratory effort or apnea depending on the clinical status of the patient and ventilatory mode. This regimen was supplemented with single doses of neuromuscular blocking agents (NMBAs) only as the dosages of benzodiazepine/narcotic were being titrated. The benzodiazepine/narcotic agents were then gradually reduced as the patient's condition improved, often using an oral route of administration.

MEASUREMENTS AND RESULTS:

The benzodiazepine/morphine combination produced apnea and diminished respiratory effort in patients requiring sedation from 2 to 50 days, including those with hemodynamic instability, hepatic dysfunction, renal dysfunction, and sepsis. The combination allowed the use of NMBAs to be minimized. There was no evidence of worsened hemodynamic instability as a result of the administration of these agents. The gastrointestinal tract could be used for nutrition in 8 of the 17 patients.

CONCLUSIONS:

Continuous infusion of a benzodiazepine and morphine controlled the respiratory rate in patients with severe respiratory failure requiring complex mechanical ventilatory support.
Prevention and Regression of Atherosclerosis: Effects of Hmg-CoA Reductase Inhibitors
Authors: Bjelajac Aleksandra , Goo Alvin KY , Weart C Wayne
Published: January 2017

OBJECTIVE:

TO review the current literature on the effects of hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors in secondary prevention and regression of atherosclerosis.

DATA SOURCES

A MEDLINE and journal search of recent studies evaluating the effects of lipid lowering with HMG-CoA reductase inhibitors on serum cholesterol as well as progression and regression of atherosclerotic coronary or carotid disease in patients with established atherosclerotic disease was conducted. Articles addressing the pathophysiology of atherosclerotic disease were identified by using the same sources.

STUDY SELECTION:

All available studies evaluating the use of HMG-CoA reductase inhibitors in the progression and regression of coronary and carotid atherosclerosis were reviewed.

DATA SYNTHESIS:

Lowering of total serum cholesterol, low-density lipoprotein cholesterol, and triglycerides, as well as increasing high-density lipoprotein cholesterol can be achieved with HMG-CoA reductase inhibitors. Aggressive lipid lowering has been demonstrated to alter progression of established atherosclerotic disease and, in some patients, actually induce regression of the atheroma. An unexpected finding of several trials was the early and significant reduction in clinical cardiac events. Other mechanisms by which clinical event reduction may be explained include plaque stabilization and restoration of endothelium vasodilation.

CONCLUSIONS:

Aggressive lipid-lowering therapy using HMG-CoA reductase inhibitors appears to alter the natural progression and promote regression of atherosclerosis in selected patients with established coronary or carotid atherosclerosis. However, it is unlikely that regression of atherosclerosis alone is responsible for the marked reduction in clinical cardiac events seen in these trials.
Media Scandals Are Political Events
Authors: Nyhan Brendan
Published: January 2017

When political scandals erupt in the press, we usually blame misconduct by public officials, but these episodes are political events whose occurrence and severity also depend in part on the political and media context. Using data on U.S. governors, I show that several key factors affect the likelihood and intensity that alleged misconduct will be politicized by the opposition and publicized by the press. First, lower approval ratings, which decrease the cost of politicizing and publicizing an allegation, are generally associated with more frequent and intense media scandals. By contrast, competing news events can crowd potential scandals off the news agenda. However, no evidence is found that opposition control of state political institutions leads to more media scandal. These results suggest that the occurrence of media scandal depends more on circumstance than we typically assume.
Science in the Social Media Age: Profiles of Science Blog Readers
Authors: Jarreau Paige Brown , Porter Lance
Published: January 2017

Science blogs have become an increasingly important component of the ecosystem of science news on the Internet. Through a survey of 2,955 readers of 40 randomly selected science blogs, we created profiles of science blog users. Super users indicated reading science blogs for a wide range of reasons, including for community-seeking purposes. One-way entertainment users indicated reading blogs more for entertainment and ambiance. Unique information-seeking users indicated reading blogs more for specific information not found elsewhere. But regardless of science blog users’ motivations to read, they are sophisticated consumers of science media possessing high levels of scientific knowledge.
Being There? The Role of Journalistic Legwork Across New and Traditional Media
Authors: Reich Zvi , Godler Yigal
Published: January 2017

In the age of spirited debates about the mediating role of technologies, the other side of the coin is the state of direct experience in contemporary news production, that is, cases in which news reporters still rely on traditional channels such as “legwork,” “firsthand witnessing,” or “shoe-leather reporting.” The present study is a systematic attempt to identify journalists’ reasons for engaging in legwork, by recreating item by item the work processes and reasoning behind hundreds of individual news reports produced in the digital age, across Israeli print, television, radio, and online news outlets ( N = 859). Insofar as legwork can serve as a proxy for painstaking journalism, journalists’ decisions make some difference in determining if more or less legwork will ensue. The data avail an opportunity to explore scholarly musings about journalists’ motivations behind legwork: be they knowledge related, medium related, or event related. We find support for all three possibilities and discuss the implications of these findings.