bluuebunny/crossref_metadata_2025 huggingface dataset:
Baclofen: Opiate Withdrawal
Authors: Generali Joyce A. , Cada Dennis J.
Published: May 2010

Off-Label Drug Uses

This Hospital Pharmacy feature is extracted from Off-Label DrugFacts, a quarterly publication available from Wolters Kluwer Health. Off-Label DrugFacts is a practitioner-oriented resource for information about specific drug uses that are unapproved by the US Food and Drug Administration. This new guide to the literature will enable the health care professional or clinician to quickly identify published studies on off-label uses and determine if a specific use is rational in a patient care scenario. A summary of the most relevant data is provided, including background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations. References direct the reader to the full literature for more comprehensive information before patient care decisions are made. Direct questions or comments regarding Off-Label Drug Uses to hospital pharmacy@wolterskluwer.com .
Contamination Comparison of Transfer Devices Intended for Handling Hazardous Drugs
Authors: Jorgenson James A. , Spivey Susan M. , Au Cam , Canann David , Ritter Howard , Smith Bart
Published: May 2010

Purpose

Heightened awareness of hazardous drug contamination in the workplace has increased the number of marketed, closed-system drug transfer devices (CSTDs). Currently, no official specifications for a closed-system device are available. Therefore, it is important to validate each system against the recommendations given by International Society of Oncology Pharmacy Practitioners and the National Institute for Occupational Safety and Health to make the best decision for an institution.

Titanium tetrachloride was selected to simulate the escape of vapor from each product. The second evaluation concentrated on the “dry connections” between the vial and syringe during drug preparation and between the syringe and access port during administration. Fluorescein sodium was selected to simulate contamination with the dry connections between the vial and syringe and between the syringe and access port.

Conclusion

The 2 studies found that only 1 of the 5 devices tested met the criteria or definition of a CSTD.
Preparing your Hospital for Compliance with the Joint Commission's National Patient Safety Goals
Authors: Murdaugh Lee , Jordin Robert
Published: May 2010

A recent Webcast hosted by Cardinal Health's Center for Safety and Clinical Excellence addressed the latest Joint Commission data, which showed a significant number of hospitals remain noncompliant with at least 1 of The Joint Commission's National Patient Safety Goals (NPSGs). This article reviews the 4 leading areas of noncompliance, discusses the expectations of Joint Commission surveyors, describes strategies for ensuring compliance, and offers guidance on how hospitals can comply with the new NPSG that addresses anticoagulant therapy management by the January 1, 2009, deadline.
Methylnaltrexone Bromide, Subcutaneous
Authors: Cada Dennis J. , Levien Terri L. , Baker Danial E.
Published: May 2010

Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing inservices. A comprehensive target drug utilization evaluation (DUE) is also provided each month. With a subscription, the monographs are sent to you in print and are also available online. Monographs can be customized to meet the needs of your facility. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X.). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. If you would like information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The September 2008 monograph topics are on difluprednate ophthalmic emulsion, eltrombopag, ustekinumab, denosumab, and milnacipran. The DUE is on certolizumab pegol.
Promoting Patient-Centered Pharmacy Services through Effective Facility Planning and Design
Authors: Mark Scott M. , Kirschling Thomas , Weber Robert J.
Published: May 2010

The Director's Forum series is written and edited by Michael Sanborn and Robert Weber and is designed for guiding pharmacy leaders in establishing patient-centered services in hospitals and health systems. Another specific goal of this column is addressing many of the key challenges that pharmacy directors currently face while providing information that will foster growth in pharmacy leadership and patient safety. A well-designed facility is an important component to providing patient-centered care. This Director's Forum article focuses on specific elements that should be considered when planning a new pharmacy facility.
Epidural-Intravenous Route Mix-Ups: Reducing the Risk for Deadly Errors; Discontinued Drug Leads to Error
Authors: Smetzer Judy L. , Cohen Michael R.
Published: May 2010

These medication errors have occurred in health care facilities at least once. They will happen again—perhaps where you work. Through education and alertness of personnel and procedural safeguards, they can be avoided. You should consider publishing accounts of errors in your newsletters and/or presenting them at your inservice training programs.

Your assistance is required to continue this feature. The reports described here were received through the United States Pharmacopeia (USP) Medication Errors Reporting Program (MERP), which is presented in cooperation with the Institute for Safe Medication Practices (ISMP). If you have encountered medication errors and would like to report them, you may call USP toll-free, 24 hours a day, at 800-233-7767 (800-23-ERROR).

Any reports published by ISMP will be anonymous. Comments are also invited; the writers' names will be published if desired. ISMP may be contacted at the address shown below.

Errors, close calls, or hazardous conditions may be reported through the ISMP ( www.ismp.org ) or USP ( www.usp.org ) Web sites or communicated directly to ISMP by calling 800-FAIL-SAFE or via e-mail at ismpinfo@ismp.org . ISMP guarantees the confidentiality and security of the information received and respects reporters' wishes as to the level of detail included in publications.
Fluticasone-Associated Churg-Strauss Syndrome; Amiodarone-Induced Lipomas; Amiodarone-Induced Pulmonary Toxicity; Hyperchloremic Metabolic Acidosis Resulting from Topiramate Use; Generalized Seizure in Patient Receiving Epidural Meperidine; Sirolimus-Induced Pneumonitis; Inappropriate Benzodiazepine Use and the Risk of Fracture; Chemotherapy-Induced Nausea and Vomiting
Authors: Shuster Joel
Published: May 2010

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the US Food and Drug Administration's (FDA's) MedWatch program (800-FDA-1088). If you have reported an interesting, preventable ADR to MedWatch, please consider sharing the account with our readers.
Automating Medication Reconciliation
Authors: Felkey Bill G. , Fox Brent I.
Published: May 2010

Due to the increase of developments that are moving and intensifying the health care field's transformation into a digital era, we feel it is appropriate to broaden our regular column, PDA Update, which previously focused on the implementation of personal digital assistants (PDAs) in pharmacy practice. We will now include viewpoints and recommendations on a broader array of information technology topics.
Isotretinoin-Associated Panenteritis; Cephalosporin-Induced Leukopenia; Two Separate Reports concerning Bupropion: Severe Constipation and Angioedema; Levetiracetam as a Possible Cause of Liver Failure; Megestrol Acetate and Adrenal Insufficiency
Authors: Shuster Joel
Published: May 2010

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the US Food and Drug Administration's (FDA's) MedWatch program (800-FDA-1088). If you have reported an interesting, preventable ADR to MedWatch, please consider sharing the account with our readers.
Economic Impact of Implementing Pneumonia Treatment Guidelines for Intravenous to Oral Conversion
Authors: Emerson Christopher R. , Antonopoulos Marilena S. , Marzella Nino , Grossman Samuel S.
Published: May 2010

Background

Inpatient treatment of pneumonia produces significant costs to the health care system. In an effort to improve quality of care, decrease length of stay, and decrease drug costs associated with treating pneumonia, on October 1, 2006, the Veterans Affairs New York Harbor Healthcare System (VANYHHS) implemented guidelines for treating hospitalized patients with pneumonia. These guidelines included specific criteria for initial selection of an antimicrobial agent based on patient risk factors, conversion from intravenous (IV) to oral antibiotics, and selection of an appropriate oral agent for conversion. The primary objective of this study was assessment of the economic impact of implementing pneumonia treatment guidelines at the VANYHHS.

Methods

Retrospective analysis of 100 patients admitted to the VANYHHS for treatment of pneumonia was completed before implementation of the guidelines, and then those data were compared with similar data from a group of 100 patients admitted to the hospital for treatment of pneumonia after implementation of the guidelines. Electronic medical records were reviewed for (1) initial antibiotic therapy administered, (2) time needed for conversion from IV to oral antibiotics after becoming eligible for the switch based on implemented guidelines, and (3) length of hospital stay.

Results

Data from the preguideline group demonstrated that it took an additional 2.31 days to convert patients from IV to oral antibiotics after they were eligible for the switch to oral therapy. The mean length of stay was 9.2 days. Data from the postguideline group illustrated that the time needed to convert patients from IV to oral therapy was decreased to 1.09 days ( P = 0.002) and the mean length of stay was decreased to 8.76 days ( P = 0.677) when compared with the preguideline group data. The estimated annual cost savings from implementing pneumonia treatment guidelines based on the decrease in mean length of stay was $290,482.20 annually.

Conclusion

Implementing pneumonia treatment guidelines was associated with decreased length of stay and, thus, a decrease in the costs associated with treating pneumonia in an institutional setting. It is estimated that the VANYHHS could save nearly $300,000 annually as a result of the implementation of the treatment guidelines for pneumonia.
Safety and Efficacy of a High-Intensity, Weight-Based, Intravenous Heparin Protocol Revision in Patients who are Obese
Authors: Dee Brian M. , Thomas Michael L.
Published: May 2010

Purpose

Data collected previously within this institution concluded that the initial heparin infusion rate in the high-intensity, weight-based, intravenous (IV) heparin protocol should be adjusted from 18 to 15 units/kg/h (based on actual body weight) in patients who are more than 50% above ideal body weight (IBW). The purpose of this study was evaluation of the safety and efficacy of the revised protocol.

Methods

A retrospective chart review was conducted from the initiation of the revised protocol on October 28, 2006, through March 15, 2007. All patients receiving high-intensity, weight-based heparin dosing were eligible for inclusion. Outcome measures included percentage of patients achieving therapeutic activated partial thromboplastin time (aPTT), time to first therapeutic aPTT, follow-up aPTT levels, adverse event occurrence, venous thromboembolism recurrence, and influence of concomitant disease states.

Results

A total of 55 regimens met inclusion criteria. There were no statistically significant differences between patients who were obese (greater than 50% above IBW) and those who were not obese (less than 50% above IBW) with respect to percentage achieving a therapeutic aPTT, time to therapeutic aPTT, or follow-up aPTT values. Patients who were more than 50% above IBW had improved therapeutic anticoagulation parameters postrevision, whereas patients who were 30% to 50% above IBW had worsened therapeutic anticoagulation parameters postrevision. Although the 30% to 50% IBW class had the highest incidence of end-stage renal disease, it appears that the group of patients in this class was overanticoagulated as a whole.

Conclusion

The institution's revised, high-intensity, weight-based, IV heparin protocol was found safe and effective, validating a potential heparin dosing adjustment for patients who are obese.
Clevidipine Butyrate Injectable Emulsion
Authors: Cada Dennis J. , Levien Terri L. , Baker Danial E.
Published: May 2010

Each month, subscribers to The Formulary Monograph Service receive 5 to 6 well-documented monographs on drugs that are newly released or are in late phase 3 trials. The monographs are targeted to Pharmacy & Therapeutics Committees. Subscribers also receive monthly 1-page summary monographs on agents that are useful for agendas and pharmacy/nursing inservices. A comprehensive target drug utilization evaluation (DUE) is also provided each month. With a subscription, the monographs are sent in print and are also available online. Monographs can be customized to meet the needs of a facility. Subscribers to the The Formulary Monograph Service also receive access to a pharmacy bulletin board, The Formulary Information Exchange (The F.I.X). All topics pertinent to clinical and hospital pharmacy are discussed on The F.I.X.

Through the cooperation of The Formulary, Hospital Pharmacy publishes selected reviews in this column. For more information about The Formulary Monograph Service or The F.I.X., call The Formulary at 800-322-4349. The November 2008 monograph topics are on romiplostim, rivaroxaban, golimumab, dronedarone, and degarelix. The DUE is on romiplostim.
Preparing the Pharmacy Information Technology (IT) Workforce for the Future
Authors: Fox Brent I. , Felkey Bill G.
Published: May 2010

Last month we introduced a new, broader focus for our column—shifting from a primary focus on portable technology to a more global look at health care automation and technology as it affects institutional systems in general and pharmacies specifically. In that regard, this month's column addresses a broad need related to health care automation and technology, which many of our readers likely have experienced. Although we are not evaluating a specific technology, this topic encompasses all automation and technology used within a pharmacy.
Supporting Literature for an Evidence-Based Metabolic Support Practice
Authors: Dickerson Roland N.
Published: May 2010

Nutrition Support Pharmacist features issues pertinent to the practice of clinical pharmacy in the area of metabolic support. This column is edited by Dr. Roland N. Dickerson, Professor of Clinical Pharmacy, University of Tennessee Health Science Center, and Clinical Pharmacist, Nutrition Support at the Regional Medical Center at Memphis.
New Drugs Approved by the FDA; New Dosage Forms and Indications Approved by the FDA; Agents Pending FDA Approval; New Drug Applications Filed by Manufacturer; Significant Labeling Changes or “Dear Health Care Professional” Letters Related to Safety
Authors: Baker Danial E.
Published: May 2010

This monthly feature will help readers keep current on new drugs, new indications, dosage forms, and safety-related changes in labeling or use. Efforts have been made to ensure the accuracy of this information; however, if there are any questions, please let us know at hospitalpharmacy@drugfacts.com .
Delayed-Onset Neutropenia Associated with Divalproex Sodium; Acute Psychosis Induced by Clarithromycin; Acute Phase Reaction with Ibandronate; Duloxetine-Associated Tachycardia; Hepatotoxicity with Valerian; Serotonin Syndrome with a Single Dose of Buprenorphine/Naloxone
Authors: Shuster Joel
Published: May 2010

The purpose of this feature is to heighten awareness of specific adverse drug reactions (ADRs), discuss methods of prevention, and promote reporting of ADRs to the US Food and Drug Administration's (FDA's) MedWatch program (800-FDA-1088). If you have reported an interesting, preventable ADR to MedWatch, please consider sharing the account with our readers.
Nitroglycerin (Topical): Raynaud Phenomenon
Authors: Generali Joyce A. , Cada Dennis J.
Published: May 2010

This Hospital Pharmacy feature is extracted from Off-Label Drug Facts, a quarterly publication available from Wolters Kluwer Health. Off-Label Drug Facts is a practitioner-oriented resource for information about specific drug uses that are unapproved by the US Food and Drug Administration. This new guide to the literature will enable the health care professional or clinician to quickly identify published studies on off-label uses and determine if a specific use is rational in a patient care scenario. A summary of the most relevant data is provided, including background, study design, patient population, dosage information, therapy duration, results, safety, and therapeutic considerations. References direct the reader to the full literature for more comprehensive information before patient care decisions are made. Direct questions or comments regarding Off-Label Drug Uses to hospital pharmacy@drugfacts.com .
Acute Sensorineural Hearing Loss: Furosemide Ototoxicity Revisited
Authors: Baldwin Kathleen A. , Budzinski Cynthia E. , Shapiro Craig J.
Published: May 2010

Background

Acquired sensorineural hearing loss occurs as a consequence of damage to the inner ear and may result from tumors, medications, or noise-induced acoustic trauma. Furosemide ototoxicity—manifested by tinnitus, vertigo, or hearing loss—is frequently reversible, but some cases may result in permanent hearing loss.

Purpose

Because of the serious nature of this adverse drug reaction, the intent of this article is heightening the awareness of furosemide-induced ototoxicity through case presentation.

Methods

An updated review of the literature is provided.

Results and Conclusion

The case demonstrates multiple risk factors that can be used to empower readers for identification of patients who are also at high risk. Strategies are presented for avoiding further cases.
Cationic rhodium(I) complex-catalyzed σ- and π-bond activation cascade: Isomerization of allyl propargyl ethers to allenic aldehydes and dienals
Authors: Tanaka Ken , Okazaki Eri , Shibata Yu
Published: May 2010

A cationic rhodium(I)/1,1'-bis(diphenylphosphino)ferrocene (dppf) complex catalyzes isomerization of allyl propargyl ethers to allenic aldehydes in good yields at room temperature 40 °C. At 80 °C, carbonyl migration from allenic aldehydes proceeds further to give dienals in good yields. The cationic rhodium(I)/dppf complex acts as a dual catalyst for activation of σ- and π-bonds in these isomerization reactions.
Mechanism of the oxidative addition of aryl halides to bis-carbene palladium(0) complexes
Authors: Jutand Anny , Pytkowicz Julien , Roland Sylvain , Mangeney Pierre
Published: May 2010

Bis-N-heterocyclic carbenes Pd0 complexes, Pd0(NHC)2, are efficient catalysts in Heck reactions performed with aryl bromides or chlorides. The Pd0(NHC)2 that are not stable are generated in situ from PdII precursors PdY2(NHC)2 (Y = halides) after a chemical reduction. The latter procedure can be mimicked by an electrochemical reduction. The transient Pd0(NHCBn)2 is generated by electrochemical reduction of PdY2(NHCBn)2, and its reactivity in oxidative addition to aryl bromides and chlorides is characterized by the same electrochemical technique with the determination of the rate constants. Pd0(NHCBn)2 is found to be more reactive than the mixed complex Pd0(NHCBn)(PPh3). Both are the reactive species in an associative mechanism. Comparison with the isolated Pd0(NHCtBu)2 reveals that Pd0(NHCBn)2 is more reactive than Pd0(NHCtBu)2 even if the latter reacts via the mono-carbene Pd0(NHCtBu) in a dissociative mechanism. This suggests that the formation of mono-carbene Pd0(NHC) is not a guarantee for a fast oxidative addition because it is always generated at low concentration in its equilibrium with the related nonreactive bis-carbene Pd0(NHC)2.
Alkynes as “masked” ylides under noble-metal catalysis
Authors: Davies Paul W.
Published: May 2010

Our development of noble-metal-catalyzed reactions that involve the preparation of sulfur ylides directly from alkynes, without employing sacrificial functionality, is reviewed.
Reviews
Authors: Mhlanga Brilliant , Way Maria , Brown Christopher R
Published: May 2010

AFRICA'S MEDIA: DEMOCRACY & THE POLITICS OF BELONGING, FRANCIS B. NYAMNJOH (2005) Pretoria: UNISA PRESS/London & New York: Zed Books (320 pp.), ISBN 978-1-84277-583-7, Hardback: 60.00/$85.00, Paperback: 18.95/$29.95

TRANSNATIONAL MEDIA EVENTS: THE
MOHAMMED CARTOONS AND THE IMAGINED CLASH OF CIVILIZATIONS, ELISABETH EIDE, RISTO KUNELIUS & ANGELA PHILLIPS (EDS) (2009) Gothenburg by NORDICOM: University of Gothenburg/Nordicom, ISBN 978-91-89471-64-1, Paperback (Research Anthologies and Monographs), Price: SEK 280, 30 (+P&P)

SWIMMING
BENEATH THE SURFACE: SEA POINT DAYS, FRANOIS VERSTER (2008)
The early screenwriting practice of Ernest Lehman
Authors: Nannicelli Ted
Published: May 2010

This article analyses Ernest Lehman's early screenwriting practice and argues that there are essential commonalities between it and his prose fiction writing practice. In the first section, I highlight the similarities between Lehman's working notes for his abandoned novel, You Scratch
My Back , and his unfinished screenplay for the MGM project, Labor Story. In the second section, I look at the ways in which Lehman's prose fiction writing practice influences the composition of his first screenplay, for Executive Suite, as well as the composition of his
screenplay for Sweet Smell of Success, and argue that in his prose fiction writing and screenwriting, Lehman uses language in the same aesthetically relevant ways.
The hero and heroine's journey and the writing of Loy
Authors: Jacey Helen
Published: May 2010

Christopher Vogler suggests an essential humanity beyond gender and sexual difference lies at the heart of the Hero's Journey archetypal paradigm which he presents in The Writers Journey (2007), yet he still advises readers to go elsewhere for alternative theories on the woman's
journey, recommending key Jungian feminist theories including Maureen Murdock's The Heroine's Journey (1990), and Clarissa Pinkola Estes's Women Who Run With The Wolves (1992). Through the practice of writing a screenplay Loy, a biopic based on the life of modernist poet
and artist Mina Loy (18821966), I questioned to what extent is the Hero's Journey useful as a metaphoric aid in supporting the development of a screenplay with two female protagonists, and to what extent does the paradigm have a masculine bias? This article first sets out the principles of
Vogler's Hero's Journey and Murdock's Heroine's Journey cycle. I then explore the strengths and weaknesses of both models as creative aids during the development of my screenplay, with particular reference to the development of character, structure and theme. Turning to the notion of archetypes
as a creative system for characterization, I discuss how I used archetypes in the development of Loy's protagonists. Finally, I draw on Clarissa Pinkola Estes's myth of the Skeleton Woman as an effective metaphoric aid for the development of narratives where relationships are central.
I conclude that while the Hero's Journey has key strengths, models from Jungian feminism are particularly rich for screenwriters developing female-led stories.
The Key Role of Managers’ Values in Exporting: Influence on Customer Responsiveness and Export Performance
Authors: Sousa Carlos M.P. , Ruzo Emilio , Losada Fernando
Published: May 2010

Values are an essential element explaining a person's attitudes and behavior. Therefore, it is surprising that despite the number of studies that have examined the organizational and managerial factors affecting export performance, little research has investigated the possible impact of a manager's individual values on strategic choice and the export performance of the firm. To address this gap in the literature, the authors examine the impact of managers’ values on the firm's customer responsiveness and export performance. In addition, they examine the mediating role of customer responsiveness in the values–export performance linkage. The authors explore the empirical usefulness of the psychic distance construct by examining its direct link with export performance and the extent to which it moderates the relationship between individual values and export performance. Overall, the results suggest that managers’ values significantly influence strategic decisions and the export performance of the firm, highlighting the need for more research attention in this area.
The relationship of coffee and green tea consumption with high-sensitivity C-reactive protein in Japanese men and women
Authors: Maki Takako , Pham Ngoc Minh , Yoshida Daigo , Yin Guang , Ohnaka Keizo , Takayanagi Ryoichi , Kono Suminori
Published: May 2010

Background: Circulating high-sensitivity C-reactive protein (CRP) is a good marker of chronic low-grade inflammation. The few studies that have addressed the relationship between coffee consumption and CRP concentrations report inconsistent findings. The authors of this study examined the relationship between coffee and green tea consumption and serum concentrations of CRP, and the interaction with alcohol consumption, smoking, and obesity in a large population of free-living Japanese men and women.

Methods: Study subjects were 10,325 men and women, 49–76 years of age, living in Fukuoka City who participated in a baseline survey of a cohort study on lifestyle-related diseases. Coffee and green tea consumption and other lifestyle characteristics were assessed using a structured questionnaire. Anthropometric measurements and venous blood samples were also included.

Results: CRP concentrations were progressively lower with increasing levels of coffee consumption, after adjustment for smoking and other covariates (p for trend=0.03) in men, but not in women. Stratified analysis indicated that this inverse association was primarily limited to men with a high consumption of alcohol (≥50 g/day). Green tea consumption showed no measurable relationship with CRP concentrations in either men or women.

Conclusions: Coffee may be protective specifically against alcohol-induced hepatic inflammation. Further studies are warranted in different populations.

Clin Chem Lab Med 2010;48:849–54.
Improving the harmonisation of the International Normalized Ratio (INR): time to think outside the box?
Authors: Favaloro Emmanuel J. , McVicker Wendy , Hamdam Sayed , Hocker Naomi
Published: May 2010

The prothrombin time (PT) assay is the most often requested coagulation test and used primarily for monitoring Vitamin K antagonist therapy, where results may be expressed as an International Normalised Ratio (INR). The INR is the patient's PT ‘mathematically adjusted’ or ‘standardised’ to take into account the specific test system used (i.e., comprising the test reagent/instrument combination). This standardisation or ‘adjustment’ is achieved by applying two ‘correction factors’, respectively defined by the ‘International Sensitivity Index’ (ISI) and the ‘mean normal prothrombin time’ (MNPT), according to the formula: INR=[patient PT/MNPT]ISI. While some manufacturers provide assigned ISI values for specific PT reagents and instrumentation, the vast number of possible reagent/instrument combinations usually precludes this in most situations. Even when an ISI is provided by the manufacturer, laboratories need to check or validate the assigned value. When a manufacturer does not provide an ISI, the laboratory needs to define its own (local ISI) value. The MNPT usually has to be locally defined, based on the population being tested. Current recommendations for defining ISI values include the classical, but prohibitively complex, World Health Organization (WHO) recommended procedure, and more recently the use of commercial reference-plasma calibration sets. The MNPT can also be defined using the WHO recommended procedure or with calibration sets. However, there is limited information to validate the performance of these in laboratory practice, and there are several unrecognised problems that limit the validity and utility of the ISI and MNPT values that are determined. Thus, it is perhaps time to start thinking outside the box, and to utilise additional methods for determining and/or validating ISI and MNPT values. This may include the use of regression analysis to assess ongoing peer-related performance in external quality assurance programmes, and to compare the behaviour of proposed replacement reagents with that of existing reagents. Such strategies have proven of considerable benefit to local laboratory practice, and should therefore enable other laboratories to optimise their practice in order to provide INRs that better reflect a patient's anticoagulant status, and thus assist in their clinical therapeutic management.

Clin Chem Lab Med 2010;48:1079–90.
Comparison of cetylpyridinium chloride and cetyltrimethylammonium bromide extractive procedures for quantification and characterization of human urinary glycosaminoglycans
Authors: Buzzega Dania , Pederzoli Francesca , Maccari Francesca , Aslan Diler , Türk Mehmet , Volpi Nicola
Published: May 2010

Background: Glycosaminoglycans (GAGs) are natural complex polysaccharides that are important in several pathological processes. Urinary GAGs have long been investigated for their possible modifications in many pathological conditions. In some cases, they have been found to have diagnostic utility. As a result, the measurement of GAGs in urine is gradually gaining importance. Cetylpyridinium chloride (CPC) and cetyltrimethylammonium bromide (CETAB) are generally used to extract urinary GAGs prior to analysis. In this study, we evaluated the extraction of human urinary GAGs using CPC in comparison with CETAB.

Methods: Extracted urinary GAGs were qualitatively and quantitatively analyzed by agarose-gel electrophoresis in the presence of sequential staining and densitometric scanning. This procedure was able to give more reproducible and reliable results for urinary GAGs, and high performance liquid chromatography (HPLC) was used for the evaluation of chondroitin sulfate (CS) disaccharides.

Results: Differences were observed between CPC and CETAB extract protocols. The absolute amount of CS evaluated by electrophoresis was found to be similar for the two protocols. However, the heparan sulfate (HS) concentration was calculated to be approximately 3.3 times greater for CPC than CETAB. When calculated in relative percentage, 33.6% HS was determined for CPC and 10.0% for CETAB. These results show a quantitative expression for greater recovery of HS by using CPC protocol than CETAB. No significant differences were found between CS quantified by agarose-gel and HPLC. In addition, no differences were observed for the CS disaccharide composition purified by using CPC or CETAB, and quite similar results were observed for 4s/6s disaccharide ratios and charge density values.

Conclusions: Extract procedures for urinary GAGs using CPC or CETAB are able to recover similar amounts of CS quantified by agarose-gel electrophoresis and HPLC. However, CPC yields greater recovery of HS than the CETAB protocol; an increase of approximately 3.3 times as evaluated by electrophoresis. This different capacity of HS extraction between CPC and CETAB should be considered when urinary GAGs of subjects affected by various diseases and related pharmacological treatments are considered, or meta-analysis is performed comparing various studies and trials performed under different experimental conditions.

Clin Chem Lab Med 2010;48:1133–9.
Effect of drying and rewetting of wood on cellulose molecular packing
Authors: Hill Stefan J. , Kirby Nigel M. , Mudie Stephen T. , Hawley Adrian M. , Ingham Bridget , Franich Robert A. , Newman Roger H.
Published: May 2010

Drying and rewetting of Pinus radiata sapwood latewood was studied by synchrotron wide angle X-ray scattering in transmission mode. Scattering from cellulose was interpreted in terms of chains distributed on a monoclinic lattice. Drying wood material to below the fibre saturation point resulted in decreased spacing between adjacent cellulose polymers within the hydrogen-bonded sheets of chains, and also decreased the monoclinic angle. The changes were partly reversed when the dried wood was rewet, but accumulated through multiple cycles of oven-drying and rewetting. No changes were observed in the fibre repeat distance, thus the distortion of the crystal lattice was not attributed to mechanical stresses associated with drying. Instead, the changes were attributed to formation of intrachain hydrogen bonds at dehydrated crystallite surfaces, causing conformational changes within the cellulose chains and increasing the density of packing. The results help account for the hysteresis observed in moisture desorption-adsorption isotherms during wood material drying and rehydration.
Functional Genomics Analysis of theSaccharomyces cerevisiaeIron Responsive Transcription Factor Aft1 Reveals Iron-Independent Functions
Authors: Berthelet Sharon , Usher Jane , Shulist Kristian , Hamza Akil , Maltez Nancy , Johnston Anne , Fong Ying , Harris Linda J , Baetz Kristin
Published: May 2010

The Saccharomyces cerevisiae transcription factor Aft1 is activated in iron-deficient cells to induce the expression of iron regulon genes, which coordinate the increase of iron uptake and remodel cellular metabolism to survive low-iron conditions. In addition, Aft1 has been implicated in numerous cellular processes including cell-cycle progression and chromosome stability; however, it is unclear if all cellular effects of Aft1 are mediated through iron homeostasis. To further investigate the cellular processes affected by Aft1, we identified >70 deletion mutants that are sensitive to perturbations in AFT1 levels using genome-wide synthetic lethal and synthetic dosage lethal screens. Our genetic network reveals that Aft1 affects a diverse range of cellular processes, including the RIM101 pH pathway, cell-wall stability, DNA damage, protein transport, chromosome stability, and mitochondrial function. Surprisingly, only a subset of mutants identified are sensitive to extracellular iron fluctuations or display genetic interactions with mutants of iron regulon genes AFT2 or FET3. We demonstrate that Aft1 works in parallel with the RIM101 pH pathway and the role of Aft1 in DNA damage repair is mediated by iron. In contrast, through both directed studies and microarray transcriptional profiling, we show that the role of Aft1 in chromosome maintenance and benomyl resistance is independent of its iron regulatory role, potentially through a nontranscriptional mechanism.
Early Course of Nicotine Dependence in Adolescent Smokers
Authors: Doubeni Chyke A. , Reed George , DiFranza Joseph R.
Published: May 2010

OBJECTIVE:

The goal was to characterize the early course of nicotine dependence.

METHODS:

Data were collected from 1246 sixth-graders in a 4-year (2002–2006) prospective study using 11 individual interviews. Subjects were monitored for 10 symptoms of dependence by using the Hooked on Nicotine Checklist. The bidirectional prospective relationship between the intensity of dependence (number of symptoms) and smoking frequency was examined by using cross-lagged analyses.

RESULTS:

Of the 370 subjects who had inhaled from a cigarette, 62% smoked at least once per month, 53% experienced dependence symptoms, and 40% experienced escalation to daily smoking. Smoking frequency predicted the number of dependence symptoms at the next interview, and the number of symptoms predicted reciprocally the observed escalation in smoking frequency. Monthly smoking was a strong risk factor for the development of symptoms (adjusted hazard ratio: 9.9 [95% confidence interval: 6.6–14.8]). A strong desire to smoke was the most common presenting symptom, typically followed by the appearance of symptoms of nicotine withdrawal, escalation to daily smoking, and then reports of feeling addicted or difficulty controlling smoking. The appearance of any dependence symptom increased the risk for daily smoking (hazard ratio: 6.81 [95% confidence interval: 4.4–10.5]).

CONCLUSIONS:

Nondaily tobacco use triggers the emergence of nicotine dependence. Early dependence symptoms promote escalation in smoking frequency and, reciprocally, more-frequent smoking accelerates the appearance of additional symptoms of dependence. As this positive feedback progresses, the symptoms of nicotine dependence present in a typical sequence, with some individual variation.
Weight Status as a Predictor of Being Bullied in Third Through Sixth Grades
Authors: Lumeng Julie C. , Forrest Patrick , Appugliese Danielle P. , Kaciroti Niko , Corwyn Robert F. , Bradley Robert H.
Published: May 2010

OBJECTIVES:

Childhood obesity and bullying both are pervasive public health problems. The objective of this study was to determine the relationship between childhood obesity and being bullied in third, fifth, and sixth grades while testing for potential confounding and moderation.

METHODS:

A total of 821 children who were participating in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (50% male, 81% white, 17% obese, 15% overweight in third grade) were studied. Generalized estimating equations were used to evaluate the relationship between child weight status and the odds of being bullied as reported by child, mother, and teacher, accounting for repeated measures and adjusting for grade level in school, child gender, child race, family income-to-needs ratio, school racial and socioeconomic composition, and mother- and teacher-reported child social skills and child academic achievement.

RESULTS:

In sixth grade, 33.9%, 44.5%, and 24.9% of the children were reported to be bullied per teacher-, mother-, and self-report, respectively. There was a significant independent association between being obese and being bullied (odds ratio: 1.63 [95% confidence interval: 1.18–2.25]). The relationship between being obese and being bullied was attenuated but not eliminated by all covariates except gender. The relationship was not moderated by any of the covariates.

CONCLUSIONS:

Children who are obese are more likely to be bullied, regardless of a number of potential sociodemographic, social, and academic confounders. No protective factors were identified. Effective interventions to reduce bullying of obese children need to be identified.
Variation in Specialty Care Hospitalization for Children With Chronic Conditions in California
Authors: Chamberlain Lisa J. , Chan Jia , Mahlow Pamela , Huffman Lynne C. , Chan Kristen , Wise Paul H.
Published: May 2010

OBJECTIVE:

Despite the documented utility of regionalized systems of pediatric specialty care, little is known about the actual use of such systems in total populations of chronically ill children. The objective of this study was to evaluate variations and trends in regional patterns of specialty care hospitalization for children with chronic illness in California.

METHODS:

Using California's Office of Statewide Health Planning and Development unmasked discharge data set between 1999 and 2007, we performed a retrospective, total-population analysis of variations in specialty care hospitalization for children with chronic illness in California. The main outcome measure was the use of pediatric specialty care centers for hospitalization of children with a chronic condition in California.

RESULTS:

Analysis of 2 170 102 pediatric discharges revealed that 41% had a chronic condition, and 44% of these were discharged from specialty care centers. Specialty care hospitalization varied by county and type of condition. Multivariate analyses associated increased specialty care center use with public insurance and high pediatric specialty care bed supply. Decreased use of regionalized care was seen for adolescent patients, black, non-Hispanic children, and children who resided in zip codes of low income or were located farther from a regional center of care.

CONCLUSIONS:

Significant variation exists in specialty care hospitalization among chronically ill children in California. These findings suggest a need for greater scrutiny of clinical practices and child health policies that shape patterns of hospitalization of children with serious chronic disease.
Family-Centered Care for US Children With Special Health Care Needs: Who Gets It and Why?
Authors: Coker Tumaini R. , Rodriguez Michael A. , Flores Glenn
Published: May 2010

OBJECTIVE:

The goal was to examine racial/ethnic and language disparities in family-centered care (FCC) and in FCC components for children with special health care needs (CSHCN).

METHODS:

Bivariate and multivariate logistic regression analyses of data from the 2005–2006 National Survey of CSHCN were performed.

RESULTS:

A total of 66% of CSHCN with a health visit in the past year received FCC. In adjusted analyses, we found lower odds of FCC for Latino (odds ratio: 0.53 [95% confidence interval: 0.45–0.63]), African-American (odds ratio: 0.60 [95% confidence interval: 0.52–0.69]), and other (odds ratio: 0.58 [95% confidence interval: 0.43–0.78]) children, compared with white children, and for children in households with a non-English primary language (odds ratio: 0.48 [95% confidence interval: 0.36–0.64]), compared with those in households with English as the primary language. These disparities persisted after adjustment for child health (condition severity and emotional, behavioral, and developmental needs), socioeconomic (poverty level, parental education, household composition, and residing in a metropolitan statistical area), and access (insurance type, usual source of care, and having a personal physician) factors. Of these factors, only condition severity was significantly associated with the racial/ethnic disparities; none was significantly associated with the language disparities. Disparities were found for Latino and African-American children and children in households with a non-English primary language for the FCC components of time spent with the provider and sensitivity to the family's values and customs.

CONCLUSIONS:

Robust FCC racial/ethnic and language disparities exist for CSHCN; initial efforts to address these disparities should focus on increasing provider time and cultural sensitivity.
Safety, Tolerability, and Immunogenicity of Gardasil Given Concomitantly With Menactra and Adacel
Authors: Reisinger Keith S. , Block Stan L. , Collins-Ogle Michelle , Marchant Colin , Catlett Melissa , Radley David , Sings Heather L. , Haupt Richard M. , Garner Elizabeth I.O. ,   for the Protocol 025 Investigators
Published: May 2010

OBJECTIVES:

Multinational phase III trials of a human papillomavirus vaccine, Gardasil, have shown the vaccine to be generally well-tolerated, efficacious, and immunogenic. We evaluated the immunogenicity and safety of Gardasil administered concomitantly with Menactra and Adacel.

METHODS:

In this open-label study, boys (n = 394) and girls (n = 648) aged 10 to 17 were randomly assigned in a 1:1 ratio as follows: group A (concomitant administration) received a 0.5-mL dose of Gardasil at day 1, month 2, and month 6 and a 0.5-mL dose of Menactra and Adacel on day 1; group B (nonconcomitant administration) received Gardasil at day 1, month 2, and month 6 and Menactra and Adacel at month 1. Antibody levels for all vaccine components were measured. Systemic, injection-site, and serious adverse experiences (AEs) were monitored.

RESULTS:

Immune responses after concomitant administration of the 3 vaccines were noninferior to nonconcomitant administration. Seroconversion for Gardasil was ≥99% in both groups A and B. For Menactra and Adacel, concomitant administration of the vaccines was demonstrated to be noninferior to nonconcomitant administration. Concomitant administration was generally well-tolerated. No participants withdrew because of an AE. One serious AE of transient muscular weakness of <24 hours' duration after the third Gardasil injection was reported in group B and was deemed possibly vaccine-related by the investigator.

CONCLUSIONS:

Overall, concomitant administration was generally well-tolerated and did not interfere with the immune response to the respective vaccines. Concomitant administration should minimize the number of visits required to deliver each vaccine individually, leading to increased compliance and more effective disease prevention.
Aborto e legislação: opinião de magistrados e promotores de justiça brasileiros
Authors: Duarte Graciana Alves , Osis Maria José Duarte , Faúndes Anibal , Sousa Maria Helena de
Published: May 2010

OBJETIVO: Analisar opiniões de juízes e promotores de justiça sobre a legislação brasileira e as circunstâncias em que o aborto induzido deveria ser permitido. MÉTODOS: Estudo transversal realizado com 1.493 juízes e 2.614 promotores no Brasil entre 2005 e 2006. Os participantes preencheram um questionário estruturado sobre características sociodemográficas, opiniões acerca da legislação que trata do aborto e circunstâncias para permiti-lo. Realizaram-se análises bivariada e multivariada por regressão de Poisson. RESULTADOS: A maioria (78%) dos participantes opinou que as circunstâncias nas quais não se pune o aborto deveriam ser ampliadas, ou mesmo que o aborto não deveria ser considerado crime. As maiores proporções de opiniões favoráveis a que o aborto seja permitido referiram-se a risco para a vida da gestante (84%), anencefalia (83%), malformação congênita grave (82%) e gravidez resultante de estupro (82%). As variáveis relativas à religião foram as mais freqüentemente associadas a essas opiniões. CONCLUSÕES: Observou-se uma tendência a considerar a necessidade de mudanças na atual legislação brasileira no sentido de ampliar as circunstâncias nas quais não se pune o aborto e até deixar de considerá-lo como um crime, independentemente da circunstância em que é praticado.
Legalização de drogas e a saúde pública
Authors: Laranjeira Ronaldo
Published: May 2010

O objetivo deste artigo para debate é: (1) avaliar a racionalidade e a oportunidade desse debate; (2) tentar estabelecer pontes com drogas lícitas; (3) avaliar os dados disponíveis sobre o efeito da legalização de uma droga; (4) propor uma alternativa de política de drogas baseada em objetivos claros a serem alcançados; e (5) descrever como a Suécia está lidando com o tema de restrição às drogas como cuidado social. Metodologicamente, o texto constitui uma síntese das leituras e elaborações do próprio autor, colocada de forma a provocar discussão. Conclui-se que quatro aspectos precisam ser levados em conta quando se analisa a política de drogas de um país: (1) fatores externos influenciam a política: tratados internacionais, políticas de saúde e de assistência social, direitos individuais, autoridade e autonomia dos médicos e outros profissionais; (2) os objetivos estabelecidos influenciam as políticas formais e sua implementação; (3) a influência simbólica que transcende à implementação - pessoas influentes fazem declarações que atingem fortemente a legitimidade e a adesão às ações; (4) as políticas formais e sua implementação recebem influência direta dos danos percebidos socialmente pelo uso de drogas, o que pode ser independente do nível real do seu uso em determinada sociedade.