bluuebunny/crossref_metadata_2025 huggingface dataset:
Mathematics Teacher Education Quality in TEDS-M: Globalizing the Views of Future Teachers and Teacher Educators
Authors: Hsieh Feng-Jui , Law Chiu-Keung , Shy Haw-Yaw , Wang Ting-Ying , Hsieh Chia-Jui , Tang Shu-Jyh
Published: April 2011

The Teacher Education and Development Study in Mathematics, sponsored by the International Association for the Evaluation of Educational Achievement, is the first data-based study about mathematics teacher education with large-scale samples; this article is based on its data but develops a stand-alone conceptual framework to investigate the quality of teacher education among various countries. The framework includes five indicators: future teacher achievement, instructor effectiveness, coherence between universities and schools, courses/content arrangement, and overall effectiveness of teacher education programs. One of the findings provides indications that it is necessary to combine theoretical knowledge with practical teaching into teacher education; another finding is that for all countries involved, future teachers are less approving of the courses/content arrangement of teacher education programs than are program educators, thus perhaps lowering educators’ motivation to improve the arrangement. The data also indicate that there is a high degree of synchronization and organization in teacher education programs in the United States; however, these programs still require further development and promotion of their future teachers’ knowledge achievements.
Supporting the Initiation and Early Development of Evidence-Based Grade-Level Collaboration in Urban Elementary Schools
Authors: Cosner Shelby
Published: April 2011

This article reports findings from a 3-year longitudinal qualitative case study conducted in three urban elementary schools that examined the ways in which local leadership supported the initiation and early development of evidence-based grade-level collaboration as a mechanism for improving student literacy learning. Findings suggest eight key leadership roles—either individually enacted or jointly performed by principals and literacy coordinators. Central features of these principal–literacy coordinator relationships are identified and a shared leadership framework that details these eight leadership roles as well as strategies associated with role enactment are presented.
The Changing Roles of Disability, Veteran, and Socioeconomic Status in Elderly Interstate Migration
Authors: Conway Karen Smith , Rork Jonathan C.
Published: April 2011

This research explores how interstate elderly migration behavior through the life course has changed over time by examining the role of individual characteristics in different types of moves. The authors focus on disability, veteran, and socioeconomic status, which research suggests are linked with differing motives for elderly migration. Using data from the 1970-2000 Integrated Public Use Microdata Series (IPUMS), descriptive and multivariate analyses show that disability status has grown in importance while veteran and socioeconomic status have declined or remained stable. These changes are unique to the elderly. The growing role of disability in elderly migration is geographically universal, extending to both return (a proxy for assistance-related migration) and nonreturn migration. Possible explanations include a tendency for the “first” (amenity-based) elderly move to occur at younger ages and a decline in primarily milder disabilities that leads to relatively more severe disabilities—and need for assistance—of those remaining.
Mothers’ and Fathers’ Perceptions of Mutuality in Middle Childhood: The Domain of Intimacy
Authors: Oliphant Amy E. , Kuczynski Leon
Published: April 2011

This study investigated parents’ experiences of closeness in their interactions with their children in middle childhood. Structured, open-ended interviews were conducted with mothers and fathers from 23 families (46 participants) with children aged between 7 and 11 years ( M = 9.2 years). Qualitative analyses indicated that parents’ experiences of close interactions were consistent with an underlying construct of parent—child intimacy. Parents reported that they experienced closeness predominantly during interactions where they perceived mutuality and shared pleasure. Parents were strategic in creating both intimate interactions and contexts for intimacy. Children were perceived to contribute to intimacy by initiating and responding to parental bids for intimate interactions.
The recognition of delirium in hospice inpatient units
Authors: Smith Jenny , Adcock Lucy
Published: April 2011

Clinical experience suggests that screening for delirium on admission to a hospice is often omitted but early recognition and detection can improve outcome for these patients. In a series of audits we have evidenced low use of the recommended screening tool provided within the admission proforma of two hospices. In some circumstances this omission is appropriate to the clinical situation, however the results show this is not always the case. These results have highlighted implications for future work exploring the barriers to routine cognitive screening on admission to an inpatient unit.
Quality of life impairment, disability and economic burden associated with chronic daily headache, focusing on chronic migraine with or without medication overuse: A systematic review
Authors: Lantéri-Minet Michel , Duru Gérard , Mudge Mia , Cottrell Suzi
Published: April 2011

Objective: To evaluate the evidence for quality of life (QoL) impairment, disability, healthcare resource use and economic burden associated with chronic daily headache (CDH), focusing on chronic migraine (CM) with or without medication overuse.

Methods: A systematic review and qualitative synthesis of studies of patients/subjects with CDH that included CM, occurring on at least 15 days per month.

Main findings: Thirty-four studies were included for review (25 studies of patients and nine of subjects from the general population). CDH and CDH with medication overuse headache (MOH) were consistently associated with a lower QoL compared to control or episodic headache (EH) and CDH without MOH. CDH was consistently associated with greater disability and productivity loss, more consultations, more or longer hospitalizations and higher direct costs than EH. Data were not amenable to statistical pooling.

Principal conclusions: The findings of this review underline the detriment to QoL and the disabling nature of CDH, and in particular CM and CDH with MOH, and negative impact on workplace productivity compared to other types of headache.
A Functional Magnetic Resonance Imaging Study of a Large Clinical Cohort of Children With Tourette Syndrome
Authors: Debes Nanette M. M. M. , Hansen Adam , Skov Liselotte , Larsson Henrik
Published: April 2011

There is evidence that cortico-striato-thalamo-cortical pathways are involved in the pathophysiology of Tourette syndrome. During the performance of neuropsychological tests in subjects with Tourette syndrome there are suggestions for increased activity in the sensimotor cortex, supplementary motor areas, and frontal cortex. To replicate findings, the authors examined 22 medication-naive children with Tourette syndrome only, 17 medication-naive children with Tourette syndrome and comorbidity, and 39 healthy controls with functional magnetic resonance imaging (MRI). There were no differences in activation in brain regions between the children with Tourette syndrome (divided according to the presence of comorbidity) and healthy controls after correction for the confounders age, sex, and intelligence. Activation in the cingulated gyrus, temporal gyrus, and medial frontal gyrus was correlated significantly with obsessive-compulsive disorder score. The authors did not find significant correlations between activation patterns and age, sex, duration of disease, intelligence, severity of tics, and attention-deficit hyperactivity disorder (ADHD) score.
Love, lust and the Irish: Exploring intimate lives through Angela Macnamara’s problem page, 1963-1980
Authors: Ryan Paul
Published: April 2011

This article explores transformations within the intimate lives of married couples in Ireland between 1963 and 1980. I use data from the problem page of renowned agony aunt Angela Macnamara to chart evidence of a renegotiation of the traditional love/lust balance identified by Wouters (1998) which has, I argue, contributed to a greater democratization emerging within these relationships. The problem page reveals tensions between a declining traditional moral code espoused by Macnamara and a new language of sexual and marital fulfilment. This new language was increasingly heard on television chat shows and soap operas, in newspapers and magazines, in Ireland and abroad. It was the language of the women’s movement and intellectuals who challenged Catholic social teaching on pre-marital sex, contraception and divorce. This article gives a unique insight into the intersection of the private lives of the column and the broader structural changes which continued to shape those lives, including Macnamara’s, over a 17-year period.
How the shadow of the future might promote cooperation
Authors: Van Lange Paul A. M. , Klapwijk Anthon , Van Munster Laura M.
Published: April 2011

It has been suggested that the expectation of repeated (versus single) interaction might promote cooperation in social dilemmas. One key question is whether the anticipation of repeated interaction may promote cooperation in those with prosocial orientations, with individualistic orientations, or both. We advance the argument that repeated interaction may be perceived in terms of opportunities for punishing noncooperation and rewarding cooperation (reciprocity), and that such “contingencies” should have a relatively greater impact on individualists’ motivations to cooperate. Consistent with hypotheses, we found evidence for the idea that the mere anticipation of repeated (versus single-trial) interaction promoted cooperation, but more so in those who pursue primarily individualistic, self-interested goals than those who are more prone to pursue prosocial goals.
Cultures of Optimism
Authors: Bennett Oliver
Published: April 2011

Drawing on material from a broad range of fields, this article identifies an ‘optimism of everyday life’ and proposes that it performs significant psychological, social and cultural functions. These functions are briefly reviewed, with particular reference to psychological and physical health, family and social relationships and the achievement of goals in different contexts. It is argued that the necessity of optimism has given rise to a complex of optimism promoters, which function as agents of implicit cultural policy. The family, religious institutions, the medical profession, psychotherapists and counsellors, businesses and political leaders are, amongst others, all seen to be part of this complex, deeply engaged in the reproduction of cultures of optimism. Whilst a multiplicity of values is reflected in individual expressions of optimism, a kind of meta-value is expressed in its common, cognitive form: of energy over entropy, of living over dying.
Long-term survivorship at a price: late-term, therapy-associated toxicities in the adult Hodgkin lymphoma patient
Authors: Straus David J.
Published: April 2011

There have been an increasing number of survivors of successful treatment of Hodgkin lymphoma (HL) over the past 30 years. Although these survivors may be cured of their HL, long-term morbidity and mortality are associated with late toxicities of treatment. Identification of these late complications will lead to strategies to manage them when they occur and hopefully to decrease the risk of their development. Second malignancies followed by cardiovascular disease are the leading causes of late morbidity and mortality. Musculoskeletal difficulties, endocrine abnormalities including sterility and thyroid disease, heart and lung damage, persistent fatigue and psychosocial distress have also been seen. The subjects of this review are the late complications of primary treatment of HL and autologous stem cell transplantation, usually for relapsed disease.
A prospective polysomnographic study on the evolution of complex sleep apnoea
Authors: Cassel W. , Canisius S. , Becker H.F. , Leistner S. , Ploch T. , Jerrentrup A. , Vogelmeier C. , Koehler U. , Heitmann J.
Published: April 2011

Complex sleep apnoea (CompSA) may be observed following continuous positive airway pressure (CPAP) treatment.

In a prospective study, 675 obstructive sleep apnoea patients (mean age 55.9 yrs; 13.9% female) participated. Full-night polysomnography was performed at diagnosis, during the first night with stable CPAP and after 3 months of CPAP.

12.2% (82 out of 675 patients) had initial CompSA. 28 of those were lost to follow-up. Only 14 out of the remaining 54 patients continued to satisfy criteria for CompSA at follow-up. 16 out of 382 patients not initially diagnosed with CompSA exhibited novel CompSA after 3 months. 30 (6.9%) out of 436 patients had follow-up CompSA. Individuals with CompSA were 5 yrs older and 40% had coronary artery disease. At diagnosis, they had similar sleep quality but more central and mixed apnoeas. On the first CPAP night and at follow-up, sleep quality was impaired (more wakefulness after sleep onset) for patients with CompSA. Sleepiness was improved with CPAP, and was similar for patients with or without CompSA at diagnosis and follow-up.

CompSA is not stable over time and is mainly observed in predisposed patients on nights with impaired sleep quality. It remains unclear to what extent sleep impairment is cause or effect of CompSA.
Otalgia and eschar in the external auditory canal in scrub typhus complicated by acute respiratory distress syndrome and multiple organ failure
Authors: Lee Bor-Jen , Chen Chia-Yi , Hu Sung-Yuan , Tsan Yu-Tse , Lin Tzu-Chieh , Wang Lee-Min
Published: April 2011

Background

Scrub typhus, a mite-transmitted zoonosis caused by Orientia tsutsugamushi, is an endemic disease in Taiwan and may be potentially fatal if diagnosis is delayed.

Case presentations

We encountered a 23-year-old previously healthy Taiwanese male soldier presenting with the right ear pain after training in the jungle and an eleven-day history of intermittent high fever up to 39°C. Amoxicillin/clavulanate was prescribed for otitis media at a local clinic. Skin rash over whole body and abdominal cramping pain with watery diarrhea appeared on the sixth day of fever. He was referred due to progressive dyspnea and cough for 4 days prior to admission in our institution. On physical examination, there were cardiopulmonary distress, icteric sclera, an eschar in the right external auditory canal and bilateral basal rales. Laboratory evaluation revealed thrombocytopenia, elevation of liver function and acute renal failure. Chest x-ray revealed bilateral diffuse infiltration. Doxycycline was prescribed for scrub typhus with acute respiratory distress syndrome and multiple organ failure. Fever subsided dramatically the next day and he was discharged on day 7 with oral tetracycline for 7 days.

Conclusion

Scrub typhus should be considered in acutely febrile patients with multiple organ involvement, particularly if there is an eschar or a history of environmental exposure in endemic areas. Rapid and accurate diagnosis, timely administration of antibiotics and intensive supportive care are necessary to decrease mortality of serious complications of scrub typhus.
Regulation of β-catenin by t-DARPP in upper gastrointestinal cancer cells
Authors: Vangamudi Bhavatarini , Zhu Shoumin , Soutto Mohammed , Belkhiri Abbes , El-Rifai Wael
Published: April 2011

Background

Truncated dopamine and cyclic-AMP-regulated phosphoprotein (t-DARPP) is frequently overexpressed in gastrointestinal malignancies. In this study, we examined the role of t-DARPP in regulating β-catenin.

Results

The pTopFlash construct that contains multiple TCF/LEF-binding sites was used as a measure of β-catenin/TCF transcription activity. Gastric (AGS, MKN28) and esophageal (FLO-1) adenocarcinoma cancer cell lines that lack t-DARPP expression were utilized to establish stable and transientin vitroexpression models of t-DARPP. The expression of t-DARPP led to a significant induction of the pTOP reporter activity, indicative of activation of β-catenin/TCF nuclear signaling. Immunofluorescence assays supported this finding and showed accumulation and nuclear translocation of β-catenin in cells expressing t-DARPP. These cells had a significant increase in their proliferative capacity and demonstrated up-regulation of two transcription targets of β-catenin/TCF: Cyclin D1 and c-MYC. Because phosphorylated GSK-3β is inactive and loses its ability to phosphorylate β-catenin and target it towards degradation by the proteasome, we next examined the levels of phospho-GSK-3β. These results demonstrated an increase in phospho-GSK-3β and phospho-AKT. The knockdown of endogenous t-DARPP in MKN45 cancer cells demonstrated a reversal of the signaling events. To examine whether t-DARPP mediated GSK-3β phosphorylation in an AKT-dependent manner, we used a pharmacologic inhibitor of PI3K/AKT, LY294002, in cancer cells expressing t-DARPP. This treatment abolished the phosphorylation of AKT and GSK-3β leading to a reduction in β-catenin, Cyclin D1, and c-MYC protein levels.

Conclusions

Our findings demonstrate, for the first time, that t-DARPP regulates β-catenin/TCF activity, thereby implicating a novel oncogenic signaling in upper gastrointestinal cancers.
Molecular epidemiology of chicken anemia virus in commercial farms in China
Authors: Eltahir Yassir M , Qian Kun , Jin Wenjie , Wang Pingping , Qin Aijian
Published: April 2011

Background

Chicken anemia virus (CAV) is the causative agent of chicken infectious anemia (CIA). A high prevalence of CAV has been reported in China. However, VP1 sequences of Chinese isolates show no clear genotype clustering or correlation with geographic origin. Therefore, the present study aimed to detect and characterize CAV isolates from China based on sequence and phylogenetic analysis of the VP1, VP2 and VP3 genes.

Results

Of 460 spleen samples tested by PCR, 47 (10.22%) were found to be positive for CAV. A total of 25 CAV, approximately full genomes, from different commercial farms were characterized. Phylogenetic analysis of the Chinese CAV sequences together with strains from different countries resulted in four distinct groups (A-D) with significant high bootstrap values. The Chinese viral sequences were located as four different clusters within groups A and D. All the Chinese CAV genomes characterized in this study had glutamine (Q) at amino acid position 394, which indicated that all are highly pathogenic. Mutations associated with attenuation and weaker reactivity with monoclonal antibody 2A9 were absent in the Chinese sequences.

Conclusions

We revealed that CAV prevalence was lower than that reported previously in commercial farms in China. We also showed four distinct sequence groups (A-D), and genetic variability in local CAV sequences that could be divided into four groups based on phylogenetic analysis.
Salvage living donor liver transplantation after percutaneous transluminal angioplasty for recurrent Budd-Chiari syndrome: a case report
Authors: Shirai Yusaku , Yoshiji Hitoshi , Ko Saiho , Yamazaki Masaharu , Ikenaka Yasuhide , Noguchi Ryuichi , Morioka Chie , Kaji Kosuke , Aihara Yosuke , Nakanishi Keisuke , Yamao Junichi , Toyohara Masahisa , Mitoro Akira , Sawai Masayoshi , Yoshida Motoyuki , Fujimoto Masao , Uemura Masahito , Nakajima Yoshiyuki , Fukui Hiroshi
Published: April 2011

Introduction

Budd-Chiari syndrome is a very rare pathological entity that ultimately leads to liver failure. Several therapeutic modalities, including percutaneous transluminal angioplasty, have been attempted to save the life of patients with Budd-Chiari syndrome. Few reports have described a salvage living donor liver transplantation performed after percutaneous transluminal angioplasty in a patient with acute Budd-Chiari syndrome.

Case presentation

A 26-year-old Japanese man developed severe progressive manifestations, such as massive ascites and hematemesis due to rupture of esophageal varices. After making several investigations, we diagnosed the case as Budd-Chiari syndrome. We first performed percutaneous transluminal angioplasty to dilate a short-segment stenosis of his inferior vena cava. The first percutaneous transluminal angioplasty greatly improved the clinical manifestations. However, after a year, re-stenosis was detected, and a second percutaneous transluminal angioplasty failed to open the severe stricture of his inferior vena cava. Since our patient had manifestations of acute liver failure, we decided to perform salvage living donor liver transplantation from his brother. The transplantation was successfully performed and all clinical manifestations were remarkably alleviated.

Conclusion

In cases of recurrent Budd-Chiari syndrome, the blocked hepatic venous outflow is not always relieved, even with invasive therapies. We have to take into account the possibility of adopting alternative salvage therapies if the first therapeutic modalities fail. When invasive therapy such as percutaneous transluminal angioplasty fails, liver transplantation should be considered as an alternative option.
Osthole induces G2/M arrest and apoptosis in lung cancer A549 cells by modulating PI3K/Akt pathway
Authors: Xu Xiaoman , Zhang Yi , Qu Dan , Jiang Tingshu , Li Shengqi
Published: April 2011

Background

To explore the effects of Osthole on the proliferation, cell cycle and apoptosis of human lung cancer A549 cells.

Methods

Human lung cancer A549 cells were treated with Osthole at different concentrations. Cell proliferation was measured using the MTT assay. Cell cycle was evaluated using DNA flow cytometry analysis. Induction of apoptosis was determined by flow cytometry and fluorescent microscopy. The expressions of Cyclin B1, p-Cdc2, Bcl-2, Bax, t-Akt and p-Akt were evaluated by Western blotting.

Results

Osthole inhibited the growth of human lung cancer A549 cells by inducing G2/M arrest and apoptosis. Western blotting demonstrated that Osthole down-regulated the expressions of Cyclin B1, p-Cdc2 and Bcl-2 and up-regulated the expressions of Bax in A549 cells. Inhibition of PI3K/Akt signaling pathway was also observed after treating A549 cells with Osthole.

Conclusions

Our findings suggest that Osthole may have a therapeutic application in the treatment of human lung cancer.
Parents' Roles in Decision Making for Children With Cancer in the First Year of Cancer Treatment
Authors: Mack Jennifer W. , Wolfe Joanne , Cook E. Francis , Grier Holcombe E. , Cleary Paul D. , Weeks Jane C.
Published: April 2011

Purpose

To evaluate the extent to which parents of children with cancer are involved in decision making in the ways they prefer during the first year of treatment.

Methods

We conducted a cross-sectional survey of 194 parents of children with cancer (response rate, 70%) in their first year of cancer treatment at the Dana-Farber Cancer Institute and Children's Hospital (Boston, MA) and the children's physicians. We measured parents' preferred and actual roles in decision making and physician perceptions of parents' preferred roles.

Results

Most parents (127 of 192; 66%) wanted to share responsibility for decision making with their children's physician. Although most parents (122 of 192; 64%) reported that they had their preferred role in decision making, those who did not tended to have more passive roles than they wished (47 of 70; 67%; P < .001). Parents were no more likely to hold their ideal roles in decision making when the physician accurately identified the parents' preferred role (odds ratio [OR], 1.04; P = .92). Parents were less likely to hold more passive roles than they wished in decision making when they felt that physician communication (OR, 0.39; P = .04) and information received (OR, 0.45; P = .04) had been of high quality. Parents who held more passive roles than they wished in decision making were less likely to trust their physicians' judgments (OR, 0.46; P = .03).

Conclusion

Most parents of children in their first year of cancer treatment participate in decision making to the extent that they wish; although, nearly one fourth hold more passive roles than desired. High-quality physician communication is associated with attainment of one's preferred role.
Crying, Moving, and Keeping It Whole: What Makes Literary Description Vivid?
Authors: Jajdelska Elspeth , Butler Christopher , Kelly Steve , McNeill Allan , Overy Katie
Published: April 2011

Vividness is used in a range of senses which often conflate the intensity of an experience with the accuracy of mental images. In this article we consider the vividness of responses to literary descriptions of faces in the light of the psychology of face perception and the neuroscience of the mirror neuron system. We distinguish between intensity of experience and accuracy of mental images and compare two models of reader response to descriptions: the jigsaw model (the reader constructs a mental image from items of verbal information) and the experiential model (the reader has an emotional, embodied, and holistic response). We predict which aspects of facial description will provoke a vivid response in the experiential sense and discuss examples of literary descriptions of faces in the light of these predictions. We conclude with an illustration of how these insights can be used in literary history and interpretation.
Platinum Metals in the Catalytic Asymmetric Isomerization of Allylic Alcohols
Authors: Mantilli Luca , Mazet Clément
Published: April 2011

Past and recent advances in the metal-catalyzed asymmetric isomerization of allylic alcohols into carbonyl compounds are discussed in the present Highlight. Emphasis is placed on rhodium, ruthenium, and iridium; the only three metals that have proven successful to date for this most challenging transformation.
Microwave Synthesis and Electrochemical Properties of Ultrafine SnO2 Nanoparticles
Authors: Yoshinaga Masashi , Kijima Norihito , Wakahara Sonoko , Akimoto Junji
Published: April 2011

Ultrafine SnO2 nanoparticles were successfully synthesized by microwave heating. Transmission electron microscopy images revealed that the size of primary particles of the synthesized SnO2 was around 5 nm. The SnO2 nanoparticles worked as a rechargeable electrode material, and the initial lithium insertion capacity of the SnO2 nanoparticles was 1670 mA h g−1 which is significantly larger than that of a specimen synthesized by conventional method.
Proceedings of the Sixth Northern Region Paediatric Colloquium
Authors: Abbott Mandy , Reid Corrine
Published: April 2011

It is apparent that the practice of medicine in today's society can often raise difficult legal and ethical dilemmas. With this in mind, senior figures from the medical, legal and theological professions have met on a biennial basis in order to discuss anonymised case material of such a nature. This provides a valuable forum in which to discuss such dilemmas, enabling the sharing of knowledge and experience from which we all can learn. To this end, we report the proceedings of the ‘Sixth Northern Region Paediatric Colloquium’, which are now the third set of proceedings to be published.
Report on suicidal trends in persons aged 60 or over in Japan: the need for effective prevention measures
Authors: Inoue Ken , Fukunaga Tatsushige , Okazaki Yuji , Ono Yuichiro
Published: April 2011

In Japan, the suicide rate has remained high since 1998, and effective suicide prevention measures that can bring about an immediate decrease in suicides are needed now. Specific suicide prevention measures must be based on the results of detailed research into the trends and causative factors of suicide. In the present study, we investigated the number of suicides and the proportion of causative factors in persons aged 60 or over compared with the total number of suicides in Japan from 1999 to 2005. We also discussed the causative factors of suicide among men and women aged 60 or over in detail. During the period from 1999 to 2005, the proportion of the number of suicides in persons aged 60 or over to the total number of suicides changed from 28.9% to 31.1% among men and from 42.5% to 45.9% among women. The most common causative factor was ‘health problems’ among both men and women, and the second most common cause was ‘economic and life problems’ among men. ‘Family problems’ was one of the major causative factors among both men and women. Therefore, more attention needs to be paid to persons aged 60 or over with regard to these factors in particular. Professionals and organizations involved in suicide prevention must work cooperatively to prevent suicide.
Eribulin Mesylate and Denosumab
Authors: Edwards Michael S. , Solimando Dominic A. , Waddell J. Aubrey
Published: April 2011

The complexity of cancer chemotherapy requires pharmacists be familiar with the complicated regimens and highly toxic agents used. This column reviews various issues related to preparation, dispensing, and administration of antineoplastic therapy, and the agents, both commercially available and investigational, used to treat malignant diseases.
Characterization of Medication Discrepancies Occurring at the Time of Discharge from an Adult State Psychiatric Inpatient Facility
Authors: Nelson Leigh Anne , Graham Maqual R. , Schaefer Monica G.
Published: April 2011

Purpose

To retrospectively measure the frequency of medication discrepancies occurring at hospital discharge and to characterize these discrepancies.

Methods

All consecutive discharges from an adult state psychiatric hospital with a length of stay ≥2 days were retrospectively evaluated for medication discrepancies occurring at the time of discharge. The content of the handwritten discharge plan was compared to the medication administration record from the last day of admission to identify medication discharge discrepancies. The primary endpoint was to determine the number of patients with a medication discharge discrepancy (MDD). Secondary objectives were to characterize the MDD by type of discrepancy and medication class (psychiatric vs nonpsychiatric).

Results

From October 1, 2008 to December 31, 2008, 205 patients were screened for eligibility; 163 patients were included. Thirty-eight patients (23.3%) had at least 1 MDD, with 10 (26.3%) of these patients having >1 MDD (range, 2-6). Characterization of the MDDs determined that 63.2% of the discrepancies occurred because a scheduled medication was omitted on the discharge plan whereas 36.8% were due to a dosing discrepancy. MDDs occurred at a similar rate for both classes of medications (ie, psychiatric and nonpsychiatric), but omission discrepancies occurred more commonly with nonpsychiatric medications and dosing discrepancies occurred more commonly with psychiatric medications.

Conclusions

Medication discrepancies occur commonly on hospital discharge. Understanding the frequency and types of MDDs occurring at this interface of care can assist in the development of more effective and targeted medication reconciliation procedures.
Use of a New Delayed Release Pancrelipase Formulation to Clear Obstructed Feeding Tubes
Authors: Gillette Michael A. , Knott Amanda , Frohnapple David J.
Published: April 2011

Obstructed feeding tubes remain a challenge for health care providers. Loss of feeding access can be detrimental to the patient's health and quality of life while increasing health care expenditures. Pancrelipase, which consists of various quantities and strengths of the digestive enzymes amylase, lipase, and protease, has long been used as an effective means for clearing feeding tubes. However, due to regulations from the US Food and Drug Administration (FDA), several formulations of pancrelipase including an immediate release crushable formulation ( Viokase, Axcan Pharma, Birmingham, Alabama) have been removed from the market, leaving only delayed release formulations available that have not been tested for this purpose. Until an immediate release pancrelipase formulation is FDA approved and can be made available, clinicians have limited options and little guidance on how to clear obstructed feeding tubes. This case series highlights the clinical dilemma created by the FDA-mandated withdrawal of Viokase and describes our observations of several health care providers in our medical center using various strengths of a new delayed release pancrelipase formulation ( Zenpep, Eurand Pharmaceuticals, Yardley, Pennsylvania) to clear obstructed feeding tubes.
New Drugs Approved by the FDA; New Dosage Forms and Indications Approved by the FDA; Agents Pending FDA Approval; Significant Labeling Changes or “Dear Health Professional” Letters Related to Safety
Authors: Baker Danial E.
Published: April 2011

This monthly feature will help readers keep current on new drugs, new indications, dosage forms, and safety-related changes in labeling or use. Efforts have been made to ensure the accuracy of this information; however, if there are any questions, please let me know at bakerdan@wsu.edu .
Developing Patient-Centered Services, Part 4: Considerations in Implementing a Pediatric Pharmacy Practice Model
Authors: Little Jeff , Davis Stephen , Goff Jeffrey , Mulvanity Meredith , Mark Scott M.
Published: April 2011

The Director's Forum series is edited by Robert J. Weber and Scott M. Mark and is designed to guide pharmacy leaders in establishing patient-centered services in hospitals and health systems. This article is the next in a series that reviews various pharmacy practice models. Pediatric pharmacy practice poses many challenges that are unique. Pediatric patients are not just “small adults.” Differences in dosing and disease states require pharmacists with adequate training in pediatrics. Operational challenges from a lack of suitable dosage forms and a lack of pediatric-specific automation create additional work for pharmacy departments. The pediatric pharmacy practice model must consider these operational challenges and manage them effectively to deploy pharmacists to direct patient care. Through the commitment of the director of pharmacy, care to the pediatric patient can be centered on meeting their unique pharmacy needs and educating parent and caregivers on the safe and effective use of medications.
Diabetes in acromegaly, prevalence, risk factors, and evolution: data from the French Acromegaly Registry
Authors: Fieffe Sandrine , Morange Isabelle , Petrossians Patrick , Chanson Philippe , Rohmer Vincent , Cortet Christine , Borson-Chazot Françoise , Brue Thierry , Delemer Brigitte , _ _
Published: April 2011

Objectives

The French Acromegaly Registry records data of acromegalic patients' since 1992 in French, Belgian (Liège), and Swiss (Lausanne) centers. We studied the prevalence of diabetes in this population looking for risk factors. Patients from one of the centers (Reims) were then analyzed more thoroughly.

Methods

This study has been conducted on all the patients recorded from 1999 until 2004 (519 patients). Evolution of cohorts' was reassessed in 2009. Of the different variables recorded in the registry: age, sex, body mass index (BMI), duration of acromegaly, GH, IGF1 and prolactin levels, pituitary tumor size, hormonal deficiencies, presence, duration and treatment of diabetes, hypertension, and rheumatological disease were analyzed.

Results

The prevalence of diabetes in the registry was 22.3%. Diabetic patients were older and had a higher BMI. Compared with the data of the French Social Security, acromegalic patients showed a more precocious apparition of diabetes and prevalence was higher in each age group.

Compared with non-diabetic acromegalic subjects, diabetic patients had a more prolonged evolution of acromegaly before diagnosis. The levels of GH and IGF1 were not significantly different between the two groups. Only hypertension was significantly more frequent in diabetic patients.

Conclusions

In our population, the prevalence of diabetes was estimated to be 22.3%. The GH and IGF1 levels did not appear as predictive factors for the presence of diabetes. On the contrary, age, BMI, and hypertension were significant risk factors as in the general population of type 2 diabetics.
Autophagy is a cell survival program for female germ cells in the murine ovary
Authors: Gawriluk Thomas R , Hale Amber N , Flaws Jodi A , Dillon Christopher P , Green Douglas R , Rucker Edmund B
Published: April 2011

It is estimated that infertility affects 15–20% of couples and can arise from female or male reproductive defects. Mouse models have ascribed roles to over 100 genes in the maintenance of female fertility. Although previous models have determined roles for apoptosis in male and female fertility, we find that compromised autophagy within the perinatal ovary, through the loss ofBecn1orAtg7, results in the premature loss of female germ cells.Becn1+/−ovaries have a 56% reduction of germ cells compared with control ovaries at post-natal day 1, whereasAtg7−/−ovaries lack discernable germ cells at this stage. Thus autophagy appears to be a cell survival mechanism to maintain the endowment of female germ cells prior to establishing primordial follicle pools in the ovary.
Fatal Coronary Artery Disease in an Infant With Severe Mucopolysaccharidosis Type I
Authors: van den Broek Leonie , Backx Ad P. C. M. , Coolen Hans , Wijburg Frits A. , Wevers Ron , Morava Eva , Neeleman Chris
Published: April 2011

A previously healthy 10-month-old boy was referred to our hospital because of coarse facial features that were suggestive of lysosomal storage disease. Apart from noisy respiration, there was no medical history. Elevated levels of urinary glycosaminoglycans and complete deficiency of leukocyte α-l-iduronidase indicated severe mucopolysaccharidosis type I. A chest radiograph revealed a markedly enlarged heart, and echocardiography revealed hypertrophic cardiomyopathy. While hematopoietic stem cell transplantation was being planned, progressive cardiac failure developed with a striking hypokinesia of the left-ventricle free wall. In combination with ischemic changes on the electrocardiogram, this was suggestive of coronary artery disease. Results of coronary echo Doppler interrogation were inconclusive, and intravascular ultrasound in this little infant was not feasible. Despite the patient's small size, a successful selective coronary angiography was performed and revealed diffuse narrowing of the left coronary artery with collateral flow from the right coronary artery. Enzyme-replacement therapy was started immediately in an attempt to improve myocardial performance. Evaluation after 3 months, however, revealed complete obliteration of the left coronary main stem with diffuse hypokinesia/akinesia of the left ventricle. At the age of 13 months the boy died of terminal cardiac failure. This case report illustrates the importance of considering early development of coronary artery disease in children with severe mucopolysaccharidosis type I and cardiomyopathy.
Association of Neck Circumference With Perioperative Adverse Respiratory Events in Children
Authors: Nafiu Olubukola O. , Burke Constance C. , Gupta Ruchika , Christensen Robert , Reynolds Paul I. , Malviya Shobha
Published: April 2011

OBJECTIVE:

The purpose of this investigation was to examine the association of neck circumference (NC) with perioperative respiratory adverse events in children undergoing elective noncardiac surgery, a relationship that has not been previously characterized.

METHODS:

Using a prospective, observational design, we studied children aged 6 to 18 years undergoing elective noncardiac surgeries at our institution. Trained research assistants collected clinical (including perioperative adverse events) and anthropometric data from all subjects. Patients were stratified into 2 classes: high NC versus low NC on the basis of age- and gender-specific receiver operating characteristic curve analysis. Subsequently, univariate factors associated with high NC were explored, and odds ratios for the occurrence of perioperative adverse events were then calculated from logistic regression after controlling for clinically relevant cofactors.

RESULTS:

Among the 1102 patients, the prevalence of high NC was 24.3%. NC was positively correlated with age and other anthropometric parameters. Children with high NC were more likely to be loud snorers and have a history of bronchial asthma, hypertension, and type 2 diabetes. Composite adverse airway events were more frequent in children with a large NC. There was no significant association between high NC and difficult laryngoscopy in our study population.

CONCLUSIONS:

NC was positively correlated with other indices of obesity in children, and large NC (indicative of central obesity) was associated with some adverse respiratory events in these children undergoing noncardiac surgery. NC could be a useful clinical screening tool for the occurrence of perioperative adverse respiratory events in children.
Cost-effectiveness of Metered-Dose Inhalers for Asthma Exacerbations in the Pediatric Emergency Department
Authors: Doan Quynh , Shefrin Allan , Johnson David
Published: April 2011

OBJECTIVE:

To compare the incremental cost and effects (averted admission) of using a metered-dose inhaler (MDI) against wet nebulization to deliver bronchodilators for the treatment of mild to moderately severe asthma in pediatric emergency departments (EDs).

METHODS:

We measured the incremental cost-effectiveness from the perspective of the hospital, by creating a model using outcome characteristics from a Cochrane systematic review comparing the efficacy of using MDIs versus nebulizers for the delivery of albuterol to children presenting to the ED with asthma. Cost data were obtained from hospitals and regional authorities. We determined the incremental cost-effectiveness ratio and performed probabilistic sensitivity analyses using Monte Carlo simulations.

RESULTS:

Using MDIs in the ED instead of wet nebulization may result in net savings of Can$154.95 per patient. Our model revealed that using MDIs in the ED is a dominant strategy, one that is more effective and less costly than wet nebulization. Probabilistic sensitivity analyses revealed that 98% of the 10 000 iterations resulted in a negative incremental cost-effectiveness ratio.

Sensitivity analyses around the costs revealed that MDI would remain a dominant strategy (90% of 10 000 iterations) even if the net cost of delivering bronchodilators by MDI was Can$70 more expensive than that of nebulized bronchodilators.

CONCLUSIONS:

Use of MDIs with spacers in place of wet nebulizers to deliver albuterol to treat children with mild-to-moderate asthma exacerbations in the ED could yield significant cost savings for hospitals and, by extension, to both the health care system and families of children with asthma.
A Systematic Review of Early Intensive Intervention for Autism Spectrum Disorders
Authors: Warren Zachary , McPheeters Melissa L. , Sathe Nila , Foss-Feig Jennifer H. , Glasser Allison , Veenstra-VanderWeele Jeremy
Published: April 2011

CONTEXT:

Early intensive behavioral and developmental interventions for young children with autism spectrum disorders (ASDs) may enhance developmental outcomes.

OBJECTIVE:

To systematically review evidence regarding such interventions for children aged 12 and younger with ASDs.

METHODS:

We searched Medline, PsycINFO, and ERIC (Education Resources Information Center) from 2000 to May 2010. Two reviewers independently assessed studies against predetermined inclusion/exclusion criteria. Two reviewers independently extracted data regarding participant and intervention characteristics, assessment techniques, and outcomes and assigned overall quality and strength-of-evidence ratings using predetermined criteria.

RESULTS:

Thirty-four unique studies met inclusion criteria. Seventeen studies were case series; 2 were randomized controlled trials. We rated 1 study as good quality, 10 as fair quality, and 23 as poor quality. The strength of the evidence overall ranged from insufficient to low. Studies of University of California Los Angeles/Lovaas–based interventions and variants reported clinically significant gains in language and cognitive skills in some children, as did 1 randomized controlled trial of an early intensive developmental intervention approach (the Early Start Denver Model). Specific parent-training approaches yielded gains in short-term language function and some challenging behaviors. Data suggest that subgroups of children displayed more prominent gains across studies, but participant characteristics associated with greater gains are not well understood.

CONCLUSIONS:

Studies of Lovaas-based approaches and early intensive behavioral intervention variants and the Early Start Denver Model resulted in some improvements in cognitive performance, language skills, and adaptive behavior skills in some young children with ASDs, although the literature is limited by methodologic concerns.
A Systematic Review of Secretin for Children With Autism Spectrum Disorders
Authors: Krishnaswami Shanthi , McPheeters Melissa L. , Veenstra-VanderWeele Jeremy
Published: April 2011

CONTEXT:

As many as 1 in every 110 children in the United States has an autism spectrum disorder (ASD). Secretin is 1 of many medical treatments studied for treating the symptoms of ASDs, but there is currently no consensus regarding which interventions are most effective.

OBJECTIVE:

To systematically review evidence regarding the use of secretin in children with ASDs who are aged 12 years and younger.

METHODS:

We searched the Medline, PsycINFO, and ERIC (Education Resources Information Center) databases from 2000 to May 2010 and reference lists of included articles. Two reviewers independently assessed each study against predetermined inclusion/exclusion criteria. Two reviewers independently extracted data regarding participant and intervention characteristics, assessment techniques, and outcomes and assigned overall quality and strength-of-evidence ratings on the basis of predetermined criteria.

RESULTS:

Evidence from 7 randomized controlled trials supports a lack of effectiveness of secretin for the treatment of ASD symptoms including language and communication impairment, symptom severity, and cognitive and social skill deficits. No studies have resulted in significantly greater improvements in measures of language, cognition, or autistic symptoms when compared with placebo; study authors who reported improvement over time did so equally for both the intervention and placebo groups.

CONCLUSIONS:

Secretin has been studied extensively in multiple randomized controlled trials, and there is clear evidence that it lacks benefit. The studies of secretin included in this review uniformly point to a lack of significant impact of secretin in the treatment of ASD symptoms. Given the high strength of evidence for a lack of effectiveness, secretin as a treatment approach for ASDs warrants no further study.