bluuebunny/crossref_metadata_2025 huggingface dataset:
Cone Photoreceptors in Bass Retina Use Two Connexins to Mediate Electrical Coupling
Authors: O'Brien John , Nguyen H. Bao , Mills Stephen L.
Published: June 2004

Electrical coupling via gap junctions is a common property of CNS neurons. In retinal photoreceptors, coupling plays important roles in noise filtering, intensity coding, and spatial processing. In many vertebrates, coupling is regulated during the course of light adaptation. To understand the mechanisms of this regulation, we studied photoreceptor gap junction proteins. We found that two connexins were expressed in bass cone photoreceptors. Connexin 35 (Cx35) mRNA was present in many cell types, including photoreceptors and amacrine, bipolar, and a few ganglion cells. Antibodies to Cx35 labeled abundant gap junctions in both the inner and outer plexiform layers. In the outer plexiform layer, numerous plaques colocalized with cone telodendria at crossing contacts and tip-to-tip contacts. Cx34.7 mRNA was found predominantly in the photoreceptor layer, primarily in cones. Cx34.7 immunolabeling was limited to small plaques immediately beneath cone pedicles and did not colocalize with Cx35. Cx34.7 plaques were associated with a dense complex of cone membrane beneath the pedicles, including apparent contacts between telodendria and cone pedicles. Tracer coupling studies of the connexins expressed in HeLa cells showed that coupling through Cx35 gap junctions was reduced by protein kinase A (PKA) activation and enhanced by PKA inhibition through a greater than fivefold activity range. Cx34.7 was too poorly expressed to study. PKA regulation suggests that coupling through Cx35 gap junctions can be controlled dynamically through dopamine receptor pathways during light adaptation. If Cx34.7 forms functional cell-cell channels between cones, it would provide a physically separate pathway for electrical coupling.
Uropathic Observations in Mice Expressing a Constitutively Active Point Mutation in the 5-HT3AReceptor Subunit
Authors: Bhattacharya Anindya , Dang Hong , Zhu Quan-Ming , Schnegelsberg Birthe , Rozengurt Nora , Cain Gary , Prantil Rachelle , Vorp David A. , Guy Nicholas , Julius David , Ford Anthony P. D. W. , Lester Henry A. , Cockayne Debra A.
Published: June 2004

Mutant mice with a hypersensitive serotonin (5-HT)3Areceptor were generated through targeted exon replacement. A valine to serine mutation (V13′S) in the channel-lining M2 domain of the 5-HT3Areceptor subunit rendered the 5-HT3receptor ∼70-fold more sensitive to serotonin and produced constitutive activity when combined with the 5-HT3Bsubunit. Mice homozygous for the mutant allele (5-HT3Avs/vs) had decreased levels of 5-HT3AmRNA. Measurements on sympathetic ganglion cells in these mice showed that whole-cell serotonin responses were reduced, and that the remaining 5-HT3receptors were hypersensitive. Male 5-HT3Avs/vsmice died at 2-3 months of age, and heterozygous (5-HT3Avs/+) males and homozygous mutant females died at 4-6 months of age from an obstructive uropathy. Both male and female 5-HT3Amutant mice had urinary bladder mucosal and smooth muscle hyperplasia and hypertrophy, whereas male mutant mice had additional prostatic smooth muscle and urethral hyperplasia. 5-HT3Amutant mice had marked voiding dysfunction characterized by a loss of micturition contractions with overflow incontinence. Detrusor strips from 5-HT3Avs/vsmice failed to contract to neurogenic stimulation, despite overall normal responses to a cholinergic agonist, suggestive of altered neuronal signaling in mutant mouse bladders. Consistent with this hypothesis, decreased nerve fiber immunoreactivity was observed in the urinary bladders of 5-HT3Avs/vscompared with 5-HT3Awild-type (5-HT3A+/+) mice. These data suggest that persistent activation of the hypersensitive and constitutively active 5-HT3Areceptorin vivomay lead to excitotoxic neuronal cell death and functional changes in the urinary bladder, resulting in bladder hyperdistension, urinary retention, and overflow incontinence.
Petrinetze – Ein anschaulicher Formalismus der Nebenläufigkeit (Teil 1) (Petri Nets – An Intuitive Formalism for Concurrency (Part 1))
Authors: Niebert Peter
Published: June 2004

Der Beitrag gibt eine kurze Einführung in Petrinetze zur Modellierung nebenläufiger Systeme. Im ersten Teil werden Stellen-Transitionsnetze als klassische Repräsentanten der Petrinetze eingeführt und grundlegende Modellierungskonzepte erläutert. Im zweiten Teil werden verschiedene Erweiterungen der Petrinetze diskutiert, welche die Ausdrucksstärke und Handhabbarkeit erheblich steigern und für größere Projekte unumgänglich sind.
Petrinetze – Ein anschaulicher Formalismus der Nebenläufigkeit (Teil 2) (Petri Nets – An Intuitive Formalism for Concurrency (Part 2))
Authors: Niebert Peter
Published: June 2004

Der Beitrag gibt eine kurze Einführung in Petrinetze zur Modellierung nebenläufiger Systeme. Im ersten Teil wurden Stellen-Transitionsnetze als klassische Repräsentanten der Petrinetze eingeführt, sowie grundlegende Modellierungskonzepte erläutert. In diesem zweiten Teil werden verschiedene Erweiterungen der Petrinetze diskutiert, welche die Ausdrucksstärke und Handhabbarkeit erheblich steigern und für größere Projekte unumgänglich sind.
Prozessalgebra, Teil 1 (Process Algebra, Part 1)
Authors: Brinksma Ed , Mader Angelika
Published: June 2004

Dieser Beitrag beinhaltet eine Einführung in die Prozessalgebra. Im ersten Teil wird eine Basis-Prozessalgebra vorgestellt und informell die Bedeutung ihrer Operatoren erläutert. Im zweiten Teil des Artikels beschreiben wir, wie prozessalgebraische Ausdrücke als Transitionssysteme interpretiert werden können. Anhand des Roboter-Beispiels der Artikelserie werden die elementaren Konzepte illustriert. Ein Kernstück der Prozessalgebra, beobachtbares Verhalten verschiedener Prozesse zu vergleichen, wird erläutert. Der Beitrag schließt mit einem kleinen Überblick über verschiedene Richtungen in der Prozessalgebra.
Prozessalgebra, Teil 2 (Process Algebra, Part 2)
Authors: Brinksma Ed , Mader Angelika
Published: June 2004

Dieser Beitrag ist der zweite Teil einer Einführung in die Prozessalgebra. Im ersten Teil wurde eine Basis-Prozessalgebra vorgestellt und informell die Bedeutung ihrer Operatoren erläutert. Im zweiten Teil des Artikels beschreiben wir, wie prozessalgebraische Ausdrücke als Transitionssysteme interpretiert werden können. Anhand des Roboter-Beispiels der Artikelserie werden die elementaren Konzepte illustriert. Ein Kernstück der Prozessalgebra, beobachtbares Verhalten verschiedener Prozesse zu vergleichen, wird erläutert. Der Beitrag schließt mit einem kleinen Überblick über verschiedene Richtungen in der Prozessalgebra.
Temporale Spezifikationslogiken (Temporal Logics for Specifications)
Authors: Dierks H. , Olderog E.-R.
Published: June 2004

Logiken sind in der Informatik ein weitverbreitetes Mittel zur Spezifikation. Dazu werden Logiken verschiedener Ausprägung benutzt, z.B. temporale Logiken für reaktive Systeme, zu denen die Systeme der Automatisierungstechnik zählen. Dieser Beitrag enthält eine Einführung in die wichtigsten temporalen Logiken und Literaturverweise.
Überwacht lernende Klassifikationsverfahren im Überblick, Teil 1 (Overview of Supervised learning Classification Methods, Part 1)
Authors: Hengen Heiko , Feid Michael , Pandit Madhukar
Published: June 2004

Der vorliegende Aufsatz beschäftigt sich mit Klassifikationsverfahren wie sie z.B. im Rahmen der technischen Diagnose oder für die digitale Bildverarbeitung eingesetzt werden können. Aus der Vielzahl der verfügbaren Methoden werden die charakteristischen Vertreter behandelt. Ein besonderes Augenmerk wurde dabei der praktischen Anwendbarkeit der Verfahren gewidmet – deren Vorzüge und Nachteile werden ausführlich erörtert und ihre Leistungsfähigkeit anhand unterschiedlicher charakteristischer Merkmalsverteilungen getestet. Ferner wird auf die Auswahl von Merkmalen sowie die dazu notwendigen Gütekriterien eingegangen. Abschließend werden die Verfahren an zwei Modellfällen aus der digitalen Bildverarbeitung und der technischen Diagnose erprobt und die erhaltenen Ergebnisse aus praktischer Sicht diskutiert.
The Self as Self‐Fulfilling Prophecy
Authors: Wiley Norbert
Published: June 2004

Using a combination of psychoanalytic and symbolic interactionist ideas, this article portrays the development of the self as a self‐fulfilling prophecy (SFP). A prominent psychoanalytic version of this idea is presented by Lacan's two mirror theories of the self. A prominent and more familiar symbolic interactionist account of the self as self‐fulfilling prophecy is the formulation by William I. Thomas and Dorothy Thomas, which suggests that once situations are defined as real, they are real in their consequences. The aim of this article is to show that these two perspectives can be reconciled in interesting ways, because both recognize that emotions are part of the world “out there” of external goals and the world “in here” of the person's inner life. Emotions are therefore “bilevel.” The SFP creates a fault line in the self and a consequent emotional vulnerability when that line is engaged or disturbed. This article explains how this self‐fulfilling prophecy works and explores the weaknesses it inflicts on the self.
Chrysalid Goffman: A Note on “Some Characteristics of Response to Depicted Experience”
Authors: Smith Gregory W. H.
Published: June 2004

Goffman's first substantial sociological work, his M.A. thesis entitled “Some Characteristics of Response to Depicted Experience,” has hitherto escaped critical commentary. Inspection of the thesis yields insights into the early development of Goffman's sociology. It shows that Goffman's later dismissal of positivistic and experimental approaches, his suspicion of interview methods, and his valorization of observational data have their origins in his research experiences in late 1940s Chicago while he worked toward his first graduate degree. The thesis fails to deliver the findings promised by the approved thesis proposal but succeeds as a demonstration of Goffman's methodological acuity.
Occupational Exposure to Aromatic Hydrocarbons at a Coke Plant: Part I. Identification of Hydrocarbons in Air and their Metabolites in Urine by a Gas Chromatography‐Mass Spectrometry Method
Authors: Bieniek Grażyna , Kurkiewicz Sławomir , Wilczok Tadeusz
Published: June 2004

Occupational Exposure to Aromatic Hydrocarbons at a Coke Plant: Part I. Identification of Hydrocarbons in Air and their Metabolites in Urine by a Gas Chromatography‐Mass Spectrometry Method: Grażyna Bieniek, et al. Department of Molecular Biology, Biochemistry and Biopharmacy, Faculty of Pharmacy, Medical University of Silesia, Poland—A method for the qualitative analysis of aromatic hydrocarbons in air and their various urinary metabolites is presented. The air was sampled in charcoal tubes and extracted with carbon disulfide. The hydrocarbons were identified as being aliphatic hydrocarbons (C9–C19), aromatic hydrocarbons and heterocyclic compounds. The urinary metabolites after enzymatic hydrolysis were analyzed by solid‐phase extraction with a styrene‐divinylbenzene resin, silylation with N,Obis(trimethylsilyl)acetamide and GC/MS for separation and detection. Satisfactory separation of all compounds investigated was achieved without interference due to matrix peaks. The following compounds were identified in the urine of workers: dimethylphenol isomers, 4‐ethyl‐1,3‐benzenediol, 2ethoxybenzoic acid and methoxyphenols. Trimethylsilyl derivatives of aromatic hydroxyacids and hydroxymethoxyacids were found in the urine of occupationally exposed workers by means of a silylation procedure.
Occupational Exposure to Aromatic Hydrocarbons at a Coke Plant: Part II. Exposure Assessment of Volatile Organic Compounds
Authors: Bieniek Grażyna , Kurkiewicz Sławomir , Wilczok Tadeusz , Klimek Katarzyna , Swia̧tkowska Longina , Lusiak Agnieszka
Published: June 2004

Occupational Exposure to Aromatic Hydrocarbons at a Coke Plant: Part II. Exposure Assessment of Volatile Organic Compounds: Grażyna Bieniek, et al. Department of Molecular Biology, Biochemistry and Biopharmacy, Faculty of Pharmacy Medical University of Silesia, Poland— The objective of the study is to assess the external and internal exposures to aromatic hydrocarbons in the tar and oil naphthalene distillation processes at a coke plant. 69 workers engaged as operators in tar and oil naphthalene distillation processes and 25 non‐exposed subjects were examined. Personal analyses of the benzene, toluene, xylene isomers, ethylbenzene, naphthalene, indan, indene and acenaphthene in the breathing zone air allowed us to determine the time weighted average exposure levels to the aromatic hydrocarbons listed above. The internal exposure was investigated by measurement of the urinary excretion of naphthols, 2‐methylphenol and dimethylphenol isomers by means of gas chromatography with a flame ionization detection (GC/FID). Urine metabolites were extracted after enzymatic hydrolysis by solid‐phase extraction with styrene‐divinylbenzene resin. The time‐weighted average concentrations of the hydrocarbons detected in the breathing zone air shows that the exposure levels of the workers are relatively low in comparison to the exposure limits. Statistically significant differences between average concentrations of aromatic hydrocarbons (benzene, toluene, xylene isomers) determined at the workplaces in the tar distillation department have been found. Concentrations of the naphthalene and acenaphthene detected in workers from the oil distillation department are higher that those from the tar distillation department. Concentrations of naphthols, 2‐methoxyphenol and dimethylphenol isomers in the urine of occupationally exposed workers were significantly higher than those of non‐exposed subjects. Concentrations of the 2methoxyphenol and dimethylphenol isomers in urine were significantly higher for the tar distillation workers, whereas concentrations of naphthols were higher for the oil naphthalene distillation workers. Operators at the tar and naphthalene oil distillation processes are simultaneously exposed to a mixture of different hydrocarbons, mainly benzene and naphthalene homologues.
Dose Responses of Years of Exposure on Lung Functions in Flour Mill Workers
Authors: Meo Sultan A.
Published: June 2004

Dose Responses of Years of Exposure on Lung Functions in Flour Mill Workers: Sultan A. Meo. Department of Physiology, College of Medicine, King Saud University Riyadh, K. S. A.— Flour dust is a heterogeneous substance with respiratory sensitizing properties; its long‐term exposure may cause acute or chronic respiratory diseases. Therefore, the aim was to investigate the dose response effects of flour dust on lung function. An additional objective was to minimize the potential health risks in flour mill workers by providing them with information about the hazards of flour dust. Pulmonary function was studied in forty‐six male flour mill workers who worked without the benefit of flour dust control ventilation or respiratory protective devices and a similar number of male control subjects. All participants were non‐smokers and were matched for age, height, weight and socio‐economic status. Pulmonary function tests were performed by using an electronic Spirometer and results were compared by a paired t‐test. The present study results showed a significant decrease in the mean values of FVC, FEV1, PEF and MVV and this impairment was increased with duration of exposure in the flour mills. This group of flour mill workers had occupationally related pulmonary function impairment and stratification of results showed a dose response of years of exposure in flour mills on lung function.
Changes in Health Habits of Female Shift Workers
Authors: Kaneko Shin‐ya , Maeda Takafumi , Sasaki Akihiko , Sato Akihiko , Tanaka Kazuko , Kobayashi Toshio , Tanaka Masatoshi , Fukushima Tetsuhito
Published: June 2004

Changes in Health Habits of Female Shift Workers: Shin‐ya Kaneko, et al. Department of Hygiene & Preventive Medicine, School of Medicine, Fukushima Medical University—This paper examines the effects of shift work on the lifestyles of female factory workers. As an indicator of healthy lifestyle habits, we used a scoring system (referred to below as the ‘health score’) based on Lester Breslow's health habits. The ‘health score’ of the women was higher than that of the men, but the shift workers’ score was lower than that of the non‐shift workers (p<0.01). In addition, the score of workers who had changed from non‐shift work to double‐shift work was remarkably low (p<0.01). These results suggest that, while the female shift workers manage to maintain relatively healthy lifestyles in comparison with the males, they have more difficulty maintaining these habits than do female workers who do not perform shift work. It can be concluded that, in addition to heightening women's consciousness of their own health, surrounding entities such as the work environment, the home, and the community in general need to pay due care to Japan's female shift workers.
Effect of Follow‐Up Intervention of Toothbrushing on Periodontal Health in Workplace Dental Examination
Authors: Hanioka Takashi , Shigemoto Yukiko , Matsuse Ryoichi , Ojima Miki , Shizukuishi Satoshi
Published: June 2004

Effect of Follow‐Up Intervention of Toothbrushing on Periodontal Health in Workplace Dental Examination: Takashi Hanioka, et al. Department of Preventive and Public Health Dentistry, Fukuoka Dental College—This study examined the effect of follow‐up intervention on periodontal health of workers on the basis of clinical assessment and a laboratory test. Toothbrushing instruction was given to 26 workers (41.4 ± 7.8 yr of age). In the experimental group (EG), 13 workers received re‐instruction and reminder messages after the initial intervention. The remaining 13 workers, who served as a control group (CG), underwent no followup. Brushing skill was assessed on the basis of plaque scores for the whole mouth (Plaque Control Record, PCR) and for eight representative teeth (Plaque Index, PLI). Periodontal health was evaluated with the Community Periodontal Index (CPI). Assessment of gingival inflammation (Modified Gingival Index, MGI), measurements of pocket depth (PD) and attachment level (AL), and collection of gingival crevicular fluid (GCF) were performed at the representative sites. Aspartate aminotransferase (AST) in GCF was determined. Periodontal assessments were conducted prior to and three months after the first examination. Data were analyzed on site‐ and subject‐bases. Both groups exhibited a significant reduction in PLI and MGI. PCR and PD significantly decreased exclusively in the EG. No significant change was observed in the CPI or AL. A significant reduction in PD in shallow pockets (PD<=3 mm) and declines in AL and AST in deeper pockets (PD>=4 mm) were detected in EG. A reduction in PD in deeper pockets was significant in the CG. These results indicate that intervention with follow‐up is more effective with respect to periodontal health of workers than is a single intervention; moreover, the laboratory GCF test could be employed to ascertain the outcome of behavioral change.
Relationship between an Interview‐Based Health Promotion Program and Cardiovascular Risk Factors at Japanese Companies
Authors: Shimizu Takashi , Horiguchi Itsuko , Kato Tokiko , Nagata Shoji
Published: June 2004

Relationship between an Interview‐Based Health Promotion Program and Cardiovascular Risk Factors at Japanese Companies: Takashi Shimizu, et al. Department of Mental Health, Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan— The present study investigated the relationship between an interview‐based health promotion program and cardiovascular risk factors at manufacturing companies. Excluding insufficient data and the workers who took medication prescribed by a physician in 1993, the subjects were six hundred and twenty‐nine 18–55‐yr‐old employees who had been working at two manufacturing companies in Kyushu from 1993 to 1997. The intervention company introduced an interview‐based health promotion program from 1993. The program consisted of health measuring, group education, and health interviewing all employees to help with their behavioral change. We subdivided the subjects into younger (18–34‐yr‐old) and older (35– 55‐yr‐old) groups. We defined changing degree (∆) with (the following data in 1997) minus (the initial data in 1993). With agreement of the subject companies, we compared the ∆ of each item, including body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), serum total cholesterol (T‐cho), serum aspartate aminotransaminase (AST), serum alanine aminotransferase (ALT), and serum gammaglutamyl transpeptidase (GGTP), in the intervention with that in the reference. BMI and SBP decreased significantly after the program in the under 35‐yr‐old intervention group. On the other hand, Tcho, AST, ALT, and GGTP decreased and HDL increased significantly after the program in the over 34‐yr‐old intervention group. Our results showed that the worksite health promotion had the potential to improve cardiovascular risk factors of Japanese employees.
Prevalence of Carpal Tunnel Syndrome in Meat and Fish Processing Plants
Authors: Kim Joon Youn , Kim Jung Il , Son Ji Eun , Yun Sung Kuk
Published: June 2004

Prevalence of Carpal Tunnel Syndrome in Meat and Fish Processing Plants: Joon Youn Kim, et al. Department of Preventive Medicine, College of Medicine, and Industrial Medicine Research Institute, Dong‐A University, Korea—This study was carried out to survey the prevalence of carpal tunnel syndrome (CTS) in a high‐risk job. The experimental group was composed of 69 workers sampled from meat and fish processing plants, who were using their upper extremities repetitively. The control group was composed of 28 workers sampled from managers, secretaries and keepers in the same companies. All the employees were examined for their work history, their symptoms, as well as physical examinations and a nerve conduction study (NCS). Fifty‐one (73.9%) workers in the experimental group had findings compatible to the NIOSH definition of Work‐Related CTS. The positive rates for Tinel and Phalen's signs were higher in the workers who had shorter working duration (<7 yr), but the positive rate in the NCS was higher in the workers who had longer working duration (≥7 yr). The prevalence of CTS in a meat and fish processing plant was much higher. Therefore this job should be managed as a high‐risk industry.
Ambulatory (24 Hour) Blood Pressure Monitoring in Police Officers
Authors: Tomei Francesco , Rosati Maria Valeria , Baccolo Tiziana Paola , Cherubini Emilia , Ciarrocca Manuela , Caciari Tiziana , Tomao Enrico
Published: June 2004

Ambulatory (24 Hour) Blood Pressure Monitoring in Police Officers: Francesco Tomei, et al. University of Rome “La Sapienza”, Department of Occupational Medicine, Italy—The aim of the study is to evaluate, by ambulatory (24 h) blood pressure monitoring (ABPM), whether police officers exposed to urban pollutants and possible psycho‐social stressors could be at risk of changes in ambulatory systolic blood pressure (SBP), and ambulatory diastolic blood pressure (DBP) compared to controls. After excluding the principal confounding factors, police officers and controls have been subdivided into non‐smoker and smoker subjects. Police officers were compared by sex, age, length of service, family history of cardiovascular disease, serum total cholesterol, serum HDL cholesterol, serum LDL cholesterol, plasma triglyceride, body mass index (BMI kg/m2) and drinking habits with controls. Smoker police officers were compared with controls also by the smoking habit. In the non smoker group 77 police officers with outdoor activity (38 men and 39 women) and 87 controls with indoor activity (43 men and 44 women) were studied. In the smoker group 43 police officers (21 men and 22 women) and 29 controls (15 men and 14 women) were studied. In non smoker male police officers ambulatory SBP mean values during 24 h, during day‐time and during night‐time were significantly higher than controls. In the same group ambulatory DBP values during 24 h and between 6 AM and 11 AM and between 10 PM and 6 AM were significantly higher in police officers than controls. The results suggest that occupational exposure to urban pollutants and possible psychosocial stressors could cause changes in ABPM values in male police officers compared to controls.
Story of Benzene and Leukemia: Epidemiologic Approach of Muzaffer Aksoy
Authors: Yaris Fusun , Dikici Mustafa , Akbulut Turhan , Yaris Ersin , Sabuncu Hilmi
Published: June 2004

Story of Benzene and Leukemia: Epidemiologic Approach of Muzaffer Aksoy: Fusun Yaris, et al. Karadeniz Technical University, School of Medicine, Department of Family Medicine, Turkey—In 1974, Professor Muzaffer Aksoy established a link to leukemia in humans as a result of occupational exposure to benzene. The aim of this study is to evaluate his epidemiological approach for his investigation on the effects of benzene and to bring attention to the benzene problem in Turkey. Dr. Aksoy observed that a large group of leukemic patients were shoemakers, or they worked in leather manufacturing. In the 1960s, benzene was a popular solvent in the leather industry. Dr. Aksoy conducted a field investigation in Gedikpasa‐ Istanbul, where the shoemakers worked so that he could draw his key observations from actual environmental conditions. With a gas detector, he found the concentration of benzene in these work places to be 150–210 ppm and up to 650 ppm on rare occasions. He performed an epidemiological study and health education among 28,500 shoe, slipper and handbag workers during the period from 1967 to 1974. He published these data, establishing an association between benzene and leukemia. The incidence of leukemia among the shoe workers was decreased by screening, health education, and legislative actions in Turkey, but it began to increase again because of lack of an occupational health policy and underestimation of the problem. These results suggest the importance of primary prevention of occupational cancers. Dr. Aksoy's epidemiologic approach may highlight the necessity for detailed investigations of the occupational status of patients who need medical aid in order to diagnose the real underlying factor.
Adequacy of Anticoagulation in Patients with Atrial Fibrillation Coming to a Hospital
Authors: Bungard Tammy J. , Ackman Margaret L. , Ho Geotham , Tsuyuki Ross T.
Published: June 2004

Study Objective. To evaluate the adequacy of anticoagulation in patients with atrial fibrillation (AF) coming to a hospital.

Design. Retrospective medical record review.

Setting. Tertiary care hospital.

Patients. Consecutive patients with a history of AF who had been prescribed warfarin and who had the international normalized ratio (INR) measured when they arrived at the hospital. Those who developed AF as a complication during hospitalization were excluded.

Measurements and Main Results. Of 1085 patients, 375 (mean age 73 yrs, 56.3% men) were eligible for further evaluation. Most had nonvalvular AF; in 44.5% the INR was subtherapeutic, in 36.5% it was therapeutic, and in 18.9% it was supratherapeutic. Patients admitted for any thromboembolic event and for ischemic stroke were significantly more likely to have subtherapeutic INRs.

Conclusion. It is well documented in the literature that warfarin is underprescribed, but our results suggest that even in treated patients, about half are inadequately protected from thromboembolism.
Growth Hormone: A Promising Treatment for the Failing Heart?
Authors: Ng Tien M. H. , Kenney Julie K. , Munger Mark A.
Published: June 2004

Many pathologic processes that accelerate the progression of heart failure, such as cardiac remodeling and impaired contractility, may be modulated by administration of recombinant growth hormone. The agent improves structural and functional aspects of the failing heart both in the short term and after several months of therapy. However, conflicting clinical results cast doubt on whether it has a clear benefit in all of these patients. In addition, growth hormone therapy may be associated with cardiac and noncardiac adverse effects. Many questions must be addressed before its place in heart failure therapy is established. Optimal patient population, dosing regimen, duration of therapy, and effect on patient survival are unknown. Until larger, blinded studies are completed, growth hormone therapy remains an investigational approach to managing refractory heart failure.
Clinical Significance of Rare and Benign Side Effects: Propofol and Green Urine
Authors: Blakey Sybelle A. , Hixson‐Wallace Julie A.
Published: June 2004

A 55‐year‐old man requiring airway protection for esophagogastro‐duodenoscopy was sedated with propofol. On the third day of propofol infusion his urine was dark green. Although he was afebrile and his white blood cell count was within normal limits, the green urine was suspected to be of infectious etiology. Laboratory tests were ordered and broad‐spectrum antibiotics were considered. Antibiotics were avoided when propofol was recognized as a rare and benign potential cause of the green urine. Earlier recognition of this side effect may have averted unnecessary laboratory monitoring. Prompt recognition of such side effects is important in limiting medical expenditures, inordinate drug exposure, and distress among patients and clinicians.
Lepirudin Dosing in Dialysis‐Dependent Renal Failure
Authors: Wittkowsky Ann K. , Kondo L. Midori
Published: June 2004

Lepirudin is a direct thrombin inhibitor indicated for parenteral anticoagulation in patients with heparin‐induced thrombocytopenia. In patients with normal renal function, a bolus dose of 0.4 mg/kg is injected over 15–20 seconds, followed by a continuous infusion of 0.15 mg/kg/hour adjusted to prolong the activated partial thromboplastin time (aPTT) to 1.5–2.5 times the patient's baseline. Because renal function directly influences lepirudin elimination, patients with renal impairment require significant adjustments in the initial infusion rate. Current recommendations suggest that patients with dialysis‐dependent renal failure should receive an initial bolus of 0.2 mg/kg, followed by 0.1 mg/kg every other day if the aPTT falls below the lower limit of the therapeutic range; however, this dosing may result in significant and prolonged overanticoagulation. A review of available literature regarding pharmacokinetics of lepirudin in renal failure suggests considerable variability in patient response over a narrow creatinine clearance range. Because there is no antidote for lepirudin if significant bleeding occurs, lower and less frequent dosing, guided by aPTT results, is recommended. (Pharmacotherapy 2000;20(9):1123–1128)
Diabetes Mellitus Associated with Recombinant Human Growth Hormone for HIV Wasting Syndrome
Authors: Schauster Amy C. , Geletko Sandra M. , Mikolich Dennis J.
Published: June 2004

Recombinant human growth hormone (rhGH) is an important treatment option for patients with human immunodeficiency virus (HIV) wasting syndrome. Side effects of rhGH are minimal when administered at physiologic and moderately high dosages, as seen in growth hormone deficiency and Turner's syndrome, respectively. The dosage of rhGH is significantly higher to treat wasting syndrome and still is being studied to determine its long‐term efficacy and safety. Individuals with HIV infection are at increased risk for adverse effects due to polypharmacy, immune system alterations, and treatment with newer agents that lack long‐term safety data. In addition, rhGH's potential for side effects becomes greater when given at high dosages for wasting syndrome. Clinically significant hyperglycemia developed in an HIV‐positive man who started rhGH for wasting syndrome 38 days before the diagnosis of diabetes mellitus.
Antimony Excretion in a Patient with Renal Impairment During Meglumine Antimoniate Therapy
Authors: Hantson Philippe , Luyasu Samuel , Haufroid Vincent , Lambert Michel
Published: June 2004

Meglumine antimoniate was administered to a patient with visceral leishmaniasis with normal renal function. Soon after the first intramuscular administration of meglumine antimoniate 20 mg/kg, equivalent to 510 mg antimony (Sb), the patient developed septic shock with oliguria. Creatinine clearance decreased to 23 ml/minute. Treatment was discontinued, and Sb urinary excretion was measured. After the initial dose, 500.25 mg Sb was recovered in urine over 8 days, corresponding to 98% of the amount of Sb given intramuscularly (66% eliminated within first 48 hrs). Nine days after the dose, meglumine antimoniate was reintroduced at a dosage of 11.7 mg/kg (equivalent to 300 mg Sb) every 48 hours with good tolerance. At that time creatinine clearance had returned to 87.8 ml/minute. By day 14 of therapy the interval was reduced to daily administration of the same dose; the dosage was increased to 16.6 mg/kg/day (equivalent to 425 mg Sb) from day 17 to day 31. The patient eventually completely recovered and was discharged with normal renal function. Although no specific guidelines exist for dosage adjustment in renal failure, monitoring of Sb urinary excretion indicates that the kidneys are the almost exclusive route of elimination.
Methods to Assess the Humanistic Outcomes of Clinical Pharmacy Services
Authors: Bungay Kathleen M.
Published: June 2004

This paper describes selected scientific principles involved in the design of patient self‐administered questionnaires to assess functioning and overall well‐being. It gives several examples of successful uses of patient surveys and suggests possibilities for the use of the results by pharmacists in clinical care. The patients' point of view about their health status is important for the decision‐making about treatment choices and as a monitoring parameter for effectiveness or toxicities. Pharmacists should approach the creation of new questionnaires or the results from untested questionnaires with caution and respect. The use of results from proven and reliable individual patient surveys will benefit from the evolution of computer adaptive testing. However, the immediate use of individual health status surveys is not discounted, provided that they accompany clinical data in decision processes.
How to Evaluate and Interpret Outcome Studies
Authors: Sanchez Lisa A.
Published: June 2004

The pharmacoeconomic literature is a vast and powerful source of information for pharmacists and others who must make decisions about services and products. Published studies can provide data quickly and inexpensively, but they may not necessarily meet criteria for quality and may not be generalizable to a specific situation. Guidelines are available that are intended to standardize study methods, minimize potential bias, and increase the comparability and credibility of data. Before relying on a published study, decision‐makers should ensure that it meets criteria related to objective, perspective, pharmacoeconomic method, design, interventions, costs, outcomes, discounting, results, sensitivity analysis, extrapolation from conclusions, and sponsorship. A sound study can be used to support decisions in such diverse areas as individual patient treatment, formulary management, drug‐use guideline development, disease management initiatives, and pharmaceutical service evaluation. A decision‐maker may be able to use the results by applying them at face value, employing a sensitivity analysis, performing a meta‐analysis, incorporating the data into a pharmacoeconomic model, or reproducing the study on a smaller scale. The selection of an application strategy should be based on the potential impact of the decision on the quality and cost of care, with more rigorous and complex strategies reserved for more extreme impacts. Published pharmacoeconomic data can help pharmacists make better and more informed decisions about pharmaceutical services and products.
Curricular Integration to Enhance Educational Outcomes
Authors: Kerr Robert A.
Published: June 2004

Integration of a pharmacy curriculum can enhance learning by structuring experiences so that students apply information and skills from a variety of domains—pharmaceutical sciences, clinical sciences, applied therapeutics, and practice experience—to solve problems. Successful curricular integration is accomplished by applying principles of instructional systems design and abilities‐based learning. Faculty from different disciplines must work together to focus on desired student performance, to view the curriculum as a system, and to assess students' abilities rather than their information recall. These approaches, while enhancing opportunities for effective learning and faculty collaboration, are difficult to design and implement. This paper discusses applying instructional design strategies to curricular integration, viewing the curriculum as a system, applying abilities‐based learning strategies for curricular sequencing, and assessing student performance.
Outcomes and Experiential Education
Authors: Beck Diane E.
Published: June 2004

Outcomes‐based assessment in education involves continuous use of assessment measures to provide feedback about the efficacy of the curricular structure, content, and teaching methods. This process is initiated by establishing educational outcome statements for the Doctor of Pharmacy curriculum, selecting assessment methods that most appropriately measure the educational outcomes, and establishing a learning environment that is congruent with both the outcomes and assessment methods. To ensure a successful continuous outcomes‐based assessment process, a systematic assessment plan should be prepared that focuses the process by identifying only the most essential hypotheses, uses a practical yet appropriate methodology, ensures efficient data collection, includes data analyses that link the educational outcomes to the learning environment, and promotes timely development and implementation of an action plan. An overview of outcomes‐based education and the use of outcomes‐based practice experiences in pharmacy education is presented.
Effective Teaching and Learning Strategies
Authors: Brandt Barbara F.
Published: June 2004

Over the past decade, leaders in pharmacy education and the profession in the United States focused on responding to the role of the pharmacist in the rapidly changing health care environment. This response included moving to the Doctor of Pharmacy as the entry‐level degree in the profession. Less understood and often overlooked are pharmacy's responses to equally dramatic changes in the national higher education environment. One trend in higher education is the use of active teaching and learning methodologies, many of which are based on cognitive science research on human learning. The primary purpose of this paper is to focus on teaching and learning by describing the philosophy and policy changes of the new American Council on Pharmaceutical Education accreditation standards advocating active teaching and learning strategies, by discussing the implications for pharmacy faculty teaching roles and responsibilities, and by providing examples of active teaching and learning strategies and relevant literature embedded in the standards.
How Resource Allocation Decisions Are Made in the Health Care Market
Authors: Vogel W. Bruce
Published: June 2004

This paper describes how economists view resource allocation decisions in health care markets. The basic economic decisions that must be made in any economic system and the resource allocation decisions in a perfectly competitive market are described. An idealized market can achieve an efficient allocation of resources and is contrasted with a more realistic description of the numerous ways in which health care markets depart from the perfectly competitive ideal. The implications of these departures for health care policy are discussed, along with key controversies concerning reliance upon markets for resource allocation in health care. In particular, the failure of competitive markets to achieve what many consider an equitable distribution of health care is emphasized. The paper concludes with some practical observations on how pharmacists can use the increasing emphasis on economic efficiency to the advantage of their profession.
Regulatory and Ethical Issues with Dietary Supplements
Authors: Harris Ila Mehra
Published: June 2004

Dietary supplements are commonly used, and many are effective or hold promise for treating various conditions. However, they do not require Food and Drug Administration (FDA) approval. Impurities and adulterants have been found in the products, mostly due to the lack of requirements for good manufacturing practices. In addition, as no standardization is required, the active ingredient may be absent or highly variable among manufacturers. The FDA published its 10‐year plan for dietary supplements that addresses safety, labeling, boundaries, enforcement, research, and outreach. This endeavor, if put into place, will be instrumental in providing consumers with more confidence in the safety, composition, and labeling of dietary supplements.
Comparative In Vitro Activity and Pharmacodynamics of Five Fluoroquinolones Against Clinical Isolates of Streptococcus pneumoniae
Authors: Kays Michael B. , Conklin Michelle
Published: June 2004

Study Objective. To compare in vitro activity and pharmacodynamics of five fluoroquinolones against clinical isolates of Streptococcus pneumoniae.

Design. In vitro analysis.

Setting. University research laboratory.

Intervention. Minimum inhibitory concentrations (MICs) were determined for penicillin and five fluoroquinolones by E test for 201 S. pneumoniae isolates. Serum concentration‐time profiles were simulated for the following regimens: ciprofloxacin 750 mg orally every 12 hours and 400 mg intravenously every 8 hours; levofloxacin 500 mg orally and intravenously every 24 hours; trovafloxacin 200 mg orally and intravenously every 24 hours; gatifloxacin 400 mg orally and intravenously every 24 hours; and clinafloxacin 200 mg orally and intravenously every 12 hours.

Measurements and Main Results. Free 24‐hour areas under the serum concentration‐time curves (AUC0–24) were calculated using the trapezoidal rule, and the average AUC0–24:MIC ratio was calculated for each regimen. Differences in ratios among agents were determined by analysis of variance (Scheffe post hoc test, p<0.05). For intravenous dosing, the average AUC0–24:MIC for gatifloxacin, clinafloxacin, trovafloxacin, ciprofloxacin, and levofloxacin was 146, 142, 122, 71, and 61, respectively. For both oral and intravenous regimens, gatifloxacin and clinafloxacin ratios were significantly greater than those for trovafloxacin, levofloxacin, and ciprofloxacin (p≤0.007). Ratios for trovafloxacin were significantly greater than those for levofloxacin and ciprofloxacin (p<0.0001), and levofloxacin and ciprofloxacin ratios were not significantly different from each other.

Conclusion. Gatifloxacin and clinafloxacin achieve significantly higher AUC0–24:MIC ratios for S. pneumoniae than trovafloxacin, levofloxacin, and ciprofloxacin. Large comparative studies are necessary to determine the clinical significance of these findings.
Randomized, Multicenter Comparison of Oral Granisetron and Oral Ondansetron for Emetogenic Chemotherapy
Authors: Herrington Jon D. , Kwan Peter , Young Robyn R. , Lagow Elaine , Lagrone Lore , Riggs Mark W.
Published: June 2004

Study Objectives. To compare the antiemetic effectiveness and safety of oral granisetron plus dexamethasone with those of oral ondansetron plus dexamethasone administered before emetogenic chemotherapy.

Design. Randomized, prospective, multicenter, open‐label study.

Settings. University‐teaching hospital and veterans health care system.

Patients. Sixty‐one chemotherapy‐naïve patients scheduled to receive emetogenic antineoplastic agents.

Intervention. A single‐dose oral granisetron 1 mg and dexamethasone 12 mg or single‐dose oral ondansetron 16 mg and dexamethasone 12 mg was administered before chemotherapy.

Measurements and Results. Twenty‐four hours after administration patients were contacted to assess nausea, emesis, and adverse events. There were no statistical differences in frequency of nausea or emesis between groups. Seventy‐six percent and 82% of patients receiving ondansetron and granisetron, respectively, experienced no emesis 24 hours after chemotherapy. Complete protection from nausea occurred in 58% and 46% of patients receiving the drugs, respectively. Adverse events were similar between groups.

Conclusion. Oral granisetron 1 mg and ondansetron 16 mg plus dexamethasone are safe and effective in preventing nausea and vomiting related to emetogenic chemotherapy.
Evaluating Health‐Related Quality of Life: Cost Comparison of Computerized Touch‐Screen Technology and Traditional Paper Systems
Authors: Lofland Jennifer H. , Schaffer Michael , Goldfarb Neil
Published: June 2004

We estimated and compared the costs for three different methods of administering and evaluating the Short Form‐36 as a routine part of clinical practice from the provider perspective. In an outpatient pain management practice, we assessed a computer touch‐screen system with facsimile and scanning scoring methods. Equipment, supply, and labor costs needed to construct, maintain, and generate reports for each system were measured. The annual fixed, variable, and total costs/survey were calculated. Sensitivity analyses were performed varying the number of surveys administered/year. The facsimile method was the least costly, $9.62 and $5.88/survey, at annual questionnaire volumes of 250 and 1000, respectively. When the annual survey volume increased to 1250 (5 surveys/day), the costs of the facsimile ($5.63/survey) and computer touch‐screen ($5.65/survey) methods were nearly equivalent per survey administration. At volumes of 1500 and above, the least costly method was the computer touch screen at $5.47/survey. The system implemented in a clinical practice is dependent not only on questionnaire volume but also on personnel availability, equipment access, required speed of results, and the acceptable level of data error.
Steady‐State Pharmacokinetics of Citalopram in Young and Elderly Subjects
Authors: Gutierrez Marcelo , Abramowitz Wattanaporn
Published: June 2004

Study Objectives. To compare the steady‐state pharmacokinetics of citalopram after multiple‐dose administration in elderly and young subjects, and to correlate pharmacokinetic measurements with tolerability.

Design. Single‐blind, multiple‐dose, dose‐escalating, randomized, placebo‐controlled trial.

Setting. The Orlando Clinical Research Center, Orlando, Florida.

Subjects. Twenty‐four healthy elderly and eight healthy young men and women.

Interventions. Subjects randomized to citalopram received 10 mg once/day for the first week, 20 mg once/day for the second week, and 40 mg once/day for the remaining 3 weeks.

Measurements and Main Results. Blood samples were collected weekly to determine steady‐state pharmacokinetics of citalopram and its primary metabolites. During dose escalation, samples were collected just before dose increase. After the final dose, blood samples were collected periodically over 480 hours to characterize the terminal elimination phase. In elderly subjects, maximum concentration, time associated with the maximum concentration, area under the concentration versus time curve from 0–24 hours, half‐life, and volume of distribution were all slightly increased; oral clearance was slightly decreased. However, only half‐life was statistically different between the groups, 30% longer in the elderly. In addition, the frequency and severity of adverse events were comparable between the two age groups and did not appear to be dose related.

Conclusions. The pharmacokinetics and tolerability of citalopram in elderly subjects are similar to those observed in younger subjects. The slight differences observed in the elderly likely reflect declining liver and kidney function.