bluuebunny/crossref_metadata_2025 huggingface dataset:
Preterm and infection-driven preterm labor: the role of peroxisome proliferator-activated receptors and retinoid X receptor
Authors: Holdsworth-Carson Sarah J , Permezel Michael , Rice Greg E , Lappas Martha
Published: March 2009

Approximately 8% of births are complicated by preterm delivery. To improve neonatal outcomes, a greater understanding of the mechanisms surrounding preterm parturition is required. Peroxisome proliferator-activated receptors (PPARs) have been implicated in the regulation of labor at term where they exhibit anti-inflammatory properties. Thus, we hypothesize that dysregulation of PPAR expression and activity may be associated with preterm labor and infection-associated preterm labor. The aim of this study was to compare the expression and activity of PPARs and the expression of retinoid X-receptor α (RXRA) in gestational tissues from term and preterm deliveries, and from infection-associated preterm deliveries. Quantitative RT-PCR, western blotting and activity ELISA were used to study expression and DNA binding profiles. Compared with term, preterm parturition was associated with an increased expression of PPAR δ (PPARD; mRNA and protein), PPAR γ (PPARG; protein) and RXRA (protein) in the placenta and PPARD (mRNA and protein) andRXRA(mRNA) in the choriodecidua. There was, however, no change in preterm PPAR DNA binding activity compared with term. Preterm chorioamnionitis (CAM) demonstrated protein degradation in the choriodecidua and was associated with a decline in the mRNA expression of PPAR α (PPARA) andRXRAcompared with uninfected preterm cases. PPAR DNA binding activity increased in the placenta (PPARD and PPARG) and decreased in the amnion (PPARA and PPARG) in association with preterm CAM. In conclusion, idiopathic preterm deliveries were associated with an increase in PPAR:RXR expression and preterm CAM was associated with a decrease in PPAR:RXR expression and tissue-specific alterations in transcriptional activity. The reasons for such dysregulation remain to be determined; however, the data are consistent with the hypothesis that PPARs may play a role in preterm labor and infection-complicated preterm deliveries.
The Evolution of Epistasis and Its Links With Genetic Robustness, Complexity and Drift in a Phenotypic Model of Adaptation
Authors: Gros Pierre-Alexis , Le Nagard Hervé , Tenaillon Olivier
Published: March 2009

The epistatic interactions among mutations have a large effect on the evolution of populations. In this article we provide a formalism under which epistatic interactions among pairs of mutations have a distribution whose mean can be modulated. We find that the mean epistasis is correlated to the effect of mutations or genetic robustness, which suggests that such formalism is in good agreement with most in silico models of evolution where the same pattern is observed. We further show that the evolution of epistasis is highly dependant on the intensity of drift and of how complex the organisms are, and that either positive or negative epistasis could be selected for, depending on the balance between the efficiency of selection and the intensity of drift.
Response of 98140 Corn With Gat4621 and hra Transgenes to Glyphosate and ALS-Inhibiting Herbicides
Authors: Green Jerry M. , Hale Theresa , Pagano Margaret A. , Andreassi John L. , Gutteridge Steven A.
Published: March 2009

The transgenic corn line 98140 has a high level of resistance to glyphosate and all five chemical classes of herbicides that inhibit acetolactate synthase (ALS). The dual herbicide resistance is due to a molecular stack of two constitutively expressed genes: gat4621, which produces a glyphosate acetyltransferase that rapidly inactivates glyphosate, and hra, which produces a highly resistant ALS. On a rate basis, the positive 98140 isoline with a single copy of the gat4621 gene is over 1,000-fold more resistant to glyphosate than a negative isoline without the transgene. Similarly, the positive 98140 isoline with the hra gene is over 1,000-fold more resistant to ALS-inhibiting herbicides such as chlorimuron and sulfometuron at the whole-plant and enzyme level. The gat4621 and hra genes do not change the natural tolerance of corn to selective herbicides, so new corn hybrids based on 98140 will give growers more options to manage weeds and delay the evolution of herbicide-resistant weeds.
A Panel Study of the Pollution-Haven Hypothesis
Authors: MacDermott Raymond
Published: March 2009

This paper tests the pollution-haven hypothesis. A fixed-effects variation of the gravity model is applied to panel data to investigate what relationship, if any, exists between environmental regulations and FDI. The data set focuses on bilateral flows of aggregated foreign direct investment between 26 OECD countries from 1982 to 1997. Use of pollution emissions as a proxy for environmental stringency shows evidence in support of the pollution-haven hypothesis. In other words, firms do seek out countries with weaker environmental regulations for production. In addition, FDI appears to fall with distance. Contrary to expectations, FDI is not influenced by interest rates, wages or GDP.
Examining Tax Strategy Patents—An Analysis of Reform Measures
Authors: McDowell Evelyn , Smith Pamela C.
Published: March 2009

Tax strategy patents (TSPs) are currently the center of debate due to their potential to monopolize interpretations of the tax code. Current legislative efforts to calm the debate surrounding tax strategy patents fail to do so. This paper analyzes current legislative reform measures aimed at TSPs. We identify both administrative and legislative problems surrounding TSPs, and argue that legislative reform that completely removes legal methods from patentable subject matter is critically necessary in order to provide equity for all taxpayers. Despite proposed legislation to curb the growth of TSPs, more stringent legislative and administrative reform is necessary in order to provide guidance to taxpayers and to advance tax policy.
Validation of Continuous Glucose Monitoring in Children and Adolescents With Cystic Fibrosis
Authors: O'Riordan Stephen M.P. , Hindmarsh Peter , Hill Nathan R. , Matthews David R. , George Sherly , Greally Peter , Canny Gerard , Slattery Dubhfeasa , Murphy Nuala , Roche Edna , Costigan Colm , Hoey Hilary
Published: March 2009

OBJECTIVE

To validate continuous glucose monitoring (CGM) in children and adolescents with cystic fibrosis.

RESEARCH DESIGN AND METHODS

Paired oral glucose tolerance tests (OGTTs) and CGM monitoring was undertaken in 102 children and adolescents with cystic fibrosis (age 9.5–19.0 years) at baseline (CGM1) and after 12 months (CGM2). CGM validity was assessed by reliability, reproducibility, and repeatability.

RESULTS

CGM was reliable with a Bland-Altman agreement between CGM and OGTT of 0.81 mmol/l (95% CI for bias ± 2.90 mmol/l) and good correlation between the two (r = 0.74–0.9; P < 0.01). CGM was reproducible with no significant differences in the coefficient of variation of the CGM assessment between visits and repeatable with a mean difference between CGM1 and CGM2 of 0.09 mmol/l (95% CI for difference ± 0.46 mmol/l) and a discriminant ratio of 13.0 and 15.1, respectively.

CONCLUSIONS

In this cohort of children and adolescents with cystic fibrosis, CGM performed on two occasions over a 12-month period was reliable, reproducible, and repeatable.
Role of Intrinsic Muscle Atrophy in the Etiology of Claw Toe Deformity in Diabetic Neuropathy May Not Be as Straightforward as Widely Believed
Authors: Bus Sicco A. , Maas Mario , Michels Robert P.J. , Levi Marcel
Published: March 2009

OBJECTIVE

Clawing of the toes in the diabetic neuropathic foot is believed to be caused by muscle imbalance resulting from intrinsic muscle atrophy. However, experimental data that support this mechanism are lacking. The aim of this study was to evaluate this hypothesis using magnetic resonance imaging (MRI).

RESEARCH DESIGN AND METHODS

In 20 neuropathic diabetic patients, 10 with claw toe deformity and 10 with normally aligned toes, multiple plane images of the foot and lower leg were acquired using T1-weighted spin-echo MRI. Atrophy of the intrinsic and extrinsic muscles controlling the toes was assessed using a semiquantitative 5-point atrophy scale. An intrinsic-to-extrinsic foot muscle imbalance score was derived from these atrophy scores, and correlation coefficients were established.

RESULTS

The mean ± SD intrinsic muscle atrophy score was 3.1 ± 1.1 for the toe deformity group and 2.6 ± 1.2 for the nondeformity group (not significantly different). The intrinsic muscle atrophy score was not significantly correlated with degree of toe deformity (r = −0.18). The muscle imbalance score was not significantly different between study groups and was not significantly correlated with degree of toe deformity (r = −0.14).

CONCLUSIONS

Neither intrinsic muscle atrophy nor muscle imbalance discriminated between neuropathic patients with or without claw toe deformity, suggesting that the role of these muscle factors in claw toe development may not be primary or as straightforward as previously believed. These findings shed new light on the etiology of foot deformity in diabetes and suggest a more complex nature of development, potentially involving anatomical and physiological predisposing factors.
Can a Low–Glycemic Index Diet Reduce the Need for Insulin in Gestational Diabetes Mellitus?
Authors: Moses Robert G. , Barker Megan , Winter Meagan , Petocz Peter , Brand-Miller Jennie C.
Published: March 2009

OBJECTIVE

A low–glycemic index diet is effective as a treatment for individuals with diabetes and has been shown to improve pregnancy outcomes when used from the first trimester. A low–glycemic index diet is commonly advised as treatment for women with gestational diabetes mellitus (GDM). However, the efficacy of this advice and associated pregnancy outcomes have not been systematically examined. The purpose of this study was to determine whether prescribing a low–glycemic index diet for women with GDM could reduce the number of women requiring insulin without compromise of pregnancy outcomes.

RESEARCH DESIGN AND METHODS

All women with GDM seen over a 12-month period were considered for inclusion in the study. Women (n = 63) were randomly assigned to receive either a low–glycemic index diet or a conventional high-fiber (and higher glycemic index) diet.

RESULTS

Of the 31 women randomly assigned to a low–glycemic index diet, 9 (29%) required insulin. Of the women randomly assigned to a higher–glycemic index diet, a significantly higher proportion, 19 of 32 (59%), met the criteria to commence insulin treatment (P = 0.023). However, 9 of these 19 women were able to avoid insulin use by changing to a low–glycemic index diet. Key obstetric and fetal outcomes were not significantly different.

CONCLUSIONS

Using a low–glycemic index diet for women with GDM effectively halved the number needing to use insulin, with no compromise of obstetric or fetal outcomes.
Effect of a High-Fiber Diet Compared With a Moderate-Fiber Diet on Calcium and Other Mineral Balances in Subjects With Type 2 Diabetes
Authors: Shah Meena , Chandalia Manisha , Adams-Huet Beverley , Brinkley Linda J. , Sakhaee Khashayar , Grundy Scott M. , Garg Abhimanyu
Published: March 2009

OBJECTIVE

High levels of dietary fiber, especially soluble fiber, are recommended to lower serum cholesterol levels and improve glycemic control in patients with type 2 diabetes. It is not clear, however, how high levels of fiber affect mineral balance.

RESEARCH DESIGN AND METHODS

In a randomized crossover study, 13 patients with type 2 diabetes were fed a high-fiber (50 g total and 25 g soluble fiber) and a moderate-fiber (24 g total and 8 g soluble fiber) diet of the same energy, macronutrient, calcium, magnesium, and phosphorus content for 6 weeks each. Intestinal calcium absorption was determined by fecal recovery of 47Ca. Stool weight and mineral content were assessed during 3 days, and 24-h urinary mineral content and serum chemistry were assessed over 5 days at the end of each phase. The results were compared by repeated-measures ANOVA.

RESULTS

Compared with the moderate-fiber diet, the high-fiber diet increased stool weight (165 ± 53 vs. 216 ± 63 g/day, P = 0.02) and reduced 24-h urinary calcium (3.3 ± 1.7 vs. 2.4 ± 1.2 mmol/day, P = 0.003) and phosphorus (29.2 ± 5.5 vs. 26.0 ± 3.2 mmol/day, P = 0.003) excretion and serum calcium concentration (2.33 ± 0.06 vs. 2.29 ± 0.07 mmol/l, P = 0.04). Calcium absorption, stool calcium, magnesium, and phosphorus content and serum phosphorus concentration were not significantly different with the two diets.

CONCLUSIONS

A high-fiber diet rich in soluble fiber has a small impact on calcium and phosphorus balance in subjects with type 2 diabetes. It may be prudent to ensure adequate intake of calcium and other minerals in individuals consuming a high-fiber diet.
Classification of resolvable balanced incomplete block designs — the unitals on 28 points
Authors: Kaski Petteri , Östergård Patric
Published: March 2009

Approaches for classifying resolvable balanced incomplete block designs (RBIBDs) are surveyed. The main approaches can roughly be divided into two types: those building up a design parallel class by parallel class and those proceeding point by point. With an algorithm of the latter type — and by refining ideas dating back to 1917 and the doctoral thesis by Pieter Mulder — it is shown that the list of seven known resolutions of 2-(28, 4, 1) designs is complete; these objects are also known as the resolutions of unitals on 28 points.
A decomposition of (λK
υ)+ with extended triangles
Authors: Huang Wen-Chung , Rodger C.
Published: March 2009

By an extended triangle, we mean a loop, a loop with an edge attached (known as a lollipop), or a copy of K
3 (known as a triangle). In this paper, we completely solve the problem of decomposing the graph (λK
υ)+ into extended triangles for all possible number of loops.
An introduction to balanced sequential arrays on the square grid
Authors: Street Anne , Nester Marks
Published: March 2009

Plants grown in large numbers for commercial purposes are usually set out on a regular grid, triangular, square or hexagonal, or possibly a rectangular grid. We need to understand their behaviour when they compete with each other for light, water and nutrients. In a greenhouse, there may be a lamp over each plant, half the plants having their lamps on and half off. The intensity of light falling on any particular plant is determined mainly by whether its own lamp is on, next by the number of its nearest neighbours whose lamps are on, and perhaps also by the number of its second-nearest neighbours whose lamps are on.

Such arrays are also used to study competition among different types of plants and, with some extra restrictions, to design field layouts as well. The problem of constructing suitable arrays was introduced in [CORMACK, R. M.: Spatial aspects of competition beween individuals. In: Spatial and Temporal Analysis in Ecology (R. M. Cormack and J. K. Ord, eds.), International Co-operative Publishing House, Fairland, Maryland, USA, 1979] and discussed in [GATES, D. J.: Competition between two types of plants with specified neighbour configurations, Math. Biosci. 48 (1980), 195–209]. Here we consider only the square grid.
Goal-minimally k-elongated graphs
Authors: Gyürki Štefan
Published: March 2009

Let k be an integer. A 2-edge connected graph G is said to be goal-minimally k-elongated (k-GME) if for every edge uv ∈ E(G) the inequality d
G−uv(x, y) > k holds if and only if {u, v} = {x, y}. In particular, if the integer k is equal to the diameter of graph G, we get the goal-minimally k-diametric (k-GMD) graphs. In this paper we construct some infinite families of GME graphs and explore k-GME and k-GMD properties of cages.
Iterative separation in distributive congruence lattices
Authors: Ploščica Miroslav
Published: March 2009

In [PLOŠČICA, M.: Separation in distributive congruence lattices, Algebra Universalis 49 (2003), 1–12] we defined separable sets in algebraic lattices and showed a close connection between the types of non-separable sets in congruence lattices of algebras in a finitely generated congruence distributive variety and the structure of subdirectly irreducible algebras in . Now we generalize these results using the concept of separable mappings (defined on some trees) and apply them to some lattice varieties.
Do Community Colleges Provide a Viable Pathway to a Baccalaureate Degree?
Authors: Long Bridget Terry , Kurlaender Michal
Published: March 2009

Community colleges have become an important entryway for students intending to complete baccalaureate degrees. However, many question the viability of the transfer function and wonder whether students suffer a penalty for starting at 2-year institutions. The authors examined how the outcomes of community college entrants compared with those of similar students who initially entered 4-year institutions within the Ohio public higher education system. Using a detailed data set, the authors tracked outcomes for 9 years and used multiple strategies to deal with selection issues: propensity score matching and instrumental variables. The results suggest that straightforward estimates are significantly biased, but even after accounting for selection, students who initially began at community colleges were 14.5% less likely to complete bachelor’s degrees within 9 years.
Effects of polyploidy on secondary chemistry, physiology, and performance of native and invasive genotypes of Solidago gigantea (Asteraceae)
Authors: Hull‐Sanders Helen M. , Johnson Robert H. , Owen Heather A. , Meyer Gretchen A.
Published: March 2009

The role of polyploidy in facilitating invasiveness of introduced plants has not been well explored. Examination of traits of diploid and polyploid plants in both their native and introduced ranges can shed light on evolutionary processes occurring postintroduction in invasive plants. We determined the distribution and prevalence of cytotypes of Solidago gigantea in both its native range (USA) and introduced range (Europe), and measured a suite of biochemical, physiological, and reproductive characters for plants from both continents. Tetraploids were the most frequent cytotype encountered on both continents, while hexaploids were found only in the USA. Hexaploids were the most distinctive cytotype, with fewer differences observed between diploids and tetraploids. Comparison of diploids and tetraploids in the USA and Europe showed that traits changed in concert for both cytotypes. Both diploids and tetraploids in Europe had reduced concentrations of three classes of secondary chemical and invested relatively more into rhizomes than into flowers. The same changes occurring in both cytotypes in the introduced range show that altered phenotypes of European plants are not due to shifts in the proportions of cytotypes but instead occur within them. There was no evidence that polyploids evolve more quickly in the introduced range.
Morphological and genetic variations of Potentilla matsumurae (Rosaceae) between fellfield and snowbed populations
Authors: Shimono Yoshiko , Watanabe Mikio , Hirao Akira S. , Wada Naoya , Kudo Gaku
Published: March 2009

Identifying ecological factors associated with local differentiation of populations is important for understanding microevolutionary processes. Alpine environments offer a unique opportunity to investigate the effects of habitat‐specific selective forces and gene flow limitations among populations at a microscale on local adaptation because the heterogeneous snowmelt patterns in alpine ecosystems provide steep environmental changes. We investigated the variation in morphological traits and enzyme loci between fellfield and snowbed populations of Potentilla matsumurae, a common alpine herb with a wide distribution along snowmelt gradients in northern Japan. We found significant differences in morphological traits between fellfield and snowbed habitats in a northern distribution region. These differences were maintained when plants were grown under uniform conditions in a greenhouse. Allozyme variations among 15 populations from geographically separated regions with different historical backgrounds showed that the populations are more genetically differentiated between the fellfield and snowbed habitats within a region than between populations occupying the same habitat type in different regions. These results suggest that variation in snowmelt regimes could be a driving force creating local adaptation and genetic differentiation of alpine plant populations.
Interspecific pollinator movements reduce pollen deposition and seed production inMimulus ringens(Phrymaceae)
Authors: Flanagan Rebecca J. , Mitchell Randall J. , Knutowski Dustin , Karron Jeffrey D.
Published: March 2009

Movement of pollinators between coflowering plant species may influence conspecific pollen deposition and seed set. Interspecific pollinator movements between native and showy invasive plants may be particularly detrimental to the pollination and reproductive success of native species. We explored the effects of invasiveLythrum salicariaon the reproductive success ofMimulus ringens, a wetland plant native to eastern North America. Pollinator flights between these species significantly reduced the amount of conspecific pollen deposited onMimulusstigmas and the number of seeds inMimulusfruits, suggesting that pollen loss is an important mechanism of competition for pollination. Although pollen loss is often attributed to pollen wastage on heterospecific floral structures, our novel findings suggest that grooming by bees as they forage on a competitor may also significantly reduce outcross pollen export and seed set inMimulus ringens.
Enantiospecific synthesis of [2.2]paracyclophane-4-thiol and derivatives
Authors: Rowlands Gareth J , Seacome Richard J
Published: March 2009

This paper describes a simple route to enantiomerically enriched [2.2]paracyclophane-4-thiol via the stereospecific introduction of a chiral sulfoxide to the [2.2]paracyclophane skeleton. The first synthesis of an enantiomerically enriched planar chiral benzothiazole is also reported.
Design, Development and Evaluation of Pictographic Instructions for Medications Used during Humanitarian Missions
Authors: Sorfleet Christopher , Vaillancourt Régis , Groves Susan , Dawson Jane
Published: March 2009

Objectives:

To develop, design and evaluate pictographic instructions for medications used during humanitarian medical missions.

Methods:

We developed and designed pictographic medication instructions based on the storyboard pictogram concept and then evaluated the pictograms during an itinerant medical mission in Gabon. We evaluated patients' comprehension of both the individual pictograms and the storyboard template at the time of dispensing or at short-term follow-up. Patients were asked questions to assess their comprehension of the indication, dose, route of administration, frequency and auxiliary instructions. Demographic data, including age, sex and mother tongue, were also collected. During the follow-up interview, we assessed the patients' understanding and recall of the pictographic instructions.

Results:

Pictograms were tested with 525 patients at the time of dispensing; 47 of these patients were also seen at short-term follow-up (the day after dispensing). Most of the pictograms tested achieved the European Commission standard for comprehension of greater than 80%, but were slightly below the American National Standard Institute criterion of greater than 85% comprehension. The use of pictograms caused a moderate increase in workload for the health care providers.

Conclusions:

The use of a pictographic storyboard was valuable for medication counselling in a humanitarian aid setting; however, the use of pictograms increased the workload of the health care providers who supplied the counselling.
A Qualitative Inquiry into the Practice Experiences of Community Pharmacy Managers
Authors: Perepelkin Jason , Dobson Roy T.
Published: March 2009

Background:

The connection between community pharmacists' dual role as professionals and businesspeople is most profound for community pharmacy managers. A greater understanding for and appreciation of the practice experiences of community pharmacy managers within a continually changing practice environment was the focus of this study.

Methods:

Semi-structured, one-on-one telephone interviews with self-identified community pharmacy managers were conducted.

Results:

Seven interviews were conducted, with a total of 9 themes emerging from the interviews: autonomy, pharmacist behaviour, environment, future, human resources, image, incentives, professional standards and role as manager.

Discussion:

Despite their common bond as pharmacists and pharmacy managers, interviewees showcased the dynamic nature of community pharmacy practice. Some shared similar thoughts and feelings about the profession and other stakeholders, while others presented opposing views.

Conclusions:

Community pharmacy managers are the link between pharmacy organizations and employees, including staff pharmacists and others. The dynamic perspective shared by each of these unique professionals highlights the fact that many models and cultures exist in practice today. However, a common vision of putting patients first united all interviewees, a vision that must be relayed to all stakeholders, including patients and employing organizations.
New Orleans Medical Students post-Katrina — an Assessment of Psychopathology and Anticipatory Transference of Resilience
Authors: Ginzburg Harold M. , Bateman David J.
Published: March 2009

Wars, conquest, famines, plagues, earthquakes, tsunamis, forest fires, cyclones, and hurricanes have the potential to cause mass migrations. Hurricane Katrina caused one of the most significant non-war-related migrations in modern history. Not since the Dust Bowl of the 1930s, where residents of the Central Plains states of the United States and Canada were forced to permanently migrate, have more than 1 million people been forced to temporarily or permanently relocate. Even more unique is the fact that the evacuation from eastern and western Louisiana, because of Hurricanes Katrina and Rita, respectively, occurred so quickly, compared with the slower sustained relocation in the 1930s.
 ABOUT THE AUTHORS
Harold M. Ginzburg, MD, JD, MPH, is with the Department of Psychiatry and Neurology, Tulane University Health Sciences Center; Department of Psychiatry, Louisiana State University Health Sciences Center; and Department of Psychiatry, Uniformed Services University of the Health Sciences School of Medicine. David J. Bateman is a 3rd-year medical student at Tulane University Medical School.

Address correspondence to Harold M. Ginzburg, MD, Clinical Professor of Psychiatry Suite 200, 3340 Severn Avenue, Metairie, LA 70002; fax 504-613-4913; e-mail haroldginzburg@hotmail.com.

Dr. Ginzburg and Mr. Bateman have disclosed no relevant financial relationships.

An acknowledgment to Jan Johnson, MD, for obtaining permission for me to conduct the study, and to Jeff Rouse, MD, for assisting in the development of the mental health questionnaire.
To Human Resilience
Authors: Fawcett Jan
Published: March 2009

We have Harold Ginzburg, MD, JD, MPH, and his contributing authors to thank for this month’s series on the impact of one of our greatest natural disasters, the landfall of Hurricane Katrina in Louisiana, Mississippi, and Alabama on August 29, 2005. As we know, such disasters — and the trauma, loss, disruption of services, and dislocation they provide — magnify the weaknesses to which we humans are heirs. We who deal with the emotional and behavioral frailties of humanity are called upon to respond with our basic skills and understanding to both the afflicted and the first responders who are called upon to rescue them, while later trying to learn from the chaos we have witnessed to be able to promote a more effective response to the next crisis.
First Responder Culture: Implications for Mental Health Professionals Providing Services Following a Natural Disaster
Authors: Kronenberg Mindy , Osofsky Howard J. , Osofsky Joy D. , Many Michele , Hardy Melissa , Arey James
Published: March 2009

Hurricane Katrina made landfall on August 29, 2005. The storm surge caused multiple levee breaches and left 80% of New Orleans and most of St. Bernard Parish underwater. Metropolitan New Orleans was in a state of chaos. First responders worked in the streets and at shelters of last resort to provide care for the remaining citizens. They engaged in crowd control, dealt with looting and gunfire incidents, and focused on rescue and recovery. During this time, all communication systems failed. First responders had no radio or telephone contact and were left isolated without backup. Multiple first responders described New Orleans and St. Bernard as “war zone(s).” Several first responders, who were also military veterans, reflected that the experience was worse than that which they had endured in Vietnam or Iraq.  ABOUT THE AUTHORS Mindy Kronenberg, PhD; Howard J. Osofsky, MD, PhD; Michele Many, LCSW; and Melissa Hardy, GSW, are with the Department of Psychiatry, Louisiana State University Health Sciences Center. Joy D. Osofsky, PhD, is with the Departments of Pediatrics and Psychiatry, Louisiana State University Health Sciences Center. James Arey, PhD, LPC, is Commander, New Orleans Police Department SWAT Negotiation Team. Address correspondence to: Mindy Kronenberg, PhD; e-mail mkrone@lsuhsc.edu. Dr. Kronenberg, Dr. Howard Osofsky, Ms. Many, Ms. Hardy, Dr. Joy Osofsky, and Dr. Arey have disclosed no relevant financial relationships.  EDUCATIONAL OBJECTIVES  Assess why a culturally sensitive approach is important in providing mental health treatment to first responders. Identify key elements of post-disaster mental health treatment for first responders. Discuss specific interventions utilized for first responders following Hurricane Katrina. 
Katrina Survivors Relocated to Oklahoma: A Tale of Two Cities
Authors: Tucker Phebe , Pfefferbaum Betty , Khan Qaiser , Young M. Jan , Aston Christopher E. , Holmes Janell , Coon Kim A. , Thompson Jamie
Published: March 2009

Survivors of Hurricane Katrina who had relocated to Oklahoma and demographically matched Oklahoma City controls were assessed 17.3 months post-Katrina for psychiatric diagnoses, symptoms of post-traumatic stress disorder (PTSD), depression, and perception of physical and mental health, quality of life, and disability. Hurricane-related PTSD was diagnosed in 10 of 22 (45.5%) adult survivors and three of 11 (11%) adolescent survivors assessed, compared with PTSD rates of 31% among adult direct survivors of a 1995 terrorist bombing in the Oklahoma City community 17 months after that incident.
 ABOUT THE AUTHORS
Phebe Tucker, MD, is Professor of Psychiatric Education and Vice Chair of Education; Betty Pfefferbaum, MD, JD, is Paul and Ruth Jonas Chair and Chairman; Qaiser Khan, MPH, is Research Coordinator; M. Jan Young, MD, is Psychiatry Resident; Christopher E. Aston, PhD, is Statistician, General Clinical Research Clinic; and Jamie Thompson is Research Clinic Coordinator, Department of Psychiatry, University of Oklahoma Health Sciences Center; Oklahoma City, Oklahoma. Kim A. Coon, EdD, is Associate Professor at University of Oklahoma HSC in Tulsa, OK. Janell Holmes, BS, is Medical Student, College of Medicine, University of Oklahoma HSC.

Address correspondence to: Phebe Tucker, MD, Professor of Psychiatric Education and Vice Chair of Education, Department of Psychiatry, University of Oklahoma HSC, WP 3440, P.O. Box 26901, Oklahoma City, OK 73190; fax: 405 271-1988; or e-mail Phebe-Tucker@ouhsc.edu.

The authors wish to acknowledge Michele Jewell, MA, and Jane Clark, RN, for their assistance with this research project.

Dr. Tucker, Dr. Pfefferbaum, Mr. Khan; Dr. Young; Dr. Aston; Ms. Holmes; Dr. Coon; and Ms. Thompson have disclosed no relevant financial information.

Support for this research has been provided by the Oklahoma Center for the Advancement of Science and Technology. Preparation of this manuscript has been supported in part by grant M01 RR14467 from the National Center for Research Resources, National Institutes of Health.
 EDUCATIONAL OBJECTIVES
Discuss the most common Axis I diagnoses and symptom levels experienced by relocated hurricane survivors.

Identify common issues faced by relocated survivors, such as economic hardships, distance from family and other social supports, different layers of trauma exposure, and survival in a new culture.

Discuss how exposure to a hurricane/flooding can lead to perceived psychosocial disability and lower satisfaction with quality of life in survivors.
Three Patients with Devout Religious Beliefs
Authors: Mahgoub Nahla
Published: March 2009

Case #1. An 18-year-old Hispanic woman reportedly attempted to scarify a house pet as a source of purification. Apparently, members of her religious community believed in scarifying animals for spiritual purification, but they knew that their belief could not be applied in the United States because of cultural differences.  ABOUT THE AUTHOR Nahla Mahgoub, MD, is an Instructor in Psychiatry and is Assistant Attending Psychiatrist, Weill Medical College of Cornell University, White Plains, New York.  Address correspondence to: Nahla Mahgoub, MD; NAMD06@aol.com; nam2024@med.cornell.edu.  Dr. Mahgoub has disclosed no relevant financial relationships.
Is the Current State of Treatment of Depression Satisfactory?
Authors: Fawcett Jan
Published: March 2009

This issue of Psychiatric Annals has the treatment of
depression as its focus. We have a review of the findings of the Sequential
Treatment Alternatives to Relieve Depression (STAR*D) study, probably the
largest study ever of sequential treatment of chronic and recurrent depression,
written by the study’s primary investigators. We also include a review of
the question of risks of antidepressant medications by Robert Howland, MD, and
a case report of an unusual medication side effect that worsened depression
until it was diagnosed. 
Antidepressants and Suicide: Putting the Risk in Perspective
Authors: Howland Robert H.
Published: March 2009

According to the Centers for Disease Control and Prevention (CDC) (2007), more than 30,000 people in the United States died by suicide in 2001, more than 116,000 people were treated and released from emergency rooms after suicide attempts in 2002, and more than 130,000 people were hospitalized following suicide attempts in 2002. Although suicidal thoughts are a symptom of depression, and completed suicide is a tragic complication of depressive illness, in October 2004, the U.S. Food and Drug Administration (FDA) ordered that all antidepressant medications carry a warning indicating that they are associated with an increased risk of suicidal thinking, feeling, and behavior in children and adolescents. In May 2007, the FDA expanded this warning to include information about an increased risk of suicidal symptoms in young adults ages 18 to 24.  ABOUT THE AUTHOR Dr. Howland is Associate Professor of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania.  Address correspondence to Robert H. Howland, MD, Associate Professor of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O’Hara Street, Pittsburgh, PA 15213; e-mail: HowlandRH@upmc.edu.  Dr. Howland has disclosed no relevant financial relationships. EDUCATIONAL OBJECTIVES  Assess the rationale for the current Food and Drug Administration warning that antidepressant medications are associated with an increased risk of suicidal symptoms in children, adolescents, and young adults. Describe some of the problems with assessing suicide risk from randomized placebo-controlled antidepressant medication trials. Discuss relevant findings from larger population-based studies on antidepressant usage and the relative risks of suicide in real-world settings. 
A 26-year-old Man with Depression, Suicidal Preoccupations, and Urinary Hesitancy
Authors: Isaac George
Published: March 2009

A 26-year-old man was admitted to an inpatient psychiatric unit because of suicidal preoccupations. He had been enrolled in a day treatment program at another hospital from where he was transferred for emergency admission because of severe depression and suicidal preoccupations.  ABOUT THE AUTHOR George Isaac, MD, is Attending Psychiatrist, Nassau University Medical Center, East Meadow, NY 11554.  Address correspondence to: George Isaac, MD, 146-20 Hawthorn Avenue, Flushing, NY 11355; or e-mail geosac@aol.com.  Dr. Isaac has disclosed no relevant financial relationships. EDUCATIONAL OBJECTIVES  Assess competency in evaluating patients with complex physical and psychiatric problems.  Develop a treatment strategy for such patients. Detect significant, but not well publicized, adverse effects of psychotropic medicines. 
From Brain to Mind: What a Glorious Journey
Authors: Fawcett Jan
Published: March 2009

Hats off to frequent contributors of great issues of Psychiatric Annals, guest editors George Viamontes and Bernard Beitman and the team of authors they have recruited for this April issue on Mechanisms of Action in Psychiatry for the intellectual-scientific “home run” they have achieved.
The Human Sexual Response Cycle: Psychotropic Side Effects and Treatment Strategies
Authors: Resnick Andrew G. , Ithman Muaid H.
Published: March 2009

In clinical practice, psychiatrists prescribe many medications with varied side effect profiles. Evaluation of side effects should be a routine part of management. Sexual side effects associated with psychotropic medications is the focus of this review. We begin with a discussion about the normal human sexual response cycle in significant detail. An understanding of the normal physiology will help us to understand the effects that medications have on this natural phenomenon. Next, the discussion turns to specific interactions by particular medications on the human sexual response cycle. The scope of this article includes both selective serotonin reuptake inhibitor (SSRI)-type antidepressants, and to a lesser extent, antipsychotic medications. Finally, we describe various treatment strategies employed to counteract these adverse events. Our goal is to inform the practitioner so that he/she may be able to make appropriate treatment decisions specific to each individual patient.

ABOUT THE AUTHORS
Andrew G. Resnik, MD, is Assistant Professor of Psychiatry, Director of Residency Training, and Consultation Liaison Psychiatry Director, Department of Psychiatry, University of Missouri, Columbia. Muaid H. Ithman, MD, is Senior Resident in General Psychiatry at University of Missouri, Columbia.

Address correspondence to: Andrew G. Resnik, MD, One Hospital Drive, University Hospital, Department of Psychiatry, Columbia, MO 65212; or e-mail resnika@health.missouri.edu.

Dr. Resnik and Dr. Ithman have disclosed no relevant financial information.
The Serotonin Transporter in Psychiatric Disorders
Authors: Shamsi Mohd A. , Jahan Sultana
Published: March 2009

The neurotransmitter serotonin has been widely studied in psychiatric disorders. Indeed, the serotonergic hypothesis for mood disorders is the most widely accepted hypothesis. Most psychotropic medications, including SSRI antidepressants and atypical antipsychotics, act on the serotonergic system. The serotonergic system consists of serotonin, serotonin receptors, and the serotonin transporter. Within the serotonergic system, the serotonin transporter protein has been a focus of intense research. Researchers have tried to investigate the role of the serotonin transporter protein in a range of psychiatric disorders, from affective disorders to posttraumatic stress disorder (PTSD) to schizophrenia. The serotonin transporter protein has also been the focus of researchers trying to explore its role in variations in drug response. In this article, we review the existing evidence involving the serotonin transporter protein in the genesis of psychiatric disorders, variations in symptom presentation, and variations in drug response. We also briefly discuss some of the peculiarities of genetic research in psychiatric disorders and how they affect the outcome of research studies.

 ABOUT THE AUTHORS
Mohd A. Shamsi, MD, MSc, is Final-year Resident, Department of Psychiatry University of Missouri-Columbia. Sultana Jahan, MD, is Assistant Professor, Department of Psychiatry, University of Missouri-Columbia.

Address correspondence to: Mohd A. Shamsi, MD; e-mail shamsim@health.missouri.edu.

Dr. Shamsi and Dr. Jahan have disclosed no relevant financial relationships.

EDUCATIONAL OBJECTIVES

Describe the location of the serotonin transporter within the serotonin system and its role in the mechanism of antidepressant action.

Demonstrate the basic terminology of genetics relevant to advances in psychiatry.

List the effects of a good study design and the importance of large sample sizes.
Evidence-Based Psychiatry
Authors: Fawcett Jan
Published: March 2009

This edition of Psychiatric Annals covers some topics in patient care management, evidence-based medicine, and its limitations. We also include an article on adherence to medications, and the issue of informed consent in adolescents. The issue is rounded out with an interesting case presentation.
Medication Adherence
Authors: Howland Robert H.
Published: March 2009

The modern era of psychopharmacology began in the 1950s with the discovery of the antipsychotic drug chlorpromazine (Thorazine). Since then, many drugs have been developed, investigated, and marketed for the treatment of all forms of mental illness. Although medications are not completely effective for all patients, most individuals will generally derive some satisfactory benefit from an appropriately prescribed medication. However, even the best medications do not work in patients who do not take them. Although not taking medication reliably is well recognized as a common problem, surprisingly, patients and their prescribers can grossly overestimate medication adherence. For this reason, the concept of medication adherence is a more practically important pharmacotherapy issue than is expert knowledge in clinical psychopharmacology. In this article, the importance of medication adherence, the factors associated with poor adherence, and some approaches for improving adherence is discussed.
ABOUT THE AUTHOR
Robert H. Howland, MD, is Associate Professor of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania.

Address correspondence to Robert H. Howland, MD, Associate Professor of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O’Hara Street, Pittsburgh, PA 15213; e-mail: HowlandRH@upmc.edu.

Dr. Howland has disclosed no relevant financial relationships.
 EDUCATIONAL OBJECTIVES
 Review why medication adherence is important.

Describe some of the factors associated with poor medication adherence.

Discuss some approaches to improving medication adherence.
 
Naltrexone Pharmacogenetics in Alcohol-dependent Patients
Authors: Berrettini Wade
Published: March 2009

Naltrexone is an opioid receptor antagonist, approved by the Food and Drug Administration (FDA) for alcohol addiction, on the basis of two double-blind, placebo-controlled trials. Naltrexone reduces risk for relapse to heavy drinking (at daily doses of 50 to 100 mg orally), as demonstrated in more than 20 double-blind, placebo controlled trials. Naltrexone is not often prescribed for the treatment of alcohol addiction, in part because compliance with chronic oral dosing is difficult to maintain. This barrier may be diminished by the introduction of an injectable-depot naltrexone, also FDA approved for alcohol addiction.
 ABOUT THE AUTHOR
Wade Berrettini, MD, PhD, is Karl E. Rickels Professor, Center for Neurobiology and Behavior, Department of Psychiatry, University of Pennsylvania School of Medicine.

Address correspondence to: Wade Berrettini, MD, PhD, Room 2206, 125 S. 31st St., Philadelphia, PA 19104; or email wadeb@mail.med.upenn.edu.

Dr. Berrettini has disclosed no relevant financial relationships.

Supported in part by grants from the VISN 4 MIRECC Philadelphia Veterans Affairs Medical Center and National Institute of Drug Abuse Grant P60 DA 11835.
 EDUCATIONAL OBJECTIVES
Identify that naltrexone reduces risk to relapse for heavy drinking but does not influence abstinence, according to results from more than 20 double-blind, placebo-controlled trials.

Summarize the nature of the A118G variant on mu opioid receptor function, both in vitro and in vivo.

Cite that Food and Drug Administration (FDA) requirements for restricting indications to specific genotypes for naltrexone will require multiple complex clinical trials.
 
Defining the Role of Anti-epileptic Pharmacogenetics in Psychiatric Drug Therapy
Authors: Dlugos Dennis J. , Buono Russell J. , Ferraro Thomas N.
Published: March 2009

Defining the Role of Anti-epileptic Pharmacogenetics in Psychiatric Drug Therapy

Several anti-epileptic drugs are widely used in the treatment of behavioral disorders. Therefore, the emerging field of anti-epileptic drug pharmacogenetics is now relevant to psychiatrists in clinical practice. Carbamazepine, valproate, lamotrigine, and oxcarbazepine are used widely for mood stabilization, while benzodiazepines and pregabalin are used to treat anxiety. Phenytoin is used less frequently in psychiatric practice, although it remains of interest due to its wide availability, low cost, and some evidence suggesting benefit in mood disorders. In this article, we provide a current perspective on the accumulating evidence that suggests that genetic variation plays a role in determining the inter-individual differences in clinical response to anti-epileptic drugs. These differences extend to both drug efficacy and tolerability, including idiosyncratic and dose-related adverse effects.
 ABOUT THE AUTHORS
Dennis J. Dlugos, MD, is with the Division of Neurology, Children’s Hospital of Philadelphia, Philadelphia. Russell J. Buono, PhD, is with the Research Service, Coatesville VA Medical Center, Coatesville, PA. Thomas N. Ferraro, PhD, is with the Departments of Psychiatry and Pharmacology, University of Pennsylvania.

Address correspondence to Thomas N. Ferraro, PhD, Center for Neurobiology and Behavior, University of Pennsylvania School of Medicine, Room 2209, Translational Research Laboratories, 125 S. 31st St., Philadelphia, PA 19104-6140; fax: 215-573-2041; or e-mail tnf@mail.med.upenn.edu

Dr. Dlugos, Dr. Buono, and Dr. Ferraro have disclosed no relevant financial relationships. .
 EDUCATIONAL OBJECTIVES
Discuss that genetic variation in the human leukocyte antigen (HLA) region can predict risk for Stevens-Johnson syndrome in patients of Asian descent who are treated with carbamazepine.

Describe the current controversy regarding the influence of genetic variation in drug-transporting proteins, such as the ATP-binding cassette family, on therapeutic response to anti-epileptic drugs in patients with epilepsy.

Discuss that, while most pharmacogenetic research with anti-epileptic drugs has been performed in patients with epilepsy, the same clinical and research questions are relevant to patients with psychiatric disorders.
 
Is Bipolar Depression the Same or Different from Unipolar Depression?
Authors: Fawcett Jan
Published: March 2009

This edition of Psychiatric Annals features a review by yours truly of the published findings of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study, some interesting case studies, and presentations of depressive symptom patterns in various cities across the country of Pakistan.