bluuebunny/crossref_metadata_2025 huggingface dataset:
Home Intermittent Amrinone Infusions in Terminal Congestive Heart Failure
Authors: Baptista Richard J. , Mitrano Francis P. , Perri-Lafrancesca Joanne
Published: May 2017

The prevalence of congestive heart failure (CHF) and its progressive degenerative course continue to generate pressure for alternative, more effective means of treatment. A confluence of factors, including the number of Americans with CHF, the spiraling costs of hospital care, and increasing interest in cost-effective home care, contribute to the current efforts to develop an effective, nontoxic therapy that effectively increases myocardial contractility and output and can be administered within the confines of the home. Given that preliminary clinical trials in the hospital setting with amrinone have produced positive results, the transition of this therapy to the home, when administered intermittently via central venous catheter and infusion pump, was undertaken. In order to prolong and increase quality of life in terminal CHF patients, intermittent amrinone infusions were provided at home to four patients as part of our pilot program. All four patients met the criteria for New York Heart Association (NYHA) functional class IV heart failure, and none had responded to conventional therapy suitable for outpatient maintenance. The patients also shared strong family support and an intense desire to improve the quality of remaining life. All four patients and designated family members were trained in the specifics of aseptic technique, medication dose preparation, central venous catheter care, and operation of an infusion pump. An ambulatory pump was used in three of the four patients. Subsequent to the initiation of intermittent home amrinone infusions, all four patients had greater tolerance to limited exercise and/or ambulation secondary to increased cardiac output and diuresis. Patients survived 8, 10, 47, and 56 weeks. This pilot program suggests that intravenous amrinone, administered intermittently at home, appears reasonably safe and might promote an improved quality of life. More research is necessary prior to substantiating any firm conclusions.
Clinical Differences among Nonsteroidal Antiinflammatory Drugs: Implications for Therapeutic Substitution in Ambulatory Patients
Authors: Levy Richard A. , Smith Dorothy L.
Published: May 2017

The practice of therapeutic substitution, i.e., replacing one drug with another chemically different drug from the same therapeutic class, represents an important therapeutic modification with potential clinical significance far beyond that of generic substitution. Adverse consequences following therapeutic substitution of nonsteroidal antiinflammatory drugs (NSAID) is of special concern because of substantial differences among these agents in pharmacokinetic, pharmacological, and clinical properties. Therapeutic substitution of NSAID for ambulatory patients may result in compromised clinical outcome because (1) patient response is unpredictable and selection of the optimal agent must be tailored for each patient; (2) substantial differences exist in adverse reaction profiles; (3) drug interaction studies are lacking; and (4) selection of an agent must be individualized to ensure compliance with the dosing regimen. Cost savings achieved through therapeutic substitution of NSAID may be lost by additional overall treatment costs due to adverse reactions or suboptimal therapy. The occurrence of adverse or suboptimal effects in ambulatory patients is more likely if NSAID are substituted without full knowledge of the patient's medical history and clinical status. Communication between the pharmacy and prescribing physician regarding a patient's specific needs is essential for rational substitution among NSAID.
Lactic Acidosis and Fatal Myocardial Failure Due to Clozapine
Authors: Koren Wladimir , Kreis Yitzhak , Duchowiczny Kira , Prince Tal , Sancovici Sigmund , Sidi Yechezkel , Gur Hanan
Published: May 2017

Objective

To describe a patient with neutropenic fever complicated by hyperglycemia, lactic acidosis, and fatal myocardial failure associated with clozapine therapy.

Case Summary

A 37-year-old Ashkenazic Jewish man was admitted for agranulocytosis and fever, which developed after 11 weeks of clozapine monotherapy for drug-resistant schizophrenia. Complete blood counts and a routine serum chemical analysis had been normal before the treatment was initiated, and remained within normal limits during the first 10 weeks of the treatment. On the day of admission, the patient deteriorated rapidly and developed extreme hyperglycemia, severe lactic acidosis, recurrent cardiac arrest, cardiogenic shock, and coma. He died 36 hours later despite intensive treatment.

Discussion

Clozapine intake induced fatal aganulocytosis, associated with hyperglycemia, lactic acidosis, and heart failure. White blood cell count monitoring was insufficient to predict these adverse effects.

Conclusions

Clozapine should be avoided in high-risk patients (e.g., the elderly, women, Ashkenazic Jews).
Myoclonus Due to Chlorambucil in Two Adults with Lymphoma
Authors: Wyllie Andrew Rj , Bayliff Charles D , Kovacs Michael J
Published: May 2017

Objective

To report myoclonus due to chlorambucil therapy in two adults with lymphoma, and to review the literature of chlorambucil neurotoxicity in adults.

Case Summaries

Case 1: An 81-year-old man with lymphoma being treated with chlorambucil developed jerking movements and stiffness that persisted for 3 days and intensified at night. The dosage of chlorambucil was decreased with a subsequent decrease in symptomatology. Resolution of the myoclonus occurred with discontinuation of the chlorambucil. Rechallenge evoked a return of tremors the next day that later became constant and again resolved on discontinuation of chlorambucil. Case 2: A 75-year-old woman with lymphoma being treated with chlorambucil developed jerking movements in her limbs, particularly in her arms and right hip. The symptoms were so severe they prevented the patient from leaving her house. All symptoms resolved within 2–3 days after the cycle was completed and did not return. She was diagnosed as having had chlorambucil-induced myoclonus.

Data Sources

Searches were performed on MEDLINE, CancerLit, and Science Citation Index Review to identify reports and articles discussing chlorambucil-induced neurotoxicity, particularly myoclonus.

Discussion

Chlorambucil-induced myoclonus has been described in overdose situations and in the treatment of nephrotic syndrome in children. Three cases of reversible myoclonic activity associated with high-dose chlorambucil in adults have also been described. In each case, the myoclonus resolved following discontinuation of the drug. Only one other conclusive case of low-dose chlorambucil-induced myoclonus in an adult has been described. The two cases presented here are unique in that the myoclonus occurred in adults receiving low-dose chlorambucil who had no myoclonus before or after treatment with the drug.

Conclusions

From the cases reviewed, it appears that chlorambucil may induce myoclonus in adults receiving therapeutic dosages of chlorambucil. The neurologic status of patients receiving chlorambucil should be followed closely during treatment. If myoclonus develops, drug-induced myoclonus should be considered, as well as discontinuation of the drug.
Hypoprothrombinemia Associated with Cefmetazole
Authors: Breen Gail A , Peter Wendy L St
Published: May 2017

Objective

To report a case of hypoprothrombinemia associated with the use of cefmetazole sodium, define patients at risk for this adverse effect, and identify options to prevent this problem.

Case Summary

A malnourished patient with endstage renal disease received cefmetazole following a below-the-knee amputation of the right leg. Three days later, a prothrombin time (FT) and an international normalized ratio (INR) were obtained and were markedly elevated from baseline; however, the patient had no clinical symptoms of bleeding. Cefmetazole was discontinued. Vitamin K and fresh frozen plasma were administered. The PT and INR normalized within 24 hours and remained normal throughout the remainder of hospitalization.

Discussion

The incidence of hypoprothrombinemia associated with cefmetazole reported in the literature is conflicting and not consistent. There are three proposed mechanisms of cephalosporin-associated hypoprothrombinemia, two of which involve the N-methylthiotetrazole (NMTT) chain. The most plausible mechanism is NMTT inhibition of vitamin K epoxide reductase in the liver. Patients at an increased risk for this adverse event include those with low vitamin K stores, specifically patients who are malnourished, with low albumin concentrations and poor food intake. The elderly and patients with liver or renal dysfunction are examples of populations at risk.

Conclusions

Hypoprothrombinemia may occur with cephalosporins and is especially problematic with those containing an NMTT side chain. Clinicians need to identify patients at risk for developing antibiotic-associated hypoprothrombinemia, monitor them closely, and give vitamin K as prophylaxis accordingly.
Nonnarcotic Analgesics: Prevalence and Estimated Economic Impact of Toxicities
Authors: Mcgoldrick M Donald , Bailie George R
Published: May 2017

Objective

To review and compare the risks of nonnarcotic analgesic toxicities in adults and estimate the relative healthcare costs of these toxicities, since direct comparison of costs is not possible.

Data Sources

A MEDLINE search of the literature from 1969 to 1995 was used to identify pertinent data. Additional references were identified from articles obtained in the search. Information was obtained from prospective, retrospective, controlled, and uncontrolled studies; case reports; and review articles.

Data Extraction

Estimates of annual US costs of toxicities were extrapolated and synthesized from data from diagnosis-related groups, published information about the incidence of toxicity, or local data.

Data Synthesis

Chronic use of nonsteroidal antiinflammatory drugs (NSAIDs) is associated with a high incidence of acute renal toxicity and gastrointestinal toxicity. The most common problems associated with acetaminophen use are hepatotoxicity after acute ingestion of large doses (>10 g) or habitual use of smaller doses (<4 g), particularly in alcoholic patients, and chronic analgesic nephropathy. Aspirin use is associated with a high incidence of gastrointestinal and acute renal toxicity in certain patient groups. Available data suggest that acetaminophen, used intermittently, remains the nonnarcotic analgesic of choice in many patient populations, including those with impaired renal function, gastrointestinal disease, and bleeding disorders. Estimated annua] US costs associated with the toxicities of acetaminophen (excluding hepatotoxicity), aspirin (acute upper gastrointestinal bleeding only), and NSAIDs (excluding non-upper gastrointestinal hemorrhagic complications and hepatotoxicity) are about $51.5 million, $458.6 million, and $1.35 billion, respectively.

Conclusions

Intermittent use of most nonnarcotic analgesics produces a small risk of chronic renal or hepatic toxicity. Gastrointestinal toxicity, especially upper gastrointestinal bleeding, remains a significant problem with NSAIDs and aspirin. Acetaminophen remains the nonnarcotic analgesic of choice for intermittent use by most patient groups. The toxicities associated with NSAIDs constitute about 72.6% of the total toxicities (costs $1.86 billion) caused by NSAIDs, acetaminophen, and aspirin.
New Approaches to Using Antiretroviral Therapy for the Management of Hiv Infection
Authors: Doran Cynthia M
Published: May 2017

Objective

To review the changes that have occurred in the past 2 years in the management of HIV infection with antiretroviral agents by contrasting the 1994 with the 1996 Guidelines.

Data Sources

Conference proceedings, clinical experience of the author and her colleagues, and English-language articles from the body of scientific literature identified via MEDLINE, AIDSLINE, and Current Contents served as data sources.

Data Synthesis

Current antiretroviral management strategies include movement away from using zidovudine monotherapy, institution of combination antiretroviral therapy earlier in HIV disease, the use of newer agents such as lamivudine, protease inhibitors (i.e., saquinavir, ritonavir, indinavir), and nonnucleoside reverse transcriptase inhibitors (i.e., nevirapine, delavirdine), prevention of vertical transmission with zidovudine, and use of HIV-1 RNA determinations (viral load) to guide the initiation and alteration of antiretroviral therapy. These strategies represent a dramatic change from the 1994 Guideline, which recommended zidovudine monotherapy in nonpregnant and pregnant individuals whose CD4 cell counts were less than 500 cells/mm3, when many of the newer agents were not available and the assays to determine viral load were strictly investigational.

Conclusions

The difference between the 1994 and 1996 Guidelines is substantial. It is likely that within a year's time, newer information on pathogenesis and antiretroviral agents in development will be known and further management strategies will need to be disseminated. Until then, the International AIDS Society — USA Guidelines for 1996 should be followed as the standard of care.
Vancomycin-Induced Thrombocytopenia: A Challenge and Rechallenge
Authors: Howard Carol E , Adams Lorie A , Admire Jennifer L , Chu Mary A , Alred Ginger L
Published: May 2017

Objective

To report a case of thrombocytopenia apparently associated with vancomycin use.

Case Summary

A 58-year-old white man was admitted to the hospital with chronic osteomyelitis of the foot due to methicillin-resistant Staphylococcus aureus that later spread hematogenously to the cervical vertebrae. During the first course of therapy with vancomycin, his platelet count decreased from 397 × 103/mm3 to 22 × 103/mm3. After discontinuation of the drug, it increased to 310 × 103/mm3. During the second course of vancomycin, the platelet count decreased to 77 × 103/mm3, and increased to 404 × 103/mm3 after discontinuation of the drug.

Discussion

Vancomycin has been reported as a rare cause of thrombocytopenia. Thrombocytopenia can occur as an adverse drug reaction by the following three mechanisms: direct toxic effect, drug absorption (hapten) formation, and an “innocent bystander” immune response.

Conclusions

We suspect that the thrombocytopenia in this patient, which involved an increased number of megakaryocytes in the bone marrow, was due to vancomycin.
Zolpidem for Dementia-Related Insomnia and Nighttime Wandering
Authors: Shelton Penny S , Hocking Leslie B
Published: May 2017

Objective

To describe two elderly patients with dementia and severe nighttime wandering in whom Zolpidem restored normal sleep patterns.

Case Summaries

A 90-year-old African-American woman (case 1) and an 87-year-old African-American man (case 2) presented with nighttime wandering associated with the progression of Alzheimerlike dementia. Both patients had previously not responded to bedtime regimens of benzodiazepines, trazodone (an antidepressant used for its sedative properties), and neuroleptics. Both patients averaged 2–3 hours of sleep each night. Low-dose Zolpidem (5 mg hs) was initiated with only partial response. The dosage was titrated in 5-mg increments until the optimum dosage was reached for case 1 (15 mg hs) and case 2 (10 mg hs). These dosages have proven to be effective over a period of 3 months, with both patients averaging 7–8 hours of sleep each night with no apparent adverse effects.

Discussion

Dementia produces inversion of the circadian sleep/ wake cycle, leading to daytime sedation and nighttime wandering. Zolpidem, a nonbenzodiazepine hypnotic with proven safety and efficacy in older patients with insomnia, was well tolerated and improved sleep patterns in two patients with dementia and severe nighttime wandering.

Conclusions

Zolpidem appears to be useful for restoring normal sleep patterns in elderly patients with dementia and nighttime wandering.
Enoxaparin-Associated Dermal Necrosis: A Consequence of Cross-Reactivity with Heparin-Mediated Antibodies
Authors: Tonn Michael E , Schaiff Robyn A , Kollef Marin H
Published: May 2017

Objective

To describe a patient with enoxaparin-induced dermal necrosis and to review previously reported cases of skin manifestations associated with low-molecular-weight heparins.

Case Summary

A 43-year-old white woman with adult respiratory distress syndrome developed localized dermal necrosis and thrombocytopenia secondary to subcutaneous administration of unfractionated heparin. Upper extremity thrombi that had developed after administration of subcutaneous heparin at an outside hospital were treated with subcutaneous enoxaparin. Although platelet counts remained stable during enoxaparin therapy, dermal necrosis developed at the injection site. Parenteral anticoagulant therapy was discontinued and the necrotic lesions secondary to enoxaparin resolved with minimal local care.

Discussion

Numerous cases of dermal necrosis secondary to heparin administration have been reported while this reaction secondary to enoxaparin use has been reported only briefly. It has been postulated that dermal necrosis secondary to heparin is associated with heparin-induced thrombocytopenia and is a result of heparin-mediated thrombosis in the microvasculature. Antibodies to heparin have cross-reactivity with enoxaparin; therefore, dermal necrosis secondary to enoxaparin may occur by a similar mechanism.

Conclusions

Although enoxaparin-associated dermal necrosis appears to be a rare occurrence, we advise against the use of enoxaparin or other low-molecular-weight heparins in patients with a previous history of heparin-associated thrombocytopenia or heparin-induced dermal necrosis.
Infectious Diseases: Interferon Alfa in the Treatment of Chronic Viral Hepatitis B and C
Authors: Woo Michael H , Burnakis Thomas G
Published: May 2017

Objective

To review the indications, efficacy, and toxicity of interferon alfa in the treatment of chronic hepatitis B and C.

Data Sources

English-language literature pertaining to chronic hepatitis B and C and their management with interferon reported between 1980 and June 1995 was identified through computer searches using MEDLINE and through extensive searching of bibliographies and identified articles.

Data Synthesis

Two major causes of chronic hepatitis are hepatitis B virus and hepatitis C virus (HBV and HCV). Worldwide, HBV infection is a major cause of cirrhosis and hepatocellular carcinoma, but in the US it is mainly a disease of high-risk groups. In the US, and particularly the southern portion, HCV is more common. Like HBV, HCV also may cause cirrhosis and hepatocellular carcinoma. Except for interferon therapy, the ability to effectively treat chronic hepatitis is limited. Interferon has antiviral, antiproliferative, and immunomodulatory activity. This agent is indicated in patients who have histologic evidence of chronic hepatitis and ongoing viral replication. Thirty percent to 40% of patients with HBV achieve loss of serum HBV e antigen and HBV DNA after treatment with interferon alfa 5 million units/d or 10 million units three times weekly for 16 weeks. Fifty percent of patients with chronic HCV respond to interferon 3 million units three times weekly for 6 months, but half of these relapse within the next 6 months. Prolonged use (18 months) may provide longer term responses in HCV. Adverse effects are common, often dose-dependent, and usually transient. A flu-like syndrome occurs early in the treatment, but fatigue is the most common adverse effect and persists throughout therapy. Long-term interferon treatment has not been extensively evaluated and the impact on survival rates is not known.

Conclusions

Interferon is the only agent to have shown a consistent therapeutic effect on chronic hepatitis. Response of HBV to interferon is usually sustained, while a recurrence of HCV occurs in 50% of those who initially respond. Despite the benefits of interferon, its adverse effects and impact on hepatitis must be considered before treatment can be freely advocated.
Hypocalcemia and Hypomagnesemia after Ibuprofen Overdose
Authors: Al-Harbi Naffaa N , Domrongkitchaiporn Somnuek , Lirenman David S
Published: May 2017

Objective

To report a case of hypocalcemia and Hypomagnesemia after ibuprofen overdose.

Case Summary

A 21-month-old boy developed acute renal failure with severe metabolic acidosis after ingestion of ibuprofen 8 g. The infant developed tonic–clonic seizures 46 hours after ingestion, with significant hypocalcemia and hypomagnesemia that required electrolyte replacement to control the seizures.

Discussion

To our knowledge this is the first case report of hypocalcemia, hypomagnesemia, and seizures in a patient after ibuprofen overdose. The mechanism is unclear; the situation was probably aggravated by the use of sodium polystyrene sulfonate and furosemide.

Conclusions

In patients with ibuprofen overdose, serum calcium and magnesium concentrations should be evaluated since seizures may be associated with a deficiency of these cations. The management of these patients should include calcium and/or magnesium supplementation when required and furosemide should be avoided.
Potential Interaction between Clarithromycin and Warfarin
Authors: Recker Mark W , Kier Karen L
Published: May 2017

Objective

To report a possible drug interaction between clarithromycin and warfarin in a patient with chronic atrial fibrillation.

Case Summary

A patient with chronic atrial fibrillation was placed on warfarin therapy. International normalized ratios (INRs) ranged from 1.61 to 3.99 while the dosage was being adjusted during the first 5 months of warfarin therapy. The dosage was titrated to 20 mg/wk; laboratory tests obtained 2 weeks after this dosage was started indicated an INR of 2.1. The same dosage was continued. Clarithromycin 500 mg bid was started for an acute exacerbation of bronchitis 10 days after the last INR was obtained and was continued for 14 days of therapy. An INR obtained 3 days after completion of the clarithromycin therapy was 16.8. The warfarin was withheld and vitamin K 20 mg im was administered. The INR obtained the next day was 1.52. The warfarin was restarted and the dosage was titrated to between 22.5 and 25 mg/wk, with INRs ranging from 0.85 to 3.14.

Discussion

Many factors influence the metabolism of warfarin, including disease states, medications, age, and diet. Data collected in this case suggested clarithromycin may have contributed to the increase in the effect of warfarin. Inhibition of the cytochrome P450 oxidizing system appears to be the reason for the increase. Numerous drugs and disease states affect the rate at which this system metabolizes drugs.

Conclusions

The potential interaction between clarithromycin and warfarin warrants prudent monitoring of the INR during concurrent administration of these drugs. Warfarin dosages may need to be reduced during concurrent clarithromycin therapy to prevent bleeding complications. Further controlled clinical trials are needed to substantiate the interaction between clarithromycin and warfarin.
Enhancement of Warfarin Response in a Patient Receiving Etoposide and Carboplatin Chemotherapy
Authors: Le Alyssa T , Hasson Noelle K , Lum Bert L
Published: May 2017

Objective

To report a case of a possible drug interaction between warfarin, carboplatin, and etoposide resulting in a marked increase in a patient's response to warfarin, and to outline monitoring strategies for this interaction.

Case Summary

A 74-year-old white man receiving warfarin (average dose 42.5 mg/wk) for atrial fibrillation was diagnosed with a right testicular non-seminoma mixed germ cell tumor. Mediastinal metastases were subsequently discovered, and the patient was treated with a chemotherapy regimen including carboplatin and etoposide. Sixteen days after the first course of chemotherapy, the international normalized ratio (INR) was increased to 12.6 from a baseline range of 1.15–2.11 that was observed over the previous 8 months of therapy, indicating a clinically significant alteration in the pharmacodynamic response to warfarin.

Discussion

This patient had no concomitant disease or dietary changes to explain the altered response to warfarin. Carboplatin and etoposide have not been reported to inhibit warfarin metabolism. However, previous reports have suggested that etoposide may displace warfarin from its protein binding sites, resulting in an early elevation in prothrombin time following chemotherapy. The late elevation of INR observed in our patient suggests that his response to warfarin may have been due to the displacement of warfarin by elemental platinum, which has a long plasma half-life.

Conclusions

This case report suggests a possible drug interaction between carboplatin, etoposide, and warfarin. Because of the risk associated with an increased response to warfarin, we recommend close monitoring of the INR, perhaps twice weekly, early and later in the time course following chemotherapy with these agents. Appropriate dosage adjustments of warfarin should be performed if an altered response to warfarin is observed.
Ibuprofen-Induced Aseptic Meningitis in Rheumatoid Arthritis
Authors: Horn Amy C , Jarrett Steven W
Published: May 2017

Objective

To report a case of aseptic meningitis related to ibuprofen ingestion.

Case Summary

We discuss the case of a 56-year-old white man with a history of rheumatoid arthritis and hypertension who became confused, nauseated, and began to vomit within 2 hours of the ingestion of ibuprofen. A diagnosis of ibuprofen-induced aseptic meningitis was made based on the patient's physical and laboratory findings, the quick onset and resolution of symptoms, and his medical history.

Discussion

Ibuprofen-induced aseptic meningitis has been most frequently reported in patients with systemic lupus erythematosus. However, there have been reports of this reaction in patients with other underlying disease states. Various nonsteroidal antiinflammatory drugs have been reported to cause this reaction, but ibuprofen is the most common offending agent. A drug-related cause should be considered in any patient who presents with typical meningitis symptoms, such as fever, headache, and stiff neck, that occur within hours of ingesting a drug.

Conclusions

Although persons with systemic lupus erythematosus appear to have an increased risk for this type of reaction, the development of signs and symptoms in other patients warrants the consideration of nonsteroidal antiinflammatory drugs as the cause of aseptic meningitis.
Perioperative blood glucose concentrations in kittens following overnight fasting and gonadectomy
Authors: Semick Danielle N , Shaver Stephanie L , Cornell Heather N , Bradley Nancy C , Kreisler Rachael E
Published: May 2017

Objectives

The objective of this study was to determine if hypoglycemia is an effect of overnight fasting and gonadectomy in kittens, as well as to determine predictors of baseline and postoperative blood glucose.

Methods

This was a prospective observational study. Seventy-five kittens between the age of 8 and 16 weeks undergoing routine castration or ovariohysterectomy at an animal shelter were included. Two blood glucose measurements were analyzed per kitten after an overnight fast: a baseline reading prior to preoperative examination, and a reading immediately postoperatively. Predictors of the baseline and postoperative blood glucose levels were determined using multi-level mixed-effects linear regression.

Results

Kittens, when fasted overnight, were not hypoglycemic (<60 mg/dl). No kittens exhibited clinical signs consistent with hypoglycemia. No kittens had a blood glucose <70 mg/dl postoperatively. Postoperative hyperglycemia (>150 mg/dl) was observed in 44% of kittens. The only predictor of fasted blood glucose levels was body condition score. The only predictor of postoperative blood glucose levels was the fasting blood glucose value.

Conclusions and relevance

Overnight fasting prior to elective sterilization in 8- to 16-week-old kittens did not result in hypoglycemia. Concern regarding hypoglycemia after a prolonged fast in kittens may be unwarranted for short procedures in healthy animals.
Enhancing egg cartons’ sound absorption coefficient with recycled materials
Authors: Satwiko Prasasto , Gharata Verza Dillano , Setyabudi Herybert , Suhedi Fefen
Published: May 2017

Egg cartons have popularly been used as sound absorbers because they are inexpensive, easy to install and easily available. However, acoustic experts have demonstrated that egg cartons are bad sound absorbers. This study developed Enhanced Egg Carton – Dry and Enhanced Egg Carton – Wet using additional recycled materials (shredded rice straw paper, textile waste, 2-cm cut rice straws) to improve the cartons’ sound absorption coefficient while retaining their original advantages. Enhanced Egg Carton – Dry and Enhanced Egg Carton – Wet were tested based on the ASTM C423-02 method of sound absorption measurement. Enhanced Egg Carton – Dry has a noise reduction coefficient of 0.6 and a sound absorption average of 0.59, while Enhanced Egg Carton – Wet has a noise reduction coefficient of 0.54 and sound absorption average of 0.54. The maximum sound absorption coefficients of Enhanced Egg Carton – Dry and Enhanced Egg Carton – Wet are, respectively, 0.77 at 500 Hz and 0.67 at 630 Hz. Enhanced Egg Carton – Dry has a sound absorption coefficient ⩾0.5, between 315 and 2500 Hz, which makes it able to absorb sound energy of the lower to upper mid-range frequencies. With their high sound absorptivity at mid-range frequencies, Enhanced Egg Carton – Dry and Enhanced Egg Carton – Wet are suitable for mosques and auditoriums, where the human voice is the dominant noise source and where an inexpensive sound absorber is needed. The production of Enhanced Egg Carton – Dry and Enhanced Egg Carton – Wet is so simple that users can do it themselves using basic home tools.
Conceptualising on-screen tourism destination development
Authors: Lundberg Christine , Ziakas Vassilios , Morgan Nigel
Published: May 2017

This article integrates cultural theory and marketing strategy to examine the complex relationship between on-screen popular culture and tourism destination place-making. Its review of the literature results in the development of an interdisciplinary conceptual framework (termed ‘on-screen dollying’) that provides a culturally grounded and contextually driven theorisation of the means by which on-screen popular culture place-making can foster destination development. In developing the conceptual framework, the article classifies the characteristics of on-screen tourism affecting destination development and identifies six strategies for leveraging on-screen tourism. Based on our interdisciplinary analysis, we propose a research agenda that integrates on-screen tourism and destination place-making and which has implications for policy and theory.
“We’re not magicians!” On the use of rhetorical resources in Swedish news media narratives portraying the social services and social workers
Authors: Blomberg Helena
Published: May 2017

This article focuses on how the Swedish news media depicts the functioning of the social services and the situation of social workers. The empirical material consists of 586 articles published online during the years 2010–2015. A discursive approach makes up the theoretical and methodological framework. The aims of the article are to identify and categorise media narratives about social services and social workers, how they are portrayed, what is conveyed and how the stakeholders’ (politicians, managers and social workers) negotiate the question of responsibility for the situation in the social services. The study identifies and categorises seven different types of media narrative. In these narratives, social workers are portrayed in various ways, such as unwilling to stay in the profession, concerned, hardworking, etc. Reports on the crisis in the social services tend to dominate, e.g. how the social services fail to follow-up cases of child abuse, social workers’ heavy workload and that legal security cannot be guaranteed. Stakeholders, faced with reported criticism, maintain credibility by taking some responsibility and/or displacing liability by using various rhetorical resources. The media produces a public image of the lack of responsibility for solving the problematic situation. In this respect, the take-action-narratives are central to the debate, which argues for joint action to be taken to find solutions. Although the media is a powerful and scrutinising tool, it also needs to report on the improvements that have been made in order to give a more balanced picture of the social services.
Characterization of Water-Clear Polymeric Gels for Use as Radiotherapy Bolus
Authors: Adamson Justus D. , Cooney Tabitha , Demehri Farokh , Stalnecker Andrew , Georgas Debra , Yin Fang-Fang , Kirkpatrick John
Published: May 2017

Our purpose was to investigate polymeric gels for use as a highly transparent radiotherapy bolus and determine the relevant physical and dosimetric properties. We first quantified tensile properties (maximum stress, strain, and Young modulus) for various polymeric gels, along with a commercial bolus product in order to illustrate the wide variety of potential materials. For a select polymeric gel with tensile properties similar to currently used radiotherapy bolus, we also evaluated mass and electron density, effective atomic number, optical transparency, and percent depth dose in clinical megavoltage photon and electron beams. For this polymeric gel, mass density was 872 ± 12 and 896 ± 13 g/cm3 when measured via weight/volume and computed tomography Hounsfield units, respectively. Electron density was 2.95 ± 0.04 ×1023 electrons/cm3. Adding fused silica (9% by weight) increases density to that of water. The ratio of the effective atomic number to that of water without and with added silica was 0.780 and 0.835 at 1 MeV, 0.767 and 0.826 at 6 MeV, and 0.746 and 0.809 at 20 MeV. Percent depth dose for 6 MV photons was within 2% of water within the first 2.5 cm and after scaling by the density coincided within 1% out to >7 cm. For 6 and 20 MeV electrons, after scaling for density D80% was within 1.3 and 1.5 mm of water, respectively. The high transparency and mechanical flexibility of polymeric gels indicate potential for use as a radiotherapy bolus; differences in density from water may be managed via either using “water equivalent thickness” or by incorporating fused silica into the material.
Women leaders in the political field in Scotland: A socio-historical approach to the emergence of leaders
Authors: Robinson Sarah , Kerr Ron
Published: May 2017

Drawing on a contextualised case, we present a specific approach to leadership studies that brings together history, sociology and politics. We start with the following event. In August 2015, the election of Kezia Dugdale as leader of the Labour Party meant that, for the first time the leaders of the three main political parties in the Scottish Parliament were women. We approach the study of this significant leadership event, first, through a critique of aspects of leadership studies as a field. We next consider the potential for socio-historical approaches in understanding this event. Then, as a contextualised example of this alternative approach to studying leadership, we apply Bourdieu’s theoretical concepts – in particular the political field – in order to historicise the conditions of possibility of this event. Finally, we consider issues of power and gender in relation to how the leaders position themselves in relation to their parties and to each other within the political field. In so doing, we contribute to critical leadership studies by developing and demonstrating a socio-historical approach that can help us to identify processes of organisation and change in relation to the emergence of leaders.
Resveratrol-decreased hyperalgesia mediated by the P2X7 receptor in gp120-treated rats
Authors: Wu Bing , Ma Yucheng , Yi Zhihua , Liu Shuangmei , Rao Shenqiang , Zou Lifang , Wang Shouyu , Xue Yun , Jia Tianyu , Zhao Shanhong , Shi Liran , Li Lin , Yuan Huilong , Liang Shangdong
Published: May 2017

Background

Chronic pain is a common symptom in human immunodeficiency virus (HIV)-1 infection/acquired immunodeficiency syndrome patients. The literature shows that the HIV envelope glycoprotein 120 (gp120) can directly cause hyperalgesia by stimulating primary sensory afferent nerves. The P2X7 receptor in the dorsal root ganglia (DRG) is closely related to neuropathic and inflammatory pain. In this study, we aimed to explore the effect of resveratrol (RES) on gp120-induced neuropathic pain that is mediated by the P2X7 receptor in the rat DRG.

Results

Mechanical hyperalgesia in rats treated with gp120 was increased compared with that in the sham group. The P2X7 expression levels in rats treated with gp120 were higher than those in the sham group. Co-localization of the P2X7 receptor and glial fibrillary acidic protein (GFAP, a marker of satellite glial cells [SGCs]) in the DRG SGCs of the gp120 group exhibited more intense staining than that of the sham group. RES decreased the mechanical hyperalgesia and P2X7 expression levels in gp120 treatment rats. Co-localization of the P2X7 receptor and GFAP in the gp120+ RES group was significantly decreased compared to the gp120 group. RES decreased the IL-1β and TNF-α receptor (R) expression levels and ERK1/2 phosphorylation levels as well as increased IL-10 expression in the DRG of gp120-treated rats. Whole cell clamping demonstrated that RES significantly inhibited adenosine triphosphate-activated currents in HEK293 cells that were transfected with the P2X7 plasmid.

Conclusions

RES relieved mechanical hyperalgesia in gp120-treated rats by inhibiting the P2X7 receptor.
Suppression of asparaginyl endopeptidase attenuates breast cancer-induced bone pain through inhibition of neurotrophin receptors
Authors: Yao Peng , Ding Yuanyuan , Han Zhenkai , Mu Ying , Hong Tao , Zhu Yongqiang , Li Hongxi
Published: May 2017

Objective

Cancer-induced bone pain is a common clinical problem in breast cancer patients with bone metastasis. However, the mechanisms driving cancer-induced bone pain are poorly known. Recent studies show that a novel protease, asparaginyl endopeptidase (AEP) plays crucial roles in breast cancer metastasis and progression. We aim to determine the functions and targeted suppress of AEP in a mouse model of breast cancer-induced bone pain.

Methods

Breast cancer cells with AEP knocked-down or overexpression were constructed and implanted into the intramedullary space of the femur to induce pain-like behavior in mice. AEP-specific inhibitors or purified AEP proteins were further used in animal model. The histological characters of femur and pain ethological changes were measured. The expressions of AEP and neurotrophin receptors (p75NTR and TrkA) in dorsal root ganglion and spinal cord were examined.

Results

Femur radiographs and histological analysis revealed that cells with AEP knocked-down reduced bone destruction and pain behaviors. However, cells with AEP overexpression elevated bone damage and pain behaviors. Further, Western blot results found that the expressions of p75NTR and TrkA in dorsal root ganglions and spinal cords were reduced in mice inoculated with AEP knocked-down cells. Targeted suppression of AEP with specific small compounds significantly reduced the bone pain while purified recombinant AEP proteins increased bone pain.

Conclusions

AEP aggravate the development of breast cancer bone metastasis and bone pain by increasing the expression of neurotrophin receptors. AEP might be an effective target for treatment of breast cancerinduced bone pain.
T1-weighted dynamic contrast-enhanced brain magnetic resonance imaging: A preliminary study with low infusion rate in pediatric patients
Authors: Rochetams Bruno-Bernard , Marechal Bénédicte , Cottier Jean-Philippe , Gaillot Kathleen , Sembely-Taveau Catherine , Sirinelli Dominique , Morel Baptiste
Published: May 2017

Background

The aim of this preliminary study is to evaluate the results of T1-weighted dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) in pediatric patients at 1.5T, with a low peripheral intravenous gadoteric acid injection rate of 1 ml/s.

Materials and methods

Children with neurological symptoms were examined prospectively with conventional MRI and T1-weighted DCE MRI. An magnetic resonance perfusion analysis method was used to obtain time–concentration curves (persistent pattern, type-I; plateau pattern, type-II; washout pattern, type-III) and to calculate pharmacokinetic parameters. A total of two radiologists manually defined regions of interest (ROIs) in the part of the lesion exhibiting the greatest contrast enhancement and in the surrounding normal or contralateral tissue. Lesion/surrounding tissue or contralateral tissue pharmacokinetic parameter ratios were calculated. Tumors were categorized by grade (I–IV) using the World Health Organization (WHO) Grade. Mann–Whitney testing and receiver-operating characteristic (ROC) curves were performed.

Results

A total of nine boys and nine girls (mean age 10.5 years) were included. Lesions consisted of 10 brain tumors, 3 inflammatory lesions, 3 arteriovenous malformations and 2 strokes. We obtained analyzable concentration–time curves for all patients (6 type-I, 9 type-II, 3 type-III). Ktrans between tumor tissue and surrounding or contralateral tissue was significantly different ( p = 0.034). Ktrans ratios were significantly different between grade I tumors and grade IV tumors ( p = 0.027) and a Ktrans ratio value superior to 0.63 appeared to be discriminant to determine a grade IV of malignancy.

Conclusions

Our results confirm the feasibility of pediatric T1-weighted DCE MRI at 1.5T with a low injection rate, which could be of great value in differentiating brain tumor grades.
Predictors of Successful Organizational Change: The Alignment of Goals, Logics of Action and Leaders' Roles to Initiate Clinical Pathways
Authors: Schmit Cécile , D'hoore William , Lejeune Christophe , Vas Alain
Published: May 2017

The implementation of clinical pathways (CPs) is a quality improvement process that uses a horizontal and multidisciplinary approach far different from the silo approach usually present in hospital structures. Because hospitals are pluralistic organizations characterized by multiple objectives and diffuse power, CP implementation represents a complex intervention. By focusing on the initiation stage, our research aims to understand the key managerial success factors to take into account during this critical period. Using a qualitative approach, we analyse the CP change initiation stage within 11 Belgian hospitals. Based on a double success indicator collected one year and a half after CP project's initiation, we focus on CP failures and successful CP implementations. This research suggests three key factors supporting CP's effective implementation: the importance of alignment between direction's goals and piloting team's expectations (alignment of goals), the piloting team's acceptance of CP choice (alignment of logics of action), and the importance of complementarities between multiple leaders (alignment of leaders' roles). In conclusion, change initiation in a complex organizational environment is a major strategic stake for its managers. The suggested triple organizational alignment is useful for any CP implementation, but also for the initiation stage of any changes in pluralistic organizations.
A Future for Pathways in Mental Health Care in Norway: A Discussion Paper Based on El-Ghorr et al. (2010)
Authors: Biringer Eva , Hartveit Miriam
Published: May 2017

We have read the paper by El-Ghorr et al. (Int J Care Pathways 2010;14:57-64) on Scotland's national approach to improving mental health services with great interest. The paper described the strategy developed by NHS Quality Improvement Scotland (NHS QIS) in which integrated care pathways were used as tools for redesign and continuous quality improvement. In our opinion, a similar national effort is also necessary in Norway. In particular, pathways would help bridge the ‘gap’ between primary and specialist services. We point to which elements of the Scottish programme it is that would be relevant to implement in Norway in future. Furthermore, we discuss factors that are already present in Norway upon which authorities, health leaders and professionals could build on in a future national-level implementation of pathways in mental health care.
Essentials in Return to Work Issues: A Tale of Two Shoulders
Authors: Sandal Candace L.
Published: May 2017

Musculoskeletal disorders are common in the workplace and often respond to first-aid treatment. Worker education combined with precise management of precautionary restrictions by occupational health nurses can decrease employees’ recovery time and lower risk of complications.
An interview with Hiroshi Hamada
Authors: Brown Katherine
Published: May 2017

Hiroshi Hamada is the Director of the RIKEN Center for Developmental Biology (CDB) in Kobe, Japan. His lab focusses on the establishment of left-right asymmetry in the mouse embryo, and the role of cilia in the symmetry-breaking event. Hiroshi's work has been recognised by various awards, including the Keio Medical Science Prize in 2014, and election as an EMBO Associate Member in 2016. We met with Hiroshi on a recent visit to the CDB, to talk about his career and current interests, and the prospects for developmental biology in Japan.
Importance of Radiological Evaluation of Global Spinal Balance Together with Lower Limb Alignment in Planning Lumbar Spine Deformity Surgery – Illustrative Case Presentation
Authors: Głowacki Mariusz , Walecki Jerzy , Kołakowski Przemysław , Kolońska Danuta
Published: May 2017

Background: The presented case illustrates the critical role of a detailed preoperative radiological evaluation in complex spine surgery.

Case Report: A 49-year-old patient was admitted for a revision surgery after L3–L5 fusion. Preoperative assessment showed preserved sagittal balance, coronal imbalance and valgus knee deformity. The patient reported pain of 8–10 in VAS (Visual Analogue Scale) and had an ODI (Oswestry Disability Index) of 60%. The first step of the surgery was L2–S1 fusion with decompression and spine deformity correction. The second step involved anti-valgus osteotomy of the right tibial bone.

Conclusions: The assessment of global spinal balance together with lower extremity alignment should be strongly recommended.